The Use & Misuse of Power in Cognitive-Behavioral Therapy, Schema Therapy, & Supervision

Prasko, J., Abeltiņa, M., et al. (2025).

Neuro endocrinology letters, 46(1), 33–48.

Advance online publication.

Abstract

Background: Power dynamics are fundamental to therapeutic and supervisory relationships in psychotherapy. In cognitive-behavioural therapy (CBT) and schema therapy (ST), the therapist's power management can help the patient make positive changes. On the other hand, the abuse of power can undermine the patient's autonomy and worsen therapeutic outcomes. Understanding these dynamics is essential for effective and ethical practice.

Objectives: This article aims to explore how power and powerlessness manifest themselves in the practice of cognitive behavioural therapy (CBT) and schema therapy (ST), analyse their impact on therapeutic and supervisory processes, identify the risk of abuse of power, and suggest strategies to support patient and supervisee autonomy.

Methods: The text provides a theoretical and practical analysis of the manifestations of power in therapy and supervision, illustrated with case vignettes to explain important processes. The discussion includes a comparison of CBT and ST, focusing on their respective approaches to power dynamics. Ethical principles, supervision practices, and cultural and institutional influences are also examined.

Results: Effective use of power in therapy and supervision increases trust, cooperation, and autonomy for both client and supervisee. In CBT therapy and supervision, collaboration with an appropriate power distribution between therapist and patient or supervisor and supervisee promotes patient or supervisee engagement. Still, excessive directiveness can sometimes threaten the relationship. In ST, where limited reparenting is the main vehicle for the therapeutic and supervisory relationship, therapeutic and supervisory leadership requires increased sensitivity by the therapist or supervisor to avoid reinforcing maladaptive modes. Supervisory approaches that rely on collaborative approaches are more supportive of professional growth than those dominated by hierarchical power structures.

Conclusions: Reflection on power dynamics is vital in cognitive-behavioural and schema therapy for maintaining ethical and effective therapeutic and supervisory relationships. Strategies that help maintain a balance of power include adherence to ethical principles, self-reflection, and regular supervision. Future research should focus on developing innovative methods to capture solutions to power distribution issues in therapy and supervision.

A pdf is here.

Here are some thoughts:

This article examines the complex role of power dynamics in cognitive-behavioral therapy (CBT), schema therapy (ST), and clinical supervision, emphasizing both the constructive use and potential misuse of power that can significantly influence therapeutic and professional outcomes. The authors highlight that power in psychotherapy stems from the therapist’s expertise, authority, and role, but it is not static—it emerges from the interaction between therapist and patient, shaped by transference, countertransference, cultural context, and institutional structures. When used ethically, power supports patient autonomy, competence, and growth; however, its misuse can lead to patient helplessness, resistance, and deterioration in mental health, while in supervision, it may result in supervisee insecurity, burnout, and impaired professional development. The paper contrasts CBT and ST: CBT’s structured, directive approach as a “coach” or “teacher” can be effective but risks undermining autonomy if overly authoritative, whereas ST’s emphasis on “limited reparenting” and emotional attunement requires heightened sensitivity to avoid reinforcing maladaptive schemas or fostering dependency. Case vignettes illustrate how therapist behaviors—such as excessive directiveness, moralizing, silence, or nonverbal cues—can subtly convey dominance and disrupt the therapeutic alliance. In supervision, hierarchical, critical, or non-collaborative approaches can replicate these dynamics, hindering the supervisee’s growth. The authors stress that self-reflection, adherence to ethical principles, ongoing supervision, and personal therapy are essential for managing power responsibly. They advocate for collaborative, transparent, and empathic relationships in both therapy and supervision, where power is shared rather than imposed, and recommend institutional support for open dialogue and accountability. Ultimately, the article calls for greater awareness and research into power dynamics to ensure ethical, effective, and empowering practices across therapeutic and supervisory settings.

Experience-based risk taking is primarily shaped by prior learning rather than by decision-making

Erdman, A., Gouwy, A.,  et al. (2025).

Nature Communications, 16(1).

https://doi.org/10.1038/s41467-025-61609-0

Abstract

The tendency to embrace or avoid risk varies across and within individuals, with significant consequences for economic behavior and mental health. Such variations can partially be explained by differences in the relative weights given to potential gains and losses. Applying this insight to real-life decisions, however, is complicated because such decisions are often based on prior learning experiences. Here, we ask which cognitive process—decision-making or learning—determines the weighting of gains or losses? Over 28 days, 100 participants engaged in a longitudinal decision task wherein choices were based on prior learning. Computational modeling of participants’ choices revealed that changes in risk-taking are primarily explained by changes in how learning, not decisions, weight gains and losses. Moreover, inferred changes in learning manifested in participants’ neural and physiological learning signals in response to outcomes. We conclude that in experience-based decisions, learning plays a primary role in governing risk-taking behavior.

Here are some thoughts:

This research is important for psychologists because it demonstrates that risk-taking behavior in experience-based decisions is primarily shaped by prior learning rather than the decision-making process itself. By tracking participants over 28 days, the study found that changes in risk preferences were largely due to how individuals learned from gains and losses, rather than how they evaluated options at the moment of decision. This insight helps psychologists understand the cognitive mechanisms behind risk behavior, which is relevant to economic choices, mental health, and conditions like addiction or anxiety, where distorted learning from outcomes can lead to maladaptive decisions.

The study also links learning biases to neural and physiological signals, such as heart rate and EEG responses to negative outcomes, offering psychologists measurable markers of how people update their evaluations over time. These findings support the development of more accurate models of behavior that incorporate learning dynamics, rather than assuming static risk preferences. This has implications for clinical interventions, as it suggests that therapies targeting how individuals learn from experiences—rather than just how they make decisions—could be more effective in treating disorders involving risky behavior.

Moreover, the research addresses the "description-experience gap" by showing that real-world, experience-based decisions differ fundamentally from those made based on described probabilities. This highlights the need for psychological research and interventions to focus on experiential learning processes to better reflect real-life decision-making contexts. Overall, the study advances psychological science by clarifying the central role of learning in shaping risk behavior and offering new directions for understanding and modifying human behavior in both healthy and clinical populations.

The fierce ethical urgency of decoloniality in therapy: From understanding to action

Chavez-Dueñas, N. Y., et al. (2025).

American Psychologist, 80(4), 510–521.

https://doi.org/10.1037/amp0001370

Abstract

Disentangling psychology from the grip of methods, values, ways of knowing, and power structures considered normative within Western societies, all of which have been used to justify dominance and coloniality, presents a complex challenge and an ethical imperative. Psychology must rise to this challenge. This article invites readers to reflect on how coloniality influences the lives of Black, Indigenous, and People of Color in the United States and people from the Global South. The article examines the history of imperialism and colonialism. It considers how Western psychology’s ideas (i.e., psyimperialism) were spread and imposed on others (i.e., psycolonization). This approach fell short of meeting psychology’s ethical responsibilities. The article then discusses why it is critical to broaden the scope of our perspective beyond reflexive acceptance of Western ways of thinking, especially those that violate our ethical values, and weigh other approaches. We conclude with a call to action, offering questions and suggesting strategies that may be useful in moving beyond intentions and commitments to effectively decolonize our practice.

Public Significance Statement

The article examines the history of imperialism and colonialism. It explores the imposition of Western psychology’s ideas onto people from other cultures, demonstrating how psychology has sometimes strayed from its ethical values. The authors invite readers to reflect on the significance of expanding the scope of our perspective beyond reflexive acceptance of Western ways of thinking, especially those that violate our ethical values, and weigh other approaches. The article concludes with a call to action, emphasizing the importance of transforming intentions into actions.

Here are some thoughts:

This article is a critical examination of how Western psychology has historically and continues to ethically fail Black, Indigenous, and People of Color (BIPOC) and people from the Global South through "psyimperialism" and "psycolonization." The article argues that decolonizing therapy is an "ethical imperative," urging psychologists to confront their colonial biases, transform training and practices, and embrace diverse, non-Western epistemologies. It provides historical context of Western psychology's harmful impositions and advocates for a shift towards self-reflection and the responsible use of power to avoid further harm, ultimately calling for a decolonial approach that centers cultural reclamation and justice.

Evaluation of mobile health applications using the RE-AIM model: systematic review and meta-analysis

De Magalhães Jorge, E. L. G., et al. (2025).

Frontiers in Public Health, 13.

https://doi.org/10.3389/fpubh.2025.1611789

Background: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model has been used as an instrument to determine the impact of the intervention on health in digital format. This study aims to evaluate, through a systematic review and meta-analysis, the dimensions of RE-AIM in interventions carried out by mobile health apps.

Methods: The systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and involved searching six databases - Medline/PubMed, Embase, CINAHL, Virtual Library in Health, and Cochrane Library. The review included randomized, cross-sectional, and cohort clinical trials assessing the prevalence of each RE-AIM dimension according to the duration of the intervention in days. The quality of the selected studies was evaluated using the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain the distribution of effects between the studies, by Stata® software (version 11.0) and publication bias was examined by visual inspection of graphs and Egger’s test.

Results: After analyzing the articles found in the databases, and respecting the PRISMA criteria, 21 studies were included, published between 2011 and 2023 in 11 countries. Improvements in health care and self-management were reported for various conditions. The result of the meta-analysis showed a prevalence of 67% (CI: 53–80) for the reach dimension, of 52% (CI: 32–72) for effectiveness, 70% (CI: 58–82) for adoption, 68% (CI: 57–79) for implementation and 64% (CI: 48–80) for maintenance.

Conclusion: The RE-AIM dimensions are useful for assessing how digital health interventions have been implemented and reported in the literature. By highlighting the strengths and areas requiring improvement, the study provides important input for the future development of mobile health applications capable of achieving better clinical and health promotion outcomes.

Here are some thoughts:

Mobile health (mHealth) applications have considerable promise for improving healthcare delivery, patient engagement, and health outcomes, but their long-term effectiveness, sustained use, and real-world impact depend on careful evaluation across multiple dimensions—reach, effectiveness, adoption, implementation, and maintenance—using frameworks like RE-AIM.

Cyber anti-intellectualism and science communication during the COVID-19 pandemic: a cross-sectional study

Kuang Y. (2025).

Frontiers in public health, 12, 1491096.

https://doi.org/10.3389/fpubh.2024.1491096

Abstract

Background

During the COVID-19 pandemic, science communication played a crucial role in disseminating accurate information and promoting scientific literacy among the public. However, the rise of anti-intellectualism on social media platforms has posed significant challenges to science, scientists, and science communication, hindering effective public engagement with scientific affairs. This study aims to explore the mechanisms through which anti-intellectualism impacts science communication on social media platforms from the perspective of communication effect theory.

Method

This study employed a cross-sectional research design to conduct an online questionnaire survey of Chinese social media users from August to September 2021. The survey results were analyzed via descriptive statistics, t-tests, one-way ANOVA, and a chain mediation model with SPSS 26.0.

Results

There were significant differences in anti-intellectualism tendency among groups of different demographic characteristics. The majority of respondents placed greater emphasis on knowledge that has practical benefits in life. Respondents’ trust in different groups of intellectuals showed significant inconsistencies, with economists and experts receiving the lowest levels of trust. Anti-intellectualism significantly and positively predicted the level of misconception of scientific and technological information, while significantly and negatively predicting individuals’ attitudes toward science communication. It further influenced respondents’ behavior in disseminating scientific and technological information through the chain mediation of scientific misconception and attitudes toward science communication.

Conclusion

This research enriches the conceptual framework of anti-intellectualism across various cultural contexts, as well as the theoretical framework concerning the interaction between anti-intellectualism and science communication. The findings provide suggestions for developing strategies to enhance the effectiveness of science communication and risk communication during public emergencies.

Here are some thoughts:

When people distrust science and intellectuals — especially on social media — it leads to misunderstanding of scientific facts, negative attitudes toward science communication, and reduced sharing of accurate information. This harms public health efforts, particularly during emergencies like the COVID-19 pandemic. To combat this, science communication must become more inclusive, transparent, and focused on real-world benefits, and experts must engage the public as equals, not just as authority figures. 

Editorial finale: Social media "wellness influencers" typically have a financial incentive to sell unproven or even harmful interventions because our current healthcare system is so expensive and so broken. Wellness influencers's power lies in the promise, the hope, and the price, not the outcome of the intervention.

Higher cognitive ability linked to weaker moral foundations in UK adults

Zakharin, M., & Bates, T. C. (2025).

Intelligence, 111, 101930.

https://doi.org/10.1016/j.intell.2025.101930

Abstract

Existing research on the relationship between cognitive ability and moral foundations has yielded contradictory results. While some studies suggest that higher cognitive ability is associated with more enlightened moral intuitions, others indicate it may weaken moral foundations. To address this ambiguity, we conducted two studies (total N = 1320) using the Moral Foundations Questionnaire-2 (MFQ-2) with UK residents. Both Study 1 and Study 2 (preregistered) revealed negative links between cognitive ability and moral foundations. In Study 1, structural models showed negative links between general intelligence (g) and both binding (−0.24) and individualizing (−0.19) foundations. These findings replicated closely in Study 2, with similar coefficients (−0.25 and − 0.18, respectively). Higher verbal ability was specifically associated with lower purity scores. These findings suggest a negative association between cognitive ability and moral foundations, challenging existing theories relating to intelligence and moral intuitions. However, causal direction remains uncertain.

Highlights

• Tested association of intelligence and moral foundations.

• Higher ability linked to lower individualizing and binding.

• Lower Proportionality, Loyalty, Authority, and Purity.

• Lower Equality and Care.

• Verbal ability linked specifically to impurity.

• Replicated in pre-registered large study.

Here are some thoughts:

This research is significant for psychologists as it clarifies the complex relationship between intelligence and moral reasoning. The study found that higher general cognitive ability (g) is negatively associated with all six moral foundations—care, equality, proportionality, loyalty, authority, and purity—suggesting that greater analytical thinking may suppress intuitive moral responses rather than enhance them. This supports what the authors call the Morality Suppression Model , which proposes that higher cognitive ability weakens emotional-moral intuitions rather than reinforcing them. Importantly, the study replicates its findings in two large, independent samples using robust and validated tools like the Moral Foundations Questionnaire-2 (MFQ-2) and the International Cognitive Ability Resource (ICAR), making the results highly credible.

The findings challenge common assumptions that higher intelligence leads to stronger or more "enlightened" moral values. Instead, they show that higher intelligence correlates with a general weakening of moral intuitions across both liberal (individualizing) and conservative (binding) domains. For instance, verbal reasoning was specifically linked to lower endorsement of the purity foundation, suggesting that linguistic sophistication may lead individuals to question traditional norms related to bodily sanctity or self-restraint. These insights contribute to dual-process theories of cognition by showing that reflective thinking can override intuitive moral judgments.

Moreover, the research has implications for understanding ideological differences, as it counters the tendency to view those with opposing moral views as less intelligent. It also informs educational and policy-related efforts aimed at ethical reasoning, particularly in professions requiring high-level decision-making. By demonstrating that the relationship between cognitive ability and moral foundations is consistent across genders and replicated in preregistered studies, this work offers a solid empirical basis for future exploration into how cognitive processes shape moral values.

Could “The Wonder Equation” help us to be more ethical? A personal reflection

Somerville, M. A. (2021).

Ethics & Behavior, 32(3), 226–240.

https://doi.org/10.1080/10508422.2020.1867861

Abstract

This is a personal reflection on what I have learnt as an academic, researching, teaching and participating in the public square in Bioethics for over four decades. I describe a helix metaphor for understanding the evolution of values and the current “culture wars” between “progressive” and “conservative” values adherents, the uncertainty people’s “mixed values packages” engender, and disagreement in prioritizing individual rights and the “common good”. I propose, as a way forward, that individual and collective experiences of “amazement, wonder and awe” have the power to enrich our lives, help us to find meaning and sometimes to bridge the secular/religious divide and experience a shared moral universe. They can change our worldview, our decisions regarding values and ethics, and whether we live our lives mainly as just an individual – a “me” – or also as a member of a larger community – a “We”. I summarize in an equation – “The Wonder Equation” – what is necessary to reduce or resolve some current hostile values conflicts in order to facilitate such a transition. It will require revisiting and reaffirming the traditional values we still need as both individuals and societies and accommodating them with certain contemporary “progressive" values.

Here are some thoughts:

This article is a personal reflection on her decades of work in bioethics and a proposal for a novel approach to navigating contemporary ethical conflicts. Central to her argument is the idea that cultivating experiences of amazement, wonder, and awe (AWA)—especially when paired with healthy skepticism and free from cynicism and nihilism—can lead to deep gratitude and hope, which in turn inspire individuals and communities to act more ethically. She expresses this as a formula: AWA + S – (C + N) → G + H → E, which she calls “The Wonder Equation.” This equation suggests that rather than relying solely on rational analysis or ideological arguments, engaging our emotional and spiritual capacities can help restore a shared sense of moral responsibility.

For psychologists, Somerville’s work holds particular importance. First, it introduces a fresh lens for understanding moral motivation. Drawing on both personal anecdotes and recent empirical research, she argues that emotional states like awe and wonder are not only enriching but are also linked to prosocial behaviors such as compassion, empathy, and a sense of connectedness. This aligns with psychological studies that show how awe can reduce narcissism, increase well-being, and promote community-oriented values. Second, Somerville’s analysis of today’s “culture wars”—and her critique of rigid ideological divisions between “progressive” and conservative values—offers psychologists insight into how clients might experience internal value conflicts in an increasingly polarized world. Her concept of “mixed values packages” underscores the psychological reality that most people hold complex, sometimes contradictory beliefs, which calls for greater tolerance and openness in both therapy and society at large.

A foundation model to predict and capture human cognition

Binz, M., Akata, E., et al. (2025).

Nature.

https://doi.org/10.1038/s41586-025-09215-4

Abstract

Establishing a unified theory of cognition has been an important goal in psychology. A first step towards such a theory is to create a computational model that can predict human behaviour in a wide range of settings. Here we introduce Centaur, a computational model that can predict and simulate human behaviour in any experiment expressible in natural language. We derived Centaur by fine-tuning a state-of-the-art language model on a large-scale dataset called Psych-101. Psych-101 has an unprecedented scale, covering trial-by-trial data from more than 60,000 participants performing in excess of 10,000,000 choices in 160 experiments. Centaur not only captures the behaviour of held-out participants better than existing cognitive models, but it also generalizes to previously unseen cover stories, structural task modifications and entirely new domains. Furthermore, the model’s internal representations become more aligned with human neural activity after fine-tuning. Taken together, our results demonstrate that it is possible to discover computational models that capture human behaviour across a wide range of domains. We believe that such models provide tremendous potential for guiding the development of cognitive theories, and we present a case study to demonstrate this.

The article is here.

Here are some thoughts:

This article is important because it introduces Centaur, a novel computational model that represents a major step toward a unified theory of cognition. By fine-tuning a large language model on a vast dataset of human behavior, the researchers created a model with superior predictive power that can generalize across different cognitive domains. This model not only outperforms existing, specialized cognitive models but also demonstrates an alignment with human neural activity, suggesting it captures fundamental principles of human thought. Ultimately, the paper proposes that Centaur can serve as a powerful tool for scientific discovery, guiding the development and refinement of new psychological theories.

To assess or not to assess: Ethical issues in online assessments

Salimuddin, S., Beshai, S., & Loutzenhiser, L. (2025).

Canadian Psychology / Psychologie canadienne.

Advance online publication.

https://doi.org/10.1037/cap0000423

Abstract

There has been a proliferation of psychological services offered via the internet in the past 5 years, with the COVID-19 pandemic playing a large role in the shift from in-person to online services. While researchers have identified ethical issues related to online psychotherapy, little attention has been paid to the ethical issues surrounding online psychological assessments. In this article, we discuss challenges and ethical considerations unique to online psychological assessments and underscore the need for targeted discussions related to this service. We address key ethical issues including informed consent, privacy and confidentiality, competency, and maximizing benefit and minimizing harm, followed by a discussion of ethical issues specific to behavioural observations and standardized testing in online assessments. Additionally, we propose several recommendations, such as integrating dedicated training for online assessments into graduate programmes and expanding the research on cross-modality reliability and validity. These recommendations are closely aligned with principles, standards, and guidelines from the Canadian Code of Ethics for Psychologists, the Canadian Psychological Association Guidelines on Telepsychology, and the Interim Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media.

Impact Statement

This article provides Canadian psychologists with guidance on the ethical issues to consider when contemplating the remote online administration of psychological assessments. Relevant sources, such as the Canadian Code of Ethics for Psychologists, are used in discussing ethical issues arising in online assessments. 

Here are some thoughts:

The core message is that while online assessments offer significant benefits, especially in terms of accessibility for rural, remote, or underserved populations, they come with a complex array of unique ethical challenges that cannot be ignored. Simply because a service can be delivered online does not mean it should be, without a thorough evaluation of the risks and benefits.

Embrace the potential of online assessments to increase access, but do so responsibly. Prioritize ethical rigor, client well-being, and scientific validity over convenience. The decision to assess online should never be taken lightly and must be grounded in competence, transparency, and a careful weighing of potential harms and benefits.