From the Actualising Tendency to Autonomy: How do we Understand and Honour Self-Determinism in Pluralistic, Integrative, and Person-Centred Therapy?
A few years ago, in therapy, as I discussed some of the more questionable choices I have made in my life, my therapist said to me ‘You always get to where you need to be, Erin. You might not always take the most orthodox route, but you always get there.’ This was a pivotal statement for me, which fundamentally changed my view of my past, my present, and my future. For the first time, I understood why my therapist never offered advice, told me I was wrong, or made judgements about my actions: he trusted me to get to where I needed to be. Slowly, as I became more able to receive and accept his trust, I grew to trust myself, gain confidence in the choices I make, and forgive myself for the mistakes I have made in the past. I am coming to see everything that I do (and have done) as part of a necessary process of learning and growth. I am more at ease with who I am and the choices I make than I have ever been before.
This prizing of self-determination informs my practice and my way of being at the very deepest level. I am an integrative therapist, and at the core of my philosophical outlook are person-centred principles. Rogers’s notion that the human organism is ever-striving, ever-actualising, resonates deeply with what I understand of my clients’ experiences and the sense I make of my therapist’s reflections on my process. Just as those potatoes in the cellar grew in the best way they could with the conditions they had, I believe that we will take the best route we can see, on the map that we have.
At first glance, a pluralistic approach looks almost indistinguishable from the way I practise as an integrative therapist: I work collaboratively with clients, and I hold the belief that a diverse client population requires a diverse choice of therapeutic approaches. Where pluralism loses me slightly is at the point where pluralistic practitioners begin to talk about ‘client preferences’ driving the therapy—giving advice, offering homework, etc.—in instances where a client asks for those interventions.
There is an interesting power dynamic at play here: the therapist offers power to the client (which is an act of power in itself), then the client can hand it back to the therapist, which might happen for any number of reasons. The therapist then may feel they have permission to act from a position of power or expertise. I think the motivations of both the client and the therapist in this back-and-forth exchange of permission and power require some careful thought.
When a client comes to therapy, they come with their experiences, and the therapist comes with theirs. It is a meeting of two people—a relationship. If the client is asked how they would like the therapist to proceed, the therapist will receive an answer that can be found on the map of routes that the client already has. For this reason, I am unsurprised that ‘advice’ features so highly on clients’ wishlists. Advice is what I wanted and expected too. I didn’t trust myself (look at all those questionable decisions I had made), so advice would be just the ticket. What happened to me instead is that I was invited to experience this different, slightly odd, sometimes infuriating, but curiously comforting new kind of relationship. One where my preconceptions about therapy, and my therapist’s opinions about me, were left at the door, and I was free from the constraints and pressures of all other relational experiences. This was a route that was not yet visible on my map, but I had the opportunity to journey into it anyway.
I think that working from client’s idea of what they want from me as a therapist is likely to have two effects.
First, I feel that we risk narrowing the map available to the client by only offering visible routes. It seems to me that if the map is set aside while the terrain is explored more freely, we might find new areas to explore, and vessels for that exploration, which were not immediately apparent. For me, this perfectly describes the act of entering into a relationship. Perhaps a client will still decide that they wish to take the route they could already see on the map they brought, but their map may be clearer, wider, and the value of their choices reinforced.
Second, a client’s self-determination is not the only important ingredient. I believe that the therapist’s agency in the therapeutic encounter is equally crucial. I do not wish to assume the client’s map any more than I would rigidly rely on my own. I want to openly explore the terrain too, from a position of ‘not knowing’. Herein is a valuable aspect of therapy—to meet the other as a unique individual, and to bring my authentic self to this, and every encounter.
For me, the client’s autonomy is fostered by the non-possessiveness of this mutual exploration, and the client’s self-direction to decide whether this part of the map provides what they are seeking. When the relationship doesn’t offer what the client needs, we have referral, or the client’s decision to do, or try, something different, either with me or elsewhere.
While I absolutely respect a client’s right to determine their own responses and actions in a therapeutic encounter, I also value my own right to determine mine.
This is not an argument against pluralism in therapy. I find the writing on this approach to be a delightful articulation of a collaborative, integrative therapy. I am pleased that it resonates with so many practitioners, and that it has given rise to such a sense of unity amongst some therapists, in the confusing and sometimes disparate world of therapy. I also see nothing inherently wrong or un-therapeutic about working to clients’ goals and preferences, and directly offering what the client asks for, if the therapist wishes to practise that way.
My caution comes when I see pluralism described as an evolution of person-centred therapy. For me, pluralism differs from person-centred therapy in that it moves away from an inherent confidence in the actualising tendency; understands and honours self-determinism in a different way, and places an emphasis on client preferences which I feel is unlikely to always be compatible with the congruence of the therapist.
I would like us, as a profession, to pay more attention to concepts like autonomy and self-determination; consider how they sit alongside power in the therapeutic relationship; and how they interact with theoretical ideas, such as the actualising tendency. I feel that both our similarities, and our differences, exist somewhere in this matrix.