Psychotherapy Bulletin

Psychotherapy Bulletin

I was recently asked to be part of panel of psychotherapists who use the theories of Carl Rogers in their practice. I had to take a few minutes to really think about it. Am I a person-centered therapist? Upon reflection, I realized that some of the best ways I am a therapist, I am a person-centered therapist.

The Rogers’ quote, “the curious paradox is that when I accept myself as I am, then I change” (1961, p. 17) was one that resonated with me when I took my first counseling skills class as an undergraduate. It is a statement that continues to echo in my mind these many years later.  Specifically, I feel person-centered theory defines my overall therapeutic approach, provides aspiration and an ethical boundary around the potential to impose my own values on clients, and provides an underlying framework for developing the working alliance.

As an approach or attitude, the Rogerian concepts of being genuine, having a positive regard for and seeing clients as having basic goodness and an internal capacity for self-growth, guides my encounters with clients. To me, being genuine means finding the balance between being a professional and being just another human being. That might mean admitting mistakes when I make them (which I do) and not hiding behind a rigid therapeutic stance. This is similar to the notion of the “Real” relationship as described by Gelso (2009)—the genuine, non-transferential relationship between two people. Rogers discussed genuineness as the ability to be aware of one’s own feelings and not present a façade. He further described genuineness as the willingness to express and behave in ways consistent with the various feelings and attitudes that one is actually experiencing.

At the best of times, I feel I am able to achieve this by sharing my reactions of caring to client expressions of loneliness, delight in their accomplishments, and sadness when things are not working out well. Feelings and reactions are not always positive, and yet at times it seems genuine or “real” to share them. Although sometimes difficult, this sharing invariably leads to a deeper exploration of the relationship and underlying client issues.

In addition to seeking to be authentic or genuine, I also work toward nurturing within myself a strong sense of positive regard toward clients. To me, having positive regard means seeing clients as much more than their symptoms or their current struggles. It means seeing each person as having intrinsic value and the capacity for self-growth. With some clients this is easy. Their struggles and personalities are comfortable to connect with.   This can be more difficult with other clients who engage in activities that seem unfair or hurt others, or those who push me and others in their life away through their anger and bitterness. With these clients, I remind myself that they have a backstory that led them to where they are now. Ultimately, I believe that each person has a basic goodness; if I can see that good behind the façade, behind the defensiveness and pain, then maybe the person can begin to see that good as well.   This helps me maintain compassion and empathy for clients, even the difficult ones.

Rogers talked about seeing each client as having value and being prized as a person of “unconditional self worth” regardless of condition, behavior, or feelings. Believing this translates into recognizing that what is important and of value to me may be different from what is important and of value to the client. No matter how much I may want a client to change, I know that the client must progress at a pace that works for that individual. Clients have the ultimate choice to live their lives in the way that works for them. This may mean staying in a relationship that seems unhealthy or deciding to not take a risk that might be beneficial. As disappointing as this may be for me at times, it is the client’s choice, not mine.

One of the more straightforward ways that person-centered theory is manifest in my work with clients is in the development and maintenance of a good working alliance. It is easy to see how the person-centered attitudes of warmth and non-judgmental, positive regard facilitate the emotional bond. Agreement on tasks and goals draws on the importance of being able to flexibly match my therapeutic style and approach to clients based on their preferences. Allowing the client’s needs and wants to direct therapy, versus therapy being directed by me, is a way of reaching agreement with the client on tasks and goals.

One area of person-centered theory that is somewhat controversial, at least in how Rogers has been interpreted over the years, relates to the use of specific techniques. If one is truly person-centered and the client wants or needs specific strategies or skills to manage, for example, panic attacks, can the therapist provide those strategies or skills and still be “person-centered”? Yes, of course they can! By doing this within the framework of being person-centered, the therapist is able to maintain a good working alliance and stay attuned to the client’s experience. The combination can be powerful!

In my clinical work, I feel I can honor the client’s expressed needs in a person centered way by responding to requests for finding new ways of thinking about things or wanting to know how to “be” different. It seems that not using some of these interventions for clients who are desperately wanting help would be un-person centered. Let me give an example.

Jackie (not real name) came to me suffering from debilitating anxiety that was making her life unbearable. She was married to a man she loved, was working at a profession that she liked, and had a one–year-old daughter she adored. Yet she would find herself obsessing about how clean the house was, worrying constantly about getting the laundry done, and worrying something terrible would happen if her daughter didn’t get her nap “on time.”

How did I use a person-centered approach with Jackie? First and foremost I was non-judgmental of her and more specifically of her behavior, which seemed to counter her own strong self criticalness and foster self acceptance of where she was at this moment of her life. We explored the level of suffering she was experiencing as a result of her anxiety. I presented strategies as things that have “sometimes helped others” but also encouraged her to tell me what would “fit” for her. She chose progressive relaxation and mindfulness as two of the offered techniques she wanted to practice.

She wanted to know where her anxieties originated, so we also explored her history. She grew up in the house of an alcoholic parent and, as the oldest, felt she had to protect her younger siblings. As we empathized with and began to understand her inner (overwhelmed) 7 year old together, it became clear why she so desperately tried to have some control in her life and was frightened if she wasn’t able to make it happen.

Jackie was the type of client who wanted to “do” something in between session.  This taps into the client’s own healing potential and reinforces the idea that the client has the ability to choose what will be most helpful. Jackie wrote a letter to her mother about how her drinking had affected her. She increasingly practiced being more in the moment with her daughter; this in itself became reinforcing, especially as I encouraged her to stay with and savor those special moments. She also set up tasks for herself around not cleaning her house as much, purposefully changing her routines to be more flexible. Jackie valued her life with her family and wanted to be free of the anxieties that kept her apart from them. To do that, she needed to accept all that she was, to acknowledge what was most important to her, and to have some basic tools she could practice that would open up her experience to “be” in a different way.

There are times when a person-centered style seems particularly effective. As the developers of Motivational Interviewing discovered, a person-centered approach is helpful when first starting a therapeutic relationship with the client (Hettema, Steele, & Miller, 2005). How better to develop trust and motivate than to demonstrate a deep understanding of the client through active listening and showing sincere interest in the client’s world? Motivational Interviewing also is person-centered in the focus on meeting the client wherever the client is—if ambivalent, reflect and explore that ambivalence; if frightened of change, meet the client there.

The person-centered approach is also beneficial when dealing with difficult client emotions. Shame stands out in my mind as one of the client experiences that can only be met with non-judgment and quiet acceptance. It is the offering of facilitative conditions that provides an environment where clients can finally open up to those debilitating feelings of shame, accept them, and let them go.

As explored in a previous Bulletin article (Vivino & Thompson, 2013) the person-centered approach blends well with the current influx of Eastern thought into mainstream psychotherapy such as mindfulness. The definitions of mindfulness such as “awareness of present experience with acceptance” (Germer, 2005, p. 7) seem very close to what Rogers described when talking about the fully functioning person as having an “increasing openness to experience” (Rogers, 1961, p. 187) and “an increasing tendency to live fully in each moment” (p. 188).

The concept of mindfulness is part of other therapy approaches I have integrated into my own, such as Linehan’s Dialectal Behavioral Therapy (1993) and Hayes’ Acceptance and Commitment Therapy (Luoma, Hayes,& Walser, 2007). These theories build on the basic foundation of person-centered therapy—accepting the client non-judgmentally and promoting here and now experiencing. For example, Dialectical Behavioral Therapy (Linehan, 1993) focuses on the importance of the therapist accepting clients’ experiences and validating their emotional pain and suffering.   Two of the Core therapeutic processes of Acceptance and Commitment Therapy are Acceptance of private events and Being Present or “promoting ongoing, nonjudgmental contact with psychological and environmental events as they occur” to promote “present moment awareness” (Luoma, Hayes, Walser, 2007, p.19).

Thanks to the work by Neff (2011), Germer (2008), and others, another “new” concept being integrated into mainstream psychotherapy that I find helpful and aligned with a person-centered approach is Self Compassion. Self-Compassion consists of three components: Self kindness (being understanding towards ourselves without self-criticism), Common humanity (recognizing we are all a part of a shared human experience), and Mindfulness (being non-judgmental) (Neff 2011).

Positive regard, empathy, and acceptance by the therapist provide the environment for clients to begin to approach themselves similarly, with positive regard, empathy, and acceptance. This seems very consistent with what Neff (2011) describes as having Self Compassion. I have also found that practicing Self Compassion helps me be more facilitative and genuine.

There are aspects of my practice that do not seem so person-centered or Rogerian. I do conduct an intake and diagnose—an inevitable byproduct of taking insurance. I believe that my intakes do help me better understand my clients and their worlds, despite my leading (yet open-ended) questions. And while I need to ask some questions about symptoms, I ask as many or more about client strengths and resources.

As I mentioned earlier, I do utilize psychoeducation and share strategies and skills with my clients when appropriate. I believe this can be done in a person-centered way—e.g., in response to specific things the client has asked for and by exploring the client’s experience of practicing the skills. Although I aspire to this, I am not always able to be as non-judgmental as I would like, nor do I always have positive regard and genuineness with clients all the time.

In conclusion, being person-centered is how I approach or aspire to approach clients. It is in how I am with my clients. It is in what I say and in how I say it. I imagine, should you examine your own practice, you might be surprised at how basic this approach is to what you do, at your best.

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Cite This Article

Thompson, B. J., & Vivino, B. L. (2014). Am I a person-centered therapist? Psychotherapy Bulletin, 49(4), 18-21.

References

Gelso, C. J. (2009). The real relationship in a post-modern world: Theoretical and empirical explorations. Psychotherapy Research, 19, 253-264. DOI: 10.1080/10503300802389242

Germer (2009). The mindful path to self-compassion: Freeing yourself from destructive thoughts and emotions. New York, NY: The Guilford Press.

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.

Linehan, M. M. (1993). Cognitive behavioral treatment of Borderline Personality Disorder. New York, NY: Guilford Press.

Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT An acceptance and commitment therapy skills-training manual for therapists. Oakland, CA: New Harbinger Publications.

Neff, K. (2011). Self-compassion step-by-step: The proven power of being kind to yourself. New York, NY: Harper Collins.

Rogers, C. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA: Houghton Mifflin Company.

Vivino, B. L., & Thompson, B. J. (2013). Musings from the psychotherapy office: A “cool” clinical approach. Psychotherapy Bulletin, 48(4), 18-20.

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