Excerpted from C.H. Patterson's Leona Tyler Award Address (The Counseling Psychologist, Vol. 24 (2), April 1996, pp. 335-347)
For most of my professional life I have found myself in disagreement with some of the contributions to the professional literature. I am comforted by a saying of Mark Twain: "Whenever you find yourself on the side of the majority, it is time to pause and reflect." One of my fantasies is to see myself standing beside a bandwagon, asking those who are scrambling to get on, "Do you know where you are going?"
One of my earliest articles, published in the American Psychologist (Patterson, 1948), was entitled, "Is Diagnosis Necessary for Psychotherapy?" It might not be accepted for publication today, although the argument is still valid. I became client centered in 1947, after spending some time with Rogers at the University of Chicago. I have stated that I became inoculated against directive systems of psychotherapy, and I have continued to be protected without a booster shot. I have suggested that I have been to Carl Rogers as Paul was to Christ. I have preached one gospel, the gospel of Carl Rogers. I apparently have not been a very effective disciple. I sometimes feel more like John the Baptist- a voice crying in the wilderness. The name of Carl Rogers is revered, but few, if any, graduate students now read any of his writings. At the 1985 Phoenix Conference on the Evolution of Psychotherapy (Zeig, 1987) he was the only one honored with a standing ovation, lasting 5 minutes. Yet one searches in vain for signs of his influence on the other presenters. It is true that the importance of the therapist-client relationship is being recognized by many theorists, including the psychoanalysts (e.g., Lomas, 1993; Meissner, 1991; Rowe & Mac Isaac, 1991). Yet there is not a single reference to Rogers in the psychoanalytic literature I have perused. It appears to be a case of the reinvention of the wheel.
My focus of interest in the past several years has been psychotherapy. Over 30 years ago, Rogers (1963) wrote, "The field of psychotherapy is in a state of chaos" (p.5). Others have echoed that conclusion since, and it appears to describe the field today. In 1985, Leo, reporting on the Phoenix Conference for Time magazine, reported one participant as saying that none of the experts present agreed. Joseph Wolpe (1987) in his presentation, called the conference a babble of conflicting voices" (p. 134). Prochaska (1988) titled his review of the report of the conference "The Devolution of Psychotherapy" and quoted from Zeig's (1987) introduction: "Here were the reigning experts on psychotherapy and I could see no way they could agree on defining the territory. Can anyone dispute, then, that the field is in disarray" (p. 305).
The implications of this situation are significant.
If there is no agreement on what psychotherapy is, how can we license or control its practice? How can it be packaged and sold to consumers? Yet it is being marketed through providers of cost-effective services of health care, who are monitored for quality control and accountability. Just what are consumers getting? If psychotherapy were a drug, it could not be approved by the Federal Drug Administration (see Patterson, 1994).
If there is no agreement on what psychotherapy is, how are psychotherapists educated? Every training program decides for itself how its students are educated. Every faculty member teaches his or her own approach to psychotherapy. Education in psychotherapy is where the education of physicians was before the Flexner report in 1910 (Flexner, 1910/1960).
Psychotherapy is being reduced to a multitude of techniques-skills, or interventions, as they are now called. Psychotherapy is being moved from a profession to a trade complete with manuals and handbooks. The specific treatments for specific diagnoses, following the medical model (see Patterson & Watkins, 1996, chap. 15, for a critique of this model). And the multicultural movement attempts to prescribe specific treatments for each culture, subculture, ethnic group, race, sex, etcetera, etcetera (see Patterson, 1996 for a critique of this movement).
It is a paradox that as medicine has been moving away from invasive to noninvasive procedures, psychotherapy is moving toward more invasive procedures.
Of course, there have been those interested in integration in psychotherapy, going back to Dollard and Miller's (1950) classic joining of behavior therapy and psychoanalysis. The current movement, however, does not have as its goal the development of a single, universal system. Rather, the movement has focused on the combination of methods and techniques in what I have called the eclectic solution. Numerous eclectic positions have been proposed. Paradoxically, eclecticism as an integrating force actually appears to be fostering divergence. Again, I must refer you to Theories of Psychotherapy (Patterson and Watkins, 1996, chap. 15) for a fuller discussion.
I have proposed what I call the common elements solution to the problem of integration (see Patterson and Watkins, 1996, chap. 16). It appears that any attempt at integration must be based on those elements present in all the major systems or theories. These factors are those involved in the relationship between the therapist and the client. The major elements were identified and defined by Rogers (1957) in his classic article, "The Necessary and Sufficient Conditions of Therapeutic Personality Change." They consist of the well-known therapist conditions of empathic understanding, respect or warmth, and therapeutic genuineness, as well as the client conditions of vulnerability, anxiousness, and perception of the therapist conditions. These are now widely recognized and accepted as common elements in psychotherapy.
There is all but universal agreement that the relationship - or the therapeutic alliance as some now prefer to call it - is a necessary condition for progress in psychotherapy. My position is that the relationship is psychotherapy and that the therapist conditions can be summed up as agape - or love. A few years ago, I visited Changua University in Taiwan. In a group of undergraduate students in a counseling course, one student asked, "What is the most important thing for a counselor to do?" After a few moments reflection I replied, "Love your client." So, if you ask me, "Is that all there is to psychotherapy?" my answer is, "Yes, my friends, that is all there is to psychotherapy." Love is the most potent reinforcer of behavior change, or as Martin Luther King is reported to have said, "Whom we wish to change we must first love." Gordon Allport (1950), over 40 years ago, wrote, "Love is incomparably the greatest psychotherapeutic agent" (p. 80). Almost 30 years ago, Burton (1967) said that "after all research on psychotherapy is accounted for, psychotherapy still resolves itself into a relationship best subsumed by the word love" (pp. 102-103). This is the essence of my "A Universal System of Psychotherapy." It would have been an appropriate article for today, but when I was informed of the award, it had already been accepted for publication (Patterson, 1995). Earlier, it had been rejected by the American Journal of Psychotherapy, whose reviewers contended that there could be no such thing as a universal system. There are many who share this view.
Copyright 1998, C.H. Patterson