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).

Both the theories and therapies based on the psychodynamic model have been criticized for their lack of scientific rigour. For example, Steele states:

Unfortunately, Freud’s belief that his work was science, and as such discovered the truth, and his stance that either someone was for or against him created a dogmatic system. He had not developed the critical consciousness necessary to see that psychoanalysis was a method which constructed a causal historical narrative, but that other methods . . . could formulate different and equally plausible scenarios. His insistence on orthodoxy kept his approach to enquiry from being either truly scientific or truly hermeneutic. (Steele 1982: 360) Critics argue that Freud’s theories are too vague to be put to the test of science (Fisher and Greenberg 1996; Sutherland 1998). The scientific process is based on the concept of falsification (Popper 1959). Thus scientific hypotheses should be formulated in a way that they are capable of refutation, that is, can be shown to be false. Although some psychoanalytical conjectures can be tested scientifically many of the concepts are complex and do not easily lend themselves to the process of falsification. However, just because an idea cannot be tested scientifically this does not mean that it is not true, only that it is not possible to provide evidence in support of it.

Evidence for the efficacy of therapeutic techniques developed out of psychodynamic approaches to psychopathology is equivocal. Some researchers point out that the scientific evidence is not convincing, and that findings are typically based on the study of a limited number of people (Eysenck and Wilson 1973). Even if there are other studies that appear to provide some evidence for the efficacy of brief psychodynamic therapies (Malan 1979; Crits-Christoph 1992; Anderson and Lambert 1995), these do not prove the validity of the psychopathological models that underpin them.

A second criticism of the psychoanalytical model is that it is mechanistic, individualistic and is tied to its medical roots. Admittedly the model takes an opposite stance to biological psychiatry, but whereas biological psychiatry tends to reduce psychological phenomena to biology, psychoanalysis tends to make everything a psychological matter – whether describing the biological or the social as well as the purely personal. For many people, there may well be Oedipal conflicts and their attendant neuroses underlying their distress but as the social cultural model of psychopathology highlights, the concerns of everyday life may have far more effect on people’s mental health. The theory and practice of psychoanalysis ignores a consideration of social realities. A third criticism is that the psychoanalytical model does not address the effect of personal futures. This excludes a field of enquiry that may exert a profound influence on human conduct and distress experienced in the present. Much empirical research points out how our expectations and aspirations influence our present conduct. The psychoanalytical model has been generally criticized for being reductionist as it reduces multiple realities experienced within complex social relationships, in the present and past, to one understood within a tightly limited version of hermeneutics. Although psychoanalysis has provided an illuminating and enriching variety of views and insights into the human condition within a hermeneutic framework, nevertheless the theory is always given precedence over the patient’s own view about themselves and their experiences of their world. The patient’s own constructions tend to be viewed as, for example, unanalysed conscious reflections and therefore, inadequate, incomplete or incorrect. Precedence is given to the analyst’s viewpoint and interpretations. The analyst of whatever specific psychoanalytical school has a set of prepared theoretical constructs or hermeneutic formats that are imposed on clients. Psychopathology appears to dominate. This not only applies to Freud’s classical psychoanalysis but also to later developments. Guntrip, for example, takes an essentially reductionist stance when he reduces homosexuality and prostitution to schizoid defences. The varied and interacting uncertainties of life tend to be reduced to single variable explanations. This criticism of reductionism can also be made of the behavioural model.

Some psychoanalysts have refuted this criticism. For example, Casement (1985) emphasizes the importance of resisting preconceptions, and cautions against the psychoanalyst imposing interpretations upon patients. He notes how Bion advised that each analytical session should be approached ‘without desire, memory or understanding’ (1985: 17).

The implicit superiority of the psychoanalyst is very different to the therapeutic position of person-centred therapy that involves being with, empathically and non-judgementally listening to and engaging with the unique experiences of patients. To allow each new patient to have a unique self-constructing story might lead to psychoanalysis turning into a form of phenomenology or existentialism, although some analysts have certainly taken this path, as seen for example in the work of R.D. Laing. Others, such as Lomas (1987), although retaining a broad allegiance to psychoanalysis, criticize its interpretive imperatives and emphasize direct knowledge of people through their unique narratives.

Conclusion

It is impossible to draw definitive conclusions about psychopathology from a psychoanalytic perspective. The legacy of Freud is that we have an understanding that unconscious motives and defence mechanisms influence human conduct, and that early childhood experiences influence later experiences and influence adult personality adjustment. Although to varying degrees, most would agree with this general view, the devil is in the detail. These  posts have inevitably had to compress extensive and complex discussions of the psychogenesis of different states of mind and presenting symptoms. The extensive body of psychoanalytical literature that addresses these issues suggests that, whatever the acknowledgement made to Freud in those enquiries, there are many ways of understanding human dilemmas and behaviours that go beyond his theories. Freud’s ideas, and those of many who have take them forward have attracted many followers as well as critics.

Many in the scientific community argue that psychoanalysis is not amenable to hypotheses testing criteria such as refutation inherent in the paradigm of traditional empirical research. Others view the empirical paradigm as an inadequate scientific model not appropriate for the study of subjective human experience. Although evidence suggests that psychodynamic therapy can be helpful, it is open to debate whether this is because psychoanalytic therapists convey valuable insights to their patients about what their suffering means, or because psychoanalysis acts as a flashlight enabling each therapist and patient to find a particular road. Psychoanalytical theory has had an important influence in a wider range of disciplines concerned with psychopathology. It has inspired many developments in the study of psychopathology, one of which we examine in rather more detail in the next posts.