What are they?

[Psyclops]

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Social work schools ask us to call those who come to us "clients". Off the top of my head, I would say that this is because many (if not most, I'd have to look it up) social workers do not work in the medical or behavioral health arena. The term "client" provides a cohesive way to refer to the people we're working with, no matter the setting or level of education. Bachelors-level social workers in no way, shape, or form should be providing any kind of medical or mental health assistance, so they should use "client". For those who have elected to focus on clinical social work, I have heard a combination of "patient" or "client", and as someone said above- the ever-dreaded "consumer". As I said, it depends largely on setting.

Makes perfect sense to me.

 

[Psyclops]

One does not typically associate "talk-therapy" with the term "medical."

If it is true that they don't associate psychotherapy with medical treatment, this has certainly not always been the case. Psychotherapy used to be the domain of only those with an MD. Psychologists had to fight for the right to engage in the practice. Now that it is no longer only practiced by MDs but by PhD/PsyDs and Master's level therapists, has it somehow become demedicalized? If anything the practice has become more rigourously researched and refined to be maximally effective. I'd be interested in hearing what the psychitraists think. Poety? OPD? DS?

When the average joe is having a rough time and is consoled by a love one, he/she wouldn't consider their verbal efforts as "medical treatment." Are our words and efforts "medicalized" somehow due to our knowledge and training? Even that fails to make sense. Is it because we talk with the intent to heal? - we'll so does the layman who tries to console his/her friend.

Yes, it is medicalized by the fact that it is developed and tested to be effective as an intervention for treatment of recognized mental disorders. The friend, although effective, is engaging on a personal level and is not "administering treatment".

This brings up a couple of points. One is the caveat that many forms of therapy have not been shown to be significantly more effective than human contact of a non-professional kind.

But that being said, jsut like psychotropic medication, many psychotherapeutic interveintions are effective at treating mental disorders and thus changing the brain states and brain chemistry associated with such a disorder. If I paint it in that light does it seem more medical?

 

[Psyclops]

Also, is it different if a PhD or an MD is administering the same therapeutic technique? I think the MD would consider their intervention medical. But maybe the PhD isn't.

 

[PsychEval]

My vote is for Patients.

 

[Logic Prevails]

Yes, it is medicalized by the fact that it is developed and tested to be effective as an intervention for treatment of recognized mental disorders.

And what is a mental disorder? 🙄 - just kidding.

I wonder though if this depends on how much you subscribe to the "disease model" of psychopathology and its alleviation. Personally, I have come to enjoy a more "adaptive-maladaptive" and dimensional way of looking at the majority of these issues (though that may change 😎 )

The friend, although effective, is engaging on a personal level and is not "administering treatment".

As therapists, we also engage on personal levels. Though not officially labeled as "administering treatment", the layman could provide the same sort of active ingredient.

But that being said, jsut like psychotropic medication, many psychotherapeutic interveintions are effective at treating mental disorders and thus changing the brain states and brain chemistry associated with such a disorder. If I paint it in that light does it seem more medical?

I see what you're saying - and I agree. However, the layman is also capable of influencing brain states in his/her interactions with others.


I know I'm just being a pain in the a$$ right now... I just really enjoy playing "devil's advocate" - it's one of the best ways of finding where I stand on different issues. I honestly don't know where I stand and I agree with much of what you have said... I still think it's quite debatable though.

Psyclops: as a side note, I would like to say that you have some very thoughtful points to make and I am glad that you're on the board!

 

[Psyclops]

Well, thanks Brad.

I'd also like to go on the record saying that I ascribe to a dimensional model of psychopathology, although as of yet there doesn't seem to be a dimensional model offered up that can account for everything we are used to dealing with. Are you familiar with Robert Krueger's 2-Factor (externalizing-Internalizing) Model? It's pretty good but lacks the breadth. L. Clark also has one that is geared only towards anxiety and depression with a three factor structure. Also Five Factor Model has been proposed as a model that can account for all of psychopathology. It is able to adequately model PDs and they are so often comorbid with axis I disorders that it would merely be an extension. Some of this stuff is beyond this thread. But anyway I wanted to say I'm with you there.

I don't like the adaptive-maladaptive distinction as much. I think that in many ways some disorders could be considered adaptive in certain environments, even if not in sociaety as a whole.

Also, I think that even if we were to adopt a view of "disordered functioning" as falling somwhere on a dimensional hyperspace, it wouldn't preclude us necessarily from still labeling "disorder" to certain patterns that are oft replicated.

Just some thoughts.

 

[PsychEval]

Sigh..... I would love to see the psychiatry folks come over and see this silly discussion...how dumb would we look. Pts seek tx, clients seek advice in a colloborative way. There is no reason why psychologists should call their pts, clients.

I also think this discussion is a little silly. I see this thread as the classic example of Psychologists being stuck in the Philosophy department.

 

[Psyclops]

I see this thread as the classic example of Psychologists being stuck in the Philosophy department.

You say that as if it is a bad thing. You need someone out there thinking about the big picture. I'm not saying this thread is covering any impressive ground. Nevertheless, I think a psychologist is first and formost a scientist, and scientists are philosphers. I think it is absurd to suggest otherwise. Clinical psychology is an applied science, thus you will have those who want to employ the advances in the field. But those who want to do nothing but practice are just technicians.

 

[PsychEval]

It seems that too much time in graduate school is utilized on this type of discussion. Psychology faculty would better serve their students by preparing them for a competitive work environment.

 

[Psyclops]

Depends on what the work environment is I suppose. I will grant you that this is for the most part a useless discussion. Unless, like one poster noted, what you call a consumer of services affects their treatment. I also think the philosophers of the field are those that are advancing it. I still think we are stuck in the stone age. Especially when it comes to the way we define psychopathology. And for those who get super turned on by the biology and genetics I have this to say: “The success of genetic approaches, however, depends heavily not only on advances in molecular biology, but equally on the availability of psychometrically reliable and valid measures of personality and psychopathology”

PS I realize that this had little to nothing to do with your remarks PE.

 

[PsychEval]

Didn’t mean to be a thread killer. Let me ask you this, what factors do you think influence whether a psychologist calls a person a patient or client?

 

[Psyclops]

Didn’t mean to be a thread killer. Let me ask you this, what factors do you think influence whether a psychologist calls a person a patient or client?

To be honest with you, and I don't have anything to back this up, but I think that the "client" stuff came about for the same reason that we feel this need to artificially boost people's self esteem. "Patient" was too stigmatizing is what I think they thought. Although it is a noble endeavor, that is to get rid of the stigma of mental disorders, I'm not certain this is an effective way of going about it. I think this was assuming that MH practitioners were supporting the stigma that went along with having a MH disorder by calling those who sought their services, patients. My knee jerk reaction to that kind of sugarcoating is to think it's a bunch of malarky wrapped up in a euphamism. Why not call a spade a spade. Also, for the most part, these days at least, I don't think practitioners in the field are trying to advance the steryotype that MH issues are morally wrong. But with a forum like this at my disposal, I wanted to hear what others thought.

I secretly believe that the client or consumer title was developed in a secret training camp high in the hills of Afghanistan where all hospital administrators and HR personel go to learn how to make our lives miserable through strange titles, paperwork, and team-building excercises.

 

[MissMuffet]

It's been a long time, but the only time I remember this being brought up when I was in school was in a Family Systems class I took post-bacc.

The prof (who was so good, I was tempted away from clinical/neuro... until i remembered how impatient I got with whining. 😎 ) warned us about the terminology when working with families. If you call all of them patients, some will be put off, especially those who didn't want to come to begin with. But to call one member (e.g. the anorexic or BPD) "patient" and the others "client" is obviously going against the "system" thang.

Like I said, it's been a long time. 😛 But that was the idea.

 

[Ratch1980]

My knee jerk reaction to that kind of sugarcoating is to think it's a bunch of malarky wrapped up in a euphamism. Why not call a spade a spade. Also, for the most part, these days at least, I don't think practitioners in the field are trying to advance the steryotype that MH issues are morally wrong. But with a forum like this at my disposal, I wanted to hear what others thought.

The term "patient" conotes illness, implying that these people are "sick" or have a "diseased mind." I'd rather call them "clients" and imply that they are people who are going through a tough time or perhaps have a chemical imbalance.

 

[Psyclops]

The term "patient" conotes illness, implying that these people are "sick" or have a "diseased mind." I'd rather call them "clients" and imply that they are people who are going through a tough time or perhaps have a chemical imbalance.

Ratch, what do you think is causing that chemical imbalance? Sometimes it may be caused by a tough time, but others may be caused by genetic predispositions. Either way, I think calling them clients furhters the stereotype and stigma that the mentally ill have something to be ashamed of. Patient certainly connotes an understanding that there is likely an underlying etiology that is not their fault.

You wouldn't think of the cancer patient as being at fault, would you? But then gain sometimes you would. Like in the case of smoking. Or bad health practices and heart disease of some kinds. HTe same would go for mental illness. Some times the patient can be held responsible for some of their symptoms, others not.

 

[Ratch1980]

Ratch, what do you think is causing that chemical imbalance? Sometimes it may be caused by a tough time, but others may be caused by genetic predispositions. Either way, I think calling them clients furhters the stereotype and stigma that the mentally ill have something to be ashamed of. Patient certainly connotes an understanding that there is likely an underlying etiology that is not their fault.

You wouldn't think of the cancer patient as being at fault, would you? But then gain sometimes you would. Like in the case of smoking. Or bad health practices and heart disease of some kinds. HTe same would go for mental illness. Some times the patient can be held responsible for some of their symptoms, others not.

My point was that they are people first and are not defined by their "illness."
They are people who have come to receive help for their mental health challenges, and by labeling them as "client" we can give them a sense of empowerment--not a sense of shame.

 

[Psyclops]

My point was that they are people first and are not defined by their "illness."

Although I'm tempted to, i'm not going to agree with you on this point. For those who have a personality disorder, their disorder is part of who they are and how they veiw themselves. It is a part of thier self. I would agree that the same goes for those who have dysthymia, MDD reccurent, and others. The nature of thier disorders, and they are disorders, chages their overall function in a chronic way, and the way in which they veiw themselves.

 

[50960]

As psychologists we are trained to treat diagnosable mental illness with research supported treatments. Doctors and patients are not the same, but I guarantee you if I develop an anxiety disorder, depression etc.. I would prefer to go to a doctor as his/her patient (not client)whether that doctor is a physician or a psychologist.

 

[MissMuffet]

When someone does have a mental disorder, it seems even they would see being called a "client" to be affected - almost manipulative.

But isn't that person most likely, or even better off, seeing someone who primarily sees "patients" and unapologetically refers to them as such?

On the other hand, students and employees seeking testing or advice, families, fellow professionals who arrange to bounce things off you... Well, I know that I would have lost trust and respect for any of the psychologists I saw in those capacities, had one said he considered me to be his "patient" rather than a client. (None would have. Most scoffed at being referred to as "Dr __".)

But really, how likely is it to even come up in such a way that the patient/client takes it personally? Hearing, "I have 2 more patients/clients this afternoon", it seems most people would simply assume it to be habit reflective of the type of person the speaker usually sees.

So it seems about 90% of this mulling over "what word should we use" is pointless angst. IMHO 😉, maybe 10% of it is worth mulling over:

a) purposefully using euphemisms don't fool anyone and feed into the mushy stereotype.

b) presuming that everyone who comes to you is afflicted with a mental disorder is risky; If you only think it, it's akin to having only a hammer in your toolbox. If the person gets the message that you insist on approaching them as a patient, you can lose their trust.

 

[Logic Prevails]

Good sum-up by missmuffett

I think my own view sits somewhere between what Ratch and Psyclops have said already.

I think it's important though (as missmuffett points out) to not assume that everyone seeking help has a mental illness.

Consider a person grieving over the loss of a loved one - very much expected and normal. Still, they may need someone to talk to - and I think it would be wrong to call them mentally ill and insist on calling them a "patient" (as if there is something wrong or abnormal with grieving).

But if they take too long to grieve (and WE know because it says so in the DSM) - then they definitely have a disorder. 😛

 

[Psyclops]

When someone does have a mental disorder, it seems even they would see being called a "client" to be affected - almost manipulative.

I agree, I think those who have a problem with "client" generally feel the same way.

On the other hand, students and employees seeking testing or advice, families, fellow professionals who arrange to bounce things off you... Well, I know that I would have lost trust and respect for any of the psychologists I saw in those capacities, had one said he considered me to be his "patient" rather than a client. (None would have. Most scoffed at being referred to as "Dr __".)

It's funny you would mention this. This is a problem that some had when they had originally proposed the wording to the ethical guidelines. The ones that say you shouldn't sleep with your patients. I think they had toyed with a wording that made it sound like it would be ethically wrong to date your grad students, collegues, etc. Not just patients.

So it seems about 90% of this mulling over "what word should we use" is pointless angst. IMHO 😉, maybe 10% of it is worth mulling over:

OF course, but this is the beauty of thi internet and forums like these.

 

[50960]

b) presuming that everyone who comes to you is afflicted with a mental disorder is risky; If you only think it, it's akin to having only a hammer in your toolbox. If the person gets the message that you insist on approaching them as a patient, you can lose their trust.

Talk to me in 5 yrs..

 

[PsychEval]

It's been a long time, but the only time I remember this being brought up when I was in school was in a Family Systems class I took post-bacc.

The prof (who was so good, I was tempted away from clinical/neuro... until i remembered how impatient I got with whining. 😎 ) warned us about the terminology when working with families. If you call all of them patients, some will be put off, especially those who didn't want to come to begin with. But to call one member (e.g. the anorexic or BPD) "patient" and the others "client" is obviously going against the "system" thang.

Like I said, it's been a long time. 😛 But that was the idea.

Your lucky, I was not as fortunate. We also had the great kleenex debate. Your two o’clock patient has arrived, five minutes into session she begins crying, do you hand her a kleenex or not?

 

[PsychEval]

Calling them clients has a touchy feely component to it. I associate those type of clinicians as the on going, long term, overly supportive, hand holding type that end up fostering dependency rather than facilitating growth. Ironically, this is the very thing they are trying to avoid in this collaborative model run a muk. The doctor/patient relationship sets up clear boundaries. It seems that the touchers and feelers could be more prone to not only burnout, but also finding themselves on a slippery slope to committing boundary violations. I also finding it amusing to read the charting from the touchy/feely type of clinician, including things like, “I shared with Heather that if she is feeling down, she could call me at home.”

 

[MissMuffet]

"b) presuming that everyone who comes to you is afflicted with a mental disorder is risky; If you only think it, it's akin to having only a hammer in your toolbox. If the person gets the message that you insist on approaching them as a patient, you can lose their trust."

Talk to me in 5 yrs..

😉

 

[mmcarson]

There are alot of good points made in this discussion. The only definite thing I can say is that if an individual is receiving psych services in a health care environment like a hospital (neuropsych, health psych, forensic psych, etc.) they should definitely be called patients. I think this goes back to a previous poster's response about keeping continuity in a given environment. In other environments it ultimately just depends on the practitioner, just as their style of therapy will depend on their personal and training preferences. I don't think either one is necessarily right or wrong, although I do prefer patients.

 

[Psyclops]

I also finding it amusing to read the charting from the touchy/feely type of clinician, including things like, “I shared with Heather that if she is feeling down, she could call me at home.”

ARE YOU SERIOUS? People write s++t like that? Gross me out the window. Gag me with a spoon.

 

[PsychEval]

ARE YOU SERIOUS? People write s++t like that? Gross me out the window. Gag me with a spoon.

Yep, I want to cross it out and put, “I informed the patient if there is a marked deterioration in her current level of functioning, she is to call 911 or go to the ER” i.e. not my problem.

 

[Psyclops]

Yep, I want to cross it out and put, “I informed the patient if there is a marked deterioration in her current level of functioning, she is to call 911 or go to the ER” i.e. not my problem.

Your problem or not, it's an appropriate next step while maintaining healthy patient/practitioner boundaries. I get very frustrated with the touchers and the feelers. The worst, I think, are the practitioners who suffer from thier own personality pathology (cluster B) and then get enmeshed with the clients who also suffer from it. I've seen it with staff on inpatient units, it can really be frustrating, it can really move the patient in the worng direction.

 

[PsychEval]

Your problem or not, it's an appropriate next step while maintaining healthy patient/practitioner boundaries. I get very frustrated with the touchers and the feelers. The worst, I think, are the practitioners who suffer from thier own personality pathology (cluster B) and then get enmeshed with the clients who also suffer from it. I've seen it with staff on inpatient units, it can really be frustrating, it can really move the patient in the worng direction.

Yep, I've seen it too. There is a dark side to the touchy/feely clinician. Some of them really are not as altruistic as they let on. They enjoy telephone interruptions from patients while out at dinner, makes them feel kind of special/important/supportive. Heather needs me!

 

[MissMuffet]

I hear y'all, but for what it's worth, that's the very style of a woman here locally who is very well respected for her success with borderliners. She doesn't pull punches, but they keep coming back to her for more.

I had one get in my face not too long ago, then call me back a few days later, telling me she was sorry, had caught herself "acting out" a lot lately and was going to go see her for a refresher, because she knew she would "kick [pt's] butt back into shape." lol

 

[Psyclops]

Yep, I've seen it too. There is a dark side to the touchy/feely clinician. Some of them really are not as altruistic as they let on. They enjoy telephone interruptions from patients while out at dinner, makes them feel kind of special/important/supportive. Heather needs me!

BEware the clinician that enjoys the power, or is in it for the power.

 

[soaringheights]

Your problem or not, it's an appropriate next step while maintaining healthy patient/practitioner boundaries. I get very frustrated with the touchers and the feelers. The worst, I think, are the practitioners who suffer from thier own personality pathology (cluster B) and then get enmeshed with the clients who also suffer from it. I've seen it with staff on inpatient units, it can really be frustrating, it can really move the patient in the worng direction.

👍 👍