Michael Dadson - What is my theory of counselling psychology person centered?

Theory of Counselling
Person-Centered
Michael Dadson
Counselling Psychology
Clinical Comprehensive Exam

⦿ I) Key Elements of the Theoretical Perspective:
• A) View of Human nature:
• B) View of Personality:
⦿ II) Theoretical Perspective’s Process of
Counselling:
• A) The Person of the Therapist:
• B) The Therapeutic Relationship:
• C) Mechanisms of change:
• D) Goals of Therapy:
• E) Interventions and techniques:
• F) Assessment and Criteria of Effectiveness:
⦿ III) Research Support and Rationale for Use:
Michael Dadson Person-Centered

I) Key Elements of the
Theoretical Perspective:
⦿A) View of Human nature: Tageson, 1982
• Basic trust in the person’s growth tendency.
• Basic trust in the pull to fulfill one’s potential.
• Basic optimism in the person’s capacity to
overcome life’s restricting experiences.

I) Key Elements of the
Theoretical Perspective:
⦿B) View of Personality:
• The human personality is in constant moving process.
Nuttin (1962)
• This process leads to: self-actualization, self
transcendence, self-awareness. This becoming is the
moral gift of the self.
• This process transforms a human being into a
genuinely caring person who will safeguard the best
interests of humanity in general (Tageson, 1982)

II) Theoretical Perspective’s
Process of Counselling:
⦿ A) The Person of the Therapist:
⦿ The therapist is a process expert who can facilitate
the development of the human psyche. Like a
farmer, the therapist sets the conditions that
cultivate the growth of the human mind.
⦿ The therapist seeks to increase the client's
awareness of his or her current feelings,
perceptions, and physical state.
⦿ The therapist views clients as being experts in
their own experience (Angus, & Kagan, 2007).

⦿B) The Therapeutic Relationship:
• Being understood and accepted by a genuine,
engaged and empathic listener, in the therapeutic
relationship, enables clients to disclose their most
important and emotionally salient personal
experiences to the therapist (Angus & Hardtke,
2006).

• Once externalized as a story, clients are then able
to “stand back” from and actively reflect on their
inner world of emotions, intentions, motives,
goals, expectations, and beliefs.
• This process provides the conditions necessary to
create moments where the client is able to sense
and see themselves.

• The relationship itself, combined with the proper
conditions, engages the client in a process that
results in the hopeful expectancy for change and a
heightened capacity to take action (Angus &
Hardtke, 2006).

⦿C) Mechanisms of change:
⦿The therapist, the therapeutic
relationship and the facilitating
conditions stimulate the actualizing
tendency that pulls the client towards
goals that she sets.

⦿C)Mechanisms of change:
⦿The human actualizing tendency is
the inherent propensity of persons to
develop and form more differentiated
and integrated personal life structures
(Bohart, 2005).

⦿C) Mechanisms of change:
⦿It is this self-righting preference that is
the primary force of change in
psychotherapy; the human growth
tendency facilitated within the
therapeutic relationship and activated
by the conditions of change (Bohart,
2005).

⦿D) Goals of Therapy:
⦿congruence,
⦿self-awareness,
⦿self-determination
⦿self-transcendence (Tageson, 1982).
⦿“The fully functioning person”

⦿ D) Goals of Therapy:
⦿ “The fully functioning person” as illustrated by the six modes of
experiencing.
⦿Rogers differentiated six process stages of
being and experiencing as a person. In the
following figures illustrate his
understanding of personality, its
relationship to the actualizing tendency,
and how these intersect with conditions of
change.

⦿The Person as Process: six process
modes of being and experiencing as a
person.
• 1. Change in relationship to feelings.
• 1 2 3 4 5 6 7
⦿ The necessary conditions stimulating the actualizing tendency
Feelings are sensed,
differentiated, and
expressed in the living
moment.
Person does not
recognize feelings.

⦿The Person in Process: six process
person.
• 2. Change in manner of experiencing.
• 1 2 3 4 5 6 7
• The necessary conditions stimulate the actualizing tendency
Remoteness from
experiencing and
its meaning.
Living, trusting and
using experience as
a way to encounter
life now with
meaning.

person.
• 3. Change in personal constructs.
●How one construes their experiences.
• 1 2 3 4 5 6 7
• The necessary conditions stimulate the actualizing tendency
Construction of
experiences as rigid,
unchanging facts.
Experience itself is only a
tentative construction and
ongoing experiences guide
formation and adaptability
to new circumstances.

person.
• 4. Change in communication of self.
• 1 2 3 4 5 6 7
The necessary conditions stimulate the actualizing tendency
Inhibiting,
inappropriate self-
consciousness.
Accurately identify and
express the complexity of
their feelings in the
moment.

person.
• 5. Change in relationship to problems.
• 1 2 3 4 5 6 7
Do not recognize
personal problems but
perceive them as
outside themselves.
Acceptance of personal
responsibility and a
willingness to understand
and confront them in
relationships.

person.
• 6. Change in interpersonal relationships.
• 1 2 3 4 5 6 7
Fear and avoidance of
close personal contact
with others.
Capable of sharing deepest
inner reactions, positive or
negative in ongoing
relationships.

⦿The Person as Process:
⦿According to Rogers, becoming autonomous is
a major goal of human development. The fully
functioning person has an internal locus of
control and operates on the basis of personally
chosen values rather than by rigidly conforming
to the dictates of society.

⦿Person as “a self in context”
• Bohart (2003) and O’Hara (1992) Argue for a self
that is interdependent and interconnected. Thus
the individual achieves integration with other
group members and with the collective mind.
Individuals do not lose their identity to the group
but integrate the I with the We.

⚫ E) Interventions and techniques:
⦿ The therapist is a process expert who can facilitate the
development of the human psyche. The therapist is like a
farmer who sets the conditions that cultivate the human mind
with:
⦿ The three conditions of change (Rogers, 1957):
⦿ 1) Unconditional Positive Regard
⦿ 2) Genuineness or Congruence
⦿ 3) Empathy.

⦿1. Unconditional Positive Regard. The
quality of likening, respecting, or prizing
directed at the client as a whole person.

⦿The conditions of change.
⦿2. Genuineness or Congruence (being
aligned and connected with one’s self).
Congruence is attending inwardly to one’s
experience and working to sort out its
meanings. It is being inwardly in tune by
sorting out the degree to which my
reactions are mine and what they mean.
⦿Incongruence is the cause of what some
would call pathology.

⦿The conditions of change.
⦿3. Empathy. The ability to perceive
the internal frame of reference of
another with accuracy, the persons
emotional components and meanings
“as if” you were that person.

Empathy continued
⦿Greenberg, Watson, Elliott, & Bohart, (2001)
define empathy as the therapist's sensitive
ability and willingness to understand the
client's thoughts, feelings, and struggles from
the client's point of view… It is this ability to
see completely through the client's eyes, to
adopt his frame of reference…It means
entering the private perceptual world of the
other and being sensitive, moment by
moment, to the changing felt meanings which
flow in this other person... It means sensing
meanings of which he or she is scarcely
aware.

⚫E) Interventions and techniques:
integration.
⚫ Other techniques can be integrated into
person-centered approaches, but only if they
further the central process of being with the
client in a real, empathic relationship. The
heart of the person-centered approach is the
therapist’s “reflective stance” towards the
client (Bohart, 2005, p.122).

⦿Allen, Fonagy and Bateman (2008), have
constructed a powerful treatment technique
called “mentalizing” which they propose as a
robust and powerful reflective process.
Mentalizing based treatments integrate and
assimilate well with person-centered focus on
the reflective process of the therapeutic
relationship.

⚫Mentalizing is a reflective process that
involves imaginatively perceiving and
interpreting behaviour of oneself and
others as conjoined with intentional mental
states (Allen, Fonagy, & Bateman, 2008). It
is to hold mind in mind and reflect on the
mental states in self and others.

⚫Mental states include: Ordinary states
like emotions, thoughts, motives, desires,
needs, beliefs, fantasies, and dreams.
Pathological processes such as panic
attacks, dissociative states,
hallucinations, and delusions (Allen,
Fonagy, & Bateman, 2008).

⦿ Stages of Mentalizing Development Allen, (2008) p. 145
⦿
⦿ Mentalizing Proper
⦿ Symbolic, imaginative and interpretive thinking about self and other;
representational/autobiographical agency.
⦿ Empathy and Realistic Attunement
⦿ Psychological mindedness; mentalized affectivity; thinking while
feeling
⦿ Reflective and Flexible Thinking
⦿ Affect regulation; attentional control; thinking about thinking and
feeling.
⦿ Awareness of Reacting
⦿ Identifying the emotion: attentional focus; “pushing the pause button”
⦿ Acting and Reacting:
⦿ Rigid and stereotypical thinking: high emotional arousal. Information
about reality is experienced as reality. The experience becomes the
self (Psychic equivalent).

Comparing and Contrasting
Mentalizing and Empathy
⦿1) Empathy focuses attention reflecting on
another person. Mentalizing focuses
attention reflecting on another person and
one’s self.

⦿2) Empathy focuses attention reflecting on
emotions. Mentalizing focuses attention on
a range of experiences: emotions,
thoughts, motives, desires, needs, beliefs,
fantasies, and dreams.

⦿3) Empathy focus attention the here and
now experience of feeling. Mentalizing
focus attention on here and now
experiences, past experiences and
anticipated future experiences of self and
others.

⦿Mentalizing techniques are well suited to
be comfortably assimilated into person-
centered perspectives because the
mentalizing construct complements and
expands the notion of empathy and the
reflective therapeutic relationship.

III) Research Support and
Rationale for Use:
⦿Research strongly supports the therapist
qualities, the therapeutic relationship and
facultative conditions as common and
central factors that produce change
(Stricker, & Gold, 2005; Lambert & Barley,
2001).

Rationale for Use:
⦿Norcross (2001) suggests that if we asked
a neutral scientific panel, from outside the
field, to review the corpus of
psychotherapy research and determine
what is the most powerful phenomenon we
should be studying, practicing, and
teaching ,the therapeutic relationship
would be the obvious, and empirically
validated answer.

Rationale for Use:
⚫ There is strong empirical evidence that a
strong therapeutic alliance is essential for
effective psychotherapy. (Orlinsky, Grawe, &
Parks, 1994)
⚫ Relationship factors like empathy,
genuineness and unconditional positive regard
have been identified as the specific
contributions that facilitate the development of
a therapeutic alliance and productive
outcomes in psychotherapy.

Rationale for Use:
⚫ Research has shown that the therapist’s
empathic, reflective engagement contributes
towards the development of a secure,
relational bond. This bond is a key
precondition for the subsequent identification
of shared goals and introduction of tasks that
taken together constitute a strong therapeutic
alliance (Angus & Kagan, 2007).

Rationale for Use:
⦿The person-centered experiential
approach and interventions are research
based, empirically supported, and
effective. They are therapeutically useful
for all populations who are able to tolerate
an open-ended, process-orientated
relationship.

⦿Empathy is a complex interactive process
that is created within the therapeutic
relationship.
⦿Barrett-Lennard (1981) conceptualizes
empathy as a process in which
• 1. The client recounts the experience
• 2. The therapist first attends to and receives the
experience, then resonates to it, and finally
expresses this awareness to the client.
• 3 The client receives this awareness and
evaluates the therapist's understanding.

⦿Empathy is a process in which the person
of the therapist resonates emotionally with
a person’s experience. The therapist is
able to sense what it is like to be the client
in their situation and can communicates
this to the client. Barrett-Lennard's (1981).

⦿How researchers operationalize empathy.
⦿The clearest operational definition of
empathy is Barrett- Lennard's (1981)
delineation of the three different
components and perspectives of empathy:
⦿1. The therapist's experience ("empathic
resonance").
⦿2. The observers' view ("expressed
empathy").
⦿3. The client's experience ("received
empathy").

⦿How researchers operationalize empathy.
⦿Who is the best person to access what
happened in session?
●Supervisor
●Therapist
●Client

⦿Greenberg, et al., (2001) conducted a
meta-analysis of the relation of empathy
to psychotherapy outcome. The resulting
sample consisted of 47 studies,
encompassing 190 separate tests of the
empathy-outcome association and a total
of 3,026 clients. Study dates ranged from
1961 to 2000. Overall, empathy accounts
for as much and probably more outcome
variance than does specific intervention
(compare to Wampold's [2001] estimate of
1 to 8% for interventions).

⦿(Angus & Kagan, 2007) noted
⦿Rogers’ (1975) definition of therapeutic
empathy, as both therapist empathic
attunement skills (inside the therapist)
and empathic communication skills (to
the client) are both viewed as essential for
sustained empathic engagement and the
development of a secure, relational bonds
in psychotherapy

⦿How is empathy effective?
⦿Therapist empathic attunement skills
facilitate the following client outcomes (In
Angus & Kagan 2007):

⦿Empathic Attunement Skills
⦿1. Create a safe and trusted relational bond:
• a) That enables clients to disclose, emotionally
significant personal stories to the therapist (Angus,
Lewin, Bouffard, & Rotondi-Trevisan, 2004).
• b) Where the absence of rejection and censure assists
the identification of core relational (Luborsky & Crits-
Christoph, 1990), and emotion themes (Greenberg,
2002).
• c) That provides a context that facilitates the
formulation of case conceptualizations and the
articulation of shared therapeutic goals.

⦿2. Help clients create meaning of their
inner world.
⦿Empathy engages clients in active, self-
reflection facilitating the expression and
symbolization of primary adaptive
emotions (Greenberg, 2002), core beliefs
(Goldfried, 2003) leading to the
construction of new, more coherent, and
empowering personal meanings (Angus,
Levitt, & Hardtke, 1999).

⦿3. Engenders agency and self-mastery
⦿Empathic attunement helps sustain
client’s active self-reflection in the therapy
and engenders a heightened sense of
personal agency and self-mastery
(Bandura, 2006), (Frank, 1961).

⦿4. Impacts client expectancies for change
and leads to enhanced motivation for
engagement in therapy tasks and goals
(Westra, 2004).

⦿5. Increase therapist attunement to
fluctuations in the depth and affective tone
of the therapeutic bond and so attunement
functions as an early warning system for
the detection and repair of alliance
ruptures (Safran & Muran, 2000).

⦿How is empathy effective?
⦿Empathic communication of therapist’s
understanding and validation facilitates
the following client outcomes (In Angus &
Kagan 2007):

⦿Empathic communication
⦿1. Assists the client to disclose deeply
personal and painful experiences to the
therapist, and feel accept and understood.
This may be the basis of a new, corrective
interpersonal experience (Castonguay,
2005; Pachankis & Goldfried, 2007) for
the client.

⦿2. Is experienced as relieving and
soothing by clients and enhances their
capacity for emotional self-regulation
(Elliott, Watson, Goldman, & Greenberg,
2004).

⦿ 3. Accounts for—new outcome stories—
helps bring saliency and meaning to
experiences (Hardtke & Angus, 2004;
Kagan, 2007) and may facilitate the
emergence of insight (Angus & Hardtke,
2006; Castonguay & Hill, 2006) and new,
more positive views of self/self-identity
(Goldfried, 2003; Kagan, 2007).

⦿Directions for new research
⦿Empathy may be conveyed using a variety
of therapist response modes, such as
interpreting, evoking, reflecting, probing,
questioning and speculating (Greenburg &
Elliott (1997).

⦿Empathic communication as a highly
selective as well as a highly reflective
process. This means the therapist is
selectively reflecting particular feelings at
particular times.

⦿Empathy involves selectively responding
both to what is most alive in the client's
experience and to primary adaptive
emotional responses.
⦿Effective empathy requires picking up the
ongoing, growing edge of the client's
experience, the aspect that is
developmentally moving the client forward to
a greater sense of competence and mastery.
(Greenberg, & Goldman, 1988)

⦿When entering the client's frame of
reference, the therapist must not respond
to just any expression of emotion but to
those emotions that provide “biologically
adaptive information.”

⦿Unconditional Positive Regard
⦿To the extent that the therapist finds himself
experiencing a warm acceptance of each aspect
of the client’s experience as being a part of that
client, he is experiencing unconditional positive
regard. …It means there are no conditions of
acceptance…it means a “prizing” of the
person… it means a caring for the client as a
separate person.
(Rogers,1957, p.101)

⦿Unconditional Positive Regard-Research
⦿ Therapists ability to provide positive regard seems to be
associated with therapeutic success—when the patients
perspective on outcome is taken.
⦿ Virtually all significant findings bear:
⦿ - modest effect sizes only, suggesting that UPR is a
significant but not exhaustive part of the process
outcome equation.
⦿ - UPR may be sufficient by itself to effect change. There
is no reason to withhold positive regard; It is the
patient’s perspective of therapist’s positive regard that is
usually associated with good outcome.
⦿ (Farber and Lane, 2002)

⦿Unconditional Positive Regard-Research
⦿ Therapists vary in the extent to which they are able to convey
positive regard to their patient (some therapists better than others at
providing it)
⦿ Client’s vary in the extent to which they need or benefit from
therapists positive regard
⦿ The level of positive regard a therapist generally functions at is
influenced by characteristics of his or her patients as well as the
current state of therapy.
⦿ Therapists, whether they are skilled at providing positive regard to
patients, need to self-monitor their ability and adjust as a function of
the needs of particular clients and particular clinical situations. Also,
there may be ruptures in alliances not only due to a therapist’s
technical errors but also the therapist’s occasional inability to
demonstrate minimally facilitative levels of positive regard.
⦿ (Farber and Lane, 2002, p. 192)

⦿Future studies:
• the question of specificity: for what clients,
presenting with what types of problems, is the
provision of therapist regard most important, and
for which is this variable of minor importance.
• interaction between modes of therapy and
positive regard. Eg. More potent interaction, in
terms of outcome, between psychodynamic
therapy and positive regard than there is between
CBT and positive regard.

⦿Farber and Lane (2002, p.192):
⦿“Despite the current zeitgeist emphasizing more
technical (technique-oriented, manually driven)
therapeutic interventions, it is difficult to envision the
future or psychotherapy without imagining therapists
who are deeply caring, compassionate, supportive, and
affirming of their patients. The research indicating a
positive, albeit modest association between therapist
positive regard for patients and outcome is testament to
the importance of a therapist’s humanity and also
testament to the importance of relational factors in the
outcome of psychotherapy.”

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