A COMPARISON OF PSYCHOANALYTIC SELF PSYCHOLOGY AND CARL ROGERS'S PERSON-CENTERED THERAPY
STEPHAN A. TOBIN, Ph.D., is an associate clinical professor at UCLA and in private practice as a clinical psychologist in Los Angeles. After receiving his Ph.D. at the University of Michigan, he practiced, wrote, and provided training as a gestalt therapist all over the United States and in Canada and Europe for 15 years and was also a co-founder, trainer, and president of the Gestalt Therapy Institute of Los Angeles. In addition to teaching at UCLA, he has also taught at California State University Northridge, California School of Professional Psychology, California Family Study Center, and Ryokan College. He also helped to found a church-sponsored mental health clinic and a growth center. For the past 10 years he has been interested in the integration of existential humanistic psychology and psychoanalysis, and has been studying, practicing, and writing in the area of Heinz Kohut's self psychology. He is also currently involved in conducting self psychology training groups and psychotherapy supervision in his practice, at UCLA, and at the Southern California Counseling Center.
This is a comparison of the philosophical, theoretical, and clinical features of Rogers's person-centered therapy and Kohut's psychoanalytic self psychology, including recent modifications of self psychology theory proposed by Robert Stolorow, his co-authors, and other self psychology theorists. The similarities covered are the phenom enological emphasis, the view of empathy, the holistic focus, the field theoretical view of the therapeutic relationship, and the therapies' views of human nature and requirements for growth, including the relative importance of emotion versus cognition in therapy. Some of the differences discussed are the ways in which Kohut and Rogers viewed theory, how the past is dealt with in therapy, the clinical methodologies of the therapies, their views of the necessary length of treatment, the importance of autonomy versus interdependence in human functioning, and differences with respect to self psychology and person-centered training methods. The author concludes that, although there are important similarities between the therapies, there are also significant differences with respect to the importance of consideration of the past, the transferential and counter transferential aspects of the therapeutic relationship, and the relative emphasis placed on developmental issues.
This article discusses some of the similarities and differences between the person-centered therapy of Carl Rogers and psycho analytic self psychology. An excellent comparison of Rogers and Heinz Kohut, the creator of self psychology, has already been written by Kahn (1985). Levin (1987) has also discussed some of the striking similarities between these theorists. Self psychology has, however, been modified and expanded by a number of other theorists, including Bacal (1985), Basch (1986), Ornstein and Ornstein (1980, 1985), Schwaber (1983), Shane and Shane (1980), Tolpin (1980), and Stolorow and his colleagues (Atwood & Stolorow, 1984; Stolorow, 1976; Stolorow, Brandschaft, & Atwood, 1987; and Stolorow & Lachman, 1980). My commentary, although covering some of the same ground as Kahn, will include reference to some of these recent theoretical developments, particularly those of Stolorow and his co-authors. I will also include my own subjective evaluation of the theories and clinical methods of Rogerian therapy and self psychology.
I recently re-read parts of Carl Rogers's considerable body of writings on psychotherapy (1951, 1959, 1961; Meador & Rogers, 1979) for the first time in many years. Even more than when I first read these works, I was impressed by the clarity, lucidity, and depth of his thinking about psychotherapy. I want to make it clear that I do not consider myself to be an expert on person-centered therapy. My existential humanism came mostly through my involvement in gestalt therapy, which I practiced and taught for many years as a member of the Gestalt Therapy Institute of Los Angeles. Some of the insights about gestalt therapy that I gained from studying self psychology have been covered in previous articles (Tobin, 1982, 1983, 1985, 1990). I also feel a greater personal and professional affinity to self psychology at this point in my career, so my evaluation cannot be considered completely neutral.
I shall first discuss the philosophical assumptions of person centered therapy and self psychology, which are mainly existential humanistic.
Rogers's ideas came first and, since both he and Kohut were at the University of Chicago from 1945 to 1957, Kohut may have heard about Rogers's ideas, and these ideas may have eventually influenced Kohut. I have no evidence of this, however, since Kohut does not mention Rogers in any of his writings. But then Kohut mentions few other writers, even those to whom he sounds very similar and who probably did influence his thinking. T. Maxwell (personal communication, 1989) has said that Kohut was probably influenced theoretically and clinically by his wife, Elizabeth Kohut, who was a psychiatric social worker, and she had some contact with Rogers.
During this period, Rogers was articulating a comprehensive existential-humanistic point of view about personality and psycho therapy. For example, in the book Client-Centered Therapy (1951), he expressed a belief in a positive view of human nature and the need for the therapist to take a positive, trusting view of his or her clients. He also stressed that one's "operational philosophy" is a fluid process, rather than being static and unchanging, and that, in order for the therapist to take a consistent attitude of trust and respect toward clients, he or she must first be able to take this same attitude toward him- or herself.
During this period of 1945 to 1957, Kohut was becoming an important practitioner, theorist, and teacher in the branch of psycho analysis called ego psychology, and was very far from being an existential humanist. For example, he achieved some notoriety for a rather harsh attack he made on Franz Alexander for his idea that psychoanalysis could be a "corrective emotional experience" (Alexander et al., 1946). To show how much Kohut changed over the years, in his last book (1984) he stated that it is "normal" for an analyst to respond joyfully to the growth steps of a patient and , if this constitutes a "corrective emotional experience . . . so be it" (p. 78).
Kohut started to develop self psychology in the 1960s because of difficulties he and most other therapists were having treating certain patients who had so-called narcissistic disorders: issues concerning self-esteem, self-equilibrium, self-regulation, and their very core sense of being. The usual way analysts attempted to deal with these demanding, frustrating, and frequently grandiose cli ents was by interpreting their incessant demands on the analyst as stemming from defenses against unconscious aggressive and sexual Oedipal feelings directed toward the analyst. These interpretations usually enraged or depressed these patients (Kohut, 1971), and most analysts, beginning with Freud, decided they could not be analyzed. Kohut gradually began to listen to them and take their complaints more seriously; the complaints concerned essential human requirements such as the gratification of needs for respect, affection, and approval, which had been denied them by practically all the significant people in their lives, including Kohut as their therapist. The result of this new perspective was a revision by Kohut of Freudian theory which culminated in his first book, The Analysis of the Self (1971). Further work by Kohut eventually resulted in his creating a new personality theory that rejects Freudian drive theory and other aspects of Freudianism, and a methodology that, while still psychoanalytic in many ways, is a radical departure from Freudian analysis. Implicit in this theory and way of working is a thoroughgoing existential-humanistic psychology.
In 1959, Kohut published an article in which he stated that all the concepts in psychoanalysis should be arrived at through data based on empathy and vicarious introspection. He attempted to follow this methodological principle the rest of his life, and it has made self psychology rigorously phenomenological. Rogers, of course, had started to emphasize phenomenology in personality theory and therapy at least as long ago as 1941, in Counseling and Psychotherapy. He was following in the footsteps of psychologists and psychiatrists such as James (1890), Minkowski (1933), Lewin (1935), Jaspers (1913) and many others who thought that psychology should concern itself mainly with subjective experience rather than behavior.
Rogers saw psychology and Kohut saw psychoanalysis as the scientific study of subjective states, not of biological forces, behavior, or the investigation of conflict between hypothetical structures of the mind. In fact, while some self psychology theorists, such as Shane and Shane (1986), do believe that it is possible for the therapist to have some "objective" knowledge about the client's past, and Basch (1986) believes that psychoanalytic concepts must be based on a knowledge of brain functioning, Stolorow et al. (1987) disagree strongly and carry Kohut's dictum about the use of empathy and introspection to its logical conclusion:
What the analyst possesses is a subjective frame of reference of his own, deriving from a multiplicity of sources and formative experiences, though which he attempts to organize the analytic data into a set of coherent themes and interrelationships. The analyst's frame of reference must not be elevated to the status of objective fact. Indeed, it is essential that analysts continually strive to expand their reflective awareness of their own unconscious organizing principles, including especially those enshrined in their "objective knowledge" and theories, so that the impact of these principles on the analytic process can be recognized and itself become a focus of analytic investigation. (p. 6, italics added)
In treatment, both person-centered therapy and self psychology focus on the client's way of living in what Rogers called "the phenomenal field." The major therapeutic stance in both therapies is the use of sustained empathy. Rogers (1951) defined the empathic attitude thusly:
It is the counselor's function to assume, in so far as he is able, the internal frame of reference of the client, to perceive the world as the client sees it, to perceive the client himself as he is seen by himself, to lay aside all perceptions from the external frame of reference while doing so, and to communicate something of this empathic understanding to the client. (p. 29)
Rogers also distinguished between empathy and emotional identification with clients and made it clear that taking an empathic attitude is difficult, taking much time and hard work on the therapist's part. These views on empathy are practically identical to the self psychological view, particularly as articulated by Stolorow et al. (1987).
The person-centered and self psychological emphasis on sustained empathy is in great contrast to the usual therapeutic attitude, which is that the therapist knows the truth about the reasons for the client's problems and knows what the client needs to do to get better. These assumptions lead most therapists to try to get clients to see things their way, by either directing or manipulating clients to think, feel, and act in the way the therapist thinks they should think, feel, and act. In contrast, both Kohut and Rogers believed that, with acceptance and understanding, people will naturally grow in the direction that is unique to and most fitting for them, and that it is unnecessary--even dangerous--for the therapist to lead the patient into growth directions the therapist deems healthy.
Both in a recent article (1986) and in response to a question I asked of him (personal communication, 1985), Rogers said that he differed from Kohut in his view of empathy in that Kohut used empathy only as a data-gathering device, while he saw empathy as having curative powers of its own. While Kohut's earlier view of empathy was of a data-gathering method, in his last writings he stressed that empathy is an "essential human bond" between people. I believe he was moving toward seeing empathy very much as Rogers did. For example, he said in his last published article, "the mere presence of empathy has also a beneficial, in a broad sense, a therapeutic effect-both in the clinical setting and in human life, in general" (Kohut, 1982, p. 397). But it is also true that he still saw empathy as being important for the therapist's gathering of data, so as to be able to make good interpretations. Since Rogers never did accept the value of making interpretations, that is one difference between them.
Kohut also made some contradictory statements about whether or not he saw empathy as a gratification of the client's needs. Sometimes he appeared to accept that gratification is a part of therapy, as in his comment about self psychology analysis being, at least partially, a "corrective emotional experience." But at other times he appeared to be tryin; to mollify the analytic establishment by maintaining the position that therapy must avoid gratifying the client. Rogers (1986, p. 132) criticized Kohut for apologizing for giving a suicidal woman two of his fingers to hold, and then explaining this to himself as "of the toothless gums of a very young child, clamping down on an empty nipple" (Kohut, 1981). This analogy may have been a defensive, intellectualized response on Kohut's part to an intervention that would be forbidden to an orthodox analyst (and Kohut was very orthodox earlier in his analytic career).
My own view of Kohut's conflict concerning gratification of patients in therapy is that being understood, accepted, and valued by another human being are among the most gratifying experiences anyone can have. Sometimes, of course, therapists have attempted to "re-parent" their clients in concrete ways and that, I believe, is impossible. What is possible, and even necessary, is for the therapist to help the patient become aware of what he or she was deprived of in childhood and to go through a process of mourn ing those deprivations.
Both Rogers and Kohut were interested in the real human be ing they were treating, and not in viewing him or her as a set of abstractions, forces, or structures. Both also used the holistic concept of the self in their personality theories, rather than more abstract, "experience-distant" (Stolorow, 1986) concepts such as ego, id, and super-ego; biological drives; or homeostatic processes. Rogers (1951) defined the self as "an organized, fluid, but consistent conceptual pattern of perceptions of characteristics and relations of the 'I' or the 'me,' together with values attached to these concepts" (p. 498).
Rogers (1986) saw Kohut's view of the self as quite similar to his own. Kohut's definition changed over time, however, and I believe that there are important differences between Rogers's and Kohut's later descriptions of the self, Kohut's being more complicated and more questionable theoretically. Kohut viewed the self as a bi-polar configuration. At one pole is the "grandiose self,'' which contains the individual's strivings toward power, mastery, and achievement. At the other pole is the "idealized parent imago,'' which contains the individual's idealized values and goals with which he or she must merge. Linking these two poles is a "tension arc" of basic skills and talents with which the individual attempts to perform the life-long balancing act of striving for individual goals while, at the same time, living in conformity with ideals and values that make his or her life meaningful.
This definition of self is relatively more distant from subjective experience than his earlier, simpler definition and is theoretically less sound than Rogers's. Stolorow (1986; Stolorow et al., 1987) and Chessick (1985) point to three theoretical problems. First, it makes self both a reified agent and a "receiver of impressions." This leads self psychologists to make statements like "The fragmented self strives to restore its cohesion." Pieces of something, however, cannot strive towards a goal. Second, Stolorow shows that some aspects of Kohut's definition of self contradict Kohut's own dictum that all the concepts in self psychology should be arrived at through empathy and introspection. For example, one cannot be aware of a "tension arc" in oneself. Third, Kohut's definition makes the self poles static entities, contradicting Kohut's (and Rogers's) idea that self is a constantly growing, changing, and fluid process. The definition also separates the structural poles from the source of energy, the "tension arc." Kohut himself was aware of the dangers of separating structure from function. Stern (1984) has pointed out that even referring to only one self-experience may not do justice to subjective experience. On the basis of his analysis of a great deal of developmental research, he articulates four distinct senses of self.
Stolorow himself defines self merely as the person's way of organizing his or her experience of the world and his or her relation to it, which is a definition of self very similar to Rogers's. To complicate matters, however, I believe that Kohut's final bi-polar definition of self does have some clinical utility, and should not be complete discarded. I myself have found it useful to think of patients in terms of the balance between the grandiose self need for achievement and the idealized parent imago need for identification with ideals, and the conflict between these essential needs.
Both Rogers and Kohut had a field theoretical view of self development. Kohut, however, spelled out much more completely than Rogers the kinds of parental responses or familial field that is necessary for the optimal growth of self.
Kohut and Rogers were also aware that the Freudian idea that the therapist should function as a blank screen was dependent on 19th-century science and was based on the "subject-object split" (May, Angel, & Ellenberger, 1958) inherent in much of Western culture. They both also saw the therapeutic relationship in field theoretical terms. But person-centered field theory differs from self psychology field theory. Meador and Rogers (1979) defined the therapeutic relationship as follows:
Because the theoretical concepts grew out of an experience of pro cess, what has developed is a field theory, rather than a genetic theory such as Freud's. Thus, the significant forces are to be found in the immediate relationships, as in an electrical field of forces. (p. 143J
Kohut, however, took the exceptionally useful step of relating field theory both to developmental processes and to the therapeutic relationship. He showed that certain categories of parental behaviors and attitudes that are necessary for the optimal growth of self are also necessary attitudes for therapists to take with patients who have uncohesive or weak self-experience, so that they can resume their self-growth in the therapeutic situation. Rogers, because of his view that all the significant forces for change exist in the present therapeutic situation, ignored developmental re search and theory. In so doing, I believe he ruled out a whole body of data that is proving to be extremely useful-perhaps even necessary-in understanding certain types of adult pathology. I am referring to the recent developmental work of people like Brazelton (1981), Demos (1984, 1985), Emde (1983), Stern (1985), and Sander (1980).
Kahn (1985) has hypothesized that Rogers may not have had to concern himself with development because he may have assumed a higher level of psychological development in his clients than the patients with whom Kohut worked. Yet Stolorow (1976), in discuss ing the same client population, has suggested that the descriptions Rogers gave of many of his clients indicates that they were similar to the narcissistically disturbed patients Kohut specialized in treating.
I think that Kohut also had a more sophisticated understanding than Rogers of the reciprocal impact patient and therapist have on each other in the therapeutic field. Kohut seems to have recognized that what the patient manifests is partially a function of who the therapist is, and vice versa. For example, Kohut implied that giving someone a diagnostic label, such as borderline state, is absurd without specifying the context in which the diagnosis is made. Thus, a patient who shows borderline symptoms with one therapist might show narcissistic personality disorder symptoms with another therapist. Stolorow and his co-authors (Atwood & Stolorow, 1984; Stolorow, 1986; Stolorow et al., 1987) have carried this field theoretical notion into new realms that will, I believe, have far-reaching implications for psychotherapy. They discuss the therapeutic relationship as an "intersubjective field-a system of differently organized, interacting subjective worlds" (Atwood & Stolorow, 1984, p. 119), which implies that the meaningful unit of study should not be the patient alone, nor the therapist alone, but their interacting phenomenological fields.
The difference in the ways Kohut and Rogers viewed the therapeutic field also carries over to differences in their attitudes about transference. Rogers believed, somewhat naively in my opinion, that he could avoid transference phenomena simply by being congruent and non-authoritarian with clients. For example, he endorses the idea (Meador & Rogers, 1979) that transference is caused by a therapist taking an evaluative stance with a client. But, as Stolorow (1976) has pointed out, Rogers has always been very skillful in fostering mirroring transferences, that is, situations in which grandiose narcissistic persons could form an archaic transference attachment to Rogers and begin to look to him for validation and acceptance. Thus, this statement by Rogers (1951) about the therapist's stance, which would help to create a mirroring selfobject transference, could easily have been made by a self psychologist:
The therapist endeavours to keep himself out as a separate person . . . his whole endeavor is to understand the other so completely that he becomes almost an alter ego of the client. . . . The whole relation ship is composed of the self of the client, the counselor being depersonalized for the purposes of therapy into being "the client's other self." (p. 42.)
But Rogers seemed much less aware of the other broad class of selfobject transferences Kohut described: the idealizing transference, where the client puts the therapist on a pedestal and idealizes him or her.
At least part of the reason Rogers viewed transference in such a negative light was that he defined it in the same way many non-self psychology analysts see it, as an irrational, defensive, and regressive perception by the patient of the therapeutic relation ship. The self psychology view, as developed by Stolorow et al. (1987), is that transference, in its most general form, is a manifestation of the patient's manner of organizing his or her experience. In therapy, this is a combination of what the client has learned in the past to expect from the world, plus the salient stimuli in the present. The most important stimulus in the psychotherapy session is often the therapist. The logical conclusion of this point of view is that neither the patient's nor therapist's perceptions of the therapeutic relationship is more correct or more real. They are just different. As Stolorow and his co-authors (1987) state,
What the analyst "knows" in the psychoanalytic situation is no more "real" than what the patient "knows." All that can be known psycho analytically is subjective reality-the patient's, the analyst's, and the evolving, ever-shifting intersubjective field created by the inter play between them. (p. 8)
This attitude also goes a long way toward removing the inequality and authoritarianism that is, in my opinion, inherent in many therapeutic relationships.
View of Human Nature and Requirement for Growth
Both Rogers and self psychologists reject the Freudian view of human nature that people are born as wild little animals who need to be socialized and that, without controls and limits on their natural instincts, they will do destructive, amoral things. Rogers objected to the Freudian view of people as driven by irrational impulses which inevitably put them in conflict with society. He saw the human being as having an innate tendency toward self actualization. But this tendency collides with the conditions others in life impose upon him or her. Then, according to Rogers (1959), "he values an experience positively or negatively solely because of these conditions of worth which he has taken over from others, not because the experience enhances or fails to enhance his organism" (p. 209).
Kohut also rejected the Freudian view of the basic nature of human beings. He saw even the most disturbed behavior as an attempt to preserve, maintain, and expand the self-structure. Hostile, destructive behavior was viewed by Kohut as the result of an injury to the self. Similarly, compulsive or perverse sexuality, split off from the holistic functioning of the individual, is the expression of a fragmented, depleted, or unharmonious self, not a manifestation of a sexual "drive." These ideas are consistent with Rogers's views of the causes of negative behavior, and Rogers was aware of the similarities between his and Kohut's views about human nature (Rogers, 1986).
Kahn (1985) points out, however, that Kohut was more pessimistic in his view of the human condition than Rogers, noticing people's failures more than their successes in outgrowing pernicious caretaker responses to their selfobject needs during pre oedipal and oedipal periods of childhood.
Seemingly without being aware of the fact, Kohut displayed some remnants of Freudian thinking about human nature in his concept of "optimal frustration" (Bacal, 1985). This concept states that self-growth occurs when a person who was serving a specific selfobject mirroring or idealizing function stops providing the function in that specific way, and the developmentally ready self is then forced to take over the function itself. In the case of a traumatic selfobject failure, the individual loses complete faith in that source of selfobject functions and a defensive reaction toward the resulting overwhelming negative emotions sets in.
For example, the mother of a former client of mine got angry and struck her when she cried about having to go to school by herself at age five. This experience was so shocking that she never again relied on her mother as a calming, soothing, supportive source of selfobject functions. Since she could not yet provide these functions for herself, her only alternative at the time was a counter phobic denial of any fears of entering new situations. Stolorow et al. (1987) have criticized the concept of optimal frustration as representing a return to Freudian drive theory and mechanistic, quantitative metaphors. Bacal (1985) has pointed out that it is not what is missing, it is what was previously there between self and selfobject that makes the assumption of selfobject functions by the person possible. Bacal has coined the term "optimal responsive ness," and Stolorow (1983) has suggested the term "optimal empathy" to describe this process.
In his article on Kohut and Milton Erickson, Rogers (1986) states that Kohut did not believe in a self-actualizing tendency in human beings, since he felt that interpretations were necessary in therapy. But this comment of Kohut's (1982) seems to me to imply a self-actualizing tendency:
Specifically, traditional analysis believes that man's essential nature is comprehensively defined when he is seen as 'Guilty Man', as man in hopeless conflict between the drives that spring from the biological bedrock of homo natura and the civilizing influences emanating from the social environment as embodied in the super ego. Self Psychology believes that man's essence is defined when seen as a self and . . . is, on the deepest level, 'Tragic Man', attempt ing, and never quite succeeding, to realize the programme laid down in his depth during the span of his life. (p. 402)
Both Kohut and Rogers saw determinism and free will as facts of human existence, which placed them both at odds with behaviorism and, to some extent, with Freudianism. Kohut saw the formation of the self as partly determined by experiences with the primary caretakers, but also stressed that, once the self is formed as a cohesive, dynamic core of the personality, the person is able to make free choices and to determine his or her own destiny. This view is very similar, if not identical, to Rogers's position on free will.
Emphasis on Emotion Rather Than Cognition
Both self psychology and person-centered therapy place a great deal of emphasis on the importance of affect or emotion in the growth of the self and in the therapeutic transactions between therapist and client.
Rogers (1951) sees emotion as accompanying and facilitating goal-directed behavior in human beings. He points out that, when the goal-directed behavior is punished, the emotion must be dis owned from the self-experience and self-concept. Successful therapy thus involves the gradual reclaiming of the dangerous emotions and attitudes.
In self psychology, Stolorow et al. (1987), while articulating a similar view, have spelled out much more fully how those who perform selfobject functions facilitate or impede the integration of affect states into the individual's self-structure. They also discuss in detail what the therapist must do to help the client reintegrate those affect states into the self. Kohut himself did not place nearly as much emphasis on affect.
Kohut and Rogers also had interests in applying their theories to societal issues. Rogers did a lot more actual applied work than Kohut (e.g., working with groups in the USSR, South Africa, and Northern Ireland), and he applied his theories to education and group work. Kohut did not do any applied hands-on work outside of his functioning as a psychoanalyst. Like many other analysts, including Freud, he was very interested in history and art, and he discussed in several articles how his ideas could be used to under stand certain important societal phenomena, such as the tendency oflarge groups of people to slavishly follow grandiose, narcissistic ally disturbed people such as Adolph Hitler (Kohut, 1985).
Both Kohut and Rogers were similar in that they created a much more humane ambience in the therapeutic setting than one finds in traditional analysis. Rather than the cold, objective stance of analytic neutrality advocated by Freud, both stressed a positive, caring attitude in the therapist toward his or her client as did Rank, Ferenczi, Fromm-Reichman, and other non-traditional analysts.
View of Theory
Rogers (1986) saw a fundamental difference between his and Kohut's view of theory. Rogers felt that all the theoretical concepts in a psychological theory should be testable by empirical means and he criticized some of Kohut's concepts as being untestable. After giving a brief discussion of Kohut's ideas about the dual lines of the developing self, Rogers says,
This is an interesting basic theory. It can never be disproved. By the same token, however, it can never be proved or validated. There is no present way by which we can enter the infant's conceptual world to know if in fact there are two lines of development. So this theoretical formulation, like most psychoanalytic theories, exists only in a speculative realm. It thus becomes a matter of belief or disbelief rather than a matter of confirmation or disconfirmation. (p. 136)
But a whole methodology has developed that does make it possible to make testable inferences about the subjective experiences of infants, and a large body of data about the interpersonal world of infancy is being collected, some of which does support Kohut's ideas (e.g., Stern, 1984).
Kohut (1959, 1978) felt that the subject matter of psychoanalysis (subjective experience) cannot be studied experimentally because subjective experience is only accessible through introspection and empathy. Thus, he saw behavioral phenomena, which can be tested experimentally, lying outside the province of psychoanalysis.
I believe that Rogers, trained as a psychologist, was much more sophisticated in experimental method than Kohut, who received his medical training in pre-World War II Vienna. Rogers was, of course, a pioneer in developing research techniques to investigate phenomenological data (Rogers & Diamond, 1964). When Kohut (1982) did discuss theory-building, however, it is clear that he had a reasonably erudite comprehension of the process of constructing both experience-near and experience-distant concepts.
View of the Past
Because Rogers believed, similarly to Lewin (1935) and Perls (Perls, Hefferline, & Goodman, 1951), that all the information necessary for change exists in the present, he did not feel it necessary to know and understand anything about the patient's past (Rogers, 1986). He thought it was impossible to ever know the past and, as I pointed out in the previous section, thought that theories of development were untestable and therefore useless.
Taking Atwood and Stolorow's (1984) phenomenological point of view, this is a naive view. According to them, there is no one "real" past, only what people experience subjectively about their pasts. For example, if a father teases his young daughter, he may feel that he is not being hostile; thus his reality does not include the idea of hostile behavior on his part. But if the daughter feels confused and humiliated by the teasing, then, for her, the teasing is hostile. Thus, there are two subjective realities here, no single objective reality.
Unlike Freudian analysis, there is no attempt in self psychology to excavate a "real" past separate from the individual's experiencing of his or her past. This approach to the past is more like the hermeneutic study of history than the objective methods of the natural sciences (Atwood & Stolorow, 1984). Helping a patient whose self-cohesion is compromised by a lack of feeling of connectedness to his or her past to create an internally consistent picture of it is considered essential for strengthening the self-structure.
Use of couch: Self psychology is, despite its existential-humanistic philosophy, an analytically oriented therapy or analysis; many of the practitioners still have their patients lie on the couch, particularly when doing psychoanalysis as opposed to analytically oriented psychotherapy. Some self psychology therapists have been suggesting that, with many clients, the use of the couch is not necessary or even desirable (see Lichtenberg, 1987). This is particularly the case with clients who need more contact with the therapist than is achieved with the couch. Lichtenberg also suggested that the therapist's sitting behind the client deprives the therapist of potentially very important empathic data, such as the expressions on the client's face, although he still sees advantages in the use of the couch with many patients.
Kahn (1985) suggests that face-to-face interaction might be preferable for working with fragmentation-prone individuals be cause the patient can then use the person of the therapist as an aid to maintenance of self-cohesion. He also makes the point that while traditional analysis' goal of widening of consciousness makes free association on the couch preferable, self psychology's goal of establishing empathic intuneness to facilitate structure formation might be better achieved through face-to-face interaction.
In any case, I believe that most self psychologists would make the use of the couch an option, rather than a necessity, and would allow the client to decide.
Interpretation: Rogers did not believe in interpretation at all, and was particularly critical of analysts who use inappropriately timed and critical interpretations. Kohut agreed very much about the detrimental effects of unempathic interpretations, but felt that genetic interpretations-connecting present events with childhood experiences--were very important. This is particularly true when the therapist unwittingly does something that results in a blow to the client's sense of self. It is then important, from the self psycho logical viewpoint, first, to find out what it was that hurt the client; second, to express understanding of the client's hurt, rather than judging it as irrational; and third, to connect the client's reaction to some similar experiences from the client's childhood. Without this last step, the client is apt to feel ashamed of his or her reaction.
Analytic neutrality and therapist self-disclosure: As Kahn (1985) points out, Rogers changed his position about therapist self-disclosure through the years.His emphasis on "prizing," un conditional positive regard, and empathy was always part of his method of treatment; it suggests an acceptance of the expression of positive feelings toward patients. It was not until relatively late in his career that he began to feel that feelings in general, including anger and other negative emotions, should be revealed to clients if they are "persistent." He admitted that he had trouble accepting the emotion of anger in himself, which may account for his rather slow acceptance of the expression of this feeling toward clients.
Kohut, being an analyst, did not advocate therapists' expressing feelings toward their patients. He did, however, as noted earlier, state that the revelation of feelings of pride and affection is "normal" and would be an important source of mirroring for patients. Concerning the expression of negative feelings toward patients, it is my opinion that most self psychologists would regard these as destructive, particularly with those patients who have severe narcissistic vulnerabilities. Kohut implies, however, that the therapist's expression of negative emotions can sometimes have a positive therapeutic effect and gives an example of a situation in which he told a self-destructive resident in analysis with him, ''You are a complete idiot" (Kohut, 1984, p. 74).
Wolf (1983), another self psychology theorist, pointed out the difference in the therapeutic ambience between self psychology and traditional analysis, and even suggests that
during the early phases of resistance analysis, the analyst may reveal that he or she is ignorant and clumsy in attempting to understand the analysand, or perhaps, the analyst's own selfobject needs may seek some surcease in the psychoanalytic situation, even at times using the patient as a selfobject. (p. 500)
Lachman (1984) suggests that some patients, particularly those who never had the experience of having their anger and competitiveness responded to by a strong but accepting selfobject, may need the therapist to be "adversarial" with them.
In response to a question about what the self psychology analyst should or should not do in therapy, Stolorow (1987) responded in a way that I think is applicable to the question about therapist self-disclosure: It is impossible to answer the question without reference to the specific therapist-client intersubjective field. If the developmental level of the patient warrants the expression of feelings by the therapist and the therapist feels comfortable doing so, then therapist self-disclosure may be useful. If the patient would not benefit or would be injured by the confrontation, or the therapist would feel uncomfortable doing so, then self-disclosure is contraindicated.
Length of Therapy
Rogers apparently believed only in short-term therapy, although he states that, as person-centered therapy developed, the length of treatment increased from about six sessions (in 1941) to as long as two years and longer (in 1960), which is not short-term. Kohut, being an analyst, did not generally do short-term therapy. My own opinion is that, to effect permanent changes in severely disturbed patients, long-term, intensive therapy is necessary. As Kahn (1985) suggested, Rogers worked mainly with people who already had a cohesive self, so they could perhaps make significant changes in a relatively short time. Kohut worked mainly with people who had weak, fragile self-structures, and I believe they need a much longer period of therapy.
Rogers was certainly much more pragmatic than Kohut, want ing to help the vast numbers of people who need therapy but cannot afford the long treatment that psychoanalysis usually involves.
View of Autonomy
Rogers's view of the necessary length of therapy, and of transference and other aspects of therapy, may have been shaped by his advocacy of what is a questionable Western cultural belief: That growth is always in the direction of greater independence and separation. He seemed to have been very concerned about people becoming too dependent on the therapist and staying dependent. I believe that part of the reason may have been due to the rigid, authoritarian upbringing he had in his own family (1960), which left him with a mistrust of authority that never got completely worked through.
There are therapists who unconsciously need their patients to become and stay dependent on them because of their own dependency needs, and who do not work with patients effectively on growing from a child-like form of dependence to a mature sense of interdependence. But I do not think Rogers recognized sufficiently that many clients actually need to allow themselves to have a dependent, childlike tie to the therapist in the early stages of therapy to be able to grow and mature into adult interdependence. This idea that growth is always in the direction of separation and independence was proposed by Margaret Mahler (Mahler, Pine, & Bergman, 1975) in her landmark work on human development, and her theory has proven very influential in psychoanalysis. More recent work-by Daniel Stern (1984), for example- suggests that some of her conclusions were faulty. The work of Stern and others supports Kohut's idea that humans, no matter how mature and well-functioning, never outgrow the need for responses from other humans to maintain, enhance, and expand the self. These responses fall into two major categories. One category, which Kohut called mirroring needs, includes approval, support, love, and acceptance. The other category, which Kohut termed idealizing needs, is the presence of something larger and more powerful outside oneself that one needs to identify with to provide meaning and value to one's life.
The differences between the child and the self-disturbed adult, on the one hand, and the cohesive adult, on the other, lie in the frequency and degree of abstractness of the needed self-sustenance. Rogers, of course, was very much aware of the mirroring needs of his clients and met these with "unconditional positive regard." He seems to have been less aware of the human need for idealization, which is ironic because so many people idealized him. I think he may have had difficulty accepting this idealization.
In his ideas about the dependency of the self on external sources of mirroring and idealization, Kohut was echoing the ideas of many feminist psychologists (e.g., Gilligan, 1982; Surrey, 1984) who stress that the self, in development and in highest functioning, is a self in-relation, not a completely autonomous self.
At the same time, Rogers was much more aware of feminist ideas than Kohut, who seems to have been fairly traditional in his views of the roles of men and women and in his attitude toward homosexuality. He implied in some of his case discussions that the attainment of health in men was a result of finding a woman who would serve selfobject functions, and in other discussions (e.g., Kohut, 1984) he saw homosexuality as an illness.
Theory of Cure
Interestingly, as Kahn (1985) points out, Rogers was more similar to Freud than he was to Kohut in the emphasis he placed on the expansion of consciousness in the achievement of change in therapy. Rogers saw the expansion as the result of the reintegration of aspects of the self that have been disowned, whereas Freud saw it as the result of the lifting of repression. It is important to note, however, that Rogers viewed the widening of consciousness as the result of the therapist's unconditional positive regard of his or her client, not of interpretations.
Kohut saw therapeutic cure as the strengthening of the self, which does not necessarily mean increased awareness. He said that, although greater cognitive insight usually does occur, it is a by-product of the therapy, and is not as important for change as the relationship with the therapist.
Stolorow and his co-authors (1987) saw this separation of in- sight and affective attachment to the therapist as
symptomatic of a chronic malady that has pervaded not only psychoanalytic theory but Western psychology in general. We refer to the fragmentation of psychic reality that artificially sections human subjectivity into cognitive and affective domains. This false dichotomy has persisted in psychoanalytic self psychology as well . . . . Furthermore, the conceptualizations of selfobject transference and of the psychoanalytic situation as an intersubjective system provide a framework for recognizing that insight through interpretation, affective bonding through empathic attunement, and the facilitation of psychological integration are indissoluble facets of a unitary development process that we call psychoanalysis. (p. 101)
Values and Ideals
Kohut and Rogers were similar in that they both emphasized values and ideals in therapy. Rogers was one of the leading proponents of existential-humanistic values. Kohut posited the existence of values and ideals as part of the very strength of the self-structure. But there is a difference, as Kahn (1985) pointed out, in how ideals were seen by Kohut and Rogers as being acquired by the individual. Kohut thought they were acquired through the identification with omnipotently and omnisciently perceived self objects; Rogers said that they are part of the individual's basic experience of being human and do not have to be learned (1951).
Method of Training
Rogers took contradictory positions about the need for formal therapy training and personal therapy for therapists. At Ohio State University, the University of Chicago, and the University of Wisconsin, he established training programs for therapists that, although not personally known to me, sound among the best ever developed (G. Haigh, personal communication, 1988; Rogers, 1961). And, although not requiring personal therapy for therapists in-training, he certainly recommended it. In more recent years, however, he minimized formal training of therapists and did not emphasize intensive therapy as necessary for them. He was op posed to licensing of therapists because he felt that many para professionals did better work than professionals. Kohut, who had a great deal of analytic training and did a great deal of training himself, felt that training in technique and theory is important and that the therapist should have a personal analysis or at least intensive psychotherapy. Kahn (1985) sees dangers in Rogers's more recent views on training and personal therapy for therapists, and even points out that Rogers himself came close to a mental breakdown in treating a seriously disturbed woman. I myself was not able to work well with severely disturbed patients until I had personal self psychology analysis and began to study what self psychology and object relations theorists had to say about border lines, narcissistic personality disorders, and other "pre-Oedipally disturbed" clients. I also needed to learn about transference and countertransference issues before I could understand, without getting hurt or angry, the seeming unrealistic, irrational demands many clients made on me.
Both Kohut and Rogers were giants in the field of psychotherapy. It is amazing that Rogers was saying, almost 40 years ago, many of the same things that Kohut said much more recently about the nature of human beings and what is curative in the therapeutic relationship. It is a measure of Rogers's profundity that his ideas about therapy are finally being supported by another, very differ ent form of psychotherapy.
I myself was attracted 30 years ago to Rogers's beliefs about the essential worth of human beings; the necessity, for therapy to be effective, that the therapist trust his or her clients' self-actualizing tendencies; and the need for the therapist to have these same accepting, loving attitudes toward him- or herself in order to have them toward his or her clients. But I think it is also an implicit commentary on Rogers's lack of appreciation of the tremendous difficulty of really living these ideas versus merely believing them that it took me so many years of work on myself in other kinds of therapy, particularly self psychology analysis, before I could fully appreciate Rogers's views and understand them on a deep level.
I think it is unfortunate that Kohut was not aware of Rogers's very important ideas or, if he was, did not make reference to his work. Rogers gives in his books and articles a very important and moving subjective view, from both the therapist's and client's perspective, of the rich, creative, life-affirming processes involved in therapy. I think Kohut could have benefited a great deal from these writings and could have sharpened his own theory. I also believe, however, that it is very fortunate that a blending of existential-humanistic psychology and psychoanalysis is occurring in the form of self psychology.
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