3. Person-Centered Therapy
(A reaction against the directive and psychoanalytic approaches)
• Challenges:
– The assumption that “the counselor knows
best”
– The validity of advice, suggestion, persuasion,
teaching, diagnosis,
and interpretation
– The belief that clients cannot understand and
resolve their own problems without direct help
– The focus on problems over persons
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (1)
4. Overview
• Founder: Carl Rogers. Born in Oak Park, IL-
1902. Trained at University of Wisconsin and
Columbia University. His educational
background was in agriculture, science,
philosophy, theology, education and
psychology. Fundamental shift in theory from
helper-to-client to person-to-person.
5. Person-Centered Therapy
• Emphasizes:
– Therapy as a journey shared by two fallible people
– The person’s innate striving for self-actualization
– The personal characteristics of the therapist and
the quality of the therapeutic relationship
– The counselor’s creation of a permissive, “growth
promoting” climate
– People are capable of self-directed growth if
involved in a therapeutic relationship
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (2)
6. Major philosophies and nature of humans
• Human beings are essentially rational, constructive,
positive, independent, realistic, cooperative,
trustworthy, accepting, forward moving and full of
potential. Humans, like all organisms, naturally tend
toward actualization of their full potential. (Gilliland
& James, 1998)
• Experience is key to Rogerian theory. Because each
person’s perception of his or her own experience is
unique, the client is the only expert on his or her
own life.
7. (Gilliland & James, 1998)
Major constructs
• Actualizing tendency. The inherent tendency of the person to
develop in ways that serve to maintain or promote growth.
• Conditions of worth. A person’s worth is conditional when his
or her self-esteem is based on significant others’ valuation of
experience.
• Congruence. The state of consonance among the person’s
acting, thinking and feeling states. When experiences are
wholly integrated into the self-concept.
• Empathic understanding. One perceives as if one were the
other person but without ever losing the “as if” condition.
8. (Gilliland & James, 1998)
Major constructs
• Experience (noun). All the cognitive and affective events
within the person that are available or potentially available to
his or her awareness.
• Experience (verb). To receive the impact of all the sensory or
physiological events happening at the present moment.
• Genuineness. The state where there is no difference between
the real and the perceived selves.
• Organismic valuing process. The process whereby
experiences are accurately perceived, constantly updated,
and valued in terms of the satisfaction experienced by the
person.
9. (Gilliland & James, 1998)
Major constructs
• Positive regard. The perception of the self-experience of
another person that leads the individual to feel warmth, liking
and respect for the acceptance of that person.
• Positive self-regard. A positive attitude toward the self that is
not dependent on the perceptions of significant others.
• Self-actualization tendency. The tendency of the person to
move toward achieving his or her full potential.
• Self-Concept. The person’s total internal view of self in
relation to the experiences of being and functioning within
the environment.
10. (Gilliland & James, 1998)
Major constructs
• Self-Experience. Any event in the individual’s
perceptual field that he or she sees as relating to the
“self,” “me,” or “I.”
• Unconditional Positive Regard. The individual’s
perception of another person without ascription of
greater or lesser worthiness to that person. It is
characterized by a total rather than a conditional
acceptance of the other person.
• Unconditional self-regard. The perception of the self
in such a way that no self-experience can be
discriminated as being more or less worthy of
positive regard than any other self-experience.
11. (Walker & Brokaw, 2005)
The Self
• According to Rogers, the Self:
– Is organized and consistent
– Includes one’s perceptions of all that comprises “I” or “me”
– Includes the relationship among I or me an other people
and features of life, as well as the value and importance of
these relationships
– Is available to consciousness but it is not always conscious
at any given moment
– The shape of the self is constantly changing, yet always
recognizable
12. A self actualized person has the
following characteristics
• Open to experience
• Aware of all experience
• Deal w/change in creative ways
• Socially effective
• Lives existentially
• Lives in the here and now
• Trusts self
13. Major personality constructs
• Personality theory has not been of major concern to
person-centered therapists, rather the manner in
which change comes about in the human personality
has been the focus. (Gilliland & James, 1998)
• Each person is unique and has the ability to reach his
or her full potential.
• Once the self-concept is formed, two additional
needs are acquired:
– the need for positive regard from others
– the need for positive self-regard
14. Nature of “maladaptivity”
• Rogerian theory speaks primarily of
“incongruence” as the primary maladaptivity.
Maladaptivity relates to the blocks that are
put in the road to actualization. (Gilliland &
James, 1998)
• Also, external locus of control and looking to
others for worth are seen as maladaptive.
15. Major goals of counseling
• The central focus of counseling is the client’s
experiencing of feelings.
16. A Growth-Promoting Climate
• Congruence - genuineness or realness
• Unconditional positive regard- acceptance
and caring, but not approval of all behavior
• Accurate empathic understanding – an
ability to deeply grasp the client’s
subjective world
– Helper attitudes are more important than
knowledge
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17. Major techniques/strategies
• The most important technique in person-centered
counseling is the establishment of the relationship
between client and counselor as one of mutual trust
and safety. The relationship is the beginning, the
main event and the end of the counseling. The
counselor deals directly, in the here and now, with
the client’s feelings and experiences rather than
intellectualize about the experiences.
• Person-centered theory is a phenomenological
approach—each person is unique.
18. Six Conditions
(necessary and sufficient for personality changes to occur)
1. Two persons are in psychological contact
2. The first, the client, is experiencing incongruency
3. The second person, the therapist, is congruent or integrated
in the relationship
4. The therapist experiences unconditional positive regard or
real caring for the client
5. The therapist experiences empathy for the client’s internal
frame of reference and endeavors to communicate this to the
client
6. The communication to the client is, to a minimal degree,
achieved
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (4)
19. Major roles of counselor and client
• Because of the essential nature of the relationship,
the major role of counselor is to create an
atmosphere of genuineness, unconditional positive
regard and empathic understanding and to reflect
content to the client.
• The reflection may include the counselor’s own
feelings so long as they are genuine and the
counselor owns them as his or her own.
• The challenges for the counselor lie in his or her
willingness to also be changed by and grow through
the counseling relationship and to be open and
transparent to the client.
20. Major roles of counselor and client
• The client’s role is to do, think, say or feel
whatever they are experiencing in the
moment.
• Within the atmosphere of unconditional
positive regard, the client will be able to
experience his or her feeling about the
experiences and the incongruence in his or
her life and will by nature, know and choose
the course toward growth and actualization.
21. The Therapist
• Focuses on the quality of the therapeutic
relationship
• Serves as a model of a human being struggling
toward greater realness
• Is genuine, integrated, and authentic, without
a false front
• Can openly express feelings and attitudes that
are present in the relationship with the client
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (5)
22. Gestalt Therapy
Be who you are and say what you feel because those
who mind don’t matter and those who matter don’t
mind.
Dr. Seuss
45. Theory and Practice of
Counseling and Psychotherapy
MacDonald
Existential Therapy
46. Questions?
• What key concepts do you know in terms of
existential therapy?
• What is the meaning or purpose of your life?
– What do you want from life?
– Where is the source of meaning for you in life?
• How do you work through a sense of “no self”
and feeling alone?
• What are the possible reasons that people tend
to blame others for their problems?
• What is the positive motivation of being anxious?
• If you only have 30 days left, what’s your
feelings? What will you do?
48. Existential Therapy
A Philosophical/Intellectual Approach to Therapy
• View of Human Nature
– The capacity for self-awareness
– The tension between freedom & responsibility
– The creation of an identity & establishing meaningful
relationships
– The search for meaning, purpose, and values of life
– Accepting anxiety as a condition of living
– The awareness of death and nonbeing
49. The Capacity for Self-Awareness
• We can reflect and make choices because we are
capable of self-awareness.
• Expanding our awareness in realizing that:
– We are finite - time is limited
– We have the potential, the choice, to act or not to act
– Meaning is not automatic - we must seek it
– We are subject to loneliness, meaninglessness, emptiness,
guilt, and isolation
50. Question
• What are the possible reasons
that people tend to blame
others for their problems?
51. Freedom and Responsibility
• We are free to choose among alternatives
• We are responsible for our lives, for our action, and
for our failure to take action.
• Blaming others for their problems---
– Recognize how they allowed others to decide for
them and the price they pay
– Encourage them to consider the alternative
options
52. Striving for Identity
• Identity is “the courage to be”
– We must trust ourselves to search within and
find our own answers
– Our great fear is that we will discover that
there is no core, no self
• Struggling with our identity:
– Challenging clients---in what ways that they
have lost touch with they identity and letting
others to design their life.
53. Question?
• How do you work through a
sense of “no self” and feeling
alone?
54. Relationship to others
• Aloneness
– We are alone---So, we must give a sense of
meaning to life, decide how we will live, have a
relationship with ourselves, and learn to listen
to ourselves.
• Relatedness
– We need to create a close relationship with
others
– Challenging clients----What they get from they
relationship? How they avoid close
relationship?
55. Question
• What is the meaning or purpose of your life?
– What do you want from life?
– Where is the source of meaning for you in life?
56. The Search for Meaning
• Therapists trust is important in teaching
clients to trust their own capacity to find their
way of being.
• Meaninglessness in life leads to emptiness
and hollowness (existential vacuum)
• Finding meaning in life is a by-product of
engagement, which is a commitment to
creating, loving, working, and building.
58. Anxiety – A Condition of Living
• Anxiety arises from one’s strivings to survive.
• Existential anxiety is normal
– an outcome of being confronted with the four given
of existence: death, freedom, existential isolation,
and meaninglessness.
– Recognize existential anxiety and find ways to deal
with it constructively.
– Anxiety can be a stimulus for growth as we become
aware of and accept our freedom
– If we have the courage to face ourselves and life we
may be frightened, but we will be able to change
59. Question
• If you only have 30 days left,
what’s your feelings? What will
you do?
60. Awareness of Death
• Death provides the motivation for us
to live our lives fully and take
advantage of each opportunity to do
something meaningful.
61. Therapeutic Goals
• To expand self-awareness
• To increase potential choices
• To help client accept the responsibility for
their choice
• To help the client experience authentic
existence
62. Therapist’s Function and Role
• Understand the client’s subjective world
• Encourage clients to accept personal
responsibility
• When clients blame others, therapist is likely
to ask them how they contributed to their
situation.
63. Client’s Experience in Therapy
• They are challenged to take responsibility for how
they now choose to be, decide how they want to be
different, and take actions.
• Major themes in therapy sessions are anxiety,
freedom and responsibility, isolation, death, and the
search for meaning.
• Assist client in facing life with courage, hope, and a
willingness to find meaning in life.
64. Relationship Between Therapist and Client
• Therapy is a journey taken by therapist and client
– The person-to-person relationship is key
– The relationship demands that therapists be in contact
with their own world
• The core of the therapeutic relationship
– Respect and faith in the clients’ potential to cope and
discover alternative ways of being
– Therapists share their reactions to clients with
genuine concern and empathy as one way of
deepening the therapeutic relationship.
65. Therapeutic techniques and
procedures
• It is not technique-oriented
• The interventions are based on philosophical
views about the nature of human existence.
• Free for draw techniques from other orientations
• The use of therapist self is the core of therapy
66. Questions
• Which populations is existential therapy
particularly useful?
• Which issues is existential therapy particularly
useful?
67. Areas of Application
• Grief work, facing a significant
decision, developmental crisis, coping
with failures in marriage and work,
dealing with physical limitations due to
age……
68. From a multicultural perspective
• Contributions
– Applicable to diverse clients to search for meaning
for life
– Be able to examine the behavior is influenced by
social and cultural factors.
– Help clients to weigh the alternatives and
consequences.
– Change external environment and recognize how
they contribute
69. From a multicultural perspective
• Limitations
– Excessively individualistic
– Ignore social factors that cause human problems
– Even if clients change internally, they see little hope the
external realities of racism or discrimination will change
– For many cultures, it is not possible to talk about self and
self-determination apart from the context of the social
network
– Many clients expect a structured and problem-oriented
approach instead of discussion of philosophical questions.
70. Summary and Evaluation
• Contributions
– Stress self-determination accepting the personal
responsibility along with freedom
– View oneself as the author of one’s life
– Understand the value of anxiety and guilty, the positive
meaning of death, the positive aspects of being alone and
choosing for oneself
– Enable clients to examine how their behavior is being
influenced by social and cultural conditioning.
71. Summary and Evaluation
• Limitations
–Lacks of a systemic principles and practice
for therapy
– No empirical research validation yet
– Limited to apply to lower-functioning clients,
clients who need directions, are concerned about
meeting basic needs, and lack of verbal skills
72. Case 1
• I find myself terrified when I am alone. I need
people around me constantly, and if I’m
forced to be alone, then I run from myself by
watching TV. I’d like to learn how to be alone
and feel comfortable about it.
– What are the issues?
– What can you do to help this client?
73. Case 2
• I feel like my existence does not matter to
anyone. If I were to die today, I fully believe
that it wouldn’t make a difference to anyone.
– What are the issues?
– What can you do to help this client?
74. Case 3
• I rarely feel close to another person. While I
want this closeness, I am frightened of being
rejected. Instead of letting anyone get close to
me, I build walls that keep them removed.
What can I do to lessen my fear of being
rejected?
– What are the issues?
– What can you do to help this client?
75. Questions
• Please discuss at least three questions to ask
speakers regarding the career issues in social
work, private practice, counseling, and family
and marriage?
78. WHY USE THE EXPRESSIVE
ARTS IN YOUR PRACTICE?
• New tool for your “toolkit”
• Address client issues
• Well suited to brief therapy
• Stay inspired & avoid burnout
• Practice self-care
79. CREATIVE EXPRESSION
& MENTAL HEALTH
1800’s to the 1900’s:
• Arts as adjunct to medicine &
psychiatry
• “Moral therapy” for mental
illness
80. 1920’s:
• Joseph Moreno: psychodrama
• Florence Goodenough: art
assessment for cognitive
development
• Margaret Lowenfield:
foundations of play therapy &
sandtray therapy
81. 1930’s and 1940’s:
• Expressive therapies more well
known
• Self-expression as “alternative”
to talk therapy
• Major psychiatric hospitals
include arts in treatment
82. 1950’s ONWARDS…
(abridged version)
• Professional associations & standards developed
• Expressive therapies integrated into medical, mental
health, & rehabilitative settings
83. WHAT ARE THE
“EXPRESSIVE THERAPIES”?
“The use of art, music,
dance/movement, drama,
poetry/creative writing, play,
and sandtray within the
context of psychotherapy,
counseling, rehabilitation, or
health care”
– Cathy Malchiodi, 2005
84. TYPES OF EXPRESSIVE
THERAPIES:
• Art Therapy
• Music Therapy
• Drama Therapy
• Dance/Movement Therapy
• Poetry Therapy
• Play Therapy
• Sandtray Therapy
• **Expressive Arts Therapy
Each discipline has its own
association, qualifications, &
professional standards
86. WHAT IS “EXPRESSIVE ARTS
THERAPY”?
• Arts-based psychotherapy
• Interdisciplinary
• Integrates the arts eg. imagery,
dance, music, drama, poetry,
movement, & visual arts
• Goal: wellness & healing
88. ALTERNATE NAMES FOR
EXPRESSIVE ARTS
THERAPY:
• “Expressive Therapy”
• “Integrative Arts Therapy”
• “Intermodal Expressive
Therapy”
• “Multimodal Expressive
Therapy”
“A rose by any other name would
smell as sweet…”
89. GUIDING PRINCIPLES OF
EXPRESSIVE ARTS
THERAPY:
• Reclaims our innate capacity
for creative expression
• Creative expression is a
healing, ‘growth producing’
process
• Therapeutic transformation
possible through expression
90. GUIDING PRINCIPLES OF
EXPRESSIVE ARTS
THERAPY:
• The arts are for everyone
• Low skill/high sensitivity
• Depth-oriented
• “Layering” of modalities
91. KEY THEORISTS IN
EXPRESSIVE ARTS
THERAPY:
Natalie Rogers: “creative
connection”; person-centered
Shaun McNiff: “therapy of the
imagination”; “art as medicine”
Paulo Knill: arts are “within each
other”; “de-centering process”
92. APPALACHIAN STATE’S
PERSPECTIVE:
• Natural world as model for
creative process
• Reclaiming ancient integration
of arts & life & healing
• Dream-work emphasis
• The ‘person of the therapist’
93. ASSOCIATION & REGISTRATION
• International Expressive Arts
Therapy Association (IEATA), 1994
– Registered Expressive Arts
Therapist (REAT) & Registered
Expressive Arts Consultant/
Educator (REACE)
• Additional Resources:
– Creative Arts in Counselling
Chapter, CCPA
– See Resource List
94. WHAT POPULATIONS WILL
THIS WORK WITH?
The expressive arts are used
with a variety of populations &
presenting issues including:
• Psychiatric disorders
• Developmental disorders
• Cognitive disabilities
• Issues including: addiction,
trauma, grief, anxiety, &
depression
95. EXPRESSIVE ARTS ARE
UTILIZED WITH:
• Clients of all ages
• Clients with diverse backgrounds
• Individuals & families
• Groups
• Outreach programs
Expressive Arts Therapy is practiced
& taught in many countries eg. Peru,
Israel & Switzerland
96. WHO USES EXPRESSIVE
THERAPIES?
Approximately 30,000 practitioners
in the U.S. are formally trained in
therapeutic use of the arts
Arts-based interventions have been
integrated into fields such as
medicine, social work, counselling,
psychiatry & psychology
97. CURRENT RESEARCH
Recent research topics on the therapeutic
use of expressive arts include:
• Creative writing in prevention &
psychotherapy
• Music therapy in hospice & palliative care
• Creative therapies in treatment for PTSD
• Dance therapy for women survivors of
sexual abuse
• Increasing counsellor empathy through
theatre exercises
• Guided imagery & relaxation for women in
early stage breast cancer
• Promoting positive mental health through
art therapy
• The use of the arts in grief & loss
99. SIMPLE WAYS TO INTEGRATE THE EXPRESSIVE
ARTS INTO YOUR THERAPEUTIC PRACTICE…
100. RECOMMENDATIONS FOR
PRACTICE:
• Try the activity 1st
yourself
• Focus on process over product
• Respond to art with process
comments; avoid likes & dislikes
• Counter negative statements eg “I
can’t do art”
• Explore when to participate versus
when to be a witness
• Create openings & closings
Notas del editor
Moral therapy considered the arts as a “humane treatment” for mental illness
Psychodrama: enactment as way to achieve mental health;
1920’s: increased interest in art created by people with mental illness
Today, we see it not as an ‘alternative’ to talk therapy, but used in conjunction with talk therapy; Major psychiatric hospitals eg Menninger Clinic in Kansas
Aesthetic focus: symbolic form to feeling
Focus is fluid, integrated
Lesley is in Boston, MA
FY: importance of witnessing
All people can engage in the arts regardless of artistic training or ability; Depth-oriented:creative work can foster access to experiences, emotions, and the unconscious; “Layering” modalities: encourages combining different forms of self-expression to enrich therapeutic experience
Rogers: “creative connection”/interconnectedness among all arts modalities; McNiff: “therapy of the imagination”: all forms of creative expression centre on imagination; Knill focuses on the inherent interdisciplinary nature of the arts: arts are “within each other”
Person of the therapist: Integrity of the therapist: personal practice in expressive arts and developing the ‘person of the therapist”; & “daily practice”
IEATA has roots in earlier organizations
Approximately 30,000 practitioners in the U.S. are formally trained in 1 or more expressive therapies at the graduate level (Malchiodi, 2005)