Existential Psychotherapy

CHAPTER 8


EXISTENTIAL PSYCHOTHERAPY


Mick Cooper


Despite being one of the oldest and most widespread forms of therapeutic practice, existential psychotherapy is, perhaps, one of the least well understood. A number of reasons exist for this. First, being derived from philosophical, rather than psychological, roots, existential psychotherapeutic texts such as Binswanger’s (1963) Being-in-the-World or Laing’s (1969) Self and Others are often as complex and challenging as the continental philosophical writings on which they are based. Second, because of its philosophical groundings, existential psychotherapists have tended to be much better at articulating the theoretical tenets of their approach than its actual concrete practices. Third, there is enormous diversity across the various branches of existential psychotherapy: Indeed, it is much more meaningful to talk of existential psychotherapies (see Cooper, 2003a) than of a singular existential approach. Hence, there is no one definable set of core beliefs, values, or practices that characterizes this approach. Fourth, existentialism is, to a great extent, a critical and reactive style of thinking rather than a proactive one. Consequently, existential therapists are often much better at saying what they don’t do than what they do do. Finally, as we see later, there is considerable emphasis in the existential approach on the uniqueness of each individual client, practitioner, and therapeutic relationship. Hence, existential therapists have often been reluctant to systematize their approach and lay down a particular set of guidelines for practice, let alone manualize their way or working.


This limitation of the existential approaches to psychotherapy, however, is also its strength. For as a heterogeneous, multifaceted, and relatively conceptual perspective on psychotherapeutic practice, it does not prescribe to therapists a particular set of techniques or tasks that they should undertake, but rather provides them with a set of ideas, possibilities, and critiques that can be incorporated into a wide array of therapeutic practices. Moreover, because it does not tie psychotherapists down to one particular way of working, it is an excellent source of stimulation and critical, creative thinking, facilitating divergent, as opposed to convergent, forms of thought that may help practitioners develop their therapeutic style in unique and idiosyncratic ways.


HISTORY OF EXISTENTIAL PSYCHOTHERAPY AND ITS VARIANTS


Beginnings of the Approach


At its most basic, existential approaches to psychotherapy can be considered those forms of therapeutic practice that are informed, to a significant extent, by the teachings of the existential school of philosophy (sometimes referred to as existentialism or existentialist philosophy, though there are debates about the synonymy of these terms) (Cooper, 2003a). Historically, this philosophical movement can be seen as having two main phases: The first was in the middle to late nineteenth century with the writings of such philosophers as Søren Kierkegaard and Frederick Nietzsche. The second, and more substantial, phase took place toward the end of World War II, when the writings of such philosophers as Jean-Paul Sartre, Maurice Merleau-Ponty, Albert Camus, Martin Buber, and Martin Heidegger attracted international interest. However, many of the ideas of existential philosophers can be traced far back into antiquity (Macquarrie, 1972), and there is enormous debate about who can and cannot be included under the existential banner. Indeed, virtually all of the philosophers labeled existentialists vehemently rejected this title, and there are considerable areas of difference and diversity among their thoughts.


What unites each of these philosophers, however, is a concern with the way in which contemporary systems of thought, religion, and science have tended to dehumanize our understanding of what it means to be a human being, reducing the actuality of lived human existence down to a series of universal, abstract, and impersonal essences (Cooper, 2003a). Søren Kierkegaard (1992) and Friedrich Nietzsche (1967), for instance, railed against nineteenth-century scientific, religious, and philosophical systems of belief, most notably G. W. F. Hegel’s (1949) absolute idealism that understood human beings as bit-players within a grand historical design. Instead, they argued that each human being should be understood in terms of his or her individual, concrete, subjective human existence. Twentieth-century existential philosophers, like Jean-Paul Sartre (1958) and Martin Heidegger (1962), developed these ideas further, reacting, in particular, against the burgeoning positivism of their day and its domination of such social sciences as psychology. Where behaviorists, for instance, construed human existence in terms of causally linked stimulus-response chains, existentialists focused on the human capacity for freedom and choice and the holistic nature of human existence. And where psychoanalysts emphasized the universal, unconscious forces that lay behind human behavior, existentialists focused on the concrete actuality of consciously lived-existence.


A key contribution to the development of existential thought was the phenomenological method and philosophy of Edmund Husserl, which emerged around the turn of the twentieth century. Indeed, such is the proximity between these two systems that it is not uncommon for people to talk about existential-phenomenological philosophy or psychotherapeutic practice. Phenomenology emerged in the late nineteenth century and, to a large extent, can be considered an extension of the Cartesian project of establishing the fundamental grounds of knowledge (see Moran, 2000). Like Descartes, Husserl adopted a standpoint of radical doubt, asking what we can know for certain. Rather than starting with knowledge (“I think therefore I am”), Husserl argued that all we can know is what we experience—the inner evidence that is given to us intuitively in our conscious experiencing of things. To truly know ourselves and our world, we need to turn our attention to our conscious, lived-experiences.


To facilitate this inquiry, Husserl outlined a range of methods or reductions, the first of which is commonly known as the phenomenological method. Spinelli (2005) describes this in terms of three interrelated steps: The first of these steps is the rule of epoché, whereby we are urged to “set aside our initial biases and prejudices of things, to suspend our expectations and assumptions, in short, to bracket all such temporarily and as far as it is possible so that we can focus on the primary data of our experience” (Spinelli, 1989, p. 17). The second step is the rule of description, the essence of which is “Describe, don’t explain” (Ihde, 1986, p. 34). Here, we are urged to refrain from producing explanations, hypotheses, or theories as to what we are experiencing, and instead to stay with the lived-experiences as they actually are. Finally, there is the rule of horizontalisation that “further urges us to avoid placing any initial hierarchies of significance or importance upon the items of our descriptions, and instead to treat each initially as having equal value or significance” (Spinelli, 1989, p. 18). Existential philosophers like Sartre and Heidegger did not wholly accept Husserl’s analysis or methods, but it did provide them with a philosophical grounding for focusing on concrete lived-experiences. Moreover, Husserl’s phenomenological approach provided them with a method by which they could begin to say something of what this lived-experiencing was like, and we explore this further later in the chapter.


In the first decades of the twentieth century, a number of psychiatrists across the European continent began to draw on the writings of existential and phenomenological philosophers—particularly Husserl and Heidegger—to develop a deeper understanding of psychiatric disorders. First among these was the German psychiatrist Karl Jaspers, who went on to become one of the most influential existential philosophers. In General Psychopathology (1963) first published in 1913, Jaspers attempted to develop a phenomenology of “morbid psychic life”: cataloguing such phenomena as derealization and hallucinations in terms of the sufferer’s subjectively lived-experiences.


Ludwig Binswanger (1963) was a second psychiatrist to play a major role in the foundation of the existential therapies. Binswanger maintained a close friendship with Sigmund Freud for many years, but felt that Freud’s attempts to develop a scientific, causal, a-worldly model of human existence had led him to dehumanize the very human beings he was attempting to understand. In contrast, Binswanger drew on the work of such existential philosophers as Martin Heidegger and Martin Buber to develop a phenomenological anthropology. Here, human beings were understood in terms of their relation to their world and to others, and psychological difficulties were conceptualized in terms of disturbances, disruptions, or restrictions of these relational modes (see Binswanger’s case study of “Ellen West” in May, Angel, & Ellenberger, 1958).


Populations and Places Where Existential Psychotherapy Developed


Existential approaches to psychotherapy have tended to emerge at times, and in regions of the world, where there is a groundswell of interest in existential philosophy. Hence, many of the first existential psychotherapies emerged in continental Europe—particularly Germany and France—where philosophers such as Heidegger and Husserl were having a significant impact on the intellectual zeitgeist. With the emergence of Nazism in the 1930s, however, many leading European thinkers—including existential philosophers such as Paul Tillich—emigrated to the United States such that, by the late 1950s, existential approaches to psychotherapy were also beginning to take shape there. Around the same time, R. D. Laing began to develop an existential perspective on psychiatric and psychotherapeutic practice in the United Kingdom. To a great extent, however, each of these forms of existential psychotherapy emerged quite independently—drawing on different existential philosophers as well as being influenced by different psychotherapeutic schools—such that, as highlighted earlier, a number of quite distinct perspectives on existential psychotherapy can be said to exist.


Key Figures and Variations of Approach


Daseinsanalysis


One of the first schools of existential therapy to emerge was that of Daseinsanalysis. This school was founded on the work of Ludwig Binswanger, but it was a second Swiss psychiatrist, Medard Boss, who turned it into a systematic form of therapeutic practice. Initially, Boss trained as a psychoanalyst, and Daseinsanalytic practice bears many hallmarks of its predecessor, such as the emphasis on dream-work, use of free association, and of the couch. In drawing on Heidegger’s later teachings as well as south Asian mysticism; however, Boss vigorously critiqued the “meta-theoretical” assumptions behind Freud’s analytical practice and proposed a radically new set of philosophical assumptions on which psychotherapy should be based (Boss, 1963, 1979).


A key aspect of Freudian meta-theory that Boss (1963, 1979) critiqued was the idea that human beings could be understood in terms of thinglike “psyches,” in which different parts, like ego and id, existed and interacted. Drawing on Heidegger’s (1962) notion of being as “in-the-world” (see “Theory of Personality and Psychopathology” section), Boss argued that existence did not reside inside people’s heads, but between people and their world. Furthermore, he argued that neuroses and psychoses were not a result of intrapsychic dysfunctions, but of limited, restricted, or closed ways of relating to the world. The aim of Daseinsanalysis was to help clients open themselves up to their world—to be like “a light which luminates whatever particular being comes into the realm of its rays” (Boss, 1963, p. 37).


This rejection of intrapsychic parts and dynamics also entailed a rejection of the unconscious and the idea that clients transferred thoughts and feelings from previous figures in their lives onto their therapist. For Boss (1963, 1979), clients were simply closed to some aspects of others’ being-in-the-world—such that they did not engage with the full totality of their therapist’s being. Hence, Boss rejected the idea that therapists should adopt the role of a blank screen and instead argued that they should be human and warm, encouraging their clients to ever-greater levels of interpersonal openness. Boss’s Heideggerian roots also meant that he rejected the causal, deterministic aspects of Freudian thinking. Although he did not deny that clients could be influenced by their past, he put greater emphasis on working with clients’ present patterns of openness and closedness, and their potentialities for freedom and choices for the future.


Logotherapy


Logotherapy, also termed existential analysis, is a form of existential psychotherapy that specifically aims to help clients discover purpose in their lives—Logos being the Greek term for meaning (Frankl, 1984)—and to overcome feelings of meaninglessness and despair. It was developed by the Viennese psychiatrist, Viktor Frankl, around 1929—and tested during his time in the Nazi concentration camps, where he found that those prisoners who had some sense of meaning and hope survived better than those who succumbed to a sense of meaninglessness and futility (Frankl, 1984).


According to logotherapists, human beings’ most fundamental needs are to find meaning in their lives (Frankl, 1984, 1986). Without this, they argue, human beings will experience deep feelings of frustration, emptiness, and depression that can develop into more serious existential (noögenic) neuroses (Frankl, 1986). Here, individuals may turn to such self-destructive patterns as addictions, compulsions, or phobias in an attempt to fill their existential void. In terms of actual practice, logotherapists use a range of relatively didactic techniques to help clients find the meaning and purpose that their lives have—from suggesting to them what that meaning might be, to engaging them in Socratic dialogue, to helping them uncover what really matters to them in their existences (see “Theory of Psychotherapy” section).


Existential-Humanistic Psychotherapy


In the United States, an existential-humanistic approach to therapy emerged under the tutelage of Rollo May. May originally trained as a minister, and he was strongly influenced by the teachings of his mentor, the existential theologian Paul Tillich. In 1958, May and colleagues coedited Existence: A new dimension in psychiatry and psychology, which brought the writings and practices of European existential and phenomenological psychiatrists to America for the first time. Other key figures in the development of the existential-humanistic approach include James Bugental, Irvin Yalom, and Kirk Schneider—all of whom worked in close collaboration with May.


At the heart of the existential-humanistic enterprise lies an essentially psychodynamic reading of existential—particularly, Kierkegaardian and Nietzschean—themes (Cooper, 2003a). This reading has taken the psychoanalytic formula: DRIVE → ANXIETY → DEFENCE MECHANISM and replaced it with REALITY OF EXISTENCE → EXISTENTIAL ANXIETY → DEFENCE MECHANISMS (based on Yalom, 1980). It asserts that clients resist an awareness of their true “existential” condition—in particular, being-toward-death, freedom, aloneness, and meaninglessness (Yalom, 1980)—pushing this knowledge down into the depths of their unconscious. Thus, the fundamental project of existential-humanistic psychotherapy is to help clients identify and overcome their resistances and to meet the anxiety of existence with an attitude of decisiveness and resolve. Therapeutic strategies range from the gently exploratory to the highly confrontational (see “Theory of Psychotherapy” section), and they are often orientated around an exploration of the dynamics of the psychotherapeutic relationship.


R. D. Laing and the British School of Existential Analysis


R. D. Laing drew on a range of existential and phenomenological teachings to critique the psychiatric assumptions of his—and to a large extent, our—day. In contrast to an objective, detached psychiatric standpoint, Laing (1965) argued that psychiatrists needed to enter the phenomenological lived-world of their patients, and that there they would find a far greater sense to the client’s madness than they had ever imagined. In his book, The Divided Self, Laing attempts to show how a condition as seemingly unintelligible as schizophrenia can become intelligible and meaningful if a therapist attempts to understand it from the patient’s standpoint.


Laing rejected therapeutic systems and techniques, and in this respect he made no attempt to codify a Laingian approach to therapy (though clients’ reports suggest that he was a highly attentive, focused, and challenging listener; Resnick, 1997). In the mid-1980s, however, a British school of existential analysis began to emerge that drew on many of Laing’s writings and ideas. The principal driving force behind this development was Emmy van Deurzen (1998, 2002; van Deurzen-Smith, 1997), a clinical psychologist originally born in Holland. Van Deurzen’s approach draws on a range of philosophical insights—including those beyond the bounds of existentialism—to help clients address the basic existential question: How can I live a better life? Van Deurzen’s (1998) starting point is that life is an “endless struggle where moments of ease and happiness are the exception rather than the rule” (p. 132) and that problems in living arise when people are reluctant to face the realities of their imperfect, dilemma-ridden, and challenging existences. Hence, the aim of existential therapy, for van Deurzen-Smith (1997), is to help clients wake up from “self-deception,” to face the challenge of living head on, and to discover their talents and possibilities.


Like Laing and van Deurzen, most therapists in the British school of existential analysis adopt a primarily descriptive, nontechnique-based approach to psychotherapy in which clients’ difficulties are seen as problems in living rather than pathological modes of functioning (see DuPlock, 1997). The British school, however, can only be considered a school in the loosest sense of the word. Van Deurzen (2002) writes, “The movement has its own history of splitting and fighting and there is a healthy disagreement about what existential work should be” (p. x). In particular, in contrast to van Deurzen’s (2002) pedagogical model of existential therapy, Ernesto Spinelli (1994, 1997, 2001) has advocated a more phenomenological, exploratory, and relational approach to practice in which psychotherapists are encouraged to “bracket” their beliefs and assumptions and to engage their clients from a stance of “not knowing.”


Dimensions of Existential Psychotherapy


As can be seen, enormous variety exists across the existential approaches to psychotherapy. Indeed, in some instances, they are hardly recognizable as the same psychotherapeutic approach (e.g., logotherapy versus Spinelli’s phenomenologically informed approach). Cooper (2003a), in reviewing these different schools of existential psychotherapy, suggests that there are nine basic dimensions along which the practices vary:



1. Bracketing assumptions (e.g., Spinelli) versus adopting existential assumptions (e.g., Yalom)

2. Directivity (e.g., logotherapy) versus nondirectivity (e.g., Laing)

3. Working descriptively/phenomenologically (e.g., Daseinsanalysis) versus analytical/explanatory work (e.g., existential-humanistic psychotherapy)

4. Psychological orientation (e.g., existential-humanistic psychotherapy) versus philosophical orientation (e.g., van Deurzen)

5. Individualising the client’s difficulties (e.g., existential-humanistic psychotherapy) versus normalising them (e.g., van Deurzen, 2002)

6. Pathologising the client’s difficulties (e.g., Daseinsanalysis) versus depathologising them (e.g., Laing)

7. Intrapersonal focus (e.g., existential-humanistic psychotherapy) versus being-in-the-world focus (e.g., British school)

8. Orientating the therapeutic work around the therapeutic relationship (e.g., Yalom) versus placing no great emphasis on the client-therapist relationship (e.g., logotherapy)

9. Therapeutic spontaneity (e.g., Laing) versus using techniques (e.g., logotherapy)

Reducing these dimensions down further, it is possible to conceptualize the existential approaches to therapy as lying roughly along a “hard-soft” axis: with the more directive, pathologizing, interpretative, and technique-based ways of working at the harder end and the more phenomenological, descriptive, relational practices at the softer one. To a great extent, such an axis can also be seen as representing a wider tension in existential thought: from a more modernist existentialism that argues that the human condition is characterized by certain truths to a more postmodern standpoint that holds that all truths, including existential ones, are ultimately only social constructions.


Most Popular Currently Practiced Variations


Currently, the British school of existential analysis is one of the most active forces in the existential therapeutic world, with regular conferences, training institutes, discussion groups, and a twice-yearly journal, Existential Analysis. The logotherapeutic movement continues to flourish today, with a range of training centers across continental Europe and America with regular newsletters, journals, and conferences. More widely, logotherapeutic practices have been incorporated into a range of other forms of interpersonal helping—such as nursing (Starck, 1993) and social work (Guttman, 1996)—and recent years have also seen the development of a more comprehensive and integrative form of logotherapeutic practice: existential-analytical psychotherapy, developed by Alfried Längle (2001). Similarly, a number of Daseinsanalytic training institutes can be found across central Europe, with Daseinsanalytic societies and associations as far as Canada and Brazil. With respect to existential-humanistic psychotherapy, training is limited to the Existential-Humanistic Institute in San Francisco, but the influence of this approach vastly outweighs the numbers of self-identified existential-humanistic practitioners, through the enormous popularity of the writings of its leading advocates, in particular, Irvin Yalom (1980, 1989, 2001).


THEORY OF PERSONALITY AND PSYCHOPATHOLOGY


Key Aspects of Theory of Personality/Psychopathology


Verblike-ness


Given its emphasis on rehumanizing our understanding of what it means to be a person, many existential philosophers and psychotherapists have explicitly rejected the idea that human beings can be understood as having a personality in the same way that inorganic entities can be described as having certain characteristics. Rather, drawing on phenomenological principles, existential philosophers have emphasized the way in which human existence is a verb-like process—a “flux” (Merleau-Ponty, 1962), an “unfolding event” (Hoffman, 1993), or a “path” (Jaspers, 1986)—without fixed qualities or traits. Nevertheless, existential philosophers, particularly those at the harder end of the continuum, have attempted to say something of what this process of being human is like—the “givens” of human existence (Cohn, 1997). A review of these qualities gives a good insight into how many existentialists view the human condition.


Uniqueness


First, many existential philosophers have emphasized that each human existence is fundamentally unique: distinctive, irreplaceable, and inexchangeable (Macquarrie, 1972). In contrast to those models of personality, which attempt to define all human exis tences along a finite set of variables (e.g., the Big Five model of personality; Costa Jr. & McCrae, 1985), existentialists have tended to argue that each human existence is an irreducible whole: a complex gestalt that cannot be broken down into the sum of its individual parts without losing its essence. Such a position is a logical consequence of the phenomenological assumption that the essence of our existence is our experiencing of the world. For if I am, at this precise moment in time thinking these thoughts, hearing these sounds, and feeling these feelings, this essence of my being can in no way be described by a common set of variables.


Freedom and Choice


Second, existentialists have tended to argue that human beingness is characterized by its capacity to make choices. Sartre writes, “Man does not exist first in order to be free subsequently; there is no difference between the being of a man and his being-free” (1958, p. 25). The capacity to choose is not an add-on to our personality or an epiphenomenon but an intrinsic aspect of human being. Such a position, again, can be seen as a logical consequence of adopting a phenomenological starting point. Viewed from the outside, it might be possible to say that human behaviors are caused or determined to happen. Viewed subjectively, human beings very rarely experience themselves as caused to do things. Rather, there is always an experiencing of possibilities and choice, even though this choice making may take place at a prereflective, rather than consciously reflectively, level (Farber, 2000).


Moreover, for existentialists like Sartre human beings are their choices: Their identities and characteristics are consequences—and not causes—of the choices that they make. This emphasis on human choice and agency contrasts sharply with those psychological and psychotherapeutic models that conceptualize human behavior and experience in deterministic terms, whether caused by unconscious psychic events, external reinforcers, or personality traits. Sartre (1996) says:


Man is nothing else but what he makes of himself. Such is the first principle of existentialism. It is also what is called subjectivity, the name we are labeled with when charges are brought against us. But what do we mean by this, if not that man has a greater dignity than a stone or table? For we mean that man first exists, that is, that man first of all is the being who hurls himself toward a future and who is conscious of imagining himself as being in the future. Man is at the start a plan which is aware of itself, rather than a patch of moss, a piece of garbage, or a cauliflower; nothing exists prior to this plan; there is nothing in heaven; man will be what he will have planned to be. Not what he will want to be. Because by the word “will” we generally mean a conscious decision, which is subsequent to what we have already made of ourselves. I may want to belong to a political party, write a book, get married; but all that is only a manifestation of an earlier, more spontaneous choice that is called “will.” But if existence really does precede essence, man is responsible for what he is. Thus, existentialism’s first move is to make every man aware of what he is and to make the full responsibility of his existence rest on him. And when we say that a man is responsible for himself, we do not only mean that he is responsible for his own individuality, but that he is responsible for all men. (p. 259)


Being-toward-the-Future


As part of this reaction to deterministic models of psychological functioning, many existential philosophers and psychotherapists have also argued that human experiencing and behavior is not driven by the past, but orientated toward the future. From an existential perspective, the basic ground for human action is motives rather than causes (Heidegger, 2001). The meanings, purposes, and goals that we have in our lives can be as fundamental to who we are as our early experiences.


Limited


Although existentialists tend to believe that human beings choose toward their own futures, it would be wrong to assume that they see human beings as free to do whatever they want. Indeed, existential philosophers have consistently emphasized the fact that human freedom is “hedged in” in innumerable ways (Macquarrie, 1972). Human beings, for instance, find themselves born into a world that is not of their making (Heidegger, 1996a), hurtling toward a death that they cannot avoid (Yalom, 1980), and between these two “boundaries” encircled by a “huge tide of accident” (Jaspers, 1932) and chance.


From an existential standpoint, there are also certain paradoxes inherent to our lives that will always limit our ability to achieve our goals: for instance, that the more we strive to be happy, the more unhappy we often become; or that the more we know, the less we seem to understand. For existential authors like van Deurzen (1998), what also limits our ability to achieve what we want is the fact that we inhabit a world of tensions: We are pulled in different directions by different needs and wants that mean we can never be wholly fulfilled. A person may have a desire for independence in his or her life and also a desire for closeness to others and, in contrast to a more humanistic standpoint (e.g., Fromm, 1963), these wants would be seen as ultimately unreconcilable. A person cannot grow to a point where both wants are fully satiated: It is a limitation of life that human beings are always pulled between desiring both independence and closeness. In these respect, many existential writers have emphasized the tragic dimensions of life: It is so often not what people want it to be, yet much of the time there is very little they can do about this. And what makes this tragic dimension even more tragic is the fact that, from an existential standpoint, people can probably never stop wanting it not to be tragic—another paradox.


Yet even with such limitations, it is important to reemphasize that, from an existential perspective, human beings are never considered caused or made to be a certain way. Even within the most restrictive circumstances, there is still the belief that human beings have the capacity to choose. This is nowhere more powerfully illustrated than in Viktor Frankl’s description of his experiences in Auschwitz. Frankl (1984) writes, “In the concentration camps… we watched and witnessed some of our comrades behave like swine while others behaved like saints. Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions” (p. 157).


Being-in-the-World


As one of the givens of human existence, a number of twentieth-century existential philosophers have also argued that human beings are fundamentally and inescapably “in-the-world” (Merleau-Ponty, 1962). We are intrinsically interconnected to our environment and the world around us and cannot be conceptualized as a wholly separate entity. Along these lines, as discussed earlier, existence is not seen as taking place within an individual, but between the individual and their world. Indeed, Heidegger uses the term Dasein—literally translated as “being-there”—to refer to the specifically human form of being; and, at other times, writes of the hyphenated “being-in-the-world” to emphasize the indissoluble unity of person and world. In his later writings, Heidegger (1996b) also talks of human beings as the “‘custodians, guardians,” or “shepherds” of being as a whole.


Being-with-Others


Alongside this concept of being-in-the-world, existential philosophers like Heidegger (1996a), Merleau-Ponty (1962), and Buber (1958) have argued that human beings are fundamentally and intrinsically “with-others.” Buber (1947) writes, “If you consider the individual by himself, then you see of man just as much as you see of the moon; only man with man provides a full image” (p. 247). Heidegger (1996a), in his earlier writings, tended to see this with-otherness in a relatively negative sense—that the meanings and purposes we have in life have never evolved wholly from ourselves, but have been acquired from our sociocultural nexus. Hence, what we take to be meaningful and of genuine value is really just a socially construed interpretation by “the One.”


Buber (1958), too, suggests that the experience of being-with-others can be dehumanizing, though his emphasis is on the dehumanization of the other rather than of the self. In his work, I and Thou, he writes of the “I-It attitude,” in which one person experiences another as a thinglike, determined object—an entity that can be systematized, analyzed, and broken down into universal parts. In contrast to Heidegger (1996a), however, Buber also described a deeply humanizing form of interrelating, the “I-Thou” attitude, or a genuinely dialogical stance that he considered ontogenetically and phylogenetically primary—in a sense, our “natural” state of being. Here, the other is beheld, accepted, and confirmed as a unique, unclassifiable, and unanalyzable totality, as a freely choosing flux of human experiencing. For Buber, such an I-Thou attitude requires a meeting with the other as they are in the present, rather than in terms of our past assumptions or future needs. It is an opening out to the other in their actual otherness—and a loving confirmation of that otherness—rather than a self-reflexive encounter with our own stereotypes and desires. Buber also argues that such an I-Thou attitude requires the I to take the risk of entering itself fully into the encounter, to leap into the unpredictability of a genuine dialogue with all of its being—including its vulnerabilities—and to be open to the possibility of being fundamentally transformed by the encounter. Buber did not believe that human beings could, or should, spend all their lives relating to others in an I-Thou way, but he did believe that human beings who only related to others in I-It ways were not experiencing or actualizing the fullness of their humanity. He also believed that moments of genuine I-Thou dialogue were becoming increasingly rare in our modern world. Buber (1947) writes:


I know three kinds [of dialogue]. There is a genuine dialogue—no matter whether spoken or silent—where each of the participants really has in mind the other or others in their present and particular being and turns to them with the intention of establishing a living mutual relation between himself and them. There is technical dialogue, which is prompted solely by the need of objective understanding. And there is monologue disguised as dialogue, in which two or more men, meeting in space, speak each with himself in strangely tortuous and circuitous ways and yet imagine they have escaped the torment of being thrown back on their own resources. The first kind… has become rare; where it arises, in no matter how “un-spiritual” a form, witness is borne on behalf of the continuance of the organic substance of the human spirit. The second belongs to the inalienable sterling quality of “modern existence.” But real dialogue is here continually hidden in all kinds of odd corners and, occasionally in an unseemly way, breaks surface surprisingly and inopportunely—certainly still oftener it is arrogantly tolerated than downright scandalizing—as in the tone of a railway guard’s voice, in the glance of an old newspaper vendor, in the smile of the chimney-sweeper. And the third….


A debate in which the thoughts are not expressed in the way in which they existed in the mind but in the speaking are so pointed that they may strike home in the sharpest way, and moreover without the men that are spoken to being regarded in any way present as persons; a conversation characterized by the need neither to communicate something, nor to learn something, nor to influence someone, nor to come into connexion with someone, but solely by the desire to have one’s own self-reliance confirmed by marking the impression that is made, or if it has become unsteady to have it strengthened; a friendly chat in which each regards himself as absolute and legitimate and the other as relativized and questionable; a lovers’ talk in which both partners alike enjoy their own glorious soul and their precious experience—what an underworld of faceless spectres of dialogue! (pp. 37–38)


Not all existential philosophers, however, have considered human existence as fundamentally relational. Kierkegaard, generally considered one of the most individualistic existential philosophers, held that each person is a solitary being, with no connections to anyone or anything else apart from God (Guignon, 2002). Within every human being there is a “solitary wellspring” within which God resides, Kierkegaard (1992) writes, and he derides those who treat immortality or faith as socially shared affairs. Existential psychotherapists like Irvin Yalom (1980) have also placed more emphasis on the “inexorable aloneness” of human existence. He writes, for instance, that there exists “an unbridgeable gulf between oneself and any other being” (p. 355). Like Heidegger (1962), Yalom suggests that this aloneness becomes particularly salient when human beings face up to their own being-toward-death—a journey that they must take alone in which no other person can act as a substitute.


Health and Pathology


From an existential perspective, then, human existence is a freely choosing being-toward-the-future, but, in contrast to humanistic theorists (e.g., Rogers, 1961), existentialists have emphasized the anxiety and pain that such a way of being brings. This is for a number of reasons. First, as beings who are free to choose, there is always the possibility that we will make the wrong choices (Sartre, 1958). Hence, with freedom comes anxiety: Indeed, Kierkegaard (1980) suggests that the more human beings acknowledge their freedom, the more anxious they become. Second, with freedom comes responsibility toward others and the possibility of guilt (Buber, 1988). As Sartre intimates earlier, every decision human beings make not only affects themselves, but also everyone else around them. Third, there are the feelings of anxiety, restriction, unfairness, and loss that come from living within limitations—that human beings can never accomplish all that they want to, that they are caught in a web of dilemmas and tensions, and that their lives will come to a definite and inescapable end (Jaspers, 1932). Fourth, the intersubjective nature of human existence means that all meanings, goals, and most deeply held values are, ultimately, only social constructions, with no absolute or extrinsic validity (Heidegger, 1962). Hence, to be human is to be, ultimately, meaningless and “absurd” (Camus, 1955), yet also to be compelled to find meaning and purpose in life (Frankl, 1986).


Hence, from an existential standpoint, to be human is to experience such feelings as anxiety, guilt, regret, remorse, and despair. Yet, because such feelings can be so painful, it is argued that human beings will try to suppress them, and they do this by denying the reality of their existences (Sartre, 1958). Yalom (1980), for instance, argues that many people defend themselves against the reality of their mortality by pretending to themselves that they are so special that death could not possibly happen to them. Alternatively, he argues, they cling on to a belief that there is an “ultimate rescuer” for them—God, a parent, a doctor, or even a psychotherapist—who will somehow rescue them from the jaws of infinite nonexistence. Similarly, in an attempt to deny their own responsibility to choose, people may procrastinate (Yalom, 1980); become apathetic (May, 1953); act on whims and impulses (Yalom, 1980); or behave in fixed, compulsive, obsessive, or phobic ways. Delegating your choices to other people, institutions, deities, or things (e.g., tarot cards) may also be a means of trying to disencumber yourself of freedom (Yalom, 1980).


From an existential standpoint, however, when human beings deny the reality of their existences, they also deny their capacity to make the most of their lives. Delegating choices to others, for instance, may give individuals a modicum of comfort, but it also means that they are then less able to choose to do the things that they find most rewarding and satisfying. Similarly, though it may be less anxiety provoking for people to fantasize that they will live forever, it means that they are more likely to defer their enjoyment to some time in the future and less likely to make the most of their now. Moreover, if people are not facing up to the realities of their existences, they are less likely to be able to deal with the challenges that inevitably arise and find constructive solutions. A financially indebted individual, for instance, who throws his bank statement away every time it arrives, may experience a temporary sense of relief, but ultimately he is much less enabled to find a way through his problems. Finally, because the reality of existence does not go away, the defenses that human beings erect to protect themselves against it inevitably falter, such that existential anxiety and guilt become neurotic anxiety and guilt (Tillich, 2000). An individual, for instance, who convinces himself that he is too special to die, also knows at some level that death is around the corner. So he will need to shore up more and more his belief in his own specialness, become neurotically obsessed with his successfulness and more and more reactive to any suggestions that he is just a normal person.


From this perspective, mental illness arises when a person denies the realities of his or her existence. This bears some similarity toward both psychodynamic (Wolitzky, 2003) and cognitive (e.g., Beck, John, Shaw, & Emery, 1979) formulations. However, in contrast to a psychodynamic approach, the existential emphasis is on the denial of in-the-world givens, rather than intrapsychic, instinctual energies. In contrast to a cognitive approach (e.g., Beck et al., 1979), there is a particular emphasis on the denial, distortion, or deliberate misperception of painful realities. If, for instance, an existential psychotherapist was working with a hypochondriacal client, she may be keen to invite the client to explore what it means to be a person-who-will-inevitably die, rather than only helping the client to examine the kind of cognitive errors that may have led him to overestimate this possibility. From an existential perspective, when people are depressed, guilt-ridden, or anxious, it is because there is really something to be depressed, guilt-ridden, or anxious about, and it is the person’s attempts to avoid these feelings—rather than his or her invocation of them through irrational thoughts—that leads to more severe psychological disturbance.


A model of mental health and pathology toward the softer end of the existential continuum comes from those existential psychotherapists who are strongly influenced by Buber’s (1947, 1958, 1988) relational existentialism (e.g., Binswanger, 1963; Friedman, 1985; Laing, 1965; Mearns & Cooper, 2005; Trüb, 1964; Von Weizsäcker, 1964). Here, as with Sartre (1958) or Heidegger (1962), psychological difficulties tend to be seen as emerging from inauthentic modes of existing. However, because, from this softer position, human existence is fundamentally relational, to be inauthentic primarily means to live in isolation from your fellow human beings and community, cut off from the deep “soul-nourishment” that others can provide (Hycner, 1991, p. 61). In this respect, relationally orientated existential psychotherapists have argued that various forms of mental illness can be understood in terms of interpersonal detachment and alienation. With respect to psychotic hallucinations, for instance, Von Weizsäcker (1964) writes that:


[T]his delusion of a double is nothing more than the hallucinated restoration of a two-ness, after one has reached the unbearable loneliness. It is a representation of a misplaced synthesis of I and Thou, the cleavage of the I represents—for a moment—the relationship of the I to the Thou which has become unattainable. It is a substitute for the latter. (p. 409)


Whereas some existential psychotherapists, however, have attempted to understand mental pathology in existential terms, others have been much more critical of the whole notion of mental illness and disease. Coming from a perspective that is highly questioning of conventionally agreed truths, existential psychotherapists such as Laing (1967) have argued that mental illnesses, as defined by the DSM or ICD systems, are more a means of labeling, dismissing, and controlling those that deviate from socially agreed norms than a psychobiological reality. From this perspective, it cannot be assumed that someone who meets the conventionally agreed criteria for mental illness is necessarily living their lives in an inauthentic way. Indeed, it may be that the depressive who feels isolated, alone, and terrified of being insignificant is actually more honest about the nature of his or her existence than the advertising executive who believes his or her job of convincing people to buy soap powders is of profound meaning. In this respect, the authentic-inauthentic axis can be seen as a quite separate one from the mental health-mental illness one (as conventionally understood)—a disparity that has important implications for the practice of existential psychotherapy in a conventional mental health setting.


Furthermore, there are those existential psychotherapists who would eschew the notion of pathology altogether (see Cooper, 2003a)—seeing it as an unnecessary devaluation of certain ways of being. From this standpoint, all people are striving to do their best in their given circumstances, and there is little to be gained—and much to be lost—by labeling, a priori, certain ways of being as more dysfunctional or maladaptive than others.


Development of Difficulties


How do some people come to adopt a more inauthentic stance toward their being than others? This is a question that few existential theorists have attempted to address. As an approach that emphasizes human beings’ capacities to make choices toward their futures, there has been a wariness about asking why people behave in the way that they do. Indeed, the very question “Why?” invites the kind of causal hypothesizing that is the antithesis of an existential ontology.


From an existential perspective, however, it would still be legitimate to ask the question: How is it that some people choose to live in a less authentic way? Using the word choice, suggests that, from an existential perspective, this movement toward an inauthentic way of being is not seen as something that happens to an individual, but as something in which an individual has an agentic role. It is a meaningful and intelligible act, rather than a consequence of dysfunctional, random, or external mechanisms. Why is it that some people should make this choice? This is uncharted territory for existential theorists, but the analysis presented above points toward one central factor: For some people, the choice of authentically facing up to their existences may be particularly painful or discomforting. A number of reasons could be posited for this.


First, it may be that individuals inhabit, or have inhabited, a world in which it is particularly anxiety inducing to acknowledge their lived-reality. Individuals, for instance, who live in poverty-stricken, unsafe environments may be more inclined to take themselves away from this existence through drugs or chaotic behaviors than people whose environments are more benign. Along similar lines, Laing (1965) has argued that individuals who adopt a psychotic way of being do so as a reaction to patterns of family communication that are so distorted and disingenuous that the person can only feel safe by withdrawing in to an inner world of their mind, leaving behind an empty, depersonalized shell on the public plane. Similarly, for clients who have experienced sexual or physical abuse, an attempted withdrawal from an interrelational existence may be understood as a strategy to protect the self from a profoundly traumatizing world.


As in this latter example, an existential perspective does not in any way suggest that the past is irrelevant to how a person develops, nor does it propose that people are to blame for their own psychological misery. What it does suggest, though, is that people are never caused or made to be a particular way by their past experiences, but they have some choice and agency in relation to these givens. In this respect, it might be useful to think of an existential perspective as one that argues that people are informed by their pasts, drawing on these experiences to choose how to behave toward the future.


One particular type of world that, for many individuals, may dramatically reduce their desire to authentically acknowledge their lived-being is a world in which the person feels that they will be criticized, punished, or judged for experiencing things in the way that they do (Boss, 1963). A young man, for instance, who is told that it is sinful for him to feel attracted toward other men, or who is told that only females get upset and cry, may make considerable efforts to distort or deny these aspects of his experiencing. This is very much the developmental model put forward by the existentially and phenomenologically informed psychotherapist, Carl Rogers (1951, 1959), who argued that people may develop a concept of self that is radically at odds with their actual experiencing and that this serves to filter out undesirable and unwanted—yet nevertheless irrepressible—experiences.


A second reason why people may choose to hide from the reality of their lived-being is that they may have simply never learnt the skills or coping strategies to face it. A young person, for instance, who sees his or her parents denying their feelings of anxiety, not facing up to the death of loved ones, or turning to alcohol when life gets challenging, may come to see these strategies as appropriate ways of dealing with life’s difficulties. In contrast to a person-centered or humanistic standpoint (e.g., Rogers, 1959), existential psychotherapists do not assume that human beings are born with a natural tendency toward a more genuine way of being. Rather, existential philosophers like Heidegger (1962) have argued that human beings are born inauthentic—thrown into a social world that parades its values and meanings as truths—and can only later come to adopt more authentic stances.


A third possibility is that some individuals may be more biologically predisposed to react toward their world in anxious ways. Contrary to popular opinion, not all existential psychotherapists reject the role that biological factors may play in human development (e.g., Cooper, 2001) although, as with past experiences, these factors would be seen as informing and influencing a person’s choices rather than determining them. A person with a more labile nervous system, for instance, may experience greater levels of anxiety when stepping aboard an airplane and therefore may be more likely to restrict his or her desire to travel, but this biological given does not actually stop him or her from flying. There is still the possibility of choosing against your biological predisposition.


THEORY OF PSYCHOTHERAPY


Goals of Psychotherapy


At the most global level, the goal of existential psychotherapy can be described as helping clients to live more satisfying and fulfilling lives through facilitating their ability to live authentically.


As we have seen, however, what existentialists consider authentic is very much dependent on what they believe is the true nature of the human condition, such that the goals of therapy vary markedly from one existential psychotherapist to another. For an existential psychotherapist like van Deurzen (1998), for instance, who sees life as an inherent struggle, the aim of therapy is to help clients wake up from their self-deceptions and to bravely face their predicaments—to “stand naked in the storm of life” (Becker, 1973, p. 86)—so that they can live lives that are fuller, more intense, and more rewarding. For an existential psychotherapist like Frankl (1986), however, who sees human existences as fundamentally purpose orientated, the aim of psychotherapy is to help clients discover their true meanings and goals in life. Another perspective comes from those existential psychotherapists who start from the assumption that human existence is fundamentally relational (e.g., Binswanger, 1963; Friedman, 1985; Laing, 1965; Mearns & Cooper, 2005; Trüb, 1964; Von Weizsäcker, 1964). Here, the goal of therapy is less to help people stand naked in the storm of life, and more to help them open up to the beingness of others and their community. Finally, there are those psychotherapists at the more postmodern end of the existential continuum (e.g., Cooper & McLeod, in press) who, committed to valuing each client’s uniqueness, would be wary of setting any a priori goals for psychotherapy, even existential ones.


Assessment Procedures


Given the emphasis in existential thinking on the uniqueness of each individual being, existential psychotherapists—even those from the harder end of the continuum—have tended to be wary about adopting any standardized assessment procedures, particularly those of a diagnostic kind. From an existential perspective, each client’s way of being is unique, as is his or her psychotherapeutic wants, such that it makes little sense to try and assess them according to some predefined diagnostic criteria. Indeed, to the extent that a psychotherapist is working with a diagnostic category rather than the specific human being in front of him or her, existential psychotherapists would suggest that the assessment procedures could be counter-therapeutic.


This does not mean, however, that existential psychotherapists do not consider it valuable to assess and explore what clients want from psychotherapy. Indeed, given the teleological assumptions underlying existential thought (i.e., being is always being-toward-a-future), clients’ wants from the psychotherapeutic process might be considered a key orientating principle for the existential psychotherapeutic process (see Cooper & McLeod, in press). From this perspective, an essential element of early contact with clients is to try and clarify what it is that they want from psychotherapy and to explore with them whether the psychotherapy is able to help them achieve that. However, assessment is not something that the psychotherapist does to the client, but something co-constructed between them (Fischer, 1970).


Process of Therapy


Just as existential psychotherapists tend to be wary about predefining clients’ psychological difficulties, so they tend to be wary about predefining the particular paths that clients should, or do, take through therapy. From an existential perspective, the priority is to be responsive to the specific therapeutic processes of each client, rather than imposing on him or her—consciously or otherwise—a set of conventionally agreed expectations or norms (cf. Stiles, Honos-Webb, & Surko, 1998). Hence, the existential psychotherapeutic process tends to be characterized by a lack of formal structures and an openness to the spontaneous, creative, and unpredictable.


Nevertheless, the one structure that most existential psychotherapists would put at the heart of an effective therapeutic journey is a genuine human relationship between psychotherapist and client (e.g., Boss, 1963; Laing, 1967; Spinelli, 1997; Yalom, 2001). Laing (1967) writes:


Psychotherapy consists in the paring away of all that stands between us, the props, masks, roles, lies, defenses, anxieties, projections and introjections, in short, all the carry-overs from the past, transference and counter-transference, that we use by habit and collusion, wittingly or unwittingly, as our currency for relationships. (p. 39)


Drawing on the work of Buber (1947, 1958), existential psychotherapists such as Friedman (1985) and Cooper (Mearns & Cooper, 2005) have described this as an I-Thou, or dialogic, encounter, in which both psychotherapist and client are able to receive and confirm the otherness of the other, while also being willing to share the essence of their own being. In Bugental’s (1978, 1999) terms, it can also be described as a state of co-presence (Mearns & Cooper, 2005) in which both therapist and client are accessible to the other—willing to allow the other to matter, while also remaining expressive and willing to share themselves in the situation. More recently, Mearns and Cooper (2005) have described such an encounter as a meeting at relational depth, defined as: “A state of profound contact and engagement between two people, in which each person is fully real with the Other, and able to understand and value the Other’s experiences at a high level” (p. xii).


Given this emphasis on an in-depth, genuinely human encounter, existential psychotherapists such as Laing (1965), have placed particular importance on the psychotherapist’s willingness to engage with his or her clients in a spontaneous and unpremeditated way, as opposed to being restricted to external boundaries and rules (see Cooper, 2003a). Laing’s sessions, for instance, would regularly run over the therapeutic hour; and, like Spinelli (2001) and Farber (1967), sessions would sometimes take place outside of the consulting room (Burston, 1996). In valuing the spontaneity of the therapeutic encounter, Laing, like many other existential psychotherapists (e.g., Spinelli, 2001), also vehemently rejected the use of specific therapeutic techniques or tools—and would almost certainly have been horrified by the idea of manualized therapeutic practices, feeling that such premeditated strategies could only serve to impede the naturalness, spontaneity, and mutuality of a genuine human encounter.


This emphasis on being real in the therapeutic relationship means that many existential psychotherapists see psychotherapists’ self-disclosures as a legitimate and important part of the therapeutic relationship (see, in particular, Yalom, 2001). Psychotherapists, for instance, may be encouraged to be open about their feelings toward their clients, their understandings of the processes and aims of the therapeutic process, and about aspects of their own lives. Spinelli (2001) and Farber (2000) put particular emphasis on the value of psychotherapists disclosing to their clients their own feelings of vulnerability and uncertainty; for instance, letting clients know that they have struggled with some of the same mental health problems, or that they do not know how best to help them. Here, however, it should be emphasized that such self-disclosures, like any flexibility around boundaries, are only ever encouraged when they are in the service of the client (e.g., helping the client to feel less isolated in his or her difficulties or encouraging the client to take responsibility for his or her problems) and not to fulfill the psychotherapist’s own narcissistic wants.


Those psychotherapists at the softer, more relational, and phenomenological end of the existential psychotherapy continuum also place considerable emphasis on the importance of a warm and accepting relationship from therapist to client (Boss, 1963; Spinelli, 1992). In this respect, the existential model of a psychotherapeutic relationship that works shares many similarities with a contemporary emphasis on the importance of a strong therapeutic alliance—in which a collaborative, positive affective bond exists between therapist and client (Hovarth & Bedi, 2002)—as well as Rogers’ (1957) advocacy of a warm, congruent, and empathic therapeutic relationship.


Whether the existential psychotherapist’s primary emphasis is on being accepting of his or her clients or on being real with them, the hope is that, by the end of the psychotherapeutic journey, the client will have moved some way to being more accepting of and real with him- or herself. For those existential psychotherapists who equate authenticity with mental health—as conventionally defined (e.g., Yalom, 1980)—such a process also involves a movement away from mental illness; however, for those existential psychotherapists who see inauthenticity and mental illness as two quite separate dimensions, there is less of an expectation that psychotherapy will result in the client being cured of his or her mental difficulties. Moreover, as an approach that tends to posit that life is inherently challenging, difficult, and tension-ridden (van Deurzen, 2002), few existential therapists expect clients to come out of the psychotherapeutic process happy, resolved, and beyond their difficulties. As van Deurzen (2002) states, “There is no cure for life.” Rather, there is an expectation that life will continue to be challenging and difficult, but that the client will be more enabled to face it, to make the most of it, and to live the life he or she does have to the fullest.


Strategies and Interventions


Phenomenological Exploration


One of the principal strategies that existential philosophers have used to understand the nature of human being is Husserl’s phenomenological method, and for many existential therapists (in particular, Spinelli, 2005), such an approach is no less valuable in the therapeutic domain.


In practice, this means that the first step for many existential psychotherapists—particularly those at the softer, more phenomenological end of the existential continuum—is to try and bracket their theories, assumptions, interpretations, prejudices, and wants and to try and encounter their clients from a place of openness and naivety. Spinelli (1997), for instance, writes that therapists should adopt a stance of “un-knowing” toward their clients, holding in abeyance fixed beliefs, values, and assumptions—including existential ones—such that they can step into their clients’ lived-worlds and interpretations. Along similar lines, Cooper (Mearns & Cooper, 2005) writes that therapists should try to let go of their desires to do something to their clients—whether it is to make them better or to find solutions to their problems—on the grounds that such a focus can divert psychotherapists’ attentions away from what their clients are actually experiencing. Here, it should be pointed out that bracketing does not mean trying to get rid of all of your assumptions—clearly, from a postmodern perspective, such absolute objectivity can never be obtained—but it does mean trying to be aware, as far as possible, of what your assumptions are, such that therapists are more enabled to put these to one side and be more open to what the client is actually reporting.


The first stage of the psychotherapeutic process is thus for therapists to clear a space in their minds so that they can really listen and attune to their clients’ being (Mearns & Cooper, 2005). Although some psychotherapists may assume that listening is the most basic of psychotherapy skills, from an existential-phenomenological perspective, it is an art that can take a lifetime to develop (e.g., Moja-Strasser, 1996). For what is meant by listening in this context is much more than simply giving clients opportunities to talk, but attending to their being in an emotional, cognitive, and embodied way. Mearns and Cooper (2005) refer to this as a “holistic listening”—a “breathing in” of the totality of the client and a willingness to let that totality infuse the therapist’s being—and see it as an essential step in developing an in-depth and accurate understanding of the client’s lived-world.


Such a process of bracketing and listening leads to a second step in the phenomenological process—working descriptively (Spinelli, 2005). Here, the aim is to help clients describe, in ever-increasing levels of detail, their experiencing of the world—their thoughts, feelings, bodily sensations, and wants—such that they can develop an increasing awareness of their lived-reality. Cooper (2003a) uses the term unpacking to describe this process, likening it to the task of opening up boxes in an attic and laying out their contents for closer scrutiny. To a great extent, the essence of this process is for psychotherapists to bracket their desires to interpret or analyze their clients’ material and instead to focus on their clients’ experiences as actually experienced. If a client was talking about his fears of being abandoned by his boyfriend, the phenomenologically orientated psychotherapist may be less inclined to ask him about earlier experiences of abandonment, and more inclined to encourage him to explore that experiencing itself: How did he feel, for instance, when he heard that his partner was going out for the evening? And where did he feel that abandonment in his body? And what were the thoughts and assumptions going through his head?


Here, an existential psychotherapist would not be closed to also exploring a client’s past, but the focus would remain on an experiential exploration of this and its link to the present, rather than the positing of abstract, causal hypotheses between the former and latter. For instance, an existential psychotherapist might say something like: “I get a sense of how terrified you are of your boyfriend leaving you, and I wonder if this is because you know how painful such a loss can be”; but might avoid statements like: “The losses you have experienced in the past seem to have made you afraid of being abandoned.”


Within the existential-humanistic domain, this process of descriptive exploration, or unpacking, is sometimes referred to as inward searching (Bugental, 1981), and existential-humanistic psychotherapists have outlined a number of ways in which it can be facilitated. At the beginning of a session, for instance, a client may simply be invited to focus on his or her concerns (Schneider & May, 1995) and to free associate, following wherever his or her sense of concern may lead (Bugental, 1978). Other strategies that existential-humanistic psychotherapists have advocated to facilitate this descriptive inquiry include:



  • Asking clients direct questions like: “What does your inner experience tell you?” or “How does it feel when you say that?” (Schneider & May, 1995).
  • Inviting clients to be as detailed as possible in describing their experiences (Yalom & Elkin, 1974).
  • Inviting clients to express how they feel in the immediate moment (Bugental, 1999).
  • Encouraging clients to retell their experiences—on the principle that a person “almost literally cannot tell the same story twice in identical terms” (Bugental, 1978, p. 54).
  • Encouraging clients to speak in the present tense and use the pronoun I cussing themselves (Schneider & May, 1995).
  • Helping clients to label, and differentiate between, different emotions (Yalom, 1989).
  • Inviting clients to visualize, role-play, or actually try a particular scenario in the therapeutic meeting (e.g., making a dreaded phone call or expressing anger) and then reflecting on how that experience felt (Schneider & May, 1995).

Existential-humanistic psychotherapists may also encourage their clients to phenomenologically explore their bodily felt sensations (cf. focusing-oriented psychotherapy, Gendlin, 1996); for instance, by asking them “How do you feel physically right now?” (Bugental, 1981, p. 239), or by inviting them to attend to their bodily sensations. When Ruth, for instance, a client of Kirk Schneider’s, said that she felt something in her stomach, the following dialogue took place:


Schneider: Can you describe, as fully and presently as possible, what it is you sense there, Ruth? What do you feel around your stomach area?


Ruth: I have an image of being bloated, gassy, and disturbed. It’s like knives sticking in to me.


Schneider: That’s a pretty strong image….


Ruth: I feel like it’s messy down there, that it’s bubbling and teeming with stuff. It’s not all bad, though. It feels like it’s part of me, part of what I am in my depths. At the same time, I also feel sealed off from these churnings. It’s like I’m underneath them, looking up at them. It’s like I am unaffected by them.


Schneider: Do any images or associations come up around what you’re feeling right now?


Ruth: Well, it’s like I feel in a great deal of my life. I feel estranged, cut off. It’s like I’m cut off from the wild and expressive part of myself, the aspiring part. (Tears begin to form.)


Schneider: See if you can stay with that feeling, Ruth. (Schneider & May, 1995, p. 159)


As part of this descriptive exploration, clients may also be encouraged to articulate how they are feeling in the living moment of the immediate therapeutic encounter and particularly how they are feelings toward their therapists. Yalom (2001) writes, “I make an effort to inquire about the here-and-now at each session even if it has been productive and nonproblematic” (p. 72), asking questions like, “How are you and I doing today?” or “How are you experiencing the space between us today?”


Within the field of Daseinsanalysis (Boss, 1957, 1963, 1979), this descriptive, phenomenological way of working is extended to the exploration of clients’ dreams, and it serves a central role in the Daseinsanalytic process. When clients report dreams, they are encouraged to give increasingly detailed accounts of them, supplementing the first sketchy remarks with more refined statements. The initial goal is to “put together as clear as possible a waking vision of what actually has been perceived in dreaming” (Boss, 1977, p. 32). In facilitating this process, Condrau (1998) suggests that the therapist should ask the tripartite question: What? Where? and How? (i.e., where is the dreamer in the dream, what does he perceive and encounter, and how is this experienced). Daseinsanalyst and client may then go on to explore the analogies between this dream and the client’s waking life. A therapist may say, for instance, “In your dream, you only seem to experience your world as hostile and threatening, and I wonder if this is how you experience your waking world, too?” The emphasis is not on analyzing or interpreting the dream but on helping the client descriptively unpack the dreamt-experience, such that he or she can develop a greater understanding of how he or she experiences his or her world both in his or her sleeping and waking lives.


Challenge


For those psychotherapists toward the softer end of the existential psychotherapeutic continuum, this process of encouraging clients to explore descriptively their lived-worlds in a supportive and comparatively assumption-free environment may be the mainstay of the psychotherapeutic process. However, such a way of working is based on the assumption that clients are relatively able and willing to access the primary elements of their being. This assumption is consistent with a phenomenological outlook (e.g., Sartre, 1958; Snygg & Combs, 1949), which holds that the primary determinants of behavior are accessible to consciousness. However, in the existential field, there are also psychotherapists who hold a more psychodynamic position (e.g., Bugental, 1981; Frankl, 1986; Yalom, 1980), arguing that aspects of lived-reality are so anxiety generating that human beings will repress an awareness of these truths in their unconscious. From this position, gently encouraging clients to undertake a descriptive exploration may be insufficient because clients tend to resist an awareness of the more discomforting aspects of their lives. Hence, existential-humanistic psychotherapists and others at the harder end of the continuum have tended to suggest that more challenging approaches are sometimes required to help clients face up to the realities of their lives.


Schneider (2003) proposes two basic forms of resistance work: (1) vivification and (2) confrontation. Vivification involves heightening clients’ awareness of how they block or limit themselves, and consists of noting clients’ initial resistances (e.g., “You seem to go quiet every time I ask you about your marriage”) and then pointing out to them every time this resistances is repeated (tagging). Confrontation is a more direct and amplified form of vivification, pressing—gently or otherwise—clients to overcome their blocks. An example of this more challenging way of working comes from Yalom’s (1989) case of the “Fat Lady” in which he tries to help his client, Betty, acknowledge and communicate the genuine painfulness of her life:


Yalom:… I think you are determined, absolutely committed, to be jolly with me.


Betty: Hmmm, interesting theory, Dr Watson.


Yalom: You’ve done this since our first meeting. You tell me about a life that is full of despair, but you do it in a bouncy-bouncy “aren’t-we-having-a-good-time?” way.


Betty: That’s the way I am.


Yalom: When you stay jolly like that, I lose sight of how much pain you’re having.


Betty: That’s better than wallowing in it.


Therapist: But you come here for help. Why is it so necessary for you to entertain me? (Yalom, 1989, pp. 97–98)


A particular challenge in existential-humanistic psychotherapy is for clients to be real and present in the psychotherapeutic relationship (Bugental, 1978, 1999; Yalom, 2001). Here, as in the earlier example, psychotherapists may draw on their own feelings of disconnection from a client or boredom in the sessions to challenge their clients to meet them more fully.


Interpretation


Coming from a more psychodynamic standpoint, Yalom (1980), Bugental (1978), and other existential-humanistic psychotherapists may also use interpretation as a means of helping clients to identify the underlying wants, feelings, and beliefs behind their manifest behaviors. Interpretations can be described as “going beyond what the client has overtly recognized” (Hill, in Crits-Christoph & Gibbons, 2002, p. 287) and, as in psychodynamic therapy, may be particularly orientated around the psychotherapeutic relationship (Crits-Christoph & Gibbons, 2002). When his client, Ginny, for example, talks about feeling strangled by a female friend, Yalom (Yalom & Elkin, 1974, p. 61) suggests to her that perhaps she is feeling strangled by him, and goes on to say that she seems to be “harboring a murderous degree of rage and has to be terribly careful not to let any of it leak out.”


Education


Further toward the harder, more directive end of the existential therapeutic continuum, there are those practitioners who sometimes simply tell their clients what they think their existences are like or how they might be able to move forward. Van Deurzen (2002), for instance, argues that there is a place for therapists to bring their philosophical knowledge and personal understandings to bear on their clients’ difficulties, which from this more normalizing position are often of a transhuman nature, and likens the role of the existential therapist to that of an art tutor: someone who facilitates and encourages his or her students’ development, but who is also not afraid to share wisdom and insights. Similarly, one of the therapeutic strategies used by logotherapists is the appealing technique (Lukas, 1979), whereby the logotherapist simply suggests to their clients what the underlying meaning or reasons for their lives might be. Frankl (1986) describes the case of an obsessive neurotic who despaired so greatly over his illness that he was on the brink of suicide. In an attempt to reconcile the man with his neurosis, and knowing that the man was deeply religious, the therapist suggested to him that perhaps his illness was the “will of God”: “something imposed upon him by destiny against which he must stop contending” (p. 187). The psychiatrist went on to suggest that perhaps the man should try to live a life pleasing to God despite his illness. Frankl reports that these arguments produced such an inner change in the man that by the second therapeutic session he had, for the first time in 10 years, spent a full hour free of his neurosis.


As will be obvious to the reader, these harder, more didactic, and interpretative ways of working are at odds with the practices of bracketing and descriptive inquiry, as outlined earlier. Nevertheless, both ways of working are endorsed by psychotherapists who would identify themselves as existential, and this is why it is so important to think of this approach as a diversity of practices, rather than a single, unified way of working. It should also be remembered that, while the therapeutic strategies are very different, the aims are relatively similar: to help clients acknowledge, inhabit, and celebrate the realities of their existences. What differentiates these approaches is a belief about how able and willing clients are to do this for themselves.


Exploring the Givens of Existence


To this point, I have focused primarily on the ways in which existential psychotherapists help clients explore their issues and concerns, as subjectively understood and defined by the clients. As outlined earlier, however, at the heart of much existential philosophizing is the assertion that human existence is characterized by certain givens: for instance, a verb-like-ness or a being-toward-the-future. From this more modernist perspective, there are certain, predefined issues or concerns that psychotherapy should be helping clients explore. Yalom (1980) suggests four ultimate concerns: (1) death, (2) freedom, (3) isolation, and (4) meaninglessness, whereas Bugental (1981) posits six: (1) finiteness, (2) potential to act, (3) choice, (4) embodiedness, (5) awareness, and (6) separateness. Along somewhat similar lines, van Deurzen (2002) suggests that there are four realms of worldly being that clients should be encouraged to explore: (1) physical, (2) social, (3) psychological, and (4) spiritual.


At the softer end of the existential continuum, this may involve little more than a particular tendency to invite clients to unpack such issues as and when they emerge in the psychotherapeutic dialogue, or as and when the psychotherapist thinks that they might be relevant to the clients’ experiences. Toward the harder end of the existential continuum, however, there may be a greater emphasis on specifically challenging clients to face up to these givens of their being. Most simply, this might involve encouraging clients to stay with such feelings as anxiety, dread, or meaninglessness when they touch on existential issues. Here, Yalom (1980) writes of “nursing the shudder” rather than “anesthetizing it” (p. 166).


Within existential-humanistic psychotherapy, there is a particular emphasis on challenging clients’ to acknowledge the freedom, choice, and responsibility that they have in their lives (May & Yalom, 1989; Yalom, 1980; Yalom & Elkin, 1974). If a client claims, for instance, that she cannot leave her partner, she may be challenged to consider whether, in fact, it is more a case of her choosing not to. In the following example, Bugental (1981) challenges his client, Thelma, to see that she does have some power in a situation, even though she claims that she is totally powerless to stop her daughter developing a relationship with a boy of ill repute:


Thelma: I can’t do a thing, she’s going to go, and that’s it.


Bugental: So you decided to let her go with John?


Thelma: I haven’t decided. She’s the one who decided.


Bugental: No, you’ve decided, too. You’ve chosen to let her go with John.


Thelma: I don’t see how you can say that. She’s insisting.


Bugental: That’s what she’s doing; what you’re doing is accepting her insistence.


Thelma: Well, then I won’t let her go. But she’ll be unhappy and make life hell for me for a while.


Bugental: So you’ve decided to forbid her to go with John.


Thelma: Well, isn’t that what you wanted? What you said I should do?


Bugental: I didn’t say that you should do anything. You have a choice here, but you seem to be insisting that either your daughter is making a choice or that I am.


Thelma: Well, I don’t know what to do.


Bugental: It’s a hard choice. (p. 346)


Van Deurzen (2002), however, places greater emphasis on challenging clients to face up to the inevitable limitations, disappointments, and tensions of life. A client, for instance, who constantly yearns for the perfect relationship may be challenged to consider whether such perfection really is a possibility or whether deep down she knows that all relationships are suffused with imperfections. In an example from my own practice, some years back I worked with a young man who had come to psychotherapy to overcome the stress that he was experiencing in his new, high-powered, executive job. From first thing in the morning to last thing at night, he said, he was at work, or thinking about work, or worrying about work, and he really wanted to go back to having more things in his life, in particular an intimate and fulfilling relationship with his partner. In our first eight sessions or so, we explored his feelings of stress at work and his desire for a fuller life, but little seemed to change. Then we explored what he wanted from work, and it became apparent that he was desperate for more and more responsibilities and loathed the idea of cutting down on his work commitments. “You know,” I said to him around our 10th session, “I get a sense that you really want to spend more time with your partner and also do more things at work, and I just wonder if that is really possible. Maybe something has to give.”


A particularly challenging approach, Socratic dialogue (Fabry, 1980), is also used by logotherapists to help clients discover that their lives are meaningful or the particular meanings that their lives have. As with rational-emotive behavior therapy (Dryden, 1999), the therapist enters into a dialogue and debate with the client, and “poses questions in such a way that patients become aware of their unconscious decisions, their repressed hopes, and their unadmitted self-knowledge” (Fabry, 1980, p. 135). As an example, Frankl (1988) presents the case of a young man, suffering from states of anxiety, who was “caught and crippled” by feelings of meaninglessness and doubt. Frankl asked him what he did in response to these feelings, to which the young man replied that he sometimes listened to music. Frankl then asked the young man whether, when the music touched him down to the depths of his being, he still doubted the meaning of his life. The young man replied that he didn’t. Frankl (1988) responds: “But isn’t it conceivable that precisely at such moments, when you get in immediate touch with ultimate beauty, you have found the meaning of life, found it on emotional grounds without having sought for it on intellectual ones?” (p. 93).


Coming from a more psychodynamic position, existential-humanistic psychotherapists like Yalom (1980) may also interpret a client’s way of being in terms of an underlying anxiety about—and defense toward—the existential givens. Yalom suggests to a client who has advanced cancer, for instance, that his attempts to convince himself that he is tantalizingly close to being loved by beautiful women is a way of buttressing his belief that he is no different from anyone else, and thereby not mortally ill. For Yalom, analyzing the transference may also be an important way of helping clients to uncover their defenses against death. If, for instance, a client relates to her therapist as if she is the one person who can save her from destruction, then—in the right circumstances—it may be appropriate to suggest that this is a means of protecting herself from an awareness of her own mortality.


For those existential psychotherapists at the hardest end of the therapeutic continuum, it may sometimes be seen as appropriate simply to inform clients about the givens of their lives. Yalom (Yalom & Elkin, 1974), for instance, tells a client that the life she is leading is her one and only life and not a rehearsal, with no rain checks, replays, or possibilities of postponement.


Curative Factors


Given the existential premise that “there is no cure for life” (van Deurzen, 2002), existential psychotherapists tend to be wary about positing curative factors within the psychotherapeutic process. Nevertheless, from an existential standpoint, a number of factors can be considered central to the process of therapeutic change and development.


Healing through Meeting


“It’s the relationship that heals, the relationship that heals, the relationship that heals,” writes Yalom (1989, p. 91). As we have seen earlier, from a relational-existential standpoint, psychological difficulties are seen as emerging when people become disconnected from others and their communities. Hence, an in-depth meeting between psychotherapist and client can provide clients with an important bridge back to the inter-human life-space, a way out of their loneliness and isolation and toward a reengagement with others. And while a client’s contact with a psychotherapist may only be for an hour a week or so, this in-depth encounter may carry the client through the rest of his or her week as a torch burning inside the client that reminds him or her that he or she is not totally alone. Through such encounters, clients can also begin to hope that it is possible for them to establish more intimate and meaningful relationships with others: “Sometimes just the discovery that certain kinds of intimacy are possible is significant” (Ehrenberg, 1992, p. 67). Most important, perhaps, through establishing and experiencing in-depth relationships with their psychotherapists, clients may acquire the skills and awareness to develop more intimate, honest, and satisfying relationships with others.


Insight


The safety and security experienced by clients in this in-depth relationship—combined with the therapeutic processes of unpacking, challenging, interpreting, and educating—can also serve an essential developmental function in helping clients express, and develop a greater awareness of, their lived-existences. From an existential standpoint, the value of this insight is then that clients can make more informed and effective choices toward their futures. The more aware clients can become of their genuine wants, resources, or the things that are truly meaningful to them, the more that they can choose to act in ways that will fulfill these potentialities. Similarly, the more aware clients can become of how they tend to block themselves from getting what they want—or how they tend to achieve one want at the expense of other wants (Cooper, 2006)—the more they can stand back from these prereflective ways of choosing and make more informed and effective choices. From an existential standpoint, helping clients become more aware of the fact that they actually do have choices is also an essential part of enabling them to choose toward more satisfying and fulfilling ways of being.


At the same time, in contrast to more humanistic and phenomenological approaches, many existential psychotherapists (e.g., van Deurzen, 2002; Yalom, 1980) would argue that it is essential for clients to become aware of the limitations of their existences. Here, it is only through an honest appraisal of what they can really achieve in their lives, and through an acceptance of such realities as their mortality, aloneness, and ultimate meaninglessness, that clients can make the most of the existences that they do have.


Acceptance


Through developing a greater awareness of how they experience their world in a genuinely warm environment, it is also hoped that existential psychotherapy clients come to develop more caring, compassionate, and understanding relationships toward themselves. In this respect, the aim of existential psychotherapy is less to change clients’ primary emotions (e.g., feelings of guilt or anger; cf. emotion-focused psychotherapy; Greenberg, Rice, & Elliott, 1993) and more their secondary feelings about these emotions (e.g., feeling ashamed for feeling sad or feeling worried about feeling anxious). Drawing on Buber’s (1958) interrelational philosophy, Cooper (2003b, 2004a, 2005a) describes this way of being as an I-Thou attitude toward yourself—or what he calls an “I-I” self-relation stance—in which clients come to value, empathise with, and own all the different aspects of their being, seeing themselves as subjectively experiencing agents rather than causally determined objects.


Special Issues


Existential psychotherapy is by no means appropriate for all clients. In particular, as van Deurzen (2002) suggests, it is unlikely to be appropriate for clients—or mental health insurers—who are looking for swift and direct cures to psychological diseases. This is not only because such understandings—that there is a disease and that it can be cured—are likely to be antithetical to the existential psychotherapists’ own assumptions, causing serious ruptures in the therapeutic alliance. It is also because, for most existential psychotherapists, a key element of successful therapy is clients’ abilities to take an active and agentic role in the psychotherapeutic process, rather than waiting for something to happen to them.


In general, existential psychotherapy might be considered most appropriate for clients who:



  • Want, and are able, to take responsibility for their own psychological development.
  • Want to find out more about themselves, as opposed to primarily wanting symptom-relief.
  • Want a more intense, meaningful, and fulfilling life, as opposed to a more comfortable and happier one.
  • Value honesty over reassurance.
  • Have a critical, inquiring mind and a desire to think (van Deurzen, 2002), and see life as a complex and challenging undertaking with no easy solutions.
  • Question the status quo and have little desire to fit in and be “normal” (van Deurzen, 2002).
  • Face, or are concerned with, such existential issues as death, making choices, and meaninglessness.
  • Want to develop their relational being, establishing more intimate and rewarding relationships with others.
  • Distrust or dislike diagnostic systems and mental pathologization, and may have a questioning stance towards psychotherapy.

Culture and Gender


Aside from a handful of chapters in May and Schneider’s (1995) The Psychology of Existence, little work has been done on applying existential psychotherapeutic insights or practices to clients of different genders or cultures, and this is clearly a problematic omission. Nevertheless, as a psychotherapeutic approach which strives to value and nurture the uniqueness of each individual client and which tends toward problematizing and challenging mainstream norms an existential psychotherapeutic approach may be of particular value to clients from minority groups who are keen to maintain and enhance their identity rather than conform to the dominant cultural group. In its relational variant, an existential psychotherapeutic approach may also be of particular value to non-Western clients or to women who may place less emphasis on achieving autonomy, independence, and personal success and more with achieving interdependence, trust, and dialogue (cf. Jordan, Kaplan, Miller, Stiver, & Surrey, 1991).


Adaptation to Special Problem Areas


Given their tendency to emphasize nontechnical, authentic relating, existential psychotherapists have spent little time considering how the approach might be adapted to clients with different problems. Moreover, in its emphasis on the uniqueness of each individual client, existential psychotherapists would be wary of identifying specific needs or ways practicing for specific groups of clients. From this standpoint, to suggest that psychotherapists should do X with clients who have Y, or do Z with clients who have W, can only serve to take psychotherapists away from the particular person in front of them.


EMPIRICAL SUPPORT


Given its tendency toward anti-systematization, it should come as no surprise that there have been few attempts to validate empirically the effectiveness of existential therapeutic practice. Indeed, a review of the relevant research by Walsh and McElwain (2002) fails to cite a single study in which the existential approaches to therapy have been adequately tested. Nevertheless, there are in existence several collections of case studies of existential therapeutic practice that testify to the potential value that this approach can have, as shown in the Case Illustration later in this chapter.


At an indirect level, however, there is considerable evidence to support an existential approach to therapeutic practice. Walsh and McElwain (2002), for instance, point to the well-established research finding that “successful psychotherapy as understood by clients involves a process of self-reflection, considering alternative choices of action, and making choices” (p. 261). They also point to the ever-increasing body of research which suggests that a warm, empathic, and honest relationship is a key factor in the successfulness of therapy (see Castonguay & Beutler, 2006; Cooper, 2004b; Hubble, Duncan, & Miller, 1999; Norcross, 2002b), second only to client factors such as commitment, drive, and willingness to explore his or her experiences.


To a great extent, however, the question of whether existential psychotherapy is helpful or not, at the most global level, runs against the very grain of existentialism, with its emphasis on the uniqueness of each human being at each unique point in time. From an existential standpoint, a much better empirical question is “Which existential practices, with which clients, at which points in time, are of particular therapeutic value?” (cf. Paul, 1967). Earlier in the chapter, a number of hypotheses were put forward—for instance, that existential psychotherapy may be particularly helpful for clients who want to live fuller, rather than more comfortable, lives—and these could be subjected to empirical exploration. Certainly, such an approach would fit better with the current psychotherapy research zeitgeist, in which “Monolithic theories of change and one-size-fits-all therapy relationships are out” and “tailoring the therapy to the unique patient is in” (Norcross, 2002a, p. 12).


DESCRIPTION OF A SPECIFIC APPROACH TO TREATMENT


Although, as discussed earlier, the world of contemporary existential psychotherapy can be divided into four principal branches, the reality is that there are as many existential psychotherapies as there are existential psychotherapists. For each practitioner in the field, different personal experiences, different politics and values, different philosophical and psychological influences, and different goals and meanings in life all influence his or her way of working; although this may be true for psychotherapists in every orientation, the existential emphasis on nonconformity and individuality means that this approach is likely to be even more diverse than most.


What follows in this section and later is an attempt to outline and illustrate one very specific form of existentially informed psychotherapy that cannot be generalized much beyond my own practice. What I hope to show here, however, is how existential ideas, understandings, and ways of working can be incorporated into a psychotherapeutic approach that draws on a wide variety of other traditions, but in which the existential component plays a central part.


In recent years, I have come to realize that the keystone of my psychotherapeutic work is not existentialism, phenomenology, or any other psychotherapeutic orientation, but a set of values and ethical beliefs (Cooper, 2007). Coming from a progressive political background (Cooper, 2006), the underlying principle of my work is that, as a psychotherapist, I should relate to my clients in as respectful a way as possible, to see them as human beings who are as intelligent and as capable as myself and who are striving just as hard as I am to do the best in their circumstances. Such a value, perhaps, comes down to little more than the golden rule of doing unto others as we would like others to do unto us (my father would often quote this to me as a young boy). Moreover, as my interpersonal experience tells me, it is when I treat others with care and respect that I am treated in those ways. Even in terms of pure self-interest, a respectful attitude toward others would seem the most constructive one to take.


The rationale for working from this core value, however, is not only ethical—it is also clinical. From an existential standpoint, psychological difficulties emerge when people do not face up to the realities of their lived-existences and, as suggested earlier, one of the main reasons for this may be a fear of judgment and criticism from others if they do. Hence, an attitude of valuing and respecting clients—whatever they share or disclose—may be one of the most effective means of helping them to express and explore all aspects of their lived-being, as well as coming to relate to themselves in a more I-I manner.


Coming from this ethico-political background, I was drawn toward existential psychotherapy because of its deeply respectful understanding of humankind. With its emphasis on people’s capacities to choose, the primacy of their subjective experiences, and the intelligibility—rather than pathology—of their being, it seemed to me a highly dignifying foundation from which to relate to clients. Here, I was not the expert or the sage who could tell clients how to live their lives, but an equally uncertain and vulnerable human being in the room with them-albeit one with expert skills and knowledge—helping them to find their own answers to their questions.


As someone who was drawn to existential philosophy because of its progressive, humanitarian qualities, I quickly became critical of the harder, more elitist elements of existential thought. For me, statements like, “Human beings need to stand naked in the storm of life,” or “Psychological health comes from finding meaning in life” seemed a return to a therapist-knows-best position, in which the clients’ own understandings of life and what they want from it take second place to the psychotherapist’s ideologies. In the writings of May (1969) and other American existentialists, I also sensed an implicit privileging of independent, autonomous, and courageous ways of being over-relational, interdependent and fearful ones: a form of hierarchization that can be seen as legitimizing individualistic, conservative, male ways of being over collectivist, progressive, female ones (see, for instance, Jordan et al., 1991).


My personal philosophy and practice tends to be at the softest, most phenomenological, postmodern end of the existential continuum, strongly influenced by person-centered thinking and its emphasis on the importance of unconditionally accepting clients (Rogers, 1959). My assumption is less that human beings need to stand naked in the storm of life and more that they are doing pretty well just to keep their clothes on and not die of hypothermia. Although much of my work, therefore, focuses on helping clients to clarify, and make sense of, their being and also to make more effective choices toward their futures, there is also a substantial emphasis on encouraging clients to appreciate just how well they are already doing. Formal existential ideas are sometimes brought into the therapeutic work, but less in terms of how people should live their lives and more in terms of hypotheses that might help them to make sense of what they are experiencing. If a client is saying that she is finding it really difficult to choose between two men, I might reflect back that sometimes making big choices can be really scary. Along with helping the client to become more self-aware, there is also an implicit desire to depathologize the client and encourage her to take a more accepting and appreciative stance toward her own being: the I-I self-relational position.


Given that my interest in existential psychotherapy is based on a set of progressive, collectivist values, I have also been drawn toward the more relational elements of existential psychotherapy, as discussed earlier, in which psychological distress is understood primarily in interpersonal terms. Hence, as a practitioner, a central emphasis of my work is on creating the conditions in which relational depth with my clients (Mearns & Cooper, 2005) and on helping them to develop more effective means of communication with others: both through exploring the therapeutic relationship, through challenge, and sometimes through direct advice (cf. interpersonal psychotherapy; Stuart & Robertson, 2003). Developing the interpersonal phenomenology of Laing (Laing, Phillipson, & Lee, 1966), a particular interest of mine is on how clients can become trapped in vicious interpersonal spirals through misperceiving the experiences of others, as well as through misperceiving others’ perceptions of them (their “metaperceptions”; Cooper, 2005b). For instance, clients may act toward others in hostile ways because they assume that those others see them as vulnerable and weak (because that is how they see themselves), when those others see them as strong and aggressive. And because they are behaving in hostile ways to others who already see them as aggressive, those others may then respond to them in even more threatening ways, which may then make them feel even more vulnerable, ad nauseum. Hence, within psychotherapy, I often encourage clients to explore how they imagine others experience them or how they imagine I experience them, and I also share with them how I actually do experience them, to try and help them develop their “other-awareness” (cf. “self-awareness”).



CASE ILLUSTRATION: A GENTLE RE-HUMANIZATION
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Jul 12, 2016 | Posted by in PSYCHOLOGY | Comments Off on Existential Psychotherapy
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