HumanisticRogerian Therapy - PowerPoint PPT Presentation

Title: HumanisticRogerian Therapy


1
Humanistic/Rogerian Therapy
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Origins of Humanistic Theory

• Emerged in 1950s in reaction to behavioural and
  psychodynamic theories
• Main objections to earlier therapies too
  dehumanizing
• Freudian behaviour dominated by primitive,
  animalistic drives
• Behavioural preoccupied with animal research and
  mechanistic, fragmented view of personality
• Both schools are too deterministic and fail to
  recognize the unique qualities of human behaviour

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Humanism

• Humanism is a theoretical orientation that
  emphasizes the unique qualities of humans,
  especially their freedom and potential for
  personal growth
• Optimistic view of human nature

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Assumptions

• 3 basic assumptions of humanistic theories
• People can rise above primitive animal heritage
  and control biological urges
• People are largely conscious and rational beings
  not dominated by unconscious, irrational needs
  and conflicts
• Subjective view of world is more important than
  objective reality

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Carl Rogers(1902-1987)

• A founder of the humanistic movement
• - Key influences in his
• client-centered theory
• and therapy
• 1. His upbringing
• 2. Change in religious
  views

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Client-Centered Theory

• Theory evolved out of clinical experience
• Not a fixed and complete approach to therapy
• A set of tentative principles relating to how
  therapy process develops not dogma

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The Phenomenological Field

• Phenomenology Behaviour is totally determined by
  the phenomenal field
• Rogerian theory Each of us lives within our own
  phenomenological field, which combines unique
  mental and bodily experiences (whether
  consciously perceived or not) into an overall
  understanding of subjective reality
• The organismic experience that makes up the
  phenomenal field refers to both mind and body
  experiences
• Only the individual fully knows his/her
  phenomenological field

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The Self

• The Phenomenal Self that part of the phenomenal
  field that the person experiences as I
• The self develops through interactions with
  others and involves awareness of being and
  functioning
• Self-concept the organized set of
  characteristics that the individual perceives as
  peculiar to himself/herself
• Basic human urge is to preserve and enhance the
  phenomenal self

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Actualizing Tendency

• Aims to develop all capacities in ways that
  maintain or enhance the organism and move it
  toward autonomy
• Its directional, constructive, and present in
  all living things
• Can be suppressed but not destroyed without
  destruction of the organism
• Only motive force in the theory
• Only the organism as a whole has this tendency,
  parts of it do not

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Self-Actualization

• Actualization of portion of experience symbolized
  in the self
• Basic human tendency is toward maintaining and
  enhancing the experiencing self
• This is what produces the forward movement of
  life
• Its in the direction of socialization, broadly
  defined

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Congruence

• Congruence - when self-experiences are accurately
  symbolized and are included in the self-concept,
  then the state is one of congruence of self and
  experience
• Incongruence when experiences are not perceived
  and symbolized accurately in awareness and are
  therefore distorted or denied into awareness

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Personality Structures
Congruence
Incongruence
Confusion, Tension, Maladaptive Behaviours
Self-Concept
Actual Experience
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Organismic Valuing and Conditions of Worth

• The organismic valuing process is an ongoing
  process whereby experiences are accurately
  symbolized and valued according to optimal
  enhancement of the organism and self
• When significant others (e.g., parents) provide
  positive regard thats conditional, the person
  introjects the desired values, making them
  his/her own and acquires conditions of worth

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Origin of Psychological Maladjustment

• The need for positive self-regard leads to a
  selective perception of experience in terms of
  the conditions of worth that now exist
• Experiences in accordance with these conditions
  are perceived and symbolized accurately in
  awareness, while those that are not are distorted
  or denied into awareness, leading to incongruence
  or psychological maladjustment

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Psychological Maladjustment

• The persons self-concept becomes defined as
  having worth only when others approve
• But this reliance on others forces the individual
  to develop a distorted self-concept that is
  inconsistent with his or her self-actualizing
  potential, inhibiting that person from being
  self-actualized
• A state of disharmony or incongruence then
  exists, which forms the basis of abnormal
  behaviour

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Fully-Functioning Person

• synonymous with optimal psychological
  adjustment, optimal psychological maturity,
  complete congruence, complete openness to
  experienceperson-in-process, a person
  continually changing. (Rogers, 1951)
• Rogers believed that fully-functioning people
  have been allowed to grow toward their potential
  and that the environmental condition most
  suitable for this growth is unconditional
  positive regard
• Essentially, significant others value and respect
  that person exactly as he or she is

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Diagnosis

• Rogers disliked labeling or diagnosing people
• Only the client has the potentiality of knowing
  fully the dynamics of his/her perceptions and
  behaviour
• Any changes in perception (during therapy) must
  be brought about by clients themselves

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Diagnosis?

• Moderate incongruence Neurosis
• Extreme incongruence Psychosis
• Neurosis Sense feelings but deny them
• Psychosis Extends into all aspects of life
  complete split from reality e.g., paranoid
  delusion

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Theory of CureClient-Centered Therapy

• Psychotherapy is a releasing of an already
  existing capacity in a potentially competent
  individual, not the expert manipulation of a more
  or less passive personality (Rogers, 1951)
• This is the growth potential
• All people possess such a potential the trick is
  to release it
• Therapy presumably releases it, permitting ones
  self-actualizing tendencies to rise above factors
  that restricted ones acceptance of personal worth

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Theory of Cure

• Effective counseling permissive relationship
  which allows the clients to gain an understanding
  of themselves to a degree which enables them to
  take positive steps in light of their new
  orientation
• Most essential ingredient in therapy is creating
  a free and permissive relationship characterized
  by warmth, acceptance, and freedom from coercion
  unconditional positive regard.

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Theory of Cure

• Client-centered because the client needs to
  reopen an inner communication between organismic
  and self-evaluations
• Part of the therapeutic cure stems from the
  clients introjecting the therapists accepting
  attitude, or making it their own

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Theory of Cure

• Clients increasingly put themselves in touch with
  their organismic values and reject distorted and
  non-genuine values of the self, thereby promoting
  congruence
• Process
• Congruence in Congruence within
• relationship between clients
  personality
• therapist and client

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Rogers 3 fundamental principles

• Congruence/genuineness The feelings and thoughts
  the therapist is feeling are available to him,
  and can be expressed, if necessary.
• Caring/acceptance/unconditional positive regard
  The therapist wishes the client to embody
  whatever feeling is going on inside, and the
  therapist cares for the client in a
  non-possessive way.
• Empathetic understanding The therapist senses a
  persons inner world, from the clients
  perspective, and tries to communicate some of
  his/her understanding of this world.

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Process of Client-Centered Therapy

• It can take form of individual therapy, group
  therapy, and even play therapy. We will start
  with individual therapy, its most prevalent form.
• It is a shared process (unlike psychoanalysis)
• Client has a great responsibility since he/she
  knows what is hurting.
• Therapist has personal/professional knowledge of
  ways of being and responding that can be helpful
  to the client.
• Clients may have difficulty with this shared
  process at the beginning so the therapists may
  assist them to show they are sensitive to the
  feelings of the other.

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Active Listening and Empathy

• Manifest work of the therapist Deeply attentive,
  sensitive listening, and expressive response when
  needed (Affirming his attention Restating)
• The therapist must also help the client to focus
  on his/her problem (Gendlin, 1981).
• Therapist can listen beyond spoken words but not
  at their expense (Interpreting).
• Therapist must respond to the meaning at a given
  moment, keeping in mind this may change over
  time, with changing context.

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Empathetic Inference, Intuition Imagery

• Therapist must encourage and facilitate the
  expression of feelings by client using images
  that convey feelings (Butler, 1974).
• The more the therapist departs from the clients
  explicit messages, the more likely he/she is to
  be off-target so the therapist must check
  understanding. Also accepting correction.
• This inference may also lead to acknowledging
  some unspoken feelings conveyed by the clients
  non-verbal acts.

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Warmth, Caring Congruence

• Personal detachment or distance will hinder the
  helping process.
• The therapist must be warm, caring (e.g.
  providing reassurance), expressing an active
  interest (affirming his attention), and
  openness--gt Express unconditional positive regard
  for patient
• To be unconditionally accepting does not mean
  therapist must accept/condone everything the
  client does. Therapist prizes the person, not
  its actions.
• Therapist should acknowledge his/her negative
  feelings since client is likely to feel them
  anyway.

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Techniques Employed by Rogers
Rogers never wanted his interactions to be
systematic so these techniques are not especially
formalized, and their use is varied across
interviews.

• Providing Orientation
• Affirming his Attention
• Checking Understanding
• Restating
• Acknowledging Clients Unstated Feelings
• Providing Reassurance
• Interpreting

• Confronting
• Direct Questioning
• Turning Pleas For Help Back to the Client
• Maintaining or Breaking Silence
• Self-Disclosing
• Accepting Corrections

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Therapeutic Progress

• Client is being congruent, and problems have
  receded.
• Therapist and client have a great understanding
  of each other, and more easily read each others
  signals and meanings. Abundant use of metaphors
  between them.
• Client is aware that his/her values have shifted,
  and that the sense of time space has changed.

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Iveys Modern Rogerian Encounter Skill Pattern

• Skills Frequently Used
• Paraphrase
• Reflection of Feeling
• Self-Disclosure
• Feedback
• Reflection of Meaning
• Skills Commonly Used
• Confrontation
• Encouragers
• Summarization

• Skills Occasionally Used
• Interpretation
• Advice
• Information/Other
• Open questions
• Closed questions

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Theory of Cure

• Summary of basic philosophical outlook to
  therapy
• Genuineness, openness, congruence, and a
  client-centered focus of concern where the
  therapist remains a facilitator of client growth
  through congruence by providing unconditional
  positive regard

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Abraham Maslow(1908-1970)

• Optimistic view of human nature didnt dwell on
  causes of disorders
• It is as if Freud supplied to us the sick half
  of psychology and we must now fill it out with
  the healthy half
• Key contributions Hierarchy of Needs and
  description of a Self-Actualized Person/Healthy
  Personality

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Maslows Hierarchy of Needs

• A systematic arrangement of needs, according to
  priority, in which basic needs must be met before
  less basic needs are aroused

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Maslows Hierarchy of Needs
Progression if lower needs are satisfied
Need for Self-Actualization
Aesthetic Needs
Cognitive Needs
Esteem Needs
Belongingness and Love
Safety Security
Physiological Needs
Regression if lower needs are not
satisfied
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Hierarchy of Needs

• Like Rogers, Maslow argued that humans have an
  innate drive toward personal growth evolution
  toward a higher state of being
• Need for self-actualization the need to fulfill
  ones potential the highest need in his
  hierarchy
• What a man can be, he must be

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The Healthy Personality

• Self-actualizing persons are people with
  exceptionally healthy personalities, marked by
  continued personal growth

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Traits of the Self-Actualized Person

• Tuned into reality and at peace with themselves
• Open and spontaneous and retain a fresh
  appreciation of the world around them
• Socially, theyre sensitive to others needs and
  enjoy rewarding interpersonal relations
• Not dependent on others for approval or
  uncomfortable with solitude
• Thrive on work and enjoy their sense of humour
• More peak experiences or profound emotional
  highs
• Both childlike and mature rational and
  intuitive conforming and rebellious

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Evaluation of Humanistic Therapies
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Early Criticism

• Nakayama Hill (2001)
• Review of client-centered therapy and
  psychotherapy (in general) over the last 50
  years.
• Journal of Clinical Psychology (1948)
• Contains an entire issue devoted to nondirective
  therapy
• Specifically its opponents

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Early Criticism

• Albert Ellis (1948)
• Critique of Carl Rogers retiring address as
  president of the American Psychological
  Association.
• Ellis made efforts to refute many of Rogers
  claims specifically in regards to their
  originality.

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Early Criticism

• Albert Ellis (1948)
• He does not make a single reference to the work
  of such psychotherapeutic theorists as Freud and
  Rank from whose formulations the theoretical
  framework of his own school of nondirective
  therapy directly descends.
• Rogers address was an attack on all schools of
  psychotherapy except nondirective counseling

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Early Criticism

• Stark Hathaway (1948)
• Brought up several concerns regarding
  client-centered therapy and psychotherapy in
  general.
• Issues raised
• Therapies were not described adequately
• There was a lack of empirical evidence to support
  the purported efficacy of client-centered and
  other forms of psychotherapy

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Early Criticism

• Stark Hathaway (1948)
• Issues surrounding client-centered therapy
• Procedures were unclear
• Procedures could not be accurately reproduced
• The technique did not lead dynamically to change
• Empirical evidence was sloppy (measurements and
  use of control groups)
• Client-centered counseling vs. therapy

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Early Criticism

• Stark Hathaway (1948)
• Other comments
• A Necessity Evaluation of Therapeutic Change
• Impartial observers
• Self-report during daily activities
• Regression to the mean
• Placebo effects therapist attention

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Early Criticism

• Stark Hathaway (1948)
• Overall, he challenged Rogers theoretical claims
  and psychotherapy in general.
• Due to the (then) lack of solid objective
  evidence
• Since this article many of Hathaways issues
  have been addressed.
• E.g., Manuals have been created for various
  psychotherapeutic techniques
• However, the use of a manual for c-c therapy
  would contradict Rogers goal to improve the
  attitude of the therapist and not their directive
  counseling skills

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Efficacy

• Many meta-analytical studies have been employed
  since the 1970s.
• Of these, no statistical differences have been
  found in terms of the different therapies
  (including client-centered techniques, which is
  as good as any other).

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Efficacy

• This equivalency has been referred to as the
  Dodo Bird Verdict (Luborskty et al., 1975).
• In keeping with this evidence, is there any
  reason to believe that one therapy should be
  preferable over another?

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Limitations

• Broad points
• Poor Testability
• e.g., concepts such as self-actualization
• Unrealistic View of Human Nature
• Humanistic portraits of psychological health are
  too optimistic
• Inadequate Evidence
• Although Rogers and Maslow conducted and
  encouraged empirical research later proponents
  have not.

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Limitations

• Reasons why there are so few client-centered
  practitioners (Cain, 1998)
• This therapy is viewed as too simple
• It is seen as limited to techniques of attending
  and reflecting--no real mechanism of change
• Some see it as ineffective, undirected rambling
  by the client (fuzzy extinction?)
• Lack of systematic training in counseling skills
  (too much emphasis on attitude)
• Some resist putting faith into their clients
  capacity to trust their own inner direction

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Limitations

• Cognitive and behavioral techniques seem to be
  more effective in general
• Not effective with psychotic patients
• Lack of technique in regards to solving specific
  problems
• Some do not want to give up their role of
  authority, and they find it essential to advise
  and direct their clients

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Ethical Considerations

• In keeping with the nondirective /
  non-manipulative approach there is little risk
  of harm within the therapeutic relationship.
• Client-centered therapy is often referred to or
  described as an ethical approach to psychotherapy
• Clients are not viewed as sick
• That is, clients have an innate capacity / drive
  to improve self-actualize

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Advantages of Client-Centered Therapy

• Empathy, warmth, and reflective listening
  facilitate better outcomes (even if not
  sufficient on their own) (Orlinsky Howard,
  1986)
• Meta-analyses find respectable effect sizes,
  superior to no treatment (though not much better
  than placebo).
• Especially effective for improving self-esteem (
  in academic populations)

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Rogers Overall Contribution

• His primary contribution client-centered
  therapy.
• Although, this form of therapy is rarely
  practiced in isolation
• Rogers emphasis on the role of the therapeutic
  relationship and the necessary facilitative
  conditions have become integrated within the
  majority of psychotherapeutic techniques.