Power in the therapist-client relationship

They each hold different kinds of power. It feels to the client like the therapist always has control, because they know everything about you, and you know nothing about them, but the client holds all the power in what is actually discussed.

Agreed--this is why I voted that the T has the power. Because I do have an emotional attachment to both my T and my marriage counselor. Over the course of a misunderstanding earlier this year, I learned that MC has the power. He probably wouldn't see it like that, and would say that I, as the client, is the one with the power. But he decides under what circumstances he'd see me, whether he'd respond to e-mails/texts/phone calls, etc. Whether to keep us longer than our usual 45-50 minutes (he does this sometimes) or end right on time (or early).

The same with my T. Who also probably wouldn't say she has the power, but from my perspective, she does. They're both the gatekeepers, both in a literal and more figurative sense.

Of course, I guess in a way I've let them have that power by becoming emotionally invested and attached...they have more power over me than previous T's did for that reason.

in my opinion, the therapist/client relationship has a power imbalance with the therapist having more power. for an example, i was a weak, vulnerable, and ill young girl seeing a male T. he developed erotic counter-transference for me, told me, and we began a sexual relationship. seeing as how i was not well, i went ahead with it. it turned out to get way worse for almost 2 yrs before i finally broke down and told someone. in this situation, my former T had power over me. i think there could be different definitions of power- but in a nutshell i do think there is an inherent power imbalance in the therapeutic relationship because of my experiences

I guess I've personally never even thought about my therapy relationships in terms of power. I think of them in terms of support, assistance, interplay, cooperation, give-and-take, but the idea of power just has never been my the radar. Honestly, I don't think of many of my relationships in terms of power now that I think about it.

I guess at work people higher up on the food chain have more power and I have to pretty much do what they ask, but that's just work and the way it is. I guess I think of the therapy relationship more along the lines of other personal relationships I have, and I don't go into personal relationships thinking about power; in fact, I don't think I would stay in a personal-type relationship where power was of any kind of dominant consideration. I suppose the power dynamic is there somehow, but it is way down the list of important factors.

The therapist definitely has the power in the relationship once the client attaches in some way, but the client can (depending on how the therapist sets it up) have equal or greater power in choosing what is discussed and when, and certain choices about method. At some point, though, if it's a therapist that's heavily leaning toward a certain approach--say behavioral—and the client is in disagreement, there will not be any give on the therapist's end. The client either leaves or submits.

If there were not a power imbalance, then there would be no need to have protections in place for the client. The varying levels of imbalance depend on how skilled and ethical the therapist is. I could see some clients feeling equal, and others being totally effed over with mind games and power plays, and everything in between.

The therapist definitely has the power to give, and take away. I felt completely powerless after that.

I'd say it's equal. The T has a certain home field advantage; it's the T's office and area of expertise. But my T can't tell me what to talk about, can't tell me what to do, and even if he tried those things, he couldn't make me do anything he says. If I answer his questions honestly it's because I'm choosing to answer, and I choose that because I believe that my problems will be resolved or at least I'll better understand them, through this process.

So I feel like I have quite a lot of power in therapy. Whatever happens in his office happens for my benefit and by my choice. It is his office, though, so there's that.

I usually don't feel any kind of power either way. I only see t about once a month now. I call or text her asking what's her openings. She gives me options and I choose one. If I don't call for too long she calls to see if I am ok.

But then again i
worried she would disapprove of my engagement so in that sense she has more power as she wouldn't worry if I disapprove of anything. But I also worry if others disapprove of me, not just t. But also that's the only topic i needed her approval as its what I am in therapy for (men and my finances ). Other topics I don't consult her on, I just share with her

I overall don't feel power play or mind games take place. I have no time for this and would be gone. I feel about t similar I feel about other trusted professionals I see ( like my ob/gyn or my financial advisor), I trust their knowledge and value their opinion but I choose what to consult them about and they don't have power over me.

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I'm not sure how to answer. This is a question I've thought a lot about.

On the one hand because I am powerfully attached my T has power. Lots of it. She controls access to a resource I feel desperately in need of ---herself. She decides frequency of sessions, outside contact etc etc. That's all out of my control.

On the other hand,she has invested a great deal of herself u to our work together. And I could just tear it away at any time. As if we were both working on a sculpture together and I just torched it and said " see ya". Assuming she is invested in her work, that would suck.

So I don't know how to answer

I see it as mutual. I have the power to discuss what I need to talk about and he has the power to comment on whether or not he feels I'm on track or off in the ozone.

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When I first started therapy for the first time I felt the therapist had more power than the client. The relationship I had with that therapist was horrible and stopped after 8 sessions. Now, I believe the client has the power. I/my insurance pays my T. I am the one who hired my T and I am the one who can fire my T. I am the expert of my own experience and she just helps to guide me to find my own answers.

I have a question. Those of you who feel the therapist has the power: Do you have a tendency to equate other relationships with issues of power? Do you have a tendency to give other people in your life your power? Do you often feel powerless in life in general?

I don't mean those questions to sound accusatory. I guess I ask them because as I was thinking about this, I realized that power (who has it and who doesn't) rarely enters my mind. In some cases it is because the power dynamic is obvious and sort of a given: employer/employee; law enforcement/citizen; big semi truck on the highway/compact car (okay, that one was being silly). Because those are accepted power dynamics, I don't give them much thought except to stay out of their way so I don't get squashed.

I don't put a therapist in that same category of natural (probably not the right word) power expectations. I seem them more in the same category as other professionals I work with: doctors, lawyers, clergy, fellow educational professionals, anyone I might hire or work with on a professional level who doesn't have the authority to fire me, order me around, etc. I work WITH these people in a variety of ways. I may ask for advice or use their services in some way. We may work together on projects or even learn from each other. But I essentially see them as just one of me. In fact, if one of these type of people tried to pull a power play on me, it would be a huge turn-off, I'd probably seek services elsewhere, try not to have to be put in the situation of having to deal with them on a regular basis if possible.

As I type this, I realize that some people would place a doctor or a lawyer in a much higher power dynamic because they view them as "the authority" rather than as a service. Is that what is going on at least in part if a client places the therapist in higher power than him/herself? Is it that they are giving away their power almost as a survival instinct because they have always felt powerless?

I'm rambling a bit. Just opening up ideas for discussion I guess.

Really good question, Lola. Yes, I definitely do think about power in other relationships. Not friendships or anything like that, but I've always been hyper-sensitive to perceived authority, and differential to it, too. Doctors, lawyers, professors, the police(!)--I've always thought about those "relationships" being hierarchical.

I know, intellectually, that I hire these people and in some respects they're providing a service at my behest. It just doesn't feel that way.

Even waiters would seem to have the upper hand. Yeah, I could leave them a crappy tip, but they could spit in my food. o.0

And, yes, that really does occur to me. If the food isn't right, if the wait is long, if the order is completely wrong I say nothing.

I wouldn't go so far as to say I feel powerless. It doesn't fill me with despair. But I'm sensitive to it and act accordingly.

So I'm willing to say that, yeah, my view of therapist/client power relations may have more to do with me than with therapy in general. And I'm VERY interested to know what other people have to say on the topic.

But see, that waiter thing isn't really logical because you don't give a tip until you are about to leave. The food would have already been eaten. And the wait time order issue, I would take up with the person who has that control, not the waiter, so I'd still not worry about the waiter (and I do let the waiter know I don't hold them responsible for what they don't have control over, not because I worry about their "power" but because I have respect for people who work often thankless jobs and get blamed wrongly for things they have no control over.)

And as I write that response, I realize I am pretty good at seeing who really does have the power and authority and placing the responsibility on the right person which may explain why I don't see the therapist as the powerful one. I was never one to agonize over whether to see a therapist again if after a few sessions it just didn't feel right. I just didn't go back. I had that power. Yet, I often read here about people who agonize over whether to go back or not, how to the let the therapist know without hurting their feelings, etc., etc. It makes me wonder why people walk into a session with a complete stranger, first meeting, and have already given their power away.

That's a good question lola. (I voted that power is equal, btw).

I have and continue to struggle with the idea of power in relationships and I did briefly struggle with this idea in therapy of my T having power. I think, for me, it came from my own inner insecurities. Once I found a place of security in myself, I didn't perceive and I don't perceive a power differential.

I also think there are shades of authority. For example, I go to my doctor and I expect her to be an expert in her field. In that sense she is *an* authority on a subject but she is not *my* authority, like my parents were when I was a child or like my boss would be at work. If I doubt her answers or I think something doesn't feel right, then I would seek out another authority, or expert, on the subject. I perceive my T the same way. He has a PhD, he's trained in evidence-based therapy, and while he may not be an expert about *me*, he does have access to knowledge and training I don't have.

The analogy breaks down because therapy has a heavier subjective component. I can learn skills and apply them in my own life. I can't learn heart surgery and then perform a bypass on myself (yikes).

But you generally have the power to get second opinions, seek out different physicians, even have a voice and collaborate on medical decisions about yourself. So, I still don't give the experts total authority all the time. I do acquiesce to their skill level to avoid the necessity to perform medical procedures on myself though.

By that same token, my therapist has a skill set, a knowledge set, that I don't possess, so I do learn from him, use what seems to make sense to me, throw out some of it, modify/personalize much of it, etc. I see our relationship as collaborative though, not authoritative. I see my pdoc similarly. He certainly has the expertise and knowledge and skill with meds that is often beyond my comprehension, but I make the final decisions and wouldn't have it any other way.

Edited to add:

So, perhaps this is about knowing really who is in power and over what.

It is okay to allow people to have a certain amount of power when they really do have the authority and we need their expertise, but we have to be wise enough to know who really does have the authority and only give them the authority over what they really need to be in charge of. When we give people power over things that we can control and manage ourselves (and probably should be), we are giving away our own power to someone else, and in a way, that creates that feeling of our own powerlessness and can really create a vicious cycle.

The power I see with mds and hospitals (and insurance companies) is that once in the hospital - it is hard to get out without their permission. They threaten, coerce, imprison and so forth to inflict what they want upon you. I do figure out alternative methods or just live with 99.9% of the things that may afflict or befall me. Dental work still eludes my grasp however and so dentists are still a necessary evil that I have chosen to deal with.

A therapist may call the police upon you, but as I make sure I don't see ones with reinforcement - I can leave and although police could be called, I simply would not go home if I thought that was a possibility. I would go to the neighboring state or a different city for a few days.
(I know how it works in the two states near me because I work to get clients out of their clutches - I know how to avoid it).

I don't think it's a mystery. You get told enough times that you're a piece of ****, you start to believe it. You get abused by authority enough, you get hyper-vigilant to further abuse. You learn that abuse can be prevented by deferring, you start to preemptively defer.

In short, it comes down to a learned pattern of thinking and behavior where you assume that others have authority, expect them to abuse it, and try to protect yourself by knowing your place.

When this pattern no longer becomes adaptive because your circumstances change, you get lots and lots of therapy.

For me, personally, the most healing (non-skills based) aspect of therapy has been the novel experience of not having someone in a position of authority (authority assumed and conferred based on status as middle-class, educated, white, male) **** with me.

Technically true, but in as much contact in my lifetime that I've had with M.D.'s and therapists (and it is A LOT), I've personally never had that issue come up or even feared it when perhaps it could have been a possibility. Those would have to be some pretty extreme circumstances. Some of my luck though wasn't "luck" at all. I specifically and carefully choose my M.D.'s, therapist, pdocs, etc. so that they aren't the sort who would easily resort to such actions, and they know I expect to be an active participant in my own care and decision making. They respect and honor that, even in some pretty hairy situations.

But then therapy becomes a place to learn that you have power, right? You said in the other thread that you felt the balance of power had changed throughout your relationship with your therapist (which is why that's a poll answer ).

So if you were to walk into a brand-new therapy relationship right now, would you go in assuming that the therapist holds more power than you?

I agree with that. What is good to realize is that, as adults, we can change our patterns of thinking and reaction over time with good therapy and/or a different support system.

Our experiences and observations are different. I have seen it enough in my profession, some with my sick person, and a tiny bit personally with an md years ago in a non-mental health area - to be extremely wary and cautious. It is one of the reasons I became a lawyer.

That's the idea, yes If I were to walk into a brand new therapy relationship I honestly still would see the T as an authority figure (habits are hard to change) but one with MUCH, MUCH less power over me than I assumed at the beginning of this first therapy relationship.

I think in general, the power is pretty equal between the therapist and the client. But if the therapist is abusive in any way, that would give the therapist more power. But I feel like that's true in any type of relationship, not just in therapy. When people are abusive, they have more power. But I think when a therapist is good, there isn't a huge gap in who has the power.

I think, for me, the power didn't come from authority but more of a f*cked up dependent love (platonic). When you love someone and want to feel safe with them, you ignore a lot of things that would normally be red flags. I was vulnerable from the beginning: isolated, depressed, barely functioning, and scared. So yes, I think I gave my power away quickly. I was desperate to feel like I mattered.

Plus I was not paying her, which made this more skewed.