Thursday, October 05, 2006

The Cultural Anthropology of Suborientation Terms in the UK: Person-Centred vs. Nondirective vs Experiential Therapy

Entry for 5 October 2006: (I’m using the train journey to catch up on some blog entries)

My natural response to being in a new environment is to try to orient myself as quickly as possible. To do this, I tend to adopt the role of an anthropologist. I listen for terms that are unfamiliar, and for the meaningful distinctions that people make among different things. So I have been trying to understand the folk categories for different kinds of humanistic therapy.

In Belgium, especially as KU Leuven, where I have been working periodically for the past 2 years, this seems to have resolved itself nicely around the term Person-Centered/Experiential (PCE for short) therapy, following the lead of the World Association for Person-Centered and Experiential Psychotherapy and Counseling (note the American spellings!).

Not so here in the UK. The Counselling Unit at Strathclyde does training in Person-Centred counselling. The national organization is called the “British Association for the Person-Centred Approach” (BAPCA). Apparently, many BAPCA members refer to what they do as Nondirective. No one in this part of the humanistic therapy tradition uses my favorite term, experiential; this term is apparently reserved for therapists/counsellors who use Gendlin’s Focusing method.

A couple of weeks ago, I ran into this issue of folk taxonomy when trying to put together a grant proposal to BAPCA for an updated/upgraded version of my ongoing meta-analysis of what I refer to broadly as experiential therapy. My contact person at BAPCA, Sheila Haugh wrote back to me,

But my experience has been that people in Britain describe themselves as either non-directive, meaning classical, or sometimes person-centred - which often means the 3 conditions [warmth, empathy, genuineness] underpin their work (and meaning using bits and pieces of other approaches). Very rarely do they describe themselves as experiential, whatever you and I think that may or may not mean. BACPA members, I think, are on the whole less classically orientated than you might imagine - well that is saying it from my description of classical! (25 Sept 2006)

Suddenly, I was confronted with a distinction that I had not realized existed; I had not realized that the term nondirective had been resurrected after all this time and was being used by anyone besides cognitive-behavioural therapists (for their so-called placebo control groups)! Afterall, Rogers abandoned the term as too negative and uninformative in his 1951 book, when he started referring to what he did as client-centered. (He later broadened the usage to person-centred, after he began working with nonclinical populations in the 1960’s.) However, it turns out that the term is still alive and well here in the UK, so while I personally disagree with the usage, my task here is not to judge, but rather to understand the local folk categories. In this case, the existence of the distinction suggests that there is a need in the UK to distinguish between counsellors/therapists who are more vs. less “pure” in their application of the classical person-centred approach. (Classical is how Beth Friere refers to what she does; presumably, this is synonymous with nondirective, but she is not a UK native speaker, since she’s from Brazil...) This means that “purity” is an important issue here, that I will need to pay attention to.

In practical terms, it means that we have to be careful how we describe the topic of the next generation of my meta-analysis of experiential therapy outcomes. My initial attempt to do this was not successful: Person-centred and related therapies simply aroused suspicions that I was trying to sneak in impure treatments. I’m still not clear on how to resolve this linguistic knot, since I am committed to continuing to include a broad range of experiential therapies. As result, I wrote the following back to Sheila, my contact at BAPCA (email, 25 Sept 2006):

Some background: In North America, we (that's Les Greenberg, myself and others in the PE/EFT suborientation) have been using "experiential" as the umbrella term to include person-centered, process-experiential, emotion-foucsed therapy, focusing & gestalt. "Experiential" refers to therapies that are centered around the client's experiencing, not just Gendlin or Mahrer's variety. We've stopped using "nondirective" because it's never good to define oneself by what one is not. We also don't like the baggage of directive/nondirective, so we've switched to "guiding" or "facilitating." Although it is true that none of these therapies directs the client's content, some of them do guide or facilitate the client's process. However, I don't want to get hung up in a lot of suborientational politics around this, I'm just explaining why "nondirective" doesn't work.

I offered "Person-centred and related" as a compromise term that would provide a big enough umbrella to encompass the same set of therapies as are covered in the PCEP journal. Remember that we plan to analyze and report Person-centered therapy separately from the others. In past analyses, as in the proposed research, I've also separated out "client-centered" (i.e., the classical variety that folks in the US & UK call Person-centered) from "nondirective" (which tends to be watered down versions, often used as control groups by CBT researchers, sometimes with minor guiding elements added, such as bits of relaxation training). I can see from BAPCA's point of view they might just be interested in classical PCT, but there is a lot more out there that is very close and therefore scientifically interesting, and I am personally committed to covering the whole range of therapies in our approach.

Personally, I think the most accurate term with the broadest appeal is "person-centered and experiential", which is what the World Association decided. As I see it, these therapies really are all both person-centered and experiential. I started to write that it would be OK with me for us to refer to the subject of this meta-analysis as "person-centred", but when I sat with this, I discovered that it wasn't OK with me, because some folks in our tradition (me included!) feel that that term has been used in the past to exclude them because they are not "classical" enough.

The irony is that actually I've been pretty strict re: "purity" of approach, which is why things like Motivational Interviewing, Acceptance and Commitment Therapy, Narrative Therapy, and Hill's dreamwork aren't included. All of these have what I see as too much content directiveness (interpretation, advice-giving). There is some kind of continuum operating here, where ultimately things get fuzzy, but you have to draw the line somewhere.

At any rate, writing this entry has inspired me to go back and revise the original small grant proposal to BAPCA, changing the therapy designation to Person-Centred and Experiential throughout. This is at least more transparent than my first try, and it follows the World Association naming convention, so I think that’s the best I’m going to for now! Then it will be up to BAPCA to decide how far they are willing to go along the PCE road...

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