Person-Centered Therapy (PCT), also known as Client-Centered Therapy, was developed by the Humanistic psychologist Carl Rogers in the 1940s and 1950s. He referred to it as Counselling rather than Psychotherapy. The basic elements of Carl Rogers' new way of therapy was to have a more personal relationship with the patient, to help the patient reach a state of realisation that they can help themselves. He did this by pushing the patient towards growth and great stress on the immediate situation rather than the past. This way the person is able to use the therapy as a way to reach a better sense of self, rather than living in an irrational world.

Person-Centered Therapy is used to help a person achieve personal growth and or come to terms with a specific event or problem they are having. PCT is based on the principle of talking therapy and is a non-directive approach. The therapist encourages the patient to express their feelings and does not suggest how the person might wish to change; but by listening and then mirroring back what the patient reveals to them, helps them to explore and understand their feelings for themselves. The person is then able to decide what kind of changes they would like to make and can achieve personal growth. Although this technique has been criticised by some for its lack of structure and set method it has proved to be a hugely effective and popular treatment. PCT is predominantly used by psychologists and counsellors in Psychotherapy.

History & Influences

Rogerian Therapy is often identified as one of the major school groups, along with Psychoanalytic (Sigmund Freud), Depth Therapy which bridges from psychoanalytic through archetypal, mythographical, dream, and unconscious material to existentialists like Rollo May, and the increasingly popular Cognitive-Behavioural school.

Rogers affirmed individual personal experience as the basis and standard for living and therapeutic effect. 3 attitudinal requirements in an effective therapist, in his view, include empathy with the patient's emotions and perspective, genuineness, and unconditional positive regard for the patient. Both active and passive aspects of empathy in the therapist have been identified. This emphasis contrasts with the dispassionate position which may be intended in other therapies. Living in the present rather than the past or future, with organismic trust, naturalistic faith in your own thoughts and the accuracy in your feelings, and a responsible acknowledgment of your freedom, with a view toward participating fully in our world, contributing to other peoples' lives, are hallmarks of Roger's Person-Centered Therapy.

According to Rogers, how we think and feel about ourselves - our sense of self-worth - is fundamental both to psychological health and to the likelihood that we can achieve goals and ambitions in life. Self-worth may be seen as a continuum from very high to very low. For Rogers (1959) a person who has high self-worth - ie: they feel good about themselves - will face up to challenges in life, accept failure and unhappiness at times and is open with people. Someone with low self-worth may avoid challenges, not accept that life can be painful at times, and will be defensive and guarded with other people.

Rogers thought feelings of self-worth formed early in childhood from the interaction of the child with their parents. In the teenage years and into adulthood interactions with ‘significant others’ - teachers, family, friends and intimate partners - influence self-worth. Early influences on a child’s feelings of self-worth can influence how future relationships and achievements are perceived. Eg: the teenager with low self-worth who attributes exam success to an easy question paper rather than their own abilities and hard work. The consequence of this perception is that low self-worth is perpetuated.

Positive Regard

Positive regard is to do with how other people evaluate and judge us in social interaction. Rogers saw unconditional positive regard is where parents and significant others accept and love the person for what they are. Such regard is not withdrawn when the person  does something wrong or makes a mistake. Unconditional positive regard allows the person to try things out and make mistakes, even if that leads to problems. According to Rogers, people who can self-actualise are more likely to have received unconditional positive regard from others - especially from parents during childhood.

Conditional positive regard is where regard, praise and approval depend upon the child, for example, behaving in ways that the parents think appropriate. In this scenario, the child is not loved for who they are but on condition that they behave in a certain way. Someone who constantly seeks approval from others is likely to have experienced conditional positive regard as a child.

In reality most people will have experience both forms of positive regard during their lives and it is the relative balance between the two that is said to determine the extent of a person’s positive or negative feelings of self-worth.

Both types of positive regard are preferable to negative regard where someone can do nothing right from another person’s point of view.

Someone who has experienced significant amount of unconditional positive regard may be reluctant to form a relationship with someone showing them only conditional positive regard.

Self-Concept and Congruence/Incongruence

For Rogers the self-concept consists of:-

• Perceived self - how someone actually sees themself - how they would answer: “Who am I? What do I think and feel? What do I believe and value?”
• Ideal self - our conception of how we should be in all aspects of our life, work, relationships, feelings of fulfilment, etc
• Organismic self - everything we are from our biology and our experiences - including experiences of which we are not consciously aware

Someone’s ideal self may not be consistent with either how they perceive themselves to be  or what actually happens in their life and experiences. These discrepancies between ideal self, perceived self and organismic self bring about incongruence. Where ideal self, perceived self and organismic self are consistent or very closely aligned, a state of congruence exists. Just about everyone experiences at least some degree of incongruence. It is the job of the integrating self to maximise congruence. Sometimes this can result in denying or distorting experiences or pushing out of awareness.

Where there is significant incongruence, someone may suffer psychological distress and find it difficult to adjust and live a satisfying and fulfilled life. High incongruence will reflect many aspects of a person’s life differing greatly from their ideal.

(See Selfplex for an elaborated discussion of Rogers’ 3 selves.)

Core Concepts  & Methodology

Unlike, say, Cognitive or Behavioural therapies, PCT does not rely on specific techniques. What is important is the relationship between the therapist and the client.

It is also ‘non-directive’ - which can make it seem unstructured to an uninformed observer.

• Congruence -  the aim of Person-centered Therapy is to increase the client's congruence. The therapist has to be real, genuine and non-defensive. Genuineness reflects harmony and trust towards the client.

• Unconditional Positive Regard  - to create an atmosphere of psychological safety (warmth and acceptance) within the counseling relationship, Rogers believed the therapist should have unconditional positive regard for the client – that is, not judge the client's character. If the client feels that his/her character is being evaluated, he/she will put on a false front or perhaps leave therapy altogether. Low self-regard, or low congruence, is the result of the client's having been judged in the past. Parents, teachers, and other authority figures often act as if the child has no intrinsic value as a person unless he/she behaves the way they say he/she ought to behave. Thus, their regard is conditional.
  The Person-Centered therapist gives unconditional positive regard as a partial antidote for the client's earlier experiences. This enables the client, feeling safe, to be more open to the therapist.

• Empathic Understanding - the person-centered therapist should sense the client's world - their subjective experiences and perceptions - as if it were her or his own. (The therapist needs to be an ‘active listener’!) However, the therapist must sense the client’s emotions without getting bound up in them. Two processes foster empathic understanding: reflection and clarification. Reflection occurs when the therapist repeats fragments of what the client has said with little change, conveying to the client a nonjudgmental understanding of his/her statements. Clarification occurs when the therapist abstracts the core or the essence of a set of remarks by the client.
  The therapist also needs to express empathy through non-verbal signals - body language - eg:nods, facial expressions and/or ‘mirroring’ the posture and gestures of the client - eg: doing the same thing with our hands, crossing/uncrossing our feet, etc.
  Sometimes the therapist might express empathy simply by not breaking a period of silence - waiting till the client feels ready to go on. (One silence in one of Rogers’ sessions was timed at 17 minutes!)
  A typical empathetic cycle involves:-

1. The therapist getting in touch with what the client feels
2. The therapist expressing their awareness of this to the client
3. The client sensing the therapist’s understanding
4. The client continuing in a way that gives feedback to the counsellor on how accurate their awareness is

Self-actualisation - Rogers (1951) took the approach that every individual has an acutalising tendency which will motivate them to want to be all they can be and that it is the role of the counsellor to provide the favourable conditions (which for Rogers were congruence, empathy and unconditional positive regard) for the natural phenomenon of personal development to occur. He often saw personal development as the process of a person becoming more fully themselves - as he began terming it in 1961, Full Function. Losing touch with the acutalising tendency or having it frustrated would lead to psychological problems. Having more of an internal locus of control - believing in yourself and what’s right for you - is key to  achieving Self-Actualisation. Having an external locus of control - where you are over-responsive to the expectations of others and most likely developed through exposure to large amounts of conditional positive regard in childhood - is seen as inhibiting the actualising tendency. (for more on locus of control, see also: Attribution Theory.)

(Note: in his later writings Rogers, like Abraham Maslow, began to see Self-Actualisation in more specific terms than ‘be all you can be’ - more as a complex or meta way of thinking.)

Outcomes

What PCT offers to the client is the opportunity to...

• Feel accepted and valued
• Start trusting their own experiences and accepting their feelings
• Restructure their experience and make better sense of it
• Be affirmed as someone who has the power to make choices and changes

Evaluation

Thomas Sexton & Susan Whiston (1994) reviewed a large number of studies into the effectiveness of Rogerian Therapy. They found that, generally, application of the 3 principles of congruence, unconditional positive regard and empathy did bring about positive personality changes and successful outcomes for the clients. However, they also reported that success was not inevitable and that much depended on the personality of the client. Clients who became very involved in the process tended to see their therapists as more helpful than those who were more detached from the process. The problem with most of the studies looked at was that they used  subjective measures - the clients’ self-reporting of improvement - rather than objective measures concerned with better functioning and adjustment to life.

Later in his career Rogers moved away from one-to-one therapy and became more involved with group counselling  - ie: encounter groups in which people could feel safe and free to express feelings and explore problems in their lives.