Equivalence of the Effectiveness of Psychotherapy

The well-established fact that major schools of thought are roughly equivalent in their effectiveness suggests that other relational factors and therapeutic procedures are at play. Some therapies such as behavior therapy rely relatively little on Rogers’s core relational variables. Alvin Mahrer (2007) contends that, “Rogers” necessary and sufficient conditions are irrelevant for my experiential psychotherapy and perhaps for many other therapies as well” (p. 275). If extremely diverse therapeutic approaches vary considerably in the way therapy is practiced, then the argument can be made that Rogers’s core conditions are neither necessary nor sufficient for all clients. The simple fact that most people deal with their problems without the help of a therapist and that many troubled persons benefit from self-help materials and self-help groups further call into question the necessity of the core conditions.

LOOKING FORWARD: REKINDLING ROGERS’S PIONEERING SPIRIT

While most person-centered scholars and practitioners, myself included, continue to acknowledge Rogers’s seminal and profound contributions to the field of psychotherapy, his belief that there was still much to be learned has not been adequately appreciated and embraced. Consequently, there is a need for members of our international person-centered community to continue to take a fresh and critical look at Rogers’s theory and the extensive body of psychotherapy research and practice that could enhance it. Toward this end, I hope to rekindle Rogers’s pioneering spirit and offer some proposals for the future

When Rogers published in 1959 “A Theory of Therapy, Personality, and Interpersonal Relationships, as Developed in the Client-Centered Framework,” he issued the following cautions that have largely been ignored to this day by most students of client/person-centered theory. Rogers warned:

I believe that there is only one statement which can accurately apply to all theories . . . from the theory I will present to the one which I hope will replace it in a decade—and that is that at the time of its formulation every theory contains an unknown (and perhaps at that point an unknowable) amount of error and mistaken inference. The degree of error may be very great . . . or small, . . . but unless we regard the discovery of truth as a closed and finished book, then there will be new discoveries which will contradict the best theories which we can now construct.

To me this attitude is very important, for I am distressed at the manner in which small-caliber minds immediately accept a theory—almost any theory—as a dogma of truth. If theory could be seen for what it is—a fallible, changing attempt to construct a network of gossamer threads which will contain the solid facts—then a theory would serve as it should, as a stimulus to further creative thinking . . . at the time a theory is constructed, some precautions should be taken to prevent it from becoming dogma. (italics added, pp. 190–191)

TOWARD A COLLABORATIVE PERSON-CENTERED PSYCHOTHERAPY: REFORMULATING ROGERS’S NECESSARY AND SUFFICIENT CONDITIONS HYPOTHESIS

In the spirit of Rogers’s open-minded receptivity to new information and evidence, I offer a reformulation and expansion of his hypothesis. These ideas evolved over 20 years of reflection about Rogers’s position. The following proposal is firmly rooted in and built on Rogers’s theory of psychotherapy, especially the conditions he proposed to effect constructive change in the client. The model proposed draws heavily from research in person-centered and humanistic–existential therapies and from many of the advances articulated by some of the leading scholars and practitioners of person-centered therapy. It also draws from a body of knowledge in the larger field of psychotherapy. It is informed by various descriptions of the therapeutic alliance (Kirschenbaum, 2007) that articulate the importance of (a) therapist collaboration, (b) the client’s belief that therapy will be effective, (c) a mutual understanding of how therapist and client will work together, (d) the client’s affective relationship with the therapist, (e) the client’s capacity to work purposefully in therapy, (f) therapist empathic understanding and involvement, and (g) agreement on the goals and tasks of therapy.

This formulation is intended to broaden the scope of what it means to be person-centered and expand the range of effective practice. The proposal represents my attempt to integrate ideas from the variations in person-centered therapies described earlier in this text. A core and pervasive premise in the position I am proposing is that of therapist–client collaboration. A major shift evident in the field of psychotherapy is that therapists are moving toward increasingly involving their clients in all aspects of the therapy, an approach advocated in the American Psychological Association’s Presidential Task Force on Evidence-Based Practice: “psychotherapy is a collaborative enterprise in which patients and clinicians negotiate ways of working together that are mutually agreeable and likely to lead to positive outcomes” (Vollmer, Grote, Lange, & Walker, 2009, p. 34). The preliminary findings of the task force indicate that clients liked being offered choices and found it important to be included in the decision-making process about their therapy.

Another guiding principle in the reformulation is to do whatever is in the best interests of the client, regardless of whether it fits with the person-centered theory from which one operates currently. This proposal is founded on a primary commitment to the client’s well-being and guided by a pragmatism that draws on whatever provides the best evidence or holds the most promise for assisting our clients.

Finally, I offer this reformulation in a tentative manner that is subject to further modification in the light of new research, theory, and innovations in practice.