Transcript The Person-Centred Challenge to the Health System

Person-Centred
Practice
An expression of
Non-medicalised
Mental Health Care
The Person-Centred Approach
Carl Rogers 1902–1987
The approach has been in continuous
development from circa 1935 to the
present day
To be radically nice
Rogers’ approach was radical because
it started in entirely the ‘wrong’ place — it
started with the client and the primacy of
understanding the client’s process
he thought that it was unhelpful to stereotype
and categorise the client’s experience: he was
set against diagnosis because it was damaging
he thought that it was unhelpful to understand
the client’s process as one of ‘sickness’
he thought it was unhelpful to play the expert,
because he believed that it was the client who
was the expert in their distress and their healing
To be radically nice
it is helpful to be humble and authentic, to
listen, understand and accept rather than judge,
interpret and categorise
people are not ‘bad’, ‘dangerous’ or ‘flawed’. As
adult human beings we do not have to be
protected from ourselves
humans are not limited to change by learning
human beings grow. We live by growing and are
constantly changing and adapting by growing.
Clients grow in multi-dimensional ways which
are frequently mysterious to the therapist
To be radically nice
John Shlien style
‘Diagnosis is not good, not even neutral, but bad.
Let’s be straightforward and flat out about it, it is
not only that its predictions are flawed, faulty, and
detrimental to the relationship and the client’s
self-determination, it is simply a form of evil. It
labels and subjugates people in ways that are
difficult to contradict or escape.’
To be radically nice
John Shlien style
‘There is no value in being ‘reasonable’, in
wanting to participate in reformulation of the
psychodiagnostic endeavor that will generate a
universally agreed-upon answer. Why petition to
be a partner to reformulation when it is wrong
from the beginning? It does not pay to make even
temporary concessions to logic you believe to be
false, or professional conventions you believe
unworthy. They haunt one forever.’
How to be nice
Try to understand the other person. Listen to how
they experience their world. Help them find
meaning in their experience. Feeling understood
is helpful in itself.
Do not interpret their experience, tell them what it
means or impose your own meanings on it. They
are the expert. If they ask you to explain their
experiences, be straight with them.
How to be nice
Accept the other person as a worthwhile human
being. You don’t have to approve of their
behaviour, but they are a human being of equal
value.
Some people have been damaged by harsh,
heavy-handed opinion, unreasonable judgement
or abuse. It’s important that they don’t get more of
the same from you.
Be positively warm and accepting of ALL aspects
of the person, including those parts that want to
choose an option that we don’t agree with.
How to be nice
Do not have a front or facade, do not act like an
‘expert’, be your real self as a helper; fallible,
vulnerable, imperfect, not knowing any of the
answers.
This goes against some of the training in the
‘helping professions’ which advises people to
keep a professional distance, bluff it out, pretend
they know what they’re doing (even if they don’t)
and close ranks.
How to be nice
Be ‘principled’ rather than ‘instrumental’ when
you offer this relationship.
Mean it, inhabit it, BE nice. Being nice is NOT a
treatment or intervention.
Understanding, acceptance and genuineness are
not tools to get to the bottom of things, extract
truths or flesh out symptoms. They are both the
means AND the end.
You will be found out if you don’t mean it.
Person-Centred:
Growth
Medical Model:
Illness/Health
Metaphors for
distress
Self-defined, described
experience of distress
Actualisation
Diversity
Changeable
Sick, ill, damage,
imbalance
Treatment from
outside the person
Disability
Immutable
Vocabulary
Potentiality
Deficiency
Authority (in
therapy)
Client
Therapist
Privileged
professional
discourse
No ‘professional’
perspective trumps the
client’s experience
[There must be room for a
‘safety’ discourse, though]
(In order of power)
Psychiatrist
Clinical psychologist
Psychiatric nurse/
Social worker
Person-Centred: Growth
Medical Model: Illness/
Health
Power relations
between client
and practitioner
[Note: ‘safety’
of self and
others must
also be
addressed]
Acknowledged, informed
by dynamics of client as
self-directing healer
Reinforce personal power
of client
Informed by need for
treatment
compliance:
predisposed to
abuse
Reinforce low
structural and
personal power of
patient
Nature and
process of
intervention
Holistic
Emphasises personal
power of client
Empathy
Potentiality
‘Being with’
Description
Reductionistic
Diagnosis
Instructional
Correctional
Reinforce deficiency
model
Prescription
Person-Centred: Growth
Medical Model:
Illness/Health
Nature of
distressed
person
Whole person
Client/subject
Director of healing
process
Represented by authentic
experience
Compartmentalised
Patient/object
Disenfranchised
Represented by
recognised
symptoms
Nature of
therapist
Companion, equal, nonexpert
Expert; Physician
Technician
Privileged
frame of
reference
Internal/the client’s
experiences/the world of
the client
External/diagnostic
framework/theory of
psychopathology
Change
process
Self directed
Growth
Actualisation
Development
Expert directed
Repair
Reprogramming
Cure
Person-Centred: Growth
Medical Model:
Illness/Health
Aim of
intervention
Fulfilment of potential
Growth through and with
current experience
Treatment compliance
Recover previous
state of being (health)
Return to
homoeostatic balance
Resources
In a rich facilitative growthorientated milieu the client
is able to make use of all
possible resources,
including the whole person
of client
Expertise of therapist
Psychopharmacology
Psychotechnology
[Note client’s ‘whole
person’ is frequently
seen as a negative
resource, an obstacle
– they don’t call it
‘treatment resistance’
for nothing]
Medical metaphors for psychological
distress – still think it’s a good idea?
‘Grief is not an illness; it is more usefully
thought of as part of being human and a
normal response to death of a loved one’
Editorial (unsigned) Lancet 18 Feb 2012
[In response to the BE being removed
from DSM-5]
Non-medical metaphors for
distress
‘Feeling low is not an illness; it is more
usefully thought of as part of being
human and a normal response to bad,
hurtful or humiliating things happening
to you.’
Commonsense (and scientific evidence)
… and Person-Centred
Non-medical metaphors
for distress
Being overwhelmed …
Hearing voices…
Having jumbled thoughts …
Not wanting to get up in the morning,
wash or eat regular meals …
… not illnesses; they are more usefully
thought of as part of being human and normal
responses to …
The struggle for meaning in
mental health professions …
psychological treatments are
so effective, only ethics and
social action can save us
When everything we do has the
same effect … use ethics
Do we choose a helping method
that is the cheapest?
Do we choose a way of helping
that treats people like machines, or
tin cans?
Do we choose a method that
boasts the white heat of psychogeno-neuro technology?
What will you choose?
When change is in the air …
Be on the side of right
• ‘Homosexuality’
• Menstruation, Pregnancy,
Premenstrual Dysphoric Disorder
Borderline Personality Disorder,
Masochistic personality Disorder.
(‘Being a woman’)
• Learning disability
CURED!
CURED!
(Well, almost!)
CURED!