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Evaluation of the efficacy of person-centered therapy
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An essay on the evaluation of the efficacy of person-centred therapy with examples and referencing.
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A critical evaluation of the person-centred approach and it’se cacy for therapeutic change and analysis of how it ts with
e ective contemporary ethical practice.
To date, person centred therapy (PCT) is one of the most widely in uential approaches to
counselling and psychotherapy with continued use from a high proportion of therapists
and counselling professions working in UK primary care settings (Stiles 2008). However,
many questions remain as to PCT’ e ectiveness, its di erential e ectiveness by disorder
along with the nature of the control groups by which its e ectiveness has been
established.
The person centred approach was developed by Carl Rogers in the 1940s from the
concepts of humanistic psychology. From the outset, Rogers’ intended to provide a
radical challenge to the notion of therapist as “expert” and to move towards a theory that
trusted the innate tendency (known as the actualising tendency). As introduced by
Maslow (1943), self-actualisation is the nal level of psychological development which
can only be attained once all other basic needs are met. Although this is a controversial
concept (Levitt, 2008), and hence a main criticism of PCT as a whole, it is also a
fundamental concept within counselling which forms the basis of PCT in that individuals
possess the ability for be self aware and change their attitudes and behaviour (Seligman,
2006).
Other key concepts from humanistic philosophy that underpin PCT are conditions of
worth and self concept. Carl Rogers (1957) asserted that we have three selves. These are
the organismic self, the ideal self and the self-concept. The organismic self, also the real
self, is innate and consistent throughout the individual’s life and is where the actualising
tendency exists. The other part of the person, the self concept, is a learned way of being.
Rogers (1951) believed that an unhealthy self concept occurs due to introjected values
and conditions of worth which in turn leads to psychological distress. Conditions of worth
refer to conditions that an individual perceives are imposed on them externally by those
around them and which they believe have to exist in order for them to be regarded
as worthy.
Rogers (1957) stated “for constructive personality change to occur, it is necessary that
these [six] conditions exist and continue over a period of time”. The necessary and
su cient conditions require both client and therapist to be in psychological contact.
Rogers also believed that the client-counsellor relationship was key in facilitating
therapeutic change. It was also necessary for the client to be incongruent. This
incongruence, as previously described, is mismatch between the person’s organismic self
and self-concept.
The following core condition necessitates that the client receives empathy from the
therapist. The key characteristic of empathy is recognising and appreciating another
individual’s subjective reality as they experience it at any given moment. It is an attitude
through which the therapist leaves her own way of experiencing and perceiving reality and
enters the client’s private perceptual world and becomes thoroughly at home within it
(Rogers, 1980). One way in which empathy is communicated in the counseling
relationship is through re ection of feeling (Rogers,1951). Truax and Carkhu (1967)
stated, “Accurate empathy involves both the therapist’s sensitivity to current feelings and
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, his verbal facility to communicate this understanding in a language attuned to the client’s
current feelings” (p. 46).
However, in contrast to the ideas of Rogers, empathy seems to be necessary, but, not
su cient, for therapy to create e ective outcomes. Research extensively reviewed on
empathy over the 1950’s to the 1990’s, highlights a decline in academic interest in the
concept of empathy in therapy, since the 1980s (Duan & Hill, 1996). The ndings
suggested this seemed to occur due to continuing methodological problems, which
appeared to generate as result of di culty in de ning the various aspects of empathy.
However, a meta-analysis by Beutler (2000) examining similarities across di erent therapy
types showed further support for empathy as a core condition throughout therapies.
Likewise, Sutton and Stewart (2008) suggested that empathy is a vital condition for a
counsellor that provides an environment for the individual with an eating disorder
whereby external conditions of worth can be gradually restored with their own internal
locus of evaluation to help them achieve a healthier self-concept, gain trust in others, and
eventually stop reliance on food as a coping mechanism.
Perhaps the most essential core condition is that the client receives unconditional positive
regard (UPR) from the therapist. UPR is the acceptance and support of a person as they
are, without evaluating or judging them. This non-judgemental attitude and acceptance is
important as it challenges the clients’ beliefs that they are only valued if they behave
according to signi cant others (conditions of worth) and allows them to share their
thoughts, feelings, and anxieties freely so they can accept them within their own frame of
reference.
On the contrary, Albert Ellis (1973) has criticised UPR stating that such an attitude is, in
fact, conditional. Meanwhile, Carl Rogers (1957), who presumably emphasised UPR,
actually implied that the individual can accept himself only when another person, such as
the therapist, accepts or loves him unconditionally; so this presents the argument that his
self-concept is still dependent on some external element and is not from within himself.
The nal condition is that the therapist must also be congruent. This is where the
therapist is authentic, open and genuine during their engagement with the client. There is
no facade and the therapist's internal and external experiences are one. This congruence
is theorised to come from the therapist’s self-acceptance and positive self-regard
(Bozarth, 2001), and as a result of an evolving capacity for self-awareness free from inner
censorship. This is one of the reasons it is required that person-centred counsellors
obtain personal counselling and gain continuous self-development in order to be to
prepared to work with clients.
In other respects, there have been suggestions that UPR could con ict with congruence.
Developing a way of being which is unconditionally accepting of the client may also be
considered inauthentic. We all make judgments and hold our own internal biases; in laying
those aside, does that leave the therapist in a position of incongruence?
Despite Rogers (1957) suggesting these six conditions together were necessary and
su cient, most attention has gone to the conditions of empathy, UPR and congruence.
He also emphasised the quality of the relationship between client and therapist as the
determinant for a e ective therapeutic process.
Ultimately, the goal of PCT is to aid clients in using their actualising tendency by being
able to recognise as well as reject conditions of worth in order to move towards using our
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