Empathy

Therapist empathy is one of the most reliable predictors of good client outcome. However, as Bachelor (1988), Grote (2005), and others have noted, what clients experience as empathic varies from client to client and may take a number of forms. Thus, it appears that, for an empathic response to be maximally effective, it needs to match the client’s view of empathy. This evidence is consistent with the research findings that client perceptions of a therapist behavior or attitude are better predictors of client outcome than therapist views of the same quality or behavior.

Brodley and Brody (1990) reported that 90% of Rogers’s responses to clients were empathic. With such a strong focus on being empathic and responding to the client’s reality, Rogers and most person-centered therapists respond predominantly in a one-sided style. In this classical form of empathic responding, the therapist often becomes so immersed in the client’s experience that the person of the therapist remains in the background in what is essentially a “selfless” desire to understand. While this disciplined style serves to promote client reflection and understanding, it tends to preclude a focus on the therapist’s reactions to the client. In contrast, by engaging in inclusion, person-centered therapists would empathically attune themselves to their clients’ experience while also remaining aware of their own thoughts, feelings, and reactions and bring these forth for clients’ consideration. Such authentic dialogue allows therapist and client to have a “meeting of their minds” that would generate varying perspectives of reality for clients to explore. Thus, therapist and client work as partners in cocreating the best understanding of the client’s experience. At times, it is desirable for therapist and client to engage in metacommunication or conversation about what transpires between them and the therapeutic process. Since both therapist and client are part of the same field, and therefore inevitably influence each other, it would seem beneficial for each to examine and understand that impact. This would serve to demystify therapy and make possible more genuine dialogue about the how the therapist and client might work more effectively.

Unconditional Positive Regard

Therapist acceptance, unconditional positive regard, and affirmation are clearly constructive attitudes and behaviors from which clients benefit. However, a problem with the concept of unconditional positive regard in practice is that it simply cannot be consistently communicated if the therapist is authentic. Therapists, like all people, inevitably feel judgmental, critical, and disapproving at times. Difficult or unpleasant clients inevitably elicit negative reactions from therapists. None of us are so tolerant or saintly as to be completely unconditional in our regard for all clients no matter how they behave. Further, therapists cannot leave their values and sense of morality outside of therapy. Nor can they maintain some hypothetical state of neutrality. Consequently, therapists do not always feel unconditional positive regard for all clients any more than we can attain the same standards toward all of the persons we know. To attempt to do so renders the therapist incongruent, dishonest, and compromises his or her integrity with the client. Obviously, there is an inevitable tension between therapist positive regard and genuineness that requires judicious consideration before the therapist decides how to respond. Germain Lietaer has observed that:

There is a potential conflict between genuineness or congruence on the one hand, and unconditionality on the other; it is a rare person and a rare time in which the constancy of acceptance can be provided for any therapist for any client. Thus, while unconditionality is not impossible, it is improbable. (Levant & Shlien, 1984, p. 41)

Although clients inevitably want to be accepted, they cannot possibly trust or find credible a therapist who condones or seems to accept all of their behaviors, however compromising, immoral, or heinous. To look the other way would do a disservice to our clients.

Mary Nicholas, author of The Mystery of Goodness and the Positive Moral Consequences of Psychotherapy (1994), takes the position that, “For the therapist to be neutral when the client is being immoral conveys to the client that the therapist does not have the courage of his convictions to risk the patient’s outrage and defensiveness and confront an immorality” (p. 13). Moreover, there are times when moral issues are at the heart of the client’s problems (e.g., cheating on one’s spouse, child abuse, fire setting, physical and psychological mistreatment of others, illegal activities). There are instances when it is desirable for therapists to take a stand regarding what is in the best interests of persons other than the client (e.g., Tarasoff-type situations where potential victims must be warned).

Values and character development are important parts of therapy that are of concern to the client. Therefore, there are times when therapists best serve their clients by engaging them in considering such value questions as: “Is your behavior compatible with the person you want to be?” or “How will you feel about yourself if you engage in x behavior?” Client guilt and shame are often vital to process because such reactions suggest that the client has violated his or her own values and standards. Sometimes our genuine concern for the client’s well-being may take precedence over absolute unconditionality. During a session with a long-term client who was expressing embarrassment about his girlfriend’s ballet dancing skills (he is an accomplished and professional ballet dancer), I noticed myself feeling a little annoyed with him. I decided to share this annoyance and then checked to assess how it was received. My client expressed his appreciation for my comment, which reflected his own dissatisfaction with himself for being critical of his less-skilled girlfriend. While this interchange was a bit risky, therapists and clients often do not share with each other their negative feelings; consequently, the integrity of the relationship is compromised, and relationship strains and ruptures sometimes occur. When such difficult and “touchy” sentiments can be shared, processed, and worked though, the quality of the relationship is often made stronger. Conversely, when such conflicts are kept underground, either to avoid conflict or to spare the other’s feelings, the relationship becomes more distant, cautious, and superficial.

Just because the therapist’s regard cannot realistically be unconditional in all instances does not mean that the therapist can’t be consistently “for” his or her client. As long as the therapist’s commitment to the client remains unwavering, it is possible for therapists to value, support, feel compassion for, and care about their clients regardless of aspects of clients’ personality and behavior that the therapist doesn’t like or condone. Mearns and Thorne (2007) articulate their position that “valuing the client as a person of worth is not conditional—it: is equally possible to feel that deep valuing of the humanity of a person who displays a pattern of values quite different from our own” (p. 97).