When YOU Are In Charge Of Therapy: Client Centred Therapy

Uploaded 9/24/2023, approx. 29 minute read

Rogers noticed problems in therapy.

At the time in the 1940s, the dominant treatment modality was psychoanalysis with some psychodynamic therapies in the process of evolving and taking over.

But he noticed, for example, the therapist experienced anxiety, a sense of vulnerability. It could have been me sitting here.

Therapists sometimes involuntarily blame the spineless victim and her poor judgment for causing the abuse. This is victim blaming and victim shaming, although these phrases did not exist at the time.

Some therapies concentrate on the victim's childhood rather than her harrowing present or accuser victim of overreacting. Some therapies assume the mantle of a chivalrous rescuer, a savior, a fixer, the knight in shining armor. That is most common or more common among male therapists.

The majority of therapists, when Carl Rogers was developing his client-centred therapy, the majority of therapists were men.

And so these rescuers' saviour types, although again these words were coined much later, they inadvertently uphold the victim's view of herself as immature, helpless, in need of protection, vulnerable, weak and ignorant.

The main therapies may be driven to prove to the victim that not all men are beasts, that they are good men, good specimen like himself.

And if the therapist's conscious or unconscious overtures are rejected, therapists may identify with the abuser. He may come to sympathize with the abuser and to re-victimize or pathologize his own patient.

Rogers was very aware of all these pitfalls. He also realised that many therapies tend to over-identify with the victim and rage at the abuser, the police, the system. They expect the victim to be equally aggressive.

And even as they broadcast to the victim how powerless, unjustly treated and discriminated against she is, they expect her to act aggressively and to kind of move on, take things into her own hands.

If she fails to externalize aggression, if she fails to show assertiveness, many therapies feel betrayed, disappointed, having failed. And they blame the victim.

Most therapies react impatiently to the victim's perceived co-dependency, unclear messaging and all of relationships with her tormentor. Such rejection by the therapist may lead to a premature turn of determination of the therapy well before the victim has learned how to process anger and how to cope with her low self-esteem and learned helplessness.

All these were obstacles and problems in therapy long before the language has been invented to describe them. So we didn't have learned helplessness. We didn't have rescued our savior. We didn't have any of this.

But Carl Rogers was aware of all this and has written about all these problems in therapy.

And this led him to develop an alternative currently known as person-centered therapy and at the time known as client-centered therapy.

This is Carl Rogers' major contribution to psychology.

Regrettably, it fell into disuse, it fell out of use, out of favor nowadays.

Again, because some elements of client-centered therapy are perceived to be bordering on the unethical and very problematic in modern settings in the world which has changed so dramatically and lacks elements of trust and innocence and seeking an empathy, seeking each other's well-being.

So let's delve into the rudiments, the pillars, the foundations and the elements of client-centered therapy.

A comment I've made in my recent talk with Davia Zhukovska, the clinical psychologist from Poland, provoked several of you to write to me and ask me to elaborate on Carl Rogers' humanistic psychology and person-centered therapy. And this is what I'm about to do in today's video. I'm about to oblige you the people pleaser that I am.

My name is Sam Vaknin. I'm the author of Malignant Self-Love: Narcissism Revisited. I'm a former visiting professor of psychology and currently on the faculty of CIAPS, Commonwealth for International Advanced Professional Studies.

And how do I know how therapists work? How do I know what are the internal processes and mechanisms and experiences of mental health practitioners?

I am not a mental health practitioner, as anyone who has visited my website, read my books, knows. So I have well over 15,000 followers on LinkedIn. Almost all of them are psychiatrists, psychologists and therapists, and I correspond with hundreds of them on a regular basis. So I have a bit of an insight as to how things work.

Carl Rogers.

Now, before we go into the details, to remove doubt, Carl Rogers developed his therapy in the 1940s and practiced it in the 1950s and 1960s. The world was very different then. More innocent, more trusting, less hypervigilant, less paranoid, less atomized, and a hell of a lot less aggressive. This was the world that Rogers was operating in.

This was the ethos of the times. Community, affection, compassion, empathy, collaboration, etc.

Many of the practices that Carl Rogers has incorporated into person-centered therapy would be considered unethical today. For example, multiple forms of bodily physical contact with clients. For example, befriending the patient after the therapy hours. For example, playing consciously the role of a father or a mother, all these are today a no-no territory. They are out of bounds and serious breaches of boundaries in an ongoing therapy with a licensed mental health practitioner.

So, Regerian therapy today is practiced very differently. The client and the therapist usually spatially separated or partitioned by an intervening disc. Even so, therapy is a very intimate relationship and we have failed to find the balance between boundary behavior by the therapist and empathic resonance with the patient, her needs and her emotions.

Carl Rogers pioneered many things and perhaps the most important was the use of counter-transferance as a diagnostic technique.

Until Carl Rogers, all the major names in psychology, starting with Freud, all the way to Carl Rogers, everyone was saying that counter-transference is bad, something to get rid of, a form of cancer on the therapy, a contamination of the therapeutic process.

Counter-transference is when the patient provokes in the therapist emotions and cognitions which actually belong to the therapist, not to the patient. These emotions and cognitions can cause the therapist to behave in ways which are counterproductive, detrimental to the therapy and bad for the patient.

Counter-transference is for the first few decades of psychology or psychoanalysis at least, counter-transference has been taboo, an area that required supervision and eradication.

Carl Rogers was the first to suggest that counter-transference teaches us a lot about the patient. He said if you as a therapist were to inspect the emotions that the patient provokes in you, the thoughts that cross your mind as you're interacting with the patient, it's likely to teach you something about the patient, her inner world, her emotions, her cognitions.

Of course, counter-transference sometimes is coupled with projective identification when the patient forces the therapist, coerces the therapist to play a role, the role of a father, the role of a mother, the role of a peer, etc., the role of a friend. This is projective identification. The patient projects parts of herself onto the therapist, forces the therapist to adopt these parts and then the therapist becomes a conspiracy, an accomplice in a conspiracy or in a collusion with the patient and this is of course very bad.

So, Carl Rogers was aware of the distinction between counter-transference as a diagnostic tool and a healing instrument and counter-transference which is really bad because it serves somehow an agenda which is not good for the therapist and not good for the patient as both of them assume roles which have no place in therapy.

But all in all, what started as patient-centered therapy and then Carl Rogers renamed it client-centered therapy and then he renamed it yet again person-centered therapy and you see the evolution and the progression of his thinking.

He said the therapist is not an observer, should not be a scientist or an analyst, should not be hands-off. The therapist should be a collaborator, therapist should work together with the patient to create something common to both of them, a space or an environment within which there are dynamics in the patient and dynamics in the therapist which are helpful essentially to both of them and to accomplish that they need to interact with each other as two people, as two human beings, not from a position of authority, not from a position of I have all the answers, not from a position of I'll provide you with interpretation but from a position of let us explore together, let us ask each other questions which will provoke thinking and provoke some kind of transformation.

And this is the topic of today's video person-centered therapy.

Client-based therapy tried the Rogerian therapy, therapy developed by Carl Rogers out of his humanistic psychology, tried to introduce basic humane and human gestures that comfort, contain, hold, enhance the patient's trust and sense of safety and buttress the bond, the bond between therapist and client known as the therapeutic alliance.

This was the main drive and thrust of Rogerian therapy.

In therapy, they are always power asymmetries, they are always knowledge asymmetries.

Therapy is often medicalized, that is the model of medicine, I'm the therapist is the expert, the patient is the mercy of the therapist and medications are dispensed.

Rogers rejected all this as absolutely the wrong way to go about healing.

He regarded these kind of attitude as dehumanizing and objectifying the patient, it's a reductionist thing, the patient is nothing but the sum of her symptoms, it's a goal-oriented approach, let's fix the patient as if it were some kind of broken device and Rogers found all this reprehensible and lamentable and tried to fix it.

Let me read you the definition of client-centered therapy from the APA dictionary, American Psychological Association dictionary.

Client-centered therapy is a form of psychotherapy developed by Carl Rogers in the early 1940s.

According to Rogers, an orderly process of client self-discovery and actualization occurs in response to the therapist's consistent empathic understanding of, acceptance of, and respect for the client's frame.

The therapist sets the stage for personality growth by reflecting and clarifying the ideas of the client, who is able to see himself or herself more clearly and coming to close a touch with his or her real self.

As therapy progresses, the client resolves conflicts, reorganizes values and approaches to life, and learns how to interpret his or her thoughts and feelings, consequently changing behavior that he or she considers problematic.

This kind of therapy was known originally as non-directive counseling or non-directive therapy, although this term is now used more broadly to denote any approach to psychotherapy in which a therapist establishes an encouraging atmosphere but avoids giving advice or prescriptions, avoid offering interpretations and avoid engaging in other actions to actively direct the therapeutic process.

It's also called patient-centered therapy, person-centered therapy, Rogerian therapy, etc.

So let's delve into the philosophy of this kind of therapy.

First, you should understand that in the 1940s, Carl Rogers was not only a pioneer, he was an iconoclast, he was a rebel because his therapy was grounded in the idea that people are inherently motivated toward achieving positive psychological functioning, whereas for example in psychoanalysis and psychodynamic therapies, it was exactly the opposite.

The idea in psychodynamic schools is that the patient obstructs progress, the patient has resistances, you have to overcome these resistances, you have to push the patient to undo defense mechanisms such as dissociation and repression, you have to confront the patient.

So psychodynamic psychotherapies, including psychoanalysis, essentially are in implicitly or subtly adversarial because it is the therapist against the patient. There's a battle there, a battle of wills if nothing else, a battle of authority.

Rogers wanted to dispense with all this when psychoanalysis and psychodynamic therapies were at their height. They were the thing, like there was nothing else and he came up with this idea that actually the patient should lead the therapy, should guide the therapy because the patient is interested in positive psychological functioning.

The patient, said Rogers, is the expert about the patient. It is a patient who knows her life much better than the therapist could ever hope to know and it is a patient that should lead the general direction of the therapy. The therapist should be there, should be non-directive, so it was not an analytical mechanistic approach, it was more a discourse, a dialogue, an interaction very similar to what you would have with a good friend who is also very alert and intelligent.

Rogers' method emphasized several techniques such as reflective listening and I'm going to dwell, I'm going to discuss these techniques at length a bit later, but reflective listening.

Empathy became a tool, an instrument in his therapy and acceptance.

Above all, there was a need to accept the client as he or she is and again this conflicts dramatically with psychoanalytic and psychodynamic schools where the patient is considered flawed, broken, damaged in need of fixing, in need of change and transformation via insight so that the patient is no longer recognizable even to herself.

Rogers rejected all this. He said you don't need to interpret behaviors, you don't need to go into unconscious drives, you need to accept the patient as he is, you just need to provide the patient with a space conducive to uncensored, fearless self-exploration in safety, in an ambulance of safety and holding containment.

The client in this kind of therapy explores their feelings, they gain a clear perception of themselves and this leads to psychological growth which I've discussed with Daria Zhukovska in our latest talk.

The idea which has not been disproven by the way is that self-exploration always leads to growth, to psychological growth.

Therapist attempts to increase the client's self-awareness and self-understanding by reflecting and carefully clarifying using questions.

It's a bit of a Socratic method.

So let's explore some of the elements of client-centered therapy.

As I said, client-centered therapy is non-directive. In most other forms of therapy, the therapist takes the lead.

There is an assumption that the therapist knows better than you do, even knows you better than you know yourself. So it's a therapist who is going to open the portal of insight and self-awareness to you. It's going to introduce you, the therapist is going to introduce you to yourself finally.

So the therapist is equipped with superior knowledge, techniques which are somewhat mysterious and it's like a mechanic. It's going to somehow tinker with your insights, rearrange the furniture up here and somehow obtain a much better outcome than you've succeeded by your own hitherto.

And this is called directive therapy.

Rogers therapy is non-directive. There's no agenda for any particular session or generally. There's just person-centered interaction. Therapist lets the client lead.

It is a client's journey, not a therapist. The client is the expert about the client. The client knows her life better than the therapist. So she should guide the therapist. She should introduce the therapist to every nook and cranny and angle and aspect and dimension of herself so that the therapist can shed light with his questioning queries, with his probing mind, with his critical thinking.

That's his role. So therapist is an equal collaborator, not an authority. He is just an expert at guiding people towards self-actualization, but they take ownership of the process. It's up to them.

The therapist in client-centered therapy, therapist never pushes, never expects, never demands, never suggests, never interprets, never does any of these things.

And this is why in the 1940s, everyone was saying patient and Rogers was the first to insist on the word client. She's not a patient. I'm not a doctor. It's a client. And I'm offering guidance only in the sense that when the client takes responsibility of her life, when she comes up with an answer, I challenge her to consider some aspects which she may have overlooked.

That's all.

So in the 1960s, person-centered therapy or client-centered therapy became closely tied to what was called at the time the human potential movement. I'm old enough to remember it. The human potential movement believed that all individuals have a natural drive towards self-actualization. This is the idea of linear inexorable progress.

So in this state, one is able to manifest their full potential when they are self-actualized.

And according to Rogers, negative self-perceptions can prevent self-actualization. So we need to get rid of them somehow because self-actualization is always the goal and it's always good. postulated that the state of incongruence in a client is actually not necessarily a bad thing.

This discrepancy between the client's self-image and the reality of their experience, what I call the grandiosity gap, that's not necessarily bad. And that applies to narcissists as well because the incongruence in healthy people, relatively healthy people, the incongruence leads to feelings of vulnerability and anxiety which the client then wants to dispose of, to dispose of. And the only way to dispose of feelings of vulnerability and anxiety is to heal, to progress, to develop, to grow, to mature. It's the only way.

So incongruence and the attendant impacts, attendant reactions of anxiety and so on, they lead to personal growth. And personal, person-centered therapy operates on a humanistic belief that the client is inherently driven toward and has a capacity for growth and self-actualization.

There's a force inside the client that the therapist can leverage or help the client to leverage in order to induce therapeutic change. Change in short comes from within, never from without. It's never external. There's nothing the therapist can do to induce change. Therapists can help the patient induce internal change.

The role of the counselor is to provide a nonjudgmental environment conducive to honest, unflinching, fearless self-exploration. Emphasis on honest.

The therapist attempts to increase the client's self-understanding by reflecting and carefully clarifying questions, but he never offers advice.

There's a big difference between asking questions which are provocative, induced thinking, intellectually challenging. There's a big difference between this and offering advice.

The questions are never construed and can never be rewritten as advice. It's just an honest attempt at curiosity. It's just a way to explore together, not knowing what's behind the curve, what's behind the curve and what's behind what's in the next street.

Both the therapist and the patient are ignorant of what's about to come. They don't pretend that they have some kind of privileged information because they don't.

The therapist functions under the assumption that the client knows themselves best and viable solution therefore can come only from the client.

The direction from the therapist can, when the therapist provides direction, it can reinforce the notion that there are external solutions to one's struggles.

If a therapist says, "Let me direct this session. Let me tell you this. The therapist gives the impression that he has the solutions, but he's withholding the solutions because the time is not right or there's some work to be done or whatever."

But in the vast majority of cases, if not in all cases, the therapist doesn't have any solutions, that's nonsense. That is self-serving, self-aggrandizing nonsense common mostly in the scam known as the self-help industry.

There are no solutions. There are no external solutions at least. Client self-exploration and reinforcement of the client's worth is the only way to improve self-esteem, increase trust in one's decision-making process, and then this leads to an enhancement of the client's ability to cope with the consequences of their decisions.

Rogers did not believe, strongly rejected the idea that psychological diagnosis was necessary, so he never diagnosed anyone. He actually came up with six conditions, some of them necessary, some of them sufficient. So these are the six conditions for this kind of person-centered therapy.

Number one, therapist-client psychological contact. The therapist and the client are in psychological contact.

Number two, client incongruence. The client is experiencing a state of incongruence, egodystonic.

Number three, therapist-congruence. The therapist is congruent, the client is incongruent, the therapist is the opposite. He is congruent, he's genuine, he's authentic, and he's in a relationship with the client. It's a relationship. It's not arm's length, it's not one step removal, it's not I'm the observer and you're the client, no way. It's a joint venture, it's a collaboration, and it is a relationship.

Number four, therapist provides unconditional positive regard. The therapist regards his client essentially as positive.

Number five, the therapist provides empathic understanding. He experiences and communicates an empathic comprehension of the client's internal perspective. He puts himself in the client's shoes and he communicates this to the client.

Right now, I'm in your shoes, I understand you fully.

And finally, client perception. The client perceives the therapist's unconditional positive regard and empathic understanding.

This induces in the client all kinds of dynamics.

Now, there are core conditions, three attitudes on the part of the therapist that are key to the success of person-centered therapy. And these core conditions are accurate empathy, congruence, and unconditional positive regard.

So three out of the six are core conditions, cynical or not. Without them, there's no way the therapy will work.

Accurate empathy means that the therapist engages in active listening. He pays careful attention to the client's feelings and thoughts. He conveys an accurate understanding of the patient's private world throughout the therapy session, as if it were the therapist's own.

So he rephrases things, he repeats things just to make clear, I get you, understand you, I'm in your shoes right now.

And one helpful technique in this core condition of accurate empathy is reflection. It's paraphrasing or summarizing the feeling behind what the client is saying, not the content of what the client is saying.

And this is very important. This is an insight that permeated even cognitive therapies.

What the client says is often not very important. It's much more important to understand why the client is chosen to say what he's saying. What are the emotions behind this choice to say something specific? What are the cognitions? And what's the connection between the emotions and the cognitions? What triggers what? What leads to what?

So this all emanates from person-centered therapy. It allows the client to process feelings. The client sees himself reflected in the therapist's eyes. The therapist paraphrases or rephrases the client's emotions and the client says, "Oh my God, that's exactly what I'm feeling right now."

By hearing his own emotions being restated by someone else, the client becomes an observer of his own internal state. It's a very powerful introspective tool.

Congolidice means that the therapist conveys their feelings and thoughts to genuinely relate to the client. And that's why person-centered therapy is a relationship because the therapist contributes as much as the patient, as much as the client.

The therapist talks about himself, how he feels, what he understands, etc. The therapist is authentically, genuinely himself does not hide behind any professional facade, is never arrogant or authoritative or supreme or superior, never deceives the client, never defrauds the client but pretending to have solutions at hand by having all the answers. The therapist shares his emotional reactions with his clients but not personal problems. And of course, never crosses the boundaries, never shifts the focus to himself. The therapist never shifts the focus to himself. If he shares anything with the client, it's to help the client, to have the client to mirror himself, to have the client to introspect, to have the client to feel that he's not alone. So it's all client-centered, it's all to help the client.

The client is not the therapist's friend and is not, God forbid, the therapist's lover. No way, these are massive, massive, forbidden taboo breach of boundaries. That's not what I'm talking about. Therapists here are much closer, shall we say, to a friend in a way and helps the patient realize that his experiences are not unique. His experiences, patient must understand that his experience doesn't render him a freak or a mentally ill person or a creep. That all human experience is the same and even his own therapist is going through the same processes, having the same emotions, etc.

Except of course in extreme cases, I don't know, serial killers, pedophiles. But in 99.99% of all encounters between therapists and clients, they're the same. Therapists actually are clients of other therapists and all therapists, all good therapists, go to supervision. They're supervised by other therapists.

So the roles are interchangeable and this is communicated very strongly in person-centered therapy.

This also links into unconditional positive regard. The therapist creates a warm environment, an environment that conveys to the client that they're accepted unconditionally, regardless of their flaws and shortcomings and mistakes and prejudices and biases and craziness and whatever they're accepted. There's no judgment, no approval, no disapproval. Never mind how unconventional the client is, schizotypal, crazy ideas, conspiracy theories, you name it.

Still, the therapist is not there to rank the client, to grade the client, to chastise the client, to reform the client. That's not therapy. That's religion maybe.

The role of the therapist is to listen, to listen to the nuances and the subtleties and the choices, to observe behavior and to correlate it with internal processes as much as they are accessible. So the therapist is there as a monitor, a little like an artificial intelligence application. As someone who can provoke in the patient or in the client the very processes that are required for growth and development and healing and so on.

But all these processes are internalized. They're not in the hands of the therapist.

The therapist has nothing to do with these processes.

Perhaps he knows how to flick the switch but the electricity network, the light, the grid belongs to the patient.

The client in this situation doesn't need to be defensive. There's no need for resistances. All natural defenses crumble clinically. The client decompensates benevolently. He doesn't decompensate because of stress. He doesn't decompensate because of a cataclysmic event. He doesn't decompensate because of catastrophizing anticipation. He doesn't decompensate because he's been rejected or abandoned or whatever. He decompensates because he can safely do so. He's allowed to remain vulnerable, exposed, defenseless, naked of course in a metaphorical sense.

Clients in person-centered therapy freely express feelings and they direct their self-exploration as they see fit. This all has to do with empathy.

Empathy, the therapist in person-centered therapy exhibits empathy. Even as the therapist applies techniques and it's clear that he's being a bit manipulative and his questioning is not random, etc., even when this structure is present, still it is imbued and permeated with empathy.

The ability to put yourself in someone else's shoes to relate to their experience, to accept them as they are, this is crucial.

Now, don't confuse, of course, empathy with sympathy. The therapist is under no obligation to be sympathetic to the client, but he needs to be empathic. He needs to understand the client. He doesn't have to feel bad for the client. He doesn't have to feel good for the client, but he needs to understand the client.

If a client does not feel understood, how can they feel safe with such a therapist? If a client is to expose himself, become vulnerable in this condition of supercharged extreme intimacy with a therapist, he needs to firmly believe that the therapist is getting him, understands her, is crucial. It's not easy, though, because the therapist needs to accept negative things, negative traits, negative emotions, negative behaviors, sometimes even egregious negative behaviors. Therapists need to remain positive, supportive and non-judgmental with a client, even when it's exceedingly difficult, even when there is moral judgment, even when it contradicts or conflicts with social mores and taboos and prohibitions and boundaries. Still, the therapist must work hard to not judge, not castigate, not criticize.

There are times that the client expresses negative emotions or describes negative traits or even goes into his history where he has committed heinous acts. And as a therapist, the therapist is human, you know, and the therapist has a reaction. It's there, it's automatic, it's reflexive.

The therapist doesn't control this reaction. But the person sent the therapist must not let this out. He must suppress this, absolutely. He must remain at all times non-judgmental and supportive and positive about the client and the client's prospects.

Sometimes the negative emotions and negative traits and even the negative actions are directed at the therapist. He becomes the target.

But even then the therapist needs to remember that his main role and job is to create a safe environment for the client where the client feels that they can share information without negativity, without judgment, without criticism, without berating.

So if the client feels negatively about the therapist, the client should feel utterly safe and comfortable to tell the therapist, I'm feeling very negatively about you. I would like to snap your head, snap your neck. I don't know. I really hate you.

The client should feel comfortable to say this.

To some extent, the therapist needs to engage in person-centered therapy. Therapist needs to engage in dissociative, in dissociation. He needs to depersonalize. If he takes everything the client says personally, the therapy cannot proceed. The therapist needs to learn to not take words personally, especially with the client who is heavily at all, is experiencing serious personal issues.

So the therapist needs sometimes to remove himself from the scene, to derealize it, to depersonalize it. It's a dissociative defense.

But throughout this, even when the therapist essentially is required to dissociate, he needs to listen. So part of him needs to be present, active listening. You're listening to the client without exhibiting judgment. You're just listening. You're just like a sounding board. You're like a tape recorder. You're like, I don't know what. But you listen in a way that lets the client know that you're listening and informs the client that you do understand what he's saying.

So your body language, you communicate to the client as a therapist, you communicate to the client via your body language, you maintain eye contact, you lean slightly forward, you keep an open style of communication, your legs are crossed, your arms are crossed.

And as I said in the 1940s, 50s and 60s, there was bodily contact. There was a lot of hugging, holding hands, playing father openly, playing the role of a father, wiping the patient's tears, crying on the therapist's shoulders, and so on and so forth.

This is unfortunately unacceptable today, unacceptable behavior, and could lead to dire consequences.

So I strongly recommend against it, the world has changed. So it's pretty normal to change our behaviors. Actually, it's an adaptation.


Another part of active listening is verbally responding to what is being said.

Now in most therapies, the therapist is trying to offer an interpretation, an insight. The therapist encourages the patient to see the patient's problems and questions through another lens, the lens of therapy, the lens of the profession, and so on.

So the therapist has an active role, but not in listening, in interpretation.

In person-centered therapy, verbal responses to what the patient is saying do not try to change the meaning of what the patient is saying. It simply reflects to the client that the therapist is there, he is alert, he is listening, and he understands what the patient is saying.

Very crucial. One way to do this is to paraphrase the client's words. It's very easy to misunderstand people. I mean, you won't believe. Actually, we misunderstand each other most of the time, and we fill in the blanks. We never listen continuously. We pick up a word here, a word there, and we fill in the blanks. This is confabulation, the theory. Everyone does that. Healthy people do it, not only the mentally ill.

So when the therapist is exposed to a client's verbal stream of consciousness, it's sometimes crucial to stop and to make sure that he understands what the client is saying. One way of doing this is to paraphrase what the client is saying. It's to clarify what's being said so that the therapist knows that he is hearing what the patient wants him to hear.

By paraphrasing the client's comments, the therapist ensures that he is on the same wave as the client. He understands the client's true communication, true meaning. The tone of voice is an important consideration. The tone should remain even, supportive, neutral, but friendly. No judgment, no distancing.

And the questions that the therapist asks to push forward, to provide an impetus for the therapy. The questions are also very important. They should be focused in a way that would produce an answer, but are also open-ended.

Now this is an exceedingly difficult balancing act. In the vast majority of other therapies, the therapist forms an opinion, has an idea, or thinks he has found a solution, and then he guides, he herds, so to speak, the client towards that ultimate goal. This is forbidden in person-centered therapy.

The questions should be open-ended. And open-ended questions are considered superior because you never know how the patient is going to react. You never know what kind of new information you're going to receive.

So the therapist is not allowed to lead the patient, the client is in control of the session. And open-ended questions elicit more information.

Once there's more information, if the therapist is up to it and inclined, he can use affirmations, verbal and nonverbal. I appreciate what you're telling me. That's a verbal affirmation. Go on. That's also a verbal affirmation. I'm interested in what you have to say, you know. Keep me interested. A nonverbal affirmation can be something as simple as nodding your head as a therapist.

So person-centered therapy puts the client in the driver's seat. The client is in charge. The therapist is there to help the client, technically, so to speak, it's like the therapist facilities the client's self-therapy. You could say safely that person-centered therapy is a form of self-therapy, similar to what Karen Horna had advocated in her books or even Freud.

So maybe in this sense it is not as divorced from psychodynamic therapies as we think, but it still at the time used to be a huge revolution. The world has changed, wars, strife, gender conflicts, victimhood movements and so on and so forth.

And today, I don't believe person-centered therapy could be practiced effectively. I don't believe this.

There's too much bad blood between people. People are too atomized and separate, lonely, alone. People don't interact anymore, meaningfully. People objectify and commoditize each other, consume each other, like consumer goods.

And in this kind of environment, artificial intelligence-like therapies, CBT for example, is totally automated, totally lexical, world-oriented. They can do the job, maybe.

But we've lost a lot in this transition from the likes of Freud and Jung and Rogers and others, Maslow, in this transition to programmable therapies like CBT, computer-like therapies. We have lost our soul. We've lost our humanity.

And it's nowhere to be found, not even in therapy.

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Narcissism Narrative Therapy ( Fix Your Narrative, Heal Yourself)

Narrative therapy is a form of psychotherapy that helps patients identify values and skills associated with them, and provides them with knowledge or ability to experience these values and exercise these skills in order to confront problems. The therapist encourages self-authorship and co-authoring a new narrative about themselves. Narrative therapy is closely associated with other therapies, such as collaborative therapy and person-centered therapy. The therapist and the client are perceived as having valuable information relevant to the process and they create together the content of the therapeutic conversation by imbuing it and suffusing it with this valuable information.

Psychopath Therapy Notes

A therapist writes notes on a first therapy session with a psychopathic patient, John Male, who was referred to therapy by the court as part of a rehabilitation program. John is serving time in prison for grand fraud, which involved hundreds of retired men and women in a dozen states over a period of three years. John shows no remorse for his actions and is contemptuous towards his victims. He is also dismissive of the therapist's attempts to understand his motivations and needs.

Protecting Us From Ourselves Defense Mechanisms

Insight from psychoanalysis suggests that we are our own worst enemies due to our capacity for self-deceit. Defense mechanisms are widely thought to be the main instruments of self-deceit, and they serve to separate internal reality from external reality in order to reduce anxiety. These defenses can be successful or unsuccessful, and they play a role in normal psychic structure formation. Additionally, there are various types of defenses, and they can evolve and transform as the ego matures.

Doubling and Role Reversal in Therapies

Psychodrama techniques, such as doubling, role playing, role reversal, soliloquy, and mirroring, are useful in cognitive behavior therapy and in treating cluster B personality disorders. Doubling involves the therapist emulating the client's emotions, cognitions, and behaviors, while role playing involves the client assuming the role of a particular person in their life. Role reversal is similar to doubling, but the therapist and client switch roles. Soliloquy involves the client describing their inner thoughts and feelings to the therapist, while mirroring involves the client observing other people's behaviors and emotions. These techniques are intended to penetrate the resistances and defenses of rigid personalities not open to change or intervention.

Healing Through Meaning: Logotherapy, PTMF, and Cold Therapy (University Lecture)

The lecture discusses the importance of meaning in therapy and presents three treatment modalities that leverage meaning as a healing tool. The Power Threat Meaning Framework focuses on understanding the role of power and threat in people's lives and how they make sense of their experiences. Cold Therapy aims to eliminate grandiosity in narcissistic disorders and depressive narratives, forcing individuals to face their traumas and construct new, reality-based narratives. Logotherapy, developed by Viktor Frankl, emphasizes the human will to find meaning in life, even in the most miserable circumstances, and the importance of suffering when creative possibilities are not available. The lecture also delves into the philosophical and metaphysical assumptions underlying logotherapy and the significance of meaning in human existence.

Staring Into Abyss: Failed Healer's Confession

Therapists, psychologists, counselors, and coaches can be traumatized by their work, especially when they encounter patients who are beyond help. These patients have minds that are tangled messes, and therapists can be drawn inexorably deeper into their primordial jungle, knowing that it could spell their own doom. When a therapist comes across a patient like this, they are liable to lose their mind, and it is a terrifying experience. Therapists can burn out, melt down, act out, decompensate, and dysregulate, and they can react very badly.

Narcissist's Victim: NO CONTACT Rules

Professor Sam Vaknin advises victims of narcissism and psychopathy to maintain as much contact with their abuser as the courts, counselors, evaluators, mediators, guardians, or law enforcement officials mandate. However, with the exception of this minimum mandated by the courts, decline any and all gratuitous contact with the narcissist or psychopath. Avoiding contact with the abuser is a form of setting boundaries, and setting boundaries is a form of healing. Be firm, be resolute, but be polite and civil.

Spot a Narcissist or a Psychopath on Your First Date

There are warning signs to identify abusers and narcissists early on in a relationship. One of the first signs is the abuser's tendency to blame others for their mistakes and failures. Other signs include hypersensitivity, eagerness to commit, controlling behavior, patronizing and condescending manner, and devaluing the partner. Abusers may also idealize their partner, have sadistic sexual fantasies, and switch between abusive and loving behavior. Paying attention to body language can also reveal warning signs.

Falsify Reality, Deny Yourself: Primitive Defense Mechanisms (NEW Intro+Compilation)

Psychological defense mechanisms are designed to prevent inner conflict and maintain comfort with oneself. They reduce anxiety and prevent disintegration by falsifying reality and denying or repressing undesirable parts of oneself. Splitting, projection, and projective identification are key mechanisms that falsify reality and manage self-perception. Splitting involves seeing oneself as all good and others as all bad, avoiding guilt or shame. Projection attributes one's own unacceptable traits to others, while projective identification goes further, inducing others to behave in ways that confirm the projection. Reaction formation involves adopting behaviors that are the opposite of one's unacceptable impulses, such as a latent homosexual displaying homophobia. These mechanisms are crucial for internal tranquility but can distort reality and interpersonal perceptions.

Transcripts Copyright © Sam Vaknin 2010-2024, under license to William DeGraaf
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