A smile is a facial expression formed by contracting muscles around the mouth and eyes. It often involves upturned lips and sometimes an open mouth. In humans, a smile may signify feelings of happiness, pleasure, or amusement, but it can also be a sign of anxiety, embarrassment, or fear. Smiles may serve to communicate greeting, appeasement, or apology. In animals (including humans and other primates), a snarl (which resembles a smile) may communicate fear, submission, or threatening intentions. For example, a dog baring the teeth might signify a warning. A chimpanzee “smile,” or a grimace with bared teeth, generally signifies fear (Waller, Vick , Bard, & Smith Pasqualini, 2007).
A smile can be produced deliberately, by contracting the facial muscles, or spontaneously, in response to emotional or social stimuli. In 1862, French neurologist Guillaume-Benjamin-Amand Duchenne (also known as Duchenne de Boulogne, 1806–1875) studied the muscles involved in different types of smiles. Specifically, Duchenne differentiated between involuntary smiles (usually expressing enjoyment) and intentional, deliberate smiles. Duchenne observed that natural, involuntary smiles contracted both the zygomaticus major muscle (raising the corners of the mouth) and the orbicularis oculi muscle (raising the cheeks and forming crow’s feet around the eyes). Charles Darwin referred to Duchenne’s work in his 1872 book The Expression of the Emotions in Man and Animals. Later, American psychologist Paul Ekman suggested that the spontaneous smile described by Duchenne (and Darwin) be referred to as a Duchenn smile (Ekman, Davidson, & Friesen 1990). A non-Duchenne (or polite) smile only involves the zygomatic major muscle. Ekman has researched facial expressions extensively using the Facial Action Coding System (FACS; Ekman, Friesen, & Hager, 2002). Ekman notes that Duchenne smiling is more often associated with actual positive feelings such as enjoyment, amusement, happiness, excitement, or interest. Non-Duchenne smiles are more often associated with negative emotions, may function as social markers (e.g., to communicate appeasement), or may be used to mask feelings or to deceive (Papa & Bonanno, 2008). Duchenne smiles tend to correspond with activation of left, anterior (front) brain regions, while non-Duchenne smiles more activate right anterior brain regions. Other research has shown that positive emotions tend to activate left brain regions, while negative feelings more often activate the right side (Ekman et al., 1990). Duchenne smiles have been associated with higher levels of social integration and better health and well-being (Papa & Bonanno, 2008).
Human infants have been observed to smile from birth, with a large increase after 10 days of age and a further increase after about two months of age. Younger infants tend to have unilateral (one-sided) smiles, while bilateral smiling (engaging both sides of the mouth) occurs in older infants (Kawakemi et al., 2006). Typically developing infants usually engage in anticipatory smiling—smiling at an object then continuing to smile while gazing at a nearby person—between 8 and 12 months. Anticipatory smiling is a precursor to developing joint attention (coordinating visual attention between an object and a social partner), which is a crucial milestone in intentional communication (Venezia, Messinger, Thorp, & Mundy, 2004).
There is a widespread belief that lower social status is associated with more smiling (Hall, Horgan, & Carter, 2002). While studies show that girls and women tend to smile more, the degree to which boys and men smile less varies by culture, role, and social expectations (LaFrance, Hecht, & Levy Paluck, 2003).
Gelotology—the study of laughter—has led to several types of therapy that make use of humor, laughter, and smiling. These include humor therapy, clown therapy, laughter therapy, laughter meditation, and laughter yoga. Promising health benefits (physical and psychological) have been demonstrated for some of these therapies (MacDonald, 2004).
The sad individual may have suffered the death of a loved one, lost a relationship, a job, or a home, or received a low score on an exam. Whether a loss will lead to sadness is a matter of individual interpretation and experience.
Scherer’s (1997) cross-functional study of emotions produced results that led to a better understanding of sadness. When research participants were asked to describe circumstances under which they felt sadness, participants mentioned that the situations were unpleasant, they conflicted with personal goals, and the losses that occurred were perceived as irrevocable. Thus sadness is associated with some level of hopelessness.
Sadness is related to other experiences, such as depression and grief, with sadness being the less complicated reaction. Depression includes sadness but also a variety of other symptoms and is longer-lasting than sadness. Grief, like sadness, is a reaction to loss but is longer lasting and includes both sadness and other emotions.
Many emotional reactions, such as fear and sexual desire, are clearly functional, leading to self-protective or self-promoting behaviors such as escape from danger or mating. Sadness is also presumed to have one or more purposes, although researchers have not agreed on what these may be. One theory is that sadness, which is associated with low activity level and social withdrawal, allows for self-reflection in the aftermath of loss of an object or person of central importance to the self (Lazarus, 1991). This reflective period allows the individual to change her plans and goals in a way that integrates the loss. A second theory is that sad behavior (facial expression, posture of sadness, etc.) evokes empathy in others and encourages others to provide help. Therefore an individual becomes sad when he needs assistance, and the signs of sadness may elicit help from others.
Sadness has reliable physiological components. Perhaps counterintuitive, sadness is associated with activation of the sympathetic nervous system, which involves the stress response. For example, with sadness, heart and respiration rates increase and cortisol (a stress hormone) is released (Buss et al., 2003). Additionally, release of beta endorphin (the body’s natural painkiller) is decreased when an individual experiences sadness. Although ordinary people may feel that they know much about this everyday emotion, it is one of the emotions about which we have the least scientific knowledge.
In 1957, Carl Rogers hypothesized six conditions as “necessary and sufficient” to promote what he called constructive personality change in the individual (p. 241).
It is also suggested that as long the therapist is able to interrelate the three salient qualities discussed earlier (congruence, empathy, and unconditional positive regard), then at a minimum the client will experience positive growth (Snodgrass, 2007; Snyder, 2002).
Table X-2 represents the key principles of client-centred theory.
|Table X-2 | Key Principles to Client-Centered Theory|
|Rogers’s Conditions of Client-Centered Theory||Underlying Assumption of Individual||Role of Therapist|
|Therapeutic relationship must exist between client and therapist/counselor||Willing to participate to some extent, capable and competent||Establishes a safe environment for cultivating the relationship; develops the conditions necessary and sufficient for constructive personality change|
|Client is in a state of incongruence||Anxious, vulnerable, distorted sense of real self versus ideal self||Remains integrated in the relationship|
|Therapist/counselor is congruent||Will be able to recognize this through therapist’s use of self and will develop trust||Genuine, sincere, authentic; demonstrates a fully integrated presence of self in relationship to client|
|Therapist experiences unconditional positive regard toward the client||Has the capacity to guide, regulate, direct, and control self providing certain conditions exist||Respect, acceptance, warmth, and a non-judgmental attitude|
|Therapist is empathetic||Has rarely experienced this level of understanding, later begins to experience and verbalize unexpressed feelings/emotions||Feels what the client feels, active listening, verbally and nonverbally communicates back to the client in a validating (not evaluating) manner|
|Communication that the therapist’s use of empathy and unconditional positive regard is understood||Experiences self-actualization and happiness; loved and valued by self and others||Maintains commitment to the advancement of love and peace as basic strivings; facilitates and recognizes the client’s full growth and potential|
In addition to Rogers’ explanation of the client-centered approach in the helping profession, there have been many others who built on this original hypothesis by expanding its application.
One such contributor to this approach is Robert Carkhuff, who elaborated on the three core conditions by adding confrontation, immediacy, and concreteness, also noted as “facilitative conditions deemed essential for effective counseling” (Horan, 1977).
In this realm, these qualities or conditions parallel Rogers’s core conditions in the following way:
- Concreteness in empathetic understanding is about “being specific”
- Immediacy with congruence refers to “what goes on between us right now”
- Confrontation is seen as useful in “all three of Rogers’ conditions” (Brazier, 1996) as “telling it like it is” (Carkhuff, 1971, as cited in Horan, 1977).
Carhuff’s emergences in the client-centered approach are often seen as more active and direct than the original precepts and are recognized as qualities that further aid the helping process of the client.
The effectiveness of client-centered therapy is primarily dependent on the relationship between the client and therapist, whereby the therapist is completely aware of him- or herself in relationship to the client and the client is able to communicate unexpressed feelings and emotions that have caused confusion with his or her notion of self.
Ultimately, clients are able to experience on their own accord that they are loved and valued, which allows them to realize their fullest potential through self-actualization.
The Client-Centered Perspective Applied to Social Work
The conditions of client-centered theory match the fundamental values and skills of social work. The two have a historically organic relationship based on the shared belief and respect for the individual’s worth and dignity, autonomy, self-determination, and ability to improve whatever conditions exist through empowerment of the individual, group, or community.
The core skills used by social workers in purposeful relationships include empathy, respect (unconditional positive regard), and authenticity (congruence), which are also noted as the key elements/attitudes to the client centered approach (da Silva, 2005; Rooney, & Larsen, 2001).
The following case is presented to illustrate the use of the client-centered approach in social work.
|Liz, a single female, age 33, sought counseling because of conflicts between her personal needs and those of her family. Liz grew up in a lower to middle-class neighborhood outside of New York City as the older of two daughters to immigrant parents from Europe. Her father, Edward, died suddenly from a heart attack at age 50 when Liz was 15 years old. Her remaining family includes her mother, Rose, age 65; and one younger sister, Angela, age 30. Both reside in New York. Liz lives and works in San Diego, California, where she is an executive marketing manager for a firm that she has been with for over ten years, since graduating from college. She provides financial support to her mother, who is unable to work due to poor health, and occasionally to her sister, who is unable to keep a job due to her substance use (among other problems) to be continued....|
|Case Example continues|
|Liz describes her relationship with her sister as strained. The last time they spoke it ended in a shouting “shouting match as usual over Angela taking advantage of their mother, and her continued lack of responsibility with self-care.” Liz states that she and her mother have a warm but contentious relationship. She claims that she talks with her mom every day and sends her money monthly for medical and living expenses but is often criticized for being selfish for not doing more to help her sister. Liz says she understands her mother’s concerns about Angela and sometimes feels guilty for being resentful of her mother’s attitude; however, she doesn’t see that it is her problem to take care of her sister any longer. She is also at a point in her life where she wants to meet someone, settle down, and hopefully start a family, but she dismisses the idea as being a “fantasy not reality.” Liz describes herself as an overachiever and the only “responsible one” in her family. She has a few close friends with whom she socializes occasionally, but she is adamantly private about her family dynamics and personal situation. Liz arrives at the social workers office feeling depressed, withdrawn, and hopeless about her current and future situation. The following are excerpts from Liz and social worker exploring her feelings about the people she identified as family members in her life.|
|Liz: [with certainty] I love my mother very much. I take care of her financially . . . and I don’t mind. I actually feel I like it’s my responsibility since she’s all alone . . . well, not really alone I suppose. My sister I guess lives with her, but that’s a whole other story . . . she’s such a loser. [At this point the client has become restless and is looking away and pulling nervously on her sweater.]|
|Social Worker: I can see you really care about your mom and her well-being. I’m also sensing that maybe you wish your sister were more responsible and involved?|
|Liz: Yeah . . . that’s if she could stop using the drugs and alcohol. I get so angry when she is so neglectful of herself. It hurts my mother so much, but she just doesn’t care.|
|Social Worker: Her lack of care upsets you the most?|
|Liz: Yes, care for herself and care for others. I almost don’t know if I even care anymore about what she does to herself; it’s just my mom that I care about. Well that’s not totally true . . . I feel guilty saying that. [pauses and starts to become tearful]|
|Social Worker: [leans forward and offers the client tissues and gently responds] This seems like a really sensitive place for you to be right now.|
Here the social worker’s use of empathetic skills encourages the client to explore more deeply her feelings of discord around family relations.
Several sessions later, Liz explores her own needs, including the desire for an intimate relationship.
|Case Example continues|
|Liz: [hesitantly] I’ve met this great guy (John) at work and we seem to have a lot in common. I really think I’m beginning to like him and I think he likes me, too.|
|Social Worker: Tell me more.|
|Liz: [enthusiastically describes some of her initial conversations with John and her attraction for him, but as she continues to offer more around her feelings she becomes sullen] Well, the truth is it probably won’t work anyway. I just keep telling myself that a relationship with him is only a fantasy it will never be a reality for me.|
|Social Worker: Hmm. Let me see if I got this right. If you could, you would ideally have a relationship with John. It sounds like you have a special connection with him, and you think he feels it too, yet you believe that this isn’t a real possibility?|
|Liz: [tearfully] Right. I would like that, but I’m so involved with my family’s problems. Why would anyone want to sign up for that? It makes me so sad I’ll probably just end up alone.|
|Social Worker: [softly] That makes me sad, too. I wonder if you realize how others see you . . . how I see you. You have such a generous heart and really care deeply about relationships with people you love. These are wonderful qualities for a successful relationship. I wonder how it would feel for you to be that generous with yourself in meeting your own needs.|
Again, we see the therapist is using empathetic skills, communicating her feelings of Liz’s experience while remaining congruent. The social worker is able to acknowledge Liz’s qualities of caring deeply for loved ones and helps her see how this does not have to mean she abandons herself or her own desires. This demonstration helps Liz with accepting that she is lovable, valuable, and capable of having a real relationship and not just the fantasy of one.
Liz returns for her final session after several weeks of continued therapy where she has explored further her desire and need for a real and intimate relationship along with her feelings of responsibility to care for her mother.
|Case Example continues|
|Liz: [happily] John and I have been dating now for almost 8 months and it’s going really well. I think he could be the one! [smiling] I feel so loved. He’s a great guy. Also, I finally convinced my mom to move to California where she will be living with me until we find her a place of her own nearby. I’m so happy about this decision, especially since my sister just move away and I was worried about [Mom] being alone. This move is really going to allow me to care for my mom in a more involved, sort of hands-on way.|
|Social Worker: It is such a pleasure to witness how you have grown through your process. It really gives me a great sense of hope. I can see how you have come to appreciate and accept yourself not only as a loving daughter who only wants the best for her mom, but also as a woman who is capable of having a successful relationship and meeting your own needs.|
In reviewing this case, we can see that the stance of the therapist was to establish a trusting relationship with the client using the three key characteristics of a client-centered approach. Throughout this relationship the social worker
- shows unconditional positive regard for the client by being warm, and nonjudgmental of the client’s presenting conflict;
- demonstrates empathy by being able to communicate an understanding through accurate reflection of the client’s feelings; and
- remains congruent even with expressing her own experience of Liz as lovable.
Through verbalizing unexpressed emotions, Liz succeeded in reconciling her feelings of despair over the role of caregiver versus her need to be loved and was able to fully realize her potential for happiness and achieve a greater and more fully integrated sense of self.
The Larger Perspective
Social workers can use client-centered practice in a multitude of settings, including family and couples counseling, group therapy, and the larger context of community work. In each of these settings, the therapist uses the three key skills to address each individual or member and his or her unique needs and concerns, ultimately facilitating an ideal scene from the present scene.
If there were a code of conduct for client-centered therapy it might read something like this.
Client-centered therapy does not diagnose, judge, assess, solve, or otherwise profess to know what is “wrong” with the individual.
Client-centered therapy focuses on the uniqueness of the individual by respecting, nurturing, loving, and fostering the fragmented aspects of the client’s notion of self while the therapist demonstrates and maintains an integrated sense of wholeness.
Client-centered therapy can be viewed as a significant precursor to other effective therapies that are intentionally directive, problem-solving, or behavior-changing in their focus. At a minimum, the client-centered approach is seen as significant in assisting the client to feel understood, loved, and fully integrated through establishing a safe, trusting, and reliable rapport with the therapist.
- Barrett-Lennard, G. T. (1998). Carl Rogers’ helping system: Journey and substance. Thousand Oaks, CA: Sage.
- Bohart, A. C., & Byrock, G. (2005). Experiencing Carl Rogers from the client’s point of view: A vicarious enthnographic investigation. I. extraction and perception of meaning. Humanistic Psychologist, 33 (3), 187-212.
- Bozarth, J.D., & Brodley, B. T. (1991). Actualisation: A functional concept in client-centered therapy. Handbook of Self-Actualisation, 6 (5), 45 – 60.
- Carkhuff, R. R. (1971). The development of human resources. New York: Holt, Rinehart & Winston.
- Cepeda, L. M., & Davenport, D. S. (2006). Person-centered therapy and solution-focused brief therapy: an integration of present and future awareness. Psychotherapy: Theory, Research and Practice, 43 (1), 1 – 12.
- da Silva, R. B. (2005). Person-centered therapy with impoverished, maltreated, and neglected children and adolescents in Brazil. Journal of Mental Health Counseling.