Person Centred Therapy Evaluation

In order to evaluate the claim that Person-Centred Therapy uses the therapist all that he/she will need to deal with clients, one should look at the theoretical concepts of person-centred treatment (PCT) and its hidden philosophical influences.

The PCT technique was established throughout the 1940's and 1950's by an American psychologist Carl Rogers, now called Rogerian counselling; he proposed brand-new humanistic concepts for counselling which moved far from the doctor/patient relationship. PCT emphasises person to individual relationship between the therapist and client and concentrates on the client's perspective; through active listening the therapist attempts to comprehend the customer's presenting problem and feelings.

In PCT the client determines the direction, course, speed and length of the treatment and the therapist assists increase the client's insight and self understanding.

Rogers and Abraham Maslow, another psychologist, were the founders of the humanistic technique to psychology. "Humanistic theories of character maintain that people are inspired by the uniquely human requirement to expand their frontiers and to understand as much of their possible as possible" (Sanders 2002 p22).

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A humanistic method is based on all people having an inbuilt ability to grow and attain their full possible referred to as "actualisation". If this quality can be utilized then humans can resolve their own issues naturally, provided the ideal conditions. Rogers and Maslow thought in an individual's capacity to reach self actualisation. Maslow nevertheless referred to the 'psychology of being' which self actualisation was an end in itself at the top of the hierarchy of needs whereas Rogers thought about the 'psychology of becoming'- the process of being able to take charge of your life and become the person you desire to be - a continuous procedure.

Maslow felt that human beings are always striving for self improvement which goes beyond that of the basic needs for survival. He believed that a person’s behaviour stems from the way in which people strive to meet different needs. From 1943 to 1954 he developed the 5-level Hierarchy of Needs: * The first, lowest level, concerns a person’s physiological needs: survival, food, water and shelter. * The second addresses safety: protection from danger and need for security, order and predictability. * The third covers love & social behaviour: for love, friendship and acceptance by peers. * The fourth addresses self respect and esteem: the need for status, independence, recognition, self confidence and respect from others. * The fifth and highest level concerns self-actualisation: the need to fulfil one’s personal potential.

His theory states that each need must be met in turn starting with the lowest concerning the need for survival and only when the lower needs are met is a person able to move on to the higher needs. However if something should happen and any lower needs are no longer satisfied then a person will concentrate on regaining them before attaining the higher ones.

The lower four levels are known as ‘deficiency’ needs which a person will strive to fulfil thereby satisfying the deficiency. However behaviour relating to self actualisation is known as a ‘growth’ need, governed by the person’s inborn need to grow and realise his full potential. Maslow felt most people only ever achieved the first four needs, and he wanted to help clients to obtain ‘Self-Actualisation’ in order to really become themselves. “The higher up the hierarchy we go, the more the need becomes linked to life experience and the less ‘biological’ it becomes.” (Gross 1996 p.97) It is a fact that people achieve self actualisation in many different ways, related to experience in later life rather than biology. If a person has a deficiency in one of the lower levels of needs then self- actualisation cannot be achieved, resulting in anger, frustration, unhappiness and depression.

Rogers trusted in people and viewed them in a positive and optimistic way, believing all human beings naturally strove to achieve their potential; mental health issues arose when barriers to personal growth were present. Accordingly a person’s behaviour is down to self perception or interpretation of a situation and as no one else could know how something was perceived, the perceiver would be the best person to help themselves. PCT looks at how the client is currently interpreting and perceiving their situation, the moment to moment experience and what is being thought and felt.

Rogers viewed psychological development as the process of a person following the path of actualisation and so becoming oneself. A fully functioning person was someone on his way to self actualisation and he identified certain qualities that enabled that person to realise his potential. A person needs to have:- Openness to experience: he can accurately perceive his own feelings and experiences in the world; Existential living: he lives in the present rather than the past; Organismic trusting: know what is good for one and trust thoughts and feelings as accurate, doing what comes naturally; Experiential freedom: the feeling of freedom when making choices and taking responsibility for personal actions; Creativity: a person will naturally socialise and participate in society through work, social relationships or through the arts or sciences.

A principal element of Rogers’ theory is the concept of self, described as being a set of self perceptions and beliefs, including self awareness or image, self esteem and worth, and Ideal self. Human behaviour is driven by people attempting to maintain consistency between their self image and esteem; sometimes this consistency is not achieved and a person’s self image may differ from their actual behaviour and how it is perceived by others. A highly successful and respected person, may see themself as a complete failure: as their actual experience is not consistent with their ideal self, an incongruent condition.

People experiencing incongruent feelings, because of conflict with their self image, feel threatened and may block or deny these feelings. It is these defence mechanisms which prevent the self from growing and changing; widening the gap between reality and the self-image until the latter becomes more unrealistic when the “incongruent person” will start to feel vulnerable, confused and suffer psychological disturbances. A congruent person’s self image is flexible and changes with new experiences, the self image matches the thoughts and actions allowing for the opportunity to self-actualise.

A person’s self concept develops through childhood. Rogers believed that humans developed conditions of worth: the conditions where positive regard would be given. In order to maintain this conditional positive regard a person will suppress or deny actions and feelings which are unacceptable to people who are important, instead of using those thoughts, feelings and perceptions as a guide to behaviour. It is this denial that causes the difference between the organism and the self, the organism being everything a person does, feels and thinks, and the self being the part that is accepted liked and respected by others - positive regard.

As people have an inherent need to be loved and accepted and therefore a need for positive self regard, they behave and act in ways that meet approval so in turn think of themselves as good, lovable and worthy. In order to experience positive self regard a person’s behaviour and condition of worth must match; sometimes conditions can force one to behave and act in ways that prevent self actualisation, thus living life by someone else’s standards. This can cause conflict between experience and self concept, leading to the development of psychological disorders.

Congruence and self actualisation can only be reached if a person is functioning as a whole organism so conditions of worth need to be substituted with organismic values. Rogers maintains that the human organism has an underlying “actualising tendency” which drives a person to develop and become independent. When a person is acting under conditional positive regard which prevents realisation of full potential, these conditions need to be removed. The difference between the self and organism then becomes minimal and the person more closely aligned with his natural values: more relaxed and happy with life.

PCT aims to provide the right environment to enable the client to grow and develop, and work through any problems by utilising the ability for personal growth. Rogers believed that the therapy should take place in a supportive environment created by a close personal relationship between the client and the therapist. It allows insight into the client’s feelings and behaviour whilst the therapist’s function is to offer warmth and empathy, congruence and unconditional positive regard toward the client, accepting what is said in a non judgmental way.

Rogers felt that the most important factor in successful therapy was the therapist’s attitude. A key element of the PCT is to reflect the client’s feelings without judgement and by doing this the client will relax and express inner feelings. It also lets the client know that the therapist is listening, trying to understand, as well as clarifying what the client is communicating. Clarification arises when the therapist picks out the key points, uses the clients own words to develop an atmosphere of trust, enabling rapport to develop leading the client to feel able to appreciate current feelings and past experiences.

Rogers believed that in order to create this environment for growth and change three core conditions need to be provided for a therapeutic relationship to be formed. Empathy. The therapist must try to enter the client’s inner world and understand how the client is feeling through sensitively listening and reflecting back what the client is saying. “Carl Rogers described empathy as the ability to sense the client’s world as if it were your own without losing the “as if” quality” (Sanders 2002 p68). Congruence. This involves the therapist being “real” open to the expressed feelings and being genuine with the client. There should be no air of authority, enabling the client to feel the therapist is being honest and responding as a real person not analysing what is being said and trying to fit it to a therapeutic model.

Unconditional positive regard (UPR). The therapist must provide non judgmental warmth and acceptance of the client, regardless of past behaviour, as a worthwhile person free to explore and discuss all thoughts, feelings and behaviour positive and negative without fear of rejection or judgement. The client must not feel the need to earn positive regard; many people seek help because of disturbances caused by unreasonable harsh judgements. It is very important to ensure that experience is not repeated during therapy. If the client feels an evaluation is being undertaken, a false front may be put up or the therapy stopped altogether.

It is these three core conditions that form the foundation of the therapeutic relationship. However, Rogers also believed that fundamental to providing the right conditions for change the helper must make psychological contact with the client. “Client and therapist need to be simultaneously aware of each other before anything therapeutic can happen” (Sanders, Franklin & Wilkins 2009 p 39.) Psychological contact, the relationship between therapist and client; the client is vulnerable or anxious; and receives empathy, UPR and congruence. All of these conditions are necessary and the core conditions must be used sufficiently for helpful change. These core conditions are believed to enable to the client to grow and develop in his own way to become the desired person. PCT focuses on the client’s own thoughts and feelings, not those of the therapist and provides an environment where the client can explore personal experiences to strengthen self structure which in turn helps to reach actualisation.

The two primary goals of PCT are to increase a client’s self esteem and openness to experience. The therapy also helps to bring the clients self image and ideal self closer together and allows the client to have a better self understanding. The client’s levels of defensiveness, guilt and insecurity are lowered resulting in more positive and comfortable relationships with others and an improving ability to experience feelings and emotions when they occur. The results of studies carried out using this approach show that clients maintain stable changes over long periods of time, and that the changes are comparable with changes achieved using other types of therapy.

It is a very effective way to treat people suffering from depression or relationship issues but PCT does appear to be less effective than other humanistic therapies where the therapist offers more advice. Rogers originally developed his PCT in a children’s clinic as ‘play therapy’ and his theory has been used to help people suffering from depression, anxiety, alcohol disorders, cognitive dysfunction and personality disorders and has been proved successful when used on an individual basis as well as in group and family therapy. In the later part of his career he worked with people suffering from schizophrenia.

Although PCT is popular and does achieve a level of success, a key criticism in this approach is that the core conditions should always be provided by a good therapist before moving onto different theories and strategies to help make the client better. This criticism shows there is a degree of misunderstanding of the real problems of constantly providing UPR, empathy and congruence in the therapeutic setting, as these can clash and cause conflict. Purely being able to maintain these core conditions requires much work on the part of the therapist, given that everyone has values and beliefs which are hard to suppress and ignore, so it may be more real for the therapist to own their own values and beliefs whilst not judging others.

PCT does not require the counsellor to undergo any specific training or self development in any particular way through personal experience, other than to provide the core conditions. Rogers believed it is the relationship between the therapist and the client that brings about the therapeutic change. Further criticism, of therapists demonstrating the core conditions, is that it can lead the client to believe that the therapist is supportive of the situation and viewpoint to such an extent that the client no longer feels the need to change. This is due to the therapist offering no alternatives as there is no position of authority in the PCT to guide the client to make constructive changes.

PCT has also been criticised for its lack of structure and insufficient direction to help people in real crisis. Some therapists would argue that this type of approach is not suitable or effective for clients who are inarticulate or poorly educated, whereas other feel that this approach can be applied to anyone. Although this approach is positive is it enough to solely create a good relationship between client and therapist and provide the clients with a safe space to feel valued and supported in order for change to take place? If a client is experiencing real difficulty and is unable to see a way forward and has lost all hope then it is important for the help to come from the therapist. Clients who have experienced this type of therapy often feel that is does not provide the desired solutions they are looking for and have become bored, frustrated and annoyed with the Rogerian style.

In summary, although the person-centred approach is clearly a highly effective method of helping and is widely accepted and used by clinical psychologists today, I do not feel that it offers the therapist all that he/she needs to treat clients. I believe that no one therapy can claim an absolute success rate in treating clients, as human beings are inherently different due to differing cultural backgrounds and life experience and hence each therapist and client relationship will be unique, producing differing results. I feel that one theory that suits everyone is not the approach a good therapist should adopt. Some people may find it easy to talk about their feelings and be able to help themselves in a PCT environment whereas to another this type of approach would be completely bewildering and unproductive.

I believe PCT is an effective therapy for treating self esteem and relationship issues however it does not go nearly far enough to help those with deep rooted psychological disorders. A client in crisis may not have the ability to self-help and the nondirective approach can be unhelpful and ineffective when a client is seeking clear guidance from a counsellor. Therefore I believe it is the job of the therapist to determine which theory would help the client best to resolve their issues and be prepared to be flexible in approach. The skill set of a good therapist would have a variety of different strategies and therapeutic approaches to offer the client and although a person-centred approach is a good place to start, the therapist should be prepared to progress to more structured approaches as appropriate.