What does successful psychotherapy look like? Carl Rogers, an American psychologist, had spent years observing therapists and counselors in their practical work. Successful psychotherapists, he found through audio recordings, primarily listen carefully, make virtually no statements of their own, summarize in between or at the end of the conversation what they believe they have understood from their client, and show empathy the whole time.
No couch, no advice
“Seen from the outside,” writes Jochen Eckert, a psychologist and professor of clinical psychology and psychotherapy at the University of Hamburg in Ways Out of Madness. Therapies for Mental Illness, “the following characteristics of conversational psychotherapy can be identified: Therapist and patient both sit in chairs, usually at a table across a corner, so that eye contact, if desired, can be actively established. The therapist says much less than the patient. The therapist primarily listens. If the therapist says anything, it is usually about the patient’s emotional experience and the patient’s evaluations of it.”
Rogers’ conversational psychotherapy
Carl R. Rogers (1902-1987) developed conversational psychotherapy. It was important to him not to direct the conversation – hence the term “non-directive psychotherapy.” The therapist does not give advice, does not interpret, does not specify topics. In contrast to psychoanalysis, which interprets unconscious conflicts, and behavioral therapy, which aims to facilitate new learning experiences, the goal of conversational psychotherapy is to support the patient (the term “client” is often used) to explore his or her own experience, to work out problems on his or her own, and to develop his or her own solutions. Behind this is the trust in a power inherent in every human being to set constructive processes of change in motion. The goal of conversational psychotherapy is therefore to create conditions that release this power.
The self strives for positive attention
To understand the essence of conversational psychotherapy – also called client-centered or person-centered therapy – here is a brief look at the theory. Mental disorders arise primarily when certain feelings are not allowed to be felt and certain experiences, which are themselves linked to certain feelings, are not allowed to be had, or are not allowed to be had fully or only in a distorted way. In this context, Carl Rogers made the concept of the self a central element in his concept of therapy and in his theory of personality. This self is a development that arises in contact with other people – in the first place these are the parents. Influencing this development of the self now is an innate need for positive attention. Important for the development of a positive self-concept are, for example, recognition and appreciation, but also the admission of feelings such as anger and sadness. If these feelings or the showing of these feelings are punished and suppressed by parents, this favors the development of a negative self-concept.
The self-concept is subject to self-awareness.
According to Rogers, a person’s self-concept is subject to constant change as a function of self-experience. The degree of congruence, that is, the congruence of the self-concept with one’s own experiences and the bodily and sensory experiences that belong to it, is important for a person’s mental health. Jochen Eckert gives an example: If, for example, the mother does not tolerate the tantrums of her child, he will later not be able to integrate this emotional experience into his self. Later, as an adult, it will tell the therapist about its own fear of anger, because angry then equates with evil.
What is psychosis?
Psychosis occurs, he says, when an emotional experience cannot be integrated by the self, but also cannot be repelled. The self-concept then breaks down. “The acutely psychotic person is then – at least for outsiders – no longer himself, but crazy.” Therapists now try in conversational psychotherapy to uncover “fractures,” that is, the incongruities. In a warm atmosphere characterized by empathy, the problems are worked out. There is no evaluation in the process.According to Rogers, the more understanding and accepting people are, the more likely they are to become capable of positively integrating their aggressive and destructive sides into their overall personality.
