Brief Person-Centred Therapies

Keith Tudor

• Publisher: SAGE Publications Ltd
• Year: 2008
• Print ISBN: 9781847873477, 9781847873460
• eBook ISBN: 9781446241509
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`This is a book that the person-centered psychotherapy community has been waiting for ... this book opens a creative space in which the ongoing conversation about therapeutic efficacy in times of shrinking resources can be successfully engaged? - Professor Maureen O?Hara, Chair, Department of Psychology, National University, La Jolla, California

`A wide-ranging and scholarly book which shows that person-centred therapy is fully alive to the challenges of the twenty-first century and is breaking new ground both clinically and theoretically? - Professor Brian Thorne, Emeritus Professor of Counselling, University of East Anglia

"Likely to be of interest to anyone involved in counselling" -

Times Higher Educaton Magazine, May 2009

Can the person-centred approach work in time-limited psychotherapy and counselling? This is a question that many practitioners grapple with as demand for brief therapy increases - particularly in the public sector. Brief Person-Centred Therapies is the first book to tackle the subject, bringing together the experience and insights of a leading international team of person-centred therapists.

The book examines the philosophical and theoretical ?fit? between the person-centred approach and brief therapy. It also explores the issues which arise when working briefly in a range of different settings, including primary care, higher education, business, and prison, with couples and groups.

Brief Person-Centred Therapies is essential reading for all person-centred trainees and for practitioners who want to work in services where brief or time-limited work is required or favoured.

Keith Tudor is a UKCP registered psychotherapist, and has a private/independent practice in Sheffield offering therapy, supervision and consultancy.

1

Time, Limits, and Person-Centred Therapies

Keith Tudor

Brief, short-term or time-limited therapy inevitably raises issues of brevity, time and limits. I say ‘inevitably’ as, even if these issues remain implicit – perhaps especially if they remain implicit – practitioners’ views and assumptions about therapy, time, change, and the context in which they work, influence their work and the therapeutic encounter. So, this introductory chapter begins with two discussions: one about time, and one about limits and limitations. Each discussion draws on person-centred literature and specifically on the literature on brief and time-limited therapy. Following this, I summarise a recent debate on time-limited person-centred counselling; and, in the fourth part of the chapter, I draw out a number of points about the practice of person-centred brief therapies.

Time

The concept of time, eternity and transience has preoccupied human beings, and especially philosophers, scientists and, more recently, psychologists and psychotherapists (see Hawking, 1988/1998; Davies, 1995) since time began. As Griffiths (2000) puts it: “‘time” has, throughout history, been used like a mirror for human nature. It is a blank screen onto which societies have always projected images of themselves’ (p. 32). Elsewhere (Tudor, 2002), I explore the meaning of time, limits, and limitations, including the philosophy, culture and politics of time.

In the person-centred context, Thorne (1999) writes eloquently about time. As he puts it (p. 8): ‘certainly the Zeitgeist exerts its own pervasive influence. We live in an era of management values where the articles of faith are short-term effectiveness, value for money, performance indicators, return on investment, accountability’. Thorne, however, goes on to remind us: ‘It is good to remember that this is a modern and upstart faith with few moral roots, with no power to nourish souls and every capacity to destroy them’. In response to the speed, rush and hurry of modern life and the common experience of the pressure of limited time, there is now more talk and public debate about the pace of life or, as Gleick (1999) puts it in the subtitle of his book Faster: The Acceleration of Just About Everything. Moreover, there are some signs of a move and a cultural shift to slow things down, so that we are more in charge or ‘at cause’ of our own time, rather than ‘in effect’ or the victims of time. In 1986, this movement found a particular voice in a protest against the opening of an outlet of McDonald’s in the Piazza di Spagna in Rome, a protest which gave rise to a ‘slow food’ movement (see www.slowfood.com). The concept of ‘slow’ is well-articulated in a book In Praise of Slow by Honoré (2004), and has been extended to ideas about slow cities or ‘città slow’ (see www.cittaslow.org.uk), and slow art (see, for instance, www.robertjarvis.co.uk/other/CFSA.htm).

Of course, as human beings we are time-limited. When we talk about time, in effect we are reminded of and resonate with the inevitable limits and limitations of life. As Taft (1933, p. 12) points out:

Time represents more vividly than any other category the necessity of accepting limitation as well as the inability to do so, and symbolizes therefore the whole problem of living. The reaction of each individual to limited or unlimited time betrays his deepest and fundamental life pattern, his relation to the growth process itself, to beginnings and endings, to being born and to dying.

Also, the limit of our time on this earth is highly contextual, and directly related to where we are born and where we live. Thus, there is a huge variation in whether we can expect to live our allotted ‘three score year and ten’. In Andorra we may, as the average life expectancy is 83.5 years; at the other end of the scale, however, we may not: in Swaziland, for instance, the average life expectancy is 32.6 years (Pearson Education, 2007).

We should not underestimate the impact of time, or our reactions to it. I have worked with a number of practitioners who work in particular time-limited contexts and who spend a lot of time complaining about the imposition of limits. Sometimes, they may even say to a client: ‘We only have six session’. In my experience, this emphasis and the accompanying tone often ‘betrays’ the therapist’s resentment of any limits or limitations on his or her work. At worst, this sets up both therapist and client to fail by not dealing with the limits and limitations of therapy and, ultimately, of life. I am not advocating an uncritical acceptance of time-limits and of short-term thinking and practice. Indeed, I agree with Thorne’s (1999, p. 10) criticism of what he refers to as ‘short-termism’ in the therapeutic field:

… could it be…that short-term therapy is the inevitable dysfunctional response to a sick society and that it seems to work for that very reason? We no longer have time to put down roots, to consolidate our beings, to reflect upon our place in the eternal order of things.

I am arguing that therapists – and clients – should engage actively with the context of therapy and of therapeutic services with regard to limits and limitations, both in terms of the particular therapeutic relationship and on the wider social/political level.

Rogers and others write about ‘moments of movement’. This strand of person-centred literature is conscious of time but not overly concerned with time limits. In 1959, Rogers wrote a paper on such moments in which he writes about a ‘molecule’ of therapy or personality change which he describes (p. 53) as having four psychological qualities:

1. It is something ‘which occurs in this existential moment. It is not a thinking about something, it is experiencing of something at this instant, in the relationship’.
2. It is an experiencing without barriers or inhibitions: a visceral, organismic, ‘united integrated experience’, and one marked by some define physiological changes which, Rogers goes on to suggest, may constitute the irreversible element of these moments.
3. It is a complete experience; whereas it may have been partially experienced before and repeated, ‘This is the first time that organismic thema, which has hitherto been denied to awareness, is freely present in awareness’.
4. It is real and acceptable.

Personal integration is the goal of therapy and, as Rogers (p. 54) puts it: ‘This is a molecular unit, a momentary experience, of what integration is’ – and, by definition, this takes place in a moment.

Drawing on Rogers’ (1942) work, O’Hara (1999) writes about the way in which the values and attitudes of person-centred therapists open sacred time and space or ‘moments of eternity’ (p. 67), ‘within which the self-organizing formative tendency in nature can become manifest and effective in the world’. She describes her work with one client who had a transformative experience in four sessions but, as O’Hara (p. 73) points out:

… it wouldn’t matter whether it had taken ten sessions or even thirty, it was the quality of the change that marks it as significant. It would miss her achievement altogether to think of what occurred in terms of ‘numbers of sessions’, ‘symptom reduction’, [or] ‘problem-solving’…this change permeated her whole existence. She had not only changed what she thought about the situation she was facing, she had changed how she was thinking. She had made an epistemological leap.

O’Hara’s work perhaps most clearly articulates the experience and view that person-centred therapists can and do facilitate clients’ movement in a moment and, therefore, that we needn’t be concerned about time limits as clients will ‘move’ or have moments of movement in whatever timeframe. O’Hara argues that therapists, too, are faced with an epistemological choice: that between an instrumentalist approach which aligns with what she refers to (p. 75) as ‘the rampant medicalization which is overtaking the psychotherapy world’; and that which aligns with the intrinsic self-healing forces in all persons.

Research on brief person-centred therapy supports these views about client movement and change. Timulák and Lietaer (2001) report their study of positively experienced episodes in brief person-centred counselling, based on three or four sessions, and identify what they refer to as ‘moments of empowerment’. The most frequently reported positive client experiences were associated with empowerment, safety, and insight. They found (p. 66) that: ‘The quality feeling of empowerment was present in every client and in 50 of the episodes’.

Cornelius-White (2003) also reports a study of brief therapy in a college counselling centre of clients who were seen for a maximum of 12 or 16 sessions, with an average of 7.72 sessions. The results of his research, using four global indexes – the Derogatis Psychiatric Rating Scale and, specifically, the Global Pathology Index, the Quality of Life Inventory, and the Global Assessment Scale – show consistent improvement throughout the weeks of therapy, with the most dramatic gains in the first four weeks of therapy. He concludes (p. 32) that: ‘The study provides a refutation to the popular perceived need of [sic] specificity and directiveness in brief therapy’, points which I discuss below.

Along with the pressure to be brief and briefer comes a pressure to be ‘more’ effective. These ideas about moments of movement, together with these research findings, may help practitioners to hold the therapeutic space, however, circumscribed by time-limits; and to work in kairos or appropriate time, and to resist the external pressures of chronos or chronological time (see Tudor, 2001). In my view, human existential reality suggests that, as practitioners, we cannot – and should not attempt to – hasten the client or the process. Indeed, Rogers (1942, p. 233) comments that:

… the desire to find short cuts, to hasten the client, nearly always increases the number of interviews necessary for improvement. The shortest successful series of therapeutic counselling interviews is the one which is handled with the greatest skill, the one which is the most completely client-centered.

The challenge of brief therapy is simply to be the best we can be in a shorter time; no more, no less: any less and we are not being authentic or doing our job; any more and we are in danger of treating brief therapy and clients with whom we work in this context in a particular, ‘extra’ special way. As ever, Taft (1933, p.11), talking about a single interview, puts it well:

… if I am willing to take that one hour in and for itself, there is no time to hide behind material, no time to explore the past or future. I myself am the remedy at this moment if there is any and I can no longer escape my responsibility, not for the client but for myself and my role in the situation. Here is just one hour to be lived through as it goes, one hour of present immediate relationship, however limited, with another human being who has brought himself to the point of asking for help.

Limits and limitations

I consider that in the person-centred literature there are essentially two perspectives on the limits and limitations of therapy with regard to time: one, stemming from Taft (1933) and Rogers (1942), which acknowledges the existence of limits and argues their benefit; the other, represented variously by Mearns and Thorne (1999), Mearns (2002), Wakefield (2005), and MacDonald (2006), which argues that a person-centred approach to therapy is not compatible with externally imposed time-limits. Indeed, Mearns (2002) has refused to operate a time-limited service. These arguments and debates centre principally on issues of experience and perception; power and locus of evaluation; and structure and directiveness – which I now address.

In his book Counseling and Psychotherapy Rogers, (1942) echoes what Taft says about time (see above) when he says (p. 101):

The time limits of the therapeutic situation, like any of the other limits, are of assistance in furnishing the counseling situation with all the aspects of the life situation. The time limit sets up an arbitrary human limit, to which the client must make adjustment. While it may be a microscopic issue compared to the issues in real life, yet it allows opportunity for all the feelings and patterns with which he responds to the larger issues.

In other words, time limits are a human existential reality to which we all have different responses and reactions, and it is the therapist’s task to help the client clarify the feelings and perceptions behind his or her reactions. Indeed, elsewhere in the same book, Rogers positively advocates understanding and adhering to time limits as an example of necessary therapeutic limits which he views, along with warmth and responsiveness, permissiveness as regards the expression of feeling, and the freedom from pressure or coercion, as basic aspects of a therapeutic relationship. The same logic may be applied to the limits of a limited number of sessions. The client – and, for that matter, the therapist – may rail against the imposition of limits, and may spend some, most or even all of the time in therapy not ‘adjusting’ to the ‘reality’ of such limits; however, for Rogers (and the present author), it is both more interesting and more therapeutic to attend to all of the client’s experiences and perceptions of, and responses and reactions to, any and all limits and limitations.

Other practitioners and writers, within the approach, take a different view. On the basis of her experience and research in primary health care, Wakefield (2005) argues (p. 1) that ‘time-limited therapy as a fixed way of working in any setting is unwise and unnecessary’. One element of her argument, which she simply asserts, is that the imposition on the client of a time limit from an external authority, mediated through the counsellor’s assessment of the client’s suitability, thereby renders the client inactive or passive. Similarly, MacDonald (2006) links her objection to imposed time limits to the person-centred concept of the ‘external locus of control’ or evaluation, and argues that such limits disempower or disenfranchise the client (p. 41):

Those who work within the limits of time usually justify the time-limiting practice in terms of ‘fairness’, i.e. being able to see more clients, or even offering concentrated beneficial work. Others see it as part of counselling boundaries, imposed by others (service managers, for example) and not by the counsellor, and by informing clients of the limits of sessions, they absolve themselves of any complicity. Since counselling concerns itself with the location of the locus of control, we have to ask where, in fact,...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Praise for the book
• Contents
• Introduction
• 1 Time, Limits, and Person-Centred Therapies
• PART I INTEGRATING PERSON-CENTRED AND EXPERIENTIAL THERAPIES
• PART II PRACTICE IN CONTEXT
• Epilogue
• Appendix 1 An Illustration of the Eight Communication Exercises in TIR Training in terms of Rogers’ Six Conditions
• Appendix 2 Time-Limited Group Counselling with Women Survivors of Childhood Sexual Abuse: Weekly Log of Themes
• Notes on Editor and Contributors
• Author index
• Subject index