'Client' or 'Patient'?

[FallenMind]

I know we all come from different backgrounds and scopes of practice, but I'm curious though: During your training (Master's or Ph.D) were you prompted to call people who come to you for services a CLIENT or a PATIENT?

I come from a clinical mental health counseling background and all my professors were adamant that we call them 'clients'. They viewed the term 'patient' as someone who passively receives treatment. The term 'client', however, meant that the individual would work collaboratively with the practitioner.

I know that it depends on your practice, but I'd really like to know everyone's thoughts! 😀

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[Pragma]

Patient is very typical in hospital settings (including outpatient hospital services, in my experiences). Client is common in community mental health, counseling centers, etc.

I've used both based on the norms of the setting.

 

[Doctor Eliza]

"Consumer" is also popular in CMH settings.

My PP uses "patient" a lot. This is because the owner is image conscious and feels it makes us seem more credible if we use medical terminology: psychologists=doctors, post docs=residents, clients=patients.

Personally, I use patient and client interchangeably. I do, however, always use patient when talking to MD's in order to communicate that we are on the same level as professionals even if we have different roles.

Dr. E

 

[Therapist4Chnge]

Patient is very typical in hospital settings (including outpatient hospital services, in my experiences).

This has been my experience as well.

"Consumer" is also popular in CMH settings.

Ugh....I really dislike this term.

 

[MBellows]

Ugh....I really dislike this term.

State agencies seem to love "consumer." Personally... I just don't want to feel like sessions are equivalent to a trip to Wal-Mart.

 

[futureapppsy2]

State agencies seem to love "consumer." Personally... I just don't want to feel like sessions are equivalent to a trip to Wal-Mart.

Yeah, "consumer" is really popular among voc rehab and independent living agencies, and I just don't get the appeal. I also don't see what's stigmatizing about "patient," tbh.

 

[FallenMind]

I've never heard of the term 'consumer' being used before. It sounds like someone going to be buy groceries or a television from Best Buy...I prefer client, but that's just because that's the way I was trained.

 

[JeyRo]

You'd love this. At the VA, in the past few years we've gone from calling them "nursing homes" to "community living centers" (e.g., CLCs). Which took some getting used to, and I don't think I necessarily like, but oh well.

Now we go from calling them nursing home "patients" to CLC "residents." (That, I actually like - it seems more descriptive and accurate.... hey, they live there).

But now I hear a rumor that now instead of "residents," the powers that be at VACO will soon be instructing us to call them "neighbors." And instead of "staff," we're to call ourselves "visitors."

Gets confusing.....

 

[FallenMind]

You'd love this. At the VA, in the past few years we've gone from calling them "nursing homes" to "community living centers" (e.g., CLCs). Which took some getting used to, and I don't think I necessarily like, but oh well.

Now we go from calling them nursing home "patients" to CLC "residents." (That, I actually like - it seems more descriptive and accurate.... hey, they live there).

But now I hear a rumor that now instead of "residents," the powers that be at VACO will soon be instructing us to call them "neighbors." And instead of "staff," we're to call ourselves "visitors."

Gets confusing.....

Now that's a little bit crazy! That's getting a little too caught up with terminology 😀

 

[PhDToBe]

I know we all come from different backgrounds and scopes of practice, but I'm curious though: During your training (Master's or Ph.D) were you prompted to call people who come to you for services a CLIENT or a PATIENT?

I come from a clinical mental health counseling background and all my professors were adamant that we call them 'clients'. They viewed the term 'patient' as someone who passively receives treatment. The term 'client', however, meant that the individual would work collaboratively with the practitioner.

I know that it depends on your practice, but I'd really like to know everyone's thoughts! 😀

I also learned that a client is someone who pays for services. I know that in forensic evals, you refer to the person as the evaluee or examinee, because they're not paying for the service. I use patient in hospital settings.

 

[ela]

"Consumer" is really off-putting. Even more so, IMO, is the term "customer"; as in "Theyre just not a customer...", which was something a supervisor at my prac site this year said frequently. I think its a David Burns thing? Not sure...I find it foul.

A humanistic psychologist who I like utilizes the term "patient" and bases this on the etymology as "one who suffers". That makes sense to me...

 

[MBellows]

So, am I just a freak for preferring Mr./Mrs. ____?

 

[ADDICTED2STATS]

In my training program it was always client. During internship, one of my supervisors (a psychiatrist) clarified it for me. He said I was a medical professional, treating a medical condition, with a scientifically supported intervention for that condition; hence, they are patients. He followed this up with, "You aren't their attorney." Made sense to me, and since then I've used patient. I'm sure you can argue against this in a number of ways, but this is what I adopted.

 

[docma]

I think a professional competence includes becoming fluent in all 3 and "trilingual" in this regard. With MDs and in hospital settings, "patient" is well understood by all. In most outpatient clinical settings client is standard or interchangeable with "patient" and I'd listen for the "client's" lead (and Mr. or Mrs. works until they guide you otherwise.) The term "consumer" comes directly from the Recovery Model (see SAMHSA et. al for more on that) and well-established in many public mental health systems. Fluency with "consumer" signals that you get the collaborative model and appreciate that you are working along side family members and peer providers who are themselves both consumers and providers of services.

In our system I work with fellow providers who are also consumers; we share clients and they are patients of a psychiatrist that is also a provider with whom I share clients....🙂

 

[Doctor Eliza]

So, am I just a freak for preferring Mr./Mrs. ____?

Well, yes, you are a freak, but not necessarily for this reason.

To patients' faces, it is useful to call them by name, but in some situations it is more confidential to use a descriptive term. "I have a client who is concerned about the type of music in the waiting room" rather than "Mr. Bellows complained about the music in the waiting room." You can't avoid it all the time. So what do you use when you have to pick?

Dr. E

 

[Pragma]

"I have a client who is concerned about the type of music in the waiting room" rather than "Mr. Bellows complained about the music in the waiting room." You can't avoid it all the time. So what do you use when you have to pick?

I think Mr. Bellows ought to just shut up and listen to whatever music I want to play in the waiting room 😀

 

[MBellows]

I think Mr. Bellows ought to just shut up and listen to whatever music I want to play in the waiting room 😀

But what if I don't like Deathklok?

To patients' faces, it is useful to call them by name, but in some situations it is more confidential to use a descriptive term. "I have a client who is concerned about the type of music in the waiting room" rather than "Mr. Bellows complained about the music in the waiting room." You can't avoid it all the time. So what do you use when you have to pick?

"Someone" works fine with me in most cases. Really though, I prefer to keep it as human person oriented as possible. I also wouldn't refer to myself as "the examiner" or include phrases that I've read like "The examinee was seen by the examiner on 2/1..." That whole system seems patently stupid to me.

In real world settings I've always (when necessary) used whatever the norm was in that particular office.

 

[Therapist4Chnge]

In a hospital setting, which includes my out-pt clinics I do the following:

All of my documentation is, "The patient is...."
When talking to other providers I'll use "patient" or Mrs. Smith.
When talking with the patient I ask their preference. I learned to do this in the VA bc most Veterans had nicknames and preferred them. I simply ask them to "call me Dr. T4C or (first name)....just not a four letter word." Sometimes it is easier for some folks to "keep things official", while others just want to feel like they are talking to a human being. 95% of the time I get Dr. T4C, but I want the patient to be comfortable. Examinee for 3rd party evals where my services have been retained by a 3rd party.

 

[neuronic]

Lawyers have clients and psychologists have patients. It seems like there is a stigma to call someone with a mental health disorder a patient, but what other doctors treat clients?

 

[JeyRo]

Lawyers have clients and psychologists have patients. It seems like there is a stigma to call someone with a mental health disorder a patient, but what other doctors treat clients?

From "Mumford" (one of my favorite films):

Mrs. Crisp: What kind of doctor are you?

Dr. Mumford: Ph.D. in psychology.

Mrs. Crisp: Oh. Not a real doctor.

Dr. Mumford: That's right, the fake kind.​

 

[KillerDiller]

Lawyers have clients and psychologists have patients. It seems like there is a stigma to call someone with a mental health disorder a patient, but what other doctors treat clients?

Probably just plastic surgeons.

I skimmed this article http://www.skininc.com/spabusiness/medicalesthetics/83060712.html , in which the author suggests that the difference between patients and clients is that clients self-diagnose and present for treatment telling their providers what they want. I suppose that would make almost all of the people psychologists see "patients" considering the rampant misunderstanding of clinical diagnoses and psychotherapies.

I'm lucky in that in a UCC setting I can simply refer to the individuals I see as "students."

 

[docma]

I think "client" came into use based on this definition: "a person who engages the professional advice or services of another" and is the terms of choice in many social service settings where a broad range of advice (and not necessarily medication/medical treatment or a "cure") is dispensed--including advice that is not psychological (eg: housing, benefits, legal aid) but may in fact be part of overall rehabilitation/recovery in a biopsycosocial framework. I like the term because providing the advice or services to another still leaves the client who "engages" us with the authority to decide what they will make use of (or not). Just my CMHC culture I guess

 

[blindchaos]

The vast majority of my practicum placements, along with my internship and postdoc all used "client". However, I did have one practicum placement that was very adamant about using "service recipient". In e-mails it could be shortened to "SR" (ie: "I have an SR who requested to be moved to Tuesdays"), but that was it. The idea was that it put everyone on a more equal ground (service providers and service recipients) whereas "client" was perceived to diminish a person's independence/power/say in the therapy process.

 

[Doctor Eliza]

The vast majority of my practicum placements, along with my internship and postdoc all used "client". However, I did have one practicum placement that was very adamant about using "service recipient". In e-mails it could be shortened to "SR" (ie: "I have an SR who requested to be moved to Tuesdays"), but that was it. The idea was that it put everyone on a more equal ground (service providers and service recipients) whereas "client" was perceived to diminish a person's independence/power/say in the therapy process.

Okay, that wins the prize for worst term. I also disagree with their reasoning in terms of this word choice empowering the client. I think "client" implies that the person has complete power and independence. If they don't like you and/or feel that you are not helpful, they can take their business elsewhere. What is more independent than that?

Dr. E

 

[cara susanna]

I totally agree that client implies power. Think of a client for interior decorating or a hair appointment--the person giving the service pretty much does what the person receiving it wants.

 

[Pragma]

I totally agree that client implies power. Think of a client for interior decorating or a hair appointment--the person giving the service pretty much does what the person receiving it wants.

Interesting. Now, I'm all for collaborative approaches to therapy, but often a therapist's "service" is going to involve challenging the ways a client wants to handle things. They're there because their way isn't working, right?

Oh I am so glad I am not a therapist.

 

[neuronic]

Setting clearly plays a large role in how the individual is described, as others have mentioned. For example, can you imagine discussions of inpatient vs. inclient. But clearly for students at counseling centers, patient just does not seem appropriate. My personal bias is for medical centers and VAs to use patient rather than client, if for nothing else than to aid in marketing ourselves to insurance companies, but clearly it is not appropriate in all settings.

 

[cara susanna]

Interesting. Now, I'm all for collaborative approaches to therapy, but often a therapist's "service" is going to involve challenging the ways a client wants to handle things. They're there because their way isn't working, right?

Oh I am so glad I am not a therapist.

That's why I prefer the term "patient" (even if I use "client" because that's my program's preference). The fact that people out there think client implies too little power is mind-boggling to me.

 

[LivingOffLoans]

'Patient' is my preference, though depending on who I'm talking to or what setting I'm in, I might adjust to say 'client'.

 

[paramour]

Patient is very typical in hospital settings (including outpatient hospital services, in my experiences). Client is common in community mental health, counseling centers, etc.

I've used both based on the norms of the setting.

Same here. What gets tricky is when I go between sites within a brief timeframe (same day/night). Clients become patients; patients become clients.

Ugh....I really dislike this term.

Yeah, the rehab program within the CMHC I work has started using "consumer." I immediately thought of a trip to the store. Of course, many of these folks also question what you're supposed to do with clients in "recovery" with no motivation to help themselves "because it's all due to a chemical imbalance anyway." It makes me wonder why they're therapists if they think like this.

 

[MBellows]

Yeah, the rehab program within the CMHC I work has started using "consumer." I immediately thought of a trip to the store. Of course, many of these folks also question what you're supposed to do with clients in "recovery" with no motivation to help themselves "because it's all due to a chemical imbalance anyway." It makes me wonder why they're therapists if they think like this.

While I don't necessarily care for the term, consumer is used in (vocational) rehabilitation programs because it is often not the person being seen that is either paying for or in control of their treatment. They are consuming services, not all of those services being therapy.

 

[Ollie123]

Its discussions like these that make me really despise the "PC" movement. I can't imagine 99.9% of people I see actually caring (or even understanding) the nuanced differences. Treat them with respect and help them make informed decisions and I cannot imagine them caring if they are called patient/client/consumer/etc. nor do I imagine practitioners treating them differently based on what they are labeled.

I think it takes the focus off important issues. Does calling them "clients" instead of patients empower them if we change nothing else about our model of care and how we approach things (i.e. things that actually matter)? I don't think it does. If we think we need to do more to empower decision-making and autonomy in folks we see, how about we focus our efforts on developing a system of care that makes that happen rather than coming up with new names for the same thing that will in time come to be associated with lack of power.

I think its important for terminology to be accurate, but I also strongly believe terminology/language follows cultural change rather than drives it - trying to use language to "drive" change without fixing the problem just seems like a waste of time (not to mention being incredibly irritating to keep track of when I imagine most of us have better things to worry about). I think creating an expectation that therapists would present different treatment options (how often does this happen? in my experience somewhere between "never" and "almost never") would do wayyyyyy more to empower clients than a new label ever could.

 

[LivingOffLoans]

Its discussions like these that make me really despise the "PC" movement. I can't imagine 99.9% of people I see actually caring (or even understanding) the nuanced differences. Treat them with respect and help them make informed decisions and I cannot imagine them caring if they are called patient/client/consumer/etc. nor do I imagine practitioners treating them differently based on what they are labeled.

I think it takes the focus off important issues. Does calling them "clients" instead of patients empower them if we change nothing else about our model of care and how we approach things (i.e. things that actually matter)? I don't think it does. If we think we need to do more to empower decision-making and autonomy in folks we see, how about we focus our efforts on developing a system of care that makes that happen rather than coming up with new names for the same thing that will in time come to be associated with lack of power.

I think its important for terminology to be accurate, but I also strongly believe terminology/language follows cultural change rather than drives it - trying to use language to "drive" change without fixing the problem just seems like a waste of time (not to mention being incredibly irritating to keep track of when I imagine most of us have better things to worry about). I think creating an expectation that therapists would present different treatment options (how often does this happen? in my experience somewhere between "never" and "almost never") would do wayyyyyy more to empower clients than a new label ever could.

Some really good thoughts in here.

+1

 

[MBellows]

Its discussions like these that make me really despise the "PC" movement.

I really don't like the term "PC." It seems to lately be this huge conservative straw man. Often enough the examples that are brought up, like these, really don't matter all that much. Then they also use the "PC" straw man outrage to stretch to "And yeah, it's no one's right to say that I'm not being correct in calling that flamer a fa**ot and telling him I don't want his kind around here."

Really though, sometimes nuance can be annoying or seemingly meaningless, but most of the time it comes down to treating people the way you would want to be treated and not being a douche, because no you're not being "politically incorrect" you're just being an a**hole (not you Ollie).

Treat them with respect and help them make informed decisions and I cannot imagine them caring if they are called patient/client/consumer/etc. nor do I imagine practitioners treating them differently based on what they are labeled.

Labels do matter quite a bit, probably not so much in this issue, but language plays a major role in how we interpret the world around us and how we act in society.

I think it takes the focus off important issues. Does calling them "clients" instead of patients empower them if we change nothing else about our model of care and how we approach things (i.e. things that actually matter)? I don't think it does. If we think we need to do more to empower decision-making and autonomy in folks we see, how about we focus our efforts on developing a system of care that makes that happen rather than coming up with new names for the same thing that will in time come to be associated with lack of power.

This would make sense if it were an either/or type thing. I'm glad that you recognize that we shouldn't stop just at changing words.

(not to mention being incredibly irritating to keep track of when I imagine most of us have better things to worry about).

This is usually what it comes to whenever I jump on one of the psychologists in my office for using the word "******ed" inappropriately.

 

[Balmoral]

Not sure if geography comes into play but when I trained in the West Coast (SoCA) the term "client" was more frequently used. Now I live in the Northeast (NYC), I find "patient" is definitely more common. Another factor I think is the school of thought. NYC still has an "old school" persona of psychology and other places take on a more normalizing approach.

I've worked at clinics (clients), CLCs (residents), and MRDD residences (consumers), and I just stick to to using "patients" because my set-shifting abilities are not that great.

 

[Buzzwordsoldier]

I think a professional competence includes becoming fluent in all 3 and "trilingual" in this regard....The term "consumer" comes directly from the Recovery Model (see SAMHSA et. al for more on that) and well-established in many public mental health systems. Fluency with "consumer" signals that you get the collaborative model and appreciate that you are working along side family members and peer providers who are themselves both consumers and providers of services.

I like this response. I would elaborate that "consumer" has very strong meaning in patients' rights circles -- as a key referent for those patients and their advocates speaking the consumer/survivor/ex-patient "dialect."

 

[silverheart]

(I'm a social worker, so my profession and training complicates things a bit.)

The field of social work as a whole uses the term client. Agencies in my area use the term consumer. I loathe this term and think it is a lame attempt to put power back into the individual's hands even though they are disadvantaged and have their hands tied by "the system." But that's a different topic... 😉

I use the term patient. I'm very psychodynamic, but that's not the reason why. The root of the word comes from Greek and means "to suffer." We are treating people that are suffering. We must focus on the reason why they're in the chair to alleviate this suffering. Using the word client to me takes the edge off of the reason WHY they're there to see you. Patient also helps me to keep my professional boundaries strong.

 

[MBellows]

I use the term patient. I'm very psychodynamic, but that's not the reason why. The root of the word comes from Greek and means "to suffer." We are treating people that are suffering. We must focus on the reason why they're in the chair to alleviate this suffering. Using the word client to me takes the edge off of the reason WHY they're there to see you. Patient also helps me to keep my professional boundaries strong.

All people suffer all of the time. There isn't a single moment in time that isn't some balance of joy and suffering. I don't see the need to call someone something different for experiencing the same thing as everyone else. That said, my mindset is about as far from PD as you can get, with a focus on function, acceptance, and resilience.

In the end though, as long as the person gets to the point of independence and to a level of function that suites them, what they're called and how they get there hardly matters.

 

[silverheart]

All people suffer all of the time. There isn't a single moment in time that isn't some balance of joy and suffering. I don't see the need to call someone something different for experiencing the same thing as everyone else. That said, my mindset is about as far from PD as you can get, with a focus on function, acceptance, and resilience.

In the end though, as long as the person gets to the point of independence and to a level of function that suites them, what they're called and how they get there hardly matters.

This viewpoint doesn't sit well with me... Whether you mean it to sound like it or not, it sounds like minimizing the individual's experience. That can be very damaging.

 

[MBellows]

This viewpoint doesn't sit well with me... Whether you mean it to sound like it or not, it sounds like minimizing the individual's experience. That can be very damaging.

If by "minimizing" you mean recognizing that everyone suffers and not pathologizing that experience unnecessarily, then guilty as charged.

 

[deleted343839]

In my training, we mainly used the term "client." But in the real world, your practice setting will influence your language. I work in a medical center and it would sound pretentious to call someone a "client" when everyone else (including the recipient of services) uses the term "patient." The reverse scenario may be true in certain private practice/mental health clinic settings. So it is very much context-dependent.

 

[erg923]

This viewpoint doesn't sit well with me... Whether you mean it to sound like it or not, it sounds like minimizing the individual's experience. That can be very damaging.

Oh good grief...