Person-Centered Therapy Origins of Person-Centered

Person-Centered Therapy

Origins of Person-Centered Approach

Concepts & Assumptions

Therapist and Patient Roles

Therapy in Practice

Current Interpretations

Sigmund Freud took the world of psychotherapy by storm in the early 20th century. He painted a picture of people who needed the guiding hand of an expert to help them overcome their malaise. In his view, only a trained therapist could uncover repressed emotions and conflicted family histories. Patients were described as suffering and also incapable of healing themselves without the dedicated help of a psychoanalyst, usually for many years of intensive therapy.

Carl Rogers rejected these fundamental assumptions of Freud and his colleagues. Instead of conceptualizing the therapist as the star of the story, with expertise to cure the ill patient, Rogers re-positioned the client as the center of the therapeutic trajectory. He argued that individuals contain the seeds of their own best selves, and that no amount of diagnosis or direction could do this work for them. Therapists' job was not to provide solutions but rather to provide an atmosphere of trust, empathy, and acceptance. In these conditions, the client would be empowered to tap into their own actualized selves.

Origins of Person Centered Approach

Carl Rogers was a therapist practicing in 1940s in Ohio. At the time, most therapy being practiced placed the therapist in a directive and interpretive role; that is, therapists were there to guide the clients' monologue, and then offer interpretations based on what the client said. Rogers questioned the wisdom of this role, and argued that in some cases, the therapist might not be effective if s/he kept this professional distance. Instead, Rogers proposed a more direct role for the therapist, in which one of the important tasks for the counselor was to create an environment that felt safe for the client. The focus shifted from the therapist as a source for expertise to the interactions between the therapist and the client. A strong relationship between the two might be the tool to allow for greater success in the patients' progress.

The second phase of the development of Rogers' signature theory came in the 1950s, when he named his approach client-centered therapy, and began practicing this strategy in his new home base of Chicago. During this phase, Rogers stressed the importance of the clients' own perspective and began to describe self-actualization as the most important piece of the therapeutic puzzle. Over the next twenty years, Rogers became a prolific writer. He practiced therapy and conducted research, and his theory blossomed. Of particular interest to him during this time was the way the patient-client relationship contributed to therapeutic outcomes.

Finally, toward the end of his career, Rogers extended his ideas beyond the counseling environment and into education, industry, and conflict resolution on a global stage. At this time, his focus was quite broad. He spoke a great deal about the role of power in defining relationships and individual satisfaction; that is, in what ways do people "obtain, possess, share, or surrender power and control over others and themselves," (Corey, 2009: 167). His ideas became known as the person-centered approach.

Like humanism and existentialism, person-centered therapy begins with a "respect for the client's subjective experience, the uniqueness and individuality of each client, and a trust in the capacity of the client to make positive and constructive conscious choices," (Corey, 2009: 168). All three of these approaches place the client, rather than the therapist, at the center of the therapeutic environment. The client is seen as an individual with unique abilities to heal himself, if only the therapist can create the right conditions for that kind of self-awareness.

Person Centered Therapy

Concepts & Assumptions

Person-centered therapy begins with a very important assumption about the validity of the client. Individuals have the innate capacity for self-healing. They can build on their own life experiences to grow into a fuller version of themselves. In fact, Rogers believed that people are naturally driven toward self-actualization, and can accomplish this if the right conditions are provided. One student of Rogers' describes self-actualization as the process of "being and behaving on the basis of one's own inner ways of being and inner possibilities," (Mahrer, 2004: 64). Thus, Rogers assumes a very positive innate human nature. Clients ultimately know what is best for them, and therapists must not interfere with this internal direction.

Moreover, Rogers values the content of the therapy relationship more than finding an accurate diagnosis or research or intellectual insight. Reflecting on his experience as a guidance counselor, he explains:

"the quality of the personal encounter is probably, in the long run, the element which determines the extent to which this is an experience which releases or promotes development and growth. I believe the quality of my encounter is more important in the long run than is my scholarly knowledge, my professional training, my counseling orientation, the techniques I use in the interview," (Rogers and Stevens, 1967: 86).

In this way, it is clear that Rogers' person-centered therapy offers a critical departure from more traditional, expert-focused approaches.

Many patients come to therapy because they are suffering from symptoms associated with incongruence. This condition may stem from a sense of dissatisfaction, or even failure, and refers to the gap between a person's idealized vision of themselves and reality. While most people experience some forms of incongruence in their lives, many are so disturbed by this gap that they begin to feel anxious, depressed, or helpless. These emotions can lead a person to seek therapeutic help.

If patients are suffering from incongruence, then it is critically important for the therapist to model congruence. Especially in a model that asks the therapist to adopt a very personal, authentic, and involved posture in the therapy session, it is up to the therapist to demonstrate her own sense of self-worth. She must be open, honest, expressive, and genuine. Therapists must be pursuing their own self-actualization and this commonality will allow them to relate more honestly with the work being done by their patients. Only in this way can a therapist be truly empathetic, and only when it is authentic will these attributes be communicated to the patient. Indeed, "accurate empathy is the cornerstone of the person-centered approach," (Corey, 2009: 175).

Finally, therapists must demonstrate unconditional positive regard and acceptance. The patient must not feel judged, and Rogers expressed concern that a remote, scribbling therapist might communicate judgment to a fragile patient, thereby negating any positive effect of the therapy. Only this kind of unconditional acceptance will create the kind of open and safe environment that allows clients to being their own journeys of self-discovery.

Self-actualization is a vague term, but Rogers provides some landmarks whereby therapists might recognize progress in this arena. People who are successfully actualizing will demonstrate openness to new experiences, trust in themselves, internal evaluation skills, and willingness to continue the work of growing (Corey, 2009). The assumption here is that people naturally tend toward these levels of self-awareness. The therapist does not need to teach or create these goals; rather, the therapist simply needs to encourage the natural path toward actualization.

Therapist & Patient Roles

The role of the therapist in person-centered therapy is to create conditions for people to pursue their natural tendency toward self-actualization. Creating these conditions means therapists must be congruent (real, authentic), demonstrate unconditional positive regard for the client, and offer accurate empathetic understanding. Clients, when provided with these conditions, "will become less defensive and more open to themselves and their world, and they will behave in pro-social and constructive ways," (Corey, 2009: 169). The therapist does not need to provide theoretical insights or behavioral modification techniques. Rather, the therapist's primary objective is to "use themselves as an instrument of change," (Corey, 2009: 171). Stepping away from their remote, professional, expert position leaves therapists perhaps vulnerable to personal involvement with their patients; indeed, this is part of person-to-person therapy. Instead of taking notes and seeking a professional diagnosis, the person-to-person therapist will encounter their patient with acceptance and empathy. It is, then, the therapists' attitudes that are the primary counseling tools.

These attitudes are also called the therapeutic core conditions. Rogers itemizes them thusly: two people exist within a therapeutic relationship; the patient suffers from incongruity -- likely stemming from a gap between her own ideal self-image and the reality of her position in life -- and as a result experiences anxiety and sadness; the therapist enjoys congruence in his mental state; the therapist has unconditional positive regard and empathy for the patient; these attitudes are communicated to the patient. Rogers makes much of this communication step, noting that "unless the attitudes I have been describing have been to some degree communicated to the client, and perceived by him, they do not exist in his perceptual world and thus cannot be effective," (Rogers and Stevens, 1967: 93).

Once clients are situated within this growth-enhancing environment, they will thrive. The goal for them is not to achieve some sort of finish line recovery, where they will be told that their work is finished and they are cured. Rather, Rogers argued that the therapist was there fundamentally in a support role, with the client in his or her own journey toward self-actualization. How then, does the client experience this kind of therapy? For many clients who are experiencing anxiety or self doubt, person-to-person therapy can lead them to discover their own ability to heal themselves. Assuming responsibility for one's own mental health by recognizing the range of life choices that are available is one positive outcome for clients who experience Roger's approach.

Traditional therapy often places the therapist in a professional, diagnostic, medical role. The patient, in this scenario, becomes increasingly convinced that s/he is not able to "get better" without the intervention of an expert. As a result, s/he may become even more despondent and feel less empowered to take control of his life. By contrast, Rogers approach re-situates the therapist and simultaneously empowers the client. This relationship may best be characterized as a way of being. It asks the therapist to be an open participant in the dialogue, and to take responsibility for her own journey as well.

Therapy in Practice

Unlike other forms of therapy, the person-centered approach does not begin with an evaluation session. Rogers was wary of evaluative testing and shied away from asking for a complete medical and psychological history. These tools, he felt, established a sense that the therapist was prepared to diagnose and solve the clients' problems for them. Rather than framing a new therapeutic relationship in the context of assessment and diagnosis, a person-centered therapist will orient a new patient by communicating the core therapeutic values: congruence, unconditional self-regard, and empathy. These values will be communicated through conversation and dialogue, without an overly structured setting.

The therapist will ask questions to help the client communicate his thoughts, and throughout will practice reflective, active listening. Infusing this kind of listening with genuine interest and empathy will naturally create conditions for enhanced conversation. Rogers (1967) reminds his therapists that "it is the realness of the therapist in the relationship that is the most important element," (188). Thus, it is the job of the therapist not to give advice but instead of listen and thereby help the client feel accepted and safe.

Client-centered therapy has been used in individual settings, as a tool in group therapy, in crisis situations, and in chemical dependency. Despite the diversity of these settings, Rogers would have argued that all consist of individual people who can be brought out if provided with a productive environment for communication. Indeed, in recent years his tools have been used in team-building and corporate contexts, in school counseling settings, in classrooms, and in all psychology training programs. After all, "if counselors are lacking in these relationship and communication skills, theyw ill not be effective in carrying out a treatment program for their clients," (Corey, 2009: 179).

Current Interpretations

Many forms of modern therapy borrow from Carl Rogers' person-oriented approach. For example, art therapy and animal therapy seek to provide a safe and enjoyable context for clients to explore their inner thoughts. The therapist in these approaches, similar to client-centered settings, seeks to create unconditional regard. That is, especially in clients who have difficulty with personal interactions or who suffer from extreme anxiety, art and animals have been shown to create feelings of relaxation and calm. This state, in turn, may help an otherwise "stuck" patient dig into his or her own shell and uncover steps toward greater psychological health. Art and animals do not judge, they do not diagnose, and they do not provide treatment by themselves. But, following Rogers' precepts, modern day art therapists begin with the assumption that "our feelings and emotions are an energy source that can be channeled into the expressive arts to be released and transformed," (Corey, 2009: 181). The extension of client-centered therapy into the world of art merely adds a tool for creating the kind of therapeutic atmosphere that Rogers' promoted.

Thus, "one of the main ways in which person-centered therapy has evolved is the diversity, innovation, and individualization in practice," (Corey, 2009: 177). While still abiding to the core principles, some therapists now practice client-centered therapy with a greater role for therapists to react and even confront their clients. Some integrate client-centered therapy with other approaches, such as cognitive behaviorism. Finally, some have suggested that not all patients are well suited for a client-centered approach; if the model is not one-size-fits-all, then there is room for therapists to interpret the assumptions as they see fit. Adaptability has become a hallmark of Rogers' school of thought. Many practitioners note that the approach is particularly well suited for a globalized world. Cross-cultural communication and diversity in inter-personal relationships can be challenging; person-centered therapy has been applied in these contexts with promising results.

Other forms of modern therapy, such as experiential therapy, accept and use some of the tools described here but reject one of the fundamental assumptions of Rogers' model. Instead of trusting the client to proceed along some innate path toward healing, experiential therapists argue that there is "no built-in force that leads one toward integration and actualization," (Mahrer, 2004: 336). In this view, providing conditions for personal growth isn't enough. The patient needs exposure to new strategies for changing undesirable behaviors.

Similarly, rational emotive behavior therapy echoes doubt about Rogers' description of self-actualization. There is no "real self" waiting to be uncovered. According to rational emotive behavior therapy, clients are biologically diverse with natural strengths and weaknesses. They are influenced not just by some internal barometer but by countless social, environmental, and physical factors. They may hold beliefs that interfere with healing, and they may harbor thinking patterns that make it difficult or impossible to access some sort of inner truth (Ellis, 1998). Still, despite disagreement here about the process toward self-actualization, there is widespread agreement about what a self-actualized person is. Characteristics that are present in these enlightened souls are envisioned similarly across disciplines; how to help clients arrive at those elusive places is much more controversial.