IJSP Number 8, 2026

International Journal of Supervision in Psychotherapy, Number 8, 2026 Page | 82 structures access to safety: who can leave a harmful job, who can report abuse without retaliation, who can afford care, who is believed when harmed. This is why radical psychotherapy repeatedly returns to questions such as: Who decides? Who is listened to? Who is protected? These questions operate at multiple levels. • In the client’s world , power determines the cost of authenticity and the risks of refusal. If refusal risks homelessness, deportation, job loss, or violence, then “assertiveness training” can become clinically naive unless it is paired with realistic safety planning and resource mapping. • In the consulting room , power is present in expertise, diagnosis, documentation, fees, and institutional affiliation. Professionalization and state regulation can intensify these asymmetries by imposing standardized forms of legitimacy and risk management [22]. A radical stance therefore includes reflexivity about how therapy itself participates in institutional power. The provocative framing of psychotherapy as a form of class struggle [23,24] is useful not because therapy must adopt a militant stance, but because it raises an essential clinical question: when distress is structurally produced, does psychotherapy primarily help individuals adapt to conditions of exploitation, or does it support them in recovering agency and dignity within—and sometimes in resistance to—those conditions? Even if one rejects the most adversarial rhetoric associated with this perspective, the core issue remains relevant. Psychotherapy cannot credibly claim neutrality with regard to power when power relations are already shaping the client’s suffering, constraints, and possibilities for action. Psychoanalytically, this focus on power also clarifies transference and countertransference dynamics. Clients who have been routinely disbelieved may anticipate disbelief in the therapist. Clients who have learned that authority is dangerous may comply outwardly while withdrawing inwardly. Radical psychoanalysis, understood as an ethical practice, therefore requires attentiveness to how social power is replayed in relational patterns, and to how the therapist’s stance can either replicate or disrupt those patterns [4]. 3.4 “PATHOLOGIZING” VS “CONTEXTUALIZING”: WHEN DIAGNOSIS HELPS, AND WHEN IT REDUCES THE PERSON The distinction between pathologizing and contextualizing is central to radical psychotherapy’s scientific and ethical credibility. Radical psychotherapy does not reject diagnosis outright; rather, it asks when diagnostic language clarifies suffering and improves access to care, and when it becomes a reductive label that eclipses biography, context, and moral meaning. Diagnosis can help when it: 1. provides a shared language that reduces isolation, 2. guides evidence-informed intervention, 3. opens access to services and accommodations, 4. legitimizes distress in systems that otherwise deny it. But diagnosis becomes pathologizing when it: 1. substitutes a label for understanding, 2. locates cause exclusively “inside” the person, 3. treats survival adaptations as defects without recognizing their function, 4. obscures power and context, implying that the client is the problem rather than living in problematic conditions.