Existential Psychotherapies EXISTENTIAL APPROACHES Way of thinking about

Existential Psychotherapies

EXISTENTIAL APPROACHES § Way of thinking about humans and about life § Closely linked to European Existential Philosophy: § Dilemmas of contemporary life (1940 -50 s) § isolation, alienation and meaninglessness § Importance of subjectivity and self-determination § Truth depends on the existing person, in a given situation and in a given time § Freedom to be ourselves implies responsibility 2

European Existential Philosophers § Kierkergard § angst - dread anxiety related to uncertainty in living § Nietzsche § Values are within the individual § Sartre § Freedom to be what we choose and related responsibility § Simon de Beauvoir The Second Sex § Buber § Stressed the I/Thou Relationship – less individualistic 3

Existentialist Psychology § Victor Frankle § Logotherapy: Man in Search for Meaning § Nietzsche “He who has a why to live for, can bear with almost any how. ” § Rollo May § First book: Meaning of Anxiety (1950) § Co-editor: Existence: A New Dimension in Psychiatry and Psychology (1958) introduced existential psychology to the US. § Irving Yalom § Existential Psychotherapy, (1980) 4

Irving Yalom https: //www. youtube. com/watch? v=tu. Ca 8 Rc 1 S ao (2005) 5

Theory of Personality § Dynamic Model Forces in conflict § need to survive and assert one’s being vs. conscious and unconscious fears related to: § Givens of Existence or Ultimate Concerns § Death Freedom/Responsibility § Isolation Meaninglessness 6

Boundary situation § Experience or event that propels the person to face one or more ultimate concerns: § § terminal illness death of a loved one life crisis – divorce, loss of job life change – empty nest, aging, retirement 7

Conflict/Mental Health § Awareness of Ult. Concerns >>>Anxiety >>> Def. Mechanisms § Ways to deal with the anxiety § Provide safety, restrict growth § Mental Health § Ability to cope with anxiety of being alive 8

Anxiety § NORMAL/Existential ANXIETY § Proportionate to the situation § Does not require repression § Can be used in a productive way § NEUROTIC ANXIETY § Disproportionate to the situation § Tends to be repressed § Paralyzes the individual 9

Guilt § Normal Ethical aspects of behavior § Existential failure to live up to one’s capacities; avoid responsibility of making own choices § Neurotic Fantasized transgressions toward others or self 10

Therapy Goals § Explore anxiety related to the ultimate concerns, conscious/unconscious § Identify mechanisms of defense (symptoms) clients use to deal with existential anxiety § Move clients to confront the fear and pain associated with the ultimate concerns § Help clients develop adaptive ways of dealing with 11 existential anxiety

Freedom vs. Responsibility § We are ultimately responsible for who we are, what we believe in, and how we behave § Anxiety is generated by our fear of not knowing or of making mistakes § We must make authentic choices rather than follow what has been given to us 12

Responsibility: Defenses § Displace it others/circumstances § Deny responsibility e. g. victim role § Avoid responsibility e. g. symptoms 13

Process of Making Decisions WISHING >>>> WILLING >>>> ACTION Symptoms § Impulsive Behavior § Non-discrimination among wishes; § Jump from every wish to action § Compulsive Behavior § Driven by ego-alien demands § Action w/o wishing 14

Freedom: Therapy § Help client recognize and accept responsibility for making choices § Confront responsibility avoidance (won’t vs. can’t) § Encourage clients to connect with their feelings § Explore how client contributes to problems 15

Isolation § Awareness of our intrinsic isolation vs. desire to be part of something larger § Interpersonal social skills, intimacy § Intra-personal connected with self § Existential Unavoidable § Defense: § Fusion: soften our ego boundaries and become part of another individual, group, or cause 16

Isolation: Therapy § Help clients confront their fear of aloneness § Personal growth entails a degree of isolation § To create authentic relationships with others we must have confronted and accepted our ultimate isolation § Within the real relationship between client and therapist, client may learn limits and rewards of intimacy 17

Meaninglessness § We naturally search for meaning, but we live in a world where there are no intrinsic meanings § Need to construct a personal sense of meaning § “Wishing” finding meaning requires access to affective experience § A sense of meaning is guided by our values: § why we live and § how to live 18

Meaninglessness: Therapy § May not be an issue for all clients § Personal growth § Boundary situations § Depression § Help clients connect with their affective selves, to discover inner sources of motivation and meaning § Help clients get engaged in life activities 19

Death § Fear of self-destruction – primary source of anxiety § Defenses against death awareness – denial, reaction formation § Awareness of death gives meaning to our life (paradox) § enhances the importance of the present moment § leads us to live more fully 20

Defense Mechanisms Awareness of Ult. Concerns >>>Anxiety >>> Def. Mechanisms Drive >>> Anxiety >>> Def. Mechanism § Defense mechanisms provide some temporary relief, but they restrict growth § Existentialists ascribe to the defense mechanisms that were proposed by Freud 21

Psychotherapy : Goals § Main goal is to help clients § Increase awareness about themselves and how they are living § Confront their anxieties and fears § Re-define themselves and their world in ways that lead to a more authentic life § Focus on the future § Main vehicle of therapy is an authentic, real relationship with therapist 22

Psychotherapy: Relationship 1/2 § Therapy is a journey taken by therapist and client § The person-to-person relationship is key § Therapists stay in contact with their own phenomenological world -- Genuine § Therapists must distinguish between transference and the actual, real relationship (they co-exist) 23

Psychotherapy: Relationship § The core of therapeutic relationship § Respect and faith in the clients’ potential to cope § Sharing reactions with genuine concern and empathy § Focus on the here-and-now experience in therapeutic relationship 24

Psychotherapy: Techniques § Paradoxical intention § Situational reconstruction § Compensatory self improvement 25

Psychotherapy: Techniques § Paradoxical intention § prescribing the symptom: help clients gain more control of their behavior, get “unstuck” § Situational reconstruction § think of three ways in which a situation could be better and three ways in which it could be worse - to help people move on from the place they are stuck § Compensatory self improvement § work on areas that you have control when you are in a situation you don't control 26

Contributions § Provides new ways of understanding death, anxiety, guilt, loneliness, and alienation § Emphasizes the person's freedom and responsibility in designing their own lives § Importance placed on the human quality of therapeutic relationship 27

Contributions § Philosophical orientation applicable regardless of counselor’s theoretical orientation § Particularly useful to understand issues presented by clients who may be confronting existential crises 28

Limitations § Lacks a systematic statement about principles and practices of psychotherapy § Does not lend itself to empirical research § Concepts are abstract and difficult to apply in practice 29

Gestalt § Existential & Phenomenological – it is grounded in the client’s “here and now” § Goal: clients gain awareness of feelings and behaviors in the here and now § Promotes direct experiencing rather than talking about situations § talk about a childhood trauma vs. become the hurt child 30

Frederick Perls 1893 -1970 § Born in Germany, § Psychiatrist and psychoanalyst § Emigrated to U. S. in 1946 and broke with psychoanalytic tradition § Controversial and charismatic figure § Gestalt therapy became a kind of cult § Collaborated with his wife (Laura Perls 19051990) in delivering workshops and writing 31

The Now § Our “power is in the present” § Nothing exists except the “now” § The past is gone and the future has not yet arrived § The power of the present is lost if : § We focus on past mistakes or engage in endless resolutions and plans for the future § Therapist focuses more on the process of therapy than on the content 32

Unfinished Business § Unexpressed feelings such as anger, resentment, and fear, that interfere with effective contact with oneself and with others § Threatening § Not fully experienced in awareness § Result in: § Preoccupation, compulsive behavior, wariness and self-defeating behaviors 33

Contact and Resistance to Contact § CONTACT § To interact openly with environment w/o losing one’s individuality § Requires contact/awareness of one-self § RESISTANCE TO CONTACT § Defenses that prevent experiencing the present fully § Defenses: used to control the environment rather than allowing real contact § Typically these defenses are out of awareness; may contribute to dysfunctional behavior 34

Defenses Resistance to Contact Introjection Uncritical acceptance of others’ beliefs and standards w/o making them our own. • Lack of clear sense of self Projection Retroflection To disown certain aspects of ourselves by ascribing them to the environment • Victim stance; powerlessness to initiate change To turn back to ourselves something we would like to do (or have done) to someone else • Self-injury vs. fear of directing aggression outwardly • Depression -psychosomatic symptoms vs. 35 expressing anger

Defenses Resistance to Contact Deflection To avoid real contact and awareness by being vague and indirect. • Humor, abstract generalizations, ignoring Confluence To loose the sense of the boundary between self and environment (others). • Go with the flow, enmeshment, 36

Goal Gestalt Therapy § Gain awareness § Know the environment § Know oneself § Learn about dominant ways of avoiding contact § What does the resistance (defense) does for the client § What it protects the person from § What it keeps the person from experiencing § Accept oneself and responsibility for self § Allow oneself to make contact 37

Therapist Role § Provide an authentic relationship § Focus on process versus content § Experiments to increase client’s selfawareness § Coach clients to arrive at their own interpretations/ counselor does not interpret § Confrontation § To help client become aware of discrepancies between: § verbal and nonverbal expressions, § feelings and actions, and/or § thoughts and feelings. 38

Gestalt Experiments § Allow clients to express themselves behaviorally § Lead to fresh emotional experiences and new insights § Facilitate experiencing in the moment, rather than talking about…. 39

Gestalt Experiments § Internal Dialogue § Empty Chair § Making the Rounds § Reversal Exercise § The Rehearsal Exercise § Exaggerating Exercise § Staying with the Feeling 40

Contributions and Limitations • Creative use of active interventions (experiments) to foster experiential learning • Confrontational style that deemphasizes cognitive factors • Experiments can be used by therapist in a manipulative way • Highly active and directive stance of therapist could lead to abuse of power 41