PersonCentred Therapy: A LEADING EDGE

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Person-Centred TherapyA LEADING EDGE

• Professor Dave Mearns

The Counselling Unit,University of
Strathclyde,Jordanhill Campus,Glasgow G13
1PPwww.davemearns.com
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Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

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Same family different emphases

• emphasising non-directivity (Brodley, Bozarth)
• emphasising the clients process (Greenberg,
  Elliott)
• emphasising focusing (Gendlin, Lietaer)
• emphasising the clients existential experiencing
  (Cooper)
• emphasising the relationship (Schmid, Mearns)

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A World View of PCE

• The World Association of Person-Centered and
  Experiential Psychotherapy and Counseling
  (WAPCEPC)
• The Triennial World Conference
• July 12-16, 2006 Potsdam, Germany
• July 6-10, 2008, Norwich, England
• The International Journal Person-Centered and
  Experiential Psychotherapies. 2001-present.

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PCE Worldwide

• U.S.A.
• Britain
• Germany
• Austria
• Holland
• Belgium
• France
• Italy

• Greece
• Croatia
• Slovakia
• Portugal
• Brazil
• Argentina
• Japan
• China

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Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

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A Schema of Working at Relational Depth
B Negotiating client processes (including
difficult process)
C Contact with the existential process
A Offering relational depth
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Definition

• Relational depth is a state of profound
  contact and engagement between two people, in
  which each person is fully real to the Other, and
  able to understand and value the Others
  experiences at a high level.
• Mearns, D. Cooper, M. (2005) Working at
  Relational Depth in Counselling and
  Psychotherapy. London Sage.

9
Schmid, P.F. (2002). Knowledge or
acknowledgement? Psychotherapy as the art of
not-knowing prospects on further developments
of a traditional paradigm, Person-Centered and
Experiential Psychotherapies, 1(1/2) 56-70.
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Encounter, not invasion
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Two Aspects of Relational Depth

• moments of relational depth
• relational depth experienced as a continuing
  relationship

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Presentational Level of Self
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Approach/ Avoidance towards being met at
relational depth
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Disguises, Clues, Lace Curtains and Safety
Screens
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How do we show our client that we are willing and
able to meet him at relational depth?

• We touch him in his experiencing
• We knock on his door at a deeper level of his
  experiencing
• We respect his positioning
• But we do not collude with a superficiality norm.

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Creating the conditions for meeting the client at
relational depth

• High levels of the therapeutic conditions in
  mutually enhancing interaction.
• The stillness and fearlessness of the
  therapist.

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Two aims in offering the client an engagement at
relational depth

• Listening to the expressing rather than the
  expression
• Meeting the client inside his experiencing

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Listening to the Expressing/Entering the
experiencing

• Tony I cant, I cant, I cant, I cant, I cant
  ..
• Bill No, .. you cant.
• Tony No one can.
• Bill Silence
• Tony (Thumping his fist on the floor and
  screaming) I need to kill myself.
• Bill Silence.
• Tony I need to go .. I must go .. I must go
  away from me.
• Bill Silence.

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• Tony I dont know how to do it.
• Bill Its hard, Tony . Its hard .. theres
  no way ..
• Tony No way .. no way .. How do people do
  it?
• Bill God knows Tony.
• Tony Can you warm me Bill?
• Bill Puts his arm round Tony.

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Much later Bill comments on this meeting

• Its an example of how you can be with someone
  and have conversation without having any idea
  what its about. Yet all the time you can feel
  them - and be with them feeling. It was weeks
  later that I found out the content of this
  meeting. Tony was being the part of him which
  had done some bad stuff. In war people can do
  bad stuff that they cant live with later. Tony
  was feeling that part - he wanted to get rid of
  it - to kill it or for it to go away - to
  exorcise it might be a good metaphor, But, of
  course, there was no way to do it - thats what
  we were in.

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• Emotional
• Depth

• Relational
• Depth

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Relational depth is about the quality of the
relational contact, not the quantity
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Relational Depth in Everyday Life

• Doug the teacher
• Mhairi the nurse
• Lillian the social worker

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Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

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Client Processes

• Existential Process
• Psychotic Process (Prouty)
• Fragile Process (Warner)
• Dissociated Process (Warner)
• Ego-Syntonic Process
• Existential Disconnection
• Transference

RestrictingExistentialContact
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The Developmental Basis of Ego-Syntonic Process

• The person has survived a parenting in which love
  and acceptance was not reliable. Negative
  experiences would follow when positives might be
  expected there was no way to rely on the
  relationship. Ridicule, hate or abuse would come
  when love might be expected.
• To survive, the person needed to
• Withdraw their emotional attachment.
• Find ways to control the relationship
• Find ways to control themselves in relationship.

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Sandy

• The fellow who has a parent who is sometimes nice
  and sometimes horrible thinks that is the way the
  world is. Now, in my own case, that is how it
  was. At the time when I came to the school I
  think the difficulty was, among other things,
  that I was confronted by Patti his counselor,
  who was an exceptionally fine human being and a
  very affectionate and decent human being. I
  wasnt able to accept the affection, which caused
  even more anger because everyone likes to accept
  affection.

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But if you condition yourself to not accepting
affection because, if by accepting it you only
let yourself in for the next downfall, you put
yourself in a position where you dont dare to
hope that the affection is for real and you keep
testing to find out if it is for real, and thats
the process where, step by step, you find out
whether it is. In a sense, maybe, that explains
my own need to hurt them, whether or not the
affection would continue to comeBettelheim, B.
(1987). The man who cared for children.
Horizon. London BBC Television.
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Ego-Syntonic Process in Adult Life
The persons self-protective systems become
generalised to other relationships (cf Sternes
RIGs Representations of Interactions that
have become Generalised). The seriousness of the
resulting pattern can vary hugely. The person may
become

• popular but unreachable
• alone and lonely
• controlling
• cold
• cruel
• homicidal and suicidal

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In its mild expression their ego-syntonic process
leads the person to be confused and scared in
relationships. They know that things go wrong for
them and they come to expect things to go wrong.
But they genuinely do not understand why they go
wrong. They have done their best. They have even
tried to think about what the other person wants,
and be that (within limits). But it always goes
wrong.
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In another expression they attract relations but
fail in relationships because, ultimately, they
have to be so controlling. They need to define
the reality and protect against its changing.
They provide well on a material level, function
well enough in more superficial relationships,
but they must not make themselves existentially
vulnerable. Usually they are genuinely surprised
when the other person leaves them. Again, they
had done their best.
32
In a more serious expression, the person is
dangerous to themselves and others. They are so
threatened by relationship that their
self-protection manifests itself not in confusion
or controlling, but in detachment and even
violence. Their fear is so profound and the
degree of adjustment they have obtained so
tenuous that detachment and even destruction (of
self or other) are the only existetial
protections they have left.
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The Hook in Ego-Syntonic Process

• But there really was someone there to love I
  saw him I saw him often.
• Its not just a rescuer thing its much
  stronger than that. I couldnt let him go
  because there were times I really saw him.
• Its so frustrating sometimes she was a
  wonderful person she was the fullest human
  being anyone could wantbut then it would
  evaporate in tears and anger.
• He couldnt let me in. For 20 years he couldnt
  let me in. We could even talk about how he
  couldnt let me in Maybe that was it at times
  he wasnt who he was.

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Client Processes

• Existential Process
• Psychotic Process (Prouty)
• Fragile Process (Warner)
• Dissociated Process (Warner)
• Ego-Syntonic Process
• Existential Disconnection
• Transference

RestrictingExistentialContact
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EXISTENTIAL DISCONNECTION

• The separation of the person in their everyday
  life from the existential significance of their
  life (c.f. Bill Murray and Scarlett Johansson in
  Lost in Translation)

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Client Processes

• Existential Process
• Psychotic Process (Prouty)
• Fragile Process (Warner)
• Dissociated Process (Warner)
• Ego-Syntonic Process
• Existential Disconnection
• Transference

RestrictingExistentialContact
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Getting beyond Transference

• A part of me is not sure she should trust you,
  but.
• I cant believe Ive just talked about me, like
  that, with an old man like you.

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• Difficult process rarely defines the whole of
  the person. Often there is a dissonant part that
  houses a different conception of self. Its
  appearance can be erratic and its voice very
  small. Often its dominant feeling is sadness.

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Working with the Client in his Existential Process

• He gives you his self as he experiences his self.
• What he gives is not dominated by relational
  self- protective strategies
• He finds it impossible to lie.

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Striving to meet at Relational Depth with the
Client in her Existential Process

• Sandie Do you really want to know me? Like, do
  you want to meet the me that I am to myself?
• Dave Yes, I want to meet all of you.
• (Pause)
• Sandie I kill my babies.
• Dave Is that meant to put me off?
• Sandie No, its just what I do.
• Dave (serious eye contact) You kill your
  babies .. Its a difficult thing even for me to
  say. I have to steel myself to say the words.
  They are hard words for me to say - I think
  thats why I was glib.

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• Sandie Its what I do - the words are me - Ive
  killed three babies inside me.
• Dave You sound .. You sound flat about it -
  on the outside at least - I dont know what you
  are inside about it ..?
• Sandie I need to feel flat inside about it as
  well.
• Dave Yes .. I think I can understand that .. I
  think I really can .. its the only way .. to
  ..
• Sandie Survive.
• Dave Yes.
• Sandie Isnt that funny ..
• Dave That when you feel as you do, you still
  want to survive?
• Sandie Yes - Ive never thought about that
  before.

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Striving to meet at Relational Depth with the
Client in his Existential Process

• Bobby Ive been feeling really bad things Dave -
  really bad things.
• Dave Tell me Bobby.
• Bobby I dont know if I can Dave .. I dont
  know if I can.
• Dave This is really tough for you Bobby - I can
  see that in your face. Youve tried to make
  yourself tell me by bringing it up. But its
  still maybe not possible. I say tell me Bobby
  like I usually do .. but this is not usual
  stuff - this is .. different ..
• (Pause)
• Bobby Dave .. I want to kill me.
• (Long silence)
• Bobby All the roads lead there - I could make a
  good job of it too.

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• Dave I bet you could, Bobby - Im scared to use
  my imagination.
• Bobby It would be one thing I could do well.
• Dave What are all the feelings Bobby - how do
  all the roads lead here?
• Bobby I dont know if I want to go into it Dave
  - Ive got to this point and I feel a kind of ..
  peace.
• Dave Christ Bobby, this is tough for me. I knew
  you were going to say that. I want to stay with
  you in that and I want to pull you away from
  that. Im no use to you unless I can stay with
  you in it.
• Bobby Thats not true Dave - its nice for me to
  hear that. Anyway, you couldnt stop me.
• Dave I really knew you were going to use that
  peace word. I could feel how all the roads
  lead there. I can see how that is a conclusion
  for you .. and a retribution for you ..

44

• Its the same as cutting yourself used to be for
  you, isnt it?
• Bobby Yes, it has the same sense of punishment
  and control .. Do you understand how important
  it is for me to face this?
• Dave Yes, I do. You must face the question that
  perhaps the only way to make retribution is to
  execute yourself.
• (Long silence)
• Dave You will have worked it all out?
• Bobby In detail, Dave - in detail.
• (Long silence)
• Bobby Its funny to feel so alone, yet with
  someone.
• (Long silence)

45

• When a client is met at relational depth and
  enters his existential process, he takes an
  inside view of his Self. From that perspective
  he sometimes experiences his Self in terms of
  different parts rather than a single whole.

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Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

47
Taking an Inside View of me

• When you are close to me I go inside myself -
  and see the different parts of me. From the
  outside I look confused and self-defeating - I
  dont look alive at all. But inside me I see
  the different parts in their own right. I see
  the scared and angry little girl and her big
  sister who bosses her around, but who really
  loves and protects her. Both of these parts are
  very alive.

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Configurations

• Mearns, D. (1999) Person-centred therapy with
  configurations of Self. Counselling, 10(2)
  125-130.
• Chapter 6 The nature of configurations within
  Self.Chapter 7 Person-centred therapy with
  configurations of Self in Mearns, D. Thorne,
  B. (2000) Person-Centred Therapy Today New
  Frontiers in Theory and Practice. London Sage.

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Definition

• A configuration is a hypothetical construct
  denoting a coherent pattern of feelings, thoughts
  and preferred behavioural responses symbolised or
  pre-symbolised by the person as reflective of a
  dimension of existence within the Self.

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Definition of Configuration (Non-Jargon Version)

• Sometimes people experience themselves as having
  different parts to their Self. Each part, or
  configuration, is well-developed, with its own
  feelings, thoughts and ways of behaving which may
  be quite different from other parts.

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Sam A 23 year old Traumatised Veteran

• I walk around watching people and myself. I
  watch myself watching myself. I have a me that
  I use for everyday life. It does all the normal
  things that other people do - it goes to work -
  it talks with other people - it goes to the store
  - it even makes love with my wife. It carries on
  as though nothing has happened. And I watch it.
  I stand in the background and wonder how I can do
  all that stuff.

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Person-Centred Therapy with Configurations of
Self(See Mearns Thorne Person-Centred Therapy
Today, Chapter 7)

• Staying close to the clients symbolisation
• Listen for the parts, but dont invent them
• Avoiding zero-sum responding
• Empathic mediation helping the parts to hear
  each other
• Multi-directional partiality prizing all the
  parts
• Therapists use of her configurational Self.

53
Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

54

• Mearns, D. Thorne, B. (2000) Advancing
  person-centred theory. Chapters 69 in
  Person-Centred Therapy Today New Frontiers in
  Theory and Practice. London Sage.
• Mearns, D. (2002) Further theoretical
  propositions in regard to Self Theory within
  Person-centered therapy. Person-Centered and
  Experiential Psychotherapies. 1(12) 14-27.

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Proposition 1

• Configurations may be established around
  introjections about self.

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Proposition 2
Configurations may also be established around
dissonant self-experiences.
57
Proposition 3
Formative configurations assimilate other
consistent elements.
58
Proposition 4
Further elements may be accrued by the
self-fulfilling nature of configurations.
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Proposition 5
Configurations inter-relate and reconfigure.
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Configuration Theory Using theory in the
person-centred approach

• Theory does not predict the behaviour or the
  experience of the client.
• Theory expands the imagination of the therapist.

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General Psychological Theory Individual
Psychological Theory
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Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

63

• Rogers, C.R. (1951) A theory of personality and
  behavior, pp 481-533 in Client-Centered Therapy.
  Boston Houghton Mifflin.

64

• Rogers, C.R. (1959) A theory of therapy,
  personality and interpersonal relationships as
  developed in the client-centered framework, pp
  184-256 in S. Koch (ed.), Psychology A Study of
  a Science, Volume 3 Formulations of the Person
  and the Social Contract. New York McGraw-Hill.

65

• Rogers, C.R. (1963) The actualizing tendency in
  relation to motives and to consciousness, pp
  1-24 in M. Jones (ed.), Nebraska Symposium on
  Motivation. Lincoln University of Nebraska Press.

66

• Rogers California Period
• A Unitary Theory

67
The value-added actualising tendency

• Feelings valued over thoughts
• Non-self-conscious being valued over
  considered action
• Free-expression valued over censoring
• Radical choices valued over conservative
  choices
• Volume-up expression of feeling valued over
  volume-down expression of feeling

68

• COULSON, W. (1987) Reclaiming Client-Centered
  Counseling from the Person-Centered Movement.
• Center for Enterprising Families, P.O. Box 134,
  Comptche, Ca 95427, USA.

69

• Reconfiguring Rogers
• Concept of the Self

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Rogers (1959 200)

• Self Self-Concept

71
Mearns Thorne (2000)
72

• A Dialogical Person-Centred
• Theory of the Self

73

• Growthful Configurations
• Not for growth Configurations

74
Proposition 6
The actualising tendency is the sole motivational
force.
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(No Transcript)
76

• I could do more with my life but I am scared to
  lose what I have.
• I need to stop this road I can see where it
  points and I dont want it not yet anyway.

77

• I fought my way out of a relationship previously,
  and I lost more than I ever imagined.
• Part of me says go for it and part of me says
  watch it I need to stay with watch it for
  now.

78

• I look at what other people have got and I want
  it like a child wants everything. But my child
  isnt going to make all my decisions.
• Everything seemed to point in the direction of
  leaving the job I needed to be free of it. But
  my family would have lost too much and that
  would mean me losing too much. So I rolled up my
  sleeves and made the best of it.

79
Proposition 8
A psychological homeostasis develops between
the drive of the actualising tendency and the
restraint of social mediation. The configuring
and re-configuring of this homeostasis is the
actualising process.
80

• In this revision of the theory, the central
  concept becomes the actualising process which is
  described by the homeostasis of the imperatives
  of the actualising tendency and social mediation
  within different areas of the persons social
  life space and the reconfiguring of that
  homeostasis to respond to changing
  circumstances.
• (Person-Centred Therapy Today p184)

81
Proposition 9
Disorder is caused when the person becomes
chronically stuck within his/her own actualising
process such that the homeostatic balance cannot
reconfigure to respond to changing circumstances.
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A Tyranny of Growth
83

• After countless years of going against my
  instinct and fitting into other peoples wishes I
  finally broke free. For a time after that I was
  impossible to live with I couldnt compromise
  at all.

84

• Its like I couldnt go against my view of events
  and what was right for me in the moment. Having
  finally got hold of myself I wasnt going to let
  go I suppose I was scared I would lose myself
  again.

85

• I can see that my sense of myself isnt working.
  Other people are giving back a different view of
  myself, and they are pretty unanimous. They say
  that I look cold and detached, when I feel
  warm. It is difficult to know who to trust.

86

• Either they share the same illusion or I have a
  huge blind spot that I cant see past. It is
  really difficult to go against my sense of myself
  I have no sense of being wrong. But these are
  good people I need to pause awhile.

87
Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

88
The Developmental Agenda for the Therapist
Working at Relational Depth

• expanding our experience of humanity
• expanding the self available in the therapy room
• configurations
• existential touchstones

89
Expanding Our Experience of Humanity

• Eventually I realised that if I was going to
  work professionally as a counsellor, I had better
  find out something about the other half of
  humanity. So I started to work with men!
• I never actively accepted myself as
  homophobic, but I was. Joining the mens group
  soon blew that away.

90

• When it would come to the edge of meeting the
  depths of my clients despair I would always pull
  back. I got over that edge, initially, through
  reading about peoples experiences of despair.
  That would take me into my tears and closer to
  my sense of my own existence.

91

• An experience which helped me to sustain myself
  in the work with Rick was attending an
  informal rap group of veterans.I used that
  group to stay connected with the kinds of
  experiencing they spoke about.
• (Mearns Cooper, 2005 107)

92
The Developmental Agenda for the Therapist
Working at Relational Depth

• expanding our experiences of humanity
• expanding the self available in the therapy room
• configurations
• existential touchstones

93

• The Therapists use of her
• configurational self?

94
Working all together with Clair
Extract 1

• Dave 1 I really dont understand why you are
  leaving the job.
• Clair 1 No, I knew you wouldnt.
• Dave 2 You mean you knew that I wouldnt
  understand it?
• Clair 2 Yes .. Ive seen it for ages. We are
  o.k. when we are working on my strong Self - that
  work has been great - I wouldnt take anything
  away from it. But my little girl isnt so sure
  about you.
• Dave 3 She doesnt trust me.
• Clair 3 She doesnt think you want to know her
  .. She is pretty scared you know.

95

• Dave 4 (pause) I suppose we havent spent enough
  time on her. (pause) I guess I didnt hear her
  very well - I didnt realise how bad she felt. I
  see now that I didnt hear her very well.
• Clair 4 I didnt let her come out very often
  with you. Maybe I thought you wouldnt like me
  if I really showed you her.
• Dave 5 And perhaps I wasnt as open to her as I
  could have been ..
• Clair 5 Well, she has got to come out now. She
  needs to become a big girl now. So I am holding
  her hand and walking her out.
• Dave 6 And what are you feeling, little girl?
• Clair 6 I am scared .. and I am angry. I am
  not sure if I can trust you .. But I want to
  trust you.
• Dave 7 I want to apologise to you for not really
  listening to you until now.

96
Extract 2 (two sessions later)

• Clair 1 It is better now, in here. It feels as
  though there are four of us working together.
• Dave 1 You mean, two of you and two of me?
• Clair 2 Yes.
• Dave 2 The two parts of you, you have called
  your strong Self and your little girl. But
  you also sense two parts to me here?
• Clair 3 Yes, dont you?
• Dave 3 Yes, but I havent given them names yet -
  in here at least - what is your sense of them?
• Clair 4 One is watching over everything that is
  happening. He is pretty competent, but he is
  also nervous. The other is not so used to being
  here but he has been invited. He has got a
  softness and vulnerability which is really good
  for me. He helps me to be soft with myself.
• Dave 4 He helps you to be soft with yourself ..?

97

• Clair 5 When it was only your strong,
  competent self that was here - then my strong
  self just got together with you and there was no
  space for softies - no space for softies in
  either of us.
• Dave 5 And it is important that we touch that
  softness in you ..?
• Clair 6 It is important that we are all here,
  together. My parts both have strength - but they
  need to get along together, like yours do.
• Dave 6 Maybe I am more tentative, than I look,
  my soft part kind of feels okay with this but
  is a bit unsure.
• Clair 7 That is what soft parts are like,
  silly! Being unsure is part of being soft.
• Dave 7 I think you are more experienced at this
  than me, Clair.
• Clair 8 Never mind, well help each other along!

98
The Developmental Agenda for the Therapist
Working at Relational Depth

• expanding our experiences of humanity
• expanding the self available in the therapy room
• configurations
• existential touchstones

99
Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

100
Definition of existential touchstones

• Life events and self-experiences from which we
  draw considerable personal strength and which
  help to ground us in relationships as well as
  making us more open to and comfortable with a
  diversity of relationships.

101
Lesleys existential touchstones

• One of my earliest memories is sitting on my
  grandfathers knee. Every time I met him he had a
  radiant smile and he would plonk me on his knee.
  What I get from that is huge it is the
  experience of completely unconditional love. That
  is a really secure part of me that helps me to
  feel at ease even in difficult situations.

102

• No matter what I did, I could never please my
  father. It happened time after time. I would be
  proud of myself for something and he wouldnt
  respond or he would nit-pick it and so devalue
  it. I can feel a childs frustration even now, as
  I talk about it. It is amazing how often that
  sense of a childs frustration helps me to get a
  flavour of my clients distress.

103

• In primary school I was frequently ridiculed for
  being thin. The most distressing event happened
  each year when we would be ceremonially measured
  and weighed in front of the whole PE class. In a
  flamboyant way, representing nothing but her own
  self-importance, the teacher announced, Watch
  that Lesley doesnt fall through the cracks in
  the floorboards! The strength I take from this
  experience is in feeling my own rage. At the time
  it happened I nearly exploded into tears but I
  was determined not to give her the satisfaction
  so all I felt was the pure rage. It is surprising
  how often that strong, clean feeling is a source
  of strength for me with clients.

104

• One year, late in my primary schooling, I came
  top of the class. Usually I was around tenth
  place but in this particular year, once all the
  marks were averaged, I was top. To my enormous
  pride the teacher invited me to the front of the
  class. I thought that my considerable achievement
  was going to be honoured. However, what the
  teacher did was to ask me to spell the word
  inexplicable. I was thoroughly confused but I
  spelled it, accurately I think. Then, with a
  broad smile and a wave of her arm towards me she
  said, inexplicable! Yes, that is the best word
  to describe you coming top of the class!

105

• This time I didnt feel angry, what I felt was an
  intense humiliation. That is something I have
  felt fairly often in my life. It is an absolutely
  dreadful feeling. It is the feeling of being
  stripped naked in public. And that is precisely
  the strength I take from it. I have been so
  severely humiliated so often that I know what it
  is. I dont need to fear it because I know it
  better than most people. I dont need to be
  afraid of looking silly or getting things wrong
  I can take risks with my self-expression because,
  no matter what happens, I could never be so
  humiliated as I have been.

106

• I learned that a very slight girl needed to use
  her brain rather than her brawn. One example of
  that was when I was surrounded pretty late at
  night in a dodgy area of town by a group of men.
  Running was not an option and fighting certainly
  wasnt! so, I amazed myself by taking the
  initiative. I broke into talking with them and
  cracking jokes and making first one and then
  another and then another laugh. One of them
  clapped me on the shoulder and said, Youre a
  good sport and I was allowed to walk away. As
  well as being a self-experience that makes me
  feel good about myself, incidents like this help
  me to feel pretty safe with just about anybody.

107

• From my time as a nurse I remember one of my
  patients who died. It had been a medical
  mistake he was given ten times the proper
  dosage of medication. It didnt happen on my
  shift, thank God, but I still carry a lot of
  guilt about it because I colluded with the
  cover-up to protect the doctor. At the time it
  felt that I couldnt do anything else although I
  was incredibly angry. The feeling was one of
  total powerlessness. That feeling of
  powerlessness is an incredibly valuable
  touchstone for meeting many of my clients.

108

• Being with someone dying and opening yourself to
  that helps to develop depth. Often the nursing
  profession runs away from that challenge but I
  remember a few cases one was with Mary, who
  was eighty-three years of age. There was no one
  to spend her death with her, so I did it. I had
  finished my shift and I knew that Mary would not
  be there the next time I clocked on, so I sat
  with her and she used me to talk about her life.
  It took two and a half hours and then she died.
  What Mary left me is useful for me with every
  single client I meet.

109
Contents

• PCE Worldwide
• A schema of working at relational depth
• Client processes
• Working with the clients configurations of
  self
• Configuration Theory
• Revising Rogers Self-Theory
• The developmental agenda for the therapist
  working at relational depth
• Existential Touchstones
• Working with Dominic.

110
From Mearns, D. Cooper, M. (2005) Working at
Relational Depth in Counselling and
Psychotherapy. London Sage.

• Dominic 1 At the start of session 3
• D1 I shouldnt have come today. Ill go away if
  you like.
• T1 Because youve been drinking?
• D2 Yeah Ive been drinking.
• T2 Do you want to go or do you want to stay?
• D3 I wouldnt mind staying.
• T3 I would like that too. But Id like us to
  keep the tape on like we usually do. Why I say
  that is that I want us to have a record of what
  happens when youre pissed its easy to forget.

111

• D4 Fine I hadnt realised it was on.
• T4 Good that I mentioned it then.
• D5 (Long pause) How do you feel about me .. now
  .. here.
• T5 Dom, I want to tell you that I feel absolutely
  nothing about the fact that youve been drinking.
  But you asked how I felt about you, now, here
  (pauses) I feel .. a bit .. scared.
• D6 Scared?
• T6 It surprises me too .. I guess it does matter
  to me that youve been drinking .. Im scared in
  case we have to start again. Its like I feel
  that weve made a really good connection .. but
  will that still be there ..today. Thats what
  makes me a bit scared.

112

• D7 Like it matters to you?
• T7 Yes it does Dom.
• D8 Like this isnt just a game to you?
• T8 I think you know that, Dom. In fact, I know
  you know that Dom.
• D9 Yes sober me knows it, but does drunk
  me?!
• T9 I dont know. Does he? Do you?
• D10 Big question maybe Ill need another vodka
  before I can answer that.
• T10 Dom be here be here drunk but dont
  play fucking games with me. Neither you nor I
  deserve that.
• D11 SILENCE
• T11 SILENCE

113

• D12 Youre really serious about this, arent
  you?
• T12 As ever.
• D13 Im sorry.
• T13 Apology accepted - where should we start
  today?
• D14 We started long ago this is me this is
  who I am.
• T14 Yes youre right I see we started at
  the beginning as usual but the start was
  different because you were different. Yes, I
  missed that.

114

• Dominic 2 Later in session 3
• D15 Its not easy to live up to a holy name.
• T15 Dominic.
• D16 Yes a good Catholic upbringing kept
  telling me how important my name was.
• T16 Like it told you what you should be?
• D17 Yeah but it was a fantasy pure fantasy
  . pure . fantasy.
• T17 Their fantasy?
• D18 Yeah It was like I didnt exist you
  know?
• T18 Like they had some image of you that was so
  far from who you were that it was like they were
  talking about someone else.
• D19 Got it in one. Youre good at this shit!
• T19 Hope so. What are you with just now?

115

• D20 (long pause) . (looks directly at T) .. I
  dont know what I m about.
• T20 (looks intensely at D and moves towards him,
  speaking slowly). That sounds like a lot,
  youdontknowwhatyoure-about
• D21 Im so full of crap.
• T21 and ?
• D22 I dont know whether to believe myself or
  not.
• T22 Say more Dom.
• D23 Im just so full of crap.
• T23 You dont know whether to believe yourself or
  not.
• D24 I think Im serious sincere. But, really,
  Im only a drunk a fuckin drunk.
• T24 You think that you are serious and sincere.
  But you are really, only, a fuckin drunk.

116

• D25 Yes.
• T25 A fuckin drunk thats all you are.
• D26 (tears welling up)
• T26 A fuckin drunk.
• D27 (hits fist on arm of chair in apparent anger
  and cries)
• T27 Dom, you are angry and you are crying.
• D28 Im so fuckin full of shit (cries).
• T28 (moves to Dominic and puts his arm round him)
• D29 (cries more and more)
• T29 It feels like a lonely place.
• D30 (looks up at T) Yes (shivers).
• T30 Cold, and lonely

117

• D31 The only warmth comes through the bottle
  whether its single malt or cheap vodka it
  doesnt matter.
• T31 It still works it still gives a feeling of
  warmth.
• D32 It does I cant describe it Im alive but
  its killing me and everything I love.
• T32 Dom can you really help me get hold of this
  It sounds really strong like you feel really
  alive that sounds real powerful. But, then,
  it is also killing you, and everything you
  love.
• D33 One part of me is really hooked on it it
  is the only buzz I get and I cant get enough
  of it.
• T33 And, there is another part?
• D34 The other part is a loving husband and
  father
• T34 Yes?

118

• D35 Who is killing his family.
• T35 You are carrying a lot a helluva lot.
• D36 And I cant carry it any more.
• T36 That sounds serious No. I dont mean to be
  glib it really does sound like you are
  serious.
• D37 Ive got to do something.
• T37 Do? What would you do Dom?
• D38 Either give it up or give it up.
• T38 I think I understand one part the one
  that is really hooked would give up on your
  normal life and the other part the one who
  is a loving husband and father would give up
  the booze.
• D39 Most people dont realize how difficult a
  choice that is.
• T39 Is it does it feel like giving up on
  living for the life you have?

119

• D40 Yes.
• T40 SILENCE
• D41 It feels like living when youre drunk
  but it isnt really.
• T41 SILENCE
• D42 Ive been scared of living all my life Ive
  been scared of living. Ive never felt like
  other people Ive never felt sure of myself
  the way other people do. If you feel sure of
  yourself you can go out and do things with your
  life. If you dont feel sure of yourself you
  cant you cant really do things with your life
  youve always got to make safe choices
  choices that dont really test you choices that
  arent really living.
• T42 SILENCE
• D43 And so, I have an ordinary life did you
  see that film?
• T43 Ordinary Lives yes.

120

• D44 LONG SILENCE
• T44 Are you stuck? Are you thinking about the
  film?
• D45 Yes their ordinary lives were blown apart
  when something terrible happened. They had taken
  the safe choices for so long that they hadnt
  developed the strength to deal with real life.
• T45 And you what about you.
• D46 Part of me tries to break free, but it also
  hasnt got experience it doesnt know how to do
  it.
• T46 SILENCE
• D47 SILENCE
• T47 I am feeling sad for it. I think I am seeing
  it better. It desperately wants to do something
  but it has been scared of living for so long
  it doesnt know what to do.
• D48 So all I can do is to go into that feeling of
  being sad and get drunk. Thats the closest I
  can get to living.

121

• DOMINIC 3 session 4
• after spending time going through part of the
  tape of session 3
• D49 It is difficult to listen to that.
• T49 Why is that, Dom?
• D50 Because Im drunk.
• T50 Yes yes, you are drunk.
• D51 I hate listening to it its not me.
• T51 Its not you.
• D52 SILENCE
• T52 Its not you.
• D53 How can I be like that? How can I be a
  drunk? How can I have let you tape that.
• T53 Dom If you want, I can wipe that tape right
  now.

122

• D54 No No Its me It is me.
• T54 It is you.
• D55 .. but not a part of me I want.
• T55 Do you recognise him?
• D56 Sure hes only a bottle of vodka away.
• T56 Where should we go with this, Dom? Where
  should we go with this right now? Where are you
  with this right now?
• D57 Ive got to meet him.
• T57 You heard him, didnt you Dom you really
  heard him.
• D58 Yes yes I heard him.
• T58 You are keeping him out but, really you
  heard him

123

• D59 I heard me the drunk. I hate him. I cry
  for him. I cry with him. I am him. He is part
  of me.
• T59 And you feel you have got to meet him.
• D60 I dont know what made me say that I hate
  him. When Im sober I believe he is gone
  forever. Why did I say that I have to meet
  him?
• T60 SILENCE
• Dominic meets Ts eyes
• D61 I have been running way from him for years
  but what I need to do is to meet him.
• T61 SILENCE
• D62 Lets play some more of the tape.

124

• DOMINIC 4 later in session 4
• D63 Dominic begins to cry as he listens to the
  tape particularly D34
• T63 SILENCE
• D64 Its like Im listening to him to me to
  that part of me, properly, for the first time.
  Ive been locked into antagonism to him
  antagonism and denial and hate. I had to deny he
  was really a part of me. He was an evil drunk.
  But he is a part of me, not just when I am
  drunk, but every minute of every day he is a
  part of me. He is sad me, lost me,
  desperate me, crying me though Im also
  crying now. Its like hes with me now, and Im
  not drunk nor am I going to get drunk today.
• T64 This sounds different like you are
  meeting him rather than dismissing him.

125

• D65 It feels strange like I am excited but also
  tense this feels different. Its not like I
  imagined it. I came into therapy to kill that
  drunk and now I am listening to him and crying
  for him/crying with him. He really is part of me
  a part that I have not been open to we had to
  be separated by a bottle of vodka.
• T65 SILENCE
• D66 LONG SILENCE
• T66 Where are you in your silence Dom?
• D67 I have suddenly become aware that you are
  here.
• T67 And how is that for you that I am here
  with you?

126

• D68 The first feeling was an acute embarrassment
  but that quickly passed. Now it feels good
  that you are here that you are sharing this
  with me. I feel so excited but also tense
  might this pass? Could I lose it?
• T68 It?
• D69 This is the first time that sober me has
  met drunk me in a way that he can understand
  him.
• T69 Can drunk me also understand sober me?
• D70 Wow thats a big question thats too much
  right now that panics me.
• T70 In case he cant?

127

• D71 Yes. Its like Ive won a lot at the
  tables today and if we go too far I might lose
  it.
• T71 Fair enough. I thought I might be pushing
  too far I knew it was a big step. In fact,
  part of me told me not to push and another
  part a kind of delinquent part said go for
  it!
• D72 Hah! So the therapist is crazy too he has
  different parts too.
• T72 Ive been found out guilty as charged!
• D73 Can we come back to your question when Ive
  lived with this for a while? (smiles)
• T73 Why cant I be as wise as that!
• SESSION ENDS

128

• This session proved to be critical for the
  therapy. Sober Dominic had met drunk Dominic
  without judgement or denial but, instead, with
  genuine understanding. In session 5 Dominic
  described himself as a partial drunk, part of
  him was a drunk and part of him was sober.
  The problem with these configurations is that the
  drunk can generally undermine the whole process
  and take over the definition of the person. One
  wonders how many other people might be described
  as partial drunks, if only we could be present at
  the meetings of their parts?