Happy Pride Month!! Use coupon code takeprideinlearning2024 to take 20% off all individual courses and memberships through June 30, 2024

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.

Relationship Boundaries From a Queer Femme Therapist: Common Barriers & Helpful Tips

Posted: 1-16-20 | Briana Shewan

Photo of femmes

This is the final installment in a three-part series on boundaries. In the first article, I discussed what boundaries are and why they’re important, and in the second article, I dispelled misconceptions about boundaries. In this last piece, I will name common barriers that femmes may experience in setting boundaries, and will share some tips to help you with this.

If the boundaries discussed here are unsafe for you to set with a partner, please check out resources on intimate partner violence for more appropriate support. 

Common Barriers to Setting Boundaries

  • You feel responsible for the other person or are preoccupied with how your boundaries will affect them
  • You feel guilty or bad
  • You don’t like yourself
  • You’re afraid of losing what you have
  • You’re afraid of being invisible as a femme without your partner
  • You love the other person and setting boundaries feels mean and selfish
  • Learning to deal with things yourself is what you’ve always done and all you’ve known how to do up to this point
  • In your culture, you don’t set boundaries with your parents or elders
  • You don’t feel like you need to set more boundaries because compared to your previous relationships, this one is better
  • Thinking about setting boundaries makes you feel confused
  • Your immediate circumstances or objective or capacity mean setting boundaries you normally would isn’t in your best interest 
  • You’re afraid the person will leave you and that someone else won’t love you

Tips for Boundary Setting

Address Power Dynamics

Particularly in intimate relationships, barriers to your exercise of boundaries may exist if your partner is more masculine than you; is older than you; has more experience sexually, in relationships, or with non-monogamy than you; identifies as straight; has been out longer if they’re queer; or is less marginalized in terms of factors such as size, ability, race, education, class, or profession. If your relationship is long-term, you cohabitate, you’re married, you parent together, and/or you’re part of a polycule, setting boundaries may have significant consequences for you and others. Whether you have a history of trauma separately or together, emotional symptoms can lead to less boundary setting for the sake of shorter-term well-being. Other barriers that may come into play are lack of access to a support system; health care, including  mental health care (and care that is affirming); and income, particularly if you depend on your partner to access these things. 

Name power dynamics early on in a relationship. Having ongoing communication about power dynamics that are inherent, meaning they won’t go away, and addressing how they impact relationship dynamics can help you work with the imbalances they cause.

Take Time & Space

In browsing other articles published on boundaries, I found a definition that stated, “Simply put, boundaries are what set the space between where you end and the other person begins” (Twardowski, 2017). One very simple way in which to achieve a sense of where you end and another person begins is to take time and space. The key is that time and space in themselves differentiate you from others. Take time for self-care and to slow down your mind through journaling, walking, gardening, drawing, and similar activities so that you can clarify what boundaries are right for you. We all process in different ways and at different paces, tolerate different amounts of confrontation, and need to separate our own experiences from the influence of other people’s perspectives.

Acknowledge Your Hurt

Acknowledging the impact of others’ behavior on us helps us set boundaries. Emotions inform our decisions. Often femmes are conditioned to deal with things on our own, say “It’s fine” rather than rock the boat, and not expect things of others. Compassion towards yourself in the form of getting in touch with your feelings like sadness, grief, and anger is foundational. Anger teaches us our boundaries because we get angry when our boundaries are crossed. Once you acknowledge the harm that someone’s behavior is causing you, you can choose to set boundaries on your own behalf. If you’re having a hard time accessing compassion towards yourself, think about what you would want for a friend or what a mentor or role model would do.

Trust Your Gut

Many people say that they know when something doesn’t feel good; they just don’t listen to their gut, or it’s hard to act on that in the moment. We are conditioned to ignore our gut telling us something is wrong, because it benefits others when we are compliant rather than when we set boundaries. Trust your gut–also referred to as your intuition–as a source of information for setting boundaries. You may not be sure why until you’ve had more time to process, and that is okay.

Know Your Needs

It’s easier to set boundaries if you first recognize your needs. Of course, this isn’t always realistic, and we learn many of our boundaries through our experiences. That being said, if you know that you don’t want children, or you don’t want others to access your email, or you alternate holiday plans year-to-year, or that because of previous traumatic experiences you need someone with a certain demeanor or communication style in order to feel safe, you can prioritize these boundaries with more self-assuredness. 

Reframe Boundaries

This section revisits many of the Common Barriers listed above so that you can work through them:

  • Boundaries allow you to have actual intimacy because the relationship is based on your true needs, capacity, and desires.
  • Saying no isn’t about not loving the other person. With boundaries you convey, “I love you, and I also love myself” (Viado & Greer, 2019).
  • Not setting boundaries with someone is actually doing a disservice to them; you’re not teaching them what’s okay or not, you’re enabling their dependence on you by doing things for them. If they’re also femme, you’re not modeling valuable skills.
  • Prioritize accountability over responsibility. Rather than not setting boundaries because of someone’s manipulation, gaslighting, blaming, denial, or guilting, set a boundary in response to it. Consider that these are effective tools for avoiding accountability rather than taking on someone’s struggles or circumstances.
  • Saying no doesn’t just mean losing something–it means making room for the people who are out there who will love you, support you, and see you for who you are.
  • Boundaries attract people who are able to respect them.
  • Becoming single doesn’t make you invisible as a femme; your essence is within you and nothing can take it away from you.
  • Boundaries free up space to accept your partner and yourself as you are without trying to change each other (Viado & Greer, 2019).
  • If someone isn’t able to meet your needs, it doesn’t mean you’re unlovable; it means that the two of you aren’t compatible at this point in time.
  • Rather than creating conflict with loved ones, boundaries give you the opportunity to confront your relationship in a deeper, more meaningful way.
  • Boundary setting allows you to truly let go of someone rather than ending the relationship out of spite, resentment, or to rebel (Viado & Greer, 2019).
  • Your feelings don’t go away just because you don’t deal with them.
  • You don’t need acceptance or validation from another person; it comes from within yourself.
  • Setting boundaries with someone from whom you’re seeking approval isn’t what keeps them from supporting you.
  • Just because something isn’t common practice around you doesn’t mean it’s not what’s best for you, nor that you’re alone in doing it.
  • No one can set your boundaries for you.
  • If your relationship is sustained by you not asserting your needs and you tell yourself that you’re being more passive for the other person’s sake, are you really avoiding risking feelings of abandonment?
  • Setting boundaries is something you can do for your younger self now that you’re an adult with more autonomy.
  • Your boundaries are tributes to all the femmes who have fought so hard for your ability to say no.
  • Boundaries are a political act; they’re the basis of movements built by people collectively saying “no more.” 

Boundaries are a practice. Each opportunity to practice boundary setting is a new one. Boundaries represent a chance for you to redefine yourself in the present. I hope that this series helps ground you to say no when you feel the need in your body. Know that you are not alone–you are a part of a long legacy of femmes enacting their worth.


Learn More

Text "Feminist Structural Family Therapy with Polyamorous Clients presented by Stephanie M. Sullivan, MS, LLMFT & John Wall MS, ALMT 2.5 CE Course" under an image of several rows and columns of people's faces intersected with dotted lines to represent a genogram within a polyamorous family  "Identity development around sexuality, gender, and relationships presented by Cadyn Cathers, PsyD 5 CE Course" under a rainbow image of several silhouettes with a magnifying glass to denote identity development in LGBTQIA+, CNM, and kink communities   Text: “The Healing Power of Open Relationships presented by Kathy Slaughter, LCSW 4 CE Course” under an image of a mobile of different colored hearts to represent how early childhood attachment can influence adult relationships and how open relationships can be healing of attachment wounds.



Desano, A. (n.d.). Intimate Partner / Domestic Violence. Retrieved from https://lalgbtcenter.org/health-services/mental-health/intimate-partner-domestic-violence.

Twardowski, J. (2017, December 7). 6 Steps to Setting Boundaries in Relationships. Retrieved from https://www.huffpost.com/entry/6-steps-to-setting-boundaries-in-relationships_b_6142248.

Viado, L., PhD, & A. G., PhD (Host & Guest). (2019, February 20). 105: Everyday Codependency [Audio blog post]. Retrieved from https://lourdesviado.com/105-everyday-codependency/