Person-centered therapy (PCT) is a radical therapeutic ethic that leads to therapeutic discipline. It is not purely idiosyncratic, with therapists doing anything willy-nilly with their clients, reacting to compulsion or fancy. That is not person-centered therapy in the slightest. Person-centered therapy is a refusal to either disempower clients or to kowtow to scientism. It is a commitment to seek understanding over giving advice and to express genuine regard for humanness.
Unfortunately, critics of PCT often cast it as a kind of therapeutic anarchy or as lacking an empirical research base. While I do not intend this as an opportunity to refute baseless critique, I do wish to convey a more objective view, at a glimpse, of one of the pioneering PCT models: Rogerian therapy. And I’ll provide a glimpse into accurate empathy in action.
“Reflect the Emotionalized Attitude Being Expressed”
Carl Rogers had a highly disciplined view of the person-centered approach. He said many times that therapists should be careful to "reflect the emotionalized attitude being expressed." In Counseling and Psychotherapy (1942), he used this phrase again and again, urging therapists not to reflect emotions or aspects of the client's mindset that you think you are perceiving but that have not yet been revealed directly by the client.
Person-centered therapists don't believe they're clairvoyant; quite the opposite. They deeply value checking their intuitions with clients as necessary for promoting true understanding. At the same time, no model can be purely logical, rational, or objective, and so that perhaps hints at the dialectic inherent in a person-centered paradigm.
The most important therapeutic tool that Rogers described is both a therapist skill and a facilitated intersubjective experience that he called “accurate empathy.” It is part of a careful dance – respectful warmness, genuineness, not presuming to know another's experience – that is what Rogers described when he spoke about "accurate empathy." It’s why he cautioned us to reflect only the emotionalized attitude being expressed and not to reflect other things – other thoughts, other feelings that we think that the client might be having, but that they have not said anything about explicitly and would amount to mere conjecture. If we’re truly Rogerian, we can conjecture on the basis only of what the client has expressed to us, not on the basis of what the client has not expressed to us. By doing so, we stay firmly in the flow of the dance with a client rather than putting ourselves in the position of expert, as if we have on one extreme, pure logic, or on the other extreme, clairvoyance.
Accurate Empathy in Action
I can remember that initially, Karys was not too happy to sit with me during weekly sessions. Having experienced a childhood of broken trust and sexual trauma and after having bounced around between too many foster homes over too many years, she was understandably reticent to relax into my couch and lean into our relationship.
Karys entered therapy oscillating between expressive anger, reflective sadness, and emotional distance. These matched her foster parents' reports from home. In her first sessions with me, she had seemed emotionally rigid. As time wore on, I began to experience Karys differently. She seemed to be appropriately vulnerable, emotionally pliable, and more deeply reflective. However, her parents’ reports to me were nearly unchanged.
With her permission, I invited Karys’s foster parents, Boyd and Angie, to join us for three sessions in which I set the tone with rules designed to keep them from utilizing our time to provide me information or bring any other agenda into session. Karys would guide us, with the caveat that, as the therapist, I would take some liberties in providing gently offered facilitation.
My goal for my own facilitative efforts was, in essence, to model for Boyd and Angie the rhythm and rhyme, give and take, of noticing and asking, along with tentatively checking my understanding of what Karys was communicating about her own thoughts, attitudes, and feelings. I often got it wrong, according to Karys. She boldly corrected me, again and again, and I’d check again to make sure I understood as fully as possible. She sometimes expressed irritation when I was “being weird,” or dense, yet she was generous in spirit, even still. I’d defend myself playfully. We’d laugh.
I wondered if Boyd and Angie noticed the elegance of empathic exchange. Some time later, Boyd asked to speak briefly with me after Karys had achieved her treatment goals and was discharged from care. He said, “It's like the light in her has been turned brighter." He also acknowledged, “It really is something, how when we shifted over to what you had modeled for us with Karys, how we were able to better understand what she was experiencing. And how she seemed to be able to better understand, of us, the love we had been trying so hard to show. It’s as if we were a threat before. Now we’re getting somewhere.”
The Heartbeat of Therapy
Beyond justifying health insurance reimbursement, “pathology” and “disorder” are often untenable, and more importantly unhelpful, categorizations of a person’s experience. And the treatment should be no more modular than the person. A wise mentor once described for me the importance of conceptualizing effective psychotherapy as “puzzling through a process with someone,” rather than the kind of rote skillset too often characteristic of “evidence-based practice."
To become increasingly flexible and resilient, clients must experience freedom within felt pushes and pulls of powerful forces in which problems maintain themselves. Therapists have skillful empathy to offer, and empathy, at its best, has power to re-shape experience. Once clients experience themselves feeling more understood in session, they often experience themselves feeling more understood in life. Do not underestimate the value of feeling understood.
This is an abridged version of an article that appears at Psychotherapy.net.
Rogers, C.R. (1942). Counseling and psychotherapy: Newer concepts in practice. Cambridge, MA: The Riverside Press.