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The Person-Centered Journal, Volume 8, Issue l, 2001 Printed in the U S.A. All riehts reserved
NON DIRECTIVE CLIENT.CENTERED TH ERAPY
WITH CHILDREN
Kathryn A. Moon, M.A.
Chicago Counseling and Psychotherapy Center
ABSTRACT This paper describes how the nondirective altitude, client-centered theory and
the three attitudinal conditions inform and become evidenl in this lherapist's psychotherapy
work with children. It is qsserted^ that the Rogerian atlitudinal conditions are sfficient
regardless of whether or nol the client articulates and understands his or her feelings. Two of
Virginia Axline's principles for child lherapy are described as being somewhat in contrast
with nondirective client-centered theory.
Introduction
Client-centered child therapy theoretically fits, I believe, within the rubric of Carl Rogers'
theory as described in his l959^ statement^ about therapy and^ personality.^ I think of my work
with child clients as being consistent with the nondirective client-centered psychotherapy to
which I aspire. As a therapist, my constant endeavor is to be fully attitudinally available in
relationship with the client.^ After^ describing^ the^ work I^ do and^ how^ it^ relates^ with^ the^ theory,^ I
would like to point out some ways in which my work contrasts with Virginia Axline's (1964;
1969) seminal description of play therapy.
Here are three vignettes from my experience when working in elementary schools. In
the school setting, the time available for each client was minimal. There was little opportunity
for supplementing the child's counseling time with parent or family sessions.
Vignette 1: Michael
A five year^ old client, Michael, was referred to me because in his kindergarten room
he was noncompliant and throwing furniture. I was told by the teacher that Michael's step-
father was maybe violent, his mother was pregnant, and that Michael was erratically switched
back and forth to sleep in either his mother's or his father's home. Michael did not want to
come with me to counseling. But when invited to bring along any child of his choosing, he
came with his cousin who was in the same class. That day in counseling, we played a few
games. The next time he chose to come alone without his cousin. I had art supplies, games,
plastic animals and family figures available for play. Michael picked up a jaws-wide-open
+J
44 Kathryn A. Moon
dimetrodon dinosaur, about five inches long. He took a large-size wooden popsicle stick and
crammed it snugly down the throat of the dimetrodon. Then, holdingthe stick, he swung, or
swept the dinosaur across the table and sent the animal figures scattering across the room. He
picked up as many ofthem as he could find, put them back on the table and swung again, and
again, and again. I did not comment upon what I guessed was his underlying feeling, anger.
Instead, I responded to his more manifest feeling, his (^) apparent pleasure (^) for what he was
doing. He nodded and took several more swings before we ran out of time. After that second
session, Michael always brought a friend, rotating about three different friends. He did not
again bring his cousin. He never again struck out at the toys. In subsequent sessions he and his
friends, who clamored to attend counseling with him, played board and card games, turning
frequently to me for assistance in regulating the rules. I would do my best to clarify my
understanding of their agreements and disagreements over the rules. Beginning on the day of
Michael's first session with me and his cousin, there were no further reports of misconduct by
Michael.
Vignette 2: Lucy
Lucy, age five, in her first^ session, sat in a chair and told me about the significance
of her grandfather's death in her life. Her grandfather had died when she was a baby. She
explained the financial^ and^ emotional toll^ his death^ took^ upon^ the fabric^ of her^ life within^ her
family, and she described the intense sadness that she carried around within herself.
Vignette 3: Boys' Group in an Elementary School
A group of four eleven to twelve year^ old boys, all very low academic achievers met
with me in a public^ elementary school.^ One^ boy^ was^ very^ shy.^ Another^ was^ frequently^ absent
from school and seldom did any homework. He was over-burdened as a care-giver to his
father who had lost both of his legs. I had the impression that the father watched pornography
videos in the boy's presence. This group of boys spentthe weekly thirty minute counseling
session modeling with clay, drawing and playing^ cards. We spent lots of time traveling up and
down three flights of stairs making cherished trips to the boys' bathroom. The boys would
compare athletic shoes and argue^ about^ sports, neighborhood^ violence^ and^ the^ details^ of
school life. At length, for many sessions, they used the clay to shape huge penises, breasts and
testicles. Chatting, they would^ lapse^ into^ speaking Spanish^ and when^ I^ broke^ into^ their
conversation with beginner's Spanish, they taught me how to say dirty words in their home-
life language. All but the one boy who was over-burdened as care-giver to^ his father^ showed
improvement in school performance within the first grading period after beginning group
counseling.
Nondirective Child Therapy and the Attitudinal Conditions
My choice to work nondirectively is based upon my sense of what is ethical. I don't
want to waste a client's time or a client's life with my beliefs, my values or my^ agenda. I
don't want to cultivate a false self for my client, and I don't want to lead my client in a
direction that is potentially harmful to the wondrous and unique existence of that^ person.
Rogerian theory provides me a way to work in accordance with my wish to honor the client's
self-direction. Trust in the client's innate propensity for constructive personal and social
46 Kathryn A. Moon
Child Therapy^ Literature^ and the^ Core Conditions
I think that some of the client-centered literature is perhaps misleading about what a
therapist should anticipate as outcome when working with children and about what a therapist
should expect to occur in^ session.^ The literature^ has perhaps burdened us with unrealistic
expectations concerning what the therapist is supposed to do with or to the child.
Virginia Axline's two wonderful books, Dibs in Search of Self and Plry Therapv, are
the play^ therapy "bibles." Axline^ (1964)^ outlines eight basic principles^ or guidelines^ for the
therapist. I disagree with two of her basic tenets, the one concerning reflection of feelings for
gaining insight and the one concerning the seffing of limits. According to Axline:
The therapist must develop a wann, friendly relationship...accepts
the child exactly as he is...establishes a feeling of permissiveness
in the relationship so that the child feels free to express his feelings
completely...is alert to recognize the (^) feelings the child is
expressing and reflects those back to him in such a manner that he
gains insight...maintains a deep respect for the child's ability to
solve his own problems...does not attempt to direct the child's
actions or conversation...does not attempt to hury the
therapy...[and] establishes only those limitations that are necessary
to anchor the therapy^ to^ the^ world of reality^ and^ to^ make^ the^ child
aware of his responsibility in the relationship (1969, p.73-74)
As I describe in^ a^ little^ more detail^ how^ I^ think^ the Rogerian conditions manifest^ themselves
in my work with younger clients, I will also attempt to address some of my differences with
Axline.
My intention as^ a^ therapist^ with^ children^ is^ to^ be^ warmly^ available^ as^ a^ person,
highly attentive to verbal and nonverbal communications from the child and as nonrestrictive
as I can manage^ given my^ personal and^ space^ limitations.^ In^ the^ interest^ of^ communicating
unconditional positive regard, I am friendly, respectful and open. I try to remain uninvested in
obtaining positive therapeutic results.
I want to communicate the unconditionality of my regard and^ this^ is^ sometimes
difficult for^ me;^ it^ connects^ with^ the^ question^ of^ how^ do^ I^ remain congruent^ as^ a therapist
while granting freedom of word and motion to a youngster^ who may be rambunctious^ and
may be disinclined to^ converse.^ How^ do^ I^ maintain^ my^ positive regard in^ the face^ of^ an^ active
child's mess and grime? As Elaine Dorfman wrote in Rogers' 195 I book, Client-Centered Therapy:
...let us consider that the therapist's^ acceptance^ of^ the^ child is^ an
instrument by means of which the child may^ come to^ self-
acceptance. What therapist can feel accepting of a child who is in
the process of flattening his cranium with a mallet? (p.258)
Axline suggested that limits "...are^ necessary to anchor the therapy^ to^ the^ world^ of^ reality^ and
to make the child aware of^ his^ responsibility^ in the relationship" (1969, p. 74).^ I^ prefer^ to^ say
that limits are set in the service of the therapist. The purpose is to help the therapist maintain
N ondirec t iv e C I ien t-C e nte red Ther a pv
equanimity and positive regard towards the client. Limits are set in the service of the child
only because they are necessary to the therapist in order for the therapist to remain acceptant,
empathic and congruent. I consider any other purpose for limits to be didactic and contrary to
the condition of unconditional positive^ regard.
At the end of their chapter on client-centered therapy in the Handbook of psychologt
with children and adolescenfs, Charlotte Ellinwood and Nathaniel Raskin (1993) give^ some
examples of limit-setting. The therapist says: "Wendy, I don't want you to draw at my desk.
This table is for you.^ Wendy, I think you might break the switch doing that and I want you to
stop" (p.279).
In both examples, the therapist expresses a wish for a change in client behavior based upon
the therapist's feeling about the behavior. This seems to me to be a direct, honest and
relationship-enhancing manner to address a therapist's potentially relationship-damaging
feelings. In nondirective therapy, a therapist's intention when setting limits is neither to
clarifl for the child what the real limits of the relationship are nor to heighten the child's
awareness of her responsibilities in the relationship. The therapist's intention is to preserve
her capacity to embody the attitudinal conditions.
My second difference with Axline^ relates^ to^ the therapist's intentions when
seeking to understand a client's experience. In the interest of being empathically present, I
want to be attentive to^ verbal and nonverbal communications^ from^ the^ child.^ I^ listen.^ watch.
seek clarification and respond. When I express my understanding of what the child is
intending, saying or doing, I hope that my communication of attention and interest is also
communicating my unconditional positive regard. I do not consider it my role to urge a child
to express the feeling or meaning that underlies a behavior or a self-expression. To press the
child to do anything, is to not fully accept him or her in the present. On the other hand, I may
seek clarification from^ a^ child^ and^ then,^ if^ the^ child^ is^ willing^ to^ clarify^ something^ for^ me,^ my
fuller understanding of who the child is and what the child intends or wants leads, I hope, to
the child's sense of a larger part of himself being understood and accepted by me.
Axline wrote: "The therapist is alert to recognize the feelings the child is expressing
and reflects those feelings back to^ him^ in^ such a manner^ that he^ gains^ insight^ into his
behavior" (1969, p. 73).
This guideline is controversial to me because it applies pressure upon a therapist to
do something for a parlicular^ purpose,^ to reflect^ a^ child's^ feelings^ in^ order^ to^ help the child
gain insight; it imposes the agenda of helping the child gain insight. The Rogerian hypothesis
that if^ the therapist embodies certain attitudes the^ client^ will^ experience constructive^ change
does not require that a client label his feelings or gain insight into his behavior. A therapeutic,
client-centered reason for^ acknowledging^ and^ expressing understanding^ of a^ client's
emotional expression might be to communicate to the client the information that the therapist
is present and following along with the client's experience and that the therapist's acceptance
ofthe client^ includes the therapist's^ acceptance^ ofthe^ client's^ current^ feeling^ and^ expression
of emotion. Barbara Temaner Brodley (1996)^ has written:
To the extent the therapist does^ not^ shift away^ from^ acceptant^ and
empathic attitudes (and in that way distract the client with external
Nondirective Cl ient-Centered Theraov
label their feelings, to better understand themselves, to learn limits in order to deal with social
realities, or to ensure that they emerge happy and capable. To press for any such
accomplishment for our client is to not fully accept the client. Instead, our role is to provide
the child with a unique relationship in which he experiences unconditional positive^ regard
from a therapist who is interested in getting to know him and be with him as much as possible
on the child's terms and followine^ the child's direction and aeenda.
Concerned adults often iuu,^ un opinion as to^ what'the^ child^ and therapist should do
and accomplish together in order to change the child to better fit into the social demands of
the culture. Regardless of the expectations of the child's care givers, my work is not results
driven. It is driven by ethical concerns and the^ theory that^ takes those concerns into account. I
hope my work is helpful to the individual. I believe it is not harmful to the client. But so
often, working with a child, it can feel like I don't "do"^ anything. There is a not-of-this-world
quality (^) to working nondirectively with children. There are moments when I think, "Thank
goodness no other adult is watching." Sometimes I wonder, "What am I doing? Is this work
nothing?"
Fortunately, the theory seems to work. We can tell parents that this work can effect
long-term, positive^ change in the child. We can say so because it happens. Grades do
improve, and children do become more self-controlled. But as a therapist, I do not strive for
these types of results. Frequently, a child is still having difficulty in the real world, but I know
from the child that he or she finds the time with me to be immensely satisf,ing. To me, this
means that my work is constructive, even ifnot necessarily successful by outside standards. In
my experience, child therapy outcomes most often include^ a belief on my part that the client
has felt enhanced as a person through relationship with me and frequently include reports
from parents or teachers that unwanted behaviors have abated or ceased.
Vignette 4: Mark
A seven year-old child was referred to therapy because parents, siblings, teachers,
and schoolmates reported impulsive, hyperactive, dangerous and asocial behaviors,
disobedience, insubordination, noncooperation and poor school performance. During therapy
sessions, Mark would think of complex arts and crafts projects^ he wanted to single-handedly
accomplish during our time together. Unvaryingly, the project would be too elaborate to be
feasible given therapy room resources, time limitations, and the capacities of his seven-year-
old hands. After a shorter or longer number of minutes, the project would be revised or
dropped, and Mark would come up with a new idea to pursue,^ usually unsuccessfully. I would
be available as an assistant to his projects, ever-seeking to understand or clarifo his intentions,
likes and dislikes as we proceeded.^ I would keep him abreast of time remaining so that he
could shift gears before the end of a session and get on with the next art or play activity he
wanted to do. Mark's more dangerous, antisocial misbehaviors disappeared almost
immediately, without Mark and I ever mentioning that they existed. In the^ course of two^ years
in therapy, others of his impulsive behaviors only gradually settled down to some extent.
Meanwhile, even though some peer and family interactions continued to be fractious and
mutually unsatis$ing, Mark was now seen as a good student; that is, his grades rose
dramatically. Individual child sessions were supplemented by occasional nondirective client-
centered parent and family^ sessions.^ Mark^ came^ to^ be appreciated^ as^ a^ very^ sensitive,^ highly
creative individual endowed with an inquiring mind.
49
50 Kathryn A. Moon
Vignette 5: Davey
Davey, age six, had suffered grievous physical and emotional trauma as well as
significant physical and cognitive developmental delay. Luckily, he was placed with a
particularly kind foster mother. Davey spent nearly every therapy session bathing baby dolls
and washing dishes in the closet sink of the therapy office. Unfortunately, the carpeted office
needed to be maintained as a presentable space designed for an adult as well as a child
clientele. All too frequently I felt compelled to communicate to Davey my wish that he not
flood the carpet. In our early sessions, he would sometimes ignore my requests that he turn
down the water, or unplug the sink before it overflowed. In our first session, in response to
one of my first expressions of worry about the volume of water, in a robot-like manner, not
looking at me, Davey swore to^ the^ wall: "You^ shut the fuck up." At these sorts of moments I
would reach around or over him and turn down the faucet or unplug the sink. Simultaneously,
I would usually acknowledge his wishes that the water keep running hard and that I not tell
him what to do. Also, I would express my regret that I couldn't let him keep the sink very full
and the water running hard.
Over time, Davey and I developed a great deal of affection for each (^) other and a
somewhat fluid manner of mutual compromise. At one time his statements were always stiff,
angry and directed to the toys or the wall; a few years later, he would turn toward me with a
smile and make a friendly announcement about an upcoming school field trip or family
vacation. Once considered oppositional^ and^ hyperactive, Davey became much better behaved
at school and at home. I attribute the lion's share of his improved behavior to the love and
acceptance he received in his foster home. However, it is clear to me that his use of our
relationship has been a constructive additional force in his experience (^) of his life.
Jerold Bozarth (1998)^ has reported that, "The most clear research evidence is that
effective psychotherapy results^ from the^ resources^ of the client (extra therapeutic variables)
and from the person-to-person relationship of the therapist and client" (p.172-173). My work
with children is guided by a^ nondirective attitude^ of respect and tmst toward the client and not
by a wish to obtain measurable results. Nonetheless, it is comforting to realize that
nondirective client-centered child therapy,^ through its emphasis upon a relationship imbued
with the therapeutic attitudes and trust in the child's resources is consistent with "the most
clear research evidence" for "effective psychotherapy results". Client-centered child therapy
is effective because as Bozarth (2000, p. 2) says, "The client resources for change and healing
emerge from this relationship," and as Barbara Brodley (1999)^ has written: "When clients
perceive and experience these [therapeutic] attitudes, distortions diminish in the psychological
expression of the actualizing tendency and the person's untapped capabilities are revealed"
(1999, p. I l5).
Conclusion
I believe that it is /!ot necessary for a therapist to urge a child client, or any client, to
better understand himself^ or to^ help^ a^ child^ learn^ to^ abide^ by the^ demands of reality.
According to Rogerian theory, it is necessary for the therapist to be warmly available to and
acceptant of the client whom the therapist^ is^ seeking to^ understand.^ In my experience, the
necessary attitudinal conditions as described in Rogers' theory statements have proven to be
sufficient. In order for the^ therapist^ to provide^ unconditional positive regard and to be
qualitatively available and understanding of the child's experience, the therapist needs to be
52 KathrynA. Moon
REFERENCES
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Bozarth, J. D. (2000,^ March). Non-directiveness in client-centered therapy: A vexed
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MD.
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Brodley, B.T. (1999). The actualizing tendency concept in client-centered theory.
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Shlien, J. M. (1961).^ A client-centered approach to schizophrenia: First
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Shlien, J. M. (1997).^ Empathy in psychotherapy:^ A vital mechanism? Yes.
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Yeager, D.(2000). Play Therapy with the ADHD Child. ITth Annual Associationfor
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