Humanistic Approaches
We
have seen that Freud played a pivotal role in launching the treatment that we
now call psychotherapy; indeed, the idea of a “talking cure” that could help
someone deal with mental distress through conversation or instruction was
essentially unknown before Freud. Nonetheless, most modern psychotherapists
employ methods very different from Freud’s and base their therapies on
conceptions that explicitly reject many of Freud’s ideas.
As we discussed, psychologists who take a humanistic approach have regarded psychoanalysis as being too concerned with basic urges (like sex and aggres-sion) and not concerned enough with the search for meaning. This orientation led them to propose several different types of therapy, which have in common the idea that people must take responsibility for their lives and their actions and live fully in the present.
Carl
Rogers’s client-centered therapy
seeks to help a person accept himself as he is and to be himself with no
pretense or self-imposed limits. In this therapy, the ther-apist listens
attentively and acceptingly to the patient (Figure 17.4). The therapist is not
there to question or to direct, but to create an atmosphere in which the
patient feels valued and understood (Rogers, 1951, 1959). Based on his analysis
of his own and others’ therapeutic attempts, Rogers concluded that three factors
were crucial to a therapist’s success: genuineness,
or sharing authentic reactions with the patient; unconditional positive regard, which refers to a nonjudgmental and
accepting stance; and empathic
understanding, which refers to sensing what it must be like to be in the
patient’s shoes (Rogers, 1980).
Rogers’s
therapeutic stance is evident in the following interaction with a patient:
PATIENT:
I cannot be the
kind of person I want to be. I guess maybe I haven’t the guts or the strength
to kill myself, and if someone else would relieve me of the responsi-bility or
I would be in an accident, I—just don’t want to live.
ROGERS:
At the present
time things look so black that you can’t see much point in living.
PATIENT:
Yes, I wish I’d
never started this therapy. I was happy when I was living in my dream world.
There I could be the kind of person I wanted to be. But now there is such a
wide, wide gap between my idea and what I am . . .
ROGERS:
It’s really tough
digging into this like you are, and at times the shelter of your dream world
looks more attractive and comfortable.
PATIENT:
My dream world or
suicide . . . So I don’t see why I should waste your time coming in twice a
week—I’m not worth it—what do you think?
ROGERS:
It’s up to you. .
. . It isn’t wasting my time. I’d be glad to see you whenever you come, but
it’s how you feel about it.
PATIENT:
You’re not going
to suggest that I come in oftener? You’re not alarmed and think I ought to come
in every day until I get out of this?
ROGERS:
I believe you’re
able to make your own decision. I’ll see you whenever you want to come.
PATIENT:
I don’t believe
you are alarmed about—I see—I may be afraid of myself but you aren’t afraid for
me.
ROGERS:
You say you may be
afraid of yourself and are wondering why I don’t seem to be afraid for you.
PATIENT:
You have more
confidence in me than I have. I’ll see you next week, maybe.
[The
patient did not attempt suicide.]
Rogers’s
client-centered therapy has, in turn, inspired a number of other forms of
intervention, one of which is motivational-enhancement
therapy (Miller & Rollnick, 2002). This is a brief, nonconfrontational,
client-centered intervention designed to change problematic behavior (such as
alcohol and other drug use) by reducing ambiva-lence and clarifying discrepancies
between how individuals are actually living and how they say they would like to
live (Ball et al., 2007).
A
second humanistic therapy is Fritz Perls’s Gestalt
therapy. Perls was a highly charismatic and original clinician who was
trained psychodynamically but drew inspi-ration from the gestalt theory of
perception. Perls believed that psycho-logical difficulties stemmed from a
failure to integrate mutually inconsistent aspects of self into an integrated
whole or gestalt. His techniques were aimed at helpingpatients become aware of
and then integrate disparate aspects of self by increasing self-awareness and
self-acceptance (Perls, 1967, 1969).
For
example, Perls was famous for asking his patients about what they were feeling
in the moment, and for pointing out apparent discrepancies between what they
said they felt and how they appeared to be feeling. Perls also used the empty chair technique, in which a
patient imagines that he is seated across from another person, such as his
parent or his partner, and tells him honestly what he feels. Using such
strategies, Perls helped his patients acknowledge and confront their feelings.
In
more modern versions of humanistic therapies—collectively referred to as the experiential therapies—these approaches
are integrated, seeking to create a genuinelyempathic and accepting atmosphere
but also to challenge the patient in a more active fashion with the aim of
deepening his experience (Elliott, Greenberg, & Lietaer, 2004; Follette
& Greenberg, 2005). This approach views the patient and, indeed, all humans
as oriented toward growth and full development of their potential, and the
therapist uses a number of techniques to encourage these tendencies.
Although
these challenges to live more actively and deeply can be disconcerting,
experiential therapies involve genuine concern and respect for the person, with
an emphasis on all her qualities, and not just those symptoms that led to a
particular diagnosis. The person’s subjective experience is also a primary
focus, and the thera-pist tries to be as empathic as possible, in order to
understand that experience. Moreover, experiential therapists reject Freud’s
notion of transference; in their view, the relationship between patient and
therapist is a genuine connection between two people, one that provides the
patient with an opportunity for a new, emotionally validating experience.
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