Many years ago, after having just invested nine years of my life in the training and diplomas necessary to qualify as a psychotherapist, I came across a dialogue between the Israeli philosopher Martin Buber and the American psychologist Carl Rogers in which Buber questions whether anyone can do psychotherapy in the role of a psychotherapist. Buber was visiting the United States at the time and had been invited, along with Carl Rogers, to a discussion at a mental hospital in front of a group of mental health professionals.
In this dialogue Buber posits that human growth occurs through a meeting between two individuals who express themselves vulnerably and authentically in what he termed an “I-Thou” relationship. He did not believe that this type of authenticity was likely to exist when people meet in the roles of psychotherapist and client. Rogers agreed that authenticity was a prerequisite to growth. He maintained, however, that enlightened psychotherapists could choose to transcend their own role and encounter their clients authentically.
Buber was skeptical. He was of the opinion that even if psychotherapists were committed and able to relate to their clients in an authentic fashion, such encounters would be impossible as long as clients continued to view themselves as clients and their psychotherapists as psychotherapists. He observed how the very process of making appointments to see someone at their office, and paying fees to be “fixed,” dimmed the likelihood of an authentic relationship developing between two persons.
This dialogue clarified my own long-standing ambivalence toward clinical detachment—a sacrosanct rule in the psychoanalytic psychotherapy I was taught. To bring one’s own feelings and needs into the psychotherapy was typically viewed as a sign of pathology on the part of the therapist. Competent psychotherapists were to stay out of the therapy process and to function as a mirror onto which clients projected their transferences, which were then worked through with the psychotherapist’s help. I understood the theory behind keeping the psychotherapist’s inner process out of psychotherapy and guarding against the danger of addressing internal conflicts at the client’s expense. However, I had always been uncomfortable maintaining the requisite emotional distance, and furthermore believed in the advantages of bringing myself into the process.
I thus began to experiment by replacing clinical language with the language of NVC. Instead of interpreting what my clients were saying in line with the personality theories I had studied, I made myself present to their words and listened empathically. Instead of diagnosing them, I revealed what was going on within myself. At first, this was frightening. I worried about how colleagues would react to the authenticity with which I was entering into dialogue with clients. However, the results were so gratifying to both my clients and myself that I soon overcame any hesitation. Today, thirty-five years later, the concept of bringing oneself fully into the client-therapist relationship is no longer heretical, but when I began practicing this way, I was often invited to speak to groups of psychotherapists who would challenge me to demonstrate this new role.
Once I was asked, by a large gathering of mental health professionals at a state mental hospital, to show how NVC might serve in counseling distressed people. After my one-hour presentation, I was requested to interview a patient in order to produce an evaluation and recommendation for treatment. I talked with the twenty-nine-year-old mother of three children for about half an hour. After she left the room, the staff responsible for her care posed their questions. “Dr. Rosenberg,” her psychiatrist began, “please make a differential diagnosis. In your opinion, is this woman manifesting a schizophrenic reaction or is this a case of drug-induced psychosis?”
I said that I was uncomfortable with such questions. Even when I worked in a mental hospital during my training, I was never sure how to fit people into the diagnostic classifications. Since then I had read research indicating a lack of agreement among psychiatrists and psychologists regarding these terms. The reports concluded that diagnoses of patients in mental hospitals depended more upon the school the psychiatrist had attended than the characteristics of the patients themselves.
I would be reluctant, I continued, to apply these terms even if consistent usage did exist, because I failed to see how they benefited patients. In physical medicine, pinpointing the disease process that has created the illness often gives clear direction to its treatment, but I did not perceive this relationship in the field we call mental illness. In my experience of case conferences at hospitals, the staff would spend most of its time deliberating over a diagnosis. As the allotted hour threatened to run out, the psychiatrist in charge of the case might appeal to the others for help in setting up a treatment plan. Often this request would be ignored in favor of continued wrangling over the diagnosis.
I explained to the psychiatrist that NVC urges me to ask myself the following questions rather than think in terms of what is wrong with a patient: “What is this person feeling? What is she or he needing? How am I feeling in response to this person, and what needs of mine are behind my feelings? What action or decision would I request this person to take in the belief that it would enable them to live more happily?” Because our responses to these questions would reveal a lot about ourselves and our values, we would feel far more vulnerable than if we were to simply diagnose the other person.
On another occasion, I was called to demonstrate how NVC could be taught to people diagnosed as chronic schizophrenics. With about eighty psychologists, psychiatrists, social workers, and nurses watching, fifteen patients who had been thus diagnosed were assembled on the stage for me. As I introduced myself and explained the purpose of NVC, one of the patients expressed a reaction that seemed irrelevant to what I was saying. Aware that he’d been diagnosed as a chronic schizophrenic, I succumbed to clinical thinking by assuming that my failure to understand him was due to his confusion. “You seem to have trouble following what I’m saying,” I remarked.
At this, another patient interjected, “I understand what he’s saying,” and proceeded to explain the relevance of the first patient’s words in the context of my introduction. Recognizing that the man was not confused, but that I had simply not grasped the connection between our thoughts, I was dismayed by the ease with which I had attributed responsibility for the breakdown in communication to him. I would have liked to have owned my own feelings by saying, for example, “I’m confused. I’d like to see the connection between what I said and your response, but I don’t. Would you be willing to explain how your words relate to what I said?”
With the exception of this brief departure into clinical thinking, the session with the patients went successfully. The staff, impressed with the patients’ responses, wondered whether I considered them to be an unusually cooperative group of patients. I answered that when I avoided diagnosing people and instead stayed connected to the life going on in them and in myself, people usually responded positively.
A staff member then requested a similar session be conducted, as a learning experience, with some of the psychologists and psychiatrists as participants. At this, the patients who had been on stage exchanged seats with several volunteers in the audience. In working with the staff, I had a difficult time clarifying to one psychiatrist the difference between intellectual understanding and the empathy of NVC. Whenever someone in the group expressed feelings, he would offer his understanding of the psychological dynamics behind their feelings rather than empathize with the feelings. When this happened for the third time, one of the patients in the audience burst out, “Can’t you see you’re doing it again? You’re interpreting what she’s saying rather than empathizing with her feelings!”
By adopting the skills and consciousness of NVC, we can counsel others in encounters that are genuine, open, and mutual, rather than resort to professional relationships characterized by emotional distance, diagnosis, and hierarchy.