SECTION 1: THE UNDERLYING EPISTEMOLOGY, PHILOSOPHY AND PRINCIPLES OF PERSON-CENTRED THERAPY. 1. The person-centred approach is a system of ideas and attitudes in which person-centred therapy is rooted. 2. Person-centred therapy has been from the outset and remains a radical challenge to the prevailing medical model and the notion of therapist as `expert’. 3. The person-centred approach embraces a family of person-centred therapies. 4. There is a philosophical basis to person-centred therapy. 5. The principle of non-directivity underpins person-centred therapy. 6. `Power’ and how it is exercised are central to person-centred therapy. 7. The issue of the compatibility of using techniques in a person-centred framework is unresolved and contentious. SECTION 2: CLASSICAL PERSON-CENTRED THEORY. 8. Person-centred practice, however it is now carried out, is founded on theory based on empirical research and observation as described by Rogers and his colleagues in the 1940s and 1950s. 9. The actualising tendency is the crucial concept at the heart of approaches to person-centred therapy. 10. The `nineteen propositions’ detailed in Rogers (1951) and the classic paper Rogers (1959) provide an elegant statement of a theory of personality consistent with person-centred concepts of change. 11. Although person-centred theory is an organismic theory, not a self theory, the notion of `self’ remains important. 12. The root of psychological and emotional distress lies in the acquisition of conditions of worth. 13. The proposal of six necessary and sufficient conditions for therapeutic change is an integrative statement describing the elements of any successful therapeutic relationship. It is untrue that the practice of person-centred therapy involves but three `core conditions’. 14. Because there is no stated or implied ranking of the six necessary and sufficient conditions and they are only effective in combination, it may be a mistake to favour one above the other. 15. The need for (psychological) contact is an often unconsidered pre-requisite for person-centred therapy. To be in contact is to be in relationship. 16. That the client is incongruent and at least to some degree aware of that incongruence (as vulnerability or anxiety) is a necessary condition for therapy. 17. Rogers’ seven stages of process provides a model for therapeutic change and guidance for the therapist in the encounter. 18. For therapy to be effective, the therapist must be congruent in the relationship. This is a requirement to `be’ and not necessarily to `do’. 19. Unconditional positive regard is the linchpin on which person-centred therapy turns but it presents a real challenge to the therapist. However, without this quality of acceptance there is a strong possibility that therapy will be unsuccessful. 20. `The ideal person-centred therapist is first of all empathic.’ `Being empathic is a complex, demanding, strong yet subtle and gentle way of being’. 21. The effectiveness of a therapist’s unconditional positive regard and empathic understanding depends on the extent to which they are perceived by the client. 22. In person-centred theory, there is no acceptance of the unconscious as a repository of repressed functions and primitive drives or desires and therefore `transference’ is of little or no relevance. SECTION 3: REVISIONS, RECONSIDERATIONS AND ADVANCES IN PERSON-CENTRED THEORY. 23. Person-centred therapy is not based on an ossified, mid-twentieth century theory but alive, dynamic and being actively researched and developed. 24. From the outset, an understanding of child development and psychotherapy with children and young people has been fundamental to the person-centred approach. Theory and practice continue to be developed and refined. 25. In the view of some, there are times when the integration of the necessary and sufficient conditions leads to another, `transformational’ quality known as `presence’. 26. For some, in classic person-centred theory the notion of the `individual/self’ as a discrete entity is over-emphasised, incomplete and/or culture bound. 27. The person may constitute a multiplicity of `selves’ rather than a unitary self. 28. Empathy is seen as multi-faceted and complex but it is important to remember that empathic understanding is what is essential to effective therapy. 29. Although the basic hypothesis does not call for it, the communication to and/or perception of the therapist’s congruence by the client has recently received attention. 30. Although it remains under-researched, unconditional positive regard has been reconsidered and re-evaluated. 31. Person-centred therapy is rooted in a philosophical and ethical tradition: the work of Peter Schmid. 32. Although diagnosis has no place in person-centred practice, assessment may be an ethical obligation. 33. Person-centred theory includes ways of understanding of psychopathology. These differ from the predominant `medical model’. 34. Pre-therapy and contact work constitute an important, person-centred way of working with `contact impairment’ and extreme mental and emotional distress. 35. Client incongruence, which can be understood as caused in various ways, is a source of mental and emotional distress. 36. The client’s style of processing may result in mental and emotional distress. 37. The causes of mental and emotional distress are environmental, social and to do with power and powerlessness. The medicalisation of distress is an error. 38. For some, an extension to person-centred working is embraced in the concept of `relational depth’. SECTION 4: CRITICISMS OF PERSON-CENTRED THERAPY – AND REBUTTALS. 39. The theory and practice of person-centred therapy has been subject to a great deal of criticism. This criticism is often based in misunderstanding. 40. It is untrue that person-centred theory holds that there is an ideal endpoint to human development and this has implications for therapy. 41. It is untrue that the model of the person advanced in person-centred theory is inadequate to explain psychopathology and leads to an unprofessional disregard for assessment. 42. It is untrue that person-centred theory includes an unduly optimistic view of human nature as fundamentally `good’ and that this leads to a naïve disregard for destructive drives and an avoidance of challenge and confrontation in the therapeutic endeavour. 43. Rogers’ (1957/1959) statement of the necessary and sufficient conditions has been challenged. While many accept the necessity of these, the sufficiency is doubted. 44. Person-centred therapy is seen as arising from and bound to a particular culture milieu and this limits its relevance and applicability. 45. In ignoring `transference’ person-centred therapy is seen as naïve and seriously lacking. 46. The non-directive attitude is a fiction and an irresponsible denial of power. 47. The concern for power in the therapeutic relationship shown by person-centred therapists is misconceived and misdirected. 48. Person-centred therapy is a palliative for the worried well but lacks the depth and rigour to deal with people who are `ill’. 49. Person-centred practice comprises solely `reflection’ and this is a technique of little effect. 50. Because of its obsession with `non-directivity’ the practice of person-centred therapy results in harmfully sloppy boundaries. SECTION 5: PERSON-CENTRED PRACTICE. Subsection 5.1: The foundations of person-centred practice. 51. Responsible person-centred practice requires a strong theoretical foundation and particular attitudes and personal qualities. 52. Person-centred practice takes place in many contexts and the terms `counselling’ and `psychotherapy’ apply to some of these but are often interchangeable. 53. The first step towards person-centred practice is a thorough grounding in person-centred theory. 54. Person-centred practitioners work with clients, not patients. 55. An objective of person-centred practice is to offer a healing relationship. This comprises several ingredients including the six necessary and sufficient conditions. 56. Because person-centred therapy relies on how the therapist is rather than what the therapist knows, there is professional obligation on person-centred therapists to attend to their own growth and development. Subsection 5.2: The initial processes of person-centred therapy. 57. In person-centred therapy, getting started with a new client is an involved and involving process. 58. Contracting and structure in person-centred therapy. 59. Assessment in person-centred practice. 60. Establishing trust. Subsection 5.3: The basic attitudes underpinning person-centred practice. 61. Non-directivity in practice. 62. Clients are the experts on themselves and are active agents in their own growth and healing. 63. The person-centred therapist’s job is to follow wherever the client leads, putting aside theoretical understanding and any other `expert’ knowledge. Subsection 5.4: The necessary and sufficient conditions in practice. 64. The necessary and sufficient conditions are all it takes for successful therapy. 65. Contact in practice. 66. The therapist’s availability for contact. 67. The client’s availability for contact. 68. Contacting the `unavailable’ client – contact impairment and pre-therapy or contact work. 69. Dealing with client incongruence. 70. Being congruent or integrated in the relationship as a therapist. 71. Developing and enhancing therapist congruence. 72. Making congruent responses. 73. Being yourself, psychologically mature and practising according to your personal style: the multifaceted nature of therapist congruence. 74. The therapist’s self-expression and self-disclosure in person-centred therapy. 75. Developing your unconditional positive self-regard. 76. Developing unconditional positive regard. 77. Unconditional positive regard in practice: paying attention to the whole client. 78. Unconditional positive regard in practice: the avoidance of positive reinforcement and partiality. 79. Unconditional positive regard in practice: the avoidance of rescuing the `helpless’. 80. Accepting the whole of the client: unconditional positive regard and configurations of self. 81. Developing your empathy. 82. Communicating your empathic understanding. 83. Facilitating the client’s perception of therapist unconditional positive regard and empathy. 84. The therapist-provided conditions as a whole: preparing for and facilitating `presence’ and/or `relational depth’. SECTION 6: PERSON-CENTRED THEORY AND PRACTICE WHEN WORKING WITH REACTIONS TO LIFE EVENTS. 85. Person-centred therapy and the `one size fits all’ approach. 86. Person-centred theory and loss and bereavement. 87. Person-centred practice with clients experiencing loss or bereavement. 88. Person-centred theory and client reactions to being abused as children. 89. Person-centred practice is effective with clients abused as children. 90. Post-traumatic stress and responses to critical incidents may be understood in terms of person-centred theory. 91. It is possible to offer person-centred therapy to people who have experienced a critical incident or other traumatic event. 92. In person-centred theory, `depressed process’ is preferred to the concept of depression. 93. A person-centred way of working with depressed process. 94. Panic and anxiety can be understood in person-centred terms. 95. Anxiety and panic can be worked with in a person-centred way. 96. There are person-centred understandings of the experiencing of different realities. 97. There are person-centred ways of working with people who experience reality differently. 98. There is a person-centred understanding of the excessive use of drugs and/or alcohol. 99. Person-centred work with people for whom their use of mood-altering substances is problematic. 100. `The facts are friendly’: research evidence indicates that person-centred therapy is effective and at least as effective as other modalities.
Paul Wilkins is a person-centred academic, practitioner and supervisor currently working for Manchester Metropolitan University.
"Paul Wilkins has authored an excellent book. It will be useful to counselling students, practitioners and scholars. He has captured the essence of Person Centred Therapy and explains it simply and clearly whilst at the same time raising issues that are thought-provoking, sometimes controversial but always extending of our understanding of theory and practice." - Dr Maggie Robson, Senior Lecturer and Director of Counselling Studies, School of Psychology, Keele University, UK "This book provides in-depth discussions on Rogers' ideas and shows how PCA (Person Centred Approach) is being applied in health, social and voluntary sectors, and is being introduced into mental health work... The style of the book encourages you to dip in and out, to read from cover to cover, or to use it as a refresher. It has many applications and I believe it is an essential book that will be a useful addition to the bookshelves of anyone interested in person-centred therapy." - Corinne Harris, The Independent Practitioner, Spring 2010