Client Issues in Counselling and Psychotherapy

Person-centred Practice

Janet Tolan, Paul Wilkins

• Publisher: SAGE Publications Ltd
• Year: 2011
• ISBN:
  9781446289938
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This is the first book to focus on commonly occurring client issues and explore how to work with them from a person-centred perspective. Extensive case studies translate person-centred theory into effective practice, enabling therapists to work successfully with clients presenting a variety of different problems including:

-Post Traumatic Stress

-Depression

-Panic and Anxiety

-Drug and Alcohol Issues

-Eating difficulties

-Self harm

-Childhood Sexual Abuse

Each chapter covers the origin and meaning of the difficulty, the person-centred therapeutic approach and process, and the outcomes. Drawing from a combined 50 years of experience in the field, Paul Wilkins and Janet Tolan bring together leading person-centred therapists to address how and why each problem can be eased by means of working with the person.

This book should be on the desk of every counselling and psychotherapy trainee, and is recommended reading for other practitioners of health and social care working with these client groups.

1

INTRODUCTION

PAUL WILKINS AND JANET TOLAN

This book is primarily about how you might work with clients experiencing one or more of a number of life events, emotional reactions to life events or behavioural reactions to life events. Our theoretical and practice stance is person-centred and a good understanding of the theory of person-centred (also known as client-centred) therapy is essential to the work described in this book. In order to set the scene, in this chapter we are going to remind you of some of the fundamentals of person-centred theory and how they relate to practice. However, our reminder is necessarily brief so, at the end of the chapter, we have provided a guide to Further Reading for those of you who want to know more.

As we say above, this book translates theory into everyday events as they affect us as people and as we encounter them in the therapy room. Why would someone wreck their own health by eating too much or by overindulging in drugs or alcohol? Why does one person seem to be able to grieve and reach a place of relative calm, where another is pitched into years of emotional pain? How does childhood abuse affect the adult and how can the person-centred therapist help? Each chapter is written by an experienced practitioner who is able to convey how it actually is in the therapy room and relate this to person-centred theory.

In the person-centred tradition different individuals respond differently to each experience they may have, in accordance with their self-structure, so that we cannot make definite statements along the lines of: if A happens then people will feel B and C. We are even rather wary of statements like most people will feel B and C because we have seen how tentative statements like Following a bereavement, a specific sample of people seemed to go through these stages have become There are five stages of grieving. However, there is a clear need for us to show how the person-centred theoretical framework is applied to a range of presenting issues that are common in the therapy room.

Presenting Issues

When a client first approaches a counselling service, we use the term presenting issue to indicate that aspect of a client’s experience they choose to highlight. However, this term covers a very wide range of experiences. We may call these experiences bereavement, depression, self-harm, sexual abuse, substance use and so on but it is important to recognise that these are a shorthand way of referring to ways of experiencing the world and reacting to life events and that they vary from individual to individual and with time. Also, in practice, these are often interrelated; for example a person may react to a life event that they have experienced (for example, childhood abuse) both emotionally (perhaps by being ‘depressed’) and behaviourally (for instance, by developing a problem with respect to food). Similarly, a bereaved person might well experience depression or turn to alcohol to numb their pain.

There are three Parts in this book. Part 1 illustrates how a client may present with a story relating to an experienced life event. Usually this will be something that has received media attention and is considered to be ‘big’ enough by the clients to warrant their giving it time and paying it attention. In this book, we use loss and bereavement, experiencing traumatising events and childhood sexual abuse as our examples. This list is not exclusive. Again, it is entirely possible – even probable – that a client who comes initially ‘suffering from’, say, depression will discover their own losses or abuse through the therapeutic process.

Part 2 of the book focuses on psychological and emotional responses to life events. The examples we use are depression, anxiety and ‘different realities’ – that is, a range of responses that are usually termed ‘psychoses’ or mental illness. Person-centred theory sees these as the positive attempts of the organism to promote change. Simplistically put, just as a broken leg hurts to alert its owner that it needs attention, so does a wounded psyche.

Part 3 looks at behavioural responses to life events, specifically substance use, difficulties with eating and self-harm. Again, in terms of person-centred theory these behaviours are seen as functional for the organism – to self-soothe, say, or to take control, or to remain part of a drug-based community. This latter point illustrates that although there might be many commonalities within a given subject area, person-centred theory demands that we listen to the individual client – to their reasons for being depressed, to their reasons for self-harming. Moreover, through this process the client will come to hear their own reasons and grow in self-acceptance.

Person-Centred Theory

Since Rogers and his colleagues began to develop what was then called ‘client-centred therapy’ (previously ‘non-directive therapy’) in the 1940s and 1950s, a family of related approaches has been established around the original conceptions. Major branches of this family include focusing, experiential and process-experiential therapies. However, the focus of this book is on what in the UK is normally called ‘person-centred therapy’ – that is, an approach to therapy that has the non-directive attitude at the centre of theory and practice. Because it focuses on and explores practice, it will be useful to people training as person-centred therapists, to practitioners of the approach and to anyone else who wants an easily accessible source-book covering the major aspects of the ‘how to’ of person-centred therapy.

At the core of person-centred theory is the hypothesis of the actualising tendency. This is the drive within us all towards accepting ourselves as we are and the world as it is. Like the plant that will keep on trying to grow no matter how badly it is treated, we are all trying to develop in the best way we can. In many therapies, there is an attempt to seek to diagnose what is wrong with a person and then to fix it. Person-centred theory tells us that people are always doing the best they can in the circumstances in which they find themselves and that the way to understand someone is for therapists to put themselves in the client’s shoes (i.e. to experience the client’s world as if it were their own). Moreover, the very act of empathising in this way becomes part of the healing process. It is because of the actualising tendency that the therapist’s job is to support the growth of the individual no matter what direction that growth may take, and so another concept central to person-centred therapy is the non-directive attitude.

However, this is a book about presenting issues. How does the theory ‘fit’ with something like bereavement – and what practice follows from this? It is impossible as a therapist to separate the person (or client) from what they are going through. Our theory explains how and why the self-structure has developed as it is in each individual and how some – or much – of this will be out of the individual’s awareness. So, when people receive psychological blows, they will each respond according to their self-structure. In dealing with the event in a therapeutic setting, each of them will probably become aware of some of those elements of the self-structure that are less functional in the current situation – and possibly in life generally. In the example of bereavement, one client may come to realise that she is driven to care for others and is not able to accept care for herself; another may realise that expressing grief is, in his own eyes, fundamentally unmanly; yet another may question his belief in a loving deity. So the basic work of person-centred therapeutic endeavour – a greater integration of self-structure and experience and hence a reduction in anxiety and distress – is undertaken.

Our theory tells us that people seek therapeutic help when difficult and uncomfortable emotions are experienced strongly or chronically. The second of Rogers’ necessary and sufficient conditions specifically requires that the client be vulnerable or anxious. This is the organism’s way of prompting us to pay attention to ourselves (just as a physical pain or ache prompts us to go to the doctor). With some clients, the prompt will be an event like a mugging or being made redundant, with others it will be a longstanding feeling that does not go away such as anxiety or depression. Because each client is unique, we need a thorough grounding in our fundamental theory of personality development and therapeutic change in addition to an understanding of the common features of presenting issues such as abuse, bereavement or depression. We also need the sensitivity and ability to combine these with a personal response to the person with whom we are working, remembering that it is the client not theory that is at the centre of the process.

Person-Centred Personality Theory

The originator of what was then usually known as client-centred therapy, Carl Rogers, wrote the following about his theory of personality (Rogers, 1951: 532):

This theory is basically phenomenological in character, and relies heavily on the concept of the self as an explanatory construct. It pictures the end-point of personality development as being a basic congruence between the phenomenal field of experience and the conceptual structure of the self – a situation which, if achieved, would represent freedom from internal strain and anxiety, and freedom from potential strain; which would represent the maximum in realistically oriented adaptation; which would mean the establishment of an individualized value system having considerable identity with the value system of any other equally well-adjusted member of the human race.

The ‘Nineteen Propositions’ detailed in Rogers (1951: 483–522) and the classic paper also by Rogers (1959) provide an elegant statement of a theory of personality consistent with person-centred concepts of change (Wilkins, 2010: 31). In these works Rogers demonstrates the person-centred view of the person as continually in process – that is, personality as fluid, not fixed. Explicit in this theory is that harmful and/or inhibiting early experiences give rise to distortions and denial of experience and that these give rise to emotional or psychological distress. However, people have the potential to accept their experiences into awareness and to move towards being ‘fully functioning’.

Rogers himself refined and restated his person-centred theory of personality, and always made it clear that he saw theory as something to be held tentatively and continually tested against practice. In the light of this encouragement towards inquisitiveness, many practitioners and writers have further explored and developed his theoretical ideas.

Drawing together threads from Rogers’ theoretical statements, Sanders (2006: 21–4) characterises person-centred personality theory as:

• A phenomenological theory: it emphasises the subjective, experiential world of the individual.
• A perceptual theory: because an individual’s reality is based on his or her perception of the world, then a change in perception leads to a change in experience and behaviour.
• A humanistic theory: it is rooted in a naturalistic philosophy that (p. 23) ‘relies primarily on reason and science, democracy and human compassion’.
• A holistic theory: the organism is central – human beings are (more than?) the sum total of their parts.
• A fulfilment of potential, growth-oriented theory: the person-centred metaphor for recovery is not ‘cure’ or ‘mending’ or ‘reprogramming’ but of growth or development to a new way of being.
• A process theory: neither personality nor self are fixed ‘things’, rather, being human is a process, not a state.

Self-Structure, Self-Concept and Organismic Experiencing

Central to person-centred theory is the concept of the ‘organism’, that is, the whole person comprising a number of subsystems, including biochemical, physiological, perceptual, emotional, behavioural and relational systems. This organism simply experiences the world. In order to make sense of that experience, human beings develop a ‘self’.

While it is acknowledged that ‘self’ is a process, fluid rather than fixed, in classic client-centred theory the term is used in two principal ways. First, there is the emerging or developing self, which was thus defined by Rogers (1959: 200):

The organized, consistent conceptual gestalt composed of conceptions of the characteristics of the ‘I’ or ‘me’ and the perceptions of the characteristics of the ‘I’ or ‘me’ to others and to various aspects of life, together with the values attached to these perceptions. It is a gestalt which is available to awareness though not necessarily in awareness. It is a fluid and changing gestalt, a process, but at any given moment it is a specific entity ...

In a way, this ‘self’, the experiencing self, is what is differentiated from the organism (as a total openness to experiencing more like that of an infant) through interaction with the environment and, especially, significant others. In the vernacular of Western society, this conceptualisation of the self may be equated with the individual.

Second, there is the self-concept which, in the simplest terms, is the view one has of one’s self. But this is intrinsically linked with the way one s...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• About the Editors and Authors
• 1 Introduction
• Part 1 Life Events
• Part 2 Emotional Reactions to Life Events
• Part 3 Behavioural Reactions to Life Events
• Index