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Mar 25 11 3:18 AM

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Alberto Segrera, Emeritus Professor at the Universidad Iberoamericana in Mexico, has just approved for sharing here his Discussion Paper which was first posted to the PCINTL listserv this Wednesday.

It's entitled:

The Necessary And Sufficient Conditions For Personality Change:
Some Comments On Its Context And Content (Discussion paper)


The Conditions paper is now available at http://bit.ly/segrera-conditions

in pdf format, and may be shared for the purposes of promoting discussion within the P-C community.

Can everyone keep Alberto informed of any feedback?
Email: "Alberto S. Segrera" asegrera_pro@prodigy.net.mx

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It's also posted here below (although the pdf is easier to read!)

THE NECESSARY AND SUFFICIENT CONDITIONS FOR PERSONALITY CHANGE
SOME COMMENTS ON ITS CONTEXT AND CONTENT

(Discussion paper)

23 March 2011

Alberto S. Segrera
Emeritus Professor
Universidad Iberoamericana
Mexico

For some time I have felt moved to reflect on my present understanding of Rogers’ The necessary and sufficient conditions of therapeutic personality change and to share with other members of the Person-Centered community comments on the context and content of this paper

This theme has been of interest to me since the beginning of my involvement with Client-Centered Therapy and, later, with the Person-Centered Approach.

It was the subject of my “memoire”: Les attitudes du thérapeute rogérien: Théorie et recherche (The attitudes of the Rogerian therapist: Theory and Research) to obtain my Licence en Psychologie at the Université Catholique de Louvain in September 1967. I beg you to be kind enough to humor my passion about it.

All opinions are welcome; they will certainly enrich a new paper I intend to write on the subject.

To understand the terminology used in Rogers publications during the second half of the 1950s it is worthwhile to take into consideration that:

- during that period, he was trying to make his ideas recognized by the psychological establishment of the time, that was very keen to classic experimental and operational ideas.

- Carl was a careful author and revised his writings before publishing them and also after.

A THEORY OF THERAPY, PERSONALITY, AND INTERPERSONAL RELATIONSHIPS, AS DEVELOPED IN THE CLIENT-CENTERED FRAMEWORK

- Carl worked, probably since 1954, on a large scope presentation of his theories, in response to a “formal request from the American Psychological Association (…) to prepare a systematic statement of this developing theory” (Rogers, 1955/1959, p. 185). He also comments that “in the invitation to participate in the APS study, I have been asked to cast our theoretical thinking in terminology of the independent-intervening-dependent variable (…) [and says] I regret that I find this terminology somewhat uncongenial” (Rogers, 1955/1959, p. 189) and states his reasons for it.

- A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework was shared with colleagues and friends of the Chicago Counseling Center in 1955, one year before The necessary conditions.

Rogers, Carl R. (1955). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework. Counseling Center Discussion Papers, 1(5), 72 pp.

- The more publicly known version appeared in 1959:

Rogers, Carl R. (1955/1959). A theory of therapy, personality, and interpersonal relationships. as developed in the client-centered framework. In Koch, Sigmund (Ed.), Psychology: A study of a science: Formulations of the person and the social context (pp. 184-256). New York, New York, USA: McGraw-Hill.

- This last version has been reproduced several times, in full or abridged form:

Rogers, Carl R. (1959/1965). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework. In Lindzey, Gadner; & Hall, Calvin (Eds.), Theories of personality: Primary sources and research (pp. 469-477). New York, New York, USA: Wiley.

Rogers, Carl R. (1959/1989). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework: The general structure of our systematic thinking. Kirschenbaum, Howard; & Land Henderson, Valerie (Eds.), The Carl Rogers reader (pp. 236-257). Boston, Massachusetts, USA: Houghton Mifflin.

- It has been brought to my attention that the unabridged version of Rogers' theoretical statement (in Koch, 1959), although otherwise out-of-print, now exists online and can be accessed in pdf format via: http://bit.ly/rogers-1959-upgrade (with thanks to Mark Harrison for the painstaking reformatting work).

- I personally consider this work as fundamental to the understanding of Carl’s theories and his implicit initial development towards what we know today as Person-Centered Approach as a larger framework that includes therapy and at the same time embraces many other realms of human existence.

THE NECESSARY AND SUFFICIENT CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE

- During the same period, probably starting in 1954, Carl worked on his statement specifically addressing, therapy, the necessary conditions of “constructive personality change” (Rogers, 1956, p. 4).

Carl comments: “One of the current products (…) is an attempt to state, in formal terms, a theory of psychotherapy, of personality and of interpersonal relationships which will encompass and contain the phenomena of my experiences. [and clarifies:] What I wish to do in this paper is to take one very small segment of that theory, spell it out more completely, and explore its meaning and usefulness” (Rogers, 1956, p. 1).

- In this paper, Carl centers on how the therapist is to conduct therapy to be helpful to the client.

- The necessary conditions was shared with colleagues and friends of the Chicago Counseling Center in 1956.

Rogers, Carl R. (1956). The necessary and sufficient conditions of therapeutic personality change. Counseling Center Discussion Papers, 2(8), 28 pp. [April].

- The most publicly known version, in which Carl changes some of the terminology to take into consideration his audience, appeared in 1957:

Rogers, Carl R. (1956/1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103.

- This last version has been reproduced several times, in full or abridged form:

Rogers, Carl R. (1956/1978). The necessary and sufficient conditions of therapeutic personality change. Emlcrest Classic of the Month, 3(11), 1 + 16 pp. [November]

Rogers, Carl R. (1956/1978). Abstract and commentary (to The necessary and sufficient conditions of therapeutic personality change). Current Contents, 18(27), 14.

Rogers, Carl R. (1956/1989). The necessary and sufficient conditions of therapeutic personality change. In Kirschenbaum, Howard; & Land Henderson, Valerie (Eds.), The Carl Rogers reader (pp. 219-235). Boston, Massachusetts, USA: Houghton Mifflin.

GENERAL COMMENTS ON THE NECESSARY CONDITIONS

Necessity and sufficiency of the conditions

- Carl recognizes as possible the existence of other conditions in Rogers (1962). The interpersonal relationship: The core of guidance. Harvard Educational Review, 32(4), p. 422:

“I regard as entirely possible that there are other conditions which I have not described, which are also essential (…) perhaps there are still elements missing which I have not captured in my formulation”.

- He admits that it is probably impossible to establish the necessity and/or sufficiency of the conditions in Rogers, C.R. and Truax, C.B. (1967). The therapeutic conditions antecedent to change: A theoretical view, in Rogers, C. R.; Gendlin, E. T. ; Kiesler, D. J.; & Truax, C. B. (Eds.). (1967). The therapeutic relationship and its impact: A study of psychotherapy with schizophrenics. Madison, Wisconsin, USA: University of Wisconsin Press (pp. 98-99):

“Though it would be difficult if not impossible to establish the necessity and or sufficiency of these three therapist’s conditions, this theoretical statement has had considerable heuristic value. It has been the springboard for a number of significant studies. By setting forth a rigorous and reasonably well-defined set of hypotheses, it has made possible a testing of the effectiveness of these conditions.

Dichotomous or gradual character of human functioning

- Rogers has spoken about the process character of human functioning in several papers, among them:

Rogers, C. R. (1959b). A tentative scale for the measurement of process in psychotherapy. In Rubinstein & Parlof (Eds.), Research in psychotherapy, Vol. 1 (pp. 96-108). Washington, District of Columbia: American Psychological Association.

Walker, A. M., Rablen, R. A. & Rogers, C. R. (1960). Development of a scale to measure process changes in psychotherapy. Journal of Clinical Psychology, 16(1), 79-85.

- In my opinion, the process elements stated by Rogers are common to all persons (clients as well as therapists, teachers and students, bosses and subordinates, husband and wife, parents and children, etc). All the specific situations mentioned above may be considered as circumstantial; being a person in process is a continuous aspect of our human life. I addressed this issue in 1982, in a presentation to the First International Forum in the Person-Centered Approach. Oaxtepec, Mexico, 1982, published as

Segrera, Alberto S. (1982/1984). Becoming being: Reflections from the perspective of the therapeutic scales. En Segrera, Alberto S. (Ed.), Proceedings of the 1st International Forum on the Person-Centered Approach (pp. 779-804). México, Distrito Federal, Mexico: Universidad Iberoamericana.

- From this point of view, the sixth conditions can be seen in all of us in terms of degrees of functioning in the process of becoming a person.

Influence of both persons involved on the character of the relationship

- The fact that Carl centers on how the therapist is to conduct therapy to be helpful to the client has led some to have the impression that the therapist is the one that influences and even determines the success of the process. This goes contrary to the actualizing therapy and the client being responsible for his own process.

- I believe that all persons involved in helping relationship (client as well as therapist) contribute to its climate, process and results, as in all human relationships.

COMMENTS ON SPECIFIC CONDITIONS (Rogers, 1956/1957, p. 96)

Condition 1. Two persons are in psychological contact.

In the 1956 version, Carl says (p. 4): That two persons are in relationship.

I personally regret that Rogers abandoned “relationship” in favor of “psychological contact” in the 1957 version. I consider “relationship” more congruent with the experiential/existential character of Carl’s theories of human relationships, even though probably less acceptable from an operational point of view.

Carl asks for a minimum degree of relationship, that only requires the “awareness of both client and therapist” (1957/1957, p. 96).

I agree with Prouty in not taking for granted that a comatose person does not at least subceive the other person’s presence.

Condition 2. The first [person], whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.

This condition has been interpreted by many as if being congruent or incongruent is a dichotomous possibility, instead of recognizing that congruence-incongruence is a continuum where we all find our place. Considering the circumstances of present day life, I wonder if any of us (including therapists) does not experience some degree of vulnerability or anxiety.

Condition 3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship

Based on similar reasons as the ones stated in Condition 2, I believe that to work as a therapist it is useful to be able to maintain a fairly high degree of congruence for others.

Carl specifies “in the relationship”. I believe that, with all due nuances, it also applies to our general way of functioning in our human relationships.

Condition 4. The therapist experiences unconditional positive regard for the client.

I believe that it is impossible to ask from any person (including therapists) to maintain continuous total unconditional positive regard in any relationship.

My reading of it is that to work as a therapist it is useful to be able to maintain a fairly high degree of unconditional positive regard for others.

Condition 5. The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavors to communicate this experience to the client.

I believe that it is impossible to reach total empathic understanding of any other person’s (internal) frame of reference.

I believe there is a difference between experiencing and communicating.

I think that Carl is mixing experiencing and communicating the experiencing in one condition and that it would be good to separate these two aspects.

Condition 6. The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.

I agree with the perception by the client being essential, the endeavor of the therapist not being enough.

It is curious to note that in condition 5 Carl only refers to endeavoring to communicate empathic understanding and in Condition 6 he speaks of the need for empathic understanding and unconditional positive regard to reach the client, and that he doesn’t mention congruence at all.

I believe that perception of the therapist congruence is an important element.

PERSONAL RESTATEMENT OF THE CONDITIONS FOR PROMOTING CONSTRUCTIVE PERSONALITY CHANGE

Based on the preceding comments, I suggest the following restatement of the conditions for the promotion of constructive personality change:

- Conditions of Presence

Condition 1. The two persons involved in this specific relationship experience at least a minimum degree of being mutually present to the other.

Condition 2. The person involved as client experiences a low degree of congruence in his/her life process, being vulnerable or anxious.

Condition 3. The person involved as therapist experiences a fairly high degree of congruence or integration in the relationship.

Condition 4. The person involved as therapist experiences a fairly high degree of unconditional positive regard for the person involved as client.

Condition 5: The person involved as therapist experiences a fairly high degree of empathic understanding of the frame of reference of the person involved as client.

- Conditions of Communication

Condition 6. The person involved as therapist endeavors to communicate these experiences of congruence, unconditional positive regard and empathic understanding to the person involved as client.

Condition 7. The person involved as client perceives the congruence, unconditional positive regard and empathic understanding experienced by the person involved as therapist.

USEFUL ALTERNATIVE PAPERS

It may also be useful to consult two papers by Rogers on the helping/interpersonal relationship, addressed to audiences different from the traditional psychological establishment, which offer alternative, complementary perspectives to The necessary conditions.

The characteristics of a helping relationship
Rogers, Carl R. (1958). The characteristics of a helping relationship. Counseling Center Discussion Papers, 4(14), 23 pp.

Rogers, Carl R. (1958). The characteristics of a helping relationship. Presentation [closing session] at the Annual Convention of the American Personnel and Guidance Association. St. Louis (Sheraton-Jefferson Hotel), Missouri, USA: American Personnel and Guidance Association; April 3.

Rogers, Carl R. (1958). The characteristics of a helping relationship. Personnel and Guidance Journal, 37(1), 6-16.

Rogers, Carl R. (1958/1961). The characteristics of a helping relationship. In On becoming a person: A therapist’s view of psychotherapy (pp. 39-58). Boston, Massachusetts, USA: Houghton Mifflin.

Rogers, Carl R. (1958/1964). The characteristics of a helping relationship. In Bennis, Warren G.; Schein, Edgar H.; & Berlew), David E. (Eds.), Interpersonal dynamics: Essays and readings on human interaction (pp. 309-325). Homewood, Illinois, USA: Dorsey Press.

Rogers, Carl R. (1958/1968). The characteristics of a helping relationship [excerpts]. In Gordon, Thomas, Parent effectiveness training: An educational experience for those who take parenthood seriously: Parent notebook (pp.31-34). Pasadena, California, USA.

Rogers, Carl R. (1958/1989). The characteristics of a helping relationship. In Kirschenbaum, Howard; & Land Henderson, Valerie (Ed.), The Carl Rogers reader (pp. 108-126). Boston, Massachusetts, USA: Houghton Mifflin.

The interpersonal relationship: The core of guidance
Rogers, Carl R. (1962). The interpersonal relationship: The core of guidance. Harvard Educational Review, 32(4), 416-429.

Rogers, Carl R. (1962/1967). The interpersonal relationship: The core of guidance. In Rogers, Carl R; & Stevens, Barry, Person to person: The problem of being human: A new trend in psychology (pp. 89-103). Moab, Utah, USA: Real People Press.

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#1 [url]

Mar 25 11 5:51 PM

Re: Segrera reformulates the Core Conditions!

I wouldn't have thought it was possible to reformulate the N&S Conditions statement and achieve it in such an uncontroversial fashion.

I find it hard to argue with this at all - even though I came expecting to do so. I'm not aware of Rogers having explained these inconsistencies. I'm left with two big questions - if the original theoretical statement is to stand, what does that say about the relationship between the different conditions? If Alberto's restatement gains acceptance, which will be the first organisation to consider a formal adoption of the revision?

I feel very odd. On the one hand this has significant implications - but on the other I just feel 'yes, that's a definite improvement and ties up those loose ends'. What I await is some serious opposition/criticism to maybe put my less critical acceptance into a more confrontational context.

Fight, fight, fight...!!

Ray x

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#2 [url]

Mar 26 11 9:53 PM

Re: Segrera reformulates the Core Conditions!

I enjoyed reading this discussion paper although I'm not sure this is much of a reformualtion, rather yet a further re-interpretation. Barrett-Lennard developed the RI based on the idea that the conditions exist on a continuum and Rogers also stated this. What I thought was interesting in this paper is that Alberto is saying that the six necessary and sufficient conditions were a statement of what Carl said 'about how to do therapy' and I think this is a mistake. The six conditions were originally presented as a hypothesis about why therapy works not how to do it which has been the common interpretation since the paper was published.
David

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#3 [url]

Mar 26 11 10:22 PM

Re: Segrera reformulates the Core Conditions!

Personally, I went on a private though sometimes public pilgrimage rejecting several concepts from the Person-Centered Approach. Among these was unconditional positive regard. Instead, I use the word "acceptance" as it has a broader connotation than unconditional positive regard. I truly feel that the concept of unconditional positive regard needs indeed to be unconditional, meaning there are no conditions related to the positive regard including the condition of simply not maintaining the condition of positive regard for any reason. That is, even I choose not to maintain unconditional positive regard, there is at least that condition which makes the positive regard conditional.

It has been my observation that pca adherents have negative regard and/or neutral regard in relationship to each other. I have no reason to think these don't exist with clients in therapy or that somehow in therapy pca practitioners reach super human status and do not have negative or neutral regard with clients. As above, being willing to be in a state of positive regard is a condition. It makes the positive regard conditional. Having negative or neutral regard also makes positive regard conditional.

I also discovered that I didn't hold my clients with pr and even had negative regard with clients. However, I found that if I accepted my negative regard as negative regard and didn't fight it, clients still changed even though I had negative regard. The difference was not acting negatively and misusing negative regard as some sort of club. Instead it is about recognizing negative or neutral as a real experience.

Acceptance then for me became recognizing that I don't always even like my clients, or even my own experiences in therapy and receiving the experience for what it was regardless of regard.

I would like to claim this as nonjudgmentalness, but I can't push it that far. Not having positive regard, well even having positive regard, seems to me to be judgmentalness. I cannot assume that nonjudgmentalness is related to not being negative towards or with clients.

I have come to see the term unconditional positive regard as a mistake. Even Rogers in the 1957 work pointed to the difficulty of using the phrase. It has become a legalistic concept often being used to assert that a given position or interaction is not person-centered. There is also has developed something of a doctrine around the concept pitting one theorist against another.

Lastly, I have doubts that it is even possible to determine if positive regard is unconditional in any given moment. Even if it is, is not regular everyday positive regard enough? What evidence is there that a client can determine if the therapist's positive regard is simple positive regard or unconditional? Thus, is the term unconditional necessary to the experience of regard?

Thus, I assert the importance of acceptance of what is, not as being regarded, but being whatever the experience is. Whether it is anger or joy, positive or negative, it is the experience it is. I feel using the term "acceptance" allows for this in a far more flexible manner than the term "unconditional positive regard."

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#4 [url]

Mar 27 11 5:19 PM

Re: Segrera reformulates the Core Conditions!

Segrera offers two suggestions for genuine alterations in the theory. One is that the congruence of the counsellor is perceived by the client. The other is that the counsellor actively endeavours to communicate their congruence and UPR to the client.

The first seems sensible; but it has no implications for practice unless the second is valid, and here I have a questionmark. As I perceive them, all the Conditions have both enduring and in-the-moment aspects. Enduring, in that they are in the totality of the relationship throughout its existence - more backgrounded between sessions; most foregrounded for the person who is at the current moment receiving the other (e.g. listening, reflecting on what they have heard, reacting emotionally to what the other has said/given/omitted). In-the-moment, in that every particular verbal or non-verbal ‘transaction’ may have within it deeper or shallower contact, empathy, positive regard, perceived receipt of empathy, etc. But I offer as a point to ponder: of all the Conditions, is counsellor empathy the one most often experienced with some depth as an in-the-moment response or reaction to an in-the-moment client communication? Maybe the reason Segrera’s suggestion of communicating congruence and UPR is new is because these Conditions (in contrast to empathy) are mostly themes of the relationship, perennials in its fabric, in place because they are aspects of our (counsellors’) “person-centred way of being”, much more than they are experienced as in-the-moment responses?

Segrera also makes the point that the client’s actualising tendency, not the counsellor, does the work and therefore ‘beneficial change’ is not always the same thing as what we counsellors, Core Form analysts, and counselling service funders conventionally think of as successful counselling. One client I had didn’t come back after two sessions, and later sent me a text the gist of which was ‘it wasn’t you that put me off, it was me: I found that by talking to you I was seeing things about me I couldn’t face looking at’. For this client, I infer, the ‘change’ that was ‘beneficial’ as perceived by their own actualising tendency was a recognition and acceptance that bringing past pain and present mental habits into awareness made them more anxious and less able to live with present life conditions than coping, as they had been before counselling, without such awarenesses.

Are the Conditions attainable?The rest of Segrera’s suggestions I hear as a fuzzying of the Core Conditions on the grounds that they are unattainable in pure form, and a fuzzying of Condition 2 on the grounds that in Rogers’s form it is invariably met.

Total empathy (understanding of another person) is indeed impossible unless one’s intuition is fully developed. But what is the bar to total UPR? Clearly Bozarth doesn’t see one – “UPR is the curative factor” in the therapeutic relationship. Neither, from practice, do I.

When clients describe experiences of non-UPR in their lives, I hear things like ‘she always said “you’re useless” ’, ‘nothing I did was ever good enough’, ‘in his mind, he was always right’, or ‘I came home with nine A grades and one A minus, and my father pointed at the A minus and exclaimed ‘what happened here?!’ Or their minds are filled with ‘you should/n’t/ have’s. Or, to borrow a memorable line from literature, people cursed them: ‘You blithering idiot! You infernal nincompoop!’ Surely as counsellors we do usually succeed in not responding in such ways to clients?

Perhaps clients most receive counsellors’ UPR when they (clients) disclose the things they feel judged for (by themselves and/or others) and discover that the counsellor’s acceptance of them, already enough felt to risk the disclosure, remains unperturbed? Perhaps it is the lack of change in me that I have experienced, for example, when a client said ‘by the way, I think I’m gay’ or ‘but I stole the guns’? That what is NOT said or felt or expressed in the face is what clients receive as UPR, with in-the-moment relief and lasting deeper trust, sense of safety, feeling heard, believed, understood and accepted – some or all of which, depending on the client’s lacks, are what make the difference - and ‘psychological contact’?

I offer a theoretical explanation of why UPR is possible for us with clients even if we do not experience total UPR for our friends, family or, as dwbower has suggested, our fellow- person-centred counsellors. A disciple of a spiritual master disobeyed him, and then returned sheepishly to his master, expecting to be judged. The master embraced him with love. When he disclosed his fears, the master replied: ‘I have no personal desires. Therefore the actions of others cannot be in opposition to wishes of mine.’ Here’s my hypothesis: It is only the desires of the ego that stop us from having UPR for every living being. You and I do not live that total freedom from ego, so we are not able to give UPR constantly to everyone in our personal lives, but we are free from desires of our egos towards our clients – or at any rate free enough from ego-desires in the relationship for our clients to feel our positive regard as unconditional. (The difference is one reason why we are wary of dual relationships such as socialising with clients down the pub.)

CongruenceSegrera’s questions the attainability of congruence too, but here he omits to address what to me is a prior question: what the deuce is congruence? Some people may find UPR hard to attain, but it is easy to comprehend; and ‘acceptance’ is a good word in common usage that substantially means what the client receives when UPR is given. Empathy is also a word in general use and can be experienced in everyday life. But congruence isn’t. ‘Congruence’ is a word we only understand (or don’t) after studying person-centred theory. When I did some research questioning experienced person-centred counsellors, many answered me with everyday words in preference to ‘congruence’: such as ‘genuineness’, ‘being real’ ‘honesty’, ‘being myself’, and ‘integrity’. And my sense is that, having translated it into English that meant something to them, they felt this quality to be a part of who they are, not an un- or questionably-attainable ideal Condition.

Rather than fuzzying the Conditions, how about fuzzying the absoluteness of “necessary and sufficient” by saying that, for all the Conditions except #2, the more fully they exist the better? The closer we get to perfect empathy, the more sustained and unconditional our UPR, the more completely the client receives our empathy and UPR, the deeper the psychological contact – both in each particular relational transaction and in the whole relationship - the more optimal the relationship then is for therapeutic client change.

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#5 [url]

Mar 31 11 9:30 AM

Re: Segrera reformulates the Core Conditions!

LIke others here, I found this a useful account of the theory considered. I sense that the author is doing what perhaps many of us do when writing discussion papers - trying to make sense, for ourselves, of something we find difficult, challenging, or just plain puzzling. It was certainly very helpful to have those developments put in the historical context - I can only be very appreciative of the author for doing that.

Different things will jump out for different readers, and for me I found the discussion around Condition 2 puzzling:

"comment on Condition 2. The first [person], whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.
This condition has been interpreted by many as if being congruent or incongruent is a dichotomous possibility, instead of recognizing that congruence-incongruence is a continuum where we all find our place. Considering the circumstances of present day life, I wonder if any of us (including therapists) does not experience some degree of vulnerability or anxiety"

For me what it leaves out is the awareness that (whatever it is) that sense of in-congruence (whether physical, mental, emotional, or holistic) is the element that drives many of us to seek help. I've only once in 30 years had a client come to me complaining she was far too happy . . . too often what drives them (or me, seeking professional help for myself) is that sense of 'something not right between the 'me-I-sense-I-am-or-could-be' and the 'me-that's-presently-existing - uncomfortably'. I suppose I'd never questioned (or imagined) congruence-incongruence as a dichotomous state - my own experience of it agrees with the authors experience of present day life all too readily

I think he makes a genuine step forward in emphasising the necessity for communicating ourselves and our understanding of our clients in the process - it took me years of practice to see the value of this, and I certainly agree that placing an emphasis on the importance of the - duality is the wrong word - dual value of both client and practitioner in relationship takes a (for me at any rate) necessary and sufficient step forward. I was very pleased to have had the opportunity to read this paper - thanks for posting it !

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#6 [url]

Mar 31 11 10:58 PM

Re: Segrera reformulates the Core Conditions!

Dear friends,
I thank all of you for offering me feedback on my discussion paper. For me a paper is a letter you send out and it is great for it to be responded to.
For the time being I prefer not to respond to specific comments. I consider all useful and I will take them into careful consideration.
"sai": It helps me to know whom I am communication with and I confess my unvoluntary ignorance about your identity. Would you be kind enough to tell me who you are?
Your thankful friend,
A

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#7 [url]

Apr 1 11 6:16 PM

Re: Segrera reformulates the Core Conditions!

Lisbeth Sommerbeck and Jerold Bozarth have kindly given permission for me to reproduce their comments on Alberto's paper here. These posts originally appeared on the PCINTL listserv.

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Dear Alberto, what a wonderful contribution!

It gave me a clearer historical perspective, and I had no idea there were so many versions of these two papers. And I have, indeed, smiled at all Rogers' Q-sort operationalisations in the 1957 paper, but I have always been of the impression that Rogers at the time was also genuinely interested in research, that it was not only to gain acknowledgement in the psychological establishment of the time.

It was a surprise, as well, to know that your starting point was in Louvain - I have always thought you were all Mexico.

I like your reformulation of the conditions for various reasons:

The "mutual" in the first condition has, in my experience, been a neccessity for me to practice ordinary CCT. Whenever I have had an experience of lack of mutuality (as if I might as well have been a spot on the wall), it has taken me into "pre-therapy mode".

Like you, I also prefer the term "relationship", and I think you are right that Rogers did, as well. At least he almost exclusively uses "relationship" or "relation" in the bulk of the text of the 1957 paper; "contact" seems to be reserved for the formal formulation in the list of conditions.

In the second condition I have felt uncomfortable with the "whom we shall term the client". I have found it very important that it is the client who defines him/herself as a client. In the Wisconsin project many of the research subjects didn't define themselves as such, but were defined as such by the research group, and I believe this was one reason for the disappointing results of the project. Your formulation avoids this, although it doesn't specify who defines whom as what.

I agree with your comment (as I understood it) about vulnerability and anxiety also being healthy aspects of the personality. I think it was Valerie who recently offered a link to a good speech about the strength of vulnerability [see http://personcentred.46.forumer.com/viewtopic.php?f=38&t=249]. And I also think this world would have been a better place if some tyrants had experienced some degree of vulnerability and anxiety. So to me it doesn't seem to be incongruence, vulnerability and anxiety, as such, that motivates people for therapy, but rather the degree of dissatisfaction with their life that they experience as a consequence of these traits.

I also agree with your continuum comments with regard to congruence (and the other conditions) - and Rogers seems very explicit about this in the 1957 paper - except for condition 1. But your formulation of condition 1 seems to change that (for the better, I think), since I believe that a characteristic like "mutuality" is also on a continuum.

Thus, I also agree with your comments to conditions 3, 4 and 5.

As to condition 6, I may well have commented, from my experience, that it can take a very long time for some clients (at least in a psychiatric setting) who have been deep in conditional regard and being pushed around by others all their life, to come to perceive UPR for what it is, rather than as a kind of indifference or something with a hidden agenda.

I think Rogers must have come across this in Wisconsin. He writes: “Our recent experience in psychotherapy with chronic and unmotivated schizophrenics raises the question whether we must modify our conception of this condition. Very tentatively it appears to me at the present time that, in dealing with the extremely immature or regressed individual, a conditional regard may be more effective in getting a relationship under way, than an unconditional positive regard”. (In the 1967 book you refer to below) I disagree very much with Rogers, here, but the reasons for that is another story.

I also like, for the reasons you offer, your restatement of the conditions for its distinguishing between "presence conditions" and "communication conditions."

Lisbeth (Sommerbeck)

[posted to the PCINTL listserv, Thursday 24 March, 2011]

---

Alberto, (and anyone interested in a rather esoteric meandering on my experiences with the theory),

Thank you for sharing your work, thoughts and understandings of Rogers' 1957 paper on the N & S conditions. I am very interested in your continued thoughts about Rogers' work. I also have much passion about the 1957 paper. I first learned about Rogers' work around 1958 after working for a year with long term institutionalized 'psychotic' individuals. I read the papers of 1951 and 1957 about the same time, discovering that Rogers offered a framework that was similar to the way the hospitalized clients had taught me a meaningful way to be with them. The 1957 paper became a functional guideline for me. In particular, I found it helped me to provide/attend to a therapeutic 'psychological climate' within a context of offering training programs, finding ways for individuals to get out of the hospital etc. For example, I found that just experiencing a person hospitalized for twenty years while he talked only about perpetual motion could result in eventual discharge from the hospital and to independent living.

I did not care much about theory until I graduated from my doctoral program in 1966. As a graduate student, I was the residential expert on cct and pca although Don Kiesler (a major author of the Wisconsin research report) was on the faculty. He, in fact, asked me a comprehensive essay question about the Wisconsin Project (WP) on my comprehensive exit examination. He readily accepted my review of the research in that project as indicating positive results. I was surprised to learn a few years later that the published report (1967) considered the research to be a generally failed project. I mention this project because I think that the WP was more of a study of the therapist conditions as stated in the N & S conditions paper of 1957. (I am convinced that the consensual conclusion of the Wisconsin Project producing insignificant results is an error but that is another story).

The 1957 paper remained central with me while I was involved with research on the N & S conditions for the next 15 years. Just prior to the 1982 Forum that you initiated, I reviewed cc research in the United States concluding that there was virtually no published research in the U.S. on client centered therapy since the 1957 paper. The studies were on the conditions as relevant in all therapies and helping relationships (as proposed in 1957 by Rogers). This led me to identify the 1957 statement as the "Integrative Statement of Carl Rogers", presented as a paper in the 1980's and revised for publication with Stubbs in the Hutterer et al book "Client-centered and Experiential Psychotherapy: A paradigm in motion" (1996) and as Chapter 12 in my 1998 book. Barrett-Lennard independently labeled 1957 as something like: "The conditions theory" in his 1998 book.

In short, I think that we are on the same page in the consideration of 1957 and 1959. I do, however, think that there is a problem when 1957 is considered as synonymous with 1959. This is due to a couple of significant differences and to the focus of relevancy for all therapies and helping relationships in 1957. Also, 1957 offered greater opportunity for deviations from the premise of the N & S conditions. This is, in fact, what happened when numerous deviations of the theory replaced Rogers' client directed therapy, e.g. Experiential, Focusing, Existential, Integrative. And skill programs replaced the client-centered postulate of attitudinal conditions while often claiming evolution of the theory of cct.

I cite a couple of important questions related to the 1957 article that might have implications for future research: The most important one, in my view, is: Do the perceptions of the conditions exist at a different level than the behavioral referents that occur? You can find other questions in my book chapter as well as more elaborate considerations about the 1957 paper. My chapter, "A Reconceputalization of the N & S Conditions" might also be relevant to your inquiry.

I think that Rogers' 1957 paper is, arguably, his most important contribution to the helping profession. It generated more than fifty years of scientific inquiry on the conditions, resulted in the conditions being accepted as basic important constructs for therapy by most psychotherapeutic approaches, and encouraged realization that the relationship is as important, if not more important, than the techniques/approaches in therapy. I think, however, that it is a mistake to consider this small part of the theory as the/a basis to further elaborate/alter the approach. The only base for further extension/revision is Rogers' self proclaimed magnum opus, the 1959 statement. I disagree that the references to needing 'more' cited now and then by Rogers has any significant meaning. After all, the theory focuses on less and not more. As Rogers said citing Gertrude Stein's quote about Paris, "It is not what Paris gives you; it is what she does not take away."

Mark H's observation that Rogers defines contact as psychological contact was meaningful to me. This observation suggests to me that Rogers must have been trying to be more clear in 1957 by incorporating the definition in the first condition statement? I have wondered about what I viewed as a difference of 'contact'/ 'psychological contact' between the two statements. I do not have immediate access to the 1955/1956 version of the theory statement prior to that published in 1959. I am now wondering about the exact statement in the earlier version vs the 1959 version; specifically, was the first version of the conditions in 1956 more similar to 1957? One thing clear to me in 1959 is that Rogers rather strongly asserted less importance of the communication of the conditions by the therapist (p. 213). However, he also accepts the emphasis of some on the communication aspect. This is possible support for your division of experiencing and communicating the conditions. Personally, I consider 'experiencing' the conditions by the therapist to include communication albeit likely a different form of communicating.

Please keep me informed of your findings and insights. I am interested in the conclusions that you reach. Thank you for the information.

Jerold (Bozarth)

[posted to the PCINTL listserv, Tuesday 29 March, 2011]

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#8 [url]

Apr 13 11 9:47 AM

Re: Segrera's discussion paper on Rogers' N&S Conditions

I really welcome all the discussions, here and on the listserve, regarding any theoretical development or 'reformulating'. In particular here, I note Doug's offereing over UPR and acceptance. I feel this resonates with some of the listserve discussions of late. another point for me is the idea of expressing congruence - I feel this is a dubious one and maybe all too easily leads to therapists offering anything with the defence "I was being congruent". I feel Rogers (1959) is clear here, yet there is something in examples of his later work and writings which has maybe been seen as him moving more towards congruent expression from his own frame. I feel this maybe needs greater clarification and consideration of why a therapist might validly express so.

My fear is of any written theory becoming stagnant. It seems to me that having theory in a form that prompts differing interpretations and then discussion maybe fuels personal creativity and development. In this, I deeply value the concise form of Rogers (1957, 1959, particularly '59), and hope that any reformulation maybe captures aspects of clarifications and developments without losing the conciseness.

Ray's comment, about which organisations might adopt any reformulation, hits me strongly. I feel each person with always hold their individual formulation, regardless of any printed words, so I am moved to consider the value of having printed words - in part, as above. Another value is maybe in promoting the approach, allowing anyone to decide if they might want to engage in counselling. And then there is the possible ogre of some sort of regulation/conformance to recignised theory etc...

Mark

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#9 [url]

Apr 13 11 1:35 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Mark,

I have long been dismayed by the conflict over interpretations of the approach. Charges of such and such a position not being person-centered, or a misunderstanding of Rogers' position have concerned me. You appeared to me to held an open position regarding the articulation of the approach.

I have had a concern about the stagnating of the approach. Certainly dogmatism stifles the approach, but so does lack of excitement. Since rejection, misunderstanding, and superficiality not to mention oppression, meanness and cruelty plague human kind, it seems odd that an approach that asserts acceptance, understanding, and genuineness would decline due to disinterest. Unfortunately, that seems to be happening save for a few places in the world.

The position on congruence in the approach is more problematic. That is, it is the hardest to describe. It is sort like describing a color to someone who can't see, or a sound to someone who can't hear. It can't go that far because people to have uncounted congruent experiences. Genuineness sort of helps, but a person is genuine when he/she is anxious, or angry, yet we in the approach would very seldom, if ever, assert that anxiety and anger are therapeutic.

I tend to think of congruence as not only being in touch with my feelings, experiences, and thoughts, by also as a state of mind of feeling my personal power, and will in relationship to having, or at least behaving constructively with my feelings, experiences and thoughts. While I see incongruence as a state of losing touch with what I am experiencing. Thus, when a person is asked "how do you feel about that?" the incongruent person says, "I don't know." Also the incongruent person may be trapped in an experience (anxiety, depression, a psychosis), and doesn't know how to get to the experiences he or she wants to have.

I see the pca as a way to open the door to the client's congruent experience paradoxically by receiving the incongruent state and the client's experiences of that incongruent state. The movement is away from "I don't know" to "Yes, I do know" and then on to "I also now know how to feel better." The therapist doesn't instill the how to, but the how to arises from within the client. The client has "ah-ha" experiences.

With that I'll close. I have found I am very seldom very good at speaking another person's position. I felt I heard yours though that might have gotten lost in my own chatter.

I have been lax in recent years on dialogue and my contributions to the person-centered literature have been languid though I have 3 books. I think it is important to keep making offerings to anyone who will listen as this approach is important. I do wish we would get away from talking so much about what Rogers said and focus on what the approach is about.

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#10 [url]

Apr 18 11 7:46 AM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Bert Rice has kindly given permission for me to reproduce his comments on Alberto's paper here. This post originally appeared on the PCINTL and NDSU listservs on Sunday 17 April 2011.

---

Dear Alberto,

Bert here. From Chicago. Thank you for the gift of your message, reprinted below, both for its scholarly information and for the insights you bring to the theory of client-centered therapy. I would like to respond to your suggested restatement of Rogers' conditions for promoting constructive personality change. I apologize to any potential reader for the length of my response. You wrote,

[quote]PERSONAL RESTATEMENT OF THE CONDITIONS FOR PROMOTING CONSTRUCTIVE PERSONALITY CHANGE

Based on the preceding comments, I suggest the following restatement of the conditions for the promotion of constructive personality change:

- Conditions of Presence

Condition 1. The two persons involved in this specific relationship experience at least a minimum degree of being mutually present to the other.

Condition 2. The person involved as client experiences a low degree of congruence in his/her life process, being vulnerable or anxious.

Condition 3. The person involved as therapist experiences a fairly high degree of congruence or integration in the relationship.

Condition 4. The person involved as therapist experiences a fairly high degree of unconditional positive regard for the person involved as client.

Condition 5. The person involved as therapist experiences a fairly high degree of empathic understanding of the frame of reference of the person involved as client.

- Conditions of Communication

Condition 6. The person involved as therapist endeavors to communicate these experiences of congruence, unconditional positive regard and empathic understanding to the person involved as client.

Condition 7. The person involved as client perceives the congruence, unconditional positive regard and empathic understanding experienced by the person involved as therapist.

I was actually unaware of the differences between the 1956 Counseling Center Discussion Paper and the 1957 published version. Since I did not know that the 1957 version was different, I have always relied on the 1956 version when thinking about the development of Rogers' thought.

I continue, however, to regard the 1959 statement of the necessary and sufficient conditions (often referred to by Jerold B. as Rogers' "magnum opus") as superior. My reasons for this may become apparent as I comment about your suggested conditions.

Condition 1: I believe Rogers' 1959 formulation of this condition in terms of "contact" is precise and concise. Granted, one then has to go to his definitions to find out what he means by "contact," but I like having fewer words used.

Condition 2: I prefer the 1959 statement, which implies that any level of incongruence on the part of the client is enough to satisfy this condition. Your reformulation could be read as dividing persons into those with low and high degrees of congruence and excluding the latter from the pool of potential clients. It is my belief that even a person with a high degree of congruence can still experience constructive personality change in connection with cc therapy.

Condition 3: What I like about the 1959 statement here is that it nails the importance of therapist congruence in the relationship. Where the therapist is congruent, all other things being equal, the therapy will go well. In areas where the therapist is incongruent, the therapy cannot be expected to go well. Your reformulation loosens that logical connection by referring to "a fairly high degree of congruence."

Condition 4: I do not understand the concept of "a fairly high degree of unconditional positive regard." If regard is conditional, it is not unconditional. Again, I think the 1959 statement expresses this condition in precise and succinct terms. Whether of not upr can actually be experienced, Rogers establishes its experience as the goal.

Condition 5: I prefer the 1959 formulation, again, for its precision and terseness.

Condition 6: I prefer the 1959 version's omission of any condition requiring the therapist to try to communicate anything to the client. I regard such effort on the part of the therapist as inconsistent with the therapist's other jobs of experiencing eu and upr. If the therapist truly is focused on the client's expressions in relationship to the client's frame of reference, then there is no room for the therapist to return to her own frame in order to figure out how to communicate the therapist's experiences to the client. It makes more sense to me to make the perception of therapist eu and upr the client's job, as Rogers did in the 1959 statement. The communication of eu and upr is something that, from the therapist's perspective, is a byproduct of the therapist's experiencings, not something the therapist is trying to do.

Concerning congruence, I do not understand the concept of communicating that concept, since no one can be aware of that of which they are not aware. In other words, I don't believe a therapist really knows how congruent she is in the relationship, so I don't understand how this can be communicated to the client.

Condition 7: I prefer the 1959 statement's sixth condition to this one because it has the qualifying phrase, "at least to a minimal degree," and because it omits "congruence."

In looking over the above, I believe I see two similar, but also different approaches to cct. I agree with you that these differences are to be celebrated, not condemned, in part because if everyone shared the same views, learning would be so much more difficult.

Love,
Bert

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#11 [url]

Apr 18 11 1:06 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

What 1959 version of the necessary and sufficient conditions was Bert referring too. I am only aware a 1957 version only mentioned by Bert. Did he make a mistake using 1959 actually meaning to write 1957 instead?

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#12 [url]

Apr 18 11 2:33 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

I'm sure he means this http://bit.ly/rogers-1959-upgrade

See also in E-Library http://personcentred.46.forumer.com/viewtopic.php?f=10&t=184

Alberto charts the history of the development of Rogers' theory in some detail in his paper, above. I'm starting to wonder if I'm missing something here?

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#13 [url]

Apr 18 11 4:21 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Thanks pchcolley. Considering I viewed that 1959 paper as more about relationships, development, and broader concepts surrounding of therapy, I didn't consider it as important to the presentation of the necessary and sufficient conditions. At least no more so than other works dealing with the core conditions.

In this, the changes made in condition 6 seemed to me to be just another way to speak to the condition or about the condition.

It would have been helpful, since Rogers wrote other material in 1959, for Bert to have specified what he was referring to and not assumed that everyone who read his material knew what he was referring to.

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#14 [url]

May 26 11 7:35 AM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Hello Peeps.

It's really great to see such a rich and thoughtful discussion of Alberto's paper. Does any of you, who have sent stuff here, object to me using your contributions in the August edition of PCQ (Person-Centred Quarterly, BAPCA's magazine)?

Mort

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#15 [url]

May 26 11 2:04 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Mort,

My material can be used.

However, I am concerned that non responses to your query could be seen as permission.

It has been a long held position of mine which led to my leaving two pc networks that materials, save for brief quotations and appropriate citations, should not be lifted up in totality without the writer's over permission. My position was and has been discarded and my materials used without my permission.

I thank you for making your query. I would like to have seen it worded from the perspective of "Who is willing to allow me to use their comments" instead of is there anyone who does not want his/her comments used.

doug bower

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#16 [url]

May 26 11 7:13 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Doug, I agree.

It was cavalier of me to invite people to object to my using their contributions in PCQ. It's too negative and it runs the risk you've identified of assuming non-objection is equivalent to giving permission.

So: Which of you, who have participated in the discussion of Alberto's paper on the N&S conditions, are happy for me to include your contribution in the August PCQ?

Hope that is closer to correct.

Mort

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#17 [url]

May 26 11 9:44 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Lord, I hope that expressing my thoughts doesn't get into the category of what is "correct." I am far more interested if you or anybody else says what they want to say, the way they want to say it. I hope that your awesome change in phrasing is about getting at the intention of your original query. I did get a sense though from your changes the changes were congruent with your beliefs.

I think the dialogue on these issues is tremendously important. We in the approach though may be among the remnant willing to address these conditions. While others in other arenas have gotten on board with the attitudes, for instance the effort of Peter Breggin, M.D., regarding empathy and therapy as he questions aggressively the use and especially the misuse of medication in the treatment of mental health problems, there doesn't seem to be here in America at least much interest in using the person-centered approach or Carl Rogers' as the basis for dealing with or talking about theory and practice.

doug bower

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#18 [url]

May 28 11 12:05 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

HI Doug, Mort and all,

Mort, I consider these boards as open to anyone, so I hold a position that unless I specifically request otherwise, anything I post might appear elsewhere.

Doug, I wonder of your saying (I maybe lose a little context here [quote]I viewed that 1959 paper as more about relationships, development, and broader concepts surrounding of therapy, I didn't consider it as important to the presentation of the necessary and sufficient conditions..

My own sense is that the "definition of constructs" (terminology) alone greatly enhances my understanding of the conditions, not to mention the intro and commentaries (in 1959, unabridged Koch version). I realise there are other explanatory texts, but for me there is a conciseness to 1959 which I feel reinforces what Rogers offered in the conditions. I generally accept Bert's comments, and particularly like how he highlights the different wording of condition 6, and the non-communication of congruence. I feel 1959 then maybe further avoids supporting mechanical empathic responding.

I've come to prefer to consider congruence as a state of the therapist where EU/UPR is most wholly experienced, and that this is then somehow 'transparently' recognised by the client (roughly). My own thought is that whilst Rogers saw congruence as the "growing edge" (1959), I think it has been used as an excuse for all sorts of therapist expressions which has muddied the concept, I feel. This is why I go for a different 'condition 7', as posted here http://personcentred.46.forumer.com/viewtopic.php?f=22&t=270

Warmly
Mark

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#19 [url]

May 28 11 1:54 PM

Re: Segrera's discussion paper on Rogers' N&S Conditions

Mark,

Naturally, I accept that the "definition of constructs" enhanced your understanding of the conditions. I find that awesome.

After that we differ greatly in virtually having opposite statements to make on those constructs. First, rather than conciseness, I found them cumbersome. I felt distracted in them and still do.

Second, I see them as Carl Rogers' comments and position and hardly of any use to me. I didn't even feel I came closer to understanding Carl Rogers' position.

Next, I see that you "prefer to consider congruence as a state of the therapist where EU/UPR is most wholly experienced."

We differ significantly here as well. First, EU strikes me as a redundant pharse. There is no empathy or understanding without being together.

Second, UPR limits acceptance to the unconditionality of positive regard. It assumes that experiences of having no regard or having negative regard aren't therapeutic. I assert that acceptance at its more profound levels receives regard for what it is positive, negative, or neutral and makes no judgment concerning the regard. In short, I don't assume that the negative regard I have in relationship to a client is a problem unless I use it to strike out at the client. In fact, I tend to see oissubke regard as a possible experience of empathy. However, even if I assume if UPR is what the condition of acceptance is about, that Unconditionality is somehow better that regular positive regard. Does PR have to be unconditional? How does one, including the therapist, really know if PR is really really really unconditional? As far as I know any given claim by the therapist that his/her positive regard is unconditional could be in that moment of incongruence where the therapist is in denial about having conditional regard. After all good pc therapists are supposed to be unconditional with their regard.

We differ further on congruence, based on your statement of course, in that I see congruence in the therapist when he/she is not empathic and is experiencing conditional positive regard. I see congruence as the therapist being in touch with his/her experiences, thoughts, ideas, and behaviors during therapy, not just about empathy and regard.

Finally, while you see congruence "as an excuse for all sorts of therapist expression which has muddied the concept," I see a wide spectrum of what congruence means and what the possible responses will be. Congruence cannot be limited to Carl Rogers' perspective, nor yours, nor mine. To make charges of mudding the waters is based on presuppositions regarding what congruence means, or how the therapist responds. In this, I have room for the therapist making mistakes in experiences and responses. Some of the mistakes I made over the years turned out to be among the most therapeutic responses I made. I saw profound change when mistakes, which I felt were mistakes because they violated my perceptions of what it a good pc therapist would experience or do, led to "ah-ha" experiences in the client.

I also have room for pc therapists viewing congruence differently than I do, though I am very willing, if possible to say how I differ. The fact is that I find a great deal of differences among the views regarding theory and practice. I get very concerned about this approach when I don't see differences. Diversity of opinion and belief say to me people aren't being funneled into a limited understanding of what this approach expected to conform to some subject or objective standard about the theory and practice of pca.

I make a commitment to the following: being open to understanding (empathy) and misunderstanding clients (part of the path to empathy); accepting a wide range of experiences from the client and within myself (acceptance); being in touch with myself so I can be in touch with the client (congruence).

doug bower

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