Existential therapy

Existential psychotherapy is a method of therapy that operates on the belief that inner conflict within a person is due to that individual's confrontation with the givens of existence. These givens, as noted by Yalom, are: the inevitability of death, freedom and its attendant responsibility, existential isolation (referring to Phenomenology), and finally meaninglessness. These four givens, also referred to as ultimate concerns, form the body of existential psychotherapy and compose the framework in which a therapist conceptualizes a client's problem in order to develop a method of treatment.

Background

The philosophers who are especially pertinent to the development of existential psychotherapy are those whose work is directly aimed at making sense of human existence. But the philosophical movements that are of most importance and that have been directly responsible for the generation of existential therapy are phenomenology and existential philosophy.

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 work of Kierkegaard and Nietzsche. Both were in conflict 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.

Kierkegaard (1813–55) protested vigorously 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 in which life was being lived by those around him and believed that truth could ultimately only be discovered subjectively by the individual in action. What was most lacking was people's courage to take the 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 own word he was lonely and much ridiculed during his lifetime.

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) and that it is up to us to re-evaluate existence in light of this. He invited people to shake off the shackles of moral and societal constraint and to discover their free will in order to live according to their own desires, now the only maintainable law in his philosophy. He encouraged people to transcend the mores of civilization and choose their own standards. The important existential themes of freedom, choice, responsibility and courage are introduced for the first time.

While Kierkegaard and Nietzsche drew attention to the human issues that needed to be addressed, Husserl's phenomenology (Husserl, 1960, 1962; Moran, 2000) provided the method to address them in a rigorous manner. He contended that natural sciences are based on the assumption that subject and object are separate 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. Prejudice has to be put aside or 'bracketed', in order for us to meet the world afresh and discover what is absolutely fundamental and only directly available to us through intuition. If we want to grasp the essence of things, instead of explaining and analyzing them we have to learn to describe and understand them.

Heidegger (1889–1976) applied the phenomenological method to understanding the meaning of being (Heidegger, 1962, 1968). He argued that poetry and deep philosophical thinking can bring greater insight into what it means to be in the world than can be achieved through scientific knowledge. He explored human being in the world in a manner that revolutionizes classical ideas about the self and psychology. He recognized the importance of time, space, death and human relatedness. He also favoured hermeneutics, an old philosophical method of investigation, which is the art of interpretation. Unlike interpretation as practised 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 subjectively experiences something.

Sartre (1905–80) contributed many other strands of existential exploration, particularly in terms of emotions, imagination, and the person's insertion into a social and political world. He became the father of existentialism, which was a philosophical trend with a limited life span. The philosophy of existence on the contrary is carried by a wide-ranging literature, which includes many other authors than the ones mentioned above. There is much to be learned from existential 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 and Emmanuel Lévinas within the French tradition (see for instance Spiegelberg, 1972, Kearney, 1986 or van Deurzen-Smith, 1997).

From the start of this century some psychotherapists were, however, inspired by phenomenology and its possibilities for working with people. Ludwig Binswanger, in Switzerland, was the first to attempt 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 (Tillich, 1952) and others, this had a considerable impact on the popularization of existential ideas as a basis for therapy (Valle and King, 1978; Cooper, 2003). Rollo May 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.

In Europe existential ideas were combined with some psychoanalytic principles and a method of existential analysis was developed by Medard Boss (1957a, 1957b, 1979) in close co-operation with Heidegger. In Austria, Viktor Frankl developed an existential therapy called logotherapy (Frankl, 1964, 1967), which focused particularly on finding meaning. In France the ideas of Sartre (1956, 1962) and Merleau-Ponty (1962) and of a number of practitioners (Minkowski, 1970) were important and influential but no specific therapeutic method was developed from them.

Development in Britain

Britain became a fertile ground for the 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 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 Wittgenstein, Derrida, Levinas and Foucault as well as the work of the French psychoanalyst Lacan. It also runs a number of small therapeutic households along these lines. The Arbours Association is another group that grew out of the Kingsley Hall experiment. Founded by Berke and Schatzman in the 1970s, it now runs a training programme in psychotherapy, a crisis centre 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 largely come from the development of a number of existentially based courses in academic institutions. This started with the programmes 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 Counselling, also 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 last decades the existential approach has spread rapidly and has become a welcome alternative to established methods. There are now a number of other, mostly academic, centres in Britain that provide training in existential counselling and psychotherapy and a rapidly growing interest in the approach in the voluntary sector and in the National Health Service.

British publications dealing with existential therapy include contributions by 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); 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. An important development was that of the founding of the Society for Existential Analysis in 1988, initiated by van Deurzen. This society brings together psychotherapists, psychologists, psychiatrists, counsellors and philosophers working from an existential perspective. It offers regular fora for discussion and debate as well as major annual conferences. It publishes the Journal of the Society for Existential Analysis twice a year. It is also a member of the International Federation for 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).

Existential Therapy's View of the Human Mind

Existential therapy starts with the belief that although humans are essentially alone in the world, we long to be connected to others. People want to have meaning in one another's lives, but ultimately we must come to realize that we cannot depend on others for our validation, and with that realization we finally acknowledge and understand that we are fundamentally alone. The result of this revelation is anxiety in the knowledge that our validation must come from within and not from others.

Psychological Dysfunction

In the existential view, there is no such thing as psychological dysfunction or being mentally ill. 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 be in life, however this may go unexercised because making changes is difficult; it may appear easier and safer not to make decisions that you 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 people to face the anxieties of life head-on and embrace the human condition of aloneness, to revel in the freedom to choose and take full responsibility for their choices. They courageously take the helm of their lives and steer in whatever direction they choose; they have the courage to be. One does not need to arrest feelings of meaninglessness, but can choose new meanings for their lives. By building, by loving, and by creating one is able to live life as one's own adventure. One can accept one's own mortality and overcome fear of death. Though the French author Albert Camus denied the specific label of existentialist, in his novel, L'Etranger, his 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.

Existential Therapy

The existential psychotherapist is generally not concerned with the client's past; 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 they are not special, and that their existence is simply coincidental, 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). 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 obviously 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.

Physical dimension On the physical dimension (Umwelt) individuals relate to their environment and to 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 to their own 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 bring great 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 in terms of 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 own character, their past experience and their future possibilities. Contradictions here are often experienced in terms of 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 here 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 world view, for others it is about discovering or attributing meaning in a more secular or personal way. The contradictions that have to 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 for instance 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.

See also

• Gestalt Therapy
• Existentialism
• Viktor Frankl
• Martin Heidegger
• Søren Kierkegaard
• R. D. Laing
• Rollo May
• Friedrich Nietzsche
• Otto Rank
• Jean-Paul Sartre
• Irvin D. Yalom
• Karl Jaspers
• Martin Buber
• Contextual therapy
• Emmy van Deurzen
• William Glasser
• Philosophical Consultancy
• Jan Hendrik van den Berg

Further reading

• Frankl, Viktor; Man's Search for Meaning (rev. & updtd.); Pocket, 1997
• Yalom, Irvin D.; Existential Psychotherapy; Basic Books, 1980
• Cooper, Mick; Existential Therapies; Sage Publ., 2003
• Spinelli, Ernesto; The Mirror and the Hammer: Challenging Orthodoxies in Therapeutic Thought; Sage Publ., 2002
• Kierkegaard, Søren; The Concept of Dread and The Sickness Unto Death, Princeton University Press
• Deurzen, E. van (2002) Existential Counselling and Psychotherapy in Practice, 2nd edition, London: Sage Publications.
• ibid (1997) Everyday Mysteries: Existential Dimensions of Psychotherapy, London: Routledge. (2nd edition 2006)
• ibid (1998) Paradox and Passion in Psychotherapy, Chichester: Wiley.
• Deurzen, E. van, and Kenward, R. (2005) Dictionary of Existential Psychotherapy and Counseling, London: Sage Publications.
• Deurzen, E. van and Arnold-Baker, C., eds. (2005) Existential Perspectives on Human Issues: a Handbook for Practice, London: Palgrave, Macmillan.
• Willburg, Peter, "The Therapist as Listener: Martin Heidegger and the Missing Dimension of Counseling and Psychotherapy Training"[1]
• Wilkes, R and Milton, M, (2006) Being an Existential Therapist: An IPA study of existential therapists' experiences, Existential Analysis. Jan 2006
• Milton , M., Charles, L., Judd, D., O'Brien, Tipney, A. and Turner, A . (2003) The Existential-Phenomenological Paradigm: The Importance for Integration, Existential Analysis
• Judd, D. and Milton, M. (2001) Psychotherapy with Lesbian and Gay Clients: Existential-Phenomenological Contributions to Training, Lesbian and Gay Psychology Review, 2(1): 16-23
• Corrie, S. and Milton, M . (2000) "The Relationship Between Existential-Phenomenological and Cognitive-Behavioural Therapies", European Journal of Psychotherapy, Counseling and Health.
• May, R. "The Discovery of Being: Writings in Existential Psychology"
• May, R. "The Cry for Myth"
• May, R. "Power and Innocence: A Search for the Sources of Violence"
• May, R. "Man's Search for Himself"
• Milton, M (2000) "Is Existential Psychotherapy A Lesbian and Gay Affirmative Psychotherapy?" Journal of the Society for Existential Analysis,
• Milton , M. and Judd, D. (1999) "The Dilemma that is Assessment", Journal of the Society for Existential Analysis, 102-114.
• Milton, M. (1999) "Depression and the Uncertainty of Identity: An existential-phenomenological exploration in just twelve sessions", Changes: An International Journal of Psychology and Psychotherapy,
• Milton, M (1997) "An Existential Approach to HIV Related Psychotherapy", Journal of the Society for Existential Analysis, V8.1, 115-129
• Milton, M (1994) "The Case for Existential Therapy in HIV Related Psychotherapy", Counselling Psychology Quarterly, V7 (4). 367-374
• Milton, M. (1994) "HIV Related Psychotherapy and Its Existential Concerns", Counselling Psychology Review, V9 (4). 13-24
• Milton, M (1993) "Existential Thought and Client Centred Therapy", Counselling Psychology Quarterly, V6 (3). 239-248
• Schneider, K.J. (2008). Existential-integrative Psychotherapy: Guideposts to the Core of Practice. New York: Routledge.
• Schneider, K.J. (2004). Rediscovery of Awe: Splendor, Mystery, and the Fluid Center of Life. St. Paul, MN: Paragon House.
• Seidner, Stanley S. (June 10, 2009) "A Trojan Horse: Logotherapeutic Transcendence and its Secular Implications for Theology". Mater Dei Institute. pp 10-12.
• Tillich, Paul (1952). The Courage to Be. Yale University Press.
• Wilberg, P. (2004) The Therapist as Listener - Martin Heidegger and the Missing Dimension of Counselling and Psychotherapy Training

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