Do you want power in the therapeutic relationship?
Take a moment and sit quietly with this inquiry. What are your beliefs around power? What do you feel in your body when you ask this question? What do you know about your power?
The word power may elicit different responses for different people. Power is often felt to have a hard edge, implying a sort of one-up position or control over another. Power is also often narrowly understood as a negative force.
This definition of power is far too limited. Perhaps by exploring power in a different context you can soften this edge and learn to foster your relationship with your clients based on shared power, while maintaining the responsibilities of the therapeutic role.
The Power Differential
Power is the ability to have an effect or to have influence. The power differential is the inherently greater power and influence we as practitioners have as compared to our clients.
We don’t have a choice about this.
The choice we do have is how we use our power and influence.
When you take on a role as a helping practitioner, you make a commitment to being of service to your clients through utilizing your professional training and expertise. You also automatically take on, through your role, an increased role of power and influence with your clients.
The power differential is simply created and maintained as a result of our professional role. This increased power and influence serves the helping relationship by creating safety through clearly stated boundaries and authoritative context that is necessary for effective work. It also creates a heightened vulnerability for clients.
Clients are in a position where they must trust in the knowledge and guidance of their massage therapist. Clients are often susceptible to harm and confusion through misuses of power and influence. This therapeutic dance is often misunderstood and filled with subtle and not so subtle complexities.
The power differential is amplified by the physical aspects of our work. Our client is lying on the table while we are standing over our client. Our client is naked while we are clothed. Our client has specific needs they enter the session with while we must keep our personal needs outside the session room. Clients pay for the service we offer. Clients are asked to reveal private or delicate information. The client most often comes to our environment.
These dynamics simply add to the existence of the power differential.
How Power is Expressed
As we move toward understanding the power differential, it is useful to consider the different ways power is expressed.
The first is an over-use of power. This misuse of our role can show up in various ways within the therapeutic relationship.
Examples of common grievances involve taking advantage of or causing harm through sexual contact, working outside our scope of practice, breaching confidentiality and not offering informed consent.
Perhaps the more subtle ways of over-use of power are not offering our clients choices (such as, “Would you prefer to begin face up or face down”), excessive self- disclosure, being late for appointments, sloppy draping, unnecessary treatments and over-identification with the power role.
Under-use of power is also a misuse of power. This often comes as an insightful shift to understanding the power differential. It challenges some beliefs, such as, “I do not want power over my clients,” or “I trust my clients know what is best for them.”
Examples of this are many and varied. You may have a difficult time enforcing your practice policies, for example, or you do not discuss client’s inappropriate language or behavior. Perhaps the therapeutic relationship feels more like a friendship, or you do not feel confident in quieting down a chatty client.
Responsible and skillful use of power is expressed in many ways. The therapeutic relationship has the potential to feel smooth, clear and authentic. Using your power to model the virtues of kindness, compassion, integrity, respect and love are the gifts you can offer your clients.
The power differential should be used primarily for the purpose of bringing value, clarity and guidance to clients. The power differential serves the therapeutic relationship by offering an authoritative context that is necessary for effective work.
Role-Dependent Power Factors
The power differential is role-dependent. The client and massage therapist inhabit different roles. Each of these roles carries with it certain responsibilities.
The practitioner role:
- Is in service to the client
- Is recognized as having a particular expertise and skill
- Can offer feedback, guidance and education
- Is responsible for establishing and maintaining good boundaries
The client role:
- Is more vulnerable and in a position of trust
- Is asked to reveal information that may be private and delicate
- May not know what kinds of behavior may cause difficult dynamics in the professional relationship.
It is important to understand that massage therapists are 150 percent responsible for what occurs in the therapeutic relationship, while the client is 100 percent responsible. It is in the best interest of the therapeutic relationship to teach clients what they are responsible for. This is often conveyed in our written practice policies and verbal informed consent.
The Value of the Power Differential
The following is a list of values of the power differential:
- The client has confidence in the massage therapist’s knowledge, training and expertise; therefore, the client can trust the direction and support offered by the massage therapist.
- The professional relationship feels secure and safe for both massage therapist and client.
- Expectations and role-boundary clarifications for both client and massage therapist are understood. This is best conveyed through practice policies.
- Both client and massage therapist have allocated responsibilities. No one person is carrying the load of the relationship. There exists collaboration between massage therapist and client. This collaboration fosters satisfaction and effectiveness. However, the massage therapist is more responsible for the overall health of the relationship.
When used wisely and appropriately, the dance of power within the therapeutic relationship offers clients some very important assurances. As a result, the relationship holds clarity and mutual respect, and may circumvent potentially awkward situations.
Inequality of Power is Essential
As a result of many discussions held around the dynamics of the professional power role, I often hear the following comment from students: “I believe we are all equal and no one has more power than another within the therapeutic relationship.”
This response comes from a lack of understanding of the profound value of the power differential.
Pause and think about what would happen if your doctor or a parent underused his or her inherent role power. What possible impact might this have on the doctor-patient or parent-child relationship?
An inequality of power is essential to the effectiveness in your professional role. (I remind my students that role power is not directly related to the universal belief held by many that we all come from the same source.)
The following three directions will help you maintain healthy power inequality.
1. Remain in charge. To remain in charge, you must track the therapeutic relationship.
It is true that clients control compliance. You cannot provide service to clients unless they give you their consent.
However, given the power imbalance that occurs in the therapeutic relationship, you are ultimately responsible for tracking the relationship and the impact on both parties.
The term tracking refers to the moment-to-moment sense of where the relationship stands. Tracking is a skill that comes with practice. I suggest practicing the disciplines of slowing down, quieting down and noticing how your client is responding to your touch and your presence.
If you don’t slow down and pay attention, you may just miss a critical client signal. You will certainly miss that delicate point in a relationship where a thoughtful response could help keep it on track.
2. Create a safe harbor. Clients require a space of trust, safety, accountability and respect. What might each of these qualities look and feel like in the therapeutic relationship?
Please pause a moment and consider the above four qualities. Take out a sheet of paper and list five actions that foster trust in the therapeutic relationship. Continue this exercise listing five actions that foster safety, accountability and respect.
3. Keep your personal life at home. Excessive self-disclosure gives away your power. It is important to keep your own personal life in the background. Excessive self-disclosure allows you to give away your power for the moment. It relieves you of the obligation to act in the best interest of the client.
At the same time, some personal connection is necessary for the client to feel comfortable. Following is an inquiry I often engage students with; “when does your self-disclosure serve the therapeutic relationship?” This conversation is rich and deep.
A Complex Dance
Remember, the power differential is inherent. It comes with the territory. There is immense value in your power role as a massage therapist. Do not underestimate this value.
Even though we have good intentions, the therapeutic relationship is filled with many complex and varied dynamics. Power issues are part of all of life’s activities and are keys to our inner lives as well.
Using your professional power is a complex dance. The ease and flow of this dance is a life-long personal and professional engagement.
About the Author
Kathy Ginn, L.M.T., B.C.T.M.B., has been active in the profession of massage therapy and bodywork since 1991 as a practitioner, teacher and mentor. She is the founder of Ethical Dimensions (ethicaldimensions.com) and is the co-creator of Life Empowered Institute. Her passion is to bring the study of ethics to life and help others see their uniqueness and potential that far exceeds what they believe themselves to be. She is a National Certification Board for Therapeutic Massage & Bodywork-approved provider, and will offer Right Use of Power teacher’s training beginning March 2018. She is a regular contributor to MASSAGE Magazine, and wrote “4 Steps That Will Guide You on Your Journey as a Massage Practitioner” for the December 2018 issue.
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