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Client-centered therapy is an approach to psychotherapy based on trust in the self-directive capacities of the individual. In this respect, it contrasts with other therapeutic orientations where the therapist characteristically acts as an expert.
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1. Historical Overview
Psychologist Carl R. Rogers ﬁrst described this new approach to psychotherapy in a talk in 1940, not realizing the impact it was going to have. This was followed by a full-length book on psychotherapy containing a clearly stated theory of therapy together with a verbatim account of an eight-interview case. This made up approximately two-ﬁfths of the book and was a pioneering method of case presentation at the time.
As client-centered theory and practice developed in the 1940s and 1950s at Ohio State University and the University of Chicago, a far-reaching body of research on a new hypothesis grew up: that if the therapist oﬀered, and the client experienced, a particular kind of relationship characterized by genuineness, unconditional positive regard, and empathy, a self-directed process of growth would follow. Moving to the University of Wisconsin from 1957 to 1963, Rogers and his associates undertook a major research project which tested the client-centered hypothesis with schizophrenic patients. In 1964, he moved to La Jolla, California, using the approach in the United States and abroad, in small and large groups, school systems, workshops, and conﬂict resolution. The broader application of the principles of client-centered therapy became known as the person-centered approach. Rogers died in February 1987. The movement he fathered but did not wish to dominate is carried on by a diverse and dedicated international community.
2. Basic Therapeutic Concepts
The following are the fundamental concepts of person centered psychotherapy:
(a) An actualizing tendency which is present in every living organism, expressed in human beings as movement toward the realization of an individual’s full potential.
(b) A formative tendency of movement toward greater order, complexity, and inter-relatedness that can be observed in stars, crystals, and microorganisms, as well as human beings.
(c) Trust that individuals and groups can set their own goals and monitor their progress toward these goals. Individuals are seen as capable of choosing their therapists and deciding on the frequency and length of therapy. Groups are trusted to develop processes that are right for them and to resolve conﬂicts within the group.
(d) Trust in the therapist’s inner, intuitive self.
(e) The therapist-oﬀered conditions of congruence, unconditional positive regard, and empathy:
(i) Congruence has to with the correspondence between the thoughts and behavior of the therapist, who is genuine and does not put up a professional front.
(ii) Unconditional positive regard, also identiﬁed as ‘caring,’ prizing,’ and ‘nonpossessive warmth,’ is not dependent on speciﬁc attributes or behaviors of the client.
(iii) Empathy reﬂects an attitude of profound interest in the client’s world of feelings and meanings, conveying appreciation and understanding of what- ever the client wishes to share with the therapist.
(f ) Self-concept, locus-of-evaluation, and experiencing are basic constructs which emerge from the client’s own interaction with the world.
(i) The self-concept is made up of the person’s perceptions and feelings about self. Self-regard or self-esteem is a major component of the self-concept.
(ii) Locus-of-evaluation refers to whether the person’s values and standards depend on the judgments and expectations of others, or rely upon his or her own experience.
(iii) Experiencing has to do with whether the person, in interacting with the world, is open and ﬂexible or rigid and guarded.
(g) The Internal Frame of Reference (IFR) is the perceptual ﬁeld of the individual, the way the world appears, and the meanings attached to experience and feeling. It is the belief of person-centered therapists that the IFR provides the fullest understanding of why people behave as they do, superior to external judgments of behavior, attitudes, and personality.
3. Theory Of Psychotherapy
The basic theory of person-centered therapy is that if therapists oﬀer, and clients experience, a particular kind of relationship characterized by genuineness, unconditional positive regard, and empathy, they will respond with greater self-direction and self-expression, an increased openness to inner and outer experiencing, more mature behavior and ability to deal with stress, and a concept of self that is more positive and more realistic.
4. Evolution Of Theory And Practice
After Rogers assumed a professorship at Ohio State University at the beginning of 1940, he received an invitation to address Psi Chi, the psychological honor society, at the University of Minnesota, on December 11, 1940, the date often cited as the time when client centered therapy was born. Rogers described a newer therapy which had the aim of helping individuals not only to solve their present problems but to grow in the capacity to solve future problems as well in a more integrated way, that took advantage of a general drive toward health, growth, and adjustment, that stressed emotional elements more than intellectual aspects, that emphasized the immediate situation rather than the past, and that viewed the therapeutic relationship itself as a growth experience.
The talk generated an intense reaction, both favorable and unfavorable. Rogers expanded his thinking into the book, Counseling and Psychotherapy (Rogers 1942), almost two-ﬁfths of which was made up of ‘The Case of Herbert Bryan,’ consisting of the typescripts of eight phonographically recorded verbatim interviews. This kind of presentation was revolutionary, standing in sharp contrast to the subjective accounts of therapy being published at the time, and provided objective research data for the study of the therapeutic process.
Rogers and his students at Ohio State developed methods of classifying client statements and counselor responses, and of measuring self-regarding attitudes. The concept of self-emerged as a central construct of personality organization, and great progress was made in the objective study of personality change and the behavior in therapy of therapist and client.
Research on person-centered psychotherapy advanced in a major way at the University of Chicago Counseling Center during Rogers’ tenure there from 1945 to 1957. An entire issue of the Journal of Consulting Psychology in 1949 was devoted to a report of the ‘parallel studies’ project, comprising six investigations of the same group of 10 completely recorded and transcribed cases, with pre-and post-tests. The studies included measures of feelings regarding self and others, the pattern of client content (e.g., statement of problem, understanding or insight, discussion of plans), defensiveness, and maturity of behavior. There was an evaluation of outcome using the Rorschach test, an analysis of the relationships among all these, and counselor ratings of improvement on a 1 to 9 scale. Two key ﬁndings were that (a) the measures applied to each interview provided a meaningful picture of the client’s adjustment at the beginning, during, and end of therapy, and (b) there was a signiﬁcant relationship between counselor estimates of success and ratings based on the interview-analysis measures. Signiﬁcant relationships were not found between Rorschach results and those of the ﬁve interview measures. It was also concluded that the research methodology was applicable to therapeutic approaches generally, and that such eﬀorts would help put psychotherapy on a scientiﬁc basis.
The ‘parallel studies’ project was succeeded ﬁve years later by a larger study (Rogers and Dymond 1954), which contained complete data on 29 clients seen by 16 therapists, as well as on a matched control group. It measured changes in self-using the Qtechnique of British psychologist William Stephenson, a sophisticated method of quantifying the way people viewed themselves at present and ideally, leading to the ﬁndings that the self-concept of clients in therapy improved signiﬁcantly, and to a signiﬁcantly greater degree than control group subjects, and that therapy achieved a signiﬁcant increase in congruence between self and ideal. Qualitative analysis showed clients in therapy growing in their feelings of self-conﬁdence, self-reliance, self-understanding, inner comfort, and comfortable relationships with others, with a decrease in negative feelings about themselves.
Person-centered and general psychotherapeutic theory advanced substantially with the introduction of the concept of ‘necessary and suﬃcient conditions of therapeutic personality change’ (Rogers 1957). Empathy, congruence, and unconditional positive regard were clearly deﬁned. Capable of quantiﬁcation, they stimulated hundreds of research projects. The Relationship Inventory (Barrett-Lennard 1998), an instrument measuring these conditions, has also been used in a vast number of research projects in psychotherapy and other human relations applications such as parent–child, student–teacher, and worker– employer relationships.
The most rigorous exposition of person-centered thinking, ‘A theory of therapy, personality, and interpersonal relationships,’ was published in Sigmund Koch’s Psychology: A Study of a Science (Rogers 1959). A pioneering research project on therapy with schizophrenic patients and normal adults at the University of Wisconsin broke new ground in working with and doing research on this population (Rogers et al. 1967).
On Becoming a Person (Rogers 1961) included a summary of the personality and behavioral changes in therapy supported by research, an objective description of the fully-functioning person, the empirical evidence for the conditions which facilitate psychological growth, and a description of the author’s struggle to reconcile the role of scientiﬁc investigator with that of therapist operating at the height of personal subjectivity. A unique, decades-long, research eﬀort in person-centered psychotherapy which supports Rogers’ description of the fully-functioning person focuses on the understanding of personality integration, which involves physiological, perceptual, cognitive, and interpersonal subsystems (Seeman 1983). Seeman has gone outside of the usual person-centered sources, drawing on the work of analysts Erik Erikson and Heinz Hartmann, and ego development specialist Jane Loevinger, among others. His conclusions are similar to Rogers, that high-functioning persons are healthier, more eﬃcient in their perception of reality, have superior environmental contact, high self-esteem, conﬁdence and trust in themselves, and possess a sense of autonomy that facilitates the development of caring and generative relationships.
Orlinsky and Howard (1978) concluded that the results of relevant studies were too variable to support the Rogerian hypothesis. But they were impressed by the evidence of 13 outcome studies of patients’ perceptions of therapist attributes such as nonpossessive warmth, positive regard, and acceptance; all 13 investigations yielded a signiﬁcant positive correlation between such perceptions and good therapeutic outcome.
Additionally, in 1978, Orlinsky and Howard reviewed 15 studies of the relationship between outcome and patients’ perceptions of their therapists as empathically understanding, and found such an association preponderantly positive, with only two or three presenting evidence to the contrary. Fourteen of 20 investigations yielded a signiﬁcant positive association between therapist self-congruence and outcome, with six showing null and marginally mixed results. Nine of 10 studies focusing on the ‘process’ or ‘experiencing’ levels conceptualized by Rogers in 1957 found signiﬁcant positive correlations between experiencing and good therapeutic outcome.
Orlinsky and Howard (1986) came to these conclusions about the relation of outcome in psychotherapy to aspects of therapeutic process which bear upon the conditions oﬀered by person-centered therapists. (a) Role-investment, empathic resonance, mutual aﬃrmation, and the overall quality of the relationship were consistently related to patient outcome in 50–80 percent of the large number of ﬁndings surveyed in this area. (b) Therapist genuineness, particularly as perceived by patients, was often but not consistently associated with better outcomes. (c) Patients’ perceptions of therapist empathy were very consistently related to good outcome. (d) Therapists’ warmth or acceptance toward their patients, especially but not only as observed by patients, was quite consistently related to good outcome in therapy.
Lambert et al. (1986), analyzing scores of studies on therapy outcome, concluded that therapist personal factors such as trust, warmth, acceptance, and wisdom were crucial ingredients, even in the more technical therapies. Similar conclusions were reached by Patterson (1984) and more recently in an examination of psychotherapy outcome research studies by Bozarth (1998) with these conclusions: successful psychotherapy depends primarily on the therapist–client relationship and the client’s internal and external resources; the type of therapy is largely unrelated to outcome; the training and experience of therapists are irrelevant to successful therapy; clients who receive therapy improve more than those who do not; the evidence is weak that there are speciﬁc treatments for particular disabilities; empathy, genuineness, and unconditional positive regard are the relationship variables that correlate most consistently with eﬀective therapy.
Watson (1984), following a careful review of the relevant research, concludes that because of methodological inadequacies, there is insuﬃcient evidence either to support or refute the eﬀectiveness of the ‘necessary and suﬃcient conditions.’
6. Concluding Comments
Person-centered psychotherapy has been evaluated assiduously, internally and externally, since its formulation by Carl Rogers in 1940. Its concepts and methods continue to be controversial in a ﬁeld that is dominated by orientations that advocate guidance by experts. Its uniqueness in the depth of belief in the self-directive capacity of individuals and groups assures its future as a vital alternative. It continues to thrive internationally as part of a broader person-centered approach with implications for group process, education, and conﬂict resolution. Contributing to the health of the movement is the diversity of interpretation and implementation of Rogerian principles; it includes ‘purists’ and those who believe that a directive dimension is sometimes required. Diﬀerent organizations and conferences aﬀord the opportunity to explore these diﬀerences.
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