Carl Rogers and Heinz Kohut

Transcription

1 Psychoanalytic Psychology Copyright 2000 by the Educational Publishing Foundulit 2000, Vol. 17, No. 2, /00/$5.(KI DOT: 10.K137// Carl Rogers and Heinz Kohut A Historical Perspective Edwin Kahn, PhD City University of New York Arnold W. Rachman, PhD Adelphi University Earlier psychoanalytic thinkers, with their humanistic orientations, anticipated Heinz Kohut's theories and, therefore, contributed to the historical evolution of self psychology. Carl Rogers, a founder of humanistic psychology in the United States, was a theorist who struggled with many of the same issues as Kohut. Rogers had new ways of looking at therapy, and especially at the therapeutic ambience, ways that foreshadowed the discoveries of Kohut. This article discusses areas of compatibility of the 2 theorists, such as their focus on empathy and the self, to encourage a rapprochement between humanistic psychotherapy and self psychology. Kohut revolutionized psychoanalysis by making it more humanistic. In that revolution, many of Rogers's empirically tested ideas were incorporated into a comprehensive psychoanalytic theory and clinical method. Because of the areas of mutual concerns and overlap, a fuller appreciation of Rogers's important ideas will be beneficial to self psychology. Edwin Kahn, PhD, Department of Social Sciences, Queensborough Community College, City University of New York; Arnold W. Rachman, PhD, Derner Institute, Adelphi University. Correspondence concerning this article should be addressed to Edwin Kahn, PhD, 50 West 97th Street, Apartment 6T, New York, New York Electronic mail may be sent to cekahntact@cs.com. 294

2 ROGERS AND KOHUT 295 Different psychoanalysts, with their humanistic orientations, such as Ferenczi, Rank, Alexander, Winnicott, Guntrip, and Fairbairn, anticipated the discoveries of Heinz Kohut and therefore made an important contribution to the evolution of self psychology (see Detrick & Detrick, 1989; Rachman, 1997a, 1997b). Carl Rogers, a co-founder of humanistic psychology in the United States, was a humanistic theorist who can be seen as struggling with some of the same issues as Kohut. Rogers, farm-raised in the Midwest, developed a theory of psychotherapy that in many respects is very American. Rogers's psychotherapy was optimistic, it focused on the here and now, and it was usually short term (contemporary Rogerian therapists report that long-term therapy is now common). Also, Rogers had more interest in personality change than in development, and he thought the relationship in the here and now was more important than transference or countertransference issues. Importantly, Rogers's approach was American because it was influenced by the logical positivism and empirical tradition of American philosophy. Personality change, expressed in terms of the self, was central in Rogers's theory and was based, considerably, on empirical data. Rogers did, for his time, have some very new ways of looking at therapy, and especially at the therapeutic ambience, ways foreshadowing different discoveries of Kohut. For example, Stolorow (1976), in an early comparison between Rogers's and Kohut's work, stated that there appear to be striking parallels between the techniques, therapeutic processes and ideal outcome formulated in the analytic treatment of narcissistic disorders,... and the techniques, therapeutic processes and ideal outcome of client-centered therapy as conceptualized by Rogers. The understanding and treatment of the narcissistic disorders may thus provide an unexpected area of rapproachement between psychoanalytic and client-centered therapists, (p. 28) Other investigators, in addition to Stolorow, have made comparisons between Rogers's and Kohut's work (see Bohart, 1991; Kahn, 1985,1989a, 1989b, 1995, 1996; Tobin, 1990, 1991). These comparisons show that a rapproachement between humanistic psychology and psychotherapy and psychoanalytic self psychology is meaningful and could be of benefit to self psychology (as well as to client-centered therapy). A discussion of Rogers's contributions as they relate to Kohut's is also important to chronicle more thoroughly the historical evolution of self psychology. To explore the potential contribution that Rogers's work can make to self psychology, the following is a summary of those aspects of his work that are relevant to a rapprochement. Rogers's basic premise was that there

3 296 KAHN AND RACHMAN is a constructive striving in each individual (as well as in all of nature) to reach his or her potentialities, which he called an actualizing tendency. When a person experiences unconditional positive regard (nonjudgmental acceptance) and empathic understanding from a significant other who is also experienced as genuine and human, the person develops unconditional positive self-regard (self-esteem), and the process of actualization is promoted. Conversely, this natural growth tendency is thwarted when the person experiences conditional acceptance or the absence of empathy. Thus, there are three conditions, according to Rogers, that are necessary and sufficient to facilitate the growth of a person: unconditional positive regard (prizing the other), empathic understanding, and a nondefensive integrated state characterized by openness and genuineness (also called congruence). In the therapeutic relationship, which came to be called client-centered therapy, Rogers focused completely on the subjective experiences of the client, seeking to be a companion to the client and to avoid imposing an agenda on or guiding the client in any way. Rogers, beginning in the 1950s, and even more so in the last decades of his life, came to emphasize that the ideas he discovered in the field of psychotherapy applied to all human relationships: that "the boundary between psychotherapy and ordinary life is necessarily thin" (Kramer, 1995, p. xii). In this respect, Rogers's ideas are quietly permeating today's culture in sell-help groups, the classroom, and parenting. Rogers's ideas were very simple, yet profound. With an accepting, understanding, and genuine attitude and the relinquishing of power and control over others, people will grow. This application of Rogerian ideas outside of therapy came to be called the person-centered approach (for a complete description of the evolution of Rogers's ideas, see Raskin & Rogers, 1995). As can be seen in these basic tenets of Rogers's humanistic psychotherapy, there are similarities and compatibilities with Kohut's thinking. Coincidentally, Kohut and Rogers were at the University of Chicago at the same time, from 1945 to Kohut was in the Department of Neurology and Psychiatry, and Rogers was a professor of psychology. Rogers, curious about the parallels between his work and Kohut's (personal communication, August 27, 1986), wrote: I certainly acknowledge there is a large and important overlap between Kohut's views and mine. What I wish I knew, and perhaps you may have some clues to Ihis, is how much uf his thinking and his "new discoveries" were based on a knowledge of my work. It certainly is not a coincidence that while at the University of Chicago he developed an interest in empathy and the self, the two major features which I had been formulating and writing about for quite a

4 ROGERS AND KOHUT 297 number of years. I deeply regret that I never had personal contact with him. The Department of Psychiatry at that time was attacking my work at the Counseling Center, declaring that we were practicing medicine without a license. They did not like the idea of psychologists doing therapy. I don't believe that Kohut had any part in this at all, hut the estrangement between the two departments was very deep and I never got to know any individuals except the chairman of psychiatry. It is of interest that Kohut was apparently aware of Rogers's work, which he unfortunately described with some disdain, but it is not clear whether any of Kohut's "discoveries" were influenced by this awareness. According to Kohut (1973/1978b): Certain forms of psychotherapeutic counseling, for example, which enjoy at present a not inconsiderable popularity, restrict their technique in the main to letting the patient say everything that occurs to him. The counselor's passive attitude seems to be similar to the analyst's attitude of expectant silence; he listens, and either says nothing or merely repeats what the patient has just said himself. But while the analyst employs his method for a specific purpose he listens in order to understand and then explain, thus enabling the patient to enlarge his knowledge of himself for the counselor, the method of free association appears to have become an end in itself. But when this use of free association is extolled as being superior to psychoanalysis, then the analyst cannot refrain from shaking his head in amazement. He understands, of course, how, in certain instances, temporary improvements are quickly brought about in this way. (pp ) Kohut went on to compare this type of psychotherapeutic counseling with the work of a repairman who managed to fix an old alarm clock of his. This repairman knew nothing about clocks; what he did to restore its functioning was just clean and oil the clock's inner parts. There is no need to spell out the analogy between the so-called watchmaker and the practitioners of certain kinds of psychotherapy except, T think, that my so-called watchmaker had a higher percentage of successes and knew more about what he was doing than most of the psychotherapists who borrow one or the other insight or technical rule from psychoanalysis and apply it without understanding. (Kohut, 1973/1978b, p. 525) With these comments, Kohut obviously was not exhibiting much appreciation of Rogers's therapeutic innovation of empathic listening, that is, attempting to see things as completely as possible from the client's framework. American psychoanalysts, in general, have rarely appreciated Rogers's contributions, which have often been dismissed as shallow or superficial. We believe that Rogers's therapeutic innovations are more

5 298 KAHN AND RACHMAN profound than has been previously appreciated and that many of his ideas have already been incorporated into psychoanalytic self psychology. One possible reason for Kohut's dismissal of Rogers's therapeutic innovations was that Kohut wanted to claim that he was the originator of the concept of therapeutic empathy. Rachman (1989, 1997a, 1997b) has noted that Ferenczi introduced "the rule of empathy" into psychoanalysis in the 1920s and that Kohut also failed to acknowledge Ferenczi's contribution. Kohut (1959/1978a) did discuss Freud's use of empathy and introspection as observational tools to investigate a person's inner world (p. 211), but nowhere, to our knowledge, did he give credit to any predecessors for the therapeutic benefits of empathy. Interestingly, there is a link between Rogers and psychoanalysis in his early training at Rochester, when he became familiar with the work of Otto Rank and several of Rank's students. For example, his "reflection of feeling" response was influenced by a Rankian-trained social worker, Elizabeth Davis (Raskin & Rogers, 1995, p. 133). Relevant to the rapprochement of Rogers's views with self psychology is Robert Stolorow's (1976) article, "Psychoanalytic Reflections on Client-Centered Therapy in the Light of Modern Conceptions of Narcissism." Stolorow (1976) described how Rogers, with his empathic reflection of feeling and his acceptant attitude, encouraged the development of a mirror transference: Indeed, Rogers' technical recommendations (which are in many respects similar to those of Kohut with regard to the unfolding of the grandiose self) seem ideally suited to promote the development of a narcissistically sustaining mirror transference. The therapist is enjoined to reflect the patient's experiences with an attitude of unconditional positive regard and acceptance, with an eye toward affirming the client's worth, significance and value to the therapist. The client thus comes to experience himself as "prized"... by the therapist, much as does the narcissistically disturbed patient immersed in a mirror transference, (p. 28) Stolorow (1976) then selected abeautiful quote from Rogers's 1951 book, Client-Centered Therapy: The therapist endeavours to keep himself out as a separate person... his whole endeavour is to understand the other so completely that he becomes almost an alter ego of the client... The whole relationship is composed of the self of the client, the counselor being depersonalized for the purposes of therapy into being "the clienl's olher self." (Rogers, 1951, pp. 42, 208) Stolorow (1976) eloquently noted the similarity of this way of being to Kohut's description of narcissistic patients who use the analyst imperson-

6 ROGERS AND KOHUT 299 ally to fill in missing parts of their self-structure. According to Stolorow (1976): The therapist who follows Rogers' recommendations thus divests himself of his own selfhood and embraces the role of a part, extension or duplicate of the client, a "pure mirror image" of the client, a depersonified medium in which the client's sense of self may germinate and consolidate. As in the handling of the mirror transference, the client-centered therapist accepts (and even promotes) his role as an impersonal function substituting for missing or defective segments in the client's own self-structure. Tt is not surprising, then, that the recipient of client-centered therapy would report a buttressing of his sense of self-cohesion, self-identity and self-esteem by virtue of his immersion in the therapeutic relationship. It is also not surprising that Rogers describes individuals in client-centered therapy who, like patients involved in a mirror transference, experience temporary states of self-fragmentation when there is a disruption in the narcissistically sustaining therapeutic relationship, (p. 28) With this comparison, Stolorow highlighted the remarkable similarity of the therapeutic relationship for Rogers and Kohut. In the remainder of this article, we further elaborate Rogers's ideas as they relate to Kohut's on a variety of issues. This comparison will be useful to self psychology, because Rogers's humanistic psychotherapy provides, in many respects, a foundation for Kohut's thinking. In other words, self psychology, with its more comprehensive theory and clinical methods, may be seen as an analytic evolution of Rogers's client-centered psychotherapy. Self-Concept Rogers and Sanford (1984) stated that very early, it was found that clients in therapy frequently focused their problems and their progress in terms of self. "I feel I'm not being my real self." "It feels good to let myself go and just be myself here." Gradually, the crucial importance of the self and its changing quality became evident, (p. 1382) Rogers became interested in the enhancement of self-regard or self-esteem in psychotherapy; that is, with unconditional positive regard, positive self-regard develops. He also described the integrated, healthy self as being able to experience nondefensively all thoughts and feelings in its organism, a way of being that he termed congruence. Incongruence occurs when experiences in the organism are blocked off from or distorted in selfawareness. Rogers's description of an incongruent client experiencing more congruence from psychotherapy appears very similar to the lifting of

7 300 KAHN AND RACHMAN repression for Freud (Kahn, 1985). However, this lifting of repression, for Rogers, came about not from interpretations but, rather, from a safe human relationship that provided unconditional positive regard and empathic understanding. Kohut, on the other hand, was more interested in selfcohesion and various expressions of narcissistic deficit, as when the self is either fragile or vulnerable. Empathy and a Changed Listening Stance Both Rogers and Kohut stressed the importance of empathy, that is, listening to and accurately understanding the subjective experience of the client or patient. Different writers have noted how special Rogers's capacity for empathy was. Stolorow (1976), for example, commented that "Rogers's discussion of the critical importance of the communication of acceptance and empathy in client-centered therapy, and his suggestions as to how this communication may be achieved, are probably unsurpassed in the clinical literature" (p. 29). And Kramer (1995), in describing Rogers's empathic stance, stated that "Rogers does what generations of psychology students have satirized him for doing, namely, repeat clients' words. But he also summarizes clients' feelings with precision, beauty of expression, and generous tentativeness" (p. xiv). Schwaber (1983, pp ) believed that Kohut's most important contribution was his shift in listening stance, that is, his making a sustained effort to listen from the patient's perspective. She described how that change occurred with Kohut's well-known patient, Miss F (Kohut, 197]). Kohut (1984) summed up this changed listening stance in the following way: If there is one lesson that I have learned during my life as an analyst, it is the lesson that what my patients tell me is likely to he Irue that many times when t believed that I was right and my patients were wrong, it turned out, though often only after a prolonged search, that my lightness was superficial whereas their lightness was profound, (pp ) Recently, Magid (1996) echoed Schwaber's sentiment: "Kohut's great contribution was conceptualizing the centrality of the empathic stance, by which the subjective validity of the patient's inner world was explored and acknowledged, without any implication that this perspective be viewed as distorted and ultimately relinquished" (p. 619). An attitude of attempting to just listen to what the client is experienc-

8 ROGERS AND KOHUT 301 ing, without interpretation, is the attitude that Rogers was advocating as early as the ] 940s. At that time, Rogers (1942) wrote: This course of action imposes much self-restraint upon the counselor. The reason is simple. As the client reveals himself more and more fully in the counseling interviews, the counselor begins to develop insight into the client's problems... There is the greatest temptation to most counselors, whether they are psychiatrists, psychologists, guidance counselors, or social workers, to inform the client as to his patterns, to interpret his actions and his personality to him... The more accurate the interpretation, the more likely it is to encounter defensive resistance. The counselor and his interpretations become something lo be feared. To resist this temptation to interpret too quickly, to recognize that insight is an experience which is achieved, not an experience which can be imposed, is an important step in progress for the counselor, (pp ) It is important to see how early Rogers was appreciating the validity of the subjectivity of the client. We believe that Rogers deserves historical credit for his role in articulating the therapeutic benefits of empathy. Psychoanalytic thinkers of today tend to overlook Rogers's original contribution in this area. Of course, Rogers did not have to extricate himself from an orthodox psychoanalytic theory that emphasized interpretations, as Kohut did. However, in the 1920s, at his doctoral internship in New York City, Rogers was trained in the dynamic Freudian approach (N. J. Raskin, personal communication, January 19, 1998), and in the 1930s he used an interpretative therapy that he eventually found unhelpful and discarded (Kirschenbaum, 1979, pp ). Unconditional Positive Regard According to Rogers and Sanford (1984): The therapeutic process is enhanced when the therapist both experiences and communicates to clients a deep and genuine caring for them as persons with many constructive potentialities. When this caring is uncontaminated by judgments or evaluations of the thoughts, feelings, or behaviors, it deserves the term "unconditional positive regard." (p. 1379) Kohut would surely agree that nonjudgmental acceptance of the person is an important quality for therapeutic effectiveness. Rather than unconditional positive regard, Kohut emphasized mirroring, or "the gleam in the mother's eye," as essential for the healthy development of the self. These concepts, unconditional positive regard and mirroring, are similar but not identical. Unconditional positive regard is an attitude of consistent accep-

9 302 KAHN AND RACHMAN tance and nonpossessive wannth and care held by the therapist (or parent) toward the person as a whole. Mirroring is a sharing of joy or pleasure, an "acceptance and confirmation of the self in its grandness, goodness, and wholeness" (Wolf, 1988, p. 184). Whereas unconditional positive regard is ever present, mirroring seems contingent on some action or responsiveness in the person and, therefore, may not be so unconditional. Whereas Rogers, from the 1940s onward (see Rogers, 1951, pp ), advocated the consistent acceptance or prizing of a client, Kohut and other self psychologists, at least through the 1970s and 1980s, were more hesitant to "prize" or "mirror" a patient in analytic therapy. For example, Stolorow (personal communication, June 1983) wrote: For Kohut, mirroring is nvl something that the analyst actually tries to provide. Rather it is something that the patient is permitted to experience subjectively as an aspect of the transference revival of an early selfobject tie. The patient's need for mirroring is accepted, understood, empathically interpreted, and ultimately worked through in the transference according to Kohut. Kohut (1983) also denied the criticism "that we gratify our patients by 'mirroring' them" (p. 402), and Basch (1981) stated that "a patient's need to be mirrored... can be met with an analytic response... no... indulgence of the patient is called for" (p. 343). One does find, however, examples in Kohut's writings in which he advocated providing positive experiences for patients. For instance, in his seminal paper on introspection, empathy, and psychoanalysis, Kohut (1959/1978a) wrote, when describing addicts: Their addiction must not, however, be confused with transference: the therapist is not a screen for the projection of existing psychological structure; he is a substitute for it... The patient now really needs the support, the soothing of the therapist. His dependence cannot be analyzed or reduced by insight; it must be recognized and acknowledged, (p. 225) And, in his final book, when discussing the overevaluation of patients by their analysts, Kohut (1984) stated that, "this overevaluating attitude too is 'normal'... and that an analyst who consciously eradicates this attitude and replaces it by cold objectivity... is as misguided as the Watson-guided 'objective' mother of half a century ago" (p. 190). Kohut (1984, pp. 78, 153) and other self psychologists (e.g., Miller, 1990; Wolf, 1990) also emphasized the importance of providing a "corrective emotional experience," as described by Alexander (1956). And Orange (1995), echoing Rogers's humanistic beliefs, has commented that "psychoanalytic understanding is, among other things, a form of loving, and it can be experienced

10 ROGERS AND KOHUT 303 in that way by the patient. It differs from empathy, which is value-neutral and can be used to hurt people" (p. 171). At this point, it may be useful to briefly discuss the relationship between unconditional positive regard and empathy. As noted, with unconditional positive regard the person as a whole is prized, whereas empathy is the ability "to perceive the internal frame of reference of another with accuracy" (Rogers, 1980, p. 140). Empathy, as pointed out by Kohut (1981) and others (e.g., Shlien, 1997; Orange, 1995), in addition to having a therapeutic function, can also be used to harm or manipulate people. In his final address, Kohut (1981) said, "If you want to hurt somebody, and you want to know where his vulnerable spot is, you have to know him before you can put in the right dig." Appreciating this negative use of empathy, Orange (1995) distinguished, in psychoanalytic epistemology, between empathy and empathic understanding: "Empathy defines the way of knowing vicarious introspection and the nature of the known complex psychological configurations that we seek to understand in depth" (p. 23). In contrast, empathic understanding includes a helpful response, such as a therapist adjusting the heat and light for a patient's comfort or a parent protecting a child from mistreatment (Orange, 1995, pp ). It seems that, for Orange, empathic understanding (in contrast to empathy by itself) includes caring responsivity (i.e., unconditional positive regard). Being Human In a conference commemorating the 100th anniversary of psychotherapy, Rogers (1985) was asked by a participant what the profession of psychotherapy had learned over the past 100 years. Rogers thought about the answer for several moments and then said, "I don't know what the profession has learned, 1 really don't. I've learned to be more human in the relationship, but I am not sure that that's the direction the profession is going." For Rogers, what is most healing is being openly oneself in a relationship. In a lovely passage, Rogers and Sanford (1984) wrote: The kind of caring that the client-centered therapist desires to achieve is a gullible caring, in which clients are accepted as they say they are, not with a lurking suspicion in the therapist's mind that they may, in fact, be otherwise. This attitude is not stupidity on the therapist's part; it is the kind of attitude that is most likely to lead to trust, to further self-exploration, and to the correction of false statements as trust deepens, (p. 1379)

11 304 KAHN AND RACHMAN Kohut (1984), although probably more reserved than Rogers, did write that, because of self psychology, "I have come to feel freer and, without guilt and misgivings, to show analysands my deep involvement and concern via the warmth of my voice, the words that I choose, and other similarly subtle means" (p. 221). And Wolf (1987), in a speech discussing whether or not interpretation should be used, stated, "It really doesn't matter what you do, what matters is who you are," which surely relates to the human qualities of the therapist. But for Rogers, Kohut did not go far enough in emphasizing the human qualities of the therapeutic relationship. For example, Rogers (1986) had interesting comments to make after viewing Kohut's (1981) last lecture, "On Empathy," given 4 days before Kohut's death. We present what Kohut said, followed by Rogers's reply. Kohut's (1981) remarks came at the end of his talk, as he described his work with a strongly suicidal I suddenly had the feeling... "how would you feel if I let you hold my fingers for a little while, now while you are talking, maybe that would help you"; doubtful maneuver, I am not recommending it, but I was desperate, I was deeply worried. So I gave her two fingers. Moved up a little bit in my chair, gave her two fingers, now I'll tell you what is so nice about that story, because an analyst always remains an analyst I gave her my two fingers, she took a hold of them and I immediately made a genetic interpretation to myself, "it was the toothless gums of a very young child clamping down on an empty nipple." That's the way it felt. I didn't say anything. I don't know whether it was right, but I reacted to it even there as an analyst to myself. [It] was never necessary any more. 1 wouldn't say that it turned the tide. But it overcame a very, very difficult impasse, at a given dangerous moment, and gaining time that way, we went on for many, many more years, with reasonably substantial success. Rogers's (1986) reaction to Kohut's remarks was as follows: It seems clear that in this interaction Dr. Kohut is experiencing desperation, caring, and compassion. He found a beautifully symbolic gesture that enabled him to express something of what he was feeling. Yet he is apologetic about this, about giving her his fingers to hold. Even more astonishing and sad is his interpretation to himself that he is giving her a dry nipple. He appears unaware that by giving something of himself of his own deep and persistent feelings he is giving her the nourishing human caring and compassion that she so desperately needs. Being thus openly feeling with her is most therapeutic. Yet he seems dubious and apologetic about his action. He appears to be unaware that being openly himself in the relationship was the most healing thing he could have done. It is obvious that I differ deeply from Dr. Kohut in the value I give to being one's own whole person in the relationship, (pp )

12 ROGERS AND KOHUT 305 Rogers, we imagine, was unable to fully appreciate the orthodox tradition that Kohut, with considerable conflict, was seeking to separate from. Toward More Equality Rogers called for a greater equality in the therapist-client relationship. He was critical of the psychoanalytic approach of his era, in which interpretations were often imposed on patients. There is no "expert" in the client-centered approach: The client's power in the relationship is protected as much as possible, and power is not invested in the therapist or specialist. Kramer (1995) stated that, "for Rogers, the cardinal sin in therapy, or in teaching or family life, is the imposition of authority" (p. xiii). The very labels he chose for his form of therapy (at first he called it nondirective therapy) illustrate this wish to relinquish any influence or control over another. In a speech, Wolf (1987) agreed with Rogers's sentiments: One can think of the analytic situation as being sort of tilted, with the analyst up here and the patient down there, and a really consistent application of selfobject theory would bring that tilt up to a more equal kind of level, and it's our defensiveness, our narcissistic defensiveness, that tries to keep us up there. Also important is that Kohut, with his changed listening stance, corrected some of the more obvious power inequities of traditional psychoanalysis. Transference as a Distortion Rogers did not elaborate a developmental theory and was not especially interested in the phenomenon of transference. He was interested in the real existential encounter in the here and now. A student of Rogers's, John Shlien (1987), in an interesting article that emphasized Anna O's erotic attachment to Josef Breuer, criticized the transference concept. Shlien argued that transference was a fiction or, rather, a defense mechanism used by therapists "to protect themselves from the consequences of their own behavior" (p. 15). According to Shlien, when a client falls in love with or gets angry at a therapist, therapists, starting with Breuer, have used the concept of transference to deny their culpability in eliciting these feelings. However, with the elaboration of a two-person paradigm in self psychology, the idea of transference as a distortion disappears. Shlien's criticism becomes moot, because in contemporary self psychology it is acknowl-

13 306 KAHN AND RACHMAN edged that, in their mutual interaction, the different qualities of the therapist are influencing the patient, and vice versa. Interpretations Kohut (1981, 1982, 1984) distinguished between two kinds of empathy understanding, a lower form, and interpretation, a higher form and he believed that an interpretative phase was necessary for a psychoanalytic cure. Rogers came to oppose interpretations; he believed that they were a manifestation of the medical model, having an expert cure an illness. For Rogers, the client has the capacity to discover his or her own answers and, as a result, will become self-empowered. After viewing Kohut's (1981) lecture, Rogers commented: Our purposes in being empathic are nol Ihe same. Kohut planned to use his perception of the inner world of the patient to make interpretations of the patient's behavior. My purpose was, through a sensitive empathy, to be a companion to my client, giving him the courage to go on in his voyage of self-discovery.... Kohut's patient, receiving an interpretation, is illuminated by the insight when he is ready to accept it. It is also very likely, judging from the analyst-patient relationship portrayed in the film, that he perceives Dr. Kohut as a wise and gifted person who can provide him with these understandings of self. My client, sensing that I am a companion to him in his search, discovers Ihe same insight and feels equally illuminated. But he also gains confidence in himself as he realizes that he has the capacity and the power to discover and learn the meanings of his own behavior. Thus, it appears to me that Kohut's patient learns and profits from the insight and becomes a bit more dependent on the analyst. My client learns and profits from the insight, perhaps a trifle later, and becomes a bit more independent and self-empowered. (Rogers & Sanford, 1984, p. 1379) The questions raised in Rogers's remarks are interesting: whether a patient becomes more dependent on an analyst as a result of an empathic interpretation and, furthermore, whether such dependency feelings, if they occur, are necessarily detrimental. Tt is noteworthy that some contemporary self psychologists have deemphasized the use of interpretations. For example, according to Miller's (1985) speech: The stressing of interpretation is an ancient tradition in analysis, a tradition that has been perpetuated through the passing of analytic generations, without, in my opinion, open-minded reexamination based upon empirical data. Tt is possible that if one attempted to maintain an empathic resonance with one's patient, in so far as possible continuously to maintain the mutual efforts at understanding the patient's inner state, that this might be the most productive way to promote increasing self-awareness and maximum therapeutic effectiveness.

14 ROGERS AND KOHUT 307 And Wolf (1986) stated that "crucial is the proper attunement of affect, guided by empathy, and not the verbal message that is being conveyed, or what explanations the therapist gives or does not give to the patient." Offering a slightly different position, Merton Gill (personal communication, August 28, 1991) wrote, "Rogers certainly performed an important service by pointing to the authoritarian way in which many analysts employ interpretation, but a misuse of a technique does not mean the technique is to be abandoned." Finally, Orange (1995) stated, "I think much of the therapeutic effect of analytic interpretation may lie, not so much in the insights provided or even jointly found, but instead in the patient's experiencing for the first time being important enough to a parent-substitute to be thoughtfully considered" (pp ). One may add that important selfobject needs of the therapist are also satisfied when, as a result of a constructive interpretation, a patient expresses appreciation. Free Will and Determinism For Kohut (1980), a self with ambitions, skills, and talents, as well as ideal goals, is poised to the future and "has a significance all of its own, independent of the genetic factors that in the area of cause-and-effect determinism had originally laid down its contents and had given it its shape" (p. 540). This view of the self, making choices and exercising free will, is central to Rogers's humanistic philosophy as well. Rogers echoed Kohut's ideas when he stated, just as in physics, where you can prove that the wave theory of light is supported by evidence; so is the corpuscular theory.... I think one would be narrowing his perception of physics to deny one of these and accept only the other. And it is in this same sense... that I regard these two dimensions [free will and determinism] as both real, although they exist in a paradoxical relationship, (cited in Kirschenbaum, 1979, p. 269) Freudian Instinct Theory Both Kohut and Rogers opposed the Freudian model of human nature: that sex and aggressive instincts need to be tamed by the influences of civilization. With humor, Gill (personal communication, December 17, 1990) wrote, "You may be amused to know by the way that once I was on a platform with Rogers and he criticized psychoanalysis for believing in original sin. I told him I felt the criticism was justified but that he apparently believed in original virtue."

15 308 KAHN AND RACHMAN Transcripts and Empirical Testing A significant contribution of Rogers is that he was the first to attempt to demystify the nature of psychotherapy by making sessions open to public scrutiny. In the 1940s, he published verbatim transcripts of therapeutic encounters. For more than 50 years, investigators such as Porter (1943), Snyder (1945), and, more recently, Bradley (1994), using these transcripts, have measured how therapists actually behave with clients. Regarding this issue, Gill (personal communication, August 28,1991) wrote, "I also think Rogers deserves a great deal of credit for being the first person to present verbatim sessions. Since him, a number of people have plucked up the courage to do so but he was the first." These transcripts, along with Rogers's persistent effort to construct a theory of the self with postulates testable through empirical means, stimulated considerable research on client-centered therapy. 1 Raskin summarized Rogers's contributions in the 1940s: In a very short time, an entirely new approach to psychotherapy was born, as was the field of psychotherapy research. This approach and its accompanying research led to the eventual acceptance of psychotherapy as a primary professional function of clinical psychologists. (Raskin & Rogers, 1995, p. 135) Magid (1996) wrote: Conclusion I think it is ironic that much of what has come to be thought of as progress in psychoanalysis has in fact been the result of subtraction from, rather than addition to, our theories. As analysts we have increasingly learned to get out of our patients' way. (p. 626) ' There has been some controversy about the empirical status of Rogers's theoretical propositions. For example, a number of reviews in the 1970s concluded that research evidence supporting Rogers's postulates was weak (Mitchell, Bozarth, & Krauft, 1977; Rappaport & Chinsky, 1972). However, the studies cited as evidence for this conclusion had serious methodological flaws (Patterson, 1984). More recent reviews of the literature indicate that the critical variables for therapeutic effectiveness are (a) the client therapist relationship and (b) extratherapeutic variables (factors that are part of the inner resources of the client and his or her environment that aid in recovery; Bohart & Tallman, 1996; Bozarth, 1998; Duncan & Moynihan, 1994; Patterson, 1984). Bozarth (1998), after reviewing the last three decades of psychotherapy research, concluded that the evidence for the importance of the person-toperson relationship of therapist and client lends support to Rogers's attitudinal qualities as the foundation for effective psychotherapy (p. 173).

16 ROGERS AND KOHUT 309 Magid's observation would please Rogers, because he, too, wanted to avoid burdensome, unverifiable theory and "learned to get out of his clients' way." This article has discussed different areas where Rogers's contributions are a precursor to some of the discoveries in self psychology. In fact, there may be more similarities between Kohut and Rogers than between Kohut and some of his psychoanalytic predecessors. For example, as noted by Stolorow (1976), Rogers's descriptions of empathy in the therapeutic relationship ("being the client's other self") anticipate Kohut's understanding of the archaic needs of narcissistic patients. Rogers's theory that unconditional positive regard and empathy encourage positive self-regard and congruence anticipates Kohut's ideas about self-cohesion and the importance of mirroring for the maturation of the self. Both Kohut and Rogers were able to free themselves from the early overemphasis on interpretation in psychoanalysis and learn to listen with empathic understanding to what the patient or client was saying. Rogers, with more freedom (but also Kohut), emphasized the human quality of the therapeutic relationship. Rogers sought to make the therapeutic relationship more equal, and Kohut, with his changed listening stance, highlighted this value as well. Each acknowledged that one can observe human existence through deterministic lenses, but to have a complete view of human psychology it is necessary to include the concept of a self that makes choices and exercises free will. Kohut revolutionized psychoanalysis by making it more humanistic. In that revolution, many of the empirically tested ideas that Rogers arrived at independently were incorporated into a comprehensive psychoanalytic theory and clinical method. For all of these reasons, a fuller understanding of Rogers's profound ideas will be beneficial to self psychology. References Alexander, F. (1956). Psychoanalysis and psychotherapy. New York: Norton. Basch, M. F. (1981). Selfobject disorders and psychoanalytic theory: A historical perspective. Journal of the American Psychoanalytic Association, 29, Bohart, A. C. (1991). Empathy in client-centered therapy: A contrast with psychoanalysis and self psychology. Journal of Humanistic Psychology, 31, Bohart, A. C., & Tallman, K. (1996). The active client: Therapy as self-help. Journal of Humanistic Psychology, 36, Bozarth, J. (1998). Person-centered therapy: A revolutionary paradigm. Ross-on-Wye, United Kingdom: PCCS Books. Brodley, B. T. (1994). Some observations of Carl Rogers' behavior in therapy interviews. Person-Centered Journal, 1,

17 310 KAHN AND RACHMAN Detrick, D. W., & Detrick, S. P. (Eds.). (1989). Self psychology: Comparisons and contrasts. Hillsdale, NJ: Erlbaum. Duncan, B. L., & Moynihan, D. W. (1994). Applying outcome research: Intentional utilization of the client's frame of reference. Psychotherapy, 31, Kahn. E. (1985). Heinz Kohut and Carl Rogers: A timely comparison. American Psychologist, 40, Kahn, E. (1989a). Carl Rogers and Heinz Kohut: On the importance of valuing the "self." In D. W. Detrick & S. P. Detrick (Eds.), Self psychology: Comparisons and contrasts (pp ). Hillsdale, NJ: Erlbaum. Kahn, E. (1989b). Carl Rogers and Heinz Kohut: Toward a constructive collaboration. Psychotherapy, 26, Kahn, E. (1995). Effecting a collaboration between Rogers's client-centered therapy and Kohul's self psychology. Person-Centered Journal, 2, Kahn, E. (1996). The intersubjective perspective and the client-centered approach: Are they one at their core? Psychotherapy, 33, Kirschenbaum, H. (1979). On becoming Carl Rogers. New York: Delta. Kohut, H. (1971). The analysis of the self. New York: International Universities Press. Kohut, H. (1978a). Introspection, empathy, and psychoanalysis: An examination of the relationship between mode of observation and theory. In P. H. Omstein (Ed.), The search for the self (Vol. 1, pp ). New York: International Universities Press. (Original work published 1959) Kohut, H. (1978b). Psychoanalysis in a troubled world. In P. H. Ornstein (Ed.), The search for the self(vo\. 2, pp ). New York: International Universities Press. (Original work published 1973) Kohut, H. (1980). Reflections on advances in self psychology. In A. Goldberg (Ed.), Advances in self psychology (pp ). New York: International Universities Press. Kohut, H. (1981, October). On empathy. Address delivered at the Fourth Annual Conference on the Psychology of the Self, Berkeley, C A. Kohut, H. (1982). Introspection, empathy, and the semi-circle of mental health. International Journal of Psycho-Analysis, 63, Kohut, H. (1983). Selected problems of self-psychological theory. In J. D. Lichtenberg & S. Kaplan (Eds.), Reflections on self psychology (pp. 387^116). Hillsdale, NJ: Erlbaum. Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press. Kramer, P. D. (1995). Introduction. In C. R. Rogers, On becoming a person (pp. ix-xv). Boston: Houghton Mifflin. Magid, B. (1996). Knowing which way is up; or, why all subjectivities are not created equal. Journal of the American Academy of Psychoanalysis, 24, Miller, J. P. (1985, October). Introductory address. In J. P. Miller (Chair), Frontiers in clinical theory and metapsychology. Symposium conducted at the Eighth Annual Conference on the Psychology of the Self, New York, NY. Miller, J. P. (1990). The corrective emotional experience: Reflections in retrospect. Psychoanalytic Inquiry, 10, Mitchell, K. M., Bozarth. J. D., & Krauft, C. C. (1977). A reappraisal of the therapeutic effectiveness of accurate empathy, nonpossessive warmth, and genuineness. In A. S.

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19 312 KAHN AND RACHMAN Tobin, S. A. (1990). Self psychology as a bridge between existential-humanistic psychology and psychoanalysis. Journal of Humanistic Psychology, 30, Tobin, S. A. (1991). A comparison of psychoanalytic self psychology and Carl Rogers's person-centered therapy. Journal of Humanistic Psychology, 31, Wolf, E. S. (1986, October). Discussant. In H. Linden (Chair), Clinical advances in self psychology. Symposium conducted at the Ninth Annual Conference on the Psychology of the Self, San Diego, CA. Wolf, E. S. (1987, October). Conversations with Franco Paparo and Ernest S. Wolf. Session conducted at the Tenth Annual Conference on the Psychology of the Self, Chicago, 1L. Wolf, E. S. (1988). Treating the. self: Elements of clinical self psychology. New York: Guilford Press. Wolf, E. S. (1990). Clinical responsiveness: Corrective or empathic? Psychoanalytic Inquiry, 10, 420^32.