This section follows a more academic discussion of my choice of therapeutic approach. I have tried to make my theoretical rationale explicit. If you find these arguments helpful to your own studies please feel free to quote the material but acknowledge the source ( © Don Rawson 2003).
Quick links: Person Centered Approach | Systemic Therapy | CBT | Multicultural CounsellingPerson Centred Approach
The Person Centred approach remains one of the most popular forms of psychological counselling. It provides a frame of reference as much as if not more than a counselling method. In Carl Rogers' original perspective, clients (as all people) are seen to engage continually in the attempt to self-actualise. This optimistic philosophy led to the promotion of a model of counselling in which clients are regarded as their own best resource for growth and change. Rogers (1951) early Non-Directive approach developed into Client Centred therapy which emphasised accuracy in empathy. In its current form, the Person Centred approach underscores the reciprocal nature of the helping relationship. At the core is a well known set of constructs about the intrinsic nature of people and the functioning of the helping relationship rather than the counselling method (the Core Conditions). Competent practitioners are thus defined by their level of self awareness and capacity to engage in a meaningful helping relationship rather than any technical knowledge of Person Centred counselling. Valuing the unique phenomenological position of the client, Person Centred counselling still retains the positive and optimistic value base of early work but now elaborates a more sophisticated model of humanity.
The concept of core conditions is inextricably linked to the early work of Rogers (1957). The terminology has since evolved but the fundamental principle of the concept of core conditions remains essentially unchanged. The original strong version of the model holds that core conditions are necessary and sufficient for clients to experience therapeutic change. Later post modern or sophisticated versions of Person Centred counselling posit that the conditions are foundations for change and adds other broader requirements (Rennie 1998). The original shortlist of core conditions has been considerably expanded (Carkhuff 1969):
I agree with Thorne (1991) that tenderness is as important a core condition as any, and something I aim towards in my own counselling practice.
Creating trust in the helping relationship is a fundamental tenet of all Person Centred therapy. Not only must the client learn to trust the counsellor, but also the counsellor must trust that the client is the best person to set their own goals and access their own resources to achieve them. The problem is, however, that people often come to counselling because they are thwarted in their capacity to identify or reach their own goals (Haley 1976).
Rather than being a passive "listening post", then, the counsellor must strive to actively listen, actively engaging mind to compare what is being revealed to previous disclosures. Clients in turn use the process to try to make sense of their experience.
Egan (1994) distinguishes primary and advanced empathy. Primary empathy is said to depend on counsellors attending, listening and communicating back their understanding of the clients position as experienced by the client. Advanced empathy, however, also incorporates self-disclosure, directiveness and interpretations. The sophisticated version thus gives a more active role to the counsellors processing and implicit use of a theoretical framework rather than relying on purely experiential nature of the counselling encounter as the main source for the validation of material presented by the client.
There is often an opportunity for relearning emotional experiences through advanced emotional empathy. As the relationship between the client and counsellor develops so it becomes possible for the client to cautiously re-experience feelings. This marks the dawning of self-awareness, recognising links between past and present, preparing the ground for problem resolution (Brems 1999).
The process of therapeutic change in Person Centred counselling represents a movement from purely cerebral to feeling states and gives immediacy. It also marks a change to an internal locus of control. Mearns (1994) distinguishes osmotic (slow developing change) and seismic (sudden shift) in experience of the self. The Person Centred approach contains much confrontation. Clients may be challenged to construct a new response to long held perceptions. Empathy is itself a confronting activity, challenging clients about the quality and validity of their feelings. The counsellors own congruence can also challenge clients where behaviours are offered as challenge to the counselling situation.
Reframing the client's narrative and confronting discrepancies in their account can open up possibilities for change. Rogers (1980) posits the counselling process is a means of rediscovering denied experiences. It aims to put clients in touch with themselves. Counsellors confrontation should be born out of respect and a desire to help the client through the struggle to realise their own potential. It is particularly important, however, for counsellors to get the power dynamic right so that the client comes to understand that the counsellor becomes responsible to rather than for the client (Mearns 1994). The aim, then is to help clients realise their own power.
Schmid (1998) points out that Person Centred counselling is in fact a radical approach. The Latin and Greek etymology of "person" is associated with mask or face. Schmid reminds us that in Greek theatre the mask did not hide the character but served to reveal the personification of the gods. Contemporary psychological meaning of the person is defined by two traditions: as an independent being; as a being in a relationship. Both concepts have powerful implications for psychotherapeutic counselling. Rogers original usage is consistent with the first definition, representing a celebration of selfhood as emancipated from the social milieu. The latter definition, however, implies persons are defined by, and indeed can only exist as, reflections of interactions with others. Schmid also contends the parallel definition creates a tension which finds its way into therapy. The client aims to become their own essential self (independent being). The therapist also tries to manifest self authentically (congruence). Paradoxically, however, it is the therapeutic relationship (being in a relationship) which is the sole vehicle for the journey.
Person Centred counselling retains a humanistic philosophy and a phenomenological focus. Prominence is given to the role of the self in effective psychological functioning. Post modern trends in counselling extend the concept of self to include interpersonal, systemic and socio-cultural aspects. Psychological difficulties have to be understood from a variety of subjective meanings and be context sensitive. It is now seen to be a "relational-contextual" self in contrast to an "autonomous-independent" self of the early Person Centred formulations (Nystul 1999: 399).
Van Kalmthout (1998) considers Roger's formulation to be one of the most useful theories of personality change for therapeutic work. As he cogently expresses:
"What crucially distinguishes PC theory from more deterministic approaches is the assumption that it is possible to go beyond our conditioning." (p.55).
That is, Person Centred counselling is emancipatory in its intent. When counsellors enter their clients phenomenal world proffering empathic understanding and positive regard they do more than stand with their client. Effectively they urge their clients to become liberated from their negative self concepts which are expressions of previous hurts and past conditioning. In this sense Person Centred counsellors have to be prepared to challenge what they hear as much as being good listeners.
Van Kalmthout (1998) argues that the basic tenet of Person Centred counselling presents a paradox in practice. The therapist tries to maintain a position of avoiding directing the client but at the same time guides the client to assert the inner self as a autonomous agent distinct from external authority. It also represents a particular Western ideal. It is distinctly not value free in its aims and methods. Van kalmthout says that PC theory offers a system of meaning, a description of the veracity of the inner subjective world. Since the empirical manifest self is a distorted version of the true essential self, the meaning of life in this scheme of things is to live as congruently as possible which also means affirming a particular set of values or indeed a spiritual attitude. It is not for the faint hearted.
Quick links: Person Centered Approach | Systemic Therapy | CBT | Multicultural Counselling
Systemically based counselling aims to help clients become aware of how the social and psychological system they belong to operates and to reflexively experience their self as part of the system as well as viewing it from the inside, thus distinguishing figure from ground. A well known adage of Systemic Therapy is that "the solution is the problem" (Watzlawick et al 1974) meaning that the problem system has continued to impose solutions which do not work. Part of the counsellor's task, therefore is to help the client escape from this circular situation. This means reframing the problem rather than imposing another solution.
Systemic thinking attempts to conceptualize individual experience through the interdependence of relationships. That is, systems are thought of as patterns of transactions between the individual elements, producing recursive cycles of cause and effect. A fundamental property of systems thinking is thus the identification of circuits rather than linear causality. Although individual behaviour will have reciprocal effects, systems are not reducible to the properties of the individual elements. Each individual element contributes to the formation of patterns of activity, which gives the system coherence. Family styles, for example, may be thought of as recurrent and enduring patterns of interaction (Minuchin 1985). Systems may exert an effect towards homeostasis, maintaining inflexible patterns of activity over prolonged periods even where this may be dysfunctional for particular individuals. In families, the same structure of relationships of power and disadvantage may be transmitted down many generations.
All behaviour is believed to be simultaneously an expression of individual agency and a communication to others (Watzlawick et al 1974). As individuals, however, we may be blind to the latter function, unable to see the systemic wood for the trees. Consequently, we may act in paradox, producing the opposite effects to our intentions, extending the problem we mean to solve or creating change where we desire continuity.
Although Systemic therapists try to move away from concepts of linear causality in interpersonal problems, families do not generally have this view but rather wish to know who is to blame. Often this reduces to versions of social or physical traumatic life events (Wynne et al 1992). Systemic therapists seek to reframe closed linear thinking and to untangle knotted relationships by locating punctuations rather than cause and effect explanations. Punctuations are "way-points" in circular interactions rather than stopping or starting points in yet more cause and effect explanations. There should, moreover, be the possibility of multiple punctuations in any one social episode allowing for potential reframing.
Systemic therapists have developed a rich repertoire of methods to help their clients work through their systemic maze. Various kinds of hypothetical questions lead to an opening up of hypothetical context and alternative possibilities. Bor et al (1992) argue that systemic questions should be circular and relational. Future oriented questions, reflexive questions and "miracle" questions amongst others have all evolved as therapeutic tactics. As Professor Robert Bor often says, the most powerful form of intervention is a question.
Campbell et al (1991) describe some useful contrasts of systemic and non systemic thinking. These can be recast as a table of fundamental principles:
all beliefs and events are self contained entities
understanding and talking about intra psychic experience is sufficient to facilitate change
therapist responds to clients needs in isolation from the wider context
In the U.K., Systemic Therapy is most often associated with family therapy. Jenkins & Asen (1992) are critical of much of this work, though, for seeing systems as only being useful when dealing with whole families. Indeed, the individual may become lost in the therapeutic process of family based systemic therapy. As Jenkins & Asen (1992:1) declare, however, "Systems therapy is not a question of how many people are seen but refers to the theoretical framework which informs what the therapist does."
Many Systemic therapists make extensive use of genograms (family tree diagrams made with conventional flow chart symbols). Constructing a genogram with the client is especially useful for showing where the client is positioned in the family system and for indicating where there are areas of missing information. To construct the genogram the therapist must ask questions, which do more than locate people in their birth order. They also provide an opportunity to observe how aware clients are of the vertical (intergenerational) and horizontal (intragenerational) processes in their family (McGoldrick & Gerson 1985), and which axes appear to be most salient from their perspective. As the view comes into focus, interactions within the family can be explored with the client, drawing attention to aspects of structure, power, dependency, shifting alliances and repeating patterns. The therapist has, however, to be aware of not taking over the client's task of renegotiating their standpoint in the family system.
Genogram analyses are founded on the assumption that socially, the family is the primary and usually most influential system, which clients belong to (though the technique can be extended to other kinds of systems such as friendship patterns and work roles in organizations). Family lines include both blood and other kinship relationships usually spanning three generations. The use of genograms in systemic therapy is mostly founded on the work of Murray Bowen. Bowen (1978) argues the same patterns of problems tend to be repeated in different forms through "multigenerational transmission". Carter (1978) usefully differentiates vertical and horizontal flow of anxiety. Dysfunctionality may flow along either axis and indeed, a preceding difficulty in the vertical (e.g. between father and daughter) may be repeated horizontally (e.g. between husband and wife).
I make extensive use of genograms. This has become my only standard tool of assessment. The diagram is constructed on art quality drawing paper in full view of both therapist and client. I usually commence work on the genogram during the first or second session but always have it available on subsequent sessions. In addition to being a useful aid to memory the device has powerful therapeutic and heuristic functions helping to reveal the systemic properties in the client's story.
I have been particularly persuaded by the strategic approach of Haley (1976), Nardone & Watzlawick (1993), Allen (1994) and Quick (1996). Strategic models developed out of Systemic Therapy (Watzlawick et al 1974) and Problem Solving Therapy (Haley 1976). Haley also incorporated many of the paradoxical techniques of Milton Erickson's therapy (see Zeig & Munion 1999). The strategic approach conceptualizes personal problems as analogical messages which may contain multiple levels of meaning in different strengths and which make sense only if the context is understood. The Strategic approach emphasizes changing the analogies through various metaphoric tasks. Symptoms are assumed to express dysfunctionality in the family system and the presenting problem often acts to keep the family together in some way. Symptoms are also thought to contain implicit directives and requests. Therapy therefore focuses on changing the analogy by supplying metaphors or other devices to reframe the problem. Clients are thereby assisted to step outside of their usual interactional patterns and encouraged to discover new potential for change.
The strategic therapist attempts to create clear goals, which commence with addressing the particular presenting problem. Through focusing on the client's social context, therapy also impacts into the clients social situation. Even if only one individual client is worked with directly, the perspective is broader, so that individual therapy becomes a strategy for interacting remotely with the client's family or social group. This means transcending the strictures absorbed from family heritage and recovering the sense of true self. But also there is a problem of staying connected. In more everyday terms the problem is to separate without rejecting, of establishing independence without isolation, of becoming "me" without alienation from "them".
Quick links: Person Centered Approach | Systemic Therapy | CBT | Multicultural Counselling
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© Don Rawson (2003) If you find any of this material helpful for your own studies please feel free to download or quote it but acknowledge the source.