DocumentChapter 4Person-Centered Counseling inRehabilitation Professions JohnSee and Brian KamnetzIt is as though he listenedand such listening as his enfolds us in a silencein which at last we begin to hearwhat we are meant to be.Lao-tse, 500 B.C.CarlRogerswasarguablythemostinfluentialpsychologistinAmeri-can history (Smith, 1982). The following are some of his majoraccomplishments (Kirschenbaum & Henderson, 1989): Founder of person-centered psychotherapy and counseling (a.k.a.client-centered or nondirective therapy). Pioneer in the development of humanistic psychology Pioneer in the development of the therapeutic encounter group Pioneerinextendingprinciplesofpsychotherapytotheentirerangeofhelpingprofessions,suchassocialwork,guidanceandcounseling,education, ministry, and child rearing Pioneerintheuseofhumanrelationshipskillsininternationalcon-flict resolution Pioneerinemphasizingtheimportanceofscientificresearchincoun-seling and psychotherapy Author of 16 books and more than 200 papers and studies, withmillions of copies printed in over 60 languages Rankedfirstamongthe10mostinfluentialpsychotherapists,includ-ing Freud76Person-Centered Counseling in Rehabilitation Professions77 Rankedfirstasthepsychologistwhosewritingshavemoststoodthetest of timeRogersmademanyimportantcontributionstotheliteratureoncounsel-ing and psychotherapy, spanning five decades (e.g., Rogers, 1942, 1951,1961, 1980). His first major theoretical contribution came in the early1940swhen,asayoungpsychologist,heaudaciouslyadvocatedthebeliefthathumanswerebasicallygoodandcouldbetrustedtodirecttheirownlives(Rogers,1942).ThisperspectivewasanathematothethenprevalentFreudian view of therapy as the process of helping people control theiruncivilized impulses. In addition to this more optimistic view of humannature, he also formulated a totally new treatment approach based moreonthepersonalcharacteristicsofthetherapistthanonanytechniquesorformaltraining.Hechallengedthepsychotherapycommunitybyformallyarticulatingthebeliefthatthefacilitativeconditionsofempathy,positiveregard, and genuineness on the part of the therapist were the necessaryand sufficient conditions for therapy (Rogers, 1957). Nothing more wasneeded; nothing less would do. This revolutionary idea meant that themedium as well as the essence of therapy was simply therelationshipbetweenthetherapistandtheclient.Thesenewhumanisticformulations,soelegantandsopowerful,wouldbecometheheartoftheperson-centeredapproach and the quiet revolution that Rogers was leading.By the early 1970s Rogers had moved beyond his seminal work onindividualpsychotherapyandhadturnedtootherperson-centeredapplica-tions in education, marriage therapy, and encounter groups. In the finaldecadesofhislifehetookperson-centeredprinciplestotheultimatelevelofworldpeace.Heandhiscolleaguesconductedconflictresolutiongroupswith warring factions, such as the Catholics and Protestants in NorthernIreland,blacksandwhitesintheUnionofSouthAfrica,andtheantagonistsinconflictsinElSalvador,Guatemala,andotherLatincountries(Kirschen-baum&Henderson,1989).Histhoughtsoninternationaldiplomacymightwellberequiredreadingforallleadersseekingrapprochementinatroubledworld.HewasnominatedfortheNobelPeacePrizeshortlybeforehisdeath.MAJOR CONCEPTSAccordingtoRogersgrandconception,humanshavetheinherent(almostmagical) capacity to grow in a positive direction and to realize their fullpotential,iftheyare(luckyenoughtobe)nourishedbytheunconditionallove and understanding of significant others. This pivotal idea, like the78Counseling Theoriestheme of a great symphony, would recur again and again in differentvariations throughout Rogers life.Of all of the major counseling theories, person-centered theory mostepitomizes democratic and libertarian ideals. It is the ultimate statementabouttolerance,acceptance,andwillingnesstoallowotherstoliveastheysee fit. It most explicitly informs people that, if they want to help othersto blossom, then they must love them but simultaneously stay out oftheir way.Overthepasthalfcenturythisseeminglysimpleideahasgrownintoafar-reaching philosophical system with implications for virtually all areasofhumaninteraction.Rogers(1980)waseventuallytosuggestauniversalformativetendencythatextendedtheideaofself-actualizationtotheentireuniverse. This formative tendency could be seen in rock crystals as wellas living organisms, since they all seemed to grow in the direction ofcomplexity, interrelatedness, and order. There are obvious philosophicalandspiritualimplicationsinthetheory.Somehavefoundecclesiasticalordeterministic overtones, while others have found almost the opposite, atotal freedom from authority.THEORY OF PERSONALITYRogers theory of personality derives from his clinical practice, in whichhe saw people move naturally in the direction of wholeness and health.He also saw the negative emotions (e.g., anxiety, anger, jealousy, self-destruction),butthesewereviewedassecondaryreactionstofrustrations,whiletheoverarchingtendencywastohealorgrowinapositivedirection.The working principles to be discussed below are an adaptation of anearlier discussion by See (1986, pp. 138139, adapted with permission).Actualizing TendencyAccordingtoRogers,humanshaveaninstinctiveneedtogrowanddevelopin a positive direction. As the acorn follows its biological blueprint anddevelopsintoamaturetree,sodohumansfollowtheirblueprints.However,before this natural tendency can operate, it must be liberated by a lovingand permissive environment. If the environment is nurturing, then theorganismwillreachitsfullpotential.Thegrowthprocessofself-actualiza-tionischaracterizedbyincreasingcomplexity,congruence,andautonomy.Self-ConceptAccording to Rogers, the central personality construct is the picture thatindividuals have of themselves. It is the perceptual Gestalt and sum totalPerson-Centered Counseling in Rehabilitation Professions79of all of the thoughts, feelings, and values held and their relationshipstothingsandpeoplewithintheworld.Itismaterialconsciouslyacknowledgedabout the self. It is more or less what individuals would say about them-selves if they were to write a candid and exhaustive autobiographyinotherwords,whoindividualsthinktheyare.Theself-conceptdeterminesto a large extent how individuals behave.Organismic Valuing ProcessInfantsevaluateexperiencesandbehavioraccordingtothefeelingselicited.Behavior produces good feelings if it furthers the actualizing tendency oftheorganism.Infantsdonotneedtobetoldwhatisrightorwrong;theyautomaticallysenseitinanintuitiveway.Bothgoodandbadexperiencesbecomepartoftheself-conceptandareaccuratelysymbolizedinawareness.Because adultslose much of thisnatural and wholesome reactivityto theworld, the task of therapy is to help them relearn how to listen to theseorganismicmessagesfromwithin.Totheextentthatadultscanrecapturethechildlikeabilitytotrustfeelings,theybecomemoreautonomous,morealive, and more congruent.Need for Positive RegardDuringtheearlystagesofdevelopment,apowerfulsecondaryneedemergesthatcanworkfororagainsttheorganismicvaluingprocesstheneedforlove, or positive regard, from others. When significant others provideunconditionallove,infantsarefreetodevelopaccordingtotheactualizingtendency and will learn of their potential by directly experiencing theworld.Becausehumansareinstinctivelygoodandactinwaysthatenhancetheorganism,thisself-directedsearchforidentitycanbetrustedtoresultin a well-developed and congruent personality. Certainly there will bemany occasions when parental guidance or discipline is essential. Forexample, children cannot be given the option of deciding whether theywill attendschool, consume alcohol,or playwith loaded guns.There aresafety, health, and legal constraints that simply are not negotiable andwhere responsible parents must set standards. But there are also vastdomains of childhoodexistence where it is safeand wholesome for themto choose for themselves what is best.Things go badlyfor developing individuals when thelove provided bysignificant others is dependent on how they behave. Conditional lovecripples development because it requires that individuals listen to othersrather than to themselves. When individuals conform in order to obtain80Counseling Theorieslove, they are living according to values introjected by others, or whatRogers calls the conditions of worth. This emotional blackmail resultsin individuals who deny their own actualizing tendency and relinquishthe right to discover their own uniqueness. In the extreme, they maybecome conforming, authoritarian types with rigid self-concepts.Inner Conflict and AnxietyInnerconflictresultswhenindividualsaretornbetweendoingwhatcomesnaturally and what others expect. When individuals accept the values ofothers in order to gain positive regard, those values are internalized andbecome part of the personality. If the individual then behaves or thinksinwaysthatareinconsistentwiththoseintrojectedvalues,theself-conceptisviolatedandthepersonlosesself-esteemandsuffersanxiety.Themotherwhospanked aman30 yearsagofor masturbatoryactivityhas longbeengone from this world, and yet the adult-child still gets nervous when hethinks of sex.Individuals defend against anxiety and threats to self-esteemby devel-opingamorerigidself-conceptthatwillbelessopentonewandpossiblydisturbing experiences. They begin to distort reality through the use ofdefense mechanisms, such as denial, projection, and reaction formations.Byputtingtightreinsonemotions,theycanliveouttheirlivesinastablebut unfulfilled state. In order for therapy to be effective, there must be aweakening of these defenses to the point where the individual can sensethe incongruity between the self-concept and the experiencing self. It isthis identity crisis and the ensuing anxiety that may motivate the personto seek help and engage in the counseling process.CLASSICAL PERSON-CENTERED THERAPYIn classical person-centered psychotherapy, treatmentisthe relationshipbetweenthe counselorandtheclient. Ifthatrelationship ischaracterizedbythefollowingsixnecessaryandsufficientconditions,thenconstructivepersonality change will take place (Rogers, 1957):1.Two persons are in psychological contact.2.Theclientisinastateofincongruence,beingvulnerableoranxious.3.The therapist is congruent or integrated in the relationship.4.The therapist experiences unconditional positive regard for theclient.Person-Centered Counseling in Rehabilitation Professions815.Thetherapistexperiencesanempathicunderstandingoftheclientsinternalframeofreferenceandtriestocommunicatethisexperienceback to the client.6.Thecommunicationtotheclientofthetherapistsempathicunder-standing and unconditional positive regard is to a minimal de-gree achieved.To appreciate the above six points, it is necessary to become steepedin the material: to study, observe, and then experience it directly. ThefollowingquotefromRogers(1980,pp.114117)inAWayofBeinggivesan excellent subjective sense of the ways in which he saw the facilitativeconditions working:WhatdoImeanbyaperson-centeredapproach?Itexpressestheprimarythemeofmywholeprofessionallife,asthatthemehasbecomeclarifiedthroughexperience,interaction with others, and research. I smile as I think of the various labels Ihavegiventothisthemeduringthecourseofmycareernon-directivecounsel-ing, client-centered therapy, student-centered teaching, group-centered leader-ship. Because the fields of application have grown in number and variety, thelabel person-centered approach seems the most descriptive.The central hypothesis of this approach can be briefly stated. (See Rogers,1959, for a complete statement.) Individuals have within themselves vast re-sourcesforself-understandingandforalteringtheirself-concepts,basicattitudes,and self-directed behavior; these resources can be tapped if a definable climateof facilitative psychological attitudes can be provided.There are three conditions that must be present in order for a climate tobe growth-promoting. These conditions apply whether we are speaking of therelationship between therapist and client, parent and child, leader and group,teacher and student, or administrator and staff. The conditions apply, in fact,inanysituationinwhichthedevelopmentofthepersonisagoal.Ihavedescribedthese conditions in previous writings; I present here a brief summary fromthe point of view of psychotherapy, but the description applies to all of theforegoing relationships.The first element could be calledgenuineness[italics added], realness, orcongruence. The more the therapist is himself or herself in the relationship,puttingupnoprofessionalfrontorpersonalfacade,thegreateristhelikelihoodthattheclientwillchangeandgrowinaconstructivemanner.Thismeansthatthe therapist is openly being the feelings and attitudes that are flowing withinatthemoment.Thetermtransparentcatchestheflavorofthiscondition:thetherapist makes himself or herself transparent to the client; the client can seerightthroughwhatthetherapistisintherelationship;theclientexperiencesnoholding back on the part of the therapist. As for the therapist, what he or sheisexperiencingisavailabletoawareness,canbelivedintherelationship,andcanbecommunicated,ifappropriate.Thus,thereisaclosematching,orcongruence,82Counseling Theoriesbetweenwhatisbeingexperiencedatthegutlevel,whatispresentinawareness,and what is expressed to the client.Thesecondattitudeofimportanceincreatingaclimateforchangeisaccep-tance, or caring, or prizingwhat I have calledunconditional positive regard[italicsadded].Whenthetherapistisexperiencingapositive,acceptantattitudetowardwhatevertheclientisatthatmoment,therapeuticmovementorchangeis more likely to occur. The therapist is willing for the client to be whateverimmediatefeelingisgoingonconfusion,resentment,fear,anger,courage,love,orpride.Suchcaringonthepartofthetherapistisnonpossessive.Thetherapistprizes the client in a total rather than a conditional way.The third facilitative aspect of the relationship isempathic understanding[italics added]. This means that the therapist senses accurately the feelingsand personal meanings that the client is experiencing and communicates thisunderstanding to the client. When functioning best, the therapist is so muchinside the private world of the other that he or she can clarify not only themeanings of which the client is aware but even those just below the levelof awareness.Thiskindofsensitive,activelisteningisexceedinglyrareinourlives.Wethinkwelisten,butveryrarelydowelistenwithrealunderstanding,trueempathy.Yetlistening, of this very special kind, is one of the most potent forces for changethat I know.HowdoesthisclimatewhichIhavejustdescribedbringaboutchange?Briefly,aspersonsareacceptedandprized,theytendtodevelopamorecaringattitudetoward themselves. As persons are empathically heard, it becomes possible forthem to listen more accurately to the flow of inner experiencings. But as aperson understands and prizes self, the self becomes more congruent with theexperiencings.Thepersonthusbecomesmorereal,moregenuine.Thesetenden-cies, the reciprocal of the therapists attitudes, enable the person to become amoreeffectivegrowth-enhancerforhimselforherself.Thereisagreaterfreedomto be the true, whole person.Clearly,Rogersintendedhistheorytoreachwellbeyondtheboundariesofformalpsychotherapy.Itappliesto anyhelpingprofessionorsituationwheretheintentionistopromotethewelfareorgrowthofanotherhumanbeing.Itappliesasmuchtotherelationshipsbetweenrehabilitationcoun-selors and their clients as it does to relationships between parents andchildren or teachers and students. Whatever the situation, if the goal isself-actualization,thenthemeanstothatendisthetherapeuticrelationshipas defined by the facilitative conditions.CASE STUDYThe following excerpt from an interview carried out by Carl Rogers in1983illustratessomeofthebasicskillsusedinperson-centeredcounseling(Raskin & Rogers, 1995, p. 144, reproduced with permission):Person-Centered Counseling in Rehabilitation Professions83Therapist 1: Ok, I think Im ready. And you...ready?Client 1:Yes.T-2:I dont know what you might want to talk about, but Imvery ready to hear. We have half an hour, and I hope thatinthathalfanhourwecangettoknoweachotherasdeeplyaspossible,butwedontneedtostriveforanything.Iguessthatsmyfeeling.Doyouwanttotellmewhateverisonyourmind?C-2:Imhavingalotofproblemsdealingwithmydaughter.Shes20years old; shes in college; Im having a lot of troubleletting her go....And I have a lot of guilt feelings abouther; I have a real need to hang on to her.T-3:Aneedtohangonsoyoucankindofmakeupforthethingsyou feel guilty aboutis that part of it?C-3:Theresalotofthat....Also,shesbeenarealfriendtome,and filled my life....And its very hard...alot of emptyplaces now that shes not with me.T-4:The old vacuum, sort of, when shes not there.C-4:Yes. Yes. I also would like to be the kind of mother thatcould be strong and say, you know, Go and have a goodlife, and this is really hard for me to do that.T-5:Its very hard to give up something thats been so preciousinyourlife, butalsosomethingthatI guesshascausedyoupain when you mentioned guilt.C-5:Yeah,andImawarethatIhavesomeangertowardherthatIdontalwaysgetwhatIwant.Ihaveneedsthatarenotmet.And, uh, I dont feel I have a right to those needs. Youknow....Shes a daughter; shes not my motherthoughsometimes I feel as if Id like her to be mother to me. Itsvery difficult for me to ask for that and have a right to it.T-6:So it may be unreasonable,but still, when she doesnt meetyour needs, it makes you mad.C-6:Yeah, I get very angry, very angry with her.PAUSET-7:Youre also feeling a little tension at this point, I guess.C-7:Yeah. Yeah. A lot of conflict...T-8:Umm-hmm...C-8:A lot of pain.T-9:Alotofpain.Canyousayanythingmorewhatthatsabout?84Counseling TheoriesC-9:(sigh) I reach out for her, and she moves away from me.And she steps back and pulls back....And then I feel likea really bad person. Like some kind of monster, that shedoesnt want me to touch her and hold her like I did whenshe was a little girl....T-10:Itsoundslikeaverydoublefeelingthere.Partofitis,Damnit, I want you close. The other part of it is, Oh my God,what a monster I am to not let you go.C-10:Umm-hmm.Yeah.Ishouldbestronger.Ishouldbeagrownwoman and allow this to happen.Raskin makes the following observation on this case study (Raskin &Rogers, 1995):The interview just quoted reveals many examples of the way in which changeandgrowtharefosteredintheperson-centeredapproach.Rogersstraightforwardstatementsinopeningtheinterview(T-1andT-2)allowtheclienttobeginwitha statementof the problem of concern to her and to initiate dialogue ata levelcomfortableforher.Justashedoesnotreassure,Rogersdoesnotaskquestions.In response to C-2, he does not ask the myriad questions that could constructa logical background and case historyfor dealing with the presenting problem.Rogers does not see himself as responsible for arriving at a solution to theproblem as presented, or determining whether this is the problem that will befocused on in therapy,or changing the clients attitudes.The therapist sees theclient as having these responsibilities and respects her capacity to fulfill them.(p.148)SUPPORTIVE RESEARCHHistorical Ebb and Flow of ResearchExtensive empirical evidence has accumulated in support of person-cen-teredtherapy,datingbacktothe1940s.Inthe1950sand1960stherewasa virtual torrent of research inspired by Rogers and his colleagues thatseemedtofirmlyestablishthelegitimacyofperson-centeredtherapy(Cark-huff, 1969; Rogers, Gendlin, Kiesler, & Truax, 1967; Truax & Carkhuff,1967).However,aspointedoutbyCorey(2001),littlesignificantresearchon person-centered therapy has been produced in the past 20 years. Inaddition, as researchers examined issues more closely in the 1970s, theybegantoexpressreservationsaboutthevalidityoftheearlyfindings.Therewas concern about the lack of rigor and quality of much of the research,and there were substantial difficulties in operationalizing the facilitativeconditions(Corey,2001;Hazler,1999).Forexample,Gladsteinandassoci-Person-Centered Counseling in Rehabilitation Professions85ates (1987) defined 18 types of empathy and eventually concluded thatempathywastoocomplextostudy.Anotherfactorwasthegrowingimpor-tance and influence of the behavioral therapies in the 1960s and, morerecently,thecognitiveandcognitive-behavioraltherapies.Therewasalsoan element of benign neglect of empirical research that was shown bysomehumanists.Indeed,accordingtoCain(1993),thereisaconservativeinfluencewithintheperson-centeredschoolthatisprotectiveoftheclassi-calformoftherapyandisunimpressedandunaffectedbynewfindingsinrelated fields, such as human development, clinical psychology, andpsychiatry.Possibly the greatest factor of all in the decline in popularity has beenthe historic migration of psychotherapy in general toward eclecticism.Sixty-eight percent of therapists have been found to claim that they wereeclectic in orientation (Lambert & Bergin, 1994). In addition, there hasbeen an ever-burgeoning number of minitheories, hybrids, and fads thathavecontinuedtoemerge.Karasu(1986)estimatedthatthereweremorethan 400 recognizable approaches to psychotherapy. Few of the theorieshavebeencarefullyresearched,andsomeofthemcanbeconsidereddanger-ous,suchastheregressiontechniquesthatproducefalsememories(Loftus,1996).Theevolutiontowardeclecticism,orwhatsomehavecalledintegra-tion, willlikely continueinto thefuture, witheven lessallegiance shownto discrete schools and theories, such as person-centered, behavioral, orpsychoanalytical.In spite of the historical decline in the popularity of classical person-centeredtherapy,substantialevidencehasaccumulatedregardingtheim-portanceofthetherapeuticrelationshipitself.Theevidencestronglysug-gests that the facilitative conditions are necessary, as Rogers advocated,but they are not necessarily sufficient. In other words, empathy, positiveregard,andgenuinenessshouldalwaysbepresent,buttherearetimesandsituations where they will not be enough and will need to be augmentedbymorespecializedtechniquesorprocedurestailoredtotheclientsneeds.Thereissomeevidencethatcognitiveandbehavioralapproachesmayhaveadvantages with particular individuals under certain circumstances, buteventhisconclusionisdebatableandrequiresfurtherdocumentation(Sel-igman, 1995).The Common FactorsA timely vehicle for understanding the current status of person-centeredtherapywouldseemtobetheso-calledcommonfactors(Bergin&Garfield,86Counseling Theories1994; Wampold, 2000, 2001). Briefly, there is considerable research evi-dence to support the effectiveness of psychotherapy in general, but verylittlesupportforthesuperiorityofonetypeorapproachoveranother.Thus,thereprobablyarecommonfactors,ornonspecifictherapeuticingredients,present in all types of therapies that account for client gain seen acrossdifferent approaches.Theimportanceofthecommonfactors,whatevertheyare,wouldappearto be substantial because they are known to be powerful healing agents,possiblyaccountingforupto85%oftheoutcomevarianceinpsychother-apy (Strupp, 1996). Research has not yet ferreted out exactly what thesecommonfactorsare,buttheycouldbesomethingasfundamentalaslove,orhumanbonding,orthetriggeringoftheplaceboeffect.Rogerstherapeuticrelationshipconditionsarewidelyconsideredtobeimportantcomponentsofthecommonfactors.LambertandBergin(1994)hadthisobservation:Amongthecommonfactorsmostfrequentlystudiedhave beenthoseidentifiedbytheclient-centeredschoolasnecessaryandsufficientconditionsforpatientpersonality change: accurate empathy, positive regard, nonpossessive warmth,andcongruenceorgenuineness.Virtuallyallschoolsoftherapyacceptthenotionthattheseorrelatedtherapistrelationshipvariablesareimportantforsignificantprogressinpsychotherapyand,infact,fundamentalintheformationofaworkingalliance. (p. 164)Few contemporary scholars and researchers in counseling, even thosewho advocate the person-centered approach, believe that the therapeuticrelationship conditions are necessaryandsufficient for accomplishingchange(Norcross&Beutler,1997;Prochaska&Norcross,1999).However,the belief that the conditions are necessary, although not sufficient, iscommonly held, and the notion that the therapeutic relationship is acommonfactorrepresentsaparadigmshiftthatcouldhavemajorimplica-tionsforcounselingtheoriesandthehelpingprofessions.If,forexample,future research confirms that Rogers therapeutic relationship conditionsare indeed a key component of the common factors, it would likelysignal a revival of interest in person-centered therapy, and would alsorequire other therapies to more deliberately incorporate the therapeuticrelationshipasabasicingredient.Thepotentialimportanceofthisdevelop-ment was anticipated by Patterson (1986) in hisTheories of Counselingand Psychotherapy:Considering the obstacles to research on the relationship between therapistvariables and therapy outcomes and the factors that militate against achievingsignificant relationships, the magnitude of the evidence for the effectiveness ofPerson-Centered Counseling in Rehabilitation Professions87empathic understanding, respect or warmth, and therapeutic genuineness isnothingshortofastounding.Theevidenceforthenecessity,ifnotthesufficiency,of these therapistqualities is incontrovertible. There is littleor no evidence forthe effectiveness ofanyother variables ortechniques orfor the effectiveness ofothermethodsorapproachestopsychotherapyintheabsenceoftheseconditions.(p.562)Although Pattersons tone might seem a bit strident, it is important tonote that he is not making the claim that the conditions are sufficient,only that they are necessary. His final phrase, in the absence of theseconditions,suggeststhat,ifthefacilitativeconditionswereremovedfromthe other therapies, then the techniques and procedures that remainedwould likely be a weak residue of questionable value. In other words,the therapeutic relationship is the platform or stage upon which morespecialized techniques must operate. Other techniques cannot exist inisolation from the therapeutic relationship, and they are probably muchless important.Outcome ResearchGreenberg,Elliot,andLietaer(1994)conductedameta-analysisofoutcomestudiesonperson-centeredtherapy,combinedwithotherexperientialther-apiessuch asGestalt,and comparedthemwith nonexperientialtherapiessuchasbehavioralandcognitiveapproaches.Thismeta-analysisincluded37studies, involving 1,272 clients. They found that the average treatedclientmovedfromthe50thtothe90thpercentileinrelationtothepretreat-ment samples, which appeared to be a large treatment effect. When thedifferent therapies were compared to each other, they all appeared to beequally effective, although the more directive forms seemed to have anadvantageoverthepassive.ThisfindingagainconfirmedtheDodobirdhypothesis fromAlice in Wonderland: The queen cried, You all win andyou all get prizes!; in other words, all therapies work, and there doesnot seem to be a significant difference between them.Thefollowingisabriefsampleofoutcomesofperson-centeredcounsel-ing that have been documented (Grummon, 1979): There is an improvement in psychological adjustment as shown onpersonality tests. There is less physiological tension and greater adaptive capacity inresponse to frustration. There is a decrease in psychological tension.88Counseling Theories There is a decrease in defensiveness. Friendstendtoratetheclientsbehaviorasmoreemotionallymature. There is an improvement in overall adjustment in the vocationaltraining setting. Successful clients evidence strong gains in creativeness.Someveryimpressiveresearchontheperson-centeredapproachcomes,notfromcounseling,butfromeducation.AspyandRoebuck(1974)rated550elementary-andsecondary-levelteachersonthefacilitativeconditions(empathy,positiveregard,andgenuineness)andthencorrelatedtheratingswithalargenumberofstudentperformancecriteria.Thefindingsseemedquite remarkable. The students of highly rated teachers showed greatergains in academic work as well as a number of nonacademic outcomes,such as creative problem-solving skills, more positive self-concept, fewerdiscipline problems, and lower absence rates.In a nationwide study of practicing rehabilitation counselors, BozarthandRubin(1978)investigatedtherelationshipofthefacilitativeconditionsexhibited by counselors to rehabilitation gain exhibited by their clients.This five-year study of 160 rehabilitation counselors and 1,000 clientsconcluded,amongotherthings,thatthecounselorswereatleastashighonlevelsofempathy,respect,andgenuinenessdimensionsasmanyotherprofessional groups, including experienced psychotherapists in privatepractice(p. 178).Withreference toclientgain, thehigherlevels oftheinterpersonalskills,eventhoughfallingontheoperationalscaledefinitionofminimally facilitative,tendedto berelated tohighervocational gainatclosure, higher monthly earnings at follow-up, positive psychologicalchange 10 months or more following intake, and greater job satisfactionat follow-up (p. 178).Althoughnotanoutcomestudy,Fier(1999)recentlyconductedasurveyof 112 Wisconsin State Division of Vocational Rehabilitation counselors.The findings indicated that, when counselors referred their clients forpsychotherapy,theysoughtthefollowingtheoreticalorientations:eclecticorgeneral(45hits),behavioral(42hits),client-centered(37hits),reality(20 hits), and rational-emotive (11 hits); Gestalt, Freudian, trait-factor,transactional analysis, and holistic all received one or two hits. Clearly,theeclectic,behavioral,andclient-centeredapproachesappearedtobethemost popular for purchase by the counselors.Inconclusion,itisimportanttorememberthat,eventhoughtheclassicalperson-centered approach has seen a decline in popularity, the empiricalsupport for person-centered therapy appears to be strong and enduring.Person-Centered Counseling in Rehabilitation Professions89The empirical support compares favorably with all of the other majortheoreticalapproachesthathavebeenexaminedovertheyears.Itispossiblethat the growing awareness of the importance of the common factorscould signal a renaissance of sorts for insight-oriented therapies such asthe person-centered, existential, and psychodynamic approaches, wheresingular importance is attached to the therapeutic relationship.PERSON-CENTERED PRINCIPLESIN REHABILITATION COUNSELINGOvertheyearsnumerousauthoritiesinrehabilitationhaverecognizedthecritical role of the facilitative conditions in rehabilitation settings (e.g.,Rubin&Roessler,2001;See,1986;Thomas,Thoreson,Parker,&Butler,1998).Regardingtheuseoffacilitativeconditionsinrehabilitationcounsel-ing settings, Rubin and Roessler (2001) stated:Aqualityrelationship(i.e.,onecharacterizedbyempathy,respect,genuineness,concreteness, and cultural sensitivity) facilitates client progress by providing asituationthattheclientwillwanttomaintain,byenablingtheclienttoverbalizereal concerns, and by making the counselor a potent reinforcer in the clientslife. Although a necessary element, a good relationship is not sufficient forensuring positive rehabilitation outcomes. As Kanfer and Goldstein (1991)pointedout,aclientshouldexpectacounselortobebothtechnicallyproficientandempathic, respectful, and genuine. Rehabilitation counselor skills must besufficientlycomprehensivesothatitisunnecessaryforclientstomakeachoicebetween the two. (p. 265)Forthosewhowishtosystematicallyincorporateperson-centeredprinci-plesintotheirrehabilitationpractice,thereareafewpracticalformulastoassist in the process. The rehabilitation service continuum can provide aframework, beginning with the client applying for services and movingthrough successive stages until eventual employment and successful caseclosure. Thefirst stageis characterized by the diagnostic workup, alongwith the exploration of feelings and the engendering of hope. Rapport isestablished and the client comes to trust and value the counselor. Herethe facilitative conditions are extremely important as the client strugglesto find the words to symbolize the inner conflict and begins to developanawarenessofanemergingselfwithpermissiontomoveforwardintherehabilitation process.After clients have made the existential determination that change ispossibleanddesirable,theyarereadytostartthinkingaboutoptions,goals,and strategies. Thissecond stageis what might be called the thinking or90Counseling Theoriesplanningstage,whereclientsandcounselorstogetheranalyzeandintegratetheinformationthatwascollectedduringtheinitialdiagnosticstageandtrytodevelopaconcretevocationalplanorgoal.TheCouncilonRehabilitationEducation(CORE,2000)hasspecifiedthatoneoftheeducationaloutcomesforstudentsofmastersdegreeprogramsinrehabilitationcounseling(Stan-dardE.3.5)istheabilitytofacilitatewiththeindividualthedevelopmentofaclient-centeredrehabilitationand/orindependentlivingplan(p.25).Inmanywaysthisisthestageofcommonsenseandlogicaldeduction.Ifone needed a counseling theory for guidance at this stage, it would mostlikelyfollow fromtrait-and-factor orpsychoeducationalapproaches.Thisstage is not as dependent on the facilitative conditions as the first stage,but, to the extent the client becomes anxious or worried, there will stillbe many opportunities to ventilate or sort things out.Thethird stagecan be characterized as the action or implementationstage,inwhichtherehabilitationplanisimplementedandtheclientactuallybegins a new job or training program. The counseling approaches thatwould have the most utility at this stage are action-oriented approaches,suchasbehavioral,rational-emotive,andrealitytherapy.Facilitativecoun-seling remains part of the repertory, but it is used primarily to help theclient deal with negative feelings that arise during the implementation ofplans. For most clients this stage is uncharted territory and can be quitestressfulandthreatening.Theanxietythatarisescanjeopardizetherehabili-tation program. The best preventative medicine at this stage is often asimple dose of the facilitative conditions in the form of active listeningby the counselor.A rule of thumb for incorporating a person-centered approach intorehabilitation might be stated as follows: The rehabilitation practitionersfunctionistoofferprofessionalservicesasneededalongacontinuumfrominsight to action, remembering along the way to offer clients as muchautonomy as they can handle, while still providing the support that theyneed.Thefacilitativeconditionsareabsolutelyessentialduringtheinitialself-exploration stages, but as the rehabilitation process evolves and theclientsfocus changesfrom subjectiveto objectiverealities,the counselorwill increasingly need to provide services related to problem solving orskill development, consistent with behavioral and cognitive approaches.Thefacilitativeconditionsremainnecessarythroughouttherehabilitationprocess,butthesufficiencyargumentlosesstrengththefurthertheprocessmoves along the continuum toward engagement with the real world.Person-Centered Counseling in Rehabilitation Professions91LIMITATIONS OF CLASSICAL PERSON-CENTEREDCOUNSELING IN REHABILITATION SETTINGSTheperson-centeredcounselingperspectiveinitsclassicformpossessesnearlyinsurmountableobstaclesforrehabilitationpractitioners.Thetermclassicalrefers to in-depth therapy, guided by Rogers formulations onpersonality development, that is totally nondirective. It relies exclusivelyonthenecessityandsufficiencyofthefacilitativeconditions.Thisclassicalapproach is as distinctive for what it proscribes as for what it prescribes.Thelimitationslistedbelowwereidentifiedinrelationtostatevocationalrehabilitation practice by See (1986); however, with slight modificationthey can be applied to virtually any rehabilitation setting:1.Theclassicalmodeldoesnotsetgoals,asidefromself-actualization;yettherehabilitationcounselorisrequiredbylawtodevelopindivid-ualized service plans.2.Theclassicalmodeldoesnotbelieveindiagnosing;yettherehabilita-tion counselor is committed to using medical, psychological, andvocational evaluations.3.Theclassicalmodeldoesnotgiveadvice;yetoneoftherehabilitationcounselors most distinctive assets is knowledge of occupationalinformation and the world of work.4.The classical model is relatively unconcerned with the externalenvironment;yettherehabilitationcounselorisinconstantinterac-tionwiththerealworldandspendsconsiderabletimecoordinatingcommunityresourcesanddeliveringconcreteservicestotheclient.5.Theclassicalmodelismosteffectivewithanxiousandverbalclients;yet many rehabilitation clients do not fit this description.6.Theclassicalmodelisprocessoriented;yetrehabilitationcounselorsare accountable for end results.7.Theclassicalmodelcallsforpersonalityrestructuring;yetthephysi-callydisabledareaspsychologicallysoundasthenondisabledanddo not necessarily need reorganization of the self-concept.8.The classical model does not focus on client behavior; yet clientskilldevelopment,education,andactionarethelifebloodofrehabili-tation. (p. 143)Inaddition,thereareotherareasofdifficultyfacedbyrehabilitationprofes-sionals who use person-centered principles.92Counseling TheoriesLack of Real-Life ExperienceOne of Rogers basic assumptions is that individuals have within them-selves vast resources for self-understanding and for altering their self-concepts, basic attitudes, and self-directed behavior...(Rogers, 1980,p.114).Thisstatementimpliesthatclientshavesufficientfamiliaritywiththeouterworldtoweighoptionsandmakechoicesbasedonrealitytesting.In vocational rehabilitation the problem is complicated by the fact thatclients haveoften not experiencedtheworld of workand so donot havea basis for forming accurate self-concepts as workers. Persons withoutdisabilities spend a major part of their lives testing and adjusting theselfagainstrealexperiencesintheenvironment,alifelongdevelopmentalprocess(Super,1990).Unfortunately,personswithcongenitaldisabilitiesmay have been deprived of these natural developmental experiences andconsequently can be vocationally immature as adults. Likewise, clientswho acquire a disability later in life can also face serious challenges. Inextremecases(e.g.,severetraumaticbraininjury)thedisabilitymaylargelyinvalidate the prior experiences upon which vocational decisions weremade. For many such clients vocational rehabilitation becomes a crashcourse in careers. They are expected to learn in months or years whatothershavespentalifetimeabsorbing,andtheywilllikelyneedvocationalexplorationandtrainingmorethanpsychotherapy.Theirvocationaluncer-taintyisoftenduetoalackofknowledgeratherthandeepinnerconflicts.Level on Needs HierarchyWith many rehabilitation clients, it might be posited that they are moreinneedofsecuritythanself-actualization.Theyareoperatingclosertothebottom of Maslows needs hierarchy than the top, and until they achievephysicalandpsychologicalsecurity,theywillnothavetheenergyorinteresttoengageinself-exploration.Someyearsago,anirreverentwagobservedthatitshardtothinkaboutself-actualizationwhenyoureuptoyourassin alligators. About the only time that the facilitative conditions couldactually harm clients is when counselors are so ideologically driven thattheycannotseethealligatorsandinsistonusinginsight-orientedtherapywhentherearemorefundamentalneeds,suchaspayingtherentorputtingfood on the table. Security trumps autonomy most of the time for mostpeople.Use of ConfrontationAcommonconcernofrehabilitationprofessionalsistheuseofconfronta-tion with clients who have inaccurate perceptions of their abilities inPerson-Centered Counseling in Rehabilitation Professions93relation to their vocational ambitions. For example, an egocentric clientwithpoorpeopleskillsmightdecidethathewantstobecomeacomputersalesperson because of the large commissions. He is unaware that otherpeopleactivelyavoidtalkingtohim.Mostcounselorsandevaluatorswouldagree that such a client must be confronted with the reality of hissituation.Many people mistakenly believe that person-centered principles arelimited to techniques of attending and reflecting, seeing the therapist assupportive without being challenging (Corey, 2001). In fact, the use ofconfrontationisaspecialskillofperson-centeredtherapists(Martin,1983;Rogers, 1970 as cited in Graf, 1994). The essence of person-centeredconfrontation differs from conventional confrontation in that clients arenot criticized or directed in any way; rather, they are simply shown thecontradictionsintheirownthoughtsandfeelings.Intheabsenceofexternalthreat, they are often able to digest information and make appropriatebehaviorchangesontheirown.Thistypeofconfrontationrequiresconsid-erable expertise, but it can be very effective.Cross-Cultural ConflictAlthough cross-cultural interactions have been a fertile ground for theapplication of person-centered principles, there have been concerns thatperson-centeredvaluesmayconflictwiththevaluesofothercultures.Forexample,theperson-centeredemphasisonindividualism,withtheimplieddeemphasis on family, friends, and authorities, can run counter to thecommunity-centered tenets of some cultures. Also seen as problematic istheperson-centeredemphasisonfeelingsandsubjectiveexperiences.Thisemphasisassumesanabilitybytheclienttoverbalizefeelingsandawilling-nessto sharethem inthe momentwiththe therapist.Persons fromsomecultures may be reluctant or unable to participate adequately in theseintrospective techniques (Freeman, 1993; Usher, 1989).CONCLUSIONCarlRogerscontributionstothehelpingprofessionsandsocietyhavebeenenormous. Rogers, Sigmund Freud, and B. F. Skinner are probably thethreemostinfluentialbehavioralscientistsofthetwentiethcentury.Eachstaked out a radically new way of viewing human nature. Freud, thepessimist, warned of the undercurrents, viewing people as possessed bydemonsandforcesthatneedtobetamed.Theroleofpsychotherapyandcivilizationistocreateaveneerofsociabilitythatwillallowpeopletolive94Counseling Theoriesinharmonywiththemselvesandtheirneighbors.Thistheorywastheoriginandinspirationofthepsychoanalyticmovementandmuchofpsychiatry.Itwas essentially a medical model to diagnose and treat mental illness.B.F.Skinner,thedisinterestedscientist,hadanentirelydifferentview.He believed that human nature was neither good nor bad; it was simplyaproductoftheenvironment.Theorganism,humanorotherwise,learnedaccordingtothepredictableprinciplesofoperantconditioning.Thechal-lengetosocietyistoengineertheenvironmentsothatindividualsdevelopin directions that are socially desirable. Positive reinforcement is thesinequa nonof the behavior therapies.Carl Rogers, the optimist, saw the angels instead of the demons. Hebelievedthatpeoplewereinnatelygood,withthecapacitytoself-actualize.Thiscapacity,however,couldonlybeunlockedbynurturingrelationshipswith significant others. This perspective is the core of most humanisticand existential therapies. Some feel that Rogers facilitative conditions(empathy,positiveregard,andgenuineness)comeclosetoanoperationaldefinition of love. The person-centered approach is especially relevantfor the rehabilitation professions because of its emphasis on growth andmaximizing human potential.Each of these remarkable thinkers contributed to an understanding ofhumannature.Theirideashavetranscendedpsychotherapyandpsychologyand find expression in virtually all levels of modern discourse. In a veryreal sense they have taught people how to think about life. The well-informed helping professional will see these theories, and their manyderivatives,aspowerfultoolsforunderstandingandworkingwithclients.The past several decades have seen a general decline in the use ofclassical person-centered psychotherapy, as well as in the other long-term insight-oriented therapies. Paradoxically, however, there has been agrowingconvictionregardingtheimportanceofthefacilitativeconditionsascommonfactorsthatexertapositiveinfluenceinvirtuallyallsettingswhere humans interact. The necessity of the facilitative conditions in thehelpingprofessionsisnowsowellestablishedthatitwouldseemtoconsti-tute an ethical violation to ignore or disregard them. 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