Instructions for Beginning to
Practice Client-Centered Therapy
Barbara Temaner Brodley, Ph.D.
Illinois School of Professional Psychology, Chicago
Client-centered therapy is a therapy based on attitudes. Unlike other
therapies its essence involves the implementation of therapeutic attitudes
congruence, unconditional positive regard and empathic understanding (Rogers
1957; 1959), not the diagnosis of disorders and subsequent application
of treatments. The client-centered therapist's behavior is guided by a
philosophy of persons and by her/him holding the therapeutic attitudes
in relationship with a client; it is not an application of techniques.
Nevertheless, for the very beginner, it is usually helpful in learning
the approach to start behaving like a client-centered therapist before
the philosophy and the therapeutic attitudes have been understood and assimilated
well enough to guide the therapist's practice. Instructions concerning
what to try to do and what to try not to do may be useful in that they
help the student to enter into a relationship and to experience and to
observe some of both the client's and the student's actions and reactions.
Such experiences can help the student to understand the client-centered
philosophy of persons, the therapeutic attitudes and some of the benefits
to clients in a personal and experiential way.
It may, however, smack of "applying techniques" to behave like a client-centered
therapist before being guided by the therapeutic attitudes. Thus, introductory
instructions, such as these which follow, risk stimulating misunderstandings
of client-centered work.
These instructions are only an introductory way to experience a client-centered
relationship. Study of and reflection upon client-centered philosophy of
persons and the therapeutic attitudes are essential for developing a true
client-centered way of practicing. This should be kept in mind when employing
the instructions because of the hazard they bring of confusing client-centered
work with application of techniques.
These instructions may be validly useful and not be misleading only
if they are used while you are learning about the philosophy, the values
and the therapeutic attitudes that are the essence of client-centered work.
The basic situation for which these instructions are intended is one
in which a speaker (client) is explaining or expressing some personal concern,
problem or symptom s/he currently experiences to a listener (therapist).
The listener (therapist)in the situation attends to the speaker (client)
and attempts to understand the speaker from the perspective of the speaker's
internal frame of reference. This intention, to attempt to understand a
speaker from the speaker's perspective, is what is called "empathic understanding"
in client-centered work.
Empathic understanding is fundamentally a subjective experience on the
part of the listener (therapist). It is a subjective and tentative understanding
of thoughts and feelings that are being expressed by a speaker. Empathic
understanding can only be tentative understanding unless or until it is
confirmed by a speaker.
The attentive listener (therapist) absorbs the client's communications
and personal expression and, at some point, comes to have a feeling of
understanding the client. From time to time, then, the listener needs to
articulate her/his felt understandings to find out from the speaker whether
or not they are accurate according to the speaker. The speaker is the only
possible judge concerning what s/he has been meaning or intending to express
and communicate.
The listener's articulations of felt understandings along with expressive
intonations and gestures are often called "reflections of feeling' or "empathic
understanding responses" in client-centered work. They are usually expressed
in the form of declarative statements. Although empathic responses are
usually in the form of statements, they are always implicit questions addressed
to the speaker. They implicitly ask the speaker "Is this what you have
been telling me?", or or "Do I understand you correctly?".
Empathic responses in client-centered work are almost always expressed
with the sole intention to check or verify the accuracy of the listener's
empathic understandings (Rogers, 1986). They are offered by the therapist
to give the client the opportunity to confirm, reject or qualify them.
The Instructions
Listen to the client. Try to do the following:
-
Absorb the meanings the client is expressing to you. Ask yourself to give
your full attention to the client and to what the client is saying to you.
What is the client succeeding in "getting at", or what is the client
trying to "get at"?
-
When you express your tentative understanding, think of yourself as trying
to check whether or not you have understood. This tentativeness may be
expressed by your intonation, or you might initiate your empathic response
with an introductory statement that communicates your tentativeness and
your interest in the client's assessment of your accuracy of understanding.
Examples of introductory statements are "Is this right..?", or "Are you
saying..?" or "Is this a correct understanding right now?...." or "I think
I understand, is this what you mean?...". You might use an assertive form
of introduction to your empathic response, although it should be in a tentative
spirit, such as "You are feeling...." or "You want to....." or "You are
telling me that...".
-
Avoid introductions to your empathic responses which suggest you are trying
to interpret the client or that your task is to find or elicit "deeper"
meanings in what the client is expressing. Introductions which sometimes
create such misunderstandings are "I sense you are feeling...", or "You
sound like you.....".
-
In your responses that are intended to express the client's point of view,
frame of reference, perspective on things, perceptions, feelings and other
reactions about things, stay entirely within the client's frame of reference.
Try to grasp, as you listen, the client's perspective or viewpoint with
the meanings and feelings that are the client's at that time. Try to absorb
those things into yourself in order to reach a feeling of understanding,
without the reservations and interference of skepticism or criticism. Put
aside any doubts or critical feelings about the client's statements and
try to understand the client's point of view and feelings.
-
If you don't understand what the client has been expressing to you - perhaps
your thoughts were distracting you, or perhaps the client's communication
was eluding you at the time - simply say you haven't understood yet, and
ask the client if s/he would repeat or say in a different way what s/he
was expressing.
-
Allow your client to initiate the next response after you make an empathic
understanding response. Allow silence. Relax and give yourself and your
client a chance to think and feel further to reflect upon the experiences
that are being expressed between you.
-
If your client asks you a question (a) give yourself a chance to absorb
the question, (b) ask for further clarification of the question if you
need it, (c) respond to the question in a direct, person-to-person manner.
This means different things, depending upon the nature of the question,
your own knowledge and expertise in regard to different matters, your own
personal feelings about self-disclosure and personal feelings about expressing
opinions. In any case, to respond to a question in a direct, person-to-person
manner means one does not avoid the question or treat the client as the
issue for asking a question. Depending on the factors mentioned above you
may literally answer the question, you may say you "don't know the answer
to that question", you may say you don't feel comfortable trying to answer
that type of question, you may say you don't feel comfortable telling such
personal things, or you may say something that is a general answer to the
question but also demur because do not know the general answer applies
in the present situation. After responding in some way directly to the
client's question you may want to check as to the client ' faction or dis-satisfaction
with your response. It is also possible to respond to questions directly
and, in addition, express an empathic response in respect to the feelings,
concerns or perspectives that seem to spark the question. Responding to
the feelings behind a question, however, should not be a means of avoiding
the question.
-
In setting up a practice client session early on in your learning it may
be easier to ask the client to defer questions until after the practice.
This may be best for you because the process of responding to questions
in the context of empathic process, in a client-centered manner, is very
dependent upon having the therapeutic attitudes firmly developed in your
character. And because it is difficult, at an early stage, to respond to
a client's self-exploratory expression and to integrate that with responding
to questions.
-
Do not ask questions that are leading or probing questions. Examples of
typical leading or probing questions are "How do you feel about that?",
"Tell me more about......", "What do you think s/he would feel about that?",
"Can you tell me more about your relationship to....?". Also, do not ask
your client questions that involve assumptions or theories that are not
part of those expressed or clearly implied in what your client has been
saying. Examples of such interpretive probing questions are "Do you find
yourself waking up early and not being able to go back to sleep?", "Do
you remember how you felt about things when your brother was born?", "How
do you feel when someone has authority over you?", etc.
Of course, many empathic understanding responses may be literally in
the form of a question because you are wanting to find out if your subjective
empathic understanding is correct or not. And sometimes you will find you
need to ask a question for simple factual clarification. For example, "Did
you say that was your sister or your cousin?" or "Did you say you got home
late or that he got home late?" or "Did you mean 'now' in the sense of
'these days' or in the sense of 'right now' here with me?"
-
Do not volunteer interpretations of any kind.
-
Do not volunteer comments upon what the client has expressed.
-
Do not make a client's statement into a generality if it is specific and
do not make a client's statement into a specific if it is a generality,
unless that is what the client seems to be intending that you understand.
-
Do not abstract feelings or emotions from the content or Situation that
the client is expressing, unless the client's point is the feelings or
emotions.
-
Do not volunteer suggestions or guidance of any kind.
-
If your client indicates s/he feels stopped and doesn't know how to proceed
and asks for your help, a relatively non-directive response that is often
helpful is to say something such as "Sometimes, if one gives oneself a
bit more time, some thoughts or direction will come to mind". Or "I feel
there's no hurry, so if you can, try to let yourself relax to give yourself
a chance to see if something comes to you".
-
If your client says s/he doesn't have anything more to say about a topic
and doesn't know what to do now, and you have tried the approach above,
and the client ask for more help - then you may suggest s/he give her/himself
time to consider if there is some other topic s/he feels concern or worry
about. Or say "Sometimes it helps to think back over the concerns that
brought you in". We do not intend to avoid giving guidance or help in proceeding
in the interaction when the client requests it, but the best guidance is
usually the encouragement to take time and search the client's own experience
and thoughts.
-
Unless the client has lost her/his train of thought or forgotten what s/he
was saying and asks for help, do not prompt or remind the client.
Scattered thoughts and discontinuity of theme should be accepted in the
same manner as developed and coherent thought.
-
Do not integrate for the client (e.g., "That sounds like it may be related
to the problem you have with your mother"). Client-centered therapy often
results in integrations, but it is not the therapist's responsibility to
find or direct such connections.
-
Do not volunteer comments about the client's apparent feelings, state or
other experiences (e.g., "You seem to have a lot of emotions about that
topic", or "It seems you have an issue with abandonment or loss", or "You
are feeling pretty angry at me right now"). Of course, these examples may
be the same or similar to empathic responses, if the client has been expressing
any of these ideas. Self-objectification is one of the productive things
clients do in therapy, but the therapist's task is not to produce
that particular relation of the client to her/himself. Self-objectification
is a common reaction on the part of clients if the therapist volunteers
comments about the client's apparent experiences.
-
In general, try to orient yourself to the client as a whole person who,
like yourself, lives, acts and reacts in a world centered in her/his own
perceptions, motives and feelings. The client-centered therapist's interest
is in the client as a whole person, not as a complex of problems or symptoms.
The client's wholeness is represented by the client functioning as agent
in relationship to the therapist. The client chooses to enter the
situation, comes to the session, talks to the therapist,
and represents her/himself to the therapist. The client is the reason
for both of you being there and the primary source of what happens.
The client-centered therapist's respect for and trust in the client is
felt by the therapist and communicated to the client primarily by means
of the therapist's expression of interest in the client's representations
of her/his inner world, inner perspective and reactions to her/his world.
The client-centered therapist's presence, influenced by her/his
philosophy of persons, values (Bozarth & Brodley, 1986) and the therapeutic
attitudes and the therapist's behavior articulating empathic understandings
are the media for communication of the therapist's empathy, acceptance
and congruence in the particular relationship.
The instructions listed above are deliberately and rationally restrictive
in keeping with the fact that the therapeutic attitudes are, usually and
typically, communicated through the checking of felt understandings and
the therapist's presence.
There is more freedom for the therapist in client-centered work than
these introductory instructions suggest. Spontaneous responses from the
therapist's frame of reference occur in client-centered practice (Brodley,
1987). In a sample of therapeutic interviews conducted by Rogers, nine
percent (9%) of Rogers' responses were found to be other than empathic
understanding responses (Brodley & Brody, 1990; Brody, 1991).
Functioning consistently as a client-centered therapist, in some interviews
Rogers produced occasional, unsystematic comments, statements of agreement,
interpretations or asked probing questions. When they occur in Rogers'
interviews they can be seen to contribute to the overall sense of Rogers'
non-directive and empathic presence in relation to his clients. Nevertheless,
the client-centered therapeutic attitudes are successfully communicated
to clients for the most part by the combination of the expression of
understandings and the omission of many other forms of response
(which may, especially when systematic, convey attitudes which are different
from and contradictory to the client-centered therapeutic attitudes).
As you try to learn the client-centered approach, when you feel constrained
or inhibited by the instructions, it may be helpful to take a break and
practice with a co-counselor, giving yourself permission to "break the
rules" and make whatever responses you feel like making. It may also be
helpful to remind yourself that, in general, in the whole process of ongoing
interaction with another person - it is what one does not think,
feel and do along with what one does think, feel and do, that communicates
our attitudes, our intentions and our understandings to the other person.
References
Bozarth, J. D. & Brodley, B. T. (1986). The core values of the
person-centered approach. Paper presented at the First Annual Meeting of
the Association for the Development of the Person-Centered Approach (ADPCA),
at the University of Chicago, International House, in September, 1986.
Brodley, B.T. (1987). A client-centered psychotherapy practice.
Paper prepared for the Third International Forum on the Person-Centered
Approach, in La Jolla, California, August 7 to 14, 1987.
Brodley, Barbara T. & Brody, Anne, F. (1990). Understanding
client-centered therapy through interviews conducted by Carl Rogers. Paper
prepared for the panel Fifty Years of Client-Centered Therapy: Recent Research,
at the American Psychological Association Convention in Boston, Massachusetts,
August, 1990.
Brody, Anne F. (1991). A study of therapeutic interviews conducted
by Carl Rogers. Clinical Research Paper prepared for partial fulfillment
of the Doctor of Psychology degree at the Illinois School for Professional
Psychology, Chicago, Illinois.
Rogers, Carl R. (1957). The necessary and sufficient conditions
of therapeutic personality change. Journal of Consulting Psychology, 21,
95-103.
Rogers, Carl R. (1959). A theory of therapy, personality and
interpersonal relationships as developed in the client-centered framework.
In S. Koch (Ed.), Psychology: A Study of a Science. Vol III. Formulations
of the Person in the Social Context. New York: McGraw Hill.
Rogers, Carl R. (1986). Reflections of feelings. Person-Centered
Review, 1, 375-377.
Copyright 1991 Barbara T. Brodley.
Permission granted to distribute freely with copyright intact.
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