rogers and kohut a historical perspective psicoanalytic psychology.pdf

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(2000). Psychoanalytic Psychology, 17:294-312

Carl Rogers and Heinz Kohut: A Historical Perspective

Edwin Kahn, Ph.D.andArnold W. Rachman, Ph.D.

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 humanisticpsychology 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 evolution,

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 10025.

Electronic mail may be sent to [email protected].

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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 theUnited 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 itwas 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 differentdiscoveries of Kohut. For example, Stolorow (1976), in an early comparisonbetween 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 arapproachement 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

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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 andsufficient 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 betweenpsychotherapy and ordinary life is necessarily thin (Kramer, 1995, p. xii). Inthis respect, Rogers's ideas are quietly permeating today's culture in self-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 thesame time, from 1945 to 1957. 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 this, is how much of 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

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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, but 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 purposehelistens in order to understand and then explain, thus enabling the

patient to enlarge his knowledge of himselffor 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. 523-524)

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 functioningwas 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

psychotherapyexcept, I 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, 1973/1978bp. 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

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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 Ferencziintroduced 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), butnowhere, 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, 1995p. 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.Storolow (1976)described how Rogers, with his empathic reflection offeeling 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 a beautiful quote from Rogers's 1951book,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

client's other self. (Rogers, 1951, pp. 42, 208)

Stolorow (1976)eloquently noted the similarity of this way of being toKohut's description of narcissistic patients who use the analyst impersonally

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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. It 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 notbeing 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 self-awareness. Rogers's

description of an incongruent client experiencing more congruence frompsychotherapy appears very similar to the lifting of

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repression for Freud (Kahn, 1985). However, this lifting of repression, forRogers, 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 inself-cohesion

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'sdiscussion 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 empathicstance, 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 (1983pp. 380-381)believed that Kohut's most importantcontribution 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, 1971). 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 be

truethat many times when I believed that I was right and my

patients were wrong, it turned out, though often only after a

prolonged search, that myrightness was superficial whereas theirrightness was profound. (pp. 93-94)

Recently, Magid (1996)echoed Schwaber's sentiment: Kohut's greatcontribution 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 experiencing,

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without interpretation, is the attitude that Rogers was advocating as early as

the 1940s. 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 to 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.

195-196)

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. Psychoanalyticthinkers 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. 86-92).

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 acceptance

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and nonpossessive warmth 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, 1988p. 184). Whereas unconditional positive regard isever 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. 159-172), advocated the consistent acceptance or prizing of a client, Kohut and

other self psychologists, at least through the 1970s and 1980s, were morehesitant to prize or mirror a patient in analytic therapy. For example,

Stolorow (personal communication, June 1983) wrote:

For Kohut, mirroring is notsomething 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 tobe 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. Hisdependence cannot be anayzed 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 isnormal 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 emphasizedthe importance of providing a corrective emotional experience, as

described by Alexander (1956). And Orange (1995), echoing Rogers'shumanistic beliefs, has commented that psychoanalytic understanding is,

among other things, a form of loving, and it can be experienced

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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, 1980p. 140). Empathy, as pointed out by Kohut (1981)and others

(e.g., Shlien, 1997; Orange, 1995), in addition to having a therapeuticfunction, 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 knowwhere 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 knowingvicarious

introspectionand the nature of the knowncomplex psychological

configurationsthat 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. 22-23). 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 ofpsychotherapy 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, I 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 lovelypassage, 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)

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Kohut (1984), although probably more reserved than Rogers, did writethat, 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 notinterpretation 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, OnEmpathy, 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 histalk, as he described his work with a strongly suicidal woman:

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 tellyou what is so nice about that story, because an analyst always

remains an analystI 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. I 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 astonishingand sadis his

interpretation to himself that he is giving her a dry nipple. He

appears unaware that by giving something of himselfof his own

deep and persistent feelingshe is giving her the nourishing human

caring and compassion that she so desperately needs. Being thusopenly 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. 132-133)

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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 therapistclient 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 inteaching 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 toJosef 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 acknowledged

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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 empathyunderstanding, a lower form, and interpretation, a higher formand 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. ForRogers, 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 not the 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 the 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, 1984p. 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. It 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. It 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.

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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 thetherapeutic 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. 30-31). 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 asideal goals, is poised to the future and has a significance all of its own,

independent of the genetic factors thatin the area of cause-and-effect

determinismhad 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 bothreal, 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.

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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, Brodley (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. 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, 1995p. 135)

Conclusion

Magid (1996)wrote:

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 theliterature 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), afterreviewing the last three decades of psychotherapy research, concluded that

the evidence for the importance of the person-to-person relationship oftherapist and client lends support to Rogers's attitudinal qualities as the

foundation for effective psychotherapy (p. 173).

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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 canobserve 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.

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Article Citation [Who Cited This?]Kahn, E. and Rachman, A.W.(2000). Carl Rogers and Heinz Kohut.

Psychoanal. Psychol., 17:294-312
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