Editor’s Note: This article first appeared on Mad in Norway. The author, Erik Rudi, voluntarily relinquishes the authority of being a “psychologist” and “healthcare professional.”

In no way would I be offended or angry if you use the term therapist for me. I just think that it is your expression of a misunderstood, imprecise and outdated definition of what mental health work entails.

If you struggle mentally, it does not mean that you are ill. It is not you, your personality, your demeanor, your thoughts or your feelings that is wrong with you. It is an expression that you have encountered loads or challenges in the encounter with your surroundings, which have become too demanding for the psychological mechanisms that the same surroundings have equipped you with in the past.

It is psychiatry’s view of what mental problems are and how they arise which in itself is pathological.

Searching for a way through

It is not treatment in the medical sense that I practice or have practiced in my work as a psychologist. I do not carry out any form of intervention, neither surgical nor chemical. Everything I do happens in dialogue. I don’t manipulate thoughts. I don’t change the way you think. But I give you access to my professional perspectives and reflections, in the hope and belief that you will be able to use them for increased self-awareness and personal growth.

I am not seeking a cure for cognitive or emotional disorders. I am looking for a real understanding and effective problem solving strategies for the individual. I have conversation tools that give you good prerequisites to get to know yourself better and what works for you.

But I’m not a therapist. I am only an interlocutor with certain, specific knowledge that can sometimes be very useful. Conversations can be encouraging, give hope and motivation, increased acceptance or possible alternatives for action. The most important thing that happens in the conversations, however, is finding security for shared wonder and the search for new insights. The collaboration to look for a good and passable road.

Don’t Call Me a Therapist – I cure nothing

It is not particularly controversial to say that I personally am not your doctor or healthcare provider. But it immediately becomes more difficult for many to swallow when I claim that talk therapy is a contrived appropriation, and that no psychologists actually provide health care.

Psychologists cure nothing. They lay the foundation for personal development that can lead to improvements in mental flexibility, adaptation and functional level.

Psychology as a field of knowledge is closer to philosophy than medicine, and is far from being a precise, scientific discipline. Descriptions of causal relationships and selection of “evidence-based” approaches are little more than qualified guesswork with a certain statistical probability of hitting the target. Qualities and characteristics of individual stories cannot be operationalized and quantified with any form of precision or objective neutrality. The psychiatric diagnosis is a medical theoretical construct with limited epistemic validity. Psychiatric diagnoses are hypotheses and not proof of the existence of real diseases.

Diagnosis as a pivot point for investigation and selection of treatment methodology is a biomedical paradigm, which is not automatically transferable to the psychosocial part of the human mind. Nevertheless, standardized investigation with differential diagnosis as the objective and allocation of the “best available” treatment resource as the endpoint has become the only goal for how we meet people who are weighed down by the burdens from their difficult encounters with a society and a reality that constantly puts more pressure on the individual.

Don’t Call Me a Therapist – The power of diagnosis

The diagnostic doctrine leads to it being considered irresponsible health care to deviate even the slightest from the Health Directorate’s guidelines, symptom checklists and NOUs on therapeutic procedures and recommendations. Emphasis on the individual’s developmental history, individual characteristics and preferences must be justified by measurable figures, instead of by an absolute minimum of trust in the shared, relationally developed understanding that good conversations provide.

I have chosen to say “take from me the authority of a psychologist and health care professional” as a protest against a Norwegian healthcare system that, under the heavy influence of an industrial efficiency mindset (New Public Management), has moved from having the optimal health condition of individual patients as the main goal setting, to using the least possible resources for the highest possible average health benefit as a guiding principle.

The introduction of the health enterprise model in 2001 gave economists and bureaucrats the mandate to override health professionals’ arguments from a cost/benefit perspective, which effectively transforms health personnel from professional service actors to gatekeepers for resources and rights.

Diagnosis is your power, with all the associated risk of abuse of power that it entails. The power of definition and the prestige that lies in being able to categorize people as either healthy and useful to society, or as sick, requiring treatment and a potential burden on society, will be difficult for those who manage it to convey. Be it politicians, hospital managers, welfare bureaucrats, supervisory bodies, children’s services, psychiatrists, doctors or psychologists.

I waive the statutory duty to follow guidelines taken from a knowledge base I can no longer trust. To paraphrase the “Iron Chancellor” Otto von Bismarck’s statement about lovers and sausages: Anyone who knows how statistics and diagnoses are designed will never again have a good night’s sleep. I know the diagnostic system. That’s why I choose not to use it. Descriptive statistics cannot function as a pillar for mental health care.

Facing a paradigm shift

You do not need treatment. You don’t need a full-blooded psychologist with a bland, public approval and a body of law and a disease terminology best suited to lead vulnerable people behind the scenes. What you need is a conversational partner who is able to reflect, explore, illuminate and wonder, together with you, on your terms.

You need a relationship that provides fertile ground for growth and development. Such relationships do not grow out of the health authorities’ organization of services. They come from knowledge acquired through education and experience, personal aptitude, relational skills and a genuine desire to contribute constructively to the individual.

We must stop pushing ready-made investigation and treatment procedures linked to diagnostic assessments. We must start taking people’s own experiences seriously. I have no doubt that we are facing a shift in the approach to mental health, forced by the inefficiency and inadequacy of the current paradigm. Eventually, there will be too many stories about misinterpretations and misdiagnoses, failed treatments and harmful, conscious and unconscious abuse of power and stigmatization.

Angry, impatient patients, who want to come to the conclusion that they are the experts in their own lives, no longer want to accept the above and the restraint that diagnostic categorization represents.

Anecdotes become empirical evidence, if there are enough of them. Not that those in power will ever care about the evidence, but loud protests and a disaffected electorate are something they don’t like. In any case, mental healthcare must, in one way or another, move away from the biomedical disease model, and into a more humanistic, relational approach.

I know what psychology and psychologists as a professional group are good for, but I also recognize the limitations. The subject and the knowledge will persist and develop further. But the management and application of knowledge and human resources must change.

I start by jumping off the high horse that is the title of psychologist, and move on a level that allows me to look people in the eye. I don’t know more about you than what you tell me, and I feel privileged if you choose to share your story with me. Then, and only then, can we figure things out. Together.

And be so kind: Don’t call me therapist.

You can view the original article, Don’t Call Me a Therapist, on Mad In America.