Zur, O. Following is one example of this: The transference phenomenon is extraordinarily powerful and yet the patient does not realize it is occurring, since it is an unconscious process. (Winer, 2008), Quotes from Attorneys on Power in Therapy. This is likely to level the playing field and to create less hierarchical relationships. While the general topic of power obviously extends to economic, political, racial, gender and many other realms, the focus of this paper is on the therapeutic arena. (2005). Therapists not only get to name or label clients so-called mental disorders and conditions but also get to lay the blame for lack of therapeutic progress at the feet of their clients. For Zur Institute Board Approvals go to 22. Of course, therapists have the fiduciary responsibility not to harm or exploit their clients, sexually or otherwise. After attending this course, participants will be able to. Well, let me tell you something about power. This current embraced the strong and the weak, the good and the not so good, the healthy and the frail and the so-called normal and the different. Psychotherapy: Theory, Research, Practice, Training, 35, 78 86. The problem with this argument is that it draws causal conclusions from statistical correlations. Very few authors, beside Beker (2015), Dineen (1996), Fay (2002), Gutheil, (1989), Heller (1985), Holmes & Jacob (2014), Lazarus (1994); Lazarus and Zur, 2002), Proctor (2002), Ravella (1988), Williams (2000), Wright (1985) and Zur (2007a, 2008c, 2017), have reflected directly on clients power or analyzed therapist-client relationships beyond the simplistic and unrealistic split of omnipotent therapists and helpless clients. On being sane in insane places. If one accepts the slippery slope and the power differential hypotheses, it readily leads to a conclusion such as that of Strasburger, et al. For example, if clients find out in their web search that their therapists are or have been engaged in criminal activities, they do gain a lot of power vis--vis their therapists. Herman, J., Gartrell, N. Olarte, et al. A plaintiff may fraudulently simulate a specific personal injury scenario for the purpose of winning a financial award or increasing the size of such an award. Gutheil (1989), similarly points out, It seems that professionals who belong to a school of thought that rejects the idea of transference, behaviorists or psychiatrists who provide only drug treatment, are being held to a standard of care they do not acknowledge (p. 31). Ross-on-Wye, Herefordshire: PCCS Books. On the one hand, feminist therapy advocates that power will be shared between therapists and clients and that egalitarian relationships must be achieved in order to promote healing. Its reliability and validly is highly questionable, even by the people who developed it. Which of the following is NOT a possible on-going consequence for the client being sexually exploited? Pope, K. S. and Wedding, D. (2007). To confuse such sequential relationships with causal ones is like saying that doctors visits cause death because most people see a doctor before they die. As was noted above, the movie, One Flew Over the Cuckoos Nest, presents the ultimately brutal and deadly power of a treating psychiatric nurse over psychiatrically incarcerated men. Many psychotherapy or counseling clients are, indeed, distressed, traumatized, anxious, depressed and therefore vulnerable. Knox, S., Hess, S. A., Williams, E. N., & Hill, C. E. (2003). United States Association for Body Psychotherapy (USABP), (2007). One way to follow the aspirational goals of these principles and to handle the ethical, legal, and clinical complexities is to have an open, truthful, and honest discussion of the therapists moral convictions, cultural biases, and legal and ethical mandates so that clients, if they even have a choice, can make informed decisions regarding their treatment. The myth of the slippery slope has not only contributed to the justification of isolation of clients but also perpetuated the illusion of the power differential and therapists omnipotence. Dawes, R. M. (1994). In the bigger scheme of things the most important changes in the late 1990s and in the beginning of the new millennium have been a less dogmatic approach to therapeutic ethics. Cults in Our Midst. (1992), who stated, Obviously, the best advice to therapists is not to start [down] the slippery slope, and to avoid boundary violations or dual relationships with patients (pp. This paper identifies nine (non-mutually exclusive) types of powers: Legitimate power; Expert-Knowledge power; Professionalism power; Positional or Role power; Knowledge-Discrepancy power; Coercive power; Reward power; Reference power; and Manipulative power. Feminist Therapy Institute, (1999). Current Psychotherapies, 8th Edition. Over the last decades, and clearly in the 21st century, a new consumer culture has emerged characterized by clients different expectations about their relationships with their medical and mental health providers. . (1998, p. 91). The issue of trust is closely related to power. The idea of powerful and influential therapists working with vulnerable, dependent clients is applicable to some situations. Thursday September 24th, 2020. Predictably, this group focuses on the protection of, what they see as, vulnerable female clients who have been sexually exploited by powerful male therapists (Borys 1992; Bouhoutsos, 1985; Brown, 1994; Sonne & Pope, 1991). Zur (2005) views this myth as one of the most prominent ways that our professional standards have been, what he called, dumbed down.. Barnett, J. E., & Yutrzenka, B. Bloomgarden, A. and Mennuti, R. B. Power in therapy can only be understood within the context of therapy. (Like, Sonne, Pope seems to view boundaries in a more flexible way in a more recent article (Pope & Wedding, 2007).) . Restrictive Draconian Views Must Be Vigorously Challenged. In the isolation of the office, clients are left to rely on their imaginations regarding their therapists and, as a result, many tend to unrealistically idealize their therapists and attribute great social and intellectual power, wisdom, beauty, or sex-appeal to them. Referent power derives from peoples liking, admiring, being attracted to, or desiring to be like another person and results in them being willing to follow that person and obey his or her requests, wishes or orders. Regardless of the scientific or non-scientific basis of these assessments and psychiatric labels, the fact that the expert therapists identify and name the mental disorders, developmental problems or family dynamics gives them power that derives from expertise and knowledge of the clients so-called diseases (Caplan, 1995; Zur, 2008a; Zur & Nordmarken, 2007). Hypnosis is viewed by many as a technique that evokes an undue power differential between patient and therapist. Units: Psychotherapists in inpatient psych. ), frequency, presenting problem, or professional discipline. The fact that therapists can detain, medicate and treat people against their will is probably one of the most profound powers that are assumed by therapists. New York: Oxford University Press. They have stressed the importance of differentiating between power over and the power to empower or, what has also been called power with. Class, Race, Gender, and Crime: The social realities of justice in America Certificate of attendance will be provided to all participants who complete an evaluation at the end of the webinar. Sarkar, S. P. (2009). It is not. People can coerce others by employing threat of physical force or actual physical force, by invoking their legal status or authority, or by blackmail, intimidation and other forms of manipulation. It took me a long time to get my head around how I had taken the slippery slope into some of these behaviours being Its all part of the phenomenon that causes us to stay inside and watch TV Referent power is often fueled by the persons charisma, social or economic status, or capacity to persuade, influence and manipulate. London: Guilford. Gutheil, TG (1989). He writes: My first experience of a true village was in East Africa in 1970 where, as a young scientist, I was attempting the interesting and ultimately impossible task of getting the villagers to eat fish from a nearby lake and thus to enrich their protein poor diet. Retrieved on September 23, 2008 from http://www.radpsynet.org/journal/vol6-1/milioni.htm. As a dynamic, relational, and multifaceted force, power may shift during and between sessions and over time. Duncan, B.L., & Miller. Brody (1992) in his book, The Healers Power, separates power into three categories of Aesculapian, Social, and Charismatic power. Exploitation of Professional Relationships. Frank, J. D. (1973). Gabbard, G. O. They argue that a true informed consent takes place where clients have true choices about their treatment, and it emerges from a dialogue between therapists and clients, which discusses treatment options, risks, benefits, therapists expertise and limitations, etc. . 1 Dell P. Hackett and James T. Reese, Law Enforcement Suicide: The Supervisors Guide to Prevention and Intervention, Suicide and Law Enforcement (2001): 97-103. (a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. In R. Rosen, S. R. Leiblum, Case Studies in Sex Therapy, (pp 264-278). Touch In Therapy and The Standard of Care in Psychotherapy and Counseling: Bringing Clarity to Illusive Relationships. Viewing women clients as always innocent and pure victims, completely vulnerable to male, sexual predators, is very far from a comprehensive view of the interplay of power and sex. Holmes, D. & Jacob, D. J. Your ethics texts make it sound like you can snap your fingers and I will jump into your bed. . (Brown, 1994, p, 29), Virtually all psychotherapy clients enter treatment with some impairment in their self-esteem and assertion skills, making the therapists approval extremely important to the client . 687-696. (2008c). Therapists can facilitate the creation of an environment that will increase the possibility of clients living up to their potential (i.e., their power), or they can create an environment that is detrimental to clients or patients. While many forms of multiple relationships are neither unethical nor avoidable, sexual dual relationships with current or recently terminated clients are always unethical and illegal in most states (Zur, 2007a). It is worthwhile repeating here what was stated earlier, that many scholars who supported this myth have found support for their dogmatic stance in the fact that generally a boundary crossing (i.e., gifts, bartering, non-sexual touch, dual relationships) always precedes sexual exploitation of clients. The therapist does not have control over whether alcohol is being served with hors doeuvres or a meal. New York: Springer. . He carefully analyzes the relationships between knowledge and power and discusses how knowledge is used to justify the just and unjust use of power. National Board for Certified Counselors code of ethics. A more detailed discussion of hypnotherapy and power is provided later on in this paper. Should psychotherapists self-disclose? Psychoanalysis has emphasized the importance of therapy in isolation and anonymity of the therapists not only for the purpose of privacy and a way to increase self-disclosure but also for transferential-clinical reasons. Welch, B. L. (2000). Psychotherapy or counseling often includes numerous rituals, actions and meta-communications that subtlety, yet significantly, enhance therapists power relative to their clients. 10-11am Pacific Time/1-2pm Eastern Time. Unpublished document. You'll come away from each session looking at your own cases with fresh eyes. 2. Therapists can deal with powerful attractions to clients by: d. monitoring boundaries by setting clear limits on physical contact, self-disclosure, and client requests for personal information. Such an idealization or projection without any real life corroborative references or support is likely to give many therapists, not only the gratification of being adored, but also power over their unrealistically adoring clients. Accordingly, the role of the therapist is to empower the client to develop the capacity to make such informed decisions. In addition, many clients now view themselves as consumers as much as patients, and these clients have increased expectations and demands for psychotherapists transparency. In summary, the slippery slope dogma that imposes greater anonymity on the therapist and increased isolation is likely to increase the power differential and exploitation rather than decrease it. Originally retrieved from http://www.advocateweb.org/hope2/tenstepslitigating.htm. 9. Movies about psychotherapists present a wide range of situations, settings and behavior showing therapists and clients power. When a client is unable to afford therapy, it is possible that he or she may: a. offer a bartering arrangement or exchanging goods in lieu of a fee. Regretfully, there is no reconciliation between these two positions within the feminist literature. Wright, R. H. (1985). Psychotherapy, 30, 41-48. Many clients are anxious or depressed when they finally seek therapy or counseling. Voice: The Art and Science of Psychotherapy, 44 (3), 32-40. The fields of psychotherapy, counseling and ethics would benefit from a more complex view of power and its many permutations. The interpersonal theory of psychiatry. In this view, transference increases therapists power and, therefore, their ability to exploit their clients. Celenza, 2008) April 1, 2008 Psychiatric Times. (1985). It also provides direct quotes from those who have perpetuated the myth that all therapists have influential power over all their clients long after the termination of the professional relationship and those who claim that: Once a client, always a client. After extensive documentation of the myth of therapists omnipotence and clients fragility, the paper explores the possible sources of such faulty beliefs. American Journal of Psychotherapy, 46(4) 544-555. The stereotype of the powerful and dominant therapist who has absolute power over vulnerable, dependent and easily influenced clients, neither fits with my view of myself as a client, nor with my extensive experience with my clients over the many years of conducting psychotherapy. 31. It can be referred to as holy or evil. ), Psychology and Psychotherapy, London, Routledge, pp. Most professional associations codes of ethics belong to the second group and present ambivalent and ambiguous guidelines in regard to how long therapists power over their clients last. The forum offers an opportunity for participants to share experiences, questions, and resources, as well as a chance to network. 25. Caudill, B. Jr., (2008) Malpractice & Licensing Pitfalls for Therapists: A Defense Attorneys List. The ethics codes of most professional organizations provide guidelines for the ethical practice of bartering. Expert power relates to the individuals knowledge, information, proficiencies, mastery of techniques and skills that are generally acquired through education, training and experience. Finally, the paper proposes new ways to view power relationships in psychotherapy that are realistic to the field of therapy and counseling and are, at the same time, respectful to clients. Gabbard, G. (1994). The slippery slope construct is unscientific and professionally precarious. Vol. Several attorneys who have contributed significantly to the literature on mental health law have also supported the theme of psychotherapy clients inherent vulnerability. It can also reveal information about the therapists family, home address, hobbies, sexual orientation, spiritual practices and much more. This free webinar is designed to support families navigate children's emotional reactions as they return to school, either in person or online. b. aggressive, frightening, intimidating, demeaning, arrogant, unwanted, insensitive, threatening, or intrusive. There are several situations and reasons that many clients are progressively more empowered, less dependent, and feel more equal to their therapists, or even superior in some areas, as therapy progresses.
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