applications
A person centered approach may not be a basis for everyday interactions but moments like these are valuable in any relationship or therapy.
Although it does not fit with punitive or policing roles it does work in most settings including crisis services and also with involuntary clients if there are sympathetic organisational structures, culture and supports. A couple of examples follow.
crisis
I used a Person centered approach to provide acute psychiatric emergency after hours services in the early 1970's in central London. We tended not to be called out for intoxication and there were fewer speed users than nowadays to complicate the work.
The small team I worked in provided backup. We went out alone. As soon as the duty worker went out on a call another would go on standby at home to receive subsequent calls. Work hours next day were flexible so we had as long as we needed to engage someone and work through how they were feeling and what they wanted.
We had authority to deal with situations or else assumed it. Although we had authority to admit to psychiatric wards, that happened on only a couple of occasions on my shifts and the admissions were voluntary.
There were few procedural limitations and minimal agency needs to be met with few set procedures and no formal assessments. A brief report was filed the next day.
Most importantly there was minimal training. In fact none that I can recall except for some instruction on how to use the phone that would be found in the hired hotel room to call up transport. We were just required to solve the problem.
I had the time and authority to wait until I was able to engage someone and if I the case of physical threats or weapons as happened occasionally in a domestic disturbance or in a national rail terminal I could organise police to step back so as not to be a distraction or threat.
The longest I spent on a call-out was a bit over 5 hours. That was on a railway station where a railways staff member had been threatened with a knife. Disembarkation was often a time of stress and sometimes the unraveling of the fantasies that led to a long train journey across the country. An altercation with another passenger or an official could end in a call out.
We were thoroughly debriefed. A typical question was “and how did you feel then?”
I discovered there that no matter how disoriented, demented or intoxicated someone was it was always possible amid the agitation or confusion to find at the very least a tiny core rational and responsive part of a person to relate with as a beginning and gradually build on. I would respond to that still functioning stable core at their pace. Initially through body language and simple explanations of my role.
Anyone coming upon one of us on a London National or international train station during a time of personal crisis or confusion would work out eventually that they were dealing with a person and not a protocol.
This could not happen now. Lengthy assessment and reporting requirements take most or all of a worker's time at the initial call out. Very distressed people with a diagnosis of personality disorder (the most traumatised and needy) are avoided. And there are strict time limits.
The most useful moments of white heat of a client's attention and interest can be lost in getting them to jump through assessment hoops and therapy is postponed - often for ever.
statutory settings
In settings like prisons or parole where clients are penalised for refusing services it is possible to offer a client centered service within the limitations of confidentiality and personal freedom offered by the agency.
For example within probation and parole services I used to outline the rules I was working within. I was available to discuss anything they wanted to and if I learnt of a bond condition being breached for instance by not reporting to me as required by the court then I would apply to the court to estreat their bond which triggers a return to court.
Three are legal limitations to confidentiality in most therapeutic settings and a therapist discloses to clients. their legal obligations as a citizen or a professional to report crimes or abuse.
Most clients worked out how to use me constructively. A few just went through the motions of turning up. Sometimes not agreeing with their sentence.
Some wanted guidance, not therapy and felt they had been promised this by the sentencing court. Providing guidance or re-parenting when requested was a way to connect with them.
a contract
A person centered approach does need participants to be really present and free to engage. But some come to therapy to please someone else. Instructed to come or imagining they are obliged to.
Most people who are under external or inner duress edit their words as if a parent, partner, authority or God is there with them. They are not fully there for for themselves. It is as if they are proxies for a fantasy or for someone else. The fantasy or the other person comes to therapy.
These disconnects may may sort themselves out in the first encounter or only emerge gradually and until they do participants may be working at cross purposes without a full agreement about what they are doing together.
I usually ask clients what they want but sometimes just wait and see where things are going. In the beginning there may not be sufficient common language and mutual understanding to pin the therapeutic contract down exactly. (There are never words for all of it.) It emerges as sessions progress.
more
I have used this approach in street-work with youth gangs – initially waiting in gang territory to be approached and responding with information about my role which included providing personal services.
This approach works with children of all ages and people with a diagnoses of dementia or schizophrenia but these are topics for whole other websites so I will leave you to work out how. The pages on awareness, emotion and mind give some clues.
copyright (C) John Brasted 2008
updated 20. Nov. 2011
