Client-centred Therapy

How's it best done?

I have been told that my approach is person, or client-centred. To some extent this has to be true in the sense that any effective therapist has to demonstrate respect and regard for the person in front of them.

That said, I am not convinced that I am person-centred in the traditional understanding of the ‘person-centred school’. This perspective can be tracked back to the work of Carl Rogers (assuming you do not want to travel back to the Greeks!). You can find a summary account of Rogers’ life and work at:

https://en.wikipedia.org/wiki/Carl_Rogers

The reason why I am reluctant to accept a person-centred label is that I may adopt an humanistic stance in my work, but that’s a rather broad term. Indeed, I raise doubts about the work of Maslow and others, on different pages.

I am less convinced about the contributions made by the core conditions that emerged from Rogers’ clear and incisive writing. When I say this, I am referring not only to his three core conditions that are well-known, but also the three less well publicised conditions laid down in his texts as:

My understanding of this summary illustration of the six conditions, in brief, is:

1. that a relationship between client and therapist must exist and that each person’s perception of the other is important.

2. that incongruence exists between the client’s experience and awareness. This is a normal human condition, but one that motivates clients to seek to change.

3. the therapist needs to be congruent within the therapeutic relationship. That means the therapist is not “acting”. They can draw on their own experiences to facilitate the relationship. Traditional therapies were doubtful about therapists’ sharing their own experiences so Rogers was breaking ground here in the mid-20th century.

4. the therapist accepts the client unconditionally, that is, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted by others.

5. the therapist seeks to experience an empathic understanding of the client’s inner world (or internal frame of reference, as it is termed). The therapist’s accurate empathy helps the client see the therapist’s unconditional regard for them.

6. The client perceives, at least to a minimal degree, that their therapist demonstrates unconditional positive regard and empathic understanding is present.

Why do I think is this? The six core conditions minimise the therapist’s knowledge and understanding.

A therapist needs to develop skills and use them

In my experience, clients do expect their therapists to use their skills and be active in using them. One such skill will be the judicious use of psycho-education. In my experience, clients do not expect knowledge and understanding to be withheld from them in the name of ‘unconditionality’, simply because they have not asked for it. It is difficult for any of us to ask for what we want when we do not know what to ask for!!

Furthermore, the six core conditions do not allow for any incongruence between the therapist’s experience and awareness. In my own view, this is not reasonable and can impair the working relationship.

A genuine therapist will experience small defeats, as well as small victories

In the ‘safe experimental’ method, a therapist will experience small defeats and small victories, as will the client. Each and every one needs to be identified and explored in therapy – between sessions and in the process of clinical supervision.

Why? It is not reasonable to expect clients to identify and use their own small defeats and small victories if I, as a therapist, am unwilling to do the same thing. It is not simply a question of setting a ‘good example’: it is demonstrating by example.

On one final point, I would say that self-regard in a client is increased not simply by gaining insights into their own current self-worth. They will also be enabled here when their therapist identifies how their own self-worth is distorted by self and others.

I am used to person-centred people saying these three issues I have listed are addressed by the condition of ‘congruence’ within the therapeutic relationship. This gives the impression that the therapist is given permission to speak their mind – discouraged to put on a professional veneer.

Would that this were so.

What I have observed, in training and in practice, is that modern therapists have swapped the ‘professional face’ of traditional therapists, with a reluctance to ask questions or to offer an opinion. This suggests a potential small, safe experiment provided by a therapist is frowned on for the most part. 

The truth be told: there is a time for “acting as if” when being a therapist. If a client appears to say something important, I can mark it with a verbal or a non-verbal response. The latter are often powerful but they require a conscious response from me – to a degree that is ‘acting’; that is, I am not responding from some notion of a ‘true self’. Some of what emerges from Neuro-Linguistic Programming (NLP) demonstrates there is an OK side to ‘act as if’.

In my view, over the years, the person-centred tradition lost the spirit of Rogers’ attitude, and his set of ethics. Training and trainers became wedded to the ideas behind the core conditions.

In time, ‘person-centredness’ became a defined quality and, in doing so, it lost its flexibility. It slid into a ‘school’ – a rather ossified institution – and one that rather assumed that ‘clients’ can benefit from the therapist’s ‘respect’ for the core conditions without limit of time.

In my own view, I trust most ‘clients’ will say that they permitted me to join them in an shared, negotiated journey – for only as long as that works for them – and with the intention, from the start, that our work will finish,

Further leads to consider

Models of therapy

Actions that might help therapy – not just sitting!

The scenic route ….

…. and its ‘parts’

When things go awry

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