Person centered therapy, also known as client-centered therapy, is one of the major models of psychotherapy practiced worldwide. The therapist offers support, guidance and structure to enable the client to discover their own personal solutions to their problems. It has been shown to be effective for a range of client problems, and primarily for anxiety and depression.1
Person centered therapy can be short-term or long-term, depending upon the client’s needs. Sessions are weekly and last for about one hour each, and costs are comparable with other types of therapy.
What Is Person Centered Therapy?
Person centered therapy is based upon the underlying belief that every person has both the ability and the desire to reach their potential through personal growth and change. This natural inclination is called the self-actualizing tendency. The ability to self-actualize derives from a person’s capacity for self-understanding and for changing their own self-concepts, as well as attitudes and behaviors. The interactions between the therapist and client facilitate this change.
It is distinct from other forms of therapy in two major ways: a focus on the unique nature of each client, and the therapist’s avoidance of giving any direction to the issues discussed. As a non-directive therapy, the therapist does not attempt to direct the conversation in the session.
The client is encouraged to lead in each session by bringing up the issues, feelings, or difficulties that are relevant to them. Each client’s thoughts, experiences, and beliefs are seen as valid content for the sessions.
Due to the uniqueness of each person, the client is viewed as the expert of his own experience, while the therapist is the expert in the theories and methods of therapy. This belief creates a team approach with equal partners in the team rather than an expert therapist with a helpless patient, as is the model in psychoanalysis.
The setting of goals in person centered therapy is also tied to the concept that the client is the only person with expert knowledge of themselves. Only the client is able to set goals that are desirable and worthwhile for themselves. There are some generalized goals as well, which include minimizing distress, improving self-esteem, increasing self-understanding, and facilitating personal growth.
Central Concepts of Person Centered Therapy
Since person centered therapy is highly dependent upon the nature of the relationship between therapist and client, it is critical that this relationship is characterized by three key qualities. These are unconditional positive regard, genuineness, and empathy. Of these, the most vital quality has been reported to be unconditional positive regard.
Unconditional Positive Regard
The therapist must provide complete acceptance of the client regardless of what they say. This means providing consistent support and willingness to listen attentively. The therapist refrains from judgements of the client’s character, showing any disapproval, and giving any advice. The purpose is to convey that the client is valued regardless of mistakes or poor decisions. Ideally, this leads to the client’s greater ability to value themself in spite of their problems or past transgressions.
Empathy, the ability to sense another person’s emotional experience as they do, is a critical quality in person centered therapy. It is necessary for the therapist to extend empathy to the client in order to fully understand and appreciate the client’s perspective. Accurate empathy guards against judgement and reinforces the unconditional positive regard.
Also called genuineness, congruence is the third critical quality of a therapist involved in person centered therapy. This is the quality of being transparent and not trying to appear as the sole expert in the therapeutic relationship. By showing congruence between who the therapist is and how they communicate and behave, the relationship is more open and honest. The client is also provided with a realistic model of vulnerability in relationships.
Conditions for Successful Person Centered Therapy
There are six necessary conditions for the effectiveness of person centered therapy, which are all related to the existence of mutual positive feelings and authenticity. When these conditions are met, there is strong potential for positive change.
The six conditions for successful person centered therapy are:2
- There must be a relationship in which both the therapist and the client perceive each other as important.
- The client is in a state of incongruence, meaning that their life experience isn’t matching up with their sense of how they would like their life to be. This may mean not feeling like oneself, not living consistently with one’s values, or not meeting one’s potential.
- The therapist must be genuine, as described above, including being aware of their own feelings.
- The therapist expresses unconditional positive regard for the client, as described above.
- The therapist feels empathy toward the client and demonstrates this empathic understanding through communication in session.
- The client recognizes the unconditional positive regard that the therapist has for them. The client perceives that the therapist understands their difficulties and challenges, and has a non-judgemental attitude towards them.
What Can Person Centered Therapy Help With?
Person centered therapy has been used in a broad range of circumstances, including work with adolescents, parenting difficulties, individual adults, as well as adult relationships. It is most effective for persons who are highly self-motivated, since much of the effort and direction actually comes from the client.
Self-motivation may come from a desire to improve a life that is acceptable, but not up to one’s potential. Alternatively, the self-motivation may result from having reached a level of distress that the client can no longer tolerate. For example, one may be struggling with an addiction, a frustrating work environment, or the end of a significant relationship. Any difficult situation may create the client’s state of incongruence.
A common concern of clients who benefit from person centered therapy is a need for greater self-confidence. This is particularly true when the lack of confidence is related to social anxiety or fear of rejection, as opposed to a lack of confidence in one’s skills or talents. Because it is relationship based, person centered therapy is well suited for the client who seeks an increase in self-esteem or in becoming open to new experiences.3
Common Person Centered Therapy “Techniques”
The traditional view of person centered therapists is that the use of techniques, per se, is actually to be avoided in this form of therapy. Using pre-established interventions is seen as depersonalizing to the relationship. The only method that is universally employed is that of active, non-judgemental listening. This is the type of communication that expresses unconditional positive regard, empathy, and therapist congruence.
However, there are guidelines that are often used by the therapist to facilitate a productive session.
Person centered therapists often follow the following guidelines:4
- Set clear boundaries for the relationship: Boundaries are always important in therapeutic relationships. These are set in order to prevent the relationship from becoming ineffective, such as might happen if too many details of the therapist’s life were discussed. There are also practical boundaries, such as how long a session will last.
- Do not lead the client: The client is the expert on their own experiences and problems, as well as their own acceptable solutions. The client must be the one to lead the discussion.
- Be non-judgemental at all times: Any judgement may be experienced as rejection and be harmful to a client struggling with low self-worth, feelings of inadequacy, or excessive guilt.
- Do not give advice or make decisions for the client: These behaviors undermine the client’s responsibility and capacity to make decisions for themselves.
- Present yourself in a genuine way to the client: It is helpful to share some facts of your own life as well as some of your own feelings. By being open and sharing some personal information, the client is likely to feel more at ease about sharing with you.
- Be accepting of negative emotions even when they are directed at the therapist: On occasion, a client may feel angry, disappointed, or annoyed by the therapist. They should be allowed to verbalize these feelings so that any relevant meaning or personal insights may be gained by talking them through.
- Recognize and acknowledge your own limitations as a therapist: At times, a therapist may determine that they cannot be an effective therapist for a particular client due to a personality trait or a problem which they lack sufficient experience in working through. In these cases, the therapist should make a referral to another therapist or agency which is likely to be more effective for that client’s particular circumstances.
Person Centered Therapy Examples
Person centered therapy is generally most effective for those who are undergoing situational types of stress, versus those with long-term mental health issues. Short term stressors often trigger anxiety, low mood, or self-destructive habits such as substance abuse. Situational problems which are effectively managed with person centered therapy include parenting difficulties, relationship conflict or loss, and frustration with work life.
Parenting a Teen Who Is Acting Out
Alice seeks out therapy for help parenting her 14 year-old son. He has been skipping school, and the school’s guidance counselor has asked for better supervision of his attendance. The therapist would listen to Alice’s description of the problem and provide empathic and non-judgemental responses to her comments.
By providing unconditional positive regard for Alice, the therapist facilitates her own ability to accept her role in the problem with her son. She eventually acknowledges that she has been drinking too much on a daily basis and is not being the type of responsible parent that she would like to be. This self-awareness leads Alice to make the decision to change her substance use habits.
Extreme Low Mood After Relationship Ends
Aaron begins therapy because he has been unable to get out of bed in the mornings, feels tearful during the day, and can’t stop thinking about his girlfriend who left him 8 months ago. He describes himself as basically flawed and unable to keep a relationship going. His self-esteem has always been low and it has been further damaged by this last relationship ending badly.
The therapist would listen actively for understanding of how Aaron perceives himself. He may share a personal anecdote to give an example of how relationships can be challenging for anyone and to empathize with the sense of disappointment that comes with a relationship ending. Along with unconditional positive regard, this genuine sharing from the therapist may facilitate Aaron’s willingness to be aware of his own strengths and unique nature in a more positive light.
Dissatisfaction at Work
Amy has been doing her current job for 5 years already and she is frustrated by the lack of promotion to a more challenging position as a manager. She believes that she is capable of doing more and does not know what is holding her back. She has been told that her conflict resolution skills are lacking and her manner is very abrupt.
In person centered therapy, Amy would not be taught any specific set of skills (unless she asked for such information), nor would she be encouraged to change her manner. She would be provided with unconditional positive regard and empathic understanding of her job-related frustrations. This supportive relationship would facilitate Amy’s ability to see her own behavior more clearly, and to develop her own personal goals in order to increase her job satisfaction.
How to Find a Person Centered Therapist
Effective person centered therapy is more challenging to conduct than it appears to be. It has been mischaracterized as a very passive process, and it can become that if the therapist is not adequately engaged with the client. A therapist who appears non-responsive to the client’s concerns in this non-directive approach will not be effective in creating a therapeutic relationship.
The initial steps in finding a person centered therapist are not different from the initial steps toward finding any qualified therapist. It is important to ask questions of a mental health provider to determine the degree to which they follow the guidelines of this approach.
Who Is Able to Offer Person Centered Therapy?
Most mental health clinician training programs in the United States continue to teach the basic “techniques” of person centered therapy as part of their broader educational programs. As a result, most mental health professionals with degrees in social work, counseling psychology, or clinical psychology are aware of and have some experience with the person centered approach.
There is no particular license or certification required to offer services as a person centered therapist, however, there is a varying degree to which any therapist might strictly follow the guidelines as outlined earlier. For example, a therapist might identify themselves as “person centered,” and yet incorporate specific skills training into the process, or encourage mindfulness techniques in sessions. Ultimately, it is up to the client to decide whether these modifications are acceptable to them.
Cost of Person Centered Therapy and Insurance Coverage
The cost of person centered therapy depends upon the length of time required to meet the client’s personal goals to their level of satisfaction. The client sets their own goals and therefore has the assumed authority to decide when those are met. Short term goals may be met within a few months or they may evolve into long term goals which require a year or longer.
Cost on a per-session basis is basically the same as the cost for any other model of therapy, such as cognitive behavioral therapy or psychoanalytic therapy. Cost varies more based upon the provider and the geographic location than upon the model of therapy.
Most insurance plans do cover person centered therapy, as the approach is well established as evidence-based and meeting professional standards. To be certain of coverage, each client must contact the customer service for their own plan and ask about the benefits for outpatient psychotherapy. There may be deductibles, copayments, co-insurance payments, or an annual maximum benefit amount.
Key Questions to Ask a Therapist When Considering Person Centered Therapy
Most of the questions relevant to person centered therapy are the same as those relevant to any form of therapy, concerning type of education and training, years of experience, and particular experience with the type of problem one is facing. There are some additional questions that would be helpful in learning about whether a particular therapist is willing and able to use this approach in an enthusiastic and effective manner.
Key questions to ask a person centered therapist include:
- What type of training do you have with person centered therapy?
- Was this training a standard part of the program or did you seek out particular expertise with this approach?
- How many years of experience do you have doing person centered therapy?
- What is your opinion of this form of therapy?
- Do you primarily provide support and empathy in sessions?
- What is your position on giving advice and information or providing direction to the conversations?
- If not 100%, what percentage of your therapy clients are involved in person centered therapy with you?
- Do you believe in the basic concept that people have a natural tendency to become their best self?
- Have you had good outcomes in doing this type of therapy?
- Based upon the problem that I’m describing, do you recommend this form of therapy for me?
What to Expect at Your First Appointment
The first session in person centered therapy will have three major objectives:
The first priority will be for the therapist to listen actively in order to fully understand the problem as experienced by the client. The client will be asked to state what is wrong or distressing to them about their current situation. Although some information from the past may be useful, the focus will be on getting an accurate description of the present circumstances. The therapist may reflect back what is said or paraphrase statements in order to make certain that they have an accurate understanding.
A second priority will be to begin to establish a working relationship with boundaries that are acceptable to both the therapist and the client. This may include an agreement about the length and frequency of sessions, as well as agreement about any topics that are not open to be discussed. By limiting the range of topics, use of session time is protected from distraction or over-focus upon therapist self-disclosure.
Thirdly, practical matters such as billing, insurance, and confidentiality of information may be discussed. This is also the opportunity to ask about how long it may take to reach some resolution to the current problems. The personal goals of the client may not be known yet, but there should be an agreement to work toward problem resolution during the subsequent sessions.
Is Person Centered Therapy Effective?
The effectiveness of person centered therapy has been reviewed and validated by both the American Psychological Association5 and the National Institutes of Health, as published by the National Library of Medicine.6 Since the therapist-client relationship is essential to the theory and practice of person centered therapy, some of the studies have evaluated the benefits of the 3 key characteristics of that relationship.
Additional studies have determined the scope of severity of symptoms for which this form of therapy is effective, as well as the range of client problems. These studies show that:
The 3 key qualities (unconditional positive regard, congruence, and empathy) were looked at to determine whether their use by the therapist was adequate to predict good outcomes, or whether they must be consciously perceived by the client. Client perception of these behaviors was determined to be present and critical to positive outcomes. This was viewed as confirmation that it is the nature of the relationship between client and therapist that is therapeutic, rather than use of particular types of communication.7
A 2008 meta-analysis of results for 697 clients over a 5 year period showed that they improved significantly compared to a control group of clients who had been wait-listed for treatment.These effects held up for clients whose symptoms of anxiety or depression were moderate to severe and of longer duration.1
Criticisms of Person Centered Therapy
There are criticisms of person centered therapy which relate to the theoretical model, the client experience, and the range of problems for which it is effective. It has been argued that it is not possible to completely avoid therapist bias or direction in sessions. The argument is that each person, as a result of their unique life experiences, has some degree of bias even when trying to remain completely objective.
The lack of any structure can be frustrating to some clients, particularly those that are seeking quick relief to their distress. The strict model of person centered therapy is to allow the client to generate their own solutions to their problems without interference from the therapist. However, a client who is in moderate to severe distress may feel a need for some direction as to how to make changes which will likely benefit them as soon as possible.
There has been a question of whether the changes which occur in person centered are lasting over time. Research which has looked at both process and outcome has led to the conclusion that person centered therapy which carefully follows the guidelines and omits any therapist directive or skills teaching does not lead to lasting changes for the client.8
Another common criticism of person centered therapy is that the 3 key qualities of the therapeutic relationship (unconditional positive regard, congruence, and empathy) are necessary, but not sufficient for bringing about change in persons who have more severe mental illness. A 2005 review of the literature indicated that, although clients with schizophrenia did respond well to the key qualities of the therapeutic relationship, the outcomes of treatment for those clients were not sufficient.9
How Is Person Centered Therapy Different from Other Therapy Techniques?
Person centered therapy differs from other earlier models of therapy, both psychoanalytic and behavioral approaches, in terms of the role of the therapist as expert, as well as the use of directive techniques in those earlier models. These basic differences have an effect upon the effectiveness of person centered therapy for treatment of certain types of disorders.
As noted earlier, PCT has been shown to be most effective for highly motivated clients whose primary symptoms are anxiety and/or depressed mood. Other therapy techniques have been recommended over PCT for particular disorders.
Person Centered Therapy vs Cognitive Behavioral Therapy (CBT)
CBT is a directive, solution-focused approach to treatment in which the therapist takes the role of the expert. Various techniques are suggested and taught by the therapist in order to guide the client toward relief of symptoms. CBT is the most well-researched form of therapy and has been shown to be effective for anxiety, depression, relationship issues, and self-defeating behavior.10 It is often recommended over other approaches for treatment of eating disorders and substance abuse problems.11
Person Centered Therapy vs Narrative Therapy
Narrative therapy is a non-directive humanistic approach and is therefore similar in some ways to PCT. All of the humanistic approaches (PCT, Narrative, Gestalt, and Existential) rely on the premise that human beings by nature have a tendency to become their best and most authentic self (self-actualizing tendency).
The narrative therapist works toward identifying the personal story (narrative) of the client’s life as the client perceives it. Most often, the narrative of a distressed person is characterized by problems from the past or present. The therapist’s role is to separate the client from the problems so that the client gains a perspective that allows them to essentially re-write their life story.
This empowers the client to create their own unique outcomes which better serve their life goals. There is very little research about the effectiveness of narrative therapy, although it has been shown to be effective in family therapy for the reduction of parent-child conflicts.12
Person Centered Therapy (PCT) vs Dialectic Behavior Therapy (DBT)
DBT is a relatively recent therapeutic approach which is both directive and evidence-based. It is one of few effective treatments for borderline personality disorder and is recommended over other therapies for that disorder. It has also been shown to be effective in treating substance use disorders, suicidal behavior, and binge-eating disorders. The need for urgent intervention in each of these situations makes DBT preferable to PCT for most clients with these presenting problems.
History of Person Centered Therapy
Person centered therapy was developed in the 1940’s by clinical psychologist Carl Rogers. The primary approaches to therapy at that time were Freudian psychoanalysis and early forms of behaviorism. Rogers saw the need to develop a form of therapy which would be useful for children as well as adults with problems related to social adjustment.
Rogers believed that the use of the term “patient” for the person in therapy was suggestive of illness and not a helpful model for many persons having problems with their current circumstances. For that reason, Rogers began the use of the term “client” to identify the person seeking help, and labelled the process “client-centered therapy.”
In addition to use of the term client (vs patient), Rogers set forth a model of therapy in which the person/client was the expert on their own life situation, rather than the therapist. In his landmark book published in 1942, he proposed a non-directive approach by the therapist to facilitate the client’s ability to direct their own progress.13
In 1951, Rogers further presented his theory about how personality develops and how each person has a natural tendency to mature and reach their potential as long as they are provided with a supportive environment.3
During the 1960’s and 1970’s, Rogers and colleagues expanded the application of client-centered concepts to use with groups, providing group leadership which was characterized by the same qualities as those of an effective therapist. His concepts were applied to conflict resolution meetings between opposing political groups with both multicultural and international populations.
Eventually, the term “client centered therapy” was replaced with “person centered therapy” in order to reflect the broader application of these concepts to situations outside of the therapy office. The basic concepts of unconditional positive regard, congruence, and empathic understanding have become recognized as central to most approaches to psychotherapy today.