The Language We Use With Chronically Ill Clients Matters More Than You Think

Kanjana Hartshorne Author

Sep 08, 2026 |

We are trained to be helpful. We are trained to look for solutions, to gently challenge cognitive distortions, and to help clients find agency in difficult situations. These are often good clinical instincts. But when a client is navigating a complex chronic illness, those same instincts can accidentally replicate the exact harm they have been experiencing in the medical system.

The language we use matters. Not just because words are powerful in a general sense, but because clients with chronic illness have often spent years being told that their experience is not real, not serious, or not as bad as they think. Every time we reach for a reframe too quickly, suggest a wellness intervention that implies they could feel better if they just tried harder, or validate a test result over a lived experience, we are adding to that pile.

Here are some of the most common language patterns that show up in therapy with chronically ill clients, why they cause harm even when well-intentioned, and what to say instead.

"Have you tried yoga? Meditation? Cutting out gluten?"

This is probably the most common one. A client describes a difficult symptom, and we immediately reach for a suggestion. It feels helpful. But to a client who has been navigating complex illness for years, this communicates: I think there is something you haven't tried yet that would fix this. For many chronically ill clients, that is the exact message they have been receiving from every provider they have seen.

Instead, try: "What has helped you manage, even a little?" This acknowledges that management, not cure, may be the realistic goal. It centers their expertise about their own body. And it doesn't imply that there is a fix they've been missing.

"Your labs look normal, so that's good news."

Normal labs are genuinely confusing for chronically ill clients. Many conditions, including POTS, MCAS, hypermobility spectrum disorders, and Long COVID, do not show up on standard bloodwork. A client who has been told their labs are normal while continuing to experience debilitating symptoms has often internalized this as: there must be something wrong with me for feeling this way when the tests say I'm fine. When we echo that framing, even with good intentions, we reinforce it.

Instead, try: "I hear that normal results feel confusing when you're still suffering." This validates the disconnect between what the tests show and what the client is living, without dismissing either.

"You need to reduce your stress."

This one is tricky because it is often technically accurate. Stress does affect the nervous system. But when a client is already doing everything they can to manage a body that is not cooperating, being told to reduce stress can feel like being told to try harder at something they are already failing at. It individualizes a problem that is often systemic, relational, and structural.

Instead, try: "It sounds like your body is carrying a lot right now." This acknowledges the weight without prescribing a solution. It opens a conversation rather than closing one.

"At least you don't have [worse diagnosis]."

Comparative suffering is never helpful, but it lands particularly hard for chronically ill clients who have often had to fight just to have their experience acknowledged at all. This phrase communicates that their suffering needs to be justified against something worse before it counts.

Instead, try: "This is hard, and it makes sense that it's hard." Full stop. No qualifiers needed.

The deeper shift underneath the language

These swaps are not just about finding better scripts. They point to a deeper clinical posture: the willingness to sit with uncertainty alongside a client without needing to resolve it.

Chronic illness, by definition, often does not resolve. The diagnostic journey may not end in a clean answer. The symptoms may fluctuate indefinitely. Our job is not to fix that. Our job is to be a consistent, believing, non-pathologizing presence in a client's life while they navigate it.

That requires us to examine our own discomfort with uncertainty. I learned this early in my career, during an internship at a cancer support community and then years in hospice. I kept wanting to move toward problem-solving, not just for my clients' sake, but because sitting in that unresolvable, icky feeling was hard for me too. Learning to stay in the relational space, to witness without fixing, was some of the most important clinical training I have ever received.

I recently taught a full continuing education training on this topic for PESI, covering the language swaps, the clinical intervention map, the ethical pitfalls, and the specific patterns that show up when working with complex chronic illness. The recording is now available for CE credit.

Watch the full CE training on PESI