Wk 4 - Person-centred therapy

Question 1

Carl Rogers (1902-87) came up with PCT because…

Answer 1

1930/40s psychoanalysis & directive approaches were used in hospital
Deeply ambivalent about exercise of power in therapy
Challenged validity of commonly accepted procedures such as:
o Advice
o Suggestion
o Direction
o Persuasion
o Teaching
o Interpretation
o Diagnosis

Question 2

What three therapies are included under the Rogerian humanistic banner?
Which became a ‘third way’ - major school of psychotherapy alongside… (x2)

Answer 2

PCT, existential and gestalt

Behavioural and psychodynamic

Question 3

What is emphasised by humanistic/Rogerian approaches? (x4)

Answer 3

People’s capacity to make rational choices and
Develop to their maximum potential.
Concern and respect for others

Question 4

How do humanists/Rogerian/PCT view human nature? (x5)

Answer 4

Positive
Essentially trustworthy
Resources for self understanding and growth
Basic drive to fulfilment and self-actualisation (cf sexual and aggressive drives in Freud’s drive theory)
Angry or destructive actions seen as product of environment

Question 5

How do humanists/Rogerian/PCT view the world? (x5)

Answer 5

Contrast with “expert” view of psychoanalytic…
“No other individual can determine what is correct or incorrect behaviour for anyone else”
His influence went beyond individual therapy context into social groups and international relations….
• If humans are truly present/practice empathic understanding etc they will be able to resolve disputes

Question 6

What are the implications of a Rogerian world view?

Answer 6

Primary responsibility lies with client - autonomy, trust = responsibility
Active client - not authoritarian therapist

Question 7

What is therapists focus in PCT/Rogerian therapy? (x4)

Answer 7

Constructive side of human nature
What is right with the person
Assets clients bring to therapy
Rather than a list of problems and deficits

Question 8

What are the central constructs of PCT? (x3)

Answer 8

Experiencing
Actualising tendency
Self-concept

Question 9

What does ‘experiencing’ mean in the context of Person-centred therapy? (x6)

Answer 9

Everything that is going on in the individual at that point in time:
• Emotions
• Sensory and physiological events
For growth, individuals must experience accurately, and
Discriminate between events that don’t/contribute to wellbeing
Therapist is not to judge/advise/interpret!

Question 10

What is the actualising tendency in PCT?

Answer 10

Innate drive for growth & autonomy
Motivational construct
Movement towards realisation of full potential

Question 11

What is the product of becoming increasingly actualised (in PCT terms)? (x4)

Answer 11

Openness to experience - take up new experiences when available, stepping out of the comfort zone
Trust in self - in ability to work it out, find out
Internal source of evaluation – not what those around us think of us
Willingness to continue growing - to keep challenging themselves

Question 12

What is the self-concept referring to in PCT? (x3)

Answer 12

= a portion of experience becomes labelled as the self,
eg if I discover that I’m good at maths, and I value maths then this ability becomes part of a positive self concept.
Self-esteem, can be positive, negative, idealised etc

Question 13

What does PCT hold as the impact of external factors? (x4)

Answer 13

Shaped by your relationships, and type of regard you experience
Unconditional positive regard “I’ll love you no matter what you do” = growth
Conditional regard “I’ll only love you if you do what I say” = reliance on external sources of validation = stunting of growth
As babies and infants, conditions of worth are external
• As we grow, the conditions of worth become more internalised as parts of the self

Question 14

What is the emphasis of therapeutic process in PCT/ (x1)

Answer 14

The world of the client

Question 15

What is the therapists role in PCT? (x4)

Answer 15

Therapist does not offer interpretation or guidance
To be present and accessible to client and
To focus on the here-and-now experience
• Changes in attitude, posture etc can signal important here and now points to focus on

Question 16

What are therapeutic goals in PCT? (x5)

Answer 16

Person not problems
• Journey to authentic self
Increase independence/integration of different aspects of psyche -
Analogous to id/ego/superego integration in psychoanalysis

Assist with growth process to cope better with future problems
Becoming a fully functioning person (self-actualised)

Question 17

According to PCT, what is the therapeutic relationship based on? (three core conditions of change) (x3)

Answer 17

Accurate empathic understanding
Congruence
Unconditional positive regard

Question 18

What is ‘accurate empathic understanding’ in the context of PCT? (x4)

Answer 18

Therapist tries to sense client’s whole subjective experience –
By careful and perceptive attention to what the client is saying.
Micro counselling techniques: eye contact, nodding, facial expression, reflection (paraphrasing and summarising).
Not just techniques, but whole attitude you take into sessions

Question 19

What is ‘congruence’ in the context of PCT? (x3)

Answer 19

Congruent therapist is open and genuine with the client rather than presenting a “professional front”
Willingness to relate to clients without hiding behind professional façade
Shares experience with client when therapeutically helpful

Question 20

What is ‘unconditional positive regard’ in the context of PCT? (x4)

Answer 20

Deep and genuine caring for client
Caring is not judgmental or evaluating
Non-possessive
Acceptance but not necessarily approval

Question 21

What is the Rogerian/PCT view of the conditions for change? (x4)

Answer 21

Apply to all clients and relationships
Necessary and sufficient for change
Therapist need not have specialised knowledge
Diagnosis is not necessary

Question 22

What is the counselling process for in PCT? (x4)

Answer 22

Explore beliefs and feelings
Express feelings too negative to accept
Increasing integration
Feel safe - become more open to experience, and more realistic

Question 23

In terms of empiricism, Rogers was the first… (x3)

Answer 23

To study counselling process in depth by analysing transcripts of actual therapy
o Looking for qualities of relationship, running themes

Clinician to conduct major quantitative studies on psychotherapy

To formulate comprehensive empiricaltheory of personality/psychotherapy

Question 24

What did Rogers find re the core conditions of change? (x1)

While more recent research holds that… (x1)

Answer 24

That they all correlated with outcomes

They are facilitative - ie necessary but no sufficient

Question 25

What are two major developments from PCT?

Answer 25

Motivational interviewing | Emotion focussed therapy

Question 26

What is motivational interviewing? (x4)

Answer 26

Offshoot of PCT Theory that motivation is dynamic construct - product of client/therapist interaction o Used to be viewed as stable, personality trait: “client didn’t improve because lacks motivation” Approach stops blaming people for what happens in therapy

Question 27

Where was/is motivational interviewing used?

Answer 27

Started with addictive behaviours, then mental illness, health behaviours, etc Where relapse is common along road – often judged as unready or unmotivated

Question 28

Why is motivational interviewing useful? (x2)

Answer 28

We know that telling a person to stop a harmful behaviour doesn’t work Aim is for the client to tell you why they should change their behaviour

Question 29

What is the procedure for motivational interviewing? (x5)

Answer 29

# Define target behaviour/goal Identify and empathise with positives • What functions does the behaviour serve that motivates continuance (different type of reaction than used to from family, GP etc) Identify and empathise with negatives Integrate with summary Invite possibility of change

Question 30

What are the five principles of MI?

Answer 30

Empathic approach toward client Develop discrepancy - between current and ideal self Avoid argumentation Roll with resistance Support client's self-efficacy for change

Question 31

How is motivational (interviewing) beneficial over confrontation? (x5)

Answer 31

Confrontation = direct feedback on negative consequences of behaviour = shame as useful pushing the client into change (negative emotion) Using negativity is a poor motivator MI focuses on building positive emotions (interest, hope, inspiration) and Client sees how change can meet his/her own needs = self-efficacy

Question 32

What did Hettema et al's meta-analysis reveal about the effects of motivational interviewing? (x4)

Answer 32

Small to medium effects in improving health outcomes. As stand-alone brief intervention, MI is supported for addictive behaviours, except smoking. Also promising in chronic health management and treatment adherence Effect sizes decrease over time

Question 33

What is emotion focussed therapy (EFT)? (x5)

Answer 33

``` Offshoot of PCT Focus on the client’s experiencing and making sense of his/her emotions: o PCT relationship o Gestalt experiential techniques o Biological theories of emotion ```

Question 34

How does Emotion Focussed Therapy facilitate emotion focus and regulation? (x3)

Answer 34

Safe, validating and empathic environment Maybe exaggerate the feeling in order to work out meaning Neuro says emotions have signalling purpose, so awareness enables figuring out the signal

Question 35

How does Emotion Focussed Therapy facilitate emotion reflection and transformation? (x3)

Answer 35

Once client makes sense out of his/her emotions, they can work out what they need Rather than cognitions, it's emotions that transform other emotions o One emotion can be transformed into another, eg Sadness into anger

Question 36

What are three types of EFT intervention?

Answer 36

Gestalt/mindfulness Emotional awareness coaching Empty/split chair

Question 37

What is Gestalt/mindfulness in EFT interventions? (x2)

Answer 37

Focus – on a physical sensation, and it's properties. Describing sensation in order to make sense of it Repeat, exaggerate – say it softer, louder

Question 38

What is involved in empty/split chair intervention in EFT? (x3)

Answer 38

Techniques to resolve unfinished business/facilitate perspective taking Empty: Pretend that someone important to the issue in the chair, and tell them about it Split: maybe then take their position in order to respond.

Question 39

What was revealed in comparison of PCT and EFT?

Answer 39

At 6 month follow-up, EFT depression clients showed slight continuing improvement (PCT worsened) EFT also had better Survival Curve to Relapse

Question 40

What are the theoretical contributions of PCT? (x4)

Answer 40

Important shift in status of the client in therapy Shift in focus from techniques to therapeutic relationship Focus on empathy Openness to research and evaluation

Question 41

What are two limitations of PCT?

Answer 41

Limited scope for technique | Little place for educative function