One simple observation, which is repeated over and over again in each successful therapeutic case, seems to have rather deep theoretical implications. It is that as changes occur in the perception of self and in the perception of reality, changes occur in behavior. In therapy, these perceptual changes are more often concerned with the self than with the external world. Hence we find in therapy that as the perception of self alters, behavior alters. Perhaps an illustration will indicate the type of observation upon which this statement is based.
A young woman, a graduate student whom we shall call Miss Vib, came in for nine interviews. If we compare the first interview with the last, striking changes are evident. Perhaps some features of this change may be conveyed by taking from the first and last interviews all the major statements regarding self, and all the major statements regarding current behavior. In the first interview, for example, her perception of herself may be crudely indicated by taking all her own statements about herself, grouping those which seem similar, but otherwise doing a minimum of editing, and retaining so far as possible, her own words. We then come out with this as the conscious perception of self which was hers at the outset of counseling.
I feel disorganized, muddled; I've lost all direction; my personal life has disintegrated.
I sorta experience things from the forefront of my consciousness, but nothing sinks in very deep; things don't seem real to me;I feel nothing matters; I don't have any emotional response to situations; I'm worried about myself.
I haven't been acting like myself; it doesn't seem like me; I'm a different person altogether from what I used to be in the past.
I don't understand myself; I haven't known what was happening to me.
I have withdrawn from everything, and feel all right only when I'm all alone and no one can expect me to do things.
I don't care about my personal appearance.
I don't know anything anymore.
I feel guilty about the things I have left undone.
I don't think I could ever assume responsibility for anything.
If we attempt to evaluate this picture of self from an external frame of reference various diagnostic labels may come to mind. Trying to perceive it solely from the client's frame of reference we observe that to the young woman herself she appears disorganized, and not herself. She is perplexed and almost unacquainted with what is going on in herself. She feels unable and unwilling to function in any responsible or social way. This is at least a sampling of the way she experiences or perceives herself.
Her behavior is entirely consistent with this picture of self. If we abstract all her statements describing her behavior, in the same fashion as we abstracted her statements about self, the following pattern emerges a pattern which in this case was corroborated by outside observation.
I couldn't get up nerve to come in before; I haven't availed myself of help.
Everything I should do or want to do, I don't do.
I haven't kept in touch with friends; I avoid making the effort to go with them; I stopped writing letters home; I don't answer letters or telephone calls; I avoid contacts that would be professionally helpful; I didn't go home though I said I would.
I failed to hand in my work in a course though I had it all done: I didn't even buy clothing that I needed; I haven't even kept my nails manicured.
I didn't listen to material we were studying; I waste hours reading the funny papers; I can spend the whole afternoon doing absolutely nothing.
The picture of behavior is very much in keeping with the picture of self, and is summed up in the statement that "Everything I should do or want to do, I don't do." The behavior goes on, in ways that seem to the individual beyond understanding and beyond control.
If we contrast this picture of self and behavior with the picture as it exists in the ninth interview, thirty-eight days later, we find both the perception of self and the ways of behaving deeply altered. Her statements about self are as follows:
I'm feeling much better; I'm taking more interest in myself.
I do have some individuality, some interests.
I seem to be getting a newer understanding of myself. I can look at myself a little better.
I realize I'm just one person, with so much ability, but I'm not worried about it; I can accept the fact that I'm not always right.
I feel more motivation, have more of a desire to go ahead.
I still occasionally regret the past, though I feel less unhappy about it; I still have a long ways to go; I don't know whether I can keep the picture of myself I'm beginning to evolve.
I can go on learning in school or out.
I do feel more like a normal person now; I feel more I can handle my life myself; I think I'm at the point where I can go along on my own.
Outstanding in this perception of herself are three things that she knows herself, that she can view with comfort her assets and liabilities, and finally that she has drive and control of that drive.
In this ninth interview the behavioral picture is again consistent with the perception of self. It may be abstracted in these terms.
I've been making plans about school and about a job; I've been working hard on a term paper; I've been going to the library to trace down a topic of special interest and finding it exciting.
I've cleaned out my closets; washed my clothes.
I finally wrote my parents; I'm going home for the holidays.
I'm getting out and mixing with people: I am reacting sensibly to a fellow who is interested in me seeing both his good and bad points.
I will work toward my degree; I'll start looking for a job this week.
Her behavior, in contrast to the first interview, is now organized, forward-moving, effective, realistic and planful. It is in accord with the realistic and organized view she has achieved of her self.
It is this type of observation, in case after case, that leads us to say with some assurance that as perceptions of self and reality change, behavior changes. Likewise, in cases we might term failures, there appears to be no appreciable change in perceptual organization or in behavior.
What type of explanation might account for these concomitant changes in the perceptual field and the behavioral pattern? Let us examine some of the logical possibilities.
In the first place, it is possible that factors unrelated to therapy may have brought about the altered perception and behavior. There may have been physiological processes occurring which produced the change. There may have been alterations in the family relationships, or in the social forces, or in the educational picture or in some other area of cultural influence, which might account for the rather drastic shift in the concept of self and in the behavior.
There are difficulties in this type of explanation. Not only were there no known gross changes in the physical or cultural situation as far as Miss Vib was concerned, but the explanation gradually becomes inadequate when one tries to apply it to the many cases in which such change occurs. To postulate that some external factor brings the change and that only by chance does this period of change coincide with the period of therapy, becomes an untenable hypothesis.
Let us then look at another explanation, namely that the therapist exerted, during the nine hours of contact, a peculiarly potent cultural influence which brought about the change. Here again we are faced with several problems. It seems that nine hours scattered over five and one-half weeks is a very minute portion of time in which to bring about alteration of patterns which have been building for thirty years. We would have to postulate an influence so potent as to be classed as traumatic. This theory is particularly difficult to maintain when we find, on examining the recorded interviews, that not once in the nine hours did the therapist express any evaluation, positive or negative, of the client's initial or final perception of self, or her initial or final mode of behavior. There was not only no evaluation, but no standards expressed by which evaluation might be inferred.
There was, on the part of the therapist, evidence of warm interest in the individual, and thoroughgoing acceptance of the self and of the behavior as they existed initially, in the intermediate stages, and at the conclusion of therapy. It appears reasonable to say that the therapist established certain definite conditions of interpersonal relations, but since the very essence of this relationship is respect for the person as he is at that moment, the therapist can hardly be regarded as a cultural force making for change.
We find ourselves forced to a third type of explanation, a type of explanation which is not new to psychology, but which has had only partial acceptance. Briefly it may be put that the observed phenomena of changes seem most adequately explained by the hypothesis that given certain psychological conditions, the individual has the capacity to reorganize his field of perception, including the way he perceives himself, and that a concomitant or a resultant of this perceptual reorganization is an appropriate alteration of behavior. This puts into formal and objective terminology a clinical hypothesis which experience forces upon the therapist using a client-centered approach. One is compelled through clinical observation to develop a high degree of respect for the ego-integrative forces residing within each individual. One comes to recognize that under proper conditions the self is a basic factor in the formation of personality and in the determination of behavior. Clinical experience would strongly suggest that the self is, to some extent, an architect of self, and the above hypothesis simply puts this observation into psychological terms.
In support of this hypothesis it is noted in some cases that one of the concomitants of success in therapy is the realization on the part of the client that the self has the capacity for reorganization. Thus a student says:
You know I spoke of the fact that a person's background retards one. Like the fact that my family life wasn't good for me, and my mother certainly didn't give me any of the kind of bringing up that I should have had. Well, I've been thinking that over. It's true up to a point. But when you get so that you can see the situation, then it's really up to you.
Following this statement of the relation of the self to experience many changes occurred in this young man's behavior. In this, as in other cases, it appears that when the person comes to see himself as the perceiving, organizing agent, then reorganization of perception and consequent change in patterns of reaction take place.
On the other side of the picture we have frequently observed that when the individual has been authoritatively told that he is governed by certain factors or conditions beyond his control, it makes therapy more difficult, and it is only when the individual discovers for himself that he can organize his perceptions that change is possible. In veterans who have been given their own psychiatric diagnosis, the effect is often that of making the individual feel that he is under an unalterable doom, that he is unable to control the organization of his life. When however the self sees itself as capable of reorganizing its own perceptual field, a marked change in basic confidence occurs. Miss Nam, a student, illustrates this phenomenon when she says, after having made progress in therapy:
I think I do feel better about the future, too, because it's as if I won't be acting in darkness. It's sort of, well, knowing somewhat why I act the way I do ... and at least it isn't the feeling that you're simply out of your own control and the fates are driving you to act that way. If you realize it, I think you can do something more about it.
A veteran at the conclusion of counseling puts it more briefly and more positively: My attitude toward myself is changed now to where I feel I can do something with my self and life. He has come to view himself as the instrument by which some reorganization can take place.
Address of the retiring President of the American Psychological Association, the September 1947 Annual Meeting. First published in American Psychologist, 2, 358-368.