There was a moment a few years ago in my clinical work with a client I still think about.

A client had just shared something vulnerable, deeply shame-filled, and brave. I nodded. I said something like, “Thank you for sharing that with me.” Then I quickly moved on to another topic. 😒

I didn’t realize until later during a consultation session and after the client stopped coming back that I had subtly sent this message: Let’s not stay here.

I wasn’t trying to shame the client. But I did. Unintentional, yet effectively stigmatizing.

When Help Feels Harmful

Researchers conclude that when patients perceive bias or judgment from language, body language, or tone, they may feel stigmatized and disengage from therapy.

“Patients pick up on provider stigma in verbal and nonverbal cues, and when they do, it can lead to feelings of marginalization, treatment dropout and failure to enter care.”
Link: https://www.apa.org/monitor/2024/07/stigma-against-patients

“Stigmatizing language… may perpetuate negative clinician attitudes and undermine the therapeutic alliance.”
Link: https://arxiv.org/pdf/2405.20582

“Clinical documentation… influences patient perceptions of care and may contribute to mistrust or disengagement when stigmatizing terms are present.”
Link: https://arxiv.org/pdf/2405.20582

The Therapy Room Isn’t Neutral

I’ve been thinking about the micro-moments: when we say something clinical to stay regulated, but it lands as rejection.

• “That’s your trauma response”
• “That sounds like distorted thinking”
• “Is there anything else you would like to share with me today?”

These phrases aren’t wrong in and of themselves. But sometimes, they seem like slammed doors to certain clients.  

Our presence, how we look up, breathe, shift in the chair, either opens space or closes it. Clients can feel the pause. The subtle flinch. The clock check. The nonverbal shift to something else.

What We Can Do

You don’t have to be a helper to do something helpful. This isn’t about shaming anyone. It’s about reflection. About returning to what we know: that healing begins with presence, not perfection.

A few ways forward for all of us, even those of us who aren’t in a helping relationship:
• Slow down before labeling. Ask: What’s this moment asking of me?
• Check your face, your tone, your urgency.
• Say the thing: “I may have missed something just now. Can we go back?”
• Invite feedback: “Have there been times I’ve made you feel misunderstood?”

When we own and try to repair the ways we’ve contributed to stigma, we actually begin to crush it.

One Thing to Do this Week

Ask someone—your colleague, your peer, your supervisor:
“Have I ever said something that felt off to you?”
Then really listen.

You don’t need to be flawless. Sometimes you just need to stay a bit longer.

Provide presence.

Reminds me of something my youngest son says each night right after I tuck him into bed, “Dada, stay a little bit longer.” ❤

Until next week, come back…be here.

Keith