There has been a controversy within psychotherapy circles for some years about whether or not to call the person who comes to see a psychotherapist for help a “patient”, a “client” or a “service user”. Some people may think such a discussion to be more worthy of being called a storm in a teacup rather than a controversy, but for what it is worth, here are our views…
The term “patient” is associated most with the medical model, that is a sick patient comes to see a doctor for diagnosis and treatment. For some psychotherapists, this model still seems to be a good one and historically the term “patient” was commonly used for someone coming for psychotherapy. However, some psychotherapists and some ‘patients’ became dissatisfied with using the term as they wished to distance themselves from the medical model. The main dissatisfactions arose from not necessarily wanting to see psychotherapy as being engaged with medical diagnosis; and also not wanting to get into the power difference that was often seen or felt within a doctor-patient relationship (powerful / ‘expert’ doctor versus subservient / ‘ignorant’ patient).
The term “client” was adopted by many psychotherapists wishing to find an alternative, and better, term than “patient”. It more accurately reflects the power differential – that is a more equally balanced one – that most psychotherapists aspire to, and is certainly an apt term in private practice where the client is paying the psychotherapist for their services.
This term has come to be the one most currently and politically correctly used within NHS mental health services. It is neutral and simply describes the relationship with the service. However, it has twice the number of syllables as either of the alternatives and, human nature being what it is, it can unfortunately sometimes be shortened to “user”. The word “user” has various potentially negative associations, including that of ‘drug addict’ or of ‘someone who is manipulating others so as to get more than their fair share’. While neither of these meanings necessarily apply to people who come for psychotherapy, the psychological associations with these meanings can render the term unpleasant as an alternative term.
My views are similar to those of my colleague Jane (see below). I think of psychotherapy as a mental health intervention, an effective approach to emotional and psychological suffering and distress. I also agree that it is also a journey of emotional growth. Although many gifted therapists come from other professional backgrounds than mental health, I think experience and training in the core mental health professions helps a therapist to be aware of the widest range of human givens and emotional problems that may need to come into therapy. I find the word ‘patient’ fits best with a mental health approach although I find myself using ‘client’ at times, too.
My professional background is being a doctor, so “patient” fits most comfortably within my professional culture. I don’t think that medical diagnosis is always a good model for applying to the problems brought by people who come for psychotherapeutic help. But sometimes they are, and so I still think in those terms first of all when assessing someone (though may decide that in this case they are unhelpful and so then move onto using a different system of thinking about things). I take the point that “patient” implies a power differential that is more often than not going to be unhelpful within psychotherapy, but take the view that if I am careful to be continually aware of this whenever I use the term “patient” then I can hopefully reduce this effect to a minimum. I do not like the term “client” when used for NHS patients, because I think it is disingenuous – the power of being a client is that you can take your money elsewhere if you don’t get what you want or were expecting, but as an NHS patient someone else decides how to spend your tax money and what services you have available to you. “Service user” is not ideal in my view either, it is ‘clunky’ in use, seems to be trying rather too hard to be politically correct for my liking, and is open to others’ malicious misuse by deliberately (rather than lazily) shortening to “user”. Finally, I prefer “patient” because it comes from a Latin word and literally means “someone who is suffering”. And that, for me, aptly describes the majority of people who come to seek my help.
For me, the words “service users” is a useful term to name the group of citizens who use corporate health services. Beyond this I think it becomes too impersonal, and I prefer the terms “patient” or “client” which imply a relationship. However, I very often use neither of these terms, and simply tend to refer to “people”- women and men.