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The Significance of Therapist
Genuineness From the
Client’s Perspective
Jutta Schnellbacher
Mia Leijssen
Katholieke Universiteit Leuven
Therapist authenticity is viewed as an important therapeutic process. The
client’s experiencing of the process and significance of therapist genuineness
is, however, under-researched. In a case study (N=6), the authors analyzed
the clients’ experiencing of the overall significance of therapist genuineness
in their therapy. Both qualitative and quantitative data were gathered and ana-
lyzed using the technique of pattern matching. The authors found that clients
also experienced processes other than genuineness as crucial therapeutic
processes. Nevertheless, the results show that therapist genuineness can be a
crucial therapeutic process. The findings imply that whether and how genuine-
ness is crucial for change also depends on the individual client.
Keywords: therapist genuineness; therapist self-disclosure; psychotherapy
relationship; psychotherapy process research
Genuineness, or authenticity,1is defined as “the ability and willingness to
be what one truly is” toward oneself and the other in the mutual rela-
tionship (Gelso & Carter, 1994, p. 297). Lambert (1992) has concluded that
practically all therapeutic orientations consider therapist genuineness as
“important for significant progress in psychotherapy, and, in fact, funda-
mental in the formation of a working alliance” (p. 104). Likewise, the Task
Journal of Humanistic
Psychology
Volume 49 Number 2
April 2009 207-228
© 2009 SAGE Publications
10.1177/0022167808323601
http://jhp.sagepub.com
hosted at
http://online.sagepub.com
207
Authors’ Note: This article is based on the master’s thesis of Jutta Schnellbacher (2005)
completed with the supervision of Mia Leijssen, Katholieke Universiteit Leuven, Belgium.
The interview protocol and the category system (the classification and coding scheme) used
in the presented study are available from the authors. We thank Robert Elliott for his helpful
and valuable comments on an earlier version of this article. We are also grateful to the
clients and therapists for their participation. Without their openness, trust, and time, this
research would not have been possible. Correspondence regarding this article should be
addressed to Jutta Schnellbacher, Leuvensestraat 11 bus 201, 3010 Kessel-Lo, Belgium;
e-mail: jutta.schnellbacher@gmail.com.
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Force on Empirically Supported Therapy Relationships recently evaluated
therapist genuineness as a “probably effective” element in the therapy rela-
tionship (Steering Committee of the APA Division 29 Task Force, 2001).
Genuineness has multiple conceptual elements in the form of different
strongly intertwined processes (Lietaer, 2001; Wyatt, 2001). Based on an
extensive literature study (Hill & Knox, 2002; Klein, Kolden, Michels, &
Chrisholm-Stockard, 2002; Knox, Hess, Petersen, & Hill, 1997; Lietaer,
2001; Wyatt, 2001; Yalom, 2002), we define therapist genuineness as being
aware of one’s own experience (self-awareness); being emotionally involved
in the client’s story and the here-and-now interaction, being personally pre-
sent (self-presence); and being willing to intentionally and verbally reveal
personal feelings, thoughts, impressions, experiences, facts, views, values,
and methods of working (self-disclosure; Yalom, 2002). Consequently, ther-
apist genuineness is an inner attitude, a relational experience, and a dynamic
process between client and therapist (S. M. Geller & Greenberg, 2002;
Grafanaki & McLeod, 2002; Klein et al., 2002; Lietaer, 2001).
This article covers the significance of therapist genuineness and focuses
on client experience. Self-disclosures, for instance, are powerful interven-
tions with a large impact on the therapy relationship and client process
(Barrett & Berman, 2001; J. Geller, 2003; Hill & Knox, 2002; Safran &
Muran, 1996; Van Kessel & Lietaer, 1998; Yalom, 2002). However, the role
and dynamics of genuineness are under- researched, compared to the fre-
quency of self-disclosures or correlations between therapist genuineness
and therapy outcome. Accordingly, little empirical knowledge exists about
the precise changing mechanisms and significance of therapist genuineness
and the corresponding client experience (Grafanaki, 2001; Hill & Knox,
2002; Knox et al., 1997). A better understanding of how clients experience
therapist genuineness would strengthen the value and usefulness that the
therapist’s authentic presence can have for clients.
Therapist Genuineness in Person-Centered
and Experiential Therapies
In person-centered and experiential (PCE) therapies, one considers the
authentic element in the therapy relationship as a crucial process for heal-
ing and substantial personality change. In present PCE therapies, therapist
genuineness is one of the most central concepts (Lietaer, 2001; Schmid,
2002; Swildens, 1988).
The significance that PCE therapists attribute to therapist genuineness can
be better understood from the context of dialogic anthropology.2Dialogic
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anthropology starts from the central idea that human existence always occurs
in relation with the other. In the encounter with the other we encounter our
own self, and in the encounter with our own self we encounter the other
(Carp, 1973, p. 35, as cited in Takens, 2001). The relationship with the other
therefore confirms our human being and brings us nearer to our process of
becoming by questioning ourselves (Schmid, 2002, p. 60). An authentic rela-
tionship is a relationship in which we address ourselves from person to
person, as opposed to purely strategic acting. Dialogic anthropology calls
this form of relationship an “encounter” (Buber, 1923/1996). Encountering
assumes that one “faces” the other, instead of either merging with the other,
or objectifying the other (Schmid, 2002, p. 61; Swildens, 1988). By posi-
tioning oneself in front of the other, one recognizes that person namely in his
or her autonomy and individuality and as someone with whom it is worth
making contact. A relationship from person to person is therefore character-
ized by authenticity in both persons involved. Authenticity presumes open-
ness both for oneself and for the other. After all, authenticity is the ability to
be touched, surprised, changed—all in the relationship with the other—while
keeping touch with one’s own inner experience and interpretations and form-
ing a personal point of view. Authenticity thus creates the foundation for
speaking with each other instead of talking about each other, and this is a con-
dition for entering into a dialogue. Consequently, authenticity is not a naïve
or merely spontaneous attitude but an intentional step toward the other to
encounter the other. Besides this, Schmid (2001) also emphasizes the inter-
connectedness of authenticity, spontaneity, and creativity. Spontaneity and
creativity are inherent in authenticity and therefore are essential in a personal
relationship. Authentic reactions are always creative reactions, fed by inner
sources and guided by trust in the actualizing tendency.
Thus, the therapist’s task is to perceive the client as a person and to
respond as a person. Therapists bring their being into the therapy relation-
ship, with their whole personality, identity, soul, and spirit. Consequently,
therapeutic genuineness always goes together with sincere involvement. An
authentic therapist does not put up a facade and does not set self aside in
emphatic listening. Neither does he or she imitate a model or copy self from
other situations (Lietaer, 2001; Wyatt, 2001). Therapist authenticity there-
fore implies room for spontaneity and creativity. This entails that the ther-
apist’s personality and way of being also determines what happens between
client and therapist. The willingness of the therapist to share experience
with the client supposes that the therapist can admit and accept his or her own
vulnerability and is open for the experience to be touched and influenced
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by the other (Gaylin, 1996; Leijssen, 1999). Perhaps it is because of this
vulnerability that no other concept seems to provoke so much uncertainty
and ambivalence among therapists as self-disclosure. Nevertheless, one
always reveals personal aspects. The question is only how much, what, and
when one discloses aspects of one’s self.
Therapist genuineness can be expressed in various ways in communica-
tion with the client. Globally, we can distinguish between (a) personal pres-
ence and (b) self-disclosure (Lietaer, 2001). In practice, these two aspects
are strongly intertwined and are situated on a continuum, rather than on two
separate poles.
Personal presence means that the therapist is emotionally involved in the
client’s story and the here-and-now interaction. Personal presence implies
“the shining through of who the therapist is as a person through everything
he [or she] does and does not do, instead of putting up a facade” (Lietaer,
2001, p. 43).
Self-disclosures have very diverse definitions in the existing literature (for
an overview, see Knox et al., 1997). We define therapist self-disclosure as
intentionally and verbally revealing personal feelings, thoughts, impressions,
experiences, facts, views, values, and methods of working. Defining self-
disclosure broadly makes it possible to investigate subtler or less intimate
forms of self-disclosures as well. Research by Schnellbacher (2005) revealed
four different kinds of therapist self-disclosure: (a) disclosures about experi-
ences or facts in the therapist’s life outside the therapy session or about
personal perspectives and values (therapist life disclosure); (b) clarity and
transparency about the therapist’s line of thoughts, reasons, and motives
during the in-session actions, the therapist’s affective state, and the personal or
tentative nature of interventions (personal clarity disclosure); (c) disclosures
of feelings, thoughts, or images evoked by the client’s story (client content
reaction disclosure); and (d) disclosures about experiences of and with the
client in the ongoing interaction (interaction disclosure).
Different helpful therapist self-disclosures are expected to have different
positive effects on the immediate process, which in turn will indirectly influ-
ence the therapy outcome. Research by Schnellbacher (2005) revealed five
different helpful effects of self-disclosures: (a) encounter with a human being;
(b) positive effects on the quality of the therapy relationship; (c) facilitating
and deepening the client’s process of experiencing; (d) facilitating constructive
changes in behavioral and mental patterns; and (e) an increased sense of the
therapist’s authentic presence. The specific effects are expected to vary widely
depending on the individual client.
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Purpose
The purpose of the present study was to examine the meaning and sig-
nificance of therapist genuineness, and the characteristic features and effects
of therapist self-disclosures. For this purpose, we used qualitative methods
to describe the extent to which findings from the literature, which are mainly
based on therapists’ clinical impressions, correspond to the experiences of 6
clients who were, or had been, in PCE therapy. The research focus was thus
on the client’s experience (see “Methodological Aspects”). To realize the
objective, we formulated, based on an extensive literature review and a con-
ceptual framework, eight hypotheses, which were tested on the client expe-
rience. In this article, we only discuss the results regarding the hypothesis
that relates to the significance of therapist genuineness as a crucial process
for healing and substantial personality change.
Methodological Aspects
A multiple case study design was used to explore client experience of
therapist genuineness and to test our hypothesis. Case study research
enables us to challenge on a micro level a specific theory by examining the
extent a hypothesis does or does not hold for a number of concrete cases
(Corveleyn & Luyten, 2002; Yin, 1989). Furthermore, case study research
enables us to modify and elaborate theory (Stiles, 2005). According to
Flyvbjerg (2006), “The closeness of the case study to real-life situations
and its richness of multiple wealth of details are important for the develop-
ment of a nuanced view of reality” (p. 223). For that reason, a case study
design lends itself for studying specific and complex therapy events in their
natural context. Real-therapy studies (as opposed to analog studies) are largely
missing in the research literature on therapist genuineness (Grafanaki, 2001;
Hill & Knox, 2002).
Researching genuineness from the client’s perspective, and not purely
from the therapist’s perspective, is in line with recent research findings that
genuineness is a relational experience and an interpersonal process, instead
of merely an attitude of the therapist (S. M. Geller & Greenberg, 2002;
Grafanaki & McLeod, 2002). Besides the client’s experience, we also used
the clinical impressions of the therapist to interpret certain results.
In the current study, we studied only the extent to which genuineness
was felt as crucial insofar as clients themselves referred to aspects of the
concept genuineness. Furthermore, we examined only the degree to which
clients experienced genuineness, as such, as a crucial therapeutic process.
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It is much more probable that therapist genuineness, besides its direct effects
on the therapy outcome, also contributes indirectly to change, namely by
mediating the impact of empathy, acceptance, and concrete interventions
(Klein et al., 2002; Lietaer, 2001). Taking these objections into account, we
therefore used rather strict criteria to be able to speak about “genuineness
as a crucial therapeutic process.”
Method
Participants
Participants in this study were 6 female clients, respectively 21, 22, 31,
40, 48, and 58 years old. All clients were of Belgian nationality. Five clients
were currently involved in outpatient psychotherapy with a PCE therapist.
One client had just terminated her outpatient psychotherapy (also with a
PCE therapist) at the time of the study. This terminated therapy had lasted
slightly more than 18 months. The duration of the therapies in progress was
between 3 months and 3 years, with an average duration of 16.2 months. The
therapy sessions took place in private practice or in the university counsel-
ing center. Clients presented with a variety of personal concerns (i.e. loss,
sexual or physical abuse, family conflicts, and difficulties in interpersonal
relationships).
Three female therapists and one male therapist participated in the study.
The therapists were two doctoral-level and two master’s-level clinical
psychologists. All therapists had followed a postgraduate training in PCE
therapy and had more than 10 years of therapy experience.
Procedure
Recruitment of clients. We asked eight therapists to participate in a dis-
sertation study about client experience of therapist genuineness. More
specifically, we requested that they ask clients whether they would like to
participate in a study about client experience of helping processes in
psychotherapy. Subsequently we contacted the clients who were willing to
participate in our study. The study was presented as an exploration of the
client’s experience of helping processes in psychotherapy. None of the
6 clients dropped out of the study. One of the clients served as pilot case to
test and modify the research design.
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Data collection. During a period of six months, the primary researcher
(Jutta Schnellbacher) conducted a semistructured interview with the 6
clients. Each interview was preceded by the procedure of informed consent
and lasted about 1.5 hr. The interviews were recorded on audiotape with
permission of the clients. Finally, there was the debriefing, in which we
informed the clients about the specific research questions and answered any
questions.
After the main data collection, we contacted the therapists, with the
permission of the clients, and asked for specific context information. This
context information served to clarify the empirical findings. In the conver-
sations with the therapists, we inquired into the clinical interpretations of
the therapist on the results we found from the interview with the client. In
this way the study material was augmented with the clinical interpretations
of the therapist.
Measures3
Context information. At the beginning of each interview, the client was
invited to recount briefly on her background, any previous therapy experi-
ences, and her treatment goals for the current therapy. This background
information provided a broader context for the interpretation of the data and
allowed understanding of the specific events and experiences clients would
describe later in the interview.
Interview. Qualitative data were collected by means of a semistructured
interview on the subjective experience of the significance and meaning
of therapist genuineness and of the features and effects of therapist self-
disclosures. The use of interviews allows collecting in-depth information
(McCracken, 1988, as cited in Hill & Lambert, 2004). At the same time, the
predefined interview protocol of a semistructured interview makes it possible
to obtain consistent data across the different cases. This type of interview is
less vulnerable to researcher effects (the tendency to confirm the researcher’s
preconceived notions), which increases the validity of the study (Hill &
Lambert, 2004). The interview protocol we had designed focused on the sub-
jective meaning the client attached to, among others, the following aspects:
the experiencing of the therapy relationship and the presence of the therapist,
the meaning of therapist genuineness, helpful processes in the therapy, and the
impact of helpful self-disclosures. In order not to influence the client and
be suggestible, we did not use terms like genuineness, authenticity and self-
disclosure in the interview. Some examples of the questions of the interview
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are the following: “What are, in your experience, important aspects of your
relationship and cooperation?” “How do you experience your therapist in
your relationship and cooperation?” “What do you experience as most help-
ful in therapy?” and “Do you remember responses of your therapist that were
special for you?”
Content Analysis
The interview data were processed by means of a carefully theory-based
systematic analysis of the clients’ meaning (content analysis). Content
analysis is a systematic, replicable method for ordering words of text into a
smaller amount of content categories (Weber, 1990). The approach to cod-
ing data we used was a priori coding. In a priori coding, a classification and
coding scheme (category system) is established before the analysis and is
based on some theory and on agreement of professional colleagues on the
categories. This scheme is tested and refined in the pilot case (Weber,
1990). The category system allowed both verification and falsification of
the hypotheses. For testing the hypothesis of this article, we primarily used
the main category “Client statements on exceptionally helpful processes for
healing and personality change offered by the therapist.” The first subcate-
gories dealt with the significance of authentic presence and exceptionally
helpful processes other than genuineness.
To form an impression of the reliability of the category system, three
coders coded the interview material from the pilot case independently of
each other. Two of the coders were not informed about the research hypoth-
esis. This enabled us during the coding of the pilot case to minimize demand
characteristics (biases in the results because of the expectations of the
researcher). Based on observed differences in assigning the codes, the cate-
gory system was adjusted.
Data Analysis
The research data were analyzed by applying the technique of pattern
matching. With the technique of pattern matching one investigates the extent
to which an empirically discovered pattern corresponds to a theoretically
predicted pattern that has been defined before data collection. The compari-
son between the predicted and the empirical pattern occurs by searching for
both converging and diverging lines of meaning in the data (Corveleyn &
Luyten, 2002), that is, for both information that confirms and informa-
tion that contradicts the hypothesis. When interpreting the data, we relied
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primarily on the client interview material. The therapist’s interview served
to complete and possibly clarify findings from the client interview.
The data analysis took place as follows. The research data were first
analyzed by case. In these intracase analyses, we examined for each case the
extent to which each hypothesis was or was not confirmed. In the cross-case
analysis, we compared the 6 cases to each other. Here we analyzed for each
hypothesis the patterns of similarities and differences between the 6 cases,
and from this we formulated conclusions about the current hypothesis.
Validity and Internal Auditing
Content validity. Content validity refers to “how good the content of a
specific theoretical construct is operationalized in a research study”
(Corveleyn & Luyten, 2002, p. 42). In the present study, the content validity
was first optimized by formulating in advance the interview protocol and
the category system, based on an extensive literature study; by consequently
testing them in the pilot study; and adjusting where necessary. Second, we
employed different empirical sources and methods in the study. According
to Yin (1989), this data triangulation has an important function in increas-
ing the validity. Indeed, our data triangulation allows for interpreting an
event from different perspectives (the client’s experience and the clinical
interpretations of the findings by the therapists).
Interpretative validity. Interpretative validity is obtained to the degree
that the meaning given by the participants is accurately understood and
reported by the researcher. To obtain as much interpretative validity as pos-
sible, we linked the interpretations in the intracase analyses as closely as
feasible to the clients’ concrete statements. In addition, we focused in the
analyses on both converging and diverging lines of meaning. Moreover, in
the interpretation, we made use of the context information we had collected
during and especially in the beginning of the interview. Finally, the data tri-
angulation we used also served to increase the interpretative validity
(Corveleyn & Luyten, 2002). Researcher effects were reduced as much as
possible by selecting the cases based on availability and by employing a
semistructured interview.
Internal auditing. In stage 1, the primary researcher coded the client
interview data for each case, the first pilot case being the last coded case
(to minimize coding based on remembering the assigned codes of the first
stage). To correct for learning effects, the coded material was critically
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compared to each other and adjusted in a second stage. Stage 3 took place
two to three months after stage 2 (to minimize coding based on remembering
prior coding), coding the interview data for each category without seeing
the already assigned codes of stage 2. In the fourth and last stage, the codes
assigned in stage 2 and 5 were compared for each line of meaning. Based
on observed differences in assigning the codes, the codes were adjusted to
receive the definitive coding for each line of meaning.
Results
Processes Other Than Genuineness as
Most Crucial Therapeutic Processes
The cases4of Anna, Amber, Kim, and Zoe do not support the hypothe-
sis that genuineness is the most crucial therapeutic process. It is obvious
that these 4 clients experience other processes than genuineness as most
crucial for healing and personality change; among these are empathy, accep-
tance, and attention to inner experiencing. In all 6 cases it appears that the
clients experienced the therapist’s attitude of acceptance as the most helpful
or an important therapeutic process. We define acceptance as an open and
receptive attitude toward the client experience, the absence of judgment,
and respect for the client as a human being. The significance of acceptance
and empathy appears, for example, in Kim’s response to the question of
what she received as most helpful in her therapy:
That T5just listened to what I was saying and really tried to understand me.
And that I was allowed to feel what I felt. When I am with her, I can say
everything. Whereas in everyday life, you’re not allowed to feel always bad.
And also that she is just there. She is there for me. This is not the way it is
like in everyday life. And that I can tell what I want and I determine by my
own what to say and what not.
The researcher said, “You are saying ‘T is there for me.’ How do you
notice that?”
I feel that she understands me. She listens. And she repeats things I told about
in her own words. And when she does not understand something, she will ask
to clarify. So I know that she can follow my reasoning. (Kim, fragment 8)
Furthermore, the cases of Anna and Lea point to the crucial significance
of attention to inner experiencing and interventions that are directed at the
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focusing process (interventions that help the client to contact her bodily felt
experience and make it more explicit). The following fragment from Anna’s
case elucidated this. The researcher asked, “What did you experience as
most helpful in therapy?”
The fact that T let me experience the things. This was for me most important
and by this, I made huge progress. I could really feel what I did wrong and
where everything was tied up. I looked at all my problems with all psycho-
logical terms, I knew everything, I had read psychological books, I knew it
all, and still I did not get further. It is only since she let me feel all these
things and worked with these feelings that I got further. (Anna, fragment 17)
Finally, clients Anna and Kim reported that they experienced increased
insight and self-knowledge and newly acquired ways of thinking as partic-
ularly helpful. For example, Kim reported that she experienced as particu-
larly helpful that T offered her new ways of thinking by introducing aspects
of her own frame of reference.
Genuineness as the Most Crucial Therapeutic Process
The cases of Lea and Eef strongly differed from the other 4 cases. The
findings from Lea and Eef support strongly—but not totally—the hypothe-
sis that genuineness is the most crucial therapeutic process. The case of Eef
supports the hypothesis because of the crucial impact of the repeated inter-
action disclosure about Eef’s caring and adapting attitude toward her ther-
apist. Eef explicitly indicated as most helpful her therapist’s emotional
involvement to name what is happening in the relational here-and-now,
instead of just letting Eef tell her story. The therapist’s self-disclosures
brought Eef into contact with qualities and needs on the interpersonal level
for which she had little eye before and stimulated her to take a less self-
effacing attitude in relationships and to dare to take more personal space,
which was in fact her treatment goal. In the following fragment, Eef pointed
out that she had experienced T’s interaction disclosure as the most crucial
therapeutic process. The therapist asked, “What did you experience as most
helpful throughout the whole therapy?”
The most helpful was T’s emotional involvement: T didn’t just let me do my
story but said, “Maybe you are now rather taking care of me.” From this emo-
tional involvement, things were questioned or confrontations or challenges
arose. The involvement also brought about an unpleasant or uncomfortable
feeling, so in that sense it was not the most pleasant, but still it was the
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thing that helped me most. Which is ultimately the purpose of therapy. (Eef,
fragment 22)
According to Eef’s therapist (personal communication, May 17, 2005),
as a child, Eef had experienced in her relationship with her mother that she
obtained her right to exist by tuning sensitively to her mother’s needs. By
repeatedly naming Eef’s pattern of a caring and adapting attitude toward
the therapist—who, for Eef, was to a certain extent a mother figure—Eef
reportedly got the opportunity to experience that she can separate without
loosing the mutual solidarity. The therapist’s genuineness in the mutual
communication appeared to facilitate the feeling that Eef could develop
more autonomy in mutual solidarity.
In the case of Lea, the crucial impact of genuineness in communication
was particularly reflected in the helpful effects of the encounter with another
human being. Lea found these “deeply human moments of encounter” the
most important moments in her therapy. The self-disclosures of Lea’s ther-
apist created intimacy, for example, and had a reassuring effect. A particu-
larly helpful intervention was in Lea’s feeling a self-disclosure in which
T responded to Lea’s description of a metaphor of her loneliness, in which
she is sitting alone on a sand dune in the desert. Lea described the impact
of this self-disclosure as follows:
It was especially the fact that T said: “I would like to sit next to you [on the
dune]. Look, we do not need to say anything to each other, right now. You are
sitting lonely at your spot, and I will go to another hill and sit there lonely
too. And we know how this feels. You do not need to talk, you do not need to
comfort or reassure each other, but you are allowed to feel lonely here and
now.” Yes, and he made this recognizable. . . . This gives me an enormous
reassurance, I mean, I do not have to fight against it: It’s alright. Human exis-
tence means being lonely, in fact. . . . It is deeply human, a deeply human
encounter. The loneliness is there, but you are not alone. And you know of
each other that you are dealing with it. . . . In my feeling, these are the most
important moments in therapy. (Lea, fragment 18, 35)
According to Lea’s therapist (personal communication, May 19, 2005),
the existential dimension was strongly present in Lea’s therapy, and this
went along with plain self-disclosures in which the therapist showed him-
self as a “companion” in human existence. Lea had, according to her thera-
pist, much feeling for existential facts in her life and this has colored the
therapy. Furthermore, the existential dimension was brought into the therapy
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by events in Lea’s life during the therapy (a fatal traffic accident of a loved
one and a life-threatening illness), through which she was confronted with
existential questions about sense, meaning, isolation, and solidarity.
However, the findings from Lea and Eef about genuineness as a crucial
therapeutic process need to be nuanced. Eef experienced therapist genuine-
ness as the most crucial therapeutic process, but she adds that the interaction
disclosure could only be helpful because of the accepting and respectful
attitude of her therapist. Lea pointed out that besides the moments of reci-
procity and encounter that resulted from her therapist’s self-disclosures, she
felt acceptance and attention to inner experiencing were crucial therapeutic
processes.
Genuineness as a Therapeutic Process
Thus, we cannot conclude that genuineness is the most crucial therapeu-
tic process for healing and personality change. However, the empirical data
give sufficient evidence that the client’s experiencing therapist genuineness
can be a crucial process for healing and personality change. In 5 of the
6 cases, therapist genuineness appears as a significant therapeutic process.
First, therapist genuineness appears as a crucial therapeutic process in the
cases of Lea and Eef. Second, the cases of Amber and Kim also show the
crucial significance of therapist self-disclosures for the development of new
behavioral and mental patterns. Third, Anna’s case points to the crucial
function of personal clarity disclosures for experiencing a safe and reliable
relationship. The following fragment illustrated the significance that Anna
attached to the personal clarity of her therapist.
What I immensely appreciate in her is that she is clear about everything.
Clear about the expectations I can have, clear in the way she works, clear in
the progress. She regularly evaluates where we stand, what is still possible,
what we will take on next. And also clear in arrangements; from the beginning
it was really clear, when do you inform. . . . So she is very clear on every level,
and that is something I find very important. (Anna, fragment 5)
Moreover, responding to the question of what she experienced as most
helpful in the therapy, Anna explained that T’s clear and honest communi-
cation had an important modeling function for her:
And due to the fact that she did that with me, in her whole attitude, week after
week, in a correct way—in practice this is now my reference. When I think
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sometimes to myself, “I have to cancel something,” or whatever, then I often
think, “How would T do this now with me?” And then I do it likewise. The
relationship as such is for me . . . you have to imagine, I’ve never learned this.
. . . She is for me a point of reference like, “How do you do this now—to form
a ‘right’ relationship?” (Anna, fragment 18)
A possible clinical interpretation of these empirical findings is that Anna
generally feels unsafe in interpersonal relationships (she is very sensible for
signs of potential rejection or disapproval and finds it difficult to keep an
appropriate distance in relationships), which Anna attributes to the conflict-
laden and traumatizing family situation in her childhood.
When comparing the 6 cases, it appears that Zoe is very different from
the other cases. Zoe reported that she would have experienced it as burden-
ing and uncaring if her therapist would have used therapist life disclosures,
client content reaction disclosures, or interaction disclosures. Zoe’s therapist
(personal communication, May 12, 2005) confirmed that she hardly applied
self-disclosure in Zoe’s therapy, sensing that moments of therapist self-
disclosure would have made Zoe feel unsafe because they would have implied
too much closeness and intimacy. Partly because of aggravating experiences
from her past (abuse, harassment, and a disrupted family situation), Zoe in
general does not enter into intimate relationships quickly because this is
threatening for her. She controls her contacts by keeping people at a distance
(Zoe’s therapist, personal communication, May 12, 2005).
In general, the 6 cases do not offer convincing evidence for the hypoth-
esis that therapist genuineness is the most crucial process for healing and
personality change. In the experience of the participating clients, genuineness
is not the only crucial, and not the most important, therapeutic process. The
results of this study suggest that most clients experience processes other
than genuineness as crucial, such as empathy, acceptance, and attention to
inner experiencing. Thus, we cannot conclude that genuineness is the most
important process for all clients. However, it appears that therapist genuine-
ness can be a crucial process for healing and personality change in the
clients’ experiencing. We found that genuineness is, for some clients, the
most important process; in other words, genuineness can be experienced by
clients as the most important therapeutic process.
It has to be stated that genuineness was probably present in all the cases but
was not experienced by clients as the most crucial process. In other words, the
presence of genuineness was not the clients’ predominant experience in these
cases. Besides, genuineness was probably strongly intertwined with other
processes such as acceptance and empathy. However, we only examined the
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degree to which clients experienced genuineness, as such, as a crucial thera-
peutic process. It is much more probable that therapist genuineness, besides its
direct effects on the therapy outcome, contributes indirectly to change, namely
by mediating the impact of empathy, acceptance, and concrete interventions
(Klein et al., 2002; Lietaer, 2001). There is a lot of empirical and conceptual
overlap between genuineness and other (relational) processes. In this sense,
we are very strict when we conclude that genuineness is not necessarily the
most crucial process in the studied cases.
Furthermore, we looked for genuineness in all the cases, using a broad
definition of genuineness (including self-awareness, self-presence, and
self-disclosure). However, we found clients typically reporting about self-
disclosure. This might be because of a memory bias of the clients: The
clients mostly reported about self-disclosure rather than other processes of
genuineness because the unusual behavior of a self-disclosure stood out in
their memory more than other more subtle processes of genuineness. Also,
our results might indicate that self-disclosure plays an important role in the
presence of genuineness.
In summary, the results of the present study show that it depends on the
individual client whether and how genuineness in communication is crucial
for personality change. For a client who quickly experiences intimacy as
intimidating, it seems appropriate to make especially sure that the client
does not experience the therapist’s interaction and communication style as
intrusive or as overstepping their boundaries. However, if clients very sen-
sitively attune to the needs of others, interaction disclosure can play an
important role in helping them to develop more autonomy in mutual soli-
darity. With clients for whom the existential dimension comes to be promi-
nent in their therapy, the therapist’s willingness to show self by means of
self-disclosures as a companion in human existence may be crucial. Finally,
we want to stress that the clinical interpretations of our empirical findings
cannot simply be generalized to other clients with similar life experiences,
personality, or interaction style. More general statements about target
groups or problems require further study.
Discussion
If one puts the individuality and the “otherness” of two people as a con-
dition for mutual dialogue, then the therapist does not have to abandon his
or her individuality when working with the client.
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The present study focused on the significance of therapist genuineness,
investigated the meaning of therapist genuineness, and explicated the char-
acteristic features and effects of therapist self-disclosures.6The hypothesis
that therapist genuineness is a crucial process for healing and substantial
personality change is like a devil’s advocate hypothesis. In the role of the
devil’s advocate, we take a position with which we disagree for the sake of
argument. We use this process to test the quality of the original argument
and identify weaknesses in its structure. More specifically, we want to rule
out that genuineness is indeed the most crucial process for change for all
clients. Even an extreme argument such as this might be useful as it sets
boundaries and creates clarity. Replication is necessary to examine the gen-
eralizability of the results. The findings still allow formulating a number of
preliminary conclusions.
Preliminary Conclusions
We found that clients experience processes other than genuineness as
crucial to therapy. These processes include empathy and attention to inner
experiencing. Thus, we cannot conclude that genuineness is the most
important process for all clients. Nevertheless, the results show that gen-
uineness is, for some clients, the most important process; in other words,
genuineness can be experienced by clients as the most important therapeu-
tic process. The findings imply that it also depends on the individual client
whether and how genuineness in communication is crucial for healing and
substantial personality change.
In all cases, however, genuineness seems to play an important part in the
change process. Sometimes, clients experience genuineness as such as an
important therapeutic process, as it is the case in self-disclosure. Often,
clients experience genuineness relatively implicitly and as a salient compo-
nent of empathy and acceptance. After all, it is likely that acceptance and
empathy would not have been most helpful if they had not been perceived
as genuine.
Implications for Practice
The findings from the present study have important implications for
practice that complement the existing literature. The findings underline the
significance and value of genuineness in communication with the client.
Indeed, the results indicate that therapist genuineness can be a crucial
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process for healing and personality change and that self-disclosures can be
powerful and directional interventions. However, the extent to which it is
appropriate to apply self-disclosures also depends on the individual client.
This points to the importance of therapists’ being very sensitive to the
specific needs of their clients and tuning their interaction and communication
style to these needs. For some clients it is more appropriate to closely follow
client experiencing and to use self-disclosures infrequently or very cautiously.
Other clients require a more dialogic interaction with their therapist and this
presses for a relatively more frequent use of self-disclosures.
Therapist genuineness can be expressed in various ways in communi-
cation with the client. Given the results that more subtle forms of self-
disclosures and disclosures about subjects with little intimacy can also have
a powerful impact, we invite therapists to pay adequate attention to these
forms of self-disclosures, besides attention for more personal self-disclosures.
The findings underscore, for instance, the significance of clarity and trans-
parency about practical agreements and treatment goals, about one’s line of
inquiry, the reasons and motives for one’s responses, and the personal or
tentative nature of interventions. This personal clarity of the therapist can
bring safety, create confidence, and have a positive influence on mutual
collaboration.
The effectiveness of a self-disclosure depends on the way genuineness
takes shape in concrete interventions. Interventions that are aimed toward
mutual dialogue and a plain application of self-disclosure that is attuned to
the needs of the individual client tend to be especially important dimensions
of helpful self-disclosures. Therapists can express an orientation toward
mutual dialogue (a) by communicating their experience in an inviting, non-
judging, and nonintrusive way; and (b) by being willing to face their own
part in the interaction as well. In general, therapists should use self-disclosures
in a directed and infrequent way and only express briefly those thoughts or
feelings that are relevant for the client and with which the client can take a
next step forward.
The effectiveness of a self-disclosure depends on the place of the self-
disclosure in the context of the interaction and the therapy process. Regarding
a proper timing of the self-disclosure in the context of the interaction, our
results complement the existing recommendations for practice as follows.
Helpful self-disclosures do not necessarily have to fit with the experience
the client has at that moment. A self-disclosure can have an equally strong
therapeutic effect if it fits with (implicit) client needs or requirements.
Furthermore, a helpful self-disclosure can actually distract the client from
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his or her current activity. It is, however, crucial that the self-disclosure does
not interfere with the client’s internal flow of experiencing. Concerning the
timing of a self-disclosure in the context of the therapy phase, the findings
draw attention to the importance of self-disclosure in the initial phase of
therapy. For instance, we encourage therapists to express openness and
clarity when discussing practical agreements and treatment goals and tasks.
Finally, the results underline the need to handle sensitively and sincerely
the client’s reactions to the self-disclosure. In the first stage of the therapy,
it might be very important to convey to the client that there is space and
openness for the client’s reaction. If self-disclosures induce ambivalent or
negative feelings in the client, we highly recommend that therapists display
a willingness to reflect in an open and honest way on one’s own contribution
as well.
Limitations and Directions for Future Research
Several limitations of the present study should be noted. These limitations
also imply directions for future research. First, one should exercise caution
when attempting to generalize from the particular sample of clients used in
our study. The small sample size leaves open the question of the represen-
tativeness of these participants. All clients were female and were in PCE
psychotherapy in an outpatient setting. Furthermore, the clients and thera-
pists who agreed to participate may have differed from those who did not,
which suggests the possibility of self-selection (e.g., all participating clients
evaluated the therapeutic alliance and their therapy in general as very posi-
tive). To increase the generalizability of the current results, future research
should include larger and more varied samples and replicate this study with
psychotherapies of different therapeutic approaches.
A second limitation is related to the retrospective self-report nature of the
data. The results are based on what participants recalled from events and
from their internal experience and thus may be liable to memory lapses and
distortions (Nisbett & Wilson, 1977). For example, despite using a broad
definition of genuineness and thus looking for different processes of gen-
uineness, we found clients typically reporting about self-disclosure. Likely,
this is because of a memory bias on the part of the clients: When one looks
for such unusual behavior as self-disclosure, it stands out in the memory.
However, the general accuracy and validity of client’s reports—despite
potential memory errors—have been demonstrated (Hill, O’Grady et al.,
1994; Martin & Stelmaczonek, 1988). In future research, videotape-assisted
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reviews could be used to obtain highly accurate and detailed data about
participants’ experiences of therapist genuineness. Methodological exami-
nation of videotape-assisted reviews supports the validity of this method
as a means of assessing in-session experiences (Hill et al., 1994). Future
researchers might analyze both participants’ retrospective data and video-
tapes of therapists’ observable and concrete behaviors. Such method and
data triangulation would further enhance the validity of the findings and
broaden our understanding of a complex phenomenon such as therapist
genuineness.
A third limitation of the present study concerns the fact that we focused
primarily on the client’s perspective of therapist genuineness. The client’s
perceptions and experience might differ from those of the therapist.
Although we also used the clinical impressions of the therapist to interpret
certain results and events, it would be interesting to give equal weight to
the corresponding therapist’s perceptions and experience. Future research
could address both therapist and client perspectives, within the context of
current relational processes.
With regard to research topics that need further empirical examination,
future research might examine the role of therapist genuineness with specific
target groups and problems. Finally, the results suggest that genuineness
has important positive effects on the therapeutic alliance. Future research is
needed to examine how and to what extent genuineness contributes to the
evolution of the alliance at vulnerable moments, such as alliance ruptures
during the therapy process (see research of Safran & Muran, 1996) and
alliance formation in the first stage of therapy.
Notes
1. The terms genuineness and authenticity are used interchangeably.
2. Dialogic anthropology investigates the meaning of existential human relationships. It
builds on the vision that a human being, because of his or her dialogic existence, can only be
understood within a relational context. This orientation is represented by, among others,
Martin Buber, Emmanuel Levinas, Paul Tillich, Gabriel Marcel, and Maurice Merleau-Ponty.
3. The interview protocol and the category system (the classification and coding scheme)
are available from the authors.
4. Names and concrete data of clients were changed or left out to guarantee clients’
anonymity. Clients were given codenames Anna, Lea, Eef, Amber, Kim, and Zoe.
5. For therapists, we use the abbreviation ‘T.”
6. Besides the hypothesis about the significance of therapist genuineness, seven other
hypotheses were formulated in our study. We do not elaborate these seven hypotheses here, but
we include their main findings in the discussion of the implications for practice.
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Jutta Schnellbacher, MS, is a psychologist and music therapist. She
works in a psychiatric hospital as a psychologist and provides individual
psychotherapy in private practice.
Mia Leijssen, PhD, a professor at Katholieke Universiteit Leuven, Belgium,
teaches experiential psychotherapy, professional ethics, and general coun-
seling skills in the Psychology Department. She has a practice in individual
psychotherapy.
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