Monday, January 11, 2010

Person-Centered Therapy



 The person-centered approach is based on concepts from humanistic psychology.  Roger’s basic assumptions are that people are essentially trustworthy, that they have a vast potential for understanding themselves and resolving their own problems without direct intervention on the therapist’s part, and that they are capable of self-directed growth if they are involved in a specific kind of therapeutic relationship.  Roger’s emphasized the attitudes and personal characteristics of the therapist and the quality of the client-therapist relationship as the prime determinants of the outcome of the therapeutic process.  He consistently relegated to a secondary position matters such as the therapists knowledge of theory and techniques.  This belief in the client’s capacity for self-healing is in contrast with many theories that view the therapist’s techniques as the most power agents that lead to change.  Rogers revolutionized the field of psychotherapy by proposing a theory that centered on the client as the agent for self-change.  Contemporary person-centered therapy is the result of an evolutionary process that continues to remain open to change and refinement.  Rogers did not present the person-centered theory as a fixed and completed approach to therapy.
4 Periods of Development of the Approach:
(1)  In the first period, during the 1940s, Rogers developed what was known as nondirective counseling as a reaction against the directive and traditional psychoanalytic approaches to individual therapy. Roger’s theory emphasized the counselor’s creation of a permissive and nondirective climate.  Rogers also challenged the validity of commonly accepted therapeutic procedures such as advice, suggestion, direction, persuasion, teaching, diagnosis, and interpretation.  This was based on his conviction that diagnostic concepts and procedures were inaccurate, prejudicial, and often misused.  Nondirective counselors avoided sharing a great deal about themselves with clients and instead focused mainly on reflecting and clarifying the clients’ verbal and nonverbal communications with the aim of gaining insight into the feelings expressed by clients.
(2)  In the second period, during the 1950s, Rogers renamed his approach client-centered therapy to reflect its emphasis on the client rather than on directive methods.  This period focused on the phenomenological world of the client.  Rogers assumed that the best vantage point for understanding how people behave was from their own internal frame of reference.  He focused more explicitly on the actualizing tendency as the basic motivational force that leads to client change.
(3)  The third period, beginning in the late 1950s and extending into the 1970s, addressed the necessary and sufficient conditions of therapy.  The process of “becoming one’s experience” is characterized by an openness to experience, a trust in one’s experience, an internal locus of evaluation, and the willingness to be in process.  He was interested in how people best progress in psychotherapy, and he studied the qualities of the client-therapist relationship as a catalyst leading to personality change.  Client-centered philosophy was applied to education and was called student-centered teaching.  It was also applied to encounter groups, led by laypersons in the 1960s.
(4)  The fourth phase, during the 1980s and 1990s, was marked by considerable expansion to education, industry, groups, conflict resolution, and the search for world peace.  The theory became known as person-centered approach.  This shift in terms reflected the broadening application of the approach.  Areas of further application include education, health care, cross-cultural and interracial activity, international relations, politics, and the achievement of world-peace.
Existentialism and Humanism:
In the 1960s and 1970s, there was a growing interest among counselors in a “third force” in therapy as an alternative to the psychoanalytic and behavioral approaches.  Under this heading fall existential therapy, the person-centered approach, and Gestalt therapy.  Existentialism and humanism are alike in that they share a respect for the client’s subjective experience and a trust in the capacity of the client to make positive and constructive conscious choices.  They have in common an emphasis on concepts such as freedom, choice, values, personal responsibility, autonomy, purpose, and meaning.  They differ in that existentialists take the position that we are faced with anxiety of choosing to create an identity in a world that lacks intrinsic meaning.  Humanists believe that each of us has a natural potential that we can actualize and through which we can find meaning.
The underlying vision of humanistic philosophy is captured by the metaphor of how an acorn, if provided with the appropriate conditions, will “automatically” grow in positive ways, pushed naturally toward its actualizations as an oak.  In contrast, for the existentialist there is nothing that we “are,” no internal “nature” we can count on.  We are faced at every moment with a choice about what to make of this condition.
The existential and person-centered approaches have parallel concepts with regard to the client-therapist relationship at the core of therapy.  The phenomenology that is basic to the existentialist approach is also fundamental to person-centered theory.  Both approaches focus on the client’s perceptions and call for the therapist to enter the client’s subjective world, and both approaches emphasize the client’s capacity for self-awareness and self-healing.
KEY CONCEPTS
View of Human Nature:  A common theme originating in Roger’s early writing and continuing to permeate all of his works is a basic sense of trust in the client’s ability to move forward in a constructive manner if conditions fostering growth are present.  Rogers maintains that people are trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives.  When therapists are able to expeience and communicate their realness, caring, and nonjudgmental understanding, significant changes in the client are most likely to occur.
He maintains that three therapist attributes create a growth-promoting climate in which individuals can move forward and become what they are capable of becoming:
1. congruence (genuineness, or realness)
2. unconditional positive regard (acceptance and caring)
3. accurate empathic understanding (an ability to deeply grasp the subject world of another person)
If therapists communicate these attitudes, those being helped will become less defensive and more open to themselves and their world, and they will behave in prosocial and constructive ways.  The basic drive to fulfillment implies that people will move toward health if the way seems open for them to do so.  The goals of counseling are to set clients free and to create those conditions that will enable them to engage in meaningful self-exploration.
The actualizing tendency is a directional process of striving toward realization, fulfillment, autonomy, self-determination and perfection.  This growth force within us provides an internal source of healing, but it does not imply a movement from relationships, interdependence, connection, or socialization.  The therapist places the primary responsibility on the client.  The person-centered approach rejects the role of the therapist as the authority who knows best and of the passive client who merely follows the dictates of the therapist.  
The person-centered therapist focuses on the constructive side of human nature, on what is right with the person, and on the assets the individual brings to therapy.  The emphasis is on how clients act in their world with others, how they can move forward in constructive directions, and how they can successfully encounter obstacles (both from within themselves and outside of themselves) that are blocking their growth.  Practitioners with a humanistic orientation encourage their clients to make changes that will lead to living fully and authentically with the realization that this kind of existence demands a continuing struggle.  People never arrive at a final or a static state of being self-actualized; rather, they are continually involved in the process of actualizing themselves.
THE THERAPEUTIC PROCESS
Therapeutic Goals:  The goals of person-centered therapy are different from those of traditional approaches.  The person-centered approach aims toward a greater degree of independence and integration of the individual.  Its focus is on the person, not on the person’s presenting problem.  Its purpose is to assist clients in their growth process.
The underlying aim of therapy is to provide a climate conducive to helping the individual become a fully functioning person.  Before clients are able to work toward that goal, they must first get behind the masks they wear, which they develop through the process of socialization.  Clients come to recognize that they have lost contact with themselves by using facades.
When the facades are worn away during the therapeutic process, what kind of person emerges from behind the pretense?  Rogers describes people who are becoming increasingly actualized as having (1) an openness to experience (2) a trust in themselves (3) an internal source of evaluation, and (4) a willingness to continue growing.  Encouraging these characteristics is the basic goal of person-centered therapy.  The therapist does not choose specific goals for the client.  The cornerstone of person-centered theory is the view that clients in a relationship with a facilitating therapist have the capacity to define and clarify their own goals.
Therapist’s Function and Role:  The role of person-centered therapists is rooted in their ways of being and attitudes, not in techniques designed to get the client to “do something.”  Basically, therapists use themselves as an instrument of change.  It is the therapist’s attitude and belief in the inner resources of the client that create the therapeutic climate for growth.
Person-centered therapist avoid certain functions:  
• They generally do not take a history, 
• They avoid asking leading and probing questions,
• They do not make interpretations of the client’s behavior, 
• They do not evaluate the client’s ideas or plans, and, 
• They do not decide for the client about the frequency or length of the therapeutic venture.
The therapist’s function is to be present and accessible to clients and to focus on their immediate experience.  First and foremost, the therapist must be willing to be real in the relationship with clients.  By being congruent, accepting, and empathic, the therapist is a catalyst for change.  The therapist meets the client on a moment-to-moment experiential basis and enters their world.  Clients are then able to loosen their defenses and rigid perceptions and move to a higher level of personal functioning.  Clients become less defensive and more open to possibilities within themselves and in the world.
Client’s Experience in Therapy:  Clients come to the counselor in a state of incongruence; that is, a discrepancy exists between their self-perception and their experience in reality.  The client must perceive that a problem exists or that they are uncomfortable enough with their present psychological adjustment to want to explore possibilities for change.
One reason clients seek therapy is a feeling of basic helplessness, powerlessness, and an inability to make decisions or effectively direct their own lives.  Clients can learn to be freer by using the relationship to gain greater self-understanding.
As counseling progresses, clients are able to explore a wider range of beliefs and feelings.  With therapy, people distort less and move to a great acceptance and integration of conflicting and confusing feelings.  They increasingly discover aspects within themselves that had been kept hidden.  As client feel understood and accepted, their defensiveness is less necessary, and they become more open to their experience.  Because they are not as threatened, feel safer, and are less vulnerable, they become more realistic, perceive others with greater accuracy, and become better able to understand and accept others.  They become less oriented to meeting others’ expectations, and thus they begin to behave in ways that are truer to themselves.  These individuals empower themselves to direct their own lives instead of looking outside of themselves for answers.  With increased freedom they tend to become more mature psychologically and more actualized.
The client is the primary agent of change.  The therapy relationship provides a supportive structure within which clients’ self-healing capacities are activated.
Relationship Between Therapist and Client:  Rogers based his hypothesis of the “necessary and sufficient conditions for therapeutic personality change” on the quality of the relationship.  Roger’s hypothesis is as follows:
1. Two persons are in psychological contact.
2. The first, or the client, is in a state of incongruence, being vulnerable or anxious.
3. The second person, or the therapist, is congruent or integrated in the relationship.
4. The therapist experiences unconditional positive regard for the client.
5. The therapist experiences an empathic, understanding of the client’s internal frame of reference and endeavors to communicate this experience to the client.
6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.
Rogers hypothesized that no other conditions were necessary.  If the core conditions exist over some period of time, constructive personality change will occur.  The core conditions do not vary according to client type.  Further, they are both necessary and sufficient for all approaches to therapy and apply to all personal relationships, not just to psychotherapy.
The client-therapist relationship is characterized by equality.  As clients experience the therapist listening in an accepting way to them, they gradually learn how to listen acceptingly to themselves.
This approach is perhaps best characterized as a way of being and as a shared journey in which therapist and client reveal their humanness and participate in a growth experience.  The core conditions of congruence, unconditional positive regard, and accurate empathic understanding are embraced by many therapeutic schools as helpful in facilitating therapeutic change.
Congruence, or genuineness.  Congruence implies that therapists are real, that is, they are genuine, integrated, and authentic during the therapy hour.  They can openly express feelings, thoughts, reactions, and attitudes that are present in the relationship with the client.
Through authenticity the therapist serves as a model of a human being struggling toward greater realness.  Being congruent might necessitate the expression of anger, frustration, liking, attraction, concern, boredom, annoyance, and a range of other feelings in the relationship.  This does not mean that therapists should impulsively share all their reactions, for self-disclosure must also be appropriate and well-timed.  Sharing because one thinks it will be good for the client without being genuinely moved to express something regarded as personal, can be incongruent.  Congruence exists on a continuum rather than on an all-or-nothing basis, as is true of all three core conditions.
Unconditional positive regard and acceptance.  The second attitude therapists need to communicate is deep and genuine caring for the client as a person.  The caring is unconditional; it is not contaminated by evaluation or judgment of the client’s feelings, thoughts, and behavior as good or bad.  Therapists value and warmly accept clients without placing stipulations on their acceptance.  Clients are free to have feelings and experiences without risking the loss of their therapists’ acceptance.  Acceptance is the recognition of clients’ rights to have their own beliefs and feelings; it is not the approval of all behavior.  All overt behavior need not be approved or accepted.  Rogers makes it clear that it is not possible for therapist to genuinely feel acceptance and unconditional caring at all times.  However, if therapists have little respect for their clients, or an active dislike or disgust, it is not likely that the therapeutic work will be fruitful.
Accurate empathic understanding.  One of the main tasks of the therapist is to understand clients’ experience and feelings sensitively and accurately as they are revealed in the moment-to-moment interaction during the therapy session.  The therapist strives to sense clients’ subjective experience, particularly in the here-and-now.
Empathic understanding implies that the therapist will sense clients’ feelings as if they were his or her own without becoming lost in those feelings.  Part of empathic understanding is the therapist’s ability to reflect the experiencing of clients.  One of the functions of therapist reflection is to encourage and enable clients to become more reflective themselves.
Accurate empathy is the cornerstone of the person-centered approach.  It is a way for therapists to hear the meanings expressed by their clients that often lie at the edge of their awareness.  Full empathy entails understanding the meaning and feeling of a client’s experiencing.  Empathy is an active ingredient of change that facilitates client’s cognitive processes and emotional self-regulation.  Empathy is a deep and subjective understanding of the client with the client.  Therapists must not lose their own separateness.
APPLICATION

Many followers of Rogers simply imitated his reflective style, and client-centered therapy has often been identified primarily with the technique of reflection.
Evolution of person-centered methods.  What is essential for clients’ progress is the therapist’s presence, which refers to the therapist being completely engaged and absorbed in the relationship with the client.  The therapist is empathically interested in the client and is congruent in relation to the client.  This presence is far more powerful than any techniques a therapist might use to bring about change.  Therapist congruence is basic to establishing trust and safety with clients, and the therapy process is likely to be adversely affected if the therapist is not fully authentic.
The role of assessment.  From a person-centered perspective, what matters is the client’s self-assessment.  The best source of knowledge about the client is the individual client.
Rogers recommended caution in using tests or in taking a complete case history at the outset of counseling.  If a counseling relationship began with a battery of tests, he believed clients could get the impression that the counselor would be providing the solutions to their problems.  It may not be a question of whether to incorporate assessment into therapeutic practice but of how to involve clients as fully as possible in their assessment and treatment process.
Areas of application.  Person-centered therapy has been proven effective with a wide range of client problems including anxiety disorders, alcoholism, psychosomatic problems, agoraphobia, interpersonal difficulties, depression, cancer, and personality disorders.  It has proven to be especially applicable in crisis intervention such as unwanted pregnancy, an illness, or the loss of a loved one.  When people are in crisis, one of the first steps is to give them an opportunity to fully express themselves.  Sensitive listening, hearing, and understanding are essential at this point.  Being heard and understood helps ground people in crises, helps to calm them in the midst of turmoil, and enables them to think more clearly and make better decisions.  Although a person’s crisis is not likely to be resolved by one or two contacts with a helper, such contacts can pave the way for being open to receiving help later.  Communicating a deep sense of understanding should always precede other more problem-solving interventions.
The person-centered approach demands a great deal of the therapist.  An effective person-centered therapist must be grounded, centered, present, focused, patient, and accepting in a way that involves maturity.  Without a person-centered attitude or way of being, mere application of skills is likely to be hollow.
MULTICULTURAL PERSPECTIVE
Contributions.  Person-centered therapy has made significant contributions to the field of human relations with diverse cultural groups.  The emphasis on the core conditions makes the person-centered approach useful in understanding diverse worldviews.
Limitations.  Many clients who come to community mental health clinics or who are involved in outpatient treatment want more structure than is provided by this approach.  They expect a directive counselor and can be put off by one who does not provide sufficient structure.
A second limitation of the person-centered approach is that it is difficult to translate the core conditions into actual practice in certain cultures.  Clients accustomed to indirect communication may not be comfortable with direct expression of empathy or self-disclosure on the therapist’s part.
A third limitation is that this approach extols the value of an internal locus of evaluation.  Yet some ethnic groups value collectivism more than individualism.  In these cultures, clients are likely to be highly influenced by societal expectations and not simply motivated by their own personal preference.
Contributions of the person-centered approach:  Rogers had a major impact on the field of counseling and psychotherapy.  When he introduced his revolutionary ideas in the 1940s, he provided a powerful and radical alternative to psychoanalysis and to the directive approaches then practiced.  Rogers was a pioneer in shifting the therapeutic focus from an emphasis on technique and reliance on therapist authority to that of relationship.  One of Rogers’s contributions to the field of psychotherapy was his willingness to state his concepts as testable hypotheses and to submit them to research.  He literally opened the field to research.  Person-centered therapy has demonstrated that therapist empathy plays a vital role in facilitating constructive changes in the client:
• Research consistently demonstrates that therapist empathy is the most potent predictor of client progress in therapy.
• Empathy is an essential component of successful therapy in every therapeutic modality.
• Empathy is a basic component of emotional intelligence.
• Client perception of therapist empathy, as opposed to that of external raters or therapists, is mot predictive of positive client outcome.
Limitations of the person-centered approach:  A potential limitation of this approach is the way that some students in training and practitioners with a person centered orientation have a tendency to be very supportive of clients without being challenging.  A related challenge for counselors using this approach is to truly support clients in finding their own way.  Counselors sometimes experience difficulty in allowing clients to decide their own specific goals in therapy.  It is easy to give lip service to the concept of clients’ finding their own way, but it takes considerable respect for clients and faith on the therapist’s part to encourage clients to listen to themselves and follow their own directions, particularly when they make choices that are not what the therapist hoped for.
Dr. Rebecca Curtis

4 comments:

  1. it is wierd how your posts cite a Dr. Rebecca Curtis but are actually taken directly from Gerald Corey's texts.

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  2. i was just going to say the same thing

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  3. that is plagiarism I believe.

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  4. absolute plagarism - from Corey's 2009 text - bad form, not even to cite - bad bad bad form

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