Power dynamic in therapeutic relationship

Day, Andrew (2010) Psychotherapists’ experience of power in the psychotherapy relationship. [Doctorate by Public Works]

Abstract

This research study investigated how psychotherapists experience power in the psychotherapy relationship. The intention of the research was to provide a rich description as to how power shapes, informs and presents itself in the psychotherapy relationship. I have used phenomenology as a philosophy and methodology in undertaking this research, drawing upon Giorgi’s (1989) and Wertz’s (2005) adaptation of the phenomenological method for psychological research. In total, nine experienced integrative psychotherapists, working in private practice, participated in an in-depth open – ended interview about their experience of power in the psychotherapy relationship. Each interview explored their experience with two clients with whom they were currently working and with whom they had been working for over six months. I identified four subordinate themes from across my participants’ accounts. These were: the therapist’s experience of both the client’s and their role power, power as a dynamic and emerging relational and social process, different forms of power dynamics in the psychotherapy relationship and the therapist’s ambivalent feelings of power. The findings highlight that power is experienced as being an inescapable phenomenon of the psychotherapy relationship, complex, constantly shifting and, at times, paradoxical. For much of the time, the power dynamic is pre-reflective and largely out of conscious awareness. Therapists experienced power to be implicit to the structure of the psychotherapy relationship and the therapeutic context. The power dynamic of the therapeutic relationship is established in the opening interactions of the therapy. This usually involves the therapist being constructed by the client as the powerful figure in the relationship. As the work continues the form of the dynamic reconfigures into different forms. These include power struggles, the client experiencing the therapist as the ‘abuser’, the therapist experiencing powerlessness or a relationship of shared power. Participants’ accounts indicate that their subjective experience of both their and the client’s vulnerability, the mutual construction of their respective social identities and status and the wider social relations of the profession of psychotherapy all influence the power dynamic of the psychotherapy relationship. This research study highlights the importance of power in the practice of psychotherapy. It demonstrated the need for the therapist to tolerate the client’s need to construct them as a figure of power, to be dependent upon them and to express their anger, hate, rage and envy of their power. Participants’ accounts revealed that the exploration and re-negotiation of the form of the power relationship between therapist and client is pivotal to the process of therapeutic change for specific clients. Therapists described how this facilitated the establishment a collaborative relationship in which power was shared between them and the client. Therapists reported that such as re-configuration of the power dynamic facilitated the client experimenting with their power in the therapeutic relationships and their relationships with others. What is evident from the findings from this study is that the phenomenon of power is central to the therapeutic relationship. It suggests that practitioners can enhance their practice by observing, exploring and negotiating the power dynamic of their relationship with their clients. Power in the therapeutic relationship therefore needs to enter the mainstream discourse and debate in the counselling psychology and psychotherapy communities.

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In episode 147 of the Counselling Tutor Podcast, Ken Kelly and Rory Lees-Oakes talk about the power dynamics in the counselling relationship. ‘Check-In with CPCAB’ then explores how counselling qualifications are issued. Last, in ‘Practice Matters’, Ken and Rory discuss how to maintain professional motivation, especially during the COVID-19 lockdown period.

The historical beginnings of psychotherapy – in the psychoanalysis developed by Sigmund Freud – portrayed the practitioner as an expert and so placed them in a position of greater power than the ‘analysand’ (client).

Since then, however, the nature of therapy has changed greatly, so that client autonomy is now seen is a vital part of therapy in all modalities.

In the power dynamics in counselling, it is possible that clients (especially those who are not yet familiar with how counselling works) may expect their therapist to provide expertise and advice to them.

This expectation may be fuelled by transference – for example, if the therapist reminds the client of a figure of authority from their past.

As counsellors, we have a responsibility to encourage exploration of any such perceptions, and to encourage clients to trust that they themselves can find their own solutions to life difficulties.

Part of this approach involves working to equalise power where possible. For example, we seek to ensure that both the client and the counsellor have a seat of the same or similar type and height.

However, there are some areas in which it is impossible to fully equalise power, for example:

it is the client who comes to us with a difficulty
it may be us who sets the time and location of the session
there are legal requirements for us to break confidentiality in certain situations.

All these aspects of counselling increase our power and reduce the client’s. What matters is being aware of the power dynamics in counselling, and doing what we can to equalise power where possible, in the service of our clients.

Rory provides an example of where power can be used positively by therapists: maintaining session boundaries (e.g. finishing at the originally scheduled end time, even when a client has arrived late) can be helpfully stabilising for clients.

Rory talks to Heather Price (Senior Counselling Professional) at CPCAB (Counselling & Psychotherapy Central Awarding Body) about how qualifications are issued.

As a student of counselling and psychotherapy, your contract is with your centre (i.e. your training provider, such as a college).

Meanwhile, your centre has a contract with the awarding body (e.g. CPCAB) – though universities are able to act as their own awarding bodies. Thus, if you have any questions about your qualification, it should be your college rather than CPCAB that you approach.

To gain your counselling qualification, it is necessary to satisfactorily complete both your internal and external assessments.

The internal assessment takes the form of a portfolio of work, while the external assessment for CPCAB is an exam.

Once you have passed both elements of the assessment, CPCAB will then issue your certificate, which it sends to your course provider to pass on to you.

Rory and Heather discuss what happens if a student has not completed all their work by the end of the course. This is more likely to happen at level 4 and beyond than it is at levels 2 and 3, since the practitioner levels require the completion of placement hours.

Tutors can contact CPCAB to request extensions on behalf of students, but only when there are genuine extenuating circumstances. Extensions are time-limited.

As a student, you have a responsibility to try your best to keep on top of your work – and to communicate at an early stage with your tutor if this becomes impossible.

You can find more information about CPCAB on its website. CPCAB is the UK’s only awarding body run by counsellors for counsellors.

Ken reflects that he – perhaps like many of us – entered the COVID-19 lockdown period with lots of good intentions about all he would achieve, but the reality can be that doing so is challenging when we have to rely on ourselves for motivation.

The usual daily routines are gone, and we must find our own daily structure and drive to keep working towards our goals.

If you do find yourself with more time during this period, it does offer opportunities for boosting our self-care, CPD and networking – all within the social-distancing requirements, of course.

Why not have a look around at what online CPD options are available?

At Counselling Tutor, we are pleased to offer you Counsellor CPD, a brand-new service aimed at qualified counsellors.

There, we have over 150 hours of formal lectures, all linked to learning outcomes, delivered by experts in the field and with CPD certificates available.

Online networking could take the form of talking online to peers from your in-person study groups – or you may like to visit the Counselling Tutor Facebook group, where you can ask questions and discuss relevant issues with over 30,000 other students, qualified counsellors, supervisors and tutors.

Power in the Counselling Relationship

*Check in with CPCAB is proudly sponsored by CPCAB, the only awarding body run by counsellors for counsellors.

To learn more about CPCAB qualifications and to get more detailed information on today's podcast topic, visit CPCAB.co.uk.