When Labels Become Limits
Why the language we use matters in vocational rehabilitation—and beyond
“Once you label me, you negate me.” — attributed to Søren Kierkegaard
I came across this quote some time ago, and it has stayed with me. I think it is particularly relevant to vocational rehabilitation. When we label someone, we run the risk of putting that person into a box. We do the same thing to ourselves through our own internal dialogue. We decide that we are smart or not smart, good at something or bad at it, capable or incapable, we are fat or thin, or good enough or not good enough, and so on. Sometimes these beliefs are based on our experiences, but sometimes they are based on things other people have told us, perhaps many years ago, that we have never really stopped to question.
The people we work with are often experiencing significant periods of change. An injury, illness or disability may affect someone's ability to work, but it can also affect their confidence, independence, relationships, sense of identity and expectations for the future. For someone already trying to make sense of what has happened and what comes next, the language used by the professionals around them can have a powerful effect.
This doesn't mean we should avoid talking about limitations or difficulties - that wouldn't be helpful either. It means being careful that the language we use to describe one aspect of someone's functioning does not become a statement about who that person is.
When a Description Becomes a Label
There is an important place for diagnoses, assessment findings and descriptions of functional abilities in rehabilitation. A diagnosis can help someone understand what they are experiencing. It may help guide treatment, provide access to services or accommodations, or assist in developing an appropriate return-to-work plan. Similarly, part of my role as a vocational evaluator is to identify both strengths and areas of difficulty. But I think there is an important distinction between describing a finding and defining a person by it.
For instance, when we think about describing performance on a measure such as an academic test or IQ/cognitive testing, we should describe the results and findings, but labelling someone does something different - it places them into a box.
The Labels We Give Ourselves
I hear self-labeling fairly regularly during vocational evaluations and albeit, I have been subject to this myself over the years. Some common labels you may have also heard in your own practice might include some or all of the following:
“I've never been smart.”
“I was never good at school.”
“I've always been a terrible reader.”
“I'm bad at math.”
Sometimes people can tell you exactly where these beliefs came from. A teacher told them they weren't very smart. They struggled with a particular subject in school. They failed a course. Someone told them they would never go very far. After enough time, something another person said can become something we say about ourselves. When someone tells me, “I've never been smart,” I use this as an opportunity to become curious about why they may think that. So I listen.
I might ask what happened in school, what they found difficult, or what experiences led them to see themselves that way. I am curious about what is underneath the statement, but I am also wondering whether that belief is affecting what the person thinks they are capable of doing now. Assessment sometimes provides an opportunity to look at those beliefs a little differently.
I have worked with people who were extremely anxious about completing academic testing, particularly mathematics or spelling, because they were convinced they would perform poorly. Sometimes they have been surprised by how well they actually perform, while sometimes they aren't.
I also recently assessed someone experiencing cognitive difficulties following a traumatic brain injury who reported difficulty finding words. During testing, however, something interesting happened. When the person had an opportunity to write the words rather than having to produce them verbally, the task became considerably easier and their performance was much stronger. This minor modification to taking the test not only informed the evaluation, but also provided the worker with a sense of their pre-disability identification of self, which can have astounding and lasting effects for rehabilitation. That did not mean their reported difficulty wasn't real - It was real, but it showed that the difficulty was more nuanced than simply saying, “This person has trouble finding words.”
Professionals Can Label People Too
We also have to be willing to look critically at ourselves as rehabilitation professionals. Before I conduct a vocational evaluation, I may review a substantial amount of medical and rehabilitation documentation. By the time I meet someone, I may already have read numerous descriptions of their symptoms, behaviour, functioning, motivation and treatment history. Occasionally, records contain words such as “malingering,” “non-compliant” or “unmotivated.”
If I accept someone else's characterization of a person before I have even met them, there is a risk that I begin looking at everything they say and do through that lens. I may not intend to do it. In fact, I may believe that I am being completely objective, which is exactly why I think we need to be conscious of it. Someone else's conclusion is information that I can consider, but it should not determine my own conclusion before I have completed my assessment and used my own clinical judgement.
This is, again, where curiosity fits in - what is this person actually telling me? What am I observing? Does the information I am gathering support what I read in the file? Does it contradict it? Is there another explanation? Those questions leave room for us to see the person beyond the descriptions we may have already read about them, because they ARE.
Even Positive Labels Can Be Limiting
Interestingly, I don't think this issue is limited to labels that we consider negative. Most of us are aware of stigmatizing language such as when we use terms such as "drug addict" or "commit suicide," but we also label people using social ideals, which can also have harmful effects such as smart, gifted, resilient, successful, strong or high achieving. These sound positive, and often they are meant as compliments, but they can create their own expectations and may even lead to re-traumatizing their perceived or actual loss due to injury/illness. If you have always been “the strong one,” what happens when you need help? If you've always been “the smart one,” what happens if an injury affects your cognitive functioning? If you have spent most of your adult life being independent, productive and successful in your occupation, what happens when an illness or injury means that you suddenly cannot work in the same way or provide for your family in the same way?
This is one of the reasons I find vocational rehabilitation so interesting. Work is rarely just work. For many people, their vocation becomes part of their identity. It can contribute to our sense of competence, independence, belonging, purpose and meaning. When someone's ability to work changes, the question may therefore be much larger than, “What job can I do?”
“Man's search for meaning is the primary motivation in his life and not a ‘secondary rationalization’ of instinctual drives.” — Viktor E. Frankl, Man's Search for Meaning
Listening With Curiosity
One of the simplest things we can do as rehabilitation professionals is also one of the most important: listen. I sometimes think there is a difference between hearing someone and really listening to them. We can hear every word a person says while still interpreting those words through our own experiences, assumptions and expectations. This is one of the reasons I find principles from motivational interviewing useful. OARS—open questions, affirmations, reflective listening and summaries—provides practical tools for slowing down the conversation and making sure we understand what the person is actually trying to communicate.
Curiosity can also help us find the balance between empathy and inadvertently reinforcing someone's belief that they are incapable. There is a difference between saying, “That sounds like it has been incredibly difficult,” and communicating, “Given what you've been through, nobody could expect you to do that.” The latter may come from a place of genuine compassion, but we also need to consider what the person may hear in those words. Acknowledging someone's challenges is important and people deserve to feel heard and understood, but we can validate what they are experiencing without unintentionally limiting what they believe may still be possible.
Leaving Room for Possibility
If there are a few things I would encourage other vocational rehabilitation professionals to consider, one would be to look at the language we use with a critical eye. Are we describing what we actually know, or are we making an assumption? When we read a characterization of someone in a report, are we treating it as information to consider, or have we already decided that this is who the person is?
Are we listening for strengths as carefully as we listen for limitations? And are we remaining curious? None of this means ignoring impairment or pretending that barriers don't exist. Sometimes an occupation simply isn't suitable. Sometimes an individual has significant limitations that need to be recognized and accommodated. Being person-centred does not mean avoiding difficult realities, it means not turning those realities into the person's identity.
What Remains?
This brings me back to the reason the Kierkegaard quote resonated with me in the first place. What happens if we take the labels away? Take away the diagnosis, the disability designation, the job title, the educational history and the test scores. Take away the successes and the failures. Take away what teachers, employers, healthcare professionals and other people have said. Even take away the positive labels: smart, successful, resilient, strong.
What remains? The person does. Viktor Frankl's work on logotherapy has always interested me because of the importance he placed on meaning. His work reminds us that human beings are not simply collections of symptoms, accomplishments or circumstances. We are also people trying to understand ourselves, find meaning in our experiences and determine what comes next. Perhaps that is particularly important to remember when someone is experiencing disability or vocational disruption. At a time when so many things that previously helped define that person may be changing, we should be very careful about giving them another identity to carry.
As rehabilitation professionals, we can listen, ask questions, acknowledge what is difficult, identify genuine barriers, recognize strengths, and remain curious about what we don't yet know. Most importantly, we can leave some room for the person to discover what is possible for themselves.
Heather Mallard, CVRP-TSA, ICVE, CCVE, RVP, Vocational Evaluator & Rehabilitation Professional | HM Vocational Consulting
About the Author Heather Mallard is a vocational evaluator and rehabilitation professional and the founder of HM Vocational Consulting. Her work focuses on vocational assessment, rehabilitation, return to work, and the relationship between work, identity and meaning.
