[nottrustin]

At work yesterday some of my coworkers were discussing unconditional positive regards. For those who don't know I am an office coordinator in a psych hospital. This conversation made me think about this group. Essentially unconditional positive regard man's that therapist accepts the client add they are without judging them for their choices and behaviors. It doesn't mean the therapist agrees with what the client does but just puts those thoughts aside. They don't point out the beviors but asks questions of the client to hopefully help them to see where the behaviors are probably not the best.

One of the therapists at work doesn't agree with this theory. He feels if somebody is making destructive choices then it should be pointed out to the client.

So my question is do you want your therapist to practice unconditional positive regard or do you want them to point out bad choices when they are negatively impact you?

Unconditional Positive Regard

My therapist is predominantly person centred and UPR is one of the core conditions of person centred theory so it is an important part of how he works.
That's not to say he doesn't gently challenge me on unhealthy behaviours. For example, he has said he is 'concerned' about a certain coping mechanism, which gives me space to explore it without feeling judged. He is talking about his own feelings and that gives me an opportunity to reflect on my own. It definitely works for what I need out of therapy though I can understand others might prefer a more directive approach.

[Elio]

For me and where I am in this round of therapy, unconditional positive regard is a necessity. I am dealing with many things that all point to core shame and attachment like issues. Without the unconditional positive regard, I would not have grown to trust her, love her, and in the process, learning to trust me and love me (the core me and not just the parts of me that I do well).

I think that unconditional positive regard is a tool in their toolbox and depending on the client more and less of it might be needed. I do think there needs to be a base level regardless of the client and overall, I believe a t can phrase things to point out bad choices while still maintaining unconditional positive regard (like what EM said). I also think that for some clients it might be necessary to be more direct in regards to destructive choices. However, I don't think that is/needs to be the norm to be "confrontational" regarding a clients behaviors/thought patterns.

[alpacalicious]

I think it depends on the client the T is seeing. Personally, I want to feel accepted by my T, and if I'm making or I made bad choices, or had a negative behaviour, I don't want my T to tell me "Look, you did something bad!". A T can say to me that I had a negative behaviour but with a right choice of words...you can disagree with someone by using gentle words, that's how I would want a T to react (and not by yelling at me, or by pointing things at me like when you speak to a child).
I also think that maybe some clients prefer this way, maybe other clients want the T to be straighforward, that's why a T has to change a bit based on the client (maybe a T can be straightforward with client1, and more "cautious" with client2). I think a T has to adapt their behaviours and their talks based on the clients.

[junkDNA]

it seems to me that my T does get upset over some things i do like doing drugs or not eating. i have seen him get upset, and he tells me he is frustrated, sad, etc. knowing these things upset him does help me to think twice about what i am doing, but i dont know if that is healthy... as i am basically only not doing it to please him. i want to be in the place where i dont do these things for my own self. i dont know how to get to that point though

[leejosepho]

Originally Posted by nottrustin

Essentially unconditional positive regard [means the] therapist accepts the client [as] they are without judging them for their choices and behaviors...
They don't point out the behaviors but ask questions of the client to hopefully help them to see where the behaviors are probably not the best...
So my question is do you want your therapist to practice unconditional positive regard or do you want them to point out bad choices when they are negatively impact you?

Judging me for making bad choices is not acceptable, but neither is being silent about my bad choices if I am choosing to play in the street. So, do not say "You are making bad choices", but please do say "Playing in the street can be deadly."

Yes, i think they should point out the behaviors, generally.

My therapist always does this, but is usually not judgemental. But there have been a couple of times that caused ruptures.

I think the problems occur when they dont connect it with your past, like understanding why youd do it (eg to protect yourself). Also not mitigating the negative woth positive points or encouragement.

By the way, my therapist is not directive, i am in psychoanalytic therapy. (So Its not always associated with more directive therapies)

Im also thinking-how in the world could therapy help if they dont bring self destructive patterns or blindspots to your attention?

[stopdog]

I do not want the therapist's opinion at all. I am not an idiot - it is not that I don't recognize when something is risky or self destructive etc. They do not get to tell me how to live my life.

[here today]

Unconditional positive regard seems a necessity for me, too, and something that I have not gotten through to a successful end to therapy.

It seems to me that a therapist could reflect back their (non-judgmental) personal feelings as JunkDNA mentioned -- sadness, etc., without losing an unconditional positive regard for the client/person as a whole.

In my case, I have a mostly compliant, "nice" exterior personality with a split-off negative, angry part. I can keep the angry part "turned off" and learned over the years in therapy to recognize her "energy" but when I have allowed her "on" to speak in therapy, I have not been able to find a therapist who could tolerate her. Unconditional negative regard for part of me then destroys the "alliance", trust, or relationship one way or the other.

Originally Posted by stopdog

I do not want the therapist's opinion at all. I am not an idiot - it is not that I don't recognize when something is risky or self destructive etc. They do not get to tell me how to live my life.

Yes, but you seem to have a good life. I dont mean without hardship or problems, but you dont sound dysfunctional. Just thinkig from what you write here. A lot of us want change.

I suppose its individual like most therapy things. Despite a short time when i was 13, i had no parenting or discipline, no rules or anyone looking out for me growing up, so it seems uncaring to me.

[leejosepho]

Originally Posted by Skies

A lot of us want change.

I suppose its individual like most therapy things. Despite a short time when i was 13, i had no parenting or discipline, no rules or anyone looking out for me growing up, so it seems uncaring to me.

I had parenting, discipline, rules and such, but nobody had ever taught me how to successfully live beyond the nest and I was incapable of figuring that out intuitively.

It may not be for everyone, but I would like my psychiatrist to point out things that would be considered destructive or unkind for myself. Thinking about it, doesn't a mental healthcare provider have a responsibility to do so?

This is a really really good question to ponder. My father actually teaches bio-medical ethics to medical and nursing students.. I am going to try to remember to ask him his own thoughts on this.

This can be interpreted different ways, im realizing.

Im thinkinh of things that cause a person psin and distress. For example, if someone talks about every session how much pain it causes them to be always losing relationships yet they contribute to the losses, thats where it makes sense to point out their own contributions to this.

Im not thinking of policing, where anything that could be minorly harmful is emphasized. Just things that contribute to emotional distress that is brought up session after session. These are often relational patterns that are not obvious.

I have told my therapist that i wanted to go smoke a joint, for example, theres nothing there that would cause me distress, so hes not going make an issue about that.

[Ididitmyway]

I think, the idea of UPR is greatly misunderstood as a "never judge anything about the client" approach.

First of all, the human mind is conditioned to judge a.k.a to have opinions on different matters which are judgments. We judge a thousand things throughout the day as either "bad" or "good" or "neutral". We have to do that because that's how we make sense of the world around us in order to understand what's the best course of action is for us at each given moment.

Judgments are different though. As it pertains to the behavior of others we are perceived as judgmental when we judge someone as a human being, not necessarily when we judge specific things that they do. As Albert Ellis said once:"I never hated Hitler. I hated what he did, but I didn't hate him as a human being." Thus he makes an important distinction between universally judging someone as "good" or "bad" or judging their actions.

We still could come across as judgmental when we judge other people's choices even when we are trying to be objective and do it just to point out that a particular choice may not be in the person's best interests. While this sounds objective and helpful, the problem with that is that we often lie to ourselves that we point something out in order to help the other person. Oftentimes, unfortunately, we give opinions not because we want to help, as we claim, but because we want to show our moral, spiritual and intellectual superiority, and usually people feel that. You may have no problem accepting judgment of your choices/actions when it comes from one person, but will vehemently reject the same judgment when it comes from somebody else. Because it's not what somebody says that makes a difference but the intention a.k.a energy attached to their words. It's the energy behind the words that people respond to, not the words themselves.

How you receive opinions/judgments also depends on the nature of your relationship with someone. If it's a close friend whom you trust and you know that they always have your best interest in mind, you could accept some pretty harsh judgments coming from them because you know they genuinely think of your best interests. If it's someone you don't have a particularly close relationship with and have no reason and no need to trust their intentions, you'd think "who the hell are you to tell me what to do?" People have to earn their right to point out to us which of our actions aren't helpful. Someone can't just come in and start "helping" me by doing that when they and I have no relationship whatsoever and when I haven't asked for that kind of help. A certain level of relational trust has to be established first in order for our words to be received well, and trust also has to be earned, not given and taken for granted.

In therapy the same principles work as in all other human relationships and interactions. The therapist has to earn their right to point out to me what is and isn't in my best interests. There has to be rapport and good connection established first in order for them to do that so I'd trust that they are coming from the right place. They also have to be brutally honest with themselves when they offer their opinions as far as whether they do it because they want to "rescue" me or "fix" my life or because they just offer an alternative perspective for me to consider. Their true intentions will come across and that will usually determine whether the client will accept their "judgment" or not.

Of course, that's not to say that people can't still perceive you as ill-intended even if it's not the case. But that doesn't contradict what I previously said. The point is that there are many factors that determine whether it is or isn't a good idea to volunteer your judgments at each particular moment. The timing by the way is also a big factor. You may have genuinely good intentions, the other person is not mistrustful but the timing may be wrong. Usually, when someone is in crisis it's not the time to be "helpful" by sharing your opinion about how that person's choices brought them where they are.

[BudFox]

Unconditional positive regard is by definition a contrivance, as nobody can view somebody with only positive regard. If it is a contrivance and not genuine, then seems to me it is not healthy. I don't want to pay a professional to coddle me or tell me they like me or care about me when they do not.

[AllHeart]

What UPC means to me is, sure, my t is human and has judgments about me. But she understands that I, too, am human and accepts me as I am regardless.

My t typically goes a round about way to address my not-so-healthy choices and behaviors. Whatever she does usually helps to uncover some of the reasons why I do these unhealthy things repeatedly, point out the patterns, or something therapeutic. Sometimes she will outright express her disappointment to me or will half jokingly say something like, "Nooo! Not again!?!" No matter what her reactions, she never condones nor condemns. Any way she addresses me with disapproval is done with love, compassion, and understanding.

[leejosepho]

Originally Posted by AllHeart

... Whatever she does usually helps to uncover some of the reasons why I do these unhealthy things repeatedly, point out the patterns, or something therapeutic. Sometimes she will outright express her disappointment to me or will half jokingly say something like, "Nooo! Not again!?!" No matter what her reactions, she never condones nor condemns. Any way she addresses me with disapproval is done with love, compassion, and understanding.

There you go: "...she never condones nor condemns...disapproval is done with love, compassion, and understanding."

We each have a right to believe as we wish and to act on our beliefs to see what might actually happen, and then a wink from someone knowledgeable and trustworthy rhetorically asking "How well is that working out for you?" does not have to be perceived as condemning.

I think unconditional positive regard and being aware of one's destructive essential can exist together.

[Merecat]

Originally Posted by nottrustin

At work yesterday some of my coworkers were discussing unconditional positive regards. For those who don't know I am an office coordinator in a psych hospital. This conversation made me think about this group. Essentially unconditional positive regard man's that therapist accepts the client add they are without judging them for their choices and behaviors. It doesn't mean the therapist agrees with what the client does but just puts those thoughts aside. They don't point out the beviors but asks questions of the client to hopefully help them to see where the behaviors are probably not the best.

As someone else said, UPR is one of 6 conditions of therapeutic relationship in person centred theory, it doesn't stand on its own. Nor does it mean the T doesn't challenge or name harmful behaviours, it means that T has an attitude of acceptance of the person the client is. It's not a tool to be pulled out of a box any more than empathy is, the therapist is empathic and unconditionally valuing of the client or not.

For me it means my therapist supports me and is accepting, valuing and respectful of me. If she does challenge behaviours she thinks might be destructive it's always from a place of care, concern and honesty. A good person centred therapist/good person centred therapy is incredibly challenging and deep - work that is possible in a safe relationship. My experience is far from someone sitting there not challenging destructive behaviours or just being positive towards me.?

There's a whole theory of personality development that person centred therapy is underpinned by and UPR really makes sense in that context. Taken in isolation, not so much.

[here today]

Originally Posted by _Mouse

I think unconditional positive regard and being aware of one's destructive essential can exist together.

Can you elaborate? I'm not sure I understand what you mean.

For me, with a (still somewhat) dissociated angry part that may include some feelings and motives of ill-will (I'm not entirely sure), maybe "unconditional acceptance" might be what "she" (and "I") need.

That might apply to self-directed ill-will, too.

I would rather that my therapist is honest with me. Unconditional positive regard is nice, but it feels fake.
My therapist gets mad at me, she tells me off, we fight, she is very honest. I am the same way towards her. but she is also honest with her praise and compliments. the anger and disagreement she shoes sometimes do not both me at all, because i can also believe her when she says positive things.

I would rather that my therapist is honest with me. Unconditional positive regard is nice, but it feels fake.

Same here Starry!! Thanks for saying this as it explains why i started to feel irritated at a therapist who was like that.

I do think confrontation is one of the most loving things a person can do for another who is unknowingly hurting themself.

I've had 2 people dear to me who had heavy addiction. No matter how many times or how gentle, the denial prevents them from taking it positively. An intervention is the most loving thing to do. I think both would be dead or in jail if there was no intervention, which is a formal and strong type of confrontation by loved ones.

I also think people who don't have addictions and are trauma survivors, can have similar defenses because we are not integrated. Well there are usually many parts, but one part of us wants to have a good life, but there is often at least another part who wants to destroy things as a means for protection. It's natural for that part to be angry when confronted by anyone as they can involve strong needs to protect ourself; the destructive part is a part of ourselves too, and if it goes away-we are destroying a part of ourself. So when confronted, it can feel like someone trying to kill us off in a sense. That is one reason why it can be so difficult to hear.

It's talked a lot about in DID materials, but I think the majority of trauma clients have splits too, just less extreme than how we normally think of DID. My last therapist called them ego splits. They often come from pre-verbal trauma; they are so deeply rooted, that it takes a lot of working through and gentle confrontation for integration to ensue, which is one primary thing that brings about the change.

There have been a couple of times where my therapist has had to confront me in a less gentle way to 'wake me up', i think. Which leads me to think-maybe that led to our recent rupture--his aggressivley confronting me? I have to talk with him about this and see if that may have led to some ruptures. Didn't think about it that way before, so I appreciative of this thread.

[nottrustin]

I have told my therapist that i wanted to go smoke a joint, for example, theres nothing there that would cause me distress, so hes not going make an issue about that.[/QUOTE]

I will give an example but know I know this is probably not the case for you but an issue we deal with. We have patients who suffer from depression and psychosis. They will come into the hospital so sick because they have not been on their medication because it doesn't help them only marijuanna does. Mj makes psychosis worse. So they come into the hospital for a few days gets stabilized on their medications and do not use mj. They feel good. Then shortly after discharge they start smioking again and then stop their meds because they still feel good. So do in a short time they are back in the hospital and the cycle repeats itself over and over. Now some of our clinicians will just remind them how how song their meds is contributing to their issues. The clinician who velieves in saying it as it is will say if marijuanna works so wonderful for you why do you keep coming back for tratmebt?

[leejosepho]

Originally Posted by nottrustin

One of the therapists at work...feels if somebody is making destructive choices then it should be pointed out to the client...

...

...if marijuana works so wonderful for you why do you keep coming back for treatment?

In my own opinion, the root question should be tossed right back into the therapist's lap: "If your meds are so great, why do I keep stopping them and trying something else?" This post of mine is just a role-play, of course, but I would refuse being scolded for self-medicating in place of something else that has yet to do much better.

[Moksha]

This is a very interesting thread.

I'm a therapist and I have been a client too. I think unconditional positive regard is an essential ingredient in order to create an authentic and as healthy as possible relationship. Of course this doesn't mean treating the client in a fake way and repressing every negative emotion towards him/her. What unconditional positive regard means to me is respecting the client's individuality and being very careful not to let these emotions and my judgement interfere with the client's process. It means being aware of my thoughts, emotions, morals, etc., as much as possible and respect those of the client and him or herself as a person that is different to me.

This doesn't mean that the therapist has to repress his/her own emotions and judgements and be "fake" towards the client. But IMO a therapist needs to have been in therapy and of course ask for supervision if he's having unmanageable emotions and judgements towards the client, which may cause damage.

There's an interesting concept in transactional analysis: the parent ego state. There's the positive nurturing parent state, which is caring, provides support, etc., but there's also the positive controlling parent state, which provides structure, limits and norms. Sometimes the therapist may have to use his/her positive controlling parent state in order to protect the client or himself, and this can be done while still keeping an unconditional positive regard towards the client.