I’m sure I’m not the first to draw a parallel between Fred and Carl Rogers. Both men have captivated millions. Both men prized warmth, empathy, safety, and inter-personal engagement. And in both Mr. Rogers’ show and Mr. Rogers’ session, everybody feels good, but not much happens.
I am no expert in the history of clinical psychology, but it seems like Carl Rogers deserves credit for the meme “therapist as paid friend,”—i.e., the therapists who are sufficiently nice to you, but don’t help you set goals and learn strategies to accomplish those goals. This week’s two articles Kirschenbaum and Jourdan’s article “Current Status of Carl Rogers and the Person-Centered Approach,” and Castonguay, Constantino, and Holtforth’s “The Working Alliance” offer no consolation—but they may offer explanation—to those of us who feel that they’ve paid about $100 an hour for a lot of really great eye contact.
Do not get me wrong, I wholeheartedly embrace the primacy of the therapeutic relationship and Rogers’ trio of core conditions: empathy, positive regard, and congruence. However, they seem more like prerequisite personality traits of clinicians. Can you even train empathy and warmth? Can you manualize it? I also wholeheartedly agree with Rogers and his followers that not one, not two, but all three conditions must be present for therapy to be “sufficient.” But sufficiently what? Yes, sitting on a comfy couch in the presence of a lovely therapist may be sufficiently, uh, pleasant? But how about raising the bar a little from “sufficient” to helpful. Could we even try, where needed, to be transformative?
Though many significant effects of Rogerian sufficiency are reported, few effect sizes are. Empathy, positive regard, and congruence, while clearly a necessary foundation for therapy, seem quite insufficient as a therapeutic technique or method. C, C, and H admit that while preliminary findings about the effectiveness of techniques designed to foster alliance are promising, “we need more convincing evidence… that such techniques have direct, unique, and causal effects on improvement.” Any mention of psychological mechanisms responsible for clients’ improvements in person-centered therapy is similarly murky. Again, my harshness may be due to not knowing enough about person-centered therapy, but it actually seems more about the therapist’s behaviors, how she should act. What are the strategies offered to the client?
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The irony is that in law (if not in logic, from which law (purportedly) stems), we would refer to the three elements of "Rogerian sufficiency" as necessary, but not sufficient, elements of successful therapy. Synergies (between these elements and other elements) seem to be what is missing from the research.
ReplyDeleteGreat point about going beyond sufficiency. It's an important need.
ReplyDeleteOne thought is that sufficiency can safeguard against burnout. Sufficiency is better than outright neglect. (A half-assed effort would likely upset patients in even the direst of circumstances.) Maybe the exhausted psychologist can have an awakening by looking to ideals like empathy. But your point about mechanizing empathy seems to trump this--a psychologist who simply goes through predetermined (e)motions seems to not be practicing empathy (or even psychology) at all. So, Burnout and Rogers' empathy might not be exclusive.
Great point about teaching empathy. Also, I'm still waiting to read about that study that perfectly transforms things like empathy, or positive regard, into control variables. Metrics that claim to delineate good seem more appropriate for grant writers than for psychologists who deal directly with patients on a day-to-day basis.
Thank you Benjamin and Bounty Hunter! Agreed--we need to import necessary / sufficient distinctions into psychology. As for quantifying vs administering empathy, that's one of those questions that underscores an essential strangeness in psychology I'd love to write more about: research and practice, while often synergistic, can also seem like strained bedfellows...
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