1. Client-Centered Psychotherapy
Slides created by
Barbara A. Cubic, Ph.D. Professor
Eastern Virginia Medical School
To accompany
Current Psychotherapies 10

2. Learning Objectives This presentation will focus on:
An overview of phenomenological theory.
Similarities and differences between Rogers’ self-directed growth process and other types of psychotherapy.
The impact of the establishment of a genuine, nonjudgmental, caring and empathic therapy approach.
Client-centered psychotherapy.

3. Client-Centered Therapy
Developed by Carl Rogers
Also termed:
Client-centered therapy
Humanistic therapy
Phenomenological therapy

4. Client-Centered Therapy
A congruent therapist who provides unconditional positive regard and empathy can stimulate change in a vulnerable person to become a creative, responsible, developing individual.
By providing a therapeutic atmosphere that is real, caring, and nonjudgmental, the person can develop to their full potential.

5. Kurt Goldstein Worked with brain-injured soldiers.
His holistic theory of personality emphasized that individuals must be understood as totalities striving to actualize themselves.
Basis of Rogers’ actualizing tendencies.

6. Rogers’ Basic Assumptions
Rogers believed in an actualizing tendency in all humans.
Represented movement towards the realization of the individual’s full potential.
Viewed as part of a formative tendency.

7. Rogers’s Basic Assumptions
This formative tendency:
Represented movement toward order, complexity and interrelatedness.
Can be seen across aspects of nature including the stars, crystals, microorganisms as well as humans.

8. Roger’s Theory
Can be summed up in Clyde Kluckhohn’s dictum: “Each person is in some respect like every other person, like some other persons, and in some respects like no other person.”

9. Client-Centered Therapy is Different than Other Models
Medical model of therapy views person as “patients” with problematic “parts.”
Other forms of treatment are directed by “experts.”
Client-centered approaches focus on the client’s inborn capacity for “self healing.”
Difference for the therapist is between “using” the self and “being” oneself.

10. Core Conditions for Therapy (Therapist)U S

11. Rogers’ Basic Assumptions (Therapist)
Genuineness/congruence:
Correspondence between the therapist’s thoughts and behavior.
Unconditional positive regard:
Therapist’s regard/attitude towards the patient remains unaltered regardless of the patient’s choices.
Empathy:
Profound interest and care for the patient’s perceptions and feelings.

12. Tout comprendre, c’est tout pardonner: “To understand all is to pardon all.”

13. Core Conditions for Therapy (Client)U S

14. Rogers’ Basic Assumptions (Client)
Self-concept
At therapy onset, self-esteem often low.
Improvements correlated with therapy.
Locus-of-Evaluation
Pre-therapy focus on other’s opinions.
Progress associated with internal locus-of-evaluation.
Experiencing
At therapy onset, rigid.
Success related to flexibility.

15. Comparing Client-Centered Therapy with Other Approaches

16. Six Basic Premises of Humanistic Psychology
Holistic approach most adequate.
Human’s subjectivity critically important.
Psychotherapy is based on a good relationship.
Hereditary, environment and creative power are crucial forces.
Anthropomorphic model preferred.
Purpose is the decisive dynamic.

17. Distinctive Components of Client-Centered Therapy
Therapist’s attitudes can be necessary and sufficient conditions for change.
Therapist needs to be immediately present and accessible to clients.
Intensive, continuous focus on client’s phenomenological world.
Process marked by client’s ability to live fully in the moment.
Focus on personality change, not structure of personality.

18. Distinctive Components of Client-Centered Therapy
Need for continuing research on psychotherapy.
Same principles of psychotherapy apply to all people, regardless of problem.
Psychotherapy is a specialized example of constructive interpersonal relationships.
Theoretical formulations built on experience.
Concern with the philosophical issues derived from psychotherapy.

19. Client-Centered Therapy vs. Psychoanalysis
Rogers
Psychoanalysis
Language
Common sense
Esoteric
How to Understand the Individual
Subjective
Interpersonal
Objective
Intrapersonal
Emphasis
Purpose
Causality
Characterization of the Individual
Holistic
Reductionistic

20. Client-Centered Therapy vs. Psychoanalysis
Rogers
Psychoanalysis
View of Human Nature
People can be good or bad
People are bad
Role of Therapist
Facilitate patient’s self discovery
Interpretation for the patient
View of Transference
Not central to the patient’s ability to change
Inevitable, fundamental to change
Presentation of the Therapist
A caring person willing to listen
Authority, teacher

21. Client-Centered Therapy vs. Behavioral Therapy
Behavior changes
through internal
factors.
Behavioral
Behavior changes
through external
factors.

22. Comparison of Client-Centered Therapy with Other Approaches
High U s e Of E m p a t h y
Client-Centered
Psychoanalysis, Eclectic,
REBT, Jungian
Low

23. Client-Centered vs. REBT
Rogers Deemed Equivalent to
Ellis on Self-Confidence and
Higher on
Rogers Deemed Low on
Therapist Directed

24. Client-Centered vs. REBT
Ellis Deemed Equivalent to
Rogers on Self-Confidence and
Higher on
Ellis Deemed Low on
Unconditional Positive Regard

25. Client-Centered (CC) vs. REBT
Differences
Similarities
CC greatly values therapy relationship.
Optimism in people’s ability to change.
CC client-directed.
Perception that individuals are often overly self critical.
CC accepting of patient’s perceptions.
Willingness to put forth great effort to help people.
In CC, client chooses actions.
Willingness to demonstrate their methods publicly.
CC therapist relates to patient at the feeling level.
Respect for science and research.

26. History of Client-Centered Therapy

27. Influences on Rogers “From Whom “I first got the notion of
responding almost entirely
to the feelings being expressed
… later called the reflection
of feeling” Rogers

28. Rogers’ Life Jan. 8, 1902 — Born in Oak Park, Illinois.
Family emphasized strong work ethic, responsibility and the fundamentals of religion.
1924 — Graduated from Univ. of Wisconsin.

29. Rogers’ Life
Started at the Union Theological Seminary then transferred to Teacher’s College, Columbia University.
Worked for 12 years at a Child-Guidance Center.
1939 — Clinical Treatment of the Problem Child published.
Offered professorship at Ohio State University.

30. Rogers’ Life
Dec. 11, 1940 — Rogers presents “Some Newer Concepts in Psychotherapy” at the Univ. of Minnesota (viewed by most as the birth of Client-Centered Therapy).
1942 — Counseling and Psychotherapy published.
During WWII, served as Director of Counseling Services for the US Organizations.

31. Rogers’ Life
Served as head of University of Chicago Counseling Center (12 years).
1957 — Rogers published classic paper on “necessary and sufficient conditions” for therapy.
Feb. 4, 1987 — Carl Rogers died.

32. Current Status of Client-Centered Psychotherapy
Special interest of Rogers was application of his theory to international relationships.
Since 1982, Biennial International Forums on Client-Centered Approach.
Workshops annually at Warm Springs, GA.

33. Current Status of Client-Centered Psychotherapy
Person-Centered Review began in 1986 (renamed The Person-Centered Journal in 1992).
World Association for Person-Centered and Experiential Psychotherapy and Counseling (WAPCEPC) founded in 2000.

34. Rogers’ Theory of Personality 19 Basic Propositions
Individual center of a changing world of experience.
Organism reacts based on their reality.
Organism reacts as a whole.
Organism has one basic tendency-actualization.
Behavior is goal-directed based on perception of reality.

35. Rogers’ Theory of Personality 19 Basic Propositions
Emotion accompanies and facilitates goal-directed behavior.
Best point to understand behavior is from the individual’s frame of reference.
Part of the perceptual field is differentiated as the self.

36. Rogers’ Theory of Personality 19 Basic Propositions
Self is formed through interaction.
Values come from experience and introjection from others.
Experiences are integrated, ignored or denied.
Behavior is generally consistent with self concept.

37. Rogers’ Theory of Personality 19 Basic Propositions
Behaviors inconsistent with self concept can occur but are seen as “not owned.”
Psychological maladjustment comes from denied experiences.
Psychological adjustment occurs when experiences are assimilated.

38. Rogers’ Theory of Personality 19 Basic Propositions
Inconsistent experiences are threats.
Under the right conditions, inconsistent experiences can be examined and assimilated.
Integrating experiences allows more understanding of others.
Integration leads to development of internal locus-of-evaluation.

39. Rogers’ Theory of Personality Summarized
Behavior is best understood through the individual’s reality (perception of experiences).
Personal growth occurs through decreased defensiveness.
Self actualization is the organism’s one, basic tendency.

40. Rogers’ Theory of Personality Summarized
Experiences inconsistent with self concept are threats leading to increased rigidity.
Therapy allows the individual to accept and integrate all of their experiences.

41. Rogers’ Theory of Personality Other Concepts
Experience
Reality
Self
Private world of the individual
Basically refers to the private
perceptions of the individual;
Social reality consists of perceptions
that have a high degree of
commonality among individuals
Organized gestalt of “I” or ‘me”

42. Rogers’ Theory of Personality Other Concepts
Symbolization
Organismic
Valuing Process
Fully Functioning
Person
Process by which an individual becomes aware of experiences
Ongoing process in which
individuals freely rely on the
evidence of their own senses
for making value judgments
An individual who relies on
the organismic valuing
process

43. Self-Determination Theory (SDT)
Developed by Deci and Ryan.
Theory focuses on intrinsic motivation.
Theory has lead to several empirical investigations of the concept.

44. Bottom Line Congruence = psychological adjustment
Lack of Congruence = psychological maladjustment

45. The Psychotherapy Process

46. Rogerian View of Psychotherapy
Basic theory is simple.
If the therapist conveys genuineness, unconditioned positive regard, and empathy, the client will make positive changes.

47. Implied Therapeutic Conditions
Client/therapist must be in psychological contact.
Client must be experiencing distress.
Client must be willing to receive conditions offered by therapist.

48. Process of Client-Centered Psychotherapy
Therapy at first contact.
Respect shown immediately to the client.
Therapy’s length determined by client.
Quick suggestions and reassurances are avoided.

49. Contrasting Client-Centered Therapy with Other Models
The traditional view is one of an uncovering of hidden or denied feelings or experiences:
Question is how these hidden experiences exist and how are they resolved.
Listening to client’s narratives are thought to be the avenue for helping the client deal with these internal conflicts.

50. Contrasting Client-Centered Therapy with Other Models
Or Zimring’s view (an example of a client-centered theorist) asserts a person becomes a person through interactions that occur within a cultural context.
Individuals born within a Western culture have a “buried conflict” as part of a cultural legacy.

51. Zimring’s View
Our phenomenological frame of references is always changing
“Under construction” resulting in a dynamic concept of the self.
Experience is seen as coming from the context in which we are in that moment.
Implies two different types of inner conflicts:
Objective: Stressed in Western culture
Subjective: Has little real world value

52. Process of Client-Centered Psychotherapy
Moment of Movement
“It is not a thinking about something, it is an experience of something … an experiencing without barriers … experience which has been repeated many times in the past but which has never been completely experienced … The experience has the quality of being acceptable.”
Rogers

53. Therapy is based on client’s rights.
Bottom Line
Therapy is based on client’s rights.

54. Client-Centered Therapy
Applications of
Client-Centered Therapy

55. Client-centered therapy is person-focused, not problem-focused
Client-centered therapy is person-focused, not problem-focused. Subsequently, each client is treated as unique

56. Creative Applications of Rogers’ Ideas
Play therapy
Client-centered group processes
Classroom teaching
Intensive groups
Conflict resolution
Individual level
International level

57. Regarding Evidence
Client-centered therapists oppose “therapist-centric” models
Imply causality moves in a linear fashion from
Treatment Disorder Outcome

58. Dodo Bird Effect
Dodo Bird Effect: Conclusion drawn from meta-analyses and large scale studies that all major psychotherapies yield comparable effect sizes.
The Dodo Bird Effect supports the concept that common factors (such as those espoused by Rogers) account for changes seen in therapy.

59. Bozarth’s (1998) Summarization of Research on Psychotherapy
Effective psychotherapy predicated on:
Relationship between therapist and client.
Inner and external resources of the client.
Type of therapy, technique, training and experience of therapist largely irrelevant.
Clients who receive psychotherapy improve more than those who do not.
Little support that specific treatments are best for particular issues.
Empathy, genuineness and positive regard (unconditional) consistently important.

60. Orlinsky, Grawe & Parks (1994)
Summarized findings from 76 studies.
Focus was on relationship between positive regard/therapist affirmation and outcome.
56% of findings showed positive relationship (65% when patient ratings were used).

61. Lambert (1992)
Conducted a meta-analytical review, which estimated that treatment outcome variance is related as follows:
30% therapeutic factors
15% techniques
15% placebo
40% client variables

62. Elliot (2002)
Meta-analysis concluded patients who received client-centered therapy show changes that are:
Significant
Maintained at follow-ups
Both < and > 12 months
Substantially greater than those seen in untreated “controls”
Equivalent to other forms of therapy, including CBT

63. Client-Centered Therapy in a Multicultural World
Each person is unique and belongs to multiple groups.
Within-group differences exceed between-group differences.
Therefore, no need for cultural-specific therapies.
Each individual treated as a unique client.