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Chapter 4

Existential Therapies

Prochaska, C. O. & Norcross, J. C. (2013). Systems of psychotherapy: A transtheoretical approach (8th edition). USA: Cengage Learning.

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A Sketch of Early ExistentialTherapists

World War 1-II

Ludwig Binswanger (1881–1966) was one of the first

mental health professionals to emphasizes the

existential nature of psychopathology

Binswanger had originally struggled to find meaning in

madness by translating the experience of patients into

psychoanalytic theory.

Medard Boss (1903–1991), a second early and influential

existential psychotherapist

European side of existential psychotherapy

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A Sketch of Early ExistentialTherapists

The most influential existential therapist in the United

States has been Rollo May (1909–1994)

Existential therapy is more a philosophy about

psychotherapy than a system of psychotherapy.

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Theory of Personality

Existentialists are uncomfortable with the term

personality if it implies a fixed set of traits within the

individual

being-in-the-world

Being and world are inseparable, because they are both

essentially created by the individual.

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Theory of Personality

We exist in relation to three levels of our world.

Umwelt (being-in-nature)

• ourselves in relation to the biological and physical aspects

of our world

Mitwelt (being-with-others)

• the world of persons, the social world

Eigenwelt (being-for-oneself)

• the way we reflect on, evaluate, and experience ourselves

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Theory of Personality

In trying to create a healthy existence, we are faced

with the dilemma of choosing the best way to be in-

nature, with-others, and for-ourselves.

The best alternative is authenticity

• An authentic existence brings with it an openness to

nature, to others, and to ourselves

• An authentic existence is healthy because the three levels

of our being are integrated, or in-joint, rather than in

conflict

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Theory of Personality

Paul Tillich (1952) outlined certain conditions inherent

in existence that tempt us to run from too much

awareness.

These conditions fill us with a dread called existential

anxiety.

• our acute awareness that at some unknown time we

must die: Being implies nonbeing.

• necessity to-act

• the threat of meaninglessness

• our isolation, our fundamental aloneness in the

universe

• finiteness

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Theory of Psychopathology

Lying is the foundation of psychopathology.

Lying is the only way we can flee from nonbeing, to not

allow existential anxiety into our experience.

• to be anxious or to lie?

• Lying always leads to a closing off of part of our world

• Lying also leads to neurotic anxiety

• Lying-for-ourselves is complicated

• Denial

• Perfection

• Workaholics

• Sexuality

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Theory of Psychopathology

Neurotic anxiety is an inauthentic response to being,

whereas existential anxiety is an honest response to

nonbeing

When neurotic anxiety leads to acting on that anxiety,

we develop psychopathology, such as a compulsion to

check on our family.

Symptoms of psychopathology are objectifications of

ourselves. In pathology, we experience ourselves as

objects without choice or will.

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Theory of Psychopathology

Through lying, we may lose contact with the source of

our personal direction, our intentionality.

• Intentionality is the creation of meaning, the basis of

our identity

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Therapeutic Processes

Because lying is the source of psychopathology, honesty

is the solution for dissolving symptoms.

• authenticity

• objectification of oneself

• active choosing

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Consciousness Raising

The Client’sWork

the implicit direction in existentialism is to be whatever

you want to be

Patients are allowed to present themselves as they

typically would relate to the world, with little

intervention from the therapist early in therapy

Patients will repeat their previous patterns of relating

and will begin to form transference relationships

Free experiencing

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Consciousness Raising

TheTherapist’sWork

Interpretations

The phenomenological method focuses on the

immediacy of experience, the perception of experience,

the meaning of that experience, and observation with a

minimum existential confrontation

• existential confrontation: existentialists reveal their own

experience of the patient and do not just reflect the

patient’s experience.

therapist’s own authenticity

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Choosing

The Client’sWork

The therapist will encourage clients to consider new

alternatives for being, but the clients are expected to

carry the burden of creating new alternatives in order

for them to experience themselves as subjects capable

of finding new directions for living.

kairos, critical choice points and momentous

opportunities for deciding whether to risk changing a

fundamental aspect of existence such as to be separate

or partnered, to remain in the security of symptoms or

to enter the anxiety of authenticity

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Choosing

TheTherapist’sWork

The existential therapist takes every opportunity to

clarify the choices that patients continually confront in

their treatment, whether the choice pertains to what

they should talk about each hour, how they should

structure their therapy relationship, or whether they

will return for future sessions.

The therapist will remain with patients throughout their

small choices and their kairos, empathizing with their

anxiety and their turmoil.

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Therapeutic Content

Anxiety and Defenses

Freudian formula

• instinctual drive produces anxiety which produces defense

mechanisms

In existential therapy

• awareness of ultimate concerns produces anxiety which

produces defense mechanisms

• anxiety is viewed as a natural consequence of becoming

conscious of nonbeing

• Because existential anxiety is a consequence of

consciousness, the only defense against it is conscious lying

• Over time, defenses can become unconscious and habitual

parts of our objectified selves.

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Therapeutic Content

Self-esteem

• Social self-esteem?

• An inner-directed person accepts that self-esteem occurs

at the level of being-for-oneself and as a function of self-

evaluation.

• An authentic person accepts that approval by oneself must

come above approval by others.

• To strive to be free from what others think of us is

romantic nonsense.

• We can be free, however, by caring more about what we

think of ourselves than about what others think of us.

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Therapeutic Content

Responsibility

• Existential guilt is a consequence of having sinned against

ourselves.

• If our lives become essentially inauthentic, we may at some

time find ourselves faced with neurotic guilt.

• The existentialist insists a patient be strong enough to

become more responsible and hence freer and more

authentic.

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Therapeutic Content

Interpersonal conflicts

• Intimacy and sexuality

• many people feel safe to relate only to objectified others and

enter only into I–it relationships

• Frequently it–it relationships

• Hostility

• To experience hostility is to experience the threat of nonbeing,

because hostility is one of the quickest and surest means to

end life.

• This hostility can elicit existential anxiety and drive us to lie

and tell ourselves or others we never get angry.

• The repression that follows can lead to our unwillingness to

enter into intense relationships because such relationships are

always potentially frustrating and thus may lead to hostility.

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Therapeutic Relationship

The chief characteristic of the therapy relationship is a

“being-together” of the therapist and client in the spirit

of “letting be”

The concept of letting be means the authentic

affirmation of the existence of another person.

The therapist strives to experience the world as the

patient experiences it.

• Dasein—the therapist’s literally “being there” with the

patient—means an unconditional meeting of experience

and relational presence

• To be authentic, the therapist can respond with positive

regard only toward honesty and authenticity but never

toward lying and pathology

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Practicalities of Existential Therapy

Except for time of kairos, they are like psychodynamic

threapists

They are flexible about formal educational grounds of

their grounds

Do not prefer medication

The length of therapy depends on the patients

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Logotherapy

Viktor Frankl (1905-1997)

Will-to meaning is the basic sustenance of existence

Death is seen as a negation of being that also brings a

responsibility for acting, because if life were endless,

decisions could be postponed indefinitely.

Even in the face of fate, a person is responsible for the

attitude assumed and choices made toward that fate.

Logotherapy is quite similar in content to existential

therapy, although Frankl gives meaning an even more

central position

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Logotherapy

therapy techniques include interpretations and

confrontations but also rely on persuasion and

reasoning to a considerable extent.

Two techniques

• paradoxical intention

• de-reflection