2. Contemporary Perspectives on Abnormal Behavior and Therapeutic Orientations
Humanistic And Person-Centered Therapy
One of the next developments in therapy for mental illness, which arrived in the mid-20th century, is called humanistic or person-centered therapy (PCT). Here, the belief is that mental health problems result from an inconsistency between patients’ behavior and their true personal identity. Thus, the goal of PCT is to create conditions under which patients can discover their self-worth, feel comfortable exploring their own identity, and alter their behavior to better reflect this identity.
History of Person-Centered Therapy
Techniques in Person-Centered Therapy
Humanistic and person-centered therapy, like psychoanalysis, involves a largely unstructured conversation between the therapist and the patient. Unlike psychoanalysis, though, a therapist using PCT takes a passive role, guiding the patient toward his or her own self-discovery. Rogers’s original name for PCT was non-directive therapy, and this notion is reflected in the flexibility found in PCT. Therapists do not try to change patients’ thoughts or behaviors directly. Rather, their role is to provide the therapeutic relationship as a platform for personal growth. In these kinds of sessions, the therapist tends only to ask questions and doesn’t provide any judgment or interpretation of what the patient says. Instead, the therapist is present to provide a safe and encouraging environment for the person to explore these issues for him- or herself.
An important aspect of the PCT relationship is the therapist’s unconditional positive regard for the patient’s feelings and behaviors. That is, the therapist is never to condemn or criticize the patient for what s/he has done or thought; the therapist is only to express warmth and empathy. This creates an environment free of approval or disapproval, where patients come to appreciate their value and to behave in ways that are congruent with their own identity.
Advantages and Disadvantages of Person-Centered Therapy
One key advantage of person-centered therapy is that it is highly acceptable to patients. In other words, people tend to find the supportive, flexible environment of this approach very rewarding. Furthermore, some of the themes of PCT translate well to other therapeutic approaches. For example, most therapists of any orientation find that clients respond well to being treated with nonjudgmental empathy. The main disadvantage to PCT, however, is that findings about its effectiveness are mixed. One possibility for this could be that the treatment is primarily based on unspecific treatment factors. That is, rather than using therapeutic techniques that are specific to the patient and the mental problem (i.e., specific treatment factors), the therapy focuses on techniques that can be applied to anyone (e.g., establishing a good relationship with the patient) (Cuijpers et al., 2012; Friedli, King, Lloyd, & Horder, 1997). Similar to how “one-size-fits-all” doesn’t really fit every person, PCT uses the same practices for everyone, which may work for some people but not others. Further research is necessary to evaluate its utility as a therapeutic approach.
Motivational Interviewing (MI) is another client centered technique that uses empathetic understanding as a means of promoting behavioral change in clients. The emphasis is on six broad humane values: compassion, respect, fairness, human potential, prizing of differences, and collaboration. These values are implicit in the spirit and practice of MI, and have implications far beyond professional practice. When considering conversations about behavior change, MI can provide a practical skill that helps preserve the self-integrity and autonomy of the conversational partner (e.g., Markland et al., 2005; Vansteenkiste and Sheldon, 2006; Leffingwell et al., 2007; Vansteenkiste et al., 2012). MI is defined as a “collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Miller and Rollnick, 2013, p. 12). Although it remains to be seen how MI fares in the context of environmental behavior change, several meta-analytic studies have established MI as an evidence-based intervention method in facilitating behavior change in the clinical context (e.g., Hettema et al., 2005; Rubak et al., 2005; Carroll et al., 2006; Lundahl et al., 2010; Magill et al., 2014).MI provides methods to deal with client resistance and to support clients’ self-efficacy by validating negative client statements (Werner et al., 2009) and by selectively attending to clients’ verbal expressions in favor of change (i.e., change talk, Miller and Rose, 2009; Glynn and Moyers, 2010).
Existential therapy contrasts the psychoanalysts’ focus on the self and focuses instead on “man in the world.” The counselor and the client may reflect on how the client has answered life’s questions in the past, but attention ultimately emphasizes the choices to be made in the present and future and enabling a new freedom and responsibility to act. By accepting limitations and mortality, a client can overcome anxieties and instead view life as moments in which he or she is fundamentally free.
Gestalt therapy focuses on the skills and techniques that permit an individual to be more aware of their feelings. According to this approach, it is much more important to understand what patients are feeling and how they are feeling rather than to identify what is causing their feelings. Supporters of gestalt therapy argued that earlier theories spent an unnecessary amount of time making assumptions about what causes behavior. Instead, gestalt therapy focuses on the here and now.
Analytical and Archetypal Psychology
C.G. Jung, James Hillman
Carl Rogers, Will Schultz
Rollo May, James F.T Bugental
Gestalt Art Therapy
Richard Bandler, John Grinder
Sensory Awareness though Movement
In his seminal work “Significant Aspects of Client-Centered Therapy,” Rogers described the discovery of the “capacity of the client” (1946):
Naturally the question is raised, what is the reason for this predictability in a type of therapeutic procedure in which the therapist serves only a catalytic function? Basically the reason for the predictability [page 418] of the therapeutic process lies in the discovery — and I use that word intentionally — that within the client reside constructive forces whose strength and uniformity have been either entirely unrecognized or grossly underestimated. It is the clear cut and disciplined reliance by the therapist upon those forces within the client, which seems to account for the orderliness of the therapeutic process, and its consistency from one client to the next.
I mentioned that I regarded this as a discovery. I would like to amplify that statement. We have known for centuries that catharsis and emotional release were helpful. Many new methods have been and are being developed to bring about release, but the principle is not new. Likewise, we have known since Freud’s time that insight, if it is accepted and assimilated by the client, is therapeutic. The principle is not new. Likewise we have realized that revised action patterns, new ways of behaving, may come about as a result of insight. The principle is not new.
But we have not known or recognized that in most if not all individuals there exist growth forces, tendencies toward self-actualization, which may act as the sole motivation for therapy. We have not realized that under suitable psychological conditions these forces bring about emotional release in those areas and at those rates which are most beneficial to the individual. These forces drive the individual to explore his own attitudes and his relationship to reality, and to explore these areas effectively.
We have not realized that the individual is capable of exploring his attitudes and feelings, including those which have been denied to consciousness, at a rate which does not cause panic, and to the depth required for comfortable adjustment. The individual is capable of discovering and perceiving, truly and spontaneously, the interrelationships between his own attitudes, and the relationship of himself to reality. The individual has the capacity and the strength to devise, quite unguided, the steps which will lead him to a more mature and more comfortable relationship to his reality. It is the gradual and increasing recognition of these capacities within the individual by the client-centered therapist that rates, I believe, the term discovery. All of these capacities I have described are released in the individual if a suitable psychological atmosphere is provided.
Rogers identified five characteristics of the fully functioning person:
Open to experience: Both positive and negative emotions are accepted. Negative feelings are not denied, but worked through (rather than resort to ego defense mechanisms).
Existential living: Being in touch with different experiences as they occur in life, avoiding prejudging and preconceptions. Being able to live in and fully appreciate the present, not always looking back to the past or forward to the future (i.e., living for the moment).
Trust feelings: Feelings, instincts, and gut-reactions are paid attention to and trusted. A person’s own decisions are the right ones and we should trust ourselves to make the right choices.
Creativity: Creative thinking and risk taking are features of a person’s life. A person does not play it safe all the time. This involves the ability to adjust and change and seek new experiences.
Fulfilled life: A person is happy and satisfied with life, and always looking for new challenges and experiences.
Video: An example of a person-centered therapy session.
Video: Carl Rogers, the founder of the humanistic, person-centered approach to psychology, discusses the position of the therapist in PCT.
Contrasts the psychoanalysts’ focus on the self and focuses instead on “man in the world.”
Focuses on the skills and techniques that permit an individual to be more aware of their feelings.
Motivational Interviewing (MI)
Client centered technique that uses empathetic understanding as a means of promoting behavioral change in clients. A collaborative conversation style for strengthening a person’s own motivation and commitment to change.
Person-centered therapy (PCT)
A therapeutic approach focused on creating a supportive environment for self-discovery.
Unconditional positive regard
In person-centered therapy, an attitude of warmth, empathy and acceptance adopted by the therapist in order to foster feelings of inherent worth in the patient.