Counselling: An analysis of the Person-Centred approach

I volunteered at LifeLine Johannesburg for 2 years from March 2020 to February 2022. In the following text I provide an analysis of the Person-Centred Approach.

The importance of lay counselling

Unmet needs for treatment via counselling (and formal clinical therapy) is the greatest among those who cannot access or afford formal therapy ​(Hubble et al., 2009)​.

Lay counselling at crisis centres makes counselling services significantly more accessible. The APA policy in Hubble also states that (2009, p29), “Services are most effective when responsive to the [client’s] specific problems, strengths, personality, sociocultural context and preferences”​(Hubble et al., 2009)​.

Lay practitioners choose the Person-Centred approach because it is simple enough to follow and easy to scale. When lay practitioners apply the Person-Centred approach (empathy, congruence and positive regard) successfully, clients speak more freely, more often and for longer ​(Watson, 2016)​. 

Why there is no right approach

Effective outcomes and change during counselling are not necessarily attributed to any one model or approach but are attributed to a core set of factors that are shared by all theoretical models ​(Hubble et al., 2009; Wampold, 2009)​.

Throughout the history of psychology different approaches and theories have come to the fore, each new theory claiming to be better than the ones before. However, Psychology has reached a point where no one theory can claim to be better than another. All theoretical models can have effective outcomes for clients and notably, even placebo effects benefit clients ​(Bohart & Tallman, 2009; Hubble et al., 2009; Wampold, 2009)​.

Indeed, counselling can be viewed as a series of placebo effects that is facilitated by a counsellor in a safe environment ​(Bohart & Tallman, 2009)​.

How effective is the Person-Centred approach?

Proof of the effectiveness of the Person-Centred approach date back to the 1940s with research done in the form of rating scales, self-report measures and therapist reports. Accordingly, Rogers filmed some of his encounter-group sessions where the Person-Centred approach can be observed in practice (See Journey Into the Self, available on YouTube). As a result of Person-Centred counselling, clients are shown to maintain gains for up to 1 year or more ​(Lambert et al., 2016; Xposé Channel, 2018)​. 

The contributions of Carl Rogers and Abraham Maslow

As the founder of Person-Centred Therapy, Carl Rogers is the most influential. Rogers emphasised the importance of the attitude and personal qualities of the counsellor in addition to the quality of the relationship between the counsellor and the client. Rogers challenged previously accepted practices like giving advice, suggestions or direction ​(Corey et al., 2017; Duncan et al., 2009)​. 

Rogers introduced a non-directive approach that is less concerned with technique and more focused on personal and interpersonal ways of being that allow for increased self-understanding and self-exploration. Rogers did not view the Person-Centred approach as a complete theory but as something dynamic that would keep evolving (Corey et al., 2017). In addition, Maslow’s theory of self-actualisation is a foundational aspect of the Person-Centred approach. Accordingly, Maslow states that people’s tendency towards growth and self-actualisation is healthy and normal ​(Corey et al., 2017)​.

The Person-Centred approach’s view of human nature

The Person-Centred approach views people as intrinsically good. In practice this means that individuals can solve their own problems (facilitated by the relationship with the counsellor) since they are the experts on their own lives. Individuals are embedded in their context and lived experience – it is one’s life circumstances that brings one to counselling in the first place ​(Corey et al., 2017; Hubble et al., 2009)​.

What does it take to be a Person-Centred counsellor?

The three most important counsellor attributes are: congruence, unconditional positive regard, and empathy ​(Corey et al., 2017)​. 

Firstly, congruence is synonymous with the concept of authenticity. Authenticity is defined as being mindful and in touch with one’s thoughts and feelings – and also behaving consistent to them ​(Cooper et al., 2016)​. 

Secondly, unconditional positive regard refers to the acceptance of others without judgement.

Thirdly, empathy helps foster positive responses to the self ​(Watson, 2016)​.

The counsellor’s ability to place themselves in the client’s shoes so that they can help them unpack their world and make sense of their feelings. As a result, this makes it easier for the client to move towards action.

One way to measure a client’s experience and perception is by using surveys to get feedback ​(Norcross, 2009)​.

The different kinds of empathy

Accurate empathic understanding refers to understanding the thoughts, feelings and experiences of the client as they experience them. Bohart and Greenberg in Watson (2016, location 2570) break empathy down, and in brief, these are: ​(Hubble et al., 2009)​.

• Person empathy: understanding the client in their current context 
• Affective empathy: understanding the client’s emotional world 
• Cognitive empathy: understanding how the client makes sense of their experiences

Congruence, unconditional positive regard, and empathy are naturally very similar, and one cannot be conveyed without the other. In summary, one can view these as a way of being in the relationship – qualities that make a good alliance ​(Lambert et al., 2016)​.

What is an alliance?

The alliance refers to the quality of the relationship between the client and counsellor and strongly influences a positive outcome. It also includes agreement on the tasks and goals of the counselling. The alliance is based on both client and counsellor attributes, and certain clients and counsellors seem to be able to form a better alliance and at a faster rate, than others. The alliance influences all aspects of counselling for both counsellor and client and creates a safe space ​(Hubble et al., 2009; Watson, 2016)​.

Training and supervision are especially important to lay counselling, and includes:

1. Personal growth and development
2. Skills training
3. An internship program

Additionally, the Person-Centred approach is supported by a comprehensive set of micro-skills

Micro-skills that can be used in a counselling session include:

• Active listening: Listening in a way that will allow a story to unfold. The 80/20 rule can be applied to counselling by listening 80% of the time and speaking only 20% of the time. Active listening implies listening to both the said and the unsaid parts of a narrative. 
• Selectively restating and reflecting content: Allows a counsellor to zoom into a specific part of a narrative and ensures that a narrative is being understood correctly. 
• Reflecting feelings: Used to connect a feeling to an event. Also used to move concrete feelings like a bodily sensation to something more abstract like a need or desire, and finally toward a goal, option or action. 
• Co-exploring options: Can help clients become unstuck.
• Gentle probing questions: Used to move a narrative forward or focus on a core issue.
• Summarising: Used to move the narrative forward or to end a session.
• Tone of voice: Should convey empathy, congruence and unconditional positive regard. This is especially important since counsellors are limited to use solely their voice over the phone; body-language is unavailable. 

Criticism of the Person-Centred approach

Due to its emphasis on ways of being, critics say that the Person-Centred approach lacks technique and as merely restating what the client is saying. Some argue that people do not have as much freedom to act as Rogers suggests because people are bound by their circumstances and personal limitations. Finally, counsellors who strictly rely on the Person-Centred approach do not confront hostile behaviours and negative feelings, like aggression ​(Corey et al., 2017; Moore, 2008)​.

Read more Psychology at Prospective.