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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.

 

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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