In therapy, the words we use carry great power. Our language shapes how we relate to those we aim to help.

A seemingly small but important choice is what to call the individuals who seek our support. Do we refer to them as "patients" or "clients"?

This question goes beyond mere words. It touches on how we view our role, responsibilities, and the dynamics of the therapeutic relationship.

Historical and Disciplinary Context

The term "patient" comes from medical and psychiatric settings, where the focus was on the pathology of the person, diagnosing, and treating illnesses.

On the other hand, "client" emerged in counseling, social work, and humanistic therapies, reflecting a more collaborative and empowering approach to therapy.

As professional identities and scopes of practice have evolved over time, so have the nuances and implications of these terms.

Definitional Clarifications

Let's take a closer look at what these terms mean in a therapy context:

• "Patient" as a descriptor: This term aligns with the medical model, suggesting a clinical relationship where the individual is viewed as having a pathological condition that requires expert treatment. The therapist acts as the authority figure responsible for diagnosing and treating the person's mental health condition.
• "Client" as a descriptor: Using "client" shifts the perspective to a more consumer-oriented, collaborative partnership. The person seeking therapy is seen as an active participant in their own growth and healing process and an expert in their life. The client and therapist work together to set and achieve treatment goals.

It's worth noting that there can be overlaps and gray areas where both terms might apply. For instance, a psychiatrist in an inpatient setting may use "patient" to adhere to the culture and language of the hospital but refer to their ‘clients’ in their outpatient practice to foster a sense of empowerment and autonomy. 

Ultimately, the choice of terminology reflects the provider's approach to care, their professional identity, and the setting in which they practice. It also influences the power dynamics and expectations within the therapeutic relationship.

Implications for the Therapeutic Relationship

The choice between "patient" and "client" carries important implications for the therapeutic relationship. It affects power dynamics, perceived expertise, and the overall tone of the therapeutic alliance.

When using "patient," the therapist may be seen as the expert who holds the knowledge and authority to diagnose and treat mental health conditions. This can create a more hierarchical relationship where the patient passively receives care. While this dynamic may work in certain medical settings, it can limit the patient's sense of autonomy and empowerment in therapy.

In contrast, using "client" highlights a more collaborative and egalitarian relationship. It positions the therapist as a partner working alongside the client to achieve mutually agreed-upon goals. This approach:

• Encourages client autonomy: Clients are invited to take an active role in their own growth and healing, making decisions about their treatment in collaboration with the therapist.
• Supports empowerment: By using language that affirms the client's agency and strengths, therapists can help clients develop a greater sense of self-efficacy and control over their lives.
• Enhances collaborative goal-setting: When clients are seen as equal partners, they are more likely to engage in setting and working towards therapeutic goals that align with their values and priorities.

The choice of terminology also shapes expectations about who "owns" the treatment process. "Patient" may imply that the therapist primarily drives the treatment, while "client" suggests shared responsibility and a more active role for the individual seeking help.

Setting‑Specific Considerations

The choice between "patient" and "client" often depends on the specific setting where therapy takes place. Different contexts come with their own norms, expectations, and legal requirements that influence which terminology is preferred.

In medical‑focused environments, such as psychiatric hospitals and integrated care facilities, the term "patient" is more commonly used. These settings emphasize the medical model of mental health treatment, viewing individuals as having specific diagnoses that need expert intervention. Using "patient" here reinforces the importance of safety protocols, medication management, and adherence to treatment plans.

Conversely, private practice and community mental health clinics usually prefer using "client." These settings typically follow a more humanistic and collaborative approach to therapy, focusing on the individual's unique needs, strengths, and goals. The term "client" aligns with the emphasis on empowerment, autonomy, and the therapeutic alliance central to these environments.

As technology changes the landscape of mental health care, telehealth and digital platforms bring new considerations for therapeutic terminology. In these virtual spaces, "patient" and "client" might be used interchangeably, depending on the platform and the providers' professional backgrounds. Just like the terms ‘patient’ and ‘client.’ other terms within this changing field are also used interchangeably. 

• Telehealth: A broad term that includes electronic and telecommunications technologies used to provide healthcare services remotely, covering both clinical and non-clinical services.
• Telemental Health: Specifically refers to behavioral health services provided using communication technology, like video conferencing for therapy sessions.
• Online Counseling/Therapy: Describes mental health services delivered via the internet, often through secure video platforms or messaging apps.

As telehealth evolves, therapists need to stay aware of the terminology used in these digital spaces and consider how their choice of words might impact the therapeutic relationship in a virtual setting.

Ethical, Cultural, and Systemic Factors

The choice between "patient" and "client" involves more than personal preference; it connects to ethical considerations, cultural factors, and systemic requirements that shape therapeutic language.

Ethical codes and professional guidelines from organizations like the American Psychological Association (APA) and the National Association of Social Workers (NASW) set standards for respectful and effective communication in therapy. These guidelines emphasize:

• Respect for individuals served: Language should avoid discrimination and maintain the individual's dignity, regardless of their background or identity.
• Accuracy and honesty: Therapists must provide truthful information and avoid misrepresenting their credentials, services, or treatment outcomes.
• Confidentiality and privacy: Ethical language use includes protecting client information in all professional communications.

Cultural awareness also plays a significant role in choosing therapeutic terminology. Different populations may interpret "patient" and "client" through their own cultural lens, requiring therapists to be sensitive to these nuances. For example:

• In some cultures, "patient" may convey trust and respect for the therapist's expertise, while in others, it may suggest a lack of agency or a power imbalance.
• Similarly, "client" might align with values of autonomy and collaboration in certain cultural contexts, while in others, it may feel too impersonal or business-oriented.

Therapists should engage in open dialogue with individuals about their preferred terminology, considering their cultural background, language proficiency, and personal preferences.

Additionally, insurance, billing, and documentation requirements can affect the choice between "patient" and "client." Many insurance providers and healthcare systems use "patient" as the standard term for those receiving medical or mental health services. Consistency in terminology is important for accurate record-keeping, billing, and communication among healthcare providers.

Despite these constraints, therapists can still prioritize respectful and person-centered language in their direct interactions. The therapeutic relationship remains at the core of effective treatment, and the words chosen should always aim to strengthen that bond.

Practical Guidelines for Choosing Your Term

Choosing between "patient" and "client" requires thinking about your therapeutic approach, considering what individuals prefer, and being consistent in your materials. Here are some important points to help you decide:

Consider your therapeutic approach:

• Medical model: If you work within a clinical or medical framework, especially in hospitals or psychiatric settings, "patient" might suit your role and environment better.
• Humanistic model: For a more client-centered approach that emphasizes empowerment and collaboration outside of a medical framework, "client" may be more fitting.
• Integrative model: Think about which term reflects your therapeutic philosophy and the relationship dynamics you want to build.

Discuss individual preferences:

• Talk openly about terminology with the people you serve, respecting their comfort and personal preferences.
• Some might prefer "patient" as it acknowledges the seriousness of their condition, while others may find "client" more empowering and less stigmatizing.
• Customizing language to meet the individual's needs can help build trust and a strong therapeutic alliance.

Maintain consistency in materials:

• Use the chosen term consistently in conversations, documentation, and professional communications to ensure clarity and build trust.
• Ensure intake forms, consent documents, and session notes align with your chosen terminology.
• Consistent language supports your therapeutic approach and helps set clear expectations for the therapeutic relationship.

There is no universally "right" choice. The most suitable term depends on your specific context, professional identity, and the people you serve. Focus on open communication, flexibility, and sensitivity to individual preferences when deciding on terminology.

Ultimately, the words you choose should enhance therapeutic rapport, reflect your values, and support positive treatment outcomes. Thoughtfully considering the "patient" vs. "client" decision allows you to build a foundation of trust and collaboration that enriches the therapeutic experience for everyone involved.

Case Vignettes and Reflective Exercises

To show how choosing between "patient" and "client" plays out in therapy settings, let's look at two case vignettes:

Vignette A: A psychiatrist in an inpatient unit—using "patient" to reinforce safety protocols

Dr. Patel, a psychiatrist in an acute inpatient unit, consistently uses the term "patient" when discussing individuals under her care. She finds that this language aligns with the medical model, is cohesive with the hospital culture, and helps emphasize the importance of adhering to safety protocols, professional boundaries, and treatment plans in this high-risk setting. By using "patient," Dr. Patel highlights her role as a medical expert responsible for overseeing the individual's care and ensuring their well-being during their stay.

Vignette B: A school counselor in a youth program—using "client" to foster agency

Mr. Rodriguez, a school-based counselor, prefers the term "client" for the students he works with. He believes that this language promotes a more collaborative and strengths-based approach, encouraging the young people to take an active role in their personal growth and development. By using "client," Mr. Rodriguez aims to create a safe, non-judgmental space where students feel encouraged to explore their challenges and build resilience.

These vignettes show how the choice between "patient" and "client" depends on the therapeutic context and the provider's goals for the relationship. It's important to consider how your own training and theoretical orientation might shape your preference for one term over the other.

Reflective Prompts:

• How has your educational background and clinical training influenced your perspective on using "patient" or "client"?
• In what ways might your therapeutic approach (e.g., cognitive-behavioral, psychodynamic, humanistic) align with or challenge your preferred terminology?
• How do you handle situations where your chosen term differs from the one used in your workplace or by other professionals you collaborate with?

Reflecting on these questions can help you develop a more intentional and adaptable approach to therapeutic language, one that prioritizes the individual's needs and the unique dynamics of each therapeutic relationship.

Recommendations and Best Practices

Choosing between "patient" and "client" in therapy involves considering your therapeutic approach, the individual's preferences, and the specific context of your practice. Here are some key points and steps for incorporating respectful language into your daily work:

Evaluate your therapeutic orientation:

• Think about how your theoretical framework and practice setting affect your choice of terminology.
• Decide whether "patient" or "client" better suits your approach to the therapeutic relationship.

Focus on individual preferences:

• Have open conversations with the people you serve about their preferred terminology.
• Honor their choices and adjust your language to their comfort level and personal identity.

Maintain consistency across materials:

• Use the chosen term consistently in all professional communications, including intake forms, consent documents, and session notes.
• Regularly review and update your materials to reflect any changes in terminology or individual preferences.

Commit to ongoing learning:

• Stay informed about changing language preferences within different communities and cultural contexts.
• Consult current research, professional guidelines, and advocacy organizations to understand best practices for respectful communication.

Promote a culture of respect:

• Provide training and guidance to all staff and collaborators on the importance of using respectful, person-centered language.
• Model consistent use of preferred terminology in your own interactions to create an environment that values individual dignity and autonomy.

For further exploration of this topic, consider:

• Reviewing ethical codes and professional guidelines from organizations like the APA and NASW for standards on respectful communication.
• Engaging in peer discussion and consultation to share experiences and insights on navigating language choices in therapy.
• Seeking out cultural competency training and resources to enhance your understanding of diverse communication styles and preferences.

Aligning Language with Values

Choosing between "patient" and "client" in therapy goes beyond semantics; it mirrors our values and therapeutic philosophy. The words we select influence the power dynamics, expectations, and overall tone of the therapeutic relationship.

As mental health professionals, we have a duty to use language that reflects our core values of respect, collaboration, and empowerment. This involves:

• Being aware of individual preferences: Engaging in open conversations with those we serve about their preferred terminology and respecting their choices.
• Reflecting on personal biases: Considering how our training, theoretical orientation, and practice setting might affect our language choices and being ready to adapt.
• Ensuring clarity and consistency: Applying chosen terms consistently across all professional communications and materials to build trust and set clear expectations.

The most effective therapeutic language strengthens the therapeutic alliance, supports positive outcomes, and respects the dignity of those we serve. As the mental health field evolves, it’s important to remain open to ongoing dialogue and adaptability in our language choices.

We encourage our peers to share their experiences and thoughts on using "patient" vs. "client" terminology in their own practice. Engaging in thoughtful discussion and reflection can help us collectively develop a more nuanced, culturally sensitive, and person-centered approach to therapeutic communication.