PSY 245 CLINICAL PSYCHOLOGY-II Assoc. Prof. Dr. BAHAR BAŞTUĞ Clinical Psychologist

PSY 245CLINICAL PSYCHOLOGY-II

Assoc. Prof. Dr. BAHAR BAŞTUĞ Clinical Psychologist

CARL ROGERS: PERSON-CENTERED THEORY AND THERAPY

Welcome

This week we’re focusing on person-centered theory and therapy (PCT).

This approach was developed by Carl Rogers.

The approach is deeply optimistic and guided by principles of trusting clients and an actualizing tendency.

Carl Rogers (1902 –1987)

Freud >>>>pessimist Adler & Jung >>>>optimist Rogers>>>>superoptimist.

Rogers developed a distinctive approach: Listening.

In his life, he strove to be a genuine and open person, he strove to be himself.

Other theorists criticized Rogers being superoptimist.

Born in 1902, in Oak Park, Illinois

LIFE OF ROGERS….

Biographical Information:

4th of 6 children to a farm family in Illinois.

His family was rigid fundamentalist Christians.

Traveled to China, had a significant change of view. “Rogers appears to have become Rogers”

Biographical Information: Carl Rogers

Carl Rogers’s development as a person was characterized by the following (and more) events:

– He rejected his parents’ conservative religious ideology.

– He decided to marry his childhood sweetheart.– He decided to pursue graduate studies at the liberal

Union Theological Seminary in New York City.– He studied clinical psychology at Columbia

University.

Married in 1924

Rogers’s relationship with his wife had a powerful affect on him. Because of his poor social skills, she was the first person with whom he ever had a caring and sharing relationship.

in 1928

At the time, Columbia University was interested in John Watson’s behaviorism. Rogers was oriented more toward the contemporary scientist-practitioner model. He was the first person to tape-record actual therapy sessions.

Rogers’s first clinical position was at the Adlerian-oriented Rochester Child Guidance Center. During this time, academic psychologists were behavioral, while clinicians were trained in either psychoanalytic or neo-analytic theory. Since Rogers wanted to help people (rather than work in a laboratory), he was trained in an analytic approach.

Rogers attended a seminar with Otto Rank and learned from a social worker, Elizabeth Davis. Ms. Davis’ way of articulating clients’ feelings fascinated Rogers.

Rogers adopted the following principles from Otto Rank:

Clients have creative powers.

Therapy should help clients accept their personal uniqueness and self-reliance.

The client is the central figure in the therapy process; the therapist only helps clients access their powers of self-creation.

Therapists shouldn’t educate clients.

Therapist shouldn’t foster dependency with clients by becoming love objects.

Therapy works when clients experience the present within the therapy setting.

Rogers was influenced by the person of Roosevelt.

Roosevelt was optimistic.

Rogers was influenced by thephilosophy of John Dewey.

Historical Context

Rogers was influenced by:– Elizabeth Davis– President Franklin D. Roosevelt– John Dewey– His relationship with his wife– His clients

Historical Context

Honoring the Client – Rogers credited his clients as the greatest

source of his development.

– Natalie Rogers stated: “And so like Carl, I stayed open to learning from my clients. They are always our best teachers.”

His daughter, Natalie Rogers, has become a significant force in integrating dance, movement, and the arts with person-centered theory and therapy.

Struggles with Psychiatry and Psychology

Rogers developed his client-centered approach to psychotherapy in a climate openly hostile to his ideas. He had to fight the behaviorism of academic psychology as well as the psychoanalysis of the clinical world.

Rogers had a battle with psychiatry to obtain for psychologists the right to practice psychotherapy.

Rogers socialized with social workers, counselors, and teachers. He rebelled against the traditional class lecture, he participated in encounter groups.

However, he was elected president of the American Psychological Association in 1946.

Evolution of Person-Centered Therapy

Rogers’s practice of person-centered theory and principles is divided into 4 periods:

1. Nondirective counseling. This period began in the 1940s and was characterized by Rogers’s growing aversion to directive, traditional therapy methods.

Evolution of Person-Centered Therapy

2.Client-centered therapy. In the 1950s Rogers changed the name of his approach from nondirective counseling to client-centered therapy.

Evolution of Person-Centered Therapy

3. Becoming a person. During the 1960s, Rogers focused on self-development. His work was strongly associated with the human potential movement. He published On Becoming a Person and moved from academia at the University of Wisconsin to California in 1964.

Person-centered therapy

Evolution of Person-Centered Therapy

4.Worldwide issues. In the 1970s and 1980s, Rogers became more interested in worldwide issues. He began dedicating his work to improving interracial relations and producing world peace. He met with Irish Catholics and Protestants, visited South Africa and the Soviet Union, and conducted cross-cultural workshops in Brazil, Dublin, and Hungary.

Theory of Personality

The person-centered approach includes a theory of personality and theory of psychotherapy. The theory of personality is complex and difficult to formulate. For this reason, it gets little attention.

Theory of Personality

• Self theory

• Phenomenology and the valuing of experience

• Learning and growth potential

• Conditions of worth

Self-Theory

Every person exists within an ever-changing world in which he or she is the center. The self is not a fixed structure, but a structure in process, capable of both stability and change.

Self-Theory

The term organism refers to the locus of all psychological experience. The organism is the entire realm of an individual’s experience, while the self is the “me” portion of the organism.

Rogers’s self has both conscious and unconscious components.

Self-Theory

The distinction between organism and self makes it possible that an individual’s self can be inconsistent with its overall psychological experience. This discrepancy is referred to as incongruence.

Self-Theory

In contrast, when the self’s experiences and perceptions are consistent with the organism’s total experience, there is congruence. Congruence between self and organism is highly desirable; it leads to adjustment, maturity, and a fully functioning individual.

Phenomenology and the Valuing of Experience

This theory is basically phenomenological. Personal experience.

Although both intellectual thinking and feelings are valued informational sources, experiencing is a direct way of accurately knowing oneself and the world.

Phenomenology and the Valuing of Experience

Person-centered therapy is designed to help clients be more open to personal experiences. True learning is best achieved through lived experience.

Learning and Growth Potential

Rogers believed in the inherent actualizing or formative tendency in humans. Rogers believed people have the capacity to learn on a moment-to-moment basis.

Rogers’ actualizing tendency is similar to Adler’s striving for superiority.

Conditions of WorthThe main two learned needs are the need for

positive regard and the need for self-regard.

1. The baby begins developing a greater and greater consciousness of self. Most parents see this behavior in their children at about age two, when the child’s favorite words become “mine!” and “no.”

Conditions of Worth

2. The growing child develops a strong need for positive regard or approval. This need for positive regard—to be prized and loved—becomes so powerful that the child is almost always looking to caregivers and significant others for acceptance and approval.

Conditions of WorthChildren begin distinguishing between

approved and disapproved feelings and actions. They sense and understand the conditions of worth present in their lives.

Children internalize caregivers’ appraisals.

A young girl loves to play aggresively with other boys and experiences disapproval from parents, she concludes:

1.When I play aggresively I’m bad. (negative self regard)

2.My parents don’t like me (negative regard from others)

3.I don’t like to play aggresively (denial of a desirable organismic experience)

Conditions of Worth

Over time, if children continually experience conditions of worth incongruous with their organismic values, a conflict may develop between their conscious, introjected values and their unconscious genuine values.

Conditions of Worth

When individuals are unaware of true selves and desires, psychopathology develops. A discrepancy occurs between real self and ideal self. It’s known as incongruence.

Conditions of Worth

Individuals are capable of perception without awareness. This process is subception. In the case of subception, a person unconsciously perceives a threatening object or situation.

In sum, it emphasizes several concepts. It is the theory of self, experience, striving for maintenance and enhancement of the self, and learned needs of positive regard.

Theory of Psychopathology

Psychopathology can be a discrepancy between the real self and the ideal self.

As humans confront challenges in life they will misperceive, operate on mistaken beliefs, and behave inadequately. Dysfunctionality occurs if we fail to learn from feedback. Dysfunctionality is a failure to learn and change.

Theory of Psychopathology

The failure to learn from experience.

Person-centered therapists work so hard to help clients become open to learning from new experiences. Rigidity is considered the antithesis of psychological health. Rigidity impairs learning.

Theory of Psychopathology

Since every moment is an opportunity for new learning, avoiding or ignoring these moments is pathological.

Theory of Psychotherapy

Psychopathology stems from the individual’s experience of judgment of the self by significant others.

A nonjudgmental atmosphere will facilitate psychological health.

Theory of Psychotherapy

The success of person-centered therapy depends on two fundamental factors:

• The therapist must trust the client.

• The therapist must establish a certain type of relationship with the client. So, clients will be able to begin trusting themselves, experiencing greater personal development and psychological health.

Theory of Psychotherapy

It is related to Rogers’s theory of personality. For constructive personality change, it is necessary for the following core conditions to exist:

1. Two persons are in psychological contact.

2. The client is in a state of incongruence.

3. The therapist is congruent in the relationship.

Theory of Psychotherapy

4. The therapist experiences unconditional positive regard.

5. The therapist experiences an empathic understanding.

6. Communication of unconditional positive regard and empathic understanding is at least minimally achieved.

The therapist communicate

congruence,

unconditional positive regard,

and empathic understanding to the client.

Congruence

is defined as authenticity or transparency. The congruent therapist is real, open, and honest.

«The more that the therapist can be genuine in the relationship, the more helpful it will be.»

Therapists should acknowledge and express both positive and negative feelings within the context of the therapy relationship.

How would you describe congruence?

Unconditional Positive Regard

Acceptance, respect, or prizing

Valuing the client as a separate person or organism whose thoughts, feelings, beliefs, and entire being are openly accepted, without any conditions. If the therapist can accept clients completely, the clients can begin exploring who they really are and what they really want. By accepting clients, therapists lead clients to begin accepting themselves.

Unconditional Positive Regard

This acceptance should extend to the moment-to-moment changes and inconsistencies manifested by clients during sessions.

Unconditional Positive Regard

At one moment the clients may identify only feelings of love and kindness toward someone, and at the next they may rage about the same person. To the person-centered therapist, both love and rage are important, valid, and equally worthy of attention. By simply listening and reflecting back both feelings, the therapist allows clients to accept what’s been expressed.

Unconditional Positive Regard

How would you describe unconditional positive regard?

Accurate Empathy or Empathic Understanding

Accurate Empathy or Empathic Understanding

Noticing your clients’ feelings.

Entering into the client’s world, seeing and experiencing what client sees and experiences.

Rogers shifts from using a second-person pronoun (“When he left, you felt betrayed and alone”) to using a first-person pronoun (“he just up and left, and I felt betrayed and alone”). This pronoun shift is referred to as walking within.

Kızılderili Atasözü

“komşun hakkında hüküm vermeden 

önce iki ay onun makosenleriyle yürü.”

Empathy

has been most widely discussed and researched. Empathy is a prerequisite for therapy and a necessary condition.

Empathy is a multidimensional concept. Three components are commonly discussed in the literature:

Subjective empathy involves to identify with a client and imagine and experience what it is like to be a patient.

Interpersonal empathy occurs when you attempt the phenomenological experiencing of a client from an extended perspective.

Objective empathy involves using the observational data to understand the client.

THE PRACTICE OF PERSON-CENTERED THERAPY

two different types of person-centered therapists:

1. The Classical person-centered therapist is highly nondirective, does not use assessment procedures, and does not establish any specific goals for clients.

2. The contemporary person-centered therapist is a more active and directive therapist.

The Practice of PCT: A Way of Being With Clients Assessment Issues and Procedures

– Classical person-centered therapists don’t employ standardized assessment or diagnostic procedures.

– Contemporary person-centered approaches sometimes employ assessment procedures.

The Practice of PCT: A Way of Being With Clients

The Therapist’s Opening Statement

– Clients can take the lead in determining what to talk about.

– Example: “Anything you’d like to tell me about yourself that will help me to know you better, I’d be very glad to hear.” (Rogers, 1963)

Experiencing and Expressing Congruence

– This can be tricky.

– How do you think therapists should experience and express congruence?

Experiencing and Expressing Congruence

The basic question is: If I am to be congruent, do I need to tell the client about my every thought and feeling?

The answer is “No.” That’s not to say that therapists should be too cautious about self-disclosing to clients.

The main aim of this openness is

communicating helpful information to clients.

A certain amount of censoring is necessary.

To use techniques in therapy is appropriate, but only when the techniques come up spontaneously, not when they’re preplanned.

Experiencing and Expressing Unconditional Positive Regard

• This is also tricky.

• It involves accepting clients as they are and avoiding judgments.

• Is this possible?

• How do you think you could experience and express unconditional positive regard?

Experiencing and Expressing Unconditional Positive Regard

Everyone is human and judges others.

The problem is how to best express positive regard. Would it be appropriate to say, “I accept you completely and totally as the person you are” or “I prize and value your total being”?

Experiencing and Expressing Unconditional Positive RegardMost therapists get themselves in trouble if they directly express unconditional positive regard to clients, for two reasons:

1.Expressing too much positive regard can be overwhelming to clients. Clients may react by wanting to break down therapy boundaries. Upon hearing such positive, loving statements they naturally seek more closeness, a friendship or romantic relationship. Some clients may react to direct expressions of affection with fear. These clients may try to expand the boundary between themselves and the therapist.

Experiencing and Expressing Unconditional Positive Regard

2. Saying “I care about you” or “I won’t judge you” can be viewed as unrealistic, especially if the therapist hasn’t spent much time with the client and doesn’t really know the client well.

Experiencing and Expressing Unconditional Positive RegardIf it’s inappropriate to directly express

unconditional positive regard to clients, how can therapists communicate this important message?

1.by keeping appointments, and by listening sensitively.

2.by allowing clients freedom to discuss themselves in their natural manner.

Experiencing and Expressing Unconditional Positive Regard3.by demonstrating that you hear and

remember specific parts of a client’s story.

4.by responding with empathy to clients’ emotional pain and intellectual conflicts.

5.clinical experience and research both indicate that clients are sensitive to an interviewer’s intentions. By making an effort to accept and respect your clients.

Experiencing and Expressing Empathic UnderstandingPerson-centered therapists do not believe it’s

possible for one individual to directly know and experience another individual’s feelings. As with unconditional positive regard, what appears important regarding empathy is not that therapists perfectly experience and express empathy, but that they try their best to do so.

Experiencing and Expressing Empathic Understanding

– Entering and becoming at home in the client’s personal perceptual world.

– Being sensitive from moment to moment with the client’s changing meanings and emotions.

– Temporarily living, and moving in the client’s life.

– Sensing deep meanings, but not uncovering feelings that are too far out of awareness.

Entering and Becoming at Home in the Client’s Private Perceptual World

Entering the client’s private world requires preparation. You need to be open to feeling what the client feels and willing to ask the empathy question:

“How would I feel if I were _____ and saying these things?”

The procedures employed to enter the client’s world include reflection of feelings, empathic exploration, and clarification.

Being Sensitive from Moment to Moment with the Client’s Changing Meanings and Emotions

Moment-to-moment sensitivity requires focused attention to your client’s changing way of being. In his emotion-focused therapy, Greenberg recommends focusing on meaning associated with the client’s verbalizations.

Temporarily Living, and Moving in the Client’s Life

To reside in another person’s life is serious business. Rogers says to do this temporarily.

Your goal is to have one foot inside the world of the client and one foot planted in your own world.

Temporarily Living, and Moving in the Client’s Life

Martin Buber, existantialist, referred to this sort of relationship experience as an I-Thou relationship, and he emphasized that it’s impossible to constantly maintain such a relationship.

Sensing Deep Meanings, but not Uncovering Feelings That Are Too Far out of Awareness

Rogers talked about working on the edge of his clients’ consciousness. As a person-centered therapist moving about within your client’s world, if you have an impulse to tell a client about something outside of his or her awareness, it’s best to hold your tongue. Your main job is to follow the client’s lead, not to walk your own path.

PCT has been integrated with other therapies. These include:

– Motivational interviewing

– Emotion-focused therapy

– Nondirective play therapy

Motivational Interviewing

was developed by William R. Miller. In his work with problem drinkers, Miller discovered that structured behavioral treatments were no more effective than an encouragement-based control group. He concluded that reflective listening and empathy were crucial in producing positive treatment effects with problem drinkers, and began his development of motivational interviewing.

MI builds on person-centered principles by adding more focused therapeutic targets and specific client goals.

Focusing on Client Ambivalence (primary target of MI)

Their four central principles of MI flow from their conceptualization of Rogers’s approach. According to these principles, it is the therapist’s job to

•Use reflective listening skills to express empathy for the client’s message.

Motivational Interviewing

• Notice and develop the theme of discrepancy between the client’s deep values and current behavior.

• Meet client resistance with reflection rather than confrontation.

• Enhance client self-efficacy by focusing on

optimism, confidence that change is possible, and small interventions that are likely to be successful.

Cultural and Gender Considerations

Empowering of all persons, including women.

Designed to address the needs and interests of unique clients.

Too indirect for some cultures, but actually could be too direct (focusing on self and emotions) in other cases.

Evidence-Based Status• Rogers was the first to record his sessions.

• Rogers studied client-centered relationship variables in the treatment of 16 hospitalized schizophrenics. The patients made little progress in PCT. But, patients who rated their therapists as higher empathy, warmth and genuineness had shorter hospital stays than patients who rated their therapists as less degree of empathy, warmth and genuineness.

Evidence-Based Status II

Recent research on the effectiveness of PCT has yielded small, but positive results.– PCT is consistently more effective than no

treatment.– It is more effective than placebo treatment.– It is less effective than structured cognitive and

behavioral treatments.

Concluding Comments

It may be that at least in some cases, the person of the therapist and the attitudes of the therapist holds are more important than specific problems or techniques.

from Lao-tse :

If I keep from meddling with people, they take care of themselves,

If I keep from commanding people, they behave themselves,

If I keep from preaching at people, they improve themselves,

If I keep from imposing on people, they become themselves.