Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 5. Person- Centered Therapies

2. A Sketch of Carl Rogers • 1902 – 1987 • Restricted, inexpressive family life • PhD in clinical psychology from Columbia • Founder of psychotherapy research • Evolved from nondirective to client-centered to person-centered • Applied his system to education, relationships, politics, & international conflicts

3. Theory of Personality • Basic motivating force is tendency toward actualization: • To meet physiological needs • To expand ourselves through growth & reproduction • We are born with actualizing forces that motivate us and valuing processes that regulate us • We acquire conditions of worth • Develop innate and learned need for positive regard

4. Theory of Psychopathology • The more conditional the parents’ love, the more likely pathology • Incongruence between what is experienced & what is person's self-concept • Psychopathology reflects a divided personality due to lack of wholeness • Defensive reactions prevent threatening experiences from coming into awareness • Defenses cause inaccurate perceptions due to distortions & selective omission of information

5. Therapeutic Relationship Necessary & sufficient conditions for personality change • Genuineness/congruence • Positive regard • Accurate empathy

6. Therapeutic Processes • Goal: increase congruence between self & experience • Combination of consciousness raising & corrective emotional experience • Therapists control the process of therapy but not the content • Use facilitative conditions (genuineness, positive regard, empathy)

7. Therapeutic Content Intrapersonal Conflicts • Anxieties & defenses • Self-esteem • Responsibility Interpersonal Conflicts • Intimacy & sexuality • Communication • Hostility • Control

8. Therapeutic Content (cont.) Indivduo-Social Conflicts • Adjustment versus transcendence • Impulse control Beyond Conflict to Fulfillment • Meaning of life • Ideal individual

9. Practicalities of Person-Centered Therapy (PCT) • Psychologicaltesting is rare • Multiple disciplines • Efforts to enhance trainee’s empathy can result in sterile technique • Typically, sessions are once/week for months • Applied to groups, couples, & families

10. A Major Alternative & Extension: Motivational Interviewing (MI) • William R. Miller (1947 - ) • Combines elements of PCT style & technique • Found therapist empathy (not tx method) predicted therapy success for problem drinkers • Extensive research supports MI’s effectiveness and cost-efficiency

11. Four Principles of MI • Express empathy • Develop discrepancy • Roll with resistance • Support self-efficacy

12. Four Skills of MI: OARS • Open questions • Affirmation • Reflective listening • Summaries

13. Effectiveness of Person-Centered Therapies • Research on facilitative conditions shows they are valuable to outcome, but rarely sufficient Meta-analyses • PCT superior to no treatment & placebo • Allegiance effect in comparing PCT to other txs • Similar treatment outcomes when controlling for investigator allegiance • But smaller effects for children and adolescents

14. Effectiveness of MI • More than 200 RCTs • Project MATCH • Strongest support in tx of substance abuse • Particularly effective with ethnic minority and resistant clients • May need to be combined with another evidence- based treatment for durable effects

15. Criticisms of Person-Centered Therapies • From a Cognitive-Behavioral Perspective (PCT is less efficacious than CBT, questionable theory) • From a Psychoanalytic Perspective (unconditional love is unrealistic) • From a Cultural Perspective (disregard of the real world, “self” is culture specific) • From an Integrative Perspective (overemphasis on relationship, MI needs to be complimented by another tx)

16. Future Directions • Methods assimilated by other mainstream therapies • Slowly declining in popularity in USA • Empathy making a comeback • Needs to maintain openness to integration with other short-term psychotherapies • Motivational Interviewing is on the rise • PCT and MI will be integrated with CBT, emotion- & solution-focused therapies

17. Key Terms actualization actualizing tendency autonomy v. heteronomy allegiance effect client markers conditions of worth counterresistance dissemination and implementation empathy existential living fully functioning person genuineness/congruence incongruence motivational discrepancy Motivational Interviewing (MI) necessary and sufficient conditions nondirective therapy organismic valuing positive regard/unconditional positive regard process research Project MATCH reflection (of feelings) roll with resistance self-authority self-concept self-regard subception

18. Recommended Websites • Association for Humanistic Psychology: www.ahpweb.org/ • Association for the Development of the Person-Centered Approach: www.adpca.org/ • Center for Studies of the Person: www.centerfortheperson.org/ • World Association for Person-Centered Psychotherapy: www.pce-world.org/ • Motivational Interviewing: www.motivationalinterview.org/