36215538 Assignment 2 PYC4809
Section A 1. Person- centred Psychotherapy Carl Rogers (1920-1987) was one of the most influ ential pioneers and inspiration behind person-centred psychotherapy. Rogers and his colleagues where innovators that refined the concepts and methods of person-centred therapy and that would later become one of the most influential and controversial of therapeutic approaches. During the 1940’s Rogers developed nondirective counselling. His theory was developed in four stages over the span of his career. This was a new direction of counselling that highlights that the direction and locus of control in therapy were clearly centred in the client, shifting the power to the person seeking help away from the th erapist. The client rather than the therapist determined the direction and goals of therapy and the therapist’s role was to help the client clarify feelings. He described his new approach in a speech in 1940, December 11 titled “Newer Concepts in Psychotherapy” as follows: “The aim of this newer therapy is not to solve o ne particular problem but to assist the individual to grow, so he can cope with the present problem...It relies much more heavily on the individual drive towards growth, health and adjustment...This newer therapy places greater stress on the emotional elements...then on the intellectual aspects....(It) places greater stress upon the immediate situation than upon the therapeutic relationship itself as a growth experience.” (David J. Cain, 2008 ) This new approach was revolutionary and Rogers transformed commonly accepted therapeutic processes such as the therapist giving advice, suggestions, direction, persuasion, teaching, diagnosis or interpreting behaviour. Rogers (1942) objected to these approaches because they assume that the therapist is the one most competent in what are the g oals of the individual and the values of what the situation are to be judged. Th ese methods resulted in the patient being more dependant and less able to solve new problems or adjustments. He saw these processes as prejudice, inadequate and often misused. The second period was developed d uring the 1950’s. Rogers wrote Client-centred Therapy in 1951 after he renamed his approach to client-centred therapy and p laced emphasise on the client and their feelings and not the problem expressed . Client-centred philosophy was applied to education and was called student-centred teaching. The third period began in the late 1950’s and extended into the 1970’s where he addresse d the necessary and sufficient conditions of therapy. He wrote “On becoming a person” ( Rogers, 1961) which deals with “becoming the self that truly is” and “becoming one’s experience” that incorporates of being open to experience, to trust in one’s expe rience, internal locus of evaluation and the willingness to be in process (Gerold Corey, 2009). There was now a shift away from clarification of feelings to a focus on the client’s lived experiences. In this period many of his hypotheses were confirmed.
The fourth phase expanded considerably to education, couples and families, industry, groups, conflict resolution, politics, and the search for w orld peace. His theory became known as the person –centred approach which took place during the 1980’s and 1990’s. It expanded to education, family life, leadership and administration, organisational development, health care, cross-cultural, and interracial activity and international relations. In the late 1980’s Rogers focused on applying his approach to politics es pecially to achieve world peace. In Counselling and Psychotherapy: Newer Concepts in Practice (1942), Rogers explained the role of the therapist as follows: ”Effective counselling consists of a definitely structured, permissive relationship which allows the client to gain an understanding of himself to a degree which enables him to take positive steps in the lig ht of his new orientation.” The core conditions which are both necessary and sufficient for successful therapy are the attitude of the therapist. Rogers believed that three attributes of the therapist are crucial for therapeutic change: 1) congruence ( realness or genuineness) 2) unconditional positive regard ( acceptance and caring ) 3) accurate empathetic understanding (an ability to deeply gras p the subjective world of another person). The relationship is non-intrusive and restrained but the therapist is a careful and understanding listener. It rejects the role of the therapist as the authority who knows best and shifts the power and responsibility to the client for the direction of therapy. These qualities, as opposed to technique release the client’s natural tendency for self actualization and growth. Growth is also fostered when the therapist has respect and basic trust in the client ’s capacity for self-direction. Rogers believed that pe ople are trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes and able to live effective and productive lives. The emphasis of person-centred therapy is on how clients act in their world with others, how they can move forward in constructive directions and how they can successfully deal with obstacles from both within and outside themselves that are blocking their growth. The goal is not merely to solve problems but for the client to be more independent, less defensiveness, greater self-exploration, increased understanding and an improved selfconcept. This strips the client of facades and to become more in contact with themselves which in turn opens them up for new experiences, internal evaluation a better trust in themselves and a willingness to grow. Person-centred psychotherapy shares many concepts and principles with the Existential and Gestalt perspective therapies which are also classified as humanistic psychotherapies. Humanistic psychologies share a respect for the client’s subjective experience, the uniqueness and individuality of each client and a trust in the capacity of the client to make positive and constructive conscious choices. They have in common an emphasis on the view of the person, their values, personal freedom and responsibility for choices, actualizing tendency, the power of the therapeutic relationship and phenomenology. Existential and person-centred therapy place little val ue on using techniques during therapy but rather place emphasise on the importance of the therapist being genuine and fully present.
For these approaches empathy, emphasis on emotion, the self (self-awareness and self healing), anxiety and meaning (making sense of experiences) are fundamental concepts during therapy. The therapist aims to provide the client with a safe, responsive, and caring relationship to facilitate self exploration, growth and healing ( Watson, Goldman, & Greenberg, 2011). Abraham Maslow also made a great contribution to humanistic psychology especially the understanding of self-actualisation. Many of Carl Rogers ’s theories were built on Maslow’s ideas for instance the positive aspects of being human and the fully functioning person. Rogers encouraged his hypothesis and theories to be tested and critically examined. According to Cain (2010) an enormous body of evidence conducted over 70 years supports the effectiveness of person-centred therapy. The biggest contribution person-centred therapy gave are the implications empathy has on successful counselling and therapy. Most other therapy approaches has also incorporated the importance of the therapists attitude in their therapy. Person-centred and humanistic approaches are both criticized for n ot using techniques or strategies in their therapy but research conducted proved that technique only accounts for 15% of client outcomes (Duncan et al., 2010). Although a few psychotherapists claim to have an exclusive person centres theoretical orientation they incorporate some of the other theories in their practice. After 70 years of founding non- directive therapy Rogers’s theory is still in practice and expanding. It had a major impact on counselling and psychotherapy and evolved into numerous psychotherapies. One thereof is person- centred expressive arts therapy that was developed by his daughter, Natalie Rogers that incorporates the expressive arts as a medium to facilitate healing and social change. Even though person-centred therapy has been criticised for lack of using strategies, the positive impact his work has had over the years cannot be underestimated. Reference list: Cain, D.J., & Seeman, J. (Eds.). (2002). Humanistic psychotherapies: Handbook of research and practice. ( pp 3-48)Washington, DC: American Psychological Association. Corey, G.T. (2009). Theory and practice of counseling and psychotherapy (9th ed). Belmont: Thomson Brooks/Cole.
2. First of all, both reading up on person-centred therapy and dealing with the terminally ill candidates have made me be more true to myself and think of the person that I am ( self reflection), that I want to be and the example I a m setting for my child. It has made me think of what is really important in life and how we sometimes waste our energy and time on trivial material things and possessions and we get caught up on how we think we must be perceived by others. I am now a lot more aware and think on how I want to spend my time, how I react in any situation and what I say. This has made me be able to spend more time with my child and husband, reducing my stress levels and has also led to me being more in control of my emotions. I have also thought of past experiences and mistakes I have made in my life that I haven’t dealt with. I have unconsciously carried around the burden of these mistakes and this has drained my energy and made me a negative and judgemental person. Letting go and forgiving myself for it has opened up a whole new perspective to my life. I now believe and feel that I have to make an effort to be kinder and more accepting of myself and see mistakes as a learning experience. This has also made it possible for me to let go of what others have done to me and has made me more accepting and tolerating of others. I have also made a point of trying not to say or think negative things of others or myse lf and to focus on the positive. I know it sounds like a c liché but it really has made a difference in my life. All these things seems trivial but combined they have made a huge differen ce in my life. I believe that I am a happier, more tolerant person, that I don’t “sweat the small things ” resulting in a lot less stress. Working with the terminally ill patients also opened up old wounds and issues of my dad’s death from cancer when I was 16 years old. I thought I have completely dealt with his and other significant peoples who died but I realized I still have a fea r of everybody that I care for dying. I suppose it is not an irrational fear but i t sometimes interfere with my day-to – day choices and it might have a negative influence on my child. I realize I need to dig deeper into myself to overcome this fear and to let go of the people that have passed away. I realize now that I am not completely the person I want to be but I am much better than the person I was. I ’m also still working on my confidence that is causing obstacles in my life but I’m sure that I am growing as a person and becoming truer and authentically me. “There is nothing noble in being superior to your fellow men. True no bility lies in being superior to your former self.” – Ernest Hemmingway
3. When I first meet the patient I firstly introduced myself and explained my presence and asked permission to have a conversation with them. When they agree to talk to me I ask them how they feel and how their week was. Then I’ll ask them if they were from around the area and if they have family or friends in the area. Usually these questions open u p the client and they then start sharing life stories with me. My first goal is always to get to know the patient and to understand their world and their unique situation. The most important objective for me is to try to create a relationship based on trust and to be authentic and empathetic toward each patient. I try to be very pos itive and unconditionally accepting even though the situation calls for being negative. To explain how I incorporate and utilize person-centred therapy I am going to refer to a few of my patients .With one of my first patients that I wrote of earlier who was very bitter toward life it was particularly challenging to not try and give her a dvice and to always be accepting. She always asked me to come and talk to her and she got very defensive if I didn’t spend enough time with her or had to go. I realized that she was very lonely but I tried to spread my time evenly to so that I get a chance to speak to all the patients. I learned from dealing with her that I have to change my approach. With my second difficult patient (patient A) I tried to approach the patient differently. He was not comfortable with being at the centre and his only goal was to leave (even though patients get extremely good care at the centre). He was not terminal but had nowhere else to go and was waiting to be placed in a different cent re. He didn’t get along with any of the other patients and didn’t want to even try to socialize with them. He was in a wheelchair and his life stopped (figuratively speaking) when the accident happened. He was extremely negative and the only positive thing he speaks about is the life he had before the accident. He has no goals for the future and he keeps himself busy watching movies on his laptop or going on the internet. A few rooms from him is another patient (patient B) that is also in a wheelchair but had exactly the opposite attitude. He is also at the centre temporally because his health deteriorated and he had nobody who could take care of him but is not terminal. Patient B accepted his situated and made a decision early after his accident that he got a second chance in life since he didn’t die the day of the accident. He has an extremely positive take on life and is living his life to the fullest – he even takes part in marathons. I try to be very accepting toward patient A and also try to guide him into speaking more of the times he was living a positive, happy life so that he knows it is still possible. To be honest it didn’t take him long to accept and to trust me since he enjoys the sessions we have together. I have a lot of empathy for his situation and he seems to have set himself some goals. The first positive goal was to shave – it seems small and insignificant but I could see a small change in his attitude. He has also started physiotherapy again and is really putting in an effort. I can see that he is a bit more open for new experiences and has some trust in himself that he can achieve things. I have also noticed that slowly but surely he is starting to talk to some of the other patients and I would really like him to make contact with patient B when the time is right. I believe that he is willing to continue to grow, even if he experiences setbacks.
With the terminally ill patients I usually only have a few weeks to visit them. Since time is limited I still incorporate the basic principle of person-centred therapy of being unconditionally positive, empathetic, and genuine. So far it has not be en difficult having these attributes towards them and I have seen a difference in patients even in the sho rt period that we have. I truly believe that your attitude is of upmost importance and giving support, acceptance and empathy fosters growth in the patients.
Section B
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1. Person-centred therapy 2. @ PEACE CARE CENTRE (HOSPICE) NGO MOSSEL BAY 14 Dahlia Avenue, Extension 6, Mossel Bay 6500 Western Cape 3. Contact person/supervisor: Prof Cora Terblanche 044 691 1108 4. +-20 hours in total. I started volunteering early in February and got to the centre every Sunday for an hour.
Section C 1.
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A challenge I faced quite early in my volunteer work is that about 98% of the patients that are in the centre are very religious. Being religious by itself is not a problem but I noticed that a lot of the patients felt that they are being punished for something they did in their past for having to suffer the way they do. Also some of the patients believe that if their faith is strong enough they will recover ev en though they are terminal. When they realise that they are not going to recover they fall into a very deep depression and become closed off. Since most of the patients come to the centre when there is absolutely no more hope for recovery and don’t receive any more medica l treatment (except pain relief medication) they usually have a few weeks left to live. I felt it was necessary for them to know that their suffering was not a punishment so that they don’t carry around the guilt and despair in their last few weeks. Also I tried to offer as much support as possible when they realize that they are not going to recover. I felt it wasn’t my place to inform them of their medical si tuation and I left that up to the medical personnel. Some of the other challenges that I faced w as that at some stage with dealing with some of the patients I felt that I came to wall. I am always very empathetic and try to be present and genuine when I communicate with them but I didn’t know how to offer them more. I listened when they wanted to talk and offered unconditional acceptance but we all knew the inevitable is around the corner and that we had very little time. I read up more about person-centred therapy and watched some videos but I still feel I need more training to offer professional help. Some of the patients are very lonely since their families live far away and don’t always have the means to come and visit them. Even if they can visit them they miss them when they leave. And at some stage the patients’ health deteriorated to such an extent that they couldn’t speak anymore , especially patients with lung, throat or mouth cancer. This made it difficult to communicate with them but I hope my presence made a difference to relieve some of the ir isolation.
2. So far my overall experience going to the centre h as been overwhelmingly positive. I feel so privileged that these people allowed me to share a few hours of their last days. I have gained so much insight into life, what is really important and how resilient the human spirit can be. To be honest, I left e very session feeling that they have taught me more than what I could ever offer them. Most of the patients lived a full life, made mistakes along the way but had eno ugh time left to reconcile and they passed away peacefully. They were open to talk t o me and share their life experiences and I had a glimpse into their life. One of the patients, Madeleine, stands out to me. She had throat cancer that spread to the rest of he r body and she was in the final stages of cancer when we met. She was in a lot of pain and could hardly eat or talk but she never complained. She shared a gre at deal of her life’s history with me. I don’t think our paths would have ever crossed if I didn’t volunteer at the centre. I had sessions with her for about 4 weeks in a row and I could see that I made a difference in her life. The last session she was not able to speak and I only sat with her and held her hand. The next week the nurses told me that she died about an hour after I left. Even though she didn’t say anything I know she died in peace. She made an enormous impact on my life- the way she handled her cancer,
her resilience and fighting spirit throughout her life and in her last days. She was still thankful, always friendly and content. Only two of the patients that I have encountered were very negative, one made very few or no real connections with other people and was bitter towards life. I later realized that I approached the first patient the wrong way and dealing with her was one of my low points. After studying more of some of the other theories I could have incorporated more of their techniques. I learned a lot dealing with her, even t hough she was a very difficult patient. She made me dig deep into myself to reveal unresolved issues that I didn’t know I had or had forgotten about. I later encountered the same type of client and I believe I had more success with him even though he is a lot younger. I haven’t had a lot of sessions with him but I hope I will have a better result with him.
Section D a. The format of the course b. The textbook c. Tutorial Letter 101 d. The voluntary work e. The work load f. Interaction with lecturers g. Contents of the course h. Overall rating
10 8 9 10 9 n/a 9 8
I really enjoyed the course and it has made a great impact on my life. The only dissatisfaction I have is that I would have liked to get more detail on the practical aspects of each theory and how to incorporate it i n to practice. I couldn’t find the dvd’s mentioned in the text book which was quite frustrating. I found some s essions and explanations on the internet but I would have liked to have mo re examples since the ones I thought were relevant only referred to group therapy. There was also n o extra journal articles or literature I could find on terminally ill patients. Also I found that there is a significant difference between the American issue and South African issue of the textbook and I definitely prefer the American issue. My ov erall experience was definitely positive.
