Power in

Viewpoint
We bring certain power relationships into the
therapy room with us, and discover certain
power relationships already there, created by
the nature of the work. I want to start by

the therapy
looking at some specific issues around power
which arise in the therapy or counselling
relationship, deriving from the general social
context where some people have more power
than others. I will then go on to discuss power

room
relations as they are structured by the therapy
relationship itself. My argument is that
practitioners need to be continuously alert to
both sorts of power issue; but also, that we
need to let go of any notion of eliminating or
defusing such issues, and instead try to open
them up to the transformative effects of
awareness.
Few human differences are neutral with respect Difference, power and rank
to power. The more aware we are of our own Like all human life, therapy happens within a
issues of power and those of our clients, the better framework of sameness and difference1.
Client and therapist both seek out ways in
therapy will work. By Nick Totton which we can see each other as similar, and
ways in which we can see each other as
different. Either of these perceptions can be
accurate or inaccurate, and either can help or
hinder the therapy relationship. But very few
human differences are neutral with respect to
power. The great majority gender, ethnicity,
class, age, income, sexuality, ablebodiedness
are signifiers of rank.
Difference in rank inflicts many of the
emotional wounds which people bring to
therapy, and which can also be re-enacted and
reinforced in the therapeutic relationship1. In
his important discussion of rank, Arnold
Mindell points out that, Whether you earned
or inherited your rank, it organises much of
your communication behavior2; and this,
combined with visual information about
gender, ethnicity and so on, enables people to
very quickly and accurately, consciously or
unconsciously, read each others relative rank
with all its implications for relative power
(power usually goes along with rank, though
not always; for example, the Queen). These
issues have been referred to in terms of
majority and minority groups; but a
disempowered group is not always a minority
for example, there are more females than
males in the world, but males are a universally
empowered group. Therefore I prefer like
Mindell2 to speak of mainstream and
non-mainstream groups.
One feature of the mainstream is that its
members may be quite unconscious of their
own rank and power compared with non-
mainstream people. A white male middle-class
therapist (like myself ) may sincerely believe
that he claims no superiority of rank over a
female working-class person of colour who is
his client. But unless he recognises the social
reality that he has far higher rank than her,
and brings awareness to how this affects their
experience of each other, the therapeutic
16 Therapy Today/September 2009
September 2009/Therapy Today 17
Viewpoint
relationship will be warped from the subject; they may get angry, but generally client. In the heightened atmosphere of the
start; for him to ignore his power is itself keep this within bounds and strive for therapy room, the least shift of intonation,
a use of that power. Rank is a drug. The reason and articulacy. Some non- the smallest pause or silence, every choice of
more you have, the less aware you are of mainstream cultures, however, tend to which statements or actions of the client to
how it affects others negatively2. use hot and non-linear communication respond to and which ones to ignore, all very
Non-mainstream people are usually styles, where emotions bubble up freely effectively convey our views even when we
better informed about issues of rank. and the conversation circles around do not intend it4.
Since I occupy a mainstream position, rather than following a straight line. The client can of course also try to
there are almost certainly dimensions of Each of these styles has its own dominate the situation; but the therapist has
difference and rank which I fail to strengths and weaknesses, each is serious advantages from the start5. She is on
recognise, and these may be deeply perhaps more useful in certain her home turf, both literally (even if not
meaningful for particular readers. situations. But the great majority of working from home, she is familiar with the
Similar failures happen in the therapy therapists are trained and expert in the environment) and in the sense that she has
room; and therapists need to be prepared cool, linear style, and may be puzzled and done this before, as many clients have not
to learn from their clients and to deskilled and therefore defensive - and even if they have been in therapy before,
apologise for the hurt which their when faced with hotter and less linear they dont know how this therapist does
unconsciousness creates. Some ways of talking. A minority of therapists things. From the moment they first enter the
practitioners are themselves carrying have been trained in growth movement room, most clients are trying to work out
wounds around rank, which may affect approaches which equally privilege a what is expected of them and, generally
their work with certain clients: black hot, emotive, right brain style and will speaking, to provide it. They are off balance;
therapist with white client, working-class tend to characterise cool communication and without even realising it, the practitioner
therapist with middle-class client, female as being stuck in your head. Either way can exploit this.
therapist with male client all need extra the client may get pathologised. I once saw a video of an initial interview
awareness to avoid persecuting their The more we are familiar with these between an analytic therapist and a
high-rank clients. issues and open to exploring them, the prospective client. The therapist began by
But generally the therapists challenge better therapy will work. But this is not offering complete silence. After a few
is to be aware of their higher rank. to endorse the liberal belief that real uncomfortable moments, the already
Whatever rank they bring with them, differences of rank and power can be flustered client asked something like, Should
psychotherapists and, to a somewhat dissolved through sufficient good will. I tell you what my problem is, then? Smiling
lesser extent, counsellors are perceived The more we try to smooth them away, gently, the therapist responded Is there
as skilled professionals, with a similar the more awkwardly and painfully they something else that you feel should happen?
authority to doctors or lawyers; often make themselves felt. Like all Within their own paradigm, the therapist
they are credited with an uncanny and psychological wounds, in order to be was responding quite reasonably and
frightening ability to see right through transformed in therapy issues of rank appropriately. For an untrained client,
people1. Therapy is a middle-class and power need to be re-enacted3. And though, the response was bizarre and
occupation, whatever the self-perception there are key aspects of the therapeutic unnerving, apparently calculated to make
of individual practitioners; and situation which make it very easy for this them feel like an idiot, and to drain all
therapists are very often white and from to happen. spontaneity from the situation. However the
middle-class backgrounds. The steadily kindly and empathetic humanistic therapist
increasing length and cost of therapy The battle for reality can be seen as offering an equally distorted
trainings is likely to intensify the One of the most fundamental features of interaction. To put the client at their ease,
difference in rank between practitioners individual therapy or counselling is that help them feel comfortable and cared for,
and clients. there are exactly two people in the room offer them understanding and unconditional
(not counting ghosts, introjects, etc.) positive regard all encourages the client to
Expectations and misunderstandings These two people will either agree about feel grateful and indebted, and to avoid
Clients have different expectations of what is going on at any given moment, or anything which might cause this comfort to
their therapist or counsellor depending they will disagree. Does each person have be withdrawn.
on social and cultural context, and on one vote on reality? Or is it more complex The clients dependence on the counsellor
perceived and experienced differences of than that? or therapist is obvious. But the therapist is
rank. Most obviously, if a client identifies My suggested answer is that both are equally dependent on the client: not only (in
themselves as relatively disadvantaged true. Each person has one vote; but at the private practice) for their money, but also and
compared with their therapist, this will same time, each person has a wide range perhaps even more importantly for their
intensify the elements of wariness, of tactics available for claiming that their positive feedback. Offering therapy is a very
deference, hostility and appeasement vote is worth more than the others, and scary and insecure experience, even if we
which are always present at the start of for influencing and manipulating how have been doing it so long that we arent often
therapy. Therapists also have different the other person uses their vote. Most conscious of the scariness; and we need our
expectations of their client, depending obviously and notoriously, the clients to appreciate what we are doing, to
on differences of setting, of rank-related practitioner can claim more authority to value us, like us - even to admire us. Some
dimensions, and also of therapeutic pronounce on the situation, because of practitioners instead deal with the anxiety of
culture. As Mindell has pointed out2, the their expertise, training, status, the therapists role by despising and
communication style of the mainstream experience, and so on. This claim can be denigrating their unfortunate clients.
(white, Western, middle-class) culture made explicitly, as used to be the norm, These needs and anxieties on both sides of
can be characterised as cool and linear. but it doesnt have to be: there are many the room fuel for all sorts of complex power
That is, mainstream individuals tend to subtle ways in which the therapist can plays, manipulations, blackmails, seductions
speak one at a time, and stick to the imply that they know better than the and seizing of the moral high ground, as part
18 Therapy Today/September 2009
 of the attempt on both sides to gain the being a nasty and dominating therapist,
This is not to endorse other persons acquiescence in a for example! All we can do is to make
particular view of what is going on in the room for the pattern of distress to
the liberal belief that room and in the clients past and present express itself; which it will necessarily do
life. Generally speaking, the therapist through the therapist.
real differences of rank wants the client to agree that they have I am talking here about enactment 3
problems, that the therapist to some (Aron, 2001, Chapter Seven): the now
and power can be extent understands those problems widely recognised fact that therapists
(because they fit with the therapists and counsellors can find themselves
dissolved through theoretical paradigm), and that the two irresistibly dreamt up to take the role of
of them are working together in a way the oppressor and wounder from their
sufficient good will... that will tend to resolve the problems. clients story, and to repeat hopefully in
What the client wants the therapist to a relatively gentle and symbolic form
Like all psychological agree about is generally more individual the traumatic experience which the
and complex perhaps, for example, that client has been struggling to process. The
wounds, in order to be the client has been badly treated by other more we try to avoid this, the more it is
people; perhaps that the meeting forced upon us. And the means of
transformed in therapy between client and therapist is a very enactment are readily available to us, in
special one, even a romantic one; the difficult power relations of the
issues of rank and perhaps that the client is a truly therapeutic situation, and in the wider
exceptional person. The possibilities are social context of power-inflected rank
power need to be endless; and of course the therapist may differences which surround and invade

re-enacted.
hold equivalent notions, often the therapy room.
unconsciously. There is generally a real So what is to be done? With
tussle going on. enactments in general, and perhaps
I am not attacking anyone by pointing especially with enactments of wounds
out the shape of the therapy situation, far around rank and power (remember that
less am I criticising the nature of children suffer greatly from low rank),
psychotherapy and counselling; I am the first issue is to recognise and
simply pointing out some of the feelings acknowledge what has happened; the
that inevitably arise when two human next issue is to distinguish between
beings come together in this context. My shame and apology. We need to apologise
interest is in what we can usefully do in for what we have done, while recognising
relation to this. I suggest that the that it has been thrust upon us by the
inevitable power struggles over the drive to heal old wounds. We must also
reality of the situation should not be recognise that enactments use the
ignored, smoothed over, or subject to therapists weak spots: if I have any
attempts to fix them. Instead, they traces of arrogance or contempt, of
should be identified, acknowledged and racism, sexism or classism and who
explored, as crucial resources in doesnt ? these will be activated on
understanding and unfolding the clients behalf of the clients process.
process. More generally, I am suggesting that
A big part of the wound which most of the struggle in the therapy room over the
us bring to therapy or counselling is the definition of reality is not pathological,
sense that our experience has been but healthy; and that it deserves
ignored and overridden. We can respond recognition and support. Rather than
to this wound in all sorts of different trying secretly or unconsciously to
ways, and find many different ways to manipulate each other, the client and
hold on to our own sense of reality; but therapist can negotiate, argue, wrestle
the core experience for most people together over how to understand their
References not surprisingly, considering dominant experience of each other. This may be a
1. Totton N. In and out of the mainstream:
Therapy in its social and political context. In
ideas about children and childcare is of challenging process; but who will find it
S Haugh and S Paul (eds), The Therapeutic having our reality denied. more threatening, the client or the
Relationship: Perspectives and Themes. Ross-on- This might seem to suggest that the practitioner?
Wye: PCCS Books; 2008, 145-55. therapists job is to comfort and soothe
2. Mindell A. Sitting in the Fire: Large Group the wound, and to offer a reparative Psychotherapists and Counsellors for
Transformation Using Conflict and Diversity.
experience of being heard and accepted. Social Responsibility are holding a one-day
Portland: Lao Tse Press; 1995.
3. Aron L. A Meeting of Minds: Mutuality in And this is indeed a very important part conference in London on 21 November on
Psychoanalysis. Hillsdale, NJ: The Analytic Press; of many therapeutic relationships. Power in the Therapy Room, with Valerie
2001. However, it is not enough. A loving and Sinason and others; for details see http://
4. Totton N. Power in the therapeutic relationship. empathetic therapy will not on its own www.pcsr.org.uk/3.html.
In N Totton (ed), The Politics of Psychotherapy. enable the client to access the pattern of
Maidenhead: Open University Press; 2006, 83-93.
5. Sands A. Falling for Therapy: Psychotherapy
their distress; in a sense it will even help Nick Totton is a therapist and trainer
from a Clients Point of View. London: Palgrave them to cover it over. There is little that in private practice in Yorkshire. Email
Macmillan; 2000. we can do deliberately to change this by [email protected]
September 2009/Therapy Today 19