The Humanistic Paradigm
...in every individual there is a uniqueness that defies all formulation.
The humanistic paradigm emerged as the “Third Force” in American psychology after World War II as scholars and psychotherapists challenged reductive renderings of classical psychoanalysis and the mechanistic limits of behaviorism. A range of thinkers and intellectual traditions have shaped understanding and practice in the humanistic schools of thought over the last half century. Clinicians have drawn on phenomenological, existential, constructivist, and experiential perspectives in developing conceptions of personality, vulnerability, and therapeutic action, and recent theorizing has been shaped by developments in fields of affective neuroscience and interpersonal neurobiology. Practitioners have embraced fimdamental concerns that converge with the principles and values of clinical pragmatism, emphasizing the individuality of the person and subjective experience; notions of agency, intention and will; exercise of freedom and choice; the crucial functions of the therapeutic relationship, collaboration, and dialogue; the co-creation of narrative and meaning; the dynamics of experiential learning, and inherent capacities for change, growth, and realization of potential in the individuation of the self. The field of psychotherapy research originated in the humanistic paradigm, shaped by the pioneering studies of Carl Rogers. Over the years researchers have demonstrated the efficacy and effectiveness of person-centered and experiential approaches, documenting the crucial role of the therapeutic relationship in outcomes.
In this chapter I review the emergence of the humanistic paradigm, outlining orienting perspectives and fimdamental concerns, and explore the ways in which concepts of therapeutic action deepen our understanding of core processes believed to bring about change and growth. As in the preceding chapters, I begin with a brief account of the intellectual traditions that have shaped the development of the paradigm and trace the evolution of clinical practice. I outline three models that exemplify the defining features of the paradigm, focusing on the person-centered approach of Carl Rogers and experiential approaches introduced by Eugene Gendlin and Leslie Greenberg.
In doing so I consider the ways in which recent developments in the science of mind and the principles and values of clinical pragmatism deepen our appreciation of essential concerns in our understanding of therapeutic action, change, and growth.
A range of intellectual traditions in philosophy and psychology' have shaped the development of humanistic thought and values in contemporary' psychotherapy. Historians trace the origins of the humanist tradition to Socrates and Plato, who rejected materialism as a means of understanding human experience, distinguishing the psyche or soul from the physical body. We are living beings—souls, selves—subjects, not objects, experiencing, feeling, thinking, willing, and acting. The Aristotelian notion of the observer studying the person as an object fails to capture the essence of what it means to be human.
Humanistic perspectives emerged in the Renaissance as the authoritarian traditions of scholastic philosophy and theology' that had shaped the assumptive world of the Middle Ages receded and scholars rediscovered the classical ideals of ancient Rome and Greece. They' emphasized the dignity and worth of the person as an individual and the belief that reason, will, and action can foster the development of the individual and the common good, improving worldly conditions. The portraiture of Renaissance art captured the subjectivity' and complexity' of human individuality' (Barzun, 2000).
A series of European philosophers introduced concerns and ideas in the 19th century that influenced existential and phenomenological conceptions of humanistic psychology' and psychotherapy. Soren Kierkegaard emphasized the crucial role of experiential reflection, freedom, and responsibility in his accounts of consciousness, self, and cultural life (1844/1944). Friedrich Nietzsche distinguished “Apollonian” and “Dionysian” views of life in his vision of the human situation. In the deepest, fullest model of living, he proposes, we come to embrace the dialectical interplay between the divergent visions of reality' and illusion, experiencing “the whole range and wealth of being natural” (1889/1982, p. 554).
Edmund Husserl, Martin Heidegger, and Karl Jaspers elaborated phenomenological perspectives in the 20th century’, arguing that we must take account of the subjectivity of the individual if we are to fully grasp the nature of human experience. The fundamental task of phenomenology', Husserl proposed, is to apprehend human experience in the subjective context of its living reality'. Heidegger drew on the existential formulations of Kierkegaard and the phenomenological methods of Husserl, his mentor, in fashioning a philosophy of being. He challenged the Western tradition that had made clear distinctions between “inner experience” and “outer realities” in his notion of “being-in-the-world,” arguing that we cannot separate the “subjective” and the “objective” from the standpoint of experience (Heidegger, 1962; Husserl, 1913/1962).
William James believed that the individual carries a “uniqueness that defies all formulation,” as noted in the account of clinical pragmatism in Chapter 1 (James, 1911/1979, p. 109). He rejected mechanistic accounts of mental life, as we saw in our discussion of the mind-body problem in Chapter 2, arguing that psychology should focus on the whole person: “The only states of consciousness that we naturally deal with are found in personal consciousnesses, minds, selves, concrete particular I’s and you’s” (1890, p. 497). His conception of “the stream of consciousness” follows from his deep appreciation of subjectivity. More than anything, he emphasizes, our experience is personal-. Even' sensation, feeling, image, thought, or action is mine, or hers, or his, or yours: “The universal conscious fact is not ‘feelings and thoughts exist,’ but ‘I think’ and ‘I feel.’ No psychology... can question the existence of personal selves” (1890, p. 499).
Evolution of Therapeutic Practice
As we have seen, the determinism of Freud’s drive psychology' moved a series of thinkers to establish humanistic perspectives in the broader psychodynamic paradigm, as outlined in Chapters 4 and 5. Carl Jung, Alfred Adler, and Otto Rank, originally members of Freud’s inner circle, challenged his biological perspective and elaborated independent schools of thought that emphasized subjectivity and personal meaning, existential concerns, and the role of relationship, social life, and culture in development, health, and well-being.
Jung described the ways in which emerging concerns, values, and organizing purposes shape efforts to realize potential and work toward the individuation of the self in adulthood and later life. Adler introduced a psychology of values that emphasized subjectivity and personal meaning; notions of will, self-determination, and responsibility; creativity and capacities for transcendence; and the crucial role of relational life and social surrounds in health, well-being, and the common good. Rank, like Adler, centered on concepts of will, self-determination, and responsibility in elaborating his developmental formulations and existential perspective.
Donald Winnicott proposed that we are born with an inherent drive to actualize the “true self,” the inviolate core of our being, and described the “maturational process” that governs the development of the individual. He introduced a language of subjectivity in his efforts to represent core states of self, exploring the experience of aliveness, authenticity, creativity, wonder, and play in everyday life. Like Winnicott, Karen Horney understood our tendency to actualize the “real” self as a cardinal motivation in human development. She described neurosis as “a special form of development antithetical to growth” (1950, p. 13), reaffirming her belief in our fundamental “wish to grow and to leave nothing untouched that prevents growth” (1942, p. 175, cited in Rogers, 1951/1965, p. 489).
Existential perspectives emerged in Europe as thinkers attempted to come to terms with the sense of alienation and vulnerability that followed the two
World Wars. Drawing on the philosophical thought of Kierkegaard, Nietzsche, Husserl, Jaspers, and Heidegger, thinkers challenged the biological perspective of Freud, rejecting his deterministic and mechanistic renderings of the human situation. They embraced notions of personal agency and will; freedom, choice, and responsibility; and the crucial role of guiding purposes as we work to create meaning and fulfill our desire to live.
Ludwig Binswanger and Medard Boss, trained as psychiatrists in Switzerland, created an approach based on Heidegger’s notion of Dasein, known as Daseinanalyse (Binswanger, 1951/1963; Boss, 1957/1963). Working from a phenomenological perspective, they emphasized the need to enter the experiential world of the patient, exploring the ways in which we give meaning to existence.
Victor Frankl, practicing as a psychiatrist in Vienna, introduced logotherapy, an approach originating in his experience as a prisoner in the Nazi death camp at Auschwitz. He thought of the “will to meaning” as the cardinal motivation in human experience, realized in unique and particular ways by each individual over the course of life (1963). Rollo May, trained as a psychoanalyst at the William Alanson White Institute in New York, introduced the European existentialists to psychotherapists in the United States in a series of writings, beginning with his seminal work, The meaning of anxiety (May, 1950/1977). Irvin Yalom would expand conceptions of therapeutic action in his classic text, Existential psychotherapy, published in 1980.
Kurt Goldstein, working as a neurologist and psychiatrist in Germany after World War I, documented the ways in which soldiers constructed their world anew following traumatic brain injury, expanding capacities for coping and adaptation. He spoke of “the essence of the individual” and elaborated a holistic conception of the person, proposing that the experience of adversity and misfortune can sponsor growth and development in accord with our current understanding of neuroplasticity. He introduced the concept of the “selfactualizing tendency,” a fundamental motivational force that mediates the course of development, guiding efforts to realize potential (Goldstein, 1934/ 1995, p. 162).
Frederick Peris, who had trained in neuropsychiatry’ in Berlin after serving in World War I, worked closely with Goldstein in his treatment of traumatic brain injury’. He was influenced by’ Goldstein’s holistic view of the individual and the “self-actualizing tendency” in forming his conceptions of gestalt therapy. He drew on a range of intellectual traditions as he continued to develop his clinical perspective, including phenomenological and existential thought; the gestalt psychology' of K. Koffka, W. Kohler, and M. Wertheimer; the psychoanalytic contributions of Rank, Horney, and Wilhelm Reich; the field theory' of Kurt Lewin; and fundamental elements of Zen. Over the course of his collaboration with Laura Peris, Paul Goodman, and Ralph Heferline, following his move to the United States in 1946, Peris deepened his exploration of concerns that would shape therapeutic practice in the broader humanistic paradigm, focusing on the domain of the body and interoceptive experience; the dynamics of sensation, feeling, thought, and behavior; awareness of the present moment; and authenticity and dialogue in the therapeutic relationship (Peris, 1947; Peris, Hefferline & Goodman, 1951).
In the domain of academic psychology' a growing number of thinkers challenged the reductionism of Freudian thought and behaviorism that had failed to take account of fundamental aspects of human life. Gordon Allport, Henry Murray, Gardner Murphy, George Kelly, Carl Rogers, and Abraham Maslow expanded conceptions of personality, focusing on the unique experiential world of the individual, exploring conceptions of purpose, meaning, and realization of potential.
Maslow emerged as the principal architect of humanistic psychology' in the 1950s, outlining fundamental concerns, themes, and assumptions that would shape understanding across the paradigm. He sought to establish what he thought of as a “Third Force” in psychology' that would deal with matters of individuality, consciousness, values, ethics, purposes, and what he described as “‘peak experience’—what you feel and perhaps ‘know’ when you gain authentic elevation as a human being” (Maslow, 1971, p. xvi; see also 1967a, 1968, 1970).
Like Jung, Winnicott, Horney, and Goldstein, Maslow believed that there is “an active will toward health, an impulse towards growth, or towards the actualization of human potentialities” (1967b, p. 153). In accord with Horney, he thought of neurosis as “a failure of personal growth,” “a falling short of what one could have been, and even, one could say, of what one should have been, biologically speaking, that is, if one had grown and developed in an unimpeded way” (1971, p. 33). He provided case studies of historical and contemporary' figures whom he regarded as exemplars of selfactualization and described the defining features of “peak experience” and “the higher reaches of human nature” found in the most fully developed individuals (1971, p. xvi).
Although Maslow did not set out to create a model of psychotherapy, his conceptual syntheses and empirical research would shape the assumptive world of clinical practice through the second half of the 20th century'. Drawing on phenomenological and existential points of view, psychotherapists increasingly' focused on the person as an individual, seeking to take account of capacities for reflective consciousness, agency and will, and purpose and meaning, emphasizing conceptions of growth that challenged reductive accounts of human experience in the psychoanalytic and behavioral paradigms.
Rogers emerged as a formative influence in the field of therapeutic practice over the course of his research and teaching in the 1950s and 1960s. He had created the first version of his approach, “non-directive therapy,” in the 1940s, and he would emphasize the crucial role of acceptance, empathic understanding, and authenticity as he elaborated conceptions of the helping relationship and interactive experience, healing, and growth in the client-centered model.
Rogers drew on a range of thinkers in developing his conceptions of therapeutic action. He had begun doctoral study in ministry' at Union Theological
Seminary in New York but left the program after two years to pursue training in clinical psychology at Columbia University, where one of his teachers, W. H. Kilpatrick, introduced him to the pragmatic philosophy of John Dewey. Like Maslow, he was influenced by Goldstein’s holistic conception of the person and his formulations of the self-actualizing tendency. His training in psychodynamic psychotherapy deepened his appreciation of the humanistic orientations of Adler and Rank and the relational formulations of Horney and Harty Stack Sullivan. He worked as a psychologist in a child guidance clinic for 12 years before he began his academic career, teaching at Ohio State University, the University of Chicago, and the University of Wisconsin. He elaborated conceptions of personality; vulnerability and problems in living; health, well-being, and optimal functioning; and concepts of therapeutic action that would influence training and practice across the foundational schools of thought (see Rogers, 1942, 1951/1965, 1957, 1959, and 1961; see Kirschenbaum, 2009, for biographical account).
Clinical scholars continued to expand the scope of therapeutic action in the humanistic paradigm, introducing a range of experiential approaches that emphasized the realm of emotion, learning, and the active role of the clinician in helping patients challenge the dynamics of inner life that perpetuate problems in living. Eugene Gendlin, who had emigrated to the United States following the Nazi invasion of Vienna in 1938, received a doctoral degree in philosophy and began to collaborate with Rogers at the University of Chicago in 1953. He carried out research on therapeutic processes and outcomes and developed an experiential approach known as focusing, described in the following section.
Like Gendlin, Laura Rice worked closely with Rogers as a student at the University of Chicago in the 1950s and continued to carry out research on psychotherapy at York University in Toronto. She introduced a method known as task analysis, exploring core processes believed to facilitate change and growth over the course of therapy. She described a systematic, evocative unfolding procedure that outlines methods of engaging the processes of discovery' and change (Rice, 1992). She collaborated with Leslie Greenberg, one of her graduate students, in developing an experiential approach known as emotion-focused therapy (Rice & Greenberg, 1984). Drawing on recent developments in affective neuroscience and interpersonal neurobiology, Greenberg and his collaborators have continued to elaborate a process-experiential approach to psychotherapy, building on classical Rogerian theory', integrating active methods from psychodynamic, cognitive, and behavioral schools of thought, described in the following section.
The person-centered perspective of Carl Rogers, experiential models, and existential approaches continue to influence formulations of therapeutic action in the wider humanistic paradigm (see Messer & Kaslow, 2020, for expanded reviews of person-centered, experiential, and existential schools of thought). More broadly, the orienting perspectives of humanistic psychotherapy' have shaped practice across the foundational schools of thought, guiding the development of integrative approaches.
Models of Therapy
In this section I outline the defining features of Rogers’ person-centered approach in greater detail and review experiential models developed by Eugene Gendlin and Leslie Greenberg and colleagues that exemplify overlapping conceptions of therapeutic action encompassed in the humanistic paradigm.
Person-Centered Approach: Rogers
Rogers assumes that the cardinal motivation in human development is to realize our potential and actualize the self. Building on Goldstein’s formulation of the actualizing tendency, he proposes: “the organism has one basic tendency and striving—to actualize, maintain, and enhance the experiencing organism” (1951/1965, p. 487). In this sense he focuses on fundamental processes thought to foster change and growth, emphasizing the crucial importance of being present in the moment to make use of experiential opportunities in the realization of potential and the individuation of the self. We must be open to our experience of inner life and outer realities as we create more differentiated and integrated ways of being and living.
Rogers centers on the phenomenal field of the person in context, taking account of the concrete circumstances of particular situations in his conceptions of moment by moment functioning, realizing that our ongoing experience of relational life and social surrounds shapes what we feel, think, and do. In following the phenomenological perspective of Goldstein, he assumes that we do not live in a realm of objective reality but negotiate the world as we experience and construct it. We create our subjective sense of self and the world through experience, he believes, proposing that the internal frame of reference of the individual is the best vantage point for understanding feeling, thought, and action (1951/1965, p. 494).
Although Rogers recognizes the role of relational and contextual factors in his conceptions of development, he emphasizes the crucial role of personal agency, values, purposes, and meaning in his formulations of self-actualization, health, and well-being. In proposals that converge with Daniel Siegel’s conceptions of development in interpersonal neurobiology', Rogers expanded his initial version of self-actualization to encompass what he imagines to be a broader organizing tendency operating in nature that moves all forms of life toward greater order, complexity, integration, and interrelatedness (Siegel, 2018, 2020).
We are born with an inherent capacity to value processes that we perceive as preserving or enhancing our lives, he proposes, just as we recognize experiences that threaten or limit our growth. Rogers anticipates formulations of “self-righting” processes described in conceptions of resilience (Bohart & Watson, 2020).
Our failure to function as a person in process, reflected in defensive, rigid, undifferentiated patterns of behavior, perpetuates vulnerability and problems in
The Humanistic Paradigm 157 living. Rogers assumes that dysfunction follows from our failure to attend to the flow of experience in ways that facilitate problem-solving and coping. Presumably, feeling, thinking, and acting in ways that violate our most fundamental sense of self creates conflict, suffering, and demoralization, limiting the extent to which we can engage the actualizing tendency.
Rogers describes three domains of concern in his accounts of the fully functioning person: “openness to experience;” “existential living,” reflected in spontaneous, flexible, functional ways of being and relating in moment by moment experience; and “organismic trusting” that shapes decision-making and behavior in light of needs, values, and essential concerns (Rogers, 1961, pp. 187-189). These concerns provide crucial points of reference over the course of the therapeutic process.
Rogers proposes that the fundamental dynamic of change in psychotherapy lies in our inherent capacities for growth and individuation; Arthur Bohart speaks of a “self-organizing wisdom” (Bohart & Watson, 2011, p. 246). The therapeutic process seeks to help the patient engage and strengthen capacities for self-actualization through the core conditions of the relationship and the interactive experience of exploration, reflection, support, and care.
Over the course of his research Rogers came to formulate the core conditions of the therapeutic relationship as unconditional positive regard, acceptance, and warmth; empathic understanding, reflected in the capacity to understand the subjective world of the patient; and genuineness or congruence, proposing that these characteristics are essential and often sufficient to bring about growth (Rogers, 1957, 1958a, 1958b). In the client-centered model of psychotherapy, the clinician’s authenticity, attunement, empathic responsiveness, and acceptance of what the individual is experiencing facilitate efforts to explore inner states encompassing the domains of sensation, emotion, thought, and imagery.
Rogers describes the conditions of receptivity that operate in the experiential field and “psychological contact” between the therapist and the patient:
The two people are to some degree in contact... each makes some perceived difference in the experiential field of the other. Probably it is sufficient if each member makes some “subceived” difference, even though the individual may not be consciously aware of this impact... it is almost certain that at some organic level he does sense this difference.
(1957, p. 96)
The clinician follows the patient’s lead in the sessions, focused on the moment by moment flow of sensation, feeling, imagery, and thought, engaging inherent capacities to guide the process of discovery and growth. The patient’s experience of the therapist’s presence and resonance, authenticity, acceptance and unconditional regard, and empathic immersion in experience fosters the process of change and growth.
Rogers assumes that the inherent strength of the actualizing tendency generates experience that leads to growth and fulfillment. The clinician works to clarify and convey understanding of the patient’s experience through reflection of feeling and thought, clarifying the meaning of what has been related. In traditional Rogerian approaches, the clinician moves beyond explicit accounts of experience and explores what the patient is experiencing but not yet able to formulate. In following the classical client-centered approach, however, the therapist remains within the individual’s current range in awareness of experience.
Although the therapeutic process carries the potential to deepen understanding and insight, Rogers rejects interpretive methods and believes that the core conditions of the relationship and the synchrony of interactive experience are the fundamental mechanisms of change and growth, helping patients strengthen capacities for processing the dynamics of inner life, negotiating problems in living, and actualizing the self. As we feel accepted, supported, and understood, Rogers believes, we are increasingly able to challenge defensive patterns of behavior, more fully experience emotion, express feelings, and develop capacities and skills in living through experiential learning.
Over the course of the therapeutic process, we negotiate incongruities between different feelings, thoughts, and actions and generate opportunities to strengthen and expand capacities and skills that foster new ways of being, relating, and living. Although person-centered therapists do not teach skills, they model ways of processing experience and provide occasions for observational learning. Patients work toward change in the processes of living, reflected in greater access to inner experience, acceptance of self, trust in the authority' of subjective experience, values, and purposes; initiative in making decisions and acting on them; and capacities to assume responsibility' for choices. The focus is on the whole person, rather than on symptoms or circumscribed problems, and the fundamental aim of psychotherapy' is to help the individual strengthen capacities for authentic way's of being, relating, and living (for expanded accounts of classical and contemporary' Rogerian approaches see Bohart & Watson, 2020).
According to the principles of the classical Rogerian approach, as we have seen, we assume that the core conditions of the therapeutic relationship and the dynamics of interactive experience cany' the potential to reinstate developmental processes, bringing about change and growth. The clinician takes a non-directive stance, accordingly, starting where the person is, believing that the therapeutic process will engage innate capacities for growth, realization of potential, and individuation of self through critical and creative intelligence (Bohart & Watson, 2020).
In expanding concepts of therapeutic action, practitioners have departed from the non-directive stance of the classical Rogerian approach, introducing
The Humanistic Paradigm 159 active methods of intervention and guidance in efforts to help patients process emotions that perpetuate problems in living. The models of Gendlin and Greenberg and his collaborators exemplify the defining features of the experiential perspective.
Over the course of his collaboration with Rogers, Gendlin created a theory of experiencing that served as the foundation for his method of focusing, an experiential approach that therapists have integrated in their practice across the foundational schools of thought. Although some clinicians think of focusing as a model of therapy, Gendlin describes it as a procedure that strengthens all forms of therapeutic practice (1991, 1996).
He assumes that our efforts to experience, formulate, and process bodily sensations and emotions create meaning, fostering change and growth (Gendlin, 1962, 1964). He conceives of experiencing as a fundamental way of knowing the dynamics of inner life and outer realities, describing it as the immediate, non-verbal sensing of patterns and relationships within the self and in the world. In light of our current understanding of brain structure and function we can think of experiencing as an implicit mode of processing information and knowing mediated largely by the right hemisphere of the brain, engaging “top-down” and “bottom-up” mechanisms of regulation.
Like Rogers, Gendlin believes that meaning generated through the embodied process of experiencing is more complex than the understanding we find through conscious, verbal, conceptual thought. In this sense he distinguishes “cognitive insight” from the experience of “emotional insight,” as psychodynamic thinkers emphasize in their conceptions of the core processes believed to foster change and growth.
When we are fully functioning, Gendlin proposes, we engage the wider range of our faculties, thinking rationally as we draw on our experiential sense of what is meaningful and negotiate problems in living. If the flow of experiencing is disrupted, however, we are unable to process emotion and create meaning. In the absence of capacities to symbolize experience, we rely on fixed perceptions, beliefs, and attitudes—what he calls “frozen wholes”—that take the place of meaning. We are bound by mental structures, he proposes, and “the structures themselves are not modifiable by present occurrences” (1964, p. 129). He explains: “Instead of the many, many implicit meanings of experiencing which must interact with present detail to interpret and react, the individual has a structured feeling pattern” (1964, p. 129).
Gendlin thinks of focusing as a point of entry into a mode of sensing, and the aim of the procedure is to reinstate the process of experiencing. He emphasizes that practitioners must not engage “mental structures” but restore capacities for “functioning experience” (1964, p. 132). The therapist helps the individual attend to the “direct referents” or “felt sense” of concerns and explore their implicit meanings, modeling ways of processing subjective experience. In his account of the process he reflects: “Most people require certain special instructions to let a felt sense come. One has to place one’s attention into the center of one’s body, and sense what comes there in relation to some problem, situation, or aspect of life” (1991, p. 271). The “explication of felt meaning” symbolizes the experience in words, images, or gestures. The process seeks to bring about a “felt shift” that sponsors a fresh unfolding of meaning, releasing one from “frozen wholes,” facilitating efforts to formulate experience and negotiate problems in functioning (for review of the structure and techniques of the procedure see Gendlin, 1996).
Gendlin centers our attention on the dynamics of bodily sensation, emotion, and meaning, strengthening experiential formulations of therapeutic action across the foundational schools of thought. He emphasizes the importance of exploring tacit information carried in bodily felt experience and the ways in which symbolization and expression of emotion fosters growth, well-being, and adaptive functioning.
Emotion-Focused Therapy: Greenberg
Greenberg observes that modern therapeutic approaches have privileged conscious understanding and cognitive and behavioral forms of change, failing to consider the domain of emotion. Drawing on recent developments in affective neuroscience and interpersonal neurobiology', Greenberg and his colleagues have expanded concepts of therapeutic action in the humanistic paradigm, continuing to elaborate what they describe as an integrative, experiential, process-oriented approach. In developing the model, they emphasize the central importance of the awareness, acceptance, and understanding of emotion; the visceral experience of emotion and bodily sensation in the therapeutic process; and the creation of meaning in change and growth (Greenberg, 2016).
Greenberg understands basic emotions—fear, anger, sadness, and disgust— as core constituents in the construction of complex frameworks that orient us to our environments. In his view, emotions are “purposive,” shaping our motivations, perceptions, thoughts, and actions, playing a fundamental role in goal-directed behavior. He explains:
Emotion sets a basic mode of processing in action. Fear sets in motion a fear processing mechanism that searches for danger, sadness informs us of loss, and anger informs us of violation. Emotions are also our primary system of communication... emotions determine much of who we are...
(2016, p. 5)
He assumes that our capacities to process subjective experience and to recognize emotion as a mode of learning and knowing are fundamental in adaptive functioning, health, and well-being. Emotional competence or “emotional literacy” involves access to inner experience; the ability to regulate and transform maladaptive emotion; and the development of narratives that affirm sense of self and identity. He traces the origins of problems in living to four fundamental causes: lack of awareness, avoidance, or disavowal of emotion; dysregulation of emotion; maladaptive emotional responses; or difficulties in processing emotion and creating meaning that fosters coping, adaptation, and realization of potential. He emphasizes the role of emotion in change and growth, accordingly, believing that a range of problems in living originate in our failures to explore and engage the dynamics of inner life.
Greenberg distinguishes methods of therapeutic action that engage the executive functions of the left hemisphere, emphasized in cognitive and cognitive-behavioral models of intervention focused on conscious control of feelings, from experiential approaches believed to engage the mechanisms of the right hemisphere, instrumental in the regulation of unconscious, bodily based emotion. In following the process-oriented approach that he and his colleagues have developed, we do not attempt to help patients “change the way they feel by changing the way they think,” but rather seek to help them embody, tolerate, and accept what they are feeling as they process experience, engaging the regulator}' functions of the right hemisphere (Greenberg, 2007, p. 415). In accordance with developments in interpersonal neurobiology, reviewed in Chapter 2, Greenberg acknowledges that the “building up of implicit or automatic emotion regulation capacities” is a prerequisite of enduring change (Greenberg, 2007, pp. 415-416).
He recognizes the crucial functions of the clinician’s presence, acceptance, attunement, and empathy; the establishment of a collaborative alliance; exploration of emotional experience, the origins and dynamics of feelings, and defensive processes; encouragement to accept emotions for the knowledge and understanding they provide; and the symbolization of emotion that underlies the creation of new meaning, narratives, and life stories (Greenberg, 2016).
The clinician and the patient attend to moment-by-moment experiencing as they explore concerns, focusing on the “felt sense” of sensations and feelings, searching for emotional, cognitive, or behavioral “markers” that serve as the focus of intervention. The clinician guides the therapeutic process at points, selecting different methods in light of particular patterns of feeling, thought, or behavior (for a description of therapeutic tasks and techniques see Greenberg, 2016).
Greenberg outlines six principles of emotion processing, centering on 1) awareness of emotion and formulating what we sense or feel; 2) expression of emotion; 3) regulation of emotion; 4) reflection on experience; 5) transformation of emotion through emotion; and 6) “corrective experience of emotion” through in-vivo experiences in therapy and the outer world. The patient and therapist collaborate in efforts to symbolize the “bodily felt referents” of inner life, creating new meaning that shapes narrative accounts and life stories. The therapeutic process deepens awareness of emotion, creating meanings that strengthen the sense of self, guiding thinking and behavior (Greenberg, 2016).
Although humanistic thinkers have drawn on a range of intellectual traditions in developing therapeutic approaches, they share orienting perspectives, basic assumptions, and essential concerns that shape understanding and practice.
Conceptions of motivation, development, and personality emphasize inherent capacities for growth and self-actualization. By virtue of being human, presumably, we are predisposed to generate enriching experience as we develop our potentialities, actualize the self, and fulfill our desire to live. Thinkers embrace a teleological perspective, emphasizing the formative influence of our anticipated sense of the future rather than the events of the past in shaping the course of development.
In accord with the above perspectives, practitioners reject objectivist conceptions of truth and embrace phenomenological approaches, proposing that the only sense of reality we can know comes through the authority of our experience. We create meaning and construct models of the world. As we see in constructivist versions of cognitive and psychodynamic therapy, clinicians assume that what we regard as “truth” is unique to the individual, carried in the coherence and meaning of particular accounts of experience and courses of action.
As in the psychodynamic paradigm, practitioners view the therapeutic relationship and intersubjective communication as crucial sources of experiencing, learning, and growth. Patients and therapists co-create conditions that foster the process of exploration and discovery', strengthening capacities for awareness and engaging the authority of self as they process their experience of inner life encompassing the domains of sensation, emotion, thought, and imagery. Rogers came to think of the relationship as the fundamental dynamic of change and growth, proposing that the conditions of empathy, unconditional regard, and authenticity are sufficient to release the self-actualizing tendency.
Although experiential practitioners recognize the healing functions of the therapeutic relationship, they depart from the non-directive stance of Rogers and employ a range of methods drawn from psychodynamic, cognitive, and behavioral schools of thought. Client-centered and experiential therapists increasingly recognize the role of emotion in change and growth following developments in affective neuroscience and interpersonal neurobiology'.
Clinicians assume that the dynamics of interaction foster the construction of new meaning and understanding as patients explore the bodily' felt referents to problems in living and symbolize subjective experience through language. In accord with Dewey’s pragmatic thought, concepts of therapeutic action recognize the functions of learning through experience that strengthens the sense of self and coping capacities (see Bohart & Watson, 2020, and Greenberg & Rice, 1997, for expanded accounts of experiential approaches).
There is a long tradition of empirical study in the humanistic paradigm, dating back to Rogers’ pioneering studies in the 1950s. Clinical researchers have continued to document the efficacy' and effectiveness of person-centered and experiential approaches. Although a review of the empirical literature is beyond the scope of this chapter, clinical scholars provide carefi.il accounts of process and outcome research (for review of empirical studies and meta-ana-lyses see Bohart & Watson, 2020; Elliott, Bohart, Watson & Murphy, 2018).
Neuroscience and Therapeutic Action
As in the psychodynamic tradition and constructivist versions of the cognitive paradigm, thinkers emphasize the crucial functions of the therapeutic relationship, open-ended dialogue, and interactive experience. In the field of interpersonal neurobiology, as discussed, clinical scholars have proposed that the presence of the practitioner and the patient’s experience of synchrony, acceptance, support, and understanding in the therapeutic relationship facilitate the expression of emotion, helping one relinquish defensive patterns of behavior and rigid perceptions of self and others, exploring aspects of experience that have been distorted, denied, or dissociated (Cozolino, 2017).
In accord with Schore’s formulations of right brain functions and therapeutic action, Rogers, Gendlin, and Greenberg emphasize the crucial importance of intersubjective communication and synchrony in regulating emotion and states of self, emphasizing the non-verbal elements of language—intonation, inflection, tone, pitch, force, and rhythm—as well as body movement, posture, gesture, and facial expression.
In Greenberg’s conceptions of “therapeutic presence” the clinician is “fully in the moment on a multitude of levels, physically, emotionally, cognitively, spiritually, and relationally. The experience of therapeutic presence,” he explains, involves “(a) being in contact with one’s integrated and healthy self,” while “(b) being open and receptive, to what is poignant in the moment and immersed in it,” and “(c) with a larger sense of spaciousness and expansion of awareness and perception. This grounded, immersed, and expanded awareness occurs with the intention of being with and for the client, in service of his or her healing processes” (Greenberg, 2014, p. 353). At the most fundamental level, as Schore observes, the intersubjective process of therapy is determined not by what the clinician says or does; the key mechanism of change and growth, mediated by the functions of the right hemisphere, is “how to be with the patient” (Schore, 2019, p. 198).
Presumably, the patient comes to experience a wider range of emotion over the course of the therapeutic process, making feelings more available for reorganization, fostering integration of neural networks. The non-directive methods of the person-centered approach potentially help individuals engage executive functions and reflective capacities. The clinician’s empathic reflection and validation of the patient’s communications and exploration of concerns strengthens capacities to formulate and integrate experience.
As discussed in Chapter 3, conditions of mild to moderate arousal are thought to activate the production of neurotransmitters and neural growth hormones that govern the mechanisms of long-term potentiation, learning, and cortical reorganization. Clinicians who adopt a more active, directive approach, following the experiential approaches of Gendlin and Greenberg, potentially intensify emotion as they explore the dynamics of inner life and interactive experience, bringing challenge that carries implications for change. In focusing on features of inner life or outer experience that patients have failed to recognize or avoided out of fear or restrictions of opportunity, clinicians encourage the individual to experience, process, and express a wider range of feelings
From the perspective of neuroscience, we assume that experiential approaches carry the potential to foster integration of neural structures and functions across the domains of sensation, emotion, imagery', cognition, and behavior. The therapeutic process engages the verbal, analytic processes of the left hemisphere as the patient and therapist render experience into words and elaborate accounts of concerns, activating the mechanisms of “top-down” integration. As David Wallin explains: “Asking our patients to label what they feel in their bodies enlists cortical capacities in the processing of painful subcortical (i.e., soma tic/affective) experience” (2007, p. 81).
Somatic approaches, engaging the breath, movement, or meditation, activate “bottom-up” forms of integration focused on the interoceptive experience of the body, engaging subcortical structures and the mechanisms of the right hemisphere, strengthening capacities for emotional regulation and coping. Growing awareness of bodily experience and processing of inner life strengthen the ability' to tolerate painful states that have been managed through dissociation or other defensive processes.
The dynamics of narration engage the core structures of the brain, as noted above, synthesizing our experience of sensation, emotion, imagery, thought, and memory' as we elaborate accounts of experience, fostering integration of neural networks throughout the cortical and subcortical regions. Although the person-centered approach does not emphasize concepts of narrative in classical formulations of therapeutic action, Rogers recognized the crucial role of language and meaning in change and growth. Clinical scholars in the experiential tradition have increasingly' focused on narrative process and the way's in which the patient and therapist co-create accounts of self, life experience, and anticipated future (see for example Greenberg, 2016).
As we have seen, a range of intellectual traditions have shaped understanding and practice in the humanistic paradigm, encompassing phenomenological, existential, psychoanalytic, constructivist, and experiential perspectives. More recent formulations of therapeutic action have drawn on the fields of affective neuroscience and interpersonal neurobiology', emphasizing the dynamics of the therapeutic relationship, emotion, meaning, and experiential learning thought to bring about change and growth.
Clinical scholars continue to engage essential concerns that converge with the pragmatic thought of James and Dewey' and the principles and values of clinical pragmatism, emphasizing the individuality and subjectivity of the person; notions of agency, intention, and will; exercise of freedom and choice; the crucial role of the therapeutic relationship, collaboration, and dialogue; cocreation of narrative and meaning; experiential learning; and inherent capacities for change, growth, and realization of potential in the individuation of the self. The focus is on the whole person, as human subject first and last—“the experiencing, active, living T” (Sacks, 1984, p. 177).
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