Issue 9/2016 summary

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Issue 9/2016 summary

Rimantas Kočiūnas (Lithuania) Quest for universal definition of existential therapy

Existential therapy is not a uniform paradigm of psychotherapy. Different schools of existential therapy have distinct philosophical foundations and, more generally, degrees to which they are based on philosophical concepts.

Different theories emphasize distinct aspects of the core points and defining notions. There are frequent declarations about justification for inclusion of various well-known theories in the ‘existentialist space’ (for instance, Frankl’s logotherapy, modern Dasein-analysis and the American theories of existential therapy).

There are numerous arguments about acceptability of use of psychotherapeutic techniques, including those introduced from other psychotherapeutic paradigms.

It is interesting that there is no univocal opinion whether to use the title ‘existential psychotherapy’ or ‘existential therapy’ (without the first word ‘psycho’).

A particular subject of disagreement is the issue of whether existential therapy can be viewed as a separate school, a paradigm of psychotherapy, although it incorporates various views, or it is only a specific standpoint of a therapist, a certain worldview, which is present in different schools of psychotherapy.

Discussion over what is understood as existential therapy intensified over the last decade, especially in the period before, during and after the first World Congress of Existential Therapy in London in 2015.

One of the first attempts at defining peculiarities of existential therapy (analysis) was undertaken by Binswanger (1962). He singled out few main points:

         Just as the other schools of psychotherapy, existential analysis explores the history of the patient’s life (the definition used by Binswanger), but it tries to understand this history as the diverse modifications of the patient’s existence in the world rather than explaining it using the terms of a certain theory of psychology or psychotherapy.

         Existential analysis aims not so much to show the patients where, when and how he or she failed to fulfil his or her human potential, bur rather strives to help survive this failure as part of the patient’s real life.

         For an existential analyst, a patient is an existential partner, because they are both on the same plain – the plain of existence, which is common for everybody.

The most concise definition was probably formulated by Yalom (2002, xvi): ‘Existential psychotherapy is a dynamic therapeutic approach focusing on the concerns rooted in existence’.

The Dictionary of Existential Psychotherapy and Counselling (van Deurzen, Kenward, 2005, 71-72) provides a broader definition of this approach: ‘The aim of existential psychotherapy is to clarify, reflect upon and understand life as each person in practice experiences it in order to overcome particular problems or resolve dilemmas […] One aim of existential therapy is to help people become better acquainted with themselves, to help them clarify their worldview through exploration of the contradictions, discrepancies and paradoxes that make attempts at self-understanding so difficult. With increased clarity comes a better chance to resolve problematic issues […] Existential therapy is scientific, in that it is methodological (through its use of the phenomenological method). […] And it is holistic in that it includes the entire context of the person’s life and world […] In practice, existential psychotherapy and counselling is characterised by the examination through dialogue of how a person lives his or her life, considering the meaning they give to their experience and what they value and disvalue. Special attention is given to signs of alienation and to indications of the pursuit or avoidance of personal choice and power. But the healing power of the therapeutic relationship itself is also considered to be extremely important.’

In the above discussion, Cooper (2010) offers his own working definition: ‘Existential therapy is a range of therapeutic practices based on the conviction that psychological well-being can be achieved by means of exploration/familiarisation with the “reality” of human existence; particular emphasis is on the human ability to choose, the uniqueness of every individual existence, the need for sense and mutual relation of human beings.’

A substantial contribution towards defining the essence of existential therapy was made by Spinelli (2013) in the Internet discussion on the issue of the general understanding of existential therapy: ‘Existential therapy is represented by a combination of therapeutic approaches and standpoints, which distinguish between different ideas, themes and views and which are taken from existential philosophy and phenomenology. The principal ones are: relations as the basis of human experience; the meaning of existence as an open question; anxiety arising as a result of comprehending existence in the presence of temporal and spatial limitations imposed by existential conditions or “givens”; the limitations and possibilities of freedom; choice and responsibility that appear in relation to these “givens”.’

I would like to conclude an overview of the definitions of existential therapy by the most recent, at the time of writing this paper, ‘well enough’ working definition (as it was described by its authors), the latest version of which was published in the Internet discussion in 2016. This rather wide definition was generated following a discussion by an international group of representatives of different branches of existential therapy, a group which in 2014 was formed as a group for the creation of the World Confederation of Existential Therapy (WCET group). Later, the American existential therapist Stephen Diamond summed up the contributions of the participants in the discussion.

I would like to dwell on the most essential points of this definition: ‘Existential therapy is a philosophically informed approach to counselling or psychotherapy. It comprises a diverse spectrum of theories and practices […] characterised […] by an emphasis on relatedness, spontaneity, flexibility, and freedom from rigid doctrine or dogma.  […] Existential therapy aims to illuminate the way in which each unique person – within certain inevitable limits and constraining factors – comes to choose, create and perpetuate his or her own way of being in the world […] existential therapy confronts some of the most fundamental and perennial questions regarding human existence: “Who am I?” “What is my purpose in life?”  “Am I free or determined?” “How do I deal with my own mortality?” “Does my existence have any meaning or significance?” “How shall I live my life?” […] For existential therapists, “phenomenology” refers to the disciplined philosophical method by which these ultimate concerns or “givens” are addressed, and through which the person’s basic experience of being-in-the-world can best be illuminated or revealed, and thus, more accurately understood. ‘

Recently, we often hear calls to stop looking for an answer to the question ‘What is existential therapy?’ and pay more attention to such questions as ‘When does existential therapy happen?’ or ‘What do I do when I say that I practice existential therapy?’ (Spinelli).

Due to the difficulty of defining existential therapy and its limits, I find interesting the pluralist approach to psychotherapy, recently developed by Cooper and McLeod (2011). Their pluralist view is based on three principles: 1) there can be many right answers to one and the same question; 2) there is no single perspective from which the ‘truth’ may be seen; 3) there is no single therapist who could claim that the reality they see is the most real one. This standpoint resonates with the idea first expressed by Yalom that a ‘new’ therapy must be created with every client. When applied to existential therapy, this idea provides a way of taking off the agenda the issue of defining existential therapy and its limits.

Erasing the borders between different therapeutic approaches based on the clients’ demands in the above-mentioned manner seems to be excessive and, on the whole, unacceptable, although we must agree that an attempt at preserving rigid borders between distinct schools of psychotherapy appears as paradigmatic rigidity and is unnatural in view of the modern tendency towards the convergence of various psychotherapeutic views.

The variety of definitions of existential therapy, controversial and occasionally incomprehensible for many people, gives rise to widespread distortions in its understanding. Here, I will mention a few of the most common misunderstandings about what is existential therapy, how it works and for whom it is meant.

  1. Existential therapy is a philosophical conversation with the client, passing to him the wisdom of life.
  2. Existential therapy is a pessimistic outlook, inviting rather to accept and humble oneself than to change.
  3. Existential therapy does not possess its own methods of work, because it is a ‘free voyage’ with the client ‘without a map or a route’.
  4. Existential therapy is best applicable to help clients with high intellectual development.
  5. Existential therapy is best suitable for certain categories of disorders and problems.

These distortions in the understanding of existential therapy partially reflect the shallowness of understanding. They also result from differences in interpreting the core of existential therapy and the limits of its application. It should be noted that certain aspects of its understanding, which seem erroneous for certain representatives of this approach, may reflect the truth for other representatives.  Therefore, the picture of possible distortions in understanding offered here is subjective and, on the whole, communicates the author’s vision of existential therapy rather than the author’s claims at the common truth.

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