Thursday, October 18, 2007

Chapter 9 Existential Therapy

My Lecture Notes.
Current Psychotherapies.
Chapter 9
Existential Psychotherapy
Rollo May and Irvin Yalom
Instructor: Jeff Garrett Ph.D.
Existential psychotherapy is not a specific technique or set of techniques. It is more philosophical in nature.
Existential psychotherapy is a philosophy about human nature.
Proponents of existential psychotherapy have not advocated specific training institutes because its presuppositions can underlie any form of therapy.
In existential terms, the conflicts individuals experience are regarding the givens of existence.
From the existential perspective "deep" conflict means the most fundamental concern at that moment.

Key Figures
Viktor Frankl.
Rollo May.
Irvin Yalom.

Viktor Frankl:
Viktor Frankl's approach to existential theory is known as logotherapy.
Rollo May:
Rollo May has been instrumental in translating some concepts drawn from existential philosophy and applying them to psychotherapy.
Irvin Yalom:
According to Yalom, the concerns that make up the core of existential psychodynamics are

Basic Concepts:
Existential psychotherapy is more philosophical in nature.
Existential psychotherapy is not a specific technique.
Focuses on issues central to human existence.

Existential therapy is basically an experiential approach to therapy.
It is based on a personal relationship between client and therapist.
It stresses personal freedom in deciding one's fate.
It places primary value on self-awareness.

View of Human Nature:
The basic dimensions of the human condition are …
The capacity for self-awareness.
The tension between freedom & responsibility.
The creation of an identity & establishing meaningful relationships.
The search for meaning, purpose, and values of life.
Accepting anxiety as a condition of living:
The awareness of death and nonbeing.
The Capacity for Self-Awareness.
We can reflect and make choices because we are capable of self-awareness.
Expanding our awareness in realizing that:
We are finite - time is limited.
We have the potential, the choice, to act or not to act.
Meaning is not automatic - we must seek it.
We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation.
Freedom and Responsibility:
The central issue in therapy is freedom and responsibility.
A concept ultimately associated with freedom is assuming responsibility.
The existential concept of freedom refers to the fact that we are the authors of our own world
The bridge between wishing and action is decision.
We are free to choose among alternatives.
We are responsible for our lives, for our action, and for our failure to take action.
Blaming others for their problems---
Recognize how they allowed others to decide for them and the price they pay.
Encourage them to consider the alternative options.
We Cannot Escape
Freedom and Responsibility:
Existential therapy is rooted in the premise that humans cannot escape from freedom and responsibility.
Freedom and Responsibility involves the notion that …
our freedom requires us to accept responsibility for directing our own life.
we are free to choose who we will be.
they go hand in hand.

What are the possible reasons that people tend to blame others for their problems?

The Concept of "Bad Faith" :
The concept of "bad faith" refers to leading an inauthentic existence.
An Example of Bad Faith.
A example statement that illustrates "bad faith" is - naturally I'm this way, because I grew up in an alcoholic family.
The creation of Identity and Establishing Meaningful Relationships

Striving for Identity:
Identity is "the courage to be".
We must trust ourselves to search within and find our own answers.
Our great fear is that we will discover that there is no core, no self.

Struggling with our identity:
Challenging clients---in what ways that they have lost touch with they identity and letting others to design their life.
Relationship to others:
We are alone---So, we must give a sense of meaning to life, decide how we will live, have a relationship with ourselves, and learn to listen to ourselves.

We need to create a close relationship with others.
Challenging clients----What they get from they relationship? How they avoid close relationship?
Relatedness can be Therapeutic.
Existentialists contend that the experience of relatedness to other human beings can be therapeutic.
The search for meaning, purpose, and values of life.

What is the meaning or purpose of your life?
What do you want from life?
Where is the source of meaning for you in life?

The Search for Meaning:
Meaninglessness in life leads to emptiness and hollowness (existential vacuum).
Existentialists believe that the major solution to meaninglessness is engagement.
Finding meaning in life is a by-product of engagement, which is a commitment to creating, loving, working, and building.

Accepting Anxiety as a Condition of Living.
Anxiety – A Condition of Living.
Existential therapists define anxiety as a threat to our existence.
Anxiety arises from one’s strivings to survive.
If anxiety is proportionate to the situation confronted, existentialists would consider it normal anxiety.
In contrast to normal anxiety, neurotic anxiety is repressed anxiety.
Existential anxiety is normal.
An outcome of being confronted with the four given of existence: death, freedom, existential isolation, and meaninglessness.
Anxiety can be a stimulus for growth as we become aware of and accept our freedom.

Two Types of Anxiety.
1. Normal Anxiety.
2. Neurotic Anxiety.
What is the positive motivation of being anxious?
Normal Anxiety.
Normal Anxiety – appropriate response to an event being faced. (motivation).
e.g., Existential Anxiety is a constructive form of normal anxiety we experience as we become increasingly aware of our freedom and responsibility.
According to May, freedom and anxiety are two sides of the same coin.
Existential anxiety is seen as a function of our acceptance of our aloneness.
From the existential viewpoint, the aim of therapy is NOT to eliminate anxiety so clients can live comfortably.

Neurotic Anxiety.
Neurotic Anxiety – out of proportion to the situation.
Out of awareeness.
Tends to immobilize the person.

The Awareness of Death and Nonbeing.
According to the existential viewpoint, death gives significance to living.

If you only have 30 days left, what’s your feelings? What will you do?

Awareness of Death:
Death provides the motivation for us to live our lives fully and take advantage of each opportunity to do something meaningful.

More Basic Concepts.
The Basic "I-Am" Experience.
The "I-Am" experience is about being i.e., the realization of one's being.
The term ontological means science of being (or the nature of being).
Existentialists consider the "I am" experience as a precondition for a solution in life and feel that this is an ontological experience.
"I am now living and I could take my life".
"The idea of suicide has saved my life many times." Nietzsche.
Existential psychotherapy seeks a deeper and more discerning type of therapy.
The "I am" experience is no a solution in itself it is a precondition for a solution.

An ontological experience;
Ontis = "to be" and Logical = "the science of".
Nonbeing is illustrated in the experience of fear of death, destructive hostility, severe anxiety and critical illness.

Existential Model of Anxiety.
Anxiety is more basic than fear.
Anxiety arises from our personal need to survive, to preserve our being, and to assert our being. Normal anxiety is proportionate to the situation. It does not require repression and can be used for creativity.
Neurotic anxiety exceeds or minimizes the situation, is repressed and destructive.
(Normal anxiety is seen as proportionate to the situation involved. When the anxiety exceeds the situation present, it is considered neurotic).
Existential Model of Anxiety (see the power point slide in class).
Awareness of Ultimate Concern ---> Anxiety ---> Defenses

Existential Model of Guilt:
Normal guilt is proportionate to the situation, sensitizes us to the ethical aspects of behavior and can be used for creativity.
Neurotic guilt is about fantasized transgressions, leads to "Forgetting being" and is destructive.

The Three Forms of Being-in-the-World.
Unwelt – world around, biological world.
Mitwelt – with world, world of one’s fellow human beings.
Eignewelt – own world; relationship to one’s self.

Significance of Time.
Human experiences like joy, depression and anxiety occur in the dimension of time rather than space.
Love cannot be measured by the number of years one has known a loved one.

Two Types of Guilt.
1. Neurotic Guilt.
Guilt that arises out of fantasized transgressions is called neurotic guilt.
2. Normal Guilt.
A characteristic of normal guilt is that it sensitizes us to ethical behavior.

Human Capacity to Transcend the Immediate Situation:
Transcend 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.
When an individual can move past a situation in order to move towards their future, it is said that the person has transcended the immediate situation.

Comparing Existential Psychotherapy to Other Systems.
Contrasts of Existential Theory to Humanistic Approaches.
Humanistic therapies overlap with existential psychotherapy.
Both emphasize growth and fulfillment of self.
Goals are for self mastery, self-examination and creativity (A primary goal of existential therapy is to help the patient accept personal responsibility).

Comparing Existential Psychotherapy to Other Systems.
(see power point slid in class).
Other Key Contrasts.
Existentialists reject concept of the person as propelled by drives and instincts.
Existentialists feel Jungians quickly avoid the patient’s immediate crises by being too focused on theory.
Rollo May's major criticism of client-centered therapists was that they overidentified with the patient.
Client-Centered Therapists do not confront the client directly and firmly.

Existential thinking has occurred throughout history.
Exemplified by Augustine, Pascal, Kierkegaard, Nietzsche.
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 clients as they really are, or are we simply seeing a projection of our theories about them?
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
In 1981 Yalom published the first comprehensive textbook in existential psychiatry entitled Existential Psychotherapy.

Other Important Writings.
Rollo May’s The Meaning of Anxiety (1977); Man’s Search for Himself (1953); Existential Psychology (1961).
James Bugental’s The Search for Existential Identity (1976).
Victor Frankl’s Man’s Search for Meaning (1963).

Six Ontological Principles
1. Humans are centered in self and derive meaning from that center.
2. Humans are responsible for mobilizing the courage to protect, affirm, and enhance the self.
3. People need other people with whom they can empathize and learn.
4. People are vigilant about potential dangers to self.
5. Humans can be aware of themselves thinking and feeling at one moment and my be aware of. themselves as the person who thinks and feels in the next moment.
6. Anxiety originates out of awareness that one’s being can end.

Existential Psychotherapy.
A form of dynamic psychotherapy.
Holds a different view of inner conflict.
Conflict is between the individual and the "givens" of existence termed ultimate concerns.
1. Death.
2. Freedom.
3. Isolation.
4. Meaninglessness.
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.

Refers to the 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.
Implications for therapy.
Existential Psychotherapy.

Isolation. - The fact that we are isolated from parts of ourselves is termed intrapersonal isolation Intrapersonal isolation = Fact we are isolated from parts of ourselves.
A form of isolation that refers to the fact that each of us enters and departs the world alone is existential.
Existential isolation differs from Interpersonal isolation = Divide between self and others.
Intrapersonal isolation = Fact we are isolated from parts of ourselves.

Meaning creates hierarchal order of our values.
From a schema regarding the meaning of life an individual generates a hierarchy of values.
Tells us how to live not why to live.
Conflict stems from "How does a being who requires meaning find meaning in a universe that has no meaning?"

Existential Frame of Reference.
Despite rationality we often believe the laws of biology are no applicable to us.

Ultimate Rescuer.
Belief in a personal omnipotent servant to guard and protect us.
(To cope with ultimate concerns regarding death individuals will often use the defense mechanism of creating an ultimate rescuer).

Ultimate concerns have implications for therapy process (Existentialists hypothesize that anxiety is the result of awareness of ultimate concerns).
Psychodynamic treatment is followed.
Ultimate concerns boundary situations which are experiences which force individuals to confront an existential situation. (Ultimate concerns create experiences, which force us to confront an existential situation called boundary situations).
An experience which forces an individual to confront an existential issue is known as a boundary situation.
Examples might be 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.

Therapeutic Goals:
To expand self-awareness.
To increase potential choices.
To help client accept the responsibility for their choice.
To help the client experience authentic existence.
Expanding Awareness:
Expanding awareness is a basic goal of existential therapy.
Fully Human.
The existential emphasis is based on the philosophical concerns of what it means to be fully human.

Therapist’s Function and Role:
Understand the client’s subjective world.
Encourage clients to accept personal responsibility.
When clients blame others, therapist is likely to ask them how they contributed to their situation.

A Prime Factor in Determining the Outcomes of Therapy.
The existential approach puts emphasis on the therapist as a person and the quality of the client/therapist relationship as one of the prime factors in determining the outcomes of therapy.
Client’s Experience in Therapy.
They are challenged to take responsibility.
Major themes in therapy sessions are anxiety, freedom and responsibility, isolation, death, and the search for meaning.
Assist client in facing life with courage, hope, and a willingness to find meaning in life.
Philosophically, the existentialist would agree that the final decisions and choices rest with the client.
people redefine themselves by their choices.
a person can go beyond early conditioning.
making choices can create anxiety.

Relationship Between Therapist and Client.
Therapy is a journey taken by therapist and client.
The person-to-person relationship is key.
The relationship demands that therapists be in contact with their own world.
The core of the therapeutic relationship.
Respect and faith in the clients’ potential to cope and discover alternative ways of being.
Therapists share their reactions to clients with genuine concern and empathy as one way of deepening the therapeutic relationship.

I/Thou Relationships in Therapy:
(Martin Buber).
Martin Buber stressed the importance of presence, which allows for the creation of I/Thou relationships in therapy.

Therapeutic techniques and procedures:
It is not technique-oriented.
The interventions are based on philosophical views about the nature of human existence.
Free for draw techniques from other orientations.
The use of therapist self is the core of therapy.

Techniques are not emphasized:
Existential therapy is not considered as a system of highly developed techniques.
Subjective understanding of clients is primary.
In the existential approach subjective understanding of clients is primary and techniques are secondary.
The term unfolding refers to the therapist's attempt to uncover with the patient what was there all along.
Which populations is existential therapy particularly useful?
Which issues is existential therapy particularly useful?

Existential Group Psychotherapy.
Clients learn how their behavior is viewed by others, makes others feel, creates opinions others have of them and influences their opinions of self.
Applications of Existential Psychotherapy.
The clinical setting determines the applicability of the existential approach.
Most applicable when clients are dealing with a phase of life issue or a boundary situation.
A comprehensive existential approach is most feasible in long term therapy.
Existential therapy is especially appropriate for clients who are struggling with developmental crises.
Identity in adolescents.
Coping with disappoints in family and career.
Grief counseling.
Coping with physical limitations as one ages.
From a multicultural perspective:
Applicable to diverse clients to search for meaning for life.
Be able to examine the behavior is influenced by social and cultural factors.
Help clients to weigh the alternatives and consequences.
Change external environment and recognize how they contribute.

From a multicultural perspective.
Excessively individualistic.
Ignore social factors that cause human problems.
Even if clients change internally, they see little hope the external realities of racism or discrimination will change.
For many cultures, it is not possible to talk about self and self-determination apart from the context of the social network.
Many clients expect a structured and problem-oriented approach instead of discussion of philosophical questions.

Major Criticisms
Vague and global approach.
Lofty and elusive concepts.
It lacks a systematic statement of the principles and practices of psychotherapy.


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imhisz yuber said...

Well, though we are the creators of ourselves. So it's only human in nature? Where is the biblical perspective about existential?

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