Group psychotherapy

Group psychotherapy or group therapy is a form of psychotherapy in

which one or more therapists treat a small group of clients together as a
group. The term can legitimately refer to any form of psychotherapy
when delivered in a group format, including Cognitive behavioural
therapy or Interpersonal therapy, but it is usually applied to
psychodynamic group therapy where the group context and group
process is explicitly utilised as a mechanism of change by developing,
exploring and examining interpersonal relationships within the group.
The broader concept of group therapy can be taken to include any
helping process that takes place in a group, including support groups,
skills training groups (such as anger management, mindfulness,
relaxation training or social skills training), and psycho-education groups.
The differences between psychodynamic groups, activity groups, support
groups, problem-solving and psycoeducational groups are discussed by
Montgomery (2002).[1] Other, more specialised forms of group therapy
would include non-verbal expressive therapies such as art therapy,
dance therapy, or music therapy.
History[edit]
The founders of group psychotherapy in the USA were Joseph H. Pratt,
Trigant Burrow and Paul Schilder. All three of them were active and
working at the East Coast in the first half of the 20th century. After World
War II, group psychotherapy was further developed by Jacob L. Moreno,
Samuel Slavson, Hyman Spotnitz, Irvin Yalom, and Lou Ormont. Yalom's
approach to group therapy has been very influential not only in the USA
but across the world. An early development in group therapy the T-group
or training group (sometimes also referred to as sensitivity-training
group, human relations training group or encounter group) is a form of
group psychotherapy where participants themselves (typically, between
eight and 15 people) learn about themselves (and about small group
processes in general) through their interaction with each other. They use
feedback, problem solving, and role play to gain insights into
themselves, others, and groups. It was pioneered in the mid-1940s by
Kurt Lewin and Carl Rogers and his colleagues as a method of learning
about human behavior in what became The National Training
Laboratories (now NTL Institute) that was created by the Office of Naval
Research and the National Education Association in Bethel, Maine, in
1947. Moreno developed a specific and highly structured form of group
therapy known as Psychodrama (although the entry on psychodrama
claims it is not a form of group therapy). Another recent development in
the theory and method of group psychotherapy based on an integration
of systems thinking is Yvonne Agazarian's "systems-Centered" approach
(SCT), which sees groups functioning within the principles of system
dynamics. Her method of "functional subgrouping" introduces a method
of organizing group communication so it is less likely to react
counterproductively to differences. SCT also emphasizes the need to
recognize the phases of group development and the defenses related to
each phase in order to best make sense and influence group dynamics.
In the United Kingdom group psychotherapy initially developed
independently, with pioneers S. H. Foulkes and Wilfred Bion using group
therapy as an approach to treating combat fatigue in the Second World

War. Foulkes and Bion were psychoanalysts and incorporated

psychoanalysis into group therapy by recognising that transference can
arise not only between group members and the therapist but also among
group members. Furthermore the psychoanalytic concept of the
unconscious was extended with a recognition of a group unconscious, in
which the unconscious processes of group members could be acted out
in the form of irrational processes in group sessions. Foulkes developed
the model known as Group Analysis and the Institute of Group Analysis,
while Bion was influential in the development of group therapy at the
Tavistock Clinic.
Bion's approach is comparable to Social Therapy, first developed in the
United States in the late 1970s by Lois Holzman and Fred Newman,
which is a group therapy in which practitioners relate to the group, not its
individuals, as the fundamental unit of development. The task of the
group is to "build the group" rather than focus on problem solving or
"fixing" individuals.
In Argentina an independent school of group analysis stemmed from the
work and teachings of Swiss-born Argentine psychoanalyst Enrique
Pichon-Riviere. This thinker conceived of a group-centered approach
which, although not directly influenced by Foulkes' work, was fully
compatible with it.[2]
Therapeutic principles[edit]
Yalom's therapeutic factors (originally termed curative factors but
renamed therapeutic factors in the 5th edition of 'The Theory and
Practice of Group Psychotherapy').
Universality
The recognition of shared experiences and feelings among group
members and that these may be widespread or universal human
concerns, serves to remove a group member's sense of isolation,
validate their experiences, and raise self-esteem
Altruism
The group is a place where members can help each other, and the
experience of being able to give something to another person can lift the
member's self esteem and help develop more adaptive coping styles and
interpersonal skills.
Instillation of hope
In a mixed group that has members at various stages of development or
recovery, a member can be inspired and encouraged by another
member who has overcome the problems with which they are still
struggling.
Imparting information
While this is not strictly speaking a psychotherapeutic process, members
often report that it has been very helpful to learn factual information from
other members in the group. For example, about their treatment or about
access to services.
Corrective recapitulation of the primary family experience
Members often unconsciously identify the group therapist and other
group members with their own parents and siblings in a process that is a
form of transference specific to group psychotherapy. The therapist's

interpretations can help group members gain understanding of the

impact of childhood experiences on their personality, and they may learn
to avoid unconsciously repeating unhelpful past interactive patterns in
present-day relationships.
Development of socializing techniques
The group setting provides a safe and supportive environment for
members to take risks by extending their repertoire of interpersonal
behaviour and improving their social skills
Imitative behaviour
One way in which group members can develop social skills is through a
modeling process, observing and imitating the therapist and other group
members. For example, sharing personal feelings, showing concern, and
supporting others.
Cohesiveness
It has been suggested[3] that this is the primary therapeutic factor from
which all others flow. Humans are herd animals with an instinctive need
to belong to groups, and personal development can only take place in an
interpersonal context. A cohesive group is one in which all members feel
a sense of belonging, acceptance, and validation.
Existential factors
Learning that one has to take responsibility for one's own life and the
consequences of one's decisions.
Catharsis
Catharsis is the experience of relief from emotional distress through the
free and uninhibited expression of emotion. When members tell their
story to a supportive audience, they can obtain relief from chronic
feelings of shame and guilt.
Interpersonal learning
Group members achieve a greater level of self-awareness through the
process of interacting with others in the group, who give feedback on the
member's behaviour and impact on others.
Self-understanding
This factor overlaps with interpersonal learning but refers to the
achievement of greater levels of insight into the genesis of one's
problems and the unconscious motivations that underlie one's behaviour.
Settings[edit]
Group therapy can form part of the therapeutic milieu of a psychiatric inpatient unit[4][5] or ambulatory psychiatric Partial hospitalization (also
known as Day Hospital treatment).[6] In addition to classical "talking"
therapy, group therapy in an institutional setting can also include groupbased expressive therapies such as drama therapy, psychodrama, art
therapy, and non-verbal types of therapy such as music therapy and
dance/movement therapy. Group psychotherapy is a key component of
Milieu Therapy in a Therapeutic Community. The total environment or
milieu is regarded as the medium of therapy, all interactions and
activities regarded as potentially therapeutic and are subject to
exploration and interpretation, and are explored in daily or weekly
community meetings.[7] However, interactions between the culture of
group psychotherapeutic settings and the more managerial norms of
external authorities may create 'organizational turbulence' which can
critically undermine a group's ability to maintain a safe yet challenging
'formative space'.[8] Academics at the University of Oxford studied the
inter-organizational dynamics of a national democratic therapeutic

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community over a period of four years; they found external steering by

authorities eroded the community's therapeutic model, produced a crisis,
and led to an intractable conflict which resulted in the community's
closure.[9]
A form of group therapy has been reported to be effective in psychotic
adolescents and recovering addicts.[10] Projective psychotherapy uses
an outside text such as a novel or motion picture to provide a "stable
delusion" for the former cohort and a safe focus for repressed and
suppressed emotions or thoughts in the latter. Patient groups read a
novel or collectively view a film. They then participate collectively in the
discussion of plot, character motivation and author motivation. In the
case of films, sound track, cinematography and background are also
discussed and processed. Under the guidance of the therapist, defense
mechanisms are bypassed by the use of signifiers and semiotic
processes. The focus remains on the text rather than on personal issues.
[11] It was popularized in the science fiction novel, Red Orc's Rage.
Group therapy is now often utilized in private practice settings
(Gardenswartz, 2009, Los Angeles, CA).
Group-analysis has become widespread in Europe, and especially the
United Kingdom, where it has become the most common form of group
psychotherapy. Interest from Australia, the former Soviet Union and the
African continent is also growing.[12]
Research on effectiveness[edit]
There is clear evidence for the effectiveness of group psychotherapy for
depression: a meta-analysis of 48 studies showed an overall effect size
of 1.03, which is clinically highly significant.[13] Similarly, a metaanalysis of five studies of group psychotherapy for adult sexual abuse
survivors showed moderate to strong effect sizes,[14] and there is also
good evidence for effectiveness with chronic traumatic stress in war
veterans.[15] There is less robust evidence of good outcomes for
patients with borderline personality disorder, with some studies showing
only small to moderate effect sizes.[16] The authors comment that these
poor outcomes might reflect a need for additional support for some
patients, in addition to the group therapy. This is borne out by the
impressive results obtained using Mentalization based treatment, a
model that combines dynamic group psychotherapy with individual
psychotherapy and case management.[17] Most outcome research is
carried out using time-limited therapy with diagnostically homogenous
groups. However, long-term intensive interactional group
psychotherapy[18] assumes diverse and diagnostically heterogeneous
group membership, and an open-ended time scale for therapy. Good
outcomes have also been demonstrated for this form of group therapy.
[19] Group Therapy has been shown to be as or more effective than
individual therapy for higher functioning adults (Gardenswartz, 2009, Los
Angeles, CA). Clinical cases have shown that the combination of both
individual and group therapy is most beneficial for such clients. (the
"multiplicative" effect).
Individual & Group Therapy
Classical Adlerian psychotherapy

Classical Adlerian psychotherapy may involve individual psychotherapy,

couple therapy, or family therapy, brief or lengthier therapy - but all such
approaches follow parallel paths, which are rooted in the individual
psychology of Alfred Adler.
History of Classical Adlerian Psychotherapy[edit]
Alfred Adler was greatly influenced by early socialism and Freud. This
can be seen in his early work and theories. He emphasized that
individuals themselves can change their lives. Adler and Freud
respected one another; however, Adler did not fully agree or accept
Freuds theories. Adler believed childhood experiences have influences
on peoples current problems, but he also did not believe they are the
only contributions. He also emphasizes free will and an inborn drive as
contributors to current problems people face. He doesnt believe
individuals are victims of their past experiences.

instead of why or where from. The goal and purpose of a behavior is

looked at instead of finding the cause of a behavior. The final cause of
the behavior is the focus, which is where fictionate final goal is termed.
Social Interest is another area that contributes to Classical Adlerian
Psychotherapy. He believes individuals are social beings. The way an
individual acts with other people is greatly important in terms of their
psychological health. Social Interest means feeling a part of a family,
group or community. An important concept related to social interest is the
ability to feel empathy. Showing empathy is a way to connect with
others.
[2]
A Brief History on Alfred Adler[edit]

[1]
Career[edit]
Early in his career Adler was focused on public health, medical and
psychological prevention, and social welfare. Later on he shifted towards
children at risk, womens rights, adult education, teacher training,
community mental health, family counseling and education, and briefly
psychotherapy. Adler started a group: The Group for Free
Psychoanalytic Research, which was later changed to Individual
Psychology, with individual meaning indivisible. With this he also
founded his own journal. This is when Classical Adlerian Psychotherapy
began. Adler focused on psychoanalysis when he started his own group,
even working in his private practice as a psychiatrist, but that did not last
long. After World War I he turned to community and social orientation.
He was known as a psychoanalyst before World War I. After the war, he
was more of a philosopher, social psychologist, and educator.
[2]
Components[edit]
Adler had many areas of focus, but there are some key components that
contributed to Classical Adlerian Psychotherapy (a.k.a. Individual
Psychology). Children are born with an inborn force, which enables
people to make their own decision, and develop their own opinions. He
stated that individuals arent just a product of their situations. They are
creators of their situations. A persons feelings, beliefs and behaviors all
work together to make each individual unique. Another area of focus on
was the concept of fictions. Its believed that fictions are conscious and
non-conscious ideas that are not necessarily aligned with reality, but
serve as a guide to cope with reality. People create fictions as ways of
seeing themselves, others around them and their environments and that
people do this to guide their feelings, thoughts, and actions.
Another concept is finality. This is the belief that there is only one
organized force, a fictionate final goal. Fictionate final goal has been
established in early childhood and is present for the rest of a persons
life. It is mostly unconscious and influences behavior. With fictionate final
goal, questions are asked more along the lines of what for or where to

Alfred Alder
"Alfred Adler was born to a Jewish family on February 7th, 1870 in the
outskirts of Vienna. He was the second oldest child of six. He was often
sick as a child, and once he became knowledgeable of death, he
decided to become a physician some day. Adler was raised as a minority
in Vienna because Jews were not in the majority population. Adler's
childhood sickness made him appear weak and inferior. A teacher
recommended that he quit school to become an apprentice shoemaker.
Adler's family objected to this and Alfred eventually went to medical
school and graduated from the University of Vienna with his medical
degree specializing in ophthalmology. Alfred met his future wife, Raissa
Timofeyewna Epstein, in a series of political meetings which revolved
around the current rising socialist movement. The two were married in
1897 Adler started a private practice which slowly switched to internal
medicine. It was here that he observed that many of his patients had
diseases that could be traced to social situation origins. Adler's first
publication discussed how the social conditions of where people worked
influenced diseases and disease processes." [2]
Adler's psychotherapy[edit]
Adler's therapy involved identifying an individual's private life plan,
explaining its self-defeating, useless and predictable aspects, and
encouraging a shift of interest towards social and communal goals.[3]
Among the specific techniques used were paradoxes, humorous or
historical examples, analysis of the self-protective role of symptoms, and
reduction of transference by encouraging self-responsibility.[4] Adler also
favoured what has been called 'prescribing the symptom' - a form of antisuggestion aimed at making the client's self-defeating behavior less
attractive to them.[5]
Based on a growth model of the mind, Adler's approach aimed at
fostering social interest,[6] and reducing repetitive life styles based on
archaic private logic.[7] With its emphasis on reasoning with the patient,
[8] classical Adlerian therapy has affinities with the later approach of
Cognitive behavioral therapy.
Classical Adlerian Psychotherapy[edit]

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Goals/Overview[edit]
Adlerian psychotherapy is unique in the sense that each client has their
own individual type of therapy. The therapy, however, is created by the
therapist on a six-phase process. The overall goal of the therapy is to
establish a relationship between client and community in order not only
to challenge the client's unhealthy and unrealistic thoughts of the world,
but also to challenge them to replace self-defeating behaviors for ones
that will lead to a more positive and healthy lifestyle.[9]
Phase 1[edit]
This stage focuses on support and is broken down into two stages. The
first stage emphasizes empathy and relationships. The therapist
provides warmth, acceptance, and generate hope while giving
reassurance and encouragement to the client. The second stage in this
phase is focused on gathering information on the client. Early childhood
memories and influences are sought out as well as details that provide
information on how the client faces life problems.[9]
Phase 2[edit]
The primary focus in phase two is on encouragement. This is done
through two stages of clarification and encouragement. Therapists clarify
any vague thinking with Socratic questioning and evaluate the
consequences of various actions or ideas. They help the client correct
inappropriate ideas about his or her self and others. They also help the
client create alternative ways of thinking to move his/her life into a new
direction while clarifying feelings.[9]
Phase 3[edit]
Insight is the headline for phase 3. Interpretation and recognition, as well
as knowing are the focus of the Insight phase. The client will learn to
interpret his/her feelings and goals as well as identify what s/he has
avoided in the past. This stage integrates many Freudian ideas such as
dreams, daydreams, and recollections. The Knowing stage is where the
client is now fully aware of his/her lifestyle and does not require any
additional help with this. They know and accept what they need to
change.[9]
Phase 4[edit]
The fourth phase is all about change. Change is first addressed through
the stage of an Emotional Breakthrough. This can be achieved through
the use of role playing, guided imagery and narration. The next stage is
Doing Differently. The client will break old patterns and change their
attitude. This is achieved through creating steps which are based on
abstract ideas. The last stage in this phase is Reinforcement. The
therapist will encourage all efforts made by the client to promote change.
They will reward and affirm positive feelings and changes while
simultaneously evaluating the progress made by the client.[9]
Phase 5[edit]
The final phase is about Challenge. The client goes through a first stage
which is characterized by social interest. S/he is instructed to give 100%
in all relationships and is encouraged to take risks. S/he is required to
extend new feelings of cooperation and empathy to others. Then,

through goal redirection, the client is challenged to release his/her old

self and open a new self and live by these new values. The last and final
stage is focused on support and launching. The therapist will inspire the
client to enjoy the unfamiliar, strengthen their feelings of connectedness
to others, and to continue self growth. ,[9][10]
Phase 6[edit]
The Meta-Therapy phase is for clients who have gone through Alders
therapy, readjusted their lives to better suit their goals, and who are
making progress in becoming who they want to be. This ending part of
the therapy advises clients to find out what aspects of life are truly
important to them, and to pursue thesehigher values.[9]
Notes on Classical Adlerian Psychotherapy[edit]
The Socratic method is aimed to guide clients to clarify feelings and
meanings, gain insight to intentions and consequences and to consider
alternative options. Guided imagery helps bring awareness, change and
growth. Role playing encourages new behaviors and gives the client
practice in how to manage conflict and other challenges. [10]
Contemporary techniques[edit]
There are two main contemporary schools of Adlerian psychotherapy,
those following Rudolf Dreikurs, and those calling themselves by
contrast classical Adlerians.
Dreikurs[edit]
Rudolf Dreikurs is a psychiatrist who studied under Adler in Vienna.
While Adlers work was very popular and received well by American
audiences, it lost popularity after his death. Dreikurs revived Adler
psychotherapy after Adlers death. [2]
Building on Adler's writings, Dreikurs conceptualised a four-stage
approach to Adlerian psychotherapy:
Establishing the therapeutic relationship.
Assessing the client's life style.
Promoting the client's insight into their fictive goal.
Encouraging clients to broaden their interests from the defensive
function of a private logic into a broader sense of community.[11]
Classical Adlerian psychologists[edit]
Adlerian clients are encouraged to overcome their feelings of insecurity,
develop deeper feelings of connectedness, and to redirect their striving
for significance into more socially beneficial directions. Through a
respectful Socratic dialogue,[12] they are challenged to correct mistaken
assumptions, attitudes, behaviors and feelings about themselves and the
world.

indulgence, with greater self-knowledge and genuine, courageous social

feelings.[13]
Uses of Classical Adlerian Psychotherapy[edit]
Individual[edit]
The basic structure of individual therapy in Classical Adlerian
psychotherapy is broken down into 5 phases plus a post-therapy follow
up, and each phase is broken down into multiple stages, 13 total. Each
of these stages has different goals for the client and therapist to
accomplish. This is the type of therapy Classical Adlerian Psychotherapy
was designed for.
Teacher-education Programs[edit]
Teacher-education programs have been designed to increase child
cooperation in classrooms. Teachers, parents, and school administrators
attend these programs and learn techniques to increase their own
teaching effectiveness in the classroom as well as how to learn to better
handle children. These programs are taught in the same manner that
marital programs are taught.
Couple-enrichment Programs[edit]
Similar to group couple counseling, couple-enrichment programs are
conducted by trained professionals and have groups of couples (typically
about 10) attend and learn how to improve and enrich their relationships.
Many different teaching formats are used that include tools such as role
playing, the viewing of videos, and the implementation of other psychosocial exercises. Sessions run for about an hours time.
Parent and Family Education Programs[edit]
These programs are comparable to classes taught by Family Life
Educators. The programs focus on building better family relaitonships.
[2]
Adlerian Psychology Today[edit]
Today, Adlerian Psychology is doing very well. There are many
organizations that write about and still practice this psychology (The
North American Society of Aldlerian Psychology (NASAP), The Journal
of Individual Psychology, the International Associate of Individual
Psychology (IAIP), the International Congress of Adlerian Summer
Schools and Institutes (ICASSI), and various other organizations). Many
United States universities and abroad Universities offer postgraduate
training in Adlerian Psychology. This psychotherapy is growing and is
steadily and increasingly being assimilated into mainstream
psychotherapy. [2]

Constant encouragement stimulates clients to attempt what was

previously felt as impossible. The growth of confidence, pride, and
gratification leads to a greater desire and ability to cooperate.

directive therapy
Etymology: L, diregere, to direct, therapeia, treatment
a psychotherapeutic approach in which the psychotherapist directs the
course of therapy by intervening to ask questions and offer
interpretations. Compare nondirective therapy. See also psychoanalysis.

The ultimate objective of Classical Adlerian psychotherapy is to replace

exaggerated self-protection (safeguarding), self-enhancement and self-

nondirective therapy
[-direktiv]

3 | Page

Etymology: L, non + digere, to direct

a psychotherapeutic approach in which the psychotherapist refrains from
giving advice or interpretation as the client is helped to identify conflicts
and to clarify and understand feelings and values. Compare directive
therapy. See also client-centered therapy.
Existential therapy
Existential psychotherapy is a philosophical method of therapy that
operates on the belief that inner conflict within a person is due to that
individual's confrontation with the givens of existence.[1] These givens,
as noted by Irvin D. Yalom, are: the inevitability of death, freedom and its
attendant
responsibility,
existential
isolation,
and
finally
meaninglessness. These four givens, also referred to as ultimate
concerns, form the body of existential psychotherapy and compose the
framework in which a therapist conceptualizes a client's problem in order
to develop a method of treatment. In the British School of Existential
therapy (Cooper, 2003), these givens are seen as predictable tensions
and paradoxes of the four dimensions of human existence, the physical,
social, personal and spiritual realms (Umwelt, Mitwelt, Eigenwelt and
berwelt).
Background[edit]
The philosophers who are especially pertinent to the development of
existential psychotherapy are those whose work is directly aimed at
making sense of human existence. But the philosophical movements
that are of most importance and that have been directly responsible for
the generation of existential therapy are phenomenology and existential
philosophy.
The starting point of existential philosophy (see Warnock, 1970;
Macquarrie, 1972; Mace, 1999; Van Deurzen and Kenward, 2005) can
be traced back to the nineteenth century and the work of Sren
Kierkegaard and Friedrich Nietzsche. Both were in conflict with the
predominant ideologies of their time and committed to the exploration of
reality as it can be experienced in a passionate and personal manner.
Kierkegaard (181355) protested vigorously against popular
misunderstanding and abuse of Christian dogma and the so-called
'objectivity' of science (Kierkegaard, 1841, 1844). He thought that both
were ways of avoiding the anxiety inherent in human existence. He had
great contempt for the way in which life was being lived by those around
him and believed that truth could ultimately only be discovered
subjectively by the individual in action. What was most lacking was
people's courage to take the leap of faith and live with passion and
commitment from the inward depth of existence. This involved a
constant struggle between the finite and infinite aspects of our nature as
part of the difficult task of creating a self and finding meaning. As
Kierkegaard lived by his own word he was lonely and much ridiculed
during his lifetime.
Nietzsche (18441900) took this philosophy of life a step further. His
starting point was the notion that God is dead, that is, the idea of God

was outmoded and limiting (Nietzsche, 1861, 1874, 1886) and that it is
up to us to reevaluate existence in light of this. He invited people to
release moral and societal constraint and to discover their free will in
order to live according to their own desires, now the only maintainable
law in his philosophy. He encouraged people to transcend the mores of
civilization and choose their own standards. The important existential
themes of freedom, choice, responsibility and courage are introduced for
the first time.
While Kierkegaard and Nietzsche drew attention to the human issues
that needed to be addressed, Edmund Husserl's phenomenology
(Husserl, 1960, 1962; Moran, 2000) provided the method to address
them in a rigorous manner. He contended that natural sciences are
based on the assumption that subject and object are separate and that
this kind of dualism can only lead to error. He proposed a whole new
mode of investigation and understanding of the world and our
experience of it. Prejudice has to be put aside or 'bracketed', in order for
us to meet the world afresh and discover what is absolutely fundamental
and only directly available to us through intuition. If people want to grasp
the essence of things, instead of explaining and analyzing them, they
have to learn to describe and understand them.
Martin Heidegger (18891976) applied the phenomenological method to
understanding the meaning of being (Heidegger, 1962, 1968). He argued
that poetry and deep philosophical thinking can bring greater insight into
what it means to be in the world than can be achieved through scientific
knowledge. He explored human beings in the world in a manner that
revolutionizes classical ideas about the self and psychology. He
recognized the importance of time, space, death and human
relatedness. He also favored hermeneutics, an old philosophical method
of investigation, which is the art of interpretation. Unlike interpretation as
practiced in psychoanalysis (which consists of referring a person's
experience to a pre-established theoretical framework) this kind of
interpretation seeks to understand how the person himself subjectively
experiences something.
Jean-Paul Sartre (190580) contributed many other strands of existential
exploration, particularly in terms of emotions, imagination, and the
person's insertion into a social and political world. The philosophy of
existence on the contrary is carried by a wide-ranging literature, which
includes many other authors than the ones mentioned above. Other
existential authors include Karl Jaspers (1951, 1963), Paul Tillich, Martin
Buber, and Hans-Georg Gadamer within the Germanic tradition and
Albert Camus, Gabriel Marcel, Paul Ricoeur, Maurice Merleau-Ponty,
Simone de Beauvoir and Emmanuel Lvinas within the French tradition
(see for instance Spiegelberg, 1972, Kearney, 1986 or van DeurzenSmith, 1997).[full citation needed]
From the start of the 20th century some psychotherapists were,
however, inspired by phenomenology and its possibilities for working
with people. Otto Rank, an Austrian psychoanalyst who broke with Freud
in the mid-1920s, was the first existential therapist. Ludwig Binswanger,
in Switzerland, also attempted to bring existential insights to his work

with patients, in the Kreuzlingen sanatorium where he was a psychiatrist.

Much of his work was translated into English during the 1940s and
1950s and, together with the immigration to the USA of Paul Tillich
(Tillich, 1952) and others, this had a considerable effect on the
popularization of existential ideas as a basis for therapy (Valle and King,
1978; Cooper, 2003). Rollo May played an important role in this, and his
writing (1969, 1983; May et al., 1958) kept the existential influence alive
in America, leading eventually to a specific formulation of therapy
(Bugental, 1981; May and Yalom, 1985; Yalom, 1980). Humanistic
psychology was directly influenced by these ideas.
In Europe, after Otto Rank, existential ideas were combined with some
psychoanalytic principles and a method of existential analysis was
developed by Medard Boss (1957a, 1957b, 1979) in close co-operation
with Heidegger. In Austria, Viktor Frankl developed an existential therapy
called logotherapy (Frankl, 1964, 1967), which focused particularly on
finding meaning. In France the ideas of Sartre (1956, 1962) and
Merleau-Ponty (1962) and of a number of practitioners (Minkowski,
1970) were important and influential but no specific therapeutic method
was developed from them.
Development in Britain[edit]
Britain became a fertile ground for the further development of the
existential approach when R. D. Laing and David Cooper, often
associated with the anti-psychiatry movement, took Sartre's existential
ideas as the basis for their work (Laing, 1960, 1961; Cooper, 1967; Laing
and Cooper, 1964). Without developing a concrete method of therapy,
they critically reconsidered the notion of mental illness and its treatment.
In the late 1960s they established an experimental therapeutic
community at Kingsley Hall in the East End of London, where people
could come to live through their madness without the usual medical
treatment. They also founded the Philadelphia Association, an
organization providing alternative living, therapy and therapeutic training
from this perspective. The Philadelphia Association is still in existence
today and is now committed to the exploration of the works of
philosophers such as Ludwig Wittgenstein, Jacques Derrida, Levinas,
and Michel Foucault as well as the work of the French psychoanalyst
Jacques Lacan. It also runs a number of small therapeutic households
along these lines. The Arbours Association is another group that grew
out of the Kingsley Hall experiment. Founded by Berke and Schatzman
in the 1970s, it now runs a training program in psychotherapy, a crisis
center, and several therapeutic communities. The existential input in the
Arbours has gradually been replaced with a more neo-Kleinian
emphasis.
The impetus for further development of the existential approach in Britain
has largely come from the development of a number of existentially
based courses in academic institutions. This started with the programs
created by Emmy van Deurzen, initially at Antioch University in London
and subsequently at Regent's College, London and since then at the
New School of Psychotherapy and Counselling, also in London. The
latter is a purely existentially based training institute, which offers
postgraduate degrees validated by the University of Sheffield and

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Middlesex University. In the last decades the existential approach has

spread rapidly and has become a welcome alternative to established
methods. There are now a number of other, mostly academic, centers in
Britain that provide training in existential counselling and psychotherapy
and a rapidly growing interest in the approach in the voluntary sector and
in the National Health Service.
British publications dealing with existential therapy include contributions
by these authors: Jenner (de Koning and Jenner, 1982); Heaton (1988,
1994); Cohn (1994, 1997);[2] Spinelli (1997); Cooper (1989, 2002);
Eleftheriadou (1994); Lemma-Wright (1994); Du Plock (1997); Strasser
and Strasser (1997); van Deurzen (1997, 1998, 2002); van Deurzen and
Arnold-Baker (2005); and van Deurzen and Kenward (2005). Other
writers such as Lomas (1981) and Smail (1978, 1987, 1993) have
published work relevant to the approach although not explicitly
'existential' in orientation. The journal of the British Society for
Phenomenology regularly publishes work on existential and
phenomenological psychotherapy. The Society for Existential Analysis
was founded in 1988, initiated by van Deurzen. This society brings
together psychotherapists, psychologists, psychiatrists, counsellors and
philosophers working from an existential perspective. It offers regular
fora for discussion and debate as well as major annual conferences. It
publishes the Journal of the Society for Existential Analysis twice a year.
It is also a member of the International Federation of Daseinsanalysis,
which stimulates international exchange between representatives of the
approach from around the world. An international Society for Existential
Therapists also exists. It was founded in 2006 by Emmy van Deurzen
and Digby Tantam, and is called the International Community of
Existential Counsellors and Therapists (ICECAP).[3]
Existential therapy's view of the human mind[edit]
Existential therapy starts with the belief that although humans are
essentially alone in the world, they long to be connected to others.
People want to have meaning in one another's lives, but ultimately they
must come to realize that they cannot depend on others for validation,
and with that realization they finally acknowledge and understand that
they are fundamentally alone (Yalom, 1980). The result of this revelation
is anxiety in the knowledge that our validation must come from within
and not from others.
Psychological dysfunction[edit]
Because there is no single existential view, opinions about psychological
dysfunction vary.
For theorists aligned with Yalom, psychological dysfunction results from
the individual's refusal or inability to deal with the normal existential
anxiety that comes from confronting life's "givens": mortality, isolation,
meaninglessness, and freedom.[4]
For other theorists, there is no such thing as psychological dysfunction
or mental illness.[citation needed] Every way of being is merely an
expression of how one chooses to live one's life. However, one may feel
unable to come to terms with the anxiety of being alone in the world. If

so, an existential psychotherapist can assist one in accepting these

feelings rather than trying to change them as if there is something
wrong. Everyone has the freedom to choose how they are going to be in
life, however this may go unexercised because making changes is
difficult; it may appear easier and safer not to make decisions that one
will be responsible for. Many people will remain unaware of alternative
choices in life for various societal reasons.
The good life[edit]
Existentialism suggests that it is possible for people to face the anxieties
of life head-on and embrace the human condition of aloneness, to revel
in the freedom to choose and take full responsibility for their choices.
They courageously take the helm of their lives and steer in whatever
direction they choose; they have the courage to be. One does not need
to arrest feelings of meaninglessness, but can choose new meanings for
their lives. By building, loving, and creating, one is able to live life as
one's own adventure. One can accept one's own mortality and overcome
fear of death. Though the French author Albert Camus denied the
specific label of existentialist, in his novel, L'Etranger, his main character
Meursault, ends the novel by doing just this. He accepts his mortality
and rejects the constrictions of society he previously placed on himself,
leaving him unencumbered and free to live his life with an unclouded
mind.[citation needed] Also, Achenbach has refreshed the socratic
tradition with his own blend of philosophical counseling. So did Michel
Weber with his Chromatiques Center in Belgium.
The strictly Sartrean perspective of existential psychotherapy is
generally unconcerned with the client's past; instead, the emphasis is on
the choices to be made in the present and future. The counselor and the
client may reflect upon how the client has answered life's questions in
the past, but attention ultimately shifts to searching for a new and
increased awareness in the present and enabling a new freedom and
responsibility to act. The patient can then accept they are not special,
and that their existence is simply coincidental, without destiny or fate. By
accepting this, they can overcome their anxieties, and instead view life
as moments in which they are fundamentally free.

reality. The four dimensions are obviously interwoven and provide a

complex four-dimensional force field for their existence. Individuals are
stretched between a positive pole of what they aspire to on each
dimension and a negative pole of what they fear.
Physical dimension On the physical dimension (Umwelt), individuals
relate to their environment and to the givens of the natural world around
them. This includes their attitude to the body they have, to the concrete
surroundings they find themselves in, to the climate and the weather, to
objects and material possessions, to the bodies of other people, their
own bodily needs, to health and illness and to their own mortality. The
struggle on this dimension is, in general terms, between the search for
domination over the elements and natural law (as in technology, or in
sports) and the need to accept the limitations of natural boundaries (as
in ecology or old age). While people generally aim for security on this
dimension (through health and wealth), much of life brings a gradual
disillusionment and realization that such security can only be temporary.
Recognizing limitations can bring great release of tension.
Social dimension On the social dimension (Mitwelt), individuals relate to
others as they interact with the public world around them. This
dimension includes their response to the culture they live in, as well as to
the class and race they belong to (and also those they do not belong to).
Attitudes here range from love to hate and from cooperation to
competition. The dynamic contradictions can be understood in terms of
acceptance versus rejection or belonging versus isolation. Some people
prefer to withdraw from the world of others as much as possible. Others
blindly chase public acceptance by going along with the rules and
fashions of the moment. Otherwise they try to rise above these by
becoming trendsetters themselves. By acquiring fame or other forms of
power, individuals can attain dominance over others temporarily. Sooner
or later, however, everyone is confronted with both failure and
aloneness.

Four worlds[edit]
Existential thinkers seek to avoid restrictive models that categorize or
label people. Instead they look for the universals that can be observed
cross-culturally.[citation needed] There is no existential personality
theory which divides humanity into types or reduces people to part
components. Instead, there is a description of the different levels of
experience and existence with which people are inevitably confronted.
The way in which a person is in the world at a particular stage can be
charted on this general map of human existence (Binswanger, 1963;
Yalom, 1980; van Deurzen, 1984).

Psychological dimension On the psychological dimension (Eigenwelt),

individuals relate to themselves and in this way create a personal world.
This dimension includes views about their own character, their past
experience, and their future possibilities. Contradictions here are often
experienced in terms of personal strengths and weaknesses. People
search for a sense of identity, a feeling of being substantial and having a
self. But inevitably many events will confront them with evidence to the
contrary and plunge them into a state of confusion or disintegration.
Activity and passivity are an important polarity here. Self-affirmation and
resolution go with the former and surrender and yielding with the latter.
Facing the final dissolution of self that comes with personal loss and the
facing of death might bring anxiety and confusion to many who have not
yet given up their sense of self-importance.

In line with the view taken by van Deurzen,[5] one can distinguish four
basic dimensions of human existence: the physical, the social, the
psychological, and the spiritual. On each of these dimensions, people
encounter the world and shape their attitude out of their particular take
on their experience. Their orientation towards the world defines their

Spiritual dimension On the spiritual dimension (berwelt) (van Deurzen,

1984), individuals relate to the unknown and thus create a sense of an
ideal world, an ideology, and a philosophical outlook. It is here that they
find meaning by putting all the pieces of the puzzle together for
themselves. For some people, this is done by adhering to a religion or

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other prescriptive world view; for others, it is about discovering or

attributing meaning in a more secular or personal way. The
contradictions that must be faced on this dimension are often related to
the tension between purpose and absurdity, hope and despair. People
create their values in search of something that matters enough to live or
die for, something that may even have ultimate and universal validity.
Usually the aim is the conquest of a soul, or something that will
substantially surpass mortality (as for instance in having contributed
something valuable to humankind). Facing the void and the possibility of
nothingness are the indispensable counterparts of this quest for the
eternal.
A structuring into the first three of these dimensions was proposed by
Binswanger on the basis of Heidegger's description of Umwelt and
Mitwelt and his further notion of Eigenwelt. The fourth dimension was
added by van Deurzen on the basis of Heidegger's description of a
spiritual world (berwelt) in Heidegger's later work.[5][6]
Client-centred therapy was founded by Carl Rogers in the 1940s. Rogers
trained to be a clinical psychologists and from 1928-40 he worked as a
director of the Child Study Department of the Rochester Society for the
Prevention of Cruelty to Children. It was through his work at the
Rochester Centre that his client centred therapy emerged. Rogers did
not use the term 'patient' because of its medical connotations and the
perception of an unequal relationship. He preferred the term 'client' he
wanted the relationship between client and therapist to be equal and
trusting. It was later changed to person-centred therapy. client-centredtherapy.jpg
Rogers believed that humans are complex and unique and that
individuals know themselves better than anyone else. He did not think it
was possible for a therapist to fully understand or enter the perceptual
world of a client which is dominated by the client's life experiences
(Rogers, 2004).
Rogers's humanistic outlook
Rogers's believed for the most part that humans are good natured and
are constantly striving towards reaching their full potential. The
psychologically healthy individual has a positive outlook on life,
continues to grow and develop as a person, is not afraid to make
decisions and accepts the consequences of same. He acknowledged
that there are psychologically maladjusted individuals whose selfconcept and conditions of worth are blocking their ability to reach their
full potential and self-actualise. Rogers believed that the self-concept
was the basis for imbalance in an individual's life and the purpose of his
therapy was the reintegration of the self-concept. He believed that
individuals could bring balance back into their lives and solve their own
problems. In counselling, the attitude of the therapist towards the client is
very important (Rogers 2004)

Rogers outlined six core conditions of counselling necessary for

therapeutic personality changes as follows:The client and the therapist must be in psychological contact. It is about
discussing inner feeling focused on the self.
The client is in a state of incongruence. The client is emotionally upset.
The therapist is congruent in the relationship. The therapist must be
genuine and aware of their own feelings.
The therapist experiences unconditional positive regard for the client.
Therapists must not judge the client but value them. They have worth
simply because they exist.
The therapist experiences an empathic understanding of the client's
internal frame of reference and endeavours to communicate this
experience to the client.
The client perceives the therapists unconditional positive regard for them
and the therapist empathic understanding of their difficulties (Rogers
2007).
Person-centred therapy is built on trust. The client must feel that he can
trust the therapist and the therapist must have trust in themselves. The
therapist needs to create a suitable environment where the personcentred therapy can be successful. Rogers believed that counselling
needed to move away from the system of the 'expert' telling the client
what was wrong with them and move more towards the following:The therapist should be a very good listener.
The therapist unreservedly accepts the client as they are at that moment
in time.
The therapist places no label or name on the client's condition.
The therapist does not rely on any of the personality theories.
The therapist listens, does not ask questions, does not interpret what is
being said, does not offer advice, but reflects back what the client says
(Rogers 2004).
Non-directive approach
The person-centred therapy is a non-directive treatment. The client
makes a journey through their problems and the therapist keeps them
company. Thorne (1984) mentions research by Tausch (1975) which has
shown that clients can experience changes when engaged in personcentred therapy, however, to date there has been no evidence that any
client has achieved Rogers's theoretical 'Fully Functioning' person. Client
changes noticed by therapists are as follows:Away from facades and the constant preoccupation with keeping up
appearances.
Away from 'ought's' and an internalised sense of duty springing from
externally imposed obligations.
Away from living up to the expectations of others.
Towards valuing honesty and 'realness' in one's self and others.
Towards valuing the capacity to direct one's own life.
Rewards accepting and valuing one's feelings whether they are positive
or negative.

Rewards valuing the experience of the moment and the process of

growth rather than continually striving for objectives.
Towards a greater respect for and understanding of others.
Towards a cherishing of close relationships and a longing for more
intimacy.
Towards a valuing of all forms of experience and willingness to risk being
open to all inner and outer experiences, however, uncongenial or
unexpected (Frick, 1971 as cited in Thorne, 1984).
Therapist perspective
Rogers believed that for person-centred therapy to be successful, the
therapists must create an environment where the client feels
unconditional positive regard, genuineness and empathy. Only when the
client experiences this can there be any commencement of therapeutic
change. In a fully supportive environment the client can begin to
understand their problems and work towards resolving them and
changing the direction of their lives.
It has been argued that person-centred therapy can be very demanding
on the therapist. The therapist has to have self-acceptance, self trust
and be comfortable with their own feeling. They must work at continuing
to grow as a person and be prepared to broaden their own life
experiences. The therapist must feel secure within themselves and be
capable of supporting the client. Therefore, the therapist msut supress
their own prejudice and values in person-centred therapy (Thorne 1984).
Scientific Evaluation
Carl Rogers was aware that the critics viewed the humanistic outlook as
unscientific. Rogers tried to evaluate his theory and he was the first to
use audiotape sessions and analyse the contents. He used the
measurement as devised by William
220px-Stephenson.jpg
William Stephenson 1902-1989
Stephenson in 1953 to qualify the changes that took place during
therapy. Q-Sort is the dependent variable measuring whether clients
consider themselves or others consider they have changed since
commencing therapy. This is a self-reporting technique where the client
fills in a questionnairebefore therapy in order to establish the client's
view of their Real Self and their Ideal Self. This exercise is repeated at
different times during therapy and if the therapy is effective there will be
greater discrepancy between their first questionnaire and the last
questionnaire. One of the weaknesses of this measurement is the
assumption that the client is able to describe their Real Self and their
Ideal Self.
Rogers believed that humans are complex and unique and that
individuals know themselves better than anyone else. He did not think it
was possible for a therapist to fully understand or enter the perceptual
world of a client which is dominated by the client's life experiences
(Maltby, Day, Macaskill, 2010).

Rogers six core conditions for counselling

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