Beyond "Nervous System" and "Inner Child" Language: The Problem with Therapy Speak

This blog was inspired by @proud_penelope's Substack note on the proliferation of "nervous system" and "inner child" languages. The overuse of fanciful terms and neologisms in the psychotherapy industrial complex is not an accident. It is reflective of a larger tendency to fall back on fanciful but accessible terminology to describe human suffering, and to claim to treat this suffering, especially when one is not adequately trained and lacks substance. 

The problem with "nervous system" language and the "inner child" in the room

Explaining psychopathology in terms of the nervous system helps to a certain extent. The fight-or-flight response is real, as are processes such as sensation, perception, attention, memory, judgment, and learning. Many of these processes operate automatically in the background, without ever reaching conscious awareness. Sensing and perceiving an external stimulus is a clear example.

The fight-or-flight response is a survival instinct that allows one to use aggression to deal with a perceived threat or escape from it. Using this language in psycho-education can demystify the mind for clients. However, it is precisely here that the problem arises. What is often labelled as "automatic neural processes" frequently overlaps with what psychoanalytic thinkers have long described as unconscious processes: repressed and suppressed memories, conditioned behaviours, emotional conflicts, and unintegrated impulses. At the most primitive level, these instinctual processes help an individual to survive a world full of dangers, and reproduce, when survival needs are met.

At its core, human experience emerges from the dynamic interaction between these primitive and automatic processes and higher-order capacities such as reasoning, social cognition, language, and decision-making. All of these shape our conscious thoughts, behaviours, and emotions. Reducing complex and dynamic interactions among different psychological variables to "chemicals in the brain" or "nervous system acting up" infantilises patients and encourages regression. Infantilising the subject negates the duty of the provider to support the adult's capacity to develop awareness and take responsibility. When "nervous system" language and the "inner child" metaphor become the only explanations, especially for reactive or destructive behaviour, they stop being useful. These half-hearted strategies become crude ways to encourage avoiding accountability while keeping the client in a state of perpetual regression.

The dual participation of patients and providers in therapy-speak

The human mind is complex and to pretend there are quick fixes and easy explanations is to be mendacious. Clinicians become aware of their lack when clinical presentations do not always align with textbook descriptions. This is why even standardised manualised treatment approaches rarely work as intended. Most psychotherapists who use manualised approaches often improvise as sessions unravel uncomfortable feelings, such as feeling powerless vis-a-vis a difficult client. Yet improvisation, coupled with fanciful jargons and explanations (such as, "inner child being activated"), rarely helps the patient.

Psychological (behavioural and cognitive) and psychoanalytical theories have been around for more than a century now, and it is time that clinical psychologists and other licensed mental health professionals go back to reading what they were supposed to during their graduate years. Freud, for instance, abandoned hypnosis because he felt its effects were often superficial and regressive, much like today's "nervous system" soothing or “inner-child” reparenting. Both can produce temporary relief while bypassing the hard work of integration and accountability. Lacan radicalised this insight: we must refuse techniques that merely flatter the ego's demand for wholeness.

As for the patients, many are motivated by a desire to understand why they feel they have been wronged by their loved ones primarily, and by the society and the world in which they live. Popular therapy-speak provides the ammunition that the patient requires to intellectualise and rationalise their own irrational behaviours and destructive impulses.

To expect that a few sessions of a trendy approach will fix problems that have accrued over a lifetime, and that they will somehow contain innate instincts that are fearsome and unacceptable, is naive at best and reckless at worst. To make matters worse, popular therapy-speak gives clients and patients street cred, which further reinforces everything that must be avoided.

Contradictions of the orthodoxy

To be clear, excellent clinicians could belong to any of the recognised schools of psychological interventions. However, the dominant trends in our field today, with their relentless focus on ego repair, affect regulation, and identity affirmation, are precisely what Lacan warned against decades ago. He saw post-Freudian psychology (especially the American ego-psychology variety) as a project of adaptation and imaginary wholeness. When we hand patients ready-made frameworks (nervous system dysregulation, inner child metaphor, trauma-informed identities, etc.), we risk offering them new mirrors for misrecognition instead of unsettling the ego so the Real can appear.

To make matters worse, psychologists’ inclinations influence their choice of vocabulary. In fact, it goes deeper than the words they choose. Their preferred modality determines how they categorise and classify information. For instance, whether you choose to describe a personality pattern as a "personality organisation" or a "personality disorder" depends on your preferred modality. How one chooses to understand or categorise information (and in this case, a person's psychopathology), can all be "kind of an illusion", as The Mel Jar describes it. It isn't wrong or incorrect, by the way, to use these illusions to one's benefit. However, it appears contradictory when those of us who are convinced of our orthodoxies tend to look down on popular trends.

Clinicians are contradictory by nature, and this is probably necessary to maintain a middle path. Franny correctly describes the balancing act between these contradictions as difficult but ultimately fruitful. Despite the illusory nature of it all, those with skin in the game are well advised to keep their therapeutic vocabulary measured, consistent, and duly supervised.

Integrating CBT-speak

Cognitive Behaviour Therapy (CBT), despite being a manualised therapy, is generally useful. It certainly helps patients to develop a benign therapy speak and teaches them to recognise their irrational beliefs. It also helps people identify cognitive distortions that help maintain their symptoms, for which they usually come to the clinic. However, it is very rare for a person to follow the guidelines, learn to observe, become aware, and learn to work with their thoughts, behaviours, and emotions in a span of few weeks, and unlearn what has been learned over a lifetime. The issue is not CBT itself, but the way these sessions are structured and mandated. Patients rarely have a simple cluster of symptoms that can be addressed by CBT. Most clinical presentations are complex and require deeper work.

Moreover, CBT fails to acknowledge drives and instincts that are often unpalatable, and that despite changing one's beliefs or rationalising one's cognitive distortions, the underlying destructive impulses often resurface during times of crisis or even when someone is just having a good time. What it really does is help the patient to intellectualise and rationalise their behaviours, thoughts, and feelings, without bringing unacceptable impulses and primitive defenses to their awareness. However, in clinical contexts, it is possible and is often necessary to integrate CBT with more traditional approaches.

On narcissism and other trendy topics

Acknowledging and working with one's own instincts is difficult and is not for everyone. This is also why psychotherapy does not work for everyone, and it is a fact that most people involved in this ecosystem refuse to acknowledge due to their own narcissistic motivations. Speaking of narcissism, which is another trendy and overused term, it's important to remember that everyone has narcissistic tendencies. Using it as a term of accusation or blaming the person you dislike as a narcissist is not going to help one understand his or her own destructive impulses. Unfortunately, there is an entire industry that is built around diagnosing "narcissism" and saving you from being manipulated by these mythical narcissists.

The therapy industry complex also includes the neurodivergent framework, "trauma-informed" therapy (if you're licensed to practice as a clinician, you're already supposed to be sensitive to traumatic incidents. It's not a special skill), "queer affirmative therapy" (homosexuality and bisexuality are simply facts of life requiring no special psychological intervention), overdiagnosis of ADHD and autism, and pseudo-mystical approaches that almost always invoke Carl Jung.

The servility of trauma and identity frameworks (what Nietzsche called slave morality), the reductionism of manualised treatments, and the mendacity of new age and pseudo-psychological treatments are neither Apollonian nor Dionysian in spirit. They offer neither the clarity and structure of rigorous frameworks nor the spontaneity that honours the chaotic and disruptive force of instincts and impulses. Rather, they represent the lack that exists in the treater and the treated. Lacan would recognise them immediately as imaginary solutions to a symbolic problem. These comforting lies help the clinician and the client to avoid the Real of the divided subject and the destructive impulses that actually define us.

It's also about money, and that's sometimes OK.

Quite clearly, there is a financial aspect to this. Insurance companies, when they do pay for psychotherapy, do not usually reimburse long-term therapeutic approaches. They prefer manualised packages that promise more than they deliver. Psychotherapists, on the other hand, whether they're trained well or quite poorly, seek refuge in a fixed number of sessions, as it is easier to sell them to their clients. Patients, on the other hand, neither have the patience nor the financial ability to pay for long-term psychotherapy.

One will quickly realise that this is an ecosystem maintained and sustained by everyone involved, including the market dynamics that bring the patient and the treatment provider together. None of this is inherently wrong if it helps the patient who seeks to improve his or her quality of life. Scamming patients using fanciful jargon, on the other hand, is not OK.

Gaining insight and making meaningful changes and restructuring one's characteristic way of thinking, behaving, and feeling takes time, effort, and motivation, all under the containing ability of the clinical psychologist or psychotherapist, who is being supervised at all times, regardless of how experienced he or she may be. That costs money.

Infantilising language and other grammatical nonsense

Psychotherapy is not about reinforcing humans' natural tendency to regress. It's an opportunity to take responsibility for one's thoughts, feelings, and emotions, and to use language as a tool rather than a crutch. All of the pseudo-psychological movements and fanciful jargon-infested therapy speak is what Wittgenstein would have termed as "grammatical nonsense". Grammatical nonsense, in this context, is psychotherapeutic language that appears meaningful but violates the proper grammar of psychological concepts.

Lacan would push this further: such discourse functions as the discourse of the Other. It promises to fill the lack while actually widening it. Patients learn to speak about their “dysregulated nervous system” or “wounded inner child” instead of speaking from the place of desire. While language is often used to cloak a lack of competence, it can also be used as an anchor to help integrate layers of personality and develop a more coherent inner speech.

A slightly contrarian take on this would also be to describe the tendency to seek refuge in psychological grammatical nonsense as a manifestation of overconfidence on the part of the psychotherapist in his or her abilities, and the patients' need for being non-accountable. The tragedy of it all is that patients, despite their desire for remaining non-accountable and finding easy explanations for their suffering, are truly the losers in the mawkish therapy ecosystem. It's the duty of the licensed provider to ensure non-maleficence and to provide the best possible care, while being supervised by other trained and regulated professionals, as the case may be, in a particular jurisdiction.

Suggestions for my younger (and older) colleagues and non-colleagues:

• Remain humble, return to basics, and read or re-read classical psychoanalytic and cognitive theorists, behaviourists, and even humanists on an ongoing basis, and receive peer supervision and personal psychotherapy.

• Work on your narcissism and destructive impulses. Personal psychotherapy is paramount for professional hygiene.

• Be warned against being seduced by simplistic frameworks, trendy therapies, and anything that costs extra money to be certified.

• If you're licensed (if you're not and are working with vulnerable individuals, you must be reported), you probably need to read what's already available in the bookstore. A lifetime isn't enough to complete the classics.

• If you don't understand something, say so. Do not explain things away by invoking the inner child or the nervous system when you are at a loss for words.

• When the patient asks you to fix their “nervous system” or heal their “inner child”, you are being invited to strengthen their imaginary ego, something that Lacan warned us against. Your job is to refuse that invitation and stay with the question their symptom is asking.

Dr. Jaiyant Cavale is an RCI and New Zealand Psychologists Board (NZPB) licensed clinical psychologist. He practices both online and at his clinic on Residency Road, Bangalore. For appointments, call / WhatsApp: +91-8826402788