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.
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