The humanist model of Person-centred counselling was developed by Carl Rogers. A non-directive approach, this model encompasses the idea that we all have the drive within ourselves to live more fulfilling lives. Through a safe therapeutic environment, clients can explore themselves and move towards greater self-understanding. Rogers’ spoke of three core conditions; empathy - allowing the client to feel heard, unconditional positive regard - acceptance of the client (which they are aware of), and congruence - being your real self.
In contrast, Beck’s model of cognitive therapy is more structured; a formulation-based practice which is focused on the client's thoughts (cognitions). A main element of Beck’s approach is the idea that how we think and our fundamental beliefs affect how we feel and behave. If these thoughts are negative and unhelpful, cognitive therapy aims to focus on them, providing techniques to challenge and alter unwanted thoughts and therefore behaviours. As an educative approach, cognitive therapy often provides homework and goals, with the client learning skills and essentially becoming their own therapist.
Within person-centred therapy, the explicit roles of client and counsellor are less specific. The therapist's role is to be their equal, providing absolute safety, positive regard and wearing their expertise as an invisible garment. Rogers believed that, when given the right environment and support, individuals strive towards fulfilment. Through this positive experience people will develop a good valuing process - an innate way in which people can trust themselves to determine what is good or bad for them, and for society. Those individuals who do not get the support they need may have a distorted valuing process, creating a conflict within themselves.
This idea of non-directive exploration differs when you look at the cognitive model. Based on the view that people’s thoughts and beliefs affect their feelings and behaviour. Beck calls these core beliefs ‘schemas’. Schemas can come from early negative experiences that distort our world view, such as neglectful care-givers. This could result in a schema that you are unlovable, which in turn creates a rule that you can only ever rely on yourself, because no one ever cared for you. When suffering from anxiety or depression, this distortion can become extreme.
The idea that every person is unique relates to the therapeutic relationship. As with all psychotherapy that involves (usually) two humans entering a relationship, both approaches emphasise this. Rogers’ core conditions aim to nurture the relationship, making the client feel safe. In the cognitive model, Beck believes the therapist's knowledge and expertise is also required. Where the client is the expert of themselves, the therapist is the expert on psychological problems and cognitive therapy does not shy away from this distinction. Does the rigid student/teacher relationship of a strictly cognitive approach hinder some people from truly opening up? From a person-centred outlook, maintaining an equal relationship may be difficult if the counsellor's expertise becomes a large part of the therapy.
How and why the client is feeling distressed is also worth exploring. Cognitive therapy understands that past trauma creates schemas and distortions This outlook draws similarities to the person-centred idea of an external locus of evaluation. The idea that whether people draw upon and trust their own values and instincts (operating from an internal locus of evaluation) or if they are influenced by the values of others (an external locus of evaluation). A person’s conditions of worth, which we mentioned before, are similar to a schema that creates negative rules. Unhelpful conditions of worth like ‘I must please everyone all the time to be accepted’, can be created from negative experiences where one might feel they can only be loved, or survive, if they strive desperately for the approval of an external value.
Whilst there are similarities regarding some of the causes of distress, there are many differences as well. One of the most clear differences is the structure of the counselling session itself. The cognitive model is formula based, goal driven and directive. Person-centred, on the other hand, believes that the client is the expert in their own lives, and allows them to drive the session, believing that they do have what they want inside of them, and with a secure relationship provided by the counsellor, they can gain greater self-understanding.
Both models, in this sense, share this idea of a greater understanding of oneself to generate wellbeing - something that could be said of most talking therapy. What initially may seem like a difference, then, actually holds many similarities. It’s in the details that the differences arise. In a cognitive therapy session, the client and counsellor may logically focus on one problem and analyse. In a person-centred session, the client will gradually gain a greater understanding of themselves, including how they think and act in the world - creating greater self-awareness for the future and the rest of their lives.
Although there are contrasts, I believe integration works, allowing the counsellor to draw upon what helps from both models. The idea of the five system formulation from cognitive therapy, which takes an issue the client is expressing and breaks it into five categories, may work well as a tool for the counsellor to use themselves when listening to the client. These categories are: environment (what is literally happening), thoughts (what am I thinking about it), emotion (what emotions am I experiencing), behaviours (how am I acting) and physiology (how do I physically feel). Instead of asking the client to essentially ‘fill out’ these categories, a counsellor may have this formulation in their head and use it to guide the client into looking at some of them, allowing them space to explore. This seems like a more natural way of looking at a problem, keeping the relationship equal and being less direct.
Each client is unique, and this is where the strength of integration really shows. There are strengths to both models, whether drawing from a formulation and applying it in a more natural way, or simply having the expertise and understanding that the cognitive approach brings, but applying it through a humanistic approach, I truly think that integration makes sense, to be adaptive and willing to utilise different techniques. One person may thrive in a formulaic environment, whereas for someone else that could be where they feel the least safe. Understanding our clients needs is fundamental to helping them gradually gain a greater understanding of themselves.
