Person-Centered Therapy Is Not Passive, It's Deep Listening

Carl Rogers is well known for his three conditions of unconditional positive regard, empathy, and congruence, but less well understood is what these look like in practice. Rogers was not proposing a passive sort of therapy in which the therapist smiles, nods, and agrees with whatever the client has said.

In this post, I will correct common misunderstandings about Rogers's approach to therapy and show that, in practice, it involves a much more active and challenging approach than is often thought.

First, it has a clear theoretical rationale. In person-centered therapy, unconditional positive regard is understood to be the healing factor. This is because in Rogers’s theory, it is hypothesized that people’s problems arise from their introjections of conditions of worth—all the 'oughts' and 'shoulds' a person learns early in life about how they need to be to please other people. This results in people having conditional self-regard; they have learned only to value themselves to the extent to which they live up to other people’s expectations. Healthy living, on the other hand, comes about when we learn to value ourselves for who we are and through setting our expectations for ourselves. For this reason, experiencing unconditional positive regard from a therapist can begin to reverse this prior conditioning.

Unconditional positive regard is, however, a hugely misunderstood concept that is often conflated with “liking” someone, but it is not about liking. Positive regard refers to the warmth and kindness that one has toward a person as a reflection of one’s general attitude toward humanity. Unconditional positive regard refers to the consistency of this regard over time. The therapist does not fluctuate in their regard for the other person. Rather, their level of regard is consistent regardless of what the other person does or says. As an example from life outside the therapy room, think of a friend who sends texts. One day they end their messages with two X’s, and another day with none, as if they are withdrawing their warmth from you at times to express some silent disapproval. Sometimes, as shorthand, the term acceptance is used to convey the idea of unconditional positive regard. Certainly, unconditional positive regard involves acceptance, but acceptance does not necessarily convey the notions of warmth and consistency.

Second, unconditional positive regard is about the attitude of the therapist. Unconditional positive regard is not a behavior; it is an attitude. But it must somehow be expressed. It is no good for the therapist to just sit there, smiling and nodding; unfortunately, this is sometimes the misplaced caricature of the person-centered therapist. The client needs to feel that they are understood, to know that they are unconditionally positively regarded. Unless we feel truly understood by another, how can we be sure that they are accepting of us? Unconditional positive regard is communicated through empathy. Empathy is the behavior. Rogers wrote that it was only if people feel truly understood by another, they can also feel unconditionally valued. That makes sense. If you feel I don’t really know you, how could you feel unconditionally accepted?

Empathy is the therapist’s attempt to show their understanding, that is to say, to demonstrate that they can sense what the client’s experience is like: to understand the client’s perceptions from their point of view—their ideas, meanings, and emotions—and, importantly, communicate this such that the client feels understood. But empathy is an active process of engaging with the client, constantly checking out with them one’s understanding of what has been said and what it means. Empathy means that we can see the world from the other person’s frame of reference.

But to truly have an unconditional attitude and the ability to empathize with others is rare.

Third, these qualities of unconditional positive regard and empathy can, however, be developed. Being more congruent, Rogers maintained, leads to the development of a greater attitude of unconditionality toward oneself and others and the ability to empathize with others. Congruence of the therapist means being aware of one’s inner experiences, thoughts, and feelings without denial and distortion and being able to express these openly and honestly, when appropriate. It is about the authenticity of the therapist, their personal development and growth as a human being, their emotional maturity, and their ability to look at themselves and their relationships with others without distortion and denial. It is important to understand that Rogers did not mean that congruence is an all-or-nothing variable, rather that it is a spectrum, one that we can move along from moment to moment. No one is completely congruent all of the time, but the therapist must be more congruent than the client in those moments of therapy. Congruence can be developed through personal growth. Therapists in training will spend years learning about themselves through their own personal therapy, encounter groups, and other activities in which they can become more authentic and fully functioning.

In these ways, being a person-centered therapist is much more than passively sitting and smiling, but actively engaging with a client in a deep and meaningful way in which the client comes to feel truly understood, valued, and therefore feels no need to defend themselves, but instead is open and honest with themselves. Imagine what it is like to be in such a relationship in which you feel truly valued and understood. No longer would you feel the need to put on an act, to try to please or impress the other person, or to be someone you are not. Only then could you really begin to listen to yourself and to work out your own best directions in life.