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Person-Centered Therapy Today
A sign on the restaurant wall where I lunched today reads, "What you call psychotic behavior ... we call company policy." A joke, obviously, but it set me thinking about differences in the world today compared to the 1950s when Carl Rogers was developing person-centered therapy. Take a small thing like "multi-tasking," for example. In the 1950s a person who drove down an expressway at 70+ miles per hour while listening to a recorded book and talking on the telephone at the same time might well be judged in need of psychological evaluation. Today we think it's "normal." Even therapists are expected to "multi-task" (Erskine, 2003). The point is, we live in a different, more complex world from the one Carl Rogers inhabited. Can a therapeutic system he designed to meet the needs of his time (before the Age of Information) be adequate to meet the needs of ours?
The prevailing view in the 1950s was that the therapist's technical knowledge and expertise was the essential determining factor for the effectiveness of therapy. The therapist was the one who objectively and dispassionately determined the timing of interventions, what was important to pay attention to, and how to interpret the "patient's" feelings and attitudes. Carl Rogers shifted the focus to the relationship between client and therapist as critical to therapeutic success. The relationship depended on a set of core conditions that were essential and if maintained would lead to a beneficial result. But are his core conditions really sufficient for therapy today? This essay will try to answer these questions by exploring (1) what Roger's system involves, (2) what some more recent researchers have to say about effective therapy, and (3) what societal influences might call for either a renewed commitment or modifications.
Roger's (1951) pointed out that client-centered therapy is "a product of its time and cultural setting." He hastens to add, however, that it would be a mistake to see it solely as "a product of cultural influences." Client centered therapy rests upon the therapeutic relationship which "transcends to some extent the limitations and influences of a given culture" (pp. 4-5). This implies that the therapeutic relationship is as important now as at any time in the past and very few therapists would deny that, even in the psychoanalytic and cognitive camps. The outcome of therapy still depends upon the actual relationship based on empathy, genuineness, and unconditional, non-possessive, positive regard -- not, as Rogers pointed out, on technical methods, on reductionist training, or the development of microskills that have little to do with a client's psychological growth.
In a speech to the American Psychological Association in 1957, Rogers explained his therapeutic approach as clinically and statistically predictable with a pattern of development that takes place within the context of the counseling process. The initial phase of catharsis, for example, is replaced by a phase in which insight is the most significant element, and in turn, this phase gives way to a phase marked by an increase in positive choice and action. The same chain of events operates in diverse situations, that is, in individual therapy, group therapy, play therapy, drama therapy, etc.
The therapist's role is to establish an atmosphere in which the client can grow, mature, and make a better adjustment. Such an atmosphere relies on certain core conditions, which release natural growth forces within every individual. Fundamental to the process is the therapist's trust that within each individual lies the potential for self-actualization. Rogers sees this as the basic driving force of human beings -- the will to develop and improve one's self and situation, to grow into what we realize consciously we really are. The force is like a mandate for discovering our potential. The maladjusted person does not recognize this fundamental force within him/herself. he/she feels manipulated by circumstances and other people and unable to fully experience, create, or live "the good life." Thus, the goal of therapy is for the client to discover this innate inner capacity and with it the power to live a rich and fulfilling life (Personality & Consciousness web site). Person-centered therapy frees the individual to find inner wisdom and confidence and to make healthier, more constructive choices (Carl Ransom Rogers web site).
Briefly, Rogers (1957) lists the following conditions as necessary to successful therapy:
The therapist operates on the principle that the individual is basically responsible for him or herself. The therapist must be willing for that responsibility to remain with the client and must not usurp it. The therapist also must operate on the principle that the client has a strong natural drive to become mature, socially adjusted, independent, and productive. For therapeutic change to happen, the counselor must rely on this inner force and not on his own powers. he/she must not try to "make it happen" or hurry it up. Instead, the counselor creates a warm and permissive atmosphere in which the individual is free to bring out any attitudes and feelings, which he/she may have, no matter how unconventional, absurd, or contradictory these attitudes may be. The client must be as free to withhold expression as to give expression to his/her feelings. Limits may be set on behavior but not on attitudes. For example, a child may not be permitted to break a window, but the child is free to feel like breaking a window. The feeling is fully accepted. An adult may not take more than an hour for the interview, by his/her desire to take more time is acceptable. The therapist uses only those procedures and techniques in the interview which convey his deep understanding of the emotionalized attitudes the client expresses and his acceptance of them. A sensitive reflection and clarification of the client's attitudes may convey this understanding, but the acceptance should be neither positive nor negative, approving nor disapproving. The therapist refrains from questioning, probing, blaming, interpreting, advising, suggesting, persuading, or reassuring (Rogers, 1957).
Rogers states that if these conditions are fully met, the client will benefit in the majority of cases. he/she will learn to express deep and motivating attitudes. He or she will be able to explore attitudes and reactions more fully than before and will become aware of aspects of his/her attitudes that were previously denied. The client will arrive at a clearer conscious realization of his/her motivating attitudes and will accept him/herself more completely. The realization, as well as the acceptance, will include attitudes previously denied. The client may or may not verbalize this clearer understanding of self and behavior but will choose on his/her own initiative new, more satisfying goals in light of this clearer self-perception and understanding. he/she will choose to behave in a different manner in order to reach these new goals. The new behavior will be in the direction of greater psychological growth and will be more spontaneous, less tense, and more harmonious with the social needs of others, more realistic and more comfortable. "It will be a step forward in the life of the individual" (Rogers, 1957, p. 417).
Rogers describes the function of the therapist as "catalytic," rather than instrumental, and the predictability of client-centered therapy he explains is based on the discovery that within the client reside constructive forces whose strength and uniformity have been either entirely unrecognized or grossly underestimated. It is the clear cut and disciplined reliance by the therapist upon those forces within the client, which seems to account for the orderliness of the therapeutic process, and its consistency from one client to the next" (p. 418).
If a suitable psychological atmosphere is provided, the individual is "capable of discovering and perceiving, truly and spontaneously, the interrelationships between his attitudes, and the relationship of himself to reality. The individual has the capacity and the strength to devise, quite unguided, the steps which will lead him to a more mature and more comfortable relationship to his reality" (p. 418). In Roger's view, these forces within the client can be trusted. In fact, the more deeply the therapist relies upon them, the more profound will be their release.
Thus, in Roger's approach, the therapist must let the client lead and direct the way. The counselor's responsibility is to create a warm and accepting relationship with understanding and safety so that the client can drop "his natural defensiveness and use the situation" (p. 420). Rogers points out that this kind of counseling demands complete consistency, discipline, sensitivity, appreciative awareness. It has only one purpose -- to provide deep understanding and acceptance of the "attitudes consciously held at the moment by the client as he explores step-by-step into the dangerous areas which he has been denying to consciousness" (p. 420). There is no faking this kind of relationship. It must genuine to be effective.
Wickman and Campbell (2003) studied a transcript of Rogers in a therapeutic interaction with Gloria (a famous, recorded session that has been widely studied) in an attempt to find how he put theory into practice. They tried to identify what…[continue]
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