Patient vs. Client: Which Term Should Therapists Use?

In the mental health field, words matter. Imagine you are welcoming someone new to your practice. Do you use “patient” or “client” when referring to them? It might seem like a simple semantic question, but it carries a significant weight.

The debate over the terms “patient” and “client” is common. Professionals often question the most appropriate terminology to use when interacting with or referring to those seeking their help.

In this article, we’ll dive into this discourse. By the end, you’ll be able to make an informed decision that is aligned with your professional values.

What is the Difference Between a Patient and a Client in the Therapeutic Relationship?

In therapy, the terms “patient” and “client” are often used to describe the person receiving professional services.

These terms have different connotations, and the choice between them can significantly influence the therapeutic relationship.

While the term “patient” may evoke a more passive role, where a person seeks treatment from a caregiver who guides the process, the term “client” suggests a more active, collaborative, and equal role. In the context of a client, the individual partners with the professional to make decisions about their mental health care.

Patient: Synonymous with Therapist-Directed Care

Historically, “patient” has been widely used to describe individuals receiving care from mental health professionals. This usage dates back to Sigmund Freud, who posited psychoanalysis as part of the medical field.

It is commonly used in medical and psychiatric settings, where the professional assumes an authoritative or expert role, while the patient adopts a more passive one. The term “patient” often conveys the idea of illness and treatment, suggesting a power imbalance between the professional and the individual receiving care.

Client: A Collaborative Approach

On the other hand, therapists who favour a humanistic approach often use the term “client,” likely influenced by Carl Rogers' client-centred methods.

Using “client” suggests a more equal and collaborative relationship, where the person seeking help is active in the therapeutic process. The term “client” also implies a solution and goal-oriented approach, where the individual is seen as a collaborator in resolving their issues.

How Does Word Choice Impact the Therapeutic Relationship?

The choice between “patient” and “client” can have significant implications for the dynamics of the therapeutic relationship.

Let's analyze these implications through four key perspectives:

• Responsibility
• Trust
• Intimacy/Familiarity
• Preference

Responsibility

The term “patient” can sometimes imply that the responsibility for the therapeutic process primarily rests on the health professional in charge of the treatment. In this context, the professional is viewed as the expert with the answers and solutions, while the patient awaits results. This perception can lead to a dynamic where the patient feels less engaged in their own healing process.

Conversely, using the term “client” can promote greater empowerment of the individual receiving help. The client is then seen as an active participant contributing to their well-being in collaboration with the professional. This approach can encourage the client's engagement and involvement in the therapeutic process, thus enhancing their sense of control and autonomy.

Trust

Trust is a central element of any therapeutic relationship. The term “patient” can cultivate trust based on the professional's authority and expertise, often associated with the expectation that the professional knows what is best, potentially reinforcing a dynamic of dependency.

In contrast, the term “client” can establish mutual trust based on collaboration and respect. The client may feel more valued and respected as an individual capable of actively contributing to their therapeutic process. This dynamic can bolster the client's confidence in their abilities and in their therapist. However, some may perceive the term “client” as transactional, possibly detaching or invalidating mental health as a health sphere.

Intimacy/Familiarity

A therapist’s word choice can also influence the perceived level of intimacy in the therapeutic relationship. Using the term “patient” can maintain a certain professional distance, which may be appropriate in medical contexts where clear boundaries are necessary for objectivity and neutrality.

On the other hand, the term “client” can foster a more personal and intimate relationship. This approach can be beneficial in contexts where deep trust and mutual understanding are essential for therapeutic success. However, it is crucial to maintain clear professional boundaries to avoid any confusion or inappropriate dependence.

Preference

Preference can be influenced by the following elements:

• Disciplinary Field: Professionals who identify their practice within the medical field and who focus on “treatment”, often use the term “patient.” Those who identify more with the “social” field tend to use the term “client.” In 2018, the American Psychological Association ruled on the use of the term "patient" to refer to individuals with a diagnosis of mental, behavioural, or medical illness, disorder, or problem who receive health care services provided by recognized psychologists, regardless of their context and practice setting.

• Intervention Approaches: The professional's word choice also reflects how they view their relationship with the individual. A psychoanalytically oriented professional might prefer “patient,” while a humanistically oriented one might choose “client.” For example, as a social worker, I prefer the term “client,” as it reflects a collaborative approach and aligns with my professional order’s requirement that the intervention plan be defined in collaboration with the individual. This places them at the centre of the intervention process and promotes self-determination.

• Practice Setting: The terms used often vary by setting. In schools (primary, secondary, and post-secondary), professionals refer to “students.” In health or social services, “patient” or “service user” is common. In private practice, “client” or “patient” is often used, while community settings may have their own specific terms.

• Individuals Receiving Care: A 2019 scoping review highlighted the complexity of these preferences, influenced by cognitive and affective factors, as well as individual and contextual elements. It is also shown that preferences are constructed in the elicitation process, where individuals obtain information allowing them to better understand and position themselves regarding the different terms. It should be noted that preferences are also influenced by the methods used to obtain them.

• Individual Identity or Perceived Social Role: The same person might identify differently in various care contexts. For instance, a person hospitalized in a psychiatric facility might prefer “patient” during hospitalization but “client” when receiving external care after discharge

Conclusion

The choice between the terms “patient” and “client” is far from trivial and can have significant repercussions on the dynamics of the therapeutic relationship. Therapists should be aware of the implications of each term and should consider how to adapt their language based on the needs and preferences of each individual they support. It is essential to remain open and flexible while being attentive to individual preferences and specific contexts.

Mental health professionals must also remember their role and responsibilities towards those they help, ensuring a safe and collaborative environment. Ultimately, a therapist’s word choice should always serve to strengthen the therapeutic relationship and promote the well-being of the individual seeking care.

Sources:

Lloyd C, King R, Bassett H, Sandland S, Savige G. Patient, Client or Consumer? A Survey of Preferred Terms. Australasian Psychiatry. 2001;9(4):321-324. doi:10.1046/j.1440-1665.2001.00358.x