Power in the therapist-client relationship

I agree on the collaborative piece. I think you and I have similar experiences with our Ts. One of the things that perhaps I've taken for granted is that when we're discussing approaching an issue to work through, my thoughts on how to approach it are taken valuable. I remember once he really thought I needed to approach one problem and we went back in forth (in mutual discussion) over a few weeks. Eventually I pointed out that with my depression the way that it was, I wasn't sure that chasing this other issue was worthwhile at the moment. I called it navel-gazing.

We chatted, he saw my point and we decided, mutually, to table it until later. It hasn't come back up although we've touched on a few surrounding issues and with my depression mostly handled, I'm more open to revisiting it and will likely bring it up with him in a few months.

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.

Exactly this^. A power imbalance or heirarchy is not inherent in therapy (though a therapy situation may be used as a vehicle for abusive action by an unethical practitioner), but rather a projection that the client does or doesn't bring to the situation. And like all learned behaviors, it can be changed.

I went for considerations of power do not apply. I have never felt a power imbalance. I think my T always tries to make me feel like I have the most power, she always tells me that I am in control while I am with her. This doesn't make me feel powerful it just stops me from thinking that she is powerful. Is this the same thing as what this thread is about..?

i guess i feel confused because when i finally told about my former T all everyone told me was about the 'power imbalance'. i felt like what happened was my fault, like i ruined his life by telling. i heard those words so much... power dynamic... power imbalance...etc. eventually hearing that did help me realize that although i did have a part in what happened, that it was my T , the professional trained in ethics, that ****ed up. maybe i am sensitive to this subject but i find it invalidating and triggering to see some people say that client's "give away " their power or something but, like i said, i have been in a uniquely unfortunate situation with a therapist, so perhaps its just my stuff

You cannot "give away" what you never had. Inherent power imbalances--power imbalances that can never be fully equalized--exist. A teenage girl cannot one-up a dirty old creep, tyrant, and abuser.

In NO WAY was anything that happened between you and your ex-T your fault. The only "part" you had in it was being in the wrong place at the wrong time.

As somebody has already said, there wouldn't be all of these ethics rules if every client were able to stand on equal footing with every therapist.

I voted other. I think we both have power just in different areas. I decide what we discuss and when. If she brings something up I can't our refuse to talk about she gladly changes the subject. I can decide I wasn't therapy to end and if I want to see her at a time she suggests. On the other hand she had control over her bounderies, when she responds to emails. Etc. She also gets to decide the days she will see people. She typically sees people 2 days a weekl but she had the power to agree to another day if needs be. I think therapy I'd like any other relationship it is give and take along with lots of communication. Neither person had all the power.

I put Other.

Like everything else here, there is no simple answer. I think there are different kinds of power (philosophers have struggled to define power) and also there are shifts of power. It also depends on the mental illness, the personalities of both T and patient, etc.

Generally speaking, the patient has the power of accepting a therapist or rejecting one. So does the therapist who can reject or accept a patient. The therapist has the power of knowledge of the workings of patient's psyche. He or she also gets to set the appointment time (or rather, we have to choose from her availability time, which can be limited) and the place, decide on the approach, define what the problem is in the first place or what should be done about it, and sometimes is also the one also prescribing medications.

Some people seem to think therapy is like other fairly straightforward professional relationships, like going to buy a a pair of pants. You try it on by yourself, decide if you like it or not and if the price is right, and it's done.

But therapy is a process, so it's not like one day you decide you're okay with the power differential, then it's done. No, every single day it can come up, each time in different shape or form. Psychologically your sense of power oscillates, not only depending on what's going on in life but also the process of therapy.

Even if we accept the premise that the patient is the one who always had the power and the therapist is the one who will help the patient realize that power within them, it still necessitates the presence of a therapist so that they have some power. Therefore I don't see any logic in the idea that patient has all the power. Nor in the idea that therapist has all the power. A therapist needs patients also because that's how they make their living. Nor can they force you to go to them.

In terms of practical concerns, of course the patient can have more power if they have a mental illness that's easy to treat, they have money and access to many good therapists, have a supportive family and friends, and other ways they don't feel desperate or lonely or one way or other, completely powerless in having to stick with whoever is willing to accept them. BTW, that's how some abusive therapists get to have patients who stick with them.

One time I read about a person with borderline personality disorder and very difficult life, who had been essentially rejected by couple of therapists, and she was also barely able to afford therapy, so when she did end up with someone who seemed to know how to treat her and was strong enough and knowledgeable enough to help her, she said she was deadly afraid of losing the therapist and doing the wrong thing. This just added to her powerlessness, and sadly she also saw it parallel to her childhood with her abusive mother, seeing how we all have only one mother, bad or good.

I never found out what happened to her but I hope she was able to have more financial success and able to feel she could sometimes call the shots, and to see the therapists who rejected her as people who were simply not strong enough or able enough to help her and that it was their own shortcomings, not hers. It's quite devastating to feel so powerless in a relationship that should be all about empowering you.

Sorry for the digression.

I don't think either party is powerless, but the therapist clearly holds the power. The client is paying for the therapists time and expertise, so hence it is like a doctor patient, mentor mentee, guru follower, type relationship. And that's whether you as a client acknowledge it as such or not. IMHO

Perhaps...but there are advantages to not acknowledging the therapist's putative power.

Yes, this. Many people are in therapy because they have been harmed or abandoned by a primary caregiver--not just someone they trusted, but someone they depended on for survival. The concept of having power is learned. To suggest that someone in therapy is giving away their power is rather blaming, especially when they are in therapy to work on such things. That's one reason why therapy can be so risky, and why it's important to find a therapist who doesn't feed on the imbalance.

And, I think like with anything, it's important to remember that there can be varying experiences in therapy.

We all have vulnerabilities and, if I had to venture a guess, the idea of "power" comes from the reality that therapists gain unique access to our vulnerabilities. While I answered that power is more or less equal (which comes from my own therapeutic experience), that doesn't mean my therapist hasn't been in a position that if he so desired, he could manipulate me based on my vulnerabilities.

That might be defined as a power differential right there for some people and I could see that. Touching a bit on the medical analogy I used earlier, I see it as like when I go to my doctor for a physical. I'm in a physically vulnerable state (like if I go under anesthesia). So maybe in that case they have power?

I'm just thinking "out loud" since "power" can mean different things in different situations.

I think the analogy works there. In either case, it involves a great deal of trust to let yourself be physically or mentally vulnerable around another person. If you can't help but be vulnerable, because that's just where you're at, you can't help but invest trust, either.

Would it be going too far to say that whenever you trust someone you hand them power along with the faith that they won't abuse it?

Maybe. Seems sort of cynical.

Well, I think in our everyday relationships, when they're healthy, there's a mutual building of trust and vulnerability. With a doctor or a therapist, we generally show up out of a place of illness. We don't go to our doctor expecting them to give us their medical history or our therapist to give us their personal problems. While I think there can be a mutual respect and a mutual trust between client and therapist, I don't think there can be an ethical building of mutual vulnerability since we're in therapy to work on very specific issues.

That would be the goal of having ethics and boards and the ability to file complaints. It would, ideally, balance the power somewhat.

My T could have preyed on my vulnerabilities and I could have reported him (and he would have likely lost his job since he works for a well-known local clinic and it would have reflected very poorly on them).

Of course, that's making it sound way easier than it is. Emotions have a lot of power over the decisions we make and how we respond to situations.

But who or what are you trusting? When I had surgery this fall, I didn't so much trust the surgeon as that a) there would be other people in the OR to observe and correct any wrongdoing, and b) there would be legal and professional consequences for the surgeon if she made any mistakes. I trusted in her skill at surgery, sure, but I did not trust in her innate goodness as a human being (or whatever); I trusted the apparatus in place to make her behave a certain way.

It seems like a lot of trust placed in therapists is placed in them as a person, not regulations governing their profession, and I think that is one source of their perceived power.

Goes too far for me, but I can see what you are getting at. Again, I don't equate trust with power, but I can easily see how the two are tangled up together for many people.

When I trust (which I do pretty easily amazingly enough), it isn't about handing someone power. It is faith; that is for sure, but I don't equate faith with power either. It is more innocent than that I guess.

I mean, our children have trust and faith in us, and I doubt, in healthy parental/child relationships, they are spending much time worrying about the power their parents have when they are quite young. As they get older, they begin to recognize that their parents do have power, but again, in healthy relationships, that isn't something particularly negative AND good parents know how to parent rather than dictate so that their children don't feel like their parents' power is being inflicted on them but rather that they are being empowered to act on their own as much as possible. AND, healthy parents will back off from their "power" and influence as a natural part of allowing those kids grow into healthy adults.

Likewise, a good therapist should be empowering clients to be as autonomous as possible and should hopefully be working towards that time when the client will be comfortable and able to function healthily on their own. I have always had the trust and faith that my therapists were working toward that goal. My most recent therapist probably most clearly explained that very concept to me; it was always quite clear that his goal was never to be the one in power. I was always the person in control, even when I didn't feel it or believe it. Over time, I really began to feel that internal power and autonomy that I didn't trust in myself for most of my life.

Maybe it isn't about trusting the therapist's power. Maybe it's more about learning to recognize and trust our own power. Hmm.

I have never understood until just this moment why I was sorted into Slytherin.

No, seriously, this has all been very thought-provoking. I wish I had something intelligent to say, but it's all just sort of sinking in. Good thread!

I just saw this part of your answer quoted and made me think. Something about the way you phrased it, of handing of power to someone, seems not how I would put it and yet I don't know how I would say it. I mean this might be presuming that we have the power to hand it over, and maybe we don't have the power or that particular kind of power. Maybe all we doing is simply exposing our vulnerability, our sense of being lost or vulnerable, to someone that we've deem worthy of our trust. So we put our guard down as we feel safe enough to trust and let another person see our naked pain and helps us get to the bottom of it.

I think this happens even on this forum. I've at times made a post then deleted it and seen others do the same. Why? Because suddenly we may doubt the trustworthiness of others, fear having overshared. The vulnerability seems dangerous so we protect ourselves. And other times the forum feels like a home and we are not even thinking about it and share and share and then suddenly somebody says something that comes across as hurtful, even with no malice, and we suddenly feel overexposed.

I believe what trust does require is vulnerability and uncertainty. If we knew exactly what was going to happen, we wouldn't need to trust someone. There must be some uncertainty. It's almost as if we're taking a journey and the therapist is the guide and we're walking over some really rocky places and our feet hurting, but T says, "Trust me it will get better" or "Trust me, this is the right path."

Given that often people repress or deny their problems, it does seem logical enough that when we face them, it hurts. So if we go by the idea that if it hurts, it's bad, then we go back to the old way of being, but then life is much less rich and we live in a very limited frightful circle. So we go for therapy and face depression and anxiety and past traumas. But therapist says that with his help and his teachings and the tools he gives us along the way, we will be able to go on and face our demons. That requires trust, but it can be built, especially as we see the result of therapy.

Also I don't think trust is a all or none kind of thing. I trust my sister and my parents and my relatives and my therapist and neighbor and my friend, but to different degrees. And some people I don't trust at all, for instance, a psychopath.

But to bring it back to power, I don't believe therapy works well if the power differential feels threatening enough that we refuse to trust the T. Somebody once said that she trusts only people who have no power or potential to hurt her. But to me that's not trust. That's reality. I mean if I live with an ant, I don't need to trust the ant to be nice to me. The cute little ant can't hurt me (or can it?!! ) But if I am forced to live with a person who previously stabbed someone, I need to be able to trust he won't hurt me, if I'm ever gonna get a few hours of sleep.

Yeah, the trust I placed in the doctor doing my c-section (and the anesthesiologist and others helping with the surgery) was different than the trust I place in T and marriage counselor. It was for a very specific procedure. I mean, yeah, she saw my insides and basically held the life of me and my daughter in her hands. But it's somehow different than the trust I put in a T to hold my emotions and all the stuff I share with her.

This is an interesting consideration. My T has not shared much about herself personally. However, my marriage counselor has shared quite a bit about himself and his experiences, including issues with his father, anxiety problems, stuff with parenting, a couple things with his wife, etc. So in a way, I could see the balance of power being different there, because I know much more about him than my T. But then, I'm also more emotionally attached to him, so I feel more vulnerable (like now, when I'm waiting on a response to an e-mail, which I don't send him very often...).

I think it's also important to separate power or relative balance of power from potential to abuse: there seems to be a tendency to assume on this thread a connection between the two as inherent to therapy. A therapist who abuses is an abuser; there's no reason not to think that if that person were in a different profession, they would still be an abuser, in some way.

I voted none of the above. I think in the beginning, the T has more power. I think the ultimate end goal is for the T and the client to have equal power.

With my t and I, there is no power struggle/ it doesnt apply. We are equals.

I believe the client has the power unless they give their power to the therapist. The only time my therapist has more power is if I am a danger to myself or others and that's only if I talk about it.

Within the relationship, the therapist has the power.
But the patient still has the power to end the relationship.

I feel it is the therapist's responsibility to make sure that power issues do not dominate. That is where Madame T failed.