MODULE 6: CLIENT-CENTERED THERAPY

first, 1940, nondirective counseling

In the _____period, during the ______s, Rogers developed what was known as _____________, which provided a powerful and revolutionary alternative to the directive and interpretive approaches to therapy then being practiced.

second, 1950s, 1951, client-centered therapy, Counseling Center at the University of Chicago

In the _____ period, during the ______, Rogers (_____) renamed his approach 1951_____________, which reflected his emphasis on the client rather than on non-directive methods. In addition, he started the _______________. This period was characterized by a shift from clarification of feelings to a focus on the phenomenological world of the client.

third, 1950, 1970, necessary and sufficient conditions of therapy

The ____ period, which began in the late ___s and extended into the ____s, addressed the ______________. Rogers (1957) set forth a hypothesis that resulted in three decades of research. A significant publication was On Becoming a Person (C. Rogers, 1961), which addressed the nature of “becoming the self that one truly is”

On Becoming a Person, becoming the self that one truly is

A significant publication was __________(C. Rogers, 1961), which addressed the nature of “______________”

Human Existence, Human Self

Subject of inquiry of Existential and Humanistic Psychology

Existence precedes essense, Essense precedes existence

Ontological position of Existential and Humanistic Psychology

Future gives the present meaning, The “here and now” gives the present meaning

Temporal Orientation of Existential and Humanistic Psychology

Awareness and acceptance of the human condition, Awareness and acceptance of the human self

Therapeutic goals of Existential and Humanistic Psychology

Anxiety, Actualizing tendency

Growth Motivator of Existential and Humanistic Psychology

State of Being, Process of Becoming

Optimal functioning of Existential and Humanistic Psychology

The search for meaning, The search for self

The good life of Existential and Humanistic Psychology

BASIC ASSUMPTIONS
• Formative tendency
• Actualizing tendency
– Maintenance
– Enhancement
• The self and self-actualization
• The self
• Self-actualization

Structure

The self-concept
• The ideal self
• Awareness

1. Level of awareness
   • Ignored or denied
   • Accurately symbolized
   • Distorted form

2. Denial of positive experiences

DYNAMICS

• Stages of therapeutic change
Stage 1 - unwillingness to communicate
Stage 2 - slightly less rigid
Stage 3 - freely talk about self
Stage 4 - to talk of deep feelings
Stage 5 - undergo change and growth
Stage 6 - experience dramatic growth
Stage 7 - fully functioning “persons of tomorrow”

DEVELOPMENT

Becoming a person
• Positive regard
• Positive self-regard

DETERMINANTS

• Counselor congruence
• Unconditional positive regard
• Empathic listening

PSYCHOTHERAPY

• Conditions of worth
• Incongruence
• Vulnerability
• Anxiety and threat
• Defensiveness
• Disorganization

PSYCHOPATHOLOGY

Carl Rogers

“Some of what I’ve done professionally and, in my work, has been a reaction to my early upbringing. Where I was not heard, I really wanna hear people.” 

Formative Tendency

believed that there is a tendency for all matter, both organic and inorganic, to evolve from simpler to more complex forms.

Actualizing Tendency

An interrelated and more pertinent assumption is the actualizing tendency, or the tendency within all humans (and other animals and plants) to move toward completion or fulfillment of potentials (Rogers, 1959, 1980).

“People have within themselves the creative power to solve problems, to alter their self-concepts, and to become increasingly self-directed.

Maintenance

Similar to the lower steps in Maslow’s hierarchy of needs. It includes such basic needs as food, air, and safety; but it also includes the tendency to resist change and to seek the status quo

Even though people have a strong desire to maintain the status quo, they are willing to learn and to change. This need to become more, to develop, and to achieve growth is called ____________.

Enhancement

The primary tendency of the organism is to maintain, actualize, and enhance itself.

Self-Actualization

Self-Concept

It includes all those aspects of one’s being and one’s experiences that are perceived in awareness (though not always accurately) by the individual.

Ideal-Self

Defined as one’s view of self as one wishes to be. The ideal self contains all those attributes, usually positive, that people aspire to possess.

incongruence and an unhealthy personality.

A wide gap between the ideal self and the selfconcept indicates?

Positive Regard

the person develops a need to be loved, liked, or accepted by another person

Positive Self-Regard

defined as the experience of prizing or valuing oneself. Receiving positive regard from others is necessary for positive self-regard.

Unconditional Positive Regard

The need to be liked, prized, or accepted by another person without any conditions or qualifications

Conditions of worth

is given only under certain circumstances. If we perceive that some of our behaviors are approved and some disapproved, then we see that our worth is conditional.

External Evaluations

Our perceptions of other people's view of us

Incongruence

Conditions of worth that we receive during childhood lead to a somewhat false self-concept, one based on distortions and denials. The self-concept that emerges includes vague perceptions that are not in harmony with our organismic experiences, and this incongruence between self and experience leads to discrepant and seemingly inconsistent behaviors.

Vulnerability

Roger believed the greater the incongruence between our perceived self (self-concept) and our organismic experience, the more vulnerable we are. People are vulnerable when they are unaware of the discrepancy between their organismic self and their significant experience.

Anxiety and Threat

whereas vulnerability exists when we have no awareness of the incongruent within ourselves anxiety and threat are experienced as we gain awareness of such incongruence.

Defensiveness

is the protection of the self-concept against anxiety and threat by the denial or distortion of experiences inconsistent with it. To prevent this inconsistency between our organismic experience and our perceived self, we react in a defensive manner.

Disorganization

Most people engage in defensive behavior, but sometimes defenses fail and become disorganized or psychotic

a. Empathy b. Congruence c. Unconditional Positive Regard

The Core Conditions

Warmth and Openness

Other Conditions or Change

Conveying Warmth

• Traux and Carkhuff found that non-possessive warmth is effective as a counselling ingredient and that the higher the level of this variable, the more evidence of constructive personality change was noted in the clients.

• Consideration for the client is rooted in the fact that the client is a person and should be respected as such.

• This conveys to the client that he/she is worthy of respect and is important to the counsellor – and not “just another patient” in the day’s schedule.

Traux and Carkhuff

___________ found that non-possessive warmth is effective as a counselling ingredient and that the higher the level of this variable, the more evidence of constructive personality change was noted in the clients.

Openness

• The secret of effective counseling might be summed up in the one word "openness." A good counselor should be open to himself and others.

• He/she is a person open to experience and ready for new insights about himself.

• His/her openness towards others includes an open hand, open eyes, an open ear, an open mind, an open heart; but a closed mouth.

openness

The secret of effective counseling might be summed up in the one word "________." A good counselor should be open to himself and others.

an open hand, open eyes, an open ear, an open mind, an open heart; but a closed mouth.

His/her openness towards others includes ?

1. Two persons are in psychological contact.

2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.

3. The second person, whom we term the therapist, is congruent (real or genuine) in the relationship, and this congruence is perceived by the client.

4. The therapist experiences unconditional positive regard for the client.

5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavors to communicate this experience to the client.

6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.

RELATIONSHIP BETWEEN THERAPIST AND CLIENT

Therapeutic Core Conditions Process

psychological contact

Two persons are in ____________.

client, state of incongruence

The first, whom we shall term the _______, is in a ______________, being vulnerable or anxious.

congruent

The second person, whom we term the _________, is _________(real or genuine) in the relationship, and this congruence is perceived by the client.

unconditional positive regard

The therapist experiences ______________for the client.

empathic understanding

The therapist experiences an ______________of the client’s internal frame of reference and endeavors to communicate this experience to the client.

therapist’s empathic understanding and unconditional positive regard

The communication to the client of the _____________________ is to a minimal degree achieved.

Client–therapist relationship is characterized by equality.

This humanistic approach is perhaps best characterized as a way of being and as a shared journey in which therapist and client reveal their humanness and participate in a growth experience.

Person-centered therapy is grounded on the assumption that clients create their own self-growth and are active self-healers

What clients value most is being understood and accepted, which results in creating a safe place to explore feelings, thoughts, behaviors, and experiences; clients also value support for trying out new behaviors (Bohart & Tallman, 2010).

CLIENT’S EXPERIENCE IN THERAPY

equality.

Client–therapist relationship is characterized by _____________

shared journey

This humanistic approach is perhaps best characterized as a way of being and as a ____________ in which therapist and client reveal their humanness and participate in a growth experience.

clients create their own self-growth and are active self-healers

Person-centered therapy is grounded on the assumption that _________________________

understood and accepted, Bohart & Tallman, 2010

What clients value most is being ________________, which results in creating a safe place to explore feelings, thoughts, behaviors, and experiences; clients also value support for trying out new behaviors (_________________).

Early Emphasis on Reflection of Feelings

Rogers’s original emphasis was on grasping the world of the client and reflecting this understanding (reflection of feelings).

As his view of psychotherapy developed, however, his focus shifted away from an absolutist, nondirective stance and emphasized the therapist’s relationship with the client.

Therapist’s presence

being completely attentive to and immersed in the client as well as in the client’s expressed concerns.

listening, accepting, respecting, understanding, and responding

Qualities and skills such as ___________________ must be honest expressions by the therapist.

empathic way, Bohart & Watson, 2011

Techniques may be suggested when doing so fosters the process of client and therapist being together in an ___________. Techniques are not attempts at “doing anything” to a client (___________, ____).

diversity, innovation, and individualization

One of the main ways in which person centered therapy has evolved is the ____________________ in practice.

Immediacy

or addressing what is going on between the client and therapist, is highly valued in this approach. This development encourages the use of a wider variety of methods and allows for considerable diversity in personal style among person-centered therapists

external and expert perspective on the client, Bohart & Watson, 2011

Person- centered therapists generally do not find traditional assessment and diagnosis to be useful because these procedures encourage an ________________ (_________, ____).

individual client

From a person-centered perspective, the best source of knowledge about the client is the __________

Crisis Situations

• If the person in crisis does not feel understood and accepted, he or she may lose hope of “returning to normal” and may not seek help in the future.

• Genuine support, caring, and non-possessive warmth can go a long way in building bridges that can motivate people to do something to work through and resolve a crisis.

• Communicating a deep sense of understanding should always precede other more problem-solving interventions.

Person-Centered Learning

“Facilitator rather than leader”

student-centered learning

Person-Centered Learning also called

Person-Centered Learning, (N. Rogers, 2011, p. 57)

• Also called student-centered learning, values are made explicit to facilitate students to have a critical and proactive role

• No method or technique can evoke trust unless the facilitator/teacher herself has a capacity to be fully present, considerate, caring, authentic, and responsive.

• This includes the ability to challenge people constructively. (_____________)

Person and Patient-Centered Care

Others consider as “Patient-centered care”, includes qualities of compassion, empathy, respect and responsiveness to the needs, values, and expressed desires of each individual patient.

holistic and inclusive, Santana et al., 2018

However, it is worth noting that person-centered care is more ___________ of family, significant others, context, prevention, promotion, and preferences, among other elements (____________, ________).

Morgan and Yoder (2011)

In their concept analysis of person-centered care, _____________________(_____)identified four attributes of person-centered care, which includes that it is holistic, individualized, respectful, and empowering.

Person-centered expressive arts therapy

employs a variety of forms—movement, painting, sculpting, music, writing, and improvisation—in a supportive setting to facilitate growth and healing

The conditions that foster creativity require acceptance of the individual, a nonjudgmental setting, empathy, psychological freedom, and availability of stimulating and challenging experiences.

N. Rogers, creative connection

_________has developed the concept of the _____________®—a process whereby the client or group member is invited to access inner feelings through an uninterrupted sequence of movement, sound, visual art, and journal writing. As the client moves through this process, hidden or unconscious aspects of self are discovered, and these insights are shared with the therapist.

Person-centered expressive arts therapy

_________________ utilizes the arts for spontaneous creative expression that symbolizes deep and sometimes inaccessible feelings and emotional states.

N. Rogers (1993), self expression and personal growth

• ____________ believes that we cheat ourselves out of a fulfilling and joyous source of creativity if we cling to the idea that an artist is the only one who can enter the realm of creativity.

• Art is not only for the few who develop a talent or master a medium. We all can use various art forms to facilitate _______________

Motivational interviewing (Mi)

_____________is a humanistic, client centered, psychosocial, and modestly directive counseling approach developed by William R. Miller and Stephen Rollnick in the early 1980s.

William R. Miller and Stephen Rollnick in the early 1980s.

Who developed Motivational interviewing?

The MI Spirit

MI is rooted in the philosophy of person-centered therapy, but with a “twist.” Unlike the nondirective and unstructured person-centered approach, MI is deliberately directive while staying within the client’s frame of reference.

The primary goal is to reduce client ambivalence about change and increase the client’s own motivation for change.

precontemplation stage

In the _______________, there is no intention of changing a behavior pattern in the near future.

contemplation stage

In the _____________, people are aware of a problem and are considering overcoming it, but they have not yet made a commitment to take action to bring about the change.

preparation stage

In the _______________, individuals intend to take action immediately and report some small behavioral changes.

action stage

In the ______________, individuals are taking steps to modify their behavior to solve their problems.

maintenance stage

During the ____________, people work to consolidate their gains and prevent relapse.

Open, Reflect, Affirm, Sum up

BASICS OF MOTIVATIONAL INTERVIEWING

Open

Ask open-ended questions

Reflect

Use a simple or complex reflection

Affirm

Identify strengths, acknowledge efforts

Sum Up

Summarize change talk, progress, & next steps

client, patient.

Rogers deliberately used the term "_____" rather than "____."

patient

He believed that "_______" implied that the individual was sick and seeking a cure from a therapist.

seeking assistance, controlling their destiny, and overcoming their difficulties.

By using "client" instead, Rogers emphasized the importance of the individual in__________________, ___________________, and _____________.

personalized approach

Alternative approaches to psychopathology should take a ____________, understanding each individual patient as unique in etiology, expression of mental suffering, treatment, and prognosis

● Anxiety and psychosis ● Dementia ● Depression ● Mood disorders ● Negative thoughts related to post-traumatic stress disorder (PTSD)

Usual Psychopathologies Addressed in Rogerian Counseling

Genuineness and congruence

_______________ appear to lead to better outcomes, especially when they are used in school counseling settings.

Unconditional positive regard

_____________ is also effective, particularly at improving overall well-being for people with mood or anxiety disorders.

Empathetic understanding

_______________ appears to promote positive outcomes, especially for people experiencing_____________

perception of their therapist

It's not clear if these factors alone are enough to promote lasting change in clients. Outcomes for clients may also depend on their ______________—if they don't see their therapist as empathetic, for instance, they may not experience positive results from treatment

● Client-centered therapy aims to encourage general improvements in how the client feel about his/her life and how he/she relate to others.

● Client feels stuck and have a desire for growth and change

● Client feels empty or lost but aren’t sure why exactly

● Client wants to develop an improved sense of responsibility or accountability

● Client feels that his/her attitude or perspectives could improve

● Client feels he/she want and can be a better person in one or more aspects

Common Issues Addressed In Counseling