Existential-Integrative Psychotherapy

Guideposts to the Core of Practice

Kirk J. Schneider

• Publisher: Routledge
• Year: 2011
• Print ISBN: 9781138969261
• eBook ISBN: 9781135918347
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Existential-Integrative Psychotherapy promises to be a landmark in the fields of psychotherapeutic theory and practice. A comprehensive revision of its predecessor, The Psychology of Existence, co-edited by Kirk Schneider and Rollo May, Existential-Integrative Psychotherapy combines clear and updated guidelines for practice with vivid and timely case vignettes. These vignettes feature the very latest in both mainstream and existential therapeutic integrative application, by the top innovators in the field. The book highlights several notable dimensions: a novel and comprehensive theory of integrative existential practice; a premium on mainstream integrations of existential theory as well as existential-humanistic integrations of mainstream theory; a focus on integrative mainstream as well as existential-humanistic practitioners, students, and theorists; a discussion of short-term and cognitive-behavioral existential-integrative strategies; a focus on ethnic and diagnostic diversity, from case studies of multicultural populations to vignettes on gender, sexuality, and power, and from contributions to the treatment of alcoholism to those elucidating religiosity, psychoses, and intersubjectivity.

Part 1
Recent and Future Trends in Existential-Integrative Psychotherapy

In this section, I examine four recent and future developments in psychotherapy that have both informed and instigated existential-integrative practice: the cognitive revolution, developments in biopsychology, and the trends toward transpersonal and social constructivist reformation. I examine the nature of these formulations, trace their application to a clinical case, and consider their relevance to existential-integrative practice. Finally, in the last half of this section, I feature a student contribution. This contribution elucidates the recent and emerging challenges of existentially oriented clinical graduate students. Specifically it anatomizes the demands faced by these (and other) students but also, and equally, the rich rewards of adopting an intensive existential-integrative “alternative.”

1
From Segregation to Integration

The world of psychotherapy, as noted earlier, is changing, and existential psychotherapy is on the cusp of that change. In the years since Existence, there have been at least four dramatic developments in psychotherapy, and each has reshaped the field. Cognitive psychotherapy, for example, brought welcome attention to the autonomy of the human intellect; biopsychology revealed untold physiological and behavioral interconnections (Beck, 1976; Thompson, 1973). In more recent years, transpersonal (or transcendental) psychotherapy and postmodernist philosophy (in the form of social constructivist approaches) have ushered in even bolder paradigmatic shifts (Wilber, Engler, & Brown, 1986; Bernstein, 1986; Gergen, 1991; Epting & Leitner, 1994). For example, transpersonal psychotherapy inspired (and in some cases revived) an interest in alternative healing methods, Eastern and Western meditative traditions, and paranormal phenomena. Social constructivist approaches, correspondingly, relativized and thereby broadened therapeutic and cultural notions of truth. Within the context of a culturally sensitive framework, all perceptual phenomena are legitimated by this framework, and none can be said to be inherently superior to any other.

However, there has been a price for these reformative developments, and the outlines of that price are becoming clear. First, I refer to contemporary therapy’s increasing specialization. We will soon be, if we are not already, threatened by a chaos of competing practices. Second, we are threatened by the limitations inherent in the respective points of view. While they are salient within their own domains, they tend to be simplistic or devitalizing when applied beyond those domains. (See, for example, the concerns expressed by May, 1967; Wampold, 2001; Wertz, 1993; Westen, Novotny, & Thompson-Brenner, 2004.)

Put plainly, we need a therapeutic foundation that will do justice to both our diversity and our particularity, our freedom and our limits. Such a foundation would view human beings in their fullness while carefully acknowledging their tragedy and incompleteness. It would honor our biological and mechanical propensities, but not at the cost of compromising our capacity to create and transcend ordinary consciousness. What, specifically, would such a foundation look like? Consider the following vignette^* for an illustration:.

Karen is a 37-year-old, middle-class female. She has a husband and a 15-year-old son who plays Little League baseball. Ordinary in most respects, Karen has one outstanding trait: She is 424 pounds.

What is a 424-pound world like? Karen reflects:

I weighed [myself on] the freight scale at Johnson’s Trucking terminal. I couldn’t buy clothes even in large-size women’s specialty shops because their sizes stopped at 52 and I was a size 60. My wardrobe consisted of three caftans which I had specially made: one — navy, black, and brown — sewn straight up the sides with openings for my head and arms. I wore slip-on sandals in summer and winter because I couldn’t bend over to lace sneakers up and dress shoes buckled under my weight. I didn’t own a coat, but that didn’t matter since I was hardly ever out of the house anyway. In the morning, I’d maneuver myself out of bed, go to the kitchen, get my stash of food, and settle into my chair in the living room, comforted by the assurance that food was all around me. My days were filled with the drone of soap operas in the background. I lived my life vicariously through my husband and children. They became my arms and legs and my windows to the outside world. When I went anywhere, I drove. The car became part of my insulation, my armor, my protection. I used to drive around town eating, stuffing down anger, guilt, hurt — eating until nothing mattered any more. (Roth, 1991, p. 173)

Let us imagine how a team of contemporary psychologists might understand Karen’s condition and what this understanding implies for the integrative vision referred to above.

From the behavioral standpoint, for example, Karen’s obesity would probably be understood as a function of her environment. Rearrange her surroundings, behaviorists would contend, and you will significantly modify her compulsion. In particular, they would pin her problem on the wealth of junk foods she keeps around her house (which serve as conditioned stimuli), her consumption of food while engaging in other behaviors (such as television viewing), and her perception of foods as positive (or negative) reinforcers. To redress these concerns, behaviorists would try to help Karen reduce or eliminate the problematic stimuli and replace them with stimuli that are more adaptive.

Physiological psychologists, by contrast, would look to Karen’s brain, central nervous system, and cell metabolism for their answers. They might conjecture that deficits in her ability to metabolize her food, for example, render

^* This vignette is modeled on the case of Karen Russell, who is eloquently described by Geneen Roth (1991, pp. 172–184). Where I have speculated about her condition, I have noted that I have done so

her physiologically predisposed to obesity. Depending on the severity of her predisposition, they might recommend a combination of drugs, dietary restrictions, and surgical procedures. To the extent that Karen was able to lose weight without severe measures, physiological psychologists might suggest that she lose weight gradually through a carefully modified diet and a regular form of aerobic exercise (such as walking).

Cognitive therapists, on the other hand, would concentrate on the relationship between Karen’s thought patterns and her malady. In particular, they would try to help Karen understand the connection between her faulty beliefs, assumptions, and expectations and her maladaptive behavior. They might point out, for example, that when she is lonely she believes she will always be lonely, and this generalization leads to the faulty belief that food is the only alternative to this loneliness. Once Karen can recognize these maladaptive schemas, the cognitive psychologists would contend, she will be able to modify or restructure them, and hence her behavior.

Let us pause a moment and reflect on Karen’s apparent response to such regimens: “I have tried to break free from my state of nonexistence hundreds of times,” Karen tells us. “I’d been to scores of doctors” (Roth, 1991, p. 174). Like many compulsive eaters, moreover, it is a good bet that Karen was helped by some of these doctors — at least temporarily. For example, Karen was probably able to reprogram her life through such contacts. In particular, she probably mustered the will needed to keep junk food out of her house, to devise new links between eating and other behaviors, and to develop fresh, more appropriate ways to reward herself. She also probably took appetite suppressants and a variety of nutritional supplements along her recuperative path.

Yet if Karen sounds bitter about these therapies, it is probably because — in spite of their efficacy — in some intimate, vital way, they failed to address her wound. “Exercise, dear,” Karen recalled angrily about the advice she had received at one of her weight-control meetings, “Just push yourself away from the table three times a day” (Roth, 1991, p. 174).

My own experience with compulsive eaters has convinced me that cognitive-behavioral and physiological treatments can be essential first steps on the path to recovery. They help people understand the importance of reassessing their habits, belief systems, and approaches to food. They educate them about their physiology and the physiology of practice. But most important, perhaps, they prompt clients to begin a process of deep reflection about their lives — who they essentially are and where they are headed — and this, in turn, sometimes leads to fundamental change (Mendelowitz & Schneider, 2008; Schneider, 1990/1999).

“Whenever something hurt too much,” Karen recollects, “I would pack up and leave myself because I was afraid that if I experienced the fear, it would eat me alive. I made the commitment to stay with myself, [however, and to] let the fear or hurt wash over me” (Roth, 1991, p. 175).

Until now, we have examined treatment regimens that help Karen and countless clients like her to get a foothold on their compulsions; they teach them operational (measurable, specifiable) ways to change their lives. Yet these methodologies tend to address narrow ranges of the problem, failing to touch the “fear” or “hurt,” as Karen puts it, that underlie those ranges. Now let us assess methodologies that purport to confront more substantive domains of psychological functioning — those of transpersonalism and social constructivism. How might they foster Karen’s emancipation from food?

Transpersonal therapy encompasses those disciplines and practices that address transcendental (or nonordinary) states of consciousness. To the extent that transpersonal psychology accepts existential mystery, for our purposes, it provides vital insights into such transcendental phenomena as energy shifts, paranormal and visionary states, religious and spiritual crises, and unitive experiences. To the extent that the discipline spurns existential mystery, on the other hand, it can impose exaggerated or premature solutions on treatment; it can also rob the client of the chance to develop her own solutions and discoveries (for examples see Dass, 1992; Cortright, 1997; May, 1986; Schneider, 1987, 1989; Zweig & Abrams, 1991; and the contribution by Hoffman, Chapter 9).

How would a team of existentially sensitive transpersonalists understand and help Karen? First, they would probably help her evolve to the point where she could begin to ask deeper questions about herself: What does she want in her life? Where is she headed? Who does she ultimately wish to become? “I grew up to believe in an angry God,” Karen acknowledges,

a God who punishes you, a God who is never pleased, for whom only perfection is enough. I went from an angry mother to an angry God to being angry at myself. Diets were an extension of the angry God; I could never be good enough. I would always rebel and feel horrible about myself afterwards….

I realized that I was not that bad and that openheartedness, not punishment, was the way into my problems with food. (Roth, 1991, p. 181)

Next, the transpersonalists might assist Karen (through meditation, for example) to dwell in formerly uninhabitable parts of herself, such as her loneliness or vacuousness. This could have the effect of opening Karen to the deeper meanings of that suffering, and of reconciling her with those meanings. No longer would she feel as compelled to fill her being with food, she would find, but could realize that solace through living.

After three and a half years of sustained meditative therapy, Karen states, “Now I am living. It’s the difference between eating my feelings and feeling my feelings” (Roth, 1991, p. 180). “I’m alive,” she goes on,

and … feel everything with great vibrancy. I walk in the woods and feel a hushed sense of awe. Driving around in the warm spring rain a few weeks ago, I was spellbound by a double rainbow…. Last week at work, I saw some bare oak trees covered with raindrops. I knew they were just raindrops on a naked tree, but to me they were diamonds. (p. 183)

The danger of such a transcendental emphasis, on the other hand, is that it unwittingly implies salvation to Karen, or that it shortsightedly implies a resolution. Anxiety can (and fruitfully does) exist alongside glimpses of divinity, and it is in the dialogue between that people achi...

Table of contents

• Contents
• Preface
• Introduction
• Part 1 Recent and Future Trends in Existential-Integrative Psychotherapy
• Part 2 Guideposts to an Existential-Integrative (EI) Approach
• Part 3 Case Illustrations of the EI Model
• Index