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TRANSCRIPT,'

, t-,'.-v s { (.,,','',' i, ,

3 3 -

S-C,)

carl Rogers(c.R. ) ; (screamingin thebachground)r' mcarr Rogers.This musr

seemconfusingand odd, interview had been kind

wereother thingsyou wantedto say.

and so on, but I,

I felt really sorry that the

of cut short 'cause I sort of felt maybethere

Loretta: I don't know, I'm being movedall right, transferred And

I was

just wonderingif I'm quitereadyfor a transfer.I've mentionedthat-it's

annoying, that woman talking, uh, she'sbeen yelling like that (referring tcpatientuko keepsscreamingin thebachground).r realiy rather like it on

I had

thought maybeI could go home from rhere. (C.R.:M-hm, m-hm.) I know being transferred means I'll probably be put to work in the laundry all day.(s*eaming in thebachground)And I don't feel quite up to that.

my ward. (C.R,: M-hm, m-hm,) And I havebeen helping

C.R,: M-hm,m-hm.Sothat'soneimmediatething of

to facewhatever'sinvolvedin moving awayfrom the spotwhereI've-?"

Loretta: Yougetkind of oriented to one placewhen you're here.

C.R.: M-hm,you get sort of usedto it and-

Loretta: oh, I meantto correctonething.when I said "no" before,I didn't

.Am I ready

concern.

*This

interviewwith LorettaisTapeNumberone in theAudiotapeLibrary of the

Psychotherapists.This transcripr was prepared by lv{arco

American Academy of

Temanerand emendedby NathanielJ.Raskin.

33

34

\'IE\fS FRONIWITHIN

mean I wastired of talking to that cloctor'I just meant' "no"' that I was ready to, that I wondered rvhy I couldn't go home'

C.R.: Yeah,yeah.That you felt he didn't quite under-stand 1ou on that (screamingin th'ebackground), that really'-

sd

a{

10

w

vr!

w(

Ra

i,n

I was

being blunt (loud screaming in the back'

I didn't rvant to talk to him angnore'

Loretta:

Maybe he thought

I meant "no,"

a.td that (Loud screaming)

lrnd

c.R.:

LTtr-huh. (scteamingcontinuesintennittentl\.)

now, i1 is, uh, a little

if l, if I sensesome

tensenessthat' that' uh' maybe he

of your feeling

dijn't really

g:etthat. Maybe he thought you were' sort of-

Loretta: I thought he thought I-

C.R.: Shutting him off, or something'

Loretta:

Yesl That's what I had thought'

i',ru

arJn't, but-

(C'R': Lrh-huh') And that isn't

don't know' I'm u'ondering if that

what I meant- (C'R.: tlh-huh') tlh,1

transfer is a good thing. I mean, they

here, arrdrtilt

over to Two, I knorv that's an open r'vard,that's [a]

make you feel soimportant around

(C'R': irn-hm'rnhm') Then when I go

dormitory' and I're 'cause

I don't like to

been wearing

launder

not so many of my own clothes

them. Just wonder if I'm ready for that change'

C.R. M-hm, and that- Loretta: 'Cause my father and that don't come to visit me or anything' so

I don't get out at all on weekendsor anything'

C.R.:

you

tut

And I'm not quite sure about this' Is it in the ward where

are now that you feel, yeah, they seeT

then really you're not' lScreaming in thebackground) ,to Is that-?

make you so important'

but I'm really not' (C'R': M hm') I

Loretta: That's reallyit. I'm important,

ward, either' Well I knorv that' you're

probably wouldn'i b. on the other

not very important when you move to that ward'

C.R: I see.So that if you're not very important where you are right norv' you feel then if you rvere transferred, even lessso'

Loretta: EveniessimPortant'

C.R.: So that's somethingthat concernsyou'

all da,vin the laundry' too' and I'm not

itl'as' And

I askcdthe doctor

Loretta:

I think it means

working

quite ready for that. I mention!d earlier that I had this tickling sensation

inmvkneeswhenlwasonSLxCwhenlrvasgettingReserpineanda

tranouilizer- ((,. R.:)t-hm, m-hm')I tlrink

TheCaseof Loreta:ltanscript

35

at that time if he lrould moveme, soI couldgo to'work and work in the laundry. (C.R.:M-hm, m-hm.)And the r.u.rrf.r.u.n" today.I didn,t ask to be transferred,though, this time.

C.R.: M-hm, m-hm. But it troublesyou asto

tvhetheryou,rereallyreadyto

face some of the things that rvould be involved.

Loretta:

think.

I don't knorv, there isn,t much to face,it's kind of confusing,I

c.R.: I see'It's more a question of facing trreuncertainties,is that what 1'OU mean?

Loreth:

I don't know nhar I mean (tittte

I jusr know that_

C.R.: Right now you feelkind of mixed up?

Loretta:

\vell, I knolv there's Anita on *rat rvard that I did.n't trust verv

far (banging in tlrc backgrortnd)becausc she,s the one that ort shocktreatment.

-"

on

C.R.: I see.

Loretta: Or I think shedid, anyway.(C.R.: M-hm, m-hm.)And her arm around my shoulderwhen I cameback,but it

srillsheput ^the

sh. was

one that told me I had to go on it and I had done nothing that I knerv of to be put on that kind of treatment.

t

n

c.R.: So that there'ssomerhing that's rearconfusing.It would be

putting

you next to a person who seemed to like you and put her arm "ror.rJ you and, by gosh, was responsible for shock trearmenr.

Loretta:

right'

of courseshesaidit

hadn't .That's talkedto a doctor that I knew of arthe

And. I tnow

ward they had them go over to the treatment ward and then back to

even though that wa, a work

rvasdoctor's orders,but I time. (C,R: M-hm, m_hm.)

that they gave them to

the rvork

then to work.

ward. (C.R: N{-hm, m-hm.) (Screaming in thebachground,) And

C.R.: M-hm, sure you heard, the explanation

that,but youcan'thelp but feel,

sheseemedto-

and all

,,Is shereallytrustworthy?,, ,Cause here

was doctor's orders

Loretta: No, I don't trust people anyway,an)rrnore.(C.R.:

M-hm, m-hm.)

That's why I don't rvantthem to rrust me. I either berievein them or i don't believein them.

C.R.: M-hm, and all or none.

Loretta: And I don't quite think I believein her rery much.

36

\'IE\qS FROM \VITHIN

m-hm. Ancl reallyrvith most peopleyou feel, "I don't think I

C.R.: M-hm,

rusL

'em."

Loretta:That'sthetruth,Idon'ttrtlst'errt'(Screaminginthebackground)

'em,

'em

or I don't' I'm

not quite certain

Eitherbelieve

rvhether I believe them yet or not' (C'R': M-hm, m-hm') But I don't

believein, trust anYmore.

or I clon'tbelieve

C.R.: M-hm, m-hm. That's one thing that you feelhasreallydropped ottt for you, thatjust to trust people' Not for you'

You can get hurt much too easilyby

Loretta: No, I don't trust trusting PeoPle.

C.R.: NI-hm,tn-hm.If you rcally believein someonc,and let your trust go out to then-r,then-

Loretta: I don't haveanytrust,that'slvhyI can'tict anytrust go out to 'em'

C.R.: M-hm, but eviclentlyyour feelingis that when that hashappenedin the past-

Loretta: Youjust get hurt bYit.

C.R.: That's thc rvayyou can gct htu t'

Loretta: That's the wayI haaebeen hurt'

C.R.: That's the way youlzauebeen hurt'

mind being moved. I mean if it's, uh (pounning

anothei thing

the.

Loretta:

I don't

!7

toward going horne' (C'R': Mhm')

bachground), uh,

(Scriamingin

don't know that he,

ansrverfrom him. (Screamingin thebackgrouncl) (C'P.':M-hm' m-hm') He

never calne.

atleastwhat I understandvouto be saying,is that

it isn't the practical questionof the moveso much that' uh' but it's the

questionof-

my brother, I rvrote a letter' but I didn't get any

thebackground') But I clon't get out arLy\iay' arrd-I don't' I

C.R.: M-hm. It isn't that,

Loretta:

C.R.: Yeah,areyou, are you readyfor a next step,is that it?

If I'm quite ready for that'

I don't think I'm going to like rvorking in the laundry' that I know'

'Cause I didn't like it either

PA systemin the bachgrowzdl A.nd' I don't think I care too much [for]

*o.kirrg on [thel f.,oi

Loretta:

the other nvo times' (Announcenwnton

[ofl

centeroverthere,either,because I workedthere

'.1 ireCasct.,1Lorctta: lranscript

),

beforc, and I didn't carefor it. (C.R.:M-hn.r,m-hm.) \'!'ell,I didn't have

anything

about a half an hour, and I blackedout, and I tried it 3 more days,and

Ijust quit trying to work there.There was

too much electricityor something.

I

the first dayI rvorkedall right, the seconddayI s'orked

I blackedout eachday,so

C.R.: M-hm,

m-hm. You feel something was lvrong over there? Too much

electricit)'or something, "that reallyhad abad effecton me'whenI lvas working there."

Loreth:

It did. I blackedout, completely.If I l.radn'tgone to sit dorvn, I

would have fainted.

C.R.: M-hm, m-hm. You feel really you wcre in, in kind of a desperatervay, at thosepoints?

Loretta: No, I didn't feeldesperate.Ijust, I didn't undcrstand it, I didn't knou, 'lvhy I blacked out.

C.R.: I sec.

Loretta: It did frighten me, though. I just couldn't work, so-

C.R.: It was just somethingvery odd happening to you.

Loretta: 'Cause I don't have epilepsyseizuresor anything like that, so I couldn't imagine rvhat it was. I don't, I'm not, I don't usually have fainting spells.

C.R.: N{-hm.Itjust madeyoufeelrealpuzzled. "What isirappeningto me?"

Loretta: \\rhat it was,yeah,I cried,but I couldn't work, and they rvanted

me to rvork, so you refuse to work.

sometimes I think yor-lget put back on treatment if

C.R.: lJh-huh. \\'e11,ma1'be,maybe shock treatmcnt is really something they may usefor punishment if you don't do the things the lvaythey rvant you to do?

Loretta:

don't rhink I rvaseven,I don't knorvwl-rythey evengaveit to ne in the

l\Iell, it rvould appear that way from rvhat everybody says,but I

first p1ace.I rvasjustbeginning to come to, enough to realizcthat I rvas

in an institution, knerv, the,vsaid,

m-hm.)And I

or an.ythingwith an,r'bod,v."(C.R.:M-hm, mJrrn.)And they said, "Well,

doctor's orders."And I said,

I think.

"You're

(C.R.: M-hm, rn-hm ) And the next thing I reaclv,you're on treatrnent." (C.R.: M-hm,

said, "Why? I didn't do anything.I haven'thad anyfight "\Vell,

I

haven't eventalked to a doctor."

3 8

VIE\(/SFROM \?ITHIN

BecauseI hadn'ttalkcd to one. (C.R.:M-hm, m-hm.) At leastI didn't know it if I had. (C.R.:M-hm, m-hm, m-hm.) And so-

C.R.: So to you it seemed, "Hcre I rvasjust beginning to comc to life a little, really to knorv a little bit lvhat rvasgoing on."

Loretta: I wasjust begimring to realize I was in the hospital- (C.R.:

Uh-huh. ) When they put me on it, and they put me to rvork the same duy'

C.R.: And then you fccl that for no reasonyou could discern,zingo, ,vou

were-

Lorelta:

And I began talking very badly and everything, and I still havcn't

forgotten some of the thingsI said.

C.R.: M-hm, m-hm, nrhrn. It feelsthat, that sort of brought out the t'orst in you, is that whal you mean?

Loretta: If I had a rvorstpart. It waslike it wasn't evenme talking.

C.R.: I-rh-huh.Almost seemed as though this-

Loretta: And then I went home weekends,and I got in trouble there, becauseI talked so much. Of course,I rvasgetting Sodium Amytal, too, so it might havebeen the combination of the two, not just the one thing.

C.R.: But there,too, I guessI get the feelingthat you'rewishingyou could understand that part of yourself; was it something that $'as not you talking, or lvas it just the effect of the drugs, or u'hat was it that made you-?

Loretta: It rvasthe combination,I think. (C.R.:Uh-huh.)If you notice,my Imovemyfeet.

C.R.: Yes,I did notice.

Loretta: As I said,my knees tickle. (C.R.:Ivl-hm,m-hm.) And I, I don't know if it'sthe drugsI'm gettingor l'hat, but it'ssometltingI can'thelP. It isn't *rat I'm so terribly nervousthat I can't sit still, that isn't it. I do that at group meetingsor anything,and I can't control them. It'srather embarrassing (ktughsnnuow\ ).

C.R.: And you rvouldlike me to understand that it isn'tjust tensenessor somethilg, it's,uh-

Loretta: No.

C.R.: It's sinrplythe-

I

ite

t'.tre

(rl L-('lcLL'l: I r'rrls!' rl''

Lorerta: SomerhingI can't control.

C.R.: Uncontrollablc tickling sensations. (Screarningin thebachground)

LoretLa: In my kneesanrl that far up, and my feetjust move'If I'm sitting uDthereinthecorneralone,thatisn,tsonruch,butmykneesstilltickle.

(i.n,

know, theyjust move.

Ht-t.r-, m-hrn.)But rr'henI get in a grouP, and

that, my, I don't

C.R.: It scemsasthough being in a group makesthis $'orse'

I-oretta: \Vell, I have it rvhen I'm

alone sometimes, too' (C'R: M-hm'

m-hm.) I think it's the medication I'm getting'

C.R.: \Vell,probablyiCs just the drugs?

mcdication I'm getting' I don't evenknow

what it is, 'cause I haven'taskecl,but then- (C'R':M-hm') (Parue)I think these meetings are \'ry enlightening (little laugh)'

Loretta:

I think it's the green

C.R.: Do you? Loretta: Wel1,if you can't think quite clear at the timc, you can think about

it later.

C.R.: N't-hm,m-hm. And in that sensethey, they're somelhat helpful in (hangzngin thebackgrourzzl)making you think morc clearly afterwards?

Loretra: I think I've been helped a lot ity, more by talking than I haveby the pills, and that.

C.R.: N{-hm,m-hm. It really,it seemsasthough getting thingsout to some degreein talk-

Loretta: Seemsto alleviatelvhatcverthe situationis (C'R : M-hm, m-hm')

I wish that $'oman

If it's createda situatior-rthat seemsto would quit screaming.

C.R.: "\\rhy doesn'tshestop?"

Loretta: Shecan't stoPtholrgh, that's the lvorst of it ' ' ' That givesyou a terrible feeling,luhut't goittg to happen to you if you end up in a' like that.

C.R.: Yeah,yeah,part of the, pirrt of the disturbanceof that noise is the

"\{y

feeling,

god, could this }'rappento me?"

Loretta: \'es. (C.R.:tr{-hm,m-hm.) Exactly.And you tl-rinkyou could just

out of your headjust from hearing that ail the time' That's

about go

b ,

she,if it's t'ho I think it is, she$'asup on the rvardfor one of those QIM

g"oingon for 3 da1'snow, and rvhy did they give her that much'

40

\TEWS FROMVITIIIN

clinics,and I satnext to her,and shesaidsomcthingabor-rtliking to talk, and all of a suddenshervas,shejust began talking and didn't quit.

C.R.: So this seemskind of arvful,that here is this person and-

Loretta: Shervasall or arlything-

C.R.: Next to you and so on, and no'w'hereiCsjust going on and on-

Loretta: You should tirink, I tliought they could relievethose, not make them worse.

C,R.: It's kind of discouragingin a scnscto fcel that thc,v,it seemsto you, that they aren't helping her.

Loretta: Yes,considering it's an admissionrvard,and they shouldn't be that far out of their heads.It's more like the drugs thev're giving after they'rehere are doing it to them.

C.R.: Almost makes you feel, "Ar'e they making her worse with their drugs?"Is that-?

Loretta: That's right.

C.R.: And that'skind of a disturbins-

Loretta: I think it is.

C.R.: Thought, too-

Loretta: Becauseafter all, I'm getting drugs, too, and I wouldn't want to end up like that.

C.R.: M-hm, m-hm. It can't help but raisethe questionin you, "\{buld the drugs they're giving me make me like that?"

Loretta: That's right. And then once you're that wa1',what can you do

perfectly all right then, calm; shervasn'ttalking

about it? Only, only I know u'hat they're like and I can seeit, so I have enough control to hang on to myself, enough to keep from just batting

, . Some of them had that feeling, I've seensomuch of it and heard

so much of it that I canhang on to myselfa little bit.

my head againstthe wall, like, ard theyjust can't control it. They

c

d '

.

$

tr

il

C.R.: Those things are kind of--

Loretta: I think that'swhy,pardon me, I think that'swhv m1'kneestingle, though, becauserather than batting my head againstthe wa1l,I have tiat t)?e of reaction.

C.R.: M-hm,m-hm.Soin asense, -vou canhold yourselfir-renough sovou'rc

Thc Ceseof Lorctta: 'Iianscript

4 1

not going to bat your head againstthe rvall,and yetit's asthough it has to come out someu'here.and it. uh-

l,oreta: Comes out in the tickling. It's terrible!.

C.R.: Comesout in the ticklingof your knees.

Loretta:

well, I've seenon dre outside,too, soI mean I know that

iCsjust futile to bat 1'or-rr head. Why anylvay,I tirink my head's too valuable to bat against thc wall (Iaughs).It'smy orvn head, and I like it.

C.R.: \bu feelby gosh, "I'm not going to smasirmy head againstrvalls."

Loretta: That's right. After all, God gaveme that head, that'sthe iiead I

rvant. I'm not going to bang it against the rvall, even if I like to, which I

\{ell, rv}ry,how does that help

locked up like that and screaminglike that?What, beneficial aid is shegetting out of tl-rat?Anything?

really rvouldn't like to do, anyrvay

that girl to be in I mean

C.R.: I guess that's the question you'rc asking yourself, "What earthly sooct-:

Loretta: No, I'm asking 1ozr.

C.R.: You're asking me. \Vell, I'm not on the liospital staff, and I really guessI rvouldn't try to answerbecauseI don't knorv heq and I don't know anything about it. But rvhatI can understandis, is the way that affectsyou and the feclingsthat it stirs up in you. 'Cause it soundsas though with you that, that is disturbing not only from the noise frorn hcr but the things that it (screamingin thebachground)stirs up in you.

I-oretta: I don't know. I'm all mlxed up. I rvant to (loudscreamingin the bachground)go to Ruilding One, but I knon'Building One'snot the next

to

But if.I could go home from One, I'd be happy

But

I'r,ebeen there before.I know it's going to be a great changefrom

this

building. I hateto leavethis building, 'cause it'squite

But

still, it, maybe it's better than listening to that girl screamingall day, every day.

C.R.: It's a real touglr choice to make.

Loretta: But I hate to think tl-ratI'm going to haveto go to rvork in the

laundryroom. I'd

rvardasthcrc is here,that much I knor.v.

and thereisn'tasmuch to do arounclthat

C.R.: Ir{-hm,m-hm. You feel that, uh-

Loretta: lbu canrelaxand.justsleep,becauseyoudo havebeds,but I don't think they do. I think rhey expectyou to work if you can.(C.R:N{-hm,

I

1

I

{

1

il

I

42

VIEWSFROM V'ITHIN

m-hm.) They don't go that far as to just let you rest like you're in a hospital for a rest. (Screamingin the bachground)Keep you rvorking all the time.

C.R.: If it, if it representeda chanceto rest,then you rnight like it, but if it'sa chancejustto rvorkall the time,uh, then you'renot surethat that's rvhat you want.

Loretta: I don't think l'm ready for it. (C.R:Uh-huh.) Bccausemy knees

tickle, maybethat's

got along all right. I knorvI cangecalong norv,but-

I rvorkedin the laundry before,and I know. I

C.R.: "I cor.rlddo it, but, uh, am I really readyfor it?"

Loretta: Though why?

C.R.: "Why?" M-hnr.

Loretta: I packedmy o1r'ngrip, so I'm all ready to go. I didn't say, "No, I won't go," becauseI'm alwaysputting up a big fight about it. (C.R.:

M-hm, m-hm.) If it's an improvement,well, I'm willing to go along with

ir.

C.R.: NI-hm.A chanceyou'rervilling to takealthoughwithin yourself,you feel a lot of qi;estionabout it.

I can't saythat I like

Loretta:

to see 'em Bet worse.But when they improve it's quitc ajoy to, to be

I rather like seeingthem admitted, although

where they're all coming in and going out.

C.R.: It kind of helpsyou inside,when they,when they'-

Loretta: To know that otlers get well and can go home.

C.R.: M-hm, m-hm. So that you're sort of discouragedand encouragedby what happensto others.

Loretta: I had thought, I had thought that I'd go home from herebecause I hadn't done anything very serious- (C.R.:M-hm.) I hadn't, uh, had any violent struggle with anybody, or anything like that.

C.R.: That's part of your feeling all the *'ay through, "I haven't done anything wrong, I've hcld myself in, you know, I really have not been violent, I haven't broken many ru1es."

Loretta: I haven't broken any, I don't think.

C.R.: Youhaven'tbroken any-

Loretta: And half the time youhaveto find outwhat the rulesare,because thev don't tell va.

i

:

ii-

{,'.

z'

l

:

.

t hc Cascof Lo;.ett.r:I r,rirscripr

4 j

C.R.: M-hm, m-hm. But your feelingis, ,,I,ve been good.,,

Loretta:

But I haven't been roagood, though, (screaming in thebackground,)

Youshouldn'tgo overboardaboutbeinggood,too. 1C.R.: M_h-. lI do.,.'t believein that, either. (C.R.: M-hm.) I've been asgood as I know horv to be. (C.R.: M-hm) And I'm nor letter-perfect.I rvoulcllike to be, but I'm not.

C.R.: But in can do.

Loretta: I'm doing asgood asI know how.

C.R.: M-hm. Loretra,I know that someof

terms of .rvhat you can do, you feelyou'ved.onethe bestyou

to go,and

I expectwe'vegor to call it quits, I appreciatethis chanceto tJk wirh yoll.

thesepeoplehavegot

Loretta: And thank you very much. I knorv that you're very important people.That's what I've heard,anyhorv.

COMMENTARY

THE CASE,OFLORETTA

A PsychiatricInpatient

Nathaniel J. Raskin

THE INTERVIEITAND ITS CONTEXT

'I'm Carl Rogers.This must seemconfusing and odd, and so on,

cut short

but I, I

'cause I

felt reaily sorry that the interview had been kind of

sort of felt maybe there were other thinqs you wanted to say.,'Thus does

Carl Rogers open his interview uith LJretta,

a ,rute hospital inpatient,

diagnosedasparanoid schizophrenic,in the summer of lg5B.The Ameri- can Academy of Psychotherapistswas in the middle of its 4dav Second Annual Workshop ar the University of Wisconsinin l\Iadison.The 30 or so participating therapistswere gathered in a small auditorium of the hospital to observe one another in actual practice. Loretta had been previouslyinterviewedby Albert Ellisro demonstrarehisrational-emotive

approach and by psychiatrist Richard l'elder to demonstrate the experien_

tial method of his Atlanta group, rvhich inclucled Carl \{hitakei Malone, and John \A'arkentin.

Tom

F,llisand Felder had had a difficult time rvirh Lorerta, and there was

in th-isdiverse group of experier.rcedtherapists for Rogers ro rry

his 1

interviewsin which, from hispoint of view,thiswoman'sexpressedfJelings and attitudeshad nor beenrespondedto empathicalll'.Ellis,the claybefori, had tried to help Loretta to seethe irrationalitv ofher behavior,and Felder,

earlier on this day, had attempted ro engageher in a person_rGperson dialogue about, among other things, a dream he har_lhaclabout her thc

ll"o:

hand *'ith her. He wasonly too willing, ashe hadsuffered thiough two

1 he Cascof l-orctca;Cornmercary

4.t

with Felder to rvhich Rogers referred

when he said he thought Loretta might havefelt cut short. Lfter

agreed to the intervierv, Loretta,

how she fek about rerurning to tark to still another psychotherapist;hcr responsewaspositive.

Aside from attending this rvorkshop as the first president of the

the

yearbefore for a

university of chicago to the university of wisconsin the

psychiarry. This bearsdirectlyon the

interviervwith Loretta, becauseRogerssawhis appointment at wisconsin

as providing an opportunity to test the hipotl-resisthat clientrentered therapy would rvork with a schizophrenic population. This woutd be

explored comprehensively in

Gendlin, Kiesler,& Truzx,

a large-scaleresearch project (Rogers,

r'gnr

Iilgisht belore.

oerore. rt was tne rntervrcw with

the interviclv

,telder

rvhich

Rogers

wl-rohad returned to her rvard,was askcd

American Academy of Psychotherapists, Rogers had moved from

joint professorshipin Psychologyand

1967);the inrerviervwith Loietta wasa si-ngle

clinical testof Rogers'h1'pothesis.

THE SIGNIFICANCE OF THE INTERVIETJT

The case of Loretta is significantin at leasttrvoways.First,it is one of the

anyorientation,

with a psychotic patient. Second,it provides a concrete example of the

application of clicnt-centercd therapy to

as paranoid schizophrenic.The interview showshow a

individual ma1'respond positivelyto the therapist-offeredionditions of empathy,congruence,and unconditional positiveregard.

that it is a superficial

approach that works primarilv

rvith

deeply disturbed

fewverbatin recordings of a thcrapeuticinterview,ndthin

a psychiatricinpatient diagnosed

One stereotypeof client-centercd therapy is

,,normal people, " for example, Rogers.nay huu. contributed to

e942)

his first book-lenqth

collegestudentswith minor problems.

this belief in counselingantl pslchotherapl

exposition

criteria for

"reasonably

radically

he rvrote:

of his approach, in rvhich he statecl,as one of the tentat]ve attempting psychotherapyof anykind, rhat rhe individuar be

free from excessiveinstabilities', (p. 77). His position was

different in his next book, Ctient-Centei,retlTherapy itgS t;. H

Presentopinion on applicabilitymust fake into accountour

client-centeredapproachhasbccn usedu'ith trvo-year-orclchirdrenandadr-rrts of 65,rvithmild adjustmenrprob)cms.suchasstudentstudyhabits,and the

experlence.A

most severedisordersofdiagnosed psychotics tance and respect,of deep understanding,is

growth,and assuchappliesto our children,our colleagues,our

well asto our clients,rvhethcrthe-sebe

An atmosphereofaccep-

o.,"I

a good climate for p"

students,as

,,normal,', neurotic,or psvchotic. This

w

+ b

\.IEWSFROM \!TTIIIN

doesnolmeanthatit rvillcureeverypsychologicalcondition,andindeedthe conceptof cureisquiteforeignto theapproach' (pp'229-230)

The interview with Loretta lasted about 30 minutes. Some of the notervorthyoccurrencesin thisbrief encounter,eachof whichisamplified, indude:

1. Loretta's explanation of her side of the processof ending the just{ompleted interview with Dr. Felder. It rvas clear that the opportunity to clarify this was important to her.

of an impending transfer to

2. Her exploration of the problem

another ward. This washer

"presenting probleln," a reai one'

3. The transition from this specificissueto the questionof rvhether shewasable to trust people in general and whethcr shecould trust the hospital staff in her treatment.

4. Her expressionsof disffessand confusion about the treatmentof a patient heard screaming in the background continually through' out the interview'

5. Her descriptionsof peculiarsensationsof ticklingin her kneesand of a feeling of electricity in the air when she had rvorked in the hospital laundrY.

6. Heiemerging positiveself-regardasthe interview progresscd'

Lorettaexplninshn sideoftheprocessofendingthejust-completedinteruiey' After introducing the subject of her impending transfer to another ward, Loretta wishes to clear up a possible misunderstanding of her attitude about ending the interview just concluded with Dr. Richard Felder' She "Oh,

before, I didn't mean I was

tired of talking to that doctor. I just wondered why I couldn't go home."

makesit ciear that the opportunity to clarify 'no' this is important to her:

I meant to correct one thin8. When I said

'no,'

meant

that I was ready to, that I

yeah' That

Rogersempathizes: "Yeah,

you felt he didn't quite understand you on that really."

At *ris point, screaming

can be heard in the background, but Loretta

I was being blunt and

comment: "Muybe he thought

responds to Rogers' 'no,'

thal I meant,

responds:

littie tensenessthat, that, uh, maybe he didn't really get that' Maybe he

thought you

agrees: "Yesl That's what I had thought." Rogers'emPathicresPonsesin this dialoguefacilitateLoretta'sexpla- nation, and, apparentlysatisfiedthat she has clarified her position, she then returns to the issueof the ward transfer'

him anlTnore " To rvhich Rogers

your feeling norv, it is, uh, a

him off, or somcthing

"

Loretta

I didn't want to talk to

"tlh-huh. And if, if I sensesome of

were, sort of

shutting

I l.reCaseof Lorerta:Comrnentary

Loretta exploresthe problenrof an impending transfn to another uard. Loretta norv begins to explain her concern, her presenting problem: "I

don't knorv.I'm being movedall right, transferred.And I wasjust wonder-

.yelling

like that (referingto patient uho keepsscreamingin the bachground).I really

rather like it on my ward." The ward transfer is clearlyan issucof great importance to Loretta, She devotes about one quarter of the interview lvith Rogers to it. To summarizesome of her attitudesabout it:

ing if I'm quite readyfor a

transfer

.

.It's annoving,that

I don't kno'w'if I'm readyfor the work that would be involvedin the transfer. I'd hate to work in the laundry room; I'm not even kecping up rvith my orvn laundry now. And when I rvorked in the food center in that rvard,I had real physical trouble. I bla&ed out. Even though the hospital makes a pretense that the Patients are

. important, I'm not really important on Iny present ward and rvouldbe lessso on the new one. At one time I wantedthe transfer,but I didn't askfor it riqht now. I'm confused. If the transferis a stepcloserto my dischargefrom the hospital,that lvould make me falor it more.

I like the building I'm in, becauseit's beautifui, and there'smore to do here, but it rr'ouldbe nice to gct awayfrom that screaming girl.

I rvouldn't mind going to the new ward if they let you rest there, but they keepyou working all the time.

I lvas able to work in the laundrv when I '!vas there before. I know I can do it now, but I'm not sureI'm ready for it.

I rvon't refuseto go. I've evenpackedmy own grip. If it's an improve- ment, I'm rvilling to go along with the move.

Rogerscommunicateshis empathicundcrstanding of theseattitudes.

Specificalll', he recognizesLoretta's feelings of confusion and uncertainty

about whether she is ready for this changein

that it is a tough choice to make and articulatesLoretta's feeling that it might not bewhat shereallvwants.This seemsto havethe effectof helping Loretta, after considerableexploration, come to a resolution of a very difficult and troubling issue:Shewould be willing to givethe transfera try, eventhough sheis not suresheis readyfor it.

her life. He acknowledges

Loretta'sexplorationoftheisnLeofthewardtransferleadsherinto theqttestion of uhethersheis ableto trustpeoplein general.After Rogers empathizes with Loretta'sfeeling of confusion ("Right now ,vou feel kind of mixed up?"),

48

\TE\?S FRON{\q]THIN

shemovesto a new issue: "Well, I know there'sAnita on that u'ard that I didl't uust very far becauseshe'sthe one that Put me on shock treatment." Later in this segment,responding to Rogers'understanding

and acceptanceof her distrust of

one person,Loretta sharcswith him the

people any\\'ayanymore"'

A little

too easilyby trusting people'"The

her disuust: "I don't trust

Iater,sheadds, "You canget hurt much

attitudes she expressesin this segment can be summarized as follorvs:

breadth of

emp

Lort

that

irapl

I clon'ttrust the staffpersonwho I think wasresponsiblefor my Setting

shock

"doctor's

therapy. She acted friendly

and

said it

was done on

orders,"but asfar asI knolv l hadn't talkedto a doctor'

ln a very general way, I don't trust people anymore' I've been hurt

when I did.

I don't understand why they suddenly ordered shock therapy for me' I wonder if it wasbecauseI saidI couldn't work and they didn't believe me. All of a sudden, I n'asgiven shock and assignedto work'

Loretta's difficulties in trusting people by consis-

tendy ulng to

Loretta'expre.r.r h

trated her shock trea[ment, Rogers

that's real confusing. It would be putting you next to a person who seem,ed to like you and put her arm around 1'ou and, by gosh, was responsible for

that the shock

shock treatment." He also empathizes with her feeling

tleatment is used to get her to perform her duties:

shock treatment is really something they may use for punishment if you

don't do the things the way they $'ant you to do?" Implicitly, in the way he responds,Rogersinvites Loretta to correct him when he has not gotten her feelings exactly right. This is cxemplified

when shebegins to discussher inability to trust PeoPle becauseit inevitably

"\4'ell, maybe, maybe

Rogersdealswith

appreciate her feelingsand percePtions' For example,when

lack of trust about

the staff member who orches-

replies, "So that there's something

leads to get;ing hurt. When

accurate i*putttyt

and states: "That's the

her clarification: "That's

Rogers responds

with rvhat appears to be

"That's the way you can get hurt," Loretta goesfurther

way I haaebeen hurt." Whereupon Rogersaccepts

the way you hauebeen hurt"'

Loretta exprasa distras and confiuion about the treatmentof a patient

heari screamingin thebachgroundduring theinterttieu.A dramatic

frequzntl2

aspectof the audiotaperecording of thisinterview is the soundof another

female patient screaming in the background. After mentioning it in her

hrst staiement, Loretta does not bring up the subjectagain until more than halfway into her dialogue with Rogers,even though the sound is piercing

and rather constant:

"I

"

*ish that lvoman would quit screarning

Rogers'

I

r

!

f

I

I

!.

t-

t

''.:

.

:1

i

.:.

:

I

i

-

_

tot

scr

the

for

the

Par

unc

Pat

int

go1

eitl

on

did

the

hor

da1

or

ov

on

fric

'_

^ f

thi

rea

The L.rscoi Loretra:eolnluentary

49

empathicresponseis in the form

Loretta'sanswertakesher into a personalconcern: "She can'tstopthough,

that's the rvorst of

happento you if you end up in a, like that." Someof the attitudesexpressedbv Loretta in this sectionare:

of a question: "Why doesn't shestop?"

That gives you a terrible feeling, .rvhat's going to

That ll'oman's screaming really bothers me. You could go out of your head hearing that aII the time. I'm worried that I could end up like that.

I sat next to her, and she seemedperfectly all right. Shewas calm and not talking. Yourvouldthink the hospitalcouldhelp somebodl,like that,not make her lvorse.

I think maybeit's the drugs thcy're giving her. I'm getting drugs, and I'm worried I could end up like that.

In his usualway,Rogersrespondswith explicit empathic understandit-rg to theseconcerns. He verbalizesLoretta's fear that what happened to this screamingwoman could also happen to her, as lvell as her suspicion that

the hospital staff had causedher disturbance rather than relieved it. Note,

for example,the following empathic responsc: 'Almost makesyou

thcy making hcr worse with their drugs?'

participation in the dialogue, one may reasonablyconclude that she feels understood regarding her misgivings about the treatrnent of the screaming

patient and her fear that she could end up the samelvay.

'Are

feel,

"

On the basis of Loretta's

Lorettadescribessensationsof tichlingin herhnea and a feeling ofelectricie

don't think I'm

in theair. Loretta explainsher expcricncesas follorvs: "I

going to like working in the laundry, that I

eitherthe other tt'o

on food center over there, either, becauseI rvorkcd there before, and I

di{n't carefor it. (C.R.:Mh-m, m-hm.)Wcll, I didn't haveanything.

know. 'Cause I didn't like it

times . And I don't think I caretoo much working

.

I

.

.

. first day, I 'rvorked all right, the second day I worked abour a half an

.

'the

hour, and I blacked out, and I tried it 3 more days,arrd I blacked out each

day,so ,

or something." To this,Rogersreplies: "NI-trrn, m-hm. You feelsomethingl\'aswrong

overthere?Too much elcctricityor something, 'that reallyhad a bad effect on me when I was rvorking there."' And :rller Loretta describeshorv

frightenedshe felt by her blackouts,Rogersresponds, "It "M-hm.

thing very odd happening to you," and then,

wasjust some-

to work there.There wastoo much electricity

I just quit trfng

It just made you feel

realpuzzled. 'What is happening to me?' A little later,Loretta describesanother s)Tnptom: "If you notice,my

"

50

\4EViS FROM W]THIN

I move my feet."To 'lvhich Rogersresponds: "Yes, I did notice."And

.

Loretta further explains: 'As I said,my kneestickle.(C.R.:M-hm, m-hm.) And I, I don't know if it's the drugsI'm getting or rvhat,but it's something I can't help.It isn't that I'm soterribly nervousthat I can'tsit still, that isn't it. I do that at group mectings or anything, and I can't control them. It's rather embarr assing(laughsneraousll)." Rogerslistensrespectfullyto Loretta'sexperiencethat the sensations "It

ma-kesthis worse."

are specificto particular situations:

seemsas though being in a group

Loretta's belief that her

He is also responsiveto

symptoms are causedby her medication: "Well, probably it's just the drugs?"Later Loretta comesup with another explanation for the sensa- tions in her knees.Shehasbeen discussingthe patient$'ho screams: 'And rhen once you're that way, what can you do about it? Only, only I knorv

what they're like and I can seeit, so I haveenough control to hang on to myself,enoughto keepfrom just batting my headagainstthe wall, like,uh.

. Some of them had that feelingand theyjust can't control it. They

I've seensomuch of it and heardsomuch of it that I canhang on to myself

I think that'swhy my knces tingle, though, becauscrather

a little

than batting my head againstthe wall, I havethat tlpe of reaction." "M-hm,

yourselfin enough so you're not going to bat your head againstthe wall,

Loretta

finishesRogers'sentence: "Comes out in thc tickling." Rogersacceptsher "Comes

way of putting it:

The striking feature of the interaction bettveenLoretta and Rogerson the topic of her odd sensationsis that he isjust asrespectfulof this kind of experience on the part of a hospitalized schizophrenic as he would be "normal"

of the everydayexperienceof a

regard for Loretta, togetherwith his empathy and genuineness,apPearto facilitate her movement toward a rational explanation of what initially

Rogers then responds:

m-hm. So in a sense,vou can hold

"

and yet it'sasthough it hasto comeout somewhere,and it, uh

out in the tickling of your knees."

client.His unconditional positive

appeared to be bizarre symptoms.

Lorettaexprusesgreatn positiueregard for herselfastheinteraieuprogresses.

The interview with Loretta illustrates a dynamic observed by Rogers from the earliest days of client-centered therapy: If the therapist conveys an empathic understanding and acceptanceof the client'snegativefeelings, the client is freed to experiencepositive aspectsof self and others. For example, immediately after the dialogue about the tickling in her knees,

Loretta

too valuable to bat against the wall (laughs).It's my own head, and I like it."

Here is a dramatic expressionof Loretta'sbelief that sheis a worthwhile person. Similarly, in her next exchangewith Rogers,shesays: "That's right. After a1l,God gaveme that head,that's the head I rvant.I'm not going to

says: "it'sjust

futile to bat your head. Why anyway,I think my head's

ilre ( ,rseof Loretr.r:Conrrrrcntar.i

5 1

bang it againstthe u'all,cvcn if I like to, lvhich I reallywouldn,t like to do.

Well,I'h1',howdoesrharhelp that girl to be in

like ?.:ryway that

lockedup

beneficialaidis

shegettingout of that?Anyrhing?" "I

'tr\'hat

"No, I'm asking.yorr. Here,then,weseeLor.ettastandingup to thisnoted

psychologist,lettinghim

and screaminglike that?What,I mcanwhat

Rogersreplyhereis,

earthlygood

"

?'

guessthat'sthequestionyou'reaskingyourself,

" LorerrainrerruptsRogersat thispoini andsays,

knowwhatshemeanr:Shewantsto knowwhatDe

thin-ksof the treatment of the screamingpatient. There are other exarnples in the interviervof Loretta'sinsistenceon bcing understood exactiy.One

such instance occurs rvhen Loretta is

Rogers'responsesis "N.{-hm, m-hm. you feel

descr.ibineher blackouts.One of

reallyyou were in, in kind.of

a desperateway,at thosepoints?"Loretta correctsRogers'statement: ,,No, I didn't feel desperare.I just, I didn't understand it. I didn,r knorv why I blackedout."

These examplesof Loretta's insistenceon being understood exactly are the secondindication of her emerging self-regardin this interview.A

thircl,somelvhatmore indirect,expressionisreflectedin her assertionthat "I

therapy hasbeen helplul to her:

ening (little

than I haveby the pills,and

think theseneetings are very enlight-

I think I've been helped a lot by, more by talking

seemsto alleviatewhateverthe situado;

is." Loretta's statemenrrhat talking to professionalsis more helpfirl than medication suggeststhat her participation in the treatment processis valuable.The intervierv with Rogers provides an example of her active

stancein sucha situation. It is notelvorrhy,too, thar rvhile talking to Rogers,Loretta expresses

concern that others may perccive her as not being good or as acting antisocially,in somewav.Thc first instanceoccurssoonafter the intervierv

begins, $'hen Loretta notes that shelvants to

have

correct an impression

When

she mav

made: "Oh, I meant to correct one thing.

I rr-id 'r-ro' before. i

didn't mean I rvastired of talking to that

was readv to, that I rvondered why I couldn't go home.,' She explains that

her intention rvasnot to be blunt, that shedicln't mean to be insr-rlting,and that shedid not want to be perceived that wav. Another instanceof hei rrishto beperceir,,edassomeonewho behaves

in an acceptablerhanner shocktl-rerapy.She says: "I

that kind of trearment."Implicitly she is expressinga

being perceived as

confirmed by rvhatshesaysafelvminuteslater: .And the next thing I

theysaid, 'You're reaciy,you're on

do anything.I haven'chad any fight or anyrhingwith anybody.' ;' Later in the intervierv,Loretta brings out her perception that the

doctor. Ijust meant, .no,' that I

occursduring her discussionof having received

had done nothing that I knew of to be put on

.And

knew,

I said, ,WhyiI dian't

concern thai she is

having done something ,,bad." This hypothesis is

52

\4EV'S FROM \{'ITHIN

decision about her releaseis relatedto whcther shehasactedout: "I had thought that I'd go home from here becauseI hadn't done anything very

serious

like that." In his responsc,Rogersrecognizesthat this is an issuethat has "That's

run

through,

reallyhavenot beenviolent,I haven'tbroken many "I

time you have to find out ra'hatthe rules are, becausethey don't teil ya'" "Mllm,

feeling is, 'I've been good.' Loretta's responseat this point is interestingand significant: "But I

haven't been too good, though.

.' I'vebebn asgood asI knorv

how to

Rogersreplies: "But in termsof what you can do, you feelyou'vedone "I'm the

doing asgood

as I know how." Here is an issueimportant to Loretta that sheresolvesin a way that e.{pressespositiveself-regard.She articulatesan impressiveacceptanceof

bestyou can do." And Loretta affirms this comment,

too

Loretta replies:

I hadn't, uh, had anyviolent strugglervithanybodl',or anything

the interviov:

part of your feeling all the rval'

haven't done anything wrong, l've held myself in, you kr-ro'iv,I

"

rules.'

she adds, 'And half the

m-hm. But your

throughout

'I

haven't broken any,I don't think." And then

Rogers then reflects her underll-ing asscrtion:

"

.You shouldn't go overboard about being

I don't believein that,

And I'm not letter-Perfect.I 'rvor-rld like to be, but I'm not."

self:Sheis only asgood asshereallyis,that shcis not perfect,and that she "overboard

doesnot believein going

about being good."

ROGERS'BEHAVIORIN THE INTERVIEW

In the courseof demonstratinghow Loretta dealtwith sir areasof concern during this intervielv, many illustrations havebeen given of thc wavRogers interacted with her. An examination of the entire interview reveais a

remarkable consistencyof empathic

of his responses,there are perhaps only one or two in which Rogers did something other than try to conveyto Loretta his understandingof what

shewas sharing with him. Loretta wasresponsiveto this emPathic approach' Sheadvancedfrom one areaof discussionto another (e.g.,from the presentingproblem of a

oossibleward transfer to the issueof her lack of trust in the institution and in people irr general), and she made progress t'ithin specific areas (e'g', resolving her conflict about moving by deciding that the transfer might be

an improvement and that she would not fight

empathic approach seemed to facilitate increased self-understanding and acceptanceaswell asa greater ability to view problems more clearly.Finally, Loretta's responsivenessto Rogers' therapeutic style is evident in the comments shemakesimmediarelyfolloltine some oFhis responscs;state-

responsivenesson Rogers' Part. Of all

it). In addition, Rogers'

,;,

:

'|

Llrc Lasc of Lorerrrr: (,onlrnentary

.) j

ments such as "That's really it," "Yes, that's what I thought" and ,,That's the truth," all indicatethat shetruly felt understood.

In addition to a high degree of empathy, Rogers provided therapist characteristicsincluded in his classicformulation of

trvo other

"necessary

and sufficient conditions of therapeutic personality change": uncond! tional positiveregardand congruence.He accordedLoretta the samekind

of respecthe rvould any client; his motive for intervieu-ing herwas his sense that her feelingshad been insufficientlyunderstood and respectedin the first wvodemonstrations.He displayedunconditional regardfor her belief

that there rvas electricity in rhe atmosphere of the

tickling sensationssheexlceriencedin her knees.He respectedher choice

laundry and for the

of topic,her manner of exploring eachone,and her decisionsto switchto other issues.I count 24 times in this short intervier.vthat Loretta took the initiative in introducing a new subject,going back to one she had been exploring earlier,coming up with an insight or nel\iattitude,or exercising someorherform of self-direction. Another index of the client-centerednessof tl-risintervietv is the number of linesin the printed transcript takenup by Loretta'sstarements (218)and the nunber rakenup by Rogers'(131).Many psychotherapists pay lip service to respectingthe strength,of their clients.However, an examinationof typescripts,when theyareavailable,characteristicallvshow

Adlerians,

pists,and othersdominating the interactionbetweenclient and therapist. This is often true of psychoanalyticallyoriented tl-rerapists,asweli. Client- centeredtherapists,becausetheyeschet'therole ofexpert, areconsistently

lessverbose,in spite of the usual relianceon lvords to conveyempathic understanding

Some support for these assertionscomes