Congruence and Therapeutic Presence

Leslie S. Greenberg

Shari M. Geller

Congruence is probably the most complex of Rogers’ three therapist offered
conditions, yet the least explicated.

As Rogers developed his ideas, he came to
see genuineness as the most basic of the conditions (Rogers and Sanford, 1984)
Possibly because of it’s later emergence as a central element, it has not received as
much attention as the other conditions, particularly empathy.

We will discuss the
concept of congruence and suggest that to be clearly understood, congruence
needs to be seen as being a process embedded in an appropriate network of beliefs
and intentions.


We will in addition suggest that it is this tacit framework of intentions
and beliefs that informs the therapist in how to be skillful in communicating
congruently.

We will also review the concept of presence and discuss it’s relation to
congruence, suggesting that therapeutic presence be viewed as an encompassing
concept that acts as a pre-condition to congruence and possibly as a pre-condition
to therapeutic effectiveness in humanistic therapies in general.

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Of the three therapist offered conditions, congruence often has been the most
troublesome to the general disciplines of psychology and psychiatry. It has been
misinterpreted either as being a license for the therapist to openly express all of his
or her feelings or needs in an undisciplined manner, or has been viewed as a
condoning what psychodynamic therapists would view as negative counter-
transference. In the sixties and seventies being authentic, self-disclosing and
encountering, often was proclaimed as central to good therapy by a number of
humanistic therapists — without much further specification of what authentic meant
or how it was therapeutic therapists (Schutz 1970). This rightfully led to the concern
among many that unbridled openness could be destructive. These
misunderstandings of what is meant by therapeutic congruence require the
clarification of this concept and an explication of some of its underlying assumptions.
Lietaer (1993) pointed out that congruence or authenticity can, at an initial
level of analysis, be broken into two separate components. These are 1) The ability
to be aware of one’s own internal experience, and 2) transparency, the willingness
to communicate to the other person what is going on within. Rogers (1961), in
using the notion of being ‘real’ with other people, appeared to emphasize both
dimensions. By being congruent he meant not only being aware of one’s own

CONGRUENCE AND THERAPEUTIC PRESENCE

internal experience but also of sharing it with the other. Thus congruence clearly
has two components — an internal component involving awareness of one’s
own flow of experience and transparency, an outer component, that refers to
explicit communication. It is with this latter component of openness and honesty
that much of the controversy around congruence has raged.
The claim that being transparent is therapeutic requires, in our view, the
specification of the set of preconditions and beliefs, intentions and attitudes that
are needed for this aspect of congruence to be therapeutic. To simply teach young
or novice therapists that they should be congruently transparent is not always
helpful. This is because being transparent presumes a certain level of personal
development and certain intellectual and value commitments. Congruence thus
does not stand alone as a therapeutic ingredient. In our view, therapeutic
congruence, as well as involving awareness and transparency, also requires that
the therapists’ internal experience arises out of attitudes, beliefs and intentions
related to doing no harm to clients and to facilitate their development. This is
the psychotherapeutic equivalent of a Hippocratic Oath.
In Person Centered therapy congruence has always been seen as being a part
of a triad of therapeutic attitudes along with empathy and unconditional positive
regard. In dialogical Gestalt therapy, the emphasis on therapists genuineness or
authenticity is based on Buber’s (1958) I-Thou relationship in which a genuine
meeting of client and therapist involves, among other things, the therapist’s
presence and non-exploitiveness. The Rogerian attitudes of a willingness to
understand the client and the prizing of a client’s experience, and Gestalt notions
of presence and non-exploitiveness, all entail intentions that are necessary for
congruence to be therapeutic. To be facilitatively congruent, therapists thus need
to be committed to understanding and respecting their clients. They need to
operate both with a genuine desire not to have power over their clients and with
a belief in the therapeutic importance of accepting their clients’ experience as
valid. Finally they need to be fully present and in contact with their clients as
well as themselves. These intentions both precede being facilitatively congruent
and are themselves important aspects of therapeutic congruence.

Varieties of congruence

One of the major purposes of congruence in psychotherapy is to help establish
trust. As Rogers said, when we are ‘real’ with each other, this facilitates trust and
communication (Rogers 1961). But of course, being real is in and of itself very
complex and needs further clarification. In a post modern era, in which
constructivist notions highlight how much is either psychologically or socially
constructed (Neimeyer and Mahoney, 1995), notions of what is real become fuzzy.
Being one’s real self, for example, has always been a problematic idea because it
implies there is such an entity as a real self, rather than seeing that the self is a
process of construction (Greenberg and van Balen, 1998; Whelton and Greenberg,
2000). Being congruent, however, when seen as a process of awareness and
openness in the moment, escapes the problem of claiming some greater
ontological validity for certain aspects of self. Being real in facilitative relationship
thus implies that the therapist does not hide relevant feelings and thoughts and

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at particular times communicates certain present and persistent feelings or
thoughts in certain ways to help build trust and openness in the dyad. This,
however, is not done manipulatively or strategically. Rather it is done from the
therapist’s experience in the moment of a genuine desire to help. It is important
to emphasize that the doing aspect of congruence involves an expressive intention
rather than a goal oriented one.
Congruence, like empathy, (cf. Bohart and Greenberg, 1997, Greenberg and
Rosenberg, 2000) is not a unitary phenomenon. Rather it includes a variety of
intentions, beliefs and attitudes and manifests in a variety of experiences and
behaviours that differ at different times. We need to recognize that although
congruence is a holistic concept, it refers, in therapy, to a complex, multifaceted,
phenomenon that is embedded in a network of attitudes, beliefs and intentions
that results in doing different things at different times.
When I am being congruent, as well as being open to my experience, I am
also doing different things at different times depending on the person I am with,
the situation and the specific in-therapy context in which I am being congruent
(cf. Wyatt 2000). Being present or fully attuned to the moment is a necessary
guide, both to being open to my own experience and to knowing how to respond
to the unique interplay of person, situation and context. Different situations call
forth different congruent actions. These can, and need to be, specified further if
we are to clearly understand what is meant by therapeutic congruence.
For example, being congruent may involve the therapist saying what she is
feeling in her body at the time. It may involve speaking of a feeling that has been
persisting over time, and actually is not being felt at the moment, in any visceral
way. Or being congruent may involve the therapist saying something that
spontaneously captures her sense of the moment. Also, the current or general
feelings being expressed congruently may range from compassion to anger, from
threat to joy, and depending on which feeling is being felt, it will be expressed in a
very specific way with it’s own expressive intentions. Anger, for example, may be
expressed in order to set boundaries and to assist in resolving the feeling of being
wronged; compassion may be expressed in order to share it and to comfort; fear is
probably often expressed in order to inform the other of one’s reaction to him or her.
In addition to disclosing what one is feeling, being congruent may involve
saying what one is thinking, disclosing an image, sharing a past experience of
one’s own, or commenting on the interaction between persons. The intentions
here may be to convey one’s understanding or deal with a relational difficulty. A
highly integrated and/or well- trained therapist, dedicated to helping, will
produce congruent responses of a different kind and quality than will an
undifferentiated or egocentric therapist or a novice. Being therapeutically
congruent thus can be seen to involve a complex set of interpersonal skills as
well as the intra-personal skill of awareness.
We suggest that the communicative aspects of congruence involve the ability
to translate intra-personal experience into certain types of interpersonal
responses, such that these responses will be consistent with certain implicit
intentions. The deeper level intentions include, in addition to valuing and
understanding the other, the intentions to facilitate the others development, to
be accepting and non-critical of the other, to confirm the others experience, to

CONGRUENCE AND THERAPEUTIC PRESENCE

focus on their strengths and, above all, to do the other no harm. These intentions,
and more, are what determine whether congruence is therapeutic. If one had a
genuine desire to harm, being congruent would not be therapeutic.
To acknowledge the tacit intentions underlying congruence does not mean
that congruence is not a spontaneous emergent experience in which one feels
whole. Feeling whole when being congruent results from the therapist’s intentions
and actions being integrated and forming a coherent whole. In a congruent state,
intentions are not in opposition and do not conflict with each other — neither
does one intention or experience obscure or suppress another, opposing one.

Being congruent — the internal awareness component.

Being aware of one’s own flow of internal experience and connecting with the
essence of one’s feeling, is a central component of congruence (Rogers, 1954).
The internal awareness component is the easiest aspect of the concept to endorse
as universally therapeutic. In our view it is always therapeutic for the therapist to
be aware of her own feelings and reactions as this awareness orients her, and
helps her be interpersonally clear and trustworthy. This inner awareness and
contact naturally flows from the experience of therapeutic presence. Therapeutic
presence is important in the practice of experiential therapies. As we will elaborate
later, therapeutic presence involves, among other qualities, being receptively open
and sensitive to one’s own moment by moment, changing experience; being fully
immersed in the moment; feeling a sense of expansion and spaciousness; and
being with and for the client. These and other aspects of presence will be discussed
more explicitly in the next section. Throughout this paper we assert that
therapeutic presence is thus essential to congruence.
With awareness there is less likelihood of a discrepancy between verbal and
non-verbal behavior and clients come to know that what they see is what they
get — they learn that there are no hidden agendas. This helps the client feel safe
and reduces interpersonal anxiety. This reduction in interpersonal anxiety allows
clients to tolerate more intra-personal anxiety and thereby to explore more deeply.
If the therapist is not aware of her feelings in interaction with her client she is
unlikely to be an effective helper because she will not have access to vital
information being generated in her therapy relationships — it would be like
operating in the dark. We know that we are most effective in helping others when
we are clear and aware of our own flow of internal experience, especially experience
that is generated out of our moment by moment interactions with our clients.

Types of incongruence.

Looking now at incongruence in the dimension of self-awareness, it is important
to note some of the different ways in which therapists can be incongruent.
Different types of incongruence for example occur:
(1) when therapists are aware of their experiencing but deliberately not
communicating. (Sometimes this is appropriate and sometimes not).
(2) When therapists are not clearly aware of what they are fundamentally
experiencing because of being anxiously unclear.

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(3) When therapists are completely unaware of their basic experience.

The first occurs when the therapist is clearly aware of feeling or thinking
something and is deliberately not saying this. Here the therapist can be
dissembling, trying to convey something he is not feeling. Then he is being phony
or fake, trying either to be nice or supportive or appear interested when he is not.
Another form of deliberate non-transparency is when he deliberately chooses
not to say something of what he feels or thinks, because it seems like it would be
distracting, or when what he is feeling seems to be more of his own ‘stuff’, or the
timing seems wrong.
The second type of incongruence is being anxiously unclear. Here a therapist’s
anxiety blocks his ability to have a flow of experience. When this occurs he is
usually unable to put this experience into words, especially at first. He may
become aware of being threatened but is unable to process this, and his awareness
becomes fused with a bodily sensed quality of tension and tingly-ness.
Consciousness becomes prickly, breathing is altered and shoulders and arms
tense up. He is then unable to listen clearly to his clients’ words or to be in touch
with his own flow of experience. The anxious body sense interferes both with
attending to his client and with putting his experience into words and may
dominate the therapist’s awareness.
In the above examples, the therapist is clearly aware of a feeling of threat.
However there are other states in which so much is happening or everything is
occurring so quickly, that the therapist is not aware. It is only later that he can
notice that he was threatened. Trainers can see that trainees often are not able to
be aware of feeling threatened when it is occurring. In this third type of
incongruence there is no awareness at the time of feeling threatened, nor of what
is occurring internally. At such times the first step for therapists in becoming
congruent, is to be able to recognize that they are feeling threatened. Yet other
forms of this type of lack of awareness in congruence can occur. For example, a
therapist can express something, in the belief that it is truly what he means, but
he is unaware that certain currently unrecognized needs are influencing his
expression. Another form of being incongruently unaware occurs when the
therapist expresses what we have called a secondary emotion rather than a
primary emotion (Greenberg et al 1993). Thus the therapist may experience and
express anger without, at that moment, being able to recognize his underlying
hurt. Here, the therapist expresses a secondary reaction to what was said and is
not in touch with essential or core self experience.
These three forms of in-congruence — conscious nondisclosure, anxiety that
prevents clear awareness and lack of awareness — all differ from one another.
Each type of incongruence involves a different process of becoming congruent,
even though it involves the common elements of being aware, and the ability to
articulate one’s own internal experience. One process involves attending to that
which is known, another focusing on the not yet articulate, and another entails
getting to what is core and acknowledging the previously unacknowledged.
Therapists generally are neither fully congruent nor incongruent, but are
congruent to differing degrees. Thus congruence itself is a process. Another
problem with the concept of congruence/incongruence is that the concept has

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a realist flavor to it, suggesting that the therapist feels something explicit and is
either aware or not aware of it. The situation however, is much more complex.
The second form of incongruence above, for example, involves the therapist being
unable to articulate in the moment what he or she is experiencing. Here the
therapist is unable to construct meaning from what is going on rather than
denying to awareness something already formed — it is not that he has a feeling,
for example of feeling ‘diminished’ sitting inside fully formed, and is unaware of
it. Rather he is unable, at the moment, to create a coherent description or narrative
of himself in the situation (Greenberg and van Balen, 1998). Thus he is unable to
articulate or configure his experience into a conscious description; he cannot
symbolize his tacit experience and is not able to make sense of his experience as,
perhaps, that of feeling diminished. The anxiety or threat is often a symptom of
being stuck and unable to carry-forward one’s experience in one’s body with
words. This, of course, is what Gendlin (1964) was pointing out in his concept of
experiencing. We (Greenberg and Pascual-Leone, 1995, 1997, 2001 Greenberg
and van Balen, 1999) have moved to the use of the word ‘coherence’ to replace
congruence in an attempt to capture the constructive element of being genuine
and to deal with the difficulty mentioned above with the concept of being real.
In being congruent, I form the moments of my experience, as much as I purely
discover them. This is a creative process, and when I’m being incongruent it is
this process that is blocked. In asserting this, I am not saying there is not
something there in me to which I can attend. There really is some bodily felt
experience there, but until I put words to it to create coherent meaning I am
stuck. This process of becoming congruent by coherence is more like the ‘seeing’
of a rabbit in a cloud formation than seeing a rabbit behind a tree. In seeing a
rabbit in the clouds I configure what I see from what is there. So too do I configure
myself in each moment from the elements of my experience. One form of
incongruence therefore is not being able to find the words, symbols or referents
to an experience, so as not to be able to make sense of and experience meaning.

Being congruent — an interpersonal skill

The case of transparency, or the communication component of congruence, is
much more complicated than the self-awareness component. It seems that being
facilitatively transparent involves many interpersonal skills. This component
involves not only the ability to express what I’m truly feeling but to express it in a
way that is facilitative. Transparency thus is a global concept for a complex set of
interpersonal skills embedded within a set of therapeutic attitudes. We argue
that the skills depend on three factors. First on therapist attitudes, second on
certain processes such as facilitativeness, discipline and comprehensiveness, and
third on the interpersonal stance of the therapist.
First, and probably most important, congruent responses as we have seen,
need always to be embedded within the therapist conditions and need to be
communicated non-judgmentally. In life, clearly one can be congruently
destructive. Thus one can congruently attack or even murder. We all know this is
not what we mean by the term congruence in therapy, because the term
congruence is really qualified, tacitly, by a number of other beliefs and views. We

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thus find it helpful to use the word ‘facilitative’ to qualify the word congruent.
When Person-Centered therapists say they are expressing themselves
genuinely, they mean they are being transparent in a disciplined manner. In order
to do this, therapists need first to be aware of their deepest level of experience —
and this may take time and reflection. Next, they need to be clear in their intention
for sharing their experience — that this is for the client or the relationship and
not for themselves. It is also always important for therapists to be sensitive to the
timing of disclosure — sensing whether clients are open to, or too vulnerable to
receive what one has to offer. Discipline thus involves not blurting out whatever
the therapist is feeling and making sure that what is expressed is a core or primary
feeling rather than a secondary. Another qualifying concept that helps to clarify
the transparency aspect of congruence is comprehensiveness — that congruence
needs to mean ‘saying all of it’. The therapist not only expresses the central or
focal aspect that is being felt, but also the meta-experience — what is felt about
what is being felt and communicated. Thus saying that one feels irritated or bored
is not saying all of it. Therapists need also to communicate their concern about
this potentially hurting their clients and express that they are communicating
this out of a wish to clarify and improve a connection, not destroy it. This is what
we mean by ‘saying all of it’.

Figure 1: Structural Analysis of Structural Behavior — (Adopted from Benjamin, 1999)

Emancipate

Separate

Affirm

Ward off

Active love

Recoil

Protect

Sulk

Control

Submit

SASB simplified cluster model of focus on other

Interpersonal stance — the third factor

The set of skills involved in facilitative congruent communication can be
explicated further, by looking at congruent interaction in terms of the
interactional stance as described by a circumplex grid of interpersonal interaction.
This grid is based on the two major dimensions of dominance/control and
closeness/affiliation. Lorna Benjamin (1996) has devised a coding system called
the Structural Analysis of Social Behavior (SASB) that can be used to describe
interpersonal interaction along these dimensions (see fig 1). Consistent with
interpersonal theory, this grid outlines a set of complementary responses that fit

SASB simplified cluster model of focus on self

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each other and that interactionally ‘pull’ for each other. Thus attack pulls for
defend or recoil, and affirm pulls for disclose or reveal. The skill of congruent
responding involves not reacting in a complementary fashion to a negative
interpersonal ‘pull’ of the client — like recoiling when attacked — but rather to
act in such a way as to ‘pull’ for a more therapeutically productive response from
one’s client, such as ‘clearly express’. This would be achieved, for example, by an
empathic understanding response to an attack.
The eight clusters of complementary positions are attack-recoil, blame-sulk,
control-submit, protect-trust, active love-reactive love, affirm-disclose,
emancipate-separate and ignore-wall off. Each cluster in turn is broken into more
specific behaviors. The cluster Affirm, for example, includes friendly listen, show
empathic understanding and confirm, and responses such as these pull
respectively for the complementary responses of openly disclose and reveal,
clearly express and enthusiastic show. The blame cluster includes punish, accuse/
blame, put down/act superior which respectively pull for, complementary
responses of whine/defend, justify/ appease, sulk/act put upon.
In addition to specifying complementary interactions, this system can be used
to understand the type of response that is the antithesis to a certain behavior,
and will act as an antidote to entering into an undesirable repetitive circular
interaction. The antithesis is the complement of what one would like the other to
do. Therapists who do not react to the negative pull of the client’s response —
but instead respond in a new way — will pull for a more constructive response
from their clients. Thus to overcome a blame-sulk cycle, a response from a
therapist to a client’s blame, of affirm rather than sulk, would pull for disclose
rather than continued blame. The affirming response has a high probability of
leading to a change in the interaction, as it will more likely pull for disclosure or
exploration from the client.
Facilitative congruent responses are most likely to fall in the high-affiliation,
low-dominance portion of the grid, or what Benjamin terms the friendly
differentiation quadrant. These responses include those in the affirming and
emancipate clusters mentioned above. Some of the specific behaviors included
in the emancipate cluster are entitled ‘encourage separate identity’, ‘you can do
it fine’’ and ‘carefully consider’. Responses by a therapist in the high dominance,
low affiliation portion of the grid — what is called the hostile differentiation
quadrant — are generally not facilitative. These include the clusters of attack
and ignore, with behaviors such as attack, angrily dismiss, abandon and neglect.
These behaviors pull for desperate protest, withdraw, detach and wall off,
respectively. The other two quadrants in this grid are friendly and hostile
enmeshed. They include clusters of responses such as protect, in the friendly
enmeshed quadrant, and blame, in the hostile enmeshed quadrant, with a cluster
of controlling responses at a mid-point between friendly and hostile.
The issue of whether hostile responses in therapy are ever therapeutically
congruent, remains to be explored. These types of hostile, dis-affiliative
interactions certainly generally would not promote trust, but at times however
for example if a client is testing a therapists limits to the extreme, a congruent
response of anger at violation in particular circumstances might be a trust
building response.

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Dealing with difficult feelings

The skills of congruent responding in dealing with difficult feelings, then, involve
the following: First, identifying one’s own internal feeling response — this is the
general skill of awareness. Next is the skill of responding. As we have explicated
elsewhere (Rice and Greenberg 1984), in order to best describe both client and
therapist responses it is useful to look at the context in which they occur. With
respect to congruence, the context is where on the interactional grid the person’s
action, to which one is responding, falls. For example, in the context of being
attacked the first step involves the therapist becoming aware of what he feels
when being attacked — which often is feeling threatened. This feeling then needs
to be symbolized in awareness. The next step in being facilitatively congruent is
being able to communicate feeling threatened in a non-blaming, non-escalatory
manner. Here according to the SASB model, therapist’s responses perceived by
clients as openly disclosing and revealing are likely to facilitate friendly listening,
while empathic understanding will facilitate clear expression from the client. It
is the interpersonal stance, particularly that of disclosing, that is crucial in making
transparency facilitative. For example, in the context of feeling angry, a therapist’s
facilitative congruent process involves first checking if her anger is her most core
feeling, if it is, then she needs to disclose this in a non-blaming, non-escalatory
fashion. If the therapist is feeling more hurt or diminished or threatened, rather
than angry, then congruence involves being aware of this and disclosing this in
an effective manner.
There are recognizable classes of difficult experiences that are often discussed
when addressing congruence in training or teaching counsellors, for example,
trainees often ask: What do you do if you feel angry? What do you say if you feel
bored? What do you say if you feel sexual? What do you say if the client doesn’t
leave, or if you feel rejecting? Situations such as these represent interpersonal
interactions, which can be well understood and described on the interpersonal
dimensions of affiliation and control or dominance. As we have seen, the
facilitativeness or destructiveness of expression is dependent on the quadrant in
which the expression falls. Anger expressed as attack from the hostile dominant
quadrant, or feeling sexual expressed as love in the close quadrant without
sensitivity to power and boundary violation issues, will not be facilitative.
Similarly, expressions of boredom or expressions of rejection (e.g. of somebody’s
dependence) that occupy an interactional position of being distant or ignoring,
will not be facilitative. These responses respectively will pull for recoil, erotic love
or walling off. The issue becomes one of how does a therapist helpfully interact
when feeling one of these feelings or when this type of issue arises in a relationship
in which the therapist is trying to be facilitative?
As we have already said, if the therapist responds from an affirming stance
this is likely to be facilitative. This is the baseline response in Person Centered
and other supportive therapies. But what to do when the therapist is not feeling
affirming but is feeling angry, critical and rejecting and can’t get past this feeling,
to something more core? Each interactional response, in order to be faciltatively
congruent, involves first connecting with the fundamental attitudes or intentions
of trying to be helpful, understanding, valuing, respecting and non-intrusive or

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non-dominant. This will lead to these feeling being expressed as disclosures. If
the interpersonal stance of disclosing is adopted, rather than the complementary
stances of attack, expressing erotic desire, or rejection, then this congruent
response is more likely to be facilitative. It is not the content of the disclosure
that is the central issue in being facilitative, rather it is the interpersonal stance of
disclosure in a facilitative way that is important. What is congruent is the feeling
of wanting to disclose in the service of facilitating, and the action of disclosing.
The different ways of being facilitatively congruent in dealing with different
classes of difficult feeling are, then, to some degree specifiable — they all involve
adopting a position of disclosing. Thus expressing a feeling that could be perceived
of as negative in a stance that is disclosing, rather than expressing it in the stance
that usually accompanies that feeling, will help make it facilitative. Disclosure
implicitly or explicitly, involves willingness to, or an interest in, exploring with
the other what one is disclosing. For example, when attacked or feeling angry, a
therapist does not attack the other but rather discloses that he is feeling angry. He
does not use blaming, ‘you’ language. Rather he takes responsibility for his feelings
and uses ‘I’ language that helps disclose what he is feeling. Above all he does not
go into a one up, escalatory, position in this communication but rather openly
discloses feelings of fear, anger or hurt. When the problem is one of the therapist
experiencing non-affiliative, rejecting feelings or loss of interest in the client’s
experience, the interactional skill involves being able to disclose this in the context
of communicating congruently that the therapist does not wish to feel this. Or,
the therapist discloses these feelings as a problem getting in the way and that
she is trying to repair the distance so that she will be able to feel more
understanding and closer. The key is communicating what could be perceived
as negative feelings in a congruently facilitative way, generally occupying an
interactional position of disclosure in the non-dominant affiliative quadrant.
For example a very fragile and explosive client once told me in an intense
encounter that she feared me and hated me because I was so phony and that I
acted so presumptuously in assuming that I understood what she felt. She said
she saw me as a leach trying to suck her emotional life out of her and that, although
I professed good intentions, I was really out to destroy her. Under the mounting,
relentless attack I told her I felt afraid of her anger, and tears came to my eyes as
I told her how I hurt. This was disclosed without blame or recrimination or without
an explicit power or control related intention to get her to stop. Just a disclosure
of what it felt like inside for me in that moment. This disclosure did have her stop
and drew from her some of her concern for me.

Can genuineness be specified?

Some readers may feel that specifying what it is to be genuine is a contradiction
in terms, because if congruence involves internal awareness and revealing it,
then trying to specify what the therapist should do, defeats the purpose of
revealing what is real. If genuineness means only spontaneity, it cannot be viewed
as a skill. Being genuine involves first and foremost feeling whatever one is
experiencing. Therefore anything employed as a skill has to be felt or used
genuinely. Genuineness, as the experience of a unique agent, cannot be specified

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beforehand. It is what it is. But what one does with it, provided it is done genuinely,
can be seen as a skill.
The discussion of whether the Rogerian attitudes can be translated into
behavioral principles and skills has a long and extensive history (Barrett -Lennard,
1999). Fundamentally, the conditions, including congruence, are attitudes not
behaviors, but if the appropriate attitudes are there, they will translate into
behaviors that have noticeable characteristics. We are suggesting that laying out
some of the principles that govern facilitative congruent communication will
help make congruence more specifiable. The SASB grid, or some such system of
describing interpersonal behavior, will help greatly to do so. The principles being
specified here for therapeutic congruent communication are that the therapist
responses be embedded in helping attitudes and be affirming or disclosing
responses, and that it is the interpersonal stance, not the content of the
transparent response, that is important in making it therapeutic.
It is significant to recognize that this is not a proposal that a therapist’s genuine
responses be determined by some pre-existing system, or that therapeutic
responses be deliberate or strategic position taking. Rather, congruent responses
have to be a genuine reflection of what the therapist feels and thinks. People are
extremely perceptive and sensitive to the genuineness of any response and so it
is only when the response genuinely fits the correct stance and has facilitative
intentions, that we will have a congruent response that is facilitative.
As in learning any complex performance, like playing a piano concerto, or
playing soccer, having both the requisite skill and developing a higher level of
integration is necessary. It is the tacit synthesis of skills and other elements that
produces masterful performances. The dilemma in training therapists is that
some people naturally seem to have the ability to be facilitatively congruent
without specifying what this involves, but some don’t. I have trained many students
who do not perform well initially in how they are genuine or congruent. It often
can be quite confusing for them. To people outside of a humanistic tradition the
prescription to be genuine often seems incomprehensible. This is because the
concept has not been fully explicated. Some grasp it intuitively but others don’t. If
we are to train people to be better therapists and not just select those with natural
abilities we need to train them in both the attitudes and skills of congruence.
While the practice of specific skills can be helpful to the development of
therapeutic abilities, letting go of these skills and any planned intent on how to
be congruent, when entering the therapy session, is extremely important and
the basis of therapeutic presence. This letting go of preconceptions and skills is a
part of a preparation that occurs with therapeutic presence, as can be seen in the
model of therapeutic presence in the next section. The learning of skills becomes
integrated on a tacit level and the appropriate response arises out of the in the
moment interaction of person, situation and experiencing. Being empty, open,
and receptive to this in the moment, and experiencing and responding from the
therapists’ authentic center involves trust, in the process, in the therapist’s own
emerging experience, and in the client’s experience, and is the foundation of
therapeutic presence as we will see below.

CONGRUENCE AND THERAPEUTIC PRESENCE

THERAPEUTIC PRESENCE

Presence involves being fully in the moment and directly encountering all aspects
of experience with one’s whole being on a multitude of levels — including
physical, emotional, mental and visceral — from a grounded and centered
position within oneself. Presence is a quality that can be experienced in many
life situations such as art, watching a sunset, teaching, or in quiet meditation
with one’s self. This discussion and the subsequent research is focused on the
therapist’s presence in the psychotherapeutic encounter, which we term
therapeutic presence. The experience of presence in art or other life situations
and therapeutic presence share similar qualities. Therapeutic presence however,
is distinguished by focusing on the therapist’s presence in an encounter, intended
as healing, in which the therapist intention is to be with and for the other. Even
though the focus here is on therapeutic presence, we will use the terms presence
and therapeutic presence interchangeably as has been done in the literature.
The concept of congruence, then, needs to be qualified in order for its
therapeutic nature to be understood. We propose that in addition to the
importance of the above-mentioned intentions, beliefs and skills, the therapist
needs to be fully present in the therapeutic encounter in order for congruence to
be therapeutic. Therapists cannot bring extraneous personal baggage, needs, or
even agendas for therapy into the encounter. Being able to be fully present to the
other is a highly developed skill that requires a letting go of preconceptions and
full attention in the moment. In order to be fully present, the therapist needs to
have developed a level of psychological maturity or level of functioning that is
rather high, or at least be able to attain this while in session.
A number of humanistic theorists suggest that therapist presence is a
necessary condition for creating a positive and supportive therapeutic
environment. It also has been seen as a key means to help clients to become
more present with their own experience and hence move in a direction of inner
growth and understanding (Buber, 1958; Bugental, 1983, 1987; Hycner, 1993;
Hycner and Jacobs, 1995; Schneider and May, 1995).
Rogers (1980) in his later writings claimed presence as important:

When I am at my best, as a group facilitator or as a therapist, I discover another
characteristic. I find that when I am closest to my inner, intuitive self, when I am
somehow in touch with the unknown in me, when perhaps I am in a slightly
altered state of consciousness, then whatever I do seems to be full of healing.
Then, simply my presence is releasing and helpful to the other. There is nothing
I can do to force this experience, but when I can relax and be close to the
transcendental core of me, then I may behave in strange and impulsive ways in
the relationship, ways in which I cannot justify rationally, which have nothing to
do with my thought processes. But these strange behaviors turn out to be right,
in some odd way: it seems that my inner spirit has reached out and touched the
inner spirit of the other. Our relationship transcends itself and becomes a part of
something larger. Profound growth and healing and energy are present (p.129).

May (1958) uses Rogers’ general comments on the nature of what it means to be
a therapist to show what he means by presence:

CONGRUENCE

I let myself go into the immediacy of the relationship where it is my total
organism which takes over and is sensitive to the relationship, not simply my
consciousness. I am not consciously responding in a planful or analytic way,
but simply in an unreflective way to the other individual, my reaction being
based (but not consciously) on my total organismic sensitivity to this other
person. I live the relationship on this basis (p. 82)

Few theoretical writings exist on therapist presence and most of what is written
is qualified by the ineffability of this important quality.


Hycner and Jacobs (1995) describe presence as a turning of the whole self to
the other — not just attending to the other but turning away from preoccupation
with self and offering one’s whole being to the other.

This involves viewing the
other in his/her uniqueness and acceptance that this is a different and unique
person, where ‘no other concern is paramount.’


Bugental (1987) writes that presence is ‘A name for the quality of being in a
situation or relationship in which one intends, at a deep level, to participate as
fully as she is able.

Presence is expressed through mobilization of one’s sensitivity
— both inner (to the subjective) and outer (to the situation and the other person(s)
in it) — and through, bringing into action one’s capacity for response.’

And that
‘full presence means being truly accessible and appropriately expressive.’ (p.222)


Schneider and May (1995) posit that ‘presence holds and illuminates that
which is palpably (immediately, kinesthetically, affectively, and profoundly)
relevant between therapists and clients and within clients. It is the ground and
eventual goal of experiential work’ (p. 174).

The goal of presence, in their view, is
to illuminate clients’ experiential world, provide a safe container for immersion
to occur, and to deepen client’s ability to constructively use her discoveries.


Therapeutic presence can be viewed as an essential therapeutic stance to open
the way for other therapist stances, such as Rogers’ therapist-offered conditions of
congruence, empathy, and positive regard, to be used and lived as part of the therapy
process.

A greater specification of therapeutic presence then seems important. In
order to further understand and describe therapeutic presence, a number of
therapists were therefore interviewed on their experience of presence in therapy.

Figure 2: Therapeutic Presence

Preparing the ground

Process of presence

(a) Receptivity

Experiencing presence

(a) Immerson

(a) Arriving and clearing a
space immediately before
the session

(b) Expansion

(b) Inwardly acting

(b) Practicing presence in life

(c) Grounding

(c) Extending and contact

(d) Being with and for the client

CONGRUENCE AND THERAPEUTIC PRESENCE

Understanding therapeutic presence

The authors (Geller, 2000; Geller and Greenberg, 2000) conducted a qualitative
study whereby seven experienced therapists from four different theoretical
orientations, who were familiar with, and knowledgeable about, the qualities of
therapeutic presence, were interviewed on their experience of presence in therapy.


A form of qualitative analysis combining condensation and categorization of
meaning was used to extract meaning units from the interviews (Kvale, 1996)
The analysis resulted in the model shown in Fig. 2.

Three overarching
categories of therapeutic presence were formed from the respondents’ reports.
One category was labeled preparing the ground for presence, referring to the pre
session and general life preparation for therapeutic presence.

Another category
described the process of presence, the processes or activities the person is engaged
in when being therapeutically present, or what the therapist does when in
presence. The third category reflected the actual in-session experience of presence.

Expanded description of presence

Preparation
Therapists described the importance of preparing the ground for therapeutic
presence to emerge, both prior to the session and through practice in their daily
life.

The therapist arrives at the session holding the intention to be fully there
with the client and to let go of his own and daily concerns. The therapist brackets
or suspends his own beliefs, assumptions, needs and concerns in order to fully
attend to what is occurring in the moment and to respond to the other based on
the experience of the moment.

The therapist clears a space inside where he can
receive whatever experience emerges in the client, in the self, or in the relationship
between the two with a sense of openness, acceptance and non-judgement.


Therapists also discussed a sense of commitment in their daily lives to the
practice of presence. Some of the therapists interviewed referred to their
meditation practice as an essential aid in being in the moment.

Ongoing care for self needs, relationships and personal growth were also viewed as support to the
practice of presence in session with the client.

Being present in one’s own life
and in personal relationships appear to be a part of the growth and development
essential for developing presence in session.

The process
Preparation appears to be an essential part of moving into presence, however,
once in session the therapist responds to whatever presents itself in the moment.



This involves a shifting awareness of the many different elements that go into a
moment of encounter with the client, including the professional and personal
being of the therapist, the being of the client, and the relationship between them.
The interaction of all these aspects in a given moment guides the therapist in
his/her understanding and response.


There is a quality of movement in the process of presence that demands the
therapist be fully immersed in each moment as it arrives. This movement involves
shifting from taking in the fullness of the client’s experience in one moment

CONGRUENCE

(receptivity), to being in contact with how that experience resonates in the
therapist’s own body (inwardly attending), to expressing that inner resonance or
directly connecting with the client (extending and contact).

Put another way, the
therapist is touched by the essence of the other, is in contact with her own
experience of how she is touched by the other, and offers this inner experience
in a way that touches the other’s essence. The therapist’s movement of attention
and contact is guided by what is most poignant in the moment.

The experience
The experience of presence involves a sense of total absorption, inner expansion,
grounding in one’s self, and being with and for the client. Therapeutic presence
involves feeling intimately engaged in the experience of each moment with the
client, with an expanded sense of awareness of the subtleties and depth of the
experience of each moment.

The therapist experiences a melding with the client
and a loss of spatial boundaries, while maintaining a sense of center and grounding
within himself in that shared space.

A sense of love and respect is felt towards the
other as the therapist meets the client in way that is with, and for, the client’s healing.
Therapeutic presence thus involves having a heightened awareness and
sensitivity to the many dimensions of experience on a moment to moment basis.
There is an absence of awareness of time, a lack of a sense of past or future.

With
therapeutic presence, the therapist is highly absorbed and engaged in the
encounter with this other human being and with the person’s suffering.

The
therapist does not turn away from the suffering of the other by labeling,
categorizing, or objectifying. Nor is the therapist engaged in focusing on her own
burdens or sufferings or worrying about how she should act or intervene.

Rather
the therapist meets the other’s suffering and pain with care, openness, awareness,
and acceptance. The therapist engages with the other as a human being and
allows herself to get as close as possible to the client’s experience while
maintaining a sense of center and grounding within her own existence.

With
presence, the therapist experiences a deep sense of trust within self, with the
process, and with the experience of the client. The therapist trusts that whatever
emerges is important and necessary for healing to occur.


This openness to and
allowing of experience is accompanied by an energized and flowing experience
in the body and in the interaction between the therapist and client.


In summary, therapeutic presence involves therapists being open and
sensitive to their own and their clients’ moment by moment, changing, awareness
and experience. This is a process of being receptive, being fully there with oneself,
and extending and making genuine contact with the client.


The experience is
one in which the therapist feels fully immersed in the moment while feeling a
sense of expansion and spaciousness, and feeling grounded and centered. It
involves a being with the client rather than a doing to the client. It is a state of
being open to all aspects of being with the client and receiving the client’s
experience in a gentle, non-judgmental and compassionate way, rather than
observing and looking at or even into the client.

This inner receptive state of the
therapist is the ultimate tool in understanding the client. Therapeutic presence
involves meeting the other in the moment where the person is, rather than trying
to change her or him in some way.

CONGRUENCE AND THERAPEUTIC PRESENCE

Presence involves an absence of judgement and instead allows for a deeper
understanding and acceptance of the client’s world. This promotes moments of
genuine meeting and this in turn invites clients to safely express and explore
their conflicts and issues.


Therapeutic presence is therefore an essential stance
in humanistic therapies, where the therapist provides a safe and supportive
container for the client’s natural growth tendency to emerge.

THERAPEUTIC PRESENCE AND CONGRUENCE

Despite presence having been posited by some as the groundwork for therapy,
the relationship between presence and congruence has not been discussed very
extensively and little empirical literature on therapeutic presence has been
generated to date. Some authors have written about presence in a way that
equates presence with congruence (Kempler, 1970; Webster, 1998).


Based on this
study it is our view that the concept of congruence does not incorporate all the
subtle aspects of presence, yet therapeutic presence includes therapist authenticity
in feeling and expression. Therapeutic presence thus prepares the ground for
congruence, is a precondition of congruence, and also goes beyond it.

Beyond internal awareness and expression

Congruence as we defined it involves awareness and transparency. Therapeutic
presence as determined from this investigation involves the process of receptivity,
inwardly attending and extending and contact, and the experience of, immersion,
expansion, grounding and being with and for the client.

It appears that the process
of inwardly attending and extending and contact, to some degree, parallel
awareness and transparency.


What therapeutic presence appears to add to
congruence is first the preliminary necessity of receptively being empty and open
to receive the totality of the client’s and one’s own experience. Receptivity comes
prior to Inwardly Attending to one’s experience of being with the other (awareness)
and Extending and sharing one’s genuine experience (transparency).


Therapeutic
presence in addition adds to congruence a specification that the therapists be
fully Immersed in the moment with the client, experience a sense of Expansion
while maintaining a Grounding in themselves. Further, although Being With and
For the Client is implied by congruence it is not explicitly in the definition.


The
awareness and transparency components of congruence therefore do not capture
the state of receptivity and intimacy with the moment involved in presence, nor
do they capture the experience of intense focus, and the combination of
expansiveness and grounding in the self.


In our view congruence therefore is an aspect of, and flows from, therapeutic
presence, but is not fully encompassing of the total experience of presence.
However, the more presence there is for the therapist, the more she will be
congruent in experience and responses.

Receptive and open: A prerequisite

Therapeutic presence precedes congruence in that the therapist must first be

CONGRUENCE

present to be receptive to, and make contact with, the fullness of the client’s and
her own immediate experience in order to understand what is being experienced
and how to respond.

The experience that is received, and experienced, resonates
in the therapist’s body and is experienced as a bodily sense in the form of feelings,
words, or images.

Being congruent at this point involves a moment of attending
inwardly to that which is being presently experienced. As we discussed, a key
aspect of congruence is being open to, and aware of, one’s ongoing flow of inner
experiencing. Here the therapist uses her bodily sense as a navigational tool in
responding to the client.

If the therapist was not present and hence not fully
open and involved, she would not be accessing the rich source of experience to
which to attend that allows her to make a split second choice as to whether, or
how, to respond from this experience.

Immersion, expansion, and grounding: going beyond congruence

In order to be acutely aware within his experience and to genuinely share his
experience with the client, the therapist needs to be immersed in the experience
of the moment with the client. Congruence is thus experienced and held in the
larger space of presence. With therapeutic presence the therapist experiences a
sense of expansion and openness.

There is a sense of deep trust and a sense of
spaciousness containing the intensity of what is being felt and expressed.
Therapeutic presence also adds to congruence a sense of grounding which
includes the therapist trusting his own felt and expressed experience. For example,
even though the therapist may be feeling intense shame, there is a calm and
trust with what is being experienced and expressed.

With congruence (and
therapeutic presence) there is a match between the intensity that the therapist
feels and the behavior that is shown. With therapeutic presence, the therapist
feels that intensity while feeling a sense of grounding in self. He feels trust in his
experience and in the process itself.

Being with and for the client: facilitative congruence and therapeutic
presence

A key aspect of the experience of therapeutic presence also involves the intention
of being with and for the client in a healing encounter. Holding the intent to not
harm the other, but instead being with the other in a way that is helpful is key in
therapeutic presence. This helping motivation is also central to being congruent
in a way that is facilitative, as mentioned previously in this paper.

If the therapist
is present with his own experience, and with the client, then the decision to share
his genuine experiencing is going to be guided by this intention.

The therapist
needs to be present with, and aware of, his own experience and be able to assess
whether it is his own issues that are emerging — and need to be put aside
temporarily — or if what is emerging could be of benefit to the client’s healing
process.

The therapist thus needs to be open and aware of his own internal
experience and genuinely sharing, while being in contact with the intention of
being there with, and for, the client.
This aspect of therapeutic presence also allows the therapist to be aware and

CONGRUENCE AND THERAPEUTIC PRESENCE

sensitive to his experience (and of course the client’s experience) so that he can
be congruent in expression in a way that is sensitive to timing. What is being felt
does not just leak out in a way that is impulsive or driven by the need to release
— hence the need for discipline.

This quality also takes a level of development
and maturity and even skill in being present with what is true in each moment. It
could mean being able to withstand some discomfort (for example in the case of
shame) and to show that potentially vulnerable feeling to the client in a way that
does not ask anything more than for the client to also be present.

What makes
the therapist therapeutically present is his willingness to be with that experience
of shame and to express it to the client while holding the intention of helping the
client or bettering the therapeutic relationship.

CONCLUSION

We have argued that for congruence to be therapeutic, the concept requires
further specification. We have suggested that first, congruence needs to be seen
as being embedded within a network of intentions and attitudes, among which
the intention to do no harm is primary.

Second we have suggested that the skill
of communicating congruently in a facilitative and disciplined manner appears
to be characterized by the adoption of a non-dominant, affiliative, stance.


Congruent communication of this type conveys a therapeutic intent to either
disclose the therapist’s internal experience, or to affirm the client’s experience
and further, these pull for listening or disclosure from the client.

Finally we have
suggested that therapeutic presence is a necessary pre-condition of congruence
and at the same time is a larger experience that contains congruence as an aspect.
More particularly, it allows the type of receptivity and intimacy with the moment
that will promote both a true meeting of client and therapist, and the healing
that occurs through this type of meeting.

The self of the therapist is brought to the encounter with the client with a
willingness to experience all that the encounter entails. She is receptive and
sensitive to the fullness of the client’s experience. This direct and immediate
encounter with the depth of the client’s experience and with a deep trust that
what is emerging is important and helpful in the process, is the very essence of
therapeutic presence. It is the sensitivity to the moment and grounding in oneself
that allows the therapist to know how to be with the other in the therapeutic
encounter — when to be transparent with experience or when to purely resonate
with the client’s pain.

Therapeutic presence is an essential precondition for congruence, particularly
to allow the type of receptivity and intimacy with the moment that will promote
a true meeting of client and therapist and the healing that occurs through this
type of meeting. Therapeutic presence is also a larger experience that contains
congruence and allows it to be more completely facilitative and genuine.

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