Client centered Therapy


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Client centered Therapy

  1. 1. Ethics, Issues & Questions
  2. 2. View of human nature That the basic nature of the human being, when functioning freely, is constructive and trustworthy’ (Rogers, 1961, p.194), is implicit in person centred philosophy. While oft-criticized as being overly optimistic and naïve, such an image does not deny the capacity for destructive thought or action, but rather, stresses the potential of the person for growth (Merry, 2000). In process, and moving toward actualizing their potential – to the extent their environment permits – individuals are viewed as capable of developing socially and emotionally in ‘self-enhancing ways and in a manner which will advance the common good’ (Thorne, 1991, p.97). In (therapeutic) practice this means that the client has the ‘strength to devise, quite unguided, the steps which will lead him to a more mature and more comfortable relationship with his reality’ (Rogers, 1946, p.419, my italics).
  3. 3. A belief in the trustworthiness, inherent goodness and wisdom of the client is considered fundamental to the therapeutic relationship, in which the client (having experienced the counsellor’s attitudes to some degree) is viewed as having the capacity for perceptual and consequently behavioural reorganization (Rogers, 1947). Operating on these assumptions, the best way to ‘help’ the client is through the provision of a relationship (imbued with values/ attitudes inherent in the PCA) wherein he may discover his strengths, move toward finding his own answers and make personal sense of himself and life.
  4. 4. Limitations: inherent in the approach or the individual counsellor?  While maintaining that, ‘the limitations of person-centred therapy reside not in the approach itself, but in the limitations of particular therapists and their ability or lack of it to offer their clients the necessary conditions for change and development’ (Thorne, 1991, p.36), Thorne, nevertheless, freely admits that in his own experience, there are certain kinds of clients who are unlikely to be much helped by the approach (ibid). Similarly, Rogers himself, was of the opinion ‘that psychotherapy of any kind, including person-centred therapy, is probably of the greatest help to people who are closest to a reasonable adjustment to life’ (ibid).That is not to imply however, that the approach – only applicable to neurotic individuals – is inappropriate for and ineffective with more severely disturbed and/or psychotic clients. Research has countered this myth (see Shlien, 2003; Joseph and Worsley, 2005); including the problem laden Wisconsin research project, which provided sufficient evidence to indicate that, the presence of Rogers’ conditions, had some positive impact with (hospitalized psychotic) clients.  Regarding the effectiveness of client-centred therapy, I was very struck by the following words ofRogers (which also convey my experience of how colleagues view the approach):  Sometimes people feel that client-centered therapy is good for going only so far, and when you really strike difficult problems you should probably be more confronting or more this or more that. I think – and I feel quite strongly from my experience – that that is really a mistaken line of thought. I think that when the situation is most difficult, that’s when a client-centered approach is most needed, and what is needed there is a deepening of the conditions…not trying something more technique oriented. (Rogers and Russell, 2002, pp. 258-9)
  5. 5. Principled non-directiveness: the nature of influence A central attitude expressing trust in the client’s organismic self- determination and authority is that of principled non- directiveness. As the ‘very fibre of the core conditions’ (Levitt, 2005, p.6), and a consequence of living person-centred philosophy, this (counsellor) posture offers the client a safe, growth-promoting environment that serves to undermine conditions of worth, enhance self-worth and facilitate congruence and/or psychological adjustment. As ‘an active and pro-active way of interaction’ (Mearns and Thorne, 2000, p.81), non-directivity implies accepting the client’s subjective reality and self-authority respecting his sense of direction (in terms of process and content), and relying upon his capacity (increasingly guided by his organismic valuing process) to explore and resolve his issues. As a ‘facilitative responsiveness’ enabling clients to discover their strengths and become directive of their own lives, the non-directive stance emphasizes that the ‘changing factor’ in therapy, rather than particular therapist skills, interventions, techniques, is in fact the client (Schmid, 2000).
  6. 6. The counsellor’s conscious relinquishing of power – ‘surrender’ of control (Prouty, 2000), through congruence, unconditional acceptance and sensitive empathic understanding, follow from subscribing to a philosophy that genuinely ‘identifies the client as his best expert about his life’ (Bozarth, 1998, p.4). This logical mode of response, serves to protect client autonomy, promote freedom and trust within the relationship, and enable clients to explore, reorganize and identify the value system and lifestyle that they discern (through dialogue) as being important to them (Merry, 2002). Further, since practitioners have an ethical responsibility to strive to mitigate (even unintended) harm to the client, non-directivity in limiting the ‘iatrogenic influence’ (Witty, 2005, p.237) reflects a commitment to the principle of non-maleficence (BACP 2001), thus serving ethical and therapeutic aims.
  7. 7. The crux of non-directivity relates to the nature and extent of the counsellor’s influence and its compatibility with Rogerian philosophy. Perspectives such as those of Patterson and others (mentioned throughout), view non-directivity as a central distinguishing characteristic of the PCA (and a defining criterion of their identity and way of relating with clients). In their practice, there is no room for directivity; not even the ‘instrumental’ kind, which directive in intent, is used to effect change (see Patterson, 2000). For Levitt (2005), it implies ‘only one kind of intent: a shedding of power over the client and his or her process, and letting go of the expert stance or role’ (p.8). When a counsellor presumes to know what is wrong with and best for the client, she has failed to maintain an ‘uncontaminated dedication’ (Bozarth, 1998, p.100) to the client’s narrative and allow the locus of decision-making and responsibility (i.e. internal locus of evaluation) to remain with him. Consequently, ‘the potency of the approach can not be fully realized if the trust of the client by the therapist is short- circuited with interventions and with the therapist’s ideas of what is ‘really’ best for the client’ (ibid, p.5).
  8. 8. In order to facilitate self-ownership and direction, then, counsellors strive not to behave in ways likely to distract the client from focusing on his own experiencing. Nevertheless, since ‘all psychotherapies may be analyzed as occasions of social influence’ (Witty, 2005, p.228), it is generally accepted that influence of some kind is an inevitable part of the counselling process and consequence of ‘being in relationship.’ In fact, as Merry (2000) and others have noted, if this were not a reality, there would be little point, let alone a demand for this type of ‘psychological opportunity’. However, as a person-centred practitioner, one hopes that the nature and extent of influence is consistent with philosophy; that is, ‘the goal of this influence is to free and foster the process of self- actualization in the client. This goal is not chosen by either the therapist or the client – it is given by the nature of the client as a living organism’ (Patterson, 2000, p.182).
  9. 9. Experience as a person-centred counsellor While I aim to create a collaborative, empowering relationship which validates client’s feelings/needs, enhances self-worth and agency, reduces the power imbalance,etc, I am aware of my perceived expert status (often in the initial stages of the relationship). In my experience, however, clients soon learn, through my non-directiveness, that I am not an authority on them/their lives, can and will not ‘rescue’ them (in the sense of becoming a disempowering, external locus of evaluation), and essentially, can not alleviate the suffering that has prompted them to seek help and occasioned our encounter.
  10. 10. Personal value system Adopting a person centred way of being will reflect my personal (including professional) values (and biases!); notions of trust, respect, autonomy, assumptions regarding un/healthy functioning, growth- promoting relationships, etc; and necessarily reveal something of my own ‘moral visions’ (Christopher, 1996); as well as, affect how and what I respond to. Regardless then of how non-directively I realize the conditions, my engagement with clients will, in some way, impact on the nature and direction of the therapeutic encounter.  The point, however, as Merry (2002) remarks, ‘is not to deny that unintended influence and direction might result from the ways in which we respond to clients but to acknowledge the intention to maintain an attitude as free as possible of the desire to control or direct people towards particular predetermined goals’ (p.91)Accordingly, remaining cognizant of how one’s internal process affects one’s ability to attend to the client, including the fact that one’s setting aside (bracketing) of theories, moral visions, will be incomplete or partial (although hopefully, sufficient to be/remain open to the client’s experiencing) is vital (Brazier, 1992).
  11. 11. A different way of being  The person centred counsellor works on the understanding that:  the constructive forces in the individual can be trusted, and relied upon…that the client knows the areas of concern which he is ready to explore…is the best judge as to the most desirable frequency of interviews…can lead the way more efficiently than the therapist into deeper concerns…will protect himself from panic by ceasing to explore an area which is becoming too painful…can achieve for himself far truer and more sensitive and accurate insights into constructive behaviour. (Rogers 1946, p.420)   From this perspective the counsellor’s ‘response-ability’ (Schmid, 2000) to the person of the client, her participation or ‘presence’ (Thorne, 1991) in the relationship reflect the reality that ‘the client-centered therapist stands at an opposite pole, both theoretically and practically’ (Rogers, 1946, p.420) (to other/expert-oriented modalities). In offering a permissive and understanding environment which can allow for ‘a process of communication and encounter which moves towards mutuality and dialogue’, (Schmid, 2000, p.10) the interpersonal relationship is essentially about equality, respect and trust; and as Wilkins (2005) notes, about communicating to the client that he is capable of making decisions about the process and content of his therapy.
  12. 12. Practising ‘client-centredly’: a personal challenge Counsellors experiencing empathy and respectful of the client’s (self- expertise) internal directive, ‘can not be up to other things, have other intentions without violating the essence of person-centered therapy. To be up to other things…whatever that might be – is a ‘yes, but’ reaction to the essence of the approach (Bozarth, 1998, p.11).  In the process of attempting to grasp the client’s inner experience, there have been occasions when I have become a little distracted, and possibly (probably!) been ‘up to other things.’ While my response may spontaneously emerge from our interaction, I am aware of my ‘conditional’ trusting of the client’s ability to grow; a real sense that their ‘getting in touch’ with their AT and movement toward ‘full functionality’, is dependant on their willingness/readiness to explore what ‘I’ conceive to be their ‘blocks to development’. Although a felt sense, or (persistent) concern about some aspect of the client’s story may be shared within the parameters of congruence ,I am also conscious of my desire for clients, particularly at ‘stuck points’ to at least try and look at the underling issues, gain a more accurate perception of aspects of themselves, their current reality, as well as, alternative, more healthy ways of responding/behaving.
  13. 13. Issues and Questions The History of Client-Centered Therapy  Carl Rogers was one of the most influential psychologists of the 20th-century. He was a humanist thinker and believed that people are fundamentally good. He also believed that people  have an actualizing tendency, or a desire to fulfill their potential and become the best people they can be.  Rogers initially started out calling his technique non-directive therapy. While his goal was to be as non-directive as possible, he eventually realized that therapists guide clients even in subtle ways. He also found that clients often do look to their therapists for some type of guidance or direction. Eventually, the technique came to be known as client-centered therapy. Today, Rogers' approach to therapy is often referred to by either of these two names, but it is also frequently known simply as Rogerian therapy.  It is also important to note that Rogers was deliberate in his use of the term client rather than patient. He believed that the term patient implied that the individual was sick and seeking a cure from a therapist. By using the term client instead, Rogers emphasized the importance of the individual in seeking assistance, controlling their destiny and overcoming their difficulties. Self-direction plays a vital part of client-centered therapy.  Much like psychoanalyst Sigmund Freud, Rogers believed that the therapeutic relationship could lead to insights and lasting changes in a client. While Freud focused on offering interpretations of what he believed were the unconscious conflicts that led to a client's troubles, Rogers believed that the therapist should remain non-directive. That is to say, the therapist should not direct the client, should not pass judgments on the client's feelings and should not offer suggestions or solutions. Instead, the client should be the one in control.
  14. 14. How Does Client-Centered Therapy Work? Mental health professionals who utilize this approach strive to create a therapeutic environment that is conformable, non-judgmental and empathetic. Two of the key elements of client-centered therapy are that it: Is non-directive. Therapists allow clients to lead the discussion and do not try to steer the client in a particular direction. Emphasizes unconditional positive regard. Therapists show complete acceptance and support for their clients. According to Carl Rogers, a client-centered therapist needs three key qualities:
  15. 15. Genuineness:  The therapist needs to share his or her feelings honestly. By modeling this behavior, the therapist can help teach the client to also develop this important skill.  Unconditional Positive Regard:  The therapist must accept the client for who they are and display support and care no matter what the client is facing or experiencing. Rogers believed that people often develop problems because they are used to only receiving conditional support; acceptance that is only offered if the person conforms to certain expectations. By creating a climate of unconditional positive regard, the client feels able to express his or her emotions without fear of rejection.  Rogers explained:  "Unconditional positive regard means that when the therapist is experiencing a positive, acceptant attitude toward whatever the client is at that moment, therapeutic movement or change is more likely. It involves the therapist's willingness for the client to be whatever feeling is going on at that moment - confusion, resentment, fear, anger, courage, love, or pride…The therapist prizes the client in a total rather than a conditional way."  Empathetic Understanding:  The therapist needs to be reflective, acting as a mirror of the client's feelings, thoughts. The goal of this is to allow the client to gain a clearer understanding of their own inner thought, perceptions and emotions.  By exhibiting these three characteristics, therapists can help clients grow psychologically, become more self-aware and change their behavior via self- direction. In this type of environment, a client feels safe and free from judgment. Rogers believed that this type of atmosphere allows clients to develop a healthier view of the world and a less distorted view of themselves.
  16. 16. How Effective Is Client-Centered Therapy? Several large-scale studies have shown that the three qualities that Rogers emphasized, genuineness, unconditional positive regard and empathetic understanding, are all beneficial. However, some studies have found that these factors alone are not necessarily enough to promote lasting change in clients.