Client-centered therapy: description of technique, basic principles and techniques

September 12, 2018
Psychotherapy
Valentina Buravleva

Initially, this approach to therapy was called non-directive. Over time, it received the name client-centered. This type of therapy was best described in the works of Carl Rogers.

Formation of the approach

Rogers, the author of numerous books, a professor of psychology, and the founder of client-centered therapy, at a certain point in time felt dissatisfaction with the principles that were used in therapy in his time. He decided to start developing his own approach. Traditional methods that were focused on diagnostics have practically ceased to justify themselves. The emerging ideas of client-centered therapy by Carl Rogers, to his surprise, did not become a repetition of previous concepts in psychology. They laid the foundation for a new theory. The experience of teaching, scientific and psychotherapeutic work allowed us to lay a solid foundation for the Rogerian concept.

Story

In his 1951 book Client-Focused Therapy, American psychologist and psychotherapist Carl Rogers (1902–1987) proposed an idea that radically changed the understanding of psychotherapy: the client, not the therapist, is his own expert.

The book was criticized by psychotherapists of various directions, who saw Rogers' position as a threat to traditional directive methods. But his next book, “The Becoming of Man” (1961), became a bestseller. For his work, based on the seemingly extremely simple ideas of humanism, Carl Rogers was nominated for the Nobel Peace Prize.

Rogers' philosophy of client-centered therapy in brief

In the psychology of that time, it was generally accepted that by internal nature a person is distinguished by irrationality, a low level of socialization, and also a desire for destruction. From the perspective of Rogers' theory, people, on the contrary, are socialized and optimistic.

If in some cases antisocial experiences appear during therapy (anger, irritation, hostility), then in reality they are a natural reaction to frustration in meeting the needs for love, protection, happiness, etc. Therefore, there is no point in trying to control negative reactions; it is necessary to pay attention to ensuring that a person has the opportunity to receive enough love, attention, positive experiences that will balance each other. For example, the need for companionship can balance out aggressiveness.

Engage with the problem using verbal and nonverbal cues

This is done using special questions (verbal methods), as well as through a tonal lowering of the voice (non-verbal methods). For example, the therapist says the phrase: “I feel that you had a hard time in this situation (lowering voice tone).” Tonal changes seem to invite the client to “fall” down and begin to tell more about the problem. At the same time, the psychotherapist’s reaction may not be so pronounced. The psychologist must feel whether the client has a desire to talk about this problem, and how long he will be able to do this.

Why you shouldn’t formulate questions instead of the client

The psychotherapist accompanies a person not in his immersion in the problem itself, but in the depths of his emotional experiences, which are currently relevant. Many clients cannot correctly formulate their own problem, so it often turns out to be pointless to ask them to do this. Formulating a question can also be dangerous because it directs the flow of the conversation and also introduces the client back into the problem. If instead of the person asking for help, you begin to make assumptions about his feelings or try to formulate the problem, then the therapist will guide him, which can negatively affect the client’s openness. The latter may become blocked and stop talking about his experiences.

For example, a teenage girl complains that she has no friends at school. The therapist may say, “You feel very lonely,” “What do you think is causing this?”, “How often does this happen?” Such questions force you to think about the circumstances in an intellectual way, and the client stops talking about his feelings.

The main principle of client-centered therapy is to be with the client during the process. And therefore, the therapist should ask questions not for himself, but for the person asking. They must help him go further into the depths of his feelings.

Empathy in Rogers' Work

When the therapist is inaccurate, the client responds: “No, that's not true” (other milder or harsher analogies are possible). Again, if there are a lot of “no”s, the client does not feel understood. At the same time, even if the therapist's empathic responses are not very accurate, the client may experience an amazing sense of co-presence. What is important is not so much the accuracy of the client's understanding in itself, but rather the therapist's interest in the client's world. Empathy is a process in which the therapist becomes closer and closer to the client's thoughts and feelings. Accurate empathy is the ideal.

When addressing the client, certain significant experiences are repeatedly emphasized. If the therapist specifically answers them (addresses them), then the therapeutic contact has taken place. For example, one woman told a psychotherapist that her 13-year-old daughter met a man who was two years older than her daughter and was registered with the juvenile police. The woman is afraid for her daughter and does not want her to learn from her own mistakes in life (fear was expressed in this moment). She is also afraid that she will lose contact with her daughter if she does not allow her to be friends with the boy. In this case, the following therapeutic response is possible: “Yes, it is very difficult to learn from your own mistakes.” When the therapist's empathic response is successful, the client begins to say things completely different from what he had prepared in advance, and often, to his own surprise, reveals his deepest feelings in the therapeutic conversation. Rogers wrote that client-centered therapy views the client's perceptual field as the basis for understanding the client, and that immersion in the client's inner world provides significant benefits. The client's behavior can be better understood as emerging from his perceptual world. The world perceived by the client is his true reality. Empathy is “entering into the personal perceptual world of another and experiencing it deeply.” It involves sensitivity to the constantly changing sensory impressions of another, which smoothly flow into one another - to fear, or anger, or tenderness, or embarrassment, or whatever he or she is experiencing. Empathy means living temporarily in the life of another, moving gently through it without judgment; empathy means feeling meanings of which he or she is barely aware...” . In the above example, the woman began to talk about herself, about her shortcomings in life that prevent her from being with her loved one, as if she had forgotten about the original request.

Rogers's empathy has the following characteristics: First, the empathic process maintains its own position as an empath, maintaining a psychological distance between him and the empathized, or, in other words, the lack of identification between the experiences of the empathized and the empath in empathy (which, in fact, distinguishes this process from phenotypically similar identification process). Secondly, the presence in empathy of empathy (whatever the sign of the empath’s experience), and not just an emotionally positive attitude (sympathy) of the empath towards the empathizer. Thirdly, this is a dynamic process, not a static state. Empathy means experiencing the client’s world as if it were the therapist’s own world, but always without losing that “as if.”

Regarding what characteristics of the client should the therapist show empathy? It is obvious that some thoughts, emotions and behavior directly stem from a person's problems, and some stem from the healthy part of the personality. Empathy for the individual as a whole is a condition for liberation from defense mechanisms (distortion and denial of experience), and empathy for healthy aspects is a mechanism for supporting the constructive principles of the individual.

Correct “mirroring” technique

This method of client-centered therapy allows you to remain “close” to the client throughout the entire session. For example, a client who comes to an appointment may say something like this: “Last night I saw my mother in a dream. While I was driving to you, I constantly thought only about her. I'm so tired of all this. I have problems at home, at work, and with children...”

An inexperienced professional working in client-centered psychotherapy may give the following answers, but they will be incorrect:

“I see that you have many serious problems.” This reaction of the therapist is, in fact, directive, since it forces the client to talk only about problems. But the client has the right to choose what to talk about.
“You’ve said a lot, tell me something more.” This response has the nature of pressure.
“Are there things besides these that bring you joy?” Such a response demonstrates emotional “deafness” towards the client. The person who turns seems to hear: “Why are you all talking about the bad and the bad. Let's talk about good things."
“I also had a similar experience, I understand you.” This answer is not intended to help the client solve the problem.

The following response from a therapist who conducts a session in line with client-centered psychotherapy would be successful: “Yes, a lot is happening to you now...” After this, the therapist waits in silence for some time. The applicant himself decides what he should talk about and whether he needs further help.

Results of psychotherapy

The client's changes are in the direction of increasing the differentiation of reactions and the spontaneity of experiencing feelings. As a result of psychotherapy, the following changes occur:

openness to experience increases;
experiences get worse;
trust in one’s own manifestations, in oneself increases;
an internal locus of assessment is formed;
readiness to enter into the “process of life” increases;
knowledge about oneself deepens in the process of experiencing.

There is always a significant risk associated with accepting your experience and experiences.

Only a small part of the personality is ego-identified, or ego-syntonic, that is, it belongs to the sphere of the Ego. Some personal manifestations (traits, experiences) are not ego-syntonic and form the spheres of “not-I” and “symptoms”. A very important personality quality is the willingness to be in the process of development. Rogers himself emphasized that this means the ability to abandon fixed goals and expectations, the willingness to abandon one's own definitions of life, which can limit self-development. The personality structure according to this therapy looks like this: at the center of the symptoms are “I” and “not-I”, as two equal parts of the personality.

The result of personality development and the most effective psychotherapy is a “fully functioning personality.” Conceptually, this concept means complete congruence, the ability to overcome the obstacles and difficulties of life, and to realize oneself creatively. As a result of a twenty-five-year research program, it was revealed that such a personality is characterized by a positive self-concept, effective social functioning and the body’s readiness to respond to any external influences. It is clear that the psychotherapeutic process moves the client toward the characteristics of a “fully functioning personality.” But the client has the right to stop therapy at any time and get as much out of it as he can. Therefore, one of the most important conditions for a client’s change in therapy is his readiness for this change.

Real psychotherapeutic practice is associated with the fact that client-centered therapists act differently and introduce their own characteristics and personally significant theoretical constructs into the psychotherapeutic process. Thus, in the actual psychotherapeutic process, a number of psychotherapists facilitate the “child” in the client. The idea of a “fully functioning personality” can be interpreted as the idea of a “child” in the sense of naturalness, naturalness of feelings, life and manifestations. It is the free expression of love, sadness, passion, sadness, anxiety, anger, etc. A person who is “closed” to the experience and expression of anger is largely “closed” to the experience and expression of love. In this sense, the "fully functioning personality" is close to Wilhelm Reich's "genital character". But the client may not accept this interpretation of a “fully functioning person,” as may the therapist.

Some therapists understand a “fully functioning personality” as “spiritual development,” that is, they place the emphasis not on life, naturalness, naturalness, but, on the contrary, on rationality, forgiveness, peace, and the like. In a word, behind the real process of psychotherapeutic interaction, it is difficult to talk about abstract mechanisms and standards for psychotherapeutic change in the client within the framework of a client-centered approach.

There is evidence of the use of Rogers therapy by some psychoanalysts as a palliative, symptomatic remedy; moreover, it is prescribed only for actual (and not infantile) and shallow neuroses and gives only a short-term effect. This is difficult to agree with, since Rogers' therapy is focused on the personality, not the symptom. In this therapy, the client progresses as much as he is willing to do so, so the effect can be permanent, palliative or completely absent, however, as with other types of therapy.

Repeat method

Another technique used in C. Rogers' client-centered psychotherapy is repetition. In this case, the psychologist simply repeats what the client said: “You dreamed of your mother today, and you were thinking about her the whole time you were getting to the appointment...” Then there should be a pause.

But if the client talks too much during the session, then the repetition technique may not work. In this case, it will simply take the client out of the process of immersion in his own feelings and experiences. In this case, a generalization technique would be more appropriate. The first option above is a classic example of generalization.

Metaphor method

Another effective technique used in client-centered therapy. Metaphor can be used both one-time and as a sustainable image that accompanies the entire therapeutic process. If it corresponds to the client’s experience, this technique helps him enter that layer of the unconscious that is filled with symbols, which allows him to escape from the objective world. Indeed, in the latter case there may be significant restrictions on the way of expressing feelings.

For example, a man who turned to a specialist for help began to hate his wife. The reason is that she gained excess weight and became ugly. Internally, he wishes her death, but cannot express this desire out loud, since it causes a strong feeling of guilt. Rogers' client-centered therapy technique called "Metaphor" can be used by the psychologist in this case. The therapist builds an image: “Once upon a time, the prince of a small kingdom planted a delicate, beautiful tree with beautiful flowers under his window. Every morning and evening he enjoyed its fragrance and watered it. However, at some point in time, the tree began to grow very quickly and began to block the light, which almost no longer penetrated the window. The prince's bedroom became cold and uncomfortable. It's hard to believe, but this was the same tree that he once fell in love with. Now he hated it. And the prince has already begun to make plans on how to destroy this tree, cut it down...”

This metaphor allows you to discuss your aggressive feelings without feeling guilty. This makes the client more open.

Non-directive approach

Initially, the method assumed a so-called non-directive approach to the client on the part of the psychologist, which meant that the therapist tried not to give advice, not answer the client’s questions, and, if possible, not even ask him questions. The idea was to give the client the opportunity to fully express his inner state, and the answers to the client's questions were to be found by him himself in the process of spontaneous and sincere self-expression. At the same time, the role of the psychologist was reduced to reflecting, as in a mirror, everything that the client said or expressed during the therapy process, as well as to clarifying these words and feelings through clarifying paraphrasing of the client’s words by the psychologist himself.

*Here we can draw an analogy with the fact that one’s thoughts, feelings and behavior are often presented to a person in a distorted form, as in the reflection of a distorted mirror, and in this case the therapist played the role of a straight mirror, which would convey to the client the true picture of his own thoughts and experiences.

That is, the psychologist’s task in non-directive therapy was to demonstrate to the client with his reaction as accurately as possible what he feels and says.

Three conditions for a client-centered approach

Perhaps Rogers' method is best illustrated by his own three necessary and sufficient conditions of therapy for transforming the client's personality. In essence, they all boil down to the transfer of unconditional positive attention from the psychologist to the client. As we remember, it was precisely the lack of the latter that Rogers explained most of people’s psychological problems. As a result of such a transfer, there should have been an expansion of the client’s self-concept and an opportunity to perceive the world through organic experiences, which would open a direct path to human self-actualization and insights.

Necessary and sufficient conditions for client-centered psychotherapy

1. Psychological contact and empathy.

This provided for the emergence of a trusting relationship between the psychologist and the client. Without this, there could be no positive results of therapy. The basis of such contact was EMPATHY on the part of the psychologist. Empathy meant understanding of the client's emotional state, with unconditional positive acceptance of this state and a clear understanding that the source of this state is another person, and not the psychologist himself. The last point was very important and meant such a subtle thing - a reflection of the client’s emotional state without reference to the latter and the differentiation of one’s own emotions from those that arose in response to the emotions of another. That is, empathy, while maintaining your own position and psychological distance with the client.

Empathy was supposed to provide an opportunity for sincere and immediate human emotional contact between psychologist and client, as opposed to the usual situation in psychotherapy when a professional armed with knowledge and techniques sat opposite you.

The peculiarities of this therapy include the fact that not a single psychotherapeutic technique could provide such conditions fully, that is, not every psychologist, even armed with deep knowledge, could provide such contact. In fact, this meant that the psychologist had to be both a professional who mastered the method and simply a person who had purely human sympathy for the client.

2. Unconditionally positive attention to the client.

This attitude means positive acceptance of any experiences of the client, respect for them and understanding. Of course, such an attitude on the part of the psychologist is one of the conditions for empathy. Another reason why unconditionally positive acceptance of any feelings expressed by the client is so important is the fact that the vast majority of people grew up and were brought up in conditions of suppression of organismic reactions, which meant a virtually guaranteed discrepancy between the self-concept and true emotional manifestations. And given the fact that Rogers believed this state of affairs to be the true cause of psychological problems, it is not difficult to imagine how important this point was.

3. Congruence of the psychologist.

This term, in the context of its application specifically in psychology, was created by Rogers and means the consistency or adequacy of the information that a person wants to convey in words and the information transmitted by him non-verbally, in a more complete sense - the consistency of information in general (sincerity, reliability).

An example of incongruity is lying, such as when you say something different from how you really feel. In this case, one thing is conveyed verbally, but non-verbally, you convey a completely different message (for example, facial expressions or body position give you away). This is a very important condition, which is a marker of the sincerity of the therapist’s attitude towards the client and the absence of the professional-client game, which any psychologist can so easily “fall into”.

Rogers identified two reasons for the lack of congruence.

— When the therapist’s feelings do not correspond to their awareness (the psychologist’s incorrect interpretation of his own emotional reactions). — When the therapist’s feelings are deliberately hidden by him.

The guarantee of congruence in psychological counseling is to be yourself and not try to play professional, even for the sake of the psychotherapeutic situation, to be open in contact with the client and to sincerely respond to the situation. In other words, the client must meet in the therapist a whole and harmonious person, whose life is built on true emotional manifestations.

Of course, it was clear that such requirements were quite difficult to meet, since they presupposed a combination in the person of a professional psychotherapist and just a person who unconditionally accepts the other.

Realizing this, Rogers did not at all believe that the psychologist should be constantly open to organismic experience. This would be an obvious utopia, since there are only a few such people. In his ordinary life, the therapist could experience anxiety, anger, hostility, or be depressed, but during the meeting with the client he had to, at least for this time, be in harmony with himself. This was a sine qua non of client-centered therapy.

Responsibility for the results of psychotherapy

Rogers' optimistic view of human nature gave rise to his belief that every individual will naturally move towards self-actualization, it is enough to create favorable conditions for this. Regarding personality transformation, the psychotherapist must completely rely on the client himself, moreover, influence this process as little as possible. Based on this view, the distribution of roles in a psychologist’s office becomes completely clear, where the therapist creates the best conditions for changes in the client’s personality, and the client himself is engaged in the transformation itself. Therefore, Rogers argued that the client, being the main agent, bears most of the responsibility for the results of therapy.

The client’s task in therapy is a gradual transformation of personality (self-concept) through awareness and acceptance of unconditional positive attention on the part of the therapist, which makes it possible to live without the use of psychological defenses, based on the experience of natural organismic experience. This result made possible the main thing - a person’s independent further movement towards self-actualization and a feeling of a fuller and deeper existence, that is, the joy of being.

Conclusion

If we talk about psychology as a therapeutic method, then the influence of Rogers cannot be overestimated, and in this sense it can only be compared with Freud. His influence on psychotherapy was enormous. Until now, many psychologists have successfully used the client-centered approach, not only in classical psychotherapy, but also in educational institutions, family, and politics. The ideas of humanistic psychology served as a starting point for many psychologists, gave rise to several independent directions and rightfully earned the name of the third force in psychology (besides psychoanalysis and behaviorism). There is no doubt that this direction will not lose its relevance in the field of psychological assistance to people for a long time.

NEXT ARTICLE IN THE SECTION – GESTALT APPROACH

Stages

As a result of many interview studies, conclusions were drawn about how the entire therapy process occurs. It has been revealed that in this case there is a movement from stagnation to process. Scientists have identified seven stages of therapy:

At the first stage, the client feels a reluctance to express himself. Communication occurs only on general topics. At this stage, people usually do not turn to a psychologist for help - they are most often brought by relatives.
At the second stage, feelings appear, but the client does not take responsibility for what is happening in his life. Life's contradictions are not recognized. There is practically no differentiation of personal meanings.
Then weakening begins, gradual self-expression. A person expresses past experiences - usually negative.
Accepting what was expressed in the previous stage allows one to move on to the next stage. A person begins to feel responsible for the problems that exist in his life.
At the fifth stage, feelings are expressed completely freely, but surprise and fear are often present. A person defines his feelings more accurately.
The sixth stage is the most dramatic. The client experiences his feelings in their entirety. The problem ceases to be an object for him.
At this stage, the person seeking help continues to move forward independently, without the help of a psychotherapist. However, the stage can be discussed at an appointment with a psychologist.

Main features

K. Rogers himself and his colleague R. Sanford (1985) pointed out the following main features of client-centered therapy:

the hypothesis that certain attitudes of the psychotherapist form necessary and sufficient conditions for therapeutic effectiveness;
the main emphasis is on the phenomenological world of the client (hence the definition of psychotherapy as “client-centered”);
the therapeutic process is focused on changes in experiences, on achieving the ability to live more fully in the moment;
attention to a greater extent to the processes of personality change, rather than to a static structure;
the hypothesis that the same principles of psychotherapy can be applied to all people, regardless of what clinical category they belong to - to persons suffering from psychosis, neurotics or mentally healthy people;
interest in philosophical problems arising from the practice of psychotherapy.

The psychologist's views have changed somewhat over time, but the key ideas have remained unchanged. The basic idea of personal contact between client and psychotherapist became increasingly emphasized by Rogers over time.

The concept of “client” (a person receiving certain services, in this case psychological) instead of the more “medical” one - “patient”, was also proposed to be used by Rogers. Thus, a person who turned to a psychologist for help is also responsible for the changes that occur to him; in addition, she is not the object of diagnosis and medical treatment. The emphasis in this case is on helping the client. It manifests itself in the adjustment and stimulation of self-development and self-realization.

Relationship with the therapist

The main principles of Rogers' client-centered therapy, on which communication with the client is based, are as follows:

Adoption. The therapist accepts the client as he is, along with his good and bad sides. His attitude towards the client is positive.
Congruence. The therapist's line of behavior is consistent. He himself is a holistic and integrated personality. He understands and is aware of his own experience.
Understanding. It means that the therapist experiences an accurate vision of the client’s world and experiences empathy.
A message of acceptance and understanding. There is no point in accepting and understanding if the person asking for help does not perceive it. Therefore, all this must be communicated to the client.
Relationships that bring positive results. The relationship with the therapist is not a “support” for the client. But they must be safe, devoid of any threats.

Client-centered therapy is a well-established method used both among people with relatively simple problems and among patients in psychiatric clinics. The empathy and warmth that accompany therapeutic sessions have a good effect - and this conclusion has been made by more than one psychotherapist over many years of practice.

Body-oriented psychotherapy

It, like art therapy, is not an independent direction of psychotherapy, but a collection of diverse practical methods. They are united by the concept of the integrity of the organism, that is, the unity of soul and body. Thus, by influencing the body, the therapist promotes the resolution of psychological internal conflicts and awareness of oneself as an integral bodily being.

The most famous technique can be called Reich's vegetative therapy. Reich suggested that suppressed emotions are reflected in the body in the form of muscle tension. By the location of these clamps you can understand what emotions you need to work with. Most often these are anger, anxiety and sexual frustration, which can be eased through awareness of repressed emotions, massage and exercise.