Client vs. Patient: Does Language Matter?
January 28th, 2013 adminI’ve been focusing madly on the official launching of the new DEFT Institute website… never dreamed how involved it would become. The only delay is due to time needed to finalize editing of some taped lectures of mine that are offered for purchase. For those who would like to preview the site, it is at www.deftinstitute.com.
Please check out my two upcoming events (June 9-14 in VA and Sept. 28, 29 in LA) with therapist/trainer/author Jon Frederickson, a collaboration that I always find extremely exciting. Perhaps this is because Jon’s mind is a beacon to our field and I always experience the joy of discovery and new insights when I speak with him, appreciating his passion and brilliance in teaching psychotherapy. Participants at these events are in for a great treat! Jon is with the Washington School of Psychiatry in D.C.
Client vs. Patient
I’d like to share some comments I made on the IEDTA listserve in response to a most lively discussion on whether we should refer to those we treat as “clients” or “patients.” I then began to reflect on a larger subject… the impact of the words we select in our comunications. By the way, I don’t use any term other than “you” when speaking directly to the person in my office, but people seeking therapy will see how we refer to them when they visit our websites, hear us lecture or read our books. And how do these terms affect their feelings about seeking therapy? How do they affect their view of themselves and the fact that they’re suffering?
Generally speaking, I have always been an aspiring wordsmith and I chew on words constantly in session to see if my words have an empowering or disempowering effect. Of course, I always want to choose the former. Having intensely observed thousands of responses to my interventions over the decades and frequently inquired into the impact of my language (“How do you feel as I say these words?”), I conclude without a doubt that my choice of words has significant impact on the therapeutic alliance. Some words and phrases enhance the relationship and are more empowering and others do the opposite even though the differences in meaning does not seem significant. If I say, “You are destroying yourself” vs. “So you have this system that operates inside you, that once tried to protect you, and now it harms you,” the client may feel less shame. As we know, use of “you messages” creates greater defense.
Also, it’s so easy for therapists to become vague in their language too. If you ask, “How do you feel this anger?” it is not as clear as “How do you feel this anger in your body? What physical sensations do you become aware of as you remember your husband….” The vague language can cause confusion in the client and thus greater shame.
I have learned that MFT’s moved away from using “patient” and substituted “client” possibly in the 90’s. This mattered to me because, when reaching out to colleagues, I want to “speak their language.” Yet my commentaries on many of the tapes I present are heavily sprinkled with references to the term “patient.” I’d never reflected much about this before receiving this feedback. I’ve discovered from the listserve discussion that there are strong preferences related to these terms among professionals. One person believed this represents a struggle based on feelings, preferences, and values between professionals, having no impact on the person seeking treatment. I would argue that words do in fact carry meaning and they get inside our bodies for good or ill. I see evidence that the medical model of mental health has in fact created much shame. How many times have I heard a client say, “I am sick.” “There’s something wrong with me.” “I must be crazy.” I’ve often responded, “There’s nothing inherently wrong with you. You just haven’t discovered this truth yet. Or tapped into your capacity for health.”
Some agree with Carl Rogers. From his website:”Rogers was deliberate in his use of the term client rather than patient. He believed that the term patient implied that the individual was sick and seeking a cure from a therapist. By using the term client instead, Rogers emphasized the importance of the individual in seeking assistance, controlling their destiny and overcoming their difficulties. Self-direction plays a vital part of client-centered therapy.” The word egalitarian also comes to mind.
My approach to therapy is very aligned with the teaching of Dr Paul Pearsall, one of the founders of positive psychology, which represents new research into optimum human functioning and emphasizes that which is healthy within us. He was selected by the Oxford Biographical Society as one of the 1000 most influential scientists of the 20th Century. He said, “For me… life is made difficult so it can be made more authentic, real and intensely meaningful. We suffer because we breathe, and asking why we must suffer is like asking why we must breathe. There is no life without it.” Indeed, we are all sufferers in this world and we rotate chairs continually between being on the receiving and the giving end of healing.
Since “patient” comes from the Latin word meaning “one who suffers,” then we could say we are all patients. How does the label feel? I think there’s a better term for all of us who “suffer.” In a word association test, if I heard patient, I’d think “sick.”
From Jonathan Mahrer, Ph.D., founder of Blue Mountain Counseling: “I use the word “client”, not “patient.” The word “patient” can imply a medical model in which the doctor works on and heals the patient, and the patient more passively receives the treatment. Psychotherapy is different.” And “The medical patient terminology can also imply that
you are sick, and can create a (to our minds) false dichotomy between sick and well, those who need help versus those who do not.” One author said, “A patient is the object of medical care, a client is the subject of medical services. In language as in life, an object is passive, a subject is active.”
As if we don’t have enough to keep track of in a session, now we must consider the impact of our language! Nevertheless, I believe it is well worth the effort.
