Existential psychotherapy is a form of psychotherapy based on the model of human nature and experience developed by the existential tradition
of European philosophy. It focuses on concepts that are universally
applicable to human existence including death, freedom, responsibility,
and the meaning of life. Instead of regarding human experiences such as anxiety, alienation and depression
as implying the presence of mental illness, existential psychotherapy
sees these experiences as natural stages in a normal process of human
development and maturation. In facilitating this process of development
and maturation existential psychotherapy involves a philosophical
exploration of an individual's experiences while stressing the
individual's freedom and responsibility to facilitate a higher degree of
meaning and well-being in his or her life.
Background
The
philosophers who are especially pertinent to the development of
existential psychotherapy are those whose works were directly aimed at
making sense of human existence. For example, the fields of phenomenology and existential philosophy are especially and directly responsible for the generation of existential therapy.
The starting point of existential philosophy (see Warnock 1970;
Macquarrie 1972; Mace 1999; Van Deurzen and Kenward 2005) can be traced
back to the nineteenth century and the works of Søren Kierkegaard and Friedrich Nietzsche.
Their works conflicted with the predominant ideologies of their time
and committed to the exploration of reality as it can be experienced in a
passionate and personal manner.
Søren Kierkegaard (1813–1855)
Soren Kierkegaard
(1813–1855) protested vehemently against popular misunderstanding and
abuse of Christian dogma and the so-called 'objectivity' of science
(Kierkegaard, 1841, 1844). He thought that both were ways of avoiding the anxiety
inherent in human existence. He had great contempt for the way life was
lived by those around him and believed truth could only be discovered
subjectively by the individual in action. He felt people lacked the
courage to take a leap of faith
and live with passion and commitment from the inward depth of
existence. This involved a constant struggle between the finite and
infinite aspects of our nature as part of the difficult task of creating
a self and finding meaning. As Kierkegaard lived by his word, he was
lonely and much ridiculed during his lifetime.
Friedrich Nietzsche (1844–1900)
Friedrich Nietzsche (1844–1900) took this philosophy of life a step further. His starting point was the notion that God is dead,
that is, the idea of God was outmoded and limiting (Nietzsche, 1861,
1874, 1886). Furthermore, the Enlightenment—with the newfound faith in
reason and rationality—had killed or replaced God with a new Truth that
was perhaps more pernicious than the one it replaced. Science and
rationality were the new "God," but instead took the form of a deity
that was colder and less comforting than before. Nietzsche exerted a
significant impact upon the development of psychology in general, but he
specifically influenced an approach which emphasized an understanding
of life from a personal perspective.
In exploring the various needs of the individual about the ontological
conditions of being, Nietzsche asserted that all things are in a state
of "ontological privation," in which they long to become more than they
are. This state of deprivation has major implications for the
physiological and psychological needs of the individual.
Edmund Husserl (1859–1938)
While Kierkegaard and Nietzsche drew attention to the human issues that needed to be addressed, Edmund Husserl's
phenomenology (Husserl, 1960, 1962; Moran, 2000) provided the method to
address them rigorously. He contended that natural sciences assume the
separateness of subject and object and that this kind of dualism
can only lead to error. He proposed a whole new mode of investigation
and understanding of the world and our experience of it. He said that
prejudice has to be put aside or 'bracketed,' for us to meet the world
afresh and discover what is absolutely fundamental, and only directly
available to us through intuition.
If people want to grasp the essence of things, instead of explaining
and analyzing them, they have to learn to describe and understand them.
Max Scheler (1874-1928)
Max Scheler
(1874-1928) developed philosophical anthropology from a material ethic
of values ("Materielle Wertethik") that opposed Immanuel Kant's ethics
of duty ("Pflichtethik"). He described a hierarchical system of values
that further developed phenomenological philosophy. Scheler described
the human psyche as being composed of four layers analogous to the
layers of organic nature. However, in his description, the human psyche
is opposed by the principle of the human spirit. Scheler's philosophy
forms the basis of Viktor Frankl's logotherapy and existential analysis.
Martin Heidegger (1889–1976)
Martin Heidegger
(1889–1976) applied the phenomenological method to understanding the
meaning of being (Heidegger, 1962, 1968). He argued that poetry and deep
philosophical thinking could bring greater insight into what it means
to be in the world than what can be achieved through scientific
knowledge. He explored human beings in the world in a manner that
revolutionized classical ideas about the self and psychology. He
recognized the importance of time, space, death, and human relatedness.
He also favored hermeneutics, an old philosophical method of investigation, which is the art of interpretation.
Unlike interpretation as practiced in psychoanalysis (which
consists of referring a person's experience to a pre-established
theoretical framework), this kind of interpretation seeks to understand
how the person himself/herself subjectively experiences something.
Jean-Paul Sartre (1905–1980)
Jean-Paul Sartre
(1905–1980) contributed many other strands of existential exploration,
particularly regarding emotions, imagination, and the person's insertion
into a social and political world.
The philosophy of existence, on the contrary, is carried by a wide-ranging literature, which includes many authors, such as Karl Jaspers (1951, 1963), Paul Tillich, Martin Buber, and Hans-Georg Gadamer within the Germanic tradition and Albert Camus, Gabriel Marcel, Paul Ricoeur, Maurice Merleau-Ponty, Simone de Beauvoir and Emmanuel Lévinas within the French tradition (see for instance Spiegelberg, 1972, Kearney, 1986 or van Deurzen-Smith, 1997).
Others
From the
start of the 20th century, some psychotherapists were, however, inspired
by phenomenology and its possibilities for working with people.
- Otto Rank (1884–1939), an Austrian psychoanalyst who broke with Freud in the mid-1920s, was the first existential therapist.
- Ludwig Binswanger, in Switzerland, also attempted to bring existential insights to his work with patients, in the Kreuzlingen sanatorium where he was a psychiatrist.
- Much of his work was translated into English during the 1940s and 1950s and, together with the immigration to the USA of Paul Tillich (1886–1965) (Tillich, 1952) and others, this had a considerable effect on the popularization of existential ideas as a basis for therapy (Valle and King, 1978; Cooper, 2003).
- Rollo May
(1909–1994) played an important role in this, and his writing (1969,
1983; May et al., 1958) kept the existential influence alive in America,
leading eventually to a specific formulation of therapy (Bugental,
1981; May and Yalom, 1985; Yalom, 1980).
- Humanistic psychology was directly influenced by these ideas.
- Viktor Frankl (1905–1997) was possibly the individual most responsible for spreading existential psychology throughout the world. He was invited by over 200 universities worldwide and accomplished over 80 journeys to North America alone, first invited by Gordon Allport at Harvard University.
- In Europe, after Otto Rank, existential ideas were combined with some psychoanalytic principles and a method of existential analysis was developed by Medard Boss (1903–1990) (1957a, 1957b, 1979) in close co-operation with Heidegger.
- In France, the ideas of Sartre (1956, 1962) and Merleau-Ponty (1962) and of some practitioners (Minkowski, 1970) were important and influential, but no specific therapeutic method was developed from them.
Development
Development in Europe
The European School of existential analysis is dominated by two forms of therapy: Logotherapy, and Daseinsanalysis. Logotherapy was developed by psychiatrist Viktor E. Frankl.
Frankl was heavily influenced by existential philosophy, as well as his
own experience in the Nazi concentration camps of World War II. The
three main components to Logotherapy
are Freedom of Will, which is the ability to change one's life to the
degree that such change is possible, Will to Meaning, which places
meaning at the center of well-being, and Meaning in Life, which asserts
the objectivity of meaning. The primary techniques of Logotherapy
involve helping the clients to identify and remove any barriers to the
pursuit of meaning in their own lives, to determine what is personally
meaningful, and to then help patients effectively pursue related goals.
Daseinsanalysis is a psychotherapeutic system developed upon the ideas of Martin Heidegger, as well as the psychoanalytic theories of Sigmund Freud, that seeks to help the individual find autonomy and meaning in their "being in the world" (a rough translation of "Dasein").
Development in Britain
Britain became a fertile ground for further development of the existential approach when R. D. Laing and David Cooper, often associated with the anti-psychiatry
movement, took Sartre's existential ideas as the basis for their work
(Laing, 1960, 1961; Cooper, 1967; Laing and Cooper, 1964). Without
developing a concrete method of therapy, they critically reconsidered
the notion of mental illness and its treatment. In the late 1960s, they
established an experimental therapeutic community at Kingsley Hall
in the East End of London, where people could come to live through
their 'madness' without the usual medical treatment. They also founded
the Philadelphia Association, an organization providing an alternative
living, therapy, and therapeutic training from this perspective. The Philadelphia Association is still in existence today and is now committed to the exploration of the works of philosophers such as Ludwig Wittgenstein, Jacques Derrida, Levinas, and Michel Foucault as well as the work of the French psychoanalyst Jacques Lacan.
It also runs some small therapeutic households along these lines. The
Arbours Association is another group that grew out of the Kingsley Hall
experiment. Founded by Joseph Berke
and Schatzman in the 1970s, it now runs a training program in
psychotherapy, a crisis center, and several therapeutic communities. The
existential input in the Arbours has gradually been replaced with a
more neo-Kleinian emphasis.
The impetus for further development of the existential approach
in Britain has primarily come from the development of some existentially
based courses in academic institutions. This started with the programs
created by Emmy van Deurzen, initially at Antioch University in London and subsequently at Regent's College, London
and since then at the New School of Psychotherapy and Counseling, also
located in London. The latter is a purely existentially based training
institute, which offers postgraduate degrees validated by the University of Sheffield and Middlesex University.
In the past few decades, the existential approach has spread rapidly
and has become a welcome alternative to established methods. There are
now many other, mostly academic, centers in Britain that provide
training in existential counseling and psychotherapy and a rapidly growing interest in the approach in the voluntary sector and the National Health Service.
British publications dealing with existential therapy include
contributions by these authors: Jenner (de Koning and Jenner, 1982),
Heaton (1988, 1994), Cohn (1994, 1997),
Spinelli (1997), Cooper (1989, 2002), Eleftheriadou (1994),
Lemma-Wright (1994), Du Plock (1997), Strasser and Strasser (1997), van
Deurzen (1997, 1998, 2002), van Deurzen and Arnold-Baker (2005), and van
Deurzen and Kenward (2005). Other writers such as Lomas (1981) and
Smail (1978, 1987, 1993) have published work relevant to the approach,
although not explicitly 'existential' in orientation. The journal of the
British Society for Phenomenology regularly publishes work on
existential and phenomenological psychotherapy. The Society for
Existential Analysis was founded in 1988, initiated by van Deurzen. This
society brings together psychotherapists, psychologists, psychiatrists,
counselors, and philosophers working from an existential perspective.
It offers regular fora for discussion and debate as well as significant
annual conferences. It publishes the Journal of the Society for Existential Analysis
twice a year. It is also a member of the International Federation of
Daseinsanalysis, which stimulates international exchange between
representatives of the approach from around the world. An International
Society for Existential Therapists also exists. It was founded in 2006
by Emmy van Deurzen and Digby Tantam and is called the International Community of Existential Counsellors and Therapists (ICECAP).
Development in Canada
New developments in existential therapy in the last 20 years include existential positive psychology (EPP) and meaning therapy (MT).
Different from the traditional approach to existential therapy, these
new developments incorporate research findings from contemporary
positive psychology.
EPP can reframe the traditional issues of existential concerns
into positive psychology questions that can be subjected to empirical
research. It also focuses on personal growth and transformation as much
as on existential anxiety. Later, EPP was incorporated into the second wave of positive psychology (PP 2.0).
Meaning Therapy (MT) is an extension of Frankl's logotherapy and
America's humanistic-existential tradition; it is also pluralistic
because it incorporates elements of cognitive-behavioral therapy, narrative therapy, and positive psychotherapy,
with meaning as its central organizing construct. MT not only appeals
to people's natural desires for happiness and significance but also
makes skillful use of their innate capacity for meaning-seeking and
meaning-making. MT strikes a balance between a person-centered approach
and a psycho-educational approach. At the outset of therapy, clients are
informed of the use of meaning-centered interventions appropriate for
their predicaments because of the empirical evidence for the vital role
of meaning in healing and thriving.
MT is a comprehensive and pluralistic way to address all aspects of
clients' existential concerns. Clients can benefit from MT in two ways:
(1) a custom-tailored treatment to solve their presenting problems, and
(2) a collaborative journey to create a preferred better future.
View of the human mind
Existential therapy
(of the American, existential-humanistic tradition) starts with the
belief that although humans are essentially alone in the world, they
long to be connected to others. People want to have meaning in one
another's lives, but ultimately they must come to realize that they
cannot depend on others for validation, and with that realization, they
finally acknowledge and understand that they are fundamentally alone.
The result of this revelation is anxiety in the knowledge that our
validation must come from within and not from others.
Existential therapy is based on a theory of mind, and of
psychology. In existentialism, personality is based on choosing to be,
authentically, the real you, given an understanding based on a
philosophical idea of what a person is. Therefore, practical
therapeutic applications can be derived give a theory of personality,
emotion, and “the good life.”
This leads to practical therapeutic applications like dealing with personal choices in life that lead to personal happiness. Personal happiness based on a concept of yourself as having the freedom of directing your life and making necessary changes (so to speak, a radical freedom). So, a full philosophical understanding of existentialism is basic to methods implemented for emotional and life changes. That is, a background in philosophy is basic to existential therapy.
Philosophical issues of the self, personality, philosophy of
mind, meaning of life, personal development are all fundamentally
relevant to any practical therapeutic expectations.
Psychological dysfunction
Because there is no single existential view, opinions about psychological dysfunction vary.
For theorists aligned with Yalom, psychological dysfunction
results from the individual's refusal or inability to deal with the
normal existential anxiety that comes from confronting life's "givens":
mortality, isolation, meaninglessness, and freedom.
For other theorists, there is no such thing as psychological dysfunction or mental illness.
Every way of being is merely an expression of how one chooses to live
one's life. However, one may feel unable to come to terms with the
anxiety of being alone in the world. If so, an existential
psychotherapist can assist one in accepting these feelings rather than
trying to change them as if there is something wrong. Everyone has the
freedom to choose how they are going to exist in life; however, this
freedom may go unpracticed. It may appear easier and safer not to make
decisions that one will be responsible for. Many people will remain
unaware of alternative choices in life for various societal reasons.
The good life
Existentialism
suggests that it is possible for individuals to face the anxieties of
life head on, embrace the human condition of aloneness and to revel in
the freedom to choose and take full responsibility for their choices.
They can aim to take control of their lives and steer themselves in any
direction they choose. There is no need to halt feelings of
meaninglessness but instead to choose and focus on new meanings for the
living. By building, loving and creating, life can be lived as one's own
adventure. One can accept one's own mortality and overcome the fear of
death. Although the French author Albert Camus denied the specific label of existentialist in his novel, L'Etranger,
the novel's main character, Meursault, ends the novel by doing just
this. He accepts his mortality and rejects the constrictions of society
he previously placed on himself, leaving him unencumbered and free to
live his life with an unclouded mind. Also, Gerd B. Achenbach has refreshed the Socratic tradition with his own blend of philosophical counseling, as has Michel Weber with his Chromatiques Center in Belgium.
The strictly Sartrean perspective of existential psychotherapy is
generally unconcerned with the client's past, but instead, the emphasis
is on the choices to be made in the present and future. The counselor
and the client may reflect upon how the client has answered life's
questions in the past, but attention ultimately shifts to searching for a
new and increased awareness in the present and enabling a new freedom
and responsibility to act. The patient can then accept that they are not
special and that their existence is simply coincidental, or without
destiny or fate. By accepting this, they can overcome their anxieties
and instead view life as moments in which they are fundamentally free.
Four worlds
Existential
thinkers seek to avoid restrictive models that categorize or label
people. Instead, they look for the universals that can be observed
cross-culturally.
There is no existential personality theory which divides humanity into
types or reduces people to part components. Instead, there is a
description of the different levels of experience and existence with
which people are inevitably confronted. The way in which a person is in
the world at a particular stage can be charted on this general map of
human existence (Binswanger, 1963; Yalom, 1980; van Deurzen, 1984).
In line with the view taken by van Deurzen, one can distinguish four basic dimensions of human existence: the physical, the social, the psychological, and the spiritual.
On each of these dimensions, people encounter the world and shape
their attitude out of their particular take on their experience. Their
orientation towards the world defines their reality. The four dimensions
are interwoven and provide a complex four-dimensional force field for
their existence. Individuals are stretched between a positive pole of
what they aspire to on each dimension and a negative pole of what they
fear. Binswanger proposed the first three of these dimensions from
Heidegger's description of Umwelt and Mitwelt and his further notion of Eigenwelt. The fourth dimension was added by van Deurzen from Heidegger's description of a spiritual world (Überwelt) in Heidegger's later work.
Physical dimension
On the physical dimension (Umwelt),
individuals relate to their environment and the givens of the natural
world around them. This includes their attitude to the body they have,
to the concrete surroundings they find themselves in, to the climate and
the weather, to objects and material possessions, to the bodies of
other people, their own bodily needs, to health and illness and their
mortality. The struggle on this dimension is, in general terms, between
the search for domination over the elements and natural law (as in
technology, or in sports) and the need to accept the limitations of
natural boundaries (as in ecology or old age). While people generally
aim for security on this dimension (through health and wealth), much of
life brings a gradual disillusionment and realization that such security
can only be temporary. Recognizing limitations can deliver a
significant release of tension.
Social dimension
On the social dimension (Mitwelt),
individuals relate to others as they interact with the public world
around them. This dimension includes their response to the culture they
live in, as well as to the class and race they belong to (and also those
they do not belong to). Attitudes here range from love to hate and from
cooperation to competition. The dynamic contradictions can be
understood concerning acceptance versus rejection or belonging versus
isolation. Some people prefer to withdraw from the world of others as
much as possible. Others blindly chase public acceptance by going along
with the rules and fashions of the moment. Otherwise, they try to rise
above these by becoming trendsetters themselves. By acquiring fame or
other forms of power, individuals can attain dominance over others
temporarily. Sooner or later, however, everyone is confronted with both
failure and aloneness.
Psychological dimension
On the psychological dimension (Eigenwelt),
individuals relate to themselves and in this way create a personal
world. This dimension includes views about their character, their past
experience and their future possibilities. Contradictions here are often
experienced regarding personal strengths and weaknesses. People search
for a sense of identity, a feeling of being substantial and having a
self.
But inevitably many events will confront them with evidence to
the contrary and plunge them into a state of confusion or
disintegration. Activity and passivity are an important polarity here.
Self-affirmation and resolution go with the former and surrender and
yielding with the latter. Facing the final dissolution of self that
comes with personal loss and the facing of death might bring anxiety and
confusion to many who have not yet given up their sense of
self-importance.
Spiritual dimension
On the spiritual dimension (Überwelt)
(van Deurzen, 1984), individuals relate to the unknown and thus create a
sense of an ideal world, an ideology, and a philosophical outlook. It
is there that they find meaning by putting all the pieces of the puzzle
together for themselves. For some people, this is done by adhering to a
religion or other prescriptive worldview; for others, it is about
discovering or attributing meaning in a more secular or personal way.
The contradictions that must be faced on this dimension are often
related to the tension between purpose and absurdity, hope and despair.
People create their values in search of something that matters enough to
live or die for, something that may even have ultimate and universal
validity. Usually, the aim is the conquest of a soul or something that
will substantially surpass mortality (as in having contributed something
valuable to humankind). Facing the void and the possibility of
nothingness are the indispensable counterparts of this quest for the
eternal.
Research support
There
has not been a tremendous amount of research on existential therapy.
Much of the research focuses on people receiving therapy who also have
medical concerns such as cancer. Despite this, some studies have
indicated positive efficacy for existential therapies with certain
populations. Qualitative research has shown there is a positive learning
outcome of Existential Therapy. Overall, however, more research is needed before definitive scientific claims can be made.
