Reflection on Person Centered Care.

by smaster2 (student)

Reflection assignment

Developed by humanist psychologist Carl Rogers as a non-directive form of talk therapy in the 1940’s and 1950’s.The goals of the person-centred approach are different to many traditional approaches to therapy.

“Its focus is on the person, not on the person’s presenting problem. The main goal of the therapy is for the client to realise their capacity for self-actualisation” (Davis).

To achieve this goal therapists would work on developing an increased self-esteem within the client and create an environment whereas the client is more open to experience (Person Centered Therapy, 2012)

Rogers (1977) did not believe that the aim of therapy was to solve problems. Rather, it was to assist clients in their growth process so clients could better cope with their current and future problems.”(Corey, 2009, p170).

Person centred therapists do not set goals for their clients, but assist clients through facilitative therapy to achieve their own goals. As self-concept develops goals would be expected to change. This therapy could not be applied to all clients as some would not possess the natural inclination towards the self-actualisation process even within the context of the supportive, facilitative client-therapist relationship.

A description of the processes and procedures of the therapy

Person centred therapy differs from other therapies in that it is not technique orientated and the therapist does not assume the expert role. Person centred therapy is a collaborative relationship where participants are equals, and it is client directed. The techniques used in person centred therapy require the therapist to create an environment that facilitates a relationship. The therapeutic client therapist relationship needs to include” six core conditions which are necessary and sufficient for personality changes to occur” (Grant) if therapy is to be successful. “Six core conditions (necessary and sufficient for personality changes to occur). For therapy to occur it is necessary that these conditions exist.

That two persons are in psychological contact. That the first person, whom we shall term the client, is in a state of incongruence, being vulnerable, or anxious. That the second person, whom we shall term the therapist, is congruent in the relationship. That the therapist is experiencing unconditional positive regard toward the client. That the therapist is experiencing an empathic understanding of the client’s internal frame of reference.

That the client perceives, at least to a minimal degree, Conditions 4 and 5, the unconditional positive regard of the therapist for him, and the empathic understanding of the therapist.”(Rogers, 1959, p189).

This approach places little emphasis on therapist skill level or training, but rather his or her attitude.

“Three interrelated attitudes/processes on behalf of the therapist are central to the success of person centred therapy: congruence; unconditional positive regard and empathy” (Friedrich).

To what extent therapists can display these processes, and possess an awareness of their own personal vulnerabilities and there transference to the client therapist relationship greatly affects client outcomes.

3. Some of the strategies unique to this therapy

Being that this type of therapy is non-directive it requires the counsellor to focus on the personal relationship they are trying to develop with their client. If trust can be created and developed it allows the client to explore their feelings, thoughts, and emotions and share these with another person. Through open discussion self-concept begins to develop and concerns or issues can also be identified. The counsellor encourages the client to create solutions to their own problems. It is through personal problem solving and creating positive changes in their life ...

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3. Some of the strategies unique to this therapy

The therapist “helps the client to express freely the emotionalized attitudes which are basic to his adjustment problems and conflicts” (Overholser,2007,pp73-74).

Counselling techniques used by person centred therapists “include reflection of feelings, open questions, paraphrasing/summarising, and minimal encouragers.”(Seligman,2006).

Person centered therapy is considered more effective with clients who are able to relate more concretely and is most fitting for freely talking, self-directed/formal operational clients who are competent to consider their own direction(Ivey, Ivey & Zalaquett,2010).

Focusing on the development of personal relationship in the client- therapist context should also take into account the social, cultural, contextual environment of the individual (Bronfenbrenner’s Ecological Systems Theory)and also the role an individual plays in their own development either dependent or independent of the context. Roger’s makes little reference or consideration of an individual’s life circumstances on their path to self-actualisation.

4. The therapist/ client relationship – who holds the power in decision making and direction of the conversation.

Person- centered therapists do not aim to” manage ,conduct, regulate, or control the client: In more specific terms the person centred therapist does not ,diagnose, create treatment plans, strategize , employ treatment techniques, or take responsibility for the client in any way”(Corey,2009,p171).

Person centred therapists generally do not take a “client history, they avoid asking leading and probing questions, they do not make interpretations of the clients behaviour, they do not evaluate the clients ideas or plans, and they do not decide for the client about the frequency or length of the therapeutic venture”(Corey, 2009,p171).

The decision making and conversation direction in the therapist/client relationship rest in the client’s hands. Highly confused and antisocial clients would experience acceptance and reflection and clarification of their feelings (possibly for the first time) hopefully leading them into further self-exploration and positive action.

5. An analysis of who holds the power overall in the relationship.

Person centred therapy requires a collaborative therapeutic relationship.

This relationship can be defined as an environment or context where an individual is “allowed to act or effect change and is shared by all persons in the relationship rather than being assigned to one person who is seen as the authority or expert” (Natiello,1990,p272 ) .

“Roger’s belief that persons have within themselves the wisdom and resources to solve their own problems, to move in growthful directions, and to become more fully functioning.”(Natiello,1990,p269).

It is the client that holds the power in the relationship; it is the therapist who facilitates the relationship in which they do their work.

6. The theoretical foundations of the therapy-where did it come from

This method of therapy originated from principles derived from Carl Rogers who could be described as the “father of the humanistic movement in psychotherapy” (Grant, p1).

Rogers theory also” shares many of the concepts of Existentialism” (Grant, p1) Person Centered Therapy began” as nondirective therapy, client centered therapy and eventually person centered therapy. In this theory

“People are seen as inherently trustworthy, capable of autonomy and to be deeply respected” (Wilkins,2009,p3).

Person centered therapy radically challenges the conventional models of therapy (psychological and medical) which place the therapist in the expert role. Roger’s should be applauded for developing his theory regardless of the resistance he experienced from his peers which was considerable. It is Roger’s foundation upon which many modern theories and practises have evolved. De-stigmatising patients and using the term client for anyone seeking treatment. Removal of the power imbalance in therapy, he rejected the need for labels or quick diagnosis, and he was against manipulation of clients during therapy. Roger’s defied all other theorists of his time by demonstrating the effectiveness of his theory by recording and publishing complete cases verbatim.

7. The philosophical underpinnings of the therapy

In person centered therapy there is no” objective truth waiting to be revealed but meaning is constructed- or, more likely co-constructed.”(Wilkins,2009, p28).

Here and now experiences are drawn upon as the client is asked to construct meaning from the present. Main philosophical points listed below.

Clients are seen as innately striving towards becoming fully functional,Humanity is viewed positively. It is the” therapist’s beliefs and attitudes in the inner resources of the client that create the therapeutic climate for growth. Clients’ self-healing activated as they become empowered. Clients actualize potential for growth, wholeness, spontaneity, inner-directedness. Client primarily brings about change, not the therapist” (Person-Centered Therapy)

Some recent and relevant research that you have discovered.

Person centered therapy continues to be practised today; it” is among the most influential and widely employed techniques in modern U.S. clinical psychology” (Grant, p1).

The popularity of this therapy lead to the establishment of the World Association for Person-Centered and Experiential Psychotherapy and Counselling in 1997.

Continual research and development of person centered therapy exists, as currently eighteen nations around the world have” Person- centered associations, organizations, and training institutes” (Kirschenbaum, & Jourdan, 2005, p47).

Rogers led the way when he asked clients to focus on the present moment; this has now been refined and has led to the development of other therapies such as Emotion Focused Therapy (EFT) and Experiential Psychotherapy. Rogers’s relational approach to clients is now seen to be practiced widely in all therapies.

“Research on psychotherapy process and outcomes has validated the importance of empathy, unconditional positive regard, and congruence” (Kirschenbaum &Jourdan, 2005, p48).

These core principles for an effective therapeutic relationship have been adopted by” many, if not most therapists, and the various schools of psychotherapy increasingly are recognising the importance of the therapeutic relationship as a means to, if not a core aspect of, therapeutic change (Kirschenbaum &Jourdan, 2005, p48).

Critics of Rogers work have argued that client centered therapy is superficial (De Mott, 1979; Friedenberg, 1971), unworkable with some populations, and unmindful of multicultural and feminist issues(Usher, 1989; Waterhouse,1993), the social context, and recent advances in behavioural, drug, and alternative therapies; that Roger’s views on human nature are unrealistically optimistic and underestimate human evil(Coulson, 1988, 1989; Lasch,1979). Such criticisms have sometimes been fair; for Roger’s, like any other individual, was a product of his times, with personal and historical limitations. Despite these criticisms, surveys taken in the

“Journal of Counselling Psychology and American Psychologist ranked Roger’s as the most influential author and counsellor/psychotherapist” (Smith,1982).

Through conducting this assignment it has helped me gain knowledge and understanding of CBT and educated me of the significance different psychotherapies has in promoting recovery. I have also developed personal understanding on how psychological interventions implements the care we give. I will utilise the knowledge learnt in my own practice when facing obstructions, rather than accept defeat I will explore possible alternatives to reach my desired outcome.

Theoretical and empirical evidence indicates CBT to be an effective nursing intervention that works with or without pharmacological assistance. There is also a high evidence base to suggest that patients who receive CBT have a low relapse rate utilising the fundamental skills learnt in the sessions lasting beyond the cessation of therapy. CBT reduces residual symptoms helping patients re-gain control of their life and identify achievable goals personal to their recovery.

References

Bozarth, J. D. (n.d.). Person Centered Therapy: A Revolutionary Paradigm.personcentered.com. Retrieved August 28, 2012, from http://www.personcentered.com/pcch1.html

Corey,G.(2009). Theory and practice of Counselling and Psycho Therapy.n.p.:Cengage learning. Retrieved from http://books.google.com.au/books?id=eg4Tev903YwC&pg=PA171&lpg=PA171&dq=therapist+client+relationship+person+centered+therapy+broadley+1997&source=bl&ots=Uj_XtX6B7o&sig=z3iSwOgLkfSiUUktXFiUKM9A_G0&hl=en#v=onepage&q=therapist%20client%20relationship%20person%20centered%20therapy%20broadley%201997&f=false

Coulson, W. (1989, April). Founder of “value-free” education says he owes parents an apology. AFA Journal, 20–21.

Davis,A. Clinical Psychology. Retrieved from http://scholar.google.com.au/scholar_url?hl=en&q=http://www.cincinnatichildrens.org/assets/0/78/1067/3427/3523/3525/3527/63717cd6-ae36-439d-b7fe-bfbfadd86edd.doc&sa=X&scisig=AAGBfm3JJugPEwy8L3H9dpAbhtUr8S2BhA&oi=scholarr&ei=BVE4ULX0J-mZiAekqYCADA&sqi=2&ved=0CBwQgAMoADAA

De Mott, B. (1979, January). Mr. Rogers’ neighborhood. Psychology Today, 90, 94, 95.

Friedenberg, E. Z. (1971). Review of C. R. Rogers’ Freedom to Learn. Journal of Higher Education, 42, 239–242.

Friedrich,S,L. Person-centered therapy.Retrieved from http://www.minddisorders.com/Ob-Ps/Person-centered-therapy.html

Grant,S,K. Person- Centered Therapy. Retrieved from http://www.csun.edu/~hcpsy002/Psy460_Ch07_Handout_ppt.pdf

Ivey, E. , Ivey, M.B. & Zalaquett, C.P. (2010). Intentional Interviewing & Counselling 7th Edition. Belmont, CA: Brooks/Cole.

Kirschenbaum, H. (1995). Carl Rogers. In M. Suhd (Ed.), Carl Rogers and other notables he influenced (pp. 1–90). Palo Alto, CA: Science and Behavior Books.

Lasch, C. (1979, March 31). On becoming Carl Rogers by Howard Kirschenbaum [Review]. New Republic, 228(12), 30–31.

Overholser, J. (January 01, 2007). The Central Role of the Therapeutic Alliance: A Simulated Interview with Carl Rogers. Journal of Contemporary Psychotherapy, 37, 2, 71-78.

Natiello,P.(1990). The person-centered approach,collaborative power, and cultural transformation. The Person –Centered Review,5(3),268-286.

Person-Centered Therapy. Retrieved from http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=2&ved=0CFMQFjAB&url=http%3A%2F%2Fwww.unm.edu%2F~htafoya%2Fclass6.doc&ei=nYQwUMCsKsWjiAeu2YGQDA&usg=AFQjCNH4P-CtH4JBBRb2d8NCJZkmi3e-aw

Rogers, C. R., & In Koch, S. (1959). A theory of therapy, personality, and interpersonal relationships: As developed in the client-centered framework. New York: McGraw-Hill.

Smith, D. (1982). Trends in counseling and psychology. American Psychologist, 37, 7.

Seligman, L. (2006). Theories of counseling and psychotherapy: Systems, strategies, and skills. (2nd ed.). Upper Saddle River, New Jersey: Pearson Education, Ltd.

Usher, C. H. (1989). Recognizing cultural bias in counseling theory and practice: The case of Rogers. Journal of Multicultural Counseling and Development, 17, 62–71.

Waterhouse, R. L. (1993, February). Wild women don’t have the blues: A feminist critique of “person-centred” counselling and therapy. Feminism & Psychology, 3(1), 55–71.

Wilkins,P.(2009).Person Centered Therapy 100 key points.n.p.: Routledge Publishing