Also
by Pauline Connolly
The 'as if' quality of empathy
The Here
and Now in Gestalt therapy
A belief/trust in the
actualizing tendency and the sufficiency of the core conditions: Implications
for person-centred therapy
Pauline Connolly
Rogers
(1957) proposed six psychological conditions,[1] necessary and sufficient for
therapeutic personality change (see Appendix). He hypothesized that when
present in a relationship, these conditions or therapeutic attitudes are
sufficient (i.e. no other conditions are necessary) to foster growth; and
further, “the more fully and consistently
the therapeutic attitudes are provided by the therapist and perceived by the
client, the greater the constructive movement that will occur in the client” (Bozarth,
2001, p.5). Described as congruence, empathic understanding of the client’s
frame of reference, and unconditional positive regard (the latter two
necessarily being perceived by the client to some degree), the conditions, or
therapists’ ‘way of being’, is essentially the
social environment that facilitates the actualizing tendency of the client
(Joseph, 2003).
The cornerstone of person-centred therapy
is the actualizing tendency. It is conceived as the sole motivating force in individuals resulting in
self-regulation and development; and the ‘mainspring of life’ and tendency upon
which therapy depends (Schmid, 2001). This growth directed process, which can
‘work’/become active in facilitative relationships, includes movement toward
autonomy, maturity, socialization, realization of individual potentialities,
etc (Schmid, 2000). As Rogers (1963, p.6, cited by Joseph, 2003, p.304) states:
“…I would affirm…my belief that there is
one central source of energy in the human organism…that is best conceptualized
as a tendency toward fulfillment…actualization…maintenance and enhancement of
the organism”.
While many consider the core conditions to
be necessary (but probably not sufficient!), they are viewed “only as
preparatory design of relations meant to establish a certain climate or
rapport, as…human preconditions…upon which actual therapeutic work still has to
be constructed” (Schmid, 2000, p.9)[2].
From a person-centred stance, however, the realization of the basic attitudes
(- principled nondirectiveness[3])
does not need to be supplemented/complemented by techniques; but rather
“…represents the help which needs no supplementation by specific methods and
techniques reserved for the expert. ‘Expertism’…lies in the ability to resist
the temptation of behaving like an expert (even against the client’s wishes) –
that means, solving problems with the help of techniques rather than facing
them as persons” (ibid p.8).
As an expression of trust in the client’s
organismic self-determination and authority, principled nondirectiveness is an
attitude[4] that offers a ‘space’ for
growth (as defined by the client), and an experience of “…being humbled before the mystery of others and wishing only to
acknowledge and respect them…an almost aesthetic appreciation for the
uniqueness and otherness of the client” (Grant, 1989, p.5). It is not a
stance that is forced/artificial, but a consequence of ‘living the attitudes’.
That is, a belief in the sufficiency of the conditions and the client as “the ultimate authority in choosing his own
path” (Natiello, 2001, p.4) presuppose therapist nondirectivity. As
According to Bozarth (1998), conceptions of
the appropriately intervening (even ‘instrumentally nondirective’) therapist,
dismiss the actualizing tendency and self-authority of the client as
unreliable; i.e. they fail to fully accept the client’s subjective reality and
self-expertise; and ultimately subscribe to “Rogers’
revolutionary stance that identifies the client as his best expert about his
life” (ibid, p.4).
Serving only a ‘catalytic function’, and
allowing the locus of decision-making and responsibility to remain with the
client (
For the person-centred therapist, his sole
directive is to enter the client’s world ‘as
if’[5] it were his own (simultaneously
aware of the client-therapist boundary); and relinquishing his position of
power (Natiello, 2001), relate to the client as an independent equal and self-authority. In so doing he attempts
to grasp, as best as possible, the accurate meaning of the client’s immediate
experiencing and communicate this to
him. Adopting the client’s phenomenological experience (perceived reality) as a
basis for dialogue, the therapist engages in a process of attempting to make
sense, not only of what is said, or expressed non-verbally, but also of what
the client wants/is trying to share; including subtle meanings that lie at the
edge of his awareness (Barrett-Lennard, 1993). Reflecting the deeper truth, or
‘full flavour’ (Rogers & Farson, 1987) of the client’s dimly perceived
and/or articulated meanings, help him to symbolize/articulate his experiencing
and empower him to proceed with his
process (of exploring, hearing his meaning and then reappraising/re-evaluating
it himself; Joseph, 2004)[6].
Rogerian empathy implies a respect for the
client’s voice (frame of reference) and excludes interpretation, judgement,
identification; any notion of the therapist as expert on the client/his
problems; as well as, any preconceived use of methods/techniques – “…not rooted in the immediate experience of
the relationship” (Schmid, 2000, p.8).
As an attitude towards and experience of
the client, it is an interpersonal process “integrally
intertwined with congruence and unconditional positive regard” (Bozarth,
1998, p, 51). Empathic responses, particularly as the therapeutic process
unfolds, may involve ‘advanced empathy’ (Egan, 1994); ‘depth reflection’
(Thorne, 1991), or what Kohut (1959, cited by Natiello, 2001) calls ‘a higher
form of empathy’ - “the process of
weaving together the fragments and threads of the client’s experiences over a
period of time” (p.10); as well as, immediacy, therapist self-disclosure,
questions, challenging, goal setting, etc. Therapist parrot-like responses
often associated with the approach, as Natiello (2001, p.10) illustrates, “have very little to do with the delicate
process of hearing the barely articulated threads of experience…of the client’s
life.”
In order to be instrumental however, such
responses must be perceived by the client[7] (as genuine). As Patterson
(1984, p.189) notes, “…these conditions
must not only be provided by the therapist; they must also be perceived by the
person to whom they are offered”. It is the ‘received’ therapist attitudes,
(by the client) that encourage self-empathy and acceptance; support and
facilitate self-exploration, awareness and dialogue (Barrett-Lennard, 1993).
Clients’ experience of a
free/non-judgemental (‘I-Thou’) relationship redresses low self-esteem and
incongruence, and fosters psychological adjustment. Therapists’ commitment “to going with the client’s direction, at
the client’s pace and in the client’s unique way” facilitate self-ownership and empower him to rely more on his
internal locus of evaluation; act upon his organismic valuing system (taking
self-initiated decisions/ actions; Joseph, 2004) and thus respond according to
the needs of his ‘real’ self. In other words, grow towards “…living with increasing openness to experience and trust in organismic
wisdom” (Natiello, 2001, p.22).
“With a
professional humility and willingness to learn from the client” (Rogers, 1946, p?), the
therapist, through empathic validation of feelings/needs, offers a safe,
growth-promoting environment which provides the client with an enhanced value
of his phenomenological experience and consequently an increased sense of
self-worth.
Without subtly intervening/guiding, with
intentions ‘to get the client somewhere’ (Bozarth, 1998), therapists,
respectful of clients’ internal directive and integrity “…can not be up to other things, have other intentions without
violating the essence of person-centred therapy. To be up to other things –
whatever that might be – is a ‘yes, but’ reaction to the essence of the
approach” (ibid, p11-12).
Experiencing this ‘personal encounter’
(Schmid, 2000) clients are assumed to have the ability and desire to use their
resources constructively; and through self-awareness/ understanding, live
healthier/happier relationships.[8] In practice therefore, the
client is his own best expert[9]; the therapist, a sensitive
companion and equal (Schmid, 2000). Remaining in the responsive mode, the
therapist’s demonstration of an accepting understanding of the client’s
experiential world and self-reliance, fosters a sense of confidence,
self-agency and hope. In the absence of a belief in the actualizing tendency,
however, the rationale for the client as expert (and all it implies) is
untenable (Joseph, 2003).
An essential trust in the actualizing
tendency and its centrality for therapy is a pre-requisite for true
person-centred practice. ‘Doing’ person-centred communication (e.g.
reflection/mirroring) without relying on than the client’s inherent drive to
become mature, socially adjusted, autonomous, etc (Rogers, 1946) – but relying
on one’s own strength as a therapist – is not ‘being’ person-centred.
Similarly, as Joseph (2003, p.305) writes, “…it
would be a nonsense for therapists to claim to practice client-centred
psychotherapy just because they endeavour to accept their clients
unconditionally if they do not hold in the first place that there is an
actualizing tendency”.
Therapy (of the kind described herein)
releases deep strengths in the client (
For Brodley (1987) these ‘change
processes’, e.g. insight, healthier ways of relating, in and outside therapy,
are a direct result of clients experiencing the conditions. “The mechanism is the process of adoption,
by the client, of the attitudinal conditions in him/herself and toward
him/herself…frees and enhances the capabilities and energies of the
client…brings out the client’s wisdom about himself and arouses potentialities
to be realized more fully in his/her life” (ibid, p.2).
Absorbing the attitudes initiates and
supports a ‘releasing therapeutic experience’ (
Without having a priori goal for clients
(other than, perhaps helping them realize their
own goals), the person-centred therapist’s a priori and immediate/constant goal
for self, is to genuinely[12] live the core conditions in the
relationship (Brodley, 1987). Besides an ethical response-ability (Schmid,
2000), this is, as Rogers and Sanford (1984, p.138, cited by Bozarth, 1998,
p.32) claim, “…a radical stance…which
advocates complete trust in individual growth and development under certain circumstances”.
And, one which further implies a rejection of the assumption that there are
specific treatments for specific problems, and thus the need to routinely take
case histories, assess or diagnose clients (including the need for treatment
plans/strategies; Joseph, 2003).
“The therapist
must lay aside preoccupation with diagnosis and his diagnostic shrewdness, must
discard his tendency to make professional evaluations, must cease his
endeavours to formulate an accurate prognosis, must give up the temptation
subtly to guide the individual, and must concentrate on one purpose only; that
of providing deep understanding and acceptance of the attitudes consciously
held at this moment by the client…” (Rogers, 1946, p.219).
According to theory, clients experiencing
emotional problems (or ‘psychological maladjustment’, due to internalizing
conditions of worth) are greatly helped when their own ‘inborn capacities for
self-healing’ (Grant, 1989, p.8) are supported. Such ‘help’ comes in the form
of a therapist willing of offer clients his full attention, compassion (love or
agape) and “…to go with them in their own
separate feelings as a separate person” (Rogers & Segel, 1955 [Film],
ibid). In offering a “warm and permissive
atmosphere in which the individual is free to bring out any attitudes and
feelings which he may have, no matter how unconventional, absurd, or
contradictory…” (Rogers, 1946, p.416)[13], therapists maximize the
freedom of client exploration; permitting deeper expression (acceptance and
assimilation) of feelings /attitudes previously denied. As perceptions of self and reality change, behavior alters.[14] This perceptual reorganization
and concomitant redirection of behaviour, toward “greater psychological growth and maturity”, consequently lead to
an “inner peace which constitutes
adjustment … congruence”(ibid, p.419).
In client-centred therapy “…there is no standard or inevitable way in
which the therapeutic conditions are lived out or expressed…” (Brodley,
1986, p.4)[15]. Thus, providing therapists
maintain an ‘uncontaminated dedication’[16]to the client’s perspective and
a belief that ‘he knows best’, behaviour will differ according to the
idiosyncrasies of the individual therapist, client and unique relationship
(Bozarth, 1998). (Differences in therapist behaviour, however, are in
communication of, not commitment to,
the attitudes; ibid). Even a
technique conventionally conceived as having ‘basically no value’[17] in person-centred practice
(Rogers 1957, p.234) may (in context) become a ‘channel’ for communicating the
conditions. Nevertheless, “…just as these
techniques may communicate the elements that are essential for therapy…”,
Essentially then, techniques may be used when/if they are compatible with the
basic attitudes, i.e. employment, experience and communication of empathy and/or
acceptance are simultaneous. The point is that the interpersonal conditions “exist as an attitudinal embodiment” (Bozarth,
1998, p.107) in the therapist’s internal experience and need not be conveyed in
a particular way.[18]
“We are not behaving according to a method
or formula, nor are we responding with any systematic intention except to
empathically understand whatever the client intends to express…” (Schmid, 2000,
p.5). Necessarily emergent from the client’s internal referent and respect for
his self-determination, the latitude of valid client-centred therapist
responses is great (ibid). Indeed, since personal development and (unplanned)
implementation of the attitudes, and each client-therapist relationship is
unique, there is “as much variation as there are persons” (Wilkins, 2000, p.
26) in the ways therapists interact.
Thus, authentic attunement to the client as
a whole person makes for an active therapeutic involvement, or presence, that can be expressed in
multi-faceted, idiosyncratic ways; involving
‘unsystematic’ application of techniques and/or other activities [19] (see Raskin’s 1988
conceptualization of systematic v unsystematic implementation, in Bozarth,
1998; Grant, 1989).
While Bozarth (1998) maintains that any
ethical response decided upon by the client, and arising from his frame of
reference and/or dialogue, constitutes a ‘viable and congruent’ activity; his
response, similar to
Generally, techniques are solution focused
and/or therapist-driven (expert-orientated); and unless they arise from ‘the
dance between client and therapist’ (Bohart, 1994, cited by Bozarth, 1998), and
a therapist in whom the attitudes are deeply ingrained, they distract
(‘contaminate’) the therapeutic process (ibid).[20]
“We are admitted
freely into the backstage of the person’s living where we can observe from
within some of the dramas of internal change, which are far more compelling and
moving than a drama which is presented on the stage viewed by the public. Only
a novelist or a poet could do justice to the deep struggles which we are
permitted to observe from within the client’s own world of reality” (Rogers,
1947, p.2).
These words of
Engaging in the process of empathic
understanding of clients, continues to teach me, that given an accepting,
respectful and honest space to explore and share the issues/aspects of one’s
life, including self, that have, and/or continue to cause suffering,
individuals (including those experiencing much grief/loss, intense anger,
depression, anxiety, etc) are capable of achieving a more accurate perception
of self and reality; experience enhanced self-esteem, confidence, acceptance;
and in their individual healing/growth processes, lead more fulfilling,
enriched lives.
In my experience, I feel that the core
conditions and a belief in the client’s innate tendency/motivation, is both
necessary and sufficient to bring about a change of (heart) perception and
behaviour; that is indicative of Rogers ‘fully functioning person’. I do
nevertheless, also believe that similar personal development can come about
through a variety of ‘vehicles of change’ (Joseph, 2003), (e.g. from
religious/spiritual to traumatic experiences); and thus, concordant with
Bozarth (1998), the conditions may not necessarily be necessary. However, when present and/or experienced, I
believe they are sufficient to facilitate growth.
Fortunately, the organization I work for
adopt a person-centred, harm-reduction philosophy,[21]enabling me to freely – to the
extent I am able – implement the principles in my own personal way. This does
not however, mean that endeavouring to be congruent and unconditionally
accepting is without its tensions and/or, even ‘always’ possible. Genuinely
holding clients in unconditional positive regard is ‘sometimes very difficult’
(
My (privileged) work with clients has
afforded me a profound, invaluable learning experience. While I remain
committed to becoming a counsellor, and enthusiastic and passionate about
Rogers’ principles - his ‘way of being with’ clients, there are aspects of
theory that I struggle to accept; and occasions/individuals which cause me to
question the actualizing tendency, and the potency/efficacy of the conditions
in releasing it. That is not to imply, however, that I consider communication
of the conditions to be limiting, unvaried or ineffective.[23]
As a trainee counsellor, any limits/shortcomings lie with me (my limited
ability to offer the attitudes; lack of experience/competence, etc) and not the
person-centred approach per se.
As Rogers’ observations proved his
hypothesis, I too, hope my clinical experience will continue to confirm without doubt that not only does the
client centred approach really ‘work’ -
as my experience thus far leads me to believe, but further, that its
therapeutic benefits for clients, far exceed that of other (more directive)
orientations. While I wish to remain as open-minded as possible, about ways of
implementing the hypothesis, and/or other ways of working. I will, in my
therapeutic relationships, endeavour to continue to consistently offer the
conditions to clients (until my experience leads me to believe ‘something else’
is needed). And, thus hopefully be able to wholeheartedly,
without reserve, share
Bristol:
2007
©
Pauline Connolly
[1]
[2] Schmid (2000), Patterson (2000), etc, argue that that reference to
the conditions as preparation for therapist ‘interventions’ demonstrates a
failure and/or unwillingness to understand/accept
[3] ‘Principled’ (not instrumental) nondirectiveness, is essential to client-centred therapy (Brodley, 1987).
[4] An attitude (not necessarily determined by response alone) informed by the client’s autonomy and absence of therapist intentions to assist clients in pre-determined directions (Bozarth, 2000).
[5] The ‘as if’ quality represents a respect for the client’s uniqueness, and an ethical/professional responsibility.
[6] As a primary means of implementing the conditions, Brodley (1987) espouses the ‘Empathic understanding response process’ (EURP): an inherently nondirective process, enabling therapists to express and check their experiential understanding of the client.
[7] Very disturbed individuals may have lost almost complete contact with experiencing their internal directive/organismic self. Where ‘psychological contact’ (the pre-condition) is difficult/improbable, grounding/pre-therapy techniques may be employed (Thorne, 1991).
[8] Implicit here is a more accepting relationship with self. Self-acceptance is crucial, since “we cannot change…move away from what we are, until we thoroughly ‘accept’ what we are” (Roger, 1944, p.2).
[9] As Rogers (1979, cited by Bozarth, (1998, p.93) advocates: “…it is the client who knows best what
hurts, what direction to go, what problems are crucial…I would do better to
rely upon the client for direction of movement in the process…”.
[10] I.e. introjected values/messages from significant others, about how one is to be in order to be accepted/valued.
[11] The major psychological dimensions indicative of
[12] Therapists must genuinely adopt this stance if the (‘I-Thou’) relationship is to exist; “To be effective, it must be genuine” (Rogers, 1946, p.219).
[13] This includes the freedom to ‘withhold’ expression of feelings.
[14] This reformulation of self structure involves the translation of
more realistic insights into behavior; i.e. living in accord with the newly
organized self-concept (
[15] The conditions say nothing about how client-therapist communication
should develop; verbal communication is not preferred to other ways of
interacting, e.g. drama, play, art therapy (
[16] ‘Contamination’ (Bozarth, 1998, p.100) results from a wavering/inconsistent adherence to the principles.
[17] E.g. dream analysis, free association, hypnosis, etc – techniques
ordinarily viewed as antithetical to the approach (
[18] A communicated empathic understanding of the client’s frame of reference is, however, the usual and for Bozarth, Brodley, etc, the purest form of communicating unconditional positive regard.
[19] Such ‘flexibility’ rebuts claims that (passive) practitioners are limited/constrained by Rogerian principles; and that there is generally little variation in their behaviour. Nevertheless, it is recommended that trainee and developing therapists, generally do exercise self-restraint/containment (see Brodley, 1991).
[20] The rationale for emergent techniques includes prevalent contexts as: client requests, setting/organizational context; and ‘clearing’/preparing oneself to better offer the conditions (become fully present), so that the potency of trusting the client’s self-direction/reliance can be realized (Bozarth, 1998, p.102).
[21] Treatment plans/goals and reappraisals thereof are not essential unless specified by the client, and/or the individual counsellor. (I personally have, as yet, not needed to use them). Further, clients, depending on staff availability, can decide the frequency, number and termination of sessions.
[22] Regular clinical supervision (peer and individual) help with ‘the working through of’ any challenges, uncertainties, questions, etc.
[23] Without employing (cognitive/behavioural) techniques – due to a lack of competence and perceived need – interaction with each client in each session is unique and fairly flexible.