The Person-centred approach (PCA) to therapy was developed by Carl Rogers (1902-87). Carl Rogers was brought up by what he described as loving but ‘controlling’ religious parents who expected him to work hard. As a boy he had an interest in science and often conducted his own experiments. Following the First World War, he studied agriculture at college in Wisconson where Rogers had the opportunity to take part in the first International Student Federation Christian Conference in China. His experiences and observations in China influenced him to the point where he wrote ‘In major ways I for the first time emancipated myself from the religious thinking of my parents, and realized that I could not go along with them’ Rogers (1961:7).
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Now married, two years later in 1924, Rogers enrolled at Union Theological Seminary to prepare for religious work. Here Rogers and others recognised they were being directed in their thinking and so they set up their own group to question and explore their own beliefs leading many of the group to the point where they ‘thought themselves right out of religious work. I was one’ … ‘I could not work in a field where I would be required to believe in some specified religious doctrine’ (Rogers, 1961:8). This is clearly where Rogers lost his religious introjects.
Having already had an interest in psychological and psychiatric work whist at Union Theological Seminary Rogers then enrolled at Teachers’ College, Columbia University where he moved from Theology to Psychology, specialising in child guidance work and where he ‘began to think of myself as a clinical psychologist’ (Rogers, 1961:9).
Rogers identified that he was more interested in the practical approach to helping children and parents than the psychometric assessment approach. He took influences from many theorists, especially Otto Rank who believed deeply in the worthiness of a person. Rogers’ first experience of working with patients was with the Child Study Department of the Rochester Society for the Prevention of Cruelty to Children in 1928 where he began to listen to his patient and began his faith in non-directive methods.
Rogers published his first book in 1939: The Clinical Treatment of the Problem Child. In this book is a framework that shows how Rogers began considering the importance of the therapist and client relationship. According to Sanders (2004:2) ‘He realised that a good relationship with the parents of the problem child was one of the keys to success and he listed the factors that he found to be important’. (See appendix A).
Rogers moved to Ohio State University as a professor in 1939 where he further developed elements of what become known as non-directive therapy. By attending to the client’s verbal and non-verbal communication, Rogers (1961:11-12) realised ‘that it is the client who knows what hurts, what directions to go, what problems is crucial, what experiences have been deeply buried’. Rogers (1961:27) summed up his non-directive attitude as ‘there is no philosophy or belief or set of principles which I could encourage or persuade others to have or hold’. The emphasis was on the counsellor’s acceptance of whatever feelings the client expressed. The central technique was the clarification of feelings with the aim of gaining insight into those feelings. He concluded that the client is the expert and not the therapist. This differed from all previous types of counselling.
In 1945, Rogers was invited to set up a counselling centre in Chicago where he tested his new therapeutic ‘techniques’ on a wide variety of people that sought psychological help following World War Two. Rogers ‘…started to win national recognition as the founder of non-directive therapy and as a spokesman for a so-called ‘third force’ in psychology’ (Cohen, 1997:120).
In 1951 Rogers’ form of therapy was renamed ‘Client-Centred Therapy’. This was because ‘non-directive’ could have suggested that there was no direction, yet Rogers believed it was the client’s direction, experiences and perceptions about their own reality. Rogers began understanding how clients behaved from their frame of reference. The approach was announced and explained in Rogers’ book ‘Client-Centred Therapy’. In chapter eleven, according to Sanders (2006:16) ‘Carl Rogers made his first attempt at a comprehensive theory of personality’. It has been suggested that:
As experience grew and both theory-building and research developed, the term ‘client-centred therapy’ was adopted which put the emphasis on the internal world of the client and focused attention on the attitudes of therapists towards their clients rather than on particular techniques (Dryden 2002:132-133).
Rogers set out his theory of personality and behaviour as nineteen propositions (see appendix B). These nineteen propositions lead into further concepts of Rogers’ theory of personality and behaviour. Propositions one to seven are the aspects of our personality that we are born with and propositions eight to nineteen describe learnt personality and behaviour from our interactions from our environment and with others. In forming our personality and behaviour key characteristics of person centred theory are used.
Rogers believed that each person experiences their own reality in a phenomenological way (see propositions I and II). This is why Rogers believed that the client is the expert. As we learn as children we decide if an experience is good or bad, using our organismic valuing process to do so (see proposition VI). This is an ongoing, changing process in accordance with the actualising tendency (see proposition IV). Sometimes we are told by people whose opinion we value that what we believe is a good experience is actually a bad experience and vice versa via their introject (see proposition X). We often then change our subjective perception of the experience to please the significant other in order to get their acceptance and approval based on our need for positive regard, creating a condition of worth. These values build up our subjective self-concept (see proposition IX). Experience that conflicts with the self concept will be denied and distorted (see proposition XI) to protect the self concept. If our values are based on our organismic valuing process we are working from an internal locus of evaluation. If our values are based on introjects we are working from an external locus of evaluation. Tolan (2003:5) wrote:
People often judge themselves according to whether others find them acceptable or wanting. Their locus of evaluation is outside of themselves. Even when someone is making her own judgements, these can be based on a system of values built into the self-structure, which are not influenced by experience (introjected values).
Denial or distortion of experience leads to psychological distress because there is too large a gap between self-image and self-ideal (see proposition XIV). Counselling allows the client to heal their self-structure by using their actualising tendency within an appropriate environment where a trusting relationship could be formed.
The importance of the therapist and client relationship that Rogers first considered in 1939 remained imperative to Rogers throughout his work. Rogers (1961:33) states his overall hypothesis:
If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth, and change and personal development will occur.
Prior to this statement, in 1957, Rogers had outlined the now famous ‘six necessary and sufficient conditions for therapeutic change’ (see appendix C). In 1959 he published another version where there was a slight difference. In order to provide the type of relationship that the PCA aims for the therapist experiences and manifests three basic attitudes in the relationship. These three attitudes are labelled as congruence, unconditional positive regard and empathy and together are known as the core conditions.
Congruence means that the counsellor’s outward responses match their inner awareness and feelings; that they are genuine, open authentic and transparent. Rogers stressed that congruence is not a question of the counsellor blurting out compulsively every passing feeling; rather it is a state of being. Feelings only are to be expressed when they are persistent and of great strength and when communication of them assists the therapeutic process. Endeavouring to be so open the counsellor acts as a role model sending the message that it’s OK to feel, communicate, trust and heal. In quoting Rogers (1959:214) Sanders (2006:52-53) describes congruence in the relationship as follows: ‘The requirement is that ‘in this moment of this immediate relationship with this specific person, [the counsellor] is fully and completely himself’.
The helper shows a deep respect, concern and care for the client. The helper affirms the worth and value of the client as a unique individual and is able to encourage the client to take responsibility for her/himself. The helper enters fully into the counselling skills relationship and is willing to risk receiving feedback from the client that is in any way challenging. Unconditional positive regard on the part of the counsellor means that the counsellor offers the person respect, acceptance (it does not have to be approval) caring and appreciation regardless of the client’s attitude or behaviour. Rogers often used the word ‘prizing’ to convey the meaning of this condition. This condition is important because it undermines the clients’ beliefs that they are only valued if they behave as required by significant others. There is no longer any need for the client to shy away from aspects of his inner self which may be painful or shameful because he learns that it is possible to be truly her/himself and still be accepted. Merry (2004:36) suggests that Unconditional Positive Regard (UPR) refers to
the generally non-judgemental, accepting attitude of the counsellor. It does not imply any approval on the part of the counsellor for destructive behaviour of the client, but an acceptance of its existence and that its roots are located within the client’s psychological history.
‘First, empathy dissolves alienation. For the moment at least, the recipient finds himself or herself a connected part of the human race’ (Rogers, 1980:151).
‘A second consequence of empathic understanding is that the recipient feels valued, cared for, accepted as the person that he or she is …. Hence the message comes through to the recipient that “this other individual trusts me, thinks I’m worthwhile. Perhaps I am worth something. Perhaps I could value myself”‘ (Rogers, 1980:152).
Empathy is the ability to put oneself into the psychological frame of another. Empathic listening is useful in the counselling relationship to be able to sense the way a person is feeling. Empathic understanding is an active process. This quality is to be able to separate own feelings of hurt, anger or joy. It involves more than verbal responses, it includes, body language, eye contact, periods of silence, tone of voice. Empathic understanding is listening for surface and deeper meaning of others’ experiences. Empathy is one of the skills that could be used to overcome prejudice and discrimination.
Merry (2004:33) states that we can regard empathy as:
A process in which the client’s feelings, thoughts and other experiences are received by the counsellor who then checks or tests his or her understanding in an intentional and purposeful way.
Rogers condenses his six therapeutic conditions into one idea, namely ‘that the client experiences himself as being fully received’ (Rogers, 1961:130, original emphasis) Sanders, (2006:8). As Rogers’ sixth necessary and sufficient condition suggests, once the client perceives, at least to a minimal degree, the therapist’s acceptance and ‘accurate’ empathic understanding the client can then self-actualise and the therapeutic movement would occur.
‘Working at relational depth’ occurs when the core conditions are all present in high degree and work together to enable client/therapist intimacy. Rogers (1980:129) described it as being:
…like my inner spirit has reached out and touched the inner spirit of the other. Our relationship transcends itself and becomes part of something larger. Profound growth and healing and energy are present.
In 1961 ‘On Becoming a Person’ was published. This book is probably one of the most well known of Rogers’ writings and describes ‘The Seven Stages of Process’.
Rogers (1961:131) states:
Individuals move, I began to see, not from fixity or homeostasis through change to a new fixity, though such a process is indeed possible. But much the more significant continuum is from fixity to changingness, from rigid structure to flow, from stasis to process.
According to Rogers personality is a process that can be split into seven stages. In stage One the organism is fixed, rigid, stuck, anxious and incongruent, through to stage Seven where the organism is fluid, spontaneous and congruent. Rogers identified similar results in the therapeutic process by providing a climate for therapist/client interpersonal relationship. He noticed familiar personality changes when the six necessary conditions were present. Clients would become more open to experience, trust themselves more and worked from an internal locus of evaluation and as a result getting closer to their organismic self, actualised and moved towards stage Seven maturity. Most people, most of the time, appear to be in stages Four and Five. The seven stages of process allows measurement of how much change occurs within the client. It gives some indication as to whether therapy is working or not for the client.
‘A common theme originating in Rogers’ early writing’ … ‘basic sense of trust in the client’s ability to move forward in a constructive manner if the appropriate conditions fostering growth are present. His professional experience taught him that if one is able to get to core of the individual, one finds a trustworthy, positive centre’ (Rogers, 1987).
Rogers’ approach was developed and improved through his learning from his own experiencing. He also encouraged others to criticise his findings in order to improve the approach. As Rogers’ work became more well known his theory became known as the ‘person-centred approach’ (PCA). Rogers spent the last ten years of his life involving himself applying the PCA to politics, hoping to achieve world peace.
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In the 1940s Rogers was a leading figure in third force in psychology, known as the humanistic psychology movement, whose followers placed their faith in the positive side of human development. Until then psychology had been diagnostic, labelling and concerned with negative functioning. Another leading figure in humanistic psychology was Abraham Maslow. Both Maslow and Rogers had theories of actualisation, defined by Tudor and Merry (2002:2) as ‘the assumed tendency of human beings to strive (though not necessarily consciously) towards fulfilment of their potential’.
Sanders (2006:26) writes:
Abraham Maslow (1954) argued that human behaviour was much more complicated than could be accounted for by physiological HOMEOSTASIS. Maslow proposed a wide range of human needs in a dynamic and changing system. He suggested a hierarchy of needs, where needs at higher levels would only be addressed when needs at lower levels had been satisfied. It is important to note that Maslow uses the term self-actualisation differently from the way Rogers uses it.
In Maslow’s hierarchy of needs self-actualisation depends on lower needs being met first.
Although Maslow influenced Rogers, Rogers did not believe in such a rigid hierarchy. He believed instead that ‘the organism has one basic tendency and striving – to actualize, maintain, and enhance the experiencing organism’ (Rogers, 1951:247) as stated in proposition four of the nineteen propositions included in Rogers’ theory of personality and behaviour (see appendix B).
Rogers’ PCA was not the only form of therapy available.
Another humanistic psychologist, Eric Berne, founded Transactional Analysis (TA). Key TA concepts are 1) the three ‘ego states’ of ‘Parent’, ‘Adult’ and ‘Child’ that together make up personality, 2) unconscious ‘life scripts’ that are made in childhood, 3) ‘injunctions’, which are like introjects but are all negative, leading to 4) the goal of TA therapy, which is to allow clients to make new and more appropriate ‘redecisions’ to replace earlier ‘decisions’. TA therapists see themselves and their clients as equals in the therapy process.
Another humanistic psychologist, Frederick (Fritz) Perls (1893-1970), founded Gestalt therapy which, like PCA, grew out of the philosophical ideas of existentialism. Gestalt ego states are known as ‘top dog’ and ‘underdog’. Gestalt therapists work in the here and now of the client/therapist relationship to bring awareness, with the aim of resolving the client’s previously ‘unfinished business’. The focus of Gestalt therapy is on ‘what’ and ‘how’, not on ‘why’. Gestalt therapists concentrate on the client’s body language. Key Gestalt concepts are 1) acceptance of personal responsibility, 2) awareness, like in PCA, 3) ‘unfinished business’ and 4) dealing with ‘impasses’. Gestalt theory believes that there is no internal and external because everything in life influences us and becomes part of us. Gestalt therapy aims to move the client to an autonomous state.
Before all of those humanistic forms of therapy there was the Psychodynamic therapy of Sigmund Freud (1856-1939). This therapy was very different in its approach. In psychodynamic therapy the therapist is the expert and is directive. It was Freud who came up with the idea of an ‘unconscious’ mind which controls human thoughts, feelings and behaviours whilst keeping our true motives hidden from our awareness. Psychodynamic therapy uses the ego states of ‘Id’, ‘Ego’ and ‘Superego’ to explain personality. Freud theorised that personality is developed by the person’s childhood experience. One aim of psychodynamic therapy is for the therapist to interpret the client’s experiences, using the client’s dreams and free associations, in order to explain the client’s unconscious motives and bring them into consciousness. This is done through a process called transference where the therapist takes on the role of important figures from the therapist’s childhood. In doing so the client is then able to choose new responses instead of being driven by past and until now unconscious choices. Unlike the humanistic psychologists, Freud believed in determinism, which is to say that we are a product of our environment and we do not have a free choice. Freud aimed to strengthen the ego in psychodynamic therapy so that behaviour is based on reality.
As per the BACP ethical framework, I would not use any techniques beyond my competence because this could leave me wide open for litigation issues. Professionally I could give counselling a bad name and I could harm the client.
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