Abstract
This essay explores person-centred therapy, particularly focusing on its founder, Carl Rogers. His theory of constructive personality change, as a result of the psychotherapeutic process is thoroughly examined. Rogers argued that it is about the therapist’s qualities, his level of genuineness, warmness, empathy, as well as his capacity for unconditional acceptance of his clients that determine, according his ability to heal. The person-centred counsellor works in a non-directive and respectful way with his clients, believing in their inner strength and facilitating their growth. Transcripts from the author’s personal practice give an example of working in a person-centred way and demonstrate the facilitating role of supervision and personal towards the counsellor’s development. A reflection on the author’s limitations and difficulties related to his clinical practice is concludes that practicing person-centred therapy is particularly difficult, as it demands the counsellor’s will to explore his own insecurities and blind sides. A critique of Rogers’ ideas, based mostly on existential theorists, like May and Spinelli, reveals some possible blind sides on Rogers’ theory: his difficulty to explore the evil side of human nature, as well as his rush to accept the client and his choice to consider any form of sub-conscious mechanisms. Finally, a connection between Rogers’ ideas and the concept of health is made. It is presented how Rogers mistrusted the process of diagnosing and avoided treating the person as a patient who needs advice, believing instead on his inner capacity to heal. Also, it is argued how he desired to avoid using his expertise or authority, as many doctors do, in order to guide, preferring to inspire the person by being empathetic and accepting.
Rogers, person-centred therapy, health, limitations
Introduction
This essay will examine the person-centred approach to counselling. On the first section, Rogers’ theory of psychotherapy will be presented, focusing on the three core conditions for personality change, as well what qualities are considered important for the person-centred counsellor. The second section will discuss my own practice and its development, using verbatim material extracted from my work with a client, followed by some thoughts on my limitations as a counsellor. The third section will include a critique on Rogers, based mostly on accusations made by existential psychotherapists and theorists. The fourth section will explore person-centred approach within the health context, analysing its relevance to issues like power, self-healing and diagnosis.
Constructive Personality Change in Person-Centred Therapy
Mearns and Thorne (2000) describe the process of person-centred therapy and argue that it is the therapist’s qualities and not his techniques and skills that allow for a trustful relationship to occur. The value of a trustful relationship towards personality change is highlighted by Rogers himself (Rogers, 1961).
Rogers (1961) identifies three conditions as necessary and sufficient for constructive personality change to occur. In order for the person to change, he needs to be involved in an intimate and trustful relationship with a person who is not going to judge him for any reason, but is going to accept him with no conditions (unconditional positive regard), who is going to be empathetic of his feelings and able to communicate that (empathy), a person that is in touch with his own experience and feelings and is also genuine (congruence),
Rogers (1961, p.283) defines unconditional positive regard as the therapist’s quality which enables him to experience “a warm caring for the client – a caring which is not possessive, which demands no personal gratification”. Rogers (1961, p.283) describes that the therapist that holds unconditional positive regard for his client creates “an atmosphere which simply demonstrates “I care”; not “I care for you if you behave thus and so”. In that way, the person does not feel judged or praised, as he is not being evaluated by the therapist.
Empathy is defined by Rogers (1961, p.284) as the therapist’s quality that enables him to experience “an accurate empathic understanding of the client’s world as seen from the inside. To sense the client’s private world as if it were your own, but without ever losing the “as if” quality”. Rogers (1961, p.284) highlights that when the therapist is empathetic towards his client’s feelings, thoughts and inner experience, he is aware of his own feelings and thoughts. In that way he will be able not to let them interfere with the process of counselling, as he will be able to approach his client’s experience more.
Rogers (1961, p.61) presents his concept of therapist’s congruence. He defines the congruent therapist as being “what he is”, “genuine and without “front” or facade”. He describes congruence as the condition when “the feelings the therapist is experiencing are available to him, available to his awareness, and he is able to live these feelings, be them, and able to communicate them if appropriate”. Rogers (1980, p.15) argues that a congruent therapist should be aware of his experience and able to communicate it. Rogers (1980, p.14) did not see congruence as an easy task, but as something that requires lifelong effort, and no one ever is totally open to his inner experience.
Mearns and Thorne (2000, p.100) underline the significance of the therapist’s congruence towards the client’s facilitation to take the difficult and deep journey towards self-awareness:
“In the company of such a person (the therapist) capable of deep self-acceptance and a determined openness to inner experience in the road) those who are hurt and wounded, or have succumbed to annihilating self-contempt, may find it possible to access the self more fully and find new hope”
Conditions of worth and locus of evaluation
Kirschenbaum and Henderson (1989) describe Rogers’ belief that from our early youth we learn not to trust our own experience and feelings, caring more about understanding what the important others need from us and believe about us. Therefore, we lose touch with our inner self, becoming in a way incongruent. This process is described by Warner (2000, p.149) as:
“some parents are relatively inattentive or have difficulty leaving their own perspectives. Hence, experiences may go unnamed or be systematically misnamed. Particular sorts of experiences such as unhappiness or anger may be threatening in some families and may be routinely labeled as something else…As the result of such empathic failure, children may never develop a capacity to hold experience in attention to check the felt rightness of its meaning”.
Rogers (1961) stated that these conditions of worth, which are imposed by society and parents, make the person mistrusting of his experience and as a result incongruent. The locus of evaluation is placed on others. Teachers, mental health “experts” and “wise” scientists hold the truth and therefore their experience is more valid.
Towards a fully functioning person
Rogers believed that in person-centred counselling, the person experiences a relationship with someone who is going to believe in his inner strength, and whom he can trust. In this trusting and non-judgmental environment, the person feels less threatened by his own experience and becomes more eager to take the journey towards his self-awareness (Kirschenbaum and Henderson, 1989).
Brodley (2006) analysed Rogers’ emphasis on non-directivity. She stated that the qualified person-centred counsellor has made a sincere and conscious decision to move away from the positivistic view of the world, as well as from any personal need to be in charge, to be an authority, and to hold power. Withdrawing from the role of the one who knows, of the expertise, of the positivistic scientist and doctor, the counsellor, instead of providing knowledge to the client, waits for the knowledge to come from the client himself.
This is reflected in the psychotherapeutic methods and qualities of the person-centred counsellor, as he is not taking charge of the dialogue, and he is being non-directive. As Brink and Farber describe (1996, p.15-24), his work is to restate, affirm his attention, check his understanding, be open to correction from the client, acknowledge his client’s unstated feelings and be able to maintain silence. So, the context of the therapeutic dialogue is decided by the client.
Also, the counsellor has to be constantly aware of any of his own desires or enquiries to be avoided since imposing these on the client will be hindering his work. Mearns and Thorne (2000, p. 22) describe that as: “restraining our need to “make sense” of the material and waiting for the “sense” to come from the client”.
This therapeutic process will facilitate the person to take responsibility for his own actions and trusting his own experience, rather than following others’ expectations out of him. The person will be then more open to his experience and his feelings (congruent) and the locus of evaluation will be internal and as a result more close to be a fully functioning person (Rogers, 1961).
Person-centred counselling in practice
Paul is 26 years old and before being allocated to me he had attended numerous sessions of CBT and as he was diagnosed with depression, his psychiatrist prescribed him medications, which he had been taking for the past 2 years. Non-directivity on behalf of the “expert” was something new for him. Apart from his doctors and previous mental health experts, the important people in his life wanted him to stop feeling sad. Therefore, they kept on prizing him at the moments when he was feeling happy and tried to help him when he was feeling down, all because of their love towards him. From my part, it was obvious that I had a genuine lack of desire to urge him into feeling “great” and acting positively because I respected his being and struggling in this world and I was just there to explore what these depressive feelings meant to him.
The first 10 sessions were important for me to get to know Paul and for Paul to trust me. I was feeling bonded with him and I held sincere acceptance of him as a person. However, I was feeling that the pace of the process was slow. When I discussed this in my supervision I discovered how it was related to my anxiety about being a competent counselor and my need to see quick, solid results. Fortunately, my supervisor “persuaded” me to be more patient and after a further discussion of those thoughts in my personal therapy I was even able to benefit in a personal level.
Paul was getting more self-reflective and self-revealing. He opened a session with the following line:
P: I wanted to tell you something positive that happened to me during the week. I read a play written from Shakespeare and I enjoyed. I felt that I was being positive.
C: So you enjoyed reading a Shakespeare’s play and you felt well for being positive.
P: Yeah, I mean… It is funny that you say this, because there is a tiny part of me who likes being depressed and negative. It makes me connect with other important people, like Bob Dylan, who were depressed as well. I also enjoy his music more.
C: So, there is a small part of you that enjoys being depressed, as it allows you to connect with some important people.
P: Yes. And then again it’s like I have picked up for role models people like Bob Dylan who got their marriage damaged and like my father also. And this made me believe that I will not live a happy marriage.
C: So it is like there is no point in trying to make your relationship work because it will eventually end, just like your father’s and Bob Dylan’s.
P: Yeah, exactly. And it is frightening to think that it may not have to end and I am missing all the opportunities to make it better.
C: So, there is the scary possibility that your relationship might work and you will have missed all the chance to work for it and get some pleasure out of it!
I did not pose any conditions in my acceptance of him. I could accept him, even though he enjoyed some depressive moments. I was ready to explore with him the possible source of these issues, holding no personal hypothesis about the reasons for his difficulties. I kept in mind that I could never know better than him. Even so, sometimes he would still ask my opinion or ask for my permission in his life choices.
I felt honored to be the one to accompany him in his journey towards self-awareness. By not seeing him as a depressed person, but as someone who often feels that there is no point in making life work, I acknowledged his right to exist in his own way. I did not try to “fix” him or make him feel happy. I was with him while he was exploring the reasons for his struggles and maybe what he was gaining out of it. And without any advice or goal settings, Paul no longer wanted to be like that and started exploring some of the reasons why he felt that way and maybe seek for a change:
P: I haven’t accomplished anything of value in my life.
C: So, you are not really proud of anything about your life?
P: Well, actually I have some things that make me happy in my life. But I think I choose to see the negative ones. And those keep spinning in my head all day.
C: So, it is not that you don’t have nice things in your life, but it is that you focus more on the negative aspects of it and end up having constant negative thoughts.
Gradually, I could feel a bigger level of empathetic attunement with his feelings. My initial image of him was deconstructed and I was trying to put aside my preconceptions and focus on the here and now of the work. This probably helped me into responding in a more empathetic way, which possibelyenabled him to dig deeper in his experience.
A constant reason for fighting with his girlfriend and family was his occasional heavy drinking, as they all kept on pressuring him to never drink again. In his previous counseling experience one of the goals of his treatment was to quit drinking and he completed a questionnaire before each session saying how much alcohol he drank that week. One day when he came to see me, this topic came up:
P: I had a huge fight with my girlfriend about drinking. She said that she has had enough. She said that she will only accept my drinking if you give me your permission!
C: So, she is fed up with trying to keep you sober and now she wants me to take that responsibility.
P: (laughs). Well, what do you believe, is it that harmful for me to drink?
C: You are asking me if it is harmful for you to drink.
P: Yes. I mean, you know more about depression and if it would be bad for a depressed person to drink.
C: So Paul, you think that I hold an answer about every person in the world that is diagnosed as depressed on whether he should drink or not!
P: (long pause). I think it wouldn’t hurt me much to drink once and then. But I have to be careful not to overdo it.
C: So, You could drink once in a while, but also be cautious.
P: Yes. And most of all not let Maria (his girlfriend) treat me like a small boy. And for that I need to grow up myself.
When he was speaking about his issue about drinking I did not experience any judgment towards him. I was sincerely accepting of his existence with no conditions. Instead of searching for a reason of his behavior I was just interested in understanding how he experiences the situation and try to empathise with his feelings of sadness and despair which he said that he felt right before drinking.
Furthermore, I did not believe that I can give him any advice, coping strategies or interpretations related to his drinking and the only thing I could do was to be present in the room.
Six months after that session, Paul now has cut down his drinking and no longer fights with his girlfriend about it. He said that maybe Maria sees him stronger and able to decide about his life. However, new issues have been raised. It is now clearer for him that he is suppressing his needs and desires for the past three years and he wants that to change. In the present, he is bringing in the counselling work his fears about this relationship, his future, his insecurity about being in a committed relationship. When I see him these days I remember Kazantzakis (1961) phrase: “Life is full of trouble, death isn’t”.
In the present work I reflect his anxieties about life and how it is not an easy procedure and it would be easier to avoid it, but also that it is worthy. In my effort not to patronise him and believe in his own abilities to make his own decisions in life, maybe I was the first person in his life to validate his being, to give him the space to exist and not fulfil others’ expectations.
Invaluable here lies the word of Laing (1960, p.139) “the sense of identity requires the existence of another by whom one is known”. In that way, many of our next sessions were chosen by Paul to discover his own voice and identity. He recently shared with me his realisation that this helplessness about changing and improving things in his life was connected to the sense that he cannot express his own thoughts, needs or dreams, as if he does, his girlfriend will leave him. He discovered step by step that she even felt happier to see him having more space and ideas. Instead, they could be in love and do different things at the same time.
P: I am feeling extremely angry at her, as I cannot pursue my dream of becoming a famous singer, while being in a relationship with her.
C: She is stopping you from fulfilling your dream and that makes you furious.
………………………………………………………………………………………………………..
P: I guess she wouldn’t mind me playing some guitar once in a while. It is not like I can be the next Bob Dylan anyway. All I really want is to be free and play some guitar.
C: So, you can be with her and also enjoy some personal time.
Finally, it has to be underlined that there are moments when in my therapeutic work with Paul, I feel that less progress is being made and I even doubt that working with me is of any benefit for him. At those moments, both my supervisor and my therapist are there to sooth me with their own accepting eye and help me be more patient, facilitating my own development as a counsellor.
Critique of Rogers’ ideas
-Rogers and evil human side
Rogers was often criticized for his totalistic belief in the positive core of the person and for his choice to ignore the dark, aggressive and violent feelings and thoughts of his clients. Rollo May (1982, p.12) indicated this absence: “client-centered therapists fail to accept and respond to negative feelings” and Rogers has been characterised as naïve and optimistic towards human nature. The social, political and ethical context of Rogers’ country of origin and his parental family seem to have influenced him into avoiding to mention, discuss and identify the negative and aggressive feelings of his clients. As O’Hara (1996, p.286) described it “Rogers’ own place in the world was firmly embodied in his theories”. Rogers himself acknowledges his tendency to oversee these dark human sides saying: “There are times that I think I don’t give enough emphasis on the shadowy side of our nature, the evil side” (as cited in Zeig, 1987, p.202).
Rogers states: “this evil side is not inherent in the human beings” (cited in Zeig, 1987, p.202), whose core includes a “wish for more socialization, more harmony, more positive values” (cited in Zeig, 1987, p.202). However, even if evil thoughts are not natural elements of the person, but products of his socialization process and the human being has a positive core, it is still more than essential to examine this evil side. Thus, it seems that working in a strictly person-centred way would create somehow a person self-accepting and in touch with his internal healing strength, but his self-awareness will be relatively limited in his dark areas, as some of his anger, aggressiveness and unsociable thoughts, instead of being explored, will be further buried in his self-perception.
This could be claimed to be responsible for the development of a false self as a result of person-centred counselling. This was again defined by Rollo May (1982, p.12) as the creation of a narcissistic human being, “lost in self-love”. Also, since the client is never judged by the counsellor he may lose the opportunity to be in a relationship where he might be judged, despite being loved and loved despite being judged.
This was also mentioned by Spinelli (1994, p.189):
“approaches inviting a celebration of being human unnecessarily also involve or at least suggest a questionable, even dangerous, elevation of the individual or the species such that special often becomes synonymous with superior”.
-Rogers and his urge to accept
As stated by Caine (1996, p.280/1), “he (Rogers) seems to downplay the importance of rational, intellectual, cognitive explanations regarding individuals’ motivations or behaviors”. Giving so much emphasis to accepting the client, Rogers underestimates the context that the client brings into the session. It seems that he is that much focused on enabling him to be self-accepting, and ignores the significance of self-awareness, which is given profoundly less attention. So, when he said to Gloria “You look to me like a pretty nice daughter”, he satisfies her need to be accepted, but he chooses that in favor of exploring her self-perception as a “bad daughter”. So, a more preferable answer to her saying “Gee, I‘d like you for my father” could be a reflection of what seemed to be her deeper feeling of needing a different father than the one she had, so that she could feel like a good daughter, a person of worth. Hence, it could have been more helpful to explore any connection of her feelings of unworthiness to her father’s attitude towards her, rather than immediately being told that she is a good daughter. It is this urge for satisfying and accepting the other, that takes away the opportunity of letting him stay with his anxiety and maybe benefit from it.
-Rogers and unconscious desires
Roger’s proposal is to always stay with what the client brings in and not to worry about the unhidden, the unconscious. Rogers focuses more on what the client brings verbally but seems to never wonder about his underlying intentions. This is obvious in Roger’s case studies and sessions with volunteer clients, who chose to bring, in front of many other people, their private thoughts to the surface. It could be argued that even though it would be hindering to pathologise their decision and try to label them, it would also be harmful to ignore and not refer to the context of the session and explore the client’s unconscious intentions.
This is even more obvious in the Gloria case study, a recorded on camera Roger’s session with a middle aged woman. In this case study we see Rogers being empathetic towards her feelings, but it may be claimed that he does not wonder about what desire or need drove Gloria to speak on camera about her issues. It should also be considered that she speaks about really private issues, like her guilt towards her children for having an unstable sexual life and her anger and resentment towards her father. Rogers does not seem to consider that Gloria chose to participate on the recorded session, even though the implications that this interview would have to her personal life could be massive.
It should be highlighted here that it is not suggested that Rogers should make assumptions about her intentions and her choice to participate in the interview despite those implications, but rather be open to reflect that or invite her to examine them together. It seems that it could be a massively productive session to focus even for the whole hour in her choice to be there, as this action of her could be equally informing about herself, as compared to the issues that she verbally mentioned.
My limitations as a person-centred counsellor
Mearns and Thorne (2000, p.91) describe the difficulty of being a person-centred counsellor, compared to other approaches where the imbalance of power can be used for self-support:
“The person-centred therapist can have little recourse to theoretical constructs or elaborate explanations of unconscious processes in order to maintain a sense of self-worthy by pathologising or otherwise objectifying the client”.
In most of my life, personal, professional and academic, I was relieved by a sense (or disillusion) of control over failing, counting on my intellectual abilities and hard work. So, in case of a failure I was not the one to blame, since I had done what was needed to succeed. In those moments, where sadness, anxiety and anger were raised, I would always search for an external reason to blame. If this failure was connected to a potential rejection on behalf of another, I would never consider the possibility that it was my fault and I would instantly try and understand the reasons for the other person’s “inability” to see my “brightness”.
Being trained and working in a person-centred way led to a massive deconstruction of my beliefs and my self-confidence, both as a person and as a mental health “expert”. The thought that I could not control my clients’ improvement, or put the responsibility on them for not progressing or leaving counselling, raised a big amount of anxiety. For the first time, I would have to take my own responsibility for a relationship and see how I hinder my work with my clients. My instant reaction to this anxiety is to try and show my competence.
My experience both as a counsellor, as a supervisee and as a client taught me that an active brain and a large list of books were not enough to keep myself from failing, the exact opposite! I would fail due to my desire to seem smart and be prized for that. Rogers (1961, p.12) spoke about the possible hindering on behalf of the counselor to “have the need to demonstrate his own cleverness and learning”. If I could manage to stay with the feelings created by having failed I would also become a better companion for my clients.
However, even though I keep that in mind, I sometimes still have that need so intense, due to my personal issues. This can be apparent in my practise and possibly be detected by the client. As it drives me to take charge of the session during counselling, speak more, make more interpretations and use questions that will confirm my prior hypothesis.
Rogers’ theory really is really inspiring, but extremely difficult for me to follow, since that seems to deconstruct some of my defence mechanisms that protected me at moments of anxiety. I am learning now how those defence mechanisms also create a distance between myself and the client. It has been really fortunate that supervision and personal therapy are compulsory aspects of my training course.
Health and Counselling
Inspired by Rogers’ humanistic approach towards the person and his valuing of the therapeutic relationship, the counsellor’s role moves away from diagnosing and treating to a focus on meeting and relating. From a person-centred perspective psychiatric labels are seen as human constructions and not as natural characteristics. It can be thus argued that they are used by people who are trying to minimize their responsibility and the following insecurity created by the difficult task to relate to another person and meet him in his despair.
It is far safer to pathologise and objectify the person, as well as to define him only by his “illness”, since in that way the “expert” does not have to explore his own “illness”. It is hard to manage to relate to someone else’s depressive feelings, since the expert should contact his own depressive feelings. Thus, it is safer to distance oneself by labeling the patient. In that way one does not take responsibility, since he chooses to hide behind his theoretical knowledge. As Heaton says (1998, p.37): “For to express what I genuinely feel or think or desire I must respond appropriately to the situation and my own place in it”.
This dehumanizing process of mental diagnosis and the necessity for positivistic knowledge about the human person could be argued to be the evolution of isolating the “ill” people from the “healthy” ones, using asylums. Here also lies the issue of power, as Foucault and Laing saw the psychiatric diagnosis. Under the label of health there is a canonistic motivation of punishing and fixing the difference. Towards that direction, the positivistic science of health does not focus on the person, but on the statistical average. “For the normal has been conflated with the average and then identified with health…This appeal to standard values, which usually is based on the therapist’s cultural biases, is appropriate for averages but not for health” (Heaton, 1998, p.39).
Even in purely physical conditions it is the relationship between the doctor and the patient that provides health’s improvement, as a caring and open connection enables the patient to take more charge of his illness and stick to the medical treatment. Also, through counselling the client may learn to love his symptoms, since they are signals of the imbalance in him and they provide him with the motivation to change his life. That could be achieved by not blaming him for his condition, but by communicating to him that he is the only one who can change it. Rogers chose not to impose his own life model on his clients, but preferred to respect the person’s different way of being, all based on his fundamental belief in the self actualizing tendency. So, it could be all a matter of whether we are ready and brave enough to trust the human’s potential.
Conclusion
The current essay has focused on all aspects of the person-centred approach, its theory, practice, its limitations, and its relevance to health. There has been an effort, though, to underline that training as a person-centred counsellor needs something more than knowledge of theoretical constructions, critical reflection and good usage of therapeutic skills. It needs the acknowledgment of the beauty of the human person, which is often hidden. It is that beauty that the counsellor has to see in his clients and connect to, rather than working towards the improvement of their symptoms. The author’s experience of therapy, supervision and practice revealed that it is not what you say to your clients, but how you see your clients and yourself, that determines the outcome of a therapeutic relationship. Thus, the major conclusion of this essay is that Rogers’ biggest contribution on the world has not been his rich theory, or even his pioneering research, but his tender eye towards people that find it difficult to be loved.
References
Brink, D & Farber, B (1996). A Scheme of Rogers’ Clinical Responses. In B. Farber, D. Brink & P. Raskin (Eds), The Psychotherapy of Carl Rogers. New York: The Guilford Press.
Cain, D. (1996). Rogers and Sylvia: An Intimate and Affirming Encounter. In B. Farber, D. Brink & P. Raskin (Eds), The Psychotherapy of Carl Rogers. New York: The Guilford Press.
Heaton, J. (1998). The Enigma of Health. European Journal of Psychotherapy & Counselling, 1:1, 33-42.
Heidegger, M (1962). Being and Time. Harper & Row, New York.
Kirschenbaum,H. & Henderson, J. (1989). The Carl Rogers Reader. London: Constable.
Laing, R. D. (1960). The divide self. London: Tavistock.
Levinas, E. (1989). Ethics as First Philosophy. Duquesne: Duquesne University Press.
May, R. (1982). The problem of evil: An open letter to Carl Rogers. Journal of Humanistic Psychology, 22, 10-21.
Mearns, D. & Thorne, B. (2000). Person-Centred Therapy Today: New Frontiers in Theory and Practice. London: Sage.
O’Hara,M. (1996). Rogers and Sylvia: A Feminist Analysis. In B. Farber, D. Brink & P. Raskin (Eds), The Psychotherapy of Carl Rogers. New York: The Guilford Press.
Rogers, C. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable.
Rogers, C. (1980). A Way of Being. Boston: Houghton Mifflin.
Spinelli, E. (1994). Demystifying therapy. London: Constable.
Zeig, J. (1987). The Evolution of Psychotherapy. New York: The Milton H. Erickson Foundation.