Being in counselling for over a year and working through my own issues, within the person-centred framework has proven to me, how effective the approach is. As a relational therapy the PCA to counselling believes “…that the focus is on the client, on the person him or herself,…” (Bryant-Jefferies, 2001, pp17, b), this means; in counselling the focus is not on specific symptom reduction, but on the client, and the very individual subjective world each client will bring to therapy. This is not to say specific symptom reduction will not occur; if it does, it is likely to be as a consequence of other changes; it is interesting to note that “…often such symptom reduction is one of the consequences of a holistic therapy even though none of the therapeutic process has actively worked on the symptom.” (Mearns and Cooper, 2005, pp 162,a). In my therapy this has been a huge benefit, I am not pushed to talk about anything, there is no direction or pressure, it has been entirely up to me to lead the sessions, which has given me the space and time I needed to feel safe, to explore issues such as my self harm.
The central hypothesis of the PCA states “…the individual has within himself or herself vast resources for self-understanding, for altering his or her self-concept, attitudes, and self-directed behaviour…” (Kirschenbaum and Henderson, 1990, pp135,a). in effect this means the client has what they need within them to create change, which to me indicates that the PCA can useful in any counselling setting, including working with clients that have addictions. The therapy is not concerned with addressing the clients addiction, but, providing a “…growth-promoting climate…” (Kirschenbaum and Henderson, 1990, pp135,b), established with the core conditions, that are integrated into the counsellors way of being. The presence of these facilitative conditions is believed to promote the client’s “…changes in personality and behaviour.” (Kirschenbaum and Henderson, 1990, pp 136,c).
It is the client that brings about the changes in him or herself, this is conducive to the person-centred belief that all individuals have an actualizing tendency “…the tendency to grow, to develop, to realise its full potential.” (Kirschenbaum and Henderson, 1990, pp 137,d).
The counsellor has a basic trust in the client. Trust, that the client, does have it within themselves to self-heal, realise their potential, alter their self-concept and make positive changes to grow towards becoming a more fully functioning person.
On reflection, I can see I was in an incongruent state when I began therapy, and I imagine that may be the case with many clients going to therapy. The consistent congruence I have felt from my counsellor has helped me gain trust in her and be more congruent with her and myself. This goes beyond the therapy room, the congruence has aided me to confront things on my own, and I am more able to be true to how I am feeling, this has been especially important for me recently. Being able to experience my feelings as they are for me in the moment has stopped me from denying and repressing them, which eases the feeling of turmoil. I can see how this may work with a client who is, for example, addicted to alcohol, it may ease the conflicting feelings within them that make them reach for a drink as they no longer need to deny how they feel to themselves and can talk it through with their counsellor.
As a counsellor it could be a challenging task to work, perhaps in an agency, with clients that have addictions, and it is really important for me to have the belief that I can do that effectively, but also regularly explore myself in relation to working in an environment where I may be faced with, drug users or alcohol users a regular basis, and the impact this may have. The best place for me to do so would be in supervision which is an integral part of the support that a counsellor has, along with counselling, especially when a client group may present challenges, such as, clients that turn up to sessions intoxicated, or who could relapse. I think these issues need to be thought about they could have an impact on the counsellor, it is important for the client and relationship; as if I cannot be congruent, available and aware of how I am feeling, it would be an injustice to the client. “In short we are not talking about ‘doing’ person-centred therapy, but about what is involved in becoming the kind of person capable of undertaking the work of a person-centred therapist.” (Mearns and Thorne, 2000, pp89,a). The counsellors way of being is central to the relationship, this is not a technique or a method that is applied, its more of a philosophy to live by, the power of which is valuable, as I have experienced in my therapy. My counsellors way of being demonstrates her acceptance of me, as a person, I am not judged for behaviour, and this is of major importance particularly when working with clients who have addictions, as they may have been judged for their behaviour and not accepted because they have an addiction, so to receive the unconditional positive regard from the counsellor is a new experience and one that may enable them to feel less guilt and shame and enable self-acceptance. I was afraid of disclosing to my counsellor at first, as I felt I would be judged and reprimanded, or even worse, she may not like me, due to other experiences I had, which induced feelings of shame and humiliation, and lessened my self-worth. I felt the need to suppress my real self, to the extent that I thought I had got rid of parts of the ’old’ me, due to negative and external conditioning, resulting in an external locus of evaluation. I believed I couldn’t be loved, and it was my fault, therefore I hurt myself, that’s all I felt I deserved, and what I got from other people. Physical pain was more bearable, than the internal pain and conflict I was experiencing “…people experience negative conditioning or conditional responses from significant others (parents, relatives, friends, teachers, etc.) that can affect their self-concept.” (Bryant-Jefferies, 2001, pp76, c). similar experiencing for clients could be a factor of their developing an addiction, maybe to numb or mask the pain, or as a form of self-harm. My counsellors acceptance has gone a long way in enabling me to have self-acceptance, explore my self-concept, and start the journey towards the real me.
The counsellors empathy is also essential and “Acceptance and empathy are partners.” (Mearns and Thorne, 2000, pp93, b). To truly be listened to and understood can have a profound effect, it lets the client know they are valued and can validate what they are saying, when the counsellor conveys her understanding. This is not only about the words but the feelings also. It lets me know, I am not alone, and the counsellor is along side me in my experiencing in that moment. It could be the first time clients are listened to, heard and understood, as oppose to being told what to do and being put down as not worth listening to. “To be understood and to feel accepted as one is, is to experience the possibility of a world where it is possible to breathe without fear.” (Mearns and Thorne, 2000, pp94, c).
If I had, had the opportunity, I would have based my essay on the relationship and the potential of working at ‘relational depth’, this aspect of the PCA, fascinates me and, for me, what sets the PCA aside from other approaches, is the recognition placed on the importance and value of relation and the healing potential it provides. It emphasises life changes can occur out of what is essentially a basic human need, and the anxiety that is caused when there is inefficient, ineffective or negative relating. “Most psychological problems in my experience stem from relational issues, and most of these can be resolved through the creation and experience of healthy relationship enabling the client to redefine their concept of themselves.” (Bryant-Jefferies, 2001, pp71,d). I can wholeheartedly say, with a passion that the relationship and meeting at moments of relational depth with my counsellor have hugely impacted my development in a positive way, and I feel that such moments could be so important when working with clients, as it could be this lack of relation which may have played a part in the formation of the addiction, and it could be the provision of an effective relationship that may help with overcoming it. “Perhaps because we are so grounded in relationship that even though we have been thoroughly damaged we see the best hope of change as through relationship.” (Mearns and Cooper, 2005, pp1,b )
There are many things that I have not been able to fully cover in this essay, but there are things which came up for me that I feel need to mentioned briefly. When working with this particular client group, there are considerations to be made; if working for an agency, I feel its important to know their rules, policies and boundaries, especially, around seeing intoxicated clients, there are many differing views on this, some believe its worthwhile, while others would not see the client, but its important to think of the impact it may have on the client, and be congruent with them, or it could lead to feelings of rejection or judgement which contradict what is being achieved in the relationship, I think it is worthwhile to think about this when developing a contract, and keeping in mind the boundaries that are stated in it. Also the therapist’s awareness of how they might feel if the client turned up drunk, for example, and would it be okay if they had one drink as oppose to ten. If I did choose to see an intoxicated client, I would be wise to remember that they may not remember what was said in the session; therefore it may be worth going over it briefly at the start of the next session.
I would be aware of mentioning the addiction before the client is ready to talk about it, I feel it is for the client to lead this disclosure and to focus on it when they are not ready, could adversely impact on the them, although if they are noticeably intoxicated, there may be a need to be congruent. Clients not turning up for sessions, due to withdrawal, or being intoxicated and so on, are possibilities to keep in mind, as is the possibility that they may suddenly stop coming to sessions. Relapse and the possibility that at first being in therapy may lead to increase in the addictive behaviour is worth thinking about, as it could lead to mixed feelings for the counsellor. Number of sessions available in agencies is a consideration, as is the length and the setting or environment of the sessions.
This client group may be involved in a framework of help or ‘treatment’ and it is important as a counsellor to be aware of different models that may be available or being used by the client. For this purpose I am going to do a compare and contrast between Alcoholics Anonymous and the PCA. This is not going to involve me going through the whole AA model; I am making the big assumption that the readers are familiar with it.
Alcoholics Anonymous, was conceived in the 1930’s in Akron, Ohio, and has since “…grown to be the most widely used organisation for the treatment of alcoholism and substance abuse.” ( 04/01/07)
It has more than 2 million members, in 134 countries, and has influenced the conception of a large number of other support groups, e.g.- eating disorders, drug addiction, and gambling, also having a great influence in the way that people think about alcohol problems. The heart of the program lies in their 12 step program.
AA believes in abstinence, for me this feels like a condition and goal-setting, and may lead to feelings of failure and shame if relapse occurs. Although for some people this may work well, it can be seen as an extreme measure, and may not be necessary, as people have been known to drink safely after having a problem with alcohol. Counselling has no specific targets or goals.
“IT seems that AA largely caters for those who are or have been at the extreme end of the drinking continuum.” (Bryant-Jefferies, 2001, pp17,e) . This is a criticism made by some people, and I feel it narrows the availability, in terms of preventative work and for those who alcohol may just be beginning to cause problems. The PCA, I feel is available whatever the situation, and can be worthwhile at any stage, there are no conditions on who can and cannot come to counselling.
AA states that “The only requirement for membership is a desire to stop drinking.” ( 04/01/07)
The wording of this, for me, is wrong, it would deter me from approaching AA, it feels like a condition, and in contrast is very different from the PCA, that has no such ‘membership requirements’
“AA meetings are accessible; there is no screening of members, and the free help can be as long term as the member desires.” ( 04/01/07) . A major advantage, in my eyes, of AA is that even if I were abroad I could attend a meeting, if it was available in the country, so there may be less anxiety when travelling. Counselling, if private, can be seen as expensive, and may deter a lot of people from coming, especially, if they are ‘using’ and need the money, for drugs or alcohol. It may be free if through an agency, but then there may be a limited amount of sessions available, but with person-centred counselling there is also no screening.
“A particular strength of the AA is its ability to help members in times of crisis.” ( 04/01/07) . The sponsor idea, of one member being available for another, in times of distress or crisis, is a great advantage, and I’m sure it provides much needed support, especially as its from people who may have been in the same situation, so there may be less feelings of guilt, shame and humiliation, in asking for help. Counselling has boundaries, and counsellors are not usually available out of sessions, this is an advantage in the sense that it doesn’t encourage dependence, and may be a part of the person being responsible for themselves, but also a disadvantage, if a person is isolated and has no one else, it could lead to desperate measures and a relapse.
The group meetings are an advantage for some people, as it provides support, and sharing of experiences with people facing similar problems, it may help people feel understood. “AA can provide the individual with an environment in which experiences can be shared and trust can be established” ( 04/01/07) .This is similar to counselling, which is on a one to one basis, and highlights the importance of trust and safe environment, whether in a group or individual setting. There are people that would feel uncomfortable in a group, so it may not be correct for everyone, just as counselling may not be.
AA believes that alcoholism is a ‘disease’, “…a progressive illness…it cannot be cured in the ordinary sense of the term, but that it can be arrested through total abstinence from alcohol in any form.” ( 04/01/07) . This would frighten me, and I think it may be a little misleading, this may shock people into wanting to stop, taking the responsibility away from the person, its not their fault, it’s a disease, this can work both ways, it may lessen feelings of guilt and shame, but also they could just give into it at some point and feel they have no control over it. From the perspective of the PCA, it is empowering to take responsibility for oneself and this has been important in the work I have done in therapy, maybe taking responsibility for the problem and owning it would be a step towards the client taking back control.
The twelve steps themselves, “…were originally adapted from a Christian organisation, The Oxford Group.” ( 04/01/07) , and their religious nature is one of the biggest criticisms of AA, and I agree it is not for me, I found them a little unnerving and apologetic, but some people may find comfort in them. The notion of the ‘Higher Power’ is something some people may not appreciate, feeling alienated by the model. The PCA, is ‘each to their own’, you can hold any belief you like and there is no emphasis on outside power, it is about empowerment and responsibility from within.
As models of care and change, both have their advantages and disadvantages, but that is my opinion. I feel there is too much emphasis on handing over power and being powerless, and the fact the steps are written as ‘we’, which feels impersonal. This may not be how other people see it; there are many people who have had success with AA, which is testament to its strengths. I feel AA is directive and the relinquishing of responsibility for self and self-direction, may have adverse affects, I interpret some of it as saying, someone else will solve the problem. It is wise to remember that AA is not a counselling theory and may work well alongside other help options.
Looking at culture and diversity, the first thing that comes to mind is that both models were developed in America by white men, both could be seen as westernised, which may make some people feel they will be of no use to them. With the AA it is the religious nature or undertones, which could isolate people from different cultures and those with different religious beliefs, such as atheists, people could be fearful of trying to be converted by AA, and may feel it has a cult like presence. The group structure may be difficult for some cultures to understand, for example, for Asians, who believe in keeping things quiet and within the immediate community.
The anonymity could prove quite appealing to people, but they may also be afraid of knowing someone in the group, who may then ‘gossip’.
Some cultures may have a problem with women going to mixed group meetings, but I believe there are women only groups.
The ‘Alcoholic’ label could be hard to adopt, being able to say they are an alcoholic and being seen to have a ‘disease’, this may lower their status somewhat, or their standing in the community.
There may be a variety of people from different backgrounds and ages at meetings, this could be daunting as people could have judgements against other cultures and may not appreciate sharing with people who are a lot younger or older.
The fact it is free makes it is available to all, this also means there may be a wide spectrum of people in the groups, with the only commonality being alcohol, therefore people again may feel isolated, in terms of backgrounds.
For people that do have a very spiritual belief, it may be very useful, as they may relate to the religious nature, and may relate the ‘higher power’ to their own beliefs.
Cultures that have drinking as a norm, may have difficulty with the abstinence, the fact they may be asked why they are not drinking, when socialising, I imagine this could be particularly difficult for younger people, who may experience peer pressure, in extreme cases maybe even bullying. It would be great to hear peoples experiences of AA, as this is the only way, I feel, of getting a feel of how effective it is in terms of culture and diversity and as a model in itself.
The PCA, is accused of being a westernised approach, it is understandable that people from varied backgrounds may not see beyond that. People that have an objective view of things, may not be able to understand the very subjective nature of the PCA, and may be afraid to ‘go there’.
There is a chance also, that male therapists may be mis-understood, especially in some cultures, where the man is seen as the strong person, who doesn’t talk about feelings and emotions, and it could be seen as being soft. I feel there may be a difficulty for some men to talk about real feelings with a male counsellor, for fear of them being judged. “Not to put too fine a point on it, the person-centred therapist’s work lacks the attributes of male dominance and seems to require the qualities more commonly associated with maternal warmth and female sensitivity.” (Mearns and Thorne, 2000, pp77, d).
The PCA, is still also referred to as being “…too American…too middle class…and too focused on the articulate worried well.” (Mearns and Thorne, 2000, pp79, e). For people of other cultures or races these views could be a ‘put off’ as they may feel they will not be understood and the counsellor would have no idea of what they need. Although counselling, I feel, can be pricey, there are agencies that provide it free of charge, so this is an outright judgement.
I am disappointed about the view of it being westernised, the diversity of the group at college, shows how much progression there is within the whole field of counselling, and I as a part of an ethnic minority have never felt misunderstood by my counsellor who is a different race. Although it is understandable how people may feel that the approach could have a lack of understanding of other cultures, it is interesting to note “…that almost all of Rogers’ work and much of that of the present authors has been translated into Japanese…” (Mearns and Thorne, 2000, pp80, f). I have to wonder, if this attitude will change with time, especially with counsellors coming from a lot of different backgrounds, would this somehow make the approach more appealing to people from various backgrounds, with the diversity and culture of counsellors growing, it also raises the question of how a westernised client may experience a counsellor of a different race?
From experience, I would say, an Asian person coming to counselling, might be searching for an answer, expecting the professional to be able to guide and direct them, be the expert and authority, some people would find it very confusing to be seen as an equal. Also for people that are used to living in a family unit and are taught to respect them, the emphasis on the individual could be quite difficult to grasp.
Last but not least, the age of the counsellor may be relevant, from experience it seems that people are sometimes reluctant to talk to counsellors who seem much younger or older, there may the assumption that they cannot have enough experience to understand, and in certain cultures it is disrespectful to talk as an equal to elders. They may feel that they will be judged or that the counsellor wouldn’t understand the issue.
My hope would be that the PCA, can be more fully understood and accepted for the wonderful experience that it can offer to anyone that is willing, but would it be effective in working with addictions? I feel this has more to do with the counsellor that is present in the room, and their way of being and willingness to relate to the client, for it is this that makes the difference between being effective and ineffective. All I can say is that I would hope that I could provide the “…gift which has the power to comfort, heal, to confer worth, to banish fear, to bring transformation.” (Mearns and Thorne, 2000, pp88, g). When dealing with issues such as addiction, the PCA may be more effective as part of a support framework for the client, and I have to emphasise that it is about choice, its up to each individual if they want to use the PCA, and only they can govern if it has helped or not.
REFERENCES
Books
Bryant-Jefferies R. (2001) Counselling the person beyond the alcohol problem, London: Jessica Kingsley Publishers.
Bryant-Jefferies R. (2003) Counselling a recovering drug user. A person-centred dialogue, Abingdon: Radcliffe Medical Press.
Kirschenbaum H. and Henderson V.L. (eds) (1990) The Carl Rogers Reader, London: Constable.
Mearns D. and Cooper M. (2005) Working at relational depth in counselling and psychotherapy, London: Sage.
Mearns D. and Thorne B. (2000) Person-centred therapy today. New frontiers in theory and practice, London: Sage.
Internet
(accessed 4th January 2007)
Le C. et al. (1995) Journal of counselling and development. Online. Available HTTP: (accessed 4th January 2007)
