Existential Therapies

Mick Cooper

• Publisher: SAGE Publications Ltd
• Year: 2016
• ISBN:
  9781473987647
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

What does it mean to practice therapy in an existential way? What are the different existential approaches? What are their strengths and limitations?

Focusing on practical, face-to-face work with clients, the book introduces students to six existential therapies, highlighting areas of commonality and difference, and discusses key figures and their contributions, including Yalom, van Deurzen, Spinelli, Frankl and Laing. It outlines the critical perspectives and key debates, and presents implications for practice, reflection and further reading.

Fully updated to reflect current issues, this book now includes:

· Sections presenting research evidence for each approach

· An extended case study running through the book, demonstrating how different therapies might approach the same case

· Chapter overviews, questions for reflection, and additional case studies of actual existential practice.

1 Introduction: The Rich Tapestry of Existential Therapies

This chapter discusses:

• The diversity of existential approaches to therapy.
• The rationale for writing this book.
• The book’s aims.
• The structure and content of the book.
• The case study that will be used throughout the book to illustrate existential theory and practice.
• My personal biases and assumptions.

‘What is existential therapy?’ As a therapist and trainer, this is one of the questions that I have been most frequently asked. It has also been one of the questions that I have found the most difficult to answer. ‘It’s … um … about facing the reality of existence,’ I have sometimes muttered, or come out with a stock response like, ‘It’s similar to person-centred therapy … only more miserable!’ Over the years, however, it has gradually dawned on me why this question has been so difficult to answer: because the term existential therapy has been used to refer to so many different therapeutic practices. Indeed, as Norcross (1987: 42) puts it, ‘Existential therapy means something to everyone yet what it means precisely varies with the exponent.’ Hence, while Yalom’s (1980) existential psychotherapy encourages clients to face up to four ‘ultimate concerns’ of existence (death, freedom, isolation and meaninglessness), van Deurzen’s (2012a) existential psychotherapy encourages clients to explore four dimensions of worldly being (the physical, personal, social and spiritual dimensions). And while Bugental’s (1978) existential-humanistic approach encourages clients to focus in on their subjective experiences, Frankl’s (1984) logotherapy often encourages clients to focus out on their responsibilities towards others. Today, then, it is widely accepted that it is not possible to define the field of existential therapy in any single way. Rather, it is best understood as a rich tapestry of intersecting therapeutic practices, all of which orientate themselves around a shared concern: human lived-existence. In other words, as Walsh and McElwain (2002: 254) conclude, it is more ‘appropriate to speak of existential psychotherapies rather than of a single existential psychotherapy’; and this is the fundamental premise for the present book.

Of course, to a great extent, there is diversity within every form of therapy. Indeed, one could quite rightly argue that there are as many forms of therapeutic practice as there are therapists. Nevertheless, there are reasons why the field of existential therapy is more diverse than most. First, as Halling and Nill (1995: 1) write, existential therapy ‘cannot be traced to a single authoritative source’. It has no founder, no Freud or Rogers, to give the approach a common theoretical and practical basis. Rather, since the first decades of the twentieth century, existential approaches to therapy have emerged spontaneously – and, at times, independently – in various regions of the world. Second, the philosophical field on which existential therapeutic practice is based (existential philosophy) is, itself, enormously diverse (Chapter 2, this volume). Hence, practitioners drawing from these ideas have tended to draw from very different beliefs and assumptions. Third, existential philosophical writings can be extraordinarily complex and difficult to understand. Hence, interpretations – and, at times, misinterpretations – of what existential philosophers have said have brought about a great diversity of therapeutic applications. Fourth, as Schneider and May (1995a) point out, existential therapists have spent much of their energies reacting against traditional approaches to therapy – particularly psychoanalysis – rather than proactively generating coherent, integrated models of practice. Finally, though, at the heart of an existential standpoint is the rejection of grand, all-encompassing systems, and a preference for individual and autonomous practices. Hence, few existential therapists have been concerned with establishing one particular way of practising existential therapy. Indeed, for most existential therapists, the idea that this approach can be systematised, or even manualised, is anathema to the very principles of the approach.

Despite this heterogeneity, the existential approach seems to be thriving today, with 136 existential therapy institutes in 43 countries across all inhabited continents (Correia, Cooper, & Berdondini, 2016a). Craig (2015: 81) writes, ‘existential thinkers and practitioners today constitute a vibrant global community of individuals and groups who gather the meanings of lived experience wherever they find the human breath and heartbeat.’ Indeed, there are claims that the existential approach is growing (e.g., Barnett & Madison, 2012; Craig, 2015); and the proliferation of existential texts, societies and training programmes would seem to testify to this (Correia, Cooper, & Berdondini, 2014b). Perhaps this is because of the intrinsically anti-conformist nature of the existential approach: its refusal to be categorised or defined. In an era of manualised, evidence-based ‘treatments’, existential therapy continues to provide counsellors and psychotherapists with an opportunity to express their independence, individuality and creativity; that is, to meet their clients as the unique human beings that they (as therapists) are, and not merely as the implementers of standardised treatment protocols. More than that, it provides a framework in which therapists can encounter each of their clients as the unique human beings that their clients are, and not merely as manifestations of particular psychological disorders.

Aims

The primary aim of this book is to introduce readers to the rich tapestry of existential therapeutic approaches. It aims to map out the different existential therapies, such that readers can learn to distinguish their Binswanger from their Bugental, and are able to identify the key dimensions along which these existential approaches differ. More than that, though, the book aims to stimulate and excite readers: to present the rich array of existential ideas and therapeutic practices in the hope that students and practitioners – of both existential and non-existential therapies – will find much here to incorporate into their own therapeutic work. A third aim of the book is to act as a signpost: to help readers identify areas of existential thought and practice that are of particular interest to them, and enable them to follow up these particular interests through further reading, or through contacting relevant organisations and/or websites. Finally, the book aims to contribute to a range of debates within the field of existential therapy, among them:

• What can clients hope to take from an existential approach?
• What are the strengths and limitations of the different existential approaches to therapy?
• What are the kinds of choices and dilemmas that existential therapists face?

Structure

Following this introduction, the book goes on to an overview of existential philosophy (Chapter 2). This is the kind of chapter that, as they say, you may want to come back to later. It’s very ‘theory-rich’, and while you may want to learn about the philosophical ideas informing the existential therapies before looking at their actual practices, you may want to start with the practice, and then later come back to explore their philosophical roots.

After this chapter, the book goes on to look at a range of existential approaches to one-to-one therapy. Here, I have tried to focus on the most prominent, pervasive and influential approaches: those around which the greatest numbers of practitioners have constellated, and which have produced the greatest number of books, journals, conferences and training courses (Correia, Cooper, Berdondini, & Correia, 2016c, see Box 1.1). Wherever possible, I have also tried to include in these chapters brief descriptions of less prominent existential therapies which can be associated with these approaches. For instance, in the chapter on the existential-humanistic approach, I have also described Betty Cannon’s (1991, 2012) ‘Applied Existential Psychotherapy’.

Box 1.1 The 20 most influential authors on contemporary existential practice

In 2012, Edgar Correia, a Portuguese existential psychotherapist, surveyed over 1,000 existential therapists from around the globe to discover the authors that they considered most influential on their practice (Correia et al., 2014a). The top 20 are presented below, with the number of times that they were cited by respondents.

Figure 1.1 Top 20 most influential authors

Given that this book aims to act as a signpost, it also concentrates primarily on those existential therapies that readers are able to follow up, where there are books that are still in print (and in English) and professional bodies that can be contacted (see ‘Recommended resources’ at the end of each chapter). In some instances, I have included books that are no longer in print in the recommended resources because they are such key texts. Often, such books can be obtained through second-hand book-finding services (for instance, www.bookfinder.com), or through a university’s inter-library loans service. These chapters also tend to focus on those existential approaches that outline specific forms of therapeutic practice, as opposed to purely psychological or psychiatric understandings.

Five existential approaches to therapy are examined in these chapters, roughly in chronological order of their origins. Chapter 3 looks at the daseinsanalytic approach, which critiques many of the dominant assumptions within the field of psychoanalysis and psychotherapy, and encourages clients to open themselves up as ‘Being-in-the-world’. Chapter 4 examines the meaning-centred approaches, based on Victor Frankl’s logotherapy, which place particular emphasis on helping clients to discover meaning in their lives. In Chapter 5, the dominant brand of existential therapy in the United States, the existential-humanistic approach, is examined. This is an approach which places particular emphasis on helping clients to uncover their subjective experiences and to courageously face the givens of their lives. Here, the work of Irvin Yalom as well as Rollo May and other well-known American existential therapists will be explored. Chapter 6 looks at the work of R. D. Laing, who developed an existential model of schizophrenia, and outlined some of the knots and entanglements that interpersonal relationships can become tied up in. This chapter is somewhat different from the others, in that Laing did not develop a particular school of practice. Nevertheless, his work is of such importance to the field that it deserves a chapter in its own right. Finally, Chapter 7 looks at the development of the existential-phenomenological branch of existential therapy, with a particular focus on the work of two key figures in the UK: Emmy van Deurzen and Ernesto Spinelli. These approaches build on the work of Laing to develop a particularly descriptive, de-pathologising model of therapy.

To avoid repetition, I have tended to focus on the distinctive ideas and practices of each of these approaches, rather than those ways of working that they share with other existential (and non-existential) therapies. In fact, research indicates that there is a lot of overlap in the practices of therapists from different existential schools (Correia et al., 2016c) – aside from the meaning-centred approaches, which do tend to be quite distinctive (Correia et al., 2016c) – so this should be borne in mind when reading these chapters.

Of course, practitioners associated with each of the different approaches will also practise in very different ways, and they may also practise very differently with different clients. So while these chapters aim to identify the core beliefs and practices of each of the approaches, it is probably more useful to think of these different ways of thinking and working as existing on a range of dimensions, which will often cut across schools. This is explored in the penultimate chapter of the book (Chapter 8). Finally, Chapter 9 concludes by looking at some of the challenges and opportunities facing existential therapies in the years to come.

Each of the chapters begins with a series of bullet points describing the content of the chapters, and ends with recommended resources (primarily books and websites). There are also questions for reflections that some readers may find useful to stimulate further thought or discussion. In addition, within the chapters are some suggested self-reflective exercises. As the questions and exercises invite you to think about yourself personally, please ensure that you have appropriate support in place should you need it (for instance, a colleague who can be contacted). Of course, they are also optional and you may choose to skip them if you think they seem unhelpful.

With respect to terminology, throughout the book, I have used the term ‘client’ rather than ‘patient’, ‘service user’, ‘analysand’, etc. However, it should be noted that some of the different existential schools do use these alternative terms. The term ‘therapy’ is also used to refer to both ‘counselling’ and ‘psychotherapy’.

Client study: Introducing Siân

For this new edition, a few people suggested that it might be helpful to have a client study running through it: something that could illustrate the different therapies and the way in which their practices might vary. So throughout the chapters of this book I will be using the case of Siân (pronounced ‘Sharn’) to illustrate the different existential methods and understandings. To preserve anonymity, and so that I can illustrate a range of practices (including those that I have not actually used in my own work), the case of Siân is fictional rather than actual. However, her characteristics, and her journey through therapy, are drawn from genuine clients who I have worked with over the years. In addition, wherever possible, the dialogues that I present with her are based on actual therapeutic work.

To introduce Siân, let’s imagine a brief vignette of a first session together. We meet in a small room in a community-based counselling centre, and we are both sitting in comfortable armchairs. The room is softly lit with up-lights, with a large photograph of a cloudscape on creamy yellow walls. Siân has a shock of pink in her shoulder-length dark hair, and a brooch on her jacket that looks like it has been made out of plasticine. She fiddles with the ring through her no...