Brian Thorne on the legacy of Carl Rogers

Last week Focus Counselling hosted Brian Thorne’s “last public speaking event on the circuit” at St. Michael’s Church on Broad Street, Bath.

I was excited. I had “discovered” Brian Thorne, the much-admired torch-holder of the Person-centred tradition in the UK, two years ago when my new supervisor pointed me towards his work. The clarity, courage and heart in his writing spoke to me of an approach to counselling that I had hitherto been unable to find, yet felt called to employ. I was grappling with the division between my experience of working in fairly directive environments (addiction rehabilitation centres) and my yearning to bring a softer, more permissive, yet more authentic aspect to the therapeutic encounter. Here, it seemed, was a man who was willing to throw caution – and perhaps the security of specific techniques or targets – to the wind: to uncompromisingly meet his clients’ relational needs. Using Carl Rogers’ triumvirate of core conditions as his watchword he shone light upon a legitimate way forwards in my ideological impasse! I admired, too, his willingness to fly in the face of convention, take risks and challenge a discipline in which it is easy to allow caution to overwhelm creative clinical integrity.

Thorne began with the impact Rogers has had on psychotherapy. He spoke with conviction about the Rogerian approach in which “what mattered was the kind of relationship he offered his clients – nothing less, nothing more.”  He touched on the actualizing tendency – the underpinning assumption of his approach -, which espouses that, if met with the right conditions, people will grow, develop and realize their full potential. He praised Rogers’ refusal to assert power within the therapeutic relationship, and noted that this commitment followed through into his work as an international peacemaker towards the end of his life.

He spoke of Rogers as “The Quiet Revolutionary”. In many ways Rogers’ impact on western society is so great that it is invisible: his ideas about the value of listening, of the transformative power of self-expression in safe conditions has become almost ubiquitous. Our society’s narcissism has, of course, taken this individualizing impulse to an extreme in which many foster a self-centredness, expressed by the need to share intimate details to all and sundry in the form of reality television, social media etc. (The irony of my posting this critique on a blog is not lost on me!). However, the cultural shift from a position of excessive emotional containment to one of increasingly widespread emotional tolerance remains a sign of progress towards a more balanced way of being.

Thorne touched on the core conditions of Unconditional Positive Regard (acceptance), Empathy (understanding) and Congruence (authenticity), which have been so influential in the development of counselling. I would have loved to hear more of his thinking around these admittedly widely discussed attitudes. But Thorne was on polemic form and seemed more interested to address some of the more contentious and portentous issues on his mind!

Thorne chose to focus on Rogers’ final book A Way of Being (1980), which came to acknowledge the transcendent, the mysterious, and the spiritual in the therapeutic encounter. In the world of psychology this unquantifiable language, let alone concept, was not welcome. Indeed, Thorne was saying that many within the person-centred tradition had actively avoided and ignored the implications of Rogers’ later writings, preferring to focus on the more accessible aspects of his early philosophy. Thorne seemed to be admirably supporting a more transparent acknowledgement of these elements within psychotherapy, and was at pains to communicate the failure of contemporary psychotherapy and society to integrate spirituality into its value systems. He did not address the issue of how this might be embodied on a practical level within counselling, or how to prevent therapists imposing, however subtly, their own belief systems on clients.

Thorne spoke as if a lone voice in the wilderness. But is he really so unusual in championing the transparency of the spiritual in therapy? Did not Jung turn to alchemy, mystery schools and eastern esoterica in his penetrating search for meaning? What about Transpersonal Psychotherapy – a whole psychological tradition that acknowledges the presence and importance of the soul life? More recently, with the fruitful incorporation of mindfulness and eastern awareness traditions into mainstream psychology, there seems to be increasing tolerance for the dogma-free techniques and tools of contemplative religion in therapeutic systems. Moreover, there are numerous openly Buddhist psychotherapists in practice and broadly held esteem. To my mind the position that Thorne was taking was aimed more at policy-makers than practicing therapists.

It was Thorne’s contention that the current climate of service provision, with its focus on outcomes and interventions, rather than the quality of human relationship, sanitizes and stultifies therapy. The current system encourages us to become “psychological technicians that tinker around with the psychological mechanisms of the human mind”. He felt that this represents more than the simple mistake of overemphasizing form over substance. For him it is evidence of the field of psychotherapy becoming infected by the shadow aspects of our society – namely an obsession with achievement over experience, productivity over provision, and consumption over everything. The increasingly litigious environment, he feels, is contributing to the crushing of therapeutic creativity – and thus we therapists are losing the ability to model a creative, spirited self to our clients for fear of judgement and condemnation. His concern was communicated with an oppressive solemnity and extended out from the therapeutic world to the challenges facing humanity in general, from continued human atrocities to global warming.

Many of his concerns I emphatically share. I’d consider myself a poor therapist indeed if my observations of societal ills did not extend into the restrictions and challenges of the context in which our clients are living. I was somewhat baffled, then, by his focus on these woes because my very being a therapist is born from a keen awareness of these massive challenges, and the instinctive desire to therefore facilitate meaningful individual and collective change. I admire his willingness to take on denial and break our seeming indifference towards the challenges we face. But in this case he was preaching to the converted, and rather than offering constructive insight, dwelt on hopelessness, whereas I see progress in many areas of human development.

He did observe that, while support for the traditional faiths of the world is dwindling in this country, the contemplative orders are flourishing and that an authentic individual search for spiritual connection is flowering. He also noted that the quality of relationship, although not yet at the centre of psychological policy in the UK, is becoming increasingly recognized. But he didn’t seem to join the dots of these significant shifts towards a brighter future. To me the growth in partisan spirituality is evidence of a cultural development that seems to embody the person-centred ethos of allowing organic, rather than imposed, evolution to take hold.

During question and answer time at the end he softened. Having sounded the clarion call of doom he was perhaps ready to acknowledge hope! Interesting questions were raised which prompted the observation that in order for things to change a crisis often needs to be reached – a scenario I’m sure many of us are familiar with in our personal and professional lives.

Near the beginning of the talk Thorne threw down the person-centred gauntlet: “I am challenged to trust my client as a person designed for wholeness and possessed of the inner resources to achieve wholeness.” I am endeavouring to extend this trust to humanity as a whole, as well as my clients. My challenge to Brian Thorne is to do the same.

As I observe clients grow I see the changes they make radiate out across the constellations of their relationships, like ripples in a pond. So, as each of us progresses along our own growth towards our potential I believe we make a microscopic, yet meaningful, contribution to the evolution of the systems to which we belong. For anyone who feels discouraged by the task ahead, be it in response to a personal or the global situation, I offer you these illuminatingly paradoxical words from Gandhi, “Whatever you do will be insignificant, but it is very important that you do it.”

The Science of Self-harm

Why do people hurt themselves?

Imagine you are feeling really upset. Something is going on inside but you may not even know what – you just know a rising sense of desperation and overwhelm is happening and you feel like you can’t cope. Something’s got to give. In your distress you’re ringing your hands. You notice as you unintentionally scrape the skin on the back of your hand against the ring on your finger the sharp sensation distracts you from these powerful thoughts and feelings. Or, perhaps, you’re digging your fingernails into your palms, which you don’t even realize you’re doing, and that somehow eases the pain in your head… A coping strategy is born…

A few weeks ago I was asked to assist Off the Record – a leading youth support service in Bristol – in delivering training for staff at 1625 Independent People on the subject of self-harm. I’ve worked with this pattern of behaviour for some years so my role was to inform the team of the psychology and physiology of why people deliberately hurt themselves. It was hoped that with a deeper understanding, along with their plentiful experience, the team could formulate an updated organizational policy on how to respond to young people in their care who were self-harming. Jonathan Parker, from Off the Record, lead the training and it was heart-warming to see both the level of care and experience amongst the 1625 I.P. staff.

So, what is happening when someone cuts, burns, scrapes, or otherwise harms themselves? Well, the best place to start is in the body. The application of pain or injury to the body stimulates the sympathetic nervous system and the “fight, fright or freeze” response is activated. This is an automatic evolutionary mechanism that enables human beings to survive in hostile situations by defending themselves by fighting or removing themselves from the circumstances. Pain is numbed and muscles are primed. Awareness is moved away from normal processing – hence awareness of emotional pain or disturbing thoughts becomes significantly reduced.

Recent neurological research has reinforced this understanding of how self-harm provides a concrete form of emotional regulation. One particularly fascinating study (Niedtfeld et al. Affect Regulation & Pain in BPD, Biological Psychiatry 2010) detailed how a collection of Borderline Personality Disordered clients (who have a high prevalence for self-harm) and controls were put in a neuro-imaging scanner and then shown three sets of pictures – “positive” ones (kittens etc), “neutral” ones (eg a chair), and “negative” ones (surgical procedures etc). The pictures were designed to generate the corresponding positive, neutral and negative emotions. The scans showed that people with BDP had mostly more than double the level of brain activity response to the pictures in certain parts of the limbic system. The limbic system is associated with emotion, impulsivity, pleasure, as opposed to the pre-frontal cortex – the logical part of the brain – which helps people to moderate behaviour through thinking. It can be inferred from these observations that the BDP subjects experience a significantly greater level of emotion than the control subjects.

The study then goes on to test what happens to this brain activity when pain is applied in the form of a heat pad to the leg. They used the same people and the same pictures but then introduced the pain. And guess what? The brain activity in response to the pictures (read the emotion) reduced in all cases. Simply put: emotional stimulation + pain = less emotion. It is remarkable that we no longer need to rely on anecdotal evidence or theory to understand the function of self-harm – we can observe these pain reduction effects happening in the brain in real-time.

Other studies have supported these findings and explored them further, leading to a suggestion that it is not the introduction of pain per se, but effective distraction, that moderates the emotion. Hence forms of distraction can be extremely useful in helping clients to cope with states that trigger the desire to self-harm.

More next week on the psychological function that SH fulfills and why self harm stops working

Continuing Personal Development – Training

Yesterday I attended a continuing personal development (CPD) training day in Stroud, an increasingly interesting and alternative town on the edge of old Gloucestershire, thirty miles or so north of Bristol. CPD is the umberella term for ongoing recognised counselling training that counsellors and psychotherapists undertake to to maintain their skills post qualifying. It is required by the accrediting bodies, such as the British Association of Counselling and Psychotherapy (BACP), that systematize professional standards in the field of psychotherapy.

I find it a rich and enjoyable process to choose and attend courses, out of the many diverse trainings that are regularly on offer in and around Bristol. Trainings on Ecopsychotherapy, CBT, Mindfulness, EFT, trauma resolution and many more are high on my list, but on this occasion it was the topic of sex that came out on top. Indeed, the title of yesterday’s training was “Sex in the Consulting Room”. Despite the roots of psychology lying in Freud’s central theories about neurosis stemming from unresolved sexual tensions, it seems that there is precious little detailed talk of sex in the modern day consulting room. Even without subscribing to Freud’s arguments, which I don’t, sex is a massive topic and our relationship to it can hold precious information about they way we relate to life. Despite this it seems that non-psychoanalytic models of therapy often don’t arm the budding therapist with practice and training around speaking about it. Perhaps this is also a cultural – British – phenomenon and there’s plenty to be said about modern society’s conflicted, one might say addicted, relationship with sex. The long and the short of it is that, with these different considerations in mind, it seems important to be able to offer clients a welcoming space in which they can sense a therapist’s genuine capacity to talk to whatever level the client would like about sex.

David Slattery, an esteemed psychotherapist who has taught at Bath Centre of Counselling and Psychotherapy (BCPC) and works extensively with couples, was holding the training. His thoughtful facilitation and accepting style of interaction allowed for a day of contained, but nonetheless, candid exploration. Each therapist had the opportunity to look at their own relationship with sex, how comfortable or not they felt talking about it, and to move closer to understanding their own blocks and fears. It has left me considerably more aware of my own responses and reactions, and made it clear how different everyone’s needs are when talking about this subject. Some people might need an open enquiry, some people might find that intrusive and need a more gentle, empathic presence. It was encouraging to see how, when the therapist is able to offer the right conditions through sensitivity and transparency, the client tends to feel able to share what is helpful to them to share.

I come away from the training curious to explore more of my own relationship to this material and more confident to assist clients in their own journeys towards understanding themselves.

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