The Client-Centered Approach and Its Aims - Report Example

Running Head: Client-centered therapy report [Name] [Professor Name] [Course] [Date] Abstract: Client-centered therapy or person-centered therapy is a kind of behavior change approach that places significant focus on the client, while the therapist withdraws. The approach largely attributed to the works of Carl Rogers (Bower, 2000). This paper entails discussion on the client-centered approach and its aims as well as the steps involved in the technique. It further presents a synthesized evaluation of the literature on the effectiveness of the technique on the three client groups, namely clients with moderate mental health problems, clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety, and cancer patients undergoing radiotherapy to manage anxiety. Also outlined include the client groups that do not suit the procedure and how to use the procedure with client group. An analysis of the procedure in terms of the behavioral principles on which it is based is also conducted. Additionally, additional strategies and argument to support why they would contribute to intervention effectiveness is examined. Introduction Behavior change has become a key objective of health intervention programs, in helping address lifestyle modifications for chronic disease management, disease prevention and addictions (Bower, 2000; Prouty, 1994). Behavior change procedures are useful in helping patients understand their health conditions as well as adjust their behavior in a manner that can improve their health. A change in the lifestyle of a patient can help to successfully manage long-term illnesses (Gretchen, Olsen & Bosworth, 2000). This paper presents a synthesis of person-centered approach, given that it presents the clients with an opportunity to come to terms with his condition and make critical decisions. Client-centered approach As the name suggests, client-centered approach is a kind of behavior change approach that places substantial focus on the client, hence the therapist abstains from making diagnoses, asking questions or reassuring the client, when interacting with them (Gatongi, 2007). This kind of therapy, which was originally called nondirective, deviates from the concept that the therapist is the authority, towards the approach that the actualizing tendency, or the trusted inherent tendency, of humans to realize fulfillment of their personal potentials (Ling, 2012). A significant aspect of the theory is that within a specific psychological environment, realization of personal potentials includes sociability, the desire to be with other human beings as well as the desire to understand to be recognized by other people (Rogers, 1946). Additionally, it entails being trustworthy and trusting, open to experience, being creative and inquisitive about the world. The psychological environment is one in which an individual is protected from psychological and physical threat. Under this kind of approach, the client and not the therapist is responsible for improving his personal life. Indeed, this is a critical change from the behavioral therapies and psychoanalysis where the client is diagnosed and treated by the doctor (McCormack, 2011). Rather, the client is deliberately and reasonably selects for himself what is right and what should be done. In addition, the therapist is regarded as more of a counselor who encourages and listens to the client on equal level (Romana, 2006). The Client-centered approach is based on three key principles, which reflect the attitude of the therapist to the client, including: The therapist is congruent with the client; The therapist supplies the client with unconditional positive regard; The therapist is empathetic to the client (Rogers, 1946; Morgan & Yoder, 2012). Effectiveness of Client-centered approach basing on three client groups Client-centered therapy is an essential treatment component for persons with any condition or disorder that can be improved through psychotherapy and traditional talk therapy. Despite the fact that client-centered therapy doesn’t address any specific disorder or diagnosis, the approach has proved a valuable tool in a range of intervention scenarios. In a study by Gibbard and Hanley (2008) of the effectiveness of client-centered therapy for individuals with mild to moderate mental health problems, the results indicated that the approach is efficient with common mental health problems, including depression and anxiety. The study further found that effectiveness is not entirely limited to the clients with mild to moderate symptoms of recent onset, rather, that it extends to individuals with moderate to severe symptoms of longer duration. In the five-year study period, which evaluated primary care counseling service providing client-centred approach, the Core Outcome Measure (CORE-COM) was applied at the start and end of the therapy. The evaluation of client-centred counseling approach started in 2001. Over the period, 12 counselors were used. The primary objective of the study was to examine the effectiveness of client-centred counseling. The results indicated that the approach is indeed an effective intervention for common primary care mental disorders. The proportion of the clients who showed reliable improvement based on the CORE-OM, and the fraction of those who reported having improved their conditions, based on the exit questionnaires, were extremely similar (68 percent and 69 percent in that order). A study by Weston (2011) measured the clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety, in the practice of a therapist, and to evaluate the therapeutic relationships as an outcome predictor. 321 clients participated in the study, where 66 percent those of mean age 31 years were female, 62 percent were single, 67 percent were parents. 88 percent were of British origin and 94 percent were taking no relevant medication (Weston, 2011). The method or research involved an uncontrolled naturalistic experiment. The outcome measures were finished during the first session of the therapy and afterwards alongside the measure of the relationship. The study found that client-centered approach is indeed an effective intervention for patients with depression, anxiety and distress. There was however no evidence of the function of therapeutic relationship, as an outcome predictor for anxiety, depression and distress (Weston, 2011). A study by Mullaney et al (2012) investigated the effectiveness of client-centered therapy in helping cancer patients undergoing radiotherapy to manage anxiety, within the radio clinic of Norrlands University Hospital (NUS) in Umeå, Sweden. It first involved literature review of nursing research on emotional experiences of patients within the radiotherapy clinic having cancer. A case study of the hospital was later conducted for the patients at the radiotherapy clinic. A design lens was applied to evaluate the interaction of patients with the physicians and the environment. The study found that client-centered approach was indeed effective as a coping technique in enabling patients with cancer to manage anxiety. The study further called attention to the triggers for anxiety as well as suggested that the solution space of client-centered approach should be extended beyond its focus on cancer patients to also include the situational triggers of anxiety (Mullaney et al, 2012). Client groups/disorders that do not suit client-centred approach Although client-centered therapy has been used to treat range of people, the approach is not intended to a particular age group or client group. The approach has proved to be ineffective when used for poor-educated or non-verbal client groups. Hence has very limited use in non-educated clients, or non-verbal clients such as young children or in persons with serious mental illnesses, as it has proved ineffective. This is because the approach has lack of interest in the patient’s trauma, dreams, the depth of unconsciousness and the need for the therapist to diagnose or interpret certain roots of dysfunction (Blarikom, 2007). Further, this is because it is a talking therapy which strives to increase the client’s agency as well as enable behavioral change, instead of focusing on the diagnosis and actual intervention by the therapist. In addition, its lack of directivity makes it ineffective in children or clients groups with schizophrenia (Prouty, 1994). While this is supposed to minimize resistance, it does not suitably fit what such client groups can find useful. Further, client-centered therapy’s avoidance of the client’s past trauma make it ineffective for clients groups who may desire and opt for counseling the platform to catharsis incidents of childhood abuse. In such cases, the assumption that the present relationships are the problem is hypocritical. For instance, relationship dysfunction may originate from primary neurological disorder or addiction. The procedure with each client group In the group, clients with mild to moderate mental health problems, all clients were referred by their general practitioner (GP) and evaluated by community psychiatrist nurse (CPN). In the client group, the therapist operated on the principle that the client is responsible for himself, and that the therapist is willing to let the individual to keep the responsibility. In cases where medication was recommended, it was offered by GP depending on CPN after the evaluation. Self help literature on depression, anxiety and stress management was also issued to the clients during the study. The CORE system was applied in measuring the result of therapy. CORE entails the Therapy Assessment Form and End of Therapy Form, which is filled by the therapist and which provide contextual information. The CORE Outcome Measure (CORE-OM) is a self report questionnaire that the clients complete and which is used to measure their distress (Gibbard & Hanley, 2008). It was issued during the first and the last therapy session. Completed forms were submitted during the discharging of the patients. Clients rated how helpful they found the therapy and how much better they felt after the therapy. In the group, cancer patients undergoing radiotherapy to manage anxiety, the radiotherapists were observed to study their behavior and how they work. The study focused on studying the roles of actors in the therapy and recording of findings. Within this client group, the therapist operated on the principle that the client has a strong drive to improve his situation or change his behavior. He therefore relied on this force and not his authority as the counseling facilitator, for therapeutic change. Observations were started in the Computed Tomography (CT) room and dose planning room to map out the client’s radiation treatment plan. The treatment room nurses were also observed to understand the client’s individual dose plan. Finally, the line of visibility within the treatment process was documented, such as the behavior of the patients and what transpired behind the scene. The stories told by the clients and the staff of the NUS radiotherapy clinic, highlighted the emotional experiences of the clients’ during treatment. The care staff responded during interviews giving more information on the potential causes of the responses on the clients. In the study by Weston (2011) that measured the clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety, the general terms of examining the clinical effectiveness of the therapy technique was reviewing self-reported changes through validated outcome questionnaires, comparing pre- and post therapy scores and reviewing client’s score of therapeutic relationship using questionnaires. Within this client group, the therapist facilitated an enabling atmosphere, in which the client was free to exude any behavior, attitude and feelings no matter how contradictory and absurd. The client on the other hand expressed his feelings freely. The study started by using a general measure of clinical distress (CORE-OM) as an outcome measure, before being added a measure of depression outcome (BDI-II), and a measure of anxiety outcome (BAI). The roles of the clients and the therapists majorly entailed answering the questionnaires (Weston, 2011). Analysis of the procedure in terms of the behavioural principles Tunis et al (2012) argues that an essential factor for successful client-centered therapy is not the therapist’s training or skill, but instead his attitude. The therapist needs to embrace three interconnected principles, which are central to the success of the therapy. The three include empathy, unconditional positive regard and congruence. This is applicable in client-centered therapies for clients with mild to moderate mental health problems, cancer patients and the clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety. The procedures in all the three scenarios were consistent with the three key principles of client-centered approach, namely unconditional positive regard, empathy and congruence. With regard to unconditional positive regard, all the therapists in the study of cancer patients, mental disorder and the clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety, appeared to have accepted the clients for who they are, without bias or prejudgment and disapproving of their particular characteristics actions and feelings. The therapists or counselors were as well willing to listen to the clients without judging them or interrupting them. For instance, the staff of the NUS radiotherapy clinic treated the patients as active participants rather than passive subject during the treatment. In all the three studies, the therapists’ or the counselors’ attitude were basically empathetic, as they sought to appreciate the situation of the client from the perspective of the client, thus showing understanding of the feelings of the client throughout the period of the therapy. This is a primary step in enabling the therapy to work, as it forms a major part of the therapy. For instance, in the study of patients with mental health, 90 percent of the clients suggested that they found counseling very helpful, while 69 percent claimed that they felt better about their problems, based on aspects of the client-centered therapy such as therapists who commit to listen without interrupting. Additionally, it indicated that the therapist is ready to give the client an opportunity to evaluate their own thoughts, when they hear them repeated by someone else. This enabled the clients to respond through reflections of their thoughts. Overall, the client-centered approaches in all the three studies were successful, since the three principles were effectively observed by the clients and the therapists. Thus the therapists or counselors did not seek to change the client’s perception or thinking. Given this non-directive approach, clients were able to reflect on the issues that were most important to them, rather than those suggested by the therapist. Based on the principle of self-actualization, the uninterrupted self-exploration enabled the clients to make out alternative ways of thinking, which could promote personal growth. Further, the therapists merely acted as facilitators by providing an environment that enable clients to engage in self-reflection (Jayadevappa & Chhatre, 2011). Additional Strategies An additional strategy that could ensure the effectiveness of client-centered therapy is that the therapist should establish a contact with the client. This implies that the therapist should be both physically and psychologically present during the therapeutic process, as he serves to facilitate an enabling environment for treatment. Overall, the thinking and the self-exploration process in client-centered therapy should be implemented with the therapists working jointly with the medical providers and the clients. However, this paper suggests that a holistic perspective of the client-centered approach is ideal for enabling the frame-shift needed to think further than the treatment to client-centered care (Baumman, 2003). In conclusion, this paper presents a synthesis of client-centered approach application in three client groups, namely the effectiveness of the technique on the three client groups, namely clients with moderate mental health problems, clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety and cancer patients undergoing radiotherapy to manage anxiety. It provides evidence that the effectiveness of the therapy technique is indeed effective in ensuring behavior change. The nondirective therapeutic relationship established between the client and the therapist has a significant impact on the client, as the client is able to make out that he is responsible for himself as well as self-reflect to select between alternative behaviors he should adapt. References Adams, N. & Grieder, D. (2004). Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery. London: Elsevier Academic Press Baumman, A., Fardy, J. & Harris, P. (2003). ‘Getting it right: why bother with patient-centred care?.’ Medline Directory of Australia, 179(5), pp. 253-256 Blarikom, J. (2007). 'A Person-Centered Approach to Schizophrenia.' Person-Centered and Experiential Psychotherapies, 5(3), pp.155-169 Bower, D. (2000). The Person-Centered Approach: Applications for Living. Toronto: iUniverse Publishers, pp.134 Gatongi, F. (2007). 'Person-centred approach in schools: Is it the answer to disruptive behaviour in our classrooms?' Counselling Psychology Quarterly, 20(2), pp.205–211 Gibbard, I. & Hanley, T. (2008). "A five-year evaluation of the effectiveness of person-centred counselling in routine clinical practice in primary care." Counselling and Psychotherapy Research, 8(4): pp.215-222 Gretchen Z., Olsen, C. & Bosworth, M. (2000).‘Stages of Change’ Approach to Helping Patients Change Behavior.' American Family Physician. 61(5):pp.1409-1416. Jayadevappa, R. & Chhatre, S. (2011). 'Patient Centered Care - A Conceptual Model and Review of the State of the Art.' The Open Health Services and Policy Journal, 4. pp15-25 Michie1,S., Abraham, C., Eccles, M., Francis, J., Hardeman, J. & Johnston, M. (2011). 'Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol.' Implementation Science, 6(10) Karzdin, A. (1977). 'Assessing the Clinical or Applied Importance of Behavior Change through Social Validation.' Behavior Modification, 1(4): pp427-452 Ling, W., Farabee D., Liepa, D., Wu, L. (2012). 'The Treatment Effectiveness Assessment (TEA): an efficient, patient-centered instrument for evaluating progress in recovery from addiction.' Substance Abuse and Rehabilitation, 3. pp.129–136 MacGregor, K, Handley, M., Wong, S., Sharifi, C., Gjeltema, K., Schillinger, D. & Bodenheimer, T., ‘Behavior-Change Action Plans in Primary Care: A Feasibility Study of Clinicians.’ Journal of the American Board of Family Medicine. 19(3) pp.215-223 McCormack, B.(2011). 'Developing Person-Centred Care: Addressing Contextual Challenges Through Practice Development.' Online Journal of Issues in Nursing, 16(2) Morgan, S. & Yoder, L. (2012). 'A Concept Analysis of Person-Centered Care.' Journal of Holistic Nursing, 30(1), pp6-15 Mullaney, T., Patterson, H.,Nyholm, T, & Stolterman, E. (2012). 'Thinking beyond the Cure: A Case for Human-Centered Design in Cancer Care,' International Journal of Design, 6(3). (online) retrieved: Accessed 6 July 2013 Prouty, G. (1994). Theoretical Evolutions in Person-Centered - Experiential Therapy: Applications to Schizophrenic and Retarded Psychoses. Westport, CT: Greenwood Publishing Group Rogers, C. (1946). 'Significant Aspects of Client-Centered Therapy.' American Psychologist, 1, 415-422. (Online) retrieved from: Accessed 7 July 2013 Romana, H. (2006). 'Is Evidence-Based Medicine Patient-Centered and Is Patient-Centered Care Evidence-Based?' Health Services Research, 41(1), pp1-8 Thorne, B. & Lambers, E. (1998). Person-Centred Therapy: A European Perspective. London: SAGE Publications Timothy W. (2007). ‘Counselling for Problem Gambling: Person-Centred Dialogues.’ Journal of Gambling Issues: Iss 20, pp. 277-279. Tunis, S., Messner, D., Mohr, P., Gliklich, R. & Dubois, R. (2012). 'A translation table for patientcentered comparative effectiveness research: guidance to improve the value of research for clinical and health policy decision-making.' Journal of Comparative Effectiveness Research, 1(3), 259–262 Weston, T. (2011). The Clinical Effectiveness of the Person-Centred Psychotherapies: The Impact of the Therapeutic Relationship. (Online) retrieved from Read More

This kind of therapy, which was originally called nondirective, deviates from the concept that the therapist is the authority, towards the approach that the actualizing tendency, or the trusted inherent tendency, of humans to realize fulfillment of their personal potentials (Ling, 2012). A significant aspect of the theory is that within a specific psychological environment, realization of personal potentials includes sociability, the desire to be with other human beings as well as the desire to understand to be recognized by other people (Rogers, 1946).

Additionally, it entails being trustworthy and trusting, open to experience, being creative and inquisitive about the world. The psychological environment is one in which an individual is protected from psychological and physical threat. Under this kind of approach, the client and not the therapist is responsible for improving his personal life. Indeed, this is a critical change from the behavioral therapies and psychoanalysis where the client is diagnosed and treated by the doctor (McCormack, 2011).

Rather, the client is deliberately and reasonably selects for himself what is right and what should be done. In addition, the therapist is regarded as more of a counselor who encourages and listens to the client on equal level (Romana, 2006). The Client-centered approach is based on three key principles, which reflect the attitude of the therapist to the client, including: The therapist is congruent with the client; The therapist supplies the client with unconditional positive regard; The therapist is empathetic to the client (Rogers, 1946; Morgan & Yoder, 2012).

Effectiveness of Client-centered approach basing on three client groups Client-centered therapy is an essential treatment component for persons with any condition or disorder that can be improved through psychotherapy and traditional talk therapy. Despite the fact that client-centered therapy doesn’t address any specific disorder or diagnosis, the approach has proved a valuable tool in a range of intervention scenarios. In a study by Gibbard and Hanley (2008) of the effectiveness of client-centered therapy for individuals with mild to moderate mental health problems, the results indicated that the approach is efficient with common mental health problems, including depression and anxiety.

The study further found that effectiveness is not entirely limited to the clients with mild to moderate symptoms of recent onset, rather, that it extends to individuals with moderate to severe symptoms of longer duration. In the five-year study period, which evaluated primary care counseling service providing client-centred approach, the Core Outcome Measure (CORE-COM) was applied at the start and end of the therapy. The evaluation of client-centred counseling approach started in 2001. Over the period, 12 counselors were used.

The primary objective of the study was to examine the effectiveness of client-centred counseling. The results indicated that the approach is indeed an effective intervention for common primary care mental disorders. The proportion of the clients who showed reliable improvement based on the CORE-OM, and the fraction of those who reported having improved their conditions, based on the exit questionnaires, were extremely similar (68 percent and 69 percent in that order). A study by Weston (2011) measured the clinical effectiveness of client-centered approach in treating patients with depression, distress and anxiety, in the practice of a therapist, and to evaluate the therapeutic relationships as an outcome predictor.

321 clients participated in the study, where 66 percent those of mean age 31 years were female, 62 percent were single, 67 percent were parents. 88 percent were of British origin and 94 percent were taking no relevant medication (Weston, 2011). The method or research involved an uncontrolled naturalistic experiment. The outcome measures were finished during the first session of the therapy and afterwards alongside the measure of the relationship.

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