What if It's All Been a Big Fat Psychotherapeutic Lie? By Howard Rosenthal, EdD on 11/28/10 - 1:22 PM

In the early 90's I developed a classroom exercise to teach my students an important academic lesson. This is one of those experiential exercises where the professor feels holier-than-thou because he or sheknows the outcome in advance. First, I placed the students in groups of two's and asked one of the students to play the part of the helper while the other played the part of the client who tells a real or fictitious problem.

Next I pulled the helpers into the hallway. During the first trial the helpers were merely instructed to give the clients advice, suggestions, ask lots of questions, be extremely directive, and provide psychological interpretations. There was absolutely no empathy, warmth, or relationship building . . . I repeat no relationship building.  This session was a strict Rogerian's worse nightmare.

I then gave the helpers and the helpees about a five or ten minute session together. I then pulled the folks playing the helpers out in the hall once more and explained that during trial number two they were forbidden to give any advice, interpretations, or suggestions. They were also told not to ask the person playing the client any questions. Instead, they were merely instructed to be totally nondirective, paraphrase, reflect, and make statements that conveyed a high degree of empathy. Using the same partner with the same problem, the students were given another five minutes together.

Next using a scale of 0 to 100 (in which 0 is terrible, 50 is average, and100 is perfection) the students playing the part of the client were going to rate their helpers. Needless to say, I knew that the clients would rate their helper higher during trial two; except for one thing: it didn't happen!  The ratings for the first session devoid of empathy were significantly higher.  In fact, it was a blow-away landslide in favor of the directive approach. Say what?

I mentally scratched my head and made a joke out of the whole experience, convinced the results in this class were merely an anomaly. "Listen," I told the class, "I knew you guys were strange, but I didn't know how strange." I then explained that exercises in class often do not parallel what transpires in the real world of therapy.  Secretly, I also told myself that these were undergraduate students that most likely didn't do the interventions correctly.

There is only one problem: I have now been doing this experiential exercise (switching the order of the trials) for approximately 17 years and I can't remember a single trial when the relationship building non-directive approach won when I looked at the results for the entire class! And while no self-respecting researcher would be impressed by my experimental rigor, they would be impressed by my N; over 1000 individuals have now participated in my therapeutic scenario. Since the aforementioned first trial I've added grad students, probation and parole officers, guidance counselors, therapists in training seminars, and therapeutic supervisors, to the rank of participants.

How can this be? Many, if not most, research studies insist empathy is the most important trait for a counselor. I nearly always use what I consider a Rogerian, person-centered, non-directive, heavy on the empathy approach during my initial sessions with a client even if I plan to switch to more directive interventions during subsequent sessions. Heck, it has to be true, it says so in most counseling books, including some I have penned! So what is the explanation for these seemingly contradictory results?

1. Well, there's the rationale (or should I say rationalization?) I've been giving to my classes and in seminars for years now; simply that students and workshop participants are not like real clients and this exercise would turn out differently if we used real clients. In other words, the folks in my classes or seminars are training to work in the field or they are working in the field and therefore believe in suggestions and advice . . . no empathy necessary! The problem with this explanation is that often students are real clients, otherwise we wouldn't have college and university counseling centers.  In the case of therapists, many do seek treatment from other helpers. Indeed, if my armchair experiments are on target then relationship building, non-directive, empathy laden initial sessions, should not be used with those in the field or folks planning to go into the field.

2. Students, grad students, or helpers in the field don't really know how to perform person-centered, Rogerian slanted interventions. Maybe it's just too complicated. Although this is theoretically possible, the eminent psychologist Ray Corsini once told me that Rogers confided in him that he could teach anybody to do client-centered therapy in two weeks.

3. The paraphrasing, reflecting, and rating responses on an empathy scale paradigm we use to teach this approach actually bears little or no resemblance to what Carl R. Rogers was actually doing with his clients. Hmm that's certainly conceivable. Or . . .

4. What if it has all been a big fat psychotherapeutic lie?

As for me, well at this point in time I guess I must admit that despite a wealth of experience and knowledge, I remain a psychotherapeutic agnostic. You decide.

File under: The Art of Psychotherapy, Musings and Reflections