Monday, February 12, 2007

Existential Therapy

[Episode 7] In today's podcast, I talk about Existential therapy as an intellectual or philosophical approach to working with people. Although some authors have attempted to manualize Existential therapy (see Keshen, A. (2006). A new look at existential psychotherapy. American Journal of Psychotherapy, 60(3), 285-298), the existential approach is not known for specific techniques or procedures. Rather, its influence has been most notable in encouraging clinicians to focus on the ideas of freedom of choice, the responsibility that accompanies choice, and the notion that the inevitability of death is what gives life meaning.


Download MP3 [18:09]



Transcript

Today, we're going to be talking about existential therapy.  Existential therapy is an insight-oriented therapy much like Freudian psychoanalysis or Adlerian personal psychology.  What distinguishes existential therapy from other insight-oriented therapies is that existential therapy is more of a philosophical or intellectual approach to understanding a person’s problems rather than a set of techniques.  Existential therapy emphasizes our freedom to choose what we make of our circumstances and believes that we are free and therefore responsible for our choices and actions.

In essence, as Gerald Corey (2005) writes, we are the authors of our lives. Gerald Corey identifies six key concepts associated with existential therapy.  The first is that we have the capacity for self awareness.  Now, the greater our awareness, the greater our responsibilities for freedom and Corey writes that awareness is realizing that we are finite, that we understand that time is limited.  We have the potential and the choice to act or not to act and that meaning is not automatic that we must seek it.  And finally, that we are subject to loneliness, meaninglessness, emptiness, guilt and isolation.

The second key concept is that because we're basically free beings, we must accept the responsibility that accompanies our freedom.  In other words, because we're free to choose we have to take responsibility for the choices that we make.

A third key concept is that we have a concern to preserve our uniqueness and identity.  We come to know ourselves in relation to knowing and interacting with others.  Our identity is the courage to be.  We must trust ourselves to search within and find our own answers. Corey writes that one of our greatest fears is that we'll discover that there is no core and no self.  Another key concept is that the significance of our existence and the meaning of our life are never fixed once and for all.  Instead, we recreate ourselves through our projects.  Our search for meaning must be pursued obliquely.  This means that finding meaning in life is by necessity a by-product of a commitment that we make to creating, loving and working.

Another way of thinking about this is that we can't directly seek meaning.  Rather, we have to engage in activities and it is through that engagement that we actually find the meaning in our lives.  Viktor Frankl talked about the will to meaning as our primary focus in life.  Frankl said that life in and of itself is not meaningful. The individual must create and discover that meaning.

Now, one of the themes here is that people are creating their own realities and this is a phenomenological approach similar to Adler but very dissimilar to Freud and this phenomenological approach assumes that we are actively involved in the creation of our own realities.  As a therapist, if we understand that our client is creating their own reality, it's therefore important for us to assess and identify what that reality is and the meanings that our client is making of his or her reality.

Final key concepts include anxiety as part of the human condition.  The existentialist believes that anxiety is a basic condition of life and they call this existential anxiety and they consider it to be normal.  In fact, life can't be lived nor can death be faced without anxiety.  Anxiety can be a stimulus for growth as we become aware of and accept our freedom.  We can blunt our anxiety by creating the illusion that there is security in life and if we have the courage to face ourselves in life, we might be frightened, but we will be able to change.

A final concept is that death is a basic human condition and awareness of death gives significance to living.  So, these are the six key concepts that Corey identifies in existential therapy.

One of the criticisms of existential therapy is that its concepts can be vague and hard to understand, so in the attempt to make it a little bit more clear what existentialist stand for I'm going to compare and contrast the existential approach to therapy with Freud’s psychodynamic approach.

Existentialism believes that we are free to make our choices and we're not hindered by the past or by biological drives.  In contrast, Freudian psychoanalysis believes that freedom is restricted by unconscious forces, irrational drives and past events.  In existentialism, anxiety can be useful.  In psychodynamic theory, anxiety or neurosis is not useful and is in fact pathological and something that needs to be addressed.

In existentialist therapy, techniques are antithetical to truly being there for the client.  This is one of the reasons why existential therapy is more of an approach rather than a prescription for therapy.  In Freudian psychoanalysis, techniques are essential to making the unconscious conscious and these techniques can include dream analysis, transference, counter-transference, interpretation, very specific things and it's specific because the therapist is considered the expert in interpretation and understanding the objective world of the client.

Now both existential and psychodynamic are insight orient.  In existential therapy, treatment is based on the here and now and explorations of the past seek to identify the origins of the world view.  Again, there we have this idea that our clients are constantly creating the way that they understand the world, so explorations of the past are simply a way of better understanding how our clients came to view the world that they do.

In psychodynamic therapy, change occurs by exploring the past.  In existential treatment, dream analysis sheds light on possibilities.  Dreams are commonly understood to mean I don’t know what's happening to me.  In contrast in Freudian psychoanalysis, dream analysis identifies unconscious content that symbolizes conscious issues.  This is a very different approach because again you have symbols that have objective meanings in psychodynamic frameworks
such as a cigar is sometimes not a cigar.

In contrast in existential therapy, dreams are seen more as close as to the meaning that people have made for themselves.  So, one clarifying example is that if we imagine that we're working with a war vet and the vet meets criteria for posttraumatic stress disorder, is having difficulty focusing on family relations, difficulty holding a job, has exaggerated sterile response, is increasingly focused on issues related to current conflicts around the world as presented on the TV and radio.

Psychoanalysis might say that the war experiences have triggered repressed pre-sexual experiences for the vet and that the impulses are in conflict with the super ego.  In contrast, in existential approach to therapy, you must say that without the focus on the Vietnam and posttraumatic symptomology, the vet’s world would be revealed as pointless and absurd.  If there were specific issues around building a family or future orientation that the vet was having a hard time addressing, existential therapy would probably say this is because the vet is not considering the future as viable and instead understanding that the imminence of death is causing serious questions as to the point of life.

Now, the therapist-client relationship is considered to be collaborative.  In fact, Corey describes it as a journey taken by the therapist and the client together.  The relationship demands that the therapist be in contact with his or her own phenomenological world.  That is, the therapist must be aware of the way that he or she is constructing their own world so that they understand that their client is constructing his or her own world and that those worlds are necessarily going to be somewhat different.

The core of the therapeutic relationship is respect and faith and the client’s potential to cope and sharing reactions with genuine concern and empathy.  Now, some therapeutic goals in existential therapy include giving attention to the client’s immediate ongoing experience with the aim of helping them to develop a greater presence in their quest for meaning and purpose.

Another goal is to recognize factors that block freedom.  A third goal is to challenge clients to recognize that they are doing something that they formally thought was happening to them.  So, again, this addresses the concept of freedom and responsibility.  If your client believes that child protective services is something that is happening to them, it's important for you to help them understand that in fact they are active participants in this world in this situation and that their choices and their decisions are components of the current situation that they're in.

No judgment on whether or not a confirmed case of abuse has merit, but I'm just saying that in existential theory that the important thing is to focus on helping your client understand their own action as being part of their world.  And finally, the goal – the final goal is to accept freedom and responsibilities that go along with that action.

The phases of counseling can be broken down into the initial, the middle and final.

In the initial phase, you really want to see how your client understands their world. Again, this is the phenomenological viewpoint.  In the middle phase, you can explore how your clients develop that view of the world and how that view of the world is affecting what's currently going on with them, how that emphasize or how that influences what it is that they see as their responsibilities, their actions, what they have choices over.  And finally, the last phase of counseling is geared towards understanding how clients can take what they’ve learned in making their lives more purposeful, intentional and grounded in meaning.

Some of the things to do during the assessment phase is to identify existential themes and these are themes related to responsibility, mortality, isolation and meaningless.  These are the big four that Yalom discussed in his classic 1980s text “dreaming like waking is a mode of existence or being in the world and special attention is paid to themes and dreams in making sure not to place emphasis on the therapist’s interpretation.”

So whereas in Freudian psychoanalysis, really it's the therapist that’s responsible for ultimately interpreting what a dream means not because the client is unconscious of the meaning.  In existential approaches, it's really the client that ultimately determines what a dream means.  Some assessment techniques are the use of objective and projective tests such as the Rorschach and the thematic apperception test, the purpose of life test.  This addresses individuals’ views of life goals, their world and their death and the experiencing scale which looks at feelings and self-awareness.

Because there are no specific techniques in existential therapy, application really looks like incorporating techniques and approaches that you as a therapist are comfortable using.  Just remember that as you use your techniques, the primary emphasis is on understanding the client’s current experience.  As you adapt interventions that you're really focusing on these issues of choice, freedom and responsibility and ultimately you're guided by the philosophical framework about what it means to be human.

Now, existential therapy has been applied to multiple areas.  Clients who are seeking personal growth are great candidates for taking an existential approach, career or marital failure, retirement, grief work and any transition from one stage of life to another.  Existential approaches are wonderful for working with teenagers and for whom the questions of what is my purpose, what is the meaning of my life, how am I to live the best life I can, all of these questions are classic teenage angst questions.

A final area of application is helping those who are struggling to find meaning in life and facing the anxiety of their eventual death.  An obvious group for this is older adults.  Existentialist philosophy and existential therapy have contributed a lot to social work practice and clinical work in general.  One of the big ones is that existential theory contributed the concepts of self-determination and personal responsibility.  It provided a perspective for understanding the value of anxiety and guilt and the role and meaning of death in treatment.

The existential approach really enables clients to examine the degree to which their behavior is influenced by social and cultural conditioning.  In his 2005 text, Gerald Corey in fact argues that the existentialist approach is perhaps the most culturally competent approach because it provides social workers with a framework for understanding the universal issues of freedom, choice, life and death and because it's not technique-bound there are no cultural limitations on how this approach is practiced.

However, one of the limitations of an existentialist approach is that it lacks systematic statements of principles and practices of therapy.  It uses vague and global terms and abstract concepts that can be very difficult to grasp such as the will to meaning.  Finally, it's not been subjected to scientific research as a way of validating its procedures.

Now, in a recent article, Aaron Keshen acknowledged the limitations of existential therapy primarily in its lack of empirically testable techniques or approaches.  In a 2006 article, he attempts to operationalize existential techniques.  If you want more information on his approach, his article can be found in the American Journal of Psychotherapy, volume 60, issue 3 and the article is called “A New Look at Existential Psychotherapy” and in this article he attempts to operationalize the issues of your actual purpose or your substituted purpose in life and then he applies those to issues of mental illness, substance abuse, personality disorders, things like that.


So, in conclusion, existential therapy is really a philosophical or intellectual approach that provides the therapist with a framework to understanding their client’s problems rather than providing a set of techniques for actually addressing the problems the clients come in with.  The main issues that existential approaches address are issues of freedom, the freedoms that we have to choose and the responsibilities that come with those choices.  The other main issues that are significant are issues of the meaning of life and the reality and acceptance of death.


References


Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed). Belmont, CA: Wadsworth/Thomson.

Keshen, A. (2006). A new look at existential psychotherapy. American Journal of Psychotherapy, 60(3), 285-298.




APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2007, February 12). Existential therapy [Episode 7]. Social Work Podcast [Audio podcast]. Retrieved from http://socialworkpodcast.com/2007/02/existential-therapy.html

2 comments:

Harjit said...

Hey, a lot of the podcasts don't come up in itunes as existing (it says the files don't exist) but do on the actual site here. Not sure what to do...

Steven said...

You have a nice blog.I enjoy reading many of the books and papers on building a successful practice but “Change Therapy” by David Diana is one of the most unique yet. It is a collection of articles and stories that read like Levitt’s Freakonomics or Gladwell’s Outliers. The stories are fresh, unexpected and thought provoking. It’s a free download so take a look for yourself or share with your community. http://www.davidpdiana.com/about-2/change-therapy-e-book-download/