Psychotherapy: Theory, Research, Practice, Training Copyright 2005 by the Educational Publishing Foundation

2005, Vol. 42, No. 1, 37–51 0033-3204/05/$12.00 DOI: 10.1037/0033-3204.42.1.37

THE CURRENT STATUS OF CARL ROGERS AND THE

PERSON-CENTERED APPROACH

HOWARD KIRSCHENBAUM AND APRIL JOURDAN

University of Rochester
This investigation of Carl Rogers’s seeks to answer this question by examining three
work explores the current status of the areas in which the status of Rogers’s work may
client-centered/person-centered ap- be ascertained—the number of publications on
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

the client-centered/person-centered approach, the

proach within the United States and
This document is copyrighted by the American Psychological Association or one of its allied publishers.

extent of person-centered organizations and train-

internationally. The status is revealed ing institutes around the world, and the role of
1st by the volume of person-centered client-centered principles in the last several de-
literature that has been published since cades of research on psychotherapy process and
Rogers’s death in 1987. The prevalence outcomes.
of Rogers’s work is also measured in
the number of professional organiza- Historical Influence
tions, institutes, and journals dedicated
Carl Rogers and his colleagues were the first to
to the person-centered approach. Fi- record, transcribe, and publish complete cases of
nally, recent research on therapy out- psychotherapy (C. R. Rogers, 1942). Using these
comes, common factors, the working recordings, Rogers conducted and sponsored
alliance, and therapeutic relationships more scientific research on psychotherapy than
has validated 2 or 3 of Rogers’s core had ever been undertaken before (e.g., C. R.
conditions— empathy, unconditional Rogers & Dymond, 1954; C. R. Rogers, Gendlin,
Kiesler, & Truax, 1967). Rogers developed the
positive regard, and, possibly, “nondirective,” “client-centered” approach to
congruence—as being critical compo- counseling and psychotherapy, which became a
nents of effective psychotherapy. mainstay of therapists’ repertoires (C. R. Rogers,
1942, 1951). In so doing, he popularized the term
“client” as the recipient of therapy in nonmedical
The historical influence that Carl R. Rogers settings, virtually founded the professional coun-
(1902–1987) had on the field of clinical psychol- seling movement (Capuzzi & Gross, 2001; Gib-
ogy, psychotherapy, and counseling is widely son & Mitchell, 1999; Gladding, 2000; Nugent,
known— but what prevalence does Rogers’s 2000), and made professional counseling avail-
work still have today? Have current trends in able to diverse helping professions. For these
research and practice rendered Rogers’s contri- accomplishments, he was the first psychologist or
butions to that of historic, foundational interest psychotherapist ever to receive the American
only, or are Rogers’s contributions still valid, Psychological Association’s (APA’s) highest sci-
relevant, and alive in the 21st century? This study entific and professional honors: its Distinguished
Scientific Contribution Award (APA, 1957) and
its Distinguished Professional Contribution
Award (APA, 1973).
Howard Kirschenbaum and April Jourdan, Department of C. R. Rogers’s “self-theory” (1959) became a
Counseling and Human Development, University of Rochester. prominent theory of personality that is still in-
April Jourdan is now at Abraham Lincoln High School, San
cluded in most personality texts today (e.g., Clon-
Francisco Unified School District, San Francisco, California.
Correspondence regarding this article should be addressed inger, 2003; Feist & Feist, 2001; Hall, Lindzey,
to Howard Kirschenbaum, EdD, Department of Counseling & Campbell, 1998; Monte & Sollod, 2002; Ryck-
and Human Development, Warner Graduate School of Edu- man, 2004). He served as President of the Amer-
cation, University of Rochester, Rochester, NY 14627. E- ican Association of Applied Psychology, the
mail: [email protected] American Association of Psychotherapists, the

37
 Kirschenbaum and Jourdan

APA, and the APA Division of Clinical Psychol- TABLE 1. Number of Publications on Carl Rogers and the
ogy, among other offices (Kirschenbaum, 1979). Person-Centered Approach
He became a leading spokesperson for the hu- Publication 1946–1986 1987–2004
manistic psychology movement (e.g., C. R. Rog-
ers & Skinner, 1956) and for encounter groups Books 84 141
Book chapters 64 174
(C. R. Rogers, 1970), and his many books, in- Journal articles 456 462
cluding On Becoming a Person (Rogers, 1961), Total 604 777
helped bring the tenets of the client-centered, and
later “person-centered,” approach to ever wider Note. Based on bibliographies in Russell (2002) and a
search of the PsycINFO database (January 25, 2002, and
audiences (C. R. Rogers, 1969, 1977, 1980). September 6, 2004) (not counting Rogers’ own 16 books
and over 200 chapters and articles). The PsycINFO data-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

base can be accessed (by subscription) from the American

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Current Status Psychological Association (http://online.psycinfo.com).

What has occurred since then? Is Rogers’s
presence as strong as ever, or has it faded as tions simply made reference to Rogers’s or the
research on other approaches has proliferated, client-centered approaches’ historical role, this
new knowledge about therapy has emerged, pro- might not be significant; but, in fact, our scanning
tocols for research funding have changed, and of these publications indicates that the majority
other models, trends, and pop psychology move- are describing new research, new theory, and new
ments have developed? Without the living exam- applications.
ple of Carl Rogers—teaching, writing, and dem- The numbers above reflect primarily the psy-
onstrating his theories and methods around the chology literature. As Rogers’s work has perme-
world— have other researchers and practitioners ated many different professions—social work,
continued to carry out and develop the client- education, pastoral counseling, group leadership,
centered/person-centered approach? and others— databases for other fields would cer-
Assessing the prevalence of a therapeutic ap- tainly reveal many more publications.
proach is no simple task. There are some objec- It should also be pointed out that the citations
tive data that help shed light on the question, but included above reflect primarily a narrow con-
some interpretation of current trends and research struction of the client-centered or person-
findings also are required to understand the ebb centered approach. In the past 30 years, there
and flow of a professional movement. As an have been at least two offshoots of the client-
initial attempt to assess the current status of Carl centered approach, often known as “focusing”
Rogers’s and the person-centered approach, we (Gendlin, 1978, 1996) and “process-experiential”
explore three indices: the number of publications (Greenberg, Rice, & Elliott, 1993; Rice & Green-
in the field, the proliferation of the person- berg, 1984, 1990), which remain closely aligned
centered approach around the world, and current with the person-centered movement. For exam-
research on the client-centered approach and psy- ple, on the Focusing Institute’s Web site,
chotherapy outcomes. Wiltschko (1994) stated, “Focusing Therapy is a
form of client-centered therapy, is part of the
Number of Publications person-centered approach” (p. 2). Process-
experiential therapy combines the person-
One measure of prevalence is the number of centered and Gestalt approaches but remains es-
publications appearing on a particular person or sentially person centered. As Elliott (2003)
approach. By one count, from January 1, 1987 to wrote, “Working effectively with clients requires
September 6, 2004, 141 books, 174 book chap- adapting the therapist’s approach to the client’s
ters, and 462 journal articles appeared on Carl general presenting problems, the within-session
Rogers or the client-centered/person-centered ap- task, and the client’s immediate experience in the
proach (see Table 1). moment” (p. 2). “Davis (1995) found that more
Therefore, not counting his own writings, more than three quarters of PE therapists’ responses
books and articles were written on Carl Rogers were either empathic understanding (57%) or em-
and the client-centered/person-centered approach pathic exploration (19%), and that process-
in the 17 years after his death than were written in directing responses occurred at a rate of about
the previous 40 years. If most of these publica- 8%” (Elliott & Greenberg, 2001, p. 290).

38
 Current Status of Carl Rogers and P-C Approach

A thorough bibliography including focusing Freud and psychoanalysis appear largely in psy-
and process-experiential approaches would yield choanalytic journals in the United States and
many more titles and present a more accurate abroad. Very few appear in general publications,
reflection of the current influence of the person- meaning that the authors are mostly speaking to
centered approach. Indeed, Lietaer (2002a) in- themselves. They focus almost exclusively on
cluded 477 books on client-centered/experiential theory and practice issues, with practically no
psychotherapy from 1939 –2000, many in lan- controlled outcome studies. Publications on the
guages other than English, about twice as many person-centered approach, in contrast, appear in a
titles as shown in Table 1. wide variety of journals and publications and
How do these numbers compare with other often include rigorous empirical research.
approaches? Using only the PsycINFO database By this narrow measure, then, it appears that
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

for comparison, 777 books, chapters, and articles the person-centered approach, although by no
This document is copyrighted by the American Psychological Association or one of its allied publishers.

on Rogers and the client-centered/person- means a leading topic of scholarship in psycho-

centered approach were found between 1987 and therapy and psychology, is alive and well. There
2004. Again, this is only a portion of the actual is a steady stream of publications on theory,
number, but confining ourselves to a single data- research, and practice in this area.
base allows an apples-to-apples comparison
among approaches. Table 2 compares the number Professional Organizations and Journals
of publications on various, major approaches to
psychotherapy. Another measure of status is the number of
Of course, these numbers do not tell the whole professional organizations and journals using the
story. Aside from excluding many citations not ideas of Carl Rogers and the client-centered/
listed in the PsycINFO database, they do not person-centered approach. Currently, there are
indicate the content or type of publications. For approximately 200 organizations and training
example, the large number of publications on centers located around the world dedicated to
researching and applying the principles devel-
TABLE 2. Number of Publications on Various Approaches
oped by Rogers (see Table 3). Many of these
to Psychotherapy countries have more than one client-centered/
person-centered organization. This table provides
No. of only a sample of person-centered organizations
Search descriptors publications
around the world.
Sigmund Freud or psychoanalysis 22,436 Some of these organizations are fairly small,
Family systems therapy or family therapy such as the Association for the Development of
(Family systems therapy alone ⫽ 127) 9,838 the Person-Centered Approach in the United
Aaron Beck or cognitive therapy 7,963
B. F. Skinner or behavioral therapy 2,788 States with only a few hundred members. Others
Cognitive behavioral therapy 2,273 are quite large and active, such as the Gesell-
Carl Rogers or client-centered therapy or schaft fur Wissenschaftliche Gesprachspsycho-
person-centered therapy 777 therapie in Germany, with over 4,300 members;
Fritz Perls or Gestalt therapy 620
Albert Ellis or rational emotive therapy 581 the British Association for the Person-Centered
Multicultural counseling 448 Approach in England, with over 1,000 members;
Alfred Adler or Adlerian therapy 364 and the Association Francophone de Psycho-
Psychodynamic therapy 363 thérapie Centrée-sur-la-Personne et Experienti-
William Glasser or reality therapy 336
Viktor Frankl or existential therapy 328
elle in Belgium with over 1,000 members. As
Eclectic approach or integrative therapy 223 these examples suggest, Europe is currently the
most active center for research, training, and
Note. Based on a search of the PsycINFO database
(September 5, 2004). Descriptors are sometimes con-
practice in the person-centered approach, and the
trolled by PsycINFO. For example, when one types be- person-centered approach is one of the leading
havior therapy, PsycINFO tells the user to use the behav- therapeutic approaches on that continent.
ioral therapy descriptor. To derive the number for Furthermore, there are Focusing Institutes lo-
cognitive therapy, we had to ask for cognitive therapy, not cated throughout Europe, India, Israel, Japan,
behavior and not behavioral. We recognize that more
than one person’s name is associated with any particular Taiwan, Thailand, New Zealand, Australia, Can-
approach, but we only used one name so as to render a ada, and the United States (Focusing Institute,
fair comparison. 2003). As mentioned earlier, the experiential fo-

39
 Kirschenbaum and Jourdan

TABLE 3. Examples of Person-Centered Organizations Around the World

Country Organization

Argentina A.E.D.E.C.e.P.—Asociación para el estudio y desarrollo del Enfoque Centrado en la Persona

Austria PCA — Person-Centered Association in Austria
Belgium A.F.P.C. — Association Francophone de Psychothérapie Centrée-sur-la-Personne et Expérientielle
VVCgP — Vlaamse Vereniging voor cliëntgerichte psychotherapie (Flemish-speaking society)
Brazil C.E.P./RS — Centro de Estudos da Pessoa
Canada CRAM—Centre de Relation d’Aide de Montréal
Czech Republic PCA Institut Praha
France PCAI-F — Person-Centered Approach Institute
Germany GwG — Gesellschaft für wissenschaftliche Gesprächspsychotherapie
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Greece PCA—Hellenic Association of Person-Centered Approach

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Hungary HAPCCPM—Hungarian Association for Person-Centered Psychotherapy and Mental Health

Italy IACP—Istituto dell’Approccio Centrato sulla Persona
The Netherlands VCgP—Vereniging voor Cliëntgerichte Psychotherapie
Portugal APPCPC—Associação Portuguesa de Psicoterapia Centrada na Pessoa e de Counselling
Scotland PCT—Person Centred Therapy
South Africa APCASA—Association for the Person-Centered Approach South Africa
Switzerland SGGT–SPCP—Swiss Association for Person-centered Psychotherapy and Counseling
United Kingdom BAPCA—British Association for the Person-Centred Approach
United States ADPCA—Association for the Development of the Person-Centered Approach
Note. Based on authors’ research and Peter Schmid’s Web site (www.pfs-online.org), which has a complete listing of
organizations and training institutes around the world.

cusing approach developed by Eugene T. Gendlin ropean level. Both the WAPCEPC and the
is closely aligned to the client-centered/person- NEAPCEPC adhere to the following principles.
centered tradition; therefore, these organizations The aim is to provide a world-wide forum for those profes-
also promote many of the ideas of the client- sionals who have a commitment to the primary importance in
centered/person-centered approach. therapy of the relationship between therapist and client, an
In addition to the various organizations and essential trust in the experiential world of the client and its
centrality for the therapeutic endeavor, a belief in the efficacy
training institutes in various countries, there are of the conditions and attitudes conducive to therapeutic move-
umbrella organizations that connect the individ- ment first postulated by Carl Rogers and a commitment to
ual organizations and provide a means for com- their active implementation within the therapeutic relation-
municating ideas among client-centered, person- ship, a commitment to an understanding of both clients and
centered, and experiential theoreticians and therapists as persons who are at one and the same time
individuals and in relationship with others and with their
practitioners. The World Association for Person- environment, an openness to the elaboration and development
Centered and Experiential Psychotherapy and of person-centered and experiential theory in the light of
Counseling (WAPCEPC) was developed in 1997 current and future practice and research. (Schmid, 2003; see
during the Fourth International Conference on also WAPCEPC, 2004)
Client-Centered and Experiential Psychotherapy The influence of these organizations extends
held in Portugal. Stated at the conference, through their professional journals, which reach a
this will be the tenth year since Carl Rogers’s death and an wider audience than their membership and train-
appropriate time to take a major step to ensure the continuing ing programs. Schmid (2003) listed more than 50
vitality and influence of the distinctive approach to psycho- person-centered or experiential periodicals and
therapy to which we are committed in our various ways. journals with primary contributions from client-
(Schmid, 2003)
centered/person-centered theorists, researchers,
Another organization to emerge from this con- and practitioners. The list includes journals from
ference was the Network of the European Asso- Portugal, Germany, France, Great Britain, Mex-
ciations for Person-Centered Counseling and ico, Japan, Ireland, the Netherlands, Belgium,
Psychotherapy (NEAPCEPC). The purpose of the Canada, and the United States. There are regional
NEAPCEPC is to support client-centered/person- journals as well, such as Person, published in
centered organizations throughout Europe and to German by the German, Austrian, and Swiss as-
ensure the presence of the approach on the Eu- sociations. On the international level, a new jour-

40
 Current Status of Carl Rogers and P-C Approach

nal was created in 2001 by WAPCEPC. Although These studies taken together suggest that therapists or coun-
the journal is published in English, it includes selors who are accurately empathic, nonpossessively warm in
attitude, and genuine, are indeed effective. Also, these find-
research contributions from non-English- ings seem to hold with a wide variety of therapists and
speaking countries. counselors, regardless of their training or theoretic orienta-
All this activity is far more than that which tion, and with a wide variety of clients or patients, including
occurred during Carl Rogers’s lifetime. Rogers, if college underachievers, juvenile delinquents, hospitalized
schizophrenics, college counselees, mild to severe outpatient
anything, discouraged institutes and organiza- neurotics, and the mixed variety of hospitalized patients.
tions that bore his name or promulgated the Further, the evidence suggests that these findings hold in a
client-centered approach. He was worried they variety of therapeutic contexts and in both individual and
would foster a personality cult or rigid orthodoxy. group psychotherapy or counseling. (p. 310)
Rogers’s death freed up a great deal of energy Gurman (1977) concluded that “there exists
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and initiative by person-centered theorists, re-

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substantial, if not overwhelming, evidence in

searchers, and practitioners around the world, support of the hypothesized relationship between
making the person-centered approach more of a patient-perceived therapeutic conditions and out-
broad-based, international movement than it ever come in individual psychotherapy counseling” (p.
was during Rogers’s lifetime. 523). Orlinsky and Howard’s (1986) extensive
review of process– outcome studies concluded
that, regarding empathic resonance, mutual affir-
Research Findings mation, therapist role-investment (which in-
cluded the patient perceiving the therapist as gen-
In 1957, “Rogers set forth a hypothesis that uine), and the overall quality of the relationship,
evoked more than 3 decades of research”
(Bozarth, Zimring, & Tausch, 2001, p. 153). That generally between 50 and 80% of the substantial number of
findings in this area were significantly positive, indicating that
hypothesis, essentially, was that when a therapist these dimensions were very consistently related to patient
demonstrates the “core conditions” of uncondi- outcome. This was especially true when process measures
tional positive regard, empathic understanding, were based on patients’ observations of the therapeutic rela-
and congruence and when the client perceives tionship. (p. 365)
these at least to a minimal degree, then psycho- In contrast to the growing evidence testifying
therapeutic personality change and its positive to the efficacy of the core conditions in promot-
correlates are inevitable. Moreover, C. R. Rogers ing therapeutic improvement (and, conversely,
(1957) argued that these conditions of effective low therapist conditions causing deterioration in
therapy operated independently of the therapeutic clients), some studies showed no particular ben-
approach being used. He wrote, “the techniques efits resulting from one or another of the core
of the various therapies are relatively unimpor- conditions. Hence, a number of research reviews
tant except to the extent that they serve as chan- of studies in the 70s and early 80s reported equiv-
nels for fulfilling one of the conditions” (p. 102). ocal findings as to the efficacy or effectiveness of
Among other instruments developed to assess the core conditions (e.g., Bergin & Suinn, 1975;
this hypothesis, Halkides (1958) created scales Mitchell, Bozarth, & Krauft, 1977; Parloff, Was-
with which outside judges, listening to audiotapes kow, & Wolfe, 1978). Many reviewers then
of therapy sessions, could rate the therapists on (Mitchell et al., 1977) and since (Bozarth et al.,
their demonstrated levels of the three conditions, 2001; Elliott, 2001; Patterson, 1984) have
and Barrett-Lennard (1962) created the widely pointed out that these studies and reviews were
used Relationship Inventory, used by clients to flawed in at least three respects.
rate their therapists on the core conditions. Re- First, the studies often used therapists who
search over the next quarter century involved exhibited minimal levels of the core conditions.
many studies that confirmed the efficacy of the That is, many studies were comparing no facili-
core conditions. Truax and Mitchell (1971) re- tative conditions to minimal facilitative condi-
ported on the results of 14 studies that involved tions. Patterson (1984) argued that, considering
992 participants. Across these studies, there were that so many studies on the core conditions found
66 statistically significant correlations between positive outcomes when therapists’ levels of the
positive outcome and the core conditions, versus conditions were minimal and when sample sizes
one statistically significant negative correlation. were small only goes to demonstrate how effec-
The authors summarized, tive the core conditions are when therapists are

41
 Kirschenbaum and Jourdan

trained to provide high levels of positive regard, largest meta-analysis of research on empathy,
empathy, and congruence. When researchers con- including 47 studies from 1961–2000, involving
trolled for such bias, Stubbs and Bozarth (1994, 3,026 clients, with 190 separate empathy–
as cited in Bozarth et al., 2001) “did not find one outcome associations studied. They found a
direct study that supported the assertion that the weighted, unbiased effect size of .32, which is
conditions are not sufficient” (p. 166). considered a medium effect size. In the context of
Second, those who interpret studies that show psychotherapy outcome research, this would be
no positive effect from one of the core conditions considered a meaningful correlation between em-
as evidence that that condition is unimportant pathy and positive therapeutic outcomes. Al-
misunderstand Rogers’s hypothesis. For exam- though recognizing the importance of empathy,
ple, although therapist empathy in and of itself many researchers (e.g., Bohart et al., 2002; Duan
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may not be a necessary condition of effective

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& Hill, 1996; Gladstein, 1987; Sexton & Whis-

therapy (Bergin & Suinn, 1975; Lambert & Ber- ton, 1994) have suggested that empathy is a more
gin, 1994), what does seem important is that complex concept than Rogers and others have
clients perceive their therapist to be empathic recognized. They have argued that more research
(Barrett-Lennard, 1962; P. J. Martin & Sterne, is needed to understand therapeutic empathy—its
1976). This, in fact, was C. R. Rogers’s (1957) different forms and its most effective applications
hypothesis—the client must perceive the thera- with different clients, in different therapeutic
pists’ empathy, unconditional positive regard, contexts, and at different stages of the therapy
and congruence. Studies that use only outside relationship.
observer or therapist ratings to measure the core As with empathy, of 24 relatively recent stud-
conditions fall short of testing Rogers’s hypoth- ies addressing therapists’ “affirmation” of clients
esis, even though a large number have produced (a concept that includes acceptance, nonposses-
positive findings. The truer test of Rogers’s hy- sive warmth, and positive regard), a large major-
pothesis is achieved when the core conditions are ity of the studies showed a positive correlation
rated by the client, and such studies have pro- between affirmation and outcomes, compared
duced the most consistently positive findings. with some neutral and only one negative finding
Finally, the fact that some studies, albeit a (Orlinsky, Grawe, & Parks, 1994). When com-
minority, show that empathy by itself does not bined with studies from Orlinsky and Howard’s
produce positive change does not mean that em- (1986) review, Orlinsky, Grawe and Parks
pathy is not effective; this just means that, by
itself, empathy is not sufficient. The same is true summarized the results of 154 findings . . . drawn from a total
for unconditional positive regard and congruence. of 76 studies. They found that 56% of the findings were
Rogers did not suggest that each condition was positive, and that, again, the findings based on the patients’
. . . sense of the therapist’s positive regard yielded even a
sufficient but that all were sufficient. When all higher rate of positive therapeutic outcomes, 65%. (Farber &
three conditions are present and the client per- Lane, 2002, p. 184)
ceives them, Rogers said that positive change will
occur. Stated differently, there were 87 findings with
a statistically significant positive relationship be-
tween therapist affirmation and positive out-
Later Studies and Reviews
comes, 63 findings that showed no relationship,
In any case, in spite of some equivocal reviews and only 4 that showed a negative relationship.
in the 70s, most research in the 1980s and 90s Furthermore, most recent studies done follow-
continued to support the importance of the core ing the “working alliance” model (discussed be-
conditions. Reviewing 12 studies, Sexton and low), rather than the client-centered model, found
Whiston (1994) wrote, “This research seems to similar findings. In 16 studies, about half of the
support previous findings regarding the impor- associations between therapists’ warmth/positive
tance of empathy in the counseling relationship” regard and outcomes are positive, about half
(p. 15). Orlinsky, Grawe, and Parks (1994) re- show no difference, and none are negative. How-
ported similar positive results in 10 studies from ever, again, “as noted by previous reviewers,
this period (only one overlapping with Sexton when the patient rates both the therapist’s posi-
and Whiston’s sample). Bohart, Elliott, Green- tive regard and treatment outcome, a positive
berg, and Watson (2002) conducted possibly the association between these and other variables is

42
 Current Status of Carl Rogers and P-C Approach

especially likely” (Farber & Lane, 2002, p. 185). Lietaer and his colleagues produced similar find-
Farber and Lane (2002) concluded, ings (e.g., Lietaer, Rombauts, & VanBalen, 1990;
Lietaer, van Praag, & Swildens, 1984; VanBalen,
The therapist’s ability to provide positive regard seems to be
significantly associated with therapeutic success—at least Leijssen, & Lietaer, 1986). Summarizing this pe-
when we take the patient’s perspective on therapeutic out- riod of research, Bozarth et al. (2001) wrote,
come. However, virtually all the significant findings bear
The studies by Tausch and his colleagues as well as others in
relatively modest effect sizes, suggestive of the fact that, like
Europe are quite positive. Positive findings are consistent in
the therapeutic alliance, it is a significant but not exhaustive
the areas of individual psychotherapy . . .; group psychother-
part of the process– outcome equation. Extrapolating some-
apy; and groups with cancer patients, prisoners, judges, teach-
what from the data, we conclude that therapists’ provision of
ers, and geriatric individuals. The findings extend to encoun-
positive regard is strongly indicated in clinical practice. (p. 191)
ter groups, education, and daily life activities (p. 162).
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Research on congruence has been more ambig- Speaking more broadly, Stubbs and Bozarth
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uous, with many studies showing a positive cor- (1994) wrote, “Over four decades, the major
relation with positive outcomes, many showing thread in psychotherapy efficacy research is the
no correlation, and some showing a negative cor- presence of the therapist attitudes hypothesized
relation (Klein, Kolden, Michels, & Chisholm- by Rogers” (p. 109).
Stockard, 2002; Sachse & Elliott, 2001).
Kirschenbaum (1979) wrote that congruence was
the least clearly explained of Rogers’s core con- A New Generation of Research
ditions; hence, it may be the most difficult of the In spite of all the research support for empathy,
core conditions for therapists to get right. The positive regard, and congruence, even strong ad-
research indicates, for example, that although vocates of client-centered/experiential therapy
certain amounts and types of self-disclosure by have conceded or concluded that the core condi-
the therapist may be helpful, too much or inap- tions may be neither necessary nor sufficient
propriate self-disclosure can be harmful (Orlin- (Tausch, 1990). Lietaer (2002b) has pointed out
sky et al., 1994). Sachse and Elliott (2001) sug- that certainly there has been at least one case in
gested that more research is needed to learn about which a client perceived the therapist as em-
how congruence can be used most helpfully in pathic, accepting, and real yet did not improve.
counseling and psychotherapy. This shows that the conditions are not sufficient
for all clients. Similarly, there have been individ-
Research in Europe ual patients who improved even though the ther-
apist lacked one or more of the core conditions.
As research on client-centered therapy in the Hence, one cannot maintain that all the core
United States diminished in Rogers’s later years conditions are necessary. As Gelso and Carter
(Lietaer, 1990), when his professional attention (1985) stated, “the conditions originally specified
turned elsewhere, research on person-centered by Rogers are neither necessary nor sufficient,
and experiential psychotherapies increased sig- although it seems clear that such conditions are
nificantly in Europe. Reinhold Tausch and his facilitative” (p. 220) or, as Lietaer (2002b) said,
students and colleagues in Germany engaged in a “crucial.” As we would put it, although neither
major program of psychotherapy research (see necessary nor sufficient for all clients, the core
Bozarth et al., 2001, for a summary of this re- conditions are helpful to extremely helpful with
search program). For example, in one study in- virtually all clients.
volving 80 client-centered therapists and 149 cli- Indeed, the direction of much of the latest
ents and their wait-list control clients, it was research on psychotherapy outcomes is consistent
found that significant improvement in clients with this view. This newer research has gradually
took place when therapists demonstrated two of come to recognize or acknowledge, first, that the
the three core conditions (Rudolph, Langer, & success of psychotherapy is only partly deter-
Tausch, 1980). (Again, this recalls C. R. Rog- mined by the psychotherapy itself, that is, by the
ers’s, 1957, hypothesis that single conditions are therapist’s approach, skill, attitudes, and relation-
not sufficient, but that all— or as this study dem- ship with the client. For example, on the basis of
onstrated, at least two— of the core conditions are Lambert, Shapiro, and Bergin’s (1986) review of
necessary for change.) the voluminous research on psychotherapy out-
Studies in Belgium and the Netherlands by comes, Lambert (1992) concluded that whatever

43
 Kirschenbaum and Jourdan

positive change occurs during psychotherapy can 56). Although Rogers was not the first person to
be attributed approximately 45% to the psycho- suggest that common factors in the therapy rela-
therapy (a combination of the therapy relation- tionship account for its benefits (Rosenzweig,
ship and the therapist’s techniques), 15% to the 1936, first introduced the idea), he was the first to
placebo effect (the client’s expectation that this spell out this relationship in detail and conduct
process will be good for him or her), and 40% to extensive scientific research on it. Years later,
extratherapeutic variables like the social and fam- citing Hubble et al.’s (1999) book on common
ily support systems in the client’s life, the client’s factors research, The Heart and Soul of Change,
ego strength, and fortuitous events (see also Bozarth et al. (2001) would write that “the per-
Hubble, Duncan, & Miller, 1999; Wampold, vasive conclusion of decades of therapy research
2001). [is] that outcome is related to common factors
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Another recognition of the newest generation rather than particular therapies” (p. 150).
This document is copyrighted by the American Psychological Association or one of its allied publishers.

of psychotherapy research, albeit a controversial The common factors in effective psychother-

one, is that the success of psychotherapy is not apy have been characterized many different
due primarily to the particular therapeutic ways. Lambert and Bergin (1994) cataloged sup-
approach—whether it be cognitive– behavioral, port factors, learning factors, and action factors.
client-centered, psychoanalytic, or any other. Among the support factors are therapist warmth,
Rather, these approaches are roughly equivalent respect, empathy, acceptance and genuineness,
in their effectiveness (Elliott, 1996; Luborsky, positive relationship, and trust. New studies con-
Singer, & Luborsky, 1975; M. L. Smith & Glass, ducted by non-client-centered therapists continue
1977; M. L. Smith, Glass, & Miller, 1980; Wam- to support the importance of these support
pold et al., 1997). Some research has supported factors.
the superiority of certain approaches for certain For example, one of the largest and best ex-
client problems, such as cognitive– behavior ther- perimental studies conducted in the United
apy for the treatment of depression; however, States, funded by the National Institute of Mental
many researchers (e.g., Elliott, 2001; Luborsky et Health (Blatt, Zuroff, Quinlan, & Pilkonis, 1996),
al., 1999; Robinson, Berman, & Neimeyer, 1990; compared three treatment approaches for
Wampold, 2001) have argued persuasively that, depression—administration of the drug imipra-
in addition to other limitations, these studies do mine, cognitive– behavioral therapy, interper-
not take therapist “allegiance” into account. They sonal therapy, and “ward management,” which
suggest, for example, that the cognitive– was meant to serve as a placebo treatment. What
behavioral therapists in these studies (and the distinguished this study was that it involved
researchers) had a level of training and commit- many therapists and many patients who were
ment to cognitive– behavioral therapy that was randomly assigned to the various treatment
greater than the training and commitment of the groups.
therapists in the comparison groups and that The patients were selected in terms of specifically defined
when these differences in therapist allegiance are criteria; three large medical centers were used in order to
controlled statistically, the differences in treat- provide adequate samples of patients; manuals were available
ment approaches all but disappear. for each of the forms of psychotherapy being evaluated; the
therapists were experienced clinical psychologists and psy-
chiatrists who received specialized training in one of the
Common Factors and Core Conditions psychotherapies being evaluated; a variety of well-known
standardized evaluative procedures were used; and competent
Hence, much of the latest research on psycho- statistical consultants participated in the project. (Lambert &
therapy outcomes has demonstrated that, rather Bergin, 1994, p. 220)
than particular approaches, it is certain “common As it turned out, there were no significant differ-
factors” in the therapy relationship that account ences among the three therapeutic treatments on
for therapeutic change (Goldfried, 1980; Frank, patient outcomes. However, across all groups, the
1982; Grencavage & Norcross, 1990; Lambert, therapist’s empathy, positive regard, and congru-
1992). “Our major theoretical schools, although ence at the end of the second session were sig-
effective, seem no better than one another. In- nificantly correlated with outcomes. As Blatt et
stead, it seems that there is some set of common al. (1996) wrote, “Higher levels of an experi-
elements and process underlying successful ther- enced therapeutic relationship [that is, as experi-
apy” (Sexton, Whiston, Bleuer, & Walz, 1997, p. enced by the patient] were significantly related to

44
 Current Status of Carl Rogers and P-C Approach

better outcome, especially with the measures of than) previous analyses of the relationship be-
change in general clinical and social functioning” tween therapeutic alliance and outcome” (p. 96).
(p. 166). Bozarth et al. (2001) wrote that the Although there is still some debate over the rel-
single best predictor of success at the end of ative strength of the necessary and sufficient con-
therapy was the patients’ perception of the ther- ditions and the therapeutic alliance models, nev-
apist’s empathy at the end of the second session. ertheless, there is little debate that recent,
process– outcome research in psychotherapy has
Therapeutic Alliance and Core Conditions focused primarily on the common factors in the
therapeutic or working alliance.
In spite of the significant empirical support for Ironically, Lambert and Bergin (1994) wrote,
Rogers’s core conditions, other researchers have “There is more disagreement about the therapeu-
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proposed other models as providing a more sat- tic alliance construct than there was with the
This document is copyrighted by the American Psychological Association or one of its allied publishers.

isfactory explanation of the common factors that client-centered conditions” (p. 165). Descriptions
account for therapeutic progress. One of these is of the therapeutic alliance include the therapist’s
the therapeutic alliance or working alliance engagement (efforts to promote the process, ac-
model, which originated in the psychoanalytic tive interventions, and showing interest) and the
literature (Bordin, 1979; Menninger, 1958). As therapist’s collaboration (taking a mutual, invi-
Sexton et al. (1997) wrote, “The working alli- tational, negotiating stance; Sachse & Elliott,
ance, social influence and interactional models of 2001). Another description of the working alli-
the counseling relationship have received consid- ance includes “client– counselor agreement on
erable research attention and garnered strong em- goals, agreement on therapeutic tasks, and the
pirical support. The strength of the evidence for emotional bond between client and counselor”
these models far exceeds that demonstrated by (Sexton et al., 1997, p. 78). The therapeutic alli-
the prevalent Rogerian model” (p. 78). Although ance is influenced by other common factors
they present little evidence to support this claim (Grencavage & Norcross, 1990; Wampold, 2001,
with respect to the latter two models, research p. 150). These include the client’s belief about the
reviews and meta-analyses on the therapeutic al- effectiveness of therapy and his or her hope and
liance (e.g., Gaston, 1990; Horvath & Symonds, expectation about getting better (Frank, 1961);
1991; Luborsky, Crits-Christoph, Mintz, & Auer- whether the therapist’s behavior fits the client’s
bach, 1988; D. J. Martin, Garske, & Davis, 2000; expectations; whether the client and therapist can
Orlinsky et al., 1994) have helped establish this establish a contract—a mutual understanding of
model as a popular new explanation for effective how they will work together, how long it will
therapeutic relationships. Orlinsky et al. (1994) take, how much it will cost, what kind of material
wrote, “The strongest evidence linking process to will be explored, and how they will do this. All
outcome concerns the therapeutic bond or alli- these common factors affect the therapeutic out-
ance, reflecting more than 1,000 process– come. Summarizing many different conceptions
outcome findings” (p. 360). of the alliance concept, Gaston (1990) identified
Whether it far exceeds the core conditions four broad dimensions:
model is debatable. Lambert (1992) wrote, “Re- the therapeutic alliance, or patient’s affective relationship to
search on the therapeutic alliance has, as yet, far the therapist . . . [b] the working alliance, or patient’s capacity
less research than that generated by client- to purposefully work in therapy . . . [c] the therapist’s em-
centered theory” (p. 108), although subsequent pathic understanding and involvement . . . [and; d] the
research on the alliance has been profuse. “The patient–therapist agreement on the goals and tasks of treat-
ment. (p. 145)
results of the meta-analysis indicate that the over-
all relation of therapeutic alliance with outcome As Gaston’s description makes explicit, and as
is moderate” (D. J. Martin, Garske, & Davis, many scholars have pointed out (Feller & Cat-
2000.) “Moderate” in this sense refers to effect tone, 2003), the Rogerian and therapeutic alliance
size or just how large the relationship is between explanations are not mutually exclusive. Orlinsky
the alliance and the outcome. Statistically speak- et al. (1994) wrote, “Theoretical interest in the
ing, the same could be said of empathy (see therapeutic alliance . . . has continued the move-
Farber & Lane, 2002, above). Bohart et al. (2002) ment launched by C. R. Rogers’s (1957) concep-
stated, “The effect size [for empathy] is on the tion of the therapeutic relationship” (p. 308).
same order of magnitude as (or slightly larger Wampold (2001) wrote, “Empathy and the for-

45
 Kirschenbaum and Jourdan

mation of the working alliance, for example, are would talk when they were not doing these other things.
intricately and inextricably connected” (p. 211). (McCulloch, 2003)
Burns and Nolen-Hoeksema (1992) studied the In this case, the therapist’s empathy, uncondi-
role of empathy as one component of the thera- tional positive regard, and congruence made a
peutic alliance when using cognitive– behavioral therapeutic alliance possible. The process is sim-
therapy for the treatment of depression. They ilar in less dramatic cases. The core conditions
reported both facilitate the therapeutic alliance and play an
integral part in the therapeutic process. Rogers’s
The patients of therapists who were the warmest and most
empathic improved significantly more than the patients of core conditions may or may not be necessary or
therapists with the lowest empathy ratings, when controlling sufficient for effective psychotherapy (the debate
for initial depression severity, homework compliance, and is ongoing), but whether considered among the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

other factors. This indicates that even in a highly technical

This document is copyrighted by the American Psychological Association or one of its allied publishers.

common factors of effective therapy or a means

form of therapy such as CBT [cognitive– behavioral therapy],
the quality of the therapeutic relationship has a substantial
to achieve a therapeutic alliance, the value of
impact on the degree of clinical recovery. This is the first empathy, unconditional positive regard, and con-
report we are aware of that has documented the causal effect gruence is supported by the latest generation of
of therapeutic empathy on recovery when controlling for the psychotherapy process– outcome research. As
simultaneous causal effect of depression on therapeutic em- Lambert (1992) concluded
pathy. (p. 447)
Among the common factors most frequently studied have
The results were so robust that, thereafter, all been those identified by the client-centered school as ‘neces-
patients at the medical center where the research sary and sufficient conditions’ for patient personal change:
was conducted were required to complete a “ther- accurate empathy, positive regard, nonpossessive warmth,
and congruence or genuineness. Virtually all schools of ther-
apeutic empathy form” after each interview, so apy accept the notion that these or related therapist relation-
that therapists would get timely feedback if their ship variables are important for significant progress in psy-
patients perceived a lack of empathy on their part. chotherapy and, in fact, fundamental in the formation of a
“Thus, difficulties in the therapeutic alliance can working alliance (p. 104).
be more rapidly identified and addressed” (p. 445).
Indeed, it is the therapist’s empathy, accep- The Therapeutic Relationship and Empirically
tance, and genuineness that allow many clients to Supported Treatments
feel safe enough to enter into a real relationship
with the therapist and be willing to develop an This is not just the conclusion of a few indi-
implicit or explicit agreement, understanding, or vidual scholars or of researchers with a client-
“contract” to engage in therapy. One client- centered leaning. At the end of the 20th century,
centered therapist (McCulloch, 2000, 2003) ex- the APA Division of Psychotherapy (Division
plained how she was able to establish meaningful 29) created a distinguished panel to summarize
counseling relationships with male prisoners with the research on effective therapy relationships
diagnoses of antisocial personality disorder. (Norcross, 2001). This task force, of whose 10
Prison psychologists had given up on them; they steering committee members none particularly
were reluctant or refused to accompany McCul- identified with the client-centered approach, was
loch on her clinical rounds through the cell block. in part a response to the growing movement,
On her first visit to the cells, prisoners exposed particularly in the United States, toward “empir-
themselves, urinated, spat toward her, and voiced ically supported treatments.” Federal funding of
obscenities. On subsequent visits, many inmates research on psychotherapy was moving strongly
stopped these behaviors, began speaking with toward identifying those treatment approaches
her, and agreed to participate in counseling ses- that were shown empirically to be effective, par-
sions. Her fellow psychologists could not under- ticularly with patients with specific diagnoses—
stand how she accomplished this, but her expla- anxiety, depression, drug abuse, and the like.
nation was simple: Concerned that this movement essentially ig-
nored 30 or more years of research that demon-
I treated them like human beings. I showed concern and strated that treatment approaches made relatively
interest while accepting their anger without judging it. I little difference compared with the therapeutic
expressed my own limits by telling them that I was distracted
by their behavior, that I wanted to give them my full attention, relationship itself, the task force was charged
and that I found it difficult to do so when I was distracted. I with summarizing the scientific research on the
told them that I valued speaking with them and hoped we therapy relationship.

46
 Current Status of Carl Rogers and P-C Approach

Published in a massive volume called Psycho- pathy, and goal consensus and collaboration. As-
therapy Relationships That Work (Norcross, pects of the therapy relationship judged to be
2002) and summarized in its professional journal promising and probably effective were positive
(Norcross, 2001), the task force’s six main con- regard, congruence/genuineness, feedback, repair
clusions were as follows. of alliance ruptures, self-disclosure, management
of countertransference, and quality of relational
1. The therapy relationship makes substantial interpretations. The task force leader, referring to
and consistent contributions to psychother- the Bill Clinton presidential campaign slogan, “It
apy outcome independent of the specific is the economy stupid,” quipped that their find-
type of treatment. ings could be summarized by the slogan, “It is the
relationship, stupid!” (Norcross, 2001, p. 347).
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2. Practice and treatment guidelines should

This document is copyrighted by the American Psychological Association or one of its allied publishers.

explicitly address therapist behaviors and

qualities that promote a facilitative therapy The Move Toward Eclecticism and Integration
relationship.
Consistent with this large body of research,
3. Efforts to promulgate practice guidelines or most therapists have been moving away from a
evidence-based lists of effective psycho- strict allegiance to specific therapeutic ap-
therapy without including the therapy rela- proaches or schools of thought (Lambert & Ber-
tionship are seriously incomplete and po- gin, 1994; Norcross & Goldfried, 1992). Surveys
tentially misleading on both clinical and of therapists over the past 30 years have demon-
empirical grounds. strated a growing proportion of practitioners who
identify themselves as “eclectic” or “integrative”
4. The therapy relationship acts in concert (Garfield & Kurtz, 1977; Jensen, Bergin, &
with discrete interventions, patient charac- Greaves, 1990; D. Smith, 1982; Norcross &
teristics, and clinical qualities in determin- Newman, 1992; Norcross & Prochaska, 1988), to
ing treatment effectiveness. A comprehen- the point where “the vast majority of therapists
sive understanding of effective (and have become eclectic in orientation” (Lambert &
ineffective) psychotherapy will consider all Bergin, 1994, p. 181). In many of these surveys,
of these determinants and their optimal although a very small percentage of practitioners
combinations. identify themselves as being primarily person
5. Adapting or tailoring the therapy relation- centered, a significant proportion of counselors,
ship to specific patient needs and character- psychotherapists, and social workers (typically
istics (in addition to diagnosis) enhances the 25–50%) identify “Rogerian,” person-centered,
effectiveness of treatment. experiential, and humanistic methods as being a
significant part of their integrative approach. One
6. The following list embodies the Task Force can only speculate that many more therapists,
conclusions regarding the empirical evi- although not identifying themselves as primarily
dence on General Elements of the Therapy or partially person centered, nevertheless incor-
Relationship primarily provided by the psy- porate Rogers’s core conditions as important in-
chotherapist. (Task Force on Empirically gredients in their own therapeutic approach. In
Supported Therapy Relationships, n.d., p. 2) this sense, Rogers’s influence lives on in the
practice of many, if not most, eclectic and inte-
Evaluating the strength of the various correla- grative counselors and psychotherapists.
tions, the task force grouped qualities and aspects
of the therapy relationship according to whether Conclusion
they were demonstrably effective across thera-
pies; promising and probably effective across We have attempted to assess the current status
therapies; demonstrably or probably effective of Carl Rogers’s contributions to psychotherapy
with particular types of clients, or not yet shown by examining three indicators of prevalence. The
by research to be effective. The three aspects of number of publications on Rogers and the client-
the individual therapy relationship shown to be centered/person-centered approach has increased
clearly demonstrated by the research were (not in substantially since Rogers’s death. Person-
order of importance) the therapeutic alliance, em- centered associations, organizations, and training

47
 Kirschenbaum and Jourdan

institutes have proliferated around the world. Re- process and outcomes—whether couched in
search on psychotherapy process and outcomes terms of the core conditions, common factors, or
has validated the importance of empathy, uncondi- the therapeutic/working alliance— has validated
tional positive regard, and probably congruence— many of Carl Rogers’s original insights about the
Rogers’s core conditions for an effective therapeu- importance and nature of the effective therapeutic
tic relationship. relationship. This should be acknowledged more
By all these indicators, the person-centered widely in university classrooms, publications,
approach, which holds the therapeutic relation- research-funding protocols, and professional
ship as central and essential to effective counsel- training programs. In the last area, there are many
ing and psychotherapy, is alive and well. Al- new resources available (e.g., Kirschenbaum,
though relatively few therapists describe 2003; PCCS Books, 2004; N. Rogers, 2002;
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

themselves as primarily client-centered in their WAPCEPC, 2004) to assist university training

This document is copyrighted by the American Psychological Association or one of its allied publishers.

orientation, client-centered principles permeate programs and independent institutes in preparing

the practice of many, if not most, therapists. psychotherapists, counselors, and other clinical
Various schools of psychotherapy increasingly workers.
are recognizing the importance of the therapeutic Looking ahead, it is unclear whether the client-
relationship as a means to, if not a core aspect of, centered/person-centered approach will remain a
therapeutic change. separate and distinct orientation in psychother-
Of course, these three indicators do not tell the apy; whether its expansion to the person-
whole story. A thorough examination of Rogers’s centered-experiential approach, as advocated by
and the person-centered approach’s current status many leading person-centered scholars and re-
would look more deeply at the “person-centered- searchers today, will become the accepted, wider
experiential” movement, teasing out the distinc- orientation; or whether the person-centered-
tions between and synthesis of person-centered, experiential movement will be subsumed under
focusing, and process-experiential approaches the more general heading of humanistic psycho-
and charting their collective prevalence and vi- therapies as some advocate (Lietaer, 2002c; see
tality. One might also review the extent to which also Cain & Seeman, 2001). Whichever evolves,
the person-centered approach may be found in it seems likely that Carl Rogers’s legacy will
current textbooks in clinical psychology, psycho- endure, not just as an area of study of historical
therapy, and counseling; the extent to which importance, but as a body of research and prac-
funded research projects reflect or study person- tice that will influence the work of future re-
centered principles or methods; and the extent to searchers and practitioners for generations to
which person-centered approaches are reim- come.
bursed by insurance carriers in different states
and countries. Another useful measure is the ex-
tent to which current practitioners identify them- References
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