EXISTENTIAL THERAPY

1. EXISTENTIAL THERAPY Slides created by Barbara A. Cubic, Ph.D.Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10

2. Learning Objectives • This presentation will focus on: • Overview of existential psychotherapy • History of existential psychotherapy • Applications of existential psychotherapy • Treatment techniques associated with existential psychotherapy

3. Existential Psychotherapy • Can be integrated with other therapy approaches. • Represents a way of thinking about human experience that can constitute a part of all therapies. • Asks deep questions about human experiences such as anxiety, despair, grief, loneliness, isolation, anomie, meaning, creativity and love.

4. Existential Psychotherapy In his seminal work, Existential Psychotherapy, Yalom (1980)likened the unique aspects of interactions therapists have with their patients as the extras in a recipe that make it work.

5. Basic Concepts Existential psychotherapy is “an encounter with one’s own existence in an immediate and quintessential form.” — Rollo May (1967)

6. Basic Concepts • People are meaning-making beings who are both subjects of experience and objects of self-reflection. • Focus on questions like: • Who am I? Is life worth living? Does it have a meaning? How can I realize my humanity? • Asserts that only in reflecting on our mortality can we learn how to live.

7. Basic Concepts • Existential therapy believes we all must come to terms with the questions related to our existence. • Each of us is responsible for who we are and what we become.

8. Authenticity and Subjectivity • Because theories may dehumanize and objectify people, authentic experience takes precedence over artificial explanations. • When experiences are molded into some preexisting theoretical model, they lose their authenticity and become disconnected from the individuals who experience them.

9. Authenticity and Subjectivity • Existential psychotherapists focus on the subjectivity of experience rather than “objective” diagnostic categories.

10. Existential Crises • We are thrown alone into existence without a predestined life structure and destiny. • Each of us must decide how to live as fully, happily, ethically, and meaningfully as possible.

11. Existential Crises • Diagnosable presenting “symptoms” may mask existential crises. • Existential dilemma ensues from the existential reality that although we crave to persist in our being, we are finite creatures.

12. Ultimate Concerns • Freedom • As authors of our own lives, we face responsibilities we dread and try to escape. • Isolation • Interpersonal, intrapersonal, or existential isolation • Meaning • Search for purpose can throw us into crisis. • Death • Death awareness is painful, but enriches life.

13. Ultimate Concern: Freedom “Humans are condemned to freedom.”

14. Freedom • Refers to fact that humans are the authors of their own world. • We are responsible for our own choices. • Conflict is between groundlessness and desire for ground/structure.

15. Freedom • Implications for therapy: • Responsibility • Willing • Impulsivity • Compulsivity • Decision

16. Isolation • Existential isolation differs from: • Interpersonal isolation: Divide between oneself and others. • Intrapersonal isolation: Fact we are isolated from parts of ourselves.

17. Isolation Each of us enters existence alone and must depart from it alone.

18. Meaninglessness What is the meaning of life?

19. Ultimate Concern: Death "Everything wishes to persist in its own being." — Spinoza

20. Ultimate Concern: Death • The most obvious ultimate concern • “A Terrible Truth” • Conflict between awareness of death and desire to live. • To cope, we erect defenses against death awareness. • Psychopathology, in part, is due to failure to deal with the inevitability of death.

21. The Fellow Traveler • Awareness of ultimate concerns as givens of existence produces a relationship between therapist and patient as one of fellow travelers. • Labels of patient/therapist, client/counselor suggest distinctions between “them” (the afflicted) and “us” (the healers).

22. The Fellow Traveler • We are all in this together; no person is immune to the inherent tragedies of existence. • Sharing the essence of the human condition becomes the bedrock of therapeutic work.

23. Comparing Existential psychotherapy to Other Approaches

24. Key Differences with Other Approaches

25. Key Differences with Other Approaches

26. Comparison of Existential Theory to Humanistic Approaches • Humanistic therapies overlap considerably with existential approaches. • Both emphasize growth and fulfillment of the self. • Goals are for self mastery, self-examination and creativity.

27. Comparison of Existential Therapy to Other Therapies Most Different Most Similar Behavioral Psychoanalytic Humanistic

28. Other Key Contrasts of Existential Theory Compared to Other Systems • Existentialists reject concept of the person as propelled by drives and instincts. • Existentialists feel Jungians quickly avoid the patient’s immediate crises by being too focused on theory. • Client-centered therapists do not confront the patient directly and firmly.

29. Precursors • Philosophers, theologians, poets throughout time have wrestled with existential issues. • Epicurus emphasized death concerns may not be conscious to the individual but might be inferred by disguised manifestations. • Nabokov viewed life as crack of light between two eternities of darkness. • St. Augustine believed that only in the face of death is a person’s self born.

30. Beginnings • Term existentialism is associated with Sartre and Marcel. • Influenced by philosophers including Heidegger, Husserl, Levinas and Buber. • Central foundational philosophers of existential psychotherapy are Kierkegaard and Nietzsche.

31. Rollo May • Existence: A New Dimension in Psychiatry and Psychology • May, Angel, and Ellenberger • Introduced existential psychotherapy to the US in 1958. • May wrote two main chapters: • The Origins of the Existential Movement in Psychology • Contributions of Existential Psychology

32. Beginnings • Other influences: • Binswanger • Ellenberger • Minkowski • Straus • von Gebsattel • Kuhn • Fromm

33. Beginnings • Works by Yalom • Existential Psychotherapy (1980) • Love’s Executioner(1989) • Momma and the Meaning of Life (1999) • When Nietzsche Wept(1992) • Lying on the Couch(1996) • The Schopenhauer Cure (2005) • The Spinoza Problem (2012) • Staring at the Sun: Overcoming the Terror of Death(2008)

34. Other Key Writings • Victor Frankl • Man’s Search For Meaning (1956) • Influential text that sets out an approach to logotherapy, a form of psychotherapy focused on will, freedom, meaning, and responsibility. • Allen Wheelis • How People Change (1973) • Wrote about the specter of death and the search for meaning.

35. Current Status • Existential psychotherapy has never supported specific institutes because it deals with issues underlying therapy of any kind. • Existentially-oriented psychotherapists tend to further their knowledge through personal therapy, supervision, and reading.

36. Current Status • Therapists trained in different schools can legitimately call themselves existential if their assumptions are in line with those of existentialists. • Concerned with rediscovering the living person amid dehumanizing modern culture. • Human-focused approaches to psychotherapy suffer in a climate of market forces.

37. The Psychotherapy Process

38. Existential Therapy "... is concerned with patients' ways of dealing with the fundamental issues of human existence, the meaning and purpose of life, isolation, freedom and the inevitability of death. In this method of treatment, increased awareness of the self is more important than exploration of the unconscious, but many of the techniques are borrowed from brief psychoanalytic therapy." Oxford Textbook of Psychotherapy

39. Theory of Personality • Existential focus concerns whether or not people are living as authentically and meaningfully as possible. • Utilizes a dynamic model of personality as a system of forces in conflict with one another. • Emotions and behavior may exist at different levels of consciousness.

40. Existentialists • Suggest we do not possess a personality rather we embody an experience. • Neurosis is tantamount to avoidance. • Example: Neurotic individuals are living in the every day rather than dealing with the challenges of ultimate concerns.

41. Psychotherapy and Freedom • Freedom is the capacity to choose within natural and self-imposed limits of living. • Freedom implies responsibility. • Destiny refers to awareness of our limitations. • The ultimate limitation is death. • Through struggle, freedom and destiny are appreciated.

42. Psychotherapy and Isolation • Authenticity must be modeled by the therapist. • Therapist meets the patient in the space between “I” and “Thou.” • Therapeutic relationship heals through therapist’s presence, genuineness, and receptiveness. • Done from a position of being a fellow traveler.

43. Psychotherapy and Meaninglessness • Therapist must be aware of the importance of meaning as for some it is profound and pervasive. • Jung estimated that >30% of patients sought therapy because of meaninglessness. • Victor Frankl: • “Happiness cannot be pursued, it can only ensue.”

44. Psychotherapy and Death • “An awakening experience.” • A personal confrontation with death may cause a radical shift in life perspective and lead to personal change. • Death anxiety may be a primary focus of therapy.

45. Every Day Concerns and Existential Issues • Fear of flying • Ultimate concern of death • Difficulty adjusting after a divorce • Ultimate concern of isolation

46. Existential Frame of Reference Awareness of Ultimate Concern Anxiety Defenses

47. Denial Systems: Specialness • Individuals hold beliefs of personal inviolability, invulnerability, and immortality. • Unconsciously, individuals believe laws of biology do not apply to them. • People can camouflage their fears of death behind a belief that one’s specialness will somehow override it. • People may seek therapy when the defense of specialness fails to ward off anxiety.

48. Denial Systems: Belief in an Ultimate Rescuer • Belief that someone is watching over in an indifferent world. • People may imagine their rescuer to be human or divine. • May result in a character structure displaying passivity, dependency, and obsequiousness. • Individuals may dedicate their lives to locating and appeasing an ultimate rescuer.

49. Process and Content • Strategies similar to other dynamic therapies, but with different content. • Focus on patient’s current life situation and enveloping unconscious fears. • Therapeutic relationship viewed as fundamentally important in itself, especially with regard to engagement and connection. • Emphasis on a here-and-now, not from a longitudinal perspective.

50. Therapeutic Goals • Focus is on the self experience of the patient, and capacity for self-actualization and self-transcendence through engagement in life. • Goal is anxiety reduction and constructive use of the anxiety.