Continued guilt, shame, and internalised stigma correlated to alcohol and other drug use

Not long ago, words like “triggered,” “gaslighting,” “narcissist,” and “neurodivergent” belonged almost exclusively to therapists’ offices and psychology textbooks. Now they’re everywhere; in workplace training sessions, community organisations, TikTok comment sections, and casual conversation between friends over coffee. That shift has brought some genuinely important changes. But it’s also introduced some problems worth taking seriously.

The real wins

It would be unfair to dismiss this cultural shift outright. There are meaningful gains. More people today can identify manipulation, coercive dynamics, and emotional harm than any previous generation. Mental health conversations have been destigmatised in ways that would have been hard to imagine twenty years ago. People who were historically silenced, particularly those from marginalised communities, finally have language that validates their experiences and gives them permission to leave harmful situations. That’s progress

But then there’s “concept creep” (pathologising the ordinary or “diagnostic inflation”)

Psychologists use the term “concept creep” to describe what happens when a word originally defined by strict clinical boundaries starts expanding to cover increasingly ordinary experiences. And that’s precisely what happened with “trauma.”

Clinically, trauma refers to experiences that overwhelm the nervous system i.e., genuine threats to safety, severe harm, events that exceed a person’s capacity to cope. These days, the same word is regularly applied to being disagreed with, having a relationship end, receiving criticism, or simply feeling uncomfortable. Events like relationship breakdowns, job loss, or failure can be genuinely devastating, and for some people, under some circumstances, they absolutely do meet the clinical threshold for trauma. The distinction isn’t really about the type of event. It’s about the impact on the nervous system and the person’s capacity to integrate the experience.

When everything qualifies as trauma, the word stops doing useful work. Worse, it can actually undermine the resilience people need to navigate a genuinely difficult world.

The nervous system problem

Here’s where it gets important. In actual “clinical” trauma, the brain’s threat-response systems activate intensely. Memory processing is disrupted. The body mobilises for survival in ways that can leave lasting marks.

Discomfort is different. It involves real emotional activation, it’s not pleasant, but cognitive flexibility remains available. The capacity to think, reflect, and choose a response is still intact.

When people learn to label ordinary emotional discomfort as trauma activation, the consequences compound. If discomfort feels equivalent to harm, avoidance becomes a logical response. But avoidance prevents the gradual building of tolerance. And without tolerance, the world gets smaller.

Trauma as identity and social currency

In some online communities, there’s an uncomfortable dynamic worth naming: being “highly traumatised,” “chronically triggered,” or “deeply misunderstood” can confer real social benefits — belonging, validation, moral authority, and attention.

This doesn’t mean the experiences aren’t real. But when distress becomes central to someone’s identity, letting go of that distress can start to feel like losing themselves. Recovery, paradoxically, becomes threatening.

The fragility trap

In certain environments, fragility functions as a kind of protection. If I am highly sensitive, others must accommodate me. Challenge becomes inappropriate. Accountability becomes unsafe. The person is shielded, but the cost is enormous.

Resilience, both psychologically and biologically, develops through graded exposure to stress. We become capable through encountering difficulty, not by avoiding it. Systems that never face adaptive pressure weaken over time. This is simply how human development works.

Why this moment matters

Several things are converging right now. Social media algorithms reward extreme emotional narratives. Identity formation increasingly happens in digital spaces that amplify distress. Institutions have frequently overcorrected towards protective language in ways that, whatever their intentions, can inadvertently signal that discomfort is dangerous. And while there’s been important growth in awareness of systemic injustice, the corresponding emphasis on individual agency has sometimes been lost.

We’ve swung from “suppress your emotions entirely” to “your emotions define reality.” Neither extreme serves people well.

Holding the middle ground

What good support actually looks like isn’t dismissing people’s experiences, it’s deepening them. The distinction that matters is between trauma-informed practice and what might be called trauma-indulgent practice.

Trauma-informed means understanding that harm genuinely impacts nervous systems, avoiding shame, recognising power imbalances, and creating safety. It’s grounded and necessary.

Trauma-indulgent means treating all discomfort as harm, reinforcing avoidance, allowing emotional reasoning to override reality, and quietly removing personal responsibility from the picture. It feels compassionate in the moment but tends to leave people worse off over time.

In practice, holding the middle ground means validating what someone feels while gently asking whether something was truly unsafe or simply hard. It means acknowledging difficulty while also reinforcing capacity. It means introducing a reality that doesn’t get much airtime in online spaces — that we can’t always control how those around us speak or behave, but we can build our own tolerance and capacity to regulate.

The question underneath everything

There’s a deeper ethical question running through all of this: are we reducing suffering in the long run, or just distress in the short term?

Protecting people from discomfort today, if it increases fragility tomorrow, is not a kindness. But exposing people to challenge without adequate safety and support risks re-traumatising those with genuine wounds.

The balance isn’t complicated to describe, even if it’s genuinely difficult to hold: safety, combined with graduated exposure, combined with a genuine sense of agency.

Anyone supporting others through difficulty needs a calm nervous system, a high personal tolerance for distress, and the capacity to sit with being perceived as insensitive when holding a difficult but necessary line. Clear values and genuine boundaries aren’t optional extras — they’re the model.

The world remains economically uncertain, socially polarised, and digitally relentless. People will encounter disagreement, rejection, imperfect institutions, and others who handle things badly. Preparing people for a world where everyone is perfectly considerate is not just unrealistic — it’s a disservice.

If you’ve ever found yourself thinking “Part of me wants to change… but part of me’s not sure”, you’re not alone. That back-and-forth, weighing things up—“Should I? Shouldn’t I?”—is a normal part of how people process big (and small) decisions. In counselling, this is called ambivalence, and rather than seeing it as a barrier, Motivational Interviewing (MI) treats it as a starting point for meaningful conversations.

What Is Motivational Interviewing?

Motivational Interviewing is a counselling approach that helps people explore their own reasons for change, without pressure or judgment. It’s a respectful, supportive way of helping you work through the push-pull that often comes with making decisions. You’re in the driver’s seat—we’re just here to help you navigate.

You might hear MI described in different ways:

In simple terms:
“MI is a collaborative conversation style that helps strengthen your own motivation and commitment to change.”

In practice:
“MI is about helping you make sense of mixed feelings and explore what’s right for you—based on your values, your goals, and your life.”

MI isn’t about telling you what to do. It’s about listening deeply, asking thoughtful questions, and helping you make sense of where you’re at—and where you might want to go.

Why It’s Not Just a Quick Fix

While MI can be used in short sessions, the research shows it works best when there’s time to really explore your thinking. In studies where people had just one 15-minute session, the outcomes were decent. But when they had more time—say, several sessions of an hour—the results were much stronger. That’s probably because real change often takes time, reflection, and a bit of back-and-forth.

MI originally started in the health world—helping people reduce alcohol use, manage weight, or improve their health. More recently, it’s been used to address things like vaccine hesitancy. But MI isn’t just for health issues. It can also help with things like relationship struggles, career decisions, or anything where you might feel stuck or unsure.

Ambivalence Is Normal

Let’s say you’re thinking about quitting smoking, leaving a relationship, or starting something new. You might feel torn—part of you is ready, and another part isn’t. That’s ambivalence.

MI offers tools to help with this, including something called the Decisional Balance, which simply helps you look at both sides: What are the good things about staying the same? What are the reasons you might want to change?

But here’s the thing—MI isn’t about pushing you toward a particular outcome. If you’re trying to make a decision where there’s no obvious “right” answer—like whether to stay in a relationship—the counsellor stays neutral. They don’t steer you in one direction. Instead, they help you explore what matters to you.

Talking Your Way Toward Change

One of the interesting things about MI is how it pays attention to the language you use when you talk about change.

Some of the things people say when they’re starting to think about change include:

• “I probably should cut down…”
• “I’d like to feel better about this…”
• “I don’t know if I can keep doing this…”

These kinds of statements are called change talk—and they’re actually signs that something inside you is shifting. MI aims to gently encourage and grow this kind of talk, because research shows that the more someone talks about change, the more likely they are to act on it.

There’s also sustain talk, which sounds like:

• “I don’t smoke that much…”
• “I know I should, but it helps me relax.”
• “Now’s not really the right time.”

Both are normal. In MI, there’s no need to rush. Instead, the focus is on listening to both sides of you—and helping you get clearer about what you want to do next.

Getting Skilled Support

Like any professional approach, MI works best when the counsellor is trained and skilled in using it. Some practitioners have their sessions reviewed (with consent) by independent experts to make sure the spirit and skills of MI are being used well.

If you ever hear a practitioner say they “do MI”, you can ask what that looks like. The most effective use of MI goes beyond just asking open-ended questions or offering summaries—it’s about how your counsellor supports you in finding your own reasons for change.

What a Session Might Involve

Motivational Interviewing tends to follow a flexible process with four key parts:

1. Engaging – Building trust and understanding
2. Focusing – Exploring what matters most to you
3. Evoking – Drawing out your own reasons for change
4. Planning – When you’re ready, looking at possible next steps

You don’t have to go through these in a straight line. Some days you might focus on one step, then circle back to another later. It’s all guided by you—your pace, your readiness, your goals.

In Summary

If you’re feeling uncertain about making a change—or you’ve been thinking about it for a while but haven’t quite landed on what to do—Motivational Interviewing could be a really helpful way to explore things.

It’s not about being told what to do, and it’s not about “fixing” you. It’s a respectful, evidence-based approach that helps people work through their own ambivalence, connect with what matters to them, and move toward change when they’re ready.

Change doesn’t have to be instant. And it doesn’t have to be perfect. But it can start with a conversation.

I was recently browsing some of the units I completed for my counselling diploma – for revision. The human memory has not evolved to store, organise, categorise and recall all the large amounts of information we collect every day, nor is our memory always accurate. It’s important for counsellors and therapists to keep up to date with new approaches to counselling, and it doesn’t hurt to read over learned materials from college days. I thought I’d provide some learning about Acceptance and Commitment Therapy for readers.

Just to acknowledge the work of others, most of what is written below, I have retrieved and paraphrased from ACCEPTANCE AND COMMITMENT THERAPY Published by: Australian Institute of Professional Counsellors Pty Ltd.

Acceptance and commitment therapy, known as ACT (pronounced as the word ‘act’), is an approach to counselling that was originally developed in the early 1980s by Steven C. Hayes, and became popular in the early 2000’s through Hayes’ collaboration with Kelly G. Wilson, and Kirk Strosahl as well as through the work of Russ Harris. You can look them up on Youtube or Google if you’re interested in what they might have to say about ACT.

“Unlike more traditional cognitive-behaviour therapy (CBT) approaches, ACT does not
seek to change the form or frequency of people’s unwanted thoughts and emotions. Rather,
the principal goal of ACT is to cultivate psychological flexibility, which refers to the ability to
contact the present moment, and based on what the situation affords, to change or persist
with behaviour in accordance with one’s personal values. To put it another way, ACT
focuses on helping people to live more rewarding lives even in the presence of undesirable
thoughts, emotions, and sensations.”
(Flaxman, Blackledge & Bond, 2011, p. vii)

ACT interventions tend to focus around two main processes:

• Developing acceptance of unwanted private experiences that are outside of personal
  control.
• Commitment and action toward living a valued life (Harris, 2009)

In a nutshell, ACT gets its name from its core ideas of accepting what is outside of your personal control and committing to action that improves and enriches your life.

Cognitive Defusion is the process of learning to detach ourselves from our thought processes and simply observe them for what they are – “transient private events – an ever-changing stream of words, sounds and pictures” (Harris, 2006, p. 6). I think this component of ACT is incredibly beneficial if we practice it daily. I like to say, just like the function of the heart is to pump oxygenated blood around the body, one of the brain’s functions is to have thoughts. We can observe thoughts without taking them to mean more than what they are. Some thoughts are automatic, some are subconscious, and some are unconscious or preconscious beliefs that we consider to be true and factual and “rules” about how the world operates and how we have to operate in it. If someone is defused from their thought processes, these processes do not have control on the person; instead the person is able to simply observe them without getting caught up in them or feel the need to change/control them.

Acceptance is the process of opening oneself up and “making room for unpleasant feelings, sensations, urges, and other private experiences; allowing them to come and go without struggling with them, running from them, or giving them undue attention” (Harris, 2006, p. 7). Practicing acceptance is important because it encourages the individual to develop an ability and willingness to feel uncomfortable without being overwhelmed by it (Flaxman, Blackledge & Bond, 2011). It’s important to acknowledge that to accept something doesn’t mean we like it or have a passive attitude. It is to accept something exactly as it is and then we choose what to do with it. Think of the Serenity Prayer: Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.

Contact with the present moment is the concept of being “psychologically present” and bringing full attention to the “here-and-now” experience (Harris, 2009). I’d also argue that to psychologically present, we must also be aware of our physical body and the sensations within it and outside of it. Because we have the ability to think about the past and about the future, sometimes it can be difficult to stay in the present (Batten, 2011; Harris, 2009). Having contact with the present moment is essential because that it where we find out anchor and power. We have the ability to pay attention in a flexible manner to the present moment and connect with that experience rather than ruminate on past events or future possibilities (Lloyd & Bond, 2015). Some of you might say “What if I can’t stand the present moment?”. True. If you have extreme emotional experiences or have a history of trauma, it may be functional for you to use distraction or talking to someone when the present moment is “too much to take”. What we want to work towards is using healthy coping strategies in the present moment mindfully, instead of behaviours that no longer serve us.

Values, and identifying them, (i.e., what is important to the individual) is a central element of ACT because it assists clients to move in the direction of living and creating a meaningful life. One of the central goals of ACT is to help clients to connect with the things they value most and to travel in “valued directions” (Stoddard & Afari, 2014).

Committed action is the process of taking steps towards one’s values even in the presence of unpleasant thoughts and feelings (Harris, 2009). Behavioural interventions, such as goal setting, exposure, behavioural activation, and skills training, are generally used to create committed action. The ACT model acknowledges that learning is not enough, one must also take action to create change.

Self-as-context, or what I prefer to call “the observing self” or simply just our self-awareness, creates a distinction between the ‘thinking self’ and the ‘observing self’ (Harris, 2009). The thinking self refers to the self that generates thoughts, beliefs, memories, judgments, fantasies, and plans, whereas the observing self is the self that is aware of what we think, feel, sense, or do (Harris, 2009). “From this perspective, you are not your thoughts and feelings; rather, you are the context or arena in which they unfold” (Stoddard & Afari, 2014). Being aware of the observing self allows an individual to have a greater ability to be mindful and in the present moment, as they can separate themselves from the thoughts, beliefs, and memories they have.