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Power In Psychotherapy and Counseling:
Re-thinking the 'power-differential' myth and exploring
the moral, ethical and clinical issues of power in therapy

By Ofer Zur, Ph.D., Director, Zur Institute
 

This Table Of Contents is also the syllabus for: our online course, Power in Therapy for 6 CE Credit Hours (CEUs).

This course fulfills the California and other states' ethics and law requirements. Course may qualify for insurance discount. Check with your insurer.

 

Table Of Contents

Introduction

The Myth of Power-Differential–Direct Quotes

  • Scholars, Texts, and Ethicists
  • Codes of Ethics
  • Feminist Therapy
  • Psychoanalysis on Transference & Power
  • Attorneys
  • Patients as "child-like"

Power in Perpetuity: Once A Client, Always A Client

  • Scholars and Ethicists
  • Codes of Ethics
  • Licensing Boards and State Laws

Clients Come In All Shapes And Forms (of Power)

  • Therapists as Clients
  • Range of Clients
  • Clients' Power as Portrayed in the Movies

The Origin of The Myth of "Inherent Power Differential"

  • Source #1: Psychoanalytic Focus on Transference
  • Source #2: Feminist Therapy Focus on Power
  • Source #3: Prevention of Sexual Exploitation
  • Source #4: Slippery Slope Hypotheses

Types of Power in Psychotherapy

  1. Legitimate Power: Designated or legal power
  2. Expert-Knowledge power: Knowledge is power
  3. Professionalism power: Clout or aura of power
  4. Positional or Role power: Professional role as power
  5. Imbalance of Knowledge power:
    Knowledge of the other is power
  6. Coercive power: Forcing against one's will
  7. Reward power: The power to reward or withhold
  8. Reference power: The power of admiration
  9. Manipulative power: The hidden scheming power

How Psychotherapists Create Power Advantage

  • Transparency, Disclosure, and power
    • The one who gets to ask questions
    • Maintaining therapists' anonymity
    • Mystification of therapy
  • Knowledge is power
  • The power to name
  • Isolating clients
  • Setting the stage
  • Perpetuate the slippery slope myth
  • The misuse of the term "resistance"
  • For your own good – Beneficence principle
  • Perpetuate the view of clients as helpless victims
  • Meta Communications and Power Rituals
    • Setting beginning and end time of sessions
    • Note taking
    • Patronizing touch
    • Monopolizing the conversation
    • Using jargon
    • Scripted behavior

 

When Power-Differential Is Valid

  • Settings:
    • Inpatient psych. units
    • Correction
    • Forensic: Sanity and Competency to Stand Trial Evaluations
    • Child custody
    • Foster care group home
  • Populations:
    • Children
    • Mentally retarded
    • Recently traumatized
    • Persons with dementia

How Power May Shift During Therapy

  • As therapy progresses
    • More Transparency
    • Less mystery
    • Client is more autonomous-empowered
  • Multiple Relationships
    • Non-sexual
    • Sexual
  • Informed consent
  • Internet transparency-Google Factor
  • Clients' Actions
    • Not talking
    • Not following advice
    • Taking notes or recording sessions
    • Coming late or leaving early
    • Non-payment
    • Stalking
    • Change sitting arrangements
    • Provocative clothing
    • Use of language
    • Rage
    • Dominating the conversation
    • Inappropriate touch
    • Inappropriate gifts
    • Offering incentive
    • Acting seductively
  • Home visits
  • Clients who file false complaints against therapists
  • Suicidal client

Modern Clients as Consumers

What Is Power?

Power in Psychotherapy and Counseling

  • Denial of power issues by clinicians
  • Exaggerated view of power by ethicists
  • Theoretical orientations on therapist-client power issues
  • Seldom discussed issues

The Ethical Way

  • General ethical principles and power
    1. Beneficence and Nonmalfeasance
    2. Fidelity and Responsibility
    3. Integrity
    4. Justice
    5. Respect for People's Rights and Dignity

Towards a New View of Power in Psychotherapy

Summary Points

References
 

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