Changing the labels of therapy

Rogers was one of the earliest adherents of what has been called "interactional psychology"; as a result, much of the philosophy ascribed to him less abstract, simpler, and more practical than the complex theories proposed by many of his peers. Interactional psychologists believe that a healthy psyche is the result of appropriate and beneficial communication between people. Rogers continually described how such interactions should be carried out if therapists are to help people. He also explained how psychology measures helping people, and perhaps most importantly, he re-evaluated what the goals of such therapy should be. Rogers redefined everything: the description of the person seeking help, who could provide that help, what help was actually provided, and how such help was given.

Rogers did more than change terminology when he changed what patients were called. Rogers's "patients" became "clients"—persons who were in need of assistance in reaching their innate potential. This change in perception would have far-reaching implications, and it would make Rogers the father of client-centered psychotherapy. This practice of referring to clients would spread across the world, forever altering the way the psychology profession perceives people seeking help. This model would also, in keeping with Rogers's core beliefs, improve the self-esteem of the clients whom psychologists and psychiatrists saw in therapy. It would reinforce a belief Rogers shared with his colleagues Karen Horney, Abraham Maslow, and others: that there is an ever-present capacity within each of us that instinctively seeks mental health, stability, and beyond that, the fulfillment of our potential.

Rogers's use of the reflection technique in his therapy sessions has been one of the most-parodied facets of Rogerian therapy. Rogers believed that "reflection of feelings" was one of two necessary methods used toward accomplishing what Rogers calls release, the freeing of the client from the pent-up feelings. This reflection, together with simple acceptance had to be manifested in order for the client to feel free to open up and experience catharsis—the expression of feelings previously not expressed (or sometimes not even consciously felt). Both of these techniques are designed to provide the client with assurance that the therapist is attentively involved in the psychotherapy session and is accepting of what is being expressed by the client. A classic example of simple acceptance would be the therapist's response of "Yes, I see. . . ." Reflection of feelings as Rogers practiced it was more complicated, however. The ability to listen completely and totally is demonstrated to the client by the therapist mirroring back, and restating, the emotions behind what the client says.

Example Rogers provides the example of reflection in this interaction with one of his students who is getting failing grades. The supposed purpose of the session for this student is to make Rogers take responsibility for the student's decision to tell his parents.

Student: "Oh, I don't know if they're going to sort of condemn me ... in the past they've said, 'It's your fault. You don't have enough will power'..."

Rogers: "You feel that they will be unsympathetic and condemn you for your failures."

Student: "Well my—I'm pretty sure my father will ... He hasn't been—he doesn't experience these things; he just doesn't know what it's like ..."

Rogers: "You feel that he could never understand you?"

The session goes on to eventually bring forth the real problem—the student's animosity toward his father and feeling of shame that this man is his father.

Because of his focus upon interaction, many of Rogers's tenets regarding therapy bring the contact between client and therapist under a microscope with a far sharper and more distinct lens. Though libertarian in his approach, refusing to be handcuffed by any pre-set protocols developed by Freud or anyone else, Rogers still actively set standards for psychotherapy. For Rogers, a pioneer in developing a complete and cogent school of psychological theory, the rationale behind the method of treatment used always remained less important than the personal qualities that the therapist possessed and brought to each counseling session. Far more than other humanists, Rogers insisted on taking a long and hard look at the attitude that the therapist brings to the psychotherapeutic session and how this affects the person being treated.

Over the years, Rogers began to experience and discover certain requirements for success in treating people. Much of what he learned and taught to others resulted from his innovative use of technology. Rogers began tape-recording therapeutic interviews with clients in 1942, long before this became a standard practice for psychotherapists. Based on what he learned from this experience, Rogers was one of the first to elaborate certain capabilities a therapist must possess in order to help clients attain their treatment goals. Rogers was also among the first to make these theoretical requirements a part of what he called "his hypothesis" of mental health care.

Rogers believed any therapist must possess four qualities, which he describes as being "necessary and sufficient":

• Congruence, or genuineness and sincerity. The quality of congruence is quite similar to one of Rogers's criteria for being "a fully functioning person," which will be discussed in more depth under Rogers's self-actualizing tendency theory. In his or her dealings with the client, the congruent therapist must present himself or herself honestly at all costs. He or she does not have to be perfect, but the therapist should never give the client the impression that they are false or "game-playing," defensive, or all-knowing.

• Empathy, the ability to feel accurately what it is that the client is expressing. Saying "I know how you feel" when the therapist actually has no idea how the person is feeling is not considered helpful by Rogers.

• Belief that the therapist also learns from the client. The therapist should be able to quietly listen, without interrupting, and be able to provide an exchange of ideas and feelings with the client.

• Unconditional positive regard, a genuine liking and acceptance of the clients as they are. It is not necessary for the therapist to agree with everything the person says or does, but he or she must be able to accept the client totally, without any reservations.

Example Everyone, at one time or another, has tried to express to someone else how they feel when some terrible tragedy has visited them. If, for example, the person lost their spouse in the World Trade Center on September 11, 2001, and the listener responds, "Yeah, I know just how you feel ... a distant relative that I hardly knew died two years ago in Europe and I was really sad," probably neither sincerity nor empathy is present.

Rogers's theories not only redefined who received therapy and the requirements for the provision of psychotherapy, but they also revolutionized who could provide such counseling. Prior to Rogers, mental health services were almost exclusively delivered by psychiatrists or analysts trained in psychology. Rogers's criteria for psychotherapists, however, make no mention of medical degrees or the need to have personally experienced psychoanalysis. Rogers actively encouraged the involvement of others in the provision of counseling services. For the first time, this inclusion brought social workers, teachers, clergy, and other people into the counseling area of mental health care. These innovative ideas paled in comparison, however, to the other changes in treatment that were developed by Rogers.

Initially, Rogers called the type of psychotherapy that he provided "non-directive." He perceived the therapist as accompanying the client on their journey but not leading the way. Rogers eventually changed this description to "client-centered" psychotherapy. Rogers believed that this title accurately indicated what was and was not provided by him during therapy. Rogers called his therapy "supportive rather than reconstructive." Sessions would address the client's agenda, not that of the therapist. Rogerian therapy would eventually undergo one more name change, coming less from Rogers than from others. It would become known as "people-centered," due to its increasingly wide application in so many other aspects of the real world beyond psychology—in marriage and parental counseling, child guidance, education, and even leadership seminars.

From the start of his career, Rogers developed methods to test the effectiveness of his therapy; he would continue that effort throughout life. More than any of his peers, Rogers always tried to define what he and his client were trying to accomplish in psychotherapy. From his vast experience, he succeeded in outlining what the process of Rogerian psychotherapy should look like. These were the measures of success, the necessary and inevitable series of events that effective client-centered psychotherapy always followed.

Rogers's "people-centered" psychotherapeutic process includes all of the following steps:

• The person manifests a willingness to seek help. (Whether the person is able to identify this willingness or not, they show it by making an appointment with the psychotherapist for therapy.)

• The therapist outlines the scope of the assistance that will be provided to the client. It is made clear that the therapist does not have the answers to the client's problems, but assures the person that they have the capability, with the therapist's assistance, of finding their own answers to their problems.

• A warm, comforting, and safe environment is provided through the therapist's attitude. This encourages the client to freely assert both their feelings and insights about their problems.

• Negative feelings are identified for the client with the help of the therapist and are given free rein.

• When the negativity has been completely expressed, the therapist elicits the positive responses from the client that Rogers's experience had taught him would then be present.

• Both the negative and the ensuing positive feelings are recognized and accepted by the therapist.

• These six steps ultimately lead the client to insight into their problems. This insight is accompanied by new acceptance of self and self-understanding. New possibilities of action to solve the problem are brought forth.

• Positive actions to solve the problems and a decreased reliance on the help of the therapist occur.

Main points

• Rogers's hopeful, humanistic approach towards treating the mentally ill was born in the most unlikely of places—in his early experience working with abused and neglected children in upstate New York.

• Though Rogers was not the sole originator of the humanistic school of psychology, he added many important innovations to it; for example, that persons seeking help were "clients" rather than sick people, or "patients."

• Rogers was among the first to actually tape record therapeutic interviews for teaching purposes and to define what it was that he, as a psychotherapist, was trying to accomplish during psychotherapeu-tic sessions.

• Rogers developed eight criteria, or steps, listed above, for successful psychotherapy.

• Rogers believed that theory mattered less than did technique and the qualities the therapist brought to the psychotherapeutic interview. He believed that there were four qualities necessary in order for someone to successfully perform psychotherapy: congruence, or sincerity; empathy; the ability to listen and learn from the client; and a genuine liking and acceptance of the client.

Example Rogers himself provided the best metaphor for the type of therapy he spent his life practicing. He said it was similar to teaching a child to ride a bicycle. Though the teacher may initially hold onto the bicycle to steady it, eventually, in order to actually teach the child to ride, the teacher must let go of the bicycle and let the child try to ride independently. The child may take spills, yet eventually he or she will learn to ride the bicycle unassisted.

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