Humanistic counselling techniques PDF

Preview

Summary

humanistic counselling lecture notes and reading...

Description

Humanistic Psychology Person-Centred Approach Overview: - Historical background - Theory - Models in Humanistic Psychology - Introduction to Person-Centred Therapy - Humanistic Psychology and Counselling Psychology

Historical Background - Psychology in the 1950’s was dominated by Behaviourism (theory that human and animal behaviour can be explained by conditioning and treated by altering behaviour) and Psychoanalysis (investigating unconscious and conscious elements). - Humanistic Psychology was a ‘cultural reaction’ to this. - In 1945 a vast number of armed forces personnel were traumatized by their experiences and struggling to adjust to life at home. o There was therefore a demand for an accessible way to help and treat the traumatized armed service personnel’s to help them cope with the transition back to civilian life. Psychoanalysis would have been too expensive and behaviourism had not emerged. oThe non-directive approach by Rogers represented an ideal solution and thus became the main non-medical form of counselling in the USA. Humanistic Psychology Theory - Humanistic Psychology emphasises subjective experiences and is an optimistic theory. - Humanistic psychology has three core assumptions:  People have free will  People are basically good  Phenomenology is central - Philosophical underpinnings of Humanistic Psychology oPhenomenology- methods of philosophical enquiry, which aims to understand the nature and quality of human experience. It suggests that valid knowledge is obtained and understood when we explore the ways things are experienced by people. The concept of ‘bracketing off’ assumptions of a phenomenon and to describe it the way it is experienced.  It influences counselling through the attempt of the counsellor to be nonjudgemental and to facilitate and listen carefully to the experiences of the client.  PCT is built upon the phenomenological approach to knowledge  Valid knowledge and understanding can be gained by exploring and describing the ways things are experienced by people, rather than trying to construct knowledge through abstract theorising.  Phenomenology involves ‘bracketing off’ assumptions one holds about the phenomenon being investigated and describing it in a sensitive manner.  ‘Bracketing off’ assumptions ensure the phenomenal researcher doesn’t impose his/her theoretical assumptions onto the phenomenon being investigated.  The phenomenological stance is therefore important because the concept of experiencing is central to the PCT approach, the person is viewed as responding to the world on the basis of his/her flow of moment-by moment experience.

PCT thus is different from CBT and Psychoanalysis- because CBT makes a firm distinction between cognition and emotion and psychoanalysis makes a distinction between unconscious and conscious experience- whereas in PCT cognition and emotion and conscious and unconscious material are always interwoven within the experience of the person. oExistentialism- philosophy highlighting the isolation and uniqueness of human experience, it states that human experience is unexplainable and emphasises free will and individual responsibility for consequences. oHumanistic psychology is not one model, it is a set of models linked together by shared values and assumptions about human nature, within Counselling and Psychotherapy, the 2 predominant models of humanistic psychology are PCT and Gestalt therapy. oThe key elements that link them together is the focus of the experiential process of therapywhich is based or involves experience and observation.



CARL ROGERS AND PCT - Person Centred Therapy, Humanistic Psychology, Rogerian Psychology oCalled at various times; ‘non-directive, client-centred etc- used alone but also integrated into other approaches (Thorne, 1992) - Rooted in the values of American Society. - Developed one of the most widely used orientations to counselling in the past 50 years. - PCT has also been integrated into many other therapeutic ways of working. - Rogers stated that the therapist could be most helpful, if they helped the client to find their own solution to their problems, through the help of the therapist. oThe emphasis on the client as the expert and the counsellor as a source of reflection and encouragement was captured in the designation of the approach as ‘non directive counselling’. - Emphasis on the client ‘as an expert’ o2 basic therapeutic principles of PCT  PCT practioners seek to create and maintain a relationship with clients that is characterised by respect, quality and authenticity. The client is the ‘expert’ and though a facilitative relationship the client can identify and accept their problems and come up with solutions.  Assumption that it is good to work with clients in a way so that they are more aware of their here and now experiences- so that patterns of thought and feelings that are associated with difficulties in everyday life are being continually recreated so we can learn about these patterns and change them. THE CORE CONDITIONS -

In 1957 Rogers wrote a paper on the ‘Necessary and Sufficient’ Conditions in counselling:  2 persons are in psychological contact  The first, whom we shall term the client is in a state of incongruence, being vulnerable and anxious  The second person, who we shall term the therapist, is congruent or integrated in the relationship  The therapist experiences unconditional positive regard for the client  The therapist experiences an empathetic understanding of the client’s internal frame of reference and endeavours to communicate this to the client.  The communication to the client of the therapist’s empathetic understanding and unconditional positive regard is to minimum extent achieved.

The person in PCT - The person is shaped by conditions of worth from childhood - Organismic valuing process- people are good and are capable of self actualisation - 2 primary needs which are independent of biological needs to survive- 1) to be loved and valued by others and 2) self-actualisation oOrganismic valuing process- actualising tendency- one motivational force that determines the development of the human being. oPCT – the person is acting to fulfil 2 primary needs  1) self actualization  2) need to be loved and valued by others - ‘self-concept’ describes how people describe and think of themselves in the present and also how they would ideally like to be. oSelf-concept the way in which one perceives they. The self-concept of a mentally health person is consistent with his/her thoughts, experiences and behaviour. oOnce the self-concept is internalised- the person tends to reinforce it. oSelf-concept is central in PCT. ‘Self-concept’ are attributes or areas of experiencing about which the person can say ‘I am strong’, ‘I am angry’ etc. oThe aim of PCT is enable the person to move in the direction of his/her self-defined ideas. - The task of therapy is to help the client move towards their self-defined ‘ideal’. - Incongruence describes the range of problems that clients bring to counselling through incongruence within the self-concept.

Development of problems - -Incongruence- contradictions; may be struggling with inconsistencies in life and self-concept. - Locus of control and evaluation- external vs internal oLocus of evaluation- which people refer to in order to make judgements about themselves, others and the world. internal an external. - Can they trust others/therapeutic relationship- experiences of others as incongruent. - Conditions of worth- love and acceptance have been conditioned in life- certain aspects of behaving have been hidden. oSometimes self worth is conditioned upon winning approval and avoiding disapprovalmeans they can only behave in ways that are acceptable to others.- they are the victims of conditions of worth that others have imposed on them. - Defences- e.g. laughter, hiding and disguising self-concept, parts that they don’t accept. - ‘for constructive personality change to occur, it is necessary for these conditions to exist and continue over a period of time’. Self-Actualisation - Freud (with his background in medicine and psychiatry) used his work to explain and understand illness and pathology- essentially pessimism - Rogers and Maslow regarded positive aspects of being (e.g. creativity and joy) as intrinsic qualities- optimistic - The self-actualised person is a ‘fully functioning’ person and they are congruent/authentic, able to use their natural emotions to guide their behaviour and autonomous and self-reliant. oThe idea of the ‘actualized’ or fully functioning individual represents an important strand in the attempt by humanistic psychology to construct against psychodynamic. oFreud to understand pathology or illness, whereas Rogers regarded creativity, joyfulness and spirituality as intrinsic human qualities and include these in theory. - This process is seen as continuous and in flux and Rogerian’s criticize models, which see people as a static makeup.

o‘The idea of becoming a person’- the person is always in progress, always becoming ever changing. Anything that portrays a static fixed entity is inadequate. The Therapeutic Relationship - PCT is a relationship therapy - The therapist offers ‘… the client a wholly personal involvement in the relationship between them’Mcleod - Empathy, congruence and acceptance- offered by the counsellor, these are not separate skills they work together. o‘for constructive personality change to occur, it is necessary that these conditions exist and continue over a period of time’- the 6 core conditions - Presence of the core conditions in the relationship alone is enough to bring about change within the individual. - Internalisation of the core conditions of therapeutic relationship

1) Empathy o Empathy is trying to understand what it is like to be another person, how they feel and think (Sanders, 2011) o ‘ To sense the clients private world as if it were your own, but without ever losing the ‘what if quality’ oBeing heard or understood leads to greater capability to explore and accept previously denied aspects of the self. o o Being in psychological contact as much as possible. o The therapist is never in any doubt about what the patient means o The therapist remarks fit in just right, with the patients mood and content. o The therapists tone of voice conveys the complete ability to share the patients feelings (Rogers, 1957) oTechniques of empathy- providing orientation, checking understanding, reassuance and restating and maintain and breaking silences. o Barrett-Lennard (1981) proposes a model of empathy as a cycle:  1) Empathic set by counsellor- they are actively attending to a client’s expression of experience.  2) Empathetic resonation- therapist resonates to the clients experience  3) Expressed empathy- counsellor expresses their felt awareness.  4) Received empathy- client perceives the counsellors understanding  5) Empathy cycle continues- client continues to express feelings that give counsellor feedback as to accuracy of response and the quality of the therapeutic relationship. o There exists good evidence for the basic validity of the key assumption of this theory- particularly the role of empathy and genuineness (Elliot et al, 2011; Kolden et al, 2011) o Sachse (1990,1992 and Sachse and Elliot,2002)- PCT- counselling was analysed in terms of ‘triples’- client statement, then counsellor statement and then client statement again- found that the counsellors empathetic reflections that were at a deeper level than the preceding client statements, tended to lead to a deepening of the clients level of exploration of a problem.providing evidence for the impact of the counsellors empathetic ability on the process of counselling.

Problems of Empathy research The current state of empathy research article

o When researchers attempted to measure the levels of empathetic responding exhibited by counsellors, they found that ratings carried out from different points of view produced different patterns of results. o A specific statement by the client, resulted in a different rating by the client, the counsellor and an external examiner- (Kurtz & Grummon, 1972) o If research is to examine the process of empathy, then it must take into account not only the verbal response of the counsellor but also the interaction sequence which had led up to that response. If it doesn’t and only focuses on the verbal response then this is an oversimplification reductionist pastime that only looks at ‘communication skills aspect of empathy. (Mearns and Thorne, 2013) -

-

Common experiences- having had such common experiences may ease communication and make it easier to establish early trust between the counsellor and client, but the empathy may then become assisted, in that the counsellor may make guesses as to what the client is experiencing.- common experiences can actually become a hindrance to counselling by making empathy more difficult. Counsellor might have a strong need to be liked or needed by her client, thus resulting in overinvolvement.

Strengths of Empathy research - The fact that empathy correlates with counselling is well established in research, even from 50 years ago (Barrett-Lennard, 1962; Patterson, 1984; Sasche, 1990) - Empathy extends to work with schizophrenia diagnosis oThose patients in relationships where empathy was very low showed a slight increase in schizophrenic pathology (Rogers, 1967) oSuggesting that the presence of empathy is helpful but also the counsellors that fail to create empathetic process could be damaging.

-

-

-

-

-

2) Congruence Realness, authenticity, genuineness. Within the relationship the therapist is ‘freely and deeply themselves’, with their actual experience accurately represented by their awareness of their self, it is the opposite of presenting a façade, either knowingly or unknowingly. oIt was largely the result of the Wisconsin project, during which Rogers and colleagues struggled to find ways of communicating with deeply withdrawn Schizophrenic patients, that it became apparent that the therapist’s contribution is important. oCongruence is not a skill to be deployed, but it is something that is much more central to the therapeutic endeavour. oCongruence is the state f being of the counsellor when her outward responses to her client consistently match her inner experiencing of the client. o Counsellor congruence can have a number of valuable effects on therapy (Wyatt, 2001)  Helps develop trust in the relationship  Counsellor accepts his/her feelings of vulnerability then easier for client to accept their own  Congruence makes it easy for the client to trust the counsellors and the counselling process, if the client accepts the counsellor as congruent then he/she knows the response from the counsellor is true and open thereby resulting in the client being freerer in the relationship.  Congruence maintains and enforces an egalitarian relationship- the counsellor earns trust rather than commanding it through mystery and superiority.  Counsellor is able to draw upon unsaid or ‘sub vocal’ elements in their relationship.  Likewise, if the counsellor is consistently incongruent, the client is likely to become confused and lack confidence in the counselling relationship. The therapist should not be deceiving the client as to how they are feeling. At points in therapy, therapists may need to talk about their own feelings, if they are getting in the way of the other conditions. Not acting like an ‘expert’, not knowing the answers Not the same as self-disclosure- boundaries and working are in the interest of the client- approach specific- i.e. every client is different so take a different approach with different clients. Grafanaki and Mcleod (1999,2002) found that particularly powerful episodes in therapy were characterised by the occurrence of mutual congruence, where client and counsellor were both open to the experience of the other. The more the counsellor is able to be herself in the relationship and not put up a façade- the greater the chances of client changing and developing in a constructive manner. Counsellor- ‘transparant’- Mearns and Thorne (2013)- thus the counsellor refuses to encounter an image of herself as being superior, an expect or omniscient. In a relationship where the counsellor is congruent- the client will not cling to the idea that the counsellor will provide answers for him. 3) Unconditional Positive Regard There are no conditions of acceptance Caring for the client as a separate person with no possessiveness Non-judgemental warmth and acceptance Believing that everyone is worthwhile no matter what they do. Not the same as approving behaviour- but then what if the client describes something that you do not approve of? E.g. murder? The client who has been reared under oppressive conditions of worth will have learnt that he has value in so far as he behaves in accordance with the expectations of significant others.

-

-

-

Unconditional positive regard breaks into a clients cycle (where they feel inadequate, weak and unemotional) as the counsellor refuses to be deflected by the clients self-protective behaviour and instead offers the client consistent acceptance of his intrinsic worth. The client may not accept the counsellor’s unconditional positive regard on the same basis as it is offered. The counsellor’s acceptance is the context required for the client to accept their feelings. The client is more likely to feel safe, explore negative feelings and more information in the core of their anxiety and depression.

Critique of PCT - Some theorists argue that the core conditions are necessary but not sufficient. - Is it possible to be non-directive? - Culturally specific - Difficult to do in a time-limited way - Difficulty to do with hard to reach client groups e.g. those with learning disabilities and dementia and schizophrenia patients. - How to access core conditions empirically? oSelf-report- therapists and clients rate differently oDistinguish between core conditions? How? oObserver report - The debate over Non-directedness o‘Non directedness’ used to describe Rogers new approach to therapy oIn 1999, Edward Kahn, in paper Journal of Humanistic Psychology, agreed that ‘nondirectedness’ was central to good practice, but argued that it was impossible for any practioner to be consistently ‘non-directive’, because of unavoidable subject biases in therapy. oKahn, 1999- suggested that perhaps it would be better to think in terms of non-directive attitude as opposed to a non-directive pattern of behaviour. oJournal of Clinical Psychology, published in 1948, a collection of critiques made of the nondirective approach  Notion of non-directedness implies a contradiction. How could anyone in a close relationship fail to influence each other? At least slightly? In one direction or another?  Traux (1966)- non-directive counsellors in fact subtly reinforced certain statements made by clients and didn’t offer their encouragement to other statements made.

The Therapeutic process in PCT - From a PCT perspective, the process of therapeutic change in the client is described in terms of a process of a greater openness to experience, an increase in awareness of previous denied experience and the greater reliance on personal experiences as a source of values and standards. - The acceptance and genuineness of the counsellor encourages the growth and trust in the client and increases the expression of thoughts and feelings that would have been previously censored or suppressed - The willingness of the counsellor to accept the existence of contradictions in the way the client experiences the world gives the client permission to accept himself/herself. - Mearns (1994) at the beginning of therapy, likely that the client will interact with others from the perspective of an external locus of evaluation, he/she will be looking for guidance and advice

from others. At this stage the counsellor needs to be rigorous in following the client and maintaining empathy and accepting the frame of ref...