Person-Centred Psychopathology: A Positive Psychology of Mental Health

Edited by Stephen Joseph and Richard Worsley

Reviewed by Tom Patterson, Clinical Psychologist.

As the editors of this book point out, it is because of its fundamental assumptions about the
human condition that the person-centred approach (PCA) offers mental health practitioners a
radical alternative paradigm to the medical model for understanding and responding to human
distress. Bringing together a very broad range of the latest research, theoretical and
therapeutic advances in the PCA to psychopathology, Person-Centred Psychopathology offers
a cutting-edge overview of the relevance of the PCA to the field of mental health today

Five sections (Introductions, Theory, Contexts, Research, and Conclusion) and twenty-three
chapters provide a comprehensive coverage of most of the major issues of concern to modern
therapeutic practitioners in the field of mental health. In the introductory chapter, the often
cited criticism that the PCA is unsophisticated and naive is rebuffed by the editors, who
convincingly argue that the model constitutes a fundamentally different approach that has a
vital contribution to make in terms of the treatment of severe and chronic mental health
problems.

The Theory section begins with a chapter by Paul Wilkins explaining person-centred theory's
relevance to understanding psychopathology, while Margaret Warner goes on to argue that
the PCA provides us with a model of human functioning that is relevant to all of clinical
psychology and the social sciences. The conflict between the values of psychiatry and the
PCA is also given consideration in a thoughtful contribution from Lisbeth Sommerbeck,
while a further chapter by Paul Wilkins outlines the contribution person-centred theory can
make to assessment and diagnosis of psychopathology by providing an alternative to the
therapist as expert paradigm.

The section on Contexts with its focus on the therapeutic applications of the PCA to serious
and chronic mental health problems distinguishes this book from other books on client-
centred therapy. Dion Van Werde provides a stimulating exploration of the use of pre-
therapy to establish therapeutic contact with clients experiencing psychosis by providing
reflections of contact as an antidote to psychotic alienation from reality, affect and other
people, and thus restoring or strengthening the individual's impaired contact functioning. The
chapter also addresses the challenges of providing a PCA within the multidisciplinary context
of a ward milieu. Following this, a PCA to understanding and working with antisocial
personality disorder is considered by Leslie McCulloch who incorporates substantial research
findings from her own work and that of others. McCulloch argues that the relationship
conditions provided by client-centred therapy can successfully overcome the characteristic
distrust and resistance to therapy shown by individuals with antisocial personality disorder,
and which have made effective interventions using other approaches so difficult in the past.

Elaine Catterall argues that client-centred therapy is exceptionally well placed to address the
unique challenges childbirth brings to the mothers' identity and self-concept, at the
intrapersonal, interpersonal, and socio-cultural levels, while Jacky Knibbs and Heather Moran
discuss the application of the person-centred perspective, with its rejection of the language of
deficit, to therapeutic work with children and young people who are diagnosed with autistic
spectrum disorder. Gillian Proctor's chapter considers her own experiences of adopting a
PCA in her work as a clinical psychologist, arguing that clinical psychology has been overly

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reliant on empirical evidence to inform its therapeutic stance, while ignoring issues of values,
ethics, status and power to the detriment of clients. Other chapters in this section cover the
application of the PCA to understanding post-traumatic stress responses (Stephen Joseph), to
working with survivors of childhood abuse (Jan Hawkins), and to working with people with
special needs (Marlis Portner).

Research is also comprehensively addressed in this book. Currently, there is an emphasis in

modern healthcare services on the provision of psychological therapies with a clear evidence
base, with current healthcare funding decisions being strongly influenced by research reviews
and clinical practice guidelines. One undeniably important contribution in this section is the
chapter by Jerold Bozarth and Noriko Motomasa, who review evidence highlighting the
critical role of relationship variables in therapeutic outcome across all psychotherapies.
Discussing findings from reviews of outcome research suggesting that approximately 30% of
the variance in outcome across therapies is accounted for by client-therapist relationship
variables compared to 15% accounted for by specific techniques, these authors highlight
consistent research findings indicating that relationship variables (and in particular the
variables of empathy, positive regard, and congruence-genuineness) play a greater role than
specific techniques in determining successful therapeutic outcome.

In the final section of the book, a strong case is made by the editors that meta-theoretical
elements of person-centred theory promise to provide the foundation for a new positive
psychology of mental health that can move beyond the traditional focus of psychologists on
the negative aspects of psychological functioning. PCA is seen to provide a coherent
standpoint from which to understand and 'treat' psychopathology, based on its unique
perspective that human beings have an inherent tendency towards growth, development and
optimal functioning that can be facilitated or inhibited depending on the social-environmental
conditions experienced. Support for this argument is present throughout the book. For
example, in chapter 13 Stephen Joseph shows how person–centred theory is able to provide a
more positive psychological understanding of post-traumatic stress disorder while also
accounting for post-traumatic growth, with client-centred therapy offering an alternative
approach to working with traumatised clients based on this theoretical framework.

In summary, Person-Centred Psychopathology offers the reader a refreshing and coherent

perspective on psychopathology that has the potential to inform theory, research and practice
in the management of mental distress for many years to come. In my view, it is a book that
will attract a wide readership, due both to the scholarly approach it adopts in addressing the
practical challenges of treating serious and chronic mental health problems, and to the
unflinching commitment of all its contributors to an ethical standpoint that presents a forward
looking and inspirational challenge to those of us who work in the field of mental health.