Existential Psychotherapy

Existential psychotherapy originated in thework of four psychiatrists: Karl Jaspers in Germany, (1951, 1964), Ludwig Binswanger (1946, 1963) and Medard Boss (1957, 1962, 1979) in Switzerland, and Victor Frankl in Austria. Existential psychotherapy was introduced into the UK by Ronald Laing, but it fell to Emmy van Deurzen to create the Society of Existential Analysis, and the first training programme in existential psychotherapy in the UK, at Antioch University's London branch. Existential psychotherapy, as developed in the UK, is particularly appropriate to focal therapy and, with the shift from long-term to more focussed therapy in recent years, it has grown into a significant psychotherapy modality . Existential approaches to couples therapy, to the therapy of developmental disorders, and to group psychotherapy have been developed.

Emmy and Digby have recently presented existential approaches to reflective practice at the 2005 annual conference of the Society of Existential Analysis, and you can look at their presentations by clicking Emmy or Digby here (note you will need Adobe Acrobat to see these, which is downloable free from or click the icon).

If you are interested in reading more about the existential approach, click one of the links below.

• Fundamental ideas
• Meaning of life
• Existential anxiety
• Value
• Situations
• Limit situations
• Self-deception
• Time
• The transparent self
• Existential guilt
• Four dimensions of existence
• A dialectical approach
• Conclusion
• Bibliography

More information about existential psychotherapy at: Society of Existential Analysis

History

The philosophers who have most influenced existential psychotherapy were the 19th century philosophers of existence Kierkegaard (1844,1855) and Nietzsche (1882, 1883)and the methods they used were modelled on the phenomenological work of Husserl (1900, 1913) and Heidegger (1927,1954). Since then other therapists have developed new methods based on these early attempts as well as on the philosophical works of existentialist, structuralist and post-modern philosophers such as Sartre (1939,1943), de Beauvoir, Camus, Merleau Ponty, Levinas, Derrida and others. Out of this wealth of theoretical background and early clinical work a myriad of therapies have emerged. Some therapies like the person-centred approach or Gestalt psychotherapy are to some extent rooted in this existential thinking. But the practitioners who have really made a significant effort to base therapy and counselling in philosophical considerations rather than in restrictive psychological models, are people like Frankl (1946, 1955, 1967), May (1958, 1969, 1983), Laing (1960, 1967), Szasz (1961, 1965,) and Yalom (1980, 1989, 1996). Recently the approach has been intensively developed in the UK, mainly through the publication of Existential Counselling and Psychotherapy in Practice (van Deurzen, 1988, 2nd edition 2002) and publication of subsequent books (van Deurzen, 1997, 1998) and also by my initiating the founding of the Society for Existential Analysis in 1988 with the support of colleagues from the Philadelphia and Arbours Associations. The Journal of the Society has gone from strength to strength and is an important international voice in the field of psychotherapy, as is the work of the editors who have given it much of their time, Simon Du Plock (1997) and Hans Cohn (1997).

In terms of training much has happened in those past twenty years as well. After setting up the first University based psychotherapy training in existential counselling and psychotherapy for Antioch University in London in 1982 I developed this into the School of Psychotherapy and Counselling at Regent's College, which has trained many practitioners over the years. After my departure from the College in 1996, I founded the New School of Psychotherapy and Counselling, which is entirely devoted to the training of existential counsellors and therapists and which is validated by the University of Sheffield. Establishing the approach in the UK has taken a long time, but now there is a new generation of new practitioners who have become teachers in their own right and the existential approach is firmly on the map. Other courses in the approach can for instance be found at Brighton and Surrey Universities and in a number of Colleges across the country.

Fundamental ideas.

There are many differences of opinion between various practitioners and authors over what existential psychotherapy consists of. This diversity and ongoing debate is one of the strengths of the approach. Some practitioners who claim the existential label however seem to disagree with the most fundamental existential ideas. An approach can not be truly existential unless it takes into account the cultural, social, political and ideological context of a person's existence for instance. An existential approach is an approach that explores the human condition and tries to capture and question and individual's experience of it. It aims at clarifying and understanding personal worldviews, values and beliefs and it makes explicit what was previously implicit and unsaid. Its practice is primarily philosophical and seeks to enable a person to live more deliberately, more authentically and more purposefully, whilst accepting the limitations and contradictions of human existence. It is essentially about investigating human existence through the particular preoccupations of one individual and this has to be done without preconceptions or set ways of proceeding. It is certainly nothing like the magical make-believe of the Dumbo school of thought that Spinelli described in a recent article in this Journal (Spinelli, 2001). The existential counsellor or therapist needs to come to the sessions with complete openness to the individual situation and with an attitude of wonder that will allow the specific circumstances and experiences to unfold in their own right. Assisting other human beings in understanding their own life in a genuine and meaningful manner is a serious matter. Each and every discovery is personal and unpredictable. We can however distinguish a number of themes that will often emerge in this process.

Meaning of life

According to Heidegger the most fundamental philosophical questions are: 'Why is there something rather than nothing?' and 'What is the meaning of being?'. We do not actually know the answer to these questions, but most people sooner or later ask them. When people wonder what it is all good for and they cannot find a satisfactory answer for themselves they may come to a counsellor or a therapist. But in actual fact such doubts about the meaning of life are the beginning of all philosophy and should not be confused with pathology. Doubt and wonder enable us to rediscover the miracle of being. Once upon a time the meaning of life was given by religion or by social rule. These days meaning is often looked at in a far more sceptical manner (Tantam, 2000). It is therefore not surprising that people can find themselves in what has been called a vacuum of meaning (Frankl 1946,1955). The experience of meaninglessness becomes a major problem in many people's lives and it may lead to a number of concrete difficulties, which may look like personality problems or other forms of pathology. We can only engage in discussions about meaning if we have been willing to question our own lives and can recognize that anxieties and doubts about meaning do not have to be equated with personal pathology or mental illness (Szasz 1961, 1965, 1992).

It is by no means easy to be truly available to help others in finding meaning in their lives when their existence is in crisis. The meaning of life is never given and can not be transmitted unless a person is willing to search for it independently. Phenomenologists recognized that meaning making is one of the defining characteristics of human consciousness. Logotherapist Frankl (1946) spoke of three sources of meaning. Firstly through taking from the world what is there, learning to savour and appreciate what is already given to us, as in aesthetic enjoyment of nature or the pleasures of the senses. Secondly to give to the world and add new enjoyments to it through acts of our own creativity and by giving to others in this way as well. Thirdly by suffering, which is to endure the harsh conditions we may be exposed to. If there is no alternative to our suffering, it is always possible to find an attitude of human dignity by enduring the hard labour, pain and disappointments, Frankl argues, even when we have to face up to extremes of torture and deprivation.

Existential anxiety

The experience of meaninglessness and the creation of meaning are closely related to the experience of Angst or existential anxiety. This occurs against the backdrop of the personal realization that I am ultimately alone in the world and that I have to contend with my mortality and other limitations, taking responsibility for myself in the face of endless challenges and confusions. This crisis of meaning was first described by Kierkegaard (1844, 1855), who thought that it was a great deal preferable to begin to feel anxious about life and question it, rather than to live in the despair of those who deny the need to think for themselves. Kierkegaard thought that human beings would only gradually become capable of such questioning. For the process of thinking alone plunges us into Angst, or existential anxiety, which was likened by Kierkegaard to a dizziness of freedom. He thought that experiencing Angst was the sine qua non of us assuming our responsibility as individuals and that without it we could never come face to face with the demands our life makes on us.

Anxiety or Angst is a core concept in existential counselling and therapy, for it is seen as the basic ingredient of vitality. Learning to be anxious in the right way, i.e. not too much or too little is the key to living a reflective, meaningful human life. As Kierkegaard put it:

Whoever has learnt to be anxious in the right way has learnt the ultimate. (Kierkegaard 1844:155)

Anxiety has to be distinguished from fear. The former is a generalized feeling of Unheimlichkeit (Heidegger 1927), of not being at ease, or at home in one's world, whereas the latter has a concrete object. It is anxiety that allows us to define ourselves as a separate person and to become responsive and responsible as well as aware and alert. Although we may become overwhelmed with anxiety, so that it becomes counterproductive, on the whole anxiety is to be seen as a positive breakthrough towards the goal of living fully.

Values

It is hard enough to find your way in the world at the best of times, but when you start to live in openness to your anxiety, it is easy to lose your sense of direction. Moral and ethical issues are increasingly obscure in the world we live in today. It can be helpful to turn to Nietzsche's challenge (Nietzsche 1883) that we should re-value all values. He insisted that our thinking had gone astray and that much that people took for granted had to be reconsidered. He thought it crucial to consider afresh what a good human life consists of. This leads to noticing with phenomenologists such as Husserl (1900, 1913, 1929) that human consciousness is essentially transparent and in this sense is always and necessarily connected to a world. It is never independent and always has an object. As we are non-substantial, transparent beings we cannot but reach out to a world. We are always in relation. Through us the world comes to light. We always, think, do, desire, imagine something. There always is some contents to our mind. It is possible to set aside our automatic ways of intending things and judging things and take heed of our tendency to do so. We can learn to be disciplined about our intentionality and through the phenomenological reduction question all the automatic judgements we normally take for granted. Husserl called this process 'coming to the things themselves' and it is often referred to as the epoché or suspension. It consists of putting our usual assumptions about the world in brackets. This does not mean that we get rid of them or pretend they do not exist, but rather that we deal with them separately so that we can describe the situation, object of our attention or other person we are dealing with fairly and as it really is. To make oneself consistently query one's assumptions about the world and reconsider it with a cleared attitude of openness is obviously extremely relevant to the practice of psychotherapy. Existential therapists and counsellors learn to have a phenomenological attitude and to set aside their assumptions about everything, in order to look at their values and those of their clients in recognition of their bias.

Situations

When we do this we discover immediately that people are always connected to the world in a number of concrete ways. Heidegger (1927) in this context spoke of our 'thrownness'. He said that we are always thrown into a world that is already there to start with and into which we simply get inserted. It is important to recognize the factual situations that we are confronted with. We are part of a certain culture, a certain environment with a particular climate and history, a certain society and a specific situation. It is only within the givens of that situation that we can exercise our own choices. Sartre (1943) called this our facticity and he recognized that we can never release ourselves from this, even though we can choose our position in relation to it. In terms of psychotherapy it also means that it may be necessary to look at people's problems in a structural way. Instead of seeing everything as the person's psychological, emotional or internal problem, difficulties can be seen as part of an overall situation. Context is crucial and has to be taken into account.

Limit situations

Of all the situations in which we can find ourselves there are certain ones that are irrevocable. These situations have to be accepted and worked with. We cannot avoid them or overcome them: we have to learn to live with them. Heidegger emphasised the importance of death as a marker of our finite nature. Death in this sense is not to be taken as something happening to us at some point later, but as something that is relevant to us right now. The realities of our mortality and of our incompleteness have to be faced for us to become aware of and true to our nature, which is to be finite. Heidegger considered that the reality of our death is that it completes us. The recognition of the inevitability of death gives us a certainty that nothing else can give us. The fear in the face of death allows us to claim back our individuality, our authentic being, as we are inevitably alone in death and find ourselves much sobered and humbled by the knowledge of our mortality. Death, according to Heidegger:

...amounts to the disclosedness of the fact that Dasein exists as thrown being towards its end. (Heidegger 1927:251)

In other words: death is part of me and to accept my living towards this end gives my life back to me in a new way.

Jaspers (1951, 1971) spoke of limit situations as those situations which define our humanity. Sooner or later we inevitably come up against guilt, death, pain, suffering and failure. The philosophical take on this is that it is more helpful to encourage people to come to terms with some of the inevitable conflicts and problems of living than to help them cover them up. Limit situations are what bring us in confrontation with ourselves in a decisive and fundamentally disturbing way. They evoke anxiety and therefore release us from our tendency to be untrue and evasive about ourselves and our lives.

Self-deception

Sartre was particularly adamant that as human beings we try to pretend that we are solid and definite in the way that objects are. People do not like to face up to their fundamental nothingness and mortality. We think we can pretend to be like a stone or a solid thing, but in fact in doing so we are deceiving ourselves, reinventing ourselves in bad faith (Sartre 1943). To be in bad faith is an almost unavoidable state of play for human beings as we seem to find it particularly difficult to face up to the implications of our freedom as consciousness. One of the objectives of human living is to become increasingly aware of our ability to choose to live deliberately rather than by default and to diminish the extent to which we seek to tell ourselves false stories about ourselves. Sartre said that the only choice we do not have is not to choose because not to choose involves a choice as well.

In fact we are a freedom which chooses, but we do not choose to be free. (Sartre 1943:485)

The coward is fulfilling the project of cowardice, in the same way in which the hero is fulfilling the project of heroism. They can both either choose to take responsibility for their choice or pretend that it just happened to them and is not open to question.

Heidegger saw the existence of other people, with whom we are fallen into a world where the anonymous 'They' in our own mind decides about our actions and our identity as the major obstacle to authenticity. He recognized, as Sartre did, that human beings are condemned to living inauthentically for much of the time, but that they can nevertheless aim to retrieve themselves from inauthenticity. It is the anxiety of your possible death and your discovery that you are alone in the face of your own fate and destiny that allows you ultimately to take yourself seriously and affirm yourself resolutely as an individual facing death.

Time

This is when it also becomes possible to become more aware of the dimension of time, which is a crucial category of human living. It is always today and not tomorrow or yesterday. I am always no longer and not yet. We orientate ourselves in relation to the various ways in which we stand out in time. Our lives are a constant process of transformation that we cannot stop. Heidegger spoke of the three ec-stasies of time (Heidegger 1927:329), which are the ways in which we stand out in the past, in the present and in the future. We go back to ourselves in terms of remembering the past. We let ourselves be encountered by the world in the present and we reach out towards ourselves in the future. All of our actions are full of the awareness of temporal change. There is decay and development around us. Life consists of movement, transformation and action. All of these are only possible in time. My existence is historic. It creates a story. How I create this story is of utmost importance. Existential psychotherapy is about retracing the story and reorienting a person in time.

The transparent self

The way in which I tell my story is the way in which I create a self. Existential philosophy does not posit the notion of a fixed and determined self. There is no such thing as an essential solid self, only intentionality and being in the world. Sartre used to say that existence preceded essence. I come into the world first and exist and only after that do I create a self for myself out of my actions. The self is a window on the world and out of our living in time and standing out in the world we become what we are. Sartre went as far as to say that people were the sum of their actions. Therefore the choices we make are constitutive of the sort of person we become. We are constantly in the process of creating a self, yet when we try to capture this self, we realize it is as if we were trying to catch our shadow: it moves away from us and changes as we try to fix it. We cannot be a definitive something. Our stories change as we live and so we are changed too. Any image we create of ourselves is in a sense a lie: it never tells the full story about who we are or could be. We have to re-create ourselves every day and can never really take anything for granted, nor will we ever be all that we could be.

Existential guilt

Most of us will therefore have a frequent sensation of unease with ourselves. The awareness that we are not true to our full human ability and that we live inauthentically will lead to the experience of existential guilt. In existential guilt we hear the voice of our conscience and this must be taken extremely seriously. We are not guilty because we have fallen short by other people's standards or because we have behaved badly, but simply because we fall short as human beings. It is important to note that most existential philosophers assume that human living will inevitably expose us to falling short and therefore to feeling existential guilt. We are always indebted to life. We are always capable of being more alive, more open, more true to the potential of human consciousness than we actually are. We are therefore condemned to feel existential guilt, as we are condemned to feel existential anxiety; largely because we are, as Sartre said, condemned to be free.

Four dimensions of existence

Systematic descriptions of human experience have outlined four dimensions on which we exercise our freedom. Heidegger spoke of the different dimensions as those of earth, world, man, and gods (Heidegger 1957). Binswanger (1946,1963) spoke of the Umwelt (environment), Mitwelt (world with others) and Eigenwelt (personal world), whilst a spiritual dimension (Uberwelt) is also implied in his work (van Deurzen 1984). In essence philosophers have recognized that human experience is multiple and complex and takes place on a number of different levels. Firstly there is our involvement in a physical world of objects, where we struggle between survival and death. Secondly there is our activity in a social world of other people, where we struggle with the contradictions between our need to belong and the possibility of our isolation. Thirdly there is a personal dimension where we grapple with the tension between integrity and disintegration. Finally there is a spiritual dimension where we seek to find meaning against the threat of meaninglessness. On each of these dimensions we have to learn to stand in the tension between opposites and hold the paradox, discovering that we cannot have life without death, love without hate, identity without confusion, and wisdom without doubt. As Paul Tillich once said:

The courage of confidence takes the anxiety of fate as well as the anxiety of guilt into itself (Tillich 1952:163).

A dialectical approach.

Approaching psychotherapy from an existential perspective is to see that a dialectical process manages all these tensions of human existence. Conflicts are constantly generated and then overcome, only to be reasserted in a new form. Paradoxes are inevitable and life flows out of contradictory forces working against and with each other. The existential psychotherapist has as primary task to recognize together with the client the specific tensions that are at work in the client's life. This requires a process of careful scrutiny and description of the client's experience and a gradually growing familiarity with the client's particular situation and stance in the world. To understand the worldview and the states of mind that this generates is to grapple with the way the client makes meaning, which involves a coming to know of clients' values and beliefs. The particular circumstances of the client's life are recognized, as is their wider context. The psychotherapeutic process of existential therapy is then to elicit, clarify and put into perspective all the current issues and contradictions that are problematic. Part of the work consists in enabling the client to come to terms with the inherent contradictions of human living. Another part of it is to help clients find a satisfactory direction for their future life with a full recognition of the paradoxes that have to be faced in the process. Ultimately the therapeutic search is about allowing the client to reclaim personal freedom and a willingness and ability to be open to the world in all its complexity. Authentic living with courage (Tillich 1952) and in humility would be a suitable existential objective. Learning to reflect for oneself and communicate effectively with others is another (Buber 1923, 1929). As mentioned before existential psychotherapy can take many different shapes and forms, but it always requires a philosophical exploration of what is true for the client. When this exploration is conducted satisfactorily and fully it often leads to a greater recognition of what is true for human beings in general, affording the beginning of a genuine philosophical exploration, which is meaningful in itself and which may make it easier to tackle life's inevitable darkness and adversity.

Conclusion.

Existential therapy is a serious, deep and far-reaching enquiry into what it means to a particular person to be a human being. It involves an often-painful process of squarely facing up to those things that are ordinarily avoided and evaded. Paradoxically such a process can bring great strength and unexpected joy. Existential work is not for the fainthearted and it may sometimes consist of encouraging rather than soothing anxiety and guilt. The essence of the existential approach is to deflate our human vanities and remember that at the end of all our worldly adventures and preoccupations we are born to die. Lots of good therapists from different orientations understand about existential issues, but very few have investigated the philosophical dimension of the subject in any great depth. Training in existential therapy and counselling requires students to thoroughly familiarize themselves with the philosophical investigation of human living, to practice the application of such ideas by intensively supervised philosophical therapeutic practice and from having a deep and real understanding of their own experiences of crisis and distress, through their training analysis. It is a remarkable fact that those who come for existential training tend to have varied and often-intense life experiences behind them. The approach just does not make sense unless you have first come to find out a bit about life the hard way and quite by yourself.

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Bibliography

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Click here for Emmy and Digby's lectures at last annual conference of Society for Existential Analysis