Carl Rogers Core Conditions for Therapy

¶ … Person-Centered Therapy Today

A sign on the restaurant wall where I lunched today reads, "What you call psychotic behavior ... we call company policy." A joke, obviously, but it set me thinking about differences in the world today compared to the 1950s when Carl Rogers was developing person-centered therapy. Take a small thing like "multi-tasking," for example. In the 1950s a person who drove down an expressway at 70+ miles per hour while listening to a recorded book and talking on the telephone at the same time might well be judged in need of psychological evaluation. Today we think it's "normal." Even therapists are expected to "multi-task" (Erskine, 2003). The point is, we live in a different, more complex world from the one Carl Rogers inhabited. Can a therapeutic system he designed to meet the needs of his time (before the Age of Information) be adequate to meet the needs of ours?

The prevailing view in the 1950s was that the therapist's technical knowledge and expertise was the essential determining factor for the effectiveness of therapy. The therapist was the one who objectively and dispassionately determined the timing of interventions, what was important to pay attention to, and how to interpret the "patient's" feelings and attitudes. Carl Rogers shifted the focus to the relationship between client and therapist as critical to therapeutic success. The relationship depended on a set of core conditions that were essential and if maintained would lead to a beneficial result. But are his core conditions really sufficient for therapy today? This essay will try to answer these questions by exploring (1) what Roger's system involves, (2) what some more recent researchers have to say about effective therapy, and (3) what societal influences might call for either a renewed commitment or modifications.

Roger's (1951) pointed out that client-centered therapy is "a product of its time and cultural setting." He hastens to add, however, that it would be a mistake to see it solely as "a product of cultural influences." Client centered therapy rests upon the therapeutic relationship which "transcends to some extent the limitations and influences of a given culture" (pp. 4-5). This implies that the therapeutic relationship is as important now as at any time in the past and very few therapists would deny that, even in the psychoanalytic and cognitive camps. The outcome of therapy still depends upon the actual relationship based on empathy, genuineness, and unconditional, non-possessive, positive regard -- not, as Rogers pointed out, on technical methods, on reductionist training, or the development of microskills that have little to do with a client's psychological growth.

In a speech to the American Psychological Association in 1957, Rogers explained his therapeutic approach as clinically and statistically predictable with a pattern of development that takes place within the context of the counseling process. The initial phase of catharsis, for example, is replaced by a phase in which insight is the most significant element, and in turn, this phase gives way to a phase marked by an increase in positive choice and action. The same chain of events operates in diverse situations, that is, in individual therapy, group therapy, play therapy, drama therapy, etc.

The therapist's role is to establish an atmosphere in which the client can grow, mature, and make a better adjustment. Such an atmosphere relies on certain core conditions, which release natural growth forces within every individual. Fundamental to the process is the therapist's trust that within each individual lies the potential for self-actualization. Rogers sees this as the basic driving force of human beings -- the will to develop and improve one's self and situation, to grow into what we realize consciously we really are. The force is like a mandate for discovering our potential. The maladjusted person does not recognize this fundamental force within him/herself. he/she feels manipulated by circumstances and other people and unable to fully experience, create, or live "the good life." Thus, the goal of therapy is for the client to discover this innate inner capacity and with it the power to live a rich and fulfilling life (Personality & Consciousness web site). Person-centered therapy frees the individual to find inner wisdom and confidence and to make healthier, more constructive choices (Carl Ransom Rogers web site).

Briefly, Rogers (1957) lists the following conditions as necessary to successful therapy:

The therapist operates on the principle that the individual is basically responsible for him or herself. The therapist must be willing for that responsibility to remain with the client and must not usurp it. The therapist also must operate on the principle that the client has a strong natural drive to become mature, socially adjusted, independent, and productive. For therapeutic change to happen, the counselor must rely on this inner force and not on his own powers. he/she must not try to "make it happen" or hurry it up. Instead, the counselor creates a warm and permissive atmosphere in which the individual is free to bring out any attitudes and feelings, which he/she may have, no matter how unconventional, absurd, or contradictory these attitudes may be. The client must be as free to withhold expression as to give expression to his/her feelings. Limits may be set on behavior but not on attitudes. For example, a child may not be permitted to break a window, but the child is free to feel like breaking a window. The feeling is fully accepted. An adult may not take more than an hour for the interview, by his/her desire to take more time is acceptable. The therapist uses only those procedures and techniques in the interview which convey his deep understanding of the emotionalized attitudes the client expresses and his acceptance of them. A sensitive reflection and clarification of the client's attitudes may convey this understanding, but the acceptance should be neither positive nor negative, approving nor disapproving. The therapist refrains from questioning, probing, blaming, interpreting, advising, suggesting, persuading, or reassuring (Rogers, 1957).

Rogers states that if these conditions are fully met, the client will benefit in the majority of cases. he/she will learn to express deep and motivating attitudes. He or she will be able to explore attitudes and reactions more fully than before and will become aware of aspects of his/her attitudes that were previously denied. The client will arrive at a clearer conscious realization of his/her motivating attitudes and will accept him/herself more completely. The realization, as well as the acceptance, will include attitudes previously denied. The client may or may not verbalize this clearer understanding of self and behavior but will choose on his/her own initiative new, more satisfying goals in light of this clearer self-perception and understanding. he/she will choose to behave in a different manner in order to reach these new goals. The new behavior will be in the direction of greater psychological growth and will be more spontaneous, less tense, and more harmonious with the social needs of others, more realistic and more comfortable. "It will be a step forward in the life of the individual" (Rogers, 1957, p. 417).

Rogers describes the function of the therapist as "catalytic," rather than instrumental, and the predictability of client-centered therapy he explains is based on the discovery that within the client reside constructive forces whose strength and uniformity have been either entirely unrecognized or grossly underestimated. It is the clear cut and disciplined reliance by the therapist upon those forces within the client, which seems to account for the orderliness of the therapeutic process, and its consistency from one client to the next" (p. 418).

If a suitable psychological atmosphere is provided, the individual is "capable of discovering and perceiving, truly and spontaneously, the interrelationships between his attitudes, and the relationship of himself to reality. The individual has the capacity and the strength to devise, quite unguided, the steps which will lead him to a more mature and more comfortable relationship to his reality" (p. 418). In Roger's view, these forces within the client can be trusted. In fact, the more deeply the therapist relies upon them, the more profound will be their release.

Thus, in Roger's approach, the therapist must let the client lead and direct the way. The counselor's responsibility is to create a warm and accepting relationship with understanding and safety so that the client can drop "his natural defensiveness and use the situation" (p. 420). Rogers points out that this kind of counseling demands complete consistency, discipline, sensitivity, appreciative awareness. It has only one purpose -- to provide deep understanding and acceptance of the "attitudes consciously held at the moment by the client as he explores step-by-step into the dangerous areas which he has been denying to consciousness" (p. 420). There is no faking this kind of relationship. It must genuine to be effective.

Wickman and Campbell (2003) studied a transcript of Rogers in a therapeutic interaction with Gloria (a famous, recorded session that has been widely studied) in an attempt to find how he put theory into practice. They tried to identify what Rogers did conversationally to support his core conditions for client-centered counseling. One thing they found was that he used non-expert language. You could say Rogers spoke in a caring, supportive way as a friend and equal, not as an authority. As he put it himself in On Becoming a Person (1961): "I have found that the more that I can be genuine in the relationship, the more helpful it will be. This means that I need to be aware of my own feelings, in so far as possible, rather than presenting an outward facade of one attitude, while actually holding another attitude at a deeper or unconscious level" (p. 33). He avoided giving advice, and several times during the interview with Gloria commented on the difficulty of her problem. In the beginning she presented the problem that she recently had been divorced and had started having sex with a male friend. She was worried what the effect might be on her daughter. She didn't know if she should be honest about this with her daughter or not. If she lied, she feared it might eventually affect their relationship negatively.

Rogers did not "lead" her to the real problem, but she found her way there herself as she talked and was able at the end to experience greater self-acceptance: "Something happened in those few short minutes which has stayed with me ever since. He simply helped me to recognize my own potential -- my value as a human being. All the words couldn't possibly express the importance of that for me" (Dolliver, Williams, & Gold, 1980, p. 141 cited in Wickman and Campbell, 2003).

The researchers found that in practice the core conditions were not isolated or separate from each other but that they overlapped so that no conversational turn addressed only one core condition: " ... all of his interactions had a focus on being simultaneously empathic and genuine while displaying unconditional positive regard. In other words, Rogers did not suddenly think 'Oh, this is a good time to be empathic' but instead had automatized the conditions into his natural communication style" (p. 183). Rogers (1961) pointed out himself that the therapist's true attitude about the worth and dignity of the client cannot be just a verbal expression but comes out operationally and behaviorally as well. Empathy is not necessarily a skill that can be learned but seemed more like his way of being.

Carlozzi et al. (2002) conducted a survey among psychologists and counselors regarding their theories of empathy, their definitions, and their use of empathy in practice. Those who were humanistic/experiential practitioners had similar views of how empathy is defined and viewed, and they reported using empathy more than those practicing in other theoretical arenas did. The humanists defined empathy as the therapist sensing the client's feelings as if they were his own. Because Rogers described empathy as the most important of the core conditions, it could be considered a central ingredient in the relationship between client and therapist, and in fact, the defining factor in what makes a therapeutic relationship successful and beneficial to the client. The researchers found that humanistic/experiential practitioners took the view that empathy is an innate ability, rather than a communication skill, and gave empathy a central role in their work with clients. Of course, they were answering a survey, and they could be overestimating or underestimating how much they actually use empathy in their practice. It would be interesting to survey the clients as well to see if their perceptions of their therapist's empathy matched or did not match with the therapist's report. A study like this contributes to a broader understanding of the connection between theory and practice.

Lambert et al. (2001) examined psychotherapy outcome-research literature and drew several conclusions about the impact of various factors in producing client change, including empathy. They point out that clients often attribute a positive outcome to the personal attributes of their therapist. For example, they often described their therapist as "warm, attentive, interested, understanding, and respectful." Several therapist variables and behaviors, such as credibility, skill, empathic understanding, and affirmation of the patient, with the ability to engage the patient, to focus on the patient's problems and to direct the patient's attention to his feelings have been consistently shown to have a positive impact on treatment. These are similar to the core conditions Carl Rogers proposed for person-centered therapy; that is, empathic understanding and the degree to which the therapist communicates understanding of the client's experience; positive regard, the extent to which the therapist communicates caring and respect; and authenticity, the degree to which the therapist is real and not phony. The researchers recommend a constant emphasis on the therapeutic relationship in all settings.

Kirschenbaum and Henderson (1989) suggest that therapists question themselves to what extent they really do rely on the individual client's ability to guide his/her own growth and development. Do therapists who claim to believe in the patient's inner capacity for growth, for example, actually introduce into therapy motivation, strategies, guidance, direction, or even coercion? It is not easy to be a facilitator, and the client-centered approach requires discipline. There are many therapists, for example, who claim that their clients do most of the talking in counseling sessions, but when video taped, they see that they themselves do most of the talking. It is one thing to say that we believe in the client's freedom and ability to express his/her own thoughts and feelings and find a unique pathway through therapy, but more challenging to practice on that basis consistently. Fortunately, method is not everything. Rogers, himself, said that the core conditions were more important to success than the method chosen. Certainly, his core conditions are still present in newer and emerging forms of therapy.

In Beyond Empathy, for example, Erskine, Moursund, & Trautmann (1999) present an integrated model of psychotherapy, which they see as an extension of client-centered therapy that accommodates the demands of a modern day practice. Their approach, like Roger's, emphasizes the relationship but advances a theory of contact in relationships. Human beings require contact with others. The contact produces respect and value and fulfills relational needs. The ability to make full contact with others and with the self may be disrupted by traumatic events and result in psychological dysfunction. Dysfunction is seen as lack of contact with internal as well as external aspects of the self. Erskine et al. present a multifaceted therapy structured around client-centered therapy, transactional analysis, gestalt therapy, and contemporary psychoanalysis. The goal is to achieve full awareness and contact with the self and others through the process of integration. They embrace the idea of empathy and the importance of the therapeutic relationship, but go beyond Roger's approach with increased emphasis on respect. The client feels respected, according to them, to the extent that the therapist is attuned to the client and conveys that attunement effectively.

Erskine et al. (1999) extends Roger's work by also considering the past and the idea that past experiences may be causing lack of self-contact and determining unhealthy ways of relating to others. Rogers acknowledges that self-image often stems from evaluations made by parents and others in the past, but he focuses on how these experiences affect the future. Roger's approach is more forward-looking. Erskine et al., on the other hand, places more importance on the past and points out that clients may regress during therapy to an earlier stage of development.