The way forward? Re-humanising therapy – An existential-humanistic ethics at the core of psychological practice Mick Cooper Professor of Counselling University.

The way The way forward?forward?

Re-humanising therapy – An existential-humanistic

ethics at the core of psychological practice

Mick CooperProfessor of CounsellingUniversity of Strathclyde

[email protected]

BackgroundBackground

• Time of great transition for counselling psychology, and psychological therapies:– HPC regulation– IAPT roll-out– Skills for Health competencies

• Calls for counselling psychology to amalgamate with/be subsumed by clinical psychology

Amalgamation?Amalgamation?

‘I think that any distinctions between counselling and clinical

psychology are becoming nugatory …. So… in ten years time… I suspect there will no

longer be many people registered with the HPC as “counselling

psychologists” ’ (Peter Kinderman, CPR, 2009, p.20)

Aims of talkAims of talk

1. To look at how counselling psychology might move forward, by…

2. Trying to articulate the core value(s) of the profession

3. Look at how those values might be more fully actualised

4. Reflect on implications for identity and future of counselling psychology

Values at the core IValues at the core I

• For many (not all) counselling psychologists, core of approach is foundation in ethics:

‘Counselling psychology is unique in that its competencies

are founded upon a philosophically-orientated and explicit statement of values’

(Ralph Goldstein, 2009, p.36)

Values at the core IIValues at the core II

• All professions grounded in ethics (Daryl Koehn, 1994) – E.g. BPS code of ethics

• But, counselling psychology practice is application of ethics: e.g., – Trustworthiness– Fidelity– Confidentiality

Ethics

Practice

Eth

ics-

as-p

ract

ice

Core values ICore values I

1. A prioritisation of the client’s subjective, and intersubjective, experiencing (cf. a prioritisation of the therapist’s observations, or ‘objective’ measures)

2. A focus on facilitating growth and the actualisation of potential(cf. a focus on treating pathology)

Core values IICore values II

3. An orientation towards empowering clients(cf. viewing empowerment as an adjunct to mental health)

4. A commitment to a democratic, non-hierarchical client—therapist relationship (cf. therapist as expert)

Core values IIICore values III

5. An appreciation of the client as a unique being (cf. viewing the client as an instance of universal laws)

6. An understanding of the client as a socially- and relationally-embedded being(cf. a wholly intrapsychic focus)

The The essenceessence of counselling of counselling psychology valuespsychology values

• Counselling psychology values generally defined as ‘humanistic’

• But what unifies them? What is underlying essence?

Intentionally ‘I-Thou’ Intentionally ‘I-Thou’ (Buber), (Buber),

rather than intentionally rather than intentionally ‘I-It’?‘I-It’?• Counselling psychology strives

to relate to the client as an experiencing human subjectivity, rather than an object of natural scientific enquiry

I-It I-Thou

I-It I-THOU

It-ifying Humanising

Fragmenting Relating to wholeness

Construing as determined

Acknowledging freedom

Experiencing in the past or future

Encountering in the present

Generalising Individuating

Non-confirming Confirming

Relating in fragments Relating as wholeness

Protectiveness Willingness to take risks

Monologue Dialogue

Levinas: ‘Welcoming the Levinas: ‘Welcoming the Other’Other’

• An ethic of respecting, honouring, prizing the Other: “the stranger, the widow, the orphan, to whom I am obligated” (Levinas, 1969, p.215)

The The Otherness Otherness of the Otherof the Other

• The Other is infinitely transcendent, infinitely foreign, infinitely distant, ‘irreducibly strange’

• Always transcends and overflows my idea of him or her

• Ethical relationship does not ‘neutralise’ Other to theme or object, to the ‘same’

Welcoming the Welcoming the othernessotherness

• Ethical relationship does not ‘neutralise’ Other to theme or object, to the ‘same’:

• A ‘non-allergic reaction with alterity’ (p. 47)

• To renounce ‘psychagogy’ and let Other be

Welcoming the Welcoming the othernessotherness

A deep welcomingA deep welcoming

• Welcoming is not just superficial friendliness, but a…– Radical– Challenging– Transformative

…acceptance of Other in all their otherness

Welcoming as TherapyWelcoming as Therapy

• A deep welcoming is core of therapy: – Supporting client in welcoming own

alterity: “I-I” self-relational stance– Welcoming client back into human

relatedness and community– Supporting clients in welcoming alterity

of others: ‘The road from mental illness to mental health is…to regain one’s obligations, one’s responsibilities to and for the other’ (Cohen, 2002)

The way forward…

1.Seeing beyond

diagnoses

Distance from Distance from diagnosisdiagnosis

• The ethical relationship does not reduce the Other to a theme– A non-allergic relationship to

alterity

• Counselling psychology: as a profession that welcomes the vastness and richness of clients beyond their diagnosis: meets the face of the Other

Case example: Case example: DarynDaryn

• 30 year Afro-Caribbean man

• ‘I just want to find myself; to work out who I really am’

• Fallen into psychiatric system, range of diagnoses and medication

• Psychological work: helping Daryn re-connect with actual subjective experiencing and desires

• Supporting discovery of unique identity:>> development of pride in self-beyond-diagnosis

Diagnosis in counselling Diagnosis in counselling psychology practicepsychology practice

• Someone needs to meet the person-beyond-the label

• Even within diagnostic-orientated settings, can hold, and develop, welcoming of client beyond diagnosis

• Working creatively with ‘diagnostic-holistic’ tension

2.Enhancing our responsiveness

ResponsivenessResponsiveness• Welcoming Otherness of clients

means attuning to unique individual

…And their changing wants/needs

• Cf. ‘ballistic action’ (Stiles et al., 1998): treatment is determined at inception and carried through irrespective of events

Goal- and task- Goal- and task- dialoguesdialogues

• Importance of ongoing dialogue with clients re:– what they want from counselling

psychology (goals)– how that might be best facilitated

(tasks)(Cooper and McLeod, 2007, Pluralistic Framework)

‘‘Therapy feedback Therapy feedback form’form’

• Need to develop techniques and measures that can help us be more responsive: e.g. – Therapy Feedback Form

In what ways might we be able to improve your therapy?

More advicefrom the therapist

Less advicefrom the therapistExactly right

More focuson my past

More focuson my presentExactly right

The therapist to saymore about him/herself

The therapist to sayless about him/herselfExactly right

More structurein the sessions

Less structurein the sessionsExactly right

Going more intoDifficult/painful feelings

Going less intoDifficult/painful feelingsExactly right

Anchoring the work Anchoring the work

• Goals and preferred tasks not always easy to elicit

• But dialogue around hopes, fears, expectations, wants, beliefs, etc. nearly always serves to create ‘anchor’ for work

Helpful Aspects of Helpful Aspects of TherapyTherapy

• ‘At last week’s session talking about patterns of behaviour got me thinking about this and how stuck I have been in a pattern of behaviour’ (Session 4: Helpful aspects of Therapy form – rated 8/9 ‘greatly helpful’)

Humanistic ethic Humanistic ethic ≠≠ humanistic practicehumanistic practice

• Implication of responsiveness stance is that ‘humanistic’ practice is not always the most (ethically) humanistic way of working: – Clear evidence that some clients

prefer more directive, structured approach

Non-directive/Responsive

Directive/Fixed

Non-directive Directive

Responsive

Fixed (‘ballistic’)

Counselling Psychology

ClassicalCCT

Process

Met

a-pr

oces

s

ManualisedCBT

3.Orientating

towards client intelligibility

Wellbeing psychologistsWellbeing psychologists

• To welcome the Other = encountering them as meaning-seeking, striving, intelligent beings

• Emphasis on clients’ strengths and abilities, not pathologies

• Aligning counselling psychology with current policy initiatives…

Wellbeing Wellbeing agendaagenda

• Foresight ’Mental Capital and  Wellbeing Project’, 2008:

‘Encouraging and enabling everyone to realise their

potential throughout their lives with be crucial for our future

prosperity and wellbeing’

Recovery agendaRecovery agendaRecovery ‘involves a process of changing one’s orientation and

behaviour from a negative focus on a troubling event, condition or

circumstance to the positive restoration, rebuilding, reclaiming

or taking control of one’s life.’(NIMHE Guiding Statement on

Recovery)

Therapist as healerTherapist as healer

Therapy

Therapist as catalystTherapist as catalyst

Therapy

Consistent with Consistent with evidenceevidence

“at the heart of most successful therapies, is a client who is willing and able to become involved in making changes to her or his life. If that client then encounters a therapist who she or he trusts, likes and feels able to collaborate with, the client can make use of a wide range of techniques and practices to move closer towards her or his goals. For different clients, different kinds of therapist input may be more or less helpful; and there may be certain kinds of input that are particularly helpful for clients with specific psychological difficulties; but the evidence suggests that the key predictor of outcomes remains the extent to which the client is willing and able to make use of whatever the therapist provides. The old joke, then, would seem to have got it right:

‘How many therapists does it take to change a lightbulb?’

‘One, but the lightbulb has really got to want to change.’”

4.Giving

psychology away

‘[T]he secrets of our trade need not be reserved for highly trained specialists. Psychological facts should be passed

out freely to all who need and can use them….

I can imagine nothing that we could do that would be more relevant to human welfare, and nothing that could pose a

greater challenge to the next generation of psychologists, than to

discover how best to give psychology away.’

George Miller, 1969, APA Presidential Address: ‘Psychology as a means of promoting human welfare’

The ‘gift’ of psychological The ‘gift’ of psychological knowledgeknowledge

• Welcoming the Other through supporting independence and self-development

• Counselling psychologists moving to the forefront of giving away psychological expertise

How do we give How do we give (counselling) psychology (counselling) psychology

away?away?• Supporting development of ‘skilled

clients’ (Nelson-Jones, 2003)• Taking leadership role in

development and delivery of self-help programmes

• Moving beyond one-to-one focus (M. Thatcher and Manktelow, 2007)

• But, challenge of giving away a relational ethic (cf. techniques)

5.Developing the evidence base

Research as Research as reductionismreductionism

• Research in counselling psychology relatively low key

• Predominantly adopts qualitative approach

<< Ethic: protecting face of Other from scientific reductionism /obliteration

Research as openness to Research as openness to OthernessOtherness

• But research/evaluation also gives voice to Other

• Puts clients’ perceptions/experiences before therapists’ assumptions

• Research evidence as ‘infinitely distant,’ ‘irreducibly strange’

<< Particularly when asked from a position of genuine inquiry (cf. research-as-propaganda)

• Quantitative/experimental methods can be very useful for this

What kind of research What kind of research should we be taking should we be taking

forward?forward?• Not just treatment research, but

research specific to counselling psychology field: – Wellbeing: facilitating factors,

inhibiting factors, phenomenological descriptions

– Therapeutic relationship: qualities of healing encounter

– What is experienced as welcoming relating? What is the link between this and psychological change, if any?

– How can we help people with mental health problems feel less stigmatised?

<< Need to develop counselling psychology knowledge base

Summary

How should counselling How should counselling psychology go forward? psychology go forward? • By going back to its roots in ethics

and values and looking at how this can be more fully actualised:– Moving further beyond diagnosis– Looking at ways of deepening our

responsiveness to clients– Aligning ourselves with the wellbeing

and recovery agendas– Taking a lead in giving psychology

awayResearching how we can do all this

Counselling PsychologyCounselling Psychology

A profession that strives to help individuals and communities develop their potentiality and wellbeing through responsive, empowering, deeply respectful

ways of relating;

and which takes an active lead in finding out how this can be

achieved

Is this realistic?Is this realistic?

• A spectrum/tension, not all-or-nothing

• The power of a consistent minority (Moscovici)

• Shaping – not waiting for – the future

To be To be assimilated, or assimilated, or

not?not?• Issue of whether or not values survive probably more important than survival of counselling psychology, per se

• Other professions may move in more humanistic direction

• But somewhere in psychological therapies field, need professionals who can draw on psychological knowledge to nurture the otherness of Others

Thank youThank you

Mick CooperProfessor of CounsellingUniversity of Strathclyde

[email protected]