Out On The Couch

Making the most of your clinic’s power

Posted: 9-1-21 | Melissa Dellens

Collage of people in meetings and a water droplet leading to ripples to represent how power dynamics can play out within an organization, between organizations, and within organizations.

Organizational empowerment is an active and participatory process through which individuals, organizations, and communities gain greater control, efficacy, and social justice (Peterson & Zimmerman, 2004). Firstly, we explored Brofenbrenner’s ecological model (Hess & Schultz, 2008), and Prillelensky’s (2008) understanding of power dynamics.  Secondly, we will introduce organizational empowerment theory (Peterson & Zimmerman, 2004) and then explore how clinics, treatment centers, and group practices can be more intentional about the power they hold in the communities they serve. Importantly, Prilleltensky (2008) reminds us that the actions of institutions (including clinical communities) reflects how conscious they are about the power they hold. 

Certainly, there is a lot of focus on individual empowerment in psychotherapy. However, this can unintentionally place blame on one person when more dynamic forces are at play (Peterson & Zimmerman, 2004). In short, organizational empowerment uses Broffenbrenner’s Ecological Model to visualize how power moves, and how communities, collectives, and coalitions can use power as a resource to make impactful change. 

In short, organizational empowerment theory considers how the power dynamics in larger systems affect and impact individual empowerment. Above all, clinical and program directors must consider providing affirmative care in their clinical communities. Organizational empowerment theory assesses power and its leverage at the intraorganizational, interorganizational and extraorganizational levels. 

Personal Power Dynamics: Seating yourself in the ecosystem

In the microsystem, we begin to understand who has more access to power and who doesn’t. Individual status begins to take shape in relationships. Children have less power than grown ups. Employees have less power than employers. Clients have less power than therapists. Additionally, there can be real and perceived power differences between friends and colleagues. For example, other individual social characteristics like intelligence, beauty, confidence, humor or assertiveness can be forms of power as well.  Some questions to consider in exploring your access to power:

  • What people in your life influence your beliefs and values? 
  • Who has the power to influence your expression of self or your identities? 
  • When you think about the people you spend the most time with, where do you hold more or less power in relationship to: 
    • age
    • race
    • religion
    • ability
    • socio-economic status
    • ability
    • gender
    • sexuality
    • relationship constellations  
  • Are the people in your ecosystem positioned similarly to you? 
  • Where do you situate yourself when you consider socially constructed power (beauty, intelligence, assertiveness, humor, social skills?)
  • Do these secondary privileges become more or less important depending on your community setting?

There isn’t necessarily anything good or bad in this. Simultaneously locating yourself in your microsystem while understanding the part power plays in each of your relationships is a start in understanding your role in creating safer communities for LGBTQIA+, consensually non monogamous, and kinky people. 

Thinking about your clinical community

Mesosystems begin to group the people from microsystems together into communities gathering around a common interest, task, mission, or setting (Hess & Schultz, 2008). This is the most important level of the ecological model when considering organizational empowerment (Peterson & Zimmerman, 2004).  

As a clinical community, seeing yourself as an essential mesosystem for the clients and patients you serve deeply affects how you provide care. When considering the treatment your LGBTQIA+, CNM, and kink clients are currently receiving, seeing each of those communities as an additional mesosystem can help leverage your power dynamics in providing affirmative care. 

In short, organizational empowerment theory assesses intra-organizational, inter-organization power, at this level in the ecosystem, and identifies ways to leverage that power more equitably amongst members. 

Intraorganizational power dynamics

This is the power dynamic within your mesosystem. In other words, it is the capacity to provide the highest level of care possible to the most amount of people. This assessment considers your power and ability to do what you said you set out to do. Consequently, you can identify the individual empowerment of your staff and their confidence in their ability to act on the clinic’s mission and values. 

Some things to consider: 

  • What are your organizational mission and values? 
  • Do they actively include LGBTQIA+, CNM, and kink clients? 
  • How diverse are the demographics of your clientele? 
  • What incentives do your staff have to become more affirmative? 
  • Are you providing ongoing education? 
  • What about ongoing anti-racism or anti-bias training?
  • Are there opportunities for personal growth? 
  • Are you aware of the emotional labor of your staff, especially members of more marginalized communities? 

Interorganizational power dynamics

Next, we look at collaboration, coalitions, and alliance building. In short, this is the power your clinic has to partner with other organizations, communities, and actions. However, this power dynamic is most often complicated by time, money, and priorities. Thinking about the care of LGBTQIA+, CNM, and kinky clients in your mesosystem isn’t enough. Leveraging your power to collaborate with their mesosystem can increase your capacity to provide healing is key. 

Some things to consider:

  • Are you collaborating with others in the field in providing affirmative therapy? 
  • Have you considered the current challenges different mesosystems are facing? 
  • Is the power of your mesosystem helping to build alliances with others? 
  • Do you know how to access social support systems, medical care, and other affirming mesosystems for all your clients?

"Empowerment is an active, participatory process through which individuals, organizations, and communities gain greater control, efficacy, and social justice." (Peterson & Zimmerman, 2004). Grey background with white text. Rainbow colored exclamation points.

Considering the greater community

Finally, extraorganizational power is your clinic’s power in impacting and influencing cultural and political considerations for LGBTQIA+, CNM, and kink communities. In short, clinical communities have power in impacting macrosystems through the individual patients they treat, the microsystems they influence, the other meso systems they collaborate with, and the kind of treatment, legislation, and funding they advocate for. 

Some things to consider: 

  • Are you advocating and supporting your clients to advocate for the less affirming systems in their life? 
  • At an organizational level, are you engaged in political advocacy? For example, supporting the passage of the Equality Act at the federal level, and other local legislation that limit power and wellness of your clients? 
  • Do you offer clinical programs that affect the power and wellness of LGBTQIA+, CNM, and kink communities? 
  • Are you positioning yourself as a leader in affirmative care? 
  • Can you share your power and resources across multiple levels of your local ecosystem? 

Being more conscious about power dynamics

When we return to Prilletensky’s hypotheses about power, it becomes important to think about a couple things. Clinical communities have to promote health and wellness, but also the power to resist oppression in all levels of the ecosystem. Prilleltensky reminds us that time is short, and suffering is vast. Access to care for gender-, sexuality-, and relationship- expansive communities depends entirely on individual access to basic needs and resources like time and money. To sum up, clinical communities should constantly be assessing their access to power in every level of their ecosystem, and proactively considering how to do more for LGBTQIA+, CNM, and kink communities.  

Learn More from Melissa Dellens, MA, AMFT

             Text: “Autistic Affirmative Therapy for Allistic Providers Presenter: Melissa Dellens, MA, AMFT, 3 CE Course” under an image of infinity symbol in rainbow colors on rainbow background depicting Autistic affirmative therapy         Text: “Power dynamics in the facilitating environment presented by Melissa Dellens, MA 6 CE Course” under an image of two heads in rainbow colors facing each other depicting the tension between community and clinical approaches in healing LGBTQIA+ communities         



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.

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