Carl Rogers Person-Centred Approach
Carl Rogers (1902-1987) a psychologist developed the person-centred approach. The approach to turn individuals (clients) into subjects of their own therapy. In his theory it was noted that individuals are endowed with the power of self-actualization (motivation to realise ones own potential) and through their own perception of resources inherent in them, they can provide remedy for change in their difficult situations, provided a facilitating environment exists This view as expressed by Rogers implied that every person has a tendency to grow and attain a certain level of actualization. He observed that in order to allow the client (person) asses his/her own wisdom and self defeating behaviours and also engage in therapeutic movement with the therapist, there must be a favorable climate. Three conditions were identified.Genuineness (Congruence), Empathy and Unconditional Positive Regard. GENUINENESS (Congruence)
In this relationship the therapist is expected to show a real sense of genuine attitude towards the client’s feelings and thoughts, be willing and ever present to assist them in whatever situation they may be. He should be transparent and discourage the attitude of being the superior in the situation. This attitude would in turn retain a high sense of confidence in the client towards realization of him/herself in therapy. Any deviation from this attitude renders the process unworkable. UNCONDITIONAL POSITIVE REGARD (Total Acceptance) According to Rogers, the therapist in this situation must show non-judgemental and total acceptance to the client’s feelings and his perceptive world as a whole to enhance his process of recovery. This total acceptance of the client’s attitude and perception should be devoid of whatsoever differences that might exist between them either culturally or socially.
However in doing so the therapist should ensure the safety and security of the client. EMPATHETIC UNDERSTANDING In his theory, showing empathy refers to the ability of the therapist to show positive sensitivity to the client’s world, his perception towards recovery and also communicate his feelings to the client. This will convey a special meaning to the client of his relationship with the therapist and consequently solidify their mutual relationship towards the expected therapeutic movement. Rogers continue to state that any deviation from these attitudes on the part of the therapist makes it difficult for the process to continue. This empathetic attitude is more exhibited by therapists who are more confident about their own identity and can cope with other person’s world without any fear. PERSON-CENTREDNESS AS A CONCEPT
Person-centeredness a concept in health care delivery has poor and conflicting definitions over the years and is considered one of the best ways of health care delivery in which patients are valued as individuals (Winfield et al. 1996). It has further been observed by (Slater 2006; Leplege et al 2007), that the concept of person-centredness has been described using different terms like patient-centred, client-centred, person-centred interchangeably which makes it most often unclear which consistent term to use in the description of the concept. Notwithstanding all these difficulties, Kitwood (1997) defined person-centredness as “a standing or status that is bestowed upon one human being by others in the context of relationship and social being. It implies recognition, respect and trust”. (p.8) Kitwood (1997) further used person-centredness to formulate ideas and ways of working which puts much emphasis on communication and building relationships in care. Brooker (2004), elaborating on person-centred approach found out that the definition of the term has such characteristics as:
· Respecting and valuing the individual as a full member of society · Providing individualised places of care that are in line with people’s changing needs · Understanding the perspective of the person and providing a supportive social psychology in order to help people live a life of relative well-being. Dwelling on these definitions of Kitwood and Brooker, it is evident that they are built on the works of Carl Roger’s (1950), which developed person-centred approach as a way of facilitating psychological growth (Natiello 2001).In addition a critical look at Kitwoods definitions definitions showed that personhood has been considered very essential. (Dewing 2008) observed that Person-centredness is often associated with gerontological nursing and more particularly issues relating to dementia care and have personhood as a basis of promoting its practice. It is therefore relevant to explore the philosophical and theoretical underpinnings of personhood in as much as it recognised in person-centredness (Baker 2001; Ford & McCormack 2000; Fares 1997).
Baker (2001) declared that personhood is consistent with individuality and has three dimensions; the person’s world which relates to understanding the person’s needs, self relating to emotional and physical security and others which signify social and material world that considers the need for interventions and a sense of belonging and place. Similarly (Ford & McCormack 2000) recognises personhood as the person’s ability to rational make decision by virtue of his reflection on available needs, choices wants and desires. On the contrary this ability to make rational decisions might be difficult particularly in persons with dementia (Kitwood 1997), however choices can be offered to the person. Harre (1998, p.6) drawing on the work of Apter (1989),concludes that ; a sense of personal distinctiveness, a sense of personal continuity and a sense of personal autonomy important phenomenon that best described personhood.
Elsewhere in literature, transcendence – (a state beyond material or usual existence) has been referred to as an essential characteristic for description of personhood (Heron 1992 & Kitwood 1990a, 1997).This goes to establish the assertion that “personhood” can be accessed from three type of literature- theology and spiritual, ethics and social psychology and each of these literature gives different meanings to attributes relating to personhood (Kitwood 1997, p.8). McCormack (2004) compared the definition of person-centredness by Kitwood and his own findings in an extensively reviewed literature and concludes that four concepts should be considered in describing person-centred nursing. These are: Being in Relation, Being in Social Context, Being In Place, Being With Self. What is the Person-Centred Approach?
The Person-Centred Approach developed from the work of the psychologist Dr. Carl Rogers (1902 – 1987). He advanced an approach to psychotherapy and counselling that, at the time (1940s – 1960s), was considered extremely radical if not revolutionary. Originally described as non-directive, this therapy moved away from the idea that the therapist was the expert and towards a theory that trusted the innate tendency (known as the actualising tendency) of human beings to find fulfilment of their personal potentials. An important part of this theory is that in a particular psychological environment, the fulfilment of personal potentials includes sociability, the need to be with other human beings and a desire to know and be known by other people. It also includes being open to experience, being trusting and trustworthy, being curious about the world, being creative and compassionate.
The psychological environment described by Rogers was one where a person felt free from threat, both physically and psychologically. This environment could be achieved when being in a relationship with a person who was deeply understanding (empathic), accepting (having unconditional positive regard) and genuine (congruent). Although initially developed as an approach to psychotherapy (eventually becoming known as client/person-centred therapy/counselling), Rogers and his colleagues came to believe that their ideas could be transferred to other areas where people were in relationships.
For example teaching, management, childcare, patient care, conflict resolution. Today there are many people who, although not working as psychotherapists and counsellors, use the work of Rogers as guiding principles in their day-to-day work and relationships. At one level, Rogers’ theory and work is very simple to describe. As many people would attest, both those using the approach and those working as person-therapists/counsellors, it can be very difficult to put into practice because the approach does not use techniques but relies on the personal qualities of the therapist/person to build a non-judgemental and empathic relationship.
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