1. Existential Psychotherapies

2. EXISTENTIAL APPROACHES
Way of thinking about humans and about life that may be applied to other psychotherapy approaches
Closely linked to European Existential Philosophy:
Dilemmas of contemporary life ( s)
isolation, alienation and meaninglessness
Importance of subjectivity – we create our values, our lives, ourselves
Truth depends on the existing person, in a given situation and in a given time
Freedom to be ourselves implies responsibility

3. European Existential Philosophers
Kierkergard
angst - dread and anxiety related to uncertainty in living
Nietzsche
Values are within the individual
Sartre
Freedom to be what we choose and related responsibil ity
Simon de Beauvoir The Second Sex
Buber
Stressed the I/Thou Relationship – less individualistic
Biswanger
existential analyst, emphasized subjective and spiritual dimensions

4. Existential Psychology
Victor Frankle
Logotherapy Man in Search for Meaning
Nietzsche “He who has a why to live for, can bear with almost any how.”
Rollo May
Co-editor : Existence: A New Dimension in Psychiatry and Psychology (1958) introduced existential psychology to the US. 
Irving Yalom
Existential Psychotherapy

5. Basic Dimensions of the Human Condition
Capacity for self-awareness
Freedom and responsibility
Creating one’s identity and meaningful relationships with others
Search for meaning, purposes, values and goals
Anxiety as a condition for living
Awareness of death and non-being

6. Theory of Personality Dynamic Model Forces in conflict
need to survive and assert one’s being vs.
conscious and unconscious fears related to:
Givens of Existence or Ultimate Concerns
Death Freedom
Isolation Meaninglessness

7. Conflict/Mental Health
Awareness of Ult. Concerns >>>Anxiety >>> Def. Mechanisms
Ways to deal with the anxiety
Provide safety, restrict growth
Mental Health
Ability to cope with normal anxiety

8. Anxiety NORMAL ANXIETY NEUROTIC ANXIETY Proportionate to the situation
Does not require repression
Can be used creatively
NEUROTIC ANXIETY
Disproportionate to the situation
Tends to be repressed
Paralyzes the individual

9. Guilt Normal Ethical aspects of behavior
Neurotic Fantasized transgressions toward others, or failure to live up to one’s capacities

10. Objective of Therapy
Explore anxiety related to the ultimate concerns, concious/unconscious
Identify mechanisms of defense (symptoms) clients use to deal with existential anxiety
Move clients to confront the fear and the pain associated with the ultimate concerns
Help clients develop adaptive ways of dealing with existential anxiety

11. Freedom vs. Responsibility
We are ultimately responsible for who we are, what we believe in, and how we behave
We must make authentic choices rather than follow what has been given to us
Anxiety is generated by our fear of not knowing or of making mistakes

12. Responsibility: Defenses
Displace it others/circumstances
Deny responsibility e.g. victim role
Avoid responsibility e.g. symptoms

13. Process of Making Decisions
WISHING >>>> WILLING >>>> ACTION
Symptoms
Impulsive Behavior
Non-discrimination among wishes
Compulsive Behavior
Driven by ego-alien demands

14. Freedom:Therapy
Help client recognize and accept responsibility for making choices
Confront responsibility avoidance (won’t vs. can’t)
Encourage clients to connect with their feelings
Explore how client contributes to problem situation

15. Isolation
Awareness of our intrinsic isolation vs. desire to be part of something larger
Interpersonal social skills, intimacy
Intra-personal connected with self
Existential Unavoidable
Defense:
Fusion: soften our ego boundaries and become part of another individual, group, or cause

16. Isolation: Therapy Help clients confront their fear of aloneness
Personal growth entails a degree of isolation
To create authentic relationships with others we must have confronted and accepted our ultimate isolation
Within the real relationship between client and therapist, client may learn limits and rewards of intimacy

17. Meaninglessness
We naturally search for meaning, but we live in a world where there are no intrinsic meanings
Need to construct a personal sense of meaning
“Wishing” Source of meaning require access to affective experience
Meaning is usually found when we look beyond ourselves and meeting our material needs.
A sense of meaning is related to our values that tell us why we live and how to live

18. Meaninglessness: Therapy
May not be an issue for all clients
Personal growth
Boundary situations
Depression
Help clients connect with their affective selves, to discover inner sources of motivation and meaning
Help clients get engaged in life activities

19. Boundary situation
Experience or event that propels the person to face an existential situation related to any of the ultimate concerns:
terminal illness
death of a loved one
life crisis
life change

20. Death Fear of self-destruction – primary source of anxiety
Defenses against death awareness – denial, reaction formation
Awareness of death gives meaning to our life
enhances the importance of the present moment
leads us to live more fully

21. Defense Mechanisms
Awareness of Ult. Concerns >>>Anxiety >>> Def. Mechanisms
Drive >>> Anxiety >>> Def. Mechanism
Defense mechanisms provide some temporary relief, but they restrict growth
Existentialists ascribe to the defense mechanisms that were proposed by Freud

22. Psychotherapy : Goals Main goal is to help clients
increase awareness about themselves and how they are living
confront their anxieties and fears
re-define themselves and their world in ways that lead to a more authentic life
Main vehicle of therapy is an authentic, real relationship with therapist

23. Psychotherapy: Relationship 1/2
Therapy is a journey taken by therapist and client
The person-to-person relationship is key
Therapist stays in contact with their own phenomenological world
Therapist must distinguish between transference and the actual, real relationship (they co-exist)

24. Psychotherapy: Relationship
The core of the therapeutic relationship
Respect and faith in the clients’ potential to cope
Sharing reactions with genuine concern and empathy
Focus on the here-and-now experience in the therapeutic relationship

25. Psychotherapy: Techniques
Paradoxical intention
prescribing the symptom: help clients gain more control of their behavior, get “unstuck”
Situational reconstruction
think of three ways in which a situation could be better and three ways in which it could be worse - to help people move on from the place they are stuck
Compensatory self improvement
work on areas that you have control when you are in a situation you don't control

26. Contributions
Provides new dimensions to the understanding of death, anxiety, guilt, loneliness, and alienation
Emphasizes the person's freedom and responsibility in designing their own lives
Importance placed on the human quality of the therapeutic relationship

27. Contributions
Philosophical orientation applicable regardless of counselor’s theoretical orientation
Particularly useful to understand issues presented by clients who may be confronting existential crises

28. Limitations
Lacks a systematic statement about principles and practices of psychotherapy
Does not lend itself to empirical research
Concepts are abstract and difficult to apply in practice

29. Gestalt
Existential & Phenomenological – it is grounded in the client’s “here and now”
Initial goal is for clients to gain awareness of what they are experiencing and doing now
Promotes direct experiencing rather than the abstractness of talking about situations
Rather than talk about a childhood trauma the client is encouraged to become the hurt child

30. Frederick Perls 1893-1970 Born in Germany,
Psychiatrist and psychoanalyst
Emigrated to U.S. in 1946 and broke form psychoanalytic tradition
Controversial and charismatic figure
Gestalt therapy became a kind of cult
Collaborated with his wife (Laura Perls ) in delivering workshops and writing

31. The Now Our “power is in the present”
Nothing exists except the “now”
The past is gone and the future has not yet arrived
The power of the present is lost if :
We focus on past mistakes or engage in endless resolutions and plans for the future
Therapist focuses more on the process of therapy than on the content

32. Unfinished Business
Unexpressed feelings such as anger, resentment, and fear that are:
Threatening
Not fully experienced in awareness
Interfere with effective contact with oneself and with others
Result:
Preoccupation, compulsive behavior, wariness oppressive energy and self-defeating behavior

33. Contact and Resistance to Contact
To interact with environment w/o losing one’s individuality
Requires awareness, energy and ability to express oneself
RESISTANCE TO CONTACT
Defenses that prevent experiencing the present fully
There are five major channels of resistance to attempt to control the environment rather than allowing real contact
Typically are out of awareness; may contribute to dysfunctional behavior

34. Defenses Resistance to Contact Introjection Projection Retroflection
Uncritical acceptance of others’ beliefs and standards w/o making them our own.
Lack of clear sense of self
Projection
To disown certain aspects of ourselves by ascribing them to the environment
Victim stance ; powerlessness to initiate change
Retroflection
To turn back to ourselves something we would like to do (or have done) to someone else
Self-injury vs. fear of directing aggression outwardly
Depression; psychosomatic symptoms

35. Defenses Resistance to Contact Deflection Confluence
To avoid real contact and awareness by being vague and indirect.
Humor, abstract generalizations, ignoring
Confluence
To loose the sense of the boundary between self and environment (others).
Go with the flow, enmeshment,

36. Goal Gestalt Therapy Gain awareness
Know the environment
Know oneself
Learn about dominant ways of avoiding contact
What does the resistance does for the client
What it protects them from
What it keeps them from experiencing
Accept oneself and responsibility for self
Allow oneself to make contact

37. Therapist Role Provide an authentic relationship
Focus on process versus content
Devise experiments to increase client’s self-awareness
Coaches clients to arrive at their own interpretations/does not provide them
Confrontation
Intervention to help clients become aware of discrepancies between verbal and nonverbal expressions, feelings and actions, and/or thoughts and feelings.

38. Gestalt Experiments Allow clients to express themselves behaviorally
Lead to fresh emotional experiences and new insights
Facilitate experiencing in the moment, rather than talking about….

39. Gestalt Experiments Internal Dialogue Making the Rounds
Reversal Exercise
The Rehearsal Exercise
Exaggerating Exercise
Staying with the Feeling

40. Contributions and Limitations
Creative use of active experiments and activities to help clients achieve experiential learning
Confrontational style that deemphasizes cognitive factors
Experiments can be used by therapist in a manipulative way
Highly active and directive stance of therapist may lead to abuse of power