Corsini- Existential Psychotherapy

7/28/2019 Corsini- Existential Psychotherapy

1/5

EXISTENTIAL PSYCHOTHERAPY

Rather than being a technical approach that offers a new set of rules for psychotherapy, itrepresents a way of thinking about human experience that canor perhaps should bea part

all therapies.

Everyone must confront the timeless and intractable issues of the ultimate concerns:death, freedom, isolation, and meaning. An existential approach to therapy involvessomeone, a therapist, willing to walk unflinchingly with patients through lifes deepestand most vexing problems. Existential psychotherapy is an attitude toward human suffering

and has no manual. It asks deep questions about the nature of the human being and the natureof anxiety, despair, grief, loneliness, isolation, and anomie. It also deals centrally with thequestions of meaning, creativity, and love. Out of reflection on these human experiences,existential psychotherapists have devised attitudes toward therapy that do not distort humanbeings in the very effort of trying to help them.

Basic Concepts

Existentialists regard people as meaning-making beings who are both subjects of experienceand objects of self-reflection. We are mortal creatures who, because we are self-aware, knowthat we are mortal. Yet it is only in reflecting on our mortality that we can learn how to live.People ask themselves questions concerning their being: Who am I? Is life worth living? Does

it have a meaning? How can I realize my humanity? Existentialists hold that ultimately, eachof us must come to terms with these questions and each of us is responsible for who we areand what we become.Existential psychotherapists, then, focus on the subjectivity of experiencerather than objective diagnostic categories.

The Ultimate ConcernsThe existential dilemma ensues from the existential reality that although we crave topersist in our being, we are fi nite creatures; that we are thrown alone into existence without apredestined life structure and destiny; that each of us must decide how to live as fully,happily, ethically, and meaningfully as possible. Yalom defi nes four categories of ultimateconcerns that encompass these fundamental challenges of the human condition. These are

freedom, isolation, meaning(-lessness), and death.

FreedomIt refers to the idea that we all live in a universe without inherent design in which weare the authors of our own lives. Life is groundless, and we alone are responsible for our

choices. This existential freedom carries with it terrifying responsibility and is alwaysconnected to dread. Erich Fromm (1941) described thelust for submission thataccompanies the effort to escape from that freedom. Ultimately, we are responsible for whatwe experience in and of the world. Responsibility is inextricably linked to freedom becausewe are responsible for the sense we make of our world and for all of our actions and ourfailures to act.The work of therapy is very muchabout the (re)assumption of responsibility for ones experience.

Isolation


2/5

Individuals may be isolated from others (interpersonal isolation) or from parts of themselves(intrapersonal isolation).But there is a more basic form of isolation, existential isolation thatpertains to our aloneness in the universe, which, though assuaged by connections to otherhuman beings, yet remains.

MeaningAll humans must find some meaning in life, although none is absolute and none is given to us.We create our own world and have to answer for ourselves why we live and how we shalllive. One of our major life tasks is to invent a purpose sturdy enough to support a life; oftenwe have a sense of discovering a meaning, and then it may seem to us that it was out there

waiting for us. Our ongoing search for substantial purpose-providing life structures oftenthrows us into a crisis. More individuals seek therapy because of concerns about purpose inlife than therapists often realize.Death

Overshadowing all these ultimate concerns, the awareness of our inevitable demise is themost painful and difficult. We strive to find meaning in the context of our existential

aloneness and take responsibility for the choices we make within our freedom to choose, yetone day we will cease to be. And we live our lives with that awareness in the shadow. Deathis always the distant thunder at our picnic, however much we may wish to deny it. Everythingfades. This is the sad existential truth. Life is truly linear and irreversible. This knowledge canlead us to take stock of ourselves and ask how we can live our lives as fully as possible.

Existential psychotherapy emphasizes the importance of living mindfully and purposefully,aware of ones possibilities and limits in a context of absolute freedom and choice. Death, in

this view, enriches life.

The Therapeutic Stance: The Fellow Traveler

Awareness of the ultimate concerns as givens of existence fundamentally changes therelationship between therapist and patient to that offellow travelers. From this vantage point,even labels of patient/therapist, client/counselor, analysand/analyst become inappropriate tothe nature of the relationship, for they suggest distinctions between them (the afflicted) andus (the healers). However, we are all in this together, and there is no therapist and noperson immune to the inherent tragedies of existence. Sharing the essence of the humancondition becomes the bedrock of the work of existential psychotherapy.

HISTORY

Epicurus, St. Augustine

The contemporary term existentialism is most often associated with the French philosophers

Jean Paul Sartre and Gabriel Marcel, who developed this philosophy in the 1940s. Existentialtherapists have also been infl uenced by the work of such philosophers as Martin Heidegger,Edmund Husserl, Emmanuel Levinas, and Martin Buber.--The central foundational philosophers of existential psychotherapy are two

19th-century intellectual giants, Sren Kierkegaardand Friedrich Nietzsche.

--The Swiss psychiatrist Ludwig Binswanger (18811966), a colleague and friend of

Sigmund Freud, was the fi rst physician to combine psychotherapy with existentialism.


3/5

Theory of Personality

Existential psychotherapy is a dynamic psychotherapy. It takes from Freud the modelof personality as a system of forces in conflict with one another. The emotions and behavior

(both adaptive and pathological) that constitute personality may exist at different levels ofconsciousness, some entirely out of awareness, and may conflict.

Existential Psychodynamics

In contrast to the Freudian model, which posits conflict between instincts and the demands ofthe environment (or the superego, which is the environment internalized), and in contrast tothe interpersonal and object relational models that posit conflict stemming from interactionswith significant powerful others in childhood, the existential model of personality postulates

that the basic conflict is between the individual and the givens, the ultimate concerns ofexistence. Thus, the existential system replaces the Freudian system of

DRIVEANXIETYDEFENSE MECHANISMwith

AWARENESS OF ULTIMATE CONCERNANXIETYDEFENSE MECHANISM

Variety of Concepts

May attributes anxiety to the fundamental clash between being and the threat of nonbeing.A

certain amount of anxiety is therefore a normal and inevitable aspect of every personality.

Freedom

Freedom in the existential frame of reference is riveted to dread. Freedom refers to the factthat the human being is responsible for and the author of his or her own world, own lifedesign, and own choices and actions. The human being, as Sartre puts it, is condemned tofreedom (1956, p. 631). Rollo May (1981) holds that freedom, in order to be authentic,requires the individual to confront the limits of his or her destiny.

Awareness of freedom implies responsibility for ones life.

Another aspect of freedom is willing. To be aware of responsibility for ones situationis to enter the vestibule of action or, in a therapy situation, of change. Willingrepresents the passage from responsibility to action, moving from wishing to deciding(May, 1969). Many individuals have enormous diffi culties in experiencing or expressing awish. Thus, personality is informed by how people deal with the dilemmas of freedom. Fromthe duty-bound to the capricious to the dependent, people have an array of mechanisms todeny or displace their freedom.

Isolation

Fear of existential isolation (and the defenses against it) underlies a great deal of interpersonal

psychopathology.


4/5

Meaninglessness

The human being appears to require meaning.Our perceptual neuropsychologicalorganization is such that we instantaneously pattern random stimuli.A sense of meaning oflife is necessary for still another reason: From a meaning schema, we generate a hierarchy of

values. Values provide us with a blueprint for life conduct; values tell us not only why we livebut how to live.To grow as a person, one must constantly challenge ones structure of meaning, which is thecore of ones existence, and this necessarily causes anxiety. Thus to be human is to have theurge to expand ones awareness, but to do so causes anxiety. Growth, and with it normalanxiety, consists of the giving up of immediate security for the sake of more extensive goals(May, 1967). The authentic person recognizes the hazards of exploring uncharted territoryand does so nonetheless. The anxiety associated with moving forward into the unknown is anunfortunate concomitant of exercising ones freedom and realizing a quest for meaning.

DeathFrom the existential point of view, a core inner conflict is between awareness of inevitabledeath and the simultaneous wish to continue to live.Psychopathology, to a very great extent, is the result of failed death transcendence; thatis, symptoms and maladaptive character structure have their origin in the individual terror ofdeath. There are many defense mechanisms that might be employed for dealing with theanxiety emerging from awareness of death, among them an irrational belief in personalspecialness and an irrational belief in the existence ofan ultimate rescuer (Yalom,

1980).

SpecialnessAlthough at a rational level we recognize the foolishnessof these beliefs, nonetheless, at a deeply unconscious level, we believe that the ordinary lawsof biology do not apply to us. What psychotherapists might simply label narcissism orentitlement may actually be subterfuge for the belief that specialness is an antidote to death.Similarly, workaholism or preoccupation with getting ahead, with preparing for the future,amassing material goods, or becoming more powerful or more eminent can be compulsiveways of unconsciously trying to ensure immortality.

The Belief in the Existence of an Ultimate RescuerA second denial system is belief in an ultimate rescuer. People may imagine their rescuer tobe human or divine, but the belief is in someone who is watching over them in an indifferentworld.

Theory of Psychotherapy

Existential therapy is nota comprehensive psychotherapeutic system; it is a frame of

referencea paradigm by which one views and understands a patients suffering in a

particular manner.

Existential therapists begin with presuppositions about the sources of a patients anguish andview the patient in human rather than behavioral or mechanistic terms. They may employ any

of a large variety of techniques used in other approaches insofar as they are consistent withbasic existential presuppositions and a human, authentic therapistpatient encounter.


5/5

The basic approach in existential therapy is strategically similar to other dynamictherapies. The therapist assumes that the patient experiences anxiety that issues from someexistential conflict that is at least partially unconscious and that suffering ensues fromproblems in being (Wheelis, 1973). The patient handles anxiety by a number of ineffective,maladaptive defense mechanisms that may provide temporary respite from anxiety butultimately so cripple the individuals ability to live fully and creatively that these defensesmerely result in still further secondary anxiety.

The existential therapist strives for an understanding of the patientscurrent life situation andcurrentenveloping unconscious fears.From the existential perspective, deep means the most fundamental concerns facingthe individual at that moment. The past (i.e., ones memory of the past) is importantonly insofar as it is part of ones current existence and has contributed to ones current modeof facing ultimate concerns.Existential therapy does not attempt to excavate and understand the past; instead, it is directedtoward the futures becoming the present and explores the past only as it throws light on the

present.

Process of Psychotherapy

In the existential framework, anxiety is so riveted to existence that it has a differentconnotation from the way anxiety is regarded in other frames of reference. The existentialtherapist hopes to alleviate crippling levels of anxiety but not to eliminate it. Life cannot belived (nor can death be faced) without anxiety. The therapists task, as May reminds us (1977,p. 374), is to reduce anxiety to tolerable levels and then to use the anxiety constructively.

Documents

Corsini- Existential Psychotherapy