PCT or RT/CT?
1. Introduction
The purpose of this essay is to offer a brief overview of two theoretical therapy orientations: Carl Rogers’ Person Centred Therapy (PCT) and William Glasser’s Choice Theory/Reality Therapy (RTCT). This will be achieved by initially providing a succinct outline of the theorist’s background. Following this, each theory will be examined using Sharon Cheston’s Ways Paradigm.
Cheston’s model (2000, p.256) proposes “that the subject of counselling theory and practice can be organised around three principles: a way of being, a way of understanding and a way intervening. This essay will commence with an exploration of PCT, including an evaluation of the strengths and limitations. In the ensuing section, the author will then present RT/CT using the same format. Furthermore, the work will then encompass multicultural considerations.
2. Person Centred Therapy – An Overview
2.1. Carl Rogers – A Brief Biographical Background
Kirshenbaum states that Rogers grew up in a strict religious home and was “a product of mid-western American” (2007, p.1). He further describes Rogers as “a rather sickly child – slight, prone to tears, often the target of jokes and teasing by his older brothers” (Kirshenbaum, 2007, p.2) When Rogers was twelve, his father bought a farm in a “rural community about 30 miles west of Chicago” (Gale, 2015, p.6). In most biographies (Kirshenbaum 2007; Gale, 2015; Thorne & Sanders, 2013), this farm was presented as influential in Roger’s later ideas. Here he developed his work ethic, his interest in science and the idea that everything strives to grow. Rogers described his upbringing as loving, but controlling (Rogers, 1961, p.5). Furthermore, Nelson-Jones (2011) suggested that it created a young person who did not feel safe sharing personal feelings.
While Rogers initially studied agriculture, he later decided he would become a Christian minister and attended the World Student Christian Federation Conference. Thorne and Sanders (2013, p.4) describe this a “watershed in Rogers’ spiritual and intellectual development.”
Rogers married Helen Elliot shortly after graduating and quickly after this, he was accepted into Theology training. Thorne and Sanders (2013) tell us that shortly into his training, he became restless. This led to him undertaking training in clinical psychology at Teacher’s College, where he began his long and fruitful foray into therapy. Kirshenbaum & Jourdan (2005, p.37) argue that no matter what happens to PCT; Carl Rogers has left “a legacy [which] will endure”.
2.2. Person Centred Therapy Through the Ways Paradigm
2.2.1. A Way of Being (WOB)
For Rogers, relationship was central to the WOB. He believed that for change to occur, certain conditions were necessary. While he lists six conditions (Rogers, 1957), in this section, the reader will be presented with an overview of three: Empathy; Unconditional Positive Regard (UPR) and Congruence.
2.2.1.1. Empathy:
Rogers (1980) argued that empathy allows the therapist to enter the client’s world and understand the meanings of their experiences. This involves meanings that existed both in and out of the client’s surface awareness. To accurately enter another’s world, we must put aside what Rogers called our Subjective Frame of Reference. He suggested that we should aim to perceive the world of another “without ever losing the ‘as if’ condition” (Rogers, 1969, pp.210-211). Rogers viewed empathy as vital, and, in fact linked it to “Positive Outcome” (Rogers, 1975, p.2).
2.2.1.2. Unconditional Positive Regard:
Rogers (1956, pp.97) explained UPR as “experiencing a warm aspect of the client’s experience as being part of that client…” However, the experiencing of this UPR is not enough. The therapist must be able to convey it to the client.
On the surface, this seems easy, but what if one is faced with a client whose behaviour is so henious that it seems impossible to experience a warm aspect of said experience? The emphasis here is on conditional. Lietear (1993, p.1) describes this beautifully when she says ‘unconditionality refers to the constancy in accepting the client, the extent to which the therapist accepts his client without ‘ifs’”. It is a beautiful and challenging ideal.
2.2.1.3. Congruence
In PCT genuineness is paramount. The therapist’s WOB will therefore be rooted in congruence. McMillan (2004, p.56) states that Rogers offered up “the notion of ‘transparency’ to capture the essence of this realness.” This willingness to be ‘authentic’ has been positively correlated with good outcome (Cashwell, Shcherbakova & Caswell, 2003); however, others (Brodley, 1998, as cited by McMillan 2004, p. 56) argue, “the precise meaning of congruence remains somewhat ambiguous.”
As a way of being, congruence means being real, but some theorists appear to have linked it directly with the intervention of self-disclosure (Lietear, 1993). Perhaps here we are essentially presented with the difference between the WOB and the way of intervening.
2.2.2. A Way of Understanding (WOU)
Central to PCT is the idea that there is “a growth force within us [which] provides an internal source of healing” (Corey, 2009, p.169). Rogers (1980, p.123) stated we are:
… dealing with an organism which is always seeking, always initiating, always ‘up to something…it is most simply conceptualized as a tendency toward fulfilment, toward actualization, involving not only maintenance but also the enhancement of the organism.
According to McLeod (2013, p. 172) “the person is…viewed as acting to fulfil two primary needs.” McLeod summarises this as the need for self-actualization and the need to be loved and valued.
Another important aspect in the WOU relates to ‘Conditions of Worth.’ If we are to understand the acquisition and maintenance of difficulties, we must strive to understand how clients became who they are. In this regard, the idea of self-concept is vital. Rogers described this as problematic when a discrepancy exists between the real and imagined self.
In PCT the need for love is seen as emerging in the family of origin, and that often, conditions of worth are imposed, i.e. the love children receive is conditional on them being a certain way. In such cases, a child will “adopt these conditions of worth as its own” (Eisenberg & Strayer, 1990, p.89). The links between the WOU and the WOB are crystal clear here, as “in therapy, these conditions of worth can be ‘undone’ by the therapist’s unconditional positive regard” (Eisenberg & Strayer, 1990, p.89).
2.2.3. A Way of Intervening (WOI)
PCT is often considered ‘non-directive’ in terms of interventions, as the client is seen as “an expert for his or own experiences” (Lux et al, 2013, p. 18). McLeod states that PCT ‘is a relationship therapy’ (2013, p. 175). Much has been written about the importance of the relationship, the therapeutic alliance and the characteristics of the relationship. Essentially, the WOI and the WOB in PCT are the same. The relationship is the main tool. The presence of empathy, UPR and congruence are the methods by which change is facilitated. Importantly, the presence of said conditions must also be accompanied by an ability to communicate them to the client. As Wood & Jatoba (1997) state, “Roger’s way of being was both the means and the end.”
3. Choice Theory / Reality Therapy – An Overview
3.1. William Glasser – A Brief Biographical Background
Glasser was born in 1925 in Cleveland, Ohio (Howatt, 2001, p.7). Nelson-Jones (2011, p.173) tells us that he realised at an early age how incompatible his parents were. While his father was described as a gentle person, Glasser himself described his mother as controlling (1990, p. 90). He trained initially as a chemical engineer, but then undertook a Masters in Clinical Psychology, before returning to medical school to become a psychiatrist (Corey, 2009).
He rejected the Freudian model early in his career, and in the Ventura school, where he completed the third year of his internship, he began to apply a different way of working whereby he “taught that each person was responsible for her own behaviour” (Fall, Holden & Marquis, 2011, p.324). Through his work here, he began to develop his own theory, leading to the eventual publication of a multitude of books.
3.2. CT/RT Therapy Through the Ways Paradigm
We all create the person we become by our choices as we go through life. In a real sense, by the time we are adults, we are the sum total of the choices we have made.
-Eleanor Roosevelt.
3.2.1. A Way of Being in CT/RT
According to Corey (2009, p.321) in RT “therapy can be considered a mentoring process.” This implies a certain level of psycho-educational interaction. That said, “creating the counselling environment” was also seen as vital (Corey, 2009, p. 323). Howatt (2001, p. 9) informs us, “What Glasser wanted to do in the first part of his therapy was to develop a humanistic relationship with the client.” Essentially, the therapist will strive to become a QW picture for their client (Glasser, 1998). One way of doing this is through the use of humour (Sharf, 2015, p.453). While CT/RT can be seen as confrontational (Sharf, 2015), Lujan (2015) argued that the Therapeutic Alliance is vital in CT/RT. Lujan contended that the Reality Therapist will establish rapport, accept the client, use empathy and reflect feeling to build trust.
3.2.2. A Way of Understanding in CT/RT
Glasser’s approach to therapy is underpinned by the idea that we are internally motivated (internal locus of control) and that “all behaviour is a result of choices, and our life choices are driven by our genetically encoded basic needs” (Bradley, 2014, p. 7). According to Glasser (1984), any behaviour is a person’s best attempt to meet one or more of their basic needs (Love & Belonging, Freedom, Fun, Power and Survival).
Corey (2011, p.337) tells us that we “we do not satisfy our needs directly”, but rather we create a quality world (QW). Wubbolding (2000) suggests that this QW consists of pictures of everything and anything that is need fulfilling. Corey (2011) proposes that people are the most important thing in the quality world.
If Glasser is correct, and all chosen behaviour is the person’s best attempt to satisfy needs, a vital aspect of the WOU in CT/RT is the concept of Total Behaviour (TB). Wubbolding (2000) informs us that “The behaviour generated to fulfil quality world wants is always composed of four elements: actions, thinking, feeling and physiology.” In this model, the thinking and doing components of behaviour are seen as easiest to change, with the feeling and physiology following. Perkins (2015, p.13) describes this beautifully when he refers to this essential truth: “As I do, so will I be.”
3.2.3. A Way of Intervening in CT/RT
If CT is the theoretical aspect of this model, then RT is its clinical application. According to Howatt (2001, p. 9) RT, “had two defined steps when it was first created.” Essentially, step one was the development of the relationship, after which the procedures could be applied in practice.
As so much of the model hinges on the idea that people are behaving (constructively or destructively) to fulfil needs (and QW pictures), then the Reality Therapist must ascertain what is in the client’s QW. Wubbolding, Brickell, Burdenski & Robey (2012, p.22) suggest that this exploration can be summed up using the idea of “Wants.” Active listening and the use of questions are the methods suggested by the authors. Once the therapist has established what the client wants, they then begin the process of exploring the current behaviour, or the “Doing.” Again, the use of skills such as open-ended questions (with a behaviour focus) is vital. Examples of this would be questions such as “Where are your choices taking you?” (Cengage N/D), or “What are you doing to get what you want?”
Once the client has identified their QW picture and their current behaviour, the reality therapist will help them to “Evaluate” (Howatt, 2001). This evaluation is a self-evaluation, where the client is asked to weigh up the efficacy of their chosen behaviour. Perkins (2014, p. 15) proposes that this links to the “principles of cause and effect…. if one keeps doing the same actions (total behaviour), why should that person expect” different results.
Once the client has evaluated the ineffectiveness of their behaviour, the therapist then helps them “Plan.”
4. Descriptive Analysis Review
4.1. Similarities Between PCT and CT/RT
Relationships between people people are a critical and decisive force. The quality of relationship most often determines the quality of life.
- Gilbert (1992, p.3)
Both PCT and CT/RT place a huge importance on the relationship. In both approaches, the idea of connection, focusing on the here and now and avoiding diagnosis are present. Both PCT and CT/RT believe wholeheartedly in the potential for client change. For instance, in CT/RT, Lujan (2015, p.22) argues, “It is the psychology that bestows the utmost faith in the individual”, and Rogers (as cited by Lux, 2015, p.10) believed that “Individuals have in themselves vast resources for self-understanding and for altering their self-concepts.”
4.2. Differences Between PCT and CT/RT
One key difference is in the WOI. While both place an emphasis on empathy, the CT/RT practitioner will have a specific focus to therapy. The set of procedures means that there is, to some degree, an agenda. In essence, there is a directedness to CT/RT that is not present in PCT. Glasser (1998, p.334) viewed the presenting problem as “always part of our present lives” whereas Rogers allowed for exploration of the past more than Glasser.
4.3. Strengths and Limitations of PCT
PCT has demonstrated longevity. A key strength is its evidence base. Rogers fostered a spirit of enquiry that is still evident today in terms of research into the impact of empathy (Singer, 2001; Feller & Rocco, 2003; Elliot et al 2011).
One potential limitation of PCT is that in trying to be non-directive, the therapist may avoid challenging. Some clients need challenge, and in fact, some may actively seek it. (Mulhauser, N/D). Additionally, as the application of PCT rests on the effective conveyance of Empathy, UPR and Congruence, it must be noted, “not every client will improve in a relationship that includes the core conditions” (Patterson, 1986, p. 89). Furthermore, while the core conditions are wonderful ideals, arguably, it may not be easy to remain empathic with a client who has done something completely at odds with one’s value system? Will the novice therapist struggle to communicate UPR to a client who has engaged in repulsive behaviours?
Additionally, from a theoretical perspectives, questions are posed regarding the validty of the theory relating to issues of suicide. Is the suicidal client really driven to self-actualise? That said, the longevity of the model clearly shows the value of the approach and while no approach is without its weaknessess, it is arguable that the value of PCT far outweighs the limitations.
4.4. Strengths and Limitations of CT/RT
Glasser’s model offers a practical, short-term approach. Perkins (2015, p.13) suggests CT/RT “works because it does not require an endless commitment.” However, one has to wonder if there is a danger in falling into the trap of thinking there is a “quick fix.” Corey (2009, p. 330) purports that RT/CT “can be applied both individually and in groups”, which is a definite strength, particularly in situations where services are under-resourced.
Another strength proposed by Corey (2009, p. 331) is that it provides clients with “tools to make the changes they desire.” This could limit any potential for over dependence on the therapist. Perkins (2015, p.14) suggests that the structure of CT/RT itself is a strength in that it provides a “workable outline” for which to address client issues. That said, when it comes to assessing clients, Perkins (2015, p.12) also argues that in CT/RT, the simplicity of the assessment tools available in the model may be limiting.
While Glasser’s theory makes sense, one question arises regarding the supposition that our needs are genetically encoded. While it is clear we do have needs as human beings, nothing in Glasser’s writing has demonstrated the genetic basis of this.
Arguably, the fact that CT/RT is not past-focused could also be a limitation. If therapy is for the client, should we not give space to discuss anything they wish to talk about, even the past?
One criticism of CT/RT is Glasser’s attitude to Mental Health. Wubbolding (2011) counters this by suggesting that “Theories don’t have opinions, people have opinions.” Nevertheless, Glasser developed CT/RT and he (2003, p. xii) argued that while he did not deny the symptoms people experienced, “grouping them together and calling them mental disorders is wrong.” Glasser’s approach, while controversial, viewed the ‘mentally unwell’ client as having the capability to gain a more effective locus of control through changing their behaviour.
Nevertheless, there is a biological argument for mental health, with newer neurological research finding that some brain differences are present. Lujan (2015, p.20) counter argues, “brain scans do not have the capacity to diagnose mental illness alone. Thus, mental illness is diagnosed on behavioural patterns, and not on the discovery of disease patterns.” Nonetheless, from a purely practical perspective, sometimes a diagnosis is the only thing that affords treatment.
4.5. Applications in a Multicultural Setting
Understanding the cultures of those we serve requires more than words and good intentions. The journey toward cultural comptence requires the willingness to learn from one’s experience and act.
- Jerome Hanley
In An Introduction to Counselling McLeod ponders if PCT is culturally transferrable. Corey (2009, p183) argues that it is, as central to PCT is the therapist’s attempt to view the world as the client views it, regardless of their background. Therefore, arguably, it has relevance in many societies. Notably, Rogers worked in many cultures in a reconcilitary capacity, including Ireland during the troubles and the middle east (Thorne & Sanders, 2012). While this was not in a counselling capacity, he clearly brought many of the PCT ideals to this conflict resolution work, for which he was nominated for the Nobel Peace Prize.
Wubbolding (2000) describes how CT/RT has been applied in a variety of cultures. However, when it comes to CT/RT, Fall et al (2015, p. 341) argue that CT/RT should be modified to incorporate the client’s cultural world view. Because one’s quality world is formed within the content of one’s culture, the counsellor who considers the client without respect to culture would fail to understand the world view of the client.
Furthermore, regarding RT/CT, Corey (2011, p. 351) suggests that we must be cautious not to “overstress the abilitiies of these clients to take charge of their lives” as there can be systemic (cultural) and environmental aspects at play.
Essentially, in practice, regardless of orientation, we must strive to consider the cultural context of the client. Erikson et al (2010, p.7) define Multi-cultural competence as “the extend to which a psychotherapist is actively engaged in the process of self-awareness, obtaining knowledge and implementing skills in working with diverse individuals.” In order to do this, we must move away from an ethnocentric mindset, and allow our client to teach us. Within all of us there is the potential for xenophobia, and self-awarness and knowledge of other cultures is key to ensuring that this does not impact negatively on clinical work.
5. Conclusion
The purpose of this article was to explore two approaches to psychotherapy: Person Centred Therapy and Choice Theory/Reality Therapy. This was achieved by presenting both models through Sharon Cheston’s Ways Paradigm. The strengths and limitations of the approaches, as well as brief multicultural considerations, were then examined. Both models hold value and both have their weaknesses, but ultimately, they complement each other offering the novice therapist the beginnings of an integrationist approach to therapy.
While there is no absolute best way to do therapy, the therapist in training has much to learn from both Glasser and Rogers’ models of therapy.
By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest.
- Confucious, as cited by Lyons, 2010, p.87
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