Person-Centred Therapy Today: It’s Not What You Think

Client: I have been feeling really low recently.

Therapist: Uh huh, uh huh (nodding head). Really low.

Client: I just can’t get out of bed.

Therapist: (Nodding head) Mm… bed. (Long pause).

Client: When I wake up I feel so awful.

Therapist: Mm… So it’s something that… mm… (nodding head)… feels awful.

Client: Yes, awful.

Therapist: Really awful. (Nodding head)

Client: Just terrible.

Therapist: Really terrible. (Nodding head)

(Long, awkward silence)

Client: Are you just repeating the last part of everything I say?

Therapist: It sounds like… you feel that… I’m just repeating the last part of everything you say…

If that’s how you think of person-centred therapy, with the therapist like a nodding dog, repeating everything the client says in a wishy-washy, pseudo-sympathetic voice, it’s time to think again. Person-centred therapy was only ever like that if it was done really badly, and these days person-centred therapy has evolved into a dynamic and multi-faceted field, with therapists working in a range of ways to help bring out the deepest, most fundamental elements of a client’s experiences.

Digging into feelings

A first major change over the past decades has been the development of ‘emotion-focused’ therapies. Whereas the classical approach to person-centred therapy tends to work in a more ‘non-directive way’, encouraging the client to take the lead, emotion-focused approaches adopt a more proactive standpoint, with the therapist actively encouraging the client to connect with their feelings, emotions, and hidden experiences.

This isn’t about directing the content of what the client is saying, but it is about ‘process direction’: helping the client to use the therapy in the most productive way.

It started with the work of the American psychologist and philosopher Eugene Gendlin, back in the Fifties, and these days a lot of person-centred therapists will use a more emotion-oriented approach, particularly those in particular branches of person-centred therapy called ‘emotion-focused therapy’, ‘person-centred experiential counselling for depression’ and ‘focusing’.

Emotion-focused therapy, in particular, has been developed through extensive research exploring the nature of emotions and how they relate to psychological health. It uses techniques like ‘two-chair work’, more-commonly associated with Gestalt therapy, to help clients really dig into their feelings and needs.

Focusing on relational depth

A second major change is that there’s more of a relational focus in a lot of contemporary person-centred work. Person-centred therapy was always about the relationship – Rogers, famously, suggested that three ‘core conditions’ were sufficient and necessary for the client’s therapeutic development: empathy, acceptance, and authenticity – but classical person-centred therapists could tend to be a bit passive and quiet, because they wanted the client to sort things out for themselves.

Now, like with the emotion-focused approaches, person-centred therapists may be more inclined to take a dynamic role and be more fully engaged with the relationship.

Giving advice, for instance, was a real ‘no-no’ for many person-centred therapists, but these days some person-centred therapists might feel that, if they’re really engaged in a relationship and have some suggestions to offer, it’s not the end of the world if they do so. It’s part of being a real human being in a real, caring relationship. Here, the focus is on the depth of connection between therapist and client – what we call ‘relational depth’ – rather than just what’s going on inside the client’s mind.

Developing person-centered research tools

With both these two developments, much is related to a third major advance in the person-centred field in recent years, and that’s to do with the increase in research and how it’s informed practice. Rogers’s necessary and sufficient conditions for therapeutic change were built on research, but it was research from over 60 years ago now, and what we’ve learnt about what clients need and want has moved on considerably.

For instance, we know more about trauma now and the need for ‘stabilisation’ before clients’ are encouraged to go into really traumatic experiences. Research has shown that clients can really benefit from going deeply into their emotions and experiences, and also that the depth of relating is an important marker of the helpfulness of the therapeutic work.

Person-centred researchers have also been developing tools that can help to assess the quality of person-centred practice. For instance, a ‘Person-Centred and Experiential Psychotherapy Scale’ has recently been developed, with a version for young people, which can be used to evaluate recordings of therapy in terms of ‘holding’ of the client, or ‘accepting presence’. And there’s a ‘Strathclyde Inventory’ which can be used to assess outcomes from a person-centred, rather than diagnostic, standpoint: Does the client become more authentic by the end of therapy?

For Carl Rogers, the founder of the person-centred approach, a person-centred way of being was always about growth, flexibility, and change – so it’s no surprise to see person-centred therapy changing and evolving with the times: taking on new and exciting forms.

If you’re interested in finding out more, join our workshop this Friday (17th March 2023), where we’ll be taking a tour around theory and practice in the contemporary person-centred field.