Person Centered Therapy - Essay Example

Person Centered Therapy Counseling came into existence when the first man ever sought advice from the other. Though the paradigms of modern day counseling may well be never ending, yet the actual essence remains the very same. Whether it be a psychological issue at hand, or even a personal problem, whenever a person seeks advice, and there is another one to offer it, it falls in the realm of counseling. “Carl R. Rogers, the originator of Person-centered therapy, did not intend to found a school of psychotherapy with a set practice” (Personality Research, 2006). Instead, he worked with his clients, reflected on the therapy process and, at a certain point, he advanced a set of hypotheses about the causes of constructive personality change. He presented the theory so it could be tried out by others and so it could be used as a basis for further research on psychotherapy. “Rogers thought his theory was an approximation to the truth about therapy” (Johnson, 1992). But he was, also, committed to protecting and encouraging a spirit of experimentation, discovery and creativity about psychotherapy. Rogers (1957) confessed that he did not want Person-centered therapy to be "frozen" but, rather, to be a working hypothesis, a stimulus to further inquiry about the therapy process. Theory Base – Person Centered Therapy Person Centered Therapy (PCT) is one of the major orientations of psychotherapy and represents a unique category of psychological intervention because it derives from person centered and behavioral psychological models of human behavior that include for instance, theories of normal and abnormal development, and theories of emotion and psychopathology. The person centered psychotherapy, is based on the clinical application of extensively researched theories of behavior, such as learning theory (in which the role of classical and operant conditioning are seen as primary). “Early behavioral approaches did not directly investigate the role of cognition and person centered processes in the development or maintenance of emotional disorders” (Berglund, 1998). Person centered therapy is based on the clinical application of the more recent, but now also extensive research into the prominent role of cognitions in the development of emotional disorders. “The term ‘Person Centered Therapy’ (PCT) is variously used to refer to therapy based on the pragmatic combination of principles of person centered theories” (Richards, 2000). New PCT interventions are keeping pace with developments in the academic discipline of psychology in areas such as attention, perception, reasoning, decision making etc. Person centered and/or client centered psychotherapists work with individuals, families and groups. The approaches can be used to help anyone irrespective of ability, culture, race, gender or sexual preference. Forrester et al.(1995), shows that “person centered and/or behavioral psychotherapies can be used on their own or in conjunction with medication, depending on the severity or nature of each client’s problem”. First, Person-centered therapy is distinguishable by its form. The salient form of Person-centered therapy is the empathic understanding response process. The empathic understanding response process involves the therapist maintaining, with consistency and constancy the therapeutic attitudes in his/her experience and expressing him/herself to the Person through empathic understanding responses. Please turn to the appendix of this presentation for four segments of therapy sessions which can serve as illustrations of empathic understanding response process. Empathic understanding responses are the observable responses which communicate empathic understanding to the Person. They are responses intended to express and check the therapist's empathic understanding experience of the Person. “What makes these types of response function as empathic understanding responses is that the therapist expresses them to the Person with the intention to ask the Person - 'is this what you are telling me?' or 'is this what you mean?', or 'is this what you are feeling?'” (Leape, 2003). These types of response, and others, may be the vehicle for the expression of empathic understanding as long as their sole intended function is to help the therapist in his attempt to understand the Person's internal frame of reference as the Person is searching himself and communicates to the therapist. Kinds of Research in PCT Put in simple words, PCT involves two different kinds of researches: Qualitative and Quantitative. Quantitative methods are useful for describing social phenomena, especially on a larger scale, whereas qualitative methods allow social scientists to provide richer explanations (and descriptions) of social phenomena, frequently on a smaller scale. There is some debate over whether ‘quantitative’ and ‘qualitative’ methods can be complementary: some researchers argue that combining the two approaches is beneficial and helps build a more complete picture of the social world, while other researchers believe that the epistemologies that underpin each of the approaches are so divergent that they cannot be reconciled within a research project. However, it is increasingly recognized that the significance of these differences should not be exaggerated and that quantitative and qualitative approaches can be complementary. They can be combined in a number of ways, for example: Qualitative methods can be used in order to develop quantitative research tools. For example, focus groups could be used to explore an issue with a small number of people and the data gathered using this method could then be used to develop a quantitative survey questionnaire that could be administered to a far greater number of people allowing results to be generalized. Qualitative methods can be used to explore and facilitate the interpretation of relationships between variables. For example researchers may hypothesize that there would be a positive relationship between positive attitudes of sales staff and the turnover of a store. However, quantitative structured observation could reveal that this was not the case, and in order to understand why the relationship between the variables was negative the researchers may undertake qualitative case studies of four stores including participant observation. This might confirm that the relationship was negative, but that it was not the positive attitude of sales staff that led to low sales, but rather than high sales led to busy staff who were less likely to be positive at work! The central hypothesis of this approach can be briefly stated. “It is that the individual has within him or her self vast resources for selfunderstanding, for altering her or his selfconcept, attitudes, and self-directed behavior--and that these resources can be tapped if only a definable climate of facilitative psychological attitudes can be provided” (Robert, 2005). There are three conditions which constitute this growth-promoting climate, whether we are speaking of the relationship between therapist and Person, parent and child, leader and group, teacher and student, or administrator and staff. “The conditions apply, in fact, in any situation in which the development of the person is a goal” (Steven, 2005). Epistemological assumptions of the research Epistemology from the Greek words episteme (knowledge) and logos (word/speech) is the branch of philosophy that deals with the nature, origin and scope of knowledge. Historically, it has been one of the most investigated and most debated of all philosophical subjects. Much of this debate has focused on analyzing the nature and variety of knowledge and how it relates to similar notions such as truth and belief. Much of this discussion concerns the justification of knowledge claims. Not surprisingly, the way that knowledge claims are justified both leads to and depends on the general approach to philosophy one adopts. Thus, philosophers have developed a range of epistemological theories to accompany their general philosophical positions. More recent studies have re-written centuries-old assumptions, and the field of epistemology continues to be vibrant and dynamic. Person-centered therapy is a distinctive and important practice and that it can be defined as a practice and its parameters clarified (NHS, 2000). I do not believe it would, by defining it in a delimiting way, become static or not evolve further. Rather, its evolution would be conceived within certain limits. Functioning therapeutically outside those limits would be considered, perhaps, a new and other person-centered therapy. Or someone might, also, be developing a practice outside the defined limits of the person-centered therapies. Certainly many of those already exist. The point is, this system of classification gets around the problem of freezing Person-centered therapy but also permits distinctions in respect to the practices of therapy that are out there in the reality of therapeutic work. The differences distinguishable among person-centered therapies probably make substantial differences in the experience of therapy by both Person and therapist and make differences in what is observable on tapes and films and, probably, make differences in the effects of the therapy on the lives of its persons. We can study and understand these different effects much better if we distinguish practices. But most important is, the clarification and definition of Person-centered therapy as distinguishable from other person-centered therapy practices can contribute to the presentation and evolution of this unique and extremely effective way of working with persons. Implications of the research epistemology The person centered psychotherapy targets problems in the here and now with much less therapeutic time devoted to experiences in early life. The therapeutic relationship is seen as an essential ingredient but unlike other psychotherapies is not viewed as the main vehicle of change. Instead the focus is in collaborative working on jointly agreed problems. Swinburn (1999) believes that the effectiveness of PCT is supported by evidence from randomized controlled trials (RCTs), uncontrolled trials, case series and case studies. It is both highly structured (although always based on a formulation of the relationship between the client’s presenting problems and underlying person centered and/or behavioral processes) and flexible due to the constant evaluation of the outcome of the interventions. The non-radical approach to social epistemology is essentially the study of the contribution of various social mechanisms to the growth of knowledge. It takes the traditional conception of knowledge as the justified, true beliefs of individuals as a point of departure, augmenting it with the social factors that impinge on these beliefs. Radical social epistemologists believe that taking account of the effects of social factors on the production of knowledge will have much more serious consequences for epistemology. Mischel (1986) elaborates that person centered therapists do not usually interpret or seek for unconscious motivations but bring cognitions and beliefs into the current focus of attention (consciousness) and through guided discovery encourage clients to gently re-evaluate their thinking. It is a form of therapy that addresses problems in a direct and targeted way. It focuses on a shared model of understanding, using a psycho-educational approach, open sharing of the formulation and teaching of self-evaluation and management skills. Its potency as a model is shown by its increasing use and accumulating recommendation by a range of evidence-based guidelines. “Person-centered therapy is also distinguishable by the extreme emphasis the practice places on the non-directiveness of the therapist” (Brown, 2000). In Person-centered therapy the therapist is intensely mindful to respect and protect the autonomy and self-direction of the Person. The Person is viewed as the expert about himself and the therapist views himself as expert only in maintaining the attitudinal conditions in the relationship with the Person, not as an expert on the Person. The therapeutic relationship is inherently an unequal relation in which the Person is self-defined as vulnerable and in need of help and the therapist is self-defined as one who can help. An element in the person/Person-centered perspective is the belief that unequal relationships are naturally, to some extent, hurtful or harmful to the persons involved in them. Hull believes that “unequal relationships are sometimes necessary, for example the physician and patient or the teacher and student, because they offer desired benefits” (1999). However, it must also be seen that the person/Person-centered perspective fosters the abdication of the pursuit of power and would argue for minimizing the hurt or harm by sharing the authority as much as possible. Evaluating the theory base According to Wittig (2002), the process of research, therapy and the skills required by PCT psychotherapists involves: (a) Assessment – knowledge and understanding of a range of PCT assessments. (b) Formulation – to derive formulations of presenting problems or situations which integrate information from assessments within a coherent PCT framework drawing upon theory and evidence based practice. (c) Intervention – On the basis of the formulation the therapist will be able to implement therapy or intervention techniques appropriate to the presenting problem and to the psychological and social circumstances of the client. (d) Evaluation – to select and implement appropriate methods to evaluate the effectiveness, acceptability and broader impact of the interventions (both individual and organizational), and use this information to inform and shape practice. This method would allow a way of being with clients based on an equal partnership, each party bringing something to the relationship. “The therapist brings skills and knowledge of psychological processes, theories of emotion and techniques that have helped others and could help the current client” (Schulz, 2002). The client is an expert in their own experience, and brings their own resources. The therapist should not have pre-conceived ideas about where the therapy is going. The overall aim is for the individual to attribute improvement in their problems to their own efforts, in collaboration with the psychotherapist. According to Mythos and Logos (2006), therapy is not experienced as something that has been “done to” the client. Here, the concept of formulation deliberates upon a unique map or hypothesis of presenting problems or situations which integrate information from assessments within a coherent PCT framework drawing upon theory and evidence based practice. “Socratic dialogue/ guided discovery – is a style of questioning to both gently probe for people’s meanings and to stimulate alternative ideas” (Baron, 1980). It involves exploring and reflecting on styles of reasoning and thinking and possibilities to think differently. PCT is not about trying to prove a client wrong and the therapist right, or getting into unhelpful debates – rather by skillfully collaborating, clients come to see for themselves (discover) that there are alternatives Homework – the client tries things out in between therapy sessions, putting what has been learned into practice. This is referred to as homework and sometimes includes behavioral experiments. Researchers must have an effective understanding of the range of person centered, person centered-behavioral and/or behavioral models of Human Behavior and/or the Person. They must have an effective understanding of the theoretical and research-based models of individual development across the lifespan, and within the cultural and social contexts prevailing. Further, they must have a good knowledge of the philosophical and theoretical bases of PCT, their practical application to various client groups and their current empirical status. “PCT psychotherapists are able to identify and critically evaluate relevant research” (CSP, 2005). The PCT psychotherapist should be able to justify the interventions being used with clients on the basis of research evidence. The process of therapy itself is based on a scientist-practitioner model. A hypothesis (formulation) is formed which leads to an intervention the results of which are then evaluated for their effectiveness. Conclusions are drawn and the hypothesis may change due to the outcome of the intervention and evaluation process. This in turn may lead to the intervention being changed. “Person-centered therapy stems from ethical values and beliefs, even though they are held with the reservation that they are hypotheses” (NMC, 2004). These values assert respect for the individual person and the belief that unconditional caring for the person is constructive for the person and also for the social milieu of the person. Whatever scientific support there may be for the Person-centered theory of therapy - and there is considerable support for it, the science is not the start of the practice for the practitioner. It simply gives support for where we place our faith. Because no-one knows the truth about therapy and no-one knows what is right. References Baron, R. et al (1980). Psychology. Japan: Holt-Saunders. Brown, R. (2000). Therapeutic Counseling. New York: Brooks/Cole. Hull, B. 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