Ch. 1: Introduction

Question 1

Cooking class with Armenian matriarch

Answer 1

Yalom & Co could never get as delicious dishes even following the recipe, until he one day saw her servant throw in spices before putting the dish into the oven. Yalom believes psychotherapy is similar - the books, articles, lectures portray the recipe, yet “I believe that when no one is looking, the therapist throws in the ‘real thing’.”

Question 2

Throw-ins

Answer 2

Compassion, presence, caring, extending oneself, touching the patient at a profound level, wisdom?

Freud and Elisabeth von R.: officially Freud treated her with abreaction, but actually talked to her mom, said to visit a man she found attractive, untangled family finances, sent her to visit her sister’s grave, induced calmness before life’s uncertainty.

Question 3

Initial definition of existential psychotherapy

Answer 3

a dynamic approach to therapy which focuses on concerns that are rooted in the individual’s existence.

Yalom believes that no matter the school of thought, most psychologists employ many of his insights.

Question 4

Dynamic

Answer 4

Lay definition: derives from Greek dunasthi, “to have strength”; evokes energy and movement

Technical sense: there is no non-dynamic therapist, no slow or sluggish one; instead the technical term involves the concept of “force” - there are forces in conflict inside individual that result in thoughts, emotions, behaviors, both adaptive and psychopathological
- At different levels of awareness!

Question 5

Avenues to study the forces

Answer 5

deep reflection, dreams, nightmares, flashes of profound experience and insight, psychotic utterances, study of children.

Question 6

Freudian Psychodynamics

Answer 6

A child is governed by instinctual forces and unfurl through a psychosexual developmental cycle.

• Later a child has to balance this (id) with the demands of the environment (ego) and the demands of the internalized environment (superego).
• Struggle between delayed gratification and instincts.

Question 7

Neo-Freudian (Interpersonal) Psychodynamics

Answer 7

Aside from being instinct-powered and preprogrammed, a child is entirely shaped by the cultural and interpersonal environment.

• Basic need = security (acceptance and approval)
• Quality of interaction with significant adults determines character
• Conflict arises between natural growth inclinations (energy, curiosity, innocence) and the child’s need for security and approval.
• Severe conflict ensues from neurotic parents, growth is compromised

Question 8

Existential Psychodynamics

Answer 8

Conflict that flows from the individual’s confrontation with the givens of existence - intrinsic properties that are a part of the human’s existence of the world.

• Deep personal reflections (solitude, silence, time, freedom from distraction) help us uncover these givens to reach the ground that underlies all other ground
• From here on called “ultimate concerns”
• Often this process of reflection is catalyzed by certain urgent experiences, i.e. “boundary” situations: confrontation with one’s death, collapse of fundamental schema etc.

Question 9

Four ultimate concerns

Answer 9

Death: most easily apprehended - one day we’ll cease to be. Spinoza: “Everything endeavors to persist in it’s own being.” Terrifying.
- Conflict: knowing you’re going to die and wishing to continue to be.

Freedom: far less accessible one. Usually thought of as unequivocally positive, yet in its existential sense it refers to the absence of external structure. An individual is entirely responsible for their own world, choices, actions. In this sense, “freedom” is terrifying: there is no ground beneath us, just a void.
- Conflict: confrontation with groundlessness and our wish for ground.

(Existential) Isolation: not interpersonal, but a fundamental isolation both from creatures and the world. No matter how close you get with someone, there’s always a final unbridgeable gap - each of us enters existence alone and must depart alone.
- Conflict: awareness of absolute isolation and wish for contact, protection.

Meaninglessness: If we must die, if we constitute our own world, if each is ultimately alone in an indifferent universe, then what meaning does life have? Why and how?
- Conflict: meaning seeking creature seeking meaning in a meaningless universe.

Question 10

Freud vs Existential

Answer 10

Freud: DRIVE → ANXIETY → DEFENSE MECHANISM

Existential: AWARENESS OF ULTIMATE CONCERN → ANXIETY → DEFENSE MECHANISM

Freud: “deep” = “earliest” or “first” experience of conflict, chronological unlayering

Existential: deep means brushing away everyday concerns and thinking deeply about one’s existential situation. Not to think about how one came to be what one is but to think about that one is. To think outside of time.

Question 11

Otto Rank: leverage

Answer 11

therapist has far more leverage if they view the individual as primarily fearful, suffering rather than instinctually driven one. Our psychic operations (defense mechanisms) evolve to deal with anxiety.

Question 12

“At this moment, what are the most fundamental sources of dread?”

Answer 12

Answer cuts beneath any personal life history; instead the answer applies to every person - it belongs to the human being’s “situation” in the world.

Question 13

Existential Orientation: Strange But Oddly Familiar

Answer 13

Material can feel strange regarding the terms used, but familiar because it tries to get at the “real thing” that therapists throw in.

There’s also familiarity because philosophers, poets and theologians have asked existential questions throughout time (even though modern thinkers might pride otherwise). Existential dread is familiar too because it applies to everyone, not just psychologically ill.

Parish priest: “People are much more unhappy than one thinks… and then the fundamental fact is that there is no such thing as a grown up.”

Question 14

Noxious agents

Answer 14

With physical disease there are always noxious agents in the body fighting against the host’s resistance (already before illness). Similarly with psychological illness, the disease doesn’t arise just from a bacterial or viral agent invading the body, it arises as a result of disequilibrium between the agents and the host’s resistance (defence mechanisms). All of us have the noxious agents, some are unable to cope with it.

Question 15

Cervantes

&

Energizing questions

Answer 15

These topics are not easy to deal with. Cervantes: “Which would you have, wise madness or foolish sanity?”

In therapy, existential questions are intensely energizing, but often both therapist and client don’t know how to continue with them, thus “Well that’s life, innit? Let’s move on to something neurotic, something we can do something about!”

Question 16

The Field of Existential Psychotherapy

Answer 16

Doesn’t really belong anywhere. No formal school, not welcomed into better academic neighborhoods, no robust journal or society. Yet there are a few scattered cousins.

Question 17

THE ANCESTRAL HOME

Answer 17

Two philosophers labeled “existential” may disagree on every cardinal point (aside from their shared aversion to being labeled so).

Most texts resolve to listing a number of themes: being, choice, freedom, death, isolation, absurdity.

Question 18

The “existential” tradition is ageless

Answer 18

all thinkers have thought about life and death

Question 19

The “existential” school (in philosophy) probably starts

Answer 19

with a Dane in 1834, who thought that he hasn’t contributed much to life like others who have contributed railways, telegraphs, steamboats, literature etc. He mused:

“You must do something but inasmuch as with your limited capacities it will be impossible to make anything easier than it has become, you must, with the same humanitarian enthusiasm as the others, undertake to make something harder.”

Meaning that when all combine to make something easier, then easiness could become excessive. He thought that someone should make things difficult again, and thus Kierkegaard found his destiny. And he didn’t have to look long for the things to make difficult - existence, dread, choices, possibilities and limitations were a good target. A lot of his work had little influence until almost a century later when his works were discovered after WWI by Martin Heidegger and Karl Jaspers.

Question 20

Literary exposition

Answer 20

“I will use philosophy a bit, but assume no philosophical background.” However: “Never understood why complicated words are important. That’s why Sartre, Camus, Unamuno, Buber prefer literary exposition rather than formal philosophical argument.”

Question 21

Aim of the existential therapist

Answer 21

The aim of the existential therapist is to uncover what the patient has always known all along not offer formal explication.

Question 22

Criticism of Freud (Old Country Cousins)

Answer 22

if one applies one schema to explain all individuals then one misses the unique experience of the particular person.

They objected to his:

• reductionism (all behaviour = few basic drives),
• materialism (explaining higher in terms of the lower),
• determinism (belief that all mental functioning is caused by identifiable factors already in existence).

Question 23

Existential analysts agree on one point (Binswanger)

Answer 23

analyst must approach phenomenologically - enter the patient’s world and listen to the phenomena of that world without the presuppositions that distort understanding.

Binswanger: “Not one space and time only, but as many spaces and times as there are subjects.”

Question 24

Names who are almost entirely unknown to the Americans

Answer 24

Binswanger, Melard Boss, Minkowsky, Gebsattel, Roland Kuhn, G. Caruso, Buytendijk, G. Bally, Viktor Frankl

Question 25

HUMANISTIC PSYCHOLOGISTS: FLASHY AMERICAN COUSINS

Answer 25

Two dominant schools in the 50s: behaviorism and psychoanalysis.

Abnormal psychologists and social psychologists were comfortable in experimental psychology. However, many of these personality psychologists - Gordon Allport, Henry Murray, Gardner Murphy, George Kelly, Abraham Maslow, Carl Rogers, and Rollo May - became uncomfortable with the limitations of behaviorism and psychoanalysis.

They wanted to make space for values, love, creativity, self-awareness, human potential - “humanistic psychology”.

Humanistic psychology became the third force in psychology after behaviorism and psychoanalysis.

Question 26

Five postulates of humanistic psychology

Answer 26

1. Human supersedes the sum of his parts - cannot be understood from a scientific study of part-functions.
2. Human has his being in a human context - cannot be understood by part-functions which ignore interpersonal experiences.
3. Human is aware - cannot be understood by a psychology which fails to recognize man’s continuous, many-layered self-awareness.
4. Human has choice - man is not a bystander to his existence, he creates his own experience.
5. Man is intentional - man points to the future; has purpose, values, and meaning.

Question 27

American vs European

Answer 27

The humanistic approach is much more American than its European counterpart psychoanalysis, perhaps the antideterminism, freedom, choice, values etc. comes because Europeans have seen human limitations and tragedy much more closely than Americans. The US bathed in a zeitgeist of expansiveness, optimism, limitless horizons and pragmatism.

Question 28

Counterculture and humanism

Answer 28

With counterculture, humanism came to include all sorts of different approaches, perhaps too many.

Emphasis on:

• hedonism (“if it feels good, do it”),
• anti-intellectualism (any cognitive approach = “mind-fucking”),
• individual fulfillment (“doing your own thing”, “peak experiences”),
• self-actualization (a belief in human perfectibility).

These soon led to a divorce between humanistic psychology and the academic community.

Question 29

HUMANISTIC PSYCHOANALYSTS: FRIENDS OF THE FAMILY

Answer 29

Otto Rank, Karen Horney, Erich Fromm, Helmuth Kaiser closely parallel some of the work. All objected to Freud’s instinct-powered model and made contributions of their own.

• Rank: emphasised the importance of will and of death anxiety
• Horney: emphasised the crucial role of the future (ideals, purpose, goals motivate rather than past events) as an influencer of behavior
• Fromm: illuminated the role and fear of freedom in behavior
• Kaiser: responsibility and isolation

Dostoyevsky, Kafka, Tolstoy, Sartre, Camus are also incredibly important.

Question 30

Quarantined by the academic establishment

Answer 30

The reason is “How do we know what we know?” - academic psychiatry and psychology are grounded in a positivist tradition, value empirical research as the method of validating knowledge.

Question 31

Problem with Empiricism

Answer 31

Problem: the empirical method requires that the investigator study a complex organism by breaking it down into parts simple enough for empirical investigation.

Frankl story: “His cat ate ten pounds of my butter.” → Wise man put the cat on the scale - exactly 10 pounds. Wise man: “Well, here’s the butter, but where’s the cat?” → Human is greater than the sum of its parts.

Question 32

Rollo May on Western thought

Answer 32

But it goes further than “where’s the cat?”. Rollo May: “existentialism is the endeavor to understand man by cutting below the cleavage between subject and object which has bedeviled Western thought and science since shortly after the Renaissance.”

PS!: Empirical limitations exist everywhere, it’s just that they are more explicit in existential. Insofar as therapy is deeply personal, there will be errors and limited value. Many great clinicians put down their tables of random numbers once they’ve reached their academic achievements.

Question 33

Cartesian vs Existential (incl Heidegger)

Answer 33

Cartesian: world is full of objects and of subjects who perceive them. Thus, objects with a finite set of properties that can be understood through objective investigation.

Existential: person not just a subject who can perceive reality under certain circumstances, but as a consciousness who participates in the construction of reality.

Heidegger referred to human as dasein: at once the meaning giver and the known

Question 34

Yalom’s personal story on measurement

Answer 34

Personal story: measured 
1) participants perspective 
2) group leader’s perspective, 
3) participant’s co-members 
4) participant’s social network
 → correlation between all of these was zero. 

The more methods used to assess outcome, the less certain is the researcher of his results! Ways to deal with this:

• Less sources = more reliability
• Only quantitative sources (how much alcohol, number of interruptions, number of bites of food etc.)

But try to measure ability to love and care, humor, courage, engagement, spontaneity etc.! Strange science.

Question 35

“Phenomenological” alternative

Answer 35

To go directly into the phenomena themselves, to encounter the other without “standardized” instruments and presuppositions. However, this is of course problematic for the research who struggles to achieve high scientific standards.

There’s a story of a man who searched at night for a lost key not in the whole dark alley where he dropped it but under a lamppost because the light was better.

The book intends to offer a paradigm that offers the clinician a system of explanation.