Managing the power relation
• Being nice is not enough
• Expose and use the power relation

A significant differential is present in the power relation in a clinical encounter. This is a challenge to achieving collaborative work where both parties can meaningfully participate in negotiating the encounter. Otherwise it can be like a situation where a bulldozer is negotiating with a bicycle. This power relation contributes significantly to the reluctance of the people we are working with to bring forward their knowledge and ideas into the conversation. Just being ‘nice’ or attempting to conceal the power relation has little real effect. It also risks making it harder for the person to identify the experience of having their knowledge trumped and to challenge the process or the content of the conversation.

We can address the power differential more effectively if it is exposed, rather than concealed. We need to take up the opportunity to use the power we hold in positive interventions to bring forward agency, resources and knowledge of the people we are working with. This requires more than just an intention. It also requires constant vigilance for opportunities to move it into action.

Addressing the power relation is one of the strands woven through every action and intervention in Johnella Bird's work. Specific strategies can include taking control of the conversation and slowing it down, making positive interventions to elicit and carefully listen to and inquire after, people’s responses as in working in the present moment, tentative telling and inquiry, consulting with people as to the direction and content of the conversation, providing support to people to articulate their ideas around maintaining limits to exposure, etc.

Working in the present moment
• Asides to address non-verbal responses can be a good use of time
• Brings forward emotional responses, differing ideas, etc

In the context of taking a history, doing psycho-education, developing action plans, etc, the clinician needs to focus on a longitudinal, overall view and attend to content. There is often material which needs to be covered, a range of disorders which need to be screened for, etc. Refocusing attention on processes which are happening in the room can appear to be a deviation which take up time.

Noting non-verbal responses from people and events in the emerging clinical relationship and bringing them forward can significantly increase the usefulness of the conversation. Wandering attention, a lot of sighing, tears arising, a warm laugh, etc, can indicate a response which may not be available to the person’s conscious processing. They may not articulate it because of the power relation. The very noting of the person’s apparent response, in a tentative, respectful way, contributes towards managing the power relation.

It is a practical demonstration of the value put on the person’s response and it defers to their authority in identifying it. On a pragmatic level it can also bring forward differing ideas of the usefulness of the conversation. If brought into the open, these differences can be addressed.