The Current Status of Carl Rogers and the Person-centered Approach
The Current Status of Carl Rogers and the Person-centered Approach
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-
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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
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39
Kirschenbaum and Jourdan
Country Organization
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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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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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
This document is copyrighted by the American Psychological Association or one of its allied publishers.
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.
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-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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.
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).
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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.
48
Current Status of Carl Rogers and P-C Approach
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psychotherapy integration (pp. 94 –129). New York: Ba- 13th Annual Counselor’s Renewal Conference, Univer-
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