Book Reviews

Review of 'A Grammar of Power in Psychotherapy: Exploring the Dynamics of Privilege'

Marina Costa reviews the powerful work of Malin Fors.
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By Marina Costa

Bias, prejudice and privilege are everywhere in the world. So just as there is no such thing as a completely unbiased or unprejudiced person, there is no such thing as a completely unbiased or unprejudiced therapist. Swedish psychologist, Malin Fors, in her book, "A Grammar of Power in Psychotherapy: Exploring the Dynamics of Privilege," aims to uncover how privilege and power dynamics can influence the efficacy of psychotherapy. She investigates how ignoring these dynamics can be cause for psychotherapeutic blind spots, effectively negating much of the potential benefit for clients in therapy. This book is a comprehensive examination not only of various power and privilege dynamics but also is filled with brilliant and apt clinical vignettes, ideal for both psychology or mental health professionals and clients alike. 

Disparities in levels of social power or privilege can present in a variety of ways. Either the client and clinician share in their access to social power and privilege or they share in their nonprivileged or the privilege favors only the client or the clinician. All four of these unique circumstances can create an environment for clinical blind spots or psychotherapeutic blunders. Considering that much of our bias and prejudice can present implicitly, without our conscious awareness, it is reasonable to see how power and privilege dynamics can create an inhospitable environment for successful therapy.

It is also important to highlight how innately intersectional the nature of power and privilege dynamics are within each individual’s identity. Elements of identity can be almost anything from gender identity, sexual orientation, race, religious identity, socioeconomic status and level of education. Affiliation to the social majority allows the member higher social power and privilege. Therefore, social majorities are granted the luxury of being spared much of the daily gruff minority populations face. Additionally, social majorities can enjoy the validation of being recognized for their majority affiliation more often than certain minorities. For example, feminine lesbians or masculine gay men are regularly mistaken within a heteronormative society for being heterosexual. So while certain "straight presenting" members of the LGBTQ community have come to accept this as a societal norm, it can nevertheless be cause for upset within the context of psychotherapy. 

In a psychotherapeutic relationship, privilege favoring the therapist can lead to blind spots where the therapist unintentionally offends or engages in microaggressions towards their client. For example, an LGBTQ client seeing a heterosexual therapist would likely feel slighted or misunderstood if the therapist were to assume they are heterosexual merely because heterosexuality represents the majority among sexual orientations. This type of microaggression could weaken their therapeutic alliance and create a more inhospitable environment for the client to disclose their sexual orientation, if they chose to do so.

Whereas privilege favoring the client can lead to "confused subordination" where the typical power dynamics are offset, and the clinician feels they do not have the professional upper hand in the therapy. At times when the client and therapist share the same minority identity, the client can engage in prejudicial behavior through their own internalized bias, racism or homophobia. Instead of finding solidarity in seeing a therapist of their own minority identity, they feel slighted or overlooked by a clinician of a majority identity. Malin Fors notes the examples of a Black client expressing upset for being scheduled to see a Black therapist, or a gay client struggling with internalized homophobia being put-off by seeing a gay therapist.

Furthermore, when the client and clinician share in their majority access to social power and privilege, there can be an assumption that they also share certain prejudicial thoughts and feelings. In other words, fellow in-group members of majority races, gender identities, sexual orientations or other identity-defining populations can feel comfortable sharing their explicit bias towards various minority groups — trusting their mutual majority-affiliation has won them a certain amount of in-group comradery and understanding.

As Malin Fors so eloquently writes, so much of what affects power dynamics and clinical blind spots in psychotherapy is due to a lack of examination and dialogue about minority and majority influences within the therapeutic dyad. Books such as "A Grammar of Power in Psychotherapy: Exploring the Dynamics of Privilege" help to create awareness around privilege and power disparities. This awareness helps to combat implicit or unconscious bias while simultaneously holding others accountable for their explicit bias. Though saying that “the first step to solving a problem is to acknowledge there is a problem” is a superficial platitude, within this context, it is accurate.

To ignore power and privilege disparities in psychotherapy is to effectively ignore their existence within the broader societal and global context. Malin Fors’ detailed examination of power and privilege dynamics allows readers to learn not only what the literature says, but also to hear firsthand accounts of Fors’ experiences both in and out of the therapeutic dyad. Lastly, Fors' leaves space to discuss where we can go from here and reminds the reader that this book is not intended as a manual or set of instructions, rather an incomplete, ever-evolving grammar geared at upheaving clinical blind spots, and raising awareness around power and privilege disparities within psychotherapy.

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