European Journal of Psychotherapy and Counselling Vol. 14, No.

1, March 2012, 517

From either/or to both/and: Developing a pluralistic approach to counselling and psychotherapy

Mick Coopera* and John McLeodb
a School of Psychological Sciences and Health, Counselling Unit, University of Strathclyde, Glasgow, UK; bSchool of Social and Health Sciences, University of Abertay, Dundee, UK

(Received 1 November 2011; final version received 2 December 2011)

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The pluralistic approach to therapy that we have articulated is grounded in ethics, and strives to develop therapists abilities to engage with clients in deeply respectful and valuing ways. In this article, we argue that a principle obstacle to such engagements can be a tendency in the psychological therapies to hold either/or, polarised positions, such that we are not fully open to the complexity and diversity of the actual clients that we encounter. This article focuses on three particular polarisations: between advocates of different orientations, between integrative/eclectic versus single orientation practices and between client-led versus therapist-led practices. The article argues that a pluralistic approach may be able to overcome such schisms, and discusses the implications and limits of this perspective for therapeutic thinking and practice. Keywords: pluralistic therapy; meta-therapeutic dialogue; therapeutic alliance; humanistic psychotherapy El metodo pluralista en psicoterapia se fundamenta en la etica y se esfuerza en ayudar a los terapeutas a desarrollar sus habilidades para involucrarse con el cliente de una manera respetuosa. En este art culo se discute que el principal obstaculo para esto, puede ser la tendencia en el terapeuta a sostener posiciones polarizadas caracterizadas por : este o aquel metodo; de esta manera no se sienten en libertad para considerar la complejidad y diversidad de sus clientes. Este art culo se concentra en tres polarizaciones particulares: 1: entre los que abogan por diferentes orientaciones; 2:entre el metodo integrativo/eclectico versus terapia segun una sola orientacion, 3: psicoterapia orientada en el cliente versus la orientada en el terapeuta. Se discute que un metodo pluralista puede servir para reducir estas esciciones y se presentan las implicaicones y l mites de esta perspective para la practica de la psicoterapia. Palabras clave: terapia pluralistica; dialogo metaterapeutico; alianza terapeutica; psicoterapia humanistic

*Corresponding author. Email: mick.cooper@strath.ac.uk

ISSN 13642537 print/ISSN 14695901 online 2012 Taylor & Francis http://dx.doi.org/10.1080/13642537.2012.652389 http://www.tandfonline.com

M. Cooper and J. McLeod

` Lapproccio pluralistico alla terapia che abbiamo illustratato e radicato ` ` nelletica ed e volto a sviluppare le abilita dei terapeuti ad impegnarsi con i clienti in maniera profondamente rispettosa e con stima. In questo studio si ` discute sul fatto che lostacolo principale per questo tipo di impegno puo essere rappresentato da una tendenza delle terapie psicologiche a mantenere ` una posizione polarizzata luno o laltro, in modo tale tale che non si e ` ` completamente aperti nei confronti della reale complessita e peculiarita dei clienti che incontriamo. Questo documento si concentra su tre polarizzazioni particolari: tra sostenitori di diversi orientamenti, integrativa/eclettica in antitesi alle pratiche di orientamento singolo e pratiche incentrate sul cliente in opposizione alle pratiche guidate dal terapeuta. Il documento ` sostiene che un approccio pluralistico puo essere in grado di superare tali scismi e discute le implicazioni ed i limiti di questa prospettiva per il pensiero terapeutico e la sua pratica. Parole chiave: terapia pluralistica; dialogo meta-terapeutico; alleanza terapeutica; psicoterapia umanistica

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Lapproche pluraliste de la therapie que nous avons articulee prend ses racines dans lethique et sefforce de developper les capacites des ` therapeutes a sengager avec les clients de facon profondement respectueuse ` et valorisante. Dans cet article, nous avancons que le principal obstacle a des tels engagements semble etre une tendance au sein des therapies ` psychologiques a occuper des positions polarisees telles que soit/soit et ` ainsi netre pas totalement ouvertes a la complexite et la diversite des clients tels quils sont rencontres dans la realite. Cet article met laccent sur trois ` polarisations particulieres: entre les defenseurs de differentes orientations, ` entre integratif/eclectique contre des pratiques a orientation unique et entre des pratiques menees par le client et celles menees par le therapeute. Cet article soutient quune approche pluraliste est capable de depasser des tels schismes et discute les implications et limites de cette perspective pour la pensee et le pratique therapeutiques. Mots-cles: therapie pluraliste; dialogue meta-therapeutique; alliance therapeutique; psychotherapie humaniste

Introduction In recent years, we have attempted to articulate a pluralistic approach to counselling and psychotherapy (Cooper & McLeod, 2007, 2010, 2011a, 2011b; McLeod & Cooper, in press). This is not the only attempt to apply pluralistic concepts and terms to the therapeutic field (see also, House & Totton, 1997; Samuels, 1997), but its focus is relatively distinct. Its two core tenets are that many different things can be helpful to clients, and that therapists should work collaboratively with clients to help them work out what they want from therapy and how this might best be achieved. Although this pluralistic approach is articulated in terms of the theory and practice of counselling and psychotherapy, its rationale and underlying foundations like Loewenthals (2011) post-existentialism are not psychotherapeutic or psychological but ethical. The approach developed as a means of trying to take forward a progressive, humanistic agenda: of striving to encounter clients and fellow professionals in the most valuing and respectful

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ways possible (Cooper, 2007). In this sense, our pluralistic approach is less a set of directions for how therapy should be conducted, and more an agenda and set of questions for how our field might progress: questions that could be addressed through a variety of means, such as research, self-reflection, and dialogue within and across our therapeutic community. What does it mean to engage with another in a deeply valuing and respectful way? For Levinas (1969), an ethical relationship is one in which we are open to the otherness of the Other. By this, he means that we do not try and reduce them down to some a priori, finite set of laws, characteristics and features: for instance, as a schizophrenic or a borderline. Rather, it means that we are willing to go beyond what is familiar to us and embrace the Other in their indefinability and complexity: as something that we can never fully grasp. Levinas uses the metaphor of the face to describe this indefinable complexity. Each persons face is a quite unique configuration of features that can never be wholly captured in terms of labels and categories. We can say that someone is beautiful or wrinkled, but the actuality of their facial appearance always exceeds those descriptions. Similarly, from a Levinasian position, the actuality of an Others being vastly exceeds any finite terms or concepts that we might have for them: psychological or otherwise. In this respect, to respond to them ethically, as human beings worthy of respect, means to stay open to that totality and not to do violence to it by attempting to reduce it down to something definite and contained. Loewenthal (2011, p. 23) writes: It is the face of the client that both commands the psychological therapist not to harm, and solicit the psychological therapists aid.

Either/or So how is it that we might lose sight of the totality of the Other? Across a range of psychotherapeutic orientations, one means that has been identified by which people can lose touch with the reality of their world and those around them is through either/or thinking. Wikipedia describes this as a false dilemma and writes:
A false dilemma (also called false dichotomy, the either-or fallacy, fallacy of false choice, black-and-white thinking or the fallacy of exhaustive hypotheses) is a type of logical fallacy that involves a situation in which only two alternatives are considered, when in fact there are additional options (sometimes shades of grey between the extremes). For example, It wasnt medicine that cured Ms. X, so it must have been a miracle.

The problematic effects of either/or thinking are particularly emphasised within the cognitivebehavioural field (Beck, John, Shaw, & Emery, 1979). However, within the psychodynamic field, splitting is commonly identified as a pathogenic mechanism (Wolitzky, 2003); and much therapeutic work in the humanistic field (e.g. Greenberg & Dompierre, 1981) is also oriented around the psychological difficulties that can emerge when two aspects of a persons being become polarised. In each case, what is emphasised is the way that people can encounter problems when they start to see their world in over-simplified,

M. Cooper and J. McLeod

dichotomous or polarised ways. The complex, shades of grey reality of what is actually out there gets missed, such that the person cannot function effectively in relation to the actual world that they are inhabiting. Most of the work on either/or thinking has been at the level of the individual. However, we might also extend this concept to the intra-group plane. Here, we can consider the way in which communities may also become internally polarised with different members holding opposed and mutually excluding positions such that the complex lived-reality of the people that they encounter also gets overlooked: both by individual members of the community and by the community as a whole. Such, we would argue, is the situation within much of the counselling and psychotherapy field, where either/or thinking has been prevalent since its very inception (Cooper & McLeod, 2011b). Some examples of either/or polarisations are:

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. Practice A as most effective versus Practice B as most effective (versus Practice C, etc.), . Theory A as the best explanation for a persons distress versus Theory B (versus Theory C, etc.), . common factors explanations for therapeutic change (e.g. Hubble, Duncan, & Miller, 1999) versus orientation-specific explanations (e.g. Chambless, 2002), . relational explanations for therapeutic change (e.g. Mearns & Cooper, 2005) versus technique-based explanations (e.g. Clark et al., 1994), . emphasis on differential effectiveness across therapists (e.g. Kim, Wampold, & Bolt, 2006) versus emphasis on consistency across therapists (Elkin, Falconnier, Martinovich, & Mahoney, 2006), . socio-political models for psychological change (e.g. Proctor, Cooper, Sanders, & Malcolm, 2006) versus intrapsychic ones, . single orientations practices versus integrative/eclectic practices, . client-led practices versus therapist-led practices, . research-informed approaches versus practice/experience/theoryinformed approaches. Viewed dialectically, the development of such positions may have been important in helping the counselling and psychotherapy field evolve. Yet these polarised positions can also detract us, as individuals and as a community, from the diversity, complexity and shades of grey lived-reality of each of our clients: that people may have developed psychological difficulties for a wide variety of different reasons; and that different change processes and different therapeutic practices may be more or less relevant to different clients at different points in time. From this standpoint, then, such debates as whether change happens through relational factors or techniques factors are limited in their value both answers may be right. In other words, in trying to meet our clients in the fullness of their otherness and diversity, a pluralistic approach argues that it is helpful to move from an either/or standpoint to one of both/ and. In the following sections, we outline three of the ways in which we have attempted to achieve this, with respect to some of the key schisms in our field.

European Journal of Psychotherapy and Counselling Practice A versus Practice B

The first basic assumption underlying our pluralistic approach is that Lots of different things can be helpful to clients (Cooper & McLeod, 2011b, p. 6). In other words, for some clients, at some points in time, psychodynamic interpretations may be helpful; and for other clients, at other points in time, Socratic questioning may be helpful; and it is of little value to argue over which of these approaches is better it is just a question of which method is most useful to which client at which points in time (Paul, 1967). Here, to use an analogy, debating which therapeutic approach is best is like debating which flavour of ice cream tastes the nicest: the reality is, different people like different things, and the same person may like different things at different points in time or even all together at once. And even if, on average, it is demonstrated that one flavour is most popular overall (vanilla, according to www.makeicecream.com), this does not detract from the reality that, for some people at some points in times, other flavours will be much more preferred. That different clients will benefit from different therapeutic methods is evident from the research. For instance, clients with high levels of resistance (i.e. who have a tendency to behave in oppositional ways) tend to benefit more from non-directive practices, whereas those who are non-defensive seem to benefit more from directive therapeutic procedures (Beutler, Blatt, Alimohamed, Levy, & Angtuaco, 2006). Similarly, clients who have a predominantly externalising coping style (i.e. who deal with new or problematic situations by behaving impulsively, actively and excessively) tend to do better with technique-oriented therapies than clients with an internalising coping style (i.e. who deal with new or problematic situations by turning in on themselves and becoming self-critical or depressed), and vice versa (Beutler, Machado, Engle, & Mohr, 1993; Beutler, Mohr, Grawe, Engle, & MacDonald, 1991). It is also clear that clients want different things from therapy. For instance, in recent years, we have been using the Therapy Personalisation Form Assessment (TPF-A) in our clinical work (Bowens & Cooper, 2012) which asks clients, at assessment, to indicate the kind of stance that they would prefer their therapist to take: for instance, more challenging more gentle, or focus more on my past focus more on my future. From this, it is apparent that clients coming to therapy can want very different things. For instance, one client indicated that he had a strong preference for the therapist to focus on specific goals, while another wanted exactly the opposite: for the therapist to eschew goals and simply be with her in the relationship. Even for the same client and within the same session, the things that can be experienced as helpful may be associated with very different orientations. When asked to describe something that had been helpful in session 11 with Mick, for instance, Tanya wrote about the value of emotional processing: I let myself get in touch with how I really felt about all this, I hadnt up to now because I just felt disengaged. When asked to describe a second helpful activity, however, she described something much more associated with a cognitive ways of working: Objective/logical thinking about the situation.

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In this respect, the kind of divisions that we draw in the therapy field, such as between affect-oriented and cognitive-oriented processes, may be much less salient to external others. Indeed, as we have argued (Cooper & McLeod, 2011b, p. 95), much psychotherapeutic work, at least from the outside, may be simply conceptualised as just talking: an activity which naturally flows between a variety of different forms. This assumption, that different things can help different people at different points in time, does not require therapists to radically revise their practice. It does, however, bring to the fore certain questions for our field, which may help us develop our capacity to engage more fully and respectfully with our clients. For instance: . How can we, as therapists and trainees, develop a greater awareness of our biases and assumptions about what works, and develop the skills to put these to one side where appropriate? . How can we develop a greater awareness of the limits of our practice? . How can we refer clients on most helpfully? . How can we most effectively communicate to clients what it is that we, specifically, are able to offer them?

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Single orientation versus integrative/eclectic therapies Since the 1930 s, and particularly from the 1970 s onwards (Nuttall, 2008), there has been a rapid growth in integrative and eclectic practices, such that it is now the most common theoretical orientation of English-speaking psychotherapists (Norcross, 2005), with around 2550% of American clinicians identifying in this way (Norcross, 2005; Orlinsky & Rnnestad, 2005). As with the pluralistic approach, integrative and eclectic therapists have tended to reject the idea that any one core theoretical model is superior, preferring to draw principles and methods from a range of different orientations. With the development of integrative and eclectic practices, however, comes the danger of a new dichotomy emerging: between pure forms of therapy, and those that combine elements of different therapeutic approaches. Is it better to stick to one therapeutic orientation or to work in an integrative way?. From a pluralistic standpoint, the danger with such a question is that it again returns to an either/or way of thinking, ignoring the empirical reality that clients seem to benefit from both stances (Cooper, 2008), and that different clients may benefit from different levels of purism/integrationism at different points in time. While our pluralistic approach, therefore, is closely associated with an integrative and eclectic approach, we have also been very careful to ensure that it does not negate or exclude the value of single orientation, specialist practices (Cooper & McLeod, 2011b). To do this, we distinguish between a pluralistic sensibility, and a pluralistic practice, per se. A pluralistic sensibility, perspective or viewpoint refers simply to the belief that there is no, one best set of therapeutic methods. This is a general definition, which does not make any specific recommendations about how a therapist might go about implementing

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a pluralistic perspective in their own practice (Cooper & McLeod, 2011b, pp. 78). By contrast, pluralistic practice refers to a specific form of therapy which draws on methods from a range of orientation, and which is characterised by meta-therapeutic dialogue: talking to clients about what they want from therapy and how that might be achieved. Making this distinction is important because, although pluralistic practice is rooted in a pluralistic viewpoint, it is also quite possible for therapists to hold a pluralistic viewpoint while working in a non-pluralistic, single orientation ways (Cooper & McLeod, 2011b, pp. 78). For instance, a person-centred therapist may choose to specialise solely in non-directive practice, but can still be pluralistic in the sense of appreciating and valuing other ways of working, and being open to dialogue with practitioners from other orientations who may bring new perspective to their work. In this respect, the opposite of a pluralistic approach, when considered as a viewpoint or sensibility, is not single orientation practice, but schoolism: the belief that one way of working is superior to others.

Therapist-led versus client-led In attempting to develop a more respectful relationship to clients, a second basic principle of our pluralistic approach is that: If we want to know what is most likely to help clients, we should talk to them about it (Cooper & McLeod, 2011b, pp. 78). This refers to meta-therapeutic dialogue: the process of talking to clients about what they want from therapy, and how they think they may be most likely to achieve it. It is essential to emphasise, however, that talking to clients at a meta-therapeutic level (i.e. about the process of therapy) is not the same as doing what clients want. In attempting to overcome the polarisation between therapist-led and client-led approaches, we have emphasised the importance of both members of the therapeutic dyad bringing their skills, knowledge, intuitions and understandings to the therapeutic exchange, such that the best outcomes can be achieved for the client. The following example of meta-therapeutic dialogue comes from a first session of therapy that Mick had with a client, Saskia (Cooper & McLeod, 2011b, p. 111). Saskia had indicated that she wanted lots of input and guidance in the therapy work. Mick was fairly happy to work in this way, but he also sensed that Saskia had a relatively externalised locus of evaluation (i.e. she tended to look towards others to tell her what to do) and he had some concerns about simply reinforcing this.
Mick: So it sounds like feedback will be useful? Saskia: Yeah, Yeah. Mick: OK. Saskia: Yes, definitely, because . . . . no matter who we are in the world, wherever we are in life, there is always going to be something that weve missed, either because we dont want to see it, or because we just didnt see it. Even if someone is 90% actualised . . . theyre not going to see everything. [So] you [can] turn around and say: You could have said this, you could have done that. And theyre: Oh, really, thanks Mick, I neverI never saw that.

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Mick: I guess the important thing for me, in giving feedback, is that you can say Thats not right [Saskia: Sure.] And you can say, No, that doesnt fit, or Thats not helpful [Saskia: Sure, sure.]. I mean, one of the ways that I like to work isis very much with feedback . . . and that needs you to say to me, No, dont like that . . . Thats good . . .

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In this example, Mick listened to, and tried to engage with, Saskias request for feedback. Yet he also challenged it and invited Saskia to consider a somewhat different way of working: one in which she also felt free to challenge and question Micks responses. In this respect, meta-therapeutic dialogue is not about an uncritical acceptance of the clients viewpoint, but it is also not about its uncritical negation; rather, it is about trying to move from a rigidly client-led or therapist-led position to one which emphasises mutual working together. For therapists, this emphasis on meta-therapeutic dialogue raises the question of when we might be able to communicate with clients in this way. Opportunities for meta-therapeutic dialogue and information-sharing may include: . before therapy begins: e.g. in pre-therapy information, or in initial contact, . assessment/initial sessions: often, this is the principal and most appropriate opportunity to discuss with clients their therapeutic goals and preferred ways of working, . start of sessions: for instance, asking clients what they want from today, . end of sessions: asking clients how they found the session, what helped/did not help and what they might want from the subsequent session, . within sessions: at stuck points, ruptures, after new methods have been introduced or after specific goals have been achieved, . at regular/scheduled review sessions, . end of therapy: reflecting on what worked and did not work, and strategies for on-going development for the client. That such explicit meta-therapeutic dialogue can be helpful is based on the fact that, as therapists, our intuitive understandings of what clients want, need and experience is often way off the mark (Cooper, 2008). Research shows, for instance, that therapists ratings of the quality of the therapeutic relationship tend to show only moderate agreement with clients ratings (e.g. Gurman, 1977; Tryon, Blackwell, & Hammel, 2007); and in just 3040% of instances do therapists agree with clients on what was most significant in therapy sessions (Timulak, 2010). This mismatch has also been evident in our own practice. Within the pluralistic research protocol at the University of Strathclyde (www.pluralistictherapy.com) for instance, both clients and therapists, at the end of the session, rate how helpful they believe the session was on a series of scales. Data here indicates that, although there is a significant overlap between clients and therapists ratings, it is relatively small: only around 14% beyond what would be expected by chance.

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Qualitative, post-session reflections also indicate how different perceptions of a session can be. For instance, the following is Donnas feedback at the end 29, which she had rated overall as Greatly helpful:
Tried to allow myself to feel vulnerable . . . . [The therapist] asked where the sense of shame came from. Not by a dialogue but an invite . . . . Helps me to realise both the extent to which the fear of being the object or violated by others and the trauma of it plays itself out in a way that involves self-isolation.

By contrast, the therapist, Mick, rated the session as Neither helpful nor hindering overall, and gave the following comment:
Not really connected with much, or much new thing coming out.

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In this instance, Micks genuine, intuitive feel for how the session had gone missed much of what Donna had gained from it. There are also examples, however, of therapists rating the session very positively, while clients had a much less satisfactory experience. For instance, in session 5, Mick had been exploring with Sandra about her deep need to connect with others. Mick rated the session, overall, as moderately helpful, and wrote:
[It felt helpful for the client to . . . ] think about the strength of her drive for connection and intimacy with others . . . Develop more awareness of how strong that drive is, and perhaps more able to stand back from it.

The client, however, had had a very different experience of this interaction, rating the session overall as Slightly hindering:
When I was talking about my desire for communication/relationships, the therapist said that he imagines how difficult it must be to feel this, and that few people must feel like this. This made me feel kind of isolated, i.e. the only one feeling like this in the world, and feeling a problematic poison. This makes me more sad and scared.

By being aware of this discrepancy, however, Mick could then come back to this with Sandra in the next session, apologise for wording things clumsily, and work to clarify what he had actually been trying to communicate. By the end of the session, this rupture had been resolved. This example highlights the value that measures and questionnaires can have for facilitating meta-therapeutic dialogue. Such instruments are not a substitute for face-to-face conversations, but the evidence shows that there is much that clients find difficult to say to a therapists face (Hill, Thompson, Cogar, & Denman, 1993; Rennie, 1994). Here, a measure such as the TPF (Bowens & Cooper, this volume) may provide a third space in which a client can privately express their views or experiences, which can then be incorporated back into the therapeutic dialogue. There may also be aspects of the clients experiencing that they are not aware of, or do not realise are legitimate to discuss, until a measure helps them bring it to the fore. As with other aspects of our pluralistic approach, this attempt to transcend the client-led versus therapist-led dichotomy raises a number of questions for our field: . When, and how, might it be most helpful to communicate about metatherapeutic issues with clients?

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M. Cooper and J. McLeod . How can we, most effectively, create an environment where clients feel able to openly and honestly communicate their meta-therapeutic wants and preferences? . In what ways can we become more finely attuned to what will work best for individual clients in therapy?

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Discussion In this article, we have outlined some of the ways in which we feel our pluralistic approach to therapy has attempted to overcome dichotomies and polarisations in our field. In doing so, we believe that it has introduced some innovative ideas and questions about how, as a field, we might more fully engage with our clients in their complexity and heterogeneity. Of course, there is also the danger here of creating one more polarisation: between pluralistic and monistic stances; or even between either/or and both/and positions. A pluralistic stance, therefore, also needs to be pluralistic about pluralism, and recognise that this, too, can become an entrenched position which serves to create further schisms in the field. In other words, a pluralistic position needs to keep a critical eye towards pluralism itself; and not only ask about its value, but also its limits and contradictions. For instance, is there a danger that, in breaking down different therapies into their component parts and attempting to combine them, the true efficacy of the practices as holistic, integrated worldviews gets diluted or even lost? Key, here, may be the question of when meta-therapeutic communication may become too much for clients at certain times: unhelpful, interruptive and inhibiting. One participant, for instance, in a recent qualitative study by Keri Andrews (Andrews, 2011), stated:
As a client, I felt like she would ask me how the session had been for me at the end of every session as a kind of mini-review and I just felt totally, like, put on the spot, and still trying to process whatever we had been talking about. So it kind of took me out of what I had been thinking about and I lost touch with the process, rather than become absorbed in it. And then I do the sort of people pleaser thing of trying to be like Yeah, yeah, it was really good, really helpful, and really want to answer her question as I do not want to say anything was unhelpful as that feels really uncomfortable.

As this quote suggests, another particular schism that a pluralistic approach may need to avoid fostering is that between explicit and implicit therapeutic processes and characteristics. In our work, we have tended to emphasise the importance of explicit, transparent, primarily verbal and conscious therapeutic communications and processes. In doing so, however, there is the danger that the very indefinability that we are striving to honour the mysterious, nonverbal, non-conscious and hidden become marginalised. Loewenthals (2011) post-existentialism, coming from a very similar starting point, has paid much more attention to this realm; arguing that an ethics-based psychotherapy needs to eschew the fixed answers and certainties that can foreclose dialogue. This is something we would very much agree with, such that finding ways of engaging with clients that fully value their un-articulable experiences, while also deeply

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respecting their consciously articulated wants (as they emerge through dialogue), may be an important area for further pluralistic inquiry. To conclude: in this article, we hope to have set out the essential purpose, ethics and method for our pluralistic approach to therapy. In striving to embrace the Otherness and diversity of our clients, we have looked towards ways in which we can overcome polarisations in our field: allowing us to encounter the actual faces of our clients, rather than simply reflections of our own schoolistic assumptions and doctrines. No doubt, as our psychotherapeutic theories suggest, staying open to this multi-faceted Otherness and not falling into fixed, polarised and over-simplified viewpoints is a major challenge. Yet it is what, so often, we hope for in our clients: to transcend the need for certainty and definiteness, and to be able to stand in the paradoxical, unstable and ambiguous.

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Acknowledgements
The authors thank Katie McArthur and students on the 3rd year of the Doctorate in Counselling Psychology at Glasgow Caledonian University/University of Strathclyde (20112012) for their suggestions on opportunities for meta-therapeutic dialogue.

Notes on contributors
Mick Cooper is a Professor of Counselling at the University of Strathclyde, a Chartered Counselling Psychologist, and a UKCP-registered existential psychotherapist. Mick is author of a range of texts in the field of relational therapies, including Existential therapies (Sage, 2003) and Working at relational depth in counselling and psychotherapy (Sage, 2005, with Dave Mearns). Most recently, he co-authored Pluralistic counselling and psychotherapy with John McLeod (Sage, 2011). John McLeod is Emeritus Professor of Counselling at University of Abertay Dundee. He is author of many books and articles, including An Introduction to counselling (Open University Press, 4th edition, 2009), Counselling skills (with Julia McLeod, Open University Press, 2nd edition, 2011), and Pluralistic counselling and psychotherapy (with Mick Cooper, Sage, 2011) and was the founding editor of the Counselling and Psychotherapy Research journal.

References
Andrews, K. (2011). Client narratives of perceived helpful factors of person centred therapy (Doctorate in Counselling Psychology dissertation). University of Strathclyde/Glasgow Caledonian University, Glasgow. Beck, A.T., John, R.A., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford. Beutler, L.E., Blatt, S.J., Alimohamed, S., Levy, K.N., & Angtuaco, L. (2006). Participant factors in treating dysphoric disorders. In L.G. Castonguay & L.E. Beutler (Eds.), Principles of therapeutic change that work (pp. 1363). Oxford: Oxford University Press.

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