Rogers also developed what he called "positive regard," (PR)
which grew out of John Dewey's work on valuation, especially
Dewey's concept of "prizing."
In this podcast, I interview Barry A. Farber about his new book
(co-authored with Jessica Suzuki, and Daisy Ort) which is an
up-to-date and comprehensive presentation of PR, its history,
theoretical underpinnings, interscholastic variations, empirical
support, and practical applications. This book is primarily
directed towards practitioners and theorists of psychotherapy, as
the interview with Dr. Farber will show; it will be featured in our
forthcoming series on psychotherapy podcasts.
For philosophers, however, the book and the interview may also
be of interest, especially for philosophers interested in
phenomenology, intersubjectivity, talk therapy, and valuation.
The remainder of this blog entry provides additional background
for philosophers who may not be familiar with Rogers'
work.
Rogers started his career with a doctorate from teacher's
college and then practical work as a psychologist at the Society
for the Prevention of Cruelty to Children in Rochester, NY.
Outside of his clinical work, he started writing books and then
transferred to academic work at the University of Wisconsin and the
University of Chicago.
Although appreciative of Freud's writings, Rogers attacked the
doctrinaire Freudians of the American Psychoanalytic Association
who dominated American postwar psychotherapy. He was a committed
empiricist who developed testable versions of his theories.
His primary concern was: what works in talk
therapy.
Rogers acknowledged that he learned the essence of his
psychotherapeutic technique from two people primarily. First: Otto
Rank, once one of Freud's inner circle who came to the United
States and found significant influence in schools of social
work. Rogers was completely UNinterested in Rank's
theoretical work (regarding, e.g., birth trauma), but he was
fascinated by Rank's ideas on
psychoanalytic practice.
For example, Rank de-emphasized intellectual
understanding, and instead emphasized the therapeutic use of
empathy. Rank wrote, "What prevents us from a correct ...
therapeutic understanding is the desire to understand
intellectually. Correct understanding is one of
empathy, ... whereas intellectual understanding is ... a
compelling of the other to our own thought, our own
interpretation." Also, he wanted to "put[] the whole emphasis
of the process on emotional, instead of intellectual,
experience."
Rank's name is also associated with "Will" therapy. He
emphasized that in the therapeutic situation, the patient in some
sense "willed" the illness (gained a "substititute satisfaction"
from the illness [today we, might say, a "jouissance"], one that
the patient would resist relinquishing. For example, Rank wrote
that, "As a result of my experience, I found ... that the illness
is nursed by the patient in order to withdraw from life ... [I]t is
self-willed, a sort of [personal creativity that finds] expression
only in this negative, destructive way."
Finally, Rank is well-known for flipping the hierarchy in the
therapy situation. "The whole [traditional, "Freudian"]
psychoanalytic approach is centered around the therapist, who is
doing the research and the explaining on the basis of what he
knows. Real therapy has to be centered around the client,
his difficulties, his needs, his activities." And, succinctly, "The
therapist must not take the part of
authority of
any kind, but must be satisfied with the role
of an ego helper (assistant ego)."
The second primary influence on Rogers' technique was the
philosopher Jessie Taft. Taft wrote one of the earliest
dissertations on the feminist movement; her 1913 University of
Chicago thesis (advised by George Mead) was The Woman Movement
from the Point of View of Social Consciousness.
As a woman, Taft was unable to receive an academic position. She
went to work in the "mental hygiene" movement with Virginia
Robinson who would become her life partner and her career
partner. As life partners, Taft and Robinson adopted two
children and lived in a "Boston marriage." As career
partners, they founded the school of social work at the University
of Pennsylvania; they also are known as the founders of a
school-of-thought within social work, the "functional" school.
In official versions of the history of American talk therapy,
Taft is regularly overlooked (again, presumably because the link is
made from male Rogers to male Rank), but Rogers acknowledged that
his personal interaction with Rank was limited, and it was truly
Taft and her team who actually taught their method
hands-on.
There are, of course, many gifted therapists who never wrote
down their method, or published their method as a book. Taft,
however, was a professor, scholar, translator, and psychoanalyst.
(She translated Ranks's major works, and she chose Rank as her
training analyst).
A strong case could be made that the first book in the Rogerian
tradition was Taft's 1933 The Dynamics of Therapy in a
Controlled Relationship. Originally, the
client-centered (Rogerian) approach was called either
"nondirective" or "passive" therapy (meaning that the therapist was
"passive" as in not
active, not the center of attention in the
therapy).
Taft originally attempted to work as a psychotherapist, but she
felt her attempts were failures. Thus, she went to look for a
training analyst (and chose Rank). Her description of her
first session with Rank is telling:
"When I finally came to my first hour with Rank, while
consciously submissive, afraid, and fully aware of my ignorance of
psychoanalysis, my underlying attitude was far from humble. I was,
after all, a psychologist. I had some knowledge of myself and my
problems. I had achieved a point of view psychologically. If there
was anything in my unconscious in terms of buried memories, I would
have to be shown. And so the battle was joined; but I soon found
that it was a battle with myself. I was deprived of a foe.
"It took only two weeks for me to yield to a new kind of
relationship, in the experiencing of which the nature of my own
therapeutic failures became suddenly clear. No verbal explanation
was ever needed; my first experience of taking help for a need that
had been denied was enough to give a basis for the years of
learning to follow."
The Rank-Taft-Rogers approach has also been called
"relationship" therapy--in that the therapy provides a new kind of
(disciplined) relationship, one which serves as fertile soil for
the client to grow from his/her own action.
Excerpts from Taft (1933)
"Therapy as it relates to the balance of forces in the
organization of personality has always been of prime importance to
me, but my concept of what such therapy involves has undergone a
complete revolution in the past twenty-five years. It has developed
from the notion of a reform of the 'other' through superior
knowledge of life and psychology, a concept closely allied to that
of scientific control in the field of emotions and behavior, to my
present acceptance of therapy as presented in this volume, a
therapy which is purely individual, non-moral, non-scientific,
non-intellectual, which can take place only when divorced from all
hint of control, unless it be the therapist's control of [herself]
in the therapeutic situation."
"The word 'therapy' is used instead of 'treatment' because in
its derivation and in my own feeling about the word, there is not
so much implication of manipulation of one person by another. To
treat, according to the dictionary is to apply a process to someone
or something. The word 'therapy' has no verb in English, for which
I am grateful; it cannot do anything to anybody, hence can
better represent a process, going on, observed perhaps, understood
perhaps, assisted perhaps, but not applied.
"The Greek noun from which therapy is derived means 'a servant'.
The verb means 'to wait'. … No one wants another to apply any
process to the inmost self, however desirable a change in
personality and behavior may seem objectively."
"Over [the client's use or non-use of the therapeutic
relationship,] I have no control beyond [1] the genuineness of my
understanding of the difficulty with which anyone takes or seeks
help, [2] my respect for the strength of the patient, however
negatively expressed, and [3] the reality of my acceptance of my
function as helper not ruler."
"As I conceive it, the therapeutic function involves the most
intense activity but it is an activity of attention, of
identification and understanding, of adaptation to the individual's
need and pattern, combined with an unflagging preservation of one's
own limitation and difference.
"[Any] preconceived idea of what the interview should sooner or
later bring forth, tends just as much to control and domination of
the client as if [the caseworker] had tried [deliberately] to
reform [the client's] habits or his morals. Very few case workers
ever realize [this], because if they did they would be greatly at a
loss as to what function remains for them."
"One might fairly define relationship therapy as a process in which
the individual finally learns to utilize the allotted hour from
beginning to end without undue fear, resistance, resentment or
greediness ... In so far [as] he has learned to live, to accept
this fragment of time in and for itself, and strange as it may
seem, if he can live this hour he has in his grasp the secret of
all hours, he has conquered life and time for the moment and in
principle."
"In the last analysis therapy as a qualitative affair must
depend upon the personal development of the therapist and [her]
ability to use consciously for the benefit of [her] client, the
insight and self-discipline which [she] has achieved in [her] own
struggle to accept self, life and time, as limited, and to be
experience fully only at the cost of fear, pain, and loss. ... To
make case work therapeutic, incidentally or deliberately, one must
be a therapist and only to the extent that this is true are the
relationships one sets up therapeutic … rests upon strength of
will, freedom to feel, and an ability to lend oneself to the use of
the other … in addition to skill. … [p. 22] to develop or
accept the self which is required by her job, a self with real
strength to be utilized therapeutically by the client.
"If I had followed out my own theoretical interest, I should
have pursued some of the biological material introduced by John,
his symbolic use of the rug in a birth struggle, his references to
toilet functions and breast, his use of the tent, etc. But I am
convinced that in so doing I should have lost sight of and
interfered with the creative use of a present experience, which I
had only to understand and respond to intuitively not to interpret
or investigate in terms of my own intellectual curiosity. To pursue
the symbol may be science. It is not therapy."
Podcast
Transcript
August Baker:
Welcome to Psychotherapy podcast. This is August Baker.
Psychotherapy podcast is where we interview leading scholars about
their books on psychotherapy. Today, I'm talking about the book,
Understanding and Enhancing Positive Regard in Psychotherapy: Carl
Rogers and Beyond. It's by Barry A. Farber, Jessica Y. Suzuki and
Daisy Ort.
Today, I'm privileged to speak to Barry Farber. He's a
professor of psychology and education at Teachers College Columbia
University. His research interests include the nature and
consequences of therapist provision of positive regard, the extent
to which patients, therapists, supervisors, and supervisees
honestly disclosed to each other, and the ways in which individuals
construct and evoke mental representations of others. Previous
books include Secrets and Lies in Psychotherapy, Self-disclosure in
Psychotherapy, which I highly recommend, the Psychotherapy of Carl
Rogers, and Rock and Roll Wisdom. He recently completed a term as
editor of the Journal of Clinical Psychology in Session and
maintains a small private practice of psychotherapy. Welcome,
Barry.
Barry A. Farber:
Thank you. August. Nice to be here.
August Baker:
To start off, tell us something about your two co-authors
rather than have me read the blurbs.
Barry A. Farber:
For sure.
Jessie Suzuki is a recent graduate, doctoral graduate, of our
clinical psychology program in Teachers College who's now in
private practice in New York. Actually, teaches for us at this
point our, family therapy course. Her dissertation was about
positive regard and she'd been working with me for years on issues
surrounding positive regard.
Daisy Ort is a current fourth year doctoral student in our
program, applying for internships. Another very talented doctoral
student who's also been running one of the research labs on
positive regard.
Both of them are wonderful additions and contributors to this
book.
August Baker:
Great. Thank you for that.
I want to start off, generally. Tell us about the book, what
it covers, its intended audience, and also something about the
history of the Positive Regard Lab, which I was interested in.
Barry A. Farber:
Some of your listeners, perhaps most of your listeners, will
know Roger's posited three necessary and sufficient ingredients of
psychotherapy. To be more technical, actually posited more than
that, but three fundamental conditions, which was the therapist
provision of empathy, positive regard, and
genuineness/transparency/authenticity. The other two, meaning the
empathy piece in particular and, to a certain extent, the
authenticity piece had been and continues to be fairly widely
researched. Especially, the empathy piece. Books, research
articles, conference presentations, et cetera.
For some reason, positive regard was neglected in the history
of psychotherapy research. Maybe, 10 years ago or so, we decided to
look at that particular variable a little more closely. Rogers
considered only the ways in which the client received positive
regard is what was important. That is, it wasn't, from his
perspective anyway, it didn't really matter what the therapist was
providing what mattered was what the patient... Well, actually he
preferred the word client, the nature of what the client was
receiving.
Over the years we started looking at the ways in which clients
most preferred, that is what kinds of positive regard they most
preferred. We expanded greatly the classic measures of positive
regard to include other potential aspects that clients might regard
as positively regarding. We also looked at the ways in which
therapists thought that they most often provided positive regard
and that which they thought the most salient aspects of positive
regard were. We started looking at some cultural aspects of
positive regard. That work is really central to what these labs are
continuing to do.
Now, one of the peculiarities of that positive regard or,
actually, two of them. Is the extension, which Rogers never really
articulated what positive regard looked like in psychotherapy. That
he thought of it as an attitude and he used multiple synonyms for
positive regard, non-possessive love, acceptance, liking among
others.
August Baker:
Prizing.
Barry A. Farber:
The ways in which the classic ways of actually assessing
positive regard was tremendously confounded with empathy. In fact,
when Rogers gave a couple of examples of positive regarding his
case history it was, essentially, empathy. One of the other pieces
we try to look at was to see whether positive regard could be
defined and whether it was manifest in both patients and therapists
views as more than empathy. What else it might consist of other
than the therapist's ways of accurately hearing what the client had
to say. Those are some of the activities that the lab has been
doing for about 10 years.
August Baker:
Yeah, that's interesting that empathy was confused with
positive regard. I think Kohut would say that empathy is neither
positive nor negative. You can understand what drives someone and
understand their perspective and then there's a question about
whether you're going to use that for good or for the ill of that
person.
Barry A. Farber:
A hundred percent.
August Baker:
Right.
Barry A. Farber:
Of course, the other piece that researchers have tried to
distinguish around empathy is the whole notion of intellectual
empathy versus emotional empathy. Do you understand or what I'm
saying? Or do you really feel on a more visceral level what I'm
trying to convey?
August Baker:
Right.
Barry A. Farber:
The other piece that you and I, for your listeners, have been
writing each other about is the extent to which Kohut did or didn't
benefit from being at least in proximity to Rogers, even though he
never quite acknowledged that.
August Baker:
He didn't. The Strozier biography of Kohut says that he never
mentioned him in his writing and it seems that he didn't really
understand what Rogers was saying. He seemed to think, from my
understanding of the Strozier biography of Kohut, there were two
times where Kohut mentioned Rogers peripherally. He expressed it as
though Rogers were asking people to free associate, but then not
add any interpretation.
Barry A. Farber:
I think, the last part of the sentence is true. He didn't add
interpretations, very often. Although, like virtually all
psychotherapists he wasn't pure in his theoretical implementation.
He did occasionally interpret, he did occasionally ask leading
questions. Yeah.
The other thing you and I have communicated about too before
this podcast is the extent to which, in particular, I feel, that
relate contemporary relational dynamic therapist having given
Rogers is due for emphasizing the extent to which the relationship
is fundamental, foundational even for the provision of good
psychotherapy. You have books about contemporary dynamic therapy,
even a book called Relationality by Stephen Mitchell, one of the
founders of Contemporary Relational Dynamic Therapy. He never even
mentions Rogers and the book called Relationality.
August Baker:
I like the distinction between being reparative or being
skeptical, paranoid. The paranoid way to say would be that the
psychoanalytic tradition is so arrogant that they don't want... The
thought of Rogers as a popularizer and we are not even going to
read him, because we don't think there's anything there. The more
repetitive way would be to say each of these traditions really only
reads the people in their tradition.
Barry A. Farber:
Every tradition is so insular, it's a hundred percent sure.
What's ironic, of course, is the extent to which most, especially
experienced therapists, now regard themselves as integrative. It's
a funny integration. It's like, "I'll utilize multiple aspects of
multiple traditions, but I'm not going to read bunch about any of
them."
August Baker:
Right. Exactly. Often my impression, a very strong emotional
loyalty towards their particular school or their particular...
Yeah.
Barry A. Farber:
Well, it's only relatively recently, in the last couple of
decades, that the American Psychological Association has insisted
that programs become more diversified in the theoretical
orientations that they're offering. That is in the eighties,
nineties, you could essentially have a doctoral program in clinical
or counseling psychology and offer one theoretical position. Now,
APA is more or less insisting that you offer your students multiple
ways of understanding clinical phenomena. Most new students, to the
point, is most new students are at least being... Understanding,
getting some awareness of the ways that... Even, say, at Teacher's
College, which is still primarily a psychodynamic tradition, our
students are learning a great deal about cognitive behavior
therapy, about IPT, interpersonal psychotherapy, and that's true
multiple places across the country.
August Baker:
Let me read a... This is an endorsement, which I think covers
nicely what the book covers. This is from Adam Horvath of Simon
Frazier University. He says, "Under one cover, this book offers a
rich and thorough review of the history and philosophical roots of
positive regard, the related empirical research," and I'll add that
includes both quantitative research and qualitative research, "and
a practical guide for clinical uses. It provides both an inside,
within the client centered tradition or the Rogerian tradition and
broader pan theoretical perspective."
I'll add there that the book goes into how other traditions
have developed these concepts, whether we're talking about
Winnicott or Kohut, or whether we're talking about back in
cognitive behavioral or Miller in Motivational Interviewing. Even
when they have... This book will cover how those traditions have
developed similar concepts and how they're different.
Barry A. Farber:
Yes.
August Baker:
Then continuing with Horvath, "The authors offer a deep
appreciation of the value of PR and, at the same time, also
carefully delineate the limits and challenges associated with the
concept." He says, "This outstanding book is a rare combination of
scientific rigor and tried clinical wisdom in an accessible and
engaging format. An essential item in the library of every
psychologist."
I thought that was very true.
Barry A. Farber:
Well, thank you and thank you, Adam.
August Baker:
Yeah. I didn't think you would want to say that, so I thought
I should read that. Let's talk about it.
Barry A. Farber:
There should be a limit to everyone's narcissism, but thank
you for offering that.
August Baker:
Let's talk about what is positive regard in one sense? Well,
you could look up positive, you could look up regard, that's what
it is, but it's really a term of art. It's more than just those two
words.
Barry A. Farber:
One of the complications I think you're getting to, which I'm
a good thing to speak about, is Roger's confusion. That's probably
a little bit too leading. Rogers wasn't clear throughout his career
and whether positive regard was really one attitude or two or one
omnibus attitude. What do I mean by that? In the beginning, he was
mostly about positive regard, which by the way was a term offered
by one of his doctoral students that he adopted, it was for the
most part acceptance. That is the therapist was to be nonjudgmental
and accepting of virtually everything that the client had to say.
That said, it wasn't just acceptance, because they also used words
like support, caring, liking. There was often an added emotionally,
positively laided emotional piece to it. To accept something
neutrally is distinctly different then me as a therapist letting
you know that not only do I accept what you say, but I care for
you, I support you. I like you. Non possessively loving you.
At times, including some ways assessing positive regards.
Barrett-Lennard Scales originally had two positive regards scales
that try to distinguish between these two. Historically, they've
melded into one piece in part, because of the quirk, I think of the
Bergen and Garfield Handbook of Psychotherapy and Behavior Change.
Sort of the Bible of psychotherapy research. Where the success of
addition talked about acceptance and affirmation as one
chapter.
August Baker:
Right.
Barry A. Farber:
There are times where the purer Rogerian's have pushed back
against positive regard as including an element of affirmation.
Other times, particularly non-classical person center theorists, as
well as other psychotherapy researchers have suggested no positive
guard needs to be seen as not just acceptance, but as having this
positive valence attitude of caring for. That's the confusion in
the literature.
August Baker:
Very interesting. You can see that you could have one of those
and not the other.
Barry A. Farber:
A hundred percent August.
August Baker:
You could be very caring about someone, but really hate it
when they tell you something about themselves. You can be...
Actually, it's pretty easy to be accepting of someone that you
don't care about. Right?
Barry A. Farber:
Right.
August Baker:
Yeah. You can see how they're different.
Barry A. Farber:
You're right. Now, contemporary, most not all. Contemporary
theorists with who still adhere to believe themselves as person
centered have more or less adopted the more omnibus definition and
positive regard. Some of the research outside my lab have pushed
back hard against that. "No. That's not what Rogers meant. That's
not what positive regard is." Positive regard is more or less
acceptance. If you add an element of evaluation you're no longer
talking about positive regard and have actually pushed back against
the term. It's really not positive regard they say. That's an
unfortunate term that Rogers adopted from his, as I said, his
student was actually Stendhal. You don't have suggested, the term
has sort of lost its essential meaning, because now we're including
too many attributes around it. I think not by the way, but there's
always people within every tradition who are more classical, and
traditional, and who don't like central terms to be adopted for
contemporary reasons...
August Baker:
Right.
Barry A. Farber:
...or somehow expanded in their meaning.
August Baker:
In one of the Rogers classic articles, and your book talks
about this, he uses the word prizing.
Barry A. Farber:
Prizing. Yeah. I forgot that. Absolutely uses the word
prizing. You're 100% right. Of course.
August Baker:
That's really supportive and...
Barry A. Farber:
100%. That's part of this other secondary definition. If I
prize you it's more than accepting you.
August Baker:
Yeah, that's right. Prizing, it's clearly emotional. There's
also a sense in which it's something you can do. You can cultivate.
It's not just, I don't know, I either like you or I don't. It's
something that it has a bit of an action within it.
Barry A. Farber:
I think I agree with you entirely. I can make statements that
suggest that I affirm, prize, support your actions. I'm proud of
you.
August Baker:
Right.
Barry A. Farber:
I've done well. I'm pleased with the work we're doing
together. I think that was an appropriate behavior that you showed
last week.
August Baker:
One really, as you said earlier, one of the things Rogers
claimed was that he didn't want to impose any theory on people.
Barry A. Farber:
Right. Though he did.
August Baker:
It's like a respecting a person's autonomy.
Barry A. Farber:
Right.
August Baker:
Is that part of... Do you put that under positive regard also?
Or is that sometimes considered there?
Barry A. Farber:
No, I do. It's one of the aspects.
August Baker:
Right.
Barry A. Farber:
Except a person's... Rodger's predated the army, "Be all that
you can be," but that was his notion.
August Baker:
Right.
Barry A. Farber:
Yes and no, "Be all that you can be," but he also, of course,
as you know, believed that if he showed you his total acceptance
and believed in your ability to find your own way that you would in
fact find a way toward being a virtuous person.
August Baker:
Right. Yeah. I think he had a view, as my understanding, which
is quite common today, I think, which is that yes, people can be
terrible, and vicious, and cruel, but it's usually coming from a
defensive place and that actually underneath that you wouldn't find
it. It's coming from a place of insecurity or defensiveness.
Barry A. Farber:
In that regard, he aligns himself to a great degree with
psychoanalytic tradition. That the object relations people suggest
that aggression is not particularly a primary drive as Freud would
have it, but rather reaction to people not getting what they
need.
August Baker:
One of the things-
Barry A. Farber:
Lack of interpersonal caring from others leads to aggressive
stance rather than it being a primary motive in life.
August Baker:
Right. The idea was he's not saying I'm okay with your
aggressive behavior or your aggressive thoughts. He's saying, I can
accept it and then he has this idea that rather than criticizing
you accepting you will get you to start to change.
Barry A. Farber:
Exactly. It's roughly analogous to the parental stance. To the
good parents who give the message to their kids, I don't like what
you're doing right now, but I'll always love you.
August Baker:
That's been misinterpreted a lot, of course, because people
don't read Rogers and they think he's saying I like
everything...
Barry A. Farber:
What you do. Right.
You and I agree entirely on this.
August Baker:
Okay.
Barry A. Farber:
Rogers would actually be asked that a fair amount in small
groups. How can you accept someone who's openly racist? For
example. He would give the answer that you and I are deliberating
on now, which is I don't accept the racism I accept the person and,
ultimately, to the extent that the person feels accepted by me he
will have not only a better view of him/herself, but of others in
the world as well.
August Baker:
He said it about himself also. He says, I find that the first
way for me to change is to accept myself the way I am.
Barry A. Farber:
Exactly.
August Baker:
Yeah.
Barry A. Farber:
Right.
August Baker:
This is a really current issue, because a lot of people who
are psychotherapists would be a really heightened, have heightened,
awareness of racism, for example. The question is what is your
advice to someone who is treating a patient who's racist and wants,
and feels it's their responsibility to respond to this, not just
acquiesce to it. I can see it would be really frustrating to think,
"Well, if I accept it eventually the person may come out of it
themselves." It's not immediate. And it seems to be...
Barry A. Farber:
I think you're a hundred percent right. There's a certain
irony in the extent that ultimately that working from a Rogerian
person-centered perspective, the person would change his/her point
of view. The irony I'm pointing to is that Rogers rarely, if ever,
did long term work. Especially, the whole second half of his life.
It was mostly demonstration interviews. He also remembered, and it
reminded your audience, that a good deal of the last few decades of
his life he spent with what we would now call social justice
pieces. Working in South Africa, working in Northern Ireland trying
to get warring factions to speak to each other by hearing and
accepting your points of view.
The notion is consistent with what you're suggesting. That
once a person feels heard, once a person feels truly heard, that he
or she can begin to let go of some of the anger and frustration.
That ways, it's a psychoanalytic piece too. That the psychoanalyst
who believe that underneath anger there is always... There's
inevitably sadness in that. What's manifest is not really what we
need to get to, but the sadness underneath the anger. Rogers of
course doesn't hold... He never liked psychoanalytic meta
psychology, but implicitly he believes something like that. That if
you go beyond the surface of what a person was saying by accepting
the person and letting the person consistently know that I care
about you, I support you, that the person would give up the more
aggressive, mean spirited pieces of both... Toward themselves,
toward any self-defeating behavior, as well as toward rank or
toward others.
Did it work? To a certain extent. People who are at the
conferences in South Africa have written reports that people began
to talk to each other with more respect after working with Rogers.
Did it lead to any long lasting changes? Hard to know. There's no
follow... 10, 20 year follow ups on his social justice work. Not
enough work, in general. Not just in person center Rogerian
tradition, but this too. One of the limitations of psychotherapy
research is how little follow up work we've done, whether
psychotherapies affects when door 1, 5, 10 years later. What we're
left with. What's the half life of psychotherapy person centered or
otherwise?
August Baker:
It occurs to me that one area where.... Again, I don't know
how much credit is given to Rogers, but this sounds also very much
like a technique or an approach to couples counseling or family
work. Where the therapist wants to get the people to be heard.
Barry A. Farber:
A hundred percent August. To be heard. In a somewhat similar
fashion, there are people who suggested all of Rogers conditions
really could be consolidated into one, which is the therapists need
to be responsive, and respectful, and that these are all variations
on the same thing. That people want to be heard.
August Baker:
If you can, even provisionally, bracket your own views on it,
and at least understand it, and show that you do that somehow leads
to something positive for Rogers.
Barry A. Farber:
I couldn't have said it better.
August Baker:
Let's talk about the empirical results, because Yalom has this
quote expresses his frustration with empirical work. Not that he
doesn't value empirical work, but that he finds it frustrating. He
says, "In psychotherapy research the precision of the result is
directly proportional to the triviality of the variables
studied."
Barry A. Farber:
Isn't that wonderful? I didn't know that quote, but I love
it.
August Baker:
You're picking here a variable that is very difficult to
capture.
Barry A. Farber:
Right.
August Baker:
The other thing that Yalom says is look, this is the nature of
the field where we can't be looking for precision. We have to live
in uncertainty. Still, it would be nice to be able to say no to
someone who says, "Oh, positive regard. There's no evidence that
correlates with anything."
Barry A. Farber:
Actually, there is good evidence.
August Baker:
That's what I'm saying. It's nice that... Yeah.
Barry A. Farber:
There are. At this point, there's a hundred or so studies that
taken together... I'm not going to get into the statistical piece,
but you throw all the studies into a blender, and you look at
outcome, and there's a moderate correlation between positive
regarding and outcome. To take in a larger look, there's only
positive correlations between any variable in outcome. Probably,
the largest correlation is between the alliance and outcome. Even
that is in the high point, maybe 0.28, something like that
range.Any variable taken by itself only is accounting for a small
proportion of the variance in outcome.
I like Yalom's quote. Let me get to your point.
August Baker:
Yeah.
Barry A. Farber:
What Yalom is suggesting, and Yalom and Rogers actually liked
each other and respected each other's work, they're suggesting that
the way that outcome is measured in psychotherapy research is
almost always in terms of reduction in symptoms. Saying the brief
symptom inventory or multiple other variations on that. That
doesn't per Rogers, per Yalom measure what they're doing. It's not
about reduction in symptoms it's something far more humanistic and
existential than that. It's more about how the person regards him
or herself. It's the way that you accept yourself. It's the way
that you accept others. It's the way that you connect with others.
I think Yalom and Rogers would agree as saying the way that outcome
is measured is not what I have in mind about what psychotherapy is
about.
August Baker:
But I want to do the best I can.
Barry A. Farber:
Absolutely.
August Baker:
The other thing that a lot of people may not know about Rogers
was that he was very committed to empirical research.
Barry A. Farber:
There are a lot of people who think Rogers is the first
significant psychotherapy researcher. As you know, the first person
who made his recordings available to the research community.
August Baker:
Right.
Barry A. Farber:
The first fully published transcript.
August Baker:
Right. Yeah. He was just very committed to... People think of,
"Oh, he's touchy feely," but he was...
Barry A. Farber:
No he was a theorist.
August Baker:
Yes.
Barry A. Farber:
He was very open to doing psychotherapy research. He really
wanted to identify the elements that worked. He specified what he
thought were the necessary and sufficient conditions, which by the
way are probably not neither necessary nor sufficient, though they
were significant.
August Baker:
He certainly framed it in a testable way.
Barry A. Farber:
A hundred percent, August. Couldn't agree more. He was a...
Right. Which by the way is in great contrast to Freud, that I don't
have the exact quote, but Freud is often cited as one person
interested in doing hard research on Freudian psychoanalysis in the
turn of the 20th century. Freud saying something like, I guess it
couldn't hurt, but it doesn't matter what you find, because I know
I'm right.
August Baker:
Right. Also, those concepts were not... He didn't have an eye
at all on testing. Melancholy is aggression turned inward. What are
you going to do with that?
Barry A. Farber:
Not much.
August Baker:
Yeah. Here's the thing. We can say there is evidence...
Barry A. Farber:
There is. Right.
August Baker:
...that there is hopeful. The question is now, if you have a
therapist who is not feeling positive regard...
Barry A. Farber:
What do you?
August Baker:
... with their patient do they...
Barry A. Farber:
Fake it.
August Baker:
...try to cultivate it? Do they fake it? Do they...? Roger's
response would be, well, they need to accept it in themselves and
that's the first step.
Barry A. Farber:
That's right.
August Baker:
But it's not...
Barry A. Farber:
I have a whole section on the book as that deals with this.
What happens when the mandate to be positive regarding seems to
conflict with the mandate to be authentic.
August Baker:
Yes. Right.
Barry A. Farber:
That's a incredibly hard issue. I think the way that you just
posed it now is essentially what Rogers would say. I'm going to try
to accept my sense of what you're trying to say here, but Rogers is
quoted at least once as saying something on the order of "If I
really didn't like the client. I would hope that I would have the
courage to say as much and to be authentic in my interactions with
that client." In one sense, that's virtuous. In another sense,
there's something ironic about it, because like Will Rogers, he
never met someone he didn't like.
August Baker:
Right.
Barry A. Farber:
It was never tested.
August Baker:
It was easy. Right.
Barry A. Farber:
Right. You have all these clients and he has probably more
than any other therapist living or dead, he has more case studies
available to study than any other person, but there's essentially
no evidence of him being angry or disappointed in a client.
August Baker:
Right. Except we do have this one case. I don't know. Did you
get a chance to read the description I sent you?
Barry A. Farber:
Yeah.
August Baker:
For our listeners, there was this one case which was really
affected Rogers.
Barry A. Farber:
Very much so.
August Baker:
Could you describe it in your terms? I didn't know what to
make of it.
Barry A. Farber:
Well, yeah.
Again, for your listeners, August and I had this wonderful
email correspondence about this case. You're right, the paragraph
before I'd forgotten that and saying... He did struggle mightily.
In fact, he struggled so mightily working with this woman who he
regarded a schizophrenic that following that he did two things. He
went into treatment and he also took a long vacation...
August Baker:
Right.
Barry A. Farber:
with his [inaudible 00:30:11]. He was incredibly upset with
himself for not being able to be helpful to this patient. He really
didn't look forward to working with her and felt he was not a good
therapist, because of that. He became quite self-deprecating. Both
you, August, and I agree that he probably misdiagnosed his patient
based on her presenting symptoms. Virtually everyone now would not
diagnose her as schizophrenic, but rather borderline. Although very
technically, we talked about borderline patients as early as Robert
Knight and Manager Clinic in the 40s, people really weren't talking
much about borderline patients when he was writing about his work
with her in the 50s. He misdiagnosed her and now we would have a
much greater understanding of why he was struggling with her. She
was pushing the boundaries. She was showing up in his doorstep
without having appointments.
August Baker:
Going to his house. Yeah.
Barry A. Farber:
Yeah. What I... Doorstep, literally. Not as professional
room.
August Baker:
Right.
Barry A. Farber:
His personal, yeah, exactly, home. He didn't keep the
boundaries that we would now regard as fundamental in working with
someone who would be diagnosed with borderline personality
disorder. There's a bit of a glib statement that people working in
inpatient hospital units have uttered over the years, including
even 40 years ago when I was an intern. 45 years ago. Something
like if the hospital ward feels absolutely overwhelming and
psychotic it's not because there are schizophrenic patients on the
ward. It's because there are borderline patients on the unit who
tend to push buttons, and push boundaries, and be provocative.
This is one of those instances where Rogers, as you know,
didn't like diagnoses. Really believe in diagnoses. In this case,
had he understood more about diagnoses, including what patients
diagnosed now with borderline personality disorder were presenting,
he would probably have a better sense of what he didn't do
sufficiently well. You're right, absolutely. That was an important
case in which he didn't like. He didn't say he didn't like it, but
he did say he didn't like himself for...
August Baker:
True.
Barry A. Farber:
...for not being a good enough therapist for this person. He
certainly implied that he didn't enjoy working with her and he
almost escaped from her quote clutches.
August Baker:
Right.
Barry A. Farber:
He stopped working with her. He did, to his credit, reassign
her to someone else in his clinic, but...
August Baker:
Right.
Barry A. Farber:
Yeah, she certainly pushed his buttons mightily.
August Baker:
Right. He says, "I started to feel it was a real drain on me.
Yet, I stubbornly felt that I should be able to help her..."
Barry A. Farber:
That's right.
August Baker:
"...and permitted the contact to continue long after they had
ceased to be therapeutic and involved only suffering from me. I
recognized that many of her insights were sounder than mine and
this destroyed my confidence in myself. I got to the point where I
could not separate myself from hers. I literally lost the
boundaries of myself."
Barry A. Farber:
Terrible.
August Baker:
He says, "This situation's best summarized by one of her
dreams in which a cat was clawing my guts out, but really did not
wish to do so." Does this have anything to do with positive regard
with a borderline patient? Is the positive regard to stimulating
or...?
Barry A. Farber:
It certainly can be. There's another section of the book that
speaks about, for some patients who've grown up feeling is that the
only thing they deserve is hurt the positive regard feels
disingenuous. They don't deserve to be positive regarded. It's a
little more complicated than, actually, the sentence I just made,
because, as you know, the primary defense mechanism for borderline
patients is splitting. On the one hand, borderline patients want to
idealize and be idealized, but on the other hand, it doesn't take
much for them to turn on you. When you go from being idealized to
being completely criticized and being seen as worthless.
Particularly, for novice therapists to working with borderline
patients often there's a vacillation between wanting to save them.
I'll be the first person in a long line of people, long line of
therapists, to work effectively with this person diagnosed with
borderline person disorder. Versus, I can't tolerate the feelings
that I have for, I'm going to use female pronoun here, for her or
for myself. Or Rogers feeling totally ineffective.
Yeah, I think one has to be very careful in what one offers to
borderline patients. Almost from many theoretical perspective.
August Baker:
Right.
Barry A. Farber:
Positive regard, one has to be particularly careful about, one
accepts the patient. In fact, borderline patients need to feel
accepted, because per almost any theoretical tradition it's the
fact that they were, many anyway, were abused, traumatized,
invalidated, in Marsha Linehan's terms growing up. The notion of
the quick digression, Marsha Linehan's notion of validation has
much in common with Roger's notion of positive regard.
Yes, it's important to validate why a borderline patient would
act as, I'm going to use female pronoun here, she does or would,
but one has to be very careful about going over the top and being
overly supportive, because then you're setting up the stage for the
person always wanting that. Particularly, patients within this
diagnosis are going to feel deprived if you're not sufficiently
giving them that and push for more.
I think your point is, and it's very well taken, I do note
this in the book, we I should say, because I have authors, of
course, note this in the book. Positive regard like almost any
variable needs to be offered in part with a notion of who this
person is diagnostically, terms of identity, understanding there
are cultural differences. All of these need to be taken into
consideration. One should be thinking about not just that I'm
accepting, but what forms of positive regard am I offering at this
time, to this person with what potential consequences. I ask people
to be mindful. I think in positive regard is incredibly significant
and important virtually all forms of psychotherapy. Again, it's an
attitude that needs to be thought about in terms of dosage, timing,
the exact type one is being offered. Now we're in the realm of what
Bill Stiles calls responsiveness. One has to think about what's the
best way of offering, what kind of intervention, at what point in
the therapy, for this particular patient.
August Baker:
I see that here's a case where we separate the acceptance and
the support. Right.
Barry A. Farber:
I think that's right.
August Baker:
Something about the support, that patient wanting to go into
his house.
Barry A. Farber:
I accept the fact that you want to do this...
August Baker:
Right.
Barry A. Farber:
...but I simply can't allow it. I certainly don't support your
behavior in this regard.
August Baker:
Right.
Barry A. Farber:
No positive reinforcement for your doing it. I'm not seeing
you.
August Baker:
Right. The caring, liking, it's like, "Oh my gosh. You care
and like me, we should be living together." Is that another
possibility.
Barry A. Farber:
That's certainly true of borderline patients who will
continue, of course, as you know, to push boundaries. Right? I
accept the fact that you want this, but my authentic self, and my
need to protect myself, and protect the relationship says we need
to talk about this, but we can't have this. That's a little
psychodynamic rather than person centered. When I say, we need to
talk about this, but I think at Roger's best except the roots of
the need, but certainly not offer any support for the behavior per
se.
August Baker:
Excellent. Well, this has been a privilege to speak to you
today Barry. This is a great book, Understanding and Enhancing
Positive Regard in Psychotherapy: Carl Rogers and Beyond, Barry
Farber, Jessica Suzuki, and Daisy Ort, 2022, American Psychological
Association. Thanks for joining me.
Barry A. Farber:
My pleasure, August.
August Baker:
Thanks very much.
