Power, Difference, and Culture, Essay Example

Analysis of How Power, Difference, and Culture Affect the Therapeutic Relationship Using Evidence from Literature and Personal Experiences

Introduction

Therapy is a fundamental treatment modality administered to patients in the clinical environment. One essential subtype within the vast field of therapy is person-centred therapy. It is underpinned by the focus on the care and the patient’s environment to enable them to actualise their tendencies. The person-centred approach was developed by Carl Ranson Rodgers. He postulated that individuals have vast resources within themselves for self-understanding and encouraging a change in their attitudes and behaviours when provided with a proper environment or set of attitudes (Malembaka, 2021). Rodgers deviated from the psychoanalytical approach to treatment through observation of the fact that patients put under the diagnostic criteria achieved little improvement. However, he observed that clients who were engaged in constructive and permissive relationships improved. This is in line with Rodger’s views of the potential of human nature; he views humans as having the capability to be good, generous, trustworthy, dependable, and other positive qualities. Within person-centred therapy, therapists aim to focus on the client and not on the specific problems the client describes during the session (Mocan, 2018). By providing an enabling environment, the counsellor assists the client to become more a fully-functioning individual through the self-actualisation process. These clients also become more positive-minded through the person-centred therapeutical approach. The client-therapist relationship is an important association that determines the quality of care rendered to the patient. Within person-centred therapy, various dynamics influence the interaction between the patient and the therapist; the principal ones are power, difference, and culture. Examining how the above factors influence patient-centred therapy is essential to understand the treatment approach better. Patient-centred therapy is a mainstay therapeutical approach that can lead to massive improvements in the patient’s state.

How Power Dynamics, Within and Outside of the Person-Centred Counselling Relationship, May Impact on the Lives and Growth of Individuals

Feelings of powerlessness are the most common cause of psychological distress to clients. The feelings of powerlessness often occur as a result of various experiences, difficult situations and socio-economic problems. The feeling of powerlessness makes clients feel as if they have limited control of themselves and their environments, leading to anxiety (Hagerman et al., 2019). Within the therapeutic relationship, counsellors need to understand the needs of the client and attempt to imbue a feeling of power and control over the latter’s situations. It can be done by addressing the power dynamics that exist inside and outside the counselling relationship. The internal factors are ethics and practice, while a critical external factor is politics. The resolution of powerlessness will lead to increased therapeutic outcomes from patients.

Ethics

There are various ethical issues when promoting the power of patients involved in therapy. First, these patients need to be empowered to make changes in their lives, which indicate that they are responsible for their ultimate outcomes in life. It also provides the perspective where they control the environment instead of their environment controlling them. The approach is fundamental to realising sustained dissipation of powerlessness in the client. Second, advocating for the rights and needs of the client is an essential part of incorporating power. Therapists can serve as great advocators for their clients and foster the attention of the issue that their clients are facing (Rogers et al., 2020). The advocating process will impart more credibility to the health claims of the patient, which is essential in providing heightened levels of care within person-centred care. The third ethical issue within the relationship is beneficence, where the counsellor should look to achieve heightened outcomes for the patient at all times. The drive to high expectations and outcomes for the patient is essential to improving the quality of the client-therapist relationship. Considering the ethical issues during therapy is essential in imparting power to clients.

Practice

Another essential internal contributor to the feeling of power is practice quality. Within this paradigm is the power that clients have over the counsellors as well as the power that counsellors have on their clients; both aspects are sides of the same coin that need to be addressed. The power that the counsellor has on the client can be expressed in the form of the ability of the counsellor to extract definite life experiences, thoughts and prejudices of the client and utilise them to construct a beneficial therapeutical solution. Counsellors also have knowledge power over their clients; in this methodology, the counsellor is considered an expert that guides the therapeutic process (Felten-Barentsz et al., 2020). The client is expected to trust the judgments made by the counsellor as they are rooted in high knowledge and experience. Therapists also exhibit legitimate power over their clients. This power is expressed in the form of an official license from the government that authorises them to engage in the therapeutic counselling of different clients. Their professional clout and public image also influence the extent of power by therapists. It is important in establishing the power differential between clients and counsellors.

Patients also need to express their power during the therapeutic relationship with the counsellor by offering feedback about their progress and whether the therapy is beneficial. Clients have the right to complain about inconsistent and low levels of care from their counsellors. It will provide the opportunity for clients to express the injustices they are experiencing. The approach gives them the necessary power to actualise changes to the therapeutic relationship.

Politics

An external factor that influences power is politics. In line with politics, power is expressed such that the needs of the majority in the population are addressed appropriately to improve their clinical outcomes. Change within the therapeutic relationship should be done so that the needs of the majority within the relationship are realised. Politics also allocated power by determining the ability of individuals to be granted equal rights in their attempts to access therapy (Cornelius-White et al., 2013). There should be no bias when allocating resources to different clients. Politics is essential in the power dynamics in the therapist-patient relationship.

How Culture, within and Outside of the Person-Centred Counselling Relationship, May Impact the Lives and Growth of Individuals

Culture is an essential part of person-centred relationships due to its influence on the quality of care afforded to clients. Culture is an important consideration due to the high levels of cultural diversity in the UK and in other countries in the world. Patients are becoming more culturally diverse, which increases the cultural mismatch of patient-therapist dyads. The phenomenon impacts the ability of professionals to offer competent care to them. Culture needs to be considered in terms of the norm that is found both within and outside of patient-centred therapy. Culture is an essential factor in person-centred relationships.

An essential part of culture is the cultural mores by the patient. Most times, patients tend to communicate in particular ways to counsellors, who, in turn, need to recognise that different individuals communicate in different ways, influencing the quality of care rendered. An example of this is the black community with a long-standing distrust and disharmony with governmental services. As such, therapists dealing with such groups will benefit from knowing that their cultural mores are likely constricted due to the limited trust they associate with medical care. As such, a counsellor will look to debunk their beliefs about the issue and lead to heightened patient outcomes.

Culture is also an essential determinant of the ability of clients to express themselves within the person-centred relationship. Some cultures have barriers against expressing emotions, leading to low chances of patients expressing themselves (Crumb, 2019). It is the case in the South Asian culture, where privacy is highly valued. As such, members from the community are not expected to detail their mental instabilities, which can lead to shame, not only for the affected individual but also for the entire family. An individual with a South Asian culture is more likely to be secretive about the problems they are facing, which negates the ability of the therapist to offer competent levels of care. A similar phenomenon is present in the East Asian culture where members emphasise stature and honour, with illness signifying weakness. Members of the community are also likely to be resistant to expressing themselves within person-centred care. It leads to poor outcomes for these patients.

Counsellors need to demonstrate heightened levels of cultural competency in the person-centred relationship. Cultural competence confers the counsellors the ability to work with diverse sets of individuals with minimal friction (Day, 2021). To realise cultural competency, the therapists need to respect the patients’ traditional backgrounds. The approach sets the stage for heightened involvement levels from the client. Another aspect of offering culturally competent care is that counsellors need to be aware of how their individual culture influences the patient’s reception and experience of care. They should ensure that their values contribute positively to the experience within person-centred care. Cultural competence should be expressed on all levels of the person-centred relationship to improve the client’s life.

Issues Involved in Working with Difference and Diversity within the Person-Centred Counselling Relationship

The person-centred relationship offers an individualised approach to contact clients such that the counsellor attends to a diverse group of patients. One issue involved with working with difference and diversity is that the counsellors tend to categorise the needs of the minority within society as common. The view often leads to a limited approach to the therapy offered to patients from different minority groups. For instance, there is a tendency to treat blacks and Asian Americans similarly due to their immigrant status. However, counsellors need to determine the unique experiences and needs of the groups, which contribute to their difference. Such a difference is vital when tailoring the quality of care to address the needs of the client, leading to the heightened outcomes experienced by the patient-centred relationship. Counsellors need to resist categorising minority groups as having the same experiences.

Another issue involving difference and diversity is that patients demand increasing levels of personalised care. Even though patient-centred care is between the counsellor and the client, more needs to be done to heighten the levels of personalised care (Cornelius-White et al., 2013). Efforts should be made to tailor the environment for therapy to address the specific needs of the patient. The approach requires measures such as learning the client’s language to foster communication and understanding aspects of the patient’s culture. Even though it is impractical for counsellors to address all the needs of their clients, increasing the levels of competency through techniques such as continuous care is essential. The increased levels of difference and diversity demand that patients be provided with personalised care levels.

Communication needs to be streamlined when addressing diversity and difference issues within person-centred relationships. The exchange of information between the patient and the client should be such that differences and diversities are addressed. For instance, the ability of counsellors to talk in the native language of their clients is fundamental to providing increased levels of care to the patient (Cornelius-White et al., 2013). It will promote the client and the counsellor’s understanding, which is critical in person-centred relationships where the therapist is supposed to enable the client to express themselves and their issues to evoke a resolution. Communication can also be enhanced by addressing an essential difference in the client population, the time allocated to the client. Clients should be encouraged to express themselves freely without constraint. They should be made aware that their differences and diversity are a source of strength rather than a barrier to providing heightened care levels. Communication needs to be utilised to bridge issues involving diversity and difference.

Understanding of Prejudice and Oppression and of How This Might Impact on Client, Counsellor and the Therapeutic Relationship

Prejudice is the phenomenon where individuals express a negative attitude about others based on their inclusion in particular social groups. These social groups include gender, ethnicity, sexual orientation, profession, social class, and religion (Hjerm et al., 2020). This aspect leads to the development of hate against members of the above social classes despite not having contact with them. Prejudice often originates from a particular stereotype where individuals hold certain beliefs and attitudes about a specific group. These stereotypes are then overgeneralised and applied to the members of the group. Based on experience, there are different types of prejudice, such as racism, which is expressed against particular ethnic groups; sexism, which is based on an individual’s sexual orientation; and ageism, which is expressed to people based on their ages. Prejudice is an essential dynamic that influences the perceptions that people have about one another.

Oppression is the burden that people experience as a result of prejudice. Various social structures within the community cause prejudice and, as a result, facilitate the oppression of the prejudiced group. It leads to the suffering of the community members due to the bad experiences that these people have when contacting others for help (Hjerm et al., 2020). It also leads to the inaccessibility of certain areas and resources. The role of oppression is to prevent certain people from experiencing benefits, leading to the sustainment of social structures such as patriarchy and white supremacy. Oppression results from the experience of prejudice by different community members.

Prejudice and oppression lead to low levels of care afforded to the client. It is the case where the client belongs to a group that is oppressed, such as a minority group like the blacks. Most of these patients expect to be oppressed due to their previous experiences. The negative outlook limits the expectations of the members of the community such that they are not inclined to accept being treated properly. Counsellors dealing with oppressed groups will encounter difficulties getting their cooperation and eliminating scepticism within the person-centred relationship. The occurrence of prejudice and oppression leads to a low quality of care given to clients.

Prejudice and oppression also have the impetus to affect counsellors within patient-centred care. Since prejudice and oppression originate from the existence of a stereotype against certain groups of people, a social aspect is attached. Counsellors who express prejudice against their clients because they belong to particular social groups depress the quality of care they provide. They are not inclined to apply their knowledge and experiences for the client’s benefit. It leads to poor outcomes for clients since they are offered low levels of care. The outcomes of these patients are worsened, which leads to low standards of living among the prejudiced community. The occurrence of prejudice and oppression prevents counsellors from expressing high levels of care to their clients.

Key professional and Personal Qualities and Attributes in Line with the BACP Ethical Framework for the Counselling Professions

Professional Qualities and Attributes

The British Association for Counselling and Psychotherapy (BCAP) is a UK-based organisation mandated to increase the quality of counselling services to its clients. The organisation outlines the key qualities and attributes that counselling professionals need to work with to ensure harmonious relationships (BACP, 2020). First, professional qualities are essential in counselling. Counselling professionals need to use their skills within the legal and ethical guidelines that require them to avoid breaking the rights of their clients. Counselling professionals are also expected to act within the boundaries of their profession, which promotes their roles and the setting of the therapy. This requires the observation of the time and communication limits with clients. Counselling professionals need to be competent in providing care to their patients, which requires recognising the needs of their clients, followed by a purposive plan to achieve the desired outcomes. Another professional quality involves offering support and guidance to patients through interventions such as coaching and consultative support. Counselling professionals also need to be able to recognise and reflect on their professional outcomes such that they continuously evaluate their results, with the aim of improving practice.

Counselling professionals also need to demonstrate an ability to establish a working alliance. Counselling skills should be applied to establish, maintain and end the work, which involves informing clients what they can expect from the relationship and providing them with sufficient time to talk. Counsellors also need to be competent about informing their clients that their time together is coming to an end. They need to explore the client’s feelings regarding the termination of the therapy and suggest to them appropriate coping strategies. The counsellors also need to collaborate with their colleagues to demonstrate respect for them and their work. Proper working relationships are essential for professional counsellors.

Personal Qualities and Attributes

Counsellors also need to possess an appropriate set of personal qualities that will lead to heightened care levels for the client. First, counsellors need to demonstrate heightened self-awareness by recognising how their personal feelings can hinder their counselling skills (BACP, 2020). It needs to be followed by an ability to seek avenues for improvement such as coaching, training and support from colleagues. By being aware of their weaknesses as counsellors, an opportunity arises to bridge the quality gap, which leads to elevated care levels. Second, counsellors need to utilise positive personal attributes during the care process. It can be done by demonstrating kindness and care to patients, leading to high-quality client experiences. They also need to maintain heightened integrity levels and ensure that the clinical environment provides equitable levels of care to patients. Another essential resource for counsellors is showing high levels of patience and tolerance for their clients. In this regard, despite the fact that their clients may present challenges and massive time consumption, counsellors need to show commitment to providing high levels of care to their patients (BACP, 2020). Also essential within the personal profile of the counsellors is the ability to demonstrate increased levels of emotional maturity for clients. It can be demonstrated by understanding the experiences of the patient and acknowledging them as valid. Counsellors need to demonstrate a high level of personal qualities when interacting with clients within person-centred relationships.

Conclusion

Patient-centred therapy is a mainstay therapeutical approach that can lead to massive improvements in the patient’s state. Feelings of powerlessness are the most common cause of psychological distress to clients. The feelings of powerlessness often occur as a result of various experiences, difficult situations and socio-economic difficulties. There are various ethical issues when promoting the power of patients involved in therapy. An external factor that influences power is politics. In line with politics, power is expressed such that the needs of the majority in the population are addressed. Culture is an essential part of person-centred relationships due to its influence on the quality of care afforded to clients. An essential part of culture is the cultural mores by the patient. Most of the time, patients tend to communicate in particular ways to counsellors, who need to recognise that different individuals communicate in different ways. Culture is also an essential determinant of the ability of clients to express themselves within the person-centred relationship. The person-centred relationship offers an individualised approach to contact clients such that the counsellor is in contact with a diverse group of patients. Another issue involving difference and diversity is that patients demand increasing levels of personalised care. Communication needs to be streamlined when addressing issues involving diversity and difference within person-centred relationships. The exchange of information between the patient and the client should be such that differences and diversity are addressed. Prejudice is where individuals express a negative attitude about others based on their inclusion in particular social groups. Oppression is the burden that people experience as a result of prejudice. Various social structures within the community cause prejudice and, as a result, facilitate the oppression of the prejudiced community. Prejudice and oppression lead to low levels of care afforded to the client. In line with BCAP, counselling professionals need to use their skills within the legal and ethical guidelines that require them to avoid breaking the rights of their clients. Counsellors also need to possess an appropriate set of personal qualities that will lead to heightened care levels for the client. Person-centred therapy is an essential method to address the needs of patients.

References

BACP. (2020). Counselling skills competence framework. British Association for Counselling and Psychotherapy. https://www.bacp.co.uk/media/8890/bacp-counselling-skills-competence-framework-may20.pdf

Cornelius-White, J., Lux, M., & Motschnig-Pitrk, R. (2013). Interdisciplinary Handbook of the person-centred approach. Research and Theory, 37-62.

Crumb, L. (2019). Integrating feminist narrative therapy, person-centred therapy, and rational emotive behavioural therapy: A short-term case study. International Journal of Integrative Psychotherapy, 9, 56-72. http://www.integrative-journal.com/index.php/ijip/article/view/142

Day, S. (2021). Dreaming Indigenous graduate student experience into existence: laying medicine on the path for culturally safe counselling psychology programs (Doctoral dissertation, University of Victoria). UVIcspace. http://hdl.handle.net/1828/13183

Felten-Barentsz, K. M., van Oorsouw, R., Klooster, E., Koenders, N., Driehuis, F., Hulzebos, E. H., & van der Wees, P. J. (2020). Recommendations for hospital-based physical therapists managing patients with COVID-19. Physical Therapy, 100(9), 1444-1457. https://doi.org/10.1093/ptj/pzaa114

Hagerman, H., Engström, M., Wadensten, B., & Skytt, B. (2019). How do first?line managers in elderly care experience their work situation from a structural and psychological empowerment perspective? An interview study. Journal of Nursing Management, 27(6), 1208-1215. https://doi.org/10.1111/jonm.12793

Hjerm, M., Eger, M. A., Bohman, A., & Fors Connolly, F. (2020). A new approach to the study of tolerance: Conceptualising and measuring acceptance, respect, and appreciation of difference. Social Indicators Research, 147(3), 897-919. https://link.springer.com/article/10.1007/s11205-019-02176-y

Malembaka, E. B. (2021). Measuring and understanding individual and community health status in the eastern Democratic Republic of Congo from a person-centred perspective (Doctoral dissertation, Université Catholique de Louvain). Uclouvain. https://dial.uclouvain.be/pr/boreal/object/boreal%3A243726/datastream/PDF_03/view

Mocan, D. (2018). Complementary Aspects in Reality Therapy and Person-Centered Therapy. Open Journal for Psychological Research, 2(1), 21-26. https://doi.org/10.32591/coas.ojpr.0201.03021m

Rogers, M. R., Marraccini, M. E., O’Bryon, E. C., Dupont-Frechette, J. A., & Lubiner, A. G. (2020). Advocates in public service settings: Voices from the field. Psychological Services, 17(S1), 44. https://psycnet.apa.org/record/2019-28369-001