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"Facing Power: Relational Ethics in Therapy"
On October 10, 2025, I co-presented Facing Power: Relational Ethics in Therapy with Dr. Franchesca Fontus at the Indiana Association for Marriage and Family Therapy Annual Conference. This was the final session in a day of presentations, and the one that demanded the most honesty. The room was filled with professors, supervisors, and clinicians who understand how much harm can occur even when our intentions are good.
This presentation was created because ethical harm is often minimized or abstracted in clinical spaces. The language of “competence” and “best practice” can obscure the ways therapists misuse power, silence clients, or reproduce systemic inequities. Facing Power existed to make that visible — to ask what accountability looks like when harm happens inside care, and how relational ethics might offer a path toward repair.
Ethics as Lived Relationship
We began by naming that power is always present in therapy — professional, emotional, sociopolitical, and bureaucratic. When left unacknowledged, power distorts safety; clients learn to perform compliance instead of expressing truth.
We clarified that this presentation was not about Contextual Therapy but about relational ethics as a way of being — an ethic of presence, reflexivity, and accountability within the therapeutic bond. Relational safety, we explained, does not mean comfort or the absence of conflict. It means the trustworthy use of power.
Drawing from Fife et al. (2014), Davis et al. (2020), and Fors (2021), we introduced three capacities that sustain ethical practice:
Self-Awareness – Recognizing personal history, biases, and triggers that shape perception.
Relational Empathy – Attuning to the client’s lived experience within systemic and cultural context.
Moral Courage – Acting ethically and naming harm even when doing so risks comfort or approval.
When these capacities thin under pressure, relational integrity erodes, and what might have been a repairable rupture can deepen into moral injury — an existential wound to trust and dignity.
The Elena Case
To ground the theory, we shared a training scene portraying “Elena,” a client experiencing moral anguish. Her therapist, relying on a rigid DBT framework, reframed Elena’s pain as “all-or-nothing thinking” and called her moral system “dysfunctional.” The exercise illustrated how professional skill without ethical presence can retraumatize rather than heal.
Audience members immediately recognized the rupture. Some noticed the therapist’s flat affect and lack of mirroring; others identified the absence of cultural attunement or the signs of burnout and dissociation that clinicians often hide. The conversation that followed was frank. Several participants shared that they had once been that therapist — competent, well-trained, and entirely disconnected.
Together we examined which capacities had failed and which sections of the AAMFT Code of Ethics were compromised:
1.8 – Client Autonomy in Decision Making → requires relational empathy.
3.1 – Maintenance of Competence → requires self-awareness.
1.7 – Abuse of the Therapeutic Relationship → requires moral courage.
These standards presume that therapists possess the very capacities that often waver under stress. Our discussion turned to the lived question of repair: When harm has occurred, what is possible — and when is repair no longer ethical to pursue?
Dialogue on Repair and Safety
The room opened into shared reflection rather than debate. Clinicians described moments when apology became self-protection, when clients withdrew silently, or when supervision failed to name the injury at all.
Our branch director, Dr. Rachael Olufowote, graciously joined the session and offered several questions that grounded the discussion in relational practice. She invited us to consider how therapists can proactively check for safety before rupture grows invisible:
“How would I know if you’re feeling unsafe or uncomfortable with me?”
“What do you think I might notice about you?”
“If it became hard to tell me, what cues would I see from you?”
These questions reposition safety as a shared process. They remind therapists that feedback is not a threat but an ethical necessity.
Later, a participant referenced The Hour of the Heart by Irvin Yalom. Even at ninety, Yalom wrote of his own errors and the importance of apologizing to patients. The Yalom example emphasized that ethical integrity is an ongoing discipline rather than a permanent state.
Integrating the Discussion
As we spoke about repair, participants noted the fine line between accountability and emotional transfer. A sincere apology becomes manipulative when it asks the client to comfort the therapist. Ethical repair, several agreed, requires differentiation — the ability to hold guilt without offloading it.
We closed with three guiding actions synthesized from Eubanks et al. (2018):
Validate the client’s reality.
Name your contribution to harm.
Restore the client’s voice and agency.
These are not procedural steps but relational movements that rebuild dignity. When moral injury occurs, repair means restoring belief in the therapeutic process itself — in the possibility that care can again be trusted.
Near the end of the session, a participant asked why this topic is such a passion of mine. I shared that my commitment to this work comes from witnessing, and at times personally experiencing, harm in therapeutic relationships that was never meaningfully addressed. Those moments revealed how deeply the absence of accountability can fracture trust—not only between therapist and client, but within the helping profession itself.
I told the room that this work is about what happens when we hide behind competence instead of relationship. Too often, therapists mistake authority for moral certainty. Some of us even learn to weaponize therapy language—using words like boundaries, transference, or self-care to defend against discomfort or maintain control. When we do this, we make ourselves less trustworthy. We are not above our clients; we are accountable to them.
The Relational Integrity synthesis was created to reflect on this tension—to examine how self-awareness, relational empathy, and moral courage can sustain ethics when we are most afraid of being wrong. It challenges the illusion that good intentions or theoretical fluency ensure safety. Institutions often reward efficiency over reflection, leaving little room for humility or ethical repair. The pressure to look competent can eclipse the duty to be accountable. Our profession needs structures that make integrity actionable—supervision that names harm, feedback that surfaces risk early, and leadership that treats repair as a standard of care rather than reputational damage control.
The discussion affirmed that ethics is a living relationship, not a document to memorize. Its purpose is to help therapists hold both humility and responsibility at once—to act with integrity even when we falter, and to return, again and again, to the work of care. The work continues wherever power is unexamined and wherever repair remains possible. That possibility is what gives this work its meaning—the belief that repair, though imperfect, is still within reach.