Process Work in Person-Centred Therapy

Richard Worsley

• Publisher: Bloomsbury Academic
• Year: 2009
• Print ISBN: 9780230213159
• eBook ISBN: 9781350305861
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This unique and important book breaks new ground in the theory and practice of person-centred psychotherapy by focusing on the issue of process. Process belongs to both client and counsellor. Worsley conceptualises process in relation to the core principles of the person-centred approach but also to the humanistic and phenomenological roots of person-centred therapy. Combining academic rigour with the wisdom of an experienced clinical practitioner, he opens up a more inclusive and integrative way of being with clients that nonetheless chimes with classical person-centred principles. The book features: - Activities and vivid case studies to illustrate and expand on the theoretical points being developed, allowing the reader to see easily how these might apply to practice.
- Engagement with theoretical approaches such as transactional analysis and Gestalt, as well as discussion of philosophy, spirituality and psychopathology.
- New discussion of the processes involved in mental illness, drawing on the work of Prouty and Warner to understand the client's world of experiencing.
- New material on the plural self and configurations of the self.

1

Process and Listening

A Case Study in Process

Ah! A chocolate biscuit! How nice! I shouldn’t . . . . But I am going to!

I do not know how many times in a year I play out this strange little verbal ritual about being offered a chocolate biscuit. Perhaps my colleagues at work are tired of it. Yet, counsellors do find biscuits a good way to alleviate tiredness. Behind the words over the biscuit lie quite complicated processes, I suspect. Firstly, because it is a ritual, it is also a game. I expect others not to take me too seriously. Secondly, I suspect this means that I am quite serious about what is going on. It starts with my body and my nose and my eyes. It centres on the biscuit, of course. I want it. I mean I really want it. Nothing appeals like temptation. I then act out an inner conflict, but fairly light-heartedly. The conflict is between my need to enjoy something sweet and my need to watch my diet. However, I suspect other things are going on. I seem to need to ‘amuse’ others with this conflict. I notice I feel far from comfortable acknowledging this to myself. Perhaps they would like me to stop doing it. But I won’t! I am proud of being determined, but my Dad called it being stubborn. Being determined (or stubborn) helps me sometimes to give containment to fragile clients. Perhaps I use it to keep the diet going, but in a way that isn’t too strict. Or perhaps it is all about a bit of irritating exhibitionism. The point is, even I cannot be sure. And, if I can’t be sure about my process, you certainly couldn’t, at least not without a lot of shared exploration.

Even eating a chocolate biscuit seems to involve a lot of interesting process. Some of this I can be quite sure about. Other aspects of it make me feel uncertain, and even rather chary of exploring it. This is a book about process in counselling. Process is not easy to ‘get’. When I use the word ‘get’, I imply that process, as a concept and as a practical understanding, cannot be defined adequately. It has to be intuited. That is because it is something under the surface of all communication, hovering between what we are keenly aware of and that which is beyond our immediate awareness. A definition provides only conceptual understanding, a known meaning. Intuition provides a grasp of a complex phenomenon at a gut level. When I intuit, I am not bound by words and intellect. I am freed to experience meaning within me. If I understand a definition, the best I will say is, I know about that now. If I intuit something, I will say, I recognize that, because I have tasted it; but with more experience I will recognize it more fully. This book aims to provide an intuitive recognition of process, and then to help the reader consider how this act of recognizing might legitimately nourish the art of person-centred therapy.

In this chapter, I set out the case of Henry, as a way to think through and recognize process in both client and therapist. This description of work with Henry does not portray process as simple, straightforward. If I tried to make it simpler, I would deceive you. The process of the client, that of the therapist and even that of the therapist’s supervisor interweave. While the background is important, I focus near the end of the account upon one particular interaction, over two weeks, between Henry and me. Because thinking about process is never simple, I offer, at the beginning of the next chapter, another type of account of process, as well.

Case 1.1 Henry

Henry had arrived at my front door looking wet and bedraggled. The rain had come down in torrents at the last minute, and he had no raincoat with him. His umbrella had not protected his suit. He had come direct from his office. His jacket was shiny at the elbows and his trousers needed a press. He looked exhausted. Over the next two and a half years, we worked together, albeit with one break of four months, after the birth of Henry’s first child. However, I could not forget that first impression of him as so tired and not a little bedraggled. While he was mainly smart and brisk, at least on the surface, what I first saw remained with me as an image of his discouragement in life.

Henry was aged 34, and was a slight figure of a man. He struggled to eat enough. Some days he looked slim, and on other days he looked drawn. He worked as an executive with a small, scientific instruments firm. He explained at that first meeting that executive was a strange word. It made him seem better at what he did that he thought he was. Henry’s fragile surface was well-enough groomed. His dark hair and olive skin at times looked positively handsome. Yet, beneath this veneer was a well of depression that felt to me to be of huge depth, a bottomless pit.

Henry’s swarthy looks witnessed to a fascinating family background. His father, older than his mother by some 15 years, had been part of a trade delegation to Sri Lanka. There, he met and married Henry’s mother, a Sinhalese Buddhist. She struggled to survive being uprooted from her family and culture to live a very ‘English’ life – at least on the surface. Henry’s father had married late, and rather in desperation, I suspect. There seemed little love lost between Henry’s parents. Henry’s father was cold and rejecting of Henry, a replica indeed of his own father. The mother was lost in an unfamiliar country and felt that she could not cope. She seems to have moved between feeling depressed and being aggressive towards Henry in her attempts to survive. When Henry was nine years old his father left his mother.

I have often noted that when parents split up, children, especially those before the age of puberty, are left with a terrible dilemma. Who has left whom, and why? Adult logic sees an adult relationship failing. The child, often haunted with incomplete memories of distress, conflict and loneliness, feels that it is he, the child, who has been deserted. There is a primitive process, another version of logic if you will, in operation. The child has to make sense of this from his own resources, and these can be quite thin. Some days I would see glimpses of this confused and angry child trying desperately to make sense of it all appearing beneath Henry’s professional veneer. Anger with the father seemed pointless. Henry’s feelings seemed pointless. They could rot, as far as others were concerned. If the pain was so great, then the conclusion was inevitable for any child. Such punishment was definitive. It was Henry’s fault. He was hateful. He had contaminated his parents’ marriage, and it had broken like an abused toy. Henry’s self-condemnation knew no bounds.

Henry was intellectually most able. Bullied at school with few friends, he had little to distract him from his studies. He opted to go to Manchester Business School. I reflected that he seemed to be following in his lost father’s footsteps. However, his time there had been traumatic. He had suffered his first major bout of depression, and had to take a year out to complete his studies, but more to the point had become saturated with a desire for a string of sexual liaisons which were as personally vacuous for him as they were torrid. At least one of his girlfriends, and the one boy he experimented in sleeping with, managed to exploit him financially to the tune of several hundreds of pounds. Until his late twenties, Henry vacillated between intense loneliness and sexual encounters which spoke deeply of his need for genuine love and approval. I could applaud what he was seeking, but he could not. It was only another sign of his weakness, and a proof that what he had worked out about himself more than a decade ago must be true.

Five years before coming to see me he had met and then married Jennifer. I never met her, but she seemed by all accounts a genuinely loving person, who, although more pedestrian than Henry, was a source for him of stability. He also admired her. Marriage had not been easy. After 18 months, Jenny miscarried their first child. They were both devastated. Instead of giving support, Henry felt again the call of the wild! Other women, the old pattern, became a huge part of his life. Was it just gratification or was it more: the illusory or even real means of exiting into a new life? At about the time of his marriage to Jenny, Henry had returned, somewhat to his astonishment, to his mother’s Buddhist faith and practice. He found some comfort in meditation. The image of letting go of attachment and of seeking some form of perfection strengthened him, but at other time intimidated and haunted him.

We spent many a long week working upon Henry’s feelings of worthlessness and of hopeless depression. Looking back, I struggle to remember the full course of the therapy, but was aware of the endless circling around Henry’s conviction that he deserved all he got, and was somehow perverse in his badness. Even in the first group of sessions, lasting some 20 months, I could alternate between deep affection for Henry and a scarce muted fury at his ability to believe himself of no worth and yet to insist against every fibre in my body that he just knew he was rotten to the core.

I came to think of this as cognitive stuckness. I even contemplated a referral for cognitive–behavioural therapy. (Let someone else try to unstick this!) One day, however, Henry gave me a glimpse of another world. He suddenly looked at me and asked, The death of our baby. Tell me it’s my karma and not Jenny’s. In spite of a degree in theology, I found myself disorientated. Surely Buddhism came into being to get rid of the problem of karma as it had been in Hinduism. Some quick reading between sessions re-orientated me. For Henry, as for his mother, karma is one of a number of forces in our life. It is the weight of sin from past lives, if you will. Yet, Buddhism offers hope that karma is not malign. While the West deals in forgiveness, religiously, Buddhism finds hope in the fact that the bad can be wiped out, just like the repayment of a debt. The debt, the sin, is earned, deserved.

I wondered how I would respond in the next session. However, the chance never came. Like so much that is fascinating in counselling, the question of karma disappeared – and just when I had found out something about it! However, I could see the Buddhist doctrine as a fascinating aspect of Henry’s awareness. The misdeeds in past lives looked very much like his pondering in childhood what must have been his twistedness that caused his father to leave and his mother to be perpetually angry. Yet, Henry’s ability to meditate upon his own pain, together with the doctrine of karma, offered him a way out of the absoluteness of his self-condemnation. Even more, he wanted to protect Jenny from karmic vindication. He could seek to preserve that which he loved.

Bit by bit, the depression lifted. At about this time, Henry left therapy because of the birth of their new child. Expense and exhaustion took away from him the resources to pay much attention to himself.

Four months later, he returned. I had not expected that. I was glad to see him, but thrown by his state of mind. He was down. He was flat. He hated himself. Strangely, he said that he did not exactly feel depressed. He just felt awful. The shield of depression had lifted. He had moved from helplessness and lack of emotional intensity to a simple state of pain. He was in the depths of despair, but in such a way that the experience seemed to have a strange purity to it. I could feel within me some of my old irritation with Henry’s implacable, grinding self-condemnation. Neither Jenny’s everyday love nor the gift of a child alleviated this. In other circumstances I would have needed to work my way towards being able to be immersed in this dark field for month after month.

However, there was an external problem. My partner’s job was taking us away from the area. This was the end of my private practice, and I had this to grieve too. One of my supervisees was working her way through her anger with me for going only eight months after taking her on. So, Henry too was going to be short-term! Perhaps all I had to offer him was the ending. I encouraged him to see an ending in the very short term indeed. I was desperate that he just got to grips with what we had learned before. In short, the ending made me want to rescue him by getting the cognitive stuff into place, and the need to do so made me press even harder than circumstances required for an ending. We agreed – or at least I specified – an ending for mid-November. I was moving in the New Year.

Henry commented resentfully that all that counselling seemed to have done for him was to make him feel the pain of despair more acutely.

We resumed our second set of sessions with about five sessions to go, although eleven would have been possible, practically. While the precise content of each session seems to me less that relevant now, I was increasingly aware that Henry had come back feeling utterly stuck in his pain. The depression seemed to have moved away, and what remained felt raw. In the first set of sessions, Henry had begun to develop some sense of how his present and his past connected. Some clients can see the past as a true explanation of the present in a way that is really useful to them. (See, for instance, Hilary in Chapter 13.) Others seem not to need to visit the past at all. Acceptance and empathy in the present connects for them. For Henry, the past seemed a useful but alien territory. Yes, he could grant that his childhood had been painful, even that it had distorted his perception of himself. But only rarely did this seem to help him locate a felt-shift in his emotions.

Over some three sessions, I noticed that I was working very hard, and desperately wanted Henry to forge connections with his past. Perhaps I expected Henry to have a rational relationship with himself, in spite of what I knew about emotions. Since he knew the origin of his sense of self-rejection he should surely forgive himself! At worst, I became acutely aware of Henry, under pressure from me, meeting time and again those parts of himself he detested, and when invited to consider what they meant, would say, Don’t know! Of course, he wasn’t wrong. But I could not get why I could feel so irritated about this. Sometimes it can take hard thinking and too much time for a stuck therapist to get what is going on – the process.

What finally dawned upon me was that there was no gap – literally no time gap – between what I said and Henry’s ‘Don’t know’! He did not stop to think. And my irritation? Henry felt like a sullen teenager. He wasn’t trying. He wasn’t on my side. Eventually I turned that round. Maybe I wasn’t on his side either. Something had to shift. It was a shift inside me that mattered. Only then could Henry and I shift together.

The next session, I told Henry that I was aware that I wanted to get the ending done and help him to survive without me, to solve how he was for himself. I told him that I thought this would no longer do, and that he could have the seven or so sessions that remained to him; that he would need to construct his own ending with me; that I was going to get off his case and stop trying to be at all helpful. Finally I added that it really was his job, and that how he did with it was up to him. I was a companion on that journey but no more. (I winced. Did that sound harsh? It was not meant to.) Henry took on board what I said. Considering what a hole I had dug for myself over three sessions, I thought he did this very graciously. I might have been rather more pissed off with me.

The next session, I could feel myself settling down into my chair. I felt warm and comfortable and, well, just less responsible. I cannot recall what Henry talked about at first. I do remember how much I enjoyed listening to him. Then, about half way through the session, Henry looked at me and said, I guess when I am under this sort of pressure I regress to a default position, and that is my teenage years. I simply echoed his words: When life hurts, it’s as if you become a sullen teenager again. That is such a simple response, but I wanted to emblazon it across the sky. Why? I guess from that point onwards I thought that a real shift was happening. What is the process? To understand process, we must begin with the very bedrock of person-centred therapy.

The Bedrock of Person-Centred Therapy

The starting point of all person-centred therapy must be the therapist’s trust in the client’s actualizing tendency, the natural, organismic potential of the client to seek to lower psychological incongruence, the tension between...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgements
• Who This Is Book For?
• 1. Process and Listening
• Part I Addressing Process Work
• Part II Phenomenological Perspectives
• Part III Existential Perspectives
• Part IV Moving into Process Work
• Bibliography
• Index