The Nonjudgemental Witness

When I was trained to be a cognitive-behavioral psychotherapist not too long ago, my professors explained to me that there were two key components to effective therapy. Those two components were: 1) a body of technique based on theory and (as much as possible) supported by empirical research, and 2) something called "nonspecific factors", which were the non-technical parts of therapy, such as the quality of the rapport (or relationship) between the therapist and the client. The idea was, more or less, that the nonspecific factors served as a sort of foundation upon which therapy could be conducted. The implied idea (or perhaps wish) was that the active ingredient of successful therapy would come from the technical side of the house, while the nonspecific factors would serve more passively as a sort of glue that held the process together. I'm simplifying what was actually taught, for purposes of this essay; but not too much that I think I'm distorting the message that was conveyed.

There is a lot to be said for this formulation, actually, and good reasons for why my professors were so hot to emphasize the technical side of the house. Psychotherapy has historically been a sort of wild-west process, based more on testimonial and charisma than science. Therapists who were best able to sway the opinion of their fellows (Freud is a good example) became famous and got to pass on a body of techniques but it was never quite clear, when the hype was removed, whether those techniques really worked all that well in practice. My professors were trying to combat this "cult-of-personality" approach with a science-based alternative. The version of psychotherapy they were promoting to us students was based on testable theory and repeatable techniques, and had been subject to clinical trials demonstrating that it worked. The approach has been very successful, and has started to dominate the way that modern psychotherapy is conducted.

I have never questioned the soundness of the science-based approach, as to do so asks the question of whether there is a better method than science for figuring out how the world works. Though Tom Cruise and the people behind the Discovery Institute might disagree, there frankly isn't any better method than science for figuring out how things really work. Only a science based approach towards understanding reality actually tests assumptions against the world in rigorous and systematic ways. More importantly, only a science based approach provides a framework for overthrowing previously accepted theory when the accumulating data show that those theories are not sufficiently accurate.

I've previously written about the technical side of psychotherapy and may do so again in the future. For today, however, I'm interested in focusing on those nonspecific factors, because lately I have been appreciating just how completely important they are to the success of some types of psychotherapy, and also to self-acceptance, more generally.

Nonspecific Factors

When psychotherapists talk about nonspecific factors, they use words like "authenticity", "genuineness", and "presence". What these words boil down to is the idea that good therapists offer their clients real caring and compassion, and whole attention. They are there not just physically, but are also wholly attentive, focused on the client's difficulties, and actively listening to and thinking about what the client is describing in the hopes of finding ways to help that client. They empathize and emotionally connect with what their clients are going through, although they do not take these feelings on, or allow themselves to become overwhelmed by these feelings. They are emotionally, intellectually and physically there with their clients, in the room and receptive and without judgement. This state is not an artifice but rather a true receptivity and willingness to be present. There is no hidden or alternative agenda beyond this mission of compassion and desire to help.

I should hasten to add that all this openness, receptivity and desire to help is entirely one-sided. It is focused on the client. There is no expectation that the client should reciprocate, as would be the case in any other sort of similarly charged relationship. Good therapists keep the focus on the client, and share very little about their own lives, if anything at all.

It is incredibly difficult to fake the state of receptivity and compassion that characterizes the nonspecific factors. Almost all of the time, clients know when therapists are faking it. It's not something you have to think about; you just know when someone is really paying attention to you in an open and compassionate way, and when they are not.

When a client comes to a therapist saying, "I want help with kicking this crappy mood I've been in for the last month", and they are otherwise well adjusted and motivated to do the work, then nonspecific factors don't count for much. Motivated clients, confident clients don't require much support, and the therapist and the client can simply get down to the work of teaching and learning techniques that will help achieve the effect that is desired. However, when clients come to therapists with issues of trust, confidence, doubt, or self-esteem, the nonspecific factors become a hugely important thing that will make or break the success of the therapy. This is because techniques cannot be easily conveyed in the context of an untrusting relationship, which is what the therapy situation will be in the absence of the nonspecific factors.

Nonjudgemental Witnessing

Nonspecific factors are about more than simply convincing clients to trust therapists. That sounds manipulative, and if you've been following the spirit what I'm attempting to convey you'll know that manipulation is the exact opposite of what the nonspecific factors are about. Clients respond to nonspecific factors when they are present because they sense in their guts that trusting the therapist is warranted, not because they have been fooled.

The message of the nonspecific factors is one of compassion and non-judgement, in a word, "acceptance". Dr. Carl Rogers, the giant of this approach, called this thing "unconditional positive regard", but that phrase puts too much of a happy face on the thing for my taste. It's not that the therapist is necessarily conveying to the client that he or she loves them; it's more like a sort of deep acceptance that occurs. What clients frequently sense is that they are accepted by their therapist; that their therapist will not judge them and that therefore, they need not judge themselves.

Nonspecific factors are about creating an environment in which clients will not feel judged, or be judged. This is important because so much of what drives people into therapy involves judgement and rejection. People either feel judged by others or alternatively, they judge themselves (having internalized the other's voice). They react to those feelings of shame and guilt by becoming depressed or anxious, by going into denial or repressing their actual interests, and/or by developing a substance abuse disorder or eating disorder. Of course, this is not the only way that such problems develop, but it is one of the major paths leading to these destinations.

The nonspecific factor environment of non-judgement, compassion and authenticity of presence acts as a sort of solvent for shame and guilt. Shame and guilt feelings can start to dissolve away in such an environment, where in any other sort of environment, they grow instead. This is so because only in a non-judgemental environment can people feel safe expressing themselves in an uncensored and spontaneous manner. And it is only through such spontaneous and uncensored expression that people come to accept who they really are inside.

I should briefly talk here about limits of non-judgement for a moment, for in every relationship there need to be limits to non-judgement. When I talk about therapists providing a non-judgemental environment so that clients are freed to express their spontaneous and uncensored selves, I don't mean that literally everything and anything they want to talk about is fine and dandy. There are clear boundaries imposed by law and by society as to what is acceptable and what is not. Talking about an impulse to commit suicide is okay, for example, but actually making plans to kill yourself is not. No reasonable therapist would allow that discussion to proceed except under very special circumstances (for instance, possibly, in places where assisted suicide is legal, and a client is faced with a terminal disease).

Fortunately, by and large, clients' secret shames are more on the pedestrian side. Honestly, I once had a client come to me asking if she was crazy because she couldn't stop herself from sneaking a small piece of chocolate bar from her freezer each day. She was ashamed of her inability to control her desires. You would have thought she was completely out of control from the way she shamed herself, but it was just a little bit of chocolate (I had to explain to her about how many women consider chocolate to be an extra food group ... ). As this story illustrates, people find ways of being ashamed of themselves for all sorts of things. They're ashamed of having homosexual desires, or heterosexual desires, of not having pleased their parents with their choice of career, and of not feeling confident enough to speak in public. They may feel that they somehow caused their parents' divorce, or that they aren't smart enough, or they wonder if their spouse is right that they are too needy and demanding; stuff like that. Any number of secret shames that function as so much baggage, holding people back from their potential to be happy.

People simply don't share these secret desires and feelings with most people they know. There is simply too much perceived danger that seems to be involved; too much possibility of being teased or ostracized for acting funny. "Sticks and stones may break my bones ... ", right? Actually, people seem to me to be less afraid of physical damage than they are of emotional damage. Names can hurt you. For many people, rejection is perhaps the worst ordinary punishment they can contemplate. Even with close friends, family and confidants, there are frequently feelings and thoughts that cannot be shared for fear of rejection. In the absence of the certain knowledge that at least one other person can accept you knowing you feel or think in the ways you do, it is easy to doubt that such feelings and thoughts are okay. In that case, self-doubt and self-rejection become shame, and shame tends to hang around, fester, and contribute to life problems.

The point I've been working up to is this: Therapists who can be non-judgemental witnesses for their clients offer those clients a very great service precisely because of the shortage of people in most clients' lives who can otherwise wholly accept them. Many people who become psychotherapy clients are motivated to do so because they have never felt accepted by others, or felt accepted only in very constrained and artificial ways that left them feeling like they have to hide their true selves or risk rejection. Others used to feel accepted but got themselves into relationships as adults where that no longer occurs and now are hungry for it. On the surface, they may be looking to the therapist for guidance, but down below, they are also looking for acceptance; some confirmation that they are an acceptable person worthy of love and respect.

Self-regard and thus self-acceptance is ultimately modeled on how others have viewed you in the past. While you can become less dependent on others for this function as you mature, the starting place for self-acceptance remains whether others you've cared for or respected accepted you first. People need to have non-judgemental witnesses in order to learn how to accept themselves. Fulfilling this role of the non-judgemental witness is one of the more basic missions of the therapist.

What's your experience? Please share your comments below:

Comments
  • Lyn

    I enjoyed reading the article and I agree with the importance of the non-judgemental therapist. I come from a history of violent, long-term, physical child abuse and it breeds a whole lot of misplaced guilt. I have a very good therapist and yet I begin to get anxious about my appt. at least 24 hours before. If my therapist was not compassionate and non-judgemental I would never make it into my appt. Trusting another person is very difficult and this relationship is important in teaching me that trust is possible.

  • Anonymous-1

    I just came across your article and a few hours ago I terminated with my therapist C.F. Exactly what you shared in the article that happens when a therapist misses out on the importance of the non-judgemental, fully accepting patient as they are, not like she would like me to be is what occurred with me and my therapist. She was an effective therapist except that when working with me as someone with a Borderline Personality disorder, the rapport/caring between therapist/client needed to be genuine and it just wasn't there. Perhaps it isn't fair for me to indirectly judge my therapist C.F since we only worked together for a short period of time, thus making harder for us to work on developing that "genuiness" in our relationship, however, I needed to know and feel that she loved and accepted me for who I am and not reject me when I behaved in ineffective ways. Yes, I was DBT experienced but my despair doesn't just disappear with the use of DBT skills. My pain is more real and that's what I need the therapist to understand, then we can work on being effective. I'm sorry C.F for quitting so abruptely. Take Care From A.R.

  • Patrick

    I enjoyed your article. I recently terminated with my therapist, and your article helped me understand why. I just did not feel confident enough to reveal to her the true source of my shame, because I could not get past the feeling of how disappointed with me she would be. Whenever I would miss a small goal, she'd frown and tell me I needed to work harder. Maybe it was really just my interpretation of her response, but I just couldn't get past it.

  • LN

    I agree with 99% of your article. I just had an experience (okay, there's been more than one) where I revealed a source of deep shame to my therapist. She is totally non-judgmental and told me she doesn't even "go there". She truly is present in every sense of the word as much as humanly possible. What I find difficult is that I share so much of my life with her and I know very little about her life. I know she has three kids (hard to miss when your therapist is pregnant). I don't even know her family's last name though as she uses her maiden name. She wouldn't have a choice in the matter if she were male. These little things bother me. I long for a friend I guess. I am fortunate to have good friends and know that what I really need is a therapist but this issue keeps popping up for me.

  • John Crawford

    Excellent article. Absolutely essential and in short supply as you point out. Complete acceptance as a concept can most easily be understood when we begin with the premise that everyone seeks happiness. How we go about that can be misguided, but the original intent is usually to "do the right thing" So blame, shame, guilt and self abasement, is a misunderstanding of this fact. There are some funny old ideas in the world of therapy. First that you have to feel worse before you feel better...and then that therapy is not working because of "client resistance" ...or "they don't really want to get better". Hogwash! It's a simple formula and thewriter hits thenail on the head. Our clients turn up needing acceptance, and being really afraid that their therapist is going to tell them what everyone else has told them ...that THEY are the problem. You know sometimes they are...but there are ways of explaining that to someone in need which brings understanding ...not judgement. You did X but you were seeking solution. It didn't work out. This is where the acceptance comes from. In truly understanding this as a living breathing fact of existence. We do the best we can with what we have at any given time. The rest is learning. Providing we are willing to learn from our mistakes then therecan never be any place for guilt blame and shame. We cn acknowledge those parts of ourselves that carry these negative images and invite them to leave their baggage at the door and come home. It's the "unacceptableness" which keeps us separated from ourselves! I loved your article because it really made the distinction between someone who chooses not to show judgement and someone who is really 100% with the client because they understand the nature of these things.

  • Anonymous-2

    You disclaim manipulation. But, of course that's what it is, even if well meant. The whole basis of "therapy" is to have certain affects on the customer. Yet, to hire someone to do such a highly specialize ritual of non-personal "relationship" is a dubious thing. Aside from the theoretical premises, it's not at all like real life and, while it might "feel good", it's only a placebo routine, at best. The plain fact is, the supposed goal of therapy is to discontinue therapy, in favor of just living one's own real life. Paying someone to merely listen, with whatever degree of "nonjudgement" (or a convincing seeming to be) is just a pitch that that does anything at all otherwise. Rather than sell people on the belief that they somehow "need" that, which delays and interferes with their living their life without therapy, a truer "help" would be to encourage them to not keep seeking any such thing but get on with it. "Psychotherapy" largely creates its own "need" for unnecessary steps for people in living their real lives and is a self-serving commercial concept. One that just doesn't stand up to either its theories or claims, in practice, when carefully checked.

  • Anonymous-3

    Until recently I thought therepy had nothing to do with me and my life. I thought it was a sort of hobby or lifestyle that someone chosse like a religion or to join a sports team to help them through life. I was encouraged to see a college councillor after an assult earlier this year and having nowhere eles to turn I thought I would go along with the idea. I wasnt entirely sure why there has been a change in my opinion now about therepy until I came across this article. It made me think about why something which seemed so "foregin" to me is not so anymore. I think that seeing my therpist at college works for me because she is geniune and is present in the moment- all those attributes highlighted in the article. If she wasnt fully responsive and accepting of me as I am, then I certainally would not be still attending and gaining the benifits of looking at the patterns of my life and understanding myself and so forth. It is this genuine approach that she works with which must come from her very own self and couldnt be part of her training which makes her successful at engaging someone like myself who was pessermistic about mental health and therepys. Over all it is her proffessional tone which makes me feel safe and happy seeing her because I know that she isnt a friend with whom I have to hold back she is a proffessional who is paid to help and her success comes from her genuine approach combined with her proffessional togetherness and distance. I dont look for a friend in a therpist I look for a compitant therpist with whom I can see a friendly geniune warmth behind her words and approach. That proffessional distance for me is important.

  • Anonymous-4

    Blah blah. So what? No one can afford this guy's services anyway so what's the point of taking about technique? Doctors command so much for their services that 45,000,000 of us have no recourse when we need medical attention. Lower your goddamn prices and then we'll talk about how much you "care" about people.

  • Anonymous-5

    Therapy is one type of treatment for mental illnesses, just as anti-hypertensives or diet and excercise are for high blood pressure. If someone is sick, most people would seek help, whether it is physical or mental. No one complains that mechanics charge $$$$ for fixing a car, but when it comes to one's mental health and vitality, it is an issue of money. It is about priorities. People choose what they want to spend their money on.

  • Phil

    I think the article misses one important detail. The witness cannot help but be judgemental. We _judge_ on a continual basis, whether we admit it or not. The therapist (witness), however, is an advocate for the patient. The therapist is committed to finding the good in the patient, and to helping the patient unravel the ball of decisions that led to their current situation. So, in this respect, the witness is not judging the actions of the patient so much as has pre-judged the positive potential (god within or soul) of the individual and is determined to find the light under which the subject's actions can be understood, and help the patient make better decisions (behave ethically) moving forward. The client's actions are still judged, however, there is a desire by the therapist to understand the pain or anger that drove any negative behavior. Thanks.

  • flawedplan, of Our Common Condition

    Oh yes, in an age of socio-cognitive behavioral primacy this is a timely and necessary essay. The humanistic approach was tailor made for today's so-called "borderlines" and it is very rare to see articles like this written by a psychiatrist who understands particular approaches for particular populations. I read this five times and it made my day. It's linked on my message board, Our Common Condition, with a thorough endorsement and analysis from the "consumer" perspective.

  • Anonymous-6

    My 39+ year therapy relationship ended 5 months ago because the therapist (age 73) no longer wanted to take the necessary state licensing requirements. Had the licensing laws been different, he would have continued on a 2-3 times a month basis the laws made seeing me without the license unethical and illegal. No records were kept and no fees were involved. I was a 19 year old college student when it started and sessions were held on a college campus. I was his psychology student, manager of the college bookstore (still am) and worked in project headstart where he was clinical director. We worked on a Headstart documentary film together, etc. etc. I am heart broken at this rejection and agree that psychological loss or rejection is one of the most painful experiences. I feel completely destroyed.

  • bernadette

    "I will always be there, yes even after termination if you need. I will always be there"yes but then, he cancelled and his wife answered the phone, " oh and I am to give him that message am I?" How could I ring if she would answer, this strikes at basic oedipal problems, he was showing me that I was worthless and his wife was the person important in his life. Not too difficult to persude me of my unimportance.

    Editor's Note Unless the therapist's wife is serving as receptionist, it does seem inappropriate for her to pick up the office phone. However, the writer is reading meaning into this exchange that may not have been there at all. It is reasonable for a therapist to have a wife (or a husband) who is the emotional center of his (or her) life. Becuase such a spouse exists is not evidence that the patient is unimportant to the therapist.

  • Anonymous-7

    I started therapy about a year ago and just recently my therapist retired. I have not gone to anyone else since. I know I need to continue, however the thought of starting over (starting over at the same office, same file, new therapist) makes me sick. Even after months of treatment I would get very anxious days before the appt. About a month before I found out she was leaving I started telling her about all my secrets. I decided to start the therapy, no one forced me into it, so why did it take me so long to confide. She did not judge me or, anything I told her about. Starting over freaks me out, I don't know what to do!!!!

  • Anonymous-8

    Why not give equal time and emphasis to the other side the knowledge and study required of the professional, to be deemed professional. Today we have "Life Coaches." Where does a title like that come from? Where are their credentials? Is this not just one more scam like so many others? (Fortune Telling, Shamans, Boy Scout Leaders, Priests, Rabbis and Pastors, and so forth.) You get the point? I know some therapists are much better than others. A defect in the profession is they are not graded and supervised in any special way. My best friend may have more to offer towards a personal life conflict, than a bad but licensed so called professional. So, let the buyer beware as in all other social intercourse. (pun intended)

  • Milwaukee Guy

    I truly appreciate the non-judgemental viewpoint of my therapist. I've disclosed a number of things to her, even in small steps as I felt comfortable to do so, and she was open to hearing them. She asked questions to clarify what we were talking about, and she questions my judgement at times, but I never feel as if she is weighing me as "Good" or "Bad" based on what I talk about with her.

    I trust that if there is something that I should have caution about, she will make it clear for me to see the need for caution.

    Her non display of judgement helps me to feel comfortable telling her more. I have Bipolar disorder and I understand that sometimes my thinking is a bit (or more than a bit) distorted by that. She is helpful in helping me to be sure I am as grounded in reality as I can be.

    She has displayed, in the 4 years that I have been seeing her that she does not judge me even by what I have not told her. I've receintly disclosed some events of my adult life that happened since I have been seeing her, and she was not offended that I did not include her in it right then.

    Her open mindedness and non personalization and that has permitted me to be frank and open with her, and I am ready to face some tough issues of my past that haunt me to this day.

  • Paul

    The article mentions that it's Ok to talk of suicidal ideation, but not of actual suicide. This requires the therapist to judge that suicide is wrong, and that I am wrong to consider it. How does this square up with non-judgemental witnessing? My therapist of many years violated my confidence by contacting my spouse directly on this issue, and said she would do so again "in a heartbeat" if she felt my life was in jeopardy. Since she's judged suicide in this way, and betrayed my confidence, I no longer feel free to talk about this with her - if I need it, I have the means, but it's now off the table as far as my therapy goes. I guess there's a limt to everything, but it seems unfortunate.

    Editor's Note: Therapists in many professions are bound by ethical codes and by actual law to breach confidentiality and make a report to police or other authorities (and sometimes to spouses or to targets of possible violence) when they learn information about a client that leads them to believe that that patient is actually going to harm themselves or someone else if intervention does not take place. What therapists are supposed to do is to make this crystal clear at the outset of therapy so that the client knows what the limits are. Not every therapist does this, however. This sort of limit should not be something that gets triggered on a client who was not expecting it.

  • Cathy

    If the therapist starts using this immediately "let me ask you about your parents and growing up" rather than looking at the issues right now in the person's life, what happens to the person's life as it continues to disintegrate? I have seen it suggested that 6 months up to 2 to 3 years of weekly therapy is recommended - the partner/family could move to China and have began a new life by then. Doesn't the medical professional call this "bedside manner"? So, the therapist becomes the new "best" friend by being accepting and sympathic of the behavior that the client has probably came to the office for and then the client goes home feeling like "it's not me, it's you" and I just know that will be a welcome attitude in an already strained situation. These are only rhetorical questions. I lean more towards an artistic view as in " what's it going to take for you to get your head out of your butt therapy". I do appreciate the article and it did give me a good understanding really. I'm just set in my ways I guess.

  • Anonymous-9

    We need so much understanding, empathy and patience from therapists, and I can't help but sour a little over the money angle. Is there anyone that altruistic?

    ....."Let me tell you a little story first...." ...."I'm going to Belize next week, so call Dr." Carter" (that son of a bitch who blamed me for asking for a refill on my meds). "Oops, your time is up."What is this shit?

    "Lower your goddamn prices and then we'll see how much you care about people" is right on!

    Does there really exist a non-judgmental therapist?

    Dr. Dombeck's Note: Money issues come up frequently in therapy relationships. They are not always talked about out in the open between therapist and client, however. Frequently, at issue is the client's perception or belief that if you are paid to provide attention and care, that care is motivated primarily by the money and not by a genuine desire to be helpful. To my mind, having been both a therapist and a client in various turns of my life, the two needs (for payment to compensate the therapist's professional time for genuineness of caring about the client) are not mutually exclusive but rather co-exist in a sometimes uneasy tension.

  • Linda

    I enjoyed your article. I happen to have a Psychoanalyst who created a safe place for me to explore and express myself without fear of being judged or rejected. I am an educated 48 year old woman and have felt undeserving and inadequate most of my life. Shame consumed me. My past is riddled with failed suicidal attempts, and an inability to regulate my emotions and sustain meaningful employment.

    My analyst appears authentic and genuine at all times. I always feel he is present. His acceptance of me and my experiences have allowed me to share, grow, and become comfortable with who I am and what I want. I am starting to feel truly deserving of good in my life.

    Our sessions are always focused on me. He keeps his personal views and his personal life to himself to ensure I don’t hold back on what I feel or say. He stands way above other therapist that I’ve had. It is because of his ability to be a nonjudgmental witness that has afforded me the opportunity to change. I am loving life now, and each day have a little better understanding of myself, and a greater sense of acceptance for who I am.

  • Mary S

    The attitude of acceptance described in this article sounds great to me. But I've rarely found it in therapy. Instead, I've gotten experiences like the following (with three different therapists):

    1) Me: I'm somewhat shy. Therapist:You gave up your power.

    2) Me: I want to talk about shame. Therapist: I don't know what you mean by shame. I've looked it up in the dictionary, and I still don't understand. (Finally, after I tried to explain three times -- it's awfully difficult to explain what an emotion is -- she just laughed.)

    3) Me (after therapist said he'd also had "bad therapy," and gave some details): But that's very different from my experience (followed by explanations of how). Therapist: I think you're harming yourself by focusing so much on differences between you and me. You need to focus more on similarities.

    As I see it, acceptance can provide the "missing ingredient" that can give me the little boost to help myself. It's much more helpful than "technique". But rare to find in a therapist. (Number 3 actually was accepting enough to be of some help, at least for a while, before he got into the incident described above.)

  • Anonymous-10

    If only all this were true. In fact I have seen a great many therapists over the years and have yet to find a single one who does not feel compelled to judge me, seemingly for the simple reason that I do not fit conveniently into any stereotypes which they may have at their disposal. The therapists I have seen are not interested in helping me to achieve self-acceptance, they are interested in turning me into a "normal" person. The implication here is that, as I am, I am unacceptable and wrong their continued judgements to this effect have greatly added to the initial feelings of shame, guilt and low self-esteem.

    I do not generally post comments on the Internet, but am moved to do so in order to point out how extremely few therapists - I have not yet met any - actually adhere to the lofty principles set forth in this article.