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Although the authors cautiously emphasize that these findings re- late only to the treatment of schizophrenics, I am inclined to dis- agree. I suspect that similar facts would be found in a research study of almost any class of helping relationship.

Another interesting study focuses upon the way in which the per- son being helped perceives the relationship. Heine 11 studied in- dividuals whohad gone for psychotherapeutic help to psychoan- alytic, client-centered, and Adlerian therapists. Regardless of the type of therapy, these clients report similar changes in themselves. But it is their perception of the relationship which is of particular interest to us here.

Whenasked what accounted for the changes which had occurred, they expressed some differing explanations, de- pending on the orientation of the therapist.

But their agreement on the major elements they had found helpful was even more significant. They indicated that these attitudinal elements in the relationship accounted for the changes which had taken place in themselves: the trust they had felt in the therapist; being understood by the therapist; the feeling of independence they had had in makingchoices and de- cisions.

The therapist procedure which they had found most help- ful was that the therapist clarified and openly stated feelings which the client had been approaching hazily and hesitandy. There was also a high degree of agreement amongthese clients, regardless of the orientation of their therapists, as to what elements had been unhelpful in the relationship. Such therapist attitudcs as lack of interest, remoteness or distance, and an over-degree of synl- pathy, were perceived as unhelpful.

As to procedures, they had found it unhelpful whentherapists had given direct specific advice regarding decisions or had emphasizedpast history rather than pre- sent problems. Guiding suggestions mildly given were perceived in an intermediate range -- neither clearly helpful nor unhelpful. Fiedler, in a nmch quoted study 7 , found that expert therapists of differing orientations formed similar relationships with their clients. Quinn presented his judges only with recorded therapist statements taken from inter- views.

The raters had no knowiedgsof what the therapist was re- sponding to or howthe client reacted to his response. Yet it was found that the degree of understanding could be judged about as well from this materhl as from listening to the response in context.

As to the emotional quality of the rehtionship, Seeman 16 found that success in psychotherapy is closely associated with a strong and growing mutual liking and respect between client and therapist.

It is also worth noting that it is the way in which his attitudes and procedures arc perceived which makesa difference to the client, and that it is this perception which is crucial. These studies have to do with what we might think of as manufactured relationships. Verplanck 17 , Greenspoon 8 and others have shown operant conditioning of verbal behavior is possible in a relationship.

Very briefly, if the experimenter says "Mhm,"or "Good," or nods his head after certain types of words or statements, those classes of words tend to increase because of being reinforced. It has been shown that using such procedures one can bring about increases in such diverse verbal categories as plural nouns, hostile words, state- ments of opinion.

The person is completely unaware that he is being influenced in any way by these reinforcers. The implication is that by such selective reinforcement we could bring it about that the other person in the relationship would be using whatever kinds of words and makingwhatever kinds of statements we had decided to reinforce.

Following still further the principles of operant conditioning as developed by Skinner and his group, Lindsley 12 has shownthat chronic schizophrenic can be placed in a "helping relationship" with a machine. The machine, somewhatlike a vending machine, can be set to reward a variety of types of behaviors. Initially it simply re- wards- with candy, a cigarette, or the display of a picture- the lever-pressing behavior of the patient.

But it is possible to set it so that many pulls on the lever may supply a hungry kitten- visible in a separate enclosure--with a drop of milk.

In this cage the satis- faction is an altruistic one. Plans are being developed to reward simi- lar social or altruistic behavior directed toward another patient, placed in the next room. The only limit to the kinds of behavior which might be rewarded lies in the degree of mechanical ingenuitT of the experimenter. Lindsley reports that in some patients there has been marked clin- ical improvement.

The patient gradually regressed, grew untidy, uncommunica- rive, and his grounds privilege had to be revoked. This to me pathetic incident would seemto indicate that even in a relationship to a machine, trustworthiness is important if the relationship is to be helpful.

Still another interesting study of a manufactured rehtionship is being carried on by Harlow and his a. Infant monkeys,removedfrom their mothers almost im- mediately after birth, are, in one phase of the experiment, presented with two objects.

One might be termed the "hard mother," a slop- ing cylinder of wire netting with a nipple from which the baby may feed. The other is a "soft mother," a similar cylinder madeof foam rubber and terry cloth.

Even whenan infant gets all his food from the "hard mother" he dearly and increasingly prefers the "soft mother. Of the many interesting and challenging implications of this study, one seems reasonably clear. It is that no amountof direct food reward can take the place of certain perceived qualities which the infant appears to need and desire.

The first is an experiment conducted by Ends and Page 5. Workingwith hardened chronic hospitalized alcoholics who had been committed to a state hospital for sixty days, they tried three different methods of group psychotherapy.

Their results showedthat the therapy based upon a learning theory approach was not only not helpful, but was somewhatdeleterious. The outcomeswere worse than those in the control group which had no therapy.

The analytically oriented ther- apy produced some positive gain, and the client-centered group therapy was associated with the greatest amountof positive change. Follow-up data, extending over one and one-half years, confirmed the in-hospital findings, with the lasting improvement being greatest in the client-centered approach, next in the analytic, next the con- trol group, and least in those handled by a learning theory approach.

As I have puzzled over this study, unusual in that the approach to which the authors were committed proved least effective, I find a clue, I believe, in the description of the therapy based on learning theory Essentially it consisted a of pointing out and label- ling the behaviors which had proved unsatisfying, b of exploring obiectively with the client the reasons behind these behaviors, and c of establishing through re-education more effective problem- solving habits.

But in all of this interaction the aim, as they formu- lated it, was to be impersonal. The therapist "permits as little of his ownpersonality to intrude as is humanlypossible.

The final study I wish to report is one iest being completed by I-lalkides 9. She started from a theoretical formulation of mine regarding the necessary and sufficient conditions for therapeutic change Ona randombasis she picked nine client-counselor interaction units -- a client statement and a counselor response-- from each of these interviews.

This gave her several hundred units which were now phced in randomorder. I think all of us whoknewof the study regarded it as a very bold venture. Could iudges listening to single units of interaction possibly make any reliable rating of such subtle qualities as I have mentioned? And even if suitable reliability could he obtained, could eighteen couuselor-client interchanges from each case--a minute sampling of the hundreds or thousands of such interchanges which occurred in each case--possibly bear any relationship to the therapeutic outcome?

The chance seemed slim. The findings are surprising. It proved possible to achieve high reliability, between the iudges, most of the inter-iudge correlations being in the 0. It was found that a high degree of empathic understanding was significantly as- sociated, at a. Only in the investigation of the matching intensity of affective expression were the results equivocal. It is of interest too that high ratings of these variables were not associated more significantly with units from later interviews than with units from early interviews.

If he was highly empathic, he tended to be so from first to last. If he was lack- hag in genuineness, this tended to be true of both early and late interviews.

As with any study, this investigation has its limitations. It is concerned with a certain type of helping relationship, psycho- therapy. It investigated only four variables thought to be significant.

Perhaps there are manyothers. Nevertheless it represents a signif- icant advance in the study of helping relationships. Let me try to state the findings in the simplest possible fashion. It also meansthat if the counselor is congruent or trans- parent, so that Iris words are in line with his feelings rather than the two being discrepant; if the counselor likes the client, uncondi- tionally; and if the counselor understands the essential feelings of the client as they seem to the client-- then there is a strong proba- biLity that this will be an effective helping relationship.

They have inves- tigated different facets of the problem. They have approached it from very different theoretical contexts. Theyhave used different methods. They are not directly comparable. Yet they seem to me to point to several statements which maybe madewith some assur- ance. It is equally clear that the studies thus far madedo not give us any final answers as to what is a helping rehtiouship, nor how it is to be formed. I believe each of us working in the field of humanrelationships has a similar problem in knowinghow to use such research knowl- edge.

Wecannot slavishly follow such findings in a mechanical way or we destroy the personal qualities which these very studies show to be valuable. It seems to methat we have to use these studies, testing them against our ownexperience and forming new and further personal hypotheses to use and test in our own further per- sonal relationships. So rather than try to tell you how yon should use the findings I have presented I should like to tell you the kind of questions which these studies and my own clinical experience raise for me, and some of the tentative and changing hypotheses which guide my behavior as I enter into what I hope may be helping relationships, whether with students, staff, family, or clients.

Let me list a numberof these questions and considerations. Can I be in some way which vail he perceived by the other person as trustworthy, as dependable or consistent in some deep sense? Both research and experience indicate that this is very im- portant, and over the years I have found what I believe are deeper and better ways of answering this question. But experience drove homethe fact that to act consistently acceptant, for example, if in fact I waS feeling annoyed or skeptical or someother non-acceptant feeling, was certain in the long run to be perceived as inconsistent or un- trustworthy.

I have cometo recognize that being trustworthy does not demandthat I be rigidly consistent but that I be dependably real. By this I meanthat whatever feeling or attitude I amexperiencing would be matchedby my awareness of that at- titude. Whenthis is true, then I am a unified or integrated person in that moment, and hence I can be whatever I deeply am. This is a reality which I find others experience as dependable. A very closely related question is this: Can I be expressive enoughas a person that what I amwill be communicatedunambig- uously?

I believe that most of myfailures to achieve a helping re- lationship can be traced to unsatisfactory answers to these two questions. WhenI am experiencing an attitude of annoyanceto- ward another person but am unawareof it, then my communication contains contradictory messages.

Mywords are giving one message, but I am also in subtle ways communicatingthe annoyance I feel and this confuses the other person and makeshim distrustful, though he too maybe unawareof what is causing the difficulty.

Whenas a parent or a therapist or a teacher or an administrator I fail to listen to what is going on in me, fail because of myown defensiveness to sense my ownfeelings, then this kind of failure seems to result. It has madeit seem to me that the most basic learning for anyone who hopes to establish any kind of helping relationship is that it is safe to be transparently real.

If in a given relationship I amreasonably congruent, if no feelings relevant to the relationship are hidden either to me or the other person, then I can be almost sure that the relation- ship will be a helpful one. One way of putting this which may seem strange to you is that if I can form a helping relationship to myself-- if I can be sensitively aware of and acceptant toward my ownfeelings- then the likeli- hood is great that I can form a helping relationship toward another.

Now, aeceptantly to be what I am, in this sense, and to pernfit this to show through to the other person, is the most difficult task I know and one I never fully achieve.

It has meant that if I am to facilitate the personal growth of others in relation to me, then I must grow, and while this is often painful it is also enriching.

A third question is: Can I let myself experience positive atti- tudes toward this other person--attitudes of warmth,caring, lik- ing, interest, respect? It is not easy. I find in myself, and feel that I often see in others, a certain amount of fear of these feelings. Weare afraid that if we let oursdves freely experience these positive feelings toward another we may be trapped by them. They may lead to demandson us or we maybe disappointed in our trust, and these outcomeswe fear.

I feel quite strongly that one of the important reasons for the pro- fessionalizadon of every field is that it helps to keep this distance. In the cliuieal areas we develop elaborate diagnostic formulations, seeing the person as an object. In teaching and in administration we develop all kinds of evaluative procedures, so that again the per- son is perceived as an object.

In these ways, I believe, we can keep ourselves from experiencing the caring which would exist if we ree- ogulzed the relationship as one between two persons. It is a real achievement when we can learn, even in certain relationships or at certain times in those relationships, that it is safe to care, that it is safe to relate to the other as a person for whomwe have positive feelings. Another question the importance of which I have learned in my own experience is: Can I be strong enough as a person to be separate from the other?

Can I be a sturdy respecter of my own feelings, myown needs, as well as his? Can I own and, if need be, express my own feelings as something belonging to me and separate from his feelings? AmI strong enough in my own separateness that I will not be downcastby his depression, frightened by his fear, nor en- gulfed by his dependency? Is my inner self hardy enough 1:o realize that I amnot destroyed by his anger, taken over by his need for dependence, nor enslaved by his love, but that I exist separate from him with feelings and rights of myown?

WhenI can freely fed this strength of being a separate person, then I find that I can let myself go muchmore deeply in understanding and accepting him because I amnot fearful of losing myself.

The next question is closely related. Can I permit him m be what he is-- honest or deceitful, infantile or adult, despairing or over-confident? Can I give him the freedom to be? Or do I feel that he should follow myadvice, or remain somewhatdependent on me, or mold himself after me?

On the other hand, the better adjusted and more competent counselor can interact with a client through manyinterviews without interfering with the freedom of the client to develop a personality quite separate from that of his therapist. I should prefer to be in this latter class, whether as parent or supervisor or counselor.

Another question I ask myself is: Can I let myself enter fully into the world of his feelings and personal meanings and see these as he does? Can I step into his private world so completely that I lose all desire to evaluate or judge it? Can I enter it so sensitively that I can move about in it freely, without trampling on meanings which are precious to him? Can I sense it so accurately that I can catch not only the meanings of his experience which are obvious to him, but those meanings which are only implicit, which he sees only dimly or as confusion?

Can I extend this understanding without limit? There is a strong temptation to set students "straight," or to point out to a staff memberthe errors in his thinking. Yet whenI can permit myself to understand in these situations, it is mutually rewarding. Still another issue is whether I can be acceptant of each facet of this other person which he presents to me. Can I receive him as he is?

Can I communicatethis ammde? Or can I only receive conditionally, acceptant of some aspects of his feelings and silendy or openly disapproving of other aspects? It has been my experience that whenmyammdeis conditional, then he cannot change or grow in those respects in which I cannot fuUy receive him.

And when--afterward and sometimes too late- I try to discover why I have been unable to accept him in every respect, I usually discover that it is because I have been frightened or threatened in myself by some aspect of his feelings. If I amto be morehelpful, then I must myself grow and accept myself in these respects.

A very practical issue is raised by the question: Can I act with sufficient sensitivity in the relationship that mybehavior win not be perceived as a threat?

The work we are beginning to do in studying the physiological concomitants of psychotherapy confirms the re- search by Dittes in indicating howeasily individuals are threatened at a physiological levd. Mydesire to avoid even such minor threats is not due to a hypersensitivity about my client.

It is simply due to the conviction based on experience that if I can free him as completely as possible from external threat, then he can begin to experience and to deal with the internal feelings and confliem which he finds threatening within himself. A specific aspect of the preceding question but an important one is: Can I free him from the threat of external evaluation?

In almost every phase of our lives-- at home, at school, at work -- we find ourselves under the rewards and punishments of external judg- ments. But, in my ex- perience, they do not make for personal growth and hence I do not believe that they are a part of a helping relationship. Curiously enough a positive evaluation is as threatening in the long run as a negative one, since to inform someonethat he is good implies that you also have the right to tell him he is bad.

So I have cometo feel that the more I can keep a relationship free of iudgmentand evalua- tion, the morethis will permit the other person to reach the point where he recognizes that the locus of evaluation, the center of re- sponsibility, lies within himselL The meaning and value of his ex- perience is in the last analysis something which is up to him, and no amount of external judgment can alter this.

So I should like to work toward a relationship in which I am not, even in my own feel- hags, evaluating him. This I believe can set him free to be a self- responsible person. One last question: Can I meet this other individual as a per- son who is in process of becoming, or will I be bound by his past and by mypast?

If, in my encounter with him, I am dealing with him as an immaturechild, an ignorant student, a neurotic personal- ity, or a psychopath, each of these concepts of mine limits what he can be in the relationship. Martin Buber, the existentialist philoso- pher of the University of Jerusalem, has a phrase, "confirming the other," which has had meaningfor me.

I can rec- ognize in him, know in him, the person he has been.. I confirm him in myself, and then in him, in relation to this potentiality that.. If I accept the other person as something fixed, already diagnosed and classified, already shaped by his past, then I am doing my part to confirm this limited hypothesis. If I accept him as a process of be- coming, then I am doing what I can to confirm or makereal his potentialities. It is at this point that I see Verplanck, Lindsley, and Skinner, working in operant conditioning, coming together with Buber.

At least they cometogether in principle, in an odd way. Andif I see this as his potentiality, he tends to act in ways which support this hypothesis. If, on the other hand, I see a relationship as an opportunity to "reinforce" all that he is, the person that he is with all his existent potentialities, then he tends to act in ways which support this hypothesis.

Personally I prefer this second type of hypothesis. Endeavoringto keep that knowiedgein mind I then took up the kind of questions which arise from an inner and subjective point of view as I enter, as a person, into relationships.

This has raised in my mind the strong suspicion that the optimal helping relationship is the kind of relationship created by a person who is psychologically mature. Or to put it in another way, the degree to which I can create relationships which facilitate the growth of others as separate persons is a measure of the growth I have achieved in myself. In somerespects this is a disturbing thought, but it is also a promising or challenging one. It would indicate that if I am interested in creating helping relationships I have a fascinat- hag lifetime job ahead of me, stretching and developing my poten- tialities in the direction of growth.

I am left with the uncomfortable thought that what I have been working out for myself in this paper mayhave little relationship to your interests and your work.

If so, I regret it. It is upon us whoare trying to understand and deal with the interactions between humanbeings who are trying to create helping rehtinuships. So I hope that the questions I ask of myself witl be of some use to you in gaining un- derstanding and perspective as you endeavor, in your way, to facili- tate growth in your relationships. Baldwin, A. Kalhom,and F. Patterns of parent behavior. PsychoL Monogr. Betz, B. The relationship of the therapist to the outcome of therapy in schizophrenia.

Research Reports Y. Washington, D. Buber, M. Transcription of dialogue held April 18, , Ann Arbor, Mich. Dittes, J. Ends, E. A study of three types of group psycho- therapy with hospitalized male inebriates. Alcohol, Farson, R. Introjection in the psychotherapeutic relationship. Unpublisheddoctoral dissertation, University of Chicago, Quantitative studies on the role of therapists feelings toward their patients.

In Mowrer,O. NewYork: Ronald Press, , Chap. Greenspoon, J. The reinforcing effect of two spoken sounds on the frequency of two responses. Halkides, G. An experimental study of four conditions necessary for therapeutic change. Unpublished doctoral dissertation, University of Chicago, Harlow, H.

The nature of love. Heine, R. Unpublished doctoral dissertation, Universiw of Chicago, Lindsley, O. Operant conditioning methodsapplied to research in chronic schizophrenia. Research Reports L Research techniques in schizophrenia. Page, C. A review and synthesis of the literature suggesting a psychotherapeutlc technique based on two-factor learn- ing theory. Unpublished manuscript, loaned to the writer.

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