Patient vs Client: Democratization or Corporatization of Psychiatry

[Psychic Meep]

I had been listening to some interesting talks about the corporatization of education in America and universities starting to model their education system after businesses and the corporate structure. The guy mentioned that some universities had started to think about calling students "clients" instead. I searched a bit and found this article which made some interesting points:

4 Reasons to Say 'Patient' Instead of 'Client' — Mark Ettensohn, Psy.D.

It's an unspoken rule that we don't treat patients in psychotherapy; we work with clients . When I opened my own practice, I decided to buck convention by switching to patient. Here's why.

www.drettensohn.com

I'm personally in favor of continuing to call patients patients and not clients. What are your thoughts?

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[Bartelby]

I strongly favor the term patients over clients. Calling our patients clients seems to emphasize/imply that their problems are not medical and that this is not a traditional "doctor-patient" relationship. I think that is the wrong message.

 

[Ceke2002]

As a former patient in psychiatric treatment, I absolutely loathe and abhor the term 'client'. I wasn't a 'client', I wasn't popping down to get my hair and nails done; I was being treated, as a patient, for psychiatric health issues. Seriously, eff off with your 'client' nonsense, it's reductive.

 

[comp1]

I usually see the most push by outside agencies for the use of "client" in settings where the patient has the least autonomy, ie locked psychiatric units or county clinics for seriously mentally ill. I don't see many cash pay Rodeo Drive or Upper Westside patients demanding to change terms. I've always felt the people trying to change the terminology have significant ulterior motives.

 

[futureapppsy2]

As a psychologist, I have moved to using “patient” even though I was trained to use “client.” Especially in rehabilitation psychology, patient better captures our role and relationship with the person receiving care, imo.

 

[NickNaylor]

I never use the word client, even when I work with psychology students that have been trained to use that terminology. At least at my institution, the psychology students here seem to prefer the term client. I agree that the terminology implies a different relationship that doesn't reflect what I consider to be the therapeutic relationship.

 

[Mad Jack]

The term client implies someone purchasing a commodity. I've always found it to be demeaning to both the nature of healthcare and the doctor-patient relationship. It emphasizes the nature of the relationship as transactional, rather than therapeutic; a monetary exchange rather than one of healing.

 

[WisNeuro]

Patient, always. Whether or not I am doing assessment or therapy. We're all patients at some time or another, there is nothing wrong or stigmatizing with the term.

 

[Liquid8]

During my training years the business corporate speak started to take root, with “consumer” being the preferred term to replace patient. I assume it was related to reducing stigma and well intentioned, although in my mind that term simply reduces a patient to being an economic unit of consumption. To me “client” also infers a different kind of transactional nature and not something I’d use either.

 

[clausewitz2]

During my training years the business corporate speak started to take root, with “consumer” being the preferred term to replace patient. I assume it was related to reducing stigma and well intentioned, although in my mind that term simply reduces a patient to being an economic unit of consumption. To me “client” also infers a different kind of transactional nature and not something I’d use either.

I can see why "consumer" sounds like corporate speak but it came out of the recovery/psychiatric survivor movement, not from the world of business. The idea is to specify someone who is receiving mental health services without necessarily conceding that the person in question has a "disorder" or has anything "wrong" with them in any way. It is also meant to be empowering folks with SMI to advocate for their needs and make reasonable demands of their treaters instead of simply having care imposed upon them. The idea is that the mental health services should be there to serve the needs of the people they work with.

I'm not necessarily on board with this entirely but thought it worth pointing out where this terminology actually originated.

 

[WisNeuro]

I can see why "consumer" sounds like corporate speak but it came out of the recovery/psychiatric survivor movement, not from the world of business. The idea is to specify someone who is receiving mental health services without necessarily conceding that the person in question has a "disorder" or has anything "wrong" with them in any way. It is also meant to be empowering folks with SMI to advocate for their needs and make reasonable demands of their treaters instead of simply having care imposed upon them. The idea is that the mental health services should be there to serve the needs of the people they work with.

I'm not necessarily on board with this entirely but thought it worth pointing out where this terminology actually originated.

While I understand the concept, healthcare as a whole treats non-disordered individuals often as patients. I am a patient when I go in for my annual physical. I am a patient when I go in for my dental exam. The term has always been used in a fairly broad sense. I am also skeptical about the "empowerment" claims.

 

[clausewitz2]

While I understand the concept, healthcare as a whole treats non-disordered individuals often as patients. I am a patient when I go in for my annual physical. I am a patient when I go in for my dental exam. The term has always been used in a fairly broad sense. I am also skeptical about the "empowerment" claims.

My criticism of the recovery movement as a whole is that it is a suite of ideas that fits the experiences, needs, and priorities of a very specific segment of high-functioning activists with SMI who mostly come from affluent backgrounds and is an excellent development for them. It kind of forgets about the needs and priorities of everyone else who might attract a diagnosis most people would agree counts as SMI.

 

[FlowRate]

I don't think I've ever heard psychiatrists call people "clients." It's mostly social workers and, to a slightly reduced degree, psychologists.

 

[WisNeuro]

I don't think I've ever heard psychiatrists call people "clients." It's mostly social workers and, to a slightly reduced degree, psychologists.

There are definitely regional and generational differences in this one. Though SW has probably done this for a while.

 

[sloop]

Patient for clinical work. Defendant, plaintiff, petitioner, etc. for forensic work.

I suppose there could be certain types of forensic evaluations where I was directly retained by the evaluee and, in those circumstances, they might technically be my client. Generally though, the client would be a lawyer rather than the evaluee. Even in the aforementioned case, I would try to use some other term than client because I think it could be perceived as implying that the evaluee has a level of control over the opinion I render.

 

[WisNeuro]

Patient for clinical work. Defendant, plaintiff, petitioner, etc. for forensic work.

I suppose there could be certain types of forensic evaluations where I was directly retained by the evaluee and, in those circumstances, they might technically be my client. Generally though, the client would be a lawyer rather than the evaluee. Even in the aforementioned case, I would try to use some other term than client because I think it could be perceived as implying that the evaluee has a level of control over the opinion I render.

I like claimant. In my cases, whether it's for the plaintiff or defendant side, claimant works either way. I only do civil casework though, not criminal.

 

[Stagg737]

The only time I could imagine myself using “client” would be if I did work as a “life coach” or “wellness” coach. Basically some non-medical situation where I would be getting paid to give advice or basic life skills but not providing any actual therapy or treatment. Not that I would actually do that, but it just feels icky calling people patients in situations where they aren’t actually getting treatment.

 

[allantois]

My understanding is that therapists (psychologists and otherwise) started using the term client since they are not medical professionals.

 

[WisNeuro]

My understanding is that therapists (psychologists and otherwise) started using the term client since they are not medical professionals.

I do not believe that this is true, at least for psychology. It's fairly recent in psychology and, as pointed out above, grounded in patient empowerment/cultural sensitivity nonsense.

 

[AcronymAllergy]

I do not believe that this is true, at least for psychology. It's fairly recent in psychology and, as pointed out above, grounded in patient empowerment/cultural sensitivity nonsense.

This was my experience (in graduate school) as well, and it was primarily used by student therapists for therapy cases seen in the university's psychological services clinic; for psychologists who train only or primarily in those settings, I could see the term sticking when they transfer elsewhere. At other practica sites, it was nearly always "patient." At my last clinic, always "patient" except by some social workers.

And I would add that "fairly recent" goes back about 10-15 years, which is when I first started hearing about the push toward using "client" for purposes of patient empowerment, to reduce the power differential in the doctor-patient relationship, and to enhance a sense of agency in the individual receiving treatment. I don't know that it successfully did any of those things.

 

[Merovinge]

It's lovely to see the left wing and right wing posters all come together to bash the absurdity of changing the nomenclature to client. I fight any change in language that would make psychiatry sound artificially different than any other field of medicine. Somehow none of the neurosurgeons down the street have any clients.

 

[WisNeuro]

Hey now, I consider myself firmly in the Moderate camp! Also, relatedly, "The Coddling of the American Mind" kind of goes with this conversation, just re-read it a few weeks ago. Strongly recommend to people across the political spectrum.

 

[Ceke2002]

I can see why "consumer" sounds like corporate speak but it came out of the recovery/psychiatric survivor movement, not from the world of business. The idea is to specify someone who is receiving mental health services without necessarily conceding that the person in question has a "disorder" or has anything "wrong" with them in any way. It is also meant to be empowering folks with SMI to advocate for their needs and make reasonable demands of their treaters instead of simply having care imposed upon them. The idea is that the mental health services should be there to serve the needs of the people they work with.

I'm not necessarily on board with this entirely but thought it worth pointing out where this terminology actually originated.

Honestly I can see both sides of the argument here. Back in the 80s and 90s, in particular, I knew quite a few folks (myself included) with diagnoses of mental illness, who were treated as if they had some sort of moral failing by their friends and family. It's one thing to acknowledge that someone has something wrong with them that is a treatable and/or manageable condition, it's obviously quite another to acknowledge there's something wrong with someone and then whack a moral judgement of their condition on top of that. Just personally I found using the term 'patient' to be empowering, because it was, in part, my way of giving a middle finger to the messages I'd received earlier in life that having a mental health diagnosis was something I was meant to keep hidden and be ashamed of. If I'm not ashamed of currently being a patient at a cancer centre, and I don't feel the need to hide my diagnosis of non hodgkin's lymphoma, why should my being a former psychiatric patient be any different? (Obviously it shouldn't, hence why I personally find the term 'client' to be reductive).

Having said that though I do know a couple of people for whom the term client may very well have been helpful in getting them to better engage with treatment for SMI, without the need to have them forced into treatment, and with potentially better outcomes overall. I'm not necessarily against the term 'client' being used in certain situations where it may indeed be helpful in engaging someone with treatment (etc), but I do think it should be up to the person themselves to decide what their comfortable with, rather than just this blanket idea of calling everyone a 'client' or 'consumer'.

 

[FatherPsychiatry]

I used to call them patients but about a year ago I started calling them clients and consumers. I was doubtful at first but it truly did empower them beyond what I expected. My Schizophrenic clients became fully medication compliant and started taking daily showers, while my Bipolar customers made sure to keep a very regular sleep schedule and avoid marijuana. This naming change has been the biggest improvement in the history of psychiatry (just barely edging out other recent game changers, like DSM 5 and Vraylar), far outclassing such overrated DRUGS like lithium and Clozakill.

 

[Trismegistus4]

I always liked "consumer" the least because it sounds as though they're shoppers at Best Buy or Target. Which, come to think of it, are... dun dun dun... Big Box Shops! Ahhh, it's all becoming clear now!

 

[Liquid8]

I can see why "consumer" sounds like corporate speak but it came out of the recovery/psychiatric survivor movement, not from the world of business. The idea is to specify someone who is receiving mental health services without necessarily conceding that the person in question has a "disorder" or has anything "wrong" with them in any way. It is also meant to be empowering folks with SMI to advocate for their needs and make reasonable demands of their treaters instead of simply having care imposed upon them. The idea is that the mental health services should be there to serve the needs of the people they work with.

I'm not necessarily on board with this entirely but thought it worth pointing out where this terminology actually originated.

That does sound about right. When I think back to the time when I first came across the term, over 90% of my patients would have come in under involuntary treatment orders, either demanding not to be treated or wanting only benzodiazepenes/stimulants etc to use. In the case of those refusing help, this only led to a gradual watering down of mental health related legislation and the creation of additional barriers to treatment. Countless hours wasted at mental health tribunals arguing with lawyers and others more concerned with rights whilst having no responsibility for said consumers is time I will never get back. That’s before delays in treatment, and farcical situations where it is decided that the patient can be immediately treated in a less restrictive manner leading them to be discharged into the community, restarting the cycle of non-compliance/drug abuse, police and emergency involvement and re-admission which in some instances might only be a day or two later.

I think my frustration with terminology changes and other window dressing is that those most visibly pushing these are seemingly ignorant about the reality of the system we operate in. In western societies there are very few people who can legally take away one’s liberty – judges have the power to imprison people, as do doctors and psychiatrists to a limited degree. In some ways it would have been much easier if they’d removed the power of psychiatrists to make involuntary orders, thereby placing accountability back on the patient. Surely there is nothing more empowering than that? Of course, this would also mean they would also be responsible for any negative consequences of their decisions too with more mental health cases being processed through legal channels.