The Dynamics of Power and Privilege in Psychotherapy

Societal issues based in power and privilege inevitably enter the therapy room. In this video, Malin Fors offers a fresh synthesis of ideas to unmask these hidden dynamics and in the process improve therapeutic relationships and outcomes.

During the discussion with interviewer Dr. Katherine Helm, Fors explains the matrix of relative privilege, a model consisting of four core client–therapist dynamics:

• similarity of privilege
• privilege favoring the therapist
• privilege favoring the patient
• similarity of nonprivilege

This matrix may be used to understand the power dynamics not only in psychotherapy and counseling, but in all treatment relationships.

In this program, Malin Fors demonstrates and discusses clinical topics associated with the model, such as voluntary and involuntary self-disclosure, similarities between patient and therapist, and internalized oppression, and then highlights specific moments in the demonstration session where client–therapist power dynamics come into play.

The benefits of understanding the invisible grammar underlying how relative societal privileges may be enacted in psychotherapy lie not simply in rectifying injustices and making our work more accessible to subordinated groups. The gains are also general and technical, as this perspective adds a new language and new knowledge about how to conceptualize and interpret transference, countertransference, and resistance, and how to weigh options for interpretation and self-disclosure in all therapeutic dyads.

Without competing with standard therapeutic approaches, the matrix of relative privilege adds a new dimension by which to conceptualize common clinical phenomena. Much scholarly work on diversity and cultural competency assumes an audience of majority therapists working with minority patients.

Malin Fors is a Swedish psychologist and psychoanalyst living in the world's most northern town, Hammerfest, Norway.

She has broad experience in both clinical work and teaching. She has worked for a decade at the local hospital's psychiatric outpatient unit and also has a busy private practice.

For more than ten years, as a guest lecturer at Gothenburg University in Sweden, Fors has been teaching students in clinical psychology about how issues of power, privilege, and gender create biases in the assessment of psychopathology.

She is assistant professor at UiT, the Arctic University of Norway, where she teaches medical students on topics of diversity, privilege awareness, and critical perspectives on cultural competency. Fors also serves as an external examiner for the Swedish Psychological Association's Specialist degree program. She was chosen to represent the Psychiatric Clinics on the Clinical Ethics Board for the Finnmark Hospital Trust, 2009–2012.

She is the author of A Grammar of Power in Psychotherapy (2018). In 2016, APA Division 39 (Psychoanalysis) and the APA Publications Office awarded it the 2016 Johanna K. Tabin Book Proposal Prize.

• Drescher, J., & Fors, M. (2018). An appreciation and critique of PDM-2's focus on minority stress through the case of Frank. Psychoanalytic Psychology, 35(3), 357–362.
• Fors, M. (2018). Geographical narcissism in psychotherapy: Countermapping urban assumptions about power, space, and time. Psychoanalytic Psychology. Advance online publication.
• Fors, M., & McWilliams, N. (2016). Collaborative reading of medical records in psychotherapy: A feminist psychoanalytic proposal about narrative and empowerment. Psychoanalytic Psychology, 33(1), 35–57.

APA Videos

• Culturally Informed Psychoanalytic Psychotherapy
  Pratyusha Tummala-Narra
• Culturally Responsive Cognitive–Behavioral Therapy in Practice
  Pamela A. Hays
• Ethnocultural Psychotherapy
  Lillian Comas-Diaz
• Inclusive Cultural Empathy in Practice
  Paul B. Pedersen and Jon Carlson
• Multicultural Care in Practice
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• Qualities and Actions of Effective Therapists
  Bruce E. Wampold
• The Therapy Relationship
  Charles J. Gelso
• Using Client Feedback in Therapy
  Barry L. Duncan
• Working With Issues of Social Class in Psychotherapy
  William Ming Liu

APA Books

• A Grammar of Power in Psychotherapy: Exploring the Dynamics of Privilege
  Malin Fors
• Becoming an Effective Psychotherapist: Adopting a Theory of Psychotherapy That's Right for You and Your Client
  Derek Truscott
• Clinical Dilemmas in Psychotherapy: A Transtheoretical Approach to Psychotherapy Integration
  Douglas J. Scaturo
• Insight in Psychotherapy
  Louis G. Castonguay and Clara E. Hill
• On Becoming a Better Therapist, Second Edition: Evidence-Based Practice One Client at a Time
  Barry L. Duncan