PSY 245 CLINICAL PSYCHOLOGY-II

1
PSY 245CLINICAL PSYCHOLOGY-II

• Assoc. Prof. Dr. BAHAR BASTUG
• Clinical Psychologist

2
CARL ROGERS PERSON-CENTERED THEORY AND THERAPY
3
Welcome

• This week were focusing on person-centered
  theory and therapy (PCT).
• This approach was developed by Carl Rogers.
• The approach is deeply optimistic and guided by
  principles of trusting clients and an actualizing
  tendency.

4
Carl Rogers (1902 1987)
5

• Freud gtgtgtgtpessimist
• Adler Jung gtgtgtgtoptimist
• Rogersgtgtgtgtsuperoptimist.
• Rogers developed a distinctive approach
  Listening.

6

• In his life, he strove to be a genuine and open
  person, he strove to be himself.
• Other theorists criticized Rogers being
  superoptimist.

7
LIFE OF ROGERS.
Born in 1902, in Oak Park, Illinois
8
Biographical Information

• 4th of 6 children to a farm family in Illinois.
• His family was rigid fundamentalist Christians.
• Traveled to China, had a significant change of
  view. Rogers appears to have become Rogers

9
(No Transcript)
10
Biographical Information Carl Rogers

• Carl Rogerss development as a person was
  characterized by the following (and more) events
  
• He rejected his parents conservative religious
  ideology.
• He decided to marry his childhood sweetheart.
• He decided to pursue graduate studies at the
  liberal Union Theological Seminary in New York
  City.
• He studied clinical psychology at Columbia
  University.

11
Married in 1924

• Rogerss relationship with his wife had a
  powerful affect on him. Because of his poor
  social skills, she was the first person with whom
  he ever had a caring and sharing relationship.

12
in 1928

13

• At the time, Columbia University was interested
  in John Watsons behaviorism. Rogers was oriented
  more toward the contemporary scientist-practitione
  r model. He was the first person to tape-record
  actual therapy sessions.

14

• Rogerss first clinical position was at the
  Adlerian-oriented Rochester Child Guidance
  Center. During this time, academic psychologists
  were behavioral, while clinicians were trained in
  either psychoanalytic or neo-analytic theory.
  Since Rogers wanted to help people (rather than
  work in a laboratory), he was trained in an
  analytic approach.

15

• Rogers attended a seminar with Otto Rank and
  learned from a social worker, Elizabeth Davis.
  Ms. Davis way of articulating clients feelings
  fascinated Rogers.

16

• Rogers adopted the following principles from Otto
  Rank
• Clients have creative powers.
• Therapy should help clients accept their personal
  uniqueness and self-reliance.
• The client is the central figure in the therapy
  process the therapist only helps clients access
  their powers of self-creation.

17

• Therapists shouldnt educate clients.
• Therapist shouldnt foster dependency with
  clients by becoming love objects.
• Therapy works when clients experience the present
  within the therapy setting.

18

• Rogers was influenced by the person of Roosevelt.
  
• Roosevelt was optimistic.
• Rogers was influenced by the
• philosophy of John Dewey.

19
Historical Context

• Rogers was influenced by
• Elizabeth Davis
• President Franklin D. Roosevelt
• John Dewey
• His relationship with his wife
• His clients

20
Historical Context

• Honoring the Client
• Rogers credited his clients as the greatest
  source of his development.
• Natalie Rogers stated And so like Carl, I
  stayed open to learning from my clients. They are
  always our best teachers.

21

• His daughter, Natalie Rogers, has become a
  significant force in integrating dance, movement,
  and the arts with person-centered theory and
  therapy.

22
Struggles with Psychiatry and Psychology

• Rogers developed his client-centered approach to
  psychotherapy in a climate openly hostile to his
  ideas. He had to fight the behaviorism of
  academic psychology as well as the psychoanalysis
  of the clinical world.
• Rogers had a battle with psychiatry to obtain for
  psychologists the right to practice
  psychotherapy.

23

• Rogers socialized with social workers,
  counselors, and teachers. He rebelled against the
  traditional class lecture, he participated in
  encounter groups.

24

• However, he was elected president of the American
  Psychological Association in 1946.

25
Evolution of Person-Centered Therapy

• Rogerss practice of person-centered theory and
  principles is divided into 4 periods
• 1. Nondirective counseling. This period began in
  the 1940s and was characterized by Rogerss
  growing aversion to directive, traditional
  therapy methods.

26
Evolution of Person-Centered Therapy

• 2.Client-centered therapy. In the 1950s Rogers
  changed the name of his approach from
  nondirective counseling to client-centered
  therapy.

27
Evolution of Person-Centered Therapy

• 3. Becoming a person. During the 1960s, Rogers
  focused on self-development. His work was
  strongly associated with the human potential
  movement. He published On Becoming a Person and
  moved from academia at the University of
  Wisconsin to California in 1964.
• Person-centered therapy

28
Evolution of Person-Centered Therapy

• 4.Worldwide issues. In the 1970s and 1980s,
  Rogers became more interested in worldwide
  issues. He began dedicating his work to improving
  interracial relations and producing world peace.
  He met with Irish Catholics and Protestants,
  visited South Africa and the Soviet Union, and
  conducted cross-cultural workshops in Brazil,
  Dublin, and Hungary.

29

• Theory of Personality

30

• The person-centered approach includes a theory of
  personality and theory of psychotherapy. The
  theory of personality is complex and difficult to
  formulate. For this reason, it gets little
  attention.

31
Theory of Personality

• Self theory
• Phenomenology and the valuing of experience
• Learning and growth potential
• Conditions of worth

32
Self-Theory

• Every person exists within an ever-changing world
  in which he or she is the center. The self is not
  a fixed structure, but a structure in process,
  capable of both stability and change.

33
Self-Theory

• The term organism refers to the locus of all
  psychological experience. The organism is the
  entire realm of an individuals experience, while
  the self is the me portion of the organism.
• Rogerss self has both conscious and unconscious
  components.

34
Self-Theory

• The distinction between organism and self makes
  it possible that an individuals self can be
  inconsistent with its overall psychological
  experience. This discrepancy is referred to as
  incongruence.

35
Self-Theory

• In contrast, when the selfs experiences and
  perceptions are consistent with the organisms
  total experience, there is congruence. Congruence
  between self and organism is highly desirable it
  leads to adjustment, maturity, and a fully
  functioning individual.

36
(No Transcript)
37

38
(No Transcript)
39
Phenomenology and the Valuing of Experience

• This theory is basically phenomenological.
  Personal experience.
• Although both intellectual thinking and feelings
  are valued informational sources, experiencing is
  a direct way of accurately knowing oneself and
  the world.

40
Phenomenology and the Valuing of Experience

• Person-centered therapy is designed to help
  clients be more open to personal experiences.
  True learning is best achieved through lived
  experience.

41
Learning and Growth Potential

• Rogers believed in the inherent actualizing or
  formative tendency in humans. Rogers believed
  people have the capacity to learn on a
  moment-to-moment basis.
• Rogers actualizing tendency is similar to
  Adlers striving for superiority.

42
Conditions of Worth

• The main two learned needs are the need for
  positive regard and the need for self-regard.
• The baby begins developing a greater and greater
  consciousness of self. Most parents see this
  behavior in their children at about age two, when
  the childs favorite words become mine! and
  no.

43
Conditions of Worth

• 2. The growing child develops a strong need for
  positive regard or approval. This need for
  positive regardto be prized and lovedbecomes so
  powerful that the child is almost always looking
  to caregivers and significant others for
  acceptance and approval.

44
Conditions of Worth

• Children begin distinguishing between approved
  and disapproved feelings and actions. They sense
  and understand the conditions of worth present in
  their lives.
• Children internalize caregivers appraisals.

45

• A young girl loves to play aggresively with other
  boys and experiences disapproval from parents,
  she concludes
• When I play aggresively Im bad. (negative self
  regard)
• My parents dont like me (negative regard from
  others)
• I dont like to play aggresively (denial of a
  desirable organismic experience)

46
Conditions of Worth

• Over time, if children continually experience
  conditions of worth incongruous with their
  organismic values, a conflict may develop between
  their conscious, introjected values and their
  unconscious genuine values.

47
Conditions of Worth

• When individuals are unaware of true selves and
  desires, psychopathology develops. A discrepancy
  occurs between real self and ideal self. Its
  known as incongruence.

48
Conditions of Worth

• Individuals are capable of perception without
  awareness. This process is subception. In the
  case of subception, a person unconsciously
  perceives a threatening object or situation.

49

• In sum, it emphasizes several concepts. It is the
  theory of self, experience, striving for
  maintenance and enhancement of the self, and
  learned needs of positive regard.

50
Theory of Psychopathology

• Psychopathology can be a discrepancy between the
  real self and the ideal self.
• As humans confront challenges in life they will
  misperceive, operate on mistaken beliefs, and
  behave inadequately. Dysfunctionality occurs if
  we fail to learn from feedback. Dysfunctionality
  is a failure to learn and change.

51
Theory of Psychopathology

• The failure to learn from experience.
• Person-centered therapists work so hard to help
  clients become open to learning from new
  experiences. Rigidity is considered the
  antithesis of psychological health. Rigidity
  impairs learning.

52
Theory of Psychopathology

• Since every moment is an opportunity for new
  learning, avoiding or ignoring these moments is
  pathological.

53
Theory of Psychotherapy

• Psychopathology stems from the individuals
  experience of judgment of the self by significant
  others.
• A nonjudgmental atmosphere will facilitate
  psychological health.

54
Theory of Psychotherapy

• The success of person-centered therapy depends on
  two fundamental factors
• The therapist must trust the client.
• The therapist must establish a certain type of
  relationship with the client. ? So, clients will
  be able to begin trusting themselves,
  experiencing greater personal development and
  psychological health.

55
Theory of Psychotherapy

• It is related to Rogerss theory of personality.
  For constructive personality change, it is
  necessary for the following core conditions to
  exist
• 1. Two persons are in psychological contact.
• 2. The client is in a state of incongruence.
• 3. The therapist is congruent in the
  relationship.

56
Theory of Psychotherapy

• 4. The therapist experiences unconditional
  positive regard.
• 5. The therapist experiences an empathic
  understanding.
• 6. Communication of unconditional positive regard
  and empathic understanding is at least minimally
  achieved.

57

• The therapist communicate
• congruence,
• unconditional positive regard,
• and empathic understanding to the client.

58
Congruence

• is defined as authenticity or transparency. The
  congruent therapist is real, open, and honest.
• The more that the therapist can be genuine in
  the relationship, the more helpful it will be.
• Therapists should acknowledge and express both
  positive and negative feelings within the context
  of the therapy relationship.
• How would you describe congruence?

59
Unconditional Positive Regard

• Acceptance, respect, or prizing
• Valuing the client as a separate person or
  organism whose thoughts, feelings, beliefs, and
  entire being are openly accepted, without any
  conditions. If the therapist can accept clients
  completely, the clients can begin exploring who
  they really are and what they really want. By
  accepting clients, therapists lead clients to
  begin accepting themselves.

60
Unconditional Positive Regard

• This acceptance should extend to the
  moment-to-moment changes and inconsistencies
  manifested by clients during sessions.

61
Unconditional Positive Regard

• At one moment the clients may identify only
  feelings of love and kindness toward someone, and
  at the next they may rage about the same person.
  To the person-centered therapist, both love and
  rage are important, valid, and equally worthy of
  attention. By simply listening and reflecting
  back both feelings, the therapist allows clients
  to accept whats been expressed.

62
Unconditional Positive Regard

• How would you describe unconditional positive
  regard?

63
Accurate Empathy or Empathic Understanding
64
Accurate Empathy or Empathic Understanding

• Noticing your clients feelings.
• Entering into the clients world, seeing and
  experiencing what client sees and experiences.

65

• Rogers shifts from using a second-person pronoun
  (When he left, you felt betrayed and alone) to
  using a first-person pronoun (he just up and
  left, and I felt betrayed and alone). This
  pronoun shift is referred to as walking within.

66

• Kizilderili Atasözü
• komsun hakkinda hüküm vermeden 
• önce iki ay onun makosenleriyle yürü.

67
Empathy

• has been most widely discussed and researched.
  Empathy is a prerequisite for therapy and a
  necessary condition.
• Empathy is a multidimensional concept. Three
  components are commonly discussed in the
  literature

68

• Subjective empathy involves to identify with a
  client and imagine and experience what it is like
  to be a patient.
• Interpersonal empathy occurs when you attempt the
  phenomenological experiencing of a client from an
  extended perspective.
• Objective empathy involves using the
  observational data to understand the client.

69
THE PRACTICE OF PERSON-CENTERED THERAPY

• two different types of person-centered
  therapists
• The Classical person-centered therapist is highly
  nondirective, does not use assessment procedures,
  and does not establish any specific goals for
  clients.
• The contemporary person-centered therapist is a
  more active and directive therapist.

70
The Practice of PCT A Way of Being With Clients

• Assessment Issues and Procedures
• Classical person-centered therapists dont employ
  standardized assessment or diagnostic procedures.
• Contemporary person-centered approaches sometimes
  employ assessment procedures.

71
The Practice of PCT A Way of Being With Clients

• The Therapists Opening Statement
• Clients can take the lead in determining what to
  talk about.
• Example Anything youd like to tell me about
  yourself that will help me to know you better,
  Id be very glad to hear. (Rogers, 1963)

72
Experiencing and Expressing Congruence

• This can be tricky.
• How do you think therapists should experience and
  express congruence?

73
Experiencing and Expressing Congruence

• The basic question is If I am to be congruent,
  do I need to tell the client about my every
  thought and feeling?
• The answer is No. Thats not to say that
  therapists should be too cautious about
  self-disclosing to clients.
• The main aim of this openness is communicating
  helpful information to clients.

74

• A certain amount of censoring is necessary.
• To use techniques in therapy is appropriate, but
  only when the techniques come up spontaneously,
  not when theyre preplanned.

75
Experiencing and Expressing Unconditional
Positive Regard

• This is also tricky.
• It involves accepting clients as they are and
  avoiding judgments.
• Is this possible?
• How do you think you could experience and express
  unconditional positive regard?

76
Experiencing and Expressing Unconditional
Positive Regard

• Everyone is human and judges others.
• The problem is how to best express positive
  regard. Would it be appropriate to say, I accept
  you completely and totally as the person you are
  or I prize and value your total being?

77
Experiencing and Expressing Unconditional
Positive Regard

• Most therapists get themselves in trouble if they
  directly express unconditional positive regard to
  clients, for two reasons
• 1.Expressing too much positive regard can be
  overwhelming to clients. Clients may react by
  wanting to break down therapy boundaries. Upon
  hearing such positive, loving statements they
  naturally seek more closeness, a friendship or
  romantic relationship. Some clients may react to
  direct expressions of affection with fear. These
  clients may try to expand the boundary between
  themselves and the therapist.

78
Experiencing and Expressing Unconditional
Positive Regard

• 2. Saying I care about you or I wont judge
  you can be viewed as unrealistic, especially if
  the therapist hasnt spent much time with the
  client and doesnt really know the client well.

79
Experiencing and Expressing Unconditional
Positive Regard

• If its inappropriate to directly express
  unconditional positive regard to clients, how can
  therapists communicate this important message?
• 1.by keeping appointments, and by listening
  sensitively.
• 2.by allowing clients freedom to discuss
  themselves in their natural manner.

80
Experiencing and Expressing Unconditional
Positive Regard

• 3.by demonstrating that you hear and remember
  specific parts of a clients story.
• 4.by responding with empathy to clients
  emotional pain and intellectual conflicts.
• 5.clinical experience and research both indicate
  that clients are sensitive to an interviewers
  intentions. By making an effort to accept and
  respect your clients.

81
Experiencing and Expressing Empathic Understanding

• Person-centered therapists do not believe its
  possible for one individual to directly know and
  experience another individuals feelings. As with
  unconditional positive regard, what appears
  important regarding empathy is not that
  therapists perfectly experience and express
  empathy, but that they try their best to do so.

82
Experiencing and Expressing Empathic
Understanding

• Entering and becoming at home in the clients
  personal perceptual world.
• Being sensitive from moment to moment with the
  clients changing meanings and emotions.
• Temporarily living, and moving in the clients
  life.
• Sensing deep meanings, but not uncovering
  feelings that are too far out of awareness.

83
Entering and Becoming at Home in the Clients
Private Perceptual World

• Entering the clients private world requires
  preparation. You need to be open to feeling what
  the client feels and willing to ask the empathy
  question
• How would I feel if I were _____ and saying
  these things?
• The procedures employed to enter the clients
  world include reflection of feelings, empathic
  exploration, and clarification.

84
Being Sensitive from Moment to Moment with the
Clients Changing Meanings and Emotions

• Moment-to-moment sensitivity requires focused
  attention to your clients changing way of being.
  In his emotion-focused therapy, Greenberg
  recommends focusing on meaning associated with
  the clients verbalizations.

85
Temporarily Living, and Moving in the Clients
Life

• To reside in another persons life is serious
  business. Rogers says to do this temporarily.
• Your goal is to have one foot inside the world of
  the client and one foot planted in your own
  world.

86
Temporarily Living, and Moving in the Clients
Life

• Martin Buber, existantialist, referred to this
  sort of relationship experience as an I-Thou
  relationship, and he emphasized that its
  impossible to constantly maintain such a
  relationship.

87
Sensing Deep Meanings, but not Uncovering
Feelings That Are Too Far out of Awareness

• Rogers talked about working on the edge of his
  clients consciousness. As a person-centered
  therapist moving about within your clients
  world, if you have an impulse to tell a client
  about something outside of his or her awareness,
  its best to hold your tongue. Your main job is
  to follow the clients lead, not to walk your own
  path.

88

• PCT has been integrated with other therapies.
  These include
• Motivational interviewing
• Emotion-focused therapy
• Nondirective play therapy

89
Motivational Interviewing

• was developed by William R. Miller. In his work
  with problem drinkers, Miller discovered that
  structured behavioral treatments were no more
  effective than an encouragement-based control
  group. He concluded that reflective listening and
  empathy were crucial in producing positive
  treatment effects with problem drinkers, and
  began his development of motivational
  interviewing.
• MI builds on person-centered principles by adding
  more focused therapeutic targets and specific
  client goals.

90

• Focusing on Client Ambivalence (primary target of
  MI)
• Their four central principles of MI flow from
  their conceptualization of Rogerss approach.
  According to these principles, it is the
  therapists job to
• Use reflective listening skills to express
  empathy for the clients message.

91
Motivational Interviewing

• Notice and develop the theme of discrepancy
  between the clients deep values and current
  behavior.
• Meet client resistance with reflection rather
  than confrontation.
• Enhance client self-efficacy by focusing on
  optimism, confidence that change is possible, and
  small interventions that are likely to be
  successful.

92
Cultural and Gender Considerations

• Empowering of all persons, including women.
• Designed to address the needs and interests of
  unique clients.
• Too indirect for some cultures, but actually
  could be too direct (focusing on self and
  emotions) in other cases.

93
Evidence-Based Status

• Rogers was the first to record his sessions.
• Rogers studied client-centered relationship
  variables in the treatment of 16 hospitalized
  schizophrenics. The patients made little progress
  in PCT. But, patients who rated their therapists
  as higher empathy, warmth and genuineness had
  shorter hospital stays than patients who rated
  their therapists as less degree of empathy,
  warmth and genuineness.

94
Evidence-Based Status II

• Recent research on the effectiveness of PCT has
  yielded small, but positive results.
• PCT is consistently more effective than no
  treatment.
• It is more effective than placebo treatment.
• It is less effective than structured cognitive
  and behavioral treatments.

95
Concluding Comments

• It may be that at least in some cases, the person
  of the therapist and the attitudes of the
  therapist holds are more important than specific
  problems or techniques.

96
from Lao-tse

• If I keep from meddling with people, they take
  care of themselves,
• If I keep from commanding people, they behave
  themselves,
• If I keep from preaching at people, they improve
  themselves,
• If I keep from imposing on people, they become
  themselves.

97
(No Transcript)