CLIENT CENTERED THERAPY:PURPOSE, BACKGROUND, PROCESS

<< PSYCHOANALYTIC ALTERNATIVES:EGO ANALYSIS, CURATIVE FACTORS

GESTALT THERAPY METHODS AND PROCEDURES:SELF-DIALOGUE >>

Clinical Psychology (PSY401)

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.

230

Clinical Psychology (PSY401)

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,

231

Clinical Psychology (PSY401)

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.

232

Clinical Psychology (PSY401)

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).

233

Clinical Psychology (PSY401)

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.

234

Table of Contents: