Do you remember the first time you truly felt powerful? Think about it for a moment. Perhaps it was on the playground the first time you kicked the ball over the fence. Maybe it was when you got your first car and the world became accessible in a whole new way. Or was it when you got your first job and began to dream about all the things you could achieve? That first experience of personal or professional power can leave a lasting impression and can make us curious about how this power thing works.

I did not spend a lot of time thinking about the topic of power until I had to. My first education about power and the impact of the power differential came in focusing on the therapist-client relationship in 1997. Through my clinical coursework, I was exposed to numerous articles and books about the topic as required reading. It came through clearly that the therapist’s ethical obligation is to hold a safe space for the client and ideally work to partner with the client rather than act as the expert in the room (actively working to decrease the power differential).

In 2006, I learned about executive power when I obtained my first director-level position. Immediately I saw how organizational power affected the nature of my friendships with co-workers. I learned the hard way about who I could trust and who I couldn’t, and I learned that many people working in behavioral healthcare have unresolved issues with authority that they choose to work out with their supervisor.

I also learned what I did and did not like about power. Let’s talk about the positives of power first. Being powerful can feel good. It has a seductive quality. People listen, do as you direct them to do and at least act like they like you. There may even be moments when you secretly feel like you’re wearing a superhero cape under your business suit: You have solutions to the problems in front of you, you know the path forward, and people will follow you because you are standing at the top of the organizational chart. It is an amazing experience when the world you oversee is built according to your design. Yes, this is big deal and most of the time it is fun, hence the phrase “drunk on power.”

The shadow side of power is that the weight of the world really is on your shoulders. You have the responsibility that comes with the trust placed in you. You care for the people you work with and their families, and you have a financial bottom line to meet. Fear, doubt and the depths of anxiety are not foreign to those with power. It is also a reality there are very few people you can talk to honestly about your fears. It truly can be lonely at the top. If we are truly honest with ourselves, power—of any kind—is a behemoth responsibility.

Power in behavioral healthcare

The topic of power in the behavioral healthcare realm is an imperative, as our relationship to power as executives in leadership is undeniably mirrored in the therapist-client relationship through a clinical phenomenon called parallel processing. I have seen this phenomenon play out in behavioral healthcare facilities reliably. Traditionally parallel processing is when a therapist recreates a client’s behavior to their supervisor, i.e., rather than verbalizing the client’s behavior, the therapist begins to behave like the client in the relationship with their supervisor. If the clinical supervisor is savvy, they work with the therapist to acknowledge this dynamic and use it deepen the clinical insight of what is going on with the client.

Where this gets interesting is that this same dynamic happens in the opposite direction in organizational relationships, i.e., the executive leadership behaves in a certain way and the therapist (or other frontline staff) will then unconsciously act this out with the client. This is the truly the crux of the discussion: The executive may unknowingly directly impact the client experience and outcomes in ways that may not be intended.

Let me share a personal example. For many years, I had the opportunity to give out annual bonuses to the staff. One year, I was particularly excited that the bonuses had been approved as I had fought hard for the staff and felt triumphant in obtaining the approval. I wanted to personally hand out the bonuses in one-on-one meetings to make this a personal thank you to each of the staff. In hindsight, what I unconsciously did was jump down the organization chart and bypassed the managers that supported these staff day-in and day-out just because I could. I gave out the bonuses (feeling happy and powerful) thinking all was well.

What happened next is that the therapist who had just received their bonus was sitting with a client in the following days. The therapist unconsciously behaved as I did and bypassed the organizational chart—the approval required by the clinical director and integrated clinical team—and they give direct permission to the client to attend an off-site activity that is not consistent with their level in treatment. Oops. It is easy to place blame on the therapist, as they made a poor choice. It is harder to place the blame on myself and to see the connection between my actions and what played out for the client as the result of my choice.

This power conversation goes deeper than this. Behavioral healthcare executives may hope or even secretly believe that there is a magic line between the executive function and the frontline or clinical function. The truth is there is not. As executives, what we say, how we say it and even when we say it matters. If we are operating from a transactional leadership approach in a behavioral healthcare setting, you can bet that your therapists are going to be directive or top-down in their clinical approach, which we know through myriad outcome studies are contraindicated. Anything that we do as executives that accentuates the power differential will directly impact the power differential in the staff-client relationship and is not conducive to a positive outcome for the client.

By consciously engaging with a genuine transformational leadership approach, we could choose to wield our power to empower others. By partnering with our managers/staff to create and support integrative teams we deliberately decrease the power differential and directly model the clinical approach of partnering with the client to bring about the best outcome. We symbolically step aside to guide, empower and partner with our managers and staff so that the client can thrive.

Admittedly, I am a very organizational chart-focused person and know, like many of us know, that without structure systems fall apart and clients struggle. I also know that the power of leadership is a privilege. It is not something to be taken lightly, wielded carelessly, or without clear and deliberate thought given to the power that we hold. I also believe it is essential to remember that power is given because you are trusted to do the right thing for the client—no matter what.

Krista Gilbert, PhD, LMFT, is chief executive officer of Constellation Behavioral Health.