Counselling and Psychotherapy Essay

Carl Ransom Rogers (1902 – 1987) was amongst the most influential figures of humanistic psychology, a school of psychotherapy that rejected medical and psychoanalytic models of treatment, and instead put forth a theory of personality and behaviour that presumed the source of psychological health ultimately resides in the individual person rather than in a programme based on the expert knowledge and authority of a psychiatric professional. Rogers’ specific form of humanistic psychology is broadly based on his view of human personality, which he believed naturally tended to develop in what he considered a healthy manner unless it is adversely influenced by life-experiences. From this theoretical basis, Rogers created a form of therapy that he called ‘client-centred’, (or person-centred) as opposed to forms of treatment that are directed by the expertise of the therapist. In the field of Counselling and Psychotherapy there are many differing theories which are used to help those who seek counselling, including client-centred therapy. In many parts of the world client-centred therapy is seen as a family of therapies, including Experiential Psychotherapy and Focusing. Closely associated with client-centred therapy are existential therapy and various integrative approaches. Since Carl Rogers’ death, there has been much debate regarding what can and cannot rightly claim to be called ‘client-centred therapy.’ Proponents of the differing ‘Tribes’ argue for their schools of thought. (Warner 2006). At the heart of all the differing thoughts and modes of delivery are the six conditions for therapeutic change which Rogers described as being needed before a client could move towards the changes that they wanted to make in their lives. Carl Rogers, along with Abraham Maslow, was the founder of the humanist approach to clinical psychology. Maslow was known as the ‘Third Force in Psychology’ but is mainly known for his thoughts on self- actualization. Prior to Maslow it was thought that human behaviour was just a set of behaviours to satiate the drive for deficits. For example the ‘lack of nutrients – feel hungry – seek food – and eat’ model. Maslow proposed a wide range of human needs in a dynamic and changing system, where needs at higher levels would only be addressed when needs at lower levels had been satisfied (see Fig 1): Rogers’ person-centred theory emphasised the concept of ‘self-actualization’ which implies that there is an internal, biological force to develop one’s capacities and talents to the fullest. The human organism’s central motivation is to learn and to grow. Growth occurs when individuals confront problems, strive to master them and, through experience, endeavour to develop new aspects of their skills, capacities, and views about life, and move forward towards the goal of self-actualization. By way of example, Rogers (1980) often illustrated the concept with reference to organisms in the natural world. He wrote about a potato in the root cellar of his boyhood home: â€Å"The actualizing tendency can, of course, be thwarted or warped, but it cannot be destroyed without destroying the organism. I remember that in my boyhood home, the bin in which we stored our winter’s supply of potatoes was in the basement, several feet below a small window. The conditions were unfavourable, but the potatoes would begin to sprout pale white sprouts, so unlike the healthy green shoots they sent up when planted in the soil in the spring. But these sad, spindly sprouts would grow two or three feet in length as they reached toward the distant light of the window. The sprouts were, in their bizarre, futile growth, a sort of desperate expression of the directional tendency I have been describing. They would never become plants, never mature, never fulfill their real potential. But under the most adverse circumstances, they were striving to become. Life would not give up, even if it could not flourish.† So it can be seen that Rogers was saying that this effective and strong constructive tendency is the underlying basis of the client-centred approach. Rogers’ groundbreaking understanding was that for a person to be truly helped, the important healing factor is the relationship itself. His view of human behaviour is that it is â€Å"exquisitely rational† Rogers (1961). Furthermore, in his opinion: â€Å"The core of man’s nature is essentially positive† Rogers (1961), and he is a â€Å"trustworthy organism† Rogers (1977). Rogers focused on ways in which the therapist could promote certain core conditions between him/herself and the client. Central to his theory was that the actualizing tendency was a natural process, yet in order for each human organism to do so it required the nurturing of a caregiver. Rogers understood that inherently people need people, and that we are fundamentally dependent on others for our being. Many critics of the theory have misunderstood Roger’s concepts and commented that this is outmoded today, and, according to Bohart (2007) the critics were saying that it â€Å"glorifies the individual at the expense of others†. Wilkins (2003) argued that Rogers’ concept of self-actualization is culturally biased, reflecting a Western cultural emphasis on the separate, autonomous individualistic self. However, Bohart states that Rogers’ concept of self as culture-specific is compatible with cultures which view the self in relational rather than individualistic terms, even cultures that have no concept of self. Self-actualization means enhancing or actualizing the self as the self is defined for that person and culture. Rogers did believe that the tendency of actualization of a person in therapy was to always go in a positive pro-social direction, but critics state that it may lead to self-centred, narcissistic behaviour (Bozarth and Brodley, 1991). Rogers recognised that environmental and social factors could inhibit or distort the process of actualization so that a negative rather than positive outcome may occur, but also that the fully functioning person is ‘soundly and realistically social’ (Rogers 1961). Rogers postulated that therapeutic movement will only occur if, and only if, the six conditions for therapeutic change were in place between the therapist and the client. 1. The first condition of client-centred therapy is that therapist and client should be in psychological contact. The first condition specifies that a minimum relationship must exist. Rogers (1957) stated: â€Å"I am hypothesizing that significant positive personality change does not occur except in a relationship†. (Sanders 2006) â€Å"The relationship is not seen as a third object in the room with the counsellor and the client, but is the client and the counsellor. They bring themselves into the room, and in doing so a unique and ever-changing relationship is the result.† Research into contact between animals and people who live in social groups has shown that in order to grow and become confident then it must be in a psychologically interactive way. Those who were deprived of such conditions, like the children in the orphanages of Romania and the monkeys in Harlow’s experiments, grew up with permanent behavioural and emotional problems. (Harlow 1959, Carlson 1999, Bowlby, 1953, Warner 2002). Rogers thought that psychological contact was an all-or-nothing, one-off event, but others like Rose Cameron (2003) and Whelton and Greenberg (2002) see psychological contact as a variable and dynamic quality in relationships, and Margaret Warner (2002:79) says that the â€Å"contact can be viewed as a continuum†. In my opinion, despite the differing views of the various ‘Tribes’, the one over-riding view is that psychological contact is essential if the therapeutic process is going to work. It can simply be the mere recognition of the other person in the room, or a deeply-shared experience between the therapist and the client. 2. Client incongruence, a state of being vulnerable and anxious, is presented as the second of the six conditions which Rogers defined as a ‘discrepancy between the actual experience of the organism and the self-picture of the individual’s experience insofar as it represents that experience’ (Rogers 1957), and which he saw as being necessary for therapy to be successful. Pearson (1974) thought that this condition had created some confusion, since the relationship between incongruence and felt anxiety or vulnerability is complex. All people are incongruent to some degree all of the time (since human beings can never fully symbolize their experience), and some sorts of incongruence may actually lower anxiety. Rogers’ concept of incongruence was simply saying that clients sense that they have underlying issues that have distorted their sense of equilibrium and therefore are motivated to seek counselling. I believe that this second condition affects how clients will respond to counselling because the change that needs to happen has to come from within the client and cannot happen against their will. For example, if someone is referred by a doctor, or school, or made to attend counselling with a spouse or parent, then the client will be in a state of incongruence and the first condition will not take place, without which there is no therapeutic relationship. 3. The third core condition is that the second person, the therapist, is congruent in the relationship. By congruent Rogers understood it to be real, genuine and transparent. As early as 1946 he wrote about the fact that the therapist should have a â€Å"genuine interest in the client†. Rogers makes it very clear in a video on the internet where he is talking about what it means to be congruent when he says: â€Å"Can I be real in the relationship; this has come to have an increasing amount of importance to me over the years. I feel that genuineness is another way of describing the quality I would like to have. I like the term congruence, by which I mean that what I am experiencing inside is present in my awareness and comes out though my communication. In a sense when I have this quality I am all in one piece in the relationship. There is another word that describes it for me; I feel that in the relationship I would like to have transparency. I would be quite willing for my client to see all the way through me and that there would be nothing hidden, and when I’m real in this fashion that I’m trying to describe, I know that my own feelings will often bubble up into awareness and will be expressed, but be expressed in ways that won’t impose themselves on my client.† (You Tube 2010). Despite Rogers’ insistence that being congruent with clients is of paramount importance, a number of studies over the years have shown that no significant relationship exists between levels of congruence and outcomes in the therapeutic relationship (Klein et al 2002, Orlinsky et al 2004, Burckell and Goldried 2006, Feifel and Eells, 1963). In contrast Cooper (2008) has suggested that this may be because it is a ‘high frequency’ event in therapy and therefore the correlation between genuineness and outcome are not truly recognised†. Without an empathetic response from the therapist I believe that the client would not feel valued or understood and the therapeutic relationship would break down. 4. In the development of self-concept Rogers also stated that the fourth condition – unconditional positive regard – the complete acceptance and support for a person no matter what they say or do – is necessary for self-actualization. By showing unconditional positive regard, or prizing, clients are said to feel valued and so accepted and take responsibility for themselves (Rogers 1957:98). Conversely, I believe self-actualization is thwarted by conditional positive regard when acceptance is dependent on the positive or negative evaluation of a person’s actions. Those raised in an environment of conditional positive regard, Rogers felt, only feel worthy if they match conditions laid down by others – conditions of worth – which, in turn, can lead to shaping themselves determined not by their organismic valuing or actualizing tendency, but by a society that may or may not truly have their best interests at heart. 5. The fifth core concept states that the counsellor should experience an empathic understanding of the client’s internal frame of reference. Each of us perceives and responds to our environments as a unified and organised whole, and each forms their unique frame of reference. Our understanding of the world is shaped through our experiences, and each time these are interpreted on the basis of our personal value system. In order for a therapist to understand a client’s behaviour it should be from the internal frame of reference of the client. Empathy is not just listening but trying to feel the experiences and feelings that the other person has at that moment in time. It involves stepping into their shoes and laying aside one’s own perceptions, values, perspectives and meanings as far as possible. If the therapist attempts to understand the client on the basis of his/her own personal experiences, this would be an external frame of reference. When the therapist remains within the client’s frame of reference, which is his/her own understanding of the world, it enhances empathy and promotes unconditional positive regard. Holding an external frame of reference might convey to the client that the therapist has their own agenda or is criticising the client. The question is, would the therapeutic process take place if the counsellor did not enter the client’s world so personally? From the large number of studies that have been carried out in an attempt to measure client’s reaction to the therapist’s empathy, the evidence shows it to be a ‘demonstrably effective element of the therapeutic relationship’ (Steering Committee, 2002). 6. The sixth and final condition – client perception – is as important as all the others, and is complementary to the idea that the first condition – psychological contact – is continued. Rogers (1959:213) wrote: ‘that the client perceives, at least to a minimal degree, conditions 4 and 5 – the unconditional positive regard of the therapist for the client – and the empathetic understanding of the therapist’. To some degree client perception has been ignored over the years. Tudor in 2000 referred to it as â€Å"the lost condition†. Sanders (2004) states that â€Å"Carl Rogers made it clear that the client was the centre of the therapeutic process, and furthermore it was the client who had the final say as to whether the ‘therapist-provided conditions’ were actually provided (as opposed to being assumed by the therapist)†. Dagmar Pescitelli (1996) argues that the theory of client-centred therapy may not be effective for severe psychopathologies such as schizophrenia (deemed to have a strong biological component) or other disorders such as phobias, obsessive-compulsive disorder, or even severe depression (currently effectively treated with drugs and cognitive behavioural therapy, or CBT). Pescitelli (1996) cites one meta-analysis of psychotherapy effectiveness that looked at 400 studies, and person-centred therapy was found least effective. In fact, it was no more effective than the placebo condition (Glass 1983; cited in Krebs & Blackman, 1988). In contrast, meta-analyses of client-centred therapy as a whole support the theory that it is an efficacious and effective form of therapy, no matter what ‘Tribe’. It is similar to other orientations such as CBT and psychodynamic therapy, with evidence indicating that all schools may be efficacious for clients with depressive, traumatic, schizophrenic and health related problems, but there is less evidence on the impact of anxiety disorders (Elliott, Greenberg et al., 2004).