Person-Centered Therapy and Motivational Interviewing

Introduction to Person-Centered Therapy

Person-Centered Therapy (PCT) is a form of counseling based on open dialogue with the patient that allows him or her to express a subjective view of themselves and the world in order to arrive at a more objective, clarified understanding. The patient enters therapy in a state of incongruity and, through a series of PCT sessions, is gradually relieved of that incongruity as it is exposed through his or her own dialogue with the therapist. The dialogue is primarily centered on the patient, which is why this approach is called person-centered therapy. This therapeutic approach is evident in the sessions between John (patient) and Dr. David J. Cain (therapist) (American Psychological Association, 2012a). This paper addresses the nature of PCT by exploring several key questions about how the therapy works, why the relationship matters, why the approach has lost ground to competing methods, and how motivational interviewing fits within this framework.

How Change Occurs in PCT

Change occurs in the patient over a series of interviews with the therapist, as both parties explore together a range of issues of which the patient gradually becomes aware through talking, reflecting, and discovering underlying themes and patterns within his or her own life and behavior. In the case of John, for instance, he enters therapy aware of a heightened stress level in his life, which he attributes to the man with whom he is living. Yet as the therapist encourages John to talk, it becomes evident to John himself that he has been a stressful person for some time and may even have obsessive-compulsive tendencies.

Change occurs, for example, as John discovers characteristics about himself that the therapist helps to highlight, so that John can decide whether those characteristics are negatively or positively affecting his life and what, if anything, to do about them (American Psychological Association, 2012b). This process of discovery — prompted by dialogue rather than directed by the therapist — is the defining mechanism of change in PCT.

The Therapeutic Relationship and Its Role

The relationship is key to the process because without the relationship there is no dialogue, and without the dialogue there is no discovery. The therapist facilitates person-centered therapy by motivating the patient to work through his or her own issues over the course of the interview process. The relationship allows those issues to be unlocked so that the patient can see them anew, sometimes for the first time (Li & Porock, 2014).

The therapy is not relationship-centered in the sense of cultivating external support networks; rather, it is person-centered. Even so, the relationship between therapist and patient is essential to successful therapy, because it is that relationship which allows the patient to open up in a way that keeps both individuals entirely focused on the patient. This is something that is not always possible in everyday relationships where two people must give and take equally — as is the case with John and his partner. The relationship between John and his therapist, by contrast, is ideally suited to providing the person-centered focus John needs to identify elements within himself that are affecting his life (American Psychological Association, 2012b).

As Dr. Cain demonstrates in Session 1 with John (American Psychological Association, 2012a), the relationship is key because it provides the patient with the empathy needed to open up and respond to the inner questions, ideas, and problems pressing to get out. By showing genuine interest in the patient, the therapist helps the patient recognize that he has something worth sharing — whereas previously he may have bottled everything up, assuming he had nothing to offer or nothing anyone needed to care about. When the therapist extends empathy to the patient, it functions like a release valve: it gives the patient an opportunity to come out from under his problems and unburden himself, if only by speaking aloud.

Through this relationship, the patient is also able to see which underlying fears are affecting his other relationships. In John's case, he discovers that his reluctance to make a ceremonial commitment to his partner is rooted not in commitment itself but in the ceremonial aspect. This realization would not have been possible without the therapist's role (American Psychological Association, 2012a). As the listening and empathic half of the relationship, Dr. Cain fills a gap in John's life that must be filled for John to begin understanding himself. In short, John needs a good listener.

Dr. Cain's second session with John (American Psychological Association, 2012b) reveals another dimension of why the relationship matters: Dr. Cain encourages John to engage his emotions more fully, working through them openly rather than continually repressing them. This is the other pivotal function of the PCT therapeutic relationship — the therapist assists the patient in confronting repression by encouraging him to experience the emotions simmering below the surface. This releases pressure and allows the patient to deflate the stress that has been building within. A similar dynamic is illustrated in Person-Centered Child Therapy (Allyn and Bacon, 2002), which shows how the relationship can be effective even with children by using purposeful body language to convey solidarity, support, and engagement.

In terms of its appearance, the PCT relationship is structured around what Davidson et al. (2015, p. 82) describe as a "collaborative process between the person" and the care provider "that results in the development and implementation of an action plan" geared toward allowing the individual to pursue and attain personal objectives. The goal is not to compel the patient to conform to the therapist's agenda but to help the patient identify his or her own goals and reach them through dialogue and strategic questioning that supports self-discovery. The therapist's role is to provide "engagement" with the patient (Andrus, 2014, p. 20) — offering focus, listening, empathy, and contextual framing relevant to the patient's own priorities.