Susan Lindsay talked to Mary Montaut
In recent years I’ve been preoccupied with the notion of loss and gain in Humanistic and Integrative Psychotherapy and there seem to be three main strands to my ruminations. One is the question of what I’ve integrated personally with initial humanistic experience and the importance of that. A second strand has come from my active involvement in the development of the IAHIP (Irish Association of Humanistic & Integrative Psychotherapy) and its accreditation issues. The third, more widely focused preoccupation really concerns the nature of humanistic and integrative therapy now, at the end of this century.
Re-iterating Humanistic Values
In the IAHIP we have become so immersed in issues of Accreditation and Criteria that we have not really ever got back to the question of what qualitative assessment is. We’ve felt that we had to put accreditation criteria in place – but really that was fairly antithetical to humanistic therapy, which was much more about being more open to different kinds of opportunities and possibilities, and not about trying to rigidify the thing into a format. I see the need now really to reiterate some of those values.
I think that people are coming into practice now from training schools where they’ve taken what they’re given. Certainly, they’ve tried to digest it, but maybe they haven’t really thought about whether humanistic therapy is different from other therapies, or does it have anything else to offer, or not. And then there’s a danger that we’re tending to get into a kind of mish-mash and accrediting people because they have so many hours. For example, there are some generally agreed things about how therapy happens that are widely taken on board, but not really digested or thought through or examined and which have nuances that are not particularly humanistic. I think, if we’re going to have a separate ‘Humanistic and Integrative’ section, then let’s know what we’re about.
This has really come to a head for me in the meetings about training standards and ethics. One thing that really challenged me has been the initial statement that training should have psychotherapy groups in it, but that those psychotherapy groups should not be assessed. Now, I can see good reasons why therapy groups should not be assessed and I have run therapy groups where I’ve been external to the organisation, and been asked to assess them and I’ve refused to do so Alternatively, I have used peer and self assessment by the group members, and given my assessment according to what they gave me or to whatever I came up with together with them. The first training course I ran was purely self-assessment with peer and staff feedback, and the second course was a consensual agreement among the students and staff about assessment, so you had an assessment but it was based on staff, peer and individual feedback, followed by consensus about accreditation/graduation or not. And the process had some problems, because you had to be really clear about what ‘consensus’ was going to mean.
The argument against group therapy being assessed seems to be that you cannot be there as a therapist for the participants fully to be whatever they want to be, and then assess them as good enough or not good enough. Participants will put transferential material about authority upon the group leader. As group leader, through the transference you may become schoolteacher, parent, or any other authority figure, and so you’re only confusing the therapeutic issues by having an assessment role within the group. And I agree with that. However as a humanistic therapist, I believe that it is my job to minimise transference. The move forward in humanistic therapy was to say, as our Constitution said originally, that humanistic therapy is a meeting between equals. Humanistic therapy brought in ways of working with transferential material that didn’t necessarily mean using the relationship of the therapy to develop the transference. That doesn’t mean that it does not or should not recognise that transference exists or be attentive to it, but that by minimising transference and using other kinds of experiential methods, such as the gestalt chair, imagery and so on, we could get at transference issues in a different way.
Approaches to Transference
There is a danger for humanistic therapists in trying to integrate psychoanalytic approaches, if they haven’t actually gone to the depths of an analysis. This is where the core difference is between a humanistic therapist and an analyst. The analytic process involves setting up a structure where the therapist is minimalist, with the intention of enabling the transference to become clear, on the assumption that the ways in which the client sees the therapist are to do with the ways in which the client engages with other people and particularly with authority. The idea is that the therapist is anonymous, ‘a blank screen’, for the projection of the transference, and that this does not give the therapist a lot of power. But the reality is that silence is very powerful – you can test this out sitting with anybody in silence - particularly because it does evoke transference, but it’s not a transference that can be easily addressed because the client feels so powerless. I think in the best of analytic therapy or analysis, the therapist doesn’t actually analyse the transference until the analysand is ready and sees depth for themselves, and at that stage it becomes a much more mutual endeavour.
Equal as Persons
At that point, I think that humanistic therapy wouldn’t have much difficulty in having the same dialogue, but the way in which you get to that point is different in humanistic approaches. A humanistic therapist would try to minimise the transference, not by being a silent presence but by engaging as an open, equal, vulnerable person who is willing to listen to the client’s difficulties, not only as indicative of the transference from the past, but also as indicative of the current relationship. By engaging around the therapeutic relationship, they may be learning to communicate clearly with each other, to deal with conflict, to deal with caring, feelings, and all the various relationship issues. And of course there is a transference going on as well, because there always is in every relationship. But as therapists we can address people at many different levels – it’s our job to be able to address people both at superficial levels and at the very deep levels, according to what they’re ready for and to the strength of the therapeutic relationship, and whether or not it’s strong enough at a particular time to contain looking at deeper issues.
Group Therapy Assessment
In recent years as a trainer, I have been group therapist facilitating groups that have self, peer and staff assessment, feedback and evaluation, and then a self-evaluation by the student concerned which would be put to a staff team, whose evaluation would be final but it would take into account the student’s evaluation. A clear distinction is made between being fine wherever they are, and their readiness to operate as a therapist, which is quite a different issue. By holding a congruent, person-centred relationship with the student participants in group therapy, I have found it can be done this way and that is a very real way. Staff and students agree on how a student is doing, whether they’re ready to go on, and if they’re not ready, why they’re not ready to practice, when hopefully it is a good enough finishing for the student to go on to something else for which they are ready, or to take time out and return eventually. It’s all part of the training process.
Long Term Losses?
I’m very disturbed at the suggestion that group therapy couldn’t include this kind of assessment. A way has been proposed around the problem, which is to say that the experiential training course can be assessed; and you can have experiential training that could be group therapy, but be called something else because ‘you can’t assess group therapy’. In the short term that might be fine, but in the long term, I don’t think that people looking at these Codes of Practice and Ethics will understand these distinctions and possibilities and it could become a very serious problem. I already see things that we agreed five or six years ago to deal with awkward problems, are now becoming rigidified into something that they were not meant to be. For example, when the IAHIP moved from having a Constitution into being a Company, the things in the Constitution that couldn’t be put in the Company became by-laws – and now by-laws can be changed very easily without the membership voting on them. People aren’t even clear what the by-laws are, or how they can be used, and they have very much less status than was intended as part of the Constitution before the change-over to a Company happened.
Commitment to Humanistic Therapy
I’ve been interested not only in the issues of training and group therapy and assessment and the nature of humanistic therapy, but also at the strength of my own passion in the response to it. And it suggests that something very important to me is at stake here. I’m quite tempted to leave it and go away and let people get on with it – but then I feel that something I’ve worked for for twenty-five years is being eroded and I’m sure that it’s not good for me to let it go so quickly. On this issue, we have had to find a compromise, and there is something about eroding away the last possibility of the students being more engaged in their own accreditation that disturbs me.
I’ve always been very struck by Carl Rogers’ research on education and therapy, and as a therapist I often come back to Rogers. I would say that the ground of humanistic therapy is person-centred in the way that Rogers meant the term, though not necessarily his particular process. I think a lot in his process is present in other ways in humanistic therapies, particularly to turn from being the expert as the therapist, to making the client the expert; to focus on the feelings and meaningful experience of the client; and to trust the growth process of the client, that they will come to whatever it is they need to arrive at. Also in education, his research indicated that the best education was facilitated education, though he himself said that it wouldn’t come into fashion because it was too radical and there was too much at stake – the cup and jug method of education supports the status of the teacher, and the other does not.
What Are We Assessing?
Of course students can be engaged in their own accreditation without having to be in group therapy per se, but at the core of this issue is the question of what you are assessing. As a trainer of the last sixteen years, I would say that the most important issue to a therapist’s readiness to practice is where they find themselves personally, the depth of themselves which they have been able to address and heal, and their ability to be open and congruent because of this. There are people who argue that you can’t assess people in group therapy because if they are to be assessed, they have to be allowed to present themselves in some other way than the whole of themselves. In other words, they have to be able to go to an interview and be judged on their persona – they can’t be openly vulnerable. They say it wouldn’t be fair if students were showing something they consider ‘bad’ about themselves in a therapy group, then to be assessed on that and told they weren’t ready as therapists, because they wouldn’t have revealed that part of themselves if they had thought that it would get in their way. But what does that say about therapists? That argument says that students are going to be accredited, knowing that if people really knew them they should not have been accredited – which leaves you standing on very shaky ground. This is exactly the same problem that happens to people in childhood, so it’s compounding an issue that’s already there. Plus working in those areas where people are vulnerable is actually what makes them better therapists, if they reveal them and have learned to accept them.
Real Self or Persona?
I don’t think we should be accepting people on the basis or persona, because we want to genuinely know if they are genuinely ready as people. It’s fine if you’re selling something to be assessed on whether you’ve a sales personality, but as a therapist, it’s where you really are as a person.
I would like to emphasise that group therapy per se is an entity in its own right and shouldn’t be watered down or marginalised by the forms of assessment. But I think we can do this by having training groups. I think it’s perfectly reasonable to expect trainee therapists to have to do a therapy group that requires something extra than the therapy group that an ordinary client might join. Of course, it must be clear from the very beginning what the limits of the confidentiality are – that for the most part, the contents of the group are confidential, that what happens in the group is confidential, but that there will be personal evaluation and peer and staff feedback, and ultimately that the quality of people’s participation in the group will be a factor in their final assessment. Then, if it becomes clear in the group that a person is not ready in themselves for entering into relationships at depth, or can’t handle conflict or can’t handle other people’s pain, or can’t meet people in an intimate way in the group, or other specified criteria, this will be fed into the training group with the knowledge of the participant.
Trusting the Trainers
I do agree that this could be open to abuse by therapists, if the therapist is not capable of being congruent and open and telling people honestly what they think and engaging in real dialogue at depth. But then our trainers should be able to do that. If they cannot do that, then I don’t think they should be training group therapists. As a humanistic therapist, I couldn’t envisage myself as a trainer bringing people through the training course unless we could have peer, self and staff feedback, evaluation and accreditation which would include looking at who the person really is.
Relationship in Humanistic Therapy
In Self & Society, July “98, there was an article called “What Do Humanistic Practitioners Really Believe?” and the AHPP brought out a statement of core beliefs. In it they said that humanistic psychotherapy is not just about technique, it is about a relationship. So what does a humanistic therapeutic relationship look like? I think it’s best described by Rogers in his work on Encounter Groups It’s a relationship that’s about being equal, about listening to the other person empathically and being congruent. I think we look at Rogers far too young in our lives as therapists and need to revisit him with maturity. I think that it takes time to take on the challenge of what it means to be congruent and empathic, and that when you do, the challenge is to share what’s coming up in you as a therapist, feelings and responses, in a here-and-now, immediate relationship and to engage in dialogue with the client accordingly. That doesn’t mean having to say everything that’s on your mind, but it does mean trusting what’s happening within you as having something to say to the process of the therapy.
[Susan Lindsay is a psychotherapist with Connect Associates and a trainer with the Institute for Creative Counselling & Psychotherapy, Dun Laoghaire]