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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 thehuman 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 avital 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 expertparadigm.

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 contactas 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 researchfindings 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 aPCA 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 thanspecific 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 personcentred 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 forwardlooking and inspirational challenge to those of us who work in the field of mental health.

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