Exploring power in therapeutic relationships (v.3)
Research type
Research Study
Full title
Exploring experiences of power in therapeutic relationships between NHS service users and Clinical Psychologists
IRAS ID
291953
Contact name
Fegus Gracey
Contact email
Sponsor organisation
University of East Anglia
Duration of Study in the UK
1 years, 6 months, 30 days
Research summary
Summary of Research
This study is looking at how NHS service users experience power in therapy with Clinical Psychologists. This is not currently well understood, and we hope that better understanding power in this relationship will help make the therapy more effective.
Service users in NHS community mental health teams can be offered talking treatments for support with a number of issues. Often this will be done on a one to one basis with a Psychologist. The relationship between the service user and Psychologist is very important. This is because it takes trust and courage to talk about things that might be sensitive for them. Research shows us that the strength of this relationship is an important factor in how effective the therapy is.We also know that this relationship might feel unequal for either the Psychologist or the service user. When a relationship feels unequal it might be because one person has more or less ‘power’ than the other at different times. We want to understand more about how service users experience power and how this happens in therapy. We think that this will help people understand power in this relationship better and hopefully do things differently to make the relationship stronger. This is important because we know that a stronger relationship between a Psychologist and service user means that the therapy is likely to be better.
We will do this by interviewing 8-10 NHS mental health service users for approximately 60 minutes who have been in therapy and asking them to talk about their relationship with their therapist. This will be done remotely by video link. We will then analyse this data using a method called Interpretive Phenomenological Analysis to see how individuals make sense of their relationship with their therapist.
Summary of Results
What did the study find:
The results of this analysis provides an answer to the question ‘how do NHS service users experience power in therapeutic relationships with Clinical Psychologists’. There were three smaller (subsidiary) themes that emerged in the analysis. These included:
1. “Past experiences, if you like, had shaped my thinking” - The different threads of disempowerment that shape experience in the relationship
2. “It’s never kinda been equal, but yea it didn’t feel like at the same time, it didn’t feel inequal” - The balancing of power in the relationship
3. “I think that was probably a turning point” – Pivotal therapeutic moments and ruptures that transform the experience of power.
These three smaller themes created a single overarching theme which was called “the dynamic tapestry of power”. This described the overall experience of power for the participants in the therapeutic relationship as a complex, dynamic ‘tapestry’ of experiences and emotions, shaped by previous experiences around power (especially disempowerment). When aspects of disempowerment were closely attended to in the relationship, they had transformational impacts on the relationship, particularly when power was used positively by the psychologist. This research highlights service user experiences of power and shows how it is important for therapists and clinical psychologists to think more about 'power' in their clinical work. The research also shows how some people might be disempowered when feeling grateful for the help being offered. Finally, the importance of the language that is used by psychologists and service users was highlighted as power may have been acting on them unconsciously.What were the strengths and limitations of the study:
This study had a number of strengths. This study was novel and highlighted the experiences of service users, who can be underrepresented in the literature. The study was also specific to the NHS and as such may be used to inform further research and policy to benefit the NHS, the largest healthcare provider in the UK. Finally, the methods used to answer the research question were carefully considered, suitable for answering the research question, and rigorously applied.
However, there are a number of limitations to the study. Firstly, the participants were only recruited from one NHS trust. Secondly, there was limited diversity in the sample and research team. Both of these limitations are things that could be looked at in future research. Finally, there is little way to know how much the psychologist actively addressed power in the work they did with the participants. Some may have been more aware and conscious of their own power, and this may have impacted on them compared to others.How should future research proceed:
In addition to what was mentioned above, there is potential for empirical research that looks at what difference actively exploring and addressing power in therapeutic relationships does for the outcomes of therapy. This would allow for future findings to be generalised to more people and different services.How will the research be shared:
This research will be published in a suitable academic journal as well as potentially shared at conferences.REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
21/NW/0114
Date of REC Opinion
16 Aug 2021
REC opinion
Further Information Favourable Opinion