When Death Enters the Therapeutic Space

Existential Perspectives in Psychotherapy and Counselling

Laura Barnett

• Publisher: Routledge
• Year: 2008
• Print ISBN: 9780415416559
• eBook ISBN: 9781134117000
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Although it is a natural and inescapable part of life, death is a subject that is often neglected in psychotherapeutic literature and training. In When Death Enters the Therapeutic Space Laura Barnett and her contributors offer us insights into working with mortality in the therapeutic encounter.

Taking an existential perspective, the book brings together a variety of client groups, all of whom have experienced a confrontation with mortality, and encourages the reader to engage with and reflect upon the subject of death. Although this may initially evoke anxiety and distress, Barnett and her contributors introduce the reader to the 'vitality of death' (Koestenbaum): an energy and focus that can come from confronting our greatest fears and anxieties, including the anxiety aroused by our own mortality. Topics covered include:

• philosophical roots and principal approaches to existential therapy
• health related issues including cancer, HIV and Intensive Care
• surviving violent trauma
• creating a safe space for the client
• short prognosis and palliative care
• bereavement.

When Death Enters the Therapeutic Space presents therapists with an understanding of what it means to experience such traumas and prepares them for helping the client. It will be useful for trainee counsellors and experienced therapists alike.

1
THE PHILOSOPHICAL ROOTS OF EXISTENTIAL THERAPIES

Laura Barnett

The expressions ‘existentialism’ and ‘existential philosophy’ are used to refer to a number of nineteenth- and twentieth-century philosophers, most of whom would not have categorized themselves in this way. Its central figures were Kierkegaard and Nietzsche, Heidegger, Sartre and Merleau-Ponty. While the first two were major influences on the other three and on many existential therapists, I shall be focusing in this chapter on Heidegger, whose work has had, without doubt, the greatest impact on existential therapy. His philosophy could be said to underlie every one of the characteristics of an existential perspective in therapy, as summarized in the Introduction.

When I say that many of the concepts which Heidegger articulated are fundamental to existential practice, I do not mean that we should apply them to our work like a theory, skills or a tool: rather, they offer us new ways of understanding human existence and this can have an immense impact on our therapeutic practice. Heidegger sees philosophy as:

a questioning in which we inquire into beings as a whole, and inquire in such a way that in so doing we ourselves, the questioners, are thereby also … placed into question … It deals with the whole and it grips existence through and through.

(Heidegger 1995: 9)

I have also found that reflecting on my clients has thrown a different light on some of Heidegger’s ideas; thus a two-way dialogue has emerged for me between existential thought and therapeutic practice.

Heideggerian thought and its relevance to existential therapy

(In this section, all references, otherwise specified, are to Heidegger. For Being and Time, the first page number refers to the English translation, the second, to the German edition.)

Context

Heidegger (1889–1976) spent most of his life in the Black Forest area of South West Germany. There he became professor of philosophy at the University of Freiburg, later turning down the opportunity of a professorial chair in Berlin. (Roots have an important place in Heidegger’s philosophy.) In relation to his philosophical heritage, Heidegger’s thought is marked by his ‘deconstruction’¹ of traditional metaphysics, his opposition to Cartesian dualism² and a return to Ancient Greek philosophy.

For his method of ‘hermeneutic phenomenology’, he is indebted both to Dilthey’s theory of interpretation (hermeneutics) and to his former professor, Husserl, whose method he crucially modified. Like Husserl, Heidegger sought to rid himself of the baggage of traditional philosophy and to get back ‘to the things themselves’ as they appear to us.³ But they disagreed fundamentally about what these things were:

What must be experienced as ‘the things themselves’ in accordance with the principle of phenomenology? Is it consciousness and its objectivity [the aim of Husserl’s ‘transcendental phenomenology’] or is it the being of beings in its unconcealedness and concealment?

(2003c: 74)

Unlike Husserl, Heidegger does not seek to observe phenomena in a void, suspending all personal assumptions, for in any enquiry we ‘must be guided beforehand by what is sought.’ (1962: 25; 5) Heidegger wants to uncover the very ground of these assumptions, to discover what it is about us and the world that enables us to encounter the world. Such a project cannot proceed in a void, only in the midst of beings. However, as Heidegger likes to remind us, ‘being intrinsically inclines toward self-concealment’⁴ (2000: 121). Hence there is always a more primordial and more universal aspect of being to uncover and the process of interpretation (hermeneutics) is never ending. His attempt to elucidate the ‘meaning of being’ became Heidegger’s lifelong quest, which he approached from a number of different angles.

The question

‘For manifestly you have long been aware of what you mean when you use the expression “being”. We, however, who used to think we understood it, have now become perplexed’ (1962: 19; 1). It is with this quote from Plato that Heidegger opens his book Being and Time, one of the most influential philosophical works of the twentieth century. First, we need to clarify what Heidegger means by ‘being’ and ‘beings’. The word ‘beings’⁵ does not simply refer to animals and human beings, but to ‘any entity, physical or otherwise with which we may have dealings, whether real, illusionary or imagined’ (Fried and Polt 2000: x); that includes ‘products of human work’, such as ‘Bach’s fugues’ and ‘the cathedral of Strassburg’ (2000: 81). In other words, while the above are ‘fundamentally diverse “kinds” of beings’ (1995: 275), what all these things have in common is that they are.

What Heidegger is enquiring into is the ‘being’ of these varied beings – what do we mean by it, how can we discover it, can it reveal itself to us? Why does the very question of the meaning of being seem so strange to us? Heidegger argues that this question is at the core of our Western philosophical tradition, from Early Greek philosophy to Plato and Aristotle, for whom it constituted the ‘first philosophy’. However, according to Heidegger, with the development of philosophy as an academic discipline in ancient and medieval times, the question of being became misunderstood, ‘covered over’ and forgotten. Heidegger’s aim is to ‘uncover’ being and bring it into ‘unconcealment’; this involves returning to the sources of Western philosophical thought, engaging with that thought and allowing it to challenge us personally. For the question of ‘being’ is not some intellectual debate that happens to have interested philosophers of Ancient Greece, it is, Heidegger insists, a question that concerns each and every one of us. We have lost our sense of wonderment (thauma, which characterized the attitude of the Ancient Greeks). We no longer ask ourselves (as Leibniz once did): ‘Why are there beings at all instead of nothing?’ (2000: 1, first line).

A few years ago, my husband and I spent the night in a refuge on a mountain in Switzerland which was famed for its stunning sunrise views. We got up at 4.30 am; when the sun began to rise, we were so overwhelmed by the magical splendour of this sight that, most uncharacteristically for us, our impulse was to embrace the other people who were watching with us. It was a while before I reminded myself that this sunrise was a daily occurrence! Science fiction or thoughts of a nuclear disaster can also bring us to question our daily experience of beings and being: imagine a post-nuclear explosion – desert, wasteland, a leaden sky, nothing; and then one day a blade of grass, a cloud, a birdsong. How this blade of grass, this cloud, this birdsong, why is it that they are now or at all? Where have they come from? What are they to us? Likewise, clients remind us how life-threatening events can reawaken this sense of wonder in us; for example, T recalled with tears in his eyes the unforgettable day he was able to touch his nose again.

The quest for the meaning of being: Being and Time (1927)

In Being and Time, Heidegger’s aim is ‘to work out the question of the meaning of being and to do so concretely’ (1962: 19; 1), through a study of one particular kind of being, namely human being. He does not use the German equivalent of ‘human being’ or ‘man’, but prefers the word Dasein, a common German word for ‘existence’ (made up of da ‘there’ + sein ‘to be’); his reasons for doing so will emerge from what follows. (It is the custom to keep the German word Dasein in English translations of Heidegger. However, to avoid the danger of Dasein becoming a sort of neuter person, I shall at times use ‘human existence’ and Heidegger’s own later term ‘ek-sistence’.)

Why does he choose to approach the question of being through Dasein? Because, he argues, it is the only being for whom ‘in its very being, that being is an issue for it’ (1962: 32; 12). However intelligent some animals may be, they do not have (as far as we know) the capacity to ask themselves about the meaning of their being, their place in the universe, the purpose of their existence. We do; and the very fact that we can formulate these questions for ourselves, Heidegger argues, points to our having a privileged relationship to being: ‘Understanding of being is itself a definite characteristic of Dasein’s being’ (1962: 32; 12). That is why human existence can be questioned about its being. Its characteristics are not of the same kind as the properties of a table or a tree. Rather: ‘The essence of Dasein lies in its existence’ (1962: 67; 42). My being, the way I am, depends on the way I live my life and the choices I make from among the possibilities before me. It is therefore through a concrete exploration of Dasein’s everyday way of existing that the search will have to proceed. These concrete examples will throw light on characteristics of individual Daseins (‘ontic’, ‘existentiell’ characteristics) and on Dasein’s essential characteristics (‘ontological’ characteristics or ‘existentialia’). The distinction between beings and being, between ontic and ontological is usually referred to as the ‘ontological difference’; it is fundamental to Heidegger’s thought and also has its place in existential therapy (Cohn 2002).

Being-in-the-world

Heidegger defines human existence’s specific way of being as ‘being-in-the-world’. That concept is one of the lynchpins of his thought and it underpins philosophically the holistic character of existential therapy. What does Heidegger mean by ‘being-in-the-world’? The hyphens indicate that this is a ‘unitary phenomenon’ (1962: 78; 53) and the richness and innovative character of this concept lies in the very fact that one cannot separate its three elements – ‘being’, ‘in’ and ‘world’. This makes ‘being-in-the-world’ difficult to clarify, as none of its elements can be viewed on its own and defined in isolation. Instead, Heidegger approaches being-in-the-world from different perspectives. One overarching way of describing the being-in-the-world of human existence is ‘care’.⁶ ‘Care’, Sorge, for Heidegger, does not mean ‘caring for’ and is more basic than ‘caring about’. Ek-sistence cares in that it cares that there are beings rather than nothing; that fact is meaningful to it. Heidegger goes on to illuminate from different angles the ways ek-sistence ‘cares’: its relationship to objects, to other ek-sistences, to itself, its life and its possibilities, including that of its death.

In what way is ek-sistence ‘in’ the world and what is meant by ‘world’? It is easiest to start with what ‘in’ does not mean: ek-sistence is not in the world like an apple is in a bowl, ‘in’ does not express being contained; nor does it express some form of participation in a totality of beings. Rather, ‘in’ refers to ek-sistence’s ‘dwelling’ in a ‘system of meaningful relations’ (1962: 160; 122). For example, a hammer is not first and foremost a wooden stick with a metal end-piece, it is an implement, which most of us recognize as a tool for banging in nails – one which I mainly use for hanging up pictures, but which P, my client’s father, likes to put beside his pillow for his protection when he goes to sleep at night. From this example, it is clear that our relationship to a hammer is based on both its common use and its personal associations⁷ – we have both shared meanings and individual meanings. ‘Meaningfulness’ and what we understand something as are fundamental to the elucidation of Heidegger’s concept of ‘world’. This is the essential way, for Heidegger, in which ek-sistence’s relationship to its ‘world’ differs from an animal’s relationship to its ‘environment’ (1995: 343).

Heidegger’s metaphor for ek-sistence is that of a light clearing (Lichtung) in a dark forest ‘illuminated’ (erleuchtet) by the sun’s rays (1962: 171; 133).⁸ He believes that what enables ek-sistence to perceive its world and attach meanings to it is its ‘character of having been laid open’ (1962: 105; 75). He calls it Dasein’s ‘disclosedness’. This concept has a central place in Heidegger’s thought. It expresses ek-sistence’s ontological openness and receptivity to being and to the world, as well as its capacity to open up and disclose the world and itself to itself.

These characteristics of disclosedness and meaningfulness underpin philosophically fundamental elements of existential therapeutic practice. They highlight the importance of meaning and the fact that, while our shared meanings offer us sufficient common ground to enable us to communicate, we constantly need to clarify what our clients are saying and ascertain what, for them, is the significance of it. These concepts underlie our need to constantly question our assumptions about our clients and their world, together with our assumptions about our own world. Also, while some of our clients may present as ‘closed’ to experiences and to the views of others, we must remember that openness and receptivity are existential characteristics of human existence, which may become ‘existentielly’ obscured and closed off to a certain extent.

Heidegger shows how our ‘moods’ or ‘attunement’, Befindlichkeit, Stimmung affect our understanding of our world: that understanding changes with the way we feel disposed towards it (the literal meaning of Befindlichkeit) and how we tune into it (the literal meaning of Stimmung) at any given moment. When we speak of seeing things ‘through rose-tinted spectacles’, the glass as being ‘half full’ or ‘half empty’, our idioms attest to the power of our optimistic and pessimistic attunements. Whatever the mood, it colours the way we perceive and understand the world. Heidegger’s originality, however, is to develop this much further. We are, he explains, always ‘attuned’ in some way, we cannot not be so – what may feel like no mood at all, may be a ‘pallid’ mood or a form of indifference. To find ourselves ‘always already’ disposed in a certain way is an ‘existentiale’, an essential characteristic of Dasein’s ‘disclosedness’.

Heidegger views some moods, such as anxiety, boredom, despair and joy, as being ‘fundamental attunements’ (Grundstimmungen). These moods are better able to cast light on both our finitude and our ‘thrownness’ (the fact that, from the moment of our birth, we always find ourselves ‘already’ in a certain situation). We are ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of contributors
• Foreword
• Acknowledgements
• How to use this book
• Introduction
• 1 The philosophical roots of existential therapies
• 2 Reflections on cancer counselling
• 3 HIV as a mirror to life
• 4 Surviving Intensive Care
• 5 Creating safety for the client: the London 7/7 bombings
• 6 Mortality and meaning in refugee survivors of torture and organized violence
• 7 Reflections on suicide and despair
• 8 The experience of working with patients with a short prognosis
• 9 Palliative care, pastoral care and counselling: working together, learning from one another
• 10 Working with bereavement: in the midst of life we are in death
• 11 Working with bereaved parents
• 12 And when the therapist or supervisor dies…
• 13 Dialogues: Buber, Rogers, Lévinas and the therapeutic relationship
• Conclusion: the therapeutic relationship, when death enters the therapeutic space