Reflection on the Concept of Therapeutic Presence

09 Apr 2018

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  • Tony Fowler

“I am inclined to think that in my writing I have stressed too much on the three basic conditions (congruence, unconditional positive regard and emphatic understanding). Perhaps it is something around the edges of those conditions that is really the most important element of therapy – when myself is very clearly obviously present’ (Rogers cited in Baldwin, 2013a p.28)

It has been implied through quantum physics, that on a molecular level, everyone exists within a virtual sea of energy (Gribben, 1984; Pert, 1997), and that each individual contributes to that energy field, by both affecting and being affected by everything and everyone around them, simply by being present. In an interview with Michele Baldwin towards the end of his life, Carl Rogers stated that he had become more aware of his use of ‘self’ within the therapeutic environment and that when he was intensely focused on his client, his presence alone instigated the healing process (Baldwin, 2013a).

It is widely accepted that Carl Rogers is considered to be one of the most influential cofounders of the humanistic psychotherapy movement with the development of his person centred approach to counselling clients, and I feel that this was a very bold and courageous statement to have made at this point in his career. When this statement is viewed in relation to his much publicised earlier work, where he wrote about the importance of the six therapeutic conditions, I feel that this statement, like many others humanistic practitioners, appeared to be a change of direction and philosophy for him. In his early career Rogers put particular emphasis on the three primary core conditions, congruence, unconditional positive regard and empathic understanding stating that these were all that was required for a successful therapeutic outcome (Rogers, 1957),

Presence has been considered to be a quality that arises when the therapist is present to what is happening in the right here and now. For myself, I am inclined to agree with the views of Martin Buber, from whom much of the Gestalt philosophy of therapy has stemmed from his ‘I-thou’ relationship, that presence is more than just being in the present (Greenberg and Geller, 2001). I am inclined to believe that this it was Rogers was referring to when he spoke of his simply ‘being present’ as the means to facilitating a healing outcome. Is it then that presence is more than the necessary conditions required for a successful therapeutic outcome to take place or that as Rogers suggested, something more around the edges of these conditions that is the primary element within the counselling relationship (Baldwin, 2013a)?

Geller and Greenberg (2012 p.7) define therapeutic presence as “the state of having one’s whole self in the moment on a multiplicity of levels, physically, emotionally, cognitively and spiritually”. This statement shows much duplicity to the original ideas of another proponent of the importance of the relationship between client and therapist, Sandor Ferenczi. He advocated that therapists should possess both an interpersonal and emotional attitude of tenderness, an emotional ambiance where personal caring can create a healing environment decades before Rogers first introduced us to his person centred approach (Hoffman, 2003).

It has been argued that in order for the effects of presence to be fully beneficial, preconceptions, judgements and even beliefs cannot co-exist within the present moment. Buber claims that the healing relationship between client and therapist is naturally unequal and one sided, as the client is always looking to the therapist for guidance (Baldwin, 2013b). Whilst I think this argument is true, I also believe that therapeutic presence is made up of both the unspoken and unseen connection between therapist and client that can occur within a therapeutic intervention. It involves the embracement of all core conditions, being empathetic, congruent and having unconditional positive regard for your client. It is about creating a connection with our clients, whilst maintaining one’s own boundaries and not taking on the client’s sense of frustration, anxiety, pain, or grief.

Rogers maintained that how a client sees him, whether as a professional therapist, father figure or friend, it mattered not. What was important was to hear, accept and recognise the feelings that the client was experiencing (Baldwin, 2013a). Once again I am in agreement with these views, and feel that when we sense, feel and listen to our clients, as well as to ourselves, we will eventually become more in tune with what is arising between ourselves and the client, allowing for a greater potential for healing to take place.

However, this change in Rogers’s beliefs appeared to be almost a reversal of where he had always stood, having had such a profoundly different viewpoint to that of the more traditional psychoanalysts of his time, in regards to the issue of transference. In fact it is true to say that throughout his professional career he denounced the psychoanalytical notion of transference and counter transference as sophisticated devices with the potential to inhibit any real exploration of feelings between therapist and the client (Thorne, 2012) and that there was no reason to make a big deal of it (Baldwin, 2013a).

As a result, I do agree with some critics of Roger’s new position, especially in light of his new stance on the effects of presence. Rogers stated that when a certain level of presence is reached, an intense intimacy is achieved between the client and himself and this results in a flow of energy between himself and the client. These claims have been considered by many critics as Rogers describing an almost a spiritual effect, which I am in total agreement with and inclined to consider this as both arrogant and mystical in nature.

I am once again drawn to the similarities between Rogers and that of the earlier work of Sandor Ferenczi. Ferenczi, who despite being labelled a psychoanalyst and someone who was once a close personal friend to Freud himself, became disenchanted with Freud’s perspective on the role of clients within the therapeutic session. As a result he went on to develop his own therapeutic approach on the importance of developing the relationship between client and therapist. It is this concept that influenced other significant cofounders of the humanistic psychological movement that followed, such as Abraham Maslow, Rollo May and James Bugental, and in turn Rogers himself with the development of his own Person Centred Approach (Hoffman, 2003).

Throughout humanistic approaches such as within existential therapy, presence is seen as a fundamental principle of the therapeutic process, considered by many to be central at effecting change (May, 1958; Bugental, 1987; Yalom, 2002). Within existentialism, it is believed that presence plays a pivotal role in the development of both a safe environment and an intimate therapeutic relationship. Bugental and Yalom, believed the conception of being present with your client included but went beyond the experiencing of a deep connection with the self and the other. They claimed that each person is not only related to self, to other and to the physical world, but also to each person’s past and present in the here-and-now. (Bugental, 1999; Yalom, 1980, 2002)

I find this viewpoint again almost spiritual in nature, yet subtly different to the implied spiritualistic nature of Rogers claims. I can almost sense an empiricalistic scientific desire to justify what presence actually is and how it can be achieved by the existentialists. Given Rogers theological beginnings before embarking on a more empirically based career path, I can almost understand his later life reflections on what presence was to him. However, I have to agree with other critics that his implied spiritualistic view and comments of energies that flow between therapist and client that may come from a higher transcendent place, as opinions of a more personal nature and not those that should be taken seriously by the more empirically minded practitioners of today (Thorne, 2012).

In a qualitative study by Mick Cooper (2005), the relational depth, which was defined as a profound feeling of contact and engagement with another, was investigated through a series of interviews with person centred therapists. The results of his research found that relational depth can be conceptualised as a form of ‘co-presence’ or a co-experiencing of the person-centred ‘core conditions’. Is this empirical confirmation of Roger’s statement? He himself stated that he believed that a healing outcome resulted not from an emphasised use of the core conditions, but it was possibly something more encompassing, an amalgamation of all the core elements.

As an acknowledgement of what presence is and what its effects are, I find compelling evidence within this study. Those therapists who participated in the study, Cooper (2005) interviewed, stated that they had experienced heightened feelings of empathy, acceptance and receptivity towards their clients along with a greater level of awareness, aliveness and satisfaction. He also claimed that when the therapists were having these feelings they also experienced their clients as being highly transparent, being able to articulate core concerns and being able to reciprocate the therapist’s acknowledgement of them. What makes these results so compelling is that they also support the findings and experiences that were described in Geller and Greenberg’s (2002) research on presence.

Although it is debatable as to which therapeutic orientation the notion of presence belongs, there can be no doubt that the humanistic tradition has emphasised presence as crucial to therapeutic change. However, cultivating presence is an ongoing practice. It is seen by some as a factor of therapy more important than the acquisition of academic knowledge or the mastery of particular skills set. Yet I believe that through continued use of the core conditions as laid down by Rogers’s person centred approach, we as practitioners have the methods at hand, to invite more presence into the therapy room and therefore become more helpful to our clients.

In conclusion I truly believe that having presence is attuning to what is. If one can achieve this then a resonance will occur between us and our clients, which will ultimately lead to the manifestation of trust within the therapeutic relationship. What will we get out of this sense of presence? Will we experience openness to what is? Or acquire the ability to listen to our clients more deeply? Maybe; and maybe as Sandor Ferenczi first suggested, there will naturally arises a greater emotional connection between ourselves and the client with an emphasis on empathetic presence within the therapeutic milieu.

Reference List

Baldwin, D. C., 2013b. Some philisophical and psychological contributions to the use of self in therapy. In: M. Baldwin, ed. The use of self in therapy. 3rd ed. New York: Routledge, pp. 64-80.

Baldwin, M., 2013a. Interview with Carl Rogers on the use of self therapy. In: M. Baldwin, ed. The use of self in therapy. 3rd ed. New York: Routledge, pp. 28-35.

Bugental, J. F. T., 1987. The art of the psychotherapist. New York: Norton.

Bugental, J. F. T., 1999. Psychotherapy isn't what you think. Phoenix, AZ: Zeig, Tucker & Theisen.

Cooper, M., 2005. Therapists experiences of relational depth: A qualitative interview. Counselling and Psychotherpay Research, 5(2), pp. 87-95.

Geller, S. M. and Greenberg, L. S., 2002. Therapeutic presence: Therapist's experience of presence in the psychotherapy encounter. Person-Centered and Experiential Psychotherapies, 1(1&2), pp. 71-86.

Geller, S. M. and Greenberg, L. S., 2012. Therapeutic presence; a mindful approach to effective therapy. Washington DC: American Pysgological Association.

Greenberg, L. S. and Geller, S. M., 2001. Congruence and therapeutic presence. In: G. Wyatt, ed. Rogers therapeutic conditions: Evolution, theory and practice - Congruence. Ross on Wye: PCCS Books, pp. 131-148.

Gribben, J., 1984. In search of schrodinger's cat: Quantum physics and reality. New York: Bantam Books Inc.

Hoffman, D., 2003. Sandor Ferenczi and the origins of humanistic psychology. Journal of Humanistic Psychology, Volume 43, pp. 59-86.

May, R., 1958. Contributions of existential therapy. In: R. May, E. Angel & H. Ellenberger, eds. Existance: A new dimension in psychiatry and psychology. New York: Basic Books, pp. 37-91.

Pert, C., 1997. Molecules of emotion: Why you feel the way you feel. New York: Simon and Schuster Inc.

Rogers, C. R., 1957. The necessary and sufficient condiitons of therapeutic personality change. Journal of Counsulting Psychology, Volume 21, pp. 95-103.

Thorne, B., 2012. Counselling and spiritual accompaniment: Bridging faith and Person Centred Therapy. 1st ed. Chichester: John Wiley & Sons Ltd.

Yalom, I., 1980. Existential Therapy. New York: Basic Books.

Yalom, I., 2002. The gift of therapy. New York: Harper Collins.

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