Client-centred Therapy

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 client-centredness to 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 vague phrase. 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.

My understanding 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’s unconditional positive regard and empathic understanding is present.

These conditions have been labelled “necessary and sufficient” for effective therapy. For myself, I regard them as a global basis for working towards being an effective therapist – they are, indeed, necessary but the six conditions are not sufficient.

Why do I think is this? The six core conditions minimise the therapist’s knowledge and understanding. In my experience, clients do expect their therapists to have some skills and to be active in using them. They 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 if 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 the ‘safe experimental’ method, a therapist will experience small defeats and small victories, as will the client. All need to be identified, discussed and explored in therapy, between sessions and in the process of clinical supervision. Why? It is not reasonable to expect clients to undertake a process if I, as a therapist, am unwilling to do the same thing. It is not simply a question of settling 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 can swap the ‘professional face’ of traditional therapists with a reluctance to ask questions or to offer an opinion. Suggesting a potential small, safe experiment 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 ‘acting as if’.

In my view, over the years, the person-centred tradition lost the spirit of Rogers’ attitude or a 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.

In doing so, the school became less motivated to follow the client’s own journey. A person-centred therapist is likely to be enraged by this statement. I can appreciate that most therapists want to walk alongside a client on their journey into a changed future; one that is shaped by that client. It is easy to say those words, and even easier to stop demonstrating the difficult actions required to keep two people together, on the scenic route, negotiating a joint focus on the road ahead.

My own view is that the client’s map provides the best guide to the therapeutic territory.  I am collaborating with another to explore the landscape in front of the two of us. Even so, we are meeting several different views as we cross the terrain. This can be a ‘plus’; when either of us gets stuck along the way, we can join with the other to explore alternate routes and alter the path of the scenic route.

As Barry L. Duncan and Scott D. Miller (2000)  say in The Client’s Theory of Change: Consulting the Client in the Integrative Process:

“Historically, mental health discourse has relegated clients to playing nameless, faceless parts in therapeutic change. This is giving way. No longer interchangeable cardboard cut-outs, identified only by diagnosis or problem type, clients emerge as the true heroes and heroines of the therapeutic stage”

Personally, I’d dump the ‘hero’; if my clients and I are to share things, I’d rather not be a ‘hero’,  and it would help me if they did not adopt that role in our journey.

I can accept that respecting a “client’s theory of change is a proactive initiative“, as Duncan and Miller say, and I can see that effective therapy requires me to dismount any charging white stallion of theoretical purity and technical proficiency in order ‘to rescue the client needing my help’. The client’s voice can, instead, take editorial and directorial control of the action as it unfolds. T

hey can permit me to join them in an shared, negotiated journey for as long as that works for them.

Return to:

Welcome

What is a nudge?

How to design a nudge

What is helpful change?

A letter to anyone wanting to nudge themselves

Other ways to travel?