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Tuesday 1 May 2012

Unconditional Positive Regard: Therapy's Poison Pill for the Culture

Okay, so maybe there's one exception.

Carl Rogers was a great man and a brilliant therapist. Among all the talk of cognitive behaviour therapy and all the other “evidence based treatments” is an acknowledgement that most of the improvement typically seen in therapy can be readily attributed to the so-called “nonspecific factors”, of which the quality of the relationship between client and therapist is the greatest part. And Rogers was the king of process, to the exclusion of almost all technique. Rogers’ ideas influence what almost all clinicians regard as the foundation of all of their other work.

Then there is unconditional positive regard.

This is a therapeutic stance that the clinician is enjoined to adopt during the therapy session. Whatever the client says or does, it is the clinician’s job to maintain his or her seat as a clinician, to see that the client’s emotions and actions make some kind of sense if only we understand them well enough, and to sweep our own fragile egos out of the way as best we can.

So far so good. But unconditional positive regard somehow leaked out into the public consciousness and became an expectation of parents, spouses, friends, family members, and all who work with the public. Whatever a person does, they should be met with the warm solidity of a relationship that is supportive without any conditions whatsoever. Those who fail to provide this nurturing blanket are simply not living up to their responsibilities as humans in relationship.

There’s just one problem.

Unconditional positive regard is a myth.

It doesn’t exist, not even in therapists. It is a stance. A role. Not a reality.

The truth is, none of us are able to manage truly unconditional positive regard for anyone – not a customer, not a stressed-out spouse, not an innocent infant relentlessly throwing food on the floor, not a faultlessly dementing parent asking the same question again and again. Certainly not for a rebellious teenager in a rage about being insufficiently “validated.”

We might strive to maintain our equanimity, to remind ourselves that the infant is learning about cause and effect, the parent honestly does not recall asking the question four times in a row, the adolescent exists within a toxic hormonal soup of confusion and fear. But we do not entirely succeed and we never will.

Like emulating the Buddha, or Christ, or the religious leader of your choice, unconditional positive regard is an admirable goal. But if we actually expect it of ourselves, or believe that others have easily mastered what seems so impossible for us, then it becomes a tool for guilt.

And because the term has been bandied about so much in the public discourse, people have naturally come to expect unconditional positive regard from others. From their parents. From their siblings. From their friends. From their (God help us) spouses. And it has come full circle. Clients now arrive in therapists’ offices describing the trauma of not having been loved unconditionally by others.

Perhaps it is up to therapists, who carelessly unleashed this beast upon the world, to speak up and slay it. We need to remind the world of the truth.

There is no unconditional positive regard. You will never fully succeed in providing this, and you will never receive it. From anyone. And you shouldn’t. Feedback from others is part of what helps us to modulate our own behaviour. Positive regard from others, without any conditions whatsoever, is the desire of our own narcissism, not of our inner adult. If we snap at our spouses, put them down when they speak, ignore their achievements, rant at will, and generally misbehave, we cannot expect that their fondness for us will remain undiminished and unflickering.

Even new parents do not feel unconditional positive regard for their offspring. They are usually able to tolerate much more than they would of another adult, or perhaps of someone else’s child, but they will, inevitably, have moments of wishing they could just be alone for ten minutes, of thinking that perhaps they would have been better childless.

If we, or our clients, are searching for that all-forgiving breast, that provider of unwavering support no matter what we do, the mission of adulthood is to accept that we will not find it, not to carry out the search with an air of firm entitlement. Because we are not entitled to unconditional positive regard. And if you don’t believe that, then believe this: Even if you are entitled to it, you will never find it. If you think you have: You’re kidding yourself.

Tolerance, kindness, understanding, and, yes, unconditional positive regard are admirable aspirations.  But that last is just that: An aspiration. Not a reality. It takes time, but we can eventually get used to it.

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  1. My sentiments exactly! I'm currently in my first year of a counselling degree (integrative therapies) and the concept of UPR is being continually rammed down our throats and for some reason it just wasn't sitting well with me and seemed all rather pretentious and fake and not at all congruent.. So yours words certainly reasonated with me

  2. Ditto! I am also in my first year training to be a therapist (in the UK) and have been studying the Person Centred approach as part of my training (as well as Psychodynamics and CBT). I find Carl Rogers' approach quite hypocritical and implausible, as there seemed to be a direct conflict to me between Congruence and UPR, as the two cannot genuinely co-exist at all times IMHO. From what I have read of Rogers' work, it would seem to me that he was to some extent in denial of reality: ie. that a person has both good and bad elements in more-or-less equal quantities (as does just about everything in the world, otherwise things would be very dysfunctional - think Yin/Yan) - but this maybe be because my reading/understanding of PCT is quite limited at this stage). If I am right, then to deny the 'existence' of the 'destructive' side (or Death Instinct as I believe Freud referred to it) would only serve to quash an individual's true creativity, as true creativity and freedom of thought is based on understanding both elements.....and this wasn't Rogers' only bit of hypocrisy 'On Becoming A Person' Rogers' own words, "No approach which relies upon knowledge, upon training, upon the acceptance of something that is taught, is of any use” [Rogers, 1961 p. 32]. So what is PCT then if it isn't another 'training' or 'something that is taught'? (think 'Self-Concept' and 'Organismic-Self' etc). Is it just me? I apologise if I have got the wrong end of the stick and offended I say, my reading and understanding is very limited at this stage, but there are some things that just don't quite stack up for me when it comes to PCT...

  3. Thank you for your comment. I am a fairly dedicated CBTer, but have a much more positive view of Rogers than I think you express. Rogers was very focussed on the therapist role, and I think he would readily have agreed that it IS a role - a stance on the part of the therapist, not unlike an actor. This doesn't mean we have to be hypocritical, it simply means that, as in any role, we select what we put forward and we channel our minds to focus on the work we are doing. Positive regard IS an important element of this, and as therapists we labour to induce it in ourselves and rise above our petty judgements and discomforts.

    I wouldn't recommend that anyone swallow every sentence of any therapy developer's recommendations uncritically, but Rogers has tremendous insight into the process of therapy, as opposed to the underlying theory or the methods we might try with clients or recommend they try with themselves. The current research bears this out, finding some small indicators of modality-specific effects, but stronger predictors of therapeutic efficacy in the therapist-client alliance, which is where Rogers shines.

    What I'm focussing on here is the seepage of the idea of UPR into the general culture, with people imagining that they should get this from their parents, spouse, friends, boss, etc - something that does not happen and that we have no right to expect.

    My suggestion: Don't look for complete consistency in the writings of Rogers or any of the other humanistic therapists - nor, for that matter, in any of them. Think about your degree of openness with other people, and the specifics of their behaviour that seem to be associated with yourself opening up. You will find that Rogers has much to say about that. Set him aside, get through your program, and come back to him after a year of practice. It will be as though you have learned the language in which it was written.