Existential
psychotherapy originated in thework of four psychiatrists: Karl
Jaspers in Germany, (1951, 1964), Ludwig Binswanger (1946, 1963)
and Medard Boss (1957, 1962, 1979) in Switzerland, and Victor Frankl
in Austria. Existential psychotherapy was introduced into the UK
by Ronald Laing, but it fell to Emmy van Deurzen to create the Society
of Existential Analysis, and the first training programme in existential
psychotherapy in the UK, at Antioch University's London branch.
Existential psychotherapy, as developed in the UK, is particularly
appropriate to focal therapy and, with the shift from long-term
to more focussed therapy in recent years, it has grown into a significant
psychotherapy modality . Existential approaches to couples therapy,
to the therapy of developmental disorders, and to group psychotherapy
have been developed.
Fundamental ideas
Meaning
of life
Existential anxiety
Value
Situations
Limit situations
Self-deception
Time
The transparent self
Existential guilt
Four dimensions of existence
A dialectical approach
Conclusion
Bibliography
History
The philosophers who have
most influenced existential psychotherapy were the 19th century philosophers
of existence Kierkegaard (1844,1855) and Nietzsche (1882, 1883)and
the methods they used were modelled on the phenomenological work
of Husserl (1900, 1913) and Heidegger (1927,1954). Since then other
therapists have developed new methods based on these early attempts
as well as on the philosophical works of existentialist, structuralist
and post-modern philosophers such as Sartre (1939,1943), de Beauvoir,
Camus, Merleau Ponty, Levinas, Derrida and others. Out of this wealth
of theoretical background and early clinical work a myriad of therapies
have emerged. Some therapies like the person-centred approach or
Gestalt psychotherapy are to some extent rooted in this existential
thinking. But the practitioners who have really made a significant
effort to base therapy and counselling in philosophical considerations
rather than in restrictive psychological models, are people like
Frankl (1946, 1955, 1967), May (1958, 1969, 1983), Laing (1960, 1967),
Szasz (1961, 1965,) and Yalom (1980, 1989, 1996). Recently the approach
has been intensively developed in the UK, mainly through the publication
of Existential Counselling and Psychotherapy in Practice (van Deurzen,
1988, 2nd edition 2002) and publication of subsequent books (van
Deurzen, 1997, 1998) and also by my initiating the founding of the
Society for Existential Analysis in 1988 with the support of colleagues
from the Philadelphia and Arbours Associations. The Journal of the
Society has gone from strength to strength and is an important international
voice in the field of psychotherapy, as is the work of the editors
who have given it much of their time, Simon Du Plock (1997) and Hans
Cohn (1997).
In terms of training much has happened in those past twenty years as
well. After setting up the first University based psychotherapy training
in existential counselling and psychotherapy for Antioch University in
London in 1982 I developed this into the School of Psychotherapy and
Counselling at Regent's College, which has trained many practitioners
over the years. After my departure from the College in 1996, I founded
the New School of Psychotherapy and Counselling, which is entirely devoted
to the training of existential counsellors and therapists and which is
validated by the University of Sheffield. Establishing the approach in
the UK has taken a long time, but now there is a new generation of new
practitioners who have become teachers in their own right and the existential
approach is firmly on the map. Other courses in the approach can for
instance be found at Brighton and Surrey Universities and in a number
of Colleges across the country.
Fundamental ideas.
There are many differences of opinion between various practitioners
and authors over what existential psychotherapy consists of. This diversity
and ongoing debate is one of the strengths of the approach. Some practitioners
who claim the existential label however seem to disagree with the most
fundamental existential ideas. An approach can not be truly existential
unless it takes into account the cultural, social, political and ideological
context of a person's existence for instance. An existential approach
is an approach that explores the human condition and tries to capture
and question and individual's experience of it. It aims at clarifying
and understanding personal worldviews, values and beliefs and it makes
explicit what was previously implicit and unsaid. Its practice is primarily
philosophical and seeks to enable a person to live more deliberately,
more authentically and more purposefully, whilst accepting the limitations
and contradictions of human existence. It is essentially about investigating
human existence through the particular preoccupations of one individual
and this has to be done without preconceptions or set ways of proceeding.
It is certainly nothing like the magical make-believe of the Dumbo school
of thought that Spinelli described in a recent article in this Journal
(Spinelli, 2001). The existential counsellor or therapist needs to come
to the sessions with complete openness to the individual situation and
with an attitude of wonder that will allow the specific circumstances
and experiences to unfold in their own right. Assisting other human beings
in understanding their own life in a genuine and meaningful manner is
a serious matter. Each and every discovery is personal and unpredictable.
We can however distinguish a number of themes that will often emerge
in this process.
Meaning of life
According to Heidegger the most fundamental philosophical questions
are: 'Why is there something rather than nothing?' and 'What is the meaning
of being?'. We do not actually know the answer to these questions, but
most people sooner or later ask them. When people wonder what it is all
good for and they cannot find a satisfactory answer for themselves they
may come to a counsellor or a therapist. But in actual fact such doubts
about the meaning of life are the beginning of all philosophy and should
not be confused with pathology. Doubt and wonder enable us to rediscover
the miracle of being. Once upon a time the meaning of life was given
by religion or by social rule. These days meaning is often looked at
in a far more sceptical manner (Tantam, 2000). It is therefore not surprising
that people can find themselves in what has been called a vacuum of meaning
(Frankl 1946,1955). The experience of meaninglessness becomes a major
problem in many people's lives and it may lead to a number of concrete
difficulties, which may look like personality problems or other forms
of pathology. We can only engage in discussions about meaning if we have
been willing to question our own lives and can recognize that anxieties
and doubts about meaning do not have to be equated with personal pathology
or mental illness (Szasz 1961, 1965, 1992).
It is by no means easy to be truly available to help others in finding
meaning in their lives when their existence is in crisis. The meaning
of life is never given and can not be transmitted unless a person is
willing to search for it independently. Phenomenologists recognized that
meaning making is one of the defining characteristics of human consciousness.
Logotherapist Frankl (1946) spoke of three sources of meaning. Firstly
through taking from the world what is there, learning to savour and appreciate
what is already given to us, as in aesthetic enjoyment of nature or the
pleasures of the senses. Secondly to give to the world and add new enjoyments
to it through acts of our own creativity and by giving to others in this
way as well. Thirdly by suffering, which is to endure the harsh conditions
we may be exposed to. If there is no alternative to our suffering, it
is always possible to find an attitude of human dignity by enduring the
hard labour, pain and disappointments, Frankl argues, even when we have
to face up to extremes of torture and deprivation.
Existential anxiety
The experience of meaninglessness and the creation of meaning are closely
related to the experience of Angst or existential anxiety. This occurs
against the backdrop of the personal realization that I am ultimately
alone in the world and that I have to contend with my mortality and other
limitations, taking responsibility for myself in the face of endless
challenges and confusions. This crisis of meaning was first described
by Kierkegaard (1844, 1855), who thought that it was a great deal preferable
to begin to feel anxious about life and question it, rather than to live
in the despair of those who deny the need to think for themselves. Kierkegaard
thought that human beings would only gradually become capable of such
questioning. For the process of thinking alone plunges us into Angst,
or existential anxiety, which was likened by Kierkegaard to a dizziness
of freedom. He thought that experiencing Angst was the sine qua non of
us assuming our responsibility as individuals and that without it we
could never come face to face with the demands our life makes on us.
Anxiety or Angst is a core concept in existential counselling and therapy,
for it is seen as the basic ingredient of vitality. Learning to be anxious
in the right way, i.e. not too much or too little is the key to living
a reflective, meaningful human life. As Kierkegaard put it:
Whoever has learnt to be anxious in the right way
has learnt the ultimate. (Kierkegaard 1844:155)
Anxiety has to be distinguished from fear. The former is a generalized
feeling of Unheimlichkeit (Heidegger 1927), of not being at ease, or
at home in one's world, whereas the latter has a concrete object. It
is anxiety that allows us to define ourselves as a separate person and
to become responsive and responsible as well as aware and alert. Although
we may become overwhelmed with anxiety, so that it becomes counterproductive,
on the whole anxiety is to be seen as a positive breakthrough towards
the goal of living fully.
Values
It is hard enough to find
your way in the world at the best of times, but when you start to live
in openness to your anxiety, it is easy to lose your sense of direction.
Moral and ethical issues are increasingly obscure in the world we live
in today. It can be helpful to turn to Nietzsche's challenge (Nietzsche
1883) that we should re-value all values. He insisted that our thinking
had gone astray and that much that people took for granted had to be
reconsidered. He thought it crucial to consider afresh what a good
human life consists of. This leads to noticing with phenomenologists
such as Husserl (1900, 1913, 1929) that human consciousness is essentially
transparent and in this sense is always and necessarily connected to
a world. It is never independent and always has an object. As we are
non-substantial, transparent beings we cannot but reach out to a world.
We are always in relation. Through us the world comes to light. We always,
think, do, desire, imagine something. There always is some contents to
our mind. It is possible to set aside our automatic ways of intending
things and judging things and take heed of our tendency to do so. We
can learn to be disciplined about our intentionality and through the
phenomenological reduction question all the automatic judgements we normally
take for granted. Husserl called this process 'coming to the things themselves'
and it is often referred to as the epoché or suspension. It consists
of putting our usual assumptions about the world in brackets. This does
not mean that we get rid of them or pretend they do not exist, but rather
that we deal with them separately so that we can describe the situation,
object of our attention or other person we are dealing with fairly and
as it really is. To make oneself consistently query one's assumptions
about the world and reconsider it with a cleared attitude of openness
is obviously extremely relevant to the practice of psychotherapy. Existential
therapists and counsellors learn to have a phenomenological attitude
and to set aside their assumptions about everything, in order to look
at their values and those of their clients in recognition of their bias.
Situations
When we do this we discover immediately that people are always connected
to the world in a number of concrete ways. Heidegger (1927) in this context
spoke of our 'thrownness'. He said that we are always thrown into a world
that is already there to start with and into which we simply get inserted.
It is important to recognize the factual situations that we are confronted
with. We are part of a certain culture, a certain environment with a
particular climate and history, a certain society and a specific situation.
It is only within the givens of that situation that we can exercise our
own choices. Sartre (1943) called this our facticity and he recognized
that we can never release ourselves from this, even though we can choose
our position in relation to it. In terms of psychotherapy it also means
that it may be necessary to look at people's problems in a structural
way. Instead of seeing everything as the person's psychological, emotional
or internal problem, difficulties can be seen as part of an overall situation.
Context is crucial and has to be taken into account.
Limit situations
Of all the situations in which we can find ourselves there are certain
ones that are irrevocable. These situations have to be accepted and worked
with. We cannot avoid them or overcome them: we have to learn to live
with them. Heidegger emphasised the importance of death as a marker of
our finite nature. Death in this sense is not to be taken as something
happening to us at some point later, but as something that is relevant
to us right now. The realities of our mortality and of our incompleteness
have to be faced for us to become aware of and true to our nature, which
is to be finite. Heidegger considered that the reality of our death is
that it completes us. The recognition of the inevitability of death gives
us a certainty that nothing else can give us. The fear in the face of
death allows us to claim back our individuality, our authentic being,
as we are inevitably alone in death and find ourselves much sobered and
humbled by the knowledge of our mortality. Death, according to Heidegger:
...amounts to the disclosedness of the fact that Dasein exists as thrown
being towards its end. (Heidegger 1927:251)
In other words: death is part of me and to accept my living towards
this end gives my life back to me in a new way.
Jaspers (1951, 1971) spoke of limit situations as those situations which
define our humanity. Sooner or later we inevitably come up against guilt,
death, pain, suffering and failure. The philosophical take on this is
that it is more helpful to encourage people to come to terms with some
of the inevitable conflicts and problems of living than to help them
cover them up. Limit situations are what bring us in confrontation with
ourselves in a decisive and fundamentally disturbing way. They evoke
anxiety and therefore release us from our tendency to be untrue and evasive
about ourselves and our lives.
Self-deception
Sartre was particularly adamant that as human beings we try to pretend
that we are solid and definite in the way that objects are. People do
not like to face up to their fundamental nothingness and mortality. We
think we can pretend to be like a stone or a solid thing, but in fact
in doing so we are deceiving ourselves, reinventing ourselves in bad
faith (Sartre 1943). To be in bad faith is an almost unavoidable state
of play for human beings as we seem to find it particularly difficult
to face up to the implications of our freedom as consciousness. One of
the objectives of human living is to become increasingly aware of our
ability to choose to live deliberately rather than by default and to
diminish the extent to which we seek to tell ourselves false stories
about ourselves. Sartre said that the only choice we do not have is not
to choose because not to choose involves a choice as well.
In fact we are a freedom which chooses, but we do
not choose to be free. (Sartre 1943:485)
The coward is fulfilling the project of cowardice, in the same way in
which the hero is fulfilling the project of heroism. They can both either
choose to take responsibility for their choice or pretend that it just
happened to them and is not open to question.
Heidegger saw the existence of other people, with whom we are fallen
into a world where the anonymous 'They' in our own mind decides about
our actions and our identity as the major obstacle to authenticity. He
recognized, as Sartre did, that human beings are condemned to living
inauthentically for much of the time, but that they can nevertheless
aim to retrieve themselves from inauthenticity. It is the anxiety of
your possible death and your discovery that you are alone in the face
of your own fate and destiny that allows you ultimately to take yourself
seriously and affirm yourself resolutely as an individual facing death.
Time
This is when it also becomes possible to become more aware of the dimension
of time, which is a crucial category of human living. It is always today
and not tomorrow or yesterday. I am always no longer and not yet. We
orientate ourselves in relation to the various ways in which we stand
out in time. Our lives are a constant process of transformation that
we cannot stop. Heidegger spoke of the three ec-stasies of time (Heidegger
1927:329), which are the ways in which we stand out in the past, in the
present and in the future. We go back to ourselves in terms of remembering
the past. We let ourselves be encountered by the world in the present
and we reach out towards ourselves in the future. All of our actions
are full of the awareness of temporal change. There is decay and development
around us. Life consists of movement, transformation and action. All
of these are only possible in time. My existence is historic. It creates
a story. How I create this story is of utmost importance. Existential
psychotherapy is about retracing the story and reorienting a person in
time.
The transparent self
The way in which I tell my story is the way in which I create a self.
Existential philosophy does not posit the notion of a fixed and determined
self. There is no such thing as an essential solid self, only intentionality
and being in the world. Sartre used to say that existence preceded essence.
I come into the world first and exist and only after that do I create
a self for myself out of my actions. The self is a window on the world
and out of our living in time and standing out in the world we become
what we are. Sartre went as far as to say that people were the sum of
their actions. Therefore the choices we make are constitutive of the
sort of person we become. We are constantly in the process of creating
a self, yet when we try to capture this self, we realize it is as if
we were trying to catch our shadow: it moves away from us and changes
as we try to fix it. We cannot be a definitive something. Our stories
change as we live and so we are changed too. Any image we create of ourselves
is in a sense a lie: it never tells the full story about who we are or
could be. We have to re-create ourselves every day and can never really
take anything for granted, nor will we ever be all that we could be.
Existential guilt
Most of us will therefore have a frequent sensation of unease with ourselves.
The awareness that we are not true to our full human ability and that
we live inauthentically will lead to the experience of existential guilt.
In existential guilt we hear the voice of our conscience and this must
be taken extremely seriously. We are not guilty because we have fallen
short by other people's standards or because we have behaved badly, but
simply because we fall short as human beings. It is important to note
that most existential philosophers assume that human living will inevitably
expose us to falling short and therefore to feeling existential guilt.
We are always indebted to life. We are always capable of being more alive,
more open, more true to the potential of human consciousness than we
actually are. We are therefore condemned to feel existential guilt, as
we are condemned to feel existential anxiety; largely because we are,
as Sartre said, condemned to be free.
Four dimensions of existence
Systematic descriptions of human experience have outlined four dimensions
on which we exercise our freedom. Heidegger spoke of the different dimensions
as those of earth, world, man, and gods (Heidegger 1957). Binswanger
(1946,1963) spoke of the Umwelt (environment), Mitwelt (world with others)
and Eigenwelt (personal world), whilst a spiritual dimension (Uberwelt)
is also implied in his work (van Deurzen 1984). In essence philosophers
have recognized that human experience is multiple and complex and takes
place on a number of different levels. Firstly there is our involvement
in a physical world of objects, where we struggle between survival and
death. Secondly there is our activity in a social world of other people,
where we struggle with the contradictions between our need to belong
and the possibility of our isolation. Thirdly there is a personal dimension
where we grapple with the tension between integrity and disintegration.
Finally there is a spiritual dimension where we seek to find meaning
against the threat of meaninglessness. On each of these dimensions we
have to learn to stand in the tension between opposites and hold the
paradox, discovering that we cannot have life without death, love without
hate, identity without confusion, and wisdom without doubt. As Paul Tillich
once said:
The courage of confidence takes the anxiety of fate as well as the anxiety
of guilt into itself (Tillich 1952:163).
A dialectical approach.
Approaching psychotherapy
from an existential perspective is to see that a dialectical process
manages all these tensions of human existence. Conflicts are constantly
generated and then overcome, only to be reasserted in a new form. Paradoxes
are inevitable and life flows out of contradictory forces working against
and with each other. The existential psychotherapist has as primary
task to recognize together with the client the specific tensions that
are at work in the client's life. This requires a process of careful
scrutiny and description of the client's experience and a gradually
growing familiarity with the client's particular situation and stance
in the world. To understand the worldview and the states of mind that
this generates is to grapple with the way the client makes meaning,
which involves a coming to know of clients' values and beliefs. The
particular circumstances of the client's life are recognized, as is
their wider context. The psychotherapeutic process of existential therapy
is then to elicit, clarify and put into perspective all the current
issues and contradictions that are problematic. Part of the work consists
in enabling the client to come to terms with the inherent contradictions
of human living. Another part of it is to help clients find a satisfactory
direction for their future life with a full recognition of the paradoxes
that have to be faced in the process. Ultimately the therapeutic search
is about allowing the client to reclaim personal freedom and a willingness
and ability to be open to the world in all its complexity. Authentic
living with courage (Tillich 1952) and in humility would be a suitable
existential objective. Learning to reflect for oneself and communicate
effectively with others is another (Buber 1923, 1929). As mentioned before
existential psychotherapy can take many different shapes and forms, but
it always requires a philosophical exploration of what is true for the
client. When this exploration is conducted satisfactorily and fully it
often leads to a greater recognition of what is true for human beings
in general, affording the beginning of a genuine philosophical exploration,
which is meaningful in itself and which may make it easier to tackle
life's inevitable darkness and adversity.
Conclusion.
Existential therapy is a serious, deep and far-reaching enquiry into
what it means to a particular person to be a human being. It involves
an often-painful process of squarely facing up to those things that are
ordinarily avoided and evaded. Paradoxically such a process can bring
great strength and unexpected joy. Existential work is not for the fainthearted
and it may sometimes consist of encouraging rather than soothing anxiety
and guilt. The essence of the existential approach is to deflate our
human vanities and remember that at the end of all our worldly adventures
and preoccupations we are born to die. Lots of good therapists from different
orientations understand about existential issues, but very few have investigated
the philosophical dimension of the subject in any great depth. Training
in existential therapy and counselling requires students to thoroughly
familiarize themselves with the philosophical investigation of human
living, to practice the application of such ideas by intensively supervised
philosophical therapeutic practice and from having a deep and real understanding
of their own experiences of crisis and distress, through their training
analysis. It is a remarkable fact that those who come for existential
training tend to have varied and often-intense life experiences behind
them. The approach just does not make sense unless you have first come
to find out a bit about life the hard way and quite by yourself.
Back to top
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