In a paragraph…
When a client presents to the therapist experiencing emotional and mental distress, Person Centred Therapy (PCT ) theorises that they are in a state of "incongruence" (Rogers, 1956) i.e. that reality or distorted internal experiences conflict with the – often rigid - self-structure the person has of themselves (Rogers,1959). Through working with the PCT therapist and experiencing the core conditions of congruence, empathy and unconditional positive regard (UPR) (Rogers,1956), the therapist provides the environment for the client to feel safe, and secure enough to utilise their inherent biological impulses: the actualising and subsequent self-actualising tendencies (Rogers,1959). They are able to explore those aspects of themselves that they have denied or have found difficult to accept into awareness (Rogers, 1959). In doing so, they can assimilate all these parts into their self-structure, thus becoming their whole selves , becoming less defensive, more self-driven, mature and open to new experiences as they move in stages from "fixity to changingness", (Rogers, 1961) . In short, they are beginning to lead the "good life" (Rogers,1961) and have started the never-ending journey of becoming a "fully functioning person" (Rogers,1961).
What's different about how PCT approaches emotional and mental distress?
All psychotherapies aim to relieve the emotional and mental distress of clients. Freudians, the 'first force' in psychotherapy, look for deeply submerged primitive motivators to explain the distress, often through dream interpretation.
"The interpretation of dreams is the royal road to a knowledge of the unconscious activities of the mind." (Freud,1900)
Behaviourists, the 'second force', look to the client's thoughts and actions to try to understand the distress; in both instances, the therapist is searching or attempting to discover i.e. the power resides in the skill/knowledge of the particular therapist. Humanism, the third force in psychotherapy, believes that humans are not deficit creatures but are instead directed by growth and that growth can be stunted or frustrated. PCT a branch of humanism theorises that the therapist's role is to provide an environment of security and acceptance for that natural biological inclination for growth, termed the 'actualisation' and 'self-actualisation' tendencies (Rogers,1959) to occur. As he stated early in his career
Therapy is not a matter of doing something to the individual, or of inducing him to do something about himself. It is instead a matter of freeing him for normal growth and development, of removing obstacles so that he can again move forward. (Rogers, 1942, p. 29)
It was a radical departure at the time and, at its core, a deep belief in the essentiality of non-direction
"As no one else can know how we perceive, we are the best experts on ourselves." (Rogers, 1959)
The first attempt by Rogers to define a complete theory of this approach were the '19 propositions' (Rogers, 1951)
'Taken as a whole, the series of propositions presents a theory of behavior which attempts to account for the phenomena previously known, and also for the facts regarding personality and behavior which have more recently been observed in therapy' (Rogers, 1951: 482)
The propositions are one of three 'pillars' of PCT - the 'seven stages of process' (Rogers,1961, p.132-158) and the 'six necessary and sufficient conditions' (Rogers,1956) being the other two - an elegant brick-by-brick theory of personality. How an organism (person) perceives the world and how it 'symbolises' it concerning itself. It introduces new ideas but also builds on the work of previous pioneers such as Kurt Goldstein.
It theorises how we build an internal view of ourselves, the 'self-structure' (Rogers,1959) and if this is at odds with the experienced 'phenomenological' world, how it can cause 'psychological maladjustment' as we attempt to reconcile the contradiction. (Rogers,1951). Propositions 11,14, and 15 provide a succinct theory of how we perceive experiences, how we distort them and how we can ultimately remedy these distortions
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XI As experiences occur in the life of the individual, they are either, a) symbolised, perceived and organised into some relation to the self, b) ignored because there is no perceived relationship to the self-structure, c) denied symbolisation or given distorted symbolisation because the experience is inconsistent with the structure of the self.
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XIV Psychological maladjustment exists when the organism denies to awareness significant sensory and visceral experiences, which consequently are not symbolised and organised into the gestalt of the self-structure. When this situation exists, there is a basic or potential psychological tension.
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XV Psychological adjustment exists when the concept of the self is such that all the sensory and visceral experiences of the organism are, or may be, assimilated on a symbolic level into a consistent relationship with the concept of self. (Rogers,1951)
How does emotional distress occur?
Rogers developed his theories further, introducing the concept of the 'Organismic Valuing Process' (OVP) (Rogers,1959) ie how the organism (person) values experiences in the world, guided by an innate biological force..
The actualising tendency is thus the criterion. The simplest example is the infant who at one moment values food, and when satiated, is disgusted with it; at one moment values stimulation, and soon after, values only rest; who finds satisfying that diet which in the long run most enhances his development (Rogers, 1959, p. 210)
So left to its own devices, an organism would continually perceive experiences, value them and react appropriately to those that did or didn't enhance it and steadily develop to healthy maturation. Well, not quite, as full counselling rooms worldwide are surely a testament to. Rogers acknowledged that we become aware that our caregivers also have a valuing system and that specific actions we take may gain approval or disapproval from them. Rogers called these 'Conditions of worth' (Rogers,1959) - obligations that we must essentially fulfil to be accepted "..he values an experience positively or negatively solely because of these conditions of worth which he has taken over from others, not because the experience enhances or fails to enhance his organism." (Rogers, 1959, p. 209)
So a once trusted and autonomous OVP now shifts to accommodate some external requirements. Rogers called this the' Locus of Evaluation' (LOE), distinguishing the internal, relying on the OVP, to the external, relying more on the evaluation of others. (Rogers, 1959, p. 210)
Here we can see where the seeds of the emotional distress might be planted. As a sort of separation for the organism from its true self occurs, to one reliant on the shifting sands of external judgements. A 'tragedy' as Rogers called it (Rogers, 1959, p. 226).
He went on to theorise how this inevitably affected the organism's ever-changing and fluid view of self (self-structure) something he described as "..the organised,consistent conceptual gestalt composed of perceptions of the characteristics of the "I" or "me" and the perceptions of the relationships of the "I" or "me" to others and to various aspects of life, together with the values attached to these perceptions." (Rogers, 1959, p. 200)
Thus the values of others become part of the self-structure of the organism, e.g. a father believes that girls aren't good at technical subjects, so the child believes they are not good at maths. Because the organism is phenomenological (experiencing) in nature, it constantly processes new experiences within its field. At times, these will clash with the self-structure it has built and when this happens, 'incongruence' (Rogers, 1956) occurs. This incongruence is the source of anxiety and emotional distress. Describing it in in real time...
When the individual has no awareness of such incongruence in himself, then he is merely vulnerable to the possibility of anxiety and disorganisation. Some experience might occur so suddenly or so obviously that the incongruence could not be denied. Therefore, the person is vulnerable to such a possibility. (Rogers, 1956)
What value can PCT provide to deal with mental and emotional distress?
Rogers wanted to codify his real-life experiences in the counselling room and he became "increasingly concerned with the process of abstracting from that experience the general principles" (Rogers,1956), he knew there were conditions that needed to be present, ones that were necessary to bring about constructive psychological change ie the growth that would alleviate the mental and emotional distress. He published his theory and the second pillar of PCT, the six 'necessary and sufficient' conditions (Rogers, 1956). Although all six conditions are necessary, the main work for a counsellor is to provide the three core conditions of congruence, empathy and unconditional positive regard (UPR). Rogers believed that if the client felt valued and not judged by another, they would feel secure and confident enough to allow experiences into their awareness that they had previously denied or distorted (Rogers,1956) ie the source of their distress. The driving force, again would be their self-actualising tendency.
Let us say rather that the motivation for learning and change springs from the self-actualising tendency of life itself, the tendency for the organism to flow into all the differentiated channels of potential development, insofar as these are ex-perienced as enhancing. (Rogers, 1961, p285)
Note that the self-actualisation Rogers describes differs from Maslow's. It's a journey or aspiration, “Actualisation is a process and not a state. There is no such thing as an actualised person in Carl Rogers theory….. Actualisation is not a goal of therapy but rather the force that makes therapy work" (Bohart, 2013, p. 98)
To Rogers, with the core conditions present, clients would move through a series of seven stages of process - the third pillar of PCT theory (Rogers,1961). He describes the process as a continuum, a movement initially from a position of 'fixity' through ever more loosening and experiencing stages until reaching a stage of 'flowingness' where feelings are intense, immediate and richly felt, where they are open to change through each new experience (Rogers, 1961, p. 157). The client would move away from the emotional and mental distress not through any magical effect, but because as they grew more and more open to fully experiencing their experiences, those hidden or unacceptable parts that had previously been denied or distorted to awareness would instead be fully realised and become part of the self-structure
Thoughts, Observations and Conclusions
The core conditions may appear simple at first, one might even ask, "is that it?". But this 'simplicity' is deceptive and in reality, PCT practice can be very challenging. It requires skill,concentration and emotional openness that can sometimes be exhausting. Congruency with our clients means being genuine with our communications, trying to match how we feel with how we communicate. An obvious question follows from this, "just how honest should I be ?" if the client is dull, should I say so? Rogers indeed recognised this but perhaps left it deliberately open-ended.
"It would take us too far afield to consider the puzzling matter as to the degree to which the therapist overtly communicates this reality in himself to the client." (Rogers, 1956)
Regarding UPR, none of us is simply a sum of our deeds and any evaluation of any kind would solely be from a personal frame of reference, based on a wholly personal set of beliefs/assumptions, any of which are subjective at best and at worst, just plain wrong. Holding anything other than UPR would make us vulnerable to our conscious or unconscious assumptions and biases. No external judgement is ever going to help a client in emotional distress, it simply isn't useful and in fact just illogical.
Finally, empathy, to try and understand the client's experience from their frame of reference, but without ever identifying with it, one foot in their world and one foot in the here and now. "To sense the client's private world as if it were your own, but without ever losing the "as if" quality" (Rogers, 1956)
This is probably the most difficult as it requires mostly sensing what is being conveyed, sometimes verbally but often not, trying to understand but only from their frame of reference.
And, like any theories, there has, of course, been criticism of the effectiveness of PCT and Rogers himself. Even as recently as 2021 a study funded by BACP reported
"However, 12 months after entering treatment, the trial found that outcomes favoured the CBT group, particularly for clients who presented with more severe depression." (BACP, Person-centred experiential therapy is as effective as CBT, research shows 2021)
But equally, over the past 60 years, many research studies have been conducted on the efficacy of PCT for clients struggling with emotional and mental distress, Elliot summarises "..The maintenance of gains post therapy is consistent with Rogers' assumption of an actualising tendency, suggesting that clients continue to develop on their own after they have left therapy." (Elliot et al,2016)
Rogers would have welcomed criticism, acknowledging that all theories need a constant challenge to evolve and avoid the pitfall of dogma. Research is essential for any theory if it is to have any credibility, but the charge of ‘unscientific’ being levelled at Rogers seems particularly unfair considering "..psychological theory and research occupied a central focus for the first thirty five years of Rogers' career". (Kirchenbaum,1981, p. 201).
Ultimately the question is whether PCT is effective, so perhaps the last word on research to Bohart
"Research supports Carl Rogers hypothesis that it is clients who self-heal in psychotherapy when given proper supportive conditions (Bohart and Tallman,2010). The percentage of change that can be attributed to clients is anywhere from 40 to 87 percent, while the percentage attributed to therapy techniques ranges from 1 to 15 percent" (Bohart, 2013, p. 96) (my emphasis)
Humans are very complex, emotional, and cognitive creatures, who are often puzzled by their own internal landscapes. So much so, that the notion of any external force (counsellor) somehow providing 'answers' either through techniques/experience or force of personality seems deeply flawed, when it is clearly the client themselves who are the expert on themselves and are hence best-placed to effect the necessary change.
If, when a client presents with emotional and mental distress, At the very least, a counsellor can offer an hour of listening empathically, without judgement and with positive regard. Supporting them to find their way, to rediscover their agency in this absurd theatre we call life, this feels like something genuine and true and no small thing either.
(The above article is a condensed version of an essay submitted during year 1 of a Diploma in Person Centred Psychotherapy at the Metanoia Institute, West London)
References
Bohart, A. C. (2013). The actualizing person. In M. Cooper, M. O'Hara, P. F. Schmid, & A. C.
Elliott, Robert; Lago, Colin and Charura, Divine, eds. (2016) Research on person-centred/experiential psychotherapy and counselling : summary of the main findings. In: Person-Centred Counselling and Psychotherapy. McGraw-Hill/Open University Press, Maidenhead, Berkshire, pp. 223-232
Freud, S. and Brill, A.A. (1997) The interpretation of dreams. Hertfordshire, UK: Wordsworth Classics of World Literature.
Kirschenbaum, H. and Henderson, V.L. (1989) The Carl Rogers Reader. London, London: Constable.
Rogers, C. (1942) Counseling and psychotherapy: Newer concepts in practice. Houghton Mifflin.
Rogers, C. et al. (1951) Client-centered therapy, its current practice, implications and theory. Boston, MA: Houghton Mifflin Company.
Rogers, C., (1956) 'The necessary and sufficient conditions of therapeutic personality change', in Journal of Consulting Psychology, 1957, Vol. 21, No. 2, pp. 95–103
Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationship as developed in the client-centered framework. In S. Koch (Ed.), Psychology: A study of a science. Vol. 3: Formulations of the person and the social context (pp. 184–256). New York: McGraw-Hill.
Rogers, C.R, (1961) On Becoming A Person, a Therapists View Of Psychotherapy, Houghton Mifflin
Rogers, C. R., Stevens, B., Gendlin, E. T., Shlien, J. M., & Van Dusen, W. (1967). Person to person: The problem of being human: A new trend in psychology. Lafayette, CA: Real People Press.
Person-centred experiential therapy is as effective as CBT, research shows news from BACP (2021). Available at: https://www.bacp.co.uk/news/news-from-bacp/2021/14-may-person-centred-experiential-therapy-is-as-effective-as-cbt (Accessed: January 15, 2023).