Running head: PERSON CENTERED THEORY 1 Person Centered Theory and Considerations for Counseling Practice and Teaching Joseph A. Campbell Indiana University South Bend
Running head: PERSON CENTERED THEORY 2 Abstract This article reviews person centered theory and the core conditions: congruence, unconditional positive regard, and empathy. The discussion explores considerations for practice including effectiveness, communication of the condition, and the multicultural considerations of the theory. Additionally, cultural considerations are presented with regards to the values of person centered theory, pedagogy, and additional limitations. Keywords: person centered theory, multicultural, core conditions
Running head: PERSON CENTERED THEORY 3 Person Centered Theory and Considerations for Practice and Teaching Person centered theory is based on a phenomenological understanding of the client s subjective world views and unconditional positive regard, congruence, and empathy regarding therapy outcomes (Rogers, 1957). Humanism and specifically, person centered theory, is the most commonly used assumption driving the early clinical training experiences (i.e., practicum) in master s-level counseling training programs (Fitch, Canada, & Marshall, 2001). Therefore, it is important to consider practice and cultural implications for this theory to help train effective counselors. Professional counseling conceptualizes clients from a life span, developmental approach, and honors diversity and the worth, dignity, and uniqueness of individuals in social and cultural contexts. Counselors empower diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals (ACA, 2014). This article reviews and discusses person centered theory and considerations for practice and teaching. Research on the theory s core conditions, limitations, and multicultural considerations are integral to its use and role in counselor practice. First, an overview of person centered theory discussing significant premises and hypotheses. Next, definition and review of research related to the core conditions: congruence, unconditional positive regard, empathy, and the communication of the conditions is also necessary. Finally, a discussion of research on multicultural considerations and implications practicing from a person centered theory, including the individualistic and non-directedness value, pedagogy and multicultural education, and limitations
Running head: PERSON CENTERED THEORY 4 of person centered theory. Person centered theory has influenced the counseling profession and offers a different point of view of the counseling process from that of psychoanalysis and behaviorism. Person Centered Theory Person centered theory evolved from the work of Carl Rogers. Initial formulation of the theory came from his experience working with clients and being influenced by the introduction of relationship theory into psychology (Rowe, 2017). Relationship theory s focus is on client s self-insights and acceptance in the therapeutic relationship, not the traditional psychoanalysis focus on content related to the past (Kirchenbaum, 2004). Rogers found himself in a position where, students were not satisfied with him simply reviewing methods for helping. They wanted to know what he believed was effective (Kirchenbaum, 2004, p. 117) so he articulated his belief in a non-directive approach, departing from the medical model of illness, and advanced his ideas into the client centered approach and humanistic psychology (Kirchenbaum, 2004). Rogers (1979) described the approach as a basic trust in the organism and, in every organism, at whatever level, is an underlying flow of movement toward constructive fulfillment of its inherent possibilities. In man, too, there is a natural tendency toward a more complex and complete development (p.1). Rogers describes this natural and innate tendency toward a more complex and complete development, self-actualization. Additionally, the person centered approach holds that the six therapeutic core conditions are necessary and sufficient for client outcomes: 1. Two persons are in psychological contact.
Running head: PERSON CENTERED THEORY 5 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 shall term the therapist, is congruent or integrated in the relationship. 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 (Rogers, 1957, p. 95). Person centered theory s premise is based on Rogers (1957) hypothesis that if all six conditions are present in the therapeutic relationship, constructive personality change will happen and if the six core conditions are not present in the therapeutic relationship, personality change will not happen. These six conditions and the belief in innate self-actualizing tendencies, sets the foundation for this approach. For the purpose of this article, it is assumed the conditions of psychological contact between two individuals, one a counselor that is congruent in the therapeutic relationship and the other a client that is incongruent are met. The focus of the following section is on the communication of the conditions in the therapeutic relationship, research and outcomes, and implications and recommendations for practice for the conditions of congruence, unconditional positive regard, and empathy. The Core Conditions
Running head: PERSON CENTERED THEORY 6 The core conditions of congruence, unconditional positive regard, and empathy promote client personality change, through innate self-actualizing tendencies. These conditions are critical and need be present in the counseling relationship and also communicated to the client. The core conditions set a tone of trust, respect, and a non-judgmental orientation that are the foundational to the approach and cornerstones of the counseling profession. Reviewed below are the core conditions of congruence, unconditional positive regard, empathy, the communication of the condition, recommendations for practice, and research. Congruence Rogers (1957) describes congruence as, the therapist should be, within the confines of this relationship, a congruent, genuine, integrated person. This means he is freely and deeply himself (p. 96). Congruence is the counselor being genuine, and without a façade, in communicating to the client the interpersonal dynamics of the therapeutic relationship and communicating congruence and genuineness is critical for client personality change (Rogers, 1957) and, in practice, can be communicated through meta-statements and metaphors. One way to communicate congruence and genuineness is through meta-statements. Meta-statements in everyday conversation is to enable speakers to present slightly risky ideas or put softened frames around ideas that might otherwise be conversationally awkward (Wickman & Campbell, 2003, p. 81). In a therapeutic example, a client makes a comment that they want the counselor to be more direct and give advice. The counselor can respond with a meta-statement noting the private personal experience of an individual and that the advice and direction comes
Running head: PERSON CENTERED THEORY 7 from the individual. Additionally, a client may disclose that they do not feel connected with their counselor, the counselor might reply with a statement about how the counselor feels proud of the client s courage to articulate feelings or ask the client what it was like for them to express this concern in there here-and-now therapeutic relationship. Meta-statements help work towards being genuine and congruent in the therapeutic relationship. The use of metaphors can also help in communicating this core condition. The use of constructing conceptual metaphors within the therapeutic relationship assists in building and communicating congruence. Conceptual metaphor theory notes, people make sense of abstract concepts and events through concrete experiences with their bodies or vicariously know about experiences of other bodies in the world (Wickman & Campbell, 2003, p. 15-16). Metaphors are, surface realizations of people s underlying frameworks for understanding the concepts and experiences being described (Wickman & Campbell, 2003, p. 16). For example, a client might understand and conceptualize life in terms of a journey where people get stuck at a crossroad, do not know which way to turn, but sometimes get back on the right track. Wickman and Campbell (2003) propose, familiarity with conceptual metaphors theory as a means by which counselors can enhance their skills for facilitating congruence, empathy, and unconditional positive regard (p. 22). From this perspective, metaphors help to communicate congruence, but also convey empathy and positive regard which are foundational components of person centered theory in counseling. Unconditional Positive Regard It is often difficult to come to one definition and identify unconditional positive regard
Running head: PERSON CENTERED THEORY 8 because it has been called many names: caring, non-possessive love, acceptance, or non-possessive warmth (Farber & Doolin, 2011). Unconditional positive regard involves the counselor experiencing warm acceptance of the client s experience and Rogers (1957) defined it as, there are no conditions of acceptance, no feeling of I like you only if you are thus and so (p. 97) and this warm acceptance is communicated to the client. When a counselor does not put conditions of worth on the client, they respond with more confidence and less hostility (Kensit, 2000). Furthermore, Rogers (1961) notes that the condition of unconditional positive regard involves the counselor s willingness for the client to feel whatever is going on inside of them, here-and-now. Although unconditional positive regard is defined many different ways, Farber and Doolin (2011) found, positive regard has a moderate association with psychotherapy outcomes (p. 61). Additionally, Rogers (1960) notes research studies show that the more this attitude is experienced by the therapist, the more likelihood there is that therapy will be successful (p. 62). Even-though unconditional positive regard is defined many ways, in general, it has a positive outcome on the therapeutic process. Considering the moderate association between positive regard and counseling outcomes, there are recommendations for clinical practice with respect to positive regard: (a) it sets the stage for other interventions, and in some cases may be sufficient for positive change; (b) serves many valuable functions across the theoretical orientations of counseling (e.g., psychodynamic or behavioral); (c) may be important in situations where a non-minority counselor is working with a minority client, speaking to the effectiveness of this approach in multicultural settings; and (d) therapists cannot be content with feeling good about their clients, but should ensure that
Running head: PERSON CENTERED THEORY 9 their positive feelings are communicated to them (Farber & Doolin, 2011). Furthermore, it is important to note that unconditional positive regard is often misinterpreted and does not mean that the counselor only expresses positive and nice feedback to the client. That limits the counselor s responses and therefore limits their ability to be genuine and congruent. Unconditional positive regard needs be present in the therapeutic relationship, but like all the core conditions, needs to be communicated to the client. Communicating unconditional positive regard can be done by withholding direct responses to requests for advice and by respecting the client s ability to come to a decision (Wickman & Campbell, 2003), which is a fundamental belief of human nature in person centered theory: trust in the person (Rogers, 1961). Respecting and trusting an individual s ability to come to a decision about what is best for them seems contrary to the professions use of a is a standard 50-minute counseling session. To communicate respect, trust, and unconditional positive regard for an individual to make their own decision, Mountford (2005) experimented with allowing the client to determine the length of a session, believing that the client knows best what the client needs. Many training programs, private practice, insurance companies, mental health agencies, and other service providers promote and offer a standard 50- minute individual counseling hour. Mountford (2005) found that, a large majority preferred session length of 75-105 minutes (p. 44). From the person centered theory, the counselor works with the client to establish a pattern of session length and time together. Furthermore, if the client and counselor determine session length of the therapeutic endeavor together it can impact and decrease counselor fatigue.
Running head: PERSON CENTERED THEORY 10 Counseling is very hard on the counselor and I find it easier to see four clients in a day and offer them, say, eight hours of counseling between them than see eight clients for 50 minutes I am allowing room for the relationship to evolved in an unhurried way, I am allowing sufficient space for process, and I find the longer session a more satisfying way to work (Mountford, 2005, p.45). Empathy Rogers (1961) discusses that empathy as a feeling the counselor experiences and communicates towards the client of the counselor sensing the feelings and personal meanings that the client experiences, the client s phenomenological view. Empathy is the therapist experiencing an accurate, empathic understanding of the client s awareness of his own experience. To sense the client s private world as if it were your own, but without ever losing the as if quality this is empathy, and seems essential to therapy (Rogers, 1957, p. 97). Roger s held that empathic understanding could be directed subjectively, interpersonally, and objectively. Directing empathy subjectively, interpersonally, and objectively are ways a counselor can form hypotheses and get a sense of knowing and understanding a client s perspective. A subjective way of knowing is, an individual is able to empathically sense his or her own subjective internal state (Clark, 2004, p. 142). An interpersonal way of knowing is, the direction of an individual empathy is toward another person in an effort to grasp his or her phenomenological functioning (Clark, 2004, p. 143). An objective way of knowing is, directing a person s empathic understanding toward groups who have an external frame of reference (Clark, 2004, p. 143). Clark (2010) proposes the skill and use of empathy, as an
Running head: PERSON CENTERED THEORY 11 integrated model, across the counseling process, by which the counselor builds perspective and hypothesis based on the three ways of knowing (Clark, 2004). Wickman and Campbell (2003) found that first-person quotes and speaking from the I perspective helps externalizes a client s internal dialogue and aides in the counselor understand the phenomenological perspective of the client and communicate empathy. Rogers (1957) believed that empathic understanding and communication was part of what is necessary and sufficient for a person to make change in their lives, yet the construct of empathy has been defined many ways. Over time, the operational definition of empathy has changed and been equated with reflection of feeling skills (Clark, 2004), but Elliott, Bohart, Watson, and Greenberg (2011) note, 70% or more of Carl Rogers responses were to meaning rather than to feeling, despite the fact that his mode of responding is typically called reflection of feeling (p. 43). Depending on the perspective, focus, and type of researcher (e.g., psychoanalytic, developmental, or social psychologist), empathy has been operationally defined as different constructs: (a) a personality trait or general ability to know another person s inner experience or perceive their emotions; (b) a situational specific cognitive-affective state which is responding or sensing the client s private world as if it were one s own; and (c) as a multiphase experiential process considering the moment-to-moment experience of empathy and examine the process involved in producing and communicating an empathic state (Duan & Hill, 1996). Rogers believed that empathy was part of the necessary and sufficient conditions for client change (Roger, 1957), yet research suggests it helps, but not all the time. Research conducted points out differences in conclusions, presenting issue, and research
Running head: PERSON CENTERED THEORY 12 methodologies. Daun and Hill (1996) concluded that there have been inconsistent research results and different conclusions regarding the function of empathy in psychotherapy. Empathy was probably not sufficient for more severe individual issues (Daun & Hill, 1996). In contrast, a meta-analysis of 59 independent samples and 3599 clients, Elliott et al. (2011) found empathy as a moderately strong predictor of therapy outcomes and suggest recommendations for counseling practice: regardless of theoretical orientation, treatment, and severity of patient presenting problem, an empathic stance of the counselor is essential and that counselors make an effort to understand their client s world view and communicate empathic understanding moment-to-moment. Additionally, research methodology issues have been reported due to unreliability and inaccurate measures, no cause-effect evidence between empathy and outcomes, and the lack of attention to the role of the therapist empathic emotions and the dynamic relationship (Daun & Hill, 1996). As illustrated by the research and conceptual examples above, findings support, deny, and give mixed outcomes about the importance and impact of empathy on personality change and outcomes in counseling. Even though research conclusions and discussions have been inconsistent regarding the effectiveness of empathy and the other core conditions, in general, they are considered therapeutic skills in the counseling profession. Yet, empathy and the other core conditions, as well as the overall theory, have mixed findings of outcomes, the theory holds promise and limitations with respect to multicultural counseling, implication, and considerations. Multicultural Implications and Considerations
Running head: PERSON CENTERED THEORY 13 Person centered theory and the core conditions provide a framework for counselors in engaging clients and provides a solid foundation for practice. Fitch, Canada, and Marshall (2001) found that in Counseling and Related Education Programs (CACREP) accredited programs, counselor educators emphasize person centered theory as a method to train practicum students. Therefore, counselor educators need to be aware of multicultural implications and considerations of the core conditions and person centered theory: the values of the theory, pedagogy, and limitations with lesbian, gay. Theory Values Person centered theory has an individualistic cultural orientation. Counseling is largely based on Western European values and ways of seeing the world. The values often described include focusing on individuality and seeking an independent lifestyle (Henriksen, 2006). Yet, people from Third World traditional cultures grow up in a climate in which the adult authority cannot be contradicted and has absolute validity. In a counseling session, the client from this culture expects the counselor (i.e., the authority) to guide, probe, and provide structure (Poyrazli, 2003, p. 107). The notion of a counselor guiding and probing in a counseling session creates friction for the practitioner that has a person centered, non-directedness theoretical orientation. Furthermore, Watson (2007) note that clinicians may be, too laissez-faire and fail to adequately structure and guide their clients process (p. 270). Therefore, a strict person centered approach to counseling does not always rise to the level of meeting client needs. The individual orientation, values, and non-directional stance of person centered theory is a limitation and has multicultural and
Running head: PERSON CENTERED THEORY 14 pedagogy implications. Pedagogy During the last 25 years of Rogers life, he experimented with a person centered approach to resolving intergroup and international conflicts (Kirschenbaum, 2004, p. 122). The experimentation included workshops and filmed encounter groups with multicultural populations (i.e., Catholics and Protestants, African-Americans and European Americans), and Rogers demonstrated how, positive regard, empathy, and congruence the same growth-promoting conditions useful in all helping relationships can enhance communication and understanding among antagonistic groups (Kirschenbaum, 2004, p. 122). The experimentation and evolution of person centered theory, with applications to resolving intergroup conflicts, impacts education, in general, and multicultural pedagogy in counselor training, specifically. Person centered theory has impacted education and is known as learner (or student) centered education. Rogers saw education and the facilitation of the individual vital. Rogers s theory of education notes, the goal is the facilitation of the whole and fully functioning person, who is a citizen and leader in a democratic society (Cornelius-White, 2007, p. 114). In counselor education, part of the goal is the facilitation of the whole and fully functioning individual and person centered theory and the core conditions offers a belief of a, proactive view of humans as being in the process of actualizing (Glauser & Bozarth, 2001, p. 142). Having a proactive view of people and adopting a learner centered classroom, promotes overall student growth and development and person centered teachers have an above-average finding with positive student outcomes (Cornelius-White, 2007).
Running head: PERSON CENTERED THEORY 15 Taking this educational perspective and exploring the impact of person centered theory in counselor learning, Glauser and Bozarth (2001) found a failure to consider the importance of these [the core conditions] postulates and the more general aspects of the client centered relationship in multicultural counseling is a major flaw in the effort to find multicultural models (p. 143) of teaching and practice. This failure has an impact on the way counselors are trained and the models of multicultural education that counselor educators use to facilitate the whole person in their process of actualizing. Multicultural education and training in counselor education has, moved from assimilation and amalgamation to the metaphor of the tossed salad (Henriksen, 2006, p. 175). Henriksen (2006) proposes a transformational pedagogy in counselor education which asks the trainee to view the whole person and considers the context of the individual s lived experience. Clearly, the transformational pedagogy model incorporates foundations of person centered theory. Glauser and Bozarth (2001) note, when multicultural counseling concentrates on the counselor s use of specific techniques to do counseling, the true value of counseling is lost (p. 142). The person centered approach provides core conditions for the therapeutic relationship and has implications for pedagogy, the approach does not always fully meet the cultural needs of clients. Watson (2007) recommends that, an important adjunct to the effective communication of empathy, acceptance, and congruence is the provision of stimulation, guidance, and structure to engage client s effectively in the work of therapy (p. 271). Adapting this recommendation assists in cross cultural counseling where directness and structure are valued by cultural
Running head: PERSON CENTERED THEORY 16 perspective. Additionally, the recommendation of guidance can be helpful in the complex process of counseling to help examine possible consequences and the client focused. Discussion Meeting the needs of diverse clients is critical in the counseling profession and complex. For example, Lemoire and Chen (2005) content that person centered theory does not adequately address working with lesbian, gay, bisexual, or transgender (LGBT) clients and offers recommendations: explicit identity validation, guided risk assessment regarding disclosure, and exposure to positive LGBT communities, communication, and socialization. Additional cultural factors and multicultural considerations and applications of person centered theory speak to additional limitations and meeting the needs of diverse clients. Research on person centered counseling is supportive, aversive, and mixed. In addition to the mixed outcome research findings, there is also criticism of the person centered approach: failure to realize the power of cultural and social factors on an individual s behavior and attitudes and an over-emphasis on the innateness of empathy and the belief in self-actualization (Kensit, 2000). In addition, the non-structured approach runs a risk of being neglectful and allows clients to ramble and avoid issues (Watson, 2007). Although findings and research provided supportive, aversive, and mixed findings, person centered theory has grown and developed in student-centered teaching, couples and family counseling, groups, industry, conflict resolution, politics, and efforts of creating peace in the world (Corey, 2013). The growth of the theory into other disciplines and settings demonstrates the concepts of person centered theory and the work of Carl Rogers are enduring.
Running head: PERSON CENTERED THEORY 17 This article reviewed the work of Carl Rogers and person centered theory, the core conditions: congruence, unconditional positive regard, empathy, and the communication of the condition. Additionally, limitations of the theory to cross cultural counseling, the values of the theory, multicultural implications, and pedagogy were discussed. Person centered theory offers counselor educators and clinicians a theoretical orientation of how to engage clients in a therapeutic relationship. Yet, research also shows that, at times, the results and outcomes of practice are not always consistent and the theory does not always adequately address client needs: there are limitations. Even with the limitations and inconsistencies in research, Carl Rogers and person centered theory have a place, impact, and foundation on the practice and education of the counseling profession.
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