Mindfulness and acceptance in person-centred and experiential psychotherapy1 Karin Bundschuh-Müller If there is something bad, sick, or unsound, let it inwardly be and breathe. That is the only way it can evolve and change into the form it needs.
Eugene Gendlin Abstract:Mindfulness and acceptance are key terms within person-centred experiential psychotherapy and focusing. Here, this subject is looked at from three different angles: How does the therapist in person-centred experiential psychotherapy succeed in being mindful and accepting (the aspect of therapist variables)? How can the therapist facilitate the client to be more mindful and accepting towards him- or herself (the aspect of the client variable)? How can the client learn to develop a mindful and accepting attitude towards him- or herself (the aspect of self-help through focusing)? The therapist core variables (unconditional positive regard, empathy and congruence) are presented, with an emphasis on unconditional positive regard. Presence, a variable which has been discussed since the eighties, is understood and described as a basis variable. Eugene Gendlin generated a re-orientation within person-centred psychotherapy. The attention of the therapist does not focus so much on the person expressing feelings and opinions. Instead, what is sensed on a bodily level, even if it is still vague, is put in the centre of attention and is considered as the origin of change processes. This makes it possible for the therapist to intervene in a more accurate way by referring to the felt sense. Such a reference to the bodily sensed inner experiencing in the present moment, even if not very clear yet, leads to a decisive change in the concept of person-centred psychotherapy: the “dys-identification” or the development of a constructive inner relationship. In focusing, which enables clients to apply the core variables of PEPT towards themselves and to initiate a constructive inner process of experiencing and changing by themselves, these changes are summarised in a condensed form. With regard to the issue of “mindfulness and acceptance within the person-centred concept”, the author refers to statements by Rogers himself, but also by Gendlin and more recent authors like Greenberg, Hendrix, Iberg and Moore. A comparison between PEPT and Buddhism is made according to the example of the Japanese person-centred psychotherapist Kuno. In this discussion, differences and commonalities of the two concepts are compared. The author goes deeper into the theory of Thich Nhat Hanh and Kabat-Zinn, and compares these with statements made by Rogers and Gendlin.
Person-centred psychotherapy (better known as client-centred psychotherapy) was initiated by Carl Rogers (1902-1987) in the forties of the last century. It emerged at about the same time as behavioural therapy and it is the most important representative of the Humanistic Psychotherapies. Its basis is a view of human beings which emphasises the capacity for self-development as well as the freedom of decision and self-responsibility. Different from e.g. behavioural therapy, person-centred psychotherapy puts the relationship between the therapist and the client at the centre. It considers certain fundamental attitudes and ways of behaving with which the therapist meets, or rather encounters, the client, to be a healing force which generates change. In this way, she creates a healing atmosphere.
Like other therapeutic schools, person-centred psychotherapy has undergone fundamental changes over the past few years; specifically through Eugene Gendlin, who, complimentary to Rogers, explored the question what clients must do in order to ensure a positive therapy outcome. Based on his research, he focuses on the body and on bodily experiencing in the present moment as a main authority of human change. “Experiencing” the way it is sensed in the present is the quality which is prompted in the client, and thus what the therapist must refer to. Nowadays, this view is shared by many therapists. Apart from this, Gendlin developed a method which helps clients to learn systematically how to behave in therapy in order to achieve a positive therapy outcome. This method he called focusing. More recent theoreticians like for example Leslie Greenberg and Robert Elliott (process-oriented and emotion-focused experiential psychotherapy) combine the basic attitudes of person-centred psychotherapy with elements from focusing and gestalt-therapy.
In the following article, I shall look at the topic of mindfulness and acceptance in person-centred psychotherapy from three angles:
In which way can the therapist in person-centred psychotherapy be mindful and accepting (aspect of therapist variables)?
How can the therapist facilitate the client to be more mindful and accepting towards him- or herself (aspect of client variable)?
How can the client learn to be mindful and accepting towards him- or herself (aspect of self-help)?
I would like to start by pointing out that it is undisputed that also in the western linguistic, therapeutic and philosophical sphere (Europe, USA), the terms “mindfulness” – meaning taking care, being careful, paying attention, being alert – and “acceptance” have an important function as well as their own value and their own tradition. In person-centred psychotherapy, they even are fundamental. As will have to be demonstrated, the meaning of these terms differs little from their definition in the Eastern cultural sphere. Jon Kabat-Zinn, for example, defines mindfulness as a special form of directing attention: Conscious and intentional attention is given to experiencing in the present and in a non-judgemental way. (Heidenreich & Michalak, 2003; Kabat-Zinn, 2003).
Mindfulness and acceptance in the behaviour of therapists The classical therapist variables In person-centred psychotherapy, which was developed by Carl R. Rogers, the client and the therapist do not concentrate their common efforts on how to apply methods or on training modules. Instead, the experiencing and the experiences of the person are in the focus of their shared attention. Rogers developed central criteria for therapist behaviour which generates a process of constructive change in the client. These attitudes and relationship offers in person-centred psychotherapy are considered as necessary and sufficient conditions for constructive processes of change – not only for persons with mental illnesses, but for all sorts of clients. Rogers view always was in principle a positive and optimistic one. And thus he was profoundly convinced that certain attitudes offered by the therapist, the so-called “core variables of personal encounter”, generate a process of growth in a person in the direction of a higher level of integrity and of health. In each person, there is a power which facilitates healing and further development. Rogers called this development-oriented characteristic the “self-actualising tendency”.
Nowadays, the basic variables for effective therapeutic behaviour which he formulated and which have often been tested on an empirical level are considered to be essential features of a helping relationship and generally of constructive human relationships. They are the basic attitudes: unconditional positive regard, empathy and congruence (authenticity).
Unconditional Positive Regard Unconditional positive regard describes the attitude which a client-centred psychotherapist offers towards a client. Rogers has repeatedly described the attitude of unconditional positive regard:
“The kind of acceptance (sympathising, caring) which I am speaking of here is most helpful when it is not possessive, not a judgmental way of sympathising, but when it is rather similar to the kind of care parents experience towards their child. Even if children behave badly in the eyes of their parents, they respect the child, consider him to be a valuable person, love him and take care of him independent from a certain way of behaving.” (Rogers, 1992, p. 25)2 Here I would like to point at an essential differentiation which is easily forgotten when using the terms which have become customary in the German language area. In the original American version, it is called „unconditional positive regard“,meaning that this is a non-judgemental positive attention or care which is not subjected to any conditions. The German expression is „unbedingte positive Wertschätzung“ (which the author of this article is using in the German version). This, however, contains a judgement: “Schätzen” means that the person is appreciated. Such an attitude is also healing, but in all more limited. Whoever is “appreciated” runs the risk of losing this appreciation again or may have the impression that he or she has to earn it. For a therapist it is too much, if she has to appreciate a client all the time. My attention can, however, be positive and not connected with conditions. This is an attitude which I can control and offer myself. The person I am working with can be treated with respect and acceptance by me, but whether I appreciate him or her, I cannot guarantee. To demand this from myself would sometimes collide with my authenticity.
Nevertheless, positive regard and attention are experienced as appreciative. “Regard” and “attention” give birth to a shared space which is experienced as positive and which disappears again when the “regard” stops, when the person “turns away”. Cameron (2001) has pointed out that when the therapist “turns away” or when the attention wanes, sometimes the client experiences this as an emotional injury.
Empathic listening Empathy/empathic listening is defined as feeling the inner world of the other person. “It is an experience of taking part in the emotional state of the other person in an immediate way and of thus becoming able to understand it. At the same time, in spite of this taking part, the other person’s emotional way of being still clearly belongs to him or her” (Binder & Binder, 2003, pp. 82). In the German speaking area, this variable is also called „Spiegeln” („mirroring“), „Reflektieren” („reflecting”) or „aktives Zuhören” (“active listening”). In my training, this was still called „Verbalisierung emotionaler Erlebensinhalte” (“verbalisation of the emotional content of experience”). Empathy implies mindfulness, care, and acceptance. In order to be able to enter the world of another person in a healing way, the therapist needs to adopt an attitude of friendly, appreciative and respectful mindfulness, of “being with ” the client. This is very well exemplified by the skills of the figure of Momo, a character from a novel by Michael Ende:
“Only very few people are able to really listen. And the way in which Momo knew how to listen was utterly unique. Momo was able to listen in such a way that not so clever people suddenly had very clever thoughts. Not because she said or asked anything that evoked such thoughts in the other person. No, she would just sit there and listen, with all possible mindfulness and sympathy. At the same time, she would look at the other person with her big, dark eyes, and he or she would feel how all of a sudden thoughts began to emerge which he or she never suspected to exist in him- or herself.” (Ende, 1973, p. 15)3 Rud (2003) calls this capacity of empathic listening a contemplative state which leads to transformation.
Congruence For the core variable “congruence“ Rogers also used the term “genuineness”. The person is in tune with his or her way of being. When his or her own experiences are symbolised accurately and are integrated into the self-concept, the self and the organismic experience become congruent. The more congruence is present in the different areas of a person’s experiencing, he or she will start acting in a more mature and self-responsible way, and his or her perception will be more differentiated and more open, or also less defensive against his or her own experience. In the context of the necessary and sufficient conditions for personality changes, Rogers (1991) demanded that the psychotherapist, apart from conveying empathy and unconditional positive regard, also be genuine in the relationship. Later, Rogers called this the most fundamental therapeutic attitude. Congruence lends empathy personal colour and depth, and congruence/genuineness functions as a “barometer of interaction” for what is happening in the here and now of the relationship between client and therapist (Lietaer, 2003, pp. 79).
The core variables merge into a holistic basic attitude in which, in different situations, different aspects come to the fore to a larger or lesser extent. Congruent behaviour helps the therapist to be a real person. Then a symmetrical relationship can develop between the client and the therapist. The therapist is transparent in a particular way and does not act like an inscrutable expert. The quality of unconditional positive regard conveys a deep involvement of the therapist with the client as a person. By means of empathic listening, the therapist tunes in with the client as a person and endeavours to see the world with the client’s eyes. By really trying to understand that world and to make it more understandable to the client, she creates a climate of constructive steps of change. Empathic understanding, empathising with the client and his individual world enables the therapist to convey her attitude of positive regard to him. (Wiltschko, 1992).
Mindfulness and acceptance as implicit aspects of the core variable „unconditional positive regard“ In particular the attitude of “unconditional positive regard” can be seen as an immediate equivalent of mindfulness and acceptance. With regard to this variable, Biermann-Ratjen (2003, p. 333) explains that it is not a technique of the therapist and even less only a part of the method of client-centred psychotherapy. She states that it is an essential element of the interpersonal relationship which is a necessary and sufficient condition for self-development. The need of a person for unconditional positive regard begins at about the same time in life when a child starts to develop his or her awareness of self (Iberg, 2001). This attitude of unconditional positive regard cannot be forced or be turned on and off automatically; it develops in way of process. It can grow in the course of the therapeutic relationship and assume different dimensions. It is regulated by the therapist’s congruence.
The meaning of unconditional positive regard lies in its power to develop unconditional positive self-regard or to repair any damaged self-value within the person who receives it. According to Rogers’ notion of self-concept, the unconditional positive regard which a person receives from another exerts more influence on his or her developmental process than when this person experiences inner congruence and authenticity.
However, the unconditional character of the positive regard towards that person must be very inclusive (Wilkins, in Iberg 2001). It must accept all elements of the client’s experiencing and feeling, even including that element or those elements which do not want to change (Iberg, 2001, p. 114). Bozarth considers unconditional positive regard to be the “curative factor” in (person-centred) theory.
Rogers’ theory of pathology emphasizes UPR’s capacity to restore the even more basic actualizing tendency inherent in the client (Bozarth in Iberg, S. 114 – emphasises the capacity for unconditional positive regard to even restore or repair an inhibited or damaged actualising tendency (Bozarth, 2001).
Even if clients do not always act in a constructive way, we can still assume that this reliable phenomenon which makes clients act in a constructive way happens in a context (or as a result of) a relationship that provides unconditional positive regard and empathy (Iberg, 2001, p. 114).
Unconditional positive regard and its closeness to and its relationship with Zen-Buddhism The fact that the attitude of unconditional positive regard is close to and related with the attitude of the mindfulness which Eastern tradition displays is underlined by the estimation of Japanese client-centred psychotherapists of Buddhist orientation. In the Japanese school of person-centred psychotherapy since its introduction in Japan, a special focus is put on the quality of unconditional positive regard (Kuno, 2001). Kuno, who represents the stance of Buddhism-based psychotherapy, recognises in Rogers’ unconditional positive regard the core of Buddhism. However, unconditional positive regard is also equivalent with the Christian concept of love (Murase & Hosako, 1990, quoted by Kuno, 2001). Kuno interprets the different elements of unconditional positive regard from the Buddhist perspective:
„Unconditional“ means that a person is accepted exactly the way he or she is, independent from whether he or she expresses „bad“, painful, anxious or abnormal feelings or a “good“, positive, adult and trusting way of experiencing. To approach another person in an unconditional way of being also means that the therapist herself must learn to accept her own negative feelings in the same way as she accepts her positive feelings.
Buddha’s teachings show that everyone can reach this state of mind, if he or she can fully understand the „Four Noble Truths“, which Buddha wrote down after he reached inspiration.
The Four Noble Truths:
the Truth that there is sadness and distress
the Truth that there is a reason for sadness and distress
the Truth that there is an end to suffering
the Truth that there is a way to end suffering
In order to obtain a better understanding of the third truth, Kuno quotes Brazier’s (1995) interpretation of the second Truth which is based on the following logic: If one does not suppress or unnecessarily enhance the emotions which come with suffering, these emotions will gradually disappear without leaving a trace. However, normally we endeavour to escape our suffering, the final result of which is that we aggravate it. Buddha also teaches us to face our suffering with calmness, to exercise self-control and to make efforts to choose the right way in daily life.
Apart from „unconditionality“, Kuno also describes, as a second element, the core variable of “positive regard” from a Buddhist perspective: Rogers described positive regard as “a caring for the client, but not in a possessive way or in such a way as simply to satisfy the therapist’s own needs. It means a caring for the client as a separate person, with permission to have its own feelings, his own experiences”. (Rogers, 1957) According to Kuno, Rogers’ notion of positive regard corresponds with the teachings of Mahayana-Buddhism in that sense that priority should be given to saving others before saving one’s own soul. Kuno says that many Japanese, from the perspective of Mahayana-Buddhism, understand the variable “unconditional positive regard” in a natural way. In person-centred therapy, the feelings, the experiencing and the experiences of the client have priority over the feelings and experiences of the therapist. The therapist encounters the client with a behaviour which corresponds with the „Four Means of Embracement“, which are „to give“, „mild words“, „philanthropic deeds“ and „connection with others“ (Kuno, 2001).
Also in the western sphere, some authors point at the parallels between the variable „unconditional positive regard“ and Buddhist practice. The English author Judy Moore, who in her work combines client-centred psychotherapy with Soto-Zen-Buddhism, emphasises in her article „Acceptance of the Truth of the Present Moment as a Trustworthy Foundation of Unconditional Positive Regard“ the deep need for acceptance of the truth/truthfulness of inner experiencing. According to her, this is of existential significance for human growth. Moore designates this attitude of unconditional positive regard an exceptional letting go, an inner softening/melting, a way of forgetting or losing the Self. If it is understood in this way, unconditional positive regard is a core variable. It makes it possible for a special inner attitude of acceptance and letting things happen to develop also within the client.
Extensive case studies can be found in the writings of Iberg (2001), Moore (2001) and Sikkema (2002). They show how the variable of unconditional positive regard can be applied in difficult therapeutic situations and can generate a significant change within the client. They substantiate how in therapeutic situations where a client cannot be reached anymore by means of words, staying with the client, simply being there with her, can carry the therapeutic process forward. To simply experience being seen, being held and being carried by another human being is healing. When the therapist is “with” the client while maintaining a certain attitude and, together with the client, „listens to her inner experiencing“, inner transformation processes can take place.
Unconditional positive regard as a joy about the truthfulness of the other person Iberg (2001) quotes Thomas of Aquinus, who in the 12th century wrote about beauty: „Beauty pleases us upon being seen“. Iberg (2001) distinguishes between beauty which gives us joy and beauty which we admire. The joy of experiencing beauty only implies seeing the object – a kind of joy which is not possessive or controlling. Joy about beauty is without an agenda. It does not want to possess, to own, to consume or to control. We are happy observing the object, looking at it. This attitude resonates in Carl Rogers’ work and in the work of many others, when they describe the attitude of a person who offers unconditional positive regard to another person. Santorelli (1999, quoted by Iberg, 2001, p. 124) adds another specific aspect: „When we stay closely and non-judgementally with someone exploring pain, we find beauty in the midst of the ‘ruins’.” It is touching to be present, when a person confronts him or herself with their problems in a truthful and genuine way. It is the truthfulness, which “opens the heart” of the other person present and which evokes feelings of appreciation and respect in him or her.
The description of the three core variables – in particular the variable of unconditional positive regard – makes it clear that mindfulness and acceptance are indispensable implicit features and basics of person-oriented experiential therapy.
Presence When he was already at the end of his life and also under the influence of his intensive discussions with Eugene Gendlin, who was his assistant and had done a lot of research, Rogers put up hypotheses about a further significant variable which he called „presence“. This additional feature is one that exists in the area of the mysticism and spiritualism (Rogers, 1979; 1980; 1986). He describes in “A Way of Being” (1980) what happens in a helping relationship, when he is very close to his “inner intuitive self”:
“... When I am somehow in touch with the unknown in me, when I am perhaps in a slightly altered state of consciousness, then whatever I do seems to be full of healing. Then, simply my presence is releasing and helpful to the other. There is nothing I can do to force this experience, but when I can relax and be close to the transcendental core of me, … it seems that my inner spirit has reached out and touched the inner spirit of the other. Our relationship transcends itself and becomes a part of something larger. Profound growth and healing and energy are present.” (Rogers, 1980, p. 129)
Rogers did not elaborate on an understanding of presence. He was just in the course of developing this, when he died. In an interview with Baldwin (which was published in the year 2000), Rogers reflected on a possible essential nature or presence: „I am inclined to think that, in my writing, I have stressed too much the three basic conditions (congruence, unconditional positive regard, and empathic understanding). Perhaps it is something around the edges of those conditions that is really the most important element of therapy – when my self is very clearly, obviously present.” However, we shall see that this attitude also reflects itself in the experiential approaches and in focusing.
The „characteristic of presence” has been considered from different perspectives by client-centred authors. Thorne (1992) considers it to be a possible fourth condition of a comparable quality as the three other conditions; Mearns (1994, 1997) sees it as a mixture of the relationship conditions; Moore (2001) again describes it as a deepened form of unconditional positive regard and a “blending together“ of all variables into one single inner movement. Geller und Greenberg (2002), however, discuss this variable under the premise of a fundament for the three basic conditions.