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Chapter 1

Overview of Person-Centered Therapy


    This chapter provides an overview of person-centered therapy by focusing on the essence of this therapeutic approach. The emphasis of the chapter is upon the practicality of the therapist’s ‘being’ as a therapist rather than upon what the therapist should ‘do’. The therapist’s actions emerge from the underlying attitudes of this way of being.

    Five decades of psychotherapy outcome research now clearly identify the factors that contribute to successful client outcome. The factors of the client/therapist relationship and the client’s internal and external resources (extratherapeutic variables) account for seventy-percent of success (Duncan, Hubble, & Miller, 1997). These are the variables that are the foundation of Person-Centered Therapy. There is a proposed treatment model based upon psychotherapy research that, unrealized by the authors, is substantially the person-centered model (Duncan and Moynihan, 1994).

    I predominately use the term person-centered therapy rather than client-centered therapy in order to emphasize the remarkable resiliency and self-resources of persons entering therapy. The term also suggests greater behavioral flexibility for the therapist than is often mistakenly associated with the term client-centered therapy. I maintain that the two labels are not different and that both terms refer to the theory proposed by Carl Rogers. Periodically, the terms are used interchangeably in this book. The term person-centered therapy represents to me a re-birth of Rogers’ remarkable trust of each individual’s potency for self-determination and selt-authority.
 

Lack of understanding and/or assimilation

    Client-Centered/Person-Centered Therapy (CCT/ PCT) has not been understood or assimilated by most current scholars and practitioners of psychotherapy. The fundamental reason for this pervasive lack of understanding seems, at least in part, to be due to most therapists’ perceptual stance that the therapist is the expert who appropriately intervenes to help the client resolve problems. Rogers’ revolutionary stance that identifies the client as his or her best expert about his or her life is not well understood or assimilated by the most brilliant scholars in the field of psychotherapy. For example, Arnold Lazarus believes that the ‘necessary and sufficient conditions’ for therapeutic personality change posited by Rogers is ‘usually’ the ‘soil’ for preparing appropriate intervention by the therapist (Lazarus, 1992). Another author suggests that there is no one set of necessary and sufficient conditions and that various interventions are needed at various times for various clients. (Norcross, 1992). Others have consistently resounded the same theme; i.e., that the conditions may be necessary but are seldom sufficient (Fay and Lazarus, 1992; Norcross, 1992, Quinn, 1993). Authors exemplify the failures to understand Rogers’ position when they refer to the attitudinal qualities as being preparatory for ‘interventions’ by the therapist.
 

The Revolutionary Thrust

    The revolutionary crux of Rogers’ theory is that the therapist does not intervene and has no intention of intervening. The basic position is that the therapist trusts the actualizing tendency of the client and truly believes that the client who experiences the freedom of a fostering psychological climate will resolve his or her own problems. Person-centered therapy can not be adequately understood when viewing it from the framework of other theories, which have different basic assumptions. The potency of the approach can not be fully realized if the trust of the client by the therapist is short-circuited with interventions and with the therapist’s ideas of what is ‘really’ best for the client. The therapy developed by Carl Rogers must be understood within the context of the theory espoused by Rogers.

    Most critiques of Rogers’ theory are indicative of a process and position taken by authors to criticize the theory and hypothesis (Bozarth, 1995). The process is, in essence, that of dismissing the fundamental assumptions of the approach (of the actualizing tendency and the self-authority of the client) as untenable or questionable and proceeding with criticism of the theory from other theoretical frames of reference. The position taken is embedded to varying degrees in the assumption of the therapist as the expert for the treatment and behavior change of the client. Hence, their theoretical argument is a shift in the meaning and understanding of Rogers’ theory. Others exemplify the inaccuracy of viewing Rogers’ theory from the perspective of different frameworks when they conclude that Rogers is suggesting a ‘ . . . unitary case formulation and universal treatment plan’ and that Rogers ‘ . . . violates the principle of tailor-making the therapy to the needs of the patient’ (Norcross, 1992, p. 8; Fay and Lazarus, 1992, p. abstract). The perceptual stance of these authors that the clinician is an artful director of prescriptive matching for tailor making treatment to the individual is so radically different from Rogers’ assumption of the client knowing what is best in his or her life that they have an ironic misunderstanding of person-centered therapy. They somehow do not understand that the practice of person-centered therapy is focused on individual differences and not predicated on ‘ . . . doing something to the client that is predetermined by an authoritative therapist who takes responsibility for the treatment and behavior of the client’ (Bozarth, 1991a, p. 467). The experiencing of certain attitudes towards a person is not the same as prescribing ‘ . . .relationship stances and technical interventions for each situation . . .’ (Norcross, 1992, p. 8). Fay and Lazarus are replete in their amazement of a different way of relating to people when they sarcastically state: ‘ . . .if Rogers were correct, there would be no point in bothering to learn any specific techniques - be warm, genuine, congruent and empathic and establish a good therapeutic alliance – period’ (p. 3). Ironically, this is essentially correct. What one does, as a person-centered therapist, is what emerges in the relationship with the client. It is partly allowing the person the freedom to find his or her own ways of dealing with their problems by being in and accepting the client’s perception of the world; hence, creating an atmosphere of unconditional positive regard. In the context of person-centered theory, it is creating an atmosphere of unconditional positive regard that enables the person to develop unconditional positive self-regard and, subsequently, to resolve his or her specific problems. The theory is not one that applies certain conditions the way one applies dosages of drugs to a person in an effort to finalize a treatment plan. The therapy is a human endeavor that trusts the growth of each individual, and wherein the therapist resonates in person to person ways.

    Clinical research with ‘impossible cases’ and the conclusions of psychotherapy outcome research for the past five decades concur with the propositions of Person-Centered Therapy (Duncan, Hubble and Miller, 1997; Duncan and Moynihan, 1994). The client/ therapist relationship and the resources of the client are the paramount concerns. Duncan, et al., parallels the dedication of the person-to-person resonance of Person-Centered Therapy as they summarized their work with ‘impossible cases’ along side the conclusions of psychotherapy outcome research. They state: "Now we honor more simple but enduring acts: validating our clients’ resources, courting their positive experience of therapy and honoring their theory of change . . .’ (p. 33).
 

Overview of Person-Centered Therapy

    This section offers an overview of the theory of ‘Client-Centered Therapy’ which I, along with Rogers, believe is the same as ‘Person-Centered Therapy’ (Rogers, 1987). I believe that the terms client-centered therapy and person-centered therapy are inter-changeable. The theories developed by Rogers are the same basic assumptions for either label. However, the term person-centered therapy implies that the therapist might be more flexible in what he or she does while being dedicated to the client’s world. I contend that this is also the case for client-centered therapy. However, the label of client-centered therapy has become inaccurately associated with a particular response system. This response system is often referred to as ‘reflection’ or ‘reflection of feelings’. The empathic understanding response style is grounded in Rogers’ ideas but also too often results in a focus on the therapist’s specific responses (Brodley, 1994). This is a response style that, in my opinion, was a natural idiosyncratic way of responding by Rogers and one that was promoted by the logical positivistic research of therapy interactions undertaken by Rogers and his colleagues at the University of Chicago in the 1950’s.
 

The Foundation

    The foundation block of person-centered therapy is the actualizing tendency. Rogers stated:

Practice, theory and research make it clear that the person-centered approach is built on a basic trust in the person . . . (It) depends on the actualizing tendency present in every living organism’s tendency to grow, to develop, to realize its full potential. This way of being trusts the constructive directional flow of the human being toward a more complex and complete development. It is this directional flow that we aim to release. (Rogers, 1986b, p. 198) Rogers’ construct of the actualizing tendency is an organismic theory wherein the fundamental qualities in human nature are viewed as those of growth, process and change. In Rogers’ theory, "Man is an actualizing process" (Van Belle, 1980, p. 70). Actualization is the motivational construct in organismic theory and, thus, is embedded in the organismic growth process and is the motive for change. The organism/person is the basic unit of inquiry in Rogers’ conceptualizations. Although Rogers focused on the self-concept in earlier writings and brings in the concept of the formative tendency of the universe in later writings, the construct of the actualizing tendency for the human being is the clear foundation block in individual therapy.

    The person-centered therapist operates on a number of assumptions associated with the actualizing tendency. These assumptions include the orientation that emphasizes the world of the whole person wherein the therapist eschews knowledge ‘about’ the client, relates as an equal to the client, and trusts and respects the client’s perceptions as the authority about him/herself. The basic client/person-centered value is that the authority of the person rests in the person rather than in an outside expert. This value emphasizes the internal (i.e., the client’s) rather than the external (i.e., the therapist’s) view. Clients are viewed as going in their own ways, allowed to go at their own pace, and to pursue their growth in their unique ways. The external view is meaningless in the therapy process since the only function of the therapist is to facilitate the client’s actualizing process. This process is a directional, growth directed process that includes movement towards realization, fulfillment and perfection of inherent capabilities and potentialities of the individual (Rogers, 1963). It is a selective process in that it is directional and constructive. It tends to enhance and maintain the whole organism/person. A summary of the theory can be stated as follows:
 
 

(1)There is one motivating force in a client; i.e., the actualizing tendency.

(2) There is one directive to the therapist; i.e. to embody the attitudinal quality of genuineness and to experience empathic understanding from the client’s internal frame of reference and to experience unconditional positive regard towards the client.

(3) When the client perceives the therapist’s empathic understanding and unconditional positive regard, the actualizing tendency of the client is promoted.

Necessary and Sufficient Conditions

    Person-centered theory posits the presence of a client who is incongruent, vulnerable and anxious but who is also in psychological contact with an attentive, empathic therapist. The therapist experiences and manifests three basic attitudes in the relationship. These attitudes are labeled as (1) congruence, (2) unconditional positive regard, and (3) empathic understanding of the client’s internal frame of reference (Rogers, 1957; 1959). Rogers’ most explicit statements about these attitudes were in his 1957 statement that hypothesized the necessary and sufficient conditions of therapeutic personality change in all therapies and constructive interpersonal relationships that have constructive personality change as a goal. These conditions are also presented with a slightly different slant in his 1959 theoretical statement on psychotherapy, personality theory and interpersonal relations from the Client-Centered frame of reference. In the integration statement of 1957, he stated: 1. Two persons are in psychological contact.

2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.

3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.

4. The therapist experiences unconditional positive regard for the client.

5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavors to communicate this experience to the client.

6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved. (p. 96)

    There are slight but perhaps important differences between the 1957 and 1959 statements. In the 1959 statement, Rogers does not mention that the therapist should ‘ . . .endeavor to communicate . . .’ the experiences of empathic understanding and unconditional positive regard to the client. He continued to emphasize the importance of the client perceiving these two attitudinal experiences of the therapist. Also, the 1959 theory statement refers to the first condition (the pre-condition) simply as ‘contact’ between the client and therapist rather than ‘psychological’ contact.

Rogers’ (1957) definitions of the three attitudinal conditions are the following:

Congruency (or genuineness): ‘ . . .within the relationship (the therapist) is freely and deeply himself, with his actual experience accurately represented by his awareness of himself . . .’ and ‘ . . .he is what he actually is, in this moment of time . . .

Unconditional Positive Regard: ‘ . . .the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client’s experience as being a part of that client . . .’

Empathic Understanding: ‘To sense the client’s private world as if it were your own, but without ever losing the ‘as if’ quality . . .’

The particular manifestations or implementation of these attitudes are variable, within limits, depending upon the personal characteristics of both the therapist and the client. Rogers, in his classic delineation of a theory of psychotherapy, personality and interpersonal relationships imn 1959, hypothesized that in the psychotherapeutic relationship that the more fully and consistently the therapeutic attitudes are provided by the therapist and perceived by the client, the greater the constructive movement that will occur in the client. Rogers’ hypothesis can be generally stated in the following way:
 
 

    When the therapist can consistently be a certain way (i.e., embodying the attitudinal qualities) towards the client while trusting the client’s natural growth process, the forward growth tendency (the actualizing tendency) of the client will be promoted.

    The natural growth process of the individual is promoted when the therapist can be a certain way by embodying certain attitudinal qualities. The therapist strives to be congruent, to experience unconditional positive regard and empathic understanding toward the client. It is interesting to note that Rogers’ message is that the therapist experience empathic understanding of the client’s frame of reference and experience unconditional positive regard towards the client. He adds that the client must perceive these two conditions, at least, to a minimal degree. In therapy, the foundation block of the theory is the actualizing tendency; i.e., the tendency of the organism to grow in a positive and constructive direction; for the person ‘ . . .to become all of his/her potentialities.’ (Bozarth & Brodley, 1991). Put another way: when the therapist can be a certain way by embodying certain attitudinal qualities, then the client’s actualizing tendency is promoted. In addition, the self-actualizing tendency is promoted in a way that is harmonious with the experiencing of the actualizing organism.
 

The Essence of Person-Centered Therapy

    The essence (the basic nature and the basic core) of Person-Centered Therapy is predicated upon the clients’ authority of their own lives. (Bozarth, 1990a). After examining the results of the Bower study, examining the evolution of Carl Rogers as a therapist and from an analysis of Rogers’ writings, the essence of the approach is defined as follows (Bozarth, 1988):

The essence of CC/PC therapy is the therapist’s dedication to going with the client’s direction, at the client’s pace and in the client’s unique way of being. (p.59) And: It is the full commitment " . . .to trust in the client’s own way of going about dealing with his problems and his life." (Brodley, 1988, p. 59) The following points summarize findings that contribute to this conclusion:

    First, the Bower study which is a qualitative study of six notable CC/PC therapists doing therapy. Three listeners independently reviewed an audiotape of each therapist’s therapy sessions. The therapist and client participants responded to questions from the investigator. The emerging consensual data were the following:

1. Therapists had a wide repertoire of non-interfering responses. One therapist responded in a reflective way, with near intrusive reflective responses; another rarely commented, and then only in a way to clarify his uncertainties; another therapist was described as seductive by the listeners; another used a Gestalt- type metaphor that emerged from the client; and another therapist periodically ‘moaned’ throughout the session.

2. The clients perceived the therapists as being helpful; the clients overall directed themselves in the process of inquiry. At times, they waited for the therapists to finish responses before continuing with their own explorations. In short, the therapists were experienced as being received by clients as permissible humans whose specific responses did not seem to interfere with the clients’ directions.

3. The listeners perceived the therapists as disappearing in deference to their clients. They were experienced as being a ‘shadow to the client’. Their presence appeared obvious but there was neither intervention nor intrusion of the personality of the therapist (Bower and Bozarth, 1988).

    The overriding conclusion was that: client-centered/person-centered therapists were experienced (by clients, listeners, and therapists) as non-interfering individuals who entered the world of the client in such a manner as to "disappear" into the client’s own process of development (Bower and Bozarth, 1988).

    In brief, the study also suggested that: 1. The attitudinal qualities of empathy, unconditional positive regard, and congruence (described in various ways) were the consistent therapist attitudes that existed; 2. The therapists held a position of total trust in the client’s own direction and way; 3. The therapists were active and involved with a total dedication towards understanding the client’s world; 4. The therapists had a wide range of response repertoire and personality characteristics but were intent upon understanding and checking their understandings of their clients; and 5. The therapists did not attempt to intervene in the direction, process, or with the pace of the clients.
The therapists were actively involved and readily dialogued with their clients but ‘disappeared’ into the client’s process.
 

Analysis of the evolution of Carl Rogers as a therapist

    My examination of Carl Rogers’ evolution as a therapist is a qualitative inquiry to two questions (Bozarth, 1990a). These questions are: 1. Did Carl Rogers alter his fundamental views of client-centered therapy? and, 2. Did Carl Rogers change his operational functioning as a psychotherapist? It was my intent to further ask: What were these alterations? And, what changes occurred? My basic thought had been that there was significant alteration of some fundamental views; and that his functioning as a therapist had changed over the years.

    My assessment of Rogers’ comments in the literature, his demonstration films, and from previous personal communication led me to conclude that Carl Rogers did not alter his fundamental views of client-centered therapy. I noted that he was quite consistent in his fundamental views of the importance of the conditions of empathy and unconditional positive regard that congruent therapists needed to experience with their clients, and of his dedication to go with his clients in the direction that the client wanted to go and in the way the client wished to do it. He became more explicit about the importance of being ‘genuine’ in the relationship. The importance of genuineness (which Rogers periodically interchanged with congruence) as the primary condition to him was expressed in a dialogue with Wood and in an earlier statement when he commented that even when the conditions of unconditional positive regard and empathy were not experienced by the therapist that genuineness alone may be facilitative (Rogers, 1967; Rogers and Wood, 1984). His more explicit references to the importance of genuineness in the relationship did not represent any fundamental change in view. He was always dedicated to and intent on going with the client’s direction, at the client’s pace, and with the client’s unique way of being (Bozarth, 1990a).

    My assessment of Rogers’ functioning as a therapist by reviewing demonstration films with Miss Mun, Gloria, and Kathy led me to conclude that Carl Rogers did not change his operational functioning as a psychotherapist. (Rogers and Segal, 1955; Shostrum, 1964; Rogers, 1975). He did express a slightly wider range of responses over the twenty year period in the demonstration films; and had some spontaneous expressions that ‘bubbled up’, especially in the Gloria film. A qualitative evaluation of Rogers’ response sets in the three films indicate Rogers’ primary responses to be empathic understanding responses. The categories representing empathic understanding responses were identified as a continue frame representing ‘I am giving you my full attention, please continue’; and a check frame meaning ‘This is what I understand you to be saying. The analysis revealed: 100% of the responses in 1955 were check or continue responses (including empathic under-standing responses); 90% of the responses in 1965 were continue or check responses (the few declarative responses were the notable responses often referred to in the Gloria film); 84% of the responses were continue or check responses in 1975 (Bozarth, 1990b).

    Dr. Brodley’s examination of eight of Rogers’ interviews from the 1940’s to late 1985 using a comparable evaluation scheme revealed that in seven of them 91% to 100% of Dr. Rogers’ responses were empathic following responses (Brodley, 1988). The session consisting of 100% empathic following responses was the one in late 1985.

    Overall it seems accurate to say that Rogers increasingly referred to the importance of genuineness when working with clients and that ‘realness’ of the therapist was increasingly important in his thinking. He responded with slightly more varied comments over the twenty-year time span of the demonstration tapes but his preponderant response efforts were clearly geared to the understanding of his clients’ worlds - whether in 1955, 1965, or 1985. Carl Rogers’ fundamental views of client-centered/person-centered therapy were not altered. He did not significantly change his operational functioning as a psychotherapist (Bozarth, 1990a).

    A more holistic viewing of the films and tapes was interpreted as suggesting that Rogers allowed himself to be more expressive over the years. It also seems likely that his varied comments as a therapist over the time period were more client- and situation-specific. It became clearer to me that whatever Rogers said about CC/PC therapy or did as a therapist was within the context of placing his trust in his clients without doing anything to them or ‘being up to something’ as a therapist.

    These two examinations, the one of six notable CC/PC therapists and the other of the evolution of Carl Rogers as a therapist, support Rogers’ explicit statements about CC/PC therapy; i.e., that the foundation block of the therapy is the actualizing tendency (Rogers, 1980); that ‘. . . it is the client who knows what hurts, what directions to go, what problems are crucial. It would do better to rely upon the client for the direction of movement in the process’ (cited in Kirschenbaum, 1979, P. 89). He had a profound and unwavering dedication to trusting the client as his/her own best authority.

    These reviews lead me to conclude with a functional theoretical premise that: The essence of CC/PC therapy is the therapist’s dedication to going with the client’s direction, at the client’s pace, and with the client’s unique way of being.
 

Implications of the Essence
of Person-Centered Therapy (PCT)

    The implications of the essence of person-centered therapy is a functional premise that precludes other therapist intentions. The therapist goes with the client - goes at the client’s pace - goes with the client in his/her own ways of thinking, of experiencing, of processing. The therapist can not be up to other things, have other intentions without violating the essence of PCT. To be up to other things - whatever they might be - is a ‘yes, but’ reaction to the essence of the approach. It must mean that when the therapist has intentions of treatment plans, of treatment goals, of interventive strategies to get the client somewhere or for the client to do a certain thing, the therapist violates the essence of person-centered therapy. This holds true if the therapist is trying to move the client through a certain process, to encourage clients to experience themselves in a certain way, to teach clients to be empathic, or to impose other therapeutic methods on the client. It is a functional premise that includes wide therapist personality differences, unique ways of doing things, and idiosyncratic ways of responding as far as they are dedicated to the client’s direction, the client’s pace, and the client’s unique way of being (Bozarth, 1984). It is a functional premise that begets therapists who ascribe to Rogers’ principles to test the essence of the approach in a consistent way over time. It is thus that therapists can experience the potency of allowing individuals to engage in their own empowerment, in their own ways without being violated by the personal observations and theories of their therapists.

    Implications of this theoretical stance are integrally related to the concept of the locus of control. The therapist is promoting a natural individual and general process in the client by being a certain way; that is, experiencing certain attitudes toward the client. The client is his/her own best expert about him/her self and his/her life. The therapist’s intent is not to promote feelings or to help the client to become more independent or ‘to get’ the client anywhere. The goal is not self-actualization, actualization, independence or to help the client to become a ‘fully functioning’ person. The only therapist goal is to be a certain way and by being that way a natural growth process is promoted in the client. The foundation of Person-Centered Therapy is consistent with the five decades of findings in psychotherapy outcome research and over ten years of clinical research with impossible clients’. That is, the person of the client must be the master and director for successful outcome.

    The remaining chapters in this book examine Person-Centered Therapy from the perspective of this radically different paradigmatic approach to counseling and psychotherapy.

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email Jerold D. Bozarth, PhD