How the Language of Therapy Is Changing

Mental health issues, in general, are rife with labels, classifications, and pop-psychology definitions. Adding to the mix are divergent theoretical explanations and treatment approaches, which confuse shoppers with a plethora of choices in deciding whether they have an issue, disorder, disease, wonky patterned thought process, or 'simply' are genetically predetermined for the development of mental illness at some point in their lives. Further complicating the problem is decoding all the acronyms (CBT, ACT, IFT) alongside overlapping terminology of psychoanalysis, psychodynamic, and psychoanalytic psychotherapy; deciding what type of treatment to pursue is just plain confusing! Included in this mental health diner menu of terminology is the problem of identification, or how to identify "patient" versus "client."

Both words, patient and client, connote differently, and many projections and thoughts about ourselves and therapists who use one or the other have meaning and potential outcomes.

Understanding the motivation and intent of our words and actions is significantly shaped by our culture, current social and economic trends, and values. The shift toward healthcare practitioners of all sorts who use the term "client" rather than "patient" has a historical and cultural context.

Context Within Culture

The stigma around mental health treatment has softened in recent years, thanks, in part, to COVID-19. Streaming shows about actual therapy, podcasts with qualified and unqualified opinions, and The Sopranos, the 1990s television show that ignited the flame to peer into the complexity of the human mind and rationalize egregious behavior, are part of American culture.

The prevalence of severe mental health conditions continues to rise, especially as it relates to those suffering from substance use, self-harm behaviors like eating disorders and cutting, and those who suffer from debilitating anxiety and major depressive conditions. In 2020, 40.3 million people aged 12 or older in the United States (14.5 percent of the population) reportedly had a substance use disorder (SUD) in the past year (CDC). Eating disorders are more common than many think. Nine percent of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime (NEDA). Approximately 9.5 percent of American adults ages 18 and over will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year (John Hopkins).

There is also an increasing number of individuals seeking therapy who are not in relational distress or have significant work problems or self-care issues but instead want to understand the obstacles, even minor ones, that keep them stuck or in limbo rather than advancing in one or some areas of their lives. These individuals sometimes seek to understand what makes them tick. For instance, someone may have a healthy and stable relationship with their partner but has avoided communication about sensitive issues, like sex, and is ready to delve deeper, or someone who remains in a lower or middle management job position and wants to understand what keeps them from advancing.

Short-term, evidence-based therapies like cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and motivational interviewing, in conjunction with different psychiatric medications, address, or attempt to address, all kinds of needs, issues, disorders, and problems. Short-term therapies often focus on eliminating the problem through behavioral changes and cognitive shifts.

Medication has shown efficacy for major depressive disorder, but recent studies and meta-analyses have reported no difference between placebo and SSRIs for the treatment of all levels of depression. "In [a] meta-analysis of 91 randomized clinical trials (18,965 participants) on the use of antidepressants in major depression, no evidence was found of more variability in response to antidepressants than to placebo" (Maslej, 2021).

Psychodynamic psychotherapy maintains that human psychology is complicated. Through this lens, psychological pain needs first to be understood, not immediately sought to be reframed, challenged, or eliminated. We don't know what motivates us or makes us tick, and we often have powerful motives for keeping us from knowing and wanting to know; change, as a result, is slow and arduous.

Patient or Client?

With all these variations of individual needs, theoretical orientations, and treatment approaches, and with various motivations for seeking treatment, how do we identify the person who comes before the therapist: the patient? The client?

The American Psychological Association asserts that psychotherapy is a form of healthcare delivery. Thus, "patient" is preferred, recommended, and appropriate. However, psychologists are not mandated to use the term patient, and many do not.

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The use of the term patient denotes a person who endures pain or suffering and requires some form of healthcare attention. It connotes an implication of sickness and implies "passivity (object of an action) that removes responsibility ('bearing, enduring') which can be construed as stigmatizing as its usage may enhance perceived disability and impairment" (Shevell, 2009).

In the 1950s, Carl Rogers essentially coined the word "client" in his humanistic Client-Centered Therapy. The term subsequently stuck, as it connoted a healthcare delivery model focused on the individual as empowered, not sick or dependent. "Client" has become increasingly popular as more and more healthcare, para-health care, and lay therapists use the term without restraint. "Client" is considered by many these days to signify health, autonomy, and "agency." Agency refers to the feeling of control over one's actions and their consequences, a connection to the awareness of, and deliberateness of, our actions.

Furthermore, "client" has become the choice of language for the increasingly consumer-driven healthcare delivery system. In the world of business, "client sounds a lot more consumer-friendly.

We are all vulnerable. Patients see doctors for ailments and for regular checkups; patients see therapists for ailments or to live fuller and happier lives. Entering therapy implies an acceptance of being vulnerable; the therapist enables the process for the patient to trust and let go. As therapists, we are grounded in our ethics and values of treating our patients with dignity, mutual respect, kindness, and challenge. Embedded in the term "client," meaning "equal," is also embedded in the term "patient," also meaning "equal," but additionally includes the implicit acceptance of vulnerability. Our humanity is shared by our vulnerability and the acceptance of the human condition in that we all struggle, suffer, seek wisdom and understanding, and betterment in all self-defined ways. We are not objects of the mental health industry but people with shared experiences and commonalities. Those of us who treat never forget this or take it lightly. We are privileged to enter the spaces of those seeking our learned expertise. We are trained to accept dependency in our patients while maintaining boundaries, ethics, and trust in our knowledge when we make recommendations to them and their families.

I have sometimes wondered whether shifting to the term "client" somehow indicates the lessening of our comfort with attachment to those we treat. In a world inundated with swipes to the left, has the mental health community fallen to the same diminishment that we have sought to eliminate since our inception—disconnection from self and others?