User:MothyHarvard/Person-centered therapy

Person-centred Therapy (also known as Client-centred Therapy, particularly in the US) is a non-directive form of psychotherapy that aims to facilitate a more effective self-actualization  process so that the individual’s innate potential for personal growth can be realised, towards a state of greater authenticity. It seeks to provide the circumstances for the client to more freely and clearly articulate, from their own phenomenological viewpoint, their troubling thoughts and emotions. This is intended to stimulate the ‘cognitive reappraisal of experiencing, which facilitates a loosening and readjustment of the client’s emotional / affective states in relation to their experience’.

Person-centred Therapy is defined by a number of features including:
 * a focus on the depth of the therapeutic relationship ,
 * confidence in the client’s innate (biological) capacity to self-actualise towards constrictive personality change,
 * a commitment to work with the client’s current experiencing, including emotions, and from their own phenomenological perspective – the client is the expert,
 * a non-directive respect for the clients’ autonomy and a refusal to dominate or direct any interactions with the client,
 * the participation of the therapist’s whole, genuine, person,
 * the lack of assessment, diagnosis, or the application of specific treatment techniques.

Person-centered Therapy has proven to be an effective and popular treatment.

Origins, Influences and History
Person-centred Therapy was developed by Carl Rogers in the 1940’s and 1950’s, and brought to public awareness largely through his highly influential book, ‘Client-centred Therapy’, published in 1952. Its underlying theory arose from the results of research, and it was the first theory of therapy to be research-driven, with Rogers at pains to reassure other theorists that ‘the facts are always friendly’. Originally called non-directive therapy, it ‘offered a viable, coherent alternative to Freudian psychotherapy. …he redefined the therapeutic relationship to be different from the Freudian authoritarian pairing’.

Person-centred Therapy is often described as a humanistic therapy, but its main principles appear to have been established before those of humanistic psychology. Arguably, ‘…it does not in fact have much in common with the other established humanistic therapies’. Despite the importance of the self to person-centred theory, the theory is fundamentally organismic in nature, embracing the full person, with the individual’s unique self-concept at the centre of the unique ‘sum total of the biochemical, physiological, perceptual, cognitive, emotional and interpersonal behavioural subsystems constituting the person’.

Rogers coined the term counselling in the 1940s because at that time only medical practitioners were allowed to use the term psychotherapy to describe their work.

Person-centered Therapy has demonstrated effectiveness with all types of mental distress/illness  and has blossomed into a number of different variants and ‘tribes’, including a highly non-directive ‘classical’ version, experiential approaches, focussing,, emotion-focussed therapies and brief therapies. Person-centred theory also has parallels to Existential Therapy, Buddhist/Zen therapies, mindfulness and [positive psychology] which builds on the growth paradigms of Maslow and Rogers. Other contributions to other fields include and increased recognition of social and environmental factors in respect to mental health, and the importance of client factors and relationship factors to therapeutic outcomes, rather than the influence of specific ‘treatments’.

Many tenets of person-centred theory have been accepted by other styles of therapy, to varying degrees. Irvin Yalom noted in 1995 that Rogers’ ‘fought many battles’ to change the attitudes of fellow therapists, but that ‘Today, a half century later, Rogers’ therapeutic approach seems so right, so self-evident, and so buttressed by decades of psychotherapy research…’. The impact of Carl Rogers’ person-centred theory across the field has been such that he has been voted the most influential psychotherapist.

The term ‘person-centred’ has also been widely adopted beyond ‘Rogerian’ therapies (e.g. education, training, parenting advice, conflict resolution and healthcare management), although the radical, non-directive, nature of the person-centred approach is often largely absent in such settings, with many co-opters of the term remaining largely ignorant of the full scope and implications of the person-centred approach.

Rogers’ development of Person-centred theory was greatly influenced by phenomenology and existentialism, rather than the [Romanticism] that largely underpins humanistic philosophies.

Person-centred Therapy’s phenomenological basis, leads practitioner to approach therapy from within the individual Lebenswelt (life-world ) of the client. In this sense the unique self (of the client) is absolutely central to Person-centred Therapy. Rogers drew attention to the phenomenological basis of his theory of personality and behaviour in 1951 : ‘This theory is basically phenomenological in character and relies heavily on the concept of the self as an explanatory construct. It pictures the endpoint of personality development as being a basic congruence between the phenomenal field of experience and the conceptual structure of the self…. (Rogers, 1951, p.532).

Although Rogers did not regard himself as a phenomenologist, Person-centred Therapy has been described by existential therapist Ernesto Spinelli as ‘clinical phenomenology’. Another key philosophical influence on Person-centred Therapy is existentialism, which also has a phenomenological outlook, being concerned with how individuals subjectively construe meaning from a world that is acknowledged as godless, and meaning-free. In both existentialism and Person-centred theory the self is ‘relational’; it can only be established, developed or comprehended within the context of relationships with others.

=Person-centred Theory=

The Actualizing Tendency
Person-centred Therapy aims to utilise the client’s actualizing tendency: an organism’s innate tendency to maintain order, heal and flourish in the right conditions. This is therefore a ‘growth’ model of mental wellbeing, in contrast to the diagnosis-treatment paradigm that defines the medical model. Rogers articulated this outlook in 1942 : ‘Therapy is not a matter of doing something to the individual, or of inducing him to do something about himself. It is instead a matter of freeing him for normal growth and development, of removing obstacles so that he can again move forward’. Rogers affirmed the individual's personal experience as the basis and standard for both everyday living and therapeutic effect, and that therapeutic progress is essentially the accomplishment of the client.

Rogers’ Theory of Therapy, Personality and Interpersonal Relationships – the ‘19 Propositions’
The most comprehensive exposition of Rogers’ theory of personality, behaviour and psychopathology was presented in 1959. In this view, the person and the ‘self’ is a fluid, ongoing, actualizing process, rather than a fixed entity. The self-concept’s fluidity is responsive, and adaptive, to environmental influences (including thoughts and emotions) but as such is vulnerable to introjected ‘conditions of worth’ from significant others, which can produce incongruence and lead to psychological distress. In the presence of the right conditions – the 6 necessary and sufficient conditions – there is capacity to recover and grow. The 19 propositions address the following aspects:
 * the emergence and infancy of the self,
 * an individual’s deep need for the positive regard of significant others,
 * the development and importance of positive self-regard,
 * how conditions of worth arise,
 * the emergence of incongruence between experience and self ,
 * how the self-concept defends itself- by distorting or denting experience,
 * how the self-concept can become less integrated,
 * how the self-concept can become better integrated / coherent.

Common Conditions of Worth
Examples of conditions of worth include: Do as you are told Don’t cry Don’t get angry Put other people first Only trust family Observe religious rituals Keep quiet Be the best at everything

Rogers’ Definition of Self
Carl Rogers was one of the first psychologists to focus on the self as an important aspect of personality and psychopathology. To Rogers, a central aspect of the self was its fluid, adaptive nature, constantly evolving and as much in a state of flux as anything else in life. This was an orgasmic notion of ‘self’ which continually actualized (developed, maintained and reconfigured) as did the body’s tissues.

Rogers used the term ‘self’ in two main ways. Firstly, there is the infant’s emerging self (or developing self), which may be taken to represent what is commonly called the individual, or ‘the inner, experiencing person with reflective consciousness’. Rogers used the term ‘self-experience’ for this awareness of being. This differentiation of the self was held to occur largely through the infants interactions with parents and significant others. In 1959 Rogers defined emerging/ developing self as: ‘…the organized, consistent conceptual gestalt composed of perceptions of the of the characteristics of the ‘I’ or ‘me’ and the perceptions of the characteristics of the ‘I’ or ‘me’ to others and to various aspects of life, together with the values attached to these perceptions. It is a gestalt which is available to awareness though not necessarily in awareness’. (Rogers, 1959, p.200).

Secondly, Rogers speaks of a ‘self-concept’ which can be regarded as how one sees oneself. It is the alignment, or misalignment, of this self-concept with one’s experiencing that has the potential to lead to anxiety states and mental distress. In 1951 Rogers’ described the self-concept as: ‘…an organized configuration of perceptions of the self which are admissible to awareness. It is composed of such elements as the perceptions of one’s characteristics and abilities; the precepts and concepts of the self in relation to others and to the environment; the value qualities which are perceived as associated with experiences and objects; and the goals and ideals which are perceived as having positive or negative valence. It is, then, the organised picture, existing in awareness either as figure or ground, of the self and the self-in-relationship, together with the positive or negative values which are associated with those qualities and relationships, as they are perceived as a existing in the past, present, or future’. (Rogers, 1951, p. 501).

This self-concept includes the ‘ideal self’, that the person sees themselves being if this ever becomes attainable. Somewhere between the current self-concept and the ideal self lies the ‘fully functioning person’, who’s self-concept always accurately symbolises their self-experiences (who is free of mental distress in terms of the future (e.g. anxieties) or the past (e.g. depression), is confident in the present moment, feels at ease with themselves, and can be regarded as being on their way towards their aspirational ideal self.

Psychopathology
In person-centred theory human beings have a need for the positive regard of those close to them, and also positive regard towards themselves (Koch, 1959). Positive self-regard allows the individual to have confidence in their own perceptions, responses, and ideas. A ‘fully-functioning’ person, therefore, has a locus of evaluation that is highly internalised. If warmth and acceptance are withheld from significant others, or are hs conditional upon certain ‘approved’ behaviours, then the individual’s locus of evaluation can become highly externalised, as their sense of self-regard becomes more dependent upon conformance to the conditions of worth that have been introjected by others.

Where these conditions of worth are significantly at odds with the individual’s own actualizing tendency, then the individual will find difficulty in integrating experiences into their self-concept if these experiences seem to be incompatible with their sense of self. Their self-concept (their view of themselves), warped by conditions of worth, will either distort these experiences so that they better fit the individual’s self-concept, or will deny the experience from conscious awareness.

These defence mechanisms – distortion and denial – are the means by which psychological distress sets in, with the individual struggling to adequately process their experience (even over a short period, as with trauma). If these defence responses become overloaded, this can lead to a dis-integration, perhaps evidenced by psychotic states. Rogers held that this process of defending an incongruent self-concept accounts for: ‘…not only the behaviours customarily regarded as neurotic – rationalization, compensation, fantasy, projection, compulsions, phobias and the like – but also some of the behaviours customarily regarded as psychotic, notably paranoid behaviours and perhaps catatonic states.’

Assessment in Person-centred Therapy
While Person-centred therapy does not call for a diagnosis (and regards diagnosis as potentially harmful for the client), therapists assess whether they are confident that they can establish a therapeutic relationship built around his 6 'necessary and sufficient conditions'. Reference might also be made to the client’s stage/s of process as broadly indicated by Rogers’ Process Conception of Psychotherapy. Such assessment will usually take place gradually, and will not be formalized as a preliminary interview. No diagnosis is provided.

Rogers' 6 ‘Necessary and Sufficient Conditions’ for Therapeutic Change
In a paper published in 1957 Rogers presented the factors that, based on his research and experience, he regarded as both necessary and sufficient to facilitate therapeutic personality change. These were offered for discussion as an observation-based hypothesis: ‘As I have considered my own clinical experience and that of my colleagues, together with the pertinent research which is available, I have drawn out several conditions which seem to me to be necessary to initiate constructive personality change, and which, taken together, appear to be sufficient to inaugurate that process. As I have worked on this problem I have found myself surprised at the simplicity of what has emerged. The statement which follows is not offered with any assurance as to its correctness, but with the expectation that it will have the value of any theory, namely that it states or implies a series of hypotheses which are open to proof or disproof, thereby clarifying and extending our knowledge of the field’. ‘For constructive personality change to occur, it is necessary that these conditions exist and continue over a period of time: No other conditions are necessary. If these six conditions exist, and continue over a period of time, this is sufficient. The process of constructive personality change will follow.
 * Two persons are in psychological contact.
 * The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
 * The second person, whom 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 empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client.
 * The communication to the client of the therapist's empathic understanding and unconditional positive regard is to a minimal degree achieved.

For the purposes of this paper, Rogers defined ‘constructive personality change’ as: ‘change in the personality structure of the individual, at both surface and deeper levels, in a direction which clinicians would agree means greater integration, less internal conflict, more energy utilizable for effective living; change in behavior away from behaviors generally regarded as immature and toward behaviors regarded as mature’.

Rogers’ 1957 paper was a radical challenge to the medical model in mental health (the idea that there must be specific illnesses and specific treatments for each), Rogers commented that: ‘Probably no idea is so prevalent in clinical work today as that one works with neurotics in one way, with psychotics in another; that certain therapeutic conditions must be provided for compulsives… etc. Because of this heavy weight of clinical opinion to the contrary, it is with some “fear and trembling” that I advance the concept that the essential conditions of psychotherapy exist in a single configuration, even though the client or patient may use them very differently’.

To Rogers, it was the qualities of the therapeutic relationship that could facilitate change for the client: ‘… the therapeutic relationship is seen as a heightening of the constructive qualities which often exist in part in other relationships, and an extension through time of qualities which in other relationships tend at best to be momentary’.

A further inference drawn by Rogers was that If the crucial factor in therapy was the quality of the relationship, then therapy need not be provided by a highly trained or experienced specialist, undertaking assessment, diagnosis and then applying treatments. ‘It is not stated that special intellectual professional knowledge—psychological, psychiatric, medical, or religious—is required of the therapist.’ Not only was it the relationship that facilitated therapy, but assessment and diagnosis was often more trouble than it was worth:  ‘It is not stated that it is necessary for psychotherapy that the therapist have an accurate psychological diagnosis of the client. Here too it troubles me to hold a viewpoint so at variance with my clinical colleagues. When one thinks of the vast proportion of time spent in any psychological, psychiatric, or mental hygiene center on the exhaustive psychological evaluation of the client or patient, it seems as though this must serve a useful purpose insofar as psychotherapy is concerned. Yet the more I have observed therapists, and the more closely I have studied research such as that done by Fiedler and others, the more I am forced to the conclusion that such diagnostic knowledge is not essential to psychotherapy. It may even be that its defense as a necessary prelude to psychotherapy is simply a protective alternative to the admission that it is, for the most part, a colossal waste of time. There is only one useful purpose I have been able to observe which relates to psychotherapy. Some therapists cannot feel secure in the relationship with the client unless they possess such diagnostic knowledge’

Condition 1: Psychological Contact
Reflecting the central importance of human relationships to the development of personality, Rogers stated: I am hypothesizing that significant positive personality change does not occur except in a relationship… All that is intended by this first condition is to specify that the two people are to some degree in contact, that each makes some perceived difference in the experiential field of the other. Probably it is sufficient if each makes some “subceived” difference, even though the individual may not be consciously aware of this impact. Thus it might be difficult to know whether a catatonic patient perceives a therapist's presence as making a difference to him—a difference of any kind—but it is almost certain that at some organic level he does sense this difference….’

Condition 2: Client Incongruence
Rogers took pains to explain this concept: ‘Incongruence is a basic construct in the theory we have been developing. It refers to a discrepancy between the actual experience of the organism and the self picture of the individual insofar as it represents that experience. Thus a student may experience, at a total or organismic level, a fear of the university and of examinations which are given on the third floor of a certain building, since these may demonstrate a fundamental inadequacy in him. Since such a fear of his inadequacy is decidedly at odds with his concept of himself, this experience is represented (distortedly) in his awareness as an unreasonable fear of climbing stairs in this building, or any building, and soon an unreasonable fear of crossing the open campus. Thus there is a fundamental discrepancy between the experienced meaning of the situation as it registers in his organism and the symbolic representation of that experience in awareness in such a way that it does not conflict with the picture he has of himself. In this case to admit a fear of inadequacy would contradict the picture he holds of himself; to admit incomprehensible fears does not contradict his self concept.

‘Another instance would be the mother who develops vague illnesses whenever her only son makes plans to leave home. The actual desire is to hold on to her only source of satisfaction. To perceive this in awareness would be inconsistent with the picture she holds of herself as a good mother. Illness, however, is consistent with her self concept, and the experience is symbolized in this distorted fashion. Thus again there is a basic incongruence between the self as perceived (in this case as an ill mother needing attention) and the actual experience (in this case the desire to hold on to her son).

When the individual has no awareness of such incongruence in himself, then he is merely vulnerable to the possibility of anxiety and disorganization. Some experience might occur so suddenly or so obviously that the incongruence could not be denied. Therefore, the person is vulnerable to such a possibility. If the individual dimly perceives such an incongruence in himself, then a tension state occurs which is known as anxiety. The incongruence need not be sharply perceived. It is enough that it is subceived—that is, discriminated as threatening to the self without any awareness of the content of that threat. Such anxiety is often seen in therapy as the individual approaches awareness of some element of his experience which is in sharp contradiction to his self concept’.

Rogers used the term ‘subceived’ to describe experience that was not repressed as such (in the Freudian sense, which Rogers rejected) but yet fully articulated and made sense of. Clinical psychologist Jordan Peterson has described this ‘subceived’ experience as follows: ‘Everything that makes you emotional, those are the things that aren’t dealt with yet, they haven’t been articulated. You don’t have a strategy, you don’t have a full, developed, representational system; that’s why its still emotional. So its like your mind and body come up with emotional representations first, and as you work through them (which means to talk a out them, essentially) strategically – they don’t even turn into words before you do that’.

Condition 3: Therapist Congruence
The first of what later became known as the 3 ‘core conditions’, Rogers hypothesized that: ‘…the therapist should be, within the confines of this relationship, a congruent, genuine, integrated person. It means that within the relationship he is freely and deeply himself, with his actual experience accurately represented by his awareness of himself. It is the opposite of presenting a facade, either knowingly or unknowingly…  It should be clear that this includes being himself even in ways which are not regarded as ideal for psychotherapy. His experience may be “I am afraid of this client” or “My attention is so focused on my own problems that I can scarcely listen to him.” If the therapist is not denying these feelings to awareness, but is able freely to be them (as well as being his other feelings), then the condition we have stated is met’.

Condition 4: Unconditional Positive Regard
Strongly implying a non-directive attitude from the therapist, Rogers hypothesized that the therapist’s attitude would need to be totally accepting and non-judgmental of the client and his situation, attitudes, actions etc: ‘To the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client's experience as being a part of that client, he is experiencing unconditional positive regard… It means that there are no conditions of acceptance, no feeling of “I like you only if you are thus and so.” It means a “prizing” of the person, as Dewey has used that term. It is at the opposite pole from a selective evaluating attitude—“You are bad in these ways, good in those.” It involves as much feeling of acceptance for the client's expression of negative, “bad,” painful, fearful, defensive, abnormal feelings as for his expression of “good,” positive, mature, confident, social feelings, as much acceptance of ways in which he is inconsistent as of ways in which he is consistent. It means a caring for the client, but not in a possessive way or in such a way as simply to satisfy the therapist's own needs. It means a caring for the client as a separate person, with permission to have his own feelings, his own experiences. One client describes the therapist as “fostering my possession of my own experience … that [this] is my experience and that I am actually having it: thinking what I think, feeling what I feel, wanting what I want, fearing what I fear: no ‘ifs,’ ‘buts,’ or ‘not reallys.’

Condition 5: Empathic Understanding
This is the third of what became known as the ‘core conditions’, and was described as follows: ‘To sense the client's private world as if it were your own, but without ever losing the “as if” quality—this is empathy, and this seems essential to therapy. To sense the client's anger, fear, or confusion as if it were your own, yet without your own anger, fear, or confusion getting bound up in it, is the condition we are endeavoring to describe. When the client's world is this clear to the therapist, and he moves about in it freely, then he can both communicate his understanding of what is clearly known to the client and can also voice meanings in the client's experience of which the client is scarcely aware. As one client described this second aspect: “Every now and again, with me in a tangle of thought and feeling, screwed up in a web of mutually divergent lines of movement, with impulses from different parts of me, and me feeling the feeling of its being all too much and suchlike—then whomp, just like a sunbeam thrusting its way through cloudbanks and tangles of foliage to spread a circle of light on a tangle of forest paths, came some comment from you. [It was] clarity, even disentanglement, an additional twist to the picture, a putting in place. Then the consequence—the sense of moving on, the relaxation. These were sunbeams.”’

Rogers also noted that research had indicated the importance of the following factors:
 * The therapist is well able to understand the patient's feelings.
 * The therapist is never in any doubt about what the patient means.
 * The therapist's remarks fit in just right with the patient's mood and content.
 * The therapist's tone of voice conveys the complete ability to share the patient's feelings.

Condition 6: Client Perception of Therapist Regard and Empathy
Further emphasizing the importance of the relationship, Rogers hypothesized that: ‘Unless some communication of these attitudes has been achieved, then such attitudes do not exist in the relationship as far as the client is concerned, and the therapeutic process could not, by our hypothesis, be initiated’.

Adoption of Conditions 3, 4 and 5 by Other Types of Psychotherapy
The 3 ‘core’ conditions have been widely incorporated into other modalities of psychotherapy, but Rogers highlighted the risk that their attempted application alongside traditional, directive techniques could reduce their beneficial influence: ‘just as these techniques may communicate the elements which are essential for therapy, so any one of them may communicate attitudes and experiences sharply contradictory to the hypothesized conditions of therapy. Feeling may be “reflected” in a way which communicates the therapist's lack of empathy. Interpretations may be rendered in a way which indicates the highly conditional regard of the therapist. Any of the techniques may communicate the fact that the therapist is expressing one attitude at a surface level, and another contradictory attitude which is denied to his own awareness.’.

Non-directivity and Client Power
Often seen as the primary fundamental precept of Person-centred Therapy, the concept of non-directivity has attracted controversy and misunderstanding, It is based on respect for the unique existential and phenomenological perspective of the client: ‘Nondirective counselling is based on the assumption that the client has the right to select his own life goals, even though these may be at variance with the goals his counsellor might choose for him. There is also the belief that if the individual has a modicum of insight into himself and his problems, he will be likely to make this choice wisely’ (Wilkins, 2016). Therapy continues only so long as the client wants, and terminates at a point chosen by the client. In practice non-directivity is an active process, requiring well-developed attitudes and skills, and the ability to conduct the entire relationship from within the client’s phenomenological frame of reference. While some practitioners aim to implement a total, ‘principled non-directivity’, many are happy to practice what has been called ‘instrumental non-directivity’ (Wilkins, 2016) - i.e. to be mildly directive to the extent that this does not disrupt or divert the client’s mental flow and sense of control. Such therapists might ’sometimes offer process suggestions, proposing in a non-imposing way that the client try engaging in particular in-session activities, such as turning attention inside or saying something to an imagined person or self-aspect in the other chair'.

Rogers’ Process Conception of Psychotherapy and the ‘Fully-functioning Person’
Rogers proposed (Rogers, 1961, pp.125-159) that an individual’s ‘process’ (roughly, their capacity for efficient self-actualization) can be graded, albeit imprecisely, along a continuum, from a highly ‘fixed’, pathological state (Stage 1) to the much more fluid, self-actualization of the ‘fully-functioning person’ (Stage 7). The characteristics defined at each Stage are largely phenomenological in nature, based on his experience with clients, and Rogers noted that people with highly fixed process (e.g. Stage 1 or 2) might be unlikely to acknowledge any need for therapy. Although intended only for guidance purposes, and acknowledged as imperfect, this 7 Stage model has been criticized for the arbitrary nature of some of its classifications, for implying staged improvement rather than continued progress during therapy, and for emphasizing a linear pattern of progress instead of the freeing up of a the psychological process (Tudor and Worrall, 2006). The parameters of change along this continuum are:
 * A loosening of feelings,
 * A change in the manner of experiencing,
 * A shift from incongruence to congruence,
 * A change in the manner and extent of communication,
 * A loosening of the cognitive maps of experience,
 * A change in the individual’s relationship to his problems.
 * A change in the manner of relating. (Tudor and Worrall, 2006).

A fully functioning person displays what Rogers calls ‘maturity’, in their value systems:
 * ‘they tends to move away from facades…
 * they tend to move away from ‘oughts’…
 * they tend to move away from the meeting the expectations of others…
 * being real is positively valued…
 * self-direction is positively valued…
 * one’s self, one’s own feelings come to be positively valued…
 * being a process is positively valued…
 * deep relationships are positively valued…
 * perhaps more than all else, the client comes to value an openness to all of his inner and outer experiences…’

Characteristics of a Healing Relationship – Rogers' 10 ‘Can I’ Questions
Another influential contribution to the field was Rogers’ paper titled The Characteristics of a Healing Relationship in which he asked, and commented upon, 10 ‘Can I?’ questions of those wishing to help those in psychological distress:
 * Can I be in some way which will be perceived by the other persons as trustworthy, as dependable or consistent in some deep sense?
 * Can I be expressive enough as a person that what I am will be communicated unambiguously?
 * Can I let myself experience positive attitudes toward another person’s attitudes of warmth, caring, liking, interest, and respect?
 * Can I be strong enough as a person to be separate from the other?
 * Am I secure enough within myself to permit him his separateness? Can I permit him to be what he dishonest or deceitful, infantile or adult, despairing, or overconfident? Can I give him the freedom to be?
 * Can I let myself enter the world of his feelings and personal meanings and see these as he does?
 * Still another issue is whether I can be acceptant of each facet of the other person, which he presents to me. Can I receive him as he is?
 * Can I act with sufficient sensitivity in the relationship that my behavior will not be perceived as a threat?
 * Can I free him from the threat of external evaluation?
 * Can I meet this other individual as a person who is in the process of becoming, or will I bound by his past and by my past?

Barriers and Gateways to Communication
Rogers believed that all relationships could benefit from the application of person-centred principles. In a 1952 paper for the Harvard Business Review he challenged the reader: ‘Here’s one way to test the quality of your understanding. The next time you get into an argument with your spouse, friend, or small group of friends, stop the discussion for a moment and suggest this rule: “Before each person speaks up, he or she must first restate the ideas and feelings of the previous speaker accurately and to that speaker’s satisfaction’’.

=Evidence for the Effectiveness of Person-centre Therapy= Although the efficacy and efficiency of Person-centred Therapy has always been supported by research (Wilkins, 2016), the pace of research has accelerated since Rogers’ death in 1987.

Person-centred Therapy has been confirmed by a large body of research to be ‘as effective and efficacious as other humanistic and non-humanistic therapy’. Cooper (2008) notes that Person-centred Therapy has been found, in UK primary care, to be as effective as CBT and psychodynamic therapies for a range of psychological problems, being particularly effective for those with mild to moderate depression.

Challenges of Research
Comparisons between modalities of psychotherapy is difficult, partly because researcher allegiance is notoriously difficult to control for. For example a number of studies whose results appeared to compare other modalities (e.g. CBT) favourably with Person-centred Therapy have in fact used a watered-down interpretation of Person-centered Therapy (often inaccurately labelled ‘Rogerian’, humanistic, non-directive or supportive therapy). Wampold and Imel (2015) note that: ‘…such ‘treatments’ are neither treatments nor humanistic. Anyone who has studies Rogers or watched videos of his work will understand that these ‘common factor’ treatments do not resemble what Rogers discussed and what Rogers did in therapy’. Other difficulties include reconciliation of manualized approaches with non-manualized ones, and of outcomes in growth-model modalities versus medical / deficit model approaches.

Research Findings
A large body of research has demonstrated that in general Person-centred Therapy is as effective as other modalities. Key findings have included :
 * Although specific treatments can be effective for specific dysfunctions, it is the quality of the therapeutic relationship that is most significant to outcomes (Bozarth,1998).
 * Person-centred Therapy is as effective as CBT, if researcher allegiance is controlled for (Elliot et al, 2004).
 * Empathy plays an important role in therapy (Norcross, 2002).
 * Person-centred Therapies are ‘clinically and statistically equivalent to other therapies’ . They are associated with high levels of positive change in clients; and these gains are well-maintained over time (Elliott and Friere, 2008).
 * Meta-analyses of previous studies support the effectiveness of Person-centred Therapies (Elliott and Friere, 2010, and Elliott, 2013).

=Criticisms and Misunderstandings= Person-centred Therapy and theory continue to be widely misunderstood by therapists of other orientations, although the majority of criticisms have been shown to arise from such misunderstandings, perhaps reflecting the radical nature of the approach. It has been suggested that the more radical aspects of Person-centred Therapy have been perceived by some in other orientations as threatening to cherished axioms, and person-centred therapists have been less active in promoting and defending their orientation like other orientations have (as arguably might have happened if there was a central professional body, which many do not want). Historically, common criticisms have included :
 * An overly positive / optimistic view of human nature,
 * An over-reliance on life’s actualizing tendency,
 * Excessive focus on self-esteem and encouragement of narcissism,
 * Denial of evil,
 * Non-directivity is a denial of responsibility,
 * ‘Reflection’ is the sole therapist input,
 * An insufficient theoretical coverage of development, personality and psychopathology,
 * Lack of research,
 * Over-reliance on empathy,
 * Good for the ‘worried well’ only,
 * Disregard for assessment
 * The therapeutic conditions are no sufficient,
 * Ignoring issues of transference.