Persona Diploma in Person Centred Counselling The Course of Therapy “Whether by chance, by insightful understanding, by scientific knowledge, by artistry in human relationships, or by a combination of all of these elements, we have learned how to initiate a describable process which appears to have a core of sequential, orderly events . . . similar from one client to another” Carl Rogers, 1953 The therapy conditions model, now entering a fifth decade of influence, is concerned with the agency of change not with its unfolding course. The model's elegant economy and focus on qualities of therapist response considered of primary importance in the helping interview generally that is, at any stage in therapy, has had one unfortunate side-effect which this chapter seeks to redress. The model has tended to divert attention from a complementary focus on the course or pathway of therapy, where the feature of interest is the change and progression in process front start to conclusion. Therapy as a natural progression Nothing stood in the way of pursuing the broad interest of this chapter during the emergence of non-directive client-centred therapy. As already mentioned, in his founding book on the new therapy, Rogers suggested that the approach involved a sequence of twelve typical steps. He took care to acknowledge that these steps are not all discontinuous events but shade into each other, and that their stated order is an approximation. His central point was that there is foundation for the hypothesis that skillfully conducted treatment interviews are not a hodgepodge of discrete elements, but that taken as a whole they represent a complete chain in which one element tends to follow another. (1942a: 47). A fresh summary of Rogers' original account of this chain is given in my prior publication on the topic of this chapter (Barrett-Lennard, 1990).' Later in the book I will come back to related early work, in discussing the first phase of empirical study of client-centred therapy, a phase which centred on analyzing interview content to discern both constancies and shifts in pattern as therapy advanced. What follows here is a new explorer's map of the general route of client centred therapy. The therapy enterprise is broadly a means to the end of healing and growthful change, each step reflecting and building on gains already made. Thus the path or course of events is the enterprise, in basic part; and to map this path is to throw further light on the phenomenon and nature of therapy. In seeking to freshly characterize the course of client-centred therapy, issues at once spring to view regarding its fundamental nature. Is it an educative process, centred on personal-emotional learning? Is it a form of healing, of recovery from psychic damage? Is it a matter of discovery and development of undeveloped potentials? Does it centre on emotional and interpersonal growth? Is it a means of transformation from being a passive or reactive recipient of influence to being an active agent in one's world? Is the therapy an approach to redress from the alienating effects of much of contemporary life? With individually varying emphasis, it is surely all of these, and more. Can such a broad spectrum of purpose in its manifold expressions be pursued through the `same' overall process, or reach fruition through the same kind of journey? This at first sight seems improbable. Yet it is the process that largely defines client-centred therapy, or therapy of any distinctive orientation. And consistency of process, or means, implies a coherence of ends or outcome; a complex singularity to the nature of help in a given approach. Client-centred therapy in particular is a many-sided living whole in which a certain diversity arises naturally from the uniqueness of each client and each emergent relationship between therapy partners. However, the diversity may seem greater than it is, as a result of mixing process or effects that belong to different stages in the journey. Thus the process of therapy has more than one principal face, as well as many features within each one. A major, now familiar aspect or face is the quality of the therapist-client relationship, especially as seen through the lens of the therapy conditions model. Looking at the whole phenomenon in its developmental dimension yields another principal face. © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling Immediate distress may ease fairly quickly in therapy but pattern change takes more time and literal work, work that hinges on the therapy alliance. A healing and growthful engagement - unique in kind to most clients - does not spring full-blown into being. Working steps in therapy occur within this evolving relationship and contribute to it. Client issues change as progress is made, and these and other features combine to trace a pathway which constitutes the journey or course of therapy; a dimension as fundamental as the general level of the relationship conditions. The Phases of Therapy Following is a contemporary view of the basic `pathway' of client/personcentred therapy. It encompasses five main, qualitative phases, each distinct in principle but shading into the next in practice. As described, each phase is like a crest or hilltop from which the view is clearer and the location more discernible than on the slopes and in the valleys between. The phases, together, span the whole therapy route I see, although in practice this may be cut short and end almost anywhere along the way. A Beginning: the Entry Phase This description of the way therapy unfolds assumes that the client is present voluntarily, even if pushed by inner desperation and pain, or if approaching therapy tentatively as a possible recourse; and that client and therapist are meeting together in these capacities for the first time. Assuming they are not already in close relationship, whether they are acquainted from other contexts, or meeting as strangers, has no consistent significance.' More important is whether the client has effectively made an informed choice of therapist and approach or has come with little or no knowledge of the particular therapist (T) or of the process and philosophy of helping with which T is identified. Where the client is making an informed choice, the entry phase generally includes the period from the client's (C's) first approach to the therapist as helper, through whatever preliminaries are involved before the first therapy meeting, to the end of that meeting. What happens, among other effects, tends to confirm C's choice and add more specific experiential meaning to it. Where the choice is not an informed one, the preliminaries to the first therapy contact generally involve greater information exchange, and the first meetings tend to have a more visibly exploratory character with regard to the therapy medium and enterprise. The entry phase, in this case, may easily take more than one therapy interview session - and it might not come to fruition at all. Several elements help to signify and mark that the beginning phase is accomplished but without implying that therapy will necessarily continue through its whole potential course, or that a highly productive outcome is certain. The proposed signs of advancement through this starting phase, straightforward in essence, are as follows: Present by choice. C has indicated that s/he is there, meeting with T as a counselor, by her/his own decision - or, at the least, by agreement with any external advice to take this step. This may only become quite clear when arrangements are being made for a further interview or series of meetings. Owning to personal difficulty. C has taken steps to account for his or her presence, owning to difficulty or distress with self, with relationships, or the disturbing impact of particular life events. There is a message in some form that `All is not well with me (I'm troubled, dissatisfied, confused, or hurting), and that's why I'm here.' Feelings are an issue. C has directly expressed feeling or, at minimum, acknowledged that feelings exist and need be reckoned with, for example, by facing and clarifying them, gaining relief from some torment, or changing the balance of inner feeling life. Beyond rehearsed content. At least part of the time, C has departed (as it were) from a prepared text. Communication is not limited to reporting experiences, or reciting rehearsed © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling content. There are discernible moments in which C is speaking from what is coming now in his/her feelings or thoughts. Monologue to duologue. There is a perceptible shift in C's awareness of T, which T of course plays a part in. It is a qualitative shift, perhaps from thinking/feeling aloud to an awareness of engagement with the other person, or, from addressing a figure made up from variously based expectations, to communicating with a person now felt and coming into view as a distinctive other presence. Awareness of being heard. There are indications that the client has begun to feel heard by the therapist and to anticipate further personal understanding. Being here matters. What is happening in this forming relationship has begun to matter to both participants. Neither C nor T could walk away from their association without significant after-thought or feeling; and in balance both wish to go further. 3 A great deal can happen in the first interview in (client-centred) therapy. Usually, it seems, few sessions are as critical, although later on eventfulness may be differently experienced and measured. The following excerpts from the first interview with a woman client in her early or mid-thirties, and whose choice was relatively informed, are thought to illustrate most elements and features so far mentioned. The dialogue begins with the first client statement, following an invitation by the therapist to say what brought her to therapy or to share how she is feeling; in effect, to begin wherever she wishes. She knew that the session was being both observed and recorded. CI 1: I've been thinking about where to start. There's no really logical place. I guess I'll go from the general to the specific. I've been in therapy a few times and I find each time it helps me but as soon as anything out of the ordinary happens I go back to stage one. So that I find that even though I've gotten some partial help to cope with a specific situation that there hasn't been any - enough change, I find, in my vision or whatever, that makes me feel safe enough for the future, I guess. I always Th 2: [Interrupting] But you came into this situation, this therapy - this prospective therapy experience - with a background of having been in therapy before . . . CI 2: [Quickly breaking in] Does that invalidate it in any way? Th 3: No, I'm just responding to - making sure I'm catching your meaning - and what I'm hearing is that you have tried therapy; you haven't given up on it or you wouldn't be here, but it hasn't been of any long-range help so far. CI 3: Right! [Pauses, thinking]. Specifically what happened this summer, or last year, when things started to get uncomfortable, was that I was in a dancing class and I suffered some damage to my knees ... [details omitted]. One of the doctors seems to think there may be some permanent damage and that my life might possibly be narrowed down, that my activities might be narrowed down, for keeps. That threw me into a pretty severe depression which brought on a lot of other things kind of tied to it. [T begins to respond, C interrupts and, after a few short exchanges, they return to the same theme.] CI 7: And I guess I was just a little bit weakened to handle them, I was - wasn't - I was. Th 8: Demoralized'? Cl 8: Right! I was pretty demoralized. And all of a sudden it just flashed on me how - I think even though this time 1'm by now maybe feeling that I could control them again and just push them into a closet, 1 never know when they'll come out again under different circumstances. I just don't feel safe any more, I just feel very - er - that 1'm just not really handling them [C agitated, moist-eyed, continues speaking], that I'm just repressing them which doesn't help so far [C's voice breaks a little] because they are still very active. And 1'm conscious - all of a sudden I started seeing patterns that I haven't seen before. I always saw every situation apart, and 1 was sort of wondering how much I did to get myself into these things, how much of it was [pause] was perhaps self-destructive. [C pauses, her eyes moist.] © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling Th 9: Hmmm. Sounds, as I'm hearing what you are saying, it's . . . you're feeling rather upset as you try and express how it is for you, now, and how it has been recently. And, especially this aspect of feeling that you begin to see a pattern where you may have been - I'm not quite sure what you mean by self-destructive - but somehow bringing injury on yourself [said both with emphasis and a question mark]. [After brief further discussion/clarification of the client's meaning she turns to another side of the same issue.] CI 12: [More firmly] When I get to the point that I'm functioning well I ado' things. I add too much, and hmm . . . until everything just topples from the load of it. Th 13: Until you just can't cope with it all. CI 13: Right; and I find I've been doing this a lot. After my daughter was born, I was just barely coping with having her and studying, and as soon as 1 was just barely able to fit her and my husband and my studies together I started dancing again, and that really got me very rushed, got my husband very rushed because he had to give me rides back and forth, gave me much less time with my daughter. It was like I just - I insisted on it very much, and even after I hurt my leg 1 went on back dancing two or three times. So, you know, with hindsight, I'm wondering if . . . [pauses]. Th 14: If part of your way of being is to push yourself all the time beyond your own limits, somehow? Cl 14: So then I have a good excuse to fail. I don't know; this is just seeing with hindsight . . . [Client adds a bit more context and history, and then returns to the theme of her efforts to understand and explain.] Cl 17: . . . I guess I'd always been trying to explain why 1 got myself in hot water before. And every time I had a different explanation. And I was wondering if I couldn't find one that would fit everything; if it seems to be a habitual pattern ... I was [C clearing her nose] wondering if it had to do with, with that particular - [C stops]. Th 18: By the way, I'm -- Oh, there is some Kleenex [pushes it over to client]. It sounds as though you - ehr - you know, you really wish you could understand; that you were on top of whatever the hell it is that's going on underneath in you, somehow, that's behind the things, that's driving you or propelling you in the ways that you go. [Passage omitted until T asks a question, inviting C to focus on the change she is seeking.] Th 24: I guess I find myself sort of wondering, wanting to get more of a feeling for how you would like to change or what you would like to change, what ways you would like to be different than you are? Cl 24: [Pause] I suppose self-assurance springs to mind, but that can mean anything. [Slight pause] Yes, I suppose that would cover it. . . . The interview continued with deepening expression by the client of how tightly and painfully she was `holding everything up' in her life. This part of the dialogue (immediately following Cl 24) appears in Chapter 6, under the heading `Active listening and empathy'. Toward the end of this further sequence the client, who had been chain smoking, mentioned that she had run out of matches. This problem, which T could not help with directly, created opportunity for an episode which undoubtedly brought the client and therapist more distinctly into view to each other, and also provided the lightest moments in the interview. The episode began with T returning to the client's predicament and mentioning that if they looked outside the door of the interview room shortly, he believed there would be a box of matches there. Only momentarily puzzled, C tuned to the tacit message to the unseen observers. Sure enough the matches were there! T was glad C knew how they had appeared, saying that he did not want her to think he was any kind of magician, either in reference to the matches or to therapy. The spontaneous `lesson' was fun; C was alive in her awareness and evident feeling of contact with T. There was increase in her confidence and spontaneity in the therapy situation, linked to a rise in the immediacy of her communication. At the end of the session she planned a series of appointments, envisaged as continuing for a number of months - seven months, in the event. © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling It became quite clear, within this interview, that the client felt she was in trouble in her own functioning; that this had led to a choice to seek help through therapy; that she experienced distressing feelings, which she wanted to change or gain relief from; that although she started out by describing difficulties and reporting on her experience she soon began to pick up on the therapist's responses to her and go into what she was feeling as she spoke; and that the therapist came into view to her as another person closely listening, seeking to understand and actively responding to her - mostly in serious vein but, at one point, almost in playful mode. An engagement of consequence to the participants had begun which they both wished to continue. Thus, each of the suggested criteria for the Entry Phase was met in the course of this interview. As well, the sessions that immediately followed were broadly consistent with the next phase to be described. B Forging a Personal-working Alliance and The Passage from Woundedness to Hope Two main streams flowing through the course of therapy can be distinguished. Each feeds and furthers the other, but is distinct. One stream is the development of the client therapist relationship, encompassing each one's evolving perception of the other and the view each has of the kind and quality of their partnership in the enterprise they are engaged in. The other stream (to come back to), centres on client issues and process, as these unfold and change over the course of therapy. Since the client is in some way struggling or stuck in his/her own process, in a situation of troubling adversity, and has enlisted T's help to gain relief and work through and out of this affliction, the client centred helping association is a form of alliance. And as the relationship between C and T is employed as a means, and the enterprise is both person focused and demanding, the term 'personal-working alliance' seems usefully appropriate. In this phase the helping relationship comes strongly into being, although not yet to optimal fruition. As this is happening, the therapist comes to be experienced as a resourceful ally in a rather unique sense. (If this does not occur, therapy is likely to be aborted.) In client-centred therapy the client leads the alliance in terms of content issues, and contributes (if not as senior partner) to determining process. C may wish that T would `take over' more, but this wish recedes as the alliance grows stronger. In fact, initiatives expanded beyond T's usual repertoire may naturally occur; for example, if C truly seems lost, frozen, in an abyss of confusion or despair, or in the grip of extreme anxiety or other emotion seeming to have a life of its own. Even without such extremity, Gendlin (1978) and other exponents of focusing may become active during this phase in working to directly help clients engage and dialogue with their own inner felt sense. In effect, this is the make-or-break phase of therapy from the standpoint of therapists. The therapist ally needs to come into view for the client in his/her own distinctive likeness as helper-person; and the client likewise needs to become not just a string of feelings and perceptions responded to one by one but an increasingly known whole configured person to the therapist. The alliance evolves unevenly, as any significant relationship does, but in overall pattern toward deeper engagement and eventfulness, and greater commitment to what has become a sharply real and consequential enterprise. Alternatively, such development never really takes off, or it begins to and then falters and ceases, or is aborted by circumstance. C may never move into a fullfledged therapeutic mode of self-inquiry and discourse with T, perhaps resting instead with modest gain in terms of the immediate felt situation that prompted entry to therapy. ln the latter case, therapy would stop without the alliance aspect or stream developing to fruition. One might refer to this as a Phase 13 termination. The reader might wonder about my use of' the term `forging'. To speak of forging the personal working alliance could evoke imagery of hammering something softe ned by treat into shape, which seems scarcely in keeping with a humanistic person -centred approach! However. if figurative usage is granted, and give, that people can be drawn from within to undertake strenuous and difficult tasks requiring an unusual kind of team effort - one-to-one therapy in this instance - the term begins to seem more fitting. As © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling with any complex collaborative or team effort, instant fruition is not possible. Hard working practice experience, including some trial and error, is inherent. Part of the unusual demand of therapy is that clients cannot for long coast through a well-practiced repertoire, without the process grinding to a halt or becoming visibly pointless. Add further the feature of a therapist"-partner who usually is a stranger and whose way of responding is unfamiliar in its total pattern. Then, it is indeed the case that the alliance is not simply present or given but something produced through strenuous application in a mode of' searching dialogue; at once with self and with other. However, in a fruitful alliance so forged, the engagement becomes selfpropelling for both partners. As `person-centred' implies. the therapist as person is present too, in such a way that experience or expertise do not diminish the challenge or lessen the rewarding elements for the helper partner in a personal helping alliance. The second stream in phase B flows from the general nature or thrust of issues likely to be ha! -amount for the client at this still early stage I I I therapy. My approach to identifying and framing the central or underlying client issue cuts across a wide range of individual expressions. It starts from the idea of a shift or passage from X to Y, from something, that is part of what propels nearly anyone to enter personal therap y to something that encourages and makes them want to keep going with the enterprise of therapy. As 1 pondered on this, what stood out to me is that the `X` in this transition is some quality of woundedness, and the 'Y' amounts to an increase or awakening of hope. Reflected in this distinction is the idea that nearly all of us me wounded at times, in a psycho-social sense, and that we carry old wounds that may. under relevant conditions of stress, flare up again. Clients typically begin personal therapy wit h past wounds that have flared up again and which may have been augmented by present/recent wounding. These varied wounds tend to have in common painfullydiminished self-esteem or sense of worth, feelings of apprehension or anxiety, a degree of depression or a more existential kind of despair and loss of meaning, and some fresh hurt or disturbing life difficulty in which anger and pain are often fused . Such woundedness from long-term and immediate causes, leaves the person without confidence that `good ’ can come of his or her efforts, leading to a view of things as through a darkened and narrowing lens – in short, a loss of hope. Person choosing to enter therapy have not lost all hope, and the fact of taking this plunge itself typically brings some increment. The clients woundedness may be used to arise from some form of psychic or psycho social assault. Experientially, it is something which happens to the individual, even if later it is seen to have been brought on or played into by self. Hope on the other hand arises within the person and is energizing and activating. In a wounded state the individual naturally retreats, or hits out reactively. The hopeful person reaches from within, initiates takes action. In passing from woundedness to hope the p erson typically shifts from suffering passivity or reactiveness to a wide -awake, more purposeful and active mode. Such movement may not be large in Phase B but the direction is discernible. In navigating the passage through Phase B, the client’s exploration begins to loosen areas of pain, anger, sorrow or other woundedness, and the helping partnership that meets this test significantly evolves in the process. One outcome is that C ventures, dares now, to actually believe and feel that there is a way ahead that is better than the track behind. Therapy has begun to ease the burden C has been carrying, it is giving safety to communication and search from the heart and the edge of awareness, and there is promise of further respite, discovery, even new vision. There is, it seems, a route to change in a journey that has actually started. Hope has reawakened. Of course, this transition does not occur for every client, and it’s completion is a matter of impression and judgment, not of literal and marked dis-continuity in the therapy process. Its duration may have been only two or three eventful meetings, or a threemonth saga of hardworking therapy sessions. With very deeply disturbed clients, it may take longer still but happen none the less, as implied for example in the case of ‘The silent young man’ in the Wisconsin psychotherapy research project (Rogers, © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling 1967f: 401-416). Moving to Phase C is like rounding a wide, rising curve, distinct at the end of the altered driver, both in rear-view and in terms of the new vista and discernibly changing landscape ahead. It is as though the travelers feel, if they pause to think of it ‘Now we are really on the way, and able to count on each other. Change is possible, although it’s hard going – so let’s get on!’ ‘Getting on ‘ is not a matter of either changing gears or of going on just as before, but of finding and creating the way through newly central issues in the alliance and in the clients quest. C Trust Development and The Quest for Self: ‘Who am I?’ ‘How Do I Want to Be?’ The two streams (i) of relationship development and (ii) of client issues and process, continue their flow, on further levels, through Phase C. The recovery or awakening of hope in the client is as individual in specific quality as the client is distinct as a person from others. However, in one form or another, this awakening of hope in the client is as individual in specific quality as the client is distinct as a person from others. However, in one form or another, this awakening leads into a new intensity or scope of self-exploration, a more literal questing search for the heart of the individual’s identity or for a reconciliation of elements in conflict within the self. By ‘self’ I do not mean to refer solely to the person's inner or intra-psychic being but also to the self as manifest and related to others in the world. It is this world which helped to fashion such aspects as the owned accepted-me, the me-I-fear, the wanted-me and the not-me, and in relation to which change has its primary eventual meaning. In order for C to deeply open the self to view and review, especially in its generally hidden and most problematic aspects, therapy must be a safe haven and unusual in the authenticity and measure of therapist empathy and other crucial relationship qualities. Put in other terms, in order for C to searchingly disclose unshared thoughts, feelings and actions of the self and to work openly at inner dialogue with very indistinct but pressing elements of his or her being - in effect, to search, feel and inquire into the very soul of self - a rare quality of experienced safety and positive trust of T is necessary. This trust, implicitly building in Phase B, is, in its fuller development and significance, advanced as the central feature of the therapeutic relationship and alliance in Phase C. In original application of the process conception and scales, the assumption was made that clients in therapy were in the relatively constant situation of being `psychologically received' (Rogers, 1961b: 130-131). Trust in the sense used here, has related, even stronger meaning. The client is not only `received' but actively companioned in the risky enterprise of open-ended self exploration in its fullest sense. Requisite conditions for the needed strong trust in the therapist-companion include repeated experience of being deeply heard, of C having literally felt T resonating and almost knowing at critical moments `what it is like to be me'. It is not necessary or realistic that C experiences this quality of empathy continuously, or during every pregnancy and birthing of fresh awareness. The important element is that genuine close personal understanding has happened and led to confidence by C that it will recur, especially when his/her feelings flow into little-explored inner territory. Such trust also depends on C having experienced T's caring interest coupled with absence of personal evaluative judgment. Most crucial are contexts where C censures him or herself, that is, in sensitively difficult areas where other people W C's life, and finally C him/herself, have tended to be chronically evaluative. Usually crucial to the quality of trust is C's experience of T as open and revealing of her/his own personhood, not necessarily via informational communication but through a way of responding that expresses what is immediately present in T's experiencing, with transparent ownership of this experience. Clients themselves may stress the importance to them of this openness or transparency, especially near the close of therapy. For the therapist to share, even with simple and straightforward brevity, from his or her own life, involves an element of risk-taking. At minimum there is likely to be some felt risk of distracting the client or of seeming to invite a shift in content focus from C to T, or perhaps (for the novice therapist) of being `unprofessional' by behaving in a fashion out of © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling keeping with providing a specialized therapeutic service to the client. The positive thesis here is that personal realness and transparency works to disarm and evoke trust in the other - legitimately so since it is showing what is actually present. (To mimic transparency would be such a contradictory process that cues of a kind to deter trust seem very likely.) This trust in turn melts away motivation in C to keep up his or her accustomed guard. Thus, a high level of trust reduces concern to portray a socially acceptable self and allows self-known secrets which burden the client to come into open view. Beyond this, such founded trust helps inner walls to become permeable or gradually transparent. The continued exploration provides additional confirmation that T is there unafraid and unjudging beside C, sharing in awareness of that which is gradually emerging or sometimes erupting into C's felt view, In alternate metaphor, C's trust of T permits them to approach and hear together the first whispers and growing voice of newly released inner dialogue and communication, amplified in volume, clarity and movement by the act of sharing. Clients very often 'are struggling with severe and deeply stressful crises in their lives, have not necessarily played a foremost part in precipitating their crises, and might be average or above the norm in respect to basic personality integration, or to level of functioning on the process continuum or Gendlin's experiencing scale. However, those who elect and choose to continue in client-centred therapy, in effect hold themselves responsible in significant degree for the pain and needs that bring them to therapy, and have implicitly opted for .self-change, within the broad meaning of `self' earlier discussed. It would follow that they tend to hold `internal locus of control' attitudes, implying assumed agency and responsibility in their lives. In practice, it may seem to them that their self-influence is at present blocked or impaired, and that a broad purpose of therapy is to restore and develop effective selfpropulsion. Effectively, they seek to attain a self or `me' at one with itself, which reaches out resourcefully and without censure from its own core, that senses where it is going and knows how to proceed with the journey, and which feels alive and part of lives beyond itself. Persons on the other hand whose orientation is strongly external, whose pervasive feeling and stance is that the causes of both trials and joys lie outside themselves, are less likely to make an active choice of clicnt-centred therapy, or to follow through in the course outlined here. A major sub-issue or theme in Phase C is the client's feeling and exploration of responsibility in his/her life, for example: 'How am I making things go wrong?' A more positive, self--affirming counterpart is also likely to arise: `I'm better [or stronger, more resourceful, more `with it'] than I thought'; `Although disappointed, feeling T let myself [or others] down, I now see how/ why I did it, and feel wiser for the future'; or, `I don't want to play that kind of game [specified], or model myself after that person. It's not me. It's not i?1P ' There is increasing ownership of the self or `I' as the agent of experience as well as where it is happening, and more sense of the ability to make active choices and to discover, learn and change. The latter Can lead to the theme: `What do 1 most want to change about myself -- in ways that I feel, how I react to other people, or the load from my past that I carry around'?' or, `What are my goals for myself, for the ways T want to develop and grow?' In the nature of client centred therapy, the last questions are almost certain to become prominent in some form, and especially so when the client is working directly at sorting out and further establishing his or her personal identity. 5 Rogers' process conception grew out of experience in therapy and some of its main elements tend to be apparent in Phase C, as features or issues in the client's exploration and modes of self-expression. Shifts in process level in the environment of therapy occur, although perhaps not over such a wide span as initially implied (Rogers, 1959b). Rogers originally suggested that `many people who seek psychological help are at approximately the point of stage three', on the seven-stage continuum distinguished. He continued: `They may stay at roughly this point, for a considerable time, describing non-present feelings and exploring the self as an object, before being ready to move on to the next stage' (Rogers, 1961b: 136-137).6 When such movement does occur, and in terms of about stage 4 in Rogers' portrayal, feelings tend at first to be reported in an objectified way from the past (`It felt'), in the client's life in general (`My feeling has always been . . .'), as desirable possibilities (`It would mean a lot to me if . . .'), and in other `pointing at' or arm's length ways. Then, in stage 5, `we find many feelings freely expressed in the © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling moment of their occurrence', and previously denied feelings really begin to `bubble through' into awareness (Rogers, 1959b: 99). Hesitantly at first, but increasingly through stages 4 and 5, clients ascribe meaning to and from their own experience. This reflects awareness that the constructs they use, especially in discriminations regarding self and others, are not absolute givens but invented lenses that can be modified, replaced, experimented with. Inner discrepancies and incongruence, and sometimes recognition of self as a complex plurality or system rather than an indivisible monad, are significantly and increasingly in view in process stages 4 and 5.' In its operational formulation by Gendlin and collaborators the (manner of) experiencing scale is depicted as concerned broadly with `the degree to which the client manifests inward reference in his verbalizations'. The core feature of stage 4 is that the client describes him/herself, or at minimum tries to communicate directly what he/she is like. However, although aware of personal feelings and qualities, the client at this level is not strenuously exploring self. But assuming therapy progresses, a major corner is about to be turned. At stage 5, `The client is now using his feelings in a struggle to explore himself' and at this point is seen as `clearly engaged in a process of self exploration in order to achieve self-understanding' - with all the effort and unevenness that `struggle' implies (Gendlin et al., 1967). Phase C of the course of therapy thus encompasses elements and qualities particularly associated with in-therapy client functioning at stages 4 and S in the process conception and experiencing scale. As seen from a matrix of convergent viewing planes, the client's advance through this phase is made possible by the deepening quality of trust in the relationship, in the meaning described. The association is a recursive one: the trust is `earned' and evolves as the client ventures a cautious step or unexpected leap, is companioned in helping mode, strives again and is confirmed once more in T's response. Within the client, not only are rigid, unchosen older moorings left behind, but any fixed anchorages are used in diminishing degree by an increasingly buoyant and mobile, becoming self. Assuming therapy runs the full course outlined here, Phase C is expected to be the longest in working duration; and in such cases probably the phase in which greatest personal change occurs. A proportion of clients would proceed from Phase C directly to termination, or to a termination phase that included foreshortened elements from Phase D. There is no clear-cut boundary between Phases C and D, but a qualitative transition, most evident after its occurrence, in the working process of the relationship between C and T and in the ways in which C is proceeding in his or her quest. These two streams now tend more than in earlier stages to move and flow together almost as one. D. Synchronous Engagement; and the Becoming Self in Action In Phase D, feelings and thoughts arising within the client tend to be recognized as forming within the context of the relationship with the therapist and often as having reference to it. The therapy discourse is synchronous on several levels. First, there is an in-phase quality to what is happening from moment to moment in the inner experiencing of the client and its outward expression to T, as responsive partner and contributor to this experience. (In familiar, older terminology, the client is being congruent.) Second, there is generally close coincidence between what each partner is experiencing and meaning in their expression and what they are taken to be feeling and meaning by the other. Simpler expressions of this more `sympatico' mutual awareness are that either partner at times accurately finishes the other's words, or `reads' non-verbal signs without distortion of the other's feeling or thought. (These aspects of strongly synchronous interaction are substantially founded on the development of trust in Phase C.) The in-phase quality applies in a further pair of ways, the first related to congruence. At this stage, much of the client's communication is an encoded surfacing of the flow of feeling and experiential meaning as the latter is occurring. (In older terms, this implies immediacy.) Very little is said that is planned ahead. While self-exploration may still, at moments, involve struggle, the quality of this struggle itself tends to be communicated as it occurs; and there is a relatively small and diminishing gap between what is immediately © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling beneath the surface of expression and that which is put into words or conveyed in an explicit non-verbal way. The twin to this feature of the process is the interlock and interplay between the client's undifferentiated felt sense and the symbolizing meaning giving level of consciousness. The client now generally can find verbal form and expression for immediately present features of this organic inner sense and substratum of experience. Whether portrayed through the language and vision of focusing (e.g. Gendlin, 1969, 1981) or under the heading of self-empathy (&arrett-Lennard, 1997a), a condition of easy interchange or `dialogue' between the symbolizing, form-giving self, and the person's underlying, organically present self, is assumed fundamental to wholeness and well-ness of functioning. In Phase D, this capacity is both clearly manifest and further developed in the context of the helping relationship mode in its more advanced, synchronous expression. Discernible instances of such inner dialogue generally have occurred before this point but have not been such a prominent or major feature. It seems that spontaneous engagement in this dialogical process hinges on other process qualities, especially the strong development of trust described in Phase C. As well as moving to the process qualities so far described, clients now experience or notice new levels of personal change. Often, they are conscious that their values hare been shifting and that at minimum there are clarifications and alterations in balance among involvements that are important to them. Their personal priorities, what they most cherish, aspects of the ways they wish to live, have all moved somewhat and are in sharper focus. One's body, visible and internal, tends to become a more integral aspect of self, in this phase; and clients may have a new sense of their own whole presence, of the space they occupy when in motion or still, of their mass and momentum and of their life energy radiating and receiving from the energy of others. In Phase D the client is likely also to explore, reflect on or notice change in his or her time sense, and of living in time. If such change is only noticed and mentioned after it happens, this may not come up until the next, concluding phase. It may be, for example, that C is now very conscious of being able in a new way to live in the moment, to be interactively in touch, as with the therapist, at the instant things are happening. In addition, C often has a stronger, more differentiated sense of his or her own identity not only in the moment but as a life. There is a new reality to living through and in one's whole life span, to being one's life as well as being more nearly one's whole present-becoming self in each step and moment of time. The use of metaphor and the sharing of literal subjective images, by the client as well as therapist, generally is more prominent and more telling in its expressive-communicative power in Phase D than in other phases. Feelings may be portrayed using space-time metaphor, or as geometric forms, or as though they could be touched and had physical texture, or as being like solid objects or living organisms, and in other ways associated with corporeality. III seeming paradox, such language can help to intensify and give more accurately fitting and communicative expression to highly personal, felt meaning than more literal and less muscular formulation can achieve. Effectively, there is in Phase D more poetry both in the therapy interaction and in the way the client tends to construe and express felt experience. Partly because most of us live in a 'left-brain' world, stressing rationality, analytical thought and measured description, in the course of achieving greater wholeness in therapy the more artistic/poetic/intuitive-expressive side comes forward.' *N/Ian', Rogers has argued, is wiser than his intellect'. and the spontaneous use of metaphor and subjective images is reflective of this wisdom. As an assimilated part of the person's way of' being, it can add to personal effectiveness in real-world contexts. Client-centred therapy sustained at Phase D tends to liberate the creative artist within the client, if not literally then in the sense of being a contributing architect of self and a more creative builder in relationships with others. The becoming self-in action looks backward largely to enhance or deepen experience in the present, and to see more clearly ahead. Memory, of what has gone before is open, not barred, and very strong feelings may come to the fore through this memory. Ihowever, memories do not of themselves (any longer) produce agonies of despair or © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling mourning, intense fears or high exultation. As earlier implied, the person experiences, sense,, his or her identity in the whole process of becoming, even in the trajectory glimpsed ahead as well as in the `now-being' of tile sell'. Intensive, personal therapy, in keeping with other potently formative experiences, has some of the elements and crudities of birthing. In t1w caw of client-centred therapy, this does not imply regression to redo an earlier stage of development but does connote emergent shifts in awareness and ways of processing experience, broadly in the direction of a more self-transcending and becoming way of being. As such change occurs it is highly likely that at some stage in Phase ®, and in ways consistent with other- incretion aspects of in-therapy process and wider movement. clients will explore the TV or lack of it between the becoming self they now, experience and the larger context or their life activity and priorities. Usually, the importance of existing close relationships is affirmed, with a sense of further discovery of what is actual and desired in these relationships. As well, where it has been deeply at issue, a desired .-feared separation is by now largely drained of internal conflict (and is a matter in and of ON rather than a symbol of something broader), and clients in open dialogue with rather than a symbol of something broader), and clients in open dialogue with self can now weigh and choose their course on an organismic basis. They may take steps to develop new associations; and are both more open to the perceptions of others, and less concerned about their image in public contexts or casual encounters. Major decisions are not necessarily made in the vocational sphere, but active reappraisal typically occurs, the client feels less imprisoned where this has been an issue, and the increased vitality and assurance of the becoming self is evident in his/her working life as in other spheres. Transition from Phase D to the concluding Phase E often is influenced by practical considerations that, indirectly or in part, are a consequence of therapy. These potentially include financial and time/energy/priority considerations on the part of the client, relocation or extended absence by client or therapist, and the existence of fresh or altered situations and relationships in the client's life which are now effective growth contexts. More intrinsic termination conditions evolving in Phase D tend to include the following: 1 The crises or other conditions precipitating the client's entry to therapy have receded or taken on different meaning to a person whose formerly constricted energies are in flow again, and whose resources are more integrated and in harmony. 2 The client has learned or rediscovered how to travel and move inwardly, knows vividly how it is to be out of touch and recover connection, and is applying the fruits of his or her therapy journey to outside life contexts. The relationship with the therapist is now enjoyable rather than essential to sustain altered qualities of experiencing and questing. 3 When a client has for some time been working in therapy in ways inclusive of Phase D level qualities, the therapist may begin to anticipate termination. In the open flow of the relationship, indications of the shifting balance in T's expectancy are experienced by C and, in practice, form part of the data by which the client judges when the time is ripe to conclude therapy. 4 A more tentatively advanced condition is that the client becomes ready for a time of psychic relaxation or `letting be', rather than continuing so directly to question, explore and work at his/her own functioning and identity. 5 The client typically is less vulnerable and much less strained and anxious. This change diminishes one of the posited main conditions of therapy (Rogers, 1957a). It also allows for a greater sway of conserving or homeostatic processes, seen as existing side by side with the growth and actualizing tendencies. In these outlined circumstances, it is likely that C will come to the topic of termination and explore experienced issues and meanings around this in accord with the same kind of © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling in-phase, inward/outward and forward-moving process as other felt issues. Such exploration would herald the transition to Phase E. E Termination Process: Ending and Entry The explicit termination phase in client-centred therapy, if following on from phase mode D (or, C)' typically is brief in terms of interview duration. It might directly occupy only a single meeting. usually, after being foreshadowed in a previous session. Where the total course of therapy is lengthy. or where the time of ending is governed by external circumstances known in advance, the termination phase may directly include several meetings. The ending of client-centred therapy, while it may be uncomplicated in the actual event. contains elements of paradox. It occurs at the point where C and T know each other best as persons, probably value their relationship the most, feel their association merging or capable of merging into a literal friendship relationship and, aside from any anxiety around their separation, when they are generally most relaxed with one another. Precisely the same features would make it most difficult for C to continue to `buy' T's time or for them to proceed on the basis of an underlying or explicit contract for set vice. The last-mentioned aspects contribute in a mixed positive- negative sense to the possibility and meaning of termination of ongoing contact between coworkers, fellow travelers and would-be friends. There is no proscription in client-centred therapy against actual friendship or collegial associations continuing after therapy but, often, various feature,,; of the persona! and life situations of C and T mitigate against such an association. Thus the ending of a deeply meaningful human association is naturally and often one important issue; an issue revolving around ways that the therapy partners feel with each other and toward the other, the ways they can communicate self to self, and their pool of experience together. Each is managing u very real separation which in some ways is a prototype of other life partings. The process of leaving therapy and, usually, any active association with one another, naturally includes some sharing of its import and meaning to the participants. Particular. appreciated events and qualities together, and outcomes beyond their relationship, are likely to be singled out. Typically there is reference to current outside projects or forwardreaching plans in the client's life, ones that may sharpen further in their mention, and which express the refreshed or re-awakened becoming self. As the phase continues images of birthing (as mentioned also in Phase D), of literal Unfolding or metamorphosis, quite often occur to the client or therapist. In any case, termination of the journey and course of therapy finally impresses itself as a beginning more than an ending, an entry not necessarily to a new life context, but to a duality or way of being in life. Elements of this ‘way’ include an openness to feelings as they are happening, a quality of in-touchness and fluency in speaking from differing levels of one's experiencing, a more continuous. regardful and resonant engagement with others, and a quality less of effortful striving and more of spontaneous purpose. There may be moments of sadness in the parting of client and therapist, but termination when the time is ripe, especially following mode D, is such an affirming step that there is little or no continuing sense of loss. While there is any sharp sense of loss or distinct lack of closure, or while the client is more occupied with departure issues than entry ones, the termination phase is not yet complete and, desirably, one or more further meetings would precede literal parting. As with any significant human association, to a degree the relationship lives on within the participants; but the memories bring no sorrow or regret, in the case of optimal termination. Further, in client-centred therapy, the door is rarely closed permanently. Unless changes in location would make any further contact impractical, the therapist is potentially available in the case of future emergency. And even without such emergency, if C's and T's paths should later cross, each would welcome this contact and easily move to sharing communication. © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122 Persona Diploma in Person Centred Counselling Concluding implications I am now conscious that as the thought presented here evolved, through periodic work over a number of years, plotting the pathway as such became less an end in itself and more another useful vehicle in the search to work out and communicate the process nature of client-centred therapy. For me as author many threads have come together, in this search, and I shall be pleased if the result is also evocative for the reader. Clearly this chapter, unlike most others before it, is not a closely documented distillation calling step by step on an array of sources. It flows, rather, from a fertilizing immersion in the approach over a long period, influenced in both visible and subtle ways by the work of many others but none the less my own envisioning beyond their responsibility. It would be contrary to my own meaning to interpret the `phases' deciphered here as uniform steps or exact markers. They flow from an attempt to catch the essence of a distinct, unusual quality of association and quest, one which in its specifics is as individual as are the participants in the enterprise. Given the requisite resources and commitment, this enterprise and process builds on itself until it becomes evident that another phase, or level, has been reached. No main level can be entirely skipped, for each is a vital part of the foundation for the next. Thus, also, no phase mode in full expression can simply be switched into at will, or as an instant product of specific technique, for its emergence is a growth process and not just a matter of where or how attention is centred. Therapy of course can come to an end, in practice does end, almost anywhere along the broad continuum. Moreover, the journey is not always as distinctly unidirectional as my picture might suggest. In or out of therapy, we are subject to mood swings, biochemical rhythms, ups and downs in relationships and achievement, uneven life stresses. Clients can move ahead strongly in therapy and then seem to slip back, with the process being more like an earlier phase. Oscillating motion, or spiral-like return to familiar issues tackled on n somewhat different level, complicate identification of where the travelers are on their journey. Nevertheless if therapy is to come to strong fruition, the journey is a progressive one and its underlying direction generally in accord with the sequence discussed. Beyond this, client issues or therapist emphases may work to favour processes in one phase more than in another, especially as between phasic modes C and D. In introducing this perspective, the issue of therapy as recovery and healing, as reeducation or growth, or self and interpersonal learning, or social reconnection, etc., was acknowledged. More than difference in language is implied by these alternative and complementary designations. They connote axes and levels of change which appear in differing balance in the phases distinguished. Literal healing and recovery processes are most obvious in Phases B and C. Growthful change to new levels of functioning are discernible earlier but most evident in Phase D. Clients may largely heal and recover, with important elements of growth, without going on to Phase D_ Development of a person's values and life-style would occur more strongly through Phase D process than in other phases. The `person of tomorrow', in Rogers' eloquent description (Rogers, 1977a: ?62274), would soon be at home in Phase C interaction and be likely to move on to Phase D. The person identified as schizophrenic may struggle in therapy (as earlier implied) for a long time before reaching a Phase C process. Coming to that stage Would represent a great deal of healing movement. Therapists of a most distinctly client-centred approach, especially if trained in the heyday of self-theory, or for whom Rogers' own work remains a central model and influence, would tend to set much store by Phase C process, work hard and patiently in facilitating its fruition with clients, and not judge that therapy was faltering if phasic mode D did not appear in any full-fledged way. Therapists particularly influenced by Rogers' later process thinking and, especially, by Ciendlin and others of more `experiential' persuasion, may have greatest interest and confidence in therapy that clearly moved to the Phase D level of process. For therapists of either emphasis, working with clients in Phase D probably helps most in the therapist's growth. © Carl Rogers’ Helping System, Journey & Substance, Godfrey T.Barrett-Lennard, Sage Publications Ltd 1998 Chapter 7 : The Course of Therapy pp 104-122