The Egalitarian Relationship

At the heart of feminist therapy lies the egalitarian relationship, the interpersonal context of psychotherapy in which empowerment is gestated (Brown, 1994; Faunce, 1985; Greenspan, 1983; Smith & Siegel, 1985). Therapy is not, as the early feminist therapists imagined, a consciousness-raising group of two and not, as some then thought, a relationship of equals. It is instead a relationship founded in the notion that equal value should be accorded all participants in therapy; that each participant is an expert, bringing particular sets of skills and knowledge to the collaboration, with no one set more highly valued than another; and that every act of the therapist has as one of its aims the empowerment of the client. While psychotherapy as generally practiced assumes the imbalance of power and has few or no systemic commitments to decreasing that imbalance, feminist therapy acknowledges that there is such an imbalance and then pursues systemic strategies to make that imbalance as small as feasible, given the legal and ethical norms for psychotherapy practice to which a therapist subscribes. In the social system that is the psychotherapy relationship, feminist therapy strives to shift privilege to the voice, knowing, and experiences of people who come to therapy, not those who deliver it.

The ideal of an egalitarian relationship suffered much at first from the fact that it and the word equal have the same Latin roots, and the development of a therapeutic egalitarian relationship involved some missteps. In some of the earliest stages of feminist therapy’s development, particularly during the first phase in which there was no clear theory or ethics of feminist practice, a few therapists used feminism as a rationale for having no boundaries, including few or no sexual boundaries with clients. These individuals rationalized their actions by pointing to the egalitarian relationship ideal and arguing that this meant a relationship of pure equals. Thus, a therapist could not exploit a client or abuse power if the powers of both parties were deemed to be equal. Almost no feminist therapists or thinkers agreed with this construction of egalitarianism, pointing out that it was usually the therapist using the power of her or his role to decide who was equal to whom. The Feminist Therapy Institute Code of Ethics was developed in the context of this particular misstep and reflects the understanding in feminist therapy for the past 2 decades of the reality that the therapist, by virtue of role, has unequal power in the relationship and holds responsibility for delineation and maintenance of boundaries while also having a responsibility to empower clients within that other-than-equal framework (Feminist Therapy Institute, 1990, 2000).

In defining the parameters of what constitutes egalitarian dynamics, attention must be paid to the ways in which social privilege enters the psychotherapeutic realm (McIntosh, 1998). Privilege is a construct that calls attention to how certain social locations confer on those situated in them experiences of power, access to resources, and protection from harm, all of which are unearned and may function to oppress others, intentionally or unintentionally. Thus, persons of Euro American ancestry whose skin is called “white” in Western cultures have phenotype privilege; by virtue of being born with certain pigmentation and shapes of eyes, nose, and mouth, these people benefit from the fact that they live in a culture that is informed by white racism. Their lives are safer and easier in both large and small ways than are those of people who are perceived as not being white. Even a Euro American person who is not intentionally or actively racist or discriminatory benefits from phenotype privilege. Mcintosh’s article, which focused on this “white skin” privilege, listed a host of things that people of European ancestry can easily take for granted, from the banal—makeup and hair products that work for you—to the serious and endangering—you are unlikely to be stopped by the police if you are driving a luxury car because there is no assumption that a Euro American person driving that car will have stolen it or have drugs in it. Similar privileges attend upon other dominant social locations in Western cultures. These include heterosexuality (the many legal and financial benefits of being able to marry the person with whom you wish to partner, unavailable to most of those with same-sex partners living in the United States), adherence to a Christian faith (primary religious holidays in the Western world are usually official days off work), or middle-class and higher social status (access to resources such as free checking accounts, good credit ratings, higher quality public schools, and safer neighborhoods) as examples. Privilege is unearned and cannot be gotten rid of; even social class privilege, in the form of cultural capital such as knowledge acquired, can persist when a person’s financial circumstances change (Lochner, Kawachi, & Kennedy, 1999). Awareness of one’s privilege informs an understanding of power in social relationships, including psychotherapy.

The theory of feminist therapy thus argues that one aspect of the egalitarian relationship emerges from the therapist’s exploration and analysis of issues of privilege as they emerge in the therapeutic encounter and affect each persons power, both outside of and during the therapy hour. Privilege unexamined increases power because it then operates out of the conscious awareness of the privileged person, and privilege unspoken of operates in an oppressive manner, as the privileged party can create assumptions about reality that are present but difficult to confront.

A middle-class therapist gives a book on self-care to her working-class client and suggests that she try some of the strategies in the book for homework. The therapist, who has read the book, thinks that the examples of self-care, such as getting oneself a massage, going out for a nice dinner, or taking a weekend retreat to a lovely setting, all seem like wonderful ideas. Her client returns the book the following week, never commenting on the fact that each of these suggestions are financially beyond her means, something the therapist has never taken into account because of a failure to explore her social class privilege. Soon thereafter, the client leaves therapy. Privilege unexamined can lead to failures of empathy.

Feminist therapists take on an ethical obligation as a component of feminist practice to introduce awareness of and, if appropriate, discussions of privilege into the therapeutic environment, owning their greater privilege when it is present, and exploring for themselves the meanings of it when they have less privilege than clients (Feminist Therapy Institute, 1990, 2000).

Feminist therapists collaborate with clients on goals of therapy, both the broad overarching goals and the specifics of a given encounter, with the emphasis on discovering what works for clients within the parameters of what the therapists have available within their competencies. Such collaboration requires careful attention to clients’ levels of readiness and willingness to approach any topic or problem and places the definition of the problem into the collaborative space. A feminist therapist cannot have a favored, one-size-fits-all intervention strategy, as this would implicitly disempower clients and represent a misuse of therapist power, stripping egalitarian dynamics from the exchange. While a given feminist therapist’s work may have a strong flavor of cognitive–behavioral therapy or Gestalt or psychodynamic practice, she or he must always be integrating that into the overarching goal of empowerment of the client.

Jillian, a middle-class Euro American woman from a poverty-class background who worked in software sales, told Irena, her middle-class Euro American therapist, that it was important to her to find ways to become more detached from her emotions in her work. She had this as a goal because she felt herself to be overly vulnerable to approval and disapproval from the people to whom she was trying to sell software, and she saw this as decreasing her ability to earn money—and thus maintain her personal power. Irena had a strong background in emotion-focused psychotherapies and tended to see her clients’ empowerment emerging from improved contact with affect in the moment. Jillian and Irena worked out a plan for Jillian’s goals that assisted her in increased awareness of emotions while simultaneously being able to make better choices about how she was affected by feelings as they emerged in the moment. The integrity of both parties was respected, and Jillian’s goals for personal empowerment were met; she was not more detached but more self-aware and more capable of choice.

Even with persons who are actively suicidal, a group of people who pull strongly for authoritarian rather than egalitarian responses from therapists, feminist practice does not eschew client empowerment. The feminist therapist in that situation must instead be creative in finding ways to both empower a client to create safety and also continue to respect the client’s autonomy to the degree possible while preserving life. Brown (2006) noted that many therapists, fearing liability, turn coercive and disempowering of clients when this most frightening topic emerges in the therapy. The power struggles that therapists experience when attempting to control clients who are frightening them with suicidality are construed in feminist therapy as evidence of the destructiveness inherent in letting go of an egalitarian stance and as a therapeutic misdirection that ultimately disempowers both parties. If the way in which people can demonstrate their autonomy from the therapist is to hurt or try to kill themselves, the inutility of a coercive response becomes more apparent.

Feminist therapy suggests that a therapist at this juncture must instead find ways to empower clients that do not require a lethal strategy for asserting power and autonomy over one’s body and life. A feminist therapeutic assessment of potential lethality (Brown, 2006) empowers both therapist and client by identifying how or if the therapy relationship itself, and other contextual factors in the client’s life, might be modified to be protective against the client’s urge to permanently disempower herself or himself by being dead. Representing suicide as the ultimate loss of power, rather than as an ultimate expression of it, and placing that interpretation into an already-present framework of empowerment and egalitarian practice, can invite people to consider staying alive as their powerful choice (Brown, 1992b).

Brown and Bryan (2007) discuss how a feminist therapist would respond to a client using self-inflicted violence (SIV) as a coping strategy (this therapy is discussed in further detail in chap. 4, this volume). Rather than demanding that the client agree to stop using SIV to contain affect and self-soothe, the feminist therapist honors the goals of the strategy, which are self-soothing and preventing suicide, while offering ways of developing alternatives for accomplishing the same outcomes that are less harmful to the body, and thus more powerful. The frame of empowerment that imbues egalitarian relationship sets the tone for the therapist to convey respect for a client’s autonomy and creative attempts to solve problems of extreme emotional distress, simultaneous with concern for safety of the person’s physical self, without privileging the therapist’s need to feel safe and secure by having the illusion of having controlled the client.