Existential Thought and Therapeutic Practice

An Introduction to Existential Psychotherapy

Hans W Cohn

• Publisher: SAGE Publications Ltd
• Year: 1997
• Print ISBN: 9780761951094, 9780761951087
• eBook ISBN: 9781446224762
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`A lucid and much-needed account of existential psychotherapy... As well as locating existential psychotherapy within a historical and philosophical context, Hans W Cohn encompasses various therapeutic issues and provides some vivid and sensitive passages of case material... I found the book provided a concise and clarifying account of the underlying philosophy and of the psychotherapeutic practice... The existentialist challenge to Freud outlined in the book provides an alternative point of view to counter potentially engulfing aspects of a psychoanalytic vision. This is a stimulating book which is a valuable contribution towards dialogue between different approaches of psychotherapy? - International Journal of Psychotherapy

`If you want at least one "existential psychotherapy" text in your library, buy this one. It?s a winner? - The Psychotherapy Review

The theoretical framework used by many counsellors and psychotherapists is predominantly `psychodynamic?, rooted in psychoanalytic theory and frequently felt to be inadequate for an understanding of the many-shaded spectrum of disturbances experienced by clients. Although many practitioners have discovered existential-phenomenological thought, they may wonder what relevance these philosophical ideas have to their actual practice, to their day-to-day meetings with clients and to the relation between client and therapist. There is often a divide between thought and practice, and this book bridges that gap.

The author introduces the history and ideas of existential phenomenology and existential psychotherapy, and shows how therapeutic phenomena familiar to all therapists and counsellors can be understood from an existential viewpoint. Hans W Cohn also demonstrates how the existential approach opens up access to issues that other therapeutic orientations have neglected, such as the difficulty of choice, the burden of responsibility and the inevitability of death. The existential approach is constantly compared to the relevant psychodynamic counterpart, so that readers can assess the unfamiliar against a background of the more familiar.

1

What is Existential Psychotherapy?

Most forms of psychotherapy and counselling, unless they use a behavioural approach, keep within a framework derived from psychoanalytic concepts. Frequently, of course, these therapeutic approaches do not comply with the classical Freudian model – clients are not seen four or five times a week and a chair facing the therapist usually takes the place of the couch. The model of thought supporting the therapeutic process is, however, a more or less modified version of assumptions which are essentially psychoanalytic.

What is the core of these psychoanalytic assumptions? Freud suggested that ‘instinctual’ wishes which are experienced as threatening and unacceptable are ‘repressed’ into an ‘unconscious’ area of the psyche. Defences are built to prevent their return. When they try to re-enter consciousness, they do so in disguise. Such disguised wishes appear as dreams, as symptoms and as various forms of disturbed behaviour. The psychoanalytic process is, so to speak, a de-masking of disguised desires so that they can be accepted into consciousness and the need for disguise becomes redundant. The disappearance of symptoms and disturbances depends on ‘making the unconscious conscious’. ‘Where id was,’ said Freud, ‘there ego shall be’ (1933: 80 [2: 112]). This account is of course over-simplified, but I think it contains the essence of a psychoanalytically informed therapeutic process.

More recently the term ‘psychoanalytic psychotherapy’ has been introduced to describe an approach that bases itself on the Freudian model. But I consider that all therapeutic approaches that call themselves ‘psychodynamic’ have their roots in psychoanalysis. The term ‘psychodynamic’ is often used very loosely but the word itself supports Walrond-Skinner’s definition of psychodynamic as ‘relating to a theory of interacting mental forces, operating within the psyche’ (1986: 275), particularly if this interaction takes place unconsciously. This definition would apply to most forms of psychodynamic therapy, including Jung’s ‘analytical psychology’.

A number of theorists have seen psychoanalysis as an essentially biological speculation, concerned with ‘instincts and their vicissitudes’, as the title of one of Freud’s papers puts it. (‘Instinct’ is in fact a mistranslation of the German word Trieb which means ‘drive’, a much less rigidly defined, more flexible concept than instinct.) In his Three Essays on the Theory of Sexuality, Freud described drives as ‘lying on the frontier between the mental and the physical’ (1905: 168 [7: 83]). Laplanche and Pontalis refer to them as representatives ‘sent into the psyche by the soma’ (1973: 215). Psychoanalytic theory is based on an exploration of the fate of these essentially biological forces, their origin, aims and ‘objects’.

It was important for Freud to define psychoanalysis as a science. His own background was, of course, scientific: he studied zoology before he established himself as a neurologist and worked at the Viennese Physiological Institute under E.W. von Brücke, who believed that the natural sciences could provide the proper framework for the investigation of the human mind. Brücke’s influence on the development of Freud’s ideas cannot be overestimated. Freud recognized that his propositions were extraordinary and sometimes shocking, and he realized the framework of the natural and physical sciences was likely to give them credibility. Apart from this, scientific terminology seemed to offer the possibility to put his discoveries into words. Thus his presentation of psychoanalytical theory used the language of the natural and physical sciences. Freud described the mind as a ‘psychical apparatus’, which is ‘extended in space’ and ‘made up of several portions’ (1940: 145 [15: 376]). This apparatus is kept in motion by a ‘psychic energy’ and functions through the interaction of its parts. Terms like projection, introjection and transference are derived from physics, and describe psychological change and interchange as if they were movements of matter in space.

Freud at times confessed that he was not at ease with his terminology. In his Introductory Lectures on Psycho-Analysis, after describing consciousness and the unconscious as two rooms with a threshold between them on which a ‘watchman performs his function’ and ‘acts as a censor’, he points out that these ideas are admittedly ‘crude’ and ‘incorrect’ and promises that he has ‘something better to take their place’ (1917: 295–6 [1: 337]). But he never revealed what this was, and the psychoanalytical vocabulary has remained essentially unchanged.

Though he presented psychoanalysis as a science, he was aware and regretted that his theories lacked predictability and thus fell short of classical scientific criteria. More importantly, he was concerned with meaning and thus stepped outside the aims of the usual scientific project with its concern for explanation and origin. Some dimensions of Freud’s thinking fractured the Newtonian framework within which he tried to express it.

In the course of time – and more than a hundred years have passed since psychoanalytic ideas were first formulated – some psychoanalytic therapists and theorists have found the Freudian model too mechanistic and restricted to account for the wide range of phenomena met in the consulting room. The Freudian concepts seemed inadequate for an understanding of what was going on in relationships between people, and modifications and new conceptualizations seemed necessary to do justice to therapeutic experience.

W.R.D. Fairbairn laid the foundation of what he calls an ‘object relations theory of the personality’. Fairbairn turned his back on the concept of instinctual energy. Though he retained the term ‘libido’, he defined it as ‘object-seeking’ rather than ‘pleasure-seeking’. Further, he saw its aim in the establishment of relationships rather than the relief of tension. A number of psychoanalysts developed this new model, but though it focuses on relationships, these were brought about by the internalization of ‘objects’ – aspects and representations of other people. The model remained intrapsychic and did not explore what really happened between one particular person and another. D.W. Winnicott, for instance, was unwilling to examine the mother-child relationship only in the light of this theory and placed particular emphasis on what was happening between a child and its real mother. John Bowlby similarly regretted the loss of reality which followed the enthronement of intrapsychic fantasy at the centre of psychological happening. S.H. Foulkes, the creator of group analysis, saw the individual as an ‘abstraction’: he emphasized the priority of the group and described communication as the therapeutic process par excellence. His revision of psychoanalytical theory was quite radical and became the basis for group-analytic therapy; this will be discussed further in a later chapter.

Most therapists and theorists who felt dissatisfied with the theoretical framework offered by psychoanalysis either modified the meaning of its terms or integrated, with varying success, new concepts into the existing theory. Only a few attempted to refer their therapeutic experience to a new conceptual framework in order to see more clearly what had eluded previous explanations. Two therapists who did just this were the psychiatrist Ludwig Binswanger and the psychoanalyst Medard Boss. Both developed an existential-phenomenological – that is a philosophical rather than a scientific – approach to psychotherapy. They both called their approach Daseinsanalyse (literally, the analysis of being there), basing it on Martin Heidegger’s philosophy of existence, though their understanding of what that meant differed considerably, as we shall see.

In my view, Binswanger’s and Boss’s work and writings are the most comprehensive and radical attempts made so far to provide a philosophical answer and alternative to Freud’s scientific project. Binswanger was introduced to Freud by Jung, and his friendship with Freud survived their theoretical disagreements. At first, Binswanger tried to integrate Freudian ideas into his own approach, which was influenced by his studies of Husserl and Heidegger. However, in an important address on the occasion of Freud’s eightieth birthday in 1936, Binswanger showed his dissent from Freud’s approach very clearly. ‘Now that he had developed his own anthropology on Heideggerian foundations, Freud’s “naturalism” in the shape of man as homo natura, i.e. as being definable completely in terms of the natural sciences, proved in its one-sidedness to be unacceptable to Binswanger.’ (Spiegelberg, 1972: 198–9).

Boss also had a personal contact with Freud – when he was 22 years old he was analysed by him, and this was the beginning of his training as a psychoanalyst. In his interesting ‘self-presentation’, Boss describes his early reservations about some of Freud’s concepts, particularly his determinism and his dream theory, and the impact which Binswanger’s address in 1936 had made on him:

This excellent critique of Freud made me understand why Freud saw himself compelled to invent his dream theory including his proposition of an ‘unconscious’. As a child of his time he believed he had to submit to the rule of scientific dogma of a causal chain without gaps – a dogma he had taken over without question. (Pogratz, 1973: 87/8 – my translation)

It was also Binswanger who mentioned Heidegger’s Being and Time to Boss. Boss felt he needed Heidegger’s help to understand it; he wrote to Heidegger, and this led to a friendship that lasted many years. For fifteen years Heidegger visited Boss to run seminars in Boss’s house for psychiatric students and colleagues. In 1987 a book appeared edited by Boss, the Zollikoner Seminare, which contains the summaries of ten years of seminars as well as the contents of many talks between Heidegger and Boss and excerpts from letters (this book remains untranslated). Also it is said that Heidegger co-operated in the writing of Boss’s Existential Foundations of Medicine and Psychology (1979), though he is not mentioned as a co-author. Boss’s conception of existential psychotherapy, which he presented in his 1963 book Psychoanalysis and Daseinsanalysis, is thus the result of a dialogue of many years between a psychoanalyst and one of the originators of ‘existentialism’. Similarly, though less personally, Binswanger’s new way of looking at ‘mental illness’ was the result of a continuing confrontation between Freudian concepts and the phenomenological explorations of Husserl and Heidegger. I do not think that any presentation of an existential psychotherapy can afford to neglect the extensive groundwork of Boss and Binswanger.

There is a significant difference in the approaches of these two Swiss pioneers in existential psychotherapy. There are a number of reasons for this. As a psychiatrist, Binswanger focused in his writings on the phenomenological investigation of the ‘psychoses’, that is, schizophrenia and manic-depressive afflictions. Boss also wrote about psychotic disturbances, but as a psychoanalyst he had probably a wider experience of the neuroses. Though Binswanger’s ideas about therapy are implicit in his phenomenological descriptions, Boss concerned himself more openly with therapeutic questions. Most importantly, Binswanger was mainly influenced by the writings of Husserl and the early Heidegger, while at the time of Boss’s closer contact with Heidegger the philosopher had, to some extent, left behind the more phenomenological aspects of Being and Time. It would be fair to say that we go to Binswanger for his subtle and often profound phenomenological descriptions of a client’s world, while for our understanding of the therapeutic process, in the light of Heidegger’s analysis of existence, we turn to Boss. In our exposition of the philosophical background we shall discuss this difference in greater depth.

Saying that we should not neglect the groundwork of Binswanger and Boss does not mean, of course, that this work is a kind of theoretical system to which we have to adhere. This would be a contradiction of the existential striving for openness to whatever addresses us. ‘Daseinsanalysis’ is, I think, a necessary point of departure but we need to go beyond it, as there are aspects of psychotherapy which have not been covered, or not covered adequately, by Binswanger and Boss. For an understanding of our relation to our body we need to turn to Merleau-Ponty, whom Heidegger is said to have praised for his insight into this problematic area. The question of groups has been raised by Sartre, but his interest is essentially political. In order to gain a phenomenological perspective on groups we need to consult Foulkes, though he never mentions phenomenology or existentialism. Finally, when it comes to the theme of sexuality Boss has left us with some ideas which are rather questionable and certainly not existential-phenomenological – in this area a great deal of work remains to be done.

This book, after a brief introduction to the basic concepts of existential phenomenology, outlines an existential-phenomenological approach to psychotherapy by comparing psychoanalytic and existential concepts. This will, I hope, revive something of the creative confrontation with Freud which characterizes the work of Binswanger and Boss.

References

Boss, M. (1963) Psychoanalysis and Daseinsanalysis. Tr. J. Needleman. New York: Basic Books.

Boss, M. (1979) Existential Foundations of Medicine and Psychology. Tr. S. Conway and A. Cleaves. Northvale: Jason Aronson.

Freud, S. (1905) Three Essays on the Theory of Sexuality. S.E. VII. London: Hogarth Press. (Pelican Freud Library. Vol. 7. Harmondsworth: Penguin Books.)

Freud, S. (1917) Introductory Lectures on Psycho-Analysis. S.E. XVI. London: Hogarth Press. (Pelican Freud Library. Vol. 1. Harmondsworth: Penguin Books.)

Freud, S. (1933) New Introductory Lectures on Psycho-Analysis. S.E. XXII. London: Hogarth Press. (Pelican Freud Library. Vol. 2. Harmondsworth: Penguin Books.)

Freud, S. (1940) An Outline of Psycho-Analysis. S.E. XXIII. London: Hogarth Press. (Pelican Freud Library. Vol. 15. Harmondsworth: Penguin Books.)

Heidegger, M. (1987) Zollikoner Seminare. Protokolle – Gespräche – Briefe. Ed. M. Boss. Frankfurt a.M.: Klastermann.

Laplanche, J. and Pontalis, J.B. (1973) The Language of Psychoanalysis. London: karnac Books.

Pogratz, I.J. (1973) Psychotherapie in Selbstdarstellungen. Bern: Huber.

Spiegelberg, H. (1972) Phenomenology in Psychology and Psychiatry. A Historical Introduction. Evanston: Northwestern University Press.

Walrond-Skinner, S. (1986) A Dictionary of Psychotherapy. London: Routledge & Kegan Paul.

2

Philosophical Background

Before we can turn our attention to an existential-phenomenological consideration of psychological phenomena we need to become familiar with some of the basic ideas of this philosophical approach. It is, of course, neither appropriate nor necessary to give a comprehensive outline, historically and conceptually, of this orientation. What I propose to do is to clarify those existential-phenomenological concepts which have a direct bearing on the phenomena and experience of psychotherapy. Besides, existential phenomenology is not a consistent ‘system’ which we have to accept in all its aspects and ramifications. Different existential philosophers and therapists vary in the emphasis they give to different dimensions of man’s existence, man’s relation to the world and other people. We have already seen that Boss and Binswanger, though both influenced by Heidegger, tend to differ in their therapeutic viewpoint.

Nevertheless, there are certain fundamental views, with a variety of nuances, shared by philosophers and therapists who call themselves ‘existential’. It is on these views that our considerations centre in this introductory section. First of all, we need to consider phenomenology and existentialism separately, and then see in what way they relate to each other.

The of phenomenology

It is often helpful to consider the etymology of a word in order to comprehend its full meaning. The Greek word ‘phenomenon’ is derived from a verb meaning ‘to appear, to come into the light’. ‘Logos’, on the other hand, is rooted in a Greek verb meaning ‘to say’. As John Macquarrie, in his book on existentialism, formulates it: ‘Speech articulates the phenomenon’ (1972: 25). ‘Speech’ implies here exploration and understanding. ‘What appears’ does not mean ‘mere appearance’ – whatever appears is real: reality is here not a Kantian ‘noumenon’, an unknowable ‘thing-in-itself’ hidden behind the ‘phenomenon’. Heidegger’s definition stresses the accessibility of phenomena: ‘We must keep in mind that the expression phenomenon signifies that which shows itself in itself, the manifest’ (1962: 51). This implies a consciousness to which it shows itself and is another way of saying that consciousness and world cannot be separated.

This is a new position for consciousness to be in. Since the seventeenth century Western thinking has been dominated by Descartes’s separation of mind from matter, the thinking subject from the world. In the course of his bold search for certainty Descartes found that all was doubtful except our capacity to find it so – that is, to think – and th...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Dedication
• Preface
• Notes
• Acknowledgements
• 1 What is Existential Psychotherapy?
• 2 Philosophical Background
• 3 Existential Psychotherapy and Psychoanalysis: a Comparison
• 4 The Therapeutic Relationship
• 5 Existential-phenomenological Dimensions of Groups
• 6 Mind and Body
• 7 Aspects of Anxiety and Guilt
• 8 The Question of the Unconscious
• 9 Dreams and Symptoms
• 10 Being-in-the-World Sexually
• 11 Withdrawal and Delusion
• 12 Aims of Psychotherapy
• Recommended Reading
• Index