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Carl Rogers's Client-Centered Therapy

Insight Therapies

Sometimes called experiential therapies, humanistic and existential therapies, like

psychoanalytic
therapies, are insight-focused, based on the assumption that disordered behavior can
best be treated by
increasing the individual's awareness of motivations and needs. But there are useful
contrasts between psychoanalysis and its offshoots on the one hand and humanistic
and existential approaches on the other. The psychoanalytic paradigm assumes that
human nature, the id, is something in need of restraint, that-effective socialization
requires the ego to mediate between the environment and the basically antisocial, at
best, asocial, impulses stemming from biological urges. (As we have seen, though, ego-
analytic theorizing deemphasized these features of classical Freudian thought and
introduced concepts that bring contemporary psychoanalytic thinking closer to
humanistic and existential approaches.) Humanistic and existential therapies also place
greater emphasis on the person's freedom of choice. Free will is regarded as our most
important characteristic. Free will is, however, a double-edged sword, for it not only
offers fulfillment and pleasure but also threatens acute pain and suffering. It is an
innately provided gift that must. be used and that requires special courage to use. Not
all of us can meet this challenge: those who cannot arc regarded
as candidates for client-oriented, existential, and Gestalt therapies.

Carl Rogers, a humanistic therapist, proposed that the key ingredient in therapy is the
attitude and style of the therapist rather than specific techniques. Carl Rogers was an
American psychologist whose theorizing about psychotherapy grew slowly out of years
of intensive clinical experience. After teaching at the university level in the 1940s and
1950s, he helped organize the Center for Studies of the Person in La Jolla, California.
Rogers made several basic. assumptions about human nature and the means by which
we can try to understand it (Ford & Urban,1963; Rogers, 1951, 1961).

1. People can be understood only from the vantage point of their own perceptions and
feelings, that is, from their phenomenological world. To understand individuals, then,
we must look at the way they experience events rather than at the events themselves,
for each person's phenomenological world is the major determinant of behavior and
makes that person unique.

2. Healthy people are aware of their behavior. In this sense Rogers's system is similar
to psycho-analysis and ego analysis, for it emphasizes the desirability of being aware of
motives.

3. Healthy people are innately good and effective: they become ineffective and
disturbed only
when faulty learning intervenes.
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4. Healthy people are purposive and goal-directed: they do not respond passively to
the influence of their environment or to their inner drives. They are self-directive. In this
assumption Rogers is closer to ego analysts than to orthodox Freudian psychoanalysis.

5.Therapist should not attempt to manipulate events for the individual; rather they
should create conditions that will facilitate independent decision making by the client.
When people are Not concerned with the evaluations, demands, and preferences of
others, their lives are guided self-actualization.

The therapist should have three core qualities: genuineness, unconditional positive
regard and
empathic understanding.
Genuineness, sometimes called congruence encompasses spontaneity, openness, and
authenticity.

The therapist has no phoniness or professional facade, disclosing his feelings and
thoughts informally and candidly to the client. He should do honest self-disclosure as
he is the model for the client.

The second attribute is UPR and accept the clients as they are and for what they are.

Third quality, accurate empathic understand- ability to see the world through the eyes
of clients from moment to moment, to understand the feelings of clients both from their
own phenomenological vantage point, which is known to them, and from perspectives
of which they may be only

Empathy

Empathy is Therapist's acceptance, recognition, and clarification of client's feelings. It is

one of the few pies of Rogerian therapy. Within the context of a warm therapeutic
relationship, the therapist encourages the client to talk about his or her most • felt
concerns and attempts to restate the emotional aspects, not just the content of what
the client says. This reflection of feelings to the client helps to remove gradually the
emotional conflicts that are blocking self-actualization. Because feelings are miirrored
without judgment or disapproval, the client can look at them, clarify them, and
acknowledge and accept them. Feared thoughts and emotions that were previously too
threatening to enter awareness can become part of the self-concept
In Rogers' view (1977) the aim of therapy is not merely to solve problems. Rather, it is
to assist clients in their growth process, so that they can better cope with problems
they are now facing and with future problems.

In primary empathy the therapist tries to restate to clients their thoughts, feelings, and
experiences
from their own point of view. The work here is at the phenomenological level: the
therapist views the
client's world from the client's perspective and then communicates to the client that
this frame of refer-
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ence is understood and appreciated. In advanced empathy the therapist generates a
view that takes
the client's world into account but conceptualizes things, it is hoped, in a more
constructive way. The
therapist presents to the client a way of considering himself or herself that may be
quite different from
the client's accustomed perspective.

Evaluation

Largely because of Rogers's own insistence that the outcome and process of therapy be
carefully scrutinized and empirically validated, numerous studies have attempted to
evaluate client-centered therapy. Indeed, Rogers can be credited with originating the
whole field of psychotherapy research. He and his students deserve the distinction for
removing the mystique and excessive privacy of the consulting room; for example, they
pioneered the tape recording of therapy sessions for subsequent analysis by
researchers.
Rogers (1961) writes that people who enter psychotherapy are often asking:
"How can I discover my real self? How can I become what I deeply wish to become?
How can I get behind my facades and become myself?"

The underlying aim of therapy is to provide a climate conducive to helping the

individual become a fully functioning person. Before clients are able to work toward that
goal, they must first get behind the masks they wear, which they develop through the
process of socialization. Clients come to recognize that they have lost contact with
themselves by using these facades. In a climate of safety in the therapeutic session,
they also come to realize that there are other possibilities.

When the facades are worn away during the therapeutic process, what kind of person
emerges from behind the pretenses? Rogers (1961) describes people who are
becoming increasingly actualized as having (1) an openness to experience, (2) a trust
in themselves, (3) an internal source of evaluation, and (4) a willingness to continue
growing. Encouraging these characteristics is the basic goal of person-centered
therapy.

Openness to experience. Openness to experience entails seeing reality with out

distorting it to fit a preconceived self-structure. The opposite of defensive-ness,
openness implies becoming1 more aware of reality as it exists outside oneself. It also
means that one's beliefs are not rigid; one can remain open to

further knowledge and growth and can tolerate ambiguity. One has an aware-ness of
oneself in the present moment and the capacity to experience oneself infresh ways.

Self-trust. One goal of therapy is to help clients establish a sense of trust in themselves.
In the initial stages of therapy clients often trust themselves and their own decisions
very little. As clients become more open to their experiences, their sense of trust in self
begins to emerge.
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Internal source of evaluation. Related to self-trust, an internal source of evaluation
means looking more to oneself for the answers to the problems of existence. Instead of
looking outside for validation of personhood, one increasingly pays attention to one's
own center. One decides one's own standards
of behavior and looks to oneself for the decisions and choices to live by.

Key figure: Alfred Adler. Following Adler, Rudolf Dreikurs is credited with popularizing
the approach in the United States. A growth model, it .stresses taking responsibility,
creating one's own destiny, and finding
meaning and goals to give life direction. Key concepts are used in most other current
therapies.

The Basic Philosophies: A positive view of human nature is stressed. Humans are
motivated by social interest, by striving toward goals, and by dealing with the tasks of
life. People are in control of their fate, nut victims of it. Each person at an early age
creates a unique style of life, which tends to remain relatively
constant throughout life.

Key Concepts: Based on a growth model, this approach emphasizes the individual's
positive capacities to live in society cooperatively. It also stresses the unity of
personality, the need to view people their subjective perspective, and the importance
of life goals that give direction to behavior. People are motivated by social interest and
by finding goals to strive for. Therapy is a matter of providing encouragement and
assisting clients in changing their cognitive perspective.

The Therapeutic Relationship: The emphasis is on joint responsibility, on mutually

determining goals, on
mutual trust and respect, and on equality. A cooperative relationship is manifested by a
therapeutic contract. Focus is on examining life-style, which is expressed by the client's
every action.

Goals of Therapy: To challenge clients' fundamental premises and life goals. To

provide encouragement so that they can develop socially useful goals. To change faulty
motivation and help them feel equal to others.

Therapy Techniques: Adlerians draw from many techniques, a few of which are
paraphrasing, providing encouragement, confrontation, interpretation, gathering life-
history data (family constellation, early recollections), therapeutic contracts. homework
assignments, use of "The Question," paradoxical intention. and suggestions.

Applications: Can be applied lo all spheres of life, such as parent/child counseling,

marital and family therapy, individual counseling with children and adolescents,
correctional and rehabilitation counseling, group counseling, substance-abuse
programs, and dealing with problems of the aged. Being a growth model, it is ideally
suited to preventive menial health and alleviating a broad range of conditions that
interfere with growth.

Contributions of the Approaches: More than any other system, this approach has
generated controversy as well as exploration and has stimulated further thinking and
development of therapy. It has provided a detailed and comprehensive description of
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personality structure. It has brought into prominence factors such as the unconscious
as a determinant of

behavior and the role of trauma during the first five years of life. It has developed
several techniques fur tapping the unconscious. It has shed light on the dynamics of
transference and countertransference. resistance, anxiety, and the mechanisms of ego
defense.

One of the major contributions is the influence that Adlerian ideas have had on other
systems and their integration into the mainstream of other contemporary therapies.
Many basic concepts of other systems bear a strong resemblance to those of this
approach, One of the first approaches to therapy that was humanistic, unified, and goal
oriented and that put an emphasis on social and psychological factors.

Limitations of the Approaches: Weak in terms of precision, testability, and empirical

validity attempts have been made to validate the basic concepts and methods. Tends
to oversimplify some complex human problems based heavily on common sense.

Adlerian Therapy is a growth model. It stresses a positive view of human nature and
that we are in control of our own fate and not a victim to it. We start at an early age in
creating our own unique style of life and that style stays relatively constant through the
remained of our life. That we are motivated by our setting of goals, how we deal with
the tasks we face in life, and our social interest. The therapist will gather as much
family history as they can. They will use this data to help set goals for the client and to
get an idea of the clients' past performance. This will help make certain the goal is not
to low or high, and that the client has the means to reach it. The goal of Adlerian
Therapy is to challenge and encourage the clients' premises and goals. To encourage
goals that are useful socially and to help them feel equal. These goals maybe from any
component of life including, parenting skills, marital skills, ending substance-abuse, and
most anything else. The therapist will focus on and examine the clients' lifestyle and
the therapist will try to form a mutual respect and trust for each other. They will then
mutually set goals and the therapist will provided encouragement to the client in
reaching their goals. The therapist may also assign homework, setup contracts between
them and the client, and make suggestions on how the client can reach their goals

Client-Centered Therapy and Dissociation

Whenever the treatment of the dissociative disorders is discussed, one hears about the
usual suspects: psychodynamically informed psychotherapy, hypnotic techniques,
EMDR, attachment-theory oriented treatment, Ego State Therapy, and Dialectical
Behavior Therapy. I have always felt like the odd man out when I tell colleagues that I
rely mostly on a client-centered approach. I was therefore pleased to see that there is
now a book chapter entitled "A client-centered approach to therapeutic work with
dissociated and fragile process." The chapter was written by Margaret Warner and
appears in the Handbook of Experiential Psychotherapy edited by Leslie Greenberg,
Jeanne Watson, and Germain Lietaer and published by Guilford in 1998.

It has always seemed to me that the client-centered approach with its emphasis on
therapist genuineness, empathy and unconditional positive regard, with its abhorrence
of suggestive and coercive therapeutic interventions, and with its focus on helping
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clients to attend to their inner embodied felt experiencing was a natural match for the
needs of many dissociative clients. The client-centered approach allows clients to work
at their own particular pace without much danger of the therapist pushing the client
into places where the client is not quite ready to go. In addition, client-centered
therapists are particularly adept at sitting unflinchingly with clients in their moments of
despair and hopelessness without needing to "fix them."

In this kind of therapy the therapist does not map ego states, and does not call out ego
states in session, but is willing to work with whomever comes into the room in an even-
handed and respectful way. The therapist works with whomever comes in whatever way
he or she needs to work. The therapist does not push to resolve ambivalences and
uncertainties, but only respectfully mirrors back and deepens the client's own
experience of ambivalence and uncertainty, believing in

the client's own ability to sort things out in due time. The therapist does not doubt the
reality of separate ego states, nor does he/she insist on the reality of separate ego
states. There is no special interest in or fascination with dissociative phenomena. There
is only a special interest in the client's exploring the way-things-really-are-in-the-
moment, and the client's growing capacity for tolerating, honoring, and welcoming the
entirety of his or her experiencing in all its ambiguity and complexity.

Are their limits to the effectiveness of a purely client-centered approach? Of course.

One need only think of the client who is working obsessively on memory recovery
without the necessary distress tolerance skills in place. Here the therapist cannot
uncritically accept the client's idea of pacing. One can think of any number of occasions
when the therapist must take some control over the course of a therapy up to and
including overriding a client's preferences about hospitalization.

In my own approach I talk about a process of shared influence and control which is
always on the table to be commented on and discussed.

As I read Margaret Warner's chapter I am readily aware of how she has adapted her
own client-centered approach, borrowing and gleaning from Kluft, Putnam, Ross, and
others. The complexities of treating dissociative disorders are such that no one
approach has a corner on the correct treatment market. Nevertheless, the client-
centered approach has much to recommend it. Had it been more of an influence in the
early days of treating dissociation, many problems could have been avoided. I am
speaking here of the problems that arise from suggestive and coercive treatment, and
also the problems that arise when therapists rescue clients rather than having faith in
client's own abilities to self-heal.

Dissociative Identity Disorder as a "Not to Know Strategy"

In the September/October 1999 issue of the ISSD (International Society for the Study of
Dissociation ) newsletter, ISSD president Peter Barach lists 10 changes in the treatment
of DID that have occurred in the past 10 years. Number 3 is "Focusing on the
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dissociative patient as a whole." He writes, "Along these lines, I have found that
referring to DID as the 'not to know strategy' can facilitate this shift in focus."

Some of my patients and I like this and find it useful in treatment because it is non-
pathological, describing a strategy rather than a disorder. DID in adulthood is, of
course, a disorder, causing much difficulty and dysfunction in daily living. It should stay
in the DSM and should be treated as a psychological problem. But the etiology of DID in
childhood, engendered in experiences of abuse, suggests that it arose originally as a
strategy, as a way to avoid full conscious experiencing of something intolerable.

Calling it the "not to know strategy" emphasizes the functionality of the dissociative
splits. They were, in effect, a way not to know everything all at once. "Not to know"
includes not knowing actual events, and also their attendant emotions, cognitions and
behaviors. Blocking all or part of this knowing allows a child to function.

This title also puts less emphasis on the separateness of the parts, and more on the
functionality and reason for the separateness. Along these lines, I am sometimes calling
parts "knowing areas." I talk about them more as areas of knowing certain things rather
than as separate entities. For instance, one knowing area can know part of what
happened, and others can know other parts. This is helpful for some patients who have
a sense of wholeness at times -- it doesn't imply that they aren't whole.

When I think this way, I don't use the term integration as much, when referring to
processes of unification or removal of the dissociative barriers. While I do believe that
integration should be the goal of treatment, I think of it more as a gradual

process of increasing the sharing of knowing among parts, than as a discrete event. I
am substituting "increasing self knowing and self tolerance" for the term "integration."
When I work this way, the work often feels more fluid and gentle, and there is more
empowerment for the patient. If it serves them, they can choose to share knowing
between areas. I notice that more of the work of therapy is done with co-consciousness
when we think this way.

Example: A patient I will call Jody had been feeling very anxious for a week, and could
not discover the reason, no matter how much we explored it. The anxiety was
becoming intolerable. Using the "not to know" framework, I asked if the knowledge
about the source of the anxiety was located in a knowing area, and asked if she wanted
to increase knowing between herself and this area, in order to decrease her anxiety.
She agreed. She simply asked herself where the knowing about the anxiety was, and if
that "knowing area" was willing to share with her. She became aware of hearing the
information being shared within her, and, by understanding the reasons for the anxiety,
was able to take steps to diminish it.

In summary, I propose that thinking and talking about DID in treatment (not in terms of
the DSM) can be helpful in focusing on the wholeness of the patient, de-pathologizing
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the origin of DID, and facilitating improved daily life through increased co-
consciousness.