Existential Therapies

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Existential Therapies

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Praise for the Book

‘Mick Cooper has done the counselling and psychotherapy community a great service by tracing the many influences that have shaped contemporary approaches to existential therapy. Cooper has woven together the various strands of thought into a coherent and lively presentation of how existential therapy is practised today. The book combines scholarship with a writing style that makes difficult concepts accessible. It should be required reading on any course where the existential tradition plays a part, and that includes person-centred courses and all sympathetic to the idea that psychotherapy is, in essence, a human encounter where warmth, understanding and a deep respect for the individual are key values.’ Tony Merry ‘This is a book of superb thoroughness and scholarship – an unprecedented guide to existential therapy’s chief positions and controversies.’ Kirk J. Schneider, President of the Existential-Humanistic Institute ‘Though philosophers through the ages have practised existential counselling, it is only in the past hundred years that this approach has been formally developed and recognized as a form of psychotherapy. This publication marks a milestone in the long history of the existential therapies in providing an excellent, clear and critical overview of the contrasting forms of the approach as it is currently practised. Cooper’s special merit is to present the different flavours of existential therapy in an evocative and sometimes provocative fashion. He invites his readers to sample the whole range; he highlights potential bias, and then in true existential tradition leaves his readers to arrive at their own conclusions and work out their own versions of existential therapy.’ Emmy van Deurzen

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Existential Therapies Mick Cooper

SAGE Publications London • Thousand Oaks • New Delhi

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© Mick Cooper 2003 First published 2003 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Inquiries concerning reproduction outside those terms should be sent to the publishers. SAGE Publications Ltd 6 Bonhill Street London EC2A 4PU SAGE Publications Inc 2455 Teller Road Thousand Oaks, California 91320 SAGE Publications India Pvt Ltd B-42, Panchsheel Enclave Post Box 4109 New Delhi 100 017 British Library Cataloguing in Publication data A catalogue record for this book is available from the British Library ISBN 0 7619 7320 6 ISBN 0 7619 7321 4 (pbk) Library of Congress Control Number: 2002115863

Typeset by C&M Digitals (P) Ltd, Chennai, India Printed in Great Britain by The Cromwell Press Ltd, Trowbridge, Wiltshire

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Dedication

In loving memory of my father, Charles Cooper (1910–2001), a communist and humanist, who taught me to value freedom, to question conventional wisdoms, and to honour the tragic side of life – an existentialist in spirit, if not in name.

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Contents

Acknowledgements

viii

1 Introduction: the Rich Tapestry of Existential Therapies

1

2 Existential Philosophy: an Introduction

6

3 Daseinsanalysis: Foundations for an Existential Therapy

35

4 Logotherapy: Healing Through Meaning

51

5 The American Existential-Humanistic Approach: Overcoming a Resistance to Life

63

6 R. D. Laing: Meeting without Masks

91

7 The British School of Existential Analysis: the New Frontier

107

8 Brief Existential Therapies

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9 Dimensions of Existential Therapeutic Practice

138

10 Conclusion: the Challenge of Change

147

Contacts

152

References

155

Index

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Acknowledgements

From an existential perspective, a human being is inseparable from their social context, and the writing of this book would not have been possible without the emotional and intellectual support of numerous friends, colleagues, family members and teachers. Thanks, first of all, go to my partner, Helen Cruthers. Helen gave me enormous encouragement, love and help during the writing of this book, and her comments and guidance on numerous drafts were invaluable. On the home front, I would also like to thank my two little daughters, Maya and Ruby. Lost in tomes of Heideggerian and Kierkegaardian thought, nothing could have lifted my spirits more than to have a young toddler bound into my study, smile mischievously, and then proceed to pile all my philosophical books, one-by-one, onto the floor! Special thanks also go to Jennifer Cruthers and Kitty Cooper, who grandmothered Maya and Ruby so lovingly and diligently, and helped me find the time to complete this book. I am also greatly indebted to Emmy van Deurzen, who gave me extensive and detailed feedback throughout the writing of this book. Many thanks also go to the following colleagues and friends for their informative, encouraging and challenging feedback: Ivan Ellingham, Alec Grant, Mike Harding, Angie Hart, Helen Hopkins, Tim LeBon, Paul McGahey, Tony Merry, Jacquy Paizas, Geraldine Pass, Kirk Schneider, Ernesto Spinelli, Freddie Strasser, Dominic Velarde and Sarah Young. A number of therapists and academics also generously gave me their time to talk through various aspects of the existential therapies, and to them I am also grateful: Hans Cohn, Erik Craig, Miles Groth, John Heaton, Wilhelm Maas and Paul Wong. The majority of this book was researched and written during a sabbatical semester, and for that I would like to thank colleagues in the School of Applied Social Science at the University of Brighton, who not only awarded me the sabbatical, but covered my teaching load. I am also very grateful to the learning resources team at the University of Brighton’s Falmer Library, who patiently processed for me numerous inter-library loan requests. Finally, I would like to say a special thank you to Lucia Moja-Strasser, one of the great unsung heroes of existential therapy. Like many other UK-trained existential therapists, Lucia was a pivotal figure in my development as an existential therapist, and without her dedication, honesty and

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x Acknowledgements encouragement, I very much doubt I would have been in a position to write this book today. Needless to say – and particularly from an existential standpoint – the contents of this book are my responsibility alone.

Mick Cooper

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1. Introduction: the Rich Tapestry of Existential Therapies1

‘What is existential therapy?’ As an existential therapist and trainer, this is one of the questions that I have been most frequently asked. It has also been one of the questions that I have found the most difficult to answer. ‘It’s ... um ... about facing the reality of existence’ I have sometimes muttered, or come out with a stock response like, ‘It’s similar to personcentred therapy ... only more miserable!’ Over the years, however, it has gradually dawned on me why this question has been so difficult to answer: because the term existential therapy has been used to refer to so many different therapeutic practices. Whilst Yalom’s (1980) existential psychotherapy, for instance, encourages clients to face up to four ‘ultimate concerns’ of existence – death, freedom, isolation, meaninglessness – van Deurzen’s (2002a) existential psychotherapy encourages clients to explore four dimensions of worldly being: the physical, personal, social and spiritual dimensions. Similarly, whilst Bugental’s (1978) existential-humanistic approach encourages clients to focus in on their subjective experiences, Frankl’s (1984) existential analysis frequently encourages clients to focus out on their responsibilities towards others. As several other commentators have concluded, then, it is simply not possible to define the field of existential therapy in any single way (Moja-Strasser, 1996). Rather, it is best understood as a rich tapestry of intersecting therapeutic practices, all of which orientate themselves around a shared concern: human livedexistence. In other words, as Walsh and McElwain conclude, it is more ‘appropriate to speak of existential psychotherapies rather than of a single existential psychotherapy’ (2002: 254); and this is the fundamental premise for the present book. Of course, to a great extent, there is diversity within every form of therapy. Indeed, one could quite rightly argue that there are as many forms of therapeutic practice as there are therapists. Nevertheless, there are reasons why the field of existential therapy is more diverse than most. First, as Halling and Nill write, existential therapy ‘cannot be traced to a single authoritative source’ (1995: 1). It has no founder, no Freud or Rogers, to give the approach a common theoretical and practical basis. Rather, since the first decades of the twentieth century, existential approaches to therapy have emerged spontaneously – and, at times, independently – in diverse parts of western Europe and subsequently the United States (see

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2 Existential Therapies Further Reading at the end of this chapter for historical overviews). Second, the philosophical field on which existential therapeutic practice is based – existential philosophy – is, itself, enormously diverse. Hence, practitioners drawing from these ideas have tended to draw from very different beliefs and assumptions. Third, existential philosophical writings can be extraordinarily complex and difficult to understand. Hence, interpretations – and, at times, misinterpretations – of what existential philosophers have said has brought about a great diversity of therapeutic applications. Fourth, as Schneider and May (1995a) point out, existential therapists have spent much of their energies reacting against traditional approaches to therapy – particularly psychoanalysis – rather than proactively generating coherent, integrated models of practice. Finally, though, at the heart of an existential standpoint is the rejection of grand, allencompassing systems; and a preference for individual and autonomous practices. Hence, few existential therapists have been concerned with establishing one particular way of practising existential therapy. Indeed, for most existential therapists, the idea that this approach can be systematised or even manualised – as some forms of therapy are now beginning to be (for instance, Wilson, 1998) – is anathema to the very principles of the approach. The primary aim of this book, then, is to introduce readers to the rich tapestry of existential therapeutic approaches. It aims to map out the different existential therapies, such that readers can learn to distinguish their Binswanger from their Bugental and are able to identify the key dimensions along which these existential approaches differ. More than that, though, the book aims to stimulate and excite readers: to present the rich array of existential ideas and therapeutic practices in the hope that students and practitioners – of both existential and non-existential therapies – will find much here to incorporate into their own therapeutic work. A third aim of the book is to act as a signpost: to help readers identify areas of existential thought and practice that are of particular interest to them, and enable them to follow up these particular interests through further reading, or through contacting relevant organisations and/or websites. Finally, the book aims to contribute to a range of debates within the field of existential therapy, amongst them: • What can clients hope to take from an existential approach? • What are the strengths and limitations of the different existential approaches to therapy? • What are the kinds of choices and dilemmas that existential therapists face? The book begins with an overview of existential philosophy. This is the kind of chapter that, as they say, you may want to come back to later. It’s very theory-rich, and whilst you may want to learn about the philosophical ideas informing the existential therapies before looking at their

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actual practices, you may want to start with the practice and then come back later to explore their philosophical roots. In the following chapters, the book goes on to look at a range of existential approaches to one-to-one therapy. Here, it has tried to focus on the most prominent, pervasive and influential approaches: those around which the greatest numbers of practitioners have constellated, and which have produced the greatest number of books, journals, conferences and training courses. Given that this book aims to act as a signpost, it also concentrates primarily on those existential therapies that readers are able to follow up: where there are books that are still in print (and in English), and professional bodies that can be contacted. (In some instances, I have included books that are no longer in print under Further Reading because they are such key texts. Such books can be obtained through secondhand book-finding services; for instance, www.bookfinder.com, or through inter-library loans.) These chapters also tend to focus on those existential approaches that outline specific forms of therapeutic practice, as opposed to purely psychological or psychiatric understandings (readers interested in these latter areas should see Further Reading at the end of this chapter). In these chapters, six existential approaches to therapy are examined, roughly in chronological order of their origins. Chapter 3 looks at the Daseinsanalytic approach, which critiques many of the dominant assumptions within the field of psychoanalysis and psychotherapy, and encourages clients to open themselves up to their ‘Being-in-the-world’. Chapter 4 examines Victor Frankl’s Logotherapy, which places particular emphasis on helping clients to discover meaning in their lives. In Chapter 5, the dominant brand of existential therapy in the US, the existentialhumanistic approach, is examined: an approach which places particular emphasis on helping clients to uncover their subjective experiences and to courageously face the givens of their existence. Here, the work of Irvin Yalom, as well as Rollo May and other well-known American existential therapists will be explored. Chapter 6 looks at the work of R. D. Laing, who developed an existential model of schizophrenia, and outlined some of the knots and entanglements that interpersonal relationships can become tied up in. The development of this work, through the British school of existential analysis, is then discussed in Chapter 7, where a particularly descriptive, de-pathologising model of therapy has evolved. Chapter 8 rounds off this part of the book by looking at two time-limited approaches to existential therapy. To avoid repetition, I have tended to focus on the distinctive ideas and practices of each of these approaches, rather than those ways of working that they share with other existential – and non-existential – therapies. This should be borne in mind when reading about these different approaches. It should also be borne in mind that each of the practitioners associated with each of the different approaches will practice in very different ways, and that they will also practice very differently with different clients. Whilst these chapters, then, identify some of the core beliefs

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4 Existential Therapies and practices within each of the different fields, it should be remembered that there will also be a great deal of homogeneity between, and heterogeneity within, the different approaches. In Chapter 9, these existential approaches are brought into a unified framework through an identification of the similarities and differences across the different existential therapies. Chapter 10 concludes by looking at some of the challenges facing existential therapies in the years to come. Finally, a word about personal bias. From an existential perspective, bias is unavoidable: it simply isn’t possible for me, or for anyone else, to stand above the world of existential therapies and give an objective, ‘God’s eye account’ (Merleau-Ponty, 1945/1962) of the field. This means that the way I present the different approaches, the criticisms I raise, and even the approaches that I choose to present will undoubtedly be influenced by my own particular leanings. This I cannot change, but what I can do is two things. First, I can try to minimise any biases that I know are present. Second, I can alert you, the reader, to my own particular perspective, such that you are more able to put my biases and assumptions to one side. My own approach to therapy sits somewhere between an existential and a person-centred perspective (Rogers, 1959), with a liberal sprinkling of postmodern sensibilities (for instance, Lyotard, 1984). I tend to believe that a client’s difficulties (at least, those that a therapist can help them with) are rooted in a lack of ‘self’-acceptance, and that a warm, empathic and honest relationship can help clients to accept more fully the totality of their being. For me, this person-centred starting point is augmented by an existential understanding of human existence, which helps me to develop a deeper appreciation of my client’s lived-being. Because I use existential ideas in this person-centred way, I am particularly drawn to those existential practices that I feel respect and validate clients’ experiences, whilst hostile to those that I see as implicitly judgemental, patronising or disempowering. I am particularly critical of those existential practices that seem to impose a set of truths and assumptions onto their clients – particularly where it is under the guise of facilitating autonomy and independence. My person-centred take on existential therapy also means that I am particularly drawn towards those existential ideas that I feel shed new light on what it means to exist as a human being – that offer new, and potentially more constructive, ways of understanding human existence.

Note 1. Like Spinelli, I feel that ‘it is not possible to make a generally accepted differentiation between counselling and psychotherapy’ (1994: 39). For this reason, I have used the term ‘therapy’ throughout this book to refer to the talking therapies as a whole.

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Further reading Halling, S. and Nill, J. D. (1995) ‘A Brief History of Existential-Phenomenological Psychiatry and Psychotherapy’, Journal of Phenomenological Psychology, 26(1): 1–45. Concise, clearly written and comprehensive overview of the historical development of existential-phenomenological psychiatry and psychotherapy. Spiegelberg, H. (1972) Phenomenology in Psychology and Psychiatry: A Historical Introduction. Evanston, IL: Northwestern University Press. Comprehensive tome detailing the development of phenomenological and existential thought in psychiatry, psychology and psychotherapy. For a more condensed account that also covers humanistic psychologies, see Misiak and Sexton (1973). May, R., Angel, E. and Ellenberger, H. F. (eds) (1958) Existence: A New Dimension in Psychiatry and Psychology. New York: Basic Books. Collection of translated casestudies and papers by early European existential and phenomenological psychiatrists – including Binswanger’s notorious case study of Ellen West – with excellent introductions to, and summaries of, their works. May’s introductory chapters can also be found in The Discovery of Being (1983). Van Deurzen, E. (1997) Everyday Mysteries. London: Routledge. Chapters 12–23. Useful overview of key figures in the existential therapeutic field: both past and present.

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2. Existential Philosophy: an Introduction

At the heart of each of the therapies discussed in this book is an existential philosophical stance. The deeper, then, that one can understand this philosophical stance, the deeper one can grasp the heart and soul of these existential therapies. Unfortunately, the field of existential philosophy is surrounded by much confusion and misunderstanding. For many people it is associated with images of gloomy cafés in post-World War II France and Gauloisessmoking intellectuals furtively discussing the meaninglessness of existence. Many people also associate it with such concepts as nihilism, angst, atheism and death. These images and associations have tended to arise because existential philosophy is sometimes equated with the existentialist movement of Jean-Paul Sartre and his circle, who did, indeed, develop their writings in France around the end of World War II, and took a relatively sober – though by no means pessimistic (Sartre, 1945/1996) – view of existence. Today, however, the term ‘existential philosophy’ tends to be used in a broader sense, to refer to the writings of a loosely connected group of thinkers who are neither predominantly French, atheistic or concerned with the meaninglessness of existence (Guignon, 2002) (see Box 2.1).1 Indeed, whilst many of these thinkers were active around the first half of the twentieth century, existential ideas have a lineage that ‘can be traced far back in the history of philosophy and even into man’s pre-philosophical attempts to attain some self-understanding’ (Macquarrie, 1972: 18). Existential ideas, questions and ways of philosophising have been identified in the teachings of such notable figures as Socrates, Jesus and the Buddha (Macquarrie, 1972), as well as in such ancient philosophical systems as Stoicism (van Deurzen, 2002a). The confusion surrounding existential philosophy, however, has not been helped by existential philosophers themselves. Many of these philosophers’ writings are exceedingly opaque; and some, such as Kierkegaard (1846/1992), have deliberately aimed to express their ideas indirectly. Take the following passage, for instance: ‘The self is a relation that relates itself to itself or is the relation’s relating itself to itself in the relation; the self is not the relation but is the relation’s relating itself to itself’ (Kierkegaard, 1849/1980: 13). The fact that existential philosophers have also advocated highly diverse – and, at times, divergent – points of

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Existential Philosophy

BOX 2.1

7

Key existential philosophers

• Kierkegaard, Søren (1813–55): Danish philosopher and father of modern existentialism. Criticised the lack of passion and the conformity of nineteenth century Christendom, as well as the all-embracing, abstract philosophising of Frederich Hegel. Argued that human beings needed to turn towards their own subjective truths, and make a personal leap of faith towards God. • Nietzsche, Friedrich (1844–1900): German philosopher. Attacked the slavish, herd mentality of conventional Christianity, and preached an atheistic gospel of aspiration towards the Übermensch: the autonomous superman who creates his or her own values and morality, and lives an earthly life of passion and power. • Buber, Martin (1878–1965): Jewish philosopher and theologian. Emphasised the relational nature of human existence, and the distinction between ‘I–Thou’ and ‘I–It’ modes of relating. • Jaspers, Karl (1883–1969): German psychiatrist-turned-philosopher, whose ideas underpinned many twentieth century developments in existential philosophy, amongst them the unavoidable ‘boundary situations’ that human beings face. • Tillich, Paul (1886–1965): German protestant theologian who fled to the United States in the 1930s, bringing with him the existential style of philosophising. Advocated courage in the face of the anxiety of non-being, and distinguished between ‘existential’ and ‘neurotic’ anxiety and guilt. • Marcel, Gabriel (1889–1973): French philosopher, playwright and Christian. Emphasised the mysteriousness and immeasurability of existence, and the importance of fidelity and openness to others, as well as the primacy of hope. • Heidegger, Martin (1889–1976): German philosopher, generally considered the most significant and influential of the existential thinkers. Earlier work emphasised resolution in the face of anxiety, guilt and death, whilst later work placed greater emphasis on language and an openness towards Being. • Sartre, Jean-Paul (1905–80): French philosopher, novelist, playwright and social critic. Probably the best known existential philosopher, who emphasised the freedom at the heart of human existence and the angst, meaninglessness and nausea that it evokes. Later work shifted towards a more Marxist standpoint. • Merleau-Ponty, Maurice (1907–61): French philosopher, particularly noted for his emphasis on the embodied nature of human existence. • Camus, Albert (1913–60): French novelist and philosopher. Emphasised the absurdity of human existence, but the possibility of creating meaning in a meaningless world.

view also makes it difficult to develop a coherent understanding of existential thinking. For instance, whilst some existential philosophers are deeply religious (such as Kierkegaard, Buber and Marcel), others are

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8 Existential Therapies committed atheists (such as Sartre, Nietzsche and Camus). Similarly, whilst some emphasise the need for individuality (such as Kierkegaard and Nietzsche), others emphasise the need for relationship (such as Buber, Marcel and Jaspers). And whilst some consider existence to be ultimately meaningless (such as Sartre and Camus), others place great emphasis on the primacy of hope (such as Marcel). One can only speak of existential philosophers in the loosest sense, then, as a group of thinkers – across history – who show some ‘family resemblances’ in their outlook and style of philosophising. The fact that existential philosophy is a difficult, contradictory and illdefined field of inquiry, however, is in no way grounds for dismissing it out of hand. Indeed, as a philosophy that emphasises diversity over uniformity, concreteness over abstractness, dilemmas over answers, and subjective truths over grand-encompassing theories, such complexity is the very life-blood of existential philosophy itself. Furthermore, the contemporary trend to summarily dismiss any set of ideas that can not be reduced to sound-bite status is often more a consequence of anxiety in the face of uncertainty than a genuine desire for knowledge. Existential philosophy is difficult to understand, in part, because it is a difficult set of ideas – ideas that challenge our very assumptions about how things are. Indeed, it is difficult to understand because existence itself is difficult to understand! To engage with these ideas, then, requires a willingness to step into an uncertain and dimly-lit world, and to put to one side a need for certainty and quick, easily-digestible answers.

Existence What, then, is the family resemblance that all existential philosophers share? A useful starting point is to consider existential philosophy an approach that, as the name suggests, takes as its primary concern the existence of human beings (Ellenberger, 1958). To understand this notion of ‘existence’ we can compare it against its traditional counterpart, ‘essence’. The essence of an entity is what it is: the universal, abstract and unchanging characteristics that make it one kind of an entity rather than another (Macquarrie, 1972). For instance, we might say that the essence of this book is that it is about existential therapy. By contrast, the existence of an entity is the fact that it is, that it has a particular, concrete being. The existence of this book, then, is that it is this particular book that you have in front of you, with all its particular sentences, scribbles in the margins, and coffee stains. This existence is more than a collection of abstract, essential qualities; it is the reality of the actual entity in front of you. Figure 2.1 is an attempt to diagrammatically represent existence and essence. As this diagram suggests, an entity’s essence is what it is made up of, and one must imagine each of these ‘internal’ essences being

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Existential Philosophy Figure 2.1

9

Existence and essence

Existence

Existence Essence

Existence Existence

common to a whole range of entities. By contrast, the existence of this entity is how this particular entity manifests itself in its totality: it is the unique way in which this particular entity encounters its world. Try looking over this book for a minute or two, focusing on its particular concrete existence. If such a way of looking at it seems unusual to you, it is probably because, in our culture, we tend to focus on essences rather than existence. Since the time of Plato (427–347 BC), philosophy has searched for the universal, abstract and unchanging truths that lie behind manifest existence (Macquarrie, 1972). Science, borne from within this tradition, has emerged as the essentialist project par excellence, breaking reality down into ever-more fundamental laws and components. Within this essentialist world-view, an entity’s existence is little more than a superficial mask that conceals its ‘true’ reality. Over the course of the nineteenth and twentieth centuries, this essentialist outlook has become increasingly applied to an understanding of human beings. Positivism, developed by Auguste Comte (1778–1857), proposed that human society and human beings could be understood in terms of their underlying laws and rules (Mautner, 1996). This led to the development of such essentialist psychologies as behaviourism and psychoanalysis, where the concrete individual was broken down into such constitutive parts as stimuli and response, id and superego (for instance, Freud, 1923; Watson, 1925). Similarly, Frederich Hegel (1770–1831), one of the most influential philosophers of the nineteenth century – and to whom much contemporary existential thought is a reaction – developed a philosophical system in which concrete, individual human existences were subsumed within a model of highly abstract and universal processes. Few existential philosophers have questioned the value of studying inanimate objects in an essentialist, scientific way. What they vigorously

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10 Existential Therapies reject, however, is the extension of this outlook to an understanding of human beings. Indeed, some existential philosophers, such as Heidegger (1926/1962), use the term ‘existence’ to refer solely to human existence. Existential philosophy, then – particularly in its nineteenth and twentieth century form – can be understood as a reaction to philosophical and scientific systems that focus on the universal, abstract and unchanging essences behind concrete human existence that treat particular human beings primarily as members of a genus or instance of universal laws (Guignon, 2002). Such essentialist approaches are rejected because, from an existential perspective, the concrete reality of human existence is irreducible to a set of essential components. That is, even if I could list every one of your essential qualities – for instance, your level of extraversion, your ‘Intelligence Quotient’, the neurochemicals passing through your brain – I would still not be describing you, because the actual, concrete you that you are is more than all these essential components put together. Furthermore, from an ethical standpoint, to try and reduce your being down to a set of essential components would be to diminish the fullness of your humanity, to transform you into nothing more than a sophisticated robot or computer. The aim of existential philosophy, then, is to develop a deeper and more complete understanding of this existence – the irreducible, indefinable totality that you, me, and others are.

The phenomenological method A key contribution to this search has been the phenomenological method, as developed by the German philosopher Edmund Husserl (1859–1938). Following in the footsteps of the French philosopher René Descartes (1596–1690), Husserl adopted a standpoint of radical doubt, arguing that all we can know is what we experience: the ‘inner evidence’ that is given to us intuitively in our conscious experiencing of things. In other words, to truly know ourselves and our world, we need to turn our attention to our conscious, lived-experiences. To do so, Husserl outlined a range of methods or ‘reductions’, starting with the ‘phenomenological method’, which Spinelli (1989), drawing on Ihde (1986), describes 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: 17). In particular, Husserl urges us to set aside our ‘natural attitude’ – that objects in the external world are objectively present in space and time – and instead focus solely on our immediate and present experiencing of them. It is important to note here that Husserl is not suggesting that we should try to deny, negate or eradicate our assumptions. Rather, he is suggesting that we ‘bracket’,

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‘suspend’, ‘withhold’ or ‘parenthesise’ them, such that we can consider alternate possibilities, and develop a deeper understanding of how we actually experience our world. The second step in the phenomenological method, according to Spinelli (1989), is the ‘rule of description’, the essence of which is ‘Describe, don’t explain’ (Ihde, 1986: 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’, which ‘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: 18). Drawing on this phenomenological method, twentieth century existential philosophers – such as Sartre, Merleau-Ponty and Heidegger (who was an assistant to Husserl) – have all argued that, to understand human existence, we need to put to one side abstract hypotheses, analytical procedures and philosophical theories, and instead focus on human existence as it is actually lived. Indeed, these philosophers are often referred to as ‘existential phenomenologists’. There are a number of important differences, however, between an existential philosophical outlook and a Husserlian phenomenological one. First, existential philosophers have rejected the idea that, through the various reductions, we can arrive at a pure consciousness and transcendent ego. Rather, they have argued that human existence is fundamentally and inextricably immersed in its world. Second, existential philosophers have moved away from the Husserlian emphasis on cognitive, conscious processes, to focus on embodied, practical, concrete involvement in the world. Existential philosophers have also gone on to try and say something about the nature of this concrete human existence. Specifically, they have attempted to describe some of the inescapable, universal features of the human condition, within which each particular human existence resides. (Heidegger uses the term ‘ontological’ to refer to these universal features of human being, and the term ‘ontic’ to refer to the activities of each particular human existence within these givens.) Different existential philosophers have emphasised different – and, at times, contrasting – givens of human existence, but there are a number of commonalities across the existential spectrum, and these will be explored in the following sections.

Existence as unique One of the characteristics of each human existence that existential philosophers have most consistently pointed to is its uniqueness. Each of us, it is argued, is distinctive, irreplaceable and inexchangeable (Macquarrie, 1972), with a unique potential that we bring into the world. This is an

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12 Existential Therapies inevitable corollary of a philosophical outlook that emphasises concrete, particular actualities over shared, universal essences. If, for instance, you and I were understood in terms of such universal characteristics as levels of extraversion or neuroticism (for instance, Goldberg, 1990) then it might emerge that we are relatively similar people. If, however, I am understood as me-writing-this-now, and you are understood as you-reading-thisthen, then we are of a qualitatively distinct order. For some existential philosophers, this emphasis on the uniqueness of each human existence is coupled with a highly individualistic outlook. Kierkegaard, often 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, he writes (1846/1992), and he derides those who treat immortality or faith as socially-shared affairs. On the bases of such writings, it is often assumed that all existential philosophers hold that ‘the individual is inexorably alone’ (Yalom, 1980: 353). Many existential philosophers, however, hold that the basic state of human existence is to be with-others. As Macquarrie writes, then, there is a ‘deep tension to be found among existential philosophers, even sometimes in one and the same philosopher, as they are torn between the individual and communal poles of existence’ (1972: 84). As we shall see, this tension is also evident in the contrasting practices of some existential therapists.

Existence as verb-like Virtually all existential philosophers have also argued that human existence is not a noun-like thing, but a verb-like happening. This is a challenge to the commonly held assumption, derived from a natural science world-view, that human beings are entities alongside other entities in the world: fixed, static, substance-like objects that can be studied in the same way that atoms or tables can (Heidegger, 1926/1962). In contrast, existential philosophers have argued that human existence is fundamentally dynamic in nature, that it is a flux (Merleau-Ponty, 1945/1962), an unfolding event (Guignon, 1993), a path (Jaspers, 1986) or a process. Indeed, the very word ‘exist’ comes from the Latin verb existere, which means to stand out or emerge (Macquarrie, 1972; May, 1958b). Existence, then, can be conceived of as an upsurge (Sartre, 1943/1958): a becoming, a bursting forth into the world. A phenomenological exercise may help to illustrate this point. Reflect, for a minute, on what you are experiencing as you read these words. Initially, you may perceive yourself as a thing-like self encountering another thing: this book. If you try to bracket this natural attitude, however, and simply focus on what you are experiencing, you may come to

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Existence precedes essence

Existence

Existence

Essence

Existence

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see that your experiencing is a reading-of-these-words-now, or a wonderingwhat-this-is-on-about, rather than a fixed thing encountering another fixed thing. From an existential perspective, then, we are first and foremost a verblike being, and it is only subsequently that we may define ourselves as a noun-like thing: such as ‘an extrovert’ or ‘a therapist’. This is the meaning of the well-known Sartrean phrase: ‘Existence precedes essence’ (1943/1958: 568) (see Figure 2.2). In other words, human beings are not fixed selves, but a relationship towards their own being; or, as Kierkegaard puts it, ‘a relation that relates itself to itself’ (1849/1980: 13). For Heidegger, too, the essence of human existence is ‘self-interpretation’ (Dreyfus, 1997). As human beings, we are constantly making sense of ourselves and understanding who we are – even if this is not at a level of reflective self-awareness.

Existence as freely choosing At the heart of existential philosophy is also the assertion that human existence is fundamentally free (Macquarrie, 1972). Such an assertion directly challenges the assumption – particularly prevalent amongst scientific psychologies – that human thoughts, feelings and behaviours are determined by a prior set of circumstances or conditions, such as

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14 Existential Therapies ‘unconscious’ drives or external stimulus. For existential philosophers, such as Kierkegaard (1844/1980) and Sartre (1943/1958), human existence erupts into the world out of no-thingness, and thereby can not be reduced to a set of determinative causes. From this perspective, freedom is not an add-on to being, but the essence of being itself (Sartre, 1943/1958). 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’ (1943/1958: 25). Whilst there is no way of empirically demonstrating that human beings are free, phenomenological reflection reveals that such freedom is an integral part of human lived-experience (Guignon, 2000). As you are reading this, for instance, you are unlikely to experience yourself as being impelled by a set of causes to act in a particular way. You are unlikely to feel, for instance, that you are determined to turn the page, or caused to adopt the particular beliefs outlined in this book. Rather, you are likely to experience yourself as having the possibility of making choices. You may feel, for instance, that you could choose to stop reading this book and make yourself a cup of tea, or tear up the pages of this book and burn them. Of course, you may not want to behave in this way, but wanting is a very different notion from being deterministically impelled to do one thing or another. Of all the existential philosophers, it is Sartre (1943/1958) who places the greatest emphasis on human freedom. In asserting that existence precedes essence, he is not only suggesting that we are an upsurge of nothingness prior to any fixed identity, but that ‘Man is nothing else but what he makes of himself’ (1945/1996: 259). In other words, we are our choices: our identity and characteristics are a consequence – and not causes – of the choices that we make. From this perspective, then, there is nothing that caused you to become the person you are: whether you ‘are’ a therapist, parent or extravert. Rather, you became you by virtue of the choices that you made in your life, and these identities are only an outcome of the decisions that you have made – decisions that are ultimately without any solid ground beneath them. Sartre also argues that human beings are the creators of their own values: ‘My freedom is the unique foundation of values and ... nothing, absolutely nothing, justifies me in adopting this or that particular value’ (1943/1958: 38). Not all existential philosophers, however, agree. Marcel (1949), in particular, argued that values are not chosen but recognised. In other words, we do not decide to value something in a particular way, but have a direct and immediate intuition of its intrinsic worth. This is a point of view shared by Max Scheler (1874–1928), a prominent phenomenologist, who influenced both Sartre and Heidegger. Scheler drew an analogy between values and colours, arguing that both are directly experienced qualities of things. For instance, just as we immediately intuit that an object is red, so, for Scheler, we immediately intuit whether it is pleasant or unpleasant, valuable or worthless, and so on. Scheler argued that this immediate, intuitive and pre-rational apprehension of values is given in our feelings (Dunlop, 1991), such that we experience happiness when we

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intuit pleasantness in a thing, or bliss when we intuit spirituality. The significance of this position will become apparent when we go on to look at the logotherapeutic approach in Chapter 4.

Existence as towards-the-future, drawing-on-the-past and in-the-present In challenging a causal, deterministic understanding of human beings, existential philosophers – most notably Heidegger (1926/1962) – have also challenged traditional assumptions about the nature and movement of time. In general, we tend to think of past, present and future as three consecutive regions on a time-line, with the present moving imperceptibly from what was to what will be. If we start with how human beings actually experience their world, however, this conceptualisation would no longer seem satisfactory. As you read these words, for instance, your initial experiencing is not something that is past, but something that is in the present. You are reading these words here, not the words in the sentence before. In this sense, then, one might say that the present tends to precede the past: existence begins with an eruption in the immediate now, and only subsequently goes back to its prior state of being. Contrary to popular myth, however, existential philosophers do not ‘begin by isolating man on the instantaneous island of his present’ (Sartre, 1943/1958: 109). Rather, they see existence as inextricably past, present and future. Whilst the past, then, is not seen as causing the present, it is still seen as being fundamentally woven into its woof. As you read this sentence, for instance, you do so in the present, yet the way you presently experience it is inextricably related to what you have experienced in the past. Had you been brought up only learning Norwegian, for instance, then your experiencing of these words would be very different: as meaningless blurs. Existence, then, may emerge in the present, but it always ‘takes up’ its own past (Heidegger, 1926/1962). For Heidegger, however, ‘Everything begins with the future!’ (2001: 159). In taking up our past, we do not simply apply it to the present, but use it to act towards future goals, meanings and possibilities. ‘Man first of all,’ writes Sartre, ‘is the being who hurls himself towards a future and who is conscious of imagining himself as being in the future’ (1945/1996: 259). From an existential perspective, then, the basic ground for human action is motives rather than causes (Heidegger, 2001): we pull ourselves from ahead, rather than being pushed from behind. In other words, your reading of this book is not first and foremost something that was caused to be, but something that is orientated towards an end goal, such as achieving a greater knowledge of existential therapy. Sartre (1943/1958) uses the term ‘projects’ to refer to the kinds of plans that we have for the future, and suggests that they may be of a higher or lower order. The project of reading this book, for instance, may be part of

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16 Existential Therapies a higher order project of becoming a better therapist, which might, itself, be part of a higher order project, such as ‘contributing to a better society’. As with our freedom, however, Sartre argues that our projects – right up to our highest order, ‘original’ ones – are ultimately groundless. That is, they have no externally-given, extrinsic foundations: nothing outside of ourselves on which they can be based. In other words, from a Sartrean perspective, our lives have no given, automatic meaning: there are only the meanings that we choose to endow them with. I may decide, for instance, that the meaning of my life is to help others or be happy, but these meanings are not based, or legitimised, by anything outside of myself. Viktor Frankl (1986), founder of logotherapy, likens this selfcreation of meaning to the illusion of the Indian Fakir, who throws a rope up into the air and then proceeds to climb up it himself; and, like the Fakir’s illusion, both Sartre and Camus (1942/1955) conclude that life is essentially absurd. For them, there is no profound reason for living, for going through the agitation of daily living and suffering. Whilst we strive towards meanings and purposes, there are none to be found – only those that we have created ourselves out of nothing. This leads Camus to state that: ‘There is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy’ (1942/1955: 11). Later on in this chapter, we will see how Camus attempts to answer this question. It should be noted again, however, that not all existential philosophers share this belief. For Marcel, for instance, the hope that there is an order and integrity to the universe is ‘oxygen for the soul’ (Blackham, 1961), and not something to be disparaged. Buber, too, emphasises the fact that, in the presence of a Thou (see below), there is an inexpressible confirmation and assurance of meaning, such that ‘The question about the meaning of life is no longer there’ (1923/1958: 140). We will come back to this viewpoint when we look at the logotherapeutic approach in Chapter 4.

Existence as limited Whilst existential philosophers argue that human beings are fundamentally free to choose their own future, it would be wrong to assume that they see human beings as free to do whatever they want. Indeed, existential philosophers have consistently emphasised the fact that human freedom is ‘hedged in’ in innumerable ways (Macquarrie, 1972), and an understanding of the limits of human existence is as important to existential philosophers as an understanding of its freedom. For Kierkegaard (1849/1980), both ‘possibility’ and ‘necessity’ are intrinsic aspects of our existence, and the ‘mirror of possibility’ alone reflects only half the truth. Similarly, for Jaspers (1986), human existence runs up against numerous ‘limit-situations’ – such as death, suffering, struggle and guilt – which can not be transcended, avoided or resolved.

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Heidegger (1926/1962) and Sartre (1945/1996) use the term ‘facticity’ to designate the limiting factors of existence (Macquarrie, 1972). The factical is the given, and some of the factical aspects of human existence have already been examined in this chapter: such as the fact that we are free. From an existential perspective, for instance, we cannot choose not to be free: even if we choose not to choose, we are still making a choice. Facticity also refers to the fact that we always find ourselves in a particular concrete situation. For instance, right now I am surrounded by a computer, a desk, a phone and walls, none of which are of my making, and all of which limit my freedom in some way. I can not just walk through the space where the wall is to get directly to my kitchen. My freedom is bounded in a very real way. Heidegger (1926/1962) uses the term ‘thrownness’ to refer to the fact that existence, right from its very start, finds itself thrown into a particular factical situation that is not of its making. We did not choose, for instance, to be born to our particular parents, nor did we choose the particular social, historical and cultural context in which we emerged. The term thrownness also refers to the fact that, like the throwing of a dice, there is no reason why we should find ourselves emerging in one particular situation rather than another (Macquarrie, 1972). From an existential perspective, then, we do not determine the beginning of our existence; and neither do we determine its end. Death, as Heidegger (1926/1962) and other existential philosophers have emphasised, is the inescapable, immovable boundary at the end of our lives. Like a road block beyond which we can not pass, it brings to an end all our projects and possibilities. It is the ‘congealing point of existence’ (Jaspers, 1932), which summarises and completes our being. For Heidegger, this death is of particular importance because of his emphasis on being as being-towards-the-future. Hence, for Heidegger, our being is a beingtowards-death. In this respect, death is not only an unavoidable event at some point in our future, but an intrinsic component of our every moment of being. Thrownness and death, then, are like two bookends on either side of existence – boundaries that our freedom and choice cannot extend beyond – and circumscribing these two boundaries is the boundary condition of chance (Jaspers, 1932). There is no reason why we are thrown into our particular beginnings, often no reason why we meet our particular end, and, in between, we are constantly encircled by a ‘huge tide of accident’. Opportunities come to us or evade us in ways that are beyond our control: a chance meeting sets the beginnings of a life-long relationship; we lose our job because of a fall in shares on the Tokyo stock market; cells mutate in our body and we are afflicted with cancer. From an existential perspective, then, we can not fully control our beginnings, our endings, or much of what happens in between, but what we can choose is how we face these ontological limitations. Even a person who is imprisoned, writes Sartre (1943/1958), is free to decide whether to

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18 Existential Therapies stay put or to try and escape. Even if we might say, then, that human existence is constricted like a rat in a cage, this is very different from saying that a human being is a cage: that it is fixed and determined without any possibility of movement and choice.

Existence as in-the-world Whilst earlier existential philosophers tended to emphasise the individuality and aloneness of each human being, later existential thinkers – most notably Heidegger (1926/1962) and Merleau-Ponty (1945/1962) – have emphasised the in-the-worldness of human existence. ‘[T]here is no inner man,’ writes Merleau-Ponty, ‘man is in the world, and only in the world does he know himself’ (1945/1962: xi). In other words, existence is not located within the individual, but between the individual and their world. Indeed, Heidegger uses the term Dasein – literally translated as ‘beingthere’ – to refer to the specifically human form of being; and, at other times, writes of the hyphenated ‘being-in-the-world’ to emphasise the indissoluble unity of person and world. In other words, he is suggesting that your reading-these-words-here is not something that takes place in your head, but between you and the words on this page: it is located on the interworldly, rather than intrapersonal, plane. Such an assertion is a radical challenge to another pervasive assumption within Western culture: that we can talk about human beings in isolation from their context. The roots of this philosophical standpoint can be found in the phenomenological concept of intentionality, which proposes that consciousness is always consciousness of something (Spinelli, 1989). My awareness is always directed to something outside of myself – whether real or imagined – and if my conscious existence is my very being, then those external entities are a fundamental part of who I am. Heidegger (1926/1962) developed this standpoint by arguing that in our everyday existence we are constantly appropriating objects and tools without being aware of them as separate entities. As I write these words, for instance, I am not experiencing my computer as something that is separate from me: at the level of existence, it is a fundamental part of my very being. Only when it goes wrong do I then experience it as something distinct: as that useless pile of plastic and silicone. Hence, if my very being is my concrete doing, then these objects within the world are a primordial part of my existence. In his later writings, Heidegger moved away from an understanding of human beings as the manipulators of their world, and towards an understanding of human beings as the ‘custodians’, ‘guardians’ or ‘shepherds’ of Being as a whole (1947/1996). That is, Dasein is like the guardian of a clearing in the forest, where the Being of the world can be seen for what it is; or like an ‘aperture’ in which the truth of Being can be revealed. From this perspective, man is not the ‘Lord of Being’ but its servant, who is

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entrusted with the most dignified of tasks: of bringing the truth of Being to light. This notion of human being as an openness to the world is of particular importance to the Daseinsanalytic school of existential therapy, which will be examined in Chapter 3.

Existence as with-others Along with arguing that human existence is fundamentally in-the-world, later existential philosophers have also argued that human existence is fundamentally with-others. This philosophical position – generally referred to as an ‘intersubjective’ one (Crossley, 1996) – further challenges the dominant Western belief that human beings are separate and distinct identities. It proposes that each of our existences is fundamentally and primordially intertwined with the existences of others. Heidegger’s (1926/1962) account of this intertwining is rooted in the fact that the way we appropriate entities in the world is based on public – rather than private – understandings. The way I type on my computer, for instance, is not something that I determined alone, but is based on how my culture has deemed it appropriate to type: for instance, with ten fingers, putting spaces between words and so on. Indeed, the very language that I use to write this book is not something that I have evolved independently, but is acquired from my socio-cultural nexus. If, then, my very existence is a typing-these-words-here, it is fundamentally infused with the being of those others, and can never slip out of its cultural context. On this basis, Heidegger (1926/1962), like Sartre (1943/1958), argues that our existence is fundamentally contingent and groundless. By this, Heidegger means that our being-in-the-world is not rooted in some personal truth or reality, but in interpretations that are public and nonspecific to us (Dreyfus, 1997). We are, as Dreyfus puts it, ‘interpretation all the way down’ (1997: 25): our very being is permeated by social, generic, impersonal understandings. Heidegger refers to these understandings as the world of ‘the they’ or ‘the One’.2 It should be noted here, however, that Heidegger is not simply talking about a tendency to conform. Rather, he is saying that we are fundamentally and unavoidably infused with the being of others. In other words, the way that we play sports, the way we talk to each other, the way that we relate to our children are all grounded in a socially-constructed nexus of meanings and interpretations that are not solely of our making. Heidegger (1926/1962) also presents some preliminary ideas about concrete relationships with others, and identifies two particular modes of relating: ‘leaping in’ and ‘leaping ahead’. ‘Leaping in’ involves taking over the other person’s concerns and projects for them, and handing them back the task when it has been completed, or disburdening them of it altogether. In such relating, writes Heidegger, ‘the Other can become one

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20 Existential Therapies who is dominated and dependent, even if this domination is a tacit one and remains hidden from him’ (1926/1962: 158). For him, this is the most prevalent form of relating to others. By contrast, in ‘leaping ahead’ we help the other to do things for themselves, to address their own concerns and projects (1926/1962: 159). For Heidegger, such a form of relating helps the other to open up to their possibilities for being, and to exist in a more authentic manner (see below). This distinction is of clear relevance to the practice of therapy, and is particularly emphasised by the Daseinsanalytic approach (see Chapter 3). Of all the existential philosophers, however, it is Buber (1923/1958) who examines concrete relationships with others in most detail. Like Heidegger (1926/1962), Buber holds that the I is always in relation to an Other, but he makes a fundamental distinction between ‘I–It’ and ‘I–Thou’ attitudes to this Other. In the I–It attitude, the other is experienced as a thing-like, determined object: an entity that can be systematised, analysed and broken down into universal parts. We might perceive the Other, for instance, as a neurotic whose adult ego is constantly threatened by their unconscious drives. By contrast, in the I–Thou attitude, we behold, accept and confirm the other as a unique, un-classifiable and un-analysable 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 in to 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 is not talking here about a merging with the Other – we cannot encounter what we are – nor is he suggesting that we can, or should, always relate to others in an I–Thou way. What he is suggesting, though, is that we have the potentiality of experiencing moments of deep I–Thou connection with Others; and we shall explore the relevance of this assertion to therapy later on in the book. For Sartre (1943/1958), too, human existence is inextricably social; yet, in contrast to Buber (1923/1958), he tends to see relationships as inevitably ‘it-ifying’. For Sartre, the ‘look’ of the other constantly threatens to turn the I into an object, into a fixed thing that is devoid of freedom and possibilities. Suppose, for instance, that as you are reading this book, you become aware that someone is standing behind you, observing your every movement. Now, instead of experiencing yourself as a ‘readingthis-book’, you become aware of yourself as an object to this person’s gaze: a thing with such characteristics as sloppy posture or unkempt hair. In attempting to defend ourselves against such objectification, Sartre

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suggests that human beings may try to objectify the other instead, and get locked in a battle of objectify-or-be-objectified. For Sartre, such a struggle becomes even more complex in loving relationships, where we want to possess the love of another, yet want this love to be freely given. It is of little value, for instance, to know that someone loves us because they have to, yet it can be equally frustrating to feel that someone else’s love is beyond our control. For Sartre, then, relationships are almost inevitably frustrating, unfulfilling and conflict-ridden. ‘Hell,’ he famously suggests, ‘is other people’. This perspective is of particular importance when we go on to look at Laing’s description of interpersonal relationships in Chapter 6.

Existence as embodied Many existential philosophers, most notably Merleau-Ponty (1945/1962), have also emphasised the fundamentally-embodied nature of human existence. That is, we are inextricably bodily beings, we are our bodies, and it is only through our bodies that we can engage with, encounter and ‘rise towards’ our world. This can be illustrated through phenomenological reflection. If you focus on what you are experiencing as you read this, you will become aware that it has an ineradicably bodily dimension. For instance, you may notice that you experience a slight straining at the side of your eyes, or a gnawing in the pit of your stomach. You will also become aware that these bodily experiences cannot be entirely separated off from your ‘mental’ experiences: at every moment, your experiencing has the quality of a psycho-somatic whole. Such a standpoint, then, challenges the traditional Cartesian assumption that mind and body are qualitatively distinct entities, and that the former is in some way superior to the latter. Indeed, existential philosophers, such as Heidegger (1926/1962) have argued that the very way we understand our world is embodied. As you read this chapter, for instance, you will be intellectually processing these words; but you will also be experiencing them in a bodily-felt way. For instance, you may experience feelings of excitement in response to some of these ideas, or frustration in response to others. From a traditional, Cartesian standpoint – one that puts mind over body – such bodily-felt experiences are little more than secondary, irrational responses; but from an existential perspective, our bodily-felt experiences are an immediate, direct and intuitive apprehension of our world that may precede our intellectual grasp. Rather than being derivative, then, they can be considered ‘equiprimordial’ (of equal priority); and rather than being considered merely irrational, they can be considered of equal validity to our intellectual understandings. Indeed, as Nietzsche writes: ‘There is more wisdom in the body than in thy deepest learnings’ (1883/1967: 71). The idea that we apprehend our world in a direct and bodily way leads Heidegger (1926/1962) to state that we are always ‘in a mood’. By this, he

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22 Existential Therapies does not mean that we are always grumpy or irritable, but that human existence is intrinsically attuned to its world. Furthermore, these moods – as immediate, intuitive ways of recognising particular facts (Warnock, 1970) – give us vital access to the truth of our being (Guignon, 2002).

Existence as anxious Of all the moods that can help us recognise the truth of our being, existential philosophers – most notably Heidegger (1926/1962) and Kierkegaard (1844/1980) – have placed particular emphasis on anxiety. Whilst it may seem that existing as a unique, no-thing-like, freelychoosing happening is relatively agreeable, existential philosophers have argued that such a being-ness brings with it profound feelings of dread and angst – particularly the fact that we are freely choosing beings. ‘[F]reedom’s possibility announces itself in anxiety’, writes Kierkegaard (1844/1980: 74); and he goes on to argue that the more someone acknowledges and acts on their freedom, the more they will experience angst. Why should this be the case? First, as Yalom puts it, ‘alternatives exclude’ (2001: 148). In choosing one thing, I am always choosing against something else, and there is always the possibility that I will choose against the better alternative. In choosing to study existential therapy, for instance, I am choosing against studying psychodynamic therapy or Gestalt therapy, and there is always the possibility that the other alternatives would have been preferable. For Sartre (1943/1958), what makes these choices particularly serious is the fact that I not only choose for myself, but for others as well. If, for instance, I decide to quit my job, then my partner and children are implicated in that decision – as are my colleagues and my students. Hence, whilst I, alone, am responsible for my decisions, I carry a responsibility to the rest of the world on my shoulders. No wonder, then, that Sartre describes human beings as ‘condemned’, rather than ‘blessed’, to be free. From an existential perspective, what further exacerbates this anxiety is the fact that we have nothing solid on which to base these choices. As Sartre (1943/1958) argues, we have no fixed identity, no given meanings to guide us – or on which we can blame our choices. Like a person lost in the jungle, we are forced to cut our own path through life, with no directing signs or maps to point us in the right direction. Indeed, from a Heideggerian (1926/1962) perspective, the most fundamental anxiety comes from a realisation that all those signs and maps that we thought were givens are ultimately only socially agreed conventions. With a flash of dread, we realise that all those activities we assumed were intrinsically meaningful – the way we do our jobs, the way we treat our friends, the way we think and write – have no ultimate grounding, and could easily be other. It is as if we suddenly realise that our whole world is nothing but

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a theatre stage and we are merely playing a part: absorbed in a world of empty constructs and roles that only give the illusion of some ultimate meaning-motivating action (Dreyfus, 1997). From an existential perspective, however, is not only freedom and nothingness that brings with it anxiety, but also the fact that our existence runs up against unmovable boundaries, such as death and chance. Indeed, it is only because of these boundaries that our choices are infused with angst. If, for instance, I could train in every psychotherapeutic discipline, I would not worry about choosing existential therapy over gestalt therapy. But because my life – and finances – is finite, a choice for one thing means a choice against something else. In other words, anxiety is the ‘dizziness of freedom’ (Kierkegaard, 1844/1980: 61) in the face of limitations.

Existence as guilty For Heidegger (1926/1962), freedom not only brings with it anxiety, but also guilt. Here, Heidegger is not using ‘guilt’ in the traditional sense of having wronged others, but in the sense of having wronged oneself: of having failed to fulfil one’s ownmost potential. (Yalom (1980) suggests that we might think of such existential guilt as ‘regret’ or ‘remorse’.) For Heidegger, such guilt is unavoidable. As we have seen, in making choices we are always excluding certain alternatives, such that we are always in debt to ourselves for not carrying out all our possibilities in life. In other words, we always lag behind who we might have been. In choosing to follow an academic path, for instance, I renounced the possibility of developing my skills as a journalist. Such a possibility continues to haunt me: perhaps I could have been the editor of Time Magazine by now – I will never know. From an existential perspective, however, one thing is certain: were I the editor of Time Magazine, I would still be experiencing guilt about something else, such as my failure to actualise my teaching potential.

Existence as inauthentic From an existential perspective, then, anxiety and guilt – as well as other ‘negative’ feelings, such as dread, despair, unsettledness and a sense of absurdity – are responses to the reality of our human condition. It is also argued, however, that few of us welcome the emergence of such feelings. Rather, we try to quell them; and we do so by turning a blind eye to the reality of our existence, pretending to ourselves that things are other than they really are. Heidegger (1926/1962) refers to such self-relating as ‘inauthentic’, whilst Sartre (1943/1958) writes of ‘self-deception’ or ‘bad faith’. At the heart of such self-deception is a denial of our freedom and responsibility, and we may do this in a number of ways. Supposing, for

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24 Existential Therapies instance, that in the midst of my annual diet I am visited by a friend who brings with him a large bar of chocolate. I am then faced with a choice: do I eat some of the chocolate and undermine my diet, or do I commit myself to spending the whole evening staring longingly at it? One strategy that I may adopt to attenuate the anxiety that this choice evokes is to turn myself into a ‘thing’ (Sartre, 1943/1958). For instance, I may tell myself that I am ‘someone with no will-power’, such that the eating of the chocolate becomes a fait accompli. Alternatively, I may tell myself that I am ‘a committed dieter’, such that there is no chance of me eating the chocolate. Either way, by turning myself into a object-like thing, I am denying the reality that, at that point in time, I am entirely free to choose how I behave and am neither compelled to behave in one way or the other. If I subsequently eat the chocolate, I may then adopt a number of strategies to deny my responsibility for doing so. For instance, I may blame my friend for bringing the chocolate around; or I may blame it on some unconscious, inner urge: ‘I just couldn’t stop myself’. Adhering to an ideology or dogma may be another form of denying my true freedom and responsibility. I might say to myself, for instance, that inner desires should always be followed – such that there is no question of choice whenever they emerge. From an existential perspective, another means of denying the freedom and responsibility that I, as an individual, hold, is by falling in with the crowd. I might think to myself, for instance, that if my friend is eating the chocolate, then it is probably best if I do the same. That way, I do not need to think for myself, but can simply adhere to the behaviours and values of others. For Heidegger (1926/1962), the essence of inauthenticity is such a falling in with the world of ‘the One’, but it is important to remember here that he is not simply talking about conforming. Rather, he means the tendency to fall in with the socially agreed nexus of meanings, and to take them as givens, rather than realising their fragileness and contingency. It is not just a question, then, of me eating the chocolate as my friend is doing; rather, it is my falling in with the whole world of dieting, and the fact that I do not question whether being thin is really so meaningful. I have simply assumed I should try to lose weight, rather than questioning the whole validity of this cultural assumption. Here, it is important to note that, for Heidegger, we do not start off as true to ourselves and only later become inauthentic. Rather, from his perspective, we are primordially fallen into the social world, and can only subsequently start to gain some distance from it. Self-deception may also involve trying to deny the given restrictions and limitations of our lives. I know, for instance, that my friend’s chocolate bar is enormously high in calories, but I may try to pretend to myself that things really aren’t quite so fixed. I might say to myself, for instance, that it’s probably a relatively low-calorie chocolate, or that the peanuts in it reduce the calorific intake. In terms of denying the givens, Heidegger

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(1926/1962) puts particular emphasis on the way that we tend to deny our impending demise. We talk of death, for instance, as something that only happens to other people; or we paint the faces of the deceased for funeral viewings, such that we can pretend death is a peaceful state of slumber, rather than the complete absence of all existence (Farber, 2000). Indeed, for Sartre (1943/1958) bad faith is ultimately a continual slippage between a wholly deterministic understanding of our being and a wholly volitional one. We veer from seeing ourselves as totally determined to seeing ourselves as totally free, such that we can never get pinned down to the anxiety-evoking reality of our being: that we are free to choose within a given set of limitations. From an existential perspective, then, human beings have a tendency to try and hide from the reality of their existence; but, they argue, we pay a heavy price for such self-deception. For philosophers like Heidegger (1926/1962) and Sartre (1943/1958), when we deny our freedom and responsibility, we also deny our possibility of freely choosing towards our own future, and actualising our ownmost potentiality for being. Instead of developing our unique possibilities, we become ‘levelled down’: ‘dispersed’ within a public world that reduces everything down to a bland, uniform averageness. Here, we lose the possibility of a life infused with passion, creativity and vitality, and instead become deadened, domesticated, tranquillised and alienated from ourselves (Guignon, 2002). In essence, we live only half a life rather than a full one. Moreover, because we are not engaging with life as it really is, we are less capable of meeting the challenges and givens that will inevitably confront us. And finally, because the reality of our existence does not go away, the defences that we erect to protect ourselves against it will inevitably falter. Here, existential anxiety and guilt become neurotic anxiety and guilt (Tillich, 1952/2000), and we will explore these processes more fully in Chapter 5.

Existence as authentic How, then, can we forge a life that is intense, passionate and whole? In moving towards a more authentic way of being, Heidegger (1926/1962), like many other existential philosophers, has emphasised the importance of adopting an attitude of courage and resolve: a willingness to ‘stand naked in the storm of life’ (Becker, 1973: 86). In particular, it has been argued that we need to be willing to face our anxiety. For Kierkegaard, the courageous person does not shrink back when anxiety announces itself, ‘and still less does he attempt to hold it off with noise and confusion; but he bids it welcome, greets it festively, and like Socrates who raised the poisoned cup, he shuts himself up with it and says as a patient would say to the surgeon when the painful operation is about to begin: Now I am ready’ (1844/1980: 156).

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26 Existential Therapies Through facing up to such anxiety, we are ‘jerked’ out of our pseudosecurities – out of our absorption in pseudo-familiar tranquillity (Macquarrie, 1972: 131) – and summoned to face our ownmost freedom and possibilities (Heidegger, 1926/1962: 232). In this respect, then, anxiety – at least of the existential sort – is not irrational or a sign of pathology, but a teacher and guide. ‘Whoever has learned to be anxious in the right way’, writes Kierkegaard, ‘has learned the ultimate’; and he goes on to state that ‘the more profoundly he is in anxiety, the greater is the man’ (1844/1980: 155). In the example of choosing whether or not to eat the chocolate, then, adopting an attitude of resolve means putting to one side attempts to attenuate my anxiety. It means acknowledging the fact that this is a difficult decision for me: that I really do want to stick to my diet and have an enjoyable evening. It also means, however, being willing to leap into one choice or the other despite the anxiety – of committing myself to a particular path in the knowledge that it may not be the right one. In this respect, an attitude of resolve also involves courageously facing one’s existential guilt. As we have seen, to some extent, we will always experience a sense of guilt over our unfulfilled possibilities, but the more that we hide from our freedom and potentiality, the more this sense of guilt will grow. For Heidegger (1926/1962), this guilt is revealed to us in the call of our ‘conscience’: ‘an abrupt arousal’ that calls us back to ourselves, that reminds us of our debt to our own being. It is a summons – albeit a silent one – out of our lostness in the One. And although, for Heidegger, we can never entirely stand outside of the nexus of social meanings, we can ‘choose to choose’ which social practices and possibilities we take up, rather than blindly falling in with Others. Like existential anxiety, then, existential guilt is not considered a negative experience, but a mentor on the path towards greater freedom. ‘The more profoundly guilt is discovered,’ writes Kierkegaard, ‘the greater the genius’ (1844/1980: 109). Existential philosophers have also argued that an authentic selfrelational stance involves resolutely facing the fact that there are no ultimate grounds for our projects, meanings and interpretations. This is not to suggest, however, that we should adopt a nihilistic or hopeless attitude towards life. As Camus (1942/1955) states, we can still live and create in the very midst of a desert. A resolute attitude, then, means committing ourselves to projects despite their absurdity. It involves ‘a decisive dedication to what we want to accomplish for our lives. And our stance towards the future is that of “anticipation” or “forward-directedness”: a clearsighted and unwavering commitment to those overriding aims taken as definitive of one’s existence as a whole’ (Guignon, 1993: 229). Camus likens this commitment-in-absurdity to the activities of the mythological Sisyphus, who is condemned by the Greek gods to ceaselessly roll a rock to the top of a mountain, whereupon the stone falls back under its own weight. Sisyphus’s task is absurd, unceasingly meaningless, and yet he does

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not falter or give up. ‘The struggle itself towards the heights is enough to fill a man’s heart’, writes Camus (1942/1955: 111); and he suggests that, through being conscious of his fate, Sisyphus gains a strength and dignity, such that he can descend the mountain in joy as well as sorrow. In adopting a more authentic self-relational stance, Heidegger (1926/1962) also puts particular emphasis on resolutely facing our mortality. Here, however, he is not suggesting that we should be broody or pessimistic, but that we should live every day in the knowledge that we are moving towards an inevitable – and indeterminable – ending. For him, it is through such an acknowledgement that we can make the most of our days: it is as if we darken the background behind our existences such that the foreground of our being comes to light more fully. To know that our existences may end at any moment also means that we can not continually defer our choices and projects. It means that we must get on with life. Furthermore, in acknowledging our beingness-towards-death, we are lifted above the world of the One; for, according to Heidegger, our being-towards-death is the one journey that we must take alone. No one can die for us, no public body or group of friends can protect us from our inevitable demise (Hoffman, 1993), and no-one else can draw together the totality of our lives in the face of this final ending. Hence, through acknowledging that we are on an individual and unique journey towards death, we also come to realise the individuality of our lives, and with it the possibility of actualising our ownmost potential. In striving towards a more authentic way of being, many other existential philosophers have also emphasised the importance of distancing ourselves from ‘the crowd’. For Kierkegaard (1846/1992) our true and highest task is to be a single individual: to turn towards ourselves, to think for ourselves, and find truth in aloneness rather than in ‘chumminess with others’. This authentic individual, for Kierkegaard, has a great love of, and need for, solitude, and he compares him to those ‘“Utterly superficial nonpersons and group people”’ who experience ‘such a meagre need for solitude that, like lovebirds, they promptly die the moment they have to be alone’ (1849/1980: 64). For Kierkegaard, then, ‘Everyone should be chary about having dealings with “others” and should essentially speak only with God and with himself’ (quoted in Buber, 1947: 208). Similarly, for Nietzsche, ‘the one essential for the morally adult man is to create his own values and reject the stock morality of his group’ (Warnock, 1970). To be authentic is to be true to one’s own ideals, values and beliefs rather than those of ‘the herd’.

Towards otherness For some existential philosophers (such as Sartre, 1943/1958), authenticity tends to end here: with a commitment to one’s own projects and

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28 Existential Therapies possibilities in the face of absurdity. As we have seen, however, for many philosophers of existence, such as Buber (1923/1958), human existence is not a self-contained phenomenon, but something that reaches out beyond its own being. From this standpoint, then, to exist authentically is to acknowledge and actualise one’s connectedness with something – or someone – beyond one’s own self. For Kierkegaard, for instance, resolutely facing one’s anxiety and withdrawing from the crowd were not ends in themselves, but first – albeit essential – steps on a journey towards an authentic relationship with God (Macquarrie, 1972). Tillich (1952/2000), too, highlights the possibility of moving beyond self-acceptance towards acceptance by a transcendent other; and, like Kierkegaard, challenges traditional conceptions of faith and God. For Tillich, absolute faith is not a belief in some kind of concrete, ego-like patriarch – or what Kierkegaard calls a ‘super-father Christmas’ (1849/1980: 123) – rather, it is an openness to ‘the God above the God of theism’ (Tillich, 1952/2000: 186). Tillich describes this God above Gods as a kind of acceptance or forgiveness, a transcendence that can not be demonstrated or proved. For him, then, absolute faith is the ‘acceptance of acceptance without somebody or something that accepts’ (1952/2000: 185): it is an openness to being accepted and forgiven, even though one cannot identify the source of that unconditional love. Another philosopher of existence who has placed great emphasis on the transcendence of the self towards God is Buber. In direct contrast to Kierkegaard, however, Buber (1947) argues that the way to God is not through renouncing relationships with others, but through developing closer and more intimate interpersonal relationships. For Buber, God is the ‘eternal Thou’, the ‘Centre’ where the ‘extended lines of relation’ meet (1923/1958: 99); hence, in developing and maintaining I–Thou relationships with other human beings, he suggests that we have an imminent and immediate experience of God. Buber argues, then, that ‘the inmost growth of the self is not accomplished, as people like to suppose today, in man’s relation to himself, but in the relation between one and the other’ (1965/1988: 61). For Marcel (1949) – whose brand of existential philosophy shares many similarities to Buber’s – such a reciprocal relationship of presence also requires a fidelity to the Other: a faith in the presence of an other-than-me to which I respond, and to which I continue to respond (Blackham, 1961). For Marcel, such fidelity is ‘like the faithful following, through darkness, of a light by which we have been guided and which is no longer visible to us directly’ (1949: 72). It is an unwavering loyalty to the other, whether human or supra-human. For Marcel, such fidelity also involves an ‘availability’ to the other: a being at the ‘disposal’ of the Other when they are in pain or in need; and a ‘receptivity’ to the Other: in the sense that one might actively receive a guest. Marcel writes that such an understanding of human existence and relating is a way out of the ‘extravagantly

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dogmatic negativism which is common to Sartre, to Heidegger and even to Jaspers’ (1949: 65), in that it forms the basis for a genuine hope. Through loving and being loved by something outside of myself, my existence no longer feels superfluous, but ‘upheld’, ‘willed’ and ‘justified’. In his later writings, Heidegger also emphasises the importance of an openness to something beyond the self – an emphasis which balances his earlier focus on resolve (van Deurzen, 1998). For him, however, this something is not God, but Being itself. Human beings, as we have seen him suggest, are the ‘shepherds’ of Being (1947/1996); in his later writings, he outlines a stance by which Daseins can authentically fulfil this role. This is an attitude of Gelassenheit, which might be translated as a stance of ‘abandonment’ or ‘releasement’ towards things (Macquarrie, 1972). It is a non-manipulative, non-imposing way of lettings things be what they are, an openness to the Being of beings, a meditative ‘letting-oneself-intonearness of Being’ (Heidegger, 1959/1966). Such a way of being accords with a meditative form of thinking: a waiting upon thoughts to come, rather than a wilful generation of ideas and representations. It is also a form of thinking characterised by composure, calmness and concern – a slowing down of pace – and contrasts with ‘calculative’, scientific thinking, which manipulates its world and races from one idea to the next.

The tensions, dilemmas and paradoxes of existence From the preceding sections, one might conclude that existential philosophers have proposed an essentially linear view of human development: that human beings, fallen into a world of inauthenticity and alienation, have the possibility of recovering themselves through an attitude of resolve and openness to others. In many respects, however, existential philosophy arose as a reaction to those modernist narratives – most notably Hegel’s philosophical system – that place human beings, both collectively and individually, on an ever-forward-moving path. From an existential perspective, life is not a unidirectional process; rather, it is caught in a web of manifold tensions. There is, for instance, the tension between freedom and limitations, between self and others, between the I–Thou and the I–It (Buber, 1923/1958), and between hope and despair (Marcel, 1949). Furthermore, at the heart of an existential outlook is the assertion that there are no intrinsically ‘right’ answers. Rather, there is only a constant pull from one side to the other. Such tensions are paradoxes: contradictions that cannot be overcome. Jaspers calls these ‘antinomies’ and writes that ‘They are not resolved but only exacerbated by clear thinking, and solutions can only be finite, can resolve only particular conflicts in existence, while a look at the whole will always show the limiting insolubilities’ (1932: 218).

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30 Existential Therapies Ultimately, even authenticity and inauthenticity can be seen as two poles of a dilemma, neither of which are intrinsically ‘better’. Heidegger (1926/1962) explicitly rejects the idea that a moral judgement is associated with either of these terms, as well as the idea that authenticity is some kind of goal that we can attain. Rather, as Moran (2000) suggests, authenticity is probably best understood as something that we may have moments of: for we can never stand naked in anxiety for more than a flash of time before falling back into a more comfortable and protected state of being (Tillich, 1952/2000). From an existential perspective, then, authenticity should not be perceived as the end-point of some linear journey, like the summit of a mountain that we can reach and rest upon. Rather, as in Camus’s (1942/1955) myth of Sisyphus, it is probably better understood as those moments of insight and awareness in which we face up to the reality of our condition and possibilities, before falling back in to the world of everyday understandings and practices.

Critical perspectives Criticising existential philosophy, as a whole, is not an easy task because of the great diversity of existential viewpoints. As Macquarrie writes, ‘Criticisms that may be very much to the point as regards some form of existentialism miss the mark when extended to others’ (1972: 219). Nevertheless, a number of general criticisms have been – and can be – made. First, there would seem to be something of a contradiction between the anti-essentialist starting point of existential philosophy, and its attempts to describe the characteristics of human existence. Specifically, ‘if each individual existent is unique and can not be regarded as a specimen of a class, how can one generalise about human existence, as a philosophy of existence seems compelled to do?’ (Macquarrie, 1972: 55). To suggest, for instance, that human existence is a being-towards-death (Heidegger, 1926/1962) would seem to be putting universal statements about human existence before the concrete individuality of each unique human existence. Macquarrie counters this critique by suggesting that what existential philosophers are describing here is not the properties of human existence, but their possibilities. In other words, existential philosophers have not attempted to reduce human existence down to a set of finite, essential characteristics, but rather to build it up through outlining some of the interwoven layers of human complexity. There is no suggestion, then, that existence is ‘nothing but’ being-towards-death, embodied and so on. Rather, existential philosophers have suggested that existence is an embodied-anxious-being-towards-death, ad infinitum. Furthermore, as Boss (1963) points out, these characteristics of human existence are not seen as being abstract-able from the human context: something that can float on a metaphysical realm of their own, like an IQ or an ego. Rather, they are inextricably bound to the factually observable, concrete behaving

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human being. Nevertheless, there is an undeniable tension within existential philosophy between the emphasis on universal characteristics, and the emphasis on unique, personal ones, and this is something that also arises in the existential approaches to therapy. This leads on to the identification of a second contradiction that is apparent in some of the earlier, more proselytising, existential writings. On the one hand, there is the invitation to turn away from the crowd and towards one’s ‘innermost truths’ (for instance, Kierkegaard, 1846/1992); yet such an invitation, in itself, would seem to be an admonishment to follow a particular path. Neither Kierkegaard nor Nietzsche were blind to this contradiction, and Nietzsche specifically implored people to find their own way rather than following his. Nevertheless, in the writings of some existential philosophers, there would seem to be scant respect for those who choose a life of conformity, passionlessness or obedience. A third criticism frequently levelled at existential philosophy is that it is essentially amoral (Macquarrie, 1972). In emphasising human freedom, the self-creation of values and the lack of any absolutes, it has been argued that existential thought is an ethic-less, ‘anything goes’ philosophy in which values such as justice, equality and beneficence can no longer be privileged over their opposites. Heidegger’s well-documented flirtation with Nazism in the 1930s does much to reinforce these concerns about the morality of existential philosophy; although it must be remembered that many other existential philosophers, such as Sartre and Camus, took an active stand against fascism. In responding to these charges of amoralism, however, it can be argued that the very foundations of existential philosophy are ethical ones: that human beings should be seen and treated as human beings, and not as a collection of bit-parts or deterministic mechanisms. A fourth criticism of existential philosophy is that it is overly-morbid: that it tends to focus on such experiences as despair, anxiety, guilt and a facing up to death, to the neglect of more positive and pleasurable experiences. As Schrader writes: ‘Some readers have concluded that to be an existentialist one needs simply to accentuate in a rather brooding way the darker side of life and cosmologize his anguish’ (1967: 13). As we have seen, however, some existential philosophers have written about the more positive moods, such as joy and hope (for instance, Marcel, 1949). Furthermore, those existential philosophers who do tend to place greater emphasis on the more ‘negative’ experiences do not see these as ends in themselves, but as aspects of a more fulfilling, intense and alive way of being. Indeed, the emphasis on ‘negative’ experiences is often an attempt to counterbalance the tendency within modern culture to deny the more painful and discomforting sides of our lives. Existential philosophy, then, is less a philosophy of doom and despair, and more a philosophy of balance (Kohn, 1984: 385). This issue of balance is also a response to a fifth criticism of existential philosophy: that in prizing passionate inquiry over objectivity and systematic thinking, it is essentially irrationalist (Macquarrie, 1972).

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32 Existential Therapies Again, there is some truth in this: existential philosophers have emphasised the importance of being open to the non-rational and mysterious (for instance, Marcel, 1949). This is not, however, a rejection of the rational, but an attempt to see the other side of it. As Macquarrie writes: ‘Existentialism at its best is neither irrational nor anti-rational but is concerned rather with affirming that the fullness of human experience breaks out of the confines of conceptual thought and that our lives can be diminished by too narrow a rationalism’ (Macquarrie, 1972: 221). At the other end of the scale, however, is an equally serious criticism, and one that has, perhaps, been the most significant factor in the recent decline of existential philosophising. Existential philosophy is fundamentally grounded in the assumption that existence is real, that it is a phenomenon that is there, and which transcends the particular words or discourse we use to describe it. In recent years, however, postmodern philosophers such as Derrida (1974) and Lyotard (1984) have argued that any knowledge is always contained within a particular language system or ‘discourse’, and that it is not possible to stand outside of this system and prove the reality of a phenomenon. In other words, we cannot go beyond the bounds of our language to show that existence really exists – it is, ultimately, only a particular narrative that we adopt. This criticism has serious repercussions for a philosophy that invites people to authentically acknowledge their true existence, and is by no means easy to respond to. Indeed, to answer in words the postmodern critique would be to prove the very postmodern point: that our arguments are always constrained within the boundaries of language. Nevertheless, what is important to note is that, whether it is real or not, human beings’ existences are of great significance to themselves. Hence, even if we cannot prove that existence exists, we can certainly show that it is of great relevance to human beings – and thus to the process of therapy (M. Cooper, 1999). It is perhaps no surprise, then, that whilst little new existential philosophy has been developed over the past half-century, existential ideas have increasingly spread into the therapeutic arena.

Conclusion Existential philosophy, by its very nature, is a vast and sprawling edifice, replete with debates, contradictions and half-completed arguments. As we have seen, however, what each philosopher of existence shares is a concern with the nature of human existence: that unique, concrete, indefinable totality. Existential philosophers have depicted this existence in many different ways, but what is common to each of their descriptions is a radical challenge to many of our contemporary assumptions about what it means to be human. At times, these challenges can be more destructive than constructive, but together they create a radically new, and radically humanising, image of what it means to exist. What better foundations,

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then, on which to construct the most human of professional practices: counselling and psychotherapy.

Notes 1. In this book, I have used the term ‘existential philosophy’ to refer to a particular philosophical stance or style of philosophising, also referred to as ‘existentialism’ (Macquarrie, 1972) or ‘existentialist philosophy’ (D. E. Cooper, 1999). It should be noted however, that the term can also be used in a broader sense. For instance, van Deurzen (2002c) uses the term ‘existential philosophy’ to refer to all enquiries into the question of how to live a better life, of which the existential philosophy discussed in this chapter is just one part. 2. As Dreyfus (1997) suggests, I have used ‘the One’ – as is ‘one does ...’ – rather than ‘the they’ throughout this book, as the latter term can imply that the self is not part of this social order.

Further reading Introductions and overviews Guignon, C. B. (1988) ‘Existentialism’, in E. Craig (ed.) Routledge Encyclopedia of Philosophy (vol. 3). London: Routledge. Very brief, but enormously lucid, accessible and incisive summary of existential thought. Macquarrie, J. (1972) Existentialism. Harmondsworth: Penguin. Uniquely accessible, comprehensive and coherent account of key themes and debates within existentialism. If you only ever read one book on existential philosophy, make it this one. Warnock, M. (1970) Existentialism (rev. edn). Oxford: Oxford University Press. Classic introduction to the writings of Kierkegaard, Nietzsche, Husserl, Heidegger, Merleau-Ponty and Sartre. Cooper, D. E. (1999) Existentialism (2nd edn). London: Routledge. Contemporary overview of existential thought. Van Deurzen-Smith, E. (1997) Everyday Mysteries: Existential Dimensions of Psychotherapy. London: Routledge (Chs. 1–6). Useful summary of the ideas of key existential philosophers and their relevance to therapeutic practice. Spinelli, E. (1989) The Interpreted World: An Introduction to Phenomenological Psychology. London: Sage. Very clear introduction to phenomenology, specifically orientated towards therapists and psychologists. Moran, D. (2000) Introduction to Phenomenology. London: Routledge. Comprehensive, accessible and in-depth introduction to the writings of Husserl and the key phenomenologists, including such existential-phenomenologists as Heidegger and Merleau-Ponty. Cohn, H. W. (2002) Heidegger and the Roots of Existential Therapy. London: Continuum. Clearly and simply outlines some of Heidegger’s key concepts and their implications for therapeutic practice. Polt’s (1999) introduction to Heidegger is a more in-depth, and brilliantly lucid, introduction to his works, as is Dreyfus’s Beingin-the-World, which systematically outlines key aspects of Heidegger’s thinking.

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34 Existential Therapies Original texts None of the books below are easy, and some can seem impenetrable at times, but there is nothing like reading a philosopher’s original works to give you a sense of his or her outlook and style of philosophising. Don’t worry too much if you can’t understand all of what you read – or even most of it – some of the greatest minds of our century have struggled with these texts. Friedman, M. (ed.) (1964) The Worlds of Existentialism: A Critical Reader. Chicago: University of Chicago Press. Anthology of existential writings, with a whole section on existentialism and psychotherapy. Kaufman’s (1975) anthology has fewer readings, but they are more in depth. Heidegger, M. (1962) Being and Time. (Trans. J. Macquarrie and E. Robinson.) Oxford: Blackwell. (Original work published 1926.) Probably the single most important and influential existential text. Brings to the fore the question of existence, highlights its ‘in-the-world’-ly nature, and outlines its authentic possibilites. Tough-going, but enormously stimulating and thought-provoking. Stambaugh’s (1996) more recent translation has been very well received. Sartre, J. P. (1958) Being and Nothingness. (Trans. H. Barnes.) London: Routledge. (Original work published 1943.) Turgid, dense and highly inaccessible, but Sartre’s magnum opus provides a brilliant analysis of the human condition – in all its freedom, absurdity and nothingness – and is one of the most significant existential texts. Merleau-Ponty, M. (1962) Phenomenology of Perception. (Trans. C. Smith.) London: Routledge. (Original work published 1945.) Merleau-Ponty’s most important work, emphasising the fundamentally embodied nature of human existence. A brilliant and original analysis, but extremely tough-going. Camus, A. (1955) The Myth of Sisyphus. Harmondsworth: Penguin. (Original work published 1942.) Camus’s key philosophical work. Succint and relatively accessible, asks whether life is worth living, and concludes that human beings can still create meaning and an intensity of living in a meaningless universe. Kierkegaard, S. (1992) Concluding Unscientific Postscript to Philosophical Fragments. (Trans. H. V. Hong and E. H. Hong.) Princeton, NJ: Princeton University Press. (Original work published 1846.) Generally recognised as Kierkegaard’s magnum opus, emphasising the subjective, individual nature of truth and the path towards God. Turgid and tough-going, but surprisingly humorous at times, and with remarkably vivid insights into the human condition. Nietzsche, F. (1967) Thus Spake Zarathustra. (Trans. T. Common.) London: Allen and Unwin. (Original work published 1883.) Nietzsche’s classic work, filled with aphorisms on the body, courage and the will to power. Buber, M. (1958) I and Thou (2nd edn). (Trans. R. G. Smith.) Edinburgh: T & T Clark. (Original work published 1923.) Poetic, passionate and relatively accessible – Buber’s essential work contrasting the I–Thou and I–It ways of being. Tillich, P. (2000) The Courage to Be. New Haven, CT: Yale University Press. (Original work published 1952.) Popular and relatively accessible work that advocates a stance of courageousness and faith in the face of moral, spiritual and ontological non-being. Heidegger, M. (1966) Discourse on Thinking. (Trans. J. M. Anderson and E. H. Freund.) London: Harper Colophon Books. (Original work published 1959.) Relatively accessible introduction to, and presentation of, Heidegger’s later thought: contrasting ‘meditative’ and ‘calculative’ thinking.

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3. Daseinsanalysis: Foundations for an Existential Therapy

It is something of a paradox that one of the earliest attempts to develop an existential approach to therapy is grounded in some of the latest existential thinking. Daseinsanalysis draws almost exclusively from Heidegger’s later teachings (Cohn, 2002a) and, as such, places a great deal of emphasis on helping clients to open up to their world. This makes it very distinctive amongst the existential therapies. What also makes it very distinctive is the depth and thoroughness with which it has critiqued the theoretical foundations of classic Freudian psychoanalysis. Ludwig Binswanger (1881–1966), a Swiss psychiatrist, founded the Daseinsanalytic movement in the early 1930s. Binswanger was a close friend of Freud, but felt that Freud’s attempts to understand human beings scientifically had led him to reduce people to a distinctly inhuman collection of causal mechanisms, instincts and formulae (see Binswanger, 1963). Binswanger also felt that Freud had split human beings off from the world that they inhabited – referring to this subject–object divide as ‘the cancer of psychology’ (Spiegelberg, 1972). In an attempt to construe a more dignified and holistic understanding of human existence, Binswanger turned to the work of such existential-phenomenological philosophers as Husserl, Buber and Heidegger, and developed an approach that he termed ‘Daseinsanalyse’ or ‘phenomenological anthropology’. Here, he attempted to describe the nature of human psychopathology in terms of the sufferer’s way of being-in-the-world – a descriptive enterprise that did not attempt to reduce human suffering to deterministic, world-less mechanisms. Drawing on Buber, Binswanger also critiqued, and attempted to develop, Heidegger’s work on interpersonal relationships, arguing that the highest and most original form of human existence is the reciprocal love relationship: the ‘dual mode of love’ (Frie, 1997). It was one of Binswanger’s followers, the Swiss psychiatrist Medard Boss (1903–1990), however, who was to become the pivotal figure in the development of Daseinsanalysis. Whilst Binswanger was primarily interested in understanding psychopathology from an existential and phenomenological perspective, Boss went on to consider the implications of Heideggerian thought for therapeutic practice. Binswanger’s denunciation by Heidegger (2001) – for fundamentally misinterpreting Being and

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36 Existential Therapies Time in individualistic and subjectivistic terms – also led to his increasing marginalisation within the Daseinsanalytic movement. In contrast, Boss maintained a close friendship and collaboration with Heidegger for many years; and, between 1959 and 1969, hosted a series of seminars by his mentor (Heidegger, 2001). Even in his later years, Boss felt that there was nothing that he could criticise or modify in Heidegger’s thought (Craig, 1988b). Indeed, such was Boss’s devotion to Heidegger that one of Boss’s key works, Existential Foundations of Medicine and Psychology (1979), was written under Heidegger’s watchful eye. In 1971, Heidegger encouraged Boss to establish the first Daseinsanalytic training institute: the Daseinsanalytic Institute for Psychotherapy and Psychosomatic Medicine in Zurich, Switzerland. Today, several further Daseinsanalytic training institutes have been established across mainland Europe. Gion Condrau, director of the original Zurich Institute, is now one of the key international proponents of Daseinsanalysis, and has made many steps to popularise and broaden the appeal of this approach. Recent years have also witnessed the growth of the Swiss Society for Daseinsanalysis, which has provided a second focal point for the Daseinsanalytic movement: one that is less wedded to a strictly Heideggerian and Bossian viewpoint (Craig, 2001, personal communication). Unfortunately, few of the writings of this new school of Daseinsanalysis have been translated into English. There are, however, a handful of papers in a special edition of the Humanistic Psychologist (edited by Eric Craig) that give a flavour of this emerging approach (Holzhey-Kunz, 1988; Kastrinidis, 1988).

Influences As indicated above, Daseinsanalysis is almost exclusively grounded in the philosophical perspective of Martin Heidegger, and particularly the perspective that he developed in the later years of his life (when he was most closely in contact with Boss). Indeed, the name of the approach, ‘Daseins-analysis’, makes it clear that it is primarily concerned with an analysis – in the sense of an exposition – of human da-sein. Daseinsanalysis, then, does not start with the notion of human beings as entities that are separate and distinct from their world. Rather, it starts from the notion of human existences that are fundamentally connected to their world: an ‘openness’ towards Being. Drawing on the later Heidegger, Boss describes human existence as ‘a light which luminates whatever particular being comes into the realm of its rays’ (1963: 37), and it is this understanding of human being that forms the core of the Daseinsanalytic outlook. A second important influence on the development of Boss’s thought and therapeutic practice was his encounter with the teachings of south-east Asian scholars and sages (Boss, 1965). Here, he discovered a world-view

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that, he believed, supported his Heideggerian outlook – particularly its conception of human Dasein as a world-disclosing openness. Indeed, it is probably because of this eastern influence that Boss tends to place a greater emphasis on human existence as an openness to the world than many of his followers within the Daseinsanalytic movement, such as Condrau (1998). A third major influence on the development of Daseinsanalysis was Freud’s psychoanalytic approach, and to a lesser extent Jung’s analytical psychology. Boss claims to have been in training analysis with Freud himself, and for many years practised as a classical psychoanalyst before developing an interest in Jungian analysis in the 1930s. Such a steepening in traditional analytic practice left an indelible mark on Boss’s (1963) Daseinsanalysis, which, in its practical aspects, bears a close proximity to classic Freudian analysis. As with psychoanalysis, for instance, Daseinsanalytic patients traditionally attend three or four times a week, are invited to lie down on a couch, and are encouraged to follow the fundamental rule of ‘free association’: saying whatever passes through their heart or mind, without censorship or exception. Their analyst, meanwhile, listens attentively with ‘evenly hovering attention’ and, as with classic Freudian or Jungian analysis, may be particularly keen to direct her clients towards exploring and understanding their dreams. At the heart of Daseinsanalysis, however, is a vigorous rejection of the theoretical superstructure on which psychoanalytic techniques are based – a rejection that has important implications for how those techniques are implemented. Like Binswanger (1963), Boss (1963; 1979) felt that Freud’s psychoanalytic theory was a ‘conceptual monstrosity’ of inhuman mechanisms, dynamics and parts; superfluous to an understanding of actual lived-existence; and built upon a theoretical superstructure of unverifiable, arbitrary suppositions. The aim of Daseinsanalysis, therefore, was to ‘dispense with the tedious intellectual acrobatics required by psychoanalytic theory’ (Boss, 1963: 234), and instead to develop a grounding for analytical practice that was rooted in the phenomenological lived-actuality of human existence. Indeed, it was Boss’s hope that not only Daseinsanalysts but therapists of all persuasions would eventually turn to his existential-phenomenological foundations as the basis for their therapeutic practice.

From psyche to being-in-the-world Freudian psychoanalysis (Freud, 1923) – like many other forms of psychotherapy, such as Transactional Analysis (Berne, 1961) – is based around the analysis of a ‘psyche’: a self-contained, thing-like entity, within which various parts – such as an id and ego, or adult and child ego-states – exist and interact. In drawing on an existential-phenomenological standpoint, however, Daseinsanalysts fundamentally reject this concept of a

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38 Existential Therapies world-less, isolated psyche, and with it such notions as ‘intrapsychic parts’ and ‘intrapsychic dynamics’ (Boss, 1963; 1979). Not only, then, do they draw on the existential-phenomenological argument that we do not experience existence as a thing inside our head, but they go on to argue that we do not experience existence as a collection of sub-things interacting inside our head, like coloured balls on a pool table. Rather, existence is fundamentally in-the-world, something that emerges at the interworldly, rather than intrapersonal, level. Whilst Daseinsanalysts, therefore, continue to invite their clients to free associate, the way they understand what they are hearing – both during the therapeutic session and later in supervision – tends to be very different from a psychoanalytic, or other psyche-centred, perspective (Boss, 1963; 1979). Gone are attempts to understand clients’ experiences in terms of such intrapsychic parts as id, ego and superego (Freud, 1923). Gone, too, are attempts to understand the clients’ experiences in terms of intrapsychic processes, such as repression, denial and sublimation. Instead, Daseinsanalysts aim to stay with their clients’ in-the-world experiences as they are described. A Daseinsanalyst, for instance, would not speculate as to whether a client who expressed anger towards his partner was speaking from his inner vulnerable child, or whether this anger was an expression of suppressed rage. Rather, he would simply try to stay with the client’s lived-anger-towards-their-world as expressed. This replacement of the psyche with being-in-the-world has major implications for the Daseinsanalytic understanding of psychological difficulties. From a psychoanalytic, or other psyche-centred, perspective psychological problems tend to be construed in terms of conflictual relationships within the psyche: a struggle, for instance, between the critical Parent and the free Child ego-states (Berne, 1961). In Daseinsanalysis, however, psychological difficulties tend to be construed in terms of an individual’s ‘closedness’ to their world. For Boss (1988), the human being is a bundle of possibilities for relating to the world, and ‘mental illness’ is the privation, blocking or constriction of these potentialities. An individual who refuses to trust others, then, would be seen as someone who is closed to the care and concern that others may hold towards them: someone who is only open to others’ maliciousness and aggression. Daseinsanalysts are also particularly interested in the way that such closedness to the world may be expressed in a bodily way: for instance, through a writer’s cramp that stops the person from expressing herself, or through an ulcer which refuses to take in nourishment. Metaphorically, then, the psychologically distressed individual is like a light that only allows itself to shine on a very limited range of surfaces. As the converse to this, psychological health, from a Daseinsanalytic perspective, is construed as a state of openness and letting be – both mentally and physically (Boss, 1963; 1979) – and particularly an openness to loving and trusting others (Condrau, 1998). It is a way of being in which all that ‘stakes a claim’ on the beingness of Dasein can be perceived

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and responded to in all its richness and complexity: an attitude of Gelassenheit (see Chapter 2). This does not mean experiencing everything at once – at any point in time, in any mood, we will always be closed to certain aspects of our world – but it does mean having the openness and flexibility to move around the whole spectrum of world-relating possibilities. Metaphorically, then, the psychologically healthy individual is like a light that can shine itself across the full terrain of its world (see Box 3.1).

BOX 3.1

Illuminating your world

Imagine that you are a light with the potential to illuminate all the different aspects of your world: • Which aspects of your world do you tend towards illuminating? • Which aspects of your world do you tend towards leaving in darkness? As an example, you may feel that you tend towards illuminating the chaotic and unpredictable aspects of your world, but rarely illuminate the more ordered, safe and trustworthy elements. You may find it useful to think about this question in relation to the four dimensions of worldly being outlined in Table 7.1: the natural world (such as your environment), the social world (such as your relationships), the personal world (such as your dispositions) and the spiritual world (such as your values). You may also find it useful to think about this question in relation to your clients: which aspects of their world are they open to, and which aspects do they tend to be closed to?

From unconscious to closedness In rejecting the notion of intrapsychic parts and dynamics, most Daseinsanalysts also reject the notion of an ‘unconscious’ – a part of the psyche which, by its very definition, is not phenomenologically experienced (Boss, 1963; 1979). Daseinsanalysts, as discussed above, accept the idea that human beings may close themselves off to certain aspects of their world, but they totally reject the idea that these aspects are hidden away in some box-like, intrapsychic container; or that forces within this container can cause individuals to feel and behave in certain ways. Whilst Daseinsanalysts, then, might understand a client’s depression in terms of a closedness to worldly beauty and joy; they would not understand this depression as the product of some hidden, internal forces: such as unconscious aggression turned inwards. Rather, the depression would be understood in a purely descriptive, experiential way: as a restricted world-openness that is focused primarily on the dreadful and gloomy.

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40 Existential Therapies This replacement of ‘the unconscious’ with ‘closedness to the world’ has subtle, but important, implications for therapeutic practice. Let us take the example of a client who consistently turns up to sessions ten minutes late, and who accounts for this behaviour by saying that she is simply terrible at time-keeping. Here, a therapist who believes in the unconscious may be inclined to wonder, and encourage his client to wonder, what is ‘behind’ this lateness. Is it, for instance, that she is actually angry with her therapist, and that perhaps this anger is a projection of anger towards her father? By contrast, a therapist who rejects the notion of the unconscious is more likely to trust the client’s awareness of her own experience, and help her develop a deeper and broader understanding of what this experience actually is. For instance, the therapist might ask his client how it feels to be terrible at time-keeping, or, from a Daseinsanalytic perspective, point out to her that she seems closed to generally-agreed time frames. Here, then, the aim is not to help the client find some hidden motive or force that is causing her to behave in a particular way, but to help her develop a greater awareness of her experiences as they are actually experienced.

From transference to real relationships Given that Daseinsanalysts reject the notion of intrapsychic, unconscious dynamics, it should come as no surprise that they also vigorously reject the notion of transference – one of the most cherished of psychoanalytical concepts (Boss, 1963; 1979). For Boss, the idea that clients might transfer onto their therapists feelings and ideas which derive from previous figures in their lives is yet one more piece of psychoanalytic ‘ballast’, which fails to accord with the phenomenological reality of the client’s lived-experiences and degrades the actuality of the therapist–client encounter. Furthermore, it implies that human beings can somehow have neutral, non-transferential relationships with other people – an assumption that contradicts the Heideggerian, intersubjective assumption that human beings are always, inextricably tied up with others in their world. Daseinsanalysts, however, are still very interested in how clients perceive and behave towards their therapists, and what these perceptions and behaviours might say about their wider being-in-the-world (Boss, 1963; 1979). Instead of being interpreted as projections of clients’ feelings towards parental figures, however, they are understood in terms of clients’ openness or closedness towards others. That is, clients, like all human beings, are open to some aspects of the people they encounter in their world and closed to others – and this openness and closedness will be extended to their relationships with their therapists. Hence, if a client treats his therapist as an all-powerful, dominating tyrant, a Daseinsanalyst may wonder whether this client tends to be open to other people’s power and force, but not to their vulnerability and weakness.

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Such an understanding of the client–therapist encounter has important implications for how Daseinsanalysts work with the therapeutic relationship (Boss, 1963; 1979). Rather than wondering – either privately or aloud – whether a client’s behaviour to their therapist is a carry-over from a previous relationship, the Daseinsanalyst is more likely to simply note that the client is open to certain aspects of their being but not to others, and wonder whether this pattern of openness and closedness extends beyond the therapeutic relationship. For instance, a Daseinsanalyst might say to her client, ‘I get a sense that you can see my strengths but not my weaknesses’, or ‘You seem to find it difficult to acknowledge that I don’t have the answers to your questions, and I wonder if you tend to overlook others’ uncertainties too.’ This Daseinsanalytic reinterpretation of transference also has implications for therapists’ general stance towards their clients. From a classic psychoanalytic perspective, the more ‘neutral’ a therapist can be, the more a client’s projections can be discerned upon the ‘blank screen’ of their being. If, from a Daseinsanalytic perspective, however, a therapist can never be other than an integral part of a unique, complex and fundamentally two-way relationship, then it is meaningless to suggest that they should, or would ever be able to, maintain a neutral stance. Hence, from a Daseinsanalytic position, there is little value in the therapist attempting to attain the mirror-like impassivity prescribed – but not always enacted – by Freud (Friedman, 1985); indeed, Boss (1963) suggests that such an attitude is, itself, an inadequate and restricted mode of relating, with the potential to close clients even further to their worlds. Rather, from a Daseinsanalytic perspective, therapists should be genuine and real, capable of modelling for their clients ways of being that are responsive and open to their world. Along similar lines, Boss (1963) suggests that therapists should be supportive and warm, encouraging their clients to ever greater levels of openness. From a Daseinsanalytic perspective, it is an attitude of loving acceptance to all aspects of a client’s existence – an attitude not unlike Rogers’s (1957) ‘unconditional positive regard’ – that plays a major role in helping clients to gradually open themselves up to the totality of their world. A client, for instance, who does not feel judged for saying how much she hates the people in her workplace may gradually be able to open herself up to what is detestable in her world. The aim of the Daseinsanalyst, therefore, is to create a ‘trial world’ in which clients can begin to experience a more open way of being: to create an atmosphere of permissiveness and openness which ‘enables the patient to unfold all his world-disclosing possibilities of relating toward the particular beings which he encounters’ (Boss, 1963: 253). In other words, just as the psychological healthy individual is a shepherd to the Beingness of the world, so the effective therapist is a shepherd to the Being of the client, which allows all of her world-disclosing possibilities to come to light. Indeed,

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42 Existential Therapies such is the importance of creating a permissive environment that Boss sums up the difference between psychoanalysis and Daseinsanalysis by saying that, whilst the former asks the question ‘Why?’ the latter asks the question ‘Why not?’ A therapist, for instance, might ask his client, ‘Why not allow yourself to trust others?’ or ‘Why not allow yourself to talk about what you hate?’ Such a stance of ‘Why not?’ asking also means that, when clients are ‘acting out’ their problems towards their therapists, they may be positively encouraged to do so. Rather than seeing this acting out as the repetition of repressed emotions – as Freud did – Boss writes that ‘Actingout may indicate that something is unfolding for the first time in the analysand’s life. He dares to behave in a manner which has never been permitted him (at least not sufficiently)’ (Boss, 1963: 240). Hence, the Daseinsanalyst ‘will let the acting-out continue to the greatest extent possible without violating his own integrity, inner freedom, and selfless concern for the analysand’ (Boss, 1963: 240). Boss goes on to warn against the dangers of trying to defuse or interpret a client’s acting-out. He writes that it may be experienced by the client as a further prohibition on their behaviour, push them back into a narrowly intellectual mode of relating, or keep them locked in the false hope that if they can find an answer for why they do what they do, all their problems will be solved. To illustrate his approach, Boss (1963) gives the example of a ‘Sadistic pervert’ who experienced intense and, at times, overwhelming feelings of violence towards others. This client had, indeed, attempted to strangle a young woman, but for the vast majority of his existence he restricted himself to an attitude of aloofness, intellectual speculation and cool indifference, fiercely struggling against his world-hating possibilities. For Boss, then, an important part of the therapeutic work involved allowing the client to gradually begin acting out – in a non-physical way – his hatred towards the therapist. He writes: For weeks on end, our work in the analytic sessions consisted in simply allowing the patient to revile the analyst, the entire staff of the asylum, and the world in general. Every time we suspected that he was hesitating before some especially crass insult to ourselves, we encouraged him to still greater bluntness by asking him why he would not speak out. Thus for a long period he was allowed for the first time in his life, and within the safe realm of the analyst–analysand relationship, to learn to know the possibilities of hating the world openly and to appropriate this way of relating to people as belonging to his existence, too. (1963: 195)

Clearly, such openness to a hateful way of relating to the world was not the end-point of this therapeutic process. However, in allowing the client to openly hate the world, the client’s (unsuccessful) attempts to close himself off to hate-disclosing possibilities were diminished. As the therapy progressed, therefore, the client’s battle against his experiencing

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of hate diminished, and that meant that he could open himself up to further ways of relating to his world, such as tenderly and vulnerably (Boss, 1963). For the Daseinsanalyst, however, such an attitude of permissiveness should not be confused with one of complete sympathy or collusion; nor should it be confused with one of ‘doing the work for the client’ (Boss, 1963). Drawing on Heideggerian thought – and, according to Boss, in complete accord with psychoanalysis – Boss suggests that a therapist’s stance towards her client should be one of ‘leaping ahead’ rather than ‘leaping in’ (see Chapter 2). That is, the therapist should anticipate their client’s potential for being and provide a space in which they can come to fulfil it (Condrau, 1998). The therapist should not, however, leap in to rescue, reassure or give the client answers, a form of relating that is seen as having the potential to undermine the client’s own freedom and responsibility.

From causality to choice and freedom Drawing on existential philosophising, another key aspect of classic psychoanalytic thinking that Daseinsanalysts forcefully reject is the notion that a human being’s thoughts, feelings and behaviours are caused, or determined, by their past. States Boss: ‘Any psychological theory that translates a motive or motivational context into a psychic cause or a psychodynamic causal chain destroys the very foundations of human being’ (1979: 152). In other words, the Daseinsanalytic approach is not primarily concerned with the childhood origins of an individual’s distress, but their here-and-now means of relating to their world (Condrau, 1998). This is not to say that Daseinsanalysts reject the idea that an individual’s present is influenced by their past. Indeed, like psychoanalysts, they firmly root the sources of most individuals’ psychological difficulties in early childhood experiences. From a Daseinsanalytic perspective, however, the individual’s life history is ‘formative’ rather than ‘determinative’ (Hicklin, 1988). Boss writes: A Daseinsanalytic study of pathogenesis does not aim to trace phenomena back to causes, but is concerned with discovering biographical incidents which then motivated a human being to conduct himself in a certain way and which still motivate him to perpetuate these modes. Pathogenic, biographical motivating incidents are motives which induce a person to restrict, or partially blind him to, the abundance of his inborn possibilities of relating so that he fulfils only a few neurotic modes of relation to his world. (Boss, 1979: 192)

In line with much psychodynamic and humanistic thinking (Rogers, 1959), Daseinsanalysts construe such pathogenic incidents primarily in terms of inadequate parenting, in which the client feels unloved, criticised

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44 Existential Therapies or punished for experiencing the world in a particular way (Boss, 1988). The individual who trusts no-one, for instance, may have been hurt and betrayed by his parents so many times that, as an adult, he has come to believe that an openness to loving relationships will only lead to more pain. Indeed, according to Daseinsanalysts, if the inadequacy of the individual’s parenting is acute, then the adult may have effectively remained in a child-like state of stunted world-openness (Boss, 1963; Condrau, 1998), closed to more adult and mature possibilities. Here, the role of the Daseinsanalyst is essentially to re-parent the client: to create a permissive, warm environment in which the client can mature properly, with the full plethora of their world-disclosing possibilities intact. The connection that Daseinsanalysts draw between a client’s past and their present also means that Daseinsanalysts will not shy away from helping clients to reflect on their past, and to see how their freedom to experience the full richness and complexity of their world has become malevolently impaired and constricted (Boss, 1963). As with ‘transferential interpretations’, therapists may also help clients to examine the early life experiences that have led them to be open or closed to their therapist in particular ways. A client, for instance, who is closed to their therapist’s caring qualities – as well as the caring qualities of others – may be invited to consider whether this arises from a fear that their therapist’s care and concern, like that of their mother’s, will turn out to be ultimately untrustworthy. Unlike more classic psychoanalytic interpretations, however, Daseinsanalysts would be extremely careful to avoid implying that the client’s present is caused by their past, and would steer clear of such phrases as ‘x made you y’, or ‘because of x you now do y’. As well as being seen as inaccurate, Daseinsanalysts would be concerned that such deterministic invocation would undermine the client’s sense of autonomy and responsibility. In shifting from a causal to a volitional theoretical framework, Daseinsanalysts are also interested in helping their clients examine what choices they have in their world, and perhaps to see that they have more choices than they imagine they do (Boss, 1963). A client, for instance, who feels that his only response to his boyfriend when he feels put down is to become aggressive, may be helped to see that he can also walk out of the room or leave the relationship. Indeed, Condrau goes so far as to say that ‘The entire purpose of the psychotherapeutic relationship lies in mobilizing and directing the capabilities of two persons (the therapist and client) in order to free the one (the client)’ (Condrau, 1998: 36). Such a statement is entirely consistent with the earlier claim that the aim of Daseinsanalysis is to help the client open herself up fully to her world; for, from a Heideggerian (1929/1949) position, to be free is to allow what-is to manifest itself. An individual, for instance, who is only open to the maliciousness of others, is likely to be locked in a rigid pattern of cautious and paranoid behaviours. Were she able, however, to open herself up to the

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full truth of her world, then she would be able to experience and engage with others in a multiplicity of ways.

Daseinsanalytic dream-work Like the classic Freudian and Jungian psychotherapies from which it has evolved, much of Daseinsanalysis is concerned with helping clients to explore, and make sense of, their dreams (Boss, 1957; 1977). Given, however, Daseinsanalysis’s rejection of the unconscious, it should come as no surprise that it also rejects the Freudian assumption that dreams are a symbolic representation of unconscious forces and intrapsychic dynamics. Rather, from a Daseinsanalytic perspective, the manifest content of a dream is simply what it is – a carrot is a carrot – there is nothing behind the manifest phenomena (Boss, 1977). Furthermore, from a Daseinsanalytic perspective, dreams are not considered ‘minor, truncated, spectral, reproductions of waking life’ (Stern, 1977: xv), but modes of experience that are autonomous and authentic in themselves (Boss, 1977). A dream no more points to meanings in waking life than waking life points to meanings in dream: they are two forms of experiencing of equal validity and legitimacy. Nevertheless, from a Daseinsanalytic perspective, what a human being’s dreaming and waking experiences share are relatively similar spectrums of world-openness (Boss, 1977). A woman who dreams of great sexual enjoyment and pleasure, for instance, is likely to be open to that possibility in her waking life too, whilst an individual who lives a ‘neurotically restricted’ life is likely to have only a limited number of sequences and themes in his dreams. Hence, for Daseinsanalysts, the enormous significance of dreams is that they can reveal much about a client’s spectrum of world-openness. This is in two senses. First, it is in terms of what is allowed, or not allowed, to manifest itself in the individual’s dream world. A person who dreams of a kindly old man, for instance, would seem open to experiencing the caring, tenderness of the world; whilst a person who only ever dreams of desolate, uninhabited landscapes would seem closed to the possibility of intimate human contact. Second, it is in terms of how the dreamed-self responds to whatever is revealed in the dream world. A person who dreams of embracing a beautiful peacock, for instance, would seem open to the splendour and exquisiteness of the world, whilst a person who dreams of killing, or running away from, such a bird would seem closed to this worldlysplendour. Daseinsanalysts also seem particularly interested in dreamedentities that are boxed, caged or locked in, pointing to potential ways of being-in-the-world that have not yet achieved their freedom. The significance of dreams for the Daseinsanalyst, however, is not just that they mirror the client’s spectrum of openness and closedness in

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46 Existential Therapies the waking world. Rather, ‘it often happens that previously unknown significations and referential contexts address the human being and become existent for the first time during dreaming’ (Boss and Kenny, 1987: 160, italics added). A social worker who consistently dreams of being an isolated, frightened child, for instance, may come to realise that, alongside her professional, nurturing role, she primarily perceives the world as a daunting and terrifying place. Yet, within the dream world, latent potentialities for experiencing may also be revealed for the first time. Amongst rivers of excrement and vomit, for instance, a depressed individual may also dream of witnessing a beautiful peacock, a manifestation of the fact that she is beginning to be able to experience the beauty and splendour of the world. From a Daseinsanalytic perspective, the fact that this quality is encapsulated within a particular dream entity or person – rather than the dreamer herself – suggests that it is still a very latent possibility. But if the client, in her waking life, can be encouraged to explore this worldlypossibility, then perhaps she will be able to experience it more directly in subsequent dreams: as an entity she runs towards, feels a sense of joy towards, or, perhaps, as something that she embodies herself. In this respect, Daseinsanalysts are particularly interested in clients’ dream series, and what this may indicate about their increasing openness to their worlds. Daseinsanalytic dream-work starts by asking clients to give increasingly detailed accounts of the dream that they have brought to the session, supplementing the first sketchy remarks with more refined statements (Boss, 1977). The initial goal is to ‘put together as clear as possible a waking vision of what actually has been perceived in dreaming’ (Boss, 1977: 32). In this first stage, the Daseinsanalyst will avoid commenting on the specific content or narrative in the dream, restricting himself to questions that help clarify the dream experience. In particular, Condrau (1998) suggests that the therapist should ask the tripartite question: What? Where? and How? In other words, where is the dreamer in the dream, what does he perceive and encounter, and how is this experienced? To facilitate this process, the Daseinsanalyst may also ask the client to re-visualise the dream or elements of it, as a means of building up an increasingly detailed picture of it. 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 desolate and uninhabitable, and I wonder if there is an element of this in your waking life too?’ Alternatively, the therapist might say, ‘In your dream, you ran away from the seductress, and I wonder if, in your waking life, you find it difficult to be fully open to the erotic and sensual too?’ A Daseinsanalyst will also be very keen to help her clients identify latent potentialities in their dreams, and perhaps to suggest that these are ways of being that they can become more fully in touch with. With a ‘highly timid’ client who dreams about sharing his room with the Persian King Cyrus, for example, Boss suggests asking:

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a. Don’t you find it very satisfying that in your dreaming you are now already able to stand very near to Cyrus-like strength and sovereignty? b. Of course, in your dreaming that strength and sovereignty both exist only outside of yourself still. Are you more fortunate in your waking life, in that you perceive some of that masculine strength in yourself? (Boss, 1977: 94)

As this example demonstrates, Boss also suggests that a client should be praised for the new potentialities that emerge in his dream-world – just as he should be encouraged and praised for the new potentialities that emerge in his waking life. To a depressed client who dreams of eating a hot dog, for instance, Boss suggests responding: ‘I think it is wonderful that, at least while dreaming, you allow yourself the deep, though unshared, sensual pleasure of eating a juicy hot dog’ (1977: 79). As discussed earlier, through such loving acceptance of the client’s experiences – whether waking or dreamed – the client can begin to unfurl their full potential.

From interpretation to description Perhaps the best way of summing up the Daseinsanalytic approach is that, as with the phenomenological method, its concern is ‘to see, not to explain’ (Condrau, 1998: xi). That is, the aim of Daseinsanalysis is not to help clients discover why they have the experiences they have – whether because of unconscious forces or past experiences. Rather, it is to help them build up an increasingly detailed and complex picture of the way in which they experience their world; for, by doing so, they can begin to break through their areas of world-closedness and un-freedom. As a Daseinsanalyst sits with her clients, then, she is not primarily thinking ‘I wonder why my client behaves in that way?’ rather, she is likely to be thinking ‘I wonder how my client is experiencing her world?’ Hence, the questions and observations emanating from the therapist are all likely to be aimed at broadening the client’s awareness of her way of being, including those questions and observations concerning the client’s past. In other words, the Daseinsanalytic approach stands in direct opposition to the Freudian maxim that ‘the phenomena that are perceived must yield in importance to trends which are only hypothetical’ (Freud, 1916: 67). Rather, the therapist must start with the client’s experiences as perceived, and attempt to bracket any hypothetical or abstract interpretations.

Critical perspectives Whilst Daseinsanalysis’s greatest contribution to psychotherapy may be its critique of psychoanalysis, it has been argued that the psychoanalysis it criticises is ‘only the most narrow, orthodox and stereotypical of psychoanalytic formulations, formulations which were more characteristic

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48 Existential Therapies of psychoanalysis as it was practice in the first half of the [twentieth] century’ (Craig, 1993). Daseinsanalytic writers, for instance, have almost entirely ignored such contemporary developments in psychoanalytic theory and practice as the Lacanian approach, where there is a much greater appreciation of intersubjective being. Whilst Daseinsanalysts, then, are still disputing old deterministic concepts like transference and countertransference, more progressive psychoanalysts are increasingly open to immediacy, purposefulness and co-constitutionality. It may be questioned, therefore, how relevant Daseinsanalytic criticisms are. Moreover, by concentrating much of their energy on repeatedly setting up and knocking down a psychoanalytic Aunt Sally, Daseinsanalysts have failed to develop and advance their own approach to psychotherapeutic practice. As Craig states, ‘Today it seems important for Daseinsanalysts to move away from reactive argumentation with psychoanalysis and, instead, move steadily towards proactive research of its own, drawing on the richness of their own investigative methods.’ (1988a: 229) With the emergence of the ‘new school’ of Daseinsanalysis, Craig (2001, personal communication) reports that some of these developments are beginning to take place, and there is an increasing engagement with the works of more contemporary psychoanalysts, such as Winnicott, Fairbairn and Kohut. Boss’s unerring loyalty towards Heidegger – the man who brought phenomenology to ‘its perfection’ (Boss and Kenny, 1987: 187) – also gives Daseinsanalysis a somewhat reactionary, stagnant feel. Whilst Heidegger is undoubtedly one of the great philosophers of the twentieth century, to tie a therapeutic approach to one particular philosopher makes it very difficult for that approach to develop and grow – particularly once that philosopher has died. Moreover, Daseinsanalysis’s rigid adherence to a Heideggerian framework has meant that some of its most innovative notions – such as Binswanger’s writings on the dual mode of love – have fallen by the wayside. The close association with classic psychoanalytic techniques – such as dream analysis and the use of a couch – also gives Daseinsanalysis a somewhat reactionary feel, although Craig (2001, personal communication) reports that Daseinsanalysts of the ‘new school’ are beginning to move towards more flexible ways of working. Another criticism of Daseinsanalysis is that, whilst it claims to work in a phenomenological way – bracketing assumptions and engaging with the client’s actual lived-existence – there are many assumptions that seem to find their way back in. In Daseinsanalytic dream analysis, for instance, the Daseinsanalyst will often comment on the meaning or significance of a dream entity without recourse to the client himself. To a client who has dreamt about running away from a horrible-looking giant, for example, Boss suggests inquiring about his relationship to adult manhood. There is no reason, however, why a giant should be interpreted in this way. As Eugene Gendlin writes, ‘Boss imposes his scheme of ideas and also his

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personal values onto a dream with as little justification as is done in the methods of interpretation he attacks’ (1977: 57). Boss’s dream analysis, then, has not entirely overcome the symbolism of its Freudian and Jungian roots. More ominously, Daseinsanalytic writings – and presumably practice – have abounded with numerous assumptions and prejudices as to what constitutes healthy and unhealthy ways of being. In his book The Meaning and Content of Sexual Perversions (1947/1949), for instance, Boss takes it for granted that ‘normal love’ is heterosexual, and defines homosexuality as a sexual perversion. Similarly, as recently as 1987, Boss writes of a woman’s destiny as being to have ‘family and children, in loving union with a man’ (Boss and Kenny, 1987)! In many respects, then, Boss’s Daseinsanalysis has failed to overcome a medical, normative way of understanding clients, and retains a strong element of judgement and prescription. Such a criticism relates to a point made by British existential therapist Darren Wolf (2000), which is relevant to many of the different existential therapies discussed in this book. Wolf argues that any therapeutic approach that tries to take the writings of a philosopher as a guidebook for living will inevitably contain prescriptive elements: squeezing and pushing the client’s experiences into a particular framework. For Wolf, the value of Heidegger’s writings lies not in their ability to guide the client, nor in the nuggets of wisdom that they contain and which can be mined for the therapeutic encounter, but in the therapist’s ability to directly engage with the texts – learning to see the world in a new way. ‘In this way philosophical theory becomes something like an existential therapy training, with the aim of changing us into the sort of people who might be able to be philosophical or existential therapists’ (2000: 61).

Conclusion Paradoxically, whilst Daseinsanalysis is an approach that advocates openness and flexibility, it has its own tendencies towards dogmatism and closedness. Perhaps this is part of the reason why Boss never achieved the revolution in psychoanalytic thinking that he hoped for. Nevertheless, Boss’s writings provide some of the most incisive and comprehensive critiques of psychoanalytic assumptions – assumptions that continue to pervade the therapeutic world today. In this respect, Daseinsanalytic writings offer therapists of all persuasions an opportunity to reflect on, and reconsider, some of their most cherished beliefs. Through these critiques of classic psychoanalytic assumptions, Daseinsanalytic writers have also laid the foundations for subsequent existential therapies; indeed, Boss’s (1963) Psychoanalysis and Daseinsanalysis is still one of the clearest articulations of how existential ideas can be applied to the therapeutic plane. Furthermore, Daseinsanalysis

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50 Existential Therapies offers therapists a range of concepts and practices that they might find useful in their own work: in particular, an understanding of psychological distress in terms of closedness and a non-analytical approach to working with dreams.

Further reading Boss, M. (1963) Psychoanalysis and Daseinsanalysis. (Trans. L. B. Lefebre.) London: Basic Books. Boss’s finest English-language text, which provides a clear and comprehensive introduction to Daseinsanalysis, exploring its similarities with, and differences from, Freudian psychoanalysis. Also provides an excellent introduction to Heidegger’s later thinking. Boss, M. (1979) Existential Foundations of Medicine and Psychology. (Trans. S. Conway and A. Cleaves.) London: Jason Aronson. Later, colder and more convoluted presentation of Daseinsanalytic theory and practice, with a particular emphasis on the treatment of psychosomatic illnesses and Daseinsanalysis’s relationship to natural scientific thinking. Boss, M. (1977) ‘I Dreamt Last Night . . .’. New York, NY: Gardner. Comprehensive presentation of the Daseinsanalytic approach to dream analysis, with numerous case examples. Craig, E. (ed.) (1988) ‘Psychotherapy for Freedom: The Daseinsanalytic Way in Psychology and Psychoanalysis’. Special issue of The Humanistic Psychologist, 16:1. Invaluable collection of recent papers on Daseinsanalysis. Condrau, G. (1998) Martin Heidegger’s Impact on Psychotherapy. Dublin: Edition MOSAIC. Contemporary, concise and accessible introduction to Daseinsanalytic thought and practice.

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4. Logotherapy: Healing Through Meaning

What is the purpose of your life? To be happy? To help others find happiness? To actualise your true potential? As we have seen in Chapter 2, this is a question of great interest to existential philosophers, and empirical research suggests that many clients are also concerned with the meaning of their lives (Yalom, 1980). Logotherapy is a therapeutic approach that specifically aims to help clients discover purpose and orientation in their lives – ‘Logos’ being the Greek term for ‘meaning’ (Frankl, 1984) – and to overcome feelings of emptiness and despair. Logotherapy was developed by the Viennese psychiatrist, Viktor Frankl (1905–97), around 1929 (Klingberg, 1995). It continues to flourish today, with logotherapeutic training institutes across continental Europe and the American continent (though, interestingly, not in the United Kingdom). Logotherapeutic ideas and practices have also extended in to a wide range of non-therapeutic interpersonal practices, most notably pastoral and career counselling (Wong, 1998), as well as nursing (Starck, 1993), social work (Guttman, 1996) and even dentistry (Jepsen, 1979). Logotherapy has also, perhaps, reached further into the public consciousness than any other form of existential therapy. Frankl’s key work, Man’s Search for Meaning (1984), has sold over 2 million copies, and has been translated into 19 different languages.

Influences Whilst logotherapy is orientated around some key existential concerns, it rarely draws explicitly from the writings of existential philosophers. Frankl shows some familiarity with the writings of such existential philosophers as Heidegger and Sartre (Tengan, 1999), but his existential outlook seems to have evolved independently of the wider philosophical field. The one important exception to this, however, is Frankl’s indebtedness to the work of the phenomenologist Max Scheler. Indeed, Frankl explicitly states that whilst ‘Binswanger’s work boils down to an application of Heideggerian concepts to psychiatry ... logotherapy is the result of an application of Max Scheler’s concepts to psychotherapy’ (Frankl, 1988: 10). Two aspects of Scheler’s work were of particular importance to Frankl

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52 Existential Therapies (Tengan, 1999). First was the idea that values are intuitively experienced qualities of things, such that people can discover the true meaning of a situation. Second was the idea that human reality could be stratified into body, mind and spirit, and that the latter could stand apart from, and even oppose, the physical and psychological planes. As with most forms of existential therapy, logotherapy was also heavily influenced by psychoanalytic thinking. Frankl grew up in Vienna, home of Sigmund Freud, and corresponded with him whilst still a teenager. Later, he went on to join Alfred Adler’s ‘second Viennese School of Psychotherapy’ – ‘Individual Psychology’ – before being expelled for criticising Adler (Frankl, 2000). In contrast to the Daseinsanalytic approach, Frankl did not adopt Freud’s psychoanalytic techniques. What he did take from both psychoanalysis and individual psychology, however, was the assumption that there was one driving force behind all human thought, feelings and behaviour. For Freud, this was the pleasure principle; for Adler, it was the will to power; and for Frankl, in developing ‘The Third Viennese School of Psychotherapy’ (Frankl, 2000: 64), it was the will to meaning. From Adler, Frankl also developed the idea that an individual’s ‘final goal’ gave unity and direction to their personality (Tengan, 1999). Another important influence on the development of logotherapy was the religious background of its founder. Both of Frankl’s parents were devout Jews, and although Frankl himself did not admit to being religious – fearing that people would say, ‘“Oh well, he’s that religious psychologist. Take the book away!”’ (Scully, 1995: 43) – his approach is clearly underpinned by religious beliefs (Tengan, 1999). In particular, there are echoes of Jewish, talmudic thought throughout logotherapy: that human beings should live according to externally-given values; that each human being is called to a particular task in their life; and that suffering, guilt and anxiety have a positive role to play in life (Bulka, 1982; Gould, 1993). Frankl’s assertion that each human being has a spiritual core also has clear religious connotations. Indeed, later in his life, Frankl stated that ‘he was seen to be closer in thought to Marcel than to any other contemporary philosopher’ (Gould, 1993), and perhaps Frankl can be most appropriately classed alongside the other spiritual existential philosophers. Finally, there is the influence on logotherapy of Frankl’s own, personal history. It is well-known that, during World War II, Frankl was interned for two and a half years at a range of concentration camps, including Auschwitz, and that his parents, brother, first wife and unborn child were exterminated in the Nazi genocide. It would be a mistake to assume, however, that Frankl’s logotherapeutic approach arose primarily as a response to these experiences. By the age of four, Frankl was already beginning to ask himself whether life had any meaning; and his internment in the concentration camps occurred more than ten years after the establishment of his approach. A more significant personal factor in the development of logotherapy, then, may have been the intense ‘hell of despair’ that he

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Logotherapy 53 went through, as a young man, over the apparent meaninglessness of life. Having experienced a ‘total and ultimate nihilism’ (Frankl, 1988: 166), Frankl found a means of inoculating himself against this ‘disease’. It was probably his desire to help others overcome such despair – particularly the self-harming and suicidal clients that he worked with throughout his life – that played the largest part in motivating him to develop his particular brand of therapeutic practice (Frankl, 2000). Nevertheless, there is no doubt that the concentration camps provided Frankl with a testing ground for his theory. He wrote: ‘Life in a concentration camp tore open the human soul and exposed its depths’ (Frankl, 2000: 108). There, he observed how those who were able to transcend their immediate circumstances and hold on to something meaningful – for instance, by focusing on a reunion with a loved one – were more likely to survive than those who saw their situation as hopeless and futile (Frankl, 2000). In the concentration camps, Frankl also found support for the existential belief that human beings can always choose how to respond to their circumstances, however restrictive these circumstances might be. ‘In this living laboratory,’ he wrote, ‘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 actualised depends on decisions’ (Frankl, 1984). Equally significantly, Frankl saw the holocaust as the logical end-point of a nihilistic world-view and it reinforced his belief that the ‘scourge’ of nihilism and cynicism must be fought against at every opportunity.

The search for meaning For Frankl (1984; 1986), a human being’s most basic motivation is to find meaning in her life: ‘A cause, a reason, a “certain why,” an aim, an ideal, or a purpose in the sense of an orientation towards a goal for which one devotes one’s energies and time’ (Tengan, 1999: 142). Other motivations, for Frankl, are subsidiary to this one. Hence, for instance, an individual may strive to be happy, but this is because she has set happiness as her life’s goal. Alongside this, Frankl argues that a lack of such direction can lead to a deep sense of frustration, emptiness and depression, as well as neurosis – a hypothesis that has received some preliminary empirical support (see Baumeister, 1991). Frankl goes on to suggest that many people today show a more-or-less marked degree of ‘existential vacuum’, and that this sense of meaningless may be particularly prevalent at certain periods in an individual’s life: for instance, during adolescence, following retirement, or after a crisis of some sort. Here, everyday existential frustration and questioning can develop into a more serious ‘existential’, or ‘noögenic’, neurosis, whereby the individual turns – consciously or unconsciously – to such self-destructive behaviours as addictions,

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54 Existential Therapies compulsions or phobias in an attempt to fill their existential void. Logotherapy, then, aims to help individuals suffering from noögenic neuroses to rediscover a sense of meaning, purpose – and hope (Long, 1997) – in their lives. Indeed, even for individuals who are not suffering from existential neurosis, Frankl argues that finding a meaning in life can help people overcome the most appalling physical and psychological torment. As Nietzsche states, and Frankl frequently quotes: ‘He who has a why to live can bear with almost any how’ (in Frankl, 1984: 97). As discussed earlier, however, it is important to note that logotherapists do not talk of helping clients to create meaning in their lives, but of helping them to discover it (Frankl, 1986). Logotherapists believe that each individual’s existence is ascribed a super-, or ultimate-meaning: a unique calling that only they have the ability, and responsibility, to fulfil. Furthermore, logotherapists believe there is only one true meaning to each situation an individual encounters, and it is the responsibility of each individual to decipher what this true meaning is, before that situation and its potentiality is lost forever (Frankl, 1988). Fabry writes: ‘Finding the true meaning of a situation is like finding the right answer in a multiplechoice quiz. Several answers are possible; only one is right. Several interpretations of a situation are possible; only one is the true one’ (1980: 53). In other words, an individual in a situation, such as losing her job, should not ask herself, ‘What can I make of this situation?’ but, ‘What is this situation asking of me?’ Frankl (1988) goes on to argue, however, that each individual, unconsciously, knows the answer to this question, and he refers to this intuitive insight as the human ‘conscience’. Clearly, such an outlook is at odds with the Sartrean (Sartre, 1943/1958) notion that human beings are free to choose their own meanings and values in each situation. Indeed, in some respects, it can be read as highly deterministic. Nevertheless, at the core of the logotherapeutic approach is the belief that human beings are fundamentally free. As with Heidegger, however, Frankl (1986) does not see this freedom as the ‘random ability to do as we please’ (Heidegger, 1929/1949: 307), but the freedom to respond to the demands of a particular situation – to listen to the call of our conscience – as opposed to turning away from it. Frankl (1986) suggests there are three types of values that may lay dormant in any situation, and which the individual can meaningfully actualise. The first are creative values, which can be actualised through work or artistic activity. For instance, losing one’s job may present an individual with the opportunity to discover a new career path. The second type of values are ‘experiential’ values, which can be actualised through an increased receptivity to one’s world, and particularly through love (cf. Daseinsanalysis). Most importantly for logotherapy, however, is the third type of values that may lie dormant in a situation: ‘attitudinal’ values, which can be actualised through changing one’s attitude to a situation. Hence, as logotherapists argue, even when there are no creative

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Logotherapy 55 or experiential meanings to be actualised in a situation – for instance, when experiencing a financial disaster, losing a loved one, or, of course, being imprisoned in a death-camp – there are still attitudinal values that can be discovered and responded to. For logotherapy, however, there is not only meaning to be found in situations where suffering is externally-determined, but also in situations where it is internally-determined. Frankl (1946–47/1998) argues that the human ‘spirit’ has the capacity to transcend – and defy – both physiological experiences (for instance, bodily pain) and psychological ones (for instance, inherited disposition, instincts, psychological mechanisms and neurosis). Hence, for example, even though an individual may not be able to cure their depression – and Frankl (1986), in contrast to Laing (see Chapter 6), believed that many forms of mental misery were biologicallydetermined – they may be able to change their attitude towards it. For instance, they may start to see it as a challenge to be overcome rather than as a disease to fear. According to logotherapy (Frankl, 1986), these latter choices – finding meaning in one’s psychological suffering – are much less likely to fuel the original difficulty: avoiding, for instance, a vicious cycle whereby the shame about the depression makes the person feel more depressed, which then makes them feel more ashamed about their higher levels of depression, ad infinitum.

The appealing technique For Frankl (1986), then, each human being has an unconscious knowledge of the meanings lying dormant in their situation, and the aim of the logotherapist is to act as a ‘midwife’ (Fabry, 1980), facilitating the birth of this deeply-held knowledge. To achieve this, logotherapists use a range of relatively challenging techniques. At the most directive end, logotherapists may suggest to their clients that they should see their world in a particular way: for instance, that every life-situation has a meaning, or that they always have the capacity to change their attitude to their suffering. Lukas (1979) writes that this ‘appealing technique’ is not a preferred method of treatment – having only short-term effects – but is a necessary form of ‘last aid’ if a client is desperate or threatening suicide. As an example, Frankl (1986) describes the case of an obsessive neurotic who despaired so greatly over his illness that he was on the brink of suicide. His psychiatrist, in an attempt to reconcile the man with his neurosis, and knowing that the man was deeply religious, suggested to him that perhaps his illness was the ‘will of God’: ‘something imposed upon him by destiny against which he must stop contending’ (1986: 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

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56 Existential Therapies man that by the second therapeutic session he had, for the first time in ten years, spent a full hour free of his neurosis.

Socratic dialogue A somewhat less didactic technique is termed ‘Socratic dialogue’ (Lukas, 1979) – a strategy also widely used by rational-emotive behaviour therapists (Dryden, 1999). Here, 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: 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 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? At such moments we do not ask ourselves whether life has a meaning or not; But if we did, we could not but shout out of the depth of our existence a triumphant ‘yes’ to being. (1988: 93)

Socratic dialogue may also be used to help clients find meaning in their suffering: to discover the attitudinal value of their situation. Joyce Travelbee (1979), who incorporated logotherapy into her nursing work, gives the example of a middle-aged woman who had spent much of her life caring for her elderly parents, and consequently felt depressed that she ‘had wasted her life’. Travelbee: Client:

Travelbee: Client:

Suppose you had not cared for your parents. What would have happened to them? [After some thought] I guess they would have had to go on welfare. They would have had to go to the free hospital for medical care. It would have killed my father. He was such a proud man. You spared your parents much suffering by your sacrifices. Have they really been in vain? I don’t regret what I have done. They had only me. They gave me life. In return I was able to give more years to their lives. It does count for something. (Travelbee, 1979: 136)

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Logotherapy 57 Travelbee (1979) reports that after several such conversations the client’s depression began to lift, and she no longer experienced bitterness towards her life. As part of this Socratic inquiry into clients’ most basic goals and meanings, logotherapists may also use a range of creative and improvisational techniques. Fabry (1980), for instance, suggests that clients might be asked to act out or paint parts of themselves that they want to become. Paul Wong (1998), who has developed ‘Meaning-Centred Counselling’ – a cognitive-behavioural reformulation of logotherapy – describes another technique entitled ‘Fast-Forwarding’, in which clients are encouraged to imagine the kind of scenarios that are likely to follow a particular choice. Through being asked such questions as, ‘Where will it get you?’, ‘What differences will it make to your life?’ and ‘Are you sure this is what you really want to do?’ clients can be helped to identify their most fundamental goals, and also to take responsibility for the consequence of their decisions. Another technique suggested by Wong is to ask clients ‘miracle questions’ (cf. Brief Solution-Focused Therapy). Wong suggests three: • If you were free to do whatever you want and money is not an issue, what would you like to do on a daily basis right now? • If God would grant you any three wishes, what would be your top three wishes? • If you were able to decide your future, what would be an ideal life situation for you three or five years down the road? Wong (1998) suggests that these questions can help clients develop a deeper insight into what they really want from life, temporarily free from their immediate anxieties and concerns. Some further questions and exercises that may facilitate this process are: • Select one word which best expresses the meaning you would like life to have. • Write the epitaph which you would prefer for yourself. • If a murderer offered to let you live provided you could give him one good reason why you should live, what reason would you have? (Crumbaugh, 1979) Logotherapists may also use a range of metaphors to help clients develop a deeper understanding of their lives (Box 4.1).

Paradoxical intention Alongside specific techniques for dealing with existential anxieties and neuroses, logotherapy has developed two techniques for treating a wider range of psychological disorders. The first of these is termed ‘paradoxical

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BOX 4.1

Metaphors in logotherapy

• To describe the apathy and aimlessness that comes from not having a meaning in one’s life: ‘The person without meaning is like a mountainclimber who enters a dense fog and, lacking the goal before his eyes, is in danger of succumbing to a total weariness’ (Frankl, 1986: 117). • To emphasise the gravity and irreversibility of each life-choice a client makes: ‘Life is like a moving-picture which is being continually shot, but which we are unable to go back and edit’ (Frankl, 1986). • To challenge the idea that, if we are not aware of an ultimate meaning in our lives, none can exist: ‘We can not always grasp the super-meaning of our lives, just as a branch cannot grasp the meaning of the whole tree’ (Frankl, 1986: 31). • To describe the nature of conscience: ‘Our conscience is like a little receiver, still primitive and unreliable, that tries to pick up on the signals sent out by the supertransmitter of ultimate meaning’ (Fabry, 1980: 52).

intention’. This is based on the assumption, as discussed above, that individuals can choose the stance they take towards their psychological difficulties, and that the more they become afraid or saddened by their psychological symptoms, the more those symptoms are likely to be exacerbated. Hence, paradoxical intention involves encouraging a client to stop fighting against his difficulties and, instead, ‘to evoke in his mind a strong wish and intention to do, or to experience, just what is most terrifying and embarrassing to him’ (Frankl, 1965: 364). An insomniac, therefore, may be told to try as hard as possible to stay awake; or a client with a fear of germs may be instructed not to wash his hands. Frankl (1986) gives another example of a man with a fear of sweating, who was advised to deliberately show people how much he could really sweat. As in all cases of paradoxical injunction, the aim here was to try and undermine the client’s vicious circle – in this case, a fear of sweating which led to more sweating which led to more fear, ad infinitum – by trying to replace the client’s fear, shame or depression about his difficulties with a more positive, reconciliatory attitude. Clients are encouraged to want to do the things they most desperately fear, and in so doing, the wind is taken out of the anxiety’s sails. Furthermore, according to Frankl (1986), the humour that is often inherent in paradoxical suggestions may help clients to gain some detachment from their difficulties. Rather than being overwhelmed by their anxieties, they may come to see them in a more absurd or inconsequential light. Ascher and Pollard (1983) suggest that paradoxical intention can be used with a variety of psychological difficulties – including sleep disturbances, sexual dysfunctions, obsessive-compulsive disorders, phobias and social anxiety – and that its effectiveness has received preliminary

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Logotherapy 59 empirical support. Indeed, a number of practitioners in the fields of behaviour therapy and family therapy have adopted this technique (for instance, Marks, 1978). Frankl (1986) suggests that paradoxical intention may be particularly useful in short-term therapy, especially in cases of phobia where clients seem to exhibit substantial anxiety about their anxiety. However, Ascher and Pollard and Frankl warn that it should not be used without proper assessment, and Frankl is particularly concerned to stress that it is absolutely contraindicated where clients are threatening suicide.

Dereflection The second general therapeutic technique developed by logotherapy is that of ‘dereflection’ (Frankl, 1986). This is based on the existentiallogotherapeutic assumption that human beings, in their natural, spontaneous state, are fundamentally engaged with their world, and that it is through this engagement that they find meaning and satisfaction. According to logotherapy, however, in some cases of neurosis and psychosis, an individual becomes so preoccupied with himself and his internal processes – a state of ‘hyperreflection’ (Frankl, 1986) – that he forgets this basic external-orientation. A man suffering from impotence, for instance, may become so focused on his sexual difficulties that he loses sight of the person he is in bed with, and consequently has no chance of becoming sexually aroused. In these situations, Frankl (1986) suggests that dereflection may be appropriate, which essentially involves encouraging clients to ignore their symptoms – to stop reflecting on themselves – and instead orientate their attention to the world around them. A man suffering from impotence, then, might be encouraged to stop focusing on his state of arousal when he tries to make love, and instead keep his attention on his partner. Similarly, a client who has a fear of being sick in public might be encouraged to focus on the people and events around her, instead of her feelings of nausea.

Critical perspectives Perhaps the strongest charge that has been levelled against logotherapy is that it has distinctly authoritarian overtones (May, 1978; Yalom, 1980). Indeed, van Deurzen asks ‘whether such a directive approach can be seen to be at all existential or whether it is more a kind of pastoral counselling and didactic behavioural method’ (2001, personal communication). Logotherapists are not averse to instructing their clients to think in particular ways, or to using techniques or lines of argument to strongly influence their clients’ beliefs, feelings and choices. Indeed, logotherapists

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60 Existential Therapies quite explicitly state that in many cases it would be dangerous, if not fatal, to leave decisions to the client alone (Frankl, 1986). Such an authoritarian stance, as Yalom (1980) writes, may ultimately undermine a client’s sense of responsibility, as well as his self-esteem. Indeed, it would seem something of a contradiction in terms to state that ‘The task of the logotherapist is to educate the patients to take charge of their own lives’ (Lukas, 1979: 100). Several logotherapists, such as Bulka (1978), have attempted to counter these charges, but their responses tend to betray even further the authoritarian thread that runs through logotherapy. Bulka, for instance, writes that ‘Giving the patient a positive life view, even through convincing argument, is not the same as authoritarian coercion’ (1978: 53); but it is, if a client has a primarily negative and pessimistic world-view, and if she is instructed to adopt a more positive one. What logotherapists seem to overlook is the fact that their therapeutic system is founded on a set of assumptions – such as ‘it is good to have a positive view of life’ – rather than unalterable truths. Hence, whilst they may feel that they are simply helping clients to see the world as it really is – or what clients know ‘unconsciously’ to be true – they can be accused of imposing on their clients a very specific set of philosophical, anthropological and ethical assumptions. Probably the biggest, and most contentious, assumption within logotherapy is that human existence is intrinsically meaningful. Frankl offers little support for this assertion, and the arguments that he does put forward – such as life must be meaningful because people have a need for meaning (1988), or that life must be meaningful because people with a sense of meaning are more contented – have little logical validity. Indeed, from the position of Sartre (1943/1958) or Camus (1942/1955), Frankl’s assertion that life is ultimately meaningful could be considered little more than bad faith: a desperate attempt to deny the fundamental meaninglessness absurdity of human existence. (Certainly, there is empirical evidence to suggest that people will often grasp at any meaning they can find to fill the vacuum of meaninglessness (Baumeister, 1991).) What logotherapists do not seem to do, then, is to allow clients to decide for themselves whether or not there is any given purpose for their being here; and, in this respect, it may be of limited value to clients who want to answer this question for themselves. Within the logotherapeutic world, the assumption that each situation has one true meaning and one correct response would also seem to be highly dubious. At the very least, it would seem important to talk about the possibility of conferring meaning on a situation, as well as discovering it (Baumeister, 1991). Another questionable assumption at the heart of logotherapy is that human beings’ most fundamental need is for meaning. Yalom writes: ‘The belief that life is incomplete without goal fulfilment is not so much a

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Logotherapy 61 tragic existential fact of life as it is a Western myth, a cultural artifact. The Eastern world never assumes that there is a “point” to life, or that it is a problem to be solved; instead, life is a mystery to be lived’ (1980: 470). Finally, the assertion that human beings have a single, super-meaning meaning to their lives would seem to be inconsistent with the reality of actual lived-existence. ‘People make sense of their lives one day at a time,’ reports Baumeister, and he goes on to state that, ‘A multitude of small, local meanings do not necessarily add up to one grand meaning’ (1991: 60).

Conclusion ‘Within the logotherapy movement,’ writes Wong, ‘there is little evidence of critical self-examination and creative tension. What is needed are fresh ideas, rigorous debate, and systematic research, without which new developments in logotherapy are unlikely’ (1998: 400). Despite this, there is much that the logotherapeutic approach can offer therapists of all persuasions. In particular, it encourages therapists to take their clients’ feelings of meaninglessness seriously, and to address them directly, rather than seeing them as symptomatic of other, ‘underlying’ disorders. In addition, it encourages therapists to be aware that feelings of meaninglessness may be at the root of a client’s difficulties: that their depression or anxiety may be as much about their future as it is about their past. As an example, I once worked with an elderly client who found it impossible to lift herself from her depression.1 For many sessions, this client and I explored the childhood experiences that might have been at the root of these feelings, but it was only when I gradually encouraged her to explore her feelings about her future that a fuller understanding began to emerge. Now that she was retired, she felt that she had nothing to live for, so what was the point of getting out of bed, looking after herself, or caring about anything – nothing felt of any real value. Such a realisation did not immediately lift the client’s depression, but it did encourage her to think about goals and meanings that she might identify, such that she could feel more fulfilled in her life. Logotherapy, writes Frankl, is a ‘supplement, rather than a substitute for psychotherapy’ (1986: xii) and perhaps it is best understood in this way. As a form of therapy in itself, it is, perhaps, too narrow and restricted; but as a set of ideas and practices, it is capable of enhancing both existential and non-existential therapies, as well as the many forms of non-therapeutic helping relationships. Furthermore, under the leadership of Alfried Längle, the International Society for Logotherapy and Existential Analysis has begun to develop and incorporate Logotherapy into a broader – and less directive – form of existential therapy. Logotherapy, then, continues to have much to contribute to the therapeutic world as a whole.

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Note 1. In this, as with other case studies in this book, I have disguised various features of the client to ensure complete confidentiality.

Further reading Whilst Frankl has published a number of books in English, there is a great deal of overlap between them. Virtually all his key ideas can be found in the first three works below. Frankl, V. (1984) Man’s Search for Meaning. (Revised and updated edn.) London: Washington Square Press. Bestselling account of Frankl’s experiences in the deathcamps, arguing that meaning, freedom and dignity can still be found in the midst of the most horrendous suffering. Includes a concise introduction to logotherapeutic principles and practice. Frankl, V. E. (1986) The Doctor and the Soul: From Psychotherapy to Logotherapy. (3rd edn.) New York: Vintage Books. Clearest, most comprehensive and most detailed presentation of logotherapeutic principles and practice. Frankl, V. E. (1988) The Will to Meaning: Foundations and Applications of Logotherapy. (Expanded edn.) London: Meridian. Duplicates much of the material in The Doctor and The Soul, but provides some valuable insights into the philosophical and psychological foundations of logotherapy, and includes several examples of Frankl’s logotherapeutic practice. Fabry, J. P., Bulka, R. P. and Sahakain, W. S. (1995) Finding Meaning in Life. (Formerly titled Logotherapy in Action.) London: Jason Aronson. Mixed bag of papers on the fundamentals of logotherapeutic thought and practice, and their application to a range of settings (e.g. nursing), problems (e.g. addiction, delinquency), community concerns (e.g. new careers for offenders) and forms of counselling (e.g. marriage counselling, counselling the elderly). Tengan, A. (1999) Search for Meaning as the Basic Human Motivation. Frankfurt am Main: Peter Lang. One of the few books that provides a critically detailed examination of logotherapy. See also Gould (1993). Wong, P. T. P. (1998) ‘Meaning-Centred Counseling’, in P. T. P. Wong and P. Fry (eds) The Quest for Human Meaning: A Handbook of Theory, Research and Application. Mahwah, NJ: Lawrence Erlbaum. Concise, contemporary and practical cognitivebehavioural reformulation of logotherapy.

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5. The American ExistentialHumanistic Approach: Overcoming a Resistance to Life

The American approach to existential therapy provides, perhaps, the best contrast to the Daseinsanalytic approach examined in Chapter 3. Whilst Daseinsanalysis emphasises the in-the-world nature of human beings, existential-humanistic therapists – particularly in their earlier writings – have tended to take a more inward turn, focusing on the struggle of the individual to be true to her own subjective existence. This American brand of existential therapy has been variously christened as ‘existentialanalytic psychotherapy’ (Bugental, 1981), ‘existential psychodynamics’ (Yalom, 1980) and ‘existential-integrative psychotherapy’ (Schneider and May, 1995c), but perhaps the term ‘existential-humanistic psychotherapy’ (Bugental, 1978; Schneider, 2003) most accurately encapsulates this approach. This American, existential-humanistic approach can be traced back to 1958 and the publication of Existence: A New Dimension in Psychiatry and Psychology by Rollo May and colleagues. Through the publication of this book, the ideas and writings of Binswanger and other European existential psychiatrists were brought to America for the first time. Rollo May (1909–94), who first trained as a minister but then went on to be a clinical psychologist, is generally considered the ‘father of existential psychology in America’ (Hoeller, 1999). Alongside co-editing Existence, he wrote a number of highly popular books – most notably Man’s Search for Himself (1953) and Love and Will (1969b) – which analysed such contemporary issues as sex, violence and the abuse of power from an existential perspective. May, himself, wrote little about the actual details of existentialhumanistic practice, but three of his protégés were to become the leading exponents of this approach. The first of these, James Bugental (1915– ), was the most explicitly humanistic of May’s mentees, and has presented and illustrated the existential-humanistic approach to therapy through numerous publications. The second, Irvin Yalom (1931– ), is probably the best known advocate of existential therapy in America – if not in the world – but is, paradoxically, probably the least existential of May’s mentees (van Deurzen-Smith, 1997). Finally, in recent years, Kirk Schneider (1956– ) has taken a leading role in the development of existentialhumanistic therapy, co-editing a handbook of ‘existential-integrative’

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64 Existential Therapies therapy with May (1995c), and taking on the role of president of the recently-established Existential-Humanistic Institute in San Francisco, California. Today, the practice of existential-humanistic therapy is primarily concentrated around this Institute and the west coast of the United States, but existential-humanistic practitioners have had a major impact on the practice of humanistic therapy, both in America and the wider world.

Influences Like the logotherapists, existential-humanistic therapists have not tended to immerse themselves in the writings of existential philosophers. Indeed, many of them openly admit that they find these writings abstruse and impenetrable (Schneider, 1990; DeCarvalho, 1996). Nevertheless, existentialhumanistic therapists have been influenced by the writings of the existential philosophers through the teachings of Rollo May’s mentor, Paul Tillich (1952/2000), and have also shown some interest in the works of Kierkegaard (Schneider and May, 1995c) and Nietzsche (Yalom, 1992). In contrast to the Daseinsanalysts, then, existential-humanistic therapists, particularly Bugental, have tended to draw from the more individualistic elements of existential philosophy: those that emphasise the need for the human being to stand alone, and courageously face the anxiety of existence. From Tillich, there is also the notion that ‘neurotic anxiety’ emerges when existential anxiety is denied; and that human beings face a particular set of core concerns. As the name suggests, the existential-humanistic approach has also been strongly influenced by the humanistic psychotherapy and psychology movement, which originated in the 1940s (Cain, 2002) and reached its zenith in the 1960s on the west coast of America. Indeed, to a large extent, the two approaches have grown up side-by-side, and have always been closely interrelated (Bugental, for instance, was the first president of the Association for Humanistic Psychology; whilst Carl Rogers and Abraham Maslow, two key figures in the humanistic psychology movement, contributed chapters to May’s (1969a) Existential Psychology). As a reaction to the dominant, de-humanising psychologies of its day – behaviourism and psychoanalysis – humanistic psychology drew on many key existential premises: that human beings should be conceptualised as freely-choosing, self-aware, unique, meaning-orientated and fundamentally whole beings (Cain, 2002). In contrast to much existential philosophising, however, humanistic psychologists such as Maslow (1968) and Rogers (1959) placed particular emphasis on the sovereignty of individual, subjective experiences, and the need for human beings to be true to their own needs, rather than conforming to the needs of others. Maslow and Rogers also tended to downplay the tragic dimensions of

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American Existential-Humanistic Approach 65 existence, arguing instead that human beings have an innate tendency to actualise their potential and to grow. In contrast to other existential therapies, then, the existential-humanistic approach adopts the most optimistic outlook on life and the possibilities of therapeutic change and, again, places the greatest emphasis on the individual, subjective dimensions of existence. Its more humanistic agenda also means that it has adopted certain humanistic therapeutic practices, such as Gendlin’s (1996) focusing technique and Rogers’s (1957) core conditions. Like Daseinsanalysis and logotherapy, the existential-humanistic approach also draws widely from psychodynamic theory and practice. Indeed, because it places less emphasis on the in-the-world nature of human beings, intrapsychic concepts such as resistance, transference and unconscious processes form a central element of existential-humanistic theory and practice. The existential-humanistic emphasis on choice and will also draws heavily from some of the more humanistically-inclined psychodynamic therapists, such as Alfred Adler, Otto Rank, Eric Fromm, Freida Fromm-Reichmann and Leslie Farber. Existential-humanistic therapists, most notably Yalom, are also indebted to the ‘Interpersonal psychiatry’ of Harry Stack Sullivan (1968), which understands mental misery in terms of an individual’s dysfunctional interactions with others. In contrast to the European schools of existential therapy, the existentialhumanistic approach also has a decidedly American feel. May, Schneider and Bugental all came from a mid-western background, and many of the values held in high regard by that culture – strength, courage and fortitude – have infused this particular brand of existential therapy (Hannush, 1999). This background may also go some way to explaining the existential-humanistic tendency to aggrandise the individual and her search for independence (Schneider and May, 1995c). There is something of the frontier spirit here, the lone individual searching to find her way in a chaotic and uncertain world. The existential-humanistic approach is also infused with the spirit of pragmatism, as developed by such American philosophers as William James (1842–1910). American existential-humanistic therapists, then, are not afraid of working in an eclectic way, using whatever response or technique seems most appropriate at a particular point in time. Roleplays, cognitive restructuring techniques, behavioural interventions, therefore, may all be part of an existential- humanistic psychotherapist’s ‘grab-bag’ of approaches (Yalom and Elkin, 1974).

Resistance is futile At the heart of the existential-humanistic enterprise lies an essentially psychodynamic reading of existential – particularly Kierkegaardian and Nietzschean – themes. For Freud, the eruption of sexual or aggressive drives from the depth of the unconscious creates a sense of anxiety, which

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66 Existential Therapies the individual then attempts to quell through defence mechanisms such as denial and introjection (Yalom, 1980). Existential-humanists like Yalom (1980) agree with Freud that much human energy is dissipated in an attempt to ward off anxiety; and they also agree with Freud that much of this process goes on outside of consciousness. Unlike Freud, however, they argue that the root of human anxiety is not sexual and aggressive impulses, but an awareness of the reality of existence. That is, existence – with all its uncertainty, pain, freedom and meaninglessness – may be so threatening to the individual that they attempt to deny or distort this reality through such defensive mechanisms as compulsive behaviours or projection. A young person, for instance, who faces the anxiety of choosing a career, may attempt to deal with this discomfort by projecting her responsibility onto her parents; or she may develop an obsessive pattern of behaviour – such as obsessive tidiness – such that she no longer needs to address the more pressing concern. In this respect, then, the psychoanalytic formula of: DRIVE ⇒ ANXIETY ⇒ DEFENCE MECHANISM is replaced with: REALITY OF EXISTENCE ⇒ ANXIETY ⇒ DEFENCE MECHANISMS. (based on Yalom, 1980: 9–10) From an existential-humanistic perspective, such short-term defensive behaviours may bring a semblance of peace but, as in the psychodynamic model, it is argued that they ultimately cause more problems than they alleviate (Bugental, 1981). First, from an existential-humanistic perspective, human beings are innately actualising organisms, so if they partly deny their being, they also deny their ability to actualise their full potential and deal with their circumstances in the most effective and creative way. A young woman, for instance, who lets her parents decide her future has abandoned her own, ‘inner’ sense of what is best for her. Furthermore, from an existential-humanistic perspective, individuals who attempt to deaden a part of their existence will inevitably lead a ‘shrunken’, ‘imprisoned’ life devoid of passion, vibrancy and the full spectrum of emotions. ‘Emotions,’ writes Bugental, ‘are not so many packages of breakfast food lined up on the shelf, separate and unitary. Emotionality is a unitary dimension of being: one suppresses one aspect at the cost of crippling all’ (Bugental, 1978: 126). To make matters worse, the defensive strategies that individuals use to protect themselves from existential anxiety may engender anxiety – of a neurotic kind – themselves. The individual who ‘lets’ her parents decide for her, for instance, may then feel frighteningly out of control. If she responds to this anxiety through such defences as detaching herself from others, or imagining herself to be omnipotent, she then starts a process of building up layer upon layer of defences.

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American Existential-Humanistic Approach 67 Bugental – particularly in his earlier writings – refers to all those ways in which the client seeks to avoid existential anxiety as ‘resistances’ (1981: 63). Here, he is using the term in the broadest possible sense to refer to those blockages to reality that an individual erects, both outside and inside of a therapeutic relationship. The fundamental project of existentialhumanistic therapy, then, is to help clients identify and overcome their resistances: to unmask their self-deceptions, and meet the anxiety of existence with an attitude of commitment, decisiveness, courage and resolve (May, 1958a). Through such a process, it is proposed that clients can overcome their neurotic anxieties, live in harmony with the basic conditions of being human (Bugental, 1987), and re-connect with their potentiality for growth. From an existential-humanistic perspective, however, the overcoming of these resistances will by no means be easy. Drawing on psychodynamic thinking, existential-humanistic therapists like Bugental (1981) and Yalom (1980) assert that an individual’s resistances are likely to be deeply entrenched – and frequently unconscious. For Bugental, then, the process of tackling layer upon layer of resistance – which he likens to peeling an onion – will be ‘an agonizing and conflictful struggle, for as the resistances are exposed and begin to be loosened, the threatening material which they covered press into consciousness’. Here, the client may be, ‘flooded with feelings of fright, pain, guilt, shame, dread and futility, and these may mount to a point at which the client feels unable to endure letting go of the ways which for so long gave a measure of protection’ (1978: 8). Because resistances are understood in this way, existential-humanistic therapists tend to adopt a relatively challenging stance towards their clients, encouraging them to face their fears and overcome their hurdles to reality. Existential-humanistic therapists also make it clear, however, that the aim of this process is to facilitate the client’s own recognising and releasing of resistances (Bugental, 1978), and to empower clients, rather than to impose an external authority on them (Schneider and May, 1995c). Schneider (2003) has also emphasised the importance of respecting a client’s resistances: of acknowledging that they may be a client’s way of feeling safe and on familiar ground.

Facilitating the inner search From an existential-humanistic perspective, this facing up to existence begins with an acknowledgement of our ‘inner world of subjective experience’ (Bugental, 1978): the kinaesthetic-affective realm of body, imagination, fantasy life and intuition (Schneider and May, 1995c). For Bugental (1978), this private realm is our homeland – the centre of our being (May, 1953) – but a homeland that many of us are exiles from. One of the first, and most important, aspects of existential-humanistic therapy, therefore, is to help clients become aware of their actual, in-the-moment experiences

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68 Existential Therapies (Bugental, 1999). Bugental (1981) refers to this process as ‘inward searching’: ‘in which the awareness is tuned into one’s own subjective experiencing in the moment and given free rein to move as it will’ (Bugental, 1978: 52). To begin this process, existential-humanistic therapists may invite their clients to focus on their concerns (Schneider and May, 1995b) and to free associate, following wherever their sense of concern may lead (Bugental, 1978). Bugental sometimes gives the following directions to clients, if they inquire as to what they should talk about: Tell me what is of concern to you, what matters to you in your life today, right now as you lie here. What is it that you want to think through? What is it in your living that you want to make different? As you talk to me about your concern let yourself be open to mention any other awarenesses that come in whether or not they seem pertinent to what we are talking about. Sometimes these other awarenesses will be memories, sometimes physical sensations, sometimes emotions. Whatever they may be, let yourself mention them and then continue with what you were telling me about, or follow whatever you find is of concern to you at that point. Talk to me about what concerns you in your life. (1981: 107)

Existential-humanistic therapists may also use a range of other strategies to help clients focus on their inner experience. For instance: • Asking clients direct questions like: ‘What does your inner experience tell you?’ or ‘How does it feel when you say that?’ (Schneider and May, 1995b). • Inviting clients to be as detailed as possible in describing their experiences (Yalom and Elkin, 1974). • Inviting clients to express how they feel in the immediate moment, and in relation to their therapist (Bugental, 1999). • Encouraging clients to re-tell their experiences – on the principle that a human being ‘almost literally cannot tell the same story twice in identical terms’ (Bugental, 1978: 54). • Encouraging clients to speak in the present tense and use the pronoun ‘I’ when discussing themselves (Schneider and May, 1995b). • Helping clients to label, and differentiate between, various emotions (Yalom, 1989). • Inviting clients to visualise a particular scenario, role-play it, or actually try it out in the therapeutic meeting – for instance, making a dreaded phone call or expressing anger – and then reflecting on how that experience felt (Schneider and May, 1995b). • Encouraging clients to develop the skill of self-awareness outside of the therapeutic encounter as well as inside it (Schneider and May, 1995b). From an existential-humanistic perspective, it is also important that therapists:

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American Existential-Humanistic Approach 69 • provide clients with sufficient time to talk (Bugental, 1981): Bugental suggests a ratio of client-talk to therapist-talk of approximately 19:1; • listen out for the dominant emotional theme that emerges in clients’ narratives, or what Bugental (1981) refers to as the ‘red thread’; • pay attention to their own feelings, and uses this as a guide to what clients might be experiencing (Schneider and May, 1995b); and • trust that clients’ experiences of pain and/or hurt will eventually transform, and assist clients to acquire that trust (Schneider and May, 1995b). This emphasis on internal, subjective experiences also means that clients may be encouraged to specifically focus on their bodily sensations. A client, for instance, might be asked ‘How do you feel physically right now?’ (Bugental, 1981: 239), or the therapist might comment upon the client’s body postures, breathing patterns and vocal fluctuations (Schneider and May, 1995b). Schneider also describes an approach, which he terms ‘embodied meditation’, in which clients are encouraged to relax and focus their attention on their bodies. A client of Schneider’s, Ruth, for example, noticed that she felt something in her stomach when she relaxed and turned her attention inward: 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 and May, 1995b: 159) From an existential-humanistic perspective, such a process of inward searching will help clients to become more in touch with their subjective reality. As they do so, however, they will inevitably experience the anxiety of authenticity, and attempt to resist their inner search through blocking, deflecting or distorting their awareness (Bugental, 1978). According to existential-humanistic therapists (Bugental, 1978; Schneider and May, 1995b), clients may:

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70 Existential Therapies • • • • • • •

start to change the topic; become distracted; talk about trivialities; talk in clichéd, polite, formal, abstract or disinterested ways; talk so quickly that they cannot ‘hear’ themselves; start to intellectualise, rationalise, analyse or try to solve their concern; or distance themselves from their experiences and talk about themselves as if they are a different person.

Hence, in facilitating a client’s inward search, a key role for the therapist is to help the client notice when he is resisting the process. Schneider (2003) identifies two basic forms of ‘resistance work’: ‘vivification’ and ‘confrontation’. Vivification involves heightening the client’s awareness of how they block or limit themselves. It consists of ‘noting’ the client’s initial resistances – for instance, ‘You seem to change the topic every time I ask you about your illness’ – and then pointing out to them every time this resistance is repeated (‘tagging’). Confrontation is a more direct and amplified form of vivification, pressing – gently or otherwise – the client to overcome their blocks. Bugental (1987) adds to this that it is useful to teach clients the negative effects of resisting their inner search and to help them to see that this is not merely an arbitrary or careless behaviour, but a motivated attempt at blocking an inner awareness.

Interpersonal presence From an existential-humanistic perspective, an individual’s authenticity is not only defined in terms of their willingness to know themselves, but also in terms of their willingness to be known by others (Bugental, 1978). This is defined as ‘presence’: being ‘as aware and as participative as one is able to be at that time and in those circumstances’ (Bugental, 1978: 36). As well as facilitating a client’s inner search, then, existential-humanistic therapists will also try and facilitate a client’s presence to another: their ability to communicate and express their authentic, in-the-moment experiencing (Bugental, 1999). In this respect, both Yalom and Bugental place considerable emphasis on encouraging clients to articulate how they are feeling in the ‘living moment’ of the immediate therapeutic encounter: and particularly how they are feeling towards the therapist. Indeed, Yalom writes that ‘I make an effort to inquire about the here-and-now at each session even if it has been productive and nonproblematic’ (Yalom, 2001: 72). This may involve questions like ‘How are you and I doing today?’ or ‘How are you experiencing the space between us today?’. A good example of this comes from Yalom’s work with Ginny Elkin, which both therapist and client describe in Every Day Gets a Little Closer (Yalom and Elkin, 1974). Here, Yalom relentlessly inquires into his client’s

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American Existential-Humanistic Approach 71 feelings towards him, and what her ways of behaving in the sessions might reveal. Why, for instance, does she not ask him any questions? Disagree with him? or Tell him that she cares about him? When, for instance, Ginny says that she feels strangled by a friend, Yalom wonders whether she also might be feeling strangled by him. Similarly, he ‘hones in very hard’ on Ginny’s feelings about alterations in the therapeutic frame. Having cancelled a session with Ginny, for instance, Yalom suggests to her that she may well be feeling angry or depressed about this. Like the process of inward searching, however, existential-humanistic therapists acknowledge that this process of being fully present and open to another can be highly anxiety-creating (May, 1958a). Much of the existential-humanistic work around presence, then, involves vivifying and challenging clients’ resistances to fully engaging with the therapeutic encounter. In his case of the ‘Fat Lady’, for instance, Yalom points out to his client, Betty, that the way she presents herself does not seem to reflect her real feelings and concerns. Yalom: Betty: Yalom:

Betty: Yalom: Betty: Therapist:

... I think you are determined, absolutely committed, to be jolly with me. Hmmm, interesting theory, Dr Watson. 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. That’s the way I am. When you stay jolly like that, I lose sight of how much pain you’re having. That’s better than wallowing in it. But you come here for help. Why is it so necessary for you to entertain me? (Yalom, 1989: 97–8)

In the case of the ‘Fat Lady’, Yalom (1989) also uses his feelings of boredom and disinterest in the client as an indication that she is not fully present. From an existential-humanistic perspective, if therapists do not feel engaged with their clients, it may be that the clients are only presenting a lifeless façade of who they could be, rather than a vibrant and complex picture of their true existence. Expressing one’s authentic being, however, is only one side of the presence coin. The other, ‘input’, side is what Bugental terms ‘accessibility’: ‘having the intention to allow what happens in a situation to matter’ (1978: 37). Being fully present, then, is as much about being open to the authentic being of others as it is about expressing one’s own authenticity; and existential-humanistic therapists like Yalom will readily challenge clients to acknowledge the existence of another human being in the room with them. When Yalom’s client Ginny, for instance, says that she cannot

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72 Existential Therapies even look at him, Yalom challenges her to do so, and he fixes her gaze for a length of time (Yalom and Elkin, 1974). Construing presence in terms of accessibility as well as expressiveness also means that, from an existentialhumanistic perspective, ‘transference’ is one particular form of resistance to presence. It is a strategy by which the client ‘tries to recreate a collaboration such as he has had in the past with some important person’ (Bugental, 1981: 137), and by so doing avoid the anxiety of being fully present to a unique, unfamiliar and unpredictable other. ‘Analysing the transference’, therefore, can be an important element of existential-humanistic psychotherapy (Bugental, 1981). By helping clients to see how, and from what source, they mis-perceive their therapists – and by extension other people in their lives – they can be helped to relate to others in a more authentic way. From an existential-humanistic perspective, however, such a process can only be facilitated if the therapist is also genuinely present to her clients (Bugental, 1978). Without this happening, therapists and clients would have no way of knowing the ways in which clients constrict their perceptions of a real other, nor would clients be able to learn to develop fully authentic relationships. Furthermore, according to Schneider and May (1995b), a therapist’s presence creates a sense of safety in which a client’s problems can be confronted, and deepens a client’s capacity to constructively act upon her discoveries. A final reason for the vital importance of therapists’ presence is that it can create for clients a model of authentic living. Despite the many different techniques and interpretative formulations developed within the existential-humanistic approach, then, all this is considered secondary to the development of an authentic, genuine relationship between therapist and client (Bugental, 1978). As Yalom’s ‘personal mantra’ puts it: ‘It’s the relationship that heals, the relationship that heals, the relationship that heals’ (1989: 91). With respect to the accessibility side of the presence coin, therapist presence means that an existential-humanistic therapist must be sensitive and open to the full scope of her client’s being. In the case of the ‘Fat Lady’, for instance, Yalom (1989) comes to see that his disgust of obesity stops him from being fully attentive, and caring, towards his client. With respect to the expressive side of the presence coin, it means that a therapist should be open and willing to self-disclose to her client, rather than remaining opaque and aloof (Yalom, 2001). Yalom suggests that therapists should always answer their client’s questions, and outlines three particular areas in which he feels therapists should be transparent. First is the mechanism of therapy, such as the assumptions and rationale behind the process, and the ways in which the client might be most able to maximise their progress. Second is the therapist’s feelings towards their client in the immediate here-and-now: whether tenderness, disinterest or an uncertainty about how to progress. Third, and perhaps most controversially, Yalom suggests that therapists should be willing to be honest about their

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American Existential-Humanistic Approach 73 own lives, such as whether or not they are in a relationship, what their sexuality is, or what kind of films they like. Yalom makes it clear that this needs to be done tactfully, and that therapists should also try to explore the process of the client’s personal enquiries, but concludes that ‘I have always facilitated therapy when I have shared some facet of myself’ (2001: 90).

The givens of existence Up until this point, the existential-humanistic approach is not that dissimilar from other forms of humanistic therapy, such as person-centred counselling (Rogers, 1957) or focusing-oriented psychotherapy (Gendlin, 1996). In drawing on existential philosophy, however, the existentialhumanistic approach goes beyond this exploration of the subjective and intersubjective realms to suggest that there are certain givens, or ‘ultimate concerns’ (Yalom, 1980), that all individuals face. From an existentialhumanistic perspective, these are the concerns that are at the fount of all our anxieties: the terrors of existence that become revealed once all the layers of resistance are peeled away (Bugental, 1978). According to Bugental, many clients will eventually come face to face with these terrors, and he calls this ‘dark night’ of the therapeutic journey the ‘existential crisis’. Yalom (1980), on the other hand, takes a less linear perspective, suggesting that individuals at any point in their growth may face ‘boundary situations’: ‘an event, an urgent experience, that propels one into a confrontation with one’s existential “situation” in the world’ (Yalom, 1980). Bugental (1981) and Yalom (1980) also differ in their classification of these ultimate concerns. Yalom outlines four: death, freedom, isolation and meaninglessness; whilst Bugental outlines six: finiteness, potential to act, choice, embodiedness, awareness and separateness (this latter given was subsequently revised to separate-but-related (Bugental and Sterling, 1995)). For the purposes of this chapter, Yalom’s somewhat more concise schema will be used – though Bugental’s concerns will be examined where relevant.

Confronting death For Yalom (1980), death is the primordial source of anxiety. He writes that it is ‘ubiquitous and of such magnitude that a considerable portion of one’s life energy is consumed in the denial of death’ (1980: 41). In Love’s Executioner (1989), he adds that the thought of a loved one dying can also be a source of tremendous anxiety. Bugental (1981) construes this given of existence in slightly wider terms, as ‘finiteness’, and suggests that an awareness of the limits of our existence brings us face to face with uncertainty, and evokes an anxiety of fate as well as death. Nevertheless,

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74 Existential Therapies both psychotherapists agree that most human beings fiercely defend against the knowledge that they are going to die, and force such awareness down into the depths of their unconscious. Yalom (1980) outlines two particular strategies by which individuals may attempt to defend themselves from an awareness of their demise. The first of these is a belief in one’s own specialness. Here, individuals ward off an awareness of their own finitude by convincing themselves that they are unique and special, such that, whilst mortality may apply to other people, they are exempt from this natural law. Such a resistance may be manifest in a number of forms. Through compulsive risk-taking, for instance, individuals may attempt to prove to themselves that they are uniquely invulnerable to the threat of death. Aggressive and controlling behaviours may also be ways in which individuals attempt to prove their superiority over others, and hence their uniqueness. According to Yalom, another manifestation of the ‘I’m special’ defence may be workaholism, in which individuals strive to achieve a unique position in the workplace hierarchy, and thereby stand far above the yawning chasm of mortality. Individuals who adopt the ‘I’m special’ defence may also manifest many narcissistic traits: an intense self-focus, the expectation that they should be loved and admired for whatever behaviours they emit, and a diminished recognition of the rights and needs of the other. The second defensive strategy identified by Yalom is that of the ‘ultimate rescuer’: a belief that some being – God, a parent, a doctor, or even one’s therapist – will somehow rescue one from the jaws of infinite non-existence. Existential-humanistic psychotherapists have identified numerous other strategies by which individuals may attempt to ward off an awareness of their own mortality. Through the clamour of compulsive sexual activity, for instance, individuals may attempt to drown out the everwaiting presence of death and reassure themselves of their vitality and youthfulness (May, 1969b). Compulsive sexual activity, like workaholism, social activism or a desperate desire for children, may also be an attempt to ‘leap-frog’ death by leaving some kind of legacy behind. Yalom (1980) refers to such defence mechanisms as ‘immortality projects’. Defences against death may also be highly personal. In Yalom’s (1989) case of the ‘Fat Lady’, for instance, the client’s experience of seeing her father wither away from cancer meant that she strived, albeit ‘unconsciously’, to maintain her body fat, lest she should die too. Yalom (1980) suggests that a defence against the reality of one’s own death, to some extent, may serve an important self-protective function. As La Rochefoucauld observes: ‘One cannot look directly at either the sun or death’ (quoted in Yalom, 1980: 103). Like all defences against reality, however, at more developed levels they can become highly dysfunctional. Indeed, Yalom states that, as death is the primordial source of anxiety, it is also the primary fount of psychopathology. Individuals who doggedly try to assert their own specialness, for instance, are unlikely to be able to

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American Existential-Humanistic Approach 75 form mutual and intimate relationships, and may risk their lives in ‘death-defying’ activities. Similarly, individuals who adopt the ultimate rescuer defence may consequently suffer from ‘self-effacement, fear of withdrawal of love, passivity, dependence, self-immolation, refusal to accept adulthood, and depression at collapse of the belief system’ (Yalom, 1980: 134). Furthermore, as Heidegger argues, by not facing up to their own finitude, individuals are not able to make the most of the life that they do have; or, put the other way around, the neurotic refuses the loan of life to escape the debt of death (Rank, 1936). Existential-humanist therapists also agree with existential philosophers that facing up to the reality of death shocks the individual into taking the present seriously and making the most of it (May, 1953), and can give the individual a sense of fellowship with other human beings who are ‘in the same boat’ (May, 1999). For the existential-humanistic therapist, then, and particularly for Yalom, helping clients to face up to the reality of their inevitable demise is an important part of the therapeutic work. Indeed, Yalom writes that, ‘any long-term intensive therapy will be incomplete without working through awareness and fear of death’ (1980: 194). Yalom does not suggest, however, that therapists should specifically confront clients with the fact that they are going to die. Rather, in instances where clients are temporarily divested of their defences against death – for instance, when they realise they are less special than they thought, lose their parental ultimate rescuer, or pass through such milestones as birthdays and anniversaries – therapists should try to ‘nurse the shudder rather than to anesthetize it’ (Yalom, 1980: 166). At the most basic level, this may simply involve encouraging clients to talk about their death-anxieties rather than blandly reassuring them that they’ve got years to go, or interpreting the death anxiety as a product of non-death-related fears. Yalom (1989) goes further than this, however, and may interpret a client’s way of being in terms of an underlying anxiety about – and defence towards – death. Yalom suggests to a client who has advanced cancer, for instance, that his attempts to convince himself that he is tantalisingly 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. Similarly, for Yalom, a client’s refusals to acknowledge the ending of the therapeutic relationship may say something about his attitude towards human finiteness. For Yalom, analysing the transference may also be an important way of helping clients to uncover their defences 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. In exploring death and finitude, Yalom may take an even more didactic stance: reminding a client that the life they are leading is their one and only life

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76 Existential Therapies and not a rehearsal, with no ‘rainchecks’, replays or possibilities of postponement (Yalom and Elkin, 1974: 20). Helping clients explore their anxieties, defences and attitudes towards death may be particularly important when they are in the boundary situations of serious or terminal illness. Here, writes Yalom (1980), the defences erected against death invariably falter, and individuals are faced with the reality that they are not special and exempt, and that there are no ultimate rescuers waiting in the wings. In the face of such realisations, Yalom suggests that terminally ill clients can feel betrayed: as if their very foundations have been kicked away from underneath them. However, for Yalom, the breaking down of such defences against death can also act as a catalyst towards significant personal change, particularly if the awareness of death is fostered, rather than countered, by a therapist. Yalom reports that such squaring up to death can help clients live more fully in the present and overcome the tendency to ‘postpone existence’; appreciate more deeply the positive aspects of their lives; and dis-identify with the more superficial aspects of themselves, including their pre-illness worries and neuroses. Box 5.1 presents some useful exercises for the therapist.

BOX 5.1

Artificial aids to increase death awareness

For therapists to work effectively with clients’ anxieties and feelings about death, they, too, will need to face up to their own demise. Yalom (1980) outlines a number of exercises that may be useful for this purpose: • Write your own obituary or epitaph. You may want to try writing this both as you think it will be, and how you would ideally like it to be. (An even more challenging exercise might be to write an obituary for a loved one.) • Close your eyes and try to visualise your own death: Where do you imagine it will occur? When? How? What would your funeral be like? • On a blank sheet of paper, draw a line, with one end representing your birth and one end representing your death. Draw a cross to represent where you are now, and spend some time meditating on this image. • In small groups, write all the names of group members on slips of paper, and then place them in a bowl. Begin a conversation about any topic, and at some point, pick – or have a facilitator pick – one of the names from the bowl. The person picked should then stop talking and turn their back to the others. After some minutes, discuss your experience of the exercise. What was it liked to be picked? What was it like to have someone ‘taken away’ from you? And, What was it like to experience the arbitrariness of the choosing?

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Confronting freedom The second given of existence identified by Yalom is that of freedom. May, in Love and Will, usefully breaks this concept down into a number of constituent parts. At the root of human freedom, he suggests, is ‘intentionality’: the basic human tendency to ‘stretch’ towards something. ‘Wish’, ‘the imaginative playing with the possibility of some act or state occurring’, lies on top of this; and on top of wish lies ‘will’: ‘the capacity to organise one’s self so that movement in a certain direction or towards a certain goal may take place’ (1969b: 218). Drawing on the writings of the American psychotherapist Leslie Farber (2000), May also distinguishes between effortful will – as in the Victorian notion of ‘will-power’ – and the more spontaneous, automatic and unconscious will by which many of our actions take place. For May, the significance of this distinction is that we may be making choices even when we do not experience ourselves as consciously, wilfully choosing. In other words, freedom is not limited to those moments of deliberate decision-making, but is an all-pervasive component of human experiencing. As existential philosophers have pointed out, however, this freedom to wish, will and choose can be profoundly unsettling. Hence, as with the defence against the anxiety of death, existential-humanistic psychotherapists have identified numerous ways in which individuals may try to defend themselves against the anxiety of freedom. To avoid having to make choices, 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 one’s choices to other people, institutions, deities or things (for instance, tarot cards), may also be a means of trying to disencumber oneself of freedom (Yalom, 1980). Rebellion is another strategy by which individuals may try to avoid choosing. Although this may have a semblance of freedom, by simply doing the opposite of what they are told or expected to do, rebels, as much as conformists, can avoid having to really think and choose for themselves (May, 1953). Human beings may use similar strategies to avoid taking responsibility for the choices that they have made in the past. One of the most common means of defending themselves against the threat of guilt and blame is by displacing the responsibility for their actions onto something external. Individuals, for instance, may hold other people – including their therapists – responsible for the choices that they have made (May, 1969b), concomitantly construing themselves as the innocent victims of other people’s actions (Yalom, 1980). Individuals may also hold social institutions responsible for their choices, or displace their responsibility onto such transpersonal forces as ‘the universe’. As part of this displacement of responsibility, individuals may feel that they have a ‘divine right to be taken care of’ (May, 1953): that the world owes them a living, rather than

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78 Existential Therapies them having the responsibility for creating a life of their own. Human beings, however, may also try to divest themselves of their responsibility by attributing their choices to uncontrollable internal factors: such as their personality, genes, mental illness, childhood or the unconscious. Alternatively, they might claim ‘I just lost control’, ‘I don’t know what came over me’ or ‘I was out of my mind’ (Yalom, 1980). Individuals may also try to defend themselves against the guilt and regret of responsibility by revising their view of the alternatives they needed to choose between. For instance, they may devalue the un-chosen alternative – a process that social psychologists refer to as ‘self-justification’ (Aronson et al., 1999) – such that the feelings of loss and remorse can be attenuated (Yalom, 1980). A client, for example, who has chosen to stay in a loveless relationship, may then try to reassure themselves that they would have ‘fallen apart’ had they chosen to leave, such that they feel less regretful about their choice. As existential philosophers have argued, however, the consequences of such defences against the dizziness of freedom can be severe. By denying their ability to choose, human beings undermine their ability to act in ways that feel meaningful and right for them, and leave them with a sense of powerlessness, hopelessness and futility. By failing to fulfil their potential, they also increase their sense of existential guilt (Yalom, 1980). Moreover, the defence against existential anxiety becomes a breeding ground for neurotic anxiety. They may, for instance, develop obsessive feelings of hatred and anger towards those who they perceive as restricting their freedom (May, 1953); or become trapped in a vicious circle of apathy and powerlessness. Furthermore, because they cannot entirely deny that they are making choices – even if the choice is not to choose – then they continue to be haunted by the threat of blame (Bugental, 1981) and the call of their conscience. As with Daseinsanalysis, then, a central aim of the existential-humanistic approach is to help clients discover, establish and use their freedom (May, 1981). Indeed, Yalom (1980) writes that therapy is effective to the extent that it influences and mobilises patients’ wills. This means that an important aspect of the existential-humanistic approach is helping clients to recognise points at which they could – or can – make choices, and encouraging them to act in wilful, rather than compulsive, ways (Bugental, 1981) both inside and outside of the therapeutic relationship. Here, clients may be encouraged to consider the alternative paths of action that they can take (Yalom, 1980). They may also be encouraged to ‘slow down’, so that they have ‘the power to stand outside the rigid chain of stimulus and response, to pause, and by this pause to throw some weight on either side, to cast some decision about what the response will be’ (May, 1953: 161). From an existential-humanistic perspective, helping clients to become more aware of their feelings and in-the-moment experiences will also help them to become more aware of their deeper wishes

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American Existential-Humanistic Approach 79 (May, 1953; Yalom, 1980; Schneider and May, 1995b). If a male client, for instance, is helped to see that he feels angry every time his partner puts him down, then he can begin to recognise that one of his central wishes is to be treated with warmth and respect. Yalom may also use a more didactic approach to help clients recognise the ‘intrauterine kicks of their inborn will’ (Yalom and Elkin, 1974: 226). During one session with his client Ginny, for instance, Yalom tries to make her realise that her situation is not out of control as she imagines it to be, and that she retains freedom of choice in each instant. She can, he says, take each of her problems one by one, and think of correct moves. In helping clients acknowledge their freedom and possibilities, he suggests that four insights, in particular, may be useful for the therapist to convey to their client: • • • •

Only I can change the world I have created. There is no danger in change. To get what I really want, I must change. I have the power to change. (Yalom, 1980: 340–1)

Challenging clients’ resistances to making choices and taking control of their lives is also a central aspect of the existential-humanistic therapeutic process. Clients, for instance, may be encouraged to replace words like ‘can’t’ with ‘won’t’ (May and Yalom, 1989). Through observation or interpretation, therapists may also point out to their clients ways in which they seem to divest themselves of power, and act in non-assertive ways (Yalom and Elkin, 1974). May points out to a mother, for instance, the way in which she subordinates her needs to the needs of her child, and gives him power as a way of evading her own assumption of it (May, 1972). Helping clients to see how they divest themselves of power within the therapeutic relationship may be a particularly immediate and direct means of helping clients to see their resistances to choice in everyday life. Do they, for instance, look to their therapist to make something happen (Yalom, 1980); believe that their therapist is a God who knows how the therapeutic work should progress (May, 1953); or expect their therapist to dictate the process of therapy (Bugental, 1981) and then ‘rebel’ against every suggestion that they make? Some years back, for instance, I worked with a female client who would come to each session saying that she didn’t know what to talk about, and asking me for some suggestions. Every time I reluctantly suggested a particular line of exploration for her; however, she would sooner or later find fault with it: that she’d already talked about this before, or that she really couldn’t see the point in talking about this. When I fed back to her my perception of this process, we came to see that she felt much safer saying ‘nay’ or ‘yea’ to my choices than making choices of her own. Furthermore, she realised that this was a dynamic that

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80 Existential Therapies occurred in many other areas of her life. We also came to see that, whilst she felt less exposed and open to criticism by reacting against the choices of other, it also meant that she rarely got to do what she wanted, and that she was often left feeling angry that others had not made the right choices for her. To challenge clients’ resistances against taking control within the therapeutic relationship, it can also be very useful for therapists to ask and re-ask their clients what they want from the therapeutic process (Yalom and Elkin, 1974), or even ‘why they have come today’ (May, 1969). This forces the client out of the passive, yet somewhat comforting, stance that the therapeutic healing will simply happen to them if they turn up on a weekly basis – like turning up for a dental appointment – and into an acknowledgement that they are responsible for making the therapeutic growth occur. Existential-humanistic therapists may also be keen to point out to their clients that not choosing is a choice in itself. In the following exchange, for instance, Bugental encourages a mother, Thelma, to see that she is making numerous choices about her daughter’s relationship with a boy of ‘ill repute’: Thelma: Bugental: Thelma: Bugental: Thelma: Bugental:

I can’t do a thing, she’s going to go, and that’s it. So you decided to let her go with John? I haven’t decided. She’s the one who decided. No, you’ve decided too. You’ve chosen to let her go with John. I don’t see how you can say that. She’s insisting. 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. (Bugental, 1981: 346)

Confronting isolation For both Yalom (1980) and Bugental (1981), a third given of existence is that ‘the individual is inexorably alone’ (Yalom, 1980: 353). Yalom writes that there exists ‘an unbridgeable gulf between oneself and any other being’ (1980: 355), as well as an unbridgeable gap between the individual and their world. For Bugental (1981), an awareness of this fundamental

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American Existential-Humanistic Approach 81 separateness evokes an anxiety of loneliness and isolation in people, as well as an anxiety that no-one really cares about them or is thinking about them, and that they do not really matter to other people. One could also include here the anxiety that they are unloved by others, and that no-one could really love them if they knew who they were. As with the other givens of existence, Yalom (1980) and Bugental (1981) argue that, at an unconscious level, human beings develop numerous defensive strategies to protect themselves against an awareness of their fundamental isolation. For instance, they may constantly strive to be noticed and affirmed in the eyes of others, like a little child shouting ‘look at me’, ‘look at me’ (Yalom, 1980). Individuals who have a desperate desire to be famous, or who behave in attention-seeking or overlydramatic ways may have adopted this line of defence. Another defence may be to try and fuse with others (Yalom, 1980): to soften one’s egoboundaries and to try and become part of another person, group or thing. For instance, an individual may sacrifice his individuality in a relationship: obsequiously following the dictates and behaviours of another; or he may unquestioningly conform to his culture’s values, norms and ways of behaving. Not expressing one’s anger or disagreeable feelings towards another can also be part of this struggle to merge (Yalom and Elkin, 1974) – as can the desire to take on a nurturing or ‘rescuing’ role. Sexual obsessiveness can be another manifestation of the desire to merge with another (Yalom, 1980). According to May (1953), individuals may also try and protect themselves against an awareness of their isolation through religion: by believing in a ‘cosmic papa’ – like God who is always by their side. Paradoxically, however, such defences against existential isolation often lead individuals to become more isolated in their lives rather than less. ‘If,’ as Yalom writes, ‘we are overcome with dread before the abyss of loneliness, we will not reach out towards others but instead will flail at them in order not to drown in the sea of our existence’ (1980: 363). In these instances, he goes on to write: ‘We behave toward other beings as towards tools or equipment. The other, now no longer an “other” but an “it,” is placed there, within one’s circle of world, for a function’ (1980: 363). Hence, rather than individuals developing mutual, I–Thou love, individuals develop ‘use and be used’ relationships, in which elements of true connectivity and intimacy are rare. Furthermore, potential mates are likely to find such neediness – whether in terms of a need to be dominated, or a need to nurtured – unattractive, and consequently push the person further away. Another reason why defences against isolation may lead to further isolation is because they are likely to engender neurotic anxiety: feelings which individuals may defend themselves against by withdrawing further from relationships. An individual, for instance, who desperately desires to merge with another may fear tremendously that this desire will be rejected. Consequently, he may defend himself against his neurotic anxiety by withdrawing from intimate relationships

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82 Existential Therapies altogether. Finally, because, of course, the anxiety of existential isolation does not go away, individuals who defend themselves against it will constantly worry that they will one day be left on their own. From an existential-humanistic perspective, then, it is only by acknowledging their true isolation and individuality that individuals can come together with another, and love and be loved in a mature and need-free way (see Fromm’s The Art of Loving (1963)). From an existential-humanistic perspective, such an acknowledgement also allows individuals to actualise their own, unique potential – free of the desire to conform and be approved of by others. Alongside helping clients face up to their death and freedom, then, existential-humanistic psychotherapists may also be concerned with helping their clients face up to their fundamental aloneness (Yalom, 1980). Clients may be encouraged to plunge into their feelings of lostness and loneliness, and, during the course of the therapy, may even be advised to have periods of self-enforced isolation. Clients may also be challenged to look at the ways in which they attempt to defend themselves against their fundamental aloneness and, as with the other existential givens, may be particularly encouraged to look at the ways they try to defend themselves against this anxiety within the therapeutic relationship itself. Indeed, Yalom writes: ‘The characteristics of a need-free relationship provide the therapist with an ideal or a horizon against which the patient’s interpersonal pathology is starkly illuminated’ (1980: 393). Therapist and client, for instance, can look at whether the client tends to constantly seek affirmation from his therapist, or whether the client maintains a stance of detachment and disinterest. Through the challenging of such resistances, the client can then begin to experience the depths of aloneness in the therapeutic relationship and, with it, his ability to relate to his therapist in an independent, need-free way. Whilst such a relationship may be temporary, what remains with the client is his knowledge that he has the potential for this kind of relationship.

Confronting meaninglessness A fourth existential given identified by Yalom (1980) and Bugental (1981) is that of meaninglessness. Yalom, drawing heavily from the work of Frankl, argues that human beings are fundamentally meaning-seeking creatures. In contrast to Frankl, however, both he and Bugental hold that human beings must face up to the ultimate meaningless of their existence: ‘that there exists no “meaning”, no grand design in the universe, no guidelines for living other than those the individual creates’ (Yalom, 1980: 423). On this basis, then, an existential-humanistic approach to meaninglessness might highlight the way in which individuals tend to defend themselves against an awareness of this given – for instance, by throwing themselves into mindless pursuits or crusading for a cause – and how

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American Existential-Humanistic Approach 83 these defences fail to really stem the sense of nihilism, absurdity and despair (Bugental, 1981). It might also argue that if human beings can face up to the meaninglessness of their existence, they can confront it directly, and find ways of carving out their own, personal meaning in life: for instance, through altruistic acts, dedication to cause, creativity or hedonism (Yalom, 1980). From this standpoint, the role of therapists would be to help clients identify their defences against the anxiety of meaninglessness, and to encourage them to ‘stay with’ the awareness that there is no given meaning to their lives. Helping clients to identify the ways in which they deny meaninglessness in the therapeutic relationship – for instance, by assuming that the therapist knows what the ultimate value of therapy is – would also be an intrinsic part of this process. Interestingly, however – and, again, in direct contrast to Frankl – Yalom suggests that the anxiety of meaninglessness may not be a primary anxiety, but a ‘“stand-in” for anxiety associated with death, groundlessness and isolation’ (1980: 470). From this perspective, an individual who desperately wants to find some meaning in her life may be seen as trying to find a way of transcending her death by leaving a legacy behind. Similarly, an individual may be seen as feeling that life is intrinsically meaningless because she is so defended against close, loving relationships that nothing provides her with any sense of pleasure. On this basis, Yalom suggests that therapists should not take clients’ statements that ‘life has no meaning’ at face value, but should ‘rigorously examine the legitimacy of the complaint’ (1980: 462) and help clients to examine the other concerns and anxieties on which such statements may be based. Furthermore, based on the analysis that a sense of meaninglessness often comes from a lack of engagement with the world, Yalom suggests that therapists should pursue the question of meaning obliquely, helping clients to re-engage with their world and immerse themselves in the river of life.

Confronting embodiedness A fifth given of existence outlined by Bugental is that of ‘embodiedness’: ‘Our bodies are the always-present condition of our conscious experience, so that the fact of embodiedness permeates all phases of our living’ (1981: 443). As with the other existential givens, however, Bugental argues that an awareness of our embodied being evokes anxiety – specifically the anxieties of pain and destruction – such that we tend to repress this awareness, through such strategies as dissociation and depersonalisation. The consequences of such denial, however, are that individuals feel a deadened, joyless existence within their body. Hence, the more that therapy can help clients to reconnect with their physical being – through such strategies as embodied visualisations – the more that clients can experience the fullness of an embodied life.

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84 Existential Therapies May focuses on one very specific aspect of this embodied, biological being: what he calls ‘the daimonic’. By this, he means ‘any natural function which has the power to take over the whole person’ (May, 1969b: 123). This is not unlike Freud’s id, and consists of all those untamed energies that reside ‘deep’ within the individual’s being: for instance, sex and eros, anger and rage, and the craving for power. Like Freud, May sees these energies as having a very destructive potential; and, in contrast to humanists like Rogers, believes that ‘We humans carry within us the seeds of our own destruction ... We must hate as well as love’ (p. 145). At the same time, he sees them as a source of great potential personal power, creativity and connection to others. According to May (1969b), for instance, the daimon eros is a yearning to transcend ourselves and bind with others, to achieve a greater state of wholeness. Similarly, whilst the daimon rage has the potential to be highly destructive, it is also a means by which we can assert and affirm our being. As with the other givens of existence, May (1969b) argues that, within our culture, we tend to repress an awareness of such uncontrollable, animal-like and potentially overwhelming forces. The result of this, however, is an increasing feeling of apathy and lifelessness. May, for instance, argues that the contemporary obsession with the technicalities of sex – with its emphasis on performance, length and the acquisition of new techniques – is a consequence of the loss of eros from the sexual arena. Sex today, states May, is about sensation rather than passion: it has lost its intimacy, spontaneity and abandon in an effort to eliminate anxiety from the sexual act. Furthermore, where individuals repress their daimonic energies, there is always the danger that those energies will finally erupt in uncontrollable and highly destructive ways. An individual, for instance, who does not allow herself to experience her anger, may finally get to a point where she explodes in rage and violence. To avoid such forms of ‘daimonic possession’ then, May suggests that individuals need to move beyond a stage in which the daimonic is a blind, impersonal push, and begin to own and integrate the daimonic in a personal way. By directing and channelling these powers, individuals can begin to transform their destructive side into constructive activities, and achieve a higher level of integrated consciousness. In terms of therapeutic practice, then, existential-humanistic practitioners may try to help clients develop a greater awareness of their inner daimons, and to come to accept and utilise these aspects of themselves. Many of the therapeutic strategies discussed earlier in this chapter may be used to facilitate this process. For instance, clients may be provided with space to express their inner daimons; encouraged, directed or instructed to express such daimonic feelings as anger or sexuality (Yalom and Elkin, 1974); or helped to understand their feelings and behaviours in terms of the expression – or resistance towards – daimonic energies. Again, too, there may be an emphasis on looking at how these energies are manifested

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American Existential-Humanistic Approach 85 and resisted within the therapeutic relationship. Yalom, for instance, strongly encourages his client Ginny to explore any sexual feelings she may have towards him (Yalom and Elkin, 1974), and interprets some of her behaviour and verbalisations in terms of her sexual attraction towards him. He also suggests to Ginny that her timid, respectful and kind behaviour is perfectly explicable in terms of the murderous degree of rage she is harbouring, and her fear that some of this will leak out. May (1972) takes this a step further and actually models the expression of anger for one of his clients: venting rage towards the client’s mother so that the client can eventually acquire this mode of behaviour herself.

The constrictive-expansive polarity In recent years, Schneider (Schneider and May, 1995c; Schneider, 1999) has attempted to develop a more integrated model of existential anxieties and resistances. Drawing partially from Kierkegaard’s notion of ‘finitude’ and ‘infinitude’ (1849/1980), as well as May’s (1969b) emphasis on the ‘fundamental polarity of all reality’, Schneider suggests that all human experience exists along a constrictive-expansive polarity. At the constrictive end of the pole is the experience of smallness, confinement, and of ‘drawing back’ thoughts, feelings and sensations. It is associated with such words as ‘retreating’, ‘diminishing’, ‘refining’, ‘falling’, ‘emptying’ and ‘slowing’. At the expansive end of the pole, on the other hand, is the experience of greatness, of ‘bursting forth’ thoughts, feelings and sensations. It is associated with such words as ‘gaining’, ‘enlarging’, ‘dispersing’, ‘ascending’, ‘filling’ or ‘accelerating’. Schneider (1999) argues that, in cases of psychopathology, individuals tend to restrict themselves to only one side of this polarity, or shift wildly between expansive and constrictive extremes. ‘Hyperconstrictive dysfunctions’ (those in which the individual only allows themselves to experience smallness), he writes, include agoraphobia, depression and dependent personality traits, whilst ‘Hyperexpansive dysfunctions’ (those in which the individual only allows themselves to experience greatness) include mania, impulsiveness and claustrophobia. Hyperconstrictive/expansive blends (those in which individuals shift between extremes of smallness and greatness) include manic depression and schizophrenia. Schneider goes on to suggest that people develop these pathological states as a defence against the opposite extreme, and the dread that they will be annihilated if they experience ultimate constriction or ultimate expansion. Individuals suffering from depression, for instance, may fear that the consequences of opening themselves up to their world would be catastrophic: that their very selves would be splintered by the needs and demands of others. At the hyperexpansive end of the pole, individuals who suffer from

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86 Existential Therapies claustrophobia may fear that being trapped within a room would cause them to disappear down into nothingness. Schneider (1999) also suggests that these dreads frequently develop as a consequence of early childhood experiences. A child who is acutely traumatised through the hyperconstrictivity of sexual abuse, for instance, may develop a phobia of this way of being and overcompensate in later life: for instance, by being hyperexpansively un-boundaried and chaotic. In cases of on-going, chronic trauma, on the other hand, Schneider suggests that the child may become unable to counteract, and thereby conform to their hyperconstrictive or hyperexpansive pressures. Prolonged, hyperconstricting criticism and ridicule by a parent, for instance, may leave the child feeling that they cannot experience expansive states. Finally, Schneider suggests that children may also learn revulsion for hyperconstrictive or hyperexpansive experiences vicariously – for instance, by being told by their parents that they should always keep themselves to themselves. He terms this ‘implicit trauma’. From this perspective, a psychologically healthy individual is one who is willing to confront, rather than avoid, both ends of the constrictiveexpansive continuum, and is able to move freely along this spectrum. In this respect, a primary aim of existential-humanistic therapy – or what Schneider (1999) has termed ‘paradox analysis’ – is to gradually help clients identify and overcome their resistances to the full spectrum of constrictive-expansive experiences. If this can be achieved, then the client can be liberated from their narrow and rigid ways of experiencing their world, and actualise both their constrictive and expansive potentials. In terms of practice, then, Schneider (2002, personal communication) attempts to mirror back to clients how they engage or deflect their constrictive or expansive worlds, what choices they have in response to those patterns, and how or whether they are willing to act on, grapple with or encounter those choices. For instance, he may vivify a client’s tendency to avoid hyperconstrictive or hyperexpansive experiences, or gently challenge her to stay with her feared pole. In the following dialogue, Schneider helps his client go deeper into the feelings of smallness and despair that are beginning to emerge: Schneider: Where do you feel [the sadness] in your body? Client: [Points to stomach.] Schneider: [Touches his own stomach.] What’s there, Joe? Slowly now, can you describe it? Client: It’s like a big pit, a black hole from which nothing can escape. Schneider: What else? Any other images? Client: There I am, this little white face in the midst of that hole. I feel lost, like on a vast, dark sea. I don’t know what’s happening to me, do you?

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American Existential-Humanistic Approach 87 Schneider: See if you can stay with it a little longer to find out ... (Schneider and May, 1995c: 151)

Critical perspectives From an existential philosophical position, the existential-humanistic approach can be criticised for lacking philosophical depth (van Deurzen, 1991). Certainly, within the writings of Bugental (1981) and May (1969b), there are some fairly radical misunderstandings of key existential ideas, many of them revolving around a tendency to reduce ontological concepts to the ontic level. Bugental, for instance, writes that presence is Dasein ‘in the purest sense’ (1981: 383), as if an individual can be more or less ‘there’, whilst May (1958a) equates being-in-the-world with the experience of community. From a more intersubjective, existential position, the existentialhumanistic emphasis on subjectivity and ultimate aloneness is also problematic. How, for instance, can we talk of the sovereignty and separateness of individual subjectivity, when a key component of that subjective experiencing – thought – is dependent upon the sociallyconstructed medium of language? As Schneider (2002, personal communication) suggests, however, recent years have seen a move within the existential-humanistic camp towards a more intersubjective standpoint. Bugental, for instance, has redefined the existential given of separateness as ‘separateness but relatedness’ (Bugental and Sterling, 1995), and Yalom’s latest work (2001) is almost entirely concerned with the establishment of interpersonal relationships, with virtually no mention of the aloneness of human beings. The inclusion of Maurice Friedman into the existential-humanistic fold (Schneider, 2003) – one of the key commentators on Buber’s work and an advocate of dialogic therapy (Friedman, 1985) – also suggests that the existential-humanistic approach is moving in a more intersubjective direction. From an existential perspective, a third criticism of the existentialhumanistic approach is that it is relatively dependent on the notion of unconscious processes, particularly resistance. This criticism is confounded, however, by the fact that existential-humanistic practitioners rarely say what they mean by this term. When May (1999), for instance, talks about ‘the workings of the unconscious’, he would seem to be positing the existence of an independent, autonomous, intrapsychic realm; and this would seem clearly at odds with a world-view that emphasises the wholeness and in-the-worldness of human beings. At other times, however, he defines the unconscious as ‘potentialities for knowing, feeling and awareness that we cannot yet actualise’ (1999: 36), and this would seem more compatible with an existential-phenomenological framework.

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88 Existential Therapies A fourth criticism of the existential-humanistic approach is that it tends to present authenticity as a goal that clients can work towards, rather than as a form of self-relating that is inherently transient (see Chapter 2). In this respect, existential-humanistic therapists tend to present the therapeutic process as one of linear, unidirectional growth – the peeling of the onion layers – rather than as an on-going grappling with life. In this vein, van Deurzen (1991) criticises Schneider’s work on polarities for attempting to find solutions to the tensions of existence, rather than helping clients to come to terms with the inevitable struggles and tensions of life. Schneider vigorously rejects these charges, but he does acknowledge that the existential-humanistic approach has a relatively hopeful and optimistic view of the potential for therapeutic transformation: that clients can grow towards a more authentic, liberated and self-accepting way of being (2002, personal communication). Closely related to this, however, is the tendency within the existentialhumanistic approach to present authenticity as a somewhat superior way of being. ‘[T]he good life is an authentic life’ writes Bugental, whilst ‘Inauthenticity is illness’ (1987: 246). This tendency to privilege authentic over inauthentic ways of being is also apparent in the existential-humanistic notion of ‘resistance’, which tends to imply that a client’s desire to keep themselves safe and protect themselves from the reality of their existence is less valid than their desire to emerge and grow. Again, this is not entirely consistent with an existential philosophical position, which holds that ‘The essential nature of Dasein requires us to be as open to inauthenticity as to authenticity’ (van Deurzen, 1999: 123), and that there are no given, ‘right’ ways of being. The problem with making such a judgement is also that existential-humanistic therapists may then be tempted to point their clients in the ‘right’ direction; and, indeed, some existentialhumanistic therapists, most notably Yalom, are not averse to coaxing, coercing, directing or instructing their clients to be more authentic and free (see Yalom and Elkin, 1974; Bugental, 1987). It may also mean that clients feel judged for choosing to ‘resist’ a frightening step forward. As discussed earlier, however, there does seem to be a softening of the existential-humanistic approach in recent years: a less linear, judgemental and directive approach to the therapeutic relationship that emphasises clientinitiated, interdependent change (see Schneider, 2003).

Conclusion To some extent, it might be argued that the existential-humanistic approach is more existential in content than practice (van Deurzen-Smith, 1997). Certainly, there are some very directive and interpretative elements in the work of Yalom; and both Yalom (in Brainard, 1992) and May (in Kohn, 1984) state that their practice is not existential therapy but a

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American Existential-Humanistic Approach 89 therapeutic approach informed by existential concerns. Nevertheless, of all the existential therapies, the existential-humanistic approach has probably done most to outline the nature of an existential therapeutic relationship, and have presented a uniquely comprehensive and coherent account of the kinds of existential concerns that clients may face. Furthermore, without fearing to talk about intrapsychic processes, they have done much to show how clients may attempt to avoid and deny these givens of existence. Most uniquely, though, existential-humanistic practitioners like Yalom (1989; 1999) and Bugental (1976) have produced an enormously accessible body of work, which allows readers to get right into the very heart of an existentially-informed therapeutic practice.

Further reading Bugental, J. F. T. (1981) The Search for Authenticity: An Existential-Analytic Approach to Psychotherapy. (Exp. edn.) New York: Irvington. A forgotten classic in the world of existential therapies. Repetitive and rambling at times, but a uniquely comprehensive, detailed and in-depth presentation of an existential-humanistic approach. The most explicitly existential of Bugental’s works. Yalom, I. D. (1980) Existential Psychotherapy. New York: Basic Books. Yalom’s magnum opus, detailing the manifestations of, resistances to, research about, and therapeutic work with four ‘ultimate concerns’ of existence: death, freedom, isolation and meaninglessness. Essential reading for existential therapists of all persuasions. Schneider, K. J. (2003) ‘Existential-Humanistic Psychotherapies’, in A. S. Gurman and S. B. Messer (eds), Essential Psychotherapies. New York: Guilford Press. Useful summary of contemporary existential-humanistic thought and practice. Bugental, J. F. T. (1978) Psychotherapy and Process: The Fundamentals of an ExistentialHumanistic Approach. Boston, MA: McGraw-Hill. Concise, accessible and engaging introduction to Bugental’s Existential-Humanistic approach. Schneider, K. J. and May, R. (eds) (1995) The Psychology of Existence. New York: McGraw-Hill. Handbook of existential-humanistic therapy, with philosophical, literary and psychological readings; summaries of theory and practice (with a particularly Schneiderian edge); and case-studies, including work with clients from ethnic and sexual ‘minorities’. Somewhat fragmented at times, but a useful source of material. Yalom, I. (2001) The Gift of Therapy: Reflections on Being a Therapist. London: Piatkus. Tips from the master, with a particular emphasis on the importance of being real with clients and working with the here-and-now relationship. Yalom, I. (1989) Love’s Executioner and Other Tales of Psychotherapy. London: Penguin. Hugely popular collection of case-studies, which brings Yalom’s existentially-informed therapy to life in a uniquely vibrant, humane and engrossing way. See also Yalom’s sequel Momma and the Meaning of Life (1999), and his twice told tale of therapy, Every Day Gets a Little Closer (1974). May, R. (1969) Love and Will. New York: Norton. May’s magnum opus, which critiques the apathy and emptiness of contemporary society, encouraging people to realise and recognise their will, their ‘daimonic’ urges and their passion.

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90 Existential Therapies Schneider, K. (1999) The Paradoxical Self: Towards an Understanding of Our Contradictory Nature. (2nd nd edn.) Amherst, NY: Humanity Books. Construes consciousness along an ‘expansive-constrictive’ polarity, with psychopathology a morbid dread of either pole. Considers the therapeutic implications of this model. The Review of Existential Psychology and Psychiatry. An intermittently published and relatively academic American-based journal, which publishes some key international papers on existential therapy, many from an existential-humanistic perspective.

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6. R. D. Laing: Meeting without Masks

R. D. Laing (1927–89), the Scottish psychiatrist, is one of the most infamous, yet most frequently misunderstood, existentially-informed therapists (see Box 6.1). At the height of his career, in the mid- to late1960s, he ‘was the most widely read psychiatrist in the world, reaching people across disciplinary boundaries and all walks of life’ (Burston, 2000: 1). Today, more than ten years after his death, Laing’s ideas are still intensely debated in books, journals and conferences, and a number of therapeutic communities and organisations in the UK and the US continue to develop his work.1 Laing’s disposition has been variously described as mercurial, enigmatic, arrogant, iconoclastic and brilliant, and his writings display each of these characteristics. Of all the existential therapies examined in this book, Laing’s approach is the most difficult to characterise. Laing makes no

BOX 6.1

R. D. Laing: myth and reality

Myth: Laing romanticised and idealised schizophrenia. Reality: Laing did assert that, for some people, ‘what we call psychosis may be sometimes a natural process of healing’ (1969: 74); but he never described the experience of the schizophrenic ‘as anything but a mixture of chronic fear, confusion, isolation and despair, punctuated by relatively brief intervals of lucidity or ecstasy’ (Burston, 2000: 70). Myth: Laing rejected the theory that schizophrenia has a genetic, biological basis. Reality: Laing believed that the case for biological determinants remained unproven, but he also acknowledged that biological factors could predispose an individual to psychosis (Resnick, 1997). Myth: Laing founded the ‘anti-psychiatry’ movement. Reality: The term ‘anti-psychiatry’ was developed by David Cooper – one of Laing’s associates – and was explicitly rejected and abhorred by Laing, who wanted to circumvent such partisan terms (Burston, 1996). For Laing, the issue was not one of pro- or anti-psychiatry, but the fact that psychiatric treatments could be imposed on a patient regardless of their will.

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92 Existential Therapies attempt to codify his way of working, gives virtually no examples of his practice, and changed his ideas quite substantially across time. Hence, it is only through brief passages in his writings and the accounts of his clients that one can begin to build up a picture of his work. To some extent, however, this is deliberate: Laing feared that any attempt to formalise his approach would be corrupted and misunderstood (Mullan, 1995), and would undermine the very principles of spontaneity that formed the core of his therapeutic outlook. Laing’s primary concern with the aetiology and treatment of schizophrenia may also have meant that he focused less of his energies on outlining his broader therapeutic practice. Nevertheless, Laing’s critique of contemporary psychiatric practice, his existential-phenomenological analysis of mental misery, and his interpersonal approach to therapeutic practice have a key place in the pantheon of existential therapies.

Influences Whilst Laing (1965) acknowledged that his key work, The Divided Self, was not a direct application of any established existential philosophy, he goes on to state that his main intellectual indebtedness is to the existential tradition. Laing read many of the key existential texts whilst still in his youth, and draws liberally from a range of existential-phenomenological thinkers, amongst them Kierkegaard, Nietzsche, Tillich, Heidegger, Buber, Jaspers, Merleau-Ponty, Husserl and Sartre. In particular, Laing ‘lifted’ from Husserlian phenomenology the idea that to fully understand another’s lived-experience, one must bracket off all attempts at categorising, labelling or diagnosing them, and should try, instead, to stay with that person’s lived-experience at a purely descriptive level. Laing was also strongly influenced by Sartre, particularly his later works on social processes (see The Critique of Dialectical Reason (1960/1976)), and the way in which human beings can become enmeshed in particular social structures (Collier, 1977). Like Sartre’s (1943/1958) earlier work, Laing also had an interest in the way in which individuals may tend to objectify and dehumanise each other. At other times in his work, however, Laing takes a more optimistic view of human relationships and possibilities, and here he comes closer to Buber’s (1923/1958) notion of an I–Thou interpersonal attitude (see Mullan, 1995). To some extent, Laing’s approach was also influenced by the work of those European psychiatrists who had attempted to formulate psychological difficulties in existential and phenomenological terms (see Further Reading in Chapter 1). Earliest amongst these was Karl Jaspers, whose General Psychopathology (1959/1963), first published in 1913, attempted to move away from detached scientific observations and causal explanations of ‘abnormal psychic phenomena’ to describing these phenomena in terms of the patients’ actual, meaning-orientated, conscious lived-experiences.

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R. D. Laing 93 Another European existential psychiatrist who had impressed Laing was Eugène Minkowski, who was particularly interested in the way that certain psychological problems were associated with particular experiences of time (Mullan, 1995). (A depressed individual, for instance, may have no sense of the long-term future, whilst an individual in a state of mania may only be able to experience the immediate present.) There are also a number of notable parallels between Laing’s account of schizophrenia and that developed by Binswanger (1963): for instance, the assertion that the schizophrenic withdraws from independent autonomous selfhood, tries to defend herself against dissolution, and experiences a sense of naked horror in the face of potential annihilation. Indeed, prior to Laing, Binswanger (1958) had argued that there is method and meaning – rather than pure chaos – in the alleged disorder of insanity, and that ‘a person is judged “sick” wherever his social behaviour deviates from the respective norm of social behaviour and thus appears conspicuous or strange’ (1958: 227). Interestingly, however, Laing does not cite Binswanger as a direct influence. Like the proponents of Daseinsanalysis, logotherapy and the existentialhumanistic approach, Laing was also significantly influenced by psychoanalytic thinking. In Laing’s case, however, this was more the influence of the British school of object relations and the middle group of psychoanalysis than of Freud directly. Having spent a number of years practising and researching at the Tavistock Institute – during which time he graduated as a qualified psychoanalyst – Laing rubbed shoulders with many of the British psychoanalytic greats, amongst them John Bowlby, D. W. Winnicott, Marion Milner (who acted as his supervisor), and Charles Rycroft (who acted as his therapist). The influence of British psychoanalytic thinking on Laing’s work – particularly Winnicott – is particularly noticeable in his tendency to account for adult experiences and behaviour in terms of early childhood experiences, particularly the absence of love. Laing, in his earlier work, also drew heavily from psychoanalytic, Winnicottian concepts in his idea of the ‘true’ and ‘false’ selves. In practice, too, Laing owed a great deal to psychoanalysis. Laing was thoroughly schooled in the psychoanalytic practice of free association, whereby the client is encouraged to utter out loud whatever comes into their mind, and this served as the basis to much of his clinical practice (Thompson, 1997). Laing also drew heavily from the psychoanalytic practice of interpreting the transference, whereby the client’s displacement onto their therapist of feelings and ideas derived from previous figures in their lives is elucidated and expounded upon. Like Yalom (1980) and the American existential-humanistic therapists, Laing was also influenced by the Interpersonal psychiatry of Harry Stack Sullivan (see Mullan, 1995). In addition, Laing drew on the work of Gregory Bateson and the ‘Palo Alto’ group (Bateson et al., 1956), who argued that schizophrenia may emerge when a person is caught up in dysfunctional family patterns of communication.

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94 Existential Therapies A fifth important influence on Laing’s work was a broadly socialisthumanist-libertarian standpoint. Laing rarely took an explicitly left-wing stance, but he had read Marx widely and was deeply committed to challenging injustices – a commitment that lay at the heart of his approach to mental misery. Like Marx, Laing also argued that a micro-context could not be understood without an understanding of the macro-context (Collier, 1977: x). That is, an individual could not be understood in isolation from their family system, and a family system could not be understood without an understanding of its wider social, cultural and political nexus. Laing’s grounding in Marxism also led him to question the assumption that what we take for normal is necessarily good. Rather, like Marx – as well as like Heidegger (1926/1962) and other existential philosophers – he came to believe that ‘normal’ human beings are, in fact, hugely alienated from their own selves and potential: ‘a shrivelled, desiccated fragment of what a person can be’ (Laing, 1967: 22). A final factor that almost certainly had a major influence on Laing’s thinking was his own childhood. Perhaps the single most important element here was the loveless, suffocating and confusing relationship that he had with his mother. From the biographical evidence, it seems that Laing was not wanted by his mother (Burston, 1996), and her antagonism towards him was manifested in many ways. She rarely cuddled or touched him; destroyed toys and musical instruments that he became attached to; and even, when he was older, stuck pins into a ‘Ronald doll’ in the hope of giving him a heart attack! Just as significantly, however, Laing’s mother consistently denied these hostile feelings, telling her son that she loved and cared for him, and acting towards him in overtly possessive and intrusive ways (for instance, not allowing him out of the house until his first day of school). It is perhaps no surprise, therefore, that much of Laing’s writings are concerned with the way that children are subjected to rejection, invalidation and emotional violence by their parents (particularly by their mothers), often under the guise of love. Indeed, a number of the examples of parental mis-treatment in Laing’s books are, in fact, directly from his own childhood.

Finding meaning in madness As a trainee psychiatrist in the 1950s, Laing came to reject the general psychiatric world-view of his – and, to a large extent, our – day. This was for a number of reasons. First, he abhorred the ‘unspeakable violence’ of lobotomies, electro-convulsive therapies and padded cells. Second, he felt that there was a complete breakdown of genuine, human relationships between psychiatrists and patients. Third, he felt that psychiatrists had an unparalleled degree of power over those in their charge. Fourth, he felt that the psychiatric system – by labelling and dismissing certain

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R. D. Laing 95 people as ‘mentally ill’ and ‘dysfunctional’ – failed to acknowledge the sense and meaning behind these people’s symptoms (Laing, 1965). In contrast to this approach, then, Laing argued that psychiatrists and therapists should strive to enter their client’s phenomenologically-lived world. Here, he argued, they would come to see a far greater meaning and purposiveness in their client’s thoughts, feelings and behaviours than they had initially imagined. In this respect, Laing’s work extends and radicalises the viewpoint of earlier existential and phenomenological psychiatrists. Whilst Jaspers (1959/1963), for instance, described neurotic and psychotic experiences phenomenologically, he still retained the use of such terms as ‘abnormal’ and ‘psychopathological’, and distinguished between ‘those affective states which emerge in understandable fashion’ and those ‘which defeat understanding’ (Jaspers, 1959/1963: 110). Similarly, Daseinsanalysts like Boss (1963) continued to talk about ‘perversions’ or ‘obsessional neuroses’, as if these ways of being were somehow less legitimate, valid or meaningful than more ‘normal’ ones. Laing, on the other hand, wanted to show that even the most bizarre behaviours were intelligible from the sufferer’s point of view. As an example, one of the young women in Laing and Esterson’s (1964) series of case studies, Sanity, Madness and the Family, would sit or stand still for over an hour at a time. Psychiatrically, such behaviour could be diagnosed as ‘catatonic immobility’: typical symptoms of her schizophrenic illness that have no meaning other than to indicate her level of impairment. When Laing and Esterson interviewed this young woman, however, ‘putting entirely in parenthesis the validity of any attribution of illness’ (1964: 204), they found that the young woman’s immobility was anything but meaningless. When asked, for instance, what she would do if her mother – an intrusive and infantilising woman – expressed an opinion that she disagreed with but subsequently saw to be right, the young woman replied that she would go rigid and stiff inside so that no-one could ‘get at her’ and alter her opinion. Furthermore, she said that she held her breath – and displayed other symptoms of her ‘schizophrenia’, such as habitually sniffing and coughing – to protect herself from her mother’s barrage of words. Unusual behaviours, perhaps, but the point was that there was an intelligibility behind this young woman’s behaviours and ‘symptoms’: they were more than just random expressions of crazed activity. For therapists, then, the Laingian edict is, perhaps, ‘assume intelligibility unless proved otherwise’, as opposed to ‘assume unintelligibility unless proved otherwise’. In other words, therapists should try to engage with their clients holding a basic trust that the client’s behaviours and experiences are meaningful attempts to deal with their world, rather than pathological or irrational errors of functioning. Maintaining such a trust, however, is by no means easy, because the very foundation of therapy tends to be the assumption that the client is getting something wrong.

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96 Existential Therapies As a personal example, I worked some years ago with a man in his mid-50s who, after many years of failing to find work, was finally offered an exciting opportunity at a new local firm. My initial assumption was that this client should have been delighted with this offer, and when he ‘ummed’ and ‘ahhed’ about the post – and seemed to fall into deeper depression – my instinctive response was to try and help him look at what was ‘impeding’ his growth. As we explored his situation further, however, it became increasingly apparent that there was a great deal more sense and intelligibility to his ambivalence than I had imagined. Suppose he did take this job. Supposing it was rewarding and enjoyable. What terrible, crushing regret he would then have to live with: that he hadn’t manage to find such a job 20 years ago. In a way, it was less painful for him to forgo the job and maintain his belief that he simply wasn’t employable. My initial tendency, then, was to look for what this client was doing wrong, and it was only by trying to bracket my assumptions that I could begin to understand the sense behind his behaviour and feelings. Indeed, I got to the point where I genuinely didn’t know what was the best thing for him to do – a good indicator, perhaps, that I had truly entered his lived-world.

Ontological insecurity In attempting to demonstrate that ‘schizophrenia’ may be the outcome of meaningful, intelligible acts, Laing describes a range of intrapsychic and interpersonal ways of being that may lead individuals to develop psychosis. At the intrapsychic level, Laing suggests that schizoid-predisposed individuals may experience a fundamental sense of ‘ontological insecurity’. This is where an individual has not developed a ‘firm sense of his own and other people’s reality and identity’, and has not acquired any ‘unquestionable self-validating certainties’ (Laing, 1965: 39). Laing goes on to state that the ontologically insecure person: ... may feel more unreal than real; in a literal sense, more dead than alive; precariously differentiated from the rest of the world, so that his identity and autonomy are always in question. He may lack the experience of his own temporal continuity. He may not possess an over-riding sense of personal consistency or cohesiveness. He may feel more insubstantial than substantial, and unable to assume that the stuff he is made of is genuine, good, valuable. (1965: 42)

Because people in a state of ontological insecurity feel that they cannot take their identity for granted, there is a constant fear that their very self will be annihilated. In particular, Laing talks about three fears that ontologically insecure people may have. First, there is a fear of ‘engulfment’, that their autonomy will be devoured and subsumed by the will of others.

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R. D. Laing 97 Second, they fear ‘implosion’, a terror that they will be obliterated by the ‘real’ world around them: ‘as a gas will rush in and obliterate a vacuum’ (Laing, 1965). Here, one can include the fear of intrusion and invasion by others (Collier, 1977). Third, there is the fear of ‘petrification and depersonalisation’: the dread of being turned into an inanimate object – an ‘it’ – by the other (note the similarity here with Sartre’s (1943/1958) notion of ‘the Look’). How does ontological insecurity lead to ‘schizophrenia’? Laing (1965) suggests that the ontologically insecure person may attempt to deal with the perceived threats to their existence by ‘splitting in two’. They may withdraw their ‘true self’ from their body and retreat into an inner, private citadel of their mind where they hope they will be safe from the threat of annihilation. What they leave behind is a de-personalised body, a ‘false self’, a shell that they hope will protect them against the threat of engulfment, implosion, petrification and depersonalisation. In a sense, the only way that the individual feels that she can preserve her sense of being is by sacrificing one component of it – a decoy that she throws to the outside world in the hope that her real being may be left alone. At this point, such an individual may be perceived by the external world as quite normal. Indeed, because she has forgone responsibility for her false, public self, she may willingly comply with the demands of those around her – even going so far as to imitate the personalities and behaviours of those she complies to. As the real self withdraws further and further inwards, however, so the sane schizoid individual may cross the boundary into psychosis. She is so withdrawn and alienated from her body that she feels others must be controlling her actions. She may try to overcome her sense of physical deadness through self-mutilation. She may be furious at those who demand her compliance (as well as the false part of herself that complies with these demands) and hence grotesquely characterisation and ridicule – rather than imitate – those she is complying with. And because, as the real self withdraws, it becomes less and less able to experience real relationships with, and confirmation through, others, so it loses what precarious sense of realness it has. Ultimately, the desperate battle to protect the self brings about its own annihilation: a descent into the gates of hell, wracked with despair, terror and a sense of dissolution (Laing, 1985). In the eyes of the world, then, the individual has moved from good, to bad, to mad (Collier, 1977).

The social context of mental misery For Laing, however, severe forms of mental misery, like schizophrenia, could not just be understood as private, individual, intrapsychic activities. Rather, Laing believed that schizophrenia was a particular strategy that individuals develop to try and survive in particular social situations

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98 Existential Therapies (Laing, 1967). Like many intersubjective philosophers, Laing believed that human beings were essentially inter-relational beings, such that the experience and behaviours of one individual could not be understood without an understanding of the experiences and behaviours of those around them. Hence, where an individual develop such bizarre forms of behaviour and experiences as paranoia or psychosis, Laing believed that it was only through an understanding of the social context in which these responses arose that the true meaning and intelligibility of these ways of being could come to light. For Laing, the family was the primary social context through which an individual might come to a state of severe mental misery. Laing, at his most rhetorical, described the family as a ‘protection racket’ (1967: 55), which, as the primary agent of socialisation, beats its children into shape ‘in the manner that beggars maim and mutilate their children to make them fit for their future situation in life’ (1967: 56). For Laing, however, this beating was not carried our primarily physically, but through disturbed and disturbing means of relating and communicating. Central to Laing’s (1969) analysis of the family was his extension of the psychoanalytic concept of ‘phantasy’ from the individual to the family as a whole. Laing suggested that families, like all groups, develop ‘social phantasy systems’: shared sets of inferences and assumptions – frequently held non-consciously – about the way in which the family and its members experience their world. For the family – including, at least initially, the ‘sick’ individual – this phantasy system is the right way of seeing things, such that if individuals testify to experiences that lie outside of these systems, or attempt to extricate themselves from these systems, their families will defend themselves against such threats. Here, Laing is extending the psychodynamic concept of defence mechanisms from the intrapersonal level to the transpersonal level. Such transpersonal defences may involve a denial, distortion or invalidation of a family member’s experiences, and there are numerous examples of this in Laing and Esterson’s (1964) Sanity, Madness and the Family. One young woman, for instance, upon telling her parents that she masturbated and wondered about them having sex, was simply told that she didn’t. Another young woman, upon trying to challenge the family myth that she and her mother were entirely alike, was quickly misinterpreted into saying that she was the same as her mother. In attempting to maintain the social phantasy system, a young person’s perception of what others are really up to may also be discounted or denied. For instance, when one of the young women in Sanity, Madness and the Family, during an interview, left the room, her mother, father and brother began a furtive whispered exchange about her. When she re-entered the room and said uncertainly that she thought they had been talking about her, however, the family denied the accusation and looked at the researchers as if to say ‘see how suspicious she is’ (Laing and Esterson, 1964: 114).

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R. D. Laing 99 Through such an invalidation of feelings and perceptions, Laing (1969) suggests that individuals can come to mistrust the fabric of their own experiences, and lose any sense of self-assurance. Individuals no longer know what is right or not: Are people really talking about them? Are people meddling in their relationships? Are the people who are supposed to love them lying to them? Furthermore, if the individual’s experiences are denied by others, and other experiences are imposed upon them, then they may be induced into what Laing termed a ‘false position’, in which they lose any real sense of their own experiences and actions. As Laing writes: ‘I’m sure that truth deprivation can wreak as much havoc to some people as vitamin deprivation’ (1976b: 136). To further compound matters, the family system may not only deny individuals’ experiences, but also deny that any denial is taking place – or even deny that a denial is being denied! Writes Laing: ‘It is not enough to destroy one’s own and other people’s experiences. One must overlay this devastation by a false consciousness inured ... to its own falsity’ (1967: 49). Laing (1967) believed that the emotional and communicational violence perpetrated in families was often conducted under the name of love, and perhaps there is no better example of this than in Laing’s own family, where his mother’s cold, rejecting attitude was covered up beneath a façade of care and concern. Through mystifications such as these – where there is a ‘constant shifting of meaning and of position’ (Laing and Esterson, 1964: 96) – Laing believed that young people may come to find their position not only false but untenable. That is, they feel that there is no way for them to turn. They know that they are being lied to, but cannot acknowledge the lie; know that they are living falsely, but cannot acknowledge the falsity of their position. One untenable position that Laing was particularly interested in was that of the ‘double-bind’ – a concept that Laing adopted from the American anthropologist Gregory Bateson and his team (Bateson et al., 1956). Such a situation is one in which an individual is told that they will be punished if they do one thing, but also told – often at a more covert, non-verbal level – that they will also be punished if they don’t do that thing. Furthermore, there may also be a further injunction that they cannot leave the situation. For instance, one of the mothers in Laing and Esterson’s (1964) Sanity, Madness and the Family expressed regret that her ‘schizophrenic’ daughter did not express herself more, but then, when the daughter did express herself, the mother interrupted her, dismissed her or criticised her for fussing. Here, where the individual feels that they ‘cannot make a move without catastrophe’ (Laing, 1969: 146), they may seek refuge in their own inner world. They may also lose their trust in others, or start to communicate at a more metaphorical and indirect level as a means of communicating what they want to communicate, whilst protecting themselves from retaliation and attack (Bateson et al., 1956). What appears to be withdrawn, paranoid or bizarre behaviours,

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100 Existential Therapies then, may be the individual’s attempts to keep themselves sane in an insane world. Laing was not only interested, however, in the knots and tangles of family life, but also those of adult relationships. In his 1966 book Interpersonal Perception (written with H. Phillipson and A. Russell Lee) Laing examines the realms of meta-perceptions: ‘What I think you think of me’ and ‘What you think I think of you’. One of the basic premises in this book was that the way we imagine other people see us (our metaperceptions) is often very different to the way they actually perceive us (their perceptions), and this can lead to some vicious and destructive spirals. For example, a client of mine, Sally, had a tendency to assume that other people saw her as childish and immature (her meta-perception). From what I could gather, and certainly from my experience, this wasn’t actually the case (others’ perceptions), but because she expected people to perceive her in this way, she tried to compensate for it by coming across as serious and somewhat emotionally detached. What seemed to happen then is that people (including myself) experienced her as cold, and kept a distance from her – which she interpreted as people not wanting to be around her because of her childishness. Consequently, she tried even harder to be serious and mature, which pushed people away even further, and perpetuated the vicious cycle. Such an understanding of Sally’s difficulties proved invaluable to the therapeutic work, where an exploration of the perceptions and meta-perceptions within the therapeutic relationship helped her to overcome this vicious cycle. During his career, Laing (1970; 1976a) also published a number of poems and imaginary conversations that attempted to describe some of the entanglement, knots, conundrums, vicious circles and binds that can beset adult relationships.

Candid confrontation So how did Laing set about helping his clients to untie the interpersonal and intrapsychic knots that they had tangled themselves up in? At the most basic level, Laing believed in the crucial importance of attending to his clients: a simple, focused listening in which clients had an opportunity to articulate, and connect with, their real experiences. From a Laingian perspective, clients had withdrawn into the inner citadels of their mind to protect themselves from a demanding, intrusive world. Hence, a noninvasive, non-intrusive interpersonal connection was necessary to facilitate their self-recovery and re-integration: a journey that Laing referred to as ‘metanoia’ (Burston, 1996). In this respect, it was not unusual for Laing to remain silent for whole sessions, although, as former client Jan Resnick (1997) reports, such was his attentiveness that he could repeat back to clients what they had said, word-for-word, in subsequent sessions. Furthermore, as with the Daseinsanalytic approach, Laing’s attentiveness

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R. D. Laing 101 went far beyond a detached, psychoanalytic ‘neutrality’. Many of Laing’s clients have described the intensity of his therapeutic engagement; Resnick, for instance, writing that ‘The atmosphere was often electric, charged with the silent tension of a chess match. Deep concentration’ (1997: 378). As we have seen, however, Laing also believed that clients had become entangled due to deceptive, manipulative and indirect methods of relating. Disentanglement, therefore, required honest, non-manipulative and direct I–Thou engagement. Laing 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. (1967: 39)

Through such an authentic encounter, Laing believed that the client’s capacity for real relatedness to others could be restored, and with it their ability to meet their most basic ‘existential needs’: love, ontological security, freedom from deception, the ability to self-disclose, affirmation by others, and, of course, real human relatedness (Burston, 1996). What seems to have been most fundamental to Laing’s therapeutic approach, therefore, was that he was simply himself. Laing, as a therapist, wore no masks. He did not become another person when the therapeutic session commenced: he simply said what he thought, felt and perceived – drawing on all his insights into the human condition. Mina Semyon, one of Laing’s long-term clients, describes him as having an ‘intimate directness’. For instance, during their initial session, Semyon said to Laing that she wanted to do something with her life. Laing simply replied, ‘Then do something’. Semyon: Laing: Semyon: Laing: Semyon:

Laing:

I don’t know what. Then do nothing. But I want to do something. Then do something. [Tears welling in eyes – Laing smiles] I feel like I’ve made a deal with ... I don’t know whom ... let nothing exceptionally good happen to me as long as nothing exceptionally bad happens either, and I made a promise I won’t attempt to rise above mediocrity. Do you realise you’ll have to give up the deal if you want to do something in life that is meaningful to you? Do you think you could? (Semyon, 1997: 187)

Semyon’s (1997) account shows that Laing could be strikingly honest with his clients as to how he perceived them. He told Semyon that she was

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102 Existential Therapies ‘extraordinarily naïve’ and, when she complained that her husband saw her as critical and judgemental, Laing said that he agreed with her husband’s perception. In another instance, when Semyon complained that people lost interest in her, Laing replied that she carried with her ‘the gloom of the Russian steppes’. In letting his clients know how he perceived them, Laing also sometimes drew on psychoanalytic theory, or his own insights into the nature of human beings, such as the tendency for people to withdraw into their own inner world. Laing suggested to one of his supervisees, for instance, that he might say something like the following to one of his clients, a woman who was highly distressed and seemingly incapable of speaking directly about anything personal: I am about to make a remark to you which is not intended as a criticism ... I simply want to point out that in the past (however many number of) sessions after about 15 minutes you run away from me (in your own mind). You appear to be frightened about what might happen if you don’t. You seem to go a long way into yourself to get a safe psychological distance from me ... Are you afraid of my feelings? my impulses? what I might do? Or afraid of your own feelings? what you might want to do? Could this be based on a memory? a fantasy? or some former catastrophe? What dreadful catastrophic possibility is evoked for you when you are here for over 15 minutes? You seem to be going into all of this (regressive behaviour) because something might happen that you feel the need to avoid . . . (Resnick, 1997: 389–90)

Resnick reports that when he did ‘parrot’ something like this to his client, she ‘came out of her fog’, focused her eyes, and said, ‘That’s right. I am afraid that if I really show you how horrible I am inside that you won’t be able to cope with it’ (1997: 390). As a consequence of this ‘distinctly Laingian brand of honesty’ (1997: 390), Resnick reports that his client became more present in the therapeutic relationship, and more able to engage fully with him. Whilst Laing, therefore, believed that empathic attunement was essential to the therapeutic process, his realness meant that, at times, he could also be highly confrontational. In particular, Laing believed that it was essential that therapists did not collude with the phantasy system that clients would almost inevitably be projecting onto them – phantasy systems in which clients would often construe themselves as powerless, and ‘the other’ as responsible and in control. Laing was unequivocal that such invitations to collusion should be rejected; and not, in the psychodynamic manner, with tentative interpretations over a period of time, but with direct and honest challenge. Resnick reports that a typical Laingian ‘construction’ might be: ‘You seem to feel that you are unhappy because I am not giving you what you want. But if you look closely at what leads you to this expectation I suspect you will find its origins entirely within yourself’ (1997: 378). Laing, himself, puts it more bluntly: ‘I might say “do you realize that by virtue of what you’ve just said you are treating me like

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R. D. Laing 103 your father. Now I want to point out to you that I’m not your fucking father”’ (Mullan, 1995: 319). Laing (1969) believed that such non-collusive therapy would almost certainly be experienced by the client as frustrating, but he felt that therapists needed to be able to tolerate a client’s basic hatred as a way of evoking a more genuine human relatedness. However, he was also clear that candid confrontation could only be effective if it was preceded by a basic sense of communion and relatedness between client and therapist (Burston, 2000). Laing’s genuineness in the therapeutic relationship also meant that he had little time for externally-imposed boundaries. His sessions would regularly run over ‘the therapeutic hour’, he might go for walks with clients, accept cigarettes from them, or see them for longer periods of time if they were in crisis (Burston, 1996). More heretically, Laing might also meet clients outside the therapeutic relationship for discussion groups, yoga or partying; he was well known for forming friendships with current, and ex-, clients. In the case of Mina Semyon, Laing went to court at her request, and even holidayed with her and her family. For Laing (1967), then, rules and guidelines were of far less therapeutic significance than the spontaneity and unpredictability of a genuine human encounter. Indeed, Laing believed that the decisive moments in therapy were often the ones that were unpredictable, unique, unforgettable, always unrepeatable and often indescribable – moments of I–Thou encounter, which, as Buber (1923/1958) states, cannot be ordered or planned. Laing gives the example of a seven-year-old girl who was brought to him by her father because she had stopped talking. Without any plan, Laing sat down on the floor in front of her and touched the tips of her fingers with his: And for something like forty minutes or so, nothing [happened] except a gradually developing movement dance with the tips of her fingers ... After about forty minutes, I opened my eyes and as I opened my eyes I found her eyes opening just at the same moment, without a word having been spoken. So we withdrew our fingers from each other, and went back to my chair. I said to her, bring your dad along now if that’s all right with you, and she nodded. (Quoted in Schneider, 2000)

According to Laing, when the father subsequently asked the young girl what had gone on between her and Laing, she had replied ‘it’s none of your business!’ – the first words she had spoken for approximately two months (in Schneider, 2000).

Post-Laing Despite the absence of any Laingian therapeutic system, Laing’s ideas and practice has had a major impact on the development of existential therapies within the English-speaking world. With respect to the existential-humanistic approach, for instance, Kirk Schneider writes that Laing

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104 Existential Therapies brought something unique to it – ‘the high art of presence or attention as a healing practice’ (2000: 598) – that had not been characterised before, and had yet to be fully articulated. Other therapists developing Laing’s work have tended to fall into one of two, relatively overlapping camps. First are those therapists, such as Emmy van Deurzen, who have developed the more existential aspects of his approach, and whose work will be discussed in the following chapter. Second are those therapists who have attempted to articulate and develop the more psychoanalytic aspects of Laing’s thinking, such as M. Guy Thompson (1994) and members of the Philadelphia Association (Cooper et al., 1989). In developing Laing’s work, many of these more analytically-orientated post-Laingians have also drawn on the works of such contemporary philosophers and psychoanalysts as Levinas, Wittgenstein, Derrida and Lacan (for instance, Gans, 1989). In terms of therapeutic practice, this means that there is something of a move away from Laing’s attempts to establish a relationship of ‘pure presence’ (Oakley, 1989) – in which all the masks, defences and pretences have been stripped away – and instead an acknowledgement that all relationships are ultimately mediated through language, discourses and narratives. In this respect, these practitioners are less concerned than Laing with getting to the ‘real person’ beneath the mask, and more accepting of the inevitable limitations and ‘unknowns’ in developing a close, therapeutically-healing relationship (Cooper et al., 1989). Many of these therapists also remain involved with the operation of therapeutic houses, along the lines developed by R. D. Laing at Kingsley Hall in the 1960s.

Critical perspectives Undoubtedly, one of Laing’s most enduring contributions to the fields of psychotherapy and psychology – if not psychiatry – has been his notion of ontological insecurity. Van Deurzen, however, argues that he failed to make explicit, or understand, that ‘the ontological insecurity at the core of schizophrenia is essentially there in all of us’ (1998: 10). (Indeed, Laing’s very use of the word ontological would suggest that this insecurity is a universal given of human existence.) For van Deurzen, what Laing was describing as ontological insecurity was ‘pure existential anxiety’ (1998: 8): the dread of nothingness and sense of not-at-home-ness at the heart of the human condition, and this, as existential philosophers have argued, is an experience that all human beings face. Furthermore, there is no reason why the fears that Laing associated with ontological insecurity (engulfment, implosion and petrification), and the strategies that he suggested people develop to protect themselves against these fears (such as splitting and withdrawal), should be seen as being limited to severely distressed individuals. As Collier (1977) points out, for instance, many people describe themselves as having real and false selves. Similarly, Eleftheriadou

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R. D. Laing 105 (1997) draws some interesting parallels between the experiences of ethnic minority members and such fears as depersonalisation and engulfment. With respect to the fear of being petrified by another, it is also important to note that Sartre (1943/1958) considered this a universal human concern, and not one limited to schizophrenically-predisposed individuals (Collier, 1977). Along very similar lines, it would seem evident that many of the dynamics that Laing associated with dysfunctional families – such as deceptions and double-binds – are at work within numerous family settings (van Deurzen, 1998). Van Deurzen’s critique of Laing’s ontological insecurity, however, runs deeper than this. Not only does she criticise Laing for tying ontological insecurity down to a specific way of being, but she criticises him for ‘medicalizing it by tying it to a pathological condition’, making it ‘more taboo, isolating it, as it were, in a psychotic ghetto’ (1998: 9). For van Deurzen, as discussed above, ontological insecurity is equivalent to existential anxiety and, as such, is not a problem to be overcome but a force to be faced and tapped. From this perspective, then, Laing’s attempts to cure his clients of their ontological insecurity are fundamentally misguided. Rather, therapists should be helping their clients find ways of courageously and constructively coming to terms with this given of existence. Van Deurzen concludes, then, that Laing’s work never fully overcame the medical model of illness and cure, and that ‘Most of the concepts Laing contributed fit more naturally with Winnicottian analysis than with existentialist theory’ (1997: 165). Such a criticism is borne out by a third difficulty with Laing’s work: that he tends towards reifying the notion of the self (Heaton, 1991; Cohn, 1993). That is, rather than seeing human existence as a verb-like flux of experiencing, Laing (1965) tends to talk about ‘true’ and ‘false’ selves, as if they were object-like entities. Moreover, Laing’s suggestion that the schizoid individual ‘retracts his lines of defence until he withdraws within a central citadel’ (1965: 77) suggests that this real self is located – or locatable – within the individual, rather than between the individual and their world. Despite Laing’s commitment to an inter-relational understanding of human beings, then, he has been accused of ultimately adopting a relatively individualistic and solipsistic perspective (Collier, 1977; Heaton, 1995).

Conclusion To some extent, Laing’s work deviates from an established existential position, and this is something that he acknowledges in the preface to The Divided Self (1965). Nevertheless, his teachings are of considerable significance to the world of existential therapies and beyond. Laing challenges therapists to question their assumptions about normality and abnormality, and to look for the sense in even the most bizarre behaviour. Furthermore, he provides therapists with many different models and concepts through which this understanding can be enhanced. Within Laing’s work, there

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106 Existential Therapies are also a whole host of ideas whose therapeutic and psychological potential has yet to be tapped: most notably, perhaps, his work on meta-perceptions. Laing’s actual therapeutic practice, although somewhat inscrutable, also offers some important challenges to the practitioners of today. In particular, his commitment to being real in the therapeutic relationship invites us to consider just how genuine we really are with our clients. At a time when therapists are becoming increasingly preoccupied with regulations and codes, such a challenge may be of particular significance.

Note 1. For the purposes of this book, I will only be discussing Laing’s approach to one-to-one therapy, and not his wider involvement with therapeutic communities.

Further reading Laing, R. D. (1965) The Divided Self. (Pelican edn.) Harmondsworth: Penguin. Laing’s best known work: a brilliant existential-phenomenological exposition of the symptomatology and aetiology of schizophrenia. Laing, R. D. (1969) Self and Others. (2nd edn.) Harmondsworth: Penguin. Groundbreaking study of the relationship between one person’s experiences and behaviours and those of another, and how certain ways of relating can lead to ‘madness’. Possibly Laing’s most difficult – but also most rewarding – work. Laing, R. and Esterson, A. (1964) Sanity, Madness and the Family. Harmondsworth: Penguin. Fascinating and disturbing case studies of 11 young, female ‘schizophrenics’ and their families, demonstrating the intelligibility of the women’s symptoms within a context of deceit, double-binds and denial. Laing, R. D. (1967) The Politics of Experience and the Bird of Paradise. Harmondsworth: Penguin. Laing at his most lucid, rhetorical and revolutionary. Argues that society, and particularly the family, serves to massively alienate people from their authentic possibilities and experiences, and that ‘schizophrenia’ is one strategy that some people invent to try and survive in this insane world. Mullan, B. (1995) Mad to Be Normal: Conversations with R. D. Laing. London: Free Association Books. Over 250 pages of in-depth interviews with Laing on every area of his work and life, including his therapeutic approach and philosophical background. Laing, A. (1994) R. D. Laing: A Biography. New York: Thunder’s Mouth Press. Accessible account of Laing’s life and work by his son that pulls no punches. Mullan’s (1999) biography is more sympathetic to Laing, whilst Burston’s (1996) has a more theoretical focus. Burston, D. (2000) The Crucible of Experience: R. D. Laing and the Crisis of Psychotherapy. London: Harvard University Press. Detailed, critical examination of Laing’s relationship to existential-phenomenological philosophy and psychology. Cooper, R., Friedman, J., Gans, S., Heaton, J. M., Oakley, C., Oakley, H. and Zeal P. (eds) (1994) Thresholds Between Philosophy and Psychoanalysis. London: Free Association Books. Collection of papers by current and former members of the Philadelphia Association.

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7. The British School of Existential Analysis: the New Frontier

This British school of existential analysis, writes American psychotherapist Miles Groth, ‘is one of the most hopeful signs of health of existential psychotherapy anywhere in the world ... [It] represents an almost singlehanded revival of the practice of existential analysis and the training of existential psychotherapists’ (2000: 7, 13). The establishment and development of this school – or what has previously been referred to as the ‘London school of existential analysis’ (van Deurzen-Smith, 1997) – is primarily due to the pioneering work of Emmy van Deurzen (1951– ) (formerly van Deurzen-Smith). Born in the Netherlands, van Deurzen worked as a therapist and trained as a clinical psychologist in France, before coming to the UK in 1977 to work in a Laingian-style therapeutic community. In 1982, van Deurzen established the first UK-based training course in existential therapy and, since then, has continued to establish and develop existential training programmes, first at the School of Psychotherapy and Counselling at Regents’ College, London, and, since 1996, at the London-based New School of Psychotherapy and Counselling at Schiller International University. In 1988, van Deurzen founded the Society for Existential Analysis, which aimed to ‘provide a forum for the expression of views and the exchange of ideas amongst those interested in the analysis of existence from philosophical and psychological perspectives’ (Existential Analysis, back cover). This Society continues to be a focal point for the activities of the British school of existential analysis: organising regular discussion fora and conferences and publishing an internationally-respected journal, Existential Analysis. In 1988, van Deurzen also published Existential Counselling in Practice, a landmark text that presented a uniquely accessible, systematic and comprehensive account of existential therapeutic practice. The British school of existential analysis, however, can only be considered a school in the loosest sense of the word. Whilst there are, as we shall see, a number of commonalities across the approach, it is probably the most diverse of the existential therapies examined in this book. Indeed, as van Deurzen acknowledges: ‘The movement has its own history of splitting and fighting and there is a healthy disagreement about what existential work should be’ (2002a: x). For this reason, the main section of this

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108 Existential Therapies chapter will not attempt to present the British school as a whole, but will focus on the work of three of its most influential and prominent advocates: Emmy van Deurzen, Ernesto Spinelli and Hans Cohn.

Influences Given the diversity of interests and practices within the British school of existential analysis, it should come as no surprise that it is influenced by a wide variety of existential philosophers. Practitioners within the British school have drawn on such existential philosophers as Kierkegaard (van Deurzen-Smith, 1997), Nietzsche (van Deurzen-Smith, 1997), Sartre (Spinelli, 1997b), Jaspers (van Deurzen-Smith, 1997), Buber (MorganWilliams, 1996) and Merleau-Ponty (Diamond, 1996). Considerable interest has also been expressed in such post-existential philosophers as Wittgenstein (Harding, 1999) and Derrida (M. Cooper, 1999). As with the Daseinsanalytic approach, however, Heidegger’s writing – particularly Being and Time (Heidegger, 1926/1962) – tends to be the key influence on the British school. This Heideggerian influence means that there are notable similarities between the British and Daseinsanalytic approaches, and there have been some fruitful exchanges over the last decade (for instance, Condrau, 1993; Young, 1993). As with the Daseinsanalysts, therapists within the British school of existential analysis tend to place great emphasis on the fundamentally in-the-world-with-others nature of human existence, and reject the individualism and subjectivism that is inherent in more humanistic approaches. British therapists like Spinelli (1994) and Cohn (1997) have also joined with – and drawn on – Boss and Binswanger in critiquing many of the assumptions within traditional psychoanalytic thinking, such as the notion of an unconscious and intrapsychic dynamics. In contrast to many Daseinsanalysts, however, few therapists within the British school see in Heidegger’s writings the definitive version of human truth; and some, such as Spinelli (1996b), openly question the applicability of Heidegger’s ideas to the therapeutic arena. Moreover, most therapists within the British school have dispensed with the more psychoanalytic aspects of Daseinsanalytic practice. Clients are usually seen just once a week, often for relatively short periods of time (see Strasser and Strasser’s Existential Time-Limited Therapy in Chapter 8), are not usually invited to recline on a couch (Cohn, 1997), and are not encouraged to become dependent on their therapist (van DeurzenSmith, 1994). In contrast to the Daseinsanalytic approach, British existential therapists also tend to be more directly influenced by Husserl’s phenomenological method (Spinelli, 1994; Adams, 2001). This means that there is a greater emphasis on the act of bracketing. Consequently, many of the assumptions and prejudices that are implicit within Boss’s writings have

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British School of Existential Analysis 109 been ironed out (Cohn, 1997). In drawing directly from Husserl, British existential therapists also place great importance on working in a descriptive, rather than analytical or interpretative, way (see case studies in DuPlock, 1997). Hence, whilst interpretations, explanations and diagnoses sometimes find their way back in to Daseinsanalytic, logotherapeutic, existential-humanistic and even Laingian ways of working, therapists within the British school tend to be very committed to staying with the actuality of the client’s lived-experience. This Husserlian influence, combined with its Laingian roots, means that the British school, of all the existential therapies, tends to most vigorously reject the medical model of mental health (van Deurzen, 1998). There is a strong commitment to dispensing with distinctions between ‘healthy’ and ‘pathological’ modes of functioning (van Deurzen-Smith, 1995a), and therapists tend not to view their clients through clinical categories and diagnoses (van Deurzen-Smith, 1997). Rather, clients are seen as having ‘problems with living’ (Spinelli, 1996a; van Deurzen, 2002a): problems that all human beings, including their therapists, may face at some time in their lives. Hence, British existential therapists, along Laingian lines, tend to reject the idea that clients should be helped towards some norm of mental health whereby they can slot back into society and the status quo (van Deurzen-Smith, 1995a; 1997). Rather, clients are encouraged to find their own unique way of being (van Deurzen, 2002a). Within the British school, there is also a strong emphasis on an egalitarian relationship between therapists and clients (van Deurzen-Smith, 1997).

Emmy van Deurzen: meeting the challenge of life Alongside founding the British school of existential therapy, van Deurzen has developed her own, unique approach to existential practice. What makes her approach particularly novel is the fact that, in contrast to previously discussed approaches, such as Yalom’s (1980) or Boss’s (1963), it is primarily concerned with helping clients face up to the challenges of everyday life, rather than the more over-arching ontological givens of existence. Of all the existential therapies, van Deurzen’s approach is also the most explicitly philosophical, and she 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 starting point is that life is an ‘endless struggle where moments of ease and happiness are the exception rather than rule’ (1998: 132). Life, she states, is hard, tough, rough and unfair: filled with crises, disappointments, injustices and failures (van Deurzen, 1998; 2002a). Moreover, she argues that human beings are constantly caught up in

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110 Existential Therapies irresolvable dilemmas, tensions and paradoxes. A human being, for instance, can never overcome the tension between wanting solitude and wanting closeness to others. For her, then, there is no possibility of attaining a perfect life: a paradise on earth. Even if, as she argues, a human being’s external world was ideal, the fact that human beings are a nothingness or lacking (see Chapter 2) means that they will constantly be striving for something more. Drawing on Kierkegaardian and Heideggerian thinking, van Deurzen (2002a) argues that, in the face of these challenges, imperfections and tensions, human beings inevitably experience anxiety. And, in an attempt to dispel this anxiety, they try to lose themselves in the certainty of shared cultural practices: fantasising about the perfect and problem-free life that is ‘just around the corner’ (van Deurzen-Smith, 1994: 41) – if only they could get that promotion, or have a child, or find out the underlying ‘cause’ of their psychological difficulties. In other words, people become reluctant to face the reality of their lives: they shy away from their true condition. Such self-deception, she suggests, may provide a modicum of comfort, but when things go wrong – as she argues they inevitably will do – then the temporary security provided by the social world and the fantasised life fall apart. A parent dies, the individual loses their job, or a relationship comes to an end, and the individual comes face to face with life in all its merciless reality – as well as the realisation that no-one, and no thing, can ever wholly protect them. Moreover, van Deurzen argues that because the individual has held on to the belief that life can be – and should be – perfect, each crisis is experienced as a massive disappointment: an unfair, unjust tragedy that undermines their very faith in existence. At these crisis points, van Deurzen (1995a) suggests that the individual can either try to resolutely face their problems, or else retreat further and further from reality. For van Deurzen, the latter alternative can only bring ‘doom and despair’ (2002a: 41): ‘Life has a way of exposing cracks in the most stubborn self-deceptions’ (1997: 274) she writes. Like debtors who try to deal with their financial problems by refusing to open their bank statements, people who turn away from life’s challenges only make things worse for themselves. The problems build up, fester and reach a point where they feel insurmountable. For van Deurzen, then, the psychologically distressed individual is not sick or ill, but ‘clumsy at living’ (2002a: 18). In other words, their problems are not caused by deep-seated psychological injuries, but by a misguided philosophy of life, which leads them down a path of disillusionment, self-destruction and misery. Hence, for van Deurzen (1997) the aim of existential therapy is to help clients face up to the reality of their situation and to wake up from selfdeception. It strives to help clients come to terms with life in all its contradictions: to immerse themselves in life rather than evading their troubles, and to creatively grapple with life’s problems. Clients are encouraged to bravely face up to their predicaments and struggles, their

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British School of Existential Analysis 111

BOX 7.1

Criteria for clients and therapists

Van Deurzen (1995a; 2002a) is one of the few existential therapists to explicitly acknowledge that existential therapy is not suitable for all clients – nor for all therapists. She outlines the following criteria. Client • Accepts – or is open to – the idea that their problem is with living, rather than a form of pathology. • Is not looking for immediate symptom relief, or expects the outcome of therapy to be a ‘smooth and perfect’ life. • Has a critical mind and a desire to think, and is not looking for another’s opinion on what ails them. • Is ready to take stock of their lives – to question themselves and be questioned. • Is someone who questions the status quo, rather than wanting to fit in and be ‘normal’. Therapist • Is mature and experienced, and has negotiated a number of life-difficulties themselves. • Is able to face their own dilemmas and challenges with dignity and courage. • Has been immersed in society from many different angles. • Is self-reflexive, questioning and curious. • Has a good knowledge of philosophy – and existential philosophy in particular. • Has a broad, flexible stance, with no fixed ideology. • Has humility, and the wisdom to know that there are many things they do not know. • Is open to being transformed during the therapeutic encounter.

trials and tribulations, their irresolvable tensions and dilemmas, and their inevitable failings and frailties, and they are also encouraged to discover the strengths and talents within them that can help them overcome these challenges. Given van Deurzen’s (1997; 1998; 2002a; 2002b) assertion that ‘life is an endless struggle’, it should come as no surprise that her claims for what therapy can achieve are relatively modest (see also Box 7.1). For her, there are no instant gratifications, no dramatic results and no cures at the end of the therapeutic road. For her, clients do not come out of the therapeutic process self-actualised; rather, like Camus’s Sisyphus, they are still burdened with the reality of a challenging, rough and unfair existence. However, she does suggest that the therapeutic process can help clients to

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112 Existential Therapies achieve a number of things. First, it can help them get back on top of their lives, take control, and have a sense of mastering their world rather than being at its mercy. Second, it can help them realise that they are able to take much hardship, and that they are stronger than they think. Third, it can help them to welcome, rather than fear, life’s challenges: to take life’s ups-and-downs more in their stride. Fourth, it can help them to respond to life’s challenges as constructively as possible: summoning and harnessing all their resources to find the most satisfactory ways forward. Fifth, it can help clients to experience the whole spectrum of their ways of being, rather than being stuck in rigid patterns of behaviour. Sixth, it can help them re-discover a passion for life: an aliveness, enthusiasm and sense of adventure that comes from fully engaging with the world, and meeting the challenges of life. Finally, then, for van Deurzen, existential therapy can help clients move beyond a fear of life, to a discovery that life is full of promise and ultimately worth living.

Exploring the client’s world In striving to enable clients to ‘become truthful with themselves again’ (1995a: 9), van Deurzen advocates a primarily descriptive approach to therapy, in which clients are encouraged to describe, in increasing levels of detail, the actuality of their lived-world. Within this process, the existential therapist is a ‘fellow investigator’ or ‘ally’, who joins her clients on this journey of exploration. Van Deurzen (2002a) also likens the existential therapist to an art tutor, who helps his students get a sense of perspective and build up an increasingly detailed picture of the world around them and their place within it. Van Deurzen (1995a) does not attempt to outline specific techniques or strategies by which this descriptive exploration can take place. For her, the therapeutic process is a conversation, and any form of engagement that can help clients to clarify their understanding of their lived-world may be an appropriate part of this dialogue. A therapist, then, might ask his clients questions like, ‘Can you tell me more about that experience?’ or ‘What did you mean when you said you felt angry?’ or offer simple reflections and summaries. The therapist may also offer her client interpretations, in the sense of making explicit the implicit links, connections and themes in a client’s world-view (van Deurzen-Smith, 1997). If a client, for instance, says that his friends always let him down, and then goes on to talk about the way in which his girlfriend is trying to swindle him out of his house, his therapist might suggest that perhaps he sees others as fundamentally untrustworthy. To some extent, this descriptive exploration will be similar to the existential-humanistic ‘inner search’. Given her Heideggerian background, however, van Deurzen is less interested in an exploration of clients’

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British School of Existential Analysis 113 Table 7.1

Van Deurzen’s (1997; 2002a) four dimensions of existence

Dimension Relation to

Physical (umwelt)

Social (mitwelt)

Personal (eigenwelt)

Spiritual (uberwelt)

Things

Others

Self

Life

World of … • natural environment, climate, etc. • physical environment • body • health • physical needs: e.g. hunger, thirst, warmth, comfort • leisure activities • material possessions Polarities

• interpersonal relationships • culture • race • class • family

• sense of ‘me’ • character/ disposition • intimate relationships

• domination – • extroversion – • acceptance introversion • expansion – • egoism – contraction altruism • birth – death • intimacy – • separation • trust – distrust • • belonging – isolation • • competition – cooperation • conformity – individualisation

selfacceptance – selfdevelopment authenticity – inauthentic integrity – disintegration resolve – yielding

• • • • •

values meanings faith ideals systems of belief • philosophical outlook

• meaning – meaninglessness • purpose – futility • good – evil • transcendence – mundanity

subjective experiences, per se, and more in an exploration of the different ways in which they relate to their world. More specifically, van Deurzen (2002a) outlines four different – though entirely interdependent and interlinked – dimensions of worldly-being that clients can be encouraged to explore: the physical dimension, the social dimension, the personal dimension and the spiritual dimension (see Table 7.1). The first three of these dimensions are drawn from Binswanger’s work, but van Deurzen has added the fourth, spiritual dimension – the dimension of things that can’t be seen or proven – and emphasises these four dimensions more strongly than contemporary Daseinsanalysts. Van Deurzen argues that one of the central values of such a map is that it can help both therapists and clients to stand back from clients’ immediate concerns, and ensure

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114 Existential Therapies ‘that all different aspects of the client’s reality are explored’ (2002a: 62). As van Deurzen states, a client’s understanding of their world will inevitably be ‘partial, deficient, full of holes and lacking in perspective’ (2001, personal communication). Such a map, then, allows some of these gaps in awareness to be filled in. For instance, a client who spends much of her time in therapy talking about relationships with others might be encouraged to reflect upon – and investigate – her feelings towards her self, or her sense of her physical, embodied being. Van Deurzen’s (1997) map of existence also helps to highlight some of the polarities, tensions and dilemmas that clients face, and which they can be encouraged to explore. For van Deurzen, ‘we are involved in a fourdimensional forcefield at all times’ (1997: 100), pulled, not only between the different dimensions, but within the dimensions themselves. In the personal dimension, for instance, clients may be pulled between a desire to accept themselves as they are and a desire to better themselves. In facilitating an exploration of these dilemmas, a particularly important role for therapists may be to help their clients see the shadow, unacknowledged sides of their polarity. A client, for instance, who claims that he desperately wants to give up gambling but ‘can’t’ may be helped to see that this desire is opposed by an equally strong – if not stronger – desire for excitement. Here, as discussed earlier, the aim is not to help clients find answers to their dilemmas, but to help them accept the fundamentally dilemmaridden nature of their existence. Through such an acceptance, clients can then begin to address the real challenges that face them: for instance, ‘How do I give up gambling even though it’s the most exciting thing in my life?’ Within these four dimensions of existence, there are also numerous paradoxes that clients can be encouraged to explore and come to terms with (van Deurzen-Smith, 1995a). In the social dimension, for instance, there is the paradox that the more we try to get people to like us, the more we often succeed in pushing others away. Similarly, in the personal plane, the more we strive for happiness, the more we often end up feeling dissatisfied. In helping clients face up to the reality of their existence, van Deurzen (2002a) advocates an approach that can be challenging – even ‘ruthless’ – at times. For her, the existential therapist acts as a surrogate conscience, gently but firmly calling her clients back to the actuality of their existences – in all their anxiety- and guilt-invoking reality – even if this means that the clients may become perturbed for a period of time. For van Deurzen, it is of particular importance that therapists challenge their clients’ un-examined assumptions: those beliefs that they hold true without questioning, but which may blind them to the reality of their existence. A client, for instance, may assume that there are easy answers to life’s questions, or that it is possible for them to ‘achieve a smooth and perfect life’ of everlasting security, where the past is all achievement and the future is

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British School of Existential Analysis 115 all promise. (Interestingly, many of these assumptions may come from the world of therapy itself – for instance, the assumption that it is possible to achieve ‘the good life’ (Rogers, 1961).) For van Deurzen, it is also important that therapists challenge their clients’ self-deceptions. 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 really knows that all relationships are suffused with challenges and imperfections. From a van Deurzenian standpoint, challenging the contradictions in clients’ narratives is also an important way of helping them to develop a deeper understanding of their lived-world. Supposing, for instance, that a client says that he has forgiven his abuser, but says at other times that he’d like to ‘hang him up by his balls’. By feeding this contradiction back to the client, he may be able to reflect on, and clarify, the true nature of his feelings towards his abuser: for instance, that he desperately wants to forgive him, but can’t. Alternatively, it may help him to acknowledge and accept irresolvable tensions: for instance, that he despises his abuser, but also feels some compassion towards him. The aim of van Deurzen’s (2002a) existential therapy, however, is not simply to challenge clients’ assumptions and highlight the irrationality of their thinking. Rather, the ultimate aim ‘is to assist the client in grasping the principles that will turn out to withstand questioning’ (2002a: 105): to identify what it is that really matters to them. Van Deurzen’s existential therapy, then, is particularly concerned with helping clients to identify their core values: the things that they think it is worth living or dying for. As with the logotherapeutic approach, it is also fundamentally concerned with helping clients uncover the meanings and goals to which they truly wish to strive. This means that van Deurzen’s (2002a) approach, somewhat in contrast to the existential-humanistic approach, is not only focused on immediate, emotional experiences but on the ‘spiritual world’ of values, meanings and assumptions. Whilst van Deurzen does see the exploration of emotions as an integral part of the therapeutic process, for her, this is a means towards identifying clients’ underlying values and meanings, rather than a goal in itself. ‘Emotions are our most sensitive barometers,’ she writes, ‘and they give us accurate information about what we value’ (1997: 243). A client who feels angry for not being promoted at work, for instance, might be encouraged to explore the values that lie behind this feeling: perhaps a belief that success at work is of utmost importance in her life. For van Deurzen, helping clients to explore their dreams and fantasies can also be a way of helping them to identify – and feel motivated towards – their underlying goals. Having developed a deeper understanding of their values, meanings and goals, van Deurzen (2002a) suggests that therapy can then help clients to consider how to proceed into their future. A client, for instance,

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116 Existential Therapies who decides that what really matters to her in life is to help others could be encouraged to look at ways in which she might realise this possibility: for instance, by volunteering at a local charity. For van Deurzen, an important part of this future-moving process is helping clients to identify their talents, strengths and hidden potentials. Just as an art tutor helps her students develop their own particular style, so van Deurzen writes that clients should be encouraged to discover what they are best at, so that they can develop their way of being to the best of their abilities. Moreover, van Deurzen not only encourages clients to identify specific strengths, but to see that they have the strength to face the challenges of life: that they have been, are, and will be able to ride the storm of existence, and forge constructive and positive ways forward. For van Deurzen (1997; 1998), each client must come to find her own, personal, answers to life’s challenges. At the same time, she argues that the problems, dilemmas and paradoxes that clients face are not unique ones, but shared challenges for all of humankind. It is not only the client, for instance, who is struggling to become emotionally involved with another human being whilst maintaining her independence, or who is trying to work out what makes a life fulfilling. For van Deurzen, then, existential therapy is not only a personal, psychological exploration but a philosophical dialogue: where universal human questions are brought to the fore, and guiding principles for living are distilled. In this philosophical dialogue, the therapist, as a fellow human being, is likely to ‘resonate’ with many of the challenges and difficulties that the client faces. She too, for instance, may have spent many hours trying to understand what makes a life worthwhile. Furthermore, through her training, she will have explored many of the client’s concerns from a range of different perspectives: philosophical, psychological and therapeutic. For van Deurzen (2001; 2002a), then, the therapist – and particularly the more seasoned one – is not only a fellow traveller, but a ‘mentor’ or ‘wise person’ who brings a special wisdom and experience to the client’s journey – a wisdom that she should not be afraid of sharing. Van Deurzen is not suggesting here that the therapist should lead the therapeutic work, nor that she should proscribe to the client certain solutions to his problems in living. Rather, she is suggesting that it is legitimate for the therapist to present to her client different ways of seeing things, such that the client can consider a wider range of standpoints than just his own. If, for instance, a client states that he struggles to be happy but can’t, the therapist might suggest that perhaps striving for happiness is self-defeating, or that maybe there are other things in life as important as being happy.

Critical perspectives From her writings, it is clear that van Deurzen (2002a) is committed to a therapeutic approach that allows the client to take the lead, and which

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British School of Existential Analysis 117 respects and values the client’s point of view. At times, however, her writings convey more of a prescriptive sentiment: specifically, that it is better for clients to face up to life and meet its challenges head on, rather than to ‘cowardly’, ‘weakly’ and ‘complacently’ hide from life (1998: 70). ‘We need to learn to say “yes” to life’ she writes (1998: 70), but this would seem to provide little space or validation for the client who, at the most fundamental level, may want to say ‘no’ to life, and hide herself away with her daydreams, fantasies and ‘untruths’. In this sense, then, van Deurzen has a tendency to smuggle normative judgements back into therapy (Wolf, 2000); and, whilst her way of working may place less stress on the illness–health dimension than most other existential therapies, it still tends towards valuing certain ways of being over and above others. Put another way, whilst van Deurzen argues that no pole of a dilemma is better than its opposite, she does not always extend this impartiality to the ‘face up to life’ versus ‘bury your head in the sand’ dilemma, where the former pole is usually – though not always – attributed greater validity. To her credit, however, van Deurzen acknowledges that ‘This is clearly a value judgement and a basic assumption on my part’ (2001, personal communication) and does not attempt to portray herself as adopting a ‘neutral’ perspective in which all values are bracketed. The strength and passion with which van Deurzen holds this basic assumption means that, at times, her therapeutic work can tend towards the somewhat directive. Commenting on van Deurzen’s (1997) case study of Laura in Everyday Mysteries, Jackie Hornby, an existential therapist, describes van Deurzen’s challenges as ‘very directive’ and writes that she ‘does seem surprisingly anxious to teach this client something’ (Hornby, 1997: 183). Laura’s own comments reinforce this criticism: ‘I felt an ideology was being conveyed to me’ she states (in van Deurzen-Smith, 1997: 281–2), though she adds that she found this ideology exciting and challenging. Whilst van Deurzen’s approach (1997), then, aims to provide clients with a range of philosophical perspectives, it tends towards presenting only a limited range of outlooks. Van Deurzen makes it clear that her existential approach to therapy is not only informed by the teachings of nineteenth and twentieth century existential philosophers (2002c, personal communication), but it does tend to promote an existential outlook on life over and above such alternative standpoints as hedonism or new age optimism. Indeed, with the recent emergence of ‘philosophical counselling’ – which uses a range of philosophical insights and methods to help people through significant issues in their lives (LeBon, 2001) – there would seem little justification for a philosophically-based therapy that is orientated around one particular standpoint. At the very least, van Deurzen will need to show that coming to terms with the inevitable challenges, anxieties and frustrations of living really does lead to a more fulfilling life – at least, for some people. For many people, this outlook may seem unnecessarily pessimistic, and denies the possibility that people are capable of achieving a happier, more relaxed and less anxiety-ridden

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118 Existential Therapies existence without constant struggle and challenge. Furthermore, there is a growing body of evidence to suggest that a certain degree of illusion, distortion and self-deception are integral to the way ‘well-adjusted’ people perceive their world (Baumeister, 1991), and that those who adopt an unrealistically optimistic outlook can often fare better than those who face up to the brute reality of their situation (Armor and Taylor, 1998).

Ernesto Spinelli: embodying an existential-phenomenological stance The work of Ernesto Spinelli (1989; 1994; 1997b; 2001a) provides an interesting contrast to that of van Deurzen. Spinelli (1949– ) trained as a developmental psychologist, and joined the faculty of Regents’ College School of Psychotherapy and Counselling in 1989, becoming Dean of the School in 1997. Unlike van Deurzen, Spinelli has never published a comprehensive account of his therapeutic approach. Nevertheless, his numerous case- studies (Spinelli, 1997b), his existential-phenomenological reformu-lations of classic therapeutic assumptions (Spinelli, 1994; 2001a), and his writings on phenomenological psychology (Spinelli, 1989) form a particularly influential and engaging body of existential therapeutic literature within the British existential therapeutic world. Like van Deurzen, Spinelli (1989; 1997b) advocates a primarily descriptive approach to therapy. In contrast to van Deurzen, however, he is strongly influenced by the teachings of Husserl and the phenomenologists, as opposed to Kierkegaard and Heidegger. Indeed, at times Spinelli (1992) has specifically referred to himself as a ‘phenomenologically-oriented’ therapist. In contrast to van Deurzen too, Spinelli has been influenced by such social constructionist thinkers as Kenneth Gergen (see Gergen, 1999). This means that there is a particular emphasis in his work on challenging taken-for-granted assumptions, and being open to a multitude of perspectives. A third contrast with van Deurzen is that Spinelli’s approach is strongly influenced by the more intersubjective and dialogic existentialphenomenologists, such as Buber, Binswanger and Farber. In this respect, he puts particular emphasis on the quality of the relationship between therapist and client, suggesting that the way in which things are talked about in therapy is often of far more importance than what is discussed. ‘My clients remind me over and over again,’ he states, ‘that what they take from me is, first and foremost, the me who they experience being there with them. What I say to them, what we discuss, what knowledge I have is way down the line in terms of its significance to their lives’ (Spinelli, 2002, personal communication). For Spinelli, then, the primary value of existential-phenomenological thinking for therapists is that it offers them a way of being which they can come to embody (see Spinelli and Marshall’s Embodied Theories, 2001), rather than providing a framework by which to understand clients, or as a blueprint for living.

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British School of Existential Analysis 119 Bracketing assumptions What does it mean, then, to embody an existential-phenomenological outlook? As the previous chapters have shown, at the heart of an existentialphenomenological way of being is an attitude of openness. In relational terms, this means an openness to the other: a willingness to respect and confirm the other’s way of being and viewpoints, rather than attempting to impose one’s own biases and assumptions. Much of Spinelli’s writings, then (1994; Spinelli and Marshall, 2001), are concerned with helping therapists to reflect on and question their own assumptions, such that they can be more fully available to their clients’ ways of being. Clearly, as Spinelli acknowledges (2002, personal communication), it is never possible for therapists to entirely bracket their own perspectives. Nevertheless, what is important, he argues, is that therapists convey to their clients a willingness to bracket their perspectives – as well as an acknowledgement that they can never wholly achieve it. This, suggests Spinelli, lets the client know that the therapist is willing to encounter them in the fullness of their humanity, and also that they, the therapists, are fallible – and thereby real – human beings. On this basis, Spinelli (1994; 2001a), like Boss (1963), has challenged many of the sacred cows of the therapeutic world, amongst them ‘transference’, ‘the unconscious’ and the notion of a fixed, thing-like self. In contrast to the Daseinsanalysts, however, Spinelli has proposed an alternative way of understanding the self and accounting for apparently ‘unconscious’ phenomena. Like Bugental (1981) and Rogers (1959), Spinelli (1994) distinguishes between the way individuals develop a particular sense of self – or what he calls the ‘self-structure’ – and the actuality of their lived-experiences. On this basis, he argues that human beings will tend to disown, or dissociate from, those experiences that do not fit in with the believed-in self. An individual, for instance, who has constructed a notion of himself as strong and invulnerable may not acknowledge his feelings of vulnerability. In Husserlian (1931/1960) terms, these experiences remain at a straightforward, rather than reflective, level. Furthermore, the more fixed – or what Spinelli, drawing on Merleau-Ponty, terms ‘sedimented’ – an individual’s self structure, the greater the number of experiences that remain unacknowledged. Spinelli particularly emphasises the fact that individuals may dissociate from their experiences by attributing these experiences to other people or forces. He gives the example of a client, Clive, a fundamentalist laypreacher, who believed that he had ‘conquered the evils of the flesh’ by no longer experiencing sexual arousal: But, lo and behold!, at times his response to women is obviously one which expresses sexual arousal. In order that the sedimented self-construct can remain in a way that it can deny or disown these challenging experiences, Clive ‘explains’ such occurrences in terms of ‘being possessed by Satan’. Via this

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120 Existential Therapies explanation, it is an ‘alien construct’ that responds in a sexually-arousing fashion. (Spinelli, 1996c: 65)

In this way, Spinelli (1994; 1996c) attempts to account for those experiences that seems to ‘happen’ to us, but which we do not fully feel the authors of, without invoking a phenomenologically problematic notion of the unconscious. Like Boss, Spinelli (1994) has also critiqued the assumption that an individual’s present experiences are caused by their past. Going beyond the Daseinsanalytic critique, however, he argues that the way individuals remember their past are often a consequence of the way they see themselves in the present, or would like to see themselves in the future. That is, individuals’ reconstructions of their pasts can never be wholly accurate – they are always interpretations – and the way in which individuals selectively recall certain events, whilst selectively overlooking others, may say much about their current self-structures and future-directed motivations. An individual, for instance, who only tends to remember the happy events in her past may be trying to reinforce her self-structure as a happygo-lucky person. Indeed, Spinelli suggests that the very search for past experiences may be part of an attempt to maintain a particular self-structure. Clients, for instance, who long to recall the event in their past that has caused them to experience such misery and sadness may be desperately trying to preserve a ‘my-life-isn’t-my-fault’ self-structure, rather than acknowledging their role in their own difficulties. Within Spinelli’s (1997b) approach, there is also an almost complete bracketing of any assumptions as to what constitutes ‘good’ mental health. In contrast to the Daseinsanalytic, logotherapeutic or existentialhumanistic approaches, there is no assumption that it is better to be open to the world, meaning-orientated, or courageously facing the givens of existence. Furthermore, in contrast to van Deurzen’s approach, Spinelli does not assume that it is better to face up to the challenges and vicissitudes of life. Spinelli also makes very few assumptions about the aetiology of a client’s troubles, although he does seem to associate them with highly sedimented beliefs and interpretations, and particularly a highly sedimented self-structure. Even here, however, Spinelli (2001a) writes that it would be quite legitimate and appropriate for clients to decide that they did not want to adopt – or even consider – alternative ways of seeing themselves and their world. In this sense, Spinelli (1997b) emphasises the importance of respecting and accepting the client’s existence as it is currently being lived, rather than as it could be. For Spinelli (2001a), then, the aim of therapy is not to do something to the client: to encourage them to change or to adopt a more existential way of living. Rather, it is to help them examine, reflect on and clarify their way of experiencing their beingin-the-world, such that they can either truly choose this way of being or else, in identifying unnecessary and counter-productive limitations,

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British School of Existential Analysis 121 embark on a process of transformation. In this respect, Spinelli goes further than any of the other therapies examined in this book towards bracketing existential assumptions themselves. He writes: ‘If the existential insights are valid, they are straightforward enough for anyone – clients included – to arrive at them. They do not need to have them rammed down their throats’ (2002, personal communication). Ultimately, Spinelli (1994) even questions the value of therapy itself. He argues, for instance, that much of the ‘magic’ of therapy is brought about by therapists’ beliefs in their theories and techniques, rather than the theories and techniques themselves. He terms this the ‘Dumbo effect’, after the Disney cartoon character who mistakenly believed that he needed a magic feather to help himself fly. Spinelli (1994) is also very critical of the power imbalances that he believes often exist within the therapeutic relationship, in which therapists may use and abuse their position of trust over their clients. At a personal level, too, Spinelli acknowledges that his own experiences of therapy ‘have been on the whole disappointing with regard both to the quantity and quality of insights they have provoked’ (2001a: 158). He writes: When placed next to my experiences of visiting and living in foreign countries, of sociopolitical involvement, of reading and writing fiction and poetry, of meditation, of immersion in music and song, of recording and exploring my dreams or watching others’ dreams projected on to cinema screens or canvases or chiselled out of rocks, and, most of all, of allowing myself to feel love for others and to feel another’s love for me, that which I have gained from my personal therapy remains barely significant. (2001a: 158–9)

Un-knowing in practice Spinelli, then, questions and criticises many of the assertions that are made in the name of therapy, but he continues to maintain ‘an unwavering belief as to its unique value and worth’ (2001a: 20). In particular, he feels that it can provide clients with the kind of caring engagement that allows them to honestly reflect on, and reconsider, their lives. For this to take place, however, he argues that therapists need to remain as open as possible to whatever presents itself in their encounters with their clients. He refers to this as a stance of ‘un-knowing’. Here, he is not referring to the feigning of ignorance, but of attempting to bracket one’s assumptions: striving to hold in abeyance fixed beliefs, values and assumptions. In suggesting this, he is also not proposing that therapists should adopt a laissez-faire attitude. Rather, he writes that therapists should both ‘be with’ and ‘be for’ their clients (Spinelli, 1994) (these concepts should not to be confused with Heidegger’s (1926/1962) ‘leaping in’ and ‘leaping ahead’). By ‘being with’, Spinelli means staying with the client’s experienced

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122 Existential Therapies truth as it is being related, rather than seeking to confirm its objective validity. By ‘being for’, Spinelli means being prepared to step into the client’s lived-worlds as fully as possible: to try and experience their world as they experience it. This being for, writes Spinelli (1994), is not unlike the task of the method actor whose essential aim revolves around immersing herself or entering into a specific character or object. For Spinelli (1992), humour and warmth also play an important part in the therapeutic relationship, as part of a genuine, caring human relationship. In ‘being with’ and ‘being for’ the client, the therapeutic process outlined by Spinelli (1994) becomes a wholly descriptive one – as prescribed by the second stage of the phenomenological method (see Chapter 2). As with van Deurzen’s (2002a) approach, clients are encouraged to explore their meanings, values, interpretations, feelings and beliefs, and the therapist, through attempting to develop a clearer and clearer understanding of the client’s lived-world, facilitates this exploration. Spinelli is particularly concerned, however, with helping clients explore their interpretations of their world, and particularly their interpretations of who they, themselves, are. Hence, he may encourage clients to explore the kinds of self-structures that particular behaviours reflect, or, indeed, ‘make viable’ (1997b: 24). In working with a client with addictive behaviours, for instance, he might ask: • Who does your addiction allow you to be that you would not otherwise be able or allowed to be? • What do you think might be lost to you if you were to cease being an addict? • When you say ‘I am an addict’, what are the statements or judgements that immediately follow this statement? (1997b: 142) For Spinelli (1994), however, the self-structure is not an independent entity, but something that is constructed and maintained in relationship to others. An individual, for instance, does not just see themselves as weak, but sees themselves as weak in comparison to others who are strong. Furthermore, Spinelli argues that this relational self-structure is only one of four, inter-related foci that can be examined in every encounter. For not only has an individual developed some sense of themselves, but they have developed some sense of the other that they are encountering, some sense of what goes on between the two of them, and some sense of how that other relates to further others in their world (see Table 7.2). Within the therapeutic relationship, Spinelli (1994) suggests that clients can be encouraged to explore each of these realms, as well as the extent to which their experiences of self, other, we and they in the therapeutic relationship are representative of their experiences of self, other, we and they in extra-therapeutic encounters. A client, for instance, who experiences herself as passive in the therapeutic relationship, her therapist as hostile and the interaction between them as frosty, may experience much the same

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British School of Existential Analysis 123 Table 7.2

Spinelli’s (1994; 2001a) four realms of encounter

‘I-focused’ realm

‘You-focused’ realm

‘We-focused’ realm

‘They-focused’ realm

My experience of my self in any given relationship. What I tell myself about my current experience of me in this relationship. My experience of the other being in relationship with me. What I tell myself about my current experience of you being in the encounter. My experience of us being in relation with one another. What I tell myself about us in the immediacy of our encounter. My experience of the other’s experience of others in his or her world. What I tell myself about the other’s experience with further others.

thing with her friends and families. Indeed, Spinelli (2001a) suggests that the structured exploration of these four ‘realms of encounter’ is what provides existential therapy with its uniqueness. In other words, in the therapeutic relationship, therapists should keep an awareness of these four different realms in the back of their minds, and encourage their clients to explore each of these aspects of the interpersonal encounter. For Spinelli (1994), however, the therapeutic relationship provides a particular opportunity for therapist and client to explore the third, interactional realm – an exploration that can throw light on the client’s experiencing of the other three realms. An interesting example of this comes from Spinelli’s (1997b) work with Jennifer, a ‘studiously guarded’ young woman who was wracked with a multitude of concerns, amongst them bulimia. At one point in the therapeutic dialogue, Jennifer and Spinelli speak simultaneously, to which Jennifer quickly apologises (we-focused realm). Spinelli encourages Jennifer to stay focused on this interaction, and he asks her what kind of messages she picked up from him as a consequence of it (you-focused realm). She says that she heard a critical one. Spinelli then asks her to explore the kinds of things she was saying to herself when she spoke at the same time as him (I-focused realm). ‘I’m awful! Despicable! How could I be so stupid and arrogant’ (1997b: 144) she reports. To explore the generalisability of these experiences, Spinelli then asks her whether these are common messages she hears from others and says to herself when she feels she’s done something wrong. She replies in the affirmative. Through this process, Jennifer is helped to develop a greater awareness of how she experiences interpersonal interactions – and, with it, self and others. For Spinelli, however, the particular specialness of therapy lies in the fact that it allows client and therapist an opportunity to explore ‘the various conjunctions or points of contact between the participants’ relational realms’ (1994: 332). For it is not only the client, but the therapist, too, who

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124 Existential Therapies experiences self, other, we and they in the therapeutic encounter; by sharing these experiences with the client, the client may be helped to revise and reconsider her own relational understandings. Jennifer, for instance, assumes that Spinelli (1997b) is angry with her for interrupting him. In fact, as he lets her know, he is angry with himself for blurting out what he did. By letting her know this, he gives her an opportunity to revise her view of the relational encounter, and thereby her views of self and other. For Spinelli (1997b), then, one of the most important characteristics of therapists is that they are representative of all others in a client’s world, whilst at the same time able to be an exception to the rules that a client has regarding the perception of others. A client, for instance, who assumes that everyone dislikes her, is challenged to reconsider this view if her therapist says that she actually finds her quite likeable. Spinelli (1997b), then, can be quite disclosing in his therapeutic work – particularly where the focus is on the third, inter-relational realm. Indeed, drawing on the American psychotherapist Leslie Farber (2000), Spinelli (2001a) goes beyond Yalom and Laing in arguing that one of the most helpful things a therapist can do is to reveal to clients their own uncertainties and vulnerabilities. For instance, a therapist might share with their client that they genuinely don’t know how the client can overcome their anxieties, or might disclose that they struggle with similar challenges themselves. Initially, a client might find this very disconcerting, but by realising that the therapist does not have the answers, they may come to revise their view of others as informed and themselves as ignorant. Instead, they may come to see that others, like themselves, are uncertain and powerless in the face of the ‘impossible dilemmas of being human’ (Spinelli, 2001a: 168). Furthermore, by realising their therapist’s vulnerabilities, the client may start to develop a true caring for the therapist (Farber uses the more challenging term ‘pity’): a caring that may help them re-discover their ability to connect with others, and feel more empowered. As Table 7.2 indicates, Spinelli (2001a) also identifies a fourth realm of encounter: the they-focused realm. Here, Spinelli is suggesting that therapists should not only help their clients explore their relationship with themselves and others, but also those others’ inter-relational worlds. Spinelli suggests that such an exploration may be particularly important towards the end of the therapy, where clients may be making decisions and acting upon their theoretical insights. Spinelli argues that this exploration is important for two reasons. First, from an existential, intersubjective perspective, clients’ experiences and choices can not be isolated from the choices and experiences of those around them. ‘In the inescapable interrelationship that exists between “a being” and “the world”,’ Spinelli writes, ‘each impacts upon and implicates the other, each is defined through the other and, indeed, each “is” through the existence of the other’ (Spinelli, 2001a: 16). Second, Spinelli argues that a therapeutic approach which ignores the relational realms of those outside of the therapeutic

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British School of Existential Analysis 125 relationship abandons any sense of social responsibility or potential for social change, and instead becomes little more than a vehicle for selfserving individualism. Spinelli (2001a) gives the example of a middle-aged man who comes into therapy, experiencing various mid-life crises. As a result of an exploration of his own needs and desires, he comes to the conclusion that he should leave his wife and children, and move in with his young lover who makes him feel more alive, alert and sexual than he has for years. Is this the end of the therapeutic work? Spinelli suggests not, and that, from an intersubjective perspective, there are still a great many issues for the client to consider and confront. For instance, what does he imagine that the effects of his decision will be on his wife’s inter-relational world: on her relationships with her children, and on her relationship with him? Critical perspectives Spinelli’s critiques of many of the most cherished assumptions within therapy have raised the hackles of some commentators. Nash Popovic (2001), writing in the British Association for Counselling and Psychotherapy’s Journal, accuses Spinelli of over-emphasising the limitations of the therapeutic enterprise, and of criticising everybody else rather than offering any constructive alternatives. Spinelli (2001b) strongly refutes this latter accusation, but there is no doubt that his writings challenge and unsettle many of the widely-accepted assumptions within the counselling and psychotherapeutic field. From an existential perspective, Spinelli’s therapeutic approach could also be accused of lacking philosophical depth. In contrast to the works of van Deurzen (2002a) or Boss (1963), Spinelli’s writings contain little explicit reference to the teachings of Heidegger, Kierkegaard, or other key existential philosophers. Indeed, Spinelli’s approach might be seen as being closer to a person-centred, phenomenological way of working (without the emphasis on actualisation and individual subjectivity) than an existentially-informed one. Here, Spinelli argues that he is attempting to embody existential-phenomenology rather than ‘talk the talk’ (2002, personal communication). However, there is no doubt that there are many elements of his work that bear a close proximity to the writings of Carl Rogers (1957; 1959): in particular, the focus on lived-experiences, the distinction between self-as-experienced and self-as-construed, and the emphasis on relating to clients in an empathic, congruent and accepting way.

Hans Cohn: living within the givens A third therapist who has made an important contribution to the development of the British school of existential analysis, though he has written

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126 Existential Therapies less about his work, is Hans Cohn (1916– ), who originally trained psychoanalytically. Cohn’s existential approach to therapy is based on a meticulous reading of Heidegger’s work, particularly the earlier Being and Time (1926/1962) and the Zollikon Seminars (2001). Like Yalom (1980), Cohn (1997; 2002a) asserts that psychological difficulties arise when individuals attempt to run against the ontological givens of existence. In contrast to Yalom, however, Cohn’s (1997) Heideggerian grounding means that he outlines a somewhat different set of givens: being-in-the-world, being-in-the-world-with-others, thrownness, mortality, the inevitability of choice, embodiment, the spatiality of existence, the temporality of existence, mood and sexuality. In contrast to Yalom (1980), too, Cohn (2002a) does not attempt to pin a client’s difficulties down to specific existential anxieties. Rather, like other therapists within the British school, he encourages clients to descriptively explore their lived-worlds, and puts particular emphasis on ‘broadening the known context so that a fuller understanding of the troubling phenomena is reached’ (2002a: 48). ‘Existential interpretation,’ he states, ‘is an increase of the understanding (and not the explanation) of a situation by asking questions which do not lead to true answers but to further questions: while a true answer is never reached, a clearer understanding emerges gradually’ (2002b, personal communication). Along these lines, Cohn follows a policy of ‘include everything’. That is, he considers everything that a client talks about – whether the film she saw last night or her views on the issues of the day – relevant to the therapeutic enquiry: utterances that help her map out her web of being-in-the-world, rather than superficialities disguising the ‘real’ issues. Through this broadening process, Cohn suggests that a client may come to realise – and come to terms with – the immovable boundaries that circumscribe their existence. In doing so, they may then stop banging their head against this wall, and instead look at ways in which they can most effectively relate to it. As an example, a client may have been so hurt and abused as a child that he comes to therapy saying that he wants to dispense with interpersonal relationships altogether. Here, Cohn might encourage him to say more about this desire, asking him questions like ‘What would this life without other people be like?’ Through such a descriptive exploration, the client might be gently helped to see that his quest to escape the ontological given of being-with-others is futile. Having accepted this, he might then start to look at ways in which he could live within these givens: for instance, by trying to make his relationships with his closest friends safer and more accepting.

Conclusion Emmy van Deurzen, Ernesto Spinelli and Hans Cohn have each made a major contribution the development of the existential therapy within the

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British School of Existential Analysis 127 UK and beyond. Van Deurzen, with her enormous passion and drive, has re-ignited interest in the existential approach to therapy, and has developed her own, uniquely pragmatic and philosophical way of working. Spinelli has brought phenomenology and bracketing to the fore, whilst Cohn has developed Heidegger’s ideas in original and innovative ways. Together, these practitioners’ approaches form the basis for a ‘radical existential therapy’ (van Deurzen-Smith, 1995b): one that moves away from diagnosis, pathologisation and value-judgments, towards a descriptivelyfocused exploration of the client’s lived-world and their problems in living. Of equal significance, however, are the many new voices that are emerging from within the British school of existential analysis – such as Darren Wolf (2000), Martin Milton (Milton et al., 2002) and Greg Madison (2002) – who are developing existential thinking and practice in original and innovative ways. As Groth (2000) suggests, then, the British school of existential analysis is one of the most vibrant and radical foci of existential therapy across the world, and looks set to be at the forefront of developments in this field in years to come.

Further reading Van Deurzen-Smith, E. (2002) ‘Existential Therapy’, in W. Dryden (ed.) Handbook of Individual Therapy. (4th edn.) London: Sage. Concise and informative overview of van Deurzen’s existential approach to therapy. Van Deurzen, E. (2002) Existential Counselling and Psychotherapy in Practice. (2nd edn.) London: Sage. Classic introduction to van Deurzen’s therapeutic approach: practical, accessible and illustrated throughout with illuminating and evocative case studies and examples of therapist–client dialogue. Van Deurzen-Smith, E. (1997) Everyday Mysteries: Existential Dimensions of Psychotherapy. London: Routledge. Extensive and in-depth presentation of van Deurzen’s therapeutic approach, with a particular focus on the philosophical and therapeutic foundations of her work. Van Deurzen, E. (1998) Paradox and Passion in Psychotherapy: An Existential Approach to Therapy and Counselling. Chichester: Wiley. A highly personal and passionate – if somewhat fragmented – presentation of existential ideas and therapeutic practices, emphasising the importance of facing the challenges and paradoxes of life to forge an existence that is vibrant and full. Spinelli, E. (1994) Demystifying Therapy. London: Constable. Highly accessible and popular critique of commonly-held assumptions within the therapeutic world – such as the existence of an ‘unconscious’ – outlining a range of existentialphenomenological alternatives. Spinelli, E. (1997) Tales of Un-Knowing: Therapeutic Encounters from an Existential Perspective. London: Duckworth. A compelling, moving and insightful collection of case studies, that reveals something of the warmth, humour and humility of Spinelli’s therapeutic approach. An excellent introduction to his work, and existential practice in general. Spinelli, E. (2001) The Mirror and the Hammer: Challenges to Therapeutic Orthodoxy. London: Continuum. Collection of thought-provoking and insightful essays

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128 Existential Therapies challenging therapeutic orthodoxy on such issues as self-disclosure, boundaries and ‘the self’. Cohn, H. W. (1997) Existential Thought and Therapeutic Practice: An Introduction to Existential Psychotherapy. London: Sage. Slim but useful book, comparing the existential and psychodynamic approaches, and briefly introducing Cohn’s own therapeutic ideas and developments. Very accessible. DuPlock, S. (ed.) (1997) Case Studies in Existential Psychotherapy and Counselling. Chichester: Wiley. Collection of case studies illustrating the practice of 12 different existential therapists located around the British school of existential analysis. Particularly illuminating are case studies by Milton, DuPlock and Goldenberg. Existential Analysis (formerly known as The Journal of the Society for Existential Analysis). Twice-yearly journal that publishes a range of scholarly, practical and engaging papers on all aspects of existential therapy and philosophy. Available through the Society of Existential Analysis – see Contacts.

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8. Brief Existential Therapies

There has been a tendency amongst existential therapists to be somewhat wary of those ‘time-limited’ or ‘short-term’ approaches in which a specific number of sessions – usually between about 6 and 20 – are agreed at the onset of therapy. Not only do existential therapists tend to hold that there are no quick and easy answers to life’s challenges (van Deurzen, 2002a), but there also tends to be a preference for flexibility over rigid boundaries and open-questioning over focused problem-solving. Nevertheless, with the recent moves within a variety of settings – such as education, health and the voluntary sectors – towards a shorter-term therapeutic approach, the question of how existential therapy might be practised in a more timelimited way is unavoidable. This chapter looks at two attempts within the field of existential therapies to develop a time-limited approach: the first from an existential-humanistic background, and the second from within the British school of existential analysis.

Short-term existential-humanistic therapy In Schneider and May’s (1995c) The Psychology of Existence, James Bugental very briefly sketches out some preliminary thoughts on a short-term existential-humanistic approach. Bugental writes that short-term work ‘requires a clearly (and usually explicitly) defined and limited focus of effort (goal of treatment) and thus a more overt structure to maintain maximum gain from limited opportunity’ (1995: 262). This structure consists of a series of sequential phases, each of which may occupy a session or more, although the exact pace will depend on each client–therapist pairing. These phases are as follows: 1

2

Assessment: Therapist and client assess whether the presenting problem can be isolated from its context and made into an explicit objective, and whether the client is able to engage in an intensive therapeutic process. If so, client and therapist proceed to phase two. Identifying the concern: The client is encouraged to present his concerns in the most succinct form, and a specific, focused objective is established.

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130 Existential Therapies 3

4

5

6

Teaching the searching process: The client is encouraged to examine her subjective experiences of the concern under examination (see Chapter 5). Identifying resistances: The client is helped to identify and realise the significance of resistances to an awareness of this concern. In contrast to longer term therapy, however, the client is not invited to work through the resistances, but to simply take note of them and return to the inner search. The therapeutic work: Client and therapist address the issue of central concern, keeping a clear focus on this issue and not allowing it to be displaced by other issues. Termination: The client is encouraged to assess what has been accomplished and what remains to be done, and the extent to which she has incorporated the searching process into her extra-therapeutic life. Client and therapist may negotiate a new series of short-term therapeutic sessions.

From Bugental’s description of short-term existential-humanistic psychotherapy, it would seem that he sees it as an essentially attenuated and less adequate version of the longer form (perhaps this is not surprising from a man who states that thoroughgoing therapeutic results require at least 250 hours of contact!). He writes, for instance, that any ‘changes are apt to be more shallow and possibly less lasting’ (1995: 263) and that ‘A series of short-term therapeutic efforts is not the equivalent of a long-term psychotherapy’ (1995: 264). Indeed, he suggests that a client’s insistence on one series of short-term therapeutic encounters after another ‘is a major resistance to commitment to one’s life, disguising a deeper sense of genuine need’ (1995: 264).

Existential time-limited therapy A very different approach is presented by Freddie and Alison Strasser (1997), who are closely connected to the British school of existential analysis. In contrast to Bugental (1995), Strasser and Strasser suggest that, for existential therapists, there are some very distinct benefits to working in a time-limited way. Much of this revolves around the fact that a timelimited therapeutic encounter mirrors, in many respects, the time-limited nature of human existence. Hence, in contrast to longer-term therapies, clients are brought face-to-face with issues of finitude and temporality in a very direct and immediate way. This gives them an opportunity to become more aware of how they relate to finitude in the extra-therapeutic world, and to develop strategies for relating to it in more constructive and effective ways. A client, for instance, who tends to treat the time-limited therapeutic relationship as if it will go on for ever, may also tend to ignore the fact that her time on the earth is limited. If this is pointed out to the

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Brief Existential Therapies 131 client and the possible connections explored, it may encourage the client to face up to the finitude of her being, and make the most of the time that she does have. Strasser and Strasser (1997) also suggest that a time-limited therapeutic approach may be particularly effective at helping clients overcome overly-high expectations of life. Just as clients may hope for a ‘smooth and perfect life’ (van Deurzen, 1998), so they may expect that therapy will provide them with either an ‘instant cure and complete elimination of their presenting problem or some particular method or tool that can specifically help in overcoming their dilemma’ (Strasser and Strasser, 1997: 54). With only 12 or so weeks to work in, however, clients are confronted with the fact that any change will inevitably be limited. The time-limited nature of the therapeutic process, then, encourages clients to reduce their expectations to feasible and workable levels; if this relaxation of standards can be generalised beyond the therapeutic environment, then clients may develop more realistic and achievable expectations in life as a whole. The short-term, finite nature of time-limited existential therapy also means that the ending is likely to be a prominent feature of the therapeutic relationship. Strasser and Strasser (1997) write that the ending will inevitably evoke some kind of emotional response in the client – such as fear, anger or sadness – as well as recollections of previous losses and rejections. Here again, then, the time-limited nature of the therapeutic relationship may help clients to develop a greater awareness of a particular area of their extra-therapeutic life, as well as of their values and coping strategies. Strasser and Strasser (1997) also suggest that the constant reminder of the ending will intensify a client’s commitment to the therapeutic process, encouraging the client to bring to the fore anxieties or concerns that, in a less time-pressurised environment, she might tend to withhold. Furthermore, they suggest that this intensification takes place between the sessions as well as during them. Strasser and Strasser, however, write that this increased sense of tension has negative as well as positive ramifications. Clients’ unrealistic desires to reach a state of cure may be intensified and, for therapists, there may be an increasing desire to leap in for the client to facilitate a positive outcome and thereby ‘impede the process of enabling the client to reflect and challenge their own discrepancies’ (1997: 13). Another significant difference between Bugental’s (1995) short-term existential-humanistic approach and Strasser and Strasser’s (1997) existential time-limited therapy is that Strasser and Strasser do not attempt to focus clients on one particular issue or to set specific targets or goals. Rather, they suggest that ‘all of the client’s presenting issues are interconnected to his or her life experience and therefore it is largely irrelevant which issues become the focus’ (1997: 44). Hence, wherever a client starts from, it is suggested that she will come around to the central issues and concerns. From this perspective, to delineate only one issue, or a small set

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132 Existential Therapies of issues, as being of concern – as Bugental suggests – would be to ‘impede the natural flow of the client’s self-disclosure’ (1997: 44). Structurally, Strasser and Strasser (1997) suggest that therapist and client should meet for approximately 12 sessions, with one follow-up session approximately 6 weeks later, and a second follow-up session approximately 6 weeks after that. They also suggest that, at the final followup session, therapist and client may choose to negotiate a further ‘module’ of 12 + 2 sessions. Their approach is also structured around two ‘wheels of existence’ (see Figures 8.1 and 8.2), which, they argue, accelerate and improve the therapeutic process. The first of these wheels (Figure 8.1) is a diagrammatic representation of the existential givens that every human being faces – most of which have been examined in earlier chapters of this book. Those segments of the wheel in roman script represent the givens outside of human influence (sections 1, 2, 3, 7 and 9), whilst those segments of the wheel in italics represent the human reactions and responses to these givens (sections 4, 5, 6, 8 and 10). As the diagram states, these segments are not in any linear or chronological order: they are a set of possibilities and limitations that ‘the moving SELF’ – that is, the self-image (Strasser, 2001, personal communication) – shifts between. Through keeping this wheel at the back of their minds, Strasser and Strasser (1997) suggest that therapists are able to grasp, at an earlier stage in their work, the kinds of issues that their clients are addressing and, perhaps more importantly, those that they are not addressing (cf. van Deurzen’s four worlds). Strasser and Strasser also suggest that this wheel can help therapists bracket off their own prejudices and biases when engaging with their clients, and to take a ‘step backwards’ from the situation such that they can understand their clients’ experiences in a broader way. Where a client is very focused on her anxiety about the future, for instance, these wheels can remind a therapist that it may be important to help the client examine his self-concept or relationship to time as well. A third value of this wheel, for Strasser and Strasser, is that it can remind therapists of the fundamentally interconnected nature of human existence: that each issue clients raise and address must be seen in the context of many others. Finally, Freddie Strasser (2001, personal communication) suggests that therapists can use this wheel to guide their own journey of self-discovery such that they have a greater understanding of their own relationship to the existential givens. The second wheel (Figure 8.2) is a representation of the methods and skills that therapists can use to address each of the corresponding possibilities and limitations. Hence, for instance, ‘identifying value systems and polarities’ (segment 4) can be used to address the ‘creation of patterns of value and behaviour systems’. Strasser and Strasser (1997) make it clear that these methods and skills should not be applied in a techniquelike, imposing way. Rather, as with the first wheel, they are strategies that therapists may wish to keep at the back of their minds, to help them guide their client through the therapeutic process. Many of the methods

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Brief Existential Therapies 133 Figure 8.1 The existential wheel: concepts (Existential Time-Limited Therapy, F. Strasser and A. Strasser, 1997, reproduced by permission of John Wiley & Sons Limited) The existential wheel of possibilities and limitations in ‘being-in-the-world’ Concepts (a structural view)

Freedom to choose

Existential anxiety

Uncertainty

Interpersonal relationships

1

10

2 9 Creation of self-concept and self-esteem

3

The moving SELF

8

Time and temporality

4 7 The four dimensions of existence

6

Polarities

5

Creation of patterns of values and behaviour systems

Creation of sedimentations of value and behaviour patterns

The diagram represents a non-chronological and non-linear interconnection of the concepts

and skills identified by Strasser and Strasser primarily involve helping clients to become more aware of particular aspects of their existence, whilst others involve challenging particular aspects of their clients’ world-views (for instance, that they can live an anxiety-free life (segment 9). Some of the methods and skills, however, are less self-evident. For instance, to help clients come to terms with the uncertainty of their existences, Strasser and

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134 Existential Therapies Figure 8.2 The existential wheel: methods and skills (Existential TimeLimited Therapy, F. Strasser and A. Strasser, 1997, reproduced by permission of John Wiley & Sons Limited) The existential wheel of possibilities and limitations in ‘being-in-the-world’ Methods and skills (a structural view)

Identifying choices and meaning

Challenging misconceptions about anxiety

Establishing the frame and contract

1

10

2

Interpersonal relationships and phenomenological method of investigation

9 Identifying self-concept and self-esteem

3

The moving SELF

8

Establishing perception of time and the timing of interventions

4 7 Exploring the four worlds

6

Identifying polarities and paradoxes

5

Identifying value systems and polarities

Challenging rigid sedimentations

The diagram represents a non-chronological and non-linear interconnection of the methods

Strasser emphasise the importance of establishing a clear frame and contract (segment 1). Strasser (2001, personal communication) suggests that creating this clearly boundaried environment helps clients to feel sufficiently safe to explore the lack of safety and uncertainties in the extra-therapeutic world. Furthermore, he suggests that, if and when the boundaries in therapy are modified or broken, clients have an opportunity to directly explore their feelings about this lack of certainty and safety. Similarly, Strasser and Strasser suggest that therapists can develop a greater insight into their relationship with time and temporality by reflecting on the timing of their interventions. If, for instance, a therapist

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Brief Existential Therapies 135 tends to try and squeeze as many interventions as possible into the therapeutic hour, it may be that she has a very compacted sense of time, and feels that there is always far too much to be done for the time available. The case of Simona provides a good illustration of many of the key concepts, methods and skills of Strasser and Strasser’s (1997) time-limited existential approach. Simona, a 25-year-old woman, was coming to the end of her university studies but felt ‘compulsively’ unable to get up in the morning to attend lectures and study, and experienced uncontrollable feelings of rage, usually directed towards her boyfriend. In the first five to six sessions of the time-limited existential therapy, Simona was encouraged to explore her history, her world-view and the motivations behind her value systems. It emerged that she had developed strong perfectionist tendencies as a means of coping with an uncertain and uncontrollable childhood, and her ‘inability’ to get up was motivated by a sense that if she could not do things perfectly – like achieving a first-class degree – then there was no point in doing them at all. Simona also came to see that her desire for perfection was accompanied by a strong desire to control the world around her, and this was leading her to feel enraged by her boyfriend, who was not always conforming to her needs and demands. Through keeping in mind the wheels of existence, Simona’s therapist was able to map out some of the key issues Simona was facing, and help her address these aspects of her being: • Safety and security (segment 1): Simona had a strong belief that she could reach a state of total security. Through being provided with a fixed contract and set of boundaries, she felt safe enough to explore the less secure aspects of her existence. • Time and temporality (segment 3): Simona felt guilty that she had not achieved enough for her age, and this sense of pressure was also evident in her attitude towards the therapeutic encounter, where she felt that she was not working hard enough and was failing to reach her desired goals. Her compulsive perfectionist tendencies were also manifested in the face of the therapeutic ending: as a desire that all issues should be ‘properly’ analysed away. By being encouraged to reflect on these issues, and to consider whether an imperfect therapeutic outcome could still be good enough, she was helped to relax the timepressures that she placed upon herself. • Values and behaviour patterns (segment 4): Simona greatly valued perfection and control. By being helped to see how highly she prioritised these values and the problems they were creating for her, she was empowered to re-evaluate this sedimented set of beliefs. • Polarities (segment 6): Simona oscillated between a desire for complete perfection and a depression at her inability to get anything right. By being helped to see the polarised nature of these two alternatives, she could begin to contemplate the possibility of a middle ground.

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136 Existential Therapies • The four dimensions of existence (segment 7): Simona was almost entirely preoccupied with aspects of her natural world, such as her sleep and waking up. In the therapy, she was given the opportunity to analyse her lack of interest in the spiritual and social worlds, and to develop a deeper understanding of her private, personal experiences. • Anxiety (segment 9): Simona’s perfectionist tendencies were rooted in a desire to entirely eliminate anxiety from her life. By being helped to see that this was an existential impossibility, Simona began to accept and re-engage with the messy imperfections of everyday life. • Possibility and freedom of choice (segment 10): By being helped to recognise that she could choose how she thought and behaved, Simona was empowered to challenge and change her sedimented beliefs and behaviours. For instance, in the final follow-up session, she reported that she had decided to try and accept her boyfriend as he was, and work at their differences. As Spinelli (1997a) writes, Strasser and Strasser (1997) have brought into being a valid and important time-limited approach to existential therapy, and have made a particularly valuable contribution in alerting existential therapists to the possible benefits of working in a time-limited way. However, a number of limitations to their approach can still be identified. First, their choice of concepts – as well as the corresponding methods and skills – would seem somewhat limited and arbitrary. Whilst, for instance, they include many of the key existential givens that philosophers and psychotherapists like Yalom (1980) and Cohn (1997) have outlined, there are also some notable omissions, such as embodiment, guilt and sexuality. From a Bugentalian (1995) perspective, there is also the question of whether, within a limited time-span, it might not be more efficacious to help clients focus on particular concerns, or sets of concerns. Certainly, with only 12 weeks or so to work in, it is questionable whether it is helpful for therapists to have in the back of their minds a further series of ‘givens’ for exploration.

Conclusion This chapter has presented two models of brief existential therapy. Whilst Bugental’s (1995) model is something of a concession to a short-term way of working, the approach outlined by Strasser and Strasser (1997) emphasises the positive benefits to existential therapists of working in a time-limited way. The development of brief existential therapies, however, is still very much in its infancy, and there is no doubt that much further work can be, and needs to be, done in this area. In particular, a development that brought together aspects of both Bugental’s and

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Brief Existential Therapies 137 Strasser and Strasser’s approaches might be of great value: a brief existential therapy that helped clients address specific issues, but did not ignore the wider context of possibilities and limitations.

Further reading Bugental, J. (1995) ‘Preliminary Sketches for a Short-Term Existential-Humanistic Therapy’, in K. Schneider and R. May (eds) The Psychology of Existence: An Integrative, Clinical Perspective. New York: McGraw-Hill. Brief thoughts on a timelimited existential-humanistic approach. Strasser, F. and Strasser, A. (1997) Existential Time-Limited Therapy. Chichester: Wiley and Sons. Accessible introduction to a time-limited existential therapy.

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9. Dimensions of Existential Therapeutic Practice

The preceding chapters have examined a range of existential approaches to therapy. The aim of this chapter is to draw these approaches together into a more unified framework: to look briefly at the similarities across these approaches, and then to identify nine key dimensions along which they differ.

Shared therapeutic practices The following practices tend to be shared across the existential therapies: • The aim of the therapeutic work is to help clients become more authentic: to become more aware of their actual existence, and to live more in accordance with their true values, beliefs and experiences. • Therapists tend to work with the concrete actuality of clients’ experiences, rather than viewing these experiences in terms of abstract or hypothetical constructs. • Clients are encouraged to acknowledge, and act on, their freedom and responsibility. • Clients are encouraged to acknowledge, accept and learn from the more ‘negative’ feelings, such as anxiety, guilt, despair and a sense of tragedy. • Clients are encouraged to explore their present and future experiences, as well as their past ones. • Clients are encouraged to explore all aspects of their being – emotions, beliefs, behaviours, physiological responses and so on – and to see these aspects as fundamentally interconnected. • Therapists tend to be relatively genuine and direct with their clients, rather than adopting the role of a blank screen. • Flexibility and adaptability of practice tend to be emphasised over fixed and immovable boundaries.

Differences in existential therapeutic practice Across the existential therapies discussed in this book, a number of differences can also be identified.

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Dimensions of Therapeutic Practice 139 Phenomenological-existential One of the most fundamental dimensions along which the existential therapies vary is the extent to which they attempt to stay with the clients’ lived-experiences (for instance, Spinelli, 1997b), as opposed to orientating the therapeutic work around certain existentially-derived assumptions. Such assumptions might be that clients need to find meaning in their lives (for instance, Frankl, 1986), that clients are ultimately concerned with such issues as death and isolation (for instance, Yalom, 1980), or that they need to face up to the inevitable challenges and vicissitudes of human existence (for instance, van Deurzen, 2002a). To illustrate this, and subsequent dimensions, let us imagine the following example. Sasha is a television producer in her mid-30s who refers herself to therapy. ‘I can’t believe how much I constantly mess up my relationships,’ she says in the first session. ‘It’s really getting me down.’ In the first few sessions, it emerges that Sasha’s boyfriend, Omar, is keen for her to move in with him, and is becoming increasingly frustrated with her for vacillating over the issue. ‘I’m just no good around commitment,’ Sasha says. ‘I definitely love Omar, but there’s just something that seems to stop me moving ahead.’ As the work progresses, however, it becomes increasingly apparent that Sasha’s feelings towards Omar are more complex. At the beginning of the sixth session, Sasha reports: Omar got furious with me last night. We went out for a meal and he asked me if I was ever going to move in with him, and I just kind of looked blank at him. I was thinking, ‘I guess I sort of do want to, but I love having my own space and I don’t know how well we’ll get on, and I don’t want to go down the road of kids and school runs and all that – How the hell am I going to move on in my career if I’m changing nappies all day and night?’ But I felt really bad because he’s asked me so many times, so I said to him that I’d be alright with living together. He said, ‘Thanks for being so bloody magnanimous’ and walked out.

Here, a therapist at the phenomenological end of the phenomenologicalexistential spectrum might encourage Sasha to describe in more detail the various experiences that she relates. What was her feeling, for instance, when Omar asked her about moving in? What did she experience when Omar walked out of the restaurant? And, how does she feel talking about the experience now? A therapist at the more existential end of the spectrum, on the other hand, might be more inclined to bring into the dialogue such existential issues as choice and finitude. For instance: ‘I get a sense that you’re not really choosing whether or not to move in with Omar – it’s more a case of you responding to his choices’; or perhaps, ‘There’s almost a sense that you could put off the decision for ever, but I wonder if at some point you’ll need to choose.’ For those approaches that do tend to orientate the therapeutic work around certain existential assumptions, there are also a number of

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140 Existential Therapies dimensions along which these assumptions sit. First, there is a contrast between those therapies that encourage clients to discover the meaning and purpose of their lives (for instance, Frankl, 1986), as opposed to those approaches which encourage clients to accept that life is devoid of intrinsic meanings (for instance, Yalom, 2001). Second, there are those approaches that encourage clients to face their fundamental aloneness (for instance, Yalom, 1980), in contrast to those approaches that encourage clients to acknowledge their fundamental beingness-with-others (for instance, Cohn, 1997). Third, there are those approaches that encourage clients to face up to their existence with resolution and fortitude (for instance, May, 1958a), in contrast to those approaches that put greater emphasis on helping clients adopt an attitude of openness, contemplation and Gelassenheit (for instance, Boss, 1963). Directive-non-directive A second, closely-related dimension, is the extent to which the therapeutic approach is directive: that is, the extent to which it ‘influences the therapy process and content, by raising issues, asking questions, and suggesting content as opposed to encouraging the client to choose his or her own topics and modes of processing’ (Sachse and Elliot, 2002: 89). In the example of Sasha, for instance, a therapist towards the more directive end of the dimension might say something like ‘Perhaps we should have a look at your feelings towards Omar’, whilst a therapist towards the less directive end of the dimension might simply remain silent or reflect back to Sasha the experience she has related. This directive-non-directive dimension is clearly related to the phenomenological-existential dimension, in the sense that those approaches that tend to orientate the therapeutic work around certain existential themes, incorporate, by their very nature, an element of directivity. At the same time, however, a phenomenological way of working could also be very directive: for instance, Sasha could be instructed to descriptively explore particular aspects of her lived-experiences. To some extent, the location of the different existential therapies on this directive-non-directive dimension is related to their views about the unconscious and self-deception. The more that an existential therapist believes that a client represses her true concerns into her unconscious (for instance, Yalom, 1980) – as opposed to simply being reluctant to face what they know to be true (for instance, van Deurzen, 2002a) – the more they are likely to feel that direction and challenge are required to ‘unearth’ the client’s real experiences. Where therapists sit on this dimension is also likely to be related to their views on therapeutic growth. If, for instance, therapists believe that clients can move towards a better way of being, and have some beliefs about what that way of being is (for instance, Schneider and May, 1995c), then they are more likely to feel that it is

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Dimensions of Therapeutic Practice 141 legitimate to point their clients in that particular direction. If, on the other hand, they hold that life will always be a struggle between polarities (for instance, van Deurzen, 2002a), or make few assumptions about the best way to live (for instance, Spinelli, 2001a), then they are less likely to want to point their clients in any particular way. Descriptive-explanatory A third dimension across the existential therapies is the extent to which they encourage clients to undertake a descriptive exploration of their lived-experiences (for instance, Spinelli, 1997b), as opposed to encouraging clients to look for reasons and explanations for how they have come to think, feel and behave in the way that they do (for instance, Yalom, 2001). This, again, is quite similar to the phenomenologicalexistential dimension – in the sense that therapist who adopts a phenomenological way of working will, by definition, be working descriptively – but a therapist who works from certain existential assumptions will not necessarily use those assumptions to try and explain the client’s experiences (for instance, Cohn, 1997). In the case of Sasha, then, an existential therapist working in a more explanatory way might go beyond Sasha’s own narrative, encouraging her to explore whether, perhaps, her fear of commitment was related to fears of being isolated, or whether she was encouraged as a child to feel responsible for others’ feelings. Along psychodynamic lines, many of the existential therapists discussed in this book tend to account for present experiences in terms of childhood experiences (May, 1969b; Laing, 1976b). In the case of logotherapy, however, explanations may primarily be in terms of future fears or hopes: for instance, Sasha may be encouraged to consider whether her fear of interpersonal commitment is due to the prioritisation of career-based life goals. Explanations may also be offered in terms of underlying fears or concerns in the present. As we have seen, for instance, Yalom (1980; 2001) may account for a client’s preoccupation with sex in terms of their fear of death or their desire for attention in terms of a fear of isolation. In contrast with other forms of therapy such as psychoanalysis, however, it should be noted that all of the existential therapies sit fairly close to the descriptive end of the descriptive-explanatory spectrum. Indeed, even Yalom (2001), drawing on the empirical evidence, acknowledges that clients generally value his intellectual interpretations far less than he does.

Psychological-philosophical A fourth dimension along which the existential therapies vary is the extent to which the therapeutic process is seen as an exploration of

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142 Existential Therapies psychological experiences and processes (for instance, Schneider and May, 1995c), as opposed to a more philosophical exploration of how to live life in a constructive and meaningful way (for instance, van Deurzen, 2002a). In the case of Sasha, we have already seen several examples of how a therapist at the more psychological end of this dimension might respond: encouraging Sasha to unpack the experience in more detail or consider explanations for why she behaved in the way she did. A therapist at the more philosophical end of the dimension, however, might also broaden out the therapeutic inquiry. For instance, she might say to Sasha, ‘I get a sense that you want intimacy without commitment, and I just wonder if that’s possible’. An existential therapist working in this more philosophical way might also bring in some specific philosophical ideas to help the client think through her situation. For instance, she might say to Sasha, ‘You know, some people argue that we can’t get what we want in life without going through some anxiety, and I just wonder whether you need to take the risk of telling Omar what’s really going on for you.’ This psychological-philosophical dimension can also be conceptualised in terms of those approaches that tend towards encouraging clients to explore their emotions (for instance, Schneider and May, 1995c), as opposed to those approaches that place an equal, or greater, emphasis on encouraging clients to explore the world of values and meanings (for instance, van Deurzen, 2002a). Does the therapist, for instance, principally encourage Sasha to look at what she felt when she told Omar that she would move in with him, or does she encourage Sasha to look more at her beliefs about commitment.

Individualising-universalising This leads on to a closely-related, but not identical, dimension: the extent to which the therapeutic approach encourages clients to focus in on the individual, personal dimensions of their experiences (for instance, Boss, 1963; Yalom, 1980), as opposed to the more universal, trans-personal dimensions (for instance, van Deurzen-Smith, 1997). In the example of Sasha, this would be the difference between saying something like ‘I get a sense that you find it difficult to be honest with Omar about your feelings’ (individualising) as compared with ‘It can be really frightening to tell people that we love things that might hurt them’ (universalising). Similarly, it would be the difference between saying something like ‘You seem to find it difficult to reconcile your need for intimacy with your need for space’ (individualising) and ‘It’s not easy to reconcile the need for intimacy with the need for space, is it?’ (universalising). Whilst an individualising approach, then, encourages clients to see their experiences as uniquely theirs, a more universalising approach encourages clients to think about their experiences as something shared across humanity.

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Dimensions of Therapeutic Practice 143 Pathologising-de-pathologising Following on from this is the extent to which the existential approach tends to construe clients’ difficulties in terms of individual disorders to be overcome and cured (for instance, Boss, 1963; Frankl, 1986), as opposed to more universal problems in living that need to be accepted and faced (for instance, van Deurzen, 2002a). An existential therapist from a more pathologising perspective, for instance, might think of Sasha as someone who is closed to the possibility of an intimate and committed relationship, or as someone who resists taking responsibility for her needs and choices. An existential therapist from a more de-pathologising perspective, however, would want to try and see the sense behind Sasha’s uncertainty – to resonate with the very real difficulty of being both intimate with others and yet having one’s own space, of trying to be honest with others and yet not wanting to hurt them. Subjective-inter-worldly A seventh dimension is the extent to which the therapeutic approach encourages clients to focus in on their personal, subjective experiences (for instance, Bugental, 1981), as opposed to focusing out on their in-theworld and intersubjective experiences (for instance, Frankl, 1986). In the case of Sasha, for instance, a more subjectively-orientated therapist might encourage her to explore her emotional and bodily responses to Omar’s question about moving in. Did she feel, for instance, a tightness in her chest when she started to think about school runs, or an emptiness in her stomach when she imagined her hoped-for future dissolving away? In contrast, a more inter-worldly-orientated therapist might shift the emphasis towards Sasha’s experiencing of Omar; indeed, he might want to help Sasha explore her perceptions of Omar’s perceptions of her. Whilst those existential therapists who adopt a more subjectivist standpoint, then, tend to want to help clients get in touch with their own needs, those therapists who adopt a more inter-worldly and intersubjective standpoint may also be interested in helping clients get in touch with the experiences and needs of others. Such therapists may also be keen to help clients explore their ethical responsibilities towards others in their lives. Immediacy-non-immediacy An eighth dimension across the existential therapies is the extent to which the therapeutic approach tends towards focusing the therapeutic work around the immediate therapeutic relationship (for instance, Spinelli, 1997b; Yalom, 2001), as opposed to paying less attention to the therapist– client dynamic (for instance, Frankl, 1986; van Deurzen, 2002a). In the

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144 Existential Therapies example of Sasha, for instance, an existential therapist who prioritises the immediate therapeutic encounter might say something like, ‘I get a sense that you find it difficult to tell Omar what you really want from him, and I wonder if you find it difficult to tell me these kind of things too.’ Alternatively, such a therapist might ask, ‘I wonder if you ever feel that conflict between the desires for intimacy and space when you are here with me?’ This contrasts with a therapist who would simply keep the focus of the work on the client’s in-the-world relationships. Those existential approaches that put greater emphasis on the immediate therapeutic encounter also tend to advocate a more self-disclosing therapeutic stance (for instance, Yalom, 2001). In the example of Sasha, a therapist might say, ‘You know, I find myself wondering about your commitment to therapy too. Sometimes I feel very close to you, but at other times I feel like you could just wander off and I’d never see you again.’ Such a therapist might also share his resonances with Sasha’s dilemma, and be open about his own vulnerabilities and struggles. He might say, for instance, ‘I really know what you mean about the difficulties of telling someone you like that you don’t want to live with them.’

Spontaneity-techniques A final dimension along which the existential therapies discussed in this book differ is the extent to which they tend towards drawing on specific therapeutic techniques (for instance, Frankl, 1986; Yalom, 2001), as opposed to encountering the client in a spontaneous and un-premeditated way (for instance, Laing, 1965). In the example of Sasha, an existential therapist with a more technical approach might invite Sasha to try role-playing the argument with Omar, but this time telling him exactly what she is feeling and thinking. Alternatively, along the lines of paradoxical intention, she might be set some ‘homework’ to tell Omar exactly why she doesn’t want to move in with him, to see if his anger is really as bad as she imagines it will be. Again, however, in contrast to other therapeutic approaches, particularly cognitive-behavioural therapy (Trower et al., 1988), all of the existential therapies – apart from logotherapy – tend to be at the relatively spontaneous end of the spontaneity-technique dimension.

Conclusion Table 9.1 presents a summary of where each of the existential approaches to therapy tend to sit on each of the dimensions outlined. In cases where it is not clear or relevant where an approach is located, these approaches have been omitted. It should be noted, however, that this table provides only a rough approximation of where each of these approaches are

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Dimensions of Therapeutic Practice 145 Table 9.1

Dimensions of existential therapies

Phenomenological

Non-directive

Descriptive

Psychological

Individualising

Pathologising Subjective

Immediacy

Spontaneity

Spinelli

Van Deurzen Logotherapy Laing Daseinsanalysis Ex-humanistic British school Laing Logotherapy Daseinsanalysis Ex-humanistic British school Laing Daseinsanalysis Ex-humanistic Daseinsanalysis Logotherapy Van Deurzen Ex-humanistic Laing Ex-humanistic Logotherapy Van Deurzen Daseinsanalysis Laing Logotherapy Laing British school Daseinsanalysis Ex-humanistic Ex-humanistic Daseinsanalysis Spinelli Laing Van Deurzen Logotherapy Ex-Humanistic Daseinsanalysis Logotherapy Laing Van Deurzen Spinelli British school Ex-humanistic Logotherapy Laing Daseinsanalysis

Existential

Directive

Explanatory

Philosophical

Universalising

De-pathologising Inter-worldly

Non-immediacy

Techniques

located. As discussed in the introduction, within each approach there will be substantial variations across practitioners, and each practitioner may work in very different ways with different clients. Where each existential therapy tends to sit on these different dimensions will be related to a range of factors. In this book, for instance, we have seen how such factors as philosophical allegiances, personal history, political outlook, type of training and proximity to other schools of therapy can all influence a particular approach. Given, however, that no therapist works at just one end of these polarities, I want to conclude by offering a somewhat different way of thinking about these dimensions: as practice dilemmas. That is, just as human beings are consistently pulled between the poles of different dilemmas (van Deurzen-Smith, 1997), so existential therapists – indeed, all therapists – are consistently pulled between various dilemmas of practice: for instance, should I direct the client here or be non-directive? Should I bring in my own experiences here or should I stay with the client’s narrative? Viewed in this way, the question is not ‘Which end of the dimension is the best way of working?’ but ‘Which way of working is most appropriate for a particular client at a particular point in time?’ If, for instance, Sasha is someone who always talks in general

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146 Existential Therapies terms, it may be very useful to help her individualise her concerns, whereas if she is someone who feels that she is the only person in the world struggling with her difficulties, it may be more useful to work in a more generalising way. Such an understanding, then, allows existential therapists to be open to the potential value of each other’s practices, without ignoring the very real differences that lead particular therapists to favour particular ways of working. It also encourages existential therapists to move away from relatively unproductive disputes over who is right and who is wrong, and towards looking at the specific factors that may make a particular way of working most useful at a particular point in time.

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10. Conclusion: the Challenge of Change

As stated in the introductory chapter, the aims of this book have been fourfold. First, to introduce readers to the rich tapestry of existential therapies; second, to provide readers with ideas and practices that they can incorporate into their own work; third, to help readers identify – and follow up – areas of existential therapy that are of particular interest to them; and fourth, to contribute to a range of debates within the existential therapy field. It is my hope that this book has achieved these aims and, in particular, has served to stimulate and excite its readers. In conclusion, this book looks at some of the challenges facing existential therapy in the years ahead.

Demonstrating therapeutic efficacy First, there is the challenge of meeting the current calls for greater therapeutic efficiency – particularly within the public and voluntary sectors. Few psychotherapists working in these contexts are now able to contract with their clients on an open-ended basis. Instead, they are increasingly being expected to achieve ‘results’ in a limited number of weeks – sometimes as few as six or ten. This challenge is particularly acute for existential therapists for a number of reasons. First, existential therapists tend to dislike the idea that therapy is about producing results – seeing it as a somewhat mechanistic, impersonal understanding of the therapeutic relationship. Second, for existential therapists like van Deurzen (2002a), there are no easy ‘results’ to come by. As she frequently states, ‘there is no cure for life’, and clients cannot be expected to achieve peace and happiness in a short number of weeks – if at all. Both Bugental (1995) and Strasser and Strasser (1997), however, have begun to outline ways in which existential therapy could be practised in a time-limited way and, despite the limitations of each model, they provide a useful basis from which shorter term existential models can be developed. Strasser and Strasser have performed a particularly valuable service by beginning to outline some of the possible benefits, for existential therapists, of working in a time-limited way. This means that existential therapists can begin to move away from an attitude of resignation

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148 Existential Therapies towards the current calls for efficiency and to constructively and creatively grappling with the givens of the current climate. To avoid being engulfed by an increasingly mechanistic model of treatment and cure, it may also be very important for existential therapists to be more explicit about the aims of their therapeutic work, and the kinds of clients they can do this most effectively with (as van Deurzen-Smith (1995a) has begun to do). The more vague existential therapists are on these issues, the more they may be expected – by referral agencies and clients – to achieve the same results as everyone else: such as lowered levels of anxiety or heightened feelings of well-being. If existential therapists, however, can explicitly state what their work is about (for instance, ‘helping clients choose more effectively’) and explicitly state with whom this work is most appropriate (for instance, ‘clients who are not expecting immediate symptom relief’), then there may be less expectation that existential therapists will bring about conventional therapeutic outcomes. This may mean that existential therapists will have fewer clients, but it does mean that those clients going to see existential therapists will be most able to benefit from this work and will have a clear and realistic sense of what the therapeutic work may be able to achieve. A related challenge is the growing call for therapists to demonstrate the empirical validity of their work. Again, this is a challenge that is particularly acute to existential therapists, who have tended to reject the idea that the therapeutic process can be measured and evaluated in quantitative terms. How, for instance, can one put a score to the ‘I–Thou-ness’ of a therapeutic relationship? With the increasing emergence of qualitative research methodologies (for instance, McLeod, 2000), however, there is little reason for a continued rejection of empirical assessment and evaluation. Indeed, many of the newly-emerging research methodologies – such as Kvale’s (1996) qualitative interviewing approach – are entirely consistent with an existential outlook. These research methodologies may never meet the alleged ‘gold standard’ of therapeutic evaluation: double-blind studies – in which the researcher is not aware of the experimental condition the participant is in – but they would do much to help existential therapists, and those outside the field, to understand the value of the approach. In particular, it could give existential therapists enormous insights into clients’ experiences of existential therapy, and help them to develop their way of working. In this respect, Walsh and McElwain’s (2002) recent review of the evidence in support of an existential approach to therapy is an excellent start, but it also reveals the distinct lack of studies that directly evaluate and examine this approach.

Establishing a dialogue with other approaches Given the current trend towards more integrative ways of working – for instance, in the field of counselling psychology – another challenge for

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The Challenge of Change

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existential therapists, as van Deurzen suggests, is to establish ‘an on-going dialogue with other similar approaches, such as the person-centred one, Gestalt, personal construct therapy and some forms of cognitive therapy, also with psychodynamic therapy’ (2001, personal communication). Existential therapists could learn much from these different approaches. From Gestalt (Perls et al., 1951) and experiential therapists (Mahrer, 1996), for instance, existential therapists could learn a range of strategies for helping clients reflect on their experiences more fully, and from personal construct therapists (such as Kelly, 1955) they could develop their understanding of polarities and dilemmas. At the same time, as this book hopes to have shown, there is much that existential therapists can contribute to the wider field of therapeutic practice: in particular, an understanding of – and ways of working with – such givens of human existence as freedom, anxiety and the search for meaning. In this respect, Milton et al. (2002) present a very interesting discussion of the contribution that existential therapy can make to an integrative counselling psychology practice. Most importantly, however, what existential therapists may be able to contribute to the wider field of therapeutic practice is its critical and questioning edge: its willingness to challenge the assumptions and practices that many other therapists take for granted. In this respect, it can help to keep the field of therapy self-aware and alive, counteracting the inevitable tendency to fall into dogma and conformity. As van Deurzen states (2001, personal communication), one talking therapy that existential therapy will particularly need to ‘rub shoulders with’ is that of philosophical counselling. Here, there is much that existential therapists can learn about with regard to helping clients to address philosophical issues. However, a real challenge for existential therapists – particularly those who tend towards seeing it as a tutorial in the art of living (for instance, van Deurzen, 2002a) – will be to articulate and emphasise the strengths of a specifically existential philosophical inquiry. Perhaps these existential therapists will become ‘philosophical counsellors with a special knowledge of existential philosophy’ or perhaps they will describe themselves as ‘philosophical counsellors who primarily explore what it means to exist’. Simon DuPlock (1999), a British existential therapist, has begun to outline some of the ways in which existential therapy differs from a philosophical counselling approach, and this is something that existential therapists may need to develop in the near future.

Postmodernism With respect to philosophy, another major challenge to existential therapies is the ongoing development of postmodern thinking, and its increasing penetration into the world of therapy (for instance, McNamee and Gergen, 1992; McLeod, 1997). As a world-view which can see human beings as ‘swallowed up by the “blank and pitiless” forces of language

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150 Existential Therapies games, discourses and texts’ (Cooper and Rowan, 1999: 1), the existential project of helping clients to live more authentically and to choose more actively is in danger of being reduced to little more than one narrative amongst many others. Unlike van Deurzen (1998), however, I believe the postmodern challenge to existential therapy is primarily a positive one. First, it can help existential therapists remember that the existential world-view is not a truth, but just one way of seeing the world that is always open to question and doubt. Second, it can help existential therapists be more aware of the kinds of narratives and discourses that their clients bring in to the therapeutic relationship, and the kinds of impacts that these stories might have on their lives. Third, it encourages existential therapists to move away from a focus on universal human givens and concerns, and towards a greater openness to the enormous diversity and heterogeneity of clients’ issues and backgrounds. Indeed, whilst some existential therapists have begun to look at the application of their work to such ‘minority’ groups as Chinese clients (Galvin, 1995) and Native American clients (Alsup, 1995), there is still much work to be done in this, and related, areas.

Unpacking existential thought There are many challenges to existential therapy, then, from outside of the existential field, but there are also many challenges from within. Inside the body of existential philosophy, there are numerous concepts and ideas whose therapeutic potential has yet to be fully unpacked: such as Marcel’s (1949) work on fidelity, and Merleau-Ponty’s (1945/1962) writings on embodiedness. Buber’s (1923/1958) concept of the I–Thou attitude, too, has yet to be developed into a fully comprehensive therapeutic system – though some preliminary attempts have been made (for instance, Friedman, 1985). Even aspects of Heidegger’s work have yet to be fully unpacked by existential therapists: for instance, his understanding of human existence as a practical, engaged activity (1926/1962). Within the world of existential therapy, too, there are also many writings that have yet to be fully developed. Most significantly, perhaps, is the vast body of literature by Binswanger and other European existential psychiatrists – such as Eugene Minkowski, Erwin Straus and Viktor Emil von Gebsattel – that remains largely un-translated into English, and thereby inaccessible to many English-speaking therapists. More contemporarily, there are also a number of individual and less well-known existential therapies that could usefully be brought into dialogue with the various mainstreams. For instance, there is Betty Cannon’s (1991) Sartrean-based therapy; the Buberian, dialogic therapies of Maurice Friedman (1985) and Hycner and Jacobs (1995); and the highly idiosyncratic approach of Leslie Farber (2000), which is only now beginning to receive its due recognition.

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The Challenge of Change

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Beyond the walls of the talking, one-to-one therapies, there are also many interesting developments in the field of existential therapies that may have important contributions to make to the wider field: for instance, Jim Lantz’s (1993) existential family therapy; Cohn’s (1997) work on existential therapeutic groups; Bruce Moon’s (1995) existential art therapy; and King and Citrenbaum’s (1993) existential hypnotherapy.

A new openness Perhaps the greatest challenge to the existential therapies, then, is to stand by their own philosophical principles of openness and wonder in the face of so many external and internal challenges and possibilities. Existential approaches to therapy, like all social systems, can all too easily fall into inauthentic ways of being in which tradition, conformity and dogma take precedence over critical self-reflection and active choice-making. In the history of the existential therapy movement, there have been numerous examples of such stagnation, but there have also been many times when existential therapists have embraced the challenge of change. Perhaps this is because, as Cohn (1997) writes, there are so ‘many ways of being an existentialist’. If this is the case, then it is my hope that this book will add to a process of growing openness, by highlighting the many different ways in which existentially-informed therapists can think and practice. Just as there is no one way of being an existential thinker, so there is no one way of being an existential therapist, and it is this very diversity and difference that is the life-blood of the existential therapeutic field.

Further reading Walsh, R. A. and McElwain, B. (2002) ‘Existential Psychotherapies’, in D. J. Cain and J. Seeman (eds) Humanistic Psychotherapies: Handbook of Research and Practice. Washington, DC: American Psychological Association. Reviews research relevant to an existential approach to therapy, and provides an excellent overview of key existential therapeutic themes.

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Contacts

Existential philosophy Society for Phenomenology and Existential Philosophy http://www.spep.org/

Daseinsanalysis The International Organization for Daseinsanalysis http://www.daseinsanalyse.com Swiss Society for Daseinsanalysis c /o Holzhey-Kunz Alice, Dr. phil. Sonneggstr. 82 8006 Zürich Switzerland Tel: +41 1 361 77 31 http://www.daseinsanalyse.ch/ Gion Condrau’s home page http://www.condrau.ch/

Logotherapy Viktor Frankl Institute Vienna Langwiesgasse 6 A-1140 Vienna Austria Tel: +43 1 914 2683 http://www.logotherapy.univie.ac.at/ International Associations of Institutions for Training and Research in Logotherapy and Existential Analysis http://www.logotherapie-inter-ges.com/indexen.html International Society for Logotherapy and Existential Analysis http://www.existential-analysis.org

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Contacts 153 International Network on Personal Meaning http://www.meaning.ca/ Viktor Frankl Institute of Logotherapy Box 15211, Abilene Texas 79698-5211 USA Tel: +1 915 692 9597

Existential-humanistic Existential-Humanistic Institute 870 Market Street, Suite 463 San Francisco, CA 94102 USA Tel: +1 415 421 3355 http://www.existentialhumanisticinstitute.com

Laing The Philadelphia Association 4 Marty’s Yard 17 Hampstead High Street London NW3 1QW UK Tel: +44 20 7794 2652 [email protected]

British school of existential analysis Society for Existential Analysis BM Existential London WC1N 3XX Tel: +44 7000 473337 http://www.existentialanalysis.co.uk/ New School of Psychotherapy and Counselling Royal Waterloo House 51–55 Waterloo Road London SE1 8TX UK Tel: +44 20 7928 4344 http://www.nspc.org.uk/

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154 Contacts Regent’s College School of Psychotherapy and Counselling Regent’s College Inner Circle, Regent’s Park London NW1 4NS UK Tel: +44 20 7487 7406 http://www.spc.ac.uk/

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absurdity of life, 16, 26–8, 82–3 ‘accessibility’ (Bugental), 71 ‘acting-out’ by clients, 42 addiction, 122 Adler, A., 52 ‘antinomies’ (Jaspers), 29 anxiety, 22–6 over freedom to choose, 77–9, 110 protection from, 66–7 ‘appealing technique’, 55 Ascher, L.M., 58–9 atheism, 7–8 authentic and inauthentic ways of being, 23–30, 70, 72, 88, 101 Bateson, G., 93, 99 Baumeister, R.F., 61 Becker, E., 25 behaviourism, 9 ‘being with’ and ‘being for’ (Spinelli), 122 bias, 4 Binswanger, L., 35–7, 48, 51, 63, 93, 108, 113, 150 Boss, M., 30, 35–49 passim, 108 brief existential therapies, 129–37, 147 British school of existential analysis, 3, 107–27 Buber, M., 7–8, 16, 20, 28, 87, 103, 150 Bugental, J., 1, 63–73, 80–3, 87–9, 119, 129–32, 136–7, 147 Bulka, R.P., 60 Burston, D., 91 Camus, A., 7–8, 16, 26–7, 31 candid confrontation, 100–3 Cannon, B., 150 childhood experiences, 86, 93–4, 141 Citrenbaum, C.M., 151 Cohn, H., 8, 125–7, 151 Collier, A., 104 Comte, A., 9 concentration camps, experience of, 52–3 Condrau, G., 36–7, 44, 46 ‘conscience’, 26, 54

constructive-expansive polarity, 85–7 Cooper, M., 32, 150 Craig, E., 36, 48 daemonic energies, 84–5 Daseinanalysis, 2, 18–20, 29, 35–50, 88, 95 critical perspectives on, 47–9 death, 17, 25, 27, 73–6, 83 defensive behaviours, 66 depression, 39, 55, 61, 85, 93 dereflection, 59 Descartes, R., 10 description, rule of, 11 descriptive exploration of lived-experience, 141 directive and non-directive approaches to therapy, 140–1 displacement of responsibility, 77–8 ‘double-bind’ situations, 99, 105 dreams, 45–50 Dreyfus, H.L., 18 ‘Dumbo effect’, 121 DuPlock, S., 149 efficacy of existential therapies, demonstration of, 147–8 egalitarian therapeutic relationships, 109 Eleftheriadou, Z., 104–5 Elkin, G., 70–1, 79, 85 embodied meditation, 69 embodiedness, 21, 83–5, 150 emotionality, 66 encounter, four realms of (Spinelli), 122–4 epoche, 10 essence, concept of, 8–9, 13–14 essentialist psychologies, 9 existence, 8–10 as anxious, 22–3 as authentic, 25–7 as embodied, 21 four dimensions of (van Deurzen), 114 as freely-choosing, 13–15 ‘givens’ of, 73

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168 Index existence, cont. as guilty, 23 as inauthentic, 23–5 as in-the-world, 18–19 verb-like nature of, 12–13 as with–others, 19–21 existential-humanistic psychotherapy, 3, 63–89 clients’ resistance to, 69–70 critical perspectives on, 87–8 short-term, 129–30, 136–7, 147 strategies used in, 68–9 existential movement, 6 existential philosophy, 6–30 critical perspectives on, 30–2 existential therapies definition of, 1–2 demonstration of empirical validity of, 147–8 differences in practice between, 138–44 integrated ways of working in, 148–9 practices shared by, 138 scope for further development of, 150–1 summary of dimensions of, 144–5 ‘existential vacuum’, 53 ‘existential wheels’, 132–4 expectations of clients and referral agencies, 131, 148 experiential therapy, 149 Fabry, J., 54, 57 facticity, 17 faith, 28 family relationships, 98–100 Farber, L., 77, 124, 150 ‘fast-forwarding’ technique, 57 Frankl, V., 1–2, 16, 51–61, 82–3 free association, 37–8, 93 Freud, S., 35, 37, 41–2, 45, 47, 52, 65–6, 84 Friedman, M., 87, 150 Gelassenheit, 29, 39, 140 Gendlin, E., 48–9, 65 Gergen, K., 118 Gestalt therapy, 149 God, 28, 81 Groth, M., 107, 127 Guignon, C.B., 26 ‘guilt’ (Heidegger), 23, 26 Halling, D., 1 Hegel, F., 9, 29 Heidegger, M., 7, 10–31 passim, 54, 74, 94, 108, 126–7, 150 and Daseinanalysis, 35–6, 40, 43–4, 48–9, 51

horizontalisation, rule of, 11 Hornby, J., 117 humanistic psychotherapy and psychology movement, 64 Husserl, E., 10–11, 92, 108–9, 118–19 Hycner, R., 150 hyperconstructive and hyperexpansive dysfunctions, 85–6 hyperreflection, 59 I-It attitude to the Other, 20 immediacy and non–immediacy in therapeutic relationships, 143–4, ‘implicit trauma’ (Schneider), 86–7 individual psychology, 52 individualising approach to therapy, 142 ‘inner world’ of subjective experience, 67–9 intentionality, 18 intersubjectivity, 19, 40, 87 isolation of individuals, 80–2, 140 I–Thou attitude to the Other, 20, 28, 92, 101, 103, 150 Jacobs, L., 150 James, W., 65 Jaspers, K., 7–8, 16–17, 29, 92, 95 Judaism, 52 Jung, C. G., 37 Kierkegaard, S., 6–8, 12–16, 22–31, 85 King, M.E., 151 Kvale, S., 148 Laing, R.D., 3, 55, 91–106 Längle, A., 61 Lantz, J., 151 La Rochefoucauld, Duc F. de, 74 ‘leaping in’ and ‘leaping ahead’ (Heidegger), 19–20, 43 logotherapy, 3, 16, 51–61, 141 critical perspectives on, 59–61 Lukas, E., 55, 60 McElwain, B., 1, 148 Macquarrie, J., 12, 30, 32 Madison, G., 127 Marcel, G., 7–8, 14, 16, 28–32, 52, 150 Marx, K., 94 Maslow, A., 64–5 May, R., 2–3, 63, 72, 77–89 passim meaning-centred counselling, 57 meaning in life, 53–5, 58–61, 82–3, 140 mental illness, 38, 55, 94–5, 97–8 Merleau-Ponty, M., 7, 18, 21, 150

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Index metanoia, 100 Milner, M., 93 Milton, M., 127, 149 Minkowski, E., 93, 150 ‘miracle questions’, 57 ‘moods’ (Heidegger), 21–2 Moon, B., 151 morality of existential philosophy, 31 Moran, D., 30 Nazism, 31 Nietzsche, F., 7–8, 21, 27, 31, 54 nihilism, 53, 82–3 Nill, J.D., 1 objectification, 20–1 obsessive behaviour, 66 ontic activities, 11 ontological insecurity, 96–7, 104–5 paradox analysis (Schneider), 86 paradoxical intention, 57–9 parenting, 43–4 pathologising and non-pathologising perspectives on clients’ problems, 143 person-centred therapy, 4, 125 personal construct therapy, 149 ‘phantasy’ concept, 98, 102 phenomenology, 10–11, 92, 108, 118, 125, 141 philosophical counselling, 117, 149 Pollard, C.A., 58–9 Popovic, N., 125 positivism, 9 postmodernism, 32, 149–50 ‘projects’ (Sartre), 15–16 psyche, the, 37–8 psychoanalysis, 9, 37, 42–3, 47–9, 52, 93 psychological health, 38–9, 86, 120 qualitative interviewing, 148 ‘resistance’ (Bugental), 67 Resnick, J., 100, 102 Rogers, C., 41, 64–5, 84, 119, 125 Rowan, J., 150 Rycroft, C., 93 Sartre, J. -P., 6–7, 13–31 passim, 54, 92 Scheler, M., 14, 51–2 schizophrenia, 92–3, 96–8, 104–5 Schneider, K., 2, 63–72 passim, 85–8, 103–4

169

Schrader, G.A. Jr, 31 self, sense of, 119 self-deception by clients, 110 Semyon, M., 101–3 short-term existential-humanistic therapy, 129–30, 136–7, 147 Sisyphus myth, 26–7, 30, 111 Society for Existential Analysis, 107 Socratic dialogue, 56–7 Spinelli, E., 10, 108, 118–27, 136 critical perspectives on, 125 spontaneity in encounters with clients, 144 Strasser, F. and A., 130–7, 147 Straus, E., 150 subjective experience, therapeutic focus on, 143 subjectivity, 87 Sullivan, H. S., 65, 93 Tavistock Institute, 93 terminal illness, 76 therapists’ relationships with clients, 40–7, 71–2, 79–83, 100–4, 109, 118, 123–4, 134–5 Thompson, M. G., 104 ‘thrownness’ (Heidegger), 17 Tillich, P., 7, 28, 64 time-limited existential therapy, 130–6, 147 transference, 40–1, 72, 93, 119 Travelbee, J., 56–7 ‘ultimate concerns’ of clients, 73 unconditional positive regard, 41 unconscious, the, 39–40, 65, 108, 119–20, 140 uniqueness of human existence, 11–12, 74 universalising approach to therapy, 142 values, 14, 27, 52–5 van Deurzen, E., 1, 59, 88, 104–5, 107–18, 126–7, 149–50 critical perspectives on, 116–18 vivification, 70–1 von Gebsattel, V. E., 150 Walsh, R.A., 1, 148 Winnicott, D.W., 93 Wolf, D., 49, 127 Wong, P., 57, 61 ‘workaholics’, 74 Yalom, I., 1, 3, 22–3, 60–89, 141

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