psychotherapy. Horvath, Del Re, Fluckiger, and
Symonds (2011) analyzed data from over 200 studies
and reported that quality of therapeutic alliance was
correlated significantly (r .28) with good outcome.
Elliott, Bohart, Watson, and Greenberg (2011)
reported that empathy scores were significantly cor-
related (r .31) with therapy outcome across
59 studies, and Farber and Doolin (2011) reported
a correlation of .27 between measures of positive
regard and outcome across 18 studies. Finally,
Kolden, Klein, Wang, & Austin (2011) reported a
correlation of .24 between measures of congru-
ence/genuineness and outcome across 16 studies.
In summary, research evidence suggests that
client-centered therapy is moderately efficacious,
but no more effective than any other psychological
treatment. As for what components or features of
Person-Centered/Experiential therapy seem most
important for positive outcome, Norcross and
Wampold (2011) suggest that these recent meta-
analyses indicate the positive effect of a high-
quality therapeutic alliance, empathy expressed
and experienced in the relationship, and the expres-
sion and experience of positive regard.
The Negative. There is, however, another side of
the coin. Client-centered therapists repeatedly
argue that their efforts do not change clients.
Instead, they say, the client’s inner potential for
growth is released. Whether this view is based on
conviction or modesty, it seems to be incomplete.
Therapy is a stimulus (the particular character of
which is greatly affected by the therapist) that sets
many reactions into motion. Whether those reac-
tions are deemed positive, negative, or neutral, they
seem in large measure to be attributable to the
stimuli and the methods of the therapist.
Client-centered therapists claim that to under-
stand clients, one must experience the same
phenomenological world. But how does one do
that? With intuition? How does one ever
completely shed the idiosyncratic bias of a personal
framework? Critics would argue that avoiding
assessment and giving the past short shrift may actu-
ally impair the therapist’s ability to understand and
enter into the client’s perceptual framework.
Client-centered therapy seems to involve only
one technique, or rather one attitude set: empathy,
acceptance, and unconditional positive regard.
Thus, every client is treated in exactly the same
way. The therapist need not assess the client to
choose the most effective therapy or the specific
technique to fit the unique characteristics of that
client. Thus, a good case could be made for the
contention that client-centered therapy is really
technique centered! However, more recently, rec-
ognition of the problems with a one-size-fits-all
approach to therapy has led some to develop spe-
cific techniques and methods for certain client
problems (Greenberg et al., 2003).
There is also an abiding faith that the client
knows best. The movement’s emphasis on democ-
racy, freedom of choice, and the indisputable
supremacy of the client’s inner potential leads to con-
demnation of therapist“interference”through inter-
pretation, advice, or expressed values. In many cases,
however, the severity of the client’s problems would
seem to dictate the use of a more active and directing
set of procedures. For example, one might have rea-
son to doubt the wisdom and resources of a psycho-
pathic or schizophrenic client. Even if it were true
(though this is probably not a testable proposition)
that, given unlimited time or optimum circum-
stances, each client could make the right decisions
or reach the proper conclusions, it seems a very inef-
ficient way to operate. Client-centered therapists, at
times, seem to be seeking to change the client
(though claiming not to do so) without collecting
enough diagnostic and/or historical data to do so
efficiently. Their emphasis on verbal reports by the
client places them at the mercy of information that is
often defensive, distorted, and incomplete.
Much of the research on the effectiveness of
client-centered therapy has relied on internal crite-
ria. That is, clients are said to be improving when
they take more responsibility for the conversation
during the therapy session or talk proportionately
more than the therapist. Others would argue, how-
ever, that the real criteria for improvement must
come from outside the therapy room (through
observation, reports by peers and spouse, etc.).
Without validation from such external sources, it380 CHAPTER 13