Power Dynamics Can Ruin Therapy: Avoid These Pitfalls!

Lisa Marie Bobby:

  Clients come to therapy. Because they’re not okay. They are seeking help oftentimes during distress. They are going through a very hard time. Sometimes the worst time in their entire life. Very frequently, they legitimately do not know what to do to help them. themselves in some ways. They’re out of ideas. And so all of this really can heighten these feelings of vulnerability and dependency.

 Power Dynamics in Therapy. I tell you what, we as therapists don’t like this idea. We like the idea of having  an equitable, client centered relationship with our clients,  where it’s focused on them, it’s not about us. That’s the way we want it to be, and that’s the way it should be. And the reality is that  power dynamics are always part of the equation in our relationships with clients. 

And so we need to be grappling with this directly and intentionally so that we can,  be acting in ways that promote equality and client centeredness  to the extent that we are able, but also manage and minimize the risk that the power dynamics inherent in these relationships can create.

If this is your first time tuning in with me, I’m so glad you’re here. I’m your host, Dr. Lisa Marie Bobby. Like you, I’m a therapist. I’m a licensed psychologist. I am also a licensed marriage and family therapist, and I am a board certified coach very proudly. I’m a huge fan of coaching in the hands of competent professionals.

I am also an AMFT approved clinical supervisor, and I’m the founder of, a fairly substantial group private practice called Growing Self Counseling and Coaching. We have 50 plus therapists running around here these days and because of all of these layers of professional experience, my work with my own clients, my own supervision and professional development, but also my role as a clinical supervisor and also as person responsible for the healthy functioning of a large group practice, I have a fair amount of visibility into the things that can trip therapists up.

Even really good, talented, caring, largely effective, and very well intentioned therapists can be vulnerable to a number of different things. And I can. It’s true for you. And so that’s, where love, happiness, and success for therapists is in some ways coming from is to be talking about the things that we need to be talking about and being aware of so that we can go into every session with our clients.

from a place of genuine ethical operations, but also efficacy, but also with the intention of not just creating positive outcomes for our clients, but being well ourselves in the process, we’ve chosen of course, and challenging profession in some ways. And so we need to go about this a little bit more intentionally than some people in other professions might.

So that is why we’re here. We’re going to be talking about three different pieces of this today. First of all, we’re going to be talking about just the reality of power differentials. Again, because we don’t want it to be true, I think we can avoid accepting the reality that it is true. We’re going to do a quick review of why this is.

And then also I’m going to be sharing just a refresh of some different strategies and not just ideas, but really practical things that you can be doing in your sessions to manage some of this. And then also loading you up with plenty of free resources at the end of this training in order to support your growth and efficacy and to help you do great work.

Let’s dive right in. As promised, the first thing we’re going to do is a quick review of the reality of power dynamics and therapeutic relationships, lest you have forgotten. And also just to say, In counseling school, psychology school, whatever kind of school you did, we had ethics classes, didn’t we?

And in these classes, we were taught about power differentials in therapy, and that was part of our training, but then sent off into the world. And if you’re like most clinicians who have been doing this five years, 10 years, 15 years, 20 years right out of school. We can get some distance from these really good foundational ideas that we were taught as students.

Like how do we get reminded of these things as seasoned professionals, right? So just as a very quick recap let’s talk about why there is always going to be a power differential in our relationships with clients, whether we want it to be or not. First of all, is that we are, whether or not we want to be, whether or not we say this out loud, perceived as the expert authorities in the room. We hold a position of expertise. And there’s a reason for that. You went to school to learn about all these different things you may have more insight into how this all works than your clients do. And just by virtue of the relationship itself, somebody is coming to you for help. Your clients will view you as an authority figure, whether or not you view yourself in that way, or whether or not you want their clients to perceive you in that way. This in itself can lead to an imbalance where your clients might feel differential to you or reliant on you or inclined to maybe take your thoughts, feelings, opinions over their own sometimes like trusting you maybe more than they trust themselves in a way that can diminish their own insight or agency. And that is why it is so important to be very sensitive to this reality and have a robust set of tools and ways of being with clients that help you minimize the risks of this. We can’t sweep it under the rug. To compound this natural power that is being seen as authority figures, it is also true that frequently our clients are very vulnerable when they enter into their relationships with us. Clients come to therapy. You know this. If you’ve entered into therapy, it’s because they’re not okay.

They are seeking help oftentimes during distress. They are going through a very hard time. Sometimes the worst time in their entire life. Very frequently, they legitimately do not know what to do to help them. themselves in some ways. Like they’ve done everything that they know how to do and now they’re here talking to you, right?

Because they’re out of ideas. And so all of this really can heighten these feelings of vulnerability and dependency. And even too, just the nature of the things that clients are telling us. It’s often things that they’ve never said out loud to another human.

The level of vulnerability that people courageously engage in their relationships with us is profound, but it also creates this Experience in clients where they are totally open and as that can be very receptive to your influence, sometimes in ways that are even problematic to their own empowerment and their own autonomy, unless you’re handling it really carefully. Beyond that, there are often cultural, social, societal power differentials that come into play in the relationships that we have with our clients. So race, gender, socioeconomic status, even the reality of being a highly educated, professional person, depending on the population that you’re seeking to serve, you may be working with people who are in a different reality and may view you as being in a different league as they are.

And so these are moments when these power dynamics can intensify, they almost layer. So you’re the authority, and clients are super vulnerable, and layered on top of that, maybe there are a lot of big differences in terms of class, education, culture, socioeconomic status. But consider, working with a client from a marginalized group, based on things Race, gender, sexual orientation, right?

May feel that this therapist holds unspoken power based on their perceptions of your societal privilege.

The reality of privilege is something that we therapists don’t often like to think about either, which is why we talk about this on this podcast, love, happiness, and success for therapists. If you’re interested in just doing a recap on that, I would encourage you to go back into my feed and check out a really cool podcast that I did with Dr.

Diana Strada. on bias in therapy and how to help ourselves stay very aware of our own blind spots and privilege and the impact of privilege being one of them. And this is especially true for you. If you’re listening to this and being like, I don’t have privilege. Listen to that podcast.

And then, of course, last but not least, this is a big one, is that You are in the role of the guide in your therapeutic relationships, again, whether or not you want to be. In our schooling, as counselors, as psychologists, we are trained to be client centered, that clients should be self directed, and all of these things.

And this is all well and good, and yes, this is the way that we should be operating in our relationships with our clients. But

here’s another thing that therapists don’t like to consider, is that you are quite literally the guide. You are the person that somebody else is coming to for help and assistance with a problem that they don’t feel like they can solve on their own. They are looking to you to help them navigate the situation and get to a better place.

Additionally, it is your responsibility as the therapist, as the guide, to be helping your client understand what this is all about, how it works, what we’re doing here, why you are the person that they are looking to for like ideas about how are we going to make this better, right? That is the literal and also energetic role that you are in every time you meet with a therapy client. And so all of these things come together to create a situation where you have a lot of power in your relationship with your clients, where they are vulnerable to your influence in a way that is really different from other relationships, and that it is vitally important that you are keeping this in mind all the time.

all the time and then practicing strategies in order to manage this well because if you’re not doing that it can create real problems. Just for fun, let’s take a look at what some of those potential problems and pitfalls can be if, like many therapists, you’re in this mindset of, I am client centered, I am non directive, I don’t believe in power, I am social justice, equality, all these things to the degree that you are denying or minimizing your own power, your own privilege in these relationships, here’s what can happen. First of all, if you’re not careful, this can lead to a profound level of disempowerment for your clients, which I know is exactly the opposite of what you want for them. But disempowerment can be subtle and really real. For example, I recently recorded another episode of love, happiness, and success for therapists on the phenomenon of therapists taking up an awful lot of space with their clients, telling stories about their own lives or teachable moments, right? Where in reality, this therapist is oversharing, talking a lot about their own stories to a client on the couch.

She’s like, uh huh. Oh, that must’ve been so hard. By understanding the nature of power dynamics, we can understand why that might be. Is that a client doesn’t know what to do with that? You’re the guide, you’re the authority figure. Is there a reason that they’re telling me about all this stuff?

What do I do? Like it turns into all of these kinds of things. And especially for a highly vulnerable client, do they feel that they can say, you know what? We’re here on my dime and I don’t want to hear about your mother’s cancer anymore. Can we talk about me?

Because of the nature of power differentials, it is very difficult for clients to be able to do that, particularly if you layer some of the other things on top of this, the socioeconomic factors, your education, the authority of whether how vulnerable that client is. If they’re really in such an awful place, like they really need you to be there.

in charge in healthy ways, which oftentimes be managing yourself. So not dominating the conversation can be a simple way of doing that. That is just one small example of what it can look like in practice when power dynamics are not being well managed. But additionally, when it comes to disempowerment, being super careful and thoughtful that we are not anywhere close to making decisions for clients or, providing advice or solutions, strategies, whatever it is that clients are not. Asking for that are not self generated and while certainly we can be psychoeducation and teaching different skills that they this is definitely a thing.

And there’s a time and place for that being super careful that we are not doing that for clients to the degree that it is not self generated at all. Cause it needs to be another huge area of vulnerability in this for many clients is being with a therapist who might be over pathologizing them. And a client, especially a vulnerable one, may not agree with some of what the therapist is saying, but may not feel empowered to speak up. And that could lead to very serious consequences for a client, particularly if there’s counter transference stuff coming up for the therapist who may, depending on the situation, like in a, custody evaluation, or if there’s an involvement with social services have very real and enduring consequences for the life trajectory of a vulnerable client sitting in front of them.

Okay.

And this can happen in more subtle ways too, anytime we are even unawarely imposing our value system, our belief system our treatment goals, like here’s what I want for you onto clients, again, intentioned but anytime we’re doing this, we are running into very real risks of our power being very detrimental to our clients. For more on this topic around how to make sure that your own thoughts, feelings, values, don’t slip. Spill out onto your client in unhelpful ways. I would refer you back to a podcast episode I recorded on this topic about value conflicts with clients and how to maintain hopefully a level of non judgment and non bias to the degree that you’re able to be helpful to clients, how to manage some of those feelings when they can and do show up. But here’s another consequence of unmanaged power that I think therapists don’t think often enough about is related to a very real risk of fostering dependency. Excellent effective power. powerful therapists will create very strong and enduring bonds with their clients. And there’s nothing inherently wrong with that.

But if it also turns into this thing where client relationships are being maintained most more for the therapist’s benefit than for the client’s benefit. That is a big deal. And also if there is this power differential where a client is looking to a therapist for different things, they may become very reliant on that.

Does the therapist approve of my decisions? Am I able to think through things on my own without a therapist helping me do that? Remembering that our job is to help our clients graduate from therapy with us. That is the ultimate sign of our efficacy. And to, have situations where people are becoming overly reliant on us in an unhelpful way can create this dynamic where clients feel unable to make decisions or overreliant.

Or cope without us, which ultimately weakens their confidence in their own abilities.

But wait, there’s more. All of the phs, transference and counter transference are much more likely to be not just present, but unhelpfully and not managed well in a situation where there is an unmanaged power dynamic that maybe the therapist doesn’t fully appreciate.

 Of course, we all know to be paying attention to transference, to counter transference when we are in relationships with clients because there’s good deep stuff in there, but if we’re not also paying enough attention to power dynamics in the relationship, the pieces of transference can get weird.

Let me tell you why.

If there are power dynamics that are not really overtly being attended to in your therapeutic relationships, some clients, particularly those with heavy histories of abuse or neglect, could be more likely to interpret your way of being as overly controlling, dangerous, untrustworthy, which can be a huge barrier in your relationship.

And so that’s one of the reasons that you need to be talking about power dynamics explicitly in order to prevent clients, particularly certain kinds of clients, from feeling unnecessarily unsafe with you. And of course, all us therapists are vulnerable to unconsciously projecting our own feelings or issues onto clients. And this can be more prominent when power dynamics are not carefully managed. If we are not aware of these dynamics, and we’re doing a little bit of. Blurring boundaries, over identification, or going into that rescue mentality.

It can amplify an unhelpful dynamic that we might not even be aware we’re doing. And, I didn’t have this in my little slideshow, but I want to say this out loud. Another unintended consequence of power dynamics that are not being addressed openly, frequently, and with a lot of intention is this unintended reinforcement of social, cultural, racial inequalities. And for example, if you, me, any of us, we’re vulnerable to not fully being completely connected with things like how race, gender, sexual orientation, or socioeconomic are really present in the room, maybe not for us, maybe more for our client, and how that amplifies these power dynamics in We can accidentally and unintentionally reinforce the societal power imbalances.

So for example, a white therapist working with a client of color might have a tendency to unconsciously downplay a client’s experiences of discrimination or marginalization because it’s not their experience, but this perpetuates a sense of invisibility or invalidation, and it is amplified by virtue of the power dynamics.

We need to be very cautious and similarly cautious to how our Culturally defined many times way of being or value systems can get communicated and transmitted to clients, in large ways and small, but also how that is amplified by the power dynamics that we’re talking about today. And they are going to feel more intense for some clients than others, depending on how many of the components of power are true in this specific relationship.

At the end of the day, there are so many reasons to be thinking about power, using it intentionally. But there’s one thing to consider is that if this isn’t being managed intentionally you will see usually one of two things, hopefully, because it is actually Sign of empowerment of autonomy of self protection is that clients will either become more and more resistant to the work and to you personally, or there will be a rupture and they will drop out.

They will break their relationship with you because it’s feeling so uncomfortable for them. And do not assume. that your clients are going to be bringing this up ahead of time, especially when there’s a strong power dynamic. What is normal and expected is that they are not going to do that. Cause remember this power dynamic breeds silence.

It takes away the voice of your clients. And so it is actually a sign of their health. When they’re like, I don’t want to do this anymore. That’s actually a good thing. But of course, ideally you would be seeing this coming, being sensitive to it, talking about it out loud ahead of time so that clients don’t have to flee the situation in order to feel like they are comfortable and able to be, self directed to be empowered and to be the agents of agency in their own lives.

So just be aware of that too. So if you’ve been feeling slightly traumatized by this conversation, it’s okay. And hope is here because the next thing we’re going to talk about are some really powerful strategies and best practices that you can be using in your clinical practice to avoid these pitfalls and really operating in a

sensitive and aware way. And so the first thing to be considering is collaboration with your clients in every single way that you can imagine you are co creating this experience with them. Every step of the way, It is absolutely essential for you to be working with your client to make sure that they are an active participant in every single aspect of the therapeutic or coaching process. And this means that they are. Asking for their permission to even talk about certain things. Is it okay if I asked you some more questions about X, Y, Z?

To be getting their consent when you broach certain topics and being respectful of their boundaries, if they don’t want to do that with you right now, also being really tentative and collaborative when it comes to things like treatment, Or coaching goals. All of this can reduce the sense of your client that you are the one in control and instead positions them as being the ultimate authority and whatever we’re doing in our work with them.

There are so many ways that you can do this. And every single session, I am always starting with what would be most helpful for you, for us to focus on today. I know last time we talked about X, Y, Z, but I don’t want to assume that is still important to you this week. Did you have hopes for our time together?

Truly like following them and us. Always checking in about what they want, how they’re feeling, what is important to them in a way that really places them at the very center of their work all of the time.

And even if you’re in a position where you need to be diagnosing clients or creating treatment plans, these are the criteria, the diagnostic criteria that I’m thinking about as we’re talking about these things. I feel like this is probably the most important diagnosis, but does this feel true for you?

If not, why not? And this is the treatment plan I’m considering that will guide our work together, but how do you feel about this? Do you understand this? I’m happy to explain some of this. And does this sound in alignment with what you want our work to be about? So every single step of the way, be collaborating.

Another super important thing that all therapists and coaches need to be doing is extreme transparency. And I think, in my experience, both as a supervisor operating as a clinical director in the past and running a fairly large organization, what I see as being the biggest mistake. One mistake that therapists will make in this is not being nearly as transparent enough as they should be with their clients.

And this amplifies an unhealthy power dynamic. So what is this transparency of which I speak? It is really going into very clearly explaining either your therapeutic process or your coaching process. If you’re operating as a coach the techniques that you use. the methodology, why you’re thinking about certain interventions and asking your clients how they are feeling about this.

We know this stuff back, forth and sideways. We can just drop in and start doing stuff and don’t consider the fact that our clients might not know why we’re doing things the way that they are, why we’re asking them to talk about certain things or why we’re Recommending that we use certain activities or even assessments.

And so the more transparent that we can be to explain things that kind of settles down that power dynamic, but also provides your clients with a lot of opportunity to tell you how they feel about this and whether or not the course of action that you think might be the best one is in fact congruent with what.

They want this to be it demystifies therapy. It equalizes the relationship, but it also levels out this knowledge gap between you and your clients. And it also provides lots of opportunities for truly informed consent above and beyond them signing your disclosure paperwork.

Additionally, we need to be emphasizing client autonomy in every way that we can. This means truly letting your client control and guide the process and doing that real explicitly. Saying out loud in words that, I am here to serve as a collaborative guide to support your growth. However, I want to make sure that you know that I am not here as any kind of authority figure who is here to tell you what to do or how to do it. My role is to be a process builder. partner to create a space for you to get to know yourself more deeply.

And at the end of the day, come up with a stronger clarity about your values, your goals, the best course of action for you in your life. And I think that some people, think that they’re going to come into therapy or even coaching. Drop in, tell a therapist everything that’s going on and then have that therapist tell them, okay, so here’s what the problem is.

Here’s what you should do. And that is not how this works. We are here to help you tell me what is going to work Best for you. And my role is as a experiential person that helps you have a time and space to do that. So I might ask you questions to elicit, your thoughts about things, but it’s really important that you’re telling me not the other way around.

And I just wanted to say that out loud, cause a lot of people don’t know that about therapy or coaching. So how do you feel about having that kind of relationship with me? So being able to. Say that kind of thing out loud in words to your clients is oftentimes first of all, surprising to them because it might be in opposition to what they think this is if they haven’t done therapy before.

But also I think it really does a lot to again, flatten out that power hierarchical assumption or thing that clients can tend to experience if they don’t understand what our intentions really are and what our role really is. That facilitation of client autonomy is incredibly important and also certainly extends to if we do have thoughts about things that could be helpful because we might feel like it would be helpful for a client to learn a new skill or to practice something differently, to do that in a very tentative way.

I have an idea, but what do you think about this? As opposed to saying, here’s what you should do. Oh, my little slide that was supposed to say humility as in healthy humility, meaning that we are always, receptive and open to other people’s ideas and way of being and not prioritizing or, supremacizing our own. There are so many different ways of expressing healthy humility in our therapy and in our coaching practice. But I think some of the biggest ways is just being really curious about clients and doing so explicitly and saying out loud things like I hadn’t thought about it that way before.

That’s an interesting perspective. Tell me more where you are out loud in words, presenting yourself as being what is appropriate for this role of being a humble person who is curious and interested to understand your client, as opposed to this authority figure who may be sitting in judgment of them.

It’s really important that we’re doing that explicitly. And then of course, the most powerful tool that we all have at our disposal, our regular check ins with our clients and asking for feedback routinely and making that just be part of the work. I cannot stress enough the reality that our clients are not going to broach challenging things with us as it relates to the relationship and will oftentimes prefer to avoid the relationship altogether than confront us about something that is maybe not feeling that great for them.

It is our responsibility to be creating change. spaces all the time and really have it be an expectation that your client is going to be telling you how they are experiencing the work and how they are experiencing you. I set this expectation up with my clients in the very first consultation before I even have them as clients.

Here’s what you need to know about working with me. We’re doing this together. I’m going to be asking you how this is going. And it’s vitally important that you’re telling me how. Honestly. And so you can just expect that from me and then reinforcing that. And of course, being extremely appreciative and always non defensive if I hear anything that will help me improve my performance with them.

But this is another crucially important piece of rectifying a power imbalance. So on this, I have a bunch of free resources for you that will help you keep growing in this area. On previous episodes of love, happiness, and success for therapists. I do deep dives into how to always be assessing, how to be checking in with clients, how to prevent client ruptures and maintain alignment with your clients over the long haul.

And then of course you can find all of those on my website, growing self. com forward slash. therapist. And also, I hope that while we’re thinking about connecting, you also connect with me on LinkedIn. This is where I post all of my different podcasts and videos and tools and resources to help you as a therapist grow and thrive.

So I hope that you connect with me there. If you have any questions or want to hear topics, that I haven’t discussed yet on the show, but also I’d be very curious to hear your thoughts about power imbalances in your therapeutic or coaching relationships. And if there are any strategies that you have employed over the years that you’ve found to be really effective and leveling that out and avoiding some of the pitfalls that we can all be vulnerable to, if we’re not taking that power dynamic really Seriously.

So thank you again so much for listening and joining me on today’s episode of love, happiness, and success. I absolutely love spending this time with you. I think I’m a, I don’t know. It’s just a very fulfilling role for me. I’ve always loved being a clinical supervisor. And so this podcast feels like a little mini extension of it.

So thank you for allowing me into your life. And I truly am making these for you and for your benefit. So again, if there’s anything you want to hear about, or when I contribute to the conversation, or maybe you have a message to share, maybe you’re in the same space and you’re teaching therapists or have a resource, let me know, be on the show, be my guest.

I’d love to talk with you. So thanks again. And I’ll be back in touch with you next week with another episode of love, happiness, and success. Four therapists.

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