Massage Today February, 2004, Vol. 04, Issue 02

Power Differential

By Ben Benjamin, PhD

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Author's note: The following article is adapted from "The Ethics of Touch: The Hands-On Practitioners Guide To Creating a Professional, Safe and Enduring Practice," by Ben Benjamin and Cherie Sohnen-Moe.

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It is difficult to understand the therapeutic relationship between client and practitioner without comprehending the dynamics of power in a therapeutic relationship.

There are natural power differentials in many (but not all) relationships, including those between parent and child, teacher and student, employer and employee, and, of course, health care practitioner and client. Parents, teachers, employers and health care practitioners have the more powerful position. They are the authority figures whose actions, by virtue of their roles, directly affect the well-being of the other. The child, student, employee and client are in the more vulnerable position. In theory and ethical practice, the power differential exists for the purpose of bringing benefit to these more vulnerable individuals; that is, the child's well-being should be enhanced by a parent's care, the employee should benefit from the employer's management, and so on.

In the health care field, the power differential is amplified by the physical aspects of practice. The client takes a position - usually lying or sitting - and allows the practitioner access to his or her body. The practitioner positions himself or herself within the client's physical space, often leaning over the client. Furthermore, in many professions, the client is partially or fully unclothed. Although draping is used for privacy, the psychological effect of the unclothed client and the clothed practitioner increases the imbalance of power. Finally, as the practitioner's hands make physical contact with the client's body, the client's physical safety is literally in the practitioner's hands.

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