What does “person-centered" mean?

In my practice, I identify myself as a person-centered counselor. I’ve had people ask me what that means on many occasions and I thought it would be good to blog about it as a way of getting the information out to anyone interested in my condensed version. This is not the only theoretical perspective and it is not the only perspective that has research supporting it.

The following is what it means to me to be person-centered. Many people have written books on this material. This is my attempt to distill the research available in a concise manner. My attempt to be concise may leave you with many questions. If so, please discuss it with your counselor, family and friends. You can also feel free to post questions on here but please know that I can’t guarantee anonymity if you do so.

The person-centered approach is a researched theoretical approach to counseling clearly defined by Carl Rogers (Wilkins, 2010; Ellis, 1948; Kearney, 2009). The underlying theme throughout the person-centered theory is that change is always happening. Carl Rogers states “it is our design to self-actualize” and he goes in depth about the process (Rogers, 1942; Rogers, 1951; Rogers, 1957; Rogers, 1975). The key is that it happens whether we want it or not and whether we actively participate in it or not.

~If change is going to happen regardless of our desire, should we participate actively in how and what changes occur?

The person-centered approach to counseling suggests six guiding elements called necessary and sufficient conditions by Carl Rogers (1957:96). Those conditions are:

1. Two persons are in psychological contact.
2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.
4. The therapist experiences unconditional positive regard for the client.
5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client.
6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.

If all these elements are present, there is evidence that significant and positive change will occur in the client (Stiles, Barkham, Twigg, Mellor-Clark & Cooper, 2006). If you are anything like me, you make question what “significant and positive” means. In counseling language, significant is based on statistical significance. This means a person is statistically a number of percentage points more likely to be happy, fulfilled and content if they have a relationship with a counselor as described above. Positive change is a measure of how a person perceives their life before and after a therapeutic relationship that contains the six elements Carl Rogers described. I view this as the more subtle, but not less important, perspective of viewing the world from a half full perspective as apposed to a half empty one.

~Can seeing the world from an optimistic perspective make a person happier?

Yes. There is an entire category of psychology called positive psychology. I’m not going to go in depth with this right now but it is important to know that the research supports the idea that thinking positive matters immensely.

~okay, you gave us the components but now what?

You’ll notice the first thing on the list is the necessity of a relationship. As a professional counselor, I take this to mean I have to be authentic in the relationship. For example, I can’t expect a client to work on the things that brought them in unless I too am willing to be attentive to and work on things in my personal life. It’s a way of life, not just a cool idea.
The second and third components assume that brokenness is part of each and every person and health is also a part of each and every person. If we work with the assumption that we all have brokenness and we all require relationships with others, then the difference between relationships that improve our well being(are healthy) and those that harm our well being(are unhealthy) is simply the judgment to know what information to share and what to withhold for the sake of the other person. In this way, a counselor must be aware of and filter personal influences that may negatively influence the relationship while the client must attempt to be honest with the counselor or risk slow progress or stagnation.

The fourth component of unconditional positive regard is how a person-centered therapist maintains the attitude that “I am in this with you no matter what”. To be in a relationship with someone who is “in it no matter what” builds trust and encourages the growth process. Having unconditional positive regard does not imply taking on every relationship. Sometimes unconditional positive regard means handing off a relationship to a person more capable of working with the person where they are. That’s why I am willing to refer people to other counselors when my skills don’t match up with a client’s needs.

More and more research is being done that shows the importance of empathy in relationships. For our purposes at this time, we won’t go into a lot of depth. However, I think it’s essential to know that empathy is a set of skills that can be learned and improved. There are many techniques that can be taught to even the most rigid or chaotic people that will project the sense of togetherness. I may go into more depth about empathy in another blog.
The final component is all up to the client or the person who wants to improve their life. The ability to receive empathy and unconditional positive regard (trust) takes a willingness to admit areas of weakness and areas of strength. As the relationship grows and points out such areas, clients often feel a desire to avoid the growth because it hurts. Maintaining a positive direction is not easy and can only be encouraged. It is still up to each of us to stay focused on our progress and growth. The pain is part of the process.

The reason I choose to call myself a person-centered counselor is because it fits me and I fit it. I see it as a way of living as much as a theory because it applies to all relationships whether personal or professional. If you are interested in learning more about the details of a person-centered approach, I provide a few resources below. The Wilkins book called Person-centered therapy is one of my favorite because it has historical perspective as well as current research.

Ellis, A. (1948). A critique of the theoretical contributions of non-directive therapy. Journal of Clinical Psychology, 4(3), 248-255.

Kearney, J. (2009). Rogerian principles and the writing classroom: A history of intention and (mis)interpretation. Rhetoric Review, 28(2), 167-184. doi:10.1080/07350190902740034

Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton-Mifflin.

Rogers, C.R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston: Houghton Mifflin Company.

Rogers, C.R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.

Rogers, C.R. (1975). Empathic: An unappreciated way of being. The Counseling Psychologist, 5(2), 2-11.

Stiles, W., Barkham, M., Twigg, E., Mellor-Clark, J. & Cooper, M. (2006). Effectiveness of cognitive-bahvioural, person-centered, and psychodynamic therapies as practiced in UK National Health Service settings. Psychological Medicine, 36, 555-566.

Wilkins, P. (2010). Person-centered therapy: 100 key points. New York, NY: Routledge Taylor and Francis Group.

Pain sucks… really?

There are many people smarter than I who have written about pain. One of my favorite examples is the author of The Chronicles of Narnia, C.S. Lewis. He wrote an entire book called The Problem of Pain. For your sake and for my own, I’m going to keep this much briefer than a book. There are only three things I am going to address in this particular blog. One is the fact that pain sucks. Another is the fact that pain is awesome (This might be hard to believe). The final part will be about balance. We know pain sucks. On a good day we can usually admit that it has a purpose that is good and healthy. How do we balance the two views? I suggest we look at it as part of our design.

The challenge of pain:
It would be foolish of me not to recognize that each of you have pain that is very real and possibly traumatic in your history. The pains you have felt may have shaped defense mechanisms you still use today. I call this scaffolding and will likely blog separately in the future. In some cases, the mechanisms are unhealthy and can recreate different forms of the pain you felt the very first time you experienced it. For example, sometimes little children are taken from their homes and put in foster care. They may experience the separation as a terrible loss of their primary care giver or they may experience the separation as an extreme relief due to the poor attachment to their primary care giver. Both situations cause real and memorable pain and both situations can cause unhealthy mechanisms that may lead to additional future pain. Boldly put, the suffering part of pain sucks.

Let’s take the same example and fast forward ten years. The little child is now sixteen years old and has their first boyfriend or girlfriend. They begin to feel very close and even express that they are “in love”. The child who, at age six, felt relief from the experience of separation may find themselves wanting to break up because the emotions are too intense. The defense mechanism that helped them survive an early trauma can prevent healthy attachment to others.

The positive side:
We are designed to heal! It may be very difficult and it may take an entire lifetime but our brains are designed to take in new information all the time and the brain is even designed to “trim” unnecessary paths (Badenoch, 2008). In English, this means we can take bad situations and make them unbelievably positive points of change in our life.

I have a bias toward finding positive things even in the most hideous of situations. The reason I feel it’s important to give you this disclaimer at this point is because I am going to take the example from above and show some positive aspects to the difficult situation. There is no intent to minimize how difficult it is to make changes and to heal wounds that run as deep as many of you have. With that said, there exist other perspectives to every situation. Sometimes it’s helpful to learn new ways of viewing old stories. It might create a paradigm shift that will change your life forever in very good ways.

Let’s take the six year old child and say that they felt relief after being removed from their home. Let’s also say the child gets placed in a home with adults that know how to create a healthy attachment to children. The child may feel scared and nervous as they attach to the surrogate parents but with patience and empathy, the child is able to create a healthy attachment. The child has worked through the pain. The key is they didn’t ignore it and they had someone who showed them appropriate empathy. If these things happen, pain can be an awesome thing. Awesome is a powerful word and appropriate because pain can improve resilience. When difficult things arise in the life of a person who is resilient, they can often feel as though it will work out in the end. People who have suffered and worked through the pain often carry more hope. This is one way how the terrible thing of pain can be an amazing and powerful benefit.

A balancing act:
For those of you who are up for a challenge, I’m going to get a little psycheducational now. Pain is felt physically and mentally. If you ask someone who has a bad back problem, they might say the most annoying pain of all is the one you can’t see but still puts you on your knees in pain. Emotional pain can be just as intense as bad back pain for many people. It can make a person curl up in the fetal position and sob uncontrollably or it can make a person completely irrational. The pain is real! I don’t have all the answers as to why this happens. I wish I did. I have learned a few things about the healing process that might be helpful though.

First, everyone is unique and their situation is also unique. You don’t have to try to be special because you are. It’s amazing to me how many people are trying to be unique rather than being who they are. At the same time, anyone who assumes they have the answers for you probably needs a little more humility in their life. I, by no means, believe that what I suggest to folks is going to heal them. Sometimes I get lucky and look like I work miracles but my suggestions are merely an attempt to empathize with people and present other possible outlooks. The real work and growth comes from the people I have the privilege to know.

Second, empathy is a requirement in healing. We cannot heal ourselves no matter how strong we are and no matter how much we want to. It’s the reason I have chosen the counseling profession. I may not be able to work miracles but I can be present for a person in need and sometimes that’s enough. Many counselors use treatment techniques to promote healing. I’m still learning about the techniques. It seems to me that the techniques being used are generally different ways of showing people empathy. If I’m right, I don’t know for certain if I am, then empathy is the healer more than any given technique. If empathy is the healer then we all have the power to heal by listening to the story of another unique person.

For those of you who want a more scientific explanation, this part is for you. There is a place in the brain called the hippocampus. According to Paul David Nussbaum in his book titled Save Your Brain, the hippocampus is said to be an area of the brain that decides what will get stored in long term memory. An interesting thing happens when we feel pain that is physical and/or emotional. The hippocampus is highly active. Joy has a similar effect on the hippocampus. We can only make a conjecture about the meaning. It seems reasonable to guess that we were designed to remember pain and joy. If this is the case, then I believe we were designed in this manner as a means of staying balanced and protected simultaneously. We’re supposed to experience pain and joy.

To all you logical people out there, feeling pain and joy lead to intelligence. Intelligence leads to improved decision making ability and improved decision making ability leads to hope. Even though hope is an emotion, it is a logical emotion because the logical path comes from preparation just as hope comes from preparation, also known as pain and joy.

Thanks again for taking the time to read a little about my perspectives. I hope you find the content to bring you appropriate joys and struggles. I also hope you have people in your life that support your growth. Remember that there are counselors in almost every community that would love to get to know your personal struggle. They are bound ethically and legally to keep your information confidential in almost every case. Please feel free to read my very first blog if you would like to know more about why I think going to counseling is a good idea.

Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. W.W Norton Company.

Frequency, Intensity & Duration

For those of you keeping up with me each week, you'll notice I didn't post last week. I was doing some self care by doing some camping. My supervisor at Fairview Clinical Services recently drew my attention to a process this week described by Ray S. Anderson in his book “Self Care”. The process was described like this:


Beginning at the bottom with any event that comes to mind, it is explained that we experience a trigger which gives us an internal sensation that becomes a feeling. From the feeling state, we have the option of going down the thinking path or the emotion path to the application phase. For the purpose of this blog, I’m not going to go into much more detail than that. Instead, I would like to take a moment to focus a little bit on the part in the middle that is bold and in red. I added this piece based on what I learned in Research Methods and Statistics a couple years ago. I’ve found it very helpful.

Frequency-Intensity-Duration

As part of our design, we are intended to measure subtleties. It helps us survive and thrive in our world. When we encounter a trigger that leads us to “thinking” or “emotion” it is sometimes helpful to slow the process down. Slowing down the process gives us the opportunity to more clearly identify the trigger before we get too far away from the trigger. Ultimately, growth or healing is easiest when we can identify what causes us to respond in certain and sometimes unhealthy ways. Could we wait for the behavior (Application Phase)? Sure we could. What I’m suggesting is that when we find ourselves moving from the observation phase to the application phase, we consider three things.

1) Frequency
2) Intensity
3) Duration

These three things provide us great insight. With insightfulness, we can be more purposeful in our decisions and actions. The truth is, people are often hurting others or helping others without even knowing it. Through insight, I believe people can maximize how much good they do for themselves and others.

Have you ever wondered how others see you?

In the 1950’s Joseph Luft and Harrington Ingham created a model of mapping personality awareness called the Johari Window. The idea was to create opportunities for improved awareness and therefore opportunities for personal growth. Like Joseph Luft and Harrington Ingham, I believe personal insight is a key piece to becoming who we want to be.

So, what is Johari’s window? The first image below is for all of you who are more visual and the second image will tie it all together. Johari’s Window takes into account the perspective from an individual and from people around that individual. You’ll see it described as “self” and “others”. The second image describes the visibility from the self and from the other. You’ll see that each person can only see part way across the box. For example, we have “blind spots” that others can see but we can’t and we have an “unknown” section that no one can see, including ourselves. The “façade” section is the section that we choose to keep from others and I will refer to it as secrets.

Now it gets interesting. Through insight, I believe we can gain control over the impacts of our blind spots, the unknown, the façade (secrets) and the things we project in the open arena. For example, there are times in our lives when we keep secrets and it’s healthy. There are also times when we keep secrets and it’s unhealthy. Knowing the difference between when it is healthy and when it is unhealthy is very important. I was recently asked what kind of things would fall in the “façade” box that would be healthy. I responded by discussing importance of openly sharing details of previous relationships with a current partner. You may have dated someone in the past that shared too many details about other relationships. It can be annoying, hurtful, or just a waste of time to have all that detail. What matters most is who you are now and therefore some of the details are not necessary and can be kept secret. It’s often best to weigh the benefits and risks of each specific situation. As you might quickly see, there are many risks to keeping secrets. For example, if a man or woman cheats on their partner should they keep it secret? People who cheat on their partners have many things going on that need to be dealt with and it quickly becomes very complex. Therefore, each situation should be dealt with on an individual basis. Your counselor would become a great asset in discussing how and when disclosure should happen or if it shouldn’t happen. Through insight, possibly by use of the Johari’s Window, our actions become more intentional which makes mistakes less likely.

On a side note, I’ve modified Johari’s Window below to show an example of what I think happens as we learn about ourselves and consider other’s perspectives along with our own in making personal changes. Though the process of getting to this point can be long and difficult, notice the reduced risks associated with the long term work. The blind spots shrink, the secrets diminish and the unknown becomes discoverable.

Is there value in going to a counselor? If so, what is it?

Welcome!
I have thought for a long time about what I should post as my first blog. I hope the days, weeks, months and possibly years of posts to come are helpful in providing hope and insightfullness. We all experience difficult times and need voices of strength and wisdom. I hope to be a source of strength and wisdom for people. I won't always get it right but as part of my journey I will attempt to learn from all of my opportunities, whether good or bad.

My first post...
I would be in the wrong profession if I didn’t believe what I do matters. So, my answer is YES. Counseling has value and lots of it. It’s my opinion that most people don’t need consistent and long term counseling. However, almost everyone I know, or have come in contact with, would benefit from having a counseling relationship that they can go to when things in their life are particularly challenging. I can tell you that one of my goals with clients is to get them to a place where they no longer need me. This isn’t to say they won’t need to come back down the road, but I believe I should not be the source of a person’s strength because that strength should, ultimately, come from within them.
As a counselor intern I have noticed that people don’t normally establish counseling relationships when things are going well in their life. Though it makes sense financially and for the sake of time not to see a counselor when our lives are generally healthy, there are two reasons that I believe it is important to establish a relationship when we are in good health.
1) The client will be more selective
2) The counselor will have a chance to know the client
I believe a client in good health is better suited to ending a relationship with a counselor who is not a good match. The question I thought about was, “Do people make more rational decisions when they are in a good place or when they are struggling with things?” I think most people would say they make better decisions when they feel healthy, not necessarily stress free but healthy. In physics there is a great tangible example found in Newton’s first law of motion. It says an object in motion stays in motion until an object of greater force acts upon that object. In people terms, this describes the momentum of the good getting better and the bad getting worse until there is some sort of “shock” to the individual’s path.
Another reason I think a client should seek counseling when they are feeling like things are going well is because it gives the counselor a baseline of what the client views as healthy. I, personally, would love to have a frame of reference of what a client is like when they view themselves as healthy. I can think of several advantages to having this knowledge. For example, it would make it much easier to identify where the client is in the process of healing and growth. It would likely make it hard for a client to fall as deep into things like depression, anxiety, hopelessness, etc. In a literal example, a client would be able to say something like, “You know this isn’t like me. I don’t know why I’m feeling [depressed, anxious, exhausted, scared, nervous, etc.].” The response would likely be a more accurate form of empathy because the counselor would know what is being said to be factual and not a different symptom. Thus the speed of the healing process would be exponentially increased or the depth of the symptoms would be lessened.
With all this said, I believe it’s essential for a person in the middle of life’s struggles to get connected and a counselor is a great connection. It’s my belief that as part of the human specie, we are relational beings and our mental health improves through healthy relationships such as those a client should have with a counselor. So as a concluding statement, I would encourage everyone to find a counselor they can connect well with. Who knows when life’s challenges will get to be too much to deal with alone? Get prepared. Find a good counselor.