Person-Centred

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.

Forthcoming training

If you are interested in finding out more about the person-centred approach, join us for our workshop: The Person-Centred Approach: A Contemporary Introduction on Saturday 12th November (online).

The Branches of the Person-Centred Tree: Some Pointers

Person-centred therapy is a wonderfully rich set of therapeutic approaches, based on the work of the US psychologist Carl Rogers. The aim of these pointers is to give a brief and systematic description of each of the principle ‘branches’, or ‘tribes’, of the person-centred approach.

The selection, and description of, these approaches is inevitably subjective, and other authors have articulated the principal branches in somewhat different ways (e.g., Sanders, 2012). Of course, there are no ‘right’ answers and the field of person-centred counselling and psychotherapy—as a complex, multifaceted entity—could be ‘organised’ in a multiplicity of ways. Indeed, one could say that there are as many different person-centred therapies as there are person-centred therapists.

This means, too, that the branches are not clearly separable entities, but overlapping sets of concepts and practices with numerous commonalities between them. The following pointers tend to emphasise the differences, to try and highlight the distinctive contributions of each branch; but please bear in mind these are, in the main, tendencies and emphases rather than ‘hard-and-fast’ polarities.

Note, also, that due to my language (in)abilities the selection of branches, and literature, here is relatively Anglo-centric. There may be many very exciting developments across Europe, South America, Africa, and Asia in non-English languages that have not been captured in this taxonomy. If colleagues are aware of these or, indeed, any other major branches, please do add some information in the comments below.

As with Sanders (2012), I have described these branches as members of the ‘person-centred’ nation, but it may be more accurate to describe the field, as a whole, as ‘person-centred and experiential’ (as, for instance, the journal Person-Centered & Experiential Psychotherapies). Again, there are no right answers: it depends how the term ‘person-centred’ is defined.  

An earlier version of this blog is available as a pdf post that can be downloaded from here.

What is a ‘branch’?

I have defined a person-centred ‘branch’ as a form of therapeutic practice, that:

  • Has evolved, wholly or primarily, from Rogers’s work.

  • Is a comprehensive form of therapy in itself, rather than solely a ‘bolt-on’ to another practice.

  • Has a ‘community’ of currently active practitioners (> 100 or so practitioners).

  • Has key texts, trainings, and websites currently available.

General Resources

Classical Client-Centred Therapy

Non-directive practice, as originally developed by Rogers, in which the therapist provides the client with an empathic, accepting, and genuine therapeutic relationship, thereby supporting the client’s own actualising process.

Founding Figure(s)

  • Carl Rogers (1902–1987, US). Other figures associated with classical CCT include Barbara Brodley, John Shlein, Jerold Bozarth, Tony Merry, Pete Sanders, Elizabeth Freire.

Timeline

  • 1928: Rogers begins career as psychologist, working with children and families.

  • 1942: Publication of Counselling and Psychotherapy: Newer Concepts in Practice, where Rogers introduces principles of non-directive practice.

  • 1951: Publication of Client-Centred Therapy, detailing theory of development and behaviour.

  • 1957: Classic paper on ‘necessary and sufficient conditions’ (Rogers, 1957).

Develops Rogerian Principles of…

  • Non-directivity.

  • ‘Core conditions’: empathy, acceptance, congruence.

Other Influences

  • Philosophical humanism (e.g., Rousseau).

Key Concepts

  • Actualising tendency is core motivating drive: towards maintaining and enhancing organism. Clients can find own answers to problems, if allowed to re-connect with inner experiencing and not swayed by externally-imposed conditions of worth.

Key Practice(s)

  • ‘Empathic understanding response process’ (Brodley): tentative following of client and reflecting back/summarising meanings and understandings, in non-judgmental and genuine way.

  • Principled (rather than instrumental) non-directivity: attitude of recognising client’s autonomy and following their lead—not technique or mechanistic practice.

Client Populations

  • Diverse.

Evidence base

  • Large number of controlled studies, for diverse populations, showing relatively good effects, though possibly marginally less than for more directive approaches (Elliott et al., 2013).

  • Core conditions (as rated by clients) associated with positive outcomes (Norcross & Lambert, 2019), though not evidenced as necessary or sufficient.

Current Dissemination

  • Large, classical-ish PCT practitioner communities in UK and several other countries (e.g., Germany, Austria, Argentina). Only small community remaining in US.

Examples of Practice

  • Numerous Rogers videos available online, most famously Gloria (09:27–40:38). Brief: Richie.

  • For contemporary CCT work with young people (including outcome tools), see here.

Further Resources

  • Introductory chapter: Merry, T. (2012). Classical client-centred therapy. In P. Sanders (Ed.), The Tribes of the Person-Centred Nation (2nd ed., pp. 21-46). Ross-on-Wye: PCCS.

  • Core text: Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103.

  • Website/Training: www.the-pca.org.uk/ (UK), www.adpca.org (US)

Child-Centred Play Therapy

Application of non-directive principle to therapy with children, based around play, as children’s natural mode of expression.

AKA

  • Non-Directive Play Therapy

Founding Figure(s)

  • Virginia Axline (1911–1988), Clark Moustakas, Garry Landreth, Sue Bratton, Dee Ray (US)

Timeline

  • 1940s: Axline develops nondirective play therapy, based on Rogers’s newly emerging PCA.

  • 1987: Centre for Play Therapy established at University of North Texas.

  • 1992: British Association of Play Therapy established.

Develops Rogerian Principles of…

  • Actualising tendency.

  • Non-directivity.

Other Influences

  • Early child psychotherapists (e.g., Anna Freud). Attachment principles.

Key Concepts

  • Belief in child’s inner capacity towards growth and healing, through natural media of play and creativity.

Key Practice(s)

  • Accepting, warm, respectful, permissive relationship in which child can take lead.

  • Empathy: looking at the world through the child’s eyes and reflecting back feelings, perceptions, and behaviours.

Client Populations

  • Children. Some application also with adolescents.

Evidence base

  • Well-established evidence of effectiveness across multiple, rigorously-conducted trials (e.g., Lin & Bratton, 2015).

Current Dissemination

  • Moderate-sized community of professional play therapists, and training programmes, in UK, US, and other regions of the world.

Examples of Practice

Further Resources

    

Focusing-Oriented Therapy

‘Process directive’ practice, based on the method of focusing, in which clients are encouraged to bring awareness to—and articulate—their bodily ‘felt senses’, such that there is a ‘carrying forward’ of experiencing.

Founding Figure(s)

  • Eugene Gendlin (1926–2017, American).

Timeline

  • 1953: Gendlin joined Rogers’s group at University of Chicago.

  • 1960s: Gendlin increasingly articulated own ideas and practices, following ‘Wisconsin project’ (client-centred therapy with schizophrenics).

Develops Rogerian Principles of…

  • ‘Experiencing’ as basis to human being and growth.

Other Influences

Phenomenological and existential philosophy, especially Merleau-Ponty.

Key Concepts

  • Clients with low levels of ‘experiencing’ less likely to make good progress may be helpful for therapists to encourage/facilitate clients’ experiential awareness.

  • Felt sense: a bodily, implicit, not-yet-fully-articulated sense of what is ‘right’ (i.e., fits) or ‘not right’: a ‘gut feeling’, at the edges of awareness.

  • ‘Carrying forward’ of felt senses can be blocked/stuck/interrupted.

Key Practice(s)

  • Focusing procedure (client-led, but with varying degrees of therapist encouragement/guidance/instruction): bringing awareness into the body, noticing concerns, articulating ‘felt sense’ in words/images, noticing when it brings relief, ‘receiving what has come from that experiential shift’ (Purton, 2012, p. 50).

Client Populations

  • Focusing method widely used in self-help and by lay people in ‘focusing partnerships,’ as well as in professionally-delivered therapy.

Evidence base

  • Limited trials of effectiveness; but good evidence that deeper experiencing is associated with better outcomes (Hendricks, 2002; Krycka & Ikemi, 2016).

Current Dissemination

  • Large international focusing community, inclusive of focusing-oriented therapists.

  • Focusing method incorporated into wide range of person-centred, humanistic, and integrative practices.

Examples of Practice

Further Resources

  • Introductory chapter: Purton, C. (2012). Focusing-oriented therapy. In P. Sanders (Ed.), The Tribes of the Person-Centred Nation (2nd ed., pp. 47-70). Ross-on-Wye: PCCS Books.

  • Introductory book: Cornell, A. W. (1996). The Power of Focusing: Finding Your Inner Voice. Oakland, CA: New Harbinger Publications.

  • Core book: Gendlin, E. T. (1996). Focusing-Oriented Psychotherapy: A Manual of the Experiential Method. New York: The Guilford Press.

  • Website/Training: www.focusing.org/

       

Emotion-Focused Therapy

‘Process-directive’ practice in which clients are invited to deepen emotional processing through a range of tasks (e.g., two-chair work), grounded in a collaborative and empathic therapeutic alliance.

AKA

Founding Figure(s)

  • Laura Rice (1920–2004, Canada), Les Greenberg (Canada), Robert Elliott (US/Scotland).

Timeline

  • Mid 1970s: Rice and Greenberg identify particularly helpful change events in therapy (e.g., two chair technique to resolve intrapersonal splits, Greenberg, 1979).

  • ·   1993: Publication of key text, Facilitating Emotional Change.

  • 2011: Foundation of International Society for Emotion Focused Therapy.

Develops Rogerian Principles of…

  • Centrality of emotions to experiencing.

Other Influences

  • Focusing, Gestalt therapy, contemporary psychological theory and research (e.g., cognitive neuroscience, attachment theory, emotion theory).

Key Concepts

  • Emotion schemes: synthesising structures that process cognitive, affective, and sensory information—at a pre-conscious level—to create meaning (cf. CBT’s cognitive schema). Schemes can be dysfunctional, such that we respond in maladaptive ways >> poor ‘emotion regulation’. Emotion schemes can be restructured if evoked, symbolised, and ‘worked through’.

  • Primary and secondary emotions: latter are feelings about feelings (e.g., shame about feeling angry), and may be problematic: blocking natural, organismic emotional response. 

Key Practice(s)

  • Range of therapeutic ‘tasks’ proposed where ‘task markers’ present—though practice always grounded in empathic attuned, accepting, and collaborative alliance. Tasks include: focusing for unclear felt sense, two-chair dialogue for self-criticism/conflict splits, empty chair work for unfinished business (Elliott et al., 2004) >> re-establish adaptive emotions/emotion regulation.

Client Populations

  • Diverse. Evidence based for depression (in US). Tailored treatment models/tasks being researched and developed for range of other difficulties (e.g., generalised anxiety, trauma).

  • UK: Person-Centred Experiential Counselling for Depression (prev. ‘Counselling for Depression’) is NICE-approved, combines elements of EFT with Classical CCT (Murphy, 2019).

Evidence base

  • Substantial, and growing, body of rigorous research demonstrating effectiveness of EFT, and EFT tasks, for depression and other problems (Elliott et al., 2013).

Current Dissemination

  • Active, and growing, international community of practitioners and trainers.

Examples of Practice

Further Resources

  • Introductory book: Elliott, R. & Greenberg, L. S. (2001). Emotion-Focused Counselling in Action, London: Sage.

  • Key book: Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating Emotional Change: The Moment-by-Moment Process. New York: Guilford Press.

  • Website: International Society for Emotion Focused Therapy.  

Dialogical/Relational Approaches

Variant of classical client centred therapy that puts stronger emphasis on interactional, two-way encounter between therapist and client, as contrasted with wholly non-directive stance.

Founding Figure(s)

  • Peter Schmid (1950–2020, Austria), Dave Mearns (Scotland).

Timeline

  • 1990s/2000s: Peter Schmid publishes range of papers describing the essence of person-centred therapy in ‘dialogical’, ‘encounter-based’ terms: ‘the unfolding of interpersonality.’

  • 2005: Publication of Working at Relational Depth (1st ed.).

Develops Rogerian Principles of…

  • Relationship, encounter.

Other Influences

  • Existential/relational philosophy: Martin Buber’s I and Thou, Emmanuel Levinas.

  • Relational perspectives in wider therapy and psychology field: e.g., attachment, relational Gestalt therapy, interpersonal neuroscience.

Key Concepts

  • Intersubjective ontology: human beings dialogically intertwined with others, not isolated entitles.

  • We are always, unavoidably influencing others: ‘non’-directivity is never wholly possible.

  • The client as Other: ‘infinitely foreign,’ ‘infinitely distant,’ ‘irreducibly strange’ (Levinas, 1969). Dialogue as welcoming/openness to encounter with Other.

  • Relational depth: ‘a state of profound contact and engagement between people’ (Mearns & Cooper, 2005, p. xvii).

Key Practice(s)

  • Flexibility and range of therapist responses, above and beyond empathic understanding response process: bringing therapist’s own responses, questions, reflections, perceptions in (without taking focus off client). Directivity (to a limited degree) is not taboo.

  • Focus of work is on establishing connection, being together, co-presence—allowing the emergence of relational depth.

Client Populations

  • General.

Evidence base

  • No trials of effectiveness, or comparison against classical approach

  • Good evidence that range of relational factors are associated with positive outcomes (Norcross & Lambert, 2019), with preliminary evidence relational depth is too (Wiggins, 2012).

  • Current body of research looking at experience of relational depth, its measurement, impact, and facilitating/inhibiting factors (see Cooper, 2013; Mearns & Cooper, 2018).

Current Dissemination

  • Loosely disseminated across person-centred practice and training in UK—and, to some extent, internationally—to varying degrees.

Examples of Practice

Further Resources

  • Core paper: Schmid, P. F. (2006). The challenge of the other: Towards dialogical person-centered psychotherapy and counseling. Person-Centered and Experiential Psychotherapies, 5(4), 240-254.

  • Core book: Mearns, D., & Cooper, M. (2018). Working at Relational Depth in Counselling and Psychotherapy (2nd ed.). London: Sage.

  • Websites: http://pfs-online.at/ , www.mick-cooper.squarespace.com/relational-depth

Creative Person-Centred Practices

A range of practices that use creative media—such as movement, dance, painting, sculpting, music, and creative writing—in a non-directive and non-interpretative way to facilitate self-discovery, spontaneity, healing, and growth.

Founding Figure(s)

  • Natalie Rogers (1928­–2015, US); Liesl Silverstone (1927–2013, UK).

Timeline

  • 1970s/1980s: Natalie Rogers (Carl Rogers’s daughter) develops person-centred expressive arts therapy and establishes training and community.

  • 1985: Liesl Silverstone establishes the Person-centred Art Therapy Centre in London.

Develops Rogerian Principles of…

  • Creativity, as pathway towards healing and growth.

Other Influences

  • Arts, performance, and creative practices.

Key Concepts

  • Creativity is an expression of our organismic actualising tendency: our movement towards healing and growth.

  • Creative methods can be a powerful means of helping clients express feelings and discover hidden aspects of ‘self’.

Key Practice(s)

  • Creative media (e.g., paints, clay, musical instruments) made available to client, and client invited to express emotions and experiences through them.

  • Client provided with a permissive, supportive, non-judgmental environment in which they can express themselves spontaneously and freely.

  • Reflection back to client of emotions, perceptions, actions, words, and artwork. Focus is on creative process, creative work, and meaning (rather than outputs).

  • Clients’ creative processes and work not interpreted, directed, or judged. Trust in client’s own path.

Client Populations

  • Adults, young people, and children. Individual and groups.

Evidence base

  • None.

Current Dissemination

  • Small community with handful of training courses in the US and UK.

Examples of Practice

Further Resources

  • Introductory chapter: Rogers, N. (2013). Person-centred expressive arts therapy: connecting body, mind and spirit. In M. Cooper, P. F. Schmid, M. O'Hara & G. Wyatt (Eds.), The Handbook of Person-Centred Psychotherapy and Counselling (2nd ed., pp. 237-247). Basingstoke: Palgrave.

  • Core text: Rogers, N. (1993) The Creative Connection: Expressive Arts as Healing, Ross: PCCS.

  • Core text: Silverstone, L. (1997) Art Therapy—The Person-Centred Way: Art and the Development of the Person, 2nd ed., London: Jessica Kingsley.

  • Website (UK): Association for Person Centred Creative Arts

  • Website (US): Person-Centered Expressive Arts

Pre-Therapy

A form of non-directive practice specifically developed for people with psychosis and other ‘contact impairments’, aiming to facilitate re-connection through very close, ‘mirroring’ reflections.

Founding Figure(s)

Garry Prouty (1936–2009, US), Dion Van Werde (Belgium).

Timeline

1966: Garry Prouty gives ‘birth’ to Pre-Therapy, working with mentally ill clients in Illinois.

1970s: Prouty starts to publish work.

1985: Pre-Therapy International Network established.

Develops Rogerian Principles of…

  • Psychological contact, as the first condition for therapeutic work.

Other Influences

  • Gendlin (who mentored Prouty), phenomenology.

Key Concepts

  • ‘Contact’ = contact with the world (reality contact), contact with emotions (affective contact), or contact with others (communicative contact).

  • Contact needs to be established before therapeutic work can progress. But helping clients re-establish contact functioning (as expressed in ‘contact behaviours’) can be valuable in itself.

Key Practice(s)

  • Contact reflections: very concrete, literal, ‘duplicative’ reflections that closely mirror the client’s actions and aim to re-establish a ‘web of contact’ with the client:

  • Situational reflections of client’s behaviour in context, e.g., ‘Rana is touching the table’.

  • Facial reflections: reflective expressions and affect, e.g., ‘You are looking sad.’

  • Body reflections: e.g., ‘You are rocking,’  ‘You are holding your arm out.’

  • Word-for-word reflections, even if not fully clear or coherent, e.g., client says, ‘Fast… very fast… very fast’; therapist repeats ‘Fast… very fast... very fast’.

  • Reiterative reflections: repeat of reflections that have previously established contact.

Client Populations

  • People with ‘contact impairment’ and ‘grey-zone’ (i.e., partially impaired) functioning; for instance schizophrenia, learning disabilities, organic impairments, autism, dementia.

  • Practiced both as formal one-to-one therapy, and in more informal/everyday care interactions (e.g., as part of nursing practice). Also group/ward practices to establish ‘contact milieu’.

Evidence base

  • Very limited body of controlled, pre-/post-, and case studies; but showing some evidence of positive effects (Dekeyser et al., 2008).

Current Dissemination

  • Small international network. Training at post-qualification level. 

Examples of Practice

Further Resources

  • Introductory chapter: Van Werde, D., & Prouty, G. (2013). Clients with contact-impaired functioning: Pre-therapy. In M. Cooper et al. (Eds.) The Handbook of Person-Centred Psychotherapy and Counselling (2nd ed., pp. 327-342). Basingstoke: Palgrave.

  • Introductory book: Sanders, P. (2007) The Contact Work Primer. Ross: PCCS.

  • Core book: Prouty, G., Pörtner, M., & Van Werde, D. (2002). Pre-Therapy: Reaching Contact Impaired Clients. Ross: PCCS.

  • Website: Pre-Therapy International Network

     

Motivational Interviewing

Person-centred style of guiding, developed for people with substance use problems, which specifically aims to elicit and strengthen motivation for change.

Founding Figure(s)

  • William Miller, Stephen Rollnick.

Timeline

  • 1983: Motivational Interviewing (MI) first described by Miller.

  • 1991: Publication of comprehensive guide.

Develops Rogerian Principles of…

  • Empathic, accepting, collaborative relationship (cf. authoritarian, pathologising approach to people with substance use problems).

  • Aimed at eliciting client’s own desire for change and growth (cf. persuasion, confrontation).

  • (MI/Miller explicitly claims Rogerian heritage, see Miller & Moyers, 2017).

Other Influences

  • ‘Stages of change’: precontemplation, contemplation, preparation, action, maintenance, termination (Prochaska & DiClemente, 1986). Empirical research. Behaviour change principles.

Key Concepts

  • Change talk: person’s own statements that favour positive change (e.g., ‘I want to stop drinking’); cf. sustain talk, statements favouring status quo. Ambivalence (existence of both change and sustain talk) is the norm. MI specifically sides with change talk (cf. classical CCT).

Key Practice(s)

  • Guiding principles: express empathy, develop discrepancy (i.e., elicit client’s desire for things to be different/change talk), avoid arguments, ‘roll with the resistance’, support self-efficacy.

  • Four processes/steps:

    • Engaging: establishing relational foundations—listening, understanding, open questions.

    • Focusing: establishing orientation, direction, goals towards positive change.

    • Evoking: inviting and supporting client’s change talk (desires, abilities, reasons, needs, importance); using open questions, affirmation, reflection, and summaries.

    • Planning: establishing specific, concrete strategies; supporting confidence, persistence.

Client Populations

  • Primarily used as brief intervention for people with alcohol and other substance use problems, across a broad range of settings (e.g., addition treatment, healthcare, social work); but can be used with other client populations or incorporated into more general therapy.  

Evidence base

  • Vast body of rigorous trials show effectiveness of MI for substance use problems, at level equivalent to CBT and AA (DiClemente et al., 2017; Project MATCH Research Group, 1997).

  • Process evidence supports MI claim that more change talk >> more change.

Current Dissemination

  • Extensively used, across globe, in range of addiction and treatment settings. Less common as one-to-one counselling/psychotherapy. Somewhat outside of global PCA community.

Examples of Practice

Further Resources

Integrative Person-Centred Approaches

Range of both general integrative frameworks (e.g., ‘pluralistic therapy’) and specific integrative combinations (e.g., ‘person-centred CBT’) which encourage the combination of person-centred principles and practices with other therapeutic ideas and methods.

Founding Figure(s)

Numerous, including Reinhard Tausch (German), Les Greenberg (see EFT, above), David Cain (American), Richard Worsley (British), John McLeod & Mick Cooper (Scottish/British).

Timeline

  • Late 1970s: Greenberg researches effectiveness of Gestalt method two chair technique.

  • Late 1980s: Tausch proposes ‘supplements’ to PCT.

  • 2000s: McLeod & Cooper articulate ‘pluralistic’ variant of person-centred practice.

Develops Rogerian Principles of…

  • Full functioning (in therapist) = flexibility, responsiveness, and openness to multiplicity of understandings and practices.

  • Uniqueness of each individual client, their strengths, and their therapeutic needs.

  • Uniqueness of each individual therapist and their strengths and abilities (Keys, 2003). 

Other Influences

  • Specific integrative practices have combined PCT with numerous other approaches, e.g., CBT (e.g., Josefowitz & Myran, 2005), systemic (e.g., O'Leary, 1999), existential (e.g., Cooper, 2012).

  • General integrative frameworks draw on postmodern rejection of singular ‘truths’: no one size fits all (including classical PCT concepts of ‘actualising tendency’ and ‘non-directivity’).

Key Concepts

  • Core conditions can be useful supplemented (for some clients, some of the time) by understandings and practices from other approaches. Challenges PCT ‘purism’.

Key Practice(s)

  • Diverse practices (alongside core conditions), depending on particular type of integration.

  • Pluralistic framework emphasises shared decision-making/preference work.

Client Populations

  • Diverse.

Evidence base

  • No trials of effectiveness outside of EFT (see above).

  • Good evidence for working with preferences/shared decision making (e.g., Swift et al., 2019).

Current Dissemination

  • Numerous counsellors and psychotherapists, worldwide, integrate core person-centred practices with ideas and methods from other approaches (Thoma & Cecero, 2009).

  • Integrative practices less clearly/confidently articulated in person-centred field, per se.

  • Small but lively pluralistic community in UK, distinct from PCT community.

Examples of Practice

Further Resources

  • Introductory chapter: Cain, D. (2013). Integration in person-centred psychotherapies. In M. Cooper, P. F. Schmid, M. O'Hara & G. Wyatt (Eds.), The Handbook of Person-Centred Psychotherapy and Counselling (2nd ed., pp. 248-260). Basingstoke: Palgrave.

  • Introductory chapter: Worsley, R. (2012). Integrating with integrity. In P. Sanders (Ed.), The Tribes of the Person-Centred Nation (2nd ed., pp. 125-147). Ross-on-Wye: PCCS Books.

  • Core debate: See Cooper & McLeod, ‘Person-centered therapy: A pluralistic perspective’ with critique by Ong et al., ‘Unnecessary and incompatible’.

  • Website/Training: www.pluralisticpractice.com  

References

  • Cooper, M. (2012). Existentially informed person-centred therapy. In P. Sanders (Ed.), The tribes of the person-centred nation: An introduction to the schools of therapy related to the person-centred approach (2nd ed., pp. 131-160). Ross-on-Wye: PCCS Books.

  • Cooper, M. (2013). Experiencing relational depth in therapy: What we know so far. In R. Knox, D. Murphy, S. Wiggins & M. Cooper (Eds.), Relational depth: New perspectives and developments (pp. 62-76). Basingstoke: Palgrave.

  • Dekeyser, M., Prouty, G., & Elliott, R. (2008). Pre-Therapy Process and Outcome: A review of research instruments and findings. Person-Centered & Experiential Psychotherapies, 7(1), 37-55.

  • DiClemente, C. C., Corno, C. M., Graydon, M. M., Wiprovnick, A. E., & Knoblach, D. J. (2017). Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychology of Addictive Behaviors, 31(8), 862-887. https://doi.org/10.1037/adb0000318

  • Elliott, R., Greenberg, L. S., Watson, J. C., Timulak, L., & Freire, E. (2013). Research on Humanistic-Experiential Psychotherapies. In M. J. Lambert (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change (pp. 495-538). New Jersey: John Wiley.

  • Elliott, R., Watson, J. C., Goldman, R., & Greenberg, L. S. (2004). Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change. Washington DC: American Psychological Association.

  • Greenberg, L. S. (1979). Resolving splits: Use of the two chair technique. Psychotherapy: Theory, Research, Practice, Training, 16(3), 316-324.

  • Hendricks, M. N. (2002). Focusing-oriented/experiential psychotherapy. In D. J. Cain & J. Seeman (Eds.), Humanistic Psychotherapies: Handbook of Research and Practice (pp. 221-252). Washington, DC: American Psychological Association.

  • Josefowitz, N., & Myran, D. (2005). Towards a person-centred cognitive behaviour therapy. Counselling Psychology Quarterly, 18(4), 329-336. https://doi.org/10.1080/09515070500473600

  • Keys, S. (Ed.). (2003). Idiosyncratic Person-Centred Therapy. Ross-on-Wye: PCCS Books.

  • Krycka, K. C., & Ikemi, A. (2016). Focusing-oriented-experiential psychotherapy. In D. Cain, K. Keenan & S. Rubin (Eds.), Humanistic psychotherapies (2nd ed., pp. 251-282). Washington: APA.

  • Levinas, E. (1969). Totality and Infinity: An Essay on Exteriority (A. Lingis, Trans.). Pittsburgh, PA: Duquesne University Press.

  • Lin, Y. W., & Bratton, S. C. (2015). A meta‐analytic review of child‐centered play therapy approaches. Journal of Counseling & Development, 93(1), 45-58. https://doi.org/10.1002/j.1556-6676.2015.00180.x

  • Mearns, D., & Cooper, M. (2005). Working at Relational Depth in Counselling and Psychotherapy. London: Sage.

  • Mearns, D., & Cooper, M. (2018). Working at Relational Depth in Counselling and Psychotherapy (2nd ed.). London: Sage.

  • Miller, W. R., & Moyers, T. B. (2017). Motivational interviewing and the clinical science of Carl Rogers. Journal of Consulting and Clinical Psychology, 85(8), 757-766. https://doi.org/10.1037/ccp0000179

  • Murphy, D. (2019). Person-Centred Experiential Counselling for Depression. London: Sage.

  • Norcross, J. C., & Lambert, M. J. (Eds.). (2019). Psychotherapy relationships that work (3rd ed. Vol. 1: Evidence-based therapist contributions). NY: Oxford University.

  • O'Leary, C. (1999). Counselling Couples and Families: A Person-Centred Approach. London: Sage.

  • Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors (pp. 3-27): Springer.

  • Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58(1), 7-29.

  • Purton, C. (2012). Focusing-oriented therapy. In P. Sanders (Ed.), The Tribes of the Person-Centred Nation: An Introduction to the Schools of Therapy Related to the Person-Centred Approach (2nd ed., pp. 47-70). Ross-on-Wye: PCCS Books.

  • Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103.

  • Sanders, P. (Ed.). (2012). The Tribes of the Person-Centred Nation: An Introduction to the Schools of Therapy Related to the Person-Centred Approach (2nd ed.). Ross-on-Wye: PCCS Books.

  • Swift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2019). Preferences. In J. C. Norcross (Ed.), Psychotherapy relationships that work (3rd ed., pp. 157-187). NY: Oxford University.

  • Thoma, N. C., & Cecero, J. J. (2009). Is integrative use of tehcniques in psychotherapy the exception or the rule? Results of a national survey of doctoral-level practitioners. Psychotherapy, 46(4), 405-417. https://doi.org/10.1037/a0017900

Wiggins, S. (2012). Development and validation of a measure of relational depth. (PhD dissertation), University of Strathclyde, Glasgow. Retrieved from http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.576407

 

Citation

This blog post can be referenced as: Cooper, M. (2021, Sept. 30). The branches of the person-centred tree: Some pointers. https://mick-cooper.squarespace.com/new-blog/2021/9/29/the-branches-of-person-centred-therapy-some-pointers

Credits  

Photo by niko photos on Unsplash

Non-Directivity: Therapeutic and Meta-Therapeutic Perspectives

What does it mean to be non-directive? Tony Merry, in his definitive introduction to classical client-centred therapy, describes it as respect for a person’s process of self-determination, and creating a relationship in which the sources for change reside in the person themselves.

In recent years, however, I think two different ways of understanding this non-directive stance have been articulated. The first is what we might call therapeutic non-directivity. Here, the therapist is not directive in the therapy session. They trust the client to talk about what is important to them, and to lead the way in finding answers to the question that they are posing. The therapist works mainly through empathic reflection and understanding.

The second is what we might call meta-therapeutic non-directivity. This is also a form of trusting the client’s own process of self-determination, but this time in terms of what they might want from therapy itself: that is, at a meta-therapeutic level. So, when the therapist is being non-directive at the meta-therapeutic level, one option might be to work in a therapeutically non-directive way. But there could be other options too—depending on what the client wants and what the therapist is skilled in and able to offer. For instance, if a client wanted to learn a particular mindfulness technique, or if they wanted advice on relationship problem, the therapist might input on these areas if they know how to. This wouldn’t, then, be therapeutic non-directivity, but it would still be non-directive at the meta-therapeutic level as it’s trusting that the client knows what is best for them.

It is often assumed, particularly in early stage person-centred trainings, that non-directivity means therapeutic non-directivity. So, for instance, if a client asks for guidance or suggestions, you reflect back to them that this is what they are looking for, and encourage them to find their own answers instead. But, in recent debates, many experienced person-centred practitioners have said that, in such instances, it may be quite appropriate for therapists to respond to the client’s wants: that is, to practice non-directivity at the meta-therapeutic level. Pluralistic therapy is a form of practice, emerging from the person-centred field, which particularly emphasises meta-therapeutic non-directivity. Some people have argued that pluralistic therapy is unnecessary because the person-centred approach, by its very nature, advocates this already. However, this criticism is very dependent on how the person-centred approach is defined. Given that, in many cases, person-centred non-directivity is understood at the therapeutic level alone, it may be useful to have a perspective that explicitly advocates a meta-therapeutic approach.

To a great extent, the stance that people take here may be dependent on how they understand the actualising tendency, and this is another person-centred concept that is open to a wide range of interpretations. In particular, do you understand the actualising tendency as something that lies deep within the person, outside of consciousness (what I have called an ‘essentialist understanding’ of the actualising tendency); or do you understand the actualising tendency in terms of the person knowing, consciously and here-and-now, what is best for themselves (an ‘existential understanding’)? If you take the latter perspective, you are more likely to trust that the person can, there-and-then in therapy, articulate something of what they want and need. But if you see the actualising tendency as something buried deeply away, you are more likely to feel that it needs time, space, and therapeutic non-directivity to be able to emerge.

At the meta-therapeutic level, we can also distinguish between active and reactive non-directivity. Reactive non-directivity is where we would respond to particular requests from the client if they made them (assuming, again, we were appropriately trained), but we wouldn’t specifically solicit meta-therapeutic suggestions or suggest options. Active non-directivity at the meta-therapeutic level, on the other hand, might mean that we would ask clients about the kinds of therapeutic inputs that they would want, or even make suggestions about what we believed might help them. Pluralistic therapy tends to advocate such an approach. The assumption here is that, because of the power differential between therapists and clients, clients may not feel able to say what they want unless they are asked. They might also not be aware of all the different options. But the danger, here, is clearly that clients may feel obliged to agree with therapists, and in so doing lose their own self-direction.

Of course, there are no rights or wrong here, and each of these forms of non-directivity may be very useful to clients. They are also not mutually exclusive. But what may be important is that therapists—and particularly trainees—are aware of what kind of non-directivity they are advocating and practising. The general definition of non-directivity is so broad, and so open to misunderstandings, that specifying what you, personally, mean by it is essential for anyone advocating such a stance (and particularly if you are trying to write about it in an assignment!). Non-directivity, as Tony Merry said, is about a deep respect for the client’s own process of self-determination, but how we manifest that respect in our client work is a complex and multifaceted issue that requires careful consideration and articulation.

This blog post can be referenced as: Cooper, M. (2021, Sept. 21). Non-directivity: Therapeutic and meta-therapeutic perspectives. https://mick-cooper.squarespace.com/new-blog/2021/9/21/non-directivity-therapeutic-and-metatherapeutic-perspectives

'Advice' in Counselling and Psychotherapy: What is it Good For?

From a person-centred standpoint, advice is very much a no-no. Indeed, it’s virtually a taboo in the person-centred field: the first thing you learn when you learn about practising non-directively. That’s not surprising given where Carl Rogers, its founder, came from. He wanted to counteract the expert-led tendency of the therapies of his day (the 1930s and 1940s), which involved the therapist telling the client how to solve their problems. It assumed that the clinician knew: about the client’s life, about the best way forward for them, about how they should live their life. Rogers reacted, and many of us still baulk today for these same reasons: who gives the clinician the right to think they know better than the client about the client’s own life?

Given that advice-giving is so intrinsic to how many us learn to ‘help’ others, it seems essential to me that counselling trainings should start with learning how not to give advice: to bracket that need and to learn to just be with clients so that they can develop their own skills in problem solving. If we just ‘leap in’ all the time, we may really get in the way of that. It’s also important for trainees to recognise that, in many cases, giving advice can be more about the ‘kick’ we get from being smart and showing that we know things, rather than coming from a genuine desire to help the other. Amongst the many different forms of therapy responses, research shows that advice is rated as one of the least helpful.

I know that for myself, as a client. If a therapist tries to give me advice, I nearly always feel patronised, directed, belittled. It makes me feel like, ‘Why the hell do you think you can tell me what to do, after years of me trying to sort it out for myself.’

But sometimes, actually, I have found it helpful. One of the most helpful things a therapist ever said to me, and actually probably one of the least humanistic, was this: ‘Why don’t you think of what a “normal” person would do in those circumstances and try and do that.’ On pretty much every index that’s a ghastly intervention, but actually it was incredibly helpful for me and something that supported me through a lot. And I think the danger in dismissing all forms of advice is that we may actually then not see when it can be helpful—as us pluralists say—for different clients at different points in time. So there is another side to this.

For a start, we’ve found in our research with young people in school counselling that, again and again, they say that they value the advice that they get from the counsellor (and you can see a great review of the evidence here). And this is kids in person-centred counselling. Of course, I’m sure sometimes what they are calling advice is actually the therapist reflecting back to them what they, themselves, worked out; but the point is that they see it as advice, and they love it. Along similar lines, we’ve found in our surveys on therapy preferences that about two-thirds of individuals want a therapist to give them advice, against about a quarter who don’t (see chart below). You could say, ‘Well, that’s because they don’t really know what therapy is or what’s really going to help them’; but then, paradoxically, that’s the essence of a therapist-expertise stance: saying what clients really need even if clients are saying something different.

Participants preference for advice vs not advice from a therapist, using the C-NIP form

Participants preference for advice vs not advice from a therapist, using the C-NIP form

Part of the issue, I think, is that the word ‘advice’ tends to be used in a very generic and non-specific sense, when actually it can cover a whole spectrum of different responses to clients. It’s one thing to say to a client, ‘You really ought to be kinder to your mum and, if you aren’t, you should feel ashamed of yourself’ (which, of course, no therapist would ever say); and quite another to say something like, ‘I wonder if you have ever thought about telling your mum how you’re feeling.’ So while the first kind of pressuring, very rigid advice might be unhelpful for nearly all clients; something much softer and more tentative may be of greater therapeutic value, and not have the effect of pressuring the client in any one way. So we need to nuance what we mean by ‘advice’.

Closely related to that is the fact that we are always influencing our clients—just by being there in the room with them—so there isn’t really any such hard division between ‘influence’ vs. ‘non-influence’. Rather, there’s different degrees of influence and some of the most powerful ways may be the most implicit. For instance, if we smile when a client tells us about their feelings we are implicitly conveying to them that they are doing something of value. Or, if we encourage them to think about their genuine needs, we are conveying that it’s good to be authentic. That maybe isn’t explicit advice but it is a valuing of one particular way of being, and can have, effectively, pretty much the same impact. Indeed, you could argue that, by being implicit, it’s actually more coercive—perhaps giving direct advice is more congruent and transparent.

There’s also good reasons why clients might value advice. Sometimes, as I’ve argued in my latest book, we’re just don’t know the things we need to do to get to where we want to be. If my car breaks down, I need someone to tell me how to fix it. I don’t have some inner organismic sense of what I need to do. And, similarly, clients may need some guidance on how to make friends, or overcome anxieties, or give up alcohol. That’s not such a terrible thing to acknowledge, is it? The positive effects of psycho-educational approaches like social skills trainings show that clients can really gain a lot from such direct education.

Conclusion

I think there’s some very good reasons why therapists should be trained out of automatically giving advice; and it’s certainly not a response mode we should use more than sparingly—unless a client has specifically signed up for a psychoeducational approach. Helping people work things out for themselves is, I’m sure, generally a more sustainable form of learning. It’s also important that, if we’re giving advice, we’re skilled and knowledgeable about what we are saying: none of us want to be telling clients to do things that just aren’t helpful. So just to be really clear, I’m not saying in any way that we should just break with our training and start advising our clients, willy-nilly, on how to live their lives, what to do, what they should wear, etc. But I am saying that, in the person-centred and humanistic therapies, I think we have tended to get a bit ‘phobic’ about advice; and turned something that was a counteraction to some over-directive practices into a rigid ‘law’ about what we can and cannot do. From a pluralistic standpoint, and based on the evidence, advice can be helpful for some clients some of the time. And perhaps it would be better to be working out when it might be helpful, and what are the best ways of giving it at those times. For instance, I’m sure that tentative ways of advising, rather than impositional ones, are of greatest value to most clients. And asking clients whether they’d like advice or not is also, probably, a helpful practice so that clients don’t feel imposed upon. There’s also the question of what kind of advice is most beneficial? For instance, from our research with young people, we’re finding that it tends to be in two areas—social skills and coping behaviours—and developing knowledges in such areas may be very helpful in terms of optimising the value of advice-type responses.

Perhaps the question we always need to ask, as Teresa Cleary notes in her comments below, is whether our responses is in the best interests of the client, or whether it’s to meet some personal need or agenda. The problem with giving advice is that it is, indeed, often more the latter than the former; but not giving advice can also be so—if, for instance, it’s about conforming to some inner set of ‘shoulds’ about how counsellors behave. So there’s no easy answers. It’s complex. And while having some basic rule about ‘not giving advice’ is a great starting point in training, like all skills and competencies, it is something that can get nuanced and developed over time.

[Spanish translation of this blog post]

Non-Directivity: Some Critical Reflections

The concept of non-directivity emerged in Carl Rogers’s work in the 1930s and 1940s as an alternative to the therapist-led counselling of his day. There, the clinician defined the interview situation, asked questions, diagnosed, and proposed particular activities (if you’re interested in its origins, do get hold of a copy of Rogers’s early work, Counseling and Psychotherapy). Rogers’s ‘non-directive’ approach was a radical innovation, which aimed to put the client’s own goals and understandings at the very centre of the therapeutic work. Underlying this was a humanistic ethic that placed ‘a high value on the right of every individual to be psychologically independent and to maintain his [or her] psychological integrity’ (p. 127).

Looked at today, it seems to me that there is still enormous value in emphasising the client’s right to direct their own therapy. Just as one example, for instance, when I’ve analysed interviews with young people in person-centred school counselling, it is clear that some really value not being told what to do by the counsellor. They say things like, ‘The counsellor asked me questions, but she didn’t push me. That felt calm and relaxed (and much better than the person I had before who was just talking all the time/getting me to do things).’ ‘Non-directivity’, then, can clearly be helpful for at least some clients some of the time; and, even without that, there would be an ethical argument for starting therapy with the client’s own directions. That’s why, perhaps, a ‘person-centred’ approach is becoming increasingly dominant in the health and social care fields. That doesn’t mean a strictly Rogerian practice, but one that aims to put the client right at the heart of the decision-making process. Health Education England, for instance, write:

Being person-centred is about focusing care on the needs of individual. Ensuring that people's preferences, needs and values guide clinical decisions, and providing care that is respectful of and responsive to them.

So, in that sense, Rogers’s basic principle of ‘non-directivity’ has been accepted as a starting point for the whole care field, and is, in many ways, incontrovertible. I think that’s great. I also think that it’s really important that, on counselling and psychotherapy training courses (pretty much of any orientation), trainees are taught the discipline of being able to recognise their own particular directions and agendas, and to try and de-prioritise these in favour of the client’s.

However, it’s worth noting the change in terminology — from ‘non-directivity’ to ‘person-centred’ — and to a great extent that is evident in Rogers’s work too. In his later books he uses the term ‘non-directive’ a lot less: indeed, it’s not even there in the index of his 1961 classic: On becoming a person. Personally, I think that’s a good thing: for me, while the ethos of non-directivity is incredibly important, the term is problematic for a few inter-related reasons.

First, from an intersubjective standpoint, it doesn’t make much sense to talk about being ‘non-directive’. Intersubjectivity is the philosophy that human beings only exist in relation to each other; and, if that’s the case, then simply being in the room with another person will have some influence on them. Here, then, we can never not direct another, and that’s what comes through in the research. For instance, some of the young people whose interviews I’ve looked at find it really awkward when the counsellor doesn’t say much, and particularly when there’s silence. I’m sure the counsellors, here, are trying to be non-directive and not leading but, actually, it has a very powerful effect on the client. So there’s no ‘neutral’ when it comes to counselling, no pure reflection; and it’s probably important that therapist know that so that they can think about the impact that their behaviours are having, whatever they do. If they try to direct, it will influence the client in certain ways; but if they try not to direct, it will also influence the client in certain ways. The term ‘non-directive’ seems to imply that we can act without influence, and that, I think, occludes rather than clarifies what happens in the counselling room.

Second, I think that the term ‘non-directivity’ can lead to a particularly passive understanding of person-centred practices — especially for trainees who are new to the field. What we see with young people is that, although most do really love their counselling, there is a significant minority (maybe 15% or so) who experience their person-centred counsellor as too passive: too quiet, too purely reflective — not offering enough input or advice. Again and again, too, when I ask my adult clients about their previous therapies I hear things like, ‘She was really nice, but she just didn’t do anything, and I am not sure I got much out of it.’ So I think that person-centred therapists need to be wary about ‘sitting back’ too much — at least with some clients. Person-centred therapy, per se, can be incredibly active and dynamic — the therapist fully present and immediate in the room. But I think the term ‘non-directive’, all too easily, points away from that: it infers not-doing, not-acting, not-taking initiative. ‘Person-centred’ or ‘client-centred’ or ‘client-oriented’ seem much better terms to me: that emphasise that the therapy is based around the client but don’t position the therapist as, inherently, non-active in that.

Third, the concept of ‘non-directivity’ throws up a paradox: because what does it mean to be non-directive with a client who wants direction? And it’s certainly the case that that’s what some clients wants. Take the graph below, for instance, from some research we recently conducted on individuals’ preferences for therapy. Respondents were asked to say what they would want a therapist to do, from a scale of 3 (Allow the therapy to be unstructured) to 3 in the other direction (Give structure to the therapy). Here, around 65% of respondents were saying that they wanted a structured, therapist-led approach; compared with around 15% wanting an unstructured approach: and that was similar on all our other therapist directiveness dimensions.

Structure graph.jpg

So, if a client is scoring a ‘3’ for wanting structure in their therapy, what is the ‘non-directive’ thing to do? You could say, ‘Well they’re asking for structure, but really they need to learn to live without structure and find their own direction,’ but that seems to be putting the therapist’s perspective before the client’s — hardly non-directive! So a more non-directive approach, it seems to me, is to try and accommodate the client’s preference and provide some structure (if we can and if we genuinely think it might be helpful for the client) — and this is what we’ve tended to advocate in pluralistic therapy (see here). But then the term ‘non-directive’ doesn’t seem to particularly fit any more. Not unless we say that being ‘non-directive’ can include such therapist-led activities as providing structure, activities, and guidance — but that’s really not what the term would seem to suggest. So, again, I think terms like ‘person-centred’ or ‘client-oriented’ are much better ways of expressing that desire to actively align ourselves with the client’s own directions: to put their wants and preferences right at the heart of the therapeutic work.

Finally, I think the term ‘non-directivity’ implies that, as therapists, we can act without directions when, actually, directions are inherent to all our actions. That’s something I’ve particularly focused on in my most recent book, which argues that ‘directionality’ is an essential quality of human being: that forward-moving, agentic thrust of being that can exist unconsciously as well as consciously. This means that, as therapists, we are never not trying to do something. We might want to be conveying empathy to our clients, or understanding them, or facilitating their own self-empowerment; but these are all directions in themselves, and recognising what these directions are is probably more important — in terms of our own self-awareness — than assuming (or hoping) that we’re acting without direction. This links to the earlier point that we’re always going to influence another, whether we like it or not.

I guess, in conclusion, what I am saying is that, although the thinking and ethics behind the term ‘non-directivity’ are of critical importance, the term, itself, is not always a helpful one. It’s good in reminding therapists to recognise, and de-prioritise, their own agenda; but it can imply an individualistic understanding of human being, and it points towards an interpretation of person-centred practice which is too passive and too non-engaged for some clients. In fact, I would say that it’s maybe time to drop the term from our training and literature, and instead to focus on being ‘client-’ or ‘person-’ centred, and what that really means. Or maybe we think about person-centred therapy as an approach which, fundamentally, strives to align itself with the direction of the client and to facilitate that. So not ‘non-directive’ but ‘client direction-centred’. Person-centred therapy, ultimately, isn’t about lack. It’s about dynamism, responsiveness, presence. And I think there are better terms that convey that deep engagement with clients. We’re not non-something. We are something. And emphasising what we are is, I think, a more constructive and positive way forward for the person-centred approach.


[Image by Agnieszka Zapart: see https://www.facebook.com/PsychoterapiaGestaltAgnieszkaZapart/ for her wonderful illustrations]

[Spanish translation of this blog post]

Person-Centred Therapy is Not One Thing: An Introduction to the Tribes

Has anyone ever said to you, ‘That’s not person-centred’, or ‘Person-centred therapists would do…’? If so, you might want to point out to them that there’s no such thing as ‘person-centred’—it’s not one, homogeneous ‘thing’. Rather, it’s a wonderfully diverse family of approaches, each with something very special to offer to the wider therapeutic field.

It starts with the classical client-centred approach of Carl Rogers from the 1930s onwards. Rogers reacted against the behaviourism and expert-directed approaches of his time, and instead emphasised the client’s own ability to find their answers to their problems. So the hallmark of the classical approach is a non-directive stance: letting the client lead the way in an accepting and empathic environment. The classical approach is still very popular and you can read about it in Tony Merry’s chapter in the brilliant Tribes of the Person-Centred Nation. There’s some argument that Rogers, himself, moved away from a classical stance in the 1960s towards a more relational standpoint (see below), but others argue that Rogers style of practice never really varied throughout his career.

Out of Rogers’s work you get the emergence of non-directive therapies with children, particularly the work of Virginia Axline. Person-centred play therapies are still very popular today and have a very good evidence base, developed by world-class researchers like Dee Ray at the University of North Texas. Natalie Rogers, Carl Rogers’s daughter, also developed an approach called Creative Connections which offers clients a non-directive space to engage with a wide variety of creative media, such as dance, music, and drama.

Focusing, which emerged in the 1960s, was probably the most important development from Rogers’s work, and took it in new and creative directions. Gendlin, its founder, believed that some clients needed to get more in touch with their inner ‘felt senses’ before they could really use therapy to its fullest. So focusing encourages clients to ‘listen inwards’ to their bodies and allow their feelings and bodily experiences to emerge. It’s really popular today in ‘peer focusing partnerships’, as well as in focusing-oriented psychotherapy; and psychotherapists of all orientations may use focusing methods in their work.

One reason why Gendlin’s break from Rogers was so critical is because it introduced the idea that some clients, some times, do need therapist direction to make the most of the work. This stance was developed further by Laura Rice and subsequent founders of emotion-focused therapy (EFT; like Les Greenberg, Robert Elliott, and Jeanne Watson) who articulated a series of methods that could be used to help clients get deeper into their emotions: the key, as they saw it, to therapeutic progress. EFT, for instance, uses ‘empty chair work’ to help clients express, and process, their feelings towards others; and ‘clearing a space’ to help them deal with overwhelming feelings. EFT is very well supported by the empirical evidence and in the US is ranked as an evidence-based therapy for depression. There’s lots of CPD trainings available on it and an international society. Sue Johnson, who worked with Les Greenberg, developed an approach called emotionally focused therapy, which has many similarities to Greenberg et al.’s EFT but is particularly oriented to work with couples. However, there’s another EFT, ‘emotional freedom technique’ (the one with lots of tapping), which is something entirely differ.

Counselling for Depression (CfD, now termed person-centred experiential counselling for depression) combines a classical person-centred approach with some ideas and practices from EFT. It was specifically developed to fit within the NHS’s NICE guidelines for treatments for depression, and was based on core competences for humanistic therapies. This therapy is now delivered across the country, mainly within health settings, as an evidence-based interventions. Several CPD trainings in this approach are available, for instance at the Metanoia Institute in London.

Around the 1980s, motivational interviewing (MI) began to develop in the field of treatments for drug dependency, and is now one of the best evidence interventions across the psychotherapy field. Bill Miller, one of the founders of the approach, was strongly influenced by the writings of Carl Rogers, and there is an emphasis in the approach on being empathic and engaging with the client’s perspective. However, it is more directive than classical person-centred therapy. For instance, if a client is struggling between the part of them that wants to give up drugs and the part of them that doesn’t, an MI therapist would tend focus on their ‘change talk’ (that is, the part that does want to give up drugs), whereas a classical person-centred therapist might be more likely to reflect both positions.

Another important development around this time was pre-therapy. Developed by Garry Prouty in the US, this approach was specifically developed for clients who are ‘contact impaired.’ That is, who are less in touch with ‘reality’: for instance, people experiencing psychosis or depersonalisation. Pre-therapy uses very concrete reflections—for instance, ‘You are looking at the wall,’ ‘You are smiling’—to try and help the client back into contact with their world and with others.

Relational, or dialogical, approaches to person-centred therapy differ from EFT or MI in that they are not a specific set of therapeutic methods, but more of a description of a therapeutic style or stance. As with EFT or MI, though, they are something of a break from the more classical style, and emphasise a more interactive therapeutic approach in which the emphasis is on the therapist being particularly present and real to the client. So that might involve some more challenging, or more introduction of the therapist’s own perspective into the work. You can read about the philosophy underlying this approach in the work of Peter Schmid, or see my own work with Dave Mearns on relational depth.

Similarly, an existentially-informed approach to person-centred therapy, which you can also read about in the Tribes book, is not a specific therapeutic model but a form of classical/relational person-centred therapy informed by ideas from existentialism. So the therapist might be particularly attuned to a client’s sense of meaning in life, or their anxieties around freedom and choice.

Of course, in reality, a wide variety of therapeutic methods and theories can be (and have been) incorporated into a person-centred approach, and that leads us to integrative approaches to person-centred therapy. Sometimes these are just personal forms of integration: for instance, when a person-centred practitioner begins to bring in ideas and methods from narrative therapy, or from transactional analysis. But there are also more systematic forms of therapeutic integration, and David Cain writes about these in his chapter in the Handbook of Person-Centred Psychotherapy and Counselling (2nd ed). Pluralistic therapy, for instance, developed by John McLeod and myself, argues that being ‘person-centred’ means responding to the unique individual wants and needs of each client, and that means recognising that a strictly non-directive approach will not be the most appropriate way of working at all times. Rather, pluralistic therapy suggests that we should talk to clients about what they want from therapy, and be transparent about what we can offer; that we can either offer our clients the kind of therapy that may most help them, or else refer on as appropriate. You can read more about a pluralistic approach to person-centred therapy on my blog here.

For me, what makes person-centred therapy wonderful is this diversity of riches: so many different ways to think and practice. And, perhaps, we shouldn’t expect anything less from a therapy that focuses on the person and how they, uniquely, see and experience the world. Of course, when we first train, we often need to start with the basics—like the ‘core conditions’, or unlearning a natural tendency to give advice—but growing as a person-centred therapist means recognising that there are so many different ways we can flesh out this identity: spreading our wings, and finding our own unique person-centred stance.

To find out more about the different forms of person-centred therapy, Pete Sanders’s (ed.) Tribes of the Person-Centred Nation (2nd ed) provides a great account of the major developments. Pete’s chapter in the Handbook of Person-Centred Psychotherapy and Counselling (2nd ed) gives a very useful summary. The national organisation for person-centred therapists in the UK is The Person-Centred Approach (TPCA), and their website has lots of useful information and links to current developments.

The 'Actualising Tendency': A Directional Account

What is the ‘actualising tendency’? It’s something that is referred to throughout the person-centred and humanistic field. But what does it actually mean, does it make sense, and, perhaps most importantly, does it really ‘exist’?

Carl Rogers (1959, p. 196), in his classic monograph, defined it as the, ‘inherent tendency of the organism to develop all its capacities in ways which serve to maintain or enhance the organism.’ To be honest, I’ve studied and quoted that definition again and again over the last 30 years, but I’m still not entirely sure what it means. The problem for me is the term ‘capacities’—what actually are they? Similarly, when the Dictionary of person-centred psychology defines the actualising tendency as ‘the tendency in all forms of organic life to develop more complex organisation, the fulfilment of potential…’ (Merry & Tudor, 2002, p. 2), I’m left with the question, ‘What actually is this “potential”?’ Presumably it’s something we are born with. But was I born with the potential to become a professor, or a football player, or a sociopath? And, if so, why did I actualise some potentials and not others? I guess, for me, terms like ‘capacities’ and ‘potential’ just feel too vague and non-specific, and don’t seem to give us much concrete direction about how to engage most helpfully with our clients.

So does the ‘actualising tendency’ mean something about an inherent capacity to self-heal, or ‘self-right,’ as Bohart and Tallman (1999) put it? I think that is how it is most commonly understood. That is, we each, within us, have the capacity to sort ourselves out—to find the answers to our problems. If we get cut, our bodies form scabs to heal us; or send out antibodies to help us overcome an infection. In the same way, then, deep inside of us is a tendency towards psychological healing, maintenance, and growth. We know what is right for us: an amazing, organismic wisdom that can help us overcome even the most challenging of circumstances. Viewed in this way, the concept of the actualising tendency becomes a revolutionary and deeply democratising challenge to those approaches—like traditional psychoanalysis and behaviour therapy—that see expert knowledge and intervention as the source of psychological healing. Here, from this humanistic standpoint, we don’t need to depend on others, or look to our ‘betters’, to sort ourselves out. Rather, it’s we, ‘the people’, who are our own authorities in our own lives.

Progressive though it is, this understanding of the actualising tendency begs an obvious question: if we’ve got such a deep tendency towards healing and growth, how is it that people can get so f*%£ed up in their lives? Why, for instance, do people end up addicted to drugs, or battering themselves psychologically or physically, or chasing after money in a way that drives them to an early grave? Fortunately, from a self-righting perspective, there’s a pretty good answer to this: because, instead of trusting our own inner wisdom, we end up being guided by the outside world. So, for instance, we come to believe that the most important thing in life is to have a Rolex watch, or thousands of Facebook ‘friends’; and we come to ignore that own inner voice that is just wanting to have fun, or be creative, or lie in bed with our partners watching the rain against the window pane. In Rogerian terms, we develop an ‘external locus of evaluation’, instead of an ‘internal’ one.

There’s evidence in support of this position. For instance, we know that people feel happier and more satisfied when they achieve ‘intrinsic’ goals, as opposed to ‘extrinsic’ ones (Sheldon & Kasser, 1998). However, the idea that our actualising tendency gets scuppered by the outside world is problematic in several ways (Cooper, 2013). First, it tends to position the person as a ‘victim’ of their external circumstances, which isn’t consistent with the person-centred idea that we are all inherently agentic. Rollo May, the founder of existential therapy in the US, criticised Rogers for this, saying it was the ‘most devastating of all judgements’: that we are all essentially ‘sheep’ following whoever is ‘the shepherd’. Second, it’s based on a very individualistic view of human being: that we come into the world as a separate entity, divorced from those around us, and with an ability to return to an independent, individual self. For a lot of contemporary ‘postmodern’ thinkers, these individualistic assumptions are more a product of western, patriarchal culture than an ‘objective’ reality; and they would argue that human beings are always, inevitably, inter-mixed with others. So, from this standpoint, it really doesn’t make sense to pitch ‘the individual’ against ‘society’. Third, and perhaps most basically, is it really true that we always know what is right—social forces or not? If I get lost, for instance, sometimes I have a deep, intuitive feeling about where I need to go, and it’s absolutely spot on. But sometimes I don’t. And sometimes my deep intuitive feeling takes me in totally and utterly the wrong direction, while Google Maps is perfect at getting me there. So surely we do learn, sometimes, some very helpful and healing things from the outside world? As the developmental psychologist Piaget argued, growth and learning comes from both ‘assimilation’ (fitting the external world to what we already know) but also ‘accommodation’ (adapting our ways of seeing the world to what we learn from outside). So to only focus on ‘inner wisdom’, and not the wisdom of others or the outside world, would seem somewhat myopic.

Given these issues, I want to propose another way of thinking about the actualising tendency which, for me, helps to make sense of some of these problems. It’s based on some thinking and research that I did for my latest book, Integrating counselling and psychotherapy: Directionality, synergy, and social change (Sage, 2019).

The book starts with the assumption, derived from existential philosophy, that human being is essentially directional. This is not entirely dissimilar from the idea of an actualising tendency—indeed, the actualising tendency has been described as directional. However, directionality isn’t defined, per se, in terms of pointing in a healing or necessarily growthful direction. Rather, it refers to the way that, as human beings, we are always ‘on-the-way-to-somewhere’: agentic and acting intelligibility (i.e., in the best ways we know how) towards different possibilities, rather than being sponge- or machine-like ‘things’. Of course, we can have many different directions; and what the framework goes on to suggest is that these directions fit together in a ‘hierarchical structure’: with our strongest, most fundamental directions at the top (for instance, for relatedness, self-worth, or meaning), and lower-order directions as the means by which we try and fulfil these higher-order desires. So, for instance, we might have a desire to find a good TV box set on Netflix (lower-order direction), so that we can spend time with our partner (higher-order direction), so that we can experience relatedness in our lives (highest-order direction).

This distinction between higher- and lower-order directions may be helpful in trying to make sense of the actualising tendency, because what I want to suggest is that, whilst our higher-order directions may be an expression of some inner, self-righting wisdom, our lower-order directions may not necessarily be. So the first part of this is that only we can know what we most fundamentally want and need in our lives: no one, for instance, can tell me that I need faith, or that the most important thing for me in my life is to be powerful and dominant. I know, deep inside, that what matters for me most is intimacy and love and social contribution. And even if I didn’t know it, it’s my right to set those highest-order directions for myself. But when it comes to lower-order directions, the means to get to where we want to be, there is maybe a lot more that we can learn from the world; and a lot more that we might get, intuitively, wrong. So, for instance, my desire to experience relatedness in my life: yup, definitely actualising. My desire to do that by watching TV with my partner: yup, probably so, although there might be better ways towards intimacy. My desire to sit through sit through six seasons of Gossip Girl … Hmm… ‘anti-actualising’ for sure, and this is where I could definitely do with some external guidance and advice.

This directional understanding of the actualising process has clear implications for how we might work with our clients. If all the wisdom is within the client, then the best thing we can do to help them is to really step back from any guidance, advice, or directions; and just allow their own self-righting force to come to the fore. In other words, classical non-directive client-centred therapy. But if we say that, at lower orders, people can get things wrong, then guidance, and directions, and specific therapeutic methods can also have a legitimate place. So, for instance, we might teach a client social skills, so that he or she can get the intimacy that they are yearning for. Or we help them to discover that the best way to overcome a phobia is by facing up to it, through exposure techniques. Here, we’re not telling the person what their highest-order directions are; but we’re helping them learn about the best ways to get there—on the assumption that that wisdom is not always inside. Of course, we can’t all offer these different methods, and the suggestion here is not that we should all become polymaths (or even integrative or eclectic) in how we think and practice. But it points towards the ‘pluralistic’ principle that we should all be as aware as possible of what we can, and cannot, offer clients; and have the knowledge and skills to refer on, as and where appropriate (Cooper & McLeod, 2011).

In summary, an understanding of human beings as self-healing is a great reminder of the incredible creativity and wisdom that clients can have in finding their own answers. But, as a complete model in itself, it can also be limited and lacking in nuance. Most importantly, perhaps, it can mean we overlook times in which clients could really, genuinely, do with some external guidance, to help them towards the things that they most deeply want. From a directional perspective, human beings are still conceptualised as agentic, intelligible beings. But there’s an acknowledgement that, while we may always be striving to do our best, that’s not always the best thing we can be doing. Sometimes, with the best will and reasons in the world, we end up doing things that really mess us up. Hence, while therapists need to really, deeply listen to what it is that clients want—and how it is that they think they can get there—it may also be important to recognise that, at least for some clients, the pathways towards getting there are not always ‘inside’: there’s a place for wisdom without, as well as wisdom within.

References

Bohart, A. C., & Tallman, K. (1999). How Clients Make Therapy Work: The Process of Active Self-Healing. Washington: American Psychological Association.

Cooper, M. (2013). The intrinsic foundations of extrinsic motivations and goals: Towards a unified humanistic theory of wellbeing. Journal of Humanistic Psychology, 53(2), 153-171. doi: 10.1177/0022167812453768

Cooper, M., & McLeod, J. (2011). Pluralistic Counselling and Psychotherapy. London: Sage.

Merry, T., & Tudor, K. (2002). Dictionary of Person-Centred Psychology. London: Whurr Publishers.

Rogers, C. R. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework. In S. Koch (Ed.), Psychology: A Study of Science (Vol. 3, pp. 184-256). New York: McGraw-Hill.

Sheldon, K. M., & Kasser, T. (1998). Pursuing Personal Goals: Skills Enable Progress, but Not all Progress is Beneficial. Personality and Social Psychology Bulletin, 24(12), 1319-1331. doi: 10.1177/01461672982412006

 

[An edited version of this blog post was published as ‘Cooper, M. (2019). What does the 'actualising tendency' actually mean? Therapy Today, 30(7), 42-43’.]

 

Person-Centred Therapy: Myths and Realities

Myth: Person-centred therapy is ‘just the basics’—everyone does it, it’s just that some therapists go on to do more advanced things, like psychodynamic therapy or cognitive-behavioural therapy.

Reality: Developing one’s capacity to engage with another human being at a level of interpersonal depth is a life-time’s achievement. Few ‘purely’ person-centred therapists, even after many years, would claim that they have reached the end of that road, so the chances of getting there after a few years’ study are pretty remote. Moreover, skills and ideas from other therapeutic approaches—like psychodynamic therapy or cognitive-behavioural therapy—can’t just be ‘dumped’ on top of a person-centred foundation: they need careful integration. Finally, whilst it’s true that the skills and ideas associated with person-centred therapy can be taught at a fairly basic and accessible level, the roots of the approach dig down into some far more complex ideas. Understanding the person-centred approach, then, can involve engaging with the ideas of such philosophers as Martin Buber and Edmund Husserl, as well as the complex psychological processes that Carl Rogers, the founder of the approach, outlined in his theory of therapy, personality and interpersonal relationships (see here).

 

Myth: There’s no evidence that person-centred therapy works.

Reality: Rogers was one of the first people to systematically study the therapeutic process, and his hypotheses about the necessary and sufficient conditions for therapeutic personality change were firmly grounded in the empirical data. Today, more than ever, there is compelling evidence that person-centred therapy is effective with a whole host of psychological difficulties (see Elliott et al, here); and that relational factors—such as empathy, unconditional positive regard and congruence—are central to the process of therapeutic change (see here). (For more discussion of the evidence base, see my previous blog here).

 

Myth: Person-Centred therapy doesn’t have a model of psychopathology.

Reality: It’s certainly true that person-centred therapists try to see their clients, first and foremost, as unique individuals, and not as representatives of a particular label; and it’s also true to say that person-centred therapists are as interested in their clients’ potentialities as they are in their problems. But, in recent years, numerous therapists within the person-centred field have attempted to understand severe psychological distress from a humanistic perspective (see here). For instance, there is the work of Margaret Warner on ‘difficult’ and ‘fragile’ psychological processes; Elke Lambers’ accounts of psychosis, neurosis, and personality disorders; and Gary Prouty’s work on ‘pre-therapy’ with schizophrenic and other ‘contact-impaired’ clients.

 

Myth: Person-centred therapy is one, particular approach to therapy.

Reality: Both within and outside of the person-centred field, many people do not realise the sheer scope of, and diversity within, this approach. At one end of the spectrum, for instance, are those ‘classical client-centred therapists’ who put great emphasis on not directing the client in any way; whilst there are others who put much more emphasis on entering into a dialogue with the client, and acknowledging that the client may be influenced by the therapist (and vice versa) in numerous ways. Then there are those in the closely related field of the ‘process-experiential therapies’, who will actively invite their clients to process their experiences in particular ways (whilst not attempting to direct the content of those experiences). There are also arts-based approaches to person-centred therapy, the aforementioned person-centred approaches to working with ‘contact-impaired’ clients, and approaches which are fundamentally integrative/pluralistic in nature. In fact, these days, many people talk about the ‘family’ of person-centred and experiential therapies, or of the different ‘tribes’ of person-centred therapy, to highlight the diversity of ideas and practices within this field (for a great introduction to the many different tribes, see here).

 

Myth: Person-centred therapists mustn’t ask questions.

Reality: Most person-centred therapists are keen for their clients to take a lead in the therapeutic work, and, for this reason, they will avoid bombarding them with questions. But there are no ‘mustn’t’s, ‘must’s, ‘don’t’s or ‘should’s about person-centred practice, because person-centred therapy is not about behaving in a particular way with clients, but about being a particular type of person with another human being. So, for instance, in attempting to establish an empathic understanding of a client, a person-centred therapist may ask them a question; or they may ask them a question as an expression of their interest in that client’s experiences.

 

Myth: It’s not person-centred to challenge clients.

Reality: Person-centred therapists are careful to avoid criticising clients and undermining their sense of self-worth, but it can also be one of the most challenging and direct forms of therapy. In being congruent with a client, for instance, a person-centred therapist may really let that client know how hurt or angry he or she feels towards him or her; or, in being unconditionally accepting of a client, a person-centred therapist may really challenge a client’s feelings of low self worth.

 

Myth: Being a person-centred therapist means having to like your clients and everything that they do.

Reality: At the heart of a person-centred approach to therapy is the distinction between what a person experiences and the way in which they behave. So, whilst a person-centred therapist would want to unconditionally value everything that their client experiences—whether it’s love, jealousy or rage—this doesn’t mean that they would unconditionally value every way in which their clients behave. If a client physically threatened another person, for instance, a person-centred therapist might experience feelings of annoyance or anger, and might well communicate to their client that they were doing so. What they would also try and do, though, is to communicate to that client that they also valued the feelings and experiences that underlay those behaviours, and their belief that the client had the potentiality to find more constructive ways of expressing these feelings.

[image, Kendl123, Creative Commons Attribution-Share Alike 3.0 Unported license]

Is Person-Centred Therapy Effective? The Facts

Are you sick and tired of people telling you that ‘person-centred therapy doesn’t work’? Does your manager try and convince you that there’s no evidence for the approach? Would you like to scream at the next person who tells you person centred therapy is ‘just the basics’ and that ‘everyone does it all anyway’? If so, here’s ten facts about the evidence base for person-centred therapy that might just keep you sane… and everyone else that better bit informed.

  1. Humanistic and experiential therapies, of which person-centred approaches form a substantial part, bring about large and significant reductions in psychological distress (see Elliott et al.’s 2021 comprehensive meta-analysis for the definitive review).

  2. The effects of humanistic and experiential therapies, overall, tend to be similar to other therapies, including CBT. This is particular true when the allegiance of the researchers is taken into account (see Elliott et al., 2021). However, a major recent study did find that, 12 months after assessment, person-centred experiential counselling for depression had slightly poorer outcomes than CBT (see here). There is also some evidence that non-directive therapy may be a little less effective than other therapies for depression (see here). Overall, what the research shows is that the more active, process-guiding forms of person-centred therapy are as effective as other therapies, but a strictly non-directive approach may be marginally less effective than most.

  3. Studies which compare the outcomes of person-centred therapy in real world settings (e.g., IAPT) show that these are very similar to CBT and, indeed, may be achieved in a shorter period of time (see Pybis et al., 2017).

  4. There’s no consistent evidence that CBT or psychodynamic therapies have longer lasting effects than person-centred therapy, or that they ‘work’ more quickly. Indeed, in the recent major study (see #1), person-centred therapy actually seemed to act more quickly.

  5. It’s the dodo bird, stupid (though maybe don’t say the ‘stupid’ bit to your manager!). Again and again, what the research tends to show is that ‘everyone has won and all must have prizes’—all therapies, overall, do about as well as each other.

  6. There is an overwhelming body of data to show that Rogers’s three ‘core conditions’—empathy, unconditional positive regard, and congruence—are all associated with positive outcomes (see Norcross and Lambert, 2019).

  7. Studies which ask clients what they found helpful in therapy (whether CBT, psychodynamic, or humanistic) show, again and again, that much of what they most value is relational qualities closely associated with a person-centred approach: e.g., therapist warmth, caring, and trustworthiness (see here for one very recent example).

  8. Consistent with person-centred theory, research shows that, by far, the largest contribution to therapeutic outcomes comes from clients: their levels of motivation, involvement, engagement. It’s clients that make therapy work, not therapists (see Bohart and Wade, 2013).

  9. Person-centred counselling with children, and with young people, also shows good outcomes, at a level generally consistent with other therapeutic orientations.

  10. Even if there are small differences in the overall effectiveness of different orientations, this doesn’t take into account the fact that different clients do better or worse in different therapies (and at different points in time). Research shows, for instance, that clients who are more independent, who deal with issues in a more ‘internal’ way, and who particularly want space to talk are likely to do very well in a person-centred approach (see my Facts are Friendly).

The bottom line… be proud of being a person-centred practitioner and all the evidence behind our approach. But be informed as well (see here for an overview of all the evidence). There’s every reason to challenge someone who belittles the evidence base for person-centred therapy, but you need to know your research and what it all means.

What do clients want from therapy (and is it what person-centred therapists might want them to want)?

In a research paper published today (see here for journal version, and here for author final version), we found that a majority of clients wanted a more directive approach to therapy. Our data shows, for instance, that over 70% of clients wanted their therapist to focus on specific goals in therapy, to give structure to the therapy, and to take the lead. Clients expressed a particularly strong preference for therapists to teach them skills to deal with their problems. By contrast, only around 15% of clients wanted a more non-directive approach.

What we also did in our paper was to compare these preferences against therapists’ preferences, themselves. Not surprisingly, perhaps, we found that counsellors and psychotherapists—mainly of a person-centred orientation—wanted a lot less direction. So if we’ve used our own preferences as a guide to what clients are likely to want, it may come as something of a shock to see that, in fact, clients tend to want a lot more structure and leading. But that’s what we found, in two pretty rigorous surveys, and it’s matched by previous findings in the field (see, for instance, here).

These findings may be pretty challenging to those of us, from person-centred, humanistic, and relational orientations, that tend to work in more non-directive and unstructured ways. It suggests that what clients want is sometimes (perhaps often) different from what we tend to offer.

We could try and dismiss these findings by arguing that what clients want is not necessarily what they need. And, indeed, there’s good evidence that people don’t always know what is best for themselves (see, for instance, here). Two problems though. First, the evidence shows that there is quite a good association between what clients say they want from therapy, and how well they end up doing in it (see, for instance, here). So clients’ explicitly-stated preferences do indicate, on average, what works better for them, and also the kind of therapy that they are more likely to stick with. Second, if we start saying that clients don’t really know what they need (and we do), then we’re moving dangerously close to an ‘expert-driven’ perspective which holds that, as therapists, we know what’s best for clients. Not a good place for person-centred therapists to find themselves at!

Maybe it’s a case that clients’ preferences change over time. That is, they start off wanting more therapist direction but, once they get into therapy, they get more used to taking control for themselves. That may also be true in certain instances; but our data suggests that, across therapy, clients’ preferences don’t change too much. Certainly, in my own experience of using a preference inventory, I’ve found that what clients want stay pretty consistent. That is, at the start of therapy, clients are often saying things like, ‘Mick, I’d like this therapy to be fairly task-oriented,’ and after a few sessions they are saying, ‘So come on, when are we going to start on tasks!’

Perhaps clients’ desires for goals, tasks, and CBT is a consequence of neoliberalism, with the promise of an easy fix around every corner: someone who can always sort you out. Maybe. But, in my experience, when clients are asked why they want direction they come out with pretty cogent rationales: for instance, ‘Goals give me a sense of what I can focus on,’ or ‘I’d like to see things from a different perspective.’ And it’s a bit patronising, too, to assume that, because clients may want things different from us, it’s because they’ve been socialised into ‘faulty’ ways of thinking. Again, if we’re coming from a person-centred perspective, and trusting in the client’s own wisdom, surely we should be valuing how they see things from the start.

Does this mean that clients don’t want empathy, or acceptance, or an intense relational encounter as well? Not at all. In fact, we didn’t even ask about those relational qualities because we figured that, for most clients, the choice between an ‘empathic’ or a ‘non-empathic’ relationship would just be a no brainer.

And does this research suggest we should all re-train as CBT therapists? No, of course not. For a start, there are clearly some clients who do want a less directive approach, or who have tried CBT and are now wanting something different.

More importantly, perhaps, I think that the kinds of qualities that clients are asking for are all things that can be incorporated into a person-centred, humanistic, or relational practice. What, I think, a lot of clients are saying is something like this, ‘I want a therapist who is going to be active, who is going to do things, who is going to “sit forward” rather than “sit back”’. It’s like what I’ve wanted when I’ve been for a massage. It may feel less painful if the masseur is soft and gentle, but what I really want is someone who is going to be digging their knuckles in, making things happen. Clients invest a lot in therapy—time, emotionally, and financially often—and I think what many of them are saying is, ‘I want you, as a therapist, to be really involved here. To do things. Not just to sit back and let me do all the work.’

So I do think these findings challenge some ways of being a person-centred, humanistic, or relational therapist (or psychoanalytic, for that matter). I think they challenge a fairly ‘passive’, non-involved, ‘neutral’ style—or one where the therapist sticks mainly just to reflecting the client, and doesn’t add too much beyond that. The limitations of such a style are also very evident from research we’ve done with young people, as well as findings from adult clients: that a passive, non-involved stance can really ‘freak’ some clients out. They want to feel that the therapist is a ‘real person’, with real thoughts and ideas. And if everything is just focused on them, it can feel very unnatural.

More than that, from a pluralistic person-centred stance, goals, structure, and skills training can all be part of our therapeutic work—if that’s what clients are wanting, we’re appropriately trained in it, and we’re happy to work in that way. So while we can’t ever be everything to every client, a pluralistic PCA always tries to put the needs and wants of the individual client before any rigidity or dogma of method. If a client wants it, and we can do it, and we can both see how it might be helpful, then why not!

One of the nice things about a pluralistic person-centred stance is also that we can be really open to whatever the research says, and not having to reinterpret it to fit our own needs and agendas. As Carl Rogers so beautifully puts it (and there’s a great book of this title :-) ):

…[T]he 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.

Finally, just to say, the whole point of this blog isn’t to argue that we should all, now, work in more active and directive ways with every client. From a pluralistic standpoint, different clients need different things at different points in time; so there’s undoubtedly some clients out there who really want—and need—us to be quieter and more sitting back. Rather, the point of this blog is to say that we should always try and stay open to each individual client, and not prefigure what they want or need. In fact, if I think about myself, I tend to prefer a therapeutic style that gives me lots and lots and lots of space. But then, I’m a therapist.

Person-centered therapy: A pluralistic perspective

Updated author final version of:

Cooper, M., & McLeod, J. (2011). Person-centered therapy: A pluralistic perspective. Person-Centered and Experiential Psychotherapies, 10(3), 210-223.

INTRODUCTION

Since the 1970s, the field of person-centered therapy has witnessed increasing differentiation (Lietaer, 1990), with the emergence of several distinctive “tribes” (Sanders, 2004; Warner, 2000). Some have questioned the legitimacy of certain members of this family (e.g., Brodley, 1990), but with an increasing emphasis on “inclusivity and the embracing of difference” within the PCE world (Sanders, 2007, p. 108), many now see this diversity as a positive quality to be prized (e.g., Cooper, O’Hara, Schmid, & Wyatt, 2007). From this standpoint, each of the members of the PCE family can be seen as drawing on, and developing, different elements of Rogers’ work. While those who identify with a “classical client-centered” standpoint, for instance, can be seen as orientating primarily around Rogers’ (1942) concept of nondirectivity (e.g., Bozarth, 1998; Brodley, 1990); emotion-focused/process-experiential therapists (e.g., Greenberg, Rice, & Elliott, 1993) can be understood as placing more stress on the affective experiences and processes that Rogers placed at the heart of the therapeutic enterprise (e.g., Rogers, 1959).

The aim of this paper is to introduce, and critically discuss, an alternative reading of what it means to be person-centered. This is one that is primarily rooted in the idiographic assumptions underlying the person-centered worldview: that each individual is distinct, and that the role of the therapist should be to facilitate the actualization of the client’s unique potential in the way that best suits the individual client.

PERSON-CENTERED VALUES: PRIZING THE UNIQUENESS OF HUMAN BEING AND BECOMING

Person-centered therapy, as with other humanistic and existential approaches, can be understood as a form of counseling and psychotherapy which puts particular emphasis on “conceptualizing, and engaging with people in a deeply valuing and respectful way” (Cooper, 2007, p. 11). As a consequence of this, a key element of person-centered thought is a rejection of psychological and psychotherapeutic systems which strive to reduce individual human experiences down to nomothetic, universal laws and mechanisms. Rather, there is an emphasis on viewing each human being “as a unique entity, unlike any other person who has existed or will exist” (Cain, 2002, p. 5). In other words, while person-centered theorists have argued that certain psychological features, such as the need for positive regard or conditions of worth (Rogers, 1959), are universal, there is a particular emphasis on the fact that each human being is distinctive, irreplaceable and inexchangeable. Levitt and Brodley (2005, p. 109), for instance, stated that client-centered therapy “is not centered on what a general client would or should be. It is not centered on a theory external to the client…. The focus of the therapist is entirely on understanding the client as an individual, in all his uniqueness, from moment to moment.”

In Rogers’s work, this idiographic emphasis is particularly evident in his assertion of the “fundamental predominance of the subjective” (Rogers, 1959, p. 191). Each individual, for Rogers (1951, p. 483), “exists in a continually changing world of experience of which he is the center”; and, given that this ever-changing phenomenological experiencing will be unique to the individual, the very essence of each human reality is distinct. Rogers’s (1942) idiographic emphasis is also evident in his critical stance toward diagnosis, preferring to view human beings as unique, individual organisms rather than as manifestations of trans-individual dysfunctional states.

This emphasis on the psychological irreducibility of each client, however, is not merely a theoretical assumption, but is rooted in a deep ethical commitment within the person-centered field to engaging with an Other in a profoundly honoring way. Here, the work of the French philosopher Emmanuel Levinas (1969, 2003) has been particularly influential (e.g., Cooper, 2009; Schmid, 2007; Worsley, 2006), with his emphasis on the “absolute difference” of the Other (Schmid, 2007, p. 39): that they are “infinitely transcendent,” “infinitely foreign,” “infinitely distant,” “irreducibly strange.” For Levinas, the Other always overflows and transcends a person’s idea of him or her, is impossible to reconcile to the Same, is always more than – and outstrips – the finite form that they may be afforded. From this standpoint, then, it is not just that each human being is unique, but that each human being is so unique that they can never be fully understood by an other: Their difference, at least to some extent, is transcendent. This is similar to Rogers’ (1951, p. 483) statement that the private world of the individual “can only be known, in any genuine or complete sense, to the individual himself.”

This idiographic emphasis within the person-centered approach is associated with a theory of psychotherapeutic change in which there is a particular emphasis on helping clients to actualize their distinctive potential and become their “own unique individual self” (Rogers, 1964, p. 130). Person-centered therapy (Rogers, 1957, 1959) aims to provide clients with a set of therapeutic conditions in which they can reconnect with their actual, individual experiences and valuing processes, moving away from a reliance on more external, “leveled down” (Heidegger, 1962) judgments and introjects.

An emphasis on the distinctiveness of each human being and their change processes also means that each individual’s needs and wants can be considered, at least to some extent, unique and unknowable. Bozarth (1998) wrote that the process of actualization – the motivational tendency underpinning all growth and development – “is always unique to the individual” (Bozarth, 1998, p. 29); and he described it as an “idiosyncratic” (Bozarth, 1998, p. 24) process that cannot be predicted (or determined) by another.

A commitment to supporting the actualization of the Other in their own, unique way also reflects a fundamental person-centered ethic of respect for the client’s autonomy (Keys & Proctor, 2007). Grant (2004) has argued that the basis for person-centered therapy lies in the ethic of “respecting the right of self determination of others” (Grant, 2004, pp. 158). Similarly, Cain (2002, p. 5) stated that “A fundamental value of humanistic therapists is their belief that people have the right, desire, and ability to determine what is best for them and how they will achieve it.” In Levinas’s (1969, p. 47) terms, this could be described as a fundamental ethical commitment to letting the Other be in all their Otherness: a “non-allergic reaction with alterity.”

TOWARD A PLURALISTIC PERSPECTIVE

At the heart of a person-centered approach, then, is an understanding that human beings may want and need different things, and that an individual’s distinctive wants and needs should be given precedence over any generalized theories that another holds about them. Extrapolated to the therapeutic process, this suggests that a basic person-centered assumption should be that clients are likely to want and need many different things from therapy – both things traditionally associated with PCE practice (such as empathic understanding responses) and things not (such as Socratic questioning) – and that any generic theories of change that we, as therapists, may hold, should be subordinate to the client’s specific needs and wants.

The hypothesis that different clients want different things from therapy is supported by empirical research (see Cooper & McLeod, 2011 for a review of the research). In a major trial (King, et al., 2000), for instance, primary care patients for whom a brief therapeutic intervention was indicated were given the option of choosing between nondirective counseling or cognitive-behavior therapy (CBT). Of those patients who specifically opted to choose one of these two therapies, around 40% chose the nondirective option, while 60% chose the CBT.

Of course, what clients believe they want is not, necessarily, what they need, nor what will necessarily be of greatest benefit to them. However, an emerging body of evidence indicates that different clients do, indeed, benefit from different types of therapeutic practices. While there is clear evidence, for instance, that most clients do best when levels of empathy are high (Bohart, Elliott, Greenberg, & Watson, 2002), there are some clients – individuals “who are highly sensitive, suspicious, poorly motivated” – who seem to do less well with highly empathic relationships (Bohart, et al., 2002, p. 100). There is also evidence that clients with high levels of resistance and with an internalizing coping style tend to do better in nondirective therapies, while those who are judged to be nondefensive and who have a predominantly externalizing coping style tend to benefit from more technique-orientated approaches (Beutler, Blatt, Alimohamed, Levy, & Angtuaco, 2006; Beutler, Engle, et al., 1991; Beutler, Machado, Engle, & Mohr, 1993; Beutler, Mohr, Grawe, Engle, & MacDonald, 1991).

Within the PCE field, this assumption – that different clients may benefit from different therapeutic practices (at different points in time) – has been articulated particularly well by Bohart and Tallman (1999). Process-experiential/emotion-focused therapists (e.g., Greenberg, et al., 1993) have also argued, and demonstrated, that particular therapeutic methods may be more or less helpful at particular moments in the therapy. In addition, from texts such as Keys’s (2003) Idiosyncratic Person-Centred Therapy and Worsley’s (2004) “Integrating with integrity,” it is evident that many person-centered therapists already incorporate a wide range of therapeutic methods into their work. Cain (2002, p. 44) wrote that one of the primary ways in which humanistic therapies have evolved is in their diversity and individualization in practice, and he went on to state that, ideally, humanistic therapists:

Constantly monitor whether what they are doing “fits,” especially whether their approach is compatible with their clients’ manner of framing their problems and their belief about how constructive change will occur. Although the focus of humanistic therapies is primarily on the relationship and processing of experience, they may use a variety of responses and methods to assist the client as long as they fit with the client’s needs and personal preferences.

In recent years, Cooper, McLeod, and colleagues have come to describe this standpoint, which prioritizes the therapist’s responsiveness to the client’s individual wants and needs, as a “pluralistic” one (Cooper & Dryden, 2016; Cooper & McLeod, 2007, 2011; McLeod, 2018). This is a stance which holds that “there is no, one best set of therapeutic methods,” and has been defined as the assumption that “different clients are likely to benefit from different therapeutic methods at different points in time, and that therapists should work collaboratively with clients to help them identify what they want from therapy and how they might achieve it” (2011, pp. 7–8). Cooper and McLeod’s pluralistic approach emerges from the person-centered values and practices discussed above, but it has been presented as a way of thinking about, and practicing, therapy which extends these values to the whole psychological therapies domain.

In terms of translating this general pluralistic stance into concrete therapeutic practice, Cooper and McLeod (2007, 2011) have emphasized two particular strategies. The first is to specifically orientate the therapeutic work around the client’s goals (or ‘directions’, Cooper, 2019), and the second is to develop the degree of negotiation, metacommunication, and collaboration in the therapeutic relationship.

CLIENTS’ GOALS AS AN ORIENTATING POINT FOR THERAPY

Cooper and McLeod (2007, 2011) have suggested that the goals that clients have for therapy can – and should – serve as an orientating point for thinking about, practicing, and evaluating therapeutic work. A client, for example, may want “to feel a sense of self-worth,” “to not experience anger and distrust toward my husband,” or “to be able to think about work without feeling stressed or panicky.” From a more classical person-centered standpoint, there is a risk that such a goal focus can lead to an overly mechanistic and ends-oriented approach to therapy, but there are several reasons why it is also highly consistent with a person-centered approach. First, it fits strongly with the concept of the client as active, meaning-orientated agent (Bohart & Tallman, 1999), who is engaged in constructing his or her life and relationships. Second, it privileges the client’s perspective – regarding what he or she want both in life and from therapy – over the therapist’s. Third, it moves away from a diagnostic, or even problem-centered, understanding of the client and the therapeutic process toward a potentiality-centered one – based around where the client wants to “go” in their lives. Finally, an orientation around the client’s goals may be the most explicit way of meeting, and responding to, the client as a self-determined, agentic subjectivity, who has the right to choose for him- or herself how he or she would like to pursue their own process of actualization. However, given that the term ‘goals’ can imply a more ends-oriented, cognitive emphasis, Cooper (2019) has suggested that the term ‘directions’ may be a more appropriate one: embracing embodied and unconscious, as well as cognitive and conscious, hopes, aspirations, and desires.

In order to help clients reach their goals, Cooper and McLeod (2007, 2011) have suggested that it may also be useful to think about the particular pathways by which these can be attained. Cooper and McLeod (2011, p. 12) refer to such possibilities as “tasks”: “The macro-level strategies by which clients can achieve their goals.” Examples of common tasks within therapy might include: “making sense of a specific problematic experience,” “changing behavior,” “negotiating a life transition or developmental crisis,” “dealing with difficult feelings and emotions,” and “undoing self-criticism and enhancing self-care.” Note, while process-experiential/emotion-focused therapists also refer to therapeutic “tasks” (e.g., Elliott, Watson, Goldman, & Greenberg, 2004), Cooper and McLeod use the term in a somewhat higher order sense: to refer to more general pathways or strategies. By contrast, the specific, micro-level concrete activities that clients and therapists undertake to complete these tasks are referred to as “methods,” such as “listening,” “participating in two-chair dialogue,” and “undertaking a guided visualization.” Cooper and McLeod also distinguish between the “therapist activities” that form one part of a therapeutic method and the “client activities.” Such a distinction may be useful when thinking about the kinds of therapeutic “methods” that clients may undertake outside of the immediate therapeutic relationship: for instance, reading self-help literature, exercising, or talking to friends and partners.

COLLABORATIVE ACTIVITY

This goal–task–method framework provides a means for therapists to think about what kind of therapeutic practices may be most helpful to a particular client. Of much more importance, however, is that it highlights three key domains in which collaborative activity can take place within the therapeutic relationship. For Cooper and McLeod (2007, 2011), such collaborative activity needs to be a key element of a pluralistically informed approach to therapy: maximizing the extent to which clients’ perspectives, wants and agencies can inform the therapeutic work. This activity has been described as metatherapeutic communication (Papayianni & Cooper, 2018), and it may be particularly appropriate in a first or early session of therapy: talking to clients about what they would like to get out of the therapeutic work, and how they feel that they might be able to get there. For example, a therapist might ask:

  • “Do you have a sense of what you want from our work together?”

  • “What do you hope to get out of therapy?”

  • “If you were to say just one word about what you wanted from this therapy, what would it be?”

  • “Do you have a sense of how I can help you get what you want?”

  • “What have you found helpful in previous episodes of therapy?”

  • “How would you like me to be in this therapeutic relationship: more challenging, more reflective?”

Although metatherapeutic communication is primarily orientated toward clarifying the client’s perspective, it by no means requires the therapist to ignore his or her own views and experience. Rather, the emphasis is on a dialogue between both members of the therapeutic dyad (Cooper & Spinelli, in press), in which therapist and client draw on their particular bodies of knowledge and expertise. Hence, the goals, tasks and methods of therapy emerge through a collaborative, negotiated dialogue; and may continue to be changed as the therapy unfolds.

An example of dialogue and metatherapeutic communication around a client’s goals for therapy comes from Mick’s work with a young man, Alex (details of clients have been changed to preserve anonymity). Alex was from a working class background, and had recently chosen to leave college feeling that he could no longer cope with his feelings of anxiety and depression. Alex began the session talking about his current difficulties, and the physical abuse he had experienced from his mother as a child.

Alex:    Obviously the fact that it was my mum that I got the abuse from makes it a lot harder. Because I kind of feel that people look at me a little bit – There’s always this sense of attack.

Mick:   There’s an underlying sense of attack from people.

Alex:    It’s kind of paranoid in a way. It kind of annoys me that I’m still doing it, but it doesn’t make any difference. It doesn’t stop. It’s not even getting gradually better now that I’ve realized – everything’s just exactly the same, but … more frustrating because I know that it’s going to take time, but I feel that I’m kind of at a standstill, and don’t know really where to go ….

At this point, Mick invited Alex to try and specify more clearly where he would like therapy to take him to with this difficulty.  

Mick:   So, if we were to, kind of, think about specific things that you’d want from the counseling, it sounds like one of the things would be around – what would it be? Would it be about not wanting to experience people as so critical or … How would you phrase some of the things that you’d want? So – where – like in 15 or 20 sessions, where would you like to be at the end of it, in contrast to now?

Alex:    I suppose I’d like to improve my personal relationships, in the sense that I have more self-worth. Because … mm … in arguments and upsets … I value myself a lot less than I should. I just let people get their own way, just because it makes things easier …. I take a lot of hits from other people.

Mick:   So there is something about wanting to feel more of a sense of self-worth?

Alex:    Yeah, in that I can make these objections and that my feelings are equal to the other persons.

Mick:   So something about being able to feel that my opinions and what I want is valid, and not put other people’s first.

Alex:    Yeah.

These goals, as identified by Alex, then served as an orientating point to the ongoing therapeutic work.

A second example of this dialogical process, with respect to collaboration around therapeutic methods, comes from McLeod’s work with a young male client, Haruki.

During one of the early sessions that focused on the task of dealing with his panic feelings, John and Haruki talked together about the various ways that Haruki thought that it might be possible for them to address this issue. John wrote down the ideas that emerged, on a flipchart. Haruki began by saying that the only thing that came to mind for him was that he believed that he needed to learn to relax. John then asked him if there were any other situations that were similar to performing in seminars, but which he was able to handle more easily. He could not immediately identify any scenario of this type, but later in the session he returned to this question, and told John that he remembered that he always took the penalties for his school soccer team, and dealt with his anxieties by running through in his mind some advice that he had received from his grandfather, about following a fixed routine. John then asked him if he would like to hear some of John’s suggestions about dealing with panic. John emphasized that these were only suggestions, and that it was fine for him to reject them if they did not seem useful. John mentioned three possibilities. One was to look at a model of panic, as a way of understanding the process of losing emotional control. The second was to use a two-chair method to explore what was going on in his mind, in terms of what he was internally saying to himself at panic moments. The third was to read a self-help booklet on overcoming panic. (Cooper & McLeod, 2011, p. 93)

From a person-centered standpoint, one counterargument to this call for greater metahtherapeutic communication (as mentioned above) might be that what clients want in therapy – or what they believe themselves to want – is not necessarily what they need. Clients may have introjected, for instance, certain beliefs about what will be most helpful to them (such as external advice or suppression of emotions), and this may run counter to their actual organismic valuing (Rogers, 1959). As indicated above, however, metatherapeutic communication does not simply involve doing whatever the client wants; if the therapist has a different view of what might be helpful, this is something that can be brought into the dialogue. Having said that, any therapeutic approach which claims to be client-centered needs to be very careful not to dismiss, minimize, or override a client’s own views of what it is they want. Moreover, research suggests that clients who get the therapeutic interventions that they want do tend to experience more benefit, and are much less likely to drop out, than those who do not (Swift, Callahan, Cooper, & Parkin, 2018).

A second counterargument to this call for greater metacommunication may be that it overemphasizes verbal and conscious communication processes in the therapeutic relationship, and overlooks the value of more subtle, nonconscious, and intuitive understandings: such as the therapist’s felt-sense of what the client needs, or their embodied empathic understanding (Cooper, 2001). However, research tends to suggest that therapists, in fact, are generally not that good at accurately intuiting what their clients really want or are experiencing (see Cooper, 2008, p. 2). Moreover, a substantial body of research on “client deference” indicates that clients are often very wary of communicating to their therapists what it is that they really want or need (Rennie, 1994) – including to person-centered therapists – and will often hide things from their counselors or psychotherapists (Hill, Thompson, Cogar, & Denman, 1993). Hence, although overt, explicit communication may not be the only channel through which therapists can develop a greater understanding of their clients’ actual wants and needs, empirical research suggests that this is one mode of communication that many therapists could utilize more fully.

Indeed, given the difficulties that clients may have directly expressing their goals, wants, and preferences to their therapists, pluralistic therapists have suggested a range of tools and measures that therapists may want to incorporate into the therapeutic process. For instance, the Cooper-Norcross Inventory of Preferences (Cooper & Norcross, 2016) invites clients to indicate on a range of dimension how they might like their therapist to be: such as, “Be more challenging – Be more gentle,” and “Focus more on my feelings – Focus more on my thoughts and cognitions,” (download from here). Another tool that has been developed is the Goals Form (download from here) where clients’ goals for therapy can be jotted down in an early session (and revised if necessary), and then rated every week on a 1 (Not at all achieved) to 7 (Completely achieved) scale. For Alex (discussed above), for instance, three of his identified goals were to “Feel a sense of self-worth,” “Feel that my opinions and wants are valid in relationships,” and “Not interpreting what others say and do in critical way.” At assessment, the average rating across these three items was 1.33 (i.e., very close to “Not at all achieved”) and, by session five, had increased to 3.

IMPLICATIONS FOR ESTABLISHED PERSON-CENTERED AND EXPERIENTIAL THERAPIES

A pluralistic reading of person-centered therapy does not, in any way, challenge the value or legitimacy of other perspectives and practices within the PCE field. Nor does it call on all PCE therapists to be more integrative in their work. Cooper and McLeod (2011) make a clear distinction between pluralism as a perspective on psychotherapy and counseling, and pluralism as a particular form of therapeutic practice. Hence, a therapist who offers classically orientated client-centered therapy could still subscribe to a pluralistic viewpoint: believing that there are many different ways of helping clients, even though they choose to specialize in just one. More specifically, it may be useful to think about a pluralistic approach as residing on a spectrum: from a simple acknowledgment of the value of different therapeutic methods; to an enhanced use of goal orientation, metacommunication and negotiation in the therapeutic work; to a therapeutic practice that draws on methods from a wide range of orientations.

Even at a most minimal level, however, what a pluralistic perspective does offer is a challenge to the assumption that any one person-centered perspective, method or set of hypotheses holds some kind of “metanarrative” status (Lyotard, 1984): that it is true, or superior, for all people at all times. More than that, it challenges “dogmatic person-centeredness” (Worsley, 2001, p. 25): the belief that person-centered and experiential theories or methods are in some, generic way superior to other therapeutic practices and understandings. Rather, it invites members of the person-centered community to hold our person-centered theories and practices “lightly,” and to be open to challenges and different viewpoints from both within, and outside of, the person-centered field. At this level, it invites us to be “person-centered” about person-centered therapy: nondefensive, open to a range of experiences, and willing to be “in process” rather than holding a fixed and rigid concept of self (Rogers, 1961).

A pluralistic perspective also invites PCE therapists to be more explicit about the particular ways in which our therapies may be able to help people; and the kinds of clients and contexts for which they may be most likely to be helpful. Person-centered and experiential therapists, for instance, might find it useful to undertake a “personal audit,” looking at the kinds of goals they feel most able to help clients to achieve, and the particular methods they would have for getting them there. This is something that might then be made clearer to clients prior to starting therapy, such that clients are more enabled to decide whether or not a PCE therapy is right for them. Further empirical research would be particularly helpful in this regard. For instance, we already know that clients with high levels of reactivity tend to be more likely to benefit from nondirective methods than clients with low levels of reactivity, but are there other groups of clients, or problems, or goals for which PCE methods or a PCE attitudinal stance may often be of greatest help?

Finally, for those interested in moving toward a more pluralistic practice, the pluralistic strategies outlined by Cooper and McLeod (2011) may help PCE practitioners to enhance their work through greater dialogue around the goals, tasks, and methods of therapy. And for PCE practitioners who are interested in incorporating other methods into their work, it provides a framework in which this can be achieved in a coherent and client-centered way.

DISCUSSION

Our hope is that the articulation of a pluralistic understanding of what it means to be person-centered will bring something fresh and vibrant to the person-centered field, even if it primarily involves the explication of something that has always been implicit. First, a pluralistic perspective offers PCE therapists a means of resolving the tension between commitment and antidogmatism (Hutterer, 1993). It provides a conceptual framework in which PCE therapists can feel proud of the work that they do and can develop and deepen this specialism, while at the same time avoiding a judgmental attitude toward other therapeutic orientations. More than this, it has the opportunity to give PCE therapists a unique identity in the therapeutic field: as champions of inclusivity and mutual respect across therapies. Second, closely related to this, it facilitates the building of bridges with other progressive, client-orientated approaches, such as the “client-directed” practices of Duncan, Hubble, Sparks and colleagues (2004) and the work of many postmodern-informed family therapists (see Sundet, 2011). Third, a pluralistic perspective on therapy provides a means of conceptualizing, not just processes within the counseling and psychotherapeutic domain, but the whole range of personal development activities. In this way, a pluralistic perspective can help the person-centered and humanistic field move away from an exclusive focus on how professional therapists “bring about” change in clients, and toward a more client-orientated and client-agentic stance (Bohart & Tallman, 1999). Fourth, a pluralistic viewpoint provides a means by which person-centered practices can be more fully opened up to new and emerging research – as well as new theories and ideas – such that it can remain a growing and actualizing field. Closely linked to that, it provides a framework for researching and thinking about the complex question of how therapists can most constructively engage with our clients’ individual wants and needs. Finally, for some person-centered practitioners, the development of a pluralistic practice may allow them to grown more fully as therapists. It provides a highly flexible model of practice in which therapists can incorporate, and advance, whatever potentialities, strengths and resources they have. If, as Rogers’ (1961, p. 158) suggested, the fully functioning person is not rigid in their constructs, but an “integrated process of changingness,” then a pluralistic form of practice may offer some PCE practitioners a means of moving to a more fluid and creative actualization of their full potentialities.

In summary, from a pluralistic perspective, to be person-centered means to be someone who acknowledges the vast diversity and unknowability of human being, and who prizes the unique needs and wants of each individual client. It means to be someone who puts their clients wants for therapy before their own assumptions about what those wants might be, and who strives to be responsive within the limits of their own training, expertise and interest. For some person-centered therapists, it may also mean drawing on a variety of therapeutic methods from both PCE and non-PCE sources. Whether or not a therapist practices pluralistically, however, a pluralistic person-centered standpoint means an acknowledgment and prizing of the many different ways in which non-PCE therapies can be of value to clients; while also a recognition of the power and depth of the established PCE approaches.

FAQs (2019)

Isn’t pluralism just what a lot of people do anyway? Yes, absolutely, and so we’re not suggesting a new model of practice. But putting words and terms to what we do may help us develop, research, and more deeply understand that way of working.

What’s the difference between ‘pluralism’ and ‘integration’? Two main things. First, from a pluralistic standpoint we put a particularly strong emphasis on the collaborative relationship between therapist and client—metatherapeutic communication—which is there in many integrative forms of therapy but is not implicit to integration per se. For instance, you could have an integrative approach that is very strongly therapist-led. Second, pluralism is proposed as a framework and set of values, as well as a particular form of practice, whereas integration does refer to a particular practice. So you could say, for instance, ‘I practice person-centred therapy from within a pluralistic standpoint,’ but it wouldn’t make sense to say ‘I practice person-centred therapy from within an integrative standpoint.’

But Rogers talks about being flexible with, and responsive to, clients. So how is pluralistic therapy any different? If person-centred therapy is practiced in a genuinely flexible way, where we’re responding to what clients want and need with all of our skills and expertise, then the differences may well be very limited. But pluralism means respecting the wide diversity of methods that may be very helpful to clients—above and beyond empathy, acceptance, and congruence—such as psychoeducation, skills training, and interpretations. Some person-centred therapists, no doubt, do incorporate such methods into their work (with appropriate training and experience) and if that’s in response to client need, then that’s absolutely pluralistic.

Surely a therapist can’t know every different method going. Absolutely, and pluralism is not about being able to give everything to everyone. It’s about recognising what we can and cannot do and being flexible within that.

Isn’t there a danger that the pluralistic therapist ends up just being a chameleon and inauthentic: a different person to each client? That’s certainly a risk, and one of the challenges of pluralism is to try and meet, as well as possible, the client’s wants and needs, while staying true to one’s own self, knowledge, and expertise. So the first step in pluralism is for the therapist to be really aware of what they can, and cannot, offer to a client—where their boundaries are—so they know what they’re able, and willing, to offer. Remember that shared decision-making is not simply a ‘patient choice’ model, whereby the therapist hands over all responsibility to the client. Rather, it’s a dialogical approach that sits midway between paternalistic and ‘patient choice’ approaches to healthcare.

How can you just combine therapies with fundamentally different theoretical assumptions about the person: like person-centred therapy and CBT? Research shows that the differences here are often much more ‘real’ to therapists than clients. If you look at the research on what clients find unhelpful, they rarely say things like, ‘The therapist combined too many approaches,’ or, ‘Their epistemological assumptions just didn’t match their ontologies.’ Clients, in general, are much more interested in real, practical solutions to their problems, and often appreciate a therapist who is willing to draw on whatever skills and knowledge they have to help that as much as possible.

So does pluralism actually have any consistent, underlying philosophy? Yes. Pluralism, itself, is an underlying philosophical framework, see for instance the work of Isaiah Berlin or Nicholas Rescher. Importantly, we can distinguish between a ‘foundational pluralism’, which is akin to relativism, and a more moderate ‘normative pluralism’, which is underpinned by a unified set of values. What are those? More than anything else, pluralism means an ethics of ‘welcoming otherness’: a commitment to being open, appreciative, and respectful of difference. In that sense, as with Levinas, it puts ethics as ‘first philosophy’: that how we treat others is the most fundamental issue, and a starting point for philosophical questioning that precedes ontology, epistemology, or other philosophical concerns.

What about clients who don’t know what they want from therapy, or what they’d prefer? Something that’s increasingly clear from our research is that clients do, indeed, differ very much in how much they know about therapy, and how clear they are about their own goals or preferences. So a pluralistic approach to therapy doesn’t just mean ‘handing the ball’ to the client and expecting them to do all the work. It’s a dialogical approach, where both therapist and client bring together their understanding and respective expertises to work out what is best for the client.

From a person-centred perspective, the person has the answers within them—their inner growth tendency—so why should they need more from the therapist than contact, empathy, UPR, and congruence? Theoretically, that’s where a pluralistic approach would differ from a purely person-centred approach. Pluralistically, the sources of potential healing are plural. So they definitely might come from ‘within’ the person, but also from ‘without’: books, learning, other people, pets… Rogers developed his ideas as a much needed counterbalance to the behaviourism of his time, which focused solely on external learning. But, taken in isolation, person-centred theory may veer too far the other way, and forget that external learning can be a crucial source of growth too.

Can’t pluralistic therapy end up being a ‘school’ of therapy in itself, with its own dogma, certainty, and closed-mindedness? Yes, that’s absolutely a risk, and one that we’ve tried to be mindful of from the start. So we’ve always advocated holding pluralism lightly, and in a self-critical and reflexive way. And if you look at our literature and research, you can, hopefully, see how the approach has grown and evolved as we’ve seen that some things work better than others. For instance, my latest work on directionality emerged in response to criticisms about ‘goals’ and the somewhat mechanistic, ends-oriented nature of that concept.

Where can I find out more information about pluralism in therapy? A good starting point is the Pluralistic Practice Network website. You can also find some resources and papers on the pluralistic therapy training page on this site.

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Carl Rogers's 'core conditions': Are they necessary and sufficient?

It’s the essay title just about every person-centred student has to address at some point in their training: Was Rogers right to claim, as he does in his classic 1957 paper, that the therapist’s (a) congruence, (b) unconditional positive regard, and (c) empathic understanding are necessary and sufficient conditions for therapeutic personality change to occur (along with (d) therapist—client contact, (e) client vulnerability, and (f) the therapist’s communication of these conditions)? Rogers’s hypotheses were based on the available research of his time, and were an amazingly insightful and succinct reading of it. But over 60 years have elapsed since Rogers put forward his position: Does it still stand up to the evidence?

Let’s start with 'necessary’. That means that those first three ‘therapist-provided’ conditions (along with the three ‘relationship’ and ‘client’ conditions) needs to be there for therapeutic personality change to occur. Here, the research suggests a resounding ‘no’. The problem is, it’s evident that therapeutic personality change can happen through a variety of mechanisms where there really isn’t much of a relationship at all. For instance, James Pennebaker has shown that writing about emotional experiences (as with keeping a diary) can be a profoundly therapeutic experience; and there is good evidence that online therapies can be as helpful as face-to-face therapies, often with minimal interpersonal contact. Have you ever watched a film that has had a profound effect on you, or read a book that has moved you to see life in a really different way? If so, it’s really not possible to claim that any kind of relationship factors are necessary conditions for therapeutic personality change.

What about ‘sufficient’? Well, yes, the very latest research does show that each of Rogers’s core conditions are associated with positive therapeutic change. But it’s not necessarily the case from that that they are causing the change. It may be, for instance, that clients who improve then start to feel that their therapists are more accepting and empathic. I know, for instance, that if my doctor gives me some good news, I tend to like them more. And what the evidence also shows is that Rogers’s core conditions are just three of many different relationship factors that are associated with positive outcomes. For instance, alignment on the goals of therapy also seems to be important, and then there’s the therapist’s capacity to deal with ruptures in the alliance, and the use of systematic client feedback. All of these factors are closely related to Rogers’s conditions, but it suggests that the ones Rogers identified don’t have some kind of ‘magical significance’: they’re three factors amongst a sea of inter-related relational variables that all, together, are associated with positive outcomes. Add to that is the problem that, for different clients, Rogers’s therapist-provided conditions may be more or less helpful. For instance, research into empathy shows that, for some clients—highly sensitive, suspicious, and poorly motivated—very high levels of empathy may be counter-productive. Certainly, some clients can feel that a therapist is just too positive, or too in their shoes, or too present and full on. And, finally, there’s some very good evidence, both quantitative and qualitative, that clients can really value, and benefit from, ‘non-relational’ interventions, like normalisation through therapist’s expert knowledge, or ‘behavioural activation’. Maybe the relational elements of these therapeutic encounters are sufficient to bring about some degree of change, but to just focus on that would be to ignore what some clients, themselves, are saying matters most.

The problem with Rogers’s hypothesis is that, in many ways, they’re not very ‘Rogerian’: in the sense that they assume everyone responds in the same way, without taking into account individual differences. When you say things are ‘necessary and sufficient’, the inference is that this is going to be true for us all, and that doesn’t allow for people to respond to therapies in different ways. That’s why John McLeod and I have been arguing that one way of really embodying person-centred principles is through a pluralistic approach to therapy: acknowledging the many different ways in which clients can be helped and the individual differences in what works for each of us (see blog on Person-centred therapy: A pluralistic perspective). I’m sure that Rogers, like most of us in the person-centred field, would have wanted to respect those differences; and no doubt his ‘conditions’ were an attempt to speak the language of his times: scientistic, nomothetic (i.e., universal), and absolute. In fact, I remember reading somewhere that he does acknowledge that it probably wasn’t the best way of phrasing things. If he’d said something like ‘congruence, empathy, and unconditional positive regard are incredibly important elements of therapy for many people, much of the time’, he’d have been absolutely spot on. It’s a bit less snappy, but 60 years later he would have still been absolutely spot on with what the evidence is telling us, and that’s an amazing thing.

So what would Rogers say now. Reading the evidence, very closely as he did, I’d like to think he’d say something like the following:

What we know is that the quality of the therapeutic relationship is one of the best predictors of outcomes; and a growing body of research is beginning to show that it does, indeed, have the capacity to bring about positive change. For lots of clients, having a good quality therapeutic relationship—empathic, trustworthy, and caring, for instance—can have an enormous impact, just in itself; and for others, it can be an essential vehicle through which other change processes can happen. However, different clients need different things: and it may be that some clients need more: more psychoeducation, or more challenge, or more interpretation. Different people are different. So nothing is necessary and sufficient for everyone. But if you want to practice therapy in a safe and effective way, then establishing an empathic, honest, and unconditionally accepting relationship is, for most clients, one of the best things that you can do.

If people have a natural tendency to 'actualise' their potential, how is it we get so f...ed up?

It’s the quandary that just about every trainee on person-centred or humanistic courses asks (or, at least, thinks) on the first day of their training program… If human beings have a natural tendency towards self-healing, if they know what’s best for them, if they have an ‘organismic valuing potential’—why is it that we can end up in such messes in our lives?

An immediate answer might be that we have this natural tendency towards actualisation and growth, but it gets suppressed by the world and others around us. The problem with that, though, is that if we’re such actualising beings, why is it that that tendency so weak? Why does it just give up the ghost the moment it gets challenged? Not much of an actualising tendency!

Based on the work I’ve been doing for my new book: ‘Integrating counselling and psychotherapy: Directionality, synergy, and social change’ (Sage, Feb 2019), here’s three inter-related answers that, for me at least, can help to resolve this quandary.

First, we might know and feel what we want and what’s best for us, but we don’t always know how best to get there. I know, for instance, that I want to be close to my friends, or that I want to feel calmer in my life—and that’s my internal, organismic sense of what’s best for me—but that doesn’t mean that I’ll always have the skills or tools to make that happen. With the best will in the world, sometimes we just haven’t learnt the best ways of doing things (I still haven’t learnt how to change a car tyre), or we’ve learnt ways of doing things that might have worked in the past, but don’t work in our present circumstances. Maybe I learnt as a boy, for instance, that the best way to make friends was to act cool and distant because people respected me that way, but as an adult what that actually does is just keep people away. And, of course, people who have been traumatised and deeply hurt in the past learn that, to keep themselves safe, they may need to do things like avoid relationships and intimacy altogether. That’s exactly what they might have needed to get through life as a kid, but as an adult, when the world is different, it’s now become a barrier to closeness. So although we can say that people are always striving to do their best, doing our best isn’t always the best thing that we could be doing. Sometimes we need to learn better ways towards getting the things that we really want and need in life: and that’s something that therapy can be great for. We start with working out what we really want—self-worth, relatedness, autonomy, safety, etc—and work back from there to think about how we might get it more effectively.

Second, sometimes the things that we want are pulling us in opposite directions, so that the more we actualise one potential in our lives, the more we can end up actually getting less of something else that is really important to us. For instance, we really want to make the most of every moment in our lives. We want to be always doing things and being active and engaging with the world around us; but then that takes us away from actualising our potential to have a calm, relaxed, and relatively sane existence. And, of course, the basic tension at the heart of person-centred theory can be understood in this way: that we really want people to like and value us, but the problem is, the more we strive for that, the more we end up doing things that don’t suit other parts of ourselves: for instance, our desire for creativity or freedom or being unique. Again, that’s where therapy can be really helpful because it can give us a chance to weigh up these different wants, and also to find ways of living our lives more ‘synergetically’: that is, getting more of what we most deeply want more of the time. For instance, if the problem is that we want to be really creative, but the people around us are judgey’ about that, then maybe we can come to see that we need different people around us in our lives so that we can get creativity and relatedness at the same time: they don’t need to pull in opposite ways.

And that brings us to the third possibility: that some times the world around us makes it really difficult for us to get to the places that we know and feel, deep down, we really want to get to. An asylum seeker, for instance, wants safety in her life, and to feel self-respect, but living in the midst of a racist social context makes it really difficult for her to get that. And note here, it’s not that her actualising tendency gets squashed or suppressed or goes away, it’s that, with the best will in the world, she can’t get to where she wants to be because her world is standing in her way. In fact, when we look at both of the two other answers above, they’re also very much about a person’s social context. So, for instance, we don’t learn from the world about how best to actualise our most important directions; or the world creates conditions for us (like judgemental friends) that means the actualisation of one direction means the undermining of another. Here, therapy can help us think about how we change our world; but, as in the case of the asylum-seeker above, it sometimes needs more than that. If the problems are obstacles in the world, it needs real social and political change—equality, social justice, ending racism, etc—to help more people get more of what they deeply want more of the time.

So, for me, it makes really good sense to say that people know, deep down, what they want in their lives, and what’s good for them. No-one can tell me that what I really need in my life is closeness, or becoming a writer, or caring for others. I know, ‘inside’, what works best for me, what feels right. But when it comes to me trying to actually achieve that, things can get a lot more complicated, and however much I might try and do my best, I’m not always, necessarily, doing the best thing that I could be doing. Sometimes, for the world I inhabit, it’s not always the most effective way, or the most synergetic way—and that’s where therapy is great. But sometimes, however smart I am, the world just isn’t going to let me get to where I know I want to be: and then we might need to change that world, through personal or collective action. As human beings, we can be amazingly smart, but that doesn’t mean we always get it right all of the time. Recognising that things can be better—both at the individual and at the social level—is what gives us our incredible capacity to grow.