I cringe when I hear therapist colleagues referring to the people in therapy with them as “patients.” My online dictionary defines patients as “persons receiving or registered to receive medical treatment: “ My online Thesaurus uses synonyms as these: “A sick person, case, sufferer, victim; invalid, convalescent, outpatient, day patient, inpatient, hospital patient; the sick, the infirm.” The term “patient” is thus clearly in the realm of the medical model, where the practitioner is a physician who treats patients by using their medical knowledge for treatment of physical illnesses. The patient is usually ignorant about the details of the physician’s treatments. In many cases, there is even little cooperation needed by their patients beyond following their directions during their course of treatment, including taking the medications they prescribe. Perhaps my humanistic colleagues have the same dialogic, egalitarian stance toward their clients that I do, but I also wonder if their thinking of them as patients may be an indication of an unconscious bias to see them as sick people who need to be fixed.

The term patient to refer to people in psychotherapy started, of course, with Freud, an MD. Most of the analysts he trained were also physicians, but he actually did not want psychoanalysis controlled by the medical profession, and even openly supported a non-MD, Theodor Reik, in receiving analytic training and practicing psychoanalysis. It was only in the United States that the most prestigious training institutes would not even admit non-MDs for training unless they promised only to do research. But the medical model actually tended to fit most psychoanalytic treatment because the analyst was clearly the "doctor," the holder of the truth about the patient. In Freudian analysis the practitioners were not supposed to reveal anything about themselves to the patient and the relationship between analyst and patient was clearly a hierarchical one. The patient was supposed to be passive, to say whatever was on their mind, and the analyst interpreted the meaning of the patient's verbalizations. It is only in the last 20 or so years that some psychoanalytical theories have begun to see the therapy relationship as more egalitarian and relational.

Carl Rogers was, as far as I know, the first theorist to object to the use of the term patient, preferring the word client to refer to people with whom he was working. He called it Client-Centered Therapy. Later on, it was changed to Person-Centered therapy so, perhaps, he even objected to the word client.

The hierarchical relationship implied by the doctor-patient phrase patient does not, in my opinion, fit with therapies, such as Gestalt Therapy and Person Centered Therapy, which emphasize dialogue, a partnership between therapist and client. I of course see myself as having more knowledge than my clients about human development and problems of living, but I never am, on purpose, in the hierarchical type of role implied by the term patient. The client and I are a team, my attempting to understand them and communicating that understanding to them. I at times will take a more directive role with someone whom I feel is avoiding self-awareness by, e.g., talking constantly and not giving me the opportunity to provide input. Or I might take a more directive role with very young clients when I feel they need some information that they did not get from other people, such as the parents, in their lives. The psychiatric profession of course tends to see all of the people who have emotional problems in their lives as sick and most are not even trained to do psychotherapy. My opinion is that only people with psychoses, such as those who have bipolar or schizophrenic disorders , can be termed “sick.”

At the same time, I learned many years ago from Heinz Kohut, the founder of psychoanalytic Self Psychology, that some clients need to idealize me, see me as a fount of wisdom and power. They are at a developmental level where they need to idealize someone in somewhat the global way a child needs to idealize a caretaker in order to feel safe, protected and loved. For example, I have had some people in therapy with me for years who still insisted on calling me “Dr Tobin” rather than “Stephan” but that is often an expression of respect rather than idealization. I learned from sobering experience with some clients that it was a mistake to attempt to communicate to them that I was just a fellow traveler rather than some near-perfect being. It was actually threatening to them to see me as less than very wise and powerful. Some would even interpret a mistake I made with them as purposeful, sometimes to an astonishing degree! But I did not “get off” on them looking up to me in that way. I assume that, at some point, they may see me as an imperfect but caring human being who is concerned about their best interests and using my skill in working with them. .