The Rogerian way: The person-centered approach that resonates

Being person-centered evokes images of clinicians who consider the patient perspective to be paramount, perhaps someone who simply treats others with kindness and compassion, and for many, person-centeredness is a way of being.

Before medical school, as a graduate student I discovered the person-centered approach pioneered by Carl Rogers, PhD, a 20th-century American psychologist and a founder of humanistic psychology. I was studying creative arts therapy and was able to employ these person-centered skills in my play therapy and music therapy internships and later in my professional music therapy work on a palliative care team.

I immediately saw the transformative effects of this approach to working with patients. Ultimately, my interest in the Rogerian way of relating to patients led me to osteopathic medical school, with the promise that osteopathic physicians aim to be uniquely person-centered.

In this article, I’ll explain what the Rogerian way is and how it intersects with osteopathic medicine. I’ll also share my thoughts on integrating Rogerian education into the medical school curriculum and some resources for anyone who wants to learn more about this approach to interacting with others.

What is Rogerian therapy?

“In my early professional years, I was asking the question: How can I treat or cure or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?”—Dr. Rogers (1961)

According to Dr. Rogers, person-centered counseling rests on three core principles: congruence or genuineness with your clients, unconditional positive regard or being completely nonjudgemental, and accurate empathy or the ability to really understand the emotional state of others.

In practice, this style of counseling involves many reflective statements and few questions. Generally, the therapist is there to guide the client towards their own goals. As such, therapeutic rapport is very important in this pursuit.  

Dr. Rogers did not see this as a set of techniques. Still, in the pursuit of embodying the core principles he believed were required for personal growth, we are left with good models of therapeutic conversation towards this goal. Examples include reflective statements, emotional validation and utilization of silence in therapy, all skills that have become core competencies across therapeutic orientations, effectively shaping modern therapists with Rogerian fundamentals.  

Setting up the right climate for therapeutic change is not confined to talk therapy. All DOs, regardless of specialty, may feel inspired to cultivate a person-centered way of being in the vision of Dr. Rogers. Learning to listen with empathy, generate transparency to present the truest form of oneself, and deeply care without judgement are all lifelong pursuits that will lead to better relationships and positive changes.

Disclaimer: Rogerian therapy is individualized for each patient. In times when a patient is in mental health crisis, more acute measures should be considered. If you or someone you know is experiencing a mental health crisis, there are resources available now:

• You can seek immediate help in an emergency room or dial the Suicide and Crisis Lifeline at 988
• The national crisis text line can be reached by texting HOME to 741741

Similarities to osteopathic medicine

“The more I can keep a relationship free of judgment and evaluation, the more this will permit the other person to reach the point where he recognizes that the locus of evaluation, the center of responsibility, lies within himself.”—Carl Rogers (1961)

According to Dr. Rogers, most people have intrinsic potential for mental well-being. This concept fits nicely into the greater paradigm of osteopathic medicine. That is, our bodies are designed to heal on their own, given optimal structure. In the same way, true person-centered care assumes one’s ability to find fulfillment and achieve good mental health, given the right conditions.

Dr. Rogers further shifted the traditional paradigm of therapy (and healthcare) from an expert-meets-patient perspective to a more collaborative framework of therapist and client, working together to help the client find their optimal self. The client is therefore empowered to make decisions and discover their own opportunities for wellness.

“The most impressive fact about the individual human being seems to be the directional tendency toward wholeness, toward actualization of potentialities.”—Dr. Rogers (1980)

Just like Dr. Rogers, osteopathic physicians recognize the wholeness of individuals as body, mind and spirit. In true application of this philosophy, it remains integral to address all these things towards optimal health. For Dr. Rogers, this concept is discussed as self-actualization.

While DOs are particularly skilled in the treatment of body (osteopathic manipulative treatment [OMT] and medical training in general), we have an opportunity to maximize mental and spiritual wellness via well-established person-centered therapeutic conversation. It seems the Rogerian way is uniquely aligned with the osteopathic penchant for whole-person care.

“The only person who is educated is the one who has learned how to learn and change.”—Dr. Rogers (1969)

As a medical student, my clinical experience remains limited as I learn how to be a successful physician and incorporate Rogerian principles into this new work. However, one of the reasons I resonate with osteopathic care and am proud to be a future DO is the call for DOs to be different in their practice: to focus on humanistic care and see the patient as a whole human person, to emphasize prevention and to recognize that real healthcare is more than just physical medicine.

My experience with Rogerian approaches as a medical student

I am in my fourth year of osteopathic medical school. Of course I try to perform the appropriate exams to my ability, but my days are mostly filled with talking to patients and their families. I ask the questions I need to ask, doing my best to garner medical histories and deduce relevant differentials.

Still, I firmly believe that the skills I developed in my education and practice of Rogerian therapy have catalyzed positive change for some of these patients. The patient with apparent delusions who had previously declined mental healthcare finally seeking psychiatric care; the patient with reservations about early colonoscopy screening making the appointment after talking about our shared experience of a parent with colorectal cancer; and the patient with a history of not taking her blood pressure medication returning proud to share her adherence and improvement are just a few examples.

These are a few of the moments where I felt strong relationships were formed and the patients felt heard in a new way.

Perhaps as I get more skilled and knowledgeable in medicine, during my residency and beyond, my perspective will change. After all, I have spent more years providing therapy in the Rogerian style than I have as a student doctor. Still, research regarding the importance of empathy in healthcare continues to reference the work of Dr. Rogers—the idea that empathy is not necessarily a technique we employ, but a process of gaining accurate insight towards self-actualization. Again, learning to listen with empathy is an ongoing pursuit.

Incorporating Rogerian approaches in the osteopathic medical curriculum

I’ve spent a lot of time thinking about how much Rogerian training could help every medical student as they seek to establish a person-centered style of practicing medicine. Options for integration of this training into medical school vary in complexity. Below are just a few ideas:

• Required one-time, person-centered (in-person) practical training for faculty, so they may model this style for students and integrate it into clinical education opportunities.
• Psychologist faculty or consultant to provide guidance to medical students during designed clinical learning and standardized patient practica. Outline key person-centered traits in practice, implementing them into assessments and reviewing video encounters with students.
• Person-centered workshops (in-person) for medical students in their first or second year, with touchpoints to assess use and development of learned skills. Again, integrating learning into standardized patient visits and other simulations.

Where to learn more

For those who want to explore Dr. Rogers’ work on their own, I highly recommend two of his books: “On Becoming a Person: A Therapist’s View of Psychotherapy” and “A Way of Being.” Also, this book chapter in “The Encyclopedia of Clinical Psychology” is a particularly good look at the overall life of Dr. Rogers.

Dr. Rogers also participated in an educational video series, often known as the “Gloria Films,” where he demonstrated his approach with a real client. The video is available on many video streaming sites and with the Library of Congress.  

Related reading:

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