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Is the "Inherent power differential in psychotherapy" a myth? Or how powerful psychotherapists and counselors truly are? Opening statement by Ofer Zur, Ph.D. From the first day in graduate school all the way to post graduate ethics courses, psychotherapists and counselors have been instructed to:
The view of power as an entity, possessed exclusively by powerful psychotherapists and counselors, has been generally unchallenged. Scholars, ethicists, ethics texts, and risk management advice columns have presented a similar unified message about therapists' unilateral power and clients' inherent vulnerability. Many psychotherapy clients are, indeed, distressed, traumatized, anxious, depressed, young, impaired and vulnerable and can be easily influenced or controlled by their therapists. On the other hand, other clients are competent, strong, and authoritative and may be controlling. Many modern day consumers are highly informed and seek therapy to enhance the quality of their lives or to improve their loving relationships. Some are successful business people, CEO's, teachers, artists, or fellow therapists. They are neither necessarily depressed, nor traumatized, nor vulnerable. A reminder of clients' potential power is the statement that "You are one Borderline away from loosing your license." Yet, the myth of the power differential persists as if all clients are the same and all therapist-client relationships are duplicates of each other. This blog seeks to explore the beliefs inherent in power differential, the view of all clients as vulnerable and all therapists as omnipotent, and the claim that therapists' power always lasts long after termination. Online articles: Online Courses:
Sue, a client wrote:
My therapy was harmful, reinforcing my deference to an omnipotent authority rather than dismantling this construct.
One practitioner was blatantly contemptuous, employing threats and shaming, quashing my attempts at feedback and hostilely "diagnosing" me as I traumatically broke from his care. But a second "kinder" clinician was harmful in her own fashion, leading me to see her as a rescuer and encouraging wallowing in my narrative of a harsh, piteous past. I doubt either therapist had the slightest awareness of the dynamics they created. I'm left with the feeling of being charmed, then swindled, playing helpless damsel in my doctors' delusional storybook as "magical" healers. If I could design my own healing model, I'd discourage all client idealization and transference, substituting the reality-based framework of one flawed adult offering some connection and guidance to another.
07/21/10 18:18:25
David Kamen, Ph.D. wrote:
I believe that every relationship from birth onward has an inherent power differential. There is an instinctual power differential between mother (caregiver) and child, necessary to me Maslow's fundamental hierarchy of needs and to develop attachments, as Bolby talked about. There is also referential power between friends; credentialed power between expert and consumer (e.g., therapist and patient); politicized power between legislator and constituent; socialized power between men and women, and SES classes; stigmatized power between doctor and psychiatric patient; and coercive power between abuser and victim, among so many others.
The key, I think is to recognize the type of power at play in our therapeutic relationships. Further, I think it is relevant to appreciate the dynamics between our credentialed power and the personalities of our patients/clients. Typically, I find, most therapy clients have the Myers-Briggs (MBTI) INFP or ENFJ type. I have also found it helpful to assess our clients' MBTI type and to know our own so that we can be more attuned to the dynamics stemming from the credentialed power differential, from our MBTI personality type, and from our patients'/clients' MBTI types. It is a significant matter at hand, as others have written, to appreciate the power differentials at play during the process of psychotherapy.
05/03/10 21:24:38
Julie Schmidt LMFT wrote:
This may sound too simplistic. But once we realize the real "power" is formed from/in/ and between a two person (or more) relationship, "power" from top down perspective becomes a mute point. It's best the therapist acknowledges this from the get-go. It keeps the reality of where the power lays in perspective. Then mutual respect and service can begin. The very inception of synthesis of relationship holds the power. Let's leave it there. Then "we" heal with humility.
04/28/10 21:50:56
Gerald Vest, LISW/ACSW wrote:
I don't think that we have a positive healthy and respectful relationship when we use our power and authority. My main interest and commitment to those I work with is to make the "equal" so that the clients realize that it is their choice and decision to follow any suggestions or recommendations or interventions that I use. Self-determination is one of our primary principles to guide us in our practice.
10/10/09 21:26:42
Albert R.Levy,PhD wrote:
Patients just can not believe I will notice and help them NOT DEFER to me. I address this quite early on whenever I see patients who have a tendency to defer to authority. I know the therapy is going well when some patients do oppose and argue and are not afraid to speak their mind whether that be about me or the way I do therapy or point out the mistakes I make or make fun of my office. Then I know they are changing. Not this is only for those who tend to defer too much--to everyone--not just a therapist.Some patients even defer to their kids lest the kids get mad at them!!!
09/13/09 13:38:00
Vince Hamilton, LEP/MFT wrote:
. . . Another interesting thread of research and information to follow up on if folks are seriously interested in providing effective, ethical psychotherapy while exploring this issue of POWER, is accessed by googling Scott Miller, Ph.D. or Talking Cure. His group, out of Chicago, has been conducting some impressive research on counseling and psychotherapy outcomes that have major implications and may change everything. . . or not. You decide and comment.
09/03/09 11:17:13
Leslie Gray wrote:
Response to J. Tollefsrud:
I wonder how many people in the U.S. in general, let alone therapists, might genuinely be described as "dedicated to seeing and understanding power imbalances? Also, there seems to be an assumption--unless I misread- that the therapist's "seeing and understanding" will necessarily be healing for the client's particular experience. I recently came across a quote from the American Indian Poet John Trudell: "When I go around in America and I see the bulk of the white people, they do not feel oppressed; they feel powerless. When I go amongst my people, we do not feel powerless; we feel oppressed. We do not want to make the trade...we must be willing in our lifetime to deal with reality. It's not revolution; it's liberation. We want to be free of a value system that's being imposed upon us. We do not want to participate in that value system. We don't want change in the value system. We want to remove it from our lives forever... I would suggest that any effective therapy with indigenous, third-world, female, LGBT or 'oppressed' people (please note that this constitutes the majority of people and therefore of the majority of potential clients)requires an inextricable link between "analyzing power differentials" and generating solutions with the client. This is less a western model than a shamanic model. It's said of shamanism that 'the patient gets better as the doctor gets better." Lesley Gray, Ph.D. http://www.woodfish.org
09/01/09 16:34:26
Vince Hamilton, LEP/MFT wrote:
Part II: The nature of the therapeutic alliance (or misalliance) derive from a mutually, though unconscious, agreement between therapist and client. This unspoken agreement is established early on and, if healthy, propels the internal work needed by the client toward healing resolve. At times, this process ebbs and flows, but If stagnation occurs for a prolonged period of time, it is likely that a misalliance is being maintained and once established limits or destroys a therapeutic relationship. In the misalliance, the unconscious agreement between the therapist and client is to reinforce, justify or act out symptoms in perpetuity. Some say if you’ve in a consistent therapeutic relationship for more than 5 to 7 years, by default, there is an active misalliance. Under the healthy TA, the client willingly permits the therapist (helper) to participate in a real, living, breathing relationship for the healing benefit of the client. What therapists should be doing, at least in the psychoanalytic psychotherapy tradition (al la Robert Langs, M.D.), is manage the frame of the therapeutic relationship and interpret the unconscious in light of the real relationship between the two people in the room as it unfolds. If done well, the client’s own process of self-healing will be allowed to unfold. If botched, the client has found a corrupt partner to collude with in the service of mutual psychopathology or he/she never comes back.
08/25/09 10:53:20
Vince Hamilton, LEP/MFT wrote:
Part I: “Power” is a great topic for clinician’s to explore. The therapeutic alliance demands exquisite skill, talent and courage of the therapist; more than many recognize or have ever been trained for.
The base from which to start demands that a therapist apply their art first and foremost in the best interest of client. For the therapist, “know thy self” is an unavoidable imperative, as the therapist’s internal dynamics are always in play and must be analyzed and managed. Where counterproductive dynamics interfere in the client’s process (the unconscious sees all), they must be acknowledged as real events in the room and brought to light through the eyes of the client’s unconscious perceptions. In the complex and dynamic healthy therapeutic relationship the client’s “vulnerability” is always, unless derailed by premobid or psychotic process, within the client’s control. A client’s ego and defensive functions rarely allow for unfettered access to psychic vulnerability that risks psychological decompensation. The challenge for the therapist is doing a “good enough” job in earning and maintaining the trust of the client to allow the deep wounds of neurosis to be witnessed by another, correctly interpreted and reflected upon. Only then can the client let go.
08/25/09 10:38:13
Azzia Zur wrote:
As you've written plenty about, abuse of power happens in isolation, including an icy relationship.
I am currently in my favorite therapeutic relationship to date - as a patient - with an intern who is fantastic. I'm young-ish, and have been with older PhDs in the past. Seeing someone my age, a gifted healer who is interactive by training (holistic school), gives me the opportunity to grow IN a relationship. This stands opposed to the feeling of being "treated" because I am "broken" and need a big professional to heal me. In those relationships, I did feel a power difference and had the feeling of being "saved" which I outgrew as I entered my mid twenties. Horray for interaction. One of my favorite aspects of therapy with my current therapist is that when I tell an intense story, she responds! I have never seen this before, I always wondered what happened to my stories once they reached the other end of the room. It's great to see them experienced, helps me stay present too. If she were concerned with putting herself above me, I doubt she would be as experimental and expressive as she is. As it stands, we both bring something - ourselves - to the table :)
08/21/09 09:27:46
Jeff Tollefsrud wrote:
I believe power differentials are very real, and also think there's leeway depending upon the therapist, as a person and how they interact with the client, including their understanding of their theoretical style and methodology. I think a more equal distrubution of power best exists when the therapist is dedicated to seeing and understanding power imbalances in his/her own life and in social structures; this can illuminate previously unacknowledged power imbalances in our relationships with clients, as well as in other aspects of our own lives. I am thinking particularily of structures such as class, race, culture, gender, and so forth, though class in particular, as the growing focus on power imbalances has tended to ignore class, which often underlies others. Questions as basic as "what power might I experience when I spend money?" and "Do I offset any feelings or experiences of powerlessness through the relative norm of consuming?" These are just starting points, but to inquire about them with honesty can help open doors to the way we experience and employ power in the therapy hour. Certainly, a serious inquiry into one's own experience as a therapist, along with that of one's clients, is a direct way to go. I like analyzing power differentials in other situations because, given that they differ in detail, they can illuminate elements we may not have thought of. As the saying goes, what does the fish know of the water in which it swims?
Jeff Tollefsrud, MFT
08/18/09 23:04:04
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August 17, 2009: Power in Psychotherapy
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