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By Timothy Cocks Science and the world 10 Jun 2014

A good friend of noi and has generated a lot of interest and discussion with some previous posts.  He’s back with some thoughts on a key clinical skill…

Congruence is a term coined by the great psychologist Carl Rogers.  In his clinical and research work, he came to understand a way of being which was very potent in creating positive change for his clients.  To be congruent is to be deeply genuine, authentic and transparent.

Congruence requires the therapist to be both attentive and relatively free of personal shame.  It is a dynamic process wherein the therapist  attends to his inner thoughts and feelings. He then allows those inner aspects of his personality to flow freely (shamelessly) into outwards expression (facial expression, body language and speech).  This helps with two things:

1) Trust. Trust allows the patient to open up.  When a patient is open and unguarded, he will be able to integrate educational metaphors and stories.  Trust also allows hypnotic suggestions for health and well being to be integrated.   Without such open communication, even the most ‘sticky’ words and carefully constructed scripts will be forgotten.

2) When the therapist displays congruence, it gives the patient permission to be congruent himself.  ‘Unacceptable’ aspects of self are brought to light and accepted.  The person becomes more self-accepting, more whole.  As a result, pain disappears.

There are degrees of congruence.  It’s a very subtle art with great depth.  Being congruent can lead fairly readily to a state of “flow”. Flow is a state of attenuated self-referencing.  In other words, the therapist’s ego has temporarily taken a back seat. Subjectively, the patient experiences this as ‘warmth’, acceptance, connection, caring/nurturing and a deep silence.  No university degree is required for this, and yet by my reckoning it’s more powerful than anything I’ve ever learnt at uni.  It can stand completely on its own as a treatment for both acute and chronic pain. There’s a link here to my experience with Mrs X; no congruence, no flow and immediately things go badly.

I’ve collected a heap of clinical notes on the topic of congruence, flow states and the therapeutic relationship, but they are quite disorganized.  Last week I set about putting them into order so that I could present them here, but after many hours of work I thought to myself: “This is taking forever and I’m not even enjoying it!”, so I stopped and wrote this instead.  How’s that for congruence?


  1. timcocks0noi

    Great thoughts, thanks for the post.

    Looking back at my early attempts to explain pain, I reckon I failed more times than I succeeded. I suspect that I was incongruent with my message. I generally understood the pain physiology stuff but I don’t think I really *got* it – there was still a lot of Uni-learnt stuff hanging about!
    Perhaps it was my voice, my gestures, not sure, but I’m pretty sure people receiving the message picked up on it. Nowadays I do better – the message hasn’t changed but I definitely think I’m more congruent with it.


  2. This is in many ways is Motivational Interviewing. I highly recommend taking the course. JohnB


    Enjoyable and relevant post Cameron. Some of this not so relevant perhaps but I thought the comment on ‘people’ and ‘pupils’ fitted the points you were raising . The messenger rather than the message sometimes perhaps. When you yourself don’t believe or its not your own natural way of explaining things or perhaps there is a glaring awareness of hostility there may be little room for congruence to occur. How long was the MI training John?


  4. Interesting post Guys……….I think when we strip our emotional pain and suffering down to the bone and expose the “Primal wound” we will find shame as the core. For example the shame that I felt because I was unworthy of the love of my parents, otherwise they would have treated me differently…………or maybe I was just pure evil as they said……..!!!!!!!!!
    When we arrive at that moment in our lives when we can identify shame and integrate it into who we are, rather than letting it go, then we can truly “Live” empathy for ourselves and others. This is what I would call “True Congruency”. In the altruistic, empathetic form we become more capable of delivering our educational knowledge, charismatic hypnosis and hearty portion of “Hands on” treatments to the patient…..
    DB London

  5. Thanks for the feedback and comments.

    Very nicely expressed DB (of London!).

    Ian, the Claxton quote in the link resonates with me.


  6. So has anyone tried this?

    I didn’t just post it to sound clever.

    Miracles happen when you apply it. BIG and RAPID changes in pain result.

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