Why We Don’t Call Our Clients “Ill”

In Process-based Behaviour Therapy (PBBT), we have made the deliberate choice not to describe our clients as ill or sick. This is not a matter of political correctness. For us, it’s because calling someone “psychologically ill” is not only scientifically questionable, it’s deeply harmful.

Labels Stigmatise and Isolate

When an individual is told they are “ill,” the label sticks often for the rest of their life. It can become greater than any behavioural pattern or emotional struggle that existed before. The label becomes their identity.

We’ve seen it again and again with clients who are given psychiatric labels:

• The label confirms “I am the problem”.

• The label confirms “I am defective”.

• The label confirms that they are different, separate, weak, or broken.

• The label confirms that they are to blame for their situation.

• The label confirms that loved ones cannot be the main problem.

• The label denies of them of ever gaining full self-agency.

Labels are deeply isolating. They invariably become self-fulfilling. When you are told you are something by professionals and significant others, you start to live as if that is who you must be.

Most clients don’t believe deep down that there is something biologically wrong with them. But when they are told this from the outside, they go along with it, because they don’t trust their own judgement. They go along with it because it’s the story they’ve been given by professionals and society, and thus it has credibility. But deep down, they know it doesn’t explain their lived reality.

PBBT Makes a Stand

By not calling our clients ill, PBBT is taking a very clear stand. We are making an explicit shift from the traditional psychological opinion. We are placing the responsibility for how someone has learned to behave, how they react emotionally and even how they feel on the world they grew up in, not on their biology or internal events.

We say to most clients, “Your history and the context around you were the thing that was ill. You were set up to behave this way, and it was inevitable that this would be the outcome of the experiences you had in the world and the story told by those experiences. It’s not actually you, it’s the path you were placed on.”

This alternative narrative matters:

• It calls on significant others around our clients, including professionals, to take some responsibility for clients’ suffering.

• It creates space for respect, forgiveness, and compassion, all of which are essential to growth, personal freedom and self-confidence.

• It opens the door to change that is truly transformative, allowing old wounds to heal.

Hope Needs a New Narrative

There is little or no real hope for transformation in a position that sees biological defect or abnormality as the problem, where that defect is within the individual and largely beyond their control. A position of lack of control can never foster a sense of control or self-determination. How can there be hope if the problem is inside us, it is vaguely defined, we cannot see it or touch it, we don’t know how it got there, and there is no cure?

PBBT is fundamentally different from this traditional approach. If a client asks, “If it wasn’t me, then who was it?” we point to their history, the people around them, and the environments that they grew up in. 

History offers hope because it can be lived with, it can be overcome and a client’s future does not have to be owned by their past. There is a cure, there is a real chance for freedom, but it comes with love, support, compassion, explanation and a sound professional understanding of why clients do and feel as they do. We see our clients lives change day after day in real, concrete ways.

Always On Their Side

At the heart of PBBT is a commitment. We believe in our clients, we are always on their side. We see their behaviour as inevitable given what they lived through. We give them respect, forgiveness, and the tools and self-confidence they need to move forward, however they choose to do that.

By outrightly rejecting the “illness” model and the labels that go with it, we remove a fundamental barrier that limits client’s freedom. We make it possible for clients to see themselves as capable of change, worthy of connection, and free from the weight of a label and from the burdens of their history.

For PBBT, where there is humanity, there is hope.

Want to learn more?

Join us for an informational webinar on the Professional Diploma in Process-Based Behaviour Therapy (PBBT).

Date: 25th August 2025
Time: 16:00 (Irish Time)