Power Dynamics

L and I have different opinions on the power dynamics of the therapeutic relationship. She says that we're equal and where we aren't, she wants to try to make it more equal. I completely disagree. I do not think we are equal on most aspects.

One example that is huge is the issue of touch. Somehow we were got to talking about touch. She says there are certain things she won't do (i.e. hold a client, sit on the couch next to the client, etc.) because she's not trained in that type of therapy. Oh! I remember now how this came up. We always hug at the end of session. The other day she hugged me and ran her hand down my arm. This bothered me. Not because I felt violated, but because she touched me without discussing it first. I would have assumed touching my arm was against her "rules", but SHE decided that touching my arm was okay. However if I decided to, lets say hold her hand, SHE might decide that she's not "trained" to do THAT touch. That's a huge power imbalance! She's the one making the rules, not me.

And she has told me that she has a small personal bubble, and that she's normally okay with touch.

We will be talking about all of this tomorrow.

Anyways, I'm curious to know how you all have experienced the power imbalance in therapy.

Ahhh, so very in the middle of this question with my T as well. Last week I was worried that the rules would change if we sat in a different part of the office. This is a very typical fear of mine across relationships not just with T so good fodder for us to practice right? T comes back with “I’m not changing who I am and I make the rules!” (Said with all the emotion of an over confident toddler on a sugar high). I laughed so hard at him!
Feeling a bit called out on “L won’t hold a client, sit on the couch next to the client” as my T does both. My T *usually* works hard to minimize any power imbalance (unless his inner 3 year old comes out). We both have the power to say “yes” to a request and we both have the power to say “no”. He has all sorts of legal and ethical rules he has to follow on top of just being a normal civilized human. I just have to be a normal civilized human and even that isn’t always required. Ethically T’s are not supposed to abandon their clients and are supposed to make referrals if they cannot continue to work with the client for any reason. T’s are also ethically supposed to try and give the client closure if they terminate therapy. I can ghost him, I can just not reschedule, I can fire him any time I want. I have to admit that right now feeling like the one who is in control of the therapy process is really scary for me (great, another thing I can mess up!).
The touch example you gave really resonated in me with my experiences with other T’s. If I wanted touch it had to be this huge deal, conversation, what does it mean, specify boundaries... blah... blah... blah... but seeing as I generally want touch they felt it was OK for them to touch or change touch without talking about it. IMO that is unethical and a huge boundary violation and I have been badly hurt by those kinds of actions. Rules go BOTH ways!
Current T has touched me without asking first and has changed up touch without asking first (things very similar to the example you gave). BUT when I have spontaneously touched him without asking or in a different way he has extended to me the same grace I extend to him... if it is OK we just let it be the spontaneous moment that it was. If one of us didn’t feel OK about it then we talk about it. When we talk though it isn’t “you broke a rule” or “you violated a boundary” punitive power dynamic. When we talk it is more about finding the comfortable space for both of us that meets that need. For example one time he started tapping his hand on my knee in an attempt to help ground me as I was disassociating. I didn’t feel comfortable so I put my hand on top of his. He explained his intent when he touched me (help me stay present) and I said the tapping bothered me and I would be much more comfortable if he held my hand. We had an open conversation about what the different touches felt like emotionally, the connotations each of us had with the different touches and what they physically felt like for me. Now he touches my hand or my arm and it is a firm, steady touch instead of a jolting tapping. IDK, it is all new to me but it felt like a really safe, healthy way to work out mutual boundaries between two people regardless of roles.
Last week I told T I was scared that if toddler me got triggered I would touch him without asking or move too close to him without the pillow between us. He thanked me for mentioning it but assured me that even if I hadn’t it would be OK. He explained that toddlers don’t know to ask first that is a grown up thing to do and young kids have to be taught to ask. He let me know that if it happened he would respond the same way he would respond to a small child. “You want to be held? OK, let me get the pillow we use and then I can hold you OK?”. No shaming, no blame, no reacting, no anger... just a very gentle cue that she has to tell him her needs and then he will put the boundaries/safety in place.
IDK if this makes any sense at all, I am super triggered today and on migraine meds... but with my T everything goes both ways so no power imbalance IMO.

I really have never felt much of a power imbalance in therapy. My sessions were very much a dialogue - very give and take. I was free and felt free to express my opinion as to whether what we were doing, what the therapist was saying/interpreting, etc. was working or accurate and knew they would listen and we would come to a resolution on those issues together. We never really had to have discussions about boundaries or rules or touch, etc. because they just kind of naturally fell into place as we worked together - never really a power issue there.

I think there is a power imbalance built into the whole thing and it’s weird to me when Ts insist there isn’t

Since the relationship is about you as in any therapeutic relationship, she is really supposed to ask you if touching you like that is okay. It is alright for her to set boundaries, but she needs to respect your boundaries by asking what yours are.

I think in therapy there is an imbalance of power because the clinician knows all about us, and we don't know much about them. In a way, I don't want to know too much about my providers because it may interfere with the therapy and maybe even the relationship itself.

I guess my relationship with L is somewhat balanced. She does let me know things that I'm curious about 99% of the time. I can't think of an example of when she has said no to answering a question of mine, but we ALWAYS have to discuss my questions first (i.e. why I want to know, how would the different answers affect me, etc.). And she said it would make her sad if I terminated with her. I guess it's touch that I feel is imbalanced. I don't mind touch so long as it's appropriate, though I haven't explicitly defined appropriate with her yet. But she still gets to make the choice what she will and won't do based upon what she believes is past her training. It has nothing to do with what she's okay with or ethics or even what I'm okay with...just her opinion.

We were also talking about desires. She tells me that all my desires are okay. Again, I disagree. If my desires are okay, and the person is okay with them too (i.e. touch), but in reality it could never happen, then to me that equates to them being wrong.

I don't know. I just am worrying about tomorrow with her. She says everything will be okay. She says she'll be gentle, and will give me options instead of just one suggestion. I'm still worried. This is extremely important to me. I think she is understanding after all the emails I've written her, and I know we always come out of things like this okay. But I still worry.

Sorry. Maybe this thread is more about touch than I realized. But my main issue is that she says our relationship is balanced, but because of touch, I disagree. And I still feel that it's unbalanced and it upsets me that she doesn't see it from my perspective. I am not looking to change her stance. If she does, great! If not, then don't try to sell me a dream that cannot exist.

But you are taking a stance that YOU don't have personal power in touch in therapy. You can also have boundaries about touch in therapy -- you should. We all should have boundaries about what is acceptable/unacceptable in terms of touch; we teach that to small children. What we can't do is demand someone else touch us in a certain manner; your therapist can't either. So if you ask her/someone to hold your hand, THEY have the choice to agree or not; that's THEIR touch boundary. If your therapist asked to hold your hand, YOU would have the choice to agree or not; that would be YOUR touch boundary.

My therapist never touched me during session without asking permission because during the intensity of discussion and processing, I might not be aware of him approaching or might not be in a place to be touched at all. However, we might greet each other with a hug or say goodbye with a hug without it being something either of us had to ask for; that was just part of our greeting/leaving ritual. It wouldn't bother me at all if he somehow touched my arm in a different place/way in the hug; I would probably not even notice because there is not one way to hug in my experience.

Touching your arm in a hug doesn't seem like anything but part of a hug. You have put an interpretation on her touching your arm as if that was a different action, but my guess is it was just part of the hug for her. I doubt she even thought about it as anything different. YOU see it differently, and perhaps that's worth discussing, but I don't think it is about power as much as you being hypersensitive to touch issues maybe.

That's pretty concerning and, at least to me, I would consider any therapist who says there isn't a power imbalance is either a fool or a manipulator.

I think if there wasn't a power imbalance, many of us wouldn't have gotten hurt the way we did. At least I think so.

If there were no inherent imbalance it would also be okay to have a sexual relationship with a therapist, instead it’s felony rape in many states

Yes you are right. I meant to say it is necessary. I wrote this when I was very tired.

This is needed just like boundaries are needed to protect patients. Example: a friendship is a two way street; therefore, both people need to get their needs met. However, if all this occurs in a therapeutic relationship, the provider remains biased. When this happens, effective and productive therapy can't take place.

Im not disagreeing with you or anything just adding that point to the thread

I do believe the power imbalance is necessary. Without it the therapy would become biased and the aforementioned (what I typed above) would happen. Again I was very tired when I wrote that post.

I think the parties have different sorts of power. The client hands the therapist money in exchange for time. The client can terminate with no notice, explanation, or reason. Therapists need money. It is a K and each party has something the other is seeking - the client buys time and the therapist gets money from the client. The client can take their money elsewhere just like the therapist can quit selling time to the client. IT is a business contract.

Well put.

It drives me crazy when people try to make something out of the therapeutic relationship that it’s not. Therapists are not your friends or parents and are not required to act as though. Once people wrap their heads around that the less disappointed they will be.

What you said is a given.

It drives me crazy when people assume that just because they don't have a particular problem, it's not a problem at all and other people who have it should just get their **** together and deal with it like they do. If I could just feel and act as I think would be practical, I wouldn't need a bloody therapist in the first place. And for many others as well, making something out of the relationship it's not is part of the issue. Moreover, therapists call it 'transference' and insist that it's part of the process and is a good thing.

Thing is, I can't say or do anything that'd cause significant enough hurt for my therapist to have sleepless nights or slip into self-destructive emotional patterns. Not that I want to, but she can to me, and she had. There's your power imbalance.

If she does that (and shows no sign that she intends to take steps to avoid the same in the future), I have the choice of painfully cutting an attachment that I somehow developed against my own better judgment (and then possibly spend more time and money on finding another T, not to mention the stress of it), or staying and risking further hurt. Meanwhile, should I decide to leave, my therapist has to switch from taking my money to taking someone else's. She might have an empty hour for a week, maybe two if very unlucky, big deal. That's not exactly balanced either.

Mind you, for someone as ****ed up as I am, there's a power imbalance in practically every relationship, therapeutic or not (save for a select few friends), but transference issues can result in even otherwise functional people becoming more vulnerable.

I never thought there were power difference in my therapy. I understod it more as difference in roles, equally powerful people in different roles. Power difference makes me think things like authority and that someone is higher in status. I didn't feel that way.

Oh yes, different definitions of power. To me power is the ability to affect, that kind of translates to 'ability to hurt' on a more visceral level, lol. Or maybe just because I have been recently hurt by a therapist.

I guess some clients might just not be vulnerable, dunno, it might also depend on modality, but I think big part of the apparent lack of power imbalance for some people might be that when it's threatening (either due to client sensitivity or therapist misbehaviour) then it's very apparent, whereas in a relationship that feels safe, not so much.

This is a fair point. Therapists having their **** together (not expecting their needs fulfilled, having a decent handle on their own triggers and blind spots etc) contributes to their 'power', but also to their ability to shoulder the responsibility that comes with it (though some might choose not to, or slip up). Still, when the therapist doesn't have that, they still have the power advantage in the sense of ability to do massive harm and remain relatively unscathed.

Part of what happened with my therapist seems to have been that her own fears and sore spots that I triggered caused her to act out. Even so, I feel that had she signalled sooner, clearer, and in a more civilised way that I was being a pain, it could have been useful to my therapy - the problem was her playing the martyr then lashing out.