Limitations Of Rogerian Approach To Therapy

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27th Apr 2017 Psychology Reference this

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In writing this essay I wanted to answer the question as to the limitations of the Rogerian approach in a balanced and fair way. The limitations I discuss are by no means discrediting the doctrine but rather set out in a way to also present the positives as I personally see the Rogerian approach as an incredibly useful tool to have in a therapist’s repertoire.

The person centred approach to therapy was pioneered by American psychologist Carl Rogers (1902 – 1987) and has become one of the most commonly used methods of therapy today. Rogers believed that creating a strong therapeutic alliance with the client in a congruent and unconditional way, encouraged the client to eventually develop his or her own conclusions about the next step in resolving their problems. The key to this approach is active listening, the therapist carefully takes in all the client’s statements about his or her presented condition and selectively and emotively repeats back to the client key elements of those statements in such a manner as to strengthen and underpin the very ideas formed by the client and helps emphasise the therapists ability to understand the client’s problems. Rogers challenged the idea that the therapist should play a prescriptive role in the therapeutic bond between client and therapist, and disdains the idea that the therapist can use a hypodermic approach of delivering clear, unequivocal truths that the client should take on board about his or her condition; rather, the Rogerian approach sees the therapist playing the part of a facilitator helping the client work through their own problems and reach their own solutions, which very often are manifestations of deep-seated desires that the client has had all along. Rogers believed that the best expert on the client was the client him/herself. However, despite the popularity of the Rogerian approach to therapy, it is by no means the only therapeutic doctrine practiced by psychotherapists today.

Carl Rogers had the individual at the core of a constantly shifting field of experience, with the ego being developed as he/she undergoes continual adjustment of their relationship with the perceived ‘phenomenal field’ (i.e. a perception of the world is gained through the client’s experiences). Rogers believed that the notion of the ‘optimal self’, which is attained when “the individual is continually open to new experiences, lives each moment fully (in an existential manner), and perceived total freedom of choice to be a viable approach to his or her particular existence” (Rogers, 1959, in Koch, 2005 ed., p. 104). During this time of the analysis, Rogers defined a difference between being congruent and incongruent in terms of the personality. A congruous personality is that based on the full experiences and possibilities that are open to the individual, while an incongruous personality is defensive and hindered by restrictive burdens generated by those in the immediate environment. Barry A. Farber argues that “Rogers’ approach to congruence and incongruence was one of the key factors on the emergence of popular twentieth century idea of ‘truthfulness’ and ‘reality’ being seen as by far the most keenly desired personality traits” (Farber, 1998. p. 26). Although this concept was accepted long before Rogers started his work, it was only his theory regarding such factors that led to the coalescence of the notion that there is something fundamentally pejorative about untruthfulness. Some critics labelled this development as negative in the field of modern psychotherapy, but Rogers argued that “truthfulness is subjective and, regardless of the actual, cold truth of any matter, the individual’s sensation of truthfulness is likely to be of considerable benefit” (Rogers, 1959, in Koch, 2005 ed., p. 106). What Rogers is stating here is the concept of truthfulness is a dynamic, constantly shifting element of the psychotherapeutic environment.

The Rogerian approach highlights six important conditions that must be met for therapeutic change to occur. Firstly, is the strong bond created between the therapist and the client, this bond helps both parties play an integral role during the therapy. Secondly, the client must be in a state of incongruence. Thirdly, the therapist must empathise and relate to the problems presented by the client and be able to react equally on an emotional and clinical level. Fourth, the therapist must show unconditional positive regard to the client, without any judgement and ensure that the client never feels judged or indeed blamed. Fifth, the therapist must have an empathetic understanding of the presented issue. Finally, these positive aspects of the therapists approach must be manifest and must be perceived by the client (Rogers, 1959, in Koch, 2005 ed., p. 110). However there are critics who have argued that there need only be two core values rather than Rogers’ six presented above (Glassman & Hadad, 2007), but Rogers himself approached this area based on the delineation of these six distinct areas of therapy. Clearly in this mode of therapy the client and therapist’s relationship is paramount, it is the therapists job to nurture this and to also be mindful of how his or her behaviour is perceived by the client. This is often why the Rogerian approach is described as a supportive method of therapy.

The Rogerian approach clearly has many benefits. The person centred model strengthens the relationship between client and the therapist, helping the client feel more comfortable and therefore more open to discuss their true feelings; an integral part of the therapist’s role is to help the individual to feel understood and accepted. The client also plays a key role during the therapy but it is up to the therapist to encourage the client to work through his or her own feelings, helping the client to understand his or her own thoughts on their condition. Key to this is the idea that “the individual knows his own personality and problems far better than the therapist ever can, and it’s the therapists job to encourage the individual to proceed on a self-determinative basis” (Farber, 1998, p. 115). This particular holistic approach has been branded “clinically speculative… (In the sense that) it relies upon the willingness of the therapist to spend, quite often, a considerable period of time waiting for a breakthrough to be made” (Glassman & Hadad, 2007, p. 320). A criticism here would be the potential prolonging of the very symptoms that the client has come to therapy for and the lack of discouraging these conditions by the therapist, only serves to validate this behaviour and instil in the client a belief that the negative patterns of behaviour are in fact effective and viable responses. Although the passage of time plays an important role in any psychotherapeutic approach, Glassman & Hadad emphasise that for some clients this passage of time offers them a chance to stall, in that they can believe themselves to be making progress, since they are undergoing therapy, but can also avoid any uncomfortable or upsetting areas up for discussion by placing the therapy in a kind of holding pattern. For many critics of the Rogerian approach, this encouragement of such behaviour is one of it’s key failings, however, supporters of such an approach argue that many clients respond extremely well – over time – to a person centred model that accepts the importance of congruence and locates all the key elements of that congruence in the existing and current aspects of the clients personality; rather than approaching it with pre-determined rules, on which the client must act.

If we are to compare the Rogerian approach to other modes of therapy, in this instance cognitive behavioural therapy, it differs in a number of ways notably “the holistic development of the person orientated psychotherapeutic dynamic” (Merry & Brodley, 2002, p. 69). For many, the Rogerian approach to developing holistically from each client is seen as possibly one of it’s vital elements and even if the universal suitability is in doubt, it is accepted that there is substance in Rogers’ driving to change the more clinical model of therapy in favour of attending fully to the clients’ needs. This said, many critics (kahn, 2002; Bozarth 1998; and others) argue that this particular aspect to Rogerian therapy is favoured above all others and in turn can create an unbalanced stance that can place the client in extended therapy beyond its natural limits. John Russon criticises the Rogerian approach as too dependant upon the creation of what he describes as “a comfort zone in which the client is encouraged to validate his or her own approach… (and) not enough attention, if any, is paid to the fundamental changes that need to be made to the cognitive attitude of the client” (Russon, 2003, p. 78). Basically, the Rogerian approach is one that validates rather than challenges, and actually encourages the continuation of certain damaging psychological constructs within the clients’ personality. In fact Rogers himself recognised this back in 1959, but argued that this particular approach “allows for the fullest possible consideration of the client and as an individual, rather than as a type, and any negative effects of this (which are in my case debatable) must be set against the undoubtable benefits, which are definite and provable” (Rogers 1959, in Koch, 2005 ed., p. 96). So it can be seen that Rogers is accepting there are limitations to this approach but conversely suggests that these limitations should be put into context within the overall benefits that this person centred model offers to the client. It is clear that Rogers doesn’t believe in the notion of a ‘theory of everything’ in psychotherapy, in other words, an approach that provides complete help to every client, rather he suggests an approach that offers the client the best environment for therapy. In Rogers’ model the therapist efficiently manages this whole process of the therapeutic treatment to make sure that the positives far outweigh the negatives. In other words, Rogers recognised that his particular therapeutic approach does not result in absolutes.

It has been argued that the therapist’s role within the therapeutic alliance can be somewhat retrograde as it attempts to offer equalisation in the relationship and downplays the authority of the therapist. Most other models of psychotherapy are based on a hierarchy in terms of the client-therapist relationship, with the therapist indicated as the source of knowledge and experience. This is a key feature in the cognitive behavioural approach (Rogers, 1959, in Koch, 2005 ed). An authoritarian approach may have become increasingly less popular but John Russon argues that there have been studies that have indicated that in certain cases, it is precisely the lack of an authoritarian figure that causes psychological problems in the first place (Russon, 2003); while Russon’s suggestion shouldn’t indicate a total need to tip the balance in the client-therapist relationship in terms of an authoritarian approach, there is clearly a case to be made that the therapist should at least be seen to take control off the situation and steer the therapeutic process. It should be noted that Rogers’ approach doesn’t reject the importance of the therapist taking charge, it suggests that this control and steering be somewhat concealed beneath an impression of equality, and if we look at the application of a cognitive approach, this can be seen as rather counter productive. Russon also argues that “a Rogerian approach to therapy risks confirming, or in extreme cases initiating, cyclical emotional responses that become self-serving and at worst, self-perpetuating” (Russon, 2003, p. 51). Clearly this depends, to a great extent, upon the predisposition of the client and whether they are prone to such repetitive patterns. Russon goes on to refer to significant clinical evidence that he claims, “backs up the idea that Rogerian therapy can encourage the very manifestations of insecurity and persistent negative emphasis that we might otherwise expect to work against” (Russon, 2003, p. 52). This particular debate as to the authority of the therapist can be pretty complex, as it has to be viewed from numerous interpretations of the clients’ perspective: Russon, for example, appears to believe that the person centred approach dismisses the natural and potent authority of the therapist, while Rogers himself, believed that the therapists authority be masked and more gently applied within the therapeutic relationship. However, it is likely that the best approach be judged on an individual, case by case basis.

Another criticism of Rogerian therapy is it’s apparent bias towards support in the ‘here and now’ aspect of the clients character and is less likely to focus, if at all, on a restorative or reconstructive approach. As Barry A. Farber notes, “psychotherapy up to this point (1950’s) had been focused on fixing the patients problems and returning him to a state of normality, but Rogerian therapy emphasised a more palliative, almost pastoral type of care that emphasised the role of the therapist as a support mechanism” (Farber, 1998, p. 119). Rogers believed that such a support mechanism had great potential to place the individual in the correct environment so he or she can begin a sort of self-repair, but he (Rogers) also believed that if such self-repair failed to take place then at least the supportive model would prevent any further damage and help re-establish the client’s functionality. This approach from Rogers offered the key difference between person centred therapy and virtually all other mainstream modes of psychotherapy in the mid twentieth century: Rogers believed it was important to work with a client in his or her current state and work from this toward a more ideal state, while many psychotherapeutic approaches, including hypnotherapy, favoured regressing the client back to a prior state when they were perceived to be entirely functional. Critics of Rogers preferred a model of therapy geared towards specific outcomes rather than what some saw as “an amorphous feeling of general satisfaction based on self-appointed goals” (Glassman & Hadad, 2007, p. 330). This can be seen as a limitation of Rogerian therapy in that the results are not directly measurable and the capacity for incongruity is sustained rather than challenged. This led to a number of attacks on the Rogerian theory for it’s perceived bias for support and emotional reassurance rather than thorough and precise psychotherapeutic investigation. It is this notion of the Rogerian approach, being supportive rather than reconstructive, that sits at the very core of the debate concerning the suitability and validity of Rogers’ methods.

The debate on Rogerian Vs Reconstructive therapy concentrates to some extent, on the degree to which a client should, and indeed can, be encouraged to perceive an idealised self. Within the support of Rogerian approach, such an idea would be perceived as incongruous, and can be deemed an acknowledgement of what Rogers describes as “accepted incongruence” (Rogers, 1959, in Koch, 2005 ed., p. 119), in other words, a clients willingness to accept a number of unwanted factors and to believe, often incorrectly, that they have indeed conquered them. This self-confidence in fact, hides negative manifestations that result in such incongruity. Many have criticised that Rogers’ approach aims to “codify and legitimise the clients current state rather than to work towards bringing him back to a more desired position” (Farber, 1998, p. 120). Rogers is being accused here, on focusing on the acceptance and support of the individual’s current state, as opposed to the actual desired state. Here, the Rogerian approach sees the moment of therapy not as a turning point that regresses then client back towards an ideal state, but rather as a moment of reflection that continuously moves forward, i.e. a drive forward with regard to personal development. The characteristics of the incongruent personality can be absorbed and disregarded, and to some extent, reconfigured; this drives toward an examination of the problems that have lead the client to seek psychotherapy in the first place.

Examining the Rogerian approach further, there have been many suggestions that the model lacks a structure and can take a long time to reach any sort of goal or conclusion. This is primarily because as, William E. Glassman and Marilyn Hadad note, “the Rogerian approach encourages the client to work at his or her own pace and therefore to feel no pressure – in fact, this lack of pressure to reach an early resolution is viewed by many supporters of the Rogerian approach as one of its key benefits” (Glassman & Hadad, 2007, p. 331). Proponents of the Rogerian approach argue that this sense of structure is one of the problems in a more cognitive model of psychotherapy and criticise that these structures can recreate the kind of judgemental controls that are very often associated with the problem that caused the therapy in the first place. Therefore, the Rogerian approach can be seen to be a means of liberating the subject from the constraints of prescriptive, more authoritarian based psychotherapy. However, whilst praising the removal of any prescriptive model of psychotherapy, Glassman & Hadad go on to argue that Rogers could have gone too far in disregarding and structure beyond that of the basic therapeutic arrangement, and suggest that “a middle-ground, in

therapeutic milestones” (Glassman & Hadad, 2007, p. 332)… may be just as effective and prove to have quicker results. In addition, critics of the Rogerian approach argue that it simply doesn’t suit many of the more common problems that clients face, and can actually be more damaging. In particular, the condition of Post Traumatic Stress Disorder (often referred to as PTSD), for example, D. Fox and I. Prillettensky state the case that a Rogerian approach can prolong the subjects suffering, and while a more abrupt approach may appear to some to be a little more traumatic, the benefits for the long term mental health of the client are much more preferable. (Fox & Prillentensky, 2005, p. 181). This unnecessary prolonging of the clients’ symptoms within a therapeutic environment is probably on of Rogerian therapy’s biggest criticisms. Clearly, certain conditions benefit from a more direct and prescriptive approach, albeit being initially, a little more distressing for the client; hypnotherapy for example, could regress the client in trance back to and before the actual trauma (usually inducing an abreaction) and then work with the client from that point. It is easy to see that the Rogerian approach is not universally applicable and the debate on its suitability is complex and one that hasn’t reached any solid resolution. Glassman & Hadad argue that “while it’s natural for therapists to focus on their preferred method of treatment, it might be better for the client if each therapist were better able to judge the most effective method and then implement it, rather than attempting to fit their favoured approach to the specific details of each client” (Glassman & Hadad, 2007, p. 335). Such an approach maybe a little too idealistic, yet it would be better placed to serve the overall total needs of the client and give them the best possible method of treatment. In other words, the Rogerian approach can be seen as a very useful tool to have in a collective therapeutic toolbox, it’s the therapist’s job to select the best tool that meets the clients’ needs.

In summary, it is clear that the Rogerian approach has many limitations and many critics but as Barry A. Farber notes, “there are limitations to every psychotherapeutic approach” (Farber, 1998, p. 156), it would be easy to assume, possibly incorrectly, that the existence of these limitations is automatically a negative factor. The actual extent of these limitations is more difficult to judge: in the wrong hands, the Rogerian approach may prove to be a little more than a palliative and restorative comfort without attending to or advancing the clients’ situation. However, it is also clear that these very factors are an extremely important step in forming the bond between therapist and client. Perhaps the Rogerian approach is a necessary remedial to the more prevalent schools of demanding and resolute psychotherapy, for which many critics now regard as having a somewhat negative effect on the client as they attempt to ‘measure-up’ to a predefined ideal. Rogers’ approach sought to abolish such an idea and to some he went a little too far in doing so but this could be seen as a natural occurrence with such corrective measures. Clearly, the Rogerian approach doesn’t satisfy every clinical requirement. None the less, there are many key ideas within this model, such as the lack of judgement within the client-therapist relationship and the holistic person centred approach have obvious benefits for the client, although there will prove to be many occasions where a more immediate model of therapy, such as CBT, would be better suited to the client’s needs.

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