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Client-Centered Therapy and

the Gender Issue

Jerold D. Bozarth
Professor Emeritus of the University of Georgia, USA

Kathryn A. Moon
Chicago, Illinois, USA

Abstract. The intended evolution of client-centered theory and practice to incorporate explicitly such
issues as gender only detracts from the essence of a universally potent approach to helping relationships.
In relation to issues of gender, specific di^noses and multicultural issues, altering the theory and practice
by adding onto Carl Rogers' original necessary and stifFicient conditions violates the essence of the
theory of client-centered therapy (CCT) and is an attempt to ftx something not broken.

Keywords: client-centered, gender, power, person-centered

Klientenzentrierte Therapie und das Gender-Thema

Der Versuch, die klientenzentrierte Theorie und Praxis dahingehend entwickeln zu wollen, dass sie
explizit Themen wie Ceschlechtsrollen beinhaltet, lenkt nur vom Wesendichen eines universell potenten
Ansatzes fur helfende Beziehungen ab. Wenn man die Theorie und Praxis in Bezug auf Gender, spezifische
Diagnosen und mtiltikulturelle Aspekte verändert, indem man Carl Rogers' ursprünglichen notwendigen
und hinreichenden Bedingungen etwas hinzufugt, dann wird dadurch gegen das Wesendiche der Theorie
der Klientenzentrierten Therapie (CCT) verstoßen. Das stellt einen Versuch dar, etwas zu reparieren, das
gar nicht kaputt ist.

La terapia centrada en el cliente y la cuestión de género

La evolución intencional de la teoría y práctica centradas en el cliente para incorporar explícitamente
temas tales como el género, sólo le resta mérito a la esencia de un enfoque universalmente potente a las
relaciones de ayuda. Con respecto a los temas de género, diagnósticos específicos y temas multiculturales,
modificar la teoría y la práctica haciendo algún tipo de agregado a las condiciones necesarias y suficientes
originarias de Cari Rogers, viola la esencia de la teoría de la terapia centrada en el cliente (CCT) y es un
intento de arreglar algo que no está roto.

Author Note. The authors may be contacted at: <>; <>.

© Bozarth and Moon 1477-9757/08/02110-10

Bozarth and Moon

La Thérapie Centrée sur la Personne et la Question du Genre

Faire évoluer intentionnellement la théorie centrée sur la personne et sa pratique afin d'y incorporer de
façon explicite des questions telles que le genre ne fait qu' "ôter" quelque chose de l'essence même d'une
approche des relations aidantes qui est potentiellement universelle. Par rapport aux questions du genre,
aux diagnostiques spécifiques et aux questions multiculturelles, le fait de modifier les conditions nécessaires
et suffisantes originelles viole l'essence même de la théorie centrée sur le client et tente de réparer quelque
chose qui n'est pas cassé.

Terapia Centrada no Cliente e a temática do género

A evoluçâo pretendida para a teoria e a prática centradas na pessoa, de modo a incluir explicitamente
temáticas como o género apenas as desvia da sua essência, a de uma abord^em à relaçao de ajuda
universalmente potente. No que diz respeito à temática do género, diagnósticos específicos e temáticas
muíticulturáis, alterar a teoria e a prática, acrescentando as condiçôes necessárias e suficientes originalmente
propostas por Cari Rogers, viola a essência da teoria da terapia centrada no cliente (TCC). Trata-se de
uma tentativa de remendar algo que nao está danificado.

Client-centered theory is based on a radical assumption about the client's capacity and right
for self-direction and self-development. The central practice task ofthe therapist is to experience
unconditional positive regard (UPR) toward the client and empadiic understanding (EU) of
the client's frame of reference. Any issue that does not arise from the client but is brought into
the relationship by the therapist creates a diversion from the premise of radical trust inherent
in the client-centered paradigm. The issue for the therapist in C C T is to consistendy experience
UPR and EU, even in the face of client experience that is diverse or surprising to the therapist.
The capacity to do so requires therapist congruence (the integration ofthe therapist's organismic
and self-experiences in the relationship). Readiness to experience openness in relation to any
client-driven issue that arises can be cultivated by a therapist's attention to their own integration
and self-development. The client's perception ofthe therapist's experiencing of UPR and EU
allows the client to determine the issues.


Gender issues have joined others such as cross-cultural, specific diagnoses, and developmental
issues, that are said by some to warrant special consideration by the person-centered therapist
— consideration that will improve the practice and theory of CCT. It has been argued that

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Client-Centered Therapy and the Gender Issue

client-centered therapists must make conscious efforts to attend to the relationship and systemic
context of human nature and human life (Barrett-Lennard, 1998, 2005), that practitioners
must be trained about gender (Schmid, 2004), and should reframe some client statements
from an "emancipatory feminist" perspective (O'Hara, 1996, p. 289). These are admirable
objectives that fall outside the CCT paradigm; the locus of control in CCT lies radically with
the client.
The broad gender issue is that women and minorities, including gay, bisexual, intersex,
and transgendered individuals, have been marginalized and assatxlted by mainstream society.
Inequities and abtise mtist be rectified. Given contemporary awareness of socially constructed
norms and the politically driven nature of many constructs, it seems important for therapists
to be cognizant of varying sensitivities, not only in relation to gender, but also in relation to
all aspects of human living. Some writers have proposed that the gender-specific aspects in
therapeutic and psychosocial relationships can enrich tmderstanding of person-centered therapy
(Schmid, 2004). Although likely true, such emphasis is taken further when Schmid suggests
that these aspects "require concrete concepts and approaches to action, including in those
interpersonal relations we call person-centred psychotherapy and counselling" (p. 180). In
saying this, Schmid joins others in altering the fundamental assumption of CCT; namely,
that it is the client who is capable of best knowing themselves and their life.
From our viewpoint, the gender issue might either subsume, be subsumed by, or be
concomitant to other issues of power related to CCT (Glauser & Bozarth, 2001). It can be
a practice challenge for a client-centered therapist to be ready for being receptive to issues of
power as they surface for the client.
Apptxhamilage describes her sense that questions of interpersonal and structural power,
both real and perceived, pervade all htunan relationships in myriad and sometimes surprising
ways. Her statement serves as one example of a congruent, as in self-aware and self-acceptant,
stance in the face of the dilemmas power imposes upon tis:
as I always see power in every human interaction; the way I see it, it is not something
abnormal, or wrong but a part and parcel of who we are as human beings. I would
rather accept it in the open and not pretend that there is no power in the group or in
the relationship ... (email communication, Augtist 17, 2007)

Regardless of client or therapist experiences of empowerment and disempowerment that

might flicker through a therapeutic relationship, sometimes raised for discussion by the
client and sometimes not, the client-centered therapist intends that power within the
relationship emergefromand reside vñth the client. How thorotighly this therapeutic intention
is experienced by the client relates to the degree to which the therapist is experiencing the
therapeutic conditions. Ironically, if client-centered theory is rewritten to bring in therapists'
social concerns, CCT's revolutionary placement of power in the client is turned on its head
as the client becomes disenfranchised from their own way, process, and direction. The challenge
for client-centered therapists is to address their own paths of self-development for praaice.
This is not a challenge for client-centered theory. The theory is clear about where the power
in the therapeutic relationship should be. The loctxs of power rests with the client.

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The objective of C C T is to facilitate one's freedom to be oneself on one's own terms. It is with
this freedom that organismic and self-experiences can be integrated (i.e., increasing
congruence), leading to increased maturity, more efficient problem solving, decreased anxiety,
more clarity about reality, and less dysfunction. The congruent therapist facilitates client
The construct of "congruence," ... makes a complete circle containing the
incongruence and the congruence of both client and therapist (Bozarth, 1998,2001;
Merry, 2001; Moon, 2002). "The development of congruence is... a development
ofthe human potential for experiencing" (Haugh, 2001, p. 127). A therapist who is
congruent in the relationship is present [experiencing unconditional positive regard
and empathie understanding] to facilitate the development of congruence in the
client. (Moon, 2005, p. 266)

C C T is an empathie process, unendingly attendant to client elaboration and change. It is the

therapist's attitude of consistent unconditional empathie reception that frees the individual
to deal with whatever issues she finds relevant.
The freedom for the client to determine the direction is enabled by the attitudes ofthe
therapist. When the therapeutic conditions are experienced by a therapist and perceived by
the client, they are necessary and sufficient. Client-centered theory is a paradigm that proclaims
the client to have the capacity to resolve issues when freed from conditional positive regard
imposed by society (Rogers, 1959).


A review by Wolter-Gustafeon (2004) delineates the commonality of feminist and client-

centered approaches to therapy. Like CCT, feminist approaches tend to respect a woman's
point of view and to not diagnose individual difference and nonparticipation in mainstream
behavioral norms or values as illness (Chesler, 1972/1997; Brown, 1994). In disctissions of
how the person-centered and feminist approaches can inform each other. Proctor and Napier
(2004) also document instances where feminist therapists advocate doing something more
than reception and acceptance of the client. Generally, feminist approaches do aim to add
more to the prescribed therapist activities of understanding and acceptance. For example,
even Brown, who was "shaped by Rogers' insights" (2007, p. 257) defines feminist therapy as
leadinghy advancing feminist resistance and transformation in personal, social, and political
environments (1994, p. 22).
Lerman ( 1992) critiques C C T for focusing on the internal experience ofthe client since
there are outside factors known to influence individuals, and su^ests that therapists address
problems that clients don't acknowledge experiencing. Likewise, O'Hara (1996) suggests
that the clinician is always biased in some way and might as a restilt be reluctant to accept

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Client-Centered Therapy and the Gender Issue

that the clients difficulty can be due to a societal force rather than an internal psychological
diflPiculty. Negative social forces can include therapists who do not realize their own inability
to accurately empathize and underestimate their own power in the relationship. Both Lerman
and O'Hara are concerned that a therapist will blame an individual woman for problems
caused by external factors beyond the ken of an under-enlightened therapist.
C C T theory has a response to these concerns. A fundamental assumption in C C T is
that conditions of worth from society and significant others are the cause of psychological
distress. It is the freedom fi-om these conditions of self-regard that facilitates the individuals
capacity for self-empowerment. The concern in C C T is not that patriarchal institutions
limit and constrict the possibilities for women. The concern is whether or not this is, in fact,
perceived as true by a given woman and, if so perceived, that the woman's self-determination
is facilitated in a way that enables her to find her best way of dealing with the factors imposed
on her. In C C T there is no concern that problems unacknowledged by clients be addressed.
The client-centered therapist trusts that even if neither client nor therapist becomes aware of
the precise nature or source of the client's distress, the client-centered relationship can assist a
person to increase their own experiencing and to progress in their own terms. Even though a
problem may indeed be discussed by a client, C C T focuses on the person and not the
An essential difference between feminist approaches and C C T is the feminist political
interest in diagnosing and educating a woman to the socio-economic oppression she endures
and the tendency to seek to generalize experience. C C T attends to the unique experience of
a particular individual and the meanings and feelings they attribute to their experience.
Insertion of any political position into the more phenomenological paradigm of C C T distracts
from the central therapeutic intent to be with the person and not fix or treat a problem. Any
extra therapeutic agenda corrupts a therapist's potential for embodying UPR and EU. It can
undermine the therapist's capacity to embrace this woman's personal and complex experience
in the context oí her relational, economic and political context in her story at this time.
The disparities between client-centered and feminist therapies include the difference
between nondirective and directive therapy and the role of therapist expertise over the client.
In terms of the recognition of social, political and economic problems and respect for the
experience of the individual, there are similarities between C C T and some feminist therapy.
But in terms of client-centered values, therapist presuppositions about any problem can
undermine the client's internal locus of evaluation and progress toward their own goals.
In Women's Ways of Knowing, a study that crosses the lines of economics and education,
Belenky, Clinchy, Coldberger and Tarule conclude:
We have argued in this book that educators can help women develop their own
authentic voices if they emphasize connection over separation, understanding and
acceptance over assessment, and collaboration over debate; if they accord respect to
and allow time for the knowledge that emerges from firsthand experience; if instead
of imposing their own expectations and arbitrary requirements, they encourage
students to evolve their own patterns ofwork based on the problems they are pursuing.
These are the lessons we have learned in listening to women's voices. (1997, p. 229)

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Client-centered theory is consistent with this view and calls for no insertion of any particular
issue to distract from its fundamental premises.
Proctor (2004) suggests that greater knowledge about gender issues can help a therapist
better understand the client s world. This may often be true. Any education has the potential
to inform a therapist's understanding of a client's world. The client-centered task, though, is
to remember that the client's perception of what is at issue trumps everything else. The
essential instruction for a therapist is to seek to understand the client's frame of reference, not
allowing the therapist's learning to interfere with the client's initiative.


The main qualification for a client-centered therapist working from a gender stance is that
the therapist be able to understand and accept without judgment the client's phenomenological
world, including the client's meanings, intentions, experiences and wishes. It might be difficult
for a particular male therapist to really understand the world of a particular female client. A
gay or lesbian client might not be sufficiently aware ofthe cultural prejudices that affect his
or her self-esteem to be able to raise or give voice to this inner experience. Indeed, in infinite
aspects of life experience, individuals might not be out to themselves about that to which they
are as yet unaware. It is precisely this universal human condition that is addressed by client-
centered theory and practice.
The male therapist above becomes a better therapist, a more sensitive and self-aware
therapist as he stays with the client. Because the therapist is experiencing congruent self-
acceptance he can follow and listen to the client. As the therapist learns about the client's
experience, his understanding becomes richer. Also, through coming to understand an
experience that may be quite different from his own, the therapist grows. The therapist's
education in diversity is furthered by the uniqueness of each client. In 1987 Rogers was clear
on the subject of therapist prerequisites:
I know some very good person-centered therapists who have had no training at all!
... I think... one needs to experience a person-centered approach either in an intensive
group for some period of time, or in individual therapy ... I don't, however, believe
in requiring such an experience ... I think that breadth of learning is perhaps the
most important. (Rogers, in Baldwin, 2004, p. 259)

For the development of a therapist, Rogers recommended breadth of learning and not more
elaborate specialist education. Reading feminist theory might be what assists one therapist to
grow in openness toward others, while reading novels and poetry or going to the movies
might prove to be more growthful to another.
Therapist congruence is the necessary ingredient for enabling a therapist to be consistendy
empathically receptive of the client's experience. One way for client-centered therapists to
self-develop in the direction of being receptively present with clients is to seek for themselves
client-centered therapy and consultation and person-centered group meetings.

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Client-Centered Therapy and the Gender Issue


The following, reported with permission from personal notes by one of the authors, offers
one unique example of therapy with a woman who was faced with her own gender issue:
A graduate student, Sarah, requested therapy sessions. She was married with three young
daughters. Sarah had been a sttuient in a class taught by the therapist. She knew that some
theoretical approaches considered a therapeutic relationship between student and instructor
a dual relationship, but she objected to "that kind of decree. " Her husband would not
permit her to see a therapist However, he would not object to her talking with one of her
instructors as long as she kept her husband informed of their discussions.
The therapist remembered Sarahfrom class because of her astute questions and comments
as well as her outstanding work on assignments and classroom activities. They met once a
week for about five months until she graduated.
Sarah spent most sessions describing her life, expressing her lovefor her three daughters
and remembering their many activities together. She sometimesfelt guilty about returning
to school and expressed appreciation toward her husband "who is a very good man" for
allowing her to seek a vocational goal of being a counselor. She planned to be a "Christian
Counselor". She sometimes cried while describing some of her church activities, saying that
she would miss such activities after obtaining her degree. Tt became clear during the sessions
that she was a devout Christianfollowing strict tenetsprescribed by her church, and dictates
from her husband who was minister of the church.
She believed that a woman should "obey" her husband and that women should always
support their husbands. She was occasionallypunished by her husband for "sinful" behavior
whereby she was banished to her room with no books except the Bible.
There were periodically intense sessions that involved her crying and mostly expressing
how she did notfeelfree to be herself. These sessions were mixed with expressions of feeling
guilty about not being more "psycholo^cally" involved with her family. Ofien, she would
ask the therapist about his life, or just ask: "What did you do this weekend?" His answers
were generally a short response of something like: "Not much, how about you?" or "Same
old thing working around the house, andyou?" He sometimes offeredmore clearly empathie
responses referringto her wonderingwhat he did at home. Once, he spontaneously responded
to her question about his weekend with a story. The story took about five minutes to tell and
described an event that while he was working on a car, the vehicle rolled down a steep hill
and destroyed his rabbitpen. Sarah brought up the story in the next session saying that she
was glad the therapist had told it to her because it offered a "break"fiom the feeling that
came up in the session before that one. Shefelt that it made it easier for her to continue with
the feeling. She then talked about how different her family was fiom mostfamilies, and
how different her belief were fiom so many other individuals. The therapist felt that she
was hesitantly questioning her belief and, especially, her role as a woman.
One thing that occurred in later sessions was that she would often ask him if he loved
her. She would continue before he responded hy saying something like: "Well, I know that
you do, you love everyone. "

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He lost track of Sarah when she graduated. Fifteen years later, a woman came to his
table at a restaurant. The woman was Sarah. Because she had lost a hundred or more
pounds, he atftrst did not recognize her. She said that shefelt outgoing and happy. She had
divorced and remarried and worked as a health coordinatorfor a local hospital She told
him that their sessions had instigated her decision to change her life and, also said that one
thing that helped her was that she was able in her mind to have an "affiiir" with him. She
felt that this was what was needed at the time. A love affair was essentialfor her toftnd
courage toftnd her independence. It was only this that would enable her to break ftom her
husband and the abuse that she felt. She could not really take such action but felt ftee to
hold this as afantasy that carried her through some diftßcult internal decisions that eventually
led to action.


As a client-centered therapist abiding by Rogers' (1959) theory of therapy, I entered the sessions
vidth one intent. This intent was to unconditionally accept and understand Sarah's frame of
reference. I had no presuppositions about v^^hat she might do, be, or become. My only goal was
to experience Sarah's frame of reference (and as part of the empathie process to experience
unconditional positive regard towards her). This brief scenario suggests that this was achieved.
Perhaps it is significant that Sarah never did give a reason for requesting therapy. I never
questioned her about any specific topic or area. The therapeutic atmosphere felt fi^e enough for
her to raise issues and to stay vwth them or leave them. It is never up to me to decide what
direction the client should take. Some of our discussions seemed to be rambling and without
direction. I spontaneously, without any intent, told her a seemingly irrelevant story about one
ofmy weekend activities. She experienced it as meaningRil and timely. I periodically felt somewhat
embarrassed by her repeated question: "Do you love me?" Generally, I was slow enough
responding that she answered for me. The moments when I held some explanatory theme of
what she was talking about; for example, that she seemed to be discussing her beliefs and role as
a woman, I quickly dismissed them in order to attend to her fi:ame of reference.
Looking through a rear view mirror, it might be easily decided that there was a gender
issue. But, I think that issue would have been more my concern and not necessarily an issue
for Sarah. Rather, there was a complex mesh of religious beliefe, spousal relationship, motherly
love and obligations, desire for a different type of love, and feelings of low self-worth.
I, as therapist, did not know the extent of change that occurred with Sarah. I felt that I
did the best I could for her. My only goal was to experience Sarah's world with unconditional
acceptance. I could in no way imagine that through a chance encounter fifreen years later I
would discover that our interactions significantly affected her life in a positive way. I was even
more surprised by her explanation ofthe unique thought process that brought her to dramatic
life changes. I believe that my trust in her capacities and unconditional reception of her
world was part ofthe stimulant for her eventual life changing actions. This seemed to be her
opinion as well.

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Client-Centered Therapy and the Gender Issue


The survival ofthe theory of client-centered therapy as a coherent statement of a revolutionary

approach, and its potency as a worthy form of therapy, rest upon adherence to the central
tenets of its theory and the quality of its practice. That is to say, they rest on client-centered
therapist congruence within a therapeutic relationship characterized by a therapist experiencing
unconditional positive regard and empathie understanding for the client. Other therapies
may be effective but they are not client-centered in that they deviatefromthe radical assumption
of self-determination and self-growth that is the bedrock of Rogers' (1959) client-centered
therapy. When the therapeutic conditions are no longer considered sufficient, Rogers' theory
of therapy is altered. Client-centered therapy is then not being described, practiced or
understood at its most fundamental and operational level.


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