Systems of Psychotherapy CH 5 - PERSON-CENTERED THERAPIES

A SKETCH OF CARL ROGERS

Carl Rogers (1902 1987); founder of psychotherapy research

restricted, inexpressive family life; personally experienced devastating effects
on self-esteem of parents imposing conditions of worth on children
PhD in clinical psychology from Columbia; series of outcome studies at Ohio
State, U of Chicago
Evolved from nondirective to client-centered to person-centered
Applied his system to education, politics, & international conflicts
first person to open therapy room to cameras, studies, etc.

THEORY OF PERSONALITY

All humanity has but one basic motivational force: an inborn tendency toward
actualization
actualization/self-actualization = (Rogers) curative force man's
tendency to actualize himself, to become his potentialities...to
express/activate all the capacities of the organism
actualizing tendency = the inherent tendency of the organism to develop
all its capacities in ways which serve to maintain or enhance the organism
differentiate = to see the difference between experiences that are part of
our own body and functioning and those that belong to others
self-concept = includes our perceptions of what is characteristic of I or
me, perceptions of our relationships to others/world, and the values
attached to these perceptions
We create subjective world, acquire conditions of worth, value processes that
regulate us
organismic valuing = inborn ability to value positively experiences
perceived as maintaining/ enhancing our lives, to value negatively
experiences that would negate our growth
positive regard = universal human need to be prized, accepted, and loved;
so addictive that it is the most potent need of the developing person
self-regard = learned view of self/behavior; we come to see ourselves in the
same way that others have viewed them
conditions of worth = learned introjected or internalized values/conditions;
we cannot view ourselves as positively worthy unless we act in accordance
with these conditions
We learn early to exchange basic tendency for actualization for the
conditional love of others.

THEORY OF PSYCHOPATHOLOGY

Psychopathology reflects a divided personality, w/tensions, defenses,

inadequate functioning that accompany a lack of wholeness

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Systems of Psychotherapy CH 5 - PERSON-CENTERED THERAPIES

More conditional the parents love, the more likely pathology

incongruence = difference between what is being experienced and what is
symbolized as part of a persons self-concept
subception = organisms ability to discriminate stimuli at a level below that
required for conscious recognition
Defensive reactions/symptoms prevent threatening experiences from coming
into awareness
Defenses cause inaccurate perceptions due to distortions & selective
omission of information
Defenses help us survive, become problems when used exclusively

THERAPEUTIC RELATIONSHIP

Necessary & sufficient conditions = (Rogers) six conditions w/in

therapeutic relationship that are necessary for therapeutic personality
change:
o relationship = two people who make a difference to each other
o vulnerability = vulnerability to anxiety motivates client to seek
therapeutic relationship
o genuineness = the quality of being freely and deeply oneself with
actual experiences being accurately represented in the awareness of
oneself; opposite of a faade
o unconditional positive regard = acceptance; weakens existing
conditions of worth, replaces them with a stronger positive self-regard;
acceptance does not necessarily equal approval
Ellis: I dont like a lot of my clients, but I can still help them.
o empathy = experiencing clients inner world as if it were our own,
w/out our own anger, fear, or confusing interfering
o perception of genuineness = client must be able to feel genuine
acceptance of therapist

THERAPEUTIC PROCESSES

Goal: increase congruence between self & experience through facilitative

conditions
change combination of consciousness raising & corrective emotional
experience
client-centered therapy = process of expanding consciousness/awareness
through the therapist bringing about more effective information processing in
clients
Therapists control the process of therapy but not the content

CONSCIOUSNESS RAISING

The Clients Work

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Systems of Psychotherapy CH 5 - PERSON-CENTERED THERAPIES

o to inform therapist about personal experiences and receive feedback

o nondirective = the characteristic of person-centered therapy in which
the client directs the flow of therapy, and is free to discuss whatever
s/he wishes in sessions
The Therapists Work
o surrogate information processor for client; helps client
organize/interpret information, break through perceptual distortions,
help organize thoughts/feelings
o therapist controls the process of therapy, but not the content
o reflection = (person-centered therapy) the therapists task of
reflecting the clients feelings by communicating, You feel
o commitment to understanding client with accurate empathy

CATHARSIS

catharsis = release of emotional component of feelings as part of curative

process
Clients Work = describe, with increasing expression, their emotional
experiences
Therapists Work = help client get/stay in touch with, express threatening
emotional experiences, reflect back

THERAPEUTIC CONTENT

INTRAPERSONAL CONFLICTS

Anxiety = not the cause of problems, but the troubling consequence of a

divided life
Defenses against anxiety = deny, banish from consciousness, or distort for
sake of self-concept
Self-esteem (self-regard) = important, but not everything; Rogers solution
lies not in increasing self-esteem based on what we are supposed to be but in
expanding conditions of worth so we can prize all that we can be
Responsibility = becoming responsible means learning again to respons to
our natural organismic valuing rather than to the internalized values of others
o heteronomy = control by others
o autonomy = inner control

INTERPERSONAL CONFLICTS

Intimacy & sexuality

o Intimacy is therapeutic, therapy is intimate
o truly intimate relationships are rare; it is difficult for many to grant to
others what we withhold from ourselves

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Systems of Psychotherapy CH 5 - PERSON-CENTERED THERAPIES

o more natural sexuality is one that is neither goal-consumed nor

performance-oriented is most likely to occur within an intimate
relationship
Communication = once considered limited by language inadequacies; now
believed possible through caring; we stop listening when we think we know
what the other person is going to say
Hostility (Rogers) = not an inherent drive to be controlled; rather a reaction
to being overcontrolled by restrictive parenting when person is not allowed to
express anger without being made to feel guilty/unworthy
Control = attempting to impose conditions of worth on another; controllers
communicate that they will only continue to care if other person lives up to
certain image

INDIVIDUO-SOCIAL CONFLICTS

Adjustment versus transcendence = ability of a person to be fully

functioning in society and still be at-home in the world
Impulse control = ability of a person to relate to others in enhancing, not
destructive manner

BEYOND CONFLICT TO FULFILLMENT

Meaning of life emerges from actualization process; meaning already

exists for those living congruent, complete life
Ideal individual / fully functioning person = ideal individual who
demonstrates organismic trusting, be open to each new experience, allow all
significant information to flow in/through them, trust in their eventual course
of action
existential living = lifestyle in which person lets self & personality emerge
from experience to discover a sense of structure a flowing, changing
organization of self/personality

PRACTICALITIES OF PERSON-CENTERED THERAPY

self-authority = central focus of person-centered therapy; tends to mitigate

against the use of psychometric tests and routine assessment in
psychotherapy; testing is rare
person-centered approach = idea of enlarging the scope of practice from
the consulting room to universal concerns (as opposed to older term client-
centered approach)
Efforts to enhance trainees empathy often result in sterile technique
Brief PCT is uncommon; possibly hundreds of sessions; typically, once/week
for 6-12 months

MAJOR ALTERNATIVE: MOTIVATIONAL INTERVIEWING

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Systems of Psychotherapy CH 5 - PERSON-CENTERED THERAPIES

William R. Miller (1947 - ) developed motivational interviewing; Carl

Rogers in new clothes
motivational interviewing (MI) = person-centered, directive approach that
enhances intrinsic motivation to change by helping clients explore and
resolve ambivalence
Combines elements of person-centered style & technique
Four Principles of MI:
o Express empathy = using reflective listening to convey
understanding, express genuine caring; therapist empathy (not
treatment method) predicts success
o Develop discrepancy between clients values and behavior; client
talks self into changing
motivational discrepancy = a difference between present
behaviors (real self) and desired goals (more ideal self); used by
therapist to motivate behavioral change
o Roll with resistance = meet resistance with reflection, not
confrontation; non-argumentative response, uses clients energy to
steer interaction
counter-resistance = confrontation/argument more likely to
increase resistance
o Support self-efficacy by actively conveying message that client is
capable of change
Research supports MIs effectiveness
Project MATCH = one of largest-ever psychotherapy outcome studies; 4
sessions of MI compared to 12 sessions of Cognitive-Behavioral Coping Skill
Training and to 12 sessions of 12-step facilitation therapy; MI shown to be as
effective
Applications
o prelude to treatment
o stand-alone brief treatment
o combination with other treatments

EFFECTIVENESS OF PERSON-CENTERED THERAPY

process research = interactions between client and therapist, as opposed

to outcome research tracks the success or effectiveness of therapy
Research on empathy, genuineness & positive regard show they are valuable
contributors, but are neither necessary nor sufficient
PCT was clearly superior to no treatment, but barely better than placebo
When compared to CBT, person-centered was slightly less effective

FUTURE DIRECTIONS

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Systems of Psychotherapy CH 5 - PERSON-CENTERED THERAPIES

Person-centered values/methods have been assimilated by mainstream

therapies; needs to maintain openness to integration with other
psychotherapy systems
Slowly declining in popularity in USA
Empathy making a comeback
active & eclectic methods in era of short-term treatments
Motivational Interviewing is on the rise
client markers = markers that represent expressed/inferred readiness for
specific change tasks

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