Below is the article that I wrote for the BACP Journal ‘Therapy Today’ in 2014. This is the original version that I submitted before it was edited by the BACP. This article tackles, what I saw at the time (and is still an ongoing issue), of people integrating other approaches with person-centred Counselling and, in my opinion, the main issue of incompatibility of person-centred and CBT (amongst other approaches)
In this article, I hope to tackle the on-going trend of integration and pluralism across many different approaches to Counselling. I focus particularly on the Person-Centred Approach (PCA) and Cognitive Behavioural Therapy (CBT) as this appears to be the most common pairing and, in my opinion, mismatch. I argue for a re-examination of the approaches that we practice alongside each other and explain why our belief in human nature can often be at the core of our therapeutic approach, as well as a reference point for incompatibility across varying approaches.
This article has come from a place of both personal experience and growing frustration with the misrepresentation of the PCA and the move towards an integrative and often, what I believe to be, contradictory approach to Counselling.
Two things I feel I must point out to be completely transparent. Firstly, I have walked the path of pluralism that I question in this article and secondly, that I am aware of my own tendency to be more used to experiencing the faults in others. Experiencing faults in others is rooted in both my own insecurity but also in the reality of my experience. Despite there being some wonderful therapists and groups of people, my most common experience (often in a professional setting) has been a lack of integrity and commitment, rather than true individualism and dedication. The phrase ‘Walk the extra mile, it’s less crowded there’ comes to mind.
One thing that I would like to be clear on is that I do not hold the view that one approach to Counselling is better than another or that certain approaches to Counselling cannot work together. Instead, what I am exploring is the need to really examine what we are taking on by adopting a counselling approach, especially the PCA, and begin to see it as more than just a tool to add to our toolbox.
What seems to have become increasingly common in the Counselling world is Counsellor’s listing a variety of approaches, skills and tools that they follow, in the hope of covering all bases and not selling themselves short to prospective clients and employers. From looking through a directory of Counsellors online in one geographical location, from 22 Counsellors, 11 (50%) practised both CBT and person-centred Counselling together with a handful of individuals practising over 12 different approaches to Counselling each! 
As I have described earlier, I am not free from this process in the past and can completely understand how this can come about. However, I believe that we may need to be more aware of this if we are wishing to be committed to our approach, beliefs and clients. I believe that it is important to examine the reasons for our pluralism and question whether or not this is compatible, congruent or even appropriate.
Although there may be approaches to Counselling which may be better suited together and in fact, work together, my issue surrounds the PCA in particular. The reason for this is that it seems to be the most common approach in people’s repertoire, but also the approach that is, in my experience, most greatly misrepresented or misunderstood.
What seems to be becoming increasingly common is that the person-centred approach is seen as just a presence of the core conditions or a tool that can be used amongst many other approaches. My feeling is that this is giving a huge misrepresentation to the power of the person-centred approach. From my experience, the person-centred approach is a true commitment (both inside and outside of the therapy room) to not just the core conditions or necessary and sufficient conditions, but also the deep belief and trust in human’s self-governance, expertness and actualization.
I believe that if the PCA is fully understood and committed to, its presence amongst other approaches to Counselling, such as CBT, is often incompatible and shows a misunderstanding of the PCA.
The Problem of Pluralism
If we class ourselves to be person-centred and CBT, I struggle to see how can we believe in a human’s actualising tendency, self-governance and expertness and then create an environment in which we take the lead and believe that we have the tools, techniques or answers to their difficulties. Although I accept and welcome that there are many different approaches to therapy and that both therapists’ and clients’ are better suited to an approach which fits their beliefs and needs, I don’t, however, believe that different approaches like PCA and CBT can just be mixed together without doing a disservice to the PCA. If we are willing to accept and adopt two differing views of our clients and approaches to therapy, how can we practice these two opposing views in our Counselling work congruently and with full commitment and understanding?
For example, let’s take a phrase that a client may say such as “I think that everyone hates me.” Very generally, if we are following a person-centred way of working we are likely to be empathic towards this response and stay with the clients experiencing of this reality. However, if we are to work from a CBT framework, we may be inclined to challenge this belief and see how true this may actually be. I personally fail to see how these two approaches can be compatible and how someone can both believe in the actualising tendency (and that a space with the necessary and sufficient conditions is enough for therapeutic change) and be a directive therapist who has tools to fix this ‘irrational’ thinking. Surely for each therapist, one of these approaches must be incongruent?
I believe the responses we give to our clients come from our belief in what is most helpful to each person. It seems that what we believe to be most helpful to our clients comes from our belief of human nature. This seems hard to be pluralistic on.
One question I believe we need to ask ourselves when considering our Counselling approach beyond “what qualifications/training do I have?” Is “what is my belief in human nature?” And “what do I truly understand and believe by adopting this Counselling approach?”
The reason that I believe our belief in human nature to be so important is because I believe this goes a long way towards determining our choice of approach in Counselling. If we believe that humans are people who struggle with various issues and just need an expert who can point them in the right direction, then our approach to Counselling will match this. Equally, if we believe that humans have the capacity within themselves for self-determination and actualisation, we will choose an approach which matches this. A counselling approach, in my understanding, will aim to work in a way that is complementary to its belief in human nature and therefore, provides the most beneficial way it believes it can help people. This also explains the varying approaches to Counselling due to peoples varying beliefs about human nature and what is most helpful to clients.
My personal understanding of being a person-centred Counsellor is that not only do we seek to offer a growthful and facilitative climate to our clients, but even more so, we believe in the ability and expertise of the client to use the space to unlock their own potential and be the best guide for themselves. If we truly see ourselves as person-centred therapists, then I believe it follows that not only do we adopt the necessary and sufficient conditions to create therapeutic change, but we also adopt its belief in human nature and actualisation. The presence of a goal-orientated therapy or techniques alongside this, in my eyes, is incompatible.
I believe that if we are to follow a practice or theory, then we adopt it wholeheartedly. Yes, we may challenge, question and develop certain areas of that theory (as Rogers wished) but I believe that the core of that theory is crucial and essential to our commitment to it.
What seems to be becoming increasingly common, is just adding approaches as if it were a cubs scout badge (I have done this training, therefore, I can use this approach.) I believe that an approach to Counselling deserves greater respect, understanding and commitment than this. I believe it is important for us to stop and question, what am I really taking on and agreeing to by following and using this approach? If we are to do this, then I believe the option of pluralism or integration may be more limited, especially in regards to the PCA.
Black and White?
The question that arises for me as I write this, is whether my thinking is too black and white? One or the other and no in-between? Is it actually possible to have a therapist that can offer advice, techniques and guidance and also be person-centred? I think that it is fair to say that my thinking on this issue is black and white, but at the same time, I believe that it is appropriate.
An analogy that captures the way I see this issue is a vegetarian eating meat. To eat meat goes against the very essence of being a vegetarian and I see using CBT alongside PCA in the very same light. To use CBT and offer goal-orientated techniques and guidance goes against the very essence of being a non-directive person-centred Counsellor. I fully accept some theories can be integrated, however, when the thing you are offering goes against the philosophy of the PCA, I believe that you are no longer offering person-centred therapy. You cannot be a meat-eating vegetarian!
This point is captured by Barbara Temaner Brodley and Anne F. Brody:
“Infusing specific goal-orientated treatments and techniques with client-centred values in ways that influence the actual application of the treatments and techniques might well tend to greatly humanize and improve the efficacy of the treatments and the techniques. But they should not be confused with client-centred therapy.” 
As we can see from this quote, there is no question about effectiveness or the use of techniques. However, there is a point that the presence of this is not person-centred therapy.
The other point I question is, ‘is our approach to Counselling actually dependent on our beliefs in human nature?’ If I see Counselling in its most basic form, I believe that it is a service which is designed to help people with their difficulties/desires e.g. I am struggling with x or I want to be y. If we accept this, I believe the next question we have is – how can we be of most help to this person? For me, this is where the divide between therapeutic approaches and therapists happen. We have different beliefs on what is most helpful to people and why their issues come about, and as a result, this has a big part to play in the way we work with our clients.
I cannot think of a more important factor in determining how we work with our clients and how we can be of most help, other than our belief in human nature. Our work is with people and so our understanding of and belief in people is our guide as to how we approach this work. If, as a person-centred therapist, we believe in the client’s actualising tendency and self-governance, then our next step is to create a space, which is the most helpful environment for these traits to emerge. This then determines our approach to Counselling. It seems that our belief in human nature is the foundation of our practice.
With a culture that demands so much of us as therapists, alongside clients\employers wanting value for money and research findings, the progression to pluralism and an integrative approach to Counselling is unsurprising and often welcome.
However, for me, the difficulty begins to arise particularly with concern to the PCA. I feel that this is the approach that is most greatly misrepresented or shown to be misunderstood with its presence alongside other approaches to Counselling.
I believe that a large part of the difficulty of pluralism comes from seeing Counselling approaches as a technique and not a commitment to its deeper beliefs. When we begin to see the PCA as simply using the core conditions, then I believe we are more inclined to integrate this alongside other approaches and simply add varying ‘tools’ to our tool bag.
If we really stop to think about why we may adopt the PCA and what this entails, we may then begin to understand the approach more deeply and question our use of it in Counselling. If nothing else, I believe that we at least owe it to our clients to create a space that is fully committed, clear and congruent, whilst also being free from confusion and contradiction.
What I hope this discussion may trigger is a process where we stop and examine our approach to Counselling, ask ourselves why we work the way we do and what we actually believe about the approach(es) we practice. My hope is that we begin to see our approach as more of a commitment rather than a tool we use and that the PCA is understood more fully and used to its true potential.
- Counselling Directory. Search for “Preston, Lancashire.” www.counselling-directory.org.uk. 25th May 2013
- Barbara Temaner Brodley and Anne F. Brody, ‘Can one use techniques and still be client-centred?’ Kathryn A. Moon, Marjorie Witty, Barry Grant, and Bert Rice (eds.) Practicing Client-Centered Therapy: Selected Writings of Barbara Temaner Brodley Ross-on-Wye, PCCS Books, 2011 p. 250
You can see the published article here