Psychologist: Carl R. Rogers

Overview

Carl Ransom Rogers, Ph.D., was an American psychologist who developed a patient-centered method of psychotherapy: humanistic psychology.

Born January 8, 1902, in Oak Park, Illinois, Rogers remained active in his field until his passing on February 4th, 1987.[1] Regarded as a leader in the field of U.S. psychology,[2-4] he originated the non-directive, or client-centered, approach to psychotherapy, which emphasized a person-to-person relationship between the therapist and the client (formerly referred to as “patient”), and pressed it was the client (not the therapist) who determines the course, speed, and duration of treatment.[5]

Throughout his career, Rogers had written and lectured extensively on the theory and practice of psychotherapy. Publishing over 200 articles and 16 books, one text included his major theoretical work, Client-Centered Therapy (1951).[6] In the field of psychology, Carl Rogers holds many pioneering accomplishments. He was the first to offer an alternative to psychiatry and psychoanalysis[7] as well as the first to initiate research on psychotherapy,[8] recording, analyzing and publishing therapy sessions. He was among the first to use personal expression and informal style in his writings. Additionally, he was also the first to challenge commonly accepted practices of mainstream psychology, being particularly critical of research based on logical positivism, traditional modes of education and certification of therapists – challenges he continued until late in life.[9] Widespread recognition of Rogers’ cross-cultural work and his willingness to put it to the test in situations of conflict across the world (e.g., with national intergroup conflict in both South Africa and Northern Ireland) culminated in his being nominated for the Nobel Peace shortly before his passing in 1987.[10,11]


Background

Raised in a fundamentalist Christian home, Rogers initially attended the University of Wisconsin[12] and then the Union Theological Seminary, New York City. During these latter studies, his interest in psychology and psychiatry grew and after two years he left the seminary to pursue a M.A. (1928) and Ph.D. in Clinical Psychology (1931) from Columbia University’s Teachers College. While completing his doctoral studies, Rogers engaged in child study at the Society for the Prevention of Cruelty to Children, Rochester, New York, and in 1930 became its director.[13]

Following his work at the SPCC, Rogers pursued various professorships and research endeavors. From 1935 to 1940 he lectured at the University of Rochester and wrote The Clinical Treatment of the Problem Child (1939), utilizing his experience in working with troubled children. In 1940, Rogers became a professor of clinical psychology at the Ohio State University. In 1942 he penned Counseling and Psychotherapy, in which he suggested that clients, by establishing a relationship with an understanding/accepting therapist, can resolve difficulties and gain the insight necessary to restructure their lives. During his tenure as a professor of psychology at the University of Chicago (1945–57), Rogers partook in establishing a counselling center, in which he conducted various studies to measure the efficacy of his methods.[14] While in Chicago, he was elected president of the American Psychological Association in 1946.[15] Publishing his findings and theories, he wrote Client-Centered Therapy (1951) and Psychotherapy and Personality Change (1954).[16]

Moving on to the University of Wisconsin, Madison from 1957-1963, Rogers taught psychology and wrote one of his best-known books, On Becoming a Person in 1961.[17] In the 1960s, he was drawn to California where the human potential movement that had begun. Moving to La Jolla in 1963, he adopted some of the movement’s principles, including its emphasis on frank and open expression of feelings as well as the use of group therapy.[18] It was in La Jolla where he where assisted in the founding of, and became a resident fellow at, the Center for Studies of the Person.[19]  

Pioneering the field of psychological research, Carl Rogers and his colleagues were the first to record, transcribe, and publish complete cases of psychotherapy.[20] Utilizing the recordings, Rogers conducted and sponsored more scientific research on psychotherapy than had ever been undertaken before.[21,22] Based on his research findings, Rogers developed the “nondirective,” “client-centered” approach to counseling and psychotherapy, which became a mainstay of therapists’ repertoires.[23,24] Rogers’ approach to therapy helped popularize the term “client” as the recipient of therapy in nonmedical settings, he virtually founded the professional counseling movement, and further made professional counseling available to diverse professions.[25-28] For these accomplishments, he was the first psychologist or psychotherapist to receive the American Psychological Association’s (APA’s) highest scientific and professional honors: its Distinguished Scientific Contribution Award (1956) and its Distinguished Professional Contribution Award (1972).[29]

Theoretical components

From a combination of his clinical work and research, Rogers posed a decidedly contemporary debate: “Persons or Science? A Philosophical Question.” Rogers noted:

As I have acquired experience as a therapist, carrying on the exciting, rewarding experience of psychotherapy, and as I have worked as a scientific investigator to ferret out some of the truth about therapy, I have become increasingly conscious of the gap between these two roles. The better therapist I have become (as I believe I have), the more I have been vaguely aware of the complete subjectivity when I am at my best in this function. And as I have become a better investigator, more “hard-headed” and more scientific (as I believe I have), I have felt an increasing discomfort at the distance between the rigorous objectivity of myself as scientist and the almost mystical subjectivity of myself as therapist.[30]

Rogers described his journey of grappling with the conflict between the First Protagonist and Second Protagonist.[31] His noted how the therapist voice within him spoke of I–Thou relationships with others, of truth as subjective, of valuing an experiential stream of becoming, and of facilitating his clients’ self-discovery processes. The scientist voice within him, however, spoke of objectivity, of hypothesis testing and theory development, and of providing a basis for documenting change.[32] After writing about these conflicting voices, Rogers set aside this manuscript for a year and had dialogue with others to reformulate his view of science, noting “Science exists only in people.”[33]

Resolving to see science as a thoroughly subjective rather than objective, he noted how scientific questions arise in personal experiences, subjective choices are made regarding methods, scientists may choose not to believe their findings, scientific knowledge consists of beliefs held by subgroups of scientists, audiences for scientific findings must have a readiness to believe, and decisions about the application of science are made by persons. This reformulation of his view on science enabled the resolution of his subjectivity–objectivity conflict, with Rogers being able to view science as “an ‘I–Thou’ relationship with the world of perceived objects, just as therapy at its deepest is an ‘I–Thou’ relationship with a person or persons”[34]

Humanist Approach

Anchored on the work of Abraham Maslow, Carl Rogers developed the field of humanistic psychology. This field utilizes a perspective that emphasizes looking at the whole person, and the uniqueness of each individual. Further, at its core, humanistic psychology prefaces the existential assumptions that people have free will and are motivated to achieve their potential and self-actualize.[35] Referred to the “third force” in psychology after psychoanalysis and behaviorism,[36] the humanistic approach in psychology developed as a type of rebellion against what some psychologists saw as the limitations of the behaviorist and psychodynamic realms of psychology.[37]

Rogers’ focus of psychology on the study of the “self” varied from other prominent psychologists: Skinner focused on behavior; Freud the unconscious; and Wundt on how individuals perceive and interpret events.[38] According to Rogers, humans seek to feel, experience and behave in ways which are consistent with one’s self-image and reflect what they would like to be like: i.e.; one’s “ideal-self.”  The closer one’s self-image and ideal-self are to each other correlates to how consistent or congruent one is as well as to their higher sense of self-worth. Rogers noted that a person is said to be in a state of incongruence if some of the totality of their experience is unacceptable to them and is denied or distorted in their self-image.[39]

The humanistic approach states that the self is composed of concepts unique to oneself and that the self-concept includes three components:[40]

Self-worth: Rogers believed feelings of self-worth (i.e.; self-esteem) and how one thinks about themselves develop in early childhood, based on the interaction of the child with their primary caregiver(s).

Self-image: How one sees themselves affects how they think, feel and behave in the world. At its most-basic level, one might perceive themselves as good or bad, beautiful or ugly. Here within one can note the influence of one’s body image on their inner personality.

Ideal-self: The ideal-self is who one would like to be, based on their goals and ambitions in life. Dynamic, one’s ideal-self varies throughout life, particularly among age milestones. 

Fully-Functioning Person

Carl Rogers believed that humans have one basic motive: the tendency to self-actualize and fulfill their highest level of potential they can. He believed that every person could achieve their goals, wishes, and desires in life and if one succeeded in doing-so, self-actualization would take place.

Perceived as one of Rogers most important contributions to psychology, he found that for a person to reach their highest potential, a number of factors must be satisfied:[41]

1. Open to experience: Both positive and negative emotions are accepted. Negative feelings are not denied, but worked through (rather than resorting to ego defense mechanisms).

2. Existential living: One is in touch with different experiences as they occur in life, avoiding prejudging and preconceptions. Being able to live and fully appreciate the present, not always looking back to the past or forward to the future (i.e., living for the moment).

3. Trust feelings: One’s feelings, instincts, and gut-reactions are paid attention to and trusted. People’s own decisions are the right ones, and we should trust ourselves to make the right choices.

4. Creativity: Creative thinking and risk-taking are features of a person’s life. A person does not play safe all the time. This involves the ability to adjust and change and seek new experiences.

5. Fulfilled life: A person is happy and satisfied with life, and always looking for new challenges and experiences.

Rogers noted that fully-functioning people are well-adjusted, well-balanced, interesting to know and are often high achievers in society. However, despite the possibility to exist, in many ways Rogers regarded the fully-functioning person as simply an ideal and not something people ultimately achieve. The fully-functioning person should not be perceived as the apex or completion of life’s journey but rather that life is a process of always becoming and changing.[42]

Critics, however, claim that the fully-functioning person is a product of Western culture. In other cultures, such as Eastern cultures, the achievement of the group is valued more highly than the achievement of any one person, thus negating many of the five factors descriptive of a fully-functioning person.[43]

Person-Centered Approach

As Rogers and his colleagues researched their own therapy transcripts, they came to realize that transcript analysis involved mostly paying attention to the details of the therapy content and focusing on the therapist’s response. Unfortunately, he noted such analysis risked losing focus of what Rogers thought was the most critical aspect – the client–therapist relationship. Rogers feared this analytical position placed the therapist in the role of the expert, reducing therapy to a set of techniques. Further, for Rogers, every client-therapist relationship was unique; the relationship could not be duplicated from one client to the next.[44] Rogers' use of the term “client” rather than “patient” expressed his rejection of the traditionally authoritarian relationship between a therapist and their client, viewing them as equals. In sessions, he believed the client should determine the general direction of therapy, with the therapist seeking to increase the client's insightful understanding of self by asking the client informal questions to help them understand themselves more fully. One such mode utilized to accomplish Rogers's method is for the therapist to echo or reflect the client's remarks, conveying a sense of respect and a belief in the patient's ability to deal with their problems. In Rogerian therapy, the primary task is to help the client remove obstacles to self-actualization. Further, Rogers' approach emphasizes current emotions and attitudes of a client rather than their early childhood experiences.[45]

Rogers noted that a basic philosophical and methodological question continued to plague therapists: ‘To what extent do we rely on the individual’s ability to guide his own growth and development, and to what extent do we introduce outside motivation, strategies, guidance, direction, or even coercion?”[46,47]

Rogers held to his steadfast belief that human beings have within themselves a constructive tendency and “vast resources for self-understanding and for altering their self-concepts, basic attitudes, and self-directed behavior.”[48] Further, he believed that people have the tendency to grow, develop, and realize their full potential toward a more complex and complete development.[49] This belief and trust became the basis of Rogers’ approach and of humanistic psychology.[50]

Rogers’ approach, in which he developed a theory of personality, focused on the construct of self and on personality change. In his view, the goal of therapy was to move the individual towards maturity, as being and becoming what one most deeply is.[51] Accordingly, for Rogers, he believed that therapy should primarily deal with the organization and functioning of the “self,” with one’s counsellor serving as the client’s alter ego. Therapy was to be a process of exploration of feelings and attitudes (emotional catharsis) related to one’s problem areas, followed by increased insight and self-understanding.[52] He believed positive action occurred with a client fully accepted, recognized and clarified their feelings and then followed with a series of minute, yet significant, positive actions.[53] Although Rogers focused on personality change, he did not place importance on the structure or causes of a client’s personality.[54]

In 1957, Rogers set forth a hypothesis based on more than 3 decades of research.[55] Within the role of the therapist, Carl Rogers initially believed that three interrelated therapist characteristics were essential to creating a climate that supported and promoted this client-directed competence and growth.  These included: genuineness or congruence; unconditional positive regard; and empathetic understanding.[56] That hypothesis, essentially, was that when a therapist demonstrates these three “core conditions” and when the client perceives these, at least to a minimal degree, then psychotherapeutic personality change and its positive correlates become inevitable. Moreover, Rogers argued that these conditions of effective therapy operated independently of the therapeutic approach being used: “the techniques of the various therapies are relatively unimportant except to the extent that they serve as channels for fulfilling one of the conditions”[57,58]

Later adding a fourth characteristic, he referred to this as spiritual or transcendental, describing it as, “the special way a therapist can be spontaneously present with another when the therapist is closest to his inner, intuitive self and is in touch with the unknown me…then simply my presence is releasing and helpful.”[59] Rogers believed these therapist characteristics or expressions of attitudes and behaviors were a philosophical way of being and when a therapist lived this philosophy, it helped both the client as well as the therapist to expand the development of their capabilities.[60] Thus, he thought of his approach as a philosophy and his therapist stance as a person-centered way of being.

Over time, Rogers revised the name of his approach from nondirective, to client-centered and then to person-centered. While person-centered still reflected an emphasis on the client and the client’s expertise instead of the problem, it more-importantly also reflected a new emphasis on the fourth spiritual or transcendental characteristic.[61] His beliefs and procedures made Rogers, paradoxically, a therapist with enormous popularity and influence whose approach was noted to have given a breath of fresh air to the profession. At the same time, however, he was not taken seriously by some of his academic colleagues, as they charged that his approach was shallow.[62]


Discussion

Despite his role as a founder and spokesperson for the humanistic psychology movement,[63] Carl Rogers saw the practicality in fluidity and continual growth.[64] In 1959 he noted, “If theory could be seen for what it is—a fallible, changing attempt to construct a network of gossamer threads which will contain the solid facts—then a theory would serve as it should, as a stimulus to further creative thinking.”[65] Rogers worried about theory becoming dogma and discouraged the establishment of institutes or societies in his name, fearing that they would foster and promote a rigid orthodoxy.[66]

Throughout Rogers’ career, viewing science as “subjective” was highly provocative, particularly coming from someone widely recognized as a pioneer in psychotherapy research. Published reactions from the research community, were not equivocal.[67] Castore (1956) noted Rogers’ beliefs were, “painful in its implications for those who are now struggling for scientific method to clarify our present state of development,” and concluded, “I am certain that more is existent today than the hopeless conclusion provided by Rogers.”[68] Lake’s (1956) criticism was more severe: “we have respected Rogers as a creative leader. Yet what graduate student could get by with such talk of… ‘the subjective and the objective person,’ ‘the scientific versus the experiential viewpoint,’ etc.” He continued that his own research team, by contrast, avoided “semantic dichotomies,” and rejected subjectivity in science as “there are no such things as subjective data; as long as they’re subjective, they aren’t data.”[69]

Regarding the efficacy of Rogers’ approach, researchers sought to measure outcomes based on his hypothesis regarding the three conditions. Halkides (1958) created scales for outside judges to listen to the session audiotapes and rate the therapists on their demonstrated levels of the three conditions.[70] Following, Barrett-Lennard (1962) created the widely used Relationship Inventory, used by clients to rate their therapists on the core conditions.[71] Research conducted over the next quarter century confirmed the efficacy of Rogers’ core conditions. Truax and Mitchell (1971) reported on the results of 14 studies, involving nearly 1,000 participants. Across these studies, there were 66 statistically significant correlations between positive outcome and the core conditions, versus one statistically significant negative correlation; in summary, the findings indicate that therapists or counselors who are accurately empathic, non-possessively warm in attitude, and genuine, are indeed effective. Also, these findings hold across type of therapist (regardless of training or theoretic orientation) as well as varied type of client (varied clinical presentation and demographics). Further, Truax and Mitchell’s noted the evidence suggests these findings hold in a variety of therapeutic contexts and in both individual and group psychotherapy or counseling.[72]

Further, Kirschenbaum notes that those interpreting studies that show no positive effect from one of the core conditions as evidence that that condition is unimportant actually misunderstand Rogers’s hypothesis. For example, although therapist empathy, itself, may not be a necessary condition of effective therapy,[73,74] what does seem important is that clients perceive their therapist to be empathic.[75,76] Studies that use only outside observations or therapist ratings to measure the core conditions fall short of testing Rogers’ hypothesis, because they are not measuring actual client perceptions. More accurate tests of Rogers’ hypothesis are achieved when the core conditions are rated by the client; these such studies have produced the most consistently positive findings. Additionally, while some studies show that empathy, by itself, does not produce positive change does not mean that empathy is not effective; it means empathy must coexist with another core condition. The same is true for unconditional positive regard and congruence, as Rogers suggested that when all three conditions are present and the client perceives them, positive change will occur.[77]

One of the largest experimental studies conducted in the United States, funded by the National Institute of Mental Health,[78] compared different treatment approaches for depression: administration of the drug imipramine; cognitive-behavioral therapy (CBT); interpersonal therapy; versus a placebo, dubbed “ward management.”[79] This study concluded Rogers’ assumption that as there were no significant differences among the three therapeutic treatments on patient outcomes, across all groups, the therapist’s empathy, positive regard, and congruence at the end of the second session were significantly correlated with outcomes.[80]

Ever in-search of refining his theories and attempt to improve the human condition, Carl Rogers (1967) perceived that, "The good life is a process, not a state of being. It is a direction not a destination".[81]

Contributed by: Jennifer (Ghahari) Smith, Ph.D.


References

1 Carl Rogers: American Psychologist,” Britannica. (accessed 1-5-2021). www.britannica.com/biography/Carl-Rogers

2 Demorest, A. (2005). Psychology’s grand theorists: How personal experiences shaped professional ideas. Mahwah, NJ: Lawrence Erlbaum Associates.

3 Kirschenbaum, H. (2009). The life and work of Carl Rogers. Alexandria, VA: American Counseling Association.

4 Lakin, M. (1998). Carl Rogers and the culture of psychotherapy. In Kimble, G. A., Wertheimer, M. (Eds.), Portraits of pioneers in psychology (Vol. 3, pp. 245–258). Washington, DC: American Psychological Association.

5 Carl Rogers: American Psychologist,” Britannica.

6 “Carl Ransom Rogers,” Carl R. Rogers & Natalie Rogers. (accessed 1-12-2021). www.nrogers.com/Biographies.html

7 Anderson, H. (2001). Postmodern collaborative and person-centred therapies: what would Carl Rogers say? Journal of Family Therapy, 23: 339-360.

8 Bell, N. J. (2014). Dialogically based approaches to “with” and “about” the other: Thoughts on Carl Rogers’ dilemma. Theory & Psychology, 24(5), 688–708. https://doi.org/10.1177/0959354314547669

9 Rogers, C. (1980) A Way of Being. Boston, MA: Houghton Mifflin.

10 “Carl Rogers,” The Person Centred Association. (accessed 1-18-2021). www.the-pca.org.uk/about/carl-rogers.html

11 “About Carl R. Rogers,” Carl R. Rogers. (accessed 1-17-2021). carlrrogers.org/aboutCarlRogers.html

12 Carl Rogers. (2016). In J. L. Longe (Ed.), Gale Virtual Reference Library: The Gale encyclopedia of psychology (3rd ed.). Gale. 

13 Carl Rogers: American Psychologist,” Britannica.

14 Ibid.

15 Carl Rogers. The Gale encyclopedia of psychology 

16 Carl Rogers: American Psychologist,” Britannica.

17 Ibid.

18 Carl Rogers. The Gale encyclopedia of psychology 

19 Carl Rogers: American Psychologist,” Britannica.

20 Rogers, C.R. (1942). Counseling and psychotherapy: New concepts in practice. Boston: Houghton Mifflin.

21 Rogers, C.R. & Dymond, R. (Eds.). (1954). Psychotherapy and personality change. Chicago: University Press.

22 Rogers, C. R., Gendlin, E. T., Kiesler, D. J., & Truax, C. (1967). The therapeutic relationship and its impact: A study of psychotherapy with schizophrenics. Madison, WI: University of Wisconsin Press.

23 Rogers, C. R. (1942). Counseling and psychotherapy: New concepts in practice. Boston: Houghton Mifflin.

24 Rogers, C. R. (1951). Client-centered therapy: Its current practice. Boston: Houghton Mifflin.

25 Capuzzi, D., & Gross, D. R. (2001). Introduction to the counseling profession (3rd ed.). Needham Heights, MA: Allyn & Bacon.

26 Gibson, R. L., & Mitchell, M. H. (1999). Introduction to counseling and guidance (5th ed.). Upper Saddle River, NJ: Prentice Hall.

27 Gladding, S. T. (2000). Counseling: A comprehensive profession. Upper Saddle River, NJ: Merrill/Prentice Hall.

28 Nugent, F. A. (2000). Introduction to the profession of counseling (3rd ed.). Upper Saddle River, NJ: Merrill.

29  “About Carl R. Rogers,” Carl R. Rogers.

30 Rogers, C. R. (1955). Persons or science? A philosophical question. American Psychologist, 10, 267–278.

31 Ibid.

32 Bell, N. J. (2014).

33 Rogers, C. R. (1955). 

34 Ibid.

35 McLeod, S. A. (2015, December 14). Humanism. Simply Psychology. www.simplypsychology.org/humanistic.html

36 Maslow, A. H. (1968). Toward a psychology of being (2nd ed.). New York: D. Van Nostrand.

37 McLeod, S. A. (2015, December 14). Humanism.

38 Ibid.

39 Rogers, C. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework. In (ed.) S. Koch, Psychology: A study of a science. Vol. 3: Formulations of the person and the social context. New York: McGraw Hill.

40 Ibid.

41 Ibid.

42 McLeod, S. A. (2014). Carl Rogers. Simply Psychology. www.simplypsychology.org/carl-rogers.html

43 Ibid.

44 Anderson, H. (2001).

45 Carl Rogers. The Gale encyclopedia of psychology 

46 Rogers, C. (1980) A Way of Being. Boston, MA: Houghton Mifflin.

47 Kirschenbaum, H. and Henderson, V. L. (1989a) Carl Rogers Reader. Boston, MA: Houghton Mifflin.

48 Rogers, C. (1980).

49 Kirschenbaum, H. and Henderson, V. L. (1989b) Carl Rogers: Dialogues. Boston, MA: Houghton Mifflin.

50 Anderson, H. (2001).

51 Kirschenbaum, H. and Henderson, V. L. (1989b).

52 Rogers, C. (1940) Counseling and psychotherapy: new concepts in practice.

53 Rogers, C. (1942) Counseling and Psychotherapy. Boston, MA: Houghton Mifflin.

54 Anderson, H. (2001).

55 Bozarth, J. D., Zimring, F. M., & Tausch, R. (2001). Client-centered therapy: The evolution of a revolution. In D. J. Cain & J. Seeman (Eds.), Humanistic psychotherapies: Handbook of research and practice (pp. 147–188). Washington, DC: American Psychological Association.

56 Kirschenbaum, H. and Henderson, V. L. (1989a).

57 Rogers, C. R. (1957). The necessary and sufficient conditions of psychotherapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.

58 Kirschenbaum, J. (2005). “The current status of Carl Rogers and the person-centered approach.” Psychotherapy (Chicago, Ill.), vol. 42, no. 1, Educational Publishing Foundation, (pp. 37–51). doi:10.1037/0033-3204.42.1.37.    

59 Kirschenbaum, H. and Henderson, V. L. (1989b).

60 Kirschenbaum, H. and Henderson, V. L. (1989a).

61 Ibid.

62 Anderson, H. (2001).

63 Kirschenbaum, H. (2009). The life and work of Carl Rogers. Alexandria, VA: American Counseling Association.

64 Bell, N. J. (2014).

65 Demorest, A. (2005). Psychology’s grand theorists: How personal experiences shaped professional ideas. Mahwah, NJ: Lawrence Erlbaum Associates.

66 Kirschenbaum, H. (2009).

67 Bell, N. J. (2014).

68 Castore, G. F. (1956). Comments on Rogers’ “Persons or science.” American Psychologist, 11, 154–155.

69 Lake, R.A. (1956). Comments on Rogers’ “Persons or science.” American Psychologist, 11, 155.

70 Halkides, G. (1958). An experimental study of four conditions necessary for therapeutic change. Unpublished doctoral dissertation, University of Chicago.

71 Barrett-Lennard, G. T. (1962). Dimensions of therapist response as causal factors in therapeutic change. Psychological Monographs, 76 (43, Whole No. 562), 1–33.

72 Truax, C. B., & Mitchell, K. M. (1971). Research on certain therapist interpersonal skills in relation to process and outcome. In A. E. Bergin & S. L. Garfiel (Eds.), Handbook of psychotherapy and behavior change (pp. 299–344). New York: Wiley.

73 Bergin, A. E., & Suinn, R. M. (1975). Individual psychotherapy and behavior therapy. In M. R. Rosenzweig & L. W. Porter (Eds.), Annual review of psychology (pp. 509–556). Palo Alto, CA: Annual Reviews.

74 Lambert, M. J., & Bergin, A. E. (1994). The effectiveness of psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 143–189). New York: Wiley.

75 Barrett-Lennard, G. T. (1962).

76 Martin, P. J., & Sterne, A. L. (1976). Post-hospital adjustment as related to therapists’ in-therapy behavior. Psychotherapy Theory, Research and Practice, 13, 267–273.

77 Kirschenbaum, J. (2005).

78 Blatt, S. J., Zuroff, D. C., Quinlan, D. M., & Pilkonis, P. A. (1996). Interpersonal factors in brief treatment of depression: Further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64, 162–171.

79 Lambert, M. J., & Bergin, A. E. (1994).

80 Kirschenbaum, J. (2005).

81 Rogers, C. R., Stevens, B., Gendlin, E. T., Shlien, J. M., & Van Dusen, W. (1967). Person to person: The problem of being human: A new trend in psychology. Lafayette, CA: Real People Press.