Do I need therapy?
Only you can know if you need therapy, but it won’t work unless you want it. Sometimes those close to us might suggest that we consider it. Therapy can help people at major transitions in life, and those affected by medical and mental illnesses.
Many clients view therapy as an investment in their future. And for a lot of clients, therapy is the first time that they have ever actually felt properly listened to, and understood. This alone can be transformative.
Is therapy going to work?
Therapy is effective for most client / patients, and is highly effective for many. On average 8 in 10 will benefit from it. It’s effectiveness is generally as good as medication, but you get lasting change. Many people prefer to invest time and effort into personal development and change, rather than to spend years dependent upon medication.
Which type of therapy is right for me?
All major types of therapy are equally effective. But it is very important to pick the therapy that allows the most comfortable relationship with the therapist. Many adults prefer a style of therapy in which they feel largely in control of the process, to explore and articulate their own problems and solutions. If this sounds like you, then you might prefer the person-centred approach. Other people might prefer to be told what is ‘wrong’ with them and exactly what they should do about it. Perhaps they are wanting to address a very specific and clearly-defined problem. Such people could prefer a more directive therapist.
Please note the quality of the client’s relationship with the therapist is very important. It is usually more important than the particular type of therapy or ’intervention’ applied! The quality of the relationship is also more important to success than the therapist’s experience and qualifications! Find a therapist with whom you feel you can develop a close and trusting relationship. Consider spending some time with various therapists before making any long-term commitments. The person-centred approach is relationship-driven, but is not for everyone. I am very happy to refer you to another type of therapist if I think that might be in your best interest.
How effective is person-centred therapy?
Person-centred therapy (PCT) has been reliably shown over the decades to be broadly as effective as other leading types of therapy, such as CBT and psychodynamic approaches. (For example, see Person-Centred/Experiential Therapies Are Highly Effective: Summary of the 2008 Meta-analysis, Elliot et al). In fact, person-centred therapy is the approach offered by the NHS’s IAPT scheme when all other options have failed. This ‘counselling for depression’ enjoys high success rates. In another major study sponsored by the British Association for Counselling and Psychotherapy (BACP) and published in the journal The Lancet Psychiatry, found that person-centred therapy is as effective as CBT.
Person-centred therapy was the original ‘evidence-based’ approach, arising from clinical observation over thousands of hours. It is not only effective but based on a theory of personality that aligns very well with the advancing science. Jordan Peterson, the famous (infamous?) clinical psychologist has described Carl Rogers’ theory as ‘‘one of the most intellectually compelling and practically useful theories of personality’. (See Jordan Peterson’s ‘Personality and its transformations, lecture 1: introduction and overview’. Available for free on YouTube.). And this was more than 65 years after Carl Rogers originally developed his ideas!
PCT is based on a paradigm of personal growth, not one of ‘disease’. The effectiveness of PCT is easily quantifiable in terms of client feedback. But it is not easy to compare the client feedback approach of PCT to the diagnostic ‘clinician knows best’ approach of the medicalised approaches. It is difficult to do medical-style research on non-medical approaches such as PCT. This is because PCT is not dependent upon the controversial diagnostic categories that still dominate ‘medicalized’ approaches to psychotherapy. Who’s to say you have anxiety, or depression, or whatever? You’ll probably get different diagnoses from different clinicians(!)
In 2019, Professor Mick Cooper of the University of Roehampton had this to say about the effectiveness of PCT:
- “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 2013 comprehensive meta-analysis for the definitive review).
- The effects of humanistic and experiential therapies are similar, on average, to other therapies—including CBT. This is particular true when the allegiance of the researchers is taken into account (again, see Elliott et al., 2013). It’s also true whether the effects from different studies are compared against each other. Or whether two therapies are directly compared together.
- Studies which compare the outcomes of person-centred therapy in real world settings (e.g., IAPT) again show that these are very similar to CBT. Indeed, may be achieved in a shorter period of time (see Pybis et al., 2017).
- There’s no consistent evidence that CBT or psychodynamic therapies have longer lasting effects than person-centred therapy, or that they ‘work’ more quickly.
- It’s the dodo bird, stupid (though maybe don’t say the ‘stupid’ bit to your manager!). Again and again, what the research shows is that ‘everyone has won and all must have prizes’—all therapies, overall, do about as well as each other.
- 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).
- 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).
- 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 (Bohart and Wade, 2013).
- Person-centred counselling with children and young people also shows good outcomes, at a level consistent with other therapeutic orientations.
- 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).”
[See this link for Prof. Cooper’s full blog article on this: person-centred-therapy-myths-and-realities].
Why is the person-centre approach not more available?
Person-centred therapy is predicated on a model of personal growth, rather than the ‘treatment’ or ‘disease’ model that has been imported into psychotherapy from medicine. Research in recent years has, however, greatly supported the ideas that Carl Rogers put forward. He believed that it is interpersonal relationships that cause psychological distress, and that it is relationships that facilitate healing and growth. He also believed that concepts such as assessment and diagnosis are not well-suited to psychological distress. In addition, he found through extensive research that techniques and ‘interventions’ are less important to successful therapy than aspects of the relationship between the client and her therapist.
Unfortunately, for the time being most doctors, clinical psychologists and insurance companies are still highly invested in the medical ‘disease’ model, and seem to find it more expedient to provide medication than talk therapy.
How long will therapy take?
It is not possible to say how long the process of therapy will take, but with the person-centered approach the client can decide for herself when she is ready to move on. There is no ‘programme’ to be completed (because it is centred on you, not the hypothetical average person).
Is therapy confidential?
Yes, your sessions are confidential. Measures are in place to protect you personal data, in accordance with UK regulations. Please note, however, that under certain circumstances I have ethical and statutory obligations to protect the safety of children, others and yourself. In rare cases this might mean sharing information with other health professionals.
What happens in therapy?
Every client’s journey through therapy is unique, especially with relationship-based approaches such as person-centred therapy.
In the first session I will take some basic information (contact details, mental health history etc). We will talk about what you want to get from therapy / counselling / coaching (you get to decide what we call it). We will discuss your preferences: for example, would you prefer to talk about the past or the present, would you prefer to focus on behaviours or thoughts, would you prefer to to be directed or challenged, or to take charge of the conversation? I will tell you how the process works, because it is really important that you understand, from the outset, what is happening and how to make the most of it. At the end of the session I will provide you with a standard ‘client contract’ that sets out the main expectations and boundaries for the therapeutic relationship.
After the forms are completed the therapy can begin. This will involve a noticeable change in the way we talk with each other, with the client working hard to articulate and process their difficult experience/s, and the therapist working hard to provide and maintain an environment in which the client can continue to move forward. You will be talking with someone who does not judge you in any way, who is on the side of the part of you that wants to move forward, and who is clearly being sincere, open, and genuine.
Over time we will, hopefully, develop a strong and trusting connection, which will allow you to become ever more confident in your capacity to make sense of your difficulties and decide the best way forward. Change can often happen very rapidly, right there in the session. (This is a major difference between the person-centred approach and other approaches).
From time to time I will ask you how we are doing, inviting you to step back from the therapy and assess our progress. Then we can move forward again, until you eventually get to a point where you feel you no longer need help. You get to decide this for yourself – another thing that helps to define the person-centred approach.
What are the negatives with therapy?
Firstly, and obviously, therapy costs money. But so does years of medication, especially when you include the costs of a life affected by mental illness / distress.Therapy can also require commitment and courage from clients. It can be a painful journey on the way towards personal growth.
Occasionally a client can lose faith in their therapist, often because the therapist is perceived to be not listening, not understanding, or giving bad advice. Such issues are less likely with person-centred therapy, in which listening, understanding and non-directivity are central. I regularly seek feedback from my clients, so that we can both be assured that things are moving forward for them.
Is online therapy right for me?
The person-centred approach to therapy or coaching is well-suited to webcam-based meetings, but please note:
– Will your privacy be protected?
– Will you be disturbed?
– Will you be able to relax?
– Check that you have a fast internet connection?
– You might want to delete any call history that relates to therapy sessions.
I use a number of platforms, including WhatsApp, Facetime (for Apple users), Zoom and Google Meet.
What is person-centred coaching?
Person-centred coaching non-directive coaching. It is the same thing as person-centred therapy or counselling, because the person-centred approach is growth-based, and we seek growth whether we feel ill or well, whether we want to ‘get better’ or ‘do better’.
If you want to dive deeper, here’s a more detailed article on person-centred psychology with respect to coaching.