Section 3: The Key Concepts and Techniques of Person Centred Therapy

Person-centred therapy, also called person-centred counselling or client-centred counselling, is probably the most commonly used approach in counselling today. Its principles have also been widely incorporated into other human services and healthcare disciplines. The person-centred approach was originally developed by Carl Rogers and draws on three philosophical beliefs: humanism, existentialism and phenomenology. These three beliefs inform the general principles of a person-centred approach (adapted from Sims & Reeves, 2018, pp. 100-101):

• Humanism: We all have the potential for growth and development. The person-centred approach focuses on promoting positive psychological growth rather than focusing on the negative aspects of human behaviour.
• Existentialism: We all possess free will and make choices based on individual experiences and personal beliefs.
• Phenomenology: There is “no one, single reality, but rather reality is constructed through our own individual experience”. Two individuals who experience the same situation may have different accounts of such experience.

Thus, person-centred counsellors focus on their clients' conscious, subjective experiences and their individual traits, abilities, and unique frames of reference (or ways of viewing the world). It is a non-directive style of counselling that focuses on the relationship between the client and counsellor as the primary means of therapeutic change.

Carl Rogers on Person-Centered Therapy

The founder of the humanistic, person-centered approach to psychology reflects on his life, his contributions to the field of psychotherapy and shares his provocative ideas about. psychotherapy, education, and social justice.

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Person-centred counsellors focus on helping clients develop a greater understanding of themselves so that they can solve their own problems without direct intervention from the counsellor.

The relationship between the counsellor and client is vital in this approach. According to Corey (2017), a person-centred counsellor should be present, accessible, congruent, accepting, empathetic, genuine, caring, respectful, accepting, supportive and understanding. It is the counsellor’s responsibility to create a climate in which the client can feel comfortable to tap into their own resources. Rogers (1957, p. 213, cited in Sims & Reeves, 2018, p. 103) had six “necessary and sufficient” conditions to establish a counselling relationship that will create the appropriate climate for the client. They are:

Throughout the counselling literature, conditions 3, 4, and 5 listed - congruence, unconditional positive regard, and empathy – are often referred to as the ‘core conditions’ and are thought of as the key ‘techniques’ of person-centred therapy. While the ‘core conditions’ are the central concepts that are explored in more detail later in this section, it is important to understand that all six conditions are necessary to develop an effective counselling relationship.

What is Congruence in Therapy?

This useful video explains counselling jargon.

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There are several key concepts within person-centred therapy: self-actualisation, self-concept, conditions of worth, and a fully functioning person.

Self-Actualisation

Carl Rogers believed that there was one motivational force that determined the development of the human being. He called this the actualising tendency. In his development of person-centred counselling, Rogers sees self-actualisation as “more a process rather than an endpoint” of becoming the person one truly is (Casemore, 2011, as cited by Sims & Reeves, 2018, p. 101).

Self-Concept

This is the conceptual construction one has of him or herself (Mearns, Thorn & McLeod, 2013). This includes beliefs about who the person thinks they are and what they think they can do. Where a person has been exposed to an environment that has failed to provide positive regard, they may develop a poor self-concept. The following extract highlights how a client’s poor self-concept (i.e., the person’s conceptual construction of himself or herself) undermines everything that a person does or tries to be. Once a self-concept has been internalised, the person tends to reinforce it by behaving in ways which confirms this self-concept.

Conditions of Worth

This is when a person’s sense of worth has conditions placed upon it either by themselves or the people within their life, usually in the form of gaining approval and avoiding disapproval (Mearns, Thorn & McLeod, 2013). For example, “I am only a worthwhile person if I’m successful at work” or “My father only loves me if I follow his rules.”

The Fully Functioning Person

Psychologically healthy people have experienced acceptance and approval in their relationships, allowing them to develop self-concepts “to be in touch with their deepest feelings and experiences” (Mearns, Thorn & McLeod, 2013, p. 12). Such people can become what Rogers described as ‘full functioning’ people (Rogers, 1961). Becoming a ‘fully functioning person’ is one of the goals of person-centred therapy. This is achieved through meeting a person’s need to receive positive regard from themselves and others (Sharf, 2015). A fully functioning person is considered open, creative, and responsible. According to Sharf (2015), it was Rogers’ goal to become a fully functioning person himself as he believed that it would help those around him do the same.

Internalised Locus of Evaluation

Where fully functioning people are able to access their internal awareness and knowledge in the process of decision making resulting in congruent behaviour, people who have been exposed to adverse criticism and judgement may instead rely on external guidance and the judgement of others (Mearns, Thorn & McLeod, 2011). For the counsellor, one of the most significant moments in therapy is the point at which a client recognises this reference point – as shown in the following extract:

Ultimately, the goal of person-centred counselling is to remove the roadblocks and influences that stop the client from growing and “self-actualising” (Plotnik & Kouyoumdjian, 2014). Clients will likely come to counselling with a discrepant view between their self-perception and their reality (Corey, 2017). If the counsellor has successfully created the appropriate climate – by demonstrating congruence, empathy and unconditional regard - the client is more likely to have the ability to explore their perceptions, beliefs, and feelings without fear of judgement.

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As previously discussed, Rogers had six conditions that he believed were vital to counselling. Of these six, three have become known as the ‘core conditions’ of person-centred therapy and are the main ‘techniques’ used to facilitate change within a client. They are congruence, unconditional positive regard, and empathy.

Mearns, Thorn and McLeod (2013) describe empathy as a process, unconditional positive regard as an attitude, and congruence as a state of being of the counsellor in relation to the client. Let’s examine these core conditions more closely.

Empathy

Empathy is perhaps the most well-known of Rogers’ therapeutic conditions and is now considered the foundation of effective helping relationships. According to Sharf (2015, p. 221), empathy is “to enter another’s world without being influenced by one’s own views and values”; while Corey (2017) describes it as “a deep and subjective understanding of the client with the client” (p. 175). In empathising with a client, the counsellor adopts the frame of reference of that client, putting their own frame of reference to the side.

It is important to remember that empathy is not simply showing sympathy for another person but rather sharing their experience without losing yourself in the experience or allowing your own values to contribute. Most person-centred counsellors understand that knowing exactly what another person is feeling is impossible. However, it may be that trying to understand another person’s feelings is enough to allow them to feel understood. Rogers explains further:

Showing a client empathy is important for several reasons. One reason is that it can allow clients to process and pay better attention to their feelings, while seeing situations differently (Cain, 2010, cited by Corey, 2017). By reflecting how a client feels, you act as a ‘mirror’ so that they can better see themselves. This allows them a clearer understanding of their own feelings. According to Clark (2010, cited in Corey, 2017), there are three empathetic perspectives that assist the counsellor in better understanding the client’s experience. They are:

• Subjective empathy – Imagining what it is like to be the client.
• Interpersonal empathy – Attempting to understand the subjective experience of the client and relaying that back to them.
• Objective empathy – The use of data outside of the client’s experience to assist understanding.

Empathy can be experienced by listening to what the client is expressing with both their verbal and non-verbal communication. There are several common techniques that you will already be familiar with that are employed within counselling to help achieve this. They include techniques such as active listening, the use of encouraging body language and tone, and the use of questions, paraphrasing, and summarising.

Of course, empathic understanding is only effective in person-centred terms if effectively communicated to a client (as outlined in Rogers’ core condition number 6). It is important that the counsellor can tentatively communicate their understanding of the client’s feelings in such a way that the client can really experience being heard, understood, and not judged (Casemore, 2011).

Rogers highlighted that it was important to continually clarify how the client is experiencing their feelings to develop a true understanding in the counsellor and to communicate this understanding to the client. The counsellor’s intention when making an empathic response should be to check, test, and verify the accuracy of their empathic understanding. This is generally done by making a reflective statement representing the counsellor’s understanding and presenting it to the client for verification or correction. However, the expression of empathic understanding cannot be boiled down to a simple response or even a series of accurate responses (Mearns, Thorn & McLeod, 2013). Instead, empathetic understanding must be considered a continual process of being with the client.

Counsellors must also learn how to be empathetic without losing themselves in the client’s experience. Feeling a client’s emotions too strongly can harm the counsellor and make it more difficult for them to help the client.

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Congruence

In contrast to psychoanalytic therapies that require the counsellor to always ‘act’ in the formal role of an expert in their interactions with clients, the person-centred approach believes that a counsellor should behave in a way that reflects their inner experience.

Rogers (1966) highlighted the importance of the counsellor being attuned to their actual self. He stated that it was important that:

Congruency can be conceptualised as two separate components which are both essential:

• Insight – The ability to be aware of one’s own internal experience.
• Transparency – The willingness to communicate explicitly to the other person what this experience is (both positive and negative).

Rogers (1966) emphasised both dimensions:

Essentially, Rogers believed that persistent inner experiences should be expressed to the client. He argued that such feelings may be either positive or negative, and that both can be of vital importance in supporting the other core conditions (i.e., empathy and unconditional positive regard) For example, it would be better to admit to the client that you are feeling confused or frustrated than to pretend that you were not. The following extract shows how voicing a response may be helpful to the counselling process:

Congruency can facilitate the counselling process by:

• Enhancing the client-counsellor relationship by building trust.
• Conveying one’s understanding.
• Dealing with a relational difficulty in the counselling relationship.
• Setting boundaries (e.g., a counsellor may express feelings of anger and lack of respect when a client fails to attend appointments).

It is important to remember that congruency is not a deliberate ‘strategy’, but rather a genuine reflection of what the counsellor thinks and feels. Clients are sensitive to insincere or disingenuous responses and counsellor responses will only be helpful if the response matches the counsellor’s stance (Mearns, Thorn & McLeod, 2013).

While Rogers’ writings highlight the importance of being open and honest within the therapeutic relationship, the condition of counsellor congruence can be a confusing one for students learning this approach. The extent to which the counsellor should communicate their inner experiencing to the client is a common source of concern. Students often ask, “Does being congruent mean that I need to tell the client about my every thought and feeling?”- the answer to this question is no (Sommers-Flanagan & Sommers-Flanagan, 2018, p. 125). Random and unhelpful counsellor thoughts do not need to be shared as they are unlikely to be therapeutic. The aim of congruence is not for counsellors to express themselves, but to demonstrate authenticity and consistency in the counsellor, that they do not deceive the client as to their thoughts and feelings.

Not all of a counsellor’s feelings are appropriate to the counselling contact. Mearns, Thorn and McLeod (2013) set out the following three guidelines to guide counsellor expressions of congruence:

• Only the feelings and sensations experienced in relation to the client should be expressed. When a counsellor is being congruent, she is giving her genuinely felt response to the client’s experience at that time.
• The response must be relevant to the concerns of the client. For example, if the client is talking about his stress, this may lead the counsellor to think about the phenomenon of stress in general. Although these experiences are in response to the issues that the client has brought, they are unlikely to be relevant to the client’s present experiencing.
• Only those persistent and striking experiences should be voiced. A counsellor is likely to experience many feelings or sensations in relation to the client throughout the session. It would interrupt the flow of the session to respond to each of these.

Congruence can often be difficult for new counsellors because people are generally socialised to behave in particular ways – very rarely are we encouraged to do and say whatever is on our minds (Mearns, Thorn & McLeod, 2013). However, congruence is highly useful within the counselling context. Tolan (2017) suggests that if a counsellor is congruent, then the client can learn to trust their own experiences and perceptions. It can also be helpful for both the client and counsellor to receive authentic responses from each other.

In the following extract, a new counsellor outlines her struggles to be congruent in sessions and her realisation of its importance.:

It can be argued that congruence underpins the ability to truly experience the other core conditions of empathy and unconditional positive regard (Gillon, 2007). For example, if a counsellor does not possess a congruent awareness of their own inner self, then it is likely that their relationship with a client will be influenced by their own incongruence and conditions of worth. Gillon (2007) proposes that counsellor incongruence can inhibit both the experiencing and communication of empathy and unconditional positive regard in the following ways:

• If a client expresses an emotion that is being personally denied by the counsellor, then the counsellor will likely fail to recognise (and therefore empathise with) that emotion. For example, if the counsellor does not acknowledge or accept anger in himself, he may fail to recognise or even discourage that emotion in his client.
• If counsellors are not congruent in their own emotions then they are likely to distort their reactions into another feeling (e.g., distorting anger to excitement).
• If counsellors do not have an awareness of their own organismic functioning then the counsellor’s own conditions of worth are likely to intrude into the counselling relationship. For example, the counsellor’s own feelings of worth may start to be influenced by the client’s progress with the client then perhaps feeling unable to express his or her true feelings.

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Unconditional Positive Regard

Unconditional positive regard can be defined as the experiencing and offering of a consistently accepting, non-judgemental, and valuing attitude toward the client. It is perhaps the most challenging of all Rogers’ conditions for beginning counsellors to experience and express. Unconditional positive regard relies on listening and responding non-judgementally to whatever a client is experiencing at a given moment.

What is Unconditional Positive Regard?

Unconditional Positive Regard is a core aspect of Person-Centered Therapy, which was developed by the psychologist Carl Rogers. In this video we learn what unconditional positive regard is, how to maintain it even when it's most difficult to maintain, and how it can promote growth and transformation in the person receiving it.

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Sommers-Flanagan and Sommers-Flanagan (2018, p. 120) provide the following definition:

Mearns, Thorn and McLeod (2013) point out that we generally ‘like’ someone who has similar or complimentary values to our own. However, it is possible to value a client who has distinctly different values to our own.

Unconditional positive regard works by diminishing the conditions of worth which are at the root of the client’s incongruence (Gillon, 2007). You should recall from learning theory that a client’s behaviour is learned or conditioned. A client who has grown up under conditions of worth will have learned that he or she is only valued when meeting the expectations of others (i.e., being or behaving in a particular way). Responding with unconditional positive regard works as a sort of ‘counter conditioning’. The counsellor values the client regardless of whether the client fulfils perceived expectations (Mearns, Thorn & McLeod, 2013). For example, clients who lack self-acceptance tend to behave in ways which reflect that internal state by responding aggressively, withdrawing, or appearing unemotional. These behaviours create a vicious circle with the client’s behaviours, further reinforcing the client’s perceived lack of value. “Unconditional positive regard breaks into this cycle as the counsellor refuses to be deflected by the client’s self-protective behaviour and instead offers the client consistent acceptance of his intrinsic worth” (Mearns, Thorn & McLeod, 2013, p. 82).

It can be difficult when faced with challenging client behaviours to maintain a climate of unconditional positive regard, as shown in the following extract:

The expression of unconditional positive regard must be done skilfully. For example, it would not be appropriate to say to a client “I accept you completely and totally as the person you are” (Sommers-Flanagan & Sommers-Flanagan, 2018, p. 125). This sort of expression can be overwhelming or come across to the client as fake. Sommers-Flanagan and Sommers-Flanagan (2018) provide the following suggestions for how to simply express unconditional positive regard to a client:

• Keep appointments.
• Ask and then remember how your client would like to be addressed
• Listen sensitively and compassionately.
• Allow clients to talk naturally.
• Demonstrate that you are listening to the client by remembering parts of their story – this can be done by using your microskills, such as paraphrases and summaries.
• Respond with compassion to your client’s pain.
• Make your intentions clear.

Many students find the very concept of unconditional positive regard problematic. A common criticism is that unconditional positive regard requires a counsellor to withhold any judgements about the clients’ actions. Students often argue that this is either impossible or (in the case of some actions, such as violence or abuse) morally reprehensible, or that to offer unconditional positive regard is to condone the client’s actions. Consider the following extract:

Sommers-Flanagan and Sommers-Flanagan (2018) propose that one way for a counsellor to experience positive regard in these types of difficult situations is to find within themselves positive regard simply for the “suffering human being in the room” with them (p. 125). They highlight that a counsellor does not need to have positive regard for the client’s behaviours, merely for the “yearnings, longings, losses, and fears that the behaviours represent” (p. 125).

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The counsellor and client both have a role within the person-centred counselling process. The counsellor’s main role is to come to therapy with the appropriate attitude. They must believe that the client has inner resources and the ability to create change within their own life. Counsellors are required to be present, congruent, accepting, and empathetic (Corey, 2017). Corey (2017) suggests that if a counsellor can show “genuine caring, respect, acceptance, support, and understanding,” clients will be able to “loosen their defences and rigid perceptions and move to a higher level of personal functioning” (p. 180).

Person-centred counsellors are non-directive – instead, the client is responsible for determining the course of the counselling conversation. The counsellor aims to simply assist clients in finding their own path toward self-actualisation. To do this, the counsellor must adopt and express the ‘core conditions’ of the person-centred approach. According to Casemore (2011), these conditions are not simply techniques but should be considered a way of being.

Along with the core conditions of person-centred therapy, it is important that a person-centred counsellor uses fundamental counselling skills in order to foster the therapeutic relationship. These skills include using microskills, such as open questions, reflection of feelings, paraphrasing, and encouragers. As a reminder, examples of each are provided in the following table:

However, it should be noted that Rogers did not advocate for repeating back the client’s words (Raskin et al., 2019). He believed the counsellor should listen for the ‘point’ of what the client is trying to say and give empathic responses that “capture the client’s intention, agency, emotional associations and so on” (p. 123). To Rogers, a person-centred approach is more an attitude than a behaviour; it’s a way of being with clients rather than specific ways of responding to them. Person-centred counsellors should be mindful of how often they are using these microskills and consider how they can give more empathic responses.

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By its very nature, person-centred therapy is a non-directive approach to counselling. However, this does not mean that it is without structure. As you learned in the previous section of this module, there are several key processes that person-centred counsellors must keep in mind to help ensure the effectiveness of person-centred therapy. Additionally, person-centred therapy does have a theoretical process. Rogers wanted to develop a way to describe the process during person-centred therapy. To do this, he identified seven ‘stages’ that fall across a continuum representing the client's journey (Casemore, 2011). Clients move back and forth across the stages.

These stages are outlined in the following extract:

It is important to note that Rogers did not propose these as a series of discrete steps, but rather as a general trending over time.

As Tolan (2017) emphasises, these stages are rather ‘artificial’ and should be regarded more as ‘signposts’ on a route instead of ‘stages’ – “the car does not stop at each signpost: it is the overall direction that is important” (p. 108). Furthermore, clients may not enter counselling at a particular stage and progress steadily through to the seventh stage. It is possible that clients may leave counselling at an earlier point or that clients will experience some deviation from the idealised path described. It is also rare to find clients at one particular stage at a time, and clients will definitely go back and forth on this continuum. However, by understanding where the client is along this continuum the counsellor can come to a better understanding about the client’s growth and development and provide feedback to the clients when reviewing progress (Tolan, 2017).

A Note on Monitoring Progress

As in other therapies and forms of counselling, it is useful to monitor and evaluate the counselling process. In person-centred therapy, the client's evaluation is the most important part of the evaluation process. Due to the client-focused nature of this approach, it is up to the client to decide what topics or issues are discussed, how much to explore, whether the counselling has been effective, and when they would like to end counselling. Within person-centred therapy, feedback from clients is usually gathered verbally on a regular basis with the client; however, feedback can also be gathered via the use of a feedback form that can then be discussed with the client.

Role Play: Person Centred Therapy

Watch the following role-play and answer the questions that follow.

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The principles of person-centred therapy are straightforward, easy to understand, encourage finding strength within the client, and provide a foundation that can be used with a range of client issues, and in conjunction with other sorts of therapy, with individuals or multiple clients (Corey, 2017). This is why the person-centred approach has been widely applied in counselling. Its principles are also incorporated into best practices in various human services settings.

Person-centred therapy can be used with a wide range of clients and client issues. It is considered suitable for some of the most common issues and concerns that bring people to counselling (e.g., issues of anxiety, self-esteem issues, and relationship problems). Corey (2017) also suggests that person-centred therapy is particularly helpful for crisis intervention after unexpected life events (e.g., an unwanted pregnancy, illnesses, disasters, and loss).

The book Client Issues in Counselling and Psychotherapy: Person-Centred Practice edited by Tolan and Wilkins (2012) outlines several life events and emotional and behavioural reactions to life events that could benefit from person-centred therapy. They include loss and bereavement, trauma, crisis, post-traumatic stress disorders, adults who were sexually abused as children, depression, anxiety and panic, different realities, drug and alcohol issues, eating problems, and self-injury. Additionally, scientific research has shown person-centred therapy to produce positive client change for a range of specific conditions, including depression, borderline disorders, schizophrenia, anxiety, alcoholism, psychosomatic problems, agoraphobia, interpersonal difficulties, and personality disorders (Corey, 2017; Sharf, 2015).

Person-centred counsellors aim to understand the client through their own frame of reference and so have a unique perspective on each client’s specific issues and needs. The focus on the client and their point of view makes person-centred therapy particularly helpful when working with clients from different cultures. It has an individual focus for each client and works with them to activate their own inner potential without making assumptions based on culture. However, person-centred therapy is not always appropriate with culturally diverse clients. For example, Sommers-Flanagan and Sommers-Flanagan (2018) point out that the individual focus and emphasis on self-actualisation may not be useful for people who have been raised in collectivist cultures and who strongly orient themselves towards family, collectivist goals, and social or community interest. Likewise, the focus on emotional expression and congruence may not be useful for clients from cultures that view emotion as a weakness and congruence as ‘rude’ (Sommers-Flanagan & Sommers-Flanagan, 2018).

Person-centred therapy may not suit all potential clients. The nature of person-centred therapy is to put the client ‘in the driver’s seat’. This nondirective approach may differ from what some clients may expect or desire from counselling; therefore, it is important to confirm the client’s suitability for person-centred therapy at your first meeting with the client. This can be done by assessing the client’s needs and what they hope to achieve from counselling and by informing them of the person-centred therapy process.

In addition, it is important to be aware that not all person-centred counsellors will suit all potential clients. The therapeutic relationship is an integral part of the counselling process – therefore, if a counsellor does not feel as though they can accept a client unconditionally and be congruent and genuine with them, it may be better for the client to be referred to another counsellor or for the counsellor to address their issues in supervision before beginning counselling with the client. Worrall (2014) suggests that counsellors can ask themselves the following questions to help determine client suitability for their service:

From a person-centred perspective, if a counsellor is having difficulties feeling unconditional positive regard for a client, they must ensure that they seek supervision to resolve these issues as it is likely to be an issue with the counsellor themselves, rather than the client.

Although person-centred therapy is widely applied and integrated, it is not without its critics. While there is empirical evidence to support the benefits of person-centred therapy (i.e., it is better than no or placebo treatment), more support has been found for the effectiveness of cognitive and behavioural treatments (Sommers-Flanagan & Sommers-Flanagan, 2018). This has led some theorists to question the efficacy of the person-centred approach. (It is worth mentioning that motivation interviewing (MI), a brief treatment model based upon person-centred principles, has ample empirical support for its effectiveness for substance-related issues. You will learn about MI in CHCCCS014 Provide Brief Interventions later in your Diploma).

Some also criticise person-centred therapy as placing unrealistic demands upon the counsellor – person-centred is a way of being rather than merely applying skills, which can be difficult to implement (Corey, 2017). It may also create too many possibilities for transference – the projection of feelings onto the counsellor (Hough, 2021). There is also some doubt as to how counsellors can sufficiently challenge clients while being empathetic and giving unconditional positive regard. Indeed, despite its seeming simplicity, person-centred therapy is a complex approach that requires the counsellor to be highly skilled and able to rise to the challenges of this style of counselling.

Despite these criticisms, person-centred therapy is one of the most widely used counselling approaches, and many of its key concepts and techniques are used by counsellors from other theoretical orientations. Most counsellors and therapists recognise the importance of the relationship between the counsellor and the client. Therefore, the person-centred therapy principles of genuineness, acceptance, and empathy are used across various approaches, particularly in the early stages of relationship building, where counsellors are likely to listen empathically to clients' concerns. (Sharf, 2015). As such, it is not uncommon that person-centred principles are combined with the techniques and processes of other counselling approaches, some of which we will discuss over the next modules.

What are the Limitations and Criticisms of Person Centered Therapy?

This video describes the theory of Person-Centered Therapy (Rogerian Therapy) and criticisms of the theory.

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In addition to other therapies borrowing from person-centred therapy, person-centred therapists often borrow from other approaches. For example, some person-centred therapists may also use behavioural techniques such as relaxation and homework tasks (developed in collaboration with the client) in cases in which they would be suitable (Sharf, 2015). You will learn more about how the person-centred approach can be combined with the techniques and processes of other counselling approaches over the next few modules of your Diploma.

Identifying and Considering Co-Existing Issues in Counselling

In counselling, it's essential to recognise that clients may present with multiple interconnected issues. This understanding allows counsellors to provide holistic and effective support. Here are the steps to identify and consider co-existing issues when selecting courses of action.

Review Client History: Begin by reviewing the client's counselling history, including any previously discussed concerns. Clients often bring interconnected issues into counselling.

Active Listening: Actively listen to what the client shares during sessions. Pay attention to any hints or mentions of other issues or challenges they might face. Use paraphrasing and reflections to clarify understanding and convey empathy.

Open-Ended Questions: Use open-ended questions to encourage clients to share more about their experiences and feelings. This approach can help uncover co-existing issues they may not have initially mentioned.

Cognitive Distortions: Be mindful of cognitive distortions, which are negative thinking patterns that can co-exist with various concerns. If you've observed these distortions, look for signs of them during sessions. Help clients recognise limiting automatic thoughts, keeping verbal and non-verbal communication for signs of these.

Explore Connections: If clients bring up other issues or thought patterns, explore how these might be connected to their primary concerns. Understanding these connections can guide the counselling process. Seek to identify themes (repeated ideas or beliefs) and patterns – (repeated behavioural or affective sequences). Be alert for parallels in the client's story, which may help reveal underlying issues or distortions.

Prioritisation: Collaboratively prioritise the identified concerns with the client's input. Ask them which issues are most pressing and which they'd like to address first.

Setting Goals: Work with clients to set specific, measurable, and time-bound goals for addressing primary and co-existing issues. Ensure goals are written in the first person, present tense and positively framed -focus on what they will do rather than what they want to avoid.

Integrated Approaches: Integrate counselling techniques and strategies from various therapeutic approaches as needed. This might include solution-focused and cognitive-behavioural elements to address identified concerns effectively.

By following these general steps, counsellors can ensure they provide comprehensive and tailored support to clients, addressing the primary issues presented and any underlying factors contributing to their challenges. This approach enhances the effectiveness of counselling interventions and supports clients in achieving their therapeutic goals.

Reading through the following case study will help you better understand the processes and techniques of person-centred therapy. (Note: This case study involves a counsellor working with a client on issues of loss and grief, which may be triggering for some people. Make sure that you look after your own wellbeing and take breaks as required.)

As a counsellor, you will encounter a number of varying client issues, including loss and grief. Loss is a concept that is commonly associated with bereavement (i.e., losing a loved one) but can also include loss of identity, loss of an object (e.g., one’s home), loss of a relationship, and loss of a job - you will learn more about providing grief and loss support in CHCCCS017 later in your study. Person-centred approach can be quite effective (and often used in conjunction with other therapeutic approaches) when working with loss and grief issues because it promotes the kind of quality engagement with a client which supports them to embark on a journey of self-discovery and deeper exploration of grief (Machin, 2014).

Case Study - Maggie

Maggie is a 35-year-old woman who came for counselling six months after the break-up of her nine-year marriage to Michael, the father of her two children (Josh aged 6 and Joseph aged 12 months). Currently both children are in Maggie’s sole care. Maggie has been referred to counselling by her General Practitioner whom she has been seeing for a number of minor physical ailments.

Background

Maggie and Michael met at university when they were studying business computing. After graduating they were employed in separate companies and dated for a number of years before finally getting married. They both continued working until the birth of their first child, Josh, when Maggie took a year off before returning to work part time. Michael continued in full time work and received a number of promotions over his years of continuous employment.

Maggie continued working part time until the birth of their second child, Joseph, when she again took a year off to care for both children at home. She was about to return to work when Michael came home one night and said he was leaving her for a woman he had met at work. Two weeks later Michael moved out of the family home. He has not contacted Maggie or the children since. Maggie has not felt well enough to return to work and is now in danger of losing her position with the company.

Application of Person-Centred Therapy

The counsellor applying this approach is primarily concerned with communicating empathy and unconditional positive regard to the client. This includes the application of micro-skills such as active listening, reflection of feeling and meaning, and summaries in the context of a genuine interaction between the counsellor and the client. The counsellor’s role is specifically ‘non-expert’, supporting the client to recognise personal strengths and to find answers that are congruent with her/his own values and beliefs.

Preparation

The counsellor’s preparation of the counselling room included placing chairs in slightly angled, face-to-face position, checking the position of curtains to minimise glare, and placing a box of tissues within easy reach of the client’s chair. The counsellor also spent a couple of quiet moments clearing her mind of prevailing thoughts from the previous client in order to give Maggie her full attention.

Session Details

Upon Maggie’s arrival, the counsellor introduced herself and spent some time developing rapport in an attempt to make Maggie feel welcome and at ease. This was done by asking Maggie to be seated, making general conversation about the weather, and asking about how Maggie’s day had been so far.

The counsellor formally began the session by asking Maggie whether she had received the counselling organisation’s letter sent to confirm her appointment details and a brochure containing information about the counselling service including fees, hours of operation, qualifications of staff, and map location. Maggie confirmed she had received the leaflet and said that it had been very useful and informative.

The counsellor then asked if Maggie had any questions not covered in the information brochure. Maggie replied in the negative and the counsellor proceeded to ask Maggie what had brought her to counselling.

Maintaining good eye contact and an open posture, the counsellor waited for Maggie to start speaking. After about 20 seconds of silence during which Maggie looked down at the floor, she finally spoke through tears. “My husband left me for another woman six months ago and I just don’t seem to be able to get on with my life.”

The counsellor observed Maggie’s emotional reaction and decided that Maggie would be best supported by a person-centred approach which would allow her to voice her feelings surrounding the loss of her marital relationship.

The counsellor responded with a paraphrase and reflection of feeling, “You sound devastated by the loss of your marriage Maggie.”

Maggie replied, “Yes I am, but it was six months ago; I should be getting on with my life by now. That’s what my family and friends are saying anyway. But I still miss Michael so terribly, and the boys cry for him every night at bedtime.”

Counsellor:	“So, am I right in saying that you and the boys are still heartbroken, yet friends and family think you should be over it by now?”
Maggie:	“Yes, that’s about it. Maybe I should be over him by now. What do you think?”
Counsellor:	“Let me ask you Maggie. Do you think six months is long enough to mourn the loss of a longterm intimate relationship?”
Maggie:	“No I don’t.”
Counsellor:	“And you’re the only one who knows how it feels to have lost your relationship with Michael, Maggie.”

Maggie nodded and continued telling the story of her life in the past six months, occasionally pausing to wipe her reddened eyes with a tissue from the box nearby. Maggie described the physical and emotional upheaval as she struggled to cope with looking after the children on a limited income. She also voiced her fears and uncertainty about her and her children’s futures.

The counsellor continued to stay focused on Maggie emotionally and to use encouragers and reflections of feelings to confirm and validate her feelings.

After one of many silences, during which the counsellor had remained silent but attentive, Maggie looked up without speaking. The counsellor decided that this was an opportune time to summarise some of the issues Maggie had raised so far and said, “Maggie, you’ve described a huge upheaval in your life in the past six months that has meant reorganising your life in many ways. You’ve taken on the sole responsibility for two children, managing the house and finances and, at the same time dealing with the emotional loss of your marriage. That sounds like an awful lot to deal with at once.”

Maggie:

“Yes, I suppose it is when you put it all together. It didn’t seem so daunting when Michael was there to help.”

Thereafter, through continued bouts of tears, Maggie described her childhood dream of being married with children and the emptiness she now felt, having lost that dream so suddenly. She also voiced feelings of anger and self-recrimination for not being able to cope with her new circumstances as a sole parent.

Through the use of open questions, paraphrases and reflections, the counsellor explored with Maggie her feelings of anger and clarified the meaning of what being a ‘good mother’ meant to her. Maggie talked about memories of her own mother, who did not work outside the home and was always waiting for her when she returned home from school.

Further exploration through paraphrases and reflections highlighted the significant differences in parenting lifestyles of the past and today, with many parents now assuming the onerous task of undertaking responsibilities of homemaking, parenting and external work.

Maggie then said, “Yes, I suppose being a mother has changed a lot since my Mum’s time.”

Counsellor:

“That’s for sure, Maggie.”

Maggie then described how much she missed working outside the home and having a career. The counsellor reflected on Maggie’s feelings (expressed explicitly verbally and implicitly through non-verbal signals such as frowns, smiles and wistful glances at the ceiling) and used open questions to explore what Maggie liked about her work, including her strengths and capabilities.

Maggie:	“You know, maybe I could negotiate to return to work part-time for a while until I can get my life organised a bit better? I have a few friends who might help me pick the boys up from childcare if I need to work late occasionally.”
Counsellor:	(smiling) “So you think working part-time with some childcare support from friends might be the way to go, Maggie?”
Maggie:	“Yes, I think I’ll put the idea to my boss on Monday.”

From then on, Maggie’s talk slowed, and she assumed a more relaxed posture sitting back in her chair. The counsellor asked if there was anything else she’d like to talk about today. Looking at her watch, Maggie replied that she would need to pick the boys up from the childcare centre. She also said she would like to come back again the following week.

The counsellor replied that she was most welcome to return anytime and wished her luck as she left looking tired but definitely more relaxed.

Session Summary

In this session, Maggie, given the freedom to voice her emotional pain in an atmosphere of empathy, genuineness and unconditional positive regard, acknowledged that the expectations she was placing on herself were unrealistic and began to consider other ways of managing her new life.

The person-centred approach to counselling in this initial session was well suited to a client such as Maggie, who could articulate and explore her feelings associated with the loss of her marriage and future uncertainty.

The key concepts of person-centred therapy applied in this session were:

• Creating a nondirective and growth-promoting climate wherein the client feels nurtured and respected.
• A congruent and empathic approach by the counsellor that emphasises and promotes self-worth and empowerment, encouraging clients to find answers that are congruent with their own values and beliefs.

In this section of the module you have learned about the key concepts and techniques of person-centred therapy. While this knowledge will better equip you to understand its application from both a theoretical and practical perspective, it is important to understand that person-centred counselling is a complex approach. Students who have developed an interest in this approach to counselling are encouraged to seek out further training and skill development to broaden their understanding and enhance their practice capabilities.

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