Client-centered therapy (CCT) is a psychotherapeutic approach that wasdeveloped by Carl Rogers (Berrett- Lennard, 1962). The method assumesthat the therapist is not an expert and his role is to guide a clienttowards self cure and eventually, self-actualization (Berrett-Lennard, 1962). The client centered theory remains an effectivemethod of treating patients with mental illnesses (Kirschenbaum &Jourdan, 2005). It has remained relevant in modern times and studiesare being conducted to improve its applicability and usage(Kirschenbaum & Jourdan, 2005). The wider application of thisapproach in the therapeutic setting provides us with the opportunityto explore this theory further Kirschenbaum & Jourdan, 2005).Evidence based research continues to support the applicability of themethod and its impact in treating patients of mental illnesses(Berrett- Lennard, 1962).The articles in this study werefound through Psyc INFO and Academic Search Premier, key words usedwere the working alliance, and client centered therapy, therapeuticrelationship, client’s feelings, and therapist response.
Theempirical studies available on the subject are limited and all thearticles from the onset of the therapy to current times will beconsidered and analyzed in order to offer an insightful approach tothe theory (Kirschenbaum & Jourdan, 2005). The purpose is to givean informed research about the theory in order to show itssignificance, contribution to therapy, and any knowledge gaps thatmay enhance its applicability in future. Thus, the aim is to provethe role of the theory in treating mental illnesses and how thetheory can be improved for future applications. This chapter focuseson showing the relevance of the client centered theory in treatingmental illnesses, its limitations, suggestions, and futureimprovements on research as will be discussed. There are threeimportant factors that will be discussed that can help or hinder theeffectiveness of client centered therapy the working alliance, thetherapist’s personality, and the client’s behavior.
Theresearch activities carried out wanted to establish how therelationship between the client and the therapist affected theprocess and outcome of the therapy.Theworking alliance is the therapeutic bond between the therapist andthe client (Horvath and Symonds (1991). This alliance is essential soas to have an effective relationship that facilitates therapy.Rogers, defined a positive therapeutic relationship as one where thetherapists promotes the growth of the clientand accepts them unconditionally (1958). An effective workingalliance takes places when the therapist is able to be accpeting,empathic, and congruent (Horvathand Symonds, 1991 Gerwood, 1993).Theworking alliance has been proven to play a key role in therapy asDupont et al, proved in their research activity (Dupont et al, 1953).The research investigated the importance of a healthy relationshipbetween the therapist and the client during therapy. This was done inorder to investigate the impact of the therapeutic alliance on ayoung boy who has speech and emotional disturbances (Dupont et al,1953).
Unlike,Dupont et al, (1953) who only studied the working alliance, Horvathand Symonds (1991) examined an additional component of the workingalliance, collaboration. The working alliance was also studied byHorvath and Symonds, who noted that an effective relationship is onewhere both client and therapist collaborate and negotiate taskstogether in order to have positive therapeutic outcomes (1991). Thepurpose of this study was to examine the relationship between theworking alliance and the therapeutic outcome. This study alsoexamined whether collaboration and negotiating treatment goals leadto a stronger therapeutic alliance. Both the client and therapistwork towards a significant goal (Horvath & Symonds, 1991). Thisshows that the client and the therapist are working towards a commonobjective and the client is motivated through the working alliance toachieve the objective.
Thestudy by Martin et al, (2000) was another study, created to establishwhether the working alliance had a great significance to thetherapeutic process. Martin et al, (2000) investigated theimportance of a working relationship and how best to establish it.Like Horvath & Symonds, 1991, Martin et al (2000), defined theworking alliance in terms of collaboration, therapeutic bond, and thenegotiation of treatment goals. The purpose for this study was alsoto determine the relationship between the working alliance and theclient’s outcome (Martin et al, 2000). A trusting environment isimportant to a working alliance as this is what lays the ground to aclose working relationship (Martin et al, 2000 Gerwood, 1993).Gerwood (1993), examined the importance of having a goodunderstanding between the therapist and the schizophrenic client. Theimportance of this study was to determine if therapeutic relationshipin client centered therapy would work with schizophrenic clients.This positive working alliance formed between the therapist andclient creates a positive environment, which enables the client tosuccessfully overcome his or her challenges (Gerwood, 1993). Apositive environment is created through a warm emotional andpsychological environment, where the therapist is completelyaccepting of the client.
Oneof the key aspects of an effective client centered therapy is a closetherapeutic alliance between the client and the therapist as shown byDupont, Landsman, and Valentine (1953). The researchers carried out aclinical case study, where they used qualitative analysis to studythe case of Johnny, a young boy, suffering from delayed speech. Theresearchers investigated the importance of a friendly environment,characterized by unconditional positive regard, in establishing aclose working alliance. Horvath and Symonds (1991) on the other hand,carried out a Meta analytic study that shed more light on the role ofa working alliance in client centered approach as they found out thata close working alliance led to significance strides made duringtherapy. This is because those clients who had a close relationshipwith the therapist tended to recover faster than those who took longto establish a relationship with the therapist. They carried out aliterature review of documented individual cases of person centeredtherapy, from four different sources being MedLine, Educationalresource information center, PsychoInfo, and Dissertation abstracts.These sources showed different perspectives by different observers ofthe significance of a working alliance. Similarly, Martin et al,(2000) used meta analytic method to investigate the importance of aclose working alliance in therapy. The meta analytic method was meantto show different aspects of the working alliance in therapy. On thecontrary, Gerwood (1993) used an empirical study, by qualitativeanalysis where he studied how therapists established a trustingrelationship with their clients, leading to a warm environment intherapy. The therapist established the relationship by beingunderstanding and attentive to what the client was saying. This waspreceded by a proper sampling process that chose suitable literature.
Horvathand Symonds (1991) sampled the literature of authors who had playeddifferent roles in CCT and observed its outcome based on severalcriteria. This include the author had to state his role in thetherapy session, the data had to have a quantifiable relationshipbetween the therapist and the client, the research had to includeclinical studies, and the reports had to have five or more client.This was to make sure that the sampled pool had a detailed analysisand comparison of clients so as to give a holistic understanding ofclient centered theory. On the other hand, Dupont, Landsman, andValentine (1953) sampled based on the history of the client. Theychose a client with no known mental or developmental problems. Thiswould give a reflection on the role of a strong working alliance inclient centered therapy. This is because it showed that the problemwas psychological and not mental or developmental. On the contrary,Martin et al, (2000) sampled through a historical analysis of theclient. The sampled materials were chosen based on their length ofexposure to therapy. Additionally, Gerwood, (1993) sampled works oftherapists who had worked directly with schizophrenic clients andstudied how they related with the clients through a working alliance.The sampling focused on schizophrenic clients who were undermedication.
Theworking alliance can also be of help when dealing with schizophrenicpatients. This is because the therapist has to have a strongtherapeutic relationship with the client so as to encourage him toexplore his deeper feelings (Gerwood, 1993). This was demonstrated byGerwood (1993) the researchers established that those therapists thatestablished a working alliance with the therapists tended to yieldmore success. This was a result of the therapist ability to have astrong therapeutic alliance with the client by being empathic,congruent, and accepting (Gerwood, 1993). In this, the independentvariable was the rate at which schizophrenic clients declined theiraggressive and defensive behavior. The dependent variable was thetherapeutic alliance, adhering to the core conditions (Gerwood,1993). Horvath and Symonds (1991) also studied the relationshipbetween the working alliance and the therapeutic outcome. Thedependent variable is the working alliance and the independentvariable is the therapeutic outcome. In Martin’s study, theindependent variables was also the therapeutic outcome and thedependent variable was the therapeutic alliance (Martin et al.,2000). On the other hand, in Dupont et al’s article, the dependentvariable was the client’s delayed speech while the independentvariable was the therapeutic relationship. The variables seemed tofocus on the measuring scales and clients.
Dupont,Landsman, and Valentine (1953) and Gerwood (1993) found out that awarm and accepting environment was the basis for establishing arelationship with the client. The warm emotional and psychologicalenvironment is created through a close and empathetic relationshipbetween the client and the therapist. This is because once Johnny,the client, felt appreciated and had someone to listen to he learnedto trust his therapist, which enabled them to have a closerelationship where he was able to open up (Dupont et al., 1953). Thiseventually enabled Johnny to learn to trust other people and he wouldeven initiate conversations, as opposed as before where he could notand would not talk. The client was able to improve his speechimpairment because of the positive therapeutic relationship he buildwith his therapist fostered his speech growth. As, Johny becameunconditionally accepted by his therapist regardless of his speechimpairment, he was able to improve his speech and was motivated tospeak (Dupont et al., 1953). Dupont et al., (1953) also found thatclient centered therapy is an effective treatment to help childrenwith delayed speech and emotional disturbances as the therapeuticalliance helps the client grow through unconditional acceptance.Gerwood noted that the effectiveness of client centered approachdepended heavily on the ability to listen and demonstrate activelistening (1993). The ability to be an active listener creates aclose psychological relationship, which is part of a workingalliance. This calms the client down as it creates an atmosphere oftrust and thus helps build the working alliance (Gerwood, 1993).Gerwood (1993) also found out that trust led to a close workingrelationship with schizophrenic clients, who motivated them to taketheir medication and thus, they recovered quickly. These researchfindings point to a significance of a working alliance to CCT.
Horvathand Symonds (1991) established that the timing of establishing analliance had an effect on the effectiveness of the therapy. Thoseclients that established an early working relationship with theirtherapists recovered faster than others. This is because it provideda chance for them to express themselves early enough. This studyfound that there is a strong relationship between the workingalliance and the client’s therapeutic outcomes. The study alsofound was that this relationship between the working alliance and thetherapeutic outcome was due to the collaboration and negotiation ofgoals between the client and the therapist (Horvath and Symonds,1991). In comparison, Martin (2000) also found that a workingalliance must be established in the beginning to have bettertherapeutic results. In contrast, Martin et al, (2000) found that theworking alliance was an important aspect of CCT, but did not have asmuch impact in therapy as expected. Martin et al, (2000) found thatthe relationship between the working alliance and client outcome wasmoderate but consistent. The study stated that the reason why theworking alliance led to the therapeutic outcome was because theworking alliance is therapeutic itself (Martin et al, 2000).
Theresearch activities contrast in that two of the articles reliedheavily on literature review. Martin et al (2000) and Horvath andSymonds (1991) reviewed articles written by authors who playeddifferent roles during the research process. They were mainlytherapists, observers, or helpers. This gave them different outlooksand understanding on the therapy process as they gathered informationbased on different perspectives based on how the therapists viewedthe therapy sessions. However, Dupont et al, (1953) and Gerwood(1993) interacted directly with the clients, which enabled them tohave different experiences and change the process of therapyaccordingly so as to help the clients. The therapist offered apositive and warm environment which gives the client the desire toreach their full potential (Gerwood, 1993).
Thearticles reveal that there is a direct correlation between workingalliance and the effectiveness of the therapy. A strong workingalliance is built on trust, which is as a result of collaboration,acceptance, and empathy between that the therapist demonstratestowards the client, which also makes the emotional and psychologicalenvironment safe as it makes the client feel understood. If theclient is given an emotionally and psychologically warm and secureenvironment, the client forms a good working relationship with thetherapist, which facilitates the therapeutic change. Thus, thetherapist must first establish a working alliance as soon as possibleso as to facilitate an effective therapeutic process (Martin et al,2000 Horvath and Symonds, 1991).
Certaincore conditions including empathy, unconditional positive regard, andcongruence are significant in client centered therapy. Multiplestudies found that adhering to the three core conditions of CCT leadsto therapeutic change in the client (Gerwood, 1993 Barrett-Lennard, 1962 Cramer &Takens, (1992 Truax, 1996).The therapist ability to be genuine, empathic and understanding whichencourage the client to self themselves unconditionally as well(Gerwood, 1993). Truax (1996) also studied the role of coreconditions in the thearpy process. Truaxsoughtto evaluate the adequacy of empathy, warmth, and directiveness on thetherapeutic outcome of clients (1996). Thethree principles of unconditional positive regard, empathy, andcongruence were applied in this case to determine if these coreconditions were reinforcing positive change in the client.
Theseconditions were also studied by Barrett- Lennard (1962) as he triedto establish how they contributed to the process of therapy. Theresearcher hypothesized that positive change would take place withclient centered therapy because the person needs to feel comfortableand safe for him to change his behavior (Barrett- Lennard, 1962).There are certain conditions that are essential for an effectivetherapy. These conditions include the therapist’s response to thethoughts and feelings of the client (Barrett- Lennard, 1962). Theyare used to reinforce and encourage the client to reveal deeperemotions so as to begin the process of healing (Truax, 1996). Theyare also useful in reinforcing positive behavior and discouragingnegative behavior (Barrett- Lennard, 1962). Cramer and Takens, (1992)also studied the role of the core conditions in the therapeuticsetting. In contrast to the other articles, the researchers wanted todetermine whether the client’s perception of the core conditionslead to greater progress (Cramer and Takens, 1992). One of the mainpurposes of client centered therapy is for the therapist to create asafe environment where the client can undergo therapeutic change(Rogers, 1958).
Barrett-Lennard carried out descriptive- inductive research that studied howthe therapist’s responses facilitated personality change (Barrett-Lennard, 1962). The therapist’s personality affects the ability tobe empathetic and compassionate. The study by Barrett- Lennard (1962)measured 5 relationship variables that foster therapeutic change inclients. They include willingness to be known, unconditionality ofregard, congruence, level of regard, and emphatic understanding.Researcher’s documented the client’s feelings towards the therapysessions in order to record their perception about the therapist’sability to be empathic, congruent, and understanding (Barrett-Lennard, 1962). In contrast, Truax (1966) The data was collectedusing qualitative and quantitative methods (Truax, 1996) also carriedout a quantitative research where he analyzed the ratings of fivedifferent clinical psychologists on the effect of reinforces in thetherapy process. The therapists studied notes of forty differentcases and noted the number of times the therapists repeated somewords that had an effect on the client’s behavioral change. Thestudy investigated whether the therapist’s high levels or lowlevels of unconditional positive regard, empathy, and directivenessled to greater therapeutic change (Truax, 1966). Cramer and Takens,(1992) used a meta analysis to investigate the therapeutic progressas a result of the therapist’s personality. The meta analyticmethod established the importance of differe nt aspects of therapy.
InBarrett- Lennard’s research, the samples were chosen based on thetherapist’s ability to use the inductive- deductive method toanalyze the client when reporting on the progress of the therapy(1962). On the other hand, Truax (1966) used random sampling anddistribution method of the forty clients and therapists. Thissampling methods contrast in that Berraett- Lennard’s samplingmethod was purposeful and directed so as to pick the most importantaspects of the research while Truax’s method spread thedistribution across different analyzers. He picked differentobservers from different fields and collected their opinions. Crameron the other hand, chose samples from a total of 37clients who wereattending weekly psychotherapy sessions by 37 therapists (Cramer&Takens, 1992). This was meant to spread the research over a widefield so as to pick the most important aspects of the coreconditions. Gerwood (1993) also sampled literature from therapistswho were treating clients who were suffering from schizophrenia. Thesampling was random and was based on how well the therapistsinteracted with the clients. The sampling suggested that thetherapist’s personality affected therapy.
Theindependent variable in Barrett- Lennard’s (1962) and Truax’s(1966) research was the therapist’s personality and his/her abilityto adhere to the three core conditions, congruence, empathy, andunconditional positive regard (Barrett- Lennard, 1962). In contrast,The Barrett- Lennard’s (1962) study included two additionalvariables as their independent variable, which was willingness to beknown and level of regard. Level of regard is defined as one’s ownreactions in relation to another person. Willingness to be known isdefined as one’s desire to be known by another individual (Barrett-Lennard’s (1962). In comparison, the dependent variable for bothstudies was the client’s therapeutic change (Barrett- Lennard,1962 Truax, 1966). In Gerwood’s study (1993), the independentvariable was the rate at which schizophrenic clients declined theiraggressive behavior. The dependent variable was the therapist’sability to adhering to the core conditions (Gerwood, 1993). Like therest of the articles, Cramer &Takens’ study was no different interms of the dependent variables, which were the core conditions.Although, in this study the sole focus was on the therapist’sability to demonstrate empathy and unconditional positive regard(Cramer & Takens, 1992). The studies all focus on the therapist’spersonality as part of the core conditions of study.
Barrett-Lennard (1962) found that the therapist’s personality and abilityto implemement empathy, unconditional positive regard, and congruenceenhanced the therapeutic change. This study stated that the client’spersonality change was due to his or her perception of thetherapist’s qualities and the client’s perception of the coreconditions were seen as critical to the therapeutic outcome (Barrett-Lennard, 1962). In comparison, Truax (1966) also found that thetherapist’s ability to adhere to the core conditions contributed tothe client’s behavior change. Most importantly, the study foundthat greater levels of empathy and unconditional positive regard fromthe therapist lead to greater therapeutic change. These high levelsof empathy and acceptance strengthen the client’s personalitychange as the client mirrored the therapist’s acceptance andempathy and as a result accepted himself (Truax, 1966). On the otherhand, Gerwood (1993) also found a strong relationship between thetherapist’s ability to implement the core conditions and thetherapeutic outcome. Clients with schizophrenia were able t trusttheir therapists and open up about their feelings and thoughtsbecause they experienced their therapist’s understanding, empathy,and genuineness (Gerwood, 1993). In addition, Cramer and Takens(1992) also confirmed the importance of core conditions of warmth,empathy and unconditional support in therapy, as the clients understudy changed their behavior significantly. The clients under studybecame open and positive towards therapy, as they felt understood andappreciated. The ability by the therapists to display unconditionalacceptance, empathy and congruence facilitated the recovery process(Cramer and Takens, 1992).
Thecore conditions are well established if the therapist shows genuineconcern for the care of the client. The therapist indicatesgenuineness by reinforcing certain words and phrases during therapyand being honest about his feelings to himself and the client(Barrett- Lennard, 1962). Empathy indicates that the therapist is intouch with the client’s feelings and this encourages the client totrust the therapist (Barrett- Lennard, 1962). Once trust and a warmemotional and psychological environment are established, thetherapist can influence behavior and personality changes in theclient. This is because the client feels appreciated and understoodwhich leads to the desire to change (Gerwood, 1993).
Anotherimportant factor that affects client centered therapy is the client’sbehavior and attitude towards therapy. The client’s behaviorinfluences how he views therapy and as a result can impact thetherapeutic outcome. These behaviors influence how soon the clientaccepts and follows through with the therapy sessions. Thisinfluences the direction of the therapy and enhances itseffectiveness (Haigh, 1949 Lipkin, 1954 Kirtner and Cartwright,1958). The client’s behavior in terms of his attitude towardstherapy, himself, and the therapist is one aspect that can impact thetherapeutic outcome (Lipkin, 1954). Lipkin’s quantitative studyinvestigated the need of a positive client attitude towards therapy.He used clinical analysis to analyze the attitude of the veteranstowards themselves, the therapy and the therapists. Lipkin (1954)also examined whether the client’s positive attitude toward thetherapeutic process lead to greater positive change in the client.Haigh (1949) also studied how client’s behavior affects thetherapeutic outcome. This study investigated whether the client’sdefensiveness affected the therapy process and how this had a bearingon the direction, timing and effectiveness of therapy (Haigh, 1949).He used a meta- analytic method to study the case of Ms. Terry, theclient, who used defensiveness to protect her real feelings (Haigh,1949). Kirtner and Cartwright (1958) also studied the impact of theclient’s personality on the therapeutic outcome. The researchersexamined whether the way the client views and thinks about his or herproblem affects if they achieve their problem. Kirtner and Cartwright(1958) used a quantitative analysis for the study and analysis ofresults to determine the importance of the client’s attitudetowards therapy and the therapist.
Lipkin’sdependent variables were the attitudes of the veterans towards thetherapy, therapists and themselves while the independent variable isthe therapeutic outcome (Lipkin, 1954). He sampled the veterans basedon their appearance for therapy for at least five sessions. Thismeans that he had a purposive sampling method that would give a truereflection of client’s behavior because it would reflect thosevariables being tested by the therapist. The methodology used wasMeta-analysis of the veterans’ response to the therapy. Haigh(1949) used a qualitative analysis of the response of Ms. Terry totherapy by analyzing her response to questions. The dependentvariable is the client’s defensive behavior and the independentbehavior is client centered therapy. Cartwright and Kirtner’s,(1958) the dependent variable is the client’s view about theirproblem and the independent variable is the success or failure ofclient centered therapy. The variables show how the client’sbehavior influences therapy.
Therole of client behavior was further discussed by Cartwright andKirtner (1958) it was found that clients who had a positive attitudetowards their problem tended to benefit more from therapy than thosewho did not. The study indicated that differences in the success ofclient centered therapy were due to individual differences amongclients (Cartwright &Kirtner, 1958). This showed that thetherapist must first understand individual clients when undertakingtherapy. Lipkin (1954) the study strongly demonstrated thesignificance of client’s feelings toward themselves, therapy, andthe therapeutic process. It also established that those who have apositive attitude towards therapy and demonstrate a deliberateattitude to get assistance were more successful and had greaterchange (Lipkin, 1954). However, those who had a negative attitudeabout therapy did not derive any help from therapy, as they did notunderstand the importance of therapy (Lipkin, 1958). Haigh (1948)established that the defensive mechanism hindered the process ofrecovery as the therapist had to first overcome the defensemechanism. The study found that client’s with defensive behaviortend to deny their true feelings and as a result does not benefitfrom therapy and in some cases increase their defensive behavior(Haigh, 1948). Thus, the studies concluded that the client’spersonality and attitude does have an impact on the therapeuticprocess. The ability to recover and the period taken depended on theclient’s attitude.
Kirtnerand Cartwright (1958) made the hypothesis that the patient’spersonality can also affect failure zone. What this means is that thepatient’s personality at the initiation of the therapeutic sessionsignificantly affects its likelihood of failure or success (Kirtnerand Cartwright, 1958). This is because the personality affects how heappreciates the therapy. The method which they have used in order togather relevant information was the Thematic Apperception Test (TAT),which assessed the personality of each of the patients using the.They have then subjected each patient the person centered therapy andthe therapist were asked to determine if the therapeutic sessionswere successful using a rating scale of one to nine, where 9corresponds to highly successful. Results from their experimentproved their hypothesis, that indeed, the personality of the patientsmattered in the length and outcome of the therapeutic sessions(Cartwright & Kirtner, 1958). Haigh (1948) tested the hypothesiswhether the client’s defensive behavioraffected the therapeuticoutcome. He found that the client’s attitude towards himself wasthe most important factor in the therapy process, as the defensivebehavior hinders he therapeutic progress. In contrast, Lipkin (1954)tested whether the client’s attitude toward the therapist, therapyand himself had a bearing on the outcome of the therapy. The studyfound that a client benefits more when they have a positive attitude.
Theresearch activities show the success of the person centered approachin treating clients with various social problems and mental illnesses(Gerwood, 1993 Truax, 1996 Dupont et al, 1953 Kirtner andCartwright, 1958 Haigh, 1948). However, there are areas that needimprovement. Many of the studies used a one- case approach todemonstrate the effectiveness of the method (Gerwood, 1993 Haigh,1948 Dupont et al, 1953). However, a balanced approach should have acontrol groups so as to study the effectiveness of client centeredtherapy. For example, the case of the client who suffered fromschizophrenia used one client to study the role of client centeredtherapy in helping clients with schizophrenia (Gerwood, 1993). Thestudy ought to have used a control group, which took schizophreniamedication, but did not undergo counseling. This would give a clearindication of the role of therapy in enhancing recovery for clientswith schizophrenia as opposed as the medication (Gerwood, 1993). Inthe case of Johnny, the young boy who had speech impairments theresearcher ought to have also used a control group such as a clientwho only received speech therapy (Dupont et al, 1953). This wouldhave helped in assessing the effectiveness of CCT as there would havebeen an objective comparison of the research outcomes. Additionally,some studies did not have control groups or groups that wouldfacilitate comparison and this undermines the ability to applyscientific data analysis methods. This may indicate that theinformation generated may have been subject to subjectivity. Theconclusion for both studies was made from studying one patient onlywhich undermines the effectiveness of client centered therapy. Thisalso casts doubt of whether these studies were in fact effectivebased on only one client as opposed to a control group.
Theresearch activities also lacked a close monitoring of factors outsidethe therapy sessions, which may have facilitated or hindered theprocess of recovery (Dupont et al, 1953). For example, in Johnny’scase, the researchers did not analyze whether his foster home settinghad changed. This would show whether Johnny’s recovery was purelydue to therapy. The environment of the client is also an importantreinforce of the therapy sessions. This is because the environmentmay encourage or discourage the client’s recovery process, just asthe therapeutic setting encourages clients to change. For example, ifa victim of child abuse keeps staying in the abusive environment, therecovery may be hindered as the abuse persists. This gave theresearchers a one-sided approach to the study and neglected otherimportant variables such as the usual environment (Dupont et al,1953). Thus, an analysis of the client’s other living environmentswould have informed the researcher whether the therapist’s role wasthe most crucial or whether it was enhanced up by other factors. Thiswould indicate whether there are factors in the client’senvironment that affect how soon or late the client recovers.
Thetheoretical framework used in all the studies was client centeredapproach. The researchers failed to use a combination of thistheoretical framework with others such a behavioral andpsychoanalysis approaches. Studies suggest that a combination ofdifferent approaches may yield better results than using one approach(Kirschenbaum & Jourdan, 1958). The researchers may have alsoinvestigated the strength of using a combination of approaches asopposed to focusing their research on the effectiveness of only onetheoretical framework. This could be investigated by applying theother theories in the CCT process (Kirschenbaum & Jourdan, 1958).Thus, the study may be improved by studying the effectiveness ofusing a combination of therapies versus using only one therapy. Thiscan show whether CCT is effective on its own or whether combining itwith other therapies can yield better results. This is important asit demonstrates whether CCT can stand on its own effectively orwhether a combination would make it more relevant than with othertheories. This is because a combination can be used to overcome suchshortcomings of CCT as the therapist’s personality. This is becausea therapist who cannot genuinely portray empathy, compassion andcongruence cannot influence the client positively.
Additionally,the theory ought to be applied in combination with other theories soas to explore the strengths of all theories for maximumeffectiveness. The combination with other theories also limits theextent to which the negative aspects of the theory may hinder thesuccess of the theory (Horvath & Symonds, 1991). The theoryfocuses too much on the therapist’s personality. This can beovercome by applying other theories where the therapist’spersonality does not apply appropriately. This combination allows thetherapist to achieve the best results by having as informed anddiverse approach to the session. The method has gaps, which can befilled by using a combination of theories. These gaps include how aninappropriate personality can be overcome so as to use CCT. However,in such cases, the person centered approach ought to remain at thecore of the process as it has the biggest advantages such as theability to establish a good working alliance (Horvath & Symonds,1991). The fundamental approach must retain the strengths of theperson centered approach so as to explore its maximum advantages, bymaking CCT the central therapy theory.
Amajor criticism of the theory is its lack of a structure and form ofapproach. Its biggest disadvantage is the lack of a clear structureof application and its dependence on a person’s personality forapplication. For example, in Johnny’s case, the therapist was knownto be very friendly and warm and this may have been a major aspect ofthe case. The studies do not indicate how a person can be empathetic,congruent and compassionate. The studies only focus on how theseaspects of CCT are applied in therapy. The theory also treats theclient like the expert and yet, he may not have a clue on how to gethelp. This is because the client is encouraged to look for optionsthat lead to healing as opposed to being guided by the therapist(Kirschenbaum & Jourdan, 2005). Client centered therapy is veryuseful in theory, but applying it is very challenging. This meansthat its effectiveness is closely tied to certain personalities thatmay not be in all therapists. The therapist ought to have a non-judgmental and understanding personality. Researchers should provideguidelines and/or training that can help therapist practice theirability to adhere to the three core conditions. This enhances theapplicability of the theory in therapy. Therefore, modern trend ismoving towards a standardized system of application by developingmethodologies that can be utilized by all therapists. These wouldinclude the proper strategies to establish and maintain a workingalliance and how to use the core conditions to enhance therapy(Kirschenbaum & Jourdan, 2005). This includes a systematicapproach on how to initiate therapy and how to conduct it effectivelyso as to maintain a working alliance and overcome client’sbehavior. However, the application can be enhanced by having astructured approach of conducting therapy (Horvath & Symonds,1991). However, a structured approach allows therapists with diverseskills to apply the theory as it is an effective means of treatingvarious mental disorders. The structured system guides the therapiston different approaches that facilitate a suitable outcome. (Gerwood,1993). A structured approach ought to guide the therapist on how toestablish a working relationship and at what point to show differentcore aspects of CCT. It ought to also show the therapist how he canestablish core conditions and overcome client’s defensive andnegative attitudes through establishing a working alliance and usingthe core conditions.
2.3Implications of the this study
Studiesreviewed in this paper show the strength of the person centeredapproach. However, the approach has a couple of challenges that canbe improved so as to make the approach more powerful than currently.The study of the client who was undergoing therapy for behaviorchange, shows that the ability of the therapist to show empathy,withhold judgment, and show genuineness is very crucial infacilitating recovery (Truax, 1996). The studies demonstrates thatthe process is effective especially because the client is encouragedto express his feelings in a trusting environment, which enablesexpression of deep feelings that may be causing harm to the client(Truax, 1996). This implies that if a person receives understandingand empathy, he starts the process of healing as expressions leads toan active approach to problem- solving (Truax, 1996).
Clientcentered therapy is the approach in which the client is guided by thetherapist in finding solution to his problems (Kirschenbaum &Jourdan, 2005). An effective therapist in client centered therapy isone who reinforces unconditional positive regard, empathy, andcongruence (Truax, 1996). As the multiple studies show, the theorycan be applied in treating abused children, clients of schizophrenia,and children with delayed speech, people with negative socialbehaviors, and people who have defensive personalities.
Thetherapy is still very popular in the twenty first century. However,the theory has improved as it moves towards a standardized structure(Kirschenbaum & Jourdan, 2005). The application of the theory indifferent mental disorders has significantly grown in the twentyfirst century (Kirschenbaum & Jourdan, 2005). The theory hasgained ground due to its applicability in different fields andextensive research continues to be conducted on ways of improving it(Kirschenbaum & Jourdan, 2005). One of the major criticisms toclient centered theory is that it lacks a standard structure, makingits application highly dependent on the therapist’s personaljudgment (Kirschenbaum & Jourdan, 2005). Another criticism is thesubjectivity of the evaluation process with regards to itseffectiveness. In other words, there are major concerns in thereliability and applicability of person centered therapy (Barrett-Lennard, 1962).
Theresearch activities indicate that a working alliance, therapist’sresponse, and client’s behavior have a bearing on the success ofthe client centered therapy. These conditions facilitate or hinderthe success of the therapy. However, the therapist’s ability toovercome or facilitate these conditions leads to the success orfailure of the therapy. This means that the therapist’s personalityalso influences the therapy process. The therapist plays a centralrole in the therapy and recovery process, as much as the client.
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