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Clinical Psychology

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LESSON 31
CLIENT CENTERED THERAPY
Person-centered therapy, which is also known as client-centered, non-directive, or Rogerian therapy, is an
approach to counseling and psychotherapy that places much of the responsibility for the treatment process
on the client, with the therapist taking a nondirective role.
PURPOSE:
Two primary goals of person-centered therapy are increased self-esteem and greater openness to
experience. Some of the related changes that this form of therapy seeks to foster in clients include closer
agreement between the client's idealized and actual selves; better self-understanding; lower levels of
defensiveness, guilt, and insecurity; more positive and comfortable relationships with others; and an
increased capacity to experience and express feelings at the moment they occur.
BACKGROUND:
Developed in the 1930s by the American psychologist Carl Rogers, client-centered therapy departed from
the typically formal, detached role of the therapist emphasized in psychoanalysis and other forms of
treatment. Rogers believed that therapy should take place in a supportive environment created by a close
personal relationship between client and therapist. Rogers's introduction of the term "client" rather than
"patient" expresses his rejection of the traditionally hierarchical relationship between therapist and client
and his view of them as equals. In person-centered therapy, the client determines the general direction of
therapy, while the therapist seeks to increase the client's insight and self-understanding through informal
clarifying questions.
Beginning in the 1960s, person-centered therapy became associated with the human potential movement.
This movement, dating back to the beginning of the 1900s, reflected an altered perspective of human nature.
Previous psychological theories viewed human beings as inherently selfish and corrupt. For example,
Freud's theory focused on sexual and aggressive tendencies as the primary forces driving human behavior.
The human potential movement, by contrast, defined human nature as inherently good. From its
perspective, human behavior is motivated by a drive to achieve one's fullest potential.
Self-actualization, a term derived from the human potential movement, is an important concept underlying
person-centered therapy. It refers to the tendency of all human beings to move forward, grow, and reach
their fullest potential. When humans move toward self-actualization, they are also pro-social; that is, they
tend to be concerned for others and behave in honest, dependable, and constructive ways. The concept of
self-actualization focuses on human strengths rather than human deficiencies. According to Rogers, self-
actualization can be blocked by an unhealthy self-concept (negative or unrealistic attitudes about oneself).
Rogers adopted terms such as "person-centered approach" and "way of being" and began to focus on
personal growth and self-actualization. He also pioneered the use of encounter groups, adapting the
sensitivity training (T-group) methods developed by Kurt Lewin (1890-1947) and other researchers at the
National Training Laboratories in the 1950s.
While person-centered therapy is considered one of the major therapeutic approaches, along with
psychoanalytic and cognitive-behavioral therapy, Rogers's influence is felt in schools of therapy other
than his own. The concepts and methods he developed are used in an eclectic fashion by many different
types of counselors and therapists.
PROCESS:
Rogers believed that the most important factor in successful therapy was not the therapist's skill or training,
but rather his or her attitude. Three interrelated attitudes on the part of the therapist are central to the success
of person-centered therapy: congruence; unconditional positive regard; and empathy.
Congruence refers to the therapist's openness and genuineness--the willingness to relate to clients without
hiding behind a professional facade. Therapists who function in this way have all their feelings available to
them in therapy sessions and may share significant emotional reactions with their clients. Congruence does
not mean, however, that therapists disclose their own personal problems to clients in therapy sessions or
shift the focus of therapy to themselves in any other way.
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Unconditional positive regard means that the therapist accepts the client totally for who he or she is
without evaluating or censoring, and without disapproving of particular feelings, actions, or characteristics.
The therapist communicates this attitude to the client by a willingness to listen without interrupting,
judging, or giving advice. This attitude of positive regard creates a non threatening context in which the
client feels free to explore and share painful, hostile, defensive, or abnormal feelings without worrying
about personal rejection by the therapist.
The third necessary component of a therapist's attitude is empathy ("accurate empathetic understanding").
The therapist tries to appreciate the client's situation from the client's point of view, showing an emotional
understanding of and sensitivity to the client's feelings throughout the therapy session. In other systems of
therapy, empathy with the client would be considered a preliminary step to enabling the therapeutic work to
proceed; but in person-centered therapy, it actually constitutes a major portion of the therapeutic work itself.
A primary way of conveying this empathy is by active listening that shows careful and perceptive attention
to what the client is saying. In addition to standard techniques, such as eye contact, that are common to any
good listener, person-centered therapists employ a special method called reflection, which consists of
paraphrasing and/or summarizing what a client has just said. This technique shows that the therapist is
listening carefully and accurately, and gives clients an added opportunity to examine their own thoughts and
feelings as they hear them repeated by another person. Generally, clients respond by elaborating further on
the thoughts they have just expressed.
According to Rogers, when these three attitudes (congruence, unconditional positive regard, and empathy)
are conveyed by a therapist, clients can freely express themselves without having to worry about what the
therapist thinks of them. The therapist does not attempt to change the client's thinking in any way. Even
negative expressions are validated as legitimate experiences. Because of this nondirective approach, clients
can explore the issues that are most important to them--not those considered important by the therapist.
Based on the principle of self-actualization, this undirected, uncensored self-exploration allows clients to
eventually recognize alternative ways of thinking that will promote personal growth. The therapist merely
facilitates self-actualization by providing a climate in which clients can freely engage in focused, in-depth
self-exploration.
APPLICATION:
Rogers originally developed person-centered therapy in a children's clinic while he was working there;
however, person-centered therapy was not intended for a specific age group or subpopulation but has been
used to treat a broad range of people. Rogers worked extensively with people with schizophrenia later in
his career. His therapy has also been applied to persons suffering from depression, anxiety, alcohol
disorders, cognitive dysfunction, and personality disorders. Some therapists argue that person-centered
therapy is not effective with non-verbal or poorly educated individuals; others maintain that it can be
successfully adapted to any type of person. The person-centered approach can be used in individual, group,
or family therapy. With young children, it is frequently employed as play therapy.
There are no strict guidelines regarding the length or frequency of person-centered therapy. Generally,
therapists adhere to a one-hour session once per week. True to the spirit of person-centered therapy,
however, scheduling may be adjusted according to the client's expressed needs. The client also decides
when to terminate therapy. Termination usually occurs when he or she feels able to better cope with life's
difficulties.
POSITIVE RESULTS:
The expected results of person-centered therapy include improved self-esteem; trust in one's inner feelings
and experiences as valuable sources of information for making decisions; increased ability to learn from
(rather than repeating) mistakes; decreased defensiveness, guilt, and insecurity; more positive and
comfortable relationships with others; an increased capacity to experience and express feelings at the
moment they occur; and openness to new experiences and new ways of thinking about life.
Outcome studies of humanistic therapies in general and person-centered therapy in particular indicate that
people who have been treated with these approaches maintain stable changes over extended periods of time;
that they change substantially compared to untreated persons; and that the changes are roughly comparable
to the changes in clients who have been treated by other types of therapy. Humanistic therapies appear to be
particularly effective in clients with depression or relationship issues. Person-centered therapy, however,
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appears to be slightly less effective than other forms of humanistic therapy in which therapists offer more
advice to clients and suggest topics to explore.
Limitations:
If therapy has been unsuccessful, the client will not move in the direction of self-growth and self-
acceptance. Instead, he or she may continue to display behaviors that reflect self-defeating attitudes or rigid
patterns of thinking.
Several factors may affect the success of person-centered therapy. If an individual is not interested in
therapy (for example, if he or she was forced to attend therapy), that person may not work well together
with the therapist. The skill of the therapist may be another factor. In general, clients tend to overlook
occasional therapist failures if a satisfactory relationship has been established. A therapist who continually
fails to demonstrate unconditional positive regard, congruence, or empathy cannot effectively use this type
of therapy. A third factor is the client's comfort level with nondirective therapy. Some studies have
suggested that certain clients may get bored, frustrated, or annoyed with a Rogerian style of therapeutic
interaction.
THE HUMANISTIC EXISTENTIAL MOVEMENT:
The strands of phenomenology, humanism, and existentialism in psychology are inextricably woven
together. We know the importance that Rogers attached_ to immediate experience. This is basic
phenomenology. At the same time, client-centered approaches stress the worth, uniqueness, and dignity of
the client. This is basic humanism. Before we proceed to discuss existential therapies, logotherapy, and
Gestalt therapy, let us pause to acknowledge the humanistic tradition that pervades those therapies.
HUMANISM:
Although humanistic psychology is a fairly recent development, its origins extend far back into philosophy
and the history of psychology. When one speaks of humanism, one thinks of psychologists such as Allport,
Goldstein, James, Murray, and Rogers. The values that humanism contributes to psychology are not rooted
in the determinism of either psychoanalysis or behaviorism. From a humanist perspective, people are not
products of the past, the unconscious, or the environment. Rather, they exercise free choice in the pursuit of
their inner potential and self actualization. They are not fragmented patchworks of cognitions, feelings, and
aspirations; rather, they are unified, whole, and unique beings. To understand is to appreciate those
qualities, and this understanding- can only be achieved by an awareness of the person's experience. So-
called scientific constructs based on norms, experiments, or data must give way to intuition and empathy.
The emphasis is not on sickness, deviations, or diagnostic labels, but on positive striving, self-actualization
freedom and naturalness. In one form or another humanism is expressed as a resistance to the positivistic
determinism of science and as an active embrace of the essential humanity of people.
EXISTENTIAL THERAPY:
Existential psychology rejects the mechanistic views of the Freudians and instead sees people as engaged in
a search for meaning. At a time when so many people are troubled by the massive problems of a
technological society and seek to repair their alienated modes of living, existentialism has gained great
popularity. It seems to promise the restoration of meaning to life, an increased spiritual awakening, and
individual growth that will bring freedom from the conventional shackles created by a conformist society.
Hardly a unified movement that speaks with a single voice, the existential view actually turns out to be
many views. When we discuss the psychological applications of existentialism, such names as Binswanger,
Boss, Gendlin, Frankl, May, and Laing come to mind. Philosophically, existentialism springs from the same
sources as does phenomenology.
The existentialists make a number of assertions about human nature. Basic to all is a fundamental human
characteristic: the search for meaning).That search is carried out through imagination, symbolization, and
judgment. All of this occurs in a matrix of participation in society. From the standpoint of their physical,
environment and their biological environment, people function in a social context.
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A crucial facet of personality is decision making, which involves the world of both facts and possibilities.
Thus, personality is not just what one is a biological, social, and psychological being but also what one
might become.
Many existentialists believe that decision making involves a set of inevitable choices. One can choose the
present (the status quo), which represents lack of change and a commitment to the past. That choice_ will
lead to guilt and remorse over missed opportunities. But one can also choose alliance with the future.
That choice propels the person into the future with an anxiety that stems from one's inability to predict and
control the unknown. Such experiences of guilt and anxiety are not learned, but are part of the essence of
living. It requires courage to choose the future and suffer the inevitable anxieties that this -choice entails. A
person can find that courage by having faith in self and by recognizing that choosing the past will inevitably
lead to a guilt that is even more terrifying than anxiety.
THE GOALS OF THERAPY:
The ultimate goal of existential psychotherapy is to help the individual reach a point at which awareness
and decision making can be exercised responsibly. The exercise of cognitive abilities will allow for the
achievement of higher states of love, intimacy, and constructive social behavior. Through therapy, one must
learn to accept responsibility for one's own decisions and to tolerate the anxiety that accumulates as one
moves toward change. This involves self-trust and also a capacity to accept those things in life that are un-
changeable or inevitable.
Techniques:
Existential therapy does not emphasize techniques. Too often, techniques imply that the client is an object
to which those techniques are applied. Instead, the emphasis is on understanding and on experiencing the
client as a unique essence. Therapy is an encounter that should enable the client to come closer to
experience.
By experiencing self, the client can learn to attach meaning and value to life. Sometimes the therapist will
confront the client with questions, questions that force the client to examine the reasons for failure to search
for meaning in life. For example, a client who repeatedly complains that his job is not very fulfilling may be
asked why he does not search for other employment or return to school for more training.
Such questions may force the client to examine his orientation toward the past more closely, and this, in
turn, creates feelings of guilt and a sense of emptiness. Gendlin (1969, 1981) discusses focusing as a means
of reaching the pre-conceptual, felt sense. This is achieved by having clients focus on the concretely felt
bodily sense of what is troubling them. Silences are encouraged to help accomplish this. However, very few
research studies have been published that evaluate the effectiveness of focusing in treating clients; its
efficacy, therefore, remains to be established (Greenberg et al., (994)
Logo therapy:
One of the most widely known forms of existential therapy is logotherapy. This technique encourages the
client to find meaning in what appears to be a callous, uncaring, and meaningless world. Viktor Frankl
developed the technique. His early ideas were shaped by the Freudian influence. However, he moved on an
existential framework as he tried to find ways of dealing with experiences in Nazi concentration camps. He
lost his mother, father, brother, and wife to the Nazi Holocaust and was himself driven to the bunk of death
(Frankl, 1963).
It seemed to him that the persons who could not survive these camps were those who possessed only the
conventional meanings of life to sustain them. But such conventional meanings could not come to grips with
the realities of the Nazi atrocities. Therefore, what was required was a personal meaning for existence.
From his wartime experiences and the existential insights that he felt permitted him to survive, Frankl
developed logotherapy (the therapy of meaning) Frankl's views about personality and his ideas about the
goals of therapy are generally quite consonant with our previous discussion of existentialism. However, it is
not always clear that logotherapy techniques bear any close or rational relationship to the theory.
Logotherapy is designed not to replace but to complement more traditional psychotherapy. However, when
the essence of a particular emotional problem seems to involve agonizing over the meaning or the futility of
life, Frankl regards logotherapy as the specific therapy of choice. Logotherapy_ then strives to inculcate a
sense of the client's own responsibility and obligations to life (once the latter's meaning has been unfolded).
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Frankl makes much of responsibility, regarding it as more important than historical events in the client's
life. What is crucial is the meaning of the present and the outlook for the future.
In particular, two techniques described by Frankl (1960) have gained considerable exposure. Paradoxical
intention is a popular technique in which the client is told to consciously attempt to perform the very
behavior or response that is the object of anxiety and concern. Fear is thus replaced by a paradoxical wish.
For example, suppose that a client complains that she is fearful of blushing when she speaks before a group.
She would be instructed to try to blush on such occasions. According to Frankl, the paradoxical fact is that
she will usually be unable to blush when she tries to do what she fears she will do. Typically, the therapist
tries to handle all of this in a light tone. For example, in the case of a client fearful of trembling before his
instructor, Frankl (1965) instructs he client to say to himself: "Oh, here is the instructor! Now I'll show him
what a good trembler I am-I'll really show him how nicely I can tremble".
The second technique, de-reflection, instructs the client to ignore a troublesome behavior or symptom.
Many clients are exquisitely attuned to their own responses and bodily reactions. Dereflection attempts to
divert the client's attention to more constructive activities and reflections.
Gestalt Therapy
In Gestalt therapy the emphasis is on present experience and on the immediate awareness of emotion and
action. `'Being in touch" with one's feeling replaces the search for the origins of behavior. Existential
problems expressed by a failure to find meaning in life have arisen in a technological society that separates
people from themselves. Gestalt therapy promises to restore the proper balance.
CONCLUDING COMMENTS:
These approaches of treatment including Client centerd, Existential and Humanistic have made several
noteworthy contributions to the field of psychotherapy. Clients' internal experience, feelings, free will, and
growth potential have been brought to the forefront. Demonstrating the importance of the therapeutic
relationship and of rapport is another major contribution.
However, these forms of therapy also present some problems. The sometimes prejudicial language used
implies that other approaches are insensitive and harmful. Feelings seem to be overemphasized, and
behavior underemphasized. Obscure and jargon language is often used, and there is a strong bias against
empirical research and formal assessment. How these forms of treatment will be modified, or if they will
even survive in their present form, remains to be see. A number of trends (such as managed behavioral
health care) pose threats to the popularity and utility of these forms of psychotherapy.
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Table of Contents:
  1. MENTAL HEALTH TODAY: A QUICK LOOK OF THE PICTURE:PARA-PROFESSIONALS
  2. THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST:THE INTERNSHIP
  3. HOW A CLINICAL PSYCHOLOGIST THINKS:Brianís Case; an example, PREDICTION
  4. HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY:THE GREEK PERIOD
  5. HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION
  6. HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT
  7. MODELS OF TRAINING IN CLINICAL PSYCHOLOGY:PROFESSIONAL SCHOOLS
  8. CURRENT ISSUES IN CLINICAL PSYCHOLOGY:CERTIFICATION, LICENSING
  9. ETHICAL STANDARDS FOR CLINICAL PSYCHOLOGISTS:PREAMBLE
  10. THE ROLE OF RESEARCH IN CLINICAL PSYCHOLOGY:LIMITATION
  11. THE RESEARCH PROCESS:GENERATING HYPOTHESES, RESEARCH METHODS
  12. THE CONCEPT OF ABNORMAL BEHAVIOR & MENTAL ILLNESS
  13. CAUSES OF MENTAL ILLNESOVERVIEW OF ETIOLOGY:PANDAS
  14. THE PROCESS OF DIAGNOSIS:ADVANTAGES OF DIAGNOSIS, DESCRIPTION
  15. THE CONCEPT OF PSYCHOLOGICAL ASSESSMENT IN CLINICAL PSYCHOLOGY
  16. THE CLINICAL INTERVIEW:The intake / admission interview, Structured interview
  17. THE ASSESSMENT OF INTELLIGENCE:RELIABILTY AND VALIDITY, CATTELLíS THEORY
  18. INTELLIGENCE TESTS:PURPOSE, COMMON PROCEDURES, PURPOSE
  19. THE USE AND ABUSE OF PSYCHOLOGICAL TESTING:PERSONALITY
  20. THE PROJECTIVE PERSONALITY TESTS:THE RORSCHACH
  21. THE OBSERVATIONAL ASSESSMENT AND ITS TYPES:Home Observation
  22. THE BEHAVIORAL ASSESSMENT THROUGH INTERVIEWS, INVENTORIES AND CHECK LISTS
  23. THE PROCESS AND ACCURACY OF CLINICAL JUDGEMENT:Comparison Studies
  24. METHODS OF IMPROVING INTERPRETATION AND JUDGMENT
  25. PSYCHOLOGICAL INTERVENTIONS AND THEIR GOALS:THE EXPERT ROLE
  26. IMPORTANCE OF PSYCHOTHERAPY:ETHICAL CONSIDERATIONS
  27. COURSE OF NEW CLINICAL INTERVENTIONS:IMPLEMENTING TREATMENT
  28. NATURE OF SPECIFIC THERAPEUTIC VARIABLES:CLIENTíS MOTIVATION
  29. THE BEGINNING OF PSYCHOANALYSIS:THE CASE OF ANNA, THE INSTINCTS
  30. PSYCHOANALYTIC ALTERNATIVES:EGO ANALYSIS, CURATIVE FACTORS
  31. CLIENT CENTERED THERAPY:PURPOSE, BACKGROUND, PROCESS
  32. GESTALT THERAPY METHODS AND PROCEDURES:SELF-DIALOGUE
  33. ORIGINS AND TRADITIONAL TECHNIQUES OF BEHAVIOR THERAPY
  34. COGNITIVE BEHAVIORAL THERAPY:MODELING, RATIONAL RESTRUCTURING
  35. GROUP THERAPY: METHODS AND PROCEDURES:CURATIVE FACTORS
  36. FAMILY AND COUPLES THERAPY:POSSIBLE RISKS
  37. INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY:THE ENVIRONMENT
  38. METHODS OF INTERVENTION AND CHANGE IN COMMUNITY PSYCHOLOGY
  39. INTRODUCTION AND HISTORY OF HEALTH PSYCHOLOGY
  40. APPLICATIONS OF HEALTH PSYCHOLOGY:OBESITY, HEALTH CARE TRENDS
  41. NEUROPSYCHOLOGY PERSPECTIVES AND HISTORY:STRUCTURE AND FUNCTION
  42. METHODS OF NEUROLOGICAL ASSESSMENT:Level Of Performance, Pattern Analysis
  43. FORENSIC PSYCHOLOGY:Qualification, Testifying, Cross Examination, Criminal Cases
  44. PEDIATRIC AND CHILD PSYCHOLOGY: HISTORY AND PERSPECTIVE
  45. INTERVENTIONS & TRAINING IN PEDIATRIC AND CLINICAL CHILD PSYCHOLOGY