The Person-Centred Approach: Process- and Outcome-Oriented Perspectives

It’s felt a pretty bruising time in the UK person-centred community of late. Recent articles in the journal Person-Centered and Experiential Psychotherapies have critiqued our pluralistic work for being ‘erroneous and logically fallacious’ (Murphy et al., 2025); for attempting to ‘control the narrative’ (Moore, 2025); and the pluralistic framework for person-centred therapy as ‘reductionist’, ‘unnecessary and incompatible’ with the person-centred approach (Ong et al., 2019). Meanwhile, the relational depth-informed approach to therapy that we’ve tried to articulate has been described as ‘authoritarian, inconsiderate, and inconsistent’ (Sommerbeck et al., 2025); and ‘repetitive and incompatible’ with the person-centred approach (Jain & Joseph, 2024).

It hasn’t felt good, and the temptation to hit back with carefully curated academic argument has felt intense. What I keep coming back to, however, is a yearning to find a different way of responding, one which doesn’t feel like a toxically male locking of antlers: ego, ‘winning’, and the avoidance of shame. I know, for myself, how compelling that is, and how ultimately destructive it ends up being (even if it feels relieving at the time). So how do we, I, find genuinely constructive ways forward, ones that acknowledge and prize both sides? After all, if we can’t do that, if we can’t—within a person-centred, empathic, relationally-oriented community—find ways of talking to others and respecting differences across positions and perspectives, what does that say about the potential for peace, and our potential to contribute towards it in a conflict-riven world?

Is there a way, then, that we can all be right: where we’re all intelligent individuals doing our best, where all our perspectives can be of value? For me, one way into that is to try and understand more deeply the differences between the perspectives: to dig into the nuances, complexities, and actualities of what others—and, indeed, ourselves—are trying to say. It’s so easy to mischaracterise the other, oversimplify, and to project. I’m sure that’s something that I’ve done at times and I can see how unhelpful it’s been.

So I want to suggest that, perhaps, one way of understanding some differences between pluralistic and more classical takes on the person-centred approach is by contrasting, respectively, a process-oriented understanding of what it means to be person-centred with an outcome-oriented one. Of course, these distinctions aren’t either/or, and people’s understandings can have elements of both. But I think they represent two somewhat different readings of Rogers and the meaning of his work for therapy.

An outcome-oriented understanding says, ‘This is what a person-centred approach to therapy is…’ It’s Rogers’s work as product, as a formal theory of how to do therapy. For instance, it’s therapy as based on the six conditions that Rogers hypothesised as necessary and sufficient for therapeutic personality change—the most popular definition that emerged in a recent online poll of the PCA community. So, here, being person-centred is about engaging with the client in an empathic, accepting, and genuine way: it’s about listening, receiving, engaging—relating at depth with the client in a nuanced and reflective manner; it’s about going up to particular levels of ‘interventiveness’, but not beyond. This outcome-based understanding doesn’t mean that the therapist, themselves, is fixed or rigid or not adapting to the client, or not growing and evolving as a human being, but it’s about person-centred therapy being a particular thing. There’s an emphasis here on boundaries and their policing: on ensuring a non-dilution or non-contamination of the approach. And it’s a way of thinking about the PCA which can be really important to ensure the coherence of PCA as a practice—particularly, for instance, when trainees are developing as practitioners. There has to be some boundaries to the approach, some clarity about the thing itself: what PCA actually is.

Note, although an outcome-oriented approach strive to define and police the boundaries of person-centred practice, there is not one unified definition of what PCA is. In fact, there are probably numerous—and, at times, conflicting—definition of what PCA practice means. As with Wittgenstein’s ‘language games’, PCA, as outcome, is probably best considered a ‘family’ of related and overlapping understandings, with homogeneity more assumed than actually achieved.

A process-oriented understanding takes something different from Rogers. Here, the emphasis in on the PCA and the PCA community as something that is growing, evolving, and developing—in line with Rogers’s view of what it means to be fully functioning. Rogers writes, for instance, that in the fully-functioning person:

defensiveness or rigidity, tends to be replaced by an increasing openness to experience. The individual becomes more openly aware of his own feelings and attitudes as they exist in him at an organic level…. He is able to take in the evidence in a new situation, as it is, rather than distorting it to fit a pattern which he already holds…. It means that his beliefs are not rigid, that he can tolerate ambiguity. He can receive much conflicting evidence without forcing closure upon the situation. (Rogers, 1961, pp.115-6)

So, from a process-based standpoint, this is an openness to the PCA as something that is learning, changing, and evolving; that it is always striving to develop its edges and go beyond black-and-white thinking; that is ultimately unknown, plural, and heterogenous. And, from this standpoint, there’s also an emphasis on members of the PCA community relating to each other with care, valuing, and respect—to not demonise either those inside of, or out of, the person-centred field. There’s also a drawing on Rogers’s emphasis on evidence—along with experience and self-reflection. A process-oriented understanding strives to draw on research findings even if that’s emotionally hard to do and challenging our own beliefs and wants. Rogers talks about this in his own research journey: ‘in our early investigations I can well remember the anxiety of waiting to see how the findings came out. Suppose our hypotheses were dis-proved! Suppose we were mistaken in our views! Suppose our opinions were not justified!’ However, he goes on to write:

At such times, as I look back, it seems to me that I disregarded the facts as potential enemies, as possible bearers of disaster. I have perhaps been slow in coming to realize that the facts are always friendly. Every bit of evidence one can acquire, in any area, leads one that much closer to what is true. And being closer to the truth can never be a harmful or dangerous or unsatisfying thing. So while I still hate to readjust my thinking, still hate to give up old ways of perceiving and conceptualizing, yet at some deeper level I have, to a considerable degree, come to realize that these painful reorganizations are what is known as learning, and that though painful they always lead to a more satisfying because somewhat more accurate way of seeing life. (1961, p. 24)

Graphics by https://xabierlopez.co.uk

Great. But what happens when those adjustments and reconceptualizations mean moving beyond the original stipulation of PCA practice? What happens when, for instance, the evidence no longer supports the theory that six core conditions are necessary and sufficient for therapeutic personality change (see blog here). From an outcome-oriented standpoint, the emphasis needs to be on the coherence of the PCA, so if the research says there’s a problem, it’s the research that must be wrong. Evidence can be discounted, minimised, ignored: there’s a multitude of ways in which any research finding can be explained away so that coherence of the approach can be maintained. From a process-oriented standpoint, on the other hand, the evidence comes first, even if it means updating and revising one’s approach. But the question is, what then remains, and is it still ‘person-centred’? From an outcome-oriented perspective, there has to be clear boundaries, and if you’re starting to reject the central tenets, then it’s time to call what you do something else.

I imagine that where we stand on these dimensions has a lot to do with how we came into the PCA and Rogers’s work. For myself, for instance, it was through reading Rogers’s On Becoming a Person as a student, and I think I have always seen this description of the fluidity and openness of being as the essence of what it means to be person-centred. By contrast, I had just a one year certificate training in person-centred therapy before four years training as an existential psychotherapist, and only after that came back to the person-centred community. So, in contrast to many others, I had much less formal induction into person-centred therapy as trained and practiced in the UK.

So I have that alliance to a more process-oriented understanding of Rogers, as I’m calling it, but I really want to argue (and push myself to argue) that both perspectives are of value. An outcome-oriented understanding keeps a coherence at points in time. A process-oriented understanding evolves and moves through time. Both grow from Rogers’s own thinking, but they are not always aligned. Chris Molyneux, in his comments on this blog (see below), uses the metaphor of a Victorian house to describe the PCA. For me, that’s a perfect description of how the PCA is seen from an outcome-oriented standpoint: something solid, constant, relatively unchanging. And, as he puts it, if you renovate that into something different, then you can’t still claim that it’s the PCA. But from a process-oriented standpoint, a more appropriate metaphor for the PCA might be a tree, or some other kind of organism, that grows, develops, evolves. Here, multiple branches can evolve from the same roots, with none more determinedly the original tree than the others. Is the PCA more like a house or a tree? Again, at least from a process-oriented standpoint, there is no right or wrong here: both perspectives can be true; both have their strengths and their limitations.

From an outcome-oriented standpoint, there’s something that can be deeply undermining about a process-oriented approach. ‘I’m trying to do therapy here… and you’re questioning and challenging and undermining and constantly threatening to shake up the foundations on which our approach is based on. You’re confusing things in unhelpful ways.’ I think that’s how, from a more classical standpoint, a pluralistic PCA can be seen: that it’s moved beyond the fundamental principles of person-centredness and it’s now threatening to drag others with it. It needs to be expunged.

And from a process-oriented understanding, there’s something that can be seen as rigid and inflexible in a more outcome-oriented understanding of PCA. There’s a frustration, a fixidity… ‘Why aren’t you open to learning and developing and growing in an infinite, unpredictable variety of ways?’ And that calling can be very frustrating to those who are just trying to get on with their practice: who want something solid on which to define their work, and who don’t want to be redefining and reorganising their sense of therapist identity. Moreover, perhaps that urgency to grow and evolve can lead to a tendency to over-perceive, or over-emphasise, rigidity in those with a more settled PCA-ness. Settled doesn’t mean rigid—but from a labile, process-oriented standpoint, it can seem that way. Paradoxically, then, an approach which strives to overcome polarisation and over-characterisations can end up recreating it—something I know that I have been accused of. And, indeed, dichotomising, as here, between ‘process-’ and ‘outcome-oriented’ understandings of PCA can be seen as one further instance of that mischaracterisation. But then, without trying to articulate differences—even if they are only initial approximations—how does one grow and develop and reconceptualise new thinking? From a process-oriented standpoint, that’s the prime person-centred directive.

From a process-oriented standpoint—where how we relate and engage with each other is part of what it means to be person-centred—there’s a striving (albeit, inevitably, also a failing) to try and engage with difference in respectful and valuing ways: A starting point of seeing the other as an actualising, prosocial being, doing their best; and respecting that there may be multiple truths. I guess that is what I am trying to do here. As we move away from a process-oriented understanding, however, that emphasis becomes less important. So, for instance, at times when I’ve challenged by what’s felt like very critical, judgmental language on person-centred social media sites, the response has been that empathy and acceptance is what we do with clients—it’s not relevant outside of that context. Similarly, for me, referring to other members of the community as ‘illogical’ or ‘fallacious’ just doesn’t seem the spirit of PCA, but that’s because I’m reading PCA as a process and a way of relating, rather than as a territory that needs protection. From a process-oriented standpoint, then, dialogue within the person-centred community should, itself, be person-centred, meaning:

• Self-reflexivity: Recognising that one speaks from a situated perspective rather than absolute truth, and taking ownership of that position.

• Contextual awareness: Acknowledging the cultural, social, and political contexts shaping one’s views, including associated power, privilege, and disadvantage.

• Openness to strengths and limits: Appreciating both the value and the limitations of one’s own standpoint.

• Emotional and relational awareness: Being willing to explore the emotional, interpersonal, and group dynamics connected to one’s views, alongside logical and empirical considerations.

• Empathic acceptance of others: Striving to understand and value the other’s perspective as a meaningful expression of their experience and actualising tendency, while remaining able to sensitively challenge limitations.

• Respect for experiential authority: Recognising the other as the expert on their own experience and avoiding assumptions about their motives, especially negative ones.

• Openness to revision: Willingness to reconsider and adapt one’s views when limitations or errors become apparent.

• Client-centred: Oriented to what may be best for clients (drawing on, for instance, research evidence, personal experience, and a recognition of client diversity) rather than oriented to the needs and wants (conscious or unconscious) of therapists.

• Authenticity and transparency: Seeking to communicate honestly and congruently while acknowledging the subjectivity of one’s perceptions.

• Collaborative engagement: Seeking both common ground and respectful exploration of differences.

• Valuing diversity and minority perspectives: Respecting difference and recognising that validity is not determined by majority agreement.

• Plurality of ways of knowing: Remaining open to insight from personal experience, theory, logic, and empirical evidence.

• Commitment to ongoing dialogue: Understanding dialogue as an open-ended, evolving process that embraces nuance, complexity, and growth.

Just to reiterate, I know, on the basis of such principles, I have frequently failed. These are also by no means definitive. From a process-oriented standpoint, though, it makes sense to sketch out some principles by which we can maintain person-centredness with each other in our intra-community dialogues.

From an outcome-oriented PCA, there’s a right and a wrong and, I’m sure, those from such a perspective will see the blog here as illogical, unnecessary, and counterproductive—just one more attempt to undermine the truth of PCA. From a process-oriented standpoint, however, there has to be an attempt to hold both sides of the argument: to strive to empathise with disagreement and difference and try to come to a place that synthesises knowledge and wisdom from across the person-centred field. I know, for myself, I often fail at that, but for a process-oriented understanding of PCA to have any meaning, it has to be open to something other than what it is.

In some ways, I guess one could say that a process-oriented understanding is about being person-centred as a person-centred therapist, it’s a meta- perspective, while an outcome-oriented understanding is about doing person-centred therapy as a specific form of practice. And both of these are necessary, just as there is an essential dialectic between Buber’s I-Thou and I-It stances, respectively.

Both process- and outcome-oriented perspectives strive to put the client at the heart of their approach, and both emphasise the importance of tailoring the therapy to the particular client. A process-oriented approach, however, probably allows for a broader possible range of methods and styles of therapy, emphasising flexibility and openness of what it means to be PCA. However, in-the-room, many of those who frame PCA in an outcome-oriented sense would also emphasise the pluralistic nature of the approach. Where PCA, however, is defined, outcome-wise, more in terms of an empathic unfolding response process, so the range of methods is likely to become narrower.

Is there the possibility, then, of finding some kind of meeting or synergy between these two positions? Can we develop a coherent approach that also has the potential to grow and embody its own principles of openness and respect to difference?

For me, personally, I think one big thing is letting go of Rogers’s six conditions are the core of PCA. These are a brilliant set of conjectures, and they give a compelling, often very accurate narrative of how change happens; but as a universal truism, they feel to me just so outdated, so far behind the latest therapy evidence: about relationship factors, therapist factors, technique factors, and personalisation. Yes, we can redefine the core conditions, to the point where empathy means bringing in to the therapeutic work any kind of intervention that we deem helpful at that time (in a non-authoritarian way), but then the principles of person-centred practice become so diffuse, so unspecified, that it is hard to tell any more what person-centred therapy is. For me, putting ‘nondirectivity’ at the heart of person-centred practice—defined, for instance, by Susan Stephen as, ‘an attitude held by the therapist from which they trust and relate to their client as a person with agency, autonomy and the capacity to grow in response to their own unique experience in the world’—would allow the person-centred approach so much more space to grow. Or, for instance, orienting it around Margaret Warner’s levels of interventiveness and the limits to that, as Murphy et al. (2025) suggest.

For me, emotion-focused therapy and motivational interviewing are also great examples of expressions of person-centred therapy which have both form and trajectory. Based on person-centred principles of empathy and prizing, they’ve grown in steady and measured ways through clinical experience, expertise, and robust research. They are, perhaps, two of the most clearly specified of person-centred practices, with clear guidelines on what is both prescribed and proscribed, but they are also constantly evolving organisms: learning, extending, striving to move steadily closer to what is of most help to clients.

Of course I’m going to say this, but I also think that a pluralistic approach to person-centred therapy is a good synergy. What does that actually mean? Nicola Blunden has described it very well in the latest Tribes book and, for me, it’s about basing a practice around the ‘core conditions’—with empathic reflections, prizing, and relational depth—but also being open to, and accommodative of, other skills and competences (that the therapist is qualified in), as identified and developed in collaboration with the client. Sometimes, then, that means the therapist leading, and bringing in new methods and techniques, with a real tailoring around the individual needs and wants of the particular client. It’s an open, adaptable, integrative practice of PCA: fluidly moving with the client in a collaborative and transparent way.

Here, one of the most common criticisms is, ‘Yes, exactly, but that’s what person-centred therapists already do’, and I am sure that is true to some extent. In that, then, we all seem to be on the same page, and whether you call it ‘pluralistic person-centred therapy’ or just ‘person-centred therapy’ it really doesn’t matter. But I also would challenge the assertion that such flexibility and personalisation is inherent to all person-centred practice. Empirically, for instance, we found that around one-third of young people wanted more input from person-centred therapy, with a similar proportion finding the silences awkward. Clearly here, it seems to me, some clients are experiencing person-centred therapy as inadequately active. Or take the finding that experienced supervisors, themselves, rated person-centred therapy as having lower levels of therapist directiveness than Gestalt, integrative, or transactional analysis approaches (see here). If the person-centred approach is, inherently, as active and as integrative as other orientations, this really needs some empirical demonstration.

Furthermore, if such active collaboration really is what the PCA is already about, then let’s explain it, and describe it, and elaborate on what we’re talking about. Let’s put it in our competences and adherence measures, where it’s currently almost entirely absent (see, for instance, here). And, research-wise, there are so many questions to answer. For instance, what is the place of psychoeducation in person-centred therapy, and what are the subtleties, the nuances, the border conditions where, perhaps, a certain introduction of psychoeducation isn’t person-centred but another way of introducing it is? If it’s person-centred, for instance, to ‘bring ideas, interpretations, suggestions or the like’ from the therapist’s frame of reference, ‘in a way that the client could easily use them in the therapy process or let them go,’ that sounds great, but how do we know that, do that, judge that? How can we develop those skills and practices, that ability to ensure clients really do feel able to let them go (bearing in mind, for instance, deference effects)? Is it mis-characterising the PCA to say that this isn’t all, already, sorted? From a process-oriented standpoint, there is always more to learn and improve on. Empirically, for instance, we found that around one-third of young people wanted more input from their person-centred practising school counsellor, with a similar proportion finding the silences awkward. And then there’s the findings of the PRaCTICED trial—that’s the kind of thing that keeps me up at night, feeling that we have to evolve. From an outcome-oriented perspective, citing such research is further attempts to undermine the coherence of the PCA. From a process-oriented perspective, they’re challenges that we need to open ourselves up to.

And also, what are then the boundaries between PCA and other approaches? For instance, if we take Susan Stephen’s definition of nondirectivity, then are we saying that other approaches don’t ‘trust and relate to their client as a person with agency, autonomy and the capacity to grow in response to their own unique experience in the world’? Is that where other approaches end and PCA begins? For me, while I like the potential in that definition, I think it needs much more nuancing, reflection, and research to really be able to bring out the unique potential of PCA. My suspicion is, with the emergence of the pluralistic approach as well as, I am sure, many other factors, the definition of PCA has been really thrown into flux in recent years. Those from an outcome-oriented standpoint defend its coherence, but what is it, specifically, they are defending (above and beyond their own, intuitive ‘knowing’ of what the PCA is)? With an outcome oriented approach there is a risk that a lot of the intrinsic process, the growth and flux and change, gets covered over.

One of the comments I’ve had from colleagues in the person-centred community, like Chris Molyneux, is, ‘I don’t have a problem with pluralism, just don’t try and pass it off as person-centred—go do your own thing.’ On the one hand, I can see what Chris is trying to say: from a classical, UK outcome-oriented PCA, the prospect of pluralism can seem very alien (although, as above, there is also the somewhat contradictory critique that pluralism is unnecessary as it’s what PCA therapists do already). But I guess, in my heart, I fear that an exclusively outcome-oriented reading of Rogers, without any of the process-oriented understanding, loses so much of what Rogers was saying (as I understand it). And I really worry for the future of the PCA if it doesn’t engage with the critiques or the research and evolving in a process-oriented way. Yes, Victorian houses are beautiful, but they can also have leaky plumbing, creaking walls, and terrible insulation: some renovation and updating isn’t the end of the world. And, perhaps to stretch the metaphor further, not everyone can afford a Victorian house: if we want PCA to be available to all, we maybe need to think about how it might be tailored, adapted, and promoted to optimise accessibility. Again, I guess my concern is that colleagues like Chris, with the best of intentions, will take the PCA into a cul-de-sac from which it will never re-emerge.

Many of us love the person-centred approach, we love Rogers’s work, and we love it and identify with it in different ways. Of course, from a process-oriented person-centred standpoint I am going to say, ‘let’s embrace that difference’, but I also want to fight (with myself) to recognise that clearly circumscribed, well-boundaried practices are important too. Stability and change, definition and porousness, openness and firmness, doing and being, ‘it’ and ‘Thou’, all have their place. The challenge is finding a way of bringing them together, and bringing them together when that very act, itself, reflects only one half of the dialectic. It’s a conundrum, but one I hope we can find ways forward on over the coming years.

Acknowledgement

Photo by Ahmad Odeh on Unsplash. Thanks to Xabi at https://xabierlopez.co.uk/about-me/ for the graphic image.

Preferences in Person-Centred Therapy: Should We Ask Clients What They Want?

From a person-centred standpoint, should we be asking clients about their preferences for therapy: for instance, the concerns they’d like to talk about, the style of therapy they want from us, the goals they’re keen to work towards?

It’s a complex question, but an important practical one, and it highlights some of the areas of constructive difference between a pluralistic and a more classical approach to person-centred therapy.

Let’s start with areas of agreement. First, if a client expresses a preference, therapists of any person-centred persuasion (indeed, therapists of most persuasions) are likely to try their best to accommodate it. Second, across both these perspectives, therapists are likely to only offer options that they, themselves, can accommodate. That is, for instance, no one is going to be asking a client if they want EMDR or psychoeducation on sleep hygiene if they, themselves, don’t have those skills and competences. Knowing what we can actually offer—being authentic—is the first step in any preference work.

Where things start to differ, though, is around the question of whether therapists should broach the issue of preferences: that is, proactively asking a client what they might want. Is it appropriate, for instance, for a therapist to ask, ‘What would you like to explore today?’ at the start of a session, or to say to a client, ‘We could explore your feelings to your mother through talking about them, or having a go at expressing them out loud, what would you prefer?’

From a classical standpoint, things emerge naturally, and there is no need to rush the process. Indeed, if we start to probe and ask clients what they want, we may get responses from their conscious, presentational self, rather than from the deeper, and potentially more hidden, elements of their organismic wants and needs. The figure below provides a very simple model of person-centred theory. Here we have the person’s/organism’s actual experiencing, areas A + B, of which B is what they experience and can acknowledge, and A is what they experience but can’t acknowledge. And then we have area C, which are the things that the person thinks they experience, but actually doesn’t. So, for instance, a client thinks that they want CBT techniques because they’ve heard from their friends or social media CBT really works. But maybe, for them, those CBT techniques would actually be really frustrating, or unhelpful. This puts the desire for CBT techniques in area C and, if a therapist then asks the client their preferences—particularly towards the start of therapy—they may end up with responses that bear no reality to what a client actually wants or needs (areas A and B). From this standpoint, what’s essential is to give the organismic experiencing, the growth process time: when clients are ready to ask for what they want, it will emerge—naturally, organically. And no therapist direction is needed: because if the therapist starts to suggest X, or Y, or Z as possibility, it’s going to take the client even further away from their actual organismic wants and needs towards something that, for instance, is there just to please, or conform to, the therapist.

Person-Centred Model of Organismic Experiencing and Self-Concept

That all makes eminent sense but, for me, there’s also challenges with it. First, and perhaps most importantly, from a contemporary postmodern perspective (i.e., that everything is socially constructed) the assumption that there is some ‘neutral’ way of doing therapy would be seen as something of a myth. That is, whether the therapists asks the client their preferences or not, the therapist is still always doing something, still responding in some way, and what they are doing may or may not match what the client’s actual preferences are. Typically, for instance, a person-centred therapist will be engaging in an empathic, accepting, and congruent way. Great… but that is doing (or being) something, it’s engaging in a particular manner, and that may or may not align to what the client is looking for. So if you proactively ask clients their preferences, there’s the potential for preference mismatch, but if you don’t ask there’s also potential for preference mismatch: not asking is not going to just mean that everything is automatically aligned.

As a counterargument, one might suggest that what all clients want and need, most deeply, is an empathic, accepting, and congruent relationship. However, that becomes even more problematic, because then the therapist is saying that they know, most fundamentally, what the client wants and needs, even if the client does not know that themselves. So the therapist, here, is effectively adopting an expert position in a way that threatens to fundamentally undermine the client’s autonomy and sense of self-control: ‘I don’t need to ask my clients their preferences because, ultimately, I know what they need better than they do themselves.’ Again, the point here, from a pluralistic standpoint, is the ‘meta’ one: that a therapist of any orientation, person-centred or otherwise, always holds a position, always has some stance. And once you recognise that, the issue is not whether or not the therapist imposes a choice on the client, but whether or not the client has some choice in relation to the therapist’s pre-decided way of being. If not, if no choice is offered, then that’s less simply allowing the client’s organismic tendencies to emerge; and more ‘imposing’ on the client, in an unreflective way, the therapist’s own choices about what’s right in therapy.

This issue, perhaps, becomes more acute in an era when therapy is often time-limited. With infinite time, the client’s own inner actualising tendency can, perhaps, fully unfurl. There is no need to introduce choices, because the client will come to them naturally themselves. But what if a client has only six sessions, or 12? Then, there are fundamental limits on what is possible, and a therapist’s choice to be one particular way is likely to mean that a client won’t have choices for something else. Again, it comes back to the point that there is no neutrality: if you offer a client, for instance, some relaxation techniques, that is influencing them in some particular way. But, over the course of 12 weeks, if you don’t offer relaxation techniques, that is also influencing in some way—albeit through absence rather than presence.

As a counterposition to this, it could be argued that if a preference didn’t come from the client’s ‘inside’, maybe it wasn’t meant to be. Here, I think classical and pluralistic approaches also tend to have different views of where wisdom is ‘located’: individually, or in the client’s relational field. From a classical standpoint, everything that needs to be known is there, within the client, so why bring in anything, any options, from outside? But if wisdom is relational, then there may be things that the client doesn’t know that may be of genuine healing to them. Here, therapists have the potential to offer options that may be meaningful and valuable, above and beyond what is already in the client’s organismic potential.

Another counterposition from a more classical standpoint: therapists don’t need to ask, explicitly, about clients’ preferences because if they are meeting the client deeply, then they will intuitively sense what it is the client wants and needs. Again, I think there’s a lot of truth in this supposition: through a deep embodied empathy, it is remarkable what can be sensed and intuited in clients. And research, for instance, on mirror neurons shows robust neurocognitive grounds for such processes. And yet, from the psychotherapy research, we also know that therapists’ and clients’ experiences of the therapeutic process, within the same dyad, can be markedly different. For instance, in our own research on relational depth, we found times when therapists (person-centred) experienced a depth of connection with their clients that was very mismatched to the clients’ own experiencing. Overall, the level of matching was actually quite high, but that certainly wasn’t always the case, and this was as much in experienced therapists as trainees. As therapists, then, while we can learn much of what clients want and need from trusting our own intuitive sense of it, from a pluralistic perspective we should never rely on only one source of ‘truth’. Explicit, as well as implicit, conversation would be indicated to develop a more triangulated understanding of what the client wants and needs.

In terms of finding ways forward beyond this dilemma, some thoughts come to mind.

First, being upfront with clients about the way we work is a means of practising from a particular standpoint while minimising the extent to which this might be an imposition on clients. If, for instance, we describe to clients what we do from our classical standpoint—how it’s a space for clients with empathy and acceptance, where they can grow at their own pace, where we won’t be introducing or enquiring into preferences—then it gives clients more power to either choose it or choose against it and look elsewhere. Yes, as a therapist we are still holding a position, but it is a position that is explicit, that clients can see as our position, rather than a truth, and in that sense we’re minimising our power over.

Second, might be the importance of recognising that clients can really vary in how much they want therapists to introduce and ask about different options, and individualising in this way can capture the value of both classical and more pluralistic approaches. From an initial dialogue, for instance, it might become evident that clients really want space in therapy to grow at their own pace without much involvement from the therapist, or it might become clear that they would really appreciate the therapist’s regular check-ins on where they want to go. Of course, the problem here is that to find this out may require initial questions about the client preferences (about preferences), which then gets us back to the issue of whether we should be asking clients what they want or not in the first place. If we believe that wants and needs should be allowed to emerge at their own pace then, by definition, we’re not going to be asking clients what their wants and needs are for that process.

Third, research might be helpful here, asking clients what works for them in terms of these kind of preference discussions. We did a qualitative study of this type and got some interesting initial findings: seeing the range of different responses to preference work, and how it could be experienced as both helpful and not. Again, though, such research could be critiqued on the grounds that participants’ responses are going to come from their self-concept rather than their organismic experiencing (area C), and in that sense not to be trusted. If a client is saying that they valued expressing their preferences, for instance, is that because they want to be liked, or feel obliged to comply with the researcher?

Whatever positive way forward we find here, it’s likely to be in the nuances and complexities, and away from black and white generalisations. It’s true, for sure, that clients can express preferences that don’t genuinely match what they want or what helps them, but it’s also not true to say that that is always the case. Clients can know, and articulate, preferences that are of deep meaning to them, and they can also experience the process of being asked about preferences as deeply empowering. But some can find it disempowering, or even shaming if they don’t know what they want. And, most likely, preference work is not a binary thing (either we do it or not). Also, there may well be a plethora of times in our work when we are, explicitly or not, inviting clients to express and follow preferences. A simple reflection, for instance, like ‘It sounds like you were really hurt by what your mother said,’ may invite a client to consider whether they want to talk more about that hurt or not. The differences across person-centred approaches, then, are likely to be in emphases, in subtleties, in touches of more or lesser ways of explicating. For me, personally, I think it is a willingness to sit with the wholeness of that complexity, and to ask and explore these complex questions, that expresses the essence of what being person-centred means.

Acknowledgements

Photo by Sophia Kunkel on Unsplash

Note

This is something for a future blog but, in many ways, I think the Figure above (with the two circles) can help us make sense of some of the core tensions between classical and more pluralistic approaches to person-centred therapy. A classical approach puts emphasis on A and B, what is organismically there. It trusts that this will emerge, and wants to support the wholeness and authenticity of the individual coming into being. But the problem is, in doing that, it may mean not fully ‘trusting’ what is presented by the client in B (and C): it means looking, potentially, ‘past’ the person in the room with you, and thereby becoming the expert in the room, who knows what the client wants and needs beyond that client’s own understanding. By contrast, a pluralistic perspective tends to emphasise more trust in the client as they are in the room in the here-and-now: the person in front of you. So it’s not about trying to look at who they ‘really’ are, what’s ‘behind’ them, but a respect and valuing for the person then and there, and a trust in their choices and preferences, as they are now. Problem there, though, is that can then over-emphasise the conscious at the expense of what is not stated or known by the client. These aren’t, of course either/or alternatives: ideally we trust both aspects of the client—actuality and potentiality—but there’s inevitably going to be times when these trusts are pulling in different directions: like, for instance, whether we think it is of value to ask the client, in the here-and-now what it is they’re wanting from the therapeutic process. So when we talk about trust in the client’s autonomy, what do we actually mean by the client? Do we mean the person presenting in the room, or do we mean the person they can be? And we might say, ‘Well, obviously, all of this,’ but then what if these ‘parts’ are pulling in different directions? These are, again, complex questions, with no easy answers, but through respectful in-depth dialogue across positions we may, perhaps, be able to move forward to deeper understandings.

'Fantastically Boring and Completely Meaningless'... Should Person-Centred Therapists Care About Research Evidence?

I suspect Leigh Manning was not the only person-centred therapist to find our recent research on relational depth and outcomes ‘fantastically boring and completely meaningless’ when I posted our recent paper on social media earlier this month. ‘Rather than discovering something new, studies like this are in fact tiresome efforts to cling ever more rigidly to a pet theory or approach,’ wrote Leigh, ‘I could go on, but what’s the point?’ (15/9/2025, quoted with permission).

There’s things here that I agree with Leigh on, and this blog is not a personal critique of Leigh, but a counter to his position because I think he’s expressing—very eloquently—a view that, at some level, is shared in the person-centred field and beyond. Just to add, Leigh and I have been having an interesting and, I think, affable, backchannel conversation as this blog has been developing, and he specifically asked to be named, personally, in this blog, when I asked his consent to cite him: ‘Don’t feel any pressure to hold back.’ You can read Leigh’s response to the blog in the comments below. Previous reflections of mine on the role of research in person-centred therapy can be found here.

So to start with areas of agreement, I think Leigh is absolutely right that ‘allegiance effects’ are pervasive throughout the psychotherapy research field, with researchers (including, I’m sure, myself at times) setting out to prove what they believe to be true, and interpreting findings in ways that tend to support their a priori beliefs. From a person-centred standpoint, too, research evidence (particularly number-based) can reduce complex lived experiences to de-individualised ‘results’, devoid of any real human content. ‘No research comes close to encapsulating what therapy is about,’ Leigh goes on to write. He states:

Even I have no idea what it [therapy] is about what I do, how I do it, when I do it, that helps people as it seems to. These days, thankfully, I do not feel the need to know. Instead, I listen very closely to my clients, I observe what occurs to me in the moment and we go from there. We stumble around, we stall, things get clunky, but ultimately, if things go well, change occurs. Each therapy session is an encounter that is unmeasurable, unquantifiable, and irreplicable. It occurs between two (or more) enormously complex people. The only people who have any hope of knowing how this works are themselves immersed in the encounter. This to me is what makes therapy beautiful – the mystery of it. The evidence-based brigade try, unnecessarily and in vain, to find patterns in clouds.

I think that’s put beautifully, and I love the relational and holistic sentiments, but I also fundamentally disagree with Leigh on the value of research findings to person-centred therapists: indeed, to counsellors and psychotherapists of any orientation.

Admittedly, I might have a bit of a bias here, having spent the last year or so sweating blood and tears over the new edition of my Facts are Friendly book. I’ve also had a career as a researcher as well as a practitioner, so the chances of agreeing that research is ‘fantastically boring and completely meaningless’ is slim. Indeed, the truth is that it hurt, at a personal level, to read Leigh’s initial response. But I also think that, for the person-centred field, and from a person-centred perspectives, it’s essential that we don’t dismiss research evidence.

A Part of the Whole

That’s not to say that I think research gives us all the answers. Far from it. But it’s a false dichotomy to conclude that, because it doesn’t give us all the answers, it therefore doesn’t give us any answers. For me, there are multiple sources of knowledge from which to gain guidance on how to practice most helpfully. Leigh says that the only people who know what’s going on in the encounter are those immersed in it. I don’t agree. I am sure they have a particular, and perhaps privileged vantage point, but there are also an immense amount of other perspectives from which to view—and gain knowledge about—this interaction. Sociologists, for instance, would have one particular view (say in terms of the particular discourses being used), or neurobiologists (on the biochemical processes involved), or ethicists (in terms of the standards of behaviour to each other). And then there’s the evidence from psychotherapy researchers who might note, for instance, that the clients’ experiencing of empathy from the therapist is predictive of good outcomes; or that the therapist’s use of exposure techniques might cause discomfort to the client in the short term, but tends to leads to sustained long-term benefits. That’s not the answer, but why is that, one source of knowledge ‘completely meaningless’ ? I think it’s always tempting to adopt all-or-nothing positions, but my reading of Rogers’s understanding of full functioning is that we move towards appreciating the complexity of the world and the multiplicity of positions from which we can know and understand the world.

What do Clients Really Experience?

I guess, in response, you could say that Rogers does advocate that the only reality is subjective: as Leigh says, its the people who know, in their experiencing, what is ultimately going on. But we fall into an interesting paradox here, when we consider therapist and client perspectives, because how does the therapist know what the client is experiencing? If we take the client’s experiencing as the most important indicator of what the therapy is like and how helpful it is, then the therapist is never going to truly know it (as Rogers says), they can only come to an approximate understanding of it. And on what are they going to make that assessment?

Is it in the interaction: That by being deeply involved in the complex, entangled web of relating we will intuit what the client is experiencing? Yes, undoubtedly to some extent, but research findings show over and over again that therapists, with the best will in the world, often mis-perceive clients’ experiences, as well as their wants and needs. Why? Probably because our own experiences, beliefs, and perceptions are always, at least to some extent, going to get in the way—what the analysts call ‘countertransference’. We can’t ever cleanly, purely perceive what clients are experiencing, and therefore relying on our own intuitive senses can never tell us the whole story. Indeed, one of the reasons I’m so passionate about research evidence is because I think a 100% reliance on our perceptions of clients’ experiences can end up becoming a self-reinforcing, therapist-centred mode of practising (the very opposite of ‘client-centred’), in which our own assumptions, biases, and beliefs get imposed upon clients in implicit and, potentially, damaging ways.

Are we just confirming what we believe to be true?

Say I believe that insulin shock therapy is what my client needs. I really believe that: maybe it helped me at some point in my earlier life, maybe it was part of my training and it’s become the main therapy that I now earn a living from, maybe I’ve got shares in an insulin company so I’ve got a personal interest in proving its effectiveness. And so, when I see a client experiencing psychosis, or perhaps any client who is experiencing psychological distress, I ‘perceive’ that what they need is insulin shock therapy. And if that’s my honest, intuitive, deeply-felt view, then is there anything wrong with it? Of course so: ‘while widely used from the 1930s to the 1950s, insulin shock therapy was abandoned by the 1960s due to its danger and ineffectiveness’ (Google AI Overview). But if I just rely on my own sense of what is going on, or perhaps my clients if I ask them, ‘Has what I’ve done helped?’ then what’s to stop me continuing in this harmful practice? Will I see harm being conducted? Probably not because, like most people, I’m biased towards self-serving perceptions.

We might say that person-centred therapy is nothing like insulin shock therapy, and of course it isn’t, but how do we know? We perceive PCT as helpful… ok, but so did practitioners of insulin shock therapy, or scientology, or Scared Straight behavioural management programmes. Our clients say PCT’s helpful… Ok, but given the power dynamic in therapy, it can be incredibly difficult for clients in any therapy to say, or indicate, that something hasn’t helped. So I’d guess, for instance, that if a Scared Straight practitioners asked one of their young participants if they thought the programme had helped, they’d be pretty certain to say ‘yes’. So what, outside of ourselves, can we use to get some kind of perspective beyond our own, potentially self-serving, perceptions. Supervisors… yes, but if they’re from the same school of therapy as ourselves, then they’re likely to want to see what we do as helpful too. Trainers, friends, colleagues…. again, all potentially helpful sources, but there’s also the danger that this becomes something of an echo chamber, and what is often missing is the voice of the client. Leigh says, ‘No research comes close to encapsulating what therapy is about,’ but when you read the deeply layered qualitative studies of researchers like Heidi Levitt, for instance on what clients find helpful in therapy, or interpretative phenomenological studies that dig down into clients’ lived-experiences of mental health interventions (see here), you find some powerful, moving, and engrossing accounts of what it means to be a client in the therapeutic encounter. So this, for me, is where research evidence comes in. It is a perspective on therapy that, in many instances, gives us a client’s eye view on what is going on, both in terms of processes and outcomes. And it helps us see things that, from the therapist’s chair in the immediate encounter, we may not be aware of. The total answer? The final answer? No, of course not. But, as above, neither is the therapist’s intuitive perception of what the client is experiencing. So all of these are just pieces of a larger jigsaw puzzle, and an ‘evidence-informed’ approach, just like a supervisor-informed approach, or a person experience-informed approach, can help us see the greater whole.

So when Leigh writes that, ‘What [research] cannot do, no matter the methodology or researcher, is anything meaningful to improve the so-called “outcomes” of therapy’ it feels far too black-and-white to me. Indeed, if such a claim were true, we would never have the six conditions that Rogers hypothesised in 1957 to be necessary and sufficient for therapeutic personality change to happen—so much of which was built on careful, studious analysis of psychotherapy session recordings. It seems to me that, in the person-centred field itself, people sometimes forget that the approach was built on research evidence. We’ve had almost seven decades now of more research, more discoveries, more evocative and informative methods. There’s so much there now to learn from. Would a Rogers today, analysing the conditions for necessary and sufficient change, ignore the tens of thousands of research findings now available? Would he say that only research from before 1957 counted? I’d like to think that what he’d express, consistently with his philosophy, is a stance of openness and an appreciation of complexity: no, research findings aren’t the be-all and end-all of guidance on practice, but neither are they to be wholly dismissed.

I want to share a story that really moved me (details disguised to preserve anonymity). A few years ago, I was on the independent steering committee for a randomised controlled trial of a CBT programme for a particular form of eating problem. The researchers had worked incredibly hard, for about four years, to develop and test their intervention, and they were pretty heartbroken when they came to us at the end of the study to say that, on most indicators, the results showed that the programme hadn’t helped. Perhaps, because I felt sorry for them, I started talking at the meeting about the kinds of indicators that they might want to highlight to show some kinds of effects, or to examine the reasons why limited improvements were found. But, no, they were resolute: they’d found no effects and they weren’t going to try and fudge that: they had to be true to their findings. To me, that was such a fine example of what it means to be person-centred: open, humble, willing to be wrong… qualities that, for me, seem so essential to a person-centred way of being. It’s the spirit Rogers expresses when he talks about his own research and the facts being friendly: ‘in our early investigations I can well remember the anxiety of waiting to see how the findings came out. Suppose our hypotheses were dis-proved! Suppose we were mistaken in our views! Suppose our opinions were not justified!’ However, he goes on to write:

At such times, as I look back, it seems to me that I disregarded the facts as potential enemies, as possible bearers of disaster. I have perhaps been slow in coming to realize that the facts are always friendly. Every bit of evidence one can acquire, in any area, leads one that much closer to what is true. And being closer to the truth can never be a harmful or dangerous or unsatisfying thing. So while I still hate to readjust my thinking, still hate to give up old ways of perceiving and conceptualizing, yet at some deeper level I have, to a considerable degree, come to realize that these painful reorganizations are what is known as learning, and that though painful they always lead to a more satisfying because somewhat more accurate way of seeing life.

Supporting Social justice

Underneath the concerns of colleagues like Leigh is, I think, a sense that research is allied to a socially conservative agenda: that is, a mechanised, de-humanised, de-individualising way of seeing human ‘subjects’ that can underpin—and reinforce—a wider agenda of dominance and social control. I share this concern. However, what I think this also misses is the possibility that empirical research can also play an important role in challenging forces of dominance: in questioning assumed ‘truths’ and in affirming minority experiences. In a just-published article entitled, Understanding the Attack on Science as a Discrediting of Minoritized Lived Experiences: The Vital Importance of Qualitative Methods at This Time, Heidi Levitt argues that, ‘there are four routes via which qualitative research affirms minoritized experiences and supports people to understand them’:

(a) Qualitative research uncovers underlying mechanisms that were not hypothesized before but can improve interventions and access to them. (b) Qualitative research provides compelling, narrative-based information that counters harmful beliefs and myths about minoritized populations. (c) Qualitative methodology inherently values epistemic privilege and diversity of experience within the phenomena studied. (d) Qualitative research helps people to see their commonalities with others and their shared humanity.

Of course, this is not to suggest that all research serves such a social justice agenda. Only that it can: and that to entirely dismiss research is to reduce the number of tools we may have available to forge a more person-centred world.

the need to show effectiveness

And even if we’re not interested in research findings for our own practice, or out of a concern for social justice, my sense is that, for the survival and development of the person-centred approach, we desperately need to know more about research evidence and engage with the research field. Whether we like it or not, today, commissioners, funders, clients are wanting professionals to justify, with evidence, what they do. And I think they’ve got a right to. When I go and see a physiotherapist, for instance, I want them to use the methods that have shown the best outcomes to date for my problems—if they did a treatment on me that they believed was effective, even if all the evidence ran against it, I’d be annoyed. And beyond that, politically, if it’s all just about internal perceptions, then what’s to stop someone like Trump saying that paracetamol causes autism? He, no doubt, intuitive feels that that is the case, and if we say that research evidence doesn’t count, what do we turn to to assess the validity of such a claim? So why should we, as therapists, expect things to be any different when lay people look at us and our work? You could say that the intricacies of the therapeutic relationship are much more complex and individual than, say, paracetamols and autism, but, then, the latter—like most real world processes—is pretty complex too. I worry, sometimes, that there’s something of an exceptionalism in the therapy field: that we shouldn’t have to be held to the same standards as we would want others to be held to.

As a person-centred field, we have a massive hole where contemporary research evidence could be, and that absence, I would argue, has done immense damage to our field. In the last few decades, for instance, person-centred therapy has been virtually pushed out of primary care in the UK because the evidence is for CBTs, not person-centred approaches. What’s next? schools; bereavement services; or even private practice, where in some European countries insurance laws make it almost impossible to deliver non-‘evidence based’ therapies. Today, in places like Germany, the person-centred community is massively struggling and has radically reduced in size. Perhaps I’m doom-mongering, but if person-centred therapies are removed from public services, it is clients who are, ultimately, going to suffer—and particularly those clients without the socio-economic resources to afford private practice. What I think I also find frustrating is that, based on what we know, if person-centred therapists were to start evaluating their practice more, and use research evidence to refine and develop their approach (as, for instance, the emotion-focused therapy field has done), there’s a very good chance that we’d be able to show how helpful our work is, and also find ways in which, evidentially, it could be even better.

This is probably too polarised, but I think, as a person-centred community, we have a choice about what we want to be in the future. Do we want to be (or be seen) as something like crystal healing, where we’re providing a therapy outside of public services, that we claim is indefinable and un-categorisable, and based on the evidence ‘of our own eyes’—that is beyond any research validation. Or do we want to sit alongside other therapies like CBT and IPT as credible and publicly-available practices, which are seen as genuinely being able to help people with particular problems? By completely rejecting research evidence, we are in danger of falling into the former category, and I think that’s to our loss and to the loss of clients who may benefit from our services. And I don’t think we can have it both ways: I don’t think we can say that we want to be publicly commissioned and supported at a level equivalent to evidence-based therapies, but not to have to provide the evidence to sit alongside them. Again, it feels exceptionalist to me. Standing back, why should any one therapy have the right to be taken seriously by public bodies if it’s not willing to enter the public fray and demonstrate it’s worth?

Ethics

I also think there are some serious ethical issues here. Supposing—and this is totally hypothetical—there was research showing that, two years after completing person-centred therapy, clients were more depressed than before they started. But supposing that, in the therapy itself, they seemed to be doing very well. In that case, would it still be ok to use our own intuitive sense of how the sessions had gone as the sole source of guidance on what we should be doing. Worse, to give the most extreme example, supposing a research study showed that clients in person-centred therapy were actually more likely to take their own lives after therapy had ended. Again, would it be ok to ignore such evidence if it ran against our own subjective perceptions of the therapeutic interaction? Of course, there might be many reasons for such findings to emerge, and it wouldn’t necessarily mean that the person-centred therapy was causing the problems, but to entirely dismiss such evidence on the grounds that it was academic research, without even considering it? Ethically, such a position would really concern me and, I would guess, most people outside of the field. And if we, or are trainers, are not engaged with the research evidence field, how do we know that such findings are not already out there? So, for me, I think we have an ethical responsibility to be open to, and knowledgeable about, research evidence—just as we’re expected to be open to our supervisors, or are trainers, or the things our clients say. And, perhaps, the professionals bodies have a role in ensuring that therapists have that basic understanding.

I think the point here, again, is that ‘intuition’ is not neutral. Leigh, in his eloquent response to this blog, below, says that his intuitive perception is the evidence, shows what is real. And I do not doubt here that it can be very informative. But to assume that this can act as the sole source of truth denies the many factors that may also influence this intuitive sense. Indeed, research, itself, shows that our intuitive senses of things can sometimes be biased, misleading, and wrong. Daniel Kahneman summarises the plethora of research here in his book, Thinking fast and slow. For evolutionary reasons, we have to make ‘fast’, intuitive judgments all the time (what Kahneman calls ‘System 1 thinking’), but it is prone to numerous errors. For instance, we are more likely to ‘intuitively’ assess an attractive person as being kind or intelligent, and a xenophobic person will have a ‘gut feeling’ about foreigners as bad. ‘System 2’ careful, logical reasoning tends to reach more accurate conclusions. Then there is also all the self-confirmation biases, again very well established by research, that tend to show that we interpret events in ways that support our self-esteem. Of course, from a counter-position, such research can be discounted on the grounds that it is empirical research, and not the ‘research’ of one’s intuitive felt sense. Or it might be argued that such evidence may be applicable to others but not oneself. But how do any of us know that our intuitive feelings are not biased in some way? To claim that we know they are not biased because we do not experience them as biased is entirely circular and separates us off, I think, from a larger ethical responsibility to open up to the voice, experience, and perception of others. Research, at its best, represents the cumulative experiences, perspectives, and outcomes of clients, and to be entirely closed to that, whatever it indicates, in favour of our own gut feelings, seems to me an abdication of our ethical responsibilities.

a non-judgmental acceptance?

I think what concerns me most in the stance that Leigh represents, which becomes clearer in his response to this blog, is a fundamental lack of non-judgmental acceptance towards those who engage in research and academic writing. He states, for instance, that,

The reality is that psychology research papers, including in the field of psychotherapy, are almost always bone-dry, clinical, jargon-filled, statistic-obsessed documents that seem purposefully designed to obfuscate, impress, and blind the reader with a sort of meaningless science-salad.

Subsequently, he writes about researchers as being vain, desiring to impress, and being motivated by a desire to maintain their career. So where, here, is a person-centred acceptance and valuing of others, an appreciation of their actualising tendency, and a respect for the lives and activities of those who may try to grow and develop knowledge and understanding in different ways? In my experiences, there are not ‘good’ clinicians (wise, intuitive, caring) and ‘bad’ researchers (career driven, vain, and statistics obsessed). Rather, there are human beings, all of us, all trying to do the best we can in the worlds we inhabit—surely that is the essence of a person-centred outlook. So, rather than rubbishing a community that approaches the world, and uses language, in a different way, it seems incumbent on me that clinicians should engage the research community with respect and empathy. If a researcher said that the work of person-centred clinicians was ‘fantastically boring’ or ‘completely meaningless’, I think person-centred therapists would be rightly incensed. Not by the challenge, but by the tone of it and the lack of respect for difference. Even if, as members of the person-centred community, we do not want to engage with research, at the very least I think we should exemplify an attitude of respect and non-judgmental acceptance to others.

Why don’t therapists engage with research evidence?

This is what I honestly think… I think part of the reason that so many therapists are ‘allergic’ to research evidence is for all the reasons that Leigh is putting out there: we value the complexity and immediacy of the lived relationship, and have an intuitive sense of its healing capacity. But I also think that many of us come into the field from non-scientific backgrounds, and we don’t get the training to really understand—or be able to engage with—what a lot of the research studies are saying. And if you look at some of the leading journals in the field, even with my PhD in psychology and years of researching and writing, I haven’t much of a clue what’s going on: ‘The study employed a multilevel structural equation model with Bayesian estimation to simultaneously account for therapist effects, session-level fluctuations in alliance, and client-level moderators’… What’s worse, many of these findings are tucked away in journals with paywalls that make it impossible for everyday therapists to find out the latest news about what’s going on. So I think the field of research evidence can feel like a foreign, unapproachable, incomprehensible, and infinitely complex one—one where we feel way out of our depth, overwhelming—and dismissing it can be a way of reducing the dissonance and discomfort that that can evoke. If research evidence doesn’t matter, then I don’t have to worry about the thousands of findings out there that I may not understand, or that might challenge my way of thinking and practising. Phew!

OK, so now comes the plug: in my book Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly (Sage), with a second edition out in spring 2026 (and a training event on the 11th April 2026), I do try and summarise the current research findings in a way that is digestible and accessible to all. And there’s also some other texts out there, like Bergin and Garfield's Handbook of Psychotherapy and Behavior Change, that give reviews of the research evidence that are even more extensive, comprehensive, and in-depth. But I also think, as we’ve argued in a recent commentary, that there’s an onus on counselling and psychotherapy trainers to really know the research findings, and to be able to communicate this information to trainees. More than that, to communicate to trainers that a knowledge of this research evidence is one important element of professional knowledge and development. I might be wrong about this, but my guess is that most therapy trainers in the UK, (1) Don’t know much about the research findings in the therapy field, and (2) Aren’t particularly interested in them. And while that remains the case, I don’t think new practitioners are ever going to take research findings seriously.

Actions

An ongoing critique of research, particularly positivist assumptions, is an important element of a person-centred relationship to research. As Leigh does, we need to question the privilege that can be given to particular kinds of research evidence, and to emphasise the importance of human lived experience: gathered both systematically and non-systematically. But, in addition, if we want to engage with the research field, some of the things we can do are as follows:

• Person-centred trainers can ensure that they are familiar with the core research evidence on therapy, and ensure that it is integrated into their curricula.

• Academics in the person-centred field can consider conducting research that can help to genuinely develop our knowledge and understanding of person-centred practice.

• Where research is a mandated element of person-centred courses, trainers and trainees can look towards conducting research that has the potential to make a real difference to clients’ lives (e.g., research on what clients find helpful in therapy).

• Person-centred therapists can consider how they could be involved in developing research that could support the evidence base for person-centred therapies, for instance through practice research networks.

concluding thoughts

Person-centred philosophy, for me, is about growth, and change, and being open to the world so that we can become more complex, and fuller, and live life in all its diversity. And if we apply that to what it means to be a therapist, I think it means being open to the world in all its manifold elements, and not dismissing or disregarding or judging a priori any one source of knowledge. It can all be in there, as a complex, nuanced, multi-faceted whole. So there’s nothing, for me, that is inherently 'boring and completely meaningless' (except, perhaps, curtain fabrics!), and I guess you can see, in this blog, that I find it hurtful and frustrating when something I love is demeaned as such. As Leigh says, what goes on in the therapeutic relationship is, ultimately, unmeasurable, unquantifiable, irreplicable, and complex. But, for me, that doesn’t mean turning away from research findings. Rather, it means drawing on every shred of knowledge we can to help work out, with our clients, what it is that can best support them to flourish and grow.

The 'Anti-Polarisation Paradox': How do you Meet Closedness in an Open Way?

How do you meet intolerance with tolerance, dehumanisation with humanity, monism with pluralism, a striving for dominance with a spirit of equality? Oppose it and there is the danger of replicating the very thing one is striving to overcome. But fail to confront it and such polarising forces may prevail.

For me, this is a deeply personal question. I grew up in a family of communist, with parents who described a utopian future of peace and comradeship. Yet their disparagement and vitriol towards those who held opposed views felt, to me, increasingly contradictory. How can these others—the conservatives, the business owners, the wealthy (who, paradoxically, included ourselves)—be so irredeemably awful if all people, according to my communist parents, were inherently good?

More recently, as colleagues and I developed a ‘pluralistic’ approach to counselling and psychotherapy, we found ourselves lambasted in journals and social media by those who advocated more purist therapeutic approaches. The attacks could be personal, belittling, and shaming: ‘Emperor Mick has no clothes guys’, read one Facebook post. I felt a deep compulsion to retaliate, but what of pluralism if such all-or-nothing demonisation was just batted back in a spirit of the same: No, it’s not that you’re right and I’m wrong, it’s that I’m right and you’re wrong.’

Later, again on social media, some furious rows on trans rights: ‘disavowing the differences in sex’, wrote one anti-trans clinician with whom I was arguing, is akin to ‘disavowing the differences in generations (pedophilia)’. ‘Violate the distinction in register for one, and you violate for everyone else. Simple. No confusion.’ So how to respond, as someone who abhorred such alleged equivalence between trans people and paedophiles? Attack? Challenge? Counter? Or walk away and leave well enough alone?

Developmentally, I’m ashamed to admit, my default strategy has often tended towards manipulation, and sometimes even parody. In relationships with people who felt more powerful than me, and who I could not argue with, I would (unconsciously) work on sowing seeds of doubt. Always indirect, ‘under the radar’. Never quite letting the other settle: playing at the edges, ‘reverse psychology’ my most treasured weapon. Today, still, in the face of polarisation, when I do not feel listened to, I find my mind unconsciously plotting: ‘If I say X, it might achieve Y’. I would much rather be thinking X because X was my truth.

And, of course, it is a problem far bigger than my personal dynamics. How do you face the violence meted out by Putin’s Russia, or Netanyahu’s Israel, or Hamas, in a way that does not reinforce an ideology of ‘might is right’; how do you meet Trump’s racism, discrimination, or belittling of opponents (as well as allies) that doesn’t perpetuate the demonisation of difference. Gratifying, though it may feel, to mock Trump’s stupidity, greed, or his alleged micro-penis, it fails to model an alternative, more constructive way of relating to others: a way that respects difference; that seeks win-win solutions for all; that engages through cooperation, respect, and humanisation rather than competition and blame.

This, then, is what I am calling the anti-polarisation paradox: that if we meet polarisation, or intolerance, or any other form of black-and-white demonisation with the same, we end up in danger of replicating the phenomenon we are trying to transcend. And this paradox can be seen at multiple levels: whether between communities who are at war, or between people in a relationship, or even between the different ‘parts’ of a person as they interact. How do we face, for instance, our own ‘inner critic’ who tells us that we are rubbish? By criticising that inner voice and telling it that it is rubbish too? Again, there is a need to find a different way that does not replicate the thing being opposed.

This article explores how we might meet forces that polarise, demonise, and strives for dominance in a way that does not replicate them. The article does not provide any immediate or obvious answers. What it tries to do, however, is to take a step forward by mapping out some key, non-mutually exclusive strategies and weigh up their strengths and risks.

Direct Opposition

As discussed above, the most immediate, intuitive response to dominating forces may be to directly oppose. This means to fight: to use all resources available to battle: physical, psychological, and economic—no holds barred.

Almost certainly, such an approach is sometimes the only means towards meeting domination. In the face of, for instance, Nazi Germany, it was necessary to protect again genocide and authoritarian global dominance. But direct opposition also has its risks. This article is grounded in the assumption that, undertaken blindly or as a strategy in isolation, it can end up replicating the polarisation it is seeking to counter. A strategy of direct opposition can also end up generating greater resistance in those it is opposing: a ‘reactance’ whereby the other digs their heels in even further. Opposition, alone, may also mean opportunities to understand the other are missed, which may then close down possibilities of dialogue or reconciliation.

Radical Acceptance

At the other end of the spectrum is an empathic, non-judgemental, genuine acceptance of the dominating forces’ experience—though not necessarily their behaviours. This is a refusal to meet dehumanisation with dehumanisation: a willingness to hold the humanity and the personhood of the other, however they choose to behave. Such a stance models non-polarisation, openness, and respect for others—inviting the forces of domination to replicate, in kind. Through a genuine understanding of the other and their most fundamental needs and wants, mutually beneficial solutions may be more achievable; and such a stance may also help to forge an alliance—establishing leverage points for change.

The greatest risk of such a strategy, however, is that of ineffectiveness: domination is given no reason to change and therefore may continue unopposed. Appeasement failed. Marginalised groups feel unsupported and alone. The philosopher Karl Popper writes of ‘the paradox of tolerance’: ‘Unlimited tolerance must lead to the disappearance of tolerance. If we extend unlimited tolerance even to those who are intolerant, if we are not prepared to defend a tolerant society against the onslaught of the intolerant, then the tolerant will be destroyed, and tolerance with them.’ Even, in terms of forming a bridge to the dominating forces, the latter may experience radical acceptance as patronising, inauthentic, or manipulative: evoking more resistance rather than less.

Call Out

A third strategy is to name (publicly) dominating, polarising forces for what they are: ‘You are doing X to Y’, ‘You are behaving in A way.’ And then, potentially, nothing more. This challenges the other to face their actions, but in a way that does not invite, or particularly allow, a defensive response. It may allow the other to change tack without losing too much ‘face’ or, potentially, shame them into action. Calling out the other without engaging further is also a relatively efficient means of challenge, in terms of conserving resources.

As with radical acceptance, however, calling the other out may simply leave the other to continue to behave in dominating ways, unopposed. It also does not necessarily bypass the other’s resistance (‘Who are you to tell me what I am?’), and may evoke a name-calling response in return: escalation of conflict without any genuine engagement. Calling out the other also replicates something of an absolutist, hierarchical stance: ‘I know what and who you are, whether you think that or not—and I don’t even need to explain myself.’

Reflexivity

Again, a strategy that turns away from the polarising, dominating other: in this case asking, ‘What is my part here?’ Of all the strategies this is, perhaps, the one that requires the greatest level of self-renunciation. In the face, for instance, of a critical, berating other: not to align with the other, but to take a position that could easily be seen as aligning and submissive. ‘You tell me I am a terrible person… let me ask myself how I could improve and change.’ But reflexivity also has the great advantage that all resources are returned to the self and its growth: nothing is expended on the dominating force. It also has the advantages of evoking little reactance; and of modelling a self-reflexive way of being that may, ultimately, allow for constructive social change. As with other strategies that do not oppose or engage dominating forces, however, it may leave the latter with little incentive for, or need to, change.

Ignore

A more total form of turning away comes from a refusal to engage with dominating forces: ignoring (and, at its extremes and where possible, ostracising or expelling). This is a widely-invoked strategies—‘just ignore the bullies’—that conserves resources, does not directly evoke reactance, and may provide negative reinforcement for change if, in part, ‘attention’ is the dominating forces’ desired goal. If it is not, however, ignoring can just be ignored, leaving the marginalised as vulnerable to domination as ever. In this way, Ignore can easily segue into bystander apathy.

Assertiveness

Clear, honest, direct, non-manipulative, non-blaming communication. Marshall Rosenberg’s nonviolent communication is an exemplar here: ‘When you do A, I feel B, and because I need C, I would like you to do D.’ Assertiveness allows for a direct challenge to dominating forces without the kind of blame or demonisation that may be most likely to evoke resistance; and it does it in a way that models win-win, cooperative, humanising styles of communicating. Assertiveness doesn’t deny the wants or needs of the dominating forces, it allows them to co-exist, but in the context of the needs and wants of the majority and the marginalised. Assertiveness allows for nuance, clarity, multiplicity: from a phenomenological standpoint, it allows truth to emerge in all its inter-relational complexity.

Like reflexivity, an assertive stance requires a high degree of self-discipline and self-abnegation. In the face of insults and abuses, it can be hard to hold a nonviolent, non-blaming clarity. Indeed, it requires self-reflexivity—as well as a willingness to listen to the other—and as such it is resource intensive. In itself, its effectiveness may depend on the willingness and capacity of the other to reciprocate and engage in humanising and trustful ways—though assertiveness does not negate the possibility of more forceful, even physically forceful, modes of engagement.

Of note, contemporary models of conflict resolution—whether as couples therapy, inter-individual negotiation, international mediation or, at the intra-individual level, psychotherapy—typically advocate a model akin to assertiveness/nonviolent communication. This attests to its perceived—and, to some extent, empirically-demonstrated—value within professional and lay communities.

Persuade

Assertiveness strives for change on the basis of expressing—and acknowledging—needs and wants. Persuasion strives for change through logical argument and evidence: ‘You should do X because X is right to do.’ Is assertiveness or persuasion more effective? Assertiveness has the advantage that, within a particular (phenomenological) worldview, its truth claims are incontrovertible: ‘I feel B when you do A, and I would like you to do D.’ No other can claim otherwise. But such a subjectivist view of truth is not commonplace: for most people, objective realities exist and are grounds for discussion and negotiation.

Can persuasion change? It is an empirical question where, no doubts, there are levers for greater or lesser effect. Almost certainly, however, the views of those who dominate, or who think in polarised ways, will not simply fall in line with logic and fact. We know that, as human beings, we are prey to numerous logical fallacies: self-justification, salience bias, all-or-nothing thinking, to name but a few. Attempts at persuasion may also invoke resistance, or disputation, in a way that assertiveness may bypass. Few people, when told their thinking is wrong, will simply cede ground. Indeed, such challenges may evoke greater cognitive effort to shore up one’s position. In my own experience, social media disputes have hardly ever led to the ceding of points, or the development of more mutual understandings. Far more powerful is, for instance, the desire not to be seen as weak or foolish—to be publicly shamed.

Yet, even if not short-term, people’s views can change. New standards (for instance, that segregation or sexual harassment are wrong) become accepted: ‘the arc of history is long, but it bends towards justice.’ Is that through persuasion, or more social psychological processes like peer pressure or socio-economic change? Research on the way minorities influence majorities suggests that, at least in some cases, people can genuinely develop new attitudes and beliefs through being exposed to opposing views.

Genuine Dialogue

Persuasion strives to change the other; genuine dialogue involves a willingness to enter into a two-way, mutual conversation with the other: to listen as well as to talk, to be open to being changed as well as striving to effect change. Its outcome, by its very definition, is unpredictable, with the risk that one exits more aligned to the dominating forces than opposed. Of all the strategies, it is also, perhaps, the most resource intensive: a willingness to slowly, thoughtfully, talk and listen. Is there time?

Yet genuine dialogue models, perhaps, the clearest and most compelling alternative for more constructive ways of relating. Ways that have humility, an openness to the other, a willingness to understand and value both other and self. In genuine dialogue, like in assertiveness, there is a recognition of the other—of all others—as equal to the self: with views, perspectives, and experiences worthy of understanding. As such, again like assertiveness, genuine dialogue has a transitivity (i.e., that it is the same from self to other as it is from other to self) that must, of necessity, lie at the heart of a fair, cooperatively-functioning society. This is the universal, ethical ‘Golden Rule’—‘Do unto others as you would like others to do unto you’—without which, the seeds of inequality, greed, and dominance are inevitably sown.

Protect

All of the strategies discussed to this point, aside from Ignore, focus on the dominating forces. What of the marginalised? Protect focuses efforts on those marginalised. Ignore, sideline, or do whatever to the dominating forces. Who cares! The point here is to support, with maximum effort, those who are suffering. Protect optimises opportunities to equalise: it works with and for the oppressed. Yet, like Ignore, there is a risk that it fails to tackle the dominating forces effectively, and perpetuates a ‘perpetrator-victim-rescuer’ dynamic.

Pluralism: Openness to Otherness

Like Protect, Pluralism determinedly holds open a space for otherness—in the face of domination. Unlike Protect, however, this valuing of otherness becomes a universal value: extended to the dominating forces (as in Radical Acceptance) as well as those dominated. As such, it has the transitivity of Genuine Dialogue and Assertiveness, and models non-polarisation and a recognition of complexity.

The risks of pluralism, however, is that it may not—or may be seen as not—recognising the power dynamics inherent in the dominating-dominated relationship. These two groups are not equivalent and treating them as such may be seen as condoning, albeit implicitly, inequalities. When X is dominating Y, any acknowledgment or validation of X is inevitably acting against Y. What feels, to the pluralist, as a standpoint of equipoise may be experienced, by the marginalised, as collusion with the dominator. Moreover, for the dominating forces, such sympathies with the dominated may be perceived in an equally hostile way.

Discussion: Beyond Either/Or

These are only some of the possible responses to polarisation. Other, potentially overlapping, strategies might include:

• Authenticity

• Empathy

• Defuse

• Irony

As this review indicates, each of the strategies for meeting domination and dehumanisation have strengths and risks. There is no one, single ‘right’ strategy—not a surprising conclusion for an article that strives to transcend polarisation. Equally, as emphasised in the Introduction, these strategies are by no means mutually exclusive: it may be that a combination of different approaches yields greatest benefit. Indeed, it may be more fruitful to conceptualise these strategies as continua rather than categories: for instance, what degrees of reflexivity, calling out dominating forces, and protecting marginalised groups may combine to best effect?

Crucially, too, it seems likely that different factors will moderate the extent to which different strategies may be of benefit. One important factor, for instance, may be the power of the dominating forces. If low, strategies like Ignore or Assertiveness may be most appropriate whereas, if high, strategies like Direct Opposition or Protect may be most necessary for change. Other moderators may include the persuadability of the dominating forces, their underlying needs and wants, the urgency of the situation, the amount of harm that is being done, and our own positioning (are we part of the marginalised group, the dominating force, or external to both?).

This paper has considered forces like domination, dehumanisation, and polarisation as synonymous; and assumed equivalence from micro- to macro-level systems. Undoubtedly, differences in the types and effectiveness of strategies, and their moderators, may exist across all these dimensions.

Research could do much to further an understanding of effective strategies for meeting dominating forces, and their moderators. Historical analyses, for instance, would allow for a deepened understanding of which strategies have tended to work best under which circumstances. A wealth of psychological research—on, for instance, majority and minority influence, persuasion, and nonviolent communication—could also contribute to an understand of how dominating forces can be most effectively challenged. A programme of experimental research—along, for instance, the lines of the ‘prisoner’s dilemma game’—could also help to understand when, how, and why dominating groups are most effected to give up privilege. Ultimately, implementation and evaluation in ‘real world’ settings would be essential to test out the validity of identified approaches.

Despite all these complexities and future challenges, this article is an attempt to find some language and some initial framework for answering the question: How do we meet the forces of domination (and dehumanisation and polarisation etcetera) in a way that goes beyond replicating those forces? There are no simple answers, but a disciplined willingness to uphold complexity, uncertainty, and otherness seems core to the emergence of a new paradigm: one that moves beyond polarisation towards a more compassionate, caring, and humane form of human engagement.

Acknowledgment

This paper was presented at the 2025 Bridging the Arts and Sciences for Human Betterment symposium, Madison, Wisconsin. Thanks to our host, Carol Ryff, for inspiration and support.

Photo by Ernest Malimon on Unsplash

An interesting BBC In Our Time podcast on this theme is available here

Should We ‘Trust the Process’?

Yesterday (10th March 2025), the Person-Centred Association pasted an image on their Facebook page stating ‘Trust the Process’. They added: ‘In a world full of pluralistic and integrative approaches, it’s important to get back to the core philosophy of Person-Centred Therapy—trusting the individual’s inner wisdom and valuing the process of growth’.

In person-centred circles, the mantra ‘Trust the process’ is commonplace, but is it actually a meaningful, coherent, and even person-centred injunction? In this blog, I want to suggest that—as a definitive statement as to what people should do and what the person-centred approach most fundamentally means—probably not.

I’m understanding ‘trust the process’, here, as a general trust in the inner wisdom of another—as the PCA post defines it. But I also look at understandings of ‘trust the process’ that are more specific to the context of therapy.

Whose Process?

First, whose process are we trusting here? Is it just the process of person-centred therapists and clients who want this approach or, for instance, are the processes of pluralistic and integrative therapists (those who, according to the post itself, are in far too great an abundance) trusted too? Certainly, from some of the social media comments I have received from self-identified advocates of a person-centred approach, there seems very little trust in the process of those who see the world differently. Take, for instance, the comments that our pluralistic reading of the person-centred approach is ‘delulu’ and would make Roger’s [sic] ‘turn in his grave’; or that our ‘wacky’ ideas about pluralism are ‘inauthentic’ and ‘unnecessary’. Where, here, is a genuine trust in the process of those who understand person-centredness in different terms?

Perhaps, it could be argued, the phrase ‘trust the process’ is just about therapy. It’s about trusting that, if the client and the therapy relationship are allowed to evolve ‘naturally’—without structure, goals, or conscious directions—good things will come about. I certainly believe there’s a lot of truth in that, but if the process is only to be trusted under certain circumstances (and you might say, Rogers’s six conditions for therapeutic personality change), then what happens to that ‘process’ once the client moves to a different context? Does their actualising tendency, their ‘desire to maintain and enhance the capacities of the experiencing organism’, somehow disappear or become untrustworthy? That, for me, would certainly run against Rogers’s description of the actualising tendency as the ‘sole motivating force’: if they’re not actualising once they leave therapy, what are they doing, and what’s driving that? And if that trust in the process is context-dependent, then it seems a fairly superficial understanding of how people act and heal: like a switch that can turn on and off. Surely the whole point of Rogers’s model of the person is that it is about people at their deepest, most fundamental level.

And what about trusting the process with people, including clients, who may have come to feel that they cannot ‘trust their own process’? Say, for instance, people who are abusing alcohol and feel that they cannot stop themselves alone. Is this self-insight and process to be trusted too, or is it that, actually, their process has become untrustworthy. Either way, it’s not clear here what it means to ‘trust the process’ and how to avoid it falling into self-contradiction.

This contradiction gets particularly acute when we enter the field of interpersonal perceptions: what one person thinks and feels about another person’s experiences. Say Person A, deeply and intuitively, feels that Person B is experiencing X; but Person B, in all their congruence, feels that they are experiencing Y instead. So whose process and experiences do we trust: Person A or Person B? If we trust Person A, we can’t be trusting Person B’s process, and vice versa. So, at this point, the injunction that we should ‘trust the process’ fundamentally breaks down. Here, instead, I think we have to say (as Rogers does) that, ultimately, the person is the expert in their own experiences, but then we are saying that Person A’s deeply felt intuitive experiences are wrong. And, more than that, that that person actually needs to be really open to hearing what the other is, in fact, saying about their experiences.

 In my experience, in the person-centred field, that doesn’t always happen. That is, a belief in ‘trusting the process’ gets interpreted as believing that what we feel about others’ experiences are, inherently, right. Perhaps, in part, that explains way someone can feel it’s not un-person-centred to say that someone else’s deeply-felt beliefs are ‘delulu’ or ‘wacky’: ‘I’m just trusting my own sense of things’. But if ‘trusting the process’ means privileging one’s own perceptions and experiences over those that one is relating to, and engaging in ways that, to me, feel conditional, critical, and devaluing, it’s hard to see where the person-centredness is here.

More importantly, what about the majority of clients who come to therapy wanting guidance, structured, advice, and goals? Do we trust their process here or do we, actually, assume that we know ‘really’ what they want and need? If we take a position that, despite what the client says, we know really what is going on for them and what is best, how is person-centred therapy different from any other therapy that takes an expert position on the client?

 Over-simplification

For me, the problem I see with ‘trusting the process’ is that, although it is a very clear, simple, elegant, and compelling way of explaining the world, like many other simple and succinct propositions it lacks a full understanding of the complexities and balances that are needed to navigate real life. Yes, absolutely: our intuition can be amazing and sometimes trusting our deep inner sense of things is an incredible guide; but that doesn’t mean that it always is. I think about myself when I’m travelling. Sometimes, when I’m lost, I have a deep, powerful sense of where to go, and if I trust it I find, to my amazement, that I ‘magically’ arrive at where I need to be. Great! But sometimes that deep intuitive sense of where I am is completely and utterly wrong. And research shows consistently that people’s intuitive experiences are not always right. Just as one example, 90% of therapists think that they are in the top 10% of most effective therapists—that just can’t be correct: Some of those people are deeply, intuitively wrong. Research also shows that people can be fundamentally affected by the context around them: for instance, I might deeply, intuitively feel that I want chocolate, for instance, but actually that’s been shaped and biased by walking past a series of adverts for Galaxy bars.

 A ‘true’ process

So, with the example of chocolate, you could say, ‘Yes, but that’s not the person’s true process—it’s shaped by the external demands around them.’ And you could say the same thing about people wanting goals or structure in therapy: people may say they want that, but actually, at a deeper level, their process is directing them somewhere different. But first, that puts the person-centred therapist in the position of expert: ‘I know what you want and need, even if you think you need something else’. And second, what is a person’s true, genuine process? Where’s the line between what is true and what is a fake process (and, again, who gets to decide?).

Individualism

A basic problem with the idea of a ‘true process’ is that it’s based on an idea that people can be fundamentally separable from their environment. That there’s a true, original organism who comes into the world fully whole, and has wants, needs, and feelings that are distinguishable from external demands. But can we ever really separate a person from their environment? Is a baby not, inevitably, a product of their parenting, their family, their friends, their community, their sociopolitical environment? How can we ever separate the person out and, if we did so, what would that organism actually look like? Pretty much every contemporary theory of the person recognises that people are fundamentally intertwined with the worlds they inhabit: there is no real or genuine processes outside of that.  

Accommodation and Assimilation

Piaget, probably the most important developmental psychologist of the 20th century, said that people grow through two process: assimilation and accommodation. Assimilation is where we integrate the external world into our pre-existing schema; accommodation is where we change our schema to adapt to the external world: understanding it in new and fresh ways. The edict to only trust the process emphasises just the one side of this coin—assimilation—and doesn’t take into account the fact that we also, inherently, adapt and change to the external world around us. We take in from the world, we learn from it, we grow and become bigger by understanding things we didn’t understand before. When you learnt about person-centred theory and practice, you didn’t just do it through trusting an internal processes and drawing on what you already knew. You opened yourself up to new ideas: the ideas, for instance, of Carl Rogers. That wasn’t in you there, totally, before. Maybe parts of it, inklings, but something outside of your own process also ‘knocked on your door’, showed itself, became integrated into you.

Determinism

And if we just trust the process, why go to therapy at all? Surely everything we have already been doing is a legitimate part of our process, so why change anything? Of course, we might say that going to therapy is part of that process, but so would not going to therapy, and so would, in fact, anything we do. So is there any point consciously trying to do anything, or are we just—like potato sprouts—determined to develop and grow in a particular way, whatever we try to do? In which case, why bother trusting the process if, whether we trust it or not, we’re following our process? Again, the injunction to trust our process falls into a web of self-contradictions.

‘If You Don’t Trust the Process, then Get Out’

A response might be, ‘Well, the person-centred way is to trust the process, and if you don’t trust the process, then that’s fine, but don’t call yourself “person-centred”.’ The problem here, of course, goes back to the fact that it’s then not trusting the process of those who understand ‘person-centred’ in ways that don’t focus exclusively on trusting the process.

Defining Terms

I guess what I’m arguing is that a statement like ‘Trust the process’ needs a lot more nuance and clarification. Some questions and potential contradictions I’d love us to delve deeper into are:

• What is someone’s ‘process’? For instance, Is it all of someone, or some parts? Can there be elements of a person that are not part of their process? Is it the same as their experiential field? Their actualising tendency?

• At what level should the process be trusted? Is it all levels, or what we see as ‘deeper’ levels and, if so, how does that get defined? And what should we trust if people, fundamentally, do not trust their own process? Do we trust their process despite or trust their distrust of their process (and, if so, how do we account for that in person-centred terms?)

• Are all people’s processes to be trusted? What does it mean, for instance, to trust Elon Musk’s process?

• What do we trust in terms of people’s processes about other people’s processes? If someone fundamentally doesn’t trust another person’s processes, what do we trust?

A Therapist-Led Direction

Why does it matter? I think, most fundamentally, I’m concerned that meeting a client through the assumption that they should ‘trust their process’ imposes on them a particular ideology that may not be the client’s own. I think of a client who comes to see a school counsellor—maybe the only therapist they can access—and that counsellor believes that, for the client to find ways forward, they need to trust their process and come to understand their inner feelings and wants. And maybe the client doesn’t believe that. Maybe the client, like many young people, wants direction, guidance, structure and goals—as well as space to explore their feelings. Then, I think, the therapist who ‘trusts the process’, paradoxically, is at risk of imposing upon the young person a particular ideology: a view of the world and of the therapy process that may not match, or fit to, the client’s lived reality or their personal preferences and needs.

And at worst, I think the phrase ‘trust the process’ can get ‘weaponised’. It becomes a way of telling someone to do something that, insidiously, implies that ‘deep’ down the person really knows that that way of feeling or acting is the best thing for them. So rather than an assertive and honest, ‘I’d prefer it, for me, if you do X,’ it becomes, ‘If you really trusted yourself, you’d know to do X and not Y.’ Of course, the most fundamental paradox about the edict to ‘trust the process’ is that, as an injunction to act in a particular way, it’s not trusting the person’s process to find their own process. It’s a direction, an instruction… fair enough, but it’s important to be honest and transparent about that, rather than presenting it as the other’s truth.

Does that mean that therapists shouldn’t wholly trust the process. No, it’s a belief and an ideology, and it’s no more wrong than believing in God or angels. But if therapists do believe, solely, that the way to grow is to trust the process then I think that they should make that explicit to clients, and to see how this sits with the client’s own understanding of growth and change, and to give the client a chance to opt in or out. And, I think, they should also have a plan for what to do if the client sees it very differently.

Conclusion

Simplicity and elegance does not make something right. Nor does the fact that something’s partially right make it wholly right. From a pluralistic person-centred standpoint, yes, absolutely, we should be recognising and promoting the wisdom of the client and their ability—and right—to find their own self-direction; as well as the beauty of the therapy process when we just allow things to evolve without conscious direction. But we can also do that while recognising the complexity of factors that help people develop and heal. From a pluralistic standpoint, it doesn’t all come down to one thing, however elegant and compelling that one thing might be. And, from a pluralistic standpoint, what it means to be ‘person-centred’ is to begin, not with a particular ideology, but with a curiosity and openness to the client’s own understanding of healing and change. So, yes, listen to the process, be welcoming of the process, let yourself be amazed by the therapy process—but also don’t treat the process as the be-all and end-all of therapy. Nothing is the be-all and end-all of anything. To be person-centred, from a pluralistic stance, is to have the humility and openness to recognise that there are always limits to our knowledge and understanding, and that there is always so much more we can learn.

Acknowledgements

Photo by Aron Visuals on Unsplash

Social Justice and the Person-Centred Approach: Celebrating, Challenging, Evolving

This edited talk, presented as the 2025 Melissa Harte Memorial Lecture (4th Feb 2025), explores the contribution that person-centred thinking and practice can make to social justice; the limitations of this approach; and the potential for powerful, original, and exciting synergies between person-centred and social justice perspectives. The work, here, overlaps with a range of person-centred writings: such as Gillian Proctor on power, Colin Lago and colleagues on difference and diversity, and Gay Barfield on peace work. However, drawing on my recent book Psychology at the Heart of Social Change: Developing a Progressive Vision for Society (BUP, 2023), I hope that it also opens up new perspectives and possibilities. The video recording of the original talk is available here.

To start with some personal background: the question of social justice has, for me, been of critical importance throughout my life. I came from a progressive family: my parents were members of the Communist party. But that was the Highgate Communist party, and if you know where Highgate is in North London, you’ll know it’s a fairly affluent area. So there was some irony in having Communist party meetings in these very plush living rooms. Both of my parents’ families were working class emigrants from Eastern Europe: Jewish immigrants who’d experienced through their families a lot of what we call now intergenerational trauma and oppression. For my dad, who became very involved in the Communist party in the 1930s, social justice was a driving force for him in his life. And for me and my sisters, he really inculcated the sense that a meaningful life was one of trying to make a positive difference to the world. That’s a striving that I’ve carried through in my life, up to my latest book, Psychology at the Heart of Social Change, which tries to show how person centred psychological ideas can contribute to a broader and a wider understanding of what social change possibilities might be in a better world; and my involvement with the Therapy and Social Change (TaSC) Network.  

Social justice is the ‘fair and equitable distribution of resources, opportunities, and privileges within a society ensuring that all individuals, regardless of race, gender, socioeconomic status, or other characteristics, have equal access to rights and opportunities’ (ChatGPT—my new best friend!). Social justice is fundamentally about fairness, equity: about people having equal opportunities.

If you go back into the history of the person-centred approach, it did not evolve as a social justice approach. It evolved, with Rogers, as a clinical approach, and as a way of helping families and young people and adults to find greater well-being and to thrive. However, I think it really has a concept of fairness at its core. In the person censored approach, right at the heart of the approach, is the idea that the therapist isn’t somebody who is ‘better’ than the client, but someone who trusts the client: who sees them as an agentic, responsible human being—essentially, somebody who is like us. That is, in many ways, the unique quality of the person-centred approach. It’s an ethic—maybe not explicitly, but implicitly. And, I think that is what draws so many people to the person-centred approach: because, like me, when they read Rogers, they love this idea that the therapist—rather than being an expert in the client’s life, rather than being the person who comes in and says, ‘Right, I know what you need to do; you do this, this, and this, and this, and that will sort you out’—is actually someone who listens to the client. That is, someone who listens carefully, trusts, and appreciates the wisdom of the client. And that’s about equality. There’s a principle there of, ‘I’m not better than you’, but ‘You and I have a shared humanity that defines who we are and defines what the person-centred approach is.’

What I want to suggest in this talk is that the person-centred approach has a real contribution to make to social justice thinking and practice. But, at the same time, I want to suggest that there are ways in which the person-centred approach is limited, and that if we want to develop a really strongly social justice-based perspective, then there’s more that we need to take into the person-centred approach. This is a synergy between person-centred and social justice: to create something that could be so special and so powerful and so badly needed in the world today.

The Contribution of the Person-Centred Approach to Social Justice

So why might the person-centred approach, the thinking of Carl Rogers and the work since him, have so much to contribute to social justice? What the person- centred approach introduces is this idea, as discussed earlier, of psychological equality. And it’s not just seeing the other as equal in terms of how they might be or how they could be, but in their very core: in the very essence of their being. It’s an acceptance in their genuine, authentic being.

That really deep, powerful acceptance is something that many ‘social justice’, ‘progressive’ perspectives today don’t always have. They have a notion of equality. They have a notion of fairness, but often it’s a fairness at the social and at the economic level only. What’s missing is that fairness, that understanding, that depth of equality as one human being to another. ‘Social justice’ perspectives—for instance, Labour perspectives and Green perspectives in the UK—can sometimes really move into a ‘politics of blame’: where those who disagree with us are seen as bad or malevolent, they become demonized. If you look, for instance, at how left-wing MPs can talk to their opponents in political debates, or Prime Minister’s Question Time. Or if you look at election manifestos, the ways that, for instance, Labour talk about the Greens or the Greens talk about Labour. Even somebody who has a slightly different view on something—rather than being seen as another fellow human being who is doing their best to articulate and put forward a viewpoint, is often demonised, is blamed, is criticized, is seen as fallible and even malevolent. And although, for me, it’s really understandable that we can adopt those perspectives (I know I can do it myself), I think it betrays the very principles of social justice; which is a really deep, abiding valuing of everyone and their due.

So, as I state in my recent book, to deepen and advance progressive thinking and practice, we need to move from a politics of blame to a politics of understanding, and that’s one in which even our political opponents are engaged with in empathic, valuing, and caring ways. And that’s where I think the person-centred approach, with its unconditional positive regard, empathy, and congruence, has so much to offer to social justice perspectives and practices. Michael Lerner argues for something similar when he talks about a stance of revolutionary love. Lerner talks about this as a ‘socialism of the heart’, and he describes it as the love of life in all beings embracing this world with all its complexities, heartaches, and joy. It’s an approach that is caring towards everyone on the planet, even those whose behaviour we hope will change, and towards the earth in all its magnificent diversity as well.

This stance of radically accepting the other, whoever the other is, is, I know, massively controversial for progressives. Does it mean accepting people like Trump? Does it mean saying, ‘Wow! He’s such a nice guy’, we can’t criticize him. That certainly isn’t what I’m suggesting. Rather, that commitment to seeing the other as psychologically equal can run alongside a fundamental commitment to economic, political, and social equality—and being willing to challenge those who undermine it. But, despite such challenges, it is a willingness to view the other, every other, as a human being like ourselves, with needs, wants, and experiences that are, in the words of R. D. Laing, ‘intelligible’ and meaningful. In the terms of Rogers, it’s about seeing all others as striving to maintain and enhance their being: that those needs and wants are legitimate from that person’s subjectivity. It’s an openness to putting ourselves in the shoes of the other, and to taking the other’s perceptions seriously, just as we want them to take ours. Bhasker Sunkara, author of The Socialist Manifesto, said that, at its core, to be a socialist is to assert the moral worth of every person, no matter who they are, where they’re from or what they did.

In other words, when we engage with others from the assumption that we’re right or good and they’re wrong or bad, we betray a core principle of social justice thinking: that all people are of equal worth. And the person-centred approach gives us a way of moving beyond that politics of blame to one which, while still able to critique certain behaviours and say that certain behaviours are damaging, can hold that worth of people. Karl Marx’s favourite maxim was, ‘Nothing human is alien to me’, which is actually what many people say is the defining quality of humanism’. And that needs to apply from us to them, from Left to Right, as well as from them to us. That principle of psychological equality means moving beyond the demonization of the other. It means moving towards a politics of holding and prizing the other; beyond seeing our political enemies as inherently evil, manipulative, deceitful; beyond a James Bond-type world of ‘baddies’ and ‘goodies’. It doesn’t mean that we can’t oppose people who act in oppressive ways, it doesn’t mean we can’t challenge them, it doesn’t mean we can’t even use force to stop them hurting others. But in all this it means not turning the other into a monster. It means holding on to their humanity with a care, compassion, and the egalitarian spirit that is at the heart of a social justice vision.

This belief in the goodness and capability of human beings is rooted in my own personal journey. When I was a child, and I used to go to school and tell my schoolmates that I was a Communist, the first thing people would say to my sister and myself is, ‘Do you believe in money?’ and we’d say ‘no’. And people would say, ‘Well, that’s not going to work because everybody would just go to the shop and take whatever they want.’ I remember imagining people going to the local sweet shop and taking all the packets of sweets off the counter and stripping the shelves bare. But my sister and I used to have a pre-prepared answer: ‘Well, actually, people won’t do that. People are inherently good. And it’s money, society, that makes people bad.’ That conception of people as basically good is really still with me—albeit, I hope, in more sophisticated and nuanced form. But it comes from that person-centred commitment to psychological equality: a commitment that I still believe needs to be at the heart of a progressive/socialist/green outlook. Because it just seems to me deeply arrogant, patronizing, and hierarchical to think ‘I’m right’, ‘I’ve got the answers’, ‘Other people are less moral, less capable, less right than I am.’ If I see the world in that way. If I see myself as right and the other is wrong, then how am I different from any other perspective that holds, ‘I’m right. I’ve got the answers. I’m better than you’?

A second reason why I believe in the essential ‘goodness’ of others is that, if others aren’t actualizing, if they don’t have that potentiality or aren’t able to do that, then where does that lead? Does that mean that a socially-just society would need to be enforced at the endpoint of a gun: that we would need laws and regulations and force to keep people within an equitable way of being? To have a positive, thriving, socially just society, we need a vision that people can cooperate, people can work together: that people can do the best, given the possibilities and given the resources to do so.

Also, if we want to create a better society, we need to understand what people really need and want: what really motivates people. If we blame people, if we see people as demonic and bad and malevolent, we miss a deeper understanding of others. Developing a better society starts with asking what it is that people need and want: what would better look like, more of what? And I think, as therapists, that’s something we’re doing all the time: understanding people in terms of their deepest needs and wants. That is, understanding their strivings to grow; understanding people in terms of that desire for relational depth; striving, as in Rogers’s theory, for self-esteem; striving for freedom; striving for meaning. These are all things that, by sitting alongside people, empathising with people, we come to understand. What we learn as therapists is that it’s very rare that you sit with somebody—whether you work in person-centred ways or otherwise—and think, ‘My God, this is just a really bad person.’ What you see, rather, is that sometimes people do damaging things, but it nearly always comes about because they’re striving for things which, ultimately, aren’t ‘bad’: like a desire for relationality or self-worth.

So I think a person-centred attitude would allow those interested in social justice, those on the Left, those working towards a more equitable society, to understand more about what it is that people deeply want. There’s some really interesting developments at the moment around ‘wellbeing economics’. This has become very influential in places like New Zealand and in some of Scandinavia where governments, rather than thinking, ‘How do we maximize GDP?’ are thinking, ‘How do we maximize wellbeing?’ And there’s some really interesting kinds of calculations used to work out wellbeing. But it’s all got to start from this question, ‘What is it that people want? Where is it that people want to go to?’ The person-centred approach has got some great answers for that. And, in our experience as therapists, we don’t just see what people want, we experience it. I know, for myself, that when I’m sitting with clients there’s a powerful sense of another person striving towards growth and development: striving, not just for themselves, but also for others. I don’t think I’ve ever worked with a client who’s just thought about themselves. I’ve worked with clients who often struggle between the need for self and need for others, but there’s always some element of the other there in the self. And it’s something that I experience. It’s something that we deeply know, because we’ve been alongside it. Of course, as psychotherapists and person-centred therapists, we don’t have all the answers, but I do think we have something very important in terms of that lived, experiential sense of where people are striving to go to, and what people are like at that very directional core.

Of course, in Rogers’s lifetime this commitment to meeting others through a lens of psychological equality was applied and extended to thinking about politics and thinking about social justice. Rogers says, as quoted by Gay Barfield, ‘I find for myself, I’m most satisfied politically when every person is helped to become aware of his or her own power and strength.’ Rogers, in his work, was deeply political and deeply committed through his ideas and through the person-centred approach to making a change at a wider level. That was probably most manifest in Rogers’s peacework. Maureen O’Hara writes:

In his last years Rogers worked in over 20 countries, including South Africa, where he facilitated encounters between blacks and whites, Latin America, where North encountered South Europe, where Eastern bloc Marxists met Western humanists. Ireland, where Protestants met Catholics in Rust Austria, where he brought together diplomats, politicians, and peace activists from Nicaragua, the United States, and other Central American and European countries, to consider the violence then raging in Central America. And to the former Soviet Union, where participants met each other in new and more open ways.

Rogers felt that the person-centred approach had a real contribution to make at that wider political level in terms of psychological equality, in terms of a vision of people as being able to talk and listen and work together. What you see in his Rogers’s peacework (see, for instance, his video The Steel Shutter of his work with Protestants and Catholics in Northern Ireland) is him really entering into the political sphere in such a unique, original, inspiring way. He brought ideas of the intrinsic value of every person from every community together, and believing that people can hold that value of each other, and that through that communication they can find solutions.

That’s something that has continued to have a contribution to make. And we see that in work continuing today, there’s work from the Peace Project people like Gay Barfield, who for many, many years been involved in that; Maria Kontarini; the work that John Wilson’s been doing with colleagues on Going Global; Maureen O’Hara in the United States on leadership and senator John Vasconcellos, who tried to bring Rogers’s ideas in to the American political system. And, there’s some really interesting work that Emma Tickle at the University of Nottingham and colleagues are doing on peace and the person-centred approach (see here). There’s also been some really impactful and far-reaching developments, that maybe wouldn’t be called strictly person-centred, but has been very much inspired by Rogers. For instance, nonviolent communication by Marshall Rosenberg: how we can communicate with others to avoid conflict by using ‘I-statements’ and owning our feelings rather than blaming the other. Parent Effectiveness Training from Thomas Gordon. Also, a lot of the social and emotional literacy training in schools: where they train young people, for instance, in developing empathy—a lot of this has roots in Rogers’s work.

So I think the person centred approach paves the way for a new kind of progressive politics; a politics that isn’t about blame, that isn’t about ‘I’m right and you’re wrong’. It’s a progressive, emotionally-literate politics that involves progressives taking the first step to genuinely act in non-defensive, cooperative ways: putting ourselves out there and taking the risk of trusting and being open to others. This is a politics which is about accepting and valuing the others, whatever their beliefs; trying to understand where people from different views come from, engaging in genuine dialogue. A politics that is about honesty, transparency, and congruence. Imagine politicians who could recognise, and be truthful, when they make mistakes and show vulnerability; who could be self-aware. And, also very importantly, politicians who can look after themselves and self-care. At TaSC, we’ve worked quite closely with a group called Compassion in Politics, and it’s very interesting to hear from them just how little self-care there often is in political environments.

Challenges to the Person-Centred Approach from a Social Justice Perspective

So, the person-centred approach has a unique place in social justice. But, despite that, we also have to recognise that, if we look at contemporary political movements—if I talk to my Gen Z kids about the things that are the forefront of their minds—things like the trans rights movement, Black Lives Matter, #MeToo, intersectionality, responses to the far right across Europe and America…The reality is that the person-centred approach hasn’t figured heavily at all. This is in terms of both action, and in terms of making sense of some of these issues. That’s not to say that people in the person-centred approach haven’t been involved individually. I know many people have got really involved and done really good work, but as a field we’ve yet to find a way of effectively responding and leading in these areas.

I think it’s also true to say that in the therapy field, in the US, for instance, the cutting edge of therapy is now work around multicultural counselling and social justice approaches—a ‘fourth’ or a ‘fifth’ force in therapy (see competences, for instance, here). And they would actively see themselves as something that has moved on, or even moved away from, a humanistic, person-centred approach. Not to say that they’d entirely reject humanistic or CBT or psychodynamic ideas and practices, but they clearly make a mark between social justice, multicultural approaches and approaches like person-centred therapy. Part of those social justice approaches is practices like broaching (where the therapist, deliberately and intentionally, introduces issues like race, as relevant to the client’s presenting concern) or advocacy (where the therapist is working alongside the client to help them with practical issues around, say, housing or welfare). These aren’t issues that have been theorized yet and worked into person-centred practice. Indeed, in multicultural and social justice practices, at those edge, they might even say that this is something opposed to more traditional non-directive ways of working.

So I think we need to ask ourselves, ‘What is it about the person-centred approach and person-centred thinking that maybe means that we haven’t been at the forefront of some of these developments?’

Much of it, I think, comes down to the individualism of person-centred thinking. It’s individualism that makes it difficult to integrate into the approach understandings and practices which take into account wider social factors, structures, and power dynamics: both in terms of what it means to be marginalized and be at the bottom of a power hierarchy; and also what it means to have power and what it means to be privileged. Emma Tickle was saying recently that perhaps the person-centred approach is very good at the individual level, and also in terms of universal human qualities. But where it perhaps isn’t so strong, is at that meso- level: in terms of people being members of classes, cultures, particular groups—and then the interfaces between those classes and cultures and the power dynamics between them.

Much of this is rooted in the individualistic assumptions that underlies the classical person-centred approach. The basic idea within Rogers is that we come into the world as an experiencing organism: a monad-like separate entity. And when we understand people in that way, we can certainly say that all human beings phenomenologically, experientially, are equal, and should have equal rights, and should have equal freedoms. And that’s very much there in liberal ideology. But what is more difficult to conceptualize when we think about people in that individual experiential, phenomenological way—as these phenomenological wholes—is how a priori, pre-existing structures, cultures, unfreedoms, imbalances in social and economic power resources really come in. If we start with this experiencing phenomenological organism, where is the place for these a priori structures?

In many ways we can compare it with a shift from Husserl’s phenomenology to Heidegger’s existential philosophy. Husserl’s focus tended to be on individual experiencing. Heidegger, who was really influential on so much contemporary thinking, emphasised more that human being is not a fixed, finite monad, but an openness, a receptivity to the world. We are embedded, or in Heidegger’s language, ‘thrown’ into a world. So we’re not a separate being in Heidegger’s thinking in quite the way we are in earlier Husserlian thinking. We are a ‘being-in-the-world’, we are influenced and embedded within the world.

Certainly, Rogers doesn’t say that we are not influenced by the world. But, for Rogers, it’s more that we come in as a whole being, and then the world infiltrates us and affects us and damages us in various ways. For Heidegger, by contrast, and for many people who then follow on—postmodernists, many feminists, people writing about sex and gender (like Judith Butler), multicultural thinking, posthumanistic thinking—it’s all founded around the idea that we are fundamentally embedded in the world. It’s interesting to compare the Rogerian and Heideggerian ideas of authenticity. For Rogers we come into the world as authentic, become inauthentic, and then therapy can help us return to an authentic state. But for Heidegger we are inherently inauthentic, because we are inherently thrown into a world that is beyond our making. We can find some kind of awareness of where we are in that. But we can never be truly separate in this ‘intersubjective’ model of the world. One of the popular ways of thinking about that embeddedness today is from Broffenbrenner. Many people will know the ecological systems model: the idea that you have the individual, and then you have the microsystem around them, then you have the community, then you have these wider levels. And the person is all these levels. There’s not a fixed individual who is separate from all these levels. But the person is fundamentally immersed in the world.

So, for instance, when we look at issues like race: from a liberal perspective, we might say white people and people of colour are equal. That would be fundamental. But if we start from an understanding of people as embedded in classes and in structures, in powers, in hierarchies, then it’s not just that people are phenomenologically equal. It’s also that they carry the weight of different structures that they are part of. Person-centred thinking certainly allows for an appreciation of marginalization: it has enormous ability to understand that experience of oppression. But what it lacks is that ability to understand the structural embeddedness of it. For instance, as a white person, I have a certain privilege, even though I might not feel privileged, but there is still a structural privilege that goes with that that doesn’t discount the fact that phenomenologically I may not feel privileged. There is this structural, economic, social privilege. In person-centred terms, we do take into account social factors, in the sense that people experience conditional positive regard, and certainly somebody could have conditions of worth as a female or as a male, and that could limit and oppress them. But we’re not just talking about conditions of worth here because we’re talking about economic, social, political, power-based realities that mean that there are dis-equities and imbalances that sit alongside the phenomenological experiencing.

This has real implications for practice. The basis of the ‘core conditions’ is the idea that, if we can create an open, unconditionally accepting space for someone, then it allows them to express their authentic truth and to grow and enhance themselves in whichever way is right for them. But it’s based, to a great extent, on the idea that people are on an equal playing field to begin with. If we start from a more embedded, contextualized understanding—that people are marginalized and disempowered by things like social injustices, racism, and poverty—then the work as a therapist isn’t just about providing a non-directional space, but to work to bring the person back up to a level of equity. That’s the approach of people who advocate for multicultural and social justice therapies and practices like broaching. Here, you can’t assume that people are starting on the equal level. There is a dis-equality which means that interventions need to support people to come back onto the equal level.

There’s kind of been similar discussions around what happens in groups. There was a really interesting paper written by Jo Freeman in the 1970s called ‘The Tyranny of Structurelessness’. She was talking about unstructured groups in the feminist movement. But such groups are also very central to the person-centred approach, on the basis that such structurelessness allows everybody to have space to speak: to create equality. But what she argues is that, if you have unstructured groups, what comes to the fore is the pre-existing power structures. Elites, those in power, recreate those power structures in a vacuum, and therefore you may need more active facilitation: people to hold open a space for everyone. You need, maybe, structures. You need leadership as a way of allowing and supporting equality to emerge.

So while the strength of the person-centred approach is that ability to really hear deeply the phenomenological experiencing, there is also something outside of that; the a priori, the before those structures that the person-centred approach, as it’s developed, as it’s practiced, may not fully take into account. And this raises challenges for the person-centred field. I think that’s why movements like Black Lives Matter, MeToo, have moved to a radical perspective. It’s moved away from, or moved on from, or moved apart from, what is a more traditional, classic, person-centred, humanistic understandings—towards one which emphasizes power and imbalance.

The counterpoint to that, though, is that if we move too far from a phenomenological understanding, that understanding of people in terms of intelligibility: if we just understand people in a structural sense, then we lose touch with the reality of people’s experiences. I know some people have argued that the backlash against ‘wokeism’ is because people feel that they’re being accused of racism or transphobia or other wrongs, and it just doesn’t sit with their conscious, phenomenological experiencing. Certainly, this is not to suggest that that is the only reason why there’s been a rise of the Far Right. But, perhaps, there is something about people feeling that they aren’t understood because it doesn’t match their phenomenological reality. So the challenge, and I think it’s a very important challenge, is, ‘How do we hold on to…? How do we combine…? How do we create synergies between a deeply phenomenological psychological equality that really values, respects, and understands that experiencing of the other as a human being like me; but can also recognize that that sits within structures—within powers that extend beyond the phenomenological experiencing?’ For Rogers, everything is subjective. And yet, if we collapse everything into the subjective, we lose that intersubjective, we lose that structure, we lose that relationality.

Evolving Synergies between Social Justice and the Person-Centred Approach

The challenge, then, is to find some kind of structured, embedded, contextualized phenomenology. To understand phenomenological experiencing and the actualizing tendency—that striving for maintenance and enhancement of self—but to understand that within structures: not just the conditions of worth, but also economic, social class, and cultural structures.

Actually, a lot of that is already there in the work of Karl Marx, and the parallels between Marx’s and Rogers’s writings are quite striking. This, for instance, is from Marx’s Kapital:

All means for the development of production transform themselves into means of domination over, and exploitation of, the producers; they mutilate the laborer into a fragment of a man, degrade him to the level of an appendage of a machine, destroy every remnant of charm in his work and turn it into a hated toil; they estrange from him the intellectual potentialities of the labor process in the same proportion as science is incorporated in it as an independent power, they distort the conditions under which he works, subject him during the labor process to a despotism the more hateful for its meanness; they transform his life-time into workingtime, and drag his wife and child beneath the wheels of the Juggernaut of capital.

Here, we see that Marx combines that deep phenomenological understanding of self-estrangement—a distortion of the experiencing self, which Rogers also focuses on—but rather than understanding it wholly in psychological terms, Marx shows how our social and economic conditions can impact and inform our phenomenological reality. It’s something that I talk about in Psychology at the Heart of Social Change: the resources that we’re limited by and how they create internal conflict. What I argue is that, as we have more and more constricted resources then, psychologically, phenomenologically, what that does is to creates more internal conflict. It’s a bit like in chemistry: if you have a balloon and you squeeze it more tightly, the atoms bounce up more and more against each other. From a Rogerian standpoint, we are actualizing beings, meaning that we are always striving to maintain and enhance ourselves. But sometimes that can take us in different directions. There’s different things that we want to maintain and enhance. And as our resources become more and more limited, so we’re more and more forced to fight against ourselves. Rogers’s conflict between the desire for positive regard and the desire to actualise other wants and needs (like our sexuality or our sense of identity) is one example of that. In conditions where there’s very strict, conditional, positive regard, then we have to make choices about, ‘Do we actualise this or do we actualise that?’ And similarly, if we have limited economic resources—somebody who’s in a very impoverished environment—it’s not that they’re not actualizing. It’s not that they’re not still striving to maintain and enhance themselves, but they are forced more to fight against themselves and make more and more difficult choices, because to have A means that they can’t have B and vice versa. If we had unlimited resources, we could have A and B and C and D and everything that we wanted to, but as those resources become more limited, so the internal conflicts become more and more and more.

So that’s one way to develop a contextualised phenomenology, and I think that can also help us understand something of why is it that people can behave and think in ways that can really do a lot of harm and damage to other people, like the Far Right. We can understand the actualizing tendencies as operating always within a context, within a particular horizon. So rather than seeing, as Rogers tends to, that everything ultimately is aligned to a single formative tendency—that everything is ultimately for a greater good—we can understand people as acting in relation to their particular circumstances. For instance, somebody who’s driving a car to work when they don’t need to—that’s causing damage to the to the planet. We can’t say, ‘That’s not an expression of the actualising tendency’, because then we get into contradictions around the idea that sometimes people are driven by something other than actualisation (which Rogers describes as the one and only driving force). But what we can say is that, where somebody’s limited—and again, the more limited the resources, the more limited the horizon—the less far they can see: they can’t see the bigger picture, the full effect. In other words, the more limited the horizons, the more somebody might just look at their local context and just think, ‘Well, I’ve got to get to work. It’s really important to get to work. I’m stressed.’ So it is actualising. It’s a person striving to do their best in that circumstance, but because the resources are so limited, they can only see the very local context.

One of the things I talk about in a couple of recent books is the idea of rogue goals, and rogue goals is the notion that we can get caught up in local, immediate goals and miss the bigger picture. It’s not that we’re not actualizing. It’s not that we’re not directional. But we can get caught up in lower-level goals where we’re aiming for things that might seem or might feel that they’re maintaining or enhancing within that context, within the horizons that we can see. But within a broader horizon, within a broader context, they’re not actually the best thing for ourselves or for others. A classic example might be, for instance, using drugs. It’s not that someone who uses drugs isn’t trying to maintain and enhance themselves: they’re striving. It’s just that that drive is then opposed to other things that are healthy and things that they want, like good health. And we can think about that going all the way up: that people in a community or people in a class can become focused on just the goals for that class—just what that class wants—and lose sight of the bigger picture.

In terms of developing synergies, there’s also something about leadership. Sometimes, in the person-centred field, we can be very wary of leadership: we don’t want to tell people what to do. But I remember Pete Sanders always saying, ‘Don’t trust the process, organize the process’. Maybe if we recognise the risks of that actualizing tendency working towards local and lower-level kind of goals, rather than seeing the bigger picture, then we can see that there needs to be people who can be in those positions of leadership who can coordinate between different positions. Ideally, that is the role that a leader can play: not that they’re making the decisions, not that they have the power. But they’re able to coordinate between multiple perspectives and hold on to an idea of social justice and see that, when one person is striving for getting what they want… OK, that might be actualizing in that person’s context, but, actually, that could then damage others—the greater whole. What I’ve learnt in my time in the therapy field is that there’s such a desperate need for leadership, and particularly around social justice. In TaSC, we’ve had people coming in taking on leadership roles in such a supportive way to the community as a whole, and I think there’s a real ‘servant leadership’. I think it’s to the detriment of the person-centred approach if we don’t see ourselves as having the potential to take on leadership roles.

There’s also something about nuance: understanding that, if we combine structural perspectives with more phenomenological perspectives, things can get pretty complex. In the multicultural approach, they talk about the way that people can hold positions both of power and marginalization at the same time. That, for instance, as a white Jewish man, I have both privilege but also that I’m marginalized in certain ways. Some of the work around pluralism is trying to allow for heterogeneity, allowing for different perspectives. That is, allowing that tension, for instance, between class structures and community structures and psychological structures, and more messiness.

There’s also something very exciting to me about seeing parallels across different levels. If we use a concept like ‘configurations of self’—the idea that we will have different voices and parts within us—we can then think about the parallels between what goes on at an intrapersonal level, what goes on at an interpersonal level, what goes on between communities, and what goes on between nations. What are the kind of processes, for instance, that as a person-centred therapist we know work at the intrapersonal level: for instance, prizing different voices and engaging empathically. And we can think about how these processes—ways of maximising benefit—can operate across different levels. Similarly, thinking about democracy: that’s something we have a sense of is good within a nation. But then, what might it mean to have a democratic internal, psychological structure—between the configurations of self?

Finally, when thinking about social justice, I think it’s important to ask whether ‘person centred’ is the most helpful term? Will ‘person-centred’ always mean a focus on the individual and be in tension with a wider social justice perspective? And, for instance, how does that work with ‘transhumanists’ who think about animals and the environment. Do we need to think about other ways of articulating what we really believe in? In part, I guess this goes back to the question of the essence of a ‘person-centred’ approach? What is it really about? Is it a particular model of the person? Is it a particular ethic? Is it a particular set of values? Perhaps if we understand it as, most fundamentally, a set of values, then that might give it the greatest potential to align to a social justice perspective.

Conclusion

I hope I have conveyed, in this talk, my view that the person-centred approach has a unique contribution to social justice. It’s a trust in the intelligibility of the other: their deep, deep psychological equality. But I also think that the person-centred approach is not a complete theory of social justice—at least, not yet. And we have some choices, as a community, as a field, about whether we do develop the person-centred approach to be a practice fundamentally rooted in social justice, or whether we see social justice more as just a corollary of our clinical or ontological foundations. Personally, I would love to see the former, but it all comes down to how the person-centred approach is defined and conceptualised for the future. And, even as an approach that is defined primarily in clinical terms, it still has much to contribute to a fairer, more equitable society—one in which all citizens have an opportunity to thrive.

Acknowledgements

I am deeply grateful to the many people who have influenced and informed my work: John McLeod, Pete Sanders, Nicola Blunden, colleagues in the TaSC Network; and my partner Julie. Thanks to the organising group for the Melissa Harte lecture: Kurt Renders, Lou Cooper, Shari Geller, and Genevieve Rix. A very special thanks to John and Sandra Wilson at Onlinevents and their team, both for supporting this talk and also the very warm and kind support they have given to me, as a person, over the years.

Photo by Alexander Grey on Unsplash

'AI-Thou': Can There be Relational Depth with an AI Therapist?

At the recent conference of the UKCP (United Kingdom Council for Psychotherapy), it become increasingly evident that AI-delivered therapy is not a matter of ‘if’ but ‘when’. We will have Chat GPT-like technologies, ‘humanised’, providing therapy to people. But will there always be something missing? Will AI ever be as good as real human therapists? The question is not so much about now—with all the bloopers of Chat GPT, Siri, and other AI platforms; as well as their horrendous environmental impact—but in the near- and further-future, when AI will be refined and developed and able to do even more amazing things than it can do now. Nevertheless, I guess, like a lot of therapists, I am still hoping that there is something unique and special that only human therapists can provide.

And if there is, it is likely to lay in the capacity for providing a deep, interpersonal connection. AI, no doubt, will be able to remember what clients say better than us, to detect patterns and emotions in their language, to provide potential diagnoses or formulations in ways that far exceed our capabilities. In this way, I am sure that AI will become a tool to support our therapeutic work (though issues like confidentiality and data protection will need ironing out first). But, perhaps, the one thing that AI will never be able to do is to relate in the human-to-human way we have defined as relational depth: ‘A state of profound contact and engagement between two people, in which each person is fully real with the Other, and able to understand and value the Other’s experiences at a high level.’

Relational depth can be understood as a state of relating in which each person experiences the other as a ‘Thou’ rather than an ‘It’. This links back to Martin Buber’s concept of the I-Thou attitude. The I-Thou stance has a number of facets to it: (a) We stand alongside the other rather than survey and study them as a thing; (b) We encounter the other as a dynamic stream of being rather than as an object; (c) We relate to the other as a whole rather than as a collection of parts; (d) We recognise the other’s freedom and indeterminism; (e) We encounter the other as a particular, unique being rather than as a representation of particular classes: an ‘Other’; (f) We deeply accept this Other; (g) We relate as a whole, ourselves, rather than from our parts; and (h) We let go of our established ways of doing things and allow ourselves to be transformed in the relationship.

Could a client relate to an AI therapist as a Thou? Perhaps. They could experience them as a unique, accepting, empathic stream of being. The client could relate as a whole, revealing their innermost thoughts and feelings, and in ways that allowed themselves to dive into the ‘relationship’ and be transformed. But the client would also know, at least at some level, that the AI therapist was not free: that it was determined rather than self-directed—programmed to be. There would be a lack of a volitional agency meeting them, such that clients might feel drawn into relating to the AI therapist as a ‘Thou’ (the ELIZA effect), but I think they would also know that, at some level, they were experiencing an It.

And there is also the question of whether the AI therapist could experience the client as a ‘Thou’. I think, here, the answer would definitely be ‘no’. AI, however it was programmed, would always need to break the person down into parts, and to understand them through heuristics and rules. It could never go beyond it’s own knowledge base to comprehend the client in their freedom and indeterminism. By definition, AI would always need principles and procedures by which to make sense of—and respond to—the client. It could only go beyond through new principles and procedures. What’s more, in our research on relational depth, we see that a key feature of it is a genuine care towards the other: that the therapist really, genuinely wants the client to do well. AI, however well programmed, and however caring it acts, can never experience a genuine care. Things, people, cannot matter for AI. So, for the AI therapist, the client would always be an It rather than a Thou.

When people describe the experience of relational depth, they often talk about its interconnected quality: not just ‘I know you’ but ‘I know that you know me’. In those moments of meeting, we feel that the other is meeting us: that we are their Thou just as they are ours. You cannot relate at depth to something or someone who, you know, is not relating at depth to you. Will clients know that, to their AI therapist, they will always be an It? I think, again at some level, that consciousness is always going to be there. We can imagine our AI therapist really recognises us in our uniqueness, that they are able to go beyond their procedures and heuristics to experience us in novel, a-procedural ways; but won’t the client, always, at some level know? And, if so, that knowledge of the ultimate it-ness of themselves in the eyes of their AI therapist will disrupt any true sense of relational depth.

Apologies for the crudeness of this analogy, but the subject of sex toys does come to mind. Sex toys can give stimulation and pleasure, sometimes more so than other humans, but there is also a distinctive human quality missing. It’s not making love: it’s not having that deep physical-psychological-intimacy that, I think, can only be experienced with another human.

Relational depth requires reciprocity. And it requires what has been termed co-intentionality: the sense of another agentic, directional being coming towards us. Daniel Stern describes the way that, in this ‘moments of meeting’, the client and therapist—or, earlier on, the parent/carer and child—come together to share wants, needs, and goals. They align, move towards the same shared possibilities. Could an AI therapist understand and share a client’s goals for therapy? Yes, possibly. And they could certainly align on the tasks of therapy. But would a client ever have a sense of being joined by another agentic being? Like many others, in my book Integrating Counselling and Psychotherapy, I argue that the most distinctive feature of living organism is their directionality: their movement forward to fulfil wants and needs. When I look at my cat Bonnie, I can experience a relational depth because I am sensing that she is wanting something from me, is moving towards me and into me as a means of moving onto somewhere. We can join. But, if passive, dead, responsive-only, then that sense of co-doing-something-together can never quite be there. I’m in the lead—and, fundamentally, alone.

I think this question of whether AI can relate at depth is one that needs asking, and exploring, more and more for the future; because it is essential to the issue of where humans will be—and what humanity will mean—in an AI-infused (or AI-dominated) world. Almost certainly, AI is not going to stop, it’s going to evolve, and probably at a faster and faster rate. So however scary that might be, it’s an issue that we probably need to stare in the face. I’d love to know what people think: do leave comments. Perhaps the issue comes down to the ‘at some level’: to what extent will we—or will we want to and be capable of—denying what we ‘know’ as the truth? People perceived ELIZA, the ‘Rogerian’ chatbot developed in the 1960s, as having empathy and experiences. But did they really? Did they really feel and know this at an existential level? Perhaps, indeed, the non-humanity of AI will become the fifth existential given (alongside death, isolation, meaninglessness, and freedom): something that we all know, unconsciously, is true, but often deceive ourselves into believing does not exist. ‘I will not die… there is a given meaning to my life… and my AI therapist really cares for me as the unique being that I am.’ Perhaps, for the future, retrieving the actuality of human care and connection will be the greatest challenge of them all.

A final thought: If human connection is irreplaceable, it does give me some optimism that, as a humanistic- and relationally-oriented therapist, our approach may have some endurance and importance for the years to come. It’s fairly easy, for the future, to imagine AI delivering sophisticated and personalised CBT techniques, and perhaps also psychodynamic interpretations based on the client’s verbal and nonverbal expressions. And such interventions, I am sure, could be incredibly helpful. But, from a humanistic and relational perspective (including contemporary relational psychodynamics), where the heart of the therapeutic enterprise is in-depth relating, there’s always—at least, as I’ve argued here—going to need to be a human providing it. CBT and classical psychodynamic practices, delivered by AI, may do much to help people pinpoint and address particular problems that people face; but where the deepest client issues are to do with isolation, alienation, and disconnection—with feelings un-accepted by the world and outside of relationships and community—only a human being may be able to provide the ‘deep soul nourishment’ necessary to heal. AI, ultimately, might be able to replace all forms of ‘psycho-technology’ in the counselling and psychotherapy field, but relational depth may always be beyond its grasp.

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Postscript

Interestingly, AI (ChatGPT), itself, agrees with me on this one. This is how it answered the question, ‘Will an AI therapist ever be able to have relational depth?’

Relational depth refers to a profound level of connection between two individuals, where they experience mutual understanding, authenticity, and emotional resonance. This concept is deeply rooted in human qualities like empathy, shared vulnerability, and the ability to adapt to subtle interpersonal dynamics.

While an AI therapist can simulate many aspects of human interaction—such as listening, offering thoughtful responses, and even expressing simulated empathy—it may face challenges achieving true relational depth due to several inherent limitations:

Challenges for AI in Achieving Relational Depth

1. Lack of Subjective Experience:
   Relational depth often arises from shared human experiences, emotions, and the therapist's personal awareness of their own vulnerabilities. AI, being devoid of consciousness or subjective experience, cannot genuinely share in or fully comprehend these dimensions.

2. Authenticity:
   A key aspect of relational depth is the perception of the therapist as a real, authentic person. Knowing that AI responses are algorithmic may create a barrier for some clients in fully trusting or connecting at a deeper level.

3. Subtle Emotional Nuances:
   While AI can analyze verbal and non-verbal cues (e.g., tone, word choice, facial expressions), its interpretations are limited by the quality of its programming and datasets. It may miss or misinterpret the unique subtleties of human emotion, which are crucial in building profound connections.

4. Mutuality:
   Relational depth is often characterized by mutual openness and vulnerability. AI lacks the capacity to share its own vulnerabilities or develop a dynamic, evolving relationship.

Potential Strengths of AI in Therapy

That said, AI does have significant potential to contribute meaningfully to therapeutic processes, particularly for individuals who might feel stigmatized or uncomfortable with human therapists:

1. Non-judgmental Presence:
   Clients might feel less judged or intimidated by an AI, enabling them to open up more freely about certain issues.

2. Accessibility and Consistency:
   AI can provide immediate, around-the-clock support and maintain consistency in its responses, which can be comforting for some individuals.

3. Data-Driven Insights:
   Advanced AI systems can analyze patterns in client speech and behavior to offer tailored interventions, sometimes faster than a human might.

Future Possibilities

AI may approach relational depth if:

• It becomes adept at mimicking emotional resonance.

• Users' perceptions of AI evolve to accept its unique "authenticity."

• Future advancements allow for personalized learning, where AI adapts over time in a way that feels dynamic and deeply attuned.

However, it’s unlikely AI will ever fully replicate the ineffable qualities of a deep human-to-human connection. Instead, AI therapists might excel as complements to human therapists, offering preliminary support, data collection, or ongoing care in between human-led sessions.

Hungry Like the Wolf for Essential Research Findings in Counselling and Psychotherapy: Duran Duran and Me

Back in May 2024, Clare Symons, BACP’s Head of Research, told me that she was giving a talk at the BACP’s Research Conference posters and awards ceremony about how I’d plagiarised my research findings book from Duran Duran song lyrics—brilliant! Unfortunately, I couldn’t make the conference but I heard it had the audience in stitches and, to be honest, I was incredibly touched and honoured that Clare had spent the time on my research book and me. Clare very kindly agreed to let me reprint her talk, and slides, below.

***

Birmingham is the home of many rock legends such as Ozzy Osborne, Led Zepellin, Judas Priest, ELO, etc.

This got me thinking, who would we consider to be the rockstars of counselling and psychotherapy research?

John McLeod, certainly. I have seen him in a mosh pit and he’s pretty hard core.

What about Mick Cooper? Maybe. But I’ve always seen him as more New Romantic than rock – which got me wondering so I did a bit of searching and, funnily enough, this is what I turned up:

As you can see, a very fetching photo there on the left of Simon le Bon from Duran Duran – another Birmingham band - and on the right our very own Mick Cooper. I think you’ll agree that the resemblance is uncanny.

But we’re researchers, we don’t draw conclusions based on coincidence, we look at evidence. So I wondered, what evidence there might be for a connection between Mick and Duran Duran. Let me tell you, I was amazed at what I discovered.

A source at Sage very kindly shared this with me:

This is what the cover of Mick’s important book, The Facts are Friendly looked like with its original title which, as you can say, includes a blatant Duran Duran quote.

Unfortunately, the entire print run of the book had to be pulped when royalties costs were found to be too costly to include that in the title. A terrible loss, I am sure you’ll agree.

Let’s revisit where we got to with this Mick Cooper – New romantic – Duran Duran connection. As I said, I wanted to see what evidence there was for this apparent link between Mick le Bon and Simon Cooper. I decided to have a really good look through the Facts are Friendly and… you won’t believe what I found. Let me read you an extract from the book:

This comes from the conclusion where Mick is arguing strongly that students of counselling and psychotherapy should look to the evidence base for inspiration of what to research rather than simply to follow their own idiosyncratic ideas.

Now I don’t know whether any of that sounds in any way familiar to any of you who were around in the 80s but after conducting a systematic and rigorous analysis of the text (using a highlighter), here’s what I found:

These highlighted sections here show something surprising. Mick Cooper, esteemed professor of counselling psychology has been blatantly sneaking Duran Duran lyrics into one of his most widely-read works.

What else might we find if we dig a little deeper?

Here’s something interesting from chapter 2 which is about outcomes research:

Look closely. As you can probably see, there are no Duran Duran lyrics there so perhaps this is a dead end.

However, I don’t know how many of you are familiar with rickrolling – it’s the unexpected appearance of a video of a song by Rick Astley when you click on a link. But it’s actually become so much more than that. There are now very many examples of serious academics finding ways of rickrolling in their research papers. There’s even a published paper looking at how many instances there are in the academic literature.

Now, if we look closely at the section I just read to you…

We can see that we have been well and truly rickolled by Mick Cooper.

Mickrolled, if you will!!

Is Person-Centred Therapy about how we Treat People or How we Conceptualise People?

What really underpins person-centred therapy: ethics or ontology? That is, is it more important how we treat people, or how we understand their fundamental being?

Of course, ethics and ontology are fundamentally intertwined: if we think people are highly malevolent, for instance, we may treat them with extreme caution. But ethics and ontology are not synonymous. You can, for instance, see people as inherently malevolent but still treat them kindly; you can also view people as actualising but treat them very badly. We have all, I am sure, witnessed such contradictions. Believing people are inherently good, prosocial, and actualising is not the same as treating them well. Perception is a predictor of intentions, intentions are a predictor of behaviour, but the relationship is not one-to-one.

Martin Heidegger is a case in point: the greatest of the existential philosophers who fundamentally challenged the mechanisation, de-humanisation, and objectification of human existence. For him, human being was the opening where the Being of the world came to light. Beautiful, deeply humane and humanising. But Heidegger was also a card-carrying Nazi. He betrayed Jewish colleagues; never published anything about the Holocaust; and, perhaps most disturbingly, never apologized for his pro-Nazism.

Heidegger, about 1933, with Nazi insignia

Emmanuel Levinas, the Jewish Lithuanian philosopher whose work critiques and develops Heideggerian philosophy, was a prisoner of war in Nazi Germany, and lost several close family members to the holocaust, including his father and brother who were killed by the SS. You can imagine Levinas, reading the great tomes of Heideggerian literature, thinking: ‘Ontology… what the f….!! You’ve written beautiful ideas, brought Being to light so cleverly and yet, at the end of the day, you’ve colluded with one of the most brutal regimes in history. What good is all that writing, all that pontificating on Being, when your actions defended and legitimised a movement that violently persecuted millions, including those I loved.’ And, to massively over-simplify things, that’s essentially what Levinas wrote—along with Derrida and many of the other postmodernists. That there is something more important that ontology: there’s ethics, how we treat people. And that we can get so rooted and grounded in a particular model of being that, however theoretically humane, we can end up behaving in the most inhumane ways.

When I was a kid, as I’ve written in a previous blog, my favourite film was called The Little Island. In it, three beings, each of whom advocate for one virtue—good, truth, or beauty—end up coming to blow for their beliefs. One doctrine, one truth… how easy it is for those who see their ideology as the correct ideology to derogate and them demonise and then attempt to eradicate others (in acceptance and commitment therapy, the tendency to confuse our perception with the reality is termed cognitive fusion, and considered a major source of psychological difficulties). As social psychological research shows, once we identify with something, bias against the other is not far behind. And as we close into our echo chambers, our frustration and our anger, so that ire can grow. That’s why, for Levinas, care for the other needs to come first. It needs to remain our starting point and our focus. Levinas witnessed, first hand, the violence that ontology can do when held as an ultimate, primordial truth. Yes, of course, we need different models of the person, different philosophies and understandings of being; but, like a horse to a rider, these need to be tamed to a higher purpose: an ethic of care. Bolting, untamed ontology can kill.

I think most people come into person-centred therapy because, fundamentally, they care about people—not concepts. Yes, they may see the actualising tendency as the core of their person-centred beliefs, but they hold this because they have a fundamental desire to extend a deep empowerment to others. When people learn, for instance, that Abraham Maslow, one of the co-founders of humanistic psychology, wrote in his journal, ‘As for unemployed loafers today, in a time of shortages of help, I’d simply be willing to let them starve ultimately’, I think they are pretty horrified. The fact that Maslow was a leading exponent of actualisation theory doesn’t excuse or legitimise his statement. To talk about letting other people starve is horrifying, actualising ontology or not.

Those who criticise a pluralistic approach to person-centred therapy say that it claims to have no foundations: that it is a relativist, nihilist worldview (see, for instance, Ong et al., 2020). But that shows a fundamental misunderstanding of the approach. In our 2011 book, John (McLeod) and I distinguish clearly between a foundational pluralism, that is relativism all the way down, and a normative pluralism, which roots a pluralistic perspective in a particular set of values and beliefs. And we explicitly identify our pluralistic approach with the latter: that is, pluralism is not a foundationless, everything-goes relativism. Rather, we absolutely acknowledge we have certain normative assumptions, but those assumptions are not about how people are, they’re about ethics: how we treat people. Pluralism leaves an ontological conceptualisation open because, like Levinas, we think the question of how we relate to people is more important than how we conceptualise them. More than that, we think that an approach which puts ontology before ethics, like the proverbial Procrustean Bed, can end up cutting off parts of people that do not fit into our a priori schema. So a pluralistic approach does have foundations, but it’s ethical foundations not ontological ones: ‘a prizing of diversity and difference which emerges from a set of fairly specific humanistic values and assumptions which, to a large extent, are not considered negotiable.’

These issues have real, in-the-world consequences. Take a young person who goes to see a school counsellor; and say that school counsellor holds, most fundamentally, that the young person is an actualising organism who has the answers to their problems within themselves. So the counsellor responds to the young person with primarily empathic unfolding responses, reflecting back to the young person what they are saying to help them dig deeper into their experiences. For many young people, as the research shows, that can be extremely helpful, but we also know that there are young people who want something different (see for instance here). For instance, one young person who had person-centred counselling—from an experienced, well-trained, adherence-checked counsellor—said ‘I didn’t receive any techniques or stratigies [sic] to help me. I often came away feeling worse as my problems were out there with nothing to help.’ Now if the counsellor puts their model of the person first—that the young person has the answers within them—there is a real danger that they can miss such actual, expressed wants and needs. Of course, most person-centred therapists wouldn’t do that: they’d be responsive, and I think that evidences that, in reality, relating does tend to be given priority by person-centred therapists over ontology. But the more definitively person-centred therapists hold a particular view of being, the more constrained they may be in their flexibility and openness.

Rogers hypothesises that a set of six conditions were necessary and sufficient for therapeutic personality change in clients. However, his hypotheses were based on the evidence in the 1950s, and the psychotherapy research field has moved on massively since then. The research evidence now tells us a different—though not entirely unrelated—story (see here). Moreover, as Rogers, himself, acknowledged, to make any ‘totalising’ statement about what all clients need doesn’t allow for the highly individual ways in which clients may benefit from therapy. This has taken me a long time to feel brave enough to say: but my view is that it is unethical for therapists to work with clients holding a fixed and definitive belief that, in all cases, Rogers’s conditions are necessary and sufficient for therapeutic personality change. It just isn’t true, and it’s failing to recognise the uniqueness of the individual clients that we work with. That’s not to say that therapists shouldn’t recognise Rogers’s brilliance, or the importance of the core conditions to therapeutic work. But to hold that ontological assumption foremost, that ‘I know who you are irrespective of what you say to me’, is, I think, to put the therapists’ own needs (for instance, for security or self-belief) before the needs of our individual clients.

It also turns therapy into a religion: a set of beliefs which remain consistent irrespective of empirical evidence. And, of course, religions are absolutely legitimate—many of our clients will be religious or spiritual. But the difference is, religions are something that people (or their families and communities) decide on for themselves. By contrast, as therapists, our ‘religion’ exist in relation to the people we work with; and so owning it and bracketing it takes on more importance. If a young person went to see a school pastor, and if that pastor started telling them that they should see the world in a specifically Christian, or Muslim, or Jewish way—without explicit agreement from the young person and/or their parents that that is what was going to happen—there would be uproar. Similarly, if we believe in a particular ontology, that’s great—we’re all, always going to have particular models of how people work. But when we work with clients, we need to recognise that that is our ontology, and it’s a perspective, not a truth.

Sometimes I do feel that such pluralistic principles and thinking lie outside of the person-centred approach: that person-centred therapy is defined by its ontology—a belief in the actualising organism—and that pluralism is of a different type and order. But then, when I talk to students coming into the person-centred field, or reflect back on Rogers’s writings, or read research evidence on clients’ multifacted needs and wants, I really do feel that what Rogers’s person-centredness is about, first and foremost, is a particular mode of relating to others. And I feel that even more when I hear about people being brutalised in the name of ‘person-centredness’: for instance, students being shamed for being ‘too directive’ (as I’ve witnessed or been told about many times), or writings (including my own) being rubbished and demonised by other members of the person-centred. When I experience that, it makes me feel that, yes, what we’ve tried to articulate through pluralism is a really valid, legitimate, and important attempt to articulate what person-centredness is about. And I feel that most of all when I hear about clients—albeit, undoubtedly a minority—coming into person-centred therapy and leaving confused and disappointed, because they felt the therapist was inflexibly un-directive: working from assumptions about who they are, and what they wanted, that just didn’t suit and weren’t transparent.

Ultimately, it may be that someone will show that I’m wrong: that ‘person-centred’ really does refer to a model of the person rather than an ethic and a mode of relating. And, at that point, I’d be happy to walk away from the approach. Because for me, whatever we call it, what matters most is how we treat clients and what we try to do with them, not our particular theoretical model of who they are. But I just can’t quite bring myself to think that, ultimately, the person-centred approach is a cold, impersonal set of theoretical assumptions about the nature of human being. When I think of Rogers, what strikes me most is not the theories, but a felt-sense of a warm and caring man who wanted to bring more compassion, acceptance, and understanding into the world. Naïve, perhaps, but there’s also an astuteness of utmost importance in being able to name what matters most.

Further Reading

Our original paper on the pluralistic approach to person-centred therapy can be found here: Cooper, M., & McLeod, J. (2011). Person-centered therapy: A pluralistic perspective. Person-Centered and Experiential Psychotherapies, 10(3), 210-223, or in blog form here.

Nicola Blunden has written a major new account of the pluralistic approach to person-centred therapy here: Blunden, N. (2024). Pluralistic person-centred therapy. In M. Cooper (Ed.), The tribes of the person-centred nation: An introduction to the schools of therapy related to the person-centred approach (3rd ed., pp. 201-226). PCCS.

Acknowledgements

Artwork by Jules Allan

Kitty Cooper: Celebrating A Life

My mum was born on the 17th December 1932 in east Berlin as ‘Kitty Furstenberg’. She was the first child of poor Jewish parents: their unhappiness compounded by constant quarrelling. Walter, her father, had come out of the French foreign legion, and was struggling as a door-to-door salesman—Jews were barred from most occupations. Her mother, Betty, met her father in a Jewish youth organisation—Betty like all the girls, had been in love with the leader of the youth group: Walter’s handsome older brother, Solly.

Kitty was named after her paternal grandmother, Kreindla (or Katie) Wixon. However, there were so many ‘Katies’ already in the family—including my mother’s favourite cousin ‘Little Katie’, and ‘Big Katie’—that they chose the name ‘Kitty’ instead. Apparently, Kitty’s mother took the name from a Tolstoy novel she had been reading.

Kitty described her childhood in Berlin as a time of terror, abandonment, and isolation. One of her most frightening experiences—that she told me several times as a child and again when Ruby and Maya (my eldest daughters) and I interviewed her in 2010—was of a day when she and her mother had gone to the Gestapo offices. This was something that Jews were forced to do: to show that they were still living in Berlin, and that they were making every attempt—as all my mum’s family were—to leave. One visit, in early 1939, my mother overheard an elderly Jewish woman being told by the Gestapo officer that she had to leave Germany in two or three weeks. The elderly woman said that she had nowhere to go—she couldn’t get out. The officer replied that that wasn’t his problem, and that if she didn’t leave, she would be taken away. I think that was the point that my mother, just a young child, realised that her and her family’s life was in mortal danger.

My mother lived through Kristallnacht, the 9th November 1938, when so many Jewish properties were destroyed and Jews were taken away. She remembered that her father hid in a cousin’s flat: the cousin had already been taken, so my mother’s parents thought that the Nazis would not search there. My mother remembers being told that, if the Nazis did come and asked where her father is, she should say that she didn’t know.

Unlike many of my mother’s extended family who died in the holocaust—including ‘Little Katie’—Kitty and her mother were able to leave Berlin and travel to England to join her father. This was in August 1939, just three weeks before the war broke out. Kitty and her parents were guaranteed to come to England by an uncle, Bernard, who was already living here. There is a haunting photo of my mum’s extended family—all dressed in their finest clothes—saying ‘goodbye’ to Kitty and her mother on the platform in Berlin, my mum sitting on her suitcase. Kitty would never see these family members again. My mum also told the story of how, when she and her mother got to immigration at Dover, it was realised that my mum had not been put on the visa. She should have been refused entry and sent back to Germany. But the immigration officer took pity on her and waived them through. My mum always said that, if it hadn’t been for that kindly English officer, ‘it would have been the end’. She was right.

Kitty and Family at the station platform, Berlin 1939

More abandonment was to come. Three weeks after Kitty arrived in England, she and her classmates were evacuated to Norfolk. Kitty’s mum—who was afraid to tell her that she was going away for some time—had told Kitty that she was just going on a day trip. ‘It was a terrible, terrible shock to me,’ said my mum, ‘I was there for 18 months and cried every day.’ The family she went to were stern, though kindly, and to make matters worse my mother hardly spoke English. In fact, she said, she initially refused to learn English—she told others that they should learn German instead!

Eventually Kitty returned to live with her mother, moving across different rental apartments and primary schools in London. Kitty’s father, who had worked as a welder on the undersea pipeline that supplied the Normandy landings with oil, came home after the war. But that was not easy for Kitty, who was by now 12 years old. She had had relative freedom with her mother, who she described as ‘easy going’, and when her father returned to ‘lay down the law’—bringing home all of his military discipline—Kitty, as well as her mother, were not happy. ‘I was quite a rebellious teenager,’ said my mum, ‘I didn’t want to do anything my parents wanted me to do, I had my own mind of what I wanted to do.’ As a consequence, homelife was often fraught with tension and argument.

Kitty, centre, with friends

Kitty was delighted, however, when her younger sister, Sandra (who Kitty had named ‘Alexsandra’) was born in March 1945. Kitty adored her sister: a close friend, confidant, and companion throughout her life.

The two girls lived with their parents in a prefab on Gayhurst Road, Hackney. Around 1956, they moved to a house in Wood Green. Kitty’s mother worked as a seamstress, and her father set up a small metal welding business.

Kitty went to John Howard Secondary School in Hackney, leaving at the age of 15. She then attended commercial college to learn shorthand typing, which she described as ‘absolutely hating’, and subsequently took up secretarial work. When I was a child, she would tell us about some of the jobs she had, like working for Psychic News. She also worked in the El Al offices, and was there at the time of Eichman’s capture and transportation to Israel.

I didn’t know this, but when we interviewed my mum in 2010 she said that her favourite hobby as a girl had been stamp collecting—like Davina. And she ‘just loved reading books’—as anyone who spent time with her would know. Mum described going to the Hackney Library as a child and finding books that looked interesting: she loved novels, and authors such as Aldous Huxley and John Steinbeck. When my young kids looked at her bewildered, she explained, ‘because there was no television’. Kitty, throughout her life, was a woman of culture: not just literature but also art, photography, and theatre. As a young woman she also loved dancing and would go, either with friends or on her own, to ballroom dancing in Knightsbridge.

When my mum said to Maya and Ruby, in our 2010 interview, ‘What would you like to ask me?’ the first thing my girls said was, ‘Can you tell us about your past boyfriends?’ My mum said that her first great love was an Ethiopian man, then her boyfriend Silvio. Then she met Charles when she was 25 and Charles was 47. ‘Once I met Charles and once I fell in love with him, that was it,’ Kitty said.

Charles and Kitty had met at philosophy evening classes in the late 1950s. After classes, they would go for coffees with friends, and my dad—who was establishing himself as a leading UK film distributor—would tell everyone the latest news from the film industry.

Tragically, as my mum was to find out, Charles’s first wife, Cecilia, had recently died. She was just 44 years old, and together Charles and Cecilia had had two young twins—Adi and Sue—and an elder daughter, Florence.

My mum said that her first date with Charles was at the Curzon Cinema, seeing a Brigitte Bardot film. Kitty was quite shocked that my dad had taken her to something so ‘low brow’, but she discovered later that Charles had had complimentary tickets to the showing.

Kitty and Charles in later life

Kitty and Charles dated for several years. ‘He was very handsome, very presentable, and had all these women who wanted to marry him,’ said my mum. A few times, reported Kitty, she was so upset with Charles for not making things more permanent that she would ‘pack him in’—even moving up to Edinburgh to study at the University—but then they would always get back together because they both loved each other so much.

In 1964, my parents married. Davina was born in January 1965. Sadly, at the same time as Kitty was pregnant, her father Walter had died.

I was born in April 1966. As a young child, I remember my mother as a warm, loving, youthful presence. I always wanted to spend time with her: she was fun. We would play chess together, cards, watch TV. I remember sitting on the top of the bus with my mum as she took me to my speech therapy appointments. My happiest times—my ‘safe space’—was lying between my mum and dad in their bed in the mornings, cuddling them; jumping up and down, then cuddling more. Charles, as well as Kitty, had come from a family background with lots of highly expressed emotions, and so they both wanted to forge a family life that was calm and conflict-free. I never saw them argue. Kitty described her time with Charles as the happiest in her life. The home that they created together in Highgate from 1973—and which my mother stayed in until the end of her life—was a happy and welcoming environment for us and for so many children, grandchildren, family, and friends: a place of stability, vitality, and love.

My mum was a fiercely intelligent woman: she was a demon at Scrabble into her 80s, and she often told us how her name was on a plaque at the University of Edinburgh for getting the highest economics mark for her first year of study. After marrying my father, she went on to work at their company, Contemporary Films, running the International Department. She was a successful businesswoman in her own right, dealing with many of the leading figures in the cinema world, including Agnes Varda, Werner Herzog, Andrei Tarkovsky, and Jean Renoir.

Kitty was deeply political: committed to making the world a fairer and more compassionate place. She joined the Communist Party, alongside Charles, and actively engaged in party meetings and demonstrations.

Friendships, too, were an essential part of her life. She loved, and was loved by, many. Her oldest friend was Ruth Gilbert, who sadly died several years ago; and there was Anita, Pam, Kate, Lilian, Dorothy, Maggie Bowden, Michael Israel, and many, many others. My mum was a wonderful listener and always interested in others—she never put her ego first. She always had time and space for others: a calm, compassionate presence.

Charles died in 2001, after being cared for by Kitty for several years. It was a terrible loss for my mum, and she never really recovered. She missed him enormously and would sometimes see him walking around their Highgate home. Yet, as well as her children and friends, she had a growing brood of grandchildren that she spent time with and loved: Daniel, Jesse, Hannah, Emma, Frania, Rivka, Shane, Maya, Ruby, Shula, and Zac—and then nine great-grandchildren. It was amazing to see, in the hospital before she died, how many people had come to say their goodbyes: from her two-year old great-grandson Ollie to decade-long friends like Lilian.

Shula, Kitty, Zac, and Maya

The last thing my mum said to me, about a week before she died, was that she loved me. And I really felt that from my mum. We had our moments, but I always felt a deep, enduring, and unshakeable love from her. And I know that she felt that towards so many others: her children, grandchildren, and great-grandchildren; her sister and wider family; and all her friends—so many of whom are here today. Trauma, as we know, can do terrible damage to a person’s capacity to attach and relate. Yet my mum, despite all the terror, isolation, and abandonment that she experienced as a child, had a tremendous ability to love and be loved. She connected, cared, drew others in and held them with so much warmth and affection. That capacity to love so deeply and so consistently—despite what she had endured—can only be testament to her remarkable resilience, intelligence, and strength of character. That is truly something, and someone, to celebrate.

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Links

• The Guardian ‘Other Lives’ obituary, Kitty Cooper, written by Davina

• Jewish Chronicle obituary, Kitty Cooper

• Blog post: my reflection and memories of visiting my parents’ in their Soho office

• Correspondence on my grandmother, Betty Wixon, created by my mother, regarding my grandmother’s estate and German pension

Research Interviewing: Some Pointers

Interviewing is one of the most powerful tools we have for answering research questions in the counselling and psychotherapy field—indeed, any field. ‘Interviewing’ is essentially just a technical term for ‘talking to someone’—and it’s a talking that can have a great deal of depth, nuance, and complexity. What better way of finding out the answers to your questions than by going straight to the source: people, real people, and asking them what they experience or what they think. It’s not the only way of answering research questions, and it’s not always the most suitable; but if you’ve got a question about how a particular group of people experience or perceive something, it’s one of the most effective and widely used tools.

Types of interviews

Interviews can be structured, semi-structured, or unstructured. That’s essentially the amount of a priori ordering you give to an interview: how much do you run it along pre-determined lines, with the same questions, asked in the same way, to each participant? Of course, there’s no right or wrong here—it all depends on what kind of questions you are asking. Structured interviews tend to be best for smaller q (i.e., more quantitative-like) research. For instance, if you wanted to compare how much gay and bisexual men found gay-affirmative therapies helpful, you might want to use a structured interview format so that you had clear, comparable answers to analyse. If, on the other hand, you are doing larger Q research (i.e., more in-depth, experiential, explorative) an unstructured format may be better so you can really go ‘with the flow’ in each interview and explore as deeply as possible their responses. In the middle is a semi-structured approach, which is often a good compromise, and means that you are asking every respondent similar questions, but you have flexibility to go into depth and follow up particular areas without worrying too much about ‘sticking to the script’.

Interviews can also be scheduled, unscheduled, or semi-scheduled, which refers to whether questions are asked in the same order or not. Scheduled tends to go with structured, and is more suited to research questions where its important to reduce biases. Unscheduled, by contrast, gives you the flexibility to go into depth in an interview, as and where the respondent seems to be opening areas up. Again, semi-scheduled can be a good compromise, meaning there’s a provisional order to your interview, but scope to go ‘off track’ if it feels like moving the order around will be productive.

As suggested above, a semi-structured, semi-scheduled approach is a good option—and commonly used—alongside a wide variety of qualitative counselling and psychotherapy research methods, including interpretative phenomenological analysis (IPA), grounded theory, and thematic analysis. However, if you are wanting to conduct a very large Q grounded theory or thematic analysis study, a wholly unstructured, unscheduled approach may be best.

Interview Schedule

However you do your interview, even with the most unstructured of approaches, it’s generally good to prepare a schedule or protocol of how the interview is going to go. This is absolutely essential if others are going to be doing the interview as well as you, so that they know what to do and your interview is consistent across participants.

In one of my first research studies, on therapists’ experiences of relational depth, I developed a very basic interview schedule, which consisted just a few questions and prompts:

• Could you tell me about a time when you really felt that you met with a client at a level of relational depth?

  • What was that experience like?

  • What did you take from that experience?

  • What do you think your client took from that experience?

  • How did that experience come about?

• What facilitates your ability to meet clients at a level of relational depth?

• How important do you think that meeting clients at that level of depth is?

An example of a much more extensive interview schedule, for our study of clients’ experiences of working with preferences, can be found here. This was designed for use by myself and another interviewer; and with a team of very experienced international researchers discussing, drafting, and finalising it. As an interview schedule, however, the heart of it was still the questions to be asked. In this case, the main question was:

• What, if any, preferences did you have when you came into therapy?

And then, for each preference, we asked:

• Where do you think this preference might have come from?

• How, if at all, did this preference change over the course of therapy?

• How important was it to you that this preference was (a) elicited/discussed, and (b) accommodated in the therapy?

When writing a schedule, it may be useful to note follow-up prompts for different questions: potential responses you can use after the main question to help the participants go deeper into the exploration. For instance, for the question:

• Where do you think this preference might have come from?

You might then prepare prompts like:

• Was it related at all to your earlier life?

• Have you had therapy before? Was it based on those experiences?

• Are there any other origins you can think of?

On our schedule for the preference study, you’ll see that we also included:

• Notes on the general approach/style to be taken in the interview

• Materials to be taken to the interview and other general instructions

• Approximate wording for the introduction to be given to participants

• Additional questions

In this case, there’s also some guidance on questions that were asked outside of the scope of the main study.

Generally, there’s no harm having as much detail as possible in your schedule, even if it’s about engaging with your participants in an entirely unstructured and unscheduled way. Write it down—it’s a great reminder for you about what to do, something you can draw on when you write up your Methods section and, if you’re writing a thesis, a great resource to put in your Appendices: showing your examiners that you were really clear, consistent, and methodical in what you did.

Piloting

Before finalising your schedule, and definitely before running your interviews, try the interview out on someone—ideally a few people. And who better to start with than yourself. As well as giving you a real sense of what it’s like being interviewed with this schedule (and, perhaps, what’s working and what needs changing), it can help you unpack your biases and expectations with respect to the research question (again, something you may then want to write up and include as an appendix). Even if you aren’t part of the target group for the research study, you can role play it. Then try it out as an interviewer—perhaps with friends, colleagues, or peers—to get a sense of how it feels running the interview (bear in mind you may need ethical approval before doing this). If they are not part of your target group, again, they can always role play, though you will probably want to also pilot the interview with someone who is part of your target group before moving in to the main phase of interviewing. And remember, when you write up, you can describe this piloting process, showing your care and methodicalness in developing and testing out your interview schedule.

In fact, I generally encouraged my research supervisees to transcribe their pilot interviews, and even do some initial coding or analysis on them. That’s not suitable to all methods (particularly if you’re keen to go into each subsequent interview with an entirely open and ‘unbiased’ mindset), but it’s a great way of checking whether you’re data is making sense: that is, whether you’re actually getting meaningful answers to the questions that you’re asking. At the very least, ask yourself: ‘What have I learnt from this/these interviews (including the one with yourself) to the question(s) that I am asking?’ If the answer is ‘nothing’ or ‘I’m really not sure’, you may want to revisit your interview schedule or the focus for your project. Ideally, you’re coming away thinking, ‘Wow, those were some great initial answers to my questions… I’m hungry to learn more.’

Can you include data from your pilot interviews in your main analysis? Ideally, with most methods, not—formally, it’s an activity where you are preparing for the actual method you are going to use. But, as above, it’s great to write up your pilot interviews in your Methods section, and particularly what you have learnt from them. But some approaches, particularly larger Q ones (where there’s less focus on consistency or unbiasedness across interviews), may see less problems folding in your pilot interviews into your main data. If you’ve got really rich and meaningful data from them, why not use it?

Dialogue

Except for very structured, ultra-small q interviews, one of my main pointers for conducting interviews in counselling and psychotherapy research would be to see them as dialogues—with the aim of finding answers to the question(s) you are asking. Too often, particularly with trainees, there is a tendency to conduct interviews a bit like TV’s Question Time: with lots of questions, one after the other—and the interviewer’s nose in their interview schedule—without enough time, space, or attention to really explore the participants’ experiencing or perceptions in depth. I’m sure this often comes out of the interviewer’s anxiety: a worry about what to say next, and a concern to keep things going. But an overly-scheduled interview, with lots of quick fire questions, generally doesn’t allow the richness and depth of a participant’s experiences to emerge. People aren’t always able to answer well the first time around—to say what they really mean—so the interviewer needs empathic reflections, follow-up questions, prompts, paraphrases, summaries (many of the skills you may have learnt as part of a counselling training) to help the participant unpack what has really gone on for them. Below is an example of such dialogue from our study of clients’ experiences of preference work. The participant has already said that they came into therapy with a preference for ‘structure’ but, as an interviewer, I’m using reflections and further questions to try and understand more about what that means.

Interviewer: What would you say your main preferences were when you came into the therapy? You’ve already said about– there was one about structure, there– say a bit more about that.

Participant: ….So like you say, structure was important to me. I didn’t– I’ve never done anything like this before, so it’s completely new to me. I didn’t know what I should be talking about, or how to achieve those goals. So it was more kind of guidance, and what can we do to– that’s going to [pause] […] less anxious, um, I don’t know. I don’t know. I’m completely lost about how to get to those goals. So my structure would be what– what can we do to bring about those changes, how do we work towards that, what– um, so that at the end of the session, you know, I’d think– or I’d come back the next week and say, ‘Have you felt less anxious?’ and my initial reaction was that, ‘Well no, I haven’t felt less anxious, because why would I, nothing’s changed. I’ve done nothing to change it. I don’t know what to do to change it. Um… I’ve had no guidance’, so, yes, my- my answer to the question would be the same, it’s […] unless I’m doing something different.

Interviewer: So you really wanted to be… guided, and have something to do, say in between sessions?

Participant: Yeah, that would have been nice. Yeah. You know, I’ve never done this before, so I didn’t have any expectations. It was just, ‘Let’s see where it goes.’

Interviewer: Yeah, but you wanted– What you’re saying– Did you have that, like when you started therapy, were you thinking, ‘I’d really like some structure,’ or was it something that kind of emerged as the therapy continued?

So we don’t just move on from ‘a preference for structure’ once the participant has said it. Rather, we circle around it, try and go deeper, explore what the participant really means by it and how it links to other responses. It’s a process, all the time, of deepening understanding—again, just as you might do in therapy if you were trying to help a client make sense of particular experiences.

You can see that, in this last question, I’m trying to understand in more depth how this preference emerged. What’s going on in my head is, ‘I really want to understand what the participant wanted in therapy and why?’ That, those core research questions, are my focus, and I’m trying to engage with the participant in a range of different ways so that we can answer those questions. So, at those points, I’m not really thinking about my interview schedule. It’s something I’ll come back to, and I’ll try and make sure I’ve asked all the questions I’ve wanted to; but, at those times, it’s the overall objective that is the orienting point to the interview. I genuinely, deeply, want to discover—with the participant—what the answers are to my research questions. Indeed, I sometimes think that the best interviews are when the interviewer has just one main question, and riffs around it, with the interviewee, in a variety of ways to answer it as best they can.

Interpret along the way

What you can see in the interview above, and my second key pointer for most kinds of medium-to-large Q interviewing, is to try and make sense of what the participant is saying as you go along. Far better than trying to interpret what the participant was saying once you’ve got your transcript, do it as you go along with the participant. Because you’ve got them there to help you, and guide you, and tell you what it is that they actually mean. For instance, in the example above, they’d said that they wanted ‘structure’, but what did this actually mean, and were they saying they wanted guidance or something else? I wasn’t sure, and I asked.

Lots of times in interviews, you’ll be sitting there thinking, ‘I’m not really sure what this person is trying to tell me.’ That’s nothing to be ashamed of—it’s a really valuable indicator to you that you need to be asking more. You can even say to a participant, gently and kindly, something like, ‘Sorry, I didn’t quite get that, can you explain it to me?’ or ‘I think what you’re saying is …, Is that right?’ If you leave an interview really confused by what a participant has told you, chances are you’ll struggle to make much sense of it once it’s transcribed. And, of course, participants won’t always be able to make sense of things or tell you what they really mean. But to the extent that participants can explain and describe their experiences in depth, use the interview—itself—as a way of unpacking all that richness and meaning. In my own experience, I’ve been amazed by how much research participants can actually make sense of their own ‘material’, themselves—given time, space, and a dialogical sounding board to help articulate and explicate on what they are saying. And that way, when you leave the interview, a lot of the hard work of the analysis has already been done.

Just related to this, a point my colleague Gina Di Malta raised, is that it’s important to try and stick to the participant’s own words as much as possible, rather than introducing your own terms and ideas (again, a bit like therapy). You want to interpret, but you want that interpretation to be one of ‘unpacking’ the participant’s meanings, not introducing terms or conceptualisations from outside. So a question like:

• You said you wanted ‘structure’, can you say more about what that means to you?

Is probably better than one like:

• By structure, do you mean having an agenda for the sessions?

Given the power differential in the interviewing situation, a ‘yes’ to the second question really isn’t going to tell you much. Did they really want to have an agenda for the sessions, or were they just ‘deferring’ to you to be polite?

keep to task

Key pointer #3: you’re not the participants’ therapist, and you need to come away from the research interview with answers to the research questions that you’re asking (at least, in the ideal). Something I see a lot in supervisees’ interviewing, particularly when they’re training in a person-centred or relational approach, is that they tend to fall in to a non-directive, therapeutic mode of being: following the participant in whatever the participant wants to talk about. Of course, it’s important to be sensitive, empathic, and non-judgmental when you’re interviewing—and not overly-authoritarian—but participants may well come into the interview with you with things that they want to talk about or tell you about, and what they want to say may not relate in any particular way to what your research questions are asking. A participant, for instance, might want to tell you about difficulties in their marriage when you’re actually focusing on their experiences of a particular service; or they might want to tell you about their experiences of a service when your research project is actually focused on their childhood experiences. Participants have every right to want to tell you what they want to tell you, but it’s both ethically and methodologically important that you help steer the conversation to what you’re research is about. Otherwise, you can end up leaving the interview without any useable material and, more importantly, your participants can go away feeling confused and exposed by a process that was different to what they were invited in to.

So even though participants may take the interview off in all kind of directions (and that’s their right to do so), your role is to gently, sensitively, and compassionately bring them back to the main points of discussion. That doesn’t need to be rude or abrupt: if, for instance, a participant is really going off track, you can gently ask them how it relates to your key research questions, or thank them for their response and go on to the next question. And, in any interview, there’s bound to be material that is less relevant to the researcher’s question(s). In a sense, the issue is less about there being lots of ‘irrelevant’ material, and more about their being insufficient relevant material to be able to answer your research question. Having said that, transcribing and then trying to analyse page after page of material that, actually, isn’t much use to your research can be quite a heart-sink. Again, that’s why it’s really useful to do a few pilot interviews and a bit of an analysis, to make sure that the way your interview is set up is getting you the answers you want.

Keeping an interview on track means that, at times, you may need to be quite directive. For therapists schooled in the idea that directivity is just one step away from satanic worship, adopting a more proactive and leading stance can feel challenging: the natural tendency is just to go with the client/participant and not interrupt, structure, or lead. And, as above, there’s a lot of relational counselling skills that can be really valuable in interviewing work. But interviews do need to be more than just an unstructured, unfocused chat: again, not just for you, but out of an ethical duty to your participants to stick to ‘what you said on the tin’—they didn’t sign up for therapy, so you can start providing it for them.

Below is an excerpt from an interview, from the same study on client preferences, which demonstrates how an interviewer can gently and sensitively focus the interview process. In this case, the participant has been talking about a preference for a therapist who was challenging-but-supportive, but then goes on to talk about a preference for a female therapist. The interviewer positively affirms the expression of the latter preference, but then invites the participant to say more about the original preference so that they can explore it in more detail and systematically:

Interviewer: I guess there are lots of different preferences back on who your therapist is, and what the…

Participant: Oh yes.

Interviewer: …treatment is and…

Participant: Yes, I did prefer women because I just thought I would be more relaxed with that.

Interviewer: That's a good point. That's a really good example of preference, but what you said before, I'll just come back to that because that was really interesting as well. You were saying that you kind of have a preference, so someone who was a bit challenging but also quite supportive. How would you phrase that one?

Fear

Let’s be honest, interviews can be pretty scary to do especially if, like me, you’re natural tendency is towards being quite shy and unconfident. You’re interviewing someone who, pretty much by definition, knows more about something than you, and you may be interviewing people in positions of authority or power. You want to look good: you don’t want to babble away, lose your recording device, or have participants leave the interview thinking, ‘What kind of moron was that!’ Recognising any fears, of course, is the first step in managing them, and talking them through with peers or supervisors can be a really valuable next step. That can help normalise any anxieties, and also help you think about strategies for dealing with them. Ideally, you’re going into the interview feeling pretty calm, so that you can really listen to your participants. You want to have your head in your participants’ worlds—not in your own anxieties. And you also need a degree of confidence to keep your participant to task.

Having said all that, it’s also worth remembering the Yerkes–Dodson law: a bit of arousal isn’t a bad thing, and can help you be focused, attentive, and organised. It also conveys to your participant that you’re taking them and their time seriously: too laid back and your participant might feel a bit taken for granted. And, whatever else, please don’t fall asleep while doing an interview!

Stonewalled

What if you’re interviewing someone who, however, hard you try, doesn’t seem to want to give you much, or just doesn’t seem to be able to give in-depth responses? You’re getting short, one sentence answers; you probe, prompt, try to ‘unpack’ what they’re saying, but it’s just more one sentence responses, ‘I don’t knows’, or even silences. Or perhaps your participant has something that they’re so keen to tell you that you just can’t keep them to task: nothing they are saying—however hard you try—is related to your research questions.

Of course, ethics comes first. To repeat, your participant has the right to come into the interview and do, or not do, what they want (within reason), so if it’s clear that they don’t want to say more or go into more depth, that has to be respected. More than that, it’s important that the participant comes away from the interview feeling that their contribution has been valued, and not that they’ve let you down in some way.

In my own experience and that of my research supervisees, it’s very much the norm that, say out of eight interviews, at least two or three might be more limited in content. So if you’re finding that you’re not getting much from a particular interview—and you’ve tried, as much as would be reasonable and respectful, to invite more, without success—then it’s generally best just to accept that that is how that interview is going to be. In a sense, the quality and depth of a research project is not defined by how many ‘bad’ interviews you have but how many ‘good’ ones there are. And one option, if you are finding that a number of your interviews are quite limited, is simply to do more. Having said that, even where participants give relatively limited responses, the material may still be very helpful: giving an indication of the range of different responses that may be out there. Also, if you’re doing a smaller q study, with some quantification of responses, more limited interviews can still help you develop a sense of how many people experience or see things in a particular way.

Of course, if it’s the case that a large proportion of your respondents can’t give you in-depth responses to your interview questions, then that probably says something important about the way your interview is structured, or what you are trying to do. Again, that’s why it’s so important to pilot your interview schedule and to see whether people—including yourself—can give rich, deep, and interesting answers to the questions you are asking.

Ethics

A few further words on the ethical side of the research interviewing process.

Ethics, as always needs to come first. Interviews can be extremely rewarding for participants, but there are also some risks to be mindful of, particularly if you are exploring highly sensitive topics (for instance, clients’ experiences of childhood difficulties). Some pointers:

• Make explicit in the information sheet what the research will involve, including potential risks, so that prospective participants know what they are signing up for.

• Empathy and a non-judgmental acceptance should be de rigueur throughout the interviewing process: to repeat, you want your participants to leave feeling that their experiences and perceptions have been heard and are of value.

• Pay close attention to maintaining your participants’ confidentiality, particularly if materials are going to be made publicly available (for instance, on a thesis University depository or in a journal). Also, be extremely careful with audio files—it’s a lot easier for participants to be identified if their voices, as well as the content of what they say, is disclosed.

• Hope for the best but plan for the worst. What happens, for instance, if your participant gets extremely distressed during your interview and says that they are going to kill themselves? Make sure you have strategies in place to respond to such emergencies (for instance, making it clear in your information sheet that you would tell their GP if there was serious risk of harm, and providing links to support services like the Samaritans).

• Be careful (as above) not to slip into a therapist role. Some of your interview may be therapeutic for the participant, but the focus should remain on answering your research questions rather than healing for the participant, per se.

Read up on it

Finally, as with any method, it’s important to explore the contemporary literature on interviewing, to get a deeper sense of how it can be done, the issues that can emerge, and different tips and strategies for optimising benefit. My own personal bible on interviewing, for many years, was Steinar Kvale’s (1996) InterViews, now in its third edition as Brinkmann and Kvale’s (2014) InterViews: Learning the craft of qualitative research interviewing. The book gives a brilliantly humanistic, relational guide to the interviewing process. Sage also have a series of videos on in-depth interviewing that you may be able to access.

Acknowledgement

Thanks to Gina di Malta, and trainees on the PsychD Counselling Psychology Programme at the University of Roehampton for suggestions and advice.

Photo by Christina@wocintechchat.com on Unsplash

DISCLAIMER

The information, materials, opinions or other content (collectively Content) contained in this blog have been prepared for general information purposes. Whilst I’ve endeavoured to ensure the Content is current and accurate, the Content in this blog is not intended to constitute professional advice and should not be relied on or treated as a substitute for specific advice relevant to particular circumstances. That means that I am not responsible for, nor will be liable for any losses incurred as a result of anyone relying on the Content contained in this blog, on this website, or any external internet sites referenced in or linked in this blog.

Using Research Evidence to Predict and Optimise Therapeutic Benefit: A Multilayered Approach

How can we use research data to inform and improve therapeutic practice? When I wrote my book Essential research findings in counselling and psychotherapy (Sage, 2008), I did what most writers in the field had done: I tried to organise and make sense the evidence by different ‘factors’. I used the usual suspects: client factors (e.g., the client’s motivation); therapist factors (e.g., the therapist’s gender); relationship factors (e.g., the amount of goal agreement); technique and practice factors (e.g., using two-chair work); and orientation factors (e.g., working in a person-centred way). That gave a fairly simple and clear taxonomy and meant that it was possible to describe the relative contribution of different factors to therapeutic outcomes. For instance, one might estimate, based on the most recent evidence, that approximately 40% of variance in outcomes is due to client factors; 30% due to the relationship; 15% to therapist factors; and 15% due to the particular techniques, practices, or orientation used. This can then be neatly depicted in a pie chart, like Figure 1.

Figure 1. Illustrating the Contribution of Different Factors to Therapeutic Change

Despite its clarity, organising research evidence in this way has its limitations. One very obvious one is that it implies that each of these factors is discrete when, of course, they are likely to inter-relate to others in complex, mutually reinforcing ways. Another problem, more directly related to the framework developed in this article, is that they tend to infer that each client is influenced by each of these factors in the same way and to the same extent: that relationship factors such as empathy, for instance, lead to 30% of outcomes for Client A, and also for Clients B, C, and D. The reality, however, is that Client A may do very well with empathy while Client B may not; and while relationship factors may be essential to Client C’s recovery, Client D may do very well without them. Indeed, much of the cutting edge research in the psychotherapy field—by leading figures such as Zachary Cohen and Jaime Delgadillo—is on the particular factors that lead particular clients to do particularly well in particular therapies; and the algorithms that can then be developed, based on such evidence, to optimise benefit. Organising the evidence by factors may also limit its utility for therapists. As practitioners, we do not tend to think about our work, systematically, in terms of these different factors (e.g., ‘What can I do to improve myself as a therapist?’ ‘What can I do to improve my relationship?’); and it is also important to note that different factors may have very different implications for practice. Knowing, for instance, that clients with secure attachments do better in therapy than those with insecure attachments (a client factor) does not really tell us anything about how to work; while knowing that clients tend do better when their therapists are warm and genuine can have important implications for practice. So although these factors, in Wittgenstein-ian terms, have a ‘family resemblance’, they are actually quite distinctive things.

The aim of this article, then, is to describe a way of organising and conceptualising therapy research evidence that addresses some of these problems: allowing for a more nuanced, comprehensive, and personalised conceptualisation of data; and potentially more useable by therapists. The essence of this framework is a pyramid (or funnel, see Figure 2), with different layers of evidence at increasing degrees of specificity and proximity to the client. Each layer builds on the previous ones: from research evidence that is relevant to all clients to research evidence that is specific to a particular client in a particular session. As this pyramidal form suggests, as we move upwards, evidence may become more sparse. However, because of its greater specificity, and because it is most proximal to clients’ actual experiences—such evidence may be of greatest value. For instance, research suggests that clients generally do better when therapists are empathic (Layer 2), but if evidence exists that the opposite is true for highly paranoid clients (Layer 3), then the latter finding would tend to take precedence to guide practice with a highly paranoid client. However, if it was then established that, for a particular highly paranoid client, they had a strong preference for an empathic therapist (Layer 4), then this higher-layer evidence would take precedence over the group-specific (Layer 3) finding.

Figure 2. A Pyramidal Framework for Organising Therapy Research Evidence

The foundation of the pyramid, Layer 1, is general evidence on client and extra-therapeutic factors that tend to determine good outcomes. For instance, clients who are psychologically-minded tend to do better in therapy, as do clients with more social support. These factors are separated off from other factors (depicted in Figure 2 by a dividing line), because they are less relevant to what therapists do. Rather, they are the grounding—to a great extent outside of the therapist’s control—as to how therapy is likely to proceed. In this respect, these general factors have an important role in predicting outcomes—and, indeed, may explain by far the largest proportion of variance—but do not have much role, per se, in informing or shaping how therapists work.

Note, the term ‘tend to’ indicates that, while these findings are drawn from generally representative samples (or samples assumed to be generally representative), this is not to suggest that these factors will be true for each and every client. Rather, this is evidence, across all clients, of averaged tendencies, around which there will always be considerable group-, individual-, and session-layer variance.

Building on these general client and extra-therapeutic factors are general factors that are related to the therapist and their therapy (Layer 2). This includes therapist factors (for instance, therapist gender), relationship factors (for instance, the alliance), and technique factors (for instance, use of cognitive restructuring). These are findings that reach across all clients and, although still averaged trends, can be very useful for therapists to know. In the absence of any other information, they provide a useful starting point for work: for instance, be empathic, listen, or self-disclose to a moderate extent.

At a greater layer of specificity (Layer 3) is evidence of particular factors that tend to be associated with helpfulness for particular groups of clients. By far the greatest amount of evidence here focuses on clients grouped by particular mental health diagnoses—for instance moderate depression or obsessive-compulsive disorder—as reviewed and operationalised, for instance, in National Institute of Health and Clinical Excellence (NICE) guidelines. Considerable research is also now available on clients with particular cultural identities (e.g., people of colour, lesbian clients), and what tends to be most effective for them. There is also a wide range of research on other ‘aptitude–treatment interactions’ which identifies the factors that tend to be most effective with particular groups of clients. For instance, clients who are more reactive tend to do better in less directive therapies, while the reverse is true for clients who are more compliant. Of course, clients may be members of multiple groups—‘intersectionality’—such that practices indicated may be complex or, potentially, contradictory. Tailoring therapies to particular client characteristics is what Barkham terms ‘precision therapy’, linked to the wider development of ‘precision medicine’: ‘predicting which treatment and prevention strategies will work best for a particular patient’ (NHS England).

Moving up in specificity, to Layers 4 and 5, entails a shift towards individual-level research and data gathering (Figure 3). This is, perhaps, the most important and novel part of the framework being suggested here, because a continuum is being proposed from (a) general- and group-level research to (b) contemporary, individual-level monitoring: one segues into the other. In other words, the framework suggests that what researchers do ‘in the field’ is not so different from what therapists do when they are working with individual clients using routine outcome monitoring (ROM): it is all part of one broad spectrum of using data to help inform practice. This may be helpful for practice because it de-mystifies ‘research’ and puts it on a equal footing with things that a practitioner would typically do. Now, research about populations or groups is not something that researchers do far away on some other planet, but is an extension (broader, but less specific and proximal) of what therapists are, actually, doing all the time. That does not mean it can be waived away, but it does mean that it can be considered a friend rather than enemy (‘the facts are friendly’, as Carl Rogers said).

Describing individual-level data gathering as ‘research’ is a somewhat unusual extension of the term. Almost by definition, ‘research’ is seen as involving generalising from specific individuals to the wider group or population. However, if research is defined as ‘a detailed study of a subject, especially in order to discover (new) information or reach a (new) understanding’ (Cambridge Dictionary), then generalisations can also be at the individual client layer: from, for instance, one session to another, or from assessment to across the course of therapy as a whole. Individual-layer research like this is not something you would see published in a journal, nor could it be summarised in a book like Essential research findings. Even with individual-focused research methods like autoethnography or heuristic research, the aim is to reach new understandings that are of relevance across clients or contexts. But with the individual client-layer research described here, the aim is solely to use data to reach new understandings about this individual client. It is a form of systematic enquiry which the therapist, themselves, does, to help optimise their therapeutic work with the client by drawing on data.  

Figure 3. Individual Level Research

Layer 4, like Layer 3, entails the use of data, prior to the commencement of therapy, to estimate what is most likely to be helpful for a client. While Layer 3, however, makes such assumptions on the basis of group characteristics, Layer 4 focuses exclusively on that client’s individual uniqueness. This is the complex, rich mixture of characteristics and experiences that make the person who they are: irreducible to any particular set, or combination, of group characteristics. In terms of system theory, this is their ‘emergent properties’; in terms of the philosopher Emmanuel Levinas, their ‘otherness’. Understanding how data at this layer may be captured and integrated into therapy is, perhaps, the least well-developed element of this framework. However, one notable and well-researched element here is the client’s preferences: recorded, for instance, on our Cooper–Norcross Inventory of Preferences (C-NIP) at assessment. The focus of such individual layer research, then, is on what this specific client needs and wants from therapy; and the incorporation of such findings into the therapeutic process.

Finally, at the highest layer of specificity (Layer 5), is the use of data to guide the ongoing process of therapy, as in the well-researched and -developed practice of routine outcome monitoring (ROM). In ROM, the therapists uses data from ‘outcome forms’ (like the CORE-10 or PHQ-9), and potentially also ‘process forms’ (like the Session Rating Scale), to track how the client is doing, and to try and adjust the therapy accordingly. For instance, if the client’s layers of symptoms are worsening, the therapist may draw on pre-specified ‘clinical support tools’, such as a protocol for reviewing the therapeutic alliance with the client. In this way, ROM can be considered research at the highest layer of specificity: generalising from data captured at particular points in therapy (for instance, at the start of each session), to the therapeutic work as a whole. Barkham terms this in-therapy, iterative uses of data as ‘personalisation’—distinct from the ‘precision’ tailoring of Layers 3 and 4.

Note, even at these highest layers of specificity, data still only ever gives indications of what might be of benefit to a client at a particular time, not what is. Client preferences, for instance, tell us what a particular client thinks will be helpful, but there are no guarantees that such practices are of benefit; ROM predicts when clients may most be ‘off track’, but there are still numerous sources of ‘error variance’ meaning that, in fact, some of these clients may be doing very well (what has been termed ‘paradoxical outcomes’). As we move up the layers, then, we may move from distal to proximal forms of evidence, less to more trustworthy, but even at the highest layer, we are only ever dealing with approximations. Hence, while higher layer data, where present, may deserve prioritisation, best practice may ultimately come through informing clinical work with data from across multiple layers.

In fact, Layer 5 is probably not the highest and most specific layer of data usage to optimise benefits in therapy. At every moment of the therapeutic work, therapists will be striving to attune therapeutic practices to what they perceive—consciously or unconsciously—as beneficial or hindering to clients. A client seems to become animated, for instance, by being asked about their brother, and the therapist enquires further; a client glances away when the therapist asks about the psychotherapy relationship and the therapist seeks another way of addressing the here-and-now relationship. Stiles refers to this as therapist ‘responsiveness’, and this is represented as a spinning circle right at the top of the pyramid (Figure 4). Bill Stiles, in a personal communication, has written:

Representing responsiveness research as a (spinning?) circle (wheel? ball?) at the top seems to me to convey both the recursive feedback idea (circle, spinning) and the potentially high specificity (possibly millisecond-scale, e.g., responsive adjustments in mid-sentence due to facial expressions).

These five layers of evidence, then, segue into the moment-by-moment, ‘evidence based’ adjustments that therapists are constantly making throughout their work. And, as the highest layer, such responsiveness may be most proximal and attuned to what clients will find most helpful. Nevertheless, in the absence of such proximal information, each of the preceding layers will give valuable information about where best to start with clients. Moreover, as suggested in the previous paragraph, given the vagaries and potential errors inherent in each layer of data (including responsiveness: for instance, the therapist may misread the client’s reaction, or the client may be hiding it through deference), it is probably a combination of evidence from across the layers that is likely to be most beneficial in successfully guiding therapy.

Figure 4. Layers of Evidence Segueing into In-Session Responsiveness

Although each of these layers of evidence have the potential to inform therapeutic practice, different individuals, training programmes, or services may place emphasis on very different layers. For instance, in the IAPT model (Improving Access to Psychological Therapies, now NHS talking therapies), based on NICE guidelines, practice is nearly-exclusively drawn from evidence at Layer 3 (in particular, diagnoses-specific evidence), with little consideration for other layers (see Figure 5). Even responsiveness to the needs and wants to the individual client, during IAPT practice, tends to be subsumed to manualised, ‘evidence-based’ guidance.

NHS/IAPT Emphasis on Diagnosis-Specific Evidence

On the other hand, in approaches like Scott Miller’s feedback-informed therapy, there is a particular reliance on the most proximal evidence: the client’s immediate feedback through ROM (Layer 5), as well as a responsiveness to the particular client in the particular moment (Figure 6).

Figure 6. Feedback-Informed Emphasis on Proximal Data

In contrast to Layer 1, Layers 2 to 5 provide opportunities for therapists to enhance their practice (Figure 7). This is in two respects. First, at a basic level, skills and competences can be developed in practices that have been shown to lead to beneficial outcomes. This is particularly Layer 2 general relationship factors (e.g., enhancing levels of empathy) and technique factors (e.g., developing skills in two-chair work). In addition, at a more meta-level, knowledge and competences can be developed in tailoring practices to group- (Layer 3), individual- (Layer 4), and therapy- (Layer 5) specific evidence. For instance, at Layer 5, trainees can be taught how to use ROM data to monitor and enhance therapeutic outcomes, particularly with ‘not on track’ clients. Such training may be based on informal guidance and feedback (e.g., through supervision) or, itself, may be evidence based: using data to feed back to trainees how they are doing on particular competences. A supervisor, for instance, might rate segments of their supervisee’s audio recordings, across multiple time points, on a practice adherence measure like the Person-Centred and Experiential Psychotherapy Rating Scale (PCEPS). This moves us into the realm of ‘deliberate practice’ and, indeed, a separate pyramid could be developed for the use of research in training: from the most general evidence about factors that improve practice to therapist-specific data on what an individual practitioner might do to improve their outcomes.

Figure 7. Opportunities to Develop Therapist Competences and Meta-Competences

In fact, Layer 1 probably does also offer opportunities for enhancing the beneficial effects of therapeutic work—perhaps to a great extent—though this is rarely the focus of study or training. Here, emphasis is on how clients might be empowered or enabled to develop skills in using therapy most effectively. A good example would be the ‘resource activation’ work of Christoph Flückiger and colleagues, which invites clients to draw on their own strengths and resources to ‘drive’ the therapeutic process. In addition, this is the layer at which therapists might be developing competences in social and political advocacy practices. Developing the ability, for instance, to challenge unjust organisational policies might help to address the psychological distress brought about by racial discrimination.

Of course, research evidence is not the only sources of guidance on how to practice. Therapists may also draw, for instance, from theory, their own experiences, and from their supervision work. These sources are likely to be interlinked in complex ways, but for simplicity sake we can present them as per Figure 8.

Figure 8. Multiple Sources of Guidance on Practice

And, as with the layers of evidence, different individuals, training programmes, or services may place emphasis on very different sources to guide practice. In NHS Talking Therapies, for instance, practice is primarily based on research evidence (Layer 3, diagnosis-specific) (see Figure 9). By contrast, in much of the counselling field, practice is primarily guided by theory, supervision, and the therapist’s own personal experiences—as well as responsiveness in the specific moment—with research evidence playing only a very minor role (Figure 10).

Figure 9. Sources of Practice in NHS Talking Therapies

Figure 10. Typical Sources of Practice in the Counselling Field

Again, one might argue that, in best practice, there is an openness to drawing fully from all potential sources.  

This pyramidal framework for drawing on research evidence is very different from the ‘hierarchy of evidence’ as used, for instance, in NICE clinical guidelines. While the latter ranks research according to its ‘objectivity’—placing randomised clinical trials and their meta-analyses at the top and expert opinion at the bottom—the present framework makes no assumptions about the relative worth of different methodologies. Qualitative research, for instance, may be a very powerful means of understanding what particular methods or practices are particularly helpful for particular groups of clients (Layer 3). Indeed, in this framework, the data that may be of most value to particular episodes of therapy—by being most proximal—is individualised ROM data: very different from the kind of generalised RCT data prioritised in the standard hierarchy of evidence.

Conclusions

When trying to make sense of the vast body of psychotherapy research evidence, there are many different ways of organising the research:

• Different factors (therapist, client, etc)

• Degree of ‘independence’/rigour of the research (the IAPT/NICE approach)

• Effective treatments for different problems (again, the the IAPT/NICE approach)

• Evidence for different therapeutic approaches overall

• The proximity of the research evidence to the actual client and session (what is being proposed here)

Of course, there is no one right way, and these different organising principles can be combined in a wide variety of ways. For instance, the evidence at each layer of the present framework could then be organised by degree of independence of the research, or by different factors. However, each of these frameworks do prioritise and emphasise, even if implicitly, different elements of the research evidence. In the present one, there is as implicit privileging of data that is most proximal to the client—the ‘top’ of the pyramid. This can be seen as emerging from my own humanistic, existential, and phenomenological ‘ontology’ (theory of being) and ethics, which tends to reject the positivist assumption that the universe acts—and can be understood as acting—according to general, underlying mechanisms and laws. Rather, there is an emphasis here on ‘otherness’ and the irreducibility of human being. That is, that human beings’ lived-experiences can be unique, and that focusing on the unique and distinctive aspects of that experiencing is an important element—both ontologically and ethically—of understanding the whole.

Having said that, as Nicola Blunden points out in her comments below, the approach presented here is therapist-centred, in that it is a framework by which therapists can use the evidence. That is consistent with the target audience of my ‘facts are friendly’ book, but it raises the question of what a client-centred, or relationship-centred framework for making sense of the research findings would look like. Perhaps that would start with a greater focus on, and nuancing of, ‘Layer 1’ evidence: What can the client do with this to maximise their therapeutic outcomes? Nicola also raises the interesting point of whether a pyramid is still too hierarchical: would a target or spiral be a better representation of the potential use of data in therapy?

The pyramidal framework presented here is a way of organising research data to inform therapeutic practice. The pyramid builds, in layers, from the most general to the most specific evidence of what works—and is working—for an individual client. This framework does not negate a more factors-based taxonomy—indeed, it can incorporate it—but emphasises, instead, the relative proximity of different data sources to the actuality of each episode of clinical practice. Perhaps what is most useful about this framework is it provides a means of segueing from general and group-level research to individual-level research—and then, even, on to responsivity in moment-by-moment practice. This may allow a greater integration of research data into practice: research, here, is not something separate from what therapists generally do, but something spread on a continuum from the most general to the most specific. This framework is also a means of representing the way different sources of evidence may be weighted in different approaches, as well as the weighting of research evidence against other sources of clinical guidance. And while this framework does not indicate which sources (research or otherwise) should be prioritised, by mapping out possibilities in this way, it hints at the potential value of all. While this framework is a work in progress, it may be a way of organising and making sense of the research evidence that encourage a broader, more encompassing, and more pluralistic conceptualisation of all its uses.

Looking for America: Some Reflections on our Road Trip USA

Let us be lovers, we'll marry our fortunes together.

I’ve got some real estate here in my bag.

I’ve had the words of Simon and Garfunkle’s America in my head since my teens. The glamour and pathos of travelling across the US: sad, soulful, stretching out. Paris, Texas too: Harry Dean Stanton’s endless walking, desert, roads.

My partner Julie and I started with a few days in Chicago, then flew to a conference in Madison, Wisconsin. Hiring a car, we drove west through Minnesota to Badlands in South Dakota and then on to Yellowstone in Wyoming (see map and string, below). After that, we turned south to Salt Lake and Bryce Canyon in Utah. Another turn west to Las Vegas then back east through the Grand Canyon to Santa Fe in New Mexico. Finally, we turned north to Colorado. A semi-spiral of about 4,500 miles driving in total: ten states, eight national parks, three weeks. My dad had lived in the United States in the 1940s and 1950s, and often talked about his trip to Yellowstone (or was it Yosemite), the giant redwoods, and the Grand Canyon. These places had come to have an almost mythical status in my mind.

Nearly all the Americans we met were very friendly and likeable (aside from two scarily right-wing taxi drivers in Las Vegas). And not in a fake, ‘American stereotype’ way, but with genuine warmth and openness. People talked to us: about their lives, their politics, their connections to England and Europe.

‘I love you accent. Where are you from?’

‘Just south of London. Have you been there?’

‘No, I’d love to, I’ve only ever been to Paris in Europe.’

‘It’s beautiful there isn’t it. We love Paris. Did you find it different from here?’

The sheer beauty of the American landscape was, perhaps, the most memorable aspect of the trip. The Grand Canyon, Badlands, Bryce Canyon, Yellowstone, Rockies, Great Sand Dunes… so many places that swallowed you up in their vast otherworldliness (see favourite pictures, below; and full album here). The Grand Canyon was like a cut-away through the Earth; Bryce Canyon had the most weird-and-wonderful red rock sculptures. Breath-taking, and lovingly cultivated through the American national parks system. On the road too, through Wyoming or South Dakota, mile after mile of rolling land beneath the widest of skies. I can see why American colleagues of mine, like Kirk Schneider, write so much about ‘awe’: truly an awe-inspiring region of our planet.

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While American landscapes swallowed us in, urban areas seemed to do the very opposite. Whether in smallish towns like Sioux Falls or large cities like Denver, we felt we just couldn’t find their ‘centre’: the place from which the town or city radiated out? ‘Strip malls’ in the suburb, criss-crossing motorways, empty downtown areas… each time we visited a town or city we tried to start at it beating heart, but it seemed to run through our fingers like sand. Centrifugal rather than centripetal: towns that dispersed, moved away. I realised that the centrelessness I had felt, some years ago, in Los Angeles wasn’t specific to that city, but was more generic to many American conurbations (though not all: New York, for instance, felt much more ‘centred’). It felt so different to our European towns and cities, with high streets and churches at their core. Perhaps, we wondered, it was historical: our towns had evolved when people walked. American conurbations had grown up around the car. But what of community, of people constellated together? For us, as Europeans, we had a powerful sense of disorientation and anomie.

Las Vegas was the worst: we just couldn’t wait to get out of there. Mile after mile of amusement arcades—soulless, empty, barren. The dominance of machines, noise, and flashing lights over any kind of human connection.

I recently read Edmund Burke, the conservative philosopher, for my book on social change. I wanted to look at some counter-arguments to progressive thinking, but haven’t stopped quoting him since. He was writing against the French revolution, and one of his main points was that, by trying to forge something new, we can end up destroying the subtle, nuanced, imperceptible relationships that make things the complex whole that they are. American towns, with their grids of streets and avenues seemed a good example of that. Mathematically perfect and efficient, but something seemed missing: the messiness, complexity, and historicity that gives things their richness, depth, and soul. We wondered if that was why religion was so prevalent in America: because it gave people a community that they did not have otherwise.

As we drove, we listened to several American short stories from The New Yorker. The most memorable was John Cheever’s The Swimmer, written in 1964 (we watched the 1968 movie with Burt Lancaster, also very good, when we got home). It’s the simplest of narratives: a middle-aged confident, handsome man decides that he’s going to swim through the pools of New Hampshire suburbia to get back to his home and his wife and daughters (spoiler alert). In the first few pools, people greet and welcome him, give him cocktails: the local, all-American hero. But as he swims on, it becomes evident that he’s not the success that he seems: neighbours whisper about him behind his back, mock him, tell him to get out of their pool, ask when they’re going to get their money back. Eventually, it becomes evident that even the family and home he thinks he is swimming back to is an illusion: he is ruined, failed, destitute. For us, there was something so poignant about the story, and so reflective of our felt-experiencing of America: beneath the American dream, beneath those straight, clean lines of achievement and success, something much more sad, lonely, and alienated seemed to lie. Edward Hopper’s Nighthawks (1942), which we saw in the Chicago Institute of Art (below), is famous for depicting something very similar about American existence.

We were surprised by how many Americans we talked to were ardent Trump supporters. Thoughtful people, and generally kind and generous, but adamant that Biden was selling America to the Chinese and that Trump was their last hope. Digging deeper into their worldviews, we found a passionate advocacy of ‘negative liberty’: to be free of external restraints and self-determining. ‘No one has the right to tell me what to do’, ‘Why should I support people who don’t work,’ ‘“Global warming” is just the liberal elite trying to control us.’ The pursuant of liberty, but without much sense that that freedom was always within a context and had repercussions for others. Perhaps it’s the space, the vastness that has inculcated a spirit of moving out without a sense of what we might be moving in to.

And, of course, the European settlers were not reaching out over empty, unpopulated lands. As we travelled, we heard story after story of the destruction of native American peoples by the Europeans. Massacres, the abduction of children, killing off the buffalo, forced conversions to Christianity. The complex network of peoples and cultures that had existed for thousands of years was destroyed like a hand through a spider’s web. We saw some acknowledgement of this in museums across the country, but it seemed at a very formative stage compared with, for instance, Aotearoa New Zealand’s acknowledgement of Māori traditions and rights. Racism in America also seemed compounded by the abduction and enslavement of millions of Black Africans, giving it multiple historical and cultural layers.

Julie and I talked about the Europeans who had first come to America and the kind of traces that they might have left: genetically as well as culturally. Not only were these people who wanted to escape religious persecution, but also those willing to brave the journey to a new and uncertain land. Perhaps the most driven of Europeans, or the most courageous, or those who valued independence above all else. A society of strong-willed, determined people: no threads to hold them back.

We also listened to the audiobook of John Steinbeck’s East of Eden during our drive, and managed to get most of the way through its 600 pages. It’s a saga of love and hatred between brothers—inter-generational pushing and pulling, freedom and relationality. America, to me, seemed a land of push, of space, of reaching out to beyond. A wonderful strength of possibilities; but, without the centripetal pull, at risk of dissolution, dispersal, destruction. Reaching out cannot go on forever. Negative liberty pushes, but in that push it can forget that we live, inevitably, within bounds; one person’s push is another person’s subjugation. The American landscape touched that part of me that wanted to reach out infinitely; but, in its social organisation, it reminded me of my desire for relatedness, community, and soul.

The last verse of Simon & Garfunkle’s America:

‘Kathy, I'm lost’, I said, though I knew she was sleeping
I'm empty and aching and I don't know why

Perhaps I felt a little closer to understanding that ache.

Cinema Paradise, Soho: Growing up with Contemporary Films

There was always a whir of excitement, whoever was ringing. First you pulled out the red jack from its socket—its windy, stripy cord attached—and plugged it into the socket for that extension. ‘Hello, Contemporary Films, Can I help you?’ Sometimes it was easy: ‘I’d like to speak to Mr Hedges,’ or, ‘Can I talk to Kitty Cooper in International.’ Then you pulled out the black jack and put it in to that person’s extension. There was a switch that you toggled to call that person—trying, as best you could, to emulate the ‘ring, ring’ of a phone—and then, when the person picked up, you’d let them know who was calling and leave them to it. Sometimes it was trickier: ‘How much is it to rent Battleship Potemkin?’ or, ‘We’re from the Kent University Film Club and we want to know when our films will arrive?’ Then we’d have to get Auntie Rose to rescue us. ‘Um…’ we’d mumble to the caller. ‘We’ll just put you on to someone.’ Then we’d pull the jack out, put them on hold, and sheepishly slide the phone over to Auntie Rose: she always knew what to do. There were small rotating tickers on the switchboard exchange that indicated how much the outgoing calls were costing: the faster they went, the more the units of charge. We used to ask Uncle Harry about the most expensive call ever. Apparently, my dad had once called America… for almost an hour. Uncle Harry told us that the ticker was going round like crazy and he was running up and down the stairs trying to get my dad off the phone.

We started ‘helping out’ on the switchboard of our parent’s film distribution company when I was about five years old and Davina, my older sister, was about six, in the early 1970s. The reception was on the ground floor of a tall, narrow building in Soho. At the back of the reception was Uncle Harry’s shop, with his desk and cash register, and walls covered with film projectors, projector lamps, and film cans. My parents used to say that most of the people who came to buy things were from the local Soho sex shops. Uncle Harry never seemed happier than when he sold a projector. That was rare though. Mostly he sold just a few projector lamps or fuses each day, sitting at the back of the shop and looking out onto Greek Street through a cloud of cigarette smoke.

Me, 1972, about six years old

Auntie Rose was warm, loving, cuddly: some of my happiest memories were sitting on her lap on the switchboard. She would often have the latest copy of The Puzzler in her handbag: a magazine full of crosswords, logic puzzles, and other games. Davina and I would do them with her: I liked the join-the-dots and wordsearches best. When we had finished one magazine she would give us 50 pence to go the local newsagents to buy another, and an ice lolly.

‘Auntie Rose’ and ‘Uncle Harry’ weren’t quite my uncle and aunt. Uncle Harry was the older brother of my dad’s first wife, who had died tragically in her 40s. They had three children together: my oldest sister Flo, and then ‘the twins’, Sue and Adi. A few years after his first wife’s death, my dad got re-married to my mother who was over 20 years his junior. When my dad set up his film distribution company in the 1950s, he had asked Uncle Harry to join him, and Uncle Harry ran the shop while my dad ran the rest of the company.  

I loved Uncle Harry but he could be quite stern. When I was about eight years old, I started going to the Soho amusement arcades, spending one or two pence on the penny falls or the ‘one-armed bandits’. One morning I lost about ten pence. I felt so bad about it, and so determined to win it back, that I did a terrible thing: I went back to the Office and stole a 50 pence piece from Uncle Harry’s cash register. I rushed back to the arcade and, within 20 minutes or so had managed to lose most of that 50 pence as well. Just as I was desperately shoving the last few coins into the penny falls, Uncle Harry appeared in the arcade and took me back to the Office. I guess my parents worked out I must have been there: I never quite knew how. They were particularly worried because, at least according to them, there had been a shooting at the arcade a few weeks before and they were ‘all run by gangsters’. I’m not sure Uncle Harry ever knew I’d stolen his fifty pence and, in fact, he was really kind when he walked me back.

***

My dad’s office was on the second floor. You got to it through his secretary’s office, with Charles Hedges, their publicity person, opposite. My dad had a black leather swivel chair that was brilliant to sit and spin in; a window with iron frames to look down onto bustling Greek Street; and a long black leather sofa—perfect for jumping on or napping. If we went to my dad’s office he’d offer us coffee then ask his secretary to make it. We’d have coffee and biscuits sat facing him in a low leather chair, peering out over his large, laminated desk.

My parents, 1973

Once, in my twenties, I did a psychodrama exercise where we had to imagine our parents as animals. I imagined my dad as a big friendly bear. He was warm, affectionate, social—already in his late 50s by the time I was born (about the age I am as I write this). He was a schmoozer—not much of a listener. He was also, as my girlfriends have endlessly remarked, very handsome: broad-shouldered with a wide, welcoming face and strong jaw. When I went back to Ukraine, where his parents had escaped the pogroms from in the 1890s, I could see where he got his looks: all the men there, I was amazed to see, seemed to have the same square-shaped frame as my dad… and me.

My mum’s office seemed more a place where work actually happened. It was down on the first floor, with most of the other employees. She was in charge of ‘International’. My mum typed at lightning speed and had one of the first Telex machines, which I loved feeding the strips of tape in to. Like my dad, my mum was very intelligent, but less confident. I always assumed she’d been put in charge of International because of her German roots. It was not something that she would easily talk about. She refused to watch films about the holocaust. I always thought it was because of how upset it would make her—she lost several close relatives in the holocaust, including her favourite cousin, ‘Little Katie’. At one film festival, though, she inadvertently saw a film with scenes about the Shoah and, on exiting, starting screaming at two German associates outside the screening room: ‘You see what you lot have done…’. It was rage, not sadness, that she seemed most afraid of unleashing.

***

When Davina and I weren’t on the switchboard we would be in Despatch with ‘the boys’. These were the young men who would receive, check, and send out the film reels to the various cinemas or societies that would rent the company’s films. I loved ‘splicing’: checking over the films that came in to see if there was any damage and, if so, using a splicing machine to put the undamaged ends together again. Sometimes we would watch films on the large, reel-to-reel machines that they had there for checking; or we would watch them in the small preview cinema on the mezzanine between first and second floors, where one of the boys would set up a film for us. I loved that dark, cosy cinema: sinking in to the plush velvety seats. Even better, sometimes I would be allowed to thread the film through the projector and run it. So many cogs, switches, and loops… each had to be exactly right or the film would get twisted and mangled.

The problem, though, was that there was hardly ever any good films to watch. My dad, being a communist since his 20s, had set up a film company that was one of the leading distributors of progressive and foreign language films. Great if you are a member of the Young Communists, but not if you are a five-year-old wanting some entertainment during the school holidays. There were a few Eastern European short films. But, God, they could really be terrifying. One that my parents used to show me at home, where we also kept a projector, was called The naughty little goat: about this cute little baby goat that runs away from its parents’ into the woods… and is eaten by wolves. I would watch it compulsively, glued to the screen and the crescendo of screeching Slavic violin as the goat broke from its farm and rushed headlong into the woods, never to be seen again. I have no idea why my parents showed it to me. Perhaps they knew I was going to be a psychotherapist and were preparing me for dealing with trauma!

When we were really little, the film that Davina and I wanted to watch over and over again was a short about the dangers of cigarette smoking. My dad also had some Marx Brother’s film (unrelated, as I came to learn, to Karl Marx), and we particularly loved Horsefeathers. Another favourite was called The Little Island. This was a 1958 cartoon about three characters who each prize one value (‘good’, ‘truth’, or ‘beauty’) over all others, and eventually come to blows over it (in the form of a terrifying knife fight escalating to nuclear holocaust). Looking back, it’s striking to me that the message of this film—the dangers of privileging one, monolithic set of values—is exactly what we articulated decades later in our ‘pluralistic’ approach to therapy.

Thanks to Uncle Harry, my parents also had the rights to the English Coal Board’s film archives, so that was another option: long infomercials about the British coal industry. When I got into my teens, my best friend James and I would scour through the dusty film canisters that my parents kept in the basement of our house to see if we could find something with some nudity in it. It was an endless, and always disappointing, search. At one point, we were quite excited to find a film called ‘the body’, but when we threaded it onto the projector it turned out to be a medical documentary.

***

Sometimes, Davina and I would go and play in the dilapidated adventure playground off Wardour Street. My parents didn’t like that much more than the arcades because of all the rusting old iron lying about. One time, I got a nail in my foot. Foyles, just around the corner, was a preferred option for whiling away an afternoon. As the biggest bookshop in the world, it seemed an endless maze of dusty book-lined corridors. The system for buying books was particularly archaic. First you had to line up at a counter to get a ticket for the book you wanted to buy. Then you’d walk over to the cashier with the ticket and pay. Then you’d get another ticket to take back to the first counter where they’d finally give you the book in crisp, white paper wrapping. Davina liked novels, like Narnia. I liked Charlie Brown books. Sometimes, at Oma’s house on Sundays, before the lunch of chicken soup with matzo balls and boiled chicken, we’d act out scenes from Charlie Brown. Davina would be Lucy, and I’d be Snoopy, following around after her on all fours.

Oma, my grandmother, 1960s

Oma, as I discovered when I was about eight years old, wasn’t actually called ‘Oma’—she was ‘Betty’—‘Oma’ was German for ‘grandmother’. Oma and my 7-year-old mother had come over to London as Jewish refugees from Berlin in 1939. When I was very young, I sometimes mixed-up Oma with auntie Rose: both warm, loving, caring. Oma spoke with a thick German accent. But she could also be quite pushy: I remember her shoving commuters as we climbed aboard a London bus. Oma would stare intensely into your face when you ate which I always found disconcerting. When I was about 13, my best friend James and I borrowed £5 from her to go to the arcade. We said that we would mow the lawn at her house in Wood Green in return. She reminded me about that week after week but we never did it. I always felt guilty about that: right up until Oma died in the mid-1980s.

Another thing that still makes me shudder with shame. Mick Jagger came to visit the Office. He was considering a part in a film by the German director Werner Herzog and my parents had some of Herzog’s films, so they were going to show it to him at their mezzanine cinema. Davina, about 12-years-old at the time, said that she wanted to be in charge of showing him around. I was a bit nonplussed about it all until the day of the visit, when I decided that, in fact, I did really want to meet him. I rushed back to the cinema from the arcade and, as cool I could, pulled back the velvet curtain, walked into the cinema, and took a seat. I remember Jagger looking up at me as I entered, an expression of vague disinterest. The film was one of those excruciatingly dull foreign language films that my parents distributed. I remember something about a circus and a market. After what seemed an eternity the film ended, and Jagger stood up to go. My dad stood up and shook Jagger’s hand, then Davina did, then others, then I stood up with my hand outstretched. He walked straight past me and out of the cinema. I felt mortified and thought about chasing after him, down the street, so that he would give me a proper handshake. I still feel a pang of embarrassment every time I see pictures of Jagger or hear music from the Rolling Stones.

***

One of the amazing things about growing up in this world was getting to go to the film festivals. Cannes was an annual event in the Spring. For Davina and myself, that meant swimming, playing in the sand, and lounging beneath the umbrellas of the beach clubs: each club with its own adornment of different coloured stripes. We had ham and cheese toasted sandwiches for lunch. Dinner was in small local restaurants. A special treat was steak tartare: raw minced beef forked together with eggs, ketchup, and herbs, my mum looking nervously on. One year, Davina and I were asked to ‘host’ the stall for my parents’ independent film distributors association. We sat proudly behind a desk in the large festival arena, handing out leaflets. Sometimes we also got to go to the films: mostly of the long, boring subtitled types; but children’s films were also sometimes on the programme. One that Davina and I particularly liked was ‘Stubby’, about a young Swedish boy who is so good at football that he ends up playing for the national team. We loved the film so much—Stubby darting through the legs of the grown-up players—that we convinced our parents to buy its UK distribution rights. It bombed: my parents said that no children wanted to watch a film with subtitles.

One night, when Oma came to Cannes with us, my parents stayed out really late. Davina and I were back at the apartment with Oma looking after us, and I remember growing more and more anxious. Where were they? Why weren’t they back yet? I was convinced something awful had happened to them. Panic: a gnawing emptiness in my stomach, something I couldn’t control. I felt like a hole had opened in the earth and I was falling through, nothing to grip on: accelerating, terrified, down and down. Oma seemed scared too. Eventually, maybe 2am or so, my parents returned. No big deal, just a late party. Silence.

And then there was ‘The Machines’ at Venice: the happy place I would go to many years later if asked to visualise a place of safety and joy. We didn’t go to Venice as often as Cannes, but it was the same time of beaches, swimming, and sun lounging for Davina and myself. And just on the main street of the Lido—the sliver of Venice on which the film festival was held—was an arcade that stretches back beyond my earliest memories. Walking past stalls of fresh coconut, their aroma filling the warm night air, was a utopia of mechanical games, lights, and excitement: table football, penny falls, a mini bowling alley.

Some years ago, I began to recognise a lot of parallels between my parents going to film festivals and my own going to academic conferences: the networking, the schmoozing, the being part of a big community. Bumping into old colleagues and talking about the latest research findings or measures—just like my parents talking about the latest films with fellow distributors, directors, and reviewers. It wasn’t a conscious choice for me to enter this world, but perhaps, at some level, it was a way of doing things that felt safe and familiar. Or perhaps I entered into academic life with a confidence borne of seeing my parents immersed and engaged in their own community.

***

One of the best things about a day at the Office was lunch. My parents’ work day seemed to start late, about 10 o’clock, and by noon or so (with a coffee break in between) we’d be talking about where to eat. Italian was the norm, and I’d gobble up my favourite: spaghetti Bolognese. Chinese was also very popular. Oma would take us some times. Davina and I had a reputation for being badly behaved, though I’m not sure we ever were. I do remember once, though, at the Dumpling Inn Chinese restaurant, breaking set after set of chopsticks as we used them for drumming. Oma said, many times after that, that we’d nearly got thrown out of the restaurant.

It wasn’t lost on me: the contradiction between the privilege that we had, and the communism that my parents—and I—espoused. Kids at school would sometimes tease me: if your parents are communists why do you live in a big house in Highgate (a posh London suburb)? One time, there was almost a revolution at my parents’ company. I found out because, driving to work one day, I could hear them talking about an employee—someone close to them—who was stirring up trouble. I was worried it was Auntie Rose and asked. They said ‘No’. It turned out it was the boyfriend of one of my older sisters, who had been working for my parents for about a year or so. He was a bright, ambitious young man, with a pointy beard that made him look like Guy Fawkes. My parents said he was an anarchist. This boyfriend had been steadily promoted, but was now asking that awkward question: if the company was advocating socialism, why was it owned by three bosses (my parents and Uncle Harry) and not a workers’ collective? Worse, he was actually trying to collectivise it. Around half or so of the employees rallied behind him, and for some time my parents were genuinely worried that they might lose control of the company, but eventually the boyfriend left and things returned to normal.

***

By the time I got to my mid-teens, going to the Office meant getting the tube in to Tottenham Court Road with James, badgering my dad for ‘Luncheon Vouchers’, then going off to McDonalds for Big Macs, fries, and milkshakes before spending the afternoon in the arcades. By that time, I was quite seriously addicted to fruit machines—something I only really kicked in my early 20s. Sometimes I took money from my parents. Worse was asking my parents for money to buy clothes, getting the cheapest possible, then spending the rest in the arcades. I think my own kids have been surprised that, when they’ve taken money from me without asking, I’ve never got that angry. But how could I when I did that even worse.

When I was around 18, my parents felt that they couldn’t afford the rents in Soho any more and moved their offices to our house in Highgate. My dad had his own office, my mum shared with a few other staff that moved with them (including, later, Eric Liknaitzky). But my dad was increasingly losing heart, and the realities of the film business at that time meant increasingly big financial risks, which my parents were never really willing to take. The fall of the Soviet empire—and the dissolution of the British Communist Party that followed—also really hit my dad: his life’s meaning had been fundamentally scythed and he never really recovered from that. Nevertheless, my dad continued to work well into his 80s, though by that time it was more sitting in his swivel chair, pushing around a few bits of paper, and speaking into his dictaphone. He talked of making a film about his grandfather Moishe who was kidnapped into the Czar’s army as a young Jewish boy, and actually wrote up a script. Almost 40 years later, my daughter, Maya, would turn that into a short film. 

***

Ironically, the films I adore now are exactly the sort that my parents’ distributed, and which I despised as a kid. Sometimes, I’ll see a really good film and, when I tell my mum about it, she’ll say, ‘Oh, that was one of ours’. I tease my kids—products of a TikTok era where nothing last longer than 10 seconds—that they should join me to watch seven hour epics about communal farms in Slovakia. ‘There’s a scene in it’, I tell them, ‘which goes on for an hour and consists of watching a doctor get drunk in real time.’

‘Daaaad….!’

‘And then there’s an opening shot of 20 minutes of cows walking across a field’. ‘Or we could watch the three hour one about the dad and his daughter in a hut eating potatoes’.

‘Daaad….!’

‘You know what happens?’

‘Whatttt?’

‘Their horse dies.’

***

As therapists, the focus of our work is often on how the past informs the present; and we know how complex this relationship is. Somehow, through these experiences of growing up around cinema—and through thousands of other experiences—I emerged: not created by these experiences; but touched and swayed and nudged. Something complex, rich, ethereal mingled with me, enticed me, helped me develop form. I shaped myself against this world: these people, this community, these machines. When I see myself as a whole, I am also the boy jumping on his dad’s sofa, and getting dragged out of the arcade, and answering the phone on his Auntie Rose’s lap; and all the traces of those experiences as they wove their way through my life. There’s no cause-and-effect here. No simple x made me y. But through that love, that culture, those experiences of joy and shame—through all that multifaceted, intermingled complexity—my own complex and multifaceted way of being and being-in-relation evolved.

---

Further information about my father and Contemporary Films:

• Obituary (Charles Cooper), The Guardian. (4th Dec 2001)

• Dickinson, R. (1999) Rogue reels: Oppositional film in Britain, 1945-1990. BFI.

• Hogenkamp, B. (2000) Film, television and the left, 1950-1970. Lawrence & Wishart. [Including a photo of my dad, looking dapper in a tie, on the cover]

• Contemporary Films website.

The Coronation: Reflections from a Republican Therapist

I don’t bear King Charles or the royal family ill-will. My guess is, like most of us, they’re decent human beings trying to do their best for themselves and the communities around them. William and Kate, I know, have done some valuable work around child mental health. And if people around the world find community, meaning, and pleasure in the royal family and royal celebrations then good for them. I kind of wish I did. There’s enough misery going on in the world that having something to celebrate can’t be bad for people’s psychological health.

But what I worry about is the kind of mind-set that is fostered by the coronation, the royalty, and particularly the recent invitation to ‘swear allegiance’ to the King. We’ve been invited to ‘pay homage, in heart and voice, to our undoubted King, defender of all,’ and swear, ‘true allegiance to Your Majesty, and to your heirs and successors according to law’ (see here). Personally, as a therapist, I just think, ‘What the ****’ Here’s why…

When people come to therapy, it’s rarely to do with insufficient homageness/subservience to authority, or lacking some sense of a sovereign being in their lives. That’s rarely why people suffer.

Rather, in many cases, psychological problems come down to: (1) A lack of self-esteem, and/or (2) Not feeling empowered or being assertive, and/or (3) Deferring choices to others and then not feeling that one’s life is as it should be. People who come to therapy often have a pervasive—albeit implicit—sense of powerlessness: ‘everyone else can do things but me’. So choices don’t get made, others are seen as being more responsible, clients feel that they can’t say or choose towards what they want. And then life becomes unbearably empty and dull: ‘I don’t have what I want because I’ve never felt able to try and get it.’

Here, the role of therapy, so often, is to help clients see that they do have choices. Not all choices—not that they can do whatever they want—but that they have some choices, and that within those limitations they have contingent power, they can move forward. They don’t have to rely on others to lead them and to tell them how to live their lives.

So, to me, pledging homage and subservience to royalty seems the kind of thinking and behaviour that’s associated with poorer mental wellbeing, rather than better. It’s about deferring to authority, seeing someone as better and more important than you and with some god-given right to do something that you can’t do yourself. It’s an ideology that seems to run counter to the the work that therapists do: to help people feel like they’re an equal, that they’re capable and able, that their lives are their own rather than another’s.

Therapeutic wellbeing, so often, is about helping people own and embody their power. It’s about supporting people to recognise that they are ‘adults’, that they’re responsible human beings who can (and need) to take part in the development of their communities: not expect others to do it for them: they’re ‘citizens’ rather than ‘subjects’ (as Deborah Flynn-Harland wrote in response to an earlier draft of this blog). These are people that have the capacity to take leadership: who recognise that we can all lead, and develop, and be brilliant—not just a chosen few.

As a society, we worship all kinds of celebrities. Football players, musicians, artists, business moguls. That’s probably not ideal too. But the difference is that these people, in most cases, have at least done something—we look up to them because of what they achieved and what we might not be able to do ourselves. But with the royals—or with nobility and other inherited privileges—they haven’t actually done anything special or different to earn their status. They just got born into a particular class. So when we pay homage to them, when we look up to them, we’re essentially regurgitating an ideology that says, ‘You are not as good as others just because of who they—and who you—are. You’re not as worthy because you are you.’ And what does that do to people’s psyches?

I’ve been reading Jonathan Haidt’s The righteous mind (Penguin, 2012), and it’s a brilliant book about how we develop and maintain particular moral positions. Haidt argues that a morality based around the principle of obedience to authority is just as valid as one based around principles of care or fairness. It’s an interesting and challenging argument, but I think Haidt is wrong. Care and fairness advantage multiple people, it helps to create a world in which more people can benefit more of the time (as I’ve argued in my recent book, Psychology at the heart of social change , Policy, 2023). But what does obedience to authority benefit? Perhaps it gives people a sense of security, perhaps it gives society some stability. But it has so many downsides too: inequalities, marginalisation, oppression, a lack of freedom or creativity. If obedience to authority was core to wellbeing, then why isn’t it at the heart of practices like therapy, or other wellbeing-oriented practices like social and emotional learning in schools. I can’t think of one therapeutic practices that tries to help clients be more obedient to authority as a means of fostering psychological health. I can think of hundreds that try to improve self-esteem, assertiveness, and a willingness to be ‘adult’.

Actually, having said that, there is one approach to mental wellbeing that does advocate a more hierarchical approach: positive parenting. Here, in this well-evidenced practice, you do try and encourage your children to listen to you and follow you, even if, at times, you can’t fully explain why (screams: ‘Don’t cross the road, a car is coming’). But positive parenting is what adults do with children, so it begs the question, are we children to the royals? Are we their infants and they our parents? Perhaps, psychologically, we can become so; but in a world facing climate catastrophe, war, genocide, do we need more infantalised adults? Rather, I think we need more adultified adults: who can take on responsibility, and feel that they are—and can be—the backbone for a future.

When I was a teen, I was of the ‘hang the monarchy’ persuasion. Now, I think that kind of ideology is as inhumane, destructive, and unhelpful as a pro-Royalist one. And I’m going to be having fun on Saturday: albeit at our ‘Definitely Not Celebrating the Coronation’ house party. But for all the pomp, pageantry, and ‘glamour’ of the coronation (and expense!), I really can’t see how reinforcing subservience and homaging is going to help us move in the direction of personal, social, and/or environmental wellbeing—directions we so desperately need to move in right now.

Acknowledgement

Photo by Jared Subia on Unsplash

Measure Development and Testing Research: Some Pointers

Have you ever had one of those dreams where you’re running towards something, and the faster you go the further away it seems to get? That, to me, is what doing research in the measure development field seems like. Every time I think I have mastered the key methods some bright spark seems to have come up with a new procedure or analysis that is de rigueur for publishing in the field. No mind, I have to say that developing measures has been one of the most satisfying and even exhilarating elements of my research career, however humbling it might be at times. And, indeed, having gone from knowing next to nothing about measure development to creating, or helping to test, some fairly well-used measures (including one with my name on it, the Cooper-Norcross Inventory of Preferences!), I’m pretty confident that it’s a research process that anyone—who’s willing to devote the time—can get involved in.

And, of course, the point of developing and validating measures is not just for the narcissistic glory. It’s research that can help to define phenomena and explore their relationship to other factors and processes. Take racial microaggressions in therapy, for instance. Measures can help us see where these are taking place, what’s leading to them, and help us assess methods for reducing their prevalence. Of course, the downside of measures is that they take complex phenomena and reduce them down to de-contextualised, linear variables. But, in doing so, we can examine—over large, representative samples—how these variables relate to others. Do different ethnic groups, for instance, experience different levels of racial microaggressions in therapy? We could use qualitative methods to interview clients of different ethnicities, but comparing their responses and making conclusions is tricky. Suppose, for instance, of the Afro-Caribbean clients, we had four identifying ‘some’ microaggressions, two ‘none’, and three ‘it depended on the therapist’. Then, for the Asian clients, we had two saying, ‘I wasn’t sure’, three saying ‘no’, and two saying, ‘it was worse in the earlier sessions’. And one Jewish client felt that their therapist made an anti-Semitic comment while one didn’t. So who had more or less? By contrast, if Afro-Caribbean clients have an average rating of 3.2 on our 1 to 5 scale of in-therapy racial microaggressions, and Asian clients have an average rating of 4.2, and our statistical analysis show that the likelihood of this difference being due to chance is less than 1 in a 1,000 (see blog on quantitative analysis), then we can say something much more definitive.

From a pluralistic standpoint, then, measure development research—like all research methods—has a particular value at particular points in time: it all depends on the question(s) that we are asking. And while, as we will see, it tends to be based on positivistic assumptions (that there is a real, underlying reality—which we can get closer to knowing through scientific research), it can also be conducted from a more relativist, social constructionist perspective (that no objective ‘reality’ exists, just our constructions of it).

What is Measure Development and testing Research?

Measure development research, as the name suggests, is the development of ‘measures’, ‘scales’, or ‘instruments’ (also known as the field of psychometrics); and measure testing research is assessing those measures quality. Measure development studies will always involve some degree of measuring testing, but you can have measure testing studies that do not develop or alter the original measure.

A measure can be defined as a means of trying to assess ‘the size, capacity, or quantity of something’: for instance, the extent to which clients experience their therapist as empathic, or therapists’ commitment to a spiritual faith. In this sense (and particularly from a positivist standpoint), we can think of psychological measures as a bit like physical measures, for instance rulers or thermometers: tools for determining what’s out there (like the length of things, or their temperature).

Well known examples of measures in the counselling and psychotherapy field are the CORE-OM (Clinical Outcomes in Routine Evaluation – Outcome Measure), which measures clients’ levels of psychological distress; and the Working Alliance Inventory, which measures the strength of therapist-client collaboration and bond. There’s more information on a range of widely used ‘process’ and ‘outcome’ measures for counselling and psychotherapy here.

Measures generally consist of several ‘items’ combined into a composite score. For instance, on the CORE-OM, two of the 34 items are ‘I have felt terribly alone and isolated’ and ‘I have felt like crying’. Respondents are then asked to score such items on a wide range of different scales—for instance, on the CORE-OM, clients are asked to rate the items from 0 (not at all) to 4 (Most or all of the time)—such that a total score can be calculated. Note, in this way, measures are different from ‘questionnaires’, ‘surveys’, or ‘checklists’ that have lots of different items asking about lots of different things. Indeed, as we will see, the ‘combinability’ of items into one, or a few, scales tends to be a defining feature of measures.

A measure can consist of:

• One scale. An example is the Relational Depth Frequency Scale, which measures the frequency of experiencing relational depth in therapy.

• Two or more scales. An example is the Cooper-Norcross Inventory of Preferences, which has scales for ‘client preference for warm support vs focused challenge’, and ‘client preference for past focus vs present focus’.

• Two or more subscales: meaningful in their own rights, but also summable to make a main scale score. An example is the Strengths and Difficulties Questionnaire for children, which has such subscales as ‘peer problems’ and ‘emotional symptoms’, combining together to make a ‘total difficulties’ score.

Generally, A single scale measure or a subscale will have between about four and 10 items. Less than that and the internal consistency starts to become problematic (see below); more than that and the measure may too long to complete, with items that are redundant.

Measures can be designed for completion by therapists, by clients, or by observers. They can also be nomothetic (where everyone completes the same, standardised items), or idiographic (where people develop their own items, for instance on a Goals Form).

Underlying Principles

Most measure development and testing research is underpinned by a set of principles known as classical test theory. These are fairly positivistic, in that they assume that there are certain dimensions out there in the world (known as latent variables) that exist across all members of the population, and are there independent of our constructions of them. So people’s ‘experiencing of racial microaggressions’ is a real thing, just like people’s temperature or the length of their big toe: it’s an actual, existent thing, and the point of our measure is to try and get as close as possible to accurately assessing it.

You might think, ‘If we want to know about clients’ experiences of racial microaggressions in therapy, why don’t we just ask them the question, “To what extent do you experience racial microaggressions in your therapy?”’ The problem is, from a classical test theory perspective, a respondent’s answer (the ‘observed score’) is going to consist of two components. The first component is going to be the part that genuinely reflects their experiencing of microaggressions (the ‘true score’ on the latent variable). But, then, a second part is going to be determined by various random factors that influence how they answer that specific question (the ‘error’). For instance, perhaps the client doesn’t understand the word ‘microaggressions’, or misunderstands it, so that their responses to this particular item don’t wholly reflect the microaggressions that they have experienced. Here, what we might do is to try and minimise that error by asking the question in a range of different ways—for instance, ‘Did your therapist make you feel bad about your race?’ ‘Did your therapist deny your experiences of racism?’—so that the errors start to even out. And that’s essentially what measure development based on classical test theory is all about: developing measures that have as little error as possible, so that they’re evaluating, as accurately as they can, respondents’ true positioning on the latent variable. No one wants a broken thermometer or a wonky ruler and, likewise, a measure of the experiencing of racial microaggressions in therapy that only reflects error variance isn’t much good.

As you can see, all this is based on very positivist assumptions: a ‘true’, underlying (i.e., latent) reality out there in the world; acting according to laws that are true for us all; and with ‘error’ like an uninvited guest that we’re trying to escort out of the party. Not much room for the existence of unpredictability, chaos, or individual uniqueness; or the idea that ‘reality’ is something we construct according to social mores and traditions. Having said that, adopting classical test theory assumptions, for the purposes of measure development, doesn’t mean you have to be a fully-fledged positivist. From a pragmatic standpoint, for instance, you can see measure development as a means of identifying and assessing something of meaning and importance—but whether or not it is something ‘real’ can be considered a mute point. We know, for instance, that there is something like racial microaggressions that can hurt clients and damage the therapeutic relationship, so we can do our best to find ways of assessing it, while also acknowledging the inherent vagaries of whatever we do. And, perhaps, what we call ‘racial microaggressions’ will change over time and vary across cultures and individuals, but that shouldn’t stop us from trying to get some sort of handle on it, so that we can do our best to find out more and intervene.

Developing a measure

So how do you actually go about developing a measure? It might seem like most measures are developed on the back of the proverbial ‘fag packet’ but, OMG, it is vastly more complicated and time-consuming than that. I worked out that, when Gina di Malta (with myself and Chris Evans) developed the 6-item Relational Depth Frequency Scale, it took something like six years! That’s one year per item.

That’s why, for most of us who have developed measures, the first thing we say to people who want to develop their own measures is to first see if they can use measures that are already out there. That’s unless you really have the time and resources to do the work that’s needed to develop and validate your own measure. Bear in mind, a half-validated measure isn’t much valid at all.

So why does it take so long? To a great extent, it’s because there’s a series of stages that you need to go through, detailed below. These aren’t exact, and every measure development study will do them slightly differently, but the sections below should give you a rough idea of what steps a measure development study will take.

Defining the Latent Variable

Before you develop a measure, you have to know what it is that you are trying to measure. To some extent, this may emerge and evolve through your analysis, but the clearer you are about what you’re looking for, the more likely your measure will be fit for finding it.

‘I’d like to know whether clients feel that they’ve got something out of a session.’ OK, great, but what do we mean by ‘got something out of’? Is this feeling that they’ve learnt something, or finding the session worthwhile, or experiencing some kind of progress in their therapy? ‘Maybe all of those things.’ OK, but feeling like you’ve learnt something from a session may not necessarily correlate with feeling like you’ve made progress. They may seem similar, but perhaps some clients feel there’s a lot they’ve learnt while still coming out of a session feeling stuck and hopeless.

Things that just naturally seem to go together in your mind, then, may not do so in the wider world, and disentangling out what you want to focus on is an important starting point for the measure development work. How do you do that? Read the literature in the area, talk to colleagues, journal, look at dictionaries and encyclopaedias: think around the phenomenon—critically—as much as you can. What you want to identify is one discrete variable, or field, that you can really, clearly define. It could be broader (like ‘the extent to which clients value their sessions’) or narrower (like ‘the extent to which clients feel they have developed insight in their sessions’), but be clear about what it is.

item generation

Once you know what latent variable you want to measure, the next step is to generate items that might be suitable for its assessment. At this stage, don’t worry too much if the items are right or not: brainstorm—generate as many items as you can. In fact, one thing I’ve learnt over the years is that you can never have too many items at this stage, and often you can have too few. Probably around 80% or so of items end up getting discarded through the measure development process, so if you want to end up with a scale of around 5-10 items, you probably want to start with around 25-50 potential ones. Bear in mind that you can always drop items if you get to the end of the measure development process and have too many, but it’s much more difficult to generate new items if you get to the end and find you have too few.

Ideally, you want to do this item generation process in one or more systematic ways, so it is not just the first, ad hoc, items that come into your head. Some strategies for generating items are:

• Search the literature on the topic. Say we wanted to develop a measure to assess the extent to which adolescent clients feel awkward in therapy (we’re interested in differences in awkwardness across types of therapies, and types of clients). So let’s go to Google Scholar to see what papers there are on young people’s awkwardness in therapy, and also we should check the more established psychological search engines like PsychInfo and Web of Science (if we have access, generally through a university). Supposing, there, we find research where young people say things like, ‘I felt really uncomfortable talking to the counsellor’ or ‘The therapist really weirded me out’. So we can use these statements like that (or in modified form) as items for our measure, and it might also trigger some ideas about further items, like ‘I felt really comfortable talking to the counsellor’ (a reverse of the first statement here), or ‘The therapist seemed really weird’ (a modification of the second statement).

• Interviews and focus groups. Talk to people in the target population to see what terms they use to talk about the phenomena. For instance, an interview with young clients about their experiences of counselling (approved, of course, through the appropriate ethical procedures) might be an ideal way of finding out how they experience ‘awkwardness’ in therapy. What sort of words do they use to talk about it? How does it feel to them?

• Dictionaries and thesauruses. Always a valuable means of finding different synonyms and antonyms for a phenomena.

Remember, what you are trying to do is to generate a range of items which are, potentially, a means of ‘tapping into’ your latent variable. Have a mixture of phrasings, with some items that are as closely worded to your latent variable as possible (for instance, ‘I felt awkward in therapy’), but other that might come at it from a different angle, providing ‘triangulation’ (for instance, ‘The interaction with my therapist seemed unusual’). It’s also good to try reversing some items (so, for instance, having items that are about not feeling awkward, as well as feeling awkward)—though having such items in a final scale is no longer considered essential.

At this point, you’ll also need to start thinking about your response categories: the ways that people score your items. For instance, do people rate the items on a 3- or 5-point scale, and what labels might you use to describe these different points? This is an enormous field of science in itself, and usually it’s best to keep it simple and use something that’s already out there so that it’s been tried and testing. For instance, if you decide to develop your own four point scale with labels like 1 = Not at all, 2 = A really small amount, 3 = Quite a bit, 4 = Moderately, 5 = Mostly, How do you know that Quite a bit means less to people than Moderately; and couldn’t the difference between 2 and 3 (A really small amount and Quite a bit) be a lot more than the difference between 4 and 5 (Moderately and Mostly)? So have a look at what other validated and well-used measures use as response categories and see if anything there suits. Two common ones are:

1. = Strongly disagree

2. = Moderately disagree

3. = Mildly disagree

4. = Mildly agree

5. = Moderately agree

6. = Strongly agree

   Or

1. = Not at all

2. = Only occasionally

3. = Sometimes

4. = Often

5. = Most or all of the time

At this point, you’ll also need some idea of how you phrase the introduction to your measure. Generally, you’ll want to keep it as short as possible, but there may be some essential instructions to give, such as who or what to rate. For instance, for our racial microaggressions measures, we might want to say something like:

Please think of your relationship with your current therapist. To what extent did you experience each of the following?

In this instance, we might also consider it essential to say whether or not the clients’ therapists will see their scores, as this may make a big difference to their responses.

Testing items

Expert Review

The next stage of the measure development process is to pilot test our items. What we would do is to show each of our items to experts in the field (ideally experts by experience, as well as mental health professionals)—say between about 3 and 10 of them—and ask them to rate each of our potential items for how ‘good’ they are. We could do this as a survey questionnaire, on hard copy, or through questionnaire software such as Qualtrics. An example of a standardised set of questions for asking this comes from DeVellis’s brilliant book on scale development. Here, experts can be asked to rate each item on a four-point scale (1 = not at all, 2 = a little, 3 = moderately, and 4 = very well) with respect to three criteria:

1. How well the item matches the definition of our latent variable (which the experts are provided with)

2. How well formulated the item is for participants to fill in

3. How well, overall, the item is suited to the measure

Once the responses are in, those items with the lowest ratings (for instance, with an average < 3) can be discarded, leaving only the most well formulated and suitable items to go forward for further testing and analysis.

Three Step Interviewing Technique

Something else that I’ve learnt, from Joel Vos, that can be really useful for selecting items in these early stages is called The Three-Step Test Interview. This essentially involves asking a few respondents (ideally the kind of people the measure is for) to ‘think aloud’ while completing the measure, and then to answer some interview questions about their experiences and perceptions of completing the measure. This, then, gives us a vivid sense of what the experience of completing the measure is like, and what’s working and what’s not. Through this process, for instance, it might become evident that certain items—even if the experts thought they were OK—don’t make much sense to participants, or are experienced as boring or repetitive. And respondents might also have ideas for how items can be better worded. Again, questions that don’t work well can be removed at this stage and, potentially, new or modified items could be added (though bear in mind they haven’t been through the expert review process).

Exploratory psychometrics

You’re now at the stage of sending your measure out to survey. The number of respondents you need at this stage is another field that is a science in itself. However, standard guidance is a minimum of 10 respondents per item, with other guidance suggesting at least 50 respondents overall if the aim is detect one dimension/scale, and 100 for two (see, for instance, here).

At this point, you almost certainly want to be inviting respondents to complete the measure online: for instance, through Qualtrics or Survey Monkey. Hard copies are an option, but add considerably to the processing burden and, these days, may make prospective participants less likely to respond.

Ideally, you want respondents to be reflective of the people who are actually going to use the measure. For instance, if it’s a measure intended for use with a clinical population, it’s not great if it’s been developed only with undergraduate students or with just your social media contacts. Obviously, too,it’s also important to aim for representativeness across ethnicity/race, gender, age, and other characteristics.

If you’ve got funding, one very good option here can be to use a Mechanical Turk service, such as Prolific. This is, essentially, a site where people get paid to complete questionnaires; and because it’s such a large pool of people, from all over the world, it means you’ve got more chance of recruiting the participants you need. We used this, for instance, to gather data on the reliability and validity of the Cooper-Norcross Inventory of Preferences (see write-up here), and it allowed us to get US and UK samples that were relatively representative in terms of ethnicity, gender, and age—not something we could have easily achieved just by reaching out to our contacts.

Once you’ve got your responses back, you’re on to the statistical analysis. The aim, at this point, is to get to a series of items that can reliably assess one or more latent dimensions, in a way that is as parsimonious as possible (i.e., with the fewest items necessary). This scale shortening process can be done in numerous ways, but one of the most common starting points is to use exploratory factor analysis (EFA).

EFA is a system for identifying the dimension(s) that underlie scores from a series of items. It’s a bit like putting an unknown liquid on a dish and then boiling it off to see what’s left: perhaps there’s crystals of salt, or maybe residues of copper or gold. EFA has to be done using statistical software, like SPSS or R (not Excel), and you need to know what you’re doing and looking for. On a 1-10 scale of difficult stats, it’s probably about a 5: not impossible to pick up but also does require some fair degree of training, particularly if you don’t have a psychology degree. What follows (as with all the stats below) is just a basic overview to give you an idea of the steps that are needed.

The first thing you do in EFA is to see how many dimensions actually underlie your data. For instance, the data from our ‘experiences of racial microaggression’ items may suggest that they are all underpinned by just one dimension: How much or how little people have experienced microaggressions from their therapists. But, alternatively, we may find that there were more latent dimensions underlying our data: for instance, perhaps people varied in how much they experienced microaggressions, but also the degree to which they felt hurt by the microaggressions they experienced. So while some people could have experienced a lot of microaggressions and a lot of hurt, others might have experienced a lot of microaggressions but not much hurt; and any combination across these two variables might be possible.

What EFA also does is to help you see how well different items ‘load’ onto the different dimensions: that is, whether scores on the items correlate well with the latent dimension(s) identified, or whether they are actually independent of all the underpinning dimensions on the measure. That way, it becomes possible to select just those items that reflect the latent dimension well, discarding those that are uncorrelated with what you have actually identified as a latent scale. At this point, it’s also common to discard those items that load onto multiple scales: what you’re wanting is items that are specifically and uniquely tied to particular latent variables. At this point, there’s many other decision rules that can also get used for selecting items. For instance, you might want items that have a good range (i.e., going the full length of the scale), rather than all scores clustering in the higher or lower regions; and the items also need to be meaningful when grouped together. So this process of scale shortening is not just a manualised one, following clearly-defined rules, but a complex, nuanced, and selective art: as much alchemy as it is science.

By the end of this exploratory process, you should have a preliminary set of items for each scale or subscale. And what you’ll then need to do is to look at the items for each scale or subscale and think about what they’re assessing: how will you label this dimension? It may be that the alchemical process leads you back to what you set out to find: a ‘prevalence of racial microaggressions’ dimension, for instance. But perhaps what crystallised out was a range of factors that you hadn’t anticipated. When we conducted our first Cooper-Norcross Inventory of Preferences study, for instance (see here), we didn’t really know what preference dimensions would emerge from it. I thought, for instance, that we might find a ‘therapist directed vs client directed’ dimension, as we did, but I was surprised to see that there was also a ‘focused challenge vs warm support’ dimension emerging as well—I had just assumed that therapist directiveness and challenge were the same thing.

Testing the Measure

As with exploratory measure development, there are numerous methods for testing the psychometric properties of a measure, and procedures for developing and testing measures are often iterative and overlap. For instance, as part of finalising items for a subscale, a researcher may assess the subscale’s internal reliability (see below) and, if problematic, adjust its items. These tests may also be conducted on the same sample that was used for the EFA, or else a new sample of data may be collected with which to assess the measure’s psychometric properties.

Two basic sets of tests exist that most researchers will use at some point in measure development research: the first concerned with the reliability of the measure and the second concerned with its validity.

Basic Reliability Tests

The reliability of a measure is the extent to which it produces consistent, reproducible estimates of an underlying variable. A thermometer, for instance, that gave varied readings from one moment to the next wouldn’t be much use.

• Internal consistency is probably the most important, and frequently reported, indicator of a scale’s ‘goodness’ (aside from when the measure is idiographic). It refers to the extent that the different items in the scale are all correlating together to measure the same thing. If the internal reliability is low, it means that the items, in fact, are not particularly well associated; if high, it means that they are all aligned. Traditionally, internal consistency was assessed with a statistic called ‘Cronbach’s alpha (α)’, with a score of .7 or higher generally considered adequate. Today, there is increasing use of a statistic called ‘McDonald’s omega (ω)’, which is seen as giving a less biased assessment.

• Test-retest reliability is very commonly used in field of psychology, but is, perhaps, a little less prevalent in the field of counselling and psychotherapy research, where stability over time is not necessarily assumed or desired. Test-retest reliability refers to the stability of scores over a period of time, where you would expect people to score roughly the same on a measure (particularly if it is a relatively stable trait). If respondents, for instance, had wildly fluctuating scores on a measure of self-esteem from one week to the next, it would suggest that the measure may not be tapping into this underlying characteristic. Test-retest stability is often calculated by simply looking at the correlation of scores from Time 1 to Time 2 (an interval of about two weeks is typically used), though there are more sophisticated statistics for this calculation. Assessing test-retest reliability requires additional data to be collected after the original survey—often with a subset of the original respondents.

• Inter-rater reliability is used where you have an observer-completed measure. Essentially, if the measure is reliable, then different raters should be giving approximately the same ratings on the scales. In our assessment of an auditing measure for person-centred practice in young people, for instance (see here), we found quite low correlations between how the raters were assessing segments of person-centred practice. That was a problem, because if one rater, on the measure, is saying that the practice is adherent to person-centred competencies, and another is saying it isn’t, then it suggests that the measure isn’t a reliable means of assessing what is and is not a person-centred way of working.

Basic Validity Tests

The validity of a measure is the extent to which it measures the actual thing that it is intended to. Validity can be seen as the ‘outward-facing’ element of a measure (how it relates to what is really going on in the world), whereas reliability can be seen as the ‘inward-facing’ element (how the different parts within it relate together).

• Convergent validity tends to be the most widely emphasised, and reported, test of validity in the counselling and psychotherapy research field. It refers to the extent that scores on the measure correlate with scores on a well-established measure of a similar construct. Suppose we were developing a measure to assess how prized clients feel by their therapists. No measures of this exact construct exist out there in the field (indeed, if it did, we wouldn’t be doing this work), but there’s almost certainly other scales, subscales, or even individual items out there that we’d expect our measure to correlate with: for instance, the Barrett-Lennard Relationship Inventory’s ‘Level of Regard’ subscale. So we would expect to find relatively high correlations between scores on our new prizing measure and those on the Level of Regard subscale, say around .50 or so. If the correlations were zero, it might suggest that we weren’t really measuring what we thought we were. But bear in mind that correlations can also be too high. For instance, if we found that scores on our prizing measure correlated extremely closely with scores on Level of Regard (> .80 or so), it would suggest that our new measure is pretty redundant: the latent variable we were hoping to tap has already been identified as Level of Regard. Assessing convergent validity means that, in our original survey, we might also want to ask respondents to complete some related measures. That way, we don’t have to do a further round of surveying to be able to assess this psychometric property.

• Divergent validity is the opposite of convergent validity, and is essentially the degree to which our scale or subscale doesn’t correlate with a dimension that should be unrelated. For instance, our measure of how prized clients feel wouldn’t be expected to correlate against a measure of their degrees of extraversion, or levels of mental wellbeing. If they did, it would suggest that our measure is measuring something other than we think it is. Measures of ‘social desirability’ are good tools to assess divergent validity against because we really don’t want our measure to be associated with how positively people try to present themselves. As with assessing convergent validity, assessing divergent validity means that we may need to add a few more measures to our original survey, if we don’t want to go through a subsequent stage of additional data collection.

• Structural validity is the degree to which the scores on the measure are an adequate reflection of the dimensions being assessed. EFA, as discussed above, can be used to identify one or more underlying dimensions, but this structure needs validating in further samples. So this means collecting more data (or splitting the original data into ‘exploratory’ and ‘confirmatory’ subsamples), and then the new data can be analysed using a procedure called confirmatory factor analysis (CFA). CFA is a complex statistical process (about a 9 on the 1-10 scale), but it essentially involves testing whether the new data fits to our ‘model’ of the measure (i.e., its hypothesised latent dimension(s) and associated items). CFA is a highly rigorous check of a measure, and it’s a procedure that’s pretty much essential now if you want to publish a measure development study in one of the higher impact journals.

• Sensitivity to intervention effects is specific to outcome measures, and refers to the question of whether or not the measure picks up on changes brought about by therapy. We know that therapy, overall, has positive benefits, so if scores on a measure do not show any change from beginning to end of intervention, it suggests that the measure is not a particularly valid indicator of mental wellbeing or distress. To assess this sensitivity, we need to use the measure at two time points with clients in therapy: ideally at the start (baseline) and at the end (endpoint). Measures that show more change may be particularly useful for assessing therapeutic effects. For instance, in our psychometric analysis of a goal-setting measure for young people (the Goal Based Outcome Tool), we found that this measure indicated around 80% of the young people had improved in therapy, as compared with 30% for the YP-CORE measure of psychological distress.

Advanced Testing

…And there’s more. That’s just some of the basic psychometric tests and, like I said earlier, there seems to be new ones to catch up with everyday, with numerous journals and books on the topic. For instance, testing for ‘measurement invariance’ seems to becoming increasingly dominant in the field, which uses complex statistical processes to look at whether the psychometrics of the measures are consistent across different groups, times, and contexts (this is about a 15 out of 10 for me!). And then there’s ‘Rasch analysis’ (see here), which uses another set of complex statistical procedures to explore the ways that respondents are scoring items (for instance, is the gap between a score of ‘1’ and ‘2’ on a 1-5 scale the same as the gap between ‘3’ and ‘4’?). So if you’re wanting to publish a measure development study in the highest impact journals, you’ll almost certainly need to have a statistician—if not a psychometrician—on board with you, if you’re not one already.

Developing benchmarks

Once you’ve got a reliable and valid measure, you may want to think about developing ‘benchmarks’ or ‘cutpoints’, so that people know how to interpret the scores from it. This can be particularly important when you’re developing a clinical outcome measure. Letting a client know, for instance, that they’ve got a score of ‘16’ on the PHQ-9 measure of depression, in itself, doesn’t tell them too much; letting them know that this is in the range of ‘moderately severe depression’ means a lot more.

There’s no one way of defining or making benchmarks. For mental health outcome measures, however, what’s often established is a clinical cut-off point (which distinguishes between those who can be defined as being in a ‘clinical range’ and those in a ‘non-clinical range’); and a measure of reliable change, which indicates how much someone has to change on a measure for it to be unlikely that this is just due to chance variations. For instance, on the Young Person’s CORE measure of psychological distress, where scores can vary from 0 to 40, we established a clinical cut-off point of 10.3 for males in the 11-13 age range, and a reliable change index of 8.3 points (see here). The calculations for these benchmark statistics are relatively complex, but there are some online sites which can help, such as here. You can also set benchmarks very simply: for instance, for our Cooper-Norcross Inventory of Preferences, we used scores for the top 25% and bottom 25% on each dimension as the basis for establishing cut-off points for ‘strong preferences’ in both ways.

the Public domain

Once it’s all finalised and you’re happy with your measure, you still need to think about how you’re going to let others know about it. There’s some journals that specifically focus on the development of measures, like Assessment, though they’re by no means easy to get published in. Most counselling and psychotherapy journals, though, will publish measure development studies in the therapy field, and that puts your measure out into the wider public domain.

At this stage you’ll also need to finalise a name for your measure—and also an acronym. In my experience, the latter often ends up being the toughest part of the measure development process, though sites like Acronymify can help you work out what the options might be. Generally, you want a title that is clear and specific to what your measure is trying to do; and a catchy, easy-to-pronounce acronym. If the acronym actually means or sounds something like what the measure is about—like ‘CORE’—that’s even better.

If there’s any complexities or caveats to the measure at all in terms of its use in research or clinical practice, it’s good to produce really clear guidelines for those who want to use it. Even a page or so can be helpful and minimise any ambiguities or potential problems with its application. Here is an an example of the instructions we produced for our Goals Form.

It can also be great to develop a website where people can access the measure, its instructions, and any translations. You can see an example of this for our C-NIP website here.

Regarding translations, its important that people who may want to translate your measure follow a standardised procedure, so that it stays as consistent as possible with the original measure. For instance, a standard process is to ‘back translate’ an initial draft translation of the measure to check that the items are still meaning the same thing.

In terms of copyright, you can look at charging for use of the measure, but personally I think it’s great if people can make these freely available for non-commercial use. But to protect the measure from people amending it (and you really don’t want people doing their own modifications of your measure) you can use one of the Creative Commons licenses. With the measures I’ve been involved with, we’ve used ‘© licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)’ so that others can use it freely, but can’t change it or make money from its use (for instance, by putting it on their own website and then charging people to use it).

Conclusion

At the most advanced levels, measure development and testing studies can be bewildering. Indeed, even at the most basic level they can be bewildering—particularly for those who are unfamiliar with statistics. But don’t let that put you off. There’s a lot of the basic item generation and testing that you can do without knowing complex stats, and if you’re based at an institution there’s generally someone you can ask to help you with the harder stuff. There’s also loads of information that you can google. And what you get at the end of it is a way of operationalising something that may be of real importance to you: creating a tool which others can use to develop knowledge in this field. So although measure development research can feel hard, and like a glacially slow process at times, you’re creating something that can really help build up understandings in a particular area—and with that the potential to develop methods and interventions that can make a real difference to people’s lives.

Acknowledgements

Photo by Tran Mau Tri Tam ✪ on UnsplashDisclaimer

 The information, materials, opinions or other content (collectively Content) contained in this blog have been prepared for general information purposes. Whilst I’ve endeavoured to ensure the Content is current and accurate, the Content in this blog is not intended to constitute professional advice and should not be relied on or treated as a substitute for specific advice relevant to particular circumstances. That means that I am not responsible for, nor will be liable for any losses incurred as a result of anyone relying on the Content contained in this blog, on this website, or any external internet sites referenced in or linked in this blog.

Person-Centred Therapy: Four Currents

It’s generally accepted now that the person-centred approach isn’t just one ‘thing’: it’s made up of lots of different ‘tribes’ or ‘branches’, like the ‘classical approach’ and ‘emotion-focused therapy’ (see blog here).

But how do all these different strands come together? It seems to me that we can think about the person-centred approach—from where it started to where it is now—in terms of four ‘currents’. Like the different movements of water running through an ocean, these current flows into each other and intermingle; but at the same time they have some distinctive elements and can, at times, pull in different directions.

1. The Client-as-Expert

This is pretty much where Rogers started from, and is still seen by many—particularly of a ‘classical’ persuasion—as the defining (or even sole) stream of person-centred theory and practice. It’s the belief, as Carl Rogers puts it in 1961, that:

‘It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried…

Rogers work was a reaction to the more didactic, expert-led styles of counselling that were prevalent in his early years. He wanted to develop a ‘new’ form of psychotherapy and counselling that, instead of being directive, was non-directive: that trusted the client to be able to take the lead and find the answers that were right for them.

Central to this current, as it developed, was the concept of the actualising tendency. This is the idea that all of us have an inherent tendency—and ability—to maintain and enhance ourselves, and can do so given the right conditions (of empathy, acceptance, and congruence).

In recent years, however, there’s been some challenges to the concept of the client-as-expert. It is based, for instance, on an assumption that all wisdom and knowledge is ‘within’ the client, but contemporary philosophy and psychology have questioned the idea that the client—like any of us—is a self-enclosed, separate and distinct entity. Aren’t we all fundamentally relational beings (see Current #2, below)? Also, most developmental theorists and researchers, like the infamous Swiss psychologists Jean Piaget, would say that learning can happen from the ‘outside-in’ as well as the ‘inside-out’. If you go to a CPD workshop, for instance, it’s great to have space to brainstorm, discuss, and develop your own ideas; but isn’t there also a place for being directly taught things through, for instance, Powerpoint. We don’t want death-by-Powerpoint, but at the same time some degree of it can be really useful; so does learning—therapeutic or otherwise—always need to be just self-generated? Isn’t that a bit black-and-white?

2. Relational

So another current running through the person-centred approach is an emphasis on the importance of relationship. This is evident in Rogers’ ‘necessary and sufficient’ conditions which include empathy, unconditional acceptance, congruence, and contact—and it’s very clear in much of his later work, when he focuses on the healing power of relationships and of encounter in groups. For Rogers, and for most practitioners across the person-centred approach, it is not techniques or ‘interventions’ that really help someone, but the cultivation of an in-depth personal relationship. That’s been central to the work that Dave Mearns and I have done on relational depth: where the relational encounter is really brought to the fore.

From this relational perspective, the client—like all human beings—is seen, not so much a separate and distinct individual, but as part of a relational and communal network: we’re all in it together. And it’s when we find our togetherness with others that we thrive most fully. This links person-centred therapy to other approaches like interpersonal therapy and Bowlby’s attachment theory, that also put relating at the heart of healthy development.

Rogers’ focus on the client-as-expert draws from humanistic philosophy (for instance, the French eighteenth century thinker Jean-Jacques Rousseau), whereas the relational elements are more associated with contemporary dialogical and ‘intersubjective’ philosophy—as, for instance, in the work of the twentieth century Austrian-Jewish philosopher Martin Buber. Are we separate or are we inter-related? Peter Schmid, the late great person-centred writer, brought these two currents together brilliantly by showing how we could be both.

3. Experiential/Emotion-Focused

Rogers, as we’ve seen with Current #1, starts with the client, and from here he goes on to adopt a phenomenological perspective on both the person and on therapeutic work. Phenomenology, which Rogers takes in the 1940s from two psychologists, Snyggs and Combs, is a philosophical and psychological approach which emphasises experiencing as the starting point for understanding human beings and their psychological processes. Experiencing is our subjective, ever-changing, moment-by-moment ‘all that is going on’ that is potentially available to awareness. It’s our perceptions and our senses, our desires and meanings. Experiencing is my sense, right now, of a slight chill on my shoulders as winter creeps in, the darkening light in the room, and my feeling of excitement and engagement as I write this.

Rogers model of psychological distress is all about how we get estranged from our experiencing. We come to see ourselves as fixed ‘selves’, with particular qualities and characteristics (based on what we have been told are ‘good’ characteristics) and so we get alienated from that natural flow. That’s a problem, because that flow of experiencing has, as we saw in Current #1, an actualising direction: it is towards maintaining and enhancing ourselves. So, for instance, if we deny the feelings of vulnerability or hurt that are part of that organismic experiencing, we don’t allow ourselves to strive for what we need: which, for instance, might be care or protection from others.

Eugene Gendlin, who was probably the most important of Rogers’ progeny, was particularly central to this experiential current. For Gendlin, it was this process of connecting with our bodily-felt experiencing, and allowing it to ‘carry forward’ (and carry us forward with it), that was the healing process. But, critically, Gendlin did not believe that clients would always know how to connect with, and unfurl, that experiencing in the most helpful way possible. So, in the development of ‘focusing’, Gendlin proposed methods that could help clients—or people more generally—create the environment in which their bodily felt senses, their embodied wisdom, could be carried forward.

Along with felt-senses, a core part of our experiencing is our emotions: our hurt, our fears… and also an enormous spectrum of affects like anger, shame, and joy. These emotions are often a particularly hidden part of our experiencing, because we have been taught that showing emotions is not ‘good’: to be people who others like (and to like ourselves), we shouldn’t have many of the feelings we have. But the problem is, we do have them, and they’re an important part of us; and the more we suppress them the more they can tend to resurface—and often in less controlled and more destructive ways. This emphasis on emotions have been particularly developed by the ‘emotion-focused therapy’ (EFT) branch of the person-centred approach.

We can see here that a focusing on experiencing and emotions (Current #3) emerges from a belief in clients’ (Current #1) self-righting and self-healing capacities: if we help clients to connect with their true, primary emotions, then they can find ways of sorting out their own problems. But here’s the question: how able are clients, actually, to connect with their own experiences and emotions and draw on them to improve things in their lives? This is where these current can start to part ways. From a Client-as-Expert position, clients know best: we don’t need to do anything to help them connect with their experiences and emotions other than what we always do, which is to empathise, accept, and be real. But those from an experiential and emotion-focused approach tend to believe that, actually, clients can sometimes do with a bit of help in getting in touch with their underlying emotions and that therefore there can be a place for therapists’ techniques and expertise. This isn’t about directing the content of what client’s say; but it is about adopting a more ‘process-directive’ stance: helping clients develop skills and techniques that can support them to connect with their deeper felt-senses and emotions.

4. Ethical/Political

Finally, there’s a way of ‘reading’ the person-centred approach which really brings to the fore it’s commitment to social justice, equality, and engaging with others in caring and community-spirited ways. This egalitarian spirit was, perhaps, what drove Rogers in the first place—he wanted clients to be treated as equals to their counsellors, rather than as lesser beings—and it is certainly there in his later work with groups and communities. Rogers, in this later life, was amazing in travelling to places like Northern Ireland and South Africa to try and help overcome political conflict (see, for instance, The Steel Shutter, which documents his work in Northern Ireland). It is clear here that Rogers saw the person-centred approach in much broader terms than just as a clinical practice: for him it was about transformation at a social and global level to a better, fairer world.

Our own pluralistic approach to person-centred therapy is one attempt to really follow through on this current in the person-centred approach (see blog here). For instance, in terms of therapeutic practice, we really prioritise engaging with clients in caring and respectful ways. This is likely to mean seeing the client as an expert in their own life (Current #1), and also focusing on relationships (Current #2) and experiences and emotions (Current #3); but these are all in service of a respectful, caring relationship—not ends in themselves. So, for instance, if a client really feels that they would benefit from therapist expertise, and we have expertise that might help, why not? Who are we to decide for the client what it is that they really need or want in therapy.

But the pluralistic approach also goes broader than that, and understands the therapeutic process as just one forum within which positive change can happen. There’s also change, for instance, at the social and economic level; and pluralism argues that tackling issues like racism, economic inequalities, and looming climate catastrophe can all be really important ways of helping clients. Here, there’s a focus on prizing of difference and diversity—within the client, across people, across communities and nations—which is much broader than therapeutic work alone. It is about creating a better world for us all.

Conclusion

From the dawning of Rogers’ work to the person-centred field today, we can watch these four currents mingling, merging, separating, pulling apart, and mingling again. No doubt, there are other currents that flow through the person-centred approach: for example, an existential current; or a current of creativity—as articulated, for instance, in the work of Natalie Rogers and the person-centred creative arts field today. None of these currents are the one, ‘true’ Rogerian perspective: Rogers, like all of us, said different things at different times and in subtly different ways. And, even if he did not, there’s new perspectives and directions coming into—and out of—the person-centred field all the time, that can only add to our richness, complexity, and depth.

***

A Chinese translation of this blog is available here.

Skills Practice: Some Pointers

If you’re a trainee on a counselling, psychotherapy, or counselling psychology programme, skills practice is likely to be a central part of your training. This practice is invaluable in helping you develop your competences as a therapist, so it’s essential to know how to make the best use of it.

Skills practice is often in pairs or ‘triads’ (with the three roles of speaker/client, listener/therapist, and observer).

Some pointers to help you make the best use of your time:

Listener/Therapist

• Be natural: Don’t ‘play-act’ at being a Therapist or pretend that you’re in a situation other than the one you’re in. You’re probably in a classroom, listening to a peer, with someone watching you—that’s fine. So no need, for instance, to pretend you don’t know your ‘client’, or for elaborate introductions to the therapy—unless that’s a specific skills that you’re practising. Just focus on doing your best to listen and respond therapeutically, to the real person that is there in the room with you.

• If there’s a specific area of skills that you want to work on, and get feedback on, it may be helpful to let the Observer know before you start, so that they can focus on that.

• Remember that when you are practising a particular skill (such as active listening) this is not necessarily how you should always do counselling practice. Later on, for instance, you may also develop skills in empathic reflections, self-disclosures, or even advice-giving. But it’s good to be able to develop specific skills to a point where you feel confident and capable in them—then you can do more.

• Don’t rush things, or feel that you have to demonstrate everything in the practice time you have. If your client has a lot to talk about you may ‘just’ be listening. So if, for instance, you’ve got 15 minutes for practice, think of doing the first 15 minutes of a session, rather than trying to do the whole session in 15 minutes.

Speaker/Client

• Given the context and time available, it’s important you only talk about something you are comfortable sharing. At the same time…

• …It’s helpful to the Therapist if you can talk about something with some emotional resonances for you: for instance, a current worry and concern. If it’s a purely intellectual issue (like what you are going to cook for dinner) it can be hard for the therapist to engage and practice real skills.

• Use the time usefully. That’s most helpful for the Therapist (if it’s something that you’re wanting to talk about) and also most useful for you. If you’re not sure what to talk about, take a few minutes at the beginning of the time to think about what would be helpful to talk about, or just about how you’re feeling at that point in time.

• Don’t feel responsible for the Therapist, or that you have to make things ‘easy’ for them. It’s your time, and the Therapist needs to learn to deal with more difficult/complex situations, as well as with someone who can easily talk. So, for instance, if you’re feeling stuck as you talk, no need to apologise to the Therapist—give them the opportunity to practice learning how to deal with such situations.

• A Tutor may come, at times, to listen in to how your Therapist is doing, so that they can offer feedback. If you’re talking about something that you don’t want them to hear, it’s normally fine to ask them to leave.

• If you run out of things to say, try to stay in roles for the allocated time, rather than ‘switching over’ and giving someone else a go. It can be uncomfortable if things dry up but, as above, it can be important for the Counsellor to learn how to deal with such situations, and it means you can relax more into the allocated time. As the Client, you don’t have to talk if you don’t want to.

Observer/Feedback Process

•  Your feedback should be to the Therapist, not the Client. You really don’t want to get into commenting on the Client’s material, or asking them more questions about what is going on. The whole point of this exercise is to help the Therapist develop their skills, not ‘sort the Client out’ (however much you might feel you know what they should do).

• Try to give specific feedback on specific Therapist activities rather than general, vague comments.

• Keep in mind what the purpose/focus of the exercise was—for instance, to develop skills in empathy or practice minimal encouragers—and keep your comments oriented to that. If you’re not clear what the exercise/practice is for, it’s worth clarifying that before you start.

• Positive feedback is as important as more challenging feedback, so make sure you include positives and encouragements as well as possible areas for development.

• …And challenging feedback is as important as positive feedback. That can sometimes feel really tough to give, you don’t want to upset your peer (or prime them to challenge you when it’s your turn) but it’s also what can really help them learn. Some things that can help to make challenge more productive:

  • Be descriptive rather than evaluative: what you observed, saw, and felt; rather than what is ‘right’ and ‘wrong’.

  • Unconditional positive regard is, of course, essential: focus on the behaviours and activities rather than the person: ‘challenge’ rather than ‘criticism’.

  • Remember that your view is your view: just one perspective on what went on. As legitimate as everyone else’s, but not more so.

• As Observer, you might find it useful to take notes, but make sure these are confidentially destroyed at the end of it.

• Recording the session (audio or even video) and then playing it back may be useful in terms of giving concrete feedback. Again, however, it’s essential that any recordings are destroyed (or stored securely, as per ethics and relevant regulations e.g., GDPR]) to maintain Client confidentiality.

• It’s often useful to start the feedback process with the Client, as they are the one who experienced the session and have the best sense of how it went.

• In the observation and feedback process, there are some really helpful scales that you might want to use to support and structure the feedback process.

  • Person-Centred and Experiential Psychotherapy Scale-10 (PCEPS). This is a recently developed measure to assess an essential range of person-centred competences, such as ‘emotion focus’ and ‘accepting presence’. You can download the form here, and a paper describing its development and testing is here.

  • For counselling practice for work with young people, there is a PCEPS-YP that you can download from here, and a shortened version of it here. A paper describing the development and testing of the PCEPS-YP is available here.

  • To assess the depth of experiencing that counsellor and client are working at, you can consider using the Experiencing Scale. This has seven levels: from the most ‘disowned’ description of events to a deeply-felt ‘unfolding’ of experiencing. Excerpts and further information are available here.

Afterwards

• Of course, everything that the Client shared is strictly confidential, and it’s essential that none of the content is disclosed outside of that context. That includes, for instance, talking to the Client later about an issue that they shared, unless they specifically indicate to you that they would like to discuss it further.

• As the Therapist, think about what specifically you can take away from this session into your practice. Perhaps make some notes about your learning, some action points, or incorporate it into your journaling.

Skills practices

Here are some basic exercises that you might want to use, in triads, to develop core counselling skills.

Active Listening

• Choose who will be Counsellor, Client, and Observer. Each person should get a turn in each role.

• Client: Talk about an issue or concern that has some emotional resonance for you (see guidance above), for 10 minutes.

• Counsellor: Focus on just listening to the Client. Try to put to one side (‘bracket’) any need to:

  • Advise

  • Reassure

  • Guide

  • Inform

  • Solve the problem, etc.

  Just listen—take in what the Client is saying. If you want to prompt or ask questions to help the Client unpack their experiences, that’s fine (you don’t need to leave awkward silences), but try to keep it minimal. Don’t take over!

• After 10 minutes, feed back with the Observer on how that was. How easy did the Counsellor find it just to listen? What kind of things were they having to ‘bracket’? What was the need behind wanting to say those things, and would they have actually have been helpful to the Client? (perhaps ‘yes’, perhaps ‘no’).

Empathic reflections

• Choose who will be Counsellor, Client, and Observer. Each person should get a turn in each role.

• Client: Talk about an issue or concern that has some emotional resonance for you (see guidance above), for 5 minutes. No interjections from the Counsellor, except for minimal encouragers (‘mm hm’, ‘yes’, etc).

• Counsellor (5 mins): Your task now is to summarise, in your own words, what the Client said that they are (or did) experience: What are they (or were they) feeling, thinking, imagining, wanting? Try to describe their subjective, felt-experience of particular events (how it was for them), rather than the events or behaviours themselves. For instance:

  • ‘You felt upset when your brother was cold to you. You wanted to talk to his boyfriend. You imagined how it would be to have a brother who would really look after you…’

• The Client and Observer should now feed back on how well the Counsellor summarised the Client’s felt-experiences (5 mins). The question here is not so much whether they remembered everything, but whether they fed back at the level of subjective experiences (feelings, emotions, thoughts, perceptions, fantasies, desires, etc) or whether they focused more on objective, external ‘facts’.

• Once everyone has had a chance to do this exercise, you can move on to practising empathic reflections in a more interactive way.

  • Counsellor counsels the Client (10 mins), offering the Client summaries and reflections of the Client’s experiences as the session progresses (and not just at the end).

  • Feedback with the Observer on how much the Counsellor reflected back the Client’s subjective felt-experiences (5 mins).

ACKNOWLEDGEMENTS

Photo by Handy Wicaksono on Unsplash

DISCLAIMER

The information, materials, opinions or other content (collectively Content) contained in this blog have been prepared for general information purposes. Whilst I’ve endeavoured to ensure the Content is current and accurate, the Content in this blog is not intended to constitute professional advice and should not be relied on or treated as a substitute for specific advice relevant to particular circumstances. That means that I am not responsible for, nor will be liable for any losses incurred as a result of anyone relying on the Content contained in this blog, on this website, or any external internet sites referenced in or linked in this blog.

Getting Published in Higher Impact Journals: Some Pointers

Let me start with some caveats. First, I couldn’t claim to be an expert in getting published in high impact journal. I’ve had some successes—with articles, for instance, in journals like Lancet Child & Adolescent Health, Journal of Consulting and Clinical Psychology, and Clinical Psychology: Science & Practice—but also numerous failures, including a really disappointing rejection just a few nights ago. Compared to the Michael Barkhams or Clara Hills of this world, I’m a mere novice.

Second, not everyone should, or does, want to get published in higher impact journals. Indeed, for many people, it’s an elitist, Global North-centred system that excludes non-academics and those who aren’t willing to comply with a positivist, scientistic mindset. So this blog is not suggesting that higher impact journals are good to get published in, or better than other journals, or something that all academics (and non-academics) should be aspiring to. But it is written on the basis that, for some academics, getting published in higher impact journals is important: for their careers and, perhaps, more importantly, for the maintenance and development of counselling and psychotherapy programmes in higher education (HE). In the 2000s we witnessed many counselling courses at HE institutes get closed down and, in some cases, this was because the teams were seen as not producing enough research output at a sufficiently high level. So for the maintenance and enhancement of counselling in the UK and globally, it may be really important for academics to be publishing at the highest possible level: not just for them but for the counselling community as a whole.

What is an ‘impact factor’?

So what do I mean by higher impact journals? Well, for those who don’t know, impact is essentially an indicator of the status of a journal, and it’s operationalised in terms of the amount of citations that the average article will have over the two year period from publication (for a more general guide to publishing in therapy journals, see here). You can go to any journal home page and if you look under tabs like ‘Journal Metrics’ you’ll find the impact factor (sometimes specifically called the ‘2-year impact factor’): for instance, for Psychotherapy Research it’s 3.768. This means that, on average, an article in Psychotherapy Research has been cited 3.768 times by other articles, in any other academic journal, over that two year period. Higher is, of course, ‘better’, meaning that articles in that journal are being more widely drawn on by other members of the academic community.

Impact factors for journals vary a lot by particular disciplines. For instance, in the medical and scientific fields, there’s quite a quick turn-over of articles: they come out quickly and then are rapidly drawn on by other members of those disciplinary communities. That means that journals like Science Robotics or Cancer Research can easily have impact factors of 10 or more. In the counselling and psychotherapy research field, impact factors tend to be a bit more modest, though they have increased in recent years. They range from about 1 (e.g., British Journal of Guidance and Counselling) to 5 or more (e.g., Journal of Consulting and Clinical Psychology), with some of the more psychiatric journals even higher (e.g., Lancet Psychiatry with an impact factor of 27.083).

So by ‘higher impact journals’, I mean counselling and psychotherapy journals with an impact factor of, say, about 2.5 or more. In many instances, these are US-based journals; and, as above, in most cases they are of a relatively positivist, scientistic mindset. There are journals that are more experientially- or constructionistically-focused (like the European Journal of Psychotherapy & Counselling and BACP’s Counselling & Psychotherapy Research), but mostly they either have a low impact factor or none at all.

Just to note, not having a formal impact factor doesn’t mean that there are no citations to papers in that journal. To have a formal impact factor, a journal needs to be recognised by an organisation called Clarivate (formerly Thomson-Reuters), and they are very selective about the journals that are recognised. Applying for recognition can also be a very slow process. So there are some very good journals, like the Journal of Psychotherapy Integration and Counselling Psychology Quarterly, that don’t have a formal impact factor. However, these days, such journal may calculate their own 2-year impact factor and present it on their site; so a single organisation’s monopoly over impact factors seems, thankfully, to be waning.

‘Playing the game’

As indicated above, nearly all the higher impact journals in counselling and psychotherapy can be quite positivist, scientistic, and realist in their mindset. And the reality is, that’s not likely to change (at least, not in the short term). They’re bombarded with articles and can pick and choose what they want to publish, often with rejection rates of 70% or more. So if you approach them, say, with an autoethnographic study of authenticity in therapy, you can argue with them until you are blue in the face about the importance of reflexivity and the social construction of reality, but they are unlikely to budge. They’re generally quite conservative: they have their ways of doing things, and they simply don’t need to change—whether or not they should. So, as a first and overarching pointer, if you want to publish in these journals, you generally need to ‘play by their rules’. It’s an uncomfortable reality for many of us, but it’s the way things are.

Learn Stats, or Find a Statistician

And this is a first implication of playing by their rules: if you want to stand a good chance of getting published, having a high quality statistical analysis is often a good way in. Most of the higher impact journals prefer quantitative articles to qualitative; indeed, some have explicitly said that they’re not interested in publishing qualitative articles (primarily because they’re seen as lacking generalisability because of low sample sizes). And the stats we’re talking about here is more than just some means and standard deviations (see blog on quantitative analysis, here). We’re talking structural equation modelling, multilevel analysis, cross lag panel designs… the kind of stats that, I know for myself, I can only just about understand—let alone do.

So options are to learn, in depth and detail, one particular statistical method (or a few) and then apply that. Or, and this is what most of us do, bring on board a statistician who is able to do analyses at the requisite level. That latter strategy is fairly pervasive across the research field: you collaborate with someone who specialises in statistics, and pass on the data to them for an in-depth analysis. If you’re at a university, there may well be someone in your department or faculty that has that role—or you can try linking with stats experts at other universities. Generally, someone with an in-depth understanding and specialism in stats is always going to do better than a non-stats person trying to learn a new, specialised method—unless that person really love maths and stats, and has the time and inclination to learn complex methodologies.

Control, Control, Control

Controlled experimental studies (where, for instance, some participants are allocated to an intervention and some are not) are the lifeblood of the psychological field, and they’re very popular amongst the higher impact therapy journals too. Why? Because they are seen as the ‘gold standard’ means of demonstrating causal effects. Everything else—pre-post studies, qualitative research, observational studies, etc.—tend to be seen as correlational only. So if there’s a way of conducting a controlled study in your area of interest (and doing it in a highly rigorous way using, for instance, CONSORT [Consolidated Standards of Reporting Trials] guidelines), there’s a good chance of getting it published. Ideally, you’ve also got the numbers of participants to make the trial ‘powered’ at an adequate level (see more about statistical ‘power’, here). That could be 100 or so participants per condition; but even if you cannot achieve that, a ‘pilot’ or ‘feasibility’ study should be possible and publishable (albeit in lower impact journals). Also, a controlled study doesn’t have to be a trial of a full intervention. For instance, you might test the use of a particular homework exercise, or of using visualisations as part of the therapeutic work. Or perhaps you’d give some clients full information about the therapy, and others only basic information, to see if that makes a difference. Whatever you’re line of research interest, controlled trials are nearly always possible; and you can normally also conduct qualitative research alongside them to get a more experiential, in-depth understanding of the intervention effects.

If you’re doing qual, do it systematically

Having said all that, there are higher impact journals who will consider—and do publish—qualitative research, so it’s by no means impossible to get qualitative research published. But, even so, some journals can tend to assess it with a fairly ‘quantitative’, positivistic mindset (what’s been called ‘small q research’). That means that studies with larger samples, and some quantification of themes, may be preferred (for instance, ‘framework analysis’). Also, very importantly, evidence of inter-coder reliability—or some triangulation of coding—may be expected. That means having some means of demonstrating that the coding process wasn’t dependent on just the ratings of one person, but has some ‘objective’ reality. That could be done, for instance, by having two or more analysts working independently on a set of transcripts, and then agreeing together the coding. Or having a group conduct the analysis, as in consensual qualitative research. Another way of doing this would be to have a second coder do some coding and then compare this with the main coder, producing some statistic for inter-rater reliability (such as Cohen’s kappa).

There are exceptions to this. For instance, some higher impact psychotherapy research journals have published interpretative phenomenological analysis studies where there is limited or no evidence of inter-coder reliability (see an excellent example here; an IPA study on the therapeutic relationship in CBT for adolescents). And, hopefully, such kinds of studies are becoming more common in the higher impact journals. However you do it though, what’s essential is that the qualitative research is conducted systematically. That can mean sticking closely to an established, defined methodology (such as reflexive thematic analysis); or, if you are using a mixed or new method, explaining the rationale and the procedures in that very clear. It’s also essential that the methodology is in line with the aims of your research: Why use this method to be trying to answer these research questions? And finally, do make sure you really process the data: spend time with it, examine it in depth, work out what it is really telling you. There really is no easy way to sophisticated knowledge.

Systematic Reviews

If you’re not keen on stats, another option that the higher impact journals are often open to is systematic reviews. These tend to be popular because they are generally well-cited, boosting the impact factor of the journal itself (remember, journal editors will be thinking about how often your article is likely to be cited—they want to keep their impact factors up!). Again, journals often prefer statistically-based reviews of the literature (i.e., meta-analyses), but they can also be open to narrative and other types of in-depth review. If you want to increase your chances of being accepted, though, again it needs to rigorously follow well-established methods for conducting such research. So, for instance, base the review around the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines: with, for instance, multiple coders during the study selection process, flow charts, and formal assessment of bias procedures.

Plan from the Start

One of the biggest mistakes I’ve made in my academic career is starting research projects thinking, ‘Oh, I’m sure this will generate some interesting data,’ and then getting to the end of the data collection process and realising that, actually, it is not quite the right data for a high quality publication. So I’ve learnt that it is really important, if you want to publish in a higher impact journal, to plan right from the start: What the specific aims of the study are, What you want to contribute to the literature, and Where you want to publish it. Different journals have different interests, so having a specific journal in mind for publication (and knowing the kinds of articles that journal publishes) helps to ensure that you are progressing along the required tracks. Michael Barkham, Professor of Clinical Psychology at the University of Sheffield and a world-leading psychotherapy researcher, says:

I always tell folk when working out plans and methods to imagine how they are going to write this up for a high-quality journal—so your ‘headset’ is the final product that then helps to shape the process. The point here is that having a ‘headset’ of a high-quality journal output from the start becomes the guiding process for delivering better quality research (although it doesn't guarantee publication success).

If you can set your plans out in a study protocol or study analysis plan and then ‘pre-register’ it on a site like the Centre for Open Science, it can then also really help to convey to journal reviewers the rigour with which your study has been conducted. And consult: send your protocol to people who have published in those journals and see what they think. Better to make tweaks at this earlier stage then get all the way to the end of data collection before you realise your method has some severe limitations.

It Takes time

My highest impact journal publication (that I’ve led on) took about six years from conception to publication (the ETHOS study: an RCT on the effectiveness of school counselling), and there was about a decade before that of previous work in the school counselling field. To get published in these journals, you really need to be at the absolute forefront of a field—to know everything there is to know about it—and then to conduct research that is going to significantly take that field forward. So it’s not something you can do overnight, it takes times: to build up expertise, to set out a research study, to gather the requisite amount of data, to write and to finesse a paper with multiple drafts and re-drafts. Generally, developing expertise in a specialist field—and then publishing and publishing on that—is a better strategy that trying to be a generalist (and I say that from my own experience of trying to cover too much). If you get spread too thin, there’s no way that you can be at the forefront of every field. Rather, choose a field—like counselling for people with autism, or empathy in the therapeutic relationship, or moments of deep connection in therapy—and work at it and work at it and keep researching, reading, and linking up with other leading people in that field.

Work in a Team

And that links to team work. It’s very rare these days that people publish papers in leading journals that they’ve written alone. Rather, there’s often a list of three or more—and, in some of the scientific papers, hundreds—of co-authors. That’s because people have developed the research as a team, and having multiple people working with you—within the same institution, or across institutions—is often essential in bringing together the expertise needed to publish research at the highest level. If you’ve got a team, for instance, you can have world-leading expertise in research design, and in statistics (as above), and then in a particular intervention—how many people have all that in themselves? In a team, everyone can help you, as a whole, to ensure you’re at the forefront of that field. And the great thing is, for academic auditing systems like the Research Excellence Framework (REF), it doesn’t matter whether you are the first author or just one of the co-authors, it all counts towards your published ‘outputs’.

If you’re yet to publish in higher impact journals, joining up with (and contributing to) a team of more experienced researchers can give you a crucial toe-hold in this world, says Michael Barkham. ‘It gives you a connection from which you can learn how this work can be done—start as a small cog and progress from there.’ So this is about being a junior partner with more senior colleagues: for instance, conducting the qualitative analysis in a primarily quantitative trial, or being part of a coding team. That way, you can learn the craft of higher impact journal publication, and take things forward from there.

Mentoring

Allowing oneself to be mentored by a well-published researcher, suggests Michael Barkham, can be an essential part of this process. This might be an informal arrangement between colleagues (within or across universities); or a more formal arrangement, such as a PhD programme. In the US and in much of Europe, this is exactly the system that produces so many well-published young researchers. Senior academics take on a small handful of PhD students, and work closely with them—over several years—to produce high impact research. By the time the students have left the PhD programme, they have learnt the skills and requirements of higher impact journal production, and are ready to ‘fly the nest’ and lead research on their own.

Funding

Finding the time to develop that expertise isn’t always easy: not for you, and often not for your potential colleagues. So if you can get funding to pay for your time, and to bring in additional researchers (for instance, through grants from the Economic and Social Research Council), that’s nearly always a great basis for developing high quality research programmes. Getting that funding is tough, no doubt, but there’s numerous potential sources (see, for instance, Research Professional); and the more you can develop expertise in a particular area, the more successful you’re likely to be. Again, it’s about ‘playing the long game’: not one-off attempts at high impact publication, but a long and sustained development of expertise in a particular area, that will eventually bear high quality fruits.

Show Added Value

For the higher impact journals, doing a well-conducted study is not enough. Great, so you did an IPA study the right way, or conducted some high quality statistical analysis, but what does it all mean? Journals are looking for papers that really take the field forward, so you have to make it explicit in your paper what it is that you’re adding to what was already known. Maybe you’ve discovered that clients really value a particular form of therapist self-disclosure, or that relational depth is a key predictor of therapeutic outcomes. Of course, you need to be honest about the limitations of your research; but if it’s all limitations, and null results, and ambiguities, higher impact journals may be more likely to send it back. Why publish something that, at the end of the day, doesn’t tell us too much when they can publish papers that will have clear and robust implications for practice, training, or research?

Don’t Give Up

Maybe this is all a bit bleak, but it’s written from (bitter) experience. And, having said all that, it is really possible to get published in some of the best journals in the world—you just need to be smart and strategic about it. And, perhaps more than anything, you need to be resilient and keep going in the face of rejection (…after rejection, after rejection, after rejection—says a man who is still smarting after his rejection email a few days ago). These higher impact journals can be brutal in assessing work. And they can be infuriating in imposing standards that you may think are totally wrong. But if you keep at it, and learn from the feedback you’re receiving, there’s a good chance that sooner or later you’ll succeed.

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Publishing in higher impact journals is hard, it’s really hard. So it can’t be an afterthought or something you think you’ll have a go at as a corollary to something else. For instance, if you’re doing some research primarily as ‘personal development’, but then think, ‘Well, let’s see if the top journals are interested in what I’ve produced,’ the chances are, they won’t be. Rather, as above, if you want to publish in these higher impact journals, this has to be your focus and your goal, your ‘headset’, from the start. And there is a point here, perhaps, for the wider UK counselling and psychotherapy community. If we want to be part of this higher impact publishing world, then organisations (like BACP and UKCP), and counselling academics, need to be oriented this way from the off. We need, for instance, BACP to work with counselling academic groups—as I know they are trying to do—to set up specialised research programmes, with mentoring and PhDs so that there is a sustainable programme of research at the highest possible level.

Should we be compromising to get published in these higher impact journals? I read a brilliant paper by Virginia Braun and Victoria Clarke, developers of thematic analysis, on the London Underground into work this morning, and it made me feel like, ‘No, what the hell, we should be developing qualitative and phenomenological and reflexive inquiry in a way that we believe in, and we can and should be getting that work published—at the highest possible level.’ Perhaps so. I honestly don’t know. Maybe the mountain will come to us. I guess, in my own career and in the career of those in the UK counselling field, I just haven’t seen that happen too much. I was a radical in my youth. Now, as I get older and older, I see more and more the virtues of compromise. Or, perhaps more positively, compromise as a means of achieving, ultimately, more radical results. And also, compromise as a respect to those who have different views and takes on the world. There can be an arrogance in radicalism—there was in my own radicalism—which contradicts its very essence.

Finally: writing this blog makes me realise that, ultimately, getting published in higher impact journals is a process, not an outcome: publishing in these top journals needs to be embedded in a wider programme of research, development, and impact. You can’t just go off, on your own, and write a high quality paper (or, at least, I can’t). Rather, it’s about specialising, focusing, developing expertise in a particular field—and being an integral part of a community that is doing the same thing. Then, it’s not that you want to publish in the higher impact journals, it’s that they want to publish you.

Acknowledgements

Thanks to Michael Barkham for input and guidance. Photo by alex starnes on Unsplash

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Pete Sanders (1951-2022): Memories and Reflections

One of the strongest memory I have of Pete is a bit of a strange one. It’s of him playing table tennis with my (ex)wife and kids in the hall in our house in Glasgow. He was, to my surprise, actually pretty good. And I remember him laughing, smiling, chatting, having fun. It was great to see him happy and I have lots of memories of Pete happy – staying with him and Maggie at their house and helping Pete cook (he loved cooking). I remember visiting one time and going to the local pub with him and Tony Merry. They were laughing and joking all evening long. They were great mates and I know that Pete missed Tony so badly when he died – also really suddenly.  

I also have memories of Pete being great with our kids: really kind and caring. He took us all to a stone forest near where he and Maggie used to live. We went down the river in a boat. We talked about person-centred therapy, and life, and how things were going but mostly I just remember Pete having fun and laughing. He really laughed a lot.

One time I went through a really bad episode of anxiety. Pete was amazing. He’d ring me up every day or two, check on how I was doing… for months I remember Pete being there. Nothing too intrusive: just a warm, gentle, caring presence; someone I knew that I could turn to.

PCCS book, which Pete set up, was also a bit like that. What an amazing thing to do: to set up a whole publishing company that could publish books for the person-centred field. And also for other areas that Pete cared deeply about, like the abuses of psychiatry and ways of empowering service users. Pete set up PCCS books because he wanted there to be a way of communicating ideas and practices that wasn’t determined by financial drivers – as the big publishing houses tend to be. And he and Maggie were brave and courageous and took real risks – real risks – in setting up PCCS as a service that was there for us all. Just as one example, Pete took on the publishing of our person-centred journal, Person-Centered and Experiential Psychotherapy and Counselling, without any strong guarantees that it would be financially viable. And, perhaps more to the point, he was happy for the journal to move on to a larger publisher when he knew that that was best for the journal. Pete was such a generous man and really led by principles: it was about doing the right thing rather than the thing that was going to suit his finances or his ego.

I always looked forward to seeing Pete and the PCCS team at conferences. He’d be there at the PCCS stand, at lunch, or when the talks got a little wordy, or during the encounter groups (Pete always seemed to opt out of those!), and you could nip off and have a chat with Pete. He’d always be up for a discussion, and it could be personal or professional or just joking around. Pete was like a great anchor in our counselling and person-centred world, or perhaps like a harbour. It was always somewhere safe you could go back to and feel like you could reconnect to someone and to yourself.

When I passed on news of Pete’s death on social media, one of the things that people most reflected on was his First steps in counselling book, and how that had, indeed, been their first steps into the counselling and person-centred worlds. Pete had an incredible ability to write clearly and simply: to convey complex and difficult ideas in ways that people could really understand. It was clear to me that so many people really loved that book: but, more than that, they loved a man who had taken the time to really present counselling ideas in a way that was accessible and meaningful to them.

But that was Pete. Someone deeply, deeply committed to social justice and to creating a world in which everyone has access to all the best things that life can offer. Everything, in all his activities, pointed to that end: he lived a person-centred ethos as much as he wrote about it and promoted it through PCCS.

I find it impossible to imagine that Pete is gone. It’s a massive Pete-shaped hole in our person-centred and counselling community. It’s an anchor that has been raised, a harbour that’s been destroyed: it’s an existential shock, and I imagine we’re all going to need a bit of time to re-orientate ourselves.

Pete was a loving man, and a fighter, and someone you could really rely on and who held so much together. He was so sharp, smart – but also compassionate and warm. Our world will be a really different one for his loss. But in all the sadness, I can still see Pete running around that table tennis table, and laughing and smiling. For all his depth, profundity, and commitment to social justice, he also brought an amazing joy to my life and the lives of so many others, all over the world.