Theoretical Paper - Collaboration in cognitive behavioural therapy: In the shadow or in the light of power dynamics?

Abstract

BackgroundThis paper explores whether collaboration in cognitive behavioural therapy (CBT) is appropriately considered in the ‘shadow’ of the power dynamics of the client-therapist relationship, or is more appropriately considered in the ‘light’ of such dynamics. It builds on extant research, opinion and the author’s professional experience and in exploring the topic, distinction is made between modernist and postmodernist views of power.Content & FocusThe paper draws upon Beck’s model, particularly using ‘collaborative empiricism’ to illustrate the associations between collaboration and power dynamics. Three types of power in therapeutic collaboration are considered: role power, inherent in the roles of ‘therapist’ and ‘client’; societal power, power distribution in society concerning the structural positions in society of therapist and client; and historical power, the client’s and therapist’s personal experience of power and powerlessness.ConclusionThe paper concludes that all three of these types of power can have a tendency to push the therapist into a position of authority. It is, therefore, important that self-awareness is developed, particularly through therapists’ own personal therapy and clinical supervision to avoid falling into an ‘expert trap’ and misusing the societally-endorsed power of science. It is encouraging that power in the therapeutic relationship is becoming more widely discussed and accepted and there is a growing awareness of the need to take it into account from a postmodern perspective.