Person-centered therapy

Person-centered therapy

Definition

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.

Description

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. More recently, two major variations of person-centered therapy have developed: experiential therapy, developed by Eugene Gendlin in 1979; and process-experiential therapy, developed by Leslie Greenberg and colleagues in 1993.

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.

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 nonthreatening 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.

Applications

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.

Normal 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, 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.

Abnormal results

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.

Resources

BOOKS

Cain, David J., ed. Humanistic Psychotherapies: Handbook of Research and Practice. Washington, DC: American Psychological Association, 2001.

Greenberg, Leslie S., Jeanne C. Watson, and Germain Lietauer, eds. Handbook of Experiential Psychotherapy. New York: Guilford Press, 1998.

Rogers, Carl. Client-Centered Therapy. Boston: Houghton Mifflin, 1951.

———. On Becoming a Person. Boston: Houghton Mifflin, 1961.

———. A Way of Being. Boston: Houghton Mifflin, 1980.

Sachse, Rainer, and Robert Elliott. "Process-Outcome Research on Humanistic Therapy Variables." In Humanistic Psychotherapies: Handbook of Research and Practice, edited by David J. Cain. Washington, DC: American Psychological Association, 2001.

Thorne, Brian, and Elke Lambers, eds. Person-Centered Therapy: A European Perspective. London, UK: Sage Publications, 1999.

PERIODICALS

Kahn, Edwin. "A Critique of Nondirectivity in the Person-Centered Approach." Journal of Humanistic Psychology 39, no. 4 (1999): 94-110.

Kensit, Denise A. "Rogerian Theory: A Critique of the Effectiveness of Pure Client-Centred Therapy." Counselling Psychology Quarterly 13, no. 4 (2000): 345-351.

Myers, Sharon. "Empathic Listening: Reports on the Experience of Being Heard." Journal of Humanistic Psychology 40, no. 2 (2000): 148-173.

Walker, Michael T. "Practical Applications of the Rogerian Perspective in Postmodern Psychotherapy." Journal of Systemic Therapies 20, no. 2 (2001): 41-57.

Ward, Elaine, Michael King, Margaret Lloyd, Peter Bower, Bonnie Sibbald, Sharon Farrelly, Mark Gabbay, Nicholas Tarrier, and Julia Addington-Hall. "Randomised Controlled Trial of Non-Directive Counselling, Cognitive-Behaviour Therapy, and Usual General Practitioner Care for Patients with Depression. I: Clinical Effectiveness." British Medical Journal 321, no. 7273(2000): 1383-1388.

ORGANIZATIONS

Association for the Development of the Person-Centered Approach. <http://www.adpca.org>.

Center for Studies of the Person. 1150 Silverado, Suite 112, La Jolla, California 92037. (858) 459-3861. <http://www.centerfortheperson.org>.

World Association for Person-Centered and Experiential Psychotherapy and Counseling (WAPCEPC). c/o SGGT Office, Josefstrasse 79, CH-8005 Zürich, Switzerland. +41 1 2717170. <http://pce-world.org>.

Sandra L. Friedrich, M.A.