Unconditional Positive Regard: How a Therapist’s View of a Client Can Affect Treatment

Sitting in a counseling center waiting room, heart pounding, palms moist with nervous perspiration, a client awaited an initial appointment with her therapist. Her husband had told her in no uncertain terms that she needed to engage in treatment to deal with the addictions that had plagued her and beleaguered her family for years, including a longstanding eating disorder coupled with a not so-secret binge-drinking habit. She’d been on this roller coaster ride for as long as she could recall. A childhood fraught with chaos, a mother who focused on appearance and military-veteran-turned-successful-businessman father who insisted on performance created the perfect storm for addiction to take hold. After the birth of her first child, she found that to maintain her toned and trim body, she felt compelled to spend hours at the gym and restrict her food intake. After her second daughter was born, the intensity of workouts continued. Purging with diuretics and drinking mouthwash to induce vomiting became part of her routine. The combination of these factors had her taking the courageous leap into treatment. Her survival depended on it. She was also acutely aware that her daughters were beginning to emulate her perfectionistic tendencies — including her self-loathing body hatred. She didn’t want to pass this legacy on to them. As she waited nervously, ready to cry, the door opened. In walked her new clinician. She smiled, made eye contact, offered her hand in greeting and introduced herself as she ushered the woman into her office and a comfortable seat. The woman looked around, taking in the serene décor, the lush and growing plants, the sunlight streaming through windows, and the walls embellished with colorful photos and prints, some bearing inspirational quotes. She sighed and relaxed for the first time in months. Her therapist asked her to say why she came and what she hoped to see happen by the time she completed treatment. She listened intently as the woman shared her story. Her client said that the pressure to look, act and feel certain ways had become unbearable and that she was ready to put down her burden. Thus began a therapeutic alliance between the two, one that lasted for a few years until the client gradually eased her way into a life that felt successful. By working with the clinician, she became able to sustain sobriety and a healthy relationship with food and her body.

Building Trust in the Therapeutic Relationship

The counselor had decades of experience and plenty of skills in her therapeutic toolkit. Predominant among them was client-centered therapy, which was pioneered by Carl Rogers, PhD. The strengths-based approach places the client in the driver’s seat and allows them to steer. The therapist’s role is to create a safe container into which the client can pour their beliefs to sort them out and reframe what contributes to dysfunctional choices. One of the prime directives of this form of treatment is that people are inherently good and strive toward self-actualization, or the fulfillment of their potential. Another name for this approach is Rogerian therapy, which incorporates the idea that the client is the expert on their life. As such, the client plays a more empowered role than in other, more directed forms of treatment. The therapist guides more subtly than overtly. It’s also the relationship between the two that has a potent impact. A client who trusts their therapist is more likely to divulge inner dialog and create change proactively. If a person feels seen, heard and understood, they’re more likely to thrive, even in the face of the most daunting challenges.

Food for Thought and Feelings

Dr. Rogers also touted the effectiveness of unconditional positive regard, which calls for the therapist to put aside judgements about a client’s feelings or behaviors and see the person in their entirety. While this approach doesn’t condone behaviors that are damaging to self or others, it puts these behaviors into perspective in the framework of someone’s history and the perceptions that developed as a result. Dr. Rogers discovered throughout his career that when parents demonstrate that a child is loved conditionally, the child comes to accept that conditional love as their reality and often becomes addicted to performing for approval. In the client’s case, she’d been fed such messages and couldn’t digest them, so they blossomed into the eating disorder and alcohol abuse, perhaps as a means of reinforcing what she’d come to know as truth. A word of caution: Because therapists are human beings who carry preconceived notions into their work, they should consistently be mindful of the temptation to fall into judging the path the client has taken.  Therapists should remember that if they’d experienced the life this client had, and felt as the client did, they might’ve made the same choices. It’s from a growing awareness of the impact of the behaviors that the client exhibits, rather than the character of the person, that real change can take place. By Edie Weinstein, LSW Follow Edie on Twitter at @EdieWeinstein1

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