The Person-Centred Psychologist

While writing a progress letter to my client's GP, I paused.

I was about to put in his score on the PCL-5, and clearly, it hadn't changed.

In the previous session, we talked about his scores and symptoms. I told him the scores were the same and he'd told me he was still experiencing the full list of PTSD symptoms and at much the same intensity. In my early years as a psychologist, this would have got me worried and my frantic attempts to reduce his symptoms would begin.

17 years into my career, I chose a different angle. I wanted to know more. I asked him if he'd noticed any changes, even small ones. He began to tell me how his wife and kids had recently told him he was nicer to be around. He told me about a time recently when he'd experienced sadness, anger and anxiousness in quick succession. He remembered something I'd said about accepting emotions to develop psychological flexibility. So he did. He let himself feel sad, angry and anxious. He didn't grab a beer or watch hours of mindless TV.

It made me think about how narrow symptom reduction can be. How easily treatment and its formal tools can become an exercise in reducing our clients to their diagnosis. How this in turn creates a dynamic where we see our own work reduced to a single test score or handful of symptoms.

If all I'd focused on with this client were his symptoms, then the last 8 sessions would have been an abject failure. I would have had to rush around trying to figure out some new way to get his PCL score down. My reduced perspective would naturally reduce my options.

But by broadening my view of his life with a person-centred approach, there was much to be celebrated and appreciated. His relationships had improved, his insight was developing and he'd found a way to deal with his emotions that would serve him well in the long term.

Early in your career as a psychologist, it can be oddly difficult to work from a person-centred approach. Your recent education tends toward rigid approaches to what it means to use evidence-based treatment, imposter syndrome is kicking in, and you feel pressured to get quick changes for your clients. Taking the time to see the client as a whole person and look at things that might seem outside the scope of diagnosis and symptoms, can seem trivial or inefficient.

But let me encourage you to keep this in the forefront of your mind. One of the most crucial parts of treatment is the person you're treating. If they want to come back, if they tell you treatment is helping, then don't devalue that with a narrow focus on symptom reduction. Ask widely and listen well.

You have to remember that while you can always work to reduce a client's symptoms, this should never narrow your focus so much that you lose sight of your client as a whole human being.