Author: Elita Kreislere
The article «Researching The Reference Points Of Therapeutic Work In The Birštonas School Of Existential Therapy» was published in Existential Analysis 28.2 July 2017
Journal of The Society for Existential Analysis ISSN 1752-5616
The paper introduces the reference points of therapeutic work in the Birštonas School of existential therapy. The results of the qualitative research using thematic analysis are three main themes: dimension of therapeutic relationship, dimension of therapeutic interaction, dimension of theoretical understanding of therapy. Sixteen sub-themes unfold these three dimensions.
Qualitative research, therapeutic relationship, therapeutic interaction, theoretical understanding.
1.Context of the research
In the briefest possible way I can define existential therapy as a practice of paying attention to existence. As such, existential therapy slips through the net, thrown by the question ‘What is it?’ There are no prescribed user’s manuals for existential therapeutic work, so usually we come to conclusions about existential therapy by the matters of thinking about it. Such a method is a pathway to a separate person’s opinion. Some of us recently witnessed a collision of separate opinions via emails, when several dozens of existential therapists from around the world made an attempt to define existential therapy. So it seemed interesting to find another way to explore common features in the work of existential therapists.
The idea of studing the reference points of therapeutic work in the Birštonas School of existential therapy arose from a simple observation by every existential supervisor: there is a difference between a beginner and an experienced existential therapist. Despite the popular humorous saying: ‘the method of existential therapy is an absence of method’, the seasoned colleague knows, does or feels something differently than a novice. That means something important has happened in the process of becoming an existential therapist and we can try to find this and conceptualise.
Here are some of the basic ideas which led to the design of this research:
– to keep the awareness of the real life context of the practice of
– the core of the research must be thoughts, deeds and feelings of
certain existential therapists;
– the aim of the research is to recognise common or universal patterns
in unique responses of certain therapists.
Consequently it is important to outline the context of this research,
giving some brief insight into the Birštonas School of existential therapy. The heart of the Birštonas School of existential therapy is the Institute of Humanistic and Existential Psychology (HEPI), founded in 1996 in Birštonas, Lithuania. Around HEPI lives a community of existential therapists from Latvia, Lithuania, Estonia, Russia, Ukraine, Belorus and other countries of the region. Many of those who have studied in HEPI are united in the East European Association for Existential Therapy, which annually publishes the professional journal Existentia: psychology and psychotherapy, and every September in Birštonas hosts a conference ‘Existential dimension in counselling and psychotherapy’. Since 2013 the Association has been an organizational member of the European Association of Psychotherapy. In 2015 HEPI became an official training institution of EAP enabling graduates to receive EAP Certificates. HEPI has several education programmes: existential therapy, group psychotherapy, existential supervision, psychological counselling and Dasein analysis. The unofficial history of existential therapy in our region begins in the 1970s with the legendary Lithuanian psychiatrist Dr. Aleksandr Alekseick and his deeply existential group therapy method ‘Intensive therapeutic life’. Nearly everybody in this part of the world who calls themselves an existential therapist has personally experienced the awakening intensity life of his therapeutic groups. HEPI was founded and until now is led by Rimantas Kočiunas – a professor at Vilnius University. Since its foundation, around 650 students have studied there. Two points are particularly interesting about the studying process in HEPI. Firstly, students come to the tiny and tranquil town of Birštonas for two weeks to live and study all in the same house, which intensifies the study process incredibly. The second, but possibly the most important feature of education in HEPI, is that there is a complete absence of ‘the right way’ of practising existential therapy. Everyone has to find their own path in existential theory and practice as there reigns a marked emphasis in respect to diversity: students, tutors, recommended literature, leaders of therapeutic groups, books, conference guests – all are very different and all have the right to be there and find their own way of being there. Except student candidates, who in order to become HEPI students need to participate in an admission competition therapy group. And about this admission group one thing is always known in advance: everything is
unknown and uncertain.
2.Exploring the reference points of therapeutic work in the Birštonas school of existential therapy
It was decided to explore the reference points of therapeutic work in the Birštonas School of existential therapy not only from the theoretical point of view (this is only very briefly touched on in this article), but mainly to explore the embodied existential therapeutic work by certain therapists.
The choice of participants had to meet these criteria: they had to be fully educated practising existential therapists; had to be educated only in existential therapy; had to be graduates or tutors of HEPI; have experience practicing existential therapy for at least ten years. All respondents met the criteria: eight out of ten are supervisors of HEPI, eight women, two men, the mean age 50 years, all have academic psychological education, three are also medical doctors, all have extensive psychotherapeutical work experience for more than ten years, all have working experience with different groups of difficult clients. It seemed important to choose participants representing different therapeutic styles and generations from different countries – Latvia, Estonia, Lithuania and Russia.
Thematic Analysis was chosen as the most appropriate research method – a qualitative method developed by several authors, but specially established for psychology by Braun and Clarke (2006). Themes are significant repeating patterns identified in the whole body of data revealing the studied phenomenon. The study was carried out in a six stage procedure of working with data, as it is described by Braun and Clarke (2006). Ten expert interviews were conducted to obtain the original data – in-depth interviews for about 60 minutes each. The main research question was: ‘What do you think is helpful in your work as an existential therapist for your client?’ This question contains at least two aspects: ‘What do you think is helpful?’ and ‘What is in your work as existential therapist?’ The first aspect of the question invites participants to reflect at quite a high level of conceptualisation on their work, while the second focuses on the understanding of their personal experience as an existential therapist.
Interviews were recorded, transcribed and then coded. At first each interview was processed separately, then all the themes found in separate interviews were grouped, then the final themes, revealed in the whole body of data, were formulated (Guest, MacQeen & Namey, 2003). The study process was like an endless circular movement from the received data to first understanding and ideas, then back to the data, then modification of conclusions and their reformulation.
During interviews therapists were encouraged to talk about their personal experience of existential therapeutic work, personal beliefs, doubts and principles. Thus an immense difference of the possible themes was observed during the first stages of the study. Yet all therapists in the interview talked about three topics: their relationship with the clients in the therapeutic process, about therapeutic work and the understanding of the therapeutic process itself. This led to the three main groups of themes, here called dimensions:
- dimension of therapeutic relationship;
- dimension of therapeutic interaction;
- dimension of theoretical understanding of therapy.
The word ‘dimension’ is used to emphasise the wholeness and indivisible character of therapeutic work in existential therapy which we cannot deconstruct into separate parts, but we can contemplate it from different points of view. We can also understand ‘dimensions’ as different focuses of attention.
Often therapeutic process is analysed from two angles: therapeutic relationship and therapeutic work, but in existential practice these are difficult to distinguish. Here ‘dimension of therapeutic relationship’ unfolds what is not seen in the work of the therapist to an external observer without special interpretations of the therapist about his attunement and attitude towards himself, client and work. Whereas ‘dimension of therapeutic interaction’ unfolds more observable processes in therapy, which we can also call therapeutic work or methods of the therapeutic interaction.
Although the participants were not encouraged to theorise about therapy, but rather to disclose their personal experience, after all, some themes pointing towards the theoretical basis of their work were identified. They are presented in the third group of themes: ‘dimension of theoretical understanding of therapy’ and show certain aspects of the theoretical foundations of the therapeutic work in the Birštonas School of existential therapy.
3.Three dimensions of therapeutic work in the Birštonas school of existential therapy
In existential therapy the question ‘How?’ matters not less, but maybe even more than ‘What?’ happens, therefore it is important to characterise the style of a participant’s speech. Although all of them are experienced professionals, in every interview there was at least one moment where therapists were concerned and did their best to avoid high-flown phrases, overall or banal truths. This shows the therapists’ subtle self-reflection and reveals their trained skill and ability to be as personal and honest as they can be. Standardised therapists’ statements like ‘as Buber wrote’ or ‘people suffer from anxiety’ were not coded in the research process. The quotes of participants have been italicised. In the following ‘therapists’ refers to existential therapists of both sexes of the Birštonas School, and the same applies to ‘clients’.
3.1. Dimension of therapeutic relationship
Three themes unfolding the dimension of therapeutic relationship were discovered. They reveal how a therapist experiences the relationship with
a client; the therapist’s attitude to the client and the therapist’s attitude towards himself. Nearly all participants emphasised the pivotal role of the therapeutic relationship in existential therapy.
The first theme is ‘A sincere and honest therapist’s attitude towards the client as a partner in vital and real relationship’. The theme of honesty and candour in interviews with therapists manifests in a variety of contexts – the therapist’s honesty to the client, to themselves and the therapist’s experience of fairness and candidness as an outstanding unspoken requirement in training in HEPI. Therapist B. states that an honest and sincere therapist’s attitude forms the basis for a trusting and open relationship, therefore the client is able to be honest with the therapist and ‘most importantly, to himself,’ the client does not have to ‘pretend’ in front of the therapist. For therapist K. partnership in therapy is a movement from ‘now’ where the therapist and client are, towards what the client really wants: ‘it is probably some kind of alliance, a common research of givens, of difficulties, of his possible goals… it’s an equal and mutual following this path with the client.’
The second theme ‘The therapist’s accepting attitude as openness to the client and as willingness to meet and respond to everything that will occur in the therapeutic process’ holds one of the most widespread words in contemporary discourse, i.e. ‘accepting’ attitude. Often acceptance is meant as a word which does not need any further exploration or understanding. Interviews with participants give us a deeper insight into the possible connection between ‘acceptance’ and ‘openness’. Acceptance of the client means remaining open to anything that emerges in the therapy process. Therapist D. said: ‘I am ready to meet everything. I mean everything, what can and will occur in therapy process’. Therapist A. explains the difference between acceptance of everything that is emerging in therapy and agreement with everything: ‘to be open doesn’t mean embracing everything… when the client is furious at me for a long time, I am responding openly, I tell that it’s difficult for me, so it doesn’t mean I embrace everything, I mainly mean responding openly’. The meaning of ‘acceptance’ in the participants’ wording: ‘to stay in contact,’ ‘respond openly,’ ‘embrace,’ ‘allowing to be,’ ‘allowing to happen’. Therapists talked about the inner work, required by such a therapeutic position, mainly about ability to withstand the anxiety of uncertainty: ‘it takes a lot of effort – to stay there, to not hinder, to not clutter up the space in which there is a fundamental permission for everything to appear’.
The third theme is ‘Therapist’s respectfulness towards client’s freedom and responsibility for his own life and his chosen way of being’. Therapists referred to clients as the only experts of their life and this therapeutic stance we can call ‘an invited guest’s position’ in the client’s world. The client is seen as the only one who owns his existence and gives the therapist a permission, an invitation to attend, ‘to be in his world and to explore it,’ so they are limited to guest status, and respect the client’s lived world’s order. Interviews did not show an intention by the therapists to accept a knowing and educating position. The client is the only free and responsible master of his own life. Instead therapists tend to pass the responsibility to the client for his chosen way of life.
3.2. Dimension of therapeutic interaction
The second dimension unfolds the more directly observable side of the therapeutic process than the therapeutic relationship, i.e. the work therapist does during the therapy. This group of themes is much more versatile than the two others. Still this diversity brings no surprise, as existential therapy does not suggest any particular methods of therapeutic interaction and the results of this study show that the choice of any methods or techniques depends on every unique therapeutic situation.
The most repeated pattern in this dimension was: ‘The therapist’s care for the client as a constant conscious monitoring and evaluation of the client’s mental strength, resources, state of therapeutic relationship and attuning therapist’s reactions in accordance with this’. This theme was one of the surprises of the research and reveals an aspect of existential therapy on which not enough light is shed. All participants spoke about constant conscious evaluating work they are doing during the whole therapy process. Therapist C. says: ‘intensity of help must be directly proportional to the readiness and ability of client to live through suffering or trauma.’ Therapist J. emphasises caring about the whole situation of the client, including physical condition and special carefulness if the client’s condition is clinically serious: ‘clinical symptoms serve as a sign to me to be even more considerate and careful, that every word I say, must be weighed very carefully and accurately.’ Therapists also make a clear distinction between ‘caring about relationship in therapy’ and ‘talking about relationship between therapist and client’.
The theme ‘Phenomenological therapeutic position as ability to constantly reside in uncertainty and continue cooperative exploration of the client’s life’ unfolds both: the practical content of the phenomenological position of the therapist, and phenomenological research as a method in existential therapeutic work. During interviews therapists characterised their attunement to explore in such words: ‘true interest,’ ‘full attention,’ ‘openness,’ ‘genuine wonder,’ ‘true intention to understand,’ ‘careful watching’. Successful phenomenological exploration of the client’s lived world rests on a trustful relationship, and good rapport, but, on the other hand, the therapist’s disposition to cooperation and unprejudiced exploration usually benefits the creation of therapeutic contact. Therapist D. emphasises another, ontological aspect of this attunement: ‘this readiness takes me a lot of vigour, for me this means to stay in constant uncertainty and unpredictability, this readiness means overcoming the temptation to determine the clarity of the future.’
The theme ‘Therapeutic listening as the therapist’s constant perception of himself and the client through mind, feelings and sensations’ unfolds therapeutic listening as a holistic process. In the briefest way it is represented in therapist G’s. quotation: ‘the basis for the client’s reliance on the therapist can be grounded in the therapist’s striving to listen and understand the client with his mind, his feelings and body, as you must admit, that only through the mind not very much can be understood’. In the same holistic way therapists constantly listen to themselves.
The essence of the theme ‘The creativity and freedom of therapist in finding the unique way of therapeutic interaction with each client’s world’can be grasped in this short quotation by therapist E.: ‘the freedom of the therapist in choosing the appropriate methods of work is limited only by the needs and condition of the the client.’ A therapist’s ability to use everything – from what happens in therapeutic process till their personal weaknesses – for the benefit of therapeutic process, can be considered an important sign that the therapist can freely and creatively choose methods of his therapeutic work. Therapists are not inclined to use ready-made therapeutic techniques.
The theme ‘Collaborative exploration and acceptance of the client’s lived world as a method of transforming client’s assumptions about himself and his life’ unfolds ‘how?’ and ‘what for?’, the repeatedly mentioned exploration of a client’s lived world that takes place in therapy. Therapist A. in answering the question about the usefulness of such exploration work says: ‘this leads to a greater acceptance, a man can change something only when he sees it and has accepted it, until there is acceptance, no change is possible.’ Therapist B. emphasises that calm self-exploration in the presence of another person allows a client to create the basis for change he desires because ‘this process changes client’s attitude towards himself’.
The theme ‘Limitations of the therapist as an obstacle to the therapeutic process’ is an interesting nuance in existential therapy. Nearly all therapists in interviews mentioned one or another group or kind of clients they have particular struggles to work with and that they always think twice about whether they personally are be able to handle what this client brings (it would not be ethical to give any examples). Usually psychotherapists of other modalities try to identify whether this particular client is suitable for the therapy they practise. Here we see another attitude, as participants of research show their respect for any client and their right to receive help, but are considerate and critical about their ability to do it themselves in a noble way.
The theme ‘The therapist’s ability to keep a long-term openness to any feelings of the client – the central aspect of the therapeutic emotion work’ is self-explanatory. The most precise expression of this theme is found in therapist M’s. interview: ‘and if there is a very intense feeling, then you must be able to stay open and to respond to the client openly, if needed’.
He also specifies that not to be open means: ‘hide and defend yourself, i.e. close yourself for the client.’ To accept and respond openly can sometimes mean also ‘openly not to accept’ the feelings of the client and speak openly about it with the client.
The theme ‘Exploration of the client’s psychological resistance as a natural way of his being in the world’ emphasises a significant feature of existential therapy practice. Therapist K. puts it in these words: ‘If a person in therapy is very withdrawn, my interest will be attracted exactly by his withdrawnness, I will look at how much I can talk with him about how he feels himself in his withdrawnness which I experience while being with him, yes… at first comes the acceptance of him being withdrawn.’ So therapists empathically refer to the resistance of the clients as their natural behaviour which has its meaning in the client’s life.
The theme ‘The asymmetry of devoted time and attention to the client and the therapist in the therapeutic process’ emphasises that therapy time is devoted to client, his needs and his life is the central focus in therapy despite partnership-like relationship, mutual and collaborative relationship with therapist.
The next theme is ‘Setting of therapeutic goals through mutual exploration of client’s needs and his life’s difficulties’. Therapist K. says: ‘the goal of therapy must be seen to both of us and both of us must understand this goal.’ Discussion and setting of therapeutic goals is not an act or an action limited in time, but is a prolonged circular process which can be repeated several times during therapy. The therapy goal always arises from the client’s needs and his own conscious decision to change something in his life. The client’s conscious decision to change nothing is equally respected.