Insight-oriented and cognitive-behavioral psychotherapy (the dominant therapy approaches today), although very different in most ways, are philosophically similar in an important way which sets them apart from the humanistic approach to therapy. Carl Rogers, the father of humanistic psychotherapy - which he called the client-centered or person-centered approach - was explicitly rejecting the philosophical stance of psychoanalysis (CBT had not yet been invented) when he developed and elaborated his very influential ideas in the 1940's-1960's. The difference is this: whereas other theories of personality and emotional pathology emphasize that people are "pushed" in a controlling way by internal forces, Rogers emphasized the powerful way in which people can be "pulled" by purposes and goals. His theory and the therapy derived from it are imbued with an exhilarating respect for the power of free will, self-determination, and, especially, self-actualization. Self-actualization is an innate force for growth toward one's full potential. This potential can include many facets of living, such as spiritual enlightenment, the pursuit of knowledge, the desire to give to society, the expression of creativity, a comfortable acceptance of self, others and the world, the capacity for spontaneity, and a healthy balance of autonomy and intimate relatedness.
Rogers proposed that we are, from moment to moment, always engaged in efforts to enhance our 'self'. Crucially, though, enhancement includes the felt necessity to sometimes preserve or protect the self, and this is where problems of adjustment can arise. If we have an experience that is inconsistent with our current view of our self, we can find a way to learn from that experience and assimilate it into a newly-expanded, more actualized, view of self, or we can reject the experience either because we don't see its relevance to us or because we feel a threat to our self-esteem. For example, a man who perceives himself as being very attractive to women may become anxious if he is rejected by a woman, since this represents a threat to his self-concept. Faced with such a threat, he might explain away the failure ("she's damaged goods") or he might not think about the experience at all. For Rogers, the truly adjusted person, one who is proceeding unhindered toward self-actualization, is one who can integrate all experiences into his/her view of self, not just those experiences that are immediately consistent with the self-concept. Essentially, the general pull toward self-actualization is trumped by specific reactions to threats to our self-esteem. Rogers wanted to develop an approach to therapy that could promote open perception and examination of experiences inconsistent with the self so that these could be assimilated into an expanded self-concept. To accomplish this he needed a set of techniques that would eliminate the feeling of threat that we all feel when faced with information that challenges or contradicts our self-concept. The techniques he emphasized were: Accurate Empathic Understanding, Unconditional Positive Regard, and Genuineness.
Empathy: Empathic therapists are ones who can transmit to the client a sense of being understood. Such a therapist conveys an especially attuned sensitivity to the needs, feelings, and circumstances of the client. An exceptionally empathic therapist can assume the attitudes of clients and even, as it were, climb behind their eyes and see the world as they do. The following example conveys this empathic approach:
Client: My father told me again that I'm immature. I hear this so often from him these days. I can't forget what he says, but I never seem able to change his mind. Oh, what's the use!
Therapist: His attitude is always on your mind and it makes you feel hopeless and impotent at the same time.
Unconditional Positive Regard: In most relationships with parents, friends, a spouse, or others, we have learned that approval and acceptance are often conditional upon meeting certain stipulations. Perhaps our parents accept us only if we are obedient. Perhaps our spouse requires us to be financially successful. These conditions act as limitations on our ability to fulfill our potential. The therapist must lay aside all preconceived notions and be able to care about the client, be accepting, and very importantly, convey that here is someone who has faith and trust in the client's ability and strength to achieve their inner potential. Unconditional positive regard is nothing more or less than a respect and liking for the client as a human being.
Genuineness: Genuine therapists are those who express the behavior, feelings, or attitude that the client stimulates in them. One does not smile if one is angry, one does not hide behind a mask of calm if the client's remarks are upsetting. Rogers believed that in the long run clients would respond favorably to this 'realness' and honesty, knowing that the therapist was a real person dedicated to his/her welfare.
At first glance an enactment of genuineness would seem to contradict the qualities of empathy and positive regard; it does takes great skill and tact to balance empathy and acceptance with the communication of genuineness. However, the power of empathy and acceptance are greatly enhanced if the client believes that these are being offered by a real person and not someone simply adopting those behaviors for the purpose of influencing the client. As Rogers said: "This type of relationship can exist only if the counselor is deeply and genuinely able to adopt these attitudes. Client-centered counseling, if it is to be effective, cannot be a trick or a tool. It is not a subtle way of guiding the client while pretending to let him guide himself. To be effective, it must be genuine." *
Finding someone who cares, who listens intently, and who, with every comment and gesture, exudes understanding and acceptance, can be a startling and immensely rewarding experience. These therapeutic qualities go a long way toward creating an atmosphere in which the client, in the absence of threat to the self, is free to give up debilitating defenses and begin to grow as a person. Rogers proposed a set of therapist behaviors that is strikingly different from other forms of treatment. In contrast to other approaches, the client-centered therapist relinquishes any procedures that point to the therapist as an expert who is diagnosing and directly influencing the client. Typically, neither reassurance nor interpretation is offered. Similarly, advice and information are not given. The therapist does not ask questions, explicitly guide the conversation, or lead a search for causal explanations (childhood experience, irrational beliefs, etc.). The major activities of the therapist are restricted to recognizing and clarifying feelings contained in the client's statements and offering comments that convey unconditional acceptance. The idea is to place the responsibility for progress on the client's shoulders rather than on those of the therapist, trusting that the power of the client's innate drive toward self-actualization will tip the balance away from self-protection toward desired growth.
* Rogers, C.R. (1946). Significant aspects of client-centered therapy. American Psychologist, 1, 415-422.