Social Inequalities and Therapeutic Relationships

Client-therapist differences related to culture, race, gender, and class are likely to create power imbalances and dilemmas in therapeutic relationships. It is argued that therapists' awareness of these social inequalities and participatory ideologies does not in itself necessarily eliminate the possibility of clinical impasses. Complex social and health realities1 foster the perpetuation of an asymmetrical therapist-client relationship, creating contradictions in the helping process. To deal with this dilemma, a problem-posing method, based on Brazilian educator Paulo Freire's "Education for Critical Consciousness," is proposed. This method addresses the oppressive nature of non-reciprocal relationships, and involves both therapist and client/family in a process of mutual dialogue, conjoint reflection, and action.