The Rogerian Approach

The Rogerian approach to therapy tends to be supportive rather than reconstructive and as such has severe limitations.

The aim of this essay is to discuss and evaluate the Rogerian approach as a supportive psychotherapeutic model rather than a reconstructive one. The foundations and key aspects of this approach are to be compared with other psychotherapeutic modalities. Furthermore, the main limitations of this approach shall be investigated in order to identify the shortcomings of Carl Rogers' (1902-1987) doctrine.

The Rogerian approach also known as person-centered therapy was elaborated by Carl Rogers between 1940-1950. In order to fully grasp how much of this approach was revolutionary at that time, one needs to put it back into context. The world of psychology was divided into two opposite entities and schools of thoughts. At that time the Freudian legacy of psychoanalysis was suggesting that all mental conditions arise from intrapsychic conflicts or unconscious impulses. This was firmly in opposition with Skinner's behaviorism movement, claiming that human behavior was the result of reinforced conditioning by external stimulus. Rogers started elaborating his approach by observing his patients as clinical case studies, yet unlike Freud he had a nuanced perception when it came to theorized on case studies and thought that humans were not simply objects of study. This shift marked the beginning of the Humanistic movement known as the 'third force' of psychology offering an alternative approach to psychoanalysis and behaviorism. Indeed, Rogers' aim was to put the patient/client forward and allow them to play an equal part in the therapeutic process. He shifted the dynamics that were well established before him whereby the therapist was to be seen as the 'expert', this shift is also symbolized by the change of the word patient to client setting clearly the active role of the client in the process. Rogers believed that by attributing to his clients a sense of expertise and allowing them to appropriate themselves their own fate, psychological growth would be the only outcome. Indeed, Rogers thought that growing was a natural phenomena for human kind driven by a basic force that he called actualizing tendency (Atkinson and Hilgard's 2009). This tendency is seen as a natural human drive towards fulfillment and actualization to the full extent of human potential. In other words, Rogers thought that if humans were given a choice they would systematically choose growth as a result of their human drive. The Rogerian approach in that sense uses the human nature as an instrument in the therapeutic process rather than centralizing the therapy around the individuals' dysfunction and its causes. Rogers' aim was to emphasize the active role of the Self when distorted or wrongly perceived as a factor in the client's maladaptive behavior. This conception of the Self contradicted the Freudian idea of an unconscious psychological process and clashed with the Behaviorists' Nurture doctrine by putting forward the importance of the Selfs' (self-awareness, self-actualization, self-integration) as natural human tendencies (Brammer and MacDonald 2003). This approach was revolutionary in that it focused on human growth and therefore suggested that therapy is an unfinished process rather than a conditioned process so far presented as a finished product. Thus human existence is not to be seen as a means to an end but as Rogers said an "ongoing process of organismic experience" (Atkinson and Hilgard's 2009).

 

As Rogers' intention was to approach psychotherapy in a democratic fashion emphasizing the role of the therapist as much as the one of the patient/client, he equally theorized both roles in a complementary way. The word 'theorized' here is to be taken with caution since Rogers had more of a a-theoretical approach to mental illness avoiding the use of diagnosis methods. This quote of Rogers describes well what he thought of labeling human kind: "The subjective human being has an important value…that no matter how he may be labeled and evaluated he is a human person first of all" (The Psychology Book 2012). As he believed that human existence and more precisely therapy was an ongoing process, the use of such methods were to limit the client's evolution as it did not take into consideration the momentum of their progress. In Rogers own words "What I will be in the next moment, and what I will do, grows out of the moment, and cannot be predicted" (The Psychology Book 2012). In this respect, the closest Rogers came to provide empirical methodology was the use of the Q-sort. He pioneered its use by assessing clients' Self-concept in a form of correlation to see if there was any discrepancies between the results (Atkinson and Hilgard's 2009).That methodology was to be performed many times along the course of the psychotherapy as Rogers considered this process as a motion. Research more recently has demonstrated that self-discrepancies between the different Selfs that Rogers mentioned can be correlated with psychopathology (Higgins and Spiegel 2004). Person-centered therapy is articulated around main concepts, the first being Roger's theory of the Self and the second what he described to be the core conditions to allow the therapeutic process to take place. There are three main core conditions that the therapist must put forward in order to facilitate the client's self-exploration. These conditions are fundamental in person-centered therapy as they create the appropriate environment in which clients can find within themselves resources to overcome their problems. In order to fully understand Rogers approach it is important to understand independently every element of the therapy in a holistic manner as they all complement each other to create a method in itself. As this doctrine implies that clients are in full possession of a growing drive this approach is essentially based on their experience. Therefore, the therapists have a role of facilitator and should not rely on other tools but their own skills and have to put aside any form of assessments leading to labeling or diagnosing. Rogers defined and divided these set of skills into three main concepts; congruence, unconditional positive regard and empathy. The word skill here its to be perceived more as a general attitude rather than a set of techniques that the therapist applies. It is assumed that if the therapist successfully provides a therapeutic exchange based on these core conditions, as a result the client is enabled to access an inner therapeutic process. 

The first and most important conditions according to Rogers is what he called congruence. Again, Rogers firmly took position on what was established by psychoanalysis before him. Unlike the psychodynamic approach where the therapists are to be as neutral as possible and give as little away of themselves, congruence is about being genuine in the sessions. There is no need for the therapist to have a 'persona' or a psychotherapist 'façade', which allows authenticity to be shared by both parities. The idea of authenticity if very dear to Rogers as he believed that by allowing the therapist to share internally as externally their experience of the therapy by reflection the client would strive towards the same process. This emphasis on what can be seen as absolute transparency during the therapy is a central element to the Rogerian approach, almost confronting psychotherapists themselves on what is asked from clients during therapy. It seems like Rogers followed the golden rule of reciprocity of Confucius "do not do to others what you do not want done to you" and gave it a twist, asking how can the client be authentic and genuine when the therapist is not. Therefore, if the therapist is not using elaborate techniques and complex academic lexicon as a shield, the level of pretense and defense of the client should decrease. Moreover, if the therapist offers true congruence, the level of shared experience and reflective work is sublimated. As empathy was another of Rogers core conditions, the fact that the therapist could authentically relate to the client's experiences in the here and now was fundamental to his approach. Rogers is making a statement on the 'meta' aspect of psychotherapy, implying that the therapist is going through as much of a process than the client. In other words, the therapist here becomes a tool in the therapeutic movement rather than the mechanic. 

The following core condition is with no doubt the most influenced by Rogers' theory of the Self. This condition was an answer to what he considered to be the root cause of mental issues, a permanent desire to get external approval creating internal conflict. As he suggested that the discrepancy between one's actual self and the idealistic self was the cause for a psychological incongruence, he believed that acceptance was the greatest force to rebalance the Selfs. He argued that acceptance was to be reached by offering what he called unconditional positive regard (NCHP notes 2012). Again, as Rogerian's believe in humanity's core drive towards emotional and mental well-being, offering acceptance from early age creates the adequate environment for them to reach their full potential. If a client does not receive that acceptance, it is argued that the aftermath of such inner conflict worsens the discrepancy which results in a greater form of incongruence. Thus, it is the therapist's role to reestablish this unconditional acceptance so that the client can reach true congruence. This concept is rooted deeply in the humanistic tradition that puts forward the importance of experiencing a true and real sense of care for the client. This could be compared with the biblical reference to the idea of God loving the sinner but not the sin. In that same way the therapist is to accept the client and care for him/her without necessarily embracing the dysfunctional behavior. Clients are to be accepted the way they are in the session because the maladaptive behavior is not reflective of who the clients truly are, but rather a representation of the discrepancy between the Selfs that is fundamentally against their nature. This acceptance that is offered in the most authentic way possible by the therapist is hopefully internalized by the client (NCHP notes 2012). It is suggested that once the client is presented with unconditional positive regard through the therapeutic process their own sense of approval develops to the point where it becomes part of them. In this context, one could argue that Rogers first reflects the ideal parental behavior towards a child/client and expects the client to integrate that behavior almost as becoming their own parent. This phenomena can be observed in the form of transference in the documentary of Gloria (1965) when she refers to Rogers as the father she would have liked to have. In a certain way unconditional acceptance could be a seen as a counter force to any form of resistance.

Last but not least, the final core condition of person-centered therapy is represented by empathy. Reaffirming the client's expertise and own subjective experience, Rogers seeks here again equality between both parties. Setting as a ground rule empathy in his approach, he reinforces the role of the therapist as a reflective emotional entity rather than an analytical mind. Indeed, it was not a common or popular idea at his time to have therapist use their human ability to understand the client's emotions and feelings. This condition is to build a stronger sense of acceptance and allow the client to feel understood. As Rogers insisted on the importance of practice over theory, he wished for his clients to experience positively an emotional process in the sessions as a point of reference. He believed that if clients could experience feelings positively in the here and now then clients will be more comfortable with that process and that would result in an increase of self-acceptance. A very important element of empathizing with clients is that by doing so the therapist also manages to understand and therefore work according to the client's frame of references. The ideographic and phenomenological aspects of this approach are highlighted by using the uniqueness of the clients and their conscious subjective experiences. Overall, this approach marks a great turn in psychotherapy whereby the therapists themselves can be evaluated. So far, psychotherapists theorized their doctrines and were mainly presented in the form of personas. Rogers encouraged the use of non-verbal communication (prompts), questioning and listening as basic techniques to complete the effectiveness of the core conditions.These three principals can seem abstract and general if thought of as a theory's main pillars. The lack of methodology and techniques offered by the Rogerian approach remains one of its main limitation. Rogers did not stop rendering his field more humanistic in the way the client's were approached, and desecrate the therapist's image making it more human and approachable. As far as building and maintaining a strong therapeutic alliance with the client goes, the Rogerian approach is a very supportive model. Yet, the non-directive attitude of the therapist disables greatly its reconstructive potential as it will be demonstrated further on.  

Before discussing the limitations of this approach one needs to also grasp more precisely what Rogers understood by the Self. Indeed, this is the closest to a theory that Rogers got in his work and contribution, although it is often considered secondary (NCHP 2012). His thoughts on the Self were present by Rogers himself in the form of twenty-two propositions rather than a formal doctrine. The self/organismic self/self-concept/real-self (interchangeable words) is the collection of one's entire experiences, perceptions and awareness of the 'I'/'me'/'myself'. This is an inner point of reference that represents the individual's conceptual reality of him/herself rather than the actual reality. The self concept does not necessarily match the reality, for example someone can excel in their life and yet still feel like a failure. The self-concept is under the influence of the human characteristic of gradual fulfillment and growth (actualizing tendency) what Rogers perceived as the conceptual ideal-self. The ideal-self represents what we ought to be, the person we would like do be. It is proposed by Rogers that originally there is not much difference between these two different selfs (self-concept/ideal-self), but that in time a major discrepancy could result. This discrepancy would be the root of the mental disturbance of the individual and would be defined as incongruence (NCHP 2012). The greater the incongruence the more the person will get blocked in a psychological rigidity installed to cope with the mental tension of having to deal with a dissociated organismic self. This is why this approach enhances acceptance and provides a permissive environment in order to allow the client to experience an increased psychological flexibility around his/her self-concept. The only technique that was addressed to evaluate the level of incongruence between the self-concept and the ideal-self is the Q-sort test mentioned previously. 

Inversely, the limitations and weaknesses of the Rogerian approach often take root in what are also considered to be strengths. As mentioned above, the lack of distinctive techniques is widely accepted as a main limitation to the approach, yet it is also how this therapy creates an open and permissive atmosphere in which clients can feel utterly accepted. There are more severe limitations to its practicability and effectiveness. Indeed, most of Rogers' concepts and theories seem to be embedded in the conscious mind of individuals which alienates any potential unconscious originated issues. These simply will not and can not be addressed by this approach. Furthermore, Rogers stand on human kind itself could be arguable and seen as optimistic if not even Utopian. On some level, one could argue that Rogers' humanistic approach could be a societal reflection rather than a psychotherapeutic intervention. This way of portraying human kind in such positive light could benefit a society and shows the importance that one's environment can play on their life. This Utopian perspective on human nature is probably what own Rogers a nomination for the Nobel price. The way Rogers presented his theory of the self in propositions also constrains the depth and clarity of it and potentially limits its wider interpretation. The main issue with this approach reins on its non-directive format. Indeed, many issues arise from this Rogerian characteristic emphasized by its three core conditions. It is ethically difficult to justify the use of such therapy over an other one that would be directive to a client in distress (NCHP 2012). It also requires for the client to be able to make his/her own productive decisions. Also other schools of thoughts such as behaviorism argued that the non-verbal prompt elaborated as person-centered techniques could actually play a reinforcer to dysfunctional behaviors. The lack of methodology, techniques and theory made it very difficult to research and also to replicate as a model for training therapists, also as argued by (Mearns and Thorne 2007) the clients might not receive adequate answers or be able to progress in such conditions. The limitations of this approach are very visible in Gloria's session especially in comparison with the Gestalt demonstration of Fritz Perls. One can see that Gloria acts very differently with the two different therapists and seems more genuine (smoking, high and low voice pitches, attitudes, feisty, etc) with Perls than she is with Rogers. On many occasions Gloria asks very distinctive and clear cut questions to Rogers but because of the non-directive nature of his approach he avoids almost as walking on eggshells to answer her. It is striking to see the absolute absence of interventions and challenges offered by Rogers during that session. Gloria herself said in an interview after the sessions that she would have preferred the Gestalt approach than Rogers. It is very subjective and it is up to the client's discretion to evaluate the effectiveness of this therapy. Yet, one could argue that the lack of direction from the therapist and permissiveness could increase or favor the client's angst with the sessions. If a client has originally an anxious personality or strong insecurities, this permissive attitude might increase their level. Also the lack of challenge and intervention can be a factor reinforcing a client's victimization mechanisms, therefore unsupportive and not reconstructive at all. If clients demonstrate some Freudian defense mechanisms or cognitive distortions in order to rationalize their shortcomings, issues, or pathologies, then unconditionally accepting them might reinforce this destructive process. It is sometimes very effective to challenge client's core beliefs or narratives, in that it offers a possible shift or a greater endorsement of responsibility.

In conclusion, the supporting aspect of the Rogerian approach is undeniable. In the light of new research that proved that the modality is less important than the actual therapeutic alliance in the effectiveness of treatment in psychotherapy, it is important to value how to build this alliance. Rogers readdressed roles in psychotherapy by giving as much importance to the client as to the therapist and to the process. Considering that alliance and therapeutic relationship are very important concepts, it is clear that Rogers offered a brilliant structure to build this relation. Finally, Rogers elaborated a new perceptive on how to create the perfect climate for the client and the process to blossom. It would be limiting to only use person-centered as a treatment, one should rather see it as the ideal attitude and set of skills to adopt and present different approaches. Rogers contribution should be integrated in any other therapy as a way to establish a real and authentic client-therapist relationship.

 

 

 

References:

 

-Atkinson and Hilgard's 2009, Introduction to psychology, 15th editon, United Kingdom

 

-Brammer L., MacDonald G., The helping relationship, 8th edition, 2003, Boston

 

-Benson N., et al., The psychology book, first edition, 2012, New York

 

-Corey G., Case appraoch to counselling and psychotherapy, 7th edition, 2009, California

 

-Higgins, Spiegel S., Promotion and prevention strategies for self-regulation: A motivated cognition perspective, Handbook of self-regulation: Research, theory and applications, 2004, New York

 

- Mearns D., Thorne B., Person-centered counseling in action, 3rd edition, 2007, Sage publications

 

-National College of Hypnotherapy and Psychotherapy (NCHP), course notes stage two, 2012