I agree with sidestepper and do think "patient" is used on paper primarily for insurance purposes, much like a diagnosis is. In conversation however, client is more commonly heard. I've actually never heard an LMHC or LCSW refer to private clients as patient. In this respect I agree that semantics does matter since the difference is due to theoretical orientation. The first thing I learned in Ethics class is that Counselors don't technically use the medical model, while Doctorate level psychologists and psychiatrists do. Given that difference it makes sense that they would use the term "patient" over client. Maybe it sounds cold, but to me it sounds more respectful and keeps the relationship on equal footing rather than one being "sick" and the other being a "healer". It may also have political meaning within the field itself, especially where I'm from, where there is a lot of competition and a sense of elitism in certain disciplines.