March 07, 2011

What Should I Call You?

When you see your doctor, you’re a patient. When you see your accountant, you’re a client. But what about when you see your psychologist? Are you a patient or a client?

Merriam-Webster says that a patient is an individual who is awaiting or under medical care and treatment or who is the recipient of personal services. A client, M-W says, is a person who engages the professional advice or services of another or a person served by or utilizing the services of a social agency.

‘Recipient’ and ‘engages’ are the key words here. The term patient invokes the medical model, implying that you’re sick or broken and that you’re seeing an expert in order to get fixed (i.e., receive care). I consider myself a patient when I visit the sports doctor, the dermatologist, or the surgeon, and I patiently wait over an hour in waiting rooms for these professionals. In contrast, client implies that I’m paying someone to do a service for me, that I shopped around and selected the lawyer, accountant, or psychologist I want to see, and that they have to listen to my needs and preferences (and not keep me waiting).  I have more power as a client than as a patient.

The choice of term by mental health professionals provides information about the professional’s view of the power differential in the relationship, and about whether or not the professional sees him or herself as working with or for or even on the client/patient. This distinction and the paying/non-paying distinction definitely apply in psychology, where you are more likely to hear the term patient in a hospital and the term client in a private setting. My default term is client, a choice that reflects a general trend in mental health away from the medical model.

Tu versus Vous

If you live and practice in Quebec, there’s a second question to consider regarding what to call your clients. French employs second-person pronouns that connote varying degrees of politeness, social distance, courtesy, and familiarity. Vous is the formal term, used in interactions with people you don’t know (e.g., the maitre d’ at a restaurant), people older than you (e.g., your partner’s grandparents), and people with whom you have a formal relationship (e.g., the VP of your company). Tu is the familiar term used with friends, peers, children, and people who asked you to please, call them tu (e.g., your boss, your friends’ parents).

What should you call your clients?

As an intern doing therapy in French, I was taught to a) always start by calling the client vous, b) if I feel comfortable and think the other person will be more comfortable, propose the switch to tu but c) don't switch without asking, d) and don’t switch back and forth. Of my seven internship clients, I maintained vous with four of them without broaching the topic, and switched fairly quickly to tu with the three others. The three I used tu with were my age or younger and I felt quite comfortable with them. Of the other four, one was someone I saw only briefly, one was someone I was uncomfortable with, and two were clearly older than me (NB: without any discussion, one of the latter four called me tu from the very beginning, something that irked me).

Which is appropriate? 

It depends. Vous maintains formality and distance. This can be a good: for example, if a client becomes overly familiar and starts asking personal questions or for special privileges, the use of vous is one method for maintaining a bit of distance in the therapeutic relationship. However, to a socially isolated client, the therapist’s use of vous could feel standoffish, whereas the use of tu could indicate warmth. Finally, depending on your age and on the client’s age and background, some clients may be just plain uncomfortable with one or the other term.

The choice to use patient or client implies a general attitude, whereas the choice of tu or vous is more of a case by case decision involving age, experience, and comfort level. Both can impact how psychologists think about their role, and how both parties see the relationship.

As the person receiving mental health services, what would you prefer? What does it depend on?


  1. I have, on occasions, switched back and forth between the TU and the VOUS. It makes it funny (funny Ha! Ha! not funny weird). Especially, I guess, for the person who's being tu-ed and vou-ed alternatively without ever helping the poor person who doesn't know which way to turn. It's a communication issue, you need two people to get it!

  2. I still have problems with tu vs vous. And what's more, in another language (or even the same language but different country), the rules can alter slightly.

    I work with an employer who has insisted on tu-ing me (and I'm also irked by this, Sarah), while I maintain the vous-relationship with him.

    I must admit, although in English the richness of the different pronouns is lacking, it sure makes things easier sometimes!

  3. Very, very good explanation of the complex distinction between tu and vous!