John Rowan on the Ethics of Humanistic Psychotherapy

Inside Out is privileged to preview John Rowan’s forthcoming revised edition of The Reality Game, first published in 1983. This “Guide to Humanistic Counselling and Therapy” has never been superseded as a basic textbook of the humanistic therapy movement and the revised edition is extraordinarily welcome. The new edition will include a chapter on Ethics, a topic which has become increasingly 
prominent in recent years, and for our current issue on Psychotherapy, Ethics and the Law. Inside Out has been given the opportunity to read the new chapter.

The first thing that I felt on reading the new chapter which John Rowan has added to the new edition of The Reality Game was a great sense of pleasure at the consistent way in which he has addressed the subject of Ethics. It is now fifteen years since he published the original book, and since then his writings have shown him moving in new directions as well as maintaining his basic humanistic orientation, so I was interested to see how he would write about Ethics as a separate topic. Of course, ethical questions and considerations are constantly present throughout the original book, no matter what aspect of therapy he is writing about. For example, in the chapter on Transference, he said

“… One of the criticisms which analysts bring against the humanistic therapist is that the latter is seen as imputing unreal amounts of self-responsibility to the client or group member. And the question the Freudian asks is – ‘You brought this person into the consulting-room, or these people into the group room. The fact of transference, which you have now admitted to, means that they are now dependent on you – that they are handing you all the aces. Yet you are saying to them that they have to be autonomous at one and the same time. How can they be both? And what are you responsible for?’ I think this is an important question..”

It never seemed to me when I originally read The Reality Game that there was any area of therapy which did not have ethical aspects, and I suppose that it is a reflection of the changes which have happened over the last fifteen years that Rowan feels the need to include a chapter specifically on the subject now.

In the new chapter, Rowan acknowledges that the topic of Ethics has come increasingly into focus since Alice Miller’s famous assertion that therapists could unwittingly be (re)abusing their clients, and his own realization that some habits in the early Growth Movement of the 1970s showed less than scrupulous attention to this possibility. He recalls groups where the group leader’s sexual favours might be competed for by members of the group, for example. As I read this, which seems now in some way to belong to a more innocent world it struck me how brave an opening to a chapter on Ethics this was! It was stimulating to have the issue placed within the context of the history of the movement, and to recognize that even such basic issues can be subject to quite fashionable ideas.

He also reminds us that “Counselling grew up in institutions, often educational institutions and later other institutions such as churches, hospitals, prisons and commercial organizations. It also flourished in social work settings..,” so that the reader is clearly aware of the polarities from the start of the discussion about Ethics. On the one hand, free love – on the other, prison, school and social work! Neither of these, he argues, provides an adequate basis to practice therapy.

His main concern is in fact with the ethics of private practice, which he explores in the same forthright way that he wrote the book originally:

“In private practice there is no ambiguity as to whom the therapist is working for. The therapist is working exclusively for the client: hence it is a secure relationship. And most of us believe that a secure relationship is very important, particularly 
when it turns out that a long-term stint is needed… “

I found it intensely refreshing to read about the somewhat vexed and even intimidating subject of ethics in a really practical and matter-of-fact way, without fudging and without excuse:

Therapy is not a medical matter…”

“Therapy can become a form of social control. It can be a way of keeping tabs on people for the benefit of the institution and its smooth running. I am not saying this always happens or is bound to happen: for all I know it is rare. But if it is rare, this is due only to the decency of the people operating the system. The system itself allows it…”

Rowan also gives a brief account of the recent development of humanistic psychotherapy in Britain, which he feels has included due attention to both “Inward” and “Outward” aspects of the profession. Clearly, both of these are important with regard to ethics. In a most interesting discussion, he acknowledges the importance of the view that, for example, the accreditation structures which have been put into place in the formation of the United Kingdom Council for Psychotherapy (UKCP) may make the personal growth work and integrity of a therapist seem less important than initials after the name, and could even threaten the vital processes of the therapy sessions themselves (as explored when he talks about psychotherapy within institutional settings). But he argues that this attention to the “Inward” aspects of therapy has always been the most exciting and real quality of the work and doubts that people are going to stop that work now -
 whereas, he argues, therapists have tended to pay less attention to the “Outward” or public world to which they also have a responsibility. The inclusiveness of Rowan ‘s argument is encouraging, since he clearly envisages a process of growth coming from the difference, and he strongly asserts that it would be wrong to take one side only – whether Inward or Outward (self-responsibility alone or certification alone) -
 since that represents the “Either/Or” kind of thinking which he wants to move away from.

This style of approach, with insight and inclusiveness as primary qualities, was always one of the main virtues of The Reality Game. The reader is never advised that this approach works, or that technique is the latest thing, as we find in so many “Guides”; on the contrary, Rowan’s great merit is that he sustains an argument about the necessity for Humanistic therapy to address its profound task in many different ways. It is one of his gifts to be able to talk about that task without being bland and without being sententious:

Others misunderstand it by thinking it means that we are soft and mushy and want to spread peace and love all the time; but we are not in the peace and love business, we are in the reality business. Or better still, the reality game.”

The phrases seem to flow easily, but as the book develops, it becomes clearer and clearer to the reader that they are highly intentional and contain the kernal of his thoughts. Later on he confronts the artificial nature of the therapy session, the role-playing on the part of both therapist and client, and demonstrates that this in no way entails a lack of authenticity.

Usually there is a contradiction between playing a role and being authentic. But a therapist or counsellor is playing a role which essentially involves and entails being authentic. It is ‘the game of no game’ as someone once put it.”

I feel that it is Rowan’s ability to sustain these vital paradoxes, rather than struggling to resolve them into false simplicities or dichotomous formulations, that really is most valuable in his view of therapy. In the new chapter on Ethics, the approach is completely consistent with the rest of the book, so that even though it is fifteen years since the book was published, there is no sign of fashionable fluctuation in the writer’s view of therapy. His remarks about Boundaries (which are so clear and concise as to be essential reading for anyone interested in counselling and therapy) 
are an example: he begins by stating the necessity for clear boundaries, and then explores that therapeutic necessity in the light of theory and in practice. He expands the notion of a boundary beyond the holding and delineating idea, so that it clearly functions in the work of therapy itself:

“Probably the most important boundary issue is confidentiality. This is something which few people outside the world of therapy understand. Social workers don’t understand it, nurses don’t understand it, teachers don’t understand it. It means that the words of the client are sacred.

In that last phrase, the full depth of Rowan’s grasp on the meaning of therapy is revealed – that its scope property stretches from philosophical and religious aspects all the way to the most detailed, practical, down-to-earth problems.

The new edition of The Reality Game will surely be required reading for anyone starting any kind of course in counselling and psychotherapy, but I feel that even if you already have (as I do) an old copy from long ago, you should at least look at the new material in the revised edition. The questions of ethics in therapy “will become more and more complex and hard to handle” as Rowan concludes. This additional chapter is a model of clarity and good sense, profoundly consistent with the full meaning of Humanistic Psychotherapy and I feel that in many ways, it may make us reconsider areas of our practice which have perhaps been over-controlled from outside ourselves, and which have been underexamined as a defence on our part. The extra chapter seems to have the effect of pulling together all the implied ethical questions which arise constantly throughout the book and addressing them in a coherent, principled way. The subject is surely in need of such work!

Mary Montaut