Humanistic Therapies

Carl Rogers

• trained psychodynamically; didn’t stay for long; disagreed with many of Freud’s presumptions about therapy and people.

• Abraham Maslow along with Carl Rogers, pioneered humanistic movement and later on humanistic therapy

  Inner nature [of people] seems not to be intrinsically or primarily or necessarily evil. . . . Human nature is not nearly as bad as it has been thought to be. . . . Since this inner nature is good or neutral rather than bad, it is best to bring it out and encourage it rather than to suppress it. If it is permitted to guide our life, we grow healthy, fruitful, and happy. If this essential core of the person is denied or suppressed, [the person] gets sick sometimes in obvious ways, sometimes in subtle ways, sometimes immediately, sometimes later.

Assumptions

1. People have an inborn tendency to grow—self-actualization; if the environment fosters it, then it really happens without interference

2. Need for certain things to live (like sunlight in plants)—positive regard; the warmth, love, and acceptance of those around us

   • prizing - experience of receiving positive regard from others

Goal of Humanistic Psychotherapy

• primary goal: foster self-actualization

• psychological problems are by-products of stifled growth process

• people have within them the capacity and will to grow toward health but it has been interrupted or distorted

• create an environment in which client can resume their growth towards psychological health

if we are guided by the self-actualization tendency, why do we find ourselves psychologically unwell?

• need for positive regard can sometimes override this natural tendency to self-actualize

• facing the choice between receiving positive regard or follow our own natural inclinations, often choose positive regard—positive regard then is conditional

  • leads to the “only if” meeting certain conditions—conditions of worth

• leads to going astray of the self-actualization tendency → when comparing their real self and ideal self there is a discrepancy—incongruence

• congruence - a match between the real self and the ideal self; achieved when self-actualization is allowed to guide a person’s life

• conditional positive regard from others could be incorporated to our own self and become conditional positive self-regard

Elements of Humanistic Psychotherapy

There is only a need for the therapist to create the right conditions for self-actualization to occur since all individuals already possess a natural tendency towards it. They only foster healing tendencies towards growth. This is accomplished through the three essential therapeutic conditions

Empathy

• when the therapist is able to sense the client’s emotions just as the client would, to perceive and understand the events of his/her life in a compassionate way

• involves deep, nonjudgmental understanding of the client’s experiences and the therapist’s own values and point of view are suspended

• can enable clients to clarify their own feelings for themselves and have more confidence in the emotions they experience

• can also make a client feel valued and supported as an individual

Unconditional Positive Regard

• full acceptance of another person “no matter what.”

• allows clients to grow in a purely self-directed way, with no need for concern about losing the respect or acceptance of the other person in the relationship

• key for the clients to give themselves UPR eventually → higher levels of congruence and self-actualization

• provides an opportunity for clients to grow naturally into their own potential rather than being pressured by others to grow in various directions

Genuineness

• be genuine in their relationships with clients

• truly are empathic toward clients and truly do unconditionally prize them

• also called congruence

• there is a match between the therapist’s real and ideal selves—the opposite of playing a role or putting up a front

• helps humanistic therapists establish therapeutic relationships that feel “real.”

• Carl Rogers and other humanists encourage a relatively high degree of transparency by the therapist

If I can create a relationship characterized on my part

• by a genuineness and transparency, in which I am my real feelings;

• by a warm acceptance of and prizing of the other person as a separate individual;

• by a sensitive ability to see his world and himself as he sees them;

Then the other individual in the relationship

• will experience and understand aspects of himself which previously he has repressed;

• will find himself becoming better integrated, more able to function effectively;

• will become more similar to the person he would like to be;

• will be more self-directing and self-confident;

• will become more of a person, more unique and more self-expressive;

• will be more understanding, more acceptant of others;

• will be able to cope with the problems of life more adequately and more comfortably.

Necessary and sufficient?

• Rogers: necessary and sufficient

• More recent research suggests that Rogers’s core therapy ingredients are probably necessary but not always sufficient for psychotherapy to succeed

• more like a prerequisite for a good therapy; a set of conditions that is enough to facilitate significant improvement or set the stage for additional therapeutic methods that will cause significant improvement

• essential part of therapeutic relationship (humanistic or not)—common factors

Therapist Attitudes, Not Behaviors

• humanists view the 3 conditions as attitudes not behaviors

• answers how therapists should be, not what they should be

Reflection: An Important Therapist Response

• takes place when a therapist responds to a client by rephrasing or restating the client’s statements in a way that highlights the client’s feelings or emotions

• not just parroting but comment by the therapist that shows the therapist’s appreciation of the client’s emotional experience (reflection of feeling)

• mirror their clients’ affect, even if that affect is not explicitly stated

• reflection should be an attitude rather than a technical skill; and this attitude should include some humility, which can be lost when therapists reflect mechanically

• testing understandings or checking perceptions

Historical Alternatives

Existential Psychotherapy

• an approach to therapy originally developed by Rollo May, Victor Frankl, and Irvin Yalom

• centers on the premise that each person is essentially alone in the world and that realization of this fact can overwhelm us with anxiety

• anxiety may take a number of forms and is the root of all psychopathology

• holds that other inevitabilities of human life, especially death, contribute to a powerful sense of meaninglessness in many people

• place great emphasis on people’s ability to overcome meaninglessness by creating own meaning through their decisions

• encourage clients to make choices that are true to themselves; aid assuming control and assigning significance to their lives

Gestalt Therapy

• founded by Fritz Perls; emphasizes a holistic approach to enhancing the client’s experience—both mental and physical perceptions—Gestalt therapists attend to both

• encourages clients to reach their full potential, through the use of role-play techniques

• deemphasis on client’s past experiences and focus on “the now”

• integration and awareness of all parts of the self is viewed as a sign of personal growth, and, as such, it is thought to correlate with psychological well-being

Motivational Interviewing

• Emerged from humanistic therapy principles, developed by William Miller (Tudor, 2008)

• Addresses client ambivalence about changing unhealthy behaviors

• Views ambivalence as normal, not resistance or lack of motivation

• Highlighting the "discrepancy" between behavior and values (incongruence) to elicit intrinsic motivation

• Therapist Role: Collaborative, non-pressuring, empowering clients to make their own decisions for change

• Originally for addiction, now used for various client issues

• Goal: Help clients decide and commit to change themself

• can be used to enhance existing treatment approaches (e.g., cognitive-behavioral therapy)

• can be employed initially to motivate clients hesitant about therapy goals imposed by others

• Studies show clients receiving MI before cognitive-behavioral therapy for anxiety disorders showed greater engagement compared to those without MI

• By eliciting intrinsic motivation, MI empowers clients to take ownership of their treatment goals

• can help overcome initial reluctance, leading to smoother progress in the primary therapy approach

Central Principles

• Expressing empathy. Taking the clients’ points of view and honoring their feelings about their experiences are vital to MI.

• Developing the discrepancy. MI therapists show clients the mismatch between their actions and values, boosting their own motivation to change and making them the driving force for improvement.

• Avoiding argumentation. MI therapists avoid arguing with clients, even about harmful behaviors. They believe change must come from within, not pressure.

• Rolling with resistance. MI therapists validate clients' doubts about change. They understand people have mixed feelings and don't pressure them.

• Identifying “sustain talk” and “change talk”. Clients grappling with change often express both a desire to maintain the status quo ("sustain talk") and a yearning for improvement ("change talk"). Motivational interviewing (MI) therapists acknowledge this internal conflict with compassion. They don't pressure clients, but instead, guide them through exploring these mixed feelings. Research suggests that focusing on "change talk" is particularly important, as it's linked to positive behavioral changes. By helping clients identify their own motivations for change, MI therapists empower them to make their own decisions about moving forward.

• Supporting self-efficacy. MI therapists make efforts to communicate to clients that they have the power to improve themselves. The role of the therapist is facilitative; it is the client who has the most power for change.

• Numerous studies support MI's effectiveness across various issues

• benefits both psychological (anxiety, depression) and physical issues (weight management, diabetes)

• improves outcomes by motivating clients to change behaviors impacting these issues

• Meta-analyses show effectiveness in substance abuse, exercise, smoking cessation, and more (references provided)

• can be integrated with other treatment approaches, expanding its reach

• stands out as an effective humanistic therapy on lists dominated by cognitive and behavioral approaches.

Positive Interventions and Strength-Based Counseling

• Positive psychology (1990s) overlaps with core ideas of humanism

• emphasizes human strengths, happiness cultivation, and potential for growth

• moves beyond just reducing symptoms in therapy

• believes in individuals' ability to develop positive traits like hope, creativity, and resilience

• strengthening these positive aspects can prevent mental health issues or improve well-being

• Both humanism and positive psychology see people as having inherent strengths that can guide them and buffer against negativity

• Goal of Therapy: Both aim to enhance these strengths and capabilities for a better life

• Therapist Role Shift: Unlike traditional therapists, positive psychology emphasizes a dual role: healing weaknesses and nurturing strengths

• focus on strengths mirrors Carl Rogers' concept of self-actualization, a core humanistic principle

• Both approaches believe in nurturing clients' potential for healthy growth.

Therapies rooted in positive psychology share a focus on strengths and well-being, echoing humanistic principles.

• Positive interventions/Strength-based counseling: These therapies look beyond just reducing symptoms and aim to enhance a client's overall well-being. This includes aspects like:

  • Positive emotions

  • Engagement with life

  • Relationships

  • Meaning in life

  • Achievements

  This approach is supported by research showing happiness protects against mental health issues. It aligns with calls for a more comprehensive understanding of clients:

• Holistic Understanding: Positive interventions consider both strengths and weaknesses of the client.

• Four-Front Approach by Beatrice Wright and others

  • Weaknesses and undermining characteristics within the person

  • Strengths and assets within the person

  • Destructive factors and resources that are lacking in the environment

  • Resources and opportunities in the environment

• Parks and Layous’s seven basic categories of positive psychology

  • Savoring, in which clients intentionally focus on and extend, without distraction, moments of joy and happiness

  • Gratitude, in which clients purposefully focus on reasons to be thankful by writing letters, journaling, visiting important people in their lives, or simply thinking about things that make them feel appreciative

  • Kindness, in which clients deliberately do nice things for others, including the donation of money or time for charity, volunteering, tutoring, or similar activities

  • Empathy, in which clients intentionally build a sense of understanding, forgiveness, and perspective-taking with others in their lives

  • Optimism, in which clients purposefully cultivate positive expectations about the future and anticipate good things that may happen in their lives

  • Strength-based activities, in which clients deliberately use (or write about) their personal strengths in meaningful or novel ways

  • Meaning, in which clients intentionally remind themselves of their own values and set goals to live a life that falls in line with them

Positive psychology interventions (PPIs) and strength-based counseling offer benefits beyond individual therapies:

• can be combined with existing therapy approaches

• while new, PPIs are accumulating research supporting their effectiveness. This research shows:

  • Increased happiness and reduced depression

  • Fostering posttraumatic growth after trauma

• Studies suggest clients find PPIs more appealing than other therapies. This may lead to:

  • Better treatment adherence.

  • Lower dropout rates from therapy.

Overall, PPIs offer promise as both standalone therapies and complementary approaches in psychotherapy.

Emotionally Focused Therapy

• focuses on expressing and processing emotions, even those long-suppressed.

• Therapists create a safe space for clients to fully experience their feelings without judgment.

• Clients are encouraged to share emotions with others, sometimes using an "empty chair" technique to address unspoken feelings.

• frequently used with couples to improve communication and emotional connection.

• Goal: Shift patterns from blame and withdrawal to empathy and open communication.

• Benefits:

  • Shown to be effective for couples and individuals with various issues (depression, PTSD, etc.).

  • Supported by research

Other Contemporary Alternatives

Bohart and Tallman's humanistic therapy approach, detailed in their book "How Clients Make Therapy Work", emphasizes the client's own capacity for healing. Here's a breakdown:

• Client-Driven Solutions: Therapy focuses on creating a supportive environment where clients can find their own solutions

• Active Client Role: The therapist acts as a collaborator, respecting the client's views and opinions.

• Against Technique-Focused Therapy: Bohart and Tallman criticize therapy that relies on specific techniques and positions clients passively.

• Client Empowerment: They believe therapists should guide clients to self-help rather than impose solutions.

In essence, this approach views clients as capable individuals who can heal and grow within the right environment fostered by the therapist.

How Well Does It Work?

Challenges in Researching Humanistic Therapy:

• Defining and measuring self-actualization (a core concept) is difficult.

• Translating therapist behaviors based on humanistic principles can be challenging.

Carl Rogers and Pioneering Research:

• Despite these difficulties, Carl Rogers was a leader in researching psychotherapy outcomes.

• He used innovative methods like audio-recording sessions for later analysis.

• He published some of the earliest outcome studies in the field.

Resurgence of Research Interest:

• After a decline, research interest in humanistic therapy outcomes re-emerged in the 1990s.

• Meta-analyses suggest humanistic therapies are generally as effective as other major approaches.

• Studies show positive effects for various issues like depression, relationships, and substance abuse

Focus on Core Elements:

• Recent research explores the impact of specific humanistic elements: empathy, positive regard, and genuineness.

• Studies suggest all three elements contribute significantly to successful therapy, regardless of therapeutic approach

• Even therapists not identifying as humanistic can benefit from emphasizing these core components.

Motivational Interviewing (MI) as a Success Story:

• MI, derived from humanistic principles, has become a strong evidence-based therapy for various issues

• Among humanistic therapies, MI currently leads in empirical support.

Conclusion:

While challenges exist, research suggests humanistic therapy approaches can be effective. Furthermore, core humanistic elements like empathy and positive regard contribute to successful therapy in general.