Compliance

A client in the treatment program where I work has a particularly strong transference to me. I have no idea why, or what is coming up for her. I just know that she holds strong but very inaccurate beliefs about what I feel, think, and say about and to her.

It's a little unnerving to have someone reacting so strongly when you (1) don't know what is triggering it, and (2) have very little objective influence over the type or intensity of reactions. I suppose this is the nature of transference, however.

One aspect of the transference specifically stood out to me this week: the client told another staff member that I said she was not "complying with the program." This statement was interesting because I certainly did not say it...but bothersome because I would not say it.

"Compliance" (and all of its various derivatives) are words I have been conditioned to avoid because of their connotation. Compliance can mean cooperation, adherence to a plan, or conformity. However, unlike the other words I just used to define it, compliance tends to imply an expectation of obedience or yielding to authority. In fact, dictionary.reference.com adds: "especially in a weak or subservient way."

Obviously, it is a word that could be problematic if one is trying to empower clients! The medical world is consequently trying to move away from it, for example by talking about medication "adherence" rather than "compliance." In the Eating Disorder world, however, we still regularly refer to "meal plan compliance." In a population that often reports feeling powerless over their life circumstances, and has historically been disempowered by the treatment process, I find this a little problematic.

I don't know whether colleagues use this expression with clients. I do not. And I certainly never use the word "noncompliant" with clients! I think the word itself short-circuits meaningful exploration of the client's behavior, the difficulty of change, ambivalence, and the client's (legal and ethical) right to participate in decisions about treatment goals and interventions.

While it may seem like semantics, therapists (of all people) should understand the power of words - after all, we are in the business of "talk therapy." I try to choose my words carefully, and as in Jewel's song Life Uncommon, "let your words enslave no one...lend your voices only to sounds of freedom."