W5 Flashcards
Existential Psychotherapy Summarized
Existential psychotherapy is not an independent school of psychotherapy (and it’s not a technique). It is moreso a perspective that can be integrated into other approaches. It has no manual. It’s a way of thinking about human experience (a.k.a., an attitude toward human suffering) that some argue should be a part of all therapies.
It focuses on the ultimate concerns, which we all have to confront – death, freedom, isolation, and meaning. The therapist should delve unflinchingly into these problems with their client, dealing with deep questions around the nature of the human being.
Many therapists may practice existential psychotherapy without calling it that (and “off the record” addition to the recipe for successful psychotherapy)
The relationship between humans as meaning-making creatures and existential concerns
Existentialists consider people to be meaning-making beings who are both subject of experience and objects of self-reflection. Because we are self-aware, we know that we are mortal. Through reflecting on our mortality, we can learn how to live. Such questions we may ask ourselves are: Who am I? Is life worth living? Does it have a meaning? Existentialists believe that we must come to terms with these questions, and that this process has an influence on who we are and what we become.
Existentialists are conscious of the fact that theories may dehumanize people and make them into objects; therefore, authentic experience holds greater importance than artificial explanations do for them. Forcing an experience into a preexisting theoretical model robs it of some of its authenticity and disconnects it from the individual who experienced it.
The focus of this perspective is, therefore, on the subjectivity of experience rather than “objective” diagnostic categories.
What are the Ultimate Concerns?
Freedom, isolation, meaning, and death.
Existentialists contend that many diagnosable presenting “symptoms” could be masking existential crises - and this desire for meaning should be engaged with directly/genuinely.
The Existential Dilemma
A dilemma that results from the existential reality that, although humans crave to persist in being (i.e., live forever), we are finite creatures that are thrown alone into existence without a predestined life structure or destiny; and each of us must decide ourselves how to live as fully, happily, ethically, and meaningfully as possible with the time we have.
Freedom in the Existential Sense
The idea/belief that we live in a universe without inherent design, and that in this universe we are the authors of our own lives. There is a terrifying responsibility that often comes with acknowledging that we alone are responsible for our choices.
Sartre: We are the “uncontested authors” of everything we have experienced. Denying responsibility is to live inauthentically, in what Sartre called “bad faith.”
Some have argued that it is the fear of this freedom that drives people to believe in gods, or instate dictators; to place this responsibility in someone else’s hands.
Defences against freedom can sometimes give rise to psychopathology (“clumsy” modes of dealing with existence). Existential therapy seeks to guide the client towards a re-assumption of responsibility for their own experience. Through embracing freedom, freedom is increased.
Fromm’s Lust for Submission
The feeling that accompanies one’s efforts to escape existential freedom.
Interpersonal Isolation
vs.
Intrapersonal Isolation
Isolation from others
vs.
Isolation from other parts of the self.
Existential Isolation
Isolation was argued by Fromm to be the primary source of anxiety. In life, we are always managing the tension between our desire to connect with others and a knowledge of our aloneness.
Existential isolation refers to one’s sense of aloneness in the universe that cannot be extinguished fully, even if it is lessened by connection with others. It is an isolation that is riveted to existence and refers to an unsurmountable gap between oneself and others. No matter what, we will enter and leave the world alone.
Yalom noticed that most people prefer to live an observed life, and sometimes persist in unsatisfying relationships just because having a witness to their daily life serves as a buffer against experiencing existential isolation. Deep connection cannot “solve” existential isolation, but it can provide relief from it.
We are ultimately alone, and a therapist cannot change that. The client’s acceptance of this, that there is a point past which the therapist cannot offer anything more, is an important therapeutic milestone in Yalom’s eyes.
To take full responsibility for one’s life is to inevitably encounter feelings of existential isolation, as it means letting go of the belief that you have been created/guarded by another and acknowledging that the universe is indifferent to your existence and that you are alone within it.
Existential Meaning
One of the major life tasks is the inventing of a purpose on which to support or ground our lives. The search for this purpose often throws people into a crisis (“why am living?” – “what do I want to do with my life?”).
It would be reassuring to know that one has a true purpose waiting for them as opposed to just a sense of purpose that one creates for themselves. But in life, we make our own meaning.
Meaning can emerge from immersing oneself in an enlarging, fulfilling, and self-transcending endeavour. The therapist’s goal is to identify and help to remove the obstacles to such engagement for the client. An authentic immersion in the experience of life allows questions of meaning to drift away.
Existentialist Death
The awareness of one’s eventual death is the most painful and difficult of the ultimate concerns. Death shadows all other concerns; we can strive to find meaning, we can take responsibility for the choices that we make within our freedom to choose, and yet no matter what we will eventually cease to exist.
We address this fear through imagining ourselves as being carried into the future by our children, by trying to establish a legacy via fame or success, by believing in a religious entity/some ultimate rescuer etc.,
Hegel conceptualized the fear of the death as a fear of the “impossibility of further possibility”. * Confronting the reality of eventual death can drive us to live our lives as fully (mindfully and purposefully) as possible. Death can be used to enrich life.
The Therapeutic Stance of the Fellow Traveller
Awareness of the ultimate concerns as givens of existence means the relationship between therapist and patient is best conceptualised as that of a self-revealing fellow traveller.
There is no true distinction between “them” (the afflicted - who may be more troubled by the ultimate concerns) and “us” (the healers). No one is immune to the inherent tragedies of existence. In existential psychotherapy, a sharing of the essence of the human condition takes place. The only true advantage that they hold over the client is the ability to talk honestly about how these concerns manifest (confronting them) in their lives/what they feel like. There are no prescribed formulations for how the therapeutic relationship should look.
What therapies share the Existential Focus on the Here-and-Now?
The increasing interest in the here and now and awareness of the present moment across various psychotherapeutic schools (like Gestalt, expressive, dynamic, systemic therapies), reflects the focus on genuine/authentic encounters which characterizes the existentialist approach. How one experiences the therapeutic relationship is of great interest given the assumption that therapeutic change is based on lived experience.
What therapies share the existential elements of dream analysis and goal directiveness?
The existentialist stance is seen in other therapies that are phenomenological, holistic, and goal directed (like Adlerian, Rogerian, neo-Freudian, and relational psychoanalytic therapies). Like the analytic therapies, existential therapy encourages work with dreams and analyses them based on both their existential and autobiographical themes.
What therapies share the existential elements of reflecting on one’s belief systems?
Like the cognitive therapies, it encourages reflection on belief systems and examination of meaning making with an aim of taking responsibility for one’s choices. Cognitive restructuring techniques that aim at replacing maladaptive beliefs with personally meaningful values are fully consistent with an existential approach.
Is symptom elimination relevant to the existential perspective?
Cognitive therapies that aim solely at behavioural reduction or elimination of symptoms, or ones that rely on manualized treatments, do not bear any similarity to the existential perspective. Existentialists regard symptoms as potential signals of existential crises; and hence the person’s experiences of self in the world should be explore, and a unique approach should be used for each individual.
The existential approach puts existential issues in the foreground in order to sensitize the therapist to their importance and prepare therapists to discuss them honestly with their patients. It encourages therapists to consider themselves fellow travellers on the road of existence rather than as all-knowing experts
The Early Contribution of Epicurus; Nabokov; and St. Augustine
Epicurus: Greek philosopher who anticipated the later concept of the unconscious with his belief that concerns about death concerns could be unconscious to the individual, yet still manifest themselves in various ways [coining the term death anxiety]. He established methods for alleviating death anxiety. He also argued that (since he believed the soul perished with the body) we shouldn’t fear death because we will never perceive it. He also believed in the idea of symmetry: that our state of nonbeing after death is the same as it was before our birth.
Vladimir Nabokov: A Russian novelist who wrote that life is a crack of light between two eternities of darkness.
St. Augustine: Believed that the self is only born when we face death.
Who is credited with contemporary existentialism? Who is credited with the early emergence of existentialism as a psychotherapy?
The credit for existentialism as a modern term is often given to French philosophers Sartre and Marcel, who developed the philosophy in the 1940s.
The foundational philosophers/psychologists credited with the emergence of existentialism as a psychotherapy are Nietzsche and Kierkegaard. They both wrote about the increasing dehumanisation of people in an increasingly technological world.
Kierkegaard provided in depth analyses of anxiety/despair while Nietzsche examined the dynamics of resentment; and the guilt/hostility that accompany repressed emotions.
The Early Contributions of Binswanger
The first psychiatrist to OFFICIALLY combine psychotherapy with existentialism; which he laid out as a theory in his 1943 book “The Foundations and Cognition of Human Existence”. He was Swiss, and a colleague of Freud’s.
In 1944 he published a debate-provoking account of a patient with anorexia-nervosa called Ellen West who had decided to commit suicide. His work was centred in a phenomenological-existential psychotherapeutic orientation, which had arisen in critique of the theoretical frameworks of psychiatry and psychoanalysis used at the time. Other names in this movement included Boss, Straus, and Kuhn – all of whom believed that “objective” scientific theories detracted from true human existence and drew attention away from the value of an authentic therapeutic encounter.
What developments occurred in 1958 and 1988 for existentialism?
In 1958: Existential psychotherapy makes it way to the U.S with the publication of “Existence: A New Dimension in Psychiatry and Psychology” (edited by Rollo May, Ernest Angel, and Henri Ellenberger). The main introduction to the existential movement and existential psychology was in the first two chapters; written by May! The rest of the book features essays and case studies by Minkowski, Straus, Binswanger, Kuhn, etc.,
In 1988: A Society for Existential Analysis is formed in the U.K, which now publishes the journal Existential Analysis.
The Early Contributions of Rollo May
A psychoanalyst trained in a Neo-Freudian institute in New York. He read about existential therapies emerging in Europe during his time as a practicing psychoanalyst. He later aimed to reconcile existential ideas with psychoanalysis with his books, which later became important existential psychotherapy texts (especially in the U.S) These included: Man’s Search for Himself (1953), Freedom and Destiny (1981), and The Cry for Myth (1991).
The Early Contributions of Erich Fromm
A founder of the institute where May initially studied, and another author of several existential books. Two Examples: “Escape From Freedom” (1941) – which focused on the human tendency to submit to authority to defend against the existential terror of free choice; and “The Art of Loving (1956)” - which addressed the dilemmas of existential isolation.
The Early Contributions of Irvin Yalom
Writer of the first comprehensive textbook for existential psychotherapy (published in 1980).
Throughout his work and many subsequent books, Yalom sought to put to words what exactly an existential psychotherapist DOES in the therapeutic session. One of his more recent works, “Staring at the Sun: Overcoming the Terror of Death” (2008), discusses the experience and treatment of high levels of death anxiety.
Frankl’s Primary Contribution to Existentialism
Frankl’s “Man’s Search for Meaning” (1956), which details an approach for logotherapy; a form of psychotherapy focused on will, freedom, meaning, and responsibility.
Therapeutic Training for Existentialism
Existentialism is not concerned with specific techniques and, therefore, training courses for this therapy rarely exist. Typically, existentialists further their own knowledge through philosophical reading and therapeutic practice/supervision.
Indeed, therapists from varying schools can label themselves as existentialists so long as they hold existential beliefs; as existential psychotherapy is just a way of conceiving the human being (we see this crossover in Perls and Gestalt, in Yalom and the Neo-Freudian approach, in Lazarus and behaviour/multimodal psychotherapy etc.,)
The central goal of contemporary existential psychotherapists is to rediscover the living person existing in a dehumanizing modern culture. To do this, they engage in in-depth psychological analysis. The focus is less on alleviating symptoms, and more on facilitating greater awareness and life freedom.
Psychological distress can have many sources (as demonstrated by the many therapeutic schools) and that a confrontation with one’s existence is another one of these relevant sources.
Why was “The Gift of Therapy” written?
Person-focused approaches to psychotherapy have all suffered from the current focus on brief, manualized treatments oriented to symptom reduction (which has been driven by a market preference for these approaches as opposed to human need for them).
Yalom was troubled by this increasingly mechanised and decreasingly human/intimate approach to psychotherapy, so he wrote an accessible guide for all therapists called “The Gift of Therapy” (2002). Its popularity suggests the popularity of the desire to address the issues of existence with one’s clients.
What is a dynamic psychotherapy?
The psychodynamics of an individual is used to refer to that individual’s conflicting conscious and unconscious motives and fears.
Dynamic psychotherapy refers to psychotherapies based on this internal conflict model of personality structure (i.e., existential psychotherapy)
The model of personality in Existential Psychotherapy
Existentialists rely on Freud’s model of personality as a system of forces which are in conflict with one another.
However, the existential model of personality posits that the basic conflict is between the individual and awareness of the givens (a.k.a., the ultimate concerns of existence)
If we bracket the outside world (a.k.a., put aside our everyday concerns), we are inevitably faced by our inescapable ultimate concerns. Confronting each of these is what brings about internal conflict (from an existential frame of reference).
A full understanding of a person involves knowledge of that person’s circumstances (the objective part), and also knowledge of how that person subjectively structures and values those circumstances (the subjective part). Consciousness of the self allows people to escape determinism and personally influence what they do.
Existential psychotherapy doesn’t have a theory of individual differences.
It does focus in practice, however, on How Each Individual Deals Uniquely With The Ultimate Concerns! (i.e., inherently linked with its approach to psychotherapy)
