Client-Centered%20Psychotherapy

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Client-Centered Psychotherapy

• Slides created by
• Barbara A. Cubic, Ph.D.Professor
• Eastern Virginia Medical School
• To accompany
• Current Psychotherapies 10

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Learning Objectives

• This presentation will focus on
• An overview of phenomenological theory.
• Similarities and differences between Rogers
  self-directed growth process and other types of
  psychotherapy.
• The impact of the establishment of a genuine,
  nonjudgmental, caring and empathic therapy
  approach.
• Client-centered psychotherapy.

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Client-Centered Therapy

• Developed by Carl Rogers
• Also termed
• Client-centered therapy
• Humanistic therapy
• Phenomenological therapy

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Client-Centered Therapy

• A congruent therapist who provides unconditional
  positive regard and empathy can stimulate change
  in a vulnerable person to become a creative,
  responsible, developing individual.
• By providing a therapeutic atmosphere that is
  real, caring, and nonjudgmental, the person can
  develop to their full potential.

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Kurt Goldstein

• Worked with brain-injured soldiers.
• His holistic theory of personality emphasized
  that individuals must be understood as totalities
  striving to actualize themselves.
• Basis of Rogers actualizing tendencies.

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Rogers Basic Assumptions

• Rogers believed in an actualizing tendency in all
  humans.
• Represented movement towards the realization of
  the individuals full potential.
• Viewed as part of a formative tendency.

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Rogerss Basic Assumptions

• This formative tendency
• Represented movement toward order, complexity and
  interrelatedness.
• Can be seen across aspects of nature including
  the stars, crystals, microorganisms as well as
  humans.

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Can be summed up in Clyde Kluckhohns
dictumEach person is in some respect like
every other person, like some other persons, and
in some respects like noother person.
Rogers Theory
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Client-Centered Therapy is Different than Other
Models

• Medical model of therapy views person as
  patients with problematic parts.
• Other forms of treatment are directed by
  experts.
• Client-centered approaches focus on the clients
  inborn capacity for self healing.
• Difference for the therapist is between using
  the self and being oneself.

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Core Conditions for Therapy(Therapist)
T R U S T
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Rogers Basic Assumptions(Therapist)

• Genuineness/congruence
• Correspondence between the therapists thoughts
  and behavior.
• Unconditional positive regard
• Therapists regard/attitude towards the patient
  remains unaltered regardless of the patients
  choices.
• Empathy
• Profound interest and care for
  the patients
  perceptions and feelings.

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Tout comprendre, cest tout pardonner To
understand all is to pardon all.
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Core Conditions for Therapy (Client)
T R U S T
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Rogers Basic Assumptions(Client)

• Self-concept
• At therapy onset, self-esteem often low.
• Improvements correlated with therapy.
• Locus-of-Evaluation
• Pre-therapy focus on others opinions.
• Progress associated with internal
  locus-of-evaluation.
• Experiencing
• At therapy onset, rigid.
• Success related to flexibility.

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Comparing Client-Centered Therapy with Other
Approaches

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Six Basic Premises of Humanistic Psychology

• Holistic approach most adequate.
• Humans subjectivity critically important.
• Psychotherapy is based on a good relationship.

• Hereditary, environment and creative power are
  crucial forces.
• Anthropomorphic model preferred.
• Purpose is the decisive dynamic.

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Distinctive Components of Client-Centered Therapy

1. Therapists attitudes can be necessary and
   sufficient conditions for change.
2. Therapist needs to be immediately present and
   accessible to clients.
3. Intensive, continuous focus on clients
   phenomenological world.
4. Process marked by clients ability to live fully
   in the moment.
5. Focus on personality change, not structure of
   personality.

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Distinctive Components of Client-Centered Therapy

1. Need for continuing research on psychotherapy.
2. Same principles of psychotherapy apply to all
   people, regardless of problem.
3. Psychotherapy is a specialized example of
   constructive interpersonal relationships.
4. Theoretical formulations built on experience.
5. Concern with the philosophical issues derived
   from psychotherapy.

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Client-Centered Therapy vs. Psychoanalysis
Rogers Psychoanalysis
Language Common sense Esoteric
How to Understand the Individual Subjective Interpersonal Objective Intrapersonal
Emphasis Purpose Causality
Characterization of the Individual Holistic Reductionistic
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Client-Centered Therapy vs. Psychoanalysis
Rogers Psychoanalysis
View of Human Nature People can be good or bad People are bad
Role of Therapist Facilitate patients self discovery Interpretation for the patient
View of Transference Not central to the patients ability to change Inevitable, fundamental to change
Presentation of the Therapist A caring person willing to listen Authority, teacher
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Client-Centered Therapy vs. Behavioral
Therapy
Client-Centered
Behavior changes through internal factors.
Behavioral
Behavior changes through external factors.
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Comparison of Client-Centered Therapy with Other
Approaches
High
U s e Of E m p a t h y
Client-Centered
Psychoanalysis, Eclectic, REBT, Jungian
Low
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Client-Centered vs. REBT
Rogers Deemed Equivalent to Ellis on
Self-Confidence and Higher on
Rogers Deemed Low on Therapist Directed
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Client-Centered vs. REBT
Ellis Deemed Equivalent to Rogers on
Self-Confidence and
Higher on
Ellis Deemed Low on Unconditional Positive Regard
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Client-Centered (CC) vs. REBT
Differences Similarities
CC greatly values therapy relationship. Optimism in peoples ability to change.
CC client-directed. Perception that individuals are often overly self critical.
CC accepting of patients perceptions. Willingness to put forth great effort to help people.
In CC, client chooses actions. Willingness to demonstrate their methods publicly.
CC therapist relates to patient at the feeling level. Respect for science and research.
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History of Client-Centered Therapy
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Influences on Rogers
From Whom
I first got the notion of responding almost
entirely to the feelings being expressed later
called the reflection of feeling Rogers
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Rogers Life

• Jan. 8, 1902 Born in Oak Park, Illinois.
• Family emphasized strong work ethic,
  responsibility and the fundamentals of religion.
• 1924 Graduated from Univ. of Wisconsin.

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Rogers Life

• Started at the Union Theological Seminary then
  transferred to Teachers College, Columbia
  University.
• Worked for 12 years at a Child-Guidance Center.
• 1939 Clinical Treatment of the Problem Child
  published.
• Offered professorship at Ohio State University.

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Rogers Life

• Dec. 11, 1940 Rogers presents Some Newer
  Concepts in Psychotherapy at the Univ. of
  Minnesota (viewed by most as the birth of
  Client-Centered Therapy).
• 1942 Counseling and Psychotherapy published.
• During WWII, served as Director of Counseling
  Services for the US Organizations.

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Rogers Life

• Served as head of University of Chicago
  Counseling Center (12 years).
• 1957 Rogers published classic paper on
  necessary and sufficient conditions for
  therapy.
• Feb. 4, 1987 Carl Rogers died.

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Current Status of Client-Centered Psychotherapy

• Special interest of Rogers was application of his
  theory to international relationships.
• Since 1982, Biennial International Forums on
  Client-Centered Approach.
• Workshops annually at Warm Springs, GA.

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Current Status of Client-Centered Psychotherapy

• Person-Centered Review began in 1986 (renamed The
  Person-Centered Journal in 1992).
• World Association for Person-Centered and
  Experiential Psychotherapy and Counseling
  (WAPCEPC) founded in 2000.

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Rogers Theory of Personality19 Basic
Propositions

1. Individual center of a changing world of
   experience.
2. Organism reacts based on their reality.
3. Organism reacts as a whole.
4. Organism has one basic tendency-actualization.
5. Behavior is goal-directed based on perception of
   reality.

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Rogers Theory of Personality19 Basic
Propositions

1. Emotion accompanies and facilitates goal-directed
   behavior.
2. Best point to understand behavior is from the
   individuals frame of reference.
3. Part of the perceptual field is differentiated as
   the self.

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Rogers Theory of Personality19 Basic
Propositions

1. Self is formed through interaction.
2. Values come from experience and introjection from
   others.
3. Experiences are integrated, ignored or denied.
4. Behavior is generally consistent with self
   concept.

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Rogers Theory of Personality19 Basic
Propositions

1. Behaviors inconsistent with self concept can
   occur but are seen as not owned.
2. Psychological maladjustment comes from denied
   experiences.
3. Psychological adjustment occurs when experiences
   are assimilated.

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Rogers Theory of Personality19 Basic
Propositions

1. Inconsistent experiences are threats.
2. Under the right conditions, inconsistent
   experiences can be examined and assimilated.
3. Integrating experiences allows more understanding
   of others.
4. Integration leads to development of internal
   locus-of-evaluation.

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Rogers Theory of Personality Summarized

• Behavior is best understood through the
  individuals reality (perception of experiences).
• Personal growth occurs through decreased
  defensiveness.
• Self actualization is the organisms one, basic
  tendency.

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Rogers Theory of Personality Summarized

• Experiences inconsistent with self concept are
  threats leading to increased rigidity.
• Therapy allows the individual to accept and
  integrate all of their experiences.

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Rogers Theory of PersonalityOther Concepts

• Experience
• Reality
• Self

Private world of the individual
Basically refers to the private perceptions of
the individual Social reality consists of
perceptions that have a high degree of
commonality among individuals
Organized gestalt of I or me
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Rogers Theory of PersonalityOther Concepts

• Symbolization
• Organismic
• Valuing Process
• Fully Functioning
• Person

Process by which an individual becomes aware of
experiences
Ongoing process in which individuals freely
rely on the evidence of their own senses for
making value judgments
An individual who relies on the
organismic valuing process
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Self-Determination Theory (SDT)

• Developed by Deci and Ryan.
• Theory focuses on intrinsic motivation.
• Theory has lead to several empirical
  investigations of the concept.

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Bottom Line

• Congruence psychological adjustment
• Lack of Congruence psychological maladjustment

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The Psychotherapy Process
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Rogerian View of Psychotherapy
Basic theory is simple. If the therapist conveys
genuineness, unconditioned positive regard, and
empathy, the client will make positive changes.
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Implied Therapeutic Conditions

• Client/therapist must be in psychological
  contact.
• Client must be experiencing distress.
• Client must be willing to receive conditions
  offered by therapist.

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Process of Client-Centered Psychotherapy

• Therapy at first contact.
• Respect shown immediately to the client.
• Therapys length determined by client.
• Quick suggestions and reassurances are avoided.

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Contrasting Client-Centered Therapy with Other
Models

• The traditional view is one of an uncovering of
  hidden or denied feelings or experiences
• Question is how these hidden experiences exist
  and how are they resolved.
• Listening to clients narratives are thought to
  be the avenue for helping the client deal with
  these internal conflicts.

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Contrasting Client-Centered Therapy with Other
Models

• Or Zimrings view (an example of a
  client-centered theorist) asserts a person
  becomes a person through interactions that occur
  within a cultural context.
• Individuals born within a Western culture have a
  buried conflict as part of a cultural legacy.

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Zimrings View

• Our phenomenological frame of references is
  always changing
• Under construction resulting in a dynamic
  concept of the self.
• Experience is seen as coming from the context in
  which we are in that moment.
• Implies two different types of inner conflicts
• Objective Stressed in Western culture
• Subjective Has little real world value

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Process of Client-Centered Psychotherapy

• Moment of Movement
• It is not a thinking about something, it is an
  experience of something an experiencing without
  barriers experience which has been repeated
  many times in the past but which has never been
  completely experienced The experience has the
  quality of being acceptable.
• Rogers

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Bottom Line

• Therapy is based on clients rights.

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Applications of Client-Centered Therapy
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Client-centered therapy is person-focused, not
problem-focused. Subsequently, each client is
treated as unique
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Creative Applications of Rogers Ideas

• Play therapy
• Client-centered group processes
• Classroom teaching
• Intensive groups
• Conflict resolution
• Individual level
• International level

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Regarding Evidence

• Client-centered therapists oppose
  therapist-centric models
• Imply causality moves in a linear fashion from
• Treatment Disorder Outcome

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Dodo Bird Effect

• Dodo Bird Effect Conclusion drawn from
  meta-analyses and large scale studies that all
  major psychotherapies yield comparable effect
  sizes.
• The Dodo Bird Effect supports the concept that
  common factors (such as those espoused by Rogers)
  account for changes seen in therapy.

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Bozarths (1998) Summarization of Research on
Psychotherapy

• Effective psychotherapy predicated on
• Relationship between therapist and client.
• Inner and external resources of the client.
• Type of therapy, technique, training and
  experience of therapist largely irrelevant.
• Clients who receive psychotherapy improve more
  than those who do not.
• Little support that specific treatments are best
  for particular issues.
• Empathy, genuineness and positive regard
  (unconditional) consistently important.

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Orlinsky, Grawe Parks (1994)

• Summarized findings from 76 studies.
• Focus was on relationship between positive
  regard/therapist affirmation and outcome.
• 56 of findings showed positive relationship (65
  when patient ratings were used).

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Lambert (1992)

• Conducted a meta-analytical review, which
  estimated that treatment outcome variance is
  related as follows
• 30 therapeutic factors
• 15 techniques
• 15 placebo
• 40 client variables

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Elliot (2002)

• Meta-analysis concluded patients who received
  client-centered therapy show changes that are
• Significant
• Maintained at follow-ups
• Both lt and gt 12 months
• Substantially greater than those seen in
  untreated controls
• Equivalent to other forms of therapy, including
  CBT

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Client-Centered Therapy in a Multicultural World

• Each person is unique and belongs to multiple
  groups.
• Within-group differences exceed between-group
  differences.
• Therefore, no need for cultural-specific
  therapies.
• Each individual treated as a unique client.