THE CURRENT STATUS OF CARL ROGERS AND THE PERSON

THE CURRENT STATUS OF CARL ROGERS AND THEPERSON-CENTERED APPROACH

HOWARD KIRSCHENBAUM AND APRIL JOURDANUniversity of Rochester

This investigation of Carl Rogers’swork explores the current status of theclient-centered/person-centered ap-proach within the United States andinternationally. The status is revealed1st by the volume of person-centeredliterature that has been published sinceRogers’s death in 1987. The prevalenceof Rogers’s work is also measured inthe number of professional organiza-tions, institutes, and journals dedicatedto the person-centered approach. Fi-nally, recent research on therapy out-comes, common factors, the workingalliance, and therapeutic relationshipshas validated 2 or 3 of Rogers’s coreconditions—empathy, unconditionalpositive regard, and, possibly,congruence—as being critical compo-nents of effective psychotherapy.

The historical influence that Carl R. Rogers(1902–1987) had on the field of clinical psychol-ogy, psychotherapy, and counseling is widelyknown—but what prevalence does Rogers’swork still have today? Have current trends inresearch and practice rendered Rogers’s contri-butions to that of historic, foundational interestonly, or are Rogers’s contributions still valid,relevant, and alive in the 21st century? This study

seeks to answer this question by examining threeareas in which the status of Rogers’s work maybe ascertained—the number of publications onthe client-centered/person-centered approach, theextent of person-centered organizations and train-ing institutes around the world, and the role ofclient-centered principles in the last several de-cades of research on psychotherapy process andoutcomes.

Historical Influence

Carl Rogers and his colleagues were the first torecord, transcribe, and publish complete cases ofpsychotherapy (C. R. Rogers, 1942). Using theserecordings, Rogers conducted and sponsoredmore scientific research on psychotherapy thanhad ever been undertaken before (e.g., C. R.Rogers & Dymond, 1954; C. R. Rogers, Gendlin,Kiesler, & Truax, 1967). Rogers developed the“nondirective,” “client-centered” approach tocounseling and psychotherapy, which became amainstay of therapists’ repertoires (C. R. Rogers,1942, 1951). In so doing, he popularized the term“client” as the recipient of therapy in nonmedicalsettings, virtually founded the professional coun-seling movement (Capuzzi & Gross, 2001; Gib-son & Mitchell, 1999; Gladding, 2000; Nugent,2000), and made professional counseling avail-able to diverse helping professions. For theseaccomplishments, he was the first psychologist orpsychotherapist ever to receive the AmericanPsychological Association’s (APA’s) highest sci-entific and professional honors: its DistinguishedScientific Contribution Award (APA, 1957) andits Distinguished Professional ContributionAward (APA, 1973).

C. R. Rogers’s “self-theory” (1959) became aprominent theory of personality that is still in-cluded in most personality texts today (e.g., Clon-inger, 2003; Feist & Feist, 2001; Hall, Lindzey,& Campbell, 1998; Monte & Sollod, 2002; Ryck-man, 2004). He served as President of the Amer-ican Association of Applied Psychology, theAmerican Association of Psychotherapists, the

Howard Kirschenbaum and April Jourdan, Department ofCounseling and Human Development, University of Rochester.

April Jourdan is now at Abraham Lincoln High School, SanFrancisco Unified School District, San Francisco, California.

Correspondence regarding this article should be addressedto Howard Kirschenbaum, EdD, Department of Counselingand Human Development, Warner Graduate School of Edu-cation, University of Rochester, Rochester, NY 14627. E-mail: [email protected]

Psychotherapy: Theory, Research, Practice, Training Copyright 2005 by the Educational Publishing Foundation2005, Vol. 42, No. 1, 37–51 0033-3204/05/$12.00 DOI: 10.1037/0033-3204.42.1.37

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APA, and the APA Division of Clinical Psychol-ogy, among other offices (Kirschenbaum, 1979).He became a leading spokesperson for the hu-manistic psychology movement (e.g., C. R. Rog-ers & Skinner, 1956) and for encounter groups(C. R. Rogers, 1970), and his many books, in-cluding On Becoming a Person (Rogers, 1961),helped bring the tenets of the client-centered, andlater “person-centered,” approach to ever wideraudiences (C. R. Rogers, 1969, 1977, 1980).

Current Status

What has occurred since then? Is Rogers’spresence as strong as ever, or has it faded asresearch on other approaches has proliferated,new knowledge about therapy has emerged, pro-tocols for research funding have changed, andother models, trends, and pop psychology move-ments have developed? Without the living exam-ple of Carl Rogers—teaching, writing, and dem-onstrating his theories and methods around theworld—have other researchers and practitionerscontinued to carry out and develop the client-centered/person-centered approach?

Assessing the prevalence of a therapeutic ap-proach is no simple task. There are some objec-tive data that help shed light on the question, butsome interpretation of current trends and researchfindings also are required to understand the ebband flow of a professional movement. As aninitial attempt to assess the current status of CarlRogers’s and the person-centered approach, weexplore three indices: the number of publicationsin the field, the proliferation of the person-centered approach around the world, and currentresearch on the client-centered approach and psy-chotherapy outcomes.

Number of Publications

One measure of prevalence is the number ofpublications appearing on a particular person orapproach. By one count, from January 1, 1987 toSeptember 6, 2004, 141 books, 174 book chap-ters, and 462 journal articles appeared on CarlRogers or the client-centered/person-centered ap-proach (see Table 1).

Therefore, not counting his own writings, morebooks and articles were written on Carl Rogersand the client-centered/person-centered approachin the 17 years after his death than were written inthe previous 40 years. If most of these publica-

tions simply made reference to Rogers’s or theclient-centered approaches’ historical role, thismight not be significant; but, in fact, our scanningof these publications indicates that the majorityare describing new research, new theory, and newapplications.

The numbers above reflect primarily the psy-chology literature. As Rogers’s work has perme-ated many different professions—social work,education, pastoral counseling, group leadership,and others—databases for other fields would cer-tainly reveal many more publications.

It should also be pointed out that the citationsincluded above reflect primarily a narrow con-struction of the client-centered or person-centered approach. In the past 30 years, therehave been at least two offshoots of the client-centered approach, often known as “focusing”(Gendlin, 1978, 1996) and “process-experiential”(Greenberg, Rice, & Elliott, 1993; Rice & Green-berg, 1984, 1990), which remain closely alignedwith the person-centered movement. For exam-ple, on the Focusing Institute’s Web site,Wiltschko (1994) stated, “Focusing Therapy is aform of client-centered therapy, is part of theperson-centered approach” (p. 2). Process-experiential therapy combines the person-centered and Gestalt approaches but remains es-sentially person centered. As Elliott (2003)wrote, “Working effectively with clients requiresadapting the therapist’s approach to the client’sgeneral presenting problems, the within-sessiontask, and the client’s immediate experience in themoment” (p. 2). “Davis (1995) found that morethan three quarters of PE therapists’ responseswere either empathic understanding (57%) or em-pathic exploration (19%), and that process-directing responses occurred at a rate of about8%” (Elliott & Greenberg, 2001, p. 290).

TABLE 1. Number of Publications on Carl Rogers and thePerson-Centered Approach

Publication 1946–1986 1987–2004

Books 84 141Book chapters 64 174Journal articles 456 462Total 604 777

Note. Based on bibliographies in Russell (2002) and asearch of the PsycINFO database (January 25, 2002, andSeptember 6, 2004) (not counting Rogers’ own 16 booksand over 200 chapters and articles). The PsycINFO data-base can be accessed (by subscription) from the AmericanPsychological Association (http://online.psycinfo.com).

Kirschenbaum and Jourdan

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A thorough bibliography including focusingand process-experiential approaches would yieldmany more titles and present a more accuratereflection of the current influence of the person-centered approach. Indeed, Lietaer (2002a) in-cluded 477 books on client-centered/experientialpsychotherapy from 1939–2000, many in lan-guages other than English, about twice as manytitles as shown in Table 1.

How do these numbers compare with otherapproaches? Using only the PsycINFO databasefor comparison, 777 books, chapters, and articleson Rogers and the client-centered/person-centered approach were found between 1987 and2004. Again, this is only a portion of the actualnumber, but confining ourselves to a single data-base allows an apples-to-apples comparisonamong approaches. Table 2 compares the numberof publications on various, major approaches topsychotherapy.

Of course, these numbers do not tell the wholestory. Aside from excluding many citations notlisted in the PsycINFO database, they do notindicate the content or type of publications. Forexample, the large number of publications on

Freud and psychoanalysis appear largely in psy-choanalytic journals in the United States andabroad. Very few appear in general publications,meaning that the authors are mostly speaking tothemselves. They focus almost exclusively ontheory and practice issues, with practically nocontrolled outcome studies. Publications on theperson-centered approach, in contrast, appear in awide variety of journals and publications andoften include rigorous empirical research.

By this narrow measure, then, it appears thatthe person-centered approach, although by nomeans a leading topic of scholarship in psycho-therapy and psychology, is alive and well. Thereis a steady stream of publications on theory,research, and practice in this area.

Professional Organizations and Journals

Another measure of status is the number ofprofessional organizations and journals using theideas of Carl Rogers and the client-centered/person-centered approach. Currently, there areapproximately 200 organizations and trainingcenters located around the world dedicated toresearching and applying the principles devel-oped by Rogers (see Table 3). Many of thesecountries have more than one client-centered/person-centered organization. This table providesonly a sample of person-centered organizationsaround the world.

Some of these organizations are fairly small,such as the Association for the Development ofthe Person-Centered Approach in the UnitedStates with only a few hundred members. Othersare quite large and active, such as the Gesell-schaft fur Wissenschaftliche Gesprachspsycho-therapie in Germany, with over 4,300 members;the British Association for the Person-CenteredApproach in England, with over 1,000 members;and the Association Francophone de Psycho-therapie Centree-sur-la-Personne et Experienti-elle in Belgium with over 1,000 members. Asthese examples suggest, Europe is currently themost active center for research, training, andpractice in the person-centered approach, and theperson-centered approach is one of the leadingtherapeutic approaches on that continent.

Furthermore, there are Focusing Institutes lo-cated throughout Europe, India, Israel, Japan,Taiwan, Thailand, New Zealand, Australia, Can-ada, and the United States (Focusing Institute,2003). As mentioned earlier, the experiential fo-

TABLE 2. Number of Publications on Various Approachesto Psychotherapy

Search descriptorsNo. of

publications

Sigmund Freud or psychoanalysis 22,436Family systems therapy or family therapy

(Family systems therapy alone � 127) 9,838Aaron Beck or cognitive therapy 7,963B. F. Skinner or behavioral therapy 2,788Cognitive behavioral therapy 2,273Carl Rogers or client-centered therapy or

person-centered therapy 777Fritz Perls or Gestalt therapy 620Albert Ellis or rational emotive therapy 581Multicultural counseling 448Alfred Adler or Adlerian therapy 364Psychodynamic therapy 363William Glasser or reality therapy 336Viktor Frankl or existential therapy 328Eclectic approach or integrative therapy 223

Note. Based on a search of the PsycINFO database(September 5, 2004). Descriptors are sometimes con-trolled by PsycINFO. For example, when one types be-havior therapy, PsycINFO tells the user to use the behav-ioral therapy descriptor. To derive the number forcognitive therapy, we had to ask for cognitive therapy, notbehavior and not behavioral. We recognize that morethan one person’s name is associated with any particularapproach, but we only used one name so as to render afair comparison.

Current Status of Carl Rogers and P-C Approach

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cusing approach developed by Eugene T. Gendlinis closely aligned to the client-centered/person-centered tradition; therefore, these organizationsalso promote many of the ideas of the client-centered/person-centered approach.

In addition to the various organizations andtraining institutes in various countries, there areumbrella organizations that connect the individ-ual organizations and provide a means for com-municating ideas among client-centered, person-centered, and experiential theoreticians andpractitioners. The World Association for Person-Centered and Experiential Psychotherapy andCounseling (WAPCEPC) was developed in 1997during the Fourth International Conference onClient-Centered and Experiential Psychotherapyheld in Portugal. Stated at the conference,

this will be the tenth year since Carl Rogers’s death and anappropriate time to take a major step to ensure the continuingvitality and influence of the distinctive approach to psycho-therapy to which we are committed in our various ways.(Schmid, 2003)

Another organization to emerge from this con-ference was the Network of the European Asso-ciations for Person-Centered Counseling andPsychotherapy (NEAPCEPC). The purpose of theNEAPCEPC is to support client-centered/person-centered organizations throughout Europe and toensure the presence of the approach on the Eu-

ropean level. Both the WAPCEPC and theNEAPCEPC adhere to the following principles.

The aim is to provide a world-wide forum for those profes-sionals who have a commitment to the primary importance intherapy of the relationship between therapist and client, anessential trust in the experiential world of the client and itscentrality for the therapeutic endeavor, a belief in the efficacyof the conditions and attitudes conducive to therapeutic move-ment first postulated by Carl Rogers and a commitment totheir active implementation within the therapeutic relation-ship, a commitment to an understanding of both clients andtherapists as persons who are at one and the same timeindividuals and in relationship with others and with theirenvironment, an openness to the elaboration and developmentof person-centered and experiential theory in the light ofcurrent and future practice and research. (Schmid, 2003; seealso WAPCEPC, 2004)

The influence of these organizations extendsthrough their professional journals, which reach awider audience than their membership and train-ing programs. Schmid (2003) listed more than 50person-centered or experiential periodicals andjournals with primary contributions from client-centered/person-centered theorists, researchers,and practitioners. The list includes journals fromPortugal, Germany, France, Great Britain, Mex-ico, Japan, Ireland, the Netherlands, Belgium,Canada, and the United States. There are regionaljournals as well, such as Person, published inGerman by the German, Austrian, and Swiss as-sociations. On the international level, a new jour-

TABLE 3. Examples of Person-Centered Organizations Around the World

Country Organization

Argentina A.E.D.E.C.e.P.—Asociacion para el estudio y desarrollo del Enfoque Centrado en la PersonaAustria PCA — Person-Centered Association in AustriaBelgium A.F.P.C. — Association Francophone de Psychotherapie Centree-sur-la-Personne et Experientielle

VVCgP — Vlaamse Vereniging voor clientgerichte psychotherapie (Flemish-speaking society)Brazil C.E.P./RS — Centro de Estudos da PessoaCanada CRAM—Centre de Relation d’Aide de MontrealCzech Republic PCA Institut PrahaFrance PCAI-F — Person-Centered Approach InstituteGermany GwG — Gesellschaft fur wissenschaftliche GesprachspsychotherapieGreece PCA—Hellenic Association of Person-Centered ApproachHungary HAPCCPM—Hungarian Association for Person-Centered Psychotherapy and Mental HealthItaly IACP—Istituto dell’Approccio Centrato sulla PersonaThe Netherlands VCgP—Vereniging voor Clientgerichte PsychotherapiePortugal APPCPC—Associacao Portuguesa de Psicoterapia Centrada na Pessoa e de CounsellingScotland PCT—Person Centred TherapySouth Africa APCASA—Association for the Person-Centered Approach South AfricaSwitzerland SGGT–SPCP—Swiss Association for Person-centered Psychotherapy and CounselingUnited Kingdom BAPCA—British Association for the Person-Centred ApproachUnited States ADPCA—Association for the Development of the Person-Centered Approach

Note. Based on authors’ research and Peter Schmid’s Web site (www.pfs-online.org), which has a complete listing oforganizations and training institutes around the world.


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nal was created in 2001 by WAPCEPC. Althoughthe journal is published in English, it includesresearch contributions from non-English-speaking countries.

All this activity is far more than that whichoccurred during Carl Rogers’s lifetime. Rogers, ifanything, discouraged institutes and organiza-tions that bore his name or promulgated theclient-centered approach. He was worried theywould foster a personality cult or rigid orthodoxy.Rogers’s death freed up a great deal of energyand initiative by person-centered theorists, re-searchers, and practitioners around the world,making the person-centered approach more of abroad-based, international movement than it everwas during Rogers’s lifetime.

Research Findings

In 1957, “Rogers set forth a hypothesis thatevoked more than 3 decades of research”(Bozarth, Zimring, & Tausch, 2001, p. 153). Thathypothesis, essentially, was that when a therapistdemonstrates the “core conditions” of uncondi-tional positive regard, empathic understanding,and congruence and when the client perceivesthese at least to a minimal degree, then psycho-therapeutic personality change and its positivecorrelates are inevitable. Moreover, C. R. Rogers(1957) argued that these conditions of effectivetherapy operated independently of the therapeuticapproach being used. He wrote, “the techniquesof the various therapies are relatively unimpor-tant except to the extent that they serve as chan-nels for fulfilling one of the conditions” (p. 102).

Among other instruments developed to assessthis hypothesis, Halkides (1958) created scaleswith which outside judges, listening to audiotapesof therapy sessions, could rate the therapists ontheir demonstrated levels of the three conditions,and Barrett-Lennard (1962) created the widelyused Relationship Inventory, used by clients torate their therapists on the core conditions. Re-search over the next quarter century involvedmany studies that confirmed the efficacy of thecore conditions. Truax and Mitchell (1971) re-ported on the results of 14 studies that involved992 participants. Across these studies, there were66 statistically significant correlations betweenpositive outcome and the core conditions, versusone statistically significant negative correlation.The authors summarized,

These studies taken together suggest that therapists or coun-selors who are accurately empathic, nonpossessively warm inattitude, and genuine, are indeed effective. Also, these find-ings seem to hold with a wide variety of therapists andcounselors, regardless of their training or theoretic orienta-tion, and with a wide variety of clients or patients, includingcollege underachievers, juvenile delinquents, hospitalizedschizophrenics, college counselees, mild to severe outpatientneurotics, and the mixed variety of hospitalized patients.Further, the evidence suggests that these findings hold in avariety of therapeutic contexts and in both individual andgroup psychotherapy or counseling. (p. 310)

Gurman (1977) concluded that “there existssubstantial, if not overwhelming, evidence insupport of the hypothesized relationship betweenpatient-perceived therapeutic conditions and out-come in individual psychotherapy counseling” (p.523). Orlinsky and Howard’s (1986) extensivereview of process–outcome studies concludedthat, regarding empathic resonance, mutual affir-mation, therapist role-investment (which in-cluded the patient perceiving the therapist as gen-uine), and the overall quality of the relationship,

generally between 50 and 80% of the substantial number offindings in this area were significantly positive, indicating thatthese dimensions were very consistently related to patientoutcome. This was especially true when process measureswere based on patients’ observations of the therapeutic rela-tionship. (p. 365)

In contrast to the growing evidence testifyingto the efficacy of the core conditions in promot-ing therapeutic improvement (and, conversely,low therapist conditions causing deterioration inclients), some studies showed no particular ben-efits resulting from one or another of the coreconditions. Hence, a number of research reviewsof studies in the 70s and early 80s reported equiv-ocal findings as to the efficacy or effectiveness ofthe core conditions (e.g., Bergin & Suinn, 1975;Mitchell, Bozarth, & Krauft, 1977; Parloff, Was-kow, & Wolfe, 1978). Many reviewers then(Mitchell et al., 1977) and since (Bozarth et al.,2001; Elliott, 2001; Patterson, 1984) havepointed out that these studies and reviews wereflawed in at least three respects.

First, the studies often used therapists whoexhibited minimal levels of the core conditions.That is, many studies were comparing no facili-tative conditions to minimal facilitative condi-tions. Patterson (1984) argued that, consideringthat so many studies on the core conditions foundpositive outcomes when therapists’ levels of theconditions were minimal and when sample sizeswere small only goes to demonstrate how effec-tive the core conditions are when therapists are


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trained to provide high levels of positive regard,empathy, and congruence. When researchers con-trolled for such bias, Stubbs and Bozarth (1994,as cited in Bozarth et al., 2001) “did not find onedirect study that supported the assertion that theconditions are not sufficient” (p. 166).

Second, those who interpret studies that showno positive effect from one of the core conditionsas evidence that that condition is unimportantmisunderstand Rogers’s hypothesis. For exam-ple, although therapist empathy in and of itselfmay not be a necessary condition of effectivetherapy (Bergin & Suinn, 1975; Lambert & Ber-gin, 1994), what does seem important is thatclients perceive their therapist to be empathic(Barrett-Lennard, 1962; P. J. Martin & Sterne,1976). This, in fact, was C. R. Rogers’s (1957)hypothesis—the client must perceive the thera-pists’ empathy, unconditional positive regard,and congruence. Studies that use only outsideobserver or therapist ratings to measure the coreconditions fall short of testing Rogers’s hypoth-esis, even though a large number have producedpositive findings. The truer test of Rogers’s hy-pothesis is achieved when the core conditions arerated by the client, and such studies have pro-duced the most consistently positive findings.

Finally, the fact that some studies, albeit aminority, show that empathy by itself does notproduce positive change does not mean that em-pathy is not effective; this just means that, byitself, empathy is not sufficient. The same is truefor unconditional positive regard and congruence.Rogers did not suggest that each condition wassufficient but that all were sufficient. When allthree conditions are present and the client per-ceives them, Rogers said that positive change willoccur.

Later Studies and Reviews

In any case, in spite of some equivocal reviewsin the 70s, most research in the 1980s and 90scontinued to support the importance of the coreconditions. Reviewing 12 studies, Sexton andWhiston (1994) wrote, “This research seems tosupport previous findings regarding the impor-tance of empathy in the counseling relationship”(p. 15). Orlinsky, Grawe, and Parks (1994) re-ported similar positive results in 10 studies fromthis period (only one overlapping with Sextonand Whiston’s sample). Bohart, Elliott, Green-berg, and Watson (2002) conducted possibly the

largest meta-analysis of research on empathy,including 47 studies from 1961–2000, involving3,026 clients, with 190 separate empathy–outcome associations studied. They found aweighted, unbiased effect size of .32, which isconsidered a medium effect size. In the context ofpsychotherapy outcome research, this would beconsidered a meaningful correlation between em-pathy and positive therapeutic outcomes. Al-though recognizing the importance of empathy,many researchers (e.g., Bohart et al., 2002; Duan& Hill, 1996; Gladstein, 1987; Sexton & Whis-ton, 1994) have suggested that empathy is a morecomplex concept than Rogers and others haverecognized. They have argued that more researchis needed to understand therapeutic empathy—itsdifferent forms and its most effective applicationswith different clients, in different therapeuticcontexts, and at different stages of the therapyrelationship.

As with empathy, of 24 relatively recent stud-ies addressing therapists’ “affirmation” of clients(a concept that includes acceptance, nonposses-sive warmth, and positive regard), a large major-ity of the studies showed a positive correlationbetween affirmation and outcomes, comparedwith some neutral and only one negative finding(Orlinsky, Grawe, & Parks, 1994). When com-bined with studies from Orlinsky and Howard’s(1986) review, Orlinsky, Grawe and Parks

summarized the results of 154 findings . . . drawn from a totalof 76 studies. They found that 56% of the findings werepositive, and that, again, the findings based on the patients’. . . sense of the therapist’s positive regard yielded even ahigher rate of positive therapeutic outcomes, 65%. (Farber &Lane, 2002, p. 184)

Stated differently, there were 87 findings witha statistically significant positive relationship be-tween therapist affirmation and positive out-comes, 63 findings that showed no relationship,and only 4 that showed a negative relationship.

Furthermore, most recent studies done follow-ing the “working alliance” model (discussed be-low), rather than the client-centered model, foundsimilar findings. In 16 studies, about half of theassociations between therapists’ warmth/positiveregard and outcomes are positive, about halfshow no difference, and none are negative. How-ever, again, “as noted by previous reviewers,when the patient rates both the therapist’s posi-tive regard and treatment outcome, a positiveassociation between these and other variables is


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especially likely” (Farber & Lane, 2002, p. 185).Farber and Lane (2002) concluded,

The therapist’s ability to provide positive regard seems to besignificantly associated with therapeutic success—at leastwhen we take the patient’s perspective on therapeutic out-come. However, virtually all the significant findings bearrelatively modest effect sizes, suggestive of the fact that, likethe therapeutic alliance, it is a significant but not exhaustivepart of the process–outcome equation. Extrapolating some-what from the data, we conclude that therapists’ provision ofpositive regard is strongly indicated in clinical practice. (p. 191)

Research on congruence has been more ambig-uous, with many studies showing a positive cor-relation with positive outcomes, many showingno correlation, and some showing a negative cor-relation (Klein, Kolden, Michels, & Chisholm-Stockard, 2002; Sachse & Elliott, 2001).Kirschenbaum (1979) wrote that congruence wasthe least clearly explained of Rogers’s core con-ditions; hence, it may be the most difficult of thecore conditions for therapists to get right. Theresearch indicates, for example, that althoughcertain amounts and types of self-disclosure bythe therapist may be helpful, too much or inap-propriate self-disclosure can be harmful (Orlin-sky et al., 1994). Sachse and Elliott (2001) sug-gested that more research is needed to learn abouthow congruence can be used most helpfully incounseling and psychotherapy.

Research in Europe

As research on client-centered therapy in theUnited States diminished in Rogers’s later years(Lietaer, 1990), when his professional attentionturned elsewhere, research on person-centeredand experiential psychotherapies increased sig-nificantly in Europe. Reinhold Tausch and hisstudents and colleagues in Germany engaged in amajor program of psychotherapy research (seeBozarth et al., 2001, for a summary of this re-search program). For example, in one study in-volving 80 client-centered therapists and 149 cli-ents and their wait-list control clients, it wasfound that significant improvement in clientstook place when therapists demonstrated two ofthe three core conditions (Rudolph, Langer, &Tausch, 1980). (Again, this recalls C. R. Rog-ers’s, 1957, hypothesis that single conditions arenot sufficient, but that all—or as this study dem-onstrated, at least two—of the core conditions arenecessary for change.)

Studies in Belgium and the Netherlands by

Lietaer and his colleagues produced similar find-ings (e.g., Lietaer, Rombauts, & VanBalen, 1990;Lietaer, van Praag, & Swildens, 1984; VanBalen,Leijssen, & Lietaer, 1986). Summarizing this pe-riod of research, Bozarth et al. (2001) wrote,

The studies by Tausch and his colleagues as well as others inEurope are quite positive. Positive findings are consistent inthe areas of individual psychotherapy . . .; group psychother-apy; and groups with cancer patients, prisoners, judges, teach-ers, and geriatric individuals. The findings extend to encoun-ter groups, education, and daily life activities (p. 162).

Speaking more broadly, Stubbs and Bozarth(1994) wrote, “Over four decades, the majorthread in psychotherapy efficacy research is thepresence of the therapist attitudes hypothesizedby Rogers” (p. 109).

A New Generation of Research

In spite of all the research support for empathy,positive regard, and congruence, even strong ad-vocates of client-centered/experiential therapyhave conceded or concluded that the core condi-tions may be neither necessary nor sufficient(Tausch, 1990). Lietaer (2002b) has pointed outthat certainly there has been at least one case inwhich a client perceived the therapist as em-pathic, accepting, and real yet did not improve.This shows that the conditions are not sufficientfor all clients. Similarly, there have been individ-ual patients who improved even though the ther-apist lacked one or more of the core conditions.Hence, one cannot maintain that all the coreconditions are necessary. As Gelso and Carter(1985) stated, “the conditions originally specifiedby Rogers are neither necessary nor sufficient,although it seems clear that such conditions arefacilitative” (p. 220) or, as Lietaer (2002b) said,“crucial.” As we would put it, although neithernecessary nor sufficient for all clients, the coreconditions are helpful to extremely helpful withvirtually all clients.

Indeed, the direction of much of the latestresearch on psychotherapy outcomes is consistentwith this view. This newer research has graduallycome to recognize or acknowledge, first, that thesuccess of psychotherapy is only partly deter-mined by the psychotherapy itself, that is, by thetherapist’s approach, skill, attitudes, and relation-ship with the client. For example, on the basis ofLambert, Shapiro, and Bergin’s (1986) review ofthe voluminous research on psychotherapy out-comes, Lambert (1992) concluded that whatever


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positive change occurs during psychotherapy canbe attributed approximately 45% to the psycho-therapy (a combination of the therapy relation-ship and the therapist’s techniques), 15% to theplacebo effect (the client’s expectation that thisprocess will be good for him or her), and 40% toextratherapeutic variables like the social and fam-ily support systems in the client’s life, the client’sego strength, and fortuitous events (see alsoHubble, Duncan, & Miller, 1999; Wampold,2001).

Another recognition of the newest generationof psychotherapy research, albeit a controversialone, is that the success of psychotherapy is notdue primarily to the particular therapeuticapproach—whether it be cognitive–behavioral,client-centered, psychoanalytic, or any other.Rather, these approaches are roughly equivalentin their effectiveness (Elliott, 1996; Luborsky,Singer, & Luborsky, 1975; M. L. Smith & Glass,1977; M. L. Smith, Glass, & Miller, 1980; Wam-pold et al., 1997). Some research has supportedthe superiority of certain approaches for certainclient problems, such as cognitive–behavior ther-apy for the treatment of depression; however,many researchers (e.g., Elliott, 2001; Luborsky etal., 1999; Robinson, Berman, & Neimeyer, 1990;Wampold, 2001) have argued persuasively that,in addition to other limitations, these studies donot take therapist “allegiance” into account. Theysuggest, for example, that the cognitive–behavioral therapists in these studies (and theresearchers) had a level of training and commit-ment to cognitive–behavioral therapy that wasgreater than the training and commitment of thetherapists in the comparison groups and thatwhen these differences in therapist allegiance arecontrolled statistically, the differences in treat-ment approaches all but disappear.

Common Factors and Core Conditions

Hence, much of the latest research on psycho-therapy outcomes has demonstrated that, ratherthan particular approaches, it is certain “commonfactors” in the therapy relationship that accountfor therapeutic change (Goldfried, 1980; Frank,1982; Grencavage & Norcross, 1990; Lambert,1992). “Our major theoretical schools, althougheffective, seem no better than one another. In-stead, it seems that there is some set of commonelements and process underlying successful ther-apy” (Sexton, Whiston, Bleuer, & Walz, 1997, p.

56). Although Rogers was not the first person tosuggest that common factors in the therapy rela-tionship account for its benefits (Rosenzweig,1936, first introduced the idea), he was the first tospell out this relationship in detail and conductextensive scientific research on it. Years later,citing Hubble et al.’s (1999) book on commonfactors research, The Heart and Soul of Change,Bozarth et al. (2001) would write that “the per-vasive conclusion of decades of therapy research[is] that outcome is related to common factorsrather than particular therapies” (p. 150).

The common factors in effective psychother-apy have been characterized many differentways. Lambert and Bergin (1994) cataloged sup-port factors, learning factors, and action factors.Among the support factors are therapist warmth,respect, empathy, acceptance and genuineness,positive relationship, and trust. New studies con-ducted by non-client-centered therapists continueto support the importance of these supportfactors.

For example, one of the largest and best ex-perimental studies conducted in the UnitedStates, funded by the National Institute of MentalHealth (Blatt, Zuroff, Quinlan, & Pilkonis, 1996),compared three treatment approaches fordepression—administration of the drug imipra-mine, cognitive–behavioral therapy, interper-sonal therapy, and “ward management,” whichwas meant to serve as a placebo treatment. Whatdistinguished this study was that it involvedmany therapists and many patients who wererandomly assigned to the various treatmentgroups.

The patients were selected in terms of specifically definedcriteria; three large medical centers were used in order toprovide adequate samples of patients; manuals were availablefor each of the forms of psychotherapy being evaluated; thetherapists were experienced clinical psychologists and psy-chiatrists who received specialized training in one of thepsychotherapies being evaluated; a variety of well-knownstandardized evaluative procedures were used; and competentstatistical consultants participated in the project. (Lambert &Bergin, 1994, p. 220)

As it turned out, there were no significant differ-ences among the three therapeutic treatments onpatient outcomes. However, across all groups, thetherapist’s empathy, positive regard, and congru-ence at the end of the second session were sig-nificantly correlated with outcomes. As Blatt etal. (1996) wrote, “Higher levels of an experi-enced therapeutic relationship [that is, as experi-enced by the patient] were significantly related to


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better outcome, especially with the measures ofchange in general clinical and social functioning”(p. 166). Bozarth et al. (2001) wrote that thesingle best predictor of success at the end oftherapy was the patients’ perception of the ther-apist’s empathy at the end of the second session.

Therapeutic Alliance and Core Conditions

In spite of the significant empirical support forRogers’s core conditions, other researchers haveproposed other models as providing a more sat-isfactory explanation of the common factors thataccount for therapeutic progress. One of these isthe therapeutic alliance or working alliancemodel, which originated in the psychoanalyticliterature (Bordin, 1979; Menninger, 1958). AsSexton et al. (1997) wrote, “The working alli-ance, social influence and interactional models ofthe counseling relationship have received consid-erable research attention and garnered strong em-pirical support. The strength of the evidence forthese models far exceeds that demonstrated bythe prevalent Rogerian model” (p. 78). Althoughthey present little evidence to support this claimwith respect to the latter two models, researchreviews and meta-analyses on the therapeutic al-liance (e.g., Gaston, 1990; Horvath & Symonds,1991; Luborsky, Crits-Christoph, Mintz, & Auer-bach, 1988; D. J. Martin, Garske, & Davis, 2000;Orlinsky et al., 1994) have helped establish thismodel as a popular new explanation for effectivetherapeutic relationships. Orlinsky et al. (1994)wrote, “The strongest evidence linking process tooutcome concerns the therapeutic bond or alli-ance, reflecting more than 1,000 process–outcome findings” (p. 360).

Whether it far exceeds the core conditionsmodel is debatable. Lambert (1992) wrote, “Re-search on the therapeutic alliance has, as yet, farless research than that generated by client-centered theory” (p. 108), although subsequentresearch on the alliance has been profuse. “Theresults of the meta-analysis indicate that the over-all relation of therapeutic alliance with outcomeis moderate” (D. J. Martin, Garske, & Davis,2000.) “Moderate” in this sense refers to effectsize or just how large the relationship is betweenthe alliance and the outcome. Statistically speak-ing, the same could be said of empathy (seeFarber & Lane, 2002, above). Bohart et al. (2002)stated, “The effect size [for empathy] is on thesame order of magnitude as (or slightly larger

than) previous analyses of the relationship be-tween therapeutic alliance and outcome” (p. 96).Although there is still some debate over the rel-ative strength of the necessary and sufficient con-ditions and the therapeutic alliance models, nev-ertheless, there is little debate that recent,process–outcome research in psychotherapy hasfocused primarily on the common factors in thetherapeutic or working alliance.

Ironically, Lambert and Bergin (1994) wrote,“There is more disagreement about the therapeu-tic alliance construct than there was with theclient-centered conditions” (p. 165). Descriptionsof the therapeutic alliance include the therapist’sengagement (efforts to promote the process, ac-tive interventions, and showing interest) and thetherapist’s collaboration (taking a mutual, invi-tational, negotiating stance; Sachse & Elliott,2001). Another description of the working alli-ance includes “client–counselor agreement ongoals, agreement on therapeutic tasks, and theemotional bond between client and counselor”(Sexton et al., 1997, p. 78). The therapeutic alli-ance is influenced by other common factors(Grencavage & Norcross, 1990; Wampold, 2001,p. 150). These include the client’s belief about theeffectiveness of therapy and his or her hope andexpectation about getting better (Frank, 1961);whether the therapist’s behavior fits the client’sexpectations; whether the client and therapist canestablish a contract—a mutual understanding ofhow they will work together, how long it willtake, how much it will cost, what kind of materialwill be explored, and how they will do this. Allthese common factors affect the therapeutic out-come. Summarizing many different conceptionsof the alliance concept, Gaston (1990) identifiedfour broad dimensions:

the therapeutic alliance, or patient’s affective relationship tothe therapist . . . [b] the working alliance, or patient’s capacityto purposefully work in therapy . . . [c] the therapist’s em-pathic understanding and involvement . . . [and; d] thepatient–therapist agreement on the goals and tasks of treat-ment. (p. 145)

As Gaston’s description makes explicit, and asmany scholars have pointed out (Feller & Cat-tone, 2003), the Rogerian and therapeutic allianceexplanations are not mutually exclusive. Orlinskyet al. (1994) wrote, “Theoretical interest in thetherapeutic alliance . . . has continued the move-ment launched by C. R. Rogers’s (1957) concep-tion of the therapeutic relationship” (p. 308).Wampold (2001) wrote, “Empathy and the for-


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mation of the working alliance, for example, areintricately and inextricably connected” (p. 211).Burns and Nolen-Hoeksema (1992) studied therole of empathy as one component of the thera-peutic alliance when using cognitive–behavioraltherapy for the treatment of depression. Theyreported

The patients of therapists who were the warmest and mostempathic improved significantly more than the patients oftherapists with the lowest empathy ratings, when controllingfor initial depression severity, homework compliance, andother factors. This indicates that even in a highly technicalform of therapy such as CBT [cognitive–behavioral therapy],the quality of the therapeutic relationship has a substantialimpact on the degree of clinical recovery. This is the firstreport we are aware of that has documented the causal effectof therapeutic empathy on recovery when controlling for thesimultaneous causal effect of depression on therapeutic em-pathy. (p. 447)

The results were so robust that, thereafter, allpatients at the medical center where the researchwas conducted were required to complete a “ther-apeutic empathy form” after each interview, sothat therapists would get timely feedback if theirpatients perceived a lack of empathy on their part.“Thus, difficulties in the therapeutic alliance canbe more rapidly identified and addressed” (p. 445).

Indeed, it is the therapist’s empathy, accep-tance, and genuineness that allow many clients tofeel safe enough to enter into a real relationshipwith the therapist and be willing to develop animplicit or explicit agreement, understanding, or“contract” to engage in therapy. One client-centered therapist (McCulloch, 2000, 2003) ex-plained how she was able to establish meaningfulcounseling relationships with male prisoners withdiagnoses of antisocial personality disorder.Prison psychologists had given up on them; theywere reluctant or refused to accompany McCul-loch on her clinical rounds through the cell block.On her first visit to the cells, prisoners exposedthemselves, urinated, spat toward her, and voicedobscenities. On subsequent visits, many inmatesstopped these behaviors, began speaking withher, and agreed to participate in counseling ses-sions. Her fellow psychologists could not under-stand how she accomplished this, but her expla-nation was simple:

I treated them like human beings. I showed concern andinterest while accepting their anger without judging it. Iexpressed my own limits by telling them that I was distractedby their behavior, that I wanted to give them my full attention,and that I found it difficult to do so when I was distracted. Itold them that I valued speaking with them and hoped we

would talk when they were not doing these other things.(McCulloch, 2003)

In this case, the therapist’s empathy, uncondi-tional positive regard, and congruence made atherapeutic alliance possible. The process is sim-ilar in less dramatic cases. The core conditionsboth facilitate the therapeutic alliance and play anintegral part in the therapeutic process. Rogers’score conditions may or may not be necessary orsufficient for effective psychotherapy (the debateis ongoing), but whether considered among thecommon factors of effective therapy or a meansto achieve a therapeutic alliance, the value ofempathy, unconditional positive regard, and con-gruence is supported by the latest generation ofpsychotherapy process–outcome research. AsLambert (1992) concluded

Among the common factors most frequently studied havebeen those identified by the client-centered school as ‘neces-sary and sufficient conditions’ for patient personal change:accurate empathy, positive regard, nonpossessive warmth,and congruence or genuineness. Virtually all schools of ther-apy accept the notion that these or related therapist relation-ship variables are important for significant progress in psy-chotherapy and, in fact, fundamental in the formation of aworking alliance (p. 104).

The Therapeutic Relationship and EmpiricallySupported Treatments

This is not just the conclusion of a few indi-vidual scholars or of researchers with a client-centered leaning. At the end of the 20th century,the APA Division of Psychotherapy (Division29) created a distinguished panel to summarizethe research on effective therapy relationships(Norcross, 2001). This task force, of whose 10steering committee members none particularlyidentified with the client-centered approach, wasin part a response to the growing movement,particularly in the United States, toward “empir-ically supported treatments.” Federal funding ofresearch on psychotherapy was moving stronglytoward identifying those treatment approachesthat were shown empirically to be effective, par-ticularly with patients with specific diagnoses—anxiety, depression, drug abuse, and the like.Concerned that this movement essentially ig-nored 30 or more years of research that demon-strated that treatment approaches made relativelylittle difference compared with the therapeuticrelationship itself, the task force was chargedwith summarizing the scientific research on thetherapy relationship.


46

Published in a massive volume called Psycho-therapy Relationships That Work (Norcross,2002) and summarized in its professional journal(Norcross, 2001), the task force’s six main con-clusions were as follows.

1. The therapy relationship makes substantialand consistent contributions to psychother-apy outcome independent of the specifictype of treatment.

2. Practice and treatment guidelines shouldexplicitly address therapist behaviors andqualities that promote a facilitative therapyrelationship.

3. Efforts to promulgate practice guidelines orevidence-based lists of effective psycho-therapy without including the therapy rela-tionship are seriously incomplete and po-tentially misleading on both clinical andempirical grounds.

4. The therapy relationship acts in concertwith discrete interventions, patient charac-teristics, and clinical qualities in determin-ing treatment effectiveness. A comprehen-sive understanding of effective (andineffective) psychotherapy will consider allof these determinants and their optimalcombinations.

5. Adapting or tailoring the therapy relation-ship to specific patient needs and character-istics (in addition to diagnosis) enhances theeffectiveness of treatment.

6. The following list embodies the Task Forceconclusions regarding the empirical evi-dence on General Elements of the TherapyRelationship primarily provided by the psy-chotherapist. (Task Force on EmpiricallySupported Therapy Relationships, n.d., p. 2)

Evaluating the strength of the various correla-tions, the task force grouped qualities and aspectsof the therapy relationship according to whetherthey were demonstrably effective across thera-pies; promising and probably effective acrosstherapies; demonstrably or probably effectivewith particular types of clients, or not yet shownby research to be effective. The three aspects ofthe individual therapy relationship shown to beclearly demonstrated by the research were (not inorder of importance) the therapeutic alliance, em-

pathy, and goal consensus and collaboration. As-pects of the therapy relationship judged to bepromising and probably effective were positiveregard, congruence/genuineness, feedback, repairof alliance ruptures, self-disclosure, managementof countertransference, and quality of relationalinterpretations. The task force leader, referring tothe Bill Clinton presidential campaign slogan, “Itis the economy stupid,” quipped that their find-ings could be summarized by the slogan, “It is therelationship, stupid!” (Norcross, 2001, p. 347).

The Move Toward Eclecticism and Integration

Consistent with this large body of research,most therapists have been moving away from astrict allegiance to specific therapeutic ap-proaches or schools of thought (Lambert & Ber-gin, 1994; Norcross & Goldfried, 1992). Surveysof therapists over the past 30 years have demon-strated a growing proportion of practitioners whoidentify themselves as “eclectic” or “integrative”(Garfield & Kurtz, 1977; Jensen, Bergin, &Greaves, 1990; D. Smith, 1982; Norcross &Newman, 1992; Norcross & Prochaska, 1988), tothe point where “the vast majority of therapistshave become eclectic in orientation” (Lambert &Bergin, 1994, p. 181). In many of these surveys,although a very small percentage of practitionersidentify themselves as being primarily personcentered, a significant proportion of counselors,psychotherapists, and social workers (typically25–50%) identify “Rogerian,” person-centered,experiential, and humanistic methods as being asignificant part of their integrative approach. Onecan only speculate that many more therapists,although not identifying themselves as primarilyor partially person centered, nevertheless incor-porate Rogers’s core conditions as important in-gredients in their own therapeutic approach. Inthis sense, Rogers’s influence lives on in thepractice of many, if not most, eclectic and inte-grative counselors and psychotherapists.

Conclusion

We have attempted to assess the current statusof Carl Rogers’s contributions to psychotherapyby examining three indicators of prevalence. Thenumber of publications on Rogers and the client-centered/person-centered approach has increasedsubstantially since Rogers’s death. Person-centered associations, organizations, and training


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institutes have proliferated around the world. Re-search on psychotherapy process and outcomeshas validated the importance of empathy, uncondi-tional positive regard, and probably congruence—Rogers’s core conditions for an effective therapeu-tic relationship.

By all these indicators, the person-centeredapproach, which holds the therapeutic relation-ship as central and essential to effective counsel-ing and psychotherapy, is alive and well. Al-though relatively few therapists describethemselves as primarily client-centered in theirorientation, client-centered principles permeatethe practice of many, if not most, therapists.Various schools of psychotherapy increasinglyare recognizing the importance of the therapeuticrelationship as a means to, if not a core aspect of,therapeutic change.

Of course, these three indicators do not tell thewhole story. A thorough examination of Rogers’sand the person-centered approach’s current statuswould look more deeply at the “person-centered-experiential” movement, teasing out the distinc-tions between and synthesis of person-centered,focusing, and process-experiential approachesand charting their collective prevalence and vi-tality. One might also review the extent to whichthe person-centered approach may be found incurrent textbooks in clinical psychology, psycho-therapy, and counseling; the extent to whichfunded research projects reflect or study person-centered principles or methods; and the extent towhich person-centered approaches are reim-bursed by insurance carriers in different statesand countries. Another useful measure is the ex-tent to which current practitioners identify them-selves with the client-centered approach and/orRogers’s core conditions. This subject was brieflytouched on above but deserves a more thoroughexploration. Finally, a very important measure ofstatus, current and future, is the extent of univer-sity training and research programs that are pro-mulgating and studying the person-centered ap-proach. Although there may be an impressivelevel of such activity today, unless a new gener-ation of researchers and practitioners are beingprepared to assume leadership in the future, anymovement is bound to decline.

In any case, for now, the client-centered/person-centered approach appears to be experi-encing something of a revival, both in profes-sional activity and academic respectability. Thelatest generation of research on psychotherapy

process and outcomes—whether couched interms of the core conditions, common factors, orthe therapeutic/working alliance—has validatedmany of Carl Rogers’s original insights about theimportance and nature of the effective therapeuticrelationship. This should be acknowledged morewidely in university classrooms, publications,research-funding protocols, and professionaltraining programs. In the last area, there are manynew resources available (e.g., Kirschenbaum,2003; PCCS Books, 2004; N. Rogers, 2002;WAPCEPC, 2004) to assist university trainingprograms and independent institutes in preparingpsychotherapists, counselors, and other clinicalworkers.

Looking ahead, it is unclear whether the client-centered/person-centered approach will remain aseparate and distinct orientation in psychother-apy; whether its expansion to the person-centered-experiential approach, as advocated bymany leading person-centered scholars and re-searchers today, will become the accepted, widerorientation; or whether the person-centered-experiential movement will be subsumed underthe more general heading of humanistic psycho-therapies as some advocate (Lietaer, 2002c; seealso Cain & Seeman, 2001). Whichever evolves,it seems likely that Carl Rogers’s legacy willendure, not just as an area of study of historicalimportance, but as a body of research and prac-tice that will influence the work of future re-searchers and practitioners for generations tocome.

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Documents

THE CURRENT STATUS OF CARL ROGERS AND THE PERSON