Carl Rogers and Steven

Carl Rogers and Steven

Carl Rogers was one of my teachers during psychiatric residency training.  I had been impressed by his books on psychotherapy and even more so by having had the opportunity to observe him interview patients (he called them clients and labeled his efforts as client-centered).  My psychotherapy supervisor was not Carl at the time I am about to describe, but he was one of his protégés.

Steven had been hospitalized after cutting his wrists in a suicidal attempt.  He was receiving antidepressant medication. I was designated to be his psychotherapist while in the hospital.  Staff had noted that he seemed to be bottling up his feelings and they thought this was impeding his progress in terms of lifting his depression.

So my goal in our first meeting was to facilitate the expression of thoughts and feelings that he had thus far been unable to share. I employed a Rogerian technique that consists of intense listening that allows for empathic responses that are just slightly exaggerated in their emotional content.  This resulted, when it worked, in patients being able to express themselves in progressively  “deeper” and more emotionally laden ways.  This was thought to increase self-awareness and provide relief.

In the client-centered approach the therapist avoided asking direct questions, limiting his or her responses to comments made by the patient wherever that might lead.  Midway into our first session Steven began talking about his relationship with his father and the conversation with his comments and my responses to them went something like this:

“My dad and I didn’t always have the best of relationships.”

“Sometimes you and your dad didn’t hit if off too well.”

“Sometimes I thought he treated me unfairly”.

“There were times when you felt he was treating you unfairly”.

“And when that happened I’d get a little bit irritated.”

“When that would happen it would tic you off just a little.”

“In fact sometimes it would make me feel angry.”

“Sometimes it would make you mad.”

“I’d even have revengeful thoughts.”

“You’d even think about how you could get even with him.”

“It got to the point I thought I didn’t really like him like I should.”

“It was hard to like him at the same time you felt so mad at him.”

“I could feel the angry feelings starting to build up inside of me.”

“Those angry feelings were beginning to boil up inside of you.”

“And my anger at those times would become awfully intense.”

“You would get madder and madder at him.”

“I’d feel like I couldn’t keep my true feelings from him anymore”.

“You felt like you were going to just explode and gush out your feelings.”

“At those times I actually hated him!” (This was said loudly and with a facial expression that matched his words).

My softly spoken and measured response:  “At those times you didn’t just feel irritated or angry or mad at him but it reached the point where you actually hated him.”

There was a pause and then he said, as if he were amnesic for what he had just told me, “What you are telling me is true.  I never realized it before.  There were times when I hated the son of a bitch!”

In retrospect I find it interesting that this Rogerian approach helped Steven to uncover feelings he had most likely denied not only to others but also to himself up until that time.  I also find it interesting that he owned his feelings right up to the time when they became so intense that it was easier to accept his final insightful leap as coming from his therapist (me) rather than himself.  Certainly this approach may also have encouraged expression of feelings that were exaggerated in degree. At any rate, Steven continued to improve during his hospital stay.  Subsequent sessions were much less dramatic but his responses to our meetings appeared to be positive.  He was receiving medication along with group and occupational therapies as a part of his treatment experience.  My interactions with him as a novice therapist may have been helpful. At least I am fairly confident that they did not make him worse.

2006