The six conditions are the therapeutic factors that Carl Rogers proposed as “necessary and sufficient” for personality change as part of his theory of psychotherapy.
According to his theory, “if these six conditions exist, and continue over a period of time, this is sufficient. The process of constructive personality change will follow” (Rogers, C. 1957)
To understand how these factors work, it’s helpful to remember that humanistic therapists like Rogers are based on the idea that humans have an intuitive tendency to develop themselves to their full capacity. This “includes the organism’s capacity for self-healing” (Sanders, P. 2004: 22). Carl Rogers referred to this as the “self-actualisation”.
The conditions contribute to a relationship in which the person’s self-actualisation can take charge in healing them. This way, the person can organise their own resources to solve their own problems and realise themselves to their full potential.
Therefore, the role of the therapist is to create the environment for self-directed change in the client (through the conditions).
The six conditions of therapeutic personality change
The 6 conditions are (paraphrasing Rogers, 1957, emphasis mine):
- Two persons are in psychological contact
- The first (the client) is incongruent, in a vulnerable or anxious state
- The second (the therapist) is congruent or integrated.
- The therapist experiences unconditional positive regard for the client
- The therapist experiences an empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client.
- The communication of this empathic understanding and this positive regard is achieved, at least minimally.
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There is psychological contact
Originally, Rogers proposed this as a conduit for all other conditions, and asserted that it’s “such a simple one that perhaps it should be labelled an assumption”. (Rogers, C. 1957)
However, Garry Prouty focused on this condition and “reminded therapists that this cannot be taken for granted” (Sanders, P. 2004: XIV). He helpfully distinguishes “contact with self”, “contact with environment” and “social contact” as different dimensions where psychological contact can break down. To help ensure psychological contact was established or re-established he developed his work on “pre-therapy”.
The client is incongruent
Roger’s personality theory is based on the idea that we learn to accept some experiences as valid and distort other experiences and deny them from awareness. In doing so, we form a self-concept (our own idealised idea of ourselves) which is in a degree of tension with our actual experience.
As children, we receive “conditions of worth”. For example, we may be praised for being brave and chastised for being fearful. Over time, we accept our experiences where we put a brave face, and deny experiences of fear, which create tension and anxiety.
Therefore, for a therapeutic relationship to deliver personality change, the client needs to have a degree of incongruency that can be healed. In most therapeutic contexts this is the case, since the reason clients attend therapy in the first place is to address these barriers to experiencing their real selves (which show up as depression, anxiety, stress).
The therapist is congruent
For the therapist to contribute to a healing relationship, they need to be in a position where they can accept their own experiences. It means that “within the relationship, he is freely and fully himself, with his actual experience accurately represented by his awareness of himself”. (Rogers, 1957)
This simply means that the therapist is self-aware. It does not necessarily mean they need to communicate these experiences, unless doing so would be beneficial for the client, or to address important barriers in the relationship.
Taken together, the client’s incongruency needs the authenticity of the therapist to create the conditions where the client can narrow the gap between their self-concept and their more accurate bodily sense of reality as it happens.
The therapist experiences unconditional positive regard
Positive regard is the experience of acceptance without conditions or evaluations of any thoughts and feelings by the client. It is important to understand this is considered an experience of the therapist, which is borne of a value system in which the therapist believes in the client’s process as valid. As the ancient roman playwright Terence put it “Nothing human is alien to me”.
In Rogers words, it is to give the client the “permission to have his own feelings, his own experiences” (Rogers, 1957).
The therapist experiences empathic understanding
Empathy is the experience of the clients thoughts and feelings as if they were their own. Rogers proposed the helpful idea of the “internal frame of reference”.
This means the therapist is not hearing the client’s experiences and relating them to their own, but rather they stay in the point of view of the client, trying to understand what it feels to be the client. As if they were them.
The therapist succeeds in communicating this empathy and positive regard.
Not only does the therapist have to experience understanding (empathy) and acceptance (positive regard), they also need to achieve its communication, so that the client feels “fully received”. Otherwise, these ingredients don’t become active in the relationship.
What are the core conditions?
From the six conditions, three are considered “core”: that the therapist is congruent, that the therapist experiences unconditional positive regard, and that the therapist experiences empathic understanding from the client’s internal frame of reference.
Carl Rogers considered these ‘a way of being’, not skills or techniques. They stem from the a fundamental attitude from the therapist that “the individual has a sufficient capacity to deal constructively with all those aspects of his life which can potentially come into conscious awareness” (Rogers, 1951: 24)
As Tony Merry explains, “empathic understanding is not employed in order to achieve any particular effect or outcome”. The counsellor is “not trying to (…) achieve a specific set of therapeutic goals, other than the creation of a relationship in which the client’s internal resources become released for the purpose of bringing psychological change.” (Merry, T. 2004: 35)
However for other person-centred researchers such as Mick Cooper, these conditions are considered “interpersonal skills” (Cooper, M. 2008).
The core conditions deliver outcomes in therapy
Research has shown the core conditions to be effective in therapy (Cooper, 2008).
In a meta-analysis by Bohart and colleagues (2002) empathy was shown across fourty-seven studies to have a medium to large effect. According to Mick Cooper, this “suggests that therapists’ levels of empathy may make considerably more contribution to the outcomes of therapy than the techniques used” (Cooper, M. 2008: 107).
He has also found ample evidence for positive outcomes in correlation to positive regard. He concludes “many studies of the factors that clients find helpful in therapy indicate that the experiencing of a warm and positively regarding relationship with a likeable therapist are amongst the most valued aspects of therapy”. (Cooper, M. 2008: 124)
Are the conditions necessary and sufficient?
The sufficiency of these conditions is a crucial point where classic client-centred approach and later variants within the wider person-centred approach differ.
In simple words – is it enough for these conditions to be present?
For classic client-centred therapists, who use Carl Rogers’ non-directiveness as a principle, the conditions are all that is needed for someone to heal from any problems they have.
It isn’t that classic client-centred therapists are rigid in their thinking and don’t accept new valid ideas of factors that help the therapeutic process. It is simply that these conditions are considered axiomatic because ”the therapist cannot be both attending empathetically to the client’s world and simultaneously engaged in making decisions (…) with a view to intervening” (Merry, T 2004: 39)
However all the “tribes” that came after Rogers would disagree, even if ever so slightly on this sufficiency point.
Beyond classic client-centred therapy
The first therapeutic school to splinter from within what is now considered the “classical” position of the person-centred approach was Eugene Gendlin’s “Focusing”.
This modality was borne of a discovery of the important role of client characteristics in delivering successful outcomes. According to research that Rogers and his team (which included Gendlin) conducted, clients with high levels of experiencing did better in therapy. As Campbell Purton quotes Rogers “the therapist’s attitudes are clearly important, but the patient’s characteristics appear to play a definite part in eliciting these qualities” (Purton, 2004, 49).
Now, if clients who from the beginning are more able to be in touch with these emotions do better in therapy and create the conditions for therapists to be more helpful, it follows that helping clients do this can improve therapeutic outcomes. Even if that is outside the “necessary and sufficient” conditions or introduces some directiveness.
It’s perhaps uncharacteristically bold for Rogers to have claimed at the time that the “no other conditions are necessary”. And even if so, he would have missed to add that perhaps other conditions could be found to be helpful over time. That’s certainly the view from Focusers, Experientialists and Existentialists practicing from a person-centred approach (Sanders, 2004).
The “conditions” have become mainstream in the world of therapy and have influenced therapists beyond the person-centred approach. As the research bears, therapists from any modality can improve therapy outcomes by providing empathic understanding, positive regard and by working on their congruent self-awareness.
In the end, what matters is that therapists use the available research to bring to practice attitudes, ideas or techniques that can help people develop. And as Rogers himself would remind us “The facts are always friendly”.
Bibliography
Rogers, C.R., 1951. Client-Centered Therapy: Its Current Practice, Implications and Theory. Boston: Houghton Mifflin.
Cooper, M., 2008. Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. London: SAGE Publications.
Sanders, P., Merry, T., Purton, C., Baker, N., Cooper, M., Worsley. R. 2004. The Tribes of the Person-Centred Nation: An Introduction to the Schools of Therapy Related to the Person-Centred Approach. Ross-on-Wye: PCCS Books.
