Choice of topic
On receiving the assessment paperwork for my client, I felt overwhelmed and challenged by her status, and that she had previously worked with my placement director. My first reaction, was that I would not be good enough for her as a trainee.
When discussing my responses with my supervisor, she helped me to identify where this had come from, and the skills and knowledge that I had would be beneficial to this client.
To build up a working alliance, Finlay (2016), p.15, with this client, who I will refer to as Kirsty, (not her real name), the progress was slow, and I became very aware of my own counter- transferential feelings. There were areas of her narrative which I felt really in contact with.
Conducting the search
An on-line search Google scholar, using terms like, ‘The Dance of Power’ which returned results of 51, 200,000. Further searches were conducted which brought back similar figures
I then altered the search criteria to ‘The Dance of the Counter-transferential Phenomena’ which brought back 34 Items and this search was done via Wiley on-line Library. This appeared more manageable, and a further search via the same library with a different search term, ‘Undoing Trauma’ brought back just one result. This still was not what I was looking for, so I chose to remain with the search criteria of power within the therapeutic relationship.
So, within the literature, Webster’s dictionary defines power as; ‘the ability to act’ and ‘the capacity to produce and effect’ and ‘the possession of control, authority or influence over others’
Proctor (2017) states how she defines power as being related to how society is formed, and groups of people, who differ from the ‘norm’ have less access to power. These groups could be women, disabled, Black minority ethnic (BME) or working-class people, gay or lesbians. Male or females, young or old.
She suggests that these groups could be oppressed members of society who may have experienced violence or intimidation and who have little experience of power within the relationship.
The history of power within the therapeutic relationship dates to Machiavelli in the 16th century and Hobbes in the 17th century as cited by Proctor, (2017). These two theorists had different views when talking about power. It was not until the twentieth century that Hobbes view of a modernist theory was favoured. Clegg (1989) Hobbes theory of power influenced the basis of thinking around power from a modernist and structural viewpoint.
The modernists view.
This was a new form of expression that was developed in the nineteenth and twentieth centuries. This was the era when counselling and psychotherapy developed. McLeod (2009) p. 37
The Structural Theories.
These theories lie within the context of modernism and take a single point of view, that is concrete and belongs to a person. It is assumed that power is an experience that can be found in the form of economic, social, physical, or psychological capacity. For instance, Day (2010) cites Robert Dahl (1957) as, “A has the power over B to the extent that he can get B to do something that B would not otherwise do”.
These theories have emphasised the controlling, oppressive and negative angle of power. These structural theories have been critiqued as it assumes that the power is always ‘power over’ another.
Lukes, (1974) argued that it is the ability of one person, to get another, to do something that (s)he might not otherwise do. He argues that this power is a result of conflict between actors to determine who wins and who loses.
However, Arendt, (1963) saw power as being related to people joining together and making unbreakable promises. Arendt observed a difference between ‘power’ within relationships and ‘authority’ that is given to an individual because of their role. Hindess, (1996) suggests that this moves power towards a relational process and relying on the consent of others.
Post-Modern Theories
Elias, (1978) suggests that power is not something a person owns, but it is a trait of human relationships. This view is supported by Lukes, (1974). Elias further suggests that power relations are formed in relationship and that it is a result of living together and interdependence. This phenomenon is like a game of tug of war; a trial of strength between two sides pulling against each other. Oxford English Reference Dictionary (1996), p. 1548
Foucault
Foucault suggested that power follows the concepts of Nietzsche in that knowledge and thought, theories and discourses are penetrated by values, Daudi, 1986 as cited by Proctor 2017. This approach formed the basis of Foucault’s work. He sees this power relationship as not responding to others, but on their actions. Thus, it is an action upon an action. Day, (2010).
This view of power suggests that power is inherent in all relationships so it both enables and limits actions, thereby helping individuals to broaden their boundaries, Hayward, (1998)
From this perspective, “Power is everywhere…because it comes from everywhere”. Foucault (1980). Power is involved in all social interactions, because ideas operate behind all language and action. Lukes (1974).
Foucault focused on how power was used in society, such as sexuality, (1976), madness, (1967) or criminality, (1977). He looked at the aims of those involved and the tactics they used to achieve those aims and the counter actions of others to achieve the same objective. In his deconstruction of the power within these institutions, he defines ‘disciplinary power’. He defines this as “comprising a whole set of instruments, techniques, procedures, levels of application, targets”. Foucault, (1977), p.215. He emphasised the ‘struggle’ that occurs between individuals and groups in society as the discord is taken up in response to the behaviours of others. Day, (2010) suggests power operates systematically within a society not from above.
Perspectives of Power in the Psychotherapy Relationship
Whilst searching the literature, I struggled to find any published research. Where references have been uncovered, these have been philosophical or theoretical perspectives on the subject; or individual accounts of personal and professional experience. Sanders, c (2017), Totton,(2009), Amitay, (2017), Lazarus, (2015).
Positions of Power
From the literature, there appears to be four philosophical positions:
- Power as a destructive and oppressive force in the psychotherapy relationship;
- The psychotherapy Relationship as a process of liberation and empowerment of the client.
- Power as a relational, inter-subjective process in the psychotherapy relationship; and
- The denial of the existence of power in the psychotherapy relationship.
At the end of the 1980’s, the central thoughts about how the imbalances between the therapist and client can result in oppressive and destructive outcomes for clients. The following debates concentrated on the abuse of sexual boundaries and forms of discrimination and prejudice against minority groups. Bates, (2006); Lago, (2006); Masson, (1989); Smail, 1995. The way the psychotherapeutic relationship exists between the client and therapist means that there is a potential for abusive relationships in the dialogue between the client and therapist. Spinelli, (1994). This reflects a structural position on power, Day, (2010), Proctor, (2017). So, the therapist in these circumstances, has ‘power over’ the client which renders them ‘powerless’ and vulnerable.
Within the literature, Masson (1989), describes power in the therapy room as having destructive elements and that the therapy could be a form of abuse. Another form of destructive power, could be therapist abusing the client by disrespecting the sexual boundaries, Chesler, (1972), Sonne and Pope, (1991) and Gabbard, (1996).
It is suggested that these destructive ways can operate at an unconscious level thus leaving the client vulnerable to past, negative experiences. Herman, (1992) believes that it is important for the therapist to avoid using their ‘power over’ Proctor, (2017), p. 13 the client for their own needs or to direct the client’s life decisions. Day, (2010).
The British Association for Counselling and Psychotherapy, (BACP) state that under their Ethical Framework, the counsellor has a commitment to avoid harm towards the client, (2015).
It is assumed from this point of view that power is dangerous and destructive to those who are powerless. Often power is viewed from an ethical or moral basis, looking at what is right or wrong. In simple terms, power is either ‘good’ or ‘bad’. Furggeri, (1992). This view assumes that is a possession, that is in limited supply and this then forms a structural perspective of power. The client is seen as powerless and the therapist powerful. It could be argued that this is an extreme form of domination and repression. Thus, power is viewed as monolithic, unitary and unidirectional. Procter, (2002)
Psychotherapy as Empowerment for the Client.
An alternative perspective of power is seen as positive with the therapist power being good. Psychotherapy is an empowering process for the client and thus enables the client’s autonomy. This line of argument is seen in humanistic literature, feminist literature. Brown, (1994). The British Psychological Society’s (BPS), 2009 division of counselling psychology, states explicitly that it works to ‘empower the client’.
Carl Rogers was one of the first proponents of this. Rogers suggested that the therapist’s role was to avoid power over the client and also refrain from making decisions for them. Rogers supported the client’s autonomy and how they achieved this. So, the decisions are made by the client for themselves. Rogers, (1978)
Bozarth, (1998) argues that the crux of this theory is that the therapist does not intervene. Natiello, (1990), states, “…. Offers a morality of power as well as a methodology for arriving at that morality”. (p 268). She maintains that the person-centred approach offers the client the opportunity to claim his or her own personal power rather than being reliant on the power of others.
Similarly, Freud theories of psychoanalysis argue for the analysist to use their power of rational authority to free the mind of the client.
Fromm, (1956) argues that over the duration of therapy, the client frees and cures themselves from an attachment to irrational authority. Benjamin,(1995) challenged Freud’s position states “ Already idealised for his knowledge and power – his power to know her – the analyst is now internalised in the relationship of knowledge as power over self, a practice in the domination of self whose meaning Foucault (1980) has made unforgettably problematic” p. 154
Frosh, (1987) states that object relations, like psychoanalysis, sets itself up in the feeing of a person’s psyche. He argues that its objectives are to free the client from fixations created by ‘bad’ experiences and to promote internalisation of the more nurturing possibilities experienced in the relationship with the therapist.
This assumes the client is powerless and vulnerable and the therapist has the power to empower the client. Client’s therefore are viewed as powerless. This could be seen as a structural position where power is either ‘good’ or ‘bad’ and one either has it or not. A moral argument could be where one form of power is ‘right’ and others are ‘wrong’.
A Relationship of Mutuality
The psychotherapeutic relationship is viewed as one of mutuality. Aron, (1996) views this as involving mutual generation of data, mutual regulation of the relationship, mutual recognition of the others autonomy and openness on the part of the therapist as to their client’s impact upon them. Aron argues that power is dynamic that is constantly struggled with in therapy and therefore needs ‘to be continually examined, articulated and worked through’, p151. He suggests that therapists need to question their decisions with regards to ethics as well as questioning their authority and domination in the relationship, referenced in Proctor, (2002) p 133.
Frosh, (1987) believes that the objectives for therapy is to allow the client to explore the power in therapy as it copies and reminds the client of internalised introjects from their formative years. He suggests that an approach which is politicised and recognises the reality of social structures. He argues that part of the difficulties relating to change is that people need to identify, re-experience and re-frame these introjects to help to give them a new meaning in their life. Totton, (2000) argues that it is the therapist’s role to help the client find another genuine and authentic psycho- political position. The relational position, therefore sees the power dynamics as being central in the therapeutic relationship. It is suggested that power is aligned to knowledge and neither the client or the therapist can ‘know’. Thus, it is thought that it is present in all relationships rather than being a possession of the client or therapist. It is therefore unavoidable and potentially both positive and negative. Proctor, (2002) it could be argued that this view, might undermine the role of structural differences in power in society reducing it to an intersubjective process.
Concluding thoughts of the literature
Relational perspectives in psychotherapy have started to think about ‘power’ as dynamic and inevitable. Proctor, (2017). However, despite this recognition of power, the discourse on the power dynamics in psychotherapy has remained at a philosophical level. Much of the literature can be seen as a critique of other psychological therapy or it attempts to show how therapists can misuse the power differential with their clients. The question to be explored and researched further would be how psychotherapists experience the phenomenon of power with their client’s and how it can be worked with in a clinical setting.
2018-4-8-1523186705