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Is rejection of the self at the heart of mental health issues? Is that why we are so scared to show who we are as people?

Answered 20 Jun 19

 

I would say its not so much a rejection of the self (because who can say what the self is? we don’t really sense it, do we? we look outward from it). I would argue that it is the frame of reference (world-map) of the self that is at the heart of things. The self is largely a reflection of the drives, instincts, preferences, temperament, values, attitudes, opinions, emotions and thoughts etc that comprise our frame of reference. This synthesis of the inner world and the sensational world is vulnerable to corruption by what we have not properly understood or accepted. To put it bluntly we can easily lie to ourselves, particularly under the influence of others. We start navigating life by the conditioned ‘shoulds’ and ‘oughts’ in our frame of reference. The self is a casualty in this process because we blame it, not the frame of reference. (This is the secret behind person-centred therapy: strengthening the agency of the self to the point where it feels able to question and rearrange its frame of reference, realigning the values structure). By contrast we are resilient and authentic when we are driven by two things only: a clear, organismic, sense of what we (not others) value, and a stable, non-defensive openness to the truth in its clearest/hardest form.

 

 

How important is goals setting in psychotherapy?

Answered 13 Jun 19

 

It’s not so important in person-centred psychotherapy, because this approach is phenomenological and non-directive. It works from the inside out: there is a confidence that the ongoing actualisation process is ‘self-righting’ if the conditions are right. There is a recognition that although the human is ‘exquisitely rational’, their frame of reference is potentially corruptible by values introjected from others. This is important because the priorities / goals of someone in psychological distress are not necessarily the ones that will help them most. A client entering therapy knows that they don’t see things clearly enough. They have lost faith in their ability to set goals. But they can still work with whatever seems most salient to them within their frame of reference. Psychotherapy therefore allows the client to question the assumptions and values behind their current tangle of problems and goals. So the only goals that really matter are those that the client sets for herself as a result of therapy.

 

 

What is the ultimate goal of therapy? How do psychotherapists know when treatment is successful?

Answered 01 June 19

 

With therapies that are based on the medical model (assessment/diagnosis/treatment) the process would end once the client emerges from whatever particular ‘sausage machine’ they have been subjected to, in order to eliminate the deficit in their mental health and return them to ‘normal’.

Alternatively, with therapies that are based on the growth model, there is no need for the therapist to think in terms of deficits and ‘success’. In its most radical form, the non-directive person-centred therapy, the therapist will know when therapy (we don’t ‘treat’) is successful because the client will tell them so. And it is only the client’s opinion that matters: no second-guessing by the therapist is required. The ‘goal’ in such therapy is to facilitate personal development, or growth, toward a more authentic / mindful / congruent (all the same thing) way of being. This is achieved by skilfully maintaining an environment in which the client can identify, contemplate, and let go of, various parasitic values that they have acquired from others, yet which are dissonant with their innate nature and temperament.

 

Is the outcome of a person-centered therapy much different from the outcome of journaling? I journal a lot but am seeing this type of therapist soon and I was just wondering.

 

Answered Jun 3

The outcome of person-centred therapy should be a more authentic you. This is pretty much the desired ultimate outcome of any type of therapy, although they will all use their own language.

Journaling is great, but there is something powerfully therapeutic about finding your own words to differentiate, symbolise and articulate those difficult aspects of your experiencing. This is a common truth for all therapies, even if the jargon might change: something difficult must be faced and understood, we must stop denying or distorting it. Journaling can really help, but it is still a form of talking to yourself. The words can become more internally consistent, but how well do they fit with reality? Once you feel that you make sense to another, and can be accepted by them, you will be able to move forward. Our sense of self is mediated by the presence of others, for better and for worse, much as a honeycomb cell will always be defined by those around it.

 

How do you know your therapist is not a charlatan?

Answered Jun 2

 

Because he’s person-centred.

Let me elaborate. Most complaints from clients involve accusations of poor listening, wrong diagnosis, and wrong treatment.

With person-centred therapy there is minimal risk of any of these complaints because the expert, the only possible charlatan, is the client. The therapist is there to help the client find their own understanding and their own solutions, so that any change is lasting. And the relationship in person-centred therapy is so close that the therapist will call the client a charlatan if this is how she feels he is coming across.

Maybe not the answer you expected. But if you want you own solutions, for the best long-term outcome, find the right therapist.

 

 

How do you fully open up in therapy when you struggle from people-pleasing? My therapist doesn’t have any expectations of me so I’m really lost on how to be me in front of her.

 

Answered 01 June 19

 

It all depends on whether your therapist is directive or non-directive. Most therapists are directive: they will assess you and then, on the basis of their assessment, they will treat you. This inevitably necessitates judgments and expectations on you. It cannot be any other way.

By contrast, a non-directive (person-centred) therapist would be encouraged by your situation, because in person-centred therapy the ‘locus of evaluation’ is with the client. In other words it is the client who decides what is important, and what to discuss. This is actually a good thing. You struggle with people-pleasing because your locus of evaluation has so often been with others. They have decided what is important, and you have been fitting in around them, rather than being ‘the star of your own movie’. This was easier for you than saying ‘no’ to them. It is not uncommon for new clients in person-centred therapy to say nothing at the start, sometimes for many sessions. Eventually they feel sufficiently accepted to be able to speak from their deepest self, without fear that the therapist’s judgment will require the adoption of a persona. Because they can speak from their deepest self the client can start to process their experience accordingly, supported by the empathic understanding of the therapist. They can begin to identify and acknowledge the various ‘conditions of worth’ that others have placed on them (e.g. “I don’t like you when you do that”…), and which have warped their personality in a way that is inconsistent with their innate nature. But it starts with that awkward silence.

 

 

As a therapist have you ever gotten really bored listening to a client?

Answered May 24

 

Yep, and I have told them so. They were grateful. But this is ok in the person-centred approach, where the therapist provides the therapeutic conditions for the client to process their experience. (In fact if the therapist did not let the client know how they are reacting they would not be doing their job). If the client starts going around in circles or over-intellectualising then this produces a response of being bored. Being transparent, genuine, congruent, open, mindful and authentic, the therapist can say so. The client understands, because they tend to know when they are avoiding / denying / distorting something important. As a result they are made more aware of the need to accept and acknowledge this difficult aspect of their being and to explore it further.

 

 

How is it that CBT is the most effective therapy even though CBT therapists don’t place much emphasis on the therapeutic alliance?

Updated May 20

 

It isn’t the most effective therapy! It is just the one with the best-funded research, because the medical and insurance people have got so excited about it.

For example, person-centred therapy has been shown by numerous meta-analyses to be broadly as effective as CBT, and more likely to lead to lasting change. Other leading approaches can say the same.

Aside from any concerns about quick-and-shallow, industrialised, ‘conveyor belt therapy’ or ‘cognitive bandaid therapy’, a lot of the encouraging results supporting CBT come from research populations with unrealistically ‘clean’ samples (e.g. the patients only have anxiety and absolutely nothing else). Hence it is not surprising that considerable improvement was easy to demonstrate. In reality the situation of the average patient is diagnostically complex and ambiguous. It is also very hard to compare ‘growth-based’ approaches (such as PCT) with diagnosis-driven, ‘deficit-based’ approaches, because randomized control samples cannot easily be used with growth-based approaches. And a lot of the CBT research making comparisons with other types of therapy did not actually use proper versions of the other therapies. There are many instances of the PCT being conducted by non-specialists(!) . Once the innate bias of the research teams is taken into account, the differences vanish.

Lastly, I wouldn’t say that CBT therapists don’t emphasise the therapeutic alliance, because this term is commonly used by directive therapists. As a non-directive / person-centred therapist, however, I would say that the ‘therapeutic relationship’ is not emphasised in directive therapies. No ‘alliance’ is required in PCT because of its phenomenological stance and its non-directivity.

I am of the opinion that different types of people need different types of therapy. CBT can often work fine for people who truly can be helped by learning to think better: “tell me what’s wrong and what to do about it”. (This wasn’t me: I attended 2 weeks of excellent quality CBT and was offended by how disinterested the process was in me, my situation, and my experiencing – I therefore do not regard CBT as a ‘talk therapy’). Many clients would prefer to explore themselves more deeply, reach their own conclusions and find their own solutions.

 

Can there be no transference in a therapeutic relationship? If so what would cause this?

Answered May 24

Transference is not a significantly relevant concept in person-centred therapy, because of the empathic, phenomenological, experiential, ‘non-expert’, and non-directive viewpoint adopted by the therapist. This point is seriously misunderstood by many therapists from directive orientations.

As one author has put it, ‘In person-centred terms, either transference may (sometimes) be part of an interaction but it would be counter-productive to work with it (because to do so would avoid the ‘here and now’ interactions and attribute the dynamic almost solely to the client’s process) or it is a psychoanalytic theoretical construct with no reality’ (Paul Wilkins, Person-centred Therapy – 100 Points and Techniques, 2015.) .

If transference is a reaction to how the therapist is coming across, then it should be minimised where the therapist is as transparent and persona-free as possible, as in person-centred therapy. The therapist is not in conversation with the client’s persona as such, but is empathising with the more existential part of the client’s self that is doing the processing. As such, transference phenomena only occur at relatively superficial levels of interaction, and are not present at the kinds of relational depth at which person-centred therapy operates. This being so, it is likely that any therapist who reacts to a transference phenomena risks doing so counterproductively – in a non-transparent, non-empathic way. If transference statements are universal then they will also exist in person-centred therapy but would be interpreted in a person-centred way. Person-centred therapists would use the term ‘empathic responding’ rather than ‘countertransference’.

 

 

Do men usually prefer a male or female psychologist/therapist to seek help with their marital issues?

Answered 19 May

 

Historically many men have often preferred female therapists, and male therapists have been an exotic minority. It often feels that it will be easier to open up to a female, but you might also want to ask yourself about the quality/nature of the empathy. Males and females are different beasts, after all. I would always advise anyone to pick the therapist they feel they can work most closely with.

Fortunately there are now more male therapists, and men are ever more willing to seek therapy.

Unfortunately… the world of therapy is heavily corrupted by neo-Marxist notions of identity politics and political correctness. There has been a long and shameful history of men in therapy being given the distinct impression that their female therapist regards them as some kind of oppressor – because this is the nonsense that is spoon-fed to trainee therapists. They will often bounce right out of therapy and refuse to consider it again. A similar phenomenon is in play with respect to male suicide: your misery is your fault for not being a modern male, as emotionally fluent as a woman, and happy to feel ever more marginalised in marriage, work, and life. (As if the men committing suicide are not the more sensitive ones!) . This creeping fashion for misandry reached a new level recently when the American Psychological Association issued guidelines for dealing with males, in which they effectively stated that masculinity is a disorder – a disease that is passed on socially through culture. I recently received, from the main professional body in the UK(!), a brochure of training courses that included one which was all about ‘the problem of masculinity’. I felt disgusted and appalled. This whole men-are-bad thing shows staggering levels of ignorance about human biology and history, and an appalling indifference to the good that men bring, and the crisis of meaninglessness that is driving so many men to suicide. I recall having tremendous difficulties trying to get a female therapist to see things from the male perspective. Sexual politics has poisoned many things, including therapy.

So, any client of either sex should be very careful about who they seek help from. There are plenty of excellent therapists out there, of either sex, and you can always ditch them if you don’t feel accepted.

 

 

Why is intuition often referred to as a “gut feeling” when it has nothing to do with the stomach itself?

Answered May 18

 

There is a lot of naive, folk wisdom in the idea of a ‘gut feeling’.

It is well-known that much of the brain is not in the head. Other contributors have rightly pointed this out. Much of the ‘lower order’, more conscious, ‘organismic’ aspects of our valuing process are to be felt in this area. It is no surprise that extreme anxiety feels a lot like poisoning – and yes, this definitely involves the stomach.

In the 1960’s the famous therapist Eugene Gendlin developed ways of working experientially with embodied correlates of thoughts and emotions that he called ‘felt sense’. This aspect of therapy, called ‘focussing’ built on the work by Carl Rogers in which it was noted that all psychopathology involves a disconnect between two valuing systems: the innate, organismic one (our temperament), which is wordless, and centred in the body, and the learned one (our personas), with all the conditioned ‘shoulds’ and ‘oughts’ that we have introjected from significant others and the surrounding culture. If the two valuing systems are well-aligned we find ourselves relaxed, clear-headed, talking smoothly and ‘from the gut’. If the two are not aligned, there is an ‘incongruence’ between the two, and the resulting stress leaves us with a headful of negative thoughts and emotions, unsure of what we want and who we are. This can eventually manifest as a diagnosis of anxiety, depression, or virtually any other form of mental ‘illness’.

As any person-centred therapist will tell you, if you contemplate a painful future possibility your gut will feel tense and twisted. Conversely the contemplation of a fulfilling, meaningful future possibility will produce a much more ‘congruent’, aligned, centred and grounded feeling. Jordan Peterson has explained this well:  Jordan Peterson explains Carl Rogers’ concept of incongruence

Carl Rogers never used the term ‘gut feeling’, but perhaps he could have!

 

 

Do you have to tell a therapist everything for them to be able to help?

Answered May 17

 

If its a person-centred therapist you could tell them whatever you want, and hopefully, once you are comfortable enough, with the confidence to tell them what is most difficult for you in your current experience. This will enable you to ‘process’ what you are going through, with phenomenological input from the therapist.

In this manner clients can often reach depths of processing and relating that are not accessible to other (directive) therapies, and which give the client an opportunity to understand their situation in their own way, and then move forward with more authenticity and trust in their own agency.

 

How far would you go to get a correct diagnosis of the mental health issues you are facing?

Answered Nov 16

 

Eventually you might start to ask whether you are more keen to get a precise diagnosis than you are to get better.

There are real limitations to diagnoses. They are subjective guesses, and often lead only to a palliative ‘treatment’ that ignores the underlying interpersonal and socio-cultural factors that keep you trapped in a ‘depressogenic’ situation.

Understanding clearly the behavioural markers of your situation is not the same as understanding your situation, and you will need to do the latter if you are to grow past you current difficulties and find lasting change.

Regardless of the exact nature of the symptoms, the curative factors over the longer terms are likely to be more to do with your sense of self, and personal development in relation to others, than to any magic bullets that the medical folks can provide.

 

 

As a therapist, what would you do if a quiet client had an anger outburst and then started to cry?

Answered Nov 14

 

As a person-centred therapist I would continue doing what I was trying to do all along: provide the therapeutic attitudes of empathic understanding, non-judgmental acceptance / respect, and a calm genuineness that is free of any persona or facade. I would be seeing the world through the client’s eyes, through their valuing system, to the extent that this is possible.

As such, the emotional rollercoaster that the client was on would not require tactical decisions related to assessment and intervention. After all, who is the better expert on the client? Me or her? Such an approach is based on the confidence that what we really want in moments of distress is to feel understood for what we are, not classified and manipulated by yet another helper or ‘expert’. We need to make sense of things on our own terms.

I recently wrote a blog outlining how the person-centred approach is radically different from mainstream therapies, yet still just as effective despite not having to worry about exactly how to assess and intervene in any particular situation. Here’s the link: Person-centred Therapy: the misunderstood miracle – Tim Harvard

 

 

What serious things go wrong before a mental health problem is diagnosed?

Answered Nov 15

 

This might not be the answer you had in mind.

The first serious thing to go wrong before diagnosis is arguably the medical-style training for the ‘expert’ involved. This involves buying into an assumption that a diagnosis will be of more value than harm, and that nothing can be done unless there is a diagnosis. It is widely assumed, without much evidence, that the mind is like the body, and that the concept of ‘illness’ is therefore readily transferable to the psyche.

This assumption leads people to think that the only way forward is to ‘diagnose and treat’: to do something TO the client/patient. In many cases a diagnosis seems to serve largely to make the clinician feel in control and becomes a burden on the client / patient’s agency and confidence. In many cases a diagnosis is so subjective and arbitrary that you’d have to question its value, especially when it is known that the therapeutic relationship is usually more useful to the client/patient than the ‘treatment’.

In other words there is another important question: what serious things go wrong AFTER a mental health problem is diagnosed?

In most cases the process of diagnosis and treatment ignores the fact that the cause of mental distress is usually to be found in interpersonal relationships, and that the ‘cure’ is to be found in the same place. The mind does not need a mechanic. It needs to feel it can understand itself, and be understood by other minds, because these are what lie behind the ongoing process of self-actualization, and the neural integration that underlies it. This means that the disease-diagnosis-drugs medical model will mostly not address the ultimate socio-cultural causes of psychopathology, leaving the individual vulnerable to further distress in future.

 

As a therapist, have you ever had to end a session with a client because they said something that highly offensive to you?

Answered Nov 9, 2018

 

In person-centred therapy it should be much less likely to happen because the therapist is working from within the client’s frame of reference. They should be as authentic as possible, with as much ego as possible left at the door before the session begins. The appropriate response would therefore be to empathise with the client’s need to say something like that. Offence could only be taken if the therapist is attempting to maintain a persona of some sort. Otherwise there’s nothing to offend. Unfortunately however, in the age of political correctness it has become so fashionable to tell people that they are offending you that even many person-centred therapists have become keener to judge than to empathise, keener to arbitrarily ascribe ‘hate’ to someone than to actually show an empathic interest in that person. But the individualist ethos of person-centred therapy should mean that the client is the expert. If the client feels something hateful, then the therapist should acknowledge that feeling as part of their reality, and appreciate that is very possibly something they would prefer to be free from.

 

 

What are typical questions therapists ask their clients?

Updated Nov 23

 

If they’re a person-centred counsellor / therapist then the questions will not be of the usual sort. A person-centred counsellor will ask questions with the aim of empathically understanding the client’s frame of reference. This is because the client remains the expert, and the therapist does not therefore need to take control by asking questions from their own frame of reference. So there is no forcing the client’s world into someone else’s check-boxes. Once the client feels that the therapist accepts their frame of reference they will begin to accept it for themselves again, leading to a renewed sense of agency. Suddenly their world-map makes sense once more, and they can start navigating again.

As Carl Rogers said, ‘The curious paradox is that when I accept myself just as I am, then I can change’. So, with person-centred therapy it is not about what questions the counsellor asks or answers, but rather what questions the client asks themselves, and answers for themselves. Sometimes called the purist form of therapy, it is soft but strong; subtle, yet broadly as effective as other leading therapies. Yet it leaves the individual intact, indeed strengthened.

Many clients come to person-centred therapists after being disappointed with other types of therapy. Most complaints about therapists are things like ‘they weren’t listening’, ‘they wrongly interpreted my situation’, or ‘they advised the wrong things’. Each of these complaints indicates the danger of a questions-based approach to therapy. Such things are less common with person-centred therapy because it fully accepts and engages the client, and works with their own questions: it is as individual as they are.

 

Would you use telemedicine for mental health services or is it important to be face to face?

Answered Dec 13

 

As a person-centred therapist I have found that online sessions are actually very much like the ‘real’ thing. Provided that the internet connection is fast and there are no distractions, it is quite possible to establish and maintain relational depth. Issues like body-language don’t really seem to be too much of a problem, and I think this is because of the phenomenological basis of this approach: you’re seeking to empathically understand the client’s world as they see it, rather than trying to interpret and categorise their behaviour. I suspect that most therapists would prefer to meet face-to-face, but perhaps some therapies lend themselves to online work better than others.

 

Why are mental illnesses hard to cure with medicine?

Answered Dec 13

 

We’re not even sure that medical-style ‘illness’ is the most valid way to represent what might more generally be called psychological distress. DSM-style diagnosis is widely regarded as imprecise and subjective. So, if these states of mind are not really illnesses as such, why would any kind of chemical intervention provide a reliable ’cure’?

A flourishing mind, or sense of self, needs feedback from empathic, encouraging relationships, especially early in life. A coherent and content sense of self will be able to balance the individual’s innate valuing process with the valuing process that is learned as part of socialization. Psychopathology sets in when these two valuing systems give conflicting messages about the elements of one’s experiencing that are important at any one time (in extreme cases this presents as psychosis). As Carl Rogers, and more recently Dan Siegel, have pointed out, it is relationships that make and break us.

Once we recognise the central importance of relationships in psychological distress, we can see how relationship-based therapies (such as person-centred therapy) are so effective. And we can see why treatment-based therapies are no more effective than the relationship-based ones, no matter what fancy techniques are cooked up. We are hooked on the notion that the answer is to do something to the patient, rather than with them.

There is no cure for mental illness because it is not mental illness. It is the self struggling, but failing, to actualize, to self-regulate in a way – in accordance with personal values – that leads to optimal integration. In this it needs the help of another person – another self, a genuine, authentic self who provides empathic understanding, and who offers a model for unconditional acceptance and symbolization of its difficult situation.

 

 

What are the pros/cons of Client-Centered therapy? How can a client avoid having a desire to be friends with their therapist since one of the concepts is mutual sharing between client/therapist?

 

As a degree-qualifed person-centred therapist I feel I can perhaps help with this question, if only to correct some of the statements made in other responses.

Client / person-centred psychotherapy‘s non-directive, phenomenological approach is unique, and its emphasis on respect for the client’s agency and self-determination is unrivalled. It is the only therapy in which the positive regard for the client is truly unconditional – because it sees the client as the best expert on their experiencing. It is as individual as each client, because it works from the inside out. In comparison everything else is some kind of sausage machine.

It has been shown by numerous large-scale meta-analyses to be broadly as effective and efficacious as other leading approaches, for all conditions. It is particularly good at getting to lasting change, because it aims for personal growth towards a more authentic state. Yet it is so radically different from directive therapies that it remains gravely misunderstood, and mistrusted, even by many who profess to teach about it. One persistent myth is that it only works for relatively ‘easy’ cases. This myth appears to spring from a baked-in prejudice toward intervention-based approaches (‘we must do something TO him!’). But the client is never helpless, they just need to know that they can make sense of their world, and this can be greatly encouraged by the therapist’s empathic understanding – empathy with the underlying instincts and temperament, rather than with the unsatisfactory ways in which the client’s current personality might express these. If the therapist can accept the client’s world, then the client learns they can do the same.

PCT’s soft-but-strong approach allows depths of relating and processing that cannot be accessed by directive approaches. With PCT it is like you are at the back of the client’s head alongside them, looking at the confusion of their world as they see it. And they really appreciate the company! It is, contrary to myth, helpful for psychosis and schizophrenia, because it is so accepting of the clients’ experiencing. And it can be astonishingly quick – because it is driven by the client’s processing, profound change tends to happen in the session, rather than outside it. Another correction I need to make is that PCT does not feel like friendship. Friendship, like directive therapy, is persona-based, not phenomenological. It is conditional and directive. A client in PCT will frequently say something like, ‘I’ve never felt listened to, or understood, like this, with anyone’. And ‘mutual sharing’- as in personal disclosure – is not part of PCT.

But it is not for everyone, and this is almost certainly due in large part to a lack of well-trained practitioners. Many won’t take the time to explain how it works at the outset, leaving the client more and more bewildered as time progresses. But clients vary too. Many people prefer to be told what is wrong with them, and what to do about it. They would see therapy more as engineering than gardening. PCT is more for those who want to dive deep into themselves, understand their situation in their own terms, and make the most authentic decisions on that basis.

As time goes by, the world is slowly catching up with Carl Rogers’ ideas: many now recognize that diagnosis is not particularly valid or valuable, that it is our relationships that make or break us, and that values lie at the heart of things. Advances in genetics and neuroscience are very supportive of Rogers’ theory. In his excellent 2011 lecture, ‘Self-deception in Psychopathology’ Jordan Peterson managed to largely ignore Rogers, yet ironically also proposed that the best definition of mental illness might be: ‘‘Mental illness is the inability to regulate perception, action, emotion, cognition in accordance with desired values’. Rogers would have applauded.

If you are wanting to get a proper understanding of PCT, the best references would be ‘Client-centered Therapy’ by Carl Rogers (1951), and the more detailed 1959 ‘Koch paper’. You can also check out my Youtube channel and blog:

Person-centred Therapy – Tim Harvard

Person-centred therapy: the misunderstood miracle – www.harvardtherapy.co.uk

I hope this helps.

Tim

 

How do therapists deal with transference?

Answered Sat

 

This is yet another reason why I love working with the person-centred approach. “What’s transference?” 🙂

 

Is person centred therapy useful for psychosis?

Answered 9h ago

 

Yes, person-centred therapy has proven effective with psychotics.

This should not come as a surprise: its non-directive, phenomenological approach is highly respectful of the the client’s sense of agency and self-determination. This empathic, tentative approach makes it very powerful with highly disturbed and vulnerable people who struggle to stay present in ‘objective’ reality.

Carl Rogers had found that schizphrenic patients responded more positively to him than to other (directive) therapists. He was willing meet them in ‘their’ world, and this meant a lot to them. A major research study was undertaken in the 1960’s, looking at the effectiveness of PCT with schizophrenic patients. Unfortunately the research team had a fall-out and the full data set was never included in the analysis. As a consequence there is a persistent myth the PCT is not effective with psychosis. The reality is different, and if the missing data is taken into account the research verifies that PCT works well with psychosis.

These days ‘pre-therapy’, a type of person-centred therapy, helps people with severe psychosis prepare for therapy.

It is important to note that noting works for everyone, and this is particularly true with mental illness. But certainly PCT has a lot to offer those with psychosis.

 

 

What is the difference between Directive and Non-Directive Therapy?

Answered 12m ago

 

As a non-directive (person-centred) therapist, I feel I should help out with this question.

The two defining factors in non-directive / person-centred therapy are its unconditional positive regard (UPR, or what Rogers often defined as prizing the client’s personhood) for the client, and its phenomenological approach, in which the therapist attempts to see things from within the client’s frame of reference. All other therapies are directive, in that the therapist plays the role of ‘expert’, and from within their own frame of reference. (This is, for example, why transference is so easily brought about). But if there is sufficient UPR, the client’s agency will becoming significantly more involved, because their locus of evaluation is not being dominated by the other. Although most therapies claim to utilise UPR, they tend to ignore the ‘U’. The attitude of UPR is actually not compatible with telling the client what to do, expecting things of them, or even kidding yourself that you are a greater expert on their life than they are. Another consequence of UPR is therefore to avoid placing reliance on diagnosis. To base a treatment on an assessment is to pile one inference on another. By the time that is finished the client has ceased to be a person, they are merely a ‘case’. We all recognize this: medical folk often only seem interested in one or two questions, when there is so much that is distressing us. Rogers knew, and we increasingly acknowledge, that psychopathological diagnoses are often insufficiently valid to be highly valuable. He cheekily suggested that they are used primarily to make the clinician feel competent and in control. What can the clinician use then, if assessment, diagnosis and intervention are not to be trusted? How about actualization, the fact that all living things are in a constant process of re-constituting themselves, to grow, develop, and flourish. Everything is in a state of becoming. This is what life is – our chemical reactions are anything but random(!) Yet our development can be frustrated by environmental factors. So in many senses non-directivity is about the therapist being brave enough to keep things real: the client is as complex, unique and wonderful as you are. They are, at the organismic level, wanting to flourish, even if this is not consciously clear to them.

And ‘real’ means a totally different thing for the client, because everyone has a unique frame of reference. Rogers would say that humans are always ‘exquisitely rational’, within their own frame of reference, or world-map. But their frame of reference can become corrupted when they deny and distort painful aspects of their experience: when they lie to themselves. The client’s sense of agency is further facilitated because there is much less fear of judgment on the part of the client if they feel that their experience is fully accepted by the therapist. The therapist’s acceptance models acceptance for the client. It is no longer necessary to deny and distort your frame of reference, so you can feel more in control again. The phenomenological approach means that the therapist is not sat opposite the client, they are standing next to the client at the back of the client’s head, poring over the client’s world=map, with all its confusing stains and pains, whilst trying to help the client find their values ‘compass’. Personas are cast aside and the client’s existential self can find voice. The phenomenological approach allows for a depth of empathy, relating, and processing, that reaches the more innate, ‘organismic’ parts of the client’s valuing structure (their underlying instincts and temperament), which are being frustrated in their attempts to actualise by the imported values of others and the surrounding culture. It is difficult to maintain a self-concept that is not authentic, not congruent with your nature. Clients in person-centred therapy frequently say that they have never felt listened to, or understood, so profoundly.

In numerous meta-analyses non-directive / person-centred therapy has been demonstrated to be broadly as effective and efficacious as other leading approaches, for all conditions. In fact it often results in more authentic, longer-lasting changes, because it works from the inside out. It is as individual as you are. Hence, it is ‘person-centred’.

 

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