Wednesday 4 November 2009

Annie Parmeter on Counselling

This is, of necessity, a long post, but it is one of Annie Parmeter's final essays

In it, she doesn't mention any clients by name, and there is nothing identifiable about this, but she does draw upon her own experiences, and this autobiographical and reflective element, coupled with the way she integrates this with her counseling skills, to prove a framework for living, makes it what I think is one of her finest essays - full of clarity and perception and honesty.

INTRODUCTION

This essay is concerned with the exploration and evaluation of the Humanistic Therapeutic model both from a professional counselling perspective and from the way in which the philosophy surfaces in my own life.

I first came across the Humanistic method as it took its place amongst other theories used in the Integrative counselling style of a practitioner who was not only my therapist but my employer and friend. Sadly she died some years ago but she left me with a great legacy, namely the inspiration to become a therapist myself and memories of her very special gift which allowed one as client to leave each session with her feeling incredibly valued and special. I think this gift was rooted in the Humanistic tradition of listening to a client with warmth and empathy and the genuine wish to assist them towards growth and personal empowerment.

My next encounter with elements of the Humanistic method came in my practice of Re-Evaluation Co-Counselling, a non-time limited and mostly non-directive model which includes the ideas of listening to the client with full and undivided attention, cultivating the ability to recognise one's own reactions to the client's story and be congruent about them, but then to bracket them for a later session of one's own, also encouraging the client when necessary to focus in on the feelings being experienced in the here and now and to experience and explore them without intellectualising about them. However, I would not venture to label this type of counselling as purely Humanistic as it does also contain elements of Cognitive and Psychodynamic therapy.

KEY CONCEPTS OF THE MODEL

THE THERAPEUTIC RELATIONSHIP

More than any other model, the Humanistic values the client/counsellor relationship, the importance of which lies at the heart of its philosophy, the idea of healing through relationship. I understand this in terms of the contradiction that it offers to the experience of everyday life, where usually we do not give others our undivided attention, we listen with half an ear whilst continuing to follow our own agendas, we harbour assumptions and judgements about the person who is talking to us and let this influence our attitude towards them, sometimes we don't even look at them, we seldom really engage with others. When we do manage to 'lay our selves aside' something almost magical can take place.

THE CORE CONDITIONS

The practical methodology of this model involves the deployment of three key components, which Rogers named the Core Conditions and he believed that the presence of these conditions alone would be enough to bring about progress for the client.

Unconditional Positive Regard.

From a personal point of view the ideal of non-judgement is one that can be hard to live up to, our patterns lead us to judge even at a subconscious level; we also judge ourselves through internalised oppression the consequence of which is that we place artificial limits on our lives and our thinking. Healthy thinking allows us to view ourselves with UPR freeing us from the fear of taking responsibility for our lives to make real choices, if we can't accept our mistakes and move on, we cannot learn from them.

As a client UPR is a powerful contradiction to our everyday experience of worry about how others might judge what we say or do. Within the counselling relationship we are liberated from this self-censorship and conventionalised interaction and become free to explore our own issues in depth with openness and honesty, all of which facilitates the path to clarity.

As a counsellor I like the way that UPR can work wonders just on its own, the client is offered the view of a possible world where they are accepted as they are, free from the burden of pretence, the relief is sometimes almost tangible, at last the client can be who they need to be.

Congruence

"Congruence was believed by Rogers (1961: 61) to occur when; 'the feelings the therapist is experiencing are available to him, to his awareness, and he is able to live these feelings, be them, and communicate them if appropriate." (McLeod p.174)

Congruence is about openness and self-honesty, a most liberating and laudable quality but tricky to achieve, for no matter how 'real' we think are being there is so often some baggage-ridden old pattern still running at some not-quite-tangible level, or even if we are in touch with it have we truly broken it? Some of the most congruent people I have met were amongst those with various forms of dementia who resided in the care home where my father (who had Alzheimer's) lived out his final years; their congruence, although not generated by conscious means was so refreshing, free from the usual social inhibitions and removed from conventionalisation they would just 'say it how it is'. I often found it a real culture shock when I returned to the so-called real world.

As a client, to have congruence modelled to you by your counsellor, to me almost brings a sense of relief, the space to really start to tackle some of nitty-gritty of one presenting issues within the safety that is devoid of pretence.

When counselling however I find it necessary with some clients to take baby steps towards congruence as too much too soon can be a bit scary for some clients, beginning perhaps with a style of honesty delivered with kindness and charm providing encouragement to them to feel safe about being more open.

Empathy

Empathic understanding is described by Rogers as the ability of the counsellor to 'indwell' in the worldview of the client without being sucked into it. Reflection back to the client of this understanding can give them the sense that someone is really listening and taking an interest in their story possibly for the first time, they may begin to feel safe within the relationship and perhaps a little more encouraged to take risks associated with further disclosure and explore previously threatening ideas. It is indeed a quality that I would recommend to bringing to everyday life but we are so often preoccupied by the logistics of general living, pressed for time and generally stressed by modern living that we don't always have the required emotional stamina to do so. A pity as there is great reward, not least the chance to improve interpersonal relationships and move towards a greater level of closeness and intimacy with loved ones.

To be on the receiving end of empathic understanding seems to provide a safety net which makes me feel more confident to explore my difficulties with my counsellor, as if there is a secure attachment to them and that they will truly listen and try to understand.

To place oneself in the position of another person whilst still maintaining that 'as if' quality demands of the counsellor a relatively high degree of self awareness in order to distinguish and maintain the difference between their position and your own, also to be able to have sufficient self discipline to recognise and 'bracket' one's own feelings for the duration of the session.

THE CLIENT-CENTRED, NON-DIRECTIVE APPROACH

Another of Rogers' key notions was that it is the client who knows what is best for them and that it is the therapist's job to provide the right environment for change to take place and to support the client while they find their own way through their difficulties.

When I first contract with a client, apart from the practical aspects such as timing of sessions and confidentiality for example I also like to add something about what to expect from the Humanistic style of counselling, namely that as counsellor I am not there to blame or judge, that I am not 'the expert' but rather that I will walk beside them on their journey.

This presents a wonderfully liberating and empowering contradiction especially when working with clients who have previously been used to being told what to do, by parents or partners or certain authority figures, for these clients it may be the first time they have truly felt that an opportunity for growth is available. I have sometimes worked with clients who almost can't believe their 'good fortune' and have become quite emotional as they put it in the context of the oppression they have endured.

I experience a sense of ethical and moral 'rightness' about this approach as it represents a fundamental respect for the client's autonomy.

There can be however certain drawbacks with this approach, for example clients who are habitual manipulators might find it very easy to manipulate the counsellor who believes that ultimately the client knows what's best for them thus rendering the therapy pointless.

Some clients can benefit from 'lovingly being told the truth'. I can recall instances from my own experience as a client where this has helped me greatly. One of my counsellors once told me he thought I was obsessive about making arrangements whereas I just saw it as being organised, however when I really gave the matter some consideration I remembered how obsessive my father was about the same issue and a lot of other matters as well, so after a session involving the Gestalt technique of 'the empty chair' I experienced an almost immediate 'letting go' and haven't looked back; I now have a much more relaxed attitude and only make firm plans when absolutely necessary, attending class and hospital appointments for instance.

One must also consider that some clients can indulge in quite destructive behaviour both towards themselves and others and they may benefit from being from being confronted with the consequences of their actions rather than just gently challenged.

Other clients may need a more structured approach from which they can gain a sense of achievement from more measurable success. Some may benefit from being taught new coping mechanisms with which to manage their difficulties. For my own experience as client I found that the freedom afforded by Humanistic counselling was very well complemented by also attending a series of sessions of CBT, both styles of therapy presented me with advantages that the other did not.

THE ROGERIAN IMAGE OF THE PERSON

Within this concept I always see a message of hope. The aim of therapy for Rogers was for the client to reconnect with the 'fully functioning person' that they really are. This should not be defined as some ideal fixed state but rather as an ongoing process, which I happen to find more realistic as it allows for mistakes and therefore learning to take place. So what is the 'fully functioning person'? An idea that has much in common with Maslow's 'self-actualising person'. Rogers' definition "identifies what he sees as some universal directions of the process. These include letting go of facades and becoming more real and transparent, acquiring greater awareness of one's total inner experiences, listening to and trusting the guidance of one's organism, rediscovering and accepting those parts of oneself that have been 'disowned', learning to live fully in the now." (Clinebell)

In counselling practice I find this can be used as a wonderful contradiction, especially for those clients with low self-esteem. For my own part the feeling generated when being reminded by a counsellor that underneath all of those nonsensical and redundant patterns of thinking I am an intelligent being fully connected with the totality of myself is just unbeatable, it makes me feel a renewed vigour and immense hope along with a sense of reassurance that 'everything will be alright'.

What the concept requires however is a belief in the fundamental goodness of human beings and it is just a belief which takes its place alongside the Jesuit saying of give me the boy before he is seven and I will show you the man and the Catholic idea of original sin. In order to be truly congruent within Humanistic therapy therefore, it is necessary to choose to hold onto a certain faith in human nature whether full time or for the duration of the counselling practice.

THE SELF CONCEPT

Rogers suggests that over and above basic needs for food and shelter etc. human beings not only possess the drive to self-actualise but also need positive regard from others. If during childhood this regard is only given conditionally then our self worth will also become conditional and our locus of evaluation will become externalised. Once these patterns of conditional self worth have been recognised then the client's self concept can shift towards a more positive autonomous place that does not rely on the judgement of others.

This notion on the formulation of the self concept and the origins of mental disturbance appeals to me as it acknowledges the power of patterns laid down in early years and their subsequent reinforcement, it highlights the havoc and suffering that can be caused by frozen needs and how these can be played out over and over again in adult life. I have come across this with many clients who have become ensnared in an unhealthy loop where recognition of the pattern is required along with awareness of its effects. Learning to say goodbye to a need that will never be met and move on is a most liberating experience.

CONCLUSION

If I am to evaluate this model from a professional point of view I find it to be particularly ethical in respecting of the individual's right to autonomy, its phenomenological approach of avoiding over-intellectualisation by describing feelings in the here and now holds integrity in 'keeping it real' and in terms of its accessibility, it has merit in the encouragement of positive self regard and personal growth although as counsellor one should be wary of collusion with patterns of narcissism.

On a personal level I find that the philosophy lends itself very well to the formulation of en ethical framework by which to live one's life for the same reasons that validate it as a professional model. As a client it has afforded me the time and space to work through my own difficulties at my own pace and in my own way whilst feeling nurtured and supported.

As a counsellor it has taught me patience, the ability to' bracket' my own feelings until an appropriate time, being congruent enough to express them if required without being sucked in by them. I have learned something of the resilience of the human spirit and that often truth really is stranger than fiction!

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