Can Therapists Really Share Power with Clients?

Rather than trying to deny their power, therapists should be aware of it.

Posted Sep 25, 2017

GotCredit/flickr
Source: GotCredit/flickr

It’s quite trendy these days for psychotherapists to talk about “sharing,” “equalizing,” or even “giving away” their power to clients. The motivation for doing so comes from a well-intentioned place. Therapists—especially those attentive to issues of power, privilege, and social justice—worry about unintentionally using their authority in ways that inadvertently harm clients. They don’t want to pathologize clients, imperiously impose their own worldviews on them, or overlook biases that might negatively affect the therapy. All good goals, but how to achieve them? One way some therapists try to do so is by ostensibly giving their power away. Thus, they “share” it.

While the impetus behind such power sharing is certainly understandable, many questions remain unanswered. Here are some that I keep returning to whenever the issue of therapists sharing power arises:

  1. What exactly is “power” in therapy? Clinicians often talk about it, but rarely define it. Do we mean power in some Foucauldian way, or do we have something else in mind? And if we are invoking Michel Foucault, have we forgotten that he felt power is always part of every relational equation?
  2. When a therapist gives power away, what does this mean? Does the client get to decide how long sessions last? Where they are held? What diagnostic code goes to the insurance company? What theoretical orientation the clinician utilizes? What the therapist’s fee is? Some of these items might be up for discussion with clients, but my guess is that many others are typically nonnegotiable. If so, then isn’t at least some therapist power inevitably retained?
  3. How does one “share” power? Is there something one says or does that makes one a less powerful therapist? Is power-sharing a purely relational endeavor? What exactly must one do to be considered a power-sharer?
  4. Once power is shared, how does one know whether it has been shared successfully? Can we rely on client reports (“yes, I feel empowered”)? Even when clients agree that power has been shared, is it not possible that they are just saying that because, well, they fear disappointing or offending someone who they see as—dare I say—powerful?
  5. Is power sharing permanent or revocable? Can therapists take power back? For instance, when therapists become concerned that a client is dangerous to self or others, can they retract the power they previously shared? And if power is there for a therapist to take back, then was it ever truly shared in the first place? After all, if therapists can revoke power, then doesn’t it reside with them all along, whether this is admitted or not?

I’d like to suggest that therapists cannot divest themselves of power. The role of therapist unavoidably comes with certain types of power invested in it. Rather than trying to deny their power, therapists should be aware of it. They do set many of the terms of therapy. They decide which theoretical approach to use (including when they choose approaches sensitive to the misuse of power). They also determine fees, where sessions will be, and how long sessions will typically last. This sort of power is part of being a therapist.

Equally important, let’s not forget that clients have power, too. We often forget this because we get so concerned about therapist power. The power that accompanies the role of client is different from that of therapist. Clients get to decide whether to attend therapy in the first place. They also usually have the power to stop attending. Clients reserve the right to disagree with their therapists or even switch to another therapist if they are dissatisfied with the one they are seeing. Thus, clients are powerful too. Clients and therapists, by inhabiting different roles, each have distinct forms of power available to them while lacking other forms of power.

None of this is to say that therapists shouldn’t think about the power they do have. They can easily do harm when the clout they carry isn’t carefully utilized. As many of us learned (from Winston Churchill or Spider-Man, depending on our point of reference): with great power comes great responsibility. Therapists should neither deny their power, nor take it for granted. They must endeavor to use it wisely to help, rather than hinder, their clients. The risk in therapists pretending they can strip themselves of power is that—once they convince themselves they no longer have it—their potential to harm others by seeing themselves as lacking in influence rises exponentially.