AN INTERVIEW WITH DAVE MEARNS

Dave Mearns, Professor of Counselling at the University of Strathclyde and an internationally renowned figure in the person-centred world talks to Mick Cooper about the future of person-centred therapy, articulations with institutions and other approaches, key developments in the field and his own future. 

Articulating with institutions and policy-makers

Mick: So, Dave, the main thing I wanted to ask you about is where you see the person-centred approach going?

Dave: I think, in Scotland particularly, we’ve got to a certain point in development where we are visible and that makes a big difference.  I think we have some kind of credibility in today’s settings, and what’s been interesting to me is in the last few weeks I’ve travelled through England doing lectures and a number of people I’ve met are depressed in the person-centred scene. They always say it’s terrible what’s happening and there is no space to be person-centred and I look at them and think ‘Are we in the same country?’ And then, as you explore it more with them you find the same thing every time: that they haven’t been able, and aren’t able, to engage at a policy level, so they are asked to justify or indeed to evaluate their practice and they are totally lost. Or they’ve been involved in change and development and innovation, but they haven’t been able to take a seat at the policy-making table. And sometimes they will say ‘No way I could be offered a seat at the table’.  But you need to push your way in – that’s what Brian and I wrote about in the final chapter of Person-Centred Therapy Today.

At Strathclyde we’ve been really good at that: at taking a seat at the table.  Also with our Lanarkshire project – every time there has been a review of psychological therapies we’ve been right there, at the table in the sort of inner circle. Not just in the wider body to be consulted: we’ve taken an active part and we’ve joined in, we’ve taken a part in things that have nothing to do with us but it contributes and that’s so important, to do that and to be able to contribute and not narrowly to be confined to person-centred or even counselling, but to be able to contribute more widely to mental health is really important.

Mick: So are you saying that what has to happen is more involvement at the policy level, and if we don’t do that we are likely to get sidelined.

Dave: That’s right. A good example is that you are sitting at the table and someone says: ‘It’s really cognitive behaviour therapy rather than PCT we should be thinking of, because it is well validated’.  At that point it is important to insert some research awareness into the argument, but to do it gently and not in a defensive tone.  I like to begin by meeting the person where they are, in their argument, like: ‘That’s true – or at least it was true until recent years.  It’s interesting to see how the Cochrane Review of counselling in primary care is adjusting its guidance.  In earlier years CBT was usually compared with counselling undertaken by people who had not had a specialist training – but now, since King’s big RCT in 2000, people are realising what a difference training makes’.  This is usually enough for people at the table to start nodding – it’s a good tip not to ‘over-argue’ your point.  But if it needs to go further then it is worth bringing in Elliott’s ‘correction factor’ to account for the fact that the bulk of CBT positive findings, compared to counselling, have been achieved by CBT practitioners.

What we need is research awareness and the ability to discuss at a policy level.  An example, right now, is in Devon where there is a lot of good PCT work but they have not been able to claim a seat at the table – to discuss policy and evidence.  There is a big move in Devon to appoint CBT practitioners.  I know the consultant psychiatrist who is behind this move.  It’s not that he is anti-counselling – quite the contrary: he would respond well to reasoned argument, if that was forthcoming. 

Mick: So are you saying that in terms of development that we are really at a point that either we get involved in policy developments, at the policy level, and that will take us forward or there is the danger that we may not and we become sidelined?

Dave: I think we’ve got time, but we’ve got to start doing it.  I don’t think we’d ever just diminish, I think the person-centred approach is well enough established not to diminish, but what I am about is not just keeping it at this level, what I’m about is growing and growing and growing until, you know, everybody can expect counselling support – free at the point of service.  And it’s not just about counselling itself – I think we have a lot to offer in other areas like schools, residential care and many settings.  We bring the ‘potentiality model’ rather than the ‘deficiency model’ which tends to be associated with large institutions.

Mick: What do you mean by ‘potentiality model’?

Dave: Let’s start with the opposite, ‘deficiency model’, which is what rules most kind of institutions and society.  The deficiency model works on the kind of premise that the human being is basically deficient in things, they are lacking something, whereas the potentiality model turns this around and it sees that what they are not doing is kind of expressing their potential.  So what we are trying to do is to create conditions where they can more express themselves and their potential, so the way you should treat people is totally different.  In deficiency model you watch them, you teach them, you train them, you discipline them and in potentiality model you really try essentially to make them feel better with themselves, among other things.  So you listen to them and all those kinds of empowering things.

Articulating with other approaches

Mick: So do you think that the person-centred approach will become more integrative with other approaches in the years to come?

Dave: I would expect so. It’s almost like astronomy: the notion of the expanding and contracting universe theory.  I think it’s a natural thing when a discipline is starting for it to break up into bits and diverge.  But then I think it can get to a state of maturity, potentially that it can also come together, the bits can also come together and work together.

For instance, with the psychodynamic approach, I’ve seriously thought that, although from the inside we seem so different, if you actually look at us from the outside we are kind of similar. Neither them or the person-centred approach are particularly into problem-centred working, for instance, since both of them emphasize their relationship, although they look on them maybe in a different way. So I would be quite positive about sharing with an approach like psychodynamic therapy. But I think, in general, apart from people like Michael Jacobs, psychodynamic practitioners wouldn’t be the slightest interested in sharing with the person-centred approach.  Recently Michael Jacobs and I did a dialogue between person-centred and psychodynamic in London.  There were plenty person-centred people attending, but only four psychodynamic.  That was disappointing.

Mick: When you say ‘sharing’, what do you mean?

Dave: OK, take an example: counselling in primary care. Two of the biggest groups of people working in counselling primary care, apart from cognitive behavioural therapists, would be person-centred and psychodynamic.  How about the two of us getting together, to put together a joint argument for relationally-oriented working, as distinct from problem-oriented working?  Now the two of us could do that really well together, you know, and every time when I have found really expert people in the traditions they have been able to talk… they have been able to work things out together. For God’s sake, that would be really powerful, that would be much more powerful than anything the present kinds of associations are doing.

Mick: Do you see a coming together in the person-centred and psychodynamic ways of working as well?

Dave: Not particularly.  I think the interesting thing is that when you actually see how they work, the more skilled and experienced practitioners, do get more similar. I think there is a difference in the way they think about it which is fine, it’s like two different languages but that’s OK, we can actually pick up quite a lot from each other, so I don’t think that’s important. I think what’s important is a genuine recognition of each other: that we are actually in the same family and fairly closely related in terms of our emphasis on the relationship.

Person-centred contributions to the ‘family’ of therapies

Mick: What do you think are the particular contributions the person-centred approach makes to the ‘family of counselling and therapy’?

Dave: Probably the biggest thing is the real valuing of the client, in the sense of humanity, and that includes dimensions like intimacy.  Now, that’s so intense that it scares the shit out of a lot of people.  Actually sometimes it does both simultaneously.  It scares the shit out of people but also they see the significance of it – they just don’t know how to handle it.  I think that’s the most distinctive bit in all sorts of ways and it is why people often have an approach-avoidance relationship with the person-centred approach.

Mick: So what does the person-centred approach add in terms of an understanding of that relationship say as opposed to the ‘therapeutic alliance’?

Dave: The therapeutic alliance is almost like a cognitive skimming of all these things. It’s a sort of recognising the relationship is important but at a pretty low level of engagement, you know, it’s like ‘we need trust’, it doesn’t go much deeper than that. But in PCT we are going to a much deeper level, relationally.

Mick: So you are saying that the person-centred approach contributes an understanding of the relationship at a very deep level, perhaps the deepest level?

Dave: I would argue for that, yes.

Mick: And that is something that all the therapies can draw on?

Dave: I think so, particularly because many of the experienced health practitioners in other therapies would do it as well, and so it’s not something entirely remote from their experience within their approach, and equally there are a lot of person-centred people that I don’t think have got to that level of relating.  So I think there is a potential in what seems to be a major kind of thing that we are bringing to the party, I think other people are bringing other things to the party, you know, but I don’t think that we all eventually become the same, that would be terrible. The danger is that if we get closer and closer we would have to make rules about the language, which is unnecessary.

Mick: So you are saying that this diversity and the difference amongst the approaches adds a richness to the field?

Dave: Absolutely, and I don’t think I would feel that if it wasn’t for my early experiences of the first ten years in the BACP, where you were constantly working with practitioners, experienced practitioners, of other approaches.  It’s not a joke when I say that ‘some of my best friends are psychodynamic and rational emotive behaviour therapists!’

Mick: I guess it’s that difference that allows for dialogue and creativity.

Dave: That’s right. Without that difference it can stagnate, because the more it has to become similar, then the less people can find a way of being that is expressive for them. I mean I am sure when I worked once as a behaviour therapist I was terrible at it! It wasn’t that behaviour therapy was bad, I was a wrong person to do it, you know, you needed someone who was much, much more firm and clear.

Key developments in the person-centred field

Mick: What do you think are the most interesting developments that are coming out in person-centred approach at the moment? 

Dave: I like the ‘process’ work that’s been going on.  Margaret Warner is my favourite in terms of identifying difficult processes, for instance. That’s been wonderful, that’s really taken us to our kind of… what other people would call ‘psychopathological edge’, although that wouldn’t be appropriate because I don’t think what she is talking about is really psychopathology.

Mick: How do you understand her work?

Dave: What she is doing is taking on clients who are really, really difficult for us to form a relational engagement with, and clients with a particular difficulty resulting in dissociated process.  She says one hundred percent of her dissociated clients have been abused as children.  When people are struggling to protect themselves against very difficult childhood experiences, they try to use normal protective mechanisms, like ‘configurations’ in my configurations theory.  But in such abnormal pressures ‘normal’ protections are taken to the extreme and configurations become ‘dissociated process’.  The same is true of ‘fragile process’ – these are not pathologies in themselves, but extremes of self-protective mechanisms that make it difficult to obtain a depth of relational engagement.  So that’s how I see Margaret’s work – it’s about relational engagement with extremely well protected clients.  It’s not about being ‘more than’ a person-centred therapist, it’s about being a very good person-centred therapist.

And also, I think, she is taking on issues that have always been hot for me: the issue of context: that, for instance, it would probably be dangerous to work with a client with such severe fragile process if you didn’t have a context that could hold it.  If you, yourself, or a slightly fragile person needed your boundaries fairly tight and you were meeting on a once-a-week basis with this person and you weren’t willing to get to any other contact like telephone or whatever, you know, that wouldn’t be a context to meet that person equally.  Also, you can’t be someone with wishy-washy boundaries: that would be disaster for both of you.

Mick: Who else’s work do you find interesting?

Dave: Gary Prouty, obviously.  Historically he’s been interesting although I am not sure he’s done very much new in the last twenty years.  He kind of keeps repeating what he’s done but that was huge: opening up the whole world of working with people who were communicatively cut off.  I think that was huge and I don’t think it had the roll-out it should have had.  It’s very frustrating that we tried to put lot of effort into that a few years ago in Britain.  We did get quite a lot of interest but not enough. You could really see pre-therapy having a huge impact in that area of profound learning difficulties, because in that area there is no real coherent philosophy of how you work with people.  The people who work in that area would be yearning for a kind of system, you know, and I think pre-therapy is a wonderful system because it’s client-centred too. In that sense, I think it’s incredible safe because it’s not invading the client. Even if, in the worst analysis, it wasn’t doing anything positive for a client it wouldn’t be doing any negative. So that’s another example, I think – always into the bigger picture and can we get things to roll out and roll on and expand of their own momentum. What else….

Mick: Peter Schmid’s work?

Dave: I see Peter Schmid, not as the inventor of things or the innovator but I see him as the approach’s philosopher.  He is the philosopher, nobody can touch him except maybe…  Gene Gendlin, the two of them are probably right up there, although Gene more in his own world, producing his own big books whereas Peter is taking a more active role.  I think Robert Elliott and Bill Stiles… and Les Greenberg are contributing a hell of a work and that is vital: that’s probably been more important than anyone because that work is interfacing with the outside world. I mean, others can always write books and stuff like that but are mainly read inside their world which is fine, but that’s not actually impacting much on the outside world.

Dave’s Contributions

Mick: What would you say are your main contributions to the field over the years?

Dave: I think the training book, although it’s read by hardly anybody, was good because it was the first book that really tried to articulate with the mainstream and although I didn’t use that word in those days that’s what it was about.  It was like saying, ‘OK, we want to implement these rather novel training dynamics, but we want to do it inside the system rather than outside it’.  That meant that we had to ‘articulate’ with institutions – we had to listen to them and help them listen to us – both had to learn from the other.  So I am pleased with that because a lot of trainers think we need to just bow to whatever institution that we are in, but that’s not what education is about.  It is a dialogue.

I think the relational depth stuff isn’t new but it’s kind of going back and re-emphasizing findings, so I think that’s useful. 

Mick: So are you saying that you feel your basic contribution is in the ability to articulate within institutions and to bring the approach out?

Dave: I think that’s true and I think that’s the thing I am most pleased about. And the thing we get least attention for is the work I’ve been doing on the self-theory and kind of adjusting and kind of taking a more dialogical look at Rogers’ theory.  Actually, I am more pleased about that than anything else because that appeals to the sort of old-fashioned academic psychologist in me.  It’s like the kind of stuff I used to read, you know, used to study personality theories, I’m really pleased with that theoretical stuff.

Mick: Can you say a bit more about it?  How you think you’ve developed it?

Dave: I remember I took a sabbatical term when I was working on that. For the whole chapter I took a term, and it meant doing everything in the old fashioned academic way: using interlibrary loans all the time, having a constant link with the library, getting them to send me papers. And given that kind of space you really do read papers – otherwise you skim them. So you read arguments and reading Rogers at different stages and seeing what I thought were changes at different times, going back before Rogers and seeing and reading Jessie Taft. See how much he had nicked from her, well, you know… he was good at that actually, sometimes he forgot it was other people’s work!

Into the future

Mick: And where do you see the work going over the next few years?

Dave: I’m not going to do anything more on configurations, probably, I think there is enough theory in that.  It would be quite interesting doing some empirical work or supporting people doing empirical work but I can’t see more theory development there.  I think I’ll always be tempted to sit at the table in terms of policy, I think I’m getting better and better at that.  You do, you know, you build up skills to do with that.  If I have the time and the energy I might begin the work to highlight another ‘difficult process’.  My present working label for it is ‘separation process’.  It begins with a self protective and self expressive need to separate the self, relationally, from others and it ends with so-called ‘personality disorder’, psychopathy, homicide or suicide.  So many of my (male) clients have struggled with separation process that I have learned a lot about establishing relational engagement with them – that’s where my emphasis on relational depth came from.

And then there will come a time when I will be quite happy to leave it to other people.  Rogers did that wonderfully. There’s a wonderful piece described by Maria Bowen, who was a long friend of his: He must have been about 80 at the time and she said to him: ‘Carl, do you not mind that people are kind of taking your theories in all sort of places you wouldn’t have taken them?’ and he said ‘No, no, it’s up to them’.  I think his reaction is perfectly consistent, because one of the most frightening things is when old men can’t let go. I think it’s more often men: a reducing testosterone!  That’s one thing I do not want: is to get into that kind of bitter, twisted, negative way: that the world is a terrible place.  And I am true to that: if I catch myself there I’ll sack myself.

Mick: Are there any elements of your career that you regret?

Dave: Some years ago I stopped practising and that is a regret and yet such a tremendous decision.  I was so stressed with seeing maybe three clients a week – supervision and everything involved, you know: that took the best part of the day.  I haven’t done that for the last 5-6 years. So on one hand it’s a regret, and I know I can’t go on writing for too long or I’ll dry up.  But it was a good decision because I am able to do so much more at other levels. 

Why I made the decision is a wonderful story.  One weekend I took home twelve ‘transcript’ assignments.  All twelve were from our public counselling service and amazingly were all with male clients. I cried in every one of these. Every single one of these guys, in one respect they were all the same, they were all guys, working class guys who people stereotypically would say, ‘What the hell do they have to do with Counselling?’ They were not articulate or whatever but in that setting they were all articulate in an emotional way and in a very straight forward way.  They didn’t use language to dress it up and you could see with all of them this was the first time they were really using something like this.  It was really moving to listen to the tapes.  And I said to myself that weekend ‘Right, I can’t waste my time spending a day seeing three clients or whatever.  I’m better spending the day trying to help people like this to access counselling, free at the point of service.’  So, it was a good decision.

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Last modified: 12 January, 2010
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