Throughout a life time of research and clinical practice, Carl Rogers, influencial American psychologist, developed a "client centred" approach to therapy. Rogers argued that the most important factors influencing change in clients is the therapeutic relationship. This idea was not necessarily new to psychology, as psychoanalytically trained therapists knew of the importance of the threrapeutic relationship before the time of Rogers' work in the 1960s.

However, through researching the processes and outcomes of therapy, Rogers found that there were three essential components of the therapeutic relationship that brought about change in clients. These essential components were part of how the therapist engaged or related to the client. Rogers believed if the therapist displayed (i) Congruence, (ii) Empathy and (iii) Unconditional Postive Regard towards their client, that this was sufficient to create positive therapeutic change for the client. 

 

According to Carl Rogers' theory, through the process of socialisation, we learn that certain "conditions" may be attached to our sense of worth as a person. This process begins as a child where we learn what "is" and "is not" ok in the eyes of our parents, and learn "what to do" and "what not to do" to earn our parents love. That is, we can learn to behave according to the approval or disapproval of our parents. This process continues as we are then socialised outside the home in schools, by our peer groups and society at large. 

 

Conditions of worth are internalised rules or standards about the way that we think we "should" or "should not" be in the world, and these "rules" are unjustly and irrationally tied to our self worth as human beings. The core element of these rules is "I am only ok/of worth, if...........................". Each person, depending on their learning environment can develop different conditions of worth.

 

For instance, "I am only ok if I am successful", "I am only ok if I am approved of by others", "I am only ok if I am achieving", "I am only ok if I don't make mistakes", "I am only ok if I put others before myself", "I am only ok if I don't fail", "I am only ok if I am in control of my emotions", "I am only ok if I don't feel sad or vulnerable", "I am only ok if I don't feel fear or anxiety". 

 

Unfortunately, if these conditions or rules are not met in our lives, we may come to question our worth or value as human beings. This can result in low self esteem, depression, anxiety and many other psychological problems.

 

Congruence typically refers to "being one's authentic self" or being open or genuine. It is often described as the absence of a professional facade and one's external behaviours being congruent or consistent with one's feelings.

 

Empathy refers to being able to understand another's experience or to be able to put oneself in another's shoes. Empathy can range from understanding another's situation at the level of content (being able to accurately listen and understand) to a deep level (being able to accurately understand anothers feelings and emotions and to experience them "as if" they were one's own). This is different from sympathy where one completely identifies with the emotions of another. Empathy has a definitie "as if" quality, that allows the listener to remain objective at the same time.

 

Unconditional positive regard refers to an attitude of acceptance and valuing of the other person regardless of what the person says or does. Other terms that may describe this attitude is caring, non-judgmental and accepting a person for what they are from moment to moment.

 

Rogers believed that these conditions corrected a client's fundamental conditions of worth and assisted them in accepting themselves as they are, as worthwhile, but flawed human beings.  

 

Rogers' core elements of counselling has fundamentally influenced the way that most therapists approach therapy today. Whilst these three components are not primarily used by therapists today as a complete type of "therapy", these components are present in most therapies. Today, these components are considered necessary to provide a safe and supportive environment for clients in which clients can explore and reflect on their particular problems.

 

Therefore, regardless of the type of therapy used by a therapist, most therapists will be skilled in providing the above conditions for their clients. Therapists then learn particular therapy "modalities" in addition to these "core" skills. These "modalities" are scientifically researched to assess whether they are effective in helping people with different problems such as depression and anxiety disorders. Common "evidence based" therapies or "modalities" include Cognitive Behavioural Therapy, Schema Therapy, Interpersonal Psychotherapy and Acceptance and Commitment Therapy.

Research suggests that much of how we feel is a product of how we think and what we do. 

 

Cognitive behavioural therapy (CBT) aims to empower clients to try new ways of thinking and responding in their lives to bring about change, and ultimately improve the way they feel. CBT is based on a scientific understanding of the causes or maintaining factors (factors that keep psychological problems going) of clinical disorders and other problems.

 

CBT also seeks to assist clients to understand the causes of their problems and as such, CBT provides a map to understanding what changes need to occur to improve how we feel. It is a collaborative therapy where clients and therapist work as a team, and apply strategies and learn skills based on their individual circumstances.

 

CBT is an evidence based therapy, which has been shown through research to be effective in treating many clinical disorders and problems some of which include: depression and post-natal depression, panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, phobias, social anxiety disorder, post-traumatic stress disorder, health anxiety, bulimia, chronic pain, anger management, stress management, alcohol and substance problems, couples therapy......

In cognitive behavioural therapy, the initial session is usually used to assist the client in understanding the potential causes of their difficulties. This provides the framework for further sessions to continue with the therapist and client working together with strategies to assist with making changes. This is done with a specific focus on the client's unique circumstances and problems. As such, therapy is highly individualised to each person's needs. 

 

"Cognitive" largely refers to thoughts and beliefs, or how we percieve what is happening around us. Therefore cognitive interventions are interventions designed to modify unhelpful thoughts and beliefs about ourselves, others and the world that contribute to our emotional problems. Changing our thoughts and beliefs changes what we do and invariably how we feel.

 

Cognitive interventions aim to assist clients to (i) understanding that thoughts are related to feelings, (ii) Thought monitoring to develop skills in identifying negative or unhelpful thought patterns, (iii) indentifying thinking errors and (iii) Cognitive restructuring or changing negative thoughts to more helpful thought patterns.  

 

Later in therapy, deeper (core) beliefs about ourselves, others and the world that contribute to negative feelings are also discussed. The therapist and the client work together to create more helpful beliefs and philosophies about themselves, others and the world.

 

Behavioural interventions refer to interventions that focus on changing "what we do" rather than "what we think". Changing what we do changes how we think and invariably how we feel.

 

Common behavioural interventions in the treatment of depression include: activity scheduling, goal setting, communication strategies, problem solving, relaxation or meditation, assertiveness skills and behavioural experiments.

 

Common behavioural interventions in the treatment of anxiety disorders include: relaxation or meditation, planned and graduated exposure to feared situations, behavioural experiments and shame attack exercises.

 

Common behavioural interventions for the treatment of anger include: time out strategies, assertiveness strategies, problem solving, communication strategies, relaxation.

 

Whilst interventions can be described separately as "cognitive" or "behavioral", cognitive interventions inevitably influence what we do and behavioral interventions inevitably influence how we think. And changing how we think and what we do, invariably changes how we feel.