Existential Therapy

For a therapy with an approach that has stood the test of time, it would be hard to do better than Existential Psychotherapy, according to Emmy van Deurzen, director of the New School of Psychotherapy and Counselling in London. The tradition of philosophers advising us how to live a good life goes back more than 2000 years to the times of Plato and Aristotle she says.

However, although philosophers have been giving advice for thousands of years, existential psychotherapy really depends on two developments in this century. First, Freud’s invention of psychoanalysis provided a setting within which therapist and client can begin to address the client’s problems. Second, existential philosophy, particularly the writings of Heidegger and Sartre, provided a new framework for interpreting, investigating and resolving those problems.

From a practical perspective the the existential approach began with psychoanalysts who became dissatisfied with the Freudian framework in which they had been trained. “I studied philosophy and trained as a clinical psychologist and then as a psychoanalytic psychotherapist”, van Deurzen says “but I found that philosophy was more help to my patients than psychoanalysis”.

The philosophy in question is that of Heidegger, whose most influential work “Being and Time” was published in 1927. He was concerned with a uniquely human aspect of existence, which he called ‘Dasein’, the fact that our existence only means anything because of the effect we have on the world around us. The world also affects us; we must make choices about how to live, and we must face the inevitability of death. These concerns might seem overly gloomy, but Heidegger can also be seen as a pragmatist reacting against the prevailing reluctance to acknowledge our mortality and the tendency to trivialise freedom of choice. Only by acknowledging the fundamental limitations of our situation can we make rational decisions about how to behave.

From this perspective, anxiety and psychological distress are natural reactions to the uncertainty of human existence and to unexpected and uncontrollable events, according to Ernesto Spinelli, of the School of Psychotherapy and Counselling at Regent’s College in London. The task of the therapist is to help the patient to explore their current situation and the way it reflects the choices they have made in response to the tensions and pressures in their life.

The exploration can help in two ways. First, when a problem is put into context and it is clear how it relates to the patient’s circumstances and the choices they have made, the problem may be easier to accept. Second, by exploring the circumstances surrounding the problem other possible choices can be revealed and some of these may change the problem to make it more acceptable.

There is none of the Freudian emphasis on rummaging around in the patient’s unconscious for the roots of their problems. Of course by exploring the ramifications of choices, consequences and circumstances surrounding the way the patient lives, the therapist will often reveal compromises that are implicit in their behaviour but that they were unaware of, Spinelli says. But this is a pale shadow indeed of the Freudians’ sordid storehouse of unresolved conflicts and frustrated desires.

Memories have no special significance, although an existential therapist will be interested in how the client uses memories of the past to be how she is today, Spinelli says. But the main interest is in exploring what it is like to be the client. What does her problem mean to her? How will the steps she might take to solve the problem affect all the other relationships that are important to her? “It’s important to recognise that a problem doesn’t only exist as a problem for a client: it is part of the framework of events that allows that person to exist.” Spinelli says. “Sometimes they need help to find the courage to consider possible solutions.”

The therapist and the client take a collaborative approach in their discussion of the client’s problems. Consequently they are much more likely to discuss things face-to-face than to use a couch. The emphasis on circumstances and relationships means that although existential therapists will deal with any problem, they are particularly helpful with crisis situations, life transitions, adolescence, mid-life crises and relationship problems van Deurzen says.

{One advantage of existential therapy is that the fact that it seeks to explore a problem from the client’s perspective means that it in principle it is much easier for it to cross cultural boundaries.} An important area of application in recent years has been HIV and Aids counselling.

In looking for an existential therapist – as with any other psychotherapist – it is important to use a reliable referral service like those listed below, or to check the credentials of your therapist. Some of the ideas of existential therapy have been widely adopted by people interested in new age approaches. “People are calling themselves existential counsellors who were not trained in that way” van Deurzen says. Some of them probably were not trained at all!

In the UK and the US there are referral services for accredited psychotherapists.
US: Tel: 1 800 964 2000, or go to https://helping.apa.org/
UK Tel: 0207 436 3002 or go to https://www.psychotherapy.org.uk/

For further information try: