A Radical Departure?

by

Andy Rogers

February 2004

The Person-Centred approach and contemporary psychotherapeutic orthodoxy

In the conventional psychotherapeutic model, clients’ struggles are seen as residing inside their ‘personalities’ or ‘selves’, which can be fixed or tinkered with using certain expertly-applied tools. Most therapeutic approaches subscribe to this view one way or another, although they may take issue with the terms I have used. The popularity of this individualistic ‘medical model’ is hardly surprising—it accords not only with the dominant discourse of contemporary psychology, counselling and psychotherapy, but also with society’s favoured understanding of psychological difficulties. And conventional views, ideas that swim with the flow of ideological power in society, are always going to be easier to hold than those offering resistance. If, as is the case with those of us working as therapists, the very discipline in which we work actually produced some of the most influential ideas in the construction of the conventionally accepted model, it is going to be even harder to step outside of its influence and challenge its foundations.

The Person-Centred approach has been seen traditionally as resistant to the medical model in psychology, which it developed in part as a reaction against, but my concern here is with the apparent concessions of the approach to a contemporary psychotherapeutic orthodoxy that is evermore profession- rather than person-centred (House, 2003) and is becoming further entrenched in medical model assumptions and practices. Whatever its history and however strong the dissent currently simmering amongst individuals in the Person-Centred community, in my view the approach just isn’t radical enough in relation to these developments.

Perhaps this is because some elements of Person-Centred theory and practice are not as remote from medical model assumptions as we might like to think. Although often the language might be more palatable, if we peel this back we sometimes find the same tendency as other approaches to see the therapist as an expert tinkerer in the client’s psyche. This is best illustrated if we first differentiate two forms of Person-Centred work. In a 1990 paper, Barry Grant looked at the central (if contentious) concept of non-directivity in Person-Centred therapy and made an artful distinction between instrumental and principled nondirectiveness. In the instrumental form, he argued, nondirectiveness is something employed by the therapist to facilitate growth in the client and is withdrawn when the therapist judges it not to be working. In the principled form, nondirectiveness is a consistent attitude: ‘the therapist does not intend or attempt to make anything happen – growth, insight, self-acceptance – in the client, but rather provides the therapeutic conditions in the belief that they are expressions of respect’ (Grant, 1990 p. 2, my emphasis).

I will return to the principled form later but what is pertinent to the present discussion is this notion of instrumental nondirectiveness, where the Person-Centred way of being in therapy is used to bring about certain changes in the client. In the language of Rogers’ theory of personality (Rogers, 1959), these changes would be to do with: ‘actualization’; greater ‘congruence’ between the individual’s ‘self-concept’ and their ‘organismic experiencing’; an increasingly internalized ‘locus of evaluation’; the resolution or undoing of ‘conditions of worth’; the development of ‘self-regard’ and so on. The ‘core conditions’ of empathy, unconditional positive regard and congruence are used deliberately to change the client in these specific, therapist-defined ways.

This certainty about the individual’s personality and how to fix it—and the therapist’s intention to ‘facilitate’ the process—seem to me rather incompatible with the claim that the approach seeks to redress the power imbalance between therapist and client. Is the therapist not engaged in a concealment that only exacerbates the inequality of power? Although appearing (and often claiming) to act simply as a companion on the client’s unique and self-directed personal exploration, the therapist already ‘knows’ that the client’s unhappiness is a manifestation of specific personality dynamics that can be altered by offering the ‘core conditions of personality change’. The therapist could, of course, escape this duplicity and disclose from the off her particular understanding of distress and the specific ways in which she expects her attitudes and behaviours will cause change in the client but either way, by assuming covertly or dictating explicitly to clients the fundamental nature of their difficulties, the therapist is operating in an oppressive fashion that, it is usually thought, the Person-Centred approach opposes.

Instrumental Person-Centred therapy is thus caught between the principles or ‘spirit’ of the approach, between what it can be said to be ‘about’ in a political and philosophical sense, and the actuality of psychological theory and practice. The notion of respect for the client as a person is compromised by a narrow understanding of both the contents and processes of personality that are believed to be the cause of unhappiness and the relationship dynamics that are believed to bring about the change required for better (‘fuller’) functioning. What the approach claims to resist and tackle—the power and expertise of the therapist—is sacrificed as a prime concern in favour of the intention to cause the Person-Centred version of ‘growth’.

This will make uncomfortable reading for Person-Centred practitioners who do not understand their work in this way, primarily because its objectification of the client is so incongruent with the principles and attitudes of the approach. But the prevalence of such instrumental tendencies has been a crucial influence in my own drift away from thinking about my work purely in Person-Centred terms. The pathologising discussions of clients in journals and in clinical settings; the casual theorising about everyone else in less formal contexts; the relentless, therapist-led attribution of ‘responsibility’ for feelings; the ‘cutting edge’ development of personality theory; the expansion and integration of the experiential schools—are these not evidence of an alignment with the orthodox psychotherapeutic outlook, which is busier than ever peering into the person and relegating to peripheral anything not located in the client’s ‘proximal’ world (Smail, 2001), when persons themselves are, as ever, battered by forces originating outside of the hypothesised workings of their ‘personalities’ and far beyond the traditional horizon of the therapeutic gaze?

Perhaps this is partly an issue of survival in a competitive marketplace, both for the individual therapist who is rightly concerned that voicing dissent might result in diminishing work opportunities and for the approach collectively, ever fearful of the near extinction witnessed in the United States (more on professional market survival later). The history of Person-Centred therapy must be relevant here too—emerging from clinical psychology and feeling the need to construct a theoretical narrative within this discipline has left a certain legacy. Rogers himself accepted that his systematic statement of personality theory was written partly in response to ‘softly voiced but insistent pressure from my colleagues [in the American Psychological Association]’ (1959, p. 185), as well as to satisfy his own ‘need for order’ (ibid., p.188). In light of this, it is hardly surprising that the theory remains bound by mainstream psychology’s traditional focus on individual experience.

In fact, the Person-Centred approach positively embraces individualistic notions of the person and surely this is symptomatic not just of the preoccupations of psychology but of the wider social and cultural context in which the approach developed—it is saturated by a world view which sees people as self-contained bundles of potential, almost entirely unrestrained by social forces and just waiting to be ‘empowered’, which of course echoes the rhetoric of the most powerful institutions in North American (and increasingly European and global) society. This is particularly evident in the notion of the ‘actualizing tendency’.

The actualizing tendency and individual empowerment

The actualizing tendency occupies a central position in Person-Centred theory and practice and is a belief that as part of a universal, directional, ‘formative’ tendency, all organisms display an innate tendency towards growth, development, the fulfilment of inherent potential and (in persons) constructive social behaviour. There is not the space to explore the concept comprehensively here but what I would like to challenge is the focus on the actualizing tendency as a source of power located inside the individual, one which enables us to determine who we (‘really’) are and to alter substantially our social existence—to change fundamentally ourselves, our experiences and our worlds, from within.

There are similarities here with our everyday acceptance of the notion of ‘will power’, an acceptance that has long been challenged in philosophy. After all, do we really will ourselves to do things? Or do we do something while simultaneously ‘watching’ ourselves and forming a running commentary, then think about it afterwards, deluding ourselves that we made a choice, caused it to happen and that the resulting course of action was our post-choice intention all along? Is will power just an illusion? Can we really determine our feelings, our thoughts, our ‘selves’, our lives, or do they just happen to us? In his celebrated work Straw Dogs, philosopher John Gray (2003) suggests the latter:

Perhaps we do not have the choices we think we do. Perhaps some of the ideas and values liberal-humanists take for granted as being self-evidently true—autonomy, self-determination, freedom, choice, willpower, the actualizing tendency—are a contemporary illusion. They are certainly challenged by David Smail when he writes:

And:

This is particularly challenging to the Person-Centred position and its claims to facilitate personal transformation and I am not sure the approach has responded well to the critique. Conceptually, the actualizing tendency is not the same thing as will power, it is rather the motivational force that drives it, but there is an assumption that we as individuals house resources that only need to be tapped or released for us to be empowered through personal change.

And this assumption is misguided, as Smail argues, because the powers enabling us to change that we imagine to be our own, in fact reside in and structure our social environments, as do the powers that hurt us. We simply ‘mediate’ these forces—they travel through us but are not generated internally. If our environments are ‘noxious’ then we are hurt by them. We can be comforted, encouraged and supported certainly, but we cannot truly transform anything unless we can access the powers to change, resist or escape the destructive forces at work in those environments. The problem, as Smail sees it, is that these powers are elusive and/or invisible to many of us because they originate far beyond our reach in the ‘distal’ spheres of politics, economics and culture.

Person-centred theory does acknowledge the influence the environment—the actualizing tendency is thought to respond to the therapist’s attitudes and is sometimes referred to as having been ‘thwarted’ by unfavourable social/environmental conditions—but analysis of this environment is usually restricted to interpersonal relationships with significant others. The Person-Centred view is limited by this ‘proximal horizon’ (Smail, 2001) beyond which might lie the true origins of distress. Such short-sightedness goes some way to explaining its emphasis on the ability of the actualizing tendency to overcome or transcend past, present and future social forces through the individual empowerment of the client in therapy, an ability I find little evidence for, either in my personal experience or in the literature.

It is social powers that structure our experience of who we are and the world we live in—the gender roles of patriarchy, say, or individualistic notions of ‘self’ rooted in western capitalism. They also dictate many of the actual circumstances of our lives—education, employment, wealth, physical environment, social and geographical mobility and so on. Yet Person-Centred therapy’s influence upon the actualizing tendency is seen as sufficient for the individual to overcome these factors—as long as the therapist (or whoever) provides the right conditions, it is claimed, then clients become more ‘congruent’, more ‘self-regarding’, less dependent upon the judgements of others—they change in their experience of themselves and their concerns are thereby resolved. Even if we accept that all these psychological processes can be said to occur—and it is not unreasonable to suggest that when we experience the solidarity and understanding of another human being we feel any number of positive things—the problem is that in the Person-Centred model these phenomena are seen as addressing the roots of our concerns and as sufficiently potent to transform and empower us in our lives, regardless of the external forces bearing down upon us outside the therapy room.

And these forces are not so easily resisted, as an honest account of our work would probably testify. What of the clients whose ‘processes’ fail to meet the criteria for the kind of back-slapping ‘case studies’ that can be found in many therapy texts: the clients who decide therapy just isn’t working for them; the clients who stop turning up and you never hear from again; the clients who know all too well the confident and positive self-talk of therapy but who find themselves as vulnerable and disempowered as ever in the outside world; the clients who never fail to attend but never ‘get better’ as such, for whom an hour or two a week with an understanding ‘professional’ is just the tiniest of droplets in the darkest of oceans? Who cites these cases as evidence of anything other than the client’s unsuitability for therapy or a temporary ‘therapeutic stuckness’? What are the real reasons for the experiences of these everyday visitors to the counselling room? Where is the analysis of the society in which we live side by side with these people—people we would rather forget as we justify, publicise and sell our services to others—the society in which ‘we’ are one of ‘them’?

Even with more ‘successful’ work or ‘complete processes’, it is easy to assume that our clients have transformed internally (rather than just survived with support) and that they have changed as a direct result of the therapy itself. But however ‘empowered’ clients might seem—and they may have been encouraged by the therapist to describe their experience in this way—we do not usually know how this holds up after the therapy has finished and under the relentless battering that the often cruelly random events of life subject us to. Some of us, in this apparent lottery, will be ‘lucky’ and have less to cope with. But just as often this ‘luck’ is determined by the extent of our access to economic and ideological power in our social environment—wealth, influence, knowledge, education—the same access that allows some of us to escape many of the supposedly ‘random’ events themselves. (Doubters might like to look, for example, at the links between physical illness/mortality rates and social class.)

It is my understanding that whatever ‘personal growth’ and insight into our ‘selves’ is achieved in therapy, our ability to act upon this and change our lives for the better by truly affecting our social environment is dependent not solely on the extent of this insight, nor on our sense of wellbeing or ‘self-worth’, but also on the degree of ongoing (dis)empowerment we experience at the hands of the social institutions of politics, economics and culture, as their influence reaches us through our day-to-day experience and personal relationships, in our families, social lives and workplaces. There might well be a tendency towards actualization in us as connected, embodied beings, but the faith of the Person-Centred approach in this tendency’s power (as an individually-located, potentially transformative force) is surely an overstatement of the actual ability of people to transcend the realities of their physical, economic, ideological and psychological environments.

Where are our problems?

The Person-Centred orientation and other approaches aligned with the orthodox psychotherapeutic model, as I have been discussing, pay little attention to anything beyond the individual person and their significant others, instead concentrating on changing clients by dabbling in their ‘personalities’. They find themselves constructing evermore elaborate models of the interior of the person and develop an (in truth, groundless) clinical certainty in order to justify and promote both their particular brand of therapy and the project of professional psychotherapeutic help itself. All these efforts contribute to our contemporary delusion that the client’s (or anyone else’s) difficulties are to be found inside their ‘heads’, their ‘personalities’, their ‘selves’ and that these are ultimately fathomable by an expert who can make the adjustments necessary for correct functioning to return.

As well as ignoring social factors, this perspective lacks the humility that is surely more appropriate when we come to explore and communicate the mystery at the heart of human existence, a mystery better understood in music and literature than in any therapy theory and encapsulated by Fernando Pessoa when he wrote:

What would a traditional therapeutic response to this be? To name those instruments from outside, to unwind their strings and to pull apart their bodies; to analyse and generically label the symphony’s notes and phrases and suggest they be rearranged? What truth is uncovered in so doing? What is achieved or aspired to? Respect and understanding? Or control?

I am not suggesting that the pursuit of understanding is futile and that we should all sit around gawping inanely at the mystery of our lives. Existential enquiry is something we all do, one way or another, and one of the valuable if not necessarily ‘curative’ features of therapy is that it allows us to focus on these questions in a more concentrated way, hopefully with someone who is familiar with the territory and is engaged in their own rigorous examination via a range of disciplines and perspectives, which they have no intention of imposing upon us. But why must everything be reduced to technical, psychological explanations concerned solely with the processes of personality? Why not acknowledge with humility that our lives are in some ways unknowable and that perhaps mainstream therapeutic psychology, as well as asking the wrong questions of the unknown, in its present form might be far from the ideal vehicle for understanding those elements that we are able to comprehend (see Howard, internet publication)?

I have lost interest in much of what therapists have to say about what is inside our heads, what they believe to be the contents of our personalities and the reasons they give for our unhappiness. In fact, I find it increasingly difficult to accept that the ‘problems of living’ (Szasz, 1960) with which clients come to therapy are inside them at all, nor that they can be ‘sorted out’ by some intra-psychic process instigated by the therapist. As existential psychotherapist Ernesto Spinelli has argued:

This, I think, is rather persuasive, that our problems can be said to exist at the point at which we touch the world, rather than somehow inside us, and it raises the question: which needs to change, person or world? In the traditional therapeutic set-up the burden of responsibility to change is on the person and it is the person that is seen as dysfunctional or unwell. But I am increasingly convinced that the origins of our distress are to be found in the social environment in which we are embodied beings and as such it is the environment that can be said to be ‘sick’. If the powers at work in the person’s social world are oppressive and destructive, if their environment is ‘noxious’, then their experience at best will be difficult. At worst, it will be unbearable and result in what Peter Breggin refers to as ‘psycho-spiritual overwhelm’ (Breggin, 1991), or for those favouring the medical model: ‘mental illness’—experiences that are the natural (rather than pathological) embodied responses to the person’s malignant environment.

Of course, this environment has not gone unnoticed by therapy theories but, as I have mentioned in relation to the Person-Centred approach, they only extend their analyses as far as the person’s ‘proximal’ world of personal relationships, thereby contributing to the difficulty we face in doing anything about our distress—as well as struggling against the conventional, self-defeating belief promoted by most of the industry that unhappiness means there is something wrong with us as individuals, that our problems are inside us and that this is where the work is needed, if and when we do look out into the world for the causes of our unhappiness we get caught up in the fact that in our everyday experience it appears that the important influences in our lives come from our immediate surroundings (past or present).

But perhaps the roots of distress lie not just outside the person but far away in the powerful social institutions that govern, organise and structure our society. Perhaps it is the ‘impress of power’ (Smail, 2001/2003) from these ‘distal’ influences of politics, economics, culture and the information media—mediated as it is by the people and organisations close to us—that really determines whether today we feel happy or ‘depressed’.

A ‘sick society’ goes unchallenged?

What does the Person-Centred approach have to say about the current organisation of our society, the distribution of power under global capitalist principles and the cultural/ideological apparatus that normalises and distracts from inequality and injustice, facilitates the system’s acceptance amongst the population and further imbeds our reliance upon it? What does the approach have to say about the damage all of this inflicts upon us and the way that damage is spun so that we concentrate instead on the inadequacies of our (or, most often, their) flawed personalities? And what does it have to say about the role of counselling and psychotherapy in this process?

Unfortunately, it seems, very little. The claim that the Person-Centred approach is ‘revolutionary’ (Bozarth, 1998; Rogers, 1978) is painfully incongruent with its near silence in relation to these matters. Of course there are dissenting voices amongst the Person-Centred ranks but the approach, in its formalised theory and publicised concerns, has along with most therapeutic orientations failed to shed any direct critical light onto the organisation of our society or the influence it has upon the person. The approach does make a lot of its analysis of power but although way ahead of many other therapies in this regard, its contemporary understanding is often still restricted to the power dynamics of the therapy room and intra- and inter-personal rather than social or institutional power.

When challenged in this way, the political dimension of Person-Centred theory and practice is often alluded to by reference to things Carl Rogers said, wrote and did—primarily his confrontation with the psychiatric establishment, caution about the role of ‘professionals’, his peace work, criticism of developments in world affairs and the 1978 text On Personal Power—but what of that work now, many years after his death? It is not good enough to let Rogers go on speaking posthumously on these matters and smugly congratulating ourselves on the political awareness of the approach. Rogers’ work was admirable in many ways, especially his efforts at encouraging understanding between people in the grip of conflict in Northern Ireland, South Africa and so on, but as positive and hopeful and (perhaps) life-changing for the individual participants as some of that work was, the essentially political nature of these projects—among other things, facilitating the solidarity necessary for social action to occur among the disempowered—never really seemed to impact on the Person-Centred theory of therapy nor resulted in any coherent and explicit analysis of society and social power.

In On Personal Power, Rogers attempts to address the political in the Person-Centred approach and repeatedly comes back to the notion that the redistribution of power in the Person-Centred encounter is radical to the point of being ‘revolutionary’. He is hopeful that a new kind of free-thinking, empowered person will emerge from such encounters and that their (hypothesised) tendency for socially constructive action and resistance of oppression and hierarchy will result in a revolutionary shift in the organisation of society. But as encouraging as this message is, it is naïve with regard to the actual power of the social institutions that Person-Centred politics (as imagined by Rogers) might challenge.

In the ‘Politics of administration’ chapter, Rogers comments upon the ‘confused purposes of modern capitalism—truly interested in persons, so long as that interest turns to profit’ (p. 102). This follows a brief but positive account of how a large, unnamed industrial firm successfully implemented Person-Centred philosophy into its management practices. From this account, a study of an insurance firm and his own ‘puzzling and difficult’ (p. 93) experience in the late 1940s at the Counseling Center of the University of Chicago, Rogers concludes that ‘it is entirely possible to have a person-centred organization in which the basis of power is experienced by each individual as residing within himself’ (p. 103, original emphasis).

Despite his own understanding of the motives of capitalism and the problems he himself faced trying to manage in a Person-Centred way—even in the non-profit oriented context of a mid-twentieth century university counselling service—Rogers seems oblivious to the contradiction of his assertion that a Person-Centred organisation is possible within this system. If a modern capitalist organisation is interested in persons only so long as this serves this interests of capital, as Rogers states, then the outcome is not just ‘confused purposes’, it is that the organisation will fail to be person-centred at all—it is instead capital-centred. If the individual working within this organisation experiences it (incorrectly) as person-centred, experiences power as residing within themselves when in fact this is an illusion created by superficially benevolent line-managers and allowed only because it serves the interests of money-making, then what is good about that? Is the person not entitled to a more realistic awareness of the hierarchical inequality of power that structures their workplace and dictates their very existence in the organisation? It does not seem very ‘person-centred’ to fool the person into believing they have a power and centrality in the organisation that they simply do not have. Let us not forget the simple fact that in the modern capitalist organisation, as soon as the creation of capital (for the shareholders) is threatened or subordinated to other concerns (persons, wellbeing of employees), our subject’s position can be terminated in an instant. When push comes to shove, the individual’s experience of ‘empowerment’ is meaningless in the face of the self-interested operation of power by those who ultimately control the organisation, and in the end might be more distressing for the employee when the actuality of their complete disempowerment hits home.

Throughout On Personal Power (subtitled Inner Strength and its Revolutionary Impact) Rogers seems caught in this trap—acutely aware of the injustices around him and some of the effects they have on people, but convinced that this can be reversed through transformation of the way individuals feel about themselves, through the experience of empowerment. Such an analysis fails to consider the full force that social institutions can muster and exercise at even the slightest threat and seems ignorant of the fact that although in the Person-Centred organisation, group, class or therapy encounter there might be a strong sense of empowerment, how this pans out when the participants get back out into the world is a very different matter—‘inner strength’ can be swiftly trampled under the demands of a competitive society. Rogers’ message is a hopeful and at times inspirational one and of course this is worth something, but today when the Person-Centred approach has had no ‘revolutionary impact’ whatsoever and life is increasingly dictated by capital- rather than person-centred ethics and practice, does it not need to: reconsider what kind of challenge (if any) its focus on individual personal transformation actually presents; stop taking it for granted that the participants of person-centred encounters will be ‘empowered’ and inevitably go on unhindered to socially constructive action; develop a more sophisticated analysis of the workings of the most powerful social institutions in relation to the life and experiences of persons?

Perhaps not. Despite the explicitly political work of the approach’s founder, somehow a Person-Centred theory of society and its institutions and their destructive effects on persons never emerged and the work itself seems to have all but fizzled out. Instead, with a couple of notable exceptions, we have endless re-interpretation of the ‘core conditions’, an ever expanding theory of ‘personality’, and a constellation of other therapies under the Person-Centred banner that are apparently less concerned than Rogers with a ‘renunciation and avoidance by the therapist of all control over, or decision-making for, the client’ (Rogers, 1978, p. 14) and the wider implications of such a position. I am not sure any of this can be changed, reversed or sent in a new direction, nor even that it should, which is why I am writing this paper from the position of drifting away from understanding my work purely in Person-Centred terms.

Even if I could exercise some kind of dictatorial power and change the approach in the ways I might like, I am not sure that ‘belonging’ to a particular approach or brand name therapy is appropriate given the uncertain nature of much of the territory in which we operate as therapists. I am also unsure of the usefulness of labels like ‘Person-Centred’ as a kind of conversational shorthand, in the same way that in the past I came to see the problems in my insistence upon explaining my political leanings by swearing allegiance to some -ism or other. In my experience of the therapy world, terms like ‘Person-Centred’ invariably misrepresent my thoughts to the person listening, who often has all sorts of pre-existing assumptions about what they mean, assumptions that linger whatever I may go on to say. And what for me makes this area especially fraught is that the approach is so closely aligned with the developments in ‘professional therapy’ that I think are some of the most critical concerns for anyone working in this field. How can I go on ‘being’ Person-Centred if the approach is unwilling to take a stand on these issues, even when they relate directly to some of its principal concerns—power, freedom and the resistance of oppression?

‘Profession-Centred’ therapy and the Person-Centred approach

Person-Centred therapy is part of mainstream psychotherapeutic practice. There is nothing necessarily wrong with this but the things I have been talking about in this paper seem inextricably linked to the approach’s involvement with the development and promotion of counselling and psychotherapy as a ‘profession’. The therapy industry has successfully and highly profitably installed itself (or been installed) in mainstream culture, a culture in which critical analysis of and challenges to the organisation of society are generally unacceptable, unless they are kept to the fringes. To do so, the industry has had to be seen to be developing in the direction of a profession—a path that despite Carl Rogers’ suspicion of ‘professionals’, the Person-Centred approach has seemed willing to follow, albeit with the odd word of caution and even less frequent display of resistance. Again the influence of business culture and ethics is evident—as the activity of therapy becomes an industry generating a great deal of money, it becomes subject to market forces. More and more people (therapists, supervisors, trainers) feel dependent upon and in competition for the money the industry generates. To get and keep work, their practice must be of an approved sort. To avoid extinction at the hands of the market, each approach has to justify and visibly align itself with those developments that are most approved of by the purchasers of services, which, in a kind of mutually self-fulfilling prophecy, will be those developments promoted by the most powerful organisations ‘representing’ the therapy industry.

I hope it is clear that I am not suggesting a conspiracy here. Professionalisation is an inevitable outcome and necessary condition of counselling and psychotherapy’s current level of acceptance by and influence upon mainstream culture. Purchasers of counselling services understandably want to know that what they are buying can display expertise, certainty, knowledge, evidence, efficacy, accountability and so on, because on their terms only something meeting such contemporary criteria for professional help can justify the expense. And therapy organisations, with the interests of themselves and their members (though not necessarily their clients) at heart, will attempt to provide what the purchasers want.

For most kinds of professional assistance there might be nothing inherently wrong with such a system, but the concepts around which these criteria are based are highly contentious ones in therapy, which is a moral activity (Grant, 1990; Lomas, 1999) and a political and existential one, rather than being scientific, expertise-led and involving a shared knowledge and skills base comparable with established professions like medicine and the law. I refer anyone unaware of the arguments in this area to the growing and scholarly collection of critiques of professionalisation and other related developments in the psychotherapeutic field (see for example: Bates & House, 2003; House, 2003; House & Totton, 1997; Mowbray, 1995; Smail, 2001/2003). Throughout these texts the same questions arise again and again, many of which relate to the present discussion and centre around the tendency for the psychotherapeutic ‘community’ to internalise and medicalize distress and seek professional status, when such moves misrepresent the work of therapy, are potentially harmful to clients and contribute ideological support to an unjust society.

Therapy’s claim to professional status should be challenged partly because the evidence around counselling and psychotherapy ‘working’ is hotly disputed and fraught with problems of definition and subjectivity. We don’t really know why or how therapy works sometimes and not others, or even what we mean by ‘working’—therapists are nowhere near any kind of agreement on these issues and certainly cannot be said to ‘apply a defined body of knowledge’ (Health Professions Council criteria for assessment of new professions – HPC, 2003, p. 9). I do not mean to say that somehow a lack of indisputable scientific evidence completely invalidates or renders immoral the work of therapy—as I said above, therapy just isn’t that sort of activity—simply that its promotion by its unrelentingly positive advocates as an evidence-based, professional solution to many of our concerns is deeply worrying and that its touchy defensiveness in the face of criticism is at best inappropriate. There are of course those who attempt to offer an alternative or balancing view but the ability of these voices to influence developments is inhibited by the growing power and influence of organisations such as the British Association for Counselling and Psychotherapy (BACP), whose executives regularly communicate with governmental bodies and the national news media, promoting the orthodox pro-professionalisation line that is their policy.

As I have discussed elsewhere (Rogers, 2003), central to this policy is the notion that therapists can be ‘accredited’ and that this demonstrates something about the accredited practitioner that marks them out as having reached a certain and justifiable standard of competence and effectiveness. But if, as is the case, there is absolutely no evidence whatsoever to demonstrate that the ‘accredited’ or ‘registered’ practitioner is necessarily any more competent than their non-accredited colleague, then what purposes are served by the promotion of such systems? Of course accreditation systems serve a function, not least in the selection of candidates for paid therapy work and for therapists wanting for whatever reason to demonstrate that they have met the (rather arbitrary) criteria, but in relation to therapeutic ‘skill’ or competence, to responsibility, maturity, critical reflectiveness and the desire not to exercise power over clients, these systems prove nothing and we must therefore scrutinise the functions they do perform.

Being accredited does prove that a therapist has completed a certain number of hours of a certain kind of training and that they have provided evidence of having conducted a specific quantity of client work and ‘personal and professional development’ (aside: can I include hours spent reading novels or listening to music or at the pub with friends, which have often proved more valuable than the glib theorising and superficial earnestness of some counselling-related experiences?) But it is a leap of faith to think that accreditation demonstrates anything beyond this. Being able to prove certain statistical facts about your experience and write a case study and an account of the theoretical approach you claim to use, which might be tests of creative writing ability more than a test of the therapist’s quality of work and ability to reflect critically upon it, in no way prove that you will be a ‘good’ counsellor, whatever that means. And this is the point: we still do not know what a good counsellor really is, let alone how to create one, but achievement of accreditation/registration is used as if it is an accurate statement about the counsellor’s ability to help people in distress. Why do selection panels for counselling jobs introduce accreditation as one of their criteria, other than to reduce work load by filtering out candidates deemed less worthy? Why do therapists in private practice advertise that they are accredited, other than to get more business by implicitly suggesting this means something in relation to their abilities? Why do contributors to journals mention their accreditation, other than to lend weight to their arguments by implying well-earned status?

Is it really so hard to see that the orthodox line on such matters is characterised by duplicity and professional self-interest? Even if we accept that ‘protecting clients’ is the prime concern for many advocates of professionalisation, the language and processes that arise from this intention, it has been argued, demonstrate a hierarchical, disempowering and oppressive ‘regime of truth’ (House, 2003). Certainly, accreditation systems and the language and claims of professionalisation, in as much as they misrepresent the truth by elevating and enhancing the status and power of the therapist while simultaneously claiming without evidence to be in the client’s best interests, are surely an affront to the egalitarian principle of respect for clients as persons rather than patients, a principle to which the Person-Centred approach so often pays lip service. But where is the approach’s response to these issues? Where is the critique of this new regime in which clients are kept at a distance, in which they are objectified, pathologised, infantilised and feared as potential litigants?

The lack of comment—not to mention resistance—lends further weight to my suggestion that there is currently an interpretation of Person-Centredness that sees no incongruence in embracing professionalisation, seeks greater generic expertise about ‘the client’ and how best to fix the faulty workings therein, is less concerned with the principle of non-directivity and is disinterested with the influence that society and capitalist power-relations have upon the person. In my most pessimistic moments it feels like this has become the dominant interpretation. And I don’t know that I can be part of something that is so willing to acquiesce on these issues. As Craig Newnes (2003) writes:

Is any of this possible from within a Person-Centred approach that looks likely to become just another cluster of ideas within a profession-centred rather than ‘revolutionary’ paradigm?

Conclusion: To leave or not to leave... The principle of the thing

How do I decide whether I am Person-Centred or not? In some respects, I think it is for other people to make that decision. And what does it matter anyway whether I am ‘in’ or ‘out’? As one of my first supervisors said in response to my agonising that something I had done was not Person-Centred, so what? I think part of my difficulty is that the approach feels a bit like an old, comfortable armchair that I am reluctant to get rid of. It is too familiar and cosy just to throw out and in some ways does its job quite well; but the padding is bursting through the seams and the chair’s essence seems to have been rubbed away by all the different people who’ve sat there.

There is, however, much in the approach that I still find useful, which brings me back to the distinction between ‘instrumental’ and ‘principled nondirectiveness’. If the approach can be seen as containing these two distinct strands, then the principled form seems to me to be the essence of Person-Centred work. By this, I do not mean that it is the ‘right’ as opposed to the ‘wrong’ way of being Person-Centred, although there might be perfectly valid arguments (conceptual, historical, semantic) to be made one way or the other. I simply mean that whatever ideas I have considered, held, rejected and reconsidered over recent years, my involvement with and interest in the approach whirl around a central point that is best captured by the notion of principled nondirectiveness.

Let us just remind ourselves of some of its features:

If this is the essence of Person-Centred therapy then perhaps I am still a Person-Centred therapist, though I suspect not much of one. My estrangement from the approach is evident most clearly in my heretical discomfort at ‘principled nondirectiveness’ being tied to Rogers’ ‘core conditions’, which in turn are inseparable from the notion of ‘personality change’—a series of knots I can’t unravel. Empathy, unconditional positive regard and congruence, as well as carrying specific problems of their own—positive regard’s alleged ‘unconditionality’ being one—together have also come to lack a sense of the ‘ordinary’, as Peter Lomas (1999) has used the term to refer favourably to ways of relating not based upon a specific therapeutic approach. Rogers’ ‘attitudinal conditions’ are burdened by psychotherapeutic branding and intentions, which can only be escaped if we ‘remove from an otherwise benign emphasis on empathy and acceptance their element of instrumentality [intention to change the other]. They should be, simply, ends in themselves.’ (Smail, 2003, p. 58)

When I am with someone who is distressed, the response that I understand to be right—and here I do mean morally—is one in which I do my utmost not to add to their concerns by creating or contributing to their disempowerment. The absence of instrumentality is one of the principle features of such a response. My beliefs, values and general feelings of respect for persons as connected beings—though not always manifest in my behaviour outside of the therapy room (therapists are no saints)—are concentrated in the therapeutic situation because there is an inherent power imbalance between therapist and client, which if used by the therapist for any purpose in the encounter other than to acknowledge, support, respect and offer solidarity and understanding to the client, would be, in my view, to contribute to their oppression. In this context, a ‘principled nondirective attitude’ is essential in achieving a suitably non-oppressive therapeutic practice. Or perhaps we can put it less technically, that what is required is ‘compassion…recognizing not so much that it is necessary to stand in the other’s shoes, but that we already are in each other’s shoes. If you prick us, do we not bleed?’ (Smail, 2003, p. 58, original emphasis).

What we can do then—and it is no small thing—is to stand by our clients as being one of us, to respect them for their humanity, to remove any intent to change them and thereby do our utmost not to oppress them further. In a society in which disempowerment is so insidious, in which competition is placed before co-operation, capital before community and the scrabble for power before respect for persons, such an encounter might well be considered ‘radical’. But we must be realistic about its personal and socio-political potential. There will be no revolution emerging out of this or any other therapeutic encounters. The only way the jumble of people and ideas that makes up the therapy ‘community’ can hope to have any liberating impact at all is if we first get our own house in order, if we challenge the falsehoods, duplicity, injustice and oppression in our own ‘professional’ as well as ‘therapeutic’ practices and stop chasing the approval of a society that inflicts so much of the damage that we claim to be addressing in our work.

Instead of appeasing social institutions because we want to advance the interests of ‘the profession’ or our own approach (whatever those interests may be), instead of contributing—by supporting the internalisation of distress and ‘medicalization of everything’ (Newnes, 2003)—to the ideological scaffold that holds up our individualistic competition culture and separates and imprisons us within it, we should not just be avoiding acquiescence, but directly, explicitly and vehemently challenging these structures for the destructive impact they have upon us all. It won’t win us any friends in high places, nor even amongst our colleagues, but it will help us to take a step closer to really standing by our clients rather than objectifying them. Which is, after all, what being ‘person-centred’ is all about. Isn’t it?

References

Bates, Y. & House, R. (eds.) (2003) Ethically Challenged Professions Ross-on-Wye: PCCS Books.

Bozarth, J. (1998) Person-Centred Therapy: A Revolutionary Paradigm Ross-on-Wye: PCCS Books.

Breggin, P. (1991) Toxic Psychiatry London: Harpercollins.

Grant, B. (1990) ‘Principled and Instrumental Nondirectiveness in Person-Centred and Client-Centred Therapy’ Internet publication found on 15/09/99 at: http://users.powernet.co.uk/pctmk/papers/nondirec.htm Originally published in Person-Centred Review 5 (1), 77-88.

Gray, J. (2003) Straw Dogs London: Granta.

House, R. (2003) Therapy Beyond Modernity London: Karnac.

House, R. & Totton, N. (eds.) (1997) Implausible Professions – Arguments for Autonomy & Pluralism in Counselling & Psychotherapy. Ross-on-Wye: PCCS Books.

Howard, A. ‘Counselling: Hubris and Nemesis’ Internet publication found at: http://www.alexhoward.demon.co.uk/Counselling%20Hubris.doc

HPC (2003) Health Professions Council Annual Report – 1 April 2002 to 31 March 2003.

Lomas, P. (1999) Doing Good? Psychotherapy out of its depth Oxford: Oxford University Press

Mowbray, R (1995) The Case Against Psychotherapy Registration – A Conservation Issue for the Human Potential Movement Trans Marginal Press.

Newnes, C. (2003) ‘Psychology and psychotherapy’s potential for countering the medicalization of everything’ Internet publication found on 25/07/03 at: http://www.shropsych.org/countering%20medicalisation.htm and accessed via: www.djsmail.com

Pessoa, F. (2002) The Book of Disquiet London: Serpent’s Tail

Rogers, A. (2003) ‘A Question of Questions: Interviews for Counselling Jobs’ Person-Centred Practice 11 (1), 12-18.

Rogers, C.R. (1959) ‘A theory of therapy, personality, and interpersonal relationships as developed in the client-centred framework’ In S. Koch (ed.) Psychology: A study of science, Vol. 3: Formulations of the person and the social context (pp. 184-256). New York: McGraw-Hill.

Rogers, C. (1978) On Personal Power – Inner Strength and its Revolutionary Impact London: Constable.

Smail, D. (2001) The Nature of Unhappiness London: Constable & Robinson.

Smail, D. (2003) ‘Power, Responsibility and Freedom’ Internet publication found at http://www.djsmail.com/intpub.htm

Szasz, T. (1960) ‘The Myth of Mental Illness’ Internet publication found at: http://psychclassics.yorku.ca/Szasz/myth.htm Originally published in American Psychologist 15, 113-118.

Email address: ARogers@cricklade.ac.uk

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