Client-Centered Therapy (CARL ROGERS)
- 1930's—Psychoanalysis was dominant in both theory and practice; focus was being kept on theories that had a close association with treatment.
- Carl Rogers resided in New York and was heavily exposed to psychoanalytic thinking.
- Influenced by the ideologies of Otto Rank and Jessie Taft.
- Rogers adopted therapeutic notions of permissiveness, acceptance, and the refusal to give advice.
The Phenomenological World
- Teaches that behavior is totally determined by the phenomenal field of the person.
- Phenomenal Field: Everything that is experienced by a person at any given point in time.
- To understand a patient, one must know what the world is like for them.
- Phenomenal Self: The part of the phenomenal field that the person experiences as the “I”.
o Adjustment issues occur when the phenomenal self is threatened.
Theoretical Propositions of Client-Centered Therapy
- Individuals exist in a world of experience of which they are the center.
- The person is the best source of information about the self (as they are most aware of their own world).
- Relied largely on non-judgmental atmosphere, verbal self-reports rather than inferences or observations; focus on the inner world as reported by the person.
- Self-Actualization: Human tendency to maintain and enhance experience of the self. Behavior is a goal-directed for an organism to satisfy its needs.
- Self: A crucial concept, that refers to the awareness of one's being and functioning.
o Based on interaction with environment and the evaluation of others.
- The self-structure is revised to assimilate experiences that are inconsistent with the self.
- Growth Potential: A capacity for competence that all individuals have. Goal of client-centered therapy is to release this capacity^ self-actualization tendencies.
Core Features of Client-Centered Therapy
Three core therapist characteristics: accurate and empathetic understanding, unconditional positive regard and genuineness or congruence.
- Patient needs to feel that they are understood so the therapist has to convey a sensitivity to the needs, feelings and circumstances of the patient.
- Empathy does require some level of detachment in the part of the therapist.
- Deep understanding and acceptance of the attitudes consciously held by the patient at a given moment.
Unconditional Positive Regard (UPR) + Congruence or Genuineness
- Refers to respect for the client as a human being; not based on any conditions.
- Therapist must put aside all preconceived notions about the patient & be caring and accepting.
- According to Rogers every client is worthy of unconditional positive regard no matter what.
- Congruence: Refers to the honest expression by the therapist of their behaviors, attitudes & feelings that have been stimulated by the client. Seems almost opposite of empathy/UPR.
Attitude Versus Technique
- Client-centered therapy is a state of mind rather than a state of technique.
- Therapist relinquishes any produces that points to them as being the individual that will diagnose the client's ill's & recommend medication for alleviation.
- Rogers saw clients as wanting to reach for health and self-fulfillment.
- Rogers did not focus on past experience but no the PRESENT.
- Rogerians focus is that the client's inner experiences that are the most informative.
- Behavior therapists focus on manipulating the environment to elicit change but Rogers focused on change that come from within the client.
- Client centered therapy does not—give information or advice, reassurance, ask questions, make criticisms or give interpretations.
The Therapeutic Process in Client-Centered Therapy
- Structuring: Therapist explains the roles of the patient and the role of the therapist to client.
- Reassurance is conveyed by tone of voice, choice of words, facial expressions, general demeanor
- Providing information and interpretation are avoided; implies that therapist knows what is best for the client.
- Acceptance allows the client to reach their potential self-actualization and growth level
- The therapist provides warmth and understanding through accepting client's feelings.
- There are seven stages that generally occur during client-centered therapy, and at each stage the client becomes a little more open with the therapist.
- Diagnosis/Assessment is de-emphasized in client-centered therapy.
- Rogerians believe that assessment places the therapist in a “superior role” that can impede the self-actualization development.
- The focus of client-centered therapy is the patient's current feeling, not interpretation of whether they are right or wrong.
- Other applications: Developed in the counseling psychotherapy context which is its primary application but is also used for human relations training, nurses, counseling, Peace Corps...
Concluding Remarks on Client-Centered Therapy: The Positive
- It is one of the main alternative forms to psychoanalytic therapy; focused on inner feelings rather than the biological urges/instincts of the Freudian view.
- Emphasis on the client-therapist relationship & technique application was placed at the back.
- Move away from long therapy sessions focused on the past/cathartic experiences and less role of the therapist required less training
- Rogers was the first therapist to carry out research on therapeutic sessions.
o Recorded therapy sessions
o Also developed indices for interpretations out outcome
- Research suggests that client-centered therapy is more effective than those patients not receiving any therapy; but is no more effective than any other form of psychological treatment.
Concluding Remarks on Client-Centered Therapy: The Negative
- Client-centered therapists often argue that their client's do not change but their inner potential for growth is released.
- All clients are treated in only one manner—with empathy, acceptance and unconditional positive regard. So the therapist does not need to specify their method to the client (this is really a technique!).
- The notion that client knows best and not using interpretation, advice of the therapist limits this type of therapy. Client may provide incomplete or distorted information.
- Description of client-centered therapy involve undefined terminology—being, becoming, actualizing, congruency—difficulty communicating.
- Client-centered therapy grew on college campuses and the clients were college students; the therapists then went on to become staff at other college counseling centers.
o Brighter, more educated, less maladaptive issues with college students.
The Humanistic-Essential Movement
- From a humanistic perspective people are not the products of the past, unconscious or the environment.
- Humanism: People exert free choice in the pursuit of their inner potential or self-actualization.
- People are unified, whole & unique beings; focus is on freedom, positive striving, selfactualization and naturalness.
- Rejects Freud's views and instead views people as searching for meaning.
- There is a focus on restoring meaning of life and increased spiritual awakening.
- Basic human nature characteristic: search for meaning (imagination, symbolization & judgement). This search occurs within a social context/interaction with people.
- Decision making and personality (i.e. what one is & what one might become) is also a part of it.
The Goals and Techniques of Existential Therapy
- To help the individual reach a point at which awareness and decision making can be exercised responsibly.
- Does not emphasize techniques; emphasis is on understanding and experiencing the client as a unique essence.
- Therapist may ask clients questions that force them to examine the failings in their life or to search for meaning in life.
A Form of Existential Therapy: Logotherapy
- Developed by Viktor Frankl; technique encourages clients to find meaning in what appears to be callous, uncaring and meaningless world.
- He developed this therapy of meaning based on his experiences in a Nazi concentration camp.
- When agonizing over the meaning of life; Frankl believes that Logotherapy should be the therapy of choice. Client's own responsibility & obligation to the future.
- Paradoxical Intention: Client is told to perform the behavior or response that is the object of anxiety/concern.
- De-Reflection: Therapist instructs the client to ignore a troublesome behavior or symptom.
Emphasis is on present experience and immediate awareness of emotions and actions.
Movement of Heterogeneity
- Frederick (Fritz) Pearls whose education was grounded in psychoanalysis is regarded as the founder of Gestalt Therapy.
- Gestalt therapists do not agree and at times; the goal of therapy is to express an individual's own sense of uniqueness and their interpretation of life.
Basic Notions of Gestalt Therapy
- Conceptualizes the person as an absolute whole, not disjointed.
- NO! —Individual developing an awareness of themselves. The focus is on the NOW.
- Therapist facilitates client's awareness and how inner potential is being deflected from expression (in-the-moment basis).
- Focus on current awareness not recovery of memories or repressed impulses.
The Now and Nonverbal Behavior
- Reality is now, behavior is now, and experience is now. It all occurs in the now; seeking answers in the past is dealing with that which no longer exists.
- Anxiety is the gap between the now and the later.
- Therapist does not interpret patient's feelings but asks them to focus on their present emotions.
- The therapist pays close attention to non-verbal behavior (ex: using the patient's stiffness)
- Psychoanalyst asks the patient to associate various elements of the dream while the Gestalt therapist asks the patient to relive the dream in the now.
- Patient confronts the dream directly (deal with conflicting parts of the self).
Topdog-Underdog and Defenses
- Patient asked to take part in a conversation when opposing parts of the self are in conflict.
- (Topdog—superego “should's” of the personality) and (Underdog—id “primitive, evasive, disrupts efforts of the Topdog”). Goal is to integrate both parts of the self.
- Gestalt therapy aims to expose the defenses and games behind which client's hide.
Responsibility and Rules
- Gestalt therapy focuses on getting the client to accept responsibility for their own actions and feelings. Can't blame feelings on something else or someone else.
- Pillars of Gestalt therapy—Awareness, experience, now & responsibility
o Communication in the present tense (no past or future focus)
o Communication is between equals (one talks with, not at)
o Use of “I” language not “it” language—client takes responsibility
o Client's focus is on immediate experience “feelings of this moment”
o No gossip talk or talking about someone else
o Questions are discouraged
Moral Precepts or Rules to Live by for Gestalt Therapy
- Live Now (be concerned with the present not past or future)
- Live here (concerned with what is present not absent)
- Stop imagining (experience only that what is real)
- Stop unnecessary thinking (experiencing only the senses)
- Express directly (do not explain, judge or manipulate)
- Be aware of pleasant and unpleasant
- Reject all “shoulds” and “oughts” that are not your own
- Take full responsibility for your actions, thoughts and feelings.
- Surrender to being yourself.
- Gestalt therapists vehemently opposed to the idea of research.
- Clients were mostly young, well educated people whose problems were mainly alienation and estrangement.
Emotion Focused Therapy
- Also termed process-experiential therapy (PET); this integrates client-centered and Gestalt therapy.
- Emotions are adaptive and give out life experience its value, meaning and direction.
- Dysfunction is the result of an impairment in being able to integrate experiences into a coherent self.