A person centered approach is used in many different kinds of therapy communicating with words and feelings or even movement or play.
It is not intended as a basis for everyday interactions but the principles can be used there.
It may not fit fully into punitive, regulatory, crisis, or income support services with involuntary or dependant clients where there is a power imbalance or dependency but it can work to some extent if there are sympathetic organisational structures and supports. A couple of examples follow.
crisis
I used a Person centered approach in acute psychiatric emergency after hours services in the early 1970's in central London in an agency that used a psychoanalytic approach.
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 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.
We tended not to be called out for intoxication and there were fewer drug users than nowadays to complicate the work.
There were few procedural limitations and minimal agency needs to be met 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 for 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 there were 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 railway staff member was confronted with someone intoxicated holding 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.
This call-out eventually ended with a relative picking the person up and no charges or admission eventuated.
Next day we were debriefed and supported A typical question was “and how did you feel then?”
I discovered there that no matter how disoriented, demented or intoxicated, 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 to 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 could eventually work out that they were dealing with a person and not a protocol.
This might not happen now. Lengthy assessment and reporting requirements take most or all of a worker's time at the initial call out. Very traumatised and demanding people with for example a diagnosis of personality disorder are often ignored. 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.
I must add that it is very important to make sure that that a client in crisis not poisoned. Messing around with assessment or talking therapy in that case could postpone treatment and cost them their life. Delirium is one of the red flags that needs to be carefully assessed.
statutory settings
Three are legal limitations to confidentiality in most therapeutic settings. In the beginning a therapist discloses their legal obligations as a professional and as a citizen to report crimes or abuse.
In settings like prisons or parole where clients are penalised for refusing services it is possible to offer a person 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 but if I learnt of a bond condition being breached for instance by not reporting to me as required by the court or committing a crime then I would apply to the court to estreat their bond which triggered a return to court.
Most 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.
Within the limits of a statutory framework like this it is still possible to provide a person centered therapeutic service if the agency supports this.
a contract
Person Centered Therapy needs its participants to be truly present and engage freely. But some come to please someone or feel obliged or forced.
Some who feel they come under duress edit their words as if a parent, partner, authority or God is with them. They are not fully here 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 sort themselves out in the first encounter or only emerge gradually. Until then we may be working at cross purposes without a full agreement about what we are doing together.
I usually ask someone what they have come for but sometimes just wait and see where things are going. In the beginning there may not be enough 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.
street work
I used this approach in a Person Centered agency in street-work with youth gangs, initially waiting in gang territory to be approached and if approached responding with information about my role which included providing personal services. Sometimes waiting weeks for an approach.
I found this worked in other environments including schools and mental health wards.