THE POST–ROGERIAN THERAPY OF ROBERT CARKHUFF

by Dharmavidya David Brazier


Carl Rogers was the first researcher to put recording machines into the therapy consulting room. By doing so he shifted the emphasis of psychotherapy research away from examining the philosophical or theoretical assumptions held by therapists and towards the examination of what they actually do. From this came a great wealth of studies of psychotherapy process and outcomes. This was definitely a revolution in the history of applied psychology. There was a hope that it would now be possible to determine with scientific accurasy what it was that successful therapists did that unsuccessful therapists were failing to do.

This initial enthusiasm, however, waned as data accumulated without any conclusive or definitive pattern emerging. It has not proved possible to isolate behaviours by therapists which correllate consistently with positive outcomes from therapy. Some researchers such as Eysenck (1960, 1965) went so far as to propose that, in fact, therapy was ineffective. They said that as far as the statistics showed, populations who did not receive therapy did just as well as comparable groups who did.

Rogers himself was at this time developing his own theory of what was going on and it was he himself who shifted the debate back toward values and attitudes. He did this by making the, at that time extremely radical, proposal that in circumstances in which a client was in psychological contact with a therapist, if the therapist could provide a psychological climate which was defineable in terms of three dimensions, and three only, then this would bring about constructive personality change in the client. The three dimensions or "core conditions" were 1. empathy, 2. congruence and 3. unconditional positive regard.

This theory was radical in that it proposed:
1. that the three core conditions were essentially personal qualities rather than techniques;
2. that this hypothesis applied no matter what the diagnostic category of the client might be;
3. that the defined psychological climate was "both necessary and sufficient", i.e. nothing else was needed.

Actually, Rogers' theory, when examined in detail, has six elements in all, since he says that the "core conditions" operate in conditions where 4. client and counsellor are in psychological contact, 5. the client is in an incongruent state and 6. the counsellor's condition of accurate empathy is at least minimally communicated to the client. What this last point means is that not only must the counsellor have accurately understood what it is like to be in the client's shoes, but also, the client must realize that the counsellor knows. These latter three elements have been made a good deal of by some other commentators on Rogers, but they do not figure strongly in the work of Carkhuff and they are simply mentioned here for the sake of completeness. What Carkhuff was to focus upon was the question whether three core conditions was enough and we will come to this point in due course.

The implications of Rogers' theory are often over-looked. They were that:
1. much of the training which psychotherapists received in university professional programmes would be irrelevant;
2. that a great deal in therapy depended upon the therapist "having his heart in the right place" rather than on technical expertise;
3. the enormous amount of professional time and resources expended on assessment and diagnosis may be a waste of time; and
4. there may be no essential difference between what constitutes a good psychotherapeutic relationship and what constitutes a good helping relationship in many other settings such as education, social work, child rearing or even management consultancy.

Rogers' work pointed toward an erosion of the boundary between therapy and many other helping activities and invited the possibility that non-professional workers might often do as good a job as highly trained professionals.

Robert Carkhuff studied and worked with Rogers. Later, they parted company and their respective interests took them in somewhat different directions. Carkhuff's work, however, built upon that of Rogers and did so in particular by emphasizing and developing many of the themes already mentioned above. Carkhuff was involved in the research that Rogers initiated to test the theory of the three core conditions. In particular this involved the attempt to "operationalize" these conditions: to make them measurable. In order to do this, rating scales were devised for accurate empathy, congruence and unconditional positive regard, for the therapist and "depth of self exploration" for the client. By way of example, figure 1 shows a rating scale used for assessing degrees of congruence.

Together with Charles Truax, Carkhuff reviewed a great range of research, some done by themselves and much by others. They published their results in the book Towards Effective Counseling and Psychotherapy (1967). Their startling conclusion was that the reason that the statistics reviewed by Eysenck showed that on average there was no difference in outcomes between "treated" and "untreated" populations was that in the "treated" groups there was a much wider spread of results than in the "untreated" groups. What this means, in general terms, is that a group of potential clients who receive no therapy tend, with the passing of time, to improve modestly or stay much the same whereas those who receive therapy improve markedly or get worse.

This reworking of the data threw a completely different light upon the situation. Rather than it being the case that therapy made no difference, it now appeared that therapy made a great deal of difference but that this difference was not always in the desired direction: "therapy may be 'for better or for worse'" (Carkhuff 1984, p.21). This finding now made it plain that it was even more important than before to find out what distinguished the

Level Criteria
One Therapist is clearly defensive and there is explicit evidence of considerable discrepancy between what s/he says and what s/he experience. There may be striking contradictions in the therapist's statements and the content of her/his statements may contradict voice qualities and non-verbal cues.
Two Therapist responds appropriately but in a professional rather than a personal manner, giving the impression that his/her responses are said because they sound good from a distance but do not express what s/he really feels or means. There is a somewhat contrived or rehearsed quality or air of professionalism present.
Three Therapist is implicitly, but not explicitly either defensive or professional
Four There is neither implicit nor explicit evidence of defensiveness nor the presence of a facade. Therapist shows no evidence of self incongruence.
Five Therapist is freely and deeply him/herself in the relationship. Therapist is open to experiences and feelings both pleasant and hurtful without defensiveness or retreat into professionalism. Therapist accepts and recognises contradictory feelings. therapist is clearly being him/herself in all his/her responses whether personally meaningful or trite. Therapist need not express personal feelings but whether he is giving advice, reflecting, interpreting or sharing experiences, it is clear that he is being very much him/herself so that verbalizations match inner experiences.


therapy that worked from that which not only did not work, but might actually be harmful. On this question, Truax and Carkhuff's conclusions in 1967 were largely in line with those of Rogers. They high lighted the same "core conditions" as the crucial factors. And they drew similar conclusions to Rogers about implications. About this time, too, Aspy and Roebuck (1972) published research into the importance of the core conditions in the field of education and Rogers himself was talking about how the core conditions had much wider application than just counselling and psychotherapy. Carkhuff (1987) eventually concluded


These effects have been generalized in all areas of helping and human relationships where the "more knowing" person influences the "less knowing" person: parent-child relations; teacher-student relations; counselor-client relations; and therapist-patient relations. In general, the "less knowing" persons will move toward the levels of functioning of the "more knowing" persons over time, depending on both the extensiveness and intensity of contacts: helpees of high-level functioning helpers get better on a variety of process and outcome indices, while helpees of low-level functioning helpers get worse. (p.239)


Carkhuff's thinking was going in the same direction as Rogers' but was tending to go even further. Carkhuff is here beginning to evolve a theory that
1. the relationship is all important in human growth and development;
2. constructive relationships can be defined in terms of a list of factors;
3. these factors are, at least to a reasonably workable degree, observable and measurable;
4. the absence of these factors produces relationships which can cause people to deteriorate, just as their presence helps people grow.

This last point is a key stone of Carkhuff's theory and was the basis for its further elaboration. Rogers gave only a very sketchy idea of his theory of how people get worse. He concentrated almost all his attention on how to help clients release their growth potential (or "actualizing tendency"). Some of Rogers' other associates developed from this sketch a theory of "conditions of worth" as the explanation for deterioration. According to the Conditions of Worth Theory, people are born with their actualizing tendency intact, but this needs the core conditions for its fulfilment. In real life, the core conditions are not optimally provided. In fact, parents, teachers and other influential adults place conditions upon the offer of positive regard to the young person. In effect, they say to the child: We will regard you well if you fulfil the following conditions....... According to the Conditions of Worth Theory, it is this conditionality, the "if", which causes the developing child to distort their natural developmental trajectory and, in varying degrees, to become less than they could have been.

The Conditions of Worth idea has become widely established in the theorizing of many post-Rogerian writers, but it does not figure centrally in Carkhuff's work. In the Conditions of Worth Theory the suggestion is that what distorts is the presence of conditions of worth over a lengthy period of the developing person's life. In Carkhuff's theory, what causes deterioration is the absence of conditions for enhancement at points of crisis. He conceptualized life as a series of turning points at which people can grow or deteriorate. The quality of relationships available to them in these critical threshhold situations was, he suggested, the determining factor. If, at a point of crisis, a person turns to others who can offer the growth promoting psychological climate defined by the core conditions, then they are likely to come out of the crisis wiser and more mature. If this climate cannot be provided at such time, then they are likely to deteriorate.

The people who provide the necessary conditions may be professional helpers: counsellors, psychotherapists, social workers, teachers or other members of the helping professions. they might also be members of the individuals indiginous community. In many ways, members of the indiginous community are better placed to offer the necessary conditions because, sharing the "client's" culture, they are more readily able to empathize.

Carkhuff, like Rogers, was alive to the implications which this kind of research finding had for the training of potential helpers and therapists. In this respect he came to conclusions which were consistent with the findings outlined so far, conclusions which had major implications if accepted. He again based his conclusions of reviews of a wide range of research and was interested to compare findings about "lay" and "professional" helpers. Lay helpers will generally have received some training in counselling skills, but will not have completed an academic professional training qualification. The research that Carkhuff is relying on was all done in America, mostly in the 1960s. Professional training programmes have changed somewhat since then, partly under his influence. Nonetheless, his conclusions still have some force. The following quotations from Carkhuff's major two volume work Helping and Human Relations (1984 edition) summarize his position:


lay trainees function at levels essentially as high or higher (never significantly lower) and engage clients in counseling process movement at levels as high or higher than professional trainees (p.5)


lay persons effect changes on the indexes assessed that are at least as great or, all too frequently, greater (never significantly less), than professionals (p.7)


the professional trainee is functioning at higher levels prior to training and at lower levels following training, both in relation to lay trainees and himself (p.7)


While the results of lay programs exhibit trainee gains on those dimensions related to client change, the professional programs exhibit a drop in the level of trainee functioning over the course of graduate training, with the largest drop seeming to occur between the first and second year. Although with experience practitioners appear to recoup some of their losses in functioning, there are direct suggestions that many may never again function at the level at which they did when they entered graduate school. Two follow-up evaluation studies indicate that those who drop out of professional training tend to be functioning at higher levels of facilitative conditions than those who stay in. (pp.9-10)



Some of the explanations which Carkhuff adduces for this situations are:


Perhaps the lay person is motivated to help simply because he is most in contact with the need for help, for himself and for others (p.7)


we can conclude that both the means and the intentions of prospective lay helpers are more humble and direct, or honest, at the beginning of training than the means and intentions of prospective professional helpers (p.7)


[selection processes for lay programmes] select persons who exhibit a sincere regard for others, tolerance and ability to accept people with values different from one's own, a healthy regard for the self, a warmth and sensitivity in dealing with others and a capacity for empathy. The professional training programmes, in turn, are dominated by highly intellective indexes of selection, primarily grade point average (p.8)


evidence indicates that just as clients converge on the level of functioning of their counselors, so do trainees converge on the level of functioning of their trainers. The trainees of trainers who are functioning at high levels demonstrate uniformly positive change; those of trainers who are functioning at moderate or low levels demonstrate little, no, or deteriorative change. It can be inferred that the level of functioning of the professional trainer may account in large part for the negative results in studies of graduate training (p.9)


helpers who are most different from their helpees in race and social class have the greatest difficulty effecting constructive helpee changes (p.11)


Carkhuff concludes that professional helpers tend to rely upon "highly elaborate, highly cognitive systems" (p.10) and are anxious to maintain their professional role whereas "the lay counselor has less expertise; he has only himself (and sometimes his supervisor) to rely upon" (p.10). Lay helpers thus have a number of advantages as helpers:
1. it is easier for them to enter the client's milieu;
2. the relationships they establish are more peer-like;
3. they have less role constraints and so can take a more active part in the client's life;
4. they may empthize more genuinely;
5. they may have skills from their own life experience which provide a more suitable model for the client.

Another important implication of Carkhuff's findings is that they tend to break down the hard and fast divide between helpers and helpees. "This approach represents the helper therapy principle by which persons in need of help may be selected and trained to offer help. At a minimum there is evidence to suggest that indiginous persons giving help demonstrate constructive change themselves as a consequence of being cast in the helping role" (p.13).

So far we have seen how Carkhuff's conclusions were in the same direction as those of Rogers and, in fact, suggested that Rogers' had not gone far enough. Later, however, Carkhuff attempted a further development of his approach which Rogers would certainly not have supported. This was the attempt to integrate client-centred and behaviouristic methods. There were, he suggested, basically two broad approaches to helping. These he called the "insight" approach and the "action" approach. Psychoanalysis and client-centred therapy belong to the former. Behaviour therapy and various branches of applied psychology which concern themselves, for instance, with matching people to careers, belong to the latter. Carkhuff believed that these two types of approach are each incomplete, that each needs the other. Carkhuff's approach was generally to review existing research extensively and there was plenty of research to suggest that behavioural approaches got results as well as client-centred approaches. He therefore became interested in achieving an integration of the two approaches.

He saw this as an integration of the "hard" and "soft" or the "masculine" and "feminine" aspects of helping: "In effective helping processes both the male and female components are present to varying degrees, depending upon the needs of the person being helped. The effective helper is both mother and father. The whole person has incorporated both the responsive and assertive components. He (or she) can understand his internal and external physical, emotional and intellectual world with sensitivity and can act upon these worlds with responsibility" (Carkhuff 1984, p.34).

Carkhuff's integration was achieved by extending the list of core conditions. He eventually arrived at a list of eight factors which were divided into two categories, as follows:

CATEGORIES FACTORS
Responsive Dimensions Empathy
Respect
Specificity
Initiative Dimensions Genuineness
Self-disclosure
Confrontation
Immediacy
Concreteness


Sometimes Carkhuff conceptualizes the "responsive" and "initiative" dimensions as complementary aspects of a single seamless process, and sometimes he sees them as phases of a two step process, the first phase involving "inward probing" and the second "emergent directionality".

To some extent, Carkhuff's eight dimensions are simply an elaboration of Rogers three core conditions. Rogers' condition of "accurate empathy" has been separated into empathy, specificity and concreteness. Congruence has been divided into genuineness, self-disclosure and immediacy. Confrontation may include elements of all three of Rogers' conditions. It is possible to argue that everything Carkhuff says here is at least implicit in Rogers. On the other hand, this new way of presenting the ideas does tend to give them a somewhat different slant. One way of understanding this is to consider what Rogers was as well as what he articulated. What matters, after all, is not whether one adheres to the best list of principles so much as whether those principles are harmoniously integrated in one's way of being with another person and being with the world at large. Rogers was, without doubt, a disciplined and robust personality. Although he articulated the "soft" dimensions, he also exhibited the "hard" ones in his way of relating. Indeed, near the end of his life, he gave an interview in which he admitted that he had articulated the "soft" dimensions primarily because they were the ones which he himself had had most difficulty with. Such things as personal discipline he took for granted. What Carkhuff has done is to make this aspect more explicit.

In doing so, however, he has shifted the balance of the theory. There are more "initiative" dimensions than "responsive" ones in Carkhuff's theory and this does represent an attempt not just to redress the balance of Rogers' theory, but actually to shift its emphasis toward a more active approach. Carkhuff is, in effect, saying, firstly, that while gaining insight in therapy is valuable nothing will come of it unless it is translated into action and, secondly, that the therapist has a part to play in the process of helping the client translate personal learning into purposeful behaviour.

Carkhuff's theory of personal growth emphasizes the importance of the responses people make at points of crisis: "Growth or deteriorative processes take place at crisis points in an individual's life... The response the individual makes at the crisis point increases the probability of his responding in a similar manner at the next crisis point" (Carkhuff 1984, p.27). It also emphasizes that the relationships which a person relies upon at such crisis times can be the key factor in determining whether they grow or deteriorate. Unfortunately, individuals who function consistently at high levels on the kinds of factors which Carkhuff's theory identifies as growth enhancing, are rare. The implication of all this, therefore, is that everything points in the direction of the importance of enhancing the growth promoting factors in both helpers and helpees. In this respect, we all help ourselves by helping one another and vice versa. It also carries the idea that a "helping society" might be evolved: "In a sense we are suggesting a society in which we begin a chain reaction by working initially with those individuals who are best equipped to utilize and transmit their experience. In turn, these people would select and work with other people in a similar manner" (Carkhuff 1984, p.74).

This approach attempts to get over two logical problems which remained in Rogers' theory. One of these derives from the fact that according to Rogers it is the counsellor who provides the necessary conditions for the counsellee, leaving one wondering whether the counsellor also benefits, or whether the gulf between these two roles can be crossed. Rogers implies that it can, but his theory seems to point the other way. Carkhuff asserts that what is helpful for the client is for them to acquire the same characteristics as typify the effective helper. He thus came to be very enthusiastic about programmes which sought to train "indiginous helpers". Thus, programs to train psychiatric patients to communicate with others or parents to work with their own disturbed children won his approval.

The second problem in Rogers' theory becomes clear when we realize that a good deal of what goes on on Rogerian training programmes is actually behavioural training. Trainees are taught what an empathic response is by demonstation, practice and positive feedback for accurate performance. Thus there is an apparent contradiction between the contention that clients will grow and learn and change through a "non-directive" approach in which they learn by self-initiated discovery whereas those who are learning the skills by which such discovery is to be facilitated are actually trained by a completely different approach - by the very approach, in fact, which many advocates of the person-centred approach regard as anathema. Carkhuff's approach does not run into this problem because he sees the behavioural and discovery approaches as complementary. Such methods as behavioural training and systematic desensitization work, so there is no point in excluding them from consideration in appropriate cases simply on dogmatic grounds.

Carkhuff's preferred mode of helping is to help the person help themselves. This may be in very practical ways:


Courses of action may.. be.. very simple common sense procedures for attaining goals that are relevant to the helpee's functioning.. having attained some depth of self-understanding, whatever their developmental level they are asked to treat themselves as helpees and to develop effective modes of treatment for themselves. (Carkhuff 1984, p.249)


Here again we see that what is required of the trainee and what is required of the client are, in principle, the same.

By integrating client-centred and behavioural approaches Carkhuff was bringing together two systems which each rely upon a relatively simple conceptualization of the helping process. The core conditions which he proposes are, in his system, seen as the factors necessary to facilitate inter-personal learning: learning which is relevant to life, learning which is relevant to education, and learning which is relevant to work.

He thus evolved an approach which has wide appeal and is relatively simple to apply. It carries though some of the implications of Rogers' work, giving possession of the helping process back to ordinary people and breaking down the boundaries between different human relations professions. The resulting approach is eclectic:


From an eclectic stance we are free to research the basic core of facilitative conditions, and the selective use of techniques... there is now no need for the artificial dichotomy separating rigor and meaningfulness... We have attempted throughout our work to integrate the basic core of facilitative conditions with learning in a social context (Berenson & Carkhuff 1967, p.448)


Yet this is an eclecticism which is not simply a collection of expedients. It is based on a set of rational principles which integrate elements from different sources in a principled way.

The strengths of Carkhuffs approach is that it extends the radical assessment begun by Carl Rogers and challenges us to consider whether our approach to the helping task is deeply genuine, whether we really commit our caring capacity to our clients or whether we are simply playing a professional role.

It undermines much of the posturing of professional politics which seldom really serve the interests of clients. It invites us to adopt a more down to earth approach to the task of helping in all its many guises. It goes beyond and, in its own way, resolves some of the inherent contradictions left in the theory begun by Rogers. It, in its own terms, integrates the "male" and "female" aspects of helping.

The weaknesses are perhaps that it adopts an overly rational approach which could be accused of neglecting some of the infinite subtlety of the inter-personal process and, in particular, of those aspects of process which are generally referred to as "unconscious" and paradoxical.

In this respect it could be accused of naivety. Further, it could be said that this aspect has paved the way for some even more mechanistic approaches to the helping task whereby trainees are equipped with a number of rather shallow "skills" which, at worst, are then rather crassly used. In this respect Carkhuff may not have escaped from the sin of bringing into being the very syndrome of insensitive professionalism which he began by condemning.

Nonetheless, Carkhuff's approach represents one of the more influential post-Rogerian currents. It is by no means the only way in which Rogers work has been built upon since he first began to advance his theories in the 1950s and 1960s, but it is one which has made an important contribution to an important on-going creative debate. Each generation attempts to redress the balance or fill in the gaps left by the previous one. Rogers wrote against the background of a situation in psychology where the two dominant forces were behaviourism and psychoanalysis. He produced a theory which out did behaviourism in the elegant simplicity of its basic axioms yet retained the central focus upon the subjective dimension of experience which had been advanced by psychoanalysis. In the process, he articulated a message of trust in the human spirit which had immediate and widespread appeal, especially in the liberal social climate which prevailed in the 1960s.

Carkhuff's work may be seen as a continuation of many of Rogers' central themes. He is, just like Rogers, trying to integrate the rational positivism of behaviourism with the subjective depth of the psycho-dynamic approaches, without falling into the pitfalls of either.

That is, he is trying to avoid the mechanisation and technicalization of the therapy process which can easily follow from behaviourism while also avoiding the woolly thinking and pathologizing tendencies of the analytic approaches.

How far he succeeds is a matter for debate. Perhaps the more important question is whether, another generation on, we can do so ourselves.