THE NECESSARY AND SUFFICIENT CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE - Carl Roger
THE NECESSARY AND SUFFICIENT CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE - Carl Roger
THE NECESSARY AND SUFFICIENT CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE - Carl Roger
CARL R. ROGERS
University of Chicago
For many years I have been engaged in psy- effective living; change in behavior away from
chotherapy with individuals in distress. In recent behaviors generally regarded as immature and
years I have found myself increasingly concerned toward behaviors regarded as mature. This brief
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
with the process of abstracting from that experi- description may suffice to indicate the kind of
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ence the general principles which appear to be change for which we are considering the precon-
involved in it. I have endeavored to discover any ditions. It may also suggest the ways in which
orderliness, any unity which seems to inhere in this criterion of change may be determined.2
the subtle, complex tissue of interpersonal rela-
tionship in which I have so constantly been im- The Conditions
mersed in therapeutic work. One of the current
products of this concern is an attempt to state, in As I have considered my own clinical experi-
formal terms, a theory of psychotherapy, of per- ence and that of my colleagues, together with the
sonality, and of interpersonal relationships which pertinent research which is available, I have
will encompass and contain the phenomena of drawn out several conditions which seem to me
my experience.1 What I wish to do in this paper to be necessary to initiate constructive personal-
is to take one very small segment of that theory, ity change, and which, taken together, appear to
spell it out more completely, and explore its be sufficient to inaugurate that process. As I have
meaning and usefulness. worked on this problem I have found myself
surprised at the simplicity of what has emerged.
The Problem The statement which follows is not offered with
any assurance as to its correctness, but with the
The question to which I wish to address myself expectation that it will have the value of any
is this: Is it possible to state, in terms which are theory, namely that it states or implies a series of
clearly definable and measurable, the psycholog- hypotheses which are open to proof or disproof,
ical conditions which are both necessary and suf- thereby clarifying and extending our knowledge
ficient to bring about constructive personality of the field.
change? Do we, in other words, know with any Since I am not, in this paper, trying to achieve
precision those elements which are essential if suspense, I will state at once, in severely rigorous
psychotherapeutic change is to ensue? and summarized terms, the six conditions which I
Before proceeding to the major task let me have come to feel are basic to the process of
dispose very briefly of the second portion of the personality change. The meaning of a number of
question. What is meant by such phrases as “psy- the terms is not immediately evident, but will be
chotherapeutic change,” “constructive personal-
ity change”? This problem also deserves deep
1
and serious consideration, but for the moment let This formal statement is entitled “A theory of therapy,
me suggest a common-sense type of meaning personality and interpersonal relationships, as developed in
the client-centered framework,” by Carl R. Rogers. The
upon which we can perhaps agree for purposes of
manuscript was prepared at the request of the Committee of
this paper. By these phrases is meant: change in the American Psychological Association for the Study of the
the personality structure of the individual, at both Status and Development of Psychology in the United States.
surface and deeper levels, in a direction which It will be published by McGraw-Hill in one of several vol-
clinicians would agree means greater integration, umes being prepared by this committee. Copies of the unpub-
less internal conflict, more energy utilizable for lished manuscript are available from the author to those with
special interest in this field.
2
That this is a measurable and determinable criterion has
This article is a reprint from Journal of Consulting Psy- been shown in research already completed. See (7), especially
chology, 1957, Vol. 21, No. 2, 95–103. chapters 8, 13, and 17.
240
Special Section: Conditions of Therapeutic Personality Change
clarified in the explanatory sections which fol- consciously aware of this impact. Thus it might
low. It is hoped that this brief statement will have be difficult to know whether a catatonic patient
much more significance to the reader when he has perceives a therapist’s presence as making a dif-
completed the paper. Without further introduc- ference to him—a difference of any kind— but it
tion let me state the basic theoretical position. is almost certain that at some organic level he
For constructive personality change to occur, it does sense this difference.
is necessary that these conditions exist and con- Except in such a difficult borderline situation
tinue over a period of time: as that just mentioned, it would be relatively easy
to define this condition in operational terms and
1. Two persons are in psychological contact. thus determine, from a hard-boiled research point
of view, whether the condition does, or does not,
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241
Rogers
picture he holds of himself; to admit incompre- The Therapist’s Genuineness in the Relationship
hensible fears does not contradict his self concept.
Another instance would be the mother who The third condition is that the therapist should
develops vague illnesses whenever her only son be, within the confines of this relationship, a
makes plans to leave home. The actual desire is to congruent, genuine, integrated person. It means
hold on to her only source of satisfaction. To that within the relationship he is freely and
perceive this in awareness would be inconsistent deeply himself, with his actual experience accu-
rately represented by his awareness of himself. It
with the picture she holds of herself as a good
is the opposite of presenting a facade, either
mother. Illness, however, is consistent with her
knowingly or unknowingly.
self concept, and the experience is symbolized in
It is not necessary (nor is it possible) that the
this distorted fashion. Thus again there is a basic
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242
Special Section: Conditions of Therapeutic Personality Change
apist’s congruence or integration in the relation- “I am not inclined to pass judgment on what the
ship; and a low correlation, the opposite. client tells me”; “I like the client.” To the extent
that both therapist and observers perceive these
Unconditional Positive Regard items as characteristic, or their opposites as un-
characteristic, Condition 4 might be said to be
To the extent that the therapist finds himself met.
experiencing a warm acceptance of each aspect
of the client’s experience as being a part of that
client, he is experiencing unconditional posi- Empathy
tive regard. This concept has been developed
The fifth condition is that the therapist is ex-
by Standal (8). It means that there are no condi-
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Rogers
indicated by Fiedler’s research (3) in which items used as for Condition 3.) If several items descrip-
such as the following placed high in the descrip- tive of acceptance and empathy are sorted by the
tion of relationships created by experienced ther- client as characteristic of the relationship, then
apists: this condition could be regarded as met. In the
The therapist is well able to understand the patient’s feelings.
present state of our knowledge the meaning of “to
a minimal degree” would have to be arbitrary.
The therapist is never in any doubt about what the patient
means.
Some Comments
The therapist’s remarks fit in just right with the patient’s
mood and content. Up to this point the effort has been made to
The therapist’s tone of voice conveys the complete ability to present, briefly and factually, the conditions
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
share the patient’s feelings. which I have come to regard as essential for
This document is copyrighted by the American Psychological Association or one of its allied publishers.
An operational definition of the therapist’s em- psychotherapeutic change. I have not tried to give
pathy could be provided in different ways. Use the theoretical context of these conditions nor to
might be made of the Q sort described under explain what seem to me to be the dynamics of
Condition 3. To the degree that items descriptive their effectiveness. Such explanatory material
of accurate empathy were sorted as characteristic will be available, to the reader who is interested, in
by both the therapist and the observers, this con- the document already mentioned (see footnote 1).
dition would be regarded as existing. I have, however, given at least one means of
Another way of defining this condition would defining, in operational terms, each of the condi-
be for both client and therapist to sort a list of tions mentioned. I have done this in order to
items descriptive of client feelings. Each would stress the fact that I am not speaking of vague
sort independently, the task being to represent the qualities which ideally should be present if some
feelings which the client had experienced during other vague result is to occur. I am presenting
a just completed interview. If the correlation be- conditions which are crudely measurable even in
tween client and therapist sortings were high, the present state of our technology, and have
accurate empathy would be said to exist, a low suggested specific operations in each instance
correlation indicating the opposite conclusion. even though I am sure that more adequate meth-
Still another way of measuring empathy would ods of measurement could be devised by a seri-
be for trained judges to rate the depth and accu- ous investigator.
racy of the therapist’s empathy on the basis of My purpose has been to stress the notion that
listening to recorded interviews. in my opinion we are dealing with an if-then
phenomenon in which knowledge of the dynam-
The Client’s Perception of the Therapist ics is not essential to testing the hypotheses.
Thus, to illustrate from another field: if one sub-
The final condition as stated is that the client stance, shown by a series of operations to be the
perceives, to a minimal degree, the acceptance substance known as hydrochloric acid, is mixed
and empathy which the therapist experiences for with another substance, shown by another series
him. Unless some communication of these atti- of operations to be sodium hydroxide, then salt
tudes has been achieved, then such attitudes do and water will be products of this mixture. This is
not exist in the relationship as far as the client is true whether one regards the results as due to
concerned, and the therapeutic process could not, magic, or whether one explains it in the most
by our hypothesis, be initiated. adequate terms of modern chemical theory. In the
Since attitudes cannot be directly perceived, it same way it is being postulated here that certain
might be somewhat more accurate to state that definable conditions precede certain definable
therapist behaviors and words are perceived by changes and that this fact exists independently of
the client as meaning that to some degree the our efforts to account for it.
therapist accepts and understands him.
An operational definition of this condition The Resulting Hypotheses
would not be difficult. The client might, after an
interview, sort a Q-sort list of items referring to The major value of stating any theory in un-
qualities representing the relationship between equivocal terms is that specific hypotheses may
himself and the therapist. (The same list could be be drawn from it which are capable of proof or
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Special Section: Conditions of Therapeutic Personality Change
disproof. Thus, even if the conditions which have were many other conditions in addition to those
been postulated as necessary and sufficient con- described, which are essential for psychotherapy.
ditions are more incorrect than correct (which I To point this up it may be well to mention a few
hope they are not), they could still advance sci- of the conditions which, after thoughtful consid-
ence in this field by providing a base of opera- eration of our research and our experience, are
tions from which fact could be winnowed out not included.
from error. For example, it is not stated that these condi-
The hypotheses which would follow from the tions apply to one type of client, and that other
theory given would be of this order: conditions are necessary to bring about psycho-
therapeutic change with other types of client.
If these six conditions (as operationally de-
Probably no idea is so prevalent in clinical work
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
change (as defined) will occur in the client. today as that one works with neurotics in one
way, with psychotics in another; that certain ther-
If one or more of these conditions is not apeutic conditions must be provided for compul-
present, constructive personality change will sives, others for homosexuals, etc. Because of
not occur. this heavy weight of clinical opinion to the con-
trary, it is with some “fear and trembling” that I
These hypotheses hold in any situation advance the concept that the essential conditions
whether it is or is not labeled “psychother- of psychotherapy exist in a single configuration,
apy.” even though the client or patient may use them
Only Condition 1 is dichotomous (it either is very differently.4
present or is not), and the remaining five It is not stated that these six conditions are the
occur in varying degree, each on its contin- essential conditions for client-centered therapy,
uum. Since this is true, another hypothesis and that other conditions are essential for other
follows, and it is likely that this would be the types of psychotherapy. I certainly am heavily
simplest to test: influenced by my own experience, and that expe-
rience has led me to a viewpoint which is termed
If all six conditions are present, then the “client centered.” Nevertheless my aim in stating
greater the degree to which Conditions 2 to this theory is to state the conditions which apply
6 exist, the more marked will be the con- to any situation in which constructive personality
structive personality change in the client. change occurs, whether we are thinking of clas-
sical psychoanalysis, or any of its modern off-
At the present time the above hypothesis can only
shoots, or Adlerian psychotherapy, or any other.
be stated in this general form—which implies
It will be obvious then that in my judgment much
that all of the conditions have equal weight. Em-
of what is considered to be essential would not be
pirical studies will no doubt make possible much
found, empirically, to be essential. Testing of
more refinement of this hypothesis. It may be, for
example, that if anxiety is high in the client, then
the other conditions are less important. Or if uncon- 4
I cling to this statement of my hypothesis even though it
ditional positive regard is high (as in a mother’s is challenged by a just completed study by Kirtner (5). Kirtner
love for her child), then perhaps a modest degree of has found, in a group of 26 cases from the Counseling Center
empathy is sufficient. But at the moment we can at the University of Chicago, that there are sharp differences
only speculate on such possibilities. in the client’s mode of approach to the resolution of life
difficulties, and that these differences are related to success in
psychotherapy. Briefly, the client who sees his problem as
Some Implications involving his relationships, and who feels that he contributes
to this problem and wants to change it, is likely to be suc-
Significant Omissions cessful. The client who externalizes his problem, feeling little
self-responsibility, is much more likely to be a failure. Thus
If there is any startling feature in the formula- the implication is that some other conditions need to be
tion which has been given as to the necessary provided for psychotherapy with this group. For the present,
conditions for therapy, it probably lies in the however, I will stand by my hypothesis as given, until Kirt-
elements which are omitted. In present-day clin- ner’s study is confirmed, and until we know an alternative
ical practice, therapists operate as though there hypothesis to take its place.
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Rogers
some of the stated hypotheses would throw light the more I am forced to the conclusion that such
on this perplexing issue. We may of course find diagnostic knowledge is not essential to psycho-
that various therapies produce various types of therapy.5 It may even be that its defense as a
personality change, and that for each psychother- necessary prelude to psychotherapy is simply a
apy a separate set of conditions is necessary. protective alternative to the admission that it is,
Until and unless this is demonstrated, I am hy- for the most part, a colossal waste of time. There
pothesizing that effective psychotherapy of any is only one useful purpose I have been able to
sort produces similar changes in personality and observe which relates to psychotherapy. Some
behavior, and that a single set of preconditions is therapists cannot feel secure in the relationship
necessary. with the client unless they possess such diagnos-
It is not stated that psychotherapy is a special tic knowledge. Without it they feel fearful of him,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
kind of relationship, different in kind from all unable to be empathic, unable to experience un-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
others which occur in everyday life. It will be conditional regard, finding it necessary to put up
evident instead that for brief moments, at least, a pretense in the relationship. If they know in
many good friendships fulfill the six conditions. advance of suicidal impulses they can somehow
Usually this is only momentarily, however, and be more acceptant of them. Thus, for some ther-
then empathy falters, the positive regard becomes apists, the security they perceive in diagnostic
conditional, or the congruence of the “therapist” information may be a basis for permitting them-
friend becomes overlaid by some degree of fa- selves to be integrated in the relationship, and to
cade or defensiveness. Thus the therapeutic rela- experience empathy and full acceptance. In these
tionship is seen as a heightening of the construc- instances a psychological diagnosis would cer-
tive qualities which often exist in part in other tainly be justified as adding to the comfort and
relationships, and an extension through time of hence the effectiveness of the therapist. But even
qualities which in other relationships tend at best here it does not appear to be a basic precondition
to be momentary. for psychotherapy.6
It is not stated that special intellectual profes- Perhaps I have given enough illustrations to
sional knowledge—psychological, psychiatric, indicate that the conditions I have hypothesized
medical, or religious—is required of the thera- as necessary and sufficient for psychotherapy are
pist. Conditions 3, 4, and 5, which apply espe- striking and unusual primarily by virtue of what
cially to the therapist, are qualities of experience, they omit. If we were to determine, by a survey of
not intellectual information. If they are to be the behaviors of therapists, those hypotheses
acquired, they must, in my opinion, be acquired which they appear to regard as necessary to psy-
through an experiential training—which may be, chotherapy, the list would be a great deal longer
but usually is not, a part of professional training. and more complex.
It troubles me to hold such a radical point of
view, but I can draw no other conclusion from my
experience. Intellectual training and the acquiring Is This Theoretical Formulation Useful?
of information has, I believe, many valuable Aside from the personal satisfaction it gives as
results— but becoming a therapist is not one of a venture in abstraction and generalization, what
those results. is the value of a theoretical statement such as has
It is not stated that it is necessary for psycho-
therapy that the therapist have an accurate psy-
chological diagnosis of the client. Here too it 5
There is no intent here to maintain that diagnostic eval-
troubles me to hold a viewpoint so at variance uation is useless. We have ourselves made heavy use of such
with my clinical colleagues. When one thinks of methods in our research studies of change in personality. It is
the vast proportion of time spent in any psycho- its usefulness as a precondition to psychotherapy which is
questioned.
logical, psychiatric, or mental hygiene center on 6
In a facetious moment I have suggested that such thera-
the exhaustive psychological evaluation of the pists might be made equally comfortable by being given the
client or patient, it seems as though this must diagnosis of some other individual, not of this patient or
serve a useful purpose insofar as psychotherapy client. The fact that the diagnosis proved inaccurate as psy-
is concerned. Yet the more I have observed ther- chotherapy continued would not be particularly disturbing,
apists, and the more closely I have studied re- because one always expects to find inaccuracies in the diag-
search such as that done by Fiedler and others (4), nosis as one works with the individual.
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Special Section: Conditions of Therapeutic Personality Change
been offered in this paper? I should like to spell transference, hypnosis, interpretation of life style,
out more fully the usefulness which I believe it suggestion, and the like. Each of these techniques
may have. may, however, become a channel for communi-
In the field of research it may give both cating the essential conditions which have been
direction and impetus to investigation. Since it formulated. An interpretation may be given in a
sees the conditions of constructive personality way which communicates the unconditional pos-
change as general, it greatly broadens the op- itive regard of the therapist. A stream of free
portunities for study. Psychotherapy is not the association may be listened to in a way which
only situation aimed at constructive personality communicates an empathy which the therapist is
change. Programs of training for leadership in experiencing. In the handling of the transference
industry and programs of training for military an effective therapist often communicates his
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
leadership often aim at such change. Educa- own wholeness and congruence in the relation-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
tional institutions or programs frequently aim ship. Similarly for the other techniques. But just
at development of character and personality as as these techniques may communicate the ele-
well as at intellectual skills. Community agen- ments which are essential for therapy, so any one
cies aim at personality and behavioral change of them may communicate attitudes and experi-
in delinquents and criminals. Such programs ences sharply contradictory to the hypothesized
would provide an opportunity for the broad conditions of therapy. Feeling may be “reflected”
testing of the hypotheses offered. If it is found in a way which communicates the therapist’s lack
that constructive personality change occurs in of empathy. Interpretations may be rendered in a
such programs when the hypothesized condi- way which indicates the highly conditional re-
tions are not fulfilled, then the theory would gard of the therapist. Any of the techniques may
have to be revised. If however the hypotheses communicate the fact that the therapist is ex-
are upheld, then the results, both for the plan- pressing one attitude at a surface level, and an-
ning of such programs and for our knowledge other contradictory attitude which is denied to his
of human dynamics, would be significant. In own awareness. Thus one value of such a theo-
the field of psychotherapy itself, the applica- retical formulation as we have offered is that it
tion of consistent hypotheses to the work of may assist therapists to think more critically
various schools of therapists may prove highly about those elements of their experience, atti-
profitable. Again the disproof of the hypotheses tudes, and behaviors which are essential to psy-
offered would be as important as their confir- chotherapy, and those which are nonessential or
mation, either result adding significantly to our even deleterious to psychotherapy.
knowledge. Finally, in those programs— educational, cor-
For the practice of psychotherapy the theory rectional, military, or industrial—which aim to-
also offers significant problems for consideration. ward constructive changes in the personality
One of its implications is that the techniques of structure and behavior of the individual, this for-
the various therapies are relatively unimportant mulation may serve as a very tentative criterion
except to the extent that they serve as channels against which to measure the program. Until it is
for fulfilling one of the conditions. In client- much further tested by research, it cannot be
centered therapy, for example, the technique of thought of as a valid criterion, but, as in the field
“reflecting feelings” has been described and com- of psychotherapy, it may help to stimulate critical
mented on (6, pp. 26 –36). In terms of the theory analysis and the formulation of alternative con-
here being presented, this technique is by no ditions and alternative hypotheses.
means an essential condition of therapy. To the
extent, however, that it provides a channel by Summary
which the therapist communicates a sensitive em-
pathy and an unconditional positive regard, then Drawing from a larger theoretical context, six
it may serve as a technical channel by which the conditions are postulated as necessary and suffi-
essential conditions of therapy are fulfilled. In the cient conditions for the initiation of a process of
same way, the theory I have presented would see constructive personality change. A brief explana-
no essential value to therapy of such techniques tion is given of each condition, and suggestions are
as interpretation of personality dynamics, free made as to how each may be operationally defined
association, analysis of dreams, analysis of the for research purposes. The implications of this
247
Rogers
theory for research, for psychotherapy, and for ed- Adlerian therapy. J. consult. Psychol., 1950,
ucational and training programs aimed at construc- 14, 436 – 445.
4. Fiedler, F. E. Quantitative studies on the role of
tive personality change, are indicated. It is pointed therapists’ feelings toward their patients. In
out that many of the conditions which are com- O. H. Mowrer (Ed.), Psychotherapy: theory
monly regarded as necessary to psychotherapy are, and research. New York: Ronald, 1953.
in terms of this theory, nonessential. 5. Kirtner, W. L. Success and failure in client-cen-
tered therapy as a function of personality
variables. Unpublished master’s thesis, Univer.
References of Chicago, 1955.
6. Rogers, C. R. Client-centered therapy. Boston:
1. Bown, O. H. An investigation of therapeutic rela-
tionship in client-centered therapy. Unpub- Houghton Mifflin, 1951.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
lished doctor’s dissertation, Univer. of Chi- 7. Rogers, C. R., & Dymond, Rosalind F. (Eds.)
This document is copyrighted by the American Psychological Association or one of its allied publishers.
248