I am not sure what to say about the readings this week. If I were to carry Rogers in my thoughts like Ginsberg calling out to Whitman, would I be inspired to see therapists among the avocados? Let's hope not. But Carl Rogers and his legacy are surely pointing to a path for researchers and clinicians to follow into the future.
Like the words of Whitman (this is my last poetry reference, I swear!), the work of Rogers is still alive. Of course, any PsycINFO search could tell you that! Indeed, it is the status of an appproach that is most important! Sure, empirical validation is important, lest it get in the way of status... Even so, Kirschenbaum and Jourdan (2005) do report on some of this pesky validation research.
Before I comment on this, let's take a step back. It is important to remember that these studies are validating a hypothesis (that is, that the "core conditions" inevitably lead to change as long as the client perceives them to some minimal degree) - not some holy truth.
Back to the research...
Studies reporting on the importance of empathy suggest that it is the patient's perception of the therapist's empathy that is important, not necessarily empathy itself (Barrett-Lennard, 1962; P.J. Martin & Sterne, 1976 as cited in Kirschenbaum & Jourdan, 2005). Indeed, Rogers hypothesized that it was that the client perceives the therapist's empathy, unconditional positive regard, and congruence - not that the therapist can perceive it, or some third-party observer. The authors make two points here: 1) that therapist or observer ratings of empathy, then, are not true tests of Roger's hypothesis and 2) empathy by itself is not sufficient in and of itself, but must be combined with the other two core conditions. However, what the authors fail to address is the idea that what the client may be perceiving as empathy may not actually be empathy! Thus, while using only outside observer ratings may "fall short" of testing Roger's hypothesis, so too do those using only client ratings. Even if the client is perceiving the therapist as empathic, if we cannot determine what it is that the therapist is actually doing (or not doing), we are no better off.
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One of the things that creeps me out about this research is that client ratings of their therapist are likely to be biased in all kinds of ways. It is interesting that they correlate with outcomes, but I'm not convinced of the often assumed causal direction: that change (and satisfaction) follows the perception of empathy. What if the causal arrow points the other way, or if it's bi-directional? Mountains of research on self-esteem now show that it mostly follows good behavior, not that it precedes it. I wonder if many of these sorts of alliance measures suffer from the same problem.
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