An Analysis of How Carl Rogers Enacted Client-Centered Conversation With Gloria

The Role of Empathy in Health and Social Care Professionals

The current article is an integrative and analytical literature review on the concept and meaning of empathy in health and social care professionals. Empathy, i.e., the ability to understand the personal experience of the patient without bonding with them, constitutes an important communication skill for a health professional, one that includes three dimensions: the emotional, cognitive, and behavioral. It has been proven that health professionals with high levels of empathy operate more efficiently as to the fulfillment of their role in eliciting therapeutic change. The empathetic professional comprehends the needs of the health care users, as the latter feel safe to express the thoughts and problems that concern them. Although the importance of empathy is undeniable, a significantly high percentage of health professionals seem to find it difficult to adopt a model of empathetic communication in their everyday practice. Some of the factors that negatively influence the development of empathy are the high number of patients that professionals have to manage, the lack of adequate time, the focus on therapy within the existing academic culture, but also the lack of education in empathy. Developing empathetic skills should not only be the underlying objective in the teaching process of health and social care undergraduate students, but also the subject of the lifelong and continuous education of professionals.

Development of the therapeutic language coding system (SICOLENTE): Reliability and construct validity

Since the use of language is a core aspect of psychotherapy, its study requires instruments that allow for further research. The aim of this study is to present an observational instrument capable of analyzing the language used in psychotherapeutic settings, both by therapists and clients. The SICOLENTE instrument was applied to two different samples: The Three Approaches to Psychotherapy film and a naturalistic sample. 7710 utterances from 31 sessions (three from the demonstration film and 28 from a naturalistic setting) were coded. Two studies were conducted: in the first study, inter and intra coder reliability (dimension and category levels) and Generalizability theory analyzes were assessed, whilst in the second study, construct validity was tested with several hypotheses. The final instrument resulted in 20 categories with three dimensions: Conversational Act (7 categories), Therapeutic topic (6 categories) and Content (7 categories). The three dimensions showed excellent inter and intra coder reliability and the generalizability coefficients were excellent. Out of the 24 validity hypothesis proposed,19 were accepted. The finding suggests that the SICOLENTE is a reliable and valid instrument that can be applied to investigate the performance of various theoretical models. Its three dimensional structure gives it the flexibility to be able to carry out macroscopic or microscopic language research.

Narrative change in Gloria Films: Comparing various processes of therapeutic innovation

AIMS

The present study focuses on the analysis of novelty emergence in classic Gloria Films with Rogers, Perls, and Ellis to understand how the same client formulated her own problem and if and how change occurred in those three sessions.

METHOD

The Innovative Moments Coding System was applied to track innovative moments (IMs) and their themes.

RESULTS

The session with Rogers showed more diversity in disclosed problems and themes of IMs, as well as a higher proportion of reflection IMs. The session with Perls demonstrated a high proportion of protest IMs. The session with Ellis showed less innovation than other sessions. The changes found were based mostly on reflection and protest IMs in three sessions.

CONCLUSION

Narrative innovations occurred in the three single sessions. The type of dominant innovation is consistent with the therapeutic model and the IMs model. The exploration of the IMs' themes allowed a more precise identification of Gloria's new narrative positions and their development throughout those sessions.

The poetics of therapeutic practice: motivational interviewing and the powers of pause

Motivational interviewing (MI) is an increasingly prominent behavioral therapy that draws from and claims to synthesize two American therapeutic traditions long thought to be antithetical-"client-centered" and "directive" approaches. This paper proposes that MI achieves its hallmark "client-centered directiveness" through the aesthetic management of the therapeutic encounter, and more particularly, through MI practitioners' marked use of silence. Drawing on data collected during the ethnographic study of MI trainings and the formal analysis of video-recorded MI sessions that are commonly used as models in such trainings, we identify three patterns of pause that regularly fall at specific grammatical junctures within seasoned MI practitioners' turns-at-talk. We demonstrate how these pauses allow MI practitioners to subtly direct the conversation while simultaneously displaying unequivocal signs of client-centeredness. In other words, we show how and explain why the poetics of pause matter to MI. In presenting this case, we more generally highlight practice poetics-that is, the aesthetic management of the style and delivery of a professional message with a particular practical aim in mind-suggesting that this is a central if under-appreciated aspect of therapeutic practices.

Development and feasibility of an objective measure of patient-centered communication fidelity in a pediatric obesity intervention

OBJECTIVE

To develop a measure of person-centered communication (PCC) and demonstrate feasibility for use in primary care child obesity interventions.

METHODS

Helping Healthy Activity and Nutrition Directions was a primary care intervention for families of overweight or obese 5- to 8-year-old children. The PCC Coding System (PCCCS) was based on theory and a validated motivational interviewing instrument. The PCCCS provided global scores, and total, positive, and negative PCC utterance frequencies. Three trained coders tested reliability of the PCCCS on audio recordings of sessions with 30 families. Potential uses of the PCCCS were demonstrated.

RESULTS

The PCCCS demonstrated good inter-rater reliability for utterance frequencies but not for global scores.

CONCLUSIONS AND IMPLICATIONS

The PCCCS is a reliable and feasible measure of PCC utterances. More research is needed to improve inter-rater reliability of the PCC global scale. The PCCCS may be used in the future to test fidelity of PCC interventions.

Clients as conversational agents

OBJECTIVE

Conversational agency is our invented term that orients us to ways in which clients participate in therapeutic dialogues. In this study we examined how clients' conversational correctives and initiatives influenced collaborative therapeutic consultations.

METHODS

Thirty-five single-session lifestyle consultations were videotaped in which adult clients volunteered to discuss concerns of non-clinical severity with a counselor. We discursively microanalyzed excerpts where clients initiated topic shifts or corrected counselor misunderstandings and how counselors responded to them.

RESULTS

Clients were actively involved in co-managing conversational developments during the consultations. They influenced the content and course of the conversations with the counselors by correcting, interrupting, or speaking from positions contrary or unrelated to those of the counselors.

CONCLUSION

Clients observably influenced the conversational agenda through their correctives and initiatives if counselors were responsive during face-to-face consultations.

PRACTICE IMPLICATIONS

Clinicians should demonstrate increased sensitivity and relational responsivity by intentionally engaging with clients' agentive contributions to consultative dialogues.

Therapeutic work with the present moment: a comparative conversation analysis of existential and cognitive therapies

Therapeutic work with the client's present moment experience in existential therapy was studied by means of conversation analysis. Using publicly available video recordings of therapy sessions as data, an existential therapist's practice of guiding a client into immediacy, or refocusing the talk on a client's immediate experience, was described and compared with a therapist's corresponding action in cognitive therapy. The study contributes to the description of interactional practice of existential therapy, and involves the first application of conversation analysis to a comparative study of psychotherapy process. The potential utility of this approach and the clinical and empirical implications of the present findings are discussed.

Evaluation of the FOCUS (Feedback on Counseling Using Simulation) instrument for assessment of client-centered nutrition counseling behaviors

OBJECTIVE

To develop an instrument to assess client-centered counseling behaviors (skills) of student-counselors in a standardized patient (SP) exercise.

METHODS

Descriptive study of the accuracy and utility of a newly developed counseling evaluation instrument. Study participants included 11 female student-counselors at a Midwestern university-10 Caucasian, 1 African-American-for the simulated counseling sessions, in which the Feedback on Counseling Using Simulation (FOCUS) instrument was applied in 2 SP scenarios (cardiovascular disease and diabetes). FOCUS ratings of student-counselors by 4 SPs during 22 sessions were compared with ratings from a 3-member panel of experts who independently viewed the 22 videotaped sessions. Quantitative analysis of instrument validity included inter-rater reliability by computing generalizability coefficients, Pearson correlations, and Spearman rank-order correlations.

RESULTS

FOCUS criteria encompassed relevant dimensions of nutrition counseling based in a client-centered perspective. The critical points of information gathering and counseling behaviors showed internal consistency overall and good inter-rater reliability with the cardiovascular disease scenario. For both scenarios, pooled ratings of 3 experts agreed with ratings carried out by SPs.

CONCLUSIONS AND IMPLICATIONS

Initial findings suggest that the FOCUS instrument with client-centered criteria may enhance evaluation of counseling skills in SP exercises, meriting further study with larger groups.

Students Evaluate Carl Rogers and His Relationship With Gloria: A Brief Report

The Three Approaches to Psychotherapy (TAP) video series introduces students, both undergraduate and graduate, to three major schools of psychotherapy: client-centered therapy, Gestalt therapy, and rational-emotive therapy. A sample of students were asked to watch the TAP video series and were then surveyed on their perceptions of the therapists' practice of psychotherapy and explanation of his theory, and the relationship between the client and therapist, including the therapists interest in and treatment of the client. This article focuses on findings based on Carl Rogers's session with the client, Gloria. Results were consistent in that students were pleased with Rogers's theory, practice, and interaction with Gloria.

Reflections on reflecting as a dialogic accomplishment in counseling

In this exploratory study, the author examines reflection as a dialogic phenomenon constructed in the back-and-forth of counseling dialogue. He videotaped and microanalyzed 11 one-hour lifestyle consultations for the conversational practices used by counselors and clients in collaboratively reflecting on developments in their dialogues. He then invited counselors and clients back to comment on their participation in videotaped passages of their dialogue selected for microanalysis, thus permitting a juxtaposition of their retrospective comments with the analysis. The author considers the results from this study with respect to training counselors and for pointing new ways to widen the evidence base with respect to interventions in counseling, particularly social constructionist approaches.