4 - Applications and Boundaries in Verbal Articulation Therapy

Toye Oyelese

Hello again, and welcome back to MINDLESSNESS: The Power of Articulations — Clinician Series. I’m Dr. Toye Oyelese, and today we’re going to wade into some really practical territory: When does verbal articulation therapy shine, and just as importantly, where do we need to avoid it or use it with extreme care. If you've stuck with me through the last few episodes, we’ve talked theory, the why behind mindless repetition, and exactly how to facilitate the Six-Step Protocol — so today, let’s get our hands dirty with the messy clinical realities.

Toye Oyelese

Now, having worked in so many different settings — from rural health posts up north to the chaos of urban clinics — I’ve seen firsthand that not every tool is for every job. With verbal articulations, there are three buckets where I see particularly strong results. The first is mild to moderate depression and anxiety, especially where a patient’s cognitive resources are stretched thin. You probably know the drill: traditional CBT is wonderful, but for someone deep in the fog, asking them to identify cognitive distortions and reason their way out can be… well, like asking a person with a broken leg to run a race. Sometimes, we don’t need them to “understand” their way out — they just need to keep saying, “I will have hope. I will move forward.” Or even, “I will be calm.”

Toye Oyelese

Something I learned early on — and I want to emphasize this — is that during an acute crisis, insight just isn’t an option. I actually started using articulations with patients in crisis. Picture this: someone in total overwhelm, barely able to string together a thought, but still able to repeat after me, slowly — “I will survive. I will be okay.” It’s not a shortcut for crisis assessment or safety planning, but it is a stabilizing tool that buys time. An anchor. Like, when everything else is falling apart, sometimes you have to give patients something simple to hang onto.

Toye Oyelese

Another area — and this one’s close to my heart as someone who’s spent a lot of time with patients who have “done all the work” and are still stuck — is treatment resistance. Some folks, honestly, they could write a book on their anxiety patterns, but knowing isn’t doing, right? The articulation approach — and sorry, I’m not trying to sound like a salesman — skips all the insight and just lets the patient “do” something. If this is you, or your patients, I always frame it gently: “Let’s try an approach that’s about doing rather than understanding.” And of course, it’s never a replacement for medications or other therapies — more like another tool in the toolbox.

Toye Oyelese

You can pair this with CBT, meds, or exposure work too. Think of it as reinforcing what’s already underway. As your patient’s neurochemistry starts to settle, articulation gives them real-time practice with moving forward. Same for someone prepping for an exposure — it can be that phrase they repeat in the waiting room, or between sessions, to keep up their momentum. I wish I had known about this trick back when I was nervously preparing for medical board presentations in Canada — believe me, I had my own little mantra before those meetings, and it worked wonders to settle my nerves.

Toye Oyelese

And it’s not just for clinical symptoms. I’ve seen this approach help students with test anxiety, new grads about to start residency, even professionals gearing up for high-stakes performances. Sometimes, articulations like “I will be focused and clear” or “I will perform at my best” can really help foster that sense of stability and confidence as we step into the unknown. Actually, if I’m honest, I caught myself whispering something similar before doing this podcast. So, practical, real-world applications — that’s where it shines.

Toye Oyelese

But — big but here — just because you have a hammer doesn’t mean every problem’s a nail. Let’s talk about cases where this method doesn’t fit. Straight off, active psychosis: no, don’t do it. The line between internal and external reality is already blurred. If you start repeating things, you can actually make the confusion worse, or accidentally contribute to delusional thinking. In those moments, stabilization must come first — get your psychiatry consult, get symptoms controlled, and only then maybe, maybe, consider if there’s a place for articulations.

Toye Oyelese

Patients with severe dissociative disorders are another group where this method is, at best, a poor fit unless you’ve got advanced training. DID, severe depersonalization — these patients don’t have a singular internal narrator, so to speak. Articulations assume a fairly unified self, and if that’s missing, repetition may do more harm than good, or at least not work as intended. Please, refer to dissociation specialists — it’s really outside the job description for most generalists.

Toye Oyelese

Then we have active suicidality. I know this should go without saying, but just for everyone’s peace of mind: verbal articulation therapy is not a crisis response for suicidal ideation with intent or plan. The patient’s safety comes first — standard protocols, safety planning, hospitalization if need be. Down the line, when things are calm, sure, articulations might support ongoing recovery, but not in the eye of the storm.

Toye Oyelese

There’s another layer of nuance with trauma and personality disorders. For survivors of complex trauma, the forward-looking nature of, say, “I will be safe” can actually help stabilize — but here’s the real catch. Trauma survivors might have a tricky relationship with taking direction, being told what to say, or even with the sound of their own internal voice. I learned the hard way: if you don’t give complete control over the articulation, you risk re-triggering or creating resistance. Autonomy is crucial. Let them choose the words. If it feels wrong, you have to be willing to stop or adjust.

Toye Oyelese

Personality disorders — especially cluster B — are even more complex. Clinical energy shifts in the room, idealization and devaluing happen fast, one week it’s a miracle, next week it’s garbage. Grandiose or relationally-charged articulations can backfire. Again, articulation work might be possible, but only as part of a larger treatment plan, with a whole bunch of safeguards in place, and lots of clinical humility.

Toye Oyelese

Now, if you’ve made it this far in the series, you know I care a lot about clinical ethics. Verbal articulation therapy is powerful precisely because it bypasses conscious resistance — that’s the appeal, but also the greatest risk. So, we owe it to our patients to spell out what this method actually does, and how. In other words: informed consent isn’t optional. When you teach the framework, don’t just recite steps; explain that context — “This method works by getting past your conscious analysis. It’s designed to influence your mind, whether or not you believe every word at first. Do you understand, and do you consent?” I always check for confusion — you’d be surprised how often that opens the door to genuine questions.

Toye Oyelese

And autonomy — let’s talk about that. For therapy to truly work, the patient needs to own the articulation, top to bottom. If you, as a clinician, do all the work and the patient just repeats your phrase, well, you’re veering into suggestion, or even indoctrination. Not good. The safeguard is real collaboration: the patient chooses, feels resonance, and can change things any time. I’ve had cases where, after a few days, a patient says, “You know, that phrase doesn’t fit anymore,” and we shift together. That’s a sign things are actually working as intended.

Toye Oyelese

Now, I want to touch on something I don’t hear talked about enough — this whole area around manipulation. The very mechanism that lets us help can just as easily harm if misused. Back in Nigeria, I remember noticing how advertising campaigns used phrase repetition: “New Dawn! New Dawn! New Dawn!” Eventually, you find yourself repeating it without even meaning to. As clinicians, we have to acknowledge: any mind-bypassing principle can be twisted. Our job is to keep it transparent, collaborative, and grounded in patient welfare. That means regular check-ins — if conviction or confidence starts to wane, or a patient’s discomfort rises, you hit the brakes. This isn’t the only tool in the shed.

Toye Oyelese

So, that’s where I want to leave things today. To sum up: this method works wonderfully for depression, anxiety, crisis stabilization, treatment-resistant symptoms, and high-pressure transitions — but not for active psychosis or severe dissociation, and only after crisis passes in suicidality. Ethical use means true informed consent, unshakeable patient autonomy, and constant vigilance against drift into suggestion or manipulation. In our last episode of the clinician series, we’ll walk through integration — what this looks like woven into a session, or over the course of a real treatment plan, with concrete case examples. As always, I’m deeply grateful you’re here, and I look forward to continuing this journey with you in Episode 5. Take care until then.