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Psychotherapy Research
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Humanistic psychotherapy research 1990–2015: From

methodological innovation to evidence-supported
treatment outcomes and beyond
a b c d e
Lynne Angus , Jeanne Cherry Watson , Robert Elliott , Kirk Schneider & Ladislav Timulak
a
Department of Psychology, York University, Toronto, ON, Canada
b
Department of Adult Education and Counselling Psychology, University of Toronto, OISE,
Toronto, ON, Canada
c
Counselling, University of Strathclyde, Glasgow, UK
d
Psychology, Saybrook University, San Francisco, CA, USA
e
School of Psychology, Trinity College, Dublin, Ireland
Click for updates Published online: 17 Dec 2014.

To cite this article: Lynne Angus, Jeanne Cherry Watson, Robert Elliott, Kirk Schneider & Ladislav Timulak (2014): Humanistic
psychotherapy research 1990–2015: From methodological innovation to evidence-supported treatment outcomes and beyond,
Psychotherapy Research, DOI: 10.1080/10503307.2014.989290

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 Psychotherapy Research, 2014
http://dx.doi.org/10.1080/10503307.2014.989290

EMPIRICAL PAPER

Humanistic psychotherapy research 1990–2015: From methodological

innovation to evidence-supported treatment outcomes and beyond

LYNNE ANGUS1, JEANNE CHERRY WATSON2, ROBERT ELLIOTT3, KIRK SCHNEIDER4,

& LADISLAV TIMULAK5
1
Department of Psychology, York University, Toronto, ON, Canada; 2Department of Adult Education and Counselling
Downloaded by [Flinders University of South Australia] at 21:36 08 February 2015

Psychology, University of Toronto, OISE, Toronto, ON, Canada; 3Counselling, University of Strathclyde, Glasgow, UK;
4
Psychology, Saybrook University, San Francisco, CA, USA & 5School of Psychology, Trinity College, Dublin, Ireland
(Received 2 June 2014; revised 14 October 2014; accepted 14 November 2014)

Abstract
Objective: Over the past 25 years, humanistic psychotherapy (HP) researchers have actively contributed to the development
and implementation of innovative practice-informed research measures and coding systems. Method: Qualitative and
quantitative research findings, including meta-analyses, support the identification of HP approaches as evidence-based
treatments for a variety of psychological conditions. Results: Implications for future psychotherapy research, training,
and practice are discussed in terms of addressing the persistent disjunction between significant HP research productivity and
relatively low support for HP approaches in university-based clinical training programs, funding agencies, and government-
supported clinical guidelines. Conclusion: Finally, specific recommendations are provided to further enhance and expand
the impact of HP research for clinical training programs and the development of treatment guidelines.

Keywords: experiential/existential/humanistic psychotherapy; outcome research; process research; qualitative research

methods

Arising out of the nineteenth-century romantic psychotherapy research (HPR) from 1990–2015, in
movement and existentialist and phenomenological honor of the twenty-fifth anniversary of Psychotherapy
philosophy, modern humanistic psychology Research, and to reflect on future directions, chal-
addresses two basic questions: “What does it mean lenges, and opportunities for HPR in the twenty-first
to be fully human?” and “How does that under- century.
standing illuminate the vital or fulfilled life?” Accordingly, we first provide a brief historical
(Schneider, Pierson, & Bugental, 2015, p. xvii). overview of the development of HP treatment
Schneider and Leitner (2002) suggest that human- approaches, principles of practice, and research
istic psychotherapy (HP) addresses the conditions by methods that also addresses research, practice, and
which people can come to intimately know them- training challenges currently faced by HP practi-
selves and each other, and, to the extent possible, tioners and researchers. Next we provide a summary
fulfill their aspirations. As evidenced in the psycho- of humanistic therapy research contributions to the
therapy research literature, a diverse range of field of psychotherapy research, over the past quarter
humanistic therapy approaches and research meth- century, that summarizes HP meta-analytic outcome
ods have emerged over the past quarter century to findings and recent qualitative and process-outcome
further understand and address clients’ problems in studies investigating key mechanisms of client
living. The purpose of this paper is to provide an change in humanistic therapy approaches. Finally,
overview/update of developments in humanistic we critically review significant HPR findings in the

Correspondence concerning this article should be addressed to Lynne Angus, Room 213 BSB, 4700 Keele Street, North York, ON M3J
1P3, Canada. Email: langus@yorku.ca

© 2014 Society for Psychotherapy Research

 2 L. Angus et al.

context of recent developments in psychotherapy wanting/intending. As such, therapist inter-

training, research, and practice as a whole and ventions and responses that deepen or stimu-
discuss key opportunities and challenges facing HP late client emotional experiencing are
practitioners and researchers over the next quarter embedded within the context of an empathic
century. facilitative relationship. Clients are viewed as
meaning-creating, symbolizing agents,
whose subjective experience is an essential
HPR and Practice: A Brief Overview aspect of their humanity.
While it is difficult to do justice to the complexity (3) Emphasis on the operation of an integrative,
and breadth encompassed by a humanistic approach formative tendency, oriented toward sur-
to psychological research and practice, we offer the vival, growth, personal agency, and the
following working definition of HP for the purposes creation of meaning. Internal tacit experien-
of the present paper: cing is seen as an important guide to
conscious adaptive experience and poten-
Humanism is concerned with such existential tially available to awareness when the client
themes as meaning, mortality, freedom, limitation, turns attention internally within the context
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values, creativity, and spirituality as these arise in of a supportive therapeutic relationship.

personal, interpersonal, social, and cultural contexts.
In psychotherapy, humanism places special
(4) Consistently person-centered when engaging
emphasis on the personal, interpersonal, and con- clients. This involves genuine therapist con-
textual dimensions of therapy and on clients’ reflec- cern and respect for each client who is seen
tions on their relationship with self, others, and the holistically, as a unique individual, who
larger psychosocial world. (Schneider & Langle, possesses a complex array of emotions,
2012, p. 428)
behaviors, stories, and capacities that can,
at times, be viewed as representative of a
Accordingly, humanistic therapies are part of the
particular clinical diagnostic category, but
main tradition of humanistic psychology and
never reduced to one (Elliott et al., 2013;
include client-/person-centered (Rogers, 1961),
p. 495–496).
constructivist (Neimeyer & Mahoney, 1995), emo-
tion-focused therapy (EFT, also known as process- It is important to point out that some of these HP
experiential; Greenberg, Rice, & Elliott, 1993), assumptions and practices clash with what Wampold
existential meaning-making (Schneider & Krug, (2008) has termed an “excruciatingly narrow” con-
2010; Yalom, 1980), focusing-oriented (Gendlin, sensus on what is scientific and should contribute to
1978); Gestalt (Perls, Hefferline, & Goodman, twentieth- and twenty-first-century social science
1951), and transpersonal (Wilber, Engler, & Brown, research. Critically, this includes group designs,
1986) psychotherapies. unidimensional measurement, and emphasis on the
Despite the fact that these HP approaches vary to statistical central tendency, all of which ignore the
some degree in technique and conception, Elliott, person of the client and therapist and their unique
Watson, Greenberg, Timulak, and Freire (2013) contributions to treatment outcomes. There is also a
argue that contemporary HP approaches share a focus on objective, impersonal measurement, away
distinctive set of theoretical assumptions and princi- from lived experience and relationally based know-
ples of HP practice. They include: ing; reliance on simplistic linear, one-way mechan-
(1) Endorsement of the centrality of a genu- istic causal models, as opposed to complex nonlinear
inely empathic and prizing therapeutic rela- self-organizing processes; and an emphasis on dys-
tionship as the most important theoretical function rather than growth. Thus, until the 1980s,
underpinning of humanistic therapy. As humanistic therapy researchers did not have a set of
such, each client’s subjective experience is research methods appropriate to their worldview and
of central importance, and, in an effort to practices. All of these issues raised the question of
grasp that experience, the humanistic ther- whether humanistic therapy research was even
apist attempts to enter empathically into the possible.
client’s world in a way that provides the In spite of the inherent contradictions, humanistic
client with a new, emotionally validating therapy researchers using traditional, positivistic
interpersonal experience. methods have been able to establish strong empirical
(2) Focus on the promotion of in-therapy client support for the contributions of the therapeutic rela-
experiencing, defined as the holistic process of tionship for facilitating client change processes in HP,
immediate, ongoing awareness that includes which has led to a growing recognition of the import-
perceiving, sensing, feeling, thinking, and ance of a productive therapeutic alliance, across a
 Psychotherapy Research 3

diverse range of therapeutic approaches. For instance, evidenced in humanistic therapeutic sessions have
therapists’ empathy and responsivity to client feed- been examined in the work of Stiles (1979), Hill
back have been highlighted in recent approaches (1978), and Sachse (1992). This growing list of
to behavioral (Bunting & Hayes, 2008), psychoana- innovations has significantly contributed to the
lytic (Stolorow, 2011), cognitive-behavioral (Kertes, development of change process research as a distinct
Westra, Angus, & Marcus, 2011; Westra, 2012), and focus of psychotherapy research in the last 25 years.
multicultural psychotherapies (Comas-Diaz, 2012). Moreover, this intensive analysis of psychotherapy
This shift represents a revival of the core assumptions sessions has informed theory and practice leading to
of HP that rose to prominence in the 1960s as a the development of focusing-oriented psychotherapy
counterweight to more prescriptive therapy models of as well as emotion-focused psychotherapy (Green-
treatment. The incorporation of more humanistic berg & Watson, 1998; Goldman, Greenberg &
principles of practice has been fuelled by systematic Angus, 2006). Both of these approaches initially
research advances in the investigation of key processes emerged from an enhanced understanding of HP
of change, particularly in HP treatment approaches. therapeutic practices based on close observation of
The evolution of HP research methods and prac- therapeutic processes. Technological advances have
tices can be traced to the seminal contributions of key supported this work, as illustrated by Rogers’ use of
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researchers, as documented in Castonguay et al.’s phonograph, and later wire recordings of therapy
(2010) work Bringing Psychotherapy Research to Life, sessions in the 1940s. More recently, audio and
which presents the work of several key figures that video technology have made it possible to review,
contributed to the development of HPs such as Carl observe, and empirically analyze client and therapist
Rogers, Irene Elkin, Allen Bergin, Eugene Gendlin, performances for the rich, qualitative description of
Laura Rice, Donald Kiesler, Michael Lambert, Clara moment-to-moment therapeutic interactions, as they
Hill, Robert Elliott, William Stiles, and Les Green- unfold within therapy sessions (Boritz et al., 2013).
berg. Beginning with Carl Rogers (1957), an illustri- Over time, these interests have taken humanistic
ous line of HP researchers, most of whom were also therapy researchers to the edges of the prevailing
clinical practitioners, have created a distinct tradition positivism and its associated quantitative methods,
of methods and methodologies within the larger and beyond, into phenomenological/existential and
discipline of psychotherapy research, that have in constructivist philosophies of science and their asso-
turn contributed to the evolution of psychotherapy ciated qualitative, mixed, and reflexive methods. As
practice. evidenced in the following review of humanistic
Historically, HPR has been characterized by a therapy research findings, and addressed more fully
distinct set of four recurrent interests, which have in the final discussion, the development of client-
collectively moved away from positivism and toward focused inquiry methods and mixed qualitative–
a human science approach more consistent with core quantitative methods, in particular, has had a signi-
humanistic therapy values: close analysis of psychother- ficant impact on a resurgence of qualitative, quant-
apy process, client experience, qualitative methods, sys- itative, and process-outcome humanistic therapy
tematic case studies, and change processes. On the more research studies over the past 25 years.
positivist end of the spectrum has been the close At the same time, it is also important to note that
analysis of psychotherapy process, introduced by HP despite both a renewed practice and a proliferation
researchers with an initial focus on the differences of HP research methods and empirical studies (as
between good and poor outcome cases (Gendlin, evidenced in the research review to follow), there has
1978), the quality of therapist facilitative behavior also been a paradoxical decline in humanistic train-
(Truax & Carkhuff, 1967), client experiencing ing programs (Heatherington et al., 2012) over the
(Klein, Mathieu-Coughlan, & Kiesler, 1986), and past 25 years. As noted by Levy and Anderson
therapist/client vocal quality (Rice & Saperia, 1984). (2013), the powerful forward march of cognitive
Over the past 25 years, this HP research tradition behavioral psychotherapy (CBT), and its promotion
has expanded to include specific process variables as an empirically supported treatment approach, has
such as client-expressed emotional arousal (Warwar resulted in both a rapid expansion of CBT-identified
& Greenberg, 1999), emotional processing (Watson training programs and a concomitant decline in
& Prosser, 2007), expressed empathy (Watson, humanistic, psychodynamic, and interpersonal ther-
2007), client narrative integration (Boritz, Brynt- apy training clinics, across North America. This
wick, Angus, Greenberg, & Constantino, 2013), trend has occurred despite increasing empirical
innovative moments (Gonçalves, Mendes, Ribeiro, evidence that supports the identification of a range
Angus, & Greenberg, 2010), and reflective proces- of research-supported psychotherapy approaches,
sing (Watson, Steckley, & McMullen, 2014). Addi- especially for depression (see APA Division 12
tionally, discourse style and verbal response modes Research-supported Treatments website).
 4 L. Angus et al.

It is our hope that the following comprehensive (3) Clients in HPs show large gains relative to
review of significant HP research results will con- clients who receive no therapy. Elliott et al.
tribute to an increased recognition of efficacious HP (2013) analyzed data from 62 controlled
treatments in the psychotherapy practice field and studies, 31 of these randomized controlled
support the future development of mental health trials (RCTs; ns = 2144 in HPs vs. 1958 in
treatment policies/guidelines and expanded human- waitlist or no-therapy conditions). They
istic training opportunities over the next quarter found a controlled weighted effect size of
century. First, we review empirical studies that .76 (CI: .64–.88), with randomization mak-
have investigated the efficacy of HP treatment ing no difference, except that the confidence
approaches, and in effect ask the question, “Do interval was slightly wider. These findings
HPs work?” Next, we pose the key research question provide strong support that HPs are useful
of “How do HPs work?”, and report research and effective treatments for clients.
findings emerging from HP process-outcome studies (4) HPs in general are clinically and statistically
investigating humanistic principles of practice and equivalent to other therapies. In 100 studies
qualitative inquiries addressing the first-hand per- (91 of them RCTs; n = 6097 clients), there
spective of HP clients. was virtually no difference between human-
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istic and other therapies in amount of pre-

post change (weighted comparative effect
Are HPs Efficacious? size = .01; CI: –.05 to .07); again, results
Quantitative HPR were virtually identical regardless of whether
studies were randomized or not.
Quantitative outcome research is the most positiv- (5) So-called nondirective-supportive therapies
istic of the different threads of HP research, and has (NDSTs) have worse outcomes than CBT.
generally been undertaken as political necessity. Elliott et al. (2013) found that treatments
Since the founding of Psychotherapy Research, labeled by researchers as “supportive” or
research on the outcome of HPs has increased “nondirective” have somewhat smaller
many times over, from 37 studies, reviewed by amounts of pre-post change than CBT (37
Greenberg, Elliott, and Lietaer (1994) in the first studies; weighted effect size = –.27; CI: –.41
meta-analysis of this literature, to many more than to –.13). In general, these treatments turned
the 191 studies included in the most recent meta- out to be watered-down, non-bona fide ver-
analysis (Elliott et al., 2013). These meta-analyses sions of humanistic therapies, used by CBT
consistently and with increasing strength and differ- researchers.
entiation support the following conclusions: (6) Person-centered therapy is as effective, and EFT
(1) HPs are associated with large pre-post client might be more effective than CBT. Person-
change. Using a 2008 sample, Elliott et al. centered therapy was equivalent to CBT (22
(2013) looked at 199 samples of clients, from studies; weighted effect size: –.06; CI: –.11
191 studies, involving 14,235 clients, and to –.01). In a small number of studies, EFTs
reported a large weighted pre-post effect size for individuals or couples appeared to be
of .93 (95% CI: .85–1.01). Furthermore, this more effective when compared to CBT (six
is particularly true for general symptom studies; weighted comparative effect size =
measures, as indicated by two large UK- .53; CI: .13–.93).
based studies (Stiles, Barkham, Twigg, (7) HPs are most effective for interpersonal/rela-
Mellor-Clark, & Cooper, 2006; Stiles, Bark- tional problems trauma. For a range of inter-
ham, Mellor-Clark, & Connell, 2008). personal or relational problems, Elliott et al.
(2) Clients’ large post-therapy gains are maintained (2013) found very large pre-post and con-
over early and late follow-ups. Following ther- trolled effects, as well as significantly better
apy, Elliott et al. (2013) found that clients in comparative effects for humanistic therapies.
HPs maintained and slightly improved their EFT for couples has long been recognized
gains—pre-to-follow-up change at less than as an evidence-based treatment (EBT) for
12 months was 1.05; while at a year or couples (Chambless et al., 1998); however,
more it was 1.11. The maintenance of gains a range of individual humanistic therapies
post-therapy is consistent with humanistic appear to meet criteria as EBTs for inter-
ideas about clients’ self-determination and personal difficulties, including the treatment
empowerment, suggesting that clients con- of trauma from childhood abuse (but not
tinue to develop on their own after they have necessarily posttraumatic stress disorder,
left therapy. where there is still almost no research).
 Psychotherapy Research 5

(8) Humanistic therapies meet criteria as EBT for How Does HP Work?
depression. For depression in general,
Qualitative HPR
humanistic therapies have been extensively
researched, to the point where the claim of Given the central importance of the person of the
empirical support as efficacious and specific client in humanistic therapeutic approaches (Tall-
(i.e., superior to a placebo or active treat- man & Bohart, 1999), it is perhaps not surprising
ment) can be supported in general, based on that humanistic researchers have been at the fore-
meta-analytic data, with EFT for moderate front, of not only developing, but implementing
depression and person-centered therapy for qualitative research designs (Elliott, 2002; McLeod,
perinatal depression having the most solid 2011; Watson, Goldman, & Greenberg, 2007;
evidence (Elliott et al., 2013). Wertz, 2002), and post-therapy interview inquiries
(9) For psychotic conditions, humanistic therapies (Angus & Kagan, 2013; Elliott, 1986; Hardtke &
appear to meet criteria as EBTs. Although Angus, 2004), to capture clients’ experiences of
based on a relatively small number of stud- change in a range of HP approaches.
ies, the evidence analyzed by Elliott et al. By the early 1990s, two key methods had emerged
that contributed to the development of a qualitative
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(2013) showed large pre-post effects and

superior comparative treatment effects (six approach to the study of client experiences in
studies; +.39; CI: .10–.68), suggesting that humanistic therapy. First, Interpersonal Process
humanistic therapies may be effective with Recall (IPR) procedures (Kagan, 1984) were used
clients experiencing psychotic processes to capture clients’ accounts of moment-to-moment
(e.g., schizophrenia). experiencing in therapy sessions (Elliott, 1986),
(10) Humanistic therapies have potential for while Grounded Theory (Glaser & Strauss, 1967)
helping people cope with chronic medical and Empirical Phenomenology (Fessler, 1978;
Giorgi, 1975) provided rigorous, systematic meth-
conditions and for reducing habitual self-
odological frameworks for the qualitative analysis of
damaging activities. Coping with difficult
clients’ interview transcripts. This innovative integ-
medical or physical conditions (e.g., can-
ration of qualitative research methods resulted in a
cer) and habitual self-damaging activities
new line of innovative HP studies of clients’ imme-
(e.g., substance misuse) present challenges
diate experiences in therapy sessions and significant
for most forms of therapy. However, Elliott
therapy events. Later, Hill and colleagues further
et al. (2013) found that for both of these
adapted Grounded Theory to develop consensual
client populations, humanistic therapies
qualitative research (CQR; Hill, 2012; Hill, Thomp-
were in general associated with moderate son, & Williams, 1997) because the analysis of
pre-post improvement, were superior to clients’ first person accounts addresses a range of
no treatment controls, and were equivalent client experiences and therapy events ( Hill, Knox, &
to other approaches (most commonly Hess, 2012). These methods are highly consistent
CBT). with humanistic assumptions about the importance
(11) For anxiety difficulties, the humanistic therap- of the person, lived experience, and relational
ies studied so far appear to be less effective than knowing.
CBT. For anxiety problems (especially
panic and generalized anxiety), Elliott et al. Studies of clients’ experience of humanistic
(2013) reported large pre-post effects, therapy. An important contribution to the invest-
moderate controlled effects, but consis- igation of clients’ experiences in psychotherapy can
tently poorer results when compared to be found in the work of David Rennie (1992, 1994a,
CBT. Although researcher allegiance 1994b) who showed that clients engaged in monitor-
effects are a factor, Elliott et al. (2013) ing their therapists during therapy sessions, and
argued that more work is required to generally preferred to defer to their therapist’s plans
develop more effective process-guiding and shortcomings rather than challenge them. Ren-
approaches, as indicated by evidence now nie’s approach to qualitative inquiry informed Wat-
emerging from ongoing research (Timulak son and Rennie’s (1994) study on clients’ experience
& McElvaney, 2012). At this point, how- of systematic evocative unfolding of clients’ prob-
ever, based on the available evidence, the lematic reactions in EFT sessions, as well as Angus
use of traditional humanistic therapies can and Rennie’s (1988, 1989) focus on clients’ meta-
only be justified as second-line treatments phoric expressions, and Moerman and McLeod’s
for clients who have also tried or (2006) investigation of clients with an alcohol-
refused CBT. related problem. Additionally, Knox (2008) has
 6 L. Angus et al.

studied clients’ perceptions of moments of relational of problematic issues recover from depression and
depth, Schnellbacher and Leijssen (2008) and were better able to recognize and assert their needs
Rodgers (2002) studied clients’ perceptions of help- in their therapy sessions.
ful/important in-session processes, and Myers Elliott and his research group have conducted
(2000) studied clients’ perceptions of empathy. intensive case studies looking at causal links between
Overall, these studies underscore the central import- emotion-focused/humanistic therapy processes and
ance of the relational qualities offered by humanistic therapy outcome for a range of disorders such as
therapists, as clients consistently identified thera- social anxiety, panic, and bipolar disorder (Elliott,
pists’ empathic skills as essential for fostering 2002; MacLeod & Elliott, 2012; MacLeod, Elliott, &
new awareness of emotions and enhanced self- Rodgers, 2012; Stephen, Elliott, & MacLeod, 2011;
understanding. Stinckens & Elliott, 2014). Intensive case analyses
also have been employed to develop a theory of
Studies of helpful and hindering events. emotional transformation (McNally, Timulak, &
Qualitative research on HP has also focused on the Greenberg, 2014), resolution of self-critical pro-
most helpful or hindering client-identified events in cesses (Stinckens, Lietaer, & Leijssen, 2002), and
HP therapy sessions (Balmforth & Elliott, 2012; successful resolution of health anxiety (Smith, Shoe-
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Elliott, 1985; Grafanaki & McLeod, 1999, 2002; mark, McLeod, & McLeod, 2014) in the context of
Holowaty & Paivio, 2012; Honos-Webb, Stiles, humanistic therapy treatments. Taken as a whole,
Greenberg, & Goldman, 1998; Timulak, 2003; findings indicate that, in addition to depression
Timulak, Belicova, & Miler, 2010; Timulak & (Elliott et al., 2013), HP approaches such as EFT
Lietaer, 2001). To date, these studies have high- can initiate healing processes for a range of clinical
lighted the importance of (1) building clients’ sense disorders for which group outcome evidence of
of safety in therapy; (2) recognizing the fragility of treatment effectiveness has yet to be established.
clients’ sense of safety in the therapeutic process; (3) Finally, a recent series of intensive case studies
highlighting how clients are active participants in (Angus & Hardtke, 2007; Angus & Kagan, 2013;
important changes in therapy (e.g., through taking Cunha et al., 2012; Gonçalves et al., 2012; Mendes
risks in self-disclosing, through pursuing emotionally et al., 2010, 2011) have drawn on the York I
painful issues); (4) showing how the therapist’s Depression study transcript data-set (Angus, 2012)
relational and emotional processing skills can help to examine emotion-focused and client-centered
the client to bear emotional pain, experience flow, humanistic therapy sessions from a narrative-
relief, new awareness, and self-reflection; and (5) informed perspective on therapy change processes
establishing new, coherent, self-narratives, and self- (Angus & McLeod, 2004). Findings from these
empowerment. studies have highlighted the importance of protest
moments (such as challenging the voice of self-
Intensive single case studies. Many published criticism), reclamation of own needs (for instance,
qualitative research studies investigating HP by setting a boundary in an abusive relationship),
approaches have employed intensive case study working with client ambivalence and self-narrative
research methods (McLeod, 2010). For instance, reconstruction in good outcome therapy sessions.
Watson et al. (2007) conducted a series of intensive
process analyses of good and poor outcome clients Meta-synthesis of qualitative outcomes.
undergoing emotion-focused treatment for depres- Timulak and Creanere (2010) points out that qual-
sion. Findings highlighted the importance of the itative studies to date have not only captured clients’
quality of clients’ emotional and narrative proces- experiences in HP but have also assessed the impact
sing, the presence of positive introjects at the that humanistic treatments have had on their lives.
beginning of therapy, and the presence of social As such, these studies are well-suited for assessing
support and the capacity to build a strong thera- spontaneously reported changes by clients that may
peutic alliance, in contributing to positive thera- address a broader range of therapy outcomes not
peutic outcomes in short-term psychotherapy for captured by standardized questionnaires. To explore
depression. Humanistic researchers (Brinegar, this question, Timulak and Creaner (2010) con-
Salvi, & Stiles, 2008; Honos-Webb, Surko, Stiles, ducted a meta-synthesis of eight qualitative research
& Greenberg, 1999; Honos-Webb et al., 1999; studies addressing clients’ experiences of change in
Osatuke et al., 2005) have also drawn on Stiles’ HP, identifying 11 meta-categories of client-reported
(2002) Assimilation of Problematic Experiences change: Healthier Emotional Experiencing, Experi-
(APES) framework to study EFT and person-cen- ences of Appreciating Vulnerability, Experiences of
tered therapies of depression. Research findings have Self-Compassion, Resilience, Empowerment, Mas-
shown that clients with more advanced assimilation tery of Symptoms, Enjoyment of Changed Life
 Psychotherapy Research 7

Circumstances, Feeling Supported, Enjoyment of relationship, therapist empathy, heightened client

Interpersonal Encounters, Self-insight/Self-aware- experiencing, and emotional/experiential engage-
ness, and Changed View of Others. ment in therapy sessions.
Results of the meta-synthesis indicated that human-
istic clients identified qualities such as a greater The therapeutic relationship. Since Rogers’
awareness of emotional experiencing and heightened (1957) identification of therapists’ empathy, nonjudg-
vulnerability as important, positive outcomes of their mental acceptance, warmth, and congruence, as
humanistic therapy treatments, outcomes rarely necessary and sufficient conditions for therapeutic
assessed in the context of standardized therapy out- change, accumulated research evidence points to a
come measures. Levitt, Stanley, Frankel, and Raina moderate but consistent relationship between the
(2005) suggest that psychotherapy researchers who therapeutic conditions and outcome (Elliott et al.,
only include standardized symptom distress measures 2013; Elliott, Bohart, Watson, & Greenberg, 2011;
to evaluate humanistic treatment outcomes, and do Farber & Doolin, 2011; Horvath, Del Re, Flückiger, &
not include client first person accounts of therapeutic Symonds, 2011; Kolden, Klein, Wang, & Austin,
change, are “using thermometers to weigh oranges”. 2011; Watson, 2001). The Task Force on the thera-
As such, psychotherapy researchers are well advised peutic relationship designated therapist empathy as
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to include post-therapy qualitative interviews (Angus “demonstrably effective”; positive regard as “probably
& Kagan, 2013; Elliott, 2010), in addition to stan- effective”; and congruence and genuineness as “prom-
dardized symptom measures, as part of their evalu- ising but insufficient research to judge” (Norcross &
ation of humanistic therapy outcomes. Wampold, 2011, p. 424).
Although qualitative methods are still a relatively Examining the conceptual overlap between the
recent development in psychotherapy research, it is construct of the therapeutic alliance and the thera-
clear that they have gained increasing acceptance by peutic conditions, Watson and Geller (2005) found
HP researchers over the past 25 years. Frommer and that the Working Alliance Inventory (WAI; Horvath
Rennie (2002) suggest, however, that in terms of the & Greenberg, 1986) and Barrett-Lennard Relation-
important criterion of publication, especially in ship Inventory (BLRI; Barrett-Lennard, 1962) were
psychology’s mainstream journals, qualitative highly correlated, while therapeutic alliance (WAI)
research is still on the margin. To this end, several mediated the relationship between the relationship
authors have suggested that there is a need to conditions (BLRI) and outcome in both EFT and
develop explicit standards and criteria for the assess- CBT for depression. Intriguingly, this finding held
ment and review of qualitative psychotherapy despite the fact that CBT therapists were found to be
research in a wider range of psychotherapy-based, more didactic in their therapy sessions, while EFT
peer-review journals (Elliott, Fischer, & Rennie, therapists were more supportive in their interactions
1999; McLeod, 2013). with clients.

Process-outcome HPR. As noted by Elliott Therapist empathy. Investigating the impact of

(2010), HP researchers have been distinctive in their therapist empathy on changes in clients’ internal
focus on change processes within and across HP working models of self and other, Watson et al.
treatments. Indeed, many innovative genres of HP (2014) found that therapists’ empathy was associated
change process research have emerged over the last with significant improvement in attachment insecur-
quarter century to enrich our clinical understanding ity and significant decreases in self-criticism, neg-
of how change happens in effective HP treatments, lectful, and controlling behaviors toward the self at
including helpful aspects of therapy post-session the end of therapy and in turn, these positive
inquiry (Elliott & James, 1989), comprehensive changes were significantly associated with good
process analysis (Elliott, 1989), conversational ana- outcome in brief humanistic treatments of depres-
lysis (Muntigl et al., 2013; Sutherland, Peräkylä, & sion. Watson and Prosser (2007) also found that
Elliott, 2014), process-outcome quantitative and changes in clients’ affect regulation mediated the
qualitative research investigations (Angus, Goldman impact of therapists’ empathy on outcome, while
& Mergenthaler, 2008; Cooper, Watson, & Höll- Toukmanian and colleagues showed that therapists’
dampf, 2010), measure development (Wiggins, empathy, attunement, and exploration were each
Elliott, & Cooper, 2012), and systematic case studies associated with higher levels of client experiencing
(McLeod, 2010; Angus & Kagan, 2013). In particu- and client perceptual processing (Gordon & Touk-
lar, humanistic therapy researchers have investigated manian, 2002). Therapist empathy, however, was
three key mechanisms of change that cohere closely best predicted by therapists’ attunement (Macaulay,
with HP practice principles (Elliott et al., 2013): they Toukmanian, & Gordon, 2007). These recent stud-
focus on the development of productive therapeutic ies provide additional evidence and support for the
 8 L. Angus et al.

important role that the therapist empathic attune- in good outcome EFT, suggesting that finding an
ment and communication skills contribute to pro- optimal ratio of emotional expression to emotional
moting positive outcomes in psychotherapy. intensity is important for effective therapy outcomes.
Greenberg, Auszra, and Herrmann (2007) have
Quality of client exploration of inner reported that mid-phase emotional productivity pre-
experiencing. Research on clients’ experiencing dicted 66% of the outcome variance, over and above
continues to be an important focus of inquiry by working alliance, in EFT for depression and suggest
HP researchers. Goldman, Greenberg, and Pos that productive processing of emotion may be one of
(2005) found that positive shifts in the quality of the best predictors of outcome. Extending this line of
clients’ exploration of their inner experience––as inquiry, Watson, McMullen, Prosser, and Bedard
measured by the Client Experiencing Scale (Klein, (2011) found that clients’ level of affect regulation
Mathieu, Gendlin, & Kiesler, 1969)––was a stronger at the end of therapy mediated the relationship
predictor of outcome than the working alliance in between client level of emotional processing in
client-centered and emotion-focused psychotherapy therapy and final outcome, independent of the
for depression. Previous studies have also addressed working alliance.
the impact of therapist proposals on the depth of
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clients’ self-exploration (Sachse, 1992; Sachse & Quality of narrative process and emotion
Elliott, 2002) in therapy sessions and found that integration. Angus and colleagues have also investi-
therapists’ statements that were high in experiencing gated the contributions of narrative processes and
resulted in higher levels of clients’ experiencing emotional expression in CCT and EFT treatments of
during therapy sessions and that the depth of depression (Angus, 2012; Angus, Levitt, & Hardtke,
therapist experiential focus predicted overall out- 1999; Angus, Lewin, Bouffard, & Rotondi-Trevisan,
come (Adams & Greenberg, 1996). 2004). For instance, Lewin, Angus, and Blagov (2003)
Qualities of clients’ experiencing promoted in HP found that therapists in good outcome EFT cases were
approaches, such as a focus on inner experiencing, twice as likely to help clients shift to emotion-focused
questioning, and reflection on experience leading to and reflexive narrative modes than therapists of clients
shifts in perception, feeling, or thinking, have also with poor outcome. Lewin and Angus (2008) subse-
been consistently related to good outcome across a quently established that higher frequencies of emo-
range of therapeutic approaches, including CBT and tion-focused and reflexive meaning-making shifts
psychodynamic therapy (Elliott, Greenberg & Lie- predicted higher experiencing levels and treatment
taer, 2004; Giyaur, Sharf, & Hilsenroth, 2005; outcomes in EFT of depression. More recently, using
Godfrey, Chalder, Ridsdale, Seed, & Ogden, 2007; multi-level modeling analyses, Boritz, Angus, Mon-
Hendricks, 2002; Leahy, 2002; Watson & Bedard, ette, Hollis-Walker, and Warwar (2011) have estab-
2006). These findings provide support for the lished that clients in CCT and EFT treatments of
humanistic view that the manner in which clients’ depression evidence a significant increase in the
process their experience in therapy is core to change, specificity of personal stories, from early- to late-phase
irrespective of treatment approach. therapy sessions, while recovery from depression was
only predicted by a combination of high narrative
Quality of clients’ emotional engagement. specificity and expressed arousal in late phase sessions.
Research studies have also shown that higher expressed Results were interpreted as supporting the importance
emotional arousal at mid-treatment, increased reflec- of narrative and emotion integration in effective HP
tion on aroused emotion (Warwar & Greenberg, treatments of depression.
2000), and deeper emotional processing late in therapy
(Pos, Greenberg, Goldman, & Korman, 2003) predict Performance models. Finally, there has been a
good outcome in EFT and Client Centered Therapy growing research interest in understanding the con-
(CCT) treatments of depression. In another study tributions of humanistic process-guiding approaches—
using the same data-set, Pos, Greenberg, and Warwar such as tasks in EFTs (Greenberg et al., 1993)—to
(2009) found that after controlling for both the alliance effective treatment outcomes. In practice, process-
and client emotional processing at the beginning of guiding humanistic therapy approaches strive to main-
therapy, the quality of clients’ experiencing during the tain a creative tension between the person-centered
working phase of treatment was the best predictor of emphasis on creating a genuinely empathic and prizing
outcome. therapeutic relationship, and a task-focused style of
In terms of frequency and intensity of emotional engagement that promotes deeper client experiencing
expression, Carryer and Greenberg (2010) have and consequent meaning creation in therapy sessions.
shown that a medium rate (25%) of moderate-to- In order to investigate the relationship between
high-intensity emotional expression was evidenced in-session client processes and productive treatment
 Psychotherapy Research 9

outcomes, humanistic/emotion-focused psychother- included randomized comparisons among combina-

apy researchers have employed task analytic meth- tions of EFT, client-centered, and CBT to address
odology (Greenberg, 1983) to identify and test specific clinical disorders such as depression (Elli-
within-session performance models—that more fully son, Greenberg, Goldman, & Angus, 2009; Gold-
describe client behaviors, and therapist interventions— man et al., 2006; Greenberg & Watson, 1998;
during specific change episodes. In particular, intens- Watson et al., 2003) and Complex Trauma (Paivio
ive analyses of two-chair and empty-chair dialogue et al., 2004). Importantly, to answer the key empir-
tasks in EFT and Gestalt psychotherapy has led to the ical question of “does HP work?”, recent meta-
development of performance models that specify and analytic analyses, based on findings from 191 HP
empirically validate key components necessary for task outcome studies (Elliott et al., 2013), have estab-
resolution (Greenberg, 1979, 1983; Greenberg & lished that HPs are associated with large pre-post
Foerster, 1996; Greenberg & Malcolm, 2002; client change at treatment termination, up to 18-
Greenberg & Webster, 1982; Pascual-Leone, 2009; month follow-up and, in general, are clinically and
Sicoli & Hallberg, 1998; Whelton & Greenberg, 2000). statistically equivalent to other therapies, includ-
Two-chair dialogues have been shown to be ing CBT.
effective in resolving negative treatment of self, for Additionally, the implementation of multi-level
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example, self-criticism, self-silencing, self-neglect modeling analyses for the identification of key cli-
(Shahar et al., 2011), and depression (Watson, ent–therapist process variables, in the context of HP
Gordon, Stermac, Kalogerakos, & Steckley, 2003). RCT research trials, has placed HP researchers at the
In turn, empty-chair dialogues have been used to forefront of identifying core mechanisms of change
effectively address complex trauma (Paivio & Green- that are consistent with HP clinical practice princi-
berg, 1995; Paivio & Pascual-Leone, 2010) and ples and contribute to clinically significant outcomes
unresolved relationship issues (Greenberg & Mal- in HP treatments. Specifically, recent process-out-
colm, 2002; Greenberg, Warwar & Malcolm, 2008). come findings have established that therapist
Paivio, Holowaty, and Hall (2004) found that com- empathy, clients’ emotional productivity, experien-
plex trauma clients who engaged in empty-chair cing, and manner of personal narrative disclosures
dialogues evidenced more pre-post change than significantly contribute to positive HP treatment,
those who did not, independent of the therapeutic providing convergent validity for key HP theoretical
alliance. assumptions and practice principles (Elliott et al.,
More recently, Meneses and Greenberg (2011) 2013). From this work, we conclude that HP
tested a model of interpersonal forgiveness in the researchers have made significant contributions to
context of EFT for couples and found three key innovative advancements in the field of psychother-
steps, (1) acceptance of responsibility for causing the apy methods, measures, and research findings over
emotional injury, (2) the expression of shame or the past 25 years.
empathic distress, and (3) the expression of a heart- HP qualitative research findings have also pro-
felt apology—contributed to a resolution of emo- vided a strong empirical base for the further devel-
tional injuries, irrespective of initial degree of marital opment of HP theory and practice. Specifically, there
distress. Finally, by employing task analytic meth- has been increasing recognition of the role of
odology, Pascual-Leone and Greenberg (2007) developmental processes (Watson, 2011) and nar-
showed that in emotionally productive EFT sessions, rative expression (Angus & Greenberg, 2011) for
clients move from a state of global distress through enhanced emotion regulation as well as a refined
fear, shame, and aggressive anger to the expression understanding of case formulation (Goldman &
of needs and negative self-evaluations, followed by Greenberg, 1997; Watson et al., 2007) in EFT
assertive anger, self-soothing, hurt, and grief, indic- treatments. This evolution of theory has further
ative of more advanced processing. supported recent efforts to conceptualize how EFT
can be further applied to social anxiety, generalized
anxiety disorder, and eating disorders.
Discussion Finally, it is clear that there has been a renewed
emphasis on the importance of the therapeutic
Key Contributions of HP Research Findings:
attitudes as key ingredients of change with empathy
1990–2015
seen as multifunctional as it contributes to clients’
Despite a challenging funding environment and capacities for affect regulation and the development
significant decline in HP clinical training centers of positive introjects and ways of treating affective
over the past 25 years, HP researchers have com- and emotional experience (Watson, Goldman, &
pleted an increasing range of RCTs to assess the Greenberg, 2011; Watson et al., 2014). The impact
efficacy of HP approaches. These studies have of research on practice is a continually iterative
 10 L. Angus et al.

process with changes in practice leading to new to address clinically rich, practice-informed research
research questions and methods of analysis. questions in the context of HP RCTs. For instance,
humanistic researchers such as Robert Elliott, Jeanne
Watson, Sandra Paivio, Antonio Pascual-Leone,
Implications for HPR, Practice, and Training Alberta Pos, and Lynne Angus have increasingly
While the primary impetus for this review has been employed qualitative and mixed methods approaches
to investigate the empirical status of humanistic to study therapeutic processes and outcomes demon-
therapy for a diverse and growing constituency of strating the capacity to empirically investigate process
psychotherapy researchers and practitioners, a fur- variables relevant to HP practice principles—such as
ther inspiration was to assess the present implica- expressed emotion, empathy, client-experiencing
tions of humanistic therapy research for the levels, and personal story disclosure—in the context
expansion of HP clinical graduate training and the of achieving clinically significant change in human-
optimization of effective psychotherapy practice as a istic treatments of depression, anxiety and complex
whole. Acknowledging that theoretical and research trauma.
questions still remain to be addressed, we draw the A third major observation is that the current state
of humanistic qualitative and process-outcome ther-
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following conclusions about the current state of

psychotherapy research and theory in humanistic apy research evidence indicates convincingly that in
practice: (1) the renewal of key humanistic practice terms of HP therapy practice:
principles such as therapist empathy and the role of (1) The authentic personal relationship is fun-
the relationship conditions are foundational ele- damental to effective practice.
ments of therapeutic effectiveness and endorsement (2) Clients’ emotional pain is rendered more
of those principles is a salient and growing phenom- bearable within the context of an attuned
enon evidenced in leading specialty areas of psycho- and understanding therapeutic relationship.
therapy; (2) HP treatments meet criteria as EBTs for (3) The collaborative nature of the therapeutic
depression, interpersonal difficulties, and coping relationship is key to the process of therapy
with psychosis, self-damaging behaviors and chronic unfolding and to the disclosure of clients’
medical conditions and should therefore be included narratives and personal stories in order to
in the development of clinical practice guidelines; develop a shared understanding and inter-
(3) HP researchers have been at the forefront of personal trust.
developing methodologically pluralistic research (4) The essential connection between human-
approaches—such as qualitative data collection, istic therapy research activity and practice
analysis methods, and innovative measures of ther- innovation evidenced in our current review
apy process and outcome—to address clinically rich, of the HP research literature is consistent
practice-informed research questions in ways that are with the early contributions of Rogers,
much more consistent with humanistic values; (4) Gendlin, and Klein, all of whom viewed
qualitative and process-outcomes studies have fur- psychotherapy research and practice as an
ther differentiated and enriched our understanding integral part of their commitment to the
of HP principles of practice as they relate to clients’ development of a distinct HP model and
experiences of change; and finally (5) HP research treatment approach. Recognition of the
findings provide strong empirical support for the contribution of key humanistic principles of
inclusion of humanistic practice principles as a core practice—including Rogers’ (1959) theory
dimension of HP training and provide significant of facilitative conditions, Bugental’s (1987)
support for an expansion of HP training clinics and and May’s (1983) theories of therapeutic
programs. To elaborate further, we will identify four presence, Friedman’s (1985) and Yalom’s
central themes that have emerged from our overview. (1980) theories of interpersonal engage-
A first major observation addresses the empirical ment, and views of experiential contact
status of HP therapies as evidence-supported treat- variously put forward by Mahrer (1996),
ments for specific clinical disorders. Based on their Perls (1976), Gendlin (1978), and Green-
HP meta-analytic findings established by Elliott berg and Van Balen (1998)—have received
et al. (2013), and summarized in this paper, we increasing support from a growing constitu-
conclude that HPs are supported by multiple lines of ency of psychotherapy practitioners,
scientific evidence and should therefore be included researchers, and theorists (Elliot et al.,
in clinical guidelines and lists of evidence-based 2013; Schneider & Längle, 2012).
psychotherapy.
A second major observation is that HP researchers Furthermore, a “third generation” of integrative
are currently at the forefront of using mixed methods CBT approaches, such as mindfulness-based cognitive
 Psychotherapy Research 11

therapy (Segal, Williams, & Teasdale, 2001), motiva- clinical programs, and found a significantly higher
tional interviewing-informed CBT for severe anxiety endorsement of cognitive-behavioral orientation as
(Westra, 2012), acceptance and commitment therapy compared with those from behavioral, psycho-
(Hayes, Strosahl, & Wilson, 1999), existentially dynamic, humanistic, and family systems orienta-
informed CBT for generalized anxiety (Wolfe, 2008) tions. In order to investigate changes in the
and compassion-focused therapy (Gilbert, 2009) predominance of theoretical orientation in training
appear to have much in common with humanistic programs over time, Levy and Anderson (2013)
process-guiding practice models and research analyzed longitudinal data on psychotherapy theor-
approaches (Elliott et al., 2013). etical orientations (PTO) for North American clin-
Finally, a fourth major observation addresses the ical psychology faculty members over two decades.
perplexing contradiction between the weight of Results demonstrated that clinical psychology has
specific HP research evidence, as summarized in moved from a field that was relatively balanced in
this article, and the present state of official profes- percentages of faculty from cognitive-behavioral
sional advocacy in relation to the development of (CBT), psychodynamic, humanistic, behavioral,
clinical practice guidelines, policy directives, and HP and family PTOs to one that has shown highly
training programs. Although the contributors to this significant linear growth for one single PTO: CBT.
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article, as well as other recent overviews (Schneider Most other PTOs, and in particular humanistic
& Längle, 2012), report converging research findings therapy orientation, showed a significant linear
that emphatically affirm the value of humanistic decline. Levy and Anderson (2013) caution that
practice principles, as well as the efficacy of HP even if important research findings from other
treatment outcomes, large segments of the public, PTOs, such as the benefits of a strong working
the media, and even the professional practice com- alliance and therapist empathy are now co-opted into
munity continue to privilege a CBT model that CBT, essential aspects of these HP clinical concepts
minimizes the important contributions of therapist and interventions are at risk of being stripped down,
and client factors (Baker, McFall, & Shoham, 2009; muddied, or lost in a conflation with CBT treatment
Elkins, 2009) as well as the contributions of other principles when they are not guided and informed by
research-supported treatment approaches. bona fide humanistic training principles and expert-
Moreover, this reluctance to recognize the con- ise, acquired in the context of university-based HP
tributions of humanistic practice principles to pro- clinics and training programs (Pierson, Krug, Sharp,
ductive treatment outcomes not only neglects a & Piwowarski, 2015).
wealth of therapy effectiveness literature (Elkins, On the basis of the current HP research review, we
2012; Wampold, 2012), but it also presents disturb- suggest that HP clinicians and researchers are under-
ing implications for the optimization of therapeutic represented in the context of University-based Clin-
training and practice as a whole (Heatherington ical Psychology and Counseling training programs
et al., 2012; Längle & Kriz, 2012; Schneider & and insufficiently represented on government-man-
DuPlock, 2012; Stolorow, 2012). If there is one dated bodies charged with developing clinical prac-
message that resounds through the chorus of con- tice policies and guidelines. Given the substantive
tributions to this article, it is that humanistic practice empirical research evidence, humanistic therapy
principles of empathy, alliance, receptivity to client training should be included in university-based
feedback, emotional deepening, and meaning-mak- clinical and counseling training programs, so that
ing are critical to therapeutic healing in HP treat- the significant decline of humanistic therapy training
ment approaches as well as others. programs, over the past 20 years, can be reversed.
To this end we argue that there is converging
evidence to suggest that therapeutic training should
The Next 25 Years: Recommendations and
emphasize the person of the therapist (Duncan,
Future Steps
2010; Fauth, Gates, Vinca, Boles, & Hayes, 2007;
Geller & Greenberg, 2012) and enhance the devel- Prediction is a matter of either extrapolating present
opment of empathic communication skills, the capa- linear trends or else projecting our hopes and fears
city to enhance clients’ emotional expression and forward into an unknown, nonlinear future. In the
self-regulation, and the capacity to develop a secure case of HPR, we have been discussing two opposing
and productive therapeutic alliance for the facilita- trends: On one hand, there is the hopeful but
tion of client narrative disclosure and productive nascent revival and resurgence of innovative human-
meaning-making in therapy sessions. istic approaches to psychology and psychotherapy,
As noted earlier, Heatherington et al. (2012) used including a rapidly developing evidence base; and on
cross-sectional data from a recent survey of North the other hand, there is the powerful forward march
American faculty theoretical orientations within of CBT toward hegemony.
 12 L. Angus et al.

Under such conditions, some HP researchers may Third, because of their shared commitment to
become discouraged or tempted to fall back on a empirical research, HP researchers are in a particu-
fundamentalist position, rejecting quantitative larly good position to connect with sympathetic CBT
research as tainted by positivism while endorsing researchers, particularly those from the acceptance-
the sole benefits of qualitative research strategies and based, third wave approaches that have incorporated
single case analyses. In this article, we have tried to humanistic ideas into their treatments, as noted
highlight the significant research contributions of above. In fact, we would like to see a continuing
both qualitative and quantitative HP research find- place for all the main approaches in the further
ings for wide dissemination to clinical practitioners, development of theory and research on psychother-
researchers and mental health policy-makers. As apy. For example, we think that Psychotherapy
such, we have emphasized the important contribu- Research over the past 25 years has suffered from an
tions of qualitative and process-outcomes studies on under-representation of research from the CBT
HP that have enriched our understanding of how tradition and even more importantly from research
HPs work; we have also summarized HP outcome in which researchers from different theoretical tradi-
research findings that have identified HP approaches tions come together to collaborate and dialogue.
Finally, as Elliott et al. (2013) have argued, there
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have shown to be efficacious with specific client

concerns. Building on this work, we encourage are strong scientific reasons (for example, on the
future HP researchers to undertake controlled stud- basis of the Bayesian model of inference) for HP
ies of increasing scale, in order to continue to researchers to lobby for meaningful representation
provide evidence that will impact treatment on the scientific grant review panels and groups who
are developing mental health treatment guidelines in
guidelines.
various countries, pushing for full consideration of a
While research evidence is necessary, it may not
wide range of evidence and a fair and balanced
be sufficient to make a real impact on treatment
reading of that evidence. Thus, we invite a more
guidelines, as professional self-interests often have a
strategic, activist and constructive stance with regard
significant political influence on the development of
to mental health treatment guideline development
policy initiatives. As such, we will also need to
on the part of organizations like the Society for
engage in strategic thinking and planning regarding Psychotherapy Research, the new German Associ-
future steps: alliance-building, networking, lobbying, ation for Humanistic Psychotherapies, and the Soci-
and persistence over time. First, HP therapy ety for Humanistic Psychology (in the USA and
researchers will need to help build coalitions within Canada). Supporting and engaging with each other
their approach, overcoming whatever internal divi- in these ways will lead to greater understanding of
sions have been holding back further development psychotherapy, a highly focused relational form of
and the presentation of a united front. In the UK, for healing that is essential to the well-being of indivi-
example, the new humanistic “counseling for depres- duals and societies. Our clients deserve our full
sion” model (Sanders & Hill, 2014) has integrated commitment to work together to improve treatment
person-centered and EFT approaches to create a outcomes and provide them with a range of choices
growing training, accreditation, and research to facilitate their growth and healing.
initiative.
Second, because of the broader developments we References
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