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The 42st National Conference of Child and Adolescent Neurology and Psychiatry and Allied Professions with international participation


PERSON-CENTERED THERAPY- “NECESSARY AND SUFFICIENT CONDITIONS”

Autor: Georgeta Niculescu
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Carl Rogers is considered one of the most important six psychologists of the twentieth century and is the author of numerous ideas on which contemporary psychology and psychotherapy are based. Roger was much preoccupied with the psycho-therapeutic process in order to understand what exactly produces the change in psychotherapy. One of the most important conclusions he has reached is that according to which the change takes place if the following conditions are met in the therapeutic relationship: empathy, congruence and unconditional positive acceptance. Thus one of Carl Rogers’ contributions was to emphasize the importance of the therapeutic relationship and of ensuring the three “necessary and sufficient conditions”. Rogers was one of the first theoreticians who emphasized the relevance of the self and of the person’s congruent way of being. Person-centred therapy has substantially contributed to the empirical investigation of the therapy process and its tradition in research is acknowledged. Carl Rogers was presented an award by The American Psychological Association in recognition of his pioneering work in empirical research.

 


 

I. GENERAL ASPECTS

1. Theoretical paradigm

Rogers’s theoretical paradigm is similar to Freud’rsquo;s classical psychoanalytic paradigm and is called by Eugene Gendlin “repression paradigm” which states that certain aspects of human experience are denied or distorted. Although theoretical paradigm is similar to Freud’s classical psychoanalysis, Rogers does not interpret, but checks what he understands by trying to capture what the client wanted to communicate. By doing so he discovered that the client changed the first allegation. The second was closer to reality but it could have been reformulated. He continued until the client said “yes … that is it, that’s what I feel like.” Then it was quiet. Very often what came later was something much deeper, profound. Next steps are deeper and deeper and therefore a maximum opening is possible without struggle. “In the human body always occurs a flow of experiences which the inpidual can analyze over and over again, always as a referent, a landmark, in order to discover the meaning of those experiences” (Rogers, 1980).

Symbolization is an ongoing process; we cannot stop because situations in life always change. Jung says: “The symbol has a temporary validity, because it has value only for a certain situation. If the situation changes, it soon felts like needing a new truth, so truth is always tied to a particular situation. As long as the symbol constitutes a true response, and thus being the liberator in this certain situation, it is the valid and absolute truth. If the situation changes and if the symbol remains, it is but an idol that does nothing more than to impoverish and to brutalize”. (Jung in 1929’s letter to Dr. Kurt Plachte quoted in Larchet JC, Spiritual Unconscious).

The most important contribution of Carl Rogers was emphasizing the importance of the therapeutic relationship. This is sustained by many different contemporary paradigms. Actually approaches like Beck’s cognitive therapy of depression or Kohut’s self psychology emphasized empathy, too. Valorization, empathy and authenticity can be the basis of any program for development of communication skills.

 

2. The Rogersian perspective on clinical diagnosis

Carl Rogers developed the first therapeutic experiences with children and young people in the 30’s and so he has developed the first theoretical reflections on the development of the concept of person centered psychotherapy. Its tradition of working with children was continued by Axline, Ellinwood, Dorfman and Moustakas during the 50’s and the 60’s. Person centered psychotherapy offers children and youth a well-defined relationship that encourages the child tendency to update, so that therapeutic processes to take place, and bringing major changes in the self-concept. In the foreground it is the full development of the child’s personality and not the attenuation of inpidual symptoms. New experiences can be lived without fear, and the old meanings change into a relational corrective experience.

Rogers did not focus on diagnosis, but on the child’s feelings; in 1939 in the introduction of “The Clinical Treatment of the Problem Child,” Rogers wrote: “In this book we deal with the child himself, not with his symptoms. You look in vain for a chapter on theft, thumb-sucking or school truancy, because there is no treatment for such problems. There are children, boys and girls, with different life stories and different personalities. Some of them steal, some flee from school, and others love to suck on their finger, to use obscene words or to confront their parents. But in any case, we must take care of the child himself and not of his behavior in general. (Rogers, 1939, quoted in “Gesprachs-psychotherapie”, 2006).

Rogers understood and described the behavior as something influenced by different factors, namely the genetic endowment, the somatic aspect, the family (moral support and the quality of the relationship), the culture and society, the body needs and the results of the interactions of these factors. From 1939 this aspect corresponds to a valid paradigm from the modern psychiatry of children and youth, to a bio-psycho-social structure.

Clinical diagnosis is not possible outside a relationship established between the clinician and the patient. In this relationship, the patient or the client make a psychological contact regardless of the aim of the assessment. The quality of this contact has implications for diagnostic accuracy, its acceptance by the patient but also on further treatment. In the cases of children it is about the family relationships as well as about the relationship with the child.

“There isn’t an intellectual process that takes place here, so it is difficult to understand intellectually speaking; on the contrary, it must be felt, and experienced in order to be understood. The relationship between the therapist and the parents is the most important aspect of the event. Through this connection, parents can gain trust in the therapist and can find freedom to express thoughts and feelings, often retained. Effective therapy for children is described by Rogers as follows: “The child accepted the help he needs at this time, and if therapy is effective, he will become able to perceive and to solve present problems. And this is helpful on his road to maturity. Of course it is possible that at some point later, he will need help again, when there are other problems. Relationship therapy seems to be more realistic and to have a more natural aim: to have normal functions of the inpidual again, to make a new step in the maturation and to let the child’s ability to solve problems by his own. Emphasizing integrity of the child, as a significant condition, is a feature of this structure. The goal is the independence of the child, encouraging self perception as an inpidual and acceptance of the responsibility for himself (Rogers, 1939).

 

3. Client’s phenomenological world

The term “person centered” used interchangeably with the “client centered” emphasizes a focus on customer phenomenological world and on the state of being a counselor.

For Rogers the central truth was that the person who knows best how therapy should work is the client himself. Client knows what it hurts and where the pain is and he will ultimately discover the best way to cure. The therapist task is to be a companion who can relate with the client so that the client can access his own wisdom and be able to find landmarks in life (Mearns, 2010).

Phenomenology is based on the belief that reality is different for each person who perceives it; according to phenomenology, the client’s reality is valid even if the therapist’s perception about the same reality is different. Thus there is no right or wrong perception in perceiving reality; there are different realities: the client’s reality and the therapist’s reality. (Frannes, E., Logan, W, Roisman, L, 1986)

Extending these views in any clinical relationship could be a first step in dismantling the defenses of patients who may feel understood and valued, so that they can accept, reflect and integrate more easily a diagnosis and to obtain compliance so required in any intervention. The roads here can break depending on what will happen, clinical assessment, psychotherapy, diagnosis, psychiatric intervention, etc.

 

II. EMPATHY, CONGRUENCE, POSITIVE UNCONDITIONED ACCEPTANCE

1. Empathy and change

Rogers (1975) said that to be heard by someone who understands offers inpiduals the opportunity to listen better to themselves, with more empathy directed towards their own internal experiences, to their own experiences vaguely felt.

In everyday language, empathy is “mental identification with another person or felling their affects, thoughts or attitudes” (Random House College Dictionary, 1988). Metaphorically, empathy is often described as the capacity of a person “to be put in the other’s shoes” or to see a situation “from the perspective of the other”. Usually, empathy involves both cognitive and emotional echoes in the meeting with the other. By understanding the other’s perspective, you can feel the way some experiences are lived by others, to sympathize with another’s perspective which enables knowledge of it. However, resonance involved in empathy is not as intense and indiscriminate to lose distinction between personal experience and that of the others; and till this moment most scientists agree on the usage of the term empathy in this way (Warner, 1997).

But empathy can be understood very differently by clinicians based on psychological theories they prefer. Anyway, there is an interesting difference of opinion (Warner, 1997) among clinical psychologists regarding the use of the word empathy. As long as deep empathy involves understanding the inner world of another person, can it refer to his phenomenological world, to the world as he himself builds? Or may this involve a psychological interpretative perspective of his internal world – the world as that inpidual sees if he would be totally aware of his own experience or of his reason – as this world would be seen by a trained observer? This is a very important difference which leads to significant confusions in the literature, because some authors consider the first draft while others oscillate between the two without bringing further explanations.

Carl Rogers refers to the client’s own phenomenological experience when using the term empathy: the state of empathy or being empathic is to perceive the internal reference of the other person accurately with all emotional and significant components as if he was the other person, but without losing the condition “as if”. That is to feel pleasure or pain the other feels and to perceive causes as he perceives them, but without ever losing the recognition that this is “as if” you were hurt, satisfied.

This sense of the term emerges from Rogers’s way of responding empathically, in which he suggests that what he understands must be checked by the client to see if it matches with what the client himself understands. If his understanding differs from that of his client’s the therapist considers it an empathic failure.

How can communication of empathy generate change? Warner says: “I would answer that according to the practice and the theory of empathy, but it was never fully conceptualized. Communication of empathy can facilitate change because it creates a sense of recognizing different experiences inside the receiver – the feeling of being recognized by another person during his experience in a particular time and the feeling of self recognition of currently personal experiences. This recognition activity is a valuable experience in itself and it forms a human connection, and it also can switch the personal relationship to unconscious aspects of experience, implicit and organic feelings, exposing them to awareness and change”. Gendlin’s theory of “experimentation” in the article “A theory of personality change” says that we use symbols to express only a very small part of what we think. Most of significances are as sensations”. When addressing these felt references, Gendlin doesn’t refer to unconscious experiences, but to the state of consciousness that has or has not been taken care of at that time.

 

2. Therapist’s congruence in the meeting from one person to the other

Congruence has become the most important of the conditions which Rogers sometimes called “transparency”. Rogers used transparency increasingly more often in therapy, in his relation to the other person and at the same time, he referred to the importance of the meeting of one person with the other in a relationship. Also, in a more subtle way, he referred to the use of intuition by the therapist. Therefore the therapist must be constantly aware of his feelings as if they were client’s feelings, perhaps more likely “as being” than “as if”. Therapist congruence is considered to be fully interconnected with empathy. In other words, the more the therapist is congruent and transparent in his relationship the higher the level of empathy will be. Bozarth (1996) argues that the majority of the therapist’s experiences, even bizarre fantasies, will have therapeutic importance for the client and client-therapist relationship if the therapist is linked to the client in a genuine and profound way. ([author],2011).

Like empathy and unconditional positive acceptance, congruence makes the client to have confidence in the therapist and psychotherapy more easily. If the client accepts the counselor to be congruent with him he will know that the answers he receives can be accepted as opened and honest. He knows that the therapist’s concern isn’t to manipulate and therefore he may feel freer in their relationship. The congruence of person-centered approach splits the air of mystery of the counselor. Mystery implies the illusion of power; transparency dissolves it (Mearns, 2010).

When you have the ability to be congruent you are also aware of all your inner answers for your client. Do not twist nor censor those reactions which are in contradiction with what it means for you to be a good counselor. If you make a judgment about your client, then you know that you made a judgment. If you are not patience with your client you can accept your own impatience. This does not mean that you tell all your reactions to the client. That means you can choose to give tell them or not. Congruence means to learn to listen, to become aware of your own thoughts and feelings in the relation with a client and to communicate them to your client. (Tolan, [year]….).

Counselor congruence creates an interactive sequence in which phenomenological realities of the client and of the counselor can be compared. The discrepancies observed between the two phenomenological realities may constitute important therapeutic material for the client or a new learning experience for the therapist, or sometimes both.

 

3. Positive unconditioned acceptance

Positive unconditional attitude is essential to client’s perception of the process of change and it is transmitted through empathy (Bozarth, 1996). This is evident in Rogers’ assumptions and initial conceptualizations, before he used the term empathy (…..[autor], 2011).

The client, who had heavy, oppressive conditions of living, will be taught that he is valuable as long as he behaves as expected by significant persons in his life. Therapist’s unconditional acceptance is also important because it annihilates directly such valuing conditions: the counselor values the client without considering the client’s compliance to “conditions”, Lietaer (1984) uses counter-conditioning to describe the process that puts into moving the unconditional acceptance; conditional link between being valued and fulfilling conditions to be valued is broken by consistent client treatment as someone valuable in itself, whether he meets the conditions for valorization established for him in his life or not (Lietaer quoted in Brian Thorne, Dave Mearns, 2010).

Positive unconditional acceptance is to believe that everyone has his/her own reasons to do feel or think what they do, feel or think. Listening to someone is to listen to all the organic experience and to the self’s structure. In practice it is very tempting to show clients they are wrong, but any attempt, being it very subtle, can attack the person’s self structure which will respond with a defense mechanism and will become more rigid.

Client’s valorization doesn’t mean to praising the client but to shift the focus from the external frame to his internal frame. Praise can strengthen resistance as well as critics do.

 

III. CRITICS

In Rogers’ theory of personality the tendency to update is the only motivational concept. The tendency to update he described as the tendency of every human being to maintain, develop and enhance their functioning, as the “vital force” that pushes the person to act the best he can in the given circumstances. There have been many reproaches that Rogers’s view is too optimistic and that he became an exponent of the cultural revolution of the 60’s who challenged restrict self expression that the previous generation promoted as if he does not take into account the fact that much of the social restrictions are in fact “normal”. In addition to Rogers’s theory Dave Mearns and Brian Thorne help; in 2000 they introduced the concept of social mediation and make the hypothesis that this is both a force that pushes the person forward and a restrictive force trying to make contact with the person’s social contexts in an “updating-process”. This way the force aiming at developing is not allowed to impose its rhythm which is mediated by control.

Person-centered psychotherapy is not a form of therapy based on solutions and can be a cultural shock for people accustomed to a professional therapist who solves their problem. “I can’t solve any problem for you, but I can help you to solve your own problems and becoming able to do that, you’ll feel better” (C. Rogers).

 

IV. CONCLUSIONS

Empathy, unconditional positive acceptance and congruence are essential to any human relation, in general, and especially in relationships where one person, named client or patient, needs to maintain balance (or continuity of experiences), to integrate a physical or mental status change, a new, maybe unusual or traumatic life situation, a diagnosis, and the other, the doctor, clinical psychologist, psychotherapist or psychiatrist, has the role to help people to understand better what is happening to them and what they have to do.

Any communication of a diagnosis, regardless of the medical field, can have be releasing, with a clarifying effect which can further have an impact in mental functioning, so intimate, yet so difficult to decrypt. It is really necessary to provide a relationship during the assessment, diagnostics, communication of diagnosis and establishing the next steps in working with children and with adults. Sometimes weight and authority of a diagnosis are sufficient and that adding “specialist authority and pride” would make it all become too difficult to manage.

In psychotherapy feeling of being understood by another person in your own experience or that of perceiving and feeling empathy and recognition from the therapist can push and facilitate the awareness of the issues and lead to change

A deep human relationship and providing a safe environment for the client’s safety, valorization and respect are needed for the process of change. So the old significances can change into new ones allowing other new experiences to take place.

“Slowly, slowly, I accepted this suffering and I reconciled with the fact that it exists in me and perhaps it always will be, but now I am defined by something else, I am not represented by that sad past. With each session I became more aware of myself, of what happened to me, of the importance of my life, things I didn’t care very much before because I was too focused on pain and anger related to my past. I found joy in simple things, to look into the future and at the same time to accept my past “- Mrs. X.

 

BIBLIOGRAPHY:

  1. Mearns D., Thorne B. (2010) Consilierea Centrata pe Actiune, Editura Trei;
  2. Biermann- Ratjen E.M., Diether Hoger (Hrsg.), Ekert J.,(2006) Gesprachs-psychotherapie”, Springer;
  3. Everett F., and  Roisman L., Wright L., (1986) Experiential Psyhotherapy with Children, The Johns Hopkins University Press;
  4. Random House College Dictionary (1988), Random House;
  5. Warner M., (2011) Articolul Empatia poate vindeca? O reflecţie teoretică asupra empatiei, procesării mentale şi relatării istoriei personale din Bohart A., Greenberg L.,Coordonatori, Empatia în psihoterapie, Editura Trei;
  6. Bozarth J, (2011) Articolul Empatia din perspectiva teoriei centrate pe client şi a ipotezei rogersiene din Bohart A., Greenberg L.,Coordonatori, Empatia în psihoterapie, Editura Trei;
  7. Rogers C. (2008) A deveni o Persoana, Editura Trei;
  8. Tolan J. (2011) Psihoterapie şi Consiliere Centrată pe Persoană, Editura Herald;
  9. Larchet J.C., (2009) Inconştientul Spiritual, Editura Sophia.
  10. Gendlin E. (1964) A Theory of Personality Change, Chapter four in: Personality Change, Philip Worchel & Donn Byrne (Eds.), New York: John Wiley & Sons;
  11. Rogers, C. R. (1939) The clinical treatment of the problem child, Boston, Houghton Mifflin

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