Analyze this person from both Abraham Maslow’s humanistic perspective and Carl Rogers’s humanistic perspective. In other words, explain how this person’s personality would be

THE NECESSARY AND SUFFICIENT CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE

CARL R. ROGERS University of Chicago

For many years I have been engaged in psy- chotherapy with individuals in distress. In recent years I have found myself increasingly concerned with the process of abstracting from that experi- ence the general principles which appear to be involved in it. I have endeavored to discover any orderliness, any unity which seems to inhere in the subtle, complex tissue of interpersonal rela- tionship in which I have so constantly been im- mersed in therapeutic work. One of the current products of this concern is an attempt to state, in formal terms, a theory of psychotherapy, of per- sonality, and of interpersonal relationships which will encompass and contain the phenomena of my experience.1 What I wish to do in this paper is to take one very small segment of that theory, spell it out more completely, and explore its meaning and usefulness.

The Problem

The question to which I wish to address myself is this: Is it possible to state, in terms which are clearly definable and measurable, the psycholog- ical conditions which are both necessary and suf- ficient to bring about constructive personality change? Do we, in other words, know with any precision those elements which are essential if psychotherapeutic change is to ensue?

Before proceeding to the major task let me dispose very briefly of the second portion of the question. What is meant by such phrases as “psy- chotherapeutic change,” “constructive personal- ity change”? This problem also deserves deep and serious consideration, but for the moment let me suggest a common-sense type of meaning upon which we can perhaps agree for purposes of this paper. By these phrases is meant: change in the personality structure of the individual, at both surface and deeper levels, in a direction which clinicians would agree means greater integration, less internal conflict, more energy utilizable for

effective living; change in behavior away from behaviors generally regarded as immature and toward behaviors regarded as mature. This brief description may suffice to indicate the kind of change for which we are considering the precon- ditions. It may also suggest the ways in which this criterion of change may be determined.2

The Conditions

As I have considered my own clinical experi- ence and that of my colleagues, together with the pertinent research which is available, I have drawn out several conditions which seem to me to be necessary to initiate constructive personal- ity change, and which, taken together, appear to be sufficient to inaugurate that process. As I have worked on this problem I have found myself surprised at the simplicity of what has emerged. The statement which follows is not offered with any assurance as to its correctness, but with the expectation that it will have the value of any theory, namely that it states or implies a series of hypotheses which are open to proof or disproof, thereby clarifying and extending our knowledge of the field.

Since I am not, in this paper, trying to achieve suspense, I will state at once, in severely rigorous and summarized terms, the six conditions which I have come to feel are basic to the process of personality change. The meaning of a number of the terms is not immediately evident, but will be

1 This formal statement is entitled “A theory of therapy, personality and interpersonal relationships, as developed in the client-centered framework,” by Carl R. Rogers. The manuscript was prepared at the request of the Committee of the American Psychological Association for the Study of the Status and Development of Psychology in the United States. It will be published by McGraw-Hill in one of several vol- umes being prepared by this committee. Copies of the unpub- 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 been shown in research already completed. See (7), especially chapters 8, 13, and 17.

This article is a reprint from Journal of Consulting Psy- chology, 1957, Vol. 21, No. 2, 95–103.

Psychotherapy: Theory, Research, Practice, Training Copyright 2007 by the American Psychological Association 2007, Vol. 44, No. 3, 240–248 0033-3204/07/$12.00 DOI: 10.1037/0033-3204.44.3.240

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clarified in the explanatory sections which fol- low. It is hoped that this brief statement will have much more significance to the reader when he has completed the paper. Without further introduc- tion let me state the basic theoretical position.

For constructive personality change to occur, it is necessary that these conditions exist and con- tinue over a period of time:

1. Two persons are in psychological contact.

2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.

3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.

4. The therapist experiences unconditional positive regard for the client.

5. The therapist experiences an empathic un- derstanding of the client’s internal frame of reference and endeavors to communicate this experience to the client.

6. The communication to the client of the ther- apist’s empathic understanding and uncon- ditional positive regard is to a minimal de- gree achieved.

No other conditions are necessary. If these six conditions exist, and continue over a period of time, this is sufficient. The process of construc- tive personality change will follow.

A Relationship

The first condition specifies that a minimal relationship, a psychological contact, must exist. I am hypothesizing that significant positive per- sonality change does not occur except in a rela- tionship. This is of course an hypothesis, and it may be disproved.

Conditions 2 through 6 define the characteris- tics of the relationship which are regarded as essential by defining the necessary characteristics of each person in the relationship. All that is intended by this first condition is to specify that the two people are to some degree in contact, that each makes some perceived difference in the experiential field of the other. Probably it is suf- ficient if each makes some “subceived” differ- ence, even though the individual may not be

consciously aware of this impact. Thus it might be difficult to know whether a catatonic patient perceives a therapist’s presence as making a dif- ference to him—a difference of any kind— but it is almost certain that at some organic level he does sense this difference.

Except in such a difficult borderline situation as that just mentioned, it would be relatively easy to define this condition in operational terms and thus determine, from a hard-boiled research point of view, whether the condition does, or does not, exist. The simplest method of determination in- volves simply the awareness of both client and therapist. If each is aware of being in personal or psychological contact with the other, then this condition is met.

This first condition of therapeutic change is such a simple one that perhaps it should be la- beled an assumption or a precondition in order to set it apart from those that follow. Without it, however, the remaining items would have no meaning, and that is the reason for including it.

The State of the Client

It was specified that it is necessary that the client be “in a state of incongruence, being vul- nerable or anxious.” What is the meaning of these terms?

Incongruence is a basic construct in the theory we have been developing. It refers to a discrep- ancy between the actual experience of the organ- ism and the self picture of the individual insofar as it represents that experience. Thus a student may experience, at a total or organismic level, a fear of the university and of examinations which are given on the third floor of a certain building, since these may demonstrate a fundamental inad- equacy in him. Since such a fear of his inade- quacy is decidedly at odds with his concept of himself, this experience is represented (distort- edly) in his awareness as an unreasonable fear of climbing stairs in this building, or any building, and soon an unreasonable fear of crossing the open campus. Thus there is a fundamental dis- crepancy between the experienced meaning of the situation as it registers in his organism and the symbolic representation of that experience in awareness in such a way that it does not conflict with the picture he has of himself. In this case to admit a fear of inadequacy would contradict the

Special Section: Conditions of Therapeutic Personality Change

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picture he holds of himself; to admit incompre- hensible fears does not contradict his self concept.

Another instance would be the mother who develops vague illnesses whenever her only son makes plans to leave home. The actual desire is to hold on to her only source of satisfaction. To perceive this in awareness would be inconsistent with the picture she holds of herself as a good mother. Illness, however, is consistent with her self concept, and the experience is symbolized in this distorted fashion. Thus again there is a basic incongruence between the self as perceived (in this case as an ill mother needing attention) and the actual experience (in this case the desire to hold on to her son).

When the individual has no awareness of such incongruence in himself, then he is merely vul- nerable to the possibility of anxiety and disorga- nization. Some experience might occur so sud- denly or so obviously that the incongruence could not be denied. Therefore, the person is vulnerable to such a possibility.

If the individual dimly perceives such an in- congruence in himself, then a tension state occurs which is known as anxiety. The incongruence need not be sharply perceived. It is enough that it is subceived—that is, discriminated as threaten- ing to the self without any awareness of the content of that threat. Such anxiety is often seen in therapy as the individual approaches aware- ness of some element of his experience which is in sharp contradiction to his self concept.

It is not easy to give precise operational defi- nition to this second of the six conditions, yet to some degree this has been achieved. Several re- search workers have defined the self concept by means of a Q sort by the individual of a list of self-referent items. This gives us an operational picture of the self. The total experiencing of the individual is more difficult to capture. Chodorkoff (2) has defined it as a Q sort made by a clinician who sorts the same self-referent items indepen- dently, basing his sorting on the picture he has obtained of the individual from projective tests. His sort thus includes unconscious as well as conscious elements of the individual’s experience, thus repre- senting (in an admittedly imperfect way) the totality of the client’s experience. The correlation between these two sortings gives a crude operational mea- sure of incongruence between self and experience, low or negative correlation representing of course a high degree of incongruence.

The Therapist’s Genuineness in the Relationship

The third condition is that the therapist should be, within the confines of this relationship, a congruent, genuine, integrated person. It means that within the relationship he is freely and deeply himself, with his actual experience accu- rately represented by his awareness of himself. It is the opposite of presenting a facade, either knowingly or unknowingly.

It is not necessary (nor is it possible) that the therapist be a paragon who exhibits this degree of integration, of wholeness, in every aspect of his life. It is sufficient that he is accurately himself in this hour of this relationship, that in this basic sense he is what he actually is, in this moment of time.

It should be clear that this includes being him- self even in ways which are not regarded as ideal for psychotherapy. His experience may be “I am afraid of this client” or “My attention is so fo- cused on my own problems that I can scarcely listen to him.” If the therapist is not denying these feelings to awareness, but is able freely to be them (as well as being his other feelings), then the condition we have stated is met.

It would take us too far afield to consider the puzzling matter as to the degree to which the therapist overtly communicates this reality in himself to the client. Certainly the aim is not for the therapist to express or talk out his own feel- ings, but primarily that he should not be deceiving the client as to himself. At times he may need to talk out some of his own feelings (either to the client, or to a colleague or supervisor) if they are standing in the way of the two following conditions.

It is not too difficult to suggest an operational definition for this third condition. We resort again to Q technique. If the therapist sorts a series of items relevant to the relationship (using a list similar to the ones developed by Fiedler [3, 4] and Bown [1]), this will give his perception of his experience in the relationship. If several judges who have observed the interview or listened to a recording of it (or observed a sound movie of it) now sort the same items to represent their per- ception of the relationship, this second sorting should catch those elements of the therapist’s behavior and inferred attitudes of which he is unaware, as well as those of which he is aware. Thus a high correlation between the therapist’s sort and the observer’s sort would represent in crude form an operational definition of the ther-

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apist’s congruence or integration in the relation- ship; and a low correlation, the opposite.

Unconditional Positive Regard

To the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client’s experience as being a part of that client, he is experiencing unconditional posi- tive regard. This concept has been developed by Standal (8). It means that there are no condi- tions of acceptance, no feeling of “I like you only if you are thus and so.” It means a “prizing” of the person, as Dewey has used that term. It is at the opposite pole from a selective evaluating attitude—“You are bad in these ways, good in those.” It involves as much feeling of acceptance for the client’s expression of negative, “bad,” painful, fearful, defensive, abnormal feelings as for his expression of “good,” positive, mature, confident, social feelings, as much acceptance of ways in which he is inconsistent as of ways in which he is consistent. It means a caring for the client, but not in a possessive way or in such a way as simply to satisfy the therapist’s own needs. It means a caring for the client as a sepa- rate person, with permission to have his own feelings, his own experiences. One client de- scribes the therapist as “fostering my possession of my own experience . . . that [this] is my expe- rience and that I am actually having it: thinking what I think, feeling what I feel, wanting what I want, fearing what I fear: no ‘ifs,’ ‘buts,’ or ‘not reallys.’” This is the type of acceptance which is hypothesized as being necessary if personality change is to occur.

Like the two previous conditions, this fourth condition is a matter of degree,3 as immediately becomes apparent if we attempt to define it in terms of specific research operations. One such method of giving it definition would be to con- sider the Q sort for the relationship as described under Condition 3. To the extent that items ex- pressive of unconditional positive regard are sorted as characteristic of the relationship by both the therapist and the observers, unconditional positive regard might be said to exist. Such items might include statements of this order: “I feel no revulsion at anything the client says”; “I feel neither approval nor disapproval of the client and his statements—simply acceptance”; “I feel warmly toward the client—toward his weak- nesses and problems as well as his potentialities”;

“I am not inclined to pass judgment on what the client tells me”; “I like the client.” To the extent that both therapist and observers perceive these items as characteristic, or their opposites as un- characteristic, Condition 4 might be said to be met.

Empathy

The fifth condition is that the therapist is ex- periencing an accurate, empathic understanding of the client’s awareness of his own experience. To sense the client’s private world as if it were your own, but without ever losing the “as if” quality—this is empathy, and this seems essential to therapy. To sense the client’s anger, fear, or confusion as if it were your own, yet without your own anger, fear, or confusion getting bound up in it, is the condition we are endeavoring to de- scribe. When the client’s world is this clear to the therapist, and he moves about in it freely, then he can both communicate his understanding of what is clearly known to the client and can also voice meanings in the client’s experience of which the client is scarcely aware. As one client described this second aspect: “Every now and again, with me in a tangle of thought and feeling, screwed up in a web of mutually divergent lines of move- ment, with impulses from different parts of me, and me feeling the feeling of its being all too much and suchlike—then whomp, just like a sun- beam thrusting its way through cloudbanks and tangles of foliage to spread a circle of light on a tangle of forest paths, came some comment from you. [It was] clarity, even disentanglement, an additional twist to the picture, a putting in place. Then the consequence—the sense of moving on, the relaxation. These were sunbeams.” That such penetrating empathy is important for therapy is

3 The phrase “unconditional positive regard” may be an unfortunate one, since it sounds like an absolute, an all or nothing dispositional concept. It is probably evident from the description that completely unconditional positive regard would never exist except in theory. From a clinical and experiential point of view I believe the most accurate state- ment is that the effective therapist experiences unconditional positive regard for the client during many moments of his contact with him, yet from time to time he experiences only a conditional positive regard— and perhaps at times a negative regard, though this is not likely in effective therapy. It is in this sense that unconditional positive regard exists as a matter of degree in any relationship.

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indicated by Fiedler’s research (3) in which items such as the following placed high in the descrip- tion of relationships created by experienced ther- apists:

The therapist is well able to understand the patient’s feelings.

The therapist is never in any doubt about what the patient means.

The therapist’s remarks fit in just right with the patient’s mood and content.

The therapist’s tone of voice conveys the complete ability to share the patient’s feelings.

An operational definition of the therapist’s em- pathy could be provided in different ways. Use might be made of the Q sort described under Condition 3. To the degree that items descriptive of accurate empathy were sorted as characteristic by both the therapist and the observers, this con- dition would be regarded as existing.

Another way of defining this condition would be for both client and therapist to sort a list of items descriptive of client feelings. Each would sort independently, the task being to represent the feelings which the client had experienced during a just completed interview. If the correlation be- tween client and therapist sortings were high, accurate empathy would be said to exist, a low correlation indicating the opposite conclusion.

Still another way of measuring empathy would be for trained judges to rate the depth and accu- racy of the therapist’s empathy on the basis of listening to recorded interviews.

The Client’s Perception of the Therapist

The final condition as stated is that the client perceives, to a minimal degree, the acceptance and empathy which the therapist experiences for him. Unless some communication of these atti- tudes has been achieved, then such attitudes do not exist in the relationship as far as the client is concerned, and the therapeutic process could not, by our hypothesis, be initiated.

Since attitudes cannot be directly perceived, it might be somewhat more accurate to state that therapist behaviors and words are perceived by the client as meaning that to some degree the therapist accepts and understands him.

An operational definition of this condition would not be difficult. The client might, after an interview, sort a Q-sort list of items referring to qualities representing the relationship between himself and the therapist. (The same list could be

used as for Condition 3.) If several items descrip- tive of acceptance and empathy are sorted by the client as characteristic of the relationship, then this condition could be regarded as met. In the present state of our knowledge the meaning of “to a minimal degree” would have to be arbitrary.

Some Comments

Up to this point the effort has been made to present, briefly and factually, the conditions which I have come to regard as essential for psychotherapeutic change. I have not tried to give the theoretical context of these conditions nor to explain what seem to me to be the dynamics of their effectiveness. Such explanatory material will be available, to the reader who is interested, in the document already mentioned (see footnote 1).

I have, however, given at least one means of defining, in operational terms, each of the condi- tions mentioned. I have done this in order to stress the fact that I am not speaking of vague qualities which ideally should be present if some other vague result is to occur. I am presenting conditions which are crudely measurable even in the present state of our technology, and have suggested specific operations in each instance even though I am sure that more adequate meth- ods of measurement could be devised by a seri- ous investigator.

My purpose has been to stress the notion that in my opinion we are dealing with an if-then phenomenon in which knowledge of the dynam- ics is not essential to testing the hypotheses. Thus, to illustrate from another field: if one sub- stance, shown by a series of operations to be the substance known as hydrochloric acid, is mixed with another substance, shown by another series of operations to be sodium hydroxide, then salt and water will be products of this mixture. This is true whether one regards the results as due to magic, or whether one explains it in the most adequate terms of modern chemical theory. In the same way it is being postulated here that certain definable conditions precede certain definable changes and that this fact exists independently of our efforts to account for it.

The Resulting Hypotheses

The major value of stating any theory in un- equivocal terms is that specific hypotheses may be drawn from it which are capable of proof or

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