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Essential Existential Therapy

The Development and Application of Existential Psychotherapy

by Olga Dyakova

“We respect the voyager, the explorer, the climber, the spaceman. It makes far more sense to me as a valid project- indeed, as a desperately needed and urgently required project for our time- to explore the inner space and time of consciousness”
– R.D. Laing, 1967

Questions and thought process characteristic of existentialism have been prevalent throughout human history, interwoven in literature and echoed throughout philosophies of the East and West since the time of the early recorded history. At its core, existentialism seeks to understand and grasp the essence of “being”, and how it affects us in our every day life. The importance of such inquiry can be evidenced by the fact that existential ideas “sprang up spontaneously in different parts of Europe and among different schools and has a diverse body of researchers and creative thinkers”(pg. 83, Schneider, 1995). Primordial topics such as death anxiety, meaninglessness, isolation, guilt, responsibility, as well as freedom and its limits have marked existential thought for centuries- giving rise to many disquieting questions which have helped shape the existential psychology that we know today.

Despite the fact that certain problems commonly occur across the span of humanity, variety in people’s unique reactions to these events calls for a psychological approach committed to understanding the tenets of such experiences. Analysis of the structure of human existence can help practitioners from gain a better understanding of human reality underlying moments of severe crisis- regardless of theoretical orientation. For this reason, it is unnecessary and inaccurate to view the existential approach as a new branch of psychology, nor even as its own system of thought. Existential therapy is not typified by a single technique, but instead focuses on integration of philosophical ideas of the past into an approach broadly applicable to the struggle humans face throughout their experiences; a struggle to define and come to terms with their own existence, apart from that of overall society, in a personally-meaningful way. This personal examination, also labeled the experience of an “existential crisis”, can come about in response to any elemental and deep-seated concern a human may face at a given moment (May, et. al, 1969). This paper will highlight how insights gained from timeless existential questions and concerns can be used to create “a structural foundation upon which other systems could rest” (May, et. al, 1969), and how an existentially-focused theoretical foundation can be very effective in applications of severe crisis.

Existential thought came to the forefront of psychological research in the early 1960’s, in response to “a growing awareness on the part of some psychiatrists and psychologists that some serious gaps exist in our way of understanding human beings” (reference 9, pg. 37).

The existential-analytic movement sought to change the fragmentation of the human being resulting from prevailing theoretical perspectives of the time; namely behavioral and psychoanalytic frameworks. Though theoretically sound, these perspectives left therapeutic practitioners with an incomplete understanding of their patients and what was occurring within the sphere of their existence. Therapists would respond to this inadequacy by refocusing on technical aspects and applications of their theories, rather than improvement of existing conceptual theories. As Straus, an existential psychology, humorously put, “unconscious ideas of the patient are more often than not the conscious ideas of the therapist” (reference 9, pg. 40) Many psychologists of the time who acknowledged the benefit of applying Freudian concepts in certain situations refused to apply these concepts blindly, in fear that doing so would inhibit possible formulation and verification of future theories. (reference 9, p. 40)

As humanistic perspectives also began to rise to popularity during this time, finding harmony with many existential ideas- “Existential Psychology” was co-authored by great humanistic psychologists such as Carl Rogers and Abraham Maslow in addition to Rollo May (the leading existential psychologist of the time). In this text, May shifted the focus of existential inquiry from vague philosophical concepts to applicable and testable psychological theory. Upon digging deeper into the implicit beliefs and assumption of mainstream psychological thought, May encountered a darker side of the field- where therapists were faced with an ability to “help the individual adjust and be happy at the price of a loss of his being” (pg 4, May, et. al, 1969). This can be traced many centuries back, where individuals unable to adjust to society were judged psychotic. May commented that this stigma had been extended, whether or not unknowingly, throughout our current generation. He also noted how the sole emphasis on individual behavior during the 70’s, led to a fragmented understanding of the individual, for “the human being is characterized by both inner experience and outer behavior; and the critical point is the relation between the two” (pg. 40, May, et. al, 1969) This book exemplified the notion of how important it was to fully explore the entire scope of existence as clients themselves experience it- and only this approach would yield maximum therapeutic effectiveness.

From this point, Rollo May began to explore the way therapists viewed patients- and noted an inevitable pattern resulting from the conceptual system put in place during the education phase every psychotherapist must go through. May inquired if therapists were “really seeing the patient as he really is, knowing him in his own reality; or are we seeing merely a projection of our own theories about him?” (pg. 83, Schneider, 1995)

Another poignant question posed by Rollo May is whether or not neurosis is “precisely the method the individual uses to preserve his own center, his own existence? The neurotic symptoms are ways of shrinking the range of one’s world so that centeredness of existence may be protected from threat” (pg. 75, May, et. al, 1969). Neurosis, according to the dominating mainstream application influenced by psychodynamic theory, was analyzed and defined as an individual’s failure to adjust. Yet, according to existential notions, a neurosis can be seen as an adjustment just as easily as a failure to adjust! Employing May’s example of two different definitions of “neurosis” may give us some insight on unexplainable and seemingly untraceable anxieties manifested in the majority of our population, which can ultimately be traced back to societal pressures on the individual to conform.

Another example of societal pressure on the individual can be seen within the working definition of compulsive action, seen “as the failure to pause between stimulus and response’- and professionalism is typically supportive of compulsivity as a tool to improve efficiency…therefore explaining some of these behaviors (Wedding, & Corsini, 2007, pg. 113). Compulsivity is perpetuated and valued by society in one aspect, then consecutively ostracized when taken out of context. May’s comparison between views on anxiety from a technical perspective (as viewed by Freud) with the ontological view of anxiety (as viewed by Kierkegaard) also illustrate how one behavior/feeling, viewed within different theoretical orientations can yield quite diverse observable results.

Along with the rise of existentialism, crisis theory also began to grow in popularity throughout the 1970’s- influenced by existential themes in intervention strategies (Lantz & Walsh, 2007). Currently, thee types of crises have been identified: (Lantz & Walsh, 2007) developmental (when naturally-occurring life events create large-scale changes), situational (when unforeseen and unpredictable make drastic changes) and existential (when inner conflicts occur related to life’s meaning or self-definition) (Lantz & Walsh, 2007). In the third stage of crisis resolution, occurring within 4 weeks of the crisis onset, crisis is either resolved negatively (with the use of unhealthy coping solutions) or positively (with healthy coping mechanism, successful management of stress and possibly even personal growth from experience).

A social worker named Naomi Golan (1978) emphasized that people were most receptive to receiving help during the most difficult period of a crisis, and that intensive, brief interventions were more successful when the client was motivated this way (Lantz & Walsh, 2007, pg. 3). Crisis theory underscores the importance of the third stage in crisis resolution, calling attention to a need for immediate intervention- and this idea meshes well with existential psychology, as highlighted by May’s moving quote in (Schneider, 1995, pg. 102), “the experience of degeneration and of chaos is, I hope, temporary, but this can often be used as a way of reforming or reorganizing ourselves on a higher level.” Lantz (Lantz & Walsh, 2007) noted that Existential intervention is usually considered more effective through long-term intervention, especially if the client is stuck in a frozen crisis pattern. This can occur if short-term intervention has failed, often because the client did not receive help immediately after they developed a particular problem (Lantz & Walsh, 2007)

Crisis intervention is utilized to combat problems such as: sexual assault, medical illness, combat stress, post-traumatic stress, migration, suicidal ideations, chemical dependence, personal loss, school violence, partner violence and family stress (James & Gilliland, 2001). This represents a strengths approach, as well as an existential one, because it underscores the possibility of client growth even in horrible situation. The social worker must build upon the client’s strengths in order to help them adapt to, and grow from, the experience. (Gazioglu, 2004)

A literature review of “Existential Themes in the Experience of Psychotherapists Working with Survivors of Torture” highlighted specific ways in which trauma results in the questioning of many existential concepts. Torture threatens the individual’s basic assumptions about the world, destroying meaning, sense of control and connection- effecting people on an existential level because it strips “all the meaning structures that tell us we are a valued and viable part of the fabric of life” (Greening, 1997, p. 125) Death remains a constant threat, isolation is experienced in the most extreme way, and life’s meaning comes under serious scrutiny when torture is involved. What is worse is that those who inflict torture utilize such tactics intentionally- and as May stated “Human-inflicted trauma can sever a person’s basic sense of relatedness (pg 19)”

For the above-mentioned reasons, Janoff-Bulman (1992) argued that individuals who work with survivors of trauma confront generally unquestioned and unchallenged fundamental about themselves and the world (Gazioglu, 2004)- also key to existential inquiry.
“Survivors who have experienced pain and suffering beyond their limits of endurance have lost their trust in others and in the world.” (pg 13, Gazioglu, 2004)

According to Amnesty International (1999), torture and other forms of ill treatment exists in “121 of the world’s 204 countries” (as cited in Gerrity et al, 2001, p. xiii Gazioglu, 2004) Yet even with such high numbers of torture survivors, only a few studies describe the experience of therapists who treat refugees who have been tortured or severely traumatized. (pg 7, Gazioglu, 2004) Existing research has demonstrated that the mental health problems experienced by refugees and asylum seekers have not been adequately addressed […], and […] both the therapist and the survivor {of torture} may experience “profound loneliness” in the face of no adequate description of pain (Dalenberg, 2001. p. 61).

Several patterns emerged throughout the literature review relating to the application of existential psychology. One such pattern is evident in how commonly existential theoretical orientation remains applicable in settings of immense distress due to its emphasis on personal growth and opportunity in the wake of tragedy. In accordance with Rollo May’s suggestion that: “the confronting of genuine tragedy is a highly cathartic experience psychically […] tragedy is inseparably connected with man’s dignity and grandeur and is the accompaniment […] of the human being’s moment of great insight” (pg. 83, May, et. al, 1969), review of the literature pinpointed the effectiveness of applying existential outlooks on common tragedies such as chronic illness, trauma (i.e. natural disaster, battle experience, or rape), torture, and suicidal inclinations. Severe illness that overpowers an individual and requires that they find a different outlook on life in order to make sense of the unforeseen and debilitating consequences of succumbing to influence of things beyond their power. Similarly, trauma theory suggests that severe trauma results in the destruction of the individual’s connections to self, others and the world. For example, many refugees are forced to relocate from their home countries, abandoning an entire world of meaning, which often results in a loss of context within which one can make sense of self.

Another pattern emphasized throughout all of the literature was the importance of attention to the immediate relationship between the client and therapist. Several texts implicitly stated the importance of taking the therapeutic relationship beyond simple observation and steadfast reliance on theory, while others explicitly warned that such processes would dehumanize the client and therefore be quite counter productive. May’s postulates regarding consciousness highlighted that “the tragic nature of human existence inheres in the fact that consciousness itself involves the possibility and temptation at every instance to kill itself” (pg. 82, May, et. al, 1969) He noticed how the struggle for expression of consciousness is perpetuated by our societal tendency to use social sciences to explain/label and set rules by which others conform and lose their individuality (May, et. al, 1969).

Another famous existential psychologist- Otto Rank- referred to such labeling behavior from a slightly different, albeit similarly disturbing, perspective. Rank used the term “partialization” to describe human attempts at breaking the world down into small, manageable and easy to understand doses. He also argued that this created a watered-down and somewhat shallow understanding of existence, contrary to the existential therapist’s goal to help their patient fully explore their “being” (pg. 113, Wedding, & Corsini, 2007).

A literature review of “The Psychology of Existence: An integrative, Clinical Perspective” also highlighted several setbacks to blind adherence to technical theory during therapy with the example of newly-graduated students entering the profession and their tendencies to rely on technique alone in order to elicit, process and respond to client input. Though this conceptual approach is understandable, it can be inhibiting to the therapeutic process to “apply their techniques and knowledge to clients instead of working with them in shared endeavors” (pg. 126, Schneider, 1995).

In “the Psychology of Existence”, Kirk Schneider proposed a way to synthesize to existing mainstream treatment strategies with existential assumptions and ideas (pg. 135, Schneider, 1995) He commented that the existential-integrative approach was not meant to be a imposed upon the client by the therapist, but rather serve as a catalyst for change to eventual client-based discoveries. This strengthens the key existential concepts of responsibility and free will- and how they apply to the client’s ability to make meaning out of their own life (pg. 135, Schneider, 1995).

Existential psychology provides 4 strategies with which psychology students can hope to alleviate some of these pressures, making the therapeutic interaction between client and patient much more meaningful. These strategies include: a focus on the client’s immediate experience, emphasis on the human capacity for choice, acknowledgement of the limits of action, and emphasis on phenomenological formulations (pg. 126, Schneider, 1995).

These ideas were mentioned yet again in a literature review of “Case Study of an Obsessive-Compulsive Personality” where Rollo May’s (1981) “conception of freedom as the pause between stimulus and response indicated significance in both the way therapists treat their patients as well as how patients themselves react…”(Wedding, & Corsini, 2007, pg. 113). Rushing into action without adequate time for pause and reflection to make a choice is something therapists are often guilty of, making them no less guilty of compulsivity. Yet a therapist acting in this way will have doubly-bad repercussions- for they will squelch their patient’s exploration of, and potential to, change.

Limitations of an existential approach to psychology are derived from the very same points considered strengths. Due to its philosophical roots, existential exploration of the self often requires the use of rather vague and subjective terms- such as “being” and “freedom”, for example. Through the use of such terms prompt greater self discovery- it is arguably difficult to empirically test such concepts and their influence in the therapeutic environment.

Several difficulties may arise in attempt to convey existential thoughts within a framework of conventional book thinking. First and foremost, the existential psychologist must remain focused on the immediate “here and now” relationship with their clients during therapy, yet must still manage to draw some conclusions and observations for the sake of their client record- which must be filed and presented to the supervisor for review. As suggested by James Bugental, “factual reporting”, which is typically the norm for any psychological assessment- is not as objective as we are led to believe. Bugental goes on to explain how “impersonal reporting implies a universal and ultimate reality which existentialism does not agree with, so the existential psychologist may have to report on their client in the form of a more “personalized document”’ (pg. 3, Bugental, 1965.).

A personal document is necessary for the therapist to convey to the reader the entirety of the patient-practitioner interaction- in contrast to the inadequate picture presented through sole objective observation. Viewing a client as “gangly and frightened looking, with perspiration dripping only gives you a fragmented view of the client, yet “the client walked slowly, head hung in a way that made them seem ashamed, and as they sweat, they wiped their sweat and looked away as if expecting an insult” is much more descriptive, yet less objective. This necessary connection between therapist and client is consistent with the therapists responsibility to analyze clients as a whole- thereby facilitating a fuller self-exploration; yet a relationship of this dynamic could be considered transferential, which many mainstream therapists believe should be avoided. Another related limitation cited by Bugental is that the process of thinking and writing the therapists partakes in which observing a client is a part of the therapist’s own continuous inquiry and discovery, therefore each clinical statement on the client becomes somewhat out-of-date immediately after noticed and is always subject to a new interpretation. Based on aforementioned research findings, however, it seems that these limitations are quite minimal in comparison to the far-reaching benefits of existential psychology.

In conclusion, as quoted by May in (Schneider, 1995, pg. 136), the main goal of existential psychology is “to set people free”- physically, cognitively, and emotionally (pg. 19). Freedom, as previously described, can be perceived as the ability to make choices within the limits of human existence- whether these limits are naturally-occurring or self-imposed. As people attempt to make sense of life and discern which choices contribute to their personal sense of meaning, a psychologist familiar with existential ideas can be a great asset in guiding client discovery and analysis of the exclusively human questions characteristic of this school of thought.

References:
Schneider, K. J. (1995). Psychology of existence an integrative, clinical perspective. New York: McGraw-Hill.

Bugental, J.F.T. (1965). The Search for Authenticity New York: Holt, Rinehart and Winston

Gazioglu, M. (2004). Existential Themes in the Experience of Psychotherapists Working with Survivors of Torture (Doctoral dissertation, California School of Professional Psychology, 2004). San Diego.

May, R., Allport, G., Feifel, H., Maslow, A., & Rogers, C. (1969). Existential Psychology (2nd Ed.). McGraw-Hill.

Wedding, D., & Corsini, R. J. (2007). Case Studies in Psychotherapy. Belmont: Brooks Cole.

Lantz, J., & Walsh, J. (2007). Short-Term Existential Intervention in Clinical Practice. New York: Lyceum Books, Inc.

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