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Balancing the Power Dynamic in the Therapeutic Relationship

Section 5
Client and Therapist Therapeutic Alliance

Question 5 | Test | Table of Contents

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The purpose of this course is to assist you in increasing your self-awareness in balancing the power dynamic with clients. According to Pinfold, there are four characteristics that separate the normal power imbalance in a therapeutic relationship from an unethical power imbalance.

A normal power imbalance may exist for you because some of your clients may perceive you as being a "healing guru" so-to-speak. However, the four characteristics of indulgence of role reversal, professional privilege, double bind interlock, and secrecy all set in motion a series of relational changes that create a new system of power with a force all of its own.

4 Characteristics of Relational Power-Imbalance

♦ 1. Role Reversal
Regarding role reversal and shifting the emphasis from helping the client to meeting the professional’s needs, the professional may rationalize to his or herself their behavior by claiming that they are still meeting the client's needs. The client becomes the caretaker, and the professional can now look to the client to satisfy his or her needs, thus twisting the ethics of care. But the professional does not give up the control in the relationship and still defines the boundaries according to his or her own needs.

♦ 2. Indulgence of Professional Privilege
Secondly, regarding indulgence of professional privilege, for instance the professional's needs and the client's vulnerability may combine to present an opportunity for the professional to exploit the relationship. A sense of entitlement may be used to allow the professional to intrude on the client. Mary was told that the sexual contact during the session was therapeutic for her. By engaging in this activity, Russ, her therapist, told her she was learning to love again and not hate men.

♦ 3. Double Bind
Thirdly, the double bind is a form of a paradoxical communication that takes place in which the therapist expresses a message that can be interpreted in two, or contradictory, or mutually exclusive ways. Here’s how this double bind worked with Mary. She felt a commitment to action due to the faith she had placed in the therapeutic relationship.

♦ 4. Secrecy
The fourth and final characteristic that separates a normal therapy power imbalance from an unethical power imbalance is that of secrecy. The secrecy element in Mary’s case was played out by scheduling her at the end of the day, after others had left the office. Also at times, the therapist would suggest another location for the session, like the therapist’s or the client’s house.

Peterson, M. R. (2015). At personal risk: Boundary violations in professional-client relationships. W.W. Norton and Company.
Reviewed 2023

Peer-Reviewed Journal Article References:
Kivlighan, D. M., Jr., Marmarosh, C. L., & Hilsenroth, M. J. (2014). Client and therapist therapeutic alliance, session evaluation, and client reliable change: A moderated actor–partner interdependence model. Journal of Counseling Psychology, 61(1), 15–23. 

Kachanoff, F. J., Taylor, D. M., Caouette, J., Khullar, T. H., & Wohl, M. J. A. (January 2019). The chains on all my people are the chains on me: Restrictions to collective autonomy undermine the personal autonomy and psychological well-being of group members. Journal of Personality and Social Psychology, Vol 116(1),141-165.

Karlsson, M. E., Zielinski, M. J., & Bridges, A. J. (2020). Replicating outcomes of Survivors Healing from Abuse: Recovery through Exposure (SHARE): A brief exposure-based group treatment for incarcerated survivors of sexual violence. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 300–305. 

Leibovich, L., Front, O., McCarthy, K. S., & Zilcha-Mano, S. (2020). How do supportive techniques bring about therapeutic change: The role of therapeutic alliance as a potential mediator. Psychotherapy, 57(2), 151–159.

Taber, B. J., Leibert, T. W., & Agaskar, V. R. (2011). Relationships among client–therapist personality congruence, working alliance, and therapeutic outcome. Psychotherapy, 48(4), 376–380.

Zilcha-Mano, S. (2017). Is the alliance really therapeutic? Revisiting this question in light of recent methodological advances. American Psychologist, 72(4), 311–325.

QUESTION 5
What are four characteristics that separate the normal power imbalance in a therapeutic relationship from an unethical power imbalance? To select and enter your answer go to Test.

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