Therapeutic Models

Because I've been a bit under the weather, I haven't had the time to think and write as much as I would like, so this Sunday's offering is a piece by Annie Parmeter, written when she was studying counselling.

The fundamental idea that crops up in her thinking, which is one taken from co-counselling, is that of "patterns". Harvey Jackins, the founder of co-counselling, saw "patterns" as fixed reactions to hurt and pain, that were almost recorded like tape recordings, and would be replayed at other times of hurt and pain. It can be seen that this comes from a very old idea of memory, that memories themselves are like tape recordings. The notion that they can be replayed under hypnosis with "regression" also comes into this.

But we now know that human memory is not like that of a tape recorder or a computer, but is much more fluid and complex. Past lives, and alien abductions, are not examples of events recorded on an organic  tape recorder but how the human mind behaves when charged with creating events that did not exist. The work of Elizabeth Loftus shows that memories can be strong, but wholly false, and can even be implanted either by accident or by design.

And I think the same is true of "patterns" - just because we have reacted in similar situations, doesn't mean that we will simply react in the same way in future situations, like a robot programmed to react that way, because it must. The tape recorder idea of the psyche is not true either.

Yet it is true that unless we follow the Socratic ideal, and seek to "know thyself", we are also likely to be prone to follow set patterns of behaviour. This is not because they are like a tape recording which must play back exactly, or a robot programmed to react, but because they have become automatic responses. Just as when driving a car, we may take a wrong turning because we are not concentrating on where we are going, or have been distracted, and so follow the turning we usually take, so too, I suspect that our behaviour can follow learned patterns where we are not sufficiently critical and introspective. This is where therapy can be helpful, to provide a means to enable us to see our own behaviour more objectively, especially if we are not naturally introspective - and this is the subject of this piece by Annie:

Therapeutic Models
by Annie Parmeter

This week we have been asked to make an exploration of our preferred therapeutic model.

I cannot honestly say that I have any one favourite, firstly as a trainee counsellor I am still learning about a variety of different models and until I gain more experience in the practice of them I would like to keep an open mind; secondly, my experience so far has been as client and the effectiveness of a therapeutic model (if that is the criteria by which we should judge it favourite) may therefore only be indicative of my own individual needs and modes of learning, for example I value the trust, sense of safety and unconditional positive regard engendered by a humanistic style of counselling, but the more logic-based practical style of the cognitive approach appeals to the pragmatist in me and my rational need for beauty and order.

These may not be the needs or preferred learning styles of other clients and as counsellor it behoves me to remember this and act accordingly. For the purposes of this exercise I will focus on the humanistic person centred and cognitive approaches as I have found from my own experience that they can complement each other very well.

How we come to experience suffering;

Cognitive therapies (including those of Beck and Ellis) support the belief that human beings are prone to learning erroneous and self-defeating thoughts and that these thoughts are the cause of our subsequent feelings of distress, but the cognitive message is one of hope as it is believed that we can challenge these negative thoughts and relearn a more positive/rational (although we must beware of assuming that there is a universal definition of 'rational') view of the world and come to enjoy more upbeat feelings as a result. The cognitive approach recognises the degree to which negative thinking has the power to set a client on the road to self-destruction.

The person-centred approach of Rogers is constructed around the idea that human beings are motivated by the drive to 'self-actualise' and that at a very young age we begin to develop a concept of our 'self' as an individual. We also find within us a deep need for positive regard of this 'self', tailoring our behaviour in order to receive approval, we learn about the effects of our behaviour and how acceptance can be conditional upon it, if we internalise this the result can be feelings of alienation as we come to feel bad about ourselves as if we were the cause of others' perception of us.

The aim of therapy;

The cognitive approach has a present time focus and suggests that the painful 'symptoms' (the result of faulty learning) with which the client presents are the real issue to be tackled, the goal therefore is to help the client change their behaviour by unlearning destructive patterns of thinking (and ensuing behaviour) and replace it with life-enhancing skills, the therapist is seen very much as a teacher of effective behaviour.

Change-goals are set up to be limited, specific and measurable in order that client and therapist can both easily evaluate the effectiveness of the treatment.

The aim of Rogers' person-centred approach is to create for the client an environment conducive to personal growth, that is to say one of congruence, unconditional positive regard and accurate empathic understanding. Rogers believed it was from this nurturing position that clients could feel safe to examine those patterns that may be inhibiting their growth thus enabling them to change their self-concept.

How does therapeutic change come about?

The cognitive approach brings about change when the client is confronted by the therapist about their irrational notions and begins the practice of unlearning destructive or counter-productive patterns of thinking and takes on board more useful and effective ways of thinking about their life and their difficulties. This process usually involves homework.

The Rogerian humanistic counsellor/client relationship is an egalitarian one where the counsellor declining the role of 'expert' proceeds from the assumption that the best person to find the most effective way forward is the client. In a therapeutic environment that is free from blame, criticism and judgement the client can feel safe to explore the full potential of their path to self-actualisation, the resolution or working through of difficulties is deemed to be something that will occur quite naturally along the way. There is a way of looking at this type of process that we may borrow from gestalt therapy, 'The curious paradox is that when I accept myself as I am, then I change'. Rogers also played down the usefulness of intellectualising about problems in favour of a more intuitive/emotional slant that he felt was more conducive to 'whole-person learning'.

Where it became useful for me to run these therapies side by side, was when I could discharge on and clarify ideas within the safety of the humanistic 'talking therapy' then check in with a more cognitive approach in order to more swiftly and effectively set up goals for change.

There can be valuable lessons to be learned from a more confrontational approach, sometimes, additional information or an outside viewpoint can help to open up new angles on a given problem. I do however value the space afforded by a humanistic approach to explore the origins of some of my distress recordings, often this process of unravelling, recognition and understanding of the patterns currently running can be sufficient motivation to alter my thinking and behaviour, without which the cognitive restructuring approach can seem slightly like brainwashing and more definitely like trying to use a sledgehammer to crack a nut.

The Self and The Expression of Emotion

Today by way of something different, I have some of Annie's counselling notes from 2010, which deal with how people express emotions, and how to cope with listening to someone when they find something boring.

There is also an interesting biographical sketch in which she illustrates how past patterns of reacting can be set up, and we behave in such a way without realising that we are following a learnt strategy which may need to be overcome.

This also comes into her discussion of how people argue, and the defensive patterns of behaviour that can come to the fore. When there is an emotional investment in a belief, or an argument, the reactions may well be bordering on the obsessive. To look at the other point of view is something that is extremely difficult to do, and when one has an emotional attachment, anything that smacks of criticism will be sees as offensive. Patterns of reaction come into play. As David Hume observed, we are more motivated by our passions than we think.

And personally, I find discussions of football boring, but in my case I'd plead that is a rational reaction!

The Self and The Expression of Emotion
by Annie Parmeter

This evening's three-way discussion was about developing an understanding of the self with specific focus on the expression of emotion.

The first question raised was, how do we show when we are bored with what is going on?

My two other classmates stated that they usually started yawning and distracting themselves by turning their attention towards more interesting concerns.

My own reaction often includes sighing and fidgeting, eventually becoming quite stroppy. This probably relates to old fears of 'being held back' and sometimes physically oppressed by previous partners who resented my attention being turned away from them and their needs towards 'books and talking and stuff', so I can now be quite determined only to be involved in matters that hold sufficient interest for me and to be fairly focused when seeking them out. This is underlined by owning class patterns relating to arrogance and issues of control.

We also discussed the types of emotions that flag up when we are asked to do something that we don't feel confident doing. It was suggested that humour was one way of dealing with the situation, not only is this a discharge of light fears but it can create the illusion of confidence. 'Ha! I laugh in the face of fear!' (some of the old sayings really do run deepest!) One classmate said he would want to be honest and in a fit of congruence say with openness that he didn't know what to do and would someone help him.

When rationality and congruence have lost the battle, I tend to react in either of two ways, the first by becoming straight faced whilst the rest of me starts to squirm, the second by adopting a fixed and determined expression as I am overcome by feelings of defiance, both finding theirorigins in the owning class oppression of children-being raised to be superior in all things.

The first reaction is to do with the way my father used to make me feel deeply academically inadequate, I used to dread not getting full marks in school tests because of his anger at my being 'lazy' or just generally 'a waste of space'. The pattern associated with this distress can now make me internalise the oppression and feel fearful of my ignorance being 'found out' so I usually want to dodge the request entirely or run away.

The second reaction of defiance speaks at my anger towards my father (and the underlying fear that I would be emotionally crushed by him) and as I feel overwhelmed by almost manic feelings of 'there is nothing I cannot do!', reckless behaviour can ensue. Whilst on such a mission I can sometimes be seen by others as bossy, controlling, bullying, scary, intimidating and even dangerous.

What about when someone does something to me that hurts my feelings?

One classmate said she tends to withdraw and remain silent under these circumstances, blanking out the other person perhaps in an attempt to shut out the hurt. The other person said that he goes either for sulking or dismisses the remark in trying to rise above it.

My own reaction can also be one of arrogant dismissal or I can become defensive and cynical, anger would certainly feature. Once again I would seem to be imagining that my emotional survival is on the line, that my abilities and judgement are being questioned; fearful of being discovered to be inadequate I will seek to defend myself either by explaining or justifying my words or actions, or if it's a remark directed at me personally I would find myself attempting to transfer the feelings of inadequacy to the other person by making cynical or dismissive remarks in return.

Whilst giving in to fear I fail to remember that pointing the finger is a powerless act, but it would seem that I buy in to this victim mode and forget that being offended by the acts of another is to imbue those acts with importance; from an objective standpoint one should merely be considering what can be learned from the situation.

And of course... 'Self-importance is man's greatest enemy. What weakens him is feeling offended by the deeds and misdeeds of his fellow men. Self-importance requires that one spend most of one's life offended by something or someone...(we) have unmasked self-importance and found that it is self-pity masquerading as something else.' (Juan Matus). Recognising the other person's words or deeds as expressions of their own patterns, as a result of old hurts in a detached and mindful way would be a far more useful strategy.

What if I am feeling annoyed with someone with whom I want to build a relationship? Withdrawal was again offered as one coping mechanism. For my own part owning class patterns and issues around control can lead me to become aggressive and bullying.

Perhaps a more appropriate way of dealing with the situation would be to hear the other person and communicate with them in terms of Observation (strictly factual and objective), Feelings (I feel not I think), Needs (preferably rational human needs), Requests/Strategy (specific and if possible relatively immediate and easy to achieve).

We then discussed feeling angry about prejudices expressed by someone in the group.

One classmate said he would feel curious as to why and how that person had come to hold those beliefs and would seek debate with them. We all said that we would probably buy into feelings of self-righteousness with the patronising idea that the person's beliefs were founded in ignorance, we soon decided that this judgemental approach was nothing more than the expression of our own prejudices, but because they were our own prejudices we had been deluding ourselves that is was somehow OK.

Annie on Maslow

By way of contrast, as these musings tend to be, some psychotherapy. This time, a few notes, with some autobiographical comments, from my late partner, Annie Parmeter. She discussed Maslow in her class, and also with me.

The idea that the evolution of life was counter to entropy, which she begins with, was partly due to her reading of M. Scott Peck's "The Road Less Travelled", when he came out with very much that idea. It was one of the few areas that we disagreed, because while the emergence of life, and the increasing complexity of life on earth seems to run counter to the Second Law of Thermodynamics, it only does so if one assumes the earth is a closed system. But it isn't, of course, getting energy into the biosphere from the sun, all the time, and it is the sun's energy which is the engine supplying energy for life on earth - and the sun is running down gradually, so that the whole system is increasing in entropy, regardless of localised areas where it appears to be reversed.

She was very good (and where I did agree with her) in seeing, as she explains here, how part of the apparently value-free "self-actualisation" of Maslow actually embodies cultural values from 20th century America, and it must be reinterpreted or adapted to other cultures.

I'd come across a similar problem arising in conjunction with even the seemingly "objective" IQ testing - it is clear that they often involved not just logic, as their proponents suggest, but also significant cultural biases. Even items such as "Fill an empty field on the left side with the correct picture from the right side" make assumptions about symmetries and regularities which are implicit. The test assumes that the result must come from symmetries in Euclidean geometry, and this has has some absolute Platonic "correctness" in the real world, which of course, it does not. Other considerations may enter into notions of "correctness", for example - in Turkey, prayer rugs, identifiable by a deliberate lack of symmetry (the "arrow" will always be lain in the direction of Mecca), continue to be one of the more beautiful categories of traditional Turkish rugs. The same occurs in Jewish culture, where one of the stylistic traits of Ancient Jewish art is an imperfect symmetry of design where in other cultural contexts a symmetrical pattern would be expected. A "correct" picture might be very unexpected after all!

Anyhow, here is Annie's interesting take on Maslow, and some reflective comments on life:

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Refelections on Maslow by Annie Parmeter

This evening in class we revisited the work of Maslow and his idea of a hierarchy of needs, the idea of self-actualisation reflecting the popular needs and beliefs of the West coast of America in the 1950s and 60s, some focusing on the human potential of the idea, others applying the principle of self-actualisation to all life as countermanding the natural law of entropy.

The progressive system of needs outlined in Maslow's pyramid can be applied on many levels, right from an individual's addressing the fulfilment of these needs in the decision making process relating to a particular circumstance through consideration of personal development to a chronological 'lifecycle' interpretation of:

· Physiological needs being the primary concern of babies, the elderly, the sick and persons in crisis.
· Safety needs as pertaining to young children.
· Belonging needs applying to all but particularly teenagers seeking peer acceptance and finding their own social niche.
· Recognition needs relating to young adults.
· Self-actualisation needs being part of the human drive to 'create' and 'become'.

Some classmates perceived these needs as being the domain of the privileged few. I think that we all have these needs and the intelligence to find ways of fulfilling them in our daily lives, but the opportunity to address and implement them in particular ways may be the domain of the privileged few.

There are also cultural determinants involved for example our own 'western' value system may encourage a highly individualistic approach but other cultures may see that self-actualisation comes through contribution to the fulfilment of a family, tribal or other larger group need.

Personally I am in a very privileged position with regards being able to concentrate on what is important to me as I have no dependants or work commitments, the only thing that comes between me and my drive to self-actualise is chronic illness which can be an extremely demanding and unpredictable companion.

I see part of the purpose of my existence as being 'to seek out new life and new civilisations, to boldly go where no one has gone before'. I see no purpose in resistance to the inevitability of change; I welcome the opportunities and possibilities that it brings.

From amongst quite a complex layering of different patterns of attachment I have emerged with a sense of confidence in myself and in addition and perhaps as a consequence I have so far lived a most unusual and interesting life. What I do fear is injustice and men with guns.

As an only child forced to fall back on my own mental and emotional resources from the age of twelve I soon developed the need to form my own judgements of situations, and very soon realised that the view of the world that my parents had portrayed to me no longer existed in real life and quite possibly never had done.

Neither my own view nor that of my parents seemed to tie in with those of the people around me whose ideas seemed to me to be the stuff of fairytales, so I managed the situation as best I could by steering a middle path, on the one hand sticking to my own evaluations gleaned from day to day experiences but on the other presenting a sort of self-preserving collaboration so as to blend in 'undetected'. This charade diminished over the years, until now cantankerous and forty-something I scarcely have the patience to bother with it at all even for the sake of 'social niceties'.

I have made a commitment to be honest with myself, there are still plenty of things I catch myself trying to sweep under the carpet but I'm giving it my best shot. Other people frequently seem to find my honesty fairly scary!

On the subject of presenting my own views.hmm tricky. The last few years have seen me become less and less willing to form any concrete opinions let alone present them to others. Opinions seem to be limiting and bare little relevance to the shifting nature of reality, my boyfriend, a robust critical thinker sees this as a decline into the worst and woolliest sort of relativism. So. damned if you have an opinion and damned if you don't! Am I bovvered?

Taking responsibility for one's life? Quite keen on that as I'm not sure who else is going to do it (so speaks the abandoned owning-class child). I am also interested in taking my share of responsibility for my illness, which I have discussed with my consultant. He is taking care of the medical treatment plan, jointly we are setting goals and I am doing lifestyle choices, research, emotional and mental health and the fun bit.exploration of existential dilemmas.

Annie on Autism

By way of a change, a few notes on autism today. I'm posting are some of the journal entries made by Annie Parmeter on my son Martin, who has virtually no speech (he can just about whisper yes or no). The Sally-Anne test that she refers to was a marvellously simple experiment devised by Simon Baron-Cohen; basically it tests the ability of an individual to see what another person is seeing - as it were, to get "inside" of another person's mind, and understand what their perspective is. The test is very simple, and highlights one of the problems that autistic people have:

The experimenter uses two dolls, "Sally" and "Anne". Sally has a basket; Anne has a box. Experimenters show their subjects (usually children) a simple skit, in which Sally puts a marble in her basket and then leaves the scene. While Sally is away and cannot watch, Anne takes the marble out of Sally's basket and puts it into her box. Sally then returns and the children are asked where they think she will look for her marble. Children are said to "pass" the test if they understand that Sally will most likely look inside her basket before realizing that her marble isn't there. Children under the age of four, along with most autistic children (of older ages), will answer "Anne's box," seemingly unaware that Sally does not know her marble has been moved.

Here are Annie's notes, and they are also a good reminder that we don't all see the world the same way, and while we may think we are right in our understanding, those whom we disagree with also believe themselves to be right.

One of the hardest assumptions to shift is that everyone must see the world in the same way that we do and it has a been a fascinating privilege for me to spend time with some people who have Autistic Spectrum Disorders of varying degree.
 
As Simon Baron-Cohen's simple Sally/Anne test shows it can be extraordinarily difficult for people with ASDs (autistic spectrum disorders) to imagine what another person might be thinking, they tend to assume that the other person will be thinking the same as they are and this can lead to grave problems with socialisation and empathic connection even with people close to them.
 
This has served to remind me to what degree following our own assumptions can create blocks to understanding others, it has also reminded me not to make assumptions about my autistic friends even those with milder forms of ASDs especially in the realm of emotional responses and for whom anxiety due to change and lack of certainty is a big part of their lives.
 
One person in particular who is quite severely affected by his autism very seldom speaks and although he sometimes appears to laugh I have very little idea of what he finds amusing, (when he has had a verbal phase albeit fairly minimal he has said that he finds something funny although half the time I might be at pains to see why and does he mean funny in the same way that I do?)
 
He may laugh by way of discharging light fears or embarrassment or he may just be enjoying the sound of own voice, it would seem entirely inappropriate and indeed irrelevant to make any assumptions about his behaviour at all.
 
He is a human being and so logically I should assume that communication is something that I may enjoy with him but nearly all of the time I have no way whatsoever of knowing what is going on in his head, this seems to be most disconcerting for his family to be so near but yet so far as it were; but I find I can enjoy sharing other things with him like watching movies, eating sausages and playing a strange (communication?)'game' of squeezing each other's hands and feet.  He has given my existential complacency a good boot up the rear end and I am delighted to know him.

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!