Power in the therapist-client relationship

I agree. But you probably had ethical therapists. This isn't a blanket situation, but it is one way there can be a power difference. And you don't sound as emotionally dependent as I was in the first place. Or struggling as much.

Some therapists foster dependence. Mine did. She kept telling me total trust was healthy and dependency was okay because I couldn't look after myself. When
i said I was worried I wouldn't survive when she retired, she said to come with her and to start learning Spanish. No healthy person would think this dynamic was okay, but I was not a healthy person. Promises not to abandon you can be very very powerful when you grew up in neglect or abuse, and the fear of losing that safety can be a very, very strong and powerful force.

Oh yes, I absolutely had ethical therapists which is why I said I've been quite fortunate in therapy that way. I was in my earlier years much more emotionally dependent and as far as struggling goes, I have been through years and years of struggle in the past. (I didn't write my post in response to yours by the way; I think we cross-posted.)

In some situations, the client's power is neither given up nor taken away; it is gradually bled out of them as they reveal more and more emotional material.

The only way you can have parity in terms of emotional and psychological power is if there is equal vulnerability and disclosure (which is basically never the case). The more lopsided this becomes, the more exposed the client is to manipulation or wounding.

But that assumes one chooses to be dependent or not. Therapy can create strong attachment, and since early attachment is buried in implicit memory and cant be consciously accessed, the client might have little control.

I would also add that sometimes it's all about timing. Even the strongest person, given sufficiently devastating loss or illness or isolation, could become dependent.

Actually, no. I don't assume one chooses to be dependent or not at all; I think that is something that happens in the course of any relationship and can't really be planned or chosen. But dependency can be healthy. Not all dependence is unhealthy. It just isn't that black and white. It is possible to have healthy attachment and dependence. So often those concepts are thought of as negative, but the hope is that we can learn in life that we can develop healthy attachment to people with a healthy level of dependence.

This is what happened to me ^. I was pretty self-sufficient and tough. Wasn't rejection sensitive, wasn't needy, did not have attachment or abandonment issues. Had life stability, overcame a lot of diversity, and had a history of some generally good relationships and accomplishments.

New to therapy, the dependency feelings were brought out in by the relationship with the therapist within a month. The therapist was very aggressive. I had used dissociation during much of my childhood, so after interacting with this therapist, I was flooded all at once with somatic/pre-verbal and also later memories and had a breakdown. The dependency and attachment feelings came out as flashbacks. For example, I had very strong stomach pangs as longing feelings for this person who was basically a total stranger to me 2 weeks prior. It's as if I was possessed by something when I picked up the phone and called him when I had the longings (later realized these somatic type of memories are not uncommon with dissociation which starts pre-verbal) This was not something I could choose!

When feelings don't match the situation, they can sometimes be thought of or evaluated as a PTSD reaction. I developed full-blown PTSD. Since then, I've spent years and thousands on therapy trying to be stable and productive and content again. I struggle every day of my life. I turned into a mess and have never really bounced back yet. I am trying though. Lucky for me, I have a good therapist who I feel mostly safe with. Even with that, I still fear the ending will be traumatic for me and suffer with abandonment fears on a weekly basis.

The younger the trauma, the more the defenses are woven into your self and cognition. It can be really dangerous for a therapist without competence to provoke the collapse of these defenses. What happened to me was really dangerous. This is not the same as managing feelings within the realm of natural relationships. These are flashbacks, dissociated content, PTSD, whatever you call it. It never was a choice.

Who in the world would have choosen to experience what I just described? I also feel like I don't have much choice but to work through all this now. My other choice is not to work through it and try to get better through different means. Not really feeling empowered as my choices would have been much different had the therapist let me decide when to process these memories rather than forcing them out.

I suppose that is what happened to me this fall with a series of life crises. My reaction was to withdraw, but that's my usual reaction to extreme stressors, so of course I withdrew from my therapists as well. The relationships suddenly felt different - I felt even less need for them than usual (and usually I just see them as a necessary evil). And I was much more aware not of the power to leave - I was always aware of that - but of a willingness to do so. The more stuff came down the pipe and hit me, the more I was willing to tell everyone and anyone to go stuff themselves. But I would not be surprised to learn that my reaction is atypical.

I am not willing to say categorically that any client power is merely theoretical and can easily be outmaneuvered by the therapist, because that is not my experience in therapy or in life, but I see how it could indeed be some clients' experience.

I was reading between the lines of your response, and guessing at your drift, so I stand corrected.

Yes of course dependency in general can be healthy. But the question is whether it is likely to be healthy in therapy. Naturally there will be cases where it does work out, but I would argue that in general it is not a good idea to develop emotional dependence on a person that you can never really know and who is being paid to work with you (and who benefits from keeping you around). Some ethics codes warn against it.

Witness the many interminable therapy relationships, the cases of traumatic client abandonment, the endless difficulty around termination.

I think it's interesting that there are more people who believe that the Therapist holds the power. The only logical conclusion I can come to regarding that is that people are often seeking therapy at their worst. Likely they are there because they feel powerless and out of control.

For me, my therapist has set the stage by telling me "What this means is that you would come to session and talk about whatever you wanted and I would work with you on uncovering your emotions so that you could feel more safe in certain situations as well as discovering a lot more about yourself and how are you organizing your behavior which we do unconsciously, which is why it makes it so difficult to change our behavior."

Nothing happens until I start it. Therefore I have the power. At least that's how I see it.

Perhaps we could say that good/effective therapists acknowledge client power and even (as some responses here state) tell the client they do have power and that bad/abusive therapists don't only not acknowledge client power but subvert, undermine, and deny it in every way possible?

This is part of the issue too. And I admit that I was very unwell when I started therapy and she was out of her depth. Where I am now (hospital outpatient psych), everyone there is fairly sick. But what I can't figure out is why she didn't ever refer me up.

A lot of people end up in therapy at their worst. A lot if people have serious mental illnesses. A therapist should either be able to work with that without creating further damage or else refer the client to more specialized/higher level care, preferably at the beginning.

But there are many cases on this forum where it's more than just the client feeling powerless or out of control. There are many cases of just messed up, dysfunctional behavior on the part of the therapst. And blaming the victim for the issues they are there to address is a bit crazy to me.

There's a certain irony in this post, especially when you more or less say: 'I know I have power because my therapist told me I did.'

If you have power, nobody needs to tell you that you have it. It's obvious. And also, if you have power, there does not need to be a complex set of structures to protect you from the therapist in the form of social and sexual boundaries.

Honestly, I think anyone who doesn't acknowledge that the therapist has the power is in a form of denial. Maybe it's too uncomfortable to admit that someone who puts hard lines around how and when you can contact them is definitely the one in charge. Therapists play power games constantly in a myriad of forms - even the good ones.

I just think most people either overlook it, don't particularly care, or don't want to deal with the cognitive dissonance the therapy relationship creates.

People who are sensitive to power dynamics are going to be incapable of ignoring it though. I actually think people who are aware of the power dynamic in therapy are more able to protect themselves than people who pretend it isn't there. A lot of people get blindsided when the power imbalance suddenly hits home unexpectedly.

Your therapist decides when you meet, how long you meet for, whether you can email them outside therapy, whether they will suddenly go away for a few days or three months - the client has essentially no control in a therapy relationship apart from maybe what to talk about in session.

And I think that's where you're confusing your ability to pick the topic you talk about with who actually wields the power - because they're not the same thing. You can pick the topic sure, but it will a) cost you and b) end when the therapist dictates it should end (the end of the session.)

Pretending that makes you in control is just... inaccurate.

Denial's working out pretty well for me, thanks. I get what I want out of therapy, I tell them what I want them to do (and they do it), I criticize them. I don't bear any scars from nine months of therapy, and it's partly because I always knew this relationship existed at my whim. Any time I even found myself liking one of them, I would firmly remind myself that they were an employee. And that if they did any wrong I had the means and the resources to see that there would be professional consequences for them.

Now that is not a common experience, it sounds like. But it is an experience. So please don't tell people like me and the poster you're responding to that we're not in touch with reality. We are. Our reality.

It especially bothers me that the poster you responded to clearly benefits from that sense of power, and you're trying to take that benefit, that security away.

My opinion is that it is more dangerous as a client to assume the therapist has power than to assume that the client has it. That is not shared by all, probably not even the majority, on this thread, for many different reasons. And that is fine. Let everyone do what works best for them.

My therapy and therapist were atypical. And I was able to decide those things. I eventually set the price, when I would pay her, when we meet and how long. I, even substituted payment for volunteer work of my choosing. One December I saw her every single day, just like an advent calendar, only because "I wanted" to. In my mind meeting every day would somehow give me strength to get through the holidays with my FOO on the other side of the country. She was willing to meet me where I needed to be atm, so that I could feel like I had some control in my life. She did her own work in therapy, and was solid enough to do what I needed to heal. What most likely would normally needed a decade or more of therapy,if not life long, took 18 months. Granted she will only take on 1-2 clients at a time that requires from her what I needed to heal.

Now, we have a friendship and it works just like any other healthy relationship. No, imbalance of power.

Ugh. If my comments as to how I perceive the relationship 'take someone's power away', then they didn't have it in the first place. I don't write posts here to create reality. If my posts had that power, I'd be wasting my time here.

I speak my truth as I see it. You're free to speak yours. And people are free to believe as they wish.

Also, the poster I replied to had quite a lot to say about how people who perceive the therapy relationship to be imbalanced must feel and be and think. Funny how when I say precisely the same but opposite thing it's a problem.

Your reality should remain intact regardless of whether I say people who believe themselves to be in an egalitarian relationship while paying someone to play by their rules are lying to themselves or whether I say that paying someone and following all their rules is the ultimate expression of equality.

It's written into the very code of therapy that the therapist has the power. It's enshrined in all the literature. And therapy is structured to reflect that.

I'm sorry if pointing that out bothers you. Feel free to reject my reality and substitute your own.

Denial apparently has worked well for me too. Power hasn't been an issue/factor in my therapy. I have been empowered by therapists who have finally been the people in my life who listened, who supported, who validated what I had experienced. They didn't give me "permission" to learn those things about myself. They simply created a healthy setting in which I could heal.

Please do not insult those of us who have a differing experience, a healthy experience, from your own by saying we are in denial or somehow pretending that our experience is what it was. There is no one cut and dried formula for therapy. There is no one type of client. There is no one type of therapist. To say that "anyone who doesn't acknowledge that the therapist has the power is in a form of denial" is completely inaccurate.

I'm not even sure that a power imbalance in itself would mean that a relationship couldn't be healthy, helpful or healing. It's more a question of whether that power is resoected or abused.

I admit I gave away my power in that relationship, but I think im the right context it would have made me feel safer and more able to heal and regain strength and power in the world. I trusted her to guard it and protect me, and she didn't even try to minimize the harm.

So I don't even think a power inequality in itself is neccessarily harmful, but it *can* be.

This is very true. These days it's often assumed that just having power is bad, and I disagree. I obviously do not believe that the therapist has the power in the relationship, but if you do believe that, it doesn't mean that the power will be abused or that the therapist won't be helpful.

Seems to me the way to know who has the power in therapy is to ask the question--who will suffer if it ends tomorrow? If there is emotional investment on the part of the client (as SM mentioned), then how could it not be the client who will suffer exponentially more?

I have been in therapy where stopping had little impact on me, and that's because nothing of significance had occurred and so it wasn't really therapy at all. In another case stopping was traumatic because I was so emotionally and psychologically defenseless, having dared to develop a secure attachment and to risk openly exposing the full extent of my need for the T (to paraphrase one psychologist).

I am 100% invested in my therapy and I would not suffer because the relationship ends. My therapist and I have a great working relationship. I have made tons of progress and will continue to with her or someone else(if she were to end it). I wont give anyone that kind of power.

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Agree with DD. I just ended with two therapists for at least six months if not permanently, and I am not suffering at all. I do think of them on occasion, in terms of implementing practical suggestions they gave me to deal with crises, but I don't miss them. And I certainly was invested in the therapy, it certainly was therapy, and it was useful.

Therapists are replaceable to me, you see.

Has it occurred to you that there is not a single definitive answer to the question of who holds power in the relationship? I did not expect there to be one when I started the thread, and the variety of responses proves that.

I don't miss them when either of us is away or cancels appointments for what ever reason. The idea of leaving them or them me is not distressing.

I don't follow this at all. Please help me understand. How can you be 100% invested in anything and not suffer significantly as a result of its loss?

It was never devastating for me either. Even as highly emotionally invested as I was, as long as I had worked with each of my therapists, I didn't suffer when it came to an end, and in two cases the circumstances were very much out of my control. I would have loved to keep working with them, but it wasn't possible. Yes, I was sad, but suffering? No. I moved on and eventually found another therapist to continue my work with.