An overview of existential psychotherapy. The philosophical background and therapeutic process

1. Existential
Psychotherapy
Dr.V.Veera Balaji Kumar, PhD
Health Psychologist

2. Learning ObjectivesLearning Objectives
This presentation will focus on
 An overview of existential psychotherapy
 The history of existential psychotherapy
 Applications of existential psychotherapy
 Treatment techniques associated with
existential psychotherapy

3. No single founder - Many
sources
 existential therapy ‘cannot be traced to a single
authoritative source’ - no Freud or Rogers, to
give the approach a common theoretical and
practical basis.
 existential approaches to therapy have emerged
spontaneously – and, at times, independently – in
diverse parts of western Europe and
subsequently the United States.
 the philosophical field on which it is based is,
itself, enormously diverse.

4. Nietzche
 He who has a why to live can
bear with any how
 That which does not kill me,
makes me stronger

5. Key existential philosophers
 Kierkegaard, Søren (1813–55): Danish
philosopher & father of modern existentialism.
 Criticised the lack of passion and the conformity of
nineteenth century Christendom,
 Argued that human beings needed to turn towards
their own subjective truths, and make a personal
leap of faith towards God.
 Buber, Martin (1878–1965): Jewish philosopher
and theologian. Emphasised the relational nature
of human existence, and the distinction between
‘I–Thou’ and ‘I–It’ modes of relating.

6. Key existential philosophers
 Nietzsche, Friedrich (1844–1900): German
philosopher. Attacked the slavish, herd mentality
of conventional Christianity, and preached an
atheistic gospel of aspiration towards the
Übermensch: the autonomous superman who
creates his or her own values and morality, and
lives an earthly life of passion and power.
 Jaspers, Karl (1883–1969): German psychiatrist-
turned-philosopher, whose important idea of
unavoidable ‘boundary situations’ that human
beings face.

7. Key existential philosophers
 Heidegger, Martin (1889–1976): German
philosopher, influential -existential thinker.
 Earlier work emphasised resolution in the face of
anxiety, guilt and death, whilst later work placed
greater emphasis on language and an openness
towards Being.
 Sartre, Jean-Paul (1905–80): French novelist
philosopher, playwright and social critic.
 Emphasised the freedom at the heart of human
existence and the angst, meaninglessness and
nausea that it evokes.

8. Key existential philosophers
 Marcel, Gabriel (1889–1973): French
philosopher, playwright and Christian.
 Emphasised mysteriousness and immeasurability
of existence,
 and the importance of fidelity and openness to
others, as well as the primacy of hope.
 Camus, Albert (1913–60): French novelist and
philosopher. Emphasised the absurdity of human
existence, but the possibility of creating meaning in
a meaningless world.

9. History of ExistentialismHistory of Existentialism

10. What existentialism is …
 A philosophical view that emphasizes
the importance of existence, including
one's responsibility for one's own
psychological existence.

11. Existentialism continued …
 Is NOT a technical approach to counseling that
offers new rules for therapy.
 Psychoanalysis – use of transference, free-
association
 Behaviorism – stimulus/response, +reinforcement/-
reinforcement/punishment
- It is a frame-of-reference or way of viewing and
understanding a client’s suffering

12. History of ExistentialismHistory of Existentialism
““Existence precedes essence”Existence precedes essence”
SartreSartre
““Truth dwells in the inner man”Truth dwells in the inner man”
AugustineAugustine
Existential thinking has occurred throughout
history
Exemplified by Augustine, Scotus, Pascal,
Kierkegaard, Nietzsche

13. Existential View
of Human Nature
 Assumption One: As humans, our basic
conflict is between ourselves and the
“givens” of our existence.
 It’s not from instinctual drives (ego & superego)
 It’s not from significant adults in one’s early life
(need for acceptance and approval)
 It’s this anxiety we experience when we are
confronted with the givens of our existence

14. Existential View of
Human Nature
 Assumption Two: Existing in the world brings
about both normal and neurotic anxiety. “Anxiety
arises from our personal need to survive, to
preserve our being, and to assert our being (Corsini
& Wedding, 2005, p. 271)
 Anxiety occurs as we try to deal with important
life themes:
 living and dying
 freedom, responsibility, & choice
 isolation & loving
 meaning & meaninglessness.

15. Existential View of
Human Nature
 Assumption Three: As humans we
have the capacity for self-awareness.
 The greater our self-awareness, the
greater our possibilities for freedom.
 We can increase our capacity to live life
fully.

16. Existential View of
Human Nature
 Assumption Four: If a person is to be understood
and helped to understand him/herself. That person
must be understood from the perspective of the
here-and-now.
 The past is important only insofar as it is part of
one’s current existence.
 There are no attempts to uncover what happened in
the past, instead there is a focus on experiences
in the present.

17. Existential View of
Human Nature
 Assumption Five: The significance of our
existence (who we are) is never fixed. We are
always re-creating ourselves, evolving,
and becoming (Corey, 2005).
 The essence of who we are is never fixed until
we die.
 Resistance to using theorotypes or labels

18. Existence as Verb-like
 Existentialists conceive human existence as not a
noun-like thing, but a verb-like happening.
 human existence is fundamentally dynamic in
nature, that it is a flux, an unfolding event, a path
(Jaspers, 1986) or a process.
 Indeed, the very word ‘exist’ comes from the Latin
verb ‘existere’, which means to stand out or
emerge.
 Existence, then, can be conceived of as an
upsurge (Sartre, 1943/1958): a becoming, a
bursting forth into the world

19. A phenomenological exercise
 Reflect, for a minute, on what you are
experiencing as you listen my words.
 Initially, you may perceive yourself as a thing-like
self encountering another thing: my lecture.
 If you try to bracket this natural attitude, however,
and simply focus on what you are experiencing,
you may come to see that your experiencing is a
listening-to-my-words-now, or a wondering-what-
 this-is-all-about, rather than a fixed thing
encountering another fixed thing

20. A phenomenological exercise
 From an existential perspective, then, we are first
and foremost a verb-like being, and it is only
subsequently that we may define ourselves as a
noun-like thing: such as ‘an extrovert’ or ‘a
therapist’.
 This is the meaning of the well-known Sartrean
phrase: ‘Existence precedes essence’ (see Figure
2.2).
 In other words, human beings are not fixed
selves, but a relationship towards their own being

21. From Mick Cooper

22. Basic ConceptsBasic Concepts
Existential psychotherapy
is “an encounter with one’s
own existence in an
immediate and
quintessential form”
May (1967)

23. Existential PsychotherapyExistential Psychotherapy
 Not a specific technique, more
philosophical in nature
 Focuses on issues central to human
existence
 Task of therapy is to facilitate
genuineness
 Emphasis is on the phenomenological
moment between therapist and client

24. Existential Psychotherapy -Existential Psychotherapy -
OverviewOverview
 “Endeavour to understand the man as he really is”.
 Existential approach is all about exploring meaning
and values, and living authentically – in accordance
with one's own ideals, priorities and values.
 It views human beings as creature of continual
change and transformation, living finite lives in a
context of personal strengths and weaknesses as
well as opportunities and limitations created by the
environment.

25. Heidegger’s Two Basic
Patterns of Being
 Inauthentic mode
 Giving oneself over to externally
derived definitions,
“everydayness”
 Authentic (ontological) mode
 Recognizing one’s uniqueness,
remaining true to self

26. Existential Psychotherapy:Existential Psychotherapy:
The Basic “I-Am” Experience”The Basic “I-Am” Experience”
“I am now living and I could take my
life”
“The idea of suicide has saved many
lives”
Nietzsche
Existential psychotherapy seeks a
deeper and more discerning type of
therapy

27. Existential Psychotherapy:
The Basic “I-Am” Experience”
(continued)
The “I am” experience is not a solution
in itself
It is a precondition for a solution
An ontological experience
 Ontis = to be
 Logical = the science of

28. Existential Psychotherapy:
The Basic “I-Am” Experience”
(continued)
 Nonbeing is illustrated in the
experience of
 fear of death,
destructive hostility,
 severe anxiety and
 critical sickness

29. EXISTENTIAL MODEL OF ANXIETY
Anxiety is moreAnxiety is more
basic than fearbasic than fear
Anxiety arises from our personal need to
survive, to preserve our being, and to assert
our being

30. EXISTENTIAL MODEL OF ANXIETY
Normal AnxietyNormal Anxiety
Proportionate to the situation
Does not require repression
Can be used for creativity
Neurotic AnxietyNeurotic Anxiety
Exceeds or minimizes the situation
It is repressed
Destructive

31. EXISTENTIAL MODEL OF ANXIETY
Awareness of Ultimate
Concern (Death, Freedom,
isolation, meaninglessness)
Anxiety
Defenses

32. EXISTENTIAL MODEL OF GUILT
Normal GuiltNormal Guilt
Proportionate to the situation
Sensitizes us to the ethical aspects
of behavior
Can be used for creativity
Neurotic GuiltNeurotic Guilt
About fantasized transgressions
“Forgetting being”
Destructive

33. The Three Forms of World:The Three Forms of World:
Being-In-the-WorldBeing-In-the-World
UmweltUmwelt
MitweltMitweltEigenweltEigenwelt

34. The Three Forms of World:The Three Forms of World:
Being-In-the-WorldBeing-In-the-World
 Umwelt = world around; biological
world
 Mitwelt = with world; world of one’s
fellow human beings
 Eigenwelt = own world; relationship
to one’s self

35. Basic concepts
 Sensing being as real
 Understanding of a person as a being in
the world
 Differentiating ego from being
 Considering the fact of non-being death
and termination
 Viewing anxiety and guilt as ontological.

36. Focus
 On the relationships a person has both with
himself and with the world around him.
 When the relationships are not navigated
effectively psychological disturbance occurs.
 Well-being can be negotiated gradually by coming
to terms with life, the world and oneself.
 A person may be enjoying relatively healthy
functioning, yet still experience ‘Existential angst’
- existential vacuum – a realization that his life is
meaningless.

37. Objectives
 Four-part framework of client’s existence :
 Physical dimension
 Social dimension
 Psychological or personal dimension
 Spiritual dimension

38. Significance of Time
HumanHuman
experiencesexperiences
like joy,like joy,
depressiondepression
and anxiety occurand anxiety occur
in the dimensionin the dimension
of time rather thanof time rather than
spacespace

39. Significance of Time
Love can not be
measured by the
number of years
one has known
the loved one
“No clock strikes
for the happy
one”

40. Human Capacity to Transcend
the Immediate Situation
Transcendere means “to climb over and
beyond”
Existing involves a continual emerging
A transcending of one’s past and present
must occur in order to reach the future
This capacity might be neurobiologically
based

41. The phenomenological
method
 A key contribution - as developed by the German
philosopher Edmund Husserl (1859–1938).
 adopted a standpoint of radical doubt, arguing that all
we can know is what we experience: the ‘inner
evidence’ that is given to us intuitively in our
conscious experiencing of things.
 In other words, to truly know ourselves and our world,
we need to turn our attention to our conscious,
lived-experiences.

42. The phenomenological
method
 Three interrelated steps. The first of these steps is
the rule of ‘epoché’, whereby we are urged to ‘set
aside our initial biases and prejudices of things, to
suspend our expectations and assumptions,
 in short, to bracket all such temporarily and as far as it
is possible so that we can focus on the primary data of
our experience’.
 Husserl urges us to set aside our ‘natural attitude’ –
that objects in the external world are objectively present
in space &time – and instead focus solely on our
immediate and present experiencing of them

43. The phenomenological
method
 The second step in the phenomenological method,
is the ‘rule of description’, the essence of which is
‘Describe, don’t explain’ (Ihde, 1986: 34).
 Here, we are urged to refrain from producing
explanations, hypotheses or theories as to what
we are experiencing, and
 instead to stay with the lived-experiences as
they actually are.

44. The phenomenological
method
 Finally, there is the ‘rule of horizontalisation’,
which ‘further urges us to avoid placing any initial
hierarchies of significance or importance upon
the items of our descriptions, and
 instead to treat each initially as having equal
value or significance’

45. The ExistentialThe Existential
TheoryTheory
of Personalityof Personality

46. Existentialists
Suggest we do not possess a personality
rather we embody an experience
Ontology = science of being
Normalcy is seen as a failure in becoming
Neurosis is tantamount to avoidance, i.e.
neurotic individuals are living in the every day
rather than dealing with the challenges of
ultimate concerns

47. Ultimate Concern: DeathUltimate Concern: Death

48. Ultimate Concern: DeathUltimate Concern: Death
The most obvious ultimate concern
“A Terrible Truth”
Conflict between awareness of
death and desire to live
To cope we erect defenses
against death awareness
Psychopathology in part is due to
failure to deal with the
inevitability of death

49. Ultimate Concern: FreedomUltimate Concern: Freedom
Humans areHumans are
“condemned to freedom”“condemned to freedom”
SARTRE

50. Ultimate Concern: FreedomUltimate Concern: Freedom
Refers to fact that humans
are the authors of their
own world
We are responsible for our
own choices
Conflict is between
groundlessness and
desire for ground/structure

51. Ultimate Concern: FreedomUltimate Concern: Freedom
Implications for therapy
 Responsibility
 Willing
 Impulsivity
 Compulsivity
 Decision

52. Ultimate Concern: IsolationUltimate Concern: Isolation
Existential isolation differs from
Interpersonal isolation = Divide between oneself and others
Intrapersonal isolation = Fact we are isolated from parts of
ourselves

53. Ultimate Concern: IsolationUltimate Concern: Isolation

54. Ultimate Concern:Ultimate Concern:
MeaninglessnessMeaninglessness

55. Ultimate Concern:Ultimate Concern:
MeaninglessnessMeaninglessness
Meaning creates hierarchal
order of our values
Tells us how to live not why we
live
Conflict stems from “How does a
being who requires meaning
find meaning in a universe
that has no meaning”

56. Existential Frame of Reference
Awareness of Ultimate
Concern
Anxiety
Defenses

57. Existential Frame of Reference
Specialness
Despite rationality we often believe
the laws of biology are not
applicable to us
Ultimate Rescuer
Belief in a personal omnipotent
servant to guard and protect us

58. History ofHistory of
Existential PsychotherapyExistential Psychotherapy
Fundamental questions leading to the
development of existential psychotherapy
included
 Where was the actual immediate person
to whom these things were happening?
 Are we seeing patients as they really are, or
are we simply seeing a projection of our
theories about them?

59. History ofHistory of
Existential PsychotherapyExistential Psychotherapy
In 1958 existential psychotherapy
introduced to the US with publication of
Existence: A New Dimension in Psychiatry
and Psychology by Rollo May, Ernest
Angel, and Henri Ellenberger
Yalom published the first comprehensive
textbook in existential psychiatry entitled
Existential Psychotherapy in 1981

60. Existential Psychotherapy WritingsExistential Psychotherapy Writings
Rollo May
 The Meaning of Anxiety (1977)
 Man’s Search for Himself (1953)
 Existential Psychology (1961)
James Bugental
 The Search for Existential Identity (1976)
Medard Boss
 The Analysis of Dreams (1957)
 Psychoanalysis and Daseinanalysis (1982)

61. Existential Psychotherapy WritingsExistential Psychotherapy Writings
(continued)(continued)
Viktor Frankl
 Man’s Search for Meaning (1963)
Helmut Kaiser
 Effective Psychotherapy (1965)
Writings by Leslie Farber, Avery Weisman,
and Lester Havens

63. Existential TherapyExistential Therapy
existential psychotherapy "...is concerned with
patients' ways of dealing with the fundamental issues
of human existence, the meaning and purpose of life,
isolation, freedom and the inevitability of death. In this
method of treatment, increased awareness of the
self is more important than exploration of the
unconscious, but many of the techniques are
borrowed from brief psychoanalytic therapy."
Oxford Textbook of Psychotherapy

64. Existential PsychotherapyExistential Psychotherapy
Ultimate concerns have implications for
therapy process
 Death
 Freedom
 Isolation
 Meaninglessness
Psychodynamic treatment model is followed

65. Examples of how “every day” concerns
have “ontological underpinnings”
Fear of flying
 might represent ultimate concerns
regarding death
Difficulty adjusting after a divorce
 might relate to loneliness concerns

66. Existential Approach
is an Attitude
Therapist is a guide
Therapist is a symbol that an existential
ordeal can be faced and survived
The relationship heals when the
therapist is a companion as the client
confronts existence and all it entails

67. Existential PsychotherapyExistential Psychotherapy
Ultimate concerns create boundary situations
Boundary situations are experiences which force
individuals to confront an existential situation
 Examples might be the diagnosis of a terminal
illness or death of a family member or friend
Psychotherapy can address existential isolation
Jung suggested 30% of patients seek treatment
because of personal meaninglessness

68. Existential GroupExistential Group
PsychotherapyPsychotherapy
Patients learn how their behavior
 Is viewed by others
 Makes others feel
 Creates opinions others have of
them
 Influences their opinions of self

69. Comparing
Existential
Psychotherapy
to
Other
Theories

70. Psychodynamic  Existentialists reject predetermined
explanatory systems concerning
human ordeal
 Conflict viewed as grounded in the
human predicament, not suppressed
instincts
 Existentialists are not drawn to
concepts (e.g. Jung’s archetype,
collective unconscious)
Key Differences with Other
Approaches

71. Gestalt  Less emphasis on technical
contrivance in an existential model
 Gestalt approaches exemplify more
optimism
Cognitive
and
Behavioral
 Existentialists view these systems
as oversimplifying human
experience
 CBT has a more circumscribed plan
for change
Key Differences with Other
Approaches

72. Comparison of Existential TheoryComparison of Existential Theory
to Humanistic Approachesto Humanistic Approaches
 Humanistic therapies overlap considerably
with existential approaches
 Both emphasize growth and fulfillment of the
self
 Goals are for self mastery, self-examination
and creativity

73. Comparison of ExistentialComparison of Existential
Therapy to Other TherapiesTherapy to Other Therapies
Most DifferentMost Different Most SimilarMost Similar
BehavioralBehavioral PsychoanalyticPsychoanalytic HumanisticHumanistic

74. Other Key Contrasts of ExistentialOther Key Contrasts of Existential
Theory Compared to Other SystemsTheory Compared to Other Systems
Existentialists reject concept of the person as
propelled by drives and instincts
Existentialists feel Jungians quickly avoid the
patient’s immediate crises by being to focused
on theory
Client-centered therapists do not confront the
patient directly and firmly

76. Applications of
Existential Therapy
The clinical setting determines the
applicability of the existential approach
Most applicable when patients are dealing
with a phase of life issue or a boundary
situation
A comprehensive existential approach is
most feasible in long term therapy

77. Evidence for ET
 Systematic, corroborative evidence for ET is
relatively limited
 Difficult to create controlled experimental designs to
test the approach
 Much of the research supporting ET uses
qualitative/phenomenological methods
 ET is supported by the research behind “common
factors”

78. Evidence for ET
 ET was used to treat patients with schizophrenia
and compared to conventional approaches
 less re-hospitalization and psychopathology
 Improved independence and functioning
 Qualitative research has validated the importance
of presence, self-reflection, and consideration of
alternatives in therapy
 Studies have shown transcendence essential to
change