Clients, patients, consumers: What's in a word?

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About a month ago, in a study group I attend every other week, we talked briefly about using the word "patient" to refer to the people we see in psychotherapy. This was a big no-no in grad school, where I studied social work. The word we should use, we were told, is "client." "Patient" is associated to the medical model and that does not sit well with the values of social work.

The medical model, the argument goes, sees people as having issues, deficits, problems that need to be fixed. It also assumes a vertical relationship: an expert physician who knows what is best for a passive "patient." Instead, social workers focus on people's strengths, and encourages self-determination and empowerment; the "client" ought to actively participate in his or her own treatment and recovery.

This makes sense to me, even though I wonder if I could still uphold those values regardless of the word I chose. I am aware of the power words may have, so I don't mean to say it doesn't matter. However, it seems like the word "client" emerged merely as an anti-"patient" alternative, rather than as something that actually made sense in its own right.

In addition, psychotherapy and social work are not the same thing so, in order to make an informed decision about which word I would use, I decided to investigate the origins of these terms. I know it is hard to separate language from how it is used, but as a therapist I believe that understanding where things come from is very important. I am a bit of an etymology nerd, so I did a bit of digging in the Online Etymology Dictionary (etymonline.com).

Client

According to etymonline.com, this word comes from the Latin clientem, "follower, retainer," perhaps a variant of present participle of cluere ("listen, follow, obey") or, more likely, from clinare, "to incline, bend." Either way, this is definitely not how I see the people I work with!

Moreover, in ancient Rome the word referred to a plebeian (currenly defined as a member of the lower social class, according to the Oxford Dictionary), who was under the protection of a patrician. This is certainly not how I see the relationship I have with the people I work with, and it sounds really disempowering.

In English, the word "client" was originally "a lawyer's customer," but it extended to any type of customer around the year 1600. Currently, the main definition is "A person or organization using the services of a lawyer or other professional person or company." I have a problem with the idea of seeing psychotherapy as a relationship in which someone is "using" the other, and with its legal and commercial origins.

Patient

The current definition is "a person receiving or registered to receive medical treatment," which is close to the definitionthe word has had since the late XIV century. Psychotherapy as such didn't exist back then, though, so I don't believe this is an argument against using this word.

Its origin is pretty interesting. It comes from the Latin adjective patientem ("bearing, supporting; suffering, enduring, permitting; tolerant," but also "firm, unyielding, hard") which, in turn, is the present participle of pati, "to suffer, endure." Everyone who has come to my office was enduring some form of emotional or psychological suffering, so this seems very fitting.

There are two more things I like about the origin of this word:

  • Patientem was also used to describe navigable rivers, not only people, and I really like that metaphor for the journey of psychotherapy.

  • Pati is also the origin of the word "passion." Originally used to describe pain and suffering, "passion" refers to "strong emotion, desire" as far back as the XIV century. A sexual connotation was added in the 1580s, and a sense of "strong liking, enthusiasm, predilection" in the 1630s. Passion, I firmly believe, plays a crucial role in human well-being.

Consumer

I have not seen this one used very often, but I know it's floating around. Prior to becoming a psychotherapist, I worked as a Consumer Insights Expert at a consulting firm and I taught a Consumer Behavior class in college, so I have a fairly defined (and Marketing-biased) understanding of what a "consumer" is. Without going into detail, it certainly does not describe the intimate two-way relationship that is a critical healing factor in psychotherapy.

The origin of "consumer", via the verb "to consume," is the Latin consumere, "to use up, eat, waste." The current definition is of someone who "purchases goods and services for personal use" or who "eats or uses something." Even though consumption is not limited to goods and services but it can include ideas or experiences, it has an implicit sense of "using up" and a one-way connotation. Neither of those ideas resonate with my understanding of what happens in the therapy room.

In conclusion

It is interesting to note that the origins of the word "client" are linked to a specific type of relationship, the origins of "patient" relate to an intrinsic aspect of the human condition, and "consumer" derives from a particular behavior (consumption).

This realization makes me feel more comfortable, as a therapist, with the use of "patient," because it speaks to the internal reality of the people who come to our office. "Client" has some connotations that don't resonate with me and I think "consumer" is just awful.

I am not suggesting that psychotherapists should necessarily use the word "patient" instead of "client." I agree with the criticism to the medical model to which the word has been associated for centuries. However, I am not sure this is a problem of the word itself.

Based on its origins, I believe the bad reputation of "patient" deserves, at least, some reconsideration. Perhaps it is time to reclaim it as a way to empathize with the suffering we see in our office. Words matter, but it is our job as clinicians to create the conditions for the development of a healing, respectful, empathetic, attuned and responsive relationship, regardless of the term we use.

Santiago Delboy