BRIEF EXISTENTIAL THERAPY

INTRODUCTION

The emergence of existentialism began with the generation of people who felt lost after the madness of World War I and those in search for meaning after World War II.

        The philosophy, followed by the psychotherapy came out of Europe as a consequence of the realities of death and non-existence that millions of people were experiencing after these wars; this philosophy addressed fundamental questions of life and death that trouble so many (Prochaska & Norcross, 2010). This philosophy was transformed into a talk therapy that inspires people to exercise their free will to create meaning and purpose in life, when faced with feelings of hopelessness and meaninglessness (Kashyap, 2024).   

        Ludwig Binswanger (1881-1996) was among the first to identify the usefulness of this philosophy in the world of mental health and emphasized the existential nature of psychopathology and the therapeutic uses of existential crisis, which he suggested represented critical choice points for patients (Prochaska & Norcross, 2010). Medard Boss (1903-1991) was a second well-known existentialist from Europe, who, unlike Binswanger’s ideas of world design, believed that the world was something that revealed itself to us, and as much as Boss seems to stick closer to German philosopher Martin Heidgger’s original ideas (Boeree, 1998), both Boss and Binswanger were influenced by him. The most influential existentialist from the USA was Rollo May (1909-1998), whose primary aim was to understand the underlying mechanisms of human suffering and crises, which he did by combining elements of both humanistic and existential approaches (GoodTherapy).

        Existentialism as a theory takes more of a philosophical approach and so it never developed a formal system of therapy, however, several psychotherapists have tried to put together a body of work that resembles something close to a coherent clinical approach.

THEORY OF PERSONALITY

        Unlike humanists who view people as inherently good, existentialists view them as neither good or bad (Kashyap, 2024). Existentialists do not view personality as fixed or characterized by particular traits, but rather, they see existence as emerging or a process of being, and hence do not gravitate towards the term personality; they see being as an active and dynamic process that does not just occur within the individual, but rather between individuals and their world (Prochaska & Norcross, 2010), helping them recognize how personal choices impact their future (Kashyap, 2024).           

       According to Prochaska & Norcross (2010) this theory and its followers understand existence as being-in-the-world, hence for them being and the world are inseparable, because they are both created by the individual, e.g. a traditional Christian’s world includes a superior being with which one can communicate, whereas the atheist’s existence contains no such spiritual being. Being-in-the-world exists on 3 levels in our world, and are articulated in German as Umwelt, which refers to ourselves in relation to the biological and physical aspects of our world i.e. being-in-nature. Mitwelt which refers to the world of persons, or the social world and can also be stated as being-with-others, and finally Eigenwelt which means own-world and refers to the way we reflect on, evaluate, and experience ourselves i.e. being-for-ourselves. The existentialists believe that personalities differ because of how each of these 3 levels of being is expressed within each of us.

             

        The theory suggests that meaninglessness of life can be faced by finding meaning through one’s own choices, thereby changing the condition of meaninglessness (Kashyap, 2024). Existentialists view authenticity as the solution to the anxiety of non-existence, they see this as a means to bringing openness to nature, others and ourselves, because we have decided to meet the world straight on without hiding it from us or us from it. By choosing authenticity we are choosing not to hide anything from ourselves, allowing us to have a healthy existence with an awareness that any relationship that we do have is authentic, and that the other cares about us and not some façade constructed on their behalf (Prochaska & Norcross, 2010).

         The authentic existence integrates the 3 levels of our being rather than being in conflict, however, not everyone is willing to be authentic because as Theologian Paul Tillich (1952) outlined, certain aspects of existence tempt people to avoid an authentic life, filling us with a dread called existential anxiety (Prochaska & Norcross, 2010). Having the freedom and the ability to define your own future can be a stressful responsibility, especially when thinking or looking at the future in low resolution (Holland, 2020). 

                         

Prochaska & Norcross (2010) outline sources of anxiety that move us away from authenticity, the first comes from an acute awareness of an absolute truth that is death comes for all of us, the second source manifests itself from the fact that life and existence brings with it choices that each one of us must make throughout our existence, and the necessity to act. The choices we make profoundly affect our lives, yet we cannot always know how our decisions will play out in the world, leaving us with the continuous threat of the unknown, uncertainty and guilt. Third, is the possibility of meaninglessness, the idea that an entire life spent may have been meaningless is a truly frightening thought for every human. We know that we are the ones who create meaning in our lives, and we are also the ones who let it die, therefore we must be the ones to continue to create a life worth living. The phrase existence precedes essence hints at the idea that we exist and find meaning later, presenting the obvious problem that is, meaning isn’t something we are born with but must create for ourselves (Moore, 2022). Fourth as Prochaska & Norcross quote Bugental (1968) is our isolation, our fundamental aloneness in the universe, which regardless of how intimate we are with others, we can never be them nor can they be us, which means that choosing to follow our own path and create our own meaning in life, may lead to a separation. All of these sources of anxiety remind us of one thing, the finiteness of everything that is, including ourselves, which can better be understood under the umbrella of non-existence (Prochaska & Norcross, 2010). 

THEORY OF PSYCHOPATHOLOGY

             Inauthentic living happens when we close ourselves off to the realities of life or choose to live in self-deceit about ourselves or the world, it involves a kind of unconscious state of being that attempts to avoid the anxiety of existence (Baker & Deurzen, 2008). Lying is the foundation of psychopathology, it is the only way we can run from non-being and block existential anxiety from our lives. The perceived reality of non-being leaves us with the option of anxiety, or to lie which in turn leads to neurotic anxiety i.e. when the rest of the world does not play along with our lie, we are faced with the impulse for neurotic behavior that we hope will remedy our disillusionment. This neurotic anxiety that we act on, can lead to the development of compulsions such as checking on loved ones every hour, it turns us into objects without choice or will (Prochaska & Norcross, 2010).

Prochaska & Norcross (2010) highlight the manner in which lying can occur at the different levels of being:

1. Lying-in-nature which can create hypochondriacs who lie about the nature of illness and healing.
2. Lying-for-others happens when we influence others by faking sad or mad or innocence depending on their weak points, however, this leads to fear of discovery and the fear and shame of being discovered or caught, which would mean if people really knew us they would leave us alone.
3. Lying-for-ourselves which can happen when we lie to ourselves and come to believe the lie. E.g. someone who lies to themselves that they never get angry becomes depressed in an attempt to protect their idealized image of themselves, convinced that they can attain perfection.

THERAPEUTIC PROCESS

          Because lying is the source of psychopathology, honesty is the solution. Existentialists prefer to use this theory in a philosophical approach because they view rigidly defined parameters of process as an objectifying process, which reinforces to the client that they lack choice, taking away an authentic encounter between participants. Technique is slighted in order to avoid situations where therapists as the subject decides the best means by which to change the patient as an object, instead they encourage clients to enter into an authentic relationship with them and thereby increasing awareness of themselves as subjects, free to differ with the therapist (Prochaska & Norcross, 2010). Focus is on possibilities and the here-and-now, what the client wants from life and learning to think and act without concern for anxiety or fear of messing up one’s life (Holland, 2020).

            Prochaska & Norcross (2010) point out that as much as existentialists flee from rigid process, there are a couple of focus points that they bring with them into the therapeutic relationship, which requires input from both client and therapist, these are:

1. 1. Consciousness raising – The client is encouraged to express freely and honestly whatever they are experiencing in the present through language and not action, which in turn allows them to become increasingly aware that they are repeating the same pattern of being. As for the therapist, he/she can take advantage of strategies such as the phenomenological method which focuses on immediacy of experience, the perception of experience, the meaning of that experience and observation with a minimum of a priori biases. The method focuses on the nature of truth, reality, and the generation of personal meaning within the parameters of human existence, rather than on personality, illness, or cure (Adams, 2019). The therapist attempts to experience the patient’s unique understanding of the world without imposing any theoretical or personal preconceptions onto the patient’s experience. To do this the therapist uses clarification, a type of feedback through which they illuminate the patient’s experience, and also help the patient become more conscious of their being, including some aspects that have been closed off. Once the therapist has a phenomenological understanding of the patient, they can then choose what techniques to follow.

      Another strategy in the therapist’s arsenal in existential confrontation whereby the therapist reveals their own experience of the patient and not just reflect patient’s experience, this is because their honest feedback can eventually break through the patient’s closed world. If the therapist cannot be authentic, the patient may remain in a transference relationship continually trying to freeze the therapist into categories of their pathological world, but by remaining authentic, the therapist refuses to be frozen and teaches the client new alternatives for being.

   2. Choosing – Here once the client has become aware of new alternatives, they must allow themselves to experience and exist with the anxiety of the responsibility for which alternative to follow, and to choose whether to remain in the security of symptoms or to enter the anxiety of authenticity, deciding for themselves whether they can muster the courage to leap into the unknown future. As for the therapist, they take every opportunity to clarify the choices that patients continually face in treatment, making them more conscious of being an active chooser.

      The therapist also encourages the patient to use their unique human process of consciousness such as imagination, intellect, and judgment to create rational alternatives without ever making the choices for the client, this would only work to reinforce the lie that patients by definition are inadequate to direct their own lives.

 

 

 

By – Simon D.M Karanja

REFERENCES

Adams, M. (2019). Existential-phenomenological therapy: Method and practice. In E. van Deurzen, E. Craig, A. Längle, K. J. Schneider, D. Tantam, & S. du Plock (Eds.), The Wiley world handbook of existential therapy (pp. 167–180). Wiley Blackwell. https://doi.org/10.1002/9781119167198.ch9

Boeree, G. (1998). MEDARD BOSS 1903 – 1990. https://webspace.ship.edu/cgboer/boss.html

GoodTherapy. Rollo May (1909-1994). https://www.goodtherapy.org/famous-psychologists/rollo-may.html

Holland, K (2020). What Is Existential Theory and How Is It Used in Therapy. HealthLine. https://www.healthline.com/health/mental-health/existential-theory

Kashyap, N. (2024). Existential Therapy Techniques and Benefits. VeryWellHealth. https://www.verywellhealth.com/existential-theory-5272172

Moore, M. (2022). Existential Theory: Finding Meaning and Application. PsychCentral. https://psychcentral.com/health/existential-theory

Prochaska, J.O., & Norcross, J.C. (2010). Systems of psychotherapy, a transtheoretical analysis. USA. Brooks/Cole