The Four-Letter Word Child Psychologists Hate

It's not any of the ones you're thinking of.

Posted Sep 29, 2020

Igor Yarruta/123RF
I'd love to tell the world that this one word should always be banned when parenting a kid who's in therapy.
Source: Igor Yarruta/123RF

Dr. K, can’t you just tell her that there aren’t any germs on her clothes? Why can’t she just pick an outfit, get dressed, and leave the house?

Just stop overreacting, and you’ll be fine. Instead of blowing up, just count to ten and think before you act.

Just go over there and talk to her—I promise she won’t bite.

There’s a certain four-letter word that’s banned in my practice, and it’s not the kind people usually apologize for. I’m against self-censorship in therapy, but there’s one word that never has its place in healthy parenting for the psychodiverse or neurodiverse population. This word is banned so completely in my practice, I’ve been known to assign people (myself included) push-ups for uttering it.

That word is “just.”

"Just" is a four-letter word and can never be uttered in my practice. It’s the only word I have ever banned, but my office is officially the “No Just Zone.” I tell my patients that JUST stands for:

Judgmental

Utterances

Stall

Therapy

Psychodiversity Can Be Scary for Parents:

Telling a kid with OCD to “just” get over it and pick up the potentially contaminated object, turn the doorknob, or pick any shirt to wear is like telling someone like me to “just” dunk the basketball. I’m 5 feet tall on a good day—if I ever dunked a basketball—there would be no “just” about it.

I like to look at kids with diagnoses as “psychodiverse” because I think that term captures the strength-based approach I use. It’s so much more empowering than using the disease model to talk about diagnosis. New research suggests that this may be closer to reality than the current disease model we use. We also like to name the part of our brain that tells us to do the things we do that aren’t adaptive. Whether we’re talking to the Worry Monster, Mr. OCD, Professor Trauma, Dr. Hypochondria, Lady Sadness, or Anger Guy, we like to know our opponent, and part of that is giving it a name. I’ve had kids name their bipolar disorder Dr. Doom or their OCD Mrs. Maybe. (To read more about a strength-based approach to child psychotherapy, click here.)

Why do parents like to use the term “just”? I think it’s because they’re trying to shrink the monster down to size. It’s scary to think of a 6-year-old with a big diagnosis like OCD or PTSD, or a 12-year-old with bipolar disorder or Generalized Anxiety Disorder. It’s so much easier—and feels like familiar territory—when a parent can shrink the disorder down to a manageable “typical parenting” size.

Just get dressed already! You don’t have OCD, you have school-itis! This is just a good way to be late to math class.

Just stop exploding in school, and I’ll buy you that hoverboard you’ve been asking for.

Just talk in school—it’s not that hard. We can’t get you to shut up at home!

By using the term “just,” the parent turns the problem into one of will and skill. If my child would “just” shape up, we wouldn’t have to talk about scary things like psychotherapy, medication, or labels.

I get it. I’m a parent too, and it’s scary to think of such a small child with such big diagnostic letters on their medical chart.

But I also know that there’s no justice in just.

Isn't It All Just "Will and Skill?" 

It isn’t entirely a matter of will and skill when we’re dealing with kids who have already received psychodiversity diagnoses. Yes, we can raise their skill—that’s pretty much the goal of psychotherapy. We can teach them what to do when they're panicking, or how to handle explosive episodes in school. We can also raise their will in the sense that we can make their goals achievable, which is motivating. But no one asks for OCD. No kid enjoys the feeling of explosiveness and irritability that childhood-onset depression brings. Kids who are selectively mute aren’t making the choice not to speak in school. Instead, they’re grappling with opponents that are way above their weight class. The amazing thing is that these kids win at all!

The fact that increasing will and increasing skill helps children fight their monsters doesn’t mean that the monsters never existed in the first place. In fact, it’s exactly the opposite—it takes a brave and determined kid to even begin this fight. These are opponents that I’ve seen adults quail at before, and ultimately lose to. When a child manages to fight so bravely—that isn’t evidence that these disorders never existed, it’s evidence that the child has mustered every ounce of psychological resources they can.

But It’s All in His Head. Right?

You’re telling me that my daughter didn’t decide to have selective mutism, and it isn’t something she can control on her own. But you’re also telling me you can teach her—a bit at a time—to communicate in school and get better. Doesn’t that mean it’s a choice? If you can teach her to make other choices, then isn’t it within her control? You can’t say it’s both—something you can teach her to deal with and also not in her control. I think it’s all in her head, and if she’d just decide to talk, she would. She just wants attention or something.

There’s that “just” word again.

Is selective mutism, or OCD, or bipolar disorder all in a kid’s head? What about ADHD, PTSD, or Generalized Anxiety Disorder?

Sure. But only in the sense that a brain tumor is.

Our brains are the seat of our decision making, so in that sense—sure. OCD is all in your head (and perhaps your adrenal gland. And, perhaps, your gut... research is finding new areas of biology that lead to psychodiversities all the time.)

So, yeah, it’s all in your kid’s head, but that doesn’t mean it’s an act of will. It means that there are parts of the brain that are acting in a way that makes acts of daily life incredibly challenging for your child. It means that ordinary tasks—handling frustration, meeting new people, or opening doorknobs—can be mind-bogglingly complex. And then we add all the normal challenges of childhood to that.

Do you remember middle school? Most of us would rather forget. All those academic pressures, social decisions, and the need to satisfy both our peer group and parents, having the capacity to understand that choices have consequences, but not always the power to make the choices we’d prefer—it’s pretty awful. Add Mr. OCD whispering in your ear, or Anger Guy trying to get you to explode all the time—it becomes pretty much impossible.

“Just” Do It

I have to differ with Nike on their slogan here. Do it, certainly. Sometimes, we’ll say: Let’s not think so much. Let’s simply stretch out our hands and do it. Let’s talk to that new person, visualize touching that germy object, work on controlling our bodies to control our anger response—let’s simply try.

But never “just.”

There’s no justice in just.

© Robyn Koslowitz, Ph.D. 2020 All rights reserved. Unauthorized reproduction in any form prohibited.

References

Jon C. Rees, Obsessive–compulsive disorder and gut microbiota dysregulation, Medical Hypotheses, Volume 82, Issue 2, 2014, Pages 163-166, ISSN 0306-9877, https://doi.org/10.1016/j.mehy.2013.11.026.

Hofmann, Stefan & Hayes, Steven. (2019). Therapeutic change processes link and clarify targets and outcomes. World Psychiatry. 18. 287-288. 10.1002/wps.20664. 

Stefan G. Hofmann, Joshua E. Curtiss, Steven C. Hayes, Beyond linear mediation: Toward a dynamic network approach to study treatment processes, Clinical Psychology Review, Volume 76, 2020, 101824, ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2020.101824.