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Person Centred
Counselling is a modern talking therapy that improves how people feel. It was once based on the sole belief that some people suffer from a mental illness. When confronted with someone we struggled to understand, we said to ourselves "there must be something wrong here or else they wouldn't be behaving that way." But when they were examined, and others like them, they were not suffering from a physical illness. From this, people assumed they were not in a sound state of mind. They were not thinking and acting the way others did, and we thought they must have something wrong mentally. Doctors found that talking about the emotional underside of the problem helped people feel better.
Since the early days of the talking cure, counselling has moved from a single description of abnormal psychology to a vast library of models and theories. But along the way, counselling concepts have become estranged. One counsellor speaks of the unconscious, and another of the cognitive process. One therapist speaks of experience, and another of family dynamics. Today, psychotherapy is like a shredded book. Each theory provides a fragment of knowledge but remains detached from the bigger conversation.
The purpose of this book is to unite the psychotherapy literature into one model. We sketch the family tree of counselling, demonstrating through its history and relationships how it is one thing: the theory and practice of psychotherapy. In the beginning, we explore relationship-based counselling and argue for its rightful place as the foundation to all psychotherapies. Then, chapter by chapter, we take each of the most influential therapy models and combine them into a bigger picture: an integrative person-centred counselling model.
The Relationship Cure
Before the invention of counselling, human cultures always had theories about mental health. Lydia Kang and Nate Pedersen wrote a funny yet insightful book called Quackery: A Brief History of the Worst Ways to Cure Everything. In it, they tell us of doctors prescribing mercury to patients with chronic health anxiety - corroding their skin, eyes, and teeth in the process! We learn that the ancient Greeks believed mental illness signalled anger from the gods. The Romans used chants and chamomile potions to cope with anxiety. Medieval doctors leaked blood from unanaesthetised mental health patients. There's even bone evidence of our neolithic ancestors, 7,000?years ago, attempting to cure psychological disease by drilling holes into people's heads.
Modern people find these so-called treatments bizarre, but how do we know any better? What do we know about human wellbeing, and how do we know it?
Historically these are questions for shamans and village elders, but the wisest people of antiquity were unable to give scientific answers. It would have seemed naïve to suggest swapping a goat sacrifice with a listening ear or to harness the curing power of empathy in place of the punishing seclusion of a mental asylum. If an ancient time traveller visited the 21st century, they would be astonished to find that something available to everyone could cure the psychological ills of their time. They might not believe that a trusting relationship and a strong dose of empathy would become the modern medicine for anxious and depressed people. But this turns out to be the truth.
Philosophers and healers existed for thousands of years without realising the true power of relationship. The talking cure was invented prior to understanding the role of empathy in overcoming psychological hardship. This wisdom arrived late in the human story, but in the 1940s it dawned on one quiet and wholesome man. He had thick circular glasses, a shy Illinois accent, and his name was Carl Rogers.
It is true that many others had sensed the human need for empathy, but it was Carl Rogers who elevated the role of human connection to the status of a psychological cure. He was the first person to redefine talking therapy not as an intellectual task but as a relationship treatment. He famously changed the doctor's question from "How can I fix or cure a patient?" to "How can I provide a safe relationship for people to fix and heal themselves?" From his work we learned that to accept another's experience without judgement, to relate to their pain and suffering without trying to fix them, flattens the peaks of their distress. Emotional presence helps people escape from troubling experience.
For Rogers, counsellors build therapeutic relationships from three core ingredients - empathy, congruence, and unconditional positive regard. For him, the foundation of psychotherapy became a trusting relationship in which the counsellor senses, feels, and understands the client's experience. The counsellor is honest, their intentions match their actions, and they support the client without judgement or interpretation. John Norcross and Michael Lambert recently reviewed the meta-analysis, case study data, outcome studies, and random control trials on the subject. They found each of these core conditions to correlate very well with successful outcomes.
We know from the evidence that Carl Rogers' ideas do stand the test of time. But we needn't get swept up by one man and one set of ideas. The heart of psychotherapy might be relationship, empathy, and acceptance, but how does this construction of therapy interact with other ideas? Don't other therapy models have the same support from the evidence (and sometimes more convincingly so)? No single model of therapy tells the full story, but authors tend to present their approach as all-encompassing and final. In this case, psychotherapy becomes like a carousel of ideas that changes with the season. The science behind therapy, if viewed more like a fashion than a secure body of knowledge, develops more slowly. In this book we try and demonstrate how much healthier it is to build psychotherapy from the ground up, combining the approaches into one solid structure.
We have learned from our intellectual ancestors not to be blinded by received wisdom. Having different ideas, having different tools, and being open to seeing in new ways can hugely benefit clients undergoing therapy. The relationship might be a universal law of psychotherapy, but what can the discoveries of other counselling and psychotherapy models contribute to the conversation? How do we avoid shutting our eyes to alternative theories and practices?
The purpose of this counselling book is to show the theory and practice behind the most useful conclusions in psychotherapy, building from the ground up. Instead of taking a one-sided view, we apply the findings from psychology and the counselling clinic into a modern integrated psychotherapy - mixing the science and the psychology of different approaches into one coherent model. Counsellors, trainees, and interested readers will become fluent in the language of general psychotherapy, and in such a way as to be more able to tolerate and connect with other people's emotional worlds. We use Carl Rogers' ideas as the foundation to our approach and integrate them with the main psychotherapy models. This chapter sets the foundation for a humanistic, person-centred counselling. In the chapters that follow, we build onto this Rogerian foundation a range of other psychotherapy ideas, brick by brick, until a final structure is in view, a model called Integrative Person-Centred Counselling.
Humanising Mental Health
The picture we have starts with the Italian Renaissance man, Francesco Petrarch, who saw beyond the ancient fog of mental health superstition. He saw that human beings have innate potential, a healthy state of mind that grows with the right encouragement. Without support for this natural human goodness, people self-sabotage and become emotionally unwell. This was one of the first models of human wellbeing that attached itself to human nature, and it's to this model we now turn.
Petrarch is known as the father of humanism, which was developed in Italy in the 14th century AD, though it wasn't named until 500?years later. Instead of a mythical account of mental health, humanism proposed that feelings come from real things like self-worth, dignity, and a capacity for making progress. If there was a metrestick for life satisfaction, which there is, he predicted it would measure how much health, purpose, acceptance, and freedom a person has - and his predictions are now confirmed to be accurate. When researchers designed the life-satisfaction survey in the early 1990s, they found that humanistic attributes like being valued and understood match life satisfaction. The World Health Organisation took on these humanistic values by defining positive wellbeing as people feeling good about life, coping emotionally, and realising their potential. Over time, Petrarch's humanism has become a normal part of public conversation, and it now feels intuitive to most people.
In psychotherapy, humanism came of age in the 19th and 20th centuries. During this time, society witnessed the birth of psychiatry, psychoanalysis, and scientific psychology. Most humanistic counsellors came from one of these professions. Probably the most famous person to fit this mould was Carl Rogers. Dissatisfied with the psychiatric view of mental illness, that clients are inherently flawed or sick, humanistic values spoke to his inner care for people. As a psychologist, he took to the unusual practice of calling his...
