Show Notes for The Aspiring Psychologist Podcast Episode: 24: Power imbalances in fiduciary relationships and how to address them as an aspiring psychologist

Thank you for listening to the Aspiring Psychologist Podcast.

When working as in psychology, or in a caring profession, it is important we consider power imbalances. This podcast is a special request, it highlights some of the ways I consider power imbalances in my practice. It will look at how I consider individual differences, culture, language, and social factors. I hope it helps you to reflect on power imbalances in your own work!

The Highlights:

00:28: A special request on power imbalances

01:49: Fiduciary relationships

03:01: Polite and respectful

03:54: You can call me Marianne

04:57: Confidentiality and Netflix!

05:59: Overidentifying with clients

06:52: Testimonial from incoming Trainee!

07:48: What is it like for our service users?

09:32:  Trusty Maslow’s Hierarchy of Needs!

10:43: Different experiences of the same problem

11:48: Social factors

12:48: Take me through your day-to-day

13:46: Ask the difficult questions!

14:45: Language and coping strategies

15:49: Don’t be afraid and don’t assume!

16:41: Thank you, review, and the aspiring psychologist membership

17:17: Jingles

Check out ways to work with her including the upcoming aspiring psychologist book and the aspiring psychologist membership head to her linktree:

https://linktr.ee/drmariannetrent

• To check out The Clinical Psychologist Collective Book: https://amzn.to/3jOplx0 

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Hi, welcome along to the aspiring psychologist podcast. I am Dr. Marianne Trent, and I hope that you will find this really useful. Thank you for being part of my world. Today is a special request from, um, Hena who got in contact and she says, um, I'm thinking about what might be beneficial for aspiring psychologists could be power imbalances during our sessions and how to address these, and also maybe how we take into account social factors and inequalities when working with clients and families. Um, so thank you so much for, um, your request name. I will do my very best, um, to, um, to answer that for you, because it is a great question. So thank you. So when I was, um, applying for, um, doctorate places, myself, um, I had a tendency, um, to reflect on, um, fiduciary relationships, which might not be a relationship, um, that you have heard of before, but a fiduciary relationship is one where, um, someone else has, you know, a duty of care for the other person.

So one person is coming along cause they need something. Or maybe not always cuz they need something. They might not think they only need anything, but one of you has a duty of care or some kind of responsibility for the other person. So we would get fiduciary relationships. Um, if we were a psychologist and we had a client, we'd get them. If you were a GP, you'd get them. If you were a dentist, you know, or an occupational therapist, um, you know, speech and language therapist, all of these, um, professions would be whether they knew it or not, because it's not a very common term, uh, would be, um, subject to fiduciary relationships. And there are obviously, um, you know, there's caveats to that, that that can make relationships a bit more complicated. Um, you know, so along the lines of, um, the boundary setting episode, which I believe from the top of my head is episode eight, there are limits to our relationship and of course our relationships should be friendly with our service users.

They should be, um, you know, personable, I believe. Um, although I have, you know, previously worked in a service where an hour is dynamic and so, um, that is a slightly different type of relationship. You're still polite, you know, you're not rude to people. Um, so yeah, it's, it's worth thinking about, um, those power imbalances. You know, I know that many clients that I've worked with, um, have wanted to call me Dr. Trent. Um, and I say to them, you know, you don't have to call me Dr. Trent, you can just call me Maryanne. Um, but for them perhaps culturally, um, or because it's just the way they've been brought up, they want to continue to call me Dr. Trent. And I respect that about them, you know? Um, I'm not going to correct them every time I will, I will explain that with them, you know, once.

Um, but many of them do still want to call me Dr. Trent and clients that I might have been working with, um, you know, for over a year still, um, message me in emails formally as, as Dr. Trent. Um, but obviously to my face might call me Maryanne, but, um, you know, we're not, we're not correcting, um, or dismissing what a client brings to them, but, um, you know, we do have to be very careful, um, with how we are handling our power and our responsibility and, you know, just to go over some of the boundaries stuff again, we have to make sure that we are, um, being clear about the caveats to our role. We need to make sure that people have insight and can make an informed consent knowing what, um, you know, what therapy and dealing with us as a service entails for them.

Um, so yeah, you can't ever really talk too long about, um, about consent and about the limits of confidentiality. Um, and you know, sometimes it can be useful to, to say, you know, this applies for all, all of our sessions together, but sometimes people start the beginning of every session by saying, you know, um, a little something about confidentiality again, but, um, yeah, we do need to be, uh, mindful of the impact that we have over others, you know? Um, and it, uh, my clients seem to have a great deal of impact over what I watch on, on Netflix, um, because they will often tell me what they're watching and then I think, oh, well, I feel like I don't wanna miss out on the party. I feel like I need to get involved with that. Um, and you know, I might have had a similar, similar impact on you when I spoke about this is us, you know, maybe recently you listened to that and you're like, well, I've never watched this, this us, but she says, that's all right.

You know, because you go, you become a bit of an influencer don't you, when you are, um, chatting about things. Um, so yeah, um, we can have shared experiences with our clients, but we also have to know that there are differences and this is really useful fodder for supervision as well. And, you know, whilst you might have, um, shared characteristics with your clients, um, we have to be careful that we're not over identifying or diminishing our clients' experiences because we have some understanding of what they've been through, but, you know, sometimes our clients will purposefully seek us out, especially in private practice because they believe that they, we will know and resonate with, um, with what they're talking about. Let's take a short break here and I will be back with you on the other side of this, um, this break.

Hi, my name's Matt, I'm an assistant psychologist and a specialist autism team in Liverpool. And I've just gotten onto the doctor at an Exeter start in this September. The aspiring psychologist podcast has been great for me, the content and the guests are brilliant. And I think Marianne does a really good job as a host of being really positive, normalizing negative experiences and reminding people to be compassionate towards themselves. For me, the podcast is especially useful because I feel like I'm always busy and on the run of two interviews, I could listen to it Whil. I was at the gym and it allowed me to feel as though I was still getting that important time for myself and do things that are important for me whilst still engaging with stuff that is gonna help me on my psychology journey without needing to carve out any separate and dedicated time for it. I definitely recommend that anyone wanting to know more about working in psychology, give this podcast a listen, as it gives it really clear and honesty, insight into the things you can expect.

Okay, welcome back. So, um, I was talking to a journalist, um, yesterday about, um, uh, about eating alone and cooking, um, alone for ourselves, um, and how that can be an ultimate act of self care. But I also asked her to make reference to the fact that, um, for many people, um, currently it would feel like a bit of a, a decadent thing to do to be perhaps switching an oven on just for ourselves or, um, you know, using all the resources of using a gas hub and then having to wash up all of the stuff just for one person. And I think unless you've got some awareness of the social context of that, unless you've, yeah, just taken that on board, then we need to be, make, we, we need to make sure that some of the suggestions and some of the things we might be discussing with clients, um, you know, for activity scheduling, for example, or offer building structure and routine into, um, life, um, to make it more functional and enjoyable, we do need to make sure that we are not, um, you know, socially unaware of what it is like for our service users to be trying to navigate the world at the moment, um, when they might well be, you know, scared of, um, you know, factors associated with the pandemic, um, they might, um, you know, be struggling financially to heat homes or, um, put food on the table.

And so it is really useful to have, um, conversations with people even when, um, it might look like they couldn't possibly be struggling for money. It's useful to check in with people about, you know, some of the factors from the Maslow's hierarchy just to check how things are for them financially, how things, you know, you're not asking for bank statements here, but, um, if someone is really struggling to pay their water bill or, um, you know, they're worried that they can't, um, you know, can't cover the cost of the next, um, food shop that really does impact on people in, in a big and important way. And I had a recent conversation with a client, um, where it came, came to light that they, they weren't really sure how they were going to fill their cupboards next time. And so we used a bit of our time in the session to look at, um, options for, you know, emergency food provision and that then freed the client up to, to feel validated, to feel seen.

Um, and it wasn't done in a way at all to be shaming. Um, but to just feel like they had other options available to them, because if you feel like you can't feed yourself or your children, then it's, you don't know where your next meal is coming from. It's very difficult to think about anything else, you know, because it can really dominate things. So it's important for us to have conversations, um, even though it might be very different to your own experiences currently. Um, so I know everybody is feeling the pinch of, um, increased cost of living, but where, where people, where clients have got limited resources, because the benefits haven't been increased, then, you know, the pressures are going to be that much more really than if you are working with a client who is able to put up their wages or put up their rates or, you know, go out there and earn more money, um, just by picking up some more clients, for example.

So just having an awareness of the social factors, um, that are around right now, um, can be really useful. And similarly, you know, when I've worked with clients who, um, are in social housing, um, it's very difficult, um, to imagine if you aren't in that context yourself about just what an impact it has upon you, if you are living in close proximity to, you know, a crack den, for example, which is something that one of my clients had experienced, um, and the impact that has on you of being able to smell crack all the time and feeling like it's in your home and, you know, it's affecting your health. And so, you know, sometimes even just having a conversation about your home, what it's like, how you feel to be there when you are there, does it feel like a place of sanctuary or are there factors that make it very tricky?

So they might not, might not tell you about some of these factors just unless you ask, because there may be a great deal of shame or stigma. And similarly, I work with someone else who's got, um, I did, would, did work with em, don't work them anymore. Um, and then their neighbors, dogs were incredibly noisy and it was, you know, affecting all areas of their wellbeing really. And it was incredibly difficult, but it wasn't something that I never, I, I necessarily would've thought to ask about. Had we not been doing a bit of a rundown of, you know, of what it's like to be them, you know, take me through your day from, from morning to night and, you know, give me a flavor of some of the things that crop up for you in that day. So that can be a really useful exercise getting to know your client and getting to know the unique struggles that, which they might not necessarily be thinking are contributing to their difficulties.

But as we know, they really can, you know, it's impacting on our sleep, it's impacting on our ability to nourish or provide for ourselves or our children. Um, then that can be very difficult indeed. And neighbor conflict, um, is a big deal, you know, because it can really make people feel, you know, vulnerable in their homes. So these are important conversations to have, but yeah, I think being brave enough to ask questions, but also just saying, well, how is that for you? What's that like, or being honest, you know, I don't have any experience of, of growing up, um, in a situation where, you know, English, wasn't my first language, for example, how, how has that been for you? Um, and I was recently, um, doing a session with someone who spoke, uh, three or four languages. And so I asked them, well, how is it when I ask you questions in English and that isn't your first language.

Can you tell me what goes on for you at that time? Um, and they were then able to answer, um, you know, what that is like for them. And, um, they said that under pressure, it does beget. It does get a bit trickier, but generally speaking, they're able mostly to think about situations now, um, in English. Um, but under pressure, we will often revert back to our earliest coping strategies, but might be worth knowing that for many of our clients that we might be working with their earliest coping strategies might not almost be, you know, within the British, um, if you're listening to this in, in Britain, they might not be socially like that common within our British culture. So it's worth thinking with our clients about, about what makes them unique and about their coping strategies and their way of thinking about the world and what things have been like growing up and how that might be different for them.

Now. So many of my clients, um, in the past have, have, have then been not with their family, you know, not in the same birth, not in the same country as their birth families, and that has its own unique challenges as well. Um, so yeah, just be open and interested and compassionate and wise, and don't be afraid to ask how things are for your clients. Um, don't always assume that, you know, um, you know, we really want to be getting a bespoke feel, um, for, for your clients as being unique and valuable people. Um, and not just being treated as a number. So that's my own personal take on it. But, um, yeah, I hope you found this useful Hena. I hope this was what you imagined it might be, but if it hasn't been, um, let me know and I can give it another go.

Okay. Thank you so much for listening. Please do take a moment to rate and review, um, my podcast episodes, um, on the apple podcast app, find me the aspiring psychologist podcast scroll right to the bottom right underneath the trailer. And that's where you'll find the rate and review section. Um, so thank you so much for listening. If you would like to sign up to the waiting list for the aspiring psychologist membership, you can do that by checking out the details in the show notes or on my link tree. Thanks for listening and hope you have a lovely day. Take care.

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