Power in Therapy

Person-centred therapy serves to help the client to develop an internal locus of evaluation – to convey a trust which the client can internalise and begin to trust themselves.

So, while counselling from this humanistic perspective aims to empower, it seems important to ask: What power imbalances inevitably exist within the counselling relationship? and: Are we adequately aware of how they present in the room?

As well as the client and therapist’s perception of their respective societal and professional statuses, their preconceptions about each other and the mandatory reporting responsibilities of the therapist – which are all likely to contribute to the therapist being perceived as holding a role of authority – it seems to me that there is a unique relational power dynamic which affects the relationship and the work in a number of ways. Here are what I feel are some of its contributing factors:

Trust in the therapist: Often a client enters therapy with no experience of counselling or knowledge of what to expect from the therapist. In the introductory session a client is usually given some information by the therapist. In person-centred counselling his might be as simple as “I am not the expert; in therapy we will explore what is troubling you together in order to facilitate the changes you are looking for.”. Whatever boundaries are suggested by the therapist are likely to be accepted by the inexperienced client. If the therapist decides it is okay for the session to run over by ten or fifteen minutes, a client may not object. If a therapist decides to copiously self-disclose, the client may have no frame of reference as to whether this is appropriate in the context of counselling. The therapist has the benefit of supervision to check whether the counselling being delivered is appropriate, however the client often has nobody with whom to check. Which leads me to…

Isolation: There are very few relationships in life which deliver such an intense level of intimacy in complete isolation from all other relationships.  This means that no other person is witnessing the relationship, therefore there can be no objective view on its health and productivity. Even a supervisor is getting a picture of the relationship through the therapist’s filters. As I alluded to above, this means that a client has no sounding board and may not be able to independently ascertain whether the sessions are therapeutic or whether the relationship has become problematic. The BACP’s ‘Ask Kathleen’ service seeks to address this issue, however it is dependent on clients’ awareness that something may not be right and their willingness and ability to seek help. The intimacy of the relationship and the complete focus on the client may also contribute to intense feelings towards the therapist, which could potentially impact on the power dynamics…

Love and attachment: Love and attachment can form an important part of therapy. The therapeutic bond is a vessel for the work and I believe that immense healing can occur when working at relational depth. The emergence of attachment can be a large part of the therapeutic work and many modalities see the client’s attachment to the therapist as extremely valuable to the process.

Love and attachment do, of course, impact on the power dynamic in the room. Attachment towards a therapist often ties into very young feelings and can leave a client vulnerable and sensitive to perceived rejection or inconsistency. To call upon my earlier example of a therapist who allows time to run over regularly, imagine how a vulnerable client may feel if the therapist decides to book clients back-to-back one week and ushers the client out of the room right on time. From an adult perspective, the therapist is doing nothing wrong – last week they had time to go over, and this week they do not, but to a vulnerable inner child, the communication may be that the therapist has had enough of them, or they are no longer good enough or worthy of extra time. Equally with a therapist who habitually self-discloses, what if something occurs that they do not wish to disclose? Perhaps they need to miss a session due to a funeral, or an illness they do not wish to share details of. Of course a therapist does not have to disclose anything they do not wish to, but the disempowerment that a client might feel in such a scenario must not be ignored. 

A client’s feelings of love or attachment to their therapist might also impact on their willingness to make a complaint or seek an opinion on the actions of the therapist. Here lies potential for grooming, gaslighting or abuse, whether conscious or not on the part of the therapist. Additionally, if a therapist were to lose objectivity due to their feelings towards a client, they may discourage the client to leave, thereby not properly respecting the client’s autonomy or even initiate dual relationships.

It is vitally important that we keep all of this in our awareness as practitioners and ensure that we are not using the unavoidable power differences which occur in the relationship in order to meet our own needs.