I felt a desperate itch to share what I know in response to this article (‘10 Person-Centered Therapy Techniques & Interventions’). Misunderstandings about person-centred therapy seem to be stubbornly typical among non-specialists. There is so much that needs to be said here.
Trained by world-leading experts at the University of Nottingham in the UK, I have been busy in private practice for many years now, so I consider myself at least reasonably qualified to offer some clarification.
It perplexes me how is it possible to write about person-centred /non-directive therapy without making reference to any of the main texts on the topic, whether by Rogers or anyone else. Reference is made to someone called Saul McLeod, who, like Buhler, I have never heard of. If he is a leading light in person-centred therapy it is news to me.
I have read widely in the field but have never come across any of the references cited here (except for Brodley, which was kindly suggested in the comments). Rogers’ ultimate exposition of his theory is generally reckoned to be his 1959 ‘Koch paper’. This distillation of his thinking runs to over 70 pages, and he can’t be adequately understood at a technical level unless this stuff is properly absorbed. More obviously there are his better-known works such as Client-centered Therapy, On Becoming a Person, and A Way of Being. And a number of articles and papers – I’ve added a list of Rogers’ main publications below. It’s worth reading the source, or at least the writings of those regarded as experts.
We Rogerians get used to being misunderstood by the public and other orientations. In fact I once wrote about this. So let’s be systematic and start at the title, where things first went wrong. A treatment is ‘doing something to someone’. Its a terrible term. A coat of paint is a treatment. Its what medics do to us once we have admitted our helplessness and submitted to their ministrations. Like the term ‘intervention’ it presupposes that the person who knows what is best for you is now me. It presupposes that you are afflicted by an illness, the medicalised metaphor that has done so much damage to growth-based therapies, and arguably harmed our mental health too. (We used to tell you that you were afflicted with demons. Now we call it a disease. Either way you clearly need me and my trepanning kit, don’t you?).
There are no interventions or treatments in PCT, and that is the shocking, radical point. Imagine sitting in silence, resisting the urge to say something helpful, and instead, just having faith that the client is still self-actualising and still processing, so there’s no need to divert her from her current train of thought. They are doing the work, changing, right here in the session. They will unfurl if the therapist, in Rogers’ words, ‘gets out of their way’.
Let’s dive in
OK then, here we go. I’ve highlighted the article’s main mis-statements in bold, so that you’ll know what I’m addressing.
To say that all main therapies are client-centred is at once crassly naive, rather dismissive, yet also quite profound. It’s profound in that all main therapies are also cognitive, behavioural and psychodynamic. Why? Because they are all mapping the same complex territory, the human. The naivety comes from failing to point out WHY Rogers called it client-centered (and later person-centered): because it works phenomenologically, from within the client’s frame of reference. You know, that place where they Do The Work. It is the therapy that works from the inside out.
It is staggeringly inadequate to describe Rogers’s contribution as a ‘novel idea’. This only makes sense if you think his main contribution is the 3 ‘core conditions’ (not a phrase he ever used, and not one used by Rogerians). In 2009 he was voted the most influential therapist of all time (see below), but apparently this was largely because most therapists do not regard non-directivity as a gigantic, radical change in how therapy is offered. They were instead thinking of the 3 core conditions. This is how corrupted and riddled with misunderstanding is his legacy. He subversively railed against therapist ‘expertness’, yet this attitude of ‘therapist knows best’ has done its best to bury him. These are the people who never wanted to answer the annoying question of why non-directive therapy is pretty much as effective as the ‘assess-and-treat’ kind. Any visiting alien would quickly discern that the most obvious taxonomy is between the directive and the non-directive approaches, so radical is the difference between them. Yet somehow this remains lost to many therapists.
There is a gigantic amount of hard scientific evidence that Rogers was right, and we might say that person-centred therapy is the future. Neuroscience, for example, might use different words than Rogers, but it is vindicating him.
The humanism thing again
Person-centred therapy (PCT) is not humanistic. It is often described these days as humanistic, but many Rogerians would question this to some extent. Person-centred psychology was influenced more by phenomenologists and existentialists than by humanistic thinkers (even Lao Tzu, who was, actually, an acknowledged influence on Rogers). The term humanistic did not enter common usage until the mid-50’s, yet Rogers’ ideas were largely formulated in the 1940’s. And the non-directive approach is not shared with other humanistic orientations.
It can also be said that person-centred psychology is the original positive psychology, being based on a model of personal growth, rather than of perceived deficit with respect to some abstract norm. (See references for PCT’s connection with positive psychology).
The superficiality thing again
It is stated that person-centred therapy focuses on ‘what is on the surface’. This is not a sufficient analysis. PCT works with whatever the client brings, which of course is not always superficial(!), but it is all about bringing into awareness certain feelings and instincts which have been denied, distorted or otherwise ‘subceived’ beyond what he called the ‘edge of awareness’. PCT has been described as the treatment for ‘incongruence’, by which I mean it aims to bring back into my awareness the key elements of experience that do not currently fit comfortably with my ideas about myself, because of the values that have been introjected through my social conditioning. This congruence of experience and awareness (a word meaning something like alignment) is, in other words, about acceptance. It is mindfulness – not a word Rogers used, but what else shall we call the bringing of experience into awareness? PCT works – radically – by actually ignoring the surface personality and empathising instead with the inner, existential self, and what he called the client’s ‘organismic valuing’. It aims to re-integrate the innate, relatively fixed limbic responses of what we might loosely call temperament with the introjected ideas that we might loosely call the personality and conscious awareness.
The directivity thing again
It is also stated, wrongly, that many of today’s therapies are client-centered. This seems to be largely the same point as addressed above, but perhaps implies that there are differing degrees of client-centredness. There are no degrees of client-centeredness, or at least not at the level of analysis from which the author is speaking. A therapist cannot simultaneously be working from within the client’s frame of reference and from within her own. You can’t both be suggesting which turn their journey should take next whilst also allowing the psychological time and space for them to do this for themselves, from within their own train of thought. The Rogerian’s role is to accompany the client. To stand beside them at the back of the client’s head, helping them to understand their experience as they tentatively process it and integrate it into awareness. In other words to help facilitate their moment-by-moment self-actualisation process.
Person-centered therapists have never stopped arguing among themselves about what precisely is directivity v non-directivity, but this is an argument over relatively minute matters in comparison to the broad sweep of what the author here is saying. Suffice it to say that if I suggest something to the client from within their own current train of thought it is not as likely to ‘knock’ them back into a defensive state as it might be if a made a habit of trying to say something helpful. What is often not acknowledged is that person-centred therapists are clearly at much lower risk of client grievances, which usually fall into three categories: they didn’t listen, they mis-diagnosed me, and they recommended the wrong thing.
Non-specialists think Rogers was all about the ‘core conditions’
In a couple of places it is stated that UPR (unconditional positive regard) is the one vital quality or element. This is wrong. There are those who say it is the curative element, providing the safety to think, feel, say anything, the active ingredient as it were, borne upon empathy amid the therapist’s congruence. But it must be acknowledged that much mystery and debate remains with respect to the nature and relative roles of each of the 3 ‘core conditions’ (we Rogerians are more likely to call them the therapeutic attitudes). It is a gross oversimplification to say that Rogers believed that to listen non-judgmentally is enough. Just try that. The client will get bored and eventually walk out. The basis for the therapeutic facilitation of the stalled self-actualisation process is built upon the therapist’s congruence / mindfulness – I’m open to my own experience (and in doing so I’m also modelling this for the client, by the way). My own personality and its algorithms of interpretation and judgement is largely suspended. I’m open to my feelings and responses internally, and I’m open with them externally. In other words I’m transparent, not hiding behind expertness or any other facade/persona. This realness reinforces the client’s trust in the therapist.
Empathy, if sufficiently present, is the conduit for UPR. If the client’s personality, as currently configured, is sufficiently disarmed then he can allow his inner self to reconsider some of the introjected values (from social conditioning) that are contaminating and corrupting their psychological process, motivating all those difficult thoughts, words and actions that have not been sufficiently in line with their true, inner, nature. This empathy provides the love that they don’t currently have for themselves.
It is important to pause here and ask yourself whether, if these are in place, could it be possible at all to be directive? No. Any idea in me that ‘an expert would say X so therefore I should’ is me not being congruent. Any interpretation, assessment or other form of judgement is me failing to provide the attitude of UPR. Lapsing into saying something sympathetic, or saying nothing in response to a painful statement, is me being non-empathic.
Yes, it is very difficult to provide this ‘way of being’ for clients. The skills might be soft, but they are very subtle and very demanding. Unfortunately, as indicated in the article, much training does not seem to reflect this, and we seem to have produced a lot of therapists who are arguably not as effective as they might be.
All person-centred practitioners know it is impossible to hold all 3 therapeutic attitudes fully at all times, but taken as a totality, over time, there is an inflection point between what might be just another ‘helping’ conversation’ and one that exists, at least for much of the time, at a level of ‘relational depth’ that facilitates greater efficiency in the client’s self-actualisation process.
As an aside, it can be seen how transference is not really a thing in PCT if the attitude of the therapist is phenomenological and empathic, from within the client’s frame of reference, and if the focus of the conversation is in the here and now. In fact I would say ‘conversation’ is a much better word than ‘session’. We Rogerians do dialogue, not treatment.
Putting personhood first
It is true that a non-directive therapist would rather describe the person they help as a client than as a patient. But the point here is also that the best person to choose the word is, well, the client. Similarly, whether the facilitation I provide is called psychotherapy, counselling or coaching depends on what the client wants to call it. The input from me is the same, because its a growth-based paradigm, not a deficit-based one. If you want to get better you might want to call it psychotherapy. If you want to feel better you might decide to call it counselling. Want to do better, then coaching might be the word for you.
I had to admire the attempt to sum up the entirety of person-centred psychology in a quote. Don’t bother trying. The approach is not so stubbornly misunderstood for nothing! And you wouldn’t believe how much we Rogerians would squabble over such a thing. Although I humbly suggest the later quote containing ‘…How can I provide a relationship which this person may use for his own personal growth?’ might be a decent candidate for this.
No person-centred clinician would say that other approaches have thrown away ‘expertness’ after Rogers. It is simply not true. Expertness is still the norm, alongside the other great enemy of the client-centred approach, the medical ‘disease’ model. In fact at present there is a very apposite scandal here in the UK, after a number of leading bodies (the humanistic one was not invited!) worked with the government to declare that a therapist with lots of scout badges is better than one without (see ScopEd link below). This flies in the face of decades of good research proving that the non-directive approach is broadly as effective as the ‘assess-and-treat’ one (see below). Such is the power of vested interests – there’s so much money to be made from training, and people are so proud of their certificates, aren’t they?
It is stated that Rogers did not like the ‘one-size-fits-all’ approach. Yes and no – the Rogerian approach is universal in so far as the therapeutic conditions are (and have been amply demonstrated to be) both necessary and sufficient. But each client, and each therapeutic encounter is utterly unique. Rogers noted that the most personal things are the most universal, and this explains the apparent paradox here. Once we truly open up to our feelings and start articulating them with confidence we start sounding a bit more like each other. Our personalities might differ and clash easily, but our inner, existential human experience is largely universal.
To say that Rogers regarded the client’s experience as the main thing oversimplifies things. But we can say that the role of the therapist is to help the client regain faith in their own self-actualisation process, and that this is based on the ongoing innate tendency, encouraged in the presence of the right conditions, toward integration of one’s experience into one’s conscious awareness.
It is stated that PCT assumes that everyone can benefit from this approach. Again, yes and no. All therapies seem to assume that their approach will work sufficiently for everyone. But I have not yet met a decent therapist who believes this, and doesn’t instead believe that different types of people respond best to different therapeutic approaches. Yet somehow this open secret seems to remain a horrifically under-researched topic – there’s a PhD here for someone!
Stop thinking in terms of tasks!
Rogers wasn’t given to using terms like ‘putting in the effort’(!), and his theorising around actualization (a life seeking only and forever to become itself, amid whatever the world is doing to it) did not leave much in the realm of ‘effort’. If I am in a state of adequate congruence then my self-actualization process will crystallise the motivations that will be found meaningful. Being clear enough about what we want, without sinking into the distress of excessive conscious reflection, is the same thing as psychological wellbeing. Being true to yourself is not an effort. Its a discovery.
The only goals that would apply in PCT are those of the client, but don’t expect the therapist to ask for goals. She is only providing the therapeutic attitudes, that way of being. Buhler’s list of humanistic therapy goals seem pretty universal to all therapies, and do not support the idea that he has read any Rogers. Perhaps he was confusing humanistic approaches with the person-centred one.
Active listening is not a Rogerian technique
I always hate reading about how so-called ‘active listening’ is a Rogerian technique – if you’re listening properly you have no need for, and no mental space for, the set of conscious actions that constitute active listening as it is commonly taught. Again, the non-directive approach is one of attitudes, not techniques. Rogers might have used the term a little but he certainly didn’t have in mind the retention of a mental checklist and the rather wooden, inauthentic process of pretending to be interested via cunning bodily movements. Why bother with all that? Just be interested!
Some comments on the comments
Before wrapping this up I need to point out a bad thing and a good thing that I found in the Comments section. Firstly, Nicole states confidently that non-directivity is ‘a weakness’. This shows a total lack of understanding, but again I don’t think she’s a person-centred practitioner. It is hard to see how it is such a weakness if it is as effective as any other orientation! Let’s not forget that ‘client factors’ are widely recognized as a greater influence on outcome than techniques. PCT is the approach that works with client factors instead of despite them, and apparently this compensates for the lack of intervention, whilst allowing the client to retain a sense of autonomy. And many, many clients greatly value the psychological space that it provides. They feel strongly that they need to find their own understanding of what they are going through. And to end on a positive note, thanks to Travis for recommending Brodley’s excellent book. Other useful reading for a directive therapist interested in person-centred psychology might include those below. Please forgive my use of UK-based publishers.
Some things to consider reading if you want to understand Rogers:
- Cooper, M., O’Hara, M., Schmid, P. and Bohart, A. (Ed) (2013) The handbook of person-centred psychotherapy and counselling. 2nd ed. London: Palgrave MacMillan.
- Cooper, M., Watson, J. C. and Holldampf D. (Ed.) (2010) Person-centred and experiential therapies work: a review of the research on counselling, psychotherapy and related practices. Ross-on-Wye: PCCS Books.
- Joseph, S. (2015) Positive therapy: building bridges between positive psychology and person-centred psychotherapy. 2nd ed. London: Routledge.
- Joseph, S., (Ed.) (2017) The handbook of person-centred therapy and mental health.
- Ross-on-Wye: PCCS Books
- Knox, R., Murphy, D., Wiggins, S., Cooper, M. (2013) Relational, depth, new perspectives, and developments, Palgrave Macmillan, London
- Mearns, D. and Thorne, B. (2007/2008) Person-centred counselling in action. 3rd ed. London: Sage.
- Rogers, C. R. (1951/2015) Client-centred therapy. London: Robinson.
- Rogers, C. R. (1961) On becoming a person: a therapist’s view of psychotherapy. New York: Mariner Books.
- Rogers C. R. (1959). A theory of therapy, personality, and interpersonal relationships as developed in the client-centered framework. In Koch S. (Ed.), Psychology: A study of a science: Vol. 3. Formulations of the person and the social context (pp. 184-256). New York, NY: McGraw-Hill.
- Rogers, C. R. (1980, ) A way of being. New York: Houghton Mifflin Books.
- Tudor, K. and Merry, T. (2002) Dictionary of person-centred psychology. Ross-on-Wye: PCCS Books.
- Tudor, K. and Worrall, M. (2006) Person-centred therapy: a clinical philosophy. London: Routledge.
- Wilkins, P. (2016) Person-centred therapy: 100 key points and techniques. 2nd ed. London: Routledge.
- Worsley, R. and Joseph, S. (Eds.) (2007) Person-centred practice: case studies in positive psychology. Ross-on-Wye: PCCS Books.
Rogers voted most influential therapist: Cook, J. M., Biyanova, T. and Coyne, J. C. (2009) Influential psychotherapy figures, authors and books: an internet survey of over 2,000 psychotherapists, Psychotherapy (chic) Mar;46(1):42-51. doi: 10.1037/a0015152
Person-centred therapy broadly as effective as others: https://www.pce-world.org/images/stories/meta-analysis_effectiveness_of_pce_therapies.pdf
ScopEd: why person-centred therapists are leaving the British Association for Counselling & Psychotherapy: https://www.harvardtherapy.co.uk/scoped-why-person-centred-therapists-are-leaving-the-bacp/