Power In Psychotherapy and Counseling:
Re-thinking the 'power-differential' myth and exploring
the moral, ethical and clinical issues of power in therapy

Introduction

The Myth of Power-Differential–Direct Quotes

• Scholars, Texts, and Ethicists
• Codes of Ethics
• Feminist Therapy
• Psychoanalysis on Transference & Power
• Attorneys
• Patients as “child-like”

Power in Perpetuity: Once A Client, Always A Client

• Scholars and Ethicists
• Codes of Ethics
• Licensing Boards and State Laws

Clients Come In All Shapes And Forms (of Power)

• Therapists as Clients
• Range of Clients
• Clients’ Power as Portrayed in the Movies

The Origin of The Myth of “Inherent Power Differential”

• Source #1: Psychoanalytic Focus on Transference
• Source #2: Feminist Therapy Focus on Power
• Source #3: Prevention of Sexual Exploitation
• Source #4: Slippery Slope Hypotheses

Types of Power in Psychotherapy

1. Legitimate Power: Designated or legal power
2. Expert-Knowledge power: Knowledge is power
3. Professionalism power: Clout or aura of power
4. Positional or Role power: Professional role as power
5. Imbalance of Knowledge power:
   Knowledge of the other is power
6. Coercive power: Forcing against one’s will
7. Reward power: The power to reward or withhold
8. Reference power: The power of admiration
9. Manipulative power: The hidden scheming power

How Psychotherapists Create Power Advantage

• Transparency, Disclosure, and power
  • The one who gets to ask questions
  • Maintaining therapists’ anonymity
  • Mystification of therapy
• Knowledge is power
• The power to name
• Isolating clients
• Setting the stage
• Perpetuate the slippery slope myth
• The misuse of the term “resistance”
• For your own good – Beneficence principle
• Perpetuate the view of clients as helpless victims
• Meta Communications and Power Rituals
  • Setting beginning and end time of sessions
  • Note taking
  • Patronizing touch
  • Monopolizing the conversation
  • Using jargon
  • Scripted behavior

When Power-Differential Is Valid

• Settings:
  • Inpatient psych. units
  • Correction
  • Forensic: Sanity and Competency to Stand Trial Evaluations
  • Child custody
  • Foster care group home
• Populations:
  • Children
  • Mentally retarded
  • Recently traumatized
  • Persons with dementia

How Power May Shift During Therapy

• As therapy progresses
  • More Transparency
  • Less mystery
  • Client is more autonomous-empowered
• Multiple Relationships
  • Non-sexual
  • Sexual
• Informed consent
• Internet transparency-Google Factor
• Clients’ Actions
  • Not talking
  • Not following advice
  • Taking notes or recording sessions
  • Coming late or leaving early
  • Non-payment
  • Stalking
  • Change sitting arrangements
  • Provocative clothing
  • Use of language
  • Rage
  • Dominating the conversation
  • Inappropriate touch
  • Inappropriate gifts
  • Offering incentive
  • Acting seductively
• Home visits
• Clients who file false complaints against therapists
• Suicidal client

Modern Clients as Consumers

What Is Power?

Power in Psychotherapy and Counseling

• Denial of power issues by clinicians
• Exaggerated view of power by ethicists
• Theoretical orientations on therapist-client power issues
• Seldom discussed issues

The Ethical Way

• General ethical principles and power
  1. Beneficence and Nonmalfeasance
  2. Fidelity and Responsibility
  3. Integrity
  4. Justice
  5. Respect for People’s Rights and Dignity

Towards a New View of Power in Psychotherapy

Summary Points

References