Beruflich Dokumente
Kultur Dokumente
Person-Centred and
Experiential Therapies
Pete Sanders
As the final contribution to this first part of the handbook, exploring the foundations
of the person-centred approach, this chapter provides an overview of the current
strands of person-centred and experiential psychotherapies, in particular: classic
client/person-centred, dialogic, focusing-oriented, process-experiential therapies and
Pre-Therapy. It maps out the different schools of thought and discusses their
commonalities and differences. This chapter provides an introduction to the various
orientations and positions that are discussed throughout the Handbook - and it is an
invitation to dialogue.
Carl Rogers' presentation at the University of Minnesota on 11 December 1940 is
widely acknowledged as the birth of client-centred therapy (Kirschenbaum, 1979:
112) and he made his most complete theoretical statement in 1959 (Rogers, 1959).
However, theories are like genies: they have the tendency of changing shape as soon
as they are released. Rogers was at the epicentre of change in client-centred theory
during his lifetime; he disliked dogma and rigidity, describing many of his most
durable writings as 'tentative' and in his 1970 conversation with Joseph Hart he spoke
of 'the value of presenting something before you are entirely sure of it' (Rogers and
Hart, 1970: 520). In this conversation, Rogers was speaking about nothing less
important than his 'necessary and sufficient conditions' (Rogers, 1957) and 'process
conception of psychotherapy' (Rogers, 1958).
Not only did Rogers enjoy developing his own thinking, he positively encouraged
it in his students and associates. The early years of client-centred therapy at the
University of Chicago saw only a brief period as a 'unified school' (Barrett-Lennard,
1998: 58) and new developments in theory,
108
THEORETICAL FOUNDATIONS
research and practice were soon in full flow at an astonishing pace. It is not
surprising then, that it very quickly became difficult to tell where 'client-centred
therapy' ended and something qualitatively different began. Two ways of thinking
emerged to cope with this. One held true to the fundamental principles outlined by
Rogers in 1959; another favoured developing newer ideas at varying tangents to, yet
wholly informed by, Rogers' original work. Hutterer (1993) identified these as two
poles of a crisis of identity for the approach: one pole being the commitment to a set
of core person-centred values, the other 'the attempt to free theoretical thinking of
rigid concepts' (1993: 275). Or, put another way these represent the tension between
the pure form and new ideas. They also provide the axes of the map for developments in the theory and practice of client-centred/person-centred and experiential
therapies since 1959. Different developments can be located according to the
coordinates of non-directivity, the necessity and sufficiency of the therapeutic
conditions, and an understanding of the actualizing tendency (see Chapters 1, 2, 5
and 7, this volume).
In order to fully apprehend the details of the positions and arguments summarized
in this chapter, serious students of contemporary person-centred and experiential
therapies can look forward to an exploration of the extensive contemporary
literature. Such exploration is not only generally informative, but also increasingly
necessary in order that practitioners might accurately position themselves in the
'family' of these therapies.
Readers are first directed to a stream of papers and chapters complaining about,
documenting or attempting to resolve a perceived threat of imminent fragmentation
of the approach, starting with the prescient 'Roundtable discussion' in the August
edition of the Person-Centered Review, 1986 (1(3): 334-52), 'What is most essential
to the continued development of the theory and application of the person-centred
approach'. Other notable contributions include Hutterer (1993), Lietaer (2000, 2002),
Sanders (2000, 2004), Schmid (2002b, 2003) and Warner (2000). All are caught on
the horns of the dilemma: freedom from rigid theory versus definition of core values.
However, there has been movement in the 20 years since the inconclusive roundtable
discussion. The later contributions all attempt to present ways of defining core values
which place a premium on inclusivity and the embracing of difference, rather than
excluding deviation from the pure form. Most also suggest a framework or system
(different in each case) for judging the degree of person-centredness based in whole
or in part on non-directivity, the necessity and sufficiency of the conditions and the
actualizing tendency.
Core values as seen by different authors
A brief summary of Lietaer (2000, 2002), Sanders (2000, 2004), Schmid (2003) and
Warner (2000) follows in order that readers might judge each approach catalogued in
this chapter according to criteria presented in the respective papers.
109
110
THEORETICAL FOUNDATIONS
Level 2: the therapist uses personal experiences and theories in order better
to understand (but not influence) the client's experience.
Level 3: the therapist brings material into the relationship in ways that
foster the client's choice as to whether and how to use such material.
111
Level 4: the therapist brings material into the relationship from his or her own
frame of reference from a position of authority or expertise.
Level 5: the therapist brings material from outside the client's frame of
reference so that the client is unaware of the intervention, its nature or the
therapist's purpose in making the intervention.
Warner asserts that client-directed therapies would be found at levels 1-3, whilst
therapies using interpretations, suggestions and techniques would be found at levels
4-5. She also suggests that the attitudes implicit in levels 1-3 would be more
indicative of therapists who understood the actualizing tendency to be central to the
change process. In short, she concludes that whilst some person-centred and
experiential therapists might make a few interventions at level 4, her scale places
person-centred therapies in levels 1-3.
Person-centred/client-centred therapy
Classic non-directive client-centred therapy: the pure form
The appellation 'classic' or 'classical' related to client-centred therapy, is a somewhat
recent development, possibly used first by Lietaer (1990: 11) in the form 'classic
Rogerians'. As new approaches and integrative variants sprang from the work of
Rogers, those theorists and practitioners whose practice was defined by Rogers' early
work in Chicago (see Chapter 3, this volume) struggled to identify themselves as
different from what had become a general melee of generic person-centred therapists.
Some preferred to identify themselves as 'non-directive' and others as 'client-centred'
therapists (to set their work apart from what they see as the more inclusive term
'person-centred therapists'). Although far from universally accepted, the term classic
client-centered therapy is becoming more frequently used as a descriptor of Rogers'
founding formulations (e.g. Rogers, 1959), with a distinct emphasis on non-directive
intent. Those most associated with this original form are Barbara Brodley (1996),
Jerold Bozarth (1998) and most recently Tony Merry (2002), who gives a
comprehensive account of the theory of motivation (actualization), personality (19
propositions, Rogers, 1951) and therapy (Rogers, 1959), and in summary form two
years later (Merry, 2004).
The salient distinguishing features of the classic form are understanding and
accepting:
the actualizing tendency as the unitary motivation for human beings
the need for positive regard and ensuing conditions of worth as the
fundamental origin of psychopathology
the necessity and sufficiency of Rogers' therapeutic conditions for
personality
change (driven and directed by the actualizing tendency)
the inviolable sovereignty of the client and the client-centred location of
the
therapeutic process represented by principled non-directivity.
Although referred to as classic, original and pure, it cannot be said that this founding
formulation does not itself continue to develop. Many practitioners have elaborated,
extended and added to Rogers' original concepts and practice
112
THEORETICAL FOUNDATIONS
without violating the principles outlined above. An incomplete and contestable list of
developments includes Barbara Brodley's refining and elevation of the concept of
empathy, and origination of 'empathy-only' practice (Brodley, 1996, 2001); Dave
Mearns' (Mearns, 1996; Mearns and Cooper, 2005) broadening the possibilities by
developing the thesis of working at relational depth; Barry Grant's elaboration of
principled and instrumental non-directivity (Grant, 1990/2002), and Jerold Bozarth's
identification of unconditional positive regard as the 'curative factor' (Bozarth, 1998:
83) in personality change.
Encounter-oriented (analogical) approaches
Originating in the work of philosopher Martin Buber, the idea that the human change
process consists entirely in the co-created inter-subjective relationship between
helper and person helped is widely acknowledged in the person-centred 'family' of
therapies and is emerging as a sub-orientation in its own right. Such an approach is a
tacit critique of the subjective, individual self-psychology at the centre of most
interpretations of Rogers' work, and it is this strong theme that demands
consideration as an approach in its own right. A dialogical approach is implicit in the
recent work of Godfrey Barrett-Lennard (2004) and Dave Mearns (Mearns 1996;
Mearns and Cooper, 2005), but Peter F. Schmid (1998, 2001a, 2001b, 2001c, 2002a,
2006) has been foremost in elaborating dialogical therapy through the work of
philosopher Emmanuel Levinas. Schmid positions himself close to classic clientcentred therapy, non-directive and espousing the sufficiency of Rogers' therapeutic
conditions, but makes the encounter between the helper and helped much more than
a mere conduit for helping ('encounter' being different from 'relationship'). In a
sophisticated series of propositions, encounter-oriented dialogical therapy plays on
moment-to-moment interdependent meanings of 'self, 'other' and 'meeting' in the
encounter. It is very difficult to summarize these given the space allocated here, but
they could be understood as appreciating all of the potentials made possible in the
separateness of the Other anew in every moment of meeting. This acknowledgement
of the Other means that the therapist approaches the client as a naive seeker, open to
whatever the Other has to offer (see Chapter 4, this volume).
It may be the case that, in practice, an encounter-oriented therapist might look very
much like a classical client-centred therapist, but brings a very different repertoire of
sensibilities. Of the many consequences of such an ethos is appreciation of human
beings as necessarily social and creative. The individual, understood as 'self-first', is
no longer centre stage. The Other and the co-created moment between Thou and I is
at the core. A further consequence is that this approach emphasizes the social context
of therapy and thus emphasizes the value and rich possibilities of group therapy (see
Chapter 8, this volume).
How do dialogical approaches to psychotherapy fit into the person-centred and
experiential 'family'?
Setting aside the historical emphasis on individual, subjective self-psychology, there
are no differences of any substance between classical client-centred therapy
113
and the emerging dialogical therapy. Only through facing the Others and appreciating
their uniqueness can therapists free them to actualize their potential. Anything else
would effectively constitute a limiting condition of worth, either acted out, or
implied by our personal philosophy. Such implications are powerful precursors to
real behaviour and lead dialogical therapists to pay particular attention to their deep
understanding of what it is to be human.
The meta-perspective of integration
It is important to immediately distinguish between eclecticism and integration.
Eclecticism - sometimes referred to as 'technical eclecticism', a term coined by
Dryden (1984) - denotes assembling a collection of techniques on an ad hoc basis
according to the requirements of the situation as seen by the therapist. It mimics the
medical approach to treating somatic disease by affecting a 'diagnosis-andapplication-of-appropriate treatment' method. The many flaws with this type of
approach include that there is no scientific basis for such 'diagnoses' and there is
scant evidence for the appropriateness of the 'treatments' which might be applied
(Sanders, 2005).
The United Kingdom Council for Psychotherapy (UKCP) in its section on
'Humanistic and Integrative Psychotherapies' defines integrative therapy as follows:
Integrative therapy can be distinguished from eclecticism by its determination to
show there are significant connections between different therapies, which may be
unrecognized by their exclusive proponents. While remaining respectful to each
approach, integrative psychotherapy draws from many sources in the belief that no
one approach has all the truth.
(http://82.21 9.3 8.131/ukcp.org.uk/home.asp?p=sections_hips.asp)
Rather than react to the client in an entirely ad hoc way, then, integrative models
attempt to develop an effective prospectus for treatment by one or more of the
following methods:
identifying and bringing together common theoretical components identifying and
bringing together common techniques and methods development of a meta-theory
(possibly derived from the first two points above, or by extending an existing
theory).
Readers will probably be aware that this will give rise to numerous definitions of
integrative therapy - too many even to mention here. Also it may have occurred to
readers that the idea of integrative models is predicated on the idea of 'pure forms',
and so it may in fact be better to speak in terms of an integrative approach to therapy
rather than integrative models. And finally all of this reproduces the tensions in the
'family' of person-centred and experiential therapies already described - between the
'pure form' and the 'new developments'. So rather than catalogue integrative models,
I will direct readers to an approach to integrating material into person-centred and
experiential practice whilst testing the process against person-centred core theory
and exploring
114
THEORETICAL FOUNDATIONS
116
THEORETICAL FOUNDATIONS
broadened its horizons to integrate influences from a wide variety of sources from
gestalt therapy to cognitive/information-processing psychology. Close observation
and innovative research led to the building of theory which Elliott and Greenberg
(2001: 279-81) summarized as being built on:
the humanistic values of self-determination, the primacy of experiencing,
lifelong psychological development, pluralism, egalitarianism, holism and
authentic person-to-person relationships
Greenberg's emotion theory (Greenberg and Paivio, 1997)
a dialectical constructivist theory of self and change
empirically supported methods
a process orientation: that is, an emphasis on the unfolding of moment-tomoment process within the client's and therapist's experience and within their
relationship.
The treatment principles and methods (explained at two levels of therapist responses
and tasks) distilled through research, are described by Elliott and Greenberg (2001:
281-91):
Empathic attunement: actively entering the client's world anew, resonating
with the client's experience as it evolves from moment to moment, not as
a technique to evaluate or diagnose the client.
Therapeutic bond: the expression of non-judgemental, genuine prizing of
the client.
Task collaboration: build a relationship on mutual involvement in the
goals and tasks of therapy (accepting the client-generated tasks and goals
and describing the emotional processes involved).
Experiential processing: facilitating optimal client engagement with
moment-to-moment experiencing (helping the client work in appropriately
different ways with different tasks to maximize effectiveness).
Task completion: facilitate the client to complete the key therapeutic tasks
identified (persisting in helping the client to stay on task).
Growth/choice: emphasis on client agency by fostering client growth and
self-determination (encouraging the client to make in-session decisions
about goals, tasks and activities).
Within this protocol, the therapist might make use of specific interventions
prescribed by process experiential therapy, including two-chair and empty-chair
dialogue, focusing and meaning creation. Readers should be aware, however, that
this is a snapshot of a therapeutic theory in progress, since process-experiential
therapy is a developing approach that is a result of a continuous research programme.
How does process-experiential psychotherapy fit into the person-centred and
experiential 'family'?
Process-experiential therapy has a clear agenda in terms of how the relationship is to
be configured, the expert role of the therapist with regard to the therapeutic process,
the direction and progression of interventions
117
and the goals and tasks of the client. Whilst process-experiential therapy-revolves
around a therapeutic relationship founded on Rogers' therapeutic conditions, it
extends considerably beyond the sufficiency 'rule'. It actively integrates relationship
elements and techniques validated by process-experiential research, and in Warner's
terms, process-experiential therapy is self-consciously interventive at level 4. A
theory and practice edifice so constructed sparks fierce debate in person-centred and
experiential circles, and by any measure it challenges definitions of what might be
reasonably considered to be person-centred. But is this a bad thing? Its proponents,
however, frequently reassert the links with Rogers' work and continually refer to the
humanistic underpinnings, the centrality of Rogers' conditions to the therapeutic
process, the right of the client to self-determination, and collaboration.
Pre-Therapy
Although Garry Prouty himself specifically referred to his work as being not a
therapeutic approach per se, but pre- (coming before) therapy, it deserves a brief
introduction in this review (Prouty, 1994; Prouty et al, 2002) (see Chapter 18, this
volume, for a more comprehensive and detailed presentation). Prouty was the first
person to make a serious study of psychological contact. His work confirmed Rogers'
early hypothesis that therapeutic change cannot take place without psychological
contact, and developed a conceptual and practical system for understanding and
establishing contact with people whose ability to make contact had been impaired by
illness or injury, organic or psychological. The range of applications (still growing)
includes clients who are contact-impaired as a result of age-related and other forms
of dementia, brain injury, terminal illness, 'psychosis', dissociation, severe learning
disability or autism.
Prouty describes Pre-Therapy as 'applied phenomenology' and explains its action
as 'pointing at the concrete'. Through irreducible 'contact reflections' (extremely
simple reflections regarding verbal and facial expressions and the shared reality of
the environment), the client is brought back into contact with his or her experience,
other people and the world. When contact and everyday functioning is restored,
psychotherapy is then possible. The 'pre-expressive' self (the person previously
trapped inside) is now able to choose to take part in everyday human relationships
and some of the secondary symptoms of chronic isolation dissolve.
Although it might appear simple to describe, Pre-Therapy is not easy to do. Most
trained therapists have great difficulty in stripping away the finer aspects of
therapeutic communication to get to the bare bones of applied phenomenology
required for successful contact work.
How does Pre-Therapy fit into the person-centred and experiential 'family'?
There can be no doubt that Pre-Therapy is closest to the core of classic client-centred
therapy in practical terms. It is vital to remember, however, that it is not
118
THEORETICAL FOUNDATIONS
a 'normal' human relationship in the strict sense. It is a way of being for special
occasions. Its essential protocols are derived from the need to make the most basic of
relationship moments with another human being and so are incomparable with other
applications of Rogers' work. Yet Pre-Therapy is without doubt one of the purest
incarnations of person-centred communication.
Modalities
There is no space to do more than list the various therapeutic applications of classical
client-centred, person-centred, focusing-oriented and process-experiential therapies.
It is important that readers realize that there are no theoretical or practical limits
(save the imagination of the therapist) that would limit the application of this 'family'
of therapies. Readers are directed to other chapters in this book and, among others,
the work of the following innovators in their respective fields: Moon (2002) in child
psychotherapy; O'Leary (1999) in couple therapy (see Chapter 20, this volume);
Gaylin (2001) in family therapy; N. Rogers (1993) in expressive arts therapies (see
Chapter 23, this volume); Hobbs (1951), Raskin (1986a, 1986b) and Shlien (2003) in
group therapy (see Chapter 8, this volume).
CONCLUSION
If the terms 'person-centred' and 'client-centred' have become too general and lacking
in discrimination, then new descriptors are necessary. And it is possible that this list
of new names continues to grow even as I write, and certainly more variations will
have been added by the time this book is published. So, reconciled to be forever one
or two steps behind, I hope I leave readers better able to make decisions about the
newest types of therapy that claim to be inside, or just outside, the big tent of the
person-centred and experiential approaches.
It is clear that person-centred psychotherapies have developed and diversified
considerably since 1960. Today the fashion elsewhere in psychotherapy is to be
'beyond schoolism', so readers might well ask why the client-centred community
seems hell-bent on diversification, rather than unification? In addition, they might
despair that such divergence might lead to conflict. It is my view, however, that the
apparent proliferation of 'brands' is not competitive in nature; rather it is descriptive.
Better understanding of what therapists do is an ongoing process of description,
refinement and development of ideas in which all therapists should engage for the
sake of their prospective clients, for fellow professionals and for themselves. No
therapists are beyond refining their understanding and description of their own
practice, and we all have much to learn from the work of others.
119
REFERENCES
Barrett-Lennard, G.T. (1998). Carl Rogers' Helping System: journey and substance.
London: Sage.
Barrett-Lennard, G.T. (2004). Relationship at the Centre: healing in a troubled
world. London: Whurr.
Bozarth, J.D. (1998). Person-Centered Therapy: a revolutionary paradigm. Rosson-Wye: PCCS Books.
Brodley, B.T. (1996). Empathic understanding and feelings in client-centered
therapy. Person-Centered journal, 3, 1, 22-30.
Brodley, B.T. (2001). Observations of empathic understanding in a client-centered
practice. In S. Haugh and T. Merry (eds), Rogers' Therapeutic Conditions (pp. 1638). Volume 2. Empathy. Ross-on-Wye: PCCS Books.
Dryden, W (1 984). Individual Therapy in Britain. London: Harper and Row.
Elliott, R.F. and Greenberg, L.S. (2001). Process-experiential psychotherapy. In D.J.
Cain and J. Seeman (eds), Humanistic Psychotherapies: handbook of research and
practice (pp. 279-306). Washington DC: American Psychological Association.
Elliott, R., Greenberg, L. and Lietaer, G. (2004a). Research on experiential
psychotherapies. In M.J. Lambert, A.E. Bergin, and S.L. Garfield (eds), Handbook
of Psychotherapy and Behavior Change (pp. 493-539). 5th edn. Washington DC:
American Psychological Association.
Elliott, R., Watson, J.C, Goldman, R.N. and Greenberg, L. (2004b). Learning
Emotion Focused Therapy: the process experiential approach to change.
Washington DC: American Psychological Association.
Gaylin, N.L. (2001). Family, Self and Psychotherapy: a person-centred perspective.
Ross-on-Wye: PCCS Books.
Gendlin, E.T (1978). Focusing. New York: Everest House.
Greenberg, L.S. and Paivio, S. (1997). Working with emotions in psychotherapy. New
York: Guilford.
Grant, B. (1990/2002). Principled and instrumental non-directiveness in the personcentred approach. Person-Centered Review, 5, 1, 77-88. Reprinted in D.J. Cain
(ed.) (2002), Classics in the Person-Centered Approach (pp. 371-7). Ross-on-Wye:
PCCS Books.
Hendricks, M.N. (2001). Focusing oriented/experiential psychotherapy. In D.J. Cain
and J. Seeman (eds), Humanistic Psychotherapies: handbook of research and
practice (pp. 221-52). Washington DC: American Psychological Association.
Hobbs, N. (1951). Group-centered psychotherapy. In C.R. Rogers. Client-centered
Therapy (pp. 278-319). Boston: Houghton Mifflin.
Hutterer, R. (1993). Eclecticism: an identity crisis for person-centred therapists. In D.
Brazier, Beyond Carl Rogers (pp. 274-84). London: Constable.
Kirschenbaum, H. (1979). On Becoming Carl Rogers. New York: Delacorte.
Kirtner W.L. and Cartwright D.S. (1958). Success and failure in client-centered
therapy as a function of initial in-therapy behavior, journal of Consulting
Psychology, 22(5): 329-33.
120
THEORETICAL FOUNDATIONS
121
122
THEORETICAL FOUNDATIONS