Power and its Impact on Therapeutic Relationships in Psychology

This essay delves into the intricate dynamics of power within therapeutic relationships, a critical aspect of mental health care. It examines how power imbalances, often stemming from patient dependence and societal factors like race and socioeconomic status, can significantly impact the therapeutic process. The essay discusses the concept of transference, where patients may unconsciously transfer feelings of trust and dependency onto their therapists, potentially leading to vulnerability and exploitation. It highlights the importance of recognizing and managing these power differentials to ensure ethical practice and promote client empowerment. The essay also analyzes how societal influences can exacerbate power imbalances, affecting the nature of the therapeutic relationship. Ultimately, the essay emphasizes the need for a balanced approach, where therapists wield power responsibly to facilitate effective and safe care while empowering their clients. This essay provides a comprehensive overview of the topic, exploring the manifestation of power, its impacts on both patients and therapists, and the ethical considerations involved.

Running head: POWER AND ITS IMPACT ON THERAPEUTIC RELATIONSHIPS
Power and its impact on therapeutic relationships of psychology
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Mental health care is critically different from the other health care programs or genres, and
the most profound difference in the two different types of health care services is the extreme
dependence of the patients or clients on their clinical therapists. A mental patient is not just
depended for his or her health care benefits, but they are also extremely dependent on their
clinical therapist for their basic wellbeing as well. It is common knowledge that in case of health
care the dependence in most cases is necessary and inevitable, however this extreme dependence
often paves way for power imbalances in the therapeutic relationships that the patients have with
their health care provider. Many authors have discussed the implication of power imbalance and
its manifestation in the therapeutic relationship that the patients have with their mental health
care provider. The unwarranted manifestation of this power in between the client and the health
care provider is often the onset of response issues within the care program. This essay will
discuss the manifestation of power in the therapeutic relationship and its impact (Kelly et al.,
2012).
In the history of mental health care, there have been many transitions, each of the transitions
has helped more or less in enhancing the effectiveness, and the safety of the care provided to the
patients. In addition, the most important of the innovations that have occurred in the mental
health care is the diagnosis based and patient centred care. The onset of a therapeutic relationship
can be the one change in the mental health care that positively revolutionized the mental health
delivery and the quality of the care. On an elaborative note, a therapy can be defined as any care
practice or technique that is employed in order to treat or support a mental patient. The most
important difference between a conventional care technique and therapy is the fact that a therapy
requires enhanced active involvement of the patient rather than letting the patient be a passive
participant in the process (Kelly et al., 2012). A therapeutic relationship on the other hand is the

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amalgamation of growing comfort and compassionate co-operation in between the mental patient
and the care provider giving him or her therapy. By definition, a therapeutic relationship in
general is the engagement of the therapist with the patient, which helps forge a mutually
respectful and collaborative connection between the patient and the therapist.
The therapeutic relationship between the therapist and the patient has a number of variables
that define the dynamics of the therapeutic relationship that the individuals have. One very
important aspect within the same is the fact that the mental patients and their family member
bestow a lot of power to the therapist; hence, the onset of an inherent imbalance in term of power
is inevitable in case of therapeutic relationships. On a more elaborative note, the clients, or
mental patients that are engaged in the therapy provides the therapist with power which the
therapist in turn uses for the benefit of the patients in care planning and critical decision making
so that the patient can recover fast and can revert back to their regular lifestyle. However, the
power invested on the hands of a psychologist is often accused to be mis- exercised and abused
in case of the mental patients. However, in order to analyse or elaborate the factors that define
the unequal or unjustified manifestation of power in the therapeutic relationships with the mental
patients, it is crucial for individual pathways of the power manifestation to be critically analysed
(Zuroff et al., 2010).
According to the most of the research, the differential power gradient in the therapeutic
relationships with the mental patients is critically associated with the assumption in the patients
that the psychotherapists have more psychological strength, emotional control and stability than
the mental patient involved in the therapy, hence entire decision-making and judging
responsibility falls upon the therapists. Although, this understanding is completely flawed.
According to the theories of Foucault, knowledge and power are inseparable, and in case of post

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modern narrative therapy. the sensibility and relevance of the therapy is based on the theory of
Foucault, that the human beings utilize power and knowledge in an intricately linked manner,
and it is reflected in case of the psychotherapists as well (Gough, McFadden & McDonald,
2013). In order to provide the optimal care experience and helping them to recover faster, the
therapists exercise the decisive power completely and in certain cases, it is helpful as well.
For instance, in case of a mental patient with severe disconnection with the reality will
depend completely on the therapist. According to the Hjelm (2014), in such cases the mental
patient will have a sense of comfort in giving away the power led by the perception that their
psychotherapist has a special psychological might or power. However, this frequent
misperception in the patient-client relationship is based on the Freudian dogma or
psychoanalytical therapy; where the concept of transference is the most important and deciding
element of the therapy. In case of transference, the patient is coerced redirect the feelings of trust
and dependency, that humans generally feel during childhood, is persuaded to transfer that power
to the therapist. Although a little trust and dependency is required from the mental patient so that
there is enough co-operation with the therapist in the activities that is going to be performed
during the therapy. Although there is a significant drawback of phenomenon is the fact that the
excessive dependency of the patient on the therapist bestows them with a power that is easily
exploited (Zur, 2014).
It has to be mentioned in this context that exceeding dependency is not always present in the
therapeutic relationship, whereas, for the mental patients dealing with severe social rejection and
abandonment anxiety, the dependency is often the only means of comfort for these patients. The
only drawback in this case is the fact that this absolute transference of power makes these patient

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very vulnerable to the exploitation, which in most cases is not even deliberate from the clinical
therapist (Perlman, 2012).
It has to be mentioned in this context that the psychotherapists and counsellors understand
the inherent power differential in the therapeutic relationship with a distressed client as a part of
a job responsibility. In addition, it is critically ingrained within the psychotherapists’ perception
is the fact that the considerable power imbalance must never be exploited under any
circumstances. However, in the most of the scenarios, the power imbalance is manifested as an
undercurrent within the practice. For instance, it has been reported frequently that the power
imbalance is most of the times unnoticed by the therapists where the controlling and dominating
stance in the care approach of the therapists is perceived as a part of the therapeutic relationship.
Furthermore, in case of the patients, the patients facilitate the manifestation of the power
imbalance as well. For instance, it has to be considered in this discussion that most of the
psychotherapy or counselling clients is mostly distressed, traumatized, agitated and helpless;
which in turn elevates the vulnerability that these patients are accustomed to feeling (Zuroff et
al., 2010). Along with that the mental patients are often subjected to immense discrimination and
social rejection. The stigmatization adds to their helplessness and increases the need for anyone
reliable or compassionate in their life. In case of psychotherapy, the therapists and the
compassionate and understanding care approach that the therapists take often is perceived as
acceptance to the mental patients. This acceptance forces the mental patients to willingly transfer
all the decisive power to the therapists and the dependency of the mental patient on the therapists
increases multiple folds. Therefore, this group of mental patients or clients seeking therapy are at
the most risk of being exploited by the therapists, and according to the most of the researchers

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the manifestation of the power imbalance in such cases only increases with the severity of the
mental illness that the patient is suffering from (Bennetts, Cross & Bloomer, 2011).
Another very common source of manifestation of power imbalance is caused by the influence
of societal determinants on this context. On a more elaborative note, it has already been
addressed in the essay that the power imbalance or the difference in power in the therapeutic
relationship is often ignored or unnoticed by the therapists themselves, where they are
completely oblivious of the controlling and dominating approach in the care technique or therapy
design. However, with the addition of the societal factors like race, socio-economic background,
gender, sexual orientation and minority status of the mental patient can elevate the power
imbalance effectively. In this case, the profound socio-cultural power dynamics and its impact on
the therapeutic relationship can pave way effectively for the power difference to be manifested
easily and further developed (Lee, 2010). Moreover, when the clinical psychotherapist or
practitioner belongs to a strong cultural ideology, the conventional understanding of the above
mentioned socio-cultural power dynamics affects the nature of the therapeutic relationship
drastically. Most of the authors have suggested that in case of the therapists with a dominant
cultural background, the therapists can be already inclined to devalue the cultural ideologies and
the beliefs of the client. With the impact of the minor or lower socio-cultural standing of client
overshadowing the dynamics of the therapeutic relationship, the manifestation of power
difference is by far the most extreme in this case (Shelton & Delgado-Romero, 2011).
Although it has to be mentioned the need for power is crucial for the therapist to have in the
therapeutic association with the patient, in order to provide the most effective and safe care to the
mental patients. There have been many authors who have agreed to this age-old convention in
psychotherapy that therapists should be bestowed with the decision making power, however it

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also needs to be mentioned that there are considerable criticism as well. With the emphasis of the
health care industry on the patient preferences and informed consent, the new age in psychology
mandates the therapists to empower their clients. This criticism of the power manifestation is
supported by Lee (2010), in their argument they have stated that the power imbalance in the
therapeutic relationships is the main cause of client dissatisfaction. The complete decisisve
ability on the therapist’s hands often leaves the patients seeking therapy with a sense of
helplessness and anxiety, which can be detrimental for the health, and wellbeing of the patient,
completely defeating the purpose of the therapy. On the other hand, this idea is also criticised by
another school of thought elaborated by Day (2010), the decisive power bestowed on the
therapists have also been reported to be facilitating a sense of safety, security and confidence on
the expertise of the therapists. Therefore, it can be safely concluded that a consensus regrading
the impact of the power manifestation is significant, in order to arrive on a verdict, the impact of
the manifestation on both the patients seeking therapy, the therapists and the therapeutic relation
is required (Jahoda et al., 2009).
Considering the impact of the power difference in the therapeutic relationship, first and
foremost, it has to be discussed that the therapeutic bond between the client and the therapist is
the core element of the clinical psychology. It has to be mentioned here that psychology is
nothing above the general idea of help, where the experts of this field help the distressed people
cope with the different afflictions of the ever-changing societal dynamics (Kanter, Tsai &
Kohlenberg, 2010). According to Ian Parker, the main purpose of the psychology as a clinical
genre is being defeated with the complicated and critical treatment practice these days. With the
growing power imbalance in the therapeutic relationships between vulnerable mental patients
and their therapists, the practice standards have become more of a problem rather than being a

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solution. It has to be mentioned that patient centred care and autonomy is a fundamental element
of safe and effective care practice, regardless of the health care domain that the patient is seeking
help from. Hence, the consent of the patients must be given the most priority whenever providing
care to the patient, even in the case of therapeutic care (Totton, 2016).
However in case of the power imbalance in the clinical psychology between the client and
therapist complicates the ethics of the therapeutic bond and violates the concept of patient
autonomy and patient centred care. According to the Parker (2007), there is a need for a change
in the perception of the practice standards in the clinical psychology so that the intended or
unintended exploitation of the power imbalance in the therapeutic settings can be addressed. On
the other hand, for clients only seeking therapy for better living, there is no transference of power
and therefore, there is no power imbalance. This is where the consensus regarding the power
imbalance or unethical manifestation of power brews dense, where one school of thought affirms
the power imbalance and the other brushes it off as myth (Diener & Monroe, 2011).
On a concluding note, it can be stated that there is a growing consensus regarding the power
difference in the therapy setting of clinical psychology, where one school of thought agrees to
the imbalance, the disagreement states the assumption of power imbalance to be a myth.
Although, it has been explored in this essay that for the different groups of clients seeking
therapy, vulnerable mental patients and clients only seeking therapy for better living, the
scenario of power imbalance is completely different. The incidence and harmful impact of the
differential power is only imparted for the vulnerable group of mental patients, and the
magnitude of the impact cannot be overlooked either. Hence, the understanding of mutual

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respect and autonomy needs to be reinstated in the therapeutic setting, so that the trust placed by
the vulnerable patients on their therapists is not exploited under any circumstances.

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