The Irrefutable Value of Person-Centered, Change-Focused, Outcome-Driven Psychotherapy

There are many helpful lenses that therapists and other behavioral health clinicians may employ in the course of their work, typically reflective of a chosen modality. Ultimately faith, hope, relationship, and an unfathomable number of factors impossible to procedurize may catalyze therapeutic transformation. Yet with many competing priorities in our age of innovation and managed care, we must narrow our focus. Here's how—

#1 - Approach problems with warmth, empathy, and curiosity.

Years ago at a middle school, a student—my client—ran from class yelling obscenities at his teacher, who was chasing him and demanding obedience. I was asked to quickly make my way outside to assist. For ten minutes I watched the teacher run in circles after him, demanding compliance. She gave up and retreated only after reciting her demands.

I stood quietly by as the boy ran wildly to the football field. He found a long PVC pipe and began using it as a martial arts bo staff. Once within a few yards of him and as he began to prepare his weapon for defense, I grabbed another pipe and awkwardly swung it around. He scoffed, “Haaa! You’re an idiot! You don’t know what the [bleep] you’re doing!” I laughed at myself, then offered, “Nice moves. Where’d you learn how to do all that.”

He immediately began to brag about his belt rank in karate, and I listened, uttering “Ah’s” and “Oh’s” and “Um-hm’s,” along with genuinely curious questions—it was, after all, quite interesting—as he explained forms and sparring. By the time he took his first pause, nearly out of breath—from not only all the angst and exercise but also in the excitement of having someone listen to him—I shared, “Well, thanks, this was fun, but I’d better get back to my office. I have a lot of paperwork to do. Do you want to walk back with me?" I noticed a glint of suspicion in his eyes, and he declined. "Don’t stay too long," I responded. You and I both have work we should be doing.” 

As I walked away, my anxiety rose. I couldn’t leave him. Yet I couldn’t force him, and I saw no good coming from a power struggle. Still, I couldn’t return inside the building without him, or I would be reprimanded. What if he got hurt? What if he ran away?

I was thirty yards from the building by the time he caught up with me. He had run to my side and began walking with me. I smiled at him and kept walking. We walked all the way to the door of his class’s portable building, which I opened. I said, “Have a great afternoon.” He retorted, “Have fun with all that paperwork.” We both laughed, and he took his seat. The teacher silently mouthed to me gratefully, “Thank you.”

We've all taken medication whose label cautioned to "use only the minimum effective dosage." Person-centered therapy is minimalist. Jay Efran and Rob Fauber (2015) wrote, "When the therapeutic canvas is cluttered, therapists are likely to become embroiled in the client's story and distracted by their own concerns about how to intervene, often failing to see the broader prospective that might enhance therapy's impact" (p. 35).

Carl Rogers (1961) taught, “The paradoxical aspect of my experience is that the more I am simply willing to be myself, in all this complexity of life and the more I am willing to understand and accept the realities in myself and in the other person, the more change seems to be stirred up (p. 22).” Most clients don't wish for more sophisticated interventions; they wish for a more genuine relationship—in their real lives and in the ill-defined relationship with a therapist. Viktor Frankl (1988) wrote, “A purely technological approach to psychotherapy may block its therapeutic effect” (p. 6). If therapists are too lifeless or their technique too technical, participation in therapy may be worthless. Therapy, in this case, does not engage the healing power of the encounter, and what remains is, perhaps, little more than a kind of scientific experimentation.

#2 - Lean into constructive change talk and meaning-making.

Back in the '80’s, Wallace Gingerich, Steve de Shazer, and Michele Weiner-Davis (1988) conducted research which indicated a strong correspondence between a therapist’s use of what was referred to as “change talk” and positive treatment outcomes. For instance, when therapists stated in terms of “when” and “will” rather than “if” and “would” as they engaged their clients in “change talk,” clients themselves became focused on their own personal successes and, in many cases, went on to actualize those successes.

Therapists who wish to stir clients' own latent energies and motivations engage in conjecture that has the tone of curiosity, not clairvoyance. Therapists must come to believe in their clients if they expect their clients to gain in self-responsibility. If we train ourselves to talk about constructive changes, constructive changes begin to follow in some form or another, more often than not. As we talk about change, we engage language and co-create a narrative in an ongoing dialogue, and we cautiously aid in bringing the language to life.

#3 - Regularly seek feedback about progress toward clear goals.

Zig Ziglar said, “When you aim at nothing, you will hit it every time.” When therapists and clients in therapy do not take the time to assess with therapeutic goals in mind, then they may enjoy therapeutic experience and even constructive therapeutic progress, so called, yet it is difficult to say whether meaningful successes will occur in a therapeutic relationship with no consolidated agenda.

Watzlawick, Weakland, and Fisch (1974) offered, “Change can be implemented effectively by focusing on minimal, concrete goals, going slowly, and proceeding step by step, rather than strongly promoting vast and vague targets with whose desirability nobody would take issue, but whose attainability is a different question altogether” (p. 159).

Carl Rogers set the tone for a psychotherapy undergirded by such values. In Counseling and Psychotherapy (1942), he cautioned, "Much well-intentioned counseling is unsuccessful... Frequently therapists have no clear-cut notion of the relationship which should exist, and as a consequence their therapeutic efforts are vague and uncertain in direction and outcome (p. 85)." Advice and the rigid interventioning of models from manuals often pressures a client to see through our eyes; empathy promotes confidence and self-awareness as we see more clearly a client’s situation as only they can.

Whatever lenses may aid therapeutic focus and drive in-session activity, the most effective artisans of change embody a reverence for human dignity through warmth, empathy, and curiosity, engage in an intentional therapeutic optimism that redirects clients from cynicism toward hope and expectancy, and establish a clear and consolidated set of meaningful goals.

As we invest in a diversified portfolio of evidence-based practices, which we most certainly should continue to do, let us also hold firmly to these simple and fundamental values.

For more, check out my chapter, "The Empathor's New Clothes: When Person-Centered Practices and Evidence-Based Claims Collide," in the book Re-visioning Person-Centred Therapy (2018, Routledge)—Click here to order the book at Amazon.com.

Blake Griffin Edwards is a licensed marriage and family therapist, clinical fellow in the American Association for Marriage and Family Therapy, clinical program manager, and statewide behavioral health leader for the American Academy of Pediatrics in Washington state whose writing has been featured by the American Academy of Psychotherapists, the Association for Family Therapy and Systemic Practice in the UK, the Association for Humanistic Psychology in Great Britain, and the American Association for Marriage and Family Therapy.

References

Efran, J., & Fauber, R. (2015, March/April). Spitting in the client's soup: Don't overthink your interventions. Psychotherapy Networker, 31-48.

Frankl, V. (1988). The will to meaning: Foundations and applications of logotherapy. New York: Penguin Books.

Gingerich, W., de Shazer, S., & Weiner-Davis, M. (1988). Constructing change: A research view of interviewing. In E. Lipchik (Ed.), Interviewing (pp. 21-31). Rockville, MD: Aspen.

Rogers, C. (1942). Counseling and psychotherapy. Cambridge, MA: The Riverside Press.

Rogers, C. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston: Houghton Mifflin Company.

Watzlawick, P., Weakland, J, & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: W.W. Norton & Company, Inc.

Acknowledgement

Story in "#1" is an excerpt from the article “Experiential Therapy Versus Intellectual Nagging” (Edwards, B.G., 2015) published in Family Therapy Magazine (American Association for Marriage and Family Therapy) and Context Magazine (Association for Family Therapy and Systemic Practice in the UK). Reprinted with permission.