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Balancing the Power Dynamic in the Therapeutic Relationship

Section 4
Therapeutic Space

Question 4 | Test | Table of Contents

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In the case of the power-abusing therapist, a second key to the pattern is that the therapist is usually also going through a life crisis and emotional difficulty that seriously impairs his or her judgment.

Let's focus more now on the case of Mary. Mary shared with me that her therapist stated feeling "trapped in his marriage due to having two children he felt 'talked into' by his wife."

3-Step Progression in the Case Study of Mary

♦ #1. Meeting His Own Needs - Instead of the Client's
However, with Mary, the balance of power shifted to unprofessional conduct when the therapist's responsibility to act only in the client's best interests, gradually began to reframe or reshape the relationship in a way that allowed him to meet his own (rather than Mary's) needs.

Some clients or patients, as you might guess, quickly perceive that they are being treated inappropriately and terminate the therapy relationship. However, others, like Mary, get trapped and may stay in exploitative or abusive client-therapist relationships. For a time, Mary felt wonderful, viewing herself as special and feeling very nurtured, cared for, and cared about, but obviously what was really happening was quite different.

The professional's manipulation of the situation, combined with his mystique so to speak, and the power imbalance of the professional relationship made the situation more complicated. Combine this with Mary's vulnerability and you can see what kept her in an emotionally detrimental situation. This situation clearly undermined her mental health and stifled her emotional growth. In addition, needless to say, Mary was not working on her problems or difficulties regarding adjustment to her divorce that took her to the professional in the first place.

♦ #2. How the Abusive Therapy Relationship Ended
You may be wondering how Mary's abusive therapy relationship ended. When she arrived early for an appointment one day and observed a long embrace between her therapist and another female client, she began to see the true picture and realized the relationship was damaging her and that she must leave.

However, terminating the relationship did not end Mary's problems. She was left with even more difficulties and stress than when she started. Now she had the after-effects of a sexual post-traumatic stress disorder.

Many other obstacles also remained, not the least of which was the lack of support from others in her life. Mary's mother felt that she should have known better and viewed her as merely having had an affair with a married man. Because of her mother's comments, Mary, a 35 year-old, was unable to gather the courage to seek out added help from friends and relatives who may have been supportive. Mary blamed herself and felt ashamed

♦ #3. Finding a Therapist She Could Trust
As you might guess, Mary was left with major difficulties regarding trust, and was at first unable immediately to seek further therapy after the incident. When Mary began trying to understand and heal from the damage done to her, she had yet another hurdle to face which was that of finding a therapist she could trust. Mary had received my name via a word-of-mouth recommendation.

Five years after seeing the abusive therapist, Mary had moved twice and came to me blaming herself and feeling deeply ashamed. Her presenting problem was an inability to get along with co-workers, as well as to sustain a long term relationship following her divorce.

- Penford, Susan, PhD. Sexual Abuse by Health Professionals. University of Toronto, Buffalo, 2000.
Course Reviewed 2023

Peer-Reviewed Journal Article References:
Goren, E. R. (2017). A call for more talk and less abuse in the consulting room: One psychoanalyst–sex therapist’s perspective. Psychoanalytic Psychology, 34(2), 215–220.

Gueta, K., Eytan, S., & Yakimov, P. (2020). Between healing and revictimization: The experience of public self-disclosure of sexual assault and its perceived effect on recovery. Psychology of Violence, 10(6), 626–637.

Hill, C. E., Lu, Y., Gerstenblith, J. A., Kline, K. V., Wang, R. J., & Zhu, X. (2020). Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists. Psychotherapy, 57(2), 263–272.

Pizer, B. (2017). “Why can’t we be lovers?” When the price of love is loss of love: Boundary violations in a clinical context. Psychoanalytic Psychology, 34(2), 163–168.

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181.

Wu, K. S., & Sonne, J. L. (2021). Therapist boundary crossings in the digital age: Psychologists’ practice frequencies and perceptions of ethicality. Professional Psychology: Research and Practice. 

QUESTION 4
What are two hurdles that remain after a client leaves the abusive relationship? To select and enter your answer go to Test.

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