Existential Counselling & Psychotherapy in Practice

Emmy van Deurzen, SAGE Publications Ltd

• Publisher: SAGE Publications Ltd
• Year: 2012
• Print ISBN: 9781849200684, 9781849200677
• eBook ISBN: 9781446290842
• Edition: 3
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Offering a concrete framework and practical methods for working from an existential perspective, the bestselling Existential Counselling and Psychotherapy is now in its third edition.

Central to the book is the belief that many of our problems arise out of the essential paradoxes of human existence, rather than from personal pathology. From this perspective, the purpose of counselling and therapy is not viewed as problem-solving, but as a mean of enabling people to come to terms with living life as it is, with all its inherent contradictions.

Emmy van Deurzen, a leading existential philosopher and therapist, presents a practical method of working, using systematic observation, clarification and reflection to help clients rediscover their inner strengths. She shows how personal assumptions, values and talents, once acknowledged, can be turned to constructive use. Using wide-ranging case examples, the author also demonstrates the effectiveness of the existential appoach in many different situations - from crisis work to dealing with chronic unhappiness.

The existential approach is a well-respected form of psychotherapy, but most writing on the subject tends to be heavily theoretical. This book offers a practical and accessible alternative, which will be invaluable to those in training as well as to more experienced practitioners.

1

Aim and Framework

Basic assumptions

Basic assumptions are those ideas that people hold to be true without questioning them. Every approach to counselling and psychotherapy is founded on a set of beliefs and ideas about life, about the world and about people. These notions are so essential to the approach that they can easily be overlooked. Basic assumptions are implicit rather than explicit. Every intervention that a therapeutic practitioner makes expresses some of her basic assumptions, in a subtle or in a less subtle way.

Some basic assumptions, such as the belief in the fundamental possibility of understanding another person, are shared by all therapeutic approaches. Other basic assumptions are specifically related to particular perspectives in counselling and psychotherapy. No approach is without assumptions. No approach can be practised without conveying its assumptions in the process.

Clients can only benefit from an approach in so far as they feel able to go along with its basic assumptions. It is a well-documented fact that clients will generally not gain anything from working in a psychoanalytic way until they are willing to examine their resistance. This implies acceptance of one of the basic assumptions of the analytic approach, which is that all attitudes and thoughts should be made freely available for scrutiny because of their significance in terms of the underlying psychological process. To the extent that the client does not fall in with the idea that her thoughts and actions are unconsciously determined, she cannot be helped by a psychoanalytic approach.

In the same way, clients cannot be helped by cognitive or behavioural methods unless they acknowledge the importance of acquiring new skills or thought-patterns and until they begin actively to practise these. In other words, to benefit from the cognitive-behavioural approach clients have to fall in with the assumption that people learn to think and act in certain ways and that they can therefore also relearn and correct these patterns.

Clients can only benefit from person-centred work to the extent that they agree with the assumption that people can and should take responsibility for themselves. Furthermore, they will have to agree with the idea that expressing their feelings is beneficial and necessary. Clients who are assuming that it is up to the therapist to provide a solution for them while they can remain reserved and passive are unlikely to gain much from a person-centred approach.

From an existential perspective, awareness of basic assumptions is therefore deemed to be crucial for both therapist and client. Clients can only engage fully with the therapeutic process if they have confidence in its principles. They cannot be expected to co-operate wholeheartedly until they have had a chance to understand what is supposed to happen and until they have made up their mind about the rightness of the procedure.

Some clients are keen to adopt their therapist’s implicit assumptions through osmosis and through imitation of her attitudes and expressions. From an existential point of view, this is not considered helpful unless the client has some idea about possible alternatives. The existential approach assumes the importance of the client’s capacity for making well-informed choices about her own life and her attitude towards it.

This places great emphasis on the need for the practitioner to be acutely aware of her professional and personal assumptions. Philosophical clarity is the most basic requirement for the existential approach. If the therapist is to help clients to clarify their attitudes and goals, she must first examine her own with the greatest care.

In practice, all too often, practitioners do not have this kind of clarity about their own intentions and assumptions. They may find themselves operating with methods that they absorbed simply because they were on offer during their initial training. They know that they want to help their clients and therefore they often accumulate a variety of techniques which seem appealing and efficient. In the hope of becoming as professionally flexible as possible, they may adopt an eclectic or integrative stance. Unfortunately, the basic assumptions of the different strands of the approaches they try to integrate may be diametrically opposed.

Following the lead of the client one minute and giving her some homework the next is clearly inconsistent. In the first instance the underlying assumption is that of the value of the client’s autonomy, whereas in the second the necessity of the client’s obedience is assumed. In the same way, encouraging the client to express her feelings of anger most forcefully in a counselling session may clash with a subsequent interpretation of the same client’s incessant rows with her partner as an expression of emotional immaturity. In this case there is a blatant contradiction between the initial assumption of the healing power of emotional expression and the eventual assumption of the superior power of reasoning and control.

Unless the therapist is experienced and creative enough to meld different approaches and assumptions into a new and consistent synthesis, the result may be extremely confusing. Clients may pick up the message that life is confusing and that the practitioner does not really have a clue about which direction to follow. Another basic assumption often conveyed in this way, is that counselling and life are random and that the best one can do is to go along with whatever appeals or seems to be in vogue at a particular time. Clients will only benefit from this type of pluralism to the extent that they can have peace with a view of life so basically casual and incidental.

The existential approach to counselling and therapy is in many ways the opposite of the eclectic one and yet it is a form of therapeutic integration. Not only is it assumed that a diversity of techniques, tricks and gimmicks can in itself often be more harmful than helpful, it is also considered of the greatest importance that the practitioner has a clear sense of her own direction and of the laws of life that form the basis of the integration of the work. The starting point of an existential way of working is for the practitioner to clarify her views on life and living. Taking stock of one’s basic assumptions will usually involve acquaintance with possible alternatives. A therapist can be existential only if she makes understanding life her priority. The existential view is that clients are entitled to a practitioner who has grappled with the essential issues and questions that life raises. She should have reached sufficient clarity to be able to assist other people in making sense of their own lives. She should have gained a sufficiently broad perspective to be able to allow for different points of view while making sense of each.

Of all the assumptions of the existential approach, this is the most basic one – that it is possible to make sense of life and that doing so makes good sense. To put it in even stronger terms, it is considered essential for people to have a consistent framework of reference with which to reflect on their lives and organize their experience.

People who come for counselling or therapy are often confused because they cannot make sense of life or of some aspects of living. They are frequently struggling to accommodate two or more conflicting views on life. They may have just discovered that the ways in which they used to make sense of life are no longer valid in the face of a new development or crisis. Existential counselling or therapy can be seen as a process of exploration of what can make life meaningful. The despair and the sense of futility that clients start out with is construed as a necessary first step in a quest for meaning. This quest can only be undertaken if the client is ready to examine the crucial issues and to question her own basic assumptions.

Clients can therefore only benefit from an existential approach in so far as they come to the sessions with a fundamental commitment to sorting out vital issues and to coming to terms with life. If all they want is to be rid of a specific symptom or solve a particular problem without this further touching on the rest of their existence, clients will not be well served by an existential approach. Of course, it is also implied that clients need to come to do the work of their own accord and by their free choice. The existential method presupposes the client’s full engagement and her honest intention to face herself and her life more completely than she has so far been able to do on her own.

Illustration

An illustration of the appropriateness and inappropriateness of the existential approach can be seen in the experience of Leonard and James. While Leonard was advised not to venture into counselling, he was himself entirely committed to sorting things out. The urgency of his motivation and the strength of his commitment were such that he gained much from an existential approach. With James the opposite was true. He was referred to a counsellor even though he had no desire for self-examination. Although he had many reasons for needing assistance, he did not wish to consider this situation as a problem in living. The existential approach was not indicated for him.

Leonard was a forty-seven-year-old man who was dying of cancer. His relatives were keeping the medical diagnosis from him and wanted him to act as if everything was going to be all right again. Leonard, however, was not fooled for very long and he decided that he needed to survey and evaluate his life before he would be able to accept his imminent death. He had little religious faith left and he therefore did not consider confession an option. In response to Leonard’s great insistence on getting some lay help to make sense of what seemed like an absurd life, he was finally put in touch with a counsellor.

There was not much time left to reconsider or make changes; it was not possible to make a dramatically new start. Leonard had less than three months to live. All that he wanted was to find some explanation for his having squandered so much time. He desperately wanted to grasp what seemed to have totally eluded him throughout his life: the fact that he had indeed been alive. With hindsight it appeared that all his efforts had gone into pretending that life was just some kind of roller-coaster, on which you took a seemingly endless ride, trying to enjoy yourself as much as possible. The actual enjoyment now seemed futile to him, especially as it had mostly consisted of the sort of things that he now knew to have contributed to his illness. His busy lifestyle, the smoking, the drinking now just seemed like an excuse for not having to commit himself to life.

It was, as Leonard put it, as if he had all those years lived in his own shadow. His ‘larger than life’ lifestyle had stood in the way of any close encounter with himself. He had never really asked himself whether what he was doing was right or wrong. It was just so. He had lived the life of Leonard and only now that he was about to die did he wonder whether this was how he wanted to have spent his life.

Although he was glad that his illness had helped him to question the things that had previously seemed unquestionable, he was inclined to flounder in a sense of total despair and pointlessness. He despised the hypocrisy of his friends and relatives who wanted to continue pretending that all would be well. This exemplified his own former attitude of forced optimism and blinkered hedonism to him. He just wished he could have discovered its falsity without losing his life in the process.

Having begun the process of philosophical contemplation and self-reflection, eventually Leonard began to feel at peace with the life that he had lived, in the knowledge that he had done what so many people do, namely to take the intensity out of life by pretending that it will last forever. It was the understanding of his own frantic attempts to deny death that made him capable of beginning to value the reality of his now approaching ending. As he was struggling with these issues with such urgency, his last few weeks became a most intense experience.

He decided to speak to some of his closest friends and relatives about these issues and he was surprised at the vehemence of their reactions. Though many of them refused to discuss life and death with him in such a direct manner, he also found some intimacy and depth of exchange that he had not known to be possible. It was not gratuitously that Leonard spoke of himself as ‘a lucky man’ not long before he died. He had seized the opportunity of his terminal illness and made the most of it. Although it was a little late to start living deeply only just before he would die, he discovered that it was certainly not too late. In spite of much physical pain, Leonard died with great dignity. His final weeks made a considerable impact on several people in his near environment. Existential counselling had enabled him to address the issues more forcefully than he might have if he had remained encapsulated in his disgust with his former self. But of course it was Leonard who sought existential counselling and not the other way around. With James it was the exact opposite. He did not actively seek or want counselling. He just wanted to be cured of an unpleasant symptom. James was also in his mid-forties and he was referred to a therapist because he suffered recurrent nightmares. These had begun after a near fatal accident some years previously. He had been treated in a private clinic for his multiple injuries and though he made a total physical recovery after a bit more than a year, the nightmares did not recede.

By this time James was back at work with the same company that was responsible (through negligence) for his accident. He put great emphasis on the company’s responsibility in having to restore him to health. They were in fact well insured and no costs had been spared in James’s treatment. He had already been through various neurological assessments for his nightmares and it had been decided that his symptoms must be of a psychological nature. James felt greatly offended by this as he took the view that it insinuated that he was not entirely sane. He was himself convinced that his symptom was purely a physiological one and that it had no psychological significance whatsoever. The idea that his nightmare might express something of his own attitude to life was particularly unsavoury to him. He was quite reluctant even to recount the contents of the nightmare.

James liked to think of his nightmare as the simple repetition of his traumatic experience. In fact it did involve the climbing of a ladder and its collapse just as he reached the top, which was more or less how the accident had happened. But what made the dream terrifying were the people who were sabotaging the ladder while he was climbing up, obviously intent on killing him. There were also a variety of disasters that he had to try to escape from each time he went up the ladder in his dream, which made the sabotaging doubly tragic and frightening.

It seemed that there was great scope for an existential analysis of these dreams, yet James would not even consider the possibility of their wider significance. To him, these dreams were a residue of his accident, not an expression of his particular way of dealing with it. He wanted treatment, not understanding. It was pointless to attempt to convince him of a view that he would not feel comfortable making his own. When James’s viewpoint had been elucidated, it became self-evident that the referral had been inappropriate. James did not wish to take stock of his life or reflect on his attitude towards others. He thought that if he began to wonder about his fears of other people undermining and threatening him, he might lose his grip on reality.

It was then decided that James would be best served with a behavioural approach. He was referred on for relaxation therapy and he was treated for acrophobia through exposure therapy. While his fear of heights receded, other symptoms were now appearing. These were treated with medication and although the results were still not entirely satisfactory, James was getting the sort of treatment that he wanted. The existential approach would not have been effective or even possible as long as James was in total disagreement with the idea that it might be beneficial for him to examine his way of being in the world. As a coda to James’s story, it is interesting to note that he did eventually return to see a counsellor after medication had failed to cure his insomnia and remaining lack of confidence (which developed into occasional panic attacks) and that the issue he wanted to work on was his fear of giving up control. It was then possible to work with James, when he had decided that he might indeed be able to understand his own predicament.

The first basic assumption of the existential approach, that life makes sense and that people create the meaning of their world by their own attitude to life, must be acceptable in principle to the prospective client. Only then can the existential method of working help the client to sort out and make sense of her particular way of being. The process of investigation and discovery that is then embarked upon can lead to a reordering of experience and a revelation of new ways of creating meaning. There is clearly a circular argument here, which contends that people can only create or re-create meaning to the extent that they believe in their own ab...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Contents
• About the Author
• Preface
• Introduction: The Origins of Existential Therapy
• 1 Aim and Framework
• 2 Establishing Contact
• 3 Clarification of Personal Worldview
• 4 Taking Stock
• 5 Creative Explorations
• 6 Coming to Terms with Life
• Conclusion
• Recommended Reading
• References
• Index