Existential Psychotherapies

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 (1940-50s) 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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  

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

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

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

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

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 1905-1990) in delivering workshops and writing

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

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

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

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

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,

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

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.

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….

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

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