Evaluate the claim that Person Centred Therapy offers the therapist all that he/she will need to treat clients

This essay will evaluate the claim that Person- Centred Therapy (PCT) offers the therapist all that he or she will need to treat clients. I will define PCT, its origins and the theoretical constructs and philosophical influences that set it apart from other psychological theories, as well as explore how its founder viewed personality development, and psychological disorders. I will then weigh up the strengths and weaknesses of PCT, drawing upon criticisms by other writers, in order to conclude whether or not it can be used as a stand-alone tool for all clients.

Person-Centred Therapy is also know as Client-Centred Therapy, or the Rogerian approach after its founder, Carl Rogers (1902 – 1987), who was an influential American psychologist and one of the founders of humanistic psychology. Developed in the 1950s, PCT is a non-directive form of psychotherapy within the humanistic approach, which is itself often referred to as the third force of psychology – the first two being psychoanalysis and behaviourism. In addition to humanistic philosophy, Rogers was influenced by existentialism, or free will, and phenomenology, or human judgement and emotion.

Self-actualisation: Person Centred Therapy centres around the belief that human beings have one basic tendency, and that is to “actualize, maintain and enhance” (Rogers, 1951, p487). Person-Centred Therapy is therefore based on this assumption, that people are inherently good and that they strive to develop to their fullest potential given the opportunity to do so. As a result, Rogers believes that it is the subjective experience of the client that is important – they are the only person that truly knows how they feel, and how, and indeed who, they want to be. He used the term self-actualised to describe a fully functioning person, someone in a state of congruence. That is to say that how they view themselves, is in harmony with how they would like to be.

Self Concept: Rogers viewed personality development as the on-going effect that external influences such as our parents, have upon our self-concept. He described the self-concept in three components. Self image, self-worth, and the ideal self. That is, how you view yourself, how much you value yourself, and how you think you should be. These can all be affected by the way we compare ourselves to others, how others react to us and our ability to identify with people. Our social roles will also play a major part in our self-concept. When our self-image is aligned with our ideal self, we are in a state of congruence.

Organismic Valuing Process: Humans are social beings and from a young age, we want to be accepted for who we are. Babies instinctively demand what they need in order to survive; however as our personality develops, our parents, friends and teachers shape our self-concept, leading many people to believe, for example, that they will only be loved if they are well behaved, successful or attractive. The client who has existed under the constant scrutiny of others will develop distrust in their organismic valuing process, and it is the role of the Person-Centred Therapist to encourage the client to realise and engage their innate ability to self-heal this process.

Conditions of Worth: The conditions of worth are these conditions and behaviours that we impose upon ourselves, or have imposed upon us, in order to receive the acceptance, praise or feeling of self-worth that closely match our ideal-self. Conditions of worth are not a bad thing, but when they are inflicted or abused, they become a problem in the development of personality and the self-concept. Gradually, these conditions, for better or worse, shape the overall way we view the world around us. Low self worth can lead to anxiety, depression, frustration, anger and other anti-social behaviours.

Locus of Evaluation: When a person has learnt to adapt to continued criticism or judgement, they lose the ability to rely upon their organismic valuing process and may find making decisions drawn out and emotional. They may rely on others to make decisions for them, or go round in circles searching for an outcome to please all significant others. Fully functioning people on the other hand are able to trust their internal process of decision making, which Rogers called the locus of evaluation. One particular break through in PCT can be when the client first identifies their ability to differentiate between the internal and external influences in their lives (Mearns et al, 2013, P12).

Rogers describes first hand experience of this during his own upbringing:
“In major ways I for the first time emancipated myself from the religious thinking of my parents, and realised that I could not go along with them. This independence of thought caused great pain and stress in our relation¬ship, but looking back on it I believe that here, more than at any other time, I became an independent person.” (Rogers, 1961, p7)

Core Conditions: Rogers viewed psychological disorders as the result of the adverse effects of these external influences. It is his opinion that psychological wellbeing is therefore governed by the individual person, and not the delivery of professional psychiatric expertise or medical intervention. The critiques discussed later in the essay consider the extent to which this approach may treat such disorders, using the following six sufficient and necessary conditions which Rogers identified to enable therapeutic change.

1. The first condition is that a therapeutic relationship must exist. Rogers rejected the idea that a therapist must be an expert in a client’s presentation, or that the therapist should diagnose the client in any way. In fact, to the contrary, he found that many clients had come to seek therapy having lost their own self-worth amidst the opinion of the many so-called ‘experts’ in their lives; their parents, friends, partners etc. In order to set the conditions for a mutual and positive relationship therefore, Rogers refers to ‘clients’ where psychoanalysts and behaviourist see ‘patients’. This first condition simply describes the psychological contact between therapist and client, without which, the remaining conditions could not exist. 2. The second condition states that it is necessary for the client to be in a state of incongruence. This means that there is a conflict between the client’s self image and their ideal self. If the client is aware of this conflict, they may experience feelings of anxiety or vulnerability. If they are not aware, then they are susceptible to developing such feelings.

3. In contrast, the therapist must be congruent in order to meet the third sufficient and necessary condition. As mentioned above, the Person-Centred Therapist does not pose as an expert, and does not pretend to know what it best for the client. The therapist is present, whole and themselves, demonstrating “that it is not only permissible but desirable to be oneself“ (Mearns et al, 2013, p13). A key assumption of PCT is that every human being is capable of recognising their own path to recovery, and can be trusted to answer their own questions, providing the therapist sets the right conditions for this change to occur. This strengthens the case for the therapist to be congruent, rather than acting as an expert. With this third condition present, the client is more likely to seek these answers from within, without anticipating assistance from the therapist.

4. To further demonstrate to the client that they have the ability and permission to be themselves and reach their potential, the therapist must show unconditional positive regard for them, which means accepting the client irrespectively and without judgement. Rogers believed that the client would therefore feel more comfortable exploring negative emotions, and better equipped in being authentic in the therapeutic relationship, without the fear of being rejected. This can result in the clients first encounter of feeling accepted for who they are.

5. The fifth condition for therapeutic change is that the therapist must convey empathy, a genuine desire to understand how the client is feeling and the ability to communicate this understanding to them. Again, to have their feelings recognised, and sensitively and accurately echoed back to them in this way, can be a new experience for the client, and hopefully one that offers them a feeling of being valued.
6. Finally, for therapeutic change to occur, the client must perceive this empathy and lack of judgment. If the client is not able to sense the therapist’s genuine understanding and acceptance, then they cannot begin to shift. As discussed later on, clients with deep psychological damage may have difficulty in recognising or accepting empathy, whilst for others, it is the breakthrough that opens them up to the possibility of believing in themselves once again.

Strengths: Rogers insisted that these six conditions were not only necessary, but all that are sufficient for success, and three of them (congruence, unconditional positive regard and empathy) have become known as the core conditions. However, his view has been widely critiqued by those in the medical and psychiatric professions who felt their expertise were being heavily dismissed. To the other schools of psychology, the idea that the clients knows best, and has the ability to solve his own problems, lacks scientific validity. It has been condemned for being unstructured and using no specific techniques other than simply parroting what the client says. The likes of Kovel (1976, p116) and Eysenck, (2009, p27) argued that PCT works for the ‘worried well’ where the therapist does not have to delve too deep, but is not sufficient to treat severe mental disorders. It may not therefore be sufficient to treat schizophrenia, obsession related illnesses or clients who have suffered abuse or trauma. It is important to note however that Rogers never claimed that his approach worked with more severe illnesses. He acknowledged that the more seriously ill the client, the less likely he or she was able to accept the empathy of the therapist, which is necessary for therapeutic change. Kirtner and Cartwright (1958), whilst supporters and indeed colleagues of Rogers, backed up these critiques, with the discovery that PCT is very effective for clients with higher experiencing levels who seemed to know what to do intrinsically, whereby others needed additional skills. In the same vain, PCT would not be suited to the client who is seeking advice, a diagnosis, quick treatment, or looking to the therapist to provide the answers.

In criticism to the core conditions of PCT, Masson highlights the conflict that he argues would arise in order for the therapist to remain both congruent and show unconditional positive regard when faced with, in his words “a brutal rapist who murders children.” (1992, p234) In other words, how can the therapist be genuine and open with this client, but also offer them acceptance. Whilst this would highlight a limitation of the therapist, and not Rogers’ theory itself, it does nonetheless highlight a possible weakness in the actual practice PCT.
In other criticisms, it is argued that PCT ignores biological explanations of mental illnesses, and is overly optimistic, fitting only the feeling of the time in America. With it roots firmly originating from the Judaeo-Christian, American philosophy that personal growth and the individual reside over society or collective responsibility, it has been claimed that PCT does not take into account other, non-Western cultures and social values. In addition, Van Belle argues that empathy and acceptance are not sufficient to generate self worth, May states that PCT does not sufficiently deal with negative client emotions and Masson “dismisses the whole therapeutic enterprise as grotesquely inauthentic and inevitably manipulative.” (Thorne, 2103, p88)

Weaknesses: Interestingly Rogers himself agreed that limitations within any approach, including those of PCT, should be adapted in favour of practices that prove successful. (Goldfried, 2007) However he rejected claims that his theory was ineffective. Whilst psychodynamic therapists focus only on the past, PCT allows the client to take responsibility for their present, and achieve personal growth towards become a fully functioning person.
PCT does not demand an expert knowledge of a patients presentation and nor does it require a diagnosis. In Rogers’ search to explain the need for timely and in-depth diagnoses, he concluded that it may even be a “protective alternative to the admission that it is, for the most part, a colossal waste of time. There is only one useful purpose I have been able to observe which relates to psychotherapy. Some therapists cannot feel secure in the relationship with the client unless they possess such diagnostic knowledge.” Furthermore, receiving a diagnosis may even be shown to have a negative effect on a client, who then feels labeled and treated like an object, adding to their feelings of worthlessness (Lynch, 2005, p137).

The Person-Centred Therapist appreciates that the client is the best expert on his or her own life, and allows the client to go at their own speed, deciding which areas of their life need the most attention. The therapist seeks to empower the client, by listening to them and helping them believe in themselves. The client then feels they can express themselves honestly when they have no fear of being judged. This focus on a solution, rather than an upheaval of the past, is a key strength of PCT. Such therapeutic change continues long after the psychological contact itself, as the client has not merely arrived at a quick fix, but rather, lasting self-development (Bohart and Tallman, 1999). Research has now demonstrated the positive impact of the client-therapist relationship (Seligman, 2006). Figures reveal that PCT is indeed effective, and at least as effective as other therapies (Wilkins, 2009, p299). The core components of PCT are also now acknowledged by other schools of psychology, who accept that soft skills such as listening, reflecting and paraphrasing are useful when working with clients. In later life, Rogers realised that his approach could apply to all human relationships, and his ideas permeated into areas such as education, conflict resolution and family relationships, which is as relevant in today’s society as ever.

Summary: Person-Centred Therapy, developed by Carl Rogers, uses the approach that, given the necessary and sufficient conditions for therapeutic change, people can be trusted and autonomous to recognise their own self worth, and change their lives in a positive way. This approach has generated much debate due to its seemingly simplistic set of conditions, and lack of any further techniques or scientific expertise. However, a lot of this criticism may be the result of misunderstanding. Despite the absence of techniques, the importance in PCT is placed upon the relationship between the therapist and the client. It stands therefore that there is a professional obligation upon the therapist to ensure their own congruence and self development. Indeed, there are limitations to the approach in terms of the seriousness of mental illness that it can benefit, and Rogers does not deny this. What he does emphasize however is that while Freud’s psychoanalysis focuses on treating illness, PCT is about inspiring wellness.

However, the Rogerian approach is as relevant today as it was in the mid-20th century, and its philosophical roots in the ability of humans to grow and reach their potential make it an extremely popular, easily accessible and highly successful form of therapy for many.
It is evident that whilst many writers accept the necessity of Rogers’ six conditions for therapeutic change, many would question their sufficiency and I would agree with this notion. There are both merits and limitations to both PCT, as well the many criticisms of the approach, and while their fundamental principles may differ, they have all played a key part in the development of modern practice, and so an integrative approach is preferable. Therefore it is in my opinion, that whilst Person-Centred Therapy can offer the therapist most of what they need to treat the majority of clients, it cannot be used in isolation, to treat all clients in all situations.

Word count: 2456 excluding references

References

Bohart, A. and Tallman, K. (1999) How clients make therapy work. Washington DC: American Psychological Association. Accessed March 16 2015 on www.scribd.com/doc/14763851
Eysenck, M. (2009) Fundamentals in Psychology. Hove: Psychology Press.
Goldfried, M. (2007) What has psychotherapy inherited from Carl Rogers? Retrieved March 16 2015 from www.choixdecarriere.com/pdf/5671/56-2010.pdf
Kirtner, W and Cartwright, D. (1958) Success and failure in client-centred therapy as a function of initial in-therapy behaviour. Journal of Consulting Psychology 22, 329-333
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Rogers, C. (1961) On Becoming a Person. Houghton: Mifflin.
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Thorne, B. (2013) Carl Rogers. London: Sage.
Wilkins, P. (2009) Person Centred Therapy 100 Key Points. Hove: Routledge.