|
Article Psychotherapy |
Peter F.
Schmid |
Keynote lecture at the
2nd World
Conference for Psychotherapy, Vienna, July 19991
(c) 1999 by Peter F. Schmid
Overview, contents
Abstract, keywords
Paper
Endnotes
References
The varying importance of relationship in psychotherapy
Towards a dialogic and social
therapy, a creative and kairologic approach
Towards a basic consensus beyond schools
While goal- and skill-oriented approaches in psychotherapy are en vogue mainly because of socio-political claims for efficiency, open and holistic concepts and a relationship-orientated understanding become more important in various schools. In a radical paradigm change, not yet fully sounded out, the person-centered approach focussed on the human being as person and on the art of encounter half a century ago. Thus, this approach commits itself to an image of the human being rooted in the European Jewish-Christian tradition the claim of which still has to be met in theory and practice in spite of tendencies towards eclectically watering down or underrating it.
In the person-centered approach both traditional lines of understanding of the term »person« (the individualistic view of being a person which emphazises autonomy, freedom and dignity, and the relational view of becoming a person which stresses the inclination to relationship, encounter and dialogue) are connected in a unique way - in a tension which is to be endured (»Become who you are«). Thus, personhood, ethically founded, is conceptualized as response in a communication into which men and women are born, from where his or her respons-ability evolves. In the sense of encounter philosophy, in particular the radical understanding of Emmanuel Lévinas, the client is focussed as actually being an Other, which makes of the therapist not only an alter ego but a partner in the encounter. Therapy becomes a mutual experience of encounter proceeding from the enclosed »I-Thou« to the open »We«. In this perspective the importance of the group and of group therapy at the interface between person and society becomes obvious.
Actual tendencies and necessary further developments, the ongoing challenge of the person-centered approach in anthropology, theory and practice of psychotherapy and its relation to other approaches are discussed.
No doubt: In psychotherapy an increasing trend exists towards the importance of the actual relationship for the therapeutic endeavor. While goal and skilloriented approaches in psychotherapy are en vogue mainly because of sociopolitical claims for efficiency, open and holistic concepts and a relationshiporientated understanding become more important in various schools. Obviously a convergence of very different orientations can be found (not just among the original and traditional relationship therapies!) a convergence stressing the importance of the relationship between client and therapist in the very moment of therapy. Putting the focus on the actual present therapeutic relationship implies or even explicitly means also to stress the importance of the person and his or her basic attitudes, yet more: his or her way of being in the relationship. In spite of this convergence fundamental differences exist about the meaning of this remarkable new consideration of the person and the personal relationship.
The varying importance of relationship in psychotherapy
Psychodynamic and humanistic traditions always have been emphasizing the relationship as such as a central force of therapy both, individual and in groups. In the course of the development of psychoanalytical theory the relationship of the persons involved beyond transference and countertransference, the intersubjective point of view became more important. What once was merely called an object relation more and more has been viewed as a process between subjects. Behavior therapists and systemic practitioners and theoreticians increasingly deal with the therapeutic personal relationship. The latter although putting the focus on the system as such and thus paying attention to relationships from the very beginning also started to explore the person him and herself.
I was quite impressed at the First World Congress three years ago to learn how crucial it had become to very different representatives of various orientations to deal with the issue of the present relationship in therapy and with the personal qualities necessary for this venture. My impression this year is very similar. As a person-centered therapist and theoretician I observe with a smile and a grin that these developments are often praised as a most recent achievement, that they are promoted and pushed as new positions, as something at the edge of the theory of therapy and I observe with astonishment the level of ignorance towards an already quite old paradigm: the only one which is based on the conviction that the actual relationship between client and therapist and thus the way the therapist acts as a real person beyond role, function and methods is not only a precondition or a basis of the therapeutic work but is the very essence of therapy.
Without doubt it is a valuable merit of the person-centered approach that the orientations mentioned encounter the importance of the personal and of the core conditions and attitudes conducive to therapeutic movement first postulated and accurately described by Carl Rogers (1957a). Probably almost no therapist who had not heard about the trias of a person-centered relationship offered by the therapist: authenticity and genuineness, unconditional acceptance and sensitive empathy. "Without these nothing goes in therapy" a vast majority of therapists probably agree on. "We all do this kind of relationship work", a lot of colleagues think and say, "we have learned our lesson; we integrated Carl Rogers. His approach has completed a historic mission; as a separate approach it is outdated." As likely as they think this kind of relationship to be necessary they hold the position that it is insufficient. So they would add something like: "These are the foundations, this is the starting point, the precondition, but then ... then the real therapeutic work has to start, then we need diagnostics, methods, expertise, specific know how about different diseases, patterns, techniques, interventions, behavior etc. etc. to conduct at least the process (if not the client)."
No, a clear "no" from a personcentered point of view, there is no "then", no "first the relationship, then the therapy as such". There is no person-centered relationship as a means to, no relationship in order to. The genuine, accepting and empathic presence of the therapist in the relationship is not only necessary but sufficient, Carl Rogers postulated was ignored at first, got tremendous support from résearch, became a celebrity and was "zu Tode gefeiert", as we would say in German, "praised to death" so much applauded that the radical core was not even heard, was underrated, eclectically watered down, so called "integrated", neglected, and even ignored. Carl Rogers got a first class funeral.
So even if some of the person-centered positions seem to be adopted, this by no means is an expression that the radical core of the approach, its very nature, was even understood. And, embarrassingly enough, let me add critically, not even by a lot of therapists who call themselves Gesprächstherapeuten und therapeutinnen, clientcentered or personcentered.
I am convinced that the essence of the PersonCentered Approach, the revolutionary paradigm shift of Carl Rogers, has not yet been sounded out by far, let alone has it been put into effect, in its radicalism, its profound humanism and in its critical potential, a potential towards emancipation individually as well as politically. Carl Rogers positions and visions are not at all outdated, they have not even been caught up with.
What Carl Rogers initiated was a truly person-centered approach focussed on the human being as a person and thus therapy as the art of encounter as relationship person to person.
What does this mean precisely?
The paradigm shift of Carl Rogers:
The personcentered relationship as immediate encounter
The time given here is much too short to elaborate on the anthropology and epistemology in the necessary details. A few sentences must do.
As already expressed by its name the PersonCentered Approach is orientated by the person of the human being. This is a clear statement about the image of man that underlies personcentered thinking and acting. What is denoted by "person" according to the western history of anthropology, deeply rooted in the Jewish-Christian tradition, is the human being in both, his or her unparalleled unexchangability and in his or her social interconnectedness, that is, as person within society, within his or her respective system; the individual and the relational dimension of being and of becoming a person, independence and orientation towards relations are dialectically related to each other and are equally important to a personal view (Schmid 1991; 1997 b; 1997e; 1998a; 1998c). In the person-centered understanding of the person the individualistic view of being a person which emphazises autonomy, freedom and dignity, and the relational view of becoming a person which stresses the inclination to relationship, encounter, dialogue, responsibilty and solidarity are connected in a unique way in a tension which is to be endured. The task is to "become who you are". The basic axiom in personcentered anthropology are the dialectics of the actualizing tendency of the individual organism and the interconnectedness of the human being. They form the foundations of the understanding of personalisation of "on becoming a person" (Rogers 1961a).
Offering help in a personcentered understanding means letting oneself in for a personal relation. Deeply standing in the tradition of personalistic philosophy (also called dialogic or encounter philosophy) that implies putting oneself into play2 and trusting in the possibility that such an encounter from person to person, be it among two persons or within a group (Schmid 1994; 1996a; 1997b; 1997f; 1998b; 1998c), is the most important contribution to fostering those seeking for help to make better use of their so far unused or temporarily blocked inner resources, thus, developing their own personality and widening their scope of action as well (Rogers 1961a; 1970a; 1980a; Schmid 1989). Explicitly connected with it is a personality theory which considers every human being capable of living and organizing his or her life and solving the problems and, on account of their own potential, expects him or her to actualize the ability to develop in an individually and socially constructive direction, if he or she feels accepted and understood in principle, that is, in a social environment in which they may feel and behave quite authentically (Rogers 1959a). Thus, an essential trust in the experiential world of the client and its centrality for psychotherapy is unrenounceable for the PersonCentered Approach.
Such an approach quite fundamentally rules out any conception of oneself on part of the therapist or helper or teacher or social worker or pastoral worker etc. as an expert on the problems or on the person of the partner in counseling, therapy, education, supervision or any other helpful relation whatsoever. Such an approach also rules out that the therapist considers himself as an expert in the correct usage of methods and means, and even excludes any preconceived use of methods and techniques, a use which is not rooted in the immediate experience of the relationship. The only "means" or "instrument" employed is the person of the therapist him or herself. And only where "any means has fallen apart" encounter takes place, as Martin Buber (1923,19) stated unsurpassably and precisely also grasping the process of such a relationship.
Therefore the PersonCentered Approach differs radically from all other approaches which in the meantime have all more or less found their way to the core conditions. However, these approaches consider Rogers conditions, attitudes and definitions only as preparatory design of relations meant to establish a certain climate or rapport, as obviouslyhuman preconditions so to speak, upon which the actual therapeutic work still has to be constructed. From a personcentered stance the basic attitudes need no supplementation by specific methods reserved for the expert. "Expertism", if it has to be described, lies exactly in the ability to resist the temptation of behaving like an expert (even against the clients wishes) that means, solving problems with the help of techniques rather than facing them as persons.
In Carl Rogers' words: To work as person-centered therapist is not only "a way of being", but "a way of being with" in German to describe this philosophy of life we use, according to Ludwig Binswanger e.g., the term "Miteinandersein", not only "Mitsein".
The existential and immediate presence as understood by encounter philosophy, the personal beingwith which leads to a togetherness means that, in his or her psychophysical presence, the person who offers a personcentered relation opens up to his partner(s) the possibility to concentrate on the fertile instant and thus on oneself and his or her relations. In the "kairos" (which the very instant is called according to the Greek god of "the favorable opportunity", who had to be seized by his mop of hair, when hurrying past in the back he was closecropped in the German language we have the phrase "eine Gelegenheit beim Schopf packen") in the kairos it is important to take advantage of fallow potential and to seize the opportunity. A personcentered "way of being with" is applied kairology.
In spite of all inflation the term "encounter" in general and in the PersonCentered Approach in special has undergone, it has to be stated that the essential element of encounter consists in the fact that the human being meets a reality which moves him or her deeply, which is counter him or her. Encounter is not simply an experience, it is an "experience counter" which opposes the affected one. Encounter is an essentially different experience from what an idealistic and subjectivistic understanding of (solely intrinsic development) presupposes, from an understanding of development or fulfillment coming completely from itself. However, it is an alien, an Other, another reality, another person, which or who encounters my reality, which or who encounters me. This makes up the existential dimension and unavoidability of encounter.
Thus the personcentered relationship is to be regarded as a process providing room valuing spontaneity and creativity, a process in which both client(s) and therapist(s) develop towards a personal encounter. Where the person of the therapist or/and of the client expose himself or herself to the given Other, he or she can enter in a dialogue even more so, he or she is called to do so.
Challenges for the PersonCentered Approach as an encounter approach
Rogers gave such a decisive impulse and left us such a rich legacy that a concrete realization of a number of consequences is yet to come. If the approach is taken seriously as an "approach" (and not as a readymade doctrine), "not as a school or dogma but as a set of tentative principles" (Rogers/Wood 1974, 213), and if we take the implications seriously which are a consequence of the understanding of the human being as a person within society and which above all arise from the experience of personcentered group work and grouppsychotherapy, and if the paradigm shall remain true to its principles under circumstances different from those of the America at the time of the New Deal a range of necessary and farreaching changes in the sense of further developments of the approach regarding the image of man, the theory and the practice crowd into my mind.
Some of these challenges for the approach, as I see them, shall be summarized in form of theses without claiming to be complete.
The above mentioned Lithuanian philosopher Emmanuel Lévinas again and again points out that all of occidental philosophy (and this also applies for psychology as its "daughter" and psychotherapy as its "granddaughter") including its socalled humanistic orientation in this century has remained "egology". And, indeed, this fixation on the I is clearly predominant in the terminology of the numerous selfterms in Humanistic Psychology and despite all positioning against an objectivation and instrumentalization it finally indicates a reduction of the other, of what the other means to me. In this connection even a wellknown sentence by Martin Buber (1923, 18) like "I become through the Thou" all of a sudden sounds quite different: even here, as is to be suspected, everything is still focused on me. This, however, presents the ideals of the humanistic movement as such in a new light. And according to Lévinas the following applies: "What once seemed to be a distinctive human quality, the absolute desire to determine and realize oneself, "selfdetermination" and "selfrealization", has proved the reason of violence against the other human being. Not the enforcement of the egos objectives must become the basis [...] but the perception of the other. This is an ethical relation." (Waldschütz 1993)
The PersonCentered Approach includes a number of ethic implications which definitely prepare for getting beyond "egology". In doing so ethics cannot be deduced from anthropology but we have to realize that personcentered anthropology has always been ethics at first. Traditional ethics orient acting by principles which are deduced from philosophic ideas. However, a philosophy orienting itself by experience, as it undoubtedly corresponds to the PersonCentered Approach, realizes from the experience in the encounter, which is taken seriously down to the roots, ethics as the first philosophy. Especially out of the personal experience of encounter being addressed and thus encouraged by the Other a legitimate claim to an answer and to acting in the kairos is derived and this is where personcentered ethics come in.
Personcentered ethics is dialogic ethics. In so far it is ethics which never degrades a fellow being to an alter ego but sees him or her as a call and a provocation. In doing so the fellow being is the Other on principle, the one strange to me, who surprises me, and who I find myself opposed to, who I have to face neither monopolizing nor rejecting him face to face. "Encountering a human being means being kept awake by an enigma" states Lévinas (1959, 120). The presence of the Other which always "comes first" is a call for a respond which I cannot escape because nobody can respond in my place. We are obliged and responsible to the Other and owe him an answer. This causes a " priority" of the Other. From that follows a new nonindividualistic understanding of selfrealization as realization in and out of the relations, in which the individual lives, and which is never possible without the realization of the Other.
Any help whatsoever is to be understood on principle as such a response to the misery of the Other. Love, which fundamentally is experienced from the very beginning in the development of the human being (just think of the child, "conceived" and born into relations), is the deposit of solidarity that has to be made. In empathy communication becomes encouragement, becomes advocacy and becomes community.
Accordingly, psychotherapy means engaged and solidary service to the fellow person, is "diakony". Like any psychosocial activity it has a radical servicecharacter. The suffering person demands. This corresponds with the duty of responseability. From "diakony" emerges dialogue, from personcenteredness room for personal encounter. This commitment towards the Other cf. the not enough appreciated commitmentconcept of Binder and Binder (1981, 179274) , a responsibility which originates in the basic dependency of the human being on his fellow beings, calls for acting also in communication and not for talking. Therefore there can no longer be any discussion about the understandimng of the PersonCentered Approach as an action approach [Handlungsansatz] and not merely as a verbal approach, misleadingly called "Gesprächstherapie [talking therapy]".
Towards a truly dialogic and social approach
Therefore the approach, no longer just psychotherapy, claiming to be an overall philosophy of culture, is challenged to no less than increasingly understanding the conditio humana, the being human in general. (By the way, this needs to deal with ecological questions as well.)
Obviously a paradigm shift within the approach announces itself in all that. The PersonCentered Approach may well face a turningpoint of its selfunderstanding. If the underlying image of man is taken seriously it becomes obvious that the approach needs further development to a truly dialogic and social approach (also in psychotherapy), a creative, flexible and kairologic approach which becomes also clear in the claim of the anthropology represented by Kierkegaard and Buber but even more so by Lévinas.
In respect to the above mentioned ethically founded anthropology the step from the individual to the person, from relation to encounter will be made as a step from the view of the personcentered relationship as an IThourelationship to a view as a Werelationship and therefore finally towards a social therapy. Then the I will not only be found as a respond to a Thou, but the I will be a respond to a We.
Then the approach will consequently be seen as a social approach. Sociotherapy besides psychotherapy will be ranked highly in the frame of an overall therapeutic point of view implying the communities man lives in. Thus the political significance becomes obvious.
Towards a basic consensus beyond schools
Developing the approach in this way a step could be taken towards a basic orientation4 without giving up independence, as Carl Rogers intended. What is aimed at is a basic consensus beyond schools which are obliged to a "way of being with", a dialogic understanding of therapy and group work, because they carry out the paradigm shift from treatment, caretaking and counseling to encounter. In doing so they transcend models which concentrate on the individualistic self as well as on models which exclusively concentrate on a simply systemicoriented approach. As soon as this step is truly taken not the schools are the issue any more, but the issue is to really understand and practice therapy and group work as dialogue. Or expressed in a more provoking way: the PersonCentered Approach must intend and aim at making itself superfluous just as a good therapist has to do.
In order to reach that goal a lot still has to be done.
Thank you.
1 Partially translated by Josef
Tihanyi and Lilly Schmid.
2 In the whole paper always men and women are meant and addressed.
For the simplicity in reading, however, not always both formulations are used.
3 Such attempts to personcentered ethics constitute a very
important task in respect to an ethic foundation of psychotherapy and psychosocial work,
if one doesnt want to get stuck in unfounded casuistics and doesnt want to
reduce ethics to the moral discussion of single cases, e.g. concerning abuse. Cf. Schmid
1996a, 521532.
4 Cf. van Kalmthout 1997.
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Authors identification
Peter F. Schmid, Univ.Doz. Prof. Mag. Dr.
Founder of personcentered training in Austria 30 years ago, Universitätsdozent at
the University of Graz, Styria; Professor at the Hochschule St. Gabriel / Mödling;
personcentred psychotherapist; psychotherapy trainer and staff member of the
"Academy for Counselling and Psychotherapy" of the "Institute for
PersonCentred Studies" of the APG in Vienna, 10 books and numerous articles
about further developments of the PersonCentered Approach.