By Elizabeth Dickson, LCSW
Unconditional Love and the Structure of Psychotherapy
Why do we say that therapy is “all about love?” What about the therapy process generates feelings of love? We begin by looking at the structure of psychotherapy and how the role that the therapist is taking on, if successfully executed, is about as close to a definition of unconditional love as could be imagined. Of course this unconditional love is delivered within very well defined boundaries, taking place within one hour, requiring the therapist to maintain a professional role, and requiring payment by the client. But, in fact, these boundaries are an essential part of what makes it possible for therapists to provide unconditional love. Psychotherapy is an ideal incubator for unconditional love.
The therapist begins with a noble goal, which is ultimately to create a relationship with the client that is healing and will foster the client’s personal growth. And we as therapists are very much assisted in this endeavor by our appreciation of the client’s humanity as well as our recognition of the courage that is required by the client to undertake therapy in the first place. They are choosing you as a guide, as imperfect as you are, and you want to honor their position, protect them, and be worthy of the honor they have bestowed upon you.
There is something sacred about the vulnerability of the client’s position. They are asking for help; they have hit a wall in their efforts to address their problems and must be willing to acknowledge, to some extent, the limitations of their power to do it on their own. It is helpful when the therapist has been in therapy themselves and can convey, over time, that they too have hit walls in their lives and that vulnerability is a shared experience, not something that is just attributed to the client.
The Three Dimensions of a Helping Relationship
There is nothing new about seeing the role of the psychotherapist as meeting the requirements for unconditional love. The problem is that the topic is not explored further. What we do discuss at length, however, are the qualities that characterize a good psychotherapy relationship. Any examination of love in psychotherapy would benefit by looking first at the basic foundation, including the discipline and therapeutic attitudes that are associated with a safe and effective relationship.
To do this I turn to psychologist Carl Rogers, whose writings and lectures in the 1940’s, 50’s and 60’s capture the essence of the ideal helping relationship more succinctly than anything written since. In identifying the three key components of a helping relationship, Rogers has given us a type of formula or mantra that is deeply ingrained in the way most therapists today approach their work, whether we remember it consciously or not:
“Thus, the relationship which I have found helpful is characterized by a sort of
transparency on my part, in which my real feelings are evident; by an acceptance
of this other person as a separate person with value in his own right; and by a
deep empathic understanding which enables me to see his private world through
Carl Rogers from On Becoming a Person
Unlike some other psychotherapy traditions that focus more on the power of the therapist’s interpretations, Rogers believed that, in the safety of the right relationship, “the other person will discover within himself the capacity to use that relationship for growth and change and personal development will occur.” Research results support Rogers’ conclusions; the vast research in our field increasingly confirms the view that, aside from inherent client strengths, the quality of the psychotherapy relationship is the most powerful factor in predicting successful therapy outcomes, much more so than any technique or the orientation or education of the therapist.
Rogers did not use the word “love” to describe his approach, but his three components, when combined, could be said to describe the essence of unconditional love in psychotherapy. And over time more and more therapists have come around to his way of thinking. In an extensive poll of more than 2,500 psychotherapists undertaken by Psychotherapy Networker magazine in 2007, psychotherapists were asked, “Over the last 25 years, which figures have most influenced your practice?” The figure with the most votes was Carl Rogers. (Interestingly, Freud did not make the list of the top ten.)
While there is a great advantage in being left with Rogers’ three key concepts, it is unfortunate that many of us remember only certain words or phrases, typically “acceptance,” “empathic understanding,” “transparency” and “congruence”. As helpful as they are as touchstones or markers, over the years they have lost some of their original meaning and power to inspire. So I will include here a somewhat broader summary of Rogers’ concepts in the hopes of capturing more of the passion that he intended that they convey.
Revisiting Acceptance and Empathic Understanding
In using the word “acceptance,” Rogers is not referring simply to an intellectual attitude of acceptance, but to something that carries genuine feelings of warmth and respect. He describes a therapist’s acceptance of the client as “a warm regard for him as a person with unconditional self-worth—of value no matter what his condition, his behavior, or his feelings. It means a respect and liking for him as a separate person, a willingness for him to possess his own feelings in his own way.” He emphasizes that “the safety of being liked and prized as a person seems a highly important element in a a helping relationship.” Acceptance is not a resigned stance but more of an active liking and, in fact, a “prizing.” Who would not want to feel prized by their therapist, and for being just the way they are?
Rogers explains that “acceptance does not mean much until it involves understanding.” He describes a “deep empathic understanding which enables me to see his private world through his eyes.” But this is not just about “seeing.” Rogers is suggesting that the therapist resonate in a visceral way with the client’s inner experience. Empathic understanding is not something that therapists should keep to themselves; it is necessary for the client to witness the therapist’s understanding.
Rogers found that just behaving in a consistently accepting or empathic way could be counter-productive if he was actually feeling something quite different but was afraid to show it. Attempting to be consistently accepting if his feelings were not genuine would ultimately be perceived as “inconsistent or untrustworthy.” So he concluded that the attitudes of acceptance and empathic understanding must be balanced with the need to be real. Ideally everything in our expressions and body language should line up with what we are saying. Yet how do we as therapists risk exposing feelings or attitudes to a client that we might not approve of or accept in ourselves or that we fear might pose a risk to the psychotherapy relationship?
Rogers believed that if he could be conscious of his own feelings, and really accept those feelings, then there was an excellent chance that his relationship with the client would be helpful. Yet he adds that “acceptantly to be what I am, in this sense, and to permit this to show through to the other person, is the most difficult task I know and one I never fully achieve.” Nonetheless, this was a challenge that he gladly took on. According to Rogers, “It has meant that if I am to facilitate the personal growth of others in relation to me, then I must grow, and while this is often painful it is also enriching.”
Is Rogers Describing Love?
In his commitment to create the kind of relationship that his clients can use for their growth, Rogers is advocating a role for the therapist that requires considerable discipline, sacrifice, strength, flexibility, generosity, courage and wisdom. He is asking a great deal of the therapist: to create an atmosphere of acceptance and deep empathic understanding while at the same time taking the risk of being real and genuine.
In order to achieve this we must be willing to put aside our own preferences and agendas and focus on another person’s world, something we would not generally do (at least to the same degree) in our non-working lives. In addition to listening attentively, we are constantly forced to reevaluate the maps that we have constructed in our minds to help orient us to what is happening with a particular client, a process that can be humbling as well as disorienting. And it is not uncommon to have our broader worldviews or philosophies challenged as well. A therapist also needs the emotional sensitivity, strength and flexibility to be deeply empathic while at the same time maintaining our separate identities and professional roles and boundaries.
Rogers admitted that he was “by no means always able to achieve this kind of relationship” and that he needed to grow in order to better accomplish the goals that he outlined. As noted above, Rogers described his greatest challenge as the ability to accept who he is in the therapy process and then permitting this to show through to the client. Other therapists might describe the most challenging aspect of their work somewhat differently, such as the need to really struggle in some way, either with themselves or with the client in the course of a successful long-term psychotherapy relationship.
Maybe what these challenges have in common is that the therapist is forced to grow and change, either by altering our point of view or how we see the world, by expanding our ability to respect and appreciate others, by needing to address some of our own psychological demons or unfinished business, by learning to accept aspects of ourselves that have felt wrong, unattractive or shameful, by taking certain risks in our work, or, most likely, all of the above. And this willingness to grow and to experience the pain that accompanies change is a big part of what generates love in our process. While we may prefer to do much of this growing outside of the view of our clients, they often benefit from witnessing, to some degree, our struggles and involvement.
Whether what Rogers is describing deserves to be called love is a matter of debate, but there is little question that the role he advocates for therapists requires that we behave in a loving manner. And when we behave in a loving manner toward someone, our behavior tends to generate feelings of love, not only in them, but also in us. As we are reminded in any number of popular songs, love in not just something we take, it is something that we make. And when we as therapists are successful in following Rogers’ advice, we can expect that our clients feel not only accepted and understood, but also, at least on occasion, loved, and that they will respond in kind to our attentiveness and commitment, which feeds back into a virtuous cycle.