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Rethinking 'Inherent Power of Therapists' & 'Power Imbalance' in Psychotherapy

Clinical Update
By Zur Institute

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Our online course, Power in Psychotherapy and Counseling:
https://www.zurinstitute.com/power_in_therapy_course.html

 

How powerful are therapists, really?
Do we actually have all this power over our clients?
Are all our clients vulnerable and dependent?
Do clients ever have superior power over their therapists?
Do clients sometimes harm their therapists?

Dear Colleague,

I invite you to start the New Year with a reflection on issues of power in psychotherapy and counseling. Thoughts and examples from your own practice where clients were or are more powerful than you, as a therapist, are welcome.

Let us begin with an example: I once worked with an extremely successful, wealthy and highly educated client (J.D., Ph.D., MBA) woman attorney who used to tease me by saying: "You think you, with your license, degree and professional aura, have all that power over me. Like so many of your colleagues, you probably believe that with a snap of your fingers you can get me into bed with you. Let me tell you about power. I am wealthier than you are and more educated than you are, which gives me more power than you have. Also, I am professionally more successful than you are and, most importantly, with one call to your licensing board I can destroy your reputation and your entire career."

Harsh words, but not without truth.

We have all come across the terms power differential or imbalance of power in our professional literature. Ethics and risk management workshops regularly warn us never to abuse the power position that is inherent in our role as therapist. Mailings from our licensing boards and professional organizations tell us we must always protect our vulnerable clients and never exploit their dependency. In fact, it is true that our expertise and license give us some power over our clients, and we therapists should never use this power to exploit or harm our clients. It is also important to acknowledge that many clients seek therapy in a time of crisis and vulnerability.

Most seasoned therapists have worked with high-functional, successful, established and powerful clients. Many of us can also easily recall working with threatening psychopathic or anti-social clients. The professional literature reports situations in which clinicians have been bullied, threatened and stalked. In recent years, numerous therapists have been reported to licensing boards by disgruntled parents who disagreed with the custody recommendations provided by their therapists. And then, as experienced attorneys remind us, "You are always one borderline away from losing your license."

Generally, power is the capacity to direct or influence the behavior of others, or the course of events. Unlike the simplistic view of powerful therapists treating powerless clients, in reality power relationships are very complex and multidimensional. Accordingly, there are many types and forms of power. Following is an incomplete list of different types of power.

  • Legitimate Power: Kings, judges, policemen, and licensed psychotherapists have this kind of power.
  • Coercive Power: Capacity to force someone to do something against his or her will.
  • Expert Power: Related to knowledge and skills that one acquires via education, degrees, experience, etc.
  • Reference Power: Derives from people admiring or desiring to be like another person.
  • Reward Power: The ability to give or withhold what another person wants.
  • Personal Power: Derives from a person's charm, attractiveness, charisma, force of personality, or one's capacity to manipulate, elicit guilt or threaten others.

So, how powerful are we therapists, really? In my latest book, Boundaries in Psychotherapy (APA Books, 2007), I wrote on the subject of power: "In the power differential argument against boundary crossing, clients are often portrayed as passive and malleable, even defenseless, perceiving their therapists as strong and superior. In reality, many therapists work with clients who are much more powerful than they. Some clients are CEOs of large corporations, judges, powerhouse attorneys, master mediators, or successful entrepreneurs. Often, these clients do not regard their therapists as particularly powerful or persuasive, but as professional listeners or facilitators and, indeed, they may, simply by virtue of their roles in life, exert a power and influence of their own over the therapist."

Many authors have written on ways that some psychotherapists perpetuate the power imbalance between themselves and their clients. Good resources include Arnold Lazarus' The Illusion of the Therapist's Power and the Patient's Fragility (Ethics & Behavior, 1994), Thomas Szasz' The Myth of Mental Illness, Robyn Dawes' House of Cards, Paula Kaplan's They Say You're Crazy, and Richard Schwartz' recent piece in Harvard Review of Psychiatry (V 13/5). See also Manufacturing Victims: What the Psychology Industry is Doing to People by Tana Dineen and my article, DSM and Power.

Of course, there is much more to discuss, reflect, argue and debate. You are invited to email me your brief thoughts and short clinical vignettes at info@zurinstitute.com. Please, be very succinct. I promise to keep your responses anonymous and confidential.

Feel free to forward this email to friends and colleagues

Happy New Year!
OZ

 

 

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