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COMMENTS ON "THE NECESSARY AND SUFFICIENT CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE"

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It is a privilege to be given the opportunity to comment on one of the seminal articles in the field of psychotherapy. Fifty years ago, Carl Rogers (1957) articulated his view of the necessary and sufficient conditions for psychotherapeutic change to occur. He presented his view with a level of clarity, precision, and conciseness that is all too rare in our field; moreover, his hypotheses are for the most part stated in operationalized terms with illustrations of how they could be empirically tested. I will briefly describe some of the ways this classic article has impacted the field, limitations of Rogers’ model, and its most enduring aspects in current psychotherapy litera- ture and debates.
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Content Preview
Psychotherapy: Theory, Research, Practice, Training
Copyright 2007 by the American Psychological Association
2007, Vol. 44, No. 3, 265–267
0033-3204/07/$12.00
DOI: 10.1037/0033-3204.44.3.265
COMMENTS ON “THE NECESSARY AND SUFFICIENT
CONDITIONS OF THERAPEUTIC PERSONALITY CHANGE”
GEORGE SILBERSCHATZ
University of California, San Francisco
This commentary describes the impact
person” (p. 97) within the particular relationship.
of Carl Rogers’ classic article on the
The therapist expresses acceptance, “prizing,” or
?eld of psychotherapy in general and
unconditional positive regard and has an accurate
empathic understanding of the client’s feelings
on control-mastery theory and research
and experiences. Though rarely included in sum-
in particular. The relevance of Rogers’
maries of his work, the last condition described
model in the current psychotherapy liter-
by Rogers is crucially important: The client must
ature and debates is addressed as are
perceive the therapist’s acceptance and empathy,
some of the limitations of the model.
because if these therapist attitudes are not com-
municated in a manner that the client experiences
or perceives them, then from the client’s perspec-
Keywords: control-mastery theory, psy-
tive they do not exist.
chotherapy, psychotherapy research,
The model that Rogers proposed in his 1957
client-centered therapy, Carl Rogers
article has had an enormous impact on the ?eld
of psychotherapy. The necessary and suf?cient
conditions that he described— especially his
It is a privilege to be given the opportunity to
emphasis on the centrality of the therapeutic
comment on one of the seminal articles in the ?eld
relationship— have been incorporated (to
of psychotherapy. Fifty years ago, Carl Rogers
greater and lesser degrees) in all of the major
(1957) articulated his view of the necessary and
“schools” of psychotherapy (Goldfried &
suf?cient conditions for psychotherapeutic
Davila, 2005). In psychodynamic approaches,
change to occur. He presented his view with a
for instance, many contemporary theorists sug-
level of clarity, precision, and conciseness that is
gest that the therapeutic relationship plays a
all too rare in our ?eld; moreover, his hypotheses
critical role in the change process. Self psy-
are for the most part stated in operationalized
chology, interpersonal, relational, and intersub-
terms with illustrations of how they could be
jective perspectives all have much in common
empirically tested. I will brie?y describe some of
with Rogers’ model. There are particularly
the ways this classic article has impacted the
striking parallels between Rogers’ client-
?eld, limitations of Rogers’ model, and its most
centered theory and Kohut’s self psychology
enduring aspects in current psychotherapy litera-
(Kahn, 1985, 1989; Stolorow, 1976). Both em-
ture and debates.
phasize that the therapist’s accepting, af?rma-
Rogers posited that in order for psychothera-
tive attitudes have powerful mutative effects in
peutic change to occur the following conditions
psychotherapy.
must be present and must continue over a period
Beginning with the opening paragraphs of the
of time. There must be “psychological contact”
article, Rogers makes clear that all of the terms in
(i.e., a relationship) between the participants; in
his model can be operationalized, measured, and
his view, change can occur only in the context of
thus empirically supported or refuted. His com-
a relationship. One of the participants—the
mitment to empirically validating hypotheses
client—is in a state of heightened anxiety, vul-
about therapeutic change processes was ex-
nerability, or “incongruence,” and the other—the
tremely rare 50 years ago, and yet the article ?ts
therapist—is a “congruent, genuine, integrated
very neatly in current literature on empirically
validated and supported treatments. In fact, I
would argue that his pioneering efforts helped to
Correspondence concerning this article should be addressed to
George Silberschatz, 3368 Sacramento Street, San Francisco,
create and stimulate the ?eld of psychotherapy
CA 94118-1912. E-mail: George.Silberschatz@ucsf.edu
research. Many studies on the therapist’s contri-
265

Silberschatz
bution to the process and outcome of therapy and
communicating the elements that are essential for
the voluminous research on the therapeutic alli-
therapy, but they may also communicate attitudes
ance originated with Rogers. Recent work on em-
that sharply contradict the hypothesized conditions
pirically validated relationships (Norcross, 2002)
for therapy (for empirical support of this point, see
can be traced back to Rogers’ pioneering efforts.
Silberschatz, Fretter, & Curtis, 1986). Techniques
The therapeutic model that Rogers proposed is
are thus seen as epiphenomena, and it is only the
highly compatible with the control-mastery the-
quality of the relationship that determines the suc-
ory (Silberschatz, 2005; Weiss, 1993) that has
cess of therapy. Although many patients undoubt-
in?uenced most of my work in psychotherapy.
edly bene?t enormously from the therapist-offered
When Weiss began developing his theory more
conditions and relationship qualities that Rogers
than 50 years ago, he was not aware of Rogers’
described, there are patients who require more tech-
writing. There are, nonetheless, some striking
nical approaches (e.g., interpretations, homework,
similarities in the two approaches. A fundamental
relaxation techniques, mindfulness training, etc.).
assumption in Rogers’ thinking is that humans
Gelso and Hayes (1998) argued that technical and
have a self-actualizing tendency and that it is
relationship factors are tightly intertwined such that
crucially important for the therapist to create con-
techniques may enhance (or diminish) the therapeu-
ditions that allow that tendency to ?ourish. This
tic relationship and the quality of the relationship
is essentially synonymous with the control-
may enhance (or diminish) the effectiveness of
mastery concept that patients come to therapy
techniques.
with an unconscious plan to solve their problems
Although Rogers’ approach is undoubtedly cli-
and master trauma and that the therapist’s pri-
ent centered, by prescribing the same set of con-
mary role is to help the patient carry out that plan
ditions for all patients it is paradoxically lacking
(Silberschatz, 2005). Rogers’ thesis that mean-
in case speci?city. A warm, unconditionally ac-
ingful change can occur only in the context of a
cepting therapeutic stance is not universally help-
relationship is shared by control-mastery theory.
ful and may prove to be detrimental in certain
His emphasis on the therapist conveying a warm,
cases (see Silberschatz, 2005, p. 13, for an exam-
accepting, genuine, and empathic stance is re-
ple). I agree fully with Rogers’ fundamental as-
?ected in the emphasis in control-mastery theory
sumption that therapy helps to the extent that it
on the therapist creating conditions of safety for
creates an environment that promotes the client’s
the patient (Silberschatz, 2005; Weiss, 1993,
self-actualizing tendencies. However, the numer-
2005). Rogers’ point that the client must perceive
ous ways that therapists create such an environ-
the therapist’s acceptance and empathy implies
ment are certainly not limited to the ones delin-
that these therapist qualities cannot be assessed in
eated in his article.
a generic, one-size-?ts-all manner. In a similar
A more substantive limitation of Rogers’
vein, my colleagues and I have strongly argued
model is that it does not adequately consider
for the need for a case-speci?c approach that
the role of patient factors in therapeutic change
takes into account the suitability or goodness of
processes. Patients clearly differ in their abili-
?t between the therapist’s stance and the patient’s
ties to utilize treatment, and such differences
particular needs (e.g., Silberschatz, 2005; Silber-
account—at least to some extent—for thera-
schatz & Curtis, 1993; Silberschatz, Curtis, &
peutic changes. Patient factors such as motiva-
Nathans, 1989; Silberschatz, Fretter, & Curtis,
tion or readiness for change, level or quality of
1986).
attachment style, reality testing, emotional reg-
What are the limitations of the model proposed
ulation, and severity and chronicity of prob-
by Rogers? I am in full agreement with Rogers that
lems all play some role in predicting therapy
his proposed conditions are necessary for therapeu-
outcome, yet Rogers’ model does not take such
tic change to occur, but I do question whether they
important patient factors into account. More-
are entirely suf?cient in all cases. Rogers (1957)
over, many of the therapist-offered conditions
takes a very strong and clear stand on the technique
described by Rogers cannot be viewed simply
versus relationship debate: “. . . [T]echniques of the
or exclusively as therapist variables. Consider
various therapies are relatively unimportant except
as an example therapist empathy, which is typ-
to the extent that they serve as channels for ful?lling
ically understood as a therapist variable that
one of the conditions” (p. 102). He argues that
operates in a unidirectional manner. Meissner
various techniques can play an important role in
(1996) has pointed out that empathy is best
266

Special Section: Comments on Rogers
viewed in a relational and bidirectional
is to create optimal conditions for this po-
context—the patient’s capacity to have empa-
tential to be realized.
thy for the therapist in?uences the therapist’s
I believe that Rogers’ contributions place him
level of empathy for the patient and it is this
among the most important ?gures in the history
mutually regulated empathy that is essential for
of psychotherapy.
maintaining a productive therapeutic relation-
ship. In short, patient factors clearly play an
References
important role in many facets of therapeutic
change processes, even those that appear to be
GELSO, C. J., & HAYES, J. A. (1998). The psychotherapy
relationship: Theory, research, and practice. New York:
predominantly therapist-generated or -offered
Wiley.
conditions.
GOLDFRIED, M. R., & DAVILA, J. (2005). The role of rela-
Despite these limitations, Rogers’ article is a
tionship and technique in therapeutic change. Psychother-
classic in our ?eld and appropriately so. Although
apy Theory, Research, Practice, Training, 42, 421– 430.
KAHN, E. (1985). Heinz Kohut and Carl Rogers: A timely
it was written over 50 years ago, many of the
comparison. American Psychologist, 40, 893–904.
ideas are pertinent to current, intensively debated
KAHN, E. (1989). Carl Rogers and Heinz Kohut: Toward
issues such as the role of techniques in therapy,
a constructive collaboration. Psychotherapy Theory,
the therapeutic relationship, therapeutic alliance,
Research, Practice, Training, 26, 555–563.
MEISSNER, S. J. W. W. (1996). Empathy in the therapeutic
and empirical research in psychotherapy. In my
alliance. Psychoanalytic Inquiry, 16, 39 –53.
view, the key and most enduring points of the
NORCROSS, J. C. (ED.). (2002). Psychotherapy relation-
article are the following:
ships that work. New York: Oxford University Press.
ROGERS, C. R. (1957). The necessary and suf?cient con-
ditions of therapeutic personality change. Journal of
1. The relationship between therapist and client
Consulting Psychology, 21, 95–103.
is central and therapeutic change happens
SILBERSCHATZ, G. (2005). An overview of control-
only in the context of a relationship.
mastery theory. In G. Silberschatz (Ed.). Transforma-
tive Relationships
(pp. 3–23). New York: Routledge.
2. There is continuity between psychotherapeu-
SILBERSCHATZ, G., & CURTIS, J. T. (1993). Measuring the
tic and other human relationships, and the
therapist’s impact on the patient’s therapeutic progress.
Journal of Consulting and Clinical Psychology, 61, 403–
principles that explain change in psychother-
411.
apy are applicable to all relationships.
SILBERSCHATZ, G., CURTIS, J. T., & NATHANS, S. (1989).
Using the patient’s plan to assess progress in psycho-
3. The therapist must have accurate empathy for
therapy. Psychotherapy Theory, Research, Practice,
the client and, for signi?cant change to occur,
Training, 26, 40 – 46.
S
the client must perceive and experience the
ILBERSCHATZ, G., FRETTER, P. B., & CURTIS, J. T.
(1986). How do interpretations in?uence the process of
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646 – 652.
4. Hypotheses about therapeutic change pro-
STOLOROW, R. D. (1976). Psychoanalytic re?ections on
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5. The potential for adaptation, growth, and
WEISS, J. (1993). How psychotherapy works. New York:
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WEISS, J. (2005). Safety. In G. Silberschatz (Ed.). Transfor-
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267

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