Clients With Serious Mental Health Issues

The discussion of clients with serious mental health can be problematic for person- centered counselors who generally find that traditional assessment and assignment of mental disorder categories are not useful to treatment. These conceptualizations encourage people other than the client to identify the problems and the direction of treatment. The person-centered approach, in contrast, places therapeutic attention on the client's perceptions of difficulties, goals, and treatment directions. The result is that person- centered counselors who want employment in most mental health agencies or desire insurance payments for their private practice need to deal with this form of labeling at least for communication purposes.

A meta-analysis of studies on experiential therapies, the bulk of which were person- centered, showed positive effects across a wide range of disorders (Greenberg, Elliott, & Lietaer, 1994). For example, adaptations of person-centered counseling have been found to be useful with diagnoses that varied from the more common depressive disorders (Elliott et al., 1990) to those such as borderline personality disorder (Bohart, 1990), schizophrenia (Prouty, 1998), and dementia (Zeman, 1999). Seligman (2004) stated that mild disorders in accordance with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000), such as adjustment disorders or common life experiences involving problems with issues like bereavement, religion or spirituality, identity, or acculturation, are particularly amenable to person-centered counseling.

Although person-centered counseling has been found to have value throughout the most serious diagnostic categories, some treatment issues are likely to make it less effective as the primary technique. Increasing knowledge around the biological aspects of serious disorders such as schizophrenia and obsessive-compulsive disorder has led to drugs often being the treatment of choice (Day, 2004; Seligman, 2004). Such treatment options can only be expected to increase as additional advances are made in the understanding of chemical processes in the body. Disorders that require clients to learn specific skills, such as those in sex therapy, call for much more counselor directness and behavioral techniques. Also the client-directed nature of person-centered therapy requires a significant degree of client motivation so that those lacking such motivation become less viable candidates for person- centered counseling as the sole treatment model.

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