Monday, January 11, 2010

Existential Therapy




Existential therapy can best be described as a philosophical approach that influences a counselor’s therapeutic practice.  Existential psychotherapy is neither an independent nor separate school of therapy, nor is it a neatly defined model with specific techniques.  It is more appropriate to refer to existential psychotherapies.
Historical Background in Philosophy:
 Existential therapy was not founded by any particular person or group; many streams of thought contributed to it.  Drawing from a major orientation in philosophy; existential therapy arose spontaneously in different parts of Europe and among different schools of psychology and psychiatry in the 1940s and 1950s.  It grew out of an effort to help people resolve the dilemmas of contemporary life, such as isolation, alienation, and meaninglessness.  Early writers focused on the individual’s experience of being alone in the world and facing the anxiety of the situation.
These are some of the major figures of existentialism and existential phenomenology and their cultural, philosophical, and religious writings that provided the basis for the formation of existential therapy.
Soren Kierkegaard (1813-1855):  A Danish philosopher, particularly concerned with angst, w word in English that falls somewhere between dread and anxiety.  Without angst, we may go through life as sleepwalkers.  Especially in adolescence, we are awakened into real life by a terrible uneasiness.  Life is one contingency after another, with no guarantees beyond the certainty of death.  This is by no means a comfortable state, but it is necessary to our becoming human.  Becoming human is a project, and our task is not so much to discover who we are as to create ourselves.
Friedrich Nietzsche (1844-1900):  A German philosopher, who emphasized the importance of subjectivity.  Nietzsche set out to prove that the ancient definition of humans as rational was entirely misleading.  Nietzsche located values within the individual’s “will to power.”  We give up an honest acknowledgement of this source of value when society invites us to rationalize powerlessness by advocating other worldly concerns.  If we acquiesce in “herd morality,” we will be nothing but mediocrities.  If we release ourselves by giving free rein to our will to power, we will tap out potentiality for creativity and originality.
Martin Heidegger(1889-1976):  His phenomenological existentialism reminds us that we exist “in the world” and should not try to think of ourselves as beings apart from the world into which we are thrown.  The way we fill our everyday life with superficial conversation and routine shows that we often assume we are going to live forever and can afford to waste day after day.  Our moods and feelings are a form of understanding whether we are living authentically or whether we are inauthentically constructing our life around the expectation of others.  When we translate this wisdom from vague feeling to explicit awareness, we may develop more positive resolve about how we want to be.  As presented by Heidegger, phenomenological existentialism provides a view of human history that does not focus on past events but motivates individuals to look forward to “authentic experiences” that are yet to come.
Jean-Paul Sartre (1905-1980):  A philosopher and novelist believed that humans are even more free than earlier existentialists had believed.  The existence of a space – nothingness – between the whole of our past and the now frees us to choose what we will.  The failure to acknowledge our freedom and choices is what results in emotional problems.  Sartre called excuses “bad faith.”  No matter what we have been, we can make choices now and thus become something quite different.  But to choose is to become committed:  This is the responsibility that is the other side of freedom.
Martin Buber (1878-1965):  Left Germany to live in Israel.  Buber stated we as humans live in a kind of betweenness; that is, there is never just an I, but always an other.  The I, the person who is the agent, changes depending on whether the other is an it or a Thou.  Sometimes we make the mistake of reducing another person to the status of a mere object in which case the relationship becomes I/it.  The importance of presence allows 3 functions:  (1) it enables true I/Thou relationships; (2) it allows for meaning to exist in a situation; and (3) it enables an individual to be responsible in the here-and-now.
Ludwig Binswanger (1881-1966): – Binswanger proposed a holistic model of self that addresses the relationship between the person and his or her environment.  He used a phenomenological approach to explore significant features of the self such as choice, freedom, and caring.  Existential analysis emphasizes the subjective and spiritual dimensions of human existence.   He felt that crises in therapy were typically major choice points for the client.  He moved toward an existential view of his patients which allowed him to understand their worldview and immediate experiences as well as the meaning of their behavior, as opposed to superimposing his views as a therapist on their experience and behavior.
Medard Boss (1903-1991):  Boss’s major professional interest was applying Heidegger’s philosophical notions to therapeutic practice, and he was especially concerned with integrating Freud’s methods with Heidegger’s concepts.
 
Key Figures in Contemporary Existential Psychotherapy
 Four prominent developers of existential psychotherapy are: 
Viktor Frankl (1905-1997):  Central figure in developing existential therapy in Europe and bringing it to the U.S.  As a youth deeply influenced by Freud, he became a student of Adler who was later influenced by the writings of existential philosophers.  Fond of quoting Nietzsche:  “He who has a why to live for can bear with almost any how.”  “That which does not kill me, makes me stronger.”  “to be alive encompasses the ability to take hold of life day by day as well as to find meaning in suffering.”   Frankl developed logotherapy, which means “therapy through meaning.”  His philosophical model sheds light on what it means to be fully alive.  The central themes running through his works are life has meaning, under all circumstances; the central motivation for living is the will to meaning; the freedom to find meaning in all that we think; and the integration of body, mind, and spirit.  According to Frankl, the modern person has the means to live but often has no meaning to live for.  The malady of our time is meaninglessness, or the “existential vacuum,” which is often experienced when people do not busy themselves with routine and with work.  The therapeutic process is aimed at challenging individuals to find meaning and purpose through, suffering, work, and love.  Born and educated in Vienna, Germany.  From 1942 to 1945, Frankl was a prisoner in the Nazi concentration camps at Auschwitz and Dachau, where his parents, brother, wife, and children died.
Rollo May ((1909-1994):  Rollo May was also influenced by the existential philosophers, by the concepts of Freudian psychology, and by many aspects of Alfred Adler’s Individual Psychology.  He welcomed flexibility and versatility in the practice of psychoanalysis.  May was one of the key figures responsible for bringing existentialism from Europe to the U.S. and for translating key concepts into psychotherapeutic practice.  According to May, it takes courage to “be,” and our choices determine the kind of person we become.  There is a constant struggle within us.  Although we want to grow toward maturity and independence, we realize that expansion is often a painful process.  Hence, the struggle is between the security of dependence and the delights and pains of growth.  May’s own personal life consisted of struggles with his own existential concerns and the failure of two marriages.  
  
James Bugental:  Bugental describes a life-changing approach to therapy.  He views therapy as a journey taken by the therapist and the client that delves deeply into the client’s subjective world.  He emphasizes that this quest demands the willingness of the therapist to be in contact with his or her own phenomenological world.  According to Bugental, the central concern of therapy is to help clients examine how they have answered life’s existential questions and to challenge them to revise their answers to begin living authentically.
Irvin Yalom:  Yalom developed an existential approach to therapy that focuses on four ultimate human concerns:  death, freedom, existential isolation, and meaninglessness.  Yalom believes that the vast majority of experienced therapists, regardless of their theoretical orientation, employ many of the existential themes discussed in his book, Existential Psychotherapy (1980).
 
KEY CONCEPTS
Human nature:  The crucial significance of the existential movement is that it reacts against the tendency to identify therapy with a set of techniques.  It bases practice on an understanding of what it means to be human.  It uses numerous approaches to therapy based on its assumption about human nature.  Rather than trying to develop rules for therapy, existential practitioners strive to understand these deep human experiences (feeling alone in the world and facing the anxiety of isolation).
The existential view of human nature is captured, in part, by the notion that the significance of our existence is never fixed once and for all; rather, we continually re-create ourselves through our projects.  Humans are in a constant state of transition, emerging, evolving, and becoming,  Being a person implies that we are discovering and making sense of our existence.  Although the specific questions we raise vary in accordance with our developmental stage in life, the fundamental themes do not vary.  – “who am I?” “what can I know?” “what ought I to do?” “what can I hope for?” “where am I going?”
The basic dimensions of the human condition include:
(1)   the capacity for self-awareness
(2)   freedom and responsibility
(3)    creating one’s identity and establishing meaningful relationships with others
(4)   the search for meaning, purpose, values, and goals
(5)   anxiety as a condition of living
(6)   awareness of death and nonbeing
(1)      The capacity for Self-Awarenes
 As human beings, we can reflect and make choices because we are capable of self-awareness.  The greater our awareness, the greater our possibilities for freedom
• We have the potential to take action or not to act; inaction is a decision.
• We choose our actions, and therefore we can partially create our own destiny.
• Existential anxiety, which is basically a consciousness of our own freedom, is an essential part of living; as we increase our awareness of the choices available to us, we also increase our sense of responsibility for the consequences of these choices.
• We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation.
We can choose either to expand or to restrict our consciousness.  Self-awareness is at the root of most other human capacities, the decision to expand it is fundamental to human growth.  These are some awarenesses that individuals may experience in the counseling process.
• They learn that in many ways they are keeping themselves prisoner by some of their past decisions, and they realize that they can make new decisions.
• They learn that although they cannot change certain events in their lives they can change the way they view and react to these events.
• They realize that they are so preoccupied with suffering, death, and dying that they are not appreciating living.
• They come to realize that they are failing to live in the present moment because of preoccupation with the past, planning for the future, or trying to do too many things at once.
It is the therapist’s task to indicate to the client that a price must be paid for increasing awareness.  Ignorance of our condition may have brought contentment along with a feeling of partial deadness, but as we open the doors in our world, we can expect more struggles as well as the potential for more fulfillment.
 
(2)      Freedom and Responsibility
Even though we have no choice about being thrust into the world, the manner in which we live and what we become are the result of our choices.  Because of the reality of this essential freedom, we must accept responsibility for directing our lives.  However, it is possible to avoid this responsibility for directing our lives, or exhibiting “bad faith.”  Two statements that reveal bad faith are:  “Since that’s the way I’m made, I couldn’t help what I did.” Or “Naturally I’m this way, because I grew up in an alcoholic family.”  We are constantly confronted with the choice of what kind of person we are becoming, and to exist is never to be finished with this kind of choosing.
Existential guilt is being aware of having evaded a commitment, or having chosen not to choose.  This is the guilt we experience when we do not live authentically.  It results from allowing other to define us or make our choices for us. 
For existentialists, being free and being human are identical.  We are the authors of our lives in the sense that we create our destiny, our life situation, and our problems.  Assuming responsibility is a basic condition for change.  Clients who refuse to accept responsibility by persistently blaming others for their problems will not profit from therapy.
Frankl suggested that the Statue of Liberty on the East Coast should be balanced with a Statue of Responsibility on the West Coast.  His basic premise is that freedom is bound by certain limitations.
The therapist assists clients in discovering how they are avoiding freedom and encourages them to learn to risk using it.  Not to do so is to make them neurotically dependent on the therapist.  Two central tasks of the therapist are inviting client to recognize how they have allowed others to decide for them and encouraging them to take steps toward autonomy. 
 
(3)      Striving for Identity and Relationship to Others
As human beings we strive for discover or create a self – that is our personal identity and we strive for connectedness with others and with nature.  Rather than trusting ourselves to search within and find our own answers to the conflicts in our life, we sell out by becoming what others expect of us.  Our being becomes rooted in the expectations, answers, values, and beliefs that come from the important people in our world.
The courage to be:  We struggle to discover, to create, and to maintain the core deep within our being.  One of the greatest fears of clients is that they will discover that there is no core, no self, no substance, and that they are merely reflections of everyone’s expectations of them.  A client might say:  “My fear is that I’ll discover I’m nobody, that there really is nothing to me.  I’ll find out that I’m an empty shell, and nothing will exist if I shed my masks.”
Existential therapist may begin by asking their clients to allow themselves to intensify the feeling that they are nothing more than the sum of others’ expectations and that they are merely the introjects of parents and parent substitutes.  How do they feel now?  Are they condemned to stay this way forever?  Is there a way out?  Can they create a self if they find that they are without one?  Where can they begin?  Once clients have demonstrated the courage to recognize this fear, to put it into words and share it, it does not seem so overwhelming.  In other words, invite clients to accept the ways in which they have lived outside of themselves and explore ways in which they are out of contact with themselves.
The experience of aloneness:  Part of the human condition is the experience of aloneness.  The sense of isolation comes when we recognize that we cannot depend on anyone else for our own confirmation; that is, we alone must give a sense of meaning to life, and we alone must decide how we will live.  Before we can have any solid relationship with another, we must have a relationship with ourselves.  We are challenged to learn to listen to ourselves.  We have to be able to stand alone before we can truly stand beside another.  There is a paradox in the proposition that humans are existentially both alone and related, but this very paradox describes the human condition.  To think that we can cure the condition, or that it should be cured, is a mistake.  Ultimately we are alone.
The experience of relatedness:  When we are able to stand alone and dip with ourselves for our own strength, our relationships with others are based on our fulfillment, not our deprivation.  If we feel personally deprived, however, we can expect little but a clinging, parasitic, symbiotic relationship with someone else
Perhaps one of the functions of therapy is to help clients distinguish between a neurotically dependent attachment to another and a life-affirming relationship in which both persons are enhanced.  The therapist can challenge clients to examine what they get from their relationships, how they avoid intimate contact, how they prevent themselves from having equal relationships, and how they might create therapeutic, healthy, and mature human relationships.
Struggling with our identity:  Due to our fear of dealing with our aloneness, some of us get caught up in ritualistic behavior patterns that cement us to an image or identity which we acquired in early childhood.  Some of us become trapped in a doing mode to avoid the experience of being.  The therapy process itself is often frightening for clients when they realize that they have surrendered their freedom to others and that in the therapy relationship they will have to assume their freedom again.  By refusing to give easy solutions or answers, existential therapists confront clients with the reality that they alone must find their own answers.
(4)      The Search for Meaning:
Some of the underlying conflicts that bring people into counseling and therapy are centered in existential questions such as “Why am I here?  What do I want from life?  What gives my life purpose?  Where is the source of meaning for me in life?”  Existential therapy can provide the conceptual framework for helping clients challenge the meaning in their lives.  Questions that the therapist might ask are, “Do you like the direction of your life?  Are you pleased about who you are and what you want for yourself, what are you doing to get some clarity?”
The problem of discarding old values:  One of the problems in therapy is that clients may discard traditional or imposed values without finding other, suitable ones to replace them.  Clients may report that they feel like a boat without a rudder.  They seek new guidelines and values that are appropriate for the newly discovered facets of themselves, and yet for a time they are without them.  Perhaps the task of the therapeutic process is to help clients create a value system based on a way of living that is consistent with their way of being.  It is the therapist’s job to trust the capacity of clients to eventually discover an internally derived value system that does provide a meaningful life.  They will experience anxiety as a result of the absence of clear-cut values.
Meaninglessness:  Faced with the prospect of our mortality, we might ask, “Is there any point to what I do now, since I will eventually die?  Will what I do be forgotten once I am gone?  Given the fact of mortality, why should I busy myself with anything?”  Such a feeling of meaninglessness is the major existential neurosis of modern life.  Meaninglessness in life leads to emptiness and hollowness, or a condition that Frankl calls the existential vacuum.  Related to the concept of meaninglessness is existential guilt.  This is a condition that grows out of a sense of incompleteness, or a realization that we are not what we might have become.  It is the awareness that our actions and choices express less than our full range as a person.  This guilt is not viewed as neurotic, nor is it seen as a symptom that needs to be cured.  Instead, the existential therapist explores it to see what clients can learn about the ways in which they are living their life.
Creating new meaning:  The therapist’s function is not to tell clients what their particular meaning in life should be but to point out that they can discover meaning even in suffering.  Human suffering (the tragic and negative aspects of life) can be turned into human achievement by the stand an individual takes in the face of it.  Yet meaning is not something that we can directly search for and obtain.  Paradoxically, the more rationally we seek it, the more likely we are to miss it.  Finding meaning in life is a by-product of engagement, which is a commitment to creating, loving, working, and building.
(5)      Anxiety as a Condition of Living
Existential anxiety is conceptualized as the unavoidable result of being confronted with the “givens of existence” – death, freedom, existential isolation, and meaninglessness.  Existential therapists differentiate between normal and neurotic anxiety, and they see anxiety as a potential source of growth.  Normal anxiety is an appropriate response to an event being faced.  It can be used as a motivation to change.  Neurotic anxiety, in contrast, is out of proportion to the situation.  It is typically out of awareness, and it tends to immobilize the person.  Being psychologically healthy entails living with as little neurotic anxiety as possible, while accepting and struggling with the unavoidable existential anxiety that is a part of living.  When we make a decision that involves reconstruction of our life, the accompanying anxiety can be a signal that we are ready for personal change.  Opening up to new life means opening up to anxiety.  Existential therapy helps clients come to terms with the paradoxes of existence – life and death, success and failure, freedom and limitations, and certainty and doubt.  Facing existential anxiety involves viewing life as an adventure rather than hiding behind securities that seem to offer protection.  The therapist must guide clients in finding ways to deal with anxiety constructively.  The therapist can help clients recognize that learning how to tolerate ambiguity and uncertainty and how to live without props can be a necessary phase in the journey from dependence to autonomy.  When a client becomes more self-confident, the anxiety that results from an expectation of catastrophe will decrease.
(6)      Awareness of Death and Nonbeing
Awareness of death is a basic human condition that gives significance to living.  It is necessary to think about death if we are to think significantly about life.  Death provides the motivation for us to live our lives fully and take advantage of each opportunity to do something meaningful.  If we realize we are mortal, we know that we do not have an eternity to complete our projects and that each present moment is crucial.  Without being morbidly preoccupied by the ever-present threat of nonbeing, clients can develop a healthy awareness of death as a way to evaluate how well they are living and what changes they want to make in their lives.
 
THE THERAPEUTIC PROCESS
Therapeutic Goals:  Existential therapy is best considered as an invitation to clients to recognize the ways in which they are not living fully authentic lives and to make choices that will lead to their becoming what they are capable of being.  An aim of therapy is to assist clients in moving toward authenticity and learning to recognize when they are deceiving themselves.  Existential therapy seeks to take clients out of their rigid grooves and to challenge the narrow and compulsive trends blocking their freedom.  Existential therapy aims at helping clients face this anxiety and engage in action that is based on the authentic purpose of creating a worthy existence.  “The purpose of psychotherapy is not to ‘cure’ the clients in the conventional sense, but to help them become aware of what they are doing and to get them out of the victim role.” (May, 1981, page 210).  Increased awareness is the central goal of existential therapy, which allows clients to discover that alternative possibilities exist where none were recognized before.  Clients come to realize that they are able to make changes in their way of being in the world.  This requires some time in existential therapy, for it is not a matter of solving problems.  Short-term applications of existential therapy require clearly defined and less ambitious therapy goals.
Therapist’s Function and Role:  Existential therapists are primarily concerned with understanding the subjective world of clients to help them come to new understandings and options.  The focus is on clients’ current life situations, not on helping clients recover a personal past.  Existential therapists typically show wide latitude in the methods they employ, varying not only from client to client but also with the same client at different phases of the therapeutic process.  They may make use of techniques that grow from diverse theoretical orientations, yet no set of techniques is considered essential.  
Throughout the therapeutic process, techniques are secondary to establishing a relationship that will enable the counselor to effectively understand and challenge the client.  Clients with restricted existence have a limited awareness of themselves and are often vague about the nature of their problems.  They may see few, if any, options for dealing with life situations, and they tend to feel trapped or helpless.  A central task of the therapist is to confront these clients with the ways they are living a restricted existence, or how they are stuck, and to help them become aware of their own part in creating this condition.
Client’s Experience in Therapy:  Clients in existential therapy are clearly encouraged to take seriously their own subjective experience of their world.  They are challenged to take responsibility for how they now choose to be in their world.  Clients are expected to go out into the world and decide how they will live differently.  Further, they must be active in the therapeutic process for during the sessions they must decide what fears, guilt feelings, and anxieties they will explore.  Through the process of their therapy, clients can explore alternatives for making their visions real.  Clients can begin building and augmenting that range by taking small steps.
 Another aspect of the experience of being a client in existential therapy is confronting ultimate concerns rather than coping with immediate problems.  Existential therapists assist clients in facing life with courage, hope, and a willingness to find meaning in life.
Relationship Between Therapist and Client:  Existential therapists give central prominence to their relationship with the client.  The relationship is important in itself because the quality of this person-to-person encounter in the therapeutic situation is the stimulus for positive change.  Therapists with this orientation believe their basic attitudes toward the client and their own personal characteristics of honesty, integrity, and courage are what they have to offer.  It is essential for the counselor to adopt a flexible style and to draw from different theoretical approaches with different clients.
 Rather than prizing therapeutic objectivity and professional distance, existential therapists strive to create caring and intimate relationships with clients.  If counselors lack a sense of presence, it will affect the therapeutic relationship in a negative way.
 The core of the therapeutic relationship is respect, which implies faith in clients’ potential to cope authentically with their troubles and in their ability to discover alternative ways of being.
 
APPLICATION:  THERAPEUTIC TECHNIQUES AND PROCEDURES
 The existential approach is unlike most other therapies in that it is not technique-oriented.  The interventions existential practitioners employ are based on philosophical views about the essential nature of human existence.  Existential therapists are free to draw from techniques that flow from many other orientations.  They have a set of assumptions and attitudes that guide their interventions with clients.  The main guideline is that the existential practitioner’s interventions are responsive to the uniqueness of each client.   The use of the therapist’s self is the core of therapy.  Therapy is a creative, evolving process of discovery that can be conceptualized in three general phases.
? The initial phase, counselors assist clients in identifying and clarifying their assumptions about the world.  Clients are invited to define and question the ways in which they perceive and make sense of their existence.  The counselor teaches them how to reflect on their own existence and to examine their role in creating their problems in living.
? The middle phase, clients are encouraged to more fully examine the source and authority of their present value system.  This leads to new insights and some restructuring of their values and attitudes.  Clients get a better idea of what kind of life they consider worthy to live and develop a clearer sense of their internal valuing process.
? The final phase, focuses on helping clients take what they are learning about themselves and put it into action, to find ways of implementing their examined and internalized values in a concrete way.  Clients typically discover their strengths and find ways to put them to the service of living a purposeful existence.
Areas of application:  Existential therapy is especially appropriate for clients who are struggling with developmental crises, doing grief work, confronting death, or facing a significant decision.  Some examples of these critical turning points that mark passages from one stage of life into another are the struggle for identity in adolescence, coping with possible disappointments in middle age, adjusting to children leaving home, coping with failures in marriage and work, and dealing with increased physical limitations as one ages.  It tends to work well with people who are at a crossroads and who question the state of affairs in the world and are willing to challenge the status quo.  It can be useful for people who are on the edge of existence, such as those who are dying, who are working through a developmental or situational crises, or who are starting a new phase of life.
 
EXISTENTIAL THERAPY FROM A MULTICULTURAL PERSPECTIVE
Contributions:  It helps clients of all cultures find meaning and harmony in their lives, because it focuses on the sober issues each of must inevitably face:  love, anxiety, suffering, and death.  These are the human experiences that transcend the boundaries that separate cultures.  A strength of the existential approach is that it enables clients to examine the degree to which their behavior is being influenced by social and cultural conditioning.  Clients can be challenged to look at the price they are paying for the decisions they have made.
Limitations:  The existentialists can be criticized on the grounds that they are excessively individualistic and they ignore the social factors that cause human problems.  If a counselor consistently tells certain disenfranchised clients that they have a choice in making their lives better, they may feel patronized and misunderstood. 
 A limitation within existential theory is that it is highly focused on the philosophical assumption of self-determination, which does not take into account the complex factors that many people who have been oppressed must deal with.  In many cultures it is not possible to talk about the self and self-determination apart from the context of the social network and environmental conditions.  
 Another problem is the lack of direction that clients may get from the counselor.  Many clients expect a structured and problem-oriented approach to counseling that is not found in the existential approach, which places the responsibility on the client for providing the direction of therapy.
Contributions of the Existential Approach:  One of the major contributions of the existential approach is its emphasis on the human quality of the therapeutic relationship. This aspect lessens the chances of dehumanizing psychotherapy by making it a mechanical process.  Existential counselors reject the notions of therapeutic objectivity and professional distance, viewing them as being unhelpful.
Limitations and Criticisms of the Existential Approach:  A major criticism often aimed at this approach is that it lacks a systematic statement of the principles and practices of psychotherapy.   Some therapists who claim adherence to an existential orientation describe their therapeutic style in vague and global terms (such as self-actualization, dialogic encounter, authenticity, and being in the world).  The fact that few techniques are generated by this approach makes it essential for practitioners to develop their own innovative procedures or to borrow from other schools of therapy.  It must be realized, however, that philosophical insight may not be appropriate for some clients (seriously disturbed or nonverbal clients).
Dr. Rebecca Curtis
www.auburn.edu/cspd/fall04/counseling

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