Chapter 6 - Existential Therapy PDF

Existential Therapy 6...

Existential Therapy 6 Learning Objectives 1. Identify the major themes that 6. Describe the three phases of characterize existential philosophy existential counseling. and therapy. 7. Understand the applications of 2. Compare the unique contributions this approach to brief therapy. of some prominent existential 8. Identify the applications of this thinkers and therapists. approach to group counseling. 3. Examine the key concepts and 9. Describe ways in which the basic assumptions underlying existential approach is and is this approach, including self- not well suited to multicultural awareness, freedom and counseling. responsibility, intimacy and isolation, meaning in life, death 10. Evaluate the contributions and anxiety, and authenticity. limitations of the existential approach. 4. Identify the therapeutic goals of existential therapy. 5. Understand the unique emphasis placed on the therapeutic relationship. 129 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  130   C HA P T E R S IX VIKTOR FRANKL (1905–1997) was born Frankl was deeply influenced by and educated in Vienna. He founded the Freud, but he disagreed with the rigid- Youth Advisement Centers there in 1928 ity of Freud’s psychoanalytic system and and directed them until 1938. From 1942 became a student of Alfred Adler. React- to 1945 Frankl was a prisoner in the Nazi ing against most of Freud’s deterministic concentration camps at Auschwitz and notions, Frankl developed his own the- Imagno/Viktor Frankl Archiv Dachau, where his parents, brother, wife, ory and practice of psychotherapy, which and children died. He vividly remembered emphasized the concepts of freedom, his horrible experiences in these camps, responsibility, meaning, and the search but he did not allow them to dampen his for values. He established his interna- love and enthusiasm for life. He traveled tional reputation as the founder of what all around the world, giving lectures in Viktor Frankl has been called “The Third School of Europe, Latin America, Southeast Asia, Viennese Psychoanalysis,” the other two and the United States. being Sigmund Freud’s psychoanalysis and Alfred Frankl received his MD in 1930 and his PhD Adler’s Individual Psychology. in philosophy in 1949, both from the University of Frankl was a central figure in developing existen- Vienna. He became an associate professor at the tial therapy in Europe and in bringing it to the United University of Vienna and later was a distinguished States. He was fond of quoting Nietzsche: “He who speaker at the United States International University has a why to live for can bear with almost any how” in San Diego. He was a visiting professor at Harvard, (as cited in Frankl, 1963, pp. 121, 164). Frankl con- Stanford, and Southern Methodist universities. tended that those words could be the motto for all Frankl’s works have been translated into more than psychotherapeutic practice. Another quotation from 20 languages, and his ideas continue to have a major Nietzsche seems to capture the essence of Frankl’s impact on the development of existential therapy. His own experience and writings: “That which does not compelling book Man’s Search for Meaning (1963) has kill me, makes me stronger” (as cited in Frankl, 1963, been a best-seller around the world. p. 130). Although Frankl had begun to develop an existen- Frankl developed logotherapy, which means tial approach to clinical practice before his grim years in “therapy through meaning.” Frankl’s philosophical the Nazi death camps, his experiences there confirmed model sheds light on what it means to be fully alive. his views. Frankl (1963) observed and personally expe- The central themes running through his works are rienced the truths expressed by existential philosophers life has meaning, under all circumstances; the central and writers who hold that we have choices in every motivation for living is the will to meaning; we have situation. Even in terrible circumstances, he believed, the freedom to find meaning in all that we think; and we could preserve a vestige of spiritual freedom and we must integrate body, mind, and spirit to be fully alive. independence of mind. He learned experientially that Frankl’s writings reflect the theme that the modern everything could be taken from a person except one person has the means to live, but often has no mean- thing: “the last of human freedoms—to choose one’s ing to live for. attitude in any given set of circumstances, to choose I have selected Frankl as one of the key figures of one’s own way” (p. 104). Frankl believed that the the existential approach because of the dramatic way essence of being human lies in searching for meaning in which his theories were tested by the tragedies of and purpose. We can discover this meaning through his life. His life was an illustration of his theory, for he our actions and deeds, by experiencing a value (such lived what his theory espouses. as love or achievements), and by suffering. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Existe ntia l T herapy   131 ROLLO MAY (1909–1994) first lived in The greatest personal influence on Ohio and then moved to Michigan as a Rollo May was the existential theologian young child along with his five brothers Paul Tillich (author of The Courage to Be, and a sister. He remembered his home 1952), who became his mentor and a per- life as being unhappy, a situation that sonal friend. The two spent much time contributed to his interest in psychology together discussing philosophical, reli- Hulton Archive/Getty Images and counseling. In his personal life, May gious, and psychological topics. May was struggled with his own existential con- deeply influenced by the existential phi- cerns and the failure of two marriages. losophers, by the concepts of Freudian May graduated from Oberlin Col- psychology, and by many aspects of Alfred lege in 1930 and then went to Greece as Adler’s Individual Psychology. Most of a teacher. During his summers in Greece Rollo May May’s writings reflect a concern with the he traveled to Vienna to study with Alfred nature of human experience, such as rec- Adler. After receiving a degree in theology from ognizing and dealing with power, accepting freedom Union Theological Seminary, May decided that the and responsibility, and discovering one’s identity. He best way to reach out and help people was through draws from his rich knowledge based on the classics psychology instead of theology. He completed his and his existential perspective. doctorate in clinical psychology at Columbia Univer- May’s writings have had a significant impact on sity and started a private practice in New York; he also existentially oriented practitioners, and his writings became a supervisory training analyst for the William helped translate key existential concepts into psycho- Alanson Institute. therapeutic practice in the United States and Europe. While May was pursuing his doctoral program, May believed psychotherapy should be aimed at he came down with tuberculosis, which resulted in helping people discover the meaning of their lives a two-year stay in a sanitarium. During his recov- and should be concerned with the problems of being ery period, May spent much time learning firsthand rather than with problem solving. It takes courage to about the nature of anxiety. He also spent time read- “be,” and our choices determine the kind of person we ing, and he studied the works of Søren Kierkegaard, become. Questions of being include learning to deal which was the catalyst for May recognizing the exis- with issues such as sex and intimacy, growing old, fac- tential dimensions of anxiety and resulted in him ing death, and taking action in the world. According writing The Meaning of Anxiety (1950). His popular to May, the real challenge is for people to be able to book Love and Will (1969) reflects his own personal live in a world where they are alone and where they struggles with love and intimate relationships and will eventually have to face death. It is the task of mirrors Western society’s questioning of its values therapists to help individuals find ways to contribute pertaining to sex and marriage. to the betterment of the society in which they live. IRVIN YALOM (b. 1931) was born of source of inspiration and wisdom to him. parents who immigrated from Russia Early in his life he decided that writing a shortly after World War I. During his novel was the very finest thing a person early childhood, Yalom lived in the inner could do, and subsequently he has writ- city of Washington, D.C., in a poor neigh- ten several teaching novels. borhood. Life on the streets was perilous, Irvin Yalom is Professor Emeritus and Yalom took refuge indoors reading of Psychiatry at the Stanford Univer- novels and other works. Twice a week he sity School of Medicine. A psychiatrist made the hazardous bicycle trek to the and author, Yalom has been a major fig- Gerald Corey library to stock up on reading supplies. ure in the field of group psychotherapy He found an alternative and satisfying since publication in 1970 of his influen- world in reading fiction, which was a Irvin Yalom tial book The Theory and Practice of Group Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  132   C HA P T E R S IX Psychotherapy (1970/2005b), which has been trans- a sense of wonderment at the stories they reveal. He lated into 12 languages and is currently in its fifth believes that a different therapy must be designed edition. His pioneering work, Existential Psychotherapy, for each client because each has a unique story. He written in 1980, is a classic and authoritative textbook advocates using the here and now of the therapeu- on existential therapy. A contemporary existential tic relationship to explore the client’s interpersonal therapist in the United States, Yalom acknowledges world, and believes the therapist must be transpar- the contributions of both European and American ent, especially regarding his or her experience of the psychologists and psychiatrists to the development client. His basic philosophy is existential and inter- of existential thinking and practice. Drawing on his personal, which he applies to both individual and clinical experience and on empirical research, phi- group therapy. losophy, and literature, Yalom developed an existen- Irvin Yalom has authored many stories and tial approach to psychotherapy that addresses four novels related to psychotherapy, including Love’s “givens of existence,” or ultimate human concerns: Executioner (1987), When Nietzsche Wept (1992), Lying freedom and responsibility, existential isolation, on the Couch (1997), Momma and the Meaning of Life meaninglessness, and death. These existential themes (2000), and The Schopenhauer Cure (2005a). His 2008 deal with the client’s existence, or being-in-the-world. nonfiction book, Staring at the Sun: Overcoming the Yalom believes the vast majority of experienced ther- Terror of Death, is a treatise on the role of death apists, regardless of their theoretical orientation, anxiety in psychotherapy, illustrating how death address these core existential themes. How we address and the meaning of life are foundational themes these existential themes greatly influences the design associated with in-depth therapeutic work. Yalom’s and quality of our lives. works, translated into more than 20 languages, Psychotherapy has been endlessly intriguing for have been widely read by therapists and laypeople Yalom, who has approached all of his patients with alike. Introduction Existential therapy is more a way of thinking, or an attitude about psycho- LO1 therapy, than a particular style of practicing psychotherapy. It is neither an inde- pendent or separate school of therapy, nor is it a clearly defined model with specific techniques. Existential therapy can best be described as a philosophical approach that influences a counselor’s therapeutic practice. Existential psychotherapy is an attitude toward human suffering and has no manual. It asks deep questions about the nature of the human being and the nature of anxiety, despair, grief, loneliness, isolation, and anomie. It also deals centrally with the questions of meaning, creativity, and love. (Yalom & Josselson, 2014, p. 265) Existential therapy focuses on exploring themes such as mortality, meaning, freedom, responsibility, anxiety, and aloneness as these relate to a person’s current struggle. The goal of existential therapy is to assist clients in their exploration of the existential “givens of life,” how these are sometimes ignored or denied, and how addressing them can ultimately lead to a deeper, more reflective and meaningful existence. Clients are invited to reflect on life, to recognize their range of alternatives, and to decide among them. Existential therapy is grounded on the assumption that we are free and therefore responsible for our choices and actions. We are the authors Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  Existe ntia l T herapy   133 of our lives, and we design the pathways we follow. This chapter addresses some of the existential concepts and themes that have significant implications for the exis- tentially oriented practitioner. A basic existential premise is that we are not victims of circumstance because, to a large extent, we are what we choose to be. Once clients begin the process of recognizing the ways in which they have passively accepted circumstances and surrendered control, they can start down a path of consciously shaping their own lives. The first step in the therapeutic journey is for clients to accept responsibility. As Yalom (2003) puts it, “Once individuals recognize their role in creating their own life predicament, they also realize that they, and only they, have the power to change that situation” (p. 141). The aim of existential therapy is to invite clients to explore their values and beliefs and take action that grows out of this honest appraisal of their life’s purpose. The therapist’s basic task is to encourage clients to consider what they are most serious about so they can pursue a direction in life (Deurzen, 2012). Visit CengageBrain.com or watch the DVD for the video program on Chapter 6, Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the brief lecture for each chapter prior to reading the chapter. Historical Background in Philosophy and Existentialism Many streams of thought contributed to the existential therapy movement LO2 in the 1940s and 1950s, and it arose spontaneously in different parts of Europe and among different schools of psychology and psychiatry. Many Europeans found that their lives had been devastated by World War II, and they struggled with existential issues including feelings of isolation, alienation, and meaning- lessness. Early writers focused on the individual’s experience of being alone in the world and facing the anxiety of this situation. The European existential perspec- tive focused on human limitations and the tragic dimensions of life (Sharp & Bugental, 2001). The thinking of existential psychologists and psychiatrists was influenced by a number of philosophers and writers during the 19th century. To understand the philosophical underpinnings of modern existential psychotherapy, one must have some awareness of the cultural, philosophical, and religious writings of Søren Kierkegaard, Friedrich Nietzsche, Martin Heidegger, Jean-Paul Sartre, and Martin Buber. These major figures of existentialism and existential phenomenology pro- vided the basis for the formation of existential therapy. Ludwig Binswanger and Medard Boss were also early existential psychoanalysts who contributed key ideas to existential psychotherapy. Acknowledging the influence of these early philoso- phers, Yalom found that each contributed significant themes that guided his own thinking: ŠŠFrom Kierkegaard: creative anxiety, despair, fear and dread, guilt, and nothingness ŠŠFrom Nietzsche: death, suicide, and will Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  134   C HA P T E R S IX ŠŠFrom Heidegger: authentic being, caring, death, guilt, individual responsibility, and isolation ŠŠFrom Sartre: meaninglessness, responsibility, and choice ŠŠFrom Buber: interpersonal relationships, I/Thou perspective in therapy, and self-transcendence Søren Kierkegaard (1813–1855) A Danish philosopher and Christian theol- ogian, Kierkegaard was particularly concerned with angst—a Danish and German word whose meaning lies between the English words dread and anxiety—and he addressed the role of anxiety and uncertainty in life. Existential anxiety is associated with making basic decisions about how we want to live, and it is not pathological. Kierkegaard believed that anxiety is the school in which we are educated to be a self. Without the experience of angst, we may go through life as sleepwalkers. But many of us, especially in adolescence, are awakened into real life by a terrible uneasiness. Life is one contingency after another, with no guarantees beyond the certainty of death. This is by no means a comfortable state, but it is necessary to our becoming human. Kierkegaard believed that “the sickness unto death” arises when we are not true to ourselves. What is needed is the willingness to risk a leap of faith in making choices. Becoming human is a project, and our task is not so much to discover who we are as to create ourselves. Friedrich Nietzsche (1844–1900) The German philosopher Nietzsche is the iconoclastic counterpart to Kierkegaard, expressing a revolutionary approach to the self, to ethics, and to society. Like Kierkegaard, he emphasized the importance of subjectivity. Nietzsche set out to prove that the ancient definition of humans as rational was entirely misleading. We are far more creatures of will than we are impersonal intellects. But where Kierkegaard emphasized the “subjective truth” of an intense concern with God, Nietzsche located values within the individual’s “will to power.” We give up an honest acknowledgment of this source of value when society invites us to rationalize powerlessness by advocating other worldly concerns. If, like sheep, we acquiesce in “herd morality,” we will be nothing but mediocrities. But if we release ourselves by giving free rein to our will to power, we will tap our potentiality for creativity and originality. Kierkegaard and Nietzsche, with their pioneering analyses of anxiety, depression, subjectivity, and the authentic self, together are generally considered to be the originators of the existential perspective (Sharp & Bugental, 2001). Martin Heidegger (1889–1976) Heidegger’s phenomenological existentialism reminds us that we exist “in the world” and should not try to think of ourselves as beings apart from the world into which we are thrown. The way we fill our everyday life with superficial conversation and routine shows that we often assume we are going to live forever and can afford to waste day after day. Our moods and feelings (including anxiety about death) are a way of understanding whether we are living authentically or whether we are inauthentically constructing our life around the expectations of others. When we translate this wisdom from vague feeling to explicit awareness, we may develop a more positive resolve about how we want to be. Phenomenological existentialism, as presented by Heidegger, provides a view of Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  E xiste n tial T herapy   135 human history that does not focus on past events but motivates individuals to look forward to “authentic experiences” that are yet to come. Martin Buber (1878–1965) Leaving Germany to live in the new state of Israel, Buber took a less individualistic stand than most of the other existentialists. He said that we humans live in a kind of betweenness; that is, there is never just an I, but always an other. The I, the person who is the agent, changes depending on whether the other is an it or a Thou. But sometimes we make the serious mistake of reducing another person to the status of a mere object, in which case the relationship becomes I/it. Although Buber recognizes that of necessity we must have many I/it interactions (in everyday life), we are seriously limited if we live only in the world of the I/it. Buber stresses the importance of presence, which has three functions: (1) it enables true I/ Thou relationships; (2) it allows for meaning to exist in a situation; and (3) it enables an individual to be responsible in the here and now (Gould, 1993). In a famous dialogue with Carl Rogers, Buber argued that the therapist and the client could never be on the same footing because the latter comes to the former for help. When the relationship is fully mutual, we have become “dialogic,” a fully human condition. Ludwig Binswanger (1881–1966) An existential analyst, Binswanger proposed a holistic model of self that addresses the relationship between the person and his or her environment. He used a phenomenological approach to explore significant features of the self, including choice, freedom, and caring. He based his existential approach largely on the ideas of Heidegger and accepted Heidegger’s notion that we are “thrown into the world.” However, this “thrown-ness” does not release us from the responsibility of our choices and for planning for the future (Gould, 1993). Existential analysis (Daseinanalysis) emphasizes the subjective and spiritual dimensions of human existence. Binswanger (1975) contended that crises in therapy were typically major choice points for the client. Although he originally looked to psychoanalytic theory to shed light on psychosis, he moved toward an existential view of his patients. This perspective enabled him to understand the worldview and immediate experience of his patients, as well as the meaning of their behavior, as opposed to superimposing his view as a therapist on their experience and behavior. Medard Boss (1903–1991) Both Binswanger and Boss were early existential psychoanalysts and significant figures in the development of existential psychotherapy. They talked of dasein, or being-in-the-world, which pertains to our ability to reflect on life events and attribute meaning to these events. They believed the therapist must enter the client’s subjective world without presuppositions that would get in the way of this experiential understanding. Both Binswanger and Boss were significantly influenced by Heidegger’s seminal work, Being and Time (1962), which provided a broad basis for understanding the individual (May, 1958). Boss was deeply influenced by Freudian psychoanalysis, but even more so by Heidegger. Boss’s major professional interest was applying Heidegger’s philosophical notions to therapeutic practice, and he was especially concerned with integrating Freud’s methods with Heidegger’s concepts, as described in his book Daseinanalysis and Psychoanalysis (1963). Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  136   C HA P T E R S IX Jean-Paul Sartre (1905–1980) A philosopher and novelist, Sartre was convinced, in part by his years in the French Resistance in World War II, that humans are even more free than earlier existentialists had believed. The existence of a space— nothingness—between the whole of our past and the now frees us to choose what we will. Our values are what we choose. The failure to acknowledge our freedom and choices results in emotional problems. This freedom is hard to face, so we tend to invent an excuse by saying, “I can’t change now because of my past conditioning.” Sartre called excuses “bad faith.” No matter what we have been, we can make choices now and become something quite different. We are condemned to be free. To choose is to become committed; this is the responsibility that is the other side of freedom. Sartre’s view was that at every moment, by our actions, we are choosing who we are being. Our existence is never fixed or finished. Every one of our actions represents a fresh choice. When we attempt to pin down who we are, we engage in self-deception (Russell, 2007). Key Figures in Contemporary Existential Psychotherapy Viktor Frankl, Rollo May, and Irvin Yalom (featured at the beginning of the chap- ter) created their existential approaches to psychotherapy from their strong back- grounds in both existential and humanistic psychology. James Bugental has also made major contributions to the development of existential therapy in the United States, and Emmy van Deurzen continues to influence the practice of existential therapy in Great Britain. James Bugental (1915–2008) James Bugental (1987) wrote about life-changing psychotherapy, which is the effort to help clients examine how they have answered life’s existential questions and to invite them to revise their answers so they can live more authentically. Bugental coined the term “existential-humanistic” psychotherapy, and he was a leading spokesman for this approach. His philosophical and therapeutic approach included a curiosity and focus that moved him away from the traditional therapeutic milieu of labeling and diagnosing clients. His work emphasized the cultivation of both client and therapist presence. He developed interventions to assist the client in deepening inner exploration, or searching. The therapist’s primary task involved helping clients make new discoveries about themselves in the living moment, as opposed to merely talking about themselves. Central to Bugental’s approach is his view of resistance, which from an existen- tial-humanistic perspective is not resistance to therapy per se but rather to being fully present both during the therapy hour and in life. Resistance is seen as part of the self-and-world construct—how a person understands his or her being and relationship to the world at large. Forms of resistance include intellectualizing, being argumen- tative, always seeking to please, and any other life-limiting pattern. As resistance emerges in the therapy sessions, the therapist repeatedly notes, or “tags,” the resis- tance so the client increases his or her awareness and ultimately has an increased range of choices. Bugental’s theory and practice emphasized the distinction between therapeu- tic process and content. He became known for being a masterful teacher and psy- chotherapist, primarily because he lived his work. He was an existentialist at heart, Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  E xiste n tial T herapy   137 which made him a great model and mentor, not only for clients but also for students and professionals. In his workshops, he developed many exercises to help thera- pists refine and practice their skills. He frequently brought his interventions to life with live demonstrations, which emphasized therapeutic work taking place in the moment, impromptu here-and-now dialogue, and exploring in the context of self as client or therapist. Bugental’s (1987) classic text, The Art of the Psychotherapist, is widely recognized for deconstructing the therapy process and moving beyond theory and generalizations to show what actually occurs moment-to-moment in the therapeu- tic encounter. Psychotherapy Isn’t What You Think (Bugental, 1999) is the last book he wrote before he died in 2008, at the age of 93. British Contribution to Existential Therapy Emmy van Deurzen, a key contri- butor to British existential psychology, is a philosopher, psychotherapist, and counseling psychologist. Deurzen has earned a worldwide reputation in existential psychotherapy through her many books and her role in teaching and training. Deurzen (2012) states that existential therapy is not designed to “cure” people of illness in the tradition of the medical model because people are not sick but are “sick of life or clumsy at living” (p. 30). Deurzen’s (2014) psychotherapy practice has taught her that individuals have incredible resilience and intelligence in overcoming their problems once they commit themselves to a self-searching process. Her therapy clients find meaning in their past hardships rather than experiencing these difficulties as defining them in old patterns. Her clients are able to recognize the contradictions and paradoxes of life and to face their troubles and solve dilemmas. They also discover what is most important in life. Deurzen is the cofounder of the New School of Psychotherapy and Counselling, which is developing academic and training programs. In the past decades the exis- tential approach has spread rapidly in Britain and is now an alternative to tradi- tional methods (Deurzen, 2002, 2012). For a description of the historical context and development of existential therapy in Britain, see Deurzen (2002), Deurzen and Adams (2011), and Cooper (2003); for an excellent overview of the theory and prac- tice of existential therapy, see Deurzen (2012) and Schneider and Krug (2010). For information on the New School in Britain, see the Other Resources section at the end of this chapter. Key Concepts View of Human Nature The crucial significance of the existential movement is that it reacts against LO3 the tendency to identify therapy with a set of techniques. Instead, it bases thera- peutic practice on an understanding of what it means to be human. The existential movement stands for respect for the person, for exploring new aspects of human behavior, and for divergent methods of understanding people. It uses numerous approaches to therapy based on its assumptions about human nature. The existential tradition seeks a balance between recognizing the limits and tragic dimensions of human existence on one hand and the possibilities and Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  138   C HA P T E R S IX opportunities of human life on the other hand. It grew out of a desire to help people engage the dilemmas of contemporary life, such as isolation, alienation, and mean- inglessness. The current focus of the existential approach is on the individual’s experience of being in the world alone and facing the anxiety of this isolation. “No relationship can eliminate existential isolation, but aloneness can be shared in such a way that love compensates for its pain” (Yalom & Josselson, 2014, p. 281). The existential view of human nature is captured, in part, by the notion that the significance of our existence is never fixed once and for all; rather, we continually re- create ourselves through our projects. Humans are in a constant state of transition, emerging, evolving, and becoming in response to the tensions, contradictions, and conflicts in our lives. Being a person implies that we are discovering and making sense of our existence. We continually question ourselves, others, and the world. Although the specific questions we raise vary in accordance with our developmen- tal stage in life, the fundamental themes do not vary. We pose the same questions philosophers have pondered throughout Western history: “Who am I?” “What can I know?” “What ought I to do?” “What can I hope for?” “Where am I going?” The basic dimensions of the human condition, according to the existential approach, include (1) the capacity for self-awareness; (2) freedom and responsibility; (3) creating one’s identity and establishing meaningful relationships with others; (4) the search for meaning, purpose, values, and goals; (5) anxiety as a condition of living; and (6) awareness of death and nonbeing. I develop these propositions in the following sections by summarizing themes that emerge in the writings of existential philosophers and psychotherapists, and I also discuss the implications for counsel- ing practice of each of these propositions. Proposition 1: The Capacity for Self-Awareness Freedom, choice, and responsibility constitute the foundation of self-awareness. The greater our awareness, the greater our possibilities for freedom (see Proposition 2). We increase our capacity to live fully as we expand our awareness in the following areas: ŠŠWe are finite and do not have unlimited time to do what we want in life. ŠŠWe have the potential to take action or not to act; inaction is a decision. ŠŠWe choose our actions, and therefore we can partially create our own destiny. ŠŠMeaning is the product of discovering how we are “thrown” or situated in the world and then, through commitment, living creatively. ŠŠAs we increase our awareness of the choices available to us, we also increase our sense of responsibility for the consequences of these choices. ŠŠWe are subject to loneliness, meaninglessness, emptiness, guilt, and isolation. ŠŠWe are basically alone, yet we have an opportunity to relate to other beings. We can choose either to expand or to restrict our consciousness. Because self- awareness is at the root of most other human capacities, the decision to expand it Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  E xiste n tial T herapy   139 is fundamental to human growth. Here are some areas of emerging awareness that individuals may experience in the counseling process: ŠŠThey see how they are trading the security of dependence for the anxiet- ies that accompany choosing for themselves. ŠŠThey begin to see that their identity is anchored in someone else’s defi- nition of them; that is, they are seeking approval and confirmation of their being in others instead of looking to themselves for affirmation. ŠŠThey learn that in many ways they are keeping themselves prisoner by some of their past decisions, and they realize that they can make new decisions. ŠŠThey learn that although they cannot change certain events in their lives they can change the way they view and react to these events. ŠŠThey learn that they are not condemned to a future similar to the past, for they can learn from their past and thereby reshape their future. ŠŠThey realize that they are so preoccupied with suffering, death, and dying that they are not appreciating living. ŠŠThey are able to accept their limitations yet still feel worthwhile, for they understand that they do not need to be perfect to feel worthy. ŠŠThey come to realize that they are failing to live in the present moment because of preoccupation with the past, planning for the future, or try- ing to do too many things at once. Increasing self-awareness—which includes awareness of alternatives, motiva- tions, factors influencing the person, and personal goals—is an aim of all counsel- ing. Clients need to learn that a price must be paid for increased awareness. As we become more aware, it is more difficult to “go home again.” Ignorance of our condi- tion may have brought contentment along with a feeling of partial deadness, but as we open the doors in our world, we can expect more turmoil as well as the potential for more fulfillment. Proposition 2: Freedom and Responsibility A characteristic existential theme is that people are free to choose among alterna- tives and therefore play a large role in shaping their own destiny. Schneider and Krug (2010) write that existential therapy embraces three values: (1) the freedom to become within the context of natural and self-imposed limitations; (2) the capacity to reflect on the meaning of our choices; and (3) the capacity to act on the choices we make. Although we do not choose the circumstances into which we are born, we create our own destiny by the choices we make. Sartre claims we are constantly confronted with the choice of what kind of person we are becoming, and to exist is never to be finished with this kind of choosing. Living an authentic existence requires that we assume responsibility for our choices (Ruben & Lichtanski, 2015). A central existential concept is that although we long for freedom we often try to escape from our freedom by defining ourselves as a fixed or static entity (Russell, 2007). Jean-Paul Sartre (1971) refers to this as the inauthenticity of not accepting personal responsibility. We can then avoid choosing and instead make excuses such Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  140   C HA P T E R S IX as these: “Since that’s the way I’m made, I couldn’t help what I did” or “Naturally I’m this way, because I grew up in a dysfunctional family.” An inauthentic mode of existence consists of lacking awareness of personal responsibility for our lives and passively assuming that our existence is largely controlled by external forces. Freedom implies that we are responsible for our lives, for our actions, and for our failures to take action. From Sartre’s perspective, people are condemned to free- dom. He calls for a commitment to choosing for ourselves. Existential guilt is being aware of having evaded a commitment, or having chosen not to choose. This guilt is a condition that grows out of a sense of incompleteness, or a realization that we are not what we might have become. Guilt may be a sign that we have failed to rise to the challenge of our anxiety and that we have tried to evade it by not doing what we know is possible for us to do (Deurzen, 2012). This condition is not viewed as neurotic, nor is it seen as a symptom that needs to be cured. Existential guilt can be a power- ful source of motivation toward transformation and living authentically (Ruben & Lichtanski, 2015). The existential therapist explores this guilt to see what clients can learn about the ways in which they are living their life. This guilt also results from allowing others to define us or to make our choices for us. Sartre said, “We are our choices.” Authenticity implies that we are living by being true to our own evaluation of what is a valuable existence for ourselves; it is the courage to be who we are. One of the aims of existential therapy is to help people face up to the difficulties of life with courage rather than avoiding life’s struggles (Deurzen & Adams, 2011). For existentialists, then, being free and being human are identical. Freedom and responsibility go hand in hand. We are the authors of our lives in the sense that we create our destiny, our life situation, and our problems (Russell, 1978). Assuming responsibility is a basic condition for change. Clients who refuse to accept responsi- bility by persistently blaming others for their problems are not likely to profit from therapy. Frankl (1978) also links freedom with responsibility. He suggested that the Statue of Liberty on the East Coast should be balanced with a Statue of Responsibil- ity on the West Coast. His basic premise is that freedom is bound by certain limita- tions. We are not free from conditions, but we are free to take a stand against these restrictions. Ultimately, these conditions are subject to our decisions, which means we are responsible. The therapist assists clients in discovering how they are avoiding freedom and encourages them to learn to risk using it. Not to do so is to cripple clients and make them dependent on the therapist. Therapists have the task of teaching clients that they can explicitly accept that they have choices, even though they may have devoted most of their life to evading them. Those who are in therapy often have mixed feel- ings when it comes to choice. As Russell (2007) puts it: “We resent it when we don’t have choices, but we get anxious when we do! Existentialism is all about broadening the vision of our choices” (p. 111). People often seek psychotherapy because they feel that they have lost control of how they are living. They may look to the counselor to direct them, give them advice, or produce magical cures. They may also need to be heard and understood. Two central tasks of the therapist are inviting clients to recognize how they have allowed others to decide for them and encouraging them to take steps toward choosing for themselves. In inviting clients to explore other ways of being that are more fulfilling Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  E xiste n tial T herapy   141 than their present restricted existence, some existential counselors ask, “Although you have lived in a certain pattern, now that you recognize the price of some of your ways, are you willing to consider creating new patterns?” Others may have a vested interest in keeping the client in an old pattern, so the initiative for changing it will have to come from the client. Cultural factors need to be taken into account in assisting clients in the process of examining their choices. A person who is struggling with feeling limited by her family situation can be invited to look at her part in this process and values that are a part of her culture. For example, Meta, a Norwegian American, is working to attain a professional identity as a social worker, but her family thinks she is being selfish and neglecting her primary duties. The family is likely to exert pressure on her to give up her personal interests in favor of what they feel is best for the welfare of the entire family. Meta may feel trapped in the situation and see no way out unless she rejects what her family wants. In cases such as this, it is useful to explore the client’s underlying values and to help her determine whether her values are working for her and for her family. Clients such as Meta have the challenge of weighing values and balancing behaviors between two cultures. Ultimately, Meta must decide in what ways she might change her situation, and she needs to assess values based on her culture. The existential therapist will invite Meta to begin to explore what she can do and to realize that she can be authentic in spite of pressures on her by her situation. According to Vontress (2013), we can be authentic in any society, whether we are a part of an individualistic or collectivistic society. It is essential to respect the purpose that people have in mind when they initiate therapy. If we pay careful attention to what our clients tell us about what they want, we can operate within an existential framework. We can encourage individuals to weigh the alternatives and to explore the consequences of what they are doing with their lives. Although oppressive forces may be severely limiting the quality of their lives, we can help people see that they are not solely the victims of circumstances beyond their control. Even though we sometimes cannot control things that happen to us, we have complete control over how we choose to perceive and handle them. Although our freedom to act is limited by external reality, our freedom to be relates to our internal reality. At the same time that people are learning how to change their external environment, they can be challenged to look within themselves to rec- ognize their own contributions to their problems. Through the therapy experience, clients may be able to discover new courses of action that will lead to a change in their situation. Proposition 3: Striving for Identity and Relationship to Others People are concerned about preserving their uniqueness and centeredness, yet at the same time they have an interest in going outside of themselves to relate to other beings and to nature. Each of us would like to discover a self or, to put it more authentically, to create our personal identity. This is not an automatic pro- cess, and creating an identity takes courage. As relational beings, we also strive for connectedness with others. Many existential writers discuss loneliness, uprooted- ness, and alienation, which can be seen as the failure to develop ties with others and with nature. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  142   C HA P T E R S IX The trouble with so many of us is that we have sought directions, answers, val- ues, and beliefs from the important people in our world. Rather than trusting our- selves to search within and find our own answers to the conflicts in our life, we sell out by becoming what others expect of us. Our being becomes rooted in their expec- tations, and we become strangers to ourselves. The Courage to Be Paul Tillich (1886–1965), a leading Protestant theologian of the 20th century, believed awareness of our finite nature gives us an appreciation of ultimate concerns. It takes courage to discover the true “ground of our being” and to use its power to transcend those aspects of nonbeing that would destroy us (Tillich, 1952). Courage entails the will to move forward in spite of anxiety-producing situations, such as facing our death (May, 1975). We struggle to discover, to create, and to maintain the core deep within our being. One of the greatest fears of clients is that they will discover that there is no core, no self, no substance, and that they are merely reflections of everyone’s expectations of them. A client may say, “My fear is that I’ll discover I’m nobody, that there really is nothing to me. I’ll find out that I’m an empty shell, hollow inside, and nothing will exist if I shed my masks.” If clients demonstrate the courage to confront these fears, they might well leave therapy with an increased tolerance for the uncertainty of life. By assisting clients in facing the fear that their lives or selves are empty and meaningless, therapists can help clients to create a self that has meaning and substance that they have chosen. Existential therapists may begin by asking their clients to allow themselves to intensify the feeling that they are nothing more than the sum of others’ expectations and that they are merely the introjects of parents and parent substitutes. How do they feel now? Are they condemned to stay this way forever? Is there a way out? Can they create a self if they find that they are without one? Where can they begin? Once clients have demonstrated the courage to recognize this fear, to put it into words and share it, it does not seem so overwhelming. I find that it is best to begin work by inviting clients to accept the ways in which they have lived outside themselves and to explore ways in which they are out of contact with themselves. The Experience of Aloneness The existentialists postulate that part of the human condition is the experience of aloneness. But they add that we can derive strength from the experience of looking to ourselves and sensing our separation. The sense of isolation comes when we recognize that we cannot depend on anyone else for our own confirmation; that is, we alone must give a sense of meaning to life, and we alone must decide how we will live. If we are unable to tolerate ourselves when we are alone, how can we expect anyone else to be enriched by our company? Before we can have any solid relationship with another, we must have a relationship with ourselves. We are challenged to learn to listen to ourselves. We have to be able to stand alone before we can truly stand beside another. The Experience of Relatedness We humans depend on relationships with others. We want to be significant in another’s world, and we want to feel that another’s presence is important in our world. When we are able to stand alone and tap into our own strength, our relationships with others are based on our fulfillment, not our deprivation. If we feel personally deprived, however, we can expect little but a clinging and symbiotic relationship with someone else. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.  E xiste n tial T herapy   143 Perhaps one of the functions of therapy is to help clients distinguish between a neurotically dependent attachment to another and a life-affirming relationship in which both persons are enhanced. The therapist can challenge clients to exam- ine what they get from their relationships, how they avoid intimate contact, how they prevent themselves from having equal relationships, and how they might create therapeutic, healthy, and mature human relationships. Existential therapists speak of intersubjectivity, which is the fact of our interrelatedness with others and the need for us to struggle with this in a creative way. Struggling With Our Identity Because of our fear of dealing with our aloneness, Farha (1994) points out that some of us get caught up in ritualistic behavior patterns that cement us to an image or identity we acquired in early childhood. We become trapped in a doing mode to avoid the experience of being. Part of the therapeutic journey consists of the therapist challenging clients to begin to examine the ways in which they have lost touch with their identity, especially by letting others design their life for them. The therapy process itself is often frightening for clients when they realize that they have surrendered their freedom to others and that in the therapy relationship they will have to assume their freedom again. By refusing to give easy solutions or answers, existential therapists confront clients with the reality that they alone must find their own answers. Proposition 4: The Search for Meaning A distinctly human characteristic is the struggle for a sense of significance and purpose in life. In my experience the underlying conflicts that bring people into counseling and therapy are centered in these existential questions: “Why am I here?” “What do I want from life?” “What gives my life purpose?” “Where is the source of meaning for me in life?” Existential therapy can provide the conceptual framework for helping clients challenge the meaning in their lives. Questions that the therapist might ask are, “Do you like the direction of your life?” “Are you pleased with what you now are and what you are becoming?” “If you are confused about who you are and what you want for yourself, what are you doing to get some clarity?” The Problem of Discarding Old Values One of the problems in therapy is that clients may discard traditional (and imposed) values without creating other, suitable ones to replace them. What does the therapist do when clients no longer cling to values that they never really challenged or internalized and now experience a vacuum? Clients may report that they feel like a boat without a rudder. They seek new guidelines and values that are appropriate for the newly discovered facets of themselves, and yet for a time they are without them. One of the tasks of the therapeutic process is to help clients create a value system based on a way of living that is consistent with their way of being. The therapist’s job is to trust in the capacity of clients to eventually create an