Person-CentredPractice

An expression ofNon-medicalised

Mental Health Care

The Person-Centred Approach

Carl Rogers 1902–1987

The approach has been in continuous development from circa 1935 to the

present day

To be radically niceRogers’ approach was radical because

it started in entirely the ‘wrong’ place — it started with the client and the primacy of understanding the client’s processhe thought that it was unhelpful to stereotype and categorise the client’s experience: he was set against diagnosis because it was damaginghe thought that it was unhelpful to understand the client’s process as one of ‘sickness’he thought it was unhelpful to play the expert, because he believed that it was the client who was the expert in their distress and their healing

To be radically nice

it is helpful to be humble and authentic, to listen, understand and accept rather than judge, interpret and categorise people are not ‘bad’, ‘dangerous’ or ‘flawed’. As adult human beings we do not have to be protected from ourselveshumans are not limited to change by learninghuman beings grow. We live by growing and are constantly changing and adapting by growing. Clients grow in multi-dimensional ways which are frequently mysterious to the therapist

To be radically niceJohn Shlien style

‘Diagnosis is not good, not even neutral, but bad.

Let’s be straightforward and flat out about it, it is

not only that its predictions are flawed, faulty, and

detrimental to the relationship and the client’s

self-determination, it is simply a form of evil. It

labels and subjugates people in ways that are

difficult to contradict or escape.’

To be radically niceJohn Shlien style

‘There is no value in being ‘reasonable’, in wanting to participate in reformulation of the psychodiagnostic endeavor that will generate a universally agreed-upon answer. Why petition to be a partner to reformulation when it is wrong from the beginning? It does not pay to make even temporary concessions to logic you believe to be false, or professional conventions you believe unworthy. They haunt one forever.’

How to be niceTry to understand the other person. Listen to how they experience their world. Help them find meaning in their experience. Feeling understood is helpful in itself.

Do not interpret their experience, tell them what it means or impose your own meanings on it. They are the expert. If they ask you to explain their experiences, be straight with them.

How to be niceAccept the other person as a worthwhile human being. You don’t have to approve of their behaviour, but they are a human being of equal value.

Some people have been damaged by harsh, heavy-handed opinion, unreasonable judgement or abuse. It’s important that they don’t get more of the same from you.

Be positively warm and accepting of ALL aspects of the person, including those parts that want to choose an option that we don’t agree with.

How to be niceDo not have a front or facade, do not act like an ‘expert’, be your real self as a helper; fallible, vulnerable, imperfect, not knowing any of the answers.

This goes against some of the training in the ‘helping professions’ which advises people to keep a professional distance, bluff it out, pretend they know what they’re doing (even if they don’t) and close ranks.

How to be niceBe ‘principled’ rather than ‘instrumental’ when you offer this relationship.Mean it, inhabit it, BE nice. Being nice is NOT a treatment or intervention.Understanding, acceptance and genuineness are not tools to get to the bottom of things, extract truths or flesh out symptoms. They are both the means AND the end.You will be found out if you don’t mean it.

Person-Centred: Growth

Medical Model: Illness/Health

Metaphors for distress

Self-defined, described experience of distressActualisationDiversityChangeable

Sick, ill, damage,imbalanceTreatment from outside the personDisabilityImmutable

Vocabulary Potentiality Deficiency

Authority (in therapy)

Client Therapist

Privileged professional discourse

No ‘professional’ perspective trumps the client’s experience[There must be room for a ‘safety’ discourse, though]

(In order of power)PsychiatristClinical psychologistPsychiatric nurse/ Social worker

Person-Centred: Growth Medical Model: Illness/ Health

Power relations between client and practitioner[Note: ‘safety’ of self and others must also be addressed]

Acknowledged, informed by dynamics of client as self-directing healerReinforce personal power of client

Informed by need for treatment compliance: predisposed to abuseReinforce low structural and personal power of patient

Nature and process of intervention

HolisticEmphasises personal power of clientEmpathyPotentiality‘Being with’Description

ReductionisticDiagnosisInstructionalCorrectionalReinforce deficiency modelPrescription

Person-Centred: Growth Medical Model: Illness/Health

Nature of distressed person

Whole personClient/subjectDirector of healing processRepresented by authentic experience

CompartmentalisedPatient/objectDisenfranchisedRepresented by recognised symptoms

Nature of therapist

Companion, equal, non-expert

Expert; PhysicianTechnician

Privileged frame of reference

Internal/the client’s experiences/the world of the client

External/diagnostic framework/theory of psychopathology

Change process

Self directed GrowthActualisationDevelopment

Expert directedRepairReprogrammingCure

Person-Centred: Growth Medical Model: Illness/Health

Aim of intervention

Fulfilment of potentialGrowth through and with current experience

Treatment complianceRecover previous state of being (health)Return tohomoeostatic balance

Resources In a rich facilitative growth-orientated milieu the client is able to make use of all possible resources, including the whole person of client

Expertise of therapistPsychopharmacologyPsychotechnology[Note client’s ‘whole person’ is frequently seen as a negative resource, an obstacle – they don’t call it ‘treatment resistance’ for nothing]

Medical metaphors for psychological distress – still think it’s a good idea?

‘Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one’

Editorial (unsigned) Lancet 18 Feb 2012[In response to the BE being removed from DSM-5]

Non-medical metaphors for distress

‘Feeling low is not an illness; it is more usefully thought of as part of being human and a normal response to bad, hurtful or humiliating things happening to you.’

Commonsense (and scientific evidence)… and Person-Centred

Non-medical metaphorsfor distress

Being overwhelmed …Hearing voices…Having jumbled thoughts …Not wanting to get up in the morning, wash or eat regular meals …

… not illnesses; they are more usefully thought of as part of being human and normal responses to …

The struggle for meaning in mental health professions …

psychological treatments are so effective, only ethics and

social action can save us

When everything we do has the same effect … use ethics

Do we choose a helping method that is the cheapest?Do we choose a way of helping that treats people like machines, or tin cans?Do we choose a method that boasts the white heat of psycho-geno-neuro technology?What will you choose?

When change is in the air …

• ‘Homosexuality’

• Menstruation, Pregnancy, Premenstrual Dysphoric Disorder Borderline Personality Disorder, Masochistic personality Disorder. (‘Being a woman’)

• Learning disability

CURED!

CURED!

CURED!(Well, almost!)

Be on the side of right