How to Avoid Pathologising Ordinary Emotion

There’s a worrying trend that I’ve noticed creeping into referrals for a decade or more: to pathologise ordinary emotion, or at least try to. I regularly receive referrals to my psychotherapy practice from concerned parents and professionals who believe there’s something “wrong” with the young person they care about. They’re likely to have consulted artificial intelligence (AI) or Dr Google, who aren’t actual doctors or psych-professionals, of course, and decided the young person might have attention-deficit/hyperactivity disorder (ADHD), or autism spectrum disorder (ASD), or borderline personality disorder (BPD) or dissociative identity disorder (DID) or a combination of these acronyms and more. Often, they think it’s depression.

Three Examples

These three short, fictional vignettes exemplify the types of referrals and how I might respond to them, were they real.

I had a referral from a mother struggling to manage her child’s oppositional behaviour. She wondered if he had ADHD and wanted to know if I could offer anger management—to him, not her, although she sounded very angry on the phone. Her son was 5. We met for an initial consultation, and I found him delightful. He curiously poked his nose and fingers into my things and asked endless questions during our one-hour meeting. I congratulated his mother on her bright and inquisitive child and modeled firm containment, saying to the boy, “There are things in my room that are private and I’d like you not to touch them, please,” then offering a little gentle coaxing by offering him something else to explore instead. He responded age-appropriately by testing the boundary but staying within it once he realised it was firm. His mother expressed relief that there was nothing “wrong” with her son and expressed how challenging she found it to say “no,” admitting her anxiety about not being a good enough mum.

I had a request for bereavement counseling for a 10-year-old who had become clingy, refusing to go to school and not wanting to leave his mother’s side. When I learned that his grandmother had died just a few weeks before, I wondered aloud if he was afraid that something might happen to his mum, that she might die too, and wondered if that was why he wanted to keep her close. He nodded that he was. His mother acknowledged that she had been distracted by her own grief, trying not to cry in front of her child, and had been preoccupied with funeral arrangements and “death-min.” I pondered aloud that her son might be feeling left out and confused. He didn’t need bereavement counseling; he needed reassurance that it was OK to be sad, and his mother needed reassurance that it was OK to be sad too, and to model ordinary sadness in response to a sad experience.

A referral from a secondary school for a 17-year-old outlined concerns about depression, self-injury, and suicidal thoughts. When I met her, she told me she was struggling with her university application and coursework. She hadn’t harmed herself, and she didn’t want to die—I asked her outright, and she responded likewise. On the contrary, she had a clear life plan and wanted to be a success! She wasn’t depressed, but she was understandably anxious and had told her teacher she “wanted it all to end.” “It,” I discovered when I asked, encompassed exams and forms and endless choices, which had become overwhelming. After verbalising her feelings to me, she said she felt lighter. I’d listened, checked things out and validated her ordinary feelings and fears. She wasn’t depressed.

Ordinary Emotional Responses

I met each of these young people for a consultation and offered none of them psychotherapy. They weren’t mentally unwell, and they didn’t need psychological support. They were each expressing ordinary emotional responses to their experiences. Young children push boundaries, loss can lead to feelings of insecurity, and adolescents fuss and fret. We should encourage them to feel their feelings and express their emotions, and, as adults, we should model this too. It’s a healthy thing to do.