The Necessary and Sufficient Conditions for

Client Change
 The Necessary and Sufficient Conditions for Client
Change

• The core of person-centered therapy is the six necessary and

sufficient conditions for bringing about personality or
psychotherapeutic change.
• Drawing from his clinical experience, Rogers felt that if all
six of the following conditions were met, change would
occur in the client.
 Psychological contact

• There must be a relationship in which two people are

capable of having some impact on each other.
• The concept of presence, which refers to the therapist not
just being in the same room with the client but also bringing
forth her abilities to attend to and be engaged by the client.
 Incongruence

• The client must be in a state of psychological vulnerability,

that is, fearful, anxious, or otherwise distressed.
• Implied in this distress is an incongruence between the
person’s perception of himself and his actual experience.
• Sometimes individuals are not aware of this incongruence,
but as they become increasingly aware, they become more
open to the therapeutic experience.
 Congruence and Genuineness.

• In the therapeutic relationship, the therapist must genuinely be herself

and not “phony.”
• Congruence includes being fully aware of one’s body, one’s
communication with others, being spontaneous, and being open in
relationships with others.
• In addition, congruence incorporates being able to be empathic and
to offer unconditional positive regard to the client.
• Rogers (1966) defines genuineness (similar to congruence) as follows
• Genuineness in therapy means that the therapist is his actual self
in his encounter with his client. Without facade, he openly has the
feelings and attitudes that are flowing in him at the moment.
• This involves self-awareness; that is, the therapist’s feelings are
available to him—to his awareness—and he is able to live them,
to experience them in the relationship and to communicate them
if they persist.
• The therapist encounters his client directly, meeting him person
to person.
• He is being himself, not denying himself.
• [Client:] I’m lost, totally lost. I’ve got no direction.
• [Therapist:] You’re feeling lost and not sure where to go. I
sense your despair, and feel I’m here to be with you, to be
here with you in this tough time.
 Unconditional Positive Regard Or
Acceptance
• The therapist must have no conditions of
acceptance but must accept and appreciate the
client as is
• Hurtful, painful, bizarre, and unusual feelings,
as well as good feelings, are to be accepted by
the therapist.
• Even when the client lies, the therapist accepts,
and eventually the client is likely to confront his
own lies and admit them to the therapist.
 Acceptance
• Acceptance does not mean agreement with the client but
rather refers to caring for the person as a separate individual.
• By accepting but not agreeing with the client, the therapist is
not likely to be manipulated.
• Clearly, therapists do not always feel unconditional positive
regard for their clients, but it is a goal toward which they
strive.
• By appreciating clients for being themselves, the therapist
makes no judgment of people’s positive or negative qualities
• [Therapist:] I’m going to give you an appointment at that time because I’d sure
• like to see you then. (Writing out appointment slip)
• (Silence of 50 seconds)
• [Therapist:] And another thing I would say is that—if things continue to stay
• so rough for you, don’t hesitate to have them call me. And if you should
• decide to take off, I would very much appreciate it if you would have
• them call me and—so I could see you first. I wouldn’t try to dissuade you.
• I’d just want to see you.
• [Client:] I might go today. Where, I don’t know, but I don’t care.
• [Therapist:] Just feel that your mind is made up and that you’re going to leave.
• You’re not going to anywhere. You’re just—just going to leave, hm?
• (Silence of 53 seconds)
• [Client:] (muttering in discouraged tone) That’s why I want to go, ’cause I don’t
• care what happens.
• [Therapist:] Huh?
• [Client:] That’s why I want to go, ’cause I don’t care what happens.
• [Therapist:] M-hm, M-hm. That’s why you want to go, because you really
• don’t care about yourself. You just don’t care what happens. And I guess
• I’d just like to say—I care about you. And I care what happens.
• (Silence of 30 seconds) (Jim bursts into tears and unintelligible sobs.)
• [Therapist:] (tenderly) Somehow that just—makes all the feelings pour out.
• (Silence of 35 seconds)
• [Therapist:] And you just weep and weep and weep. And feel so badly.
• (Jim continues to sob, then blows nose and breathes in great gasps.)
• [Therapist:] I do get a sense of how awful you feel inside. You just sob and sob.
• (Jim puts his head on desk, bursting out in great gulping, gasping sobs.)
• [Therapist:] I guess all the pent-up feelings you’ve been feeling the last few
• days just—just come rolling out.
• (Silence of 32 seconds, while sobbing continues)
• [Therapist:] There’s some Kleenex there, if you’d like it—Hmmm.
• (sympathetically) You just feel kind of torn to pieces inside.
 Continue

• The caring and warmth for the patient, Jim, are

evident.
• The voice tone and words must be congruent
within the therapist to be perceived as caring from
the therapist.
• Statements such as those Rogers makes reduce the
isolation that the patient feels by expressing
acceptance and stressing caring.
 Empathy

• To be empathic is to enter another’s world without being

influenced by one’s own views and values.
• To do so, individuals must have sufficient separateness so
that they do not get lost in the perceptual world of the other
person.
• Rogers has eloquently described the process of empathy.
• client described previously. In this example, Rogers’s attitude of empathy toward Jim in his depressed state is clearly
evident.
• [Client:] No. I just ain’t no good to nobody, never was, and never will be.
• [Therapist:] Feeling that now, hm? That you’re just no good to yourself, no good to anybody. Never will be any good to
anybody. Just that you’re completely worthless, huh?—Those really are lousy feelings. Just feel that you’re no good at
all, hm?
• [Client:] Yeah. (muttering in low, discouraged voice) That’s what this guy I went to town with just the other day told me.
• [Therapist:] This guy that you went to town with really told you that you were no good? Is that what you’re saying? Did I
get that right?
• [Client:] M-hm.
• [Therapist:] I guess the meaning of that if I get it right is that here’s somebody that meant something to you and what
does he think of you? Why he’s told you that he thinks you’re no good at all. And that just really knocks the props out
from under you. (Jim weeps quietly.) It just brings the tears.
• (Silence of 20 seconds)
• [Client:] (rather defiantly) I don’t care though.
• [Therapist:] You tell yourself you don’t care at all, but somehow I guess some part of you cares because some part of
you weeps over it.
• (Silence of 19 seconds)
• [Therapist:] I guess some part of you just feels, “Here I am hit with another blow, as if I hadn’t had enough blows like
this during my life when I feel that people don’t like me. Here’s someone I’ve begun to feel attached to and now he
doesn’t like me. And I’ll say I don’t care. I won’t let it make any difference to me—But just the same the tears run down
my cheeks.
 Perception of empathy and acceptance.
• It is not sufficient for the therapist to unconditionally accept
and empathically understand the client.
• The client must also perceive in some way that she is being
understood and accepted.
• Communication of empathy and acceptance can be verbal or
nonverbal, but it needs to be natural and not forced or
artificial.
• By reading aloud any of the therapist comments in the
previous examples, the reader can hear the difference between
a stilted expression and a genuine expression.
• When the conditions of genuineness, acceptance, and empathy
are communicated and perceived, then, Rogers believed,
therapeutic change will take place.
The Client’s Experience in
Therapy
 Experiencing Responsibility.

• In therapy, clients learn that they are responsible for

themselves both in the therapeutic relationship and
more broadly.
• Although clients may at first be frustrated or puzzled
by the therapist’s emphasis on the client’s experience,
person-centered therapists believe that clients soon
come to accept and welcome this.
 Experiencing The Therapist.

• Gradually, the client comes to appreciate the empathy and

no conditional positive regard of the therapist.
• There is a feeling of being cared for and being fully
accepted.
• The experience of being truly cared for assists clients in
caring more deeply for themselves and for others
 Experiencing The Process of Exploration

• The caring and empathy of the therapist allow the client to

explore fearful or anxiety-producing experiences.
• These attitudes allow for the client to change and develop.
• By exploring feelings that are deeply felt rather than
feelings that should be sensed, the client can experience a
feeling of total honesty and self-awareness.
 Experiencing The Self.

• With self-exploration comes the realization that the deepest

layers of personality are forward moving and realistic.
• As individuals deal with their angry and hostile feelings,
they gradually encounter positive feelings about themselves
and others.
 Experiencing Change

• There is a sense of progress, even when the client may still

feel confused.
• Clients bring up some issues, discuss them and sense them,
and move on to others.
• The therapist’s warm presence allows the client to deal with
issues that may be upsetting and difficult.
Application of Person Centered
Therapy
 Applying It in Counseling: Techniques

• As person-centered therapy and our understanding of unconditional

positive regard develop, therapists are often recognized as agents
promoting activities and processes that facilitate growth.
• Such a view can be described as the therapist “valuing the deeper
core of the person, what she potentially is and can become,”
involving
• Positive regard

• Non-directivity –

• Unconditionality –
• Applying Rogers’s (classical) view of unconditional positive
regard as part of his theory of therapy includes therapists
engaging in the following (Bozarth, 2013):
• Being congruent in the therapeutic relationship

• Maximizing their unconditional positive regard through

empathy
• Encouraging unconditional positive self-regard in the client

• Trusting the client

 Helpful Worksheets for Your Sessions

• Person-centered therapists must show empathy,

understanding, and acceptance within the therapeutic
relationship to encourage positive outcomes and change
within the client.
• The following worksheets help by promoting unconditional
positive regard, including empathy and acceptance, within
therapy sessions.
 1. Assess Barriers to an Accepting Attitude
• Respect and acceptance are crucial in developing a positive therapeutic alliance

and unconditional positive regard.

• Use the Assess Barriers to an Accepting Attitude worksheet after individual

therapy sessions or at the end of the day to reflect on what thoughts and beliefs

may hold you back from a more accepting attitude.

• Consider each of the following:

1. Anxiety-evoking feelings, clients, and situations

2. Trigger words, phrases, and attitudes that caused you upset or a reaction

3. Prejudices that you found uncomfortable or annoying

4. Business that remains unfinished or issues not addressed

 2. Using Small Rewards
• Richard Nelson-Jones (2005, p. 99) defines small rewards as “brief verbal and non-verbal
expressions of interest designed to encourage clients to continue speaking.”
• Try out the Using Small Rewards worksheet to learn what small reward phrases look like and
consider whether you are using them in sessions.
• Examples include (modified from Nelson-Jones, 2005):
Uh-hmm
Please continue
Sure
Tell me more
Go on
Oh?
I hear you
Yes
Right
So…
Really
• Repeating the last word can also be effective.
[Client] I am feeling sad.
[Therapist] Sad?
• Reflect on how and when small rewards can keep clients talking, helping them feel respected and
understood.
 3. Visualizing to Improve Positive Regard

• Visualization can be a powerful technique for walking in another’s shoes and

understanding their thoughts, feelings, and experiences.

• Use the Visualizing to Improve Positive Regard worksheet to help you gain empathy and

grow unconditional positive regard in situations where you were previously unable to do

so.

1. Describe a situation during a therapy session when you found you were less able to show

empathy and understanding.

2. How did you react?

3. Visualize the experience described by the client. What feelings do you experience as the

client? Fear, sadness, loneliness? Imagine how it must have felt for the client talking

through the situation and how they felt.

4. Visualize how you could have reacted. Experience that (new) reaction from the client’s

perspective. How might you feel? Accepted, understood, and ready to move forward?
 4. Walking in Their Shoes

• It is helpful in therapy to become aware of, empathize, and understand the

client’s internal frame of reference more deeply.

• To fully empathize with clients, it is necessary to learn how to get inside their
skins and ‘feel’ their experiences.

• Experiencing the world through the client’s eyes can lead to a more profound,
internal frame of reference response and offer understanding. For example:

• You are frightened by the news that you are being laid off.
You are fed up with your family and their petty squabbles.
You really love having that person in your life.

• Use the Walking in Their Shoes worksheet to reflect on how sessions went and
consider whether you were adopting an internal or external frame of reference
 5. Receiving Verbal Communication Accurately

• Verbal and nonverbal communication can strengthen, weaken, and even confuse a

client’s communication.

• Using the acronym VAPER (volume, articulation, pitch, emphasis, rate) with the client

to consider five aspects of voice messages can help communication inside and outside

treatment and ultimately increase the chance of empathizing and understanding the

client and their experiences.

• Volume – Does the client speak loudly, softly, or somewhere in between?

• Articulation – Is their speech clear and distinct?

• Pitch – Is their tone harsh (too high or too low) or even threatening?

• Emphasis – Does the client use emphasis in the wrong place (too much, or too little)

so that their conversation is difficult to listen to?

• Rate – Is the client anxious and speaking too quickly? Slowing down speech may help
 6. Use of paraphrasing

• “A good paraphrase can provide mirror comments that may

be even clearer and more succinct (something said/written
clearly) than the original comments.
• It can be helpful to start each paraphrase with the pronoun
‘you’ to signal that you intend to mirror the other person’s
internal frame of reference.
• Paraphrasing can be difficult, especially when the client is
talking quickly or nearing the end of the session, yet it is
valuable in strengthening the therapeutic relationship.
 7. Goal-setting Self-talk

• At times, therapists may interrupt too often, eager to clarify a point or offer advice.

Goal-setting self-talk can help focus on listening and showing respect to the client.

• Before or during sessions, come up with a set of self-talk statements to act as in-

session reminders; for example:

1. Stop and think …

2. Calm down and listen carefully …

3. Let’s work hard to understand their perspective …

4. Let the client own their problems …

5. Remember to hear the client out …

6. Don’t judge …

• Practice using helpful self-talk until using it becomes a habit.

 CCT Deal With

• Client-centered therapy may help people who are

experiencing:
• Anxiety
• Depression
• Mood disorders
• Negative thoughts related to post-traumatic stress disorder
(PTSD)
 Criticism

• Complete lack of bias is impossible

• Lack of structure may not work for everyone
• May not provide lasting results
• It might not be enough on its own for some clients
 Limitations of Person-Centered Therapy

• Freedom to take the lead in therapy sessions

• Nondirective nature,
• Compassion fatigue