Dear Therapist:

A well-known educator recently spoke out strongly against "labeling" a child. Even if a child has a mental health issue and is receiving services, we must make sure he/she is not labeled. The remark struck a chord with me as 2 of my children are currently in therapy one for behavioral issues and one for anxiety. While the idea of not labeling a child sounds nice in theory, I am not sure how to put it in practice. At the end of the day my son knows he has behavior issues and that they are serious enough for him to require help. He does have a reputation as a trouble maker - that's the reason he is in therapy in the first place. My daughter knows she has anxiety and part of the work with her therapist is giving a name to the problem and her starting to realize when something is part of her anxiety vs something "real." Can you please share your thoughts on the issue of "labeling" a child and how it can be avoided?

Response:

I wonder to what degree your question comes down to semantics. Are you referring to the labelling of an action or the labelling of a person? When a person is labelled, this can lead to a couple of problems. They can feel that their issue is systemic—part and parcel of who they are. This can, in turn, lead to the sense that the problem will be difficult or impossible to correct.

There is also a difference between acknowledging a problem and labelling a person. The former entails recognizing that a particular thought, emotion, or action is problematic and needs to be addressed. The latter is more generalized. When the focus is on a specific issue, the person can identify strategies to resolve it. If, however, the focus is placed on the person themselves as the problem, it becomes much more difficult to acknowledge particular issues and ways of addressing them.

Though this is true for people of all ages, for children especially, when they are labelled as an “anxious child,” or a “wild kid” this can become a part of their internal sense of self. Creation of a sense of self is crucial to a child’s development. Without it, children—and people in general—tend to feel worthless. Even a negative sense of self will appear to a child to be preferable to none. In addition to the difficulty of changing “who they are,” there may be tremendous resistance to giving up a part of themselves. When a child is labelled as “angry,” “anxious,” “rebellious,” or just plain “bad,” this can become a label that they take to heart and use to help form their sense of self.

On a number of occasions, I have discussed the fact that we treat symptoms rather than diagnoses. One of the reasons that I point this out is to help people avoid the conflation of diagnosis and self-definition. A diagnosis does not determine who we are; it is simply a tool to aid in treatment and communication amongst professionals. When a person has a problem, they know what it is that they need to work on. Labelling of a problem has its benefits, but it generally adds nothing to the person’s understanding beyond what discussion of the issue itself provides. Labelling of person typically causes nothing but harm.

It is important to focus on the problem as distinct from the child. This can help the child to separate who they are from how they think or feel or what they do. As they separately develop a sense of self and recognize problematic thoughts, feelings, or behaviors, they can work on each independently.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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