Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
Recommended Principles and Practices for the Provision of Humanistic Psychosocial Services:
Alternative to Mandated Practice and Treatment Guidelines
Provision of Humanistic Psychosocial Services 
This document was formulated by a group of psychologists concerned with the increasing medicalization of and press for homogeneity in psychotherapy. The authors clearly differentiate the approach represented by those who are pressing for narrowly defined "evidence-based treatment" and the approach taken by humanistic psychologists. The members of the Task Force that produced this document were Arthur C. Bohart, Chair, Maureen M. O'Hara, Co-Chair, Larry M. Leitner, Fred Wertz, E. Mark Stern, Kirk Schneider, Ilene Serlin, and Tom Greening. An earlier version of these recommended principles was published in The Humanistic Psychologist, Volume 24, Spring 1997, pp. 64-107. They are reprinted here with permission.
An initial draft of the major portion of this document was approved by
the Board of Division 32 and subsequently published in The Humanistic
Psychologist, 25(1), Spring, 1997, as “Guidelines for the Provision
of Humanistic Psychosocial Services." This was done to solicit feedback
from Division 32 members. The additional draft section on Training and Ethics
was published in The Humanistic Psychologist, 25(3), Autumn, 1997, also
to solicit feedback. The final version was approved by the Division 32 Board in
1999. The document was then submitted to the American Psychological Association
to undergo its guidelines review process. Initial steps of this process were
successfully completed, including review by APA’s Legal Counsel and submission
to all APA divisions for feedback. Ultimately, however, because of APA’s
specific definitions of what constitutes guidelines, it was decided by the
Division 32 Board in 2001 to reconstrue the document as “Recommended
Principles and Practices For The Provision of Humanistic Psychosocial Services:
Alternative To Mandated Practice and Treatment Guidelines.” Minor changes in
wording were mandated due to this alteration, and have now been completed, along
with minor updating of research citations.
An initial draft of the major portion of this document was approved by
the Board of Division 32 and subsequently published in The Humanistic
Psychologist, 25(1), Spring, 1997, as “Guidelines for the Provision
of Humanistic Psychosocial Services." This was done to solicit feedback
from Division 32 members. The additional draft section on Training and Ethics
was published in The Humanistic Psychologist, 25(3), Autumn, 1997, also
to solicit feedback. The final version was approved by the Division 32 Board in
1999. The document was then submitted to the American Psychological Association
to undergo its guidelines review process. Initial steps of this process were
successfully completed, including review by APA’s Legal Counsel and submission
to all APA divisions for feedback. Ultimately, however, because of APA’s
specific definitions of what constitutes guidelines, it was decided by the
Division 32 Board in 2001 to reconstrue the document as “Recommended
Principles and Practices For The Provision of Humanistic Psychosocial Services:
Alternative To Mandated Practice and Treatment Guidelines.” Minor changes in
wording were mandated due to this alteration, and have now been completed, along
with minor updating of research citations.
to better provide services to people, The Division of Humanistic Psychology of
the American Psychological Association has prepared the following
recommendations concerning the principles and practices of humanistic
psychosocial services. This is necessary in a day when accountability of
service-providers is a major issue, and when some attempts to provide guidelines
for the provision of therapeutic services have threatened to restrict consumers'
freedom of choice. Under these conditions, it is important that humanistic
psychologists articulate the principles under which they operate for the
responsible and helpful provision of services.
Humanistic psychologists form their own community of practice and hold
their own distinctive views of human nature, of science, of research
methodology, and of psychotherapy. Humanistic psychotherapy deals with
psychological dysfunction in the broad context of clients' engagements in life
and ways of being in the world. Humanistic psychologists are oriented towards
promoting the psychological development and growth of individuals, families, and
communities through the support of their own creative and self-initiated
efforts. Psychological development includes the development of greater
capacities for self-understanding, understanding of others, and understanding of
relationships; clarification and development of values and life goals;
development of a greater capacity for deep experiencing; the strengthening of
relational bonds; the promotion of an environment of mutual care and empathy;
development of a greater sense of personal freedom and choice while respecting
rights and needs of others as well as the limits imposed by reality; and the
strengthening of individual, relational, and group agency. Humanistic interests
are likely to include phenomena such as the aspirations of whole persons, their
goals, their desires, their fears, their potential for growth, their higher
selves, and qualities such as empathy, congruence, authenticity, presence, and
intimacy. Discontinuities in life and in experience, tragedy, and pain, are
taken seriously as often reflecting basic issues concerning the nature of the
self, the nature of existence, and the nature of one's engagement in the world,
rather than being seen as pathogens to be eliminated. Since humanists hold
issues of human value as fundamental, the provision of humanistic services is
unavoidably an issue of human value.
Humanistic practices are holistic and are based in a view of the
therapeutic process as a dialogical activity, which occurs through
person-to-person conversations and through intersubjective symbolic activities.
Humanistic services begin from the assumption of a client whose choice to seek
therapy is personal. This entails a view of the client as an agent, who must be
engaged in the creation and development of all therapeutic processes, not only
as a matter of theoretical truth and clinical efficacy, but also of ethical
integrity and coherence. Therefore humanists reject the model of the
practitioner as the expert who decides for the patient what the appropriate
treatment is. Humanistic practitioners recognize that their job is to place
their expertise at the service of their clients and to establish a collaborative
dialogical relationship with them. The joint project of client and
psychotherapist is to work towards individualized goals that are framed in the
clients' world view and understandings of their own aspirations rather than on
normative diagnostic categories. Humanists believe that the methods used in
providing services must reflect the basic value of promoting the agency and
empowerment of individuals and groups.
Humanists, in agreement with many feminists, family-systems theorists,
and ethno-cultural therapists, believe that relational phenomena are fundamental
and not reducible to the sum of individualities. Humanists recognize both the
particular and integral aspects of consciousness, and that human beings are both
unique and yet live in larger relational contexts which have their own emergent
properties and integrity. Therefore, when humans enter into relationships with
other humans to provide help and assistance, they of necessity become part of
larger relational entities which must be treated as having their own properties
that go beyond the sum of the parts. Such a position makes any therapeutic
stance based in a view in which an individual or institution makes unilateral
decisions about the life of another person both impractical and unethical. In
this document we will elaborate on these basic ideas and present a humanistic
model of praxis, science, research methodology, diagnosis, and ethics, for the
purpose of providing guidelines for the provision of humanistic services.
It is important to recognize that this document constitutes an
alternative to practice and treatment “guidelines.” The term
“guidelines” refers to pronouncements that support or recommend, but do not
mandate, specific approaches or actions. This document, as with guidelines, is
intended to provide recommendations of principles for practice that are
aspirational in intent. However, in contrast to guidelines, which
typically focus on or recommend specific approaches or actions, these
recommendations focus on the use of guiding principles, consistent with
humanistic philosophy and practice. This document is intended to facilitate and
assist the provision of services, but it is not intended to be mandatory,
exhaustive, or definitive and may not be applicable to every situation. It
should not be construed as definitive and is not intended to take precedence
over the judgment of psychologists.
these days of public accountability—a movement which humanistic psychologists
who offer services to the public support—various groups are producing
documents specifying guidelines for appropriate practice. In this document
humanistic psychologists present their recommendations of principles for
effective practice. There are three reasons why we are doing this. First, we
want to articulate the principles upon which our community of practice is based,
so that both practitioners and consumers have criteria with which to judge if
services are being provided in a manner congruent with humanistic
principles. Second, we believe that the humanistic paradigm represents an
important perspective on the nature of human beings and human change, and we
wish to articulate its general principles and concepts for all who are
interested. Third, other groups and individuals have articulated principles
which threaten to disenfranchise humanistic as well as many other forms of
psychological practice. We believe it is important to make a positive statement
of our principles in terms of why the guidelines of these other groups do not
provide appropriate criteria for our practice.
The development of guidelines for the provision of both medical and
psychological services is a recent national and international trend. These
guidelines are based on the developers' interpretation and assessment of
available evidence, and that in turn is affected by the developers' biases
concerning their own preferred modes of treatment and their preferred ways for
conducting empirical research. The recent guidelines for the treatment of
depression (Depression Guideline Panel, 1993), for instance, issued by a
governmental agency operating within a medical model frame of reference,
privileges medication over psychotherapy [despite compelling evidence to the
contrary (Munoz, Hollon, McGrath, Rehm, & VandenBos, 1994)], and conceives
of depression as a chronic “illness.”
The development of guidelines is part of an international movement
towards "evidence-based" practice (Rowland & Goss, 2000). However
there are many different models of how to base practice on evidence. For
instance, one approach is to base practice upon evidence for various principles
of change (Bohart, 2000; Goldfried & Wolfe, 1996; Rowland & Goss, 2000).
This is the strategy that has been followed for developing the recommendations
in this document. Another approach has been the "empirically supported
treatments" movement (e.g. Chambless & Hollon, 1998), more popular in
The empirically supported treatments movement focuses on the degree of
evidence for specific treatments for specific disorders. While different authors
writing from this approach have come up with slightly different criteria,
overall there is a good deal of consistency, and these criteria are of
particular relevance to the concerns of humanistic psychologists. These criteria
are based upon implicit assumptions about the nature of psychotherapy and favor
approaches which a) adopt a medical model perspective on psychological
dysfunction and its remediation, b) are focused on symptom removal, and c) are
technological in nature. Although other approaches are not explicitly ruled out,
the criteria do not fit well with psychotherapies that are discovery-oriented,
holistic, and relational. These documents also privilege particular natural
science research methods, and marginalize other methods more compatible with the
study of psychotherapies that share a focus on the particular individual,
subjective and multiple realities, and contextuality and relationship. Because
there exists a potential for these documents to be used to dictate what is
appropriate psychotherapy practice for everyone,
it is necessary for us to articulate our alternative vision of the human
being, of psychological problems, and of psychotherapy, as well as of research
methodology and the general relationship between science and practice. For us
the issue is ultimately one of freedom of choice for consumers, who must be
allowed to choose the psychotherapy modality which best fits their needs, rather
than have that choice made for them by a particular group of professionals.
Most versions of “empirically
supported treatments” (EST) guidelines are based on traditional natural
science criteria, modified to appeal to business and governmental agencies which
think in medical model terms. The criteria rank the randomized controlled
clinical trial (RCT) at the top of a purported validity hierarchy of methods for
evaluating psychotherapy. In addition, to be considered by supporters of the EST
movement as an “empirically supported treatment”
a given therapy must have been validated in studies in which the therapy is
manualized, and where the therapy is studied as a treatment for a particular
problem or disorder. These guidelines do not require that the disorder be
specified in DSM terms. However, specific symptom-focused approaches, highly
compatible with DSM are favored. Such
criteria are biased towards certain types of therapies, and lists of empirically
supported treatments have tended to exclude therapies which emphasize personal
discovery and relationship, including many psychodynamic, feminist,
constructivist, narrative, and family systems approaches, as well as humanistic
therapies. This is despite substantial empirical support for various humanistic
practices and assumptions. For instance, EST criteria dismiss years of psychotherapy research that support
humanistic therapies and assumptions because many of the studies did not include
manualization of the therapy being studied and because the therapy was not
targeted to treat a specific disorder or problem. Proponents of ESTs also wish
to see their paradigm become the dominant one for guiding both psychotherapy
research and training (e.g., Lampropoulos, 2000).
The logic of the randomized controlled clinical trial best fits
psychotherapies which can be structured so as to operate in a manner analogous
to medications. That is, they can easily be manualized as a specific set of
procedures or strategies designed to treat a particular disorder, for instance,
a therapy which is described as a specific set of procedures and strategies for
“treating depression.” In such a case it is possible to randomly assign
depressed people to a treatment and to a control group, apply the procedures to
the treatment group, and measure to see if depression is alleviated. If so, then
it can be said that the procedures “caused” the alleviation of the
depression. The logic of the randomized controlled clinical trial purports to
establish linear, efficient causal relationships between treatment application
and outcome. However this logic does not fit with therapies which are not
conceived of as the application of specific procedures to alleviate specific
disorders—therapies where healing ultimately results from personal discovery
and where the primary modality is that of a flexible, creative, and dialogical
relationship between therapist and client.
Further, this model of science and research, limited to establishing causal
relationships, is unable to scientifically address important questions such as
the personal meaning and value of even those therapies it does fit. Thus, while
RCTs are one valuable way of investigating psychotherapy, there are many aspects
of the human experience of psychological life that cannot be addressed by such
methods. Thus RCTs themselves must be treated as only one among many methods for
investigating psychotherapy, rather than being held up as the definitive method.
Similarly, therapeutic efficacy is defined
in a manner analogous to a medical model in which the goal is cure of a
disease. That is, therapy can be said to be effective if it leads to the remedy
for a particular targeted problem or disorder. However there are many other ways
psychotherapies can be effective. Many approaches to psychotherapy do not hold
that effectiveness in psychotherapy is homologous to effectiveness of a drug.
For one thing, a therapy could be said to be efficacious if it provides a
certain kind of opportunity or experience that clients seek. Clients might take
advantage of this opportunity or experience to make a variety of personal
changes, none of which are connected in a linear, mechanistic way with what the
therapists do. Humanistic psychotherapists, with their emphasis on the
collaborative nature of the relationship with their clients, do not see
effectiveness in terms of a method's ability to operate on clients and change
them, but rather in terms of the kinds of conditions therapists provide which
allow clients to take their pain seriously, explore their lives, and find more
meaningful ways of engaging in their existence. The issue for the humanistic
psychologist, as well as for therapists of many other persuasions, is how best
to provide guidance, support, and resources which are useful to the client.
In contrast to the medical-model view
of psychotherapy implied by EST criteria,
humanistic models begin with the goals identified by the therapist-client
team when evaluating whether a given therapeutic approach is beneficial or not.
The question “Is a given technique effective?” becomes recast as “does the
professional provide the services that the team has agreed could be helpful?”
This question puts the evaluative emphasis on specific practitioners
following specific principles in specific context and asks “under these
specific conditions, do specific clients move towards their own, self-defined
goals?” One can then ask if the resources provided are helpful and useful—in
other words effective—for this particular client, under these particular
circumstances. Therefore, humanistic therapists reject the empirically supported
treatments approach to identifying effective psychotherapy, even though
several humanistic therapies have now been researched and supported from
within the empirically supported treatments paradigm (Elliott, Greenberg, &
Lietaer, in press). Although we shall cite empirical evidence supporting
humanistic practice based on natural science procedures, such externally
validated studies across multiple practitioners and multiple clients become less
relevant as evaluation criteria shift to specific instances and away from
This means that fundamentally different models of training are required
for the preparation of competent humanistic clinicians than those implied by
criteria for empirically supported treatments. Training becomes less of a matter
of acquisition of technological skills to be applied consistently and with
mastery, and more a matter of the development of: perceptual and interpersonal
sensitivity; self-awareness; higher order mental capacities such as the ability
to take multiple perspectives on issues and problems and the ability to engage
in more complex thinking about values; the skill of relating general research
findings and scholarly discourse to specific persons in naturally occurring
contexts; and other non-formalizable complex skills for facilitating human
growth and liberating client creativity. This emphasis on the therapist's
development of his or her own mental and relational capacities follows from the
humanistic position that therapists must be able to entertain and really
appreciate multiple perspectives on reality, and that it is clients who are
ultimately the experts on their own lives, their own life circumstances, and the
contextualized complexities interwoven around their problems. Therapists must be
able to believe that it is only clients who can ultimately know what are the
appropriate ways for them to approach and resolve their problems, within the
contexts of their life structures, life histories, and the constraints of
society. This means that the therapist's sensitive and flexible ability to
dialogue with clients becomes the ultimate therapeutic modality.
In the context of the current struggle to define “evidence-based”
practice (e.g., Rowland & Goss, 2000), it thus becomes necessary for
Humanistic Psychologists to either subscribe to the research, training, and
treatment protocols endorsed by others, or to establish their own criteria for
“effectiveness” to which professionals, users of services and educators can
refer as a means of discriminating good practice from the inadequate. In order
to assure that an open stance towards psychological science be maintained, and
to insure that everyone is not held to the same way of understanding human
psychological life, which we believe will result both in stifling free enquiry
and in limiting the choice of services available to the public, a humanistic
“template” is necessary. For this reason, in this document, we a) elucidate
the conceptual foundations of humanistic practice, b) elucidate the logic
underlying research support for humanistic practice, and c) present our own
recommended principles for practice. Further, we take the stance that any
genuinely scientific endeavor—one grounded in the search for truth—of
necessity must remain open to a variety of methods (i.e., different ways of
The final rationale for the creation of a humanistic set of recommended
principles and practices comes from the need to counteract the paradigmatic
biases built into other approaches. The evaluation criteria of these other
approaches discredit research performed according to research protocols at odds
with their own mechanistic positivism, and thus disenfranchise a whole body of
research performed both within and outside of the humanistic psychology
community, which already establishes the fact that humanistic psychotherapies
are both effective and well liked by the therapy-going public. These humanistic
recommendations will argue that this disenfranchisement is unwarranted based
upon the facts. Furthermore, these recommendations will support the position of
the humanistic approach by reference to studies performed using both positive
science protocols and post-positive protocols.
order to provide the ground and rationale for our guidelines, we present basic
aspects of the humanistic perspective on epistemology, on the nature of the
person, on psychological dysfunction, and on psychotherapy. There are many
humanistic theories, some of which include: person-centered, gestalt,
existential, transpersonal, constructivism, archetypal psychology, experiential
therapies, logotherapy, general semantics, the expressive therapies (art, dance,
music, poetry), integrity therapy, self psychology, radical psychotherapy,
interpersonal and relational theory, meditative psychotherapy, intensive journal
workshops, psychodrama, some forms of bioenergetic therapy, and many others. We
cannot extract a universal set of principles that all humanistic perspectives
would agree on, but we believe that the principles we present below represent
the views shared by most.
humanistic world view is not a mechanistic one, but rather relies on a nonlinear
metaphysics and postmodern constructivistic epistemology. We hold that the
realities people live in are always constructed to some extent, out of their
cultural experiences, and out of their personal histories, values, and
perspectives. As such there are many viable ways of living life. Humanists value
diversity in perspectives on reality, and therefore believe that the ultimate
goal of therapy is to help each individual, within the context of his or her
relationships and culture, find the most satisfying personal and relational life
paths. Humans are whole persons in context and therapeutic solutions must
fundamentally be grounded in their life contexts. This means they must perforce
be individualized, developed to meet the individual's particular life context,
and cannot be chosen as treatments for decontextualized disorders.
of the Person
psychology derives from trends in Renaissance, Post-Enlightenment Romantic, and
twentieth century existential thinking, and addresses the issue: what are the
distinctive features of being human? Our provisional answer to this question is
that humans are self-aware, capable of choice or freedom, and capable of
functioning in a whole or organismic manner. Humans are also delimited (though
not defined) by their genes, physical constitution, culture, and accidents of
fate. Humans are not “part-processes” and do not function in the world like
animals or objects. They are more than their physiology, overt behavior,
cognition, instincts, or even interpersonal relationships or culture, although
they are each of those also. In addition, many humanists believe that human
beings have a sense of a fundamental connection with life, with being, and with
existence (Schneider & May, 1995). In this regard, some humanists take
seriously a transcendent or spiritual side to human existence. We further hold
the following about human beings:
1. Persons are irreducible to the sum of their parts. While we recognize
the usefulness of such constructs as “ids,” “egos,” “schemas,”
“object representations,” and “conditioned habits,” overall we focus on
the whole person who is choosing, setting goals, pursuing meaning, establishing
and living in relationships, and creating.
2. It is nonsensical to consider human beings separate from their
organismic bodies. Emotions and experience are an intrinsic part of being human,
and the body and the emotional life are not “lower” than rationality.
Conversely, rationality is most fully rational when joined with the body and
with emotion. Humans are also capable of deeper, nonrational ways of knowing:
intuition, a sense of knowing by being joined with others, and knowing through
deep experiencing. Humans are more than their consciousness, but what is
nonconscious is not necessarily irrational and primitive.
3. Humans also cannot be separated from their relationships and their
worlds. Humans-in-relationships form larger units that have their own integrity
and existence. Humans are “thrown” into a world where they are inevitably
influenced by their time and place—their culture and their surroundings.
Personhood is woven out of the individual's embeddedness in time, place, and
4. Relationships are an intrinsic part of being human, and humans turn to
one another for comfort and a sense of meaning when things are going badly.
Relationships can involve a real “meeting of persons.” Such a meeting of
persons is more than the interchange of operant behaviors designed to bring
reinforcement from one another. Humanists take seriously the idea of direct
psychological contact and mutuality between two or more persons.
5. Dialogue and communication are essential parts of humanness. Dialogue
and communication are among the major means through which selves come to know
themselves and to develop and grow, and through which selves develop in relation
to others. Dialogue is a mutual process and involves a genuine interchange
6. Humans are creative, and can evolve towards more complex and
sophisticated ways of conceiving of and experiencing themselves, their
relationships, and their world. More complex and sophisticated ways of
conceiving of and experiencing self and world can lead to greater empathy for
others, a greater capacity to sustain relationships, and greater problem-solving
7. Humans are valuing beings and have a potential for developing and
living according to deeply held and abiding values.
8. Humans inhabit the past, present, and future. The past is a dynamic
past, a well of experiences influencing present reality and which, even when
involving pain and suffering, can be transformed into resources to deepen and
enrich the further life path. Humans take action in the dynamic present, but
they live towards a future. The future is the horizon of their possibilities.
9. Humans are meaning-makers. Meaning is a product of individuals,
communities, and persons-in-interaction. What constitutes a meaningful life is
chosen by individuals embedded in communities and in relationships.
10. Humans are agents. This means that they are ultimately the sources
and originators of their own actions. They are able to initiate action, make
choices, set goals, and chart life courses.
11. Humans as individuals are ultimately responsible for their own
individual choice. Individuals must make choices which take both their own
individual needs and wishes into account, and those of the people around them.
humanistic theories posit different views of psychological dysfunction. What
most share in common is the idea that psychological problems arise from the
whole person's manner of relating to self and/or to world. Problems are not
considered to be solely a product of abstract dysfunctional internal structures
such as egos or schemas, nor of isolated conditioned habits and responses, nor
of biology. Rather, they arise from the whole person's attempt to adapt and cope
with demands made upon the self by the world, biological constraints, traumatic
experiences the self has encountered, constrictive and/or oppressive political
structures or environments, relationship blocks and disruptions, rigid rules and
social norms learned from others, and the self's own anxiety generated by its
encounter with the fundamental uncertainty of life. Problematic behavior can be
an expression, albeit a counterproductive one, of individuals' desires to grow
and become more functional. Psychological problems come into being at the
contact boundary between the person and the world; they are not entities in
persons. Problems are things individuals have, not things that constitute
individuals. Problems cannot be defined independent of a) the client's own
personal goals and values, and/or b) the interface of the client's behaviors
with the viewpoint and behavior of others (cultural norms, values of one's
reference group, or significant others). Problems do not have an existence
independent of defining agents (Mahrer, 1996). Problems are inherently
valuational, and may involve intrinsically moral components.
therapies generally are seen as providing opportunities for self-confrontation,
personal exploration, and growth as the means by which individuals confront
their suffering, their limits, and their distress. As such these therapies do
not typically provide specific treatment packages for specific disorders. In
fact, “disorder” is not usually a meaningful category for defining the aim
of a humanistic therapy. Rather, humanistic therapies aim to facilitate more
general human capacities for being in the world as a way of helping individuals
confront and cope with their problems in living. As a result humanists tailor
their approaches to individuals not on the basis of the individual's disorder,
but on the basis of the individual as a unique person. Work done with one person
presenting as depressed might be more similar to work with a person labeled as
schizophrenic than to that done with another person presenting as depressed.
Because all humans think, experience, value, have aspirations and wishes, engage
themselves in life, and make choices, the kinds of experiences humanistic
therapists provide could be useful, regardless of an individual's diagnosis.
problems, or problems in living, are ultimately resolved by helping individuals
develop more complex, integrative, balanced, honest, and courageous ways of
living, i.e. through psychological growth. Psychological growth consists of
creating more deep and complex integrative modes of relating to self and to
others, and of new stances of meaning. The goal is not primarily to remedy
dysfunction, although humanistic therapists acknowledge problematic behavior and
experience and help clients stay with it and learn from it. At times humanistic
psychologists may even use symptom-focused procedures to help alleviate problem
behaviors and experience, but this is done as part of the larger context of
exploring broad personal issues and problems of meaning.
Problems in living are often not isolated entities in themselves to
simply be removed. As individuals confront issues concerning their basic values
and engagement in the world, they will also confront issues relating to their
problems. In some cases problems in living can be modified by focusing on the
enhancement of people's resources and the fulfillment of their potential,
without therapy even addressing the issue of the problem behaviors and
experience. As an example, a person with a physical problem, such as cancer or
paralysis, can still find ways to live a productive life. Likewise, even if
something that might be conceived of as a psychological “disorder” has a
biochemical component individuals can learn from the experience and incorporate
it into their lives in a functional (or even creative) manner. On the other
hand, there are instances where the painful issues associated with a symptom
need to be explored, beyond the use of procedures to facilitate symptom removal.
Humanistic therapies also value the following goals: making the
development of freedom and wholeness available to clients, to the degree that
they can engage in them; enlarging the person's sense of possibility; helping
the person become more aware, sensitive, and capable of choice; and increasing
life's vitality—creativity, meaning, purpose, and intimacy with self and
others. The aim for many humanistic therapies is to help clients attain a
greater sense of personal freedom. Freedom is defined as the capacity for choice
within the natural and self-imposed limits of living. Yet another goal of
humanistic therapies, if clients so wish, may be to help them develop deeper
capacities for experiencing in the ways they relate to themselves and the world.
Included in this may be the development of transpersonal aspects of the self.
Transpersonal aspects may include spiritual aspects, or may be nonspiritual, but
still include a deeper relational sense of connection to others, to being, and
Outcome from a humanistic perspective is highly individualized. While
recognizing the ever present possibility that people—and this applies equally
to therapists and clients—are sometimes self-deceiving, the humanistic
psychologist nevertheless accepts that ultimately what is a successful outcome
can only be best judged by the consumer.
Processes and procedures
practice, humanistic psychotherapies are not typically goal-driven in the sense
that they set out to specifically achieve a particular set of predefined goals,
such as overcoming shyness, learning to communicate better, or feeling less
anxious. Some humanistic therapies (e.g., Mahrer's, 1996, experiential therapy)
are not goal-driven at all in the sense of trying to achieve particular
outcomes, and in that sense are almost purely process and discovery oriented.
When goals are decided upon, they are decided upon by the therapist-client team.
However goals often change and evolve as the therapy process progresses. In any
given therapy encounter it is often not possible to specifically predict in
advance what kinds of positive outcomes will ultimately emerge as the
relationship evolves and changes. Outcomes are often creative emergents (Kampis,
1991), such as second-order changes (Watzlawick, 1987).
Instead of focusing on specific outcome goals, humanistic therapists
typically focus attention on process. In general therapists want to take humans
seriously in terms of their own experience, “salve the human spirit,” and
help individuals discover how they want to promote their own development, and by
so doing, cope with problems in living. In order to do this therapists aim to
provide an optimal relational process within which a client can reflect upon the
patterns of his or her life, experience him or herself more deeply, access or
mobilize his or her own capacity for agency, and experience and explore the
formation and function of relational bonds. In this regard the humanistic
therapist allows the client to stay close to his or her suffering and to learn
from it. However, distress is seen as one aspect of the whole person, and the
ultimate focus of the therapy is more on the whole person's engagement with self
and with life.
Therapists provide such an optimal relational process first by keeping in
mind the humanness of the therapeutic encounter. Both psychological problems and
their alleviation are seen as ultimately involving the humanness of the
participants. Thus post-traumatic fears are not treated simply as pathogens to
be deconditioned or emotionally reprocessed through exposure. Although a
humanistic therapist might use such behavioral techniques as exposure, it is
always included within the larger human context of the meaning of the experience
in terms of a person's values, needs, life directions and ways of being in the
world. Similarly, a humanist might use a technique like cognitive restructuring.
However what cognitive therapists call dysfunctional cognitions are not viewed
by humanistic therapists only as errors in logical computation, but as attempts
by individuals to cope with experience and to find a place in the world.
Second, therapists facilitate an optimal context by keeping their
attention primarily focused in the moment and on the experience of this unique
individual. Sensitive, skilled, and flexible attending to the ongoing emerging
process between therapist and client is the sina qua non of humanistic therapy.
Therapists sensitively track the experience of the client as the client
struggles with issues and experience, track emerging themes, and bring in
suggestions, ideas, and techniques when they are relevant to what is happening
in the moment. Therapists keep their attention focused more on what is unique
about this particular client than on what is common about him or her with
respect to others who may share the same presenting complaint or diagnostic
category. Therapy therefore consists of an open-ended process oriented towards
discovery and meaning-making. The therapist functions as a skilled and
disciplined improvisational artist, not as a technician implementing a treatment
manual. Therapists may use any of a variety of techniques, such as cognitive
restructuring or exploring childhood experiences. However these are suggested
only when they fit the needs of this particular individual in this particular
moment in the therapy process.
Third, therapists provide an optimal relational process by exercising
certain other core skills. Minimally, these include the ability to: a)
empathically understand and grasp the world of the client, b) accept, affirm,
value, or prize the client, and c) facilitate and participate in co-constructive
dialogue with the client. Additionally, most humanistic therapists also try to
optimize the relational process by: a) being a real self-in-relation to the
client, and b) genuinely engaging in a “meeting of persons” with the client.
Fourth, the therapist believes that clients are the ultimate experts on
their own experience. Ultimately it is clients who must decide, within the
constraints of their life structure and of society, what changes to make and how
to make them. Humanistic therapists hold a basic respect for the personal
reality of clients. In addition clients are seen as authentic sources of their
own experience. Further, humanistic therapists relate to the client out of a
genuinely held egalitarian stance. In such a model, it is paradigmatically
incoherent to: a) think of the client and the process of therapy primarily in
terms of the “expert therapist's” assessment of the client's “disorder,”
and b) approach therapy with a pre-defined “treatment plan” based upon that
assessment. Doing so interferes with the therapist’s capacity for tuning into
client uniqueness, individuality, strength, and potential.
Fifth, a major therapeutic issue for many clients has to do with their
personal theories of living. There often is a philosophical or moral component
to therapy, and therapy can be the facilitation of clients confronting certain
basic issues and values about being human and being alive. Therapists help
clients more meaningfully “restory” their lives to create a deeper sense of
Sixth, therapy for many clients revolves around a basic struggle to
achieve both a sense of genuineness and intimacy in relationship to other human
beings. The resolution of this struggle cannot be manualized, nor “treated”
with a “treatment plan.” Instead, the therapist must be present as another
human being and be willing to be a part of that struggle.
Humanistic therapies are thus not based on the medical model. To quote
Bohart, O'Hara, and Leitner (1997), “ In contrast to therapy as the mechanical
application of a treatment procedure, therapy is a recursive, self-adjusting,
creative, interactive intelligent process (Karen Tallman, personal
communication, October, 1996), a complex nonlinear dynamic system.” Therapist
and client are the two major variables in the approach; rather than treatment
and disorder, as is the case for the EST criteria. Dialogue, instead of preset
choice and application of technique, is the sina qua non of the process. The
process of the therapist and client listening to one another and interacting is
primary, with theoretical ideas and techniques used as aids or adjuncts in that
process. Techniques and procedures take on their meaning contextually (Butler
& Strupp, 1986). Therefore there is no such thing as an invariant procedure
uniformly applied across the board to clients who share the same diagnosis. The
therapist-client pair working together is the “treatment of choice,” rather
than any specific treatment package. As Bohart, O'Hara, and Leitner (1997) note:
therapist's particular theoretical stance and package of techniques are ways to
implement his or her therapeutic interpersonal presence and spontaneity, rather
than specific things done to make therapy happen. Different therapists can
practice in widely different ways, use widely different techniques at given
choice points, and still be effective if they are implementing certain
fundamental humanistic principles. Thus, uniformity of therapist behavior is
neither expected nor desired. What is desirable is that therapists individually
“be themselves” in their own unique idiosyncratic “healing ways.”
Therapists will not necessarily even be consistent from one moment to the next,
as they flexibly adjust to the emerging flow of interaction between themselves
and the client. This includes the therapist's own
continual self-discovery of new potentialities for helpful interaction through
dialogue with this particular client.
Based on these core, generic principles, humanistic therapists practice
in widely different ways. In all cases, humanistic practitioners recognize that
their particular philosophical and theoretical positions are guiding frames of
reference for interaction and practice, but are not “the truth” to be
imposed on their clients. The reality of the client, of the client's own
experience, and of the experiential reality created by the intersection of the
therapist's reality and the client's reality, is the ultimate determinant of
practice in humanistic therapy.
for identifying empirically supported treatments
ascribe to the idea of differential therapeutics, that is, the idea that
different “treatments” are needed for different disorders. Thus a different
therapy approach might be needed to treat schizophrenia than to treat
depression. In contrast, humanistic psychologists believe that the kind of
relationship and experiences they provide can be used by anyone, regardless of
their diagnosis. As we have noted, all people think, experience, value, have
wishes and aspirations, and make choices. Therefore we believe that people
labeled “schizophrenic” might wish to explore the basics of their
engagements in life, as might people who are depressed, and learn about how
their depression or schizophrenia (or whatever) is linked to these engagements.
“Differential therapeutics” therefore consists of the exquisitely sensitive
moment-to-moment responding we have previously referred to, wherein therapists
suggest techniques or procedures in dialogue with clients and in response to
what individual clients need at that moment in their therapeutic process.
At the same time, different clients might be attracted to different
modalities of humanistic therapy. This is not a matter of matching diagnosis to
therapy. Rather it is a matter of the particular style and content of a given
therapeutic approach particularly appealing to some clients. Clients should have
the freedom to choose modalities of therapy which best fit their personal needs.
Stance on DSM and on Diagnosis
psychologists may choose to utilize DSM where, in order to benefit their
clients, such diagnoses might be useful or required. However most humanistic
psychologists have reservations about, or are opposed to, the DSM classification
system as a basis for making therapeutic decisions.
The DSM takes great pride in its “atheoretical” nature. However,
humanistic psychologists believe, as the newer philosophies of science state so
elegantly, data never can be atheoretical. Even a decision to look at certain
phenomena and not others is a decision about the importance of considering these
phenomena versus others. That decision cannot be made independent of a view of
the nature of reality—a theory. Therefore, as in all forms of scholarship, the
DSM's theoretical views needs to be clearly understood so that an informed
choice can be made as to the whether such a theory is the best way of
Symptom clusters versus symptom meanings
of the first theoretical suppositions underlying the DSM involves the assumption
that common clusters of “symptoms” point to the same underlying
“disease.” The current nomenclature is more interested in categorizing
clusters of symptoms than in diagnosing the meaning of the symptoms for the
person. For example, all persons with certain symptoms are assumed to suffer
from an “obsessive compulsive disorder.” There is little room for persons
with differing “symptoms” to be manifesting similar (or even identical)
problems or for persons with very similar symptoms to be struggling with very
different problems. While this assumption may seem reasonable on superficial
inspection, psychotherapists have long known that individuals with identical
symptomatology are actually struggling with very different issues and need very
different treatment approaches. Therapists for persons diagnosed as “obsessive
compulsive” often speak about a group of these persons who are at high risk
for developing “schizophrenic” symptoms, in contrast to many others with an
obsessive diagnosis. (See Faidley & Leitner, 1993, for a more detailed
The myth of objectivity
DSM claims as its greatest strength the increase in diagnostic reliability
associated with the development of an objective method of classifying symptoms.
Faidley & Leitner (1993) argue that this claim is actually a myth of
objectivity. The “objective” criteria are filled with terms that allow the
clinician to project subjective values and norms into the process of diagnosis.
For example, consider the “objectivity” associated with the criteria for
receiving a diagnosis of Dependent Personality Disorder (301.6).
has difficulty making everyday decisions without an excessive amount of
advice and reassurance from others.
needs others to assume responsibility for most major areas of life.
has difficulty expressing disagreement because of fear of loss of
support or retribution. (Note: Do not include realistic fears of
has difficulty initiating projects or doing things because of a lack of
self confidence in judgment or abilities.
goes to excessive lengths to obtain nurturance or support, to the point
of volunteering to do things that are unpleasant.
feels uncomfortable or helpless when alone because of exaggerated fears
of being unable to take care of himself or herself.
urgently seeks another relationship as a source of care and support when
a close relationship ends.
8. is unrealistically preoccupied with fears of being left to
take care of himself or herself.
Our point is not that there are
subjective terms within the nomenclature; indeed, when dealing with subjective,
meaning making organisms, subjectivity in the diagnostic system is inevitable.
Rather, our concern is the ways the DSM masks this subjectivity and implies that
these value laden, impossible to quantify terms are objective.
Further, there is a blatant contradiction between the process of more humanistic therapies and the process inherent in DSM diagnoses. As Faidley & Leitner (1993) point out, the process of objectifying the other to arrive at such a diagnosis may actually be an impediment when the therapy involves the active, subjective, mutual engagement between therapist and client. At best, time is wasted as the therapist and client have to undo the damage to the therapy relationship associated with such objectivity. R.D. Laing (1959) makes a similar point when he states, “Depersonalization in a theory that is intended to be a theory of persons is as false as schizoid depersonalization of others and is no less an intentional act. Although conducted in the name of science, such reification yields false `knowledge'” (p. 24). He then states:
It is just possible to have a thorough knowledge of what has been discovered about the hereditary or familial incidence of manic-depressive psychosis or schizophrenia, to have a facility in recognizing schizoid `ego distortion' and schizophrenic ego defects plus the various `disorders' of thought, memory, perceptions, etc., to know, in fact, just about everything that can be known about the psychopathology of schizophrenia or of schizophrenia as a disease without being able to understand one single schizophrenic. Such data are all ways of not understanding. (1959, p. 33)
Related to the myth of objectivity is the extraspective theoretical assertions of the DSM. The DSM assumes an external reality that allows for the judgment of what is “excessive,” “inappropriate,” “unrealistic,” and so forth. In contrast, most forms of humanistic psychotherapy focus on understanding the introspective realities of the client's experience. Once again, this extraspective bias limits the utility of the DSM to the practicing therapist.
(e.g., Caplan, 1995) have described the ways the DSM disempowers groups of
persons (e.g., women) due to the nature of the diagnostic system. We want to
speak briefly about another form of disempowerment within the DSM. All of the
theoretical views discussed above lead to the issue of the nomenclature
disempowering people in ways that may lead to more problems for the person
seeking help. For example, a person labeled “paranoid” is faced with a
double bind. On the one hand, the very nature of the person's experience of the
world is being viewed as pathological; on the other hand, most forms of
humanistic therapies rely on the person learning to have the courage to trust
his or her experience of the world. A person who is told he or she is paranoid
may not be able to engage the world because of concerns over whether the
engagement is based upon paranoid fantasies. Such a person would be rendered
powerless and helpless. Similarly, a person who could not honor his or her
dependency needs because of the diagnosis of “dependent personality
disorder” would not be able to honor parts of the self. Humanistic therapies
emphasize the honoring of all aspects of the self. Honoring of all aspects of
the self does not mean that humanistic therapists encourage paranoid clients to
act on their paranoid suspicions. Rather, it means that therapists help
individuals take their experience seriously and explore it. It is through this
honoring that full integration of experience takes place, important
differentiations and discernments are made, and exaggerated aspects such as
paranoia become assimilated, balanced, and reorganized in the form of client
development of healthy alertness and discerning judgment. Excessive dependency
becomes integrated as a healthy capacity for intimacy, trust, and reliance on
others. Pathologizing of the person's whole manner of being in the world (e.g.,
“paranoid personality disorder” or “dependent personality disorder”)
undermines the very restorative and self-healing processes which humanistic
therapists hope to mobilize.
In contrast to the DSM, humanistic psychologists take the position that psychological diagnosis is basically a professional understanding of the client and the client's struggles. We therefore believe that diagnosis is an important part of psychotherapy. However, we favor holistic, experiential diagnoses that attempt to understand persons as whole beings-in-context as opposed to preemptive labels that are concerned with inadequacies and illnesses.
Humanistic psychologists believe that diagnostic labels are professional
constructions placed upon the client and are not, in any way, reality itself.
This awareness leads humanistic psychologists to be highly cognizant of the
power associated with the labeling of others. As such, we have a responsibility
to evaluate any diagnostic nomenclature in terms of its meeting the following
Growth inducing. Persons seek
our help in order to grow, as well as to overcome problems or deficits.
As such, any nomenclature that does not point to ways in which the
therapist and client can engage one another in the therapeutic journey
is irrelevant. Relatedly, any system that conceptualizes client
struggles as unchanging (e.g., life long, characteristic of functioning
for the foreseeable future, etc.) is of limited usefulness.
Multiple perspectives on reality.
We recognize that there are innumerable constructions of reality. We
therefore evaluate any diagnostic system in terms of its acknowledgment
of alternative, equally viable, systems for understanding human
Experiential validity. We
believe that a client's experience of the world is vital for a therapist
to understand. As such, the diagnosis should actively involve the client
and respect the client's description of the problem.
Theoretical relevance. We
understand that psychotherapy is intimately tied to theories of persons.
Therefore, we evaluate all diagnostic systems in terms of their
relevance to the particular humanistic theory with which we work.
Broadly applicable. Humanistic
psychologists deal with a wide range of persons seeking our help. Any
diagnostic system therefore must be capable of understanding a wide
range of persons and problems. Thus, we evaluate any diagnostic system
in terms of its applicability to the entire gamut of human problems we
Relationship inducing. We
understand that, fundamentally, psychotherapy is a person to person
relationship in which the person of the therapist, and the relationship
that is formed, are more powerful than any specific “technique.”
Thus, any diagnostic system is evaluated in terms of its potential for
enhancing the therapeutic connection we establish with our clients.
Client empowering. We believe
that clients' experience of disempowerment is an important issue for
many persons in distress. Therefore, we evaluate all ways of
understanding clients as to the ways the system makes clients feel
empowered, respected, and that their experiences of the world are
honored by the professional.
Many humanistic psychologists do not believe that DSM meets the above
criteria. Therefore, they have reservations about using it unless required to do
so for the benefit of clients. If required to do so, they attempt to mitigate
potential dehumanizing aspects of DSM diagnosis. Finally, humanistic
psychologists continue to advocate for a more human diagnostic system.
humanistic practitioner does not believe that science as it has been
traditionally defined by psychology is the only legitimate, or even the most
privileged way of knowing when it comes to assessing various psychotherapy
options. The humanistic viewpoint is highly critical of scientism,
the belief that all meaningful questions concerning reality, and in particular
psychotherapy, can be best answered by normal science alone. Humanistic
psychologists, in keeping with the practices of scientists in other disciplines
(including natural science), oppose hegemony in science and assert
epistemological pluralism, that is, that there are multiple valid ways of
knowing. Aside from scientific knowledge, humanistic psychologists assert that
there are relevant understandings which may be appropriated from the arts,
social studies, humanities, and popular culture, for instance, in art criticism,
literary studies, biography, history, media studies, and cultural criticism.
Indeed, there is the vernacular or prescientific knowledge utilized by the
person on the street, that represents much of the population that is served by
psychotherapy, which humanistic psychologists view as extremely important in
informing practice. However, humanistic practitioners are not anti-science; we
do not dismiss science in favor of these other forms of knowledge. In fact
humanistic psychology views itself as a scientifically based discipline.
How does humanistic psychology respect these various ways of knowing and
yet itself be and remain scientific, and without falling into a groundlessly
relativistic eclecticism in which any assertion must be viewed as valid? The key
lies in the humanist's conceptualization of science. Philosophers of science
have distinguished two major approaches to conceiving science in psychology,
what Dilthey (1894) called Naturwissenschaft
(natural science) and Geisteswissenschaft
(human science). Humanistic psychologists view the natural science model, which
has dominated the field, as having weaknesses. Humanistic psychologists do not
reject outright particular research and knowledge generated by the natural
science model; we merely see it as being limited, as all research and knowledge
is. What humanistic psychologists reject is the exclusive utilization of the
natural science approach; we reject it as the model for psychological science
because, when particular methods are identified with the science itself, it is
exclusivistic in its very constitution. We view this kind of dogmatism as, in
fact, unscientific. We endorse the human
science model of science (Giorgi, 1970, 1994) because it is more
comprehensive, capable of embracing various forms of research and knowledge in a
manner that allows complementarity in an integrated overall framework. The human
science approach requires not less but more rigor, and is more scientific than
the natural science model, because it is more inclusive and capable of
apprehending a greater complexity. We view natural science methods as offering
important knowledge (and indeed draw on a substantial body of natural science
research in the next section). However, we view natural science methods as being
neither necessary nor sufficient in themselves for the science of psychology.
Most importantly, the human science model allows and mandates research methods
and conceptualizations capable of answering questions of the meaning and value
of psychotherapy in the lives of individual human beings.
The conceptualization of science endorsed by mainstream psychology
defines science by its appropriation of methods from the natural sciences and in
doing so opposes itself chauvinistically and irrevocably to all other forms of
knowledge. First, a host of limitations arise from basing psychotherapy research
on the current nosology of mental disorders. Persons with multiple disorders,
forms of suffering that do not clearly fall into any diagnostic category,
difficulties that are social in nature—pertaining to couples, families,
groups, and even society/culture—are as relevant for psychotherapy research as
DSM defined populations. According to some leading theoretical positions in
psychology (e.g., psychoanalysis), psychopathology and normality are not
mutually exclusive and the line between them is non-existent. The need for
therapy may be a practical issue to be defined by the person in light of
life-goals rather than an absolute condition whose presence or absence is
determined by an independent “expert.” Research must be able to approach the
person not just as a diagnostic category but as a whole. Second, the requirement
that interventions be specified in manualized form has the potential to be
discriminatory against some forms of psychotherapy. A cardinal rule of some
therapies (e.g., person centered) which may in principle defy manualization, is
the mandate of not imposing predefined goals or activities and allowing the
client to proceed at his or her own pace and in his or her own direction. Key
ingredients in therapy, such as empathy, honesty, hope and so on may be less
“implemented procedures” than personal virtues that are context dependent
and not easily manipulated. Research must be able to consider therapy as an open
dialogical process that is unpredictable and unmanipulable. Third, the
predetermination and standardized operational definition of the dependent
variable, i.e., the “outcome,” in the experiment, precludes research from
assessing the full spectrum and complexity of psychotherapy outcomes.
Predefinition, measurement, and aggregate analysis of results fail to capture
unanticipated, uniquely individual, and nonmeasurable benefits. Besides limiting
our understanding to what can be measured, it even fails to inform us about the
meaning of a measured change in a given variable in the participant's life.
Research must be able to capture the nonquantifiable and the meaningful.
Moreover, although experimental methodology presumes to be atheoretical, the
implicit theory guiding it is one of linear causality. The person being
analyzed, often in aggregate, is viewed as a mere outcome or effect of a
treatment or cause. Research must be able to consider the participating
individual as an agent and interpreter of the therapeutic situation. The
probabilistic support of efficacy hypotheses typical of experimental
investigations are difficult to apply to real life persons, and many studies are
virtually noninterpretable at the level of the individual person. Research
focused descriptively and interpretively on individual persons in depth is
needed in order to complement hypothesis testing by aggregate analyses and
By contrast, the human science tradition, endorsed by humanistic
psychology, asserts that because human beings are different from physical
things, they require the development of a different and special
approach—attitudes and methods—in order to be properly scientific. The
essential attitude is that of empathy, in contrast to disinterested
objectification, which may or may not be required by a particular research
problem. The best data are those that reveal the meaning of the human subject matter, for example, psychopathology
and psychotherapy, under consideration. Artistic and literary expressions may at
times, in this regard, be judged as superior to measurements by psychological
scales. Rather than being delimited to statistical calculations, analysis
requires procedures that are capable of conceptualizing the whole person;
apprehending of multiple contexts and perspectives; interrelating constituents;
articulating temporal transformations; distinguishing idiosyncratic, typical,
and highly general patterns; grasping the essential; and so on. Experimental
efficacy studies and quasi-experimental effectiveness studies (Seligman, 1996),
far from being sufficient in themselves to constitute a science of
psychotherapy, must be understood in the context of this larger scientific
search for the meaning(s) and values of these psychotherapeutic practices in
The humanistic position is supported by some of the most eminent
historians and philosophers of science in our field. Koch (1994a), for instance,
suggests that psychology is now undoubtedly in a pluralistic
phase in which the hegemony of what Toulmin and Leary (1994) call “the cult of
empiricism” is thankfully coming to an end. Koch (1994a) believes that this
breath of life in psychology is opening the way for psychology's dialogue with
the humanities, for the legitimacy of contemplative and critical theoretical
reflection, and for exciting research methodologies including the
qualitative—for example, the hermeneutic, phenomenological, and
ethnomethodological. Koch (1994b) and Toulmin and Leary (1994) assert that this
trend does not make psychology unscientific but actually makes psychology more
like such physical sciences as biology and physics in their openness to modes of
inquiry beyond strict experimentation (see also Polkinghorne, 1983, 1992). We
affirm Giorgi's (1985) broadened characterization of what makes a science,
namely that the knowledge quest is systematic, rigorously methodical, and self
critical, because it allows and even demands the greatest possible breadth in
the psychologist's scientific considerations and the uniqueness of knowledge
required to apprehend human meaning.
Psychotherapy with persons is unlike the application of a particular
chemical to an inert substance; in the former process, meanings, values, human
freedom, indeterminacy, and a multiplicity of interpretations of the matter of
“usefulness” cannot be ignored. The human
issues involved call for multiple research methods, some of which are unique
to human science. The quantitative methodology upon which empirically supported
treatments are exclusively based misses the participating individual as an
interpreter and agent in the therapeutic situation. The qualitative forms of
empirical inquiry into the process and meaning of psychological
interventions—such as case, phenomenological, existential (Daseinsanalytic),
hermeneutic, psychoanalytic, ethnomethodological, and grounded theoretical, many
of which are designed specifically to provide insight into the complex
experiential structure of the therapeutic process with close fidelity to
individual participants as such, are totally left out of consideration. Beyond
those based in natural science experimental methods, a host of scholarship that
aims at reflection and integration in practice areas is disregarded or relegated
to a low status despite their important contributions to the evaluation of
psychological interventions. The critical theory literature which subjects
various interventions to social and historical scrutiny also offers crucial
insights into the meaning and value of procedures. With regard to outcome
measures, or more appropriately outcome understanding,
any evaluation of psychotherapies should hold high the principle of viewing the
outcome in question both from the standpoint of the theory of personality and
change that internally guides it and from the standpoints of alternative
theories and perspectives. Ultimately, in the view of humanistic psychologists,
documents that purport to set guidelines for
psychotherapy practice should not narrowly focus on utility but on the more
general question of human meaning, value and purpose.
As stated above, we are not arguing that formal research, the present
nosological system, the manualization of procedures, and the random control
trial method have no value or that they have no place in the formulation of
guidelines. Rather, we believe that their being given priority over or being
used to the exclusion of other alternatives too narrowly restricts the
formulation of guidelines and is disastrous for the science and practice of
psychotherapy. The principles expressed in the empirically supported treatments
approaches should be used as heuristics among others within a broader framework
rather than as a template, that is, rather than being imposed exclusively on all
formulations of guidelines or other documents that specify principles of
effective practice. We advocate the proposal of a variety of
documents specifying criteria for effective practice, each reflecting a
different orientation, possibly achieving distinctive results, and embodying a
unique set of values. We believe that unity may be maintained in an inclusive
effort that respects this plurality of approaches in our discipline. For a
unified, comparative, and general knowledge of this variety of psychotherapeutic
guidelines or principles of effective practice, we would recommend a broader
procedure that takes maximal account of practitioners' experience; that
acknowledges numerous ways of conceptualizing the “problems” or
“situations” that are addressed by psychological interventions; that
respects modes of practice that are in part dictated by the spontaneous
directions of clients and that unexpectedly cut across or synthesize the
procedures of different schools; that utilizes case study, qualitative research
methods, socially critical thought, philosophical reflection, and various forms
of non-scientific discourse along with surveys and experiments in the evaluation
of psychological interventions.
Finally, we must say a word about the use of the general disciplinary
stock of psychological knowledge about therapy, that is, how science is to be
related and applied to practice. Psychotherapy is not itself science, an
activity solely involving the perspective and power of the professional; it is a
practical activity that involves (at least) two people. Of course one of those
people is a professional with specialized, scientific, disciplinary knowledge
and practical skills, but this general knowledge and general skill, as formed
outside any particular therapeutic situation, must be modulated by means of a
more immediate, participatory knowledge of the unique, concrete situation at
hand, which always includes the co-constitution of the one served by the
practice. In order to be properly attuned to the field of practice, the
practitioner must utilize any and all disciplinary or general knowledge in the
context of his/her concrete dialogue with the person(s) served by the intended
practice, and a highly concrete, individualized knowledge of that particular
situation. It is never to be assumed or taken for granted that a possible course
of action—whether suggested by a poem, cultural criticism, a philosophical
text, a psychological theory, a psychotherapeutic manual, an experimental
outcome study, a cost-benefit analysis of a third party payor, or even a careful
phenomenological comparison of the meanings of different intervention
outcomes—is appropriate in the particular situation. Such knowledge at best
presents relevant possibilities which must be evaluated by psychological
practitioner and person(s) served together in dialogue in light of their shared
understanding of that situation. The situation apprehended in dialogue takes
precedence both over the psychological practitioner's own individual viewpoint
and over the body of knowledge utilized by that practitioner. In other words,
scientific knowledge may and should inform
practice, but it should never dictate it as an authority in a one way manner. At
best, it provides “applicable options” to be considered within the dialogue
about the situation addressed in the therapy, this dialogue being the ongoing
and most legitimate arbiter of its meaning and value. It is not enough to say
that a clinician's experience may lead him/her to make an exception to a
“scientifically established” guideline provided that there is a compelling
rationale. Guidelines and statements of principles of practice should -recommend
without prescribing. The most important expertise of the psychotherapeutic
practitioner is his/her ability to understandingly relate scientific,
disciplinary and other perspectives to the unique situation that presents itself
in therapy. The formulation of guidelines and recommendations about principles
of practice should stress that they are for educational purposes, to contribute
to the knowledge of those who consult them and to enhance his/her understanding
of options for action rather than to override the exigencies of the concrete
situation apprehended in dialogue.
The humanist's commitment to avoid scientism is not a rejection of science, for we advocate a maximally informed practitioner who is familiar with and appropriately uses the relevant scientific literature. However, this practitioner must be conversant with more than science, and most importantly, does not impose what follows from science on those served by it but allows them, the non-scientists, the people served in the lifeworld, to play the chief role in accepting or rejecting any knowledge and procedure that the psychologist has to offer. That, we believe, is an ethical imperative of the person who is informed of scientific research in the relationship with any potential beneficiary of that knowledge. Only in this way does science humbly serve humanity rather than vitiate it.
this section we briefly review the psychotherapy research that supports
humanistic practice. Much of the research utilized has been done using aspects
of traditional “natural science” formats, such as randomized clinical
trials, although, congruent with our paradigmatic values, most of these studies
were not conducted with manualized treatments for specific disorders. We have
previously suggested that RCTs may not be the optimal method for evaluating the
usefulness of a humanistic therapy. Nonetheless, studies using this format,
preferred by others for developing guidelines, have provided data sufficient to
justify the usefulness of humanistic therapies (Elliott, 2002). We organize our
research review to first show the empirical support for the two basic postulates
that underlie humanistic practice from a wide range of perspectives. Next we
consider outcome research on a) changes in personality functioning, b) changes
in psychological dysfunction, and c) on the facilitation of specific individual
types of outcomes, or “mini-outcomes.” Finally we consider research on
from a humanistic perspective, client agency and its facilitation is the
ultimate “engine” which drives therapy. Clients, while they may not
initially be aware of it, or even experience themselves as such, are the
ultimate experts on themselves and on what will be viable healing directions for
them to take, within the constraints of society and the constraints involved in
their life structures. Therefore, therapeutic agendas must always be developed
through dialogue with clients, and represent co-constructions of therapists and
clients together. Further, the power to make change ultimately lies in clients'
hands. Clients must decide whether or not to adopt, implement and enact
therapeutic goals and directions. Change follows from how they
implement whatever they glean from the therapy experience, not from any
mechanistic impact of “expert interventions” imposed on them by the
There is a good deal of research compatible with the postulate of client
agency as the primary healing force in therapy (Bohart & Tallman, 1999).
Direct support comes from qualitative studies demonstrating client agency during
the therapy process (Rennie, 1990, 1994; Watson & Rennie, 1994), and
evidence showing that client factors account for the largest proportion of
variance in successful therapy outcome (Lambert, 1992). This latter finding has
led two experts on psychotherapy research to comment: “Another important
observation regarding the client variable is that it is the client more than the
therapist who implements the change process... Rather than argue over whether or
not `therapy works,' we could address ourselves to the question of whether or
not `the client works'... As therapists have depended more on the client's
resources, more change seems to occur” (Bergin & Garfield, 1994, pp.
825-826). Other evidence for the power of clients' own agency and self-healing
capacities comes from studies of journaling (Pennebaker, 1990; Segal &
Murray, 1994), and self-help programs (Christensen & Jacobson, 1994). Gold
(1994) has provided qualitative evidence of cases where clients spontaneously
engaged in their own forms of integrating different approaches to psychotherapy
together. Duncan, Hubble, and Miller (1997) have demonstrated that cases found
to be “impossible” or untreatable in previous therapy were typically
untreatable because the therapists did not try to coordinate their practices
with the client's frame of reference, nor utilize the client's own capacity for
self-healing. When these factors were taken into account, these clients became
“treatable.” Evidence for the existence of human agency in general comes
from studies by Howard (1996) and Rychlak (1994).
The second postulate is that the therapist's presence as person and the
therapeutic relationship are the basis of the therapist's contribution to the
healing process, more so than the particular type of therapy practice or the
techniques used. There is considerable evidence for this postulate, perhaps more
so than for any other “fact” about the nature of psychotherapy (Norcross,
2002). A number of studies have found that some therapists are more effective
than others (Lambert & Bergin, 1994; Najavits & Strupp, 1994), even in
cases where therapists are following treatment manuals (Luborsky, McClellan,
Woody, O'Brien, & Auerbach, 1985). Moreover, therapist/relationship factors
account for 30-35% of the variance in outcome (Gaston, Marmer, Gallagher, &
Thompson, 1991; Lambert, 1992), considerably more than the 15% accounted for by
techniques or therapeutic approaches (Lambert, 1992). The alliance between
therapist and client appears to be the most important factor in outcome across
psychotherapies (Horvath, 1995), including even the use of psychotropic
medication (Krupnick et al, 1996).
In particular, there is evidence that therapist empathy correlates with
outcome (Bohart, Elliott, Greenberg,
& Watson, 2002), as does therapist affirmation, warmth, or positive regard
(Farber & Lane, 2002). Therapist congruence or “self-relatedness” also
correlates with outcome (Klein, Kolden, Michels, & Chisholm-Stockard, 2002;
Orlinsky, Grawe, and Parks, 1994). On the converse side, studies have found that
therapists whose behaviors and strategies are judged as punitive, belittling,
cold, critical, hostile, or rejecting are less effective (Gaston, Marmer,
Gallagher, & Thompson, 1991; Najavits & Strupp, 1994). A qualitative
study by Schneider (1984) found that clients' perceptions of positive counselor
characteristics included their personal involvement, which consisted of being
straightforward and integrated, caring, nonjudgmental, and experientially
empathic. Secondarily, perception of positive counselor characteristics included
the capacity for technical restructuring, which was comprised of cognitive
restructuring, experiential restructuring, exploratory restructuring, and
mirroring. Finally, perception of positive characteristics included other
positive themes such as intuition and authoritativeness. Negative
characteristics included inappropriate personal involvement which included being
seen as deceptive and lacking in personal integration, excessively friendly or
aloof, excessively judgmental or nonjudgmental, and unempathic, as well as
rigid. Schneider concluded that effective counselors were seen as appropriately
personally involved, warm, empathic, relatively nonjudgmental, integrated,
knowledgeable about what they are doing, and using appropriate skills. The
importance of maintaining an “optimal therapeutic distance”—not being
either overly involved or overly disengaged—has also been supported by Leitner
In sum, research supports the humanistic postulate that client agency is
a major generative factor in therapeutic change and that the therapist and
therapeutic relationship are more important than the therapy or method
practiced. Effective therapists take into account the client's frame of
reference, and facilitate and rely upon clients' own self-healing capacities. In
addition they are affirming, empathic, congruent, knowledgeable and skilled in
what they do, and maintain an optimal therapeutic distance.
major focus of humanistic therapy is the promotion of positive personality
growth and development. The first question is therefore whether there is
evidence that humanistic therapies do promote positive personality change. With
regard to client-centered therapy, the most empirically studied of the
humanistic therapies, research has indeed found that client centered therapy
promotes positive personality growth and self-concept change in a wide range of
clients (Ends & Page, 1959; Elliott, Greenberg, & Lietaer, in press;
Seeman, 1965; Shlien, Mosak, & Dreikers, 1962). Gestalt therapy has been
found to lead to greater adjustment (Beutler, Frank, Schieber, Calver, &
Gaines, 1984; Cross, Sheehan, & Khan, 1982; Strumpfel & Goldman, 2002).
Bednar and Kaul (1978) review a variety of studies on marathon and encounter
groups which find positive changes in things like locus of control, self image
changes, personal actualization scales, interpersonal orientation, behavior
ratings, self-ideal congruence, self-direction, and creativity.
In terms of helping clients overcome psychological dysfunction,
client-centered therapy has been found to help clients alleviate personal
distress across a wide range of kinds of problems in living (Elliott, Greenberg,
& Lietaer, 2002). This includes reduction in symptomatology in depression,
schizophrenia, anxiety disorders, interpersonal problems, stress associated with
cancer, and personality disorders. Client-centered therapy has also been shown
to facilitate alcoholics staying abstinent (Ends & Page, 1957), and the
reduction of delinquency in adolescents (Truax, Wargo, & Silber, 1966). A
psychodynamic-interpersonal approach which combines elements of both
psychodynamic and humanistic therapy has been found to be as effective as a
cognitive-behavioral approach for depression at a one-year follow-up (Shapiro,
1995). Focusing procedures have been shown to be helpful to clients coping with
cancer, and in weight reduction (Greenberg et al, 1994). Process-experiential
therapy has been shown to help clients overcome depressive symptomatology
(Greenberg & Watson,1998). Gestalt therapy has been shown to be helpful with
depression (Beutler, et al., 1991).
In sum, there is evidence that client-centered therapy, Gestalt therapy,
and encounter groups do indeed promote personal growth as hypothesized by
humanistic theory. In addition, client-centered therapy has been shown to be
helpful to individuals with a wide range of DSM dysfunctions. Recently, Elliott
(2002) and Elliott, Greenberg and Lietaer (in press) have concluded that there
is sufficient evidence that these and some other humanistic therapies, such as
process-experiential therapy, should be considered "empirically supported
(1986) has emphasized the importance of looking at “mini-outcomes” in
psychotherapy research. Mini-outcomes are specific in-session outcomes that are
associated with psychotherapy process. From a humanistic point of view, these
changes can be considered to be real outcomes of psychotherapy because they are
changes that occur as a result of the therapy and because they often represent
outcomes desired by clients. However, they do not count as outcomes under the
criteria of the empirically supported treatments movement because they are not
alleviations of DSM (or similarly defined) disorders. A wide range of specific
mini-outcomes has been found in humanistic therapies. For instance, the Gestalt
two-chair procedure has been found to help clients resolve internal conflicts
(Greenberg, 1984), and the Gestalt empty-chair procedure has been found to help
clients resolve anger and hurt feelings and other forms of “unfinished
business” with significant others (Paivio & Greenberg, 1995). An
“evocative unfolding” procedure (Rice & Saperia, 1984) has been found to
be useful in helping clients resolve feelings about situations where they
behaved in ways they did not understand. Mahrer's (1996) experiential therapy
has been shown to be associated with the production of several “good
moments” (Mahrer & Nadler, 1986) in psychotherapy, such as the arousal of
strong feeling, and the appearance of new personality-process states (Mahrer,
Lawson, Stalikas, & Schachter, 1990). Clarke (1989, 1991) studied the
process of “creating meaning” in emotional crises and found that therapists
who used metaphor, who helped condense feelings into words, who helped
synthesize the relationship between thoughts and feelings, and who helped
symbolize the discrepancy between a cherished belief and an experience,
facilitated the achievement of greater clarity and the reduction of discomfort
with respect to the crisis. Other findings from studies on experiential
therapies have found that they lead to: better understanding of self, problems,
and others, experiencing of hope and relief, and coming to own or value aspects
of the self (Greenberg, et al., 1994). These findings of specific effects from
humanistic therapies are important first because these mini-outcomes have been
found to correlate with eventual global therapeutic outcome (Greenberg et al.,
1994). Second, these changes are important because clients often come into
therapy seeking outcomes such as increased insight, greater awareness of
feelings and experience, a greater capacity to experience, or resolution of
unfinished business with significant others.
have already discussed the research for the two basic postulates of effective
humanistic practice: respecting client agency and establishing a facilitative
therapeutic relationship. In addition humanistic therapists generally believe
that therapy is more effective when it includes a focus on the emotional and
experiential dimensions of human functioning, when it facilitates dialogue which
takes clients to deeper levels of feeling and thinking, and when therapy is a
collaborative process. In regard to the first of these, a focus on feelings and
experience has been found to be associated with positive therapeutic change
(Greenberg et al., 1994; Mathieu-Coughlan & Klein, 1984; Orlinsky &
Howard, 1986). With regard to the second, Toukmanian (1992) has found that
therapist responses oriented towards facilitating clients' differentiation and
reorganization (“reschematization”) of meaning facilitate deeper levels of
client perceptual processing. Deeper levels of client perceptual processing have
in turn been found to be associated with better client outcome. Sachse (1990,
1992) has found that therapist responses which challenge the client to go deeper
into their experience do indeed facilitate this process, and client depth of
processing is associated with therapeutic outcome. Wexler and
believe that the individual therapist is far more important than the kind of
therapy being practiced or the particular methods being used. In fact, different
therapists practicing “the same” therapy may operationalize its methods and
principles in widely different ways. For instance, it has been found that
client-centered therapists, while remaining true to general client-centered
principles, practice in widely different ways (Hart, 1970), and it is well known
that Gestalt therapists differ widely among themselves. Different therapeutic
modalities are really different means whereby different therapists optimize
their own particular ways of being helpful. Thus, diversity within any given
therapeutic approach is not something to be manualized away, but rather to be
prized. This means that conclusions concerning specific approaches and who they
are “for” are somewhat out of paradigm. With this proviso in mind, however,
there is some research suggesting there are those for whom some approaches are
more helpful than others. For instance, there is some evidence that clients with
better general social skills who are high in reactance (i.e. independence) do
better with client-centered procedures, while clients low in reactance do better
with a Gestalt approach (Greenberg et al, 1994). In addition, internally
oriented clients may profit more than externally oriented clients in
client-centered therapy. Clients' general openness and interest in inner
experience may be useful predictors of success in experiential therapy. In
encounter groups, clients whose expectations do not match the practices of the
group are more likely to have a negative experience (Bednar & Kaul, 1978).
Mahrer (1996) has found that his experiential approach can be used by clients,
regardless of diagnosis, who are comfortable with his therapy format. His
approach to differential therapeutics is simply to have a trial session or two
with the client to see if he or she finds it a comfortable approach. Overall,
these findings suggest, not that a particular therapy should be prescribed for a
particular kind of client, but rather, that therapists and clients together
might wish to consider the use of different styles and techniques, depending on
what fits with the client.
sum, based on the evidence, effective humanistic therapists are collaborative
rather than highly directive, warm, empathic, congruent and genuine, provide a
safe, understanding environment, support the expression of feelings, help
clients organize and articulate their experience, and help them clarify and
resolve problems. They respond in ways that facilitate experiencing and moving
to deeper levels of understanding. They may use sensitively appropriate
experiential exercises at appropriate times, such as Gendlin's (1996) focusing
technique, or the Gestalt two chair or empty chair techniques. They confront
clients' strengths and resources, and confront in an experiential manner.
Therapists who practice in accord with these conclusions can be said to be
practicing in an “evidence-based” or “empirically-supported” fashion.
are recommended principles for the practice of helpful and ethical humanistic
psychotherapy. These recommendations reflect general humanistic principles and
what has been established through empirical research. Within the general
framework of these principles individual humanistic therapists practice in
different ways while still remaining faithful to these principles.
For Whom Is Humanistic Therapy Appropriate?
first criterion for a client engaging in humanistic therapy as opposed to some
other kind of therapy is that the client finds the process useful and rewarding.
It is appropriate for clients who find the process enriching or emotionally
challenging in a positive way. DSM diagnosis is irrelevant to whether or not a
client chooses humanistic therapy, since humanistic therapies are not conceived
of as medical-model treatments for disorders. Matching humanistic therapy with
diagnosis is not relevant within this paradigm. Clients typically choose
humanistic therapy because they have more fundamental, important, or vital goals
than only the elimination of a specific DSM disorder. They may choose humanistic
therapy because they ultimately wish to know more about their basic choices in
life, their basic values, to access their deeper potential, and to live deeper,
more authentic lives (Mahrer, 1996). Or they may choose a humanistic therapy
because they want to be treated or viewed in a certain way, i.e. as whole
people, with competency and personal dignity, over and above their having
problems in living.
Humanistic therapy is therefore appropriate for people who frame their
goals as striving for deeper personal development rather than symptom removal
alone. If a client is primarily interested in symptom removal and wishes to
achieve that through the use of a specific medical-model type of technological
treatment which has been empirically studied for that disorder, the humanistic
psychotherapist will either provide such a treatment if he or she is qualified
and wishes to do so, or will refer the client. Humanistic therapists recommend
alternative approaches if it better serves clients' needs. Otherwise, if clients
decide they wish to explore their problems in a more holistic fashion, the
humanistic therapist will work with them. In so doing, humanistic therapists may
themselves utilize symptom-focused approaches as an initial step towards more
holistic work if necessary. It is important to note that clients may not seek
deeper and more holistic changes initially, and that humanistic therapists do
not demand such changes, but that they provide the opportunity for such changes
in conjunction with the client's needs as therapy proceeds (Schneider & May,
This means that humanistic therapists prefer to work in contexts where clients choose to enter therapy or seek humanistic services volitionally. If working with someone required to seek services, say an adolescent brought by parents, or a court-referred client, humanistic therapists stay true to their principles, treating these individuals as agents, rather than as “cases” to be “treated” and “cured” by the expert of their “disorder.” Humanists believe in one sovereign entity dialoguing with another, that if they do not take the client's viewpoint seriously and dialogue with them as a sovereign agent, then no therapy can take place.
are many different modalities of humanistic therapy. However humanistic
therapists can be said to be practicing effectively if the following conditions
A. Client's role in therapy. First,
humanistic therapists respect the self-healing potentialities of clients. They
also respect and rely upon clients' agency. They do not adopt a paternalistic
attitude of expert who is to decide for the client what the appropriate
treatment is and what the appropriate changes are for the client to make.
Clients must be fully involved in all treatment decisions as co-equal
participants, both as a matter of ethics and as a matter of effectiveness.
Solutions always take into account the client's frame of reference.
B. Diagnosis and therapeutic process. The
following issues apply:
1. The practice of humanistic psychotherapy is highly individualized. Humanists focus on the uniqueness of the individual, and problems are embedded in the whole person-situation context. In that sense there is no such thing as a standardized problem. It is therefore usually out-of-paradigm for the therapist to choose a standardized treatment for the client based on some nomothetic category. DSM diagnosis is not typically used as a matter of making treatment decisions. If diagnoses are used, they are the types of diagnosis which help therapist and client together decide upon goals and strategies, and are usually more specifically framed in terms of problems, life themes, and issues with which the client is struggling. These kinds of diagnoses are always provisional, and subject to continual re-evaluation.
2. In this regard, humanistic therapists favor diagnosis which is
holistic, experiential, and descriptive rather than evaluative, and which tries
to capture the flavor of the whole person in his or her life context. This is in
contrast to a medicalized approach that focuses on the attachment of
diagnoses which represent the person primarily in terms of pathology.
Diagnostic systems are evaluated in terms of their relevance to theory, the
range of applicability for understanding all human beings, their ability for
enhancing therapeutic connection with clients, and their ability to help clients
feel respected and empowered.
3. Most humanistic therapists adopt an inductive, discovery-oriented
approach to psychotherapy practice. Solutions to client problems are
individually and jointly created and discovered through the evolving therapy
process. In this sense solutions and directions in therapy are often new and
unexpected emergent products of the particular interactive process jointly
created by therapist and client. This makes the concept of a standardized preset
outcome goal associated with a preset standardized treatment protocol irrelevant
for many humanistic therapists. As a result, developing a preset treatment plan
for a client could be out of paradigm for many practitioners.
4. In contrast to a prescriptive approach to psychotherapy where the
expert therapist decides upon a treatment for the client, the humanistic
therapist's goal is to be able to respond flexibly and creatively with a given
client. The basic therapist skills are that of flexibility in the moment and
responsiveness. Humanistic therapists are adept at process skills: tracking the
unfolding process between themselves and the client, and responding in a
facilitative way to whatever potentialities are emerging in the moment.
5. The core process in most humanistic therapies is therefore dialogue.
It is through co-constructive dialogue with clients that directions and
solutions in therapy emerge. Humanistic therapists may use a variety of
techniques but these are chosen with sensitive relevance to what is happening in
a given moment between therapist and client, and are used as part of the
therapeutic dialogue. This means that techniques are not applied
mechanistically, but rather are used as part of the ongoing discovery and
C. Therapeutic relationship. The following
1. Humanistic therapists strive to provide a trusting relationship,
consisting of an affirmative, respectful attitude towards the client, as well as
empathic understanding of the client's frame of reference. This means that they
basically respect their clients as agents in their own right, as the experts on
their own experience, and as authentic sources of experience. They listen to
clients as “equals”, are interested in clients' subjective worlds, grant
that these subjective worlds have their own internal coherence and validity,
realize that all change must flow from and respect the intrinsic logic of these
subjective worlds, and that all change is ultimately made out of the “stuff”
of these subjective worlds—including clients' experiences, values,
philosophies, fears, deepest wishes, and intuitions.
2. Additionally, humanistic therapists are mutually involving,
transparent, authentic and genuine. This means they are “in relationship” to
the client. They do not merely “provide” a relationship as if it were a drug
or a palliative. Being “in relationship” means that they are willing to meet
the other person as another person.
This means the humanistic therapist is willing to be human, i.e. to be
personally affected by the encounter with the client, share feelings and
thoughts, disclose to the degree that it is respectful of the particular
relationship with the client, allow him or herself to be “known” by the
client, and promote appropriate mutual two-way empathic sharing.
3. While respecting the client's subjective world, the humanistic
therapist, in order to be genuine, also shares his or her own perceptions. These
are shared as his or her own
perceptions, not as “the truth provided by the expert.” In this respect,
humanistic therapists may confront when appropriate. They give their own
perspectives on the client's behavior and experience, while respecting the
client's perspective. Confrontations are accomplished in a way which emphasize
client potentialities and strength.
4. Humanistic therapists realize that it is important to respect the
“psychological and physical space” of the client and the client's
boundaries. They therefore strive to maintain an optimal therapeutic distance
and to pay close attention to demonstrating respect for the client’s
5. Within the therapeutic relationship humanists strive for an optimal
balance between therapeutic support and challenge, carefully titrating levels of
support and challenge in consideration of the resilience of the client and the
trust level achieved within the therapeutic relationship. Humanists challenge
clients to go further through sensitively timed confrontations, and through
responses which invite clients to venture deeper into their experience,
thoughts, values, and issues.
6. Because the relationship is genuine and collaborative, humanistic
therapists are willing to be wrong, and to be educated by the client. They
realize that the client knows more about some things than does the
therapist—particularly about the client. Therapists are particularly willing
to be educated by those whose experiential backgrounds are different, e.g.,
whose cultural, gender, or other kinds of experiences are different. Humanists
realize that all therapeutic growth emerges creatively out of a synergistic
meeting of two subjective realities, and thus whatever the therapist has to
offer must be mapped into, reworked, and transformed to meet the different
experiential reality of the client. No theoretical idea, no technique, no
therapeutic goal, will look “the same” or have the same meaning in different
interactions with different client subjectivities.
7. Humanistic therapists recognize that any therapeutic engagement occurs
with a context that is situated culturally, historically, geographically, and
socio-politically. Humanistic therapists are sensitive to the need to bring to
awareness humanly relevant contextual resources and potential obstacles that
because of situational inequities might not be immediately discernable to the
D. Facilitative therapeutic processes. The
following issues apply:
1. Humanistic therapists pay attention to client experience and invite
clients to move into deeper levels of experiencing of self and of relationships.
2. Humanists believe that therapeutic learning and change is most often
promoted by processes that involve experiencing and are not merely cognitive and
intellectual. Accordingly, they facilitate nonrational, intuitive, and
experiential modes of knowing. They believe such modes of knowing are
particularly involved in liberating client potential and creativity for new ways
of being and behaving.
3. Humanists may therefore use techniques and procedures that facilitate
nonverbal, bodily, or experiential modes of self and interpersonal exploration
4. In this regard humanists are also interested in the facilitation of
emotional experiencing and expression, and may strive, as part of liberating
client potential for change, to provide the opportunity for the experiencing and
expression of strong levels of feeling.
Social and Legal Matters
Beyond possible legal requirements, humanists would not typically require a
client to seek medication. However humanists make clients aware of the
possibility of the use and implications of medication, and help clients decide
for themselves if they wish to avail themselves of such services.
B. Societal Responsibilities.
Humanists are agents of society as well as of the individual and will take
action to protect society from clients, even at the cost of the destruction of
the therapeutic relationship, if necessary.
C. Suicide. Humanistic
psychologists consider the issue of client suicide most seriously, and take
seriously their duty to have a cogently thought out intellectually rigorous
position that is respectful of client integrity.
D. Empirically Supported Treatments.
Humanistic psychologists recognize that for purposes of demonstrating the
usefulness of humanistic psychotherapies to some governmental agencies and
third-party payers that there is some usefulness in being able to show that
humanistic therapies can be supported under the empirically supported treatments
guidelines. Accordingly Division 32 supports and appreciates the efforts of
researchers who have shown that some humanistic therapies meet the criteria for
being empirically supported treatments (Elliott, 2002; Elliott, Greenberg, and
Lietaer, in press). Nonetheless, we reiterate that the empirically supported
treatments criteria are not paradigmatically congruent with humanistic theory
and practice and are therefore not adequate for the evaluation of humanistic
psychotherapies. The grounding and legitimzation of humanistic psychotherapies
is based in other criteria, as have been spelled out in this document.
The following is an ideal framework for training humanistically oriented
therapists. In our view, students
should receive such training, over and above their conventional training, if
they are to be trained within a humanistic context. Drawing from a humanistic
philosophical base, the training of humanistic therapists reflects a variety of
orientations. In general, these
orientations embrace a holistic conception of the human being, draw on a growth
model of dysfunction, emphasize subjective processes, and stress dialogue over
interpretation or advice-giving. Humanistic
therapy training includes but is not exhausted by client-centered, gestalt,
somatic, existential, expressive,
experiential, constructivistic, transpersonal, archetypal, imagistic,
humanistic-psychoanalytic, and group
process modes of practice.
Specifically, humanistic therapy training entails a broad and deep
understanding of persons. This
understanding considers people in their intrapersonal, interpersonal, cultural,
political, economic, mythic, spiritual and historical contexts.
The thrust of humanistic therapy training is to cultivate a whole human
being as a ground for that human being's development as a practitioner.
In keeping with recent therapy process and outcome studies, humanistic
therapy training attends to the person of the practitioner first, and
secondarily to his or her technical abilities. In particular, humanistic therapy
training emphasizes the personal growth of the therapist-trainee through courses
in holistic psychology and psychotherapy, philosophy, the arts, group process,
critical thinking, and personal therapy.
Ideally, humanistic therapy training also entails a systematic immersion
in qualitative modes of inquiry. While
quantitative methodologies may be drawn upon as an adjunct, humanistic therapy
training emphasizes such qualitative methodologies as case studies, grounded
theory, ethnomethodology, relational studies, and hermeneutics to vivify the contexts
within which clients dwell.
Central to humanistic therapy training is the attention to process
dimensions of therapeutic encounters as well as to content aspects.
By process dimensions, we mean attunement to how clients speak or express
themselves as well as to what they say or convey overtly.
Humanistic trainees develop a sensitivity to tacit areas of
awareness--gestures, vocal modulations, fluctuations in breathing, facial
expressions, body postures, and interpersonal
atmospheres, as well as attune to more overt modes of meaning and
expression. In addition to learning
about test data, the DSM, and standardized manuals-which from our perspective
have significant but limited value-humanistic trainees learn to formulate rich,
phenomenological descriptions of their clients that take into account the
multifacetedness of clients' experience.
In short, humanistic therapy training utilizes humanistic philosophical
principles to cultivate sensitive and well-rounded practitioners.
These practitioners provide a range of conditions to clients through
which clients can grow, develop meaning, and realize potentials.
in Humanistic Practice
As members of the American Psychological Association, humanistic
psychologists have developed ethical positions consistent with APA's (1992)
Ethical Principles of Psychologists and Code of Conduct. In order to document a
uniquely humanistic perspective on psychological ethics, this section of the
Guidelines will interpret the general ethical principles of the APA
(specifically the Preamble and General Principles section of the ethical code)
from a humanistic perspective. We will do this by mirroring the format of the
Ethical Principles, commenting on each section in terms of the special ways that
humanistic psychologists apply the principles.
It is important to state that nothing written in this section should be
interpreted as implying that Division 32 does not endorse APA=s
code of ethics. Much of what is written should be interpreted as implying that
all professional decisions have many layers of complexity as well as ways they
may be advantageous or harmful to those being served. Thus, humanistic
psychologists evaluate specific actions in terms of a number of different value
positions. By elaborating on the code of ethics, humanistic psychologists are
laying out a model of how certain core values can, and perhaps should, be used
in the application of the ethical principles.
Humanistic psychologists agree that they must develop a valid and
reliable body of scientific knowledge based upon research. This knowledge is
necessary to improve the lives and knowledge of persons and society. Further,
humanistic psychologists emphasize the importance of viability (i.e., utility)
in the development of knowledge. They also support the central importance of
freedom of inquiry and expression in research, teaching, and publication. In
particular, they believe that the development of valid and reliable scientific
knowledge has to include perspectives in addition to traditional experimental,
survey, statistical, and other positivistic research designs. These additional
approaches include phenomenological, narrative, qualitative, interpretive, human
science methodologies, case studies, and other post-positivistic methods and
designs. Therefore, humanistic psychologists strongly support the freedom to
publish, teach from, and draw conclusions from these varied approaches to
science. They believe that such methodological eclecticism is vital for the
development of a human science -- a science which results in human service, not
just published data.
Like all professionals, humanistic psychologists are charged with
evaluating the relevance of studies for their professional activities. In order
to make such an evaluation, humanistic psychologists consider the relevance of
the study to the mission of helping human beings live better and more whole
lives. Further, before using any study to make a decision that affects the
welfare of persons or the public, humanistic psychologists carefully evaluate
the study on the basis of whether the research methodology employed may distort
the understanding of the problem and therefore lead to conclusions that are
incomplete or detrimental to the safety and general welfare of those whom we
Humanistic psychologists agree that it is important to aspire to the
highest standards of professional conduct. They also encourage ethical
responsibility in colleagues, students, supervisees, and employees. Consistent
with humanistic principles, this encouragement involves genuine respect and
concern for other persons. In particular, humanistic psychologists openly
acknowledge that ethical principles, as abstract values and ideals, are
culturally variant and are subject to different interpretations by different
persons. In their discussions with colleagues, students, supervisees, and
employees, humanistic psychologists stress the spirit of the ethical principles
over the letter of any particular behavioral mandate and explore the concrete
ways that spirit may be manifested in concrete actions. Finally, consistent with
humanistic principles, they recognize that behaving in a professionally ethical
manner means being committed to their own personal growth such that they live
their lives with integrity and fullness.
Consistent with the Preamble to the Ethical Principles of Psychologists,
humanistic psychologists strongly support the ethical mandate to respect and
protect human and civil rights. They do not knowingly participate in or condone
unfair discriminatory practices. In addition, humanistic psychologists believe
it is important to sensitize themselves and others to both the overt and hidden
discriminatory practices in their culture and the world at large. Humanistic
psychologists, consistent with their values of openness to others and the
healing nature of personal empowerment, make efforts to expose themselves to an
understanding of the experiences of non-dominant group members and attempt to
provide a space for those members to communicate with the majority culture. In
their respecting of ethical and civil rights, humanistic psychologists attend to
the powerful and personally meaningful ways that society and culture are
intricately embedded with (and sometimes even formative of) the person's
Humanistic psychologists agree that psychologists should maintain the
highest levels of competence in their work, recognize the boundaries of their
expertise, and not practice beyond such boundaries. In addition, they believe
that ongoing education is a vital component of personal and professional growth
and competence. Since humanistic psychologists are aware of the limitations of
life experiences and theoretical understandings based upon their particular
sociocultural context, they actively strive to develop their competence in
engaging members of groups from other sociocultural contexts. Humanistic
psychologists, when possible, choose continuing education experiences that are
consistent with humanistic ideals and principles with regard to diagnosis,
therapy, and other professional issues. Due to their profound respect for the
felt experience of others and their belief in the person being the expert on his
or her felt realities, humanistic psychologists follow the Ethical Guidelines
mandate of "exercising careful judgment" when working with persons or
groups where "recognized professional standards do not yet exist" (APA,
1992, p. 1599). In these areas, they interpret the APA mandate to make
"appropriate use of scientific, professional, technical, and administrative
resources" (APA, 1992, p.1599) to mean that humanistic psychologists should
critically evaluate whether the resources being used further the goals of
Humanistic psychologists seek to promote integrity in the science,
teaching, and practice of psychology through the humanistic value of reflecting
critically on the effect of their own belief systems, values, needs, and
limitations and the effect these have on their work. Further, humanistic
psychologists also serve as valuable critics of more mainstream approaches by
making explicit the hidden value assumptions in them. When critiquing these
approaches, humanistic psychologists remain as honest, fair, and respectful as
they are when dealing with any person or group. In addition, they do not make
statements that are knowingly misleading, false, or deceptive.
With regard to empirical research, humanistic psychologists are aware
that any research paradigm has value assumptions and biases inherent in the
methodology. They tend to not accept anything as scientific until that
phenomenon has been explored through the use of both traditional and alternative
(narrative, phenomenological, qualitative, and so on) research paradigms.
Humanistic psychologists are particularly cognizant of the ways that
reductionistic approaches to psychology may result in psychologists making truth
claims that, in actuality, are misleading or harmful to those persons being
served. They also are cognizant of the ways such "scientific truths"
may, due to the errors and biases inherent in reductionistic approaches,
actually undermine the public's confidence in psychology and thereby deter the
public's use of needed services.
Humanistic psychologists understand that issues of dual relationships are
complex and difficult to sort out. On
the one hand, most professional relationships are unavoidably complex and there
are occasions where these complexities can be beneficial to those we serve. On
the other hand, humanistic psychologists believe that improper and potentially
harmful dual relationships should be avoided. When the relationship is
experienced as improper by either the psychologist or the person being served,
humanistic psychologists view the relationship as inappropriate. Humanistic
psychologists continuously monitor their experience of clients, students,
supervisees, and employees in order to ascertain when a relationship begins to
feel improper. In addition to being open to feedback from any professional or
group about when a relationship is improper, humanistic psychologists readily
seek out the opinion of colleagues concerning situations about which they feel
unsure. Such feedback is carefully and respectfully considered by the humanistic
psychologist in determining the propriety of the relationship in question. When
confronted with an unintended dual relationship, as sometimes happens in many
communities and situations, humanistic psychologists clarify with themselves and
their client, student, supervisee, or employee the nature of their role and
psychologists then monitor every decision they make concerning these persons to
insure that it is a decision consistent with their primary moral and ethical
responsibility to foster the growth and development of others.
Humanistic psychologists recognize that the persons who seek our services
often feel profoundly vulnerable and threatened. They also understand that such
persons may feel exploited by people in positions of power. Therefore,
humanistic psychologists refrain from inappropriate, especially sexual
involvements with current or former therapy clients in accordance with the
Ethical Principles of Psychologists and laws.
C: Professional and Scientific Responsibility
Humanistic psychology's emphasis on the importance of taking personal
responsibility and flexibility in engaging each client in his or her uniqueness
complies with the ethical principle of accepting "appropriate
responsibility for their behavior, and adapting their methods to the needs of
differing populations" (p. 1599). In addition to consulting with, referring
to, or cooperating with "other professionals and institutions",
humanistic psychologists consider the effect of such consultation and
cooperation on the client's personal growth. For example, humanistic
psychologists carefully consider both the potentially beneficial and the
potentially damaging effects of psychotropic medications on the evolving
therapeutic relationship when making a decision about referring for medication.
In helping clients make decisions about psychoactive substances, humanistic
psychologists are committed to the right of the client to choose freely whether
to medicate with minimal coercion by others. As a general rule, humanistic
psychologists do not believe that such medications (or any other invasive
procedures) should ordinarily not be prescribed without an ongoing weekly
therapeutic relationship with a primary therapist. Absent such a relationship,
medication only can provide a chemical controlling of behaviors without
potential for a transformation of suffering into a growth experience and may
negatively effect the prospects for future success should such a relationship
D: Respect for People's Rights and Dignity
A central tenet of humanistic psychology is that all human fundamental
rights, dignity, and worth must be respected. In this regard, humanistic
psychologists believe that clients have the right to choose the type of therapy
as well as whether to take psychotropic medications. Such respect is central to
humanistic psychology's view of the client as the empowered consumer of
psychological services. Since humanistic psychologists also respect the right to
privacy, confidentiality, and self determination, situations may present a
conflict between the client=s
right to confidentiality and society=s right to know. In such circumstances,
humanistic psychologists attempt to weigh, in good conscience and with an open
mind, the existing literature on the advantages and disadvantages of each
position as well as the relationship between these literatures and the
particular client's life. While humanistic psychologists understand that they
have the right to inform their clients that a disclosure of confidence may be
beneficial to clients as well as to others who have concerns, humanistic
psychologists understand that confidentiality is always the right of the person
seeking our professional help. These understandings point humanistic
psychologists to the importance of dialogue in determining when confidentiality
will or will not be broken as well as the humanistic position that the breaking
of professional confidence should be done only under extraordinary
In addition, situations may present a conflict between the principle of
self-determination and the principle of potential harm to self or others. Once
again, the humanistic psychologist attempts to resolve such conflicts by
weighing, in good conscience and with an open mind, the existing literature on
the advantages and disadvantages associated with each position and their effects
on a particular client=s
life. These are often situations in which humanistic psychologists seek
consultation from trusted humanistically-oriented colleagues. In these, as with
all professional circumstances, careful, honest, and respectful consideration is
given priority over routine, manualized, prescriptive, automatic, impulsive
E: Concern for Others' Welfare
Humanistic psychologists seek to contribute to the welfare of those with
whom they interact professionally. In so doing, they take particular pains to be
sensitive to "real and ascribed differences in power between themselves and
others" (APA, 1992, p. 1600); they attempt to empower others to a position
of equality with psychologists. To do this, they support the client=s
self-healing capabilities by empowering the client in the therapeutic
Consistent with feminist psychology's awareness raising as well as APA's
emphasis on non-sexist language in professional writing, humanistic
psychologists are particularly sensitive to the relation between language and
power. For example, humanistic psychologists tend to prefer terms like
"client" over "patient", "research co-participant"
over "subject", and so on; the former terms imply greater equality and
mutual expertise than the latter ones and sensitize the public to the consumer=s
rights. Finally, humanistic psychologists stress qualities such as genuineness
and openness and believe that any attempt to mislead others during or after
professional relationships undermines the fundamental healing properties of the
therapeutic encounter. Humanistic psychologists also believe that it is
unethical to lead the public into thinking that the profession of psychology has
reached agreement on singular, specific, empirically-based treatments for each
"disorder." Due to their respect for the public, humanistic
psychologists continue to sponsor discussion and education about these issues.
F: Social Responsibility
Humanistic psychologists are aware of their responsibilities to the
society in which they work and live. They apply and make public their knowledge
of psychology in order to contribute to human welfare. They attempt to educate
the public with regard to critically analyzing the values hidden in all
psychological work. Humanistic psychologists recognize that law and social
policies must be developed that serve the psychological interests of their
clients and the general public. In other words, they recognize that, along with
the privileges of being a humanistic psychologist, they have an obligation to
participate in the political process of the development of society. Consistent
with these principles, humanistic psychologists often contribute a portion of
their professional time to activities with little or no monetary advantage.
recommendations we have made for humanistic practice are based in principles
that have evolved and developed from a longstanding community of practice, and
most have been supported by empirical research. We believe that if therapists
practice within these recommendations, then they will be practicing in an
effective and ethical humanistic way. However, as recommendations, they do not
meet all contingencies of practice. There may be occasions, or methods of
practice, which depart in various ways from these recommendations, yet still may
be considered effective and ethical given specific circumstances. Such instances
must be evaluated on an individual, case-by-case basis.
Furthermore, these recommendations are not meant to be fixed for all
time. This is a living document and will be revised to meet the needs of
consumers, to profit from the experience of practitioners, and to be informed by
further empirical research.
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 The "Recommended Practices and Principles for the Provision of Humanistic Psychosocial Services: Alternative To Mandated Practice and Treatment Guidelines" is a statement of policy of American Psychological Association Division 32, Humanistic Psychology. In promulgating these recommendations, the Division is not speaking for the American Psychological Association or for any other division or unit of the American Psychological Association.
Dr. Arthur Bohart, Chair of the Division 32 Task Force that wrote this document, is a Professor of Psychology at California State University Dominguez Hills, and an adjunct faculty member at Saybrook Graduate School. He may be contacted at the following address for further information: Department of Psychology, California State University Dominguez Hills, Carson, CA 90747; e-mail: firstname.lastname@example.org or email@example.com
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