Unconditional Positive Regard - Are We Helping or Harming Our Clients?

When most people think of talk therapy, they likely conjure up thoughts about Carl Rogers’ non-directive, humanistic approach. This is what my brother refers to when he suggests that as a psychologist, I just repeat back what clients say to me…Essentially, unconditional positive regard involves “showing complete support and acceptance of a person no matter what that person says or does.”

On one hand, I totally agree and very much identify as a humanistic psychologist because I am accepting and supportive of my clients regardless of what they say or do. I think this gets tricky, however, in what this actually looks like in therapy. As a graduate student, I took this to mean listening with empathy and remaining as much of a “blank slate” as possible.

I now understand this to mean continuing to be empathic, but also providing feedback about how I feel while interacting with clients. The interpersonal process approach to therapy suggests that whatever is happening in the therapy room is also happening with others outside of therapy.

I did not randomly choose to utilize interpersonal process as my approach to therapy with clients who have eating disorders – I actually researched this as a graduate student. I constantly studied attachment, relationship behaviors, and perfectionism as predictors of disordered eating. Anecdotally, I also noticed these themes consistently in eating disorder support and treatment groups.

Relationships are extremely complicated, inevitably involve conflict/misunderstandings/misinterpretations, and are not perfect. If we as therapist provide the type of unconditional positive regard that reflects only empathizing without providing feedback, are we really helping clients? Is this how other people are going to treat them or are they going to continuously experience dysfunctional relationships outside of therapy?

We have, in my opinion, a unique opportunity to provide a context for the client to understand their way of relating to others through their relationships with us as therapists. I can accept them as they are, but also provide an opportunity for mirroring, attunement, and mutual understanding if we discuss how themes in their behaviors with others are reflected in their relationship with me. This also provides an opportunity to evaluate how one person’s feelings and experiences do not invalidate the feelings and experiences of another. Interpersonal process therapy provides an opportunity to model how relationships are not perfect, and that rupture and repair can actually deepen the relationship between two people.  

I personally feel it could be problematic to provide exclusively positive, supportive feedback because it reinforces a few problematic schemas: such as the beliefs that (1) individuals in a position of power or with certain credentials are “perfect,” or (2) the way the client is  relating (whether it is distancing, idealizing, devaluing, approval seeking, etc) is productive.

Also, I think this is where acceptance and commitment therapy blends beautifully with interpersonal process therapy because it’s an opportunity to demonstrate the importance of the ACT principle that: seeking out pleasure often involves facing at least a possibility if not a reality of experiencing pain.

It is not comfortable, even as a therapist, to muddle around in the messiness of sorting out differences in thoughts, feelings, and perspectives between myself and clients – so again, this becomes modeling how to utilize commitment to the value of the relationship as a way to calmly address anxiety that arises from differences in opinions, thoughts, feelings, and understandings.

When individuals sit in therapy and talk about issues that bother them outside of therapy, it is helpful because it provides a context for understanding themes and struggles in their lives. In order for change to occur, however, I believe it is necessary to provide a here-and-now experience where anxiety is hightened, an alternative approach demonstrates flexibility and teaches new skills, and commitment to an overall value is reinforced.

This is where my positive psychology approach comes in…I don’t think we overcome disordered eating, alcoholism, anxiety, depression, or any other mental health issue by focusing on the problem….When we find something that matters more than what we are avoiding – this is where recovery starts….

Now that I’m in private practice, I don’t have colleagues to discuss my theory of counseling with on a daily basis – so this blog has become my new sounding board….Also, maybe I miss grad school a bit – I always enjoyed conversations about theory and the human condition….