Humanistic models partly developed as a reaction against what appeared to be the determinism implicit in psychoanalysis and behaviourism. In psychoanalysis, especially if understood from a Freudian perspective before object relations theory, there was a rather pessimistic view of human nature that portrayed people as basically driven by sexual and aggressive impulses that have to be contained. Behaviourism was also seen as objectifying and dehumanizing, emphasizing environmental forces as determinants of behaviour. In contrast, the humanistic approach was to emphasize human nature as essentially positive, valued choice, values and purpose in life; and psychopathology is seen as the failure to fulfil the natural potential for personal growth.
The humanistic model encompasses a wide and diverse range of approaches. While in this chapter we include different examples within this model, in particular we focus on the approach of Carl Rogers, credited as one of the principal founders of the humanistic school. His work remains significantly influential both in its theoretical approach and in its practical therapeutic strategies and applications. Furthermore, his general approach has inspired other developments aimed at enlarging the understanding and management of psychopathology.
Carl Rogers and person-centred therapy
Rogers (1902–87) is perhaps the most well-known humanistic psychologist and is sometimes credited with being the founder of contemporary counselling. His approach to psychopathology developed as an alternative approach to the psychoanalytical, behavioural and medical models prevalent at the time of his own training. Kirschenbaum (1979) and Thorne (1992) both outline Rogers’ career and professional development. He was deeply opposed to the bio-medical model of psychopathology, both in its theoretical conceptualizations concerning the genesis of distress and in the practical intervention it viewed as appropriate to alleviate the manifestations of distress. He was sceptical about the use of psychometric tests if their main purpose was simply to diagnose and label either problems or people. Rogers’ person-centred therapy emphasizes the capacity in clients to find their own answers, once the necessary psychological conditions had been established. He applied his ideas derived from therapy to wider contexts, such as education, conflict resolution and encounter groups (see Thorne 1992). The essence of Rogers’ approach to psychopathology is based on his view that there is an inherent human motive for self-growth, or what he terms self-actualization, present in all people. In the right conditions a child increasingly develops positive self-regard and the actualizing tendency is promoted. However, during the course of development this striving can become frustrated, blocked or distorted, when the person receives conditional positive regard from his or her social environment, and thus develops what Rogers referred to as conditional positive self-regard. For example, if someone grows up in an environment where he or she learns from significant adults the belief that one has to please others in order to be loved and valued, he or she can only find value for themselves to the extent that they live up to this belief. Psychopathology is the result of the tension between a person’s inner actualizing tendency, and the conditional positive regard they receive from others. The distress resulting from manifestations of psychopathology can be ameliorated through the experience of positive relationships where the person is given unconditional positive regard. Through this experience, the person increasingly develops positive self-regard, the actualizing tendency is promoted and dysfunctional behaviour on the part of the client decreases. Thus, the person-centred model is holistic, viewing and addressing the entire experience of being a person in its consideration of human distress, rather than selecting specific symptoms of psychopathology as the focus of concern.
The actualizing tendency
The cornerstone of Rogers’ theory, the actualizing tendency, is a motivational force directed towards constructive growth. ‘It is the urge which is evident in all organic and human life – to expand, extend, to become autonomous, develop, mature – the tendency to express and activate all the capacities of the organism, to the extent that such activation enhances the organism or the self’ (Rogers 1961: 35). The fully functioning person is one who is: synonymous with optimal psychological adjustment, optimal psychological maturity, complete congruence, complete openness to experience . . . since some of these terms sound somewhat static, as though such a person ‘had arrived’, it should be pointed out that all the characteristics of such a person are process characteristics. The fully functioning person would be a person – in-process, a person continually changing. (1959: 235) In humanistic therapy, it is the therapist’s trust in this actualizing tendency that makes it so radically different from other therapeutic approaches (see Bozarth 1998). The person-centred therapist attempts to stand shoulder to shoulder with and become a companion to the client in their explorations towards self understanding. Rogers (1957) describes how in his experience he found that whatever troubled people, whether distressing feelings or difficult interpersonal relationships, they were all struggling with the same existential question, of how to be themselves.
Rogers (1957) states that for constructive personality change to occur then six conditions are necessary in the therapy. They also appear to suggest what a healthy way of being is, as opposed to inhibiting factors to personal growth. The conditions include being in psychological contact with another (or others), being congruent and genuine, being vulnerable or anxious, having unconditional positive regard, and being empathic and unconditionally accepting. The therapeutic relationship is characterized as one that tries to maintain these conditions at a heightened level of intensity.
The person-centred therapist does not attempt to change the client in any specific way, that is, its goal is not to address specific manifestations of psychopathology. For example the therapist does not set out to cure the client’s depression or alleviate their anxiety. The therapist is not so much concerned with the reasons for a client’s feelings but rather with how they feel. Exploring these ideas in the 1960s, Rogers studied the impact of his approach in research with hospitalized schizophrenics. As researchers in the person-centred tradition do not generally adopt the medical model, research data on person-centred therapy for specific psychiatric disorders is generally lacking. However some studies, such as Greenberg and Watson (1998), show that humanistic person-centred therapies are effective for the alleviation of various forms of distress such as depression. Despite the general lack of research most take the view that person-centred therapy is less effective for severe and chronic conditions, although recent writers have begun to explore its use with psychosis and personality disorders (Lambers 1994).
There have been a number of criticisms of the person-centred approach. Rogers has been criticized as presenting an overly optimistic view of human nature. Some have questioned how can there be so much suffering in the world if people are basically trustworthy, social and constructive in nature. In response to such criticisms, Rogers states: I am certainly not blind to all the evil and the terribly irresponsible violence that is going on . . . There are times that I think I don’t give enough emphasis on the shadowy side of our nature, the evil side. Then I start to deal with a client and discover how, when I get to the core, there is a wish for more socialization, more harmony, more positive values. Yes, there are all kinds of evil abounding in the world but I do not believe this in inherent in the human species any more than I believe that animals are evil. (Zeig 1987: 202)
Another line of criticism comes from adherents of the socio-cultural model of psychopathology who point out that Rogers’ approach does not in any real sense explore the client’s wider social context. They point to the influence on Rogers and contemporary humanistic writers such as George Kelly, of their own social context, which shaped their perspectives on human nature. The possibility of individual change, personal responsibility and personal freedom all reflect the individualism of American ideology. It may also be questioned whether such ideas as responsibility, choice and capacity for change are really something in an individual’s control, that can be changed at will.
Some writers have criticized as simplistic Rogers’ view that psychopathology develops through the internalization of conditions of worth. Rogers’ simplistic explanation of the genesis of people’s problems has led to a unitary diagnosis: namely that of being out of touch with the valuing process inherent in the actualising tendency. Consequently, he has restricted himself to what is essentially a single treatment approach. This is an inadequate way to approach the range of difficulties that people have in being personally responsible. (Nelson-Jones 1982: 25–6) Against this, others question the assumption that there are specific treatments for specific problems, arguing that the evidence is insufficient to draw such a conclusion (Bozarth 1998).
Another criticism concerns the concept of the actualizing tendency. Some have called this concept naive (Ellis 1959). Similar to other abstract psychological concepts that cannot be directly observed, such as Freud’s concepts of id, ego and superego, it is impossible to ascertain whether an actualizing tendency actually exists. Others, although accepting the general principle, have viewed it as an insufficient basis on which to build a theoretical framework and approach to therapy, and see a need for therapists to introduce other, cognitive and behavioural techniques to bring about effective therapeutic change (Nelson-Jones 1984). Other criticisms point out that the imprecise language and vagueness of concepts make it difficult for concepts to be subjected to empirical testing (Coffer and Appley 1964).
Tags: actualizing tendency, bio medical model of psychopathology, Carl Rogers, Freudian perspective, manifestations of psychopathology, Object relations theory, person centred therapist, person-centred therapy, pessimistic view of human nature, practical therapeutic strategies, psychoanalysis and behaviourism, Rogers’ person-centred therapy