Has anyone ever said to you, ‘That’s not person-centred’, or ‘Person-centred therapists would do…’? If so, you might want to point out to them that there’s no such thing as ‘person-centred’—it’s not one, homogeneous ‘thing’. Rather, it’s a wonderfully diverse family of approaches, each with something very special to offer to the wider therapeutic field.
It starts with the classical client-centred approach of Carl Rogers from the 1930s onwards. Rogers reacted against the behaviourism and expert-directed approaches of his time, and instead emphasised the client’s own ability to find their answers to their problems. So the hallmark of the classical approach is a non-directive stance: letting the client lead the way in an accepting and empathic environment. The classical approach is still very popular and you can read about it in Tony Merry’s chapter in the brilliant Tribes of the Person-Centred Nation. There’s some argument that Rogers, himself, moved away from a classical stance in the 1960s towards a more relational standpoint (see below), but others argue that Rogers style of practice never really varied throughout his career.
Out of Rogers’s work you get the emergence of non-directive therapies with children, particularly the work of Virginia Axline. Person-centred play therapies are still very popular today and have a very good evidence base, developed by world-class researchers like Dee Ray at the University of North Texas. Natalie Rogers, Carl Rogers’s daughter, also developed an approach called Creative Connections which offers clients a non-directive space to engage with a wide variety of creative media, such as dance, music, and drama.
Focusing, which emerged in the 1960s, was probably the most important development from Rogers’s work, and took it in new and creative directions. Gendlin, its founder, believed that some clients needed to get more in touch with their inner ‘felt senses’ before they could really use therapy to its fullest. So focusing encourages clients to ‘listen inwards’ to their bodies and allow their feelings and bodily experiences to emerge. It’s really popular today in ‘peer focusing partnerships’, as well as in focusing-oriented psychotherapy; and psychotherapists of all orientations may use focusing methods in their work.
One reason why Gendlin’s break from Rogers was so critical is because it introduced the idea that some clients, some times, do need therapist direction to make the most of the work. This stance was developed further by Laura Rice and subsequent founders of emotion-focused therapy (EFT; like Les Greenberg, Robert Elliott, and Jeanne Watson) who articulated a series of methods that could be used to help clients get deeper into their emotions: the key, as they saw it, to therapeutic progress. EFT, for instance, uses ‘empty chair work’ to help clients express, and process, their feelings towards others; and ‘clearing a space’ to help them deal with overwhelming feelings. EFT is very well supported by the empirical evidence and in the US is ranked as an evidence-based therapy for depression. There’s lots of CPD trainings available on it and an international society. Sue Johnson, who worked with Les Greenberg, developed an approach called emotionally focused therapy, which has many similarities to Greenberg et al.’s EFT but is particularly oriented to work with couples. However, there’s another EFT, ‘emotional freedom technique’ (the one with lots of tapping), which is something entirely differ.
Counselling for Depression (CfD, now termed person-centred experiential counselling for depression) combines a classical person-centred approach with some ideas and practices from EFT. It was specifically developed to fit within the NHS’s NICE guidelines for treatments for depression, and was based on core competences for humanistic therapies. This therapy is now delivered across the country, mainly within health settings, as an evidence-based interventions. Several CPD trainings in this approach are available, for instance at the Metanoia Institute in London.
Around the 1980s, motivational interviewing (MI) began to develop in the field of treatments for drug dependency, and is now one of the best evidence interventions across the psychotherapy field. Bill Miller, one of the founders of the approach, was strongly influenced by the writings of Carl Rogers, and there is an emphasis in the approach on being empathic and engaging with the client’s perspective. However, it is more directive than classical person-centred therapy. For instance, if a client is struggling between the part of them that wants to give up drugs and the part of them that doesn’t, an MI therapist would tend focus on their ‘change talk’ (that is, the part that does want to give up drugs), whereas a classical person-centred therapist might be more likely to reflect both positions.
Another important development around this time was pre-therapy. Developed by Garry Prouty in the US, this approach was specifically developed for clients who are ‘contact impaired.’ That is, who are less in touch with ‘reality’: for instance, people experiencing psychosis or depersonalisation. Pre-therapy uses very concrete reflections—for instance, ‘You are looking at the wall,’ ‘You are smiling’—to try and help the client back into contact with their world and with others.
Relational, or dialogical, approaches to person-centred therapy differ from EFT or MI in that they are not a specific set of therapeutic methods, but more of a description of a therapeutic style or stance. As with EFT or MI, though, they are something of a break from the more classical style, and emphasise a more interactive therapeutic approach in which the emphasis is on the therapist being particularly present and real to the client. So that might involve some more challenging, or more introduction of the therapist’s own perspective into the work. You can read about the philosophy underlying this approach in the work of Peter Schmid, or see my own work with Dave Mearns on relational depth.
Similarly, an existentially-informed approach to person-centred therapy, which you can also read about in the Tribes book, is not a specific therapeutic model but a form of classical/relational person-centred therapy informed by ideas from existentialism. So the therapist might be particularly attuned to a client’s sense of meaning in life, or their anxieties around freedom and choice.
Of course, in reality, a wide variety of therapeutic methods and theories can be (and have been) incorporated into a person-centred approach, and that leads us to integrative approaches to person-centred therapy. Sometimes these are just personal forms of integration: for instance, when a person-centred practitioner begins to bring in ideas and methods from narrative therapy, or from transactional analysis. But there are also more systematic forms of therapeutic integration, and David Cain writes about these in his chapter in the Handbook of Person-Centred Psychotherapy and Counselling (2nd ed). Pluralistic therapy, for instance, developed by John McLeod and myself, argues that being ‘person-centred’ means responding to the unique individual wants and needs of each client, and that means recognising that a strictly non-directive approach will not be the most appropriate way of working at all times. Rather, pluralistic therapy suggests that we should talk to clients about what they want from therapy, and be transparent about what we can offer; that we can either offer our clients the kind of therapy that may most help them, or else refer on as appropriate. You can read more about a pluralistic approach to person-centred therapy on my blog here.
For me, what makes person-centred therapy wonderful is this diversity of riches: so many different ways to think and practice. And, perhaps, we shouldn’t expect anything less from a therapy that focuses on the person and how they, uniquely, see and experience the world. Of course, when we first train, we often need to start with the basics—like the ‘core conditions’, or unlearning a natural tendency to give advice—but growing as a person-centred therapist means recognising that there are so many different ways we can flesh out this identity: spreading our wings, and finding our own unique person-centred stance.
To find out more about the different forms of person-centred therapy, Pete Sanders’s (ed.) Tribes of the Person-Centred Nation (2nd ed) provides a great account of the major developments. Pete’s chapter in the Handbook of Person-Centred Psychotherapy and Counselling (2nd ed) gives a very useful summary. The national organisation for person-centred therapists in the UK is The Person-Centred Approach (TPCA), and their website has lots of useful information and links to current developments.