Power in the therapist-client relationship

The topic has come up in another thread, and deserves its own thread.

Who do you think holds the power in the therapist-client relationship?

I am talking here about the traditional therapist-client relationship: not inpatient, but people who have regular sessions, etc.

I am not talking about:

-inpatient mental health services
-psychiatrist relationships, given the power of an MD to prescribe medications and hospitalize
-situations in which a therapist might be testifying in court in relation to the client's affairs, e.g., a custody case

So in a "normal" therapist-client relationship, who holds the power?

I put I don't know or othr as I see my T holding the power in the relationship but he keeps saying I have the power in the relationship. I suppose one day I will take power in the relationship and then I think that is the end. I am not thinking straight and I may add things on later.

I really always thought it was a given that power was skewed toward the therapist. They're the experts, right? We go to their offices for their expertise. Often we go in considerable distress and with considerable vulnerability.

Does the fact that we pay them really equalize it?

That's fine...I just thought of a seventh poll answer but of course can't edit it.

It does equalize it for me. It may not be the same for others.

If they abuse that vulnerability, I walk.

As for their expertise...they are only experts if we recognize them as such.

I or my insurance pay.
I have the power to end it at any time and walk out.
Even inpatient I hold the power to agree or disagree to a therapeutic relationship.

I think there are so many contextual variables, but honestly I think it all boils down to how vulnerable the client is. I know when I first entered, I was in a straight-up crisis. Didn't know my *** from my elbow. I was desperate for an expert. If T had told me the sky was green, I'd have believed him. If he'd abused my vulnerability, I wouldn't have been able to walk.

Of course, the story is much, much different when you enter therapy under different circumstances. Obviously it varies person-to-person.

I guess the real question is, is there an INHERENT power differential? I don't know. I'm still tempted to say it skews toward the therapist.

Never did post that link. Here it is: Power in Psychotherapy and Counseling Including Issues of Undue Influence, offered by Zur Institute, Inc.

I think both the therapist and the client have power in the relationship. I used to think the therapist had all the power until I had a talk about power with my T. She said that one of the most important things she learned while training to be a therapist was to never hold the power a therapist has over the client. The balance of power needs to be equal and it is in our relationship. She said she wouldn't be able to sleep at night if she abused the power she has as a therapist. This made me feel so much better and see her in a whole new light.

Ultimately, I think the client as the power, but they may not know it in the beginning. At lease that was my experience. I payed her for her services, and I could walk anytime, even if I was worse for the wear. For me, therapy was about finding my power and using it to negotiate my way through life. Even wield it if necessary.

My T has proven to me that SHE has the power in the therapeutic relationship.

ETA, the only power I have is to leave.

I think some of the power dynamic comes from our roles, and some of it from our own personalities. I have had several therapists that I actually felt sorry for, and my perception was they had far less power than I did - they seemed not quite up to the task, or dim-witted, or wounded.

My current therapist is very good and smart, so I don't feel that way about him. We both tend to be pretty anti-authoritarian, so neither of us are inclined to give a lot of power to his role, but sometimes I do notice that there are situations where he does seem to have more power than I do because of his role (like he can set the fee, and he changed his office location and if I wanted to keep seeing him I had no choice but to go to his new place), while he mentioned when we had a rocky spot that he was concerned I would want to quit. I feel like our power switches off a bit that way.

Power and authority are pretty big themes in my therapy, but the dynamic in our relationship is not problematic, as it feels very much in balance and appropriate. I feel like we're equal - it probably helps that in terms of education, financial status, age, family background, etc, we're pretty similar.

I think that the therapist and the client have different types of power (maybe?) but that the therapist definitely has an advantage here.

I have seen my therapist in 4 different offices now. He clearly has the power to dictate where we're going to meet. I don't get a say (other than, when he's simultaneously using two offices on different days, I can request an appointment at either one).

My therapist sets his fees. He has the power to reduce them or raise them. He's already raised them once, and he's really expensive (but he was kind enough to allow me to continue paying the old rate). I have no say about this, other than to quit if it becomes too expensive.

My therapist defines his policies, as he should. But, one policy is that he requests 3 days notice (72 hours) to cancel a session. That's 3 *business* days, it doesn't count the weekend or holidays. Again, he has the power to disregard that, and not ask me to pay for a missed session in case of an emergency - but it's up to his whim, not mine.

For these types of things, my only "power" is to quit if I disagree.

The problem is... what happens when you're vulnerable or have no other source of support? Most of the people that I used to count on are gone, or unavailable. My therapist is really *it*. So, walking out becomes a much less viable option.

On top of that, some of us take a really *long* time to get comfortable and open up. Exercising our power to leave means (at least to me) starting over at square 1 with a new therapist. I don't know if I can deal with another year and a half of trying to just get comfortable. It feels like walking away, my "power", ends up hurting me worse than my therapist...

We give our power away. We fantasise someone else has power over us. That gets world out in therapy

The office, the fees, the cancellation policy is rather like that of other professionals. I am an attorney - I set my fees and clients come to my office and so on. I can choose to bill for things or not (I rarely charge for phone calls for example) as the occasion arises.
I don't see the therapist as all that supportive so I would never look to them for that.
The only power they have that I see is that of wily manipulation at the client - and I take care to guard against that. I think they lie but as I rarely believe anything the woman says - it really does not matter for me.

In addition to the practicalities of therapy mentioned here, I think the therapist holds other powers in the relationship: the power to set boundaries about contact out of session and touch, the power to engage/encourage attachment, the ability to terminate us at his/her will with nothing but a referral to another therapist(s). However, I think that the we hold the power in how much importance we give to those things and power over our boundaries and what we will tolerate from the therapist we're seeing. We have the power to speak up for ourselves and to leave. I think both parties hold power; however, I think only the client will suffer emotional harm from a t's misue of power.

My T is a DBT T and he quotes from the DBT philosophy that therapy is a collaboration between equals. In the years I've worked with him, that has always been the case for me. There's mutual respect, I'm treated a competent adult. I have ownership of my therapy and I feel empowered.

I wasn't sure if this question specifically pertained to each individual's client/therapist relationship. For me, it has always been me who holds the power. My therapist has always made it very clear that *she* works for *me*. I am very open to her help and I have faith in her that she knows what she is doing, so I am comfortable with telling her my issues and seeing where she leads me on my journey towards healing, but at the end of the day, I am the one who pays her and I am the one who chooses to accept her services. That all being said, in session, there is a pretty clear atmosphere of team work. If we aren't on the same page, it makes for a very dismal session.

My prev t recommended the old sci fi movie with Anne Francis and robby the robot - i have to google the name - regarding power, but still i couldnt see the forest for the trees. Ah - the forbidden planet.

Client and therapist share power in the relationship - right up to the point the client becomes emotionally invested, at which point the power is immediately transferred to the therapist.

The only power the client ever has is whether or not to remain a client. The therapist gets to choose time, place, fee, how much support they will offer, whether or not you can call them outside sessions, whether or not they will take off for two months on vacation, etc, etc, etc. More importantly, the therapist is never, ever as dependent on the client as the client is on the therapist if emotions come into the picture.

As long as therapy is an emotionless business transaction, it's an egalitarian relationship. But therapy is very rarely that. Most people become attached to their therapists on some level at some point. (Not all, but most.) And as soon as that happens, they're screwed. Because emotional transactions take place in a completely different realm than financial / business ones do.

Any client experiencing attachment, transference, regression, etc, is at a disadvantage. And therapists know this, which is why there are a zillion rules around sexual contact, outside relationships, etc. A therapist who has sex with a client is abusing their power - so it's not even really a question of where the power lies, because it's pretty much enshrined in the basis of therapy.

Most people don't like being at a disadvantage power-wise, which means they develop all sorts of coping strategies to deal with it. They can try to distance themselves and refuse attachment, or deny that the attachment once it exists, actually does exist, or they can simply suffer through it (which is what most people tend to end up doing, and as long as the therapist doesn't screw you over, you'll be okay.)

The power imbalance is my absolute least favorite part of therapy. I could, of course, withdraw and hold myself at a distance, but for me that would completely defeat the purpose of going in the first place, so it's a catch-22.

When I was seeing my ex-T I felt that she abused her power. She expressed views about how I should live my life, she talked so much it was overpowering, she was selective about the things she responded to when I spoke, and by doing this she dictated the direction of our session. I brought up the issue of power with her but she never responded to this so we didn't discuss it. With my new T power doesn't feel an issue. I have a general feeling that the therapeutic relationship is perhaps far more important to me than it is to my therapists, and this creates a power imbalance.

The therapist should always respect client autonomy, and I think autonomy issues played a big part in my first therapeutic relationship failing.
With T2 I am in charge of my sessions. I go knowing what I want to achieve and trusting my own gut about what I want to talk about and what I don't.
There was one session where T was being more directive and steering the session. It was only after, when I thought about it that I realised how confusing and unsettling I had found it. The next session I said I wasn't happy with the feeling of not being in control of the direction of the session. He explained he was 'feeling anxious' about the direction of the session (he didn't explain any more and it wasn't necessary) and he said he would work on it in supervision.
Other than that one time, I have always felt in control with T2 and that's the way I like it.

I personally think that in a healthy therapeutic relationship both therapist and client have equal but very different power.

The fact that there is a very significant difference between the two in what regards self-disclosure (and normally also in what regards knowledge of psychology, psychotherapy, several cases, etc), grants the therapist more power. This is a power to understand the other in the context of their life story, a power to explicitly know the client and help him/her change, a power to be more in control of own emotions and reactions during sessions, to be the more stable person that the client usually needs (ideally and at least for the duration of the sessions), to contain the client's emotions and experiences. I think most clients need their therapist to be at least somewhat more powerful than themselves in these ways, because otherwise the therapist may not seem credible or any more helpful than a trusted friend.

On the other hand, I also think the client needs to be the more powerful of the two when it comes to choosing where to next, how far and how fast, how much or how little to be involved in the therapy process at different times, whether or not to continue therapy, whether or not an intervention is useful to the client or if maybe the client prefers somewhat of a different approach. Without this, the therapy would become more about the therapist than the client. So I think the client is the only one with the power to truly know him/herself and the power to change. (Of course, therapists can also change, but no therapist can change the client - only the client can do that).

So I really think that the therapeutic process is co-created and the people involved need to have the same amount of power so that it doesn't become an exploitative relationship, but at the same time it needs to be d ifferent forms of power so that it doesn't become a power play or a friendship.

I think it's equal. I can terminate at any time. She can try to have me sectioned anytime.

For me and t it's pretty much equal. I like what Walkedthatroad said about "finding my power and using it to negotiate my way through life" that's what I feel like I have been about in therapy.