Monday, February 12, 2007

Person-Centered Therapy

[Episode 8] Today we're going to talk about Carl Rogers and his revolutionary approach to psychotherapy - Person-Centered Therapy. Next to Freud, no other therapist has influenced the practice of therapy more than Carl Rogers. The humanistic assumptions at the core of Person-Centered therapy stand in stark contrast to the problem-centered, expert-oriented approach of what was then the dominant model of psychotherapy - Freudian Psychoanalysis. Rogers gave us an equation that would forever change the concept of therapy...

Empathy + Genuineness + Unconditional Positive Regard = Necessary and sufficient conditions for change. Although the last part - that these conditions are sufficient for change - has not enjoyed empirical support, the first part - that these conditions are necessary for change - has been confirmed in thousands of research studies over the last 50 years. In today's lecture I will look at the major assumptions of Person-centered therapy, the goals of treatment, the role and attributes of the therapist, and discuss the one technique attributed to Rogers - reflective listening. I'll end with a discussion of the contributions and limitations of Person-centered therapy.

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Transcript

In today’s lecture, we're going to be talking about Carl Rogers and his person-centered therapy.  Next to Freud, no other therapist has influenced the practice of psychotherapy more than Carl Rogers.  Over a period of more than 20 years starting in the late 1920s and culminating in the publication of his seminal work Client-Centered Therapy in 1951, Rogers developed a humanistic therapy that was non-directive and trusted the client’s capacity for growth.

Now clearly this approach was in direct contrast to the dominant psychotherapeutic model of the day Freudian psychoanalysis, which really relied on the expertise and interpretative powers of the analyst.  As Rogers continued to develop his humanistic approach, he changed the name from client-centered to person-centered to reflect his belief that his theories were meant to apply to all interactions between people, not just those between therapist and client.

In 1969, he published an educational text based on his person-centered approach called “Freedom to Learn.”  The publication of this Learner-Centered approach signaled a shift in Rogers’ focus from traditional individual psychotherapy to organizational and cultural change.  In fact, the cross-cultural workshops he developed based on his humanistic principles and conducted in high-conflict regions such as South Africa, Central America and Ireland resulted in a Nobel Peace Prize nomination for Rogers.

In today’s lecture, I will talk about the key assumptions of Rogers’ person-centered therapy, the goals of treatment and the one technique that is attributed to Carl Rogers’ reflective listening.  We'll end with a brief review of the contributions and limitations of Rogers’ model, but first I'd like to take a minute to contrast Rogers’ approach with Freud’s approach and this is important because although Rogers’ assertion that empathy, genuineness and unconditional positive regard are necessary and sufficient conditions for changes, these assertions were really radical shifts from the dominant assumptions of his day.

So, what were the differences between Freud and Rogers?  Well, in Freudian psychoanalysis, the therapist knows best.  In contrast, in person-centered therapy, it's the client that knows best.  In Freudian psychoanalysis, the personal qualities of the therapist are not very significant.  The therapist’s ability to interpret and his qualifications as an analyst that is an expert are very important.  In contrast, Rogers believe that the personal qualities of the therapist were very significant and these were much more significant than the skills or techniques that a therapist might have in his or her clinical toolbox.

Freudian psychoanalysis really places a value on advice, persuasion, teaching, diagnosis and interpretation.  And in contrast, Rogerian psychotherapy really values reflective listening, being non-judgmental and valuing the client’s unique qualities and this includes not thinking of the client in terms of a diagnosis or a pathology.  Another important difference is that Freud believed that unconscious drives were responsible for people’s behaviors.  In contrast, Rogers really believed that subjective experience was responsible for people’s behaviors.

Freud saw the personality as divided.  We can think of it as ego, super ego, topographical model and this is in contrast to Rogers’ idea that people are essentially congruent wholes that their personalities are one thing.  Freud focused on the problem, not the person.  Rogers focused on the person and not the problem.  And finally, Freud believed that clients or patients more specifically were not able to understand and resolve their problems without direct help.  And in contrast, Rogers believe that people really could resolve their own problems if the conditions were right.

Now, Rogers’ framework obviously derives from some theoretical assumptions, so let's look at those briefly.  And these following points are taken from Joseph Burke’s 1989 textbook Contemporary Approaches of Psychotherapy and Counseling.

One assumption is about the actualizing tendency and this simply means that human beings will develop all of their potentials unless there are environmental limitations and these limitations could be poverty, sexual abuse, war, these sorts of barriers to achieving all that one can achieve.

Another assumption is that reality is subjective and subjective experience is responsible for people’s behavior, so this really points to a phenomenological perspective that Rogers takes that he shares with the existentialist approach and also with the Adlerian approach, this idea that we create our own reality and this is very different than Freud who really believed that there is objective reality, so objective in fact that he could interpret somebody’s dreams accurately.

Another assumption is that self-concept is the person we are aware of being.  This is contrasted with the ideal self, which is the person that we would like to be.  Now, this is where Rogers’ idea of congruence really takes shape.  The assumption is that the subjective experience and the self-concept and ideal self are all congruent and an easy way to think about this is that the way that we are matches with the way that we would like to be and this can really be broken down into our thoughts, feelings and actions lined up.

I'd like to talk to my child and adolescent clients about this because it's a pretty simple way of explaining congruence.  Are you acting in a way that reflects how you're felling and are your thoughts, your feelings and actions all in line with each other?  Rogers assumes that psychological maladjustment results when one denies or distorts an experience causing incongruence between the actual experience and one’s self-concept.  Now, this is different than psychopathology.  Rogers in the humanistic tradition believes that we all have a propensity towards health and so ill health really is a maladjustment as opposed to an indication of more significant long-term problems.

Another assumption is that anxiety occurs when a person is unaware of incongruence between our experiences and our self-concept and that resources are needed for congruence to exist within individuals and the purpose of person-centered therapy and one of the goals is to help people realize that they have those resources within themselves.

The last couple of assumptions are that participation in the therapeutic relationship activates the client’s self-healing capacities.  And finally, it is the client who is primarily responsible for bringing about change.

Gerald Corey in his 2005 text lists six conditions that are necessary and sufficient for change in Rogers’ model (note: the points are the same in Corey's 2016 edition of the text, p. 173).  The first is that two people are in psychological contact.  The first, the client is experiencing incongruency.  The second person, the therapist is congruent or you can think about it as integrated in the relationship.  The therapist experiences unconditional positive regard or real caring for the client and the therapist experiences empathy for the client’s internal frame of reference and really tries to communicate this to the client and the communication to the client is to minimal degree achieved.  Now, these are six conditions that are necessary and sufficient for personality changes to occur.

As we've mentioned, Carl Rogers’ approach really focuses on the personality of the therapist and so it's no surprise that the therapist’s attributes are really perhaps the most important tools that the therapist can bring into a therapy session and in social work we call this professional use of self.

Rogers believed that in order for the therapist to establish a growth-promoting climate which in today’s parlance might be called keeping it real, you had to have congruence which was being genuine or real with your client.  You had to have unconditional positive regard.  This was acceptance in caring for the client, but it didn’t necessarily mean approval of all behavior.  And finally, empathic understanding and not just empathy but accurate empathy which was an ability to deeply grasp the client’s subjective world.

And all of these suggest that the therapist’s attitudes were more important than the therapist’s specific knowledge or skill set.  According to Rogers, the best therapist focuses on the quality of the therapeutic relationship.  The therapist serves as a model of a human being struggling towards greater realness, the therapist is genuine, integrated and authentic and the therapist can openly express feelings and attitudes that are present in the relationship with the client.

Now, this idea of communicating genuinely and honestly with the client can be often misinterpreted as working through transference and counter-transference.  And just to clarify, in the traditional sense transference is when the client basically projects onto the therapist past relationships.  In Rogers’ model, really what's going on is that there is a genuine and emphatic relationship happening in the moment and as a result the therapist is able to really communicate that current present real time experience to the client and it is through that current real time experience that clients actually tap into their inner resources and find the solutions to their own problems.

Now, positive self-regard is another key concept in Rogers’ model.  Positive regard means having attitudes such as warmth, liking, respect and acceptance.  Positive self-regard is accepting our physical and emotional being for what it is and congruence really depends on the belief I am worthy.  Now, in order for a person to experience self-actualization, they need to be congruent.  That is their thoughts, feelings and actions need to be in sync.  Incongruence is simply being out of sync.

Smokey Robinson has a great line that I think embodies this idea when he says "if there's a smile on my face, it's only there to fool the public, the tears of a clown when there's no one around" (Robinson, 1967).

Now, the goals of therapy are to provide a climate of safety and trust and this enables clients to engage in meaningful self-exploration.  Another goal is to identify whatever it is that’s blocking growth.  A third goal is to solve problems with the greater purpose of assisting in the client’s growth process, so solving a problem just for the sake of solving a problem is not congruent with Rogers’ model but rather solving a problem that would unleash the client’s inner capabilities to grow and self-actualize is the purpose.

Perhaps the most important part of Rogers’ model and Rogers’ contribution to therapy is his technique of reflective listening.  Now, reflection uses elements of restatement and mirroring a verbal and non-verbal communication in order to determine whether the therapist really understands the client’s inner world.  Now, this is the only technique that is attributed to person-centered therapy and the joke in schools of social work among students is that therapists are always saying things like what I hear you saying is – now I happen to love that phrase and the beauty of that phrase is that it really allows you to check in with your client to see if you understand their world and if you don’t understand their world then you can't help them because it is a subjective world and their world contains the answer to their problem.  They are the masters of their own domain if you will.  And so really reflection can be an incredibly challenging and difficult thing to do correctly.

Rogers really made it okay for therapists to be wrong.  Rogers made it okay to sit there in silence while the client was figuring things out.  Rogers really opened the door to have a genuine relationship where the therapist’s job was to support the client, to really get what they needed to get out of a therapeutic relationship.  There were occasions when Rogers would use verbatim repetition such as times when he was trying to really emphasize what a client was saying or that he really wanted to make sure that the client him or herself was hearing what he or she was saying.

So in one example, the client says to Rogers she is going to save me and Rogers repeats back verbatim, she is going to save you.  Now, this does not provide Rogers with a clear understanding of what that means to the client, but what it does do is it clarifies to the client that that’s what he or she is saying.  More typically his responses were to the client’s meanings behind their words.  His restatements in such cases really seemed to be an attempt to integrate and clarify client’s feelings and intents such as in this example where the client says sometimes I feel like I don’t know my father at all and the sadness that was coming out as well as the feelings, the sadness for him, the failings of things he wanted to do and also the sadness that I don’t know him as well as I'd like to and Carl Rogers was sitting there and going hmm, mm-hmm and his restatement was so it's sadness for him in this situation, but sadness on your part that you don’t know him.

This is really a beautiful way that Rogers was able to take the meaning that the client had and put it into terms that they weren't exact verbatim parodying of what the client said, but really summarize them so that the client knew that Rogers understood what he was saying.

Another example is when a client said and I allowed myself to and I don’t regret caring and I don’t regret loving or whatever, but you know like, I'm like a kid you know, I mean a kid in a way, I'd like to be loved, too, some reciprocity and I'm going to start I think, you know, expecting that without being cold or anything like that, but I have to, you know, start getting something back in return.  Carl Rogers responded with you want love to be mutual and the client said, “Yeah, for sure, for sure.”

So, these are some examples of how Carl Rogers use this concept of reflection and restatement in order to really get the client’s inner world.  Now, as I talked about briefly, Rogers’ model has been applied to individual, family and group treatment.  There's been empirical support for its use with a wide range of access one, two and four problems.  For example, anxiety, depression, substance abuse as well as relational problems.

Rogers’ work is also really valuable in the initial phases of crisis intervention when you're building rapport and you're identifying what the crisis situation was.  And finally as I mentioned in the beginning, Rogers ultimately adapted his work for more organizational and systemic applications.

So, finally, it's important to really understand that next to Freud no other therapist has been more influential in the practice of psychotherapy than Carl Rogers.  His emphasis of client’s internal strengths and the avoidance of categorizing or labeling clients is really something that makes his approach very user friendly when thinking about being culturally competent in your practice.

Now, some of the limitations of Rogers’ model is that Rogers’ assumption that genuineness, unconditional positive regard and emphatic understanding are necessary and sufficient for change has not been supported by research.  The necessary part has, but the sufficient for change part has not been supported by research and basically what that means is that these therapist traits are necessary, but there are many situations in which they're not sufficient.  You need to do more than just be genuine, have unconditional positive regard and be able to empathize with your client.

Another limitation of this model is – and I'm sure students can really relate to this, but because the focus is on being genuine, students and beginning clinicians often get stuck mimicking the approach rather than being themselves which of course, is the ultimate goal, which is that you bring yourself into the relationship fully, that you have professional use of self and through that relationship you will be able to help your client really identify their problems and find within themselves those solutions.

The last thing that I'm going to say before we wrap up is that Carl Rogers was actually a wonderful proponent of psychiatric social work and in fact was an officer in some of the national social work organizations.
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References


Brink, D. C. & Farber, B. A. (1996). A scheme of Rogers' clinical responses. In B. A. Farber, D. C. Brink, & P. M. Raskin (Eds.), The psychotherapy of Carl Rogers: Cases and commentary (pp. 15-24). New York: Guilford Press.

Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed). Belmont, CA: Wadsworth/Thomson.

Rogers, C. L. (1961). On becoming a person. New York: Houghton Mifflin Company.



APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2007, February 12). Person-centered therapy [Episode 8]. Social Work Podcast [Audio podcast]. Retrieved from http://socialworkpodcast.com/2007/02/person-centered-therapy.html

3 comments:

nicki said...

hi

i am hard of hearing - can i download the podcast in a readable form?

Jonathan B. Singer, LCSW said...

Nicki - there is no transcript of the podcast. However, the basic information is covered in Gerald Corey's 2005 text, Theory and practice of counseling and psychotherapy. If you don't have access to the text, let me know and I'll email you the handout from my lecture on the subject. Best, Jonathan.

nicki said...

Thanks so much for your prompt response. I'll see if i can dig it out at the library, and come back to you if not.
thanks again, much appreciated.