A client tells you they want to process their medical trauma, but before they begin, they want to make a plan for pacing it. It is the kind of request that sounds straightforward until you sit with it for a moment.

Maybe they are worried about becoming overwhelmed. Perhaps they have learned what happens when they open certain memories and then have to drive home, make dinner, answer emails, care for children, or walk into work the next morning pretending their nervous system did not just spend fifty minutes wandering through one of the most frightening periods of their life. They may have upcoming medical appointments and already know their body is going to have opinions about waiting rooms, exam tables, patient portals, test results, or the peculiar vulnerability of trying to explain what is happening inside a body to someone who has the authority to decide whether it warrants attention.

For some clients, though, the trauma is not primarily about what happened during a procedure or hospitalization. The wound lives somewhere else, in the experience of knowing something was wrong, trying to tell someone, and not being believed.

Perhaps their pain was minimized. Symptoms were attributed to stress, anxiety, hormones, weight, or being “too sensitive.” Maybe they were repeatedly reassured that everything looked normal while their lived experience continued telling them that something was not. They may have been interrupted, talked over, told to wait, encouraged to worry less, or sent home without answers. Sometimes months or years passed before someone finally listened differently, ordered another test, asked another question, or discovered what the client had been trying to communicate all along.

For many women, this story also exists within a broader history of feeling that their descriptions of pain, symptoms, and bodily experience have not been given the same weight as medical authority. Eventually, the client arrives in psychotherapy carrying more than the original illness, symptom, diagnosis, or medical event. They may also be carrying the experience of having their reality questioned.

Then they sit across from another professional and begin telling the story. Underneath everything they are saying may be a question that has become painfully familiar: Will you believe me? Somewhere beneath even that may be another: Can I learn to believe myself again?

When Medical Trauma Is About Not Being Believed

The term medical gaslighting has become common language for experiences of being dismissed, minimized, or having physical symptoms prematurely attributed to psychological causes. Clinically, I think it is useful to stay curious about the actual experience rather than becoming overly attached to the label.

We do not need to determine whether every provider intentionally dismissed the client or whether every medical conclusion was incorrect. We are psychotherapists, not retrospective medical investigators. What we can attend to is what happened psychologically when the client repeatedly communicated something about their body and experienced the response as disbelief.

That distinction matters because a person can survive a frightening medical event and develop trauma around what happened to their body, while another person may develop trauma around what happened when they tried to get help. Sometimes those experiences overlap.

When dismissal becomes part of the trauma, the injury can extend beyond mistrust of doctors. It can begin altering the person’s relationship with their own perception. The internal dialogue may begin to sound like maybe I am overreacting, maybe this really is anxiety, maybe everyone feels this way and I am just bad at handling it, maybe I shouldn’t make another appointment, maybe I need to wait until it gets worse, or maybe I need proof before I am allowed to say something is wrong.

Eventually, a person can become caught between two frightening possibilities: ignoring something important or becoming the kind of patient they have been taught to fear becoming, someone who is too anxious, too demanding, too emotional, or too complicated. So they begin editing themselves before anyone else has the opportunity.

The Trauma May Be in What Happened to Knowing

There is something particularly destabilizing about having an experience inside your own body and being told, directly or indirectly, that the experience is not happening in the way you understand it.

Our bodies are ordinarily one of our most immediate sources of information. We know when something hurts. We notice when something changes. We feel when something is unfamiliar, even when we do not yet have language for what it means.

Medical expertise offers another kind of knowing. Tests, imaging, diagnostic criteria, clinical experience, research, and differential diagnosis matter enormously, and good healthcare depends on forms of knowledge that patients simply do not possess. But patients possess knowledge too. They know what it feels like to inhabit their body.

Ideally, those forms of knowing meet each other. Sometimes they do not.

When medical authority repeatedly overrides lived experience, a client may begin to internalize the hierarchy. The question shifts from What am I noticing? to Am I allowed to trust what I am noticing? That question can follow them long after the medical encounter ends.

They may become hypervigilant to physical sensations because missing something feels dangerous. Another person may avoid appointments because being dismissed again feels intolerable. Someone else may arrive with pages of notes, photographs, symptom logs, timelines, research articles, and meticulously organized evidence because simply saying something doesn’t feel right no longer feels sufficient.

None of those responses exists in a vacuum. They may be attempts to solve the same problem: How do I make sure I am believed next time?

Therapy Can Accidentally Recreate the Same Problem

This is where trauma therapy requires some humility because a client whose experience has repeatedly been overridden by professional authority is now sitting across from another professional authority: us.

We may be warmer. Our offices probably have softer lighting. There may be a suspicious number of throw pillows involved. But the relational structure still matters because we have credentials, ask questions, write things down, formulate, diagnose, and decide which clinical concepts seem to explain what is happening.

If we are not careful, therapy can become another place where someone else tells the client what their experience really means. That’s your anxiety. That’s hypervigilance. That’s catastrophizing. That’s avoidance. That’s your trauma response. Any of those formulations may contain useful clinical information, but they can also become another way of saying, I understand your experience better than you do.

A Humanistic orientation asks us to do something different. It asks us to take the client’s subjective experience seriously without pretending that either therapist or client must possess perfect certainty about what it means. I can believe that you were in pain without knowing its medical cause. I can believe that something felt wrong without knowing whether a particular diagnosis explains it. I can believe that you felt dismissed without deciding what another provider intended, and I can believe that not being heard affected you.

We can hold experience as real without pretending uncertainty does not exist. For clients whose medical trauma involved dismissal, that distinction may be part of the therapy itself.

Pacing Is Not the Same Thing as Avoiding

Trauma therapists live inside an interesting tension. We know avoidance can keep trauma alive. If every reminder becomes something that must be escaped, suppressed, neutralized, or carefully routed around, the person’s world can become smaller while the trauma becomes strangely larger. The nervous system never gets the opportunity to discover that remembering is not the same as reliving, that activation is not always danger, or that a difficult internal experience can be approached without surrendering to it.

And yet, somewhere along the way, avoidance maintains trauma can become flattened into something much less nuanced: If the client wants to slow down, they must be avoiding. Those are not the same thing.

There is a difference between refusing to approach an experience because difficult internal states must never be felt and wanting to figure out how to approach that experience without losing connection to yourself in the process. For someone whose medical trauma involved dismissal, pacing may carry another meaning as well. The client may need to know that therapy will not become another room where a professional decides what they should be able to tolerate.

So when a client asks for pacing, I do not immediately hear resistance. I hear information, and I get curious.

Start With What “Pacing” Actually Means

Before creating a pacing plan, I want to know what the client believes the plan is protecting. I might ask what feels important about having one, what they are worried could happen if we move too quickly, what moving too slowly would feel like, and how we will know when we are moving at the right pace.

With medical dismissal, I also want to know what being believed means to them. What happened when they tried to communicate that something was wrong? At what point did they begin questioning themselves? What did they learn about asking for help? What happens inside them now when someone disagrees with their interpretation of their body? Do they become quieter, more forceful, more apologetic, more prepared, or more uncertain?

Then there is another question I particularly like: “What makes approaching this important to you?” That question shifts us from tolerance to purpose.

ACT has something valuable to offer here because the goal is not necessarily to create a life in which fear, uncertainty, anger, memories, or body sensations have been successfully evicted. The human nervous system is not an Airbnb, and apparently fear did not receive the checkout instructions. The question becomes whether we can make enough room for difficult internal experiences that they no longer get to make every decision.

Maybe the client wants to attend medical appointments without rehearsing every possible conversation for three days beforehand. Perhaps they want to ask questions without apologizing for taking up time. They may want to notice a physical sensation without immediately spiraling into fear or immediately dismissing it as “probably nothing.” Someone else may want to seek another opinion when something does not feel right without first needing permission from everyone around them.

The question is not merely Can you tolerate processing this? It is also What might become possible if you could?

Map Before You Move

I like maps in trauma work, not because trauma follows tidy roads. It generally has the navigational manners of a forest after dark. But mapping gives us a way to acknowledge the territory without insisting that we immediately walk into all of it.

With medical dismissal, the map may look different from a traditional trauma timeline. I want to know what the client noticed first, what they told someone, what response they received, and what happened next. When did they try again? Was there a moment when they stopped trusting themselves? Did someone eventually listen differently? Was a diagnosis eventually made? What happened emotionally when they learned there really had been something happening?

Then we can look beneath the events. Perhaps the deeper territory contains helplessness, humiliation, anger, betrayal, grief, shame, self-doubt, fear, or the sense of having become invisible in a room where the client desperately needed to be seen.

This is where my depth-oriented brain becomes particularly interested because trauma does not always remain inside us as a straightforward autobiographical account. Sometimes it becomes an image, a dream, a sensation, a metaphor, a recurring scene, or a story about who we are now.

The story might sound like my body cannot be trusted, authority knows better than I do, I have to prove everything, I am too much, I shouldn’t complain, no one will listen unless I make them, or I have to stay vigilant because no one else will protect me. Jungian work invites us to wonder not only what happened, but what what happened came to mean.

We might become curious about the internal figures that emerged around the experience. Is there a part that doubts everything, a vigilant researcher who arrives armed with evidence, a compliant patient who becomes agreeable the moment authority enters the room, an angry protector who refuses to ever be dismissed again, or a frightened part who still wonders whether everyone else was right?

We do not need to turn these into fixed categories or interpret every image that wanders into the room like an overeager first-year analytic candidate. Sometimes we simply notice what appears. The psyche may communicate in ways that are considerably less interested in our treatment-plan headings than we are, so we can listen without forcing meaning while remembering that mapping is not processing. Knowing something is on the map does not mean we have to open it today.

Green Does Not Mean Calm

This is where I find a traffic light surprisingly useful. Not because human nervous systems conveniently organize themselves into three colors. They absolutely do not. But metaphors give therapist and client a language that can be retrieved when the prefrontal cortex has temporarily misplaced the clinical vocabulary.

The most important thing about the traffic light is that Green does not mean calm. Green means activated and connected.

A client may be crying while telling you about the appointment where they finally stopped asking for help. Their hands may shake while remembering a provider rolling their eyes, interrupting them, or attributing symptoms to anxiety. Anger may move through their chest when they remember how long they lived without answers, while grief may appear when they consider what might have been different if someone had listened sooner. Through all of this, they may still be Green.

They know where they are, remain connected to you and the room, can notice what is happening inside them, communicate what they need, and make choices about what happens next. They are experiencing something difficult without completely disappearing inside it.

This distinction matters because therapists can become frightened by activation too. We see tears and want to soothe. We see shaking and want to regulate. We see anger intensifying and begin reaching for grounding tools before asking whether the client actually needs to leave the experience. Sometimes grounding is exactly what is needed, while at other times we have interrupted the thing the client came to therapy to finally feel.

That possibility matters enormously when the emotion is anger. Women are often given plenty of cultural instruction about how much anger is acceptable, how loudly it may be expressed, and how quickly it should become something more palatable. A therapy room does not need to become another place where anger is hurried toward regulation simply because it makes someone uncomfortable. Distress is data, not automatically danger.

Yellow Means Pay Attention

Yellow is not simply “more distressed.” Yellow means something about the client’s ability to participate is beginning to change.

Maybe they are having more difficulty tracking the conversation. Their attention begins drifting farther away. They feel an increasing urge to escape or suddenly become unsure whether their own memory is accurate. They may start minimizing what happened in the middle of describing it, apologizing for being upset, or looking to the therapist to tell them what they are supposed to think.

For a client with a history of medical dismissal, Yellow might also sound like, “Maybe I’m making too much of this,” immediately after describing something that clearly carries enormous emotional weight. That is when I become curious rather than corrective.

I might ask, “Did you notice what just happened there?” and wonder with them about what changed when they started talking about that particular moment. We could become curious about whose voice maybe I’m overreacting sounds like or what happens internally when I do not immediately tell them whether their interpretation is right or wrong.

ACT might invite us to notice the thought I’m overreacting as a thought rather than immediately treating it as fact. Depth psychology may become curious about where that voice came from and whose authority it carries, while a Humanistic stance reminds us that our job is not to replace the old external authority with ourselves.

We do not need to tell the client what to believe about themselves. Part of the work may be helping them hear themselves again.

Red Does Not Mean Failure

Red means the processing is no longer workable right now. The client may be significantly overwhelmed, panicked, disoriented, dissociated, shut down, or so disconnected that meaningful participation has become difficult.

That does not mean the client failed at trauma therapy, that their nervous system is defective, or that they are “not ready” in some sweeping and permanent sense. It means we have information about this moment, this material, this dose, and this day.

So we pause and reconnect with the room. We may notice feet against the floor, orient toward objects in the environment, move, talk, notice sounds, or simply sit together until the present becomes more available again. Then we reassess, because trauma processing is not an endurance sport and there are no bonus points for crawling across the finish line.

Give the Client the Steering Wheel

For someone whose medical trauma involved dismissal, agency is not only about being able to stop trauma processing. It may also mean being allowed to know something without immediately having to defend it.

The client can tell me to keep going, slow down, step back, pause, or stop, but I also want them to know they can disagree with me, tell me an interpretation does not fit, correct me, change their mind, be uncertain, or know something about their experience without yet having words for it.

This is where the Humanistic foundation becomes especially important. The client is not an object of our clinical observation. They are another human being participating with us in the creation of meaning.

That does not mean we abandon clinical judgment or affirm every conclusion as objective fact. It means we bring our expertise into relationship with theirs. I may know trauma treatment, a physician may know medicine, and the client knows what it is like to live inside their body. Good care needs room for more than one kind of knowing.

Choose the Dose

Before processing, I want to know what else exists in the client’s world that day. Do they have a medical appointment tomorrow? Are they waiting for test results? Did they recently encounter another provider who left them feeling unheard? Are they already exhausted? Did another piece of life just catch fire fifteen minutes before they walked into the office?

The workable dose of trauma processing does not exist independently of context, and the dose does not have to be measured by how much of the story we cover. Sometimes an entire session revolves around one moment. Maybe it is the second when the provider said, “It’s probably anxiety.” Perhaps it is the moment the client walked back to their car and cried, or the day a test finally came back abnormal and relief arrived tangled together with rage because there was finally proof.

Depth work has taught me to respect the small door because sometimes the psyche puts an entire house behind it. So my shorthand becomes enter, don’t drown. We orient, approach, process, check, adjust, integrate, and eventually close, not because therapy must follow those steps mechanically, but because they remind me that entering is only one part of the work. We also have to come back.

Be Careful With “It’s Just a Thought”

There is another place where I think therapists need to tread thoughtfully with this particular kind of medical trauma. Acceptance-based approaches can be enormously useful for helping clients develop a different relationship with frightening thoughts. A client can notice the thought something is terribly wrong without automatically treating that interpretation as a medical fact, and they can notice catastrophic predictions without needing to argue with every one of them.

But defusion is not disbelief.

For someone who has repeatedly been told that physical symptoms were anxiety, stress, catastrophizing, or “all in their head,” casually reframing bodily concerns as thoughts can recreate the very experience we are trying to understand. The therapeutic goal is not to teach the client that their mind or body is unreliable.

We can instead help them hold uncertainty more flexibly: I notice something in my body. I do not yet know exactly what it means. I can take myself seriously without immediately assuming the worst, and I can seek appropriate information without requiring myself to dismiss what I notice.

That is a very different relationship with uncertainty. Acceptance does not have to mean resignation, and psychological flexibility does not require surrendering self-advocacy. Sometimes values-consistent action means making the appointment, asking the question again, requesting clarification, bringing someone for support, seeking another opinion, or saying, “I understand what you’re telling me, and I am still concerned.”

Don’t Process to the Door

Most therapists have probably had some version of this experience. There are four minutes left in the session and the client suddenly says the sentence. You know the sentence, the one that causes every internal therapist alarm to begin blinking simultaneously while your external face attempts to remain serene.

Sometimes that cannot be helped because human beings are notoriously inconsiderate about arranging breakthroughs according to billing units. When we are intentionally doing trauma processing, however, I want to leave room for the landing.

That does not mean the client must leave perfectly calm because, again, calm is not the measure of successful processing. I want enough time to notice where they are now, what emerged, what still feels unfinished, what their body is doing, and what the rest of their day looks like. I sometimes like to ask, “What do you want to take with you from today, and what can stay here until we come back?”

There is something psychologically useful about allowing therapy to have edges. We entered something together, and we can also leave it together.

Let Tomorrow Tell You About Today’s Dose

We cannot know whether the pacing was right solely by looking at the client during the session. The nervous system gets a vote afterward.

So when we return, I want to know how that amount of processing landed. Were there dreams, intrusive memories, body sensations, exhaustion, relief, anger, avoidance, or new memories? Did something continue unfolding after the session? Did the client find themselves replaying old medical encounters or questioning whether their memories were accurate?

Because I do not want trauma therapy to become exclusively organized around symptom surveillance, I also want to know: Did anything become more possible?

Maybe they asked a question at an appointment without apologizing first. Perhaps they noticed themselves minimizing a symptom and became curious about why. They may have disagreed with a provider without immediately assuming disagreement meant they were being difficult, or noticed a physical sensation, taken it seriously, and still been able to tolerate not knowing immediately what it meant. The shift might also be quieter than any of those things. Maybe they believed themselves.

That is information too, and the map is written in pencil, so we adjust.

The Five Things I Want to Remember

When I strip the whole framework down to what I actually need available in my brain while sitting across from another person, I come back to five ideas: read the light, map before you move, protect the client’s authority over their own experience, enter without drowning, and leave room for the landing.

Reading the light means noticing whether we are Green, Yellow, or Red while remembering that Green does not mean calm. Mapping before moving means understanding not only what happened medically, but what happened when the client tried to communicate their experience and what they learned from the response. Protecting the client’s authority means resisting the temptation to become the newest expert who tells them what their experience really means. Entering without drowning allows difficult thoughts, emotions, memories, images, and sensations to exist without requiring them to disappear or allowing them to become the entire room. Leaving room for the landing reminds us that processing does not end simply because the clock says fifty minutes have passed.

Underneath all five is another question, perhaps the simplest and most important one: Are we still doing this together?

A Pacing Map You Can Use With Clients

All of this eventually led me to create a client-facing Medical Trauma Processing: Our Pacing Map that therapists can use as a starting point for these conversations. I wanted something that could take the ideas we have been exploring here and put them into language that therapist and client could actually share in the room, particularly when the medical trauma includes being dismissed, not believed, or learning to question your own experience.

The handout walks therapist and client through defining what pacing means, mapping both the medical experiences and the inner territory surrounding them, using the Green-Yellow-Red framework, establishing shared language for slowing down or stopping, choosing the dose for a particular session, checking in without constantly interrupting the work, and leaving enough room for integration afterward. It also makes explicit something I think is particularly important when working with medical dismissal: the client is allowed to disagree with us. They can tell us an interpretation does not fit, correct us, change their mind, remain uncertain, or know that something feels important without already knowing exactly what it means.

I intentionally called it Our Pacing Map rather than your pacing plan because I do not think pacing should become another responsibility we quietly hand to the client. We are doing this together. The client does not have to perfectly identify their window of tolerance, recognize every protective response, or know exactly when they are approaching their edge while simultaneously processing trauma. The therapist is paying attention too. The map gives us a shared language for noticing what is happening and deciding together what comes next.

It is also meant to remain flexible. The map is not a protocol, a contract, or another clinical form to complete correctly. It is a conversation that can change as we learn more about what helps this particular person approach difficult material while remaining connected to themselves. In that sense, the handout is less about determining the “right” pace than creating a therapeutic relationship in which the pace can be continually negotiated.

Download Medical Trauma Processing: Our Pacing Map

I created the handout to be used collaboratively rather than simply handed to a client as psychoeducation. Read through it together. Change the language if something does not fit. Add the client’s own signs of Green, Yellow, and Red. Identify the phrases they actually want to use when they need something different from you. The document matters less than the conversation it makes possible because, particularly for someone whose medical trauma involved not being heard, the process of creating the map may itself communicate something important: You do not have to convince me that your experience deserves our attention. We can become curious about it together.

Believing Someone Is Not the Same as Knowing Everything

There is a tension here that I think therapists need to be able to hold: we can believe clients without pretending we know things we do not know.

I do not have to determine whether a physician committed malpractice to believe that my client felt dismissed. I do not have to know whether an earlier diagnosis should have been made to understand the impact of living for years without answers. I do not need to affirm a medical conclusion outside my scope in order to take seriously what someone tells me about their body.

Belief does not require certainty. Sometimes it simply sounds like, “I believe that you noticed something. I believe that you were scared. I believe that you tried to get help. I believe that you did not feel heard, and I believe that mattered.” For someone who has spent years collecting evidence before allowing themselves to trust their own experience, that may be a profoundly different kind of conversation.

Are We Still Doing This Together?

We have increasingly sophisticated ways of conceptualizing trauma. We can talk about exposure, memory reconsolidation, inhibitory learning, psychological flexibility, autonomic states, dissociation, attachment, somatic memory, parts, archetypes, defenses, complexes, meaning-making, and half a dozen other things before either of us has finished our coffee. I value the science, and I value theory. I want therapists to know what they are doing when they invite someone into traumatic material.

But underneath every model is a remarkably ordinary human scene. One person is sitting with another person while something painful comes back into the room. The person remembering is trying to discover whether they can approach what happened without being swallowed by it, while the therapist is trying to remain close enough to accompany them without taking over the journey.

With medical dismissal, healing may live partly in what happens to the memory, but it may also live in what happens to the client’s relationship with their own knowing. They may begin to notice a sensation without immediately dismissing it or catastrophizing it. Uncertainty can exist without requiring either blind trust in authority or complete distrust of it. Anger can have information in it without needing to run the entire show. The client may disagree with someone and remain connected to themselves, ask questions, seek information, change their mind, and discover that taking themselves seriously does not require absolute certainty.

Perhaps most importantly, therapy can become a place where they tell another person what happened and do not immediately have to build a case for why their experience deserves to be taken seriously. They can say, Something happened to me, and instead of beginning with Are you sure?, we can begin somewhere else: Tell me.

Maybe the science gives us the map, but the art is remembering that the map is not the terrain. Therapy happens somewhere in the living landscape between the two, when we bring what we know about trauma into relationship with the person who knows what it was like to live through it, and then agree to walk into that territory together.

Written by Jen Hyatt, a licensed psychotherapist at Storm Haven Counseling & Wellness in Temecula, California.

Author Note

I wrote this article from the perspective of a psychotherapist and clinical supervisor who works from an integrative, Humanistic, neurodivergent-affirming, and depth-oriented lens. The framework presented here draws from trauma-informed care, ACT, nervous-system awareness, collaborative meaning-making, and Jungian/depth psychology, with particular attention to the relational impact of medical dismissal and what can happen when someone repeatedly feels unheard or disbelieved about their own bodily experience.

The phrase medical gaslighting is often used to describe experiences of having symptoms dismissed, minimized, psychologized, or not taken seriously. I use the term thoughtfully because not every missed diagnosis, disagreement, uncertain medical finding, or difficult healthcare interaction is necessarily gaslighting. My focus here is not on determining the intent of a medical provider or retrospectively evaluating the quality of medical care. I am interested in what can happen psychologically when someone experiences repeated dismissal and begins to question their own perceptions, body, memory, or right to ask for help.

This is also why the pacing framework emphasizes collaboration rather than therapist certainty. We can take a client’s experience seriously without pretending to know what we do not know. We can make room for uncertainty without reproducing dismissal. Most importantly, we can create a therapeutic relationship in which clients do not have to surrender authority over their lived experience in order to receive care.

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If something here gave you a thread you are not quite ready to put down, come find me in The Understory. We’ll follow it a little farther.

Disclaimer

This article and the accompanying Medical Trauma Processing: Pacing Map are provided for educational and informational purposes only. They are not a treatment protocol, clinical standard of care, substitute for individualized clinical judgment, or substitute for appropriate training, supervision, consultation, medical evaluation, diagnosis, or treatment.

The concepts and questions presented here should be adapted to each client’s clinical needs, history, culture, identities, medical circumstances, readiness, preferences, and current level of functioning. Trauma processing may not be appropriate at every stage of treatment, and therapists should practice within the boundaries of their competence, professional scope, applicable laws and regulations, and relevant ethical standards.

Psychotherapists should also remain mindful of the boundary between validating a client’s lived experience and making medical determinations outside the scope of psychotherapy. Taking a client’s pain, symptoms, concerns, or experience of dismissal seriously does not require the therapist to determine whether a medical provider acted negligently, whether a particular diagnosis should have been made, or whether a client’s interpretation of a medical condition is medically accurate. Clients with new, worsening, unexplained, or concerning physical symptoms should be encouraged to seek appropriate evaluation from a qualified healthcare professional.

The Medical Trauma Processing: Our Pacing Map is intended as a collaborative therapeutic resource rather than a diagnostic instrument, assessment measure, or prescriptive sequence for trauma treatment. Therapists are encouraged to adapt its language and use based on the individual client and the therapeutic relationship.