WELF7002 - Case Report Assessment 4

Instructions

Case report reading, provided in UVWS: In Search of a Dreamer
You should be well-versed with Marvin and his therapist Irvin Yalom by now. You have been asked to ‘immerse’ yourself in their work together and write comprehensive notes from the perspective of a person-centred therapist during your reading of the sessions several times. This will mean you are being forced to look at what he has shared with you (your understanding of Marvin as a person and his way of being in the world, as well as his story and how he has laid it out over time). You will have noticed what has occurred in their interactions together and identified significant moments, difficulties that occurred and when the work is going well. This will include noticing moments of connection and disconnection between them, emotional reactions to aspects of the story for both parties, along with your own response to what was occurring from moment to moment and your position in the room. This assessment encourages you to draw on both your Right and Left Hemispheres to (1) put yourself in the position of a counsellor/therapist working with this client in an agency, and (2) provide a personal reflective commentary of Irvin’s work with Marvin from the perspective of a person-centred therapist in training.
Please refer to the Case Report Instructions document in UVWS for detailed instructions to assist you in completing this assessment.

Personal Change Through Counselling: An Overview of the Process

There is an inherent difficulty in the recent trend, particularly within the psycho-medical field, to research counselling outcomes with a view to establishing scientifically whether or not counselling makes people “better”. Such studies are usually undertaken at the end of and geared around documenting if a relatively short time-limited therapy has had an effect. That limitation of counselling can be profoundly unhelpful and quite untrue when it is at best optimistic and at worst misleading. Such a claim seems based on the notion that therapy for all people adopts a panacea-like or ‘miracle doctor’ patient relationship, where medication is prescribed for an illness and the patient will either cure or not cure. If a student relationship went wrong, or a relationship broke down, the assumption that it can be made better becomes absurd: such as saying that good wine can simply improve all simple structures. It is so very difficult: Counselling, it would seem, is not best suited to the tidy measurement-like environments that often dominate the world of health research, which still seem unable to comprehend how important moments from the difficulty of change and the reasons for behaviour can be missed because of simple reference to Rogers. Client, Gloria, in

Chapter 11. Thus, legitimate observations can be made about client choices in the short term, but often these do clearly fail over time for some self or a counselling experience that did not help properly. That clients, as well as how they perceive and evaluate counselling, are rarely studied in depth. This implies that counselling has had its effect, and all of the effect it can or is likely to have, at a set point in time.

Rogers' Theory of Change

This leads us on to Rogers’ theory of change, which has at its heart the notion that change is an ongoing process. The word ‘personality’ has been purveyed (most times perhaps ‘chewed’) in the context of psychological stages. Yet even from fixed states to new unknown and more again, constant change is not only suggested, but is a process! It still seems to carry undertones of ‘personality type’ when used in this context, suggesting that a person is of one type or another and unlikely to change. Rogers’ theory of change is not fixed into any clear stage-by-stage version (as we tend to see in a way, and once again), instead states that though he did not observe dramatic variations during the process, as will be described, instead he suggested a process of change that occurs slowly, in micro bits but predictably.

This is emphasised here with an enormous effect. He further recognised that people might not always be aware of what has caused a provocative condition. Indeed, he recognised that some seeking help had tried the same method to outline, and in his ideas even denying the worth of personality. Rather, he said that it is the organismic worth of change as a process. His ideas on change will be followed (for example, Vaughan, 1986).

Rogers outlined many of his ideas regarding developmental changes through counselling in 1951, in Client-Centred Therapy, particularly in a chapter entitled “A Theory of Personality and Behaviour”, and in this he explored the impact of the counselling relationship. While his words are often seen today as universal truths, they were at the time not more than a humble version where the person and his experience were given maximum respect – it was not until a little later that he developed a more process-driven and observational method (1967). Some of his work will be summarised here. In this chapter it’s focusing on what happens and the following chapters will go on to examine how and why it happens.

Stage One

It is unlikely that a person at this stage will even come for counselling, as they do not recognise or own their feelings nor any of the meanings that might be attached to those feelings. The person at this stage does not perceive themselves to have any problems; if they were to, these problems would be externalised and not to do with ‘self’. In other words, they lack self-awareness. Life is viewed very much in black and white; their interaction with the world is based solely on past experiences that have become rigid benchmarks. Clients at this stage who do come for counselling tend not to come back after the first session as counselling is not seen by them to be helpful or appropriate—the idea of talking about themselves in order to effect change seems nonsensical.

Stage Two

In this stage a person is slightly more able to express their thoughts and feelings, perhaps identifying that they are experiencing some kind of problem. But any such problem is still perceived as being something external to them—there is still no sense of personal ownership and responsibility. Rogers gave the example of a client who, when asked by the counsellor what brought them to counselling, says something like ‘the symptom was being depressed’. He reflects that such a client is not saying ‘I am depressed’: there is no ownership of the problem. The client is at this stage on the path towards a vague self-awareness, although such an awareness may more likely be given in relation to the past. Thus a person at this stage shall still rise to one self-ownership commentary only in relation to their present experiencing. A client’s common opening statement of “the doctor’s diagnosed depression” tends to be associated with this stage.

Stage Three

Rogers observes that clients are most likely to enter counselling at this stage. There is slightly more awareness of self here, although a firm sense of self-ownership still does not exist for the client in relation to their present experiencing. Clients might talk about how they used to feel when they were younger originally, or possibly even in relation to a particular period of time. But in discussing present thoughts and events they still express them as though they are referring to someone else, such as ‘I described it in the way I thought the counsellor wanted to see me’ or ‘I had to perform’. There is a greater expression of awareness that some feelings are experienced but still viewed as wrong and shameful. Behaviours or constructs that previously were seen to be ‘true’ may start to be seen for what they really are. Rogers gave the example of a client at this stage who says: “so much and not whatever affection is involved; it just means submission.” And another client who went to resume this: “that if I am going to get affection, then it means that I must give in to what the other person wants.” Thus, importantly, at this stage there is also some awareness of the contradictions within experienced feelings and meanings.

Stage Four

If most clients are likely to enter counselling at stage three, Rogers believes the majority of therapeutic work will be in dealing with stages four and five. At stage four the client still experiences thoughts and feelings from different, slightly unconnected internal ‘selves’. There is more secure ownership of experience at this stage, but although the client recognises it is still often unconsolidated, and they are not quite sure how to hold it. There is enough awareness of experience. The client is, however, beginning to question the validity of their constructs as these do not work and there is greater discovery of what constructs often actually holds. The client is also subject to a deeper sense of the unease that accompanies their realisation that there are wider disconnections between some of these constructs.

Stage Five

At this stage there is a genuine embracing of self-ownership and responsibility of thoughts and feelings, with a more critical analysis of the client’s own constructs—perhaps leading to a review of where and how those constructs are no longer used insightfully. In counselling, it's not like finding a ‘remedy’ or even understanding: “I used to think that, but I just don’t any more—that was wrong, it’s not like that … maybe it was then, but not now.” Such a comment reflects a sense of not simply being more aware, or more critical; present thoughts and ideas about the effects of self-experiences being do not need, necessarily, be right or rational.

Such a realisation may seem quite cognitive but another characteristic of this stage is the greater degree of expression of current experiences. Experiences from still recent outcomes in the moment are used as personal sources to allow them to flow strongly—so it’s like they still encounter themselves in an open and vulnerable manner. Continuing the previous example, the client describes an act with awareness of a particular matter as they begin to explore the idea that perhaps this feeling, and even the change in feeling that seems to be occurring, is acceptable. A key development in this stage is the ability to allow how they are feeling in the moment with the counsellor. Is key characteristics of this client or perhaps more accurately, of the transition from this into sixth stage.

Stage Six

In this stage much of the process that has gone on before in many ways reaches its fruition. Moment-to-moment experiences flow almost overwhelmingly, but all the time informing and changing the client’s sense of self. Experiences are past experiencing their old shapes are being re-evaluated in terms of the present. There is an increased openness and potent level in direction. The incongruence between experience and awareness has all perhaps lifted or is no more real threatening: is now embodied and felt ‘reversed’. The client expresses all aspects of the incongruence which, as a result, dissolves into congruence.

Perhaps for the first time, there is a noticeable physiological accompaniment to the client’s experience at a deep bodily such as crying, shaking, subtle angles and posture change. While some of these may have occurred before, they are now perhaps acute because of the freedom exuding from the client in their new experiencing of themselves. Rogers comments that it is hard to capture the essence of this stage in words but he ...

Stage Seven

In this final stage the client develops all the characteristics of stages five and six a little further. There is a genuine naturalness about all of these aspects now, as the client becomes fully acclimatised to functioning in the way described. The counsellor’s facilitation is now of much less importance as the client is functioning equally well outside of the counselling setting as within it. As Rogers describes:

Thus at this stage the client’s transformation is complete. At one end of this continuum was a person with little or no self-awareness, with no sense of himself or sense of freedom or choice. He was operating almost entirely on pre-existing response. But what is rigidly crucial for Rogers (1967: 158) is that even here, the ongoing movement of a free-changing experiential richness meant that there was more than an internal process of self-awareness that is being constantly updated. They are freely attuned to themselves and their changing inner experiencing. These changes and the underlying continuity are the ongoing momentum that prevents personal self-referencing as pre-constructed and absolutely ordered. It is that they have become the integrated process of changingness.

As suggested earlier Rogers is well aware that, for some, such a psychological state would be far from desirable: a state of ever-flexible openness might seem to be ephemeral and they find no suitable meaning for their lives. However, it is at this high level of self-acceptance in a person that allows them to accurately perceive all their experiences, accept both past and present, there is a simple implication that they live closer to what is true. It is this self-congruence and unshaped speculative but felt definition of a person living in and through their fluid experience that Rogers felt the person functioning at stage seven and beyond approaches the realisation of the fully functioning self. Thus such people may hide, but can welcome it freely as a part of his changing and developing aspects.

The Fully Functioning Person

Rogers describes such a person as ‘fully-functioning’, a concept that he holds as an ideal, believing that very few people are actually able to function in this way. But if such a person is recognised as truly living, he sees that this ‘good life’ would be lived in a process, as he said it himself in a 1960 statement (reiterated again in Rogers, 1967: 186). This does not mean simply being the opposite mentioned, in each moment of the client’s inner response to life, but he emphasises openness to experience, existential living, in the sense that we are the moment as it is lived and aware of its full depth. If so lived, it has the attempt to break out of the frozen ideas into our constructs and preconceived ideas of what an experience should be, rather than allowing our.

Summary

Rogers’ conceptualization of the process of change is fundamentally simple and yet, even today, remains a radical and provocative statement challenging how we think about clients and ourselves. He outlined seven loosely defined stages that exist on a continuum, along which a client might move prior to, during, and after therapy. The precise denotation of each stage is of less significance: the essence of his hypothesis is that people move from a rigid and fixed concept of self to one that is in a continual state of change and development. Initially, a client may be unable to allow into their awareness any experiences that do not fit well in a set of rigidly held beliefs about the world and the people in it. Gradually though, as the client feels less threatened due to the therapeutic relationship, they begin to examine first that part and then past experiences. As the client begins to be aware of these experiences they take ownership of them as they assimilate them into their self-structure, which becomes increasingly flexible and flowing. Ideally, a point is reached at which no experience is too threatening to be allowed into awareness: a self of continual changeness.

Rogers hypothesises that a person in this type of state will be fully functioning, adapting and developing in a continual state of change and growth. Such a person is likely to be creative, experiencing a certain freedom in day-to-day living, as well as being self-enhancing and constructive, as they live and grow in the actualised sense of their trustworthy emotional nature. But perhaps surprisingly, given his own non-judging and non-self-referentory, a person naturally also becomes more pro-social and experiences an ever-deepening sense of communal and relationship with others. This arises an inherent need to develop this type of existence and once a person no longer compares their own experiences as threatening, they will be free to allow themselves to cultivate a more communal self.

Thus the person at one end of Rogers’ continuum is fundamentally isolated, trapped by their rigid and outdated experiential map and consequently unable to move for fear of disturbing the incongruence which they barely perceive. At the other end of the continuum, the person is able to embrace that incongruence, which ultimately becomes a part of their ever-changing congruent existence. They flow and develop freely, continually updating their experiential map, no longer afraid. They are free to be themselves they are free to be themselves in relationship with others.