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Person-centered therapy: The growing edge

By Mick Cooper

First published in 'Therapy Today', July 2007. Published here with permission from the British Association for Counselling and Psychotherapy

Person-centred therapy is actualising its potential in creative and original growth, forging new pathways and understandings.

Psychodynamic therapists are cold and aloof, cognitive behavioural therapists are not interested in the relationship and gestalt therapists boss their clients around... as with most orientations in our field, numerous myths and stereotypes also exist about the person-centred approach1. One of the ones that I, and many of my person-centred colleagues, find particularly frustrating is the assumption that the development of person-centred theory and practice came to a halt years ago: in 1957, to be precise, when Carl Rogers published his hypotheses regarding the six necessary and sufficient conditions for therapeutic personality growth (if you thought there were three, that's another common myth!). In fact, over the last half century, and the last decade, in particular, the person-centred world has been awash with new developments in thinking and practice, and this article reviews some of the most innovative and cutting edge areas of development.

The Development of a World Association

Much of this activity can be attributed to the establishment of the World Association for Person-Centered and Experiential Psychotherapy and Counseling in 19972. This association, which brings together person-centred and experiential therapists from over 200 national organisation and training centres, has been closely involved in the organisation of triennial (now biennial) International Conferences on Client-Centered and Experiential Psychotherapy and Counselling (the next of which will be held in Norwich, 20083). These have acted as key fora for the development and dissemination of new ideas and practices4. Most importantly, perhaps, the World Association is responsible for the publication of a quarterly journal, Person-Centred and Experiential Psychotherapies5, which ‘seeks to create a dialogue among different parts of the person-centered and experiential tradition, to support, inform, and challenge each other and to stimulate their creativity and impact in a broader professional, scientific and political context' (PCEP mission statement). With over 2,000 subscribers, PCEP is one of the most widely distributed journals in the counselling and psychotherapy field, and forms essential reading for person-centred therapists who want to stay abreast of current developments, debates and controversies.

The ‘tribes' of person-entred therapy

As the PCEP mission statement indicates, within the person-centred field, it is becoming increasingly appropriate to talk of different ‘parts' or ‘tribes' of this nation, rather than a single, unified approach6. This diversification reaches back to the early 1960s when Eugene Gendlin, one of Carl Rogers' key progeny, hypothesised that clients who were more in touch with their internal experiences got more out of therapy. This led him to develop a philosophy and a practice known as ‘focusing', which encourages clients to focus in on their immediately lived felt-senses. Building on this work, person-centred psychotherapists in north America such as Les Greenberg and Robert Elliott went on to develop a ‘process-experiential' approach to psychotherapy (also known as ‘emotionfocused' therapy [EFT]), which outlined a range of therapeutic tasks (such as ‘two-chair dialogue') that can be used to help clients resolve their intrapersonal conflicts7.

Today, across much of Europe, focusing and process-experiential practices (sometimes collectively referred to as ‘experiential' therapies) are fully integrated into the work of person-centred practitioners: hence the unified term ‘person-centred and experiential psychotherapy'). Within the UK, too, experiential approaches are gaining ground, with the establishment of postgraduate trainings and courses at the University of East Anglia8 and the University of Strathclyde9.

To a great extent, EFT can be seen as an attempt to build on Rogerian, relational practices by integrating skills and techniques from the field of Gestalt Therapy; and recent years have seen several other attempts to incorporate ideas and practices from other orientations into a person-centred, relational base. In Belgium, for instance, Germain Lietaer and colleagues have been integrating psychodynamic-interpersonal practices into their person-centred/ experiential work10; cognitive-behavioural forms of PCT have begun to evolve11; and attempts have also been made to integrate existential and phenomenological ways of working into a person-centred stance12,13.

Not all therapists within the person-centred field, however, are interested in, or even sympathetic to, these developments. For many person-centred practitioners, the essence of the approach is that the therapist refrains from directing his or her clients in any way, such that the integration of more directive practices from other orientations may be considered a betrayal of the very foundations of person-centred therapy. Today, person-centred therapists who see the non-directive principle as the touchstone of their therapeutic work tend to be referred to as ‘classical client-centred' therapists, but it would be wrong to assume that this way of working, in itself, is not also growing and developing. A recent collection of chapters entitled Embracing NonDirectivity14, for instance, critically examined a range of issues concerning non-directivity, and challenged readers to take forward this ‘revolutionary', antiauthoritarian stance towards therapy and psychological growth.

In addition, recent years have seen several attempts to extend a more classical form of person-centred practice to a range of therapeutic modalities. Charlie O'Leary15, for instance, has outlined a person-centred approach to couples and family work;

Natalie Rogers16 has established a ‘personcentred expressive arts therapy;' and Peter Schmid17 has written extensively on the development of person-centred group work. In addition, there have been several attempts to outline and develop person-centred ways of working with particular client groups, such as children and young people18 and people in crisis19.

Possibly the most innovative, exciting and important development in this area, however, has been the emergence of a person-centred approach to working with severely-impaired individuals, such as people with psychosis and/or special needs, termed ‘PreTherapy'20. Pre-Therapy was developed in the 1970s by the Gendlin-trained therapist Garry Prouty, and uses a range of very concrete, sometimes even word-for-word reflections (for instance, ‘You said that you were feeling hungry', ‘You are touching the wall') to help contact-impaired clients re-connect with their affective, physical and social world. Case study research suggests that Pre-Therapy can be highly effective, and it is increasingly being used in clinical settings with a range of client groups, such as people with dementia, geriatric populations and those on the autistic spectrum.

New theory

Alongside these advances in practice has come an emergence of new person-centred thinking, much of it drawing on contemporary philosophical and psychological developments, such as holism, constructivism, process philosophy, postmodernism and neuroscience21. Where once person-centred thinking might have been considered simplistic, it is now achieving a depth and complexity of analysis that is not so dissimilar from some of its more philosophy-rich counterparts, such as psychoanalysis and existential psychotherapy. Furthermore, like both of these orientations, one particularly important source of new thinking for the person-centred field has been the relational ethics of the 20th century French philosopher, Emmanuel Levinas. Levinas asserts that human beings have an ethical duty to respond to the ‘call of the Other', and person-centred writers, in particular Peter Schmid22, have used this to re-conceptualise the philosophical foundation of person-centred practice in dialogical terms: as an openness to the Otherness of the Other.

Like many other 20thcentury philosophers, Levinas also emphasised the fundamentally relational nature of human being, and such ‘intersubjective' thinking has been adopted by a number of contemporary person-centred authors as a means of counterbalancing the more individualistic elements of Rogers' thought23. Eva-Maria Biermann-Ratjen from Germany, for instance, has argued that human beings need interpersonal engagement, positive regard and empathy from the first moments of life; and that a failure to experience such in-depth contact can lead to profound difficulties later on. Similarly, person-centred writers like Maureen O'Hara have argued that psychological maturity is not only characterised by a movement towards autonomy (as Rogers tended to emphasise), but also by the development of a ‘relational self.'

For some theorists, this move from a ‘one-personcentred therapy' to a ‘twoperson-centred therapy' has important implications for the practice of person-centred therapy24. In particular, if clients have a fundamental need to relate to others, and if this capacity to relate is a key element of psychological wellbeing, then it is important that the therapist brings him or herself into the therapeutic encounter as an active, dynamic, really real human being: someone who can meet his or her clients at a level of ‘relational depth'. Advocates of such a ‘dialogical' form of person-centred therapy, like Dave Mearns and myself, argue that this is a subtle but significant shift away from a more classical, nondirective standpoint; with a greater emphasis on the therapist being transparent in the relationship, above and beyond those times when he or she may find it difficult to empathise with, or accept, his or her clients.

A second area of theoretical development within the person-centred field has also challenged Rogers' tendency to conceptualise human beings in singular, unitary terms. In this case, however, it is from the entirely opposite direction. Here, several person-centered and experiential writers have argued that a focus on the individual not only overlooks the multiplicity of which the individual is a part, but also the multiplicity by which the individual is constituted. In other words, what these authors have suggested is that human beings are made up of multiple elements: ‘configurations of self', ‘modes of being', ‘inner persons', ‘subselves' or ‘voices'23.

Within the psychological and psychotherapeutic fields, such a hypothesis is by no means new25. The person-centred roots of these writings, however, do mean that they have a unique contribution to make to the wider field of self-pluralistic thought and practice. Drawing on Rogers' concept of conditional positive regard, for instance, several person-centred authors have argued that individuals develop multiple self-concepts as a means of accruing positive regard - and hence positive self-regard - in a variety of different social contexts. Rogers' distinction between an individual's self-concept and their actual experiencing has also been used to explain how and why multiple selves may evolve: individuals whose experiences simply do not fit in with how they see themselves (for instance, they see themselves as placid but experience rage) may temporarily develop an ‘alternate self-concept' (‘meas-furious') as a means of maintaining some consistency between ‘self' and experiences. Person-centred thinking can also help to elucidate some of the practical implications of a self-pluralistic perspective: in particular, the potential importance of empathising with, and positively regarding, all the different voices within an individual's lived-world: a ‘multidirectional partiality.'

‘Difficult' processes

Closely related to these theoretical developments, recent years have seen a number of attempts within PCT to develop understandings of, and ways of working with, ‘psychopathological functioning'26. Here, one of the traditional stumbling blocks for person-centred practitioners has been a reluctance to see clients through a deindividualising, diagnostic lens; and also to define any one way of being as any more ‘pathological', ‘abnormal' or ‘ill' than any other. For this reason, an enormously influential contribution to the contemporary person-centred world has been the work of the American person-centred psychologist Margaret Warner27, who has re-conceptualised ‘psychopathology' in terms of ‘difficult client processes': ways of processing one's experiences that are experienced as difficult for the client, the therapist, or both (but are not ‘wrong' or inherently pathological).

Warner suggests a range of difficult processes that individuals may experience; and is particularly known for outlining a ‘fragile' processing style, in which individuals are not fully able to ‘hold' their own experiences in attention and consequently may easily feel violated, threatened and misunderstood by others. Building on this work, other person-centred theorists have gone on to suggest additional ‘difficult processes', such as ‘ego-syntonic' processing, in which individuals strive to protect themselves from intimacy through detachment and attempts to control others28.

Current research

It is ironic that, for an orientation that is so founded on empirical observation, the person-centred approach has developed something of a reputation for being research-aversive. This is not entirely unfounded: person-centred therapists can be wary of ‘imposing' evaluation tools on their clients, and of categorising them according to pre-defined diagnostic indicators. A brief scan through the NICE guidelines for mental health and behavioural conditions also indicates the scarcity of controlled research on person-centred and experiential therapies. Nevertheless, things are beginning to change, and leading international psychotherapy researchers like Robert Elliott and Jeanne Watson have been extremely active in compiling, publicising and conducting research demonstrating the efficacy of person-centred and experiential approaches. They have shown, for instance, that person-centred and experiential therapy is, overall, just as effective as other therapeutic modalities (including CBT); and that it can help clients with a wide range of psychological difficulties, including anxiety, depression and health-related problems29. Indeed, it is interesting to note that ‘experiential psychotherapies' are one of just three ‘major approaches to psychotherapy' reviewed in the bible of psychotherapy and counselling research, Bergin and Garfield's Handbook of Psychotherapy and Behavior Change30 .

Conclusion

This article reviews some of the major developments in the contemporary person-centred field. There are, of course, many other developments that could have been mentioned - for instance, Brian Thorne31 and colleagues' writings on spirituality, the development of person-centred political perspectives32, and person-centred work with clients from black and ethnic minority backgrounds33 - but, in this article, I hope to have conveyed something of the vibrancy at the growing edges of this field. August 2007 sees the publication of the first Handbook of Person-Centred Psychotherapy and Counselling34 (co-edited by Maureen O'Hara, Peter Schmid, Gill Wyatt and myself) and, in this book, we hope to have captured something of this spirit of passionate, critical inquiry. As the preface to the Handbook summarises: ‘These are exciting times for the field of person-centred counselling and psychotherapy. Over the last few years, we have witnessed major developments in our approach: an increasing in-depth exploration of its foundations and its underlying philosophy, a rapid diversification - with the emergence of such forms as ‘classical', ‘dialogical', and ‘Pre-Therapy' - and crossfertilisation with related orientations like existential and experiential therapies. We are witnessing a growing intensity of international collaboration and networking through the establishment of the World Association of Person-Centered and Experiential Psychotherapy and Counseling (WAPCEPC) and its journal, Person-Centered and Experiential Psychotherapies. Moreover, where once the focus of person-centred writings was primarily on therapeutic practice, we are seeing a rapidly expanding interest in such fields as anthropology and epistemology, developmental psychology, organisational transformation, peace studies, political theory and psychotherapeutic research, with person-centred writers and therapists at the forefront of many of these fields. The person-centred approach to psychotherapy and counselling, increasingly one of the best empirically supported approaches in the realm of therapy, today has a depth and enjoys a variety of theoretical explanatory models that would make it the envy of many other therapeutic disciplines.'

Mick Cooper is co-editor of the forthcoming Handbook of Person-Centred Psychotherapy and Counselling (Palgrave, 2007). He is Professor of Counselling at the University of Strathclyde and a practising psychotherapist whose work is influenced by person-centred, existential, postmodern and interpersonal approaches. Mick is also author of Existential Therapies (Sage, 2003) and co-author, with Dave Mearns, of Working at Relational Depth in Counselling and Psychotherapy (Sage, 2005).

References

1. Cooper M. Person-centred therapy: myth and reality. 2004. Available from www.strath.ac.uk/Departments/ counsunit/features/articles.html
2. See www.pce-world.org

3. See www.pce-world.org/idxevents.htm
4. Takens R. Resources. In: Cooper M, Schmid P, O'Hara M, Wyatt G. (eds) The handbook of person-centred psychotherapy and counselling. Basingstoke: Palgrave; 2007.

5. See www.pccs-books.co.uk
6. Sanders P. (ed) The tribes of the person-centred nation: an introduction to the schools of therapy related to the person-centred approach. Ross-on-Wye: PCCS Books; 2004.
7. Elliott R, Watson JC, Goldman R, Greenberg LS. Learning emotion-focused therapy: the process-experiential approach to change. Washington DC: American Psychological Association; 2004.
8. www.uea.ac.uk/edu/focus.pdf
9. www.strathclydecounselling.com
10. van Kessel, W., & Lietaer, G. (1998). Interpersonal processes. In L. S. Greenberg, J. C. Watson & G. Lietaer (Eds.), Handbook of Experiential Psychotherapy (pp. 155-177). New York: The Guilford Press.
11. Josefowitz N, Myran D. Towards a person-centred cognitive behaviour therapy. Counselling Psychology Quarterly. 2005; 18(4):329-336.
12. Cooper, M. (2003). Between freedom and despair: Existential challenges and contributions to person-centred and experiential therapy. Person-Centered and Experiential Psychotherapies, 2(1), 43-56.
13. Worsley, R. (2001). Process Work in Person-Centred Therapy: Phenomenological and Existential Perspectives. Basingstoke: Palgrave.
14. Levitt BE. Embracing non-directivity: reassessing person-centred theory and practice in the 21st century. Ross-on-Wye: PCCS books; 2005.
15. O'Leary, C. (1999). Counselling Couples and Families: A Person-Centred Approach. London: Sage.
16. Rogers, N. (2000). Creative Connection: Expressive Arts as Healing. Ross-on-Wye: PCCS Books.
17. Schmid, P., & O'Hara, M. (2007). Group therapy and encounter groups. In M. Cooper, P. Schmid, M. O'Hara & G. Wyatt (Eds.), The Handbook of Person-Centred Psychotherapy and Counselling. Basingstoke: Palgrave.
18. Behr, M. (2003). Interactive resonance in work with children and adolescents: A theory-based concept of interpersonal relationship through play and the use of toys. Person-Centered and Experiential Psychotherapies, 2(2), 89-103.
19. Carrick, L. (2007). Crisis Intervention. In M. Cooper, P. Schmid, M. O'Hara & G. Wyatt (Eds.), The Handbook of Person-Centred Psychotherapy and Counselling. Basingstoke: Palgrave.
20. Van Werde D, Prouty G. Pre-therapy: empathic contact with individuals at pre-expressive levels of functioning. In: Cooper M, Schmid P, O'Hara M, Wyatt G. (eds) The handbook of person-centered therapy. Basingstoke: Palgrave; 2007.
21. See for instance: Greenberg LS, Van Balen R. The theory of experience-centered therapies. In: Greenberg LS, Watson JC, Lietaer G. (eds) Handbook of experiential psychotherapy. New York: The Guilford Press; 1998. And: Tudor, K., & Worrall, M. (2006). Person-Centred Therapy: A Clinical Philosophy. London: Routledge.
22. Schmid, P. (2007). The anthropological and ethical foundations of person-centred therapy. In M. Cooper, P. Schmid, M. O'Hara & G. Wyatt (Eds.), The Handbook of Person-Centred Psychotherapy and Counselling. Basingstoke: Palgrave.
23. See Cooper M. Person-centered developmental and personality theory. In: Cooper M, Schmid P, O'Hara M, Wyatt G. (eds), The handbook of person-centered therapy. Basingstoke: Palgrave; 2007.
24. Mearns D, Cooper M. Working at relational depth in counselling and psychotherapy. London: Sage; 2005.
25. Rowan J. Subpersonalities: the people inside us. London: Routledge; 1990.
26. Eg, Joseph S, Worsley R. (eds) Psychopathology and the person-centred approach. Ross-on-Wye; PCCS Books; 2005.
27. Warner M. Client incongruence and psychopathology. In: Cooper M, Schmid P, O'Hara M, Wyatt G. (eds), The handbook of person-centered therapy. Basingstoke: Palgrave; 2007.
28. Mearns, D., & Thorne, B. (2007). Person-Centred Counselling in Action (3rd ed.). London: Sage.
29. Elliott R, Greenberg LS, Lietaer G. Research on experiential therapies. In: Lambert MJ. (ed) Bergin and Garfield's handbook of psychotherapy and behaviour change. 5th edition. Chicago: John Wiley and Sons; 2004.
30. Lambert MJ. (ed) Bergin and Garfield's handbook of psychotherapy and behaviour change. 5th edition. Chicago: John Wiley and Sons; 2004.
31. Thorne, B. (2005). Love's Embrace: The Autobiography of a Person-Centred Therapist. Ross-on-Wye: PCCS Books.
32. Proctor, G., Cooper, M., Sanders, P., & Malcolm, B. (Eds.). (2006). Politicising the Person-Centred Approach: An Agenda for Social Change. Ross-on-Wye: PCCS Books.
33. Moodley, R., Lago, C., & Talahite, A. (Eds.). (2004). Carl Rogers Counsels a Black Client. Ross-on-Wye: PCCS Books.
34. Cooper M, O'Hara M, Schmid P, Wyatt G. Handbook of person-centred psychotherapy and counselling. London: Palgrave; 2007.
therapy today July 2007