Fostering Self-Actualization: Exploring Person-Centered Therapy and its Impact on Counseling Practice

Introduction

The effectiveness of treatment primarily depends on the clinician’s attitude and understanding towards how the patient receives the treatment; this points towards whether the patient is endowed with the will and self-awareness to manage his or her own future (Cloninger & Cloninger, 2011). Person- centered therapy, which is also known as client- centered therapy, or person- centered counselling, among other names, refers to a form of psychotherapy first developed in the 1940s by Carl Rogers, who was a psychologist (Rogers, 1942). PCT seeks to facilitate the patient’s self-actualizing tendency; which may refer to an inbuilt proclivity aimed at fulfillment and growth. There are three main elements commonly associated with PCT; acceptance, congruence from the therapist and empathic understanding. Help aimed at helping an individual in the reflection of his/ her personality enables the processing of a mirror image of the individual’s weaknesses and strengths relating to life’s various challenges. The use of humanistic dialogue and interpersonal alliance in the orchestration of treatment procedures and lifestyle change that aim to promote health, prevent disease or treat illnesses is what client-centered therapy is all about (Cloninger & Cloninger, 2011).

This study encapsulates three main outcomes: First, the study endorses research and analyzes how research is important in the development of counselling practice; in this context the study shows the purpose and importance of research in practice. Second, the study critically analyzes and reviews the methods involved in counselling research and identifies one method that may prove to be valid and reliable in as far as the topic identified is concerned. Third, this identified research method is explored and expanded further hypothetically and integrated within the research.

Aims and Objectives

This research foundationally aims at analyzing the effectiveness of person- centered therapy in the management of depression. In order to achieve this main aim, specific objectives include:

I. To evaluate data from a qualitative cohort study in regards to the effectiveness of person centered therapy in depression management

II. To critically review the methods used in counselling research and establish the importance of research in the development of counselling practice

III. To analyze the efficacy of forms of available treatment methods and compare these methods with person-centered therapy

IV. To establish the importance of person centered therapy as a counselling practice method; with a particular interest in the management of depression

Background

Depression is one of the most common mental illnesses with Major Depressive Disorder (MDD) establishing itself as the most disabling and prevalent form of depression in Europe. MDD affects more than 30 million people in Europe every year (Wittchen et al 2011). The problem necessitates an analysis of the current data on the diagnosis, epidemiology and treatment of depression; as a result, it is crucial to look at the role of somatic treatments, pharmacotherapies and ultimately psychotherapies in the treatment and management of this kind of mental illness. Depressive disorders are mainly characterized by low moods and lack of interest in activities. One of the most common mental illness is the Major Depressive Disorder (MDD). Decreased expression of several neurotrophic factors, such as the factor that emerges from the brain, reduces cellular resilience which is a common cellular abnormality in the many forms of depressive disorders (Mann & Currier, 2006).

Various reports and studies have suggested that MDD is quite common, exhibiting a 16.6% lifetime prevalence and occurring at a higher frequency in women compared to men (Soleimani et al, 2011). In addition, it is aggregated in families; compared to the general population, it is likely to affect individuals with biologic relatives affected with MDD. The point prevalence reported by Soleimani et al (2011) are 15-20% in nursing care settings, 10% in primary settings and 22-33% in patients with medical illnesses. Churchill et al (2010) adds on this by foundationally highlighting that depression presents itself as a rising trend and is third leading cause of disease burden in the world. Depression has therefore, in most cases, been associated with economic, social and personal morbidity, notwithstanding loss of levels of productivity, functionality losses and significant demands in workload service provision (NICE 2009).

Literature Review

Many contemporary treatments focus on the relief of acute symptoms of diseases and illnesses; they give a partial blind eye to the promotion of well-being and health of the patients (Wong & Cloninger, 2010). In addition, impersonal approaches towards treatment but through the use of therapeutics have ultimately failed in trying to increase the average social, emotional and physical well-being of the general population. These kinds of treatments fil to look at the causes of the illnesses, and rather focus on the acute symptoms of the illnesses, therein resulting in only temporary relief; recurrence, relapse and no lasting management in regards to public health (Cloninger, 2006).

There are certain common features involved in the promotion of recovery from illness as well as well-being; these include empathy, hope and respect towards one another (Amering & Shmolke, 2009). According to Anthropedia (2009), these common characteristics arise from a participation sense in the inseparable connectedness with the human culture with the boundless unity of everything in life, in association with a self- transcendent outlook on life. These outlooks that are self- transcendent are values of typical human health and creativity across all human cultures. The dissatisfaction with ill health and life is predisposed by the outlook of separation, which leads to the person/ patient feeling fear, individual pride or shame and alienation. This is where PCT comes in; PCT promotes the quality of health through the provision of an outlook of unity represented by therapeutic alliance. This unity outlook created by PCT fosters individual well-being through activating synergistic spirals of improving self-transcendence, cooperativeness and self-directedness (Cloninger & Zohar, 2011). Whereas 85% of common factors shared by different approaches in psychotherapy can be explained in the outcomes, only around 15% can be attributed to specific techniques with respective methods.

Studies reveal that most patients prefer non- pharmacological treatment means compared to antidepressants and other pharmacological medication; this is mainly because of perceived risk of dependence, addition, cost and stigma (Prins et al 2008; Bortolotti et al, 2008). For patients with mild to moderate major depressive disorders, psychotherapy has proven to be just as effective in treatment (Campbell et al, 2013). Such qualitative based studies; which look at the efficacy and preference of PCT compared to other forms of treatment, are important in regards to highlighting the significance of PCT in mainstream medical psychology models. There are numerous psychological therapies available for treatment of common mental illnesses in the modern society. There are four broad categories of theoretical and philosophical schools; these are cognitive, behavioral, psychoanalytic and humanistic approaches. These psychotherapeutic schools contain different psychotherapeutic approaches and components (Churchill et al, 2010). Some of these approaches have been developed to address certain characteristics associated with certain conditions whereas others have been developed explicitly integrating components from various theoretical schools. Humanistic psychotherapies, such as PCT, are foundationally based on the concept of self- actualization; other common characteristic include self- awareness, free will and responsibility; these are very important factors that need to be understood within the context of individual characteristics and experiences.

All kinds of treatment exhibit common factors; these are the patient’s characteristics, the qualities of respect of the therapist, understanding, realness or genuineness and the therapeutic alliance created during the sessions; this involves common goals and emotional collaboration, exchange and engagement (Cloninger & Cloninger, 2011). For the development of well-being, these common factors are to be considered crucial by the clinician. Accordingly, the effective treatments of many mental illnesses, depression included, should depend on tools that enable the facilitation of non-stigmatizing assessment of individual personality, rapid and fostered creation of a therapeutic alliance and a guided development of self-determination and awareness so that the patient may be able to learn how to manage his health.

Evidence Based Practice in counselling

Given the complexity of counselling and psychotherapy, outlining a single theory, epistemology or methodology that provides for a comprehensive view of therapeutic exchange is difficult (Castonguay, 2011). In some contexts, the relationship that arises between research and counselling practice may even seem hostile. For instance, clinicians have often contrasted the form of randomized controlled trials as an appropriate way of evaluating or measuring psychotherapy (Henton, 2012). Evidence- based research has often been defended as the only valid method in which the causality, performance and efficacy of treatments can be measured and tested (Henton, 2012).

It is important to consider the relationship between research and counselling. On a foundational basis, Henton (2012) begins by identifying gaps between psychotherapy research and practice in counselling. In addition, the article explores the relationship between research and practice; such as the varying perspectives on research compared to evidence based practice, practitioner involvement in research and research networks. Proponents would argue that research; particularly evidence based research provides a comprehensive image of psychotherapy and is therefore significant to clinicians, policy makers, commissioners and even patients. According to Henton (2012), the UK Counselling Psychology review (CPR) over the last decade provides for counselling research philosophical parameters as pluralistic, qualitative, humanistic and postmodern. In that regard, increase circulation of the concept of evidence based research in practice in counselling is important and relevant in the counselling profession.

Research plays a prime importance in the development of client welfare. It is crucial to evidence the benefits of counselling and also record its adverse effects (Reese et al, 2009). According to the BACP Ethical Framework for the Counselling Profession, research should be highly valued within counselling for it enhances professional knowledge and provides evidence based practice with a view of benefiting the clients. As a result, appropriate, accurate and verified records are well kept and the effects of counselling are greatly felt. In regards to commissioners and other policy makers, guidelines developed by the National Institute for Health and Care Excellence (NICE) are based on research (NICE, 2009). Recommendation on respective psychotherapeutic modalities of treatment can therefore not be done where no evidence of the effectiveness of such methods can be shown.

The research culture in counselling practice encourages both supporting and critiquing education in counselling. Research enables sharing of formative lessons and experiences in counselling (Bowers et al, 2007). Research in counselling provides the best help if it is grounded and well embodied. The benefits of research in counselling practice speak to its implications to clinical practice. This research focuses on the effectiveness of a type of counselling; person-centered therapy; in the management of depression. Research is meant to demonstrate valid propositional knowledge in counselling practice (Kitchener and Anderson, 2011). It enables counsellors and other clinicians to gain a wider perspective on the topic researched on and an even wider knowledge and experience on an international scale. More rigorous and objective evidence also enables maintenance of public accountability in counselling as it demonstrates the efficacy of counselling techniques in various scenarios.

Through research, new approaches and ideas may also arise; practice in counselling continually invites innovative interventions and activities, an informed awareness is of importance in checking the value of these new ideas and activities; for instance, through this research, information on the values and harms of PCT can be clear in practice. Research also enables questions to be answered; thereby enabling personal and professional development in counselling. Additionally, different counselling techniques and other professional activities are legitimized and made credible through research.

Methodology

Is PCT effective in the management of common depressive disorders? A qualitative cohort study analyzing the effectiveness of PCT in the management of depression.

The hypothesis of this research is based on the fact that PCT, as a humanistic and holistic method of psychotherapeutic treatment, is highly effective in the management of common depressive disorders compared to other methods of treatment. PCT is significantly placed as an efficient treatment modality, both in theory and in practice. The aims and objectives highlighted in this research are a mere reflection of what the research is based on.

There are mainly four types of methods used in counselling research; qualitative, quantitative, primary and secondary research. Primary research involves gathering first-hand information from direct sources; these include case studies, observations, interviews, statistics and questionnaires. The purpose of research in counselling is to advance professional knowledge about both the process and the outcome of the type of therapy involved (Lutz and Hill, 2009). Secondary research basically refers to gathering of second hand information; it is useful in comparing studies done by various researchers and writers; these may include systematic literature reviews, research conducted on journals, case studies, reports and other literature. Quantitative research is considered to be the most scientific method and the best form of evidence based research; it mainly involves measurable elements and in most cases it results in data that is consistent, replicable and easy to analyze (Wright, 2013).

On the other hand, qualitative research aims to look beyond statistical data presentation; in counselling, this involves surveys on opinions, emotions, experiences and feelings. Therefore, qualitative research is usually detailed, unlimited and flexible. In that regard, in counselling, qualitative primary research is considered to be one of the best methods of research (Wright, 2013). These methods of research in counselling act as helpful tools because they help in studying complex relationships between the therapist, therapeutic process, externalities, in- session progress, post- session progress and the outcome of therapy at the end of the treatment. An aggregation and integration of the findings can also be achieved through these methods (Lutz and Hill, 2009). However, although qualitative methods in counselling have been established as thoughtful and well-founded, it is important to note that empirical research is needed to investigate several issues that may arise within these methods; for instance, the effects of different research teams compositions in terms of value similarity, gender and culture have to be investigated; the construction of similar concepts from the same date has to be seen, among other issues.

Certain professional practices in counselling such as sharing of information and understanding, diagnosis, assessment, treatment and interpersonal communication express the need to frame questions of validity across the methodologies involved in research. This action based insight serves appropriate contextual awareness, which inspires reflexive practice (Bowers et al, 2007). The methodological values in research and practice relate to insight processes and acknowledgment of an integrative perspective on clinical research approaches to transformation. The qualitative research method identified in this case takes the sense of a transformative discipline and its validity is largely dependent on its appropriateness and how it is context-congruent. The research is therefore valid and reliable in so far as it is grounded, centered and expanded within the context being analyzed; which is the effectiveness of PCT in the management of depression.

This research is ultimately committed to uphold ethical guidelines for research in counselling professions 2019. The researcher also regards himself as a member of the British Association for Counselling and Psychotherapy (BACP); he is a student of Preston College. The researcher undertakes to conduct a primary qualitative study which would aim at gathering opinions, views and data on PCT as a treatment modality in depressive disorders and how effective it is in regards to the same. For the purposes of credibility, it is necessary to look at more qualitative and empirical research on the effectiveness of PCT in managing depression; this importantly helps in its recognition as a mainstream model of psychotherapy (Joseph & Murphy, 2013).

The research proposes a qualitative cohort study as it purposes to deductively, systematically and critically evaluate and analyze data received from the research. This would meet the necessity to have more empirical research on the effectiveness of PCT in the management of common depressive disorders, which would produce valid and reliable results. Additionally, the research is more suitable to a qualitative design ultimately because it focuses on the impact PCT has on the management of depression; therefore the opinions and experiences of the participants will be really important. According to Song and Chung (2010), in certain clinical situations, primary studies such as cohort studies may be the best choice of methodologies in evaluating associations between exposure and illnesses.

According to Healy & Devane (2011), a qualitative cohort study refers to a study involving a certain group of individuals with particular characteristics or similarities, and conducted over a certain period. A qualitative cohort study enables the collection of information from various sources and in different times; as a result, this enables the accurate and pinpoint collection of current data, which is crucial in creating a valid basis in highlighting the importance of PCT in the management of mental illnesses, particularly depression. This also enables the comparison of data recorded between participants who have not undergone the intervention and those who have. The research further proposes a closed cohort study, in that upon the selection of a particular group of participants, no new participants would be allowed in the study. This enables the presentation of a systematic and organized analyzed information. Qualitative researches, in comparison with quantitative researches, are prospective in terms of flexibility; especially in counselling research. An important aspect in clinical practice is evidence based research. According to Chrisman et al (2014), evidence based research enables the collection, processing and implementations of research findings to improve patient outcomes, work environments and clinical practice. On the same note, well-designed primary cohort studies have been shown to provide results similar to randomized controlled studies; valid and reliable.

The research aims at sampling around 20 participants; essentially with gender parity. A qualitative cohort study requires that the research participants be members of a certain group of people brought together by certain characteristics; as a result, the participants for this study will be students recruited through advertisement with flyers passed within the school’s department; the researcher may also email to counselling students in relation to selection. The sampling technique used in the study will be stratified sampling; which will involve group classification by gender and experience, then the final selection of the study participants which will aid in balancing the participants. The research will also involve participants with past historical diagnosis or records, and treatment of depressive disorders. This being the first research conducted by the researcher, the sample size; though relatively small; presents an easier task and provides a much more efficient basis of collection of all relevant data, consequently making its analysis much more efficient and concrete. The sample size selected also makes the research easily and efficiently possible in regards to the limited time framework provided.

Geographically, the research may be limited basically because the participants will be fellow students of the researcher; this presents a limitation towards the collection of a variety of data and comparable samples in the long run.

Ethical considerations

According to Fouka & Mantzorou (2011), there are four major ethical considerations when conducting a clinical research; these are informed consent, respect for privacy, respect for confidentiality and anonymity and beneficence- which is essentially do no harm. In the researcher’s evidence based research, the researcher undertakes to observe and ensure that the research considers all these possible moral dilemmas in research so that the research may achieve the appropriate and acceptable ethical standards in clinical research; which are universally acceptable standards, including those prescribed by the BACP. In selecting the participants, the research will focus on participants who are not vulnerable or susceptible to relapse as this would potentially put them at risk of psychological harm.

Research purpose and implications to Practice

This research plays a very important role in counselling practice. As a practice, sharing research inspires and invigorates excellence in clinical work; in a collaborative foundation, clinical practice also guides and informs research. In practice, from diagnosis to treatment and long term management, this study will endorse the best position in relation to the handling of depressive disorders through PCT. The quality of the therapeutic relationship between the clinician and the patient is the most central component in the management of depression, regardless of the modality of treatment chosen. It is clear that a strong empathic listening, as well as a strong therapeutic relationship will improve outcomes (Piebe & Mccabe, 2008). This relationship should start at the first instance; should be open, non-judgmental and ultimately patient- centered. This should involve active building of mutual trust and respect.

As a result of this relationship, mutual respect and trust, therapeutic recovery is aided, therefore much more effective. Consequently, the establishment of PCT as an effective counselling technique in this research endorses therapeutic practice and enables wider acceptance of therapy as a way of managing depression; as well as in other situations (Kitchener and Anderson, 2011). As aforementioned, this research also largely enables a wider understanding and knowledge on PCT, accountability in counselling practice as it is viewed by members of the public, growth and development of personal and professional positions and enhancing the legitimacy and credibility of PCT as a method in which depression can be managed and controlled.

Conclusion

The essay critically analyzes the impact of specific research in counselling practice; it goes further to explain and evaluate how research benefits counselling in general and how empirical research plays a very significant role in the endorsement of different counselling techniques as ways in which different illnesses may be managed. This part has also critically reviewed the methods used in counselling research and has identified and justified why a qualitative cohort study would be appropriate, valid and reliable.

PCT effectively focuses on the root source of depression; it aims at accessing and transforming habitual maladaptive emotional schematic memories through an affectively attuned empathic relationship (Greenberg, 2017). Feelings of anxious insecurity, abandonment and worthlessness are often what constitute these memories. It is through PCT that adaptive emotions are accessed and a transformation is possibly achieved. In addition, specifically focusing on psychotherapies, Churchill et al (2010) has shown that there is an efficacy superiority towards the management of depression shown by humanistic approaches such as PCT compared to other forms of psychotherapies. Thus, PCT, as a counselling technique, is highly endorsed and effective; making it an efficient and reliable method of management of depression.

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Wright, R. (2013) Research Methods for Counselling: An Introduction. SAGE Publications

Person centered therapy is also known as client- centered therapy, person centered counselling or the Rogerian psychotherapy. It was developed by psychologist Carl Rogers in the 1940s. This form of psychotherapy aims at facilitating the client’s self- actualizing tendency, which is an inbuilt proclivity towards self- fulfillment, individual growth and independence (Kyle, 2014). This is primarily because it is geared towards individual unconditional positive regard (acceptance), empathic understanding and genuineness (therapeutic congruence). Depression may differ in severity; depression is however, generally characterized with loss of interest in pleasurable activities and low moods. Wai et al (2017) affirms that one of the most effective ways of managing depression includes psychotherapy.

This study basically evaluates the methodologies involved in counselling research, particularly while analyzing the effectiveness of person centered therapy in the management of depression. The qualitative method of research chosen suits the hypothetical perspective of the research and is thereby justified within this proposal.

The question the study seeks to answer is:

How effective is person centered counselling in the management of depression

In answering this question, the study aims at evaluating and analyzing data collected from a quantitative cohort study in looking at the effectiveness of person centered therapy in the management of depression; whether acute, moderate of major depressive disorders.

Somatic complaints are also a common feature of depression, in addition to a wide range of other symptoms (Churchill et al, 2014). In addition, individuals with severe depression may also develop psychotic symptoms. Depression constitutes on of the leading causes of disease burden in the world, simultaneous depicting a rising trend over future years. Depression has also been associated with significant increase in risk of mortality and personal, social and economic morbidity (NICE, 2009). This mental illness is also very common in primary care settings.

Although antidepressants are proven effective for the treatment of acute depression, the adherence rates among the patients remain very low; some of the reasons being concerns about the side effects and possible dependency. In support, surveys have consistently demonstrated that patient’s prefer psychological therapies over these antidepressants (Churchill et al, 2014). Treatment of common mental disorders presently has a wide range of psychological therapies. These types may broadly be categorized into philosophical and theoretical schools. A key psychological therapy considered to be humanistic however, includes Roger’s person- centered therapy. The client based approach entails certain aspects of responsibility and client choice, which compared to other diagnostic and prescriptive therapies, offers a more effective way of managing depression.

Methodology

Several issues arise from the investigation of methodologies involved in counselling research, this raises the need to conduct more empirical research on the topical area. Research, as shown in the study, significantly contributes towards counselling practice (Bowers et al, 2007). The hypothetical research is, therefore, more suited to a qualitative research as it focuses on the impact person- centered therapy has on management of depression. A qualitative cohort study design refers to a study conducted over a certain period of time and involves certain study participants, for instance individuals who share some similarity or commonality (Healy & Devane, 2011). As a consequence, the research will aim at sampling a total of around 20 participants; who will constitute university students, who suffer vulnerability to the problem tackled by the research; depression. This would ideally entail a balance of male and female students from the university.

Qualitative surveys would then be drawn and issued to the participants and incidence rates and variants will be consequently analyzed. The risk factors associated with person- centered counselling will be critically measured in the research. Data will then be analyzed deductively and descriptively from a qualitative basis to back up the hypothesis of the research; person- centered counselling is highly effective as a treatment of depression. The use of cohorts enables positive steps to be taken by the study regarding ethical considerations. As opposed to randomized control studies, there will be no direct exposure to mental or psychological harm as the study only focuses on the effects on those who have already been through depressive disorders (Healy & Devane, 2011).

These refer to guidelines that encourage the best practice in research; these guidelines help prevent unethical conduct and assist researchers by setting the standards for the best research practices and providing general principles (Kumar, 2014). The design of this study will consequently adhere to all relevant ethical considerations and best practice guidelines associated with it. The best form of evidence based research will be adopted. Such practices include the respect to the client’s autonomy, beneficence and non- maleficence. These applies to all primary research.

Interpersonal therapy and CBT has been favored as the first line of treatment for people with moderate to major depressive disorders by most clinical guidelines. There is little evidence that supports humanistic approaches such as the client- centered therapy in the treatment of common mental disorders such as depression. In regards to clinical practice, a high proportion of counsellors and therapists in in UK primary care settings continue to use person- centered therapy (Stiles, 2008). This basic foundation amplifies the importance of looking the research topic and consequently developing it through the cohort analysis of the effectiveness of this form of therapy in managing depression. This will go a long way in informing future clinical practice and health care policies. Some applicable factors which will be contained in the study such as comparative efficacy of different forms of therapy and treatment are also of considerable importance.

Conclusion

Through various aspects of research, this study critically reviews the methods used in counselling research and identifies the most appropriate method based on validity and reliability. Through specific techniques of empathic understanding and acceptance, the person- centered therapy goes a long way in managing depression (Haimrl et al, 2009). Both randomized and naturalistic studies have been carried out since the traditional person- centered therapy, these included the treatment of depression as well as how effective the form of therapy is compared to CBT. There are a lot of concepts that were developed by the end of the 1980s that were associated with common mental disorders, such as depressive disorders. These concepts enabled the enlightenment of the therapist’s task in relation to how they are supposed to help their patients; some of these concepts include disorder- specific discrepancies of self- ideal from self- image. As a matter of fact, a consistent collaborative pattern and proactive interaction between the therapist and the client can be witnessed in this form of therapy (Ribeiro et al, 2014).

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