On Language, Relationships, and Psychoanalysis
What’s in a Word?
In psychoanalysis, the person who turns to an analyst is typically referred to as a Patient.
At first glance, that sounds like a medical term. Striking, really – especially considering that Freud himself insisted psychoanalysts should keep distance from the medical profession.
Freud discussed the idea that psychoanalysis should maintain a degree of independence from the medical profession in several papers, but a key reference is found in his 1919 paper “Lines of Advance in Psychoanalytic Therapy” .
In this text Freud wrote:
“It is not a physician’s qualification but a specific training in psychoanalysis that forms the indispensable basis of psychoanalytic activity. The future will probably produce analysts who are not doctors and who will have the same rights and duties as their medical colleagues.”
This statement reflects Freud’s recognition that psychoanalysis is a discipline that, while originating in medicine, can stand on its own. He acknowledges that non-medical professionals could practice psychoanalysis if they undergo appropriate training.
Freud’s broader thinking on the issue appears throughout his writings, including “The Question of Lay Analysis” (1926) – where he explicitly defends the right of non-medical practitioners to become psychoanalysts, arguing that psychoanalysis is not solely a medical practice:
“Psychoanalysis is not in essence a medical matter and need not be practiced by a physician. It is a method of investigation of the mind…”
Why, then, do we still speak of “patients” rather than “clients”?
Language Shapes Relationship
The words we choose are never neutral. They reflect how we understand our practice, our roles, and the people we work with.
Patient, at the first sight, implies passivity: someone who suffers, someone to be treated by an expert.
Client, by contrast, suggests agency – a person entering into a collaborative contractual relationship with another person.
In some modern therapeutic approaches developed from classical psychoanalysis emphasizing intersubjectivity – such as interpersonal or relational psychoanalysis or approaches originating not directly but as a response to psychoanalysis like person-centered or gestalt the term Client often feels more fitting. These perspectives frame the therapeutic relationship as co-created and where both participants engage as equals.
And Yet – I Prefer Patient
I was mainly trained in interpersonal tradition, started by American psychiatrist and psychoanalyst Harry Stack Sullivan, a pioneer thinker who suggested that a therapist is not a neutral observer, but an active participant in a two-person field.
In his famous text “The Interpersonal Theory of Psychiatry”, 1953 Sullivan introduces the concept of the therapist as a “participant observer,” emphasizing that the therapist is not a detached, neutral figure but an active participant in the therapeutic process. This perspective marks a significant shift from traditional psychoanalytic approach when a therapist is seen as a neutral and abstinent expert doing something to the patient to a paradigm when a therapist and a patient are doing something together.
Sullivan writes:
“The therapist must recognize and control his own attitude in the interests of the most effective communication. In other words, he must not forget his role as a skilled, participatory observer.”
In this regard, some of my colleagues, who share the same vision, tend to identify people they work with as Clients, but I don’t feel like choosing for this term myself.
Though there is a lack of research on terms preferences within psychoanalytic approach, here is an interesting and relatively fresh survey published in The Psychiatrist that examined preferences among 350 mental health professionals – and, the term Patient is still the most preferred one.
To me, Patient carries more depth and humanity.
Client often sounds too commercial, as if therapy was just a service to be negotiated on a market. As a side-effect of this connotation, what I could get from my practice, is that therapy is often compared to services like manicure, dental, delivery etc.
Though all mentioned above, without any doubt, has relational nature – therapeutical relations, as other intimate relations, in my experience, is something far more sacred:
An intimate, fragile space of human encounter, where suffering, longing, and transformation meet.
A Word that Honors Suffering
The term Patient points directly to the suffering that leads people to seek help.
Symptoms – often confusing or even overwhelming – are usually what brings someone in. As a psychoanalytically oriented professional, I don’t aim to treat the symptom itself, but to uncover and work through its roots.
Still, that doesn’t mean the symptom – or the suffering behind it – should be dismissed.
To recognize the symptom is to recognize a cry for meaning, not just relief.
When we listen empathically to what symptoms signify, they often loosen their grip. They might fade, shift, or take a new form – until they no longer serve a psychological function, and something more enduring can take their place.
A Deliberate Choice
So yes – I prefer to use the word Patient. Not out of tradition or habit, but as a deliberate and personal choice.
Despite its medical origins, for me, it resonates with warmth, dignity, and a genuine acknowledgment of human vulnerability as well as with the intimacy of therapeutic relations.
