Tuesday, 9 August 2016

unconditional positive regard


A quick note on Rogers' third condition of learning in psychotherapy.

If there is any one aspect of person-centred psychotherapy which tends to come in for criticism it is 'unconditional positive regard'. 

I think the criticism may be summed up in the rhetorical question "But why should I be unconditionally positive in my regard for my patient?" 

...With the addendum "For that's hardly being authentic - it seems to contradict the second condition (the therapist's 'congruence' - his lack of contrivance, lack of pretence) if and when the patient is being a pain in the arse. Worse, it prevents the patient from recognising when she's being a pain in the arse, so precisely prevents her from 'learning in psychotherapy'."

...Even better: "It shows a lack of respect to the patient as a person to not be authentic ('congruent') - to not call her on her bullshit, for example, if that is what is at issue."

Well.

Yes.

If that's what Rogers meant by it.

But there's little evidence I can find that such was what he meant. And, well, it would be a bit weird if he really did mean that by it - given that, as I just wrote, it does rather contradict the second condition which he writes about just half a page earlier.

I think we'd do better, in grasping his meaning, to insert a couple of commas each side of 'positive'. ('Unconditional, positive, regard'.) Just to make it clear that he didn't write 'unconditionally positive regard'.

Here is what the man actually writes (283-4): 
A third condition is that the therapist experiences a warm caring for the client - a caring which is not possessive, which demonstrates no personal gratification. It is an atmosphere which simply demonstrates "I care"; not "I care for you if you behave thus and so." Standal ... has termed this attitude "unconditional positive regard," since it has no conditions of worth attached to it. I have often used the term "acceptance" to describe this aspect of the therapeutic climate. It involves as much feeling of acceptance for the client's expression of negative, "bad," painful, fearful, and abnormal feelings as for his expression of "good", positive, mature, confident and social feelings. It involves an acceptance of and a caring for the client as a separate person, with permission for him to have his own feelings and experiences, and to find his own meanings in them. To the degree that the therapist can provide this safety-creating climate of unconditional positive regard, significant learning is likely to take place.
Now what I'm not too comfortable with - perhaps taking it a bit too strictly - is this: who is the therapist to provide permission to the patient to have his own feelings and experiences? Surely it is the job of the therapist to help the patient see that she's gotten into an unfortunate state of mind of seeking permission to have her own thoughts and feelings, and then to encourage the patient withdraw that approval-seeking back into herself. Otherwise he just serves to maintain his patient's self-depleting transference.

But that's not the point here. Which is, instead, that what Rogers is talking about is hardly controversial. It hardly involves the therapist stifling his own warranted frustration or anger (although we might hope he'd think about it, understand what the patient is communicating, before expressing it). What it does involve is the therapist being generally caring, thoughtful, kind. It involves him not imposing meanings, not imposing himself, not imposing a theory, not imposing a criterion of mental health, not imposing a particular set of political values, on to his patient. It involves not being judgemental - which isn't the same thing as not making judgements! It involves treating the patient as an end in herself and not as a means to an end of the therapist - i.e. Kant's second formulation of his categorical imperative. Not using her. Coming to understand her in her particularity. Acknowledging her agential sovereignty.

Let's face it. If you can't treat your patient that way - if at least a good part of the time you can't attain your aspiration to treat her that way - then you should pack up shop.

Sure, Rogers could have done more to distance what he writes from a notion of offering approval of what his patient says and does. But can't we do that for him? One way to do it, by distinguishing between empirical and transcendental senses of 'acceptance' and 'condition'. (I think, by the way, this is a little different from urging that we distinguish between accepting a person and accepting her behaviour - although I suspect that those who make this latter distinction are really aiming at (if just missing) the distinction I'm drawing here.)

So, I may find your behaviour empirically unacceptable - for example when you treat me like an emotional dustbin, when you harangue me, when you endlessly test my patience, when you are selfish, when you gaslight, etc. But am I willing to work with you? Do I show you the respect of standing up to your bullshit? Whilst still offering the possibility of ongoing relationship? Now this presupposes, of course, that you are also genuinely committed to understanding yourself, to making changes, and to doing better by me. (There's no point my flogging a dead horse.) I'd not be showing myself 'unconditional positive regard' if I just kept sucking it up without any realistic commitment from you to work on it. But if you do make that commitment, if you do offer meaningful apologies, then I am - despite my finding you empirically unacceptable in your behaviour, still offering transcendental acceptance to you - when I don't just see you as, say, a 'problem to be managed'. 

Similarly for conditions as for acceptance: the therapeutic relationship is transcendentally conditioned - in so far as there are conditions on anyone who wants to enter into a relationship - conditions set by what counts as relationship. That's a different matter than someone saying they will only offer acceptance if certain empirical conditions are met - to say that is to not understand what it means to offer transcendental acceptance, i.e. to not understand what it would be to actually 'meet someone as a person', as we say.

There are I believe several things the matter with Rogers' program for psychotherapy. The fundamental one is the way he didn't get his head around the unconscious dynamics of the transference, and so was precluded from being able to grapple with aspects of the therapeutic relationship which, precisely, get in the way of its participants being able to offer one another 'unconditional, positive, regard'. But what is not the matter, so far as I can tell, is the very offering of such regard, nor the vision - which I suspect derives from the deeply humane and humble values he carried over from his pre-therapist Christian ministry - of human healing and growth obtaining not through the therapist being clever and instructional or 'delivering interventions' or what-have-you, but rather obtaining spontaneously to someone who is truly acknowledged by another as a person.