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Nearly 70 years ago a US psychologist came up with a list of the factors that he considered to be 鈥榥ecessary and sufficient鈥� to bring about 鈥榯herapeutic personality change鈥�. Over the years, that short list of six 鈥榗onditions鈥� has given birth to one of the most widely available forms of psychological helping worldwide, and numerous offshoots. Especially here in the UK, person-centred counselling (or what its originator, Carl Rogers, initially called 鈥榗lient-centered counseling鈥�) seemed to take a particular hold and has continued to thrive and dominate the talking therapy world since the 1960s, although it has been challenged of late in its dominance by CBT.

A quick scan of 香港六合彩精准资料鈥檚 therapist directory reveals both are top of the list of members鈥� offers, and with 70,000-plus members, that suggests it is practised by a lot of therapists, in private practice at least. Even in the NHS, person-centred therapy, in a modified, short form, is still holding its own, and has demonstrated its effectiveness in randomised controlled research and practice-based data.

So what was it, and is it still, about personcentred counselling that keeps it alive? Is it, indeed, still a living, growing thing, capable of continually actualising, in Rogerian terms? To mark the publication of a new edition of the classic text The Tribes of the Person - Centred Nation¹ 鈥� first issued in 2004 when it was edited by the late Pete Sanders; now edited by Mick Cooper in its third edition 鈥� we asked some of the UK鈥檚 leading theorists and practitioners for their views. Are Rogers and his theories still relevant?

By way of context, it鈥檚 helpful to know that the person-centred approach and the six conditions emerged from a 12-year period of intense theoretical creativity and research led by Rogers at the University of Chicago Counseling Center from 1945 to 1957. He then left the university to move to another professorship, uniquely of psychology and psychiatry, at the University of Wisconsin, where he sought to test person-centred practice with the most challenging of patient populations 鈥� longstay patients in a psychiatric hospital. But while at Chicago he and his team pioneered a vast programme of methodologically robust research into the effectiveness of the new, humanistic talking therapy they were developing, testing out its hypotheses with clients using the centre and instigating further developments in thinking, research and practice. Rogers didn鈥檛 just scribble the six conditions on the back of an envelope one afternoon; they were the fruit of a combined team effort.听

It鈥檚 also helpful to know that 鈥� put hugely simplistically 鈥� Rogers distinguished between client-centred counselling, the one-to-one practice, and the person centred approach, a much wider philosophical approach that could apply across the helping professions and was deliberately intended to challenge the medical, diagnostic approach then predominant in talking therapy in the US and Europe. The person-centred approach placed the person 鈥� the client 鈥� at the centre, and looked to how to provide the 鈥榥ecessary conditions鈥� for that person to thrive emotionally and psychologically to be the best they could be. As Rogers wrote in his 1980 bestseller, A Way of Being^,2 which brought his ideas to a readership far wider than psychological and counselling practitioners: 鈥楾he old concept of 鈥渃lientcentered therapy鈥� has been transformed into the 鈥減erson-centered approach鈥�. In other words, I am no longer talking simply about psychotherapy, but about a point of view, a philosophy, an approach to life, a way of being which fits any situation where growth 鈥� of a person, a group or a community 鈥� is part of the goal.鈥�

So, in this article we are talking about an approach, its underpinning philosophy and how it is currently enacted as a form of talking therapy.听

Therapy Today, June 2024

Timeless framework

The debates around the necessity and sufficiency of the conditions, the meanings of the so-called core conditions and how they are implemented in practice are legion, often heated and sometimes vicious. There are also some basic tenets of good practice that distinguish the approach from other therapies, such as its adherence to non-directivity, and notable beliefs and values, such as the belief in the human actualising tendency, the influences of the internal and external loci of evaluation, and the conditions of worth, which together encapsulate Rogers鈥� view of human personality growth and development and what hinders it.听

鈥榃hat Rogers produced was hugely ahead of its time in terms of capturing the therapeutic process,鈥� says Susan Stephen, a lecturer in counselling at the University of Strathclyde and co-editor with Mick Cooper and others of the forthcoming third edition of The Handbook of Person- Centred Psychotherapy and Counselling (Bloomsbury).⁴ Importantly, she says, Rogerian thinking hasn鈥檛 stood still since he moved on to work in other realms of practice: 鈥楾he six conditions are extremely elegant; subsequent developments have elaborated them.鈥櫶�

Moreover, it is a therapy that needs to be fought for in today鈥檚 quick-fix world where time is seen as limited and costly. If we want to inhabit a just, equal and flourishing society, we need this kind of therapy with all its values and belief in human growth and potential, she argues: 鈥楾he question is surely, can we afford not to offer that? And if we are working with people who don鈥檛 have an expectation of that or a sense of that possibility, or are caught in circumstances in which that seems impossible 鈥� that is also part of the picture. Which is why we can鈥檛 think of it as just something that happens in the therapy room, it鈥檚 a real sociopolitical issue.鈥櫶�

For Andrew Reeves, Professor of Counselling Professions and Mental Health at the University of Chester, the six conditions create the environment for the therapeutic relationship to have its effect: 鈥楾hey made sense in terms of the core relationship, and 70 years on those conditions are still equally important. If we can鈥檛 form a relationship with people in a respectful, equal way, what are we doing?鈥� He sees a particular strength in its championing of a different way of being with suffering people: 鈥楩or me there鈥檚 a philosophical issue here. I鈥檝e always been really proud to call myself a counsellor because, for me, counselling is rooted in society, in community. Philosophically it sits with the type of therapy I offer and within that humanistic approach that foregrounds the relationship. I think it鈥檚 not only relevant to us today but also crucial in enabling us to hold on to an identity of counselling that I think is under threat from all sorts of forces.鈥櫶�

Psychotherapist Val Watson has worked across a wide range of roles, including heading up university counselling programmes and counselling services for students. She currently works in private practice and as a consultant. Throughout her long career she has stayed with the person-centred approach as providing the guiding values and principles for her practice. It is timeless, and universal, she says 鈥� like Shakespeare: 鈥業鈥檝e got interested and trained in other approaches and regularly use those ideas alongside and blended with the person-centred approach. But the person-centred approach is the one that sits best with me, and the more I read Rogers and the more modalities I have studied, the more it makes sense and reinforces his relevance. I get excited all over again by what he has written. It鈥檚 the same with Shakespeare. You are taught it at school but later you return to his plays and realise that, yes, it has meaning in real life 鈥� this is how it鈥檚 touching me now. I find the more I return to Rogers鈥� writing and thinking, the more profound what he has to say is, and the more his research reveals. And I know it works because I鈥檝e lived it. But it鈥檚 not the only way, and people need to practise in the way that works for them.鈥櫶�

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Watson is black; Carl Rogers was very much white and middle class, and there has been much discussion over the decades about his apparent failure to actively acknowledge race in his work and thinking. The edited collection Carl Rogers Counsels a Black Client⁵ offers thoughtful critiques by several authors of a series of videoed demonstration interviews Rogers recorded with a young black man, in which he glides past the man鈥檚 evident anger at his experiences of racial injustice. Likewise, his contribution to Three Approaches to Psychotherapy,⁶ a series of demonstration films featuring the client 鈥楪loria鈥� that Rogers made in 1965, alongside Frederick听Perls (demonstrating Gestalt) and Albert Ellis (rational emotive therapy), has been criticised for being overwhelmingly patriarchal, notably and recently in the 2022 play The Patient Gloria. Rogers, it is said, steers the process towards his own agenda, and away from the dilemmas of being a single mother that 鈥楪loria鈥� herself was seeking to unravel.

So, does Watson think the person-centred approach crosses cultures comfortably? 鈥榃ell, yes and no,鈥� she says. 鈥楻ogers was a product of his time. He didn鈥檛 know what we know now; he wasn鈥檛 black, and he couldn鈥檛 articulate his own puzzlement and confusion in the way we can now because we have had opportunities to have that interrogated and be properly challenged. Yes, he was working from the perspective of a privileged white male, which many people are still wrestling with now. I think in terms of crossing cultures, it does, but cultural difference isn鈥檛 properly explored in Rogerian philosophy. It is very encapsulated; it doesn鈥檛 recognise that there are other people in other cultures thinking in very different ways. 听

鈥楾hat doesn鈥檛 stop it from being profound. It鈥檚 about how we make use of that basic philosophy and adapt it and make it relevant to the 21st century. It鈥檚 about critiquing and understanding what he had to say, from his position of understanding, and we can take it further, and theorists and researchers are doing exactly that.鈥�

John McLeod, Emeritus Professor of Counselling at Abertay University, cites research by Leslie Margolin¹⁰ that subjects the transcripts of the Gloria films to close scrutiny to highlight how Rogers erases her gender: 鈥業t鈥檚 not that Rogers is reframing the client鈥檚 goals and experience in terms of his own theory. All therapists do that to a greater or lesser extent. For Margolin, the problem is that Rogers 鈥� and other person-centred practitioners 鈥� insist that they are not doing that, and as a result fail to be sufficiently self-critical,鈥� McLeod says.听

And indeed, as Andrew Reeves points out, there is a similar danger with the core condition of unconditional positive regard: 鈥業 don鈥檛 think we can be unconditional, and the danger is, if we tell ourselves we are, we take our eyes off the ball of our own darkest sides 鈥� those factors in our life, social upbringing, culture, our own traumas and difficulties. If we purport to be unconditional we can miss it when we are not. It鈥檚 about holding our judgments in awareness and working with them 鈥� that to me feels a more pragmatic way of interpreting it.鈥櫶�

And yes, he says, teaching on the core conditions does perhaps encourage practitioners to think individualistically: 鈥極ur clients live in a context of family, friends, employment, community, politics, spirituality, faith, harm and abuse. People often feel they have no voice and don鈥檛 know how to advocate for themselves. There鈥檚 a danger in thinking what happens in our room is the start and finish for clients. Carl Rogers came up with the notion of person-centred therapy in a very particular social context, and that has in many ways changed beyond recognition.鈥� 听

Passive nodding

A common criticism of classical personcentred practice is that the therapist just sits and nods and repeats back what the client has just said, muttering an encouraging, 鈥楳mm, mmm鈥︹�� from time to time 鈥� the aim being essentially to follow the client in their process of working out what the problem is and how they might resolve it, rather than leading them in a more solution-focused way. Rogers鈥� friend and former colleague John Shlien was so nettled by the caricatures of this practice of 鈥榬eflection鈥� that he wrote to Rogers:⁸ 鈥樷�淩eflection鈥� is unfairly damned. It was rightly criticised when you described the wooden mockery it could become in the hands of insensitive people, and you wrote beautifully on that point. But you neglected the other side. It is an instrument of artistic virtuosity in the hands of a sincere, intelligent, empathic listener. It made possible the development of clientcentered therapy, when the philosophy alone could not have.鈥櫶�

Watson says it took time for her to appreciate the artistry the person-centred approach takes and the depths it opens up. 鈥楾he person-centred approach shuts you up and makes you listen as a therapist, and listening is the most powerful thing you can do. I say to clients who ask me to be more directive, 鈥淚 believe you can think best for yourself. If you want to know what I think, I might offer it, but I am not sure it will be very helpful.鈥� It鈥檚 inviting that conversation because quite often what brings people into therapy is they are being directed to think and feel a certain way and recognising that isn鈥檛 how they are thinking and feeling.鈥櫶�

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McLeod has moved on from his personcentred beginnings, following the research findings that tell us that clients do better if they and the therapist agree and share the same goals. In recent years he has been developing a pluralistic approach alongside Mick Cooper and a growing number of practitioners who see collaboration with the client and a more goal-directed focus as a valid branch of the person-centred tree.

He says: 鈥業n pluralistic therapy a central element is to make decisions with the client around what would be useful and helpful for them. If I am sitting with a client I might say something like, I don鈥檛 have a sense of where we are going with this, can you say more about what you want from this session? That requires a shift away from this inner being to engaging the other person in joint action. I don鈥檛 see that that metacommunication or shared decision making is destroying or undermining the person-centred way of being 鈥� it鈥檚 an add-on to it, a development and logical consequence of it. I wonder, if he had lived for another 20 years, would Rogers have come up with it himself? But people he trained came up with it, the people who influenced Mick and I came up with it. They discovered the importance of this shared negotiation of things.鈥�

Future development听

And herein lies a problem 鈥� are we today allowing Rogers鈥� original conception the space to breathe and grow, or has it become some kind of biblical dogma? Says McLeod: 鈥楾he great thing about Rogers was that he was so open to learning, and that is one of his great legacies to the whole field of counselling and psychotherapy. It seems utterly contradictory to me to teach Rogers鈥� ideas as formulated in 1960 as if that is it, it will suffice for the rest of your career. He hated that attitude during his life, and he would have hated it even more now.鈥�

So how do these commentators see or hope the person-centred theory and practice will develop over the coming years? Mick Cooper recently led a major study of school-based counselling based on person-centred principles, and found it had only a modest positive effect for the young people in reducing psychological distress. It also revealed that a proportion 鈥� around a third 鈥� didn鈥檛 like the silences and wanted the counsellor to be more active in engaging with them.⁹ He wants to see much more research to drill down into such findings of what works for whom, and a readiness to ensure children have access to a wider choice of therapies, as adults do, to ensure it is the best fit possible for their needs.听

Likewise, the PRaCTICED randomised controlled trial of outcomes from CBT and person-centred experiential counselling for depression in NHS Talking Therapies services did not produce the clear-cut evidence for the person-centred approach that many had hoped for.¹⁰ Designed to establish the 鈥榥on-inferiority鈥� of the two models, the trial showed that while at six months post-randomisation there was equivalence in outcomes, at 12 months CBT did better. 鈥楾hat鈥檚 a real challenge for the person-centred approach that can鈥檛 be ignored,鈥� Cooper says. But, looking beyond the statistical comparison, there is much more to be learned from detailed analysis of the qualitative data, Susan Stephen believes. She and colleagues are designing a study to drill down further into the findings. 鈥榃e need to know what contributes to and gets in the way of good outcomes. We have these headline results; we can make guesses at what they tell us, but we can only really understand client outcomes by looking in detail at what happened in individual cases.鈥櫶�

Andrew Reeves argues that personcentred thinking has to open itself to a more pluralistic approach. He points to a quote from Rogers himself, from On Becoming a Person, when he asks himself: 鈥榃here does this lead? To what end is all this research?鈥� His answer is telling: 鈥業ts major significance, it seems to me, is that a growing body of objectively verified knowledge of psychotherapy will bring about the gradual demise of 鈥渟chools鈥� of psychotherapy, including this one. As solid knowledge increases as to the conditions which facilitate therapeutic change, the nature of the therapeutic process, the conditions which block or inhibit therapy, the characteristic outcomes of therapy in terms of personality or behavioral change, then there will be less and less emphasis upon dogmatic and purely theoretical formulations.鈥�¹¹听

Reeves adds: 鈥楻ogers was an early advocate of pluralism, because he was saying, what matters is the relationship; the modality is less important. And that is what research repeatedly tells us.鈥櫶�

McLeod agrees: 鈥楶robably the most important thing is to move on from schools of therapy. Maybe we鈥檝e needed to be like that for the past 40 years, but there are so many points of convergence between them, it is getting in the way. Rogers was a key player and good at what he did. He gave us a lot, but we are in a different world now. It鈥檚 time to move on.鈥櫶�

Cooper, having just completed editing the new edition of Tribes, says: 鈥榃hat I love about the tribes is the diversity 鈥� from classical person-centred therapy, focusing and emotion-focused therapy, through person-centred experiential counselling for depression to pluralism and creative play therapy with children. There is something about articulating these tribes and making what each does distinctive rather than the same as everything else that is really important. It gives more opportunities to clients to find therapies that really work for them. For me there is something very beautiful about that tapestry of diversities and how people have taken Rogers and articulated the growth metaphor and seen what has flourished 鈥� they all have something distinct to offer, and that for our clients is deeply valuable.鈥�