You may have heard this kind of thing:
“I had counselling, but the counsellor just sat there occasionally nodding their head! I felt frustrated.”
“I wanted my therapist to give me some advice or at least some ideas, but they wanted me to do all the talking!”
“I’ve had two years of counselling and now I think I know why I have panic attacks – but I’ve still got the damn panic attacks!”
What’s going on? Why do some practitioners ‘just sit there’ without offering ideas or opinions, strategies or ways forward?
Person-centered counselling and people as ‘flowers’
Let’s look briefly at the origins of this.
In 1928, a book called The Child-Centered School was published. This book was to determine the direction of US (and to some extent British) education for many years to come.
The Child-Centered School borrowed many ideas from 19th century German and Swiss philosophers, such as Friedrich Froebel, who believed that children are like flowers in a garden (kindergarten literally means ‘a garden whose flowers are children’).
Froebel felt that children, when given a ‘non-threatening’ environment, would develop their potential through an automatic ‘self-actualizing’ process. Self-actualization is an abstract term meaning the process of establishing oneself as a whole person, able to develop one’s abilities and to understand oneself.
Of course, the right environment is crucial. Certainly children do need space in which to explore. Helicopter parenting, in which children have little to no unsupervised time or risk-taking opportunities, seems to grow depressed children.1
Mind you, even flowers need an input – of sunlight, moisture and nutrients. I’m not sure whether Froebel even had much experience with children, let alone his own kids!
Froebel’s non-intrusive ethos was a compulsive, almost poetic idea. But as with all oversimplified ideas, the no-strictures idea of child rearing has its problems.
Leave me alone to self-actualize!
Self-actualization, it was believed, could only occur if a child was left to develop in their own way. Externally applied discipline, direction, and laying down of boundaries would impede this process.
Nature should be allowed to take its course and the ‘flowers’ left to grow unrestrained. (I’ve used this approach in my real garden, with chaotic and jungle-like effects!)
Actually, it seems children do need direction, boundaries, and input. Support and encouragement along with clear boundaries seems to be the optimum parenting approach.2 External discipline, when required, within a supportive environment may be the primer for the development of self-discipline, which strongly predicts future success and happiness.3
Maybe flowers need skilled gardeners after all! Gardeners need to make judgement calls, set limits, and, when required, apply fertilizer!
So how does this apply to therapy? Well, this educational ideology eventually filtered into therapy.
Flowers on the couch
In the 1950s, Carl Rogers borrowed principles from child-centred education and applied them to psychotherapy. His idea was that if you truly listen to somebody by feeding back or ‘reflecting’ what they are saying, then they have the opportunity, given enough time, to ‘self-actualize’.
On no account could the therapist influence the client. Any expression of opinion or hint of direction from the therapist was forbidden as far as client-centred therapy was concerned. The therapist was to be a blank screen.
Clients were seen as infinitely fragile and to be handled with gloves. (Myself? I suspect communicating that someone is fragile and vulnerable can lead some clients to become disempowered.)
Of course, listening to someone in a safe environment is an essential part of therapy. Trust, rapport, and a sense that anything can be expressed is necessary. However, it is just a part. People who are depressed, anxious, angry, or addicted need to learn skills to stop their suffering.
So feeling safe and supported is vital. This is a minimum of good therapy. But some therapeutic ideologies have come to assume this is how all therapy should be – and this can cause real problems for some clients. People generally seek therapy because they want to be influenced in ways that help.
In order to self-actualize, that is, to develop spare capacity beyond the inner demands of emotional problems, a person needs to – extending our horticultural theme here – develop the means to cut back on unruly fears, prune depressive thinking biases, and trim the borders of ‘personality disorders‘.
So why shouldn’t therapists simply sit passively and fight hard not to influence their clients or ever judge them? Because this approach can be not only ineffective, but potentially dangerous.
Just listening and reflecting back to a depressed client may deepen the depression if it leads them to simply introspect more without necessarily building their resources or hope.4,5
Too much emotionally arousing introspection can do people a great deal of harm.6 Purist person-centred counselling, then, may be the last approach depressed people need.7 Although certainly people need space in a trusting environment to vent and discuss their issues.
Postmodern ideas about ‘whatever floats your boat’ and personal choice and everything being equally valid may be fine in the art world. Anything and everything can be art to the intellectual.
But in therapy the consequences of naive or incomplete ideology are potentially very serious. Not getting the help you need when you have gone to a supposed source of expertise may be the most demoralizing thing you can experience.In therapy, the consequences of naive or incomplete ideology are potentially very seriousClick To Tweet
Here are just three reasons why perhaps practitioners must lead their clients.
1. Just try not influencing
Is it even possible not to influence others? Emotion is contagious. If I smile at you, even a micro smile lasting no more than several milliseconds, I will influence you. I may not be conscious of that smile. You may not be conscious of that smile. But the emotion is still passed from me to you, outside our conscious awareness.
If I nod slightly when you tell me how terrible you feel you are then I may have affirmed your limited perspective. And perhaps reinforced it. Influence is happening in human interaction, whether we like it or not. It’s up to us to use it as effectively as we can.
Michael Yapko, a leading researcher of the treatment of depression, said, “It is not a question of whether a practitioner influences a client but how they influence a client. They will influence them merely by being in the same room.”
Let’s look a little more closely at this concept.
Charisma and influence
If you want to do ‘pure’ client-centred work you had better hope you are very low in natural charisma.
Charisma is a measure of how expressive and emotionally infectious we are. A charismatic person is likely to make you feel the same way as them. They lead the emotional atmosphere. And they can do this simply by being within eyesight of you, even if they don’t say a word.
‘High charismatics’ tend, of course, to be more expressive, which is often conveyed nonverbally through micro facial expressions. There’s just ‘something about them’. Conversely, a ‘low charismatic’ mood is less ‘infectious’. Charisma can be seen then as the quality of transmitting emotion and ‘infecting’ others with your mood.
In one astonishing piece of research, psychologist Howard Friedman devised a test to gauge charisma levels.8 After testing for charisma, he put a ‘high charismatic’ person in a room with a ‘low charismatic’. They could see each other but not speak. They were together for just two minutes.
What he found was that after only these two minutes of being in a room together, with no speaking, the low charismatic had joined the mood of the high charismatic, for better or for worse. In other words, if the high charismatic was in a bad mood or depressed, by the end of the two minutes the low charismatic would feel worse. And if the high charismatic was in a good mood, the low charismatic would feel better.
But nobody ever went from low to high charismatic!
Charisma, it seems, is a relatively constant characteristic. So presumably therapy schools that promote the idea that therapists should not influence their clients would need to weed out charismatic would-be therapists!
But anyway, why shouldn’t influence happen in counselling?
2. Your clients need your influence
Sometimes to be ‘client-led’, that is, to get a sense of what our client needs, means we must lead the client. We are all of us, after all, led by the needs of our clients.
If I am dying in an emergency, I don’t want the paramedic to ask me what I think needs to be done! The paramedic will be led by my needs, but will act (I hope) by influencing me rather directly and fast.
Simply listening may be a good starting point for some clients, but those in distress need direction, at least beyond a certain point.
The part of the brain that can generate wider perspective and strategies, and therefore hope, is temporarily disabled in depression.9 The depressed client needs to ‘borrow the brain’ of the therapist, to be given access to wider perspectives, for a while.
If the means to help our clients are available but we don’t use them, can this be said to be ethical?
Speaking of which…
3. Your therapy needs to be clean
That’s not a problem in and of itself. But it is a problem if the therapist remains the client’s only source of attention or kindness. Not only is this an unsustainable way for them to meet this need, but the fact that the client is feeling better may cause the therapist to misinterpret what’s really happening and start to assume it’s the ‘process’ that’s working.
The practitioner needs to understand what is happening and seek to help their client meet these vital needs outside of the therapy room.
When the client is enabled and encouraged to meet these needs in their wider or ‘real’ life, they are less likely to become dependent on unconsciously using the practitioner as the sole source of completion of their emotional needs. When this is understood by both counsellor and client, the therapy is said to be ‘clean’.
Alternatively, if the therapist doesn’t see the client’s needs clearly, they may assume any lifting of mood is indicative that the passive approach is working.
Common sense and clarity must be maintained at all times; even when we ‘go off script‘ a little we must know why we are doing it.
For some people, just quietly sitting and listening is vital for a while. But the ideological assumption that we shouldn’t influence our clients and that therapy has to be painful or encourage emotional ruminations is, in my opinion, dangerous.
The hallowed ‘therapeutic relationship’ may feel empty and void for the suicidal client if it is purely passive on the part of the therapist.
As Dr Milton Erickson said, “It isn’t so much what the therapist does, as what he gets his patient to do.”
Helping a UPTV client resist sugary treats
This client was diagnosed with type 2 diabetes more than 10 years previously. He is fully aware of what can happen if the condition remains unmanaged. He even knows someone who recently lost a toe to complications arising out of diabetes. He finds it hard to exercise because he’s had two hip replacements. His main weaknesses are jam and cream donuts and apple pies and other sugary “treats.”
This client and his wife have a son living next door so his grandchildren often come in to play. His wife keeps a “treat drawer” for the grandchildren but sometimes he raids that drawer and eats the grandchildren’s sweets!
Mark seeks to build motivation to control these impulses by disrupting the pattern and appealing through the unconscious mind to different parts of the client’s body.
- See: https://www.clinical-depression.co.uk/dlp/understanding-depression/using-the-cycle-of-depression/
- See: https://www.uncommon-knowledge.co.uk/book_review/depression_hypnosis.html and Danton, W, Antonucci, D and DeNelsky, G. (1995). Depression: Psychotherapy is the best medicine. Professional Psychology Research and Practice, 26, 574.
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