MODULE 7 CLIENT CENTRED THERAPY Quadrant 1

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1 MODULE 7 CLIENT CENTRED THERAPY Quadrant 1 1. Introduction Client Centered Therapy (CCT) established by Carl Rogers is also known by terms such as Rogerian psychotherapy, person-centered psychotherapy, person-centered counseling, and non-directive therapy. Client Centered Therapy is regarded as one among the other major psychotherapies, such as Psychodynamic Psychotherapy or Psychoanalytical Therapy, Adlerian Individual psychotherapy, Cognitive Behavioral therapy, Existential psychotherapy, etc. Client Centered therapy was developed by Carl Rogers and his colleagues, based on Roger s humanistic psychology (1970, 1980). Client Centered Therapy is found to be effectively helpful for individuals to attain enhanced levels of personal happiness and adjustment. Client Centered Therapy is a form of psychotherapy that concentrates on eliminating irrational conditions of worth conditions people believe they must meet in order to be loved or accepted. Roger s Client Centered Therapy Places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role. It vitally aims to provide conditions for individuals, an atmosphere of unconditional positive regard a setting in which they realize that they will be accepted by another person no matter what they say or do. The aim of client centered therapy is to provide a nurturing environment where clients get in closer to those essential positive elements of themselves that have been hidden or distorted from them. More congruence and less distortion together lead to greater trust that their individual selves can be relied on for effective relations with people and their environment. This module provides an introduction to Roger s Client Centered Therapy, its characteristic features, goals and principles. The skills and techniques required to practice client centered therapy are also discussed in this module. At the end of this module, the student will understand the therapeutic approach of Client centered therapy through learning the Evolution of the Client Centered Therapy Aims of Client Centered Therapy Client Centered Therapeutic Process; Significance of Therapeutic Relationship; and Intervention strategies of Client Centered Therapy 2. HISTORICAL BACKGROUND Carl Rogers did a clinical psychology programme of Columbia University, and received his PhD in He had already begun his clinical work at the Rochester Society for the Prevention of Cruelty to Children. Rogers learned about Otto Rank s theory and therapy techniques which laid the base for his own school of thought. He was offered a full professorship at Ohio State in In 1942, he wrote Counselling and Psychotherapy, which was his first book. Client centred therapy was developed by Carl. R. Rogers in USA from the late 1930s onwards, formerly known as non-directive psychotherapy. Rogers was a spokesman for humanistic psychology. Then, in 1945, he was invited to set up a counselling centre at the University of Chicago. In 1951, he published his major work Client-Centred Therapy wherein he outlines his theory. The theoretical core theme is the inevitability for non-judgemental listening and acceptance if clients are to change. He was known for originating and developing the humanistic movement in psychotherapy. Both the humanistic psychology and the existential perspective are blended together in Roger s approach. His basic assumptions are that people are essentially trustworthy; that they have potential for understanding themselves and resolving their own problems without direct intervention from the part of

2 the therapist and that they are capable of self-directed growth if they are engaged in a therapeutic relationship. For him the attitudes and personal characteristics of the therapist and the quality of the client-therapist relationship are prime determinants of the outcome of the therapeutic process. The therapist s knowledge of theory and techniques are of secondary importance. There are four periods in the development of Roger s approach. 1) Non-directive counselling: It was a reaction to the directive and traditional psychoanalytic approach. The therapist is invited to create a permissive and non-directive climate for the client. In this stage the counsellor focuses mainly on reflecting and clarifying the client s verbal and non-verbal communications. The counsellor needs to accept whatever feelings the client expressed. 2) Client-centred Therapy: Now the focus shifts from non-directive method to the client s phenomenological world that is the internal frame of reference of the client. Rogers contended that if the therapist offers a facilitative climate where congruence, acceptance, and empathy were present and the client perceived these conditions, then therapeutic change would take place. 3) The third period coincides with the publication of his book On Becoming a Person. Here the focus is on the nature of becoming the self that one truly is. 4) Person-centred approach: In this stage one sees Rogers interest in how people obtain, possess, share, or surrender power and control over others and themselves; thus his approach became person-centred. 3. Aims of Client Centered Therapy: Two major goals of Client Centered Therapy are Increased self esteem and Greater openness to experience. These are the related changes that Client Centered Therapy seeks to foster in the clients: 1) Closer agreement between the client s idealized and actual selves 2) Better self-understanding 3) Lower levels of guilt, defensiveness and insecurity 4) More positive and comfortable relationships with others and 5) An increased capacity to experience and express feelings at the moment they occur. Client Centered Therapy focuses on the individual and not on the person s presenting problem. Therapists use themselves as instruments of change. The aim is to assist clients in their growth so they are better able to cope with current problems as well as the future problems. The basic drive to fulfillment implies that people move toward health if the way seems open for them to do so. Thus, the aims of therapy are to set the clients free and to create those conditions that will enable them to engage in meaningful self-exploration. Therapists focus themselves mainly with the client s perception of self and the world. This therapeutic approach provides clients with a rare opportunity to be truly listened to without evaluation or judgment. Therapist does not choose specific goals for the client. Primary responsibility for the direction of therapy is on the client. Thus the general aims of Client Centered therapy are: i. Becoming more open to experience, ii. Achieving self-trust, iii. Developing an internal source of evaluation, iv. Being ready to continually grow

3 4. KEY CONCEPTS 4.1 VIEW OF HUMAN NATURE Actualization, which is a tendency towards the fulfillment of the potential, is the sole motivational construct in person-centred psychology. A function of the actualizing tendency differentiates a portion of one s experience into an awareness of self and the organization of a self-concept. The self-concept, or self-structure, is a consistent pattern of perception of the I or me in relation to the environment, personal values, goals and ideals. Rogers has a basic sense of trust in the client s ability to move forward in a constructive manner if the appropriate conditions for growth are present. Clients are for him trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. The attitude of the therapist is of utmost importance for the change to take place in the client. Rogers identified three attitudes namely 1) congruence (genuineness or realness), 2) unconditional positive regard (acceptance and caring), and 3) accurate empathic understanding (an ability to deeply grasp the subjective world of the other person). Because this approach believes in the capacity of the client to move forward in a constructive way, the primary responsibility for change rests with the client. 4.2 BASIC CHARACTERISTICS The person-centred approach insists on the responsibility and capacity of the client to discover ways to encounter reality more fully. The phenomenal world of the client is given importance. It is not only in psychotherapy that clients experience growth, but growth can take place even in any type of caring and understanding relationship. 4.3 THERAPEUTIC GOALS The person-centred approach aims towards a greater degree of independence and integration of the client. Therefore the focus is on the client rather than on his problem. This approach encourages openness to experience, trust in oneself, internal source of evaluation, and willingness to continue growing. 4.4 RELATIONSHIP BETWEEN THERAPIST AND CLIENT Significant positive personality change does not take place except in a relationship. According to Rogers there are six necessary and sufficient conditions required for the change to take place in the client. They are (1) two persons are in psychological contact, (2) the client experiences incongruence, (3) the therapist is congruent or integrated in the relationship, (4) the therapist has unconditional positive regard or real caring and acceptance for the client, (5) the therapist has an empathic understanding of the internal frame of reference of the client, and (6) the therapist communicates to the client empathic understanding and unconditional positive regard at least to a minimum degree. These six items are summed up in three attitudes of the therapist namely 1) congruence or genuineness, 2) unconditional positive regard and acceptance and 3) accurate empathic understanding. 4.5 CONGRUENCE OR GENUINENESS Congruence is the most important attitude on the part of the therapist. It simply means that the therapist is real, that is, he is genuine, integrated, and authentic during the therapy hour. There is no false professional front and the therapist s inner experience and outer expression of that experience match. He is capable of expressing openly his feelings and attitudes that are present in the relationship with the client. By his authenticity the therapist serves as a model for the client struggling towards greater realness. 4.6 UNCONDITIONAL POSITIVE REGARD OR ACCEPTANCE It implies deep and genuine caring for the client as a person. And this caring is unconditional which is not contaminated by evaluation or judgement of the client s feelings, thoughts, and behaviour. Acceptance is the recognition of the right of the client to have his own feelings and it does not amount to the approval of

4 all behaviour. 4.7 ACCURATE EMPATHIC UNDERSTANDING The therapist understands the feelings of the client accurately as if they were his own feelings. It is a personal identification with the client s experience. The person-centred approach is helpful especially in crisis intervention. A person in crisis wants to express himself fully. The therapist needs to listen sensitively and understandingly to the client in crisis. 5. ILLUSTRATION CLIENT: Something bothers me for some time. I had a very good relationship with my father. I have two elder brothers who have not studied as I have done. From the very beginning my father was very fond of me and he used to compare my brothers with me and show me as a model especially in studies. In the beginning I liked it but later I realized that my father is partial to me and my brothers feel that. Presently I am staying away from my parents and I come home once in a way. Last time when I came home I spoke to my father about his mistake in being partial to me. From that time onwards he is not talking to me properly and the intimate relationship we had has been broken. Now I am disturbed about it. CLIENT CENTERED THERAPIST: You realized that your father had been unfair with your other two brothers and so you spoke to him about it and in fact that broke off the relationship with your father and it worries you. CLIENT: Yes, now I find it difficult to face my father. Nowadays when I go home I avoid talking to him. At the same time I know that my father wants to talk to me but somehow I am not comfortable to talk to him. CLIENT CENTERED THERAPIST: You feel uncomfortable to face your father and avoid any chance of talking to him. Will you speak more on your feeling of discomfort? CLIENT: In a way I would say I am disappointed in my father. He is supposed to be fair to all the children. When it is the question of my brothers, my father is very hard on them. CLIENT CENTERED THERAPIST: You are disappointed in your father as he is not good in dealing with your brothers. CLIENT: It so happened last time when I was at home. I was alone and my father came home and we two happened to be together. It was a chance for my father to tell me all that he wanted to say. He was mostly complaining against my other two brothers. I did not say anything verbally but kept nodding my head. CLIENT CENTERED THERAPIST: Were you satisfied with the type of response you made to your father? CLIENT: Yes, that was all I could do. If I speak he might misunderstand me thinking that I am supporting my brothers. CLIENT CENTERED THERAPIST: Do you think that your father was pleased with your response? CLIENT: I am not quite sure about it. CLIENT CENTERED THERAPIST: If you were to tell me your concern in one sentence what would it be? CLIENT: I was very harsh with my father in dealing with our family problem and I am disturbed about it. CLIENT CENTERED THERAPIST: Is it that you did not take into consideration the feeling of your father in addressing the family problem? CLIENT: Yes, that is my problem, I think. CLIENT CENTERED THERAPIST: Can you give me a recent event of your being not sensitive to the feeling of your father? CLIENT: Two weeks back when we were all together, my father, mother, two brothers and I, I raised the issue of our family problem. At that time, I was siding with my brothers purposely and my father felt sad about it. CLIENT CENTERED THERAPIST: So you realize that you had not been sufficiently sensitive to the feeling of your father. How should you have acted if you had been sensitive to the feeling of your father? CLIENT: I should have been evenhanded with everyone in dealing with the family problem.

5 CLIENT CENTERED THERAPIST: You realize that you were not sufficiently sensitive to the feeling of your father. Now what would be your goal? CLIENT: In future I shall be quite sensitive to the feeling of my father whenever we deal with our family problems. CLIENT CENTERED THERAPIST: You seem to be deciding to be fair in dealing with all the members of your family. CLIENT: Yes, I shall be so. CLIENT CENTERED THERAPIST: How could that be expressed more concretely? CLIENT: When we discuss family matters, I shall give importance to my father and listen to him completely. On my part I shall not blindly support my brothers but will be fair in dealing with issues. CLIENT CENTERED THERAPIST: What you have decided seems good. Indeed it is fine. What are you experiencing right now? CLIENT: I feel very much relaxed and clear about the issue and my involvement. CLIENT CENTERED THERAPIST: Is there anything else you feel? CLIENT: I feel happy about my decision. Thank you very much for your availability and assistance. CLIENT CENTERED THERAPIST: Welcome. Wish you all the best. From the illustration above, we can understand the intrinsic features of client centered therapy. The following are the distinctive components: Therapist s attitude can be necessary and sufficient conditions for change. Therapist has to be immediately present and accessible to clients. Intensive continual focus on client s phenomenological world. Process marked by client s ability to live each moment fully. Focus on personality change, not structure of personality. 6. TARGET CLIENTS The Client Centered Therapy has wide application within the helping professions, voluntary sector, human relations training, group work, education and institutional settings where the goals are to foster good interpersonal skills and respect for others. This therapy is also useful in dealing with the clients in the first stage of crisis. Women clients would benefit from this therapy as they are encouraged to consider and identify their own feelings and needs, which many women may never been able to do before. People with relationship difficulties would also benefit as the client centered therapist gives them respect, understanding and openness which they may not have experienced in everyday life. The principles of the person centered approach have been applied to a variety of therapeutic situations including marriage counselling and family therapy. Many self help groups like Alcoholic Anonymous extend core conditions of respect, understanding and openness for people who want to change. Success is dependent on the therapists maintaining high trust in the feelings and actions of the client and themselves. Lack of trust often causes therapists to rely on passive reflection responses. These are necessary but become inadequate as the need for a more comprehensive therapeutic relationship develops which includes directness that comes with culturally, situational and personally relevant feelings and interactions.

6 7. SUMMARY The Client Centered Therapy is optimistic in its view of humankind. Clients are seen as basically good and possessing the capabilities for self understanding, insight, problem solving, decision making, change and growth. The therapist s role is that of a facilitator and reflector. The therapist facilitates a client s self understanding and clarifies back to the client the expressed feelings and attitudes of the client. In this therapy, giving information for problem solving is not usually considered the responsibility of the therapist. The therapist would not seek to direct the mediation of the therapist s inner world but provides a climate in which the counselee could bring about change in himself/herself. The core conditions of therapy as described by Rogers are empathy, unconditional positive regard and congruence or genuineness which is considered necessary and sufficient for therapeutic personality change. The therapeutic skills which are essential for the development of a therapeutic relationship between therapist and client are: active listening, responding to clients through reflection of feeling and content, paraphrasing and summarising, asking open questions and responding appropriately to silence and client s non-verbal communication. Silence, acceptance, restatement, empathy and immediacy responses occur most frequently with the client taking the lead on what is discussed and being responsible for outcomes. Client centered therapists encourage careful self exploration but they tend to avoid confrontation and interpretation as tools for hastening insight.