The Significance of TherapistGenuineness From the Client’s PerspectiveJutta SchnellbacherMia LeijssenKatholieke Universiteit Leuven
Therapist authenticity is viewed as an important therapeutic process. Theclient’s experiencing of the process and significance of therapist genuinenessis, however, under-researched. In a case study (N = 6), the authors analyzedthe clients’ experiencing of the overall significance of therapist genuinenessin their therapy. Both qualitative and quantitative data were gathered and ana-lyzed using the technique of pattern matching. The authors found that clientsalso experienced processes other than genuineness as crucial therapeuticprocesses. Nevertheless, the results show that therapist genuineness can be acrucial therapeutic process. The findings imply that whether and how genuine-ness is crucial for change also depends on the individual client.
Keywords: therapist genuineness; therapist self-disclosure; psychotherapyrelationship; psychotherapy process research
Genuineness, or authenticity,1 is defined as “the ability and willingness tobe what one truly is” toward oneself and the other in the mutual rela-
tionship (Gelso & Carter, 1994, p. 297). Lambert (1992) has concluded thatpractically all therapeutic orientations consider therapist genuineness as“important for significant progress in psychotherapy, and, in fact, funda-mental in the formation of a working alliance” (p. 104). Likewise, the Task
Authors’ Note: This article is based on the master’s thesis of Jutta Schnellbacher (2005)completed with the supervision of Mia Leijssen, Katholieke Universiteit Leuven, Belgium.The interview protocol and the category system (the classification and coding scheme) usedin the presented study are available from the authors. We thank Robert Elliott for his helpfuland valuable comments on an earlier version of this article. We are also grateful to theclients and therapists for their participation. Without their openness, trust, and time, thisresearch would not have been possible. Correspondence regarding this article should beaddressed to Jutta Schnellbacher, Leuvensestraat 11 bus 201, 3010 Kessel-Lo, Belgium;e-mail: [email protected].
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Force on Empirically Supported Therapy Relationships recently evaluatedtherapist genuineness as a “probably effective” element in the therapy rela-tionship (Steering Committee of the APA Division 29 Task Force, 2001).Genuineness has multiple conceptual elements in the form of differentstrongly intertwined processes (Lietaer, 2001; Wyatt, 2001). Based on anextensive literature study (Hill & Knox, 2002; Klein, Kolden, Michels, &Chrisholm-Stockard, 2002; Knox, Hess, Petersen, & Hill, 1997; Lietaer,2001; Wyatt, 2001; Yalom, 2002), we define therapist genuineness as beingaware of one’s own experience (self-awareness); being emotionally involvedin the client’s story and the here-and-now interaction, being personally pre-sent (self-presence); and being willing to intentionally and verbally revealpersonal feelings, thoughts, impressions, experiences, facts, views, values,and methods of working (self-disclosure; Yalom, 2002). Consequently, ther-apist genuineness is an inner attitude, a relational experience, and a dynamicprocess between client and therapist (S. M. Geller & Greenberg, 2002;Grafanaki & McLeod, 2002; Klein et al., 2002; Lietaer, 2001).
This article covers the significance of therapist genuineness and focuseson client experience. Self-disclosures, for instance, are powerful interven-tions with a large impact on the therapy relationship and client process(Barrett & Berman, 2001; J. Geller, 2003; Hill & Knox, 2002; Safran &Muran, 1996; Van Kessel & Lietaer, 1998; Yalom, 2002). However, the roleand dynamics of genuineness are under- researched, compared to the fre-quency of self-disclosures or correlations between therapist genuinenessand therapy outcome. Accordingly, little empirical knowledge exists aboutthe precise changing mechanisms and significance of therapist genuinenessand the corresponding client experience (Grafanaki, 2001; Hill & Knox,2002; Knox et al., 1997). A better understanding of how clients experiencetherapist genuineness would strengthen the value and usefulness that thetherapist’s authentic presence can have for clients.
Therapist Genuineness in Person-Centered and Experiential Therapies
In person-centered and experiential (PCE) therapies, one considers theauthentic element in the therapy relationship as a crucial process for heal-ing and substantial personality change. In present PCE therapies, therapistgenuineness is one of the most central concepts (Lietaer, 2001; Schmid,2002; Swildens, 1988).
The significance that PCE therapists attribute to therapist genuineness canbe better understood from the context of dialogic anthropology.2 Dialogic
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anthropology starts from the central idea that human existence always occursin relation with the other. In the encounter with the other we encounter ourown self, and in the encounter with our own self we encounter the other(Carp, 1973, p. 35, as cited in Takens, 2001). The relationship with the othertherefore confirms our human being and brings us nearer to our process ofbecoming by questioning ourselves (Schmid, 2002, p. 60). An authentic rela-tionship is a relationship in which we address ourselves from person toperson, as opposed to purely strategic acting. Dialogic anthropology callsthis form of relationship an “encounter” (Buber, 1923/1996). Encounteringassumes that one “faces” the other, instead of either merging with the other,or objectifying the other (Schmid, 2002, p. 61; Swildens, 1988). By posi-tioning oneself in front of the other, one recognizes that person namely in hisor her autonomy and individuality and as someone with whom it is worthmaking contact. A relationship from person to person is therefore character-ized by authenticity in both persons involved. Authenticity presumes open-ness both for oneself and for the other. After all, authenticity is the ability tobe touched, surprised, changed—all in the relationship with the other—whilekeeping touch with one’s own inner experience and interpretations and form-ing a personal point of view. Authenticity thus creates the foundation forspeaking with each other instead of talking about each other, and this is a con-dition for entering into a dialogue. Consequently, authenticity is not a naïveor merely spontaneous attitude but an intentional step toward the other toencounter the other. Besides this, Schmid (2001) also emphasizes the inter-connectedness of authenticity, spontaneity, and creativity. Spontaneity andcreativity are inherent in authenticity and therefore are essential in a personalrelationship. Authentic reactions are always creative reactions, fed by innersources and guided by trust in the actualizing tendency.
Thus, the therapist’s task is to perceive the client as a person and torespond as a person. Therapists bring their being into the therapy relation-ship, with their whole personality, identity, soul, and spirit. Consequently,therapeutic genuineness always goes together with sincere involvement. Anauthentic therapist does not put up a facade and does not set self aside inemphatic listening. Neither does he or she imitate a model or copy self fromother situations (Lietaer, 2001; Wyatt, 2001). Therapist authenticity there-fore implies room for spontaneity and creativity. This entails that the ther-apist’s personality and way of being also determines what happens betweenclient and therapist. The willingness of the therapist to share experiencewith the client supposes that the therapist can admit and accept his or her ownvulnerability and is open for the experience to be touched and influenced
by the other (Gaylin, 1996; Leijssen, 1999). Perhaps it is because of thisvulnerability that no other concept seems to provoke so much uncertaintyand ambivalence among therapists as self-disclosure. Nevertheless, onealways reveals personal aspects. The question is only how much, what, andwhen one discloses aspects of one’s self.
Therapist genuineness can be expressed in various ways in communica-tion with the client. Globally, we can distinguish between (a) personal pres-ence and (b) self-disclosure (Lietaer, 2001). In practice, these two aspectsare strongly intertwined and are situated on a continuum, rather than on twoseparate poles.
Personal presence means that the therapist is emotionally involved in theclient’s story and the here-and-now interaction. Personal presence implies“the shining through of who the therapist is as a person through everythinghe [or she] does and does not do, instead of putting up a facade” (Lietaer,2001, p. 43).
Self-disclosures have very diverse definitions in the existing literature (foran overview, see Knox et al., 1997). We define therapist self-disclosure asintentionally and verbally revealing personal feelings, thoughts, impressions,experiences, facts, views, values, and methods of working. Defining self-disclosure broadly makes it possible to investigate subtler or less intimateforms of self-disclosures as well. Research by Schnellbacher (2005) revealedfour different kinds of therapist self-disclosure: (a) disclosures about experi-ences or facts in the therapist’s life outside the therapy session or aboutpersonal perspectives and values (therapist life disclosure); (b) clarity andtransparency about the therapist’s line of thoughts, reasons, and motivesduring the in-session actions, the therapist’s affective state, and the personal ortentative nature of interventions (personal clarity disclosure); (c) disclosuresof feelings, thoughts, or images evoked by the client’s story (client contentreaction disclosure); and (d) disclosures about experiences of and with theclient in the ongoing interaction (interaction disclosure).
Different helpful therapist self-disclosures are expected to have differentpositive effects on the immediate process, which in turn will indirectly influ-ence the therapy outcome. Research by Schnellbacher (2005) revealed fivedifferent helpful effects of self-disclosures: (a) encounter with a human being;(b) positive effects on the quality of the therapy relationship; (c) facilitatingand deepening the client’s process of experiencing; (d) facilitating constructivechanges in behavioral and mental patterns; and (e) an increased sense of thetherapist’s authentic presence. The specific effects are expected to vary widelydepending on the individual client.
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The purpose of the present study was to examine the meaning and sig-nificance of therapist genuineness, and the characteristic features and effectsof therapist self-disclosures. For this purpose, we used qualitative methodsto describe the extent to which findings from the literature, which are mainlybased on therapists’ clinical impressions, correspond to the experiences of 6clients who were, or had been, in PCE therapy. The research focus was thuson the client’s experience (see “Methodological Aspects”). To realize theobjective, we formulated, based on an extensive literature review and a con-ceptual framework, eight hypotheses, which were tested on the client expe-rience. In this article, we only discuss the results regarding the hypothesisthat relates to the significance of therapist genuineness as a crucial processfor healing and substantial personality change.
Methodological Aspects
A multiple case study design was used to explore client experience oftherapist genuineness and to test our hypothesis. Case study researchenables us to challenge on a micro level a specific theory by examining theextent a hypothesis does or does not hold for a number of concrete cases(Corveleyn & Luyten, 2002; Yin, 1989). Furthermore, case study researchenables us to modify and elaborate theory (Stiles, 2005). According toFlyvbjerg (2006), “The closeness of the case study to real-life situationsand its richness of multiple wealth of details are important for the develop-ment of a nuanced view of reality” (p. 223). For that reason, a case studydesign lends itself for studying specific and complex therapy events in theirnatural context. Real-therapy studies (as opposed to analog studies) are largelymissing in the research literature on therapist genuineness (Grafanaki, 2001;Hill & Knox, 2002).
Researching genuineness from the client’s perspective, and not purelyfrom the therapist’s perspective, is in line with recent research findings thatgenuineness is a relational experience and an interpersonal process, insteadof merely an attitude of the therapist (S. M. Geller & Greenberg, 2002;Grafanaki & McLeod, 2002). Besides the client’s experience, we also usedthe clinical impressions of the therapist to interpret certain results.
In the current study, we studied only the extent to which genuinenesswas felt as crucial insofar as clients themselves referred to aspects of theconcept genuineness. Furthermore, we examined only the degree to whichclients experienced genuineness, as such, as a crucial therapeutic process.
It is much more probable that therapist genuineness, besides its direct effectson the therapy outcome, also contributes indirectly to change, namely bymediating the impact of empathy, acceptance, and concrete interventions(Klein et al., 2002; Lietaer, 2001). Taking these objections into account, wetherefore used rather strict criteria to be able to speak about “genuinenessas a crucial therapeutic process.”
Method
Participants
Participants in this study were 6 female clients, respectively 21, 22, 31,40, 48, and 58 years old. All clients were of Belgian nationality. Five clientswere currently involved in outpatient psychotherapy with a PCE therapist.One client had just terminated her outpatient psychotherapy (also with aPCE therapist) at the time of the study. This terminated therapy had lastedslightly more than 18 months. The duration of the therapies in progress wasbetween 3 months and 3 years, with an average duration of 16.2 months. Thetherapy sessions took place in private practice or in the university counsel-ing center. Clients presented with a variety of personal concerns (i.e. loss,sexual or physical abuse, family conflicts, and difficulties in interpersonalrelationships).
Three female therapists and one male therapist participated in the study.The therapists were two doctoral-level and two master’s-level clinicalpsychologists. All therapists had followed a postgraduate training in PCEtherapy and had more than 10 years of therapy experience.
Procedure
Recruitment of clients. We asked eight therapists to participate in a dis-sertation study about client experience of therapist genuineness. Morespecifically, we requested that they ask clients whether they would like toparticipate in a study about client experience of helping processes inpsychotherapy. Subsequently we contacted the clients who were willing toparticipate in our study. The study was presented as an exploration of theclient’s experience of helping processes in psychotherapy. None of the6 clients dropped out of the study. One of the clients served as pilot case totest and modify the research design.
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Data collection. During a period of six months, the primary researcher(Jutta Schnellbacher) conducted a semistructured interview with the 6clients. Each interview was preceded by the procedure of informed consentand lasted about 1.5 hr. The interviews were recorded on audiotape withpermission of the clients. Finally, there was the debriefing, in which weinformed the clients about the specific research questions and answered anyquestions.
After the main data collection, we contacted the therapists, with thepermission of the clients, and asked for specific context information. Thiscontext information served to clarify the empirical findings. In the conver-sations with the therapists, we inquired into the clinical interpretations ofthe therapist on the results we found from the interview with the client. Inthis way the study material was augmented with the clinical interpretationsof the therapist.
Measures3
Context information. At the beginning of each interview, the client wasinvited to recount briefly on her background, any previous therapy experi-ences, and her treatment goals for the current therapy. This backgroundinformation provided a broader context for the interpretation of the data andallowed understanding of the specific events and experiences clients woulddescribe later in the interview.
Interview. Qualitative data were collected by means of a semistructuredinterview on the subjective experience of the significance and meaningof therapist genuineness and of the features and effects of therapist self-disclosures. The use of interviews allows collecting in-depth information(McCracken, 1988, as cited in Hill & Lambert, 2004). At the same time, thepredefined interview protocol of a semistructured interview makes it possibleto obtain consistent data across the different cases. This type of interview isless vulnerable to researcher effects (the tendency to confirm the researcher’spreconceived notions), which increases the validity of the study (Hill &Lambert, 2004). The interview protocol we had designed focused on the sub-jective meaning the client attached to, among others, the following aspects:the experiencing of the therapy relationship and the presence of the therapist,the meaning of therapist genuineness, helpful processes in the therapy, and theimpact of helpful self-disclosures. In order not to influence the client andbe suggestible, we did not use terms like genuineness, authenticity and self-disclosure in the interview. Some examples of the questions of the interview
are the following: “What are, in your experience, important aspects of yourrelationship and cooperation?” “How do you experience your therapist inyour relationship and cooperation?” “What do you experience as most help-ful in therapy?” and “Do you remember responses of your therapist that werespecial for you?”
Content Analysis
The interview data were processed by means of a carefully theory-basedsystematic analysis of the clients’ meaning (content analysis). Contentanalysis is a systematic, replicable method for ordering words of text into asmaller amount of content categories (Weber, 1990). The approach to cod-ing data we used was a priori coding. In a priori coding, a classification andcoding scheme (category system) is established before the analysis and isbased on some theory and on agreement of professional colleagues on thecategories. This scheme is tested and refined in the pilot case (Weber,1990). The category system allowed both verification and falsification ofthe hypotheses. For testing the hypothesis of this article, we primarily usedthe main category “Client statements on exceptionally helpful processes forhealing and personality change offered by the therapist.” The first subcate-gories dealt with the significance of authentic presence and exceptionallyhelpful processes other than genuineness.
To form an impression of the reliability of the category system, threecoders coded the interview material from the pilot case independently ofeach other. Two of the coders were not informed about the research hypoth-esis. This enabled us during the coding of the pilot case to minimize demandcharacteristics (biases in the results because of the expectations of theresearcher). Based on observed differences in assigning the codes, the cate-gory system was adjusted.
Data Analysis
The research data were analyzed by applying the technique of patternmatching. With the technique of pattern matching one investigates the extentto which an empirically discovered pattern corresponds to a theoreticallypredicted pattern that has been defined before data collection. The compari-son between the predicted and the empirical pattern occurs by searching forboth converging and diverging lines of meaning in the data (Corveleyn &Luyten, 2002), that is, for both information that confirms and informa-tion that contradicts the hypothesis. When interpreting the data, we relied
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primarily on the client interview material. The therapist’s interview servedto complete and possibly clarify findings from the client interview.
The data analysis took place as follows. The research data were firstanalyzed by case. In these intracase analyses, we examined for each case theextent to which each hypothesis was or was not confirmed. In the cross-caseanalysis, we compared the 6 cases to each other. Here we analyzed for eachhypothesis the patterns of similarities and differences between the 6 cases,and from this we formulated conclusions about the current hypothesis.
Validity and Internal Auditing
Content validity. Content validity refers to “how good the content of aspecific theoretical construct is operationalized in a research study”(Corveleyn & Luyten, 2002, p. 42). In the present study, the content validitywas first optimized by formulating in advance the interview protocol andthe category system, based on an extensive literature study; by consequentlytesting them in the pilot study; and adjusting where necessary. Second, weemployed different empirical sources and methods in the study. Accordingto Yin (1989), this data triangulation has an important function in increas-ing the validity. Indeed, our data triangulation allows for interpreting anevent from different perspectives (the client’s experience and the clinicalinterpretations of the findings by the therapists).
Interpretative validity. Interpretative validity is obtained to the degreethat the meaning given by the participants is accurately understood andreported by the researcher. To obtain as much interpretative validity as pos-sible, we linked the interpretations in the intracase analyses as closely asfeasible to the clients’ concrete statements. In addition, we focused in theanalyses on both converging and diverging lines of meaning. Moreover, inthe interpretation, we made use of the context information we had collectedduring and especially in the beginning of the interview. Finally, the data tri-angulation we used also served to increase the interpretative validity(Corveleyn & Luyten, 2002). Researcher effects were reduced as much aspossible by selecting the cases based on availability and by employing asemistructured interview.
Internal auditing. In stage 1, the primary researcher coded the clientinterview data for each case, the first pilot case being the last coded case(to minimize coding based on remembering the assigned codes of the firststage). To correct for learning effects, the coded material was critically
compared to each other and adjusted in a second stage. Stage 3 took placetwo to three months after stage 2 (to minimize coding based on rememberingprior coding), coding the interview data for each category without seeingthe already assigned codes of stage 2. In the fourth and last stage, the codesassigned in stage 2 and 5 were compared for each line of meaning. Basedon observed differences in assigning the codes, the codes were adjusted toreceive the definitive coding for each line of meaning.
Results
Processes Other Than Genuineness as Most Crucial Therapeutic Processes
The cases4 of Anna, Amber, Kim, and Zoe do not support the hypothe-sis that genuineness is the most crucial therapeutic process. It is obviousthat these 4 clients experience other processes than genuineness as mostcrucial for healing and personality change; among these are empathy, accep-tance, and attention to inner experiencing. In all 6 cases it appears that theclients experienced the therapist’s attitude of acceptance as the most helpfulor an important therapeutic process. We define acceptance as an open andreceptive attitude toward the client experience, the absence of judgment,and respect for the client as a human being. The significance of acceptanceand empathy appears, for example, in Kim’s response to the question ofwhat she received as most helpful in her therapy:
That T5 just listened to what I was saying and really tried to understand me.And that I was allowed to feel what I felt. When I am with her, I can sayeverything. Whereas in everyday life, you’re not allowed to feel always bad.And also that she is just there. She is there for me. This is not the way it islike in everyday life. And that I can tell what I want and I determine by myown what to say and what not.
The researcher said, “You are saying ‘T is there for me.’ How do younotice that?”
I feel that she understands me. She listens. And she repeats things I told aboutin her own words. And when she does not understand something, she will askto clarify. So I know that she can follow my reasoning. (Kim, fragment 8)
Furthermore, the cases of Anna and Lea point to the crucial significanceof attention to inner experiencing and interventions that are directed at the
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focusing process (interventions that help the client to contact her bodily feltexperience and make it more explicit). The following fragment from Anna’scase elucidated this. The researcher asked, “What did you experience asmost helpful in therapy?”
The fact that T let me experience the things. This was for me most importantand by this, I made huge progress. I could really feel what I did wrong andwhere everything was tied up. I looked at all my problems with all psycho-logical terms, I knew everything, I had read psychological books, I knew itall, and still I did not get further. It is only since she let me feel all thesethings and worked with these feelings that I got further. (Anna, fragment 17)
Finally, clients Anna and Kim reported that they experienced increasedinsight and self-knowledge and newly acquired ways of thinking as partic-ularly helpful. For example, Kim reported that she experienced as particu-larly helpful that T offered her new ways of thinking by introducing aspectsof her own frame of reference.
Genuineness as the Most Crucial Therapeutic Process
The cases of Lea and Eef strongly differed from the other 4 cases. Thefindings from Lea and Eef support strongly—but not totally—the hypothe-sis that genuineness is the most crucial therapeutic process. The case of Eefsupports the hypothesis because of the crucial impact of the repeated inter-action disclosure about Eef’s caring and adapting attitude toward her ther-apist. Eef explicitly indicated as most helpful her therapist’s emotionalinvolvement to name what is happening in the relational here-and-now,instead of just letting Eef tell her story. The therapist’s self-disclosuresbrought Eef into contact with qualities and needs on the interpersonal levelfor which she had little eye before and stimulated her to take a less self-effacing attitude in relationships and to dare to take more personal space,which was in fact her treatment goal. In the following fragment, Eef pointedout that she had experienced T’s interaction disclosure as the most crucialtherapeutic process. The therapist asked, “What did you experience as mosthelpful throughout the whole therapy?”
The most helpful was T’s emotional involvement: T didn’t just let me do mystory but said, “Maybe you are now rather taking care of me.” From this emo-tional involvement, things were questioned or confrontations or challengesarose. The involvement also brought about an unpleasant or uncomfortablefeeling, so in that sense it was not the most pleasant, but still it was the
thing that helped me most. Which is ultimately the purpose of therapy. (Eef,fragment 22)
According to Eef’s therapist (personal communication, May 17, 2005),as a child, Eef had experienced in her relationship with her mother that sheobtained her right to exist by tuning sensitively to her mother’s needs. Byrepeatedly naming Eef’s pattern of a caring and adapting attitude towardthe therapist—who, for Eef, was to a certain extent a mother figure—Eefreportedly got the opportunity to experience that she can separate withoutloosing the mutual solidarity. The therapist’s genuineness in the mutualcommunication appeared to facilitate the feeling that Eef could developmore autonomy in mutual solidarity.
In the case of Lea, the crucial impact of genuineness in communicationwas particularly reflected in the helpful effects of the encounter with anotherhuman being. Lea found these “deeply human moments of encounter” themost important moments in her therapy. The self-disclosures of Lea’s ther-apist created intimacy, for example, and had a reassuring effect. A particu-larly helpful intervention was in Lea’s feeling a self-disclosure in whichT responded to Lea’s description of a metaphor of her loneliness, in whichshe is sitting alone on a sand dune in the desert. Lea described the impactof this self-disclosure as follows:
It was especially the fact that T said: “I would like to sit next to you [on thedune]. Look, we do not need to say anything to each other, right now. You aresitting lonely at your spot, and I will go to another hill and sit there lonelytoo. And we know how this feels. You do not need to talk, you do not need tocomfort or reassure each other, but you are allowed to feel lonely here andnow.” Yes, and he made this recognizable. . . . This gives me an enormousreassurance, I mean, I do not have to fight against it: It’s alright. Human exis-tence means being lonely, in fact. . . . It is deeply human, a deeply humanencounter. The loneliness is there, but you are not alone. And you know ofeach other that you are dealing with it. . . . In my feeling, these are the mostimportant moments in therapy. (Lea, fragment 18, 35)
According to Lea’s therapist (personal communication, May 19, 2005),the existential dimension was strongly present in Lea’s therapy, and thiswent along with plain self-disclosures in which the therapist showed him-self as a “companion” in human existence. Lea had, according to her thera-pist, much feeling for existential facts in her life and this has colored thetherapy. Furthermore, the existential dimension was brought into the therapy
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by events in Lea’s life during the therapy (a fatal traffic accident of a lovedone and a life-threatening illness), through which she was confronted withexistential questions about sense, meaning, isolation, and solidarity.
However, the findings from Lea and Eef about genuineness as a crucialtherapeutic process need to be nuanced. Eef experienced therapist genuine-ness as the most crucial therapeutic process, but she adds that the interactiondisclosure could only be helpful because of the accepting and respectfulattitude of her therapist. Lea pointed out that besides the moments of reci-procity and encounter that resulted from her therapist’s self-disclosures, shefelt acceptance and attention to inner experiencing were crucial therapeuticprocesses.
Genuineness as a Therapeutic Process
Thus, we cannot conclude that genuineness is the most crucial therapeu-tic process for healing and personality change. However, the empirical datagive sufficient evidence that the client’s experiencing therapist genuinenesscan be a crucial process for healing and personality change. In 5 of the6 cases, therapist genuineness appears as a significant therapeutic process.First, therapist genuineness appears as a crucial therapeutic process in thecases of Lea and Eef. Second, the cases of Amber and Kim also show thecrucial significance of therapist self-disclosures for the development of newbehavioral and mental patterns. Third, Anna’s case points to the crucialfunction of personal clarity disclosures for experiencing a safe and reliablerelationship. The following fragment illustrated the significance that Annaattached to the personal clarity of her therapist.
What I immensely appreciate in her is that she is clear about everything.Clear about the expectations I can have, clear in the way she works, clear inthe progress. She regularly evaluates where we stand, what is still possible,what we will take on next. And also clear in arrangements; from the beginningit was really clear, when do you inform. . . . So she is very clear on every level,and that is something I find very important. (Anna, fragment 5)
Moreover, responding to the question of what she experienced as mosthelpful in the therapy, Anna explained that T’s clear and honest communi-cation had an important modeling function for her:
And due to the fact that she did that with me, in her whole attitude, week afterweek, in a correct way—in practice this is now my reference. When I think
sometimes to myself, “I have to cancel something,” or whatever, then I oftenthink, “How would T do this now with me?” And then I do it likewise. Therelationship as such is for me . . . you have to imagine, I’ve never learned this.. . . She is for me a point of reference like, “How do you do this now—to forma ‘right’ relationship?” (Anna, fragment 18)
A possible clinical interpretation of these empirical findings is that Annagenerally feels unsafe in interpersonal relationships (she is very sensible forsigns of potential rejection or disapproval and finds it difficult to keep anappropriate distance in relationships), which Anna attributes to the conflict-laden and traumatizing family situation in her childhood.
When comparing the 6 cases, it appears that Zoe is very different fromthe other cases. Zoe reported that she would have experienced it as burden-ing and uncaring if her therapist would have used therapist life disclosures,client content reaction disclosures, or interaction disclosures. Zoe’s therapist(personal communication, May 12, 2005) confirmed that she hardly appliedself-disclosure in Zoe’s therapy, sensing that moments of therapist self-disclosure would have made Zoe feel unsafe because they would have impliedtoo much closeness and intimacy. Partly because of aggravating experiencesfrom her past (abuse, harassment, and a disrupted family situation), Zoe ingeneral does not enter into intimate relationships quickly because this isthreatening for her. She controls her contacts by keeping people at a distance(Zoe’s therapist, personal communication, May 12, 2005).
In general, the 6 cases do not offer convincing evidence for the hypoth-esis that therapist genuineness is the most crucial process for healing andpersonality change. In the experience of the participating clients, genuinenessis not the only crucial, and not the most important, therapeutic process. Theresults of this study suggest that most clients experience processes otherthan genuineness as crucial, such as empathy, acceptance, and attention toinner experiencing. Thus, we cannot conclude that genuineness is the mostimportant process for all clients. However, it appears that therapist genuine-ness can be a crucial process for healing and personality change in theclients’ experiencing. We found that genuineness is, for some clients, themost important process; in other words, genuineness can be experienced byclients as the most important therapeutic process.
It has to be stated that genuineness was probably present in all the cases butwas not experienced by clients as the most crucial process. In other words, thepresence of genuineness was not the clients’ predominant experience in thesecases. Besides, genuineness was probably strongly intertwined with otherprocesses such as acceptance and empathy. However, we only examined the
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degree to which clients experienced genuineness, as such, as a crucial thera-peutic process. It is much more probable that therapist genuineness, besides itsdirect effects on the therapy outcome, contributes indirectly to change, namelyby mediating the impact of empathy, acceptance, and concrete interventions(Klein et al., 2002; Lietaer, 2001). There is a lot of empirical and conceptualoverlap between genuineness and other (relational) processes. In this sense,we are very strict when we conclude that genuineness is not necessarily themost crucial process in the studied cases.
Furthermore, we looked for genuineness in all the cases, using a broaddefinition of genuineness (including self-awareness, self-presence, andself-disclosure). However, we found clients typically reporting about self-disclosure. This might be because of a memory bias of the clients: Theclients mostly reported about self-disclosure rather than other processes ofgenuineness because the unusual behavior of a self-disclosure stood out intheir memory more than other more subtle processes of genuineness. Also,our results might indicate that self-disclosure plays an important role in thepresence of genuineness.
In summary, the results of the present study show that it depends on theindividual client whether and how genuineness in communication is crucialfor personality change. For a client who quickly experiences intimacy asintimidating, it seems appropriate to make especially sure that the clientdoes not experience the therapist’s interaction and communication style asintrusive or as overstepping their boundaries. However, if clients very sen-sitively attune to the needs of others, interaction disclosure can play animportant role in helping them to develop more autonomy in mutual soli-darity. With clients for whom the existential dimension comes to be promi-nent in their therapy, the therapist’s willingness to show self by means ofself-disclosures as a companion in human existence may be crucial. Finally,we want to stress that the clinical interpretations of our empirical findingscannot simply be generalized to other clients with similar life experiences,personality, or interaction style. More general statements about targetgroups or problems require further study.
Discussion
If one puts the individuality and the “otherness” of two people as a con-dition for mutual dialogue, then the therapist does not have to abandon hisor her individuality when working with the client.
The present study focused on the significance of therapist genuineness,investigated the meaning of therapist genuineness, and explicated the char-acteristic features and effects of therapist self-disclosures.6 The hypothesisthat therapist genuineness is a crucial process for healing and substantialpersonality change is like a devil’s advocate hypothesis. In the role of thedevil’s advocate, we take a position with which we disagree for the sake ofargument. We use this process to test the quality of the original argumentand identify weaknesses in its structure. More specifically, we want to ruleout that genuineness is indeed the most crucial process for change for allclients. Even an extreme argument such as this might be useful as it setsboundaries and creates clarity. Replication is necessary to examine the gen-eralizability of the results. The findings still allow formulating a number ofpreliminary conclusions.
Preliminary Conclusions
We found that clients experience processes other than genuineness ascrucial to therapy. These processes include empathy and attention to innerexperiencing. Thus, we cannot conclude that genuineness is the mostimportant process for all clients. Nevertheless, the results show that gen-uineness is, for some clients, the most important process; in other words,genuineness can be experienced by clients as the most important therapeu-tic process. The findings imply that it also depends on the individual clientwhether and how genuineness in communication is crucial for healing andsubstantial personality change.
In all cases, however, genuineness seems to play an important part in thechange process. Sometimes, clients experience genuineness as such as animportant therapeutic process, as it is the case in self-disclosure. Often,clients experience genuineness relatively implicitly and as a salient compo-nent of empathy and acceptance. After all, it is likely that acceptance andempathy would not have been most helpful if they had not been perceivedas genuine.
Implications for Practice
The findings from the present study have important implications forpractice that complement the existing literature. The findings underline thesignificance and value of genuineness in communication with the client.Indeed, the results indicate that therapist genuineness can be a crucial
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process for healing and personality change and that self-disclosures can bepowerful and directional interventions. However, the extent to which it isappropriate to apply self-disclosures also depends on the individual client.This points to the importance of therapists’ being very sensitive to thespecific needs of their clients and tuning their interaction and communicationstyle to these needs. For some clients it is more appropriate to closely followclient experiencing and to use self-disclosures infrequently or very cautiously.Other clients require a more dialogic interaction with their therapist and thispresses for a relatively more frequent use of self-disclosures.
Therapist genuineness can be expressed in various ways in communi-cation with the client. Given the results that more subtle forms of self-disclosures and disclosures about subjects with little intimacy can also havea powerful impact, we invite therapists to pay adequate attention to theseforms of self-disclosures, besides attention for more personal self-disclosures.The findings underscore, for instance, the significance of clarity and trans-parency about practical agreements and treatment goals, about one’s line ofinquiry, the reasons and motives for one’s responses, and the personal ortentative nature of interventions. This personal clarity of the therapist canbring safety, create confidence, and have a positive influence on mutualcollaboration.
The effectiveness of a self-disclosure depends on the way genuinenesstakes shape in concrete interventions. Interventions that are aimed towardmutual dialogue and a plain application of self-disclosure that is attuned tothe needs of the individual client tend to be especially important dimensionsof helpful self-disclosures. Therapists can express an orientation towardmutual dialogue (a) by communicating their experience in an inviting, non-judging, and nonintrusive way; and (b) by being willing to face their ownpart in the interaction as well. In general, therapists should use self-disclosuresin a directed and infrequent way and only express briefly those thoughts orfeelings that are relevant for the client and with which the client can take anext step forward.
The effectiveness of a self-disclosure depends on the place of the self-disclosure in the context of the interaction and the therapy process. Regardinga proper timing of the self-disclosure in the context of the interaction, ourresults complement the existing recommendations for practice as follows.Helpful self-disclosures do not necessarily have to fit with the experiencethe client has at that moment. A self-disclosure can have an equally strongtherapeutic effect if it fits with (implicit) client needs or requirements.Furthermore, a helpful self-disclosure can actually distract the client from
his or her current activity. It is, however, crucial that the self-disclosure doesnot interfere with the client’s internal flow of experiencing. Concerning thetiming of a self-disclosure in the context of the therapy phase, the findingsdraw attention to the importance of self-disclosure in the initial phase oftherapy. For instance, we encourage therapists to express openness andclarity when discussing practical agreements and treatment goals and tasks.Finally, the results underline the need to handle sensitively and sincerelythe client’s reactions to the self-disclosure. In the first stage of the therapy,it might be very important to convey to the client that there is space andopenness for the client’s reaction. If self-disclosures induce ambivalent ornegative feelings in the client, we highly recommend that therapists displaya willingness to reflect in an open and honest way on one’s own contributionas well.
Limitations and Directions for Future Research
Several limitations of the present study should be noted. These limitationsalso imply directions for future research. First, one should exercise cautionwhen attempting to generalize from the particular sample of clients used inour study. The small sample size leaves open the question of the represen-tativeness of these participants. All clients were female and were in PCEpsychotherapy in an outpatient setting. Furthermore, the clients and thera-pists who agreed to participate may have differed from those who did not,which suggests the possibility of self-selection (e.g., all participating clientsevaluated the therapeutic alliance and their therapy in general as very posi-tive). To increase the generalizability of the current results, future researchshould include larger and more varied samples and replicate this study withpsychotherapies of different therapeutic approaches.
A second limitation is related to the retrospective self-report nature of thedata. The results are based on what participants recalled from events andfrom their internal experience and thus may be liable to memory lapses anddistortions (Nisbett & Wilson, 1977). For example, despite using a broaddefinition of genuineness and thus looking for different processes of gen-uineness, we found clients typically reporting about self-disclosure. Likely,this is because of a memory bias on the part of the clients: When one looksfor such unusual behavior as self-disclosure, it stands out in the memory.However, the general accuracy and validity of client’s reports—despitepotential memory errors—have been demonstrated (Hill, O’Grady et al.,1994; Martin & Stelmaczonek, 1988). In future research, videotape-assisted
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reviews could be used to obtain highly accurate and detailed data aboutparticipants’ experiences of therapist genuineness. Methodological exami-nation of videotape-assisted reviews supports the validity of this methodas a means of assessing in-session experiences (Hill et al., 1994). Futureresearchers might analyze both participants’ retrospective data and video-tapes of therapists’ observable and concrete behaviors. Such method anddata triangulation would further enhance the validity of the findings andbroaden our understanding of a complex phenomenon such as therapistgenuineness.
A third limitation of the present study concerns the fact that we focusedprimarily on the client’s perspective of therapist genuineness. The client’sperceptions and experience might differ from those of the therapist.Although we also used the clinical impressions of the therapist to interpretcertain results and events, it would be interesting to give equal weight tothe corresponding therapist’s perceptions and experience. Future researchcould address both therapist and client perspectives, within the context ofcurrent relational processes.
With regard to research topics that need further empirical examination,future research might examine the role of therapist genuineness with specifictarget groups and problems. Finally, the results suggest that genuinenesshas important positive effects on the therapeutic alliance. Future research isneeded to examine how and to what extent genuineness contributes to theevolution of the alliance at vulnerable moments, such as alliance rupturesduring the therapy process (see research of Safran & Muran, 1996) andalliance formation in the first stage of therapy.
Notes
1. The terms genuineness and authenticity are used interchangeably.2. Dialogic anthropology investigates the meaning of existential human relationships. It
builds on the vision that a human being, because of his or her dialogic existence, can only beunderstood within a relational context. This orientation is represented by, among others,Martin Buber, Emmanuel Levinas, Paul Tillich, Gabriel Marcel, and Maurice Merleau-Ponty.
3. The interview protocol and the category system (the classification and coding scheme)are available from the authors.
4. Names and concrete data of clients were changed or left out to guarantee clients’anonymity. Clients were given codenames Anna, Lea, Eef, Amber, Kim, and Zoe.
5. For therapists, we use the abbreviation ‘T.”6. Besides the hypothesis about the significance of therapist genuineness, seven other
hypotheses were formulated in our study. We do not elaborate these seven hypotheses here, butwe include their main findings in the discussion of the implications for practice.
Barrett, M. S., & Berman, J. S. (2001). Is psychotherapy more effective when therapistsdisclose information about themselves? Journal of Consulting and Clinical Psychology,69(4), 597-603.
Buber, M. (1996). I and Thou (W. Kaufmann, Trans.). New York: Touchstone. (Original workpublished 1923)
Corveleyn, J., & Luyten, P. (2002). Grondbeginselen van het onderzoek: geesteswetenschappelijkebenadering [Principles of research: The humanistic approach]. Unpublished syllabus,Katholieke Universiteit Leuven, Belgium.
Flyvbjerg, B. (2006). Five misunderstandings about case study research. Qualitative Inquiry,12(2), 219-245.
Gaylin, N. L. (1996). Reflections on the self of the therapist. In R. Hutterer, G. Pawlowsky,P. F. Schmid, & R. Stipsits (Eds.), Client-centered and experiential psychotherapy. Aparadigm in motion (pp. 383-393). Frankfurt, Germany: Peter Lang.
Geller, J. (2003). Self-disclosure in psychoanalytic-existential therapy. Journal of ClinicalPsychology, 59(5), 541-554.
Geller, S. M., & Greenberg, L. S. (2002). Therapeutic presence: Therapists’ experience ofpresence in the psychotherapy encounter. Person-Centered & Experiential Psychotherapies,1(1&2), 71-86.
Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Theirinteraction and unfolding during treatment. Journal of Counseling Psychology, 41,296-306.
Grafanaki, S. (2001). What counselling research has taught us about the concept of congruence:Main discoveries and unresolved issues. In G. Wyatt (Ed.), Rogers’ therapeutic conditions:Evolution, theory and practice. Vol. 1. Congruence (pp. 18-35). Ross-on-Wye, UK: PCCSBooks.
Grafanaki, S., & McLeod, J. (2002). Experiential congruence: A qualitative analysis of clientand counsellor narrative accounts of significant events in time-limited person-centred therapy.Counselling and Psychotherapy Research, 2(1), 20-33.
Hill, C. E., & Knox, S. (2002). Self-disclosure. In J. C. Norcross (Ed.), Psychotherapy rela-tionships that work. Therapist contributions and responsiveness to patients (pp. 255-265).Oxford, UK: Oxford University Press.
Hill, C. E., & Lambert, M. J. (2004). Methodological issues in studying psychotherapyprocesses and outcomes. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook ofpsychotherapy and behaviour change (5th ed., pp. 84-136). New York: John Wiley.
Hill, C. E., O’Grady, K. E., Balenger, V., Busse, W., Falk, D. R., Hill, M., et al. (1994).Methodological examination of videotape-assisted reviews in brief therapy: Helpfulnessratings, therapist intentions, client reactions, mood, and session evaluation. Journal ofCounseling Psychology, 41(2), 236-247.
Klein, M. H., Kolden, G. G., Michels, J. L., & Chisholm-Stockard, S. (2002). Congruence. InJ. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions andresponsiveness to patients (pp. 195-215). Oxford, UK: Oxford University Press.
Knox, S., Hess, S. A., Petersen, D. A., & Hill, C. E. (1997). A qualitative analysis of client per-ceptions of the effects of helpful therapist self-disclosure in long-term therapy. Journal ofCounseling Psychology, 44(3), 274-283.
226 Journal of Humanistic Psychology
at KU Leuven University Library on February 23, 2015jhp.sagepub.comDownloaded from
Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative andeclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapyintegration (pp. 94-129). New York: Basic Books.
Leijssen, M. (1999). Gids voor gesprekstherapie [Guide for counseling and psychotherapy](Rev.ed.). Utrecht, Netherlands: De Tijdstroom.
Lietaer, G. (2001). Being genuine as a therapist: Congruence and transparency. In G. Wyatt(Ed.), Rogers’ therapeutic conditions: Evolution, theory and practice. Vol. 1. Congruence(pp. 36-54). Ross-on-Wye, UK: PCCS Books.
Martin, J., & Stelmaczonek, K. (1988). Participants’ identification and recall of importantevents in counseling. Journal of Counseling Psychology, 35, 385-390.
Nisbett, R. E., & Wilson, T. D. (1977). Telling more than we know: Verbal reports on mentalprocesses. Psychological Review, 84, 231-259.
Safran, J. D., & Muran, J. C. (1996). The resolution of ruptures in the therapeutic alliance.Journal of Consulting and Clinical Psychology, 64(3), 447-458.
Schmid, P. F. (2001). Authenticity: The person as his or her own author. Dialogical and ethicalperspectives on therapy as an encounter relationship. And beyond. In G. Wyatt (Ed.), Rogers’therapeutic conditions: Evolution, theory and practice. Vol. 1. Congruence (pp. 223-228).Ross-on-Wye, UK: PCCS Books.
Schmid, P. F. (2002). Knowledge of acknowledgement? Psychotherapy as “the art of not-knowing”—Prospects on further development of a radical paradigm. Person-Centered &Experiential Psychotherapies, 1(1&2) 56-70.
Schnellbacher, J. (2005). De echtheid van de therapeut in de communicatie met de cliënt. Eenempirisch onderzoek [Therapist genuineness in communication with the client]. Unpublishedmaster’s thesis, Katholieke Universiteit Leuven, Belgium.
Steering Committee of the APA Division 29 Task Force on Empirically Supported TherapyRelationships (2001). Empirically supported therapy relationships: Conclusions and recom-mendations of the division 29 task force. Psychotherapy: Theory, Research, Practice,Training, 38(4), 495-497.
Stiles, W. B. (2005). Case studies. In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.),Evidence-based practices in mental health: Debate and dialogue on the fundamentalquestions (pp. 57-64). Washington, DC: American Psychological Association.
Swildens, H. (1988). Procesgerichte gesprekstherapie: inleiding tot een gedifferentieerdetoepassing van de cliëntgerichte beginselen bij de behandeling van psychische stoornissen[Process-oriented psychotherapy: An introduction into a differentiated application ofperson-centered principles in the treatment of mental disorders]. Leuven, Belgium: Acco.
Takens, R. J. (2001). Een vreemde nabij. Enkele aspecten van de psychotherapeutische relatieonderzocht [A stranger nearby: Research about some aspects of the therapeutic relation-ship]. Lisse, Netherlands: Swets & Zeitlinger.
Van Kessel, W., & Lietaer, G. (1998). Interpersonal processes. In L. G. Greenberg, J. C. Watson,& G. Lietaer (Eds.), Handbook of experiential psychotherapy (pp. 155-177). New York:Guilford.
Weber, R. P. (1990). Basic content analysis (2nd ed.). Thousand Oaks, CA: Sage.Wyatt, G. (2001). The multifaceted nature of congruence within the therapeutic relationship.
In G. Wyatt (Ed.), Rogers’ therapeutic conditions: Evolution, theory and practice. Vol. 1.Congruence (pp. 79-95). Ross-on-Wye, UK: PCCS Books.
Yalom, I. (2002). The gift of therapy. An open letter to a new generation of therapists and theirpatients. New York: Harper Collins.
Yin, R. K. (1989). Case study research: Design and methods. (Rev. ed.). London: Sage.
Jutta Schnellbacher, MS, is a psychologist and music therapist. Sheworks in a psychiatric hospital as a psychologist and provides individualpsychotherapy in private practice.
Mia Leijssen, PhD, a professor at Katholieke Universiteit Leuven, Belgium,teaches experiential psychotherapy, professional ethics, and general coun-seling skills in the Psychology Department. She has a practice in individualpsychotherapy.
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