Referat general Georgeta Niculescu Psihoterapia centrat pe persoan condiii necesare igeneral

Referat suficiente

Psihoterapia centrat pe persoan

condiii necesare i suficiente
Person-centred therapy
necessary and sufficient conditions

Niculescu Georgeta1
Rezumat

Carl Rogers este considerat unul dintre cei mai importani ase psihologi ai secolului XX i este autorul a numeroase idei pe care
se bazeaz psihoterapia i psihologia contemporan. Rogers a fost foarte preocupat de procesul psihoterapeutic pentru a nelege
ce anume produce schimbarea n psihoterapie. Una dintre concluziile cele mai importante la care a ajuns este cea conform creia
schimbarea are loc dac n relaia terapeutic sunt asigurate urmtoarele condiii: empatia, congruena i acceptarea pozitiv
necondiionat. Astfel una dintre contribuiile lui Carl Rogers a fost punerea accentului pe importana relaiei terapeutice i
asigurarea celor trei condiii necesare i suficiente. Rogers a fost unul dintre primii teoreticienii care a accentuat relevana self-
ului i a felului de a fi congruent al persoanei. Psihoterapia centrat pe persoan a contribuit substanial la investigaia empiric
a procesului terapiei i este recunoscut ca avnd tradiie n cercetare. Carl Rogers n 1956 a fost premiat de ctre American
Psychological Association pentru activitatea de pionerat n cercetarea empiric.
Cuvinte cheie: psihoterapie centrat pe persoan, fenomenologie, empatie, congruen, acceptare pozitiv necondiionat.

Abstract

Carl Rogers is considered one of the most important six psychologists of the twentieth century and is the author of numerous
ideas on which contemporary psychology and psychotherapy are based. Roger was much preoccupied with the psycho-therapeutic
process in order to understand what exactly produces the change in psychotherapy. One of the most important conclusions he has
reached is that according to which the change takes place if the following conditions are met in the therapeutic relationship: empa-
thy, congruence and unconditional positive acceptance. Thus one of Carl Rogers contributions was to emphasize the importance of
the therapeutic relationship and of ensuring the three necessary and sufficient conditions. Rogers was one of the first theoreticians
who emphasized the relevance of the self and of the persons congruent way of being. Person-centred therapy has substantially
contributed to the empirical investigation of the therapy process and its tradition in research is acknowledged. Carl Rogers was
presented an award by The American Psychological Association in recognition of his pioneering work in empirical research.
Key words: person-centred psychotherapy, phenomenology, empathy, congruence, unconditional positive aceptance

1
Psiholog Clinician Principal, Psihoteraput Principal,
I. Aspecte Generale
Psihoterapie Centrat pe persoan
1. Paradigma teoretic
Adres coresponden:
Str. tefan Stoika nr. 31, Bl. 20, Ap. 34, Et. 6, Sector 1, Bucureti Paradigma teoretic a lui Rogers este asemntoa-
Main clinical psychologist, Main psychotherapist, re psihanalizei clasice a lui Freud i este denumit de
Person-centered psychotherapy ctre Eugene Gendlin paradigma reprimrii, con-
form creia anumite aspecte ale experienei umane
Correspondence address:
Str. tefan Stoika nr. 31, Bl. 20, Ap. 34, Et. 6, Sector 1, Bucureti sunt negate sau distorsionate. Dei paradigma teore-

Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 1 49
Georgeta Niculescu Psihoterapia centrat pe persoan condiii necesare i suficiente
tic este asemnatoare psihanalizei clasice a lui Freud,
Rogers nu interpreta, el verific ce a neles ncercnd
s surprind exact ce a vrut clientul s comunice. F-
cnd asta, a descoperit ceva: clientul de obicei corect
prima afirmaie. A doua era mai apropiat dar i asta
ar fi putut fi reformulat. Pn cnd clientul spunea
da asta este, asta este ceea ce simt. Apoi putea fi
tcere. Foarte adesea ce vine mai apoi este ceva mult
mai profund. Cnd fiecare lucru este primit, face un
nou spaiu. Apoi paii sunt mai adnci i mai adnci
i astfel este posibil o maxim deschiderea fr im-
punere. ntotdeauna n corpul uman are loc un flux
de experienieri ctre care individul se poate ntoarce
nc i nc o dat, mereu ca la un referent, un punct
de reper, cu scopul de a descoperi semnificaia acelor
experiene(Rogers, 1980).
Simbolizarea este un proces permanent, nu ne pu-
tem opri deoarece situaiile de via se schimb. Jung
spune: Simbolul are o validitate temporar, pentru c
nu are valoare dect pentru o situaie anume. Dac
situaia se schimb, ndat se face simit nevoia unui
nou adevr, aa c adevrul este ntotdeauna legat de
o situaie anume. Atta vreme ct simbolul constituie
rspuns adevrat, i deci eliberator, la situaia care-i
corespunde, el este adevrat i valabil, i chiar absolut.
Dac situaia se schimb i simbolul se perpetueaz,
el nu mai este dect un idol care nu face altceva dect
s srceasc i s ndobitoceasc. ( Jung n scrisoare
ctre dr. Kurt Plachte 1929 citat n Larchet J.C., In-
contientul Spiritual).
Cea mai important contribuie a lui Carl Rogers
a fost punerea accentului pe importana relaiei te-
rapeutice. Aceasta este acceptat de multe i diferite
orientri n acest moment. n mod particular accentul
pus pe empatie a fost ncorporat de diverse abordri
ca terapia cognitiv a depresiei, a lui Beck, psihologia
selfului a lui Kohut. Iar condiiile de valorizare, em-
patia i autenticitatea pot constitui baza oricrui pro-
gram pentru dezvoltarea aptitudinilor de comunicare.
2.Perspectiva rogersian asupra
diagnosticului clinic
Carl Rogers a realizat primele experiene terapeu-
tice cu copii i tineri n anii 30 i astfel i-a dezvoltat
primele reflectri teoretice asupra dezvoltrii concep-
tului de psihoterapie centrat pe persoan. Tradiiei
sale n lucrul cu copii i-au urmat Axline, Ellinwood,
Dorfman si Moustakas n anii 50 i60. Psihoterapia
50 Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 1
Referat general
centrat pe persoan ofer copiilor i tinerilor o rela-
ie bine conturat, care ncurajeaz n copil tendina
la actualizare, astfel nct procesele terapeutice s se
poat desfaura, aducnd dup sine schimbri majore
n conceptul despre self. n prim-plan st dezvolta-
rea complet a personalitii copilului i nu reduce-
rea simptomelor individuale. Noile experiene se pot
realiza fr fric, iar vechile semnificaii se schimb
printr-o experien relaional de corectare.
Rogers nu a pus accentul pe diagnostic, ci pe tr-
irea copilului, n 1939 n introducerea crii:The
Clinical Treatment of the Problem Child, Rogers a
scris: n aceast carte ne ocupm de copilul nsui, nu
de simptomele sale. Cutai n zadar un capitol despre
furt, suptul degetului sau chiulul colar, cci pentru
asemenea probleme nu exist tratament. Exist copii,
biei i fete, cu diferite poveti de via i personali-
tai. Unii dintre ei fur, unii fug de la coal, altora le
face plcere s-i sug degetul, s foloseasc cuvinte
obscene sau s-i nfrunte prinii. Dar n orice caz,
noi trebuie s ne ocupm de copilul nsui, i nu de
generalitatea comportamentului su. (Rogers, 1939,
citat n Gesprachs-psychotherapie, 2006).
Rogers nelege i descrie comportamentul drept
o ntmplare influenat de factori diferii, aici fiind
vorba despre aspectele genetice, de nzestrare soma-
tic, de familie (sprijin moral i calitatea relaiei), de
cultur i societate, nevoile organismului precum i
rezultatele interaciunii acestor factori. Acest lucru
corespunde deja din 1939 cu o paradigma valabil i
astzi n psihiatria modern pentru copii i tineri, a
unei structuri bio-psiho-sociale.
Diagnosticul clinic nu se poate realiza n afara
unei relaii care se stabilete ntre clinician i pacient.
n aceast relaie pacientul sau clientul indiferent care
este scopul evalurii stabilesc un contact psihologic,
calitatea acestui contact are consecine att asupra
acurateii diagnosticului, acceptrii acestuia de ctre
pacient dar i asupra tratamentului ulterior. n cazul
copiilor este vorba att despre relaia cu familia dar i
despre relaia cu copilul.
Nu este un proces intelectual cel care are loc aici,
de aceea este neles greu din punct de vedere inte-
lectual, dimpotriv el trebuie sa fie simit, respectiv
experimentat pentru a putea fi neles. Relaia dintre
terapeut i prini reprezint punctul esenial al eve-
nimentului. Prin aceast legatur, prinii pot cpta
ncredere n terapeut i i pot gsi libertatea n ex-
primarea gndurilor i sentimentelor, deseori reinute.
Referat general Georgeta Niculescu Psihoterapia centrat pe persoan condiii necesare i suficiente
Terapia eficient pentru copii este descris de Rogers
astfel: Copilul a acceptat ajutorul de care are nevoie la
acest moment, i n cazul n care terapia este eficient,
va deveni mai capabil s i perceap problemele pre-
zente i s le rezolve. i este de ajutor pe drumul ctre
maturizare. Bineneles c este posibil ca la un mo-
ment dat, mai trziu, s aib nevoie din nou de ajutor,
cand apar alte probleme. Punctul de vedere al terapiei
de relaie pare s fie mai realist i are un obiectiv mult
mai natural, de a produce din nou funciile normale
ale individului, de a face un nou pas n direcia ma-
turizrii i de a-i lsa capacitatea s-i rezolve singur
problemele. Accentuarea integritii copilului, ca fiind
o condiie semnificativ, este o caracteristic a acestei
structuri. Scopul este independena copilului, ncura-
jarea perceperii propriului self ca individ i acceptarea
rspunderii sale pentru sine nsui. (Rogers, 1939).
3. Lumea fenomenologic a clientului
Sintagma centrat pe persoan folosit interan-
jabil cu cea de centrat pe client subliniaz accentul
pus att pe lumea fenomenologic a clientului dar i
pe starea de a fi a consilierului.
Pentru Rogers adevrul central era c cel care tie
cel mai bine cum ar trebui s funcioneze procesul
terapeutic este nsui clientul. Clientul tie ce-l doa-
re i unde se afl durerea i tot clientul este cel care,
n ultim instan, va descoperi calea cea mai bun.
Sarcina consilierului este s fie un companion care s
poat relaiona cu clientul n aa fel nct acesta s i
poat accesa propria nelepciune i sa-i poat regsi
reperele n via. (Mearns D., Thorne B. , 2010), Con-
silierea Centrat pe Aciune, Editura Trei).
Fenomenologia se bazeaz pe credina c realita-
tea este diferit pentru fiecare persoan care o perce-
pe, n acord cu fenomenologia, imaginea realitaii este
valid pentru client chiar dac percepia terapeutului
despre aceai realitate este alta. Astfel nu exist n dis-
cuie nici un punct de vedere care este corect sau greit
n percepia realitii, exist realitatea clientului i rea-
litatea terapeutului. (Frannes Everett, Logan Wright
and Lois Roisman, 1986, Experiential Psyhotherapy
with Children ).
Extinderea acestor puncte de vedere n orice re-
laie clinic ar putea fi un prim pas n procesul de
demontare a aprarilor pacienilor care se pot simi
nelei i valorizai, astfel nct s poat accepta, re-
flecta i integra mai uor un diagnostic i s se obin
Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 1
compliana att de necesar n orice tip de interven-
ie. De aici drumurile se pot despri n funcie de ce
urmeaz s se ntmple, evaluare clinic, psihoterapie,
diagnostic i intervenie psihiatric, etc.
II. Empatie, Congruen,
Acceptare pozitiv
necondiionat
1. Empatie i schimbare
Rogers (1975) spunea c a fi ascultat de cineva care
nelege ofer indivizilor posibilitatea de a se asculta
mai bine pe ei nii, cu mai mult empatie ndreptat
ctre propriile lor experiene interne, ctre propriile
lor experiene resimite n mod vag.
n limbajul curent, empatia ar fi identificarea
mental cu o alt persoan sau resimirea afectelor, a
gndurilor sau a atitudinii acestora (Random House
College Dictionary, 1988). Metaforic, empatia este
adesea descris ca fiind experiena prin care o anumit
persoan poate s se pun n pielea alteia sau s vad
o situaie din perspectiva altei persoane. De obicei,
empatia implic att preluarea perspectivei cognitive,
ct i ecoul emoional n cadrul ntlnirii cu cellalt.
Prin nelegerea perspectivei celuilalt, se poate simi
modul n care anumite experiene sunt trite de ce-
llalt; a simi mpreun cu cellalt ofer posibilitatea
cunoaterii perspectivei lui. Cu toate acestea rezonan-
a implicat n empatie nu este chiar att de intens
i de nedifereniat nct s se piard distinia dintre
experiena personal i cea a celuilalt. i pn n acest
punct, cei mai muli cercettori sunt de acord n pri-
vina folosirii acestui termen (Warner M. 1997).
Dar empatia poate fi neleas foarte diferit de cli-
nicieni n funcie de teoriile psihologice pe care le m-
brieaz. Cu toate acestea spune ( Warner M. 1997)
apare o diferen interesant de opinie n rndurile
psihologilor clinicieni n ceea ce privete folosirea
cuvntului empatie. Atta timp ct empatia implic
nelegerea profund a lumii interioare a unui alt in-
divid, se refer oare acest lucru i la lumea fenome-
nologic a acestuia, lumea aa cum i-o construiete
individul respectiv? Sau poate implic o perspectiv
psihologic interpretativ a lumii interne a acestuia-
lumea aa cum acel individ ar vedea-o dac ar fi total
contient de propria experien sau motivaie aa cum
ar fi vzut de un observator specializat? Aceasta este
o diferen foarte important, care duce la confuzii
51
Georgeta Niculescu Psihoterapia centrat pe persoan condiii necesare i suficiente
semnificative n literatur, deorece unii autori iau n
considerare prima variant iar alii oscileaz ntre cele
dou far s aduc explicaii suplimentare.
Carl Rogers se refer la experiena fenomenologi-
c proprie a clientului atunci cnd folosete termenul
de empatie: starea de empatie sau de a fi empatic este
aceea de a percepe cadrul intern de referin al celuilalt
cu acuratee i cu toate componentele sale emoionale
i semnificaiile care i aparin, ca i cum ai fi cealalt
persoan, dar far a pierde condiia ca i cum. Asta
nseamn s simi plcerea sau suferina celuilalt aa
cum o simte el i s le percepi cauzele aa cum le per-
cepe el, dar far ca vreodat s pierzi recunoaterea
faptului c este ca i cum ai fi fost rnit, satisfcut.
Aceast accepiune a termenului transpare din felul
lui Rogers de a rspunde empatic, prin care el suge-
reaz c ceea ce el nelege din semnificaiile clientului
trebuie verificat dac se potrivete cu ceea ce nelege
clientul nsui. Dac nelegerea lui este diferit de cea a
clientului o consider un eec empatic din partea lui.
Cum poate comunicarea empatiei s genereze
schimbarea? Warner M. spune: rspunsul pe care l-a
da vine n mare masur din practica i teoria empa-
tiei, dar niciodat nu a fost conceptualizat pe deplin.
Comunicarea empatiei poate s faciliteze schimbarea
deoarece genereaz un sentiment diferit de recuno-
tere experienial n interiorul receptorului - att sen-
timentul de a fi recunoscut de ctre o alt persoan
n cadrul experienei sale dintr-un anumit moment,
ct i sentimentul recunoaterii propriei experiene n
momentul respectiv. Aceast experien a recunoate-
rii este valoroas n sine i formeaz o legatur uman,
i de asemenea poate s comute propria relaie ctre
aspecte incontiente de experien, implicite i resim-
ite organic, expunndu-le contientizrii i schimb-
rii. Gendlin E. n teoria lui asupra experimentrii n
articolul O teorie a schimbrii personalitii spune
c folosim simboluri explicite doar pentru pri foarte
mici din ceea ce gndim. Pe cele mai multe le avem
sub forma semnificaiilor resimite. Cnd abordeaz
subiectul acestor refereni resimii, Gendlin nu se re-
fer la experiene incontiente, ci la stri de contien
care au fost sau nu n atenie la momentul respectiv.
2. Congruena terapeutului n ntlnirea de la
persoan la persoan
Congruena a devenit cea mai important dintre
condiiile lui Rogers pe care el uneori o numea trans-
52 Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 1
Referat general
paren. Rogers a fcut apel din ce n ce mai des la
transparena terapeutului n relaia cu cealalt persoa-
n i, n acelai timp, la importana ntlnirii persoa-
n-persoan n cadrul relaiei. De asemenea, ntr-un
mod mai subtil, el a fcut referire la folosirea intuiiei
de ctre terapeut. Prin urmare terapeutul trebuie s
fie n permanen contient de sentimentele sale ca i
cnd ar fi sentimentele clientului, poate mai degrab
ca fiind dect ca i cum Congruena terapeutului
este considerat a fi pe deplin interconectat cu em-
patia. Cu alte cuvinte cu ct terapeutul este mai con-
gruent i mai transparent n relaie, cu att nivelul de
empatie va mai ridicat. Bozarth J.(1996) susine c,
dac terapeutul este acordat cu clientul ntr-un mod
autentic i profund, atunci majoritatea experienelor
terapeutului, chiar i fanteziile bizare, vor avea o im-
portan terapeutic pentru client i pentru relaia cli-
ent-terapeut. (Empatia n psihoterapie 2011).
Ca i empatia i acceptarea pozitiv necondiio-
nat, congruena l face pe client s aib mai uor n-
credere n terapeut i n procesul psihoterapiei. Dac
clientul l accept pe consilier ca fiind congruent
atunci el va tii c rspunsurile pe care le primete de
la acesta pot fi acceptate ca deschise i sincere. El tie
c preocuparea terapeutului nu este de a-l manipula i,
n consecin, se poate simi mai liber n relaia lor. n
abordarea centrat pe persoan congruena destram
aerul de mister al consilierului. Misterul evoc iluzia
puterii, transparena o dizolv. (Mearns D., Thorne
B., 2010) .
Atunci cnd ai abilitatea de a fi congruent eti de
asemenea contient de toate rspunsurile tale interioare
pentru clientul tu. Nu deformezi i nici nu cenzurezi
acele reacii care sunt n contradicie cu ceea ce nseam-
n pentru tine a fi un bun consilier. Dac faci o judecat
de valoare despre clientul tu, atunci tii c ai fcut o
judecat de valoare. Dac nu ai rbdare cu clientul tu
poti s-i accepi propria nerbdare. Asta nu nseamn
c dai glas tuturor reaciilor tale cu privire la client. n-
seamn c poi alege s le dai glas sau nu. Congruena
presupune s nvei s asculi, s devii contient de pro-
priile tale gnduri i sentimente n relaia cu un client
i cum s le comunici clientului tu. (Tolan J. Psihote-
rapie i Consiliere Centrat pe Persoan).
Congruena consilierului creeaz o secven in-
teractiv n care realitile fenomenologice ale clien-
tului i ale consilierului pot fi comparate. Discrepan-
ele observate ntre cele dou realiti fenomenologice
pot constitui material terapeutic important pentru
Referat general Georgeta Niculescu Psihoterapia centrat pe persoan condiii necesare i suficiente
client sau o nou nvare despre sine pentru terapeut
i, uneori, ambele.
3. Acceptarea pozitiv necondiionat
Atitudinea pozitiv necondiionat nseamn per-
cepia esenial a clientului n procesul lui de schim-
bare i este transmis prin intermediul empatiei (Bo-
zarth J.,1996). Acest aspect este evident n ipotezele
i conceptualizrile iniiale ale lui Rogers, nainte ca
el s foloseasc termenul empatie (Empatia n psiho-
terapie 2011).
Clientul care a crescut n condiii de valorizare ap-
stoare, opresive va fi nvat c el este valoros doar att
timp ct se comport conform cu ateptrile persoanelor
semnificative din viaa lui. Acceptarea necondiionat a
terapeutului manifestat fa de client este importan-
t deoarece anihileaz direct asemenea condiii de va-
lorizare: consilierul ii valorizeaz clientul fr s ia n
considerare conformarea clientului la condiii; Lietaer
(1984) folosete termenul de contracondiionare pentru
a descrie procesul pe care l pune n micare acceptarea
necondiionat; legtura condiionat ntre a mplini
condiiile de valorizare i a fi valorizat este rupt prin
tratarea consecvent a clientului ca fiind o persoan va-
loroas prin sine nsi, indiferent dac ndeplinete sau
nu condiiile de valorizare stabilite pentru el n via. (Li-
etaer citat n Brian Thorne, Dave Mearns, Consilierea
Centrat pe persoan n aciune, 2010).
A accepta pozitiv necondiionat nseamn s crezi
c fiecare are propriile motive s fac ceea ce face, ce
simte i gndete. A asculta pe cineva n ntregime
nseamn a asculta att experiena organismic dar
i structura self-lui. n practic este foarte tentant ca
uneori s le ari clienilor c nu au dreptate, ns ori-
ce ncercare orict de subtil poate reprezenta un atac
la structura self-lui care va rspunde printr-un meca-
nism de aprare n timp ce va deveni i mai rigid.
Valorizarea clientului nu se refer la ludarea cli-
entului ci la mutarea accentului de pe cadrul extern
de referin pe cadrul intern de referin al acestuia. A
luda clientul poate ntri la fel de bine rezistenele ca
i atunci cnd critici clientul.
III Critici
n teoria personalitii elaborat de Rogers tendin-
a ctre actualizare este singurul concept motivaional.
Revista de Neurologie i Psihiatrie a Copilului i Adolescentului din Romnia 2012 vol. 15 nr. 1
Prin tendina la actualizare el a descris tendina de baza
a oricrei fiine umane de a-i menine, dezvolta i
intensifica funcionarea, ca fora vital care mpinge
persoana s acioneze cum poate mai bine n circum-
stanele n care se afl. Au fost foarte multe reprouri
c viziunea lui Rogers este mult prea optimist i c el
a devenit un exponent al revoluiei culturale din anii
60 care a contestat restricionarea exprimrii de sine
pe care o promovau generaiile anterioare ca i cnd
nu ia n considerare faptul c mare parte din restric-
iile sociale sunt de fapt normale. La completarea
teoriei lui Rogers contribuie Dave Mearns i Brian
Thorne care n 2000 introduc noiunea de mediere
social i vin cu ipoteza c exist att o for care
mpinge persoana mai departe dar i o for restrictiv
care ncearc s fac legtura cu contextele sociale ale
persoanei respective ntr-un proces de actualizare.
Astfel forei ndreptate spre cretere nu i se permite
s-i impun propriul ritm fr un oarecare control
sau mediere.
Psihoterapia Centrat pe Persoan nu este o form
de terapie bazat pe soluii i poate fi un oc cultural
pentru oamenii obinui ca terapeutul s fie un specia-
list care le rezolv problema. Nu pot rezolva nici o pro-
blem pentru tine, dar te pot ajuta s-i rezolvi propriile
probleme i devenind capabil s faci asta, te vei simi mai
bine (C. Rogers).
IV. Concluzii
Empatia, acceptarea pozitiv necondiionat si
congruena sunt indispensabile oricrei relaii interu-
mane n general dar mai ales n relaiile n care una
dintre persoane, numit, client, pacient sau bolnav
este n nevoia de a menine echilibrul (sau continui-
tatea tririlor), de a integra o schimbare a strii fizice
sau psihice, o situaie de via nou sau neobinuit
poate chiar traumatizant, un diagnostic, iar cealalt
respectiv, medicul, psihologul clinician, psihoterape-
utul sau psihiatrul este n rolul de a ajuta persoana
s neleag mai bine ce i se ntmpl i ce ar avea de
fcut din propriul cadru de referin.
Stabilirea unui diagnostic i comunicarea lui, in-
diferent din ce domeniu medical ar fi, poate avea
un efect de eliberare, de clarificare dar i un impact
uluitor, dezorganizator n funcionarea psihic, acea
parte att de intim i n acelai timp att de greu de
53
Georgeta Niculescu Person-centred therapy necessary and sufficient conditions 
descifrat. Astfel este realmente necesar asigurarea
unor condiii de relaionare n procesul de evaluare,
diagnosticare, comunicare a diagnosticului i de sta-
bilire a urmtorilor pai att n lucrul cu copilul dar i
cu adultul. Uneori sunt suficiente greutatea i auto-
ritatea unui diagnostic nct adugarea autoritii i
mndriei specialistului s fac ca totul s devin prea
dificil de gestionat.
n psihoterapie sentimentul de a fi neles de un altul
n cadrul experienei tale sau faptul de a percepe empatia
terapeutului dar i sentimentul recunoaterii propriei ex-
periene n momentul respectiv pot s mping, s facili-
teze procesul ctre aspecte aflate la limita contientizrii
expunndu-le astfel contientizrii i schimbrii.
Pentru schimbare este nevoie de o relaie profund
uman i asigurarea unui climat de siguran n care
* *
I. General aspects
1. Theoretical paradigm
Rogerss theoretical paradigm is similar to Freuds
classical psychoanalytic paradigm and is called by
Eugene Gendlin repression paradigm which states
that certain aspects of human experience are denied
or distorted. Although theoretical paradigm is similar
to Freuds classical psychoanalysis, Rogers does not
interpret, but checks what he understands by trying
to capture what the client wanted to communicate.
By doing so he discovered that the client changed the
first allegation. The second was closer to reality but
it could have been reformulated. He continued un-
til the client said yes ... that is it, thats what I feel
like. Then it was quiet. Very often what came later
was something much deeper, profound. Next steps are
deeper and deeper and therefore a maximum open-
ing is possible without struggle. In the human body
always occurs a flow of experiences which the indi-
vidual can analyze over and over again, always as a
referent, a landmark, in order to discover the meaning
of those experiences (Rogers, 1980).
Symbolization is an ongoing process; we cannot
stop because situations in life always change. Jung
says: The symbol has a temporary validity, because
it has value only for a certain situation. If the situa-
54 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 1
general study
clientul s fie ascultat, valorizat i respectat astfel nct
vechile semnificaii se transform n cadrul noii expe-
riene relaionale permind ca noi experiene s aib
loc far fric.
ncet, ncet, am acceptat aceast suferin i m-am
mpcat cu faptul c ea exist n mine i poate va fi n-
totdeauna, dar acum pe mine m definete altceva, nu
m mai reprezint acel trecut trist. Cu fiecare edin
am devenit mai contient de mine nsmi, de ceea ce
se ntmpl cu mine, de importana vieii mele, lucruri
de care nu mi pas foarte tare nainte pentru c eram
prea concentrat asupra durerii i furiei mpotriva tre-
cutului meu. Am descoperit ce nseamn bucuria pen-
tru lucrurile simple, s privesc nspre viitor i n acelai
timp s mi accept trecutul- Doamna X.
*
tion changes, it soon felts like needing a new truth, so
truth is always tied to a particular situation. As long
as the symbol constitutes a true response, and thus
being the liberator in this certain situation, it is the
valid and absolute truth. If the situation changes and
if the symbol remains, it is but an idol that does noth-
ing more than to impoverish and to brutalize. ( Jung
in 1929s letter to Dr. Kurt Plachte quoted in Larchet
JC, Spiritual Unconscious).
The most important contribution of Carl Rogers
was emphasizing the importance of the therapeu-
tic relationship. This is sustained by many different
contemporary paradigms. Actually approaches like
Becks cognitive therapy of depression or Kohuts self
psychology emphasized empathy, too. Valorization,
empathy and authenticity can be the basis of any pro-
gram for development of communication skills.
2. The Rogersian perspective on clinical diagnosis
Carl Rogers developed the first therapeutic ex-
periences with children and young people in the 30s
and so he has developed the first theoretical reflec-
tions on the development of the concept of person
centered psychotherapy. Its tradition of working with
children was continued by Axline, Ellinwood, Dorf-
man and Moustakas during the 50s and the 60s. Per-
son centered psychotherapy offers children and youth
general study Georgeta Niculescu Person-centred therapy necessary and sufficient conditions

a well-defined relationship that encourages the child follows: The child accepted the help he needs at this
tendency to update, so that therapeutic processes to time, and if therapy is effective, he will become able
take place, and bringing major changes in the self- to perceive and to solve present problems. And this is
concept. In the foreground it is the full development helpful on his road to maturity. Of course it is pos-
of the childs personality and not the attenuation of sible that at some point later, he will need help again,
individual symptoms. New experiences can be lived when there are other problems. Relationship therapy
without fear, and the old meanings change into a re- seems to be more realistic and to have a more natural
lational corrective experience. aim: to have normal functions of the individual again,
Rogers did not focus on diagnosis, but on the to make a new step in the maturation and to let the
childs feelings; in 1939 in the introduction of The childs ability to solve problems by his own. Empha-
Clinical Treatment of the Problem Child, Rogers sizing integrity of the child, as a significant condition,
wrote: In this book we deal with the child himself, is a feature of this structure. The goal is the indepen-
not with his symptoms. You look in vain for a chapter dence of the child, encouraging self perception as an
on theft, thumb-sucking or school truancy, because individual and acceptance of the responsibility for
there is no treatment for such problems. There are himself (Rogers, 1939).
children, boys and girls, with different life stories and
different personalities. Some of them steal, some flee 3. Clients phenomenological world
from school, and others love to suck on their finger, to
The term person centered used interchangeably
use obscene words or to confront their parents. But in
with the client centered emphasizes a focus on cus-
any case, we must take care of the child himself and
tomer phenomenological world and on the state of
not of his behavior in general. (Rogers, 1939, quoted
being a counselor.
in Gesprachs-psychotherapie, 2006).
For Rogers the central truth was that the person
Rogers understood and described the behavior as
who knows best how therapy should work is the cli-
something influenced by different factors, namely the
ent himself. Client knows what it hurts and where the
genetic endowment, the somatic aspect, the family
pain is and he will ultimately discover the best way
(moral support and the quality of the relationship),
to cure. The therapist task is to be a companion who
the culture and society, the body needs and the re-
can relate with the client so that the client can access
sults of the interactions of these factors. From 1939
his own wisdom and be able to find landmarks in life
this aspect corresponds to a valid paradigm from the
(Mearns, 2010).
modern psychiatry of children and youth, to a bio-
Phenomenology is based on the belief that reality
psycho-social structure.
is different for each person who perceives it; accord-
Clinical diagnosis is not possible outside a rela-
ing to phenomenology, the clients reality is valid even
tionship established between the clinician and the
if the therapists perception about the same reality is
patient. In this relationship, the patient or the client
different. Thus there is no right or wrong perception
make a psychological contact regardless of the aim of
in perceiving reality; there are different realities: the
the assessment. The quality of this contact has impli-
clients reality and the therapists reality. (Frannes, E.,
cations for diagnostic accuracy, its acceptance by the
Logan, W, Roisman, L, 1986)
patient but also on further treatment. In the cases of
Extending these views in any clinical relationship
children it is about the family relationships as well as
could be a first step in dismantling the defenses of
about the relationship with the child.
patients who may feel understood and valued, so that
There isnt an intellectual process that takes place
they can accept, reflect and integrate more easily a di-
here, so it is difficult to understand intellectually speak-
agnosis and to obtain compliance so required in any
ing; on the contrary, it must be felt, and experienced
intervention. The roads here can break depending on
in order to be understood. The relationship between
what will happen, clinical assessment, psychotherapy,
the therapist and the parents is the most important
diagnosis, psychiatric intervention, etc.
aspect of the event. Through this connection, parents
can gain trust in the therapist and can find freedom
to express thoughts and feelings, often retained. Ef-
fective therapy for children is described by Rogers as

Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 1 55
Georgeta Niculescu Person-centred therapy necessary and sufficient conditions 
II. Empathy, congruence, positive
unconditioned acceptance
1. Empathy and change
Rogers (1975) said that to be heard by someone
who understands offers individuals the opportunity
to listen better to themselves, with more empathy di-
rected towards their own internal experiences, to their
own experiences vaguely felt.
In everyday language, empathy is mental identi-
fication with another person or felling their affects,
thoughts or attitudes (Random House College Dic-
tionary, 1988). Metaphorically, empathy is often de-
scribed as the capacity of a person to be put in the
others shoes or to see a situation from the perspec-
tive of the other. Usually, empathy involves both cog-
nitive and emotional echoes in the meeting with the
other. By understanding the others perspective, you
can feel the way some experiences are lived by others,
to sympathize with anothers perspective which en-
ables knowledge of it. However, resonance involved in
empathy is not as intense and indiscriminate to lose
distinction between personal experience and that of
the others; and till this moment most scientists agree
on the usage of the term empathy in this way (War-
ner, 1997).
But empathy can be understood very differently
by clinicians based on psychological theories they
prefer. Anyway, there is an interesting difference of
opinion (Warner, 1997) among clinical psychologists
regarding the use of the word empathy. As long as
deep empathy involves understanding the inner world
of another person, can it refer to his phenomenologi-
cal world, to the world as he himself builds? Or may
this involve a psychological interpretative perspective
of his internal world - the world as that individual
sees if he would be totally aware of his own experi-
ence or of his reason as this world would be seen by
a trained observer? This is a very important difference
which leads to significant confusions in the literature,
because some authors consider the first draft while
others oscillate between the two without bringing
further explanations.
Carl Rogers refers to the clients own phenomeno-
logical experience when using the term empathy: the
state of empathy or being empathic is to perceive the
internal reference of the other person accurately with
all emotional and significant components as if he was
56 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 1
general study
the other person, but without losing the condition as
if . That is to feel pleasure or pain the other feels and
to perceive causes as he perceives them, but without
ever losing the recognition that this is as if you were
hurt, satisfied.
This sense of the term emerges from Rogerss way
of responding empathically, in which he suggests that
what he understands must be checked by the client to
see if it matches with what the client himself under-
stands. If his understanding differs from that of his
clients the therapist considers it an empathic failure.
How can communication of empathy generate
change? Warner says: I would answer that according
to the practice and the theory of empathy, but it was
never fully conceptualized. Communication of empa-
thy can facilitate change because it creates a sense of
recognizing different experiences inside the receiver -
the feeling of being recognized by another person dur-
ing his experience in a particular time and the feeling
of self recognition of currently personal experiences.
This recognition activity is a valuable experience in
itself and it forms a human connection, and it also
can switch the personal relationship to unconscious
aspects of experience, implicit and organic feelings,
exposing them to awareness and change. Gendlins
theory of experimentation in the article A theory
of personality change says that we use symbols to ex-
press only a very small part of what we think. Most
of significances are as sensations. When addressing
these felt references, Gendlin doesnt refer to uncon-
scious experiences, but to the state of consciousness
that has or has not been taken care of at that time.
2. Therapists congruence in the meeting from
one person to the other
Congruence has become the most important of
the conditions which Rogers sometimes called trans-
parency. Rogers used transparency increasingly more
often in therapy, in his relation to the other person
and at the same time, he referred to the importance
of the meeting of one person with the other in a re-
lationship. Also, in a more subtle way, he referred to
the use of intuition by the therapist. Therefore the
therapist must be constantly aware of his feelings
as if they were clients feelings, perhaps more likely
as being than as if . Therapist congruence is con-
sidered to be fully interconnected with empathy. In
other words, the more the therapist is congruent and
general study Georgeta Niculescu Person-centred therapy necessary and sufficient conditions
transparent in his relationship the higher the level
of empathy will be. Bozarth (1996) argues that the
majority of the therapists experiences, even bizarre
fantasies, will have therapeutic importance for the cli-
ent and client-therapist relationship if the therapist
is linked to the client in a genuine and profound way.
([author],2011).
Like empathy and unconditional positive accep-
tance, congruence makes the client to have confidence
in the therapist and psychotherapy more easily. If the
client accepts the counselor to be congruent with him
he will know that the answers he receives can be ac-
cepted as opened and honest. He knows that the ther-
apists concern isnt to manipulate and therefore he
may feel freer in their relationship. The congruence of
person-centered approach splits the air of mystery of
the counselor. Mystery implies the illusion of power;
transparency dissolves it (Mearns, 2010).
When you have the ability to be congruent you
are also aware of all your inner answers for your client.
Do not twist nor censor those reactions which are in
contradiction with what it means for you to be a good
counselor. If you make a judgment about your client,
then you know that you made a judgment. If you are
not patience with your client you can accept your own
impatience. This does not mean that you tell all your
reactions to the client. That means you can choose to
give tell them or not. Congruence means to learn to
listen, to become aware of your own thoughts and
feelings in the relation with a client and to communi-
cate them to your client. (Tolan, [year].).
Counselor congruence creates an interactive se-
quence in which phenomenological realities of the
client and of the counselor can be compared. The
discrepancies observed between the two phenomeno-
logical realities may constitute important therapeutic
material for the client or a new learning experience
for the therapist, or sometimes both.
3. Positive unconditioned acceptance
Positive unconditional attitude is essential to clients
perception of the process of change and it is transmit-
ted through empathy (Bozarth, 1996). This is evident
in Rogers assumptions and initial conceptualizations,
before he used the term empathy (..[autor], 2011).
The client, who had heavy, oppressive conditions
of living, will be taught that he is valuable as long as
he behaves as expected by significant persons in his
Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 1
life. Therapists unconditional acceptance is also im-
portant because it annihilates directly such valuing
conditions: the counselor values the client without
considering the clients compliance to conditions,
Lietaer (1984) uses counter-conditioning to describe
the process that puts into moving the unconditional
acceptance; conditional link between being valued
and fulfilling conditions to be valued is broken by
consistent client treatment as someone valuable in it-
self, whether he meets the conditions for valorization
established for him in his life or not (Lietaer quoted
in Brian Thorne, Dave Mearns, 2010).
Positive unconditional acceptance is to believe
that everyone has his/her own reasons to do feel or
think what they do, feel or think. Listening to some-
one is to listen to all the organic experience and to the
self s structure. In practice it is very tempting to show
clients they are wrong, but any attempt, being it very
subtle, can attack the persons self structure which will
respond with a defense mechanism and will become
more rigid.
Clients valorization doesnt mean to praising the
client but to shift the focus from the external frame
to his internal frame. Praise can strengthen resistance
as well as critics do.
III. Critics
In Rogers theory of personality the tendency to
update is the only motivational concept. The tendency
to update he described as the tendency of every hu-
man being to maintain, develop and enhance their
functioning, as the vital force that pushes the per-
son to act the best he can in the given circumstances.
There have been many reproaches that Rogerss view
is too optimistic and that he became an exponent of
the cultural revolution of the 60s who challenged re-
strict self expression that the previous generation pro-
moted as if he does not take into account the fact that
much of the social restrictions are in fact normal. In
addition to Rogerss theory Dave Mearns and Brian
Thorne help; in 2000 they introduced the concept of
social mediation and make the hypothesis that this is
both a force that pushes the person forward and a re-
strictive force trying to make contact with the persons
social contexts in an updating-process. This way the
force aiming at developing is not allowed to impose
its rhythm which is mediated by control.
57
Georgeta Niculescu Person-centred therapy necessary and sufficient conditions  general study

Person-centered psychotherapy is not a form of Bibliografie / bibliography:

therapy based on solutions and can be a cultural shock
for people accustomed to a professional therapist who
solves their problem. I cant solve any problem for you,
but I can help you to solve your own problems and becom-
ing able to do that, youll feel better (C. Rogers).
1. Mearns D., Thorne B. (2010) Consilierea Centrata pe Ac-
tiune, Editura Trei;
2. Biermann- Ratjen E.M., Diether Hoger (Hrsg.), Ekert
J.,(2006) Gesprachs-psychotherapie, Springer;

IV. Conclusions 3. Everett F., and Roisman L., Wright L., (1986) Experiential
Psyhotherapy with Children, The Johns Hopkins Univer-
Empathy, unconditional positive acceptance and sity Press;
congruence are essential to any human relation, in gen-
eral, and especially in relationships where one person, 4. Random House College Dictionary (1988),Random
named client or patient, needs to maintain balance (or House;
continuity of experiences), to integrate a physical or 5. Warner M., (2011) Articolul Empatia poate vindeca?
mental status change, a new, maybe unusual or trau- O reflecie teoretic asupra empatiei, procesrii mentale
matic life situation, a diagnosis, and the other, the doc- i relatrii istoriei personale din Bohart A., Greenberg
tor, clinical psychologist, psychotherapist or psychia- L.,Coordonatori, Empatia n psihoterapie, Editura Trei;
trist, has the role to help people to understand better
what is happening to them and what they have to do. 6. Bozarth J, (2011) Articolul Empatia din perspectiva teoriei
Any communication of a diagnosis, regardless of centrate pe client i a ipotezei rogersiene din Bohart A.,
the medical field, can have be releasing, with a clarify- Greenberg L.,Coordonatori, Empatia n psihoterapie, Edi-
ing effect which can further have an impact in mental tura Trei;
functioning, so intimate, yet so difficult to decrypt. It 7. Rogers C. (2008) A deveni o Persoana, Editura Trei;
is really necessary to provide a relationship during the
assessment, diagnostics, communication of diagnosis 8. Tolan J. (2011) Psihoterapie i Consiliere Centrat pe
and establishing the next steps in working with chil- Persoan, Editura Herald;
dren and with adults. Sometimes weight and author-
9. Larchet J.C., (2009) Incontientul Spiritual, Editura So-
ity of a diagnosis are sufficient and that adding spe-
phia.
cialist authority and pride would make it all become
too difficult to manage. 10. Gendlin E. (1964) A Theory of Personality Change, Chap-
In psychotherapy feeling of being understood by ter four in: Personality Change, Philip Worchel & Donn
another person in your own experience or that of per- Byrne (Eds.), New York: John Wiley & Sons;
ceiving and feeling empathy and recognition from the
therapist can push and facilitate the awareness of the 11. Rogers, C. R. (1939)The clinical treatment of the problem
issues and lead to change child, Boston, Houghton Mifflin
A deep human relationship and providing a safe
environment for the clients safety, valorization and
respect are needed for the process of change. So the
old significances can change into new ones allowing
other new experiences to take place.
Slowly, slowly, I accepted this suffering and I rec-
onciled with the fact that it exists in me and perhaps
it always will be, but now I am defined by something
else, I am not represented by that sad past. With each
session I became more aware of myself, of what hap-
pened to me, of the importance of my life, things I
didnt care very much before because I was too fo-
cused on pain and anger related to my past. I found
joy in simple things, to look into the future and at the
same time to accept my past - Mrs. X.

58 Journal of Romanian Child and Adolescent Neurology and Psychiatry 2012 15th vol. no. 1