First Name or Last? How to Address the Client

Feb 13, 2017

“I like a great library next to my study; but for the study give me a small snug place, almost entirely walled with books. There should be only one window in it, looking upon trees.”

Leigh Hunt
British Poet, Essayist

First Name or Last? How to Address the Client

TISA Description of the Problem: How to address a client in the first interview is sometimes hotly debated. I suppose there is no single correct answer, but I have found the following principles to be of practical value over the years. I, personally, feel that one should not assume a first name basis without asking first. Some clients may find a first name threatening or a “put down,” especially if the client is a young adult or much older than the clinician. Consequently, when first greeting a client I always use his or her last name.

On the other hand, the ability to use the client?s first name can be a powerful asset in engagement. When used sparingly and with good timing, it can effectively help clients to share difficult material. In a cultural sense, first names are generally used by people who care about us and are privy to our private thoughts.

Tip: Consequently, I have found it both satisfying and rewarding to simply ask how a client prefers to be addressed. If the client’s name is James McMaster then the phrasing would sound something like this: “By the way Mr. McMaster, how would you like me to address you today? By your last name, first name, what would you prefer?” Our fictitious client might respond, “Oh, just call me Jim.”

Asking the client how he or she would like to be addressed accomplishes several tasks:

1. It conveys respect.
2. It gives the client direct control over an important ego issue. (Some clients do not like to be called by last names and others do not like to be called by first names).
3. One may learn a significant amount concerning the dynamics of the client as revealed by the client?s preference.

For instance, very strong opinions voiced by the client may represent the presence of character pathology or defensive posturing, thus offering the clinician immediate grist for the mill. A client developing grandiose thinking as part of a manic episode may adamantly insist on being called, “Mr. McMaster, if you please.” At the other extreme, clients, with insecure predispositions, may sheepishly smile while stating, “Please just call me Jim.” With experience one can begin to discern the sense of self-identity implied by the client?s response to this simple question. Indeed, one wonders what dynamic issues may lie beneath ambivalent responses such as, “It doesn?t really matter, you can call me Jim, Jack, or Jimmy.”

TISA Follow-up: There are some exceptions to the above guidelines. If the clinician knows beforehand that the client has a history of paranoia, it may be advisable to use his or her last name throughout the interview, because such interpersonal “distance” may be more comfortable for the paranoid client. Clients who are much older than the interviewer may prefer to be addressed by the last name. In the opposite direction, children and adolescents generally should be addressed on a first name basis from the start. In these cases, though, it is often useful to ask the child which variant of his or her first name to use. For instance, the family may call the child “Johnny,” yet the child would prefer being called “John.” Such a simple show of respect can go a long way towards ensuring a powerful engagement.

I should add that with regard to addressing the client, I have yet to find any problem arising in either the initial interview or subsequent therapy using the above approach. In the end, the reader must decide, from your own experience, what feels most comfortable for you and your clients.

Tip provided by:

The above interviewing tip is adapted from Psychiatric Interviewing: the Art of Understanding, 2nd Edition (1998) published by W.B. Saunders and written by Shawn Christopher Shea, Chapter 2 (pages 62-63).