Discussion

Client-Centered Theory

Chapter 12

Amy Van de Motter

(adapted from the work of Michael Rothery and Leslie Tutty)

LEARNING OBJECTIVES

By the end of this chapter, you should be able to:

•understand the theoretical underpinnings of client-centered therapy,

•understand the central tenets of client-centered therapy, and

•apply client-centered therapy to individuals and groups.

INTRODUCTION

Developed by the psychologist Carl Rogers over a long career that ended with his death in 1987, client-centered (also referred to as nondirective and person-centered) therapy has been a major force in clinical mental health work and a counterweight to the deterministic behaviorism that Rogers rejected. Rogers has been seen by many as one of the foundational thinkers in the development of humanistic psychology, even as one of the most generally influential psychologists of the 20th century. His client-centered theory was a radical innovation for psychology; for social work, it was more a valuable refinement and reaffirmation of familiar principles, but it has nevertheless had a significant and beneficial impact on social work practice and education.

The fourth edition of the iconic Handbook of Psychotherapy and Behavior Change (Bergin & Garfield, 1994) is dedicated to “three distinguished pioneers who taught us how to study therapeutic change.” Carl Rogers was one of the dedicatees; given his prominence at the time, it would have raised eyebrows had he been excluded. Later, however, in the sixth edition of Bergin and Garfield’s handbook (Lambert, 2013), Rogers has become barely visible in the field he once dominated—in a volume of well over 800 pages, he receives seven brief citations.

If his name has faded over the past two decades, his work has never lost its significance: “Not only is the influence of Carl Rogers still keenly felt and expressed in many areas of life, but … the future of person-centered and experiential therapies (PCE) is looking rosy. It is remarkable that in almost every area of life that he touched, Carl Rogers left a lasting impression” (Sanders, as cited in Thorne & Sanders, 2013, pp. 99–100; see also Kramer, 1995a).

In developing the client-centered model, Rogers considered that he had identified the necessary and sufficient conditions that lead to people changing. This is not a modest claim: The suggestion is that if one wants to be an effective helper, client-centered principles are something one must learn (they are necessary) and nothing else is required (they are sufficient).

The theory guiding this therapeutic method is a theory of process. As such, the approach is firmly aligned with the belief that we do not help our clients through an expertise with theories of personality, knowledge of family dysfunction, or a deep appreciation for critical ecological systems theory. Rather, we assist people’s growth by providing a particular kind of relationship, through communications that have specific qualities.

According to client-centered theory, those essential qualities are the Rogerian core conditions: congruence, acceptance, and empathy. (As one would expect, terminology has varied over time and from one writer to another. Nuances that might distinguish congruence from genuineness or authenticity and similar semantic fine points are not important at this juncture.) When those interpersonal conditions are sufficiently available to us from our friends, loved ones, or social workers, we have what we need to grow personally, just as we grow physically when we have enough food and other necessities. Understanding exactly what those essential relational conditions are, and how we can learn to make them present in our work, was Rogers’s main mission in life.

This is a deceptively simple general idea possessing considerable explanatory force. Also, it fits easily with social work’s historic principles. Indeed, relationship has always been critical in social workers’ eyes, identified as both the context and the means for facilitating change (Biestek, 1957; Coady, 1999; Perlman, 1957, 1979). Indeed, in a book that is rightly regarded as a classic on the topic, Biestek (1957) argued that the emphasis on relationship is so important that it serves to define us:

This is one principal difference between social work and some of the other professions. In surgery, dentistry, and law, for example, a good interpersonal relationship is desirable for the perfection of the service, but it is not necessary for the essence of the service. The surgeon may not have a good bedside manner; the dentist may be inconsiderate of the patient’s feelings; the lawyer may be cold and overly businesslike. But if the surgeon operates successfully, if the dentist heals the ailing tooth, and if the lawyer wins the case, they have performed the essential service requested. Not so the caseworker. A good relationship is necessary not only for the perfection, but also for the essence, of the casework service in every setting. (p. 19)

For better and for worse, we constantly affect one another’s experience, through “the rich interplay of one human mind with another” (Garrett et al., 1982, p. 4). Being thoroughly socially embedded as we are (see Chapter 4), this mutual influence is simply a fact of life, and Rogers wanted to understand how to harness its power in the service of client growth.

OVERVIEW OF THEORY

Understanding of Human Problems

Though his theory is heavily weighted toward process, Rogers did suggest a basic psychological dynamic for understanding how we become distressed. Human problems, he thought, can generally be understood as reflecting a state of incongruence. People experience pain when they perceive themselves falling significantly short of what, ideally, they wish to be. One of his interpreters explained this aspect of Rogers’s theory:

The client’s self-image is contradicted by his life experience; thus … two levels of self-being are … constituted: one involving the …. idealized self; the other touching on and flowing from, the actual experience of self-in-process …. Determined to defend his self-concept … the client is unable to admit into clear awareness those experiences that would interfere with his sense of self-worth. (Barton, 1980, p. 169)

Take, for example, a client who is experiencing distress associated with an addiction. From the perspective of Rogers’s theory, one would determine that the client’s distress is due to the incongruence between her goals of who she wants to be and what she wants to accomplish in her life, and her actions associated with her drug use. Perhaps, she has a goal of being a loving mother, but her actions do not reflect her as such, due to her all-consuming attention toward obtaining her drug of choice This incongruence causes the client to feel a range of distressing emotions, including shame, guilt, confusion, depression, and even anger. This differs from other problem conceptualization frameworks, such as the cognitive behavioral theory that posits the client’s distress manifests as a result of the negative and maladaptive thoughts that she has about her life and her drug use. It is less about what is happening that is causing distress and more about the how that is different from the way the client wishes to be.

However, Rogers argued vehemently that beyond this it is counterproductive to approach clients with preconceptions in the form of theories of personality, or psychopathology, or anything else that might work against our openness to the uniqueness of people and their situations:

The more I have observed therapists, and the more closely I have studied [the] research …. the more I am forced to the conclusion that … diagnostic knowledge is not essential to psychotherapy. It may even be that its defense as a necessary prelude to psychotherapy is simply a protective alternative to the admission that it is, for the most part, a colossal waste of time. (Rogers, 1957, pp. 101–102)

It is therefore fair to say that Rogers and his followers did not pursue a highly developed understanding of human problems. Instead, they worked to illuminate the interpersonal processes that represent a context within which healing naturally occurs. Taking the previous case example, the primary goal would be to create a therapeutic environment in which the client, with the support of the clinician, can explore and resolve the incongruence that exists between her drug use behaviors and her goal of being a loving mother, through self-identified motivation.

Conception of Therapeutic Intervention

Rogers believed that the conditions that enable us to develop in self-actualizing ways are universal. Good clinical social work and psychology have foundations in some of the same core elements as good parenting, good teaching, and the friendships that help us flourish. These elements, such as respect, genuineness, and caring for the individual, foster the growth and development needed for self-actualization, which from this perspective is what the clinical social worker has to offer the client. To the extent that our clients may be especially estranged from themselves, and potentially from friends and loved ones, they require us to provide those conditions in a skilled, well-attuned way, but there is nothing that distinguishes their needs from everyone else’s in any formal sense.

Client-centered tenets about intervention and change have an apparent simplicity that can easily result in misunderstanding:

Very early in my work … I discovered that simply listening to my client, very attentively, was an important way of being helpful. … Later a social worker, who had a background of Rankian training, helped me to learn that the most effective approach was to listen for the feelings. … I believe she was the one who suggested that the best response was to “reflect” these feelings back to the client—”reflect” becoming in time a word that made me cringe. But at that time, it improved my work as therapist, and I was grateful.

But this tendency to focus on the therapist’s responses had appalling consequences. … The whole approach came, in a few years, to be known as a technique. “Nondirective therapy,” it was said, “is the technique of reflecting the client’s feelings.” Or an even worse caricature was simply that “in nondirective therapy you repeat the last words the client has said.” (Rogers, 1980, pp. 137–139)

The process of change, in the client-centered view, is at once simple and complex. Simply put, people are naturally inclined toward growth, and given the right conditions they will come to know themselves more fully, heal old wounds, and develop greater authenticity and congruence. They will become more knowledgeable and honest, first in relation to themselves and then in relation to others.

As we have noted, the “right conditions” that facilitate such growth are relationships with particular characteristics: congruence, acceptance, and empathy. If we are honest, accepting, and understanding, our clients will benefit from their relationship with us. The apparent simplicity of this prescription belies the subtlety of the processes it describes, however—hence, Rogers’s concern about being so easily misunderstood. We will have more to say about the complexity of the core conditions in the section on central theoretical constructs.

HISTORICAL DEVELOPMENT

Precursors and Original Development

Mary Richmond (1899) can be credited with early efforts to understand relationship and its critical importance: “Friendly visiting means intimate … knowledge of and sympathy with a … family’s joys, sorrows, opinions, feelings. … The visitor that has this is unlikely to blunder …. [although] without it he is almost certain … to blunder seriously” (p. 180). This assertion is only marginally more cautious than Rogers’s claims about necessity and sufficiency, and it represents an appreciation of the importance of empathic understanding that predates client-centered theory by a half century.

Richmond was a committed empiricist, convinced that careful case records in which services and their outcomes were documented would lead to an improved and scientific understanding of the helping process. In 1922, she wrote a short book reflecting on the essential nature of direct practice (Social Casework), in which she reported the results of her intensive analysis of six varied and well-documented cases.

A striking feature of Richmond’s (1922) conclusions is the extent to which she attributed effectiveness of service with qualitative aspects of how workers related to their clients. More specifically, she identified a capacity for honesty, affectionate acceptance, and “imaginative sympathy” (p. 37) as critical factors in relationships that support change. When Rogers came to emphasize congruence, acceptance, and empathy in his own analysis of the effectiveness of psychotherapy, the language had changed but the fundamental insight had not. It is also notable that in each case, one of these conditions is paramount—Richmond’s imaginative sympathy and Rogers’s empathy are understood to be the dimension that encourages growth more than any other.

Since Richmond’s early introduction of concepts such as friendly visiting and sympathy, social workers have striven for greater clarity in describing what it is about some relationships that makes them powerful tools for change. Different terms have been invoked in this effort to understand, such as empathy (Shaw, as cited in Biestek, 1957), rapport, emotional bridging (LeRoy, as cited in Biestek, 1957), some aspects of transference (Taft, as cited in Biestek, 1957; see also Garrett et al., 1982, which addresses the phenomenon without using the term), engagement (Smalley, 1967), and the therapeutic alliance (Coady, 1999).

As social work grew, it incorporated ideas from different disciplines, such as psychiatry and psychology, and our longstanding fascination with Freudian and related psychodynamic theories is a case in point—most observers see this development, in hindsight, as at least somewhat problematic. Like behaviorism in American psychology, Freud’s theory was highly deterministic—it was this that caused Mary Richmond, among others, to worry about its implications for a field that had always been heavily committed to important social values.

Freudian theory also discouraged our traditional emphasis on relationship as the context and means for change:

Although Freud paid some attention to the therapeutic relationship, he saw the development of insight and rationality, acquired through the analyst’s interpretations, as the curative element in psychoanalysis. … Within psychoanalysis, of course, there has always been an interpersonal school, identified mostly with Sullivan and his followers, but until recently this school remained outside the mainstream of psychoanalytic theory. (Saari, 2002, p. 125)

One of Freud’s early disciples was Otto Rank, who paid a heavy professional and personal cost for breaking with orthodox Freudian beliefs (Lieberman, 1985). In contrast to Freud’s determinism, Rank ascribed critical importance to creativity and will (Menaker, 1982)—concepts that did not fit comfortably with the narrowly scientific worldview predominant at the time. Rank also insisted that the heart of helping was not in diagnoses, interpretations, and rationalistic analyses but in relationship (Menaker, 1982; Rank, 1964, 1989; Taft, 1958; see also Becker, 1973, 1975 for a more general, deep appreciation of Rank’s thought).

Jessie Taft was the dean of the Philadelphia School of Social Work from 1934 to 1950. A friend of and collaborator with Rank, she wrote his biography (Taft, 1958) and translated some of his work into English, and it was she who brought him to the United States to share his ideas with American professionals. At the time, Carl Rogers was working with social workers in Philadelphia:

From 1928 through 1939, Carl Rogers served as a therapist at the Society for Prevention of Cruelty to Children, in Rochester, New York. …. On his staff at the Rochester clinic were a number of social workers trained at the University of Pennsylvania’s School of Social Work …. where Otto Rank had been lecturing since 1926. (Kramer, 1995b, p. 58)

The helping method identified with the University of Pennsylvania, the functional school of social work, drew heavily on Rank’s ideas and made relationship a pivotal issue in its understanding of change—a sharp difference from the competing diagnostic school, which remained more committed to orthodox Freudianism. Early in his career, Carl Rogers was a colleague of social workers imbued with functional thinking; it is likely through their influence that he came to meet Rank:

In June, 1936, intrigued by social workers who were telling him that “relationship therapy”—not “interpretive therapy”—was the emphasis of the Philadelphia School, Carl Rogers invited Otto Rank to Rochester to conduct a 3-day seminar on his new, post-Freudian practice of therapy. (Kramer, 1995b, p. 59)

This meeting was a turning point for Rogers, shaping his thinking for the rest of his life (Kramer, 1995b). Rogers, in turn, did much to clarify conceptually what the elements of a helpful relationship are and initiated a research program to measure those elements and their effects. The outcome was the client-centered school of counseling.

Otto Rank and Carl Rogers, then, are two prominent theorists whose thoughts imbue the client-centered framework. The complementarity of their ideas and values is remarkable given their differences in background. Rank was very much a product of European culture and education. Rogers, in contrast, was thoroughly American (Van Belle, 1980), the son of “a narrowly fundamentalist religious home” (Rogers, 1980, p. 27) and a graduate of universities in Wisconsin and New York.

Each man made an important mark by rebelling against his earlier training, looking for a way out of the limitations he experienced in the doctrines of the day. Rank replaced the rigid determinism of Freud’s thinking with a theory that celebrated agency, the human capacity for creativity and choice (Menaker, 1982). Rogers rejected the deterministic, objective psychology that prevailed when he was starting out, offering in its place a humanistic “home-grown brand of existential philosophy” (Rogers, 1980, p. 39). In fact, calling his work “client-centered” and “nondirective” constitutes an important philosophical position on Rogers’s part—a commitment to the belief that the resources for healing and growth are to be found primarily in the client, not in the theories and techniques of the helper.

Later Developments and Current Status

Few scholars have had the impact that Rogers enjoyed in his field. Since he began publishing his ideas in the early 1940s, he has stimulated an enormous response in terms of ongoing theory development and research. A perusal of influential journals such as The Journal of Counseling Psychology or The Person-Centered Review will verify that literally thousands of academic, research, and professional careers are rooted solidly in his work.

The client-centered model, as Rogers formulated it, has not gone unchallenged, and we indicate where problems arise toward the end of this chapter. However, it is remarkable, given the energy that has gone into its development, to note how the foundation Rogers laid—the concepts that are the primary focus of this chapter—remain essentially unaltered.

The effort to translate Rogers’s general process conditions into operational behaviors has resulted in extensive catalogs of specific counseling skills (Ivey, 1988), and the application of these in education, industry, and other organizational domains has absorbed considerable interest and energy—as has their application cross-culturally (Sue et al., 1996).

Beyond these generalities, the scope of this chapter prevents our doing justice to the vast body of work that has grown out of client-centered theory. The extent to which derivatives of the basic model diverge from their roots varies; however, none challenges it in any fundamental way, and many pay frank homage to Rogers as the germinal thinker on whose shoulders they stand.

CENTRAL THEORETICAL CONSTRUCTS

We have noted a seeming simplicity about the basic client-centered formula for change. Drawing on Rank and other humanistic influences, Rogers came to the view that everyone has a creative capacity to make choices and is motivated to grow. These naturally present capacities and inclinations can be blocked or distorted by experience, with psychological pain as a consequence. However, in the context of a sufficiently nurturing relationship, the client will rediscover them and return to a healthy, self-actualizing path.

Congruence, acceptance (or unconditional positive regard), and empathy characterize the relational context that promotes such results. Although other ingredients have been recommended as client-centered thinking has evolved, these remain primary, and, as we have emphasized, need to be understood as complex processes.

Congruence

Congruence is interpersonal genuineness, honesty, and directness. The social worker who is self-aware, comfortable with themselves, and able to find ways to relate to clients that do not disguise who they are is relating congruently. What is meant, however, is far from simple encouragement to give free expression to whatever one thinks and feels. Congruence means that “the feelings the therapist is experiencing are available to him, available to his awareness, and he is able to live these feelings, be them, and able to communicate them if appropriate” (Rogers, 1961, p. 61; see also Rogers, 1980, p. 115).

Garrett et al.’s (1982) view of the requirements of social work interviewing is similarly demanding: “An interviewer’s attention must continuously be directed in two ways: toward himself as well as toward his client” (p. 6). Both Garrett et al. and Rogers (1961), therefore, describe a disciplined effort to develop self-awareness and comfort with oneself. Further, congruence implies the ability to use that awareness in the service of the client, sharing aspects of our experience as it is appropriate to do so; that is, in a manner that is sensitively attuned to client needs and readiness.

This concept highlights the utmost importance of the social workers’ attention to their own personal awareness, experiences, and development, as a parallel process to their work with their clients. This can be understood as a form of professional self-care; social workers seek to heighten their senses in a way that allows them to recognize and understand their own emotional and cognitive processes in the moment with the client, so that not only can efforts be made to prevent them from negatively impacting their wor but that they can be used strategically to enhance the relationship and the client’s own growth. Take, for example, a client who experiences frequent interpersonal conflicts with others due to high demands of their time and emotional energy, and therefore has difficulty maintaining relationships. If the client pushes the social worker to be available more frequently, the social worker might set firm boundaries by sharing feelings of unease and defensiveness, thus illuminating the client’s behaviors that are contributing to interpersonal conflicts. This congruence within the social worker serves as a mechanism for increased self-awareness and growth within the client, which would otherwise be missed had the social worker been less forthcoming by citing agency policy or a busy schedule for not meeting the client’s demands.

Acceptance

The second condition that we provide clients in creating a context for growth is acceptance, or “unconditional positive regard,” which “involves the therapist’s genuine willingness for the client to be whatever feeling is going on in him at that moment … [and requires] that the therapist cares for the client in a non-possessive way … in a total rather than a conditional way …. and without reservations, without evaluations” (Rogers, 1961, p. 62). Thus, we work to establish with our clients a positive attitude about them as people unaffected by our reactions to how they feel or what they may have done. This implies the belief that we can (and must) cultivate a capacity for interpersonal generosity, based on a differentiated understanding of others as a complex mix of characteristics and potentials. Further, we can discipline ourselves so that client behaviors, characteristics, or experiences that distress us do not undermine this capacity. There is something about each client that we value with no strings attached—and we are able to communicate that effectively.

This concept can be a challenge for those who are new to the ideas and application of client-centered theory. Questions arise such as, “How can I show acceptance to a client who has assaulted their partner? How can I feel unconditional positive regard for someone who has harmed a child?” These questions are understandable and valid. The answer to them lies in the core values of the social work profession. Social workers value human beings and believe in the inherent dignity and worth of every individual, regardless of the acceptability of their actions. Knowing that people have the natural tendency toward growth allows the social worker to view each client in a light of humanity and potential, separate from the actions that might seem so egregious. Undoubtedly for some, this shift in thinking can be challenging, which only further highlights the importance of social workers’ attention to their own emotions and cognitions during the therapeutic process. It is imperative that this acceptance of each client is felt and communicated genuinely. Therefore, constant self-reflection, peer supervision, and a consistent personal and professional self-care practice are critical.

Empathy

The third and preeminent element in a relational context for growth is empathy. Again, Rogers took considerable pains to be clear that he did not see empathy as achievable in a formulaic, superficial manner—the caricature being an expression of soulful concern and the words “I know how you feel!” Empathic understanding is never so simple:

[Empathy] means that the therapist senses accurately the feelings and personal meanings that the client is experiencing and communicates this understanding to the client. When functioning best, the therapist is so much inside the private world of the other that he or she can clarify not only the meanings of which the client is aware but even those just below the level of awareness. This kind of sensitive, active listening is exceedingly rare in our lives, … yet [it] is one of the most potent forces for change that I know. (Rogers, 1980, p. 116)

These definitions and elaborations remain consistent in Rogers’s writing over time (compare with Rogers, 1959), and there are a number of elements in them that we would highlight. First, there is a role for intelligence, insight, training, and experience: The social worker should grasp accurately and sensitively the emotional content and meanings implied in what the client is saying.

Second, empathy as Rogers defines it is not simply understanding feelings: He is inclined to emphasize emotions, but also returns constantly to words like experiencing and meaning. Thus, the point of empathic understanding is to communicate awareness of both the emotional and narrative aspects of what the client presents. Perhaps the word experiencing is attractive because it addresses both feelings about events and the meanings attributed to them—aspects that are always so interdependent that the wisdom of separating them is questionable.

A third point is that empathy implies a strong psychological attunement by the worker to the experience of the client, but not a loss of boundaries. The therapist “can grasp the moment-to-moment experiencing which occurs in the inner world of the client as the client sees it and feels it, without losing the separateness of his own identity [italics added]” (Rogers, 1961, pp. 62–63). This is a clarification about which he was consistent:

It means to sense the hurt or the pleasure of another as he senses it and to perceive the causes thereof as he perceives them but without ever losing the recognition that it is as if I were hurt or pleased and so forth. If this “as if” quality is lost then the state is one of identification. (Rogers, 1959, pp. 210–211)

Although empathy as a concept stresses engagement, clients are served best if we are fully able to step back, not only understanding their experience but also inviting new perspectives and options.

Why is empathy considered to be such a powerful precondition for growth? Rogers explains this by suggesting several benefits that accrue when we experience an empathic relationship:

1.Empathy “dissolves alienation” (Rogers, 1980, p. 151). Clients often feel alone in their problems, and an empathic relationship with a clinical social worker is a powerful antidote: “If someone else knows what I am talking about, what I mean, then to this degree I am not so strange, or alien, or set apart. I make sense to another human being” (Rogers, 1980, p. 151).

2.Empathic understanding has the effect of communicating to people that they are valued, and is therefore useful for repairing damaged self-esteem. It is Rogers’s contention that empathy is not possible without caring, and the experience of being cared about encourages a sense of self-value.

3.Since empathy is nonjudgmental, “always free of any evaluative or diagnostic quality” (Rogers, 1980, p. 154), being empathically treated encourages self-acceptance. Aspects of ourselves from which we recoil are less corrosive to our self-esteem if we see that another person can hear about them without becoming threatened or angry—and may regard them as normal, even admirable, rather than as cause for shame and self-denigration.

4.When people receive empathic responses to their troubles, they are encouraged to self-explore, increasing their awareness and developing a richer experience of themselves. This is beneficial in and of itself, since a broader self-understanding exposes more options regarding how we can respond to situations. Further, when painful aspects of our experience are “fully accepted and accurately labeled in awareness” (Rogers, 1980, p. 158), we are able to respond more creatively to those issues.

PHASES OF HELPING

Four phases of helping characterize generalist social work practice: engagement, data collection and assessment, planning/contracting and intervention, and evaluation and termination. What can we suggest the contribution of client-centered theory is to facilitating this process?

Respecting engagement, the argument is simple. Relating honestly, respectfully, and empathically should speed the development of trust and openness. However, it may be that client-centered theory, interestingly, puts too much responsibility for such relationships on the worker. Recent research and theory emphasizes that predispositions of the client are powerful as well; however skilled we may be, we still depend on our clients to respond positively if an effective helping alliance is to be formed (Coady, 1999; Miller et al., 1997). What should a social worker do, then, if a client does not respond positively? From a client-centered perspective, the social worker might first reflect on the quality of the therapeutic skills they are using. The worker might assess whether or not they are accurately empathizing with the client or if they misinterpreted the client’s experiences. The social worker might explore their own congruence between hertheir inner experience and their interactions with the client. The social worker might ask themselves whether they are having difficulty accepting the client unconditionally, which may be inadvertently communicated through words, actions, or body language. Ultimately, it is the responsibility of the social worker to have an open, honest conversation with the client in a way that allows for that relationship to shift toward a positive, therapeutic path.

With respect to assessment, it is our view that the client-centered approach offers critical process skills. However, we would also argue that social workers require more of a framework to enable decisions regarding the kinds of data that are to be collected. With an abused spouse, we are trained to explore safety issues, for example, even if these do not automatically emerge in our interview. Similarly, if we suspect child maltreatment, addictions, suicidal tendencies, a significant lack of supports and resources, or any of a host of potentially relevant matters, we are trained to invite discussion of those, and this training is a good thing. This does not deny the risk of forming premature hypotheses about what is important and ceasing to listen carefully to the client—Rogers’s thinking and approach are very useful protections against this possibility. In addition, approaching new clients with openness, curiosity, empathy, and a genuine regard for them as individuals often helps the client feel safe in sharing personal details that are so vital to the assessment process.

With respect to planning/contracting and intervention, client-centered theory does not offer as much direction as social workers and their clients may require. The assumptions that appropriate goals and plans will emerge if clients have the opportunity to explore their experience, and that workers’ congruence, acceptance, and empathy will be sufficient to enable clients to achieve their goals, are sometimes valid, but by no means always. What can be applied here is the foundational concept of allowing the client to drive the process when formulating goals. That is not to say that the social worker does not offer guidance, insight, and expertise during this phase. However, the worker must be cautious to not insert their own goals for the client in a way that overshadows what the client wants to achieve.

The client-centered model is not prescriptive with respect to the length of treatment, and the timing of termination is likely similar to what we see with other models. What the client-centered model offers regarding termination and evaluation is, again, its understanding of the process. In terminating, the opportunity for clients to reflect on their experience with the social worker and what it has meant to them is obviously very important, and an effective helping relationship is a context designed to encourage that. With respect to evaluation, the model suggests very good criteria for assessing the helping process, these being the core conditions, widely evaluated using the Barrett–Lennard Relationship Inventory (BLRI; Simmons et al., 1995) and clients’ self-exploration. Properly speaking, these are process rather than outcome variables; outcomes independent of process have also been assessed in much recent client-centered research (Elliott et al., 2013), with measures employed that are familiar in research on other models as well. With respect to helping particular clients evaluate the success of their work, the model offers a process that facilitates that but does not suggest independent criteria for assessing the merits of goals achieved. Since it is not a domain-specific model, this is appropriate—outcomes to be evaluated will vary across people and client populations.

APPLICATION TO FAMILY AND GROUP WORK

If the basic thesis of client-centered theory is true, it should apply equally whether work is being conducted with an individual, family, group, or other social systems. It was, in fact, Rogers’s (1980) position that communicational processes favoring the core conditions would make many diverse social settings more nurturing and supportive of learning and growth. He was a leader in the encounter group movement as it developed, and suggested applications of his work in educational settings, families, and organizations of various sizes and diverse purposes.

The direct evidence for the impact of client-centered methods in groups is not strong, perhaps due to significant methodological difficulties. To the extent that modeling takes place and group members learn effective communication skills that they can use in their efforts to support and help one another, it seems logical to think this would be beneficial. In family work, there is enough evidence to convince some reviewers that the core conditions do contribute significantly to positive outcomes (Gurman et al., 1986; Nichols & Schwartz, 2004; Sexton et al., 2004).

COMPATIBILITY WITH A GENERALIST-ECLECTIC FRAMEWORK

Though Rogers was suspicious about explanatory theory, the process orientation of the client-centered model invites eclecticism. Practitioners who consider themselves Rogerians freely incorporate concepts from schools of thought as diverse as behaviorism and psychodynamic theory.

Social workers who practice from a generalist-eclectic framework commonly recognize the contribution of client-centered thinking to their work. A powerful emphasis on the importance of relationship is one shared commitment; the deep respect in client-centered theory for the competency, personal power, and motivation toward health in the client is another commonality.

Rogers’s insistence on the central importance of attunement to clients’ experience has obvious relevance to work in situations where diversity is a factor. The process of achieving and communicating shared understanding across disparate frames of reference is considered part of all helping, so it is no surprise that this knowledge has been applied in work with diverse cultural groups (Rogers, 1980). That is not to say, however, that one can assume to reach a level of empathy that allows full understanding of a client’s experience, especially when working with clients from diverse backgrounds. It would be naive to think that a Caucasian social worker could genuinely understand an African American client’s experience with systemic racism in the United States in a way that allows the social worker to truly feel and experience this reality. Therefore, it should be the goal of the social worker to empathize with the emotion and the distress that result from the experience, rather than the experience itself, and to be congruent and genuine in acknowledging the cultural and experiential differences.

For similar reasons, the theory prescribes a process that will be helpful in work with people who are different from the social worker in terms of age or gender. However, it does not offer knowledge of general themes associated with gender or the life cycle—or a systematic understanding of social systems. Familiarity with such knowledge is important to generalist-eclectic workers and will need to be acquired from sources other than the client-centered literature if holistic assessments and effective use of life-cycle theories are to be achieved.

CRITIQUE: THE STRENGTHS AND LIMITATIONS OF THE MODEL

Today, several decades after Rogers began publishing and researching his work, there is no reason to question its profound impact on social work and other helping professions. The critical significance of relationship to the helping enterprise is now widely accepted as proven. Further, there is little dispute about the relevance to helping of the core conditions; while there are ongoing discussions about how they might best be defined and measured, there is a rather impressive consensus as to their basic credibility and importance.

There are, however, qualifications to suggest in relation to this theory. In part, these derive from Rogers’s insistence that the core conditions are all there is, that they are the necessary and sufficient conditions for positive change. The latter part of this claim may evoke skepticism, especially among scholars and clinicians who employ other practice models, as this suggests those are unnecessary in clinical work. A more moderate approach might recognize and appreciate the importance and effectiveness of the client-centered model in building the therapeutic relationship, which is a foundational necessity within the use of any practice model (Miller et al., 1997).

Like all of us, Rogers brought to his work certain professional and cultural assumptions. He grew up imbued with the values of American pragmatism and the Protestant belief in individual salvation. This history sets a context within which he developed an approach to helping, which stresses (sometimes to the exclusion of all else) the need to assist clients in discovering the personal strengths and resources they possess so that they can apply them effectively in their lives. In his later years, Rogers worked for the development of better social conditions and more humane communities. However, it is still true that his theory could encourage an emphasis on the person of the client, a lack of attention to deprivations or sources of oppression in clients’ environments, and how these elements contribute to the cognitive dissonance and distress of the client.

What this suggests, as in relation to formerly discussed aspects of this framework, is the universal importance of the social workers’ awareness of both their own and their client’s cultural contexts. Social workers and other clinicians are not immune from participating in discriminatory and oppressive actions when working with clients from diverse backgrounds, albeit generally committed unknowingly or with good intentions. In order to avoid perpetuating the very oppression that many clients experience, social workers first need to understand the attitudes, social structures, and stigma of society that exist, including those that impact the social worker’s own belief systems (Lago, 2011). Despite best efforts to mitigate the power dynamic that naturally exists in a client–therapist relationship, the reality is that it is often felt strongly, especially by clients who have been disempowered and marginalized by society and its social structures.

It is therefore the responsibility of the social worker to recognize and acknowledge this dynamic, especially as it relates to the very core elements stressed in client-centered practice. Necessary considerations need to be made, such as whether the client’s distress is better accounted for by internal incongruence or by external societal factors (or a combination of both). Also, especially when a clinician comes from the dominant culture and has not personally experienced oppression, they will consider how best to sensitively express accurate empathy, without undermining the client’s unique experience of discrimination, as is done with every unique experience the client brings to treatment. To ignore those societal forces and focus attention solely on the person not only falls short of addressing the presenting issues but perpetuates oppression (Lago, 2011).

Working as they do with very difficult situations, social workers will easily recognize that a client who is hungry, or is being brutalized by an abusive parent or partner, will not necessarily have as a priority the need to explore the meanings of those experiences. Relief or protection from extremely damaging circumstances can come with concrete interventions rather than an intense helping relationship—and it may be that this is all that is required. Even when a helping relationship and the opportunity to self-explore are useful in important ways (as they must be in most cases), they will often not be sufficient.

Another general concern to be raised is that the client-centered model can be utopian, and this entails risks. This is not a necessary outcome of absorbing the theory, but a possible one to be guarded against—one that can be a more general problem with the humanistic approaches overall. If the goal of intervention is to help clients achieve congruence, or complete harmony within themselves, the goal is an ideal that is never fully reached. If the helper’s responsibility is to strive for complete attunement with the experience of another, it is a foregone conclusion that we will always fall short.

We are likely to be more comfortable, honest, and competent in our work if we remember that our interventions are intended to ameliorate problems and achieve modest objectives. Self-actualization, personal congruence, authenticity, and other forms of salvation are not disparaged as goals, but they are lifelong pursuits and require guidance and supports different from what social workers normally offer.

Given an adequate degree of realistic modesty, there are compelling reasons for social workers to learn and continually practice the approach to relating that Rogers and his colleagues have described for us. This, however, is not all we need to know.

CASE STUDY 12.1

Regina is a 56-year-old, single, African American transgender woman living in an urban, low-income neighborhood. She received a diagnosis of schizoaffective disorder, depressive type, in her early 20s, which is currently managed with psychotropic medications and community-based supports via clinical mental health counseling and case management, provided by a licensed clinical social worker. Her symptoms generally manifest as persecutory delusions that cause significant distress, primarily around the theme that people in her neighborhood are spying on her and have planted cameras in her home and microphones in her body, and that as a result of what they see and hear are constantly planning to harm her. These symptoms are often followed by or accompany symptoms of depression, including low mood, anhedonia, distractibility, hypersomnia, and low self-esteem. In the absence of psychosis, Regina has some insight into her symptoms, recognizing the discrepancy between her thoughts and reality; however, that does not diminish the distress she experiences as a result of these symptoms.

The following transcript reflects a typical session between Regina and her clinical social worker, during which Regina’s thought process and content are lucid and reality oriented. She is experiencing significant depressive symptoms, which triggered the following session, held in her home.

Regina:

I can’t talk right now. I’m just too depressed and I don’t feel like it.

Social Worker:

Wow, you feel really low right now. This must be a tough day for you.

Regina:

It is. I feel so stupid because I yelled at [her neighbor] again for watching me take a shower. He wasn’t, but I really thought he was this time. And that everyone was going to laugh at me, and call me names, and beat me up.

Social Worker:

You were having some really stressful thoughts the other day. That must’ve been really scary. It also sounds like you wish you had reacted differently.

Regina:

Yeah but I can’t help it. When I think these things are happening, I just get so embarrassed and scared, and then the only thing I can do is yell or fight back. But then I get in trouble. (Regina lives in a group home that employs consequences for disturbances with house members or neighbors.)

Social Worker:

Well it sounds to me like you acted in a way that a lot of people would when they are afraid. It’s understandable that you’d want to protect yourself from getting hurt, and that it’s scary to not feel safe in your own home.

Regina:

It is. But then, like right now, I know that I probably am safe, and so I feel stupid and embarrassed for yelling and threatening him again.

Social Worker:

So while it makes sense that you felt afraid, and maybe a lot of other people would have reacted the same way, it’s not the way you want to react in these situations.

Regina:

Right. I’m a nice person, and I have never hurt anyone. I don’t want people to be scared of me, but I think they are. Everyone thinks I’m a freak, and then they see me hollering and screaming, and just think I’m even weirder.

Social Worker:

I heard you say that everyone thinks you’re a freak and that you’re weird. Can I share with you what my experience has been since getting to know you?

Regina:

I guess.

Social Worker:

I see you as a woman who has had a lot of tough things thrown at her in life, and who is working really hard to have the kind of life she wants to have, which anybody would. We live in a world that isn’t always very understanding of people’s differences, and that can feel really scary and sad.

Regina:

You’re damn right. People see what they want to see, even though, if they really got to know me, I’d be their best friend and always have their backs. Because that’s how I am, you know? I’d have anyone’s back if they needed me.

Social Worker:

And you’re frustrated that, when you react the way you did the other day, people don’t get to see the real you.

Regina:

Exactly. I act like such a fool.

Social Worker:

And then what makes matters worse, because you do care so much about other people, you really beat yourself up about the way you react. So no wonder you feel so down today and like not getting out of the house.

Social Worker:

So tell me more about this “real you.” What do you want people to see?

Regina:

That I’m kind, that I’m funny … I can be real silly, you know (smiling). That I’m loyal … and that I’m not crazy (looking down). But my whole life people told me I’m crazy, even my family. First it was because I was hyper, you know, always running around the house. Then it was because I didn’t like to wear the clothes they bought me and wanted to be called a different name. Then it was because I had to go to the mental hospital. And all of that is true too, but they forgot about the other stuff. I’m still who I used to be.

Social Worker:

You have so many different things that make up who you are, and it feels like people only pay attention to some of them. And now you want to find a way to help them see the other things.

Regina:

Right. People would love the real me if they knew me. And maybe I wouldn’t act so stupid.

Social Worker:

So being yourself, really feeling like you’re being true to who you really are, would help you feel better, and maybe not so down. I’m also wondering, do you think it’s okay to have bad days? To have days where you don’t do everything exactly as you would like to? Does that make you a bad person or like you’re not yourself anymore?

Regina:

Oh no, I know I ain’t perfect (chuckling)! I know I’m always going to have times that I get worried people are spying on me, and you know that really stresses me out. I know that won’t go away forever. But I just want to still be me even if I feel stressed out … or at least to feel like me when it’s over. And I don’t feel like me layin’ in this bed.

Social Worker:

It seems like what you want for your life is pretty reasonable, Regina. Something most people would want, and I bet something we can work on together.

Regina:

Well I sure hope so.

The session then progressed to a more problem-solving focus, examining times when Regina was able to act in a way she felt was congruent with her true self and exploring ways she could increase the instances of those times, both during and after episodes of psychosis and mood disturbance. Much of the work with Regina continues to be centered around building coping skills and learning to manage her symptoms, mitigating the impact of her psychosis on her mood, her safety, and her daily life.

Reading through the transcript, one can see where the core concepts of client-centered theory are applied. The social worker is using the concept of congruence, both congruence of the social worker and congruence within Regina, as a way of creating a climate of safety and trust within the session. The social worker takes an opportunity to share with Regina an honest impression of her, which is done not only to offer reassurance in a moment of low self-esteem but more importantly to share the social worker’s internal experience with the client. This serves as a means of fostering trust in the relationship, as well as to encourage an alternate view of self. The social worker also uses reflections to highlight the incongruence between Regina’s wishes for herself and her life and her actions. This is not done as a means of shaming or scolding, rather it is to reflect the social worker’s understanding of Regina’s internal experience, empathizing with her personal struggles. Simply focusing on the behaviors themselves would run the risk of creating a punitive or emotionally detached tone.

Acceptance is also observed throughout the transcript, through the social worker’s neutral stance as Regina discusses intimate details about her life. They have an established working relationship, one in which Regina felt safe to discuss her experiences as a transgender woman, including how difficult it had been for her as a child. In previous conversations, she had also discussed the unique dynamic of being an African American transgender woman, living in a predominantly African American neighborhood. She felt particularly ostracized and persecuted by her own community, which one can imagine adds an additional layer of emotional distress. The social worker’s acceptance of Regina for who she is, and how she wants to portray herself, allows her to more freely and openly explore and understand her own experience, which she has historically had to stifle in order to fit in and, ultimately, survive.

Empathy is also an observable concept highlighted in the transcript. When Regina continues to talk in self-deprecating language, the social worker empathizes with the fear, anxiety, shame, and sadness that fuel the behaviors she regrets. The social worker normalizes Regina’s reactions without condoning them, validating her attempts to feel safe in her home and in her neighborhood. This is done in balance with returning to a focus on Regina’s desired reality, so as not to get stuck in inadvertent reinforcement of her actual behaviors, a delicate and important nuance. It would also be important to empathize with the actual distressing reality that Regina is faced with, being an African American transgender woman, who is diagnosed with a mental illness, in American society. While the detailed content of her delusions do not reflect reality, her fear, insecurity, and feelings of marginalization certainly do. Empathizing with the impact of discrimination on Regina’s physical and emotional well-being further fosters the therapeutic environment and demonstrates the social worker’s attempt to understand, appreciate, and respect the unique difficulties Regina has had to face, and that undoubtedly contribute to her current distress.

A clinician who is oriented to a different theoretical framework might see other directions the work with Regina could take. For example, a cognitive behavioral therapist might choose to more thoroughly explore the thought processes that occur, both during episodes of psychosis and in the aftermath when Regina is feeling particularly ashamed and depressed, that fuel her anxiety, depression, and actions. That therapist might also help Regina process through the experiences that led to her belief that she is a “freak,” “weird,” or “stupid.” Work would likely target those experiences and thought processes with the goal of establishing more helpful and adaptive ways of thinking about her experiences and the events that happen every day, so she can begin to behave in a way that aligns with her personal goals. Similarly, a trauma specialist might choose to focus on identifying and healing from traumatic events in Regina’s past that continue to plague her current experiences, potentially using somatic work, mindfulness, and coping skills. Regardless of the theoretical orientation, an awareness of the potential for trauma to have occurred in Regina’s life is paramount to not only creating a trusting, therapeutic environment, but also to ensuring ethically sound and safe treatment.

CONCLUSION

The relationship that social workers offer their clients has always been considered the sine qua non of our helping enterprise, to the extent that we may treat it overly reverentially (cf. Perlman, 1979). If we can accept a more modest position, recognizing that not all clients need a profound experience in relation to us and that in many other cases this may not be enough, then that is progress (however disillusioning).

Modifications of the Rogerian point of view will likely be a matter of continuing to recognize its contribution and importance while adding caveats and qualifications. The relationship conditions offered by the social worker do help create a context for change. So too, however, do other factors (Coady, 1999; Duncan et al., 1992; Miller et al., 1997). These include the social worker’s techniques, “extratherapeutic” or environmental factors, and predispositions on the part of the client. Continuing to capitalize on the legacy Rogers left us will (somewhat ironically) be a matter of building a more differentiated appreciation of our clients’ needs and circumstances, and a refined ability to tailor the relationship we offer to those realities. Perhaps, though it reintroduces the need for analytical thinking about clients, something that Rogers distrusted, it is a direction more congruent with his basic agenda than may seem, on the surface, to be the case.

Interest in extending Rogers’s premises continues in our professional literature. For example, the question of how such Rogerian concepts as acceptance and empathy are connected to compassion (an obvious social work concern) is attracting interest (Berlin, 2005; Nussbaum, 2001; Rothery, 1999). In psychodynamic psychology, attachment theory and self-psychology have come to ascribe basic importance to attunement and empathy as necessary experiences for human flourishing—a significant change from its traditional priorities (Saari, 2002).

As we have turned to qualitative research methods as alternatives to positivistic science, we have had to consider how disciplined communication can address such matters as subjective (and intersubjective) experience. Phenomenological researchers are especially involved in questions about the “rich interplay of one human mind with another” (Garrett et al., 1982, p. 4) and with the interpretive aspect of our efforts to understand each other well (see Kögler, 1996, for an assessment of developments in this large and complex field)—these are matters on which Rogers and his followers have much to say.

With spirituality emerging as an issue that clinicians need to address more effectively (especially in an increasingly culturally diverse world), it is noted that relationality is discussed in theology with the same interest it receives from secular helpers. In this regard, we note that Rogers seems to have seen spiritual implications in his work, and to have pursued them in discussions with prominent religious thinkers such as Martin Buber, Rollo May, and Paul Tillich (Anderson & Cissna, 1997; Kirschenbaum & Henderson, 1989). Again, scholars who are engaged with the most current issues affecting social work practice and its future can continue to look back to the work of Rogers (and Richmond, among many others) for important insights.

Increasingly, Rogers’s central concerns appear in contexts far beyond clinical psychology. A further interesting example is how aspects of critical social theory have shown an interest in how our ability to communicate well interacts with our responsibilities as citizens (Habermas, 1984). Also, there is a necessary moral dimension in how we treat one another, and the importance of congruence, acceptance, and empathy to the ethical demands of everyday life is highly relevant (Bly, 1996). At a more abstract level, social work’s commitment to the values of social justice promotes a concern with the politics of recognition (see Fraser, 1996; McLaughlin, 2006); far from being a simple clinical technique, empathic relating is seen to be the vehicle for necessary human rights to recognition and validation.

Such extensions of his work would not likely surprise Rogers himself, since he never thought the importance of his core conditions was restricted to their use in professional helping relationships. Rather, he was clear that since his concern was for the quality of our relating, his work has implications that extend to all aspects of human life. On this point as on many others, history may well be proving him correct.

SUMMARY POINTS

•explored the theoretical underpinnings of client-centered therapy,

•explained the central tenets of client-centered therapy, and

•described the application of client-centered therapy to individuals and groups.