CURRENT STATUS OF CLIENT-CENTERED THEORY Meta-analyses have shown that client-centered therapy and humanistic therapy are indeed effective and that they are just as effective as other approaches to psychotherapy (Elliott, Greenberg, Watson, Timulak, & Freire, 2013). In addition, reviews of the empirical literature have confirmed the importance of the facilitative conditions, particularly of empathy, in leading to positive outcome of therapy (Farber & Doolin, 2011; Kolden, Klein, Wang, & Austin, 2011). It appears that the facilitative conditions are important for allowing clients to feel safe and supported, to help clients have a positive relationship experience, to promote exploration, and to support clients’ active self-healing efforts.
Recent research has focused more on the working alliance, or the relationship between the therapist and the client, rather than just the therapist-offered facilitative conditions (e.g., Horvath, Del Re, Flückiger, & Symonds, 2011). Thus, contemporary researchers consider the interaction between therapist and client to be more important than just looking at what the therapist offers. In fact, it is hard to imagine the therapist being empathic without the client being responsive and engaged, given that both therapist and client are involved in the interaction.
THE RELATIONSHIP OF ROGERS’S THEORY TO THE HELPING SKILLS MODEL Rogers’s theory forms the foundation for the exploration stage and informs the insight and action stages. I agree with Rogers that helpers should maintain an empathic client-centered stance of trying to understand the client’s experience as completely as possible with as little judgment and as few prior assumptions as possible. Empathy, compassion, and a therapeutic relationship can be effective in helping clients begin to accept themselves and trust their experiences.
In contrast to Rogers’s assertion that a facilitative attitude is more important than the specific skills, I believe that a facilitative attitude and skills are inseparable (Hill, 2005b, 2007). Skills are used to express a facilitative attitude, and a facilitative attitude is needed to express the skills. In addition, as articulated in Chapter 4, awareness (including self-knowledge, in-the-moment awareness, and cultural awareness) is also crucial because without awareness, the helper is likely to act out unconscious impulses in a way that could damage clients. Client involvement is also important but of less focus at this point because we are concentrating on the helper’s contribution to the helping process. Thus, a facilitative attitude, awareness, and skills are all important components of the helper’s contribution to the helping process.
Another point on which I diverge somewhat from Rogers’s theory relates to his assertion about the helpful components of the therapeutic process. For some clients, being understood and encouraged to express their feelings is enough to get
them back to a self-healing mode so they can function again and make needed changes. Others, however, need more assistance in learning how to deal with feelings and experiences, many of which may be new to them. Furthermore, some clients need to be assisted in moving toward insight and action. In addition to maintaining the facilitative conditions, then, I posit that helpers need to be able to facilitate insight and action. Additional theories (psychoanalytic, cognitive, behavioral) are needed to assist some clients in moving beyond exploration of thoughts and feelings; these are described in later chapters.
Furthermore, I do not completely agree with Rogers that people are inherently good and striving for self-actualization. There seems to be minimal evidence for these postulates. My assumption is that people are neither good nor bad at birth but rather develop depending on temperament, genetics, the environment, parenting, and early experiences (see Chapter 2, this volume). More is known now about genetic and biological contributions to human functioning than was known when Rogers proposed his theory. Despite these differences in beliefs about human nature and biological contributions, though, I agree with Rogers about the importance of the facilitative conditions for establishing the therapeutic relationship and helping clients explore concerns and achieve self-acceptance.
Finally, Rogers did not attend closely to cultural considerations in his theory, probably because the United States was not as diverse then as it is now. Culture certainly fits into Rogers’s theory, however, in that being truly empathic and compassionate assumes a major interest in the person, awareness of who the person is, and an acceptance of the person. Thus, I would assert that multicultural awareness is important to genuinely being Rogerian.