The Person-Centered Journal, Volume 2, Issue1, 1995
A UNIVERSAL SYSTEM OF PSYCHOTHERAPY
C. H. Patterson
ABSTRACT Currently it is generally accepted that existing theories and approaches to psychotherapy, developed in Western cultures, are not applicable to other cultures. A model is proposed that, while based on certain theoretical and research foundations in Western culture, also recognizes and derives from universal drives, motivations and goals of all human beings, indeed of all living organisms. It is therefore neither time nor culture bound.
The model is developed in terms of three levels of goals: (1) the ultimate goal, common to all clients; (2) mediate goals, that allow for cultural and individual differences; and (3) the immediate goal, involving the therapy relationship. The therapist conditions necessary, and possibly sufficient, for the development of a relationship leading to the achievement of the mediate and ultimate goals are defined.
Over 20 years ago I began putting together what we know, from experience and experiment, about psychotherapy. I used the term "model" to describe the result. It is not a model in the formal or mathematical sense, but a conceptual model. It has gone by different names in the process of development as I realized that it is not limited to psychotherapy. It is actually a model for all facilitative interpersonal relationships-family (parent-child, husband-wife), teacher-student, employer-employee, supervisor-supervisee. Recently I have also come to realize that it is a universal model, in that it is not time-bound nor culture-bound.
I am aware that to suggest that there is a universal system of psychotherapy flies in the face of almost everything that has been written about cross-cultural psychotherapy. Currently it is generally accepted that existing theories and approaches to psychotherapy, developed in the Western cultures, are not applicable to other cultures. The system developed here, while based on theoretical and research foundations in Western culture, also recognizes and derives from the universal motivation and goal of all human beings.
There are three major elements of psychotherapy: (1) goals or objectives; (2) the process in the client; and (3) the therapist conditions necessary for client progress.
There has been surprisingly little fundamental consideration of the goal or goals of psychotherapy. This is surprising in view of the tremendous amount of attention to methods and techniques; it would appear that a prior concern would be the determination of goals. Outcome studies have simply accepted and used any and all measures available, with little concern about their relevance to methods and techniques or to any desirable goals of the process.
Mahrer's (1967) edited book, The Goals of Psychotherapy, revealed the almost endless number and variety of goals considered by the contributors. Parloff's (1967) contribution suggested a way of dealing with the problem. He proposed two levels of goals-mediating and ultimate. He notes that although there may be great differences in mediating goals, "differences in the stated ultimate goals will in all likelihood be small" (p. 9).
Parloff's suggestion is the basis for the present discussion. Three, rather than two, levels of goals are considered, and the definitions of ultimate and mediating goals are different. The three levels are (1) the ultimate goal, (2) mediate or mediating goals, and (3) immediate goals. The last consists of the client's behavior in the process.
THE ULTIMATE GOAL
The ultimate goal in psychotherapy concerns the kind of person we want the client to become as a result of psychotherapy. It should be apparent that the kind of person we want the client to be is the kind of person we would like all persons to be. It relates to the question of what is the purpose of life, a question with which philosophers have been concerned since Aristotle.
There have been many suggested goals. Jahoda (1958) proposed the concept of positive mental health, but it has been impossible to clearly define it. Concepts of adjustment raise the question of adjustment to what. White's (1959) concept of competence raises the question of competence for what. Psychological effectiveness involves the same problem. All require a higher level criterion.
There are a number of terms or concepts that appear to transcend this question and to constitute an acceptable criterion. These include self-realization, self-enhancement, the fully-functioning person of Rogers, and self-actualization. This last term appears to be widely and commonly used, and is adopted here.
The definition of the self-actualizing person derives from the work of Maslow (1956). He formulated a general definition of self-actualizing people as being characterized by
the full use and exploitation of talents, capacities, potentialities, etc. Such people seem to be fulfilling themselves and to be doing the best that they are capable of doing. They are people who have developed or are developing the full stature of which they are capable (pp. 161-162).
Selecting a group of people, living and dead, who seemed to represent self-actualizing people, Maslow attempted to find what these people had in common and that differentiated them from ordinary people. Fourteen characteristics emerged:
I pause to note some objections to the concept of self-actualization. These derive, in my opinion, from misconceptions or misunderstandings of the nature of self-actualization and of self-actualizing persons. One such objection is that self-actualization is inimical to individuality, since, it is claimed, self-actualization consists of a collection of traits that are the same for all persons, resulting in standard, identical behaviors. But what is actualized are varying individual potentials. As Maslow (1956, p. 192) notes, "self-actualization is actualization of a self, and no two selves are altogether alike."
A second, and opposite, misconception is that a self-actualizing person is antisocial, or at least, asocial. Maddi (1973a, 1973b) has taken this position. Williamson (1950, 1958, 1963,1965) also makes this criticism. And even Smith (1973) appears to see self-actualization as including undesirable, or antisocial behaviors, and thus unacceptable. And White (1973) appears to view self-actualization as selfish: "I ask readers," he wrote, "to observe carefully whether or not self-actualization, in its current use by psychological counselors and others, is being made to imply anything more than adolescent preoccupation with oneself and one's impulses" (White, 1973, p. 69). And Janet Spence, in her 1985 presidential address to the American Psychological Association (Spence, 1985) spoke as follows of the youth of the 60s and early 70s:
Although some were led to careers that were expressions of idealism, others turned their backs on the work ethic or substituted as a goal for material success self-actualization and 'doing your own thing'. . . Although the pursuit of self-actualization was stimulated by rejection of materialistic goals, it represents another facet of unbridled materialism (pp. 1289-1290).
These criticisms appear to confuse the concept of self-actualization with selfishness and self-centeredness, and identify it with the characteristics of the "me" generation of the 70s, the "culture of narcism" (cf. Amitai Etzioni , Christopher Lasch  and Tom Wolfe ). It is also perhaps influenced by the human potential movement, which no doubt, in many of its manifestations, promoted extreme individualism and self-centeredness.
Rogers answered these criticisms when he noted that individuals live in a society of others, and can become actualized only in interaction with others. They need others, and the affiliation, communication and positive regard of others (Rogers, 1959, 1961).
Self-actualization as the goal of psychotherapy has some significant implications:
Mediate goals are the usual goals considered by counselors and psychotherapists. They include the specific and concrete goals of behavior therapists. Contributors to Mahrer's (1967) book focused upon this level of goals, such things as reduction of symptoms; reduction of anxiety, and of psychological pain and suffering, and of hostility; elimination of unadaptive habits, acquisition of adaptive habits.
Other mediate goals include good marital and family relationships; vocational and career success and satisfaction; educational achievement, including study skills and good study habits; development of potentials in art, music, athletics, etc.
The ultimate goal is a common goal, applicable to all individuals. Mediate goals provide for, or allow for, individual differences. People have differing, and multiple, potentials; they actualize themselves in differing ways.
A number of implications of the separation of goals into ultimate and mediate become apparent:
THE IMMEDIATE GOAL
The mediating goals of Parloff (1967) are aspects of the psychotherapy process, the initiating and continuing of which is the immediate goal in the present model or system. The therapy process and its elements have been described in many ways, in the various theories of psychotherapy. Parloff (1967) included the following specific goals: making the unconscious conscious; recall of the repressed; deconditioning; counterconditioning; strengthening or weakening of the superego; development and analysis of the transference neurosis; promoting increased insight; increasing self-acceptance. There is little, if any, evidence that many of these goals lead to desirable therapy outcomes, particularly to increased self-actualization.
An essential of the therapy process is client activity of some sort. The client activity involving self-exploration, or intrapersonal exploration, appears to be universally present in successful psychotherapy. It includes some of the mediating goals mentioned by Parloff, such as developing awareness of unconscious (or preconscious) material (self-awareness).
The process of self-exploration is complex, involving several aspects or stages:
Questions have been raised about self-disclosure and self-exploration by writers about crosscultural counseling. Persons in other cultures (as well as the poor in our own culture [Goldstein, 19731), it is said, cannot, or do not, engage in self-disclosure or self-exploration (or "introspection"). Pedersen, for example, referring to American Indian clients, writes: "A counselor who expects clients to verbalize their feelings is not likely to have much success with Native American clients" (Pedersen, 1976, p. 26). Sue (1981, p. 48) refers to "certain groups (Asian Americans, Native Americans, etc.) that dictate against self-disclosure to strangers. He refers (p. 38) to "the belief in the desirability of self-disclosure by many mental health practitioners." Yet, paradoxically, he also refers to self-disclosure as an "essential" condition that is "particularly crucial to the process and goals of counseling . . . . " (Sue, 198 1, p. 48).
That is the problem. If self-exploration is essential for progress in psychotherapy (and this is supported by the research), then it cannot be abandoned, as some suggest, with the therapist taking an active, directing, leading or structured approach.
But client reluctance to self disclose or difficulty in self-disclosing is a social, not a purely cultural characteristic. People (in general, not only Asians) do not disclose to strangers, social superiors, experts, including professionals. Yet, paradoxically, people sometimes tell things to strangers (as well as to therapists) that they wouldn't tell to families or friends. Chinese with whom I have talked assure me that they self-disclose among their families and friends. The reluctance to self disclose or difficulty in self-disclosing among certain clients is not a reason for abandoning psychotherapy (for which it is a necessary condition), but for providing the conditions which make client self-disclosure possible.
How does the therapist make it possible for the client to engage in those activities necessary for therapeutic progress? He or she does so by providing certain conditions. Three major conditions have been identified and defined (Rogers, 1957) and are now supported by considerable research (Patterson, 1984, 1985). The nature of these conditions is now well known, and they are simply enumerated here.
These four conditions may be summed up, I think, in the concept of love, in the sense of agape. They are part of all the great world religions and philosophies. In 1986, Dr. Louis Thayer interviewed Carl Rogers. At one point in the interview, when Rogers commented on the presence of too much intervention, by parents, governments and policy makers (as well as by therapists), he stopped to take from his wallet a verse he carried with him, "a little quotation I treasure," he said. It was this poem by Lao Tzu, a Chinese philosopher of the 5th Century B.C. I have been using this poem in my teaching for several years, substituting therapist for leader:
A Leader (Therapist)
A leader (therapist) is best when people [clients) hardly know he exists;
The less a leader [therapist] does and says,
[Therefore] a sensible man says:
Psychotherapy is of course a two way process, a relationship, and it takes two to form a relationship. There are two conditions that must be present in the client before the process of therapy can begin.
CHARACTERISTICS OF THE SYSTEM
There are some characteristics of this system of psychotherapy that are worth noting:
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