Being Non-Expert, Non-Coercive and Non-Diagnostic. Old Wine in New Bottles

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For decades, client-, or latterly person-centred therapy (PCT) practitioners have been vexed by misinformed critiques of PCT. Ironically, recent books, papers and presentations claim to have developed the next best thing in psychological therapies, yet we find that they owe much, if not all of their prospectuses to the work of Carl Rogers and his followers’ developments of theory and practice over 70 years. Critiques of diagnosis, the value of meaning-making, listening to the service-users story, accepting unusual experiences with respect and without judgement, collaborative and cooperative working – the list goes on with or without acronyms – are all themes that have been explored, elaborated and practised by person-centred scholars over decades.

While there are many aspects of PCT theory which translate into radical practice, this short piece concerns the idea of ‘non-directivity’, or non-interference; with diagnosis being only one of many signs of interference in psychological therapies. For a robust refutation of diagnosis as a useful strategy in helping from a PCT perspective, per se, see Shlien (1989) – I am not going to cover Shlien’s lively critique here. What follows is a brief exploration of a couple of the non-expert, non-coercive and non-diagnostic keystones of classical PCT.

To discredit the idea of ‘non-directivity’ in PCT it has been argued that all human relationships influence the protagonists. Indeed, influence, benign or malign, is inevitable in any relationship – but in PCT, the point is that influence depends upon the context, the intent and the people involved. In PCT, however contestable, benign influence is acceptable. In 1942, to introduce ‘non-directive’ therapy, Rogers wrote:

‘Unlike other therapies in which the skills of the therapist are to be exercised upon the client, in this approach the skills of the therapist are focused upon creating a psychological atmosphere in which the client can work. … Client-centred counselling, if it is to be effective, cannot be a trick or a tool. It is not a subtle way of guiding the client while pretending to let him guide himself.’ (419–21)

The therapist should not behave in a way that displays their expertise or is intentionally coercive or influential. Bear in mind that Rogers’ emphasis on non-directivity began at a time when psychological therapy, influenced exclusively by psychoanalysis and behaviourism, was almost entirely a process of diagnosis, interpretation and psychoeducation. The therapist was presented and seen as an expert and gave advice based on that expertise. It is the fallacy of therapist expertise in the relationship that Rogers was challenging, and this is the basic stance of the PCT practitioner.

Non-directivity remains one of the most contentious elements of PCT theory and practice, and one of the axes used to differentiate between the different person-centred psychotherapies – hence my use of the term ‘classical person-centred’ throughout to distinguish from integrative approaches. Rogers made specific reference to the idea of ‘non-directive counselling’ in 1942 when describing the differences between his new ‘non-directive approach’ and the older, directive approaches:

‘… Non-directive counselling is based on the assumption that the client has the right to select his [sic] own life goals, even though these might be at variance with the goals that the counsellor might choose for him.’
‘… The non-directive approach places a high value on the right of every individual to be psychologically independent and to maintain his [sic] psychological integrity.’ (pp. 126–7)

Non-directivity remained a key principle of his approach, evidenced by his comments in an interview ten or so years before his death:

‘I still feel that the person who should guide the client’s life is the client. My whole philosophy and whole approach is to strengthen him [sic] in that way of being, that he’s in charge of his own life and nothing I say is intended to take that capacity or opportunity away from him.’ (Rogers, in Evans, 1975: 26)

Non-directivity is not one of Rogers’ therapist-provided conditions (Rogers, 1957, 1957), but it further positions PCT in relation to diagnosis and medicalisation, since it places the locus of evaluation and control in the other person. In terms of power and agency, Rogers put it slightly differently when he said that this approach does not give power to the other person, it just doesn’t take it away. Many people suffering psychological distress already feel disempowered if not actually violated; thus being directed, diagnosed, advised and otherwise controlled in therapy, is simply more of the same, at least adding insult to injury and sometimes actively retraumatising people. In PCT, the therapist’s non-directive attitude and behaviour is one of naïve not knowing, cooperative enquiry and accompaniment with no systematised attempt to influence the other person.

The classical person-centred therapist also eschews micro-diagnosis or moment-to-moment evaluation of the other person’s behaviour in the interview. There is simply no point because PCT theory has no framework within which to understand the person’s experiences or behaviour (other than their own), and no expert interventions in response to the (possible) changes in their demeanour. The theory is expressed in practice as ‘The other person is in control and knows what they are doing. They are doing the best they can. Although I may not understand it right now, I will try to understand them better.’ This means that the effort of the therapist is entirely directed towards both getting out of the other person’s way and understanding their world. No interpretation, no diagnosis, no typology, no suggestions, no interference. This is the essence of being a non-expert.

One consequence of non-directivity is that it puts the person’s choice as high up the agenda as they want, need or can manage. Furthermore, they do not have their idiosyncratic explanations of their experiences overruled or supplanted by the therapist’s vocabulary or taxonomy of experiences, since there isn’t one in person-centred theory. Of course, some therapists might visit their own idiosyncratic ideas on the other person, but that is bad therapy in PCT theory and practice. The therapist follows, and in so doing honours, the other person’s story, whatever that might be, including if they understand that they have become mentally ill and been helped by medication. ‘Correcting’ their ‘wrong’ thinking is both anti-therapeutic and a further assault. Classical person-centred practice is an alliance-building enterprise with no pre-ordained end-point. The other person leads and the therapist follows.

Barry Grant (1990) described two types of non-directivity: one is principled in that the non-directivity originates from the therapist’s deeply held values. It is a spontaneous, non-systematic – not part of any therapeutic ‘plan’ – attitude of non-interference and ethical respect. It is not laissez-faire nor a defensive repertoire of ‘hands off’ behaviour, nor is it a ploy or technique for ‘use’ in the early stages of a therapeutic relationship aimed at building trust or a therapeutic alliance. On the other hand, instrumental non-directivity is a set of behaviours applied in an interview with a particular end in mind. In other words, using it like a tool or instrument, e.g., to foster a sense of trust in the person, to gather information for a ‘more accurate’ diagnosis, or a foot in the door; when thereafter the therapist’s expertise is deployed. A frank deceit.

These definitions can also be applied to the other therapist-provided conditions in Rogers’ theory: empathy, congruence and unconditional positive regard. It is essential to understand that in classical PCT, relationship conditions are principled attitudes, held for their own sake, not tools, devices or interventions – contrary to therapies like CBT which use relationship variables as tools to collect data for more accurate history-taking, or therapies which use moment-to-moment micro-diagnosis to inform the next expert therapist intervention. Distressed people are vulnerable, not stupid, and will frequently spot the instrumental use of relationship elements and evade or reject them.

Later Grant took the idea further by challenging the very nature of therapy with his exploration of the ‘legitimate’ targets of empathy in therapy, which he identified as only that which is actively communicated by the person, rather than the entirety of their expressions received by the therapist. Grant’s position – described in his own phrase, that being empathic is ‘taking only what is given’ (Grant, 2005: 247), echoes Shlien’s (1970) exhortation that person-centred therapists should be literalists, not interpreting the person’s utterings, but absolutely taking them at face value. It is a disciplined position of irreducible phenomenology, quite different from dialogical approaches in PCT which understand the relationship as a co-created moment between counsellor and other person.

Grant (2005: 257, my emphasis) concludes:

‘Client-centered therapists who share this ethics-only view are motivated to do empathy primarily by the belief that clients have a right to determine their lives. … They seek only to understand what clients give.’

This approach turns away from guesswork, interpretation, delving into people’s experiences and all attempts to fit their expressions into theoretical frameworks.

In the 21st century, PCT is not approved by governments and therefore very rarely available in the NHS and other statutory services for a reason – and that reason is nothing to do with lack of ‘evidence’. It is anti-expert, anti-diagnostic and anti-medicalisation in principle from the outset. This is a powerfully counter-cultural position in a profession otherwise dedicated to parading its expertise and psycho-technologies from obfuscating terminology, micro-diagnosis and tick-box scales to brain-scans and genome analysis.

Anyone can see that PCT does not directly address issues of structural inequality or institutional power in its theory or practice, but then which therapeutic approach does, with real-world solutions? Many will argue that it is both naive and confused for practitioners to make the paradoxical claim that good PCT leads to a more autonomous, yet socialised individual, but at least the practice of PCT does not seek to constrain the content or outcomes of therapy in any way. This is more than can be said for symptom-specific or diagnosis-oriented therapies where outcomes are measured in boxes to be ticked before people are pronounced recovered. Regardless of psychological intervention, everyone is returned to the world from whence they came and for some, it is a world of unremitting adversity. That no psychotherapy concretely addresses the structural inequalities which force people to seek help (if available) in the first place, is a concern of the profession rather than individual theories, as long as the theory does not locate the problem and solution in the personality or behaviour of the individual. PCT locates the problem in the environment, proximal and distal, and the solution begins by providing a respectful, unoppressive, non-interfering environment for the distressed person, free from threat. Such an environment holds the promise of facilitating the reclamation, or invention for the first time, of autonomous, free-thinking individuals; as fit to adapt to, flourish in, or change their world without compromise, as possible – whichever they choose and can endure.

References

Evans, R. (1975) Carl Rogers: The man and his ideas. New York: Dutton.

Grant, B. (1990) Principled and instrumental nondirectiveness in person-centered and client-centered-therapy. Person-Centered Review, 5(1), 77–88. Reprinted in D.J. Cain (Ed.) (2002) Classics in the Person-Centered Approach (pp. 371–6). Ross-on-Wye: PCCS Books.

Grant, B. (2005) Taking Only What is Given: Self determination and empathy in non-directive client centered therapy. In B. Levitt (ed) Embracing Non-Directivitypp. 247–59. Ross-on-Wye: PCCS Books.

Rogers, C.R. (1942) Counseling and Psychotherapy. Boston: Houghton Mifflin.

Shlien, J.M. (1970) The literal-intuitive axis: And other thoughts. In J.T. Hart & T. M. Tomlinson (Eds.), New Directions in Client-Centered Therapy. Boston: Houghton Mifflin. Reproduced in J.M. Shlien (2003) To Live an Honorable Life: Invitations to think about client-centeredtherapy and the person-centered approach (pp. 83–92). Ross-on-Wye: PCCS Books.

Shlien, J.M. (1989) Response to Boy’s symposium on psychodiagnosis. Person-Centered Review, 4(7), 157–62. Reproduced in D.J. Cain (2002) (Ed.), Classics in the Person- Centered Approach (pp. 400–2). Ross-on-Wye: PCCS Books.

1 COMMENT

  1. This piece and reading another made me reflect on how lucky I was to be in the middle of person centred training when I had a severe adverse drug reaction to an antiemetic with antipsychotic properties. I trusted myself, followed my gut intincts and rejected the views of other people that did not sit with my experience. I shared with others who had similar experiences and was priviledged to learn with them. I believe that this approach saved my life when I needed all of the resilience I could muster. The othe case that I read (similar) was of Dr Benjamin Schaffer who comitted suicide due to akathisia. I think in a way his belief in medicine contributed to his death in that his thinking was so influenced by the medical model, that he sadly could not concieve of different options available to him. Person centred therapy freed my mind and gave me autonomy amd power that lacked in the case above. So sad and so unnecessary. I’m forever grateful for this approach and the gifts that it keeps giving me everyday. It is sorely needed now more than ever.