L1 - Client-centered therapy Flashcards
(80 cards)
1
Q
What is the Rogerian hypothesis?
A
Individuals possess vast resources of self-understanding and self-direction and are most able to access own resources when provided with a genuine, congruent therapist that is offering an unconditional positive regard, warm acceptance and is empathically receptive to client’s own perceived realities.
2
Q
What is client-centered therapy?
A
- The person - sovereign human beings who can and should be architects of their own life
- recognizes person’s self-authority as active agents of personal and social change (as opposed to the therapist being the expert on our lives)
- It’s esentially a way of helping in which the therapist facilitates a process directed by the client
- Actualizing tendency
3
Q
What is Actualizing tendency?
A
- it posits that organisms are motivated to maintain and enhance themselves
- Rogers proposed that it’s a tendency that is constantly functioning but may be distorted by environmental factors (trauma, violence, poverty): we are doing the best we can, under the circumstancewe are provided with
- It’s the basis of CCT
- It starts from the assumption that individuals prefer to be healthy rather than sick and do not need the therapist to direct them from this preference:the therapist trusts in the client’s self-righting and self-regulatory capacities
4
Q
Molen book
Self-actualization
A
- Rogers emphasizes a ‘self-actualizing tendency’ as the fundamental drive motivating individuals to develop their potentialities
- This tendency involves continual development towards an optimal personal ideal, shaped by the quality of experiences
- Rogers believes optimal experiences occur naturally under favourable circumstances
5
Q
Rogers’ understanding of human nature comprises different levels of analysis. What are these levels?
A
- Nomothetic (universal) level - humans are deeply the same and tend to respond in similar ways in particular situations
- Group differences: there are differences between certain groups of people
-
Idiographic (unique) level - each person is unique and never exactly like another person are not the same
- Rogers therapy is oriented to the idiographic human: each person has a unique temperament, history of experiences and learning and a way of using the therapeutic situation
6
Q
What are criticism of Roger’s view?
A
- criticism: optimistic and naïve & actualizing tendency is belief in moral goodness
- not what Roger’s meant, didn’t view people as inherently good or evil, rather that when provided with respectful environment, humans can move to this positive, prosocial direction
7
Q
Therapeutic relationship
A
- Therapy is a collaborative process: the client is the active agent of change, they actively construct the therapy in an accepting and empowering environment
- The therapist facilitates but doesn’t direct
- Therapist’s attitudes create a climate of freedom and safety (to promote the actualizing tendency)
- Both client and therapist are unique, there is no prediction of relationship
- Rejection of Manualization: Standardized treatments undermine the uniqueness of client experiences and contradict client-centered principles
8
Q
What is the non-directive attitude
A
- An attitude of trust in a person’s inner resources of growth and self-realization
- It doesn’t imply passivity or lack of responsiveness, but it encourages an equal power relationship instead of encouraging therapists to believe that they can become experts on others’ lives and choices
9
Q
What are concepts on the client’s side in CCT?
A
-
Self-concept - the client’s perceptions and feelings about self
↪ A major component in this is positive self-regard, which is often lacking in clients that seek help -
Locus of evaluation - the basis for a client’s standards and values (external vs. internal)
↪ At the beginning of therapy, patients are often overly concerned with what other people think of them (external locus), which later changes to being about their own inner experiencing (internal locus) -
Experiencing: the way in which a client experiences oneself and the world (rigidity vs. openness)
↪ Many, but not all, clients usually move from a rigid mode of experiencing to one of greater openness and flexibility
10
Q
What are qualities of a therapist that are conditions of therapeutic change?
A
- Congruence
- Unconditional positive regard
- Empathetic understanding of the client’s internal frame of reference
11
Q
Congruence
A
= genuineness
- The therapist’s ongoing process of assimilating, integrating, and symbolizing the flow of experiences in awareness
- It’s about being aware of and willing to represent feelings that one has in the present moment (and not hide behind the mask of professionalism)
- It usually manifests itself in a perceptible (appearance, verbal and non-verbal) transparency, genuineness, and self-disclosure
12
Q
Unconditional positive regard
A
- crucial for individual development, emphasizing the importance of experiencing unconditional acceptance from significant people in one’s environment
- In therapy: a non-judgmental openness and acceptance of the client as a person with their own behaviors, beliefs, and values, irrespective of the therapist’s own values
- The therapist should make every effort to be aware of evaluative or judgmental responses and set them aside
- It doesn’t mean that the therapist has to approve the behavior of the client
- Rather it’s about trying to understand this behavior as the best possible adjustment: what is the meaning of the behavior?
13
Q
Empathetic understanding of the client’s internal frame of reference
A
- the ability to absorb the expressed meanings of the client as if seeing the world from the client’s perspective and to feel along with the client’s pain or joy
- It’s an active, continuous attitude of wishing to grasp the client’s expression, meanings, and narrative
- However, it’s important to note that this empathy remains temporary: it should be ‘as if’ one is the patient, not losing oneself in it
- Empathy doesn’t only promote the therapeutic relationship, it also promotes exploration of the client’s perspective and emotion regulation
14
Q
Molen
How do personal problems arise?
A
- Conditional regard occurs when individuals’ acceptance depends on conforming to external expectations, leading to incongruence and internal conflict
- Forced to behave in ways he doesn’t want to or normally wouldn’t - not free and spontaneous in his behaviour
- Internalization of imposed norms makes a person confused and anxious, cautious about displaying emotions and real self
15
Q
CCT vs other approaches
CCT and the medical model
A
- Medical model = an approach to psychology that emphasizes applying appropriate treatments to disorders, placing pathology inside the person
- Most CC approaches are radically different from this medical approach, stating that it can lead to stigmatization and marginalization of the person
16
Q
CCT vs Other approaches
CCT vs Positive psychology
A
- An approach to psychology that emphasizes the desirability of focusing on clients’ strengths as the engine of change
- This focus can overlap with the actualizing of CCT
- Both focus on applying scientific methods
- However, critque = PP interventions still ground themselves in the medical model with positive interventions (e.g. happiness exercises for depression)
17
Q
CCT vs Other approaches
CCT vs feminist therapy
A
- A psychology/therapy approach that addresses that many women’s problems are rooted in social structures that oppress them, instead of their psyches
- The feminist movement in the late 1960s led women therapists to challenge the dominant therapeutic paradigms and ideas and the authority of the male founders
- Psychologists often represented male authority and their reductionist ideas of ‘what women (should) want’
- CCT overlaps with FT in that both aim to empower the client
18
Q
CCT vs Other approaches
CCT vs CBT-approaches
A
- For a very long time, CBT has been dominant based on the assumption that it’s more strongly evidence-based than other approaches
- However, this is misleading as many studies show that all psychotherapy models are roughly equal in effects (Dodo bird verdict) and that the therapeutic relationship is muc more important for the outcome
- Critics of CBT maintain that the therapeutic relationship is used to get the patient to conform to and comply with the therapist’s advice and guidance: the therapist is the one with the expert power
-> Obviously, this is ethically problematic for the CC perspective
19
Q
Theory of personality
What is the 19-proposition theory of personality & behaviour?
A
= a growth-oriented theory of personality and behavior by Rogers that is based on 19 basic
propositions - important elements:
- Every organism is the center of his/her own world, which is the reality
- The organism has 1 basic tendency: an actualizing tendency and behavior is the goal-directed attempt to satisfy this need
- The self is formed as a result of an interaction with the environment and evaluations of other people
- Experiences that occur are symbolized into some relationship to the self or denied because they inconsistent with the structure of the self
- In the latter case, there is incongruence, which is the basis of psychological maladjustment
- In contrast, psychological adjustment exists when the concept of the self is such that all experiences may be symbolized (are not denied) into one integrated selfstructure
20
Q
Terms and concepts from Roger’s theory of personality & behaviour
Experience
A
- The private world of the individual = reality for a certain person
- Experience may be conscious but can also be more difficult to bring into awareness
- An individual is the only one who can know his/her experience completely because he/she is the only one with their internal frame of reference
21
Q
Terms and concepts from Roger’s theory of personality & behaviour
Symbolization
A
- The process by which an individual becomes aware or conscious of an experience. We have tendency to symbolize experiences in ways that are consistent with the self-concept
- E.g. A self-confident person may symbolize a silent audience as attentive and interested, while a less confident person may symbolize the audience as unimpressed
22
Q
Terms and concepts from Roger’s theory of personality & behaviour
Psychological (mal)adjustment
A
- When a person’s self-concept includes elements of weakness and imperfection and is an integrated whole
- When this is the case, a person can accept experiences (behaviour) that are incongruent with their overall self-concept: they do not have to deny or distort such experiences
- When this is not the case, we speak of maladjustment
- E.g. If a child always gets punished when angry, it learns that getting angry will result in negative consequences. Thus, being angry is dissociated/not integrated in the self-concept. When he/she subsequently gets angry, incongruence arises: he/she feels angry but has learned not to express it.
23
Q
Terms and concepts from Roger’s theory of personality & behaviour
Fully functioning person
A
= Rogers’s concept of a person that can readily assimilate organismic experiencing and are capable of symbolizing these experiences in awareness
- Fully functioning persons are able to experience all of their feelings, are afraid of none of them, and allow awareness to flow freely.
24
Q
Terms and concepts from Roger’s theory of personality & behaviour
Organismic valuing process
A
- The ongoing process in which individuals rely on the evidence of their own senses to make value judgments
- This process is different from a system that makes judgments based on what is supposed to be right or wrong
- In line with person-centered hypothesis of confidence in the individual and makes for a highly responsible socialized system of values and behaviour
- The responsibility derives from persons making choices on the basis of their direct, organismic processing of situations
25
How does the process of CCT look like?
- As the client is the director of therapy, there are no a priori goals formulated for the client
- Therapy begins immediately, with the therapist trying to understand the client's world in whatever way the client wishes to share it
- The client is also a vital partner in determining the nature, frequency, and length of therapy
26
What are the mechanisms of therapy?
- In the course of development, most children learn that their worth is conditional on good behavior, moral/religious standards, performance etc.
- Empathic understanding allows the client to change from a '**me-state**' (thinking of oneself as an object in the world) to an '**I-state**' (thinking of oneself as an agent from one's own internal frame of reference)
27
Common misconceptions of CCT concerning the applicability of the approach
1. **Biased**: it's biased toward white, Western, middle-class, verbal clients
2. **Severe disorders**: it is superficial, limited, and ineffective, particularly with more severe disorders such as personality disorders
3. **Reflection**: it only uses the technique of reflection and thus fails to offer clients treatments of proven effectiveness
28
How does CCT resolve these misconceptions?
1. Doesn't aim to promote Western social values (r.g. autonomy, independence, individualism)
↪ Respect for and appreciation of clients includes their cultural or religious values
↪ If there is tension or limitations in cross-cultural scenario of a therapeutic relationship, it's due to the therapist's personal limitations and biases
2. It's generally applicable to anyone because a person is always more than his/her diagnostic label and can direct and make choices themselves (e.g. schizophrenic patient can choose to not take medication because if it is forced onto him/her they are being paternalistically treated - less than capable of deciding their own course in life)
3. It goes beyond reflection by offering clients access to a range of evidence-based resources (e.g. other therapies, medication, and support groups) when appropriate and ethically sound
29
Other forms of CCT
## Footnote
Not that important, just to illustrate the applicability
> CCT avoids the term "treatment," emphasizing that psychotherapy is metaphorical and conversational rather than a medical intervention
> The approach originated in individual psychotherapy with adults but has expanded to any context focusing on psychological growth and welfare:
- **Play therapy**: Rogers valued play therapy (by J. Taft) for fostering self-acceptance and emotional growth in children through self-directed expression
- **Client-centered group process**: promoting collaboration, empathy, and mutual respect
- **Classroom teaching**: Rogers redefined teaching by becoming a facilitator who encouraged student-led learning and shared educational goals
- **The Intensive Group**: emphasized deep, authentic group interactions that support personal growth through empathy and acceptance
- **Peace and conflict resolution**: Rogers applied the person-centred approach to global conflicts, using empathy to bridge divides and promote understanding
30
# Evidence
What are the common factors among therapies that make them effective?
- Meta-analytic studies yield comparable effect sizes across all major psychotherapies (*Dodo bird verdict*)
- Thus, outcomes in psychotherapy result from factors that all therapies have in common ( e.g. characteristics of the therapist, resources of the client)
- It seems that it is untrue that specific disorders require specific 'treatments'
31
What evidence is there for CCT?
- There is strong empirical support for the core conditions of congruence, unconditional positive regard, and empathic understanding, and for their impact on the therapy outcome
- Also, a meta-analysis of multiple humanistic therapies (including client-centered) showed that:
1) **Pre-post change**: client-centered therapies are associated with large pre-post change
2) **Long-term results**: posttherapy gains are stable and maintained over 1-year follow-ups#
3) **RCTs**: clients show substantially more change than untreated clients and equivalent amounts of change as clients in non-humanistic therapies (including СВТ)
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CCT in a multicultural world
- Avoids stereotypes; focuses on individual experience over group identity
- Recognizes diversity when clients express it
- Rejects colour-blindness; acknowledges social biases
- Emphasizes empathy, openness, and confronting therapist bias
33
Critiques of Rogers' theory
1. Too optimistic
2. Too naive
2. Too vague
34
Is Rogers too optimistic?
- Critics argue that Rogers’ concept of self-actualization under favourable circumstances is overly optimistic
- Behaviourists contend that self-actualization requires reinforcement for appropriate behaviours and correction during the learning process
- Rogers’ methods which require people to think through their problems, may be challenging for individuals with varying intellectual abilities and verbal fluency -> they might need more concrete problem-solving approaches
35
Too naive
- actualizing tendency is belief in moral goodness, that's a naive view
- However, that's not what Roger’s meant
- He didn't view people as inherently good or evil, rather that when provided with respectful environment, humans can move to this positive, prosocial direction
36
Too vague
- Cognitive psychologists criticize Rogers’ non-directive approach for lacking influence in modifying cognitive processes
- Rogers’ theory is perceived as unclear and vague regarding the process of self-actualization - it's assumed that it's takes place naturally when the person is open to his experiences
- This arises scepticism from cognitive perspectives
37
So they why study about it and why do clinicians use (methods) from Roger's theory?
- Despite criticisms, Rogers’ methods possess valuable assets and his principles can be embraced without fully agreeing with his theory of human development
- The importance of a strong helper-client relationship, characterized by warmth and genuineness, is universally acknowledged in counselling
- Rogers' techniques empower clients to discover solutions independently, emphasizing the necessity for helpers to intervene minimally
- While Rogers’ views face scrutiny for their optimism and lack of directive approaches, his emphasis on client-centred relationships remains fundamental in counselling
- The balance between intervention and autonomy in helping clients -> the ongoing relevance of Rogers’ contributions to the field
38
What is the cognitive theory of experiencing according to Roger's and Wexler?
- Rogers’ theory emphasizes a person's potential for self-actualization through changes in experiencing, influenced by interpersonal relationships = passive process from the client's part
- Wexler challenges the passive view of experiencing, arguing that individuals actively select, arrange, and interpret information, crucial for meaningful understanding
39
What role does processing of information play in the active process of experiencing?
- Information processing involves selective attention and interpreting experiences uniquely, shaping individual perceptions and responses
- This is done through continual **differentiation** and **integration** which allow for assimilation of fully new info, giving it structure and meaning
- When the processes can no longer cope with incoming information the person has difficulties in making sense of his experiences
- That's where the therapist comes in - help the client to order his information differently so that he experiences the world in a more controllable way
40
How do Rogers and Wexler differ in the role of feelings in CCT?
- Wexler and Rogers acknowledge the importance of emotions but differ in how they connect feelings to cognitive processes
- Rogers: emphasizes fully experiencing and being open to emotions
↪ suggests emotions are already within us and emerge naturally when we're open
- Wexler: argues emotions arise from cognitive processes, not automatically; they result from active information processing
41
Why do emotions arise from information processing according to Wexler?
1. **Personal relevance**: Emotion depends on how meaningful the information is to the person
2. **Change or disruption**: Sudden or significant changes (e.g., failing an exam) can cause emotional reactions like anxiety
3. **Challenge to beliefs**: New information that questions core beliefs can trigger strong emotions (e.g., hope, surprise)
42
What implications does this have for counselling?
- Strong emotions often accompany meaningful change
- Emotions should be acknowledged but not forced or exaggerated
- Helpers must ensure clients are not overwhelmed by emotional experiences
- Warning against training methods that deliberately provoke intense emotions - they may harm rather than help
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Does Rogers Really Regard Experiencing as Passive?
- Wexler's claim that Rogers sees experiencing as passive is too literal
- Rogers promotes active attention to emotions as valuable information
- Suppressed emotions (e.g., due to social taboos) lead to impoverished experiencing
- Rogers helps clients notice and verbalize these feelings — aligning with Wexler’s idea of information selection
- Both agree on the importance of emotional processing, but it should be balanced
- counselling should integrate active agency with openness to experiences, emphasizing a dynamic equilibrium between intellect and sentiment
44
# Moyers book - effective psychotherapies: ch3 Accurate empathy
What are the two components of trait empathy?
Empathy in humans consists of two related components with distinct neuroanatomical foundations
1. **Cognitive perspective-taking** - involves interpreting others' inner experiences and intentions based on complex cues
↪ likely evolved to facilitate cooperation and understanding within human groups
2. **Shared affective responding** where individuals recognize and partially experience another person’s emotions
↪ observable through physiological mirroring (mirror neurons), like changes in heart rate and skin conductance
45
Who posseses trait empathy?
- Empathy is partially heritable and normally distributed within populations
- Individuals vary in their empathic ability, with some naturally talented at understanding others’ thoughts and feelings
- Empathy can be enhanced through life experiences, intentional practice, and engagement in therapy
46
What is the skill of accurate empathy?
- Accurate empathy is a skill cultivated in helping relationships
- It's not the same as sympathy (feeling sorry for someone) nor perspective-taking (putting yourself in another's shoes - it's a prerequisite for AE)
- It involves understanding a client's perspective without necessarily sharing the same emotions in real-time or ever experienced the same experiences yourself in the past (might actually interfere with accurate empathy)
- Therapists with high skill in accurate empathy demonstrate deep understanding of a client’s meaning, reflecting this understanding back to the client
47
What attitude is required for AE?
- Fundamental to accurate empathy is a curious, open, and interested attitude towards another's experience
- It requires setting aside personal perspectives and focusing entirely on understanding the client’s experience
- It involves deep listening with a beginner's mind (not assuming you understand the person fully), gradually gaining deeper levels of understanding through reflective dialogue
- Effective communication (reflecting back) of empathic understanding fosters a stronger therapeutic connection
48
# The how of communicating AE
What is important with accurate empathy?
- In a helping relationship, accurate empathy involves conveying internal understanding outwardly to the client
- It's not just about experiencing empathy internally but expressing it effectively
49
What are the 3 ways in which you may misunderstand the meaning?
1. People often don't say precisely what they mean; their words may be influenced by motives like pleasing others or creating a particular impression
↪ Additionally, interpretation can be affected by tone, pace, and other nonverbal cues
2. Mishearing due to inattention or environmental factors can lead to inaccuracies
3. Even if the words are heard correctly, there's the risk of misinterpreting their meaning based on personal biases or assumptions
50
How can you use silence?
- Silence can be a powerful listening tool, allowing individuals time to process and reflect
- However, excessive silence may lead to uncertainty or projection by the speaker
- In therapeutic contexts, the focus is on the client's experience, and responses should convey understanding rather than inserting personal perspectives or reactions
51
What 12 roadblocks to listening well did Gordon identify?
- Accurate empathy is in part defined by what you are not doing while listening
- Roadblocks = in that speakers are easily diverted by them and must go around them in order to keep exploring the original train of thought and experience:
1. **Probing** - asking questions to gather facts or obtain more information
2. **Advising** - making suggestions and providing solutions
3. **Reassuring** - comforting, sympathizing, or consoling
4. **Agreeing** - telling people they are right, perhaps approving or praising them
5. **Directing** - telling a client what to do, as if giving an order or a command
6. **Persuading** - lecturing, arguing, disagreeing, giving reasons, or trying to convince logically
7. **Analyzing** - offers a reinterpretation or explanation of what someone is saying or doing
8. **Warning** - pointing out the risks or dangers of what a person is doing
9. **Distracting** - tries to draw people’s attention away from what they are experiencing, as by humoring or changing the subject
10. **Moralizing** - telling people what they should do and why they should do it
11. **Judging** can take the form of blaming, criticizing, or simply disagreeing
12. **Shaming** - can have a demeaning or ridiculing tone, or apply a disapproving label
These can at sometimes be helpful, but not when the goal is to deepen your understanding of a client’s experience
52
What kind of listening and form of intervention does AE involve?
- Accurate empathy involves **active listening** where you reflect back your understanding of what the speaker is communicating, not just echoing their words
- It's about stepping into their world and mirroring their feelings and unspoken meanings - helps the speaker explore their experiences more deeply
- By making statements rather than questions, you encourage the speaker to continue exploring their thoughts and feelings without feeling defensive
- it also allows for a more natural flow of conversation and prevents the speaker from feeling questioned or defensive
- This approach supports a deeper exploration of the speaker's experiences and emotions
53
What to reflect?
- When practicing reflection in therapy, therapists must make conscious decisions about which aspects of clients’ statements to emphasize or reinforce
- It involves selectively highlighting significant emotions, themes, or experiences expressed by the client
- The level of empathy expressed should align with the client's preferences and tolerance for empathic responses (therapists must adapt their empathy accordingly)
- *It matters what you choose to reflect* - an empathic listening response places particular emphasis on something a client has said, and tends to encourage more of the same
54
What do various theroies propose as criteria for determining what content to reflect?
- Reflecting underlying feelings or emotions
- Highlighting outward signs of upsetness, anxiety, or resistance and reinforce three themes:
1) human relationship
2) Self-exploration
3) Positive self-concept
- Emphasizing experiences of intense vulnerability to bring them into the present moment
55
How does the intensity of reflections play a role?
- The choice of reflection intensity impacts the client's response and further exploration
- Reflecting slightly below the client's intensity level generally encourages self-exploration
- Conversely, an amplified reflection can challenge extreme perspectives, provided it is delivered without sarcasm or criticism
1. **Undershooting**: reflecting with less intensity often encourages clients to reaffirm and delve deeper into their feelings or experiences
2. **Matching**: Reflecting at a similar intensity may validate the client's emotions or thoughts
3. **Overshooting**: Reflecting with more intensity might prompt clients to reconsider extreme positions or overgeneralizations
56
What does research say about AE?
- It stands out among therapeutic factors for its consistent positive relationship with client outcomes
- Therapists with low empathy levels raise concerns due to poor client outcomes observed in analyses of therapist effects
- Low levels of accurate empathy and Rogers's core therapeutic skills correlate with poorer client outcomes
57
What are the key findings from a meta-analysis of AE in 82 samples with 6000 patients?
- **Therapeutic Settings**: Higher levels of therapist empathy predict better outcomes in client-centred counselling, psychotherapy, CBT, emotion-focused therapy, health promotion, MI, and computer-delivered brief interventions
- **Working Alliance**: Empathic therapists tend to establish stronger working alliances, which in turn predict better outcomes for clients
- **Medical Context**: Empathy is strongly associated with patient satisfaction in medical settings, irrespective of factors like waiting time or visit duration. Even small increases in empathy among emergency room physicians can reduce patients’ thoughts of litigation
58
Do clients cause therapist empathy and does therapist influence client's prognosis?
- Clients with better prognoses, higher motivation or more articulate may elicit greater therapist empathy, enhancing outcomes
- Therapists often show higher empathy toward intelligent clients with less severe pathology
- Negative therapist attitudes can harm therapy outcomes
- Empathy levels may vary based on client-therapist similarity
- Other research shows that core therapeutic skills like empathy are relatively independent of client characteristics
- Therapists share responsibility in co-creating empathy within the therapeutic relationship
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# Moyers book - effective psychotherapies: ch4 Acceptance
What is non-judgmental acceptance?
- Fundamental therapeutic skill in counselling and psychotherapy, often considered one of the most important aspects of the therapeutic relationship
- It involves accepting and acknowledging the client's expression of both negative and positive feelings without imposing conditions or expectations
- It is characterized by listening without preconceptions, prejudice, or condemnation
- The counsellor’s attitude is **unconditional**, meaning clients are accepted and respected regardless of their thoughts, feelings, or behaviours
- This differs from everyday social interactions, which often involve judgment, criticism, or analysis
60
What role does non-judgmental acceptance play in psychotherapy?
- a cornerstone of mindfulness practice
- significant attention in research especially within third-generation CBT, stress management, and addiction treatment
- Rooted in ancient contemplative traditions, **mindfulness** involves observing one's present experience without judgment, evaluation, or the need for approval
- It fosters an appreciation of reality as it is, without imposing ideals of how things should be
61
Acceptance in therapy and therapeutic alliance
* Acceptance is based on belief in inherent human worth and unconditional respect
* Therapists convey acceptance by affirming clients’ intrinsic value and by respecting their experiences
* Rogers emphasized that unconditional acceptance (by therapist but also by others) enables personal change
* Experiencing acceptance helps individuals overcome self-judgment and grow
* Therapists model acceptance to promote clients' self-acceptance and integration
62
What are the three contrasting theories about human nature?
1. Theory A suggests people are fundamentally self-serving and would revert to selfish, hostile, and destructive behaviours without societal controls
2. Theory B posits that individuals have no innate nature but are shaped solely by genetics and experiences, essentially blank slates
3. Theory C proposes a natural predisposition towards collaboration, constructive behaviour, and trustworthiness, especially under supportive conditions that facilitate positive change
63
What does research from bussiness and therapy show about the consequences of using either of these theories?
- In companies' management, using Theory X (people are lazy) leads to strict control, while Theory Y (people are motivated) encourages support and trust -> successful companies tend to use Theory Y
- In therapy, some therapists (Group I) are warm and accepting, others (Group II) are colder and more controlling
↪ Group I therapists, who believe in their clients’ potential and show acceptance, tend to have better outcomes
↪ Especially in conditions like schizophrenia, therapist acceptance is linked to more successful treatment
- Hence, beliefs about human nature affect how therapists treat clients and acceptance, warmth, and support play a major role in client progress
64
How does resistance affect therapeutic alliance and its progress
* "Resistance" in therapy reflects attitudes about human nature and can become self-fulfilling
* Confrontational styles increase defensiveness and reduce honest communication; accepting communication has the opposite effect
* Resistance is often shaped by therapist behavior, not client pathology
* It may stem from **psychological reactance** - a natural response to unsolicited advice
* Therapists should avoid an "expert" stance and instead promote empathetic, collaborative dialogue, listen and accept
65
How to communicate acceptance?
* Acceptance means avoiding judgment, criticism, or shaming
* **Active listening** and **asking permission** before giving input -> respect
* **Acknowledging client autonomy** -> compassion and collaboration
* **Silence** can be misinterpreted; acceptance must be actively communicated
* **Empathic understanding** -> non-judgmental atmosphere
* **Mindfulness** helps therapists maintain an accepting stance
* **Affirmation** of client strengths reinforces acceptance
66
What does research on therapeutic acceptance show?
* Therapist acceptance is strongly linked to positive client outcomes - even stronger when rated by clients or independent observers
* Acceptance has an even greater impact in racially/ethnically diverse client groups
↪ Similar findings appear in motivational interviewing with minority populations
* Acceptance is especially important for marginalized clients and across cultural differences
* While modest alone, acceptance enhances outcomes even with similar treatment methods
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# Moyers book - effective psychotherapies: ch3 positive regard
What is unconditional positive regard according to Rogers?
- Essential for healing, along with empathy and genuiness
- Means offering offering warmth, acceptance, and respect without judgment or conditions
- High PR reflects deep respect for the client’s worth and autonomy
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Measure of PR
* The **Barrett-Lennard Relationship Inventory (BLRI)** is widely used and reliable
* The tool distinguishes between overall **positive regard (PR)** and its **conditionality** (whether the therapist’s approval and warmth varied depending on what the client was expressing or doing)
* Measuring the conditionality of PR is difficult, so studies often focus on overall PR
* The BLRI doesn’t identify specific therapist behaviors to express PR, leaving room for further research
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The attitude of PR
* Core therapeutic attitude of warmth, respect, and sympathy
* It emphasizes clients’ growth and well-being over focusing on pathology
* PR aligns with positive psychology’s focus on happiness, virtues, and flourishing
* Therapists express PR by respecting clients’ inner wisdom and autonomy
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The how of communicating PR
* It includes both an internal therapist mindset and how this is communicated to clients
* Highlight clients’ strengths, virtues, and intentions
* The focus is on capabilities, not just problems
* PR responses often start with **"you"** to center the client (e.g., “You showed courage”)
* Avoid **"I"** statements (e.g., “I’m proud of you”) to prevent shifting focus or implying judgment
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What is the Psychotherapist expressions of PR scale?
* Measures therapist behaviors that convey PR, including affirmations, supportive actions (e.g., handing a tissue), and warm, attentive attitudes
* Factor analysis identified key components: supportive statements, unique responsiveness (therapist deeply attentive and discovered something worthwile), and intimacy/disclosure (hugging, contact outside of therapy)
* Although **intimacy/disclosure** was negatively linked to PR on the Barrett-Lennard scale
* High-PR therapists consistently show warmth, respect, and support
* PR can vary depending on client content; understanding this variation is important
* Measuring both PR and non-judgmental acceptance separately can improve understanding of therapeutic dynamics (compared to the unconditionality subscale)
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# The how of communicating PR
Affirmation - how used in PR and types
- a direct way of conveying PR by noticing and commenting on a person's strengths, positive actions, and attributes in an honest and explicit manner
- Types:
1) **Simple** - straightforward acknowledgments of specific behaviours or actions (thanking for coming in)
↪ easy to offer but they may lack depth and sencirety if overused without addressing the specific qualities that are valued in the person
2) **Complex** - require more effort and involve listening for strengths and admirable qualities in the client as a person
↪ go beyond surface observations and connect current experiences to enduring and admirable characteristics of the individual
↪ encourage clients, instil optimism, foster a sense of being valued and appreciated, and empower to take on challenges or make difficult decisions
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Examples of complex affirmations
- Recognizing a client's decision to attend a session despite initial reluctance, highlighting their love and care for a spouse
- Acknowledging a client's perseverance and determination in overcoming obstacles
- Appreciating a client's creative problem-solving abilities
- Praising a client's reliability and commitment to their word
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Embedded PR
- PR can be shown not just through words, but also through therapists’ actions and attitudes
- Clients often feel more valued when therapists listen attentively or are flexible, rather than through verbal affirmations alone
- Internal attitude can be learned from clients - supporting them through challenges and appreciating their resilience helps therapists grow in their capacity for PR
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Can affirmating be harmful?
- Some traditions (e.g., certain psychoanalytic approaches) caution that affirmation may hinder client self-examination by reinforcing external approval-seeking
- Many psychoanalysts, however, reject the stereotype of emotional detachment and emphasize warmth and interaction
- Clinical evidence supports that affirmation and positive regard (PR) generally benefit client outcomes
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How should therapist affirm to not harm the therapeutic alliance?
* Affirmation must be genuine and accurate - shallow or inauthentic praise can backfire
* Clients with mistrust may respond cautiously to early affirmations
* Therapists should monitor client reactions and adjust the level and style of affirmation accordingly
* Misjudged affirmation can be corrected by noticing client feedback and repairing any relational ruptures.
* Effective affirmation requires balance and sensitivity - tailored to each client’s needs
* Affirmation is conveyed not only through words but also through demeanour, eye contact, and tone
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How does culture play a role in affirmations?
* Client responses to affirmation vary based on individual and cultural differences
* Cultural norms shape how affirmation is interpreted; some cultures value direct expressions of warmth more than others
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What does research show about PR and affirmations?
- Meta-analyses: modest positive effect size of PR on treatment outcomes, with this effect increasing to a moderate level after controlling for duplicate datasets across studies
- Differences in how PR is defined may explain variability in its observed effectiveness
- **Therapist affirmation**, a specific and observable form of PR, tends to reduce client defensiveness and promote openness to change
- The **content** of affirmation is important - targeted positive reinforcement can shape client behavior and speech positively
- Therapist affirmations are linked to:
1) Increased client motivation to change problematic behaviors
2) Reduced resistance to change
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Difference in research between PR, genuiness and empathy
- The effect size of PR is slightly smaller compared to accurate empathy and genuineness
- In a clinical trial focused on depression treatment, therapist PR did not predict client outcomes, whereas genuineness and empathy did
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Concrete examples from research of PR showing its effectiveness
* Even in **online therapy**, therapist affirmation and encouragement have been associated with improved client outcomes, especially in CBT for depression
* A major clinical trial compared DBT and **Comprehensive Validation Therapy (CVT)** for women with opioid dependence and borderline personality disorder:
1) Both treatments were equally effective in reducing opiate use and psychopathology.
2) CVT, which emphasized **warmth, genuineness, and validation** without DBT's structured techniques, had **0% dropout**, versus **36% in DBT**
* This trial underscores the therapeutic value of **validation and affirmation** as powerful components of effective treatment
