Power Differences in the Psychotherapeutic Alliance

Although there are different nuances within different psychotherapeutic approaches, the difference in attitude towards the client-therapist power difference can be divided into two very broad groups— symmetric and asymmetric following terminology used in Altemeyer (2013):

  1. The symmetric aspects of the relationship: In what is considered the humanistic approaches to psychotherapy, the therapist’s work is to be there as a companion to the client, to work with the client in partnership sans analyzing, judgment and oftentimes “helping”, but instead providing unconditional positive regard towards the client. For this to be achieved, there must exist a coming together of\ two authentic individuals as in Carl Roger’s person-centred psychotherapy approach that is “contact-building and acknowledging quality and empathy— without any techniques, means aims or intentions” (Schmid, 2001, p. 1).
  2. The asymmetric aspects of the relationship: Within psychiatry, and some archaic versions of the psychoanalytic/psychodynamic schools, the therapist is often expected to be the one more empowered to help the client, as a medical doctor would with his/her patient, providing analysis and nurturance, working on the interpretation of transference or dreams and the therapist’s countertransference reactions, and being a guiding figure to the client (Scharf, 2016, p. 50-55). Similarly, in behavioral & cognitive therapies, the client relies on the therapist for instructions, to set agendas, to give structure to the therapy and provide assistance for forming new experiences

Both standpoints are necessary for therapy to work. The therapist is a trained professional and has the theory behind them as tool to help the client through difficulties. Hence the therapist is the doctor and authority – and hence professional authority— with regard to psychotherapy. Concurrently, the healing process brought about through psychotherapy comes from the empathic alliance that the therapist builds into the relationship.

How then, if all approaches are viable, do we resolve these seemingly conflictual ideas of the nature of the psychotherapeutic alliance?

We can get an answer by referring back to the five-relational Clarkson framework, we may see that the asymmetric aspect or the relationship actually belongs to the first three parts of the therapeutic relationship: the working alliance (point 1), the transferential/ countertransferential relationship (point 2), and the reparative/developmentally needed relationship (point 3). The therapist’s role in these aspects of the relationship is clearly defined, and the switching of roles between therapist and client in this regard is inconceivable. The psychotherapeutic relationship must remain, on this level, an asymmetric one since the therapist has the defined role of the one who nurtures, helps the client with analysis and is the one being paid to do the job. The therapist takes on an egalitarian stance when he/she gives attention to the mutual relationship and helps the client to experience his therapeutic observations.

In the relational approaches of psychotherapy, however, the therapist helps the client to focus on the here-and-now and actively reduces the power inclination within the relationship; this with the intent to engage with the client on a more emotional and experiential level (Altemeyer, 2013). From this vantage point, we can see that the fourth and fifth aspect of the alliance— the person-to-person relationship (point 4) and the transpersonal relationship (point 5)— comes into play. With this understanding, we may be able to appreciate how and why all modalities of psychotherapy schools work: because each of the 5 levels of the alliance is (albeit in different measures and emphases) present in the relationships. We may be able to also understand why psychotherapeutic approaches over time evolve from analytical to relational and vice versa. Approaches evolve because therapists, through their experience working with their clients, have realized the need to modify their attitudes dynamically towards the therapeutic alliance in order to be effective in helping their clients.

The symmetric aspect of the relationship is important to consider– i.e. the person-to-person aspect (point no.4) and the transpersonal relationship (point no.5)— and to show that this symmetric therapist-client relationship is unique to psychotherapy and different from other healing or counselling professions. In most schools of psychotherapy, we are expected to reach into the intersubjective aspect of the relationship, which will be explained in this paper (Chew-Helbig, 2019) as the implicit material (i.e. what is between the lines and not necessarily said), whereas in counselling the focus is on the explicit material (i.e. what is being openly discussed). The symmetric aspect of the relationship is the part of the alliance that brings about enduring change in psychotherapy.

Read in this post about this part of the alliance that is actually the foundation of Freud’s work— that which Freud, through Breuer, discovered and proved to be the way to actually cure what is actually a psychosomatic condition known as Hysteria. Further discussions will move deeper into the whys and hows of what this unique aspect of the relationship actually does to alleviate the patient’s symptoms.

Click to access Helbig_2017_Bachelor_Thesis-nh-s-p.pdf

References

Altemeyer, M. (2013). Die Wiederentdeckung der Beziehung: Ein Paradigmenwechsel im Psychoanalyitschen Gegenwartsdiskurs. In B. Bocian, & F.-M. Staemmler (Eds.), Kontakt als erste Wirklichkeit. Zum Verhältnis von Gestalttherapie und Psychoanalyse (Kindle ed.).

Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.

Chew-Helbig, N. Analyzing a Gestalt Psychotherapy Session Using the Helbig Method of Dialogue Analysis (HELDA). URL: https://nikhelbig.at/wp-content/uploads/2019/05/NICOLE-HELBIG-PRINTING-copy.pdf

Clarkson, P. (2003). The Therapeutic Relationship. London: Whurr Publishers.

Scharf, R. (2016). Theories of psychotherapy and Counseling. Concepts and cases. (6th Edition ed.). MA, USA: Cengage Learning.

Schmid, P. F. (2001). Comprehension: the art of not-knowing. Dialogical and ethical perspectives on empathy as dialogue in personal and person-centred relationships. Empathy, 53-71.

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