Client-Centered Practice when Professional and Social Power are Uncoupled: The Experiences of Therapists from Marginalized Groups

Background Client-centeredness is foundational to occupational therapy, yet virtually no research has examined this aspect of practice as experienced by therapists from marginalized groups. The discourse of client-centeredness implicitly assumes a "dominant-group" therapist. Professional power is assumed to be accompanied by social power and privilege. Here, we explore what happens when professional and social power are uncoupled. Method In-depth interviews grounded in critical phenomenology were conducted with Canadian therapists (n = 20) who self-identified as disabled, minority sexual/gender identity (LGBTQ+), racialized, ethnic minority, and/or from working-class backgrounds. Iterative thematic analysis employed constant comparison using ATLAS.ti for team coding. Results: Clients mobilized social power conveying direct and indirect hostility toward the therapists. Clients used social power to undermine the professional credentials and competence of the therapists. In turn, the therapists strove to balance professional and social power, when possible disclosing marginalized identities only when beneficial to therapy. Strongly endorsing client-centered principles, the therapists faced considerable tension regarding how to respond to client hostility. Conclusions: The discourse of client-centeredness ignores the realities of marginalized therapists for whom professional power is not accompanied by social power. Better conceptualizing client-centeredness requires shifting the discourse to address practice dilemmas distinct to marginalized therapists working with clients who actively mobilize systemic oppression. Keywords racism, heterosexism, ableism, classism, ethnocentrism, Canada