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7Person-Centered Therapy

1. Examine the evolution of person- centered therapy over time.

2. Describe the main thrust of emotion-focused therapy.

3. Differentiate the contributions of Carl Rogers and Abraham Maslow to humanistic psychology.

4. Understand the role of the therapist’s attitudes in the therapy process.

5. Describe the ways that empathy, unconditional positive regard, and genuineness are fundamental to the process and outcome of therapy.

6. Identify the personal characteristics of therapists that are essential for clients’ progress.

7. Examine the application of the person-centered approach to crisis intervention.

8. Understand the unique characteristics of person-centered expressive arts and how it is based on person-centered philosophy.

9. Examine the key concepts and principles of motivational interviewing and the stages of change.

10. Recognize the contributions and shortcomings of the person-centered approach to understanding and working with clients from diverse cultures.

11. Identify the contributions and limitations of the person-centered approach.

L e a r n i n g O b j e c t i v e s

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164 CHAPTER SEVEN

CARL ROGERS (1902–1987), a major spokesperson for humanistic psychol- ogy, led a life that reflected the ideas he developed for half a century. He showed a questioning stance, a deep openness to change, and the courage to forge into unknown territory both as a person and as a professional. In writing about his early years, Rogers (1961) recalled his fam- ily atmosphere as characterized by close and warm relationships but also by strict religious standards. Play was discouraged, and the virtues of the Protestant ethic were extolled. His boyhood was somewhat lonely, and he pursued scholarly interests instead of social ones. Rogers was an introverted person, and he spent a lot of time reading and engaging in imaginative activity and reflection. During his college years his interests and academic major changed from agriculture to history, then to religion, and finally to clinical psychology.

Rogers held academic positions in various fields, including education, social work, counseling, psycho- therapy, group therapy, peace, and interpersonal rela- tions, and he earned recognition around the world for originating and developing the humanistic movement in psychotherapy. His foundational ideas, especially the central role of the client–therapist relationship as a means to growth and change, have been incorporated in many other theoretical approaches. Rogers’s ideas continue to have far-reaching effects on the field of psy- chotherapy (Cain, 2010).

It is difficult to overestimate the significance of Rogers’s contributions to clinical and counseling

psychology. He was a courageous pioneer who “was about 50 years ahead of his time and has been waiting for us to catch up” (Elkins, 2009, p. 20). Often called the “father of psychotherapy research,” Rogers was the first to study the counseling pro- cess in depth by analyzing the transcripts of actual therapy sessions, and he was the first clinician to conduct major stud- ies on psychotherapy using quantitative methods. He was the first to formulate a comprehensive theory of personality and psychotherapy grounded in empirical

research, and he contributed to developing a theory of psychotherapy that focused on the strengths and resources of individuals. He was not afraid to take a strong position and challenged the status quo throughout his professional career.

During the last 15 years of his life, Rogers applied the person-centered approach to world peace by train- ing policymakers, leaders, and groups in conflict. Perhaps his greatest passion was directed toward the reduction of interracial tensions and the effort to achieve world peace, for which he was nominated for the Nobel Peace Prize.

For a detailed video presentation of the life and works of Carl Rogers, see Carl Rogers: A Daughter’s Tribute (N. Rogers, 2002), which is described at the end of this chapter. For an in-depth look at this remarkable man and his work, see Carl Rogers: The Quiet Revolutionary (Rogers & Russell, 2002) and The Life and Work of Carl Rogers (Kirschenbaum, 2009).

NATALIE ROGERS (b. 1928) is a pioneer in the field of person-centered expres- sive arts therapy. She expanded on her father’s (Carl Rogers) theory of cre- ativity by using the expressive arts to enhance personal growth for individuals and groups. Person-centered expres- sive arts therapy employs a variety of forms—movement, painting, sculpting, music, writing, and improvisation—in a supportive setting to facilitate growth and healing. It extends person-centered

theory by helping individuals access their feelings through creative expressions. N. Rogers has developed the concept of the creative connection®—a process whereby the client or group member is invited to access inner feelings through an uninterrupted sequence of movement, sound, visual art, and journal writing. As the client moves through this process, hidden or unconscious aspects of self are discovered, and these insights are shared with the therapist.

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Introduction Of all the pioneers who have founded a therapeutic approach, for me Carl Rogers stands out as one of the most influential figures in revolutionizing the direction of counseling theory and practice. Rogers has become known as a “quiet revolution- ary” who both contributed to theory development and whose influence continues to shape counseling practice today (see Cain, 2010; Kirschenbaum, 2009; Rogers & Russell, 2002).

The person-centered approach shares many concepts and values with the exis- tential perspective presented in Chapter 6. Rogers’s basic assumptions are that peo- ple are essentially trustworthy, that they have a vast potential for understanding themselves and resolving their own problems without direct intervention on the therapist’s part, and that they are capable of self-directed growth if they are involved in a specific kind of therapeutic relationship. From the beginning, Rogers empha- sized the attitudes and personal characteristics of the therapist and the quality of the client–therapist relationship as the prime determinants of the outcome of the thera- peutic process. He consistently relegated to a secondary position matters such as the therapist’s knowledge of theory and techniques. This belief in the client’s capac- ity for self-healing is in contrast with many theories that view the therapist’s tech- niques as the most powerful agents that lead to change (Bohart & Tallman, 2010). Clearly, Rogers revolutionized the field of psychotherapy by proposing a theory that centered on the client as the primary agent for constructive self-change (Bohart & Tallman, 2010; Bozarth, Zimring, & Tausch, 2002; Elkins, 2016).

Contemporary person-centered therapy is the result of an evolutionary pro- cess that continues to remain open to change and refinement (see Cain, 2010; Cain & Seeman, 2002). Rogers did not present the person-centered theory as a fixed and completed approach to therapy. He hoped that others would view his theory as a set of tentative principles relating to how the therapy process devel- ops, not as dogma. Rogers expected his model to evolve and was open and recep- tive to change.

Visit CengageBrain.com or watch the dVd for the video program on Chapter 7, Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the brief lecture for each chapter prior to reading the chapter.

N. Rogers’s work evolved from what she felt was lacking in her father’s theory. As a woman growing up in an era when females were meant to be accommodating to men, she eventually discovered her underlying anger at being a second-class citizen. Her art was one vehi- cle to express and gain insight into this injustice. She also expressed her anger at her father because he was unknowingly a part of the patriarchal system. He was surprised but open to learning. After hearing about the role he and other men played in holding women back, he changed many of his ways of being and writing.

Today, at 87 years of age, N. Rogers continues to find ways to bring meaning to her personal and pro- fessional life. During the past 10 years she taught and facilitated workshops in the United States, England, Hong Kong, Latin America, Russia, and South Korea. She continues to participate in teaching the six-week expressive arts certificate program at Sofia University in northern California. See the resources section at the end of this chapter if you are interested in train- ing in the person-centered approach to expressive arts therapy.

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Four Periods of Development of the Approach In tracing the major turning points in Rogers’s approach, Zimring and Raskin (1992) and Bozarth, Zimring, and Tausch (2002) have identified four periods of development. In the first period, during the 1940s, Rogers developed what was known as nondirective counseling, which provided a powerful and revolutionary alter- native to the directive and interpretive approaches to therapy then being practiced. While he was a professor at Ohio State University, Rogers (1942) published Counsel- ing and Psychotherapy: Newer Concepts in Practice, which described the philosophy and practice of nondirective counseling. Rogers’s theory emphasized the counselor’s creation of a permissive and nondirective climate. When he challenged the basic assumption that “the counselor knows best,” he realized this radical idea would affect the power dynamics and politics of the counseling profession, and indeed it caused a great furor (Elkins, 2009).

Rogers also challenged the validity of commonly accepted therapeutic proce- dures such as advice, suggestion, direction, persuasion, teaching, diagnosis, and interpretation. Based on his conviction that diagnostic concepts and procedures were inadequate, prejudicial, and often misused, Rogers omitted them from his approach. Nondirective counselors avoided sharing a great deal about themselves with clients and instead focused mainly on reflecting and clarifying the clients’ ver- bal communications and intended meanings.

In the second period, during the 1950s, Rogers (1951) renamed his approach client-centered therapy, which reflected his emphasis on the client rather than on non- directive methods. In addition, he started the Counseling Center at the University of Chicago. This period was characterized by a shift from clarification of feelings to a focus on the phenomenological world of the client. Rogers assumed that the best vantage point for understanding how people behave was from their own internal frame of reference. He focused more explicitly on the actualizing tendency as the basic motivational force that leads to client change.

The third period, which began in the late 1950s and extended into the 1970s, addressed the necessary and sufficient conditions of therapy. Rogers (1957) set forth a hypothesis that resulted in three decades of research. A significant publication was On Becoming a Person (C. Rogers, 1961), which addressed the nature of “becoming the self that one truly is,” an idea he borrowed from Kierkegaard. Rogers published this work during the time that he held joint appointments in the departments of psychology and psychiatry at the University of Wisconsin. In this book he described the process of “becoming one’s experience,” which is characterized by an openness to experience, a trust in one’s experience, an internal locus of evaluation, and the willingness to be in process. During the 1950s and 1960s, Rogers and his associates continued to test the underlying hypotheses of the client-centered approach by con- ducting extensive research on both the process and the outcomes of psychotherapy. He was interested in how people best progress in psychotherapy, and he studied the qualities of the client–therapist relationship as a catalyst leading to personality change.

Rogers and his associates at the University of Chicago conducted research to identify the ingredients in psychotherapy that account for therapeutic change. The client-centered approach emphasized the role of the therapist as a facilitator of

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growth and honored the inherent power of the client. Research findings consistently supported this approach, confirming that therapeutic change is due to personal and interpersonal factors rather than to specific techniques for curing specific disorders (Elkins, 2016). On the basis of this research, the approach was further refined and expanded (C. Rogers, 1961). For example, client-centered philosophy was applied to education and was called student-centered teaching (C. Rogers & Freiberg, 1994). The approach was also applied to encounter groups (C. Rogers, 1970).

The fourth phase, during the 1980s and the 1990s, was marked by considerable expansion to education, couples and families, industry, groups, conflict resolution, politics, and the search for world peace. Because of Rogers’s ever-widening scope of influence, including his interest in how people obtain, possess, share, or surrender power and control over others and themselves, his theory became known as the per- son-centered approach. This shift in terms reflected the broadening application of the approach. Although the person-centered approach has been applied mainly to indi- vidual and group counseling, important areas of further application include educa- tion, family life, leadership and administration, organizational development, health care, cross-cultural and interracial activity, and international relations. During the 1980s Rogers directed his efforts toward applying the person-centered approach to politics, especially to efforts related to the achievement of world peace.

In a comprehensive review of the research on person-centered therapy over a period of 60 years, Bozarth, Zimring, and Tausch (2002) concluded the following:

ŠŠ In the earliest years of the approach, the client rather than the therapist determined the direction and goals of therapy and the therapist’s role was to help the client clarify feelings. This style of nondirective therapy was associated with increased understanding, greater self-exploration, and improved self-concepts.

ŠŠ Later a shift from clarification of feelings to a focus on the client’s lived experiences took place.

ŠŠ As person-centered therapy developed further, research centered on the core conditions assumed to be both necessary and sufficient for successful therapy. The attitude of the therapist—an empathic under- standing of the client’s world and the ability to communicate a non- judgmental stance to the client—along with the therapist’s genuineness were found to be basic to a successful therapy outcome.

ŠŠ The main source of successful psychotherapy is the client. The therapist’s attention to the client’s frame of reference fosters the client’s utilization of inner and outer resources.

Emotion-Focused Therapy emotion-focused therapy (eFt) emerged as a person-centered “approach informed by understanding the role of emotion in human functioning and psycho- therapeutic change” (Greenberg, 2014, p. 15). Leslie Greenberg, a prominent figure in the development of this integrative approach, states that EFT is designed to help clients increase their awareness of their emotions and make productive use of them. Like person-centered therapists, emotion-focused therapists establish a therapeutic

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relationship based on the core therapeutic conditions. Once the therapeutic alliance is created, however, the EFT practitioner actively works with emotions using a range of experiential techniques to strengthen the self, regulate affect, and create new mean- ing. New narratives can be created that disrupt maladaptive past emotional schemas, which provides opportunities for positive emotional experiencing (McDonald, 2015).

EFT strategies focus on two major tasks: (1) help clients with too little emotion access their emotions, and (2) help clients who experience too much emotion con- tain their emotions (Greenberg, 2014). Many traditional therapies emphasize con- scious understanding and cognitive and behavioral change, but they often neglect the foundational role of emotional change. A main goal of EFT is to help individuals access and process emotions to construct new ways of being. This approach has a good deal to offer with respect to teaching us about the role of emotion in per- sonal change and how emotional change can be a primary pathway to cognitive and behavioral change (Greenberg, 2014).

EFT emphasizes the importance of awareness, acceptance, and understanding the visceral experience of emotion. Greenberg (2014) believes that our emotions cannot be change merely by talking about them, understanding their origins, or by modifying our beliefs. Clients are encouraged to identify, experience, accept, express, explore, transform, and manage their emotions. The act of experiencing feelings and replacing old feelings with new positive feelings offers a corrective emotional expe- rience. “One changes emotions by accepting and experiencing them, by opposing them with different emotions to transform them, and by reflecting on them to cre- ate new narrative meaning” (p. 18).

Both psychoanalytic and cognitive behavioral approaches are increasingly focus- ing on emotions and are rapidly assimilating many aspects of EFT. Gestalt therapy has always emphasized experiencing and exploring emotions. McDonald (2015) reports that a strength of EFT is that it is an empirically validated brief therapeutic approach with demonstrated effectiveness in treating anxiety, intimate partner vio- lence, eating disorders, and trauma. EFT is being applied to counseling individuals, groups, couples, families, and in working in diverse cultural contexts.

The theory and practice of EFT are only briefly discussed in this chapter. For an in-depth discussion of the principles and techniques involved in the practice of EFT, see Greenberg (2011), Emotion-Focused Therapy.

Existentialism and Humanism In the 1960s and 1970s there was a growing interest among counselors in a “third force” in therapy as an alternative to the psychoanalytic and behavioral approaches. Under this heading fall existential therapy (Chapter 6), person-centered therapy (Chapter 7), Gestalt therapy (Chapter 8), and certain other experiential and rela- tionship-oriented approaches.

The connections between the terms existentialism and humanism have tended to be confusing for students and theorists alike. The two viewpoints have much in common, yet there also are significant philosophical differences between them. They share a respect for the client’s subjective experience, the uniqueness and individual- ity of each client, and a trust in the capacity of the client to make positive and con- structive conscious choices. They have in common an emphasis on concepts such as

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freedom, choice, values, personal responsibility, autonomy, purpose, and meaning. Both approaches place little value on the role of techniques in the therapeutic pro- cess and emphasize instead the importance of genuine encounter.

They differ in that existentialists take the position that we are faced with the anxiety of choosing to create an identity in a world that lacks intrinsic meaning. Existentialists tend to acknowledge the stark realities of human experience, and their writings often focus on death, anxiety, meaninglessness, and isolation. The humanists, in contrast, take the somewhat less anxiety-evoking and more optimistic view that each of us has a natural potential that we can actualize and through which we can find meaning. Many contemporary existential therapists refer to themselves as existential-humanistic practitioners, indicating that their roots are in existential philosophy but that they have incorporated many aspects of North American humanistic psychotherapies (Cain, 2002a; Schneider & Krug, 2010).

As will become evident in this chapter, the existential and person-centered approaches have parallel concepts with regard to the client–therapist relationship being at the core of therapy. The phenomenological emphasis that is basic to the exis- tentialist approach is also fundamental to person-centered theory. Both approaches focus on the client’s perceptions and call for the therapist to be fully present with the client so that it is possible to understand the client’s subjective world, and they both emphasize the client’s capacity for self-awareness and self-healing. The therapist aims to provide the client with a safe, responsive, and caring relationship to facilitate self- exploration, growth, and healing (Watson, Goldman, & Greenberg, 2011).

Abraham Maslow’s Contributions to Humanistic Psychology Abraham Maslow (1970) was a pioneer in the development of humanistic psychology and was influential in furthering the understanding of self-actualizing individuals. Many of Carl Rogers’s ideas, especially on the positive aspects of being human and the fully functioning person, are influenced by Maslow’s basic philoso- phy. Maslow criticized Freudian psychology for what he saw as its preoccupation with the sick and dark side of human nature. Maslow believed too much research was being conducted on anxiety, hostility, and neuroses and too little into joy, cre- ativity, and self-fulfillment. Self-actualization was the central theme of the work of Abraham Maslow (1968, 1970, 1971). The positive psychology movement that recently has come into prominence shares many concepts on the healthy side of human existence with the humanistic approach.

Maslow studied what he called “self-actualizing people” and found that they dif- fered in important ways from so-called normal individuals. The core characteristics of self-actualizing people are self-awareness, freedom, basic honesty and caring, and trust and autonomy. Other characteristics of self-actualizing individuals include a capacity to welcome uncertainty in their lives, acceptance of themselves and others, spontane- ity and creativity, a need for privacy and solitude, autonomy, a capacity for deep and intense interpersonal relationships, a genuine caring for others, an inner-directedness (as opposed to the tendency to live by others’ expectations), the absence of artificial dichotomies within themselves (such as work/play, love/hate, and weak/strong), and a sense of humor (Maslow, 1970). All of these personal characteristics are compatible with the person-centered philosophy.

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Maslow postulated a hierarchy of needs as a source of motivation, with the most basic needs being physiological needs. If we are hungry and thirsty, our attention is riveted on meeting these basic needs. Next are the safety needs, which include a sense of security and stability. Once our physical and safety needs are fulfilled, we become concerned with meeting our needs for belonging and love, followed by our need for esteem, both from self and others. We are able to strive toward self-actualization only after these four basic needs are met. The key factor determining which need is dominant at a given time is the degree to which those below it are satisfied.

The Vision of Humanistic Philosophy The underlying vision of humanistic philosophy is captured by the metaphor of how an acorn, if provided with the appropriate conditions, will “automatically” grow in positive ways, pushed naturally toward its actualization as an oak. In contrast, for many existentialists there is nothing that we “are,” no internal “nature” we can count on. We are faced at every moment with a choice about what to make of this condition. Maslow’s emphasis on the healthy side of being human and the emphasis on joy, creativity, and self-fulfillment are part of the person-centered philosophy. The humanistic philosophy on which the person-centered approach rests is expressed in attitudes and behaviors that create a growth-producing climate. According to Rogers (1986b), when this philosophy is lived, it helps people develop their capacities and stimulates constructive change in others. Individuals are empowered, and they are able to use this power for personal and social transformation.

Key Concepts View of Human Nature

A common theme originating in Rogers’s early writing and continuing to permeate all of his works is a basic sense of trust in the client’s ability to move forward in a constructive manner if conditions fostering growth are present. His professional experience taught him that if one is able to get to the core of an individual, one finds a trustworthy, positive center (C. Rogers, 1987a). In keeping with the philosophy of humanistic psychology, Rogers firmly maintained that people are trustworthy, resourceful, capable of self-understanding and self-direction, able to make construc- tive changes, and able to live effective and productive lives. When therapists are able to experience and communicate their realness, support, caring, and nonjudgmental understanding, significant changes in the client are most likely to occur.

Rogers maintained that three therapist attributes create a growth-promoting climate in which individuals can move forward and become what they are capable of becoming: (1) congruence (genuineness, or realness), (2) unconditional positive regard (acceptance and caring), and (3) accurate empathic understanding (an ability to deeply grasp the subjective world of another person). According to Rogers, if therapists communicate these attitudes, those being helped will become less defensive and more open to themselves and their world, and they will behave in prosocial and con- structive ways.

The actualizing tendency is a directional process of striving toward realization, fulfillment, autonomy, and self-determination. This natural inclination of humans

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is based on Maslow’s (1970) studies of self-actualizing people, and it has significant implications for the practice of therapy. Because of the belief that the individual has an inherent capacity to move away from maladjustment and toward psychological health and growth, the therapist places the primary responsibility on the client. The person- centered approach rejects the role of the therapist as the authority who knows best and of the passive client who depends on the therapist’s expertise. Therapy is rooted in the client’s capacity for awareness and self-directed change in attitudes and behavior.

The person-centered approach emphasizes clients’ abilities to engage their own resources to act in their world with others. Clients can move forward in constructive directions and successfully deal with obstacles (both from within themselves and outside of themselves) that are blocking their growth. By promoting self-awareness and self-reflection, clients learn to exercise choice. Humanistic therapists emphasize a discovery-oriented approach in which clients are the experts on their own inner experience (Watson et al., 2011), and they encourage clients to make changes that will lead to living fully and authentically, with the realization that this kind of exis- tence demands a continuing struggle.

The Therapeutic Process Therapeutic Goals

Rogers did not believe the goal of therapy was merely to solve problems. Rather, the goal is to assist clients in achieving a greater degree of independence and integra- tion so they can better cope with problems as they identify them. 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 facades. In a climate of safety in the therapeutic session, they also come to realize that there are more authentic ways of being. The therapist does not choose specific goals for the client. The cornerstone of person-centered theory is the view that clients in a relationship with a facilitating therapist have the capacity to define and clarify their own goals. Person-centered therapists are in agreement on the matter of not setting goals for what clients need to change, yet they differ on the matter of how to best help clients achieve their own goals and to find their own answers (Bohart & Watson, 2011).

Therapist’s Function and Role The role of person-centered therapists is rooted in their ways of being and attitudes, not in techniques designed to get the client to “do something.” Research on person-centered therapy indicates that the attitude of therapists, rather than their knowledge, theories, or techniques, facilitate personality change in clients (C. Rogers, 1961). Basically, therapists use themselves as an instrument of change by encountering clients on a person-to-person level. In examining the human elements of psychotherapy, Elkins (2016) concludes that the human dimensions are more powerful determinants of therapeutic effectiveness than theories or techniques. It is the therapist’s attitude and belief in the inner resources of the client that creates the therapeutic climate for growth (Bozarth et al., 2002).

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Person-centered theory holds that the therapist’s function is to be present and accessible to clients and to focus on their immediate experience. First and foremost, the therapist must be willing to be real in the relationship with clients. By being congruent, accepting, and empathic, the therapist is a catalyst for change. Instead of viewing clients in preconceived diagnostic categories, the therapist meets them on a moment-to-moment experiential basis and enters their world. Through the thera- pist’s attitude of genuine caring, respect, acceptance, support, and understanding, clients are able to loosen their defenses and rigid perceptions and move to a higher level of personal functioning. When these therapist attitudes are present, clients then have the necessary freedom to explore areas of their life that were either denied to awareness or distorted.

Client’s Experience in Therapy Therapeutic change depends on clients’ perceptions both of their own experience in therapy and of the counselor’s basic attitudes. If the counselor creates a climate conducive to self-exploration, clients have the opportunity to explore the full range of their experience, which includes their feelings, beliefs, behavior, and worldview. What follows is a general sketch of clients’ experiences in therapy.

Clients come to the counselor in a state of incongruence; that is, a discrepancy exists between their self-perception and their experience in reality. For example, Leon, a college student, may see himself as a future physician, yet his below-average grades could exclude him from medical school. The discrepancy between how Leon sees himself (self-concept) or how he would like to view himself (ideal self-concept) and the reality of his poor academic performance may result in anxiety and personal vul- nerability, which can provide the necessary motivation to enter therapy. Leon must perceive that a problem exists or, at least, that he is uncomfortable enough with his present psychological adjustment to want to explore possibilities for change.

One reason clients seek therapy is a feeling of basic helplessness, powerlessness, and an inability to make decisions or effectively direct their own lives. They may hope to find “the way” through the guidance of the therapist. Within the person- centered framework, however, clients soon learn that they can be responsible for themselves in the relationship and that they can learn to be more free by using the relationship to gain greater self-understanding.

As counseling progresses, clients are able to explore a wider range of beliefs and feelings. They can express their fears, anxiety, guilt, shame, hatred, anger, and other emotions that they had deemed too negative to accept and incorporate into their self-structure. With therapy, people distort less and move to a greater acceptance and integration of conflicting and confusing feelings. They increasingly discover aspects within themselves that had been kept hidden. As clients feel understood and accepted, they become less defensive and become more open to their experience. Because they feel safer and are less vulnerable, they become more realistic, perceive others with greater accuracy, and become better able to understand and accept oth- ers. Individuals in therapy come to appreciate themselves more as they are, and their behavior shows more flexibility and creativity. They become less concerned about meeting others’ expectations, and thus begin to behave in ways that are truer to themselves. These individuals direct their own lives instead of looking outside of

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themselves for answers. They move in the direction of being more in contact with what they are experiencing at the present moment, less bound by the past, less deter- mined, freer to make decisions, and increasingly trusting in themselves to manage their own lives. In short, their experience in therapy is like throwing off the self- imposed shackles that had kept them in a psychological prison. With increased free- dom, they tend to become more mature psychologically and move toward increased self-actualization.

Person-centered therapy is grounded on the assumption that clients create their own self-growth and are active self-healers (Bohart & Tallman, 1999, 2010; Bohart & Wade, 2013; Bohart & Watson, 2011). The therapy relationship provides a support- ive structure within which clients’ self-healing capacities are activated. What clients value most is being understood and accepted, which results in creating a safe place to explore feelings, thoughts, behaviors, and experiences; clients also value support for trying out new behaviors (Bohart & Tallman, 2010).

Relationship Between Therapist and Client Rogers (1957) based his hypothesis of the “necessary and sufficient condi- tions for therapeutic personality change” on the quality of the relationship: “If I can provide a certain type of relationship, the other person will discover within himself or herself the capacity to use that relationship for growth and change, and personal development will occur” (C. Rogers, 1961, p. 33). Rogers (1967) hypothesized fur- ther that “significant positive personality change does not occur except in a rela- tionship” (p. 73). Rogers’s hypothesis was formulated on the basis of many years of his professional experience, and it remains basically unchanged to this day.

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 term the therapist, is congruent (real or

genuine) in the relationship, and this congruence is perceived by the client.

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 experi- ence to the client.

6. The communication to the client of the therapist’s empathic under- standing and unconditional positive regard is to a minimal degree achieved. (as cited in Cain 2002a, p. 20)

Rogers hypothesized that no other conditions were necessary. If the therapeutic core conditions exist over some period of time, constructive personality change will occur. The core conditions do not vary according to client type. Further, they are both necessary and sufficient for therapeutic change to occur.

From Rogers’s perspective, the client–therapist relationship is characterized by equality. Therapists do not keep their knowledge a secret or attempt to mystify the therapeutic process. The process of change in the client depends to a large degree

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on the quality of this equal relationship. As clients experience the therapist listen- ing in an accepting way to them, they gradually learn how to listen acceptingly to themselves. As they find the therapist caring for and valuing them (even the aspects that have been hidden and regarded as negative), clients begin to develop worth and value in themselves. As they experience the realness of the therapist, clients drop many of their pretenses and become real with both themselves and the therapist.

This humanistic approach is perhaps best characterized as a way of being and as a shared journey in which therapist and client reveal their humanness and participate in a growth experience. The therapist can be a relational guide on this journey because he or she is usually more psychologically experienced in this role than the client. Therapists are invested in broadening their own life experiences and are willing to do what it takes to deepen their self-knowledge.

Rogers admitted that his theory was strikingly provocative and radical. His for- mulation has generated considerable controversy, for he maintained that many con- ditions other therapists commonly regard as necessary for effective psychotherapy were nonessential. The core therapist conditions of congruence, unconditional posi- tive regard, and accurate empathic understanding subsequently have been embraced by many therapeutic schools as essential in facilitating therapeutic change. These core qualities of therapists, along with the therapist’s presence, work holistically to create a safe environment for learning (Cain, 2010). Regardless of theoretical orien- tation, most therapists strive to listen fully and empathically to clients, especially during the initial stages of therapy. We now turn to a detailed discussion of how these core conditions are an integral part of the therapeutic relationship.

Congruence, or Genuineness congruence implies that therapists are real; that is, they are genuine, integrated, and authentic during the therapy hour. They are without a false front, their inner experience and outer expression of that experience match, and they can openly express feelings, thoughts, reactions, and attitudes that are present in the relationship with the client. This communication is done with careful reflection and considered judgment on the therapist’s part (Kolden, Klein, Wang, & Austin, 2011).

Through authenticity the therapist serves as a model of a human being strug- gling toward greater realness. Being congruent might necessitate expressing a range of feelings including anger, frustration, liking, concern, and annoyance. This does not mean that therapists should impulsively share all their reactions, for self- disclosure must be appropriate, well timed, and have a constructive therapeutic intent. Counselors can try too hard to be genuine; sharing because they think it will be good for the client, without being genuinely moved to express something regarded as personal, can be incongruent. Person-centered therapy stresses that counseling will be inhibited if the counselor feels one way about the client but acts in a different way. For example, if the practitioner dislikes or disapproves of the cli- ent but feigns acceptance, therapy will be impaired. Cain (2010) stresses that thera- pists need to be attuned to the emerging needs of the client and to respond in ways that are in the best interests of the individual. If therapists keep this in mind, they are likely to make sound therapeutic decisions most of the time.

Rogers’s concept of congruence does not imply that only a fully self-actualized therapist can be effective in counseling. Because therapists are human, they cannot

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be expected to be fully authentic. Congruence exists on a continuum from highly congruent to very incongruent. This is true of all three characteristics.

Unconditional Positive Regard and Acceptance The second attitude therapists need to communicate is deep and genuine caring for the client as a person. Unconditional positive regard can best be achieved through empathic identifica- tion with the client (Farber & Doolin, 2011). The caring is nonpossessive and is not contaminated by evaluation or judgment of the client’s feelings, thoughts, and behavior as good or bad. Therapists value and warmly accept clients without placing stipulations on their acceptance. It is not an attitude of “I’ll accept you when . . . ”; rather, it is one of “I’ll accept you as you are.” Therapists communicate through their behavior that they value their clients as they are and that clients are free to have feelings and experiences.

According to Rogers’s (1977) research, the greater the degree of caring, prizing, accepting, and valuing of the client in a nonpossessive way, the greater the chance that therapy will be successful. He also makes it clear that it is not possible for thera- pists to genuinely feel acceptance and unconditional caring at all times. However, if therapists have little respect for their clients, or an active dislike or disgust, it is not likely that the therapeutic work will be fruitful. If therapists’ caring stems from their own need to be liked and appreciated, constructive change in the client is inhibited. This notion of positive regard has implications for all therapists, regardless of their theoretical orientation (Farber & Doolin, 2011).

Accurate Empathic Understanding One of the main tasks of the therapist is to understand clients’ experience and feelings sensitively and accurately as they are revealed in the moment-to-moment interaction during the therapy session. The therapist strives to sense clients’ subjective experience, particularly in the here and now. The aim is to encourage clients to get closer to themselves, to feel more deeply and intensely, and to recognize and resolve the incongruity that exists within them.

empathy is a deep and subjective understanding of the client with the client. Empathy is not sympathy, or feeling sorry for a client. Therapists are able to share the client’s subjective world by drawing from their own experiences that may be similar to the client’s feelings. Yet therapists must not lose their own separateness. Rogers asserts that when therapists can grasp the client’s private world as the client sees and feels it—without losing the separateness of their own identity—constructive change is likely to occur. Empathy, particularly emotionally focused empathy, helps clients (1) pay attention to and value their experiencing, (2) process their experience both cognitively and bodily, (3) view prior experiences in new ways, and (4) increase their confidence in making choices and in pursuing a course of action (Cain, 2010).

Clark (2010) describes an integral model of empathy in the counseling process that is based on three ways of knowing: (1) subjective empathy enables practitioners to experience what it is like to be the client; (2) interpersonal empathy pertains to under- standing a client’s internal frame of reference and conveying a sense of the private meanings to the person; and (3) objective empathy relies on knowledge sources outside of a client’s frame of reference. By using a multiple-perspective model of empathy, counselors have a broader way to understand clients.

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Accurate empathy is the cornerstone of the person-centered approach, and it is a necessary ingredient of any effective therapy (Cain, 2010). accurate empathic understanding implies that the therapist will sense clients’ feelings as if they were his or her own without becoming lost in those feelings. It is a way for therapists to hear the meanings expressed by their clients that often lie at the edge of their aware- ness. A primary means of determining whether an individual experiences a thera- pist’s empathy is to secure feedback from the client (Norcross, 2010).

According to Watson (2002), full empathy entails understanding the meaning and feeling of a client’s experiencing. It is like grasping “what it is like to be you.” Empathy is an active ingredient of change that facilitates clients’ cognitive processes and emotional self-regulation. Watson’s comprehensive review of the research litera- ture on therapeutic empathy has consistently demonstrated that therapist empathy is the most potent predictor of client progress in therapy. Empathy is an essential component of successful therapy in every therapeutic modality.

Clients’ perceptions of feeling understood by their therapists relate favorably to outcome. Empathic therapists strive to discover the meaning of the client’s experi- ence, understand the overall goals of the client, and tailor their responses to the particular client. Effective empathy is grounded in authentic caring for the client (Elliott, Bohart, Watson, & Greenberg, 2011).

Application: Therapeutic Techniques and Procedures Early Emphasis on Reflection of Feelings

Rogers’s original emphasis was on grasping the world of the client and reflecting this understanding. As his view of psychotherapy developed, however, his focus shifted away from an absolutist, nondirective stance and emphasized the therapist’s relationship with the client. Many followers of Rogers simply imitated his reflec- tive style, and client-centered therapy has often been identified primarily with the technique of reflection despite Rogers’s contention that the therapist’s relational attitudes and fundamental ways of being with the client constitute the heart of the change process. Rogers and other contributors to the development of the person- centered approach have been critical of the stereotypic view that this approach is basically a simple restatement of what the client just said.

Evolution of Person-Centered Methods Contemporary person-centered therapy is the result of an evolutionary pro- cess of more than 70 years, and it continues to remain open to change and refine- ment. One of Rogers’s main contributions to the counseling field is the notion that the quality of the therapeutic relationship, as opposed to administering techniques, is the primary agent of growth in the client. The therapist’s ability to establish a strong connection with clients is the critical factor determining successful counsel- ing outcomes.

No techniques are basic to the practice of person-centered therapy; “being with” clients and entering imaginatively into their world of perceptions and feelings is sufficient for facilitating a process of change. Person-centered therapists are not

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prohibited from suggesting techniques, but how these suggestions are presented is crucial. Some clients do better with more direction, whereas others do better in a nondirective climate (Cain, 2010). What is essential for clients’ progress is the thera- pist’s presence—being completely attentive to and immersed in the client as well as in the client’s expressed concerns (Cain, 2010). Qualities and skills such as listening, accepting, respecting, understanding, and responding must be honest expressions by the therapist. Techniques may be suggested when doing so fosters the process of client and therapist being together in an empathic way. Techniques are not attempts at “doing anything” to a client (Bohart & Watson, 2011).

Rogers expected person-centered therapy to continue to evolve and supported others in breaking new ground. One of the main ways in which person-centered therapy has evolved is the diversity, innovation, and individualization in practice. There is no longer one way of practicing person-centered therapy (Cain, 2010), and there has been increased latitude for therapists to share their reactions, to confront clients in a caring way, and to participate more actively and fully in the therapeutic process (Bozarth et al., 2002). immediacy, or addressing what is going on between the client and therapist, is highly valued in this approach. This development encour- ages the use of a wider variety of methods and allows for considerable diversity in personal style among person-centered therapists. The shift toward genuineness enables person-centered therapists both to practice in more flexible and integrative ways that suit their personalities and to have greater flexibility in tailoring the coun- seling relationship to suit different clients (Bohart & Watson, 2011).

Cain (2010, 2013) believes it is essential for therapists to adapt their therapeutic style to accommodate the unique needs of each client. Person-centered therapists have the freedom to use a variety of responses and methods to assist their clients; a guiding question therapists need to ask is, “Does it fit?” Cain contends that, ide- ally, therapists will continually monitor whether what they are doing fits, especially whether their therapeutic style is compatible with their clients’ way of viewing and understanding their problems. For an illustration of how Dr. David Cain works with the case of Ruth in a person-centered style, see Case Approach to Counseling and Psychotherapy (Corey, 2013, chap. 5).

Today, those who practice a person-centered approach work in diverse ways that reflect both advances in theory and practice and a plethora of personal styles. This is appropriate and fortunate, for none of us can emulate the style of Carl Rogers and still be true to ourselves. If we strive to model our style after Rogers, and if that style does not fit for us, we are not being ourselves and we are not being fully congruent.

The Role of Assessment Assessment is frequently viewed as a prerequisite to the treatment process. Many mental health agencies use a variety of assessment procedures, including diagnostic screening, identification of clients’ strengths and liabilities, and various tests. Person- centered therapists generally do not find traditional assessment and diagnosis to be useful because these procedures encourage an external and expert perspective on the client (Bohart & Watson, 2011). What matters is not how the counselor assesses the client but the client’s self-assessment. From a person-centered perspective, the best source of knowledge about the client is the individual client. Rogers saw therapy as

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co-assessment, whereby the therapist and the client engage in a continuous process of self-understanding.

Assessment seems to be gaining in importance in short-term treatments in most counseling agencies, and it is imperative that clients be involved in a collaborative process in making decisions that are central to their therapy. Today it may not be a question of whether to incorporate assessment into therapeutic practice but of how to involve clients as fully as possible in their assessment and treatment process.

Application of the Philosophy of the Person-Centered Approach The person-centered approach has been applied to working with individuals, groups, and families. Bozrath, Zimring, and Tausch (2002) cite studies done through the 1990s that revealed the effectiveness of person-centered therapy with a wide range of client problems including anxiety disorders, alcoholism, psychosomatic prob- lems, agoraphobia, interpersonal difficulties, depression, cancer, and personality disorders. Person-centered therapy has been shown to be as viable as the more goal- oriented therapies. Furthermore, outcome research conducted in the 1990s revealed that effective therapy is based on the client–therapist relationship in combination with the inner and external resources of the client (Duncan, Miller, Wampold, & Hubble, 2010).

The person-centered approach has been applied extensively in training both pro- fessionals and paraprofessionals who work with people in a variety of settings. This approach emphasizes staying with clients as opposed to getting ahead of them with interpretations. People without advanced psychological education are able to ben- efit by translating the therapeutic conditions of genuineness, empathic understand- ing, and unconditional positive regard into both their personal and professional lives. Learning to listen to oneself with acceptance is a valuable life skill that enables individuals to be their own therapists. The basic concepts are straightforward and easy to comprehend, and they encourage locating power in the person rather than fostering an authoritarian structure in which control and power are denied to the person. These core skills also provide an essential foundation for virtually all of the other therapy systems covered in this book. If counselors are lacking in these rela- tionship and communication skills, they will not be effective in carrying out a treat- ment program for their clients.

The person-centered approach demands a great deal of the therapist. An effective person-centered therapist must be an astute listener who is grounded, centered, gen- uine, respectful, caring, present, focused, patient, and accepting in a way that involves maturity. Without a person-centered way of being, mere application of skills is likely to be hollow. Natalie Rogers (2011) points out that the person-centered approach is a way of being that is easy to understand intellectually but is very difficult to put into practice. She continues to find the core conditions of genuineness, positive regard, and empathy most important in developing trust, safety, and growth in a group.

Application to Crisis Intervention The person-centered approach is especially applicable in crisis intervention such as an unwanted pregnancy, an illness, a disastrous event, or the loss of a loved one. People in the helping professions (nursing, medicine, education, the ministry)

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are often first on the scene in a variety of crises, and they can do much if the basic attitudes described in this chapter are present. When people are in crisis, one of the first steps is to give them an opportunity to fully express themselves. Sensitive listening, hearing, and understanding are essential at this point. Being heard and understood helps ground people in crises, helps to calm them in the midst of tur- moil, and enables them to think more clearly and make better decisions. Although a person’s crisis is not likely to be resolved by one or two contacts with a helper, such contacts can pave the way for being open to receiving help later. If the person in crisis does not feel understood and accepted, he or she may lose hope of “return- ing to normal” and may not seek help in the future. Genuine support, caring, and nonpossessive warmth can go a long way in building bridges that can motivate people to do something to work through and resolve a crisis. Communicating a deep sense of understanding should always precede other more problem-solving interventions.

In crisis situations person-centered therapists may need to provide more struc- ture and direction than would be the case for clients who are not experiencing a cri- sis. Suggestions, guidance, and even direction may be called for if clients are not able to function effectively. For example, it may be necessary to take action to hospitalize a suicidal client to protect this person from self-harm.

Application to Group Counseling The person-centered approach emphasizes the unique role of the group counselor as a facilitator rather than a leader. The primary function of the facilitator is to create a safe and healing climate—a place where the group members can interact in honest and meaningful ways. In this climate members become more appreciative and trusting of themselves as they are and are able to move toward self-direction and empowerment. The facilitator’s way of being can create a productive climate within a group:

Facilitators cannot make participants trust the group process. Facilitators earn trust by being respectful, caring, and even loving. Being an effective group facilita- tor has much to do with one’s “way of being.” No method or technique can evoke trust unless the facilitator herself has a capacity to be fully present, considerate, caring, authentic, and responsive. This includes the ability to challenge people constructively. (N. Rogers, 2011, p. 57)

With the presence of the facilitator and the support of other members, participants realize that they do not have to experience the struggles of change alone and that groups as collective entities have their own source of transformation.

Carl Rogers (1970) clearly believed that groups tend to move forward if the facilitator exhibits a deep sense of trust in the members and refrains from using techniques or exercises to get a group moving. Facilitators should avoid making interpretive comments or group process observations because such comments are apt to make the group self-conscious and slow the process down. Group process observations should come from members, a view that is consistent with Rogers’s philosophy of placing the responsibility for the direction of the group on the mem- bers. Instead of leading the members toward specific goals, the group facilitator

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assists members in developing attitudes and behaviors of genuineness, acceptance, and empathy, which enables the members to interact with each other in therapeutic ways to find their own sense of direction as a group.

Regardless of a group leader’s theoretical orientation, the core conditions that have been described here are highly applicable to any leader’s style of group facilita- tion. Only when the leader is able to create a person-centered climate will movement take place within a group. All of the theories discussed in this book depend on the quality of the therapeutic relationship as a foundation. As you will see, the cognitive behavioral approaches to group work also emphasize creating a working alliance and collaborative relationships. Indeed, most effective approaches to group work share key elements of a person-centered philosophy. For a more detailed treatment of person-centered group counseling, see Corey (2016, chap. 10). Also see Natalie Rogers’s book (2011), The Creative Connection for Groups: Person-Centered Expressive Arts for Healing and Social Change.

Person-Centered Expressive Arts Therapy* Natalie Rogers (1993, 2011) expanded on her father’s (C. Rogers, 1961) the- ory of creativity using the expressive arts to enhance personal growth for individuals and groups. N. Rogers’s approach, known as expressive arts therapy, extends the person-centered approach to spontaneous creative expression, which symbolizes deep and sometimes inaccessible feelings and emotional states. Counselors trained in person-centered expressive arts offer their clients the opportunity to create move- ment, visual art, journal writing, sound, and music to express their feelings and gain insight from these activities.

Principles of Expressive Arts Therapy Expressive arts therapy uses various artistic forms—movement, drawing, painting, sculpting, music, writing, and improvisation—toward the end of growth, healing, and self-discovery. This is a multimodal approach integrating mind, body, emo- tions, and inner spiritual resources. Methods of expressive arts therapy are based on humanistic principles but give fuller form to Carl Rogers’s notions of creativity. These principles include the following (N. Rogers, 1993):

ŠŠ All people have an innate ability to be creative. ŠŠ The creative process is transformative and healing. The healing aspects

involve activities such as meditation, movement, art, music, and journal writing.

ŠŠ Personal growth and higher states of consciousness are achieved through self-awareness, self-understanding, and insight.

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*Much of the material in this section is based on key ideas that are more fully developed in The Creative Connection: Expressive Arts as Healing (N. Rogers, 1993) and The Creative Connection for Groups: Person-Centered Expressive Arts for Healing and Social Change (N. Rogers, 2011). This section was written in close collaboration with Natalie Rogers.

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ŠŠ Self-awareness, understanding, and insight are achieved by delving into our feelings of grief, anger, pain, fear, joy, and ecstasy.

ŠŠ Our feelings and emotions are an energy source that can be channeled into the expressive arts to be released and transformed.

ŠŠ The expressive arts lead us into the unconscious, thereby enabling us to express previously unknown facets of ourselves and bring to light new information and awareness.

ŠŠ One art form stimulates and nurtures the other, bringing us to an inner core or essence that is our life energy.

ŠŠ A connection exists between our life force—our inner core, or soul—and the essence of all beings.

ŠŠ As we journey inward to discover our essence or wholeness, we discover our relatedness to the outer world, and the inner and outer become one.

The various art modes interrelate in what Natalie Rogers calls the “creative connec- tion.” When we move, it affects how we write or paint. When we write or paint, it affects how we feel and think.

Natalie Rogers’s approach is based on a person-centered theory of individual and group process. The same conditions that Carl Rogers and his colleagues found basic to fostering a facilitative client–counselor relationship also help support cre- ativity. Personal growth takes place in a safe, supportive environment created by counselors or facilitators who are genuine, warm, empathic, open, honest, congru- ent, and caring—qualities that are best learned by first being experienced. Taking time to reflect on and evaluate these experiences allows for personal integration at many levels—intellectual, emotional, physical, and spiritual.

Creativity and Offering Stimulating Experiences According to Natalie Rogers, this deep faith in the individual’s innate drive to become fully oneself is basic to the work in person-centered expressive arts. Indi- viduals have a tremendous capacity for self-healing through creativity if given the proper environment. When one feels appreciated, trusted, and given support to use individuality to develop a plan, create a project, write a paper, or to be authentic, the challenge is exciting, stimulating, and gives a sense of personal expansion. N. Rogers believes the tendency to actualize and become one’s full potential, including innate creativity, is undervalued, discounted, and frequently squashed in our society. Tra- ditional educational institutions tend to promote conformity rather than original thinking and the creative process.

Person-centered expressive arts therapy utilizes the arts for spontaneous cre- ative expression that symbolizes deep and sometimes inaccessible feelings and emotional states. The conditions that foster creativity require acceptance of the individual, a nonjudgmental setting, empathy, psychological freedom, and avail- ability of stimulating and challenging experiences. With this type of environment in place, the facilitative internal conditions of the client are encouraged and inspired. The client experiences a nondefensive openness and an internal locus of evaluation that receives but is not overly concerned with the reactions of others. N. Rogers (1993) believes that we cheat ourselves out of a fulfilling and joyous source

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of creativity if we cling to the idea that an artist is the only one who can enter the realm of creativity. Art is not only for the few who develop a talent or master a medium. We all can use various art forms to facilitate self-expression and personal growth.

Motivational Interviewing Motivational interviewing (Mi) is a humanistic, client-centered, psycho- social, and modestly directive counseling approach developed by William R. Miller and Stephen Rollnick in the early 1980s. The clinical and research applications of this evidenced-based practice have received increased attention in recent years, and MI has been shown to be effective as a relatively brief intervention (Corbett, 2016; Dean, 2015). Motivational interviewing is based on humanistic principles, has many basic similarities with person-centered therapy, and expands the traditional person- centered approach.

Motivational interviewing was initially designed as a brief intervention for prob- lem drinking, but more recently this approach has been applied to a wide range of clinical problems including substance abuse, compulsive gambling, eating disorders, anxiety disorders, depression, suicidality, chronic disease management, and health behavior change practices (Arkowitz & Miller, 2008; Arkowitz & Westra, 2009). MI stresses client self-responsibility and promotes an invitational style for working cooperatively with clients to generate alternative solutions to behavioral problems. MI provides multiple ways to address the impasses clients often experience during the change process. Both MI and person-centered practitioners believe in the client’s abilities, strengths, resources, and competencies. The underlying assumption is that clients want to be healthy and desire positive change.

The MI Spirit MI is rooted in the philosophy of person-centered therapy, but with a “twist.” Unlike the nondirective and unstructured person-centered approach, MI is deliberately directive while staying within the client’s frame of reference. The primary goal is to reduce client ambivalence about change and increase the client’s own motivation for change. Miller and Rollnick (2013) believe that “MI is about arranging conver- sations so that people talk themselves into change, based on their own values and interests” (p. 4). It is essential that therapists function within the spirit of MI—that is, within the relational context of therapy—rather than simply applying the strate- gies of the approach. The attitudes and skills in MI are based on a person-centered philosophy and include using open-ended questions, employing reflective listening, creating a safe climate, affirming and supporting the client, expressing empathy, responding to resistance in a nonconfrontational manner, guiding a discussion of ambivalence, summarizing and linking at the end of sessions, and eliciting and rein- forcing “change talk” (Dean, 2015). MI therapists avoid arguing with clients and reframe resistance as a healthy response. MI therapists do not view clients as oppo- nents to be defeated but as allies who play a major role in their present and future success. Practitioners assist clients in becoming their own advocates for change and the primary agents of change in their lives.

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In both person-centered therapy and MI, the counselor provides the condi- tions for growth and change by communicating attitudes of accurate empathy and unconditional positive regard. In MI, the therapeutic relationship is as important in achieving successful outcomes as the specific theoretical model or school of psy- chotherapy from which the therapist operates (Miller & Rollnick, 2013). Both MI and person-centered therapy are based on the premise that individuals have within themselves the capacity to generate an intrinsic motivation to change. Responsibil- ity for change rests with clients, not with the counselor, and therapist and client share a sense of hope and optimism that change is possible. Once clients believe that they have the capacity to change and heal, new possibilities open up for them.

The Basic Principles of Motivational Interviewing Miller and Rollnick (2013) formulated five basic principles of MI:

1. Therapists strive to experience the world from the client’s perspec- tive without judgment or criticism. MI emphasizes reflective listening, which is a way for practitioners to better understand the subjective world of clients. Expressing empathy is foundational in creating a safe climate for clients to explore their ambivalence for change. When cli- ents are slow to change, they likely have compelling reasons to remain as they are as well as having reasons to change.

2. MI is designed to evoke and explore both discrepancies and ambiva- lence. Counselors reflect discrepancies between the behaviors and values of clients to increase the motivation to change. Counselors pay particular attention to clients’ arguments for changing compared to their arguments for not changing. Therapists elicit and reinforce change talk by employing specific strategies to strengthen discus- sion about change. Clinicians encourage clients to determine whether change will occur, and if so, what kinds of changes will occur and when.

3. Reluctance to change is viewed as an expected part of the therapeu- tic process. Although individuals may see advantages to making life changes, they also may have many concerns and fears about changing. People who seek therapy are often ambivalent about change, and their motivation may ebb and flow during the course of therapy. MI thera- pists assume a respectful view of resistance and work therapeutically with any reluctance or caution on the part of clients. MI practitioners avoid disagreeing with, arguing with, or persuading clients because this only entrenches resistance. Instead, therapists roll with the resistance, which tends to reduce clients’ defensiveness (Corbett, 2016).

4. Practitioners support clients’ self-efficacy, mainly by encouraging them to use their own resources to take necessary actions that can lead to success in changing. MI clinicians strive to enhance client agency about change and emphasize the right and inherent ability of clients to for- mulate their own personal goals and to make their own decisions. MI focuses on present and future conditions and empowers clients to find ways to achieve their goals.

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5. When clients show signs of readiness to change through decreased resistance to change and increased talk about change, a critical phase of MI begins. In this stage, clients may express a desire and ability to change, show an interest in questions about change, experiment with making changes between sessions, and envision a future picture of how their life will be different once the desired changes have been made. At this time therapists shift their focus toward strengthen- ing clients’ commitments to change and helping them implement a change plan.

The Stages of Change The stages of change model assumes that people progress through a series of five identifiable stages in the counseling process. In the precontemplation stage, there is no intention of changing a behavior pattern in the near future. In the contemplation stage, people are aware of a problem and are considering overcoming it, but they have not yet made a commitment to take action to bring about the change. In the preparation stage, individuals intend to take action immediately and report some small behavioral changes. In the action stage, individuals are taking steps to modify their behavior to solve their problems. During the maintenance stage, people work to consolidate their gains and prevent relapse.

People do not pass neatly through these five stages in linear fashion, and a client’s readiness can fluctuate throughout the change process. If change is ini- tially unsuccessful, individuals may return to an earlier stage (Prochaska & Norcross, 2014). MI therapists strive to match specific interventions with whatever stage of change clients are experiencing. If there is a mismatch between process and stage, movement through the stage will be impeded and is likely to be mani- fested in reluctant behavior. When clients demonstrate any form of reluctance or resistance, this could be due to a therapist’s misjudgment of a client’s readiness to change.

Motivational interviewing is but one example of how therapeutic strategies have been developed based on the foundational principles and philosophy of the person-centered approach. Indeed, most of the therapeutic models illustrate how the core therapeutic conditions are necessary aspects leading to client change. Where many therapeutic approaches, including motivational interviewing, diverge from traditional person-centered therapy is the assumption that the therapeutic factors are both necessary and sufficient in bringing about change. Many other mod- els employ specific intervention strategies to address specific concerns clients bring to therapy.

Person-Centered Therapy From a Multicultural Perspective Strengths From a Diversity Perspective

One of the strengths of the person-centered approach is its impact on the field of human relations with diverse cultural groups. Person-centered philosophy and practice can now be studied in several European countries, South America,

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and Japan. Here are some examples of ways in which this approach has been incor- porated in various countries and cultures:

ŠŠ In several European countries person-centered concepts have had a sig- nificant impact on the practice of counseling as well as on education, cross-cultural communication, and reduction of racial and political tensions. In the 1980s Carl Rogers (1987b) elaborated on a theory of reducing tension among antagonistic groups that he began developing in 1948.

ŠŠ In the 1970s Rogers and his associates began conducting workshops promoting cross-cultural communication. Well into the 1980s he led large workshops in many parts of the world. International encounter groups have provided participants with multicultural experiences.

ŠŠ Japan, Australia, South America, Mexico, and the United Kingdom have all been receptive to person-centered concepts and have adapted these practices to fit their cultures.

ŠŠ Shortly before his death, Rogers conducted intensive workshops with professionals in the former Soviet Union.

There is no doubt that Carl Rogers has had a global impact. His work has reached more than 30 countries, and his writings have been translated into 12 languages. The emphasis on core conditions makes the person-centered approach useful in under- standing diverse worldviews. The underlying philosophy of person-centered therapy is grounded on the importance of hearing the deeper messages of a client. Empathy, being present, and respecting the values of clients are essential attitudes and skills in counseling culturally diverse clients. Although person-centered therapists are aware of diversity factors, they do not make initial assumptions about individuals (Cain, 2010, 2013). Therapists realize that each client’s journey is unique and take steps to tailor their methods to fit the individual.

Several writers consider person-centered therapy as being ideally suited to clients in a diverse world. Bohart and Watson (2011) claim that the person-centered philos- ophy is particularly appropriate for working with diverse client populations because the counselor does not assume the role of expert who is going to impose a “right way of being” on the client. Instead, the therapist is a “fellow explorer” who attempts to understand the client’s phenomenological world in an interested, accepting, and open way and checks with the client to confirm that the therapist’s perceptions are accurate. Motivational interviewing, which is based on the philosophy of person- centered therapy, is a culturally sensitive approach that can be effective across popu- lation domains, including gender, age, ethnicity, and sexual orientation (Levensky, Kersh, Cavasos, & Brooks, 2008).

Shortcomings From a Diversity Perspective Although the person-centered approach has made significant contributions to counseling people from diverse social, political, and cultural backgrounds, there are some shortcomings to practicing exclusively within this framework. Many cli- ents who come to community mental health clinics or who are involved in outpa- tient treatment want more structure than this approach provides. Some clients seek

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professional help to deal with a crisis, to alleviate emotional problems, or to learn coping skills in dealing with everyday problems. These clients often expect coun- selors to provide guidance or give advice and can be put off by this unstructured approach.

A second shortcoming of the person-centered approach is that it is difficult to translate the core therapeutic conditions into actual practice in certain cultures. Communication of these core conditions must be consistent with the client’s cul- tural framework. Consider, for example, the expression of therapist congruence and empathy. Clients accustomed to indirect communication may not be comfortable with direct expressions of empathy or self-disclosure on the therapist’s part.

A third shortcoming in applying the person-centered approach with clients from diverse cultures pertains to the fact that this approach extols the value of an internal locus of evaluation. The humanistic foundation of person-centered therapy emphasizes dimensions such as self-awareness, freedom, autonomy, self-acceptance, inner-directedness, and self-actualization. Cain (2010) points out that “persons from collectivistic cultures are oriented less toward self-actualization and more toward intimacy, connection, and harmony with others and toward what is best for the community and the common good” (p. 143). The focus on development of indi- vidual autonomy and personal growth may be viewed as being selfish in a culture that stresses the common good.

Consider Lupe, a Latina client who values the interests of her family over her self-interests. From a person-centered perspective she could be viewed as being in danger of “losing her own identity” by being primarily concerned with her role in taking care of others in the family. Rather than pushing her to make her personal wants a priority, the counselor will explore Lupe’s cultural values and her level of commitment to these values in working with her. It would be inappropriate for the counselor to communicate a vision of the kind of woman she should be. (This topic is discussed more extensively in Chapter 12.)

Despite these shortcomings, the person-centered approach offers many oppor- tunities for working with clients from diverse cultures. There is great diversity among any group of people, and there is room for a variety of therapeutic styles. Counseling a culturally different client may require more activity and structuring than is usually the case in a person-centered framework, but the potential positive impact of a counselor who responds empathically to a culturally different client can- not be overestimated.

S tan’s autobiography indicates that he has a sense of what he wants for his life. As a person-centered therapist, I rely on his self-report of the way he views himself rather than on a formal assessment and diag- nosis. My concern is with understanding him from his internal frame of reference. Stan has stated goals that are meaningful for him. He is motivated to change

and seems to have sufficient anxiety to work toward these desired changes. I have faith in Stan’s ability to find his own way, and I trust that he has the necessary resources for reaching his therapy goals. I encourage Stan to speak freely about the discrepancy between the person he sees himself as being and the person he would like to become; about his feelings of being

Person-Centered Therapy Applied to the Case of Stan

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a failure, being inadequate; about his fears and uncer- tainties; and about his hopelessness at times. I attempt to create an atmosphere of freedom and security that will encourage Stan to explore the threatening aspects of his self-concept.

Stan has a low evaluation of his self-worth. Although he finds it difficult to believe that others really like him, he wants to feel loved. He says, “I hope I can learn to love at least a few people, most of all, women.” He wants to feel equal to others and not have to apologize for his existence, yet most of the time he feels inferior. By creating a supportive, trusting, and encouraging atmosphere, I can help Stan learn to be more accepting of himself, with both his strengths and limitations. He has the opportunity to openly express his fears of women, of not being able to work with people, and of feeling inadequate and stupid. He can explore how he feels judged by his parents and by authorities. He has an opportunity to express his guilt—that is, his feelings that he has not lived up to his parents’ expectations and that he has let them and himself down. He can also relate his feelings of hurt over not having ever felt loved and wanted. He can express the loneliness and isolation that he so often feels, as well as the need to numb these feelings with alcohol or drugs.

Stan is no longer totally alone, for he is taking the risk of letting me into his private world of feel- ings. Stan gradually gets a sharper focus on his experiencing and is able to clarify his own feelings and attitudes. He sees that he has the capacity to make his own decisions. In short, our therapeutic relationship frees him from his self-defeating ways. Because of the

caring and faith he experiences from me in our rela- tionship, Stan is able to increase his own faith and confidence in himself.

My empathy assists Stan in hearing himself and accessing himself at a deeper level. Stan gradually becomes more sensitive to his own internal messages and less dependent on confirmation from others around him. As a result of the therapeutic venture, Stan discovers that there is someone in his life whom he can depend on—himself.

Questions for Reflection ŠŠ How would you respond to Stan’s deep feelings

of self-doubt? Could you enter his frame of refer- ence and respond in an empathic manner that lets Stan know you hear his pain and struggle without needing to give advice or suggestions?

ŠŠ How would you describe Stan’s deeper struggles? What sense do you have of his world?

ŠŠ To what extent do you think that the relation- ship you would develop with Stan would help him move forward in a positive direction? What, if anything, might get in your way—either with him or in yourself—in establishing a therapeutic relationship?

Visit CengageBrain.com or watch the dVd for the video program Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes, Session 5 (person-centered therapy), for a demon- stration of my approach to counseling Stan from this perspective. This session focuses on exploring the immediacy of our relationship and assisting Stan in finding his own way.

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Gwen arrives for this session moving quite slowly. She reports having been in pain for the past few days. I asked her to describe the pain in her body, and she explains that it is a full body achiness.

Gwen: I can’t sleep through the night, and I feel tired all day long. I try to push through the achiness, but sometimes I just want to sit down and not get up.

Therapist: Tell me more about this feeling.

Gwen: I don’t mean sit down and die, I mean sit down and take a break from life for a while. I have just been feeling down and stressed.

To gain a better understanding of how Gwen’s pain has affected her week, I administer a brief rating

Person-Centered Therapy Applied to the Case of Gwen*

*Dr. Kellie Kirksey writes about her ways of thinking and practicing from a person-centered perspective and applying this model to Gwen.

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scale at the beginning of this session. The Outcome Rating Scale (ORS) is a short questionnaire developed by Scott D. Miller that assesses how well a person has been doing (individually, interpersonally, socially, and overall well-being) during the last week. I explain that the ORS will give us a quick look at her current level of functioning and feeling. The ORS can also help Gwen see which particular areas of her life hold the most stress for her. Gwen marks the form quickly, and the results indicate that personal well-being and interpersonal relationships are her most significant areas of challenge. This assessment provides a starting point for discussing how our therapeutic relationship is contributing to her overall well-being.

Therapist: Gwen, I hope that information is helpful for you. Where would you like to start today?

Gwen: I need to work on the personal well-being issues. I just want to unwind and relax a little before I go back into my busy day. I get so tired of running around so much. I seem to live in an “overwhelm” mode. I am ready to retire that way of living. I could use some balance in my life. I know that’s why I have been feeling so achy. It’s the stress I have been carrying. I can feel the tension.

Therapist: Would you like to say more about the sense of “overwhelm” you mentioned?

Gwen: I am always juggling between getting my own house in order and putting out fires with my mom’s health team or insurance. I work hard at my job, and then I come home and need to get my own house in order. I am stretched in too many directions, and at the end of the day I still feel like I am on call and can’t turn my mind off. I lay down at night and feel all my responsibilities whirling around in my mind. Sometimes I just cover my head and hope that everything will go away and I can at least have some peace at night. I know nothing will disappear from my list until I take it off and that I have to make an effort to find space for relaxation in my life.

Therapist: Hearing you explain what “overwhelm mode” looks like for you gets my heart rate up [immediacy]. Although you know that many of your responsibilities will not diminish, you

would like to find some way of dealing with them and find more peace in your life.

Gwen: Yes, but I don’t know where to begin. I can’t seem to find time for relaxation.

Therapist: It sounds like you feel unsure about where to start and whether you’ll find time for yourself at all. I am wondering when you feel somewhat relaxed.

Gwen: I feel best when I’m caught up with all my projects at work and have some time for myself. I like it when I have crossed some things off my list of things to do. I used to reward myself with a spa day when I finished a big project. I haven’t done that in ages.

Therapist: As you talk about this time, I can see how excited you are about crossing things off your list and having time for yourself. That’s when you really feel good about yourself—when you’re accomplishing things yet you realize you need to take care of yourself too.

Gwen: Before I became the caregiver for my mom, I used to get to the gym about three days a week. I loved doing dancing and yoga! It really made a difference in my stress level. Working out just fell by the wayside as my life got busier.

Therapist: That must be exhausting; you take care of your mom, husband, grown kids, colleagues, and everyone else. Yet I hear that you are not taking care of yourself. How satisfied are you about meeting your own needs right now?

Gwen: Not at all. I have totally abandoned myself. I am feeling worn down.

Therapist: Tell me more about being worn down.

Gwen: I guess saying I am worn down is a bit extreme [Gwen is smiling]. My body is definitely telling me to slow down and focus on me for a change.

Therapist: So one side is telling you that you can’t keep up this pace and you need to take care of yourself, and the other side is saying, “Gwen, you need to handle everything that’s being thrown at you.”

Gwen: That sounds right. It’s been a while since I actually paid attention to myself. I feel sad saying that out loud. I know I want to do something different. Even if it’s a small something!

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Therapist: You are disappointed in yourself for not recognizing that you need a break, and yet you seem determined to make some small change now. Can you identify what you might begin to do differently?

Gwen: I want to make myself a priority. I can start taking my breaks at work again and use that time to take care of me. I used to do some stretching at my desk and walk around the building. It was actually fun: we would do a pedometer challenge at work. It was good. I don’t know why I let all of that go. I just started putting everyone and everything in front of me. We even have a lunch time dance class I could go to. I forgot how happy doing those little things used to make me feel.

Therapist: It sounds like you regret that some of those activities aren’t in you life. What would it look like to make yourself a priority in some small way?

Gwen: I guess I could find 15 minutes to do something for myself. I could even go get my hair done. Maybe a break in my regular routine would be helpful. It’s been forever since I treated myself.

Therapist: With you changing your lifestyle, I want to make sure you do it safely. I suggest you ask your primary care physician about a physical examination to determine any possible reasons for the pain and physical symptoms you are experiencing.

Gwen: That is a good idea, and I will follow up on that suggestion.

Therapist: Before you leave, I want to give you the Session Rating Scale (SRS). All you have to do is rate today’s session based on four items: our relationship, goals and topics, therapeutic approach, and overall view of our time today. It’s similar to the form you filled out at the beginning of session.

Gwen takes a moment to fill out the form and passes it back with marks reflecting that she felt heard and that we talked about what she wanted to discuss. She also marked that there was something missing from the session, which gave us an opportunity to identify what might be missing for her. Using the ORS

and the SRS is a good way to get Gwen’s feedback on her own progress and her perception of the value of the therapy session. As a therapist, I invite this feedback and see it as a useful way of getting Gwen’s perspective. In collaboration with Gwen, I strive to make adjust- ments in my work with her based on her feedback. Gwen then says a few words about how she is feeling.

Gwen: I am definitely not as tense as I was when I first came in. I needed to get some things off of my chest. I would have liked more suggestions from you on what I need to do next. I know you don’t have the magic answer, but sometimes that’s just what I want.

Therapist: Thanks for your honest feedback. The goal is for you to be the director of this session and of your life. As you lead the way, your own answers will surface to assist you in resolving some of your challenges. In today’s session you clearly identified areas of stress, and then you reconnected with activities that brought you peace and relaxation in the past. You were able to find your answers within yourself.

Person-centered therapy is a collaborative journey driven by what the client brings into the session. I fol- lowed the lead provided by Gwen of what was troubling her and attempted to work within the framework of what she said she wanted. At each step along the way, I show empathy and compassion for her challenges as she works to rebuild self-trust and reconnect to her own sense of personal power and value.

Questions for Reflection ŠŠ What are your thoughts about soliciting client

feedback using rating scales such as the ORS and the SRS?

ŠŠ Gwen wants more suggestions from her therapist. If you were her therapist, how would you intervene with her when she wants more direction from you?

ŠŠ How does person-centered therapy fit with who you are as a person? Would you be comfortable in mostly identifying the client’s underlying mes- sages as the therapist did in this session?

ŠŠ Frequently person-centered therapists identify con- flicts or the competing sides of an issue. Where did the therapist do this in her dialogue with Gwen?

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Summary and Evaluation Summary

Person-centered therapy is based on a philosophy of human nature that postulates an innate striving for self-actualization. Carl Rogers’s view of human nature is phe- nomenological; that is, we structure ourselves according to our perceptions of real- ity. We are motivated to actualize ourselves in the reality that we perceive.

Rogers’s theory rests on the assumption that clients can understand the factors in their lives that are causing them to be distressed. They also have the capacity for self-direction and constructive personal change. Change will occur if a congruent therapist makes psychological contact with a client in a state of anxiety or incongru- ence. It is essential for the therapist to establish a relationship the client perceives as genuine, accepting, and understanding. Therapeutic counseling is based on an I/Thou, or person-to-person, relationship in the safety and acceptance of which cli- ents drop their defenses and come to accept and integrate aspects that they have denied or distorted. The person-centered approach emphasizes this personal rela- tionship between client and therapist; the therapist’s attitudes are more critical than are knowledge, theory, or techniques employed. In the context of this relationship, clients unleash their growth potential and become more of the person they are capa- ble of becoming. An abundance of research supports the notion that the human elements of psychotherapy (client factors, therapist effects, and the therapeutic alli- ance) are far more important than models and techniques in the effectiveness and outcomes of therapy (Elkins, 2016).

This approach places primary responsibility for the direction of therapy on the client. In the therapeutic context, individuals have the opportunity to decide for themselves and come to terms with their own personal power. The underlying assumption is that no one knows the client better than the client; in short, the cli- ent is viewed as an expert on his or her own life (Cain, 2010). The general goals of therapy are becoming more open to experience, achieving self-trust, developing an internal source of evaluation, and being willing to continue growing. Specific goals are not suggested for clients; rather, clients choose their own values and goals. Cur- rent applications of the theory emphasize more active participation by the therapist than was the case earlier. Counselors are now encouraged to be fully involved as persons in the therapeutic relationship. More latitude is allowed for therapists to express their reactions and feelings as they are appropriate to what is occurring in therapy. Person-centered practitioners are willing to be transparent about persistent feelings that exist in their relationships with clients (Watson et al., 2011). It is the therapist’s job to adapt and accommodate in a manner that works best for each client, which means being flexible in the application of methods in the counseling process (Cain, 2010).

Contributions of the Person-Centered Approach When Carl Rogers founded nondirective counseling more than 70 years ago, there were very few other therapeutic models. The longevity of this approach is certainly a factor to consider in assessing its influence. Rogers had, and his theory continues to have, a major impact on the field of counseling and psychotherapy.

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When he introduced his revolutionary ideas in the 1940s, he provided a powerful and radical alternative to psychoanalysis and to the directive approaches then prac- ticed. Rogers was a pioneer in shifting the therapeutic focus from an emphasis on technique and reliance on therapist authority to that of the power of the therapeu- tic relationship.

Kirschenbaum (2009) contends that the scope and influence of Rogers’s work has continued well beyond his death; the person-centered approach is alive, well, and expanding. Today there is not one version of person-centered therapy, but a number of continuously evolving person-centered psychotherapies (Cain, 2010). Although few psychotherapists claim to have an exclusive person-centered theoretical orienta- tion, the philosophy and principles of this approach permeate the practice of most therapists. Other schools of therapy are increasingly recognizing the centrality of the therapeutic relationship as a route to therapeutic change.

Person-centered therapy is strongly represented in Europe, and there is continu- ing interest in this approach in both South America and the Far East. The person- centered approach has established a firm foothold in British universities, and some of the most in-depth training of person-centered counselors is taking place in the United Kingdom today (N. Rogers, 2011).

As we have seen, Natalie Rogers has made a significant contribution to the application of the person-centered approach by incorporating the expressive arts as a medium to facilitate healing and social change, primarily in a group setting. She has been instrumental in the evolution of the person-centered approach using nonverbal methods to enable individuals to heal and to develop. Many individuals who have difficulty expressing themselves verbally can find new possibilities for self- expression through nonverbal channels and through the expressive arts (N. Rogers, 2011). Cain (2010) believes “Natalie Rogers’s expressive arts therapy represents a major innovation in practice and helped open the way for other person-centered therapists to expand the variety and range of practice” (p. 60).

Emphasis on Research One of Carl Rogers’s contributions to the field of psychotherapy was his willingness to state his concepts as testable hypotheses and to submit them to research. He literally opened the field to research. He was truly a pioneer in his insistence on subjecting the transcripts of therapy sessions to critical examination and applying research technology to counselor–client dialogues. According to Cain (2010), an enormous body of research, conducted over a period of 70 years, supports the effectiveness of the person-centered approach. This research is ongoing in many parts of the world and continues to expand and refine our understanding of what constitutes effective psychotherapy. Cain (2010) concludes, “person centered therapy is as vital and effective as it has ever been and continues to develop in ways that will make it increasingly so in the years to come” (p. 169).

Even his critics give Rogers credit for having conducted and inspired others to conduct extensive studies of counseling process and outcome. Rogers presented a challenge to psychology to design new models of scientific investigation capable of dealing with the inner, subjective experiences of the person. His theories of therapy and personality change have had a tremendous heuristic effect, and though much controversy surrounds this approach, his work has challenged practitioners and theoreticians to examine their own therapeutic styles and beliefs.

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Limitations and Criticisms of the Person-Centered Approach Although I applaud person-centered therapists for their willingness to subject their hypotheses and procedures to empirical scrutiny, some researchers have been criti- cal of the methodological errors contained in some of these studies. Accusations of scientific shortcomings involve using control subjects who are not candidates for therapy, failing to use an untreated control group, failing to account for placebo effects, reliance on self-reports as a major way to assess the outcomes of therapy, and using inappropriate statistical procedures. In all fairness, these accusations apply to the research on many other therapeutic approaches as well.

There is a similar limitation shared by both the person-centered and existential (experiential) approaches. Neither of these therapeutic modalities emphasizes the role of techniques aimed at bringing about change in clients’ behavior. Proponents of psychotherapy manuals, or manualized treatment methods for specific disorders, find serious limitations in the experiential approaches due to their lack of attention to proven techniques and strategies. Those who call for accountability as defined by evidence-based practices within the field of mental health also are quite critical of the experiential approaches.

I do not believe manualized treatment methods can be considered the gold stan- dard in psychotherapy, however. There is good research demonstrating that tech- niques account for only 15% of client outcome (see Duncan et al., 2010), whereas contextual factors have powerful effects on what happens in therapy (Elkins, 2009, 2012, 2016). Research points to relational and client factors as the main predictors of effective therapy. Furthermore, the evaluation of evidence-based practices has been broadened to include best available research; the expertise of the clinician; and cli- ent characteristics, culture, and preferences (see Norcross, Hogan, & Koocher, 2008).

A potential limitation of the person-centered approach is that some students- in-training and practitioners with this orientation may have a tendency to be very supportive of clients without being challenging. Out of their misunderstanding of the basic concepts of the approach, some have limited the range of their responses and counseling styles mainly to reflections and empathic listening. Although there is value in accurately and deeply hearing a client and in reflecting and communicat- ing understanding, counseling entails more than this. I believe that the therapeutic core conditions are necessary for therapy to succeed, yet I do not see them as being sufficient conditions for change for all clients at all times. From my perspective, these basic attitudes are the foundation on which counselors must then build the skills of therapeutic intervention. Motivational interviewing rests on the therapeutic core conditions, for example, but MI employs a range of strategies that enables clients to develop action plans leading to change.

A related challenge for counselors using this approach is to truly support clients in finding their own way. Counselors sometimes experience difficulty in allowing clients to decide their own specific goals in therapy. It is easy to give lip service to the concept of cli- ents’ finding their own way, but it takes considerable respect for clients and faith on the therapist’s part to encourage clients to listen to themselves and follow their own direc- tions, particularly when they make choices that are not what the therapist hoped for.

More than any other quality, the therapist’s genuineness determines the power of the therapeutic relationship. If therapists submerge their unique identity and style

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in a passive and nondirective manner, they are not likely to affect clients in powerful ways. Therapist authenticity and congruence are so vital to this approach that those who practice within this framework must feel natural in doing so and must find a way to express their own reactions to clients. If not, a real possibility is that person- centered therapy will be reduced to a bland, safe, and ineffectual approach.

Self-Reflection and Discussion Questions 1. To what degree do you believe clients have the ability to understand

and resolve their own problems without a great deal of advice or sug- gestions from a therapist?

2. This therapy approach places considerable importance on congruence (realness or genuineness) on the part of the therapist. How confident are you that you will be able to be genuine in your interaction with your clients?

3. The therapeutic relationship is given prominence in this theory. What kind of relationship do you hope to create with your clients? Identify the characteristics you deem most important.

4. Empathy is a core ingredient in person-centered therapy. What do you think you can do to increase your ability to develop empathy toward a client who you perceive of as being difficult?

5. How would it be for you to practice by relying on a minimum of tech- niques and instead staying tuned into a client’s moment-by-moment experience?

Where to Go From Here In the DVD for Integrative Counseling: The Case of Ruth and Lecturettes, you will see a con- crete illustration of how I view the therapeutic relationship as the foundation for our work together. Refer especially to Session 1 (“Beginning of Counseling”), Session 2 (“The Therapeutic Relationship”), and Session 3 (“Establishing Therapeutic Goals”) for a demonstration of how I apply principles from the person-centered approach to my work with Ruth.

Free Podcasts for ACA Members You can download ACA Podcasts (prerecorded interviews) by going to www.counseling .org; click on the Resource button and then select the Podcast Series. For Chapter 7, Carl Rogers and the Person-Centered Approach, look for Podcast 7 by Dr. Howard Kirschenbaum.

Other Resources The American Psychological Association offers the following DVDs in their Psycho- therapy Video Series:

Greenberg, L. S. (2010). Emotion-Focused Therapy Over Time

Cain, D. J. (2010). Person-Centered Therapy Over Time

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Psychotherapy.net is a comprehensive resource for students and professionals that offers videos and interviews featuring Natalie Rogers, Rollo May, and more. New articles, interviews, blogs, therapy cartoons, and videos are published monthly. DVDs relevant to this chapter are available at www.psychotherapy.net and include the following:

Rogers, N. (1997). Person-Centered Expressive Arts Therapy

May, R. (2007). Rollo May on Existential Psychotherapy

The Association for the Development of the Person-Centered Approach (ADPCA) is an interdisciplinary and international organization that consists of a network of individuals who support the development and application of the person-centered approach. Membership includes a subscription to the Person-Centered Journal, the association’s newsletter, a membership directory, and information about the annual meeting. ADPCA also provides information about continuing education and super- vision and training in the person-centered approach. For information about the Person-Centered Journal, contact the editor (Jon Rose).

Association for the Development of the Person-Centered Approach, Inc. www.adpca.org

The Association for Humanistic Psychology (AHP) is devoted to promoting per- sonal integrity, creative learning, and active responsibility in embracing the chal- lenges of being human in these times. Information about the Journal of Humanistic Psychology is available from the Association for Humanistic Psychology or at the pub- lisher’s website.

Association for Humanistic Psychology www.ahpweb.org

Division 32 of APA, Society for Humanistic Psychology, represents a constella- tion of “humanistic psychologies” that includes the earlier Rogerian, transpersonal, and existential orientations as well as recently developing perspectives. Division 32 seeks to contribute to psychotherapy, education, theory, research, epistemological diversity, cultural diversity, organization, management, social responsibility, and change. The division has been at the forefront in the development of qualitative research methodologies. The Society for Humanistic Psychology offers journal access to The Humanistic Psychologist. Information about membership, conferences, and journals is available from the website of Division 32.

Society for Humanistic Psychology www.societyforhumanisticpsychology.com/

The Carl Rogers CD-ROM is a visually beautiful and lasting archive of the life and works of the founder of humanistic psychology. It includes excerpts from his 16 books, over 120 photographs spanning his lifetime, and award-winning video foot- age of two encounter groups and Carl’s early counseling sessions. It is an essential resource for students, teachers, libraries, and universities. It is a profound tribute to one of the most important thinkers, influential psychologists, and peace activists of the 20th century. Developed for Natalie Rogers, PhD, by Mindgarden Media, Inc.

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Carl Rogers: A Daughter’s Tribute www.nrogers.com

The Center for Studies of the Person (CSP) offers workshops, training seminars, experiential small groups, residential workshops, and sharing of learning in com- munity meetings.

Center for Studies of the Person www.centerfortheperson.org

For training in expressive art therapy, join Natalie Rogers, Sue Ann Herron, and Terri Goslin-Jones in their course, “Expressive Arts for Healing and Social Change: A Person-Centered Approach” at Sofia University. This 16-unit certificate program requires six weeks of study spread over two years at a retreat center north of San Fran- cisco. The expressive arts within a person-centered counseling framework program includes counseling demonstrations, practice counseling sessions, readings, discus- sions, papers, and a creative project to teach experiential and theoretical methods.

Training in the Person-Centered Approach to Expressive Arts www.nrogers.com

Sofia University www.sofia.edu/

Recommended Supplementary Readings On Becoming a Person (C. Rogers, 1961) is one of the best primary sources for further reading on person- centered therapy. This classic book is a collection of Rogers’s articles on the process of psychotherapy, its outcomes, the therapeutic relationship, education, family life, communication, and the nature of the healthy person.

A Way of Being (C. Rogers, 1980) contains a series of writings on Rogers’s personal experiences and per- spectives, as well as chapters on the foundations and applications of the person-centered approach.

The Creative Connection: Expressive Arts as Healing (N. Rogers, 1993) is a practical, spirited book lav- ishly illustrated with color and action photos and filled with fresh ideas to stimulate creativity, self- expression, healing, and transformation. Natalie Rogers combines the philosophy of her father with the expressive arts to enhance communication between client and therapist.

The Life and Work of Carl Rogers (Kirschenbaum, 2009) is a definitive biography of Carl Rogers that follows his life from his early childhood through his death. This book illustrates the legacy of Carl Rog- ers and shows his enormous influence on the field of counseling and psychotherapy.

Person-Centered Psychotherapies (Cain, 2010) con- tains a clear discussion of person-centered theory, the therapeutic process, evaluation of the approach, and future developments.

Humanistic Psychology: A Clinical Manifesto (Elkins, 2009) offers an insightful critique of the medical model of psychotherapy and the myth of empirically supported treatments. The author calls for a rela- tionship-based approach to psychotherapy that can provide both individual and social transformation.

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