What is person-centred counselling?
Exploring and demystifying different therapeutic approaches is very important, and today we will look at doing this for person-centred therapy. This is a therapy that many therapists provide, and is frequently a foundation for all mental health professionals.
I often hear that from people that they have been referred to 'just counselling' as if theoretical approaches are ranked in some way from best to worst. However, person-centred therapy, which underpins the majority of all therapeutic relationships, can be a valuable tool in the right hands. It works on the premise that there is a stereotype that the therapists do something because they are the experts, yet the person-centred approach turns this on its head as the client is the expert and the client makes the change.
I think this is often where people see this as a lesser approach, because people want answers and advice, and often mistake therapy and counselling as just that. This leads to the view that person-centred counselling is 'just talking' when a good therapist will be working hard to make the conversation flow in a way that leads the pair of you to the right answer for you. If there was a right way to handle your distress or the problem you were facing, someone would have developed a single book of solutions many years ago but, people and their problems are more complex than that. Before we look at exactly how it works, let’s have a look at the history of this approach.
This approach comes from a time of post-war, where there was increased psychological testing informed by behaviourism from psychologists such as Watson (1917), with the only other therapy being psychoanalysis by Freud (1938). This approach was developed by Carl Rogers, and over time there has been a change in what this approach was called from non-directive counselling to client-centred counselling, to person-centred counselling.
The publications that informed this therapeutic approach were;
- 'Client-centred therapy' (1951)
- 'The necessary and sufficient conditions therapeutic personality change' (1957)
- 'On becoming a person' (1961)
- 'On personal power' (1977)
- 'A way of being' (1980)
- 'Theory of Change'
Maslow, in 1962, developed the hierarchy of needs which demonstrated that with the right conditions, people will grow and develop working up from things that are necessary for survival to things that help us live and develop. The person-centred counselling is attempting to help us move up this pyramid.
There are two methods of developing; one being a formative tendency whereby all organic matter evolves into more complex forms over time as the universe is constantly expanding. The other method is the actualising tendency. This is where all living beings move toward completing and fulfilling their potential. The source of psychological growth and maturity is within us all, and we are all working towards the best we can be. We, therefore, are working with multiple concepts of self. The real self is the version of you which is founded in the actualising tendency. It follows organismic valuing and needs to receive positive regard from others and yourself. The ideal self is the standard we set for our selves that is always just out of reach. This is set by the conditions of worth we set for ourselves and positive regard that is only given under certain circumstances (conditional positive regard). Person-centred therapy is attempting to get people to a state of congruence where their self-image and their ideal self align, allowing them to complete self-actualisation.
How does it work?
Rogers highlighted in 1957 that certain conditions need to be in place so that people can make a therapeutic change. These are;
- two people in psychological contact
- the first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious
- the second person, whom we shall term the therapist, is congruent or integrated into the relationship
- the therapist experiences unconditional positive regard for the client
- the therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client
- the communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved
He said that "no other conditions are necessary. If these six conditions exist and continue over a period of time, this is sufficient. The process of constructive personality change will follow". To better define these terms that the therapist is looking to provide, let’s look at congruence, unconditional positive regard, and empathy in some more detail.
A state of being of the counsellor when their outward responses to their client match the inner feelings and sensations which they have concerning the client (Mearns and Thorne, 1998).
Unconditional positive regard (acceptance) - the label given to the fundamental attitude of the person-centred counsellor towards their client. The counsellor who holds this attitude deeply values the humanity of their client and is not deflected in the valuing by any particular client behaviours. The attitude manifests in itself in the counsellor's consistent acceptance of and enduring warmth towards their client (Mearns and Thorne, 1998).
A continuing process whereby the counsellor lays aside their way of experiencing and perceiving reality, preferring to sense and respond to the experiences and perceptions of the client. This sensing may be intense and enduring, with the counsellor experiencing their client’s thoughts and feelings as powerfully as if they had originated in themselves (Mearns and Thorne, 1998).
To demonstrate these core conditions that the therapist experiences, an empathic understanding of the client’s internal frame of reference, and endeavouring to communicate this experience to the client, paraphrasing, reflecting, and summarising are used. However, Rogers has said that "if it’s simply reflection, that’s no good. It’s just a technique. It must be a desire to understand empathetically, to stand in the client shoes and see the world from his vantage point".
Does it work?
A comprehensive meta-analysis was completed by Elliott et al. in 2013 that found that person-centred therapies bring a large and significant reduction in psychological distress. It also found that the effects of these therapies were on average similar to other therapies including cognitive behavioural therapy (CBT). In addition to this when used in real-world settings such as the NHS’s Improving Access to Psychological Therapies (IAPT) service that the results of person-centred therapy were very similar to CBT and that these results can also be achieved in a shorter period. Finally, there is an overwhelming body of evidence to show that Roger’s three core conditions of empathy, unconditional positive regard, and congruence are all associated with positive outcomes (Norcross and Lambert, 2019).
Is person-centred therapy for me?
Person-centred therapy can be used for a range of mental health problems, such as;