EXISTENTIAL PSYCHOTHERAPY

EXISTENTIAL PSYCHOTHERAPY

Existential psychotherapy is a school of psychotherapeutic thought and practice that derives from multiple sources. The first of these sources is existential philosophy. This type of philosophy arose during the 19th century in continental Europe. Indeed, because of this geographic origin, it is considered part of what is called continental philosophy, philosophy that arose in continental European countries like France and Germany, rather than the British Isles. These countries had a philosophical heritage that included strong elements of rationalism, stemming from thinkers like Descartes and Kant. In contrast to British empiricism, which sought to make science and empirical knowledge the center of inquiry and justified belief, the rationalism of Continental philosophy focused on what could be known a priori, or through sheer thought and reflection.
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Philosophers like Kierkegaard, Nietzsche, Heidegger, and Sartre formed the core of existentialism. They focused on issues such as the meaning of life, death, purpose, choice, freedom, and so on. Rather than strictly logical or scientific thinking, they explored the big issues of human life that manifest themselves in our day-to-day existence (Cooper, 2003).

The other main source of existential psychotherapy comes from the school of humanistic psychology. After the hegemony of psychoanalytic and then behaviorist systems of thought in psychology, the school of humanistic psychology was branded as the “Third Force” in psychology. A main tenet of this school is that while psychoanalytic and behaviorist psychology basically broke down the individual by analyzing him/her into the relevant component parts and working on those, humanistic psychology sought to treat the whole person (Buhler & Allen, 1972).

People like Carl Rogers and Abraham Maslow were central in humanistic psychological thought. Rogers developed some of the most important ideas in the history of psychotherapy, some which inform practitioners from all schools of psychotherapy. And Maslow’s hierarchy of needs is almost a household idea. The practitioners of humanistic psychology were instrumental in inspiring the existential approach.

Existential psychotherapy drew from these two traditions. Therapists like Rollo May and Irvin Yalom explicitly developed ideas found in the writings of both existentialist philosophers like Kierkegaard and humanistic psychologists like Rogers. The practice of psychotherapy and the human relationship that it consists of has been ripe ground for these types of ideas to be put into practice. People show up in therapy for many different reasons, but the existential approach is deep and broad enough to claim territory over pretty much all human issues, at least at an abstract level.

Existential psychotherapists vary widely and there is not a tradition of standardization and scientific investigation as there is in other psychotherapeutic schools such as cognitive-behavioral therapy or even psychodynamic theories. It does not have a specific body of doctrine, evidence, or even methodology. Existential therapy has been called more of a frame than specific form of therapy (Yalom, 1980). Its main strategy is to foster exploration, awareness, and acceptance, in each individual, of broad existential themes that permeate human life and human problems. And while theorists do vary, Existential psychotherapy is centered around four basic themes, or “givens” in one form or another. Those four themes are: (a) Death, (b) Freedom, (c) Relationships, (d) Meaning. An existential approach asserts that the denial of any of these themes in one’s life can lead to a host of issues that usually go by standard diagnostic names, i.e. depression, anxiety, neurosis, psychosis, etc. We will examine each one of these themes in turn:

Death is obviously an issue that all human beings face. And while most of our problems in living seem not to be directly related to death, Existentialists argue that it is implicitly the backdrop and motivator for many of our struggles. Death is naturally anxiety provoking for human beings. Except in rare circumstances, such as extreme acts of bravery or rescue, the stuff of the so-called adrenaline rush, where one has a feeling of immediate invincibility or indifference toward death, or very positive spiritual or mystical experiences or states where one feels transcendent over or at least at peace with death, the fear of death is omnipresent in our normal modes of functioning.

This is not to say that we are conscious of this fear. Indeed, constant and persistent awareness and conscious reflection on death would not be practically attainable, and if achieved would almost certainly lead to neurosis or psychosis (Becker, 1997). Hence, existentialists recognize two main things in terms of the fear of death: it is mostly unconscious, and there is therapeutic value in recognizing occasionally this fear. The value derives from the occasional nature because advocates of existential therapy do not promote an obsessive or morbid preoccupation with death. Essentially, neither living oblivious to death nor living in constant fear of it is valuable.

The sort of Middle-Way approach to facing the issue of death in existential therapy derives from some of the ways that we tend to deny death. Yalom (1980) posits two ways that we deny death: (a) the ultimate rescuer and (b) specialness. The idea of the ultimate rescuer consists of the notion of something or someone that is external, which will rescue one from death. One can recognize this theme in countless religious and mythological narratives throughout human history and culture. Specialness, on the other hand, relates to the idea that one is so special and valuable to the world that the rules of death do not apply to them. Essentially, it is an internal source of some kind of symbolic immortality. Although they will certainly physically die, the symbolical value of their existence will contribute something to the world that will be basically eternal.

Consider that many people who do not find solace in traditional religious ideas of immortality, develop a sense of their symbolic immortality to come, whether through their creative work or through their genetic lineage or some other transference of meaning. This is one main aspect of the modern, secular world (Blumenberg, 1966). Indeed the traditional religious beliefs can be conjoined with these as well, and they often are for many people.

Whatever the nature or true ontology of the problems of death and immortality are, existential psychotherapy is not concerned with those, per se. Just as many other forms of psychotherapy are not really in the business of truth in an absolute sense, existential psychotherapy is not a body of doctrine about the truth or falsity of these ways of being or approaches to life. Existential psychotherapy is just as functional as behavior analysis in the sense that it is how these issues relate to the life of the individual and their suffering that really matter, and it is besides the point to argue over philosophical problems. Concerning these approaches to death, existential psychotherapy simply aims to recognize and alleviate problematic and fearful styles of dealing with this natural fear of death, whatever other aspects of form they may take, religious or secular, “true” or not.

Another all-important issue in existential psychotherapy is Freedom. This stems directly from Existential philosophy. For example, philosophers like Martin Heidegger and Jean-Paul Sartre were famous for notions of being and choice in the human world. Sartre proposed in his book,Being and Nothingness, that we essentially have no true nature, but rather create who we are through our choices, and at any point in time we can change by making new choices and aligning with our authenticity (Sartre, 1943). He aimed to defend the idea of human freedom against determinists of all kinds.

Not all existential psychotherapists will commit to such a radical view of human free will. But to the degree to which this tradition stems from its philosophical elders, a basic bias and tendency toward valuing and pursuing the open aspect of human freedom and choice is a main part of this therapy. Unlike behavior analysts, and even psychodynamic theorists, all of whom are deterministic (the latter perhaps less dogmatically than the former), existential psychotherapists bet on and work with human free will, whether it is an illusion or not. Again, ontology is not the business at hand.

It is important to distinguish the idea of existential freedom from that of other types of freedom, say social or political freedom. Although this latter type of freedom is not unimportant, it can be considered shallow in relation to existential freedom. One way to think of it is that one can have one freedom without the other. For example, one can lack political freedom but be existentially free, while another may have great political freedoms, but not be existentially free.

A case comes from Viktor Frankl, where he describes his experience of being detained in a concentration camp. He tells how although he lacked almost all social and political freedom, he was able to find and embrace a mode of psychological and existential freedom that gave him the strength to survive and persist under such harsh conditions (Frankl, 1984).

It is important to note that in an existential approach, freedom is directly connected to the idea of responsibility. There are many ways that people can avoid responsibility for their actions and ways of being. These often resort to attributing the causes of ones behavior to an external or uncontrollable source. And harping back to the issue of determinism, while an existential view does not necessarily deny that these other factors are causal in effecting people, there is still on emphasis on accepting and adopting a responsible stance for oneself. None of these factors make a person powerless.

Otto Rank, an initial follower of Freudian psychoanalysis who turned toward broader humanistic and existential themes, described this concept of a connection between freedom, causes, and responsibility. Rank posits that the degree to which one is unaware of the causes that influence oneself, then one is controlled by those causes. But an awareness of those factors removes their ultimate control. Not that they are no longer influential, but that don’t have the total control that they do under pure unawareness (Rank, 1996).

Through this view, one can see how an important part of existential therapy can be to simply try and understand what factors influence one’s behavior, thought, emotion, motivation, etc. To the degree that one is aware, there arises a sort of transcendence. Usually, more awareness is better from an existential approach. It can allow one not to control everything, but it can help one to not be controlled by everything. This is a subtle but important point in the following process: awareness can lead to responsibility and true freedom.

The next topic of interest in an existential approach is relationships. Alternatively, one can talk about isolation. But just as freedom and responsibility are intertwined, so is relationships and isolation. Yalom proposes three different kinds of isolation (Yalom, 1980): interpersonal isolation, intrapersonal isolation, and existential isolation. Let us look at each of these.

Interpersonal isolation is the type of isolation that we usually refer to when we use the word isolation in common language. This could be that a person is simply physically isolated from others, although it is not only this. Interpersonal isolation can also refer to a certain way of being in a relationship that is not satisfying for one’s relational needs. So a person can be physically around others and even connected in some minimal form within a relationship, but there can still exist this form of interpersonal isolation.

Many can think of situations where people experience this within the context of relationships with others. It is also common that lonely people are not in less physically in contact with others, but rather it is their mode of being that is different. Research has shown this, despite the stereotype of lonely people as being necessarily physically isolated. Lonely people do tend to spend more time with strangers and larger numbers of people rather than having more meaningful relationships with less people. Therefore it is the quality, not quantity, of relationships that leads to loneliness or not (Jones, 1982).

Intrapersonal isolation refers to the slightly more abstract idea of being split off from oneself or from others in a relationship. That is, one may be in a relationship that does not lack in ways that would bring interpersonal isolation. In other words, the relationship may be “satisfying” by most normal criteria, but there are aspects of self and its potential relationship to others that are hidden, closed off, and otherwise not authentic.

Again, we are all familiar with the sort of isolation that comes with always having personal secrets that even the most intimate of our relationships may never witness in a public or shared way. It could be argued that the default mode of functioning for each person is to withhold aspects of their self from others, and only slowly allow progressively more aspects to be revealed with growing intimacy. Intrapersonal isolation exists in degrees along this continuum of sharing and secrecy.

The last form of isolation in Yalom’s framework is existential isolation. This refers to the ultimate realization that one cannot escape one’s own consciousness and subjectivity, no matter what one does. And likewise, one cannot ever fully experience the subjectivity of another human being. This is simply a fundamental part of human limitation. In existential psychotherapy, an awareness and acceptance of this kind of isolation and limitation is seen as contributing to growth and understanding. Just like issues of death and freedom, what this approach comes down to is not some particular answer or method, but rather the exploration of, awareness of, and acceptance of existential isolation.

The final theme is meaning. Meaning is central to human life, and this is evident in the clichéd search for the “meaning of life.” This is one of the most difficult themes and arguably underlies all others. It boils down to the ultimate question, “Why?” Even more so than before, existential psychotherapy does not purport to give a right or true answer to what meaning is. But thinkers have explored the types of meaning at work in people’s lives. Like isolation, three different types of meaning can be identified: (a) false meaning, (b) transitory meaning, and (c) ultimate meaning (Hoffman, 2004).

False meaning is the type of meaning that people either explicitly or implicitly adopt that are usually either not sustainable, empowering, or helpful in any significant way. Indeed, this type of meaning is typically destructive. It may include the standard list of hedonistic pursuits, such as food, drink, sex, drugs, money, power, or any other type of pleasurable or mundane thing. This is some of the standard objects of addictions or obsessions, as well. The issue is not so much the specific object or activity at hand, but rather the simplistic nature of it, and the inability of it to address the existential issues. This is not to say that these things don’t have any positive or redeeming qualities in many contexts, for example, enjoying food with friends, or sex in an intimate relationship. These are simply many of the standard things that are the objects of false meaning, especially when not connected to other forms of meaning, specifically the ultimate kind.
Transitory meaning occupies an interesting middle ground. This type of meaning shares certain aspects with false meaning. As its name suggests, it is transitory, and hence does not sustain one’s essential (existential) needs. It can help us cope, but it does not truly fulfill. An interesting aspect of this type is that it is often what we consider to be things that contribute to our growth and development. This could include developing skills, achieving success in various fashions, receiving education, helping others, pursuing healthy interests and relationships and activities, etc. These things are often considered good and healthy things to do by most societal and personal norms. And they lack the destructive nature of objects of false meaning. Yet, they lack the transcendent nature of ultimate meaning.

Ultimate meaning is that which contributes to the transcendence of other existential themes, such as death, isolation and relationships, freedom and responsibility, and clearly, meaninglessness. There is no single answer to what things can be objects of ultimate meaning. Hoffman submits that it is through the process of relationship that ultimate meaning lies. This could be relationship to another person, and object, idea, God, etc. In essence, it is something that is not oneself. It is something greater. Despite the limitations found in human relationships and the issues concerning isolation, this idea of relationship can lead to transcending the main existential issues. Indeed, the whole approach takes place within the context of the therapeutic relationship.

Though this analysis of existential psychotherapy is partial and perhaps biased toward one way of systematizing the ideas (essentially that of Yalom and some other thinkers), it is nevertheless the only way to extract and understand the ideas within this school of thought. These themes are basically the recurrent ones within this approach to therapy. Furthermore, although there is literature on the topic, there are hardly the kinds of standardized handbooks as one would find for schools of behavior therapy or cognitive-behavior therapy. Although there are new forms of publications based on existential practice (Blugental, 1999).

As stated, existential psychotherapy, by its very nature, lacks both a specific methodology and a body of empirical evidence. It is therefore highly discriminated against in mainstream academic culture, where evidence-based treatments are all the rage and empirical testing in general is the gold standard (Yalom, 1980).

But those who appreciate its value have learnt to do so by realizing that the nature of its ideas and the therapeutic process that embodies it is simply not amenable to empirical testing in any easy or straightforward way. The themes of existential psychotherapy have to do with the most difficult and complex issues of human existence. The fact that these things cannot easily be studied in the lab should come as no surprise. And it definitely should not be a reason to dismiss the importance of existential psychotherapy.

The process of psychotherapeutic integration and eclecticism that has taken place over the last few decades has actually witnessed existential psychotherapy take an important role in the project. There are recognized proponents of existential approaches who argue that it can be the centerpiece and framework for an integrative approach to psychotherapy. The case is made that advocates of other schools of psychotherapy can consistently adopt an existential framework and ideas, which will give a profitable context within which to practice whatever method, technique, focus, or style that they wish to apply. It is argued that because existential ideas are so deep and fundamental to human life, they are compatible with other approaches, and form the natural and logical centerpiece of an integrative project. (Schneider, 2007; Schneider & Krug, 2010).

This has led prominent psychotherapy researcher Wampold to claim ““that an understanding of the principles of existential therapy is needed by all therapists, as it adds a perspective that might…form the basis of all effective treatments” (Wampold, 2008, p. 6). Indeed, rather than an antiquated philosophical orientation, existential psychotherapy is thriving, growing, and has an important role to play in the future of the field (Hoffman, Stewart, Warren, & Meek, 2009).

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References
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