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Gendlin, E.T. (1967). The social significance of the research. In C.R. Rogers (Ed.) (1967), The therapeutic relationship and its impact. A study of psychotherapy with schizophrenics, pp. 523-541. Madison: University of Wisconsin Press. From http://www.focusing.org/gendlin/docs/gol_2081.html

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The Social Significance of the Research

Eugene T. Gendlin

What did this research program contribute to the social problem that there are more than half a million people now in "mental hospitals"? How are the findings applicable to this problem, and what avenues of solution do they indicate?

Often in the past, research has measured only outcomes, but failed to define the "psychotherapy" which led to these outcomes. Thus one knew only that two people in a room did something quite undefined, called "psychotherapy" by one of them. The purpose of this research went beyond this. Its aim was to define the "essential conditions of psychotherapy" (specifically those aspects of the therapist's behavior which make it therapy) and the "essential" indices of "process" in the patient (specifically those aspects of patient behavior which indicate that he is engaged in therapy). We then tested high therapist "conditions" and high "process" against the usual outcome measures, to see whether these really are essential factors of effective psychotherapy.

The peculiar characteristic of these essential factors is that they transcend different orientations of psychotherapy as well as different situational patterns such as individual therapy, group therapy, ward, family, occupational, and vocational therapy. The essential variables apply to all interpersonal situations of any sort, for example to normal work settings, family life, classroom situations, etc. These "conditions" have been investigated in a variety of situations, and there are a whole series of tentative research findings (Berlin, 1960; Thornton, 1960; Berzon, 1961; Emmerling, 1961; Hollenbeck, 1961; Rosen, 1961; Snelbecker, 1961; van der Veen, 1961, 1962a, 1962b; Barrett-Lennard, 1962; Appell, Gendlin and Klein, 1963; de Vault, et al, 1963; Clark and Culbert, 1964; Kagan and Huntgate, 1964).

We are beginning to show, as Rogers (1957, 1959) hypothesized, that genuineness, empathy, and unconditional regard are high in successful roommates, teachers, and mothers, as well as in group (Truax, 1961) and ward therapists (see Chapter 15). If you consider what these "conditions" are, you can see why they are applicable to all interpersonal situations: the "conditions" are fundamental attitudes of one person toward another. They define a quality possible in any personal interaction. Of course, specific behaviors differ for a teacher in [Page 524] a classroom, for a therapist, a work supervisor, or a ward aide. Yet, given the different behaviors appropriate in different situations, the same fundamental attitudes determine whether there is a therapeutic quality in the interaction.

The Significance of the "Conditions" for the Mental Hospital

If these are the necessary conditions of therapeutic relationships, and if they can occur in such a variety of situations, then the question is: In what kind of situational pattern can these conditions best be provided to a large hospitalized population?

Since our variables are essential aspects of all interaction, regardless of its setting, we are free to consider an unlimited variety of situational arrangements. That is the very nature of these variables.

It is true that the findings are tentative, not completely clear-cut, and in need of replication. (But, they are in a form in which they can be replicated. They have been defined and instrumented so that anyone anywhere can determine whether the "therapy" he studies does, or does not, involve these variables.) If these findings are replicated, and continue to be supported, then they imply the question: How can we, as a society, best house and treat our "mentally ill" population so that maximal levels of these variables are offered?

The Futility of Individual Therapy

It is clear from the nature of these variables, that one would not necessarily provide them through client-centered therapy, or through any individually structured therapy, since their basic nature does not imply anything one way or the other about specific therapist techniques or about individual, group, or other situational arrangements. Above all, it does not follow that we should retain the hospital system as is, and provide the "conditions" only by sending individual therapists into the present type of state hospital. That pattern would provide these conditions in only two of the patient's 168 hours per week in the hospital. Our findings show that even in that pattern the conditions can be effective—but our findings surely do not imply that it is the only, or best, way of arranging the situation.

If we thought only of the individual psychotherapy pattern added onto the current hospital pattern, the cost would surely discourage us. Individual psychotherapy as conducted in our program was long, often stretching into years. Could a professional psychotherapist (moreover, one who is able to create a relationship with high conditions) be provided for each patient now hospitalized?

Research is laboratory work. In a laboratory one often produces—at [Page 525] high cost and with years of effort—some product which, once found and defined, can then be mass-produced at little cost. If, in practical use, the cost of an item were what it first cost in the laboratory, most new products would remain prohibitively expensive and impractical.

To bring this home I want to tell about one of our therapists who, in one of our frequent moments of discouragement, divided the total amount of our research grant by the number of therapy patients in the research: $180,000 divided by 16 = $11,250 per patient. He said, "Why don't we just give each patient eleven thousand dollars? That would get them well for sure!" If our findings mean that an individual psychotherapist-researcher must be brought into the hospital individually for a half million patients, it would cost five billion dollars—too expensive to hope for.

Because of this well-known fact, we designed the research to define and measure what is essential for a psychotherapeutic process in these patients. Much of what any method of psychotherapy champions, another equally effective method specifically eschews. One suspects (Gendlin, 1964) that neither these nor those modes are really essential. If one could define what is essential one could then see how that can be provided for all those who need it.

An example: For many centuries it was known that roots of certain plants in India, when chewed, produced a quieting effect. But it was difficult to dig these plants up. It was too expensive and clumsy to provide such roots for mass use. Then came the discovery of the chemicals which were the essential calming agents, and means of producing them cheaply. Today we have tranquilizers and no longer need to dig up the plants.

The Generalized Use of the Conditions

If genuineness, empathy, and unconditional regard are the essential ingredients of psychotherapy, there is no doubt that we can produce and offer these conditions in many different situational arrangements more economically than in individual, office-based psychotherapy.

When we discuss the prohibitive cost of offering psychotherapy to hospitalized psychotics, we should remember that more or less well-functioning and well-paying patients in ordinary psychotherapy often require two years or more! Therefore, not only with psychotics, but also with neurotics, we are currently using a situational arrangement which makes therapy prohibitively costly for most people. Thus, the isolation of the essential effective ingredients, and the possibility of providing them in other, more economical situational arrangements, has great significance for psychotherapy generally, not only for hospitalized psy- [Page 526]chotics. We can begin to think of ways of offering these "conditions" to school children, to delinquents, and to many others, in each instance devising the situational patterns best fitted and most appropriate for these people and the schools or agencies concerned with them.

In many contexts we would wish that personal interaction were therapeutic, rather than the reverse. Once we know what essentials make interaction therapeutic, we can set about reorganizing many different social patterns so that they would include these therapeutic essentials. The day is nearer when the therapeutic ingredients can be given to society generally, rather than only to those few who hire an office psychotherapist for themselves.

In this chapter we will be concerned only with hospitalized psychotics. What might be appropriate situational arrangements to expose them to genuineness, empathy, and unconditional regard?

Therapeutic responding need not occur only in an office or in privacy, or for two hours weekly. In fact, our experience shows that this individualized pattern fits the hospital situation very poorly: (a) patients do not expect "an hour" of time. Ten minutes may be enough. Nor do patients always need or expect privacy; (b) the therapist may want to remain with the patient for two or even six hours and may thereby achieve in those rare times more than can be done in years of biweekly sessions rigidly lasting an hour and then rigidly stopped; (c) many patients are threatened by the rigid office situation and reject such psychotherapy; (d) initiation of psychotherapy is extremely difficult with discouraged, frightened, withdrawn, suspicious patients. Such patients need to see and hear therapeutic relating with other patients and to approach and withdraw from it repeatedly before they can bear to try out such a relationship themselves.

Not only in initiating psychotherapy but generally, when two people relate closely in the hearing, and sight of others, these others are drawn in on an intimate level. They may be silent for a long time, or seem to ignore what occurs. However, the experience—and the possibility of similarly relating—remains with them. It does not seem an essential part of psychotherapy to shut ourselves away only with those patients with whom we relate. On a hospital ward, certainly, that is not necessary. The whole climate of the ward will be improved if we can bear to speak closely and intimately to a patient out in the open where others can hear us.

We tend to become locked into a given structural pattern of offering psychotherapy once such a pattern develops. We assume everything in the pattern is part of the therapy, part of the snakeroot that works. The great power of the "conditions" lies in what they do not include. [Page 527] Among other things they do not include one given pattern to provide therapeutic interaction.

In our research program we attempted a different pattern of offering therapeutic relations, that is, the "ward-availability" plan (see Chapter 3). This pattern was specifically designed to meet the difficulty of initiating psychotherapy, but its considerable success points to a variety of possible patterns more natural to the hospital setting and population. It also made much more economical use of the time of therapeutically oriented people than the individual psychotherapy pattern. The ward-availability pattern may reduce the time needed for this population to no more than the length necessary for an average client population. In the old pattern, the really long time was taken by the resistance, hesitation, withdrawal, rejection, and silence—sometimes lasting many months—before a therapy process really began. Of course, this slow initiation is itself a kind of therapy, but it can be easily provided by the ward-available setting: a therapist can work with those who are willing—within sight and hearing of those who are not (who hesitantly and tentatively approach and repeatedly withdraw).

Another, broader pattern (we tried it informally with some success) is to provide one therapeutically oriented staff person to form relationships with patients. If patients are not told that therapeutic relating should take 50 minutes in an office it does not occur to them to need that, especially if the relating is plainly genuine and follows no rigid format. Thus one person can be available to relate more or less simultaneously with forty-eight to ninety-six patients, and can initiate and carry forward a great many relationships. Thus, the addition of one staff member whose job would be to relate to patients with genuineness, empathy, and regard would not really be so expensive. Consider that there is now on state payrolls one hospital staff person for every three patients, and relating to patients is the chief task of none of these.

Hospital psychiatrists are overworked in the administration and supervision of the many wards of which they have charge. In the main they must work through nurses. (They often complain of this, sometimes see one or two patients in therapy to keep up their skill and motivation.)

Psychologists are often occupied with testing. Sometimes they spend many hours in psychotherapy but always with this patient or that, or with a group for a set number of weeks, or in ward meetings. Rarely is a psychologist simply available even for a few minutes to a patient other than the few specially selected ones.

Social workers plan release, and then only when the patient is well enough. Occupational therapists provide an often very helpful atmos- [Page 528]phere, but too frequently focus simply on activity. Nurses direct aides, give drugs, keep records. Aides do janitorial work and head up cleaning details. Even volunteers bring cookies, coffee, or cards, but rarely see their function as one of really relating to the patients with empathy (too often they are told to avoid painful topics, which are to be left for the doctor).

And so, even in a small, treatment-oriented, and excellently-staffed hospital (as was the one in which we worked), to relate to the patients is the primary task of not one of the wide gamut of professional specialties of the hospital. So much more true is this in the huge state hospitals (say 6,000 patients) in the big cities, and in badly understaffed hospitals out in the country.

It seems, from these considerations, that someone to relate with patients along the lines of the "conditions" can be provided for in many patterns (e.g., in some ward-available pattern) and is decidedly an economic possibility. It could often be fitted into current hospital budgets without seriously curtailing the other helping services now provided.

The Possibility of Training Laymen

Another major significance of these conditions is that they are attributes of the person, rather than of his knowledge. This does not mean that no training is required, but it is a very different kind of training. An M.D., Ph.D., or a university education is not a prerequisite for the capacity to offer high conditions.

This means that the basic population from which to draw people who can provide high conditions is the total population—everyone—not just a few expensively trained professional people. It means that the cost of providing someone to relate along these lines with every patient may be very much less than would be supposed.

At first it may seem a shocking notion that ordinary people can be trained to relate with high attitudinal conditions to patients. It seems to destroy the role of the professional. Actually, even with top-flight training, professionals are only sometimes successful and always deeply torn and worn by working with hospitalized psychotics. Could ordinary people do as well? The work of Margaret Rioch (1963) gives an answer by showing that some housewives, with a modest amount of intensive training, can be highly effective therapists.

An even more striking study is that carried out by Ernest Poser of McGill University (in press), in which it was demonstrated that college girls, without psychological training, related naturally to hospitalized schizophrenics, and these relationships proved to be very therapeutic. Actually their success with the patients was greater than that of profes- [Page 529]sionally trained therapists working under identical conditions. Thus it is clear that individuals without expensive training can deal with psychotic individuals.

If we now consider the situation of the aides in state hospitals, we realize that these are untrained individuals, working under supervision, whose main responsibilities are menial. If ordinary people were trained to relate to patients with the "conditions" they too would work under supervision. If large numbers were trained, fully professional people would not be eliminated. They would have a more vital role than ever—to supervise these large numbers.

Plans of this kind are being tried in several places. In some hospitals, aides are being trained to relate more therapeutically. In other places, volunteers who visit patients one day a week are being trained (Veterans' Administration, 1965). Always, such training seems a daring venture till one stops to think that, as it stands, the people who now chiefly work with the patient have no training at all.

Such training need not be for a hospital staff job. It could be offered to anyone interested in visiting one or two patients regularly. Many people, for example, women whose children are grown (Gendlin, 1956; Rogers, 1956; Rioch, 1963), would welcome a really meaningful occupation and would accept training for it. There is always going to be a shortage of professional people but there is no shortage of people seeking meaningful activity. [1]

Possible Programs of Training

These developments could have come about long ago but for our ignorance as to how to train such people. Of course, no one research project can alone dispel this ignorance. At most, the findings point to the direction of definable therapeutic factors which make the training of ordinary people quite conceivable.

Possibilities of training are mentioned here, not to propose this or that plan (such plans depend on many factors), but to illustrate that if the "conditions" are indeed the essential therapeutic agents, then we know [Page 530] what the essential training is and we do not require that all psychotherapists be highly trained professionals.

It is true that the research itself does not prove this, since all but one of our therapists were experienced Ph.D.'s and M.D.'s, or graduate students who, while inexperienced, were nevertheless professionally trained persons. To see the significance for a broad social application of the conditions, one must look at the conditions themselves with this question in mind: How much diagnostic and conceptual training does "empathy" require? We do not know for certain. It is likely that familiarity with the range of possible human patterns and feelings is helpful. However, in the main, as Rogers says (1957), diagnostic skill is not needed for therapeutic interaction. Margaret Rioch (1963) reports that college-educated women who had had no training in psychology or psychotherapy found it better first to listen and interact with patients, and then to learn psychopathological terms with which to name facets they observed. Thus the requirement for empathy seems to be not the technical vocabulary but the training to observe, to listen for, and to respond to, finer facets of feeling and reaction. (Most often, the unique, individual, and finely textured ways of feeling with which we must empathize have no technical names. There are only broader categories of which they are individualized instances.)

If training in empathy is conceivable without academic training, it is even more conceivable in genuineness and positive regard. There is much to learn about such responding (see Chapter 16 for only some of such learnings). But, none of these learnings require higher education. They require direct work with patients, supervision, and opportunities to discuss, differentiate, and resolve one's observations and reactions.

During the past few years we have trained a rather large number of totally inexperienced people. These included graduate students in psychology, psychiatric residents, undergraduates, and, most recently (in Illinois), volunteers. We began our training by taking the new people onto a ward in the hospital. They were asked to talk with those patients who approached them (some come up and initiate a conversation: "Are you a social worker?" "Are you a visitor?" "Do you know when I can go home?" etc.) They were told to be simply honest (when appropriate, to explain that they hoped to learn how to help people in hospitals, and that they would like to hear how the patient came to be here . . .). They were also told that it would be all right to sit next to a patient who remained silent, perhaps asking a few questions, then saying something like: "If you don't feel like talking now, that is really all right. You don't have to."

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The purpose of beginning training in this way was to enable the trainee to speak naturally with patients. We have found repeatedly that the structured therapy situation is very tense for the beginning therapist. He wants very much to behave and respond "as a therapist," but not knowing what that is, his task is much as though he were desperately trying to be a "garoompf" (something extremely important but undefined). The result is tension, and suppression of his many natural responses which—just because they are simply natural—seem as if they couldn't be what was wanted. It may take years for the therapist to regain the natural ease which he gave up at the start. By beginning on the ward, without expectations, the trainee becomes comfortable in talking with patients. As a result, trainees can more quickly give themselves fully to listening and perceiving the patient.

Meanwhile the experienced therapist is also on the ward, talking with patients, sometimes joining this or that trainee for a few minutes in his conversation with a patient. In this way the experienced therapist can demonstrate how he works, again without the artificial pressure of having to do something well because it is a "demonstration." Genuineness, empathy, and unconditional regard apply directly also to training and supervisory relationships. After such a time on the ward, an excited and involved group of trainees discuss with the (hopefully) undefensive experienced therapist what they, and he, did and might have done. In this regard Rogers has led the way for many years—by discussing his difficulties and errors, by publishing a failure case, by participating in such meetings and thinking out loud about his own feelings and sometimes poor responses, all of which swiftly frees the tense beginner similarly to accept his inevitable personal difficulties and failures as these bear on responding to a troubled individual.

I have described this training because it illustrates the social significance of the conditions as essential variables of engendering the process of constructive personality change. The training described brings home the fact that academic training is not required (although experiential training is necessary, and perhaps selection also).

Another implication of these essential variables concerns the social problem as it bears on our present failure to provide help to patients from the lower socio-economic classes (Hollingshead and Redlich, 1958). The conditions are variables which, at least in principle, require none of the conceptual articulateness and verbal habits of the middle-class university professional. (A program to train selected lower-class individuals in the conditions is under discussion in Illinois at the time of this writing [Gendlin, 1965].) Perhaps it will soon be possible to give [Page 532] lower-class individuals the essential skills to help lower-class patients. This has been successfully tried in counseling of institutionalized delinquents and criminals in California.

Finally, and most broadly, we may view the mental patient population as one which has been abandoned and isolated by society. The "illness" seems to be, at least partly, the result of no empathy, no genuineness, no unconditional regard. It is most likely that professional people alone will not be able to "cure" this "illness" in so many people. Fortunately, there are already attempts, made by ordinary, socially conscious people, to bring these people back. As half-way houses, community clinics, day treatment centers, friendship houses, volunteer programs, etc. multiply, the "conditions," as essential variables of a therapeutic process and as practised by laymen, may become the scientifically defined way of bringing patients back to interhuman living.

A New Science of Psychotherapy

Research in psychotherapy has suffered from the fact that psychotherapy was not definable. This has meant that if an experimental therapy group was compared to a non-therapy control group, some of the supposed therapy subjects were not really receiving anything therapeutic at all. Similarly, some control subjects might have had a "high condition" relationship, but one not labeled "therapy." Averaging the changes in the experimental group as compared with the control group has often showed no significant differences. To bring this home, imagine trying to investigate the effects of a drug, with an experimental group taking the drug and a control group receiving a placebo. Imagine that some (perhaps half) of your experimental group are actually taking a preparation without the effective ingredient of the drug—and you don't know which ones these are—and that one or two of your controls are actually getting the drug on the side. Your experimental treatment group is not always getting the treatment and your controls are not truly controls.

Another difficulty in this research situation was that research in psychotherapy has, until now, not really been replicable. If in one research, psychotherapy was given and found successful (significantly more than in controls), the next research group had no way of repeating such successful therapy. They could only do whatever each of their therapists called psychotherapy, without knowing if it even resembled what was done in the earlier research, now being "repeated," or just how it differed. Perhaps in the repetition no positive outcomes or differences from the controls would be found.

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The Significance of Defining the Conditions of Therapy

The conditions as measured by our instruments can be applied to any therapists. In this way any group can determine whether they are doing that which we investigated.

Since some of our findings are partial and unclear, and since in any case one study rarely provides definitive answers, it is important to notice not only the specific findings but also the general implications for the sort of variable which the conditions are. Even if future researches disprove our findings, the very possibility of such clear-cut disproof is a significant advance. This kind of variable and methodology allows therapist variables to be measured and can define "psychotherapy." Thus, if a different group of therapists views some aspect of what they do as "essential," then, by the same sort of methodology, the variable they choose can be instrumented and tested. It will be possible to replicate their "experimental treatment."

It is a major significance of this research that we have begun to define "psychotherapy" in researchable and replicable terms, so that we need no longer employ only the misleading definition of hours in a room.

Note that the conditions are variables of therapist behavior: they concern how the therapist does what he does. The direction is toward a new science about working with people—not a science which merely classifies types of people or pathological difficulties, but a science consisting of defined operations to employ with people who thereby change.

Every developed science has followed the path of first primitively classifying the phenomena as observed. (Physics began with the classes: the wet, the dry, the earthy, the fiery.) The development of science moves from classifying (and otherwise leaving unchanged) toward defined procedures to follow, and their predicted consequences. Developed science consists of operations. One predicts that, if the operation is performed upon the subject matter, certain changes will follow. Classifications are then readjusted and enormously improved in power.

Thus while our prediction—that the same operations would lead to the same change process in schizophrenics as in normals and neurotics—may seem strange, in fact the findings did indicate that the current psychopathological classifications are not very relevant to the therapeutic change process, or to the operations which bring it about. Perhaps new and better classifications may emerge (in a rudimentary way some more relevant classifications may be emerging). We should not be sad to see our current psychopathological classification becoming obsolete. [Page 534] (It is still a good set of concepts to sensitize people to the variety of human ways of feeling.) The movement of science is—as it ought to be—toward variables of what we can do to the subject matter and what happens when we do it. A science of how to approach and relate to people is replacing a science that only classified people as they are.

We may hope to develop, in the next decades, a sophisticated and socially defined language about detailed therapeutic operations (attitudes, sets, and responses). As it is today, each therapist in each generation must begin at the beginning. While our present psychopathological science gives him sophisticated concepts about the patients, it gives him very few concepts about what he is to do to help the patients change. We have as yet very little such science, very few terms about a therapist's procedure which can mean the same to all and can be defined, observed, measured. The conditions variables are an early set of such terms.

It will also become possible to use the instruments which measure such therapist behavior variables as both training aids and training measures. We have already begun (Gendlin, 1962) to use the rating scales, backwards as it were, to define and illustrate for the trainee what the conditions variables are. We have a set of tape-recorded four-minute excerpts which illustrate the conditions at the various levels, and we use some of these to teach and some of them to test the progress of the trainee. The same rating scales can then be applied to their own tape-recorded interviews to establish how well such learning generalizes in their actual therapy behavior.

Finally, we ought to look at the findings in the context of the slowly increasing knowledge about how to cure schizophrenia. I say "cure" advisedly, because while we have no sure-fire "cure" as yet, this must be the objective.

Currently, government programs, community psychology, and social psychiatry are rapidly developing community approaches to the problem of mental health. The realization is now widespread, that "one-to-one" helping is insufficient, and that the structures of hospital and community must be worked with.

So strong is this new emphasis, that there is some danger we may lose the ingredient of the personal relationship. In many minds the personal relationship has become identified with office psychotherapy. It is therefore important that the therapeutic "conditions" measured here are applicable in other arrangements. Our own "ward-availability" pattern (see Chapter 3) is one such different arrangement. But in principle it should be possible and economical to build the therapeutic conditions [Page 535] into at least one relationship with at least one person, as part of the current community approaches.

It seems probable that patients will need at least one close relationship with at least one human being (however little actual time they may have with him). The findings imply that this is one essential ingredient which we should not lose, as we develop others.

There is a time lag today (though we may not yet have all the pieces of the puzzle) between what is discovered and what is used. Moreover, as the "conditions" show, work with psychotics—and people generally—depends very greatly on human qualities and attitudes. Thus, perhaps in one hospital everything conceivable is done to aid patients. The release percentage goes up and everyone is excited, publishes, and learns. But soon the staff changes and the hospital goes back to being an ordinary custodial institution. So much of our present way of working still depends on global devotion—on the "Hawthorne effect"—whereby any sustained major effort will bring improvement because the attitudes in such an effort are the effective change agents. The "conditions" define just these attitudes. It is a major step to define them (rather than the vast variety of different behaviors, methods, vehicles, and techniques which could implement them). Such definitions move beyond the present dependence on the happenstance of individual staffs, toward a socially defined set of procedures.

Society would change its present system if a better answer were reliably shown. We believe society will adopt better methods to the extent that their effectiveness is scientifically tested. The "conditions" are not at all new, but they have not been scientifically defined and tested before. Ever since the Quakers in 1794 established "moral" institutions for a more human treatment of the insane, it has been claimed by some that "insane" people need optimal human relationships. Why was this knowledge not taken up generally? Why would we expect it to be taken up now? The hope lies in measurable and tested effects of the conditions variables. As a society we accept scientific findings as a basis for social policy. When it was scientifically demonstrated and fully replicated that sunshine is not good for tubercular patients, the sunshine treatment was discontinued. When we found radiation to have bad cumulative effects, the X-ray machines were eliminated from shoe stores. There is a time lag, but not such a lag as that from 1794 to the 1960's. On the other hand, scientific verification in this area is extremely new, and we are not accustomed to it. It requires a certain discipline on our part as researchers. We need to build studies, one on top of the other, to use the same instruments with [Page 536] one step of improvement at a time, to replicate each other's experiments, to move toward genuinely rigorous tests of what we are already convinced of as people, and slowly to devise a scientific language of terms which define significant aspects of human interaction.

In this development the present findings are only one important, but very small, step.

The Implications of the Measurement of Process Behavior

Now let us turn to the social significance of the measurement of the client's process behavior. Our ability to measure this means that we no longer need to wait several years to know whether an individual's psychotherapy is now producing change. "Process" defines behavior indices of ongoing change. If these indices are present, change is now being produced. To be able to decide this from present interview materials has enormous advantages for research, and for training and administration. Instead of having to wait many years before a given case is defined as a "failure," something can be done about it in time.

The process measures now make it possible to study different methods and arrangements of psychotherapy in terms of the levels of process behavior they engender. Research studies need no longer take so many years of waiting for "outcomes" and "follow-ups." It is now possible to study just a few interviews, or specific kinds of therapist behavior within an interview. "What is the differential result of this or that procedure?", we have always wanted to ask. It is now possible to measure the effect of a given procedure on the immediately ensuing process level in that and the next interview. Such studies can be carried out in short periods of time.

The Broader Significance of the Use of Experiencing

A much wider social significance is implied in the findings. The individual chances if he gives his felt experiencing a basic role in his thinking, talking, interpreting, and reacting. We are becoming able to measure, that is, to make public and social, a method of thinking which involves the individual's experiencing. It has always been known that some individuals are creative, that is, that they do not remain only within given interpretations and constructs. Somehow they use something else with which to arrive at new interpretations and constructs. It has been a puzzle what they do, since it has seemed as if the given ways of construing experience is all we have. It does no good to say to someone, "Hold your constructs loosely," or "Don't get so tied to how you see it now," since, if I hold my constructs and interpretations ever so loosely and open-mindedly, that alone does not get me to something new [Page 537] or better. To say, "Hold the concepts loosely," only tells me what I should not do. It does not tell me what to do. The creative individual uses something else in addition to the constructs. He has something to work with when he lets go of a given way of seeing things. He uses not only the given interpretations and constructs, but also his concretely felt experiencing, his preconceptual impression, his whole sense of the situation he observes or thinks about. He attends to, responds to, and conceptualizes aspects of this felt experiencing. As long as we could not talk about something preconceptual, not yet structured and formulated, we could only say that creativity is holding constructs loosely, somehow easily getting to new ones. We could not say what else is involved.

The use of one's felt experiencing is a method of thinking. If we find that clients cannot succeed with personal problems without reference to, and movement of, experiencing, why would we wish to let thinking in the human sciences, social planning, historical thought, ethics, psychology, and other areas remain in the kind of helpless vacuum which, for clients, we term "intellectualization" or "rationalization"? Thus a revolution in the capacities of human thought is implied. We will still be able to move from concept to concept via logical and precise, event-determined connections, but we will also, when we wish, be able to move from concept to experiential felt meaning (thereby taking in a whole texture of relevant aspects not yet formulated), and thence to new and different concepts. In retrospect we can always give logical precision to such an experiential step, although in advance we cannot replace it by deduction and constructs only, since such a step moves beyond the given constructs and their implications.

But, this "method of thinking," this "skill," this using one's felt experiencing for thought and problem solving—is it not really a matter of personal growth? Is it not "defensiveness" which prevents so many people from using their experiencing? Would there not have to be major personality change and growth before people could use it.

At one time Rogers (1959a) and I thought that high process levels were a measure of optimal adjustment. Conversely, we thought that low process levels indicated defensiveness and poor adjustment. We predicted that as the successful client moved through therapy, his process level would increase more and more. He would begin therapy at a low level and terminate successfully at a much higher level of using his experiencing. The findings of this and other researches on both neurotics and schizophrenics have shown that the situation is not that simple. It is clear now that the use of one's experiencing may be the sort of behavior which precedes change, as well as being the sort of behavior which comes more strongly into evidence in the process of [Page 538] change. Quite poorly adjusted clients (both neurotics and schizophrenics) can be helped to engage in sufficient levels of process behavior to bring about change. We found consistently and significantly (with both neurotics and schizophrenics) that the level of this behavior is consistently higher for successful clients than for failures. There is a "working level" below which no change takes place. At the working level there is enough of this change-producing type of behavior to make therapy a success.

It seems, therefore, that the ability to so employ one's experiencing is not a function of adjustment. It is possible for extremely maladjusted people near the beginning of therapy! It is not the result of therapy—on the contrary, therapy takes place only through this change-producing behavior.

It seems that skill at the use of experiencing is not an index of health. Many people may be quite well adjusted (see our normals) without it. But it does seem that if such people do get into personal trouble they lack the skill to get out of it.

But then, if this type of behavior is so crucial in order to produce change, to resolve problems, to form new concepts and interpretations, and if one need not be well adjusted to use it, why then not teach it to everyone we can?

If process modes of problem solving and thinking can be taught (perhaps in high school or earlier), we would enable many people to resolve their own emotional problems, to carry their own experiencing forward, to overcome otherwise disabling situations without having to seek a professional therapist. Similarly (since use of one's own experiencing is vital in therapeutic responding to others), this skill would enable people to listen more helpfully to each other.

Can the skill be taught, and to whom? Instruments are now being developed on a pilot basis that instruct a step-by-step focusing on one's experiencing (both on personal problems and on intellectual problems), and a set of questions that can objectively establish whether these instructions were followed. (We had found, some time ago, that even a very short instruction to focus on one's felt meaning of a personal problem succeeded in producing significantly different GSR patterns (Gendlin and Berlin, 1961). Such instructions, questionnaires, and the instruments presented in this book bring us close to being able to define this "skill" objectively and socially, and to measure whether "teaching" it is possible. It also will enable us to answer the questions: At what developmental stage and school age is it best taught? Are there differences in how well subjects can learn it who are of different personality types, adjustment levels, socio-economic class, and genetic inheritance? [Page 539]Such studies will probably lead to more and more universally applicable modes of teaching the focusing on one's experiencing (perhaps not only with middle-class verbal tools but also with images and actions).

Of course (as we said earlier about "conditions"), different types of situations may require different measurement instruments. The same basic process will have somewhat different observable indices. For example, if we wish to measure the extent to which small children in a classroom use their experiential process in their thinking about a subject, we may need somewhat different instructions and rating scales for the same basic variable. The basic question will still be: To what extent does the student refer to what he experientially senses? To what extent does he formulate freshly (as compared to using given concepts only)? To what extent is he basing his questions or comments on what we call "fresh thinking" (i.e., the use of as yet unformulated, sensed significance one newly formulates from out of one's directly sensed experience of what has been presented and discussed).

Thus we approach the time when this much more creative and powerful mode of thinking and dealing with oneself and others may become the property of everyone, taught in school by standard methods and its performance measurably tested.

The sort of society we have been evolving is more and more one in which highly specialized and complex role-slots are defined, and individuals must fit themselves into these. The individual is replaceable: someone else can be put into the same slot and perform exactly as the first one did. As society becomes more and more rationalized and complexly defined (irreversible in industrialization), we face more and more the problem of the individual person's relationship to these functionally defined roles.

To enable individuals to fill such roles, we give a highly sophisticated education to millions of them. Are we then to expect that they will shut down in themselves the (now richer than ever) experiential process so that they are only what the slot demands? It is not humanly possible. It would not be desirable. We want the individual person's creativity so that he is not only able to bear, but also able to change and improve the slot.

Similarly, we want a science which consists not only of given and rigid constructs (and just what follows logically from these) but also the experiential breadth of the individual thinker so that he can alter and improve concepts and create even better ones.

The measurement and definition of "process behavior," of giving one's felt experiencing process a basic role in one's thinking and interpreting, probably leads not only to a much improved research capable [Page 540] of improving psychotherapy, but also toward a more therapeutic society in which everyone might be enabled to employ the process and gain the power it adds to our more logical and conceptual modes of thinking and interpersonal responding.

References

APPELL,M., GENDLIN, E. T., and KLEIN, MARJORIE H. Teacher attitude variables and student explanation in three teaching methods. Unpublished research report, University of Wisconsin, 1963.

BARRETT-LENNARD, G. Dimensions of therapist response as causal factors in therapeutic change. Psychol. Monogr. 76, No. 43 (Whole No. 562), 1962, pp. 1-36.

BARRINGTON, B. Prediction from counselor behavior of client perception and of case outcome. J. counsel. Psychol. 8: 37-42, 1961.

BERLIN, J. I. Some autonomic correlates of therapeutic conditions in interpersonal relationships. Unpublished Ph.D. dissertation, University of Chicago,1960.

BERZON, BETTY. Relationship Inventory pilot study. Research memorandum, Western Behavioral Sciences Institute, 1961.

CLARK, J. V., and CULBERT, S. A. Mutually Therapeutic Perception and Self-Awareness in a T-Group. Mimeographed paper, Graduate School of Business Administration, University of California, Los Angeles, 1964.

DEVAULT, M. V., ANDERSEN, D. W., SAWIN, DOROTHY, CAUTLEY, PATRICIA, and BOEHLEBER, M. In D. W. Andersen (ed.), The Wisconsin Teacher Project: Design and Instrumentation. Mimeographed paper, University of Wisconsin, 1963.

EMMERLING, F. C. A study of the relationships between personality characteristics of classroom teachers and pupil perceptions of these teachers. Unpublished Ph.D. dissertation, Auburn University, 1961.

GENDLIN, E. T. Professional or Legal Certification of the Counseling Function. Counseling Center Discussion Papers, II, 8. Mimeographed. Chicago: University of Chicago Library, 1956.

GENDLIN, E. T. Some ideas toward measurement indices of therapist competence. Int. Ment. Hlth. Res. Newsltr. 4: Nos. 3 and 4, 1962.

GENDLIN, E. T. A theory of personality change. In P. Worchel and D. Byrne (eds.), Personality Change. New York: John Wiley & Sons, 1964, pp.100-148.

GENDLIN, E. T. Mental Health Field Worker Training Project (preliminary draft). Chicago: Illinois Department of Mental Health, Department of Planning, 1965.

GENDLIN, E. T., and BERLIN, J. Galvanic skin response correlates of different modes of experiencing. J. clin. Psychol. 17:73-77, 1961.

HOLLENBECK, G. P. The use of the Relationship Inventory in the prediction of adjustment and achievement. Unpublished Ph.D. dissertation, University of Wisconsin, 1961.

HOLLINGSHEAD, A. B., and REDLICH, R. C. Social Class and Mental [Page 541] Illness: A Community Study. New York: John Wiley & Sons, 1958.

KAGAN, M., and HUNGATE, J. I. (editors and project directors). The Field Instructor-Student Relationship in Social Work. A group research project of the Graduate School of Social Work, University of Texas. Bound, mimeographed report, April, 1964.

POSER, ERNEST. The effect of therapists' training on group therapeutic outcome. J. consult. Psychol. 30:283-289, 1966.

RIOCH, MARGARET J., ELKES, CHARMAIN, FLINT, ARDEN A., USDANSKY, BLANCHE S., NEWMAN, RUTH G., and SILBER, E. National Institute of Mental Health pilot study in training mental health counselors. Amer. J. Orthopsychiat. 33: 678-689, 1963.

ROGERS, C. R. Can we meet the need for counseling? A suggested plan. Counseling Center Discussion Papers, II, 6. Mimeographed. Chicago: University of Chicago Library, 1956.

ROGERS, C. R. The necessary and sufficient conditions of therapeutic personality change. J. consult. Psychol. 21: 95-103, 1957.

ROGERS, C. R. A tentative scale for the measurement of process in psychotherapy. In E. A. Rubinstein and M. B. Parloff (eds.), Research in Psychotherapy, Vol. I. Washington, D.C.: American Psychological Association, 1959a, pp.96-107.

ROGERS, C. R. A theory of therapy, personality, and interpersonal relationships as developed in the client-centered framework. In S. Koch (ed.), Psychology: A Study of a Science. Vol. III, Formulations of the Person in the Social Context. New York: McGraw-Hill, 1959b, pp. 184-256.

ROSEN, H. H. Dimensions of the perceived parent relationship as related to juvenile delinquency. Unpublished M.A. thesis, Auburn University, 1961.

SNELBECKER, G. E. Factors influencing college students' person-perceptions of psychotherapists in a laboratory analog. Unpublished Ph.D. dissertation, Cornell University, 1961.

THORNTON, B. M. Dimensions of perceived relationship as related to marital adjustment. Unpublished M.A. thesis, Auburn University, 1960.

TRUAX, C. B. Process of group therapy: Relationships between hypothesized therapeutic conditions and intra-personal exploration. Psychol. Monogr. 75, No. 7 (Whole No. 511), 1961.

VAN DER VEEN, F. The perception by clients and by judges of the conditions offered by the therapist in the therapy relationship. University of Wisconsin Psychiatric Institute Discussion Paper. 1: No. 10(e), 1961.

VAN DER VEEN, F. Agreement among the perceptions by clients, therapists, and judges of the conditions offered by the therapist. Unpublished research report. University of Wisconsin Psychiatric Institute, 1962a.

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FOOTNOTE

[1] Since our study had to do with one-to-one relationships, there has been little or no mention of groups. Yet the exciting work being done in basic encounter groups at various state hospitals (Camarillo State Hospital in California is an example) shows not only that a trained facilitator can provide high conditions in his relationship to the group members, but that increasingly the patients in such groups show more of these attitudes, and relate more therapeutically, to each other. This so greatly broadens the pool of people who may learn to be therapeutic for each other that it deserves separate explication by those who have been more closely involved in such work. It opens fascinating new doors for the utilization of the attitudinal conditions we have discussed.

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