Abuses Of Power In Counselling And Psychotherapy 352i1h

Abuses of Power in Counselling and Psychotherapy The topic I wish to address here is the imbalance of power which exists between a counsellor or therapist and a client. The particular way in which this imbalance usually exists is that the counsellor is professionally qualified in counselling or therapy and the client is not equally qualified. The client will come to the counsellor for help of some kind, and the counsellor will be trained in some method of therapy, whereas the client in most cases will not be. The client then usually looks to the counsellor or therapist as an expert of some kind, and will often solicit advice. That the counsellor is trained and the client is not, is one kind of power imbalance, but age, disability, gender, race, and sexual orientation are other factors which may influence the imbalance of power. It seems that characteristics of the dominant group in society, maleness, able-bodiedness, middle class background, white skin, and heterosexuality, are all factors which give the possessors of those characteristics more power and influence, and more scope to be listened to as authority figures, than those who do not posses those characteristics. Academic qualifications and hip of professional bodies are also highly significant characteristics of the dominant group. Despite the importance of these factors, I will concentrate my argument on the power imbalance in the relationship between any professional counsellor and client, focusing on analytical psychotherapy, gestalt therapy, client centred therapy, feminist therapy, and touching briefly on therapy as istered in some psychiatric hospitals. Academic qualifications and hip of professional bodies are almost always characteristics of the people istering therapy, whether or not they possess other characteristics of the dominant group. I will describe some of the ways an imbalance of power between client and counsellor has led to exploitation of clients. Mearns and Thorne (1988, p 96) describe the way an abuse of power arises in many of the helping professions, by which the client will be kept waiting in an inhospitable room, only to be summoned by a disembodied voice to a room with a closed door, eventually meeting an expert who almost ignores the client and then sends the client on their way. They comment that power games can be played with tables and chairs as much as with words and tone of voice. Many people come to counselling with lack of confidence in themselves, and low self esteem. They have usually had people telling them what to do for their whole lives. A counsellor who merely sets up a situation where the client is advised or taught the right way to think and behave, isn't doing anything new, and may just perpetuate the problem the person initially has. I am making an assumption that power imbalance is a bad thing. Not everyone will agree with this assumption and some may even say that progress is facilitated when an expert leads and a non-expert is guided. I would argue that in the matter or human behaviour and relationships, no one person can see into the mind of another, and look there to find what is best for that person. Only the person themself can know the entirety of their life situation. Given that, I would agree with Carl Rogers (1951) that the person should be the expert about their own life. When an imbalance of power exists between a client and a helper, it is all too easy for the helper to influence the client's behaviour, based on the helper's own opinions of what is best for the client. I believe that counselling is only of use in the sense that it can help the client to find their own answers for themselves. Rogers attempted to do away with many of the features that emphasised the power imbalance, insisting on the term client rather than patient, and demanded that training in his methods be open to all who showed talent and not restricted to professionals. He showed hostility to the use of labels and diagnoses, and was opposed to the use of manipulation in therapy. I do find it quite difficult to find anything bad to say about Roger as I feel his intentions were to promote equality, and he did it to his failings where they existed (Rogers 1951). My personal feelings about Rogers was that due to his own high standards, possibly his personal goodness, and his idealism and concern for equality, he was blinded to the arrogance and paternalistic domineering of professionals he worked with. Let us assume, however, that the person-centred counsellor and client have established a relationship which minimises the inherent imbalance between a professional therapist and a client. Mearns and Thorne have listed a number of ways which a person centred counsellor might ensure that they do not give a message of superiority.What might get in the way of this relationship working? Mearns and Thorne (1988, p 133) point out that a danger may arise of over involvement, where the counsellor "uses her relationship with the client as a means of confirming her own importance by exerting power over others." Although power-hungry therapists might be more attracted to a less client centred approach than that provided by person-centred counselling, a counsellor might still abuse his or her power by creating excessive dependency among clients, perhaps by making too many suggestions or encouraging requests for advice or permission, feeling and expressing very strong emotions to the client, and at the very extreme, entering into a sexual relationship with the client. Mearns and Thorne (1988, p 134). In recordings of Carl Rogers sessions with Gloria, it is easy to see how Gloria looks to Rogers for approval and advice. Gloria is intellectually aware that Rogers is not there to give advice but even so Gloria solicits it. It is possible that Rogers exploits such feelings of dependency when he and another client, Larry, talk about Larry's father-in -law and ways in which the relationship between Larry and his father-in law might be mirrored in the counselling relationship. Rogers has written extensively on the role of the person centred counsellor and emphasises the benefits of equality in the relationship. Mostly Rogers worked with unhappy people who were not seriously disturbed. However, he believed that person centred therapy could be of benefit to anyone, even people who society would consider quite "mad". In order to test this hypothesis he set up a large study of people with diagnoses of chronic and acute schizophrenia, who were on treatments of drugs and electroshock. The patients did not volunteer to be in the study. Rogers described the study thus "the therapist might force his presence on the patient...go to see him in the seclusion room (if the patient was confined there), or have him brought to the therapy office, more or less against his wishes". Rogers also acknowledged that one of the study participants described her enforced participation in the study as a form of torture. Rogers was clearly unhappy about some of the treatments which were forced on the patients he encountered in Mendota State Hospital, such as "being kept in restraints for too long a period" (Rogers, cited in Masson, 1988), but he did not criticise hospital policies because such criticism would be resented and could jeopardise his research project.

Feminist counselling, with its emphasis on non-hierarchical interactions and criticisms of social power structures, might be a good candidate for a form of counselling where the parties are more equal. Indeed, there are some organisations such as Women's Aid, which provide informal counselling and peer . These services would not exist without feminism, and they provide informal counselling with a feminist slant. Professional Feminist Counselling, however, has a formal structure and model. Jocelyn Chaplin of the Women's Therapy Centre in London, wrote a book (Chaplin, 1988) for people who want to counsel in a non-hierarchical way. However, she conforms her clients stories and experiences to her pre-existing models. In Chapter 3 "Getting Started and Building Trust: The 'Mothering Phase', she discusses the way many clients have had inadequate mothers and need a counsellor who will "play the role of accepting mother." Chaplin calls this process "remothering". She also speaks of the counsellor as a guide "showing her how to examine her feelings and thoughts" (p.87). Feminist counselling is not immune to analytical interpretation, indeed, in the version described by Chaplin, interpretation is rife! For example after an interpretation by the counsellor described on page 119 "Julia hotly denied this interpretation". I would suggest that it is an abuse of the counsellor's power to suggest they can read the client's mind and know things about them that the client has not told them. Feminist counselling was developed both out of the Feminist movement and also as a reaction against the patriarchal and hierarchical model used by early therapists such as Freud and Jung, in which a wise expert interprets, directs, and explains. A mention must be made of these two early therapists as examples of their abuses of power are striking but not widely known. Freud's case history of Dora, a young woman who he diagnosed with "hysteria" is notable for his interpretations, which are all in fitting with his theories but at variance with Dora's explanations. Initially, according to Masson (1989), Dora did not wish to be analysed. Freud got Dora's father's of why Dora was depressed, which he thought was related to Dora's perception of sexual advances made by Herr K., a family friend. Freud took note of this reason for Dora's problem, rather than asking Dora herself. He then made a number of interpretations. Many of these ran contrary to Dora's own beliefs. Perhaps it may be relevant to ask whether Freud was biased towards believing the of Dora's father and the men in her life. In a letter to his own fiancŽe', Freud writes "It seems a completely unrealistic notion to send women into the struggle for existence in the same way as men. Am I to think of my delicate sweet girl as a competitor?" (Freud, cited in Masson, 1989). It is perhaps not surprising that analytical psychotherapy does not encourage the minimisation of the power imbalance between client and therapist. After all, transference is recognised as being an essential part of treatment, and in order to facilitate transference, the therapist adopts a distance, and actually encourages dependence and uses interpretation as an essential tool. It is clear that the therapist's interpretations are highly dependent on the culture in which they are immersed. Freud interpreted the source of many of his patients' problems to be masturbation, for example in Dora's case, her stomach pains. He writes "The circumstantial evidence for her having masturbated in childhood seems to be complete....It is well known that gastric pains occur especially often in those who masturbate." (Freud, cited in Masson, 1988). A very influential disciple of Freud who influenced many of the later analysts was Ferenczi. Some of the things he wrote seem very relevant to the recordings I have seen of more recent and less analytical counsellors in action with their clients. He wrote about analytical therapy thus: "while the patient lies there in misery, we sit comfortably....we make conventional interpretations...In the best of cases , the analyst makes a colossal effort to overcome his yawning boredom" (Ferenczi, quoted in Masson, 1988). Ferenczi acknowledges that interpretations can be a dangerous act of aggression. In discussing child abuse Ferenczi stated that an imbalance of power underlay abuse, and the same power structure and the same imbalance existed in the analytical situation. This s my hypothesis. Ferenczi actually suggested that analysis might be two way and that a patient could analyse him as well, but he did not make this idea public and didn't do it. It is interesting to think what he would have thought about Carl Rogers, and co-counselling. Ferenczi criticised Freud, saying that Freud believed his patients had misunderstood the world around them in the way a child sometimes does, and like children they needed correcting in their misunderstandings. He pointed out that too many analysts felt superior to their patients and wanted to instruct them in how to live (Masson, 1988). Of course the teachings of Freud have influenced many therapists and counsellors, be they person centred, feminist, or eclectic. The existence of the unconscious and the importance of early childhood experience have ed into the public consciousness and become givens, with the weight of scientific facts like the fact that the world is round. However, Freud's theories are merely theories, not facts. Jung's work has been equally influential to that of Freud, as he founded a trend called analytical psychology which has been as influential on psychotherapy. Masson (1988) points out that Jung's of Hitler, his anti-Semitic ideas and the Nazi Party was quite clear. He quotes Jung as saying "Hitler is a medicine man, a form of spiritual vessel, a semi-deity, or even better, a myth..." (Jung, quoted in Masson, 1988). Jung's attitude to his patients was patronising and at worst, insulting. He called them sick, crazy chickens, and nuts. (Jung, quoted in Masson, 1988). Like Freud, Jung's views on women were sexist. He wrote that a man's foremost interest should be his work, but a woman's should be her home and her marriage. He writes "home is like a nest, not enough room for both birds at once. One sits inside, the other sits on the edge and ...attends to all outside business" (quoted in Masson, 1988). Apparently most of Jung's patients were women. Jung's attitudes towards black people were also reactionary, he viewed them as "savages" who needed to be mastered. Jung also had a tendency to see all problems as spiritual or religious in nature. One of his students wanted to talk to him about her parents. Apparently he responded "Don't waste your time! Anyway, I know a person's relation to his parents at first glance!" (quoted in Masson, 1988). Another patient of his suffered from "compulsive argumentativeness" as she tended to disagree with him. In paricular she disagreed with his interpretation of her dreams as that she secretly wished to marry. Apparently they caused him to think of "nymphomaniac possession". Jung used his own dreams to interpret other people's reality, and even worse, he picked up certain bizarre aspects of dreams to diagnose serious mental illnesses, for example "latent psychosis". (quoted in Masson, 1988). In my opinion, the theories and philosophy of Jung have been too readily accepted as facts by today's students of psychotherapy and counselling, as have those of Perls. (see below). Uncritical acceptance of the ideas of men who held such obnoxious and anachronistic views about so many things, (views which were merely opinions not based on scientific research), and were so keen to label people on the basis of small details, must surely be dangerous. Many abuses of power are based on the therapist's interpretations being seen as expert diagnosis. Masson cites a number of such abuses in the context of Family Therapy, where the therapist "knows best" and behaves like a "guru."

Another well known form of therapy is Gestalt therapy, a very influential form of therapy pioneered by Fritz Perls. The emphasis on experience, of being in the present, and truly experiencing life (which was not Perls' own idea but based on the ideas of the existentialists), is very helpful. However, Perls own history of helping leaves much to be desired. Masson quotes a story Perls told of his encounter with one patient who he fought and knocked to the ground. Apparently he said to her "I've beaten up more than one bitch in my life" and then continued "she finally got what ...she was asking for... there are thousands of women like her in the States. Provoking, tantalising, bitching, irritating their husbands, and never getting their spanking. You don't have to be a Parisian prostitute to need that so as to respect your man". (Perls, quoted in Masson, 1988). Masson claims that it is well known that Perls had sex with a lot of his patients ( an extreme example of the expression of the power imbalance between client and counsellor). Masson has important criticisms of a number of other highly influential therapists, and therapeutic models, including the work of Milton H. Erikson, incest survivor therapy, eclectic therapy, and in particular the work of John Rosen, founder of Direct Psychoanalysis. Rosen was Professor of Psychiatry and Chairman of the Philadelphia Mental Health and Mental Retardation Foundation. Masson suggests that Rosen was one of many therapists who harm many of their patients under the guise of greater wisdom. He believed in confronting his patients with reality in order to dissolve their delusions. He wrote "Sometimes, when I have the patient pinned to the floor, I say "I can castrate you, I can kill you, I can eat you..."". Confronting people with evidence that their irrational beliefs are delusions, either directly, or indirectly, by going along with them and then demonstrating that they are false, seems to be a basic technique of many kinds of psychotherapy, for example a patient who believed he had no colon was given an enema, and a man who feared electricity was strapped into an electric muscle stimulator (Masson, 1988). In a similar way the person centred counsellor will point out inconsistencies in the client's statements, in order that they may have a more realistic world view. It may seem that these examples I have described have no relevance to the student of counselling, and in particular to the student of person centred counselling. I would argue that it is essential that students of counselling are highly aware of the potentials for abuse which come with the power they take on when they enter into a professional relationship where they are perceived as a counsellor or therapist. Awareness of instances of abuse can give the student information with which to decide how much credence to give the theories of those founders of psychotherapy who committed abuses, and also a warning as to how easy it is to misuse and abuse the client-counsellor relationship. Specifically, I think these abuses are: encouraging excessive dependency, treating the client as a child in any way, interpretation, any form of acting on the client's behalf except where this is at the explicit wish of the client, any form of physical which goes further than normal social , giving orders or commands, and in most cases, breaking of confidentiality. References: Chaplin, J. (1988) Feminist Counselling in Action. Sage Publications, London. Masson, J., (1989) Against Therapy. Harper Collins, London. Mearns, D., and Thorne, B. (1988) Person Centred Counselling in Action. Sage Publications, London. Rogers, C. R., (1951) Client Centred Therapy. Constable: London copyright L.Henry 1999