Setting the Record Straight
For an approach built on empathy and a deep respect for the human experience, Person Centred Therapy (PCT) is surprisingly misunderstood and unfairly criticised. PCT is a deeply demanding discipline and there are some common misconceptions that have distorted and obscured the sophistication and relational courage needed to practise it for far too long. Let’s delve a little further into these in the hope of setting the record straight and maybe giving up a few ghosts.
Misconception 1: “The therapist does nothing but listen”
This stems from a misunderstanding of the principle of non-directivity. When taken out of context the term non-directive suggests the therapist is passive, simply sits back, nods, and lets you talk endlessly whilst offering no input or structure, abdicating all responsibility in the process.
Non-directivity in PCT is a philosophical stance. Even within the approach there are fierce debates about the philosophy and application of the principle. But in a glittery nutshell, it speaks to the therapist’s deep held belief that people possess the capacity for self-direction and growth and that therapy should support (not override) that capacity.
Take a moment to consider how challenging it actually is not to share your opinion, advice, guidance or even judgment when you are in an everyday conversation with someone. Now add in a hefty dose of psychological distress and pain. The Person Centred therapist knows the importance of being able to feel through your feelings and not to rescue you from them. While listening is unquestionably foundational, the therapist is involved in a disciplined effort to understand your inner world including tracking feelings and meanings that may be only dimly sensed or difficult to articulate.
They work tirelessly not to impose their own agenda, offer advice, or interpretations while holding a deep trust in your process. This is the complete opposite to what you will experience in the majority of your relationships in the world. Not to mention how much systems of oppression love to tell us repeatedly that “you can’t not trusted”
At its core, non-directivity is about respecting your right to self-determination, not about doing nothing. The therapist is continually making choices about how to respond, when to reflect, when to remain silent, when to share their own feelings, and how to maintain a therapeutic environment conducive to your inner exploration. This requires skill and presence. The reality is this such a big ask and radical perspective that Person Centred therapists will dedicate their lifetime to continuing self-reflection and self-work to be able to resist the urge to “fix”, to tolerate uncertainty and to trust in the client’s capacity for growth. It’s easy to believe in someone’s capacity for growth when things are going well but what about when that someone is actively involved in self-sabotage or unrelenting self-criticism or when they are angry or withdrawn. When we look at things through this lens, we start to gain a picture of just how demanding the work can be.
Misconception 2: “Acceptance means excusing or enabling harmful behaviour”
This relates to the concept of Unconditional Positive Regard (UPR) which is sometimes referred to as unconditional acceptance. Some critics argue that UPR is naïve or even dangerous and that it means the therapist must approve of and excuse all your actions (past and present) leading to enabling of harmful behaviour.
However, to hold this view shows a complete lack of understanding of the concept of UPR. What it actually means is accepting and valuing a person in their entirety, regardless of the many facets of their feelings, thoughts, behaviours in the moment. The theoretical explanation being that if you can value a person especially in their darkest moments when they are describing harmful thoughts and behaviours then this will help them to examine and explore these aspects of themselves more deeply and promote change.
Unconditional positive regard is absolutely not the same as unconditional approval. It does not means condoning or endorsing all actions. The therapist can disapprove of certain behaviours (e.g., violence, self-harm) while still holding a person in positive regard as a human being who is worthy of respect and care. Therapists are bound by ethical frameworks that require us to take action if we are genuinely concerned, and can justify our rationale, for the safety of the client, another person or the general public. The reality of therapy is that there are limitations and boundaries: the biggest boundary being we must work within the parameters of the law!
Misconception 3: “Person-Centred Therapy is not evidence based”
Some critics claim that the Person Centred approach is outdated, unscientific, or less effective than more structured, technique-based therapies like cognitive behaviour therapy (CBT). This perception is reinforced by policy and funding decisions that always favour manualized, highly structured, and time limited treatments.
PCT is one of the most researched forms of psychotherapy, with a robust evidence based spanning over seventy years. Meta-analyses from 2008 and 2021 found PCT to be as effective and facilitated lasting change in client outcomes equivalent to those of CBT and other approaches for a wide range of issues including depression, anxiety and relationship problems.
What research consistently shows is that it is the relational quality of the therapeutic relationship that is one of the strongest predictors of positive outcomes regardless of modality. The therapeutic relationship is the focus of PCT, it’s the beating heart of the approach, and the conditions are the guide to producing an environment that is conducive to facilitating change and growth.
Misconception 4: “Person Centred therapy just isn’t enough”
The idea that PCT is lacking in efficacy may have roots in a misunderstanding of the universality of the Actualising Tendency, the sufficiency of the core therapeutic conditions and its resistance to diagnostic reductionism. If looked at on a surface level it may be understandable to assume that it is therefore claiming to be suitable for all clients and all issues, or that it should be the default approach in every case.
The idea that PCT is an effective therapy for all forms of psychological distress fails to consider the reality that no therapeutic modality is enough to help every client, treat every psychological condition or issue. This reflects the therapy world’s sometimes obsession of finding a Holy Grail! All therapies have their limitations. No one claimed PCT to be a cure-all. However, PCT does have a unique facet, it can play well with other approaches. For example, say you are someone who experiences severe PTSD symptoms then you would probably best benefit from doing PCT, with its focus on relational safety and emotional processing, alongside more trauma focused interventions such a EMDR which would address specific symptoms.
We have just explored some the ways that PCT is misunderstood. To understand this further, I feel we would need to examine the socio-political and systemic forces at play in our societies which will have to be the topic for a future blog!
Nonetheless, this author would like to state emphatically, Person centred Therapy is not passive. Nor does it enable or excuse harmful behaviours. It has a robust, empirical evidence base. And does not, nor ever did, claim to be panacea for all of humankind’s psychological ails. But what it is, is a powerful approach that, when practiced with skill and integrity, can be a catalyst for profound and lasting change.
If this blog has sparked your curiosity and are considering trying Person Centred therapy then we are here for you.
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Gavin McDonald
Gavin McDonald, BSc, MBACP (Accred) is a Person Centred therapist and managing director of LPG Counselling based in Scotland. They are an advocate for the Person Centred approach both inside and outside the therapy room. His area of interest is the exploration of gender identity. Instagram: @gavinlpgcounselling email: gavin@lpg.scot