Professional Documents
Culture Documents
It is the client more than the therapist who implements the change
process. . . . Rather than argue over whether or not “therapy works,”
we could address ourselves to the question of whether or not “the
client works!” . . . As therapists have depended more upon the client’s
resources, more change seems to occur. (Bergin&Garfield, 1994, p. 826)
559
the client would likely benefit from counseling, regardless of who the client
was. Rogers hypothesized that no other conditions were necessary for thera-
peutic personality changes to occur as long as these conditions existed and
continued over time. His hypothesis places the onus for success or failure
almost entirely in the hands of the therapist’s ability to communicate ade-
quate levels of the core conditions to the client. Therapists know from
experience that there must be more than an “if-then” relationship between
the hypothesized conditions and successful treatment outcomes. Inevitably,
even the most skilled therapists encounter clients who do not seem to
benefit from the process.
To recognize the importance of client variables, consider that simply
from a logical point of view, if one contends that therapist behaviors can
help or hinder the process of therapy, it follows that client behaviors can
also influence whether one could expect a positive outcome for psychother-
apy. After all, there are two people involved in this unique and interactional
process called psychotherapy. Each member of the dyad brings certain charac-
teristics to the relationship that will affect how it evolves. (See also bzarth,
Zimring, and Tausch, this volume, chapter 5 , for more on client-centered
therapy.) In fairness to Rogers, he did recognize that therapy may not be
helpful to everyone as indicated by his statement: “it appears that empirical
studies can help to discover the factors which make it likely that client-
centered therapy, as it exists at the present time, will be effective or ineffec-
tive in helping the client to change” (Rogers, 1954, p. 424). So, if one takes
the position that Rogers’s stated conditions may not be sufficient in and of
themselves, one is free to explore what researchers say about client variables
that seem related to outcomes.
While this entire volume is devoted to various dimensions of research
relevant to humanistic psychotherapies, this chapter will focus in particular
on the client characteristics that are related to positive outcomes in psycho-
therapy. Specifically, the goals of this chapter are (a) to present outcome
research on client variables specific to client-centered psychotherapy, (b)
to present other outcome research on client variables that seems to have
relevance to client-centered therapy and other humanistic psychotherapies,
and (c) to provide ideas and examples of how these research findings can
be applied in a humanistic fashion when working with clients.
Therapeutic Alliance
Client Affirmation
Expressiveness
Locus of Control
Client Involvement/Participation/Motivation/Cooperation
In most cases, clients come in for therapy because they want something
better. The fact that they seek the assistance of a therapist can be taken
as an indication that they envision such an outcome as a real possibility.
The importance of client involvement to successful outcome has been clearly
demonstrated in empirical research. Hence, the need for therapists to foster
and maintain client involvement in the process is also clear. From the initial
contact with clients, the therapist’s presentation about how the process
works is critical. Unless a client has been in therapy before, he or she cannot
be presumed to know how the process actually works. Many clients are
likely to see therapists as experts with the answers to their problems. Thus,
in their explanation to the clients about their theoretical orientation, for
example, therapists need to be mindful about how they present the process.
If the description places the therapist in the role of the expert, then the
C: I have never been in therapy before. How does the process work?
T: Therapy is a collaborative process in which we can work together
to explore, clarify your concerns and by working together, hopefully,
we can find some answers that fit for you.
C: What should I talk about?Hmmm, I am not sure where to begin.
Maybe you could you ask me some questions?
T: This is your time to talk about whatever feels important to you.
C: Well, what really seems to be bothering me is . . .
The therapist in this example is making sure not to take the responsibil-
ity from and for the client. The client can potentially learn early on that
therapy is collaborative and will require a thoughtful investment for the
process to work.
Even though a therapist may ascribe to the notion that collaboration
is the most useful fashion to proceed in psychotherapy, challenging clients
may in subtle ways influence the therapist to assume a less collaborative
position. One suggestion for therapists is to become conscious of their own
self-talk. For example, if you as the therapist find yourself saying such things
as “if I could just get my client to . . .” or “If I could just convince my client
o f . . .” or “if I could just get my client to see . . . ,” or if you find yourself
thinking in terms of “persuading,”then you have likely moved to controlling
and directing, which is not likely to be helpful (Combs & Gonzalez, 1994).
The frustration that can come when working with clients who do not seem
to be progressing can result in the therapist taking too much control of the
process and losing the collaborative component.
In addition, Bohart and Tallman (1999) emphasized that true collabo-
ration goes beyond the client merely participating in the therapist’s agenda.
They contended that a truly collaborative model involves, among other
things, the therapist carefully listening to the client for client-generated
solutions and encouraging the client to more fully explain his or her point
of view. This implies a belief and respect on the part of the therapist for
the client’s capacities for self-healing and problem solving. One technique
that works from a collaborative model is termed “Ask the Expert” (Welch
& Gonzalez, 1999). For example,
A less elaborate but still potentially helpful version of “Ask the Expert”
is as follows:
C: I don’t know why I won’t stand up to my father.
T: Let’s switch seats. You are the expert. W h y does a person not stand
up to his or her father?
Therapeutic Alliance
Client Experiencing
Earlier in this chapter, we saw that the depth of the client’s experienc-
ing has an impact on outcome. Therapists use a variety of methods in the
helping process, some of which can be used to assist clients needing help in
this area. Responding with accurate levels of empathy, using self-disclosure,
and using metaphor are but a few examples that can assist clients in deepen-
ing their experience of the therapy process. Becoming skilled in empathy
Acceptance of Others
CONCLUSIONS
There are a number of key variables that are associated with positive
therapeutic outcomes. The client’s willingness and capacity to engage in
the process are strong indicators of success. For clients who are not skilled
at introspection or in the expression of feelings, therapists can help clients
REFERENCES