ABSTRACT
For the most part, in the West the treatment of people experiencing mental and/or emotional distress has been dominated by practitioners who adhere to the medical model whether they are medically trained or not. That is to say that a way of thinking about and responding to physical ailments has been applied wholesale to disorders of thought and feeling. However, the applicability of a model which goes something like (symptoms) – diagnosis – treatment – cure – (lack of symptoms) has, at least from a person-centred point of view, not been proved. A second influence on understanding psychopathology has been psychoanalysis. It is from this source that some of the familiar terms associated with psychological distress arise – for example, ‘borderline’ and ‘narcissism’. Historically, both these ways of thinking about people have been opposed by person-centred practitioners although more recently there has been some move towards developing a common or inclusive language especially by person-centred practitioners who work in medical settings. This rejection by person-centred practitioners has been criticised largely on the basis that person-centred theory lacks a model of child development and a model of psychological distress. This is easy to refute (see Wilkins 2003: 99–107, 2005b: 43–50, Point 24). 97From the outset there has been a model of child development as part of person-centred theory (see Rogers 1959: 222) and a linking of this to the development of distress (Rogers 1959: 224–230). This has subsequently been refined and developed by (for example) Biermann-Ratjen (1996: 13–14). There are in fact four major contemporary positions with respect to mental ill-health within the person-centred tradition. These are those based on:
(psychological) contact (see Point 34)
incongruence (see Point 35)
styles of processing (see Point 36)
issues of power (see Point 37).
While they share a great deal, each of these approaches to understanding emotional and mental distress has been developed primarily from a particular theoretical proposition or philosophical attitude.Understanding or working with mental distress in the context of ‘contact’ derives from the first of the necessary and sufficient conditions requiring that client and therapist are in (psychological) contact. The underpinning question is what to do if this is not so and there is an assumption that the absence of contact is in itself distressing.
The notion that it is incongruence which gives rise to mental and emotional distress is a straightforward reading of the second of Rogers’ six conditions. It is incongruence expressed as anxiety or vulnerability that leads a client to therapy. This incongruence can be anywhere on a spectrum from mild unease to acute or chronic suffering of the most disturbing kind.
Models in which ‘difficult’ process is the basis for distress derive from Rogers’ (1967: 27) description of life as ‘a flowing, changing process in which nothing is fixed’ and the recognition that sometimes this process may be interrupted, distorted, stagnant or in some other way deviate from the ideal.
That psychological distress relates to issues of power rather than to intrinsic, intrapersonal and interpersonal dynamics is based on the assumption that its causes are social and/or environmental. Perhaps this draws on person-centred philosophy as much or more than its theory of personality. It relates to the non-directive principle and the attitude to the exercise of power (Points 5 and 6). The foundation of this understanding of distress is that ‘madness’ is socially defined and that social and political circumstances at the very least contribute to mental ill-health and are possibly causal.
