* Behavioural Therapies
* Psychoanalytical and Psychodynamic Therapies
* Humanistic Therapies
Person Centred counselling was based around three core conditions, devised by Rogers;
1. Unconditional Positive Regard
It is considered essential for all counsellors to display these attributes and to consistently provide these to each client irrespective of circumstance. The Person Centred approach views the client as their own best authority on their own experience, and it views the client as being fully capable of fulfilling their own potential for growth. It recognizes, however, that achieving potential requires favourable conditions and that under adverse conditions, individuals may well not grow and develop in the ways that they otherwise could. In particular, when individuals are denied acceptance and positive regard from others, or when that positive regard is made conditional upon the individual behaving in particular ways they may begin to lose touch with what their own experience means for them, and their innate tendency to grow in a direction consistent with that meaning may be stifled. This does offer a unique perspective for both client and therapist to allow an unlocking of the clients genuine self.
The premise of this theory is that human beings are innately good and given free opportunity they will strive for goodness, further reaffirming the core conditions. If we believe that humans are good, we should always be able to supply unconditional positive regard, congruence and empathy. The role that theory plays in the process and outcome of counselling has been a subject of discussion, for almost as long as counselling has been a profession. While schools of therapy have argued that different theories produce differing and nonequivalent outcomes, this position has been challenged on numerous occasions. Fiedler (1951) first observed that therapists of differing orientations were very similar in their views of the ideal therapy. Then Sundland and Barker (1962) reported that more experienced therapists tended to be more similar, regardless of their theoretical orientation. In their extensive review of the subject, Gelso and Carter (1985) stated that most clients will profit about equally (but in different ways) from the different therapies.
They go on to suggest that the effect of process and relationship do differ among therapies and that some clients may do better with one approach than with another, based upon these two factors. Finally, Stiles, Shapiro and Elliott (1986) concluded that (a) common features shared by all psychotherapies underlie or override differences in therapists verbal techniques and (b) these common features are responsible for the general equivalence in effectiveness (of therapies). Process and relationship maybe considered as relevant as theoretical conceptualisation of a given problem. One can assume that a counselling process must be structured for each client irrespective of what theory you adhere to. The work of Rogers does do this by using the core conditions, however; arguably less so than other theories due to a lack of distinct techniques. Hough et al contribute the following for a successful counselling relationship to occur; 1.Establish a safe, trusting environment as outlined by Carl Rogers creating a relationship with the client which is in line with the core conditions. 2. Clarify: Help the person put their concern into words. As the person centred approach maintains this is how a client would be assisted by being predominantly talking and the counsellor mostly listening.
3. Use Active listening: find out the clients agenda, what do they hope to achieve by coming for counselling. a) Paraphrase, summarise, reflect and interpret To ensure that there is a greater understanding of what the client is trying to say. b) Focus on feelings, not events counselling is dealing with emotional and mental health, so it is important to unpick the feelings rather than to skim over them, like a layperson would do. 4. Transform problem statements into goal statements allow the client to depict a plan towards attaining their goal. 5. Explore possible approaches to goal, to narrow and deliberate their choices. 6. Help person choose one way towards their goal which is feasible. 7. Make a contract to fulfil the plan (or to take the next step). 8. Summarise what has occurred, clarify, and get verification from the client that this is still their goal. 9. Get feedback and confirmation that the goal remains as before. Ultimately as with all the Counselling paradigms it is key to enable the client to gain control of their own life and reach their own conclusions. The main paradigms underpin the processes of counselling usually, however; the lesser known models are also used.
If this can be agreed upon, this might suggest that the Person centred approach does fulfil the needs of a therapist when diagnosing a problem and creating a plan where they are guided but the content is filled by the client. The Person Centred approach also gave rise to the concept of The Organismic Self; a state which is considered to truly be intact for a short space of time, in basic terms this is a descriptor of our pure selves, being exactly as we are without external influence. This theory tracks our human experience and maintains that this soon becomes corrupted by what is called the Self Concept. Self Concept is the term given to explain outside influences on the Organismic Self. It could be said that the battle between who we authentically are as people and what the world and significant people around us feel we should be is what causes us to feel lost. If we think of the Organismic Self as being at one with ourselves and feeling that who we are, what we do and our general feeling of inner harmony as being comfortable, the opposite is true of the Self Concept, this is generally a feeling of awkwardness, feeling lost, unreal and can result in later life as a crisis.
Humanistic approaches in general are concerned with topics which are meaningful to human beings which makes it especially good as a theory for counselling. Humanistic approaches are also considerate of subjective experience and unpredictable events which occur in human lives. Does this then suggest that the Person centred approach is flexible and allows the therapist to address all matters which may arise rather than, comparatively using a CBT(Cognitive Behavioural Therapy) approach which focusses solely on the present. As a composite of the Person centred approach and general Humanistic theories, it is important to acknowledge the concept of Self Actualisation. The phrase was first coined by Kurt Goldstein, but is perhaps better known as associated with Abraham Maslow and his Hierarchy Of Needs and is defined as below; ¦.the desire for self-fulfillment, namely the tendency for him [the individual] to become actualised in what he is potentially.
This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming. In reference to his Hierarchy of Needs theory, Maslow advised that only 1% of all people are self-actualised which would infer the need for counselling assistance to be great. As mentioned above the flexibility of this approach may be deemed to allow therapists to treat a vast number of clients, as the growing need for counselling emerges. The non-intrusive nature of the therapy a the relatively comfortable set-up of the counselling sessions within the Person Centred approach highlights how easy it is to apply this approach practically. We certainly know of the efficacy of the Person Centred approach, in its comtinued use in modern day therapy, however; we must consider the strengths of other currently used approaches to illustrate where the Person Centred approach could improve.
I have chosen to use the Psychodynamic approach to explore this. One of the strengths of the Psychodynamic Approach is that it provided a valuable insight into how early experiences or relationships can affect our adult personality. One of the examples of this is that fixations can be caused at the Oral Stage of psychosexual development such as being separated from the primary caregiver too early. These fixations can then lead to psychological problems. Supporting evidence for this strength was carried out by Jacobs at al (1966) using Rorschach inkblots to compare the orality of smokers and non-smokers. It was found that smokers emerged as being significantly more oral.
Another strength of the Psychodynamic Approach is that it is the first approach to try and attempt to explain mental illness in psychological terms and has had an enormous influence on the understanding and treatment of mental disorders. An example of this is Psychoanalysis and Dream Therapy which aims to make the unconscious material conscious so it is easier to deal with as Freud believed that dreams showed our hidden desires. Evidence to support this was carried out by Sandell (1999) who studied the symptoms of more than 700 patients before and after three years of psychoanalysis and found that patients had significantly fewer symptoms after the therapy.
The Psychodynamic Approach also displays weaknesses, in that most of Freuds is based on findings of case studies, and anecdotal references where cases are often unique and there are problems with generalisation.
Like the Psychodynamic Approach, the Person Centred approach does not dismiss the importance of historical and childhood events. This is highlignhted in their subtheory Conditions of worth which are defined as restrictions imposed on self-expression in order to earn positive regard, which are not in and of themselves a bad thing, however; it is possible for these conditions to be overused that they can begin to be a problem. For example a child will seek to satisfy the condition of worth imposed by their parents; without realising, parents may create more complex conditions for gaining their attention. As children grow they learn a new set of rules for gaining attention, the best predictor of consequence for behavior is past experience. As such a child may learn that to receive praise from their Father is to get good results at school or join the football team. From another perspective, a child may learn that they get more attention when they fail at something or are feeling sad, as opposed to when they are successful and happy. They may also find that they are surrounded by more friends, more often when they behave in a particular way or indulge in particular activities that are acceptable.
By the time an individual reaches their teenage years, most people have a complex system of rules to abide by if we want to receive love, praise and positive regard from others. Slowly this system of conditions of worth works its way into a persons overall way of viewing the world they live in. They adopt these conditions as their own values, blocking out the true organismic values that comprise who they really are. As their real self is blocked out by this adopted system of values, incongruence results. The rules for love and positive regard lead them to live a different life, a life incongruent with who they really are, a life that does not satisfy all their other needs and tragically, often doesnt even truly satisfy their need for positive regard. Due to this, people can become unhappy, anxious and depressed, but often they only try to revise and change the conditions they are using for positive regard.
They may change their veneer, but not the root of the problem. They only shift the contents of their complex system of worth rather than trimming it back and exposing their real, true values. Its this latter state that Person Centred therapy seeks to create, allowing the counsellor to simply try to remove any conditions of worth from their relationship with the client. They offer only unconditional positive regard. This creates an environment in which a small crack is placed in the persons overarching system of conditional worth. In such an environment the person can begin to acknowledge and understand what it is they truly want and need.
These values are always trying to be heard, but are blocked out by our complex set of constructs we use to try to gain conditional positive regard. Person centred therapy simply creates a place where this system is pushed back, and ones true values can emerge. A person is then free to consider who he is and what he wants, without the threat of a loss of positive regard. No matter what is said, he can expect unconditional regard. Overall this subtheory shows a consistency throughout the Person Centred approach, tying the main premise of the core conditions to the way in which each client is treated.
To conclude my assessment of the usefulness and effectiveness of the Person Centred Therapy, I hope to have demonstrated my current level of understanding regarding this subject and illustrated how it can be used practically. It is clear that the current and continuous widespread use of the Person-Centred approach attests for its effectiveness in practice. It is good and justified to always focus on the client and their journey through whatever problems they are facing and this particular approach maintains the therapist in doing so. I believe that the most effective method of treating patients is that adopted by Chrysalis, a multidiscipline approach, whereby one can amend the tool used based upon the presented problem.
Edward L. Deci, Richard M. Ryan (1985) Intrinsic Motivation and Self-Determination in Human Behaviour; Springer Publishing.