W4 Flashcards
A brief summary of Rogers and Client-Centered Therapy
Client-centred therapy first emerged in 1940s America. It was pioneered by Carl Ransom Rogers, who had observed through his therapeutic experience that humans possess vast resources for self-understanding and self-direction. The Rogerian hypothesis advances the idea that individuals are best able to access their own creative resources when the therapeutic relationship is characterized by warmth, acceptance, and empathy; and with a therapist who is genuine and congruent themselves.
Rogers does not look at the individual as someone who needs to be fixed, but as a whole individual who might be experiencing stagnation. Indeed, being human is a process (people are consistently being impacted by new experiences, new people etc. – and the impact calls for a new response; being changed).
Rogers’s theories (of personality, therapy, and interpersonal relationships) have been utilised in peace and reconciliation work across the world; garnering Rogers a Nobel Peace Prize nomination.
[Little Note: The Tuskegee syphilis experiments of the 1930s were a 40-year study in which African American participants were deliberately injected with syphilis. The discredited “reparative therapy” is one that seeks to “cure” homosexuality]
Personhood
The ethical claim that human beings should not be used as means to achieve another’s end. All human beings are irreducible “ends” by themselves, and inherently deserve dignity and respect without having to earn it.
Client-centered therapy asserts that the client is a person; who may have had their personhood limited or denied by institutional structures or oppressive cultural/social practices. They are trusted as sovereign human beings who can/should be the architects of their own lives. The clinician is not the expert on the client’s life; the client has their own authority as an active agent of change.
The Actualizing Tendency
Organisms are motivated to maintain and enhance themselves; through moving towards increasing complexity. In other words, people do the best they can within the circumstances they are placed. This tendency may be diminished or thwarted by poverty, trauma, or violence; but it cannot be eradicated.
Ryan and Deci’s (2017) research on self-determination theory (SDT) found that the maintenance and enhancement of intrinsic motivation requires supportive conditions; and that it can easily be disrupted by various nonsupportive conditions.
It stems from the work of Goldstein post-WWI, who emphasised the importance of understanding individuals as totalities (holistic perspective) who are striving to actualize themselves. Rogers built on this concept with his speculation that the actualizing tendency is part of a more general formative tendency observable in many universal structure (stars, crystals, microorganisms, humans etc.); that manifests itself in increasing complexity, order, and interrelatedness. This is a biological perspective.
Nomothethic vs. Idiographic perspectives on human nature
On a nomothetic (universal) level of analysis, we find that humans are deeply the same and tend to respond in similar ways (i.e., people start a stampeded when someone yells “fire”!).
On the level of group differences, all people have circulatory systems, but they don’t all function with the same degree of efficiency.
On the idiographic (uniqueness) level of analysis, human bodies are never exact copies of another body. Each person has a unique temperament, a unique history, and a unique way of using the therapeutic situation.
Rogers can be described as a scientist interested in the nomothetic level of analysis (i.e., his view of the universal need for positive regard that emerges alongside self-awareness) or a phenomenologist interested in the idiographic level of analysis (i.e., his therapeutic views that value the client’s own life story and cultural background), depending on whether he is trying to analyse data from psychotherapy process/outcome studies, or working as a therapist with a unique person in which general statements lose their relevance for that encounter.
Rogers states that, when functioning freely, the basic nature of human beings is one that is constructive and trustworthy. He did not view humans as inherently good or evil and was aware of the human capacity for destructiveness. However, he repeatedly found that clients moved in positive, prosocial directions when provided with respect, unconditional positive regard, and empathic understanding.
Congruence
Rogers believed every organism engages in an inherent organismic valuing process, and the extent to which one can assimilate their lived experiencing determines whether congruence/wholeness can be achieved.
Congruence is the state of wholeness and integration within a person’s experience. It is the hallmark of psychological adjustment, and the antithesis of defensiveness and rigidity. It represents the capacity to symbolize experiences/experiencing in conscious awareness, and to subsequently integrate those experiences into our concept of the self.
Relationships that provide therapeutic conditions (whether therapeutic or not) facilitate greater integration, congruence, and wholeness.
The Therapeutic Relationship in C.C
The therapist’s attitudes promote an environment of freedom and safety, which is hypothesized to unleash the actualizing tendency.
Within this genuine relationship, clients are free to engage in whatever way they wish. Active narration of whatever they feel to be most present is accepted, but so is silence. The client steers the process.
According to Bohart, the clients’ capacity for self-healing/self-righting (along with the conditions provided by the therapist) promotes positive change. In this interactive model, the client is actively co-constructing the therapy. The uniqueness of the therapist and the client means that the relationship that subsequently develops between them cannot be prescribed or predicted in advance.
Manualized therapy practices can never truly be client centred because the same approach/protocol is used for all clients. Conversely, client-centred therapists tend to be spontaneously responsive and accommodating to the client’s requests (i.e., answering questions, moving session times, making a phone call for them) where possible. This willingness to accommodate requests is underlined by the therapist’s basic trust in/respect for the client and their aims/goals.
There is considerable evidence that when clients perceive unconditional positive regard and empathic understanding in a relationship with a congruent therapist, their self-concepts become more positive and realistic, they become more self-expressive and self-directed, they become more open and freer in their experiencing, their behaviour is rated as more mature, and they can cope more effectively with stress.
The Nondirective Attitude/ Approach in C.C
Client-centred therapy strives to be minimally directive to ensure that the client is able to value their own voice and self-authority (i.e., not disempowered by excessive therapeutic guidance)
The radical trust held by client-centred therapists towards their clients’ inherent growth tendencies and right to self-determination expresses itself in practice via the nondirective attitude. This does not imply passivity or a lack of responsiveness on the part of the therapist. It is not an expression of orthodoxy. It simply represents an ethical commitment to the egalitarian nature of the therapy, and a moral compass that guides the course of therapy without dictating its route.
It is not an easy route to take. Rogers reflected on how therapists often believe that the client would be happiest if they let the therapist choose their values, standards, and goals for them. The non-directive attitude opposes much of graduate clinical psychology/social work; in which students are encouraged to become experts on others’ lives and choices.
A client-centred therapist must be willing to learn how to be an open, authentic, empathic person in the therapeutic relationship. They should constantly seek out ways to equalize and balance the power within it.
In the present day, there is a growing acceptance that you can’t only follow, you must also lead; particularly in cases of heavy stagnation. Or, the same traumas, problems and patterns will just be relived/repeated.
Self-Concept in C.C
Client-centred therapists discovered through practice that the client’s perceptions and feelings about themselves were of central concern when they came seeking help. The major component of self-concept that was often lacking was positive self-regard. Research has shown that clients who were rated as successful in psychotherapy, had significantly more positive attitudes towards themselves
Rogers’ locus of evaluation
Clients make progress along a dimension termed locus of evaluation.
People commonly began therapy overly concerned with what others thought of them. Their locus of evaluation was external.
Success in therapy led to a growth in positive attitude towards others and themselves; and hence they became less dependent on other people for their values and standards. In other words, the gaining of self-esteem meant that their standards and values were no longer from other people’s judgments (external locus of evaluation) and were now derived from their own inner experiencing (internal locus of evaluation).
Naturally, these individuals are now more self-determining. Their motivation is authentic and self-authored, and they are no longer controlled externally. They exhibit more interest, excitement, and confidence which in turn manifests enhanced performance, persistence, and creativity, heightened self-esteem, and improved well-being.
The experiencing dimension
This is a dimension along which many but not all clients improve. This improvement is characterized by a shift from a rigid mode of experiencing the self and world, to a mode of experiencing with greater openness and flexibility.
Systems of Psychotherapy that Emerged from Rogers’ Research
Prouty’s Pre-Therapy (Prouty, 1994)
Gendlin’s Experiential or Focusing-Oriented therapy (Gendlin, 1996)
Greenberg’s Emotion-Focused Therapy (EFT; a.k.a. process-experiential) (Elliott, 2012; Greenberg, 2002)
Integrative Models (Bohart, 2005; Worsley, 2012).
Diagnostic Categories in Modern C.C therapy
A debate is still ongoing as to whether the medical model (i.e., diagnostic categories) should be fully rejected. Some have argued for the acceptance of “illness” in the person-centred approach, but Sanders (2017) has argued that describing the clients’ distress as “illness” situates pathology inside the individual. It stigmatizes and marginalizes them and fails to identify and address the social origins of their difficulties.
Positive Psychology and its Key Overlaps with C.C Therapy
Its emergence was spearheaded in the late 1990s/early 200s by Seligman and Csikszentmihalyi. They argued that clinical psychology was acutely focused on illness/pathology and “treatment”, making it a medical model. Their belief was that it was time for a focus on the positive instead. Key terminology included concepts like “flow” experiences, happiness, subjective well-being, optimism, intrinsic motivation, and self-determination.
The belief was that when strengths are consciously attended to, they activate positive emotional states that can generate change.
The first key overlap: this focus on strength/resilience/human potential (via the belief of an inherent actualizing tendency). Bohart and Tallman’s “How Clients Make Therapy Work: The Process of Active Self-Healing” focused on the client as an active agent of change with the capacity for self-righting (restoring oneself to health and balance); before the emergence of positive psychology. Similarly, Rogers’ conceptualization of the fully functioning person emphasizes the notion of optimal functioning/well-being. Person-centred therapists were the original positive psychologists.
The second key overlap comes via Rogers’ commitment to applying scientific methods to his therapeutic observations, and Seligman and Csikszentmihalyi’s emphasis on a “hard” science/science first approach to research on positive psychology. Specifically, their aim was to produce replicable, cumulative, and objective research.
Seligman and Csikszentmihalyi said that the humanistic therapy movement (of the 1960s) had not garnered much of a research base; and had encouraged narcissism and non-scientific self-help practices. Bohart and Greening, and Lambert and Erekson, both called out this shallow view of the practice; with the latter emphasizing the substantial research base (spanning 50 years) on the efficacy and effectiveness of client-centred therapy for diminishing symptoms of pathology and enhancing client well-being. Furthermore, they shared their belief that therapy DID NOT REQUIRE AN ADDITIVE focus on positive emotions; and that steering clients away from a focus on their present emotions towards a focus exclusively on positive ones was unlikely to be beneficial. Suggestions have been made that attempting to influence clients like this could undermine their own experiences and install the therapist as an expert on what they should be feeling.
Joseph and Linley (2006) add that positive psychology appears to be grounding itself in a medical model with positive interventions like “happiness exercises for depression.” Hence, their original aim of transcending the focus on illness appears to be failing. Positive psychology’s interventions may therefore be likely to just be assimilated as additional tools in the therapy toolkit.
Feminist Therapy and its links with C.C therapy
The second wave of feminism in the late 1960s, brought with it consciousness-raising groups; which were spontaneous gatherings of women in which common experiences were discussed (often leading to activism). Other “taboo” issues of sexism were brought to the forefront and this articulation of oppression was key in promoting collective action (as it emphasized that these experiences were not personal, but political/systemic in nature).
In 1970, Weisstein published a scathing critique of clinical psychology: “Kinder, Küche, Kirche”, in which she exposed the discipline for its practices that, both explicitly and implicitly, enforced social control of women’s gender roles, reproductive rights, and career aspirations.
Feminist therapists exposed diagnostic categories oppressive to women, practices in therapy that reinforced male authority, and the non-existent evidence base for essentialist formulations of women’s biological nature. The Freudian assertion that “Anatomy is destiny” became a target for critique.
However, the focus was still on the internal/intrapsychic as the source of psychological problems. Feminist critics like Kitzinger and Perkins (1993) argued that experience is never “raw;” it is embedded in a social web of interpretation and re-interpretation. By suggesting that pure, unsullied, presocialized “experience” can originate from within, therapists have disregarded the social roots/environmental influence on our inner selves.
Feminist therapy suggests that many women’s problems are rooted not in the social structures that oppress them. Rodis and Strehorn (1997) explained feminism’s assertion that the therapeutic process/relationship must be focused on a dialogue about justice (both social and interpersonal). Reaffirming justice as a moral ideal and establishing a more just society will bring about positive change.
The practice is moving forwards, and developing ways of working with transgender women/men and gender queer persons. There is a progression from the traditional supportive/nurturing models to models that energize resistance.
Client-centred feminist therapists argue that the client-centred commitment to neutrally accepting the client’s reality avoids the pitfall of replacing the client’s experienced reality with a theoretically based version. The focus on empowering over educating is consonant with feminist therapy’s aim of empowerment.
While therapy can assist clients in numerous ways, the feminist perspective notes that it is not a substitute for collective action for social change. Indeed, the institution of therapy reinforces the idea that psychological problems are manifestations of underlying “disorders” that are individual in nature (Prilleltensky)
Third-wave feminism brought about a focus on intersectionality. This concept illuminates the multiple overlapping impacts of class, race, gender, sexual orientation, immigrant status, ability status, and religious affiliation. Roth (2017) drew links between the theme of intersectionality and Rogers’ anti-diagnostic stance, as the sociopolitical ramifications of being diagnosed may be devastating; through the immediate rise of structural barriers, social isolation, exclusion from employment, lack of meaningful participation in civic society, and lack of choice in treatment.
Cognitive Behaviour Therapy and C.C Therapy
CBT has long dominated the discipline of therapy because of its assertion of having a stronger evidence base than any other approach.
CBT models argue that dysfunctional cognitive schemas sustain maladaptive behaviours. The therapist’s goal is to challenge the patient’s core beliefs, which are believed to maintain this dysfunction (or maintain psychopathology). The therapeutic relationship (while regarded by third-wave CBT therapists as important) is essentially a means to the end of ensuring client collaboration.
Critics of these approaches maintain that the collaboration in CBT is an attempt to get the patient to comply with the therapist’s guidance. A patient who resists compliance is “failing” in the therapy.
Some have argued that this perspective puts the therapist in the seat of expert power, while the client’s role is merely to receive wisdom and be instructed by the therapist on the ways in which their dysfunctional thoughts influence and maintain their dysfunctional behaviours (and can be corrected - Beck)
Proctor, in particular, stated that the practitioner has a framework for understanding the client’s problems that the client does not have ; and hence is believed to be in a better position to decide what the client needs. There is power in this position. In theory, CBT should give the client the information about this framework to enable self-understanding and autonomous decision-making. However, can consideration really be given to client autonomy when the therapist is believed to have rationality and science on their side (and know what is best for the client), regardless of the client’s views? The inherent paternalism (restriction of the freedom of others by authority figures; supposedly in their best interest) in CBT is ethically problematic for C.C.
Spinelli argues that CBT therapists “run the risk of imposing a socially conformist ideology on the client”.
The Dodo Bird Verdict
The replicated finding that all models of psychotherapy are roughly equal in their effects. Similarly, it’s been shown that the therapeutic relationship is more significant for patient outcomes than the specific techniques used.
Precursors of C.C Therapy
Rogers originally went to a Rochester child-guidance agency, believing in a diagnostic, prescriptive, and professionally impersonal approach. Only after actual experience did he conclude that it was not effective.
He tried listening and following the client’s lead rather than assuming the role of the expert, which worked better.
Support for this approach was found in the work of Otto Rank (aspects of Rankian theory bear a close relationship to principles of nondirective therapy)
Elizabeth Davis also helped Rogers to recognize the importance of responding almost entirely to the feelings being expressed, which he later termed the Reflection of Feeling.
Key Milestones in the History of C.C Therapy
1924: Rogers moves to Teachers College in Columbia where he is exposed to a contradictory combination of Freudian, scientific, and progressive thinking on education.
1939: His book “The Clinical Treatment of the Problem Child” was published and Rogers was offered a role as a professor of psychology at Ohio State University. There he lectured about newer ways of helping problem children and their parents (with assessments which provided the basis for a treatment plan - non-directive)
1940: Rogers gives a presentation (Some Newer Concepts in Psychotherapy) and client-centered therapy is born. The talk is later expanded into a book titled “Counselling and Psychotherapy”. It described the generalized process in which a client begins with a conflict situation and a predominance of negative attitudes; and moves toward insight, independence, and positive attitudes. The counsellor was posited to promote this process by avoiding advice and interpretation and by consistently recognizing and accepting the client’s feelings. Research corroborating this new approach to counselling and psychotherapy emerged soon after (first by Porter)
1957: Rogers’ paper, “The Necessary and Sufficient Conditions of Therapeutic Personality Change”, is published. Congruence, unconditional positive regard, and empathic understanding of the client’s internal frame of reference were cited as three essential therapist-offered conditions of therapeutic personality change. This applied to all types of therapy, and its impact was immense (later research showed that those who had experienced the highest degree of accurate empathy has the best outcomes, and the client’s judgement of the therapeutic relationship/its collaborative nature correlated more highly with success or failure than the therapist’s judgement of it)
Rogers (in his later life) applied the person-centered approach to teaching, educational administration, marriage and other forms of partnership, and articulate his belief that the “quiet revolution” would emerge with a new type of “self-empowered person”. Rogers also applied the person-centered approach to international conflict resolution (in South Africa, Eastern Europe, the Soviet Union, meeting with Protestants/Catholics from Ireland, etc.,).
The Basic Person-Centered Hypothesis
Individuals and groups who have experienced empathy, congruence, and unconditional positive regard will go through a constructive process of self-directed change.
Rogers 19 Basic Theoretical Propositions on Personality and Behaviour (early disinterest in psychological theory shifted over time to a greater respect)
We are the centre of our own continually changing world of experience.
The organism reacts to the field as it is perceived. This perceptual field is “reality.”
The organism reacts as an organized whole to this phenomenal field.
The organism has one basic tendency and aim: to actualize, maintain, and enhance the experiencing organism.
Behaviour is the goal-directed attempt of the organism to satisfy its needs as experienced in the field as perceived.
Emotion accompanies and generally facilitates such goal-directed behaviour, the kind of emotion being related to the seeking versus the consummatory aspects of the behaviour, and the intensity of the emotion being related to the perceived significance of the behaviour for the maintenance and enhancement of the organism.
Behaviour is best understood from the internal frame of reference of the individual.
A portion of the total perceptual field gradually becomes differentiated as the self.
As a result of interaction with the environment, and particularly as a result of evaluational interaction with others, the structure of self is formed—an organized, fluid, but consistent conceptual pattern of perceptions of characteristics and relationships of the “I” or the “me” together with values attached to these concepts.
The values attached to experiences and the values that are a part of the self-structure are sometimes values experienced directly by the organism, and sometimes values introjected or taken over from others but perceived as the former.
As experiences occur, they are (a) symbolized, perceived, and organized into some relationship to the self; (b) ignored because there is no perceived relationship to the self-structure; or (c) denied symbolization or given a distorted symbolization because the experience is inconsistent with the structure of the self.
Adopted ways of behaving are typically consistent with the concept of self.
Behaviour may, in some instances, be brought about by organismic experiences and needs that have not been symbolized. Such behaviour may be inconsistent with the structure of the self, but in such instances the behaviour is not “owned” by the individual.
Psychological maladjustment exists when the organism denies to awareness significant sensory and visceral experiences, which consequently are not symbolized and organized into the gestalt of the self-structure. When this situation exists, there is a basis for potential psychological tension.
Psychological adjustment exists when the concept of the self is such that all the sensory and visceral experiences of the organism are or may be assimilated on a symbolic level into a consistent relationship with the concept of self.
Any experience that is inconsistent with the organization or structure of self may be perceived as a threat. The more of these perceptions there are, the more rigidly the self-structure is organized to maintain itself.
Under certain conditions, involving primarily complete absence of any threat to the self-structure, experiences that are inconsistent with it may be perceived and examined and the structure of self can be revised to assimilate and include such experiences.
When the individual perceives all his sensory and visceral experiences and accepts them into one consistent and integrated system, then he is necessarily more understanding of others and more accepting of others as separate individuals.
As the individual perceives and accepts into his self-structure more of his organismic experiences, he finds that he is replacing his current value system—based so largely on introjections that have been distortedly symbolized—with a continuing organismic valuing process.
