For me, the pre-requisites for effective therapy are:
- The establishment and maintenance of the therapeutic relationship. This is “paramount” (Webster, 2012 p 1; Frank and Frank 1993, p xv; Elliot, Greenberg et al 2004 pp 7-10).
- The relationship must be built on trust, safety and a sense of hope and empowerment.
- The therapist needs to believe in their way of working as this instils confidence (Frank and Frank, 1993, p xiv; Levitt et al, 2006, pp 318-322).
- The therapist must also have empathy, congruence and positive self-regard and be mindful of where the client is (Rogers 2004, pp 37-38; Elliott 2004, pp 7-14).
- “The essence of working with another person is to be present as a living being” (Gendlin 1990, p 1; Greenberg 2014, Slide 4, Maddison 2014).
What supports change?
People have “a forward growth tendency”… and appear to ask, “how may I become more myself” (Rogers 1961 pp 26-35 and p 123; Elliot 2004, p 13; Gendlin, 1973, p 342). People also have an ‘implicit knowing’, that is, they know their forward steps (Gendlin 1996 pp 259-280; Parker pp 2-7).
Therapists can help clients get in touch with their blocked, avoided or unknown emotions so they can have their authentic emotional experience and be seen, heard, valued and feel entitled to their emotional experience (Elliot et al, 2004, Ch 2 and Webster, Stapleton, Golding 2013, pp 8-26). This supports change.
Emotional “awareness, regulation and transformation” are the “three major principles of emotional change” (Greenberg 2002, p 154, Elliot et al 2004 Ch 3, Gendlin 1958 p 2). Effective psychotherapy is the integration of emotions. This allows for a “coherent sense of self and way of being in the world” (Johnson in Furrow et al 2011, p 61-64, Ch. 1, 2 and 3, Siegal, in Furrow 2011 p 65).
Greenberg also says, “making sense of moderately aroused emotions that are deeply experienced and reflected on in the context of an empathically attuned relationship predicts therapeutic outcome” (Greenberg 2014, slide 16). Gendlin agrees with Greenberg and Webster when he adds “The greater the role played by experiencing (in therapy), the greater will be the therapeutic change and the successful outcome of therapy….clients succeed in therapy if they often experience immediately present feeling which they do not yet understand” (Gendlin, 1961 p 8, 1958, p 2). This allows then to “conceptualize and find meaning” (Gendlin, 1958, p 4). Gendlin and Greenberg noticed, this is how “change happens”.
Clients’ gain more awareness and insights when they are enabled to reveal, know and make more sense of what they do, think and feel (Webster and Gray 2013). Experiencing aids change. Focusing is one way to enable experiencing in a holistic way (Gendlin, 1979, p 3).
Gendlin, while working with Rogers in the 1950/60’s, observed some clients Focused naturally, ie they “referred to an ongoing felt experience”. These clients “tended to have significantly more positive outcomes than clients who merely talked about their problems or emotions” (Hendricks, 2001, p 2).
“People who do well in therapy pause and grope for words or images. They pay attention to an unclear, but bodily-sensed aspect of how they are in a situation. They don’t just think about the situation and they don’t just drown in emotions. They attend to what we call a ‘bodily felt sense’ of a situation or problem. Words or images arise directly from that sense. What comes is often a surprise. A new aspect of experience emerges, a small step of change that brings a body response, like a slight physical easing of tension or tears or a deeper breath” (Hendricks 2001 pp. 2 and 22 and Weiser Cornell 2013, pp. xvii to xxxvi).
In therapy, when clients are on the edge of a ‘felt sense’, the therapist can decide to help the client unfold their ‘felt sense’. The therapist could ask the client to “get a sense of the whole thing about their eg father” and just wait and see what comes. The client’s “felt sense” could unfold and with gentle guiding questions they could reveal their own way forward – a “felt shift”.
To aid change, clients also need to tend to, and tame, their inner critic or criticizing parts. Clients also need to learn how to show themselves self-empathy, compassion and to self soothe. (Greenberg, Bolger 2001, p. 209, Webster & Stewart 2013 pp 220-230, pp 51-128 and Webster, Stapleton 2013 pp 171-172, Gendlin 1978, Weiser Cornell 2013, Ch 4 & 5). The criticising parts need attention
The experience of a strong self also aids therapy and change. Focusing can help because the bigger part of the client, the “I”, comes into empathic relationship with the “it’ – the something – in the client that is, for example, sad. This fosters self-compassion, self-regulation and the ability to self soothe (Weiser Cornell 2013, p 84) which helps us deal with difficulties in life (Gilbert 2011 p 348).
We know that, “change comes by acknowledging, allowing, accepting, experiencing and expressing feelings”, because individuals gain awareness and understanding and recognize their needs, including looking at their beliefs and expectations. This results in “relief and resolution”. Greenberg notes “A clearer view of self is critical to change” (2001, pp 201-210). Greenberg also says “the tears never wept need to be wept first” (Greenberg 1988, p 38).
Focusing as a way of working helps the client to refer internally and to track their own process in their body. For example, what are they noticing, where a feeling sits physically, what images it generates and what meaning it holds. The therapist guides this process. The process may be deepened by asking, “how does that whole situation feel in your body”.
Purton states “we need both the attitude of openness to whatever may come (Focusing) and that aspect of the creative process, which involves trying out formulations that may (or may not) carry the process further” (Purton 2004 pp 245-255).
Weiser Cornell, sums up well when she says, “when something seems not to change, what it needs is attention, awareness and an attitude of allowing it to be as it is, yet open to its next steps”. This is Focusing (2005, pp 13-16). Change can happen when we are able to be with all the aspects and sides of ourselves (Weiser Cornell 2005, pp 23-54). Successful clients do the things discussed above and tend to be “more grounded, less reactive and handle their own lives better” (Weiser Cornell, 2013, p 11).
Change happens if we nurture the therapeutic relationship and make use of all the processes that help our clients have their emotion, regulate it and make sense of what they do, say, think and feel. This includes, enabling clients to show themselves compassion (including to their critical parts), unfold their ‘felt sense’ and reveal their ‘implicit knowing’ and way forward.
I am interested in anything that enables clients to realise new possibilities, enhance hope and lead to the prospect of change.
(See reference list in resources for more information about the authors quoted in this article. Also see blog that is titled “What is focusing?”)