As human beings we have an "idea" or concept of who we are and what we really should be, hence we create an Ideal Self that we constantly strive for, often in vain. If the perceived self, our own self-image, is not aligned with the actual self, how we really are, there will always be personality problems and dysfunction as one relates to one's self and the rest of the world. (Kail & Wicks 1993) In Carl's case this is certainly exacerbated by his TBI. In some sense if a human being grows in a very healthy and psychological and socially secure and protected environment, congruence should naturally be achieved. If he or she has felt the unconditional positive reinforcement that Rogers advocates, than congruence should be an outcome of certainty. (Vander Zanden 2003) However, even with the best of growth comes change and the self you are today may be different that the self you will be tomorrow, with perhaps different plans and goals. The human being's ability to adapt and change is one of the species greatest strength, but may also keep total congruence just a little out of reach. In Carl's case achieving congruence will require a great deal of adaptation to a new way of living with this TBI.

During the course of our therapy I realized that Carl had several organic as well as psychological issues that needed to be addressed. I knew it was imperative that I not only address these issues but also find a way for Carl to embrace his new self and, after a mourning period, release his concept of his old ideal self so that he may more appropriately address his issues of congruence and self-actualization. Our first interviews went slowly as we not only got to know each other but this also allowed Carl to actually begin to remember me as his short-term memory was reinforced with repetition of my presence. Afterward we worked on addressing what his ideal self had been and where his new ideal...

He began to realize that this ideal self no longer existed as we explored different avenues of limitation and of new creative avenues to explore. Creating different ways for Carl to remember and enhance his short-term memory as well as slowly but surely becoming more independent during the coure of his rehabilitation therapy as well. It was important for Carl to understand that he can have congruence once he embraces his new limitations and the changes they have made in his life. By utilizing his notebook as well as his ample sense of humor we were able to make great progress in this direction. While he is still under medical care and is taking prescription medication for depression as well as schizophrenia, there is hope that in conjuction with his primary care physician we will be able to curtail his depression by addressing these root cause of incongruence and give Carl the ability to self-actualize.
Self-actualization is the Rogerian goal of finding your actual self and discovering no differences between that self and the perceived self. This is congruence. It is hard to believe that no incongruence can ever exist in the human psyche, but there are certainly levels of development that can lead one to a more congruent life.

List of References

Demorest, Amy. 2005. Psychology's Grand Theorists: How Personal Experiences Shaped Professional Ideas. Mahwah, NJ: Lawrence Erlbaum Associates.

Kail, RV, & Wicks-Nelson, R. 1993. Developmental Psychology. 5th ed. Englewood Cliffs, New Jersey: Prentice Hall.

Vander Zanden, James W. 2003. Human Development. Crandell, L.T. & C.H. Crandell & Thomas L., Eds.. New York: McGraw Hill.