Lecture 1 : Client-centred therapy

Question 1

Empathy and its components

Answer 1

• highly evolved in humans
• involves cognitive perspective-taking (reading the apparent inner experience and intentions of others with complex and conflicting cues. Can offer an advantage)
• shared affective responding which is recognizing and experiencing another’s emotion
• can lead to co-feeling which is partially experiencing
• importance of rational compassion which is objective decision-making to avoid biases

Question 2

What is the skill of accurate empathy?

Answer 2

It does not require feeling the same thing that the client is experiencing, and does not require you to have been through an experience (it could interfere). Perspective-taking is a prerequisite and involves understanding the client’s perspective and experience

Question 3

What is central to the attitude of accurate empathy?

Answer 3

Curiosity, openness and interest in another’s experience. The focus is wanting to understand, not listening to reply. You gain deeper levels of understanding of the person’s meaning and experience

Question 4

How can accurate empathy be communicated?

Answer 4

It is important to show an outward expression of understanding than just internal experiences

Question 5

How can communication go wrong?

Answer 5

• people not saying what they mean
• mishearing
• being informed by your own interpretation

Question 6

Roadblocks to listening well

Answer 6

1. Probing is asking questions to gather facts or obtain more
   information.
2. Advising includes making suggestions and providing solutions.
3. Reassuring includes comforting, sympathizing, or consoling.
4. Agreeing is telling people they are right, perhaps approving
   or praising them.
5. Directing is telling a client what to do, as if giving an order
   or a command.
6. Persuading can be lecturing, arguing, disagreeing, giving
   reasons, or trying to convince logically.
7. Analyzing offers a reinterpretation or explanation of whatsomeone is saying or doing.
8. Warning involves pointing out the risks or dangers of what a
   person is doing.
9. Distracting tries to draw people’s attention away from what
   they are experiencing, as by humoring or changing the subject.
10. Moralizing is telling people what they should do and why
    they should do it.
11. Judging can take the form of blaming, criticizing, or simply
    disagreeing.
12. Shaming can have a demeaning or ridiculing tone, or apply a
    disapproving label.

Question 7

Empathic listening

Answer 7

• giving full attention to what person is saying and reflecting understanding
  -involves guesses for next words

Question 8

What to reflect?

Answer 8

-selectively choosing what to emphasize and strengthen
- underlying feeling or emotion is important to reflect
- outward signs of distress and reinforce relationship, self-exploration and positive self-concept
- intensely vulnerable moments
- needs to be aligned with needs of client

Question 9

Undershooting and overshooting

Answer 9

• can be done strategically, to reaffirm and explore and prompt them away from what was said

Question 10

Research on accurate empathy

Answer 10

Linked to positive client outcomes. Low levels of empathy in practice can lead to poor client outcomes

Question 11

What is another explanation for this relationship?

Answer 11

Better prognosis clients could inspire counselors to be more empathic, could also be linked to similarity between client and therapist. Likely a combination of both explanations

Question 12

Acceptance

Answer 12

Ability to listen without pre-conception, prejudgement or condemnation. Based on principles of mindfulness. Implicit attitude is that the person has inherent worth and deserves respect. When individuals are accepted as they are, they are enabled to change. Experience of conditional worth leads to rejection that does not conform to their conditions of worth

Question 13

Can affirming be harmful?

Answer 13

• withdrawing gratification can lead to maturity due to less focus on approval from others. But there is little evidence supporting this and PR is associated with better outcomes
• shallow affirmations can backfire, there are cultural differences and can be interpreted in a negative light
  -positive regard found to have low predictiveness but could be due to varying definitions, but affirmation has been linked to behaviour change

Question 14

Contrasting views about people’s inherent nature

Answer 14

Theory A: People are fundamentally self-serving; without social
controls, they would revert to an instinctual nature that is
self-centered, hostile, antisocial, and destructive.
Theory B: People have no basic nature, but are a happenstance
product of their genes and experience; they are essentially a
blank slate written upon by nature and nurture.
Theory C: People’s natural predisposition is collaborative, constructive,
and trustworthy; at least when given the supportive
conditions for change, people will typically move in a positive
and pro-social direction.

Question 15

How can these theories be used?

Answer 15

The truth cannot be proved of these theories but there is evidence on the consequences of these views. Management theory explains this:
- theory x are lazy and unmotivated, those who accept this theory are vigilant and skeptical
- theory y is that the workers have talents, enjoy work and have self-control. The manager just brings out responsibility
- works through a self-fulfilling prophecy

Question 16

How can this be used in therapy?

Answer 16

Therapists were more accepting, respectful, sympathetic and active led to more positive outcomes in the clients compared to those who were superficial, impersonal and passive

Question 16

How to communicate acceptance?

Answer 16

• avoid judging, disapproving, criticizing, disagreeing, labelling
• avoid confrontation
• use psychoeducation, and be gentle in confronting to promote self-exploration in a trusting, empathetic and accepting therapeutic relationship
• be curious and work hard to understand
• affirmations and mindfulness can help

Question 17

Resistance

Answer 17

Those with substance use disorder have a more directive and confrontational style due to self-fulfilling prophecy so could lead to worse outcomes (due to psychological reactance which is being given advice)

Question 18

When does the positive impact of acceptance increase?

Answer 18

With the proportion of racial/ethnic minorities. Could be more important for those from marginalized backgrounds

Question 19

Unconditional positive regard

Answer 19

• clients do not need to prove or earn a counselor’s respect, and holds the view that each person is positive, forward-moving, constructive, realistic and trustworthy
• warm acceptance of client’s experience
• overall level of PR and conditionality rating can be measured, but overall level more reliable

Question 20

Attitude of positive regard

Answer 20

• experential component which is cognitive and emotional disposition of therapist
• disposition is a stance of respect and benevolence towards clients

Question 21

How to communicate positive regard?

Answer 21

• communicate through words and actions by appreciating what is good within them
• shift focus to client

Question 22

What is important for PR?

Answer 22

• being supportive/caring to express warmth
• unique responsiveness ( deep attentiveness to client)
• low intimacy/disclosure which can be seen as boundary violations
• low non-judgemental acceptance

Question 23

Affirmation

Answer 23

• noticing and commenting on person’s strengths, positive actions and attributes
• can be simple which is a comment on a behaviour, but can be over-used
• complex involve more effort and connect current experience to something more enduring and admirable

Question 24

Embedded positive regard

Answer 24

Can feel valued when they are listened to and have non-judgemental acceptance. This goes beyond direct affirmations

Question 25

What has research found about the superiority of theories?

Answer 25

There has been no indication on a superior theory, but a combination of cognitive and social learning theories seems to be most effective

Question 26

Requirements of a theory

Answer 26

• should emphasize the potential of the client playing an active role in solution finding
• should be easily explainable
• broad enough in vision and approach to apply to many problems
• versatile to deal with a wide range of severity problems

Question 27

What was significant about Roger’s theory?

Answer 27

More personal, involved than was usual for his time which was a more detached and scientific approach

Question 28

Self-actualization

Answer 28

Motivational force driving a person to develop their potential, and involves growing to an optimal ideal. The quality of experiences increase as the person integrates all stimuli without inhibitions or resistance

Question 29

Unconditional acceptance

Answer 29

Being in an atmosphere of warmth and love, having an underlying sense of security. Includes an absence of indifference or irritation, expressed in a smile or nod.

Question 30

Conditional acceptance

Answer 30

When the person’s environment accepts him the way he is but love and acceptance is dependent on behaving in better ways. This is different to what the person wants to secure love, care and attention. There is less freedom and spontaneity of behaviour. There can be some incongruence as the person does not act with their own intuition and judgement but conforms behaviour to actions and norms of the environment. Leads to internalized messages which can be conflicting (feel that they are a failure and focus on shortcomings)

Question 31

How did Rogers recommend to show unconditional positive regard?

Answer 31

Accept the client along with their behaviours, opinions and feelings. It shows a sense of respect and lack of judgement

Question 32

How to show genuineness?

Answer 32

Functioning in an authentic, congruent and integrated manner, being true to himself and allowing for all kinds of thoughts and feelings, even less complimentary ones

Question 33

How does empathy ensure a client-centred approach?

Answer 33

• involves an unwilligness to judge or condemn
• ensures feeling of security
• client-centred as helper should try to enter the client’s world and trust the client to find solutions
• no imposing of standards on client by judging or criticizing

Question 34

Misconceptions about empathy

Answer 34

• is just mirroring but in reality there is more sophistication
• is completely non-directive, as the helper does need to manage the interview and respond in different ways.
• evidence has found that there more empathetic and warm responses with more personal statements and self-perception which leads to more of these responses
• does not give insight into dysfunctional thinking and behaviour so more theories need to account for this

Question 35

Critique of Roger’s theory

Answer 35

• too optimistic
• too vague
• essentialist views

Question 36

How is Roger’s too optimistic?

Answer 36

• Believes that everyone can self-actualize naturally under favourable circumstances, but this is said to be the result of reinforcement
• too optimistic in his applicability of theory and methods. Requires that client should think through problems, thoughts, feelings into words which need high intellectucal development
• good is vague and the result of an interaction between personality and environment. Helper should be used as a stimulus for change and needed to point out negative consequences

Question 37

How is Roger’s theory too vague?

Answer 37

• lack of influence in modifying cognitive processes, more focus should be on correcting erroneous and confused ways of thinking
• natural process of self-actualization seems vague

Question 38

How is Roger’s essential?

Answer 38

The principles set by Roget’s method is important as it emphasises a good relationship between helper and client
- the idea that little help should be given, that understanding is the most important gives the client more independence

Question 39

How is experiencing an active process according to the cognitive perspective?

Answer 39

• individuals are selective in arranging and giving meaning to impressions
• not everyone is receptive to all stimuli and it is limited
• everyone is selective in the information they focus on

Question 40

Features of information processing

Answer 40

• language plays an important role and putting feelings into words can be crucial
  -differentiation is how beliefs and attitudes are refined based on incoming info
• integration is how connections are made between pieces of info, so an overall pattern is discovered. This creates a whole picture
• but, when these processes can’t cope with incoming info that info is ordered in a more manageable way with the helper

Question 41

What is the role of emotions in Wexler’s perspective?

Answer 41

• emotions are linked to cognitive processes and arise due to information processing. Agrees that fully experiencing emotions is important
• But depends on the situation, can be influenced by: significance of information, degree of state of change of world, when new info causes the person to re-examine beliefs and opinions

Question 42

How can we use this perspective in practice?

Answer 42

• not necessary to evoke strong feelings to lead to change
• with strong emotions, changes should be detected and clarified
• helper is responsible to reduce escalation and assist the client

Question 43

Does Rogers really regard experiencing as passive?

Answer 43

• not necessarily, as Roger suggests that the individual should pay attention to emotions and info should be processed
• information processing should be viewed as a balance between active agency and passive openness to experience

Question 44

Rogerian hypothesis

Answer 44

people can best access their own creative resources if given a relationship with genuineness, congruency, unconditional positive regard, empathy, and acceptance

Question 45

What are the basic concepts in client-centred therapy?

Answer 45

• clients should be seen as people, not part of an institution. All respect and dignity should be given
• actualizing tendency is that organisms want to maintain and enhance themselves
• humans seen as similar (nomothetic) and unique (idiographic)
• congruence is the capacity to symbolize the experience of conscious awareness and integrate it into the self concept, not defensiveness and rigidity

Question 46

What is the relationship between the client and therapist in client-centred therapy?

Answer 46

• client can co-construct therapy
• relationship depends on therapist’s response to the help-seeking client
• directive approach should be avoided to not feel disempowered

Question 47

What is the non-directive attitude?

Answer 47

Trusting client to self-realize, which guides therapy and protects the client’s autonomy. Importance of equalizing power during therapy. Therapy related to: self concept (lacking in positive regard), locus of evaluation (shifts from other’s judgements to own) experiencing which can vary from rigidity to openness

Question 48

How have other systems influenced client-centred therapy?

Answer 48

• positive psychology which emphasises the client’s strength to lead to positive emotional change instead of emphasis on illness. Use of empirical methods to collect evidence
  -feminist movement involved deconstructing social role expectations and emphasis on diagnosis and therapy and being governed by biology. More focus on ethics and intersectionality and individual experiences
• CBT challenges dysfunctional cognitive schemas which maintain maladaptive behaviours. Therapeutic relationship here is to conform and comply with the therapist’s advice

Question 49

History of client-centred therapy

Answer 49

Rogers started out by learning about testing, measurement, diagnostic interviewing, and interpretative treatment, in addition to psychoanalytical methods on child guidance. He found out, however, that listening to the clients worked much better.

Question 50

What is the 19 proposition theory of therapy, personality and interpersonal relationships?

Answer 50

1. Each individual exists in a continually changing world of experience in which they are the center
2. The organism reacts to the field as it is perceived, this field is reality
3. The organism reacts as an organized whole to the field
4. The organism has one basic striving: to actualize and maintain experiencing
5. Behavior = goal-directed attempt to satisfy needs
6. Emotion usually facilitates goal-directed behavior: the type is related to the seeking / consummatory aspects of behavior, the intensity to the significance of behavior
7. The internal frame of reference of the individual serves as the best perspective to understand behavior
8. A part of the perceptual field becomes differentiated just like the self
9. The structure of self is formed through an interaction with the environment (especially evaluational interactions with others): this is an organized, fluid, consistent pattern of perceptions and characteristics
10. The values that are attached to experiences are experienced directly by the organism; these values are sometimes introjected or taken from others
11. Experiences can be:
    a) symbolized and perceived into some relationship to the self
    b) ignored because of a lack of a relationship
    c) denied symbolization or given a distorted one, as it is inconsistent with the self structure
12. Most ways of behavior are consistent with the self-concept
13. Some behavior may occur through experiences and needs that are not symbolized, and as such not owned by the individual
14. Psychological maladjustment can occur if experiences are denied awareness, these thus are not symbolized or organized into the self-structure
15. Psychological adjustment occurs if all experiences are assimilated on the symbolic level into a consistent self-concept
16. Inconsistent experiences may be perceived as threats: the more of these there are, the more rigidly the self-structure wants to maintain itself
17. Under certain conditions (i.e. complete absence of threats) inconsistent experiences can be perceived, examined, and the self-structure could be reconfigured to include these
18. If the person accepts and perceives all sensory experiences as a consistent and integrated system they will become more understanding of others by necessity
19. By accepting more experiences, the individual replaces the current value system (based on distortions / introjections) with one that is continuously valuing
    ⇒ the end-point of personality development shows congruence between the field of experience and the conceptual structure of the self: freedom from internal strain

Question 51

What are the implications of this theory?

Answer 51

Sensitivities of children should be considered when interacting with them to provide a caring and loving environment. Positive values are then assigned to self-enhancing experiences and negative values to those which threaten them. They use their conditions of worth to evaluate themselves and could contribute to a positive self concept

Question 52

What are key concepts in client-centred therapy?

Answer 52

Experience: private world of the individual
Reality: reality as perceived by any individual (for use within psychotherapy)
The organism’s actualizing tendency (is biological): organisms are dynamic processes that are innately motivated to maintain and enhance themselves → also present in the greater universe with increasing complexity, order, and interrelatedness in dynamic systems;
IN THERAPY: a functional construct helping to believe in the client’s self-righting and self-regulatory capacities
Internal frame of reference: the perceptual field of the individual, how the world appears to someone
Self, concept of self, self-structure: organized, consistent, conceptual whole of composed perceptions of the self and its relations to the self and others
Symbolization: process through which an individual becomes aware/conscious of an experience
Psychological (mal)adjustment: if there is no need for distorting experiences, one is psychologically adjusted - if there is incongruence between self-concept and behavior it should be integrated through changing the behavior or the self-concept to achieve congruence
Organismic valuing process: individuals relying on their own senses to make value judgments based on their own organismic processing of situations
Fully functioning person: people who can readily assimilate experiences and symbolize them in awareness (usually: positive self-concept, greater physiological responsiveness, efficient use of environment)

Question 53

Self-determination theory

Answer 53

Intrinsic motivation may be the purest phenomenon that reflects the positive potential of human nature, as it reflects a self-motivated tendency to seek out novelty and challenges.

Question 54

Conditions of client-centred therapy

Answer 54

congruence (transparent communication and symbolization of experience in therapist self-awareness) , unconditional positive regard, empathic understanding + psychological contact, incongruence within client, at least minimal success in communicating empathic understanding.

Question 55

Empathic understanding

Answer 55

grasping what the point of the client’s story is, including intentions, emotional associations, and agency. The therapist is trying to get as close to experiencing the client’s view as possible

Question 56

Unconditional positive regard

Answer 56

being aware of evaluative judgments that could occur on the side of the therapist but making every effort to set them aside and accepting the client’s views.

Question 57

What is the process of psychotherapy?

Answer 57

Trying to understand client’s experiences, non-directive when answering questions. Over time can be moments of movement (personality changes at different intervals). Involves: occurring in the moment, experiencing without barriers, past experiences never being experienced and this experience is acceptable and integrated into self-concept.

Question 58

What are the mechanisms of psychotherapy?

Answer 58

• developing conditions of worth based on certain factors and incongruent individuals need to voice preference to establish an identity
• Zimring argues that people develop through interactions with others in a culture which develops the unconscious problem to be dealt with
• self is under construction with each situation
• distinction between objective and subjective internal contexts

Question 59

Criticism of humanistic therapies?

Answer 59

→ it is biased towards WEIRD clients
→ it is limited and ineffective especially in severe disorders
→ does not provide treatment, only reflection

Question 60

How are clinical diagnoses seen in client-centred therapy?

Answer 60

Diagnoses and disorders seen as social constructs, and clients should not be seen as people with problems. They define the problem. Clinical diagnoses can become part of their self, which is inlfuenced by their group identities

Question 61

What is the approach to therapy in client-centred therapy?

Answer 61

• choose to take medication or enrol in other training programs, resources only suggested if client proposes
• can bring external people important to client or with conflict
• treatment is rejected as it medicalizes therapy
• play therapy is sometimes used which helps children overcome obstacles, more important than doing so with words

Question 62

How can client-centred therapy be applied to group settings?

Answer 62

Giving undivided empathy to others sharing experiences in a basic encounter in a more intensive group setting

Question 63

Empirically supported treatment movement

Answer 63

Advocates the use of gold standard research to test efficacy of medication and therapy. Endorses random sampling and random assignment with double blind procedure but difficult to apply this to psychotherapy. More aligned with medical model and ignores the dodo bird effect-> detrimental to psychotherapeutic practice

Question 63

How does psychotherapy manifest in a multicultural world?

Answer 63

Specific cultures do not require culture-specific therapy, many different versions of identities exist. But therapists should reflect on their own biases

Question 64

Common factors research

Answer 64

Identified factors in all forms of psychotherapy, can be therapeutic (techniques, relationship) or extratherapeutic (environment, social support, vulnerability)-> 15% placebo, 15% technique, 30% therapeutic factors, 40% client variables

Question 65

Why is the specificity myth opposed?

Answer 65

Argues that specific clinical diagnoses require specific therapies, more evidence supports the common factors approach to therapy

Question 66

What have results found about humanistic therapies?

Answer 66

There can be improvement of therapy outcomes if core conditions are met, experimental groups not well-educated on client-centred therapy so not the best validity. Not all factors are usually tested. Results found that person centred and experiential therapies produced a large change from pre to post test, these gains are stable. With untreated controls, comparable results found but with comparable controls there is a similar change as in other therapies. Empathic understanding and positive regard are supported but congruence has limited support due to issues with defining it. Should be defined as inner state of integration which changes in therapy.