Why I use “patient” instead of “client”?
The mental health field has been shifting away from the use of “patient” to refer to individuals working in therapy, to “client.”
This shift was part of a larger movement to empower individuals who sought mental health care, and to “de-pathologize” and normalize the need for mental health services, including therapy. Indeed, I do agree that the individuals I treat are not “sick,” or view them within a pathology model. I do not, however, believe that the term “client” adequately captures the relationship between myself and the individual I am working with. The term client, or consumer, is often used in healthcare, at least partly to empower the individual as the active creator of change in their own healing. The mental health world has an unfortunate history of moral and ethically problematic power dynamics between doctors or clinicians, where they may be elevated to the role of “all knowing expert” or the “actor” or “director” of change. Within this frame, individuals who seek out and participate in therapy can be viewed wrongly as “passive” recipients of therapy, whose participation is seen through the lens of treatment “compliant” or “resistant.” In other words, the clinician is elevated above the patient, and poor outcomes of treatment are seen as a failure of the patient to be compliant with the treatment recommendations of the doctor.
Fundamentally, I believe that each person who comes to see me for therapy is an active agent of change, and I honor that all of the steps they take (considering, researching, contacting, and ultimately “hiring” a therapist) are all actions that demonstrate true motivation and commitment to make changes in their own life.
I do not create change in my patient’s lives. I create conditions within therapy to facilitate a patient’s sense of safety so that they can change their lives.
I participate in a healing relationship within which patients feel safe to make changes they want for themselves, rather than changes that come “recommended” from other invested people in their lives. Rather than an expert to be consulted, I am an experienced guide, teacher, educator, nurturer, healer, and authentic human, with all of my own lived experience and training. I believe the terms client and consumer suggest a model of seeking and consuming services, however, therapy is not simply a “service” that I offer, but instead, a relationship I engage in. I am a partner in your healing journey, and because this is done within the therapeutic relationship itself, it is so important to me that this relationship itself (not simply the service “delivered” which can be removed from the provider), is highlighted by the language I use.
Additionally, as a person who has engaged in my own personal therapy, as well as a doctor who has had the honor to partner with many patients on their healing journeys, I find many people come to therapy specifically looking for care, and healing to address pain and suffering, and for some, what they consider to be illness. For them, they find comfort, and even validation, in the terms “doctor” and “patient.” It is rooted in the language of healing, and elevates mental health and psychological healing to the same level of importance as physical healing and growth.
As with all relationships, trust, communication and understanding are key. I always discuss my reasoning behind the language that I use, and the way that I “show up” to my therapeutic relationship with my patients. While I am well educated and trained to provide my patients with quality care, I am not THE exclusive expert of THEIR experience, to be elevated above them.
I am a witness, I am a resource, I am an invested person, I am an ally.
I foster an egalitarian relationship with my patients in treatment by supporting their autonomy rather than insisting on solutions, in holding space for them to consider, decide, and change their minds about things that are important to them. I tell all of my patients in our first session, “in many ways, this is a very different relationship than other ones you may have had. In particular because it is not only permissible but encouraged for you to tell me not only how you feel in your life, but how you feel about our relationship. If you have an issue, a concern, a feeling about me or how I’ve made you feel in a session, I not only welcome you sharing, but the more you share, the more it will actively benefit you and your healing. Whether you feel comfortable having “hard conversations” in a relationship or not, the therapeutic relationship is the ideal place to practice this. A good therapy relationship, in many ways, should be a corrective emotional experience, freeing you to speak up for yourself in ways you may never have felt comfortable. Therefore, I bring transparency and authenticity to each of my patients, as a demonstration of my commitment to being their partner in healing rather than an authority figure to be respected and complied with due to their role or power.
