Friday, December 24, 2010

What is person-centered therapy (PCT)?


Introduction

Psychologist Carl R. Rogers
was the leading figure in the development of phenomenological therapy, and his name has been used synonymously (“Rogerian” therapy) with person-centered therapy (or client-centered therapy). Phenomenological theory is a method of exploration that emphasizes all aspects of human experience. In particular, it highlights the importance of an individual’s creative power, in addition to genetics and environment. Moreover, this theory focuses primarily on a person’s subjective experience (opinions, viewpoints, and understandings) and defines therapy on the basis of a good human-to-human relationship.







Rogers remained primarily concerned with the conditions for personal growth rather than with the development of personality theory; he focused on personality functioning rather than on personality structures. He did, however, offer formal conceptions of personality. The central concepts and key formulations of person-centered therapy were published in Rogers’s Counseling and Psychotherapy: Newer Concepts in Practice (1942), On Becoming a Person (1961), and his landmark book, Client-Centered Therapy (1951). Rogers presented nineteen propositions about personality development. These propositions included the following concepts: Each individual exists in a continually changing world in which he or she is the center. Individuals react to the world as they experience and perceive it; thus, “reality” is defined by the person’s phenomenal field. Behavior is basically the goal-directed attempt of the organism to satisfy its needs as experienced in the phenomenal field. Each individual has a unique perspective—his or her own private world—and to comprehend a person, one must assume a frame of reference from the person’s perspective. Emotion facilitates goal-directed behavior. The structure of the self is formed as a result of evaluative interactions with others; the self is an organized, fluid, yet consistent pattern of perceptions about oneself.


The phenomenal field refers to everything experienced by an individual at any given time. The term “internal frame of reference” refers to the process by which therapists attempt to perceive clients’ experiences and “reality” as closely as they can. An individual’s reality is essentially that which the person perceives. Moreover, it is the person’s subjective experience and perceptions that shape the person’s understanding of reality and guide behavior. Events are significant for an individual if the individual experiences them as meaningful. In treatment, therapists strive to understand clients by understanding their views of themselves and the environment in which they live.




Importance of Self

A central concept within phenomenological theory is the “self” (a structure derived from experiences involving one’s own body or resulting from one’s own actions). The self (or self-concept), then, is a self-picture or self-awareness. It is a changing process that incorporates the individual’s meaning when he or she refers to the characteristics of “I” or “me” in isolation or in relationships with others. The concept of self is also considered to be an organized, consistent, and learned attribute composed of thoughts about self. Rogers views the need for positive regard to be universal. The self-concept depends, in large part, on the “conditions of worth” that a child has learned through interactions with significant others. According to Rogers, the child’s need to maintain the love of parents inevitably results in conflict with his or her own needs and desires. For example, as young children assert greater autonomy, a growing awareness of individuality and uniqueness follows. Quite often, the young child demonstrates a negativistic pattern wherein conflicts become more common as the child’s needs are in conflict with parent desires.


Maladjustment occurs when there is a lack of consistency between one’s concept of self and one’s sensory and visceral experiences. If the self-concept is based on many conditions of worth and includes components of failure, imperfection, and weakness, then a lack of positive self-regard will be evident. When such incongruence occurs, individuals are viewed as being vulnerable to psychological problems. Of particular importance is self-esteem (feelings about self), which is often negative or problematic in clients. Poor self-esteem occurs when the phenomenal self is threatened. A threat for one person is not necessarily a threat for another. A person will experience threat whenever he or she perceives that the phenomenal self is in danger. For example, if a well-adjusted athlete misses the final shot at the buzzer in a close basketball game, he or she will not blame the referees or claim physical illness, but instead will examine this experience and perhaps revise his or her self-concept.




Self-Direction, Self-Actualization, and Congruence

Other key principles that underlie person-centered theory involve the processes of self-direction and self-actualization. According to Rogers, humans have an innate tendency to maintain and enhance the self. In fact, all needs can be summarized as the urge to enhance the phenomenal self. Although the process of self-actualization may become disrupted by a variety of social, interpersonal, and cultural factors (determined in large part by the actions of parents, teachers, and peers), Rogers states that the positive growth tendency will ultimately prevail. This actualizing tendency is what produces the forward movement of life, the primary force on which therapists rely heavily in therapy with clients. Self-actualization refers to the concept that unhampered individuals strive to actualize, enhance, and reach their full potential.


Via self-actualization, a person becomes a fully functioning individual. The qualities of a fully functioning person include being open to experience all feelings while being afraid of none; demonstrating creativity and individual expression; living in the present without preoccupation with past or future; being free to make choices and act on those choices spontaneously; trusting oneself and human nature; having an internal source of evaluation; demonstrating balance and realistic expressions of anger, aggression, and affection; exhibiting congruence between one’s feelings and experience; and showing a willingness to continue to grow.


Congruence is the term used by Rogers and others to imply the correspondence between awareness and experience. If a client is able to communicate an awareness of feelings that he or she is currently experiencing, the behavior is said to be congruent or integrated. On the other hand, if an individual attempts to communicate a feeling (love, for example) to another person while experiencing incongruence (hostility toward that person), the recipient of that individual’s expression of feelings may experience an awareness of miscommunication.




Evolution of Study

Person-centered theory and therapy have evolved since the 1940s. When Rogers published Counseling and Psychotherapy, the predominant view among mental health professionals was that the therapist should act as an expert who directs the course of treatment. Rogers, however, described counseling as a relationship in which warmth, responsiveness, and freedom from coercion and pressure (including pressure from the therapist) are essential. Such an approach to treatment emphasized the client’s ability to take positive steps toward personal growth. This phase, from 1940 to 1950, has been called Rogers’s nondirective period. The second phase, reflective psychotherapy, spanned the years from 1950 to 1957. During this period, Rogers changed the name of his approach to “client-centered counseling” and emphasized the importance of reflecting (paraphrasing, summarizing, and clarifying) the client’s underlying feelings.


The third phase, experiential psychotherapy, has been described as lasting from 1957 to 1970. During this phase, Rogers focused on the conditions that would be necessary and sufficient for change to occur. Results of his studies demonstrated that the most successful clients were those who experienced the highest degree of accurate empathy, and that client ratings, rather than therapist ratings, of the quality of the therapeutic relationship were most closely associated with eventual success or failure. Also evident during this phase of development was Rogers’s deemphasis of psychotherapy techniques, such as reflection. Instead, he focused more on the importance of basic therapist attitudes. By so doing, he encouraged a wider range of therapist behaviors to establish the essential relationship components of empathy, positive regard, and congruence. Therapists were encouraged to attend to their own experiences in the session and express their immediate feelings in the therapy relationship.


In 1974, Rogers changed the name of his approach to person-centered therapy. Rogers believed that person-centered therapy more appropriately described the human values that his approach incorporates. Since the 1970s, an additional phase of person-centered therapy, incorporating a more eclectic approach to treatment, has evolved. Specifically, person-centered therapists frequently employ strategies that focus on thoughts, feelings, and values from other schools of psychotherapy within the framework of a productive, accepting relationship. Person-centered approaches have been successfully incorporated into teaching and educational curricula, marriage programs, and international conflict-resolution situations.




Therapeutic Relationships

Person-centered therapy aims to increase the congruence, or matching, between self-concept and organismic experience. As Rogers described it, psychotherapy serves to “free up” the already existing capacity in a potentially competent individual, rather than consisting of the expert manipulation of techniques designed to change personality. The primary mechanism for reintegration of self and experience is the interpersonal relationship between therapist and client. In fact, the therapeutic relationship is viewed as being of primary importance in promoting healing and growth. Thus, it is this relationship in and of itself that produces growth in the client. Rogers argues that the process of therapy is synonymous with the experiential relationship between client and therapist; change occurs primarily as a result of the interaction between them.


As described by N. J. Raskin and Rogers in 1989, the most fundamental concept in person-centered therapy is trust—that is, trust in clients’ tendency to grow toward actualization and trust in clients’ ability to achieve their goals and run their lives. Similarly, it is important that the therapist be seen as a person in the relationship (not as a role), and that the therapist be appreciated and regarded with trust. Rogers stated that clients enter treatment in a state of incongruence, often resulting in vulnerability and anxiety. For treatment to be effective, he identified three necessary and sufficient ingredients for constructive change: The counselor experiences empathic understanding of the client’s internal frame of reference, the counselor experiences unconditional positive regard for the client, and the counselor acts congruently with his or her own experience, becoming genuinely integrated into the relationship with the client. It is also essential to the therapy process that the counselor succeed in communicating unconditional positive regard, genuineness, and empathic understanding to the client.


Of particular importance is empathy. Empathy reflects an attitude of interest in the client’s thoughts, feelings, and experiences. Moreover, Rogers describes empathy as “a way of being” that is powerfully curative because of its nonevaluative and accepting quality. In fact, the process of conveying accurate empathic understanding has been described as the most important aspect of the therapeutic endeavor. Therapists who convey this form of sensitivity to the needs, feelings, and circumstances of the client can in essence climb inside the client’s subjective experience and attempt to understand the world as he or she does. Empathy facilitates a process through which clients assume a caring attitude toward themselves. Moreover, empathy allows clients to gain a greater understanding of their own organismic experiencing, which in turn facilitates positive self-regard and a more accurate self-concept.


In perhaps all of their previous relationships, clients have learned that acceptance is conditional on acting in an acceptable manner. For example, parents typically accept children if they do as they are told. In therapy, however, Rogers argued that no conditions of worth should be present. Acceptance of the client as a fallible yet essentially trustworthy individual is given without ulterior motives, hidden causes, or subtle disclaimers. The primary challenge of the therapist’s unconditional positive regard comes with clients whose behavior and attitude run strongly counter to the therapist’s beliefs. A sex offender, an abusive parent, or a lazy client can test a therapist’s level of tolerance and acceptance. Rogers’s position is that every individual is worthy of unconditional positive regard.


Genuineness refers to the characteristic of being congruent—the experience of therapists who appropriately express the behavior, feelings, and attitudes that the client stimulates in them. For example, a person does not laugh when sad or angry. Similarly, acting congruently with one’s own emotional experience does not mean hiding behind a mask of calm when a client makes upsetting statements. Rogers believed that, in the long run, clients would respond best to a “real person” who is dedicated to the client’s welfare and acts in an honest and congruent manner.




Seven Steps of Therapy

In person-centered treatment, sessions are usually scheduled once or twice a week. Additional sessions and telephone calls are typically discouraged to avoid dependency on the therapist that will stifle personal growth. Rogers has described the general process of therapy as involving a series of seven steps. Step one is an initial unwillingness to reveal self and an avoidance of feelings; close relationships may be perceived as threatening or dangerous. In step two, feelings are described briefly, but the person is still distant from his or her own personal experience and externalizes issues; the person begins to show recognition that conflicts and difficulties exist. In step three, describing past feelings becomes unacceptable; there is more self-disclosure and expression, and the client begins to question the validity of his or her constructs and beliefs.


Step four involves the description of personal feelings as owned by the self and a limited recognition that previously denied feelings may exist; there is an increasing expression of self-responsibility. Step five involves the free expression and acceptance of one’s feelings, an awareness of previously denied feelings, a recognition of conflicts between intellectual and emotional processes, and a desire to be who one really is. In step six, there is an acceptance of feelings without the need for denial and a willingness to risk being oneself in relationships with others. In step seven, the person is comfortable with his or her self, is aware of new feelings and experiences, and experiences minimal incongruence.




Influences

As Rogers began his career during the late 1930s, psychoanalysis was the primary approach to psychotherapy and the dominant model in personality theory. Though Rogers was subjected to traditional psychoanalytic influences, his perspective was nearly the exact opposite of Sigmund Freud’s theory; Rogers tended to reject the notion of unconscious processes. Instead, he was strongly influenced by the therapeutic approach of psychoanalyst Otto Rank
(and his followers at the University of Pennsylvania School of Social Work), the relationship therapy of social worker Jessie Taft, and the feeling-focused approach of social worker Elizabeth Davis. Rank believed that clients benefit from the opportunity to express themselves in session, exhibit creativity in treatment, and even dominate the therapist. Taft emphasized that there are key components to the therapeutic relationship (including a permissive therapeutic environment and a positive working relationship between the therapist and client) that are more important than psychoanalytic explanations of the client’s problems. Davis focused almost exclusively on the feelings being expressed in treatment by her clients. From his association with Davis, Rogers developed the therapy component referred to as reflection of feelings. Rogers believed strongly that no individual has the right to run another person’s life. Thus, his therapeutic approach was generally permissive and accepting, and he generally refused to give advice to clients.




Contributions to Psychology

Person-centered approaches have made major contributions to therapy, theory, and empirical research. In fact, Rogers was responsible for the first systematic investigations of the therapeutic process. He was the first to employ recordings of therapy sessions to study the interactive process and to investigate its effectiveness. Although the use of such recordings is now commonplace in most training programs, Rogers’s willingness to open his approach to such scrutiny was unusual for its time.


Person-centered therapy has generated numerous research contributions. A 1971 review of research on “necessary and sufficient” conditions concluded that counselors who are accurately empathic, genuine, and nonpossessively warm tend to be effective with a broad spectrum of clients regardless of the counselors’ training or theoretical orientation. The authors also concluded that clients receiving low levels of such conditions in treatment showed deterioration. Many researchers have questioned the “necessary and sufficient” argument proposed by Rogers, however; they suggest that the therapeutic conditions specified by Rogers are neither necessary nor sufficient, although such therapeutic approaches are facilitative.


Although Rogers’s approach was developed primarily for counseling clients, the person-centered approach has found many other applications. Person-centered approaches are frequently used in human relations training, including paraprofessional counselors, YWCA-YMCA volunteers, crisis center volunteers, Peace Corps and VISTA workers, and charitable organization workers. Small group therapy programs and personal growth groups also make frequent use of person-centered approaches.




Bibliography


Bazzano, Manu. "One More Step: From Person-Centered to Eco-Centered Therapy." Person-Centered & Experiential Psychotherapies 12.4 (2013): 344–54. Print.



Joseph, Stephen, and David Murphy. "Person-Centered Approach, Positive Psychology, and Relational Helping: Building Bridges." Journ. of Humanistic Psychology 53.1 (2013): 26–51. Print.



Kirschenbaum, Howard. Life and Work of Carl Rogers. Alexandria: American Counseling Association, 2009. Print.



Prouty, Gary. Theoretical Evolutions in Person-Centered/Existential Therapy. Westport: Praeger, 1994. Print.



Raskin, N. J., and Carl R. Rogers. “Person-Centered Therapy.” Current Psychotherapies. Ed. Raymond J. Corsini and Danny Wedding. 4th ed. Itasca: Peacock, 1989. Print.



Rogers, Carl R. Client-Centered Therapy. 1951. Reprint. Boston: Houghton, 1965. Print.



Rogers, Carl R. Counseling and Psychotherapy: Newer Concepts in Practice. 1942. Reprint. Boston: Houghton, 1960. Print.



Rogers, Carl R. On Becoming a Person. Boston: Houghton, 1995. Print.



Rogers, Carl R. A Way of Being. Boston: Houghton, 1995. Print.



Smyth, David. Person-Centered Therapy with Children and Young People: A Child-Centered Approach. London: Sage, 2013. Print.



Thorne, Brian. Carl Rogers. 2d ed. Thousand Oaks: Sage, 2003. Print.



Thorne, Brian, and Elke Lambers, eds. Person-Centered Therapy: A European Perspective. Thousand Oaks: Sage, 1998. Print.

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