Humanistic-Experiential Psychotherapy Research Paper

The major subapproaches within the humanistic tradition are the client-centered (or person-centered), Gestalt, and existential approaches. Other influential approaches have been psychodrama (Verhofstadt-Denève, 1999; Wilkins, 1999) and the body therapies and, more recently, the interpersonal views of such authors as Kiesler (1996), Yalom (1995), and Schmid (1995). More recently, humanistic approaches have begun to be grouped together under the experiential umbrella (Greenberg, Elliott, & Lietaer, 1994; Greenberg, Watson, & Lietaer, 1998). The process-experiential approach is one current expression of the contemporary humanistic-experiential tradition in psychotherapy. It integrates client-centered and gestalt therapy traditions (Greenberg, Rice, & Elliott, 1993). Gendlin’s (1996) focusing-oriented approach is another current expression.This approach emphasizes the creation of new meaning by focusing on bodily felt referents. Dialogical gestalt therapy (Hycner & Jacobs, 1995; Yontef, 1993) and some more integrative forms of person-centered or experiential psychotherapy (Finke, 1994; Lietaer & Van Kalmthout, 1995; Mearns & Thorne, 2000) are further current expressions. In practice, these contemporary approaches strive to maintain a creative tension or dialectic between the client-centered emphasis on creating a genuinely empathic and prizing therapeutic relationship (Barrett-Lennard, 1998; Biermann-Ratjen, Eckert, & Schwartz, 1995; Rogers, 1961) and a more active, task-focused, process-directive style of engagement that promotes deeper experiencing (Gendlin, 1996; Perls, Hefferline, & Goodman, 1951).

Humanistic-Experiential Theory

Humanistic theories (Greenberg & Rice, 1997) take a positive view of human nature and see subjectivity and awareness as essential for understanding human beings. They oppose views that cast the person as an object to be viewed from an external vantage point because these ignore the individual’s existential reality. Drawing on existential writers such as Kierkegaard (1843/1954) and Sartre (1943/1956), humanists believe that peoples’ uniquely human, subjective reality must be respected in order to grasp their reality. The European philosophers Husserl (1925/1977), Heidegger (1949/1962), Jaspers (1963), Marcel (1951), and Merleau-Ponty (1945/1962) were also influential in explicating and extending this position. Heidegger’s understanding of being-in-the-world and the importance of understanding phenomena as they appear to the subject are strong themes throughout humanistic-existential psychology.

Classical Humanistic Assumptions and Values

Humanistic theorists, often spoken of as the third force in psychology, have written extensively on the nature of human existence, on methods by which these uniquely human modes of functioning can be studied and grasped, and on the implications of humanistic assumptions for the goals and processes of psychotherapy.

The first and most central characteristic of humanistic psychology and psychotherapy is its focus on promoting intherapy experiencing. Methods that stimulate emotional experience are used within the context of an empathic facilitative relationship. The word “experiential” is defined in the Concise Oxford Dictionary (1990) as “involving or based on experience,” whereas experience is defined in turn as the “actual observation of, or practical acquaintance with facts or events” or “to feel or be affected by (an emotion etc.).” The distinction between two ways of knowing—knowledge by acquaintance (experiential) and knowledge by description (conceptual)—was first made by St. Augustine and later emphasized in the epistemologies of William James and Bertrand Russell. In these terms the essence of experiential therapy is its focus on promoting knowledge by acquaintance. Thus, a person does not come to know something about him- or herself conceptually but rather through emotional experience of the self interacting with others and the world. In experiential therapy the client’s ongoing experiencing process is kept as a continuous point of reference for all therapist responses; change is seen as occurring through the promotion of new in-session experiencing.

A commitment to a phenomenological approach flows directly from this central interest in experiencing. This approach is grounded in the belief in the uniquely human capacity for reflective consciousness, as well as in the belief that it is this capacity that can lead to self-determination and freedom. All humanistic psychotherapists agree on the inescapable uniqueness of human consciousness and on the importance of understanding peoples’perceptions of reality as a way of understanding their experiences and behaviors. They all build on the uniquely human capacity for self-reflective consciousness and on the human search for meanings, choices, and growth.

Apositive view of human functioning and the operation of some form of growth tendency are also highly significant issues for humanistic therapists. All would agree with the importance of the view of human beings as goal directed, striving toward growth and development rather than merely toward the maintenance of stability. All would agree that peoples’choices are guided more by their awareness of the future and of the immediate present than by the past. Consciousness in this view transforms the growth tendency in the organism into a directional tendency that places the self as a center of intentionality in a more or less constant search for meaning. The self is seen as an agent in the process of change.

The belief in the human capacity for self-determination is an important and sometimes controversial focus of humanistic theorists. The ways in which this capacity is developed and the ways in which its development can be facilitated or blocked is a key issue for humanistic therapies. Individuals are determined solely neither by their pasts nor by their environments but are agents in the construction of their worlds. All humanistic views attempt to move beyond what they regard as the restricted deterministic views of human functioning represented in the other major orientations. Although all humanistic theories have explicated views of pathological functioning, their primary focus has always been on understanding ways in which people could be helped to move toward healthy or even ideal functioning.

Humanistic approaches also are consistently person centered. This involves concern and real respect for each person. The person is viewed holistically, neither as a symptomdriven case nor as best characterized by a diagnosis. Each person’s subjective experience is of central importance to the humanist, and in an effort to grasp this experience, the therapist attempts empathically to enter into the other person’s world in a special way that goes beyond the subject-object dichotomy. Being allowed to share another person’s world is viewed as a special privilege requiring a special kind of relationship.

Theory of Human Functioning

As just outlined, humanistic-experiential therapies assume that human beings are aware, experiencing organisms who function holistically to organize their experience into coherent forms (Gendlin, 1962; Mahrer, 1978; May, Angel, & Ellenberger, 1958; May & Schneider, 1995; Perls et al., 1951; Rogers, 1951). People therefore are viewed as meaningcreating, symbolizing agents whose subjective experience is an essential aspect of their humanness. In addition, the operation of an integrative, formative tendency oriented toward survival, growth, and the creation of meaning has governed a humanistic-experiential view of functioning. Finally, in this view behavior is seen as the goal-directed attempt of people to satisfy their perceived needs (Perls et al., 1951; Rogers, 1951).

A general principle that has united all experientially oriented theorists is that people are wiser than their intellects alone. In an experiencing organism, consciousness is seen as being at the peak of a pyramid of nonconscious organismic functioning. Of central importance is that tacit experiencing is an important guide to conscious experience, is fundamentally adaptive, and is potentially available to awareness. Internal tacit experiencing is most readily available to awareness when the person turns his or her attention internally within the context of a supportive interpersonal relationship. Interpersonal safety and support are thus viewed as key elements in enhancing the amount of attention available for self-awareness and exploration. Experiments in directed awareness, in addition, help focus and concentrate attention on unformed experience and intensifying its vividness.

The classical humanistic-experiential theories of functioning posited two main structural constructs, self-concept and organismic experience, as well as one major motivational construct, a growth tendency.

Self/Self-Concept

The self is central in explaining human functioning. In devising his self theory, James (1890/1950) drew on a fundamental distinction between two aspects of self: self as subject-agentprocess (“I”) and self as object-structure-content (“me”). In developing a more systematic self theory, Rogers (1959) appears to have emphasized the self as self-concept, that is, object-content. On the other hand, Gestalt theory is less clear but appears to have characterized the self as more of an integrated whole and the agent of growth. Finally, existentialists have viewed self as a quality of existence (“being” or, more specifically, “being-for-itself”). In the end, however, all have endorsed the idea of an active integrating self.

For Rogers, the self-concept was an organized conceptual gestalt consisting of the individual’s perceptions of self and self in relation to others, together with the values attached to these perceptions. The self-concept is not always in awareness but always is available to awareness. In this view, the self has a twofold nature: It is both a changing process and, at any moment, a fixed entity. My self-concept is the view I have of myself (“me”), plus my evaluation of that view. A person may, for example, perceive herself as a good student, of superior intelligence and as loving her parents, and may value these positively; at the same time, this person may see herself as unattractive to the opposite sex and as competitive, and may in fact view these characteristics negatively. Gestalt theory also held that there is a conflict between an image (self-concept) that the person is trying to actualize and what in Gestalt is called the self-actualizing tendency. In these traditions, introjected conditions of worth are seen as crucial in forming self-concept “shoulds” by which people try to manipulate their selves to behave and experience in accord with certain dictates.

Some form of agency (“I”) is seen as an agent that is variedly identified with, or alienated from, aspects of spontaneous, organismic, preverbal levels of experiencing to form a “me” (James, 1890/1950). In addition, a core set of interruptive mechanisms were posited. These were seen as preventing the owning of emerging experience as well as preventing contact between the person and the environment. In Gestalt theory the person was also viewed as being constituted by parts and as functioning by the integration of polarities. In essence, a modular theory of self was postulated in which there existed different parts of the person that needed to be integrated.

Organismic Experience

According to Rogers (1959), experience includes everything going on within the organism that is potentially available to awareness; to experience means to receive the impact of concurrent sensory or physiological events. According to Gendlin (1962), experiencing is the process of concrete bodily feeling that constitutes the basic matter of psychological phenomena. Experience is thus a datum; it is what happens as we live. Awareness of this basic datum is seen as essential to healthy living.

The Growth Tendency

Most humanistic theorists have drawn on Goldstein’s (1939) description of a holistic actualizing tendency to describe the human tendency to organize resources and capacities so as to cope optimally. Rogers developed his notion of an actualizing tendency from his initial view of the operation of a growth and development tendency. This tendency came to be defined as the “inherent tendency of the organism to develop all its capacities in ways which serve to maintain or enhance the organism” (Rogers, 1959, p. 196). The latter view added the idea of the actualizing of all capacities to the notion of the adaptive function of a growth and development tendency. The actualizing tendency was highly important in that it offered a nonhomeostatic view of functioning. The person is not guided by deficiencies but is instead proactive.

Perls (1947) took from Gestalt psychology the view of people as active organizers of their world, including a tendency toward closure or completion of experience. This was offered as an alternative to views of people as determined, either by their history or by the unfolding of a genetic blueprint. Perls was committed to the idea of an inherent organizing tendency. This tendency leads infants to learn to walk and to develop, and people in general to learn to maintain themselves, to use tools, to develop verbal concepts, to strive for meaningful interpersonal contact, and to develop a sense of personal mastery. The holistic nature of this formative tendency was emphasized over any specific drives or needs. Maslow (1968) subsequently defined the actualizing tendency in terms of a hierarchy of needs, moving from lower level biological survival (“deficiency”) needs to higher level, growth-oriented (“being”) needs. Perls, however, rejected this level concept and adopted the more dynamic principle that the most dominant need in the situation emerges to organize the field.

All the theorists originally emphasized the growth tendency’s thrust toward autonomy from external control, a view that fitted the male-gender-role-based, autonomyoriented view of psychological health prevalent at the time. Perls, for example, stressed that maturation involves moving from environmental support to self-support. Perls and the existentialists also emphasized the importance of choice and the integration of polarities over any inherent tendency toward goodness. Rogers (1961), on the other hand, strongly emphasized the prosocial nature of the actualizing tendency. He believed that when people are guided by this tendency, they are trustworthy, reliable, and constructive.

Existential therapists, although seeing life as purposive and the organism as active in choosing its own destiny, have not explicitly posited a growth tendency. In existential terms, no innate “essence” precedes existence; rather, people determine themselves. People are born morally neutral, with a penchant both for health and sickness, and for good and bad. However, people are seen as having innate worth in the sense that they have the ability to know the difference between good and evil and the capacity to choose. Thus, a growth-like principle is implicit in existential thinking. Frankl (1963), for example, proposed a “will to meaning,” and May andYalom (1989) suggested that the therapist cannot create engagement or wishing that but the desire to engage in one’s life is always there. In his first book, The Doctor and the Soul, Frankl (1955) proposed that people live in three dimensions: the somatic, the mental, andthespiritual.Heequatedthesearchformeaningwithaspiritual struggle, and one that appears only in humans. For Frankl (1963), the will to meaning is the fundamental human drive.

Theory of Dysfunction

In the humanistic-experiential tradition, dysfunction has generally been seen as resulting from the disowning of experience. According to Rogers (1959), dysfunction is caused by incongruence between self-concept and experience. A state of incongruence exists when the self-concept differs from the actual experience of the organism. Thus, if I see myself as loving but feel angry and vengeful, then I am incongruent. When the organismic valuing process and externally imposed conditions of worth are in agreement, organismic experiencing is accurately perceived and symbolized. However, experiences that contradict conditions of worth compromise the need for positive self-regard, if accurately perceived and assimilated. Therefore, these experiences are selectively perceived, distorted, or simply denied in order to make them consistent with self-worth. This leads to progressively greater estrangement from oneself, so that the person can no longer live as an integrated whole, but is instead internally divided.

Threat or anxiety thus occurs if accurately symbolized experience violates the self-concept, leaving the person vulnerable. When a discrepancy between self-concept and experience threatens to enter awareness, the person responds by becoming anxious. However, in response to strong organismic needs, behavior inconsistent with the self-concept nevertheless occurs. Furthermore, the tacit perception (subception) of incongruence between self-concept and organismic experiencing leads to healthy acceptance, immediate distortion or disowning of experience, or (in severe instances) fragmentation of the self-concept.

Similarly, according to Gestalt theory, health involves the owning of emerging experience, whereas dysfunction involves the automatic disowning or alienation of this experience. A variety of interruptive mechanisms, including introjections, projections, and retroflections, prevents need satisfaction. Other phenomena such as conflict between polarities, habits, unfinished business, avoidance, and catastrophizing are also seen as important processes that produce dysfunction.

Different views of dysfunction and change coexist in this tradition. One, reflecting a psychoanalytic influence, held that awareness or discovery of previously unaware contents was curative, implying that hidden contents were pathogenic. Alternatively, pathology was seen as resulting from the inability to integrate one’s representations and reactions to certain experiences into one’s existing self-organization. In this view, the unacceptable is dealt with not by expelling it from consciousness (repression), but by failing to experience it as one’s own (disowning). Rather than making the unconscious conscious, therapy needs to promote reowning or the fuller experiencing of what one was talking about and already knew in some way. The important thing about this view is that what is disowned is not in itself pathogenic; instead, it is the healthy or the traumatic that has been disowned. Dysfunction occurs because of the disowning of healthy growth-oriented resources and needs or because of the avoidance of pain. It is the owning and reprocessing of experience to assimilate it into existing meaning structures, as opposed to consciousness of repressed contents, that is the key change process in this view. This is an essential difference from classical psychoanalytic views, where dysfunction arises from denial of indirect efforts to gratify infantile or nonadaptive needs.

Among the existentialists, Boss (1963) viewed psychopathology as a narrowing of the attunement that a person has to his or her world. Instead of being able to attend to numerous events in the world, the client is able to attend only to a narrower range of phenomena, so that in neurosis the person’s world of possibilities shrinks. This narrowing of attunement or attending leaves the person with only a partial view of his or her world (Boss, 1963). For May (1977), pathology develops because of the anxiety that arises from the defensive unawareness of the possibility of nonbeing. The anxiety of nonbeing (ontological anxiety) is resolved by using this angst to gain an appreciation for being. “To grasp what it means to exist, one needs to grasp the fact that he might not exist” (May, 1977, p. 51). Heidegger phrased it more strongly: To grasp what it means to exist, one needs to grasp the fact that one will, in some number of years, not exist (Heidegger, 1949/1962). In existential theory, dysfunction has been seen as resulting from lack of authenticity and alienation from experience, and the resultant lack of meaning. Therapy thus needs to promote fuller experiencing of what one is talking about and already knows tacitly. In existential theory, dysfunction therefore is seen as resulting from lack of authenticity, alienation from experience, and ontological anxiety, and the resultant lack of meaning.

Experiential Theory: A Neo-Humanistic Synthesis

The classical views of humanistic therapy described in the previous section have been complemented recently by an additionalsetofideasfromcurrentpsychologicaltheoryinorder to provide the basis for a more complete understanding of human function, dysfunction, and change (Greenberg & Van Balen, 1998; Greenberg, Watson, & Lietaer 1998). This reformulated perspective has added certain “neo-humanistic” (Elliott, 1999; Elliott, Watson, Goldman, & Greenberg, in press) principles, which provide the basis for experiential and emotion-focused therapies. The traditional humanistic assumptions have been expanded to incorporate modern views on emotion, dynamic systems, constructivism, and the importance of a process view of functioning to help clarify the humanistic views of growth and self-determination.

Contemporary emotion theory (Frijda, 1986; Greenberg & Paivio, 1997; Greenberg & Safran, 1987) holds that emotion is fundamentally adaptive in nature and provides the basis for the growth tendency. In this view, emotion helps the organism to process complex situational information rapidly and automatically in order to produce action appropriate for meeting important organismic needs (e.g., self-protection, support). Emotions provide rapid appraisals of the significance of situations to peoples’well-being and therefore guide adaptive action.

In addition, humanistic perspectives on subjectivity and perception have been connected to constructivist epistemology and views of functioning. In this view people are seen as dynamic systems in which various elements continuously interact to produce experience and action (Greenberg & Pascual-Leone, 1995, 1997; Greenberg & Van Balen, 1998). These multiple, interacting self-organizations can be described metaphorically as “voices” or parts of self (Elliott & Greenberg, 1997; Mearns & Thorne, 2000). In this view, the “I” is an agentic self-aspect or self-narrating voice that constructs a coherent story of the self by integrating different aspects of experience in a given situation; however, this voice has no special status as an “executive self.” Of particular importance are two sets of voices, which can be referred to broadly as “internal” and “external,” or as “experiential” and “conceptual.”

Furthermore, change is a dynamic, dialectically constructive process that requires that there be a clear separation between different modules, self-aspects, or voices within the person, especially between the internal-experiential and the external-conceptual aspects. These modules, aspects, or voices are then brought into direct contact with each other so that discords and harmonies can be heard. When this dialogue is successful, some form of newness is generated. As is true for all dialectically constructive processes, the precise nature of this new experience is impossible to predict in advance, although it should be understandable in retrospect (cf. Gendlin, 1996). Most important, it involves change in both aspects or voices; that is, both assimilation and accommodation occur.

Reformulation of the Self as Process and Self-Narration

Over time, the original humanistic structural theories came to be supplemented and somewhat replaced by a process conception. In his initial attempts to develop a process conception, Rogers (1958) offered a conceptualization of health that saw change as a transition from stability to flux, from rigidity to flow, and from structure to process. In his theory of experiencing, Gendlin (1962, 1964) more fully articulated this process-oriented view of experiencing and moved away from denial-incongruence models. He started from the premise that people are experiencing beings and stressed the interactional character of all naturally occurring forms of life.

Excessive stability, tied to the absence of forms of interaction that carry processes forward, was seen as the major cause of disturbance in spontaneous organismic process, or what he referred to as a bodily way of being-in-the world. Gendlin (1962) argued that optimal self-process involves an everincreasing use of experiencing as a process in which felt meanings interact with verbal symbols to produce an explicit meaning.

Gestalt theorists also proposed a self-as-process model (Perls et al., 1951). This theory made two proposals. One was that the self is the synthesizing agent, the artist of life, who creates contact at the organism-environment boundary. The second, and somewhat different, was that the self is contact with the environment and that it comes into being at the moment of contact. According to the first view of self, the self creates solutions to problems that arise at the contact boundary. According to the second view of self, when there is full contact, there is full self; and when there is little contact, there is little self. Thus, the self comes into existence in the experience of contact, and I “am” my experience. The self is removed from “inside” the person and becomes a field process. Self, in process terms, is thus the meeting point of internal and external, achieved by a process of dynamic synthesis of all elements of the field (Perls et al., 1951; Wheeler, 1991; Yontef, 1993). The self is on the surface, not somewhere deep inside, and it forms continually, at the ever-changing boundary between the organism and the environment, in order to fulfill needs, solve problems, and deal with obstacles.With this field view, culture is given an important role in understanding experience.

In the process-oriented Gestalt view, it is awareness of the process of identification and alienation of experience that are the road to health.Awareness of functioning provides people with the option to choose, if and when, to own experience (Perls et al., 1951). Therapy, then, offers clients experiments of deliberate awareness in order to promote the experience of being an active agent in experience; this allows the person to begin to experience what Perls et al. (1951) described as “It is me who is thinking, feeling or doing this” (p. 251).

Integrating and developing experiential process theory in line with modern views on emotion, constructive cognition, and the operation of dynamic systems, a dialectical constructivist model of experiential therapy has been proposed (Greenberg et al., 1993; Greenberg & Pascual-Leone, 1995, 1997; Watson & Greenberg, 1997). In this view, people are seen as active agents in the construction of their own realities, and the self is seen as a process in a continual state of self-organization. Humans are seen as symbolizing, meaning-creating beings who act as dynamic systems, constantly synthesizing conscious experience out of many levels of processing and from both internal and external sources.

Three major levels of processing—innate sensorimotor, emotional schematic memory, and conceptual level processing— have been identified (Greenberg & Safran, 1987; Greenberg et al., 1993). In addition, people are seen as organizing experience into emotion-based schemes that then play a central role in functioning.

This dynamic view supports a form of practice in which emotion plays an important role in the construction of reality and both therapeutic relationship and therapeutic work on specific problems are seen as aiding change. Emotional experience, although seen as a basically healthy resource, is viewed as capable of either providing healthy adaptive information based on its biologically adaptive origins or, in certain instances, becoming maladaptive through learning and experience. The most basic process for the individual in therapy is thus one of developing awareness of emotion and discriminating which emotional responses are healthy and can be used as a guide and which are maladaptive and need to be changed (Greenberg & Paivio, 1997). Change is seen as occurring by the coconstruction of new meaning in a dialogue between client and therapist, in which the therapist plays an active role in confirming clients’ emotional experiencing and helping them synthesize an identity based on strengths and possibilities.

In this view, it is the dialectical interaction among emotion schemes and levels of processing to synthesize new meaning that becomes the central process.This suggests that a principle of coherence can be viewed as supplementing the traditional principle of congruence in explaining healthy functioning. Thus, it is not simply that “I” become aware of my “feelings,” or that my self-concept and experience are consistent with one another. Rather, I form a coherent sense of myself, as, say, angry or sad; this form successfully organizes aspects of my experience together into a coherent whole that is viable in a given situation. In this view, adaptive functioning involves coordination among aspects of experience as well as levels of processing, with mutually affiliative relationships to one another, generating a coherent whole that makes sense and is identified as a part of one’s self-organization. This view helps overcome the problem, in both language and thought, of presuming the operation of any preexisting hidden content or meaning that comes to awareness or is accepted into a self-concept. Rather, there is an ongoing process of synthesizing levels of processing and modules of experience in a complex internal field. In addition, reowning is seen as integrating aspects of experience into coherent forms, and this involves meaning creation as well as identification with the disowned.

In this dialectical view, the person is emphasized as an active agent (cf. Bohart & Tallman, 1999) constantly organizing or configuring experience and reality into meaningful wholes. Both discovery of experience and creation of meaning operate in tandem, neither process being privileged over the other (Greenberg et al., 1993). In addition, both emerging internal experience and interpersonal support are seen as active ingredients in the process of change. Meaning is created by human activity, in dialogue with others, and people are seen as creators of the self they find themselves to be.

In this process, the self is the agent that acts to become aware of needs and creatively resolve problems that arise from interactions with the environment. Need emergence is seen as a field event rather than as an inner drive; it occurs as the self synthesizes internal and external elements into coherent forms. Needs and goals, along with meaning, are thus both created and discovered. The inability to identify and form needs and a clear coherent sense of self leads to weak self-organization.

In this view, the term “self” refers not to an entity or object but to a tacit integrating organization that separates what is “me” from what is “not me.” The self is a dynamic system organizing the elements of experience into a coherent whole by a process of dynamic-dialectical synthesis (Pascual-Leone, 1991; Smith & Thelen, 1993; Whelton & Greenberg, 2000). There is thus no central control; all elements add weight in an ongoing synthesis, producing a succession of momentary self-organizations, such as feeling shy or being assertive. Conscious control is but one aspect that can influence the synthesis process but is always itself influenced by tacit knowing.

The self-concept, in this view, is replaced by a selfnarration, that is, by a story we tell others and ourselves in order to make sense of our lives. This self-narration is not a structure or a concept but instead is an ongoing process by which we organize our experiences and provide accounts of our actions. The self-narration is a conscious conceptual process influenced by learning, by values, and by a variety of different cognitive and evaluative processes. People do not possess a self-concept; they actively narrate their experience, constructing views of who they and others are, as well as how and why things happened (Greenberg & Pascual-Leone, 1995; Watson & Greenberg, 1997).

Once we develop a conscious representation of our experience, this acts as an identity or becomes our self-narration. We then reflect on this leading to further new experiencing. We have many views of our self and are constantly revising these. Thus, we do not have a self-concept but are constantly forming it. We are engaged in an ongoing process of creating coherence and unity. In each moment we are the expression of one of many possible selves.

Experiencing

Experiencing has often been treated as the given datum. It just happens. In contrast, according to the neo-humanistic view, experiencing can be understood as the synthesized product of a variety of sensorimotor responses and emotion schemes, tinged with conceptual memories, all activated in a situation (Greenberg et al., 1993). In this view, multiple patterns of neural activation (schemes) are evoked by the same releasers and function together to produce a complex, coordinated internal field (Greenberg & Pascual-Leone, 1995, 1997; Pascual-Leone, 1991). This field provides the person with a sense of internal complexity to which to refer, and in which much more is contained at any one moment than any one explicit representation can capture.

Imagine, for example, telling the story to a friend of one of two versions of an experience the previous evening: While standing in line for a movie, you turned around and suddenly saw someone whom you either (a) wished desperately to avoid or (b) were amorously longing to meet. Depending on which experience occurred, you might be able to speak at length from two entirely different senses of internal complexity, generated in the moment by complex tacit synthesis. You could talk about how you felt in, and about, this moment, drawing on many different images and explicating complex felt meanings and their implications.All these tacit meanings occurred in the field of internal complexity but were not necessarily processed consciously in the moment that you greeted the other person.

It is important to note that this bodily felt sense of internal complexity is not only multidetermined by many modalities and modes of processing, such as auditory visual, kinesthetic, emotional, and semantic; it is also overdetermined. The sense of internal complexity is the result of many determinant causes stemming from the many compatible processes involved in the experience. Experiencing is overdetermined in the sense that many schemes or aspects are coordinated in its production (Greenberg & Pascual-Leone, 1995). A subset of these schemes might suffice to produce the same result.An experience thus means both “this” and “that,” even though the two determinants may differ and either could have sufficed to produce the result. Explanation of why one feels or does something is thus not a simple rational or linearly causal process. Conscious meaning then occurs by the symbolization of aspects of internal complexity into symbols that create distinctions in experience. These symbols in turn can be further organized by reflection to generate new felt meanings (Greenberg & Pascual-Leone, 1997; Watson & Greenberg, 1997).

Tacit decentralized control in a synthesis system of this nature makes it always possible to perceive more than we currently experience and to experience more than we currently attend to. New sets of tacit experience are always available to be explicated in consciousness. Experiencing is thus a tacit level of meaning generated by a dynamic synthesis of sensory, schematic, and conceptual levels of processing that integrate by a type of summation of related or mutual elements into a gestalt with figural and background aspects. In symbolizing experiencing, making the implicit explicit is not simply a process of representation but rather a process of construction, always limited and incomplete. Not all tacit information is used in any construction. Thus we can always explore for what more there is and reconfigure it in a new way. Explicit knowledge needs to fit adequately, to make sense of, and to integrate elements into a coherent, meaningful whole.

Growth is seen as emerging not only through the self-organization of some type of biological tendency, but also from genuine dialogue with another person. In such an I-thou dialogue (Buber, 1957), each person is made present to and by the other. In therapy, the therapist both contacts and confirms the client by focusing on particular aspects of the client’s experiencing. Contact involves a continual focus by the therapist on the client’s subjective experience, confirming the person as an authentic source of experience. Confirmation derives from the therapist’s selective focus on strengths and on what is adaptive and promotes growth. It is the therapist’s focus on subjective experience and strengths that helps guide client growth and development. In our view, people are often struggling and confused. Both “good” and “bad” inclinations exist as possibilities. Therapy is a coconstructive dialogue in which both the therapist and the client struggle to discern and confirm the client’s health-promoting tendencies and possibilities. Growth truly emerges from the “in-between,” from two people working together in a collaborative alliance toward the client’s survival, enhancement, and affirmation of life. The therapist’s ability to help the client explicate his or her experiencing, and to see and focus on implicit growthoriented possibilities, is an important element of promoting the client’s directional tendency.

Experience, then, is rich with not-yet-articulated implications. New meanings always can be created from a person’s field of internal complexity. Thus, developing oneself is really the unfolding of the implications of internal experiencing. This involves discovering some of the tacit constituents and organizing them into coherent wholes in interaction with another person. The growth tendency is thus seen as being dialectically guided both from within and from without.The internal aspect is guided by the emotion system, which evaluates situations in relation to well-being (Frijda, 1986; Greenberg et al., 1993; Greenberg & Safran, 1987; Lazarus, 1991). External guidance and support of the growth process comes from another person who sees the first person’s coping efforts, confirms them, and focuses on strengths, potentials, and possibilities. In other words, growth occurs in an interpersonal field. It is strengthened by being focused on, symbolized, and confirmed in dialogue.

Dysfunction

In the neo-humanistic process view, dysfunction occurs not through a single process, such as incongruence (Rogers, 1959), interruptions of contact (Perls et al., 1951), or a blocking of the meaning-symbolization process (Gendlin, 1962). Instead, dysfunction arises via many possible routes. This provides a more useful, flexible view of dysfunction—one that includes discerning varied current determinants and maintainers of problems.

At the most global level, we see the inability to integrate aspects of functioning into coherent harmonious internal relations as a major source of dysfunction. Thus, one’s wishes and fears, one’s strengths and vulnerabilities, or one’s autonomy and dependence may at any moment be in conflict or at any moment in danger of being disowned. Notice that conflict here is between different self organizations, not conscious versus unconscious or moral versus immoral. This view incorporates both Rogers’s and Perls’s views of incongruence and integration, as well as Mahrer’s (1978) view of the importance of affiliation and disaffiliation between operating potentials. However, these problems are attributed to the synthesizing and self-organizing functions of the self.

In line with Gendlin, Perls, and Rogers, we also see the inability to symbolize bodily felt experience in awareness as another central source of dysfunction. Thus, one may not be aware or be able to make sense of the increasing tension in one’s body, of the anxiety one feels, or of unexpressed resentment.

Athird major source of dysfunction involves the activation of core maladaptive emotion schemes, often trauma-based (Greenberg & Paivio, 1997). This leads either to painful emotions or maladaptive emotional experience and expression. The operation of this process implies that not all basic internal experience is an adaptive guide and that in addition to the benefits of becoming aware of basic experience, basic experience itself sometimes requires therapeutic change. For example, in posttraumatic stress the emotion system often signals an alarm when no danger is present. Similarly, poor attachment histories can lead to maladaptive experience of desire for, or mistrust of, interpersonal closeness.

The previous three general processes of dysfunction are supplemented by the operation of a large variety of more specific cognitive-affective processing difficulties that help explain different types of dysfunction. Greenberg et al. (1993) described a variety of particular experiential difficulties, including difficulties such as problematic reactions, in which one’s view of an experience and one’s reaction don’t fit; self evaluative splits, in which one part of the self negatively evaluates another; unfinished business, involving unresolved emotional memories; and statements of vulnerability involving a fragile sense of self. All involve different types of underlying schematic processing problems. Each state requires different interventions designed to deal with the specific cognitive-affective processing problems. This offers a differential view of dysfunction in which current determinants and maintainers of disorders are identified by a form of process diagnosis in which therapists identify markers of in-session opportunities for implementing specific types of interventions and change processes.

For example, specific problems in living such as depression might be seen as involving some of the above general processes of inability to integrate, symbolize, and separate past from present experience, but all also involve specific determinants and processing difficulties unique to different types of depressive problems or persons. For example, selfcritical depressions manifest primarily in self-evaluative conflicts in the person, whereas dependence-based depressions are organized around unfinished business with significant others (Greenberg, Watson, & Goldman, 1998).

Summary of Neo-Humanistic Theory

In the neo-humanistic view, people are seen as dynamic systems attempting to maintain the coherence of their organizing processes by continuous synthesis and restructuring. The person grows toward greater and greater complexity and coherence by constantly assimilating experience, integrating incongruities and polarities. Growth is inherently dialectical and dialogical. This view does not privilege an internal process of feeling and attending over meaning-creating processes of symbolization and reflection; nor does it privilege internal experience over contact with others. Rather, it sees a dialectical synthesis of all elements, emotion and cognition, internal and external, biological and social, as the crucial process in the creation of meaning. Culture, experience, and biology are given equally important roles.

Dysfunction occurs via different general and specific types of processing problems. In addition, any notion of a genetic or predetermined blueprint for whom the person “truly is” is rejected. In its place is an interpersonally facilitated growth tendency oriented toward increased complexity, coherence, and adaptiveflexibility.Therapyinvolvesattendingtothisadaptive capacity, confirming it, and promoting different types of processing to facilitate different types of problem resolution. In addition, therapy promotes awareness of blocks and interruptions of the person’s strengths and problem-solving capacities so that awareness becomes fluid rather than fixated on reworking unfinished situations. Therapy provides a relational environment that helps strengthen the adaptive self, creates process-enhancing interactions that will not interfere with or block healthy self-organizing processes, and will recognize the client as expert on his or her own experiencing. In addition, therapy emphasizes evoking maladaptive schemes in order to make them accessible to new experiencing. Different active methods are used to facilitate the resolution of different specific processing difficulties, always recognizing clients as having privileged access to their experience and as having the right to choose their direction, both in and outside therapy (Greenberg et al., 1993).

Realizing that emotion is a basic biologically adaptive system solves the problem of the scientific basis of the organismic valuing process (the “wisdom of the body”). This system operates by evaluating situations in relation to our well-being, thus serving as an organizing function for experience. This formative tendency works by means of a dynamic system process involving the dialectical coordination of many different elements to form inclusive, coherent syntheses of activated elements. This dialectical process works both through the medium of a basic biologically adaptive emotion system and via the human symbolic capacity and drive to make sense of things, in the service of goals to survive and to maintain and enhance the self. Thus, the organism is always producing a directional tendency informed by all its learning, experience, and interaction.

Further, human beings live and grow in the context of relationships and function by allocating attention to aspects of the organism-environment field. Attention operates under the control of emotion, interest, reason, conscious effort, and salient environmental stimuli. Attending leads to the creation of emotional meaning that organizes the person for action. At the point of symbolization, reasoning, aided by imagination, invents possible solutions and guides action. Goals, as well as plans for their attainment, are reflected on and evaluated, and the person decides on a course of action.Action on the chosen alternative then follows. This process involves emotion, reason, choice, and, above all, an ongoing process of dynamic synthesis of many elements including feelings, memories, beliefs, values, learnings, and anticipations, all constantly integrated as the self reorganizes itself to meet the environment.

The Practice of Humanistic-Experiential Psychotherapy

Having summarized humanistic-experiential theory, including a neo-humanistic, process-oriented reformulation, we now review the basic elements of humanistic-experiential therapy based on this reformulation.

Goals

The general goals of treatment are to promote more fluid and integrative self-organizations. Therapy focuses on the whole person; that is, it is person-centered rather than problem or symptom focused, but within this holistic focus the underlying determinants of different types of self-dysfunction are also an important point of focus. Both a change in manner of functioning of the whole self and changes in particular problems in self-organization are viewed as important. For example, a client may be seen as changing a general manner of functioning by becoming both more empathic toward self and better able to symbolize bodily felt experience, while also resolving a specific problem such as unfinished business with a significant other. In addition to promoting self-acceptance and a strengthening of the self, treatment also aims at solving particular problems of self-organization that emerge in treatment. The problems that are focused on emerge in a collaborative fashion over the course of treatment. The goal of treatment is to increase awareness and promote self-reorganization by integrating disparate parts of the self. In addition, awareness of the processes that regulate what enters awareness and what does not is emphasized.

The Therapeutic Relationship

In the most general terms, humanistic-experiential therapy is based on two basic principles: first, the importance of the relationship as a stubborn attempt by two human beings to meet each other in a genuine manner in order to provide help to one of them; and second, the consistent and gentle promotion of the deepening of the client’s experience. The relationship is seen as both curative, in and of itself, and as facilitating of the main task of therapy, that is, the deepening of client experiencing. The relationship is built on a genuinely prizing empathic relation and on the therapist’s guiding clients’experiential processing toward their internal experience. An active collaboration is created between client and therapist in which neither feels led, or simply followed, by the other. Instead, the ideal is an easy sense of coexploration. Although the relationship is collaborative, when disjunction or disagreement does occur, the therapist defers to the client as the expert on his or her own experience. Thus, therapist interventions are offered in a nonimposing, tentative manner, as conjectures, perspectives, “experiments,” or offers, rather than as expert pronouncements or statements of truth. Interventions are construed as offering tasks on which clients who are active agents can work if they so choose. The relationship always takes precedence over the pursuit of a task. Although the therapist may be an expert on the possible therapeutic steps that might facilitate task resolution, it is made clear that the therapist is a facilitator of client discovery, not a provider of “truth” or a psycho-educator. The role of a “life mentor” or an “internal exploration coach,” however, is compatible with a humanistic perspective.

Experiential therapy thus recognizes both the power of the understanding relationship and the importance of different in-therapy tasks in promoting different types of therapeutic change. The quality of the bond between participants as well as collaboration on the tasks and goals of therapy are seen as essential in creating a good therapeutic alliance. The bond is warm, respectful, empathic, and validating, whereas the goals and tasks focus on increasing awareness, deepening experience, and resolving specific in-session emotional problems.

The relational bond is seen as involving three main healing ingredients. First is a more transcendent aspect, the human presence of the therapist, witnessing and validating the other’s humanness; second is a set of more explicit facilitative attitudes that create a safe working environment; and the last is a set of specific interpersonal behaviors that facilitate growth and provide new interpersonal experience. Buber’s (1957) I-thou relationship, involving such elements as presence, commitment to dialogue, and nonexploitiveness, and the Rogerian triad (Rogers, 1957) of empathy, positive regard, and congruence, describe the general nature of the relationship. Empathy is seen as a complex cognitive-affective process of imaginative entry into the world of the other and involves understanding the other, including the other’s deeper experience. This process helps the client to feel connected, to regulate affect, and to construct new meaning.

A relational bond of this type is seen as both confirming the client as an authentic source of experience and as providing the optimal context for helping the client to attend to and become aware of prereflective experience and to communicate and explore it without fear of evaluation. The facilitative relationship, in addition to being curative in and of itself, also provides a safe environment for working on particular problems. Finally, not only does the relationship serve as a confirming environment and as a context for specific forms of intrapsychic work, but it is itself also a medium for specific corrective interpersonal experiences. Thus, certain forms of work on the relationship between client and therapist are also seen as mutative.

The experience of the therapist’s genuine and unconditional empathic prizing is viewed as freeing the client from the “conditions of worth” that have been assimilated from early experiences with parents and others (Rogers, 1959) and as providing new interpersonal experience that disconfirms pathogenic beliefs about self and relationship. These relationship conditions of personal genuineness and empathic prizing enable clients to express and explore their moment-to-moment experience as they describe the issues, events, and frustrations in their daily lives. The therapist’s empathic reflections of the most poignant feelings and other inner experiences enable the client to explore these inner experiences more deeply and to access aspects that have never before been fully expressed to others or even to themselves. The therapist’s clear, nonjudgmental caring reduces clients’ interpersonal anxiety and thus enables them to tolerate their own intrapersonal anxiety as they explore more and more deeply. Thus the relationship is not only a primary change agent in itself, but it also establishes a climate of inner awareness in which clients can engage in the exploratory process.

Buber’s (1957) I-thou relationship has also been adopted as an important model of relating for humanists. In this view, the therapist relates with immediacy and is fully present to the other, letting the other in on his or her own inner experience. The genuine dialogue is mutual and nonexploitive, with both participants caring about each other’s side of the dialogue. Buber sees the I-thou relationship as a genuine meeting between two people in which both openly respect the essential humanity of the other. Healing is viewed as occurring in the meeting (van Deurzen-Smith, 1996). In this sense the relationship is an active change agent. More recent interpretations of contact reflect the influence of Buber’s philosophy on Gestalt therapy and include Yontef’s (1998) concept of dialogue, a special form of contact in which people seek to be psychologically present to each other and to share what they experience as an end in itself. In experiential therapies this is considered to be the basis of effective therapy (Hycner & Jacobs, 1995).

Presence and contact are major principles of relating. Essentially, contact means that the therapist and client are fully present and engaged in a congruent fashion in whatever is occurring for the client in the moment. To the degree that the client’s internal processes interrupt the his or her contact with the self or with the therapist, the therapist attempts to bring this to the client’s awareness by inquiring about what happened at the point of interruption. Humanistic therapists believe that ultimately it is only in the context of an authentic relationship that the uniqueness of the individual can be truly recognized. Thus, the therapist strives for the genuine contact of a true encounter. This authenticity does not, however, mean overwhelming clients with self-disclosure or honesty without consideration for their needs or personal readiness.

Deepening Awareness of Client Experiencing: The Key Therapeutic Task

In addition to the provision of a “healing” relationship, facilitating work on particular therapeutic tasks is also seen as a core ingredient of experiential therapy (Greenberg et al., 1993). The most central task of experiential therapy is that of deepening the client’s experiencing. This involves focusing clients on their internal experiences, helping them to symbolize them in words and create new meaning. The therapist promotes different internal processes at different times to aid experiential processing. The processes facilitated range from symbolizing a bodily felt sense, to evoking memories, to allowing an intense feeling to form, to expressing feelings, to reflecting on experience to create new meaning. In addition, the client is encouraged to engage in such activities as psychodramatic enactments or exercises in imagination to help address particular emotional issues.

The humanistic-experiential approaches all attempt to promote client awareness and discovery, with the client viewed as the expert on his or her own experience. Drawing on existentialists such as Boss (1963) and Binswanger (1963), meaning is seen as resting in the phenomena (experiences) themselves. The view of the unconscious is not one of experience that is inaccessible to awareness other than through an external agent’s understanding and interpretation of it. Even if an experience is not available to first view, it is potentially accessible to awareness. The humanist position does not claim that there is no unconscious processing of information but subscribes to a view of a cognitive rather than a dynamic unconscious. The key difference is that in a cognitive-affective schematic processing view, the unconscious does not motivate behavior but rather influences perception and construal. Much of that which is unconscious is simply not currently in awareness and can be made aware by attentional focusing.

Empathic reflection and exploration of the client’s momentby-moment inner awareness is viewed as an important way of both guiding attention and offering symbols that enable the client to discover for his or her experience. The therapist’s reflections carry the message of empathic understanding, as well as the explicit or implicit expectation that the client will be able to correct this reflected understanding and will carry it further. The assumption is that the personal meaning of the client’s experience is in the experience itself, and under optimal conditions clients can grasp these meanings for themselves. Thus, the therapist works consistently within the client’s frame of reference, reflecting what it is like to be the person at that moment and making sure not to assume the position of being more expert than the client about the client’s experience. The therapist conveys to clients that they are the best judges of their own realities.This is a very important active ingredient of therapy because the process provides an experience that is viewed as an antidote to one of the client’s major psychological problems— not trusting their own experience because of learned conditions of worth.

Humanistic therapists integrate leading and following in their responses to clients. The therapist at times directs the process by influencing the client’s depth of experiencing and manner of processing, always guiding the client toward his or her inner experience. Therapists create experiments in order to help clients to discover aspects of their experience, share hunches about what may be occurring, and teach clients about specific interruptive and avoidance processes. Therapists train clients to become aware both of their experience and of how they interfere with their experience, directing them to attend to sensations, nonverbal expressions, and interruptive and avoidant processes (Sachse, 1996; Lietaer, Rombauts, & Van Balen, 1990; Polster & Polster, 1973).

Humanists use a combination of discovery, interpretation, and confrontation. They might challenge and interpret obstacles to choice and action. Existential therapists, for example, view the anxiety aroused by awareness of the “ultimate concerns” such as death, freedom, isolation, and meaninglessness as leading to defense mechanisms such as repression, distortion, or avoidance. It is these kinds of avoidances that are often directly challenged by the therapist. Thus, therapists may at times confront blocks or avoidances; however, the primary emphasis is on supporting clients in discovering for themselves what it is that they are experiencing, especially what they feel and need. The ultimate belief is that clients must discover the truth for themselves from their own internal experiences and that therapists cannot provide that truth or insight.

Awareness is regarded as central to change. Therapists give feedback in the form of observations about clients’ current process, particularly on nonverbal aspects of client expression,andthus,tosomedegree,therapistsviewtheclientasnot having immediate access to all experience without help. Conflicts between aspects of experience are seen as interfering with functioning and awareness, and a confrontation between these different aspects of experience, if suitably facilitated, is seen as important in the therapeutic process.

With regard to the complex issue of the possibility of knowing oneself, although humanists would not deny the constructed nature of the creation of meaning, they believe that there is an experiential reality for each person and that awareness of this reality can be progressively approximated. Although there may be no one single truth that can be attained, there will be many perspectives that would not fit the experiential data, and only a few that will provide a good fit. People know their worlds through their bodily felt experiences (Gendlin, 1962; Johnson, 1987). Once they accurately symbolize their bodily experience (e.g., that they feel tense or afraid or angry), they can construct a variety of meanings from this. But symbolizing tension as calmness, the experience of fear as grief, or anger as joy would be inherently inaccurate and distorting. People are seen as being able to determine the right paths for themselves from an intensive process of discovery, leading to an inner sense of certitude. Thus, although the person is always constructing the meaning of the experience by a synthesizing process, the elements of the synthesis have an experiential validity and can be symbolized more or less accurately.

Therapists thus work to enable clients to turn inward and get in touch with their own present organismic experience and to value it as a trustworthy guide. The emphasis is on process rather than on choosing goals, and therapy is not viewed primarily as a struggle against resistance, but as something that can be achieved under the right conditions. The therapeutic conditions of empathy, unconditional prizing, and genuineness are viewed by many as being sufficient to release and foster the actualizing tendency. The therapist is seen as needing to be very active in fostering inward experiential search, but not in judging what is best for this person.

Growth becomes possible when people fully identify with themselves as growing, changing organisms and clearly discriminate their feelings and needs. Effective self-regulation depends on discriminating feelings and needs by means of sensory awareness. This leads to awareness of intuitive appraisals of either what is good for the person and should be assimilated or of what is bad and should be rejected. The assumption is that the healthy organism “knows” what is good for it—this is organismic wisdom. This wisdom works by a spontaneous emergence of needs to guide action. Life is the process of a need arising and being satisfied and another need emerging and being satisfied.

The graded experiment was introduced in Gestalt therapy as an addition to the predominant interventions of the time, namely interpretation, reflection, or goal setting. This experimental method drew from psychodrama the use of enactment and set up in-session tasks for clients, not necessarily to be completed, but to be tried out to discover something. Experimenting in the session with tasks such as two-chair work and dream work was emphasized, but many other experiments were created in the moment to help clients intensify and embody their experiences. Creative experiments were produced to meet the client’s situation. Experiments were created such as asking the client to express resentment to an imagined other, to assert or disclose something intimate to the therapist, to curl up into a ball, to express a desire in order to make it more vivid, or to move freely and fluidly like water. The client’s experience and expression were then analyzed for what prevented or interrupted completion of these experiments. The experimental method focuses on bringing peoples’ difficulties with task completion to the surface. Therapists ask clients to become aware of and experience the interruptive processes that prevent their feelings or needs from being expressed or acted upon. In this manner, clients are seen as gaining insight into their own experience by discovery rather than interpretation.

Creative use of imagery and experiment involve “try this,” followed by “what do you experience now?” In addition to the experiment, Gestalt therapists used a set of key questions designed to get at particular aspects of clients’ functioning and to promote creative adjustment to the environment. Key questions oriented at experience include the following: What are you aware of? What do you experience? What do you need? and What do you want or want to do? Finally, identityrelated questions of the form “Who are you?” or “What do you want to be?” were also used at appropriate times.

With more fragile clients who have not developed a strong sense of self or boundary between self and other, the development of awareness was seen as more of a long-term objective. Promotion of experience and asking these clients feelingoriented questions was seen as pointless, as these clients had yet to develop an awareness of their internal worlds. With these clients, the relationship was seen as the therapeutic point of departure. Thus, more fragile clients need a more relational form of work, with the focus on the process of contact with the therapist.

Much therapeutic work thus involved helping people become more aware of sensation or experience. Blocking of arousal or excitement results from dampening or disavowal of emotional experience. Therapeutic work at times may focus on increasing awareness of muscular constriction and becoming aware of one’s other methods of suppressing emotional experience. At other times, the focus is on promoting awareness of and action to satisfy organismic needs that have been interrupted by introjected attitudesand values that create a split between wants and shoulds. Two-chair dialogues often are used at this point to resolve the split. Interruption can also occur at the completion stage when the person does not allow him- or herself to experience the satisfaction of the need.At this stage, awareness work is again implemented in order to help the person become aware of the experience of satisfaction and how he or she may be preventing it. Ultimately, awareness is seen as leading to choice; with enough awareness, the person can then make the most adaptive choices.

Gestalt therapists, such as Polster and Polster (1973), give work with dreams a central place in Gestalt therapy.Anumber of techniques are used to give dream work immediacy. The client is asked to start by telling the dream as if it is occurring in the present, which helps the dreamer relate more directly to the dream’s content. The client may also be asked to act out the dream, to identify with a figure or a mood and narrate his or her dream experiences from a subjective perspective.

Frankl (1969) writes about the two main logotherapeutic techniques. These are dereflection and paradoxical intention. Dereflection attempts to remove the “demand quality” from future events so that the person can live more spontaneously.

The technique of dereflection basically involves telling a person to stop focusing on him- or herself and to look for meaning in the outside world (Yalom, 1980). Often helpful for phobias, paradoxical intention encourages the client to wish for the very thing that he or she fears. Paradoxical intention uses the logotherapeutic principle that goals that are focused on become difficult to achieve. For example, if individuals try to gain fame and wealth, they are likely to fail. However, if people pursue something that is meaningful to them, fame and wealth may follow. Similarly, if individuals fear public speaking because they know that they will sweat, they are encouraged paradoxically to attend to the sweating and to try to force as much sweat as possible. In this way, the client’s anticipatory anxiety can be overcome. In anticipatory anxiety, a client avoids a fearful stimulus that creates the possibility that that event will occur. This is because the feared stimulus is never engaged, but always feared, thus creating a vicious cycle. By paradoxically attending to the experience of the feared stimulus, the myth of its danger dissipates.

Experiential Therapy as Process Theory

An important distinguishing characteristic of experiential therapy is that it offers a process theory of how to facilitate knowledge by acquaintance, rather than a content theory of personality or psychopathology. A process theory of this type specifies both the moment-by-moment steps in the client’s process of change and the therapist’s interventions that will facilitate these steps. The emphasis in each step always is on how to promote the direct sensing of what is concretely felt in the moment to create new meaning.

Experiential theorists and researchers have also specified patterned sequences of change processes that occur in sessions, sequences such as attending to bodily felt sensation, and symbolizing this in words, or arousing emotion followed by accessing needs. These sequence models can be used to facilitate client work in therapy sessions. The therapist is seen as an expert in the use of methods that promote experiencing and facilitate new steps rather than as an expert on what people are experiencing.

There is an explicit assumption that within each individual there is a flow of experiencing to which the person can refer in order to be informed about the personal meaning of particular experiences. The main principle of the experiential method is to have people check whatever is said or done against their own concretely felt experiences. Change is seen as emerging from a growing awareness of previously unsymbolized experience and the bringing of this experience into dialectical interaction with words or symbols and other aspects of experience to create new meaning.

The key to experiential therapy is to have clients experience content in a new way so that this new experience will produce a change in the way that they view themselves, others, and the world. Experiential therapy thus adds the emphasis that symbols, schemes, and even behavior must interact with the body-based, experiential level of existence in order to produce change. It thus offers a process theory of how body and symbol interact, as well as a set of methods for promoting this process.

Experiential therapy theorists have specified patterned sequences of change processes and events, the explicit connections of which are spelled out by their process theories of particular types of change. Three such characteristic sequences are described here. One sequence offered by Gendlin (1996) describes a series of three fundamental client change processes: (a) The client focuses on a directly felt meaning. (b) The client allows feelings, words, and pictures to arise from this inward focusing and attends to the generated feeling. (c) The client receives a new felt meaning that emerges from the ensuing shift in body experience. Another experiential sequence (Mahrer, 1989) consists of four client basic change processes: (a) The client attains a level of strong feeling. (b) The client welcomes and appreciates the accessed inner experiencing. (c) The client becomes (identifies with) the inner experiencing in the context of earlier life scenes. (d) The client becomes and behaves according to the inner experiencing in the context of imminent future life scenes.

A third sequence, specified by Greenberg and Paivio (1997), involves a series of six basic change processes: (a) The client experiences the problematic bad feelings in the session. (b) The client accesses, allows, and receives deeper core emotions and needs in the session. (c) The client and therapist together explore whether the core emotion is adaptive or maladaptive. (d) If judged to be adaptive, the core feelings are used as a guide; if judged to be maladaptive, alternate adaptive emotions and needs are accessed. (e) Any core maladaptive emotions and associated beliefs are challenged from within the client by the newly accessed adaptive emotions and needs. (f) New meaning is created based on the new experience that emerges from the dialectical interaction of adaptive and maladaptive parts of self.

In these processes the therapist is seen as an expert on how to facilitate new steps in the client’s experiencing, rather than as an expert on the content of the client’s experience. Therapists thus avoid interpretations of the content of clients’experiences that tell the client why they do things and that are theory-driven rather than experience-near. Responses that are conceptual or explanatory, or are expressed as fact, or that convey the message that truth comes from the therapists’professional knowledge, are avoided in favor of phenomenologically refined exploration of the client’s experiencing. Experiential therapy thus attempts to eliminate any interpretations that are based on the therapist’s theory of how people are, or should be, or that attempt to reveal hidden “truths.”

Instead, the experiential approach places great emphasis on, and holds great respect for, what the client experiences and pays special attention to what the client experiencesin the session with the therapist. Experiential therapy involves consistent listening from within the client’s frame of reference. Sustained empathic inquiry is a central part of practice. However, although this empathic emphasis is necessary for good psychotherapy, it is not necessarily sufficient for the best psychotherapy. The most effective psychotherapy also requires therapist practices of a technical nature, such as experiential focusing and within-session experimentation (Gendlin, 1996; Perls et al., 1951). Diagnostic understanding of the individual, as well as understanding of the social, cultural, and institutional forces affecting the individual, is also required.

Notwithstanding the fact that what the client experiences is the indispensable essence of psychotherapy, and that it is imperative that this be the subject of respectful ongoing inquiry by therapist and client, what the client does not experience is also an indispensable and critical component of what happens in therapy. Important factors that are current outside the client’s conscious awareness may also need to be explored. In experiential therapy there is a special emphasis on bringing into awareness the processes that regulate this process of awareness-unawareness (Polster & Polster, 1973; Yontef, 1993). This work is codirected by therapist and client and is not based on any alleged higher truth of the therapist. It is based on a joint empathic exploration that may include insession process observation, experimentation, and dialogue.

Basic Principles of Practice

Greenberg et al. (1993) laid out six principles describing the balance between relationship and work in experiential therapies. These guiding principles are themselves divided evenly between relationship and task facilitation elements, with the relationship principles coming first and ultimately receiving priority over the task facilitation principles.

Relationship Principles. The relationship principles involve facilitation of shared engagement in a relationship that is both secure and focused enough to encourage the client to express and explore his or her key personal difficulties and emotional pain. These involve the following:

1. Empathic attunement to the client’s subjective experiencing. Throughout, the therapist tries to enter the world of the other imaginatively in order to make contact with and maintain an understanding of the client’s internal experience as it evolves from moment to moment (Bohart & Greenberg, 1997).
2. Creating a therapeutic bond. The therapist seeks to develop a strong therapeutic bond with the client, by conveying understanding and empathy, acceptance and prizing, and presence and genuineness. The therapist’s presence as an authentic and, where appropriate, transparent human being encourages client openness and risk taking and helps to break down the client’s sense of isolation (May & Yalom, 1989). Authenticity and transparency also support the therapist’s empathic attunement and prizing, making them believable for the client. Genuineness refers to facilitative, disciplined, nonexploitive transparency, based on the therapist’s accurate self-awareness and an intention to help rather than to obtain personal gratification or simply to express self (Greenberg & Geller, 2001).
3. Facilitating task collaboration. An effective therapeutic relationship also entails involvement by both client and therapist in the overall treatment goals, immediate withinsession tasks, and specific therapeutic activities to be carried out in therapy (Bordin, 1979).

Task Principles. The other three principles are based on the general assumption that human beings are active, purposeful organisms, with an innate need for exploration and mastery of their environments. These principles are expressed in the therapist’s attempts to help the client resolve internal, emotion-related problems through work on personal goals and within-session tasks.

1. Facilitate optimal client experiential processing. Based on the recognition that optimal client in-session activities vary between and within therapeutic tasks, the therapist helps the client to work in different ways at different times (Leijssen, 1998).
2. Facilitate client completion of key therapeutic tasks. The therapist begins by helping the client to develop clear treatment foci and then tracks the client’s current task within each session. Typically, the therapist gently persists in helping the client stay with key therapeutic tasks rather than wandering off into material that does not relate to the theme of the task.
3. Foster client growth and self-determination. The therapist supports the client’s potential and motivation for selfdetermination, mature interdependence, mastery, and selfdevelopment by listening carefully for, helping the client explore, and validating the “growing edges” of new client experience.

Therapist Experiential Response Modes

In carrying out the six treatment principles, therapists use a number of specific speech acts or response modes to help clients (cf. Greenberg et al., 1993). Most of what the therapist does in experiential therapy involves empathic understanding, empathic exploration, process directing, and experiential presence responses (Elliott, 1999; Greenberg et al., 1993). These basic building blocks comprise the vast majority of what the therapist does in this treatment (Davis, 1995).

Empathic Understanding Responses

Empathic reflection seeks to communicate understanding of the client’s message and includes simple reflections and related responses (uh-huh’s). In addition to expressing the therapist’s empathic attunement, such responses commonly serve to enhance the client-therapist relationship, to offer prizing and support to the client (through understanding), and to underline issues as they emerge within therapeutic tasks. For example, a client who is talking about her shattered security after a trauma says,

C: I mean that’s the biggest grief, that’s my biggest sadness, to lose my sense of confidence in everything.

In response, the therapist reflected with,

T: That’s what you grieve for, the loss of safety, of a sense of being able to trust that things will be OK.

Empathic Exploration Responses

The most characteristic therapist response in experiential therapy is empathic exploration. These simultaneously communicate understanding and help clients move toward the unclear or emerging edges of their experience. Empathic exploration responses take a number of different forms, including evocative and leading-edge reflections, exploratory questions, and empathic conjectures. Following is a brief excerpt with the same client illustrating first an evocative empathic exploratory response followed by a response that focuses on the leading edge of the client’s experience.

C: I just want enough of who I used to be, so that I again could live like a human being.

T: “I don’t feel like a human being right now. Maybe more like a stalked animal?”

C: Just like a paranoid little girl, ya know. I just need something of what I had.

T: It’s like I need what I had—I need some of the courage and strength of what I was before it all happened.

C: Yeah. Just to feel able to face things again.

A little later, the therapist asks an exploratory question:

T: What’s it like inside? What do you feel now in this part?

C: Happy. [laughs softly]

Process Directives

These interventions are directive in process rather than in content. There are a variety of ways of being process directive, but telling the client what to do to solve problems outside the therapy session is inconsistent with the principle of client selfdetermination. However, the therapist can suggest in a nonimposing way that the client try engaging in particular in-session activities. This includes experiential teaching (giving orienting information, treatment rationales), attention suggestions (directives to attend to immediate experience), task structuring (to help the client enter into therapeutic tasks), action suggestions (directives to do or try something in the session), and task focusing (used to help the client “stay with” or “come back to” a therapeutic task after a sidetrack). These are illustrated by this sample of process directives used to help the same client grieve and reaccess her “lost strong self”:

T: Can you stay with that hurt and sadness for a minute, and just feel what that’s about and what that’s like? [Attention suggestion about her discouragement at not overcoming her fears.]

T: One way to try to work with the grief is to put that part of you that you’ve lost in the chair and talk to her. [Suggesting a potentially useful therapeutic task.]

Once the task is in process the therapist directs the process:

T: Can you go over and be in the strong part?

C: I would but I wouldn’t know how. T: Tell her, “I’d like you to have that strength.” C: I’d like you to have my strength.

T: What’s that feel like?

C: Like a—like a mom.

Experiential homework is an additional kind of process directive, as in the following example involving a client who suffers from sudden inexplicable episodes of suicidal feelings:

T: During the next week, it might be useful for you to try to pay attention to what is going on when you have these “black funnel” experiences and see if you can remember exactly what is going through your mind right before them.

Experiential Presence

Therapist empathic attunement, prizing, transparency, and collaboration—attitudes involved in fostering the therapeutic relationship—are communicated primarily through the therapist’s “presence” or manner of being with the client.The exact configuration of therapist paralinguistic and nonverbal behaviors, including silence, vocal quality, and appropriate posture and expression, is difficult to describe. There is, however, an easily recognized, distinctive style. For example, the therapist typically uses a gentle, prizing voice (and sometimes humor) to deliver the process directives just described, while empathic exploration responses often have a tentative, pondering quality intended to support client experiential search. Presence is also indicated by direct eye contact at moments of connection between client and therapist. It is important to recognize that the therapist cannot fake these behaviors, which must come naturally from the therapist’s genuine experience of being attuned, caring, and joining with the client in shared, emotionally involving therapeutic work.

Therapist process and personal disclosure responses are commonly used forms of experiential presence. Here the therapist uses a personal disclosure to help the client explore her feelings:

C: I just wish I could stop that part of me from feeling so scared.

T: I understand; it’s hard to feel so scared. But I feel sad for how alone that frightened little girl in you must feel.

Nonexperiential Responses

Although therapist responses such as interpretation, extratherapy advisement, and reassurance are typically avoided or minimized, they may at times be useful or even necessary. For example, they may be needed for clinical management of crises, suicidality, and impulsiveness or for dealing with other important practical issues. The important thing is for the therapist to say them briefly and from his or her perspective.

Experiential Tasks

As noted earlier, experiential therapy uses a variety of different sequential process experiential tasks, drawn from client-centered, Gestalt, and existential therapy traditions. These tasks all include three elements: a marker of a problem state that signals the client’s readiness to work on a particular issue or experiential task, a task performance sequence of therapist and client task-relevant actions, and a desired resolution or end state. It is useful to divide experiential tasks into three major groupings:

1. Experiential search tasks generally emphasize exploration of inner experiencing, usually ending with some form of new symbolic representation.
2. Active expression tasks are most distinctive for promoting client enactment of experiences or aspects of self in order to heighten and access underlying emotion schemes.
3. Interpersonal contact tasks center around genuine personto-person contact between client and therapist.

Experiential search tasks are those in which clients present some form of problematic experience that requires them to examine closely and put into words painful or puzzling aspects of inner experience. Two experiential search tasks are described here.

First, focusing has been described by Gendlin (1984, 1996) as a general task for working with client experiencing, and, in particular, with unclear felt sense markers. Or the client may be distancing emotionally in the session, in the form of speaking in an intellectual or externalizing manner, talking around in circles without getting to what is important to him or her. When this occurs, the therapist can gently intervene:

T: I wonder, as you are talking, what are you experiencing?

C: I’m not sure. I feel like I’m just going on talking and not really saying anything.

T: I wonder if we could try something here? [Client nods.] Can you take a minute, maybe slow down . . . and close your eyes, and look inside, to the part of you where you feel your feelings. . . . And ask yourself, “What’s going on with me right now?” . . . See what comes to you . . . Don’t force it; just let it come . . . and tell me what comes to you. . . .

Resolution involves symbolizing a felt sense, accompanied by an experienced sense of easing or relief and a sense of direction for carrying this “felt shift” into life outside the therapy session.

Second, systematic evocative unfolding is used for problematic reaction points, or instances in which the client is puzzled by an overreaction to a specific situation (Greenberg et al., 1993).

When the client presents a problematic reaction point, the therapist suggests that the client take him or her through the puzzling episode, including what led up to it and exactly what it was to which the client reacted. The therapist helps the client alternately explore both the perceived situation and the inner emotional reaction in the situation. As the client imaginally reenters the situation, he or she commonly reexperiences the reaction while the therapist begins by encouraging the client in an experiential search for the exact instant of the reaction and its trigger.As with the other tasks, resolution is a matter of degree; at a minimum, resolution involves reaching an understanding of the reason for the puzzling reaction; this is referred to as a meaning bridge. Nevertheless, the meaning bridge is usually just the beginning of a self-reflection process in which the client examines and symbolizes important selfrelated emotion schemes and explores alternative ways of viewing self. Full resolution involves a clear shift in view of self, together with a sense of empowerment to make life changes consistent with the new view of self.

The next set of tasks, active expression tasks, come out of Gestalt and psychodrama traditions and ask the client to enact aspects of self or others in order to evoke and access underlying emotion schemes. They are also used for helping clients access disowned or externally attributed aspects of self, especially anger; and they are particularly useful to help clients change how they act toward themselves (e.g., moving from self-attacking to self-supporting). The major empirically investigated active expression tasks have been extensively described elsewhere (Rice & Greenberg, 1984; Greenberg et al., 1993). Note that these active, evocative tasks generally require a stronger therapeutic alliance and thus are rarely attempted before session three.

Two-chair dialogues are used when the client presents some form of conflict split marker. While some conflicts are easily recognized, others are not:

• Decisional conflict: client feels torn between two alternative courses of action (e.g., whether to end a relationship).
• Self-evaluation split: client criticizes self; this is seen as a conflict between critic and self aspects of the person.
• Attribution split: client describes an overreaction to a perceived critical or controlling other person or situation; this is understood as a conflict between the self aspect and the client’s own critical aspect, projected onto the other person.

For obvious reasons, traumatized, anxious, and depressed clients often present self-evaluation splits. Frequently, the internal critical or threatening process is attributed to the environment and experienced as coming back at the self. For example, anxiety splits often involve a fear-inducing situation being infused with attributed meaning to which the client overreacts with the weak self (Elliott, Davis, & Slatick, 1998). This type of split can present as “X (e.g., driving on the freeway) makes me afraid.” A catastrophizing critic is often central in this experience, and as the person enacts the terrorizing road, threatening the self, the attributed catastrophizing-protective part of the self is reowned. The client then becomes an agent, enacting the warning-protective aspect of self that tries to prevent future harm by continually scaring the other aspect of the self, with the unintended consequence of making it feel weak and vulnerable.

The therapist initiates the two-chair dialogue by suggesting that the client move back and forth between two chairs, each representing one self-aspect, in order to enact the internal conversation between the two parts. (Examples of therapist process directive responses used to set up and maintain this task were given earlier in the presentation of process directing responses.) In the case of an attributional split, the client is asked to enact the other or external situation. For example, a traumatized client with a fear of driving on the freeway can be asked to “be” the freeway and “show how you scare her.” This gives the client the opportunity to identify with and reown the powerful, frightening part of the self. This reowning would constitute a partial resolution, whereas a full resolution would require some kind of mutual understanding and accommodation between the fearful self and the fear-inducing aspect. The fearful self would express its primary fear and access the core emotion scheme and needs, and the fear-inducing critic self would soften its stance toward the self aspect.

Two-chair enactments for self-interruptions are relevant for addressing immediate within-session episodes of emotional avoidance or for distancing indicative self-interruption. Depressed, anxious, and traumatized clients often suffer from an underlying emotional processing split between emotional-experiencing and intellectual-distancing aspects of self. These processing splits result in emotional blocking or stuckness and often manifest in the form of secondary reactive emotions such as hopelessness or resignation. Self-interruptions are most readily recognized when the client begins to feel something (e.g., anger) in the session, then stops him- or herself, often with some kind of nonverbal action (e.g., squeezing back tears) or reported physical sensation (e.g., headache). However, self-interruptions are also indicated by statements of resignation, numbness, stuckness, or reports of feeling weighted down, all typical of clinical depression.

Asking the client to enact the process of self-interruption facilitates resolution of this task. In a two-chair enactment the therapist directs the client’s attention to the interruption (the stuck or blocked state) and then suggests the experiment by asking him or her to “show how you stop (the client) from feeling (whatever was interrupted).” The intervention helps the client bring the automatic avoiding aspect of self into awareness and under deliberate control; this in turn helps the client become aware of the previously interrupted emotion so that it can be expressed in an appropriate, adaptive manner. Minimal resolution involves expression of the interrupted emotion, and more complete resolution requires expression of underlying needs and self-empowerment.

Empty chair work is based specifically on the assumption, discussed earlier, that primary adaptive emotions (e.g., sadness at loss, anger at violation) need to be fully expressed; to access their adaptive actions and to be processed more completely. Thus, this task is aimed at helping clients resolve lingering bad feelings (usually sadness and anger) toward developmentally significant others (most commonly parents). The marker, referred to as unfinished business, involves partial expression of the bad feelings, often in the form of complaining or blaming; this indicates that the client is blocked from fully expressing the feelings.

Empty chair work has been used extensively by therapists working with individuals who were abused or maltreated as children (e.g., Briere, 1989). Research by Paivio (1997; see also Paivio & Greenberg, 1995) supports its effectiveness for helping the client resolve unfinished emotional business. There is, however, some controversy about the therapeutic value of putting the perpetrator in the empty chair (Briere, 1989), and, in any case, the method appears to be less useful in single victimizations by strangers. Nevertheless, victimization experiences almost always involve significant others who are perceived by the person as having failed to provide adequate protection during and after the trauma (Elliott et al., 1998). Unfinished business markers also appear to be common in depressed clients as well, especially those whose depression is characterized by interpersonal loss issues.

Thus, in the presence of a strong therapeutic alliance and the unfinished business marker, the therapist suggests that the client imagine the other in the empty chair and express any previously unexpressed feelings toward him or her. The therapist may also suggest that the client take the role of the other and speak to the self. Resolution consists, at a minimum, of expression of unmet needs to the other; full resolution requires restructuring of unmet needs and a shift toward a more positive view of self and a more differentiated view of the other.

Empty chair work is highly evocative and emotionally arousing. If the client is already in a strong emotional state, he or she is likely to feel overwhelmed even by the suggestion to speak to the other in the empty chair. In any of these more expressive tasks, if emotional arousal is high to start with, it is preferable to work with the creation of meaning than to encourage further arousal because this helps the client to symbolize and contain painful emotion (Clarke, 1993). In general, in empty chair work the therapist needs to maintain constant empathic attunement to the client’s level of emotional arousal and to whether the client feels safe enough with the therapist to undertake this task.

Interpersonal contact tasks constitute the final set of experiential tasks we discuss. These tasks return to the relational strand of the therapy tradition and include three kinds of genuine person-to-person contact between client and therapist, in which change is believed to emerge directly from a therapeutic relationship characterized by empathic attunement, prizing, genuineness and collaboration. These tasks take priority over all others.

Empathic affirmation is offered when clients present a vulnerability marker, indicating the emergence of general, self-related emotional pain or shame. The client reluctantly confesses to the therapist, sometimes for the first time, that he or she is struggling with powerful feelings of personal shame, unworthiness, vulnerability, despair, or hopelessness. The sense is that the client is experiencing a pervasive, painful, shameful feeling and has run out of resources. Vulnerability markers are relatively common in work with traumatized clients (Elliott et al., 1996) and are also found in depression. When vulnerability emerges in the course of working on some other task, it takes priority.

In emotional vulnerability, the client’s need is to face and admit to another person an intense, feared aspect of self that had been previously kept hidden. The therapist’s task is to offer a nonintrusive empathic presence, accepting and prizing whatever the client is experiencing, and allowing the client to descend into his or her pain, despair, or humiliation as far as he or she cares to go. The therapist does not push for inner exploration and indeed does not try to “do” anything with the client’s experience, except to understand and accept it. When the therapist follows and affirms the client’s experience in this way, it helps to heighten the vulnerability to the point where the client “hits bottom” before beginning spontaneously to turn back toward hope. It is very important for the therapist to maintain the faith that the client’s innate growth tendencies will enable him or her to come back up after hitting bottom. Resolution consists of enhanced client selfacceptance and wholeness, together with decreased sense of isolation and increased self-direction.

Alliance dialogue takes place when the client expresses some form of complaint or difficulty with the treatment, as in the following examples (cf. Safran, Crocker, McMain, & Murray, 1990):

• I feel stuck, like I’m not progressing anymore, or maybe even going backward.
• There you go, exaggerating again.
• I know you’re not supposed to give advice, but I really think I need someone to tell me what to do about these fear attacks I keep having.

Although such alliance difficulties are relatively rare in empathic experiential therapies because of the empathic attunement of the therapist, they nevertheless occur and warrant immediate attention and the suspension of any other therapeutic tasks. Furthermore, therapeutic errors, empathic failures, and mismatches between client expectations and treatment are inevitable in any therapy. These result in disappointment and sometimes anger in the client. In addition, this task is particularly relevant to work with clients who have extensive or severe histories of abuse or other forms of victimization; such persons routinely perceive the therapist as just another potential victimizer. It is therefore very important that therapists listen carefully for and respond to therapy complaint markers.

The therapist begins alliance dialogue work by offering a solid empathic reflection of the potential difficulty, trying to capture it as accurately and thoroughly as possible. The therapist suggests to the client that it is important to discuss the difficulty in order to understand what is going on, including what the therapist may be doing to bring about the problem. The difficulty is presented as a shared responsibility for client and therapist to work on together. The therapist models and fosters this process by genuinely considering and disclosing his or her own possible role. In this way, the client is encouraged to examine his or her own part in the difficulty as well, and the client and therapist explore what is at stake for the client in the difficulty, as well as how it might be resolved between them. Resolution consists, at minimum, of client and therapist together arriving at an understanding of the sources of the problem; full resolution entails genuine client satisfaction with the outcome of the dialogue, along with renewed enthusiasm for the therapy.

Experiential interactional work involves focusing with high immediacy on what is occurring in the interaction between client and therapist, under the assumption that there is a link between a person’s problems and the person’s interactional style with the therapist (van Kessel & Lietaer, 1998).

The marker here is internal to the therapist in that he or she begins to feel some difficulty or distress in the interpersonal interaction with the client. The therapist then focuses on this internal experience in order to discern what interactional pull is being responded to. This occurs when the client’s typical style of communication calls for a response from the therapist such as humor, caretaking, or humiliation. Through a process of disciplined genuineness, the therapist needs to become clear on what his or her internal response is. The intervention involves metacommunicating about the internal reaction, elucidating the interactional pattern and providing a new experience in the relationship to help change the pattern (Kiesler, 1996; Lietaer, 1993; Rennie, 1998).

Although this task is psychodynamically derived, the experiential approach to this situation of working through transference patterns emphasizes the importance of the hereand-now interactional process with the client. This task is only when the therapist notices that a recurrent problematic interaction is currently occurring and is able to avoid being caught up in the automatic complementary response. This allows the therapist to offer his or her current, genuine response in the relationship, giving the client the experience of being known and engaged in a vital, searching human relationship. Of great importance in an experiential approach to this task is that it is engaged in only when currently relevant. Thus, rather than this being the main avenue of treatment, or the relationship being structured to evoke the pattern, the problematic interactional pattern is responded to only when it keeps reappearing overtly as an issue in the relationship and is acting as a block to the experiencing process. In addition, in experiential interaction work, the emphasis is on a new, corrective emotional experience emerging within the relationship rather than on understanding the pattern or its psychogenetic origins.

Resolution of this task involves clients’ experiencing themselves in new ways and being able to move forward in the session and experience and relate to the therapist in a new way. Therapist self-reflection, presence, and genuineness are vital here. The therapist must be able to share his or her experience of the interaction in a facilitative way so that the client truly experiences a moment of healing in the encounter with the therapist.

For example, rather than responding to repeated client ridicule with annoyance, the therapist uses his or her annoyance as a marker for a problematic client interactional style; he or she then turns attention inward, focuses, and identifies a sense of embarrassment and helplessness underneath the annoyance.Insteadofself-disclosingtheannoyance,thetherapist shares the embarrassment and helplessness, communicating both the genuine response and the desire to help the client examine the problematic interaction process. Together, client and therapist each disclose their reactions to the other, including their hopes and fears, and also exploring what has happened between them as an instance of a general way in which the client relates to other people.

Case Formulation

Historically, humanistic therapists have resisted the notion of case formulation, as traditional diagnosis and formulation were seen as potentially creating an imbalance of power and setting thetherapistuptoplaytheroleoftheexpert.Caseformulation, however, has been redefined in neo-humanistic terms as process diagnosis (Goldman & Greenberg, 1997). From this perspective, case formulation occurs within an egalitarian relationship and ultimately communicates that clients are expert on their own experience and that the therapeutic process is coconstructive. Process-oriented case formulation gives priority to the person’s experience in the moment. Therapists do not conduct a factual history taking conducted prior to or at the onset of therapy because such information is often incomplete and lacking the proper context to establish its true significance in the person’s life. Material that emerges later within a safe relationship and in a vivid emotional context will reveal whether the material is important and what aspects of it are of emotional significance.

Case formulation in this approach thus involves an unfolding, coconstructive process of establishing a focus on the key components of the presenting problems. Formulation emphasizes making process diagnoses of current in-session states and exploring these until a clear focus on underlying determinants emerge through the exploratory process. Formulation emerges from the dialogue and is a shared construction involving deeper understandings of the problem and goals of treatment. In developing a case formulation, the therapist focuses first on salient poignant feelings and meanings and notices the client’s initial manner of cognitive-affective processing and what will be needed to help the client focus internally. Then, working together, client and therapist develop a shared understanding of the main emotional problems and tasks and, finally, of the client’s emerging foci and themes.

For example, a therapist listening to a depressed man who has recently failed to get a promotion will first hear how poignant is his sense of hopelessness and loss. The client’s difficulty in focusing on his internal experience acts as an indicator that the therapist will need to direct attention toward the client’s bodily felt experience in order to access this information. As they develop an alliance, the therapist may begin to hear how much the client’s divorce three years prior is affecting him now. Over time, the therapist might notice that the client continues to return to that topic, describing the pain of the loss and the fear of continuing loss. Through their ongoing process, client and therapist may come to understand that unresolved anger and sadness about the divorce are affecting the way in which the client is navigating through current relationships and daily life. What begins to emerge out of the process is a need to focus on the loss around the divorce, the necessary grieving the client has not done, and the meaning that the divorce has for the client. After two or three sessions, the therapist would then suggest an unfinished business dialogue task with the ex-spouse in an empty chair. The therapist’s decision to initiate that dialogue would emerge from the process. The meaning of the recent loss for the client would become apparent only when the client feels safe enough to disclose it, and only then could the therapist absorb the full gravity of it. The loss, for example, may connect to unresolved losses earlier in the person’s life or to a pervasive theme of failure. It is only through material that emerges out

of the safety of the relationship (bond) and the exploratory process that both come to understand the significance of the loss and the importance of resolving it (goal) and to know the appropriate tasks that will best facilitate working it through (task alliance).

Differential Treatment

One of the major developments in practice in humanisticexperiential approaches has been the move toward specification of differential treatments for different disorders and problems. A number of books have appeared on client-centered therapy in Europe, mainly in Dutch and German, emphasizing its application to different problems and disorders (Eckert, Höger, & Linster, 1997; Finke, 1994; Lietaer & Van Kalmthout, 1995; Sachse, 1996; Swildens, 1997). For example, Eckert and Biermann-Ratjen (1998) studied clientcentered treatment of clients with borderline processes, and Teusch studied client-centered treatment of clients with anxiety disorders (Teusch & Boehme, 1999). In North America, Warner (1998) focused on working with the fragile self, and Prouty (1994) worked on the experiential treatment of clients with schizophrenic and related psychotic processes. Similarly, Gestalt therapists have begun to look at disturbances of awareness and psychological contact that occur in the personality disorders (Delisle, 1991), as well as at the importance of the differential application of a variety of aspects of Gestalt therapy to different types of clients. Practice has thus shifted from a “one treatment fits all” approach to the differential application of aspects of the different experiential approaches to different disorders (Greenberg, Watson, & Lietaer, 1998). Most notable are the development of special methods for working with hallucinations (Prouty & Pietrzak, 1988), trauma and childhood maltreatment (Kepner, 1996; Paivio & Greenberg, 1995), depression (Greenberg, Watson, & Goldman, 1998), and psychosomatic disorders (Sachse, 1998).

The Effectiveness of Humanistic Therapy

A series of meta-analyses of controlled and uncontrolled studies on the outcome of humanistic-experiential therapies have demonstrated their effectiveness (Elliott, 1996, 2002; Greenberg et al., 1994). In the latest version (Elliott, 2002), nearly 100 treatment groups were analyzed, incorporating studies with a very wide variety of characteristics. The main conclusions of this analysis follow:

1. The average effect size of change over time (d = 1.06; N = 99) for clients who participate in humanisticexperiential therapies is considered to be large.
2. Posttherapy gains in humanistic-experiential therapies are stable; that is, they are maintained over early (˂12 months) and late (12 months) follow-ups.
3. In randomized clinical trials against wait-list and notreatment controls, clients in humanistic-experiential therapies, in general, show substantially more change than comparable untreated clients (d = 99; n = 36).
4. In randomized clinical trials against comparative treatment, clients in humanistic therapies generally show amounts of change equivalent to clients in nonhumanistic therapies, including cognitive-behavioral treatments (d = 0; n = 48).
5. Client presenting problem, treatment setting, and therapist experience level did not affect outcome; however, other study characteristics did, including treatment modality (couples conjoint), researcher theoretical allegiance (in comparative treatment studies), and type of humanisticexperiential therapy (process-directive treatments had larger effects).
6. If researcher theoretical allegiance is ignored, cognitivebehavioral treatments show a modest superiority to clientcenteredandnondirective-supportivetreatments(d = ‒.33; n = 23); however, this advantage disappeared (d = ‒ .05) when allegiance was controlled for.
7. Process-directive therapies may be slightly superior to cognitive-behavior therapies (d = .29; n = 9), but this advantage also disappeared (d = ‒ .04) after controlling for researcher allegiance.

Thus,whilemoreresearchisneeded,theavailableevidence clearly runs against the claims of critics of client-centered and other humanistic therapies (e.g., Grawe, Donati, & Bernauer, 1994).

The outcome of individual process-experiential therapy has been subjected to the largest number of recent empirical investigation (n 14). This has covered various clinical populations, including major depression (Elliott et al., 1990; Greenberg & Watson, 1998) and a number of traumatic situations. The latter have included childhood abuse, unresolved relationships with significant others, and crime-related posttraumatic stress disorder (PTSD; Clarke, 1993; Paivio & Greenberg, 1995; Paivio & Nieuwenhuis, 2001). Populations with other personal and interpersonal difficulties have also been investigated (Clarke & Greenberg, 1986; Greenberg & Webster, 1982; Lowenstein, 1985; Toukmanian & Grech, 1991).

A series of meta-analyses of controlled and uncontrolled studies on the outcome of humanistic-experiential therapies have demonstrated the effectiveness of this approach in this tradition (Elliott, 1996; Greenberg et al., 1994). Results of meta-analyses for both client-centered and Gestalt therapies haveprovidedevidenceoftheireffectiveness.Theoutcomeof the contemporary form of neo-humanistic therapy emphasized in this research paper (process-experiential therapy) has been subjected to empirical investigation in at least 14 separate studies with various clinical populations, including clients with major depression (Gibson, 1998; Greenberg & Watson, 1998; Jackson & Elliott, 1990); traumatic situations, including childhood sexual abuse, other unresolved relationships with significant others, and crime-related PTSD (Clarke, 1993; Elliott et al., 1998; Paivio, 1997; Paivio & Greenberg, 1995); and other personal and interpersonal difficulties (Clarke & Greenberg, 1986; Greenberg & Webster, 1982; Lowenstein, 1985; Toukmanian & Grech, 1991).

The most recent meta-analysis yielded very large prepost effect sizes (mean effect size: 1.06 SD). In addition, in 36 controlled evaluations (involving comparison to wait-list or no-treatment conditions), the overall effect size was .99 SD, almost as large as the uncontrolled prepost effect. Moreover, in 48 comparisons between humanistic-experiential and other (mostly cognitive-behavioral) therapies, the average difference was .00, supporting the claim that experiential therapies are statistically equivalent to nonexperiential therapies in effectiveness. Finally, although very few direct comparisons exist, the available data tentatively suggest that the newer process-directive experiential therapies may be somewhat more effective than the older nondirective or client-centered therapies, although this may reflect research artifacts.

Conclusion

In the humanistic-experiential orientation described here, an empathic focus on the client’s actual experience is seen as indispensable, but the therapist is also seen as making contributions in addition to sustained empathic inquiry. Therapists complement their empathic inquiry with a variety of therapeutic interventions. These can help the client learn how to focus awareness efficiently, differentiate actual subjective experience, and highlight the processes essential to the client’s self-organization, building on a sophisticated theoretical understanding of human psychological function and dysfunction.

The strength of this orientation lies in its theory of personality change. Rather than focusing on theory of functioning or diagnosis, it has focused on understanding how people change. Macro theories (Gendlin, 1964; Perls et al., 1951; Rogers, 1959) do exist, but progress is being made on the meso (intermediate) and micro levels (Greenberg et al., 1993), where more concrete and differentiated theories on specific subprocesses of change, on both specific intrapsychic and interpersonal tasks, are taking place. Progress also is occurring in dialogue with academic psychology particularly in relation to emotion theories, constructivism, and interpersonal processes. As a consequence, the orientation is becoming more specific, suggesting different types of processes for different types of problems. A therapyoriented process diagnostics has been proposed and will hopefully be developed to allow the construction of “manuals” for ways of treating specific process blocks in specific ways, without losing the “humanistic” essence of focusing on the unique in the whole person. Process research and comprehensive qualitative research, which have contributed to this study of specific events and experiences, will continue to be the hallmark of a humanistic contribution to research on psychotherapy.

This process-diagnostic approach to treatment and research will promote the integration that is taking place within the experiential-humanistic family, one that will lead to a Gestalt that is larger than the sum of its parts (Greenberg et al., 1998). Pure-form approaches are still dominant within the humanistic orientation. In this a person is trained or practices only as a Rogerian, only as a focusing-oriented therapist, only Gestalt, only process-oriented, only existential, or only as a psychodramatist. Cross-fertilization within these approaches will lead to a richer and more wellbalanced approach and will allow trainees to search for their own styles within a more integrated orientation. This kind of integration will force a broadening of the humanistic framework and will sharpen its views on the core aspects of a humanistic identity in spite of differences between subapproaches.

Finally, it is encouraging to see that international organizations have developed over the last decade, and this augurs well for future developments in this orientation. Both the World Association of Person-Centered and Experiential Psychotherapy (WAPCEP) and an International Gestalt Therapy Organization have held a number of meetings in the last decade, and two new journals reflecting the membership of theses organization have emerged. These are the newly planned Person-Centered and Experiential Psychotherapy Journal as well as the Gestalt Review, which was first published in 1997. In these there is recognition of the need for more scholarly writing and more research in this orientation, which until recently has focused predominantly on experiential learning and teaching. More scholarly publishing will help promote the development of this orientation.

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