Developmental movement in person-centered therapy:

Analyzing a Rogers case using the Developmental Approach to Psychotherapy

Process scheme

Suzie Benack Tom SwanUnion College Siena College

Schenectady, NY Loudonville, NY

benacks@union.edu tswan@siena.edu

Dialectical Development of Meaning-making

Thesis

Antithesis

Synthesis

CONFLICT

Dialectical Development of Meaning-making

I want to be a good mother who puts her

kids’ needs first.

I want to meet my own

needs.

To take care of the kids

well, I have to take care of

myself.

THESIS

ANTITHESIS

SYNTHESIS

CONFLICT

Goals of the Developmental Approach to Psychotherapy

Process (DAPP)

Show “common factors” in all psychotherapy

Provide a common language for therapy process that goes across theoretical traditions

Enable practitioners of different approaches to talk to each other, recognize commonalities in what they are doing

The DAPP framework: 3 parts

• The client’s meaning-making

• The therapist’s actions

• (The client’s use of resources offered by therapist)

The DAPP framework: Part 1

The client’s meaning-making

THESIS

ANTITHESIS

CONFLICT

SYNTHESIS

“STUCKNESS”

The DAPP framework: Part 2The therapist’s actions

ATTENTIONAL SUPPORT Questions, restatements/reflections, encouragement to elaborate, offering feedback, providing reassurance/accurate empathy, holding emotions

INTERPRETATION Offering novel perspectives or meaning-making experiences from the therapist’s own meaning-making

ENACTMENT novel experience or activity is evoked and then made a focus of exploration…transference, homework, role-playing, meta-communication about therapy process

DAPP CODING CATEGORIES

Client’s meaning-making

Thesis, Antithesis

Conflict

Synthesis

Stuckness

Therapist’s actionsAttentional support

Interpretation

Enactment

Rogerian therapy from a DAPP perspective

• Developmental “stuckness” typically results from conflicts between aspects of experience that are accepted/conscious and aspects that are suppressed/excluded from the self

• Attentional support the primary resource offered by therapist

• Also enactment – providing novel experience of unconditional regard, modeling being fully in the moment

• Interpretation not ruled out, but done cautiously

DAPP analysis of a Rogers case:

First session with Dionne“The Right to be Desperate”

Section I: Dionne describes his

current dilemma

I am being alone and asking who I am, like

when I was seven.

People took that away from me with their expectations.

I don’t regret living up to their

expectations…

… but I’ve been through a lot of changes since

getting ill.

I accepted the death…

....but that was the start of the changes.

I’m happier now than I’ve ever been…

…but there’s a lot of hurt.

A series of unresolved contrasts…

The hurt comes from the loss of myself in conforming to people’s expectations. I’m learning that

who I am inside is OK, that I don’t have to meet social

expectations….but the hurt is still hard to deal with.

Synthesis at the end of Section I

Rogers’ activity through Section I:

Offers attentional supportthrough encouragement (mmm-hmm),

agreement (I’ll bet!), restatement

Section 2:Dionne explores the

meaning of events since his diagnosis

2A: Ways that illness has disrupted the “good Dionne” role & lost others’

acceptance/approval

I didn’t tell anyone about illness for many months.

Took control – set up for kids after I die, fought

illness, etc.

Accepted possible death Because others didn’t know, they judged me, didn’t understand, I lost their respect and acceptance“crawled up on cross,”

did for others, not self

Illness put me out of control. Did things I didn’t like bc

desperate.

I had been so good and loving to them, then when I told them, when I was needy, there was

no support, just guilt.

Now I’m “washing all that stuff out.”

Rogers’ responses in 2A

Attentional support:

Restatements and encouragement

Question: To crucify yourself? Or to be a martyr? I’m not really sure…?

2B: Deepening and intensifying the themes of hurt and loss…beginning of

theme of anger

Loss of father-in-law…real care, support

But this is all my fault because I didn’t tell the about the

illness.

Didn’t get support, love from rest of family after

giving lots.

I acted ways that lost me people’s respect, bc I was desperate…but that’s not OK cause I have to be perfect….That’s worse for me than the

lukemia!

I was criticized, my side of story wasn’t heard.

I didn’t tell bc I didn’t trust people.

I didn’t tell bc I had to be better than everyone else to

survive.

I didn’t tell bc people see the ill as “tainted,” an outsider.

Rogers’ contribution in 2B

Attentional Support

Continues encouragement and restatement, but also begins to use more selective direction of attention:

Opens with redirective question: Is that part of the hurt? You

referred earlier to hurt and I didn’t quite understand that.

Refocus of attention from content to immediate affect:

And I imagine…or perhaps I catch a little bit of resentment...

The theme of anger is brought into the conversation…

from client’s experience, but from Rogers’ perspective.

2C: Dionne begins to take a side in the inner conflict: sticks up for

his “real” self and blames his oppressors

I don’t want my children to go through that…I can

prevent it.

When I went into remission, I rode a

motorcycle…just for me, for fun…that’s good.

I suffered divorce, rejection…Good Christians didn’t act very

Christian.

Their rejection of me was racist.

Rogers shifts the groundIn addition to continuing encouragement and restatement, Rogers focuses Dionne’s attention on his immediate feeling of anger:

And I catch a note of bitterness there. A feeling that they really make judgments without, without knowing the picture.

This time Dionne picks up the language and addresses the affect:

…for sure. And I think that also caused a lot of bitterness or whatever….And that kind of stuff I want to get out of me. You know, I can’t deal with that…someone else’s trip on me. Because I don’t hate anybody or that or whatever. A lot of the things I’ve brought on myself…But at the same time, I think I really do have the right …to have been desperate.

I wanted to go out living up to standards…

Deciding I wanted to live, physically = deciding to be

my real self.

What I am into, enjoy is good for me…it keeps me

healthy, not ill.

But I’m getting a little tired of those standards.

Good things came from illness…moving, the

divorce, not living where I’m not accepted.

But it was a rough, scratchy road. When that stuff comes

in, I get sick again.

I can control my illness/health by being good to myself, getting back to my real, best self. Who I

was when I was 7

Wonder how that 7 year old would have handled the illness, all of this. (Pause). Feel some kind of

release.

Section 3:

A shift to the present moment: Dionne tests the relationship and sets an agenda for

enactment

Can I trust people…hard to do

Tentatively…that race stuff makes me mad

Don’t want it to happen to my kids- makes me angry

Laughs---getting militant

When you said that, I felt…I think all kinds of words now.

I’ve suppressed a hell of lot of anger.

The dance of expressing anger vs. being polite/refined

Final synthesis, final conflict,and a move to enactment

Rogers attempts to end session, Dionne wants to make final statement:

That is going to make me feel good. That is going to continue to have me feel positive about myself and to grow and to be nourished or whatever, but I’m really

not sure what to say. You know, but I really want to do that, so that I can continue to live, you know…That’s

important to me, but it’s just not coming. But I think I really want to say that and be comfortable in saying, you know, “I got raked over the coals and I resent it

and I’m mad and I’m angry and I need to get that to be angry…But you know how I haven’t said it yet…I really

haven’t.”

Evolution of meaning-makingDIONNE ROGERS

“Real self” at 7; returning to it since the illness

Social expectations led to false self, still in current hurts

EncouragesRestates It’s good to be undoing the effects of social

expectations, returning to my real self, but there are a lot of hurts left.

Didn’t tell family, tried to be independent and “good”

Did bad, desperate things, was false; others didn’t support

I tried to be good, but illness showed me I’m ordinary; to survive and thrive, need to “wash out” all those hurts.

Names “resentmen

t”

Begins to take sides in conflict – stick up for self, blame others.

Names “bitterness

”

SHIFTS TO ISSUE OF EXPRESSING ANGER: ENACTMENT

I want to and need to be angry, express anger.

But that’s not polite, too “militant.” Can’t do it.

Restates

Summary: Resources Rogers offers & Dionne uses

1) Encouragement and restatement(unconditional positive regard & accurate empathy)

Client feels safe expressing current meanings

Understanding/holding of one meaning leads to expressing its antithesis

Client spontaneously forms syntheses – more coherent, fuller, more integrated versions of

current meanings

Summary: Resources Rogers offers & Dionne uses

2) Expansion/ invitation to enactment

By directing attention to the client’s unrecognized present affect, makes it an object of conscious mean-making and also invites fuller enactment of the affect in the therapeutic relationship