iPsychology

Existential Therapy

The father of American Existential Psychotherapy is generally considered to be Rollo May. Author of such works as Love and Will, The Cry for Myth, and Freedom and Destiny, May was heavily influenced by the writings of the philosopher/theologian Paul Tillich. In developing an existential approach to therapy, May was also influenced by many of the existential philosophers such as Kierkegaard, Nietzsche, and Heidegger.

Existential psychotherapy is a powerful approach to therapy which takes seriously the human condition. It is an optimistic approach in that it embraces human potential, while remaining a realistic approach through its recognition of human limitation. Falling in the tradition of the depth psychotherapies, existential therapy has much in common with psychodynamic, humanistic, experiential, and relational approaches to psychotherapy.

Yalom, who was influenced heavily by May, is one of the great organizers of existential theory. In his book, Existential Psychotherapy, Yalom (1980) organized the breadth of existential theory into four major themes:

• Death
• Freedom (& Responsibility)
• Isolation
• Meaninglessness.

According to Yalom, these four existential realities are the root of most psychological problems and have no ultimate answers. While other existentialists may be more optimistic about the ability of people to find answers to these questions, it is generally agreed that these four issues are central to the human experience.

Another gift of Yalom is his writing. Both May and Yalom were very talented at being able to take abstract, difficult theory and write about it in a language which is much more understandable than many of the other existential writers. While many people are easily intimidated by existential theory, May and Yalom were able to demonstrate that it is accessible and applicable without needing to wade through the often obtuse writings of many existential scholars and practitioners.

In addition to writing one of the most significant texts on existential theory, Yalom added two fictional novels, When Nietzsche Wept and Lying on the Couch. These works are both exceptional fiction and also insightful psychological writing which illuminates existential and psychoanalytic theories. Perhaps Yalom's greatest contributions were his three book which offer case examples of existential therapy. These were written in a way to be beneficial both to therapists and clients and accomplish both very well. His first book of this nature, Every Day Gets a Little Closer: A Twice Told Therapy, was written with a former client, Ginny Elkin. The book contains the journal of Yalom and Elkin during from the therapy process allowing the reader to get a glimpse of both of their interpretations of the therapy process. The next two, Love's Executioner and Mama and the Meaning of Life, were written by Yalom and based primarily off people he worked with during his career, although a couple of partially fictionalized tales are also included.

The purpose of the Existential Psychotherapy Center of Southern California is to provide a structured professional training program where distinguished and diverse existentially-oriented scholar/practitioners share their unique clinical experience, knowledge and wisdom. The center is open to advanced graduate students, interns, psychological assistants, as well as fully licensed and seasoned psychologists, psychiatrists and other psychotherapists desiring deeper exposure to the philosophical tenets and formal training in the clinical application of existential psychotherapy. The Existential Psychotherapy Center of Southern California is committed to the theoretical and practical reconciliation of psychoanalytic, Jungian, psychodynamic, cognitive-behavioral and even psychopharmacological therapies with an existential orientation to treatment. This year, in Los Angeles, the EPCSC is offering professional training seminars in the theory and practice of existential therapy.

Existential psychotherapy is based upon the principles of psychodynamic therapy, humanistic and existential psychology, the latter being a movement with roots in the existential philosophy and writings of Heidegger, Husserl, Dostoevsky, Kafka, Camus, Kierkegaard, Nietzsche, Sartre, and others. During the mid-twentieth century, pioneering European clinicians like Otto Rank, Karl Jaspers, Medard Boss, and Ludwig Binswanger were among the first to apply existential principles to the practice of psychotherapy, followed prominently by Viktor Frankl (Vienna), R.D. Laing (London), Rollo May (pictured here) and Irvin Yalom (United States).

Existential psychotherapy is often misperceived as some morbid, arcane, pessimistic, impractical, cerebral, esoteric orientation to treatment. In fact, it is an exceedingly practical, concrete, positive and flexible approach. At its best, existential psychotherapy squarely and soberly confronts the "ultimate concerns" (Tillich) and sometimes tragic "existential facts of life": death, finitude, fate, freedom, responsibility, loneliness, loss, suffering, meaninglessness, evil and the daimonic (May and Diamond). Existential psychotherapy is concerned with more deeply comprehending and alleviating as much as possible (without naively denying reality and la condition humaine) pervasive postmodern symptoms such as excessive anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair, depression, guilt, anger, rage, resentment, embitterment, purposelessness, madness (psychosis) and violence as well as promoting the meaningful, life-enhancing experiences of relationship, love, caring, commitment, courage, creativity, power, will, presence, spirituality, individuation, self-actualization, authenticity, acceptance, transcendence and awe.

As consumers are increasingly confronted with the very real limitations of what managed mental health care, ever-briefer therapy and ubiquitous psychopharmacology can provide (see my prior post), existential psychotherapy is enjoying some resurgence. Existential psychologist Rollo May (1986) warned, whenever you perceive a person merely as a particular diagnostic disorder, neurological deficit, biochemical imbalance, cognitive schema, set of behavioral patterns, genetic predisposition, collection of complexes, or "as a composite of drives and deterministic forces, you have defined for study everything except the one to whom these experiences happen, everything except the existing person him [or her] self" (p. 25). Existential psychotherapy strives to empower and place the person--and his or her existential choices--back at the center of the therapeutic process. To cite Sartre on this subject: "We are our choices."

While the techniques of existential psychotherapy can include Freudian, Jungian, Gestalt, cognitive, behavioral or other methods, the fundamental technique shared by all existential therapists is phenomenology. Phenomenology refers to the conscious setting aside of preconceptions and dogma in an effort to discover the client or patient's actual subjective experience or "being" (Dasein). It is through this that the true experience, will and intentionality of the patient at any given moment may be discerned, understood, and appropriately responded to by the therapist. The focus of treatment is on the present, here-and-now, current circumstance, rather than exclusively on early formative influences. While the power of the past and of unconsciousness-- those aspects of ourselves of which we are unable or unwilling to become aware-- to influence the present detrimentally is recognized and addressed as it arises in treatment, the patient's subjective experience of self ("I am") and of the therapeutic encounter is of primary importance.

Choice, personal and social responsibility, integrity of the personality, courage, and authentically facing rather than escaping existential anxiety, anger and guilt are central features of existential psychotherapy. The existential therapist is not confined to the passive, neutral, anonymous and interpretive role of the psychoanalyst. The courage and commitment to truly and genuinely encounter each unique patient is required by the existential therapist, who must not avoid his or her own anxiety by hiding behind a rigid professional persona or rote therapeutic technique. In existential therapy, the human relationship between patient and therapist takes precedence over technical tricks, and, as now corroborated by research, is the basic healing factor in any psychotherapy. Coming to terms with reality-- and one's own inner "demons"-- without denying, avoiding, distorting or sugar-coating it is key to existential therapy. As Rollo May, the acknowledged American "father" of existential psychotherapy pithily put it: "I do not believe in toning down the daimonic. This gives a sense of false comfort. The real comfort can come only in the relationship of the therapist and the client or patient" (Diamond, 1996, p. xxii). This compassionate, shared, professional yet profoundly personal human relationship provides both the structured, supportive container and potent existential catalyst for therapeutic transformation.

Irvin Yalom believes that Existential Psychotherapy is not defined by specific techniques, rather it is defined by its attitude. The existential therapist, according to James Bugental, "is present as the client explores her or his deepest life predicaments." These include:

• Self and Society
• Love and Transience
• Freedom and Responsibility
• Meaning and Absurdity
• Fear and Transcendence
• Belief and Faith

Kirk Schneider and Rollo May's "The Psychology of Existence: an Integrative, Clinical Perspective" advocates for a therapy that focuses on experiential "liberation." Focusing on constriction and expansion of "experiential being" Schneider and May postulate strategies for gently challenging the client to "deeper spheres of liberation." A key element of liberation is the ability to be deeply present in our life. As Bugental states, "presence is the quality of being in a situation or relationship in which one intends at a deep level to participate as fully as [one] is able."

The roots of the existential orientation in the United States can be traced to 1958 when May, Angel, and Ellenberger's "Existence: A New Dimension in Psychiatry and Psychology" was published. The roots of the humanistic orientation are traced to 1951 when Carl Rogers' "Client-centered Therapy" was published. At the core of both orientations is an emphasis on phenomenology. As a result, the existential-humanistic perspective honors the subjectivity of conscious existence. As part of our subjective nature each individual struggles with self-awareness, basic freedom, social and intra-personal identity, the meaning of our life and death, and the anxiety associated with consciousness. James Bugental, Rollo May, Kirk Schneider, and Irvin Yalom have contemporary publications that reflect both orientations.

Many of the active members of EHI have trained with James F. T. Bugental, Ph.D., Rollo May, Ph.D., and/or Irvin Yalom, M.D. They also took part in a Pacific Institute 1997 project which provided training for a small group of psychotherapist from St. Petersburg and Moscow. Formed as a Non-Profit Corporation in 1997, EHI has provided cutting edge training and public programs to further the understanding of the existential and humanistic orientations. The formation of EHI is an important step in the face of the mainstream movement toward dehumanizing psychotherapy. Your support, feedback and interest will be appreciated.