Out On The Couch
Clinics, treatment centers, and group practices play an important role in the communities they serve. Power flows through every relationship from the individual dyad in treatment to a community clinic’s relationship with federal policy (Hess & Schultz, 2008). Moreover, these dynamics can be seen as both a commodity and resource (Peterson & Zimmerman, 2004) in working toward social justice for gender-, sexuality-, and relationship- expansive communities. First, this article will explore Brofenbrenner’s ecological model, and then Prilletinsky’s (2008) definitions of power as they apply to affirmative therapy with LGBTQIA+, consensual non-monogamous, and kink communities. Secondly, this article will set the foundation on how clinical communities can benefit from organizational empowerment theory to affect change.
Brofenbrenner’s Ecological Model
Development is clearly a lifelong process impacted by multiple forces throughout the lifespan (Hess & Schultz, 2008). Broffenbrenner’s ecological model envisions radiating rings that the individual moves in and out of as they interact with multiple levels of society throughout their life. This model is likely familiar from early psychology classes. Using this model can be helpful for therapists working individually with clients. Even more impactfully, clinical directors may be able to consider the context in which their clinicians are working, and advocate toward impacting messages and policy throughout the ecosystem.
Microsystems & Assessment of Individual Power
Our microsystems are our direct personal relationships (Hess & Schultz, 2008). In other words, the people in our lives who we are closest to: first our families and families of choice, and then our friends, mentors, colleagues, and therapists. From our earliest moments, these people impact our sense of safety and security, and also the way we experience pride and shame.
LGBTQIA+, consensually non- monogamous, and kinky people take in a lot of information from these people. For example, knowing which parts of them are safe to show, and what has to be hidden for safety can depend on who are they with. It follows that most of the work in individual therapy focuses on a client’s microsystem. Further understanding the impact of being LGBTQIA+, consensually non monogamous, or kinky has on a client’s microsystem is important to affirmative care. Consequently, if clinicians are not considering the context of the larger ecosystem, they will miss a lot of the clients’ experience.
Mesosystems & Organizational Power
Next, mesosystems begin to group the people from microsystems together into communities gathering around a common interest, task, mission, or setting (Hess & Schultz, 2008). Mesosystems are where individuals first begin to gather. This level is also where people gather around their identities, political ideations, religions, and values that are most important. Affirmative therapists should consider collective systems of support.
- school systems
- occupational settings
- recreational settings
- sports and athletics
- recovery communities
- group practices
- community mental health providers
Macrosystems & Systemic Change
Finally, macrosystems are the overall cultural patterns in society. On a social level, this system is how we understand ideas of development, identity, privilege and our sense of worth in the larger contexts where we live (Hess & Schultz, 2008). From the first brick thrown at the Stonewall Inn the LGBTQIA+ communities have historically been fighting for liberation and empowerment, equal access to housing, employment, and medical care for decades. Additionally, the field of psychiatry and psychology is a mesosystem that still has a lot of work to do to provide affirmative care.
Understanding the relational levels of the ecosystem informs how power moves through our individual autonomy, collective power, and the power to make systemic change. This clarifies how power exists both as a psychological and political force.
What is power, and why does it matter?
It follows that understanding some basic definitions of power is a first step to engaging with it. Isaac Prilletinsky (2008) is a community psychologist who thinks about meso and macro level problems. He offers us some ideas about different ways to define the idea of power.
- Our capacity and opportunity to fulfill or obstruct personal, relational, and collective needs.
- A psychological and political resource
- Currency in the ability to liberate, oppress, and resist.
These ideas about power exist at all levels of the ecosystem:
- This is a commitment to anti-bias, anti-racist work, and the individual impact we have to fulfill or obstruct need in our communities.
- Therapists’ individual votes in a democratic society is a demonstration of psychological and political power.
- Staying involved in political advocacy and including that in professional practice is an opportunity to impact need on a larger level.
- Acknowledging the power a therapist holds to fulfill or obstruct need is a part of cultural humility.
- Social isolation is a meso level problem; a problem about how groups include and exclude others.
- For LGBTQIA+, CNM, and kink communities, the reasons for inclusion and exclusion are as political as they are psychological.
- The LGBT community has proven to be a powerful political force in enacting both systemic and individual psychological change over the past decade.
- Power is indeed a currency to resist homo/bi/trans/polyam/kink phobia.
Accessing or withholding power
First, affirmative therapists and clinical directors need to know what power is. Secondly, they need to understand what it can do. That way they can know where they can exert their power to fight bias and improve patient care on multiple levels in the ecosystem.
- Be overt, covert, subtle, blatant, hidden, or exposed.
- Apply to the self, others, and collectives
- Afford people multiple identities in order to acquire resources for their collective needs.
Accessing or withholding micro power
The decision not to engage with individual power is a covert and subtle decision. Moreover, this is a choice that maintains oppressive psychological and political structures. First, being willing to engage with the people closest in your life about their individual biases and political influences is blatant and exposed. Secondly, exploring how clients do this too can have an impact on their awareness of power. Clients with more privilege can become more aware of their capacity to affect change. Speaking about religion and politics was considered rude a generation ago. As a result, personal beliefs were not be challenged. Consequently, children were expected to adopt the beliefs of their parents. Choosing whether or not to challenge this in your close relationship is a microlevel exertion or withholding of power. Challenging some of these ideas in the therapeutic setting can help clients begin engaging with power too.
Accessing or withholding meso power
Next, grassroots organizing efforts, the development of feminist psychology, and the collective ability to resist status quo are forms of power. So it follows, these efforts are important for challenging social isolation and building community. In short, these are both psychological and political ways to impact social change in the mesolevel. Subsequently, considering the collaboration opportunities organizations have in their community is an important use of power.
Choosing where to place those communal efforts is a choice of macro level power. For example, LGBTQIA+, CNM, and kink communities have fought the pathologies of their identities, decriminalization of healthy sexual behavior, marriage equality, and currently many different issues related to transgender rights. Consequently, it becomes clear that the political is personal, and the personal is political in all levels of the ecosystem when looking at power from this perspective.
Power can be complicated
In short, power can be complicated by personal wellness, relationships, organizational dynamics, the political climate, and trends in current events. As a result, putting all this into action is hard work! Systems theorists talk about homeostasis, the internal self-regulation of systems that resist change (Smith-Acuna, 2014). Certainly, this is a dynamic ongoing process.
Here, we can introduce the chronosystem in Brofenbrenner’s model. This is a model to look at the events and transitions that impact power over time. Therefore, some things to consider when thinking about power in the chronosystem and environment are:
- Context and setting matters. An individual can experience empowerment in one setting, and feel oppressed in another.
- Structural factors like class, race, gender, sexuality, ability affect access to power.
- Social and personal constructs like beauty, intelligence, assertiveness, humor, or social skills affect degrees of power.
- The exercise of power can reflect varying degrees of consciousness with respect to the awareness of one’s actions.
Putting it all together
To sum up, consciousness and awareness of power is an ongoing, iterative, and lifelong process. Therefore clinician’s evolving understanding of the impact and influence they have on the world around them is an essential part of being affirmative. Similarly, this requires therapists to continue doing their own inner work, engaging in community, having ideas challenged, and listening to those who hold less power. To clarify, a willingness to engage with power helps bring more awareness to power!
As we bring all these ideas together in context to LGBTQIA+, CNM, and kink communities, affirmative therapists can relate to how complicated power can be. Certainly, empowerment and oppression is directly related to how well we are positioned in each level of the ecosystem. Therefore resilience and coping skills to manage, navigate, and engage with more systemic forces is essential. Most importantly, engaging in structural anti-bias work can help identify where you are seated both in and out of queer community. An ongoing and increased awareness of where, when, how and why you are engaging with your personal, collective, and political power is an essential part of affirmative therapy.
Learn More from Melissa Dellens, MA, AMFT
Hess, S. & Schultz, J. (2008), Chapter 3: Bronfenbrenner’s Ecological Model. Lenses: Applying lifespan development theories in counseling, p. 52-79.
Peterson, N. A., & Zimmerman, M. A. (2004). Beyond the Individual: Toward a Nomological Network of Organizational Empowerment. American Journal of Community Psychology, 34, 129-145.
Prilleltensky, I. ( 2008). The role of power in wellness, oppression, and liberation: The promise of psychopolitical validity. Journal of Community Psychology, 36, 2, 116-136.
Smith-Acuna, S. (2014). Systems theory in action: Applications to individual, couple, and family therapy. Hoboken, N.J: Wiley.
We can help you and your clinic become more affirmative!