J Contemp Psychother (2007) 37:3–10
DOI 10.1007/s10879-006-9028-7
ORIGINAL PAPER
What Every Therapist Should Know, Be and Do: Contributions
from Humanistic Psychotherapies
David J. Cain
Published online: 7 March 2007

C Springer Science+Business Media, LLC 2006
Abstract Humanistic psychologists have made major
contributions to the theory, practice and research in psy-
chotherapy. Many of their contributions are applicable
to a variety of therapeutic approaches. In this article I
articulate what I believe to be some of the most useful
things for all practitioners to consider incorporating into
their therapeutic practice. Carl Rogers’ contributions are
considered to be universal and foundational since his strong
emphasis on the therapeutic relationship and the importance
of empathic responding are considered to be core aspects of
effective therapies. A variety of humanistic therapists have
emphasized the importance of working with client emotion,
effective use of the self, relational involvement and depth,
working within the client’s frame of reference, focusing on
the self-concept, being present and helping clients embrace
choice and responsibility, all of which are addressed in this
article.
Keywords Empathy . Humanistic psychotherapy
All clients want to be understood and accepted as they are by
a therapist who is trustworthy, caring and optimistic about
their capacity to change. In 30 years of practice I have never
met a client who complained about being understood, or one
who didn’t want to be valued despite flaws and problematic
behaviors. When clients seek help it is usually at a point
where they feel “stuck” and discouraged that what they are
doing isn’t working. In this disheartened state clients want a
therapist who feels hopeful about their capacity to deal with
their problems and move forward. Research on clients’ expe-
D. J. Cain (
)
Alliant International University,
California, USA
e-mail: david4@fda.net
rience of psychotherapists (e.g. Miller, Duncan, & Hubble,
1997; Bohart & Tallman, 1999) affirms the view that clients
are much more concerned about the personal qualities of their
therapists than their techniques. When clients tell someone
about the therapist they just saw for the first time, they are
inclined to focus on whether they liked and felt comfortable
with the therapist. In short, who we are matters more to our
clients than our theory or techniques.
In this paper I hope to identify some the best of what
humanistic therapists have to offer the field of therapy and
therapists of diverse theoretical orientations. Since most ther-
apists believe the quality of the therapist-client relationship
is crucial to successful outcome, I will begin with the en-
during relational and attitudinal qualities articulated by Carl
Rogers.
Carl Rogers as foundational and universal
I believe that Carl Rogers’ seminal ideas are timeless and
universal in their relevance to all versions of psychotherapy.
There are good reasons why Carl Rogers was identified as
the “most influential psychotherapist” in a survey of clini-
cal and counseling psychologists (Smith, 1982). His ideas
provide a foundation for working with a diverse range of
clients and problems that may be incorporated into almost
any therapist’s preferred way of working.
Carl Rogers taught us the importance of listening and
seeking to understand the client’s subjective world. Yet the
importance of this endeavor is sometimes lost as we focus on
our clients’ symptoms, diagnoses and methods to remediate
them. The importance of sensitive listening and empathic re-
sponding to clients remains underused and incompletely un-
derstood. Therefore, I will address some of the reasons why
therapists may want to re-emphasize the value of empathic
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4 J Contemp Psychother (2007) 37:3–10
responding, what Rogers once referred to as an “unappreci-
ated way of being” (1975).
When clients come to their first session, most have a
strong need to talk about themselves and what troubles them,
to tell their stories. At such moments they often feel an ur-
gency to “get it out.” Not only do they find some relief in
the telling but they also want their therapist to know them
in hopes that their therapist will know how to help them.
Thus our patient and sensitive listening means a great deal to
our clients who, in turn, feel appreciative of our desire and
willingness to understand and know them. Just yesterday a
client of mine exclaimed in relief: “ Thank God! Someone
finally understands me.” Such a powerful sense of being un-
derstood helps create a bond or alliance with the therapist.
You need only recall your own experiences as a client to
understand anew how important it is to be heard and un-
derstood. Unfortunately, therapists, even experienced ones,
often become less attentive listeners over time. Though we
may barely notice the compromised quality of our listen-
ing, our clients are often acutely aware when we listen half-
heartedly.
The therapeutic impact of empathy
Therapy may be conceived as an opportunity for clients
to learn from their experience through self-reflection. Such
learning often leads to changes in clients’ perceptions of
selves, of worldviews and life philosophy. As old things are
seen in news ways, clients often see the implications for be-
having in more functional and satisfying ways. The best way
I know of enabling clients to learn from their experiences is
to enter empathically their world and communicate clearly
what they experience for their reflection and processing. If
the psychotherapy police one day limited all therapists to
one way of responding to their clients, my choice would be
to respond with empathy. There are a number of reasons for
doing so.
Research on therapist empathy (e.g. Watson, 2002) shows
that it is usually related to constructive client outcome and
that it is never harmful (i.e. negatively related to outcome).
Whenever therapists are in doubt about what to do, listen-
ing with a desire to understand the client’s experience is
almost inevitably helpful. I often urge my graduate students
to allow themselves to be curious about their clients and try
to grasp what it is like to be the client. Our empathic re-
sponses provide our clients with an opportunity to learn to
listen to themselves. As clients become better self-observers,
especially of their feelings, intrapersonal and interpersonal
behaviors, they often develop new perspectives that lead to
more functional behavior and self-generated problem solv-
ing.
Regardless of one’s therapeutic orientation, a better un-
derstanding of the client’s world informs us on how best to
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respond. If one is trying to identify the client’s core beliefs
or schemas, patterns of behavior or lifestyle, ascertain re-
inforcement contingencies, assess personality variables and
psychopathology, identify core issues or make a diagnosis,
then empathic and exploratory listening are critical endeav-
ors to help us know our clients and decide how to respond
most effectively to them. In short, our clients benefit through-
out the course of their therapy by our desire to understand
them and our communication of our understanding of their
experiences and who they are. At this point I will offer some
thoughts about how therapists might engage their empathy
on behalf of their clients.
Respond with fresh eyes and ears
Empathic responses are more likely to be optimally impact-
ful when offered with fresh eyes and ears. Taking in one’s
client freshly means setting aside any preconceptions we may
have, bracketing assumptions and possible biases, avoiding
diagnostic categorizing as we listen, and engaging our cu-
riosity to take in the client as he or she is. This takes dis-
cipline. It is as if one meditates on and indwells the client
and becomes absorbed in the client’s experiencing, disclo-
sures and manner of comportment. As Moustakas (1995)
describes this endeavor, it is a “Being-In” the world of the
client, giving one’s self over to truly understand what it is
like to be the person of the client. Research (Watson, 2002)
has shed light on some of the behavioral correlates of em-
pathy as viewed by the client. These include: (1) direct eye
contact and a concerned expression (2) a forward trunk lean
and head nods (3) a vocal tone that communicates interest,
concern, and expression of emotional involvement and inten-
sity that matches the client’s emotional experience (4) clarity
of expression and the use of emotional words are also per-
ceived an empathic. Conversely, a tone that sounds detached
or bored, interruptions and advisements and reassurance are
negatively correlated with clients’ perceptions of therapist
empathy.
What helps clients feel understood
A recent qualitative study by Barbara Grote (2005) on
the “experience of feeling really understood in psychother-
apy” found that this experience involved clients’ feeling (1)
safe, (2) accepted, (3) relieved, (4) validated, (5) heard, (6)
seen/known, (7) engaged with an active co-participant, (8)
a sense of intimacy with the therapist, (9) surprised/sense
of awe at the discovery of a core truth or new way or
looking at a situation, (10) more self acceptance, and (11)
engaged with a compassionate, genuine “other” In short,
there are multiple attitudes, qualities, skills and behaviors
that contribute to the client’s sense of being heard and seen
accurately.
J Contemp Psychother (2007) 37:3–10
Instant replay of powerful experiences
One of the worst parodies and misunderstandings of client-
centered therapy was that it entailed a mindless parroting
or repetition of what the client just said or felt. While this
form of empathy may convey to the client that you have
listened accurately, it usually has little impact. However,
there are times when I have found it valuable to ask my client
to pause for a moment after he or she has said something
poignant. I will then say something like: “I’d like to say back
to you exactly what you said so you can hear it again.” I
do this when I have heard something from the client that
touches me strongly, often because of its dramatic language
or intonation. I ask my client to listen while I say it back
because I have the impression that they have not given the
expression and its personal meaning the attention it deserves.
For example, a client of mine said in a matter of fact way
that his life was “devoid of affection.” This statement struck
a powerful cord in me and I asked my client for a moment
to say it back. However, when I said it back I did so with a
feeling tone that conveyed the magnitude of this void in his
life. My client and I then involved ourselves in an exploration
of what it is to live this way. From this point on in therapy, my
client’s emotional isolation and lack of affectionate contact
has become a core theme of our work together.
Therapist presence, congruence and unconditional positive
regard
On several occasions, I had the opportunity to view Carl
Rogers close up when he did therapeutic demonstrations.
I was struck by his capacity and desire to concentrate on
the client before him. It was as if he and the client entered
an impenetrable bubble in which only they existed, despite
the fact that they were being watched by a large number of
observers. The quality of Rogers’ contact and engagement
with his client was extraordinary. He simply brought all of
himself fully to his client and trusted that who he was could
make a constructive impact on his client. He felt in his bones
that the sheer quality of his relationship with his client had
healing potential.
When fully present, therapists bring a focused attention
to and immerse themselves in their clients’ worlds. They are
themselves, that is congruent and without deception or any
hidden agenda. This creates a sense of safety and trust for
clients that enables them to disclose themselves more fully.
Therapist presence also involves a receptivity and an open-
ness to whatever is disclosed. When present, the therapist
enters the client’s world, is for the client and is with the
client as a separate self who is willing to encounter the client
(Moustakas, 1995). Therapists who are fully present with
their clients often draw from spontaneous and creative as-
pects of themselves that may have profound effects on their
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clients’ well being. As Rogers (in Baldwin & Satir, 1987)
commented about his presence:
I find that when I am the closest to my inner, intuitive
self-when perhaps I am in touch with the unknown in
me-when perhaps I am in a slightly altered state of
consciousness in the relationship, then whatever I do
seems to be full of healing Then simply my presence is
releasing and helpful. At those moments, it seems that
my inner spirit has reached out and touched the inner
spirit of the other. Our relationship transcends itself, and
has become part of something larger. Profound growth
and healing and energy are present. (p. 50)
When present in this manner described by Rogers, clients
are often drawn into moments of fully engaged and present
living with their therapists, an experience that is gratifying,
meaningful and hopeful since they glimpse the possibility of
living in the present moment with others. Clients also learn
that the quality of their lives in general is enhanced by being
present to themselves.
If the therapist’s regard for the client is consistently pos-
itive, devoid of conditions for acceptance and without neg-
ative judgement or evaluation, then clients are more likely
to participate fully and honestly and thrive in the therapeutic
endeavor. Lest you doubt the importance of such therapist
qualities and attitudes, consider how important they are to
you as a client or in your friendships with others. In our in-
creasingly distracted and impersonal world, one’s presence,
trustworthiness and genuine caring and regard for another
are invaluable ways of being.
Several years ago, I had the opportunity to share with
Carl Rogers what I believed to be a necessary and implicit
condition of client-centered therapy. This quality was the
therapist’s optimism about clients’ capacity to develop and
draw from their personal resources. Rogers himself seemed
to have an enormous faith in his clients, believing that, if he
could create an optimal therapeutic relationship, they would
be highly likely to develop more of their potential for more
effective living. Research now supports this position. As
Lambert (1992) has indicated, about 15% of outcome is
accounted for by clients’ positive expectation and hope that
therapy will be helpful. Such hopefulness and optimism is
strongly influenced by the therapist’s attitude and conviction
that clients can mobilize their resources for change.
Affirmation-beyond acceptance
In Carl Rogers famous interview with Gloria, toward the end
of the session he commented: “You look to be a pretty nice
daughter” a statement that seemed to touch Gloria deeply and
meaningfully. Affirmation goes beyond acceptance because
it is an active and positive acknowledgment and validation
of the other. While our empathic understanding and lack of
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6 J Contemp Psychother (2007) 37:3–10
judgmental comments may communicate acceptance to the
client, they are not affirmations. For an affirmation to be im-
pactful, the client needs to feel that the therapist sees him or
her to lend credibility to the therapist’s genuine appreciation
of some aspect of the client.
Engaging in the therapeutic process
Humanistic psychotherapists have made a number of useful
contributions that are relevant to how the therapist engages
the client optimally in the course of therapy. In this section,
I will present other therapist relational qualities or ways
of being that facilitate the client’s effective processing of
experience. Since major approaches to psychotherapy are
roughly equivalent in effectiveness (e.g. Miller, Duncan, &
Hubble, 1997) it may be reasonably argued that the person
of the therapist, as opposed to ideology or technique, is what
makes therapy effective for a given client.
Know your self. Be your self. Use your self
Humanistic therapists place a high premium on the effective
use of the self to create a relational atmosphere that facil-
itates clients’ ability to learn from their experiences. If we
are to use our personal qualities and talents effectively, we
must first know what they are. A former professor constantly
reminded his graduate students that “you can best be your-
self and nobody else.” Beissner (1970, p.77) articulates the
paradoxical theory of change of Gestalt therapy as follows:
“Change occurs when one becomes what he is, not when
he tries to become what he is not.” This view, of course,
is relevant to therapists as well. It is my belief that each of
us functions best as therapists when we find our distinctive
voices.
As we engage in a therapeutic relationship with our
clients, we are afforded an opportunity to be the best of
our selves. Each of us has distinctive personal qualities that
are likely to enhance our relationships with our clients and
effect change.
Laugh with your clients
Laughing with your clients is usually therapeutic. When I
was a doctoral student intern at the University of Wyoming
counseling center, I was often struck by the frequent rounds
of laughter emanating from Dr. Leo Sprinkle’s office. Dr.
Sprinkle’s sense of humor was infectious. I learned from
him to allow my own sense of humor to become a natural
part of my therapeutic work since it was a natural part of me.
When therapists laugh with their clients a closer bond and
alliance is formed. Humor also provides clients perspective
as they are able to take themselves and their problems less
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seriously for a moment. Humor may also enable clients to
see things from a new vantage point and consider new ways
of behaving. Therefore, if a good sense of humor is a natural
aspect of who you are, engage it more frequently with your
clients. I have noticed that when there is lots of laughter in
my sessions, they usually seem to be good sessions. I suspect
this is true of most sessions filled with laughter. Lest we
forget, there is research supporting the therapeutic benefits
of laughter for our physical and mental health.
Get involved with your clients
Effective use of the self requires that therapists allow them-
selves to leave the comfort and safety of their therapeutic
roles. As psychotherapist Irvin Yalom, author of Existential
Psychotherapy notes: “The effective therapist cannot remain
detached, passive and hidden. Therapist disclosure is inte-
gral to the therapeutic process” (1980, p. 411). Yalom further
states that “During the course of effective psychotherapy the
therapist frequently reaches out to the patient in a human and
deeply personal manner” and that “this reaching out is often
a critical event in therapy” (1980, p. 402). One of my clients
with whom I have had a strong involvement recently wrote:
“I have been thinking about you lately. I don’t know if I have
ever really thanked you for the impact you have had in my
life. Sometimes when I think about our conversations I get
tears in my eyes. I sincerely appreciate you.” This client, a
doctoral student in clinical psychology who is completing
her pre-doctoral internship, reflected on her accumulating
learning as follows: “Therapy skills and theoretical concep-
tualizations are important and necessary for our work, but
not nearly as important as connecting with our clients in a
very human way. I am no longer afraid to share me. Who-
ever came up with this blank slate business had it all wrong.
Compassion and humanness heals suffering.”
What we should know about clients
Until recently, most of the research in psychotherapy had
focused on the therapist and assumed that the therapist’s
talents were the main factor predicting good outcome. Not
so. As Bergin and Garfield have so cogently stated:
. . .It is the client more than the therapist who imple-
ments the change process. . .Rather than argue over
whether or not “therapy works,” we could address our-
selves to the question of whether or not “the client
works!”. . . As therapists have depended more upon the
client’s resources, more change seems to occur. (Bergin
& Garfield, 1994, p. 826)
Client role involvement denotes the extent to which a
client fulfills the client role, engages cooperatively, partici-
J Contemp Psychother (2007) 37:3–10
pates actively and shows commitment to the therapy process.
In about two thirds of studies cited by Orlinsky et al. (1994),
client role involvement predicted good outcome. Miller,
Duncan, and Hubble point out that “ research literature makes
clear that the client is actually the single, most potent con-
tributor to outcome in psychotherapy. . .[and that clients are]
always more powerful than their therapists”(1997, pp. 25–
26 italics in original). This position is also supported by
Lambert’s (1992) review of the research literature in which
he concluded that 40% of the variance in psychotherapy out-
come is accounted for by client factors, including the client’s
personal strengths and external resources.
Since client involvement is the best predictor of good out-
come, therapists should do whatever enhances the client’s
active participation in therapy. Consequently, the quality of
the relationship therapists provide for their clients should be
the first and primary concern of the therapist. Not surpris-
ingly, the best process predictor of client improvement is
the client’s perception of the quality of the therapeutic rela-
tionship (e.g. Cooley & LaJoy, 1980). This clearly suggests
that we should constantly monitor the quality of engagement
between therapist and client and be willing to adjust to the
client’s view of what helps.
Clients’ experience of therapy
Since clients’ involvement and participation in therapy is the
best predictor of good outcome, I will share some findings
from qualitative studies reported by David Rennie (2002)
that provide some useful insights about clients’ experience
of therapy. Some of the most compelling findings are that:
(1) Clients view their therapy as a special occasion that en-
ables them to pay attention to themselves and identified
therapist facilitation of self-focus as contributing to their
change.
(2) Client self-focus is associated with: awareness of prob-
lems and issues; motivation to change; pursuit of
change; acquisition of new understandings; acquisi-
tion of new behaviors; changes in the interpersonal
environment.
(3) Clients found the following helpful in their therapists:
providing feedback as therapist view of reality for con-
sideration; personal involvement; the therapist as a posi-
tive role model; therapist authoritativeness which comes
across as self-assurance and relaxed confidence.
(4) Clients often do not disclose their most significant ex-
periences to the therapist, including their reactions to
the therapist, and have a strong tendency to defer to the
therapist.
(5) Client storytelling is a means to deal with inner distur-
bance and, when telling the story, clients often come to
terms with the disturbance privately.
7
(6) Clients creatively use whatever the therapist offers them,
but not necessarily what the therapist imagines the client
uses
(7) The relationship with the therapist is crucial; clients pay
more attention to it than to therapist technique.
Some quantitative research also yields useful findings
about client factors related to good outcome in psychother-
apy. An extremely important finding is that client openness
correlates with positive outcome in 80% of the studies while
client defensiveness is consistently related to negative out-
come (Orlinsky et al., 1994). In addition, Orlinsky et al.
(1994) noted that both client affirmation, or liking of the
therapist, and client expressiveness predicted positive out-
come in roughly two-thirds of the available findings.
The implications of these findings are of great import for
practice since clients’ perceptions of the therapist and ther-
apy are the best predictors of outcome. Often the therapy in
which therapists think they are engaging does not match with
the client’s experience of therapy. Not surprisingly, research
suggests that therapists’ self-perceptions of their therapeutic
qualities and performance are not good predictors of out-
come. (e.g. Cooley & LaJoy, 1980).
Another important implication of these findings is that it
is desirable for therapists to communicate with their clients
about the therapy in which they are engaged. For example,
when I have said something to a client that I think may be
intimidating or threatening, I often check with my client to
assess the impact of my comment. In a recent session in
which my client was expressing embarrassment about his
girlfriend’s ballet dancing skills (My client is an accom-
plished and professional ballet dancer.), I noticed myself
feeling a little annoyed with him. I decided to share this an-
noyance and then checked to assess how it was received. My
client expressed his appreciation for my comment, which
reflected his own dissatisfaction with himself for being crit-
ical of his less skilled girlfriend. While this interchange
was a bit risky, though well received, clients often do not
share with their therapists their negative feelings about them
and thus, relationship strains and ruptures sometimes occur.
Since clients often do not share such feelings, it becomes the
therapist’s responsibility to notice and attempt to repair such
strains.
Knowing where to focus
Repetitions
One thing that psychotherapy research cannot tell us is how
to respond in each moment. Here I offer some guidelines that
I have found helpful. When I teach my graduate practicum
classes in psychotherapy, I offer my students a mnemonic
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8 J Contemp Psychother (2007) 37:3–10
device to help them know what is important to respond to.
The mnemonic is REDS where “R” stands for things the
client repeats, which usually suggests that the issue is im-
portant, not yet clarified or resolved and that the therapist
has not adequately responded to it. When clients are repet-
itive I observe it and invite them to focus where they seem
to be unfinished. For example, I commented to a client: “In
the first 30 min you’ve mentioned several times that your
husband seems more committed to his job than to you.”
Emotion
“E” signifies emotion, expressed or implied, that suggests
the issue being articulated is both personally important and
troublesome for the client. Since clients often express emo-
tions without attending to them, it is especially important for
the therapist to point to what is felt and invite the client to
attend to it with curiosity and discover its personal mean-
ing and implications. I consider emotion the body’s way of
interpreting experience. The “body knows” more than can
be articulated and finding the potential wisdom contained
in client’s feelings often leads them forward. Emotion tells
us: what matters, what’s right, what’s wrong, what’s needed
and hints at what’s forward. Consequently, I encourage my
clients to consider that their feelings are trying to tell them
something of importance if they will pause and attend to
them.
Research on emotion suggests that depth of emotional
experiencing is consistently related to good outcome (e.g.
Greenberg & Korman, 2002). However, most clients do not
tend to process their feelings uninvited while many prefer to
avoid them. Further, as Sachse and Elliott (2002) have re-
ported, the quality of the therapist’s empathic response to the
client may deepen, maintain or diminish client’s experien-
tial processing and self-exploration. In short, when therapists
deepen their responses, clients deepen theirs but when thera-
pists flatten their responses to emotion, so do clients. Finally,
it is important to underscore that both emotional expression
and reflection on the experienced emotion are critical for
client change.
Dramatic expressions
As I listen to my clients, I am particularly attuned to the
language they use, especially to dramatic and distinctive lan-
guage. Thus, the “D” in the RED mnemonic stands for “dra-
matic” language that catches the therapist’s attention, but not
always the client’s. For example, a female client of mine in
her mid-thirties who desperately wants to get pregnant and
have another child said: “All I ever really wanted was to be
a mom.” I then invited her to “tell me about being a mom”
which led her to express the depth of meaning and gratifica-
tion she experiences as a mother. Like clients, we therapists
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can easily let slip by some of our client’s dramatic language
or emotion, especially if we are working from a more cogni-
tive, behavioral, problem solving orientation. Consequently,
as we raise our consciousness about the valence of an issue
suggested by the distinctive language clients use, we will
more likely attend to what truly matters.
The self
Michael Mahoney has stated, “all psychotherapies are psy-
chotherapies of the self” (1991, p.235). The self is central to
how things are perceived by our clients since experiences are
perceived primarily in relation to one’s personal existence.
Further, experiences perceived to be inconsistent with the
self-concept are often threatening as the client is thrown into
a state of incongruence. For example, one of my clients re-
ported feeling great shame over kicking one of his dogs who
had attacked his other dog. He could not reconcile kicking
his dog, with a view of himself as fundamentally kind to
animals, even though he was trying to protect his other dog.
In my experience, a large part of therapy revolves around
exploring and revising clients’ perceptions of themselves.
The client’s view of self is often revealed by the stories they
tell in which they are a central figure. This is of great rel-
evance since people tend to behave in a manner consistent
with the way they view themselves. Consequently, I attempt
to keep my consciousness attuned to self-references- the “S”
in REDS.
Helping clients embrace choice and take responsibility
for their lives
As most psychotherapists are aware, therapy cannot proceed
effectively unless and until clients assume responsibility for
their choices, for their role in the course of their lives. Ex-
istential psychotherapist Irving Yalom (1980, p. 226) states
that the “assumption of responsibility is a precondition of
therapeutic change.” Clients, like most persons, frequently
speak as if they have little or no choice in their lives and, con-
sequently feel entrapped. This becomes evident when clients
speak a language of compulsion and limitation (e.g. “I have
to”, “I need to”, “You make me feel. . .”). When I hear such
language, my ears perk and I encourage my clients to be-
come aware of the implications of how they frame their lives
in terms of what choices they have. I often asked them to
alter their language from “I have to. . .“ to “I choose to. . .”.
I invite them to consider an experiment during the week,
namely prefacing each thing they do with “I choose to. . .” I
also speak “the language of choice” to my clients, by saying
making comments such as “You decided to. . .” You chose
to. . .” to convey that they are constantly choosing, and not
merely reacting. As clients realize that they are constantly
J Contemp Psychother (2007) 37:3–10
choosing, as opposed to simply being carried along by or re-
acting to their experiences, they become empowered. They
recognize that other paths are available to them. If they can
create the life they have, they can also create a different life.
Most clients are pleasantly surprised to discover that they
have considerably more choice in conducting their lives than
they imagined. They also report feeling freer, more in charge
of their life and more motivated to alter the course of their
daily activities.
Another barrier to freedom and choice in clients is a blam-
ing and victim mentality. Clients often believe and act as if
others are responsible for their miseries. Many clients tend to
see themselves as victims when, in reality, they often share in
the creation of the dilemmas they experience. Yalom (1980)
takes the position that:
The therapist must continually operate within the frame
of reference that a patient has created his or her own distress
[and that] the therapist must determine what role a particular
patient plays in his or her own dilemma and. . . unless one
realizes that one has created one’s own dysphoria, there can
be no motivation to change. If one continues to believe that
distress is caused by others, by bad luck, by an unsatisfying
job—in short, by something outside oneself—why invest
energy in personal change?” (p. 231).
Consequently, one of the critical jobs of the therapist
is to help persons understand that they usually have a
role to play in their dilemmas. Research on psychother-
apy by Leonard Horowitz (1979) demonstrated that success-
ful clients became increasingly more aware of their per-
sonal responsibility for their lives over the course of their
therapy.
As is familiar to you, clients often complain about some-
body else during their sessions, as if their problems would be
solved if only those others would change. Though inadver-
tent, therapists often collude with clients in focusing on the
troublesome other, sometimes being drawn into conversation
about and analyses of the other rather than the client. Instead,
clients are more likely to benefit from being helped to shift
their focus back onto their role in the interpersonal problem.
In such situations, I have found it helpful to invite clients to
consider “what might we learn about you?” and “what might
you have contributed to this problem?’ As clients reflect on
their roles in their dilemmas with others, they often begin
to see that problems with others are usually co-created and
that they always have some control over how they choose to
engage with others.
Concluding thoughts
If there is a core message that you might take from this
paper, it is this: The nature and quality of your relationship
with your clients is critical to clients’ involvement in therapy,
9
to enabling them to draw on and develop their resources, to
learn from their experiences and to moving forward in their
lives. As I imagine the concerns and hopes of a client about to
enter therapy, it goes something like: I’m having a hard time
right now; in fact, I’m not doing very well. I’m discouraged.
I guess I need some help because I haven’t been able to deal
with my problems on my own. It is with trepidation and
ambivalence that I call you for an appointment. I hope you
will be able to understand and accept me despite my flaws.
I hope I feel comfortable with you and like you. I hope you
will like me, care about me and support me. I hope you are
patient and trustworthy. It’s not going to be easy to tell you
some things about me and my life. I hope you will be able
to help me make sense of my life, feel better and learn to
function better. I hope you think I can be helped. Are you
the kind of therapist who can help me?
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