Individuals having free will and the ability to actively develop ourselves to our highest potential and reach self-actualization sums up the humanistic approach. The work of Carl Rogers focused less on diagnosing a client’s mental health and more on how a person could help themselves with the ultimate goal of becoming what Rogers called a “fully functioning person” (Feist, Feist, & Roberts), which was similar to Maslow’s theory of “self-actualization”.
His approach focuses on every aspect of the person, not just behavior, which is a holistic approach to psychology. The central theme of humanistic psychology is the belief that inner feelings and self-image are connected to behavior and that people are inherently good, with a self-motivation to improve. Rogers believed ‘self’ is the most important aspect of personality and self-concept is the mental representation of whom we feel we truly are as a person.
Rogers argued that our self-concept could be distorted by an evaluation of our worth by others (Feist, Feist, & Roberts, 2013). He also believed that parents and teachers play a crucial role in child development, especially regarding self-concept; therefore children should be treated with unconditional positive regard.
On the other hand, the social-cognitive perspective focuses on the importance of observational learning, cognitive processes, and situational influences. Albert Bandura’s theory emphasized the role of conscious thoughts including self-efficacy as central to personality. In other words, our own beliefs in our abilities increase our chances of actually accomplishing our goal.
In this theory, personality changes are linked to traits and behavior which can be influenced by circumstances or the environment. Individuals are unique in their reactions to situations, which is typically based on previous schemas and is relative to a personal belief system and self-efficacy. Also, there is a reciprocal interaction between the situation and the person, like those in a situation influence the environment and the environment influence the person. Bandura combined the concepts of thinking, observing and behaving to develop his social cognitive theory (Feist, Feist, & Roberts, 2013)
The case in question involves a 16-year-old female, Erica, who has recently been arrested for driving a car while intoxicated and has been referred to the clinic for evaluation and treatment. Erica admits to drinking from the age of 14 years old on weekends and at parties. Additionally, she admits to using marijuana but denies the use of other drugs. She stated that alcohol use helps her ‘unwind and have a good time,’ especially when she is overwhelmed or experiencing stress.
There is little information provided about family relationships other than the parent’s professions and that they are busy attending events and parties. Erica stated, ‘As long as I bring home good grades and stay out of trouble, they leave me alone. It should also be noted that Erica’s primary caregiver appears to be a nanny. She also states her parents are ‘on my case because of the arrest,’ but implies it is out of concern for their public image.
The events leading to the arrest involved Erica consuming six or seven alcoholic beverages and driving home. Her blood alcohol content was .09 which resulted in her arrest and spending the night in jail, which her father thought would teach her a lesson.
Several things stand out to me in the scenario provided. The first is the fact that Erica is in adolescent development. The changes that occur in the brain’s emotional/social network that puberty triggers typically outpace the development of the prefrontal cognitive-control network (Berk, 2018). This leads to more risk-taking, especially if it involves an immediate reward.
Adolescents do not have enough life experience in most situations, which means they lack ‘real world’ knowledge when it comes to considering the predictable outcomes of a situation. If they engage in risky behavior and suffer no negative consequences, for them, they believe the risk is low, and the benefit is high. The sense of invulnerability stems from the risk/reward cycle and makes adolescents more likely to retake similar risks or equate one risk for another.
The second thing is the parent/ child relationship, which has limited information. However, it appears based on the father’s reaction to allow Erica to spend the night in jail; there is more of an authoritarian style of parenting. Early and frequent adolescent alcohol and drug use are linked to personal, family, peer, and educational characteristics (Berk, 2018).
Erica’s self-regulation does not seem to be present based on her under-age use of alcohol and marijuana or her decision to drive while intoxicated. I believe this reflects on her relationship with her parents. “Adolescents with poor self-regulatory abilities may be difficult for parents, which may be associated with poor relationship quality; on the other hand, adolescents with high-quality relationships with parents may be better able to develop good self-regulatory capacities” (Farley, & Kim-Spoon, 2014, p. 436).
The third interrelated aspect of this case is the lack of stress-management and other coping skills. The scenario does not directly say what the stressors are but hints at the high parental expectations regarding grades and behavior. The external pressure from her parents to meet specific goals or behaviors could distort the self-image Erica has of herself leading to lower self-esteem.
Lastly, the case mentions the primary caregiver was a nanny throughout early childhood. Again, this implies there is a potential for a disrupted parent/child relationship in the formative years in which attachment and trust are established based on Erikson’s stages of development. This is also relative to Erica’s current stage of development in which the issue of identity and role confusion comes into play (Feist, Feist, & Roberts, 2013). Conflicts in earlier stages of development may have an impact on her current stage.
There are several characteristics of the humanistic approach to therapy, which could prove useful in assisting Erica with her alcohol and marijuana use. Emphasizing the choice of seeking help to deal with her drinking as a sign of courage can have an immediate positive impact on her self-esteem, which is the first step in helping her assume responsibility and foster self-regulation in social situations where alcohol and drugs are present.
A therapist exhibiting empathy, respect, and authenticity throughout the therapeutic relationship will foster a sense of trust in the therapist/client relationship, which can lead to Erica opening up to other areas of her life which may need support. There is no indication Erica has stopped using alcohol or marijuana between the arrest and first therapy session, two weeks later. She may not be able to make reasonable judgments about her well-being or future.
Rogers’ techniques would be particularly useful for the therapist who is trying to address Erica’s substance-abuse as it may motivate her for further treatment. The critical areas of creating a safe and productive therapy process are as follows (Rogers, 2007):
- Demonstration of authenticity – The therapist should establish a comfortable environment for the client early in the process by setting the tone of a genuine and authentic encounter
- Empathic understanding – The client’s frame of reference and subjective experience must be taken into consideration throughout the therapeutic process.
- Respect – The client’s cultural values and freedom to exercise choice must be considered, and the therapist should avoid placing judgment for culture values or preferences.
- Authentic and collaborative approach – The therapist should foster a genuine, caring, and cooperative relationship with their clients to help them develop insight, courage, and responsibility.
- Exploration of goals and expectations – The therapist should encourage the client to articulate the desired outcomes of treatment.
- Clarification of the helping role – The therapist is responsible for defining their role in the therapeutic process while respecting the client’s self-determination.
- Assessment and enhancement – The therapist should consistently monitor the therapeutic process to authentically and collaboratively assess the client’s motivation and progress and offer additional support where needed.
- Negotiation of a contract – To maintain the collaborative effort, the therapist should ask the client what is beneficial to them in therapy and where they want to go next in the process.
In a session between Erica and a client-centered therapist, I see the therapist engage Erica by reflectively listening, accepting Erica and her past, and clarifying her current situation and feelings. As Erica develops trust in the therapist, the therapist would begin to help her consider her positive characteristics as well as her innate potential to make meaningful choices to become the person she wants to and is capable of becoming. Another goal of therapy would be to help her develop sufficient insight so that she can make choices that reflect the desired values and principles to which she aspires.
If Erica began to feel guilt or shame about her past drinking or arrest, the therapist would demonstrate could direct the conversation by showing appreciation of her struggle to accept that aspect of herself and highlighting the fact that she is seeking help for her issues. The therapist may point out to Erica that she is still an adolescent and may not have had all the tools necessary at that time to make better choices while underscoring her current commitment to choose a better life.
The therapist using a client-centered approach would ensure Erica is supported and accepted, not criticized. She would be encouraged to express her anxiety or stressor and the effect this fear has on her. Therapy might be the first time in her life that someone has been unconditionally accepting of her or focused on her strengths rather than her failings. By being understood and accepted, her self-esteem and sense of hope would increase, and her shame would decrease.
PCT works well with clients who have anxiety and can be useful for clients ‘who have difficulty processing and expressing emotion’ (Murdock, 2013, p. 176), which based on the limited information about Erica, seems to fit with her indicators of feeling overwhelmed or stressed out. However, I believe more intervention will need to take place to resolve some deeper issues within the family and would recommend family counseling to address parenting styles based on the information provided.
A lack of parental involvement and lack of structure and rules for appropriate behavior appears to show a lack of emotional warmth, which is linked to a higher risk for alcohol and drug use in adolescence. ‘Therefore, one obvious place to look for the cause of adaptive self-regulation mechanisms is the perceived parenting style of one’s own parents’ (Patock-Peckham, Cheong, Balhorn, & Nagoshi, 2001, p. 1286).
The correlation between parenting styles and development of morality, self-regulation, and self-esteem, all of which seem to be part of the underlying issues impacting Erica’s behavior has been confirmed. Researchers (Patock-Peckham, Cheong, Balhorn, & Nagoshi, 2001) found:
Those individuals with less perceived control over their drinking or who have lower levels of self-regulatory mechanisms are thought to be using alcohol as a form of self-medication to compensate for various types of psychological maladjustment (Hutchinson et al., 1998; Room and Leigh, 1992) (p.1290)
I feel it would be essential to involve Erica’s parents in the therapeutic process, to help Erica, overcome some of the obstacles she faces. Therefore, I do not believe a person-centered approach would adequately meet the needs of this client because it does not consider the environmental factors outside of Erica’s control which still impact her development.
One aspect of adolescent development, as mentioned earlier is the risk/reward dynamic, which in Erica’s case has been unchallenged except for the said arrest. I believe this issue arises from a lack of proper self-regulation and is also related to Erica’s use of alcohol and marijuana to self-medicate during stressful situations.
A major function of thought is to enable people to predict the occurrence of events and to create the means for exercising control over those that affect their daily lives” (Bandura, 1989, p. 1176). As mentioned previously, adolescents developmentally are not very good at-risk assessment or predicting outcomes.
Self-efficacy is the cornerstone of Bandura’s theory. In this case, Erica’s confidence in her ability to regulate her motivation thought processes, and environment to attain her goals may be compromised. However, based on the scenario, she does not have any stated goals or desired outcomes. It appears she has been mandated to attend therapy, and a therapeutic relationship must be established.
Additional information about Erica’s life must be obtained to form a productive therapeutic relationship. Based on Erica’s use of alcohol and marijuana when stressed, it would be beneficial to understand the specific stressors that provoke the selection of her behavior to indulge in their consumption. It is also imperative to determine behaviors she is willing to attempt to change undesirable behavior as well as the amount of effort she will expend to master new positive responses, and the thought processes she experiences when anticipating or engaging in the action.
Knowledge is often measured along with self-efficacy because Erica may not fully understand the impact the consumption of alcohol and marijuana have on her developmentally or legally. For some change in her behavior she would need to have an initial threshold of understanding.
Self-efficacy is influenced by social persuasion, meaning Erica’s social network of peers who engage in underage consumption of alcohol and marijuana influence whether or not she will continue to participate in the same behavior (Feist, Feist, & Roberts, 2013). Due to her developmental stage and natural desire for autonomy (Berk, 2018), it may be more difficult to persuade her to examine the outcomes of behavior as harmful.
It is also vital to consider Erica’s emotional and physical state and examine their relationship to her alcohol and marijuana consumption. Her relationship with her parents and peers can have a negative impact on her desire and commitment to change her behaviors.
As mentioned in (Feist, Feist, & Roberts, 2013) “Therapeutic change, therefore, is difficult because it involves eliminating behaviors that are satisfying to the person” (p. 505). Based on the scenario provided, it does not appear Erica is internally motivated to change her behavior.
After reading more about Bandura and Rogers, I find I don’t think either will adequately address the issues Erica faces. If forced to choose one of the approaches, I find I am leaning towards the person-centered approach. I see more usefulness in forming a therapeutic environment as described by Rogers would foster more positive changes in Erica and uncover some of the underlying issues, that may be related to the formation of her relationship with her parents, which impact her decision-making process.
I believe one of the disadvantages of using either of these approaches is Erica’s age. She does not have full autonomy or personal self-efficacy at this stage in her life. This means there are some limits in what she can or cannot do because she is legally still a minor and to some degree the success of her therapy treatment falls into the hands of her parents. Their willingness to adapt their parenting style and provide a caring and warm environment for Erica while using an authoritative parenting style would have the most significant and positive impact on their relationships (Berk, 2018).
However, I think the approach to therapy developed by Rogers could be utilized as a starting point with Erica. I find it to be more adaptive to her needs as things within the therapeutic relationship grow, and that she would find the empathy and understanding and unconditional support she needs that is lacking in her parental relationship at this time.
