Abuses of Power: Power Differentials in Professional Relationships
Power differentials exist in many professional relationships. In professional relationships (with therapists, doctors, supervisors, teachers, clergy, etc.), the power differential can feel overt or subtle. Generally, being a client, patient, or student means that you have entered into a professional relationship with someone you are hoping to learn from - whose expertise, experience, and/or training in a particular area will benefit you in some way. When you seek help from any professional, there is a sense of vulnerability (to varying degrees) required for you to learn, grow, and/or heal.
Today’s post focuses on power differentials in therapy, and how to recognize the misuse or abuse of power by a mental health professional.
When Therapy Harms (Part 1)
When you decide to seek out therapy, you are looking for someone to help you with a particular struggle, problem, or concern. It's similar to going to a doctor when you don't feel well, with the hope that your doctor will listen to you, identify the problem, and offer an appropriate treatment. You are counting on the doctor's expertise, experience, and training to help you feel better. In much the same way, most people attend therapy because, in one or more ways they don't feel well. Therapy is an investment aimed at moving you toward mental wellness, with the therapist utilizing their expertise, training, and experience to help you achieve the goal of feeling better.
It’s always disheartening to hear a client talk about how they’ve had negative experiences with therapists. Some negative experiences are normal, if you happen to be working with a therapist who just isn’t a good fit for you in their personality or style of counseling. Finding a good therapeutic fit is important, and when styles or personalities don’t mesh, it’s time to seek someone with whom you feel more comfortable.
Harmful therapy experiences are different than a mismatch of personality or style, though. If you’ve never been to therapy before, you might not yet be familiar enough with the process to determine good therapy from bad. You might not know what therapy is supposed to look like. Making things more complicated is the fact that therapy can look vastly different from one experience to another. This is good news in that you can find a therapist with a style of counseling that fits well for you. On the other side of the coin, though, there is no 100%, clear-cut, same-across-the-board picture of what good therapy looks like. It can look different from one therapist to another, or one therapeutic technique to another. However, there are licensing boards with rules and ethical guidelines that therapists must follow. These guidelines can help you decipher a healthy versus unhealthy therapeutic relationship.
5 Warning Signs of Abusive Therapy:
Breaches in confidentiality - what you say in therapy should remain confidential. There are exceptions to this rule, some of which include if you are a danger to yourself or to others, or if you report a child or an elderly person is being abused. In general, though, the therapist should not talk about you or what you say in therapy with their friends, family members, other clients, etc.
Breaches in privacy - therapist are legally required to keep your health information private in a variety of ways. Without your express permission, your therapist is not allowed to even acknowledge that you are a client. There are exceptions to this rule, as well, but in general - your therapist should not disclose that you are a client without your express, written permission. Generally speaking, if you see your therapist out in public, your therapist should not approach you, wave, say hello, or in any way acknowledge that they know you. They aren't being rude - they are simply protecting your right to privacy! It is up to you whether or not to disclose that you are in therapy.
Blurring relationship boundaries - though a therapist might feel like a friend, the therapeutic relationship is a professional relationship. It is generally unethical for a therapist to engage in any kind of relationship with you outside of therapy. This means that a therapist should not hang out with you outside of the therapy setting. There are few exceptions in which a therapist may engage with you outside of the office when it is clearly therapeutically beneficial, but these exceptions are very limited and aimed toward achieving very specific therapeutic outcomes, and for very particular sets of problems or issues. It is always unethical, and never okay, for a therapist to enter into a romantic or sexual relationship with you!
Fostering dependence - when you are just getting started, or doing really hard work in therapy, you might start to feel dependent on the therapist. This is completely normal and natural. However, it is the therapist's job to empower you over time, to learn skills and techniques that help you to manage symptoms, and function independently. The nature of a successful therapy relationship means that it will eventually end, and empower you with skills and resources to function independently, and in more healthy ways. Some people spend longer in therapy than others, and some issues require more time to resolve, but therapy is not intended to last forever. If a therapist says things like, "you need me," or, "you can't get better without me," - these are both red flag statements that the therapist is misusing their power in the therapy relationship.
Withholding information - you should understand what is happening in therapy, and your therapist should be open to answering your questions about how you are working toward goals, and what techniques are being used and why. Therapists are trained specialists, and exploration of your history and concerns, as well as challenging the way you look at things, is part of the process. However, you are the client (or the customer), and you are in charge! You have every right to know and understand about your treatment options, and understand what is happening in therapy.
Potential Effects of Abusive Therapy:
1. “It’s my fault” – (guilt/shame/misplaced responsibility). While I do understand where this belief might come from, it simply is not true. I’ve heard clients say things like, “I’m an intelligent person. I should have known better.” The truth is that, yes, you are an intelligent person – but you entered into a professional relationship with a therapist who is responsible for practicing ethically, legally, and working to “do no harm.” You should expect to be able to trust in a therapist to use their knowledge and position of power to help you, not to hurt you.
2. “I’m so confused” – (confusion/ambivalence), Most of the time, therapist misconduct evolves over time, and is not overtly obvious. As with almost everything, there are exceptions here, as well. I will write more about additional warning signs of abusive therapy in Part 2, but for now, I want to help to normalize your experiences of confusion. When you start out working with a therapist, have spent time building rapport and trust, and then eventually that source of support becomes hurtful– the result is lots of confusion and ambivalence in remembering when the therapist was trustworthy and kind, mixed with remembering when the therapist was hurtful and abusive.
3. “I can’t trust anyone. I can’t trust myself” – (mistrust). Trust in therapy, especially for those of you who experienced trauma and abuse before entering therapy, can be very difficult to achieve in the first place. When a therapist proves untrustworthy or abusive, it solidifies those beliefs that you might have had in the first place – that people cannot be trusted, and trusting people can only lead to more pain. Furthermore, abuse by a therapist leads to doubt in your ability to trust yourself. “How can I know that this won’t happen again?”
4. “I want to die” – (despair/hopelessness). You entered into therapy to feel better, and perhaps to recover from prior experiences of abuse, neglect, or harm. An abusive therapist, instead of inspiring hope, has instead shown you that there is only more pain. If you are thinking about suicide, I want to encourage you to do something totally counterintuitive – give it one more try and reach out for help! While there are therapists out there who abuse their positions of power – there are far more therapists out there who want nothing more than to help you regain a sense of hope, see that there is still good in the world, and help you to heal.
While I do not have any magical words that will help you to trust that there is real, healthy, and sincere help available, I do hope that by writing this series about this little-talked-about form of abuse of power will give you a sense that you are not alone, that this has happened to other people - and that there is a way to heal from the pain of the past, reclaim your sense of self, regain your ability to trust, and to find your own infinite possibilities for a happy and meaningful life beyond therapist abuse.
Kristen Henshaw, a Licensed Professional Counselor (LPC), specializes in helping those impacted by misuses and abuses of power – including, but not limited to emotional, physical, and sexual abuse by parents, therapists, clergy, teachers, physicians, and others in positions of power. For a respectful and gentle approach to healing, contact her for your free thirty-minute consultation.