DIRECTIVE AND NON-DIRECTIVE PSYCHOTHERAPY. WHAT IS YOUR PREFERENCE?

«He is free to become himself or to hide behind a facade, to move forward or backward, to behave as a self-destructive force to himself and others or to make himself and others stronger. In the literal sense, he is free to live or die». (C. Rogers)

19 September, 2023

The theme of freedom of choice, lack of freedom, and determinism is very common in the literature on philosophy and psychology. Many practicing psychologists insist on the position that can be literally summed up as «you must accept the client as he is».

Carl Rogers, the author who most strongly emphasized the value of unconditional acceptance, described his views on psychotherapy as follows: «My goal is to understand how he (the client) feels in his inner world, accept him as he is, create an atmosphere of freedom in which he can move wherever he wants, following the waves of his thoughts and states. How does he use this freedom?»

A more general question that every practicing psychotherapist has to answer is how changes occur in psychotherapy. There is no single universally recognized answer to this question. I would like to highlight one aspect of this problem: whether the changes in the client are the result of external influence or arise spontaneously as a result of a specially constructed interaction between the client and the therapist. In other words, should the psychotherapist provoke specific changes (does the therapist have a fixed image of the desired and expected outcome for each client? does the therapist distinguish between "good» and «bad» in the client's manifestations?), or is the therapist just a witness to these changes, which occur spontaneously (which paradoxically does not exclude an active role for the psychotherapist).

If we turn to Carl Rogers' position, the essence of psychotherapy is precisely to create optimal conditions for a person to «feel» himself and begin confident movement in the direction he independently chooses, no matter how he may manifest himself: in real actions, reactions, ways of thinking, feeling about themselves and this world, etc.

The undeniable value of such an interaction style between the client and therapist (where the latter is ready for «any turn of events» and has no specific expectations towards the client) lies in the fact that during their socialization, individuals inevitably encounter a multitude of more or less authoritarian figures. Education and upbringing are directed processes aimed at shaping a certain type of personality. They may take into account the individual characteristics of the child, but not always, even parents sometimes pay more attention to their own image of a child, not to the real child. In the first place, the processes of teaching and raising a child are regulated by the existing cultural representations of a person in society at a given time, rather than tailored to each individual. That is why an environment of unconditional acceptance is of such great value. When a person has the opportunity to express himself as he currently feels how to, to turn to himself (rather than to receive a new set of requirements, instructions, and expectations from the «knower of life», the Other), then it is a case of unconditional acceptance that provokes a great therapeutic effect. If we are trying to shape a client (of course it doesn't mean that he is getting shaped according to our design), we contribute to the chain of his teachers and do not take advantage of the opportunity to create a qualitatively new situation of existence for the client when he is the main value, when his interests, views, and experiences are listened to, driven by him, not by something external. This is a movement from subjective reality to objective reality, from within to without, rather than the other way around.

I remember attending a clinical-theoretical seminar. The therapist was working with a client who had a very complex history. She had been a psychiatrist for many years and at the time of the therapeutic session, she herself was a patient in a psychiatric hospital. It was a very memorable and intense encounter. But what I remember most is the end of it. After the therapist (who was also a psychiatrist) announced that their session time was coming to an end and they had to stop, the patient asked a question that had been troubling her the most throughout the session (it was a public session): «Can I continue to practice as a psychiatrist in the future after I get cured?» There was a long pause. Everyone was eagerly waiting to see what would happen next. Would there be a direct answer to the question or not? And the answer was not given. The therapist's opinion remained unknown to everyone.

On the way back, I and several other participants who had attended the practicum were actively discussing what could be said in such a situation and why he didn't just provide a straightforward opinion to the question, especially when he, as a psychiatrist, should know the answer (with his background, many mutual acquaintances, and relevant experience). Why did he «conceal» the answer? Was it to conform to the standards of the method in which he worked, or to maintain his incognito out of considerations of the «correctness» of such an approach? But then it suddenly occurred to me. He didn't answer not because he «concealed» the answer to the question, and not because he was a «diligent» psychotherapist, but because he didn't have the answer. He had the same things as the patient—fantasies, assumptions, hopes, experiences. And introducing them, at least in the status of «knowledge from above», is not always helpful.

The weakness of the «unconditional acceptance» position may lie in the fact that one person cannot truly accept everything about another person. Everyone has their limits of «tolerance». And there is wisdom in that. For example, a client comes in, and after some time in an atmosphere of unconditional acceptance, informs you that he kills or harms children and derives pleasure from it.

In many countries psychotherapists have the same problem. A qualified psychotherapist conducting official patient sessions is obligated to report to authorities when a client discloses information about committing particularly serious offenses (murder, violence, especially involving children). Otherwise, psychotherapists may face criminal liability from the government. However, some psychological associations view any disclosure of confidential information as a breach of the ethical professional code. In the worst-case scenario, this could lead to being expelled from the professional community.

One experienced psychotherapist who lectured at my university, a pioneer in the field of psychotherapy in my country, shared her perspective on this issue. She conveyed the following message to her clients: «I will support your efforts to improve your life, but I am not willing to support your destructiveness towards yourself or others».

There is an alternative position. Its essence is that if we see that a person is engaging in clearly ineffective, destructive behavior towards themselves or others, a way of functioning, or interacting with themselves and the world that leads to suffering, we can intervene and «help the client».

«Why watch the client sitting on a nail and suffering when we can try to offer him a way to get off that nail? His suffering will end. And in a «peaceful' environment, we can find out how he ended up on that nail in the first place without noticing this for a long time».

Another way of reasoning that supports this position can be presented as follows:

A client comes to therapy experiencing some form of suffering or discomfort. They have a desire to alleviate this suffering and address the problems they have come with. However, the client's problem may be unsolvable within their existing framework of beliefs and understanding. Therefore, they need to be «taken out» of this cyclically unpromising state, no matter how it is manifested (it can be described in various ways: through emotional experience, cognitive functioning, maladaptive behavior, etc.). Thus, the therapist becomes the one who introduces something new and «pulls» their client out of the endless cycle of their unhappy life, providing them with new tools for coping with their own life.

The clear advantage of this understanding for the therapist may also be that we are all very busy, and often clients seek short-term counseling, demanding the most effective result in the shortest possible time. In such a setting, an authoritarian position allows the psychologist to have more «control» over what is happening. Because changes in clients that are not forced, in my view, occur very slowly. And the more significant these changes are, the slower they will happen.

The weakness of this perspective lies in the fact that the therapist inadvertently becomes a judge of their client. They make decisions about what is «good» and «bad» for the client, what the client is doing «right» or «wrong». Depending on their own views, they attempt to steer the client in one direction or another. In this case, the client's freedom is reduced to the choice of whether to trust the therapist, agree with him, or protest and disregard his suggestions.

There are specialists who believe that psychotherapy cannot and should not influence a client's «life philosophy» in any way. I also find it impossible for a person's worldview to remain entirely unchanged after long, intensive, and deep work in psychotherapy. However, the client's views on their life and the world in general should naturally evolve in line with their internal logic, transforming as they gain real-life experiences. The psychologist should not attempt to deliberately change or shape these views, «educating» his patient further or increasing their «psychological literacy».

Once, my friend asked me to name three main things that, in my opinion, she should change about herself. I replied, «I don't know». To which she responded, «What difference does it make, just tell me what you think? I'm not planning to do what you say anyway». And I realized that my apprehensions are not about that she might follow my advice too obsessively but that I genuinely believe that I don't know. In my understanding, the readiness for sustainable and qualitative changes matures from within and then naturally bursts outward. The resource of psychotherapy lies precisely in facilitating this maturation, after which external changes become somewhat inevitable.

Client-therapist positions are not equal; they are asymmetric. But this does not mean that one knows more than the other thinks more broadly, or feels more deeply. The client-therapist relationship is not a relationship between a teacher and a student. The therapist organizes a journey into the client's inner world and accompanies them on that path. I believe that with sufficient support and proper guidance, the client will be able to find all the necessary means and resources to resolve his life challenges.

About me

Maria Dolgopolova – a certified clinical and a jungian psychologist (Moscow Association of Analytical Psychology, an IAAP training candidate studying in CGJung Institute in Zurich) with a background in gestalt therapy (Moscow Institute of Gestalt and Psychodrama, Gestalt Associates Training Los Angeles) and in psychoanalysis of object relations.

marianifontovna@gmail.com

+7 903 542 9177 (Telegram, WhatsApp)

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