The End of Clients
I’ve previously written about why folks who come in looking for mental health services shouldn’t be labeled patients. First, the transaction isn’t a genuinely medical one (even if so-called “drugs” are often prescribed). Second, non-medical personnel like psychologists, counselors, clinical social workers, and family therapists shouldn’t have “patients.” Third, the word stigmatizes the “suddenly ill” individual for no legitimate reason. There are many other good reasons, too, not to bandy about the word “patient.”
But what about that most common alternative word “client”? What about that word? Is that a useful word, an appropriate word, or a word with its own baggage, limitations, and dangers? If we are looking to rethink mental health service provision, it is very important that we get the players in the game appropriately named. Of course the provider should be appropriately named— mental health tutor? person whisperer?—but let’s consider that matter separately. To begin with: what about the word “client”?
Who has clients? Lawyers, accountants, high-end boutiques, real estate agents, and personal shoppers have clients. Why do plumbers have customers and personal shoppers clients? Why do auto mechanics have customers and architects clients? It looks like there is something about class built into the word “client.” If you are poor and lower class you are not really anybody’s client, not even your public defender’s, who is unlikely to use that word without a good deal of irony. “Lower class client” sounds like an oxymoron.
A lower class department store has customers and an upper class boutique has clients. An auto repair shop that caters to everyday cars has customers and a shop that caters to fancy cars has clients. The guests of a motel are customers and the guests of a fancy boutique hotel are clients. If “patient” carries a tangle of meanings having to do with illness, “client” looks to come with a tangle of meanings having to do with class.
“Client” also appears connected to the idea of “better service.” We expect that you will get “better service” or “more service” or “more personalized service” in a boutique hotel than at a motel off the highway and at a boutique dress shop than in the dress department of a huge department store. A “cook” and a “chef” might do the same work but from which one do we expect “better food”? By making you my client, I am instantly upgrading myself. Isn’t that interesting? It doesn’t matter whether or not I have done anything to merit that upgrading. Language does the trick for me!
Before we try to decide whether it makes sense to ditch a class-driven word that raises the provider’s status simply by how language operates, let’s take a look at some alternative language. What other words exist to describe customers and consumers? Who is the customer of a parish priest? A parishioner. Who is the customer of a Zen master? A student. A cruise ship has passengers, a cab driver fares. None of these words or the many, many others we might name makes for a very interesting or useful alternative to “client.” Are we stuck with “client” by default? Or—oh, my!—do we have to coin some new language?
Well, what will you actually be doing as a new mental health provider in some future, better model of “mental health service provision”? You will be traveling with your customer through difficult territory where neither of you know what you will find or even what precisely you are hoping to find. That is, you will be a guide of sorts; a collaborator of sorts; a teacher of sorts; a problem-solver of sorts; a sounding board of sort; a coach of sorts; a confidante of sorts; a teammate of sorts. So, might it be a word like trekker, as in “I’m a mental health guide and I’m currently working with 25 trekkers”? Or maybe it could be a word like collaborator, as in “I’m a mental health collaborator and I’m currently working on 25 collaborations”?
Yikes! How poorly language serves us here!
And we would also have to factor customer resistance into our language. If someone is coming in wanting a pill, wanting to blame his spouse, wanting to talk but not listen, wanting insights but not the subsequent work, wanting to get better but not to change, and so on, what sort of a safari is that? One where we drag our trekker through the underbrush kicking and screaming? What sort of collaboration is that? We have two intertwined pictures to paint, one where the customer really wants his car fixed and one where he is happy to live with its dents and strange noises. What sort of customer is that? And how do we make language reflect such conflicting realities?
I fear that we indeed need new language, as difficult as it is to come up with the right language and as difficult as it would be to get general agreement on any such language. We need language that gets at the peculiar fact that our customer wants what we are offering and also does not want what we are offering. We need language that gets at the limited expertise of the provider, who on the one hand isn’t really “diagnosing and treating” anyone and who isn’t standing on a genuine body of knowledge, but who on the other hand does, one hopes, have some expertise, some skills, some wisdom, and something to offer.
Can language do this?
It would be nice to convene a panel of folks like Dorothy Parker, Jonathan Swift, George Orwell, Emily Dickinson, and other language experts with the requisite wit, whimsy, and distance from the mental health establishment to take a stab at this task. Maybe they might be able to create language that allowed us to speak appropriately and even beautifully about our new mental health provider, one freed from “diagnosing and treating,” and our new mental health customer, one adamant about rejecting labels and willing to take some responsibility for his mental health. I would enjoy sitting on that panel!