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Can you be integrative and a personcentered therapist at the same time?

Arthur C. Bohart
a

California State University Dominguez Hills, USA

Available online: 14 Mar 2012

To cite this article: Arthur C. Bohart (2012): Can you be integrative and a person-centered
therapist at the same time?, Person-Centered & Experiential Psychotherapies, 11:1, 1-13
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Person-Centered & Experiential Psychotherapies

Vol. 11, No. 1, March 2012, 113

ARTICLES
Can you be integrative and a person-centered therapist at the same time?
Arthur C. Bohart*
California State University Dominguez Hills, USA

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(Received 16 August 2011; nal version received 17 October 2011)

I argue that person-centered therapy is a fuzzy set with a variety of members
that bear a family resemblance to one another. I suggest that some members of
this fuzzy set are approaches that integrate various activities and procedures into
their practice along with traditional empathic understanding responses. Based on
quotations from Carl Rogers I demonstrate that these approaches deserve to be
included as members of the family and that if one follows what Rogers said there
is no warrant for the idea that classical nondirective practice is the only true
person-centered therapy. I argue that one can practice person-centered therapy in
an integrative way by including techniques and procedures from other
approaches, by meeting at relational depth, and by focusing on experiencing
and emotions. I conclude by arguing that it is important that we be open to
alternative ways of actualizing person-centered principles.
Keywords: psychotherapy; integration; person-centered; experiential; psychology

Kann man integrativ und zugleich ein personzentrierter Therapeut sein?

Ich argumentiere, dass Personzentrierte Psychotherapie ein unklares Konglomerat
ist mit einer Spannbreite von Mitgliedern, die familiare Ahnlichkeit haben. Ich
schlage vor, dass einige Angehorige dieses unklaren Konglomerats Ansatze sind,
die verschiedene Aktivitaten und Vorgehensweisen in ihre Praxis integrieren,
zusammen mit traditionellen empathischen Reaktionen des Verstehens. Basierend
auf Zitaten von Carl Rogers zeige ich, dass diese Ansatze es verdienen, als
Mitglieder der Familie einbezogen zu werden und dass es, wenn man dem folgt,
was Rogers sagte, keine Garantie gibt, dass die klassische non-direktive Praxis die
einzig wahre personzentrierte Therapie sei. Ich argumentiere, dass man
personzentrierte Therapie auf eine integrative Weise praktizieren kann, indem
man Techniken und Vorgehensweisen anderer Ansatze einbezieht, sich in
relationaler Tiefe begegnet und sich auf das Erleben und die Emotionen fokussiert.
Abschliessend argumentiere ich, dass es wichtig ist, dass wir oen sind fur
alternative Wege, personzentrierte Prinzipien zu aktualisieren.

Se puede ser un terapeuta integrador y centrado en la persona

al mismo tiempo?
Yo sostengo que la terapia centrada en la persona es un conjunto difuso con una
gran variedad de miembros que tienen un parecido familiar entre s . Sugiero que
algunos miembros de este conjunto difuso son enfoques que integran diversas
actividades y procedimientos en su practica junto con las respuestas tradicionales
*Email: [email protected]
ISSN 1477-9757 print/ISSN 1752-9182 online
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A.C. Bohart
comprension empatica. Basado en citas de Carl Rogers demuestro que estos
enfoques merecen ser incluidos como miembros de la familia y que si uno sigue lo
que Rogers dijo no hay ninguna justicacion para armar que la practica no
directiva clasica es la unica verdadera terapia centrada en la persona. Yo
sostengo que uno puede practicar terapia centrada en la persona de una manera
integradora mediante la inclusion de tecnicas y procedimientos de otros enfoques,
en profundidad relacional y concentrandose en el experienciar y las emociones.
Concluyo argumentando que es importante que seamos abiertos a otras formas
de actualizar los principios centrados en la persona.

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Peut-on etre en meme temps un therapeute integratif et centre sur

la personne ?
Mon argumentation est que la therapie centree sur la personne est un groupe
ou, dont les membres divers partagent un air de famille. Je sugge`re que certains
membres de ce groupe ou sont des approches qui inte`grent diverses activites et
procedures dans leur pratique ainsi que des interventions traditionnelles de
comprehension empathique. A partir de citations de Carl Rogers, je demontre que
ces approches meritent detre incluses en tant que membres de la famille et que, si
lon suit ce que Rogers dit, il ny a pas de justication a` lidee que la pratique nondirective classique est la seule vraie therapie centree sur la personne. Je postule
que lon peut pratiquer la therapie centree sur la personne de manie`re integrative
en incluant des techniques et des procedures dautres approches, a` travers la
rencontre en profondeur relationnelle et la focalisation sur lexperiencing et les
emotions. Je conclus en arguant quil est important que nous nous ouvrions a` de
manie`res dierentes dactualiser les principes centrees sur la personne.

Pode ser-se integrativo e, em simultaneo, terapeuta centrado na pessoa?

Pretendo que a terapia centrada na pessoa e um conjunto confuso, com
uma diversidade de membros que apresentam parecencas familiares uns com os
outros. Sugiro que alguns membros deste conjunto confuso sao abordagens que
integram diversas atividades e procedimentos na sua pratica, em simultaneo com
o recurso a`s tradicionais respostas de compreensao empatica. Tendo por base
citacoes de Carl Rogers, demonstro que estas abordagens merecem ser inclu das
como membros da fam lia e que, se seguirmos o que Rogers disse, nao ha
qualquer garantia de que a pratica nao-diretiva classica seja a unica terapia
centrada na pessoa verdadeira. Discuto que se pode praticar a terapia centrada
na pessoa de forma integrativa, incluindo tecnicas e procedimentos de outras
abordagens, trabalhando ao n vel da profundidade relacional e focando-nos na
experienciacao e nas emocoes. Concluo defendendo que e importante estar aberto
a formas alternativas de atualizar os princ pios centrados na pessoa.

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Person-Centered & Experiential Psychotherapies

It seems to me that the norm is for human beings to disagree. This is no less true in
the person-centered and experiential community than elsewhere. I have not found,
over the years, that we are any more tolerant of disagreements among ourselves than
anyone else. So I know that what I am going to say is going to be controversial.
I should add that I do not mind disagreement. Creativity often comes out of
disagreement. Sometimes this happens because, through discussion, new syntheses of
contradictory positions emerge. Other times this happens, because, as with one of my
colleagues, our disagreements led to a long and productive dialogue that never
changed either of our points of view, but led both of us to deepen and sharpen what
we thought. I still do not agree with his point of view, but it is a respectable one and
Im glad it is in the world.
What I have minded in our community is the contentious and dismissing tone
that has characterized some of the debate over the issues I consider in this paper.
This has happened on both sides those who are convinced that anything but
traditional, classical nondirective ways of practicing are destructive distortions; and
those who believe that if we do not add techniques and other things onto traditional
person-centered practice we are being unscientic, irresponsible, and stubborn stickin-the-muds. This contentiousness, while all too human, is odd because it is precisely
the recognition of individual dierence, of dierent paths, and of dierent ways of
being that is at the core of person-centered philosophy.
I have personally struggled with these issues since I rst became aware that
there was debate over them in 1988 at the rst world conference in Leuven, Belgium.
I have struggled because, on the one hand, my heart is with the traditional
nondirective approach. On the other hand, my experience of doing therapy has led
me to believe that I had to be open to a wide variety of tools to help my clients.
Furthermore, I became philosophically and theoretically convinced that there was
nothing incompatible about incorporating techniques and procedures into personcentered therapy.
In this paper I argue that (1) integrative approaches are compatible with a personcentered framework, and (2) it is important that we be open to integrative personcentered practice. Although I also want to be scholarly, I intend to write this article from
more of a personal perspective than academic papers are traditionally written.
The boundaries of person-centered therapy
So what is the core issue? It has to do with identifying the boundaries of personcentered psychotherapy. Is person-centered therapy a set with one member,
identically equivalent to classical, reection-based nondirective therapy, or is
person-centered therapy a family or a set of related approaches? I adopt the
heuristic of imagining a fuzzy circle named person-centered psychotherapy and
asking: What belongs within that circle? In essence, I argue for the position that
person-centered therapy is a family of related approaches.

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A.C. Bohart

Categories in the real world are almost always fuzzy (Lako, 1990). It is dicult
if not impossible to draw a hard line and to be able to say that for every X, X is or is
not a member of a given set or category. The idea that something belongs in a
category if and only if it meets certain criteria works in mathematics but rarely in the
real world. This means that often there will be pure exemplars of a given category, or
paradigmatic examples of concepts, and then after that there are varying degrees of
family resemblance. At some point we reach a fuzzy boundary where things are
particularly unclear: Is something a member of the category or not? Past that
boundary there are cases where we are usually able to say that X is not a member of
the category.
This is compatible with person-centered theory. Rogers (1959, p. 103) advocated
holding constructs tentatively. That implies that constructs are tools, not truth.
Accordingly we should not be surprised that the set person-centered therapy is a
fuzzy one.
At what point does something cross the fuzzy boundary? That is not always easy
to say, but I think that in the case of person-centered therapy most of us have no
problem identifying certain things as not person-centered. Cognitive-behavior
therapy (CBT) as currently practiced violates too many of the person-centered
assumptions to count as person-centered although there are some CBT practitioners
who argue that they are person-centered. Similarly, despite object relations
theorys emphasis on self and relationship, most of us would not locate object
relations theory within the fuzzy circle of person-centered therapies.
If we imagine this large, fuzzy circle as the set which we call person-centered
psychotherapy, then I would locate classical, nondirective therapy in the center.
That would be the most pure, paradigmatic exemplar of the approach. The debate
then concerns whether there is anything else in that circle. I believe that at least the
following belong within that circle: Gendlins focusing-oriented therapy (Gendlin,
1996); Natalie Rogerss (1993) person-centered expressive arts therapy; the emotionfocused therapy of Leslie Greenberg and his colleagues (e.g., Elliott, Watson,
Goldman, & Greenberg, 2004; Greenberg & Watson, 2006); integrative approaches
such as my own (Bohart & Tallman, 1999), the work of Tausch (1990), the pluralistic
approach of Mick Cooper and John McLeod (2011), and the recent approach of
David Cain (in press); and the relational depth approach (Mearns & Cooper, 2005).
All of these approaches have been attacked as not person-centered at various times.
There are a number of others that probably belong in the circle that I will not
consider for spaces sake.
My intention in the rest of this paper is to demonstrate, using references to the
works of Carl Rogers, the legitimacy of considering approaches like those above as
members of the set person-centered psychotherapy. In so doing I do not intend to
provide a review of all sides of the controversy as that would turn this paper into a
book. For a succinct review I refer readers to Sanders (2007). For one thoughtful and
articulate presentation of a more classical nondirective point of view that does allow
the occasional use of techniques at the clients request, see Brodley and Brody (2011).
Members of the family
My argument is that there is no warrant in the history of the approach for restricting
person-centered practice to classical nondirective psychotherapy. In order to spell
this out I am going to distinguish three core groups of person-centered therapies

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Person-Centered & Experiential Psychotherapies

(PCT): (a) eclectic integrative approaches that hold that you can incorporate or
utilize procedures and techniques, particularly from other therapies, within a personcentered base (this is where I fall); (b) the use of the self in therapy, as in the
relational depth approach; and (c) the experiential approaches of Gendlin and
Greenberg and colleagues. The questions can therefore be mapped out as three: (a) Is
it not being person-centered to utilize techniques from other approaches from within
a person-centered framework? (b) Is it not being person-centered to emphasize more
than just a rare or occasional therapist-frame-of-reference response such as a selfdisclosure, and to actively engage in meeting at relational depth? And (c) Is it not
being person-centered to try to help clients focus on experiencing and emotion?
In trying to answer these questions historically I am going to focus on Carl
Rogers. There is a danger in setting up Rogers as the nal arbiter of what is personcentered. First of all, he is no longer around to speak for himself. Secondly, he would
have objected to using him as the arbiter in the rst place. Nonetheless, as the
founder of the approach, I believe his voice is particularly important, and there are
quotes available. If we stick to Rogers, there is clear warrant for (a) integrative
practice; (b) therapy as an emphasis on meeting, self-disclosure, and relational depth;
and (c) a focus on experiencing.
Integrative practice
In a sense all three of the groups I have created could be considered integrative in
that they go beyond classical nondirective practice to adopt a model that allows the
therapist to actively incorporate the use of other techniques and procedures.
Therefore the question of integrative practice is the overarching one.
What did Carl Rogers have to say about integrative practice? I start with a quote
from Holdstock and Rogers (1983). Holdstock and Rogerss chapter is one of a
number of chapters in various textbooks co-written by Rogers and someone else. As
I understand it these chapters were often primarily written by someone else with
Rogerss participation, approval and blessing. I mention this because in some online
and informal debates quotations from such chapters have been dismissed because
they came from chapters not primarily written by Rogers. However, the fact that
Rogers signed on should be taken seriously. As we shall see, another quote from
Rogers himself supports what the following quote says.
Holdstock and Rogers (1983), referring to the use of technological expertise, said:
A fact seldom appreciated . . . is that the person-centered approach does not exclude
such expertise . . . as long as it is made available to and not forced on the client. The
person-centered approach is not a technique but a philosophy of life . . . How therapy is
done is more important than what therapy consists of . . . Making the contributions of
various techniques, such as Gestalt, transactional analysis, and behavior modication,
available to the client actually is very much in keeping with the rationale behind the
person-centered approach. It acknowledges that people perceive and are dierentially
receptive to various symbols . . . Some individuals may be particularly receptive to
therapies working with the body. Others may nd techniques dealing with skills in
interpersonal behavior useful or may prefer to deal with situational and behavioral
aspects. (p. 222)

Holdstock and Rogers went on to say that allowing therapists to utilize various
techniques also allows therapists to be more personally congruent in their presence
as well. Elsewhere, in an interview in 1975, Rogers said, One thing about the client-

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A.C. Bohart

centered approach is that I think it can utilize many modes from other points of view
and keep a basically person-centered philosophy (Francis, 2009, p. 16).
From these two quotes it seems clear that Rogers did not see a contradiction
between incorporating other therapy approaches and remaining person-centered. As
Holdstock and Rogers said, it is more how this is done.
It is not only what Rogers said, it is also what he did. I interviewed Natalie
Rogers about what her father thought about her person-centered expressive arts
therapy. Natalie incorporates various activities such as drawing, painting, dance,
music, and poetry into her therapeutic approach. She told me she has been criticized
by some on the traditional side of the debate for not being person-centered.
Natalie also told me that her father was fully supportive of her approach and even
co-taught several workshops with her later on in his life (Natalie Rogers, personal
communication, June, 2010). Rogerss actively co-teaching workshops with Natalie
is behavioral evidence that he accepted her approach enough to participate in
workshops with her.
Use of self in therapy
There have been those who have argued that the therapist should always or almost
always stay in the clients frame of reference. For the therapist to come from his or
her own frame of reference, except rarely, is a violation of nondirectivity, and hence,
of person-centered practice. The question then becomes: To what extent is use of self
compatible with being person-centered?
Once again, if we look at Carl Rogers we nd an emphasis on the therapists use
of self, on being real, and so on. Rogers talked about therapy as a meeting of persons
(Cissna & Anderson, 1994). In the book on the Wisconsin Schizophrenia Project
(Rogers, Gendlin, Kiesler, & Truax, 1967) there are numerous places where he
focused on therapist realness as the core ingredient. In one chapter Rogers invited
commentators to listen to excerpts of therapy sessions and to give their opinions.
Rollo May and Carl Whitaker, among others, were critical because they thought that
the person-centered therapists in the study were not spontaneously present enough as
persons. Rogers said in response:
I feel a little baed by these comments, largely because I feel so deeply in sympathy with
them. For more than a decade I have been trying to state that genuineness, or
congruence, and the expression of such genuineness, is probably the most important
part of the therapeutic relationship . . . the therapist as a real and spontaneous person
should be present in the relationship. (p. 511)

He went on to say:
It is important to me to be clear in the expression of my feelings. When my feeling is the
desire to understand him, I want this to be clear. When my feeling is dierent from his,
or springs entirely from myself, I want this also to be crystal clear . . . . (p. 512)

Rogers also went on to say that the best expression of what he was getting at was
given by one of the commentators, Paul Bergman. Rogers quoted Bergman as saying:
Some time ago I began, at rst cautiously and then more boldly, to experiment with
expression of my own subjective reactions to my patients . . . . This seems to be the
condition that to my mind emerges as the one of central position and highest values . . . .
(p. 513)

Person-Centered & Experiential Psychotherapies

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Rogers commented, In these excerpts it seems to me that Bergman is describing the

goal toward which most of us as therapists are striving (p. 513).
Elsewhere, in a chapter by Rogers and Wood (1974), the authors talked about a
stress on realness and give examples of self-disclosures, such as the therapist sharing
with the client his boredom and sense of remoteness from the client. They talked
about daring to be real with the client, and therapy becoming a genuine person-toperson relationship.
Thus the movement towards more person-to-person and here-and-now
encounter between therapist and client, such as is found in the relational depth
approach, is compatible with Rogerss views.
Experiencing
In my early years in psychology I was heavily inuenced by Eugene Gendlins work
on experiencing, which I read about in books such as New Directions in ClientCentered Therapy (Hart & Tomlinson, 1970). Imagine my surprise in 1988 at the rst
world conference in Leuven to hear Barbara Brodley (1990) argue that Gendlins
experiential therapy was dierent than classical client-centered therapy. At the time
Brodley was arguing that there was a family of person-centered therapies and was
not ruling Gendlin out of the family. However she was drawing a distinction between
classical client-centered therapy and focusing-oriented therapy. I came to believe
Barbara was correct about that distinction. However others have gone farther than
Brodley to argue that Gendlin and focusing-oriented therapy are therefore not
person-centered at all. With that I disagree.
I believe that both focusing-oriented therapy and the emotion-focused approach
of Greenberg and colleagues are members of the family. However, since I am relying
on the words of Carl Rogers to provide warrant for my beliefs, and Rogers was not
around to comment on emotion-focused therapy, I will direct my attention to
Gendlins experiential, focusing-oriented approach.
My rst evidence comes from a personal experience with Carl Rogers. In 1985 a
colleague and I drove Rogers and Ruth Sanford home to La Jolla from the
American Psychological Association Convention in Los Angeles, where he had been
an invited speaker. The drive was three hours and in addition we stopped for ice
cream. I had a chance to investigate issues that I was puzzling over. At the time I was
writing a textbook on clinical psychology. Gendlin had just come out with a chapter
in another book where he called his approach experiential psychotherapy.
I told Rogers I was planning on including Gendlins approach in the chapter on
client-centered therapy. I wondered what Rogers thought of that. Rogers said, And
rightly so. That is where he belongs (Carl Rogers, personal communication,
August, 1985). I also asked Rogers about the focusing exercise. Did its use t within
the person-centered framework? He thought it did, although he said he personally
did not like it.
I have been criticized for using these anecdotes as evidence, again, in informal
discussions, by some who disagree with the idea that Gendlin belongs in the personcentered camp. They have argued that my memory is not trustworthy. However, I
was writing my rst-ever book. I wanted to get it correct. It was an important
question to me. Besides, I have a witness.
Beyond my memory there is ample evidence from more reliable sources that
Rogers was comfortable with Gendlins ideas on experiencing and on using them as a

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A.C. Bohart

guide to therapeutic practice. In a chapter by Rogers and Wood (1974), Rogers

talked about responding exactly to the clients felt meaning (p. 227), a key concept
of Gendlins. He went on to say, Thus, when I experience his [the clients] sense of
forward movement, of getting more closely in touch with his own experiencing,
I know I am on the right track . . . . It is important to me to assist my client to carry
forward his own experiential process (p. 228). And, . . . his struggle to carry
forward his search for felt meanings is the very struggle I wish to assist by my
responses . . . (p. 228).
Rogerss chapter entitled Empathic: An unappreciated way of being (pp. 137163)
from A Way of Being (Rogers, 1980), has a section on experiencing as a useful construct.
Rogers said, referring to a client checking inwardly to see if something ts or not:
Against what is the man checking these terms for their correctness? Gendlins view, with
which I concur, is that he is checking them against the ongoing psycho-physiological
ow within himself to see if they t. This ow is a very real thing, and people are able to
use it as a referent. In this case angry doesnt match the felt meaning at all;
dissatised comes closer but is not really correct: disappointed matches it exactly,
and encourages a further ow of the experiencing as often happens. (p. 141)

Finally, in Rogerss foreword to New Directions in Client-Centered Therapy, he said,

Nor could we have foreseen the development of a theory of experiencing which
helps to describe the way in which the relationship is used by the person to enhance
and enrich and clarify the life he is living (1970, p. ix).
These are not the only examples where Rogers approvingly cites Gendlins ideas.
Other examples can be found in the book on the Wisconsin Schizophrenia Project
(Rogers et al., 1967) and in other areas of New Directions in Client-Centered Therapy
(Hart & Tomlinson, 1970). However these suce for me to demonstrate that Rogers
did not draw the rm line between person-centered therapy and Gendlins
experiential approach that some others currently do.
Conclusions and implications
It is clear to me that if we use Carl Rogers as a yardstick, we cannot argue
that integrating other techniques and procedures into person-centered practice is not
person-centered, that meeting at relational depth is not person-centered, or that
focusing on experiencing (and by implication, emotion) is not person-centered.
Some will object to what I have said by pointing out that Rogers did not
change his personal way of practice. I think that is debatable. He certainly changed
his practice towards more self-disclosure in encounter groups. Even if it were true
that he did not specically change his practice in demonstration therapy sessions,
Rogers always was clear that that was his own way of practicing and he never said
it should be how everyone practiced. It is not clear to me why it matters whether
he personally changed his practice or not, unless someone tries to use it to dismiss
what he said.
This then brings us back to the idea that, as Rogers concluded, it is the attitudes
that matter. It is not what we do so much as how we do it. In my view this follows
from Rogerss core idea, which comes before even the emphasis on the therapeutic
conditions. That is that we should trust the client (see also Peter Schmid, 2004). Who
do we really believe is the expert on therapy ourselves or the client? Do we really
believe that clients ultimately know best for themselves, better than any of our

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theories, our research, etc.? Do we believe that even if we have expertise, that the
clients wisdom always trumps our wisdom? This is the core of person-centered
philosophy (Wood, 2008).
It is this idea in my opinion that distinguishes us from other approaches. It is not
the relationship. Virtually everyone nowadays believes that therapists should be
accepting and empathic. And congruence and genuineness have become fashionable
in both cognitive-behavioral and psychodynamic circles. However, other approaches
do not trust the client as we do. This is not to say that they distrust the client, nor
that they do not try to utilize clients potential and strength, nor do they not try to
include them as collaborators. However they do not believe that the primary impetus
for therapy comes from the client from the clients own self-organizing wisdom
(Bohart, in press; Wood, 2008). They do not hold as an ethical position that clients
are those who decide for themselves (Grant, 2004).
Therefore, for us, all knowledge, all expertise, all suggestions, are oered as
assists to the clients own self-healing process. It is the client who is the decider as
to what direction to go in, what information to use, and what experiences to have.
This does not dictate any specic way of practicing. Rather, as Rogers said, the
person-centered approach is a philosophy, or elsewhere, a way of being.
Therefore it is how we do what we do that matters. Do we oer techniques, for
instance, as something that that intelligent other, the client, may decide is useful to
them, or do we prescribe them as solutions oered by us, the expert?
Some traditional nondirective therapists have argued that their approach does
not preclude the use of techniques. However their rule is that one only uses a
technique if the client asks for or initiates it. It is o-limits for the therapist to suggest
something. Yet if we look back at the quote from Holdstock and Rogers (1983), they
said:
Making the contributions of various techniques, such as Gestalt, transactional analysis,
and behavior modication, available to the client actually is very much in keeping with
the rationale behind the person-centered approach. It acknowledges that people
perceive and are dierentially receptive to various symbols . . . . (p. 222)

There is nothing there to imply that one must [make] the contributions of various
techniques available only when the client asks for them.
The issue becomes: What does it mean to trust the client? Does it mean that we,
for the most part, only empathically reect? That is not what it means for me. For
me it means that I trust that clients ultimately do know what is best for them, what
will best facilitate their growth. Therefore I trust that if I suggest something they will
say yes or no, and I trust that if they say yes or no, I trust myself enough to go
along with them.
My views on this have evolved in part from my practice, where many clients have
from time to time requested more active techniques than simple empathic
listening. Over time I have come to the decision to not always wait for them to ask,
but at times to suggest things. If they did not want to do it, ne. If we tried it and
they didnt like it, ne.
My views have also been inuenced by my academic work on the clients role as
active self-healer (Bohart & Tallman, 1999, 2010). In a recent chapter we (Bohart &
Tallman, 2010) reviewed research on the clients role in therapy. Clients were found
to be active contributors to and constructors of the therapy process, as Carl Rogers
had hypothesized. In addition, many studies have looked at what clients value in

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therapy. While it is generally true that the number one thing they value is empathic
understanding and being listened to, they frequently want therapists to give advice,
make suggestions, give interpretations, and suggest exercises. Many want the
therapist to take the lead, although most also highly prize and want to be treated as
collaborators.
If we are to trust clients, should we not listen to them? Should they not have a
say in what happens to them? From the research, what many want is a
collaborator who shares his or her ideas and expertise with them, not just someone
to empathically listen. There must be a way of collaboratively working with people
where I can oer my ideas, my perspectives, and my expertise, while respecting
their autonomy, independence, self-organizing wisdom, and growth process. It
seems to me there can be an attitude of genuinely trusting the client to decide on
what is best for him or her that can be held in such a way that therapist and client
can work together, and the therapist can suggest various things that the two of
them might do together.
This may be best illustrated by considering a case where the therapist suggests an
exercise and the client does not want to do it. Most therapists of all persuasions
would argue that you need to respect the clients wishes and not try to force them to
do the exercise. But why? The dierence is in the attitude. If a client does not want to
do a particular cognitive-behavioral technique, the therapist may go along with the
client, but not because they are respecting the clients personal expertise. Rather, it is
strategic. They may assume it is resistance on the clients part. They know that what
they have suggested really is best, but if you cannot get the client to do it you cannot
get the client to do it, so you have to try something else. So they back o and come at
it another way, or try to nd some way of getting the client to comply. In contrast,
I assume that the client knows best for him- or herself, either explicitly or intuitively.
At that moment it is not the organismically wise thing for the client to do. It may
never be. I trust the clients ability to decide for themselves as a wise part of their selfhealing process. In fact, I would see their deciding not to do it as part of the wisdom
of their self-healing process.
There will be those who object to the idea of therapists suggesting techniques by
bringing up issues of therapist power and client deference. They will argue that there
is evidence that clients defer to therapists. This is true, as David Rennies (2002)
research has shown. But his research has also shown that just because clients
sometimes defer publically, that does not mean they defer privately. In addition, if
there is a good relationship they will be more likely to be open. It is probable that
deference is more of a problem early in therapy than later. As the relationship gets
established, and as it becomes clear that I do not intend to impose my agenda, and
that I really mean it when I suggest something only as an idea, clients will begin to
more and more trust our process together and that they have the right to make their
own decisions.
It seems to me that the Rogerian approach boils down to two core sets of
attitudes and beliefs. One set has to do with how the therapist sees the clients role in
the process. Does the therapist see the client and the clients self-organizing wisdom,
choice, and responsibility as center stage? The second set follows from this and has to
do with how the therapist relates to the client. Does the therapist understand that
how he or she relates to the client is primary? In particular, does he or she relate to
the client in a way that respects the client as a person (Schmid, in press; Schmid,
2004)? This includes responding to the client with unconditional positive regard,

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empathic understanding, and by being willing to be real and congruent. Although

modern cognitive-behavioral and psychodynamic therapists believe in relating to
clients in respectful ways, I would argue that neither CBT nor psychodynamic
therapy genuinely hold this position that these two sets of attitudes are primary in
the change process.
Neither of these fundamental person-centered sets of attitudes precludes the
therapist and client engaging in activities beyond therapists responding only with
empathic understanding responses. Even if it is the relationship that grows people,
that does not preclude parents, for example, from playing baseball with their
children. In fact, it may be through activities that are genuinely shared that the
power of the relationship is most actualized.
Nor does it necessarily even preclude therapists adopting a somewhat more
prescriptive approach, although to do so begins to risk moving the therapist into a
position of expertise on the client where fundamental person-centered principles
could be compromised. We have seen that Rogers had no problem with Gendlins
focusing-oriented approach, wherein the therapist does not merely respond in an
empathically understanding way but explicitly focuses clients attention on their felt
meanings, either through specically structured empathic responses, or through the
use of the focusing technique. Gendlin does this because he believes he is being
congruent with person-centered principles, in that focusing clients on their
experiencing is, in his eyes, the best way to support clients self-organizing wisdom.
Gendlin also prizes the relationship as primary.
Greenberg and colleagues similarly believe that they have learned enough about
therapy through their research to be able to more eciently provide exercises that
help clients utilize their intrinsic capacities for self-generated growth. Nonetheless
their goal of therapy is to facilitate clients nding their own path, not to impose one
on them. They also believe the relationship is primary. Techniques are secondary.
There is a danger, however, with both focusing-oriented and emotion-focused
therapy that therapists could adopt an expert-therapist stance in which procedures
are applied to clients in prescriptive and mechanistic ways. However that danger is
not only true of these therapies. It can also be true of classical person-centered
therapy. John Wood (2008) has noted that in his encounter group work facilitators
were expected to express their thoughts and feelings in the moment. Wood observed
that, This can be a problem for some client-centered therapists who are accustomed
to controlling the therapeutic relationship even though this control may be as
unobtrusive as merely maintaining a certain receptive posture to allow the client the
center stage (p. 48). Wood also noted that expressing empathy in the form of
empathic reections may not work well. He went on to say, These facts of groups
frequently surprise client-centered therapists who cannot believe that, with all their
good intentions and conscious eort not to, they are nevertheless applying a method
or playing a role (p. 69). In other words, classical person-centered therapists can
themselves be guilty of prescriptive, mechanistic practice.
I am not arguing that all of us should become integrative in one or more of the
various forms. To the contrary, that would be a violation of the spirit I am hoping
to promote, which is that of openness. I think one of the most important things we
have to oer the world is a model of diversity that there are dierent ways of
actualizing person-centered values in practice, each with its own unique strengths. I
particularly value classical nondirective therapy as the purest exemplar of an
attitude of following the client. However I also value the variations I have

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A.C. Bohart

mentioned in this article and there are others. It is valuable that we have these
dierent ways of being. We should be providing a model to the world of how to
be diverse together.
I wish to close by making a pitch for providing integrative forms of personcentered therapy to the world. If we refuse to allow there to be integrative personcentered practice, restricting person-centered practice to only classical nondirective
therapy, we deny clients and the world something very valuable. We leave it to others
to provide the value of deep empathic listening, truly prizing people as people, and
trusting peoples self-organizing wisdom by happenstance, when they provide their
techniques and procedures. We are not going to change all the world into
nondirective person-centered therapists. That means many clients will not get the
experience of being prized and related to in the way we prize and relate to persons.
We must nd a way to integrate the use of techniques together with our belief in
these fundamental attitudes so that clients have the right to get everything they want
and need from therapists. This will provide an expansive, inclusive frame which in
my opinion is representative of the underlying thrust of person-centered thinking,
which has always been towards openness and inclusivity.
Note
Based on a presentation at the World Association of Person-Centered and Experiential
Psychotherapy and Counseling Conference, Rome, Italy, JuneJuly 2010.

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