Client-Centered Therapy (CARL ROGERS)

Origins

  • 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.

Empathy

  • 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

  • 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

Humanism

  • 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.

Existential Therapy

  • 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.

Gestalt Therapy

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)

Dreams

  • 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
  • Rules

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

  1. Live Now (be concerned with the present not past or future)
  2. Live here (concerned with what is present not absent)
  3. Stop imagining (experience only that what is real)
  4. Stop unnecessary thinking (experiencing only the senses)
  5. Express directly (do not explain, judge or manipulate)
  6. Be aware of pleasant and unpleasant
  7. Reject all “shoulds” and “oughts” that are not your own
  8. Take full responsibility for your actions, thoughts and feelings.
  9. Surrender to being yourself.

Concluding Remarks

  • 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.
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