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A client-centered perspective on ‘psychopathology’

Arthur C. Bohart

To cite this article: Arthur C. Bohart (2017) A client-centered perspective on

‘psychopathology’, Person-Centered & Experiential Psychotherapies, 16:1, 14-26, DOI:

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Published online: 27 Mar 2017.

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VOL. 16, NO. 1, 14–26

A client-centered perspective on ‘psychopathology’

Arthur C. Bohart
California State University, Dominguez Hills, Carson, CA, USA


I present a client-centered perspective on psychopathology. People Received 15 November 2016
have a natural capacity for self-regeneration, self-healing, intelligent Accepted 18 November 2016
functioning, and self-organizing wisdom. Psychopathology occurs
when various factors get in the way of people productively utilizing KEYWORDS
Conditions of worth;
that capacity. Conditions of worth are a major factor. Conditions of self-criticism; self-organizing
worth are ubiquitous, not just occurring in early childhood. We need to wisdom
change society in order to change psychopathology.

Eine klientzentrierte Perspektive auf

Ich stelle eine klientzentrierte Perspektive zur Psychopathologie vor.
Menschen haben eine natürliche Fähigkeit für Selbst-Regeneration,
für Selbstheilung, für intelligentes Funktionieren und für eine sich
selbst organisierende Weisheit. Psychopathologie tritt dann auf,
wenn verschiedene Faktoren dem Menschen dabei in den Weg
geraten, diese Fähigkeiten produktiv zu nutzen. Bedingungen für
Wertschätzung sind ein zentraler Faktor. Bedingungen für
Wertschätzung finden sich überall, nicht nur in der frühen Kindheit.
Wir müssen die Gesellschaft verändern, um Psychopathologie zu

Una Perspectiva Centrada en el Cliente sobre

Presento una perspectiva centrada en el cliente sobre la
psicopatología. Las personas tienen una capacidad natural para la
auto-regeneración, para la auto-curación, para el funcionamiento inte-
ligente, y la auto-organización de la sabiduría. La psicopatología ocurre
cuando varios factores obstaculizan el uso productivo de esa capaci-
dad. Las condiciones de valor son un factor importante. Las condi-
ciones de valor son omnipresentes, no sólo ocurren en la primera
infancia. Necesitamos cambiar la sociedad para cambiar la

Une perspective centrée sur la personne relative

à la psychopathologie
Je présente une perspective centrée sur la personne relative à la
psychopathologie. Les gens possèdent une capacité naturelle
d’auto-régénération, d’auto-guérison, de développement d’un fonc-
tionnement intelligent et leur propre sagesse pour s’auto-organiser.

CONTACT Arthur C. Bohart

© 2017 World Association for Person-Centered & Experiential Psychotherapy & Counseling

La psychopathologie surgit lorsque divers facteurs entravent les

personnes et les empêchent d’utiliser ces capacités de manière
productive. Les conditions de valeur constituent un facteur majeur.
Les conditions de valeur sont omniprésentes et ne se rencontrent pas
seulement durant l’enfance. Il est nécessaire que nous changions la
société en vue de changer la psychopathologie.

Uma Perspetiva Centrada no Cliente para a

Apresento uma perspetiva centrada no cliente para a
Psicopatologia. As pessoas possuem uma capacidade natural de
autorregeneração, de auto-cura, de funcionamento inteligente e
de sabedoria auto-organizadora. A psicopatologia acontece
quando vários fatores se interpõe no caminho das pessoas que
usam essa capacidade de forma ativa. As condições de valor são
um fator fundamental. As condições de valor são ubíquas, não
acontecem apenas na infância. Para mudarmos a psicopatologia
temos de mudar a sociedade.

In this paper, I present a client-centered perspective on psychopathology. My core

premise is that people have a natural capacity for self-regeneration, for self-healing,
for intelligent functioning, and for what I’ve called, after John Wood, self-organizing
wisdom (Bohart, 2015). Put another way, they have a natural capacity for trying to
proactively find their way in life. Psychopathology occurs when various factors get in
the way of people productively utilizing that capacity. Of particular importance are
conditions of worth.
By the potential for wisdom, I mean that people have the capacity to strive toward
creatively finding optimal balance between competing factors in their lives. Finding that
balance allows them to both promote their own well-being while coordinating in a life-
promoting way with others as well as with life circumstances.
Congruent with this, people have a capacity for resilience. They are built to ‘bounce
back’ from adversity and to try to find productive ways of ‘staying on the planet’, so to
speak. People can be incredibly persistent and courageous. They are able to find ways to
live in unlivable situations. My basic assumption is that humans are built to cope with
adversity. It takes a lot to defeat them.
At the same time, it is obvious that people also have a great deal of potential for
behaving dysfunctionally and/or destructively as well. They can act narrowly, selfishly,
cruelly, and unwisely. In particular, they can act in a way that society describes as
‘psychopathological’. This happens when they are not in touch with, or unable to use,
their capacity for self-organizing wisdom.
My point of view does not contradict or replace other perspectives on psycho-
pathology. There is considerable evidence to support other factors playing a role.
There is evidence for genetic factors. The use of brain imaging techniques has
identified potential neuropsychological factors involved in various psychological dis-
orders. There is also evidence supporting the role of experiential and circumstantial
factors, such as traumatic early childhood experience, learning, poor parenting,

insecure attachment relationships, and bullying. As well, there is evidence that social
factors such as discrimination, racism, homophobia, sexism, poverty, and social dis-
placement can play a role.
However, none of these per se necessarily determine that an individual will behave in
a psychopathological way. What I believe is the missing piece, what ultimately causes
psychopathology, is when people react to problems in living such as biological, experi-
ential, or circumstantial challenges in ways that are self-defeating, that get in the way of
their own natural capacities for the generation of new steps toward creatively resolving
and dealing with such challenges.

Lemonade out of lemons

Suppose that an individual faces life adversity, whether due to his or her biology, early
childhood trauma, bad parenting, social factors, or whatever. What if the individual is
able to react resiliently and proactively to the challenge? He or she is able to make
lemonade out of lemons. There is considerable research suggesting that people are
capable of this (see Bohart & Tallman, 1999; Masten, 2015; Miller & C’de Baca, 2001;
Tedeschi, Park, & Calhoun, 1998). It is not the presence of a biological problem, or a
traumatic experience, or a conflict per se that causes psychopathology. Rather it is how
one reacts to and handles that problem that can turn a problem with a small letter ‘p’
into a problem with a large capital ‘P’. What we call psychopathology is a reaction to
other problems in living. The question then becomes: ‘What interferes with persons
reacting in a proactive and resilient way to challenges?’
Before I consider this question, let me comment on the term ‘psychopathology’. I use
it because it is used in the field. However, for the most part, I do not believe that persons
have psychopathology, although they may behave dysfunctionally, self-defeatingly, or in
a socially injurious way. Rather, I believe that what we call psychopathology is some-
thing that usually arises at the interface between a person trying to cope with life, and
contexts and situations that are challenging to him or her. What we call ‘psychopathol-
ogy’ exists between persons and situations, in contrast to, for instance, pathology such as
cancer. If persons can cope successfully with the challenges they are facing, be it hearing
voices, having a biological propensity to depression, being paralyzed in a car accident,
losing a job, having a prized relationship fall apart, poverty, or being traumatized, they
will not develop ‘psychopathology’.
Therefore, what we call psychopathology is an attempt at coping or reacting to a
life circumstance that for whatever reasons presents a threat or challenge to the
person’s survival or well-being. A person may carry into a life circumstance a pre-
existing vulnerability to not cope effectively in the face of a certain kind of challenge,
but if he or she never has to face that challenge, he or she may never behave
‘psychopathologically’. For example, someone who may never have learned that it is
‘bad’ to be depressed, or who may have learned how to cope proactively with low or
depressive moods, may never need antidepressants or psychotherapy. Not fighting
against themselves, but rather focusing attention on the productive things they can
do in their lives, while feeling depressed, they may be able to ride out the depressive
mood until it eventually passes, as it usually does. Indeed, psychotherapy is,

precisely, developing that same resilient capacity to cope proactively with such life

Problems in living, not psychopathology

I personally favor the terminology of Thomas Szasz (1961), who preferred to talk about
‘problems in living’ rather than ‘psychopathology’. Then we could focus on how people
proactively or not so proactively cope with problems in living. We all have problems in
living. The research over the years has shown that rates of so-called psychopathology in
the general United States population vary between 50% and 80% (Kessler & Wang, 2008;
Srole & Fischer, 1978). That doesn’t include the socially injurious behaviors of many
individuals that are not included in formal diagnostic systems, but in my view are just as
‘crazy’ as anything in the Diagnostic and Statistical Manual of the American Psychiatric
Association (DSM-V). I think of those who deny the existence of climate change, those
who believe that it is a good idea to allow people to carry concealed weapons on
college campuses, those who are racist or homophobic, those who believe it is a good
idea to cut people’s heads off if they do not conform to one’s religion, and so on. I agree
with the observation R. D. Laing (1960) made many years ago, when he raised the issue
of who was more crazy: a girl in a mental hospital who believed there was an atomic
bomb inside her, or the society that builds atomic bombs. I believe there is a lot of
‘crazy’ and self- and other destructive behavior that occurs that is not covered in DSM-V.
My view is compatible with those who have launched social critiques of the concept
of psychopathology as well. They have argued that societal factors such as oppression,
poverty, and other factors play an important role (e.g. Moreira, 2012; Sam & Moreira,
2012). Not only may these factors create the challenges I talk about but they also often
impose conditions of worth. I will not dwell on them in this paper. In this paper, I focus
more on how these and other factors interfere with the person’s ability to utilize his or
her self-organizing wisdom.

Barriers to self-righting
Situational barriers
So what gets in the way of people’s proactive capacity for self-righting and self-
organizing wisdom when faced with challenges or threats to their well-being, personal
integrity, or ability to ‘find a viable place on the planet?’ One set of factors may be
situational. The situation may be so overwhelming that people react without utilizing
their capacity for wise intellectual and emotional processing. They may use strategies
from the past that have worked elsewhere but do not work here. Under stress, they do
not recognize that the premises they are basing their strategies on are not effective in
this situation. Often the situation is so pressing that they do not have the space to step
back and think about the situation, to get a new perspective, to see new opportunities
in the situation, to develop creative solutions – because they feel under attack. Instead
they react in the moment, and their solutions may not be effective.
A second situational factor may be that they do not have the social support to help
them cope that another person who copes successfully might have. Perhaps they have

no one to help them out financially, or to take care of the kids, or to help them fix a
broken car that they need to get to work. Or they do not have someone who can
provide emotional support or a listening ear to help them accept themselves and their
own experience, and to think out or work out their problems.
However, I would like to stress that they are still operating proactively even in
utilizing dysfunctional strategies. From their point of view they are doing what makes
sense to them, what seems right and proper (Watzlawick, Weakland, & Fisch, 1974), to
try to cope with the situation, but it backfires. And then they are not able to respond
productively to failure (Bohart & Tallman, 1999; Dweck & Leggett, 1988) and to find more
creative, wise, and proactive ways of coping. Their solutions may actually be creative,
but still dysfunctional. I believe a lot of what we call psychopathology is actually quite
creative. But a creative solution hastily conceived in the moment under duress may not
be wise and may backfire in the long run.

Barriers relating to one’s self

Although situational factors play a role in interfering with a person’s capacity for
operating in a self-organizing wisdom kind of way when faced with adversity, underlying
even situational factors may be how individuals relate to themselves. Do they relate to
themselves in ways that promote their capacity for productive, creative coping, or do
they relate to themselves in ways that get in the way of this? I am going to suggest that
it is when people get turned against themselves that they undermine their capacity for
self-healing and self-righting, even though their getting turned against themselves is an
attempt on their part to cope.
I am not alone in suggesting that it is people’s propensity for self-criticism, self-
shaming, and self-blaming, that can do them in. Dan Wile (1992) has written extensively
on how self-criticism is at the core of dysfunctional behavior in both individuals and
couples. Marino Pérez-Álvarez (2008) has recently argued that ‘hyper-reflexivity’ or
excessively self-focused attention, including self-criticism and self-blame, is the ultimate
cause of psychopathology. Cognitive behaviorists have focused on perfectionism as one
cause of depression. Psychodynamic theorists have talked about harsh superegos and
internalized critical parents. In fact, I have argued that the idea of the ‘internal critic’ as a
cause of psychopathology is a commonality across different theoretical points of view
(Bohart, 1991; Todd & Bohart, 2006).
From Carl Rogers’ (1959) point of view, it is conditions of worth that lead to
individuals turning against themselves. Conditions of worth imposed on us by others
make us feel like we are of value only if we meet others’ standards. This interferes with
internal congruence.
People are able to function optimally when they are internally congruent. What this
means is that they are internally open in a receptive, listening way. They have access to
internal information, which includes experiential-felt meanings (Gendlin, 1968),
thoughts, emotions, and even critical ‘voices’ (Stiles, Osatuke, Glick, & Mackay, 2004).
They are able to openly listen to and process what is going on outside them as well. This
puts them in an optimal position to balance and creatively synthesize information in
order for them to make the most optimal decisions they can make in a given life
situation. Conditions of worth interfere with people being able to ‘hear their own voices’,

so to speak. This is a metaphor, but I, as well as many of my clients, have had the
experience of being able to openly listen to ourselves in the presence of an empathic
listening other, listen to the cacophony within, and find a clear voice emerging that
represents ‘me’ and seems to synthesize together the various competing factors I am
experiencing into a felt sense or idea that leads me forward.
By contrast, when one is turned against oneself, one is blaming and judging oneself in
such a way that one is not able to create that internal listening space. One is not able to
openly and receptively ‘stand back’ and hear all the elements, both internal and external,
involved. Critical and self-blaming voices, if given priority, create internal blame, fear, and
defensiveness, and interfere with open information processing. They are the opposite of
the conditions needed for productive creativity. It is no wonder that people often rely on
dysfunctional strategies when internal self-blame is disrupting their ability to function in a
more wise, intelligent fashion. Better to try something than do nothing.

Origins of conditions of worth

Where do conditions of worth come from? We typically think of them coming from child-
hood, where we were taught we were not valuable or incompetent, or where we were
sexually or physically abused, and made to feel fundamentally unsafe and not of worth.
However, it is not only early childhood. It may also come from current aspects of
situations that threaten our sense of worth, our sense that we are of value, our sense
that we have some skills, some talents, or some competencies. Further, we are capable
of imposing conditions of worth upon ourselves. They do not all come from parents. I
am an intelligent being. I can look around myself and see that others set standards on
what and who is or is not acceptable. I see what others find acceptable, and then
without anyone telling me, I may conclude I am not acceptable. No one may have done
this too me, but if I see others judging others as acceptable or not acceptable, I will be
prone to thinking of myself in those terms also.
However, often conditions of worth come from others who tell us in one way or the
other that we are not acceptable. I believe this is omnipresent. It is not merely present in
early childhood. And it is not merely from one’s parents. As a 6-year-old child in Glen
Ellyn, Illinois, I was awash in conditions of worth, and they were not primarily from my
parents. A major source was my peers. Boys in my neighborhood placed huge demands
on one another as early as six to live up to various standards. And they could be quite
vicious in imposing those standards. In addition, I encountered conditions of worth from
the nasty old lady down the street, the church minister, my teacher, the school principal
with whom I had numerous encounters, and various old aunts.
This continued into adolescence. Adolescence, for most people, is also a sea of condi-
tions of worth, with immense pressures toward uniformity, bullying, and social rejection.
Simply being ignored can make one feel ‘less than’. Social rejection is particularly painful
and there is research now that shows that the brain area which registers social rejection is
literally the same area that registers physical pain. So-called normal people can be cruel. I
think of something I heard recently that Janis Joplin, when she was in college, was voted
the ugliest man on campus. Think about that as a condition of worth.

Accepting difference
We are not a species that seems to be very good at accepting difference, let alone living
with it, being actively interested in it, and appreciating and learning from it. We seem to
be very good at imposing our standards, our view of reality, on others, constantly.
Furthermore, as I have noted, conditions like poverty, homophobia, and racism may
impose conditions of worth, over and above the real stresses they create. Thus, I believe
conditions of worth are omnipresent and it takes a good deal of resilience to deal
effectively with them.
Our mental health profession is particularly good at applying conditions of worth to
people. For instance, in this optimistic society, where we’re all supposed to be happy, it is
not good to be a worrier, depressive, or pessimistic, or danger oriented (Held, 2013). It
gets labeled. But perhaps, due to biology or experience, you may be a person who is
prone to focus on the negative. Perhaps you are particularly sensitive to threat or danger.
You may be pessimistic. Yet, such ways of being may be perfectly adaptable ways of being
on the planet – until they come in contact with a society that doesn’t like them and labels
them. And then they become pathological. Then the person who has these traits may
either become defensive and resistant toward those doing the labeling and judging, and
then get further labeled, or turn against themselves and take over the prosecutorial role
from society and judge themselves, and thereby exacerbate their own problems.
Our inability to really prize and listen to one another, to accept difference, is not
merely hurtful. As I said before, it gets in the way of people’s natural capacity to
productively self-right, to productively process harmful and stressful situations. I am
going to argue that if our social environments were better at recognizing difference and
responding productively and positively to people, providing what Gendlin (1990) has
called ‘client-centered listening’, we would greatly reduce what we call psychopathol-
ogy. In that regard, Gendlin (1984) created Changes, a drop in community where anyone
could come to be listened to when they had a need for it. This fit with a good deal of
optimism about community psychology in the 1960s and 1970s, with the idea of trying
to make client-centered listening readily available through training of hairdressers,
bartenders, and many others. Sadly, this movement has gone by the wayside for the
most part as we’ve moved away from the idea that genuine empathic listening and
social support can make people flourish and grow, to a focus on biology and on social
skills training, although, again, I am not implying that those things have no value. The
training of empathic listening that is done now, such as with physicians, is often done
more as the training of a skill, rather than as an attempt to awaken a genuine capacity
for receptive listening and the meeting of another person.
Instead of empathically listening to people, we typically judge them. Then as thera-
pists we set about trying to engineer them. If we were able to empathically listen to
them, we would help ‘strengthen’ the wise intelligent part of them. We would help them
use their own creative resilience to cope with whatever problem in living they are facing,
be it a biologically based disturbance, a vulnerability from childhood, a here and now
environmental stressor, a trauma, or whatever. They would have the chance to mobilize
their own natural intelligence to move toward more wise, balanced ways of being.
I think of a client of one of my students a few years ago who was sexually attracted to
children. He liked to lurk around schools and look at them. My student felt frightened by

him. I wondered if she knew how he felt about himself. She didn’t. It turned out that he
loathed the part of himself that was like that but he did not know how to deal with it.
Through empathic listening it is not that we strengthen or validate the part of him that
wants to have sex with children; we live in a society that will not tolerate that and he
needs to learn to cope with that. Rather we help him become less split so that he can
strengthen his own proactive desires to be a positive person in society and thereby tip
the balance toward that side of him. He has the natural capacity to move in that
direction; that was the insight of Carl Rogers.
I believe this is even true for psychosis. Let me give the example of Eleanor Longden
(Longden, 2013). Perhaps you have seen the TED video of her talking about her experi-
ence with hearing voices. She started hearing voices when she was in college. She had
heard the messages from society that hearing voices meant she was crazy, that there was
something deeply wrong with her. Instead of productively coping with them, she became
frightened of herself. And so she went to seek professional help. Ironically, and accurately,
one of her voices said, ‘She’s digging her own grave’ by going to seek professional help,
and it turned out to be true. She was labeled schizophrenic, hospitalized, and told by a
psychiatrist that having schizophrenia was worse than having cancer. The result was that
she became more and more turned against herself, frightened of herself, ashamed of
herself. She felt hopeless, and the more that happened the more she deteriorated. The
more she came apart at the seams, the more the negative and destructive the voices
became. When finally she began to treat her voices with respect, and to try to listen to
them for whatever wisdom they held, and as she encountered people who supported her
and had faith in her, and listened to her, the more she reconstituted.
I remember my first clinical experience in a mental hospital when I was a graduate
student. I was assigned to do psychological testing with a man who was diagnosed
‘paranoid schizophrenic’. I could find nothing crazy about him. However, he was a
subject of the weekly ward case conference. He was led in and the ward psychiatrist
interrogated him in front of everyone. And it was a cold, confrontive diagnostic kind of
interrogation, along the lines of what R. D. Laing once called a ‘degradation ceremony’. I
watched him disintegrate before my eyes. He began to talk crazy. He said things like ‘the
feds are out to get me but I’ve done nothing wrong’, and so on. Then he was
interviewed by a guest psychiatrist, who was a kindly old man and who treated him
in a much more Rogerian way. And I watched him reconstitute on the spot.
I wonder how much careful listening to people we label psychotic might help them
reconstitute over time, and help them proactively cope with and integrate their psy-
chotic experiences, no matter what the cause. I know the answer to that; I know that for
many of them it does help (Bentall, 2009; Whitaker, 2002, 2011). I believe, with some
confidence based on research that is mostly ignored in this country, that it will work
with at least between 40% and 60% of those we give the schizophrenic label to. And I
do not know how many more it might work with because our society does not believe in
it and even distrusts it.

A threat to personal integrity

So I argue that what we call psychopathology often occurs at interface points where the
person encounters something potentially toxic to his or her well-being and something

about the situation triggers conditions of worth, which lead to blame and self-criticism,
in such a way that the person begins to feel helpless and incompetent. That interferes
with their proactive, creative capacity to cope. They begin to break down in various
ways, generate negative affective experiences that are overwhelming, and behave in
dysfunctional short-term ways to cope, which backfire and make things worse.
So basically I’m saying that, psychopathology is the result of a threat to personal
integrity, to personal survival, to having a place on the planet, which causes the person
to become desperate, feel hopeless, and grasp at solutions instead of being able to
operate in a more wise fashion. Biological predispositions, traumatic experiences, and
the like, may be in part why the situation is unlivable or unmanageable for them, but are
not per se psychopathology. If people can cope successfully with those things, they will
not exhibit ‘psychopathology’. Certain situations can be said to ‘prey upon’ our vulner-
abilities, and we all have them.

Misguided postulates of psychopathology

I want to wrap up by suggesting that some other things that our theories postulate as
causes of psychopathology may actually be consequences of the factors I have discussed
in this paper. In particular, I want to mention the pervasive idea that psychopathological
behavior is based upon ‘avoidance’. This idea goes back to Freud, but can be found in
many different modern points of view, including cognitive behavior therapy, experiential
therapy, and existential therapy. A typical idea is that we avoid certain thoughts,
feelings, and experiences because they are painful. Therapy then becomes a matter of
encouraging the client to ‘take the risk of facing up’ to their avoided or repressed
feelings and experiences. This makes therapy a matter of courage, with the concomitant
implication, never stated, that the client’s problems lie with a lack of courage (see
Bohart, 2013).
I believe that the factors that I discuss in this paper account for what looks like
avoidance of feelings and experience, and that it is not avoidance per se that is the
cause of the person’s dysfunctional behavior. Feeling helpless or incompetent or threa-
tened, feeling your life threatened, so to speak, your place on the planet threatened,
unable to cope, vulnerable, you may not have time for feelings. Avoidance of feelings is
an attempt to cope when one feels under attack. You are trying to function as best you
can. You may not know that paying attention to feelings can help you cope. Or you may
not have the time and resources to pay attention to feelings. For instance, you may not
have the kind of empathic listening others who could help you do that. So you may
need to shut off or avoid feelings, not because they are painful, but because you don’t
have time or energy or resources for dealing with them. Better to focus on what
resources you have, and devote your energies to what you think you can control.
You shut off or avoid feelings, then, not because you’re afraid of them, as our
typical psychological theories say. To the contrary, I think clients don’t pay attention
to feelings because they’re courageous. They’ve decided to pay attention outwards.
They don’t have time for feelings, just like Jack Youngblood of the Los Angeles Rams,
who played the second half of a super bowl game with a broken arm. With clients:
Who has told them that staying with feelings is useful? Who has ever demonstrated
that to them? Nobody. And so they decide to ignore them and do the best they can.

It is courageous, intelligent, not avoidant. If you were alone, stranded in the wild-
erness, having to survive day by day, you wouldn’t have time to dwell on feelings
either. Humans are actually very good at facing pain and keeping on when they have
to, or when they have some sense that they can bear it and deal with it. People do it
every day across the world. People live in painful, unlivable situations, terrifying and
awful situations, and make meaning of their lives, all the time in this world. To
accuse them of avoiding feelings because they cannot face the pain is shameful in
my view.
Similarly, there are other pejorative and moralistic concepts we hang on clients for
behaviors that make more sense if we try to understand them as proactive attempts by
the person to ‘keep a place on the planet’, so to speak. One example is ‘resistance’. Often
we see resistance as an inability on the part of the person to ‘face up to the truth’.
Alcoholics, for instance, are accused of denial. But suppose that we see them instead as
trying to preserve some integrity, and as trying to preserve some sense of having a right
to a place on the planet. What appears to be resistance makes more sense. They are not
necessarily denying the truth about themselves so much as trying to protect some sense
of integrity. You have to have some sense of pride, some sense of faith in yourself, to
keep functioning, to keep trying. Better to focus on what you can do than on how
shameful you are.
Or, by denying that they have a problem, they are trying to protect some sense of
breathing room from the ‘should’ they feel that society is trying to impose on them.
Unfortunately, instead of grasping their proactive attempt to cope underlying their
resistance, we see it as pathological and prerjoratively label what they are doing as
‘resistance’, thereby increasing the chance of either their further resisting, or, if they buy
into our view, of their shame and self-loathing, which gets in the way and undermines
their ability to proactively function.
So, experiencing threat, feeling your existence threatened, you may react extremely
and look irrational (‘in denial’) to others. It reminds me of the fact that the disenfran-
chised often are driven to act extremely in order to have an impact, and then are
perceived by those who have power as ‘out of control’.

Thus, my basic thesis is that it is not necessarily the existence of problems in living
per se, including biological problems, trauma, and so on, that cause what we call
psychopathology, but rather, how we and others react to those problems. How we
react to our problems in living is determined heavily by the messages we get from
others in our past and current social environments. Thus, even if schizophrenia has a
biological component, it may be how we relate to people who have unusual experi-
ences, and then how that influences how they relate to themselves when they begin to
have those experiences, that determines whether it goes in a constructive or destructive
direction. Similarly, even if someone is prone to depression, or anxiety, or worry, such as
myself, perhaps if people weren’t afraid of being depressed, or of being anxious, or of
worrying, perhaps if they learned to accept it as part of living, perhaps they would not
magnify it into an enduring problem.

This implies that the solution to ‘psychopathology’ is to create a much more accept-
ing and empathic social environment that prizes individuals for their strengths, accepts
difference more, and provides available empathic listening when people are coping with
difficult experiences. This means that to get rid of psychopathology, we have to change
society. It is paradoxically society that may be psychopathological.
I want to conclude with the following metaphorical story.
I live in a society where there is a mismatch between its norms of what is valuable,
right, good, or healthy, and who I am. Perhaps I am quiet. Or I am overweight. Or I
am not good looking, or I am not socially very smooth, or I hear voices and see
things, or I am moody and get down for no good reason or sometimes get up for no
good reason, or I suffer loneliness intensely, or I have a high strung personality, or I
do not have an easy temperament, or I have suffered much trauma in my life and I
am quite sensitive, and have strange experiences. Or I am rebellious and noncon-
forming, or I am emotional, or I am not emotional, or I am extroverted, or I am
introverted, or I am a creative divergent thinker in a job or society that wants
conformity. And I am told that I am wrong. I am deficient, defective. If it is something
like anxiety or depression or hearing voices I may be told there is something
biologically wrong with me. That makes me feel even more helpless and margin-
alized. And perhaps I have not had the luck to have had people around me who have
been able to see me and help me recognize that I am of worth no matter what others
say. And so I feel helpless. I may feel deformed. I have struggled unsuccessfully to
change things about myself, believing it is fundamentally me. And so I believe I am
broken. And so I come to you and hope that you can fix me.
And what I get is someone who finally really listens to me. I am amazed that someone
really cares about my story, who really wants to hear me. I start to tell my story. At first I
am telling you my story because you are the doctor and I figure you need the informa-
tion so you can fix me. You can tell me what is wrong with me or how to cope. But you
listen so intently, you are so interested in me and my story, something that no one has
ever been interested in before – not my story – not me – that I suddenly find myself
telling you about me. I tell you about my struggles. How broken I feel. How helpless I
feel about that. How I have struggled to keep myself on this planet. And as I do that I
realize that there is a proactive me inside. I do not know what that is. But what it feels
like is something beyond time, something unique. There is an 'I'. And that I has hopes
and dreams. It is I who has suffered all these things.
What I get from you as you listen to my story is that I am interesting. I am valuable
because there is something utterly unique about me and my story and how I have tried
to cope. And soon I come into focus. I begin to find a way to balance things. I find that
‘I’ – a center. A valuable, intelligent center. And it is an 'I' that has hopes and dreams, and
can rise above the critical voices I hear from either inside or outside, or the moods I
have. It is an 'I' that can ‘own’ me. And my life direction. I am all my experiences and I
can own them and mind them, and mind them for whatever value they can provide for
me in my life. I am not my voices. I am not my moods. I am not whether I’m schizo-
phrenic or borderline or shy or extrovert or introvert or conservative and quiet or
creative and wild. And yet I am all these things at the same time.
‘I’ become wiser. I can take all these things, like a bricoleur or an artist, and use them
to create my life. It doesn’t matter if they are biological. I can use them to paint a life.

And that happens because you listen. You take me seriously. You treat me as an
authentic source of my own experience. I notice that when I am with you I become calm.
There is a calming of the storm. And then I can metaphorically arise from my doubts, my
sufferings, and walk forward. And I can find my own place on the commons with the
And that is what I wish for everyone.

Disclosure statement
No potential conflict of interest was reported by the author.

Notes on contributor
Arthur C. Bohart is a retired professor emeritus at California State University Dominguez Hills. He
was also affiliated with Saybrook University. He is the co-author or co-editor of several books
including How Clients Make Therapy Work: The Process of Active Self-Healing, Empathy Reconsidered,
Humanity’s Dark Side, and Constructive and Destructive Behavior. His work has focused on experi-
encing, empathy, the person-centered approach, and evidence-based practice in psychotherapy.
He considers himself an integrative person-centered therapist

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