The Power Differential and Why It Matters So Much in Therapy

psychiatrist looking at clock“I’m trying to imagine ethics without an awareness of power. That would be like trying not to step on anyone’s toes, without an awareness of one’s feet.” —Susan Mikesic

The power differential is the inherently greater power and influence that helping professionals have as compared to the people they help. Understanding both the value and the many impacts of the power differential is the core of ethical awareness. Written codes for ethical behavior are based on the strong positive and negative impacts of this power differential.

People seeking help are in a position in which they must trust in the knowledge and guidance of their caregiver. This results in a greater-than-ordinary vulnerability. Consequently, people are unusually susceptible to harm and confusion through misuses (either under- or overuse) of power and influence.

Examples of Power Inequality

“The impact of the role, control, and power difference between client and therapist is very strong and also very subtle, and thus demands a strong ethical stance. In brief, your role as the therapist [or any helping professional] is to create a safe space, empower your client, protect your client’s spirit, and to see a wider perspective.” —Hakomi Institute Code of Ethics preface

Stated another way, there is a power inequality whenever you take on a role that gives you authority over another or creates the perception that you have authority. Power differential roles include: supervisor, clergy, body worker, healer, lawyer, coach, group leader, therapist, counselor, doctor/nurse, mediator, teacher, social worker, massage therapist, guide, and social worker.

Personal Power and Role Power

In talking about the power differential, it is necessary to clearly describe and distinguish between two kinds of power. This distinction is important because it makes clear that the increased power that accompanies a position of authority is role-based and not the same as personal power.

  • Personal power is our ability to have an effect and to have influence.
  • Role power is the added-on power (and responsibility and opportunity) that accompanies a positional role.

I like to show the difference between these two powers with scarves. When I am a therapist, I have my personal power, of course, but I wear my added-on role power as if it were a scarf. When I leave my office, I take my role-power scarf off. My personal power stays with me. It’s like my scarf has access to and stores information related to the enhanced power that belongs to my role. With my scarf on, I can remember multiple details about my clients’ processes. When I take my scarf off, I can and need to leave those details and responsibilities behind.

This is not a purely black-and-white thing. Of course I continue to have concern about the people I work with in therapy, and I am known as a therapist or teacher even when I am not in these roles. But many misuses of power are a result of the person in the up-power role over-identifying with his or her role power, forgetting that this is a role-based add-on power.

My friend Nancy’s husband, Daniel, is a commercial airline pilot. Until they understood this dynamic, their marital relationship was quite compromised each time Daniel came home and acted as if he were still the airline pilot—a commanding position. Things changed when Daniel ritually took off his hat with the symbolic words, “I’m hanging the pilot on the hook now.”

Up-Power and Down-Power

I refer to those in positions of increased role power as having “up-power” and those in corresponding positions of lesser power as having “down-power.” These are simple and directional terms not intended to indicate disrespect, disempowerment, exploitation, manipulation, better, worse, power over, or power under. Instead, these terms are intended to denote role differences in responsibility and vulnerability.

Up-power and down-power positions have cognitive, emotional, and somatic differences. As an exercise, I ask my students to walk around the room imagining walking with someone up-power to them. My students notice a variety of things—feeling smaller, more cautious, protective, turned inward (or, for some, feeling relaxed, eager, relieved). Then, when imagining walking with someone they are up-power with, they notice feeling more spacious, focused on the other, taller, kind, caring, and alert. It is very clear to them that the two roles are experienced differently. For most, this is a surprise. A student described the difference in this way: “When I’m a practitioner, my personal needs and ‘stuff’ are behind me resting against my shoulders, and when I’m a client, my personal needs and ‘stuff’ are sitting right there in a huge ball on my lap, visible and available.”

We move back and forth daily between being in up-power positions and down-power positions.

We move back and forth daily between being in up-power positions and down-power positions. (Like putting on a scarf or robe when in a role and taking it off when leaving the role, we move from up-power therapists to a down-power supervisee, or up-power doctor to down-power patient, for example.) We are usually unaware of the shift. This unconscious shifting of roles makes it more difficult to clearly understand the dynamics and impacts.

Some up-power roles carry a stronger differential—and, therefore, a stronger risk of harm—than others. For example, the president or a police officer or a therapist has a greater power difference than the chair of a committee or a clerk in a store. But all up-power roles have impacts and dynamics.

Value of the Power Differential

In the helping professions, the power differential has great value. Used wisely and appropriately, it creates a safe, well-boundaried, professional context for growth and healing. More specifically, when used ethically and effectively, the power differential offers people in therapy, students, supervisees, and patients some important assurances:

  • Confidence in their caregiver’s knowledge, training, and expertise
  • Security, safety, and protection
  • Role boundary clarification and maintenance
  • Assessments of progress
  • Sensitivity, respect, fairness, and care
  • Allocated responsibilities
  • Provision of direction, focus, treatment, guidance, and support
  • Overview and access to a bigger picture and wider view of persons and situations
  • Chain of accountability
  • Facilitated accomplishment of task and purpose
  • Final decision-making authority

These values can be reduced to six categories:

  1. Safety, kindness, and boundaries
  2. Larger frame
  3. Expertise
  4. Assigned responsibilities
  5. Accountability
  6. Assessment and productivity

Think about it. When you go to a therapist, doctor, or teacher, you want to be in an environment where you can get what you need. You want the environment to be different than just talking to a friend. When you get on a plane, for example, you want and need the pilot to look and act competent. Wearing jeans and a T-shirt just won’t do. You need him or her to be skilled, to embrace his or her role, and treat you with respect.

Understanding and Owning Your Power and Influence

Because the power differential is role-dependent, it is easy to over-identify with (or get inflated by) this increased or enhanced power. However, it is just as easy to misuse this increased power by under-identifying with it. The central idea here is the necessity to understand and own your role power so that you can be conscious and informed.

Here are several misunderstandings that illustrate the multiplicity of the impact of the power differential for both helping professionals and people who seek help:

  • Believing in equality, you may find it difficult to accept that your role creates a power inequality, and that this inequality is actually essential to your effectiveness.
  • Rushed for time, you may underestimate the power differential and over-focus on technique or useful information. Effective use of your role power involves balancing technique with the essential need for relationship connection and repair when needed.
  • In fear of manipulative and wounding abuses of power, you may find it difficult to understand that, to be able to use it for good, you must own the power you have. Under-use of power is also a misuse of power.
  • Misunderstanding your elevated role power as confirmation of your wisdom and a mandate to take charge, you may inadvertently disempower, disregard, or disrespect the people who turn to you for help.
  • Motivated by a desire to be of service, you may find it difficult to comprehend that your impact may be different from your intention, and that it may be experienced as confusing or harmful.

The power difference between therapist and person in therapy, or other similar pairs, is the dynamic that creates down-power vulnerability. Down-power vulnerability, based in a role, is what creates the need for ethical guidelines to protect people from harm.

© Copyright 2015 GoodTherapy.org. All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 9 comments
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  • candace

    candace

    October 9th, 2015 at 7:59 AM

    As long as that difference in power is not abused, and I don’t think that a true professional would ever do that, then it is necessary for there to be that line of who is helping whom, and in what ways that can be accomplished with the patient maintaining a feeling of safety and security.

  • Jessi

    Jessi

    October 9th, 2015 at 10:49 AM

    This is a place that it can almost mean more than everything eels simply because of the roles that the two people are playing.
    One is in a position where it could be perceived that they held incredible power while the other could be very vulnerable and easily taken advantage of.
    It is definitely a point to consider in multiple situations.

  • Gina

    Gina

    October 10th, 2015 at 8:43 AM

    Don’t you think that by going into this with the determination that one has more power than another is kind of the wrong way to look at it?

    Yes one has a background in helping others while the other sometimes may not, but that shouldn’t imply that one is the stronger party.

  • lynn

    lynn

    October 12th, 2015 at 8:22 AM

    Gina, I agree. Just because someone has more education in a certain background doesn’t mean that there is power over you. There has to be a level of trust established that should not ever be breached.

  • Greg

    Greg

    October 13th, 2015 at 5:19 AM

    I see this kind of client therapist relationship as the one in life that could help someone so much and if done incorrectly could also tear someone down and do so little.

  • marley

    marley

    October 14th, 2015 at 11:02 AM

    It matters so much because you have to understand that it can feel like you are giving up an awful lot to this person when you decide to go into therapy. It can also make you feel very vulnerable and for a whole lot of us that is not a comfortable position to be in. I think that you have to be willing to turn some of that vulnerability over to this person so that they can help you through it, and honestly that is just not a very comfortable situation for many of us to find ourselves in.

  • Saul

    Saul

    October 16th, 2015 at 11:17 AM

    Without this differential then it would be like talking to a friend and not a professional. I think that establishing this as a professional relationship will do much better in terms of you relating to this person in a way that would make you value what they have to say instead of brushing them off like you might be apt to do with someone who is just a friend.

  • tee l

    tee l

    October 19th, 2015 at 11:33 AM

    You want to work with someone who can see the big picture, who can help you break that huge overwhelming issue down into smaller and more manageable parts.

  • leon-hard eul-her

    leon-hard eul-her

    May 3rd, 2017 at 9:18 AM

    ffs i came here thinking i was going to learn about the differential operator between two powers but i landed on some feel good rubbish? no wonder girls don’t do maths

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