Person Centered Case Conceptualization
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Person-centered therapy was developed over the course of approximately 40 years by a man named Carl Rogers. Rogers believed a person experienced dysfunction when they are unable to experience themselves as the individual they perceive themselves to be. This is a person-centered case study for Melissa Reed who views her ideal self as a mother and wife. A woman who is now on her fifth marriage and has relational discord with her two daughters struggles with a sense of self-worth. The therapist will attempt to help Melissa progress through therapy at her own pace while working toward congruency between her real self and who she perceives herself to be. The ultimate goal is for Melissa to experience self-worth through self-actualization and learn to trust herself. Elements within the case study will bring forth the theological foundation of the Rogerian approach to therapy and whether or not the theoretical approach is compatible with the Christian worldview. Keywords: person-centered therapy, counseling and Christian worldview, treatment plan
Person-Centered Case Study of Melissa:
A Conceptualization and Treatment Plan
Melissa is a 44-year-old woman who was born with Cerebral-Palsy, although little physical evidence of the condition is present. She is in her fifth marriage and has minimal contact with her two daughters from her first marriage. Melissa has opened herself up to therapy in hopes that she will be able to improve her relationship with her daughters. Her daughters have expressed that their step-mother is more of a mother than Melissa will ever be. Melissa has expressed her desire to be a good mother to her children and how hurt she is at their actions. The daughters have yet to return the desire to have a mother-daughter relationship with Melissa. The deciding factor in choosing person-centered therapy as an approach for Melissa is the goal of assisting Melissa in discovering her true self and learning to feel and act accordingly instead of acting in accordance with the influences of others. Presenting Concerns
Melissa presents herself as feeling unfulfilled and unhappy in her relationships with her two daughters. She feels depressed, unloved, and pushed aside. She indicates that her relationship with her daughters is a continual source of contention, worry, anxiety, and unhappiness for her. Being raised in a Christian home and having raised her daughters in a Christian home with the same values only adds to the hurt. Melissa grew up being taught to honor her parents and she knows that her daughters were taught the same principles even when they were no longer living in her home. This adds to the confusion and lack of understanding as to the source of the problem. Melissa is beginning to believe that she is the source of the problem. She thinks there is something wrong with herself because it has taken five marriages to find a man that will love her and her children. For this reason and because of how her daughters respond to her, Melissa is unable to internalize any sense of worth (Murdock, 2009, pg. 159). Case Conceptualization
Melissa is experiencing incongruity between how she perceives herself and what she is experiencing. Samuel Gladding (2005) explains this incongruity as a “gap” (pg. 65). The lack of fulfillment, unhappiness, and sense of unworthiness is a symptom of alienation and maladjustment caused by a gap between what Melissa is striving to become and what she is (Gladding, pg. 65). The depression Melissa indicates she feels is a result of viewing herself in a negative light based on the influences of others, in this case her daughters. Another way to view this situation through person-centered therapy is to state that Melissa’s organismic valuing process, characterized by her internal locus of evaluation perceives the actions of her daughters as thwarting Melissa’s desire to fulfill her need to be their mother (Fall, Miner, & Marquis, pg. 175). Treatment Plan
Goals for Counseling
In order to help Melissa find a balance and congruence with her ideal self and real self, the Person-Centered therapist must create an atmosphere that encourages a sense of safety and trust for Melissa. This will allow her the freedom to explore all parts of herself; parts that have been denied or distorted as a result of her life experience. Therapy should offer her the opportunity to recognize conditions she has internalized that have caused feelings of unworthiness or conditions that are unrealistic that must be met for her to experience a sense of self-worth. Boontarika Narknisorn (2012) provides a list of qualities that person centered therapy can enhance through the goals of the therapy: “enhancing self-awareness, recognizing values of ‘congruence, unconditional positive regard, and empathic understanding’, self-responsibility, understanding one’s feelings, awareness of one’s own perspective, being open to experience, being rational, living a fuller life, positive life-direction, acceptance of one’s and other’s uniqueness, prizing one and others, and living a moral and ethical life” (pg. 343). Interventions
Creating a Therapeutic Alliance. When working with Melissa via the person-centered therapy approach, I would work at creating a strong therapeutic alliance. Clinton and Ohlschlager (2002), provide four steps to creating a therapeutic alliance within the first few sessions: “suspending criticism and judgmental talk, listening actively, staying client-centered, and beginning a global assessment of her problems, strengths, and resources” (pg. 300-301). Rogers expressed several characteristics within the therapeutic relationship that he felt must be met: “there must be contact between the counselor and the client; the counselor must demonstrate congruence, also known as genuineness, transparence, and realness, positive regard, and empathic understanding (Murdock, 2005). These are all characteristics of a therapeutic alliance. Therefore my first intervention with Melissa is to develop a strong foundation for a therapeutic alliance with Melissa by expressing my belief and confidence that her goals can be attained, explaining confidentiality, and its limits, providing her information about my training and experience, and by asking focused questions while I gather her information about the problem (Clinton & Ohlschlager, pg. 300).
Therapeutic Process and Focusing. Once a therapeutic alliance and trusting relationship has been developed, I would gently encourage or direct Melissa’s thoughts to assist her through the stages of the therapeutic process to avoid resistance. According to Murdock, because Melissa has sought help on her own, she has already reached stage three of the therapeutic process (pg. 166). Because there are no techniques per se in person-centered therapy (Murdock, pg. 168), I would employ the use of focusing. Focusing is a technique developed by Gendlin (Murdock, pg. 168). The Focusing Institute defines focusing as an inward awareness that focuses on physical sensations within the body in the present (focusing.org). The focal point within the focusing sessions would be how she feels when given the definition of rejection and how she feels when thinking about the role of a mother. The reason for focusing on these two topics is because many of us carry pain in our lives that come from rejection. We have a tendency to internalize rejection and carry it with us. Melissa has been experiencing and internalizing rejection on a daily basis because of how she perceives her relationship with her daughters.
Christ and Codependence Recovery. As a third intervention, this therapist would also introduce Christ and scriptural foundational instruction into the session if Melissa indicated that she would be accepting of this approach and instruction. I would like to work with Melissa on issues of codependency and a Christian codependence recovery program would work wonders in this area for her, in my opinion as the therapist in this case. The Christian Codependence Recovery website provides 10 steps to recovery the first is “understanding and personally experiencing the love of God; learning to differentiate true love from the counterfeit version of codependence” (christiancodependence.com).
This would be the first step in helping Melissa realign her understanding of love and creating a new experience and initiating a true sense of self-worth based on the love of God. The third step also provides healing and scriptural awareness: “coming out of denial – seeing things as they really are no matter how painful that may be” (christiancodependence.com). In this step Melissa would allow God to take her out of her painful past and provide her with a new belief system based on His truth” (christiancodependence.com). Finally, the seven step falls right in line the person-centered therapy; “reconnecting with our true self, the person God made us to be” (christiancodependence.com). Spiritual Applications
According to Murdock (2009), Rogers believed that all humans are “inherently good” (pg. 153). Unfortunately, according to scripture, due of the fall of man, the nature that God created us with has been perverted (Ecclesiastes 7:29, New International Version). Through the sin of Adam and Eve, the inherent goodness that Rogers believed in has been perverted. That is not to say that we as humans cannot have an inherent goodness within us when cultivated through the Word of God. According to Jones and Butman (2011), there are assumptions within person-centered therapy that a Christian therapist would want to avoid. Assuming that we as humans are our own masters and are of our own authority would do a grave wrong to the spiritual well-being of the therapist as well as the spiritual well-being of the client. Realigning person-centered therapy with Christ within us would be the most appropriate direction to take when using this approach. The ethical concern here is to only bring Christ into the session, with client awareness, only after the client has given permission. Otherwise, we risk putting our own morals and values onto the client which in some cases can cause more harm than good. Conclusions
Overall, the person-centered approach should work well with Melissa. Person-centered therapy has been supported through research (Murdock, pg. 170) and is diverse in its application with male and female clients. Additionally, the approach has become popular with multicultural groups despite its lack of focus on cultural effects on belief systems, attitude, and behaviors. Notwithstanding the popularity of the approach, Poyrazli (2003) has stated that the approach does not work for individuals from the Turkish culture (p. 111). Regarding the gay/lesbian/bisexual/transsexual (GLBT) group, the approach has both strengths and concerns. The approach of person-centered therapy has it concerns regarding scriptural soundness as well as previously stated. However, if the therapist can integrate and immerse Christ and the center of person-centered therapy, the approach should be able to be used without too much concern from the Christian therapist.
Creating a strong therapeutic alliance with Melissa should be achievable within a short timeframe as Melissa comes in seeking help in her relationships with her daughters; therefore she is open to a relationship with a therapist. I believe the most difficult part of the therapy will be experienced in the focusing sessions as this will be the most painful and difficult experiences within the therapy for Melissa. However, I would expect her to participate fully within the sessions and believe that she would find some comfort, guidance, and redirection through these sessions. I believe that through the focusing session that Melissa will be able to create and internalize new conditions that will enable her to experience self-actualization and fulfillment in her relationships. Through the 10 steps of Christian codependence recovery, I believe Melissa will learn who she is in Christ and begin to understand His love which will allow her to develop a new concept of what love from others should look like. I believe these steps will allow Melissa to accept her relationship with her daughters as it truly is without expecting her once distorted view of acceptance. Overall, I believe that through the use of the interventions employed with Melissa that she will experience freedom in Christ based on her newfound and authentic identity based on the person that God has created her to be.
Clinton, T. & Ohlschlager, G. (2002). Competent Christian counseling: Foundations & practice of compassionate soul care. Colorado Springs, CO: WaterBrook Press. Fall, K. A., Miner Holden, J., & Marquis, A. (2010). Theoretical Models of Counseling and Psychotherapy (2nd ed.). Florence, KY: Routledge. ProQuest ebrary. Web. 13 September 2014. Gladding, S. T. (2005). Counseling theories: Essential concepts and applications. Upper Saddle River, NJ: Pearson Education, Inc.
Jones, S. L., & Butman, R. E. (2011). Modern psychotherapies: A comprehensive Christian appraisal (2nd ed.). Downers Grove, IL: Intervarsity Press. Murdock, N. L. (2009). Theories of counseling and psychotherapy: A case approach. Upper Saddle River, NJ: Pearson Education, Inc.
Narknisorn, B. (2012). Person-centered therapy and personal growth. Journal of Social and Development Sciences, 3(9), 337-345. Poyrazli, S. (2003). Validity of Rogerian therapy in Turkish culture: A cross cultural perspective. Journal of Humanistic Counseling, Education, and Development, 42, 107-115. The Focusing Institute (2014). More about focusing. Retrieved
Criteria| Points Possible| Points Earned| Instructor’s Comments| Content|
Content demonstrates thorough understanding of selected theory, making specific and appropriate application of key concepts and techniques to the client. Appropriate terminology for the theory is consistently utilized.| 25| | | Applications consistently reflect an individualized approach for the specific client as opposed to general statements that would be true for any client being treated from this theoretical orientation.| 25| | | Suggested techniques (minimum of 3) are described with detail for the client. Examples of how the techniques are used with the client are expected.| 30| | | Student has placed him/herself in role of therapist and response demonstrates careful reflection on client/therapist dynamic.| 25| | | Multicultural, ethical, and any crisis issues are addressed thoroughly and insightfully.| 25| | | Spiritual and Christian worldview is addressed according to the instructions.| 30| | | Writing/APA|
Paper must reflect standards for graduate-level writing and conform to current APA guidelines for clear and concise writing.Paper requires a title page and a reference page. The Jones and Butman textbook and at least 5 additional academic sources are used for this section.All sources must be cited in the assignment and on a Reference Page in proper APA format. One point will be deducted for each writing or APA error.| 40| | | Total| 200| | |