Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 4. Existential Therapies

2. An Early Existential Therapist:Ludwig Binswanger • 1881 - 1966 • Became existential after reading Heidegger’s Sein und Zeit (Being & Time) • Medical director of Sanatarium Bellevue in Switzerland • Emphasis on direct, immediate experience & its meaning • Crises in psychotherapy represent critical choice points • Commitment to patient’s freedom to choose in therapy

3. An Early Existential Therapist: Medard Boss • 1903 - 1991 • Heavily influenced by Freud • Integrated Heidegger’s ideas with Freud’s methods • Wrote Daseinanalysis & Psychoanalysis • Prof of psychoanalysis at University of Zurich

4. An Early Existential Therapist:Rollo May • 1909 - 1994 • Trained in theology & clinical psychology (psych was not addressing existential questions so he turned to theology) • Studied with Alfred Adler • Contracted TB when completing Ph.D. • Found meaning in adversity

5. Theory of Personality • Personality is an emerging, a becoming, a process of being • Not fixed or characterized by traits • Being & world are inseparable • To understand a human being is to understand the world he/she constructs

6. Three Levels of our World • Umwelt (in-nature): ourselves in relation to biological & physical aspects • Mitwelt (with-others): world of persons; the social world • Eigenwelt (for-ourselves): the way we reflect on, evaluate, & experience ourselves

7. Core Constructs • Authenticity • Existential anxiety • nonbeing • meaninglessness • isolation & loneness • Finiteness • Existential givens • Intentionality

8. Theory of Psychopathology • Lying (inauthenticity) leads to neurotic anxiety • Existential anxiety differs from neurotic anxiety • Freud: instinctual drives produce anxiety, which produces defense mechanisms • Existential: awareness of ultimate concerns produces anxiety, which produces defense mechanisms

9. Therapeutic Processes I • Courageous honesty is solution for dissolving symptoms • Help individuals see themselves capable of directing their lives through active choice • Encourage clients to enter into an authentic, equal therapeutic relationship • Binswanger, Boss, & May draw heavily on psychoanalytic techniques

10. Therapeutic Processes II • Patients freely express themselves, with little intervention from therapist • Patients become conscious of repeating patterns of being • Existentialist's honest feedback facilitates breaking out of closed world • Burden of choosing is on client

11. Therapeutic Content Intrapersonal Conflicts • Anxieties & defenses • Self-esteem • Responsibility Interpersonal Conflicts • Intimacy & sexuality • Communication • Hostility • Control

12. Therapeutic Content (cont.) Indivduo-Social Conflicts • Adjustment versus transcendence • Impulse control Beyond Conflict to Fulfillment • Meaning of life • Ideal individual

13. Therapeutic Relationship • A “being-together” -- authentic affirmation of the existence of another person • A process of change & a source of content • Honesty • Patient responsible for patient; therapist not responsible for patient

14. Practicalities of Existential Therapy • Little written on particulars (e.g., schedules, fees, formats, training) • Flexible length decided by patient • No formal training criteria • Therapist gives honest & authentic opinion • Major alternatives are easier to conduct as briefer therapy

15. A Major Alternative: Existential-Humanistic • James F. T. Bugental (1915 - 2008) • Third force in psychology • European vs. American • Existential analysts report more classic psychoanalytic techniques • Existential-humanistic report more physical contact, more activity, more warmth

16. A Major Alternative: Logotherapy • Viktor Frankl (1905 - 1997) • Logo = meaning • Meaninglessness leads to pathology • Similar in content to existential analysis but closer to psychodynamic therapies • Techniques include interpretation, confrontation, & paradoxicals

17. A Major Alternative: Reality Therapy • William Glasser (1925 - 2013) • Lack of responsibility causes pathology • Mentally ill have formed strategies to deny reality & responsibility • Attempting to control others is source of misery • Primarily present centered • Rooted in choice theory, which emphasizes freedom, choice, & responsibility

18. Effectiveness of Existential Therapy • No controlled research on individual existential psychotherapy • Opposition to controlled research due to mistrust of ordinary “scientific” research • Paradoxical intention is considered effective but not more effective than straight directives • Paradoxical interventions show greater effectiveness with highly resistant patients

19. Effectiveness of Reality Therapy • Works better than no treatment • Studies lack controls and comparisons • No controlled studies on children, adults, or older adults

20. Criticisms of Existential Therapy • From a Cognitive-Behavioral Perspective (few controlled outcome studies, too much emphasis on myths) • From a Psychoanalytic Perspective (victim blaming, too much emphasis on choice) • From a Humanistic Perspective (“high IQ whimpering on a cosmic scale”) • From a Cultural Perspective (lack of women in theory, too individualistic, unsuitable for minorities) • From an Integrative Perspective (lack of therapy methods and research)

21. Future Directions • Influence is greater then the small % of psychotherapists endorsing it • Core existential concepts incorporated into many systems of psychotherapy • Existentially-informed integrative txs popular • Counter to rampant victimology and emptiness • Contribution will be as indirect social force

22. Key Terms aloneness/isolation authenticity bad faith being-for-oneself being-for-others being-in-nature being-in-the-world/existence choice theory existential givens courage to be Dasein de-reflection Eigenwelt Existentialanalysis/ Daseinanalysis existential anxiety existential confrontation existential guilt existential-humanistic therapy

23. Key Terms (cont.) existential-integrative therapy finiteness I–Thou relationship(s) intentionality kairos logotherapy lying/unauthentic existence lying/unauthentic existence meaninglessness Mitwelt objectification paradoxical intention phenomenological method reality therapy self-esteem v. social esteem Umwelt will-to-meaning

24. Recommended Websites • Existential-Humanistic Institute: www.ehinstitute.org/ • Existential Therapy: www.existential-therapy.com • International Society for Existential Psychology & Psychotherapy: www.existentialpsychology.org/ • Society for Existential Analysis: www.existentialanalysis.co.uk • Viktor Frankl Institute (logotherapy): logotherapy.univie.ac.at/ • William Glasser Institute (reality therapy): www.wglasser.com