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Social psychologists who wish to interview health practitioners - physicians, psychiatrists, and clinical psychologists - soon learn to be cautious in asking about power relationships with patients or clients. Such a question is very likely to harm their rapport, to lead to a defensive response. The term "power" often carries surplus meaning, suggesting subjugation, unbridled control, or demeaning of the target of power. While some social power relationships may be so characterized, social psychologists generally define the word "power" in more general terms, as merely the potential to influence - the influencing agent's ability to induce change in the attitudes, beliefs, emotions, or behavior of the target. As so defined, most social relationships involve some aspects of power. It is therefore important to recognize and accept the ubiquity of power, to understand the bases of power, and to be able to assess their effectiveness and the side effects of the use of power, which can sometimes be beneficial, and sometimes harmful.
A number of years ago, John R, P. French and I developed a taxonomy six bases of power: coercion, reward, legitimacy, expertise, referand information.1,2 Our first studies focused on the power of a supervisor over a subordinate in a work setting. Since then, however, our analysis has been applied by various theoreticians and researchers to a number of other differing situations: the relationships of husbands and wives, teachers and students, political figures, males and females in sexual encounters, citizens and bureaucrats, advertisers and salespersons, children and their playmates, nurses and doctors, and doctors and their patients.
PSYCHIATRIST/PATIENT RELATIONSHIP
To illustrate application to the psychiatrist/patient relationship, let us consider the following situation:
A psychiatrist in a hospital, working with a patient who is showing some schizophrenic symptoms including hallucinations and delusions, decides to prescribe a medication called "antihallucin" in order to relieve the symptoms. The patient, however, expresses reluctance to take such medication. He is an intelligent patient who has heard about undesirable side effects of antihallucin, including tardive dyskinesia. He says that he is opposed to drugs, in general, and sometimes suspects that hospital personnel are attempting to subdue him chemically, or even to poison him.
What then can the psychiatrist do to influence the patient to take the medication? Here are some possibilities.