EXISTENTIAL PSYCHOTHERAPY

 The existential approach to psychotherapy and counseling has its grounding in

existential philosophy and is concerned with human existence and the way in which
humans live and exist in the world.
Existential thinking- Although Kierkegaard is usually considered to be the founding father of
the existential tradition the roots of existential thinking can be found in the work of : (1)Socrates
(2)Aristotle (3)Plato
Common Themes or Issues that HUMAN beings experience:
• Death
• Anxiety
• Freedom and Choice
• Guilt
• Meaning
• Time and Limit Situations
Death- Death is a central theme of existential philosophy, as it is our death and our temporality
that put our lives into perspective making them meaningful and purposeful. The one certainty we
have is that we are going to die, that we have a finite period of time, which is unknown.
Anxiety- Kierkegaard saw human life as an effort that is not easy, one full of anxiety. For
Kierkegaard a person does not exist in the mode of being but of becoming, and what we become
is our own responsibility even though frequently we conceal this from ourselves
Freedom and Choice- With this statement he captured the paradoxical problem with freedom,
that we are both enslaved and liberated by it at the same time.
“MAN IS CONDEMNED TO BE FREE” – Sartre
Guilt- Heidegger elucidates this as existential guilt, which is where we are indebted to ourselves,
where we have failed to live up to our own potential. Existential guilt is about our being and
what we havent done rather than about something we have done wrong.
Meaning- If we are to create a life for ourselves, we have to create a meaningful one. Many
people reach a point when their lives have become meaningless and they question what they are
doing and where they are going. Those who were able to create a meaning for all the suffering
they were experiencing were better able to survive.
Time and Limit Situations- Past is always part of the present and projects into the future, so
that both our past and our future are part of our present experience. Karl Jaspers believed that we
must engage in the tasks of life without illusion, accepting the limits to our life, both the general
limitations and our own personal limitations and that we must at the same time go forward in
spite of them.
Nature of Persons- The existential approach considers human nature to be open-ended, flexible
and capable of an enormous range of experience. The existential approach contends that there is
no fixed self and that we are continually in a process of becoming.
Dimensions of Human Existence:
1. Umwelt- physical dimension
2. Mitwelt- social dimension
3. Eigenwelt- personal dimension
4. Überwelt- spiritual dimension
Umwelt- The Umwelt is the physical dimension and it relates to the natural world around us and
our environment. It is the dimension of our bodily needs, our senses and our embodiment.
Mitwelt- The Mitwelt is the social dimension and represents our relationships with other human
beings. These include relationships with our family, extended family, friends, work colleagues,
acquaintances and interactions with others that we do not know.
Eigenwelt- The Eigenwelt is the personal dimension, the world of the self. It is about our
identity and our relationship to our self. It includes our feelings, thoughts and personal
characteristics.
Überwelt- The Überwelt is the spiritual dimension and represents the world of our beliefs and
aspirations. It is our ideal world, our original project and it is where we make sense of our lives.

 The existential approach to psychotherapy is most closely related and informed by

positive psychology.
• Positive psychology (Seligman, 2002) emphasizes peoples strengths and what is going
well in their life rather than focusing on an individuals weaknesses or problems.
Healthy vs. Unhealthy/ Dysfunctional Living:
Healthy Functioning- Healthy functioning would be seen as a person living an authentic life. It
means that they are being true to themselves and accepting lifes limitations as well as their own
personal limitations.
Unhealthy Functioning- Inauthentic living is where we are closed off to the reality of life or
living in a self-deceived way about ourselves or about the world. This means living by other
peoples standards and rules and not thinking about the rules and standards that you want to
determine your life. Heidegger believed that most of us live our lives in this way for the
majority of the time.
The Change Process- Change for the better is not a direct goal of existential psychotherapy but
it is a by-product, which comes about when a person truly examines their life in an open and
honest manner.
Therapeutic Environment- The existential approach to psychotherapy aids the process of
change by challenging the client to examine their worldview, attitudes and values.

Therapeutic Process:
1. Assessment and Diagnosis
a. Theory-Based Assessment Strategies
- Existential therapists will look for a clients ability to question and reflect on their life; for an
openness and commitment to search for meaning and purpose. No specific assessment tools
would be used other than the dialogue that takes place during the therapeutic relationship.
2. Treatment
a. Goals
The goals of existential therapy are
-To enable people to become truthful with themselves again
-To widen their perspective on themselves and the world around them
-To find clarity on how to proceed into the future whilst taking lessons from the past and creating
something valuable to live for in the present (van Deurzen, 1990: 157).

Techniques in Psychotherapy:
Rule of Epoché- is a way of approaching something as if it were new to you, all initial biases and
prejudices are put aside and the phenomena is then revisited. Epoché is a way of looking at
things anew, to learn to see what is before our eyes rather than thinking that we know the answer.
Rule of Description- The Rule of Description can be summed up as Describe, dont explain
(Spinelli, 1989: 17). What is important is the description of an experience rather than trying to
make sense of it in terms of different theories, as this will limit the experience.
Rule of Horizontalization- Also known as Equalization Rule requires that initially the therapist
does not try and impose hierarchies or significances to what is heard. All information is treated
as equally important, of equal value and significance. Again this is an ideal rather than an aim of
this step.

"He who has a why to live for can bear with almost any how." -Nietzsche, 1984
ADLER: INDIVIDUAL PSYCHOLOGY
- born on February 07, 1870
Rudolfsheim, Vienna
- converted to Protestantism but regarded as agnostic
- often compared with Sigmund Freud
- his goal in life would be to conquer death

OVERVIEW of INDIVIDUAL PSYCHOLOGY

- presents an optimistic view of people while resting heavily on the notion of social interest

ADLERIAN THEORY
MAIN TENETS OF ADLERIAN THEORY:

1. The one dynamic force behind people's behavior is the striving for success or superiority
2. People's subjective perceptions shape their behavior and personality
3. Personality is unified and self-consistent.
4. The value of all human activity must be seen from the viewpoint of social interest.
5. The self-consistent personality structure develops into a person's style of life.
6. Style of life is molded by people's creative power.

EXTERNAL FACTORS IN MALADJUSTMENTS

(1) exaggerated physical deficiencies
(2) pampered style of life
(3) neglected style of life

SAFEGUARDING TENDENCIES
- protective devices that enable people to hide their inflated self-image and to maintain their current style
of life

EXCUSES
- typically expressed in “yes, but” or “if only”

AGGRESSION
- to protect their fragile self-esteem

3 FORMS OF NEUROTIC AGGRESSION

(1) Depreciation
(2) Accusation
(3) Self-accusation

WITHDRAWAL
- setting up a distance between themselves and their problems

MASCULINE PROTEST
- a condition in which the cultural and social practices influence many men and women to overemphasize
the importance of being manly

ADLER VS FREUD ON FEMINISM

COMPARISON
ADLER'S SAFEGUARDING TENDENCIES vs. FREUD'S DEFENSE MECHANISM

4 STAGES OF ADLERIAN THEORY

 Engagement
 Assessment
 Insight
 Reorientation

APPLICATIONS OF INDIVIDUAL PSYCHOLOGY

4 AREAS:
(1) Family Constellation
(2) Early Recollections
(3) Dreams
(4) Psychotherapy

PSYCHOANALYTIC THEORY
Psychoanalysis- Psychoanalysis was founded by Sigmund Freud (1856-1939). Freud believed that people
could be cured by making conscious their unconscious thoughts and motivations, thus gaining insight.
Basic assumptions about the theory:
● Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.
● Manifest symptoms are caused by latent (hidden) disturbances.
● Typical causes include unresolved issues during repressed trauma.

SIGMUND FREUD
Sigmund Freud (1856 to 1939) was the founding father of psychoanalysis, a method for treating mental
illness and also a theory which explains human behaviour.
Freud believed that events in our childhood have a great influence on our adult lives, shaping our
personality. For example, anxiety originating from traumatic experiences in a person's past is hidden from
consciousness, and may cause problems during adulthood (in the form of neuroses).

How can we understand the mind?

Psychoanalysis is commonly used to treat depression and anxiety disorders.
In Psychoanalysis (therapy) Freud would have a patient lie on a couch to relax, and he would sit behind
them taking notes while they told him about their dreams and childhood memories. Psychoanalysis
would be a lengthy process, involving many sessions with the psychoanalyst.
Due to the nature of defense mechanisms and the inaccessibility of the deterministic forces operating in
the unconscious, psychoanalysis in its classic form is a lengthy process often involving 2 to 5 sessions
per week for several years.
The analyst typically is a 'blank screen,' disclosing very little about themselves in order that the client
can use the space in the relationship to work on their unconscious without interference from outside.
The psychoanalyst uses various techniques as encouragement for the client to develop insights into their
behaviour and the meanings of symptoms, including ink blots, parapraxes, free association,
interpretation (including dream analysis), resistance analysis and transference analysis.

Rorschach Ink Blots- Due to the nature of defense mechanisms and the inaccessibility of the
deterministic forces operating in the unconscious, The ink blot itself doesn't mean anything, it's
ambiguous (i.e., unclear). It is what you read into it that is important. Different people will see different
things depending on what unconscious connections they make. The ink blot is known as a projective test
as the patient 'projects' information from their unconscious mind to interpret the ink blot.
Freudian Slip- Unconscious thoughts and feelings can transfer to the conscious mind in the form of
parapraxes, popularly known as Freudian slips or slips of the tongue. We reveal what is really on our
mind by saying something we didn't mean to. Freud believed that slips of the tongue provided an insight
into the unconscious mind and that there were no accidents, every behaviour (including slips of the
tongue) was significant (i.e., all behaviour is determined).
Free Association-This technique involves a therapist reading a list of words (e.g.. mother, childhood,
etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that
fragments of repressed memories will emerge in the course of free association. Freud reported that his
free associating patients occasionally experienced such an emotionally intense and vivid memory that
they almost relived the experience. This is like a "flashback" from a war or a rape experience. Such a
stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing
memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it
would be called a catharsis. Frequently, these intense emotional experiences provided Freud a valuable
insight into the patient's problems.
Dream Analysis- According to Freud the analysis of dreams is "the royal road to the unconscious." He
argued that the conscious mind is like a censor, but it is less vigilant when we are asleep. As a result,
repressed ideas come to the surface - though what we remember may well have been altered during the
dream process. As a result, we need to distinguish between the manifest content and the latent content of
a dream. The former is what we actually remember. Freud believed that very often the real meaning of a
dream had a sexual significance and in his theory of sexual symbolism he speculates on the underlying
meaning of common dream themes.

Clinical Applications

 Depression may be treated with a psychoanalytic approach to some extent. Psychoanalysts relate
depression back to the loss every child experiences when realizing our separateness from our
parents early in childhood. An inability to come to terms with this may leave the person prone to
depression or depressive episodes in later life.
 Treatment then involves encouraging the client to recall that early experience and to untangle the
fixations that have built up around it. Particular care is taken with transference when working
with depressed clients due to their overwhelming need to be dependent on others. The aim is for
 clients to become less dependent and to develop a more functional way of understanding and
accepting loss/rejection/change in their lives.

GESTALT THERAPY
(from German Gestalt “shape,” “form,” “configuration,” “totality”).

 Wolfgang Köhler, Kurt Koffka, Max Wertheimer

 (early 20th century)
 a psychological approach that focuses on the dynamic organization of experience into patterns or
configurations (APA)
 For clients, Gestalt builds self-confidence, frees people to address issues and helps them to live
life to its fullest potential.
 For practitioners, it focuses on the present moment, and on immediate thoughts and feelings,
makes it a very lively, spontaneous and creative approach.
 Gestalt therapeutic work has been shown to be effective in treating a wide range of issues such as
anxiety, stress, addiction, tension and depression, whether as a long-term therapy or via a number
of sessions.
 Gestalt therapy places emphasis on gaining awareness of the present moment and the present
context.
Contemporary Theory and Practice:

 Phenomenological method
 Dialogical Method
 Field-theoretical strategies
 Experimental freedom

Phenomenological method:
ʘ the rule of epoché
ʘ the rule of description
ʘ the rule of horizontalization.

the rule of epoché- one sets aside one's initial biases and prejudices in order to suspend expectations
and assumptions.
the rule of description- one occupies oneself with describing instead of explaining. one treats each
item of description as having equal value or significance.
Dialogical Method:
Presence- means that the therapist is actively present as a person. The therapist shows his or her true
self.
 Inclusion- is the practice of trying to see the patient’s world through the patient’s eyes.
The dialogic process- The direction of the dialogue is controlled by what emerges between patient
and therapist.

Field-theoretical strategies

 The ontological dimensions are all those physical and environmental contexts in which we
live and move.
 The phenomenological dimensions are all mental and physical dynamics that contribute to a
person’s sense of self, one’s subjective experience.
Experimental freedom- Through experiments, the therapist supports the client’s direct experience of
something new instead of iithe mere talking about the possibility of something new.

Mental Health Conditions That May Benefit From Gestalt Therapy:

 Anxiety and Depression

 Self-Esteem.
 Relationship Troubles.
 Headaches.
Techniques of Gestalt Therapy:

 Asking questions
 Role playing
 Confrontation
 Dream working

PERSON-CENTERED APPROACH: CARL ROGERS

 Seventy four years ago, the psychologist Carl Rogers introduced a new approach to
psychotherapy, designed as a contrast to the behavioral and psychoanalytic theories dominant at
the time. Unlike behavior therapy, the Rogers approach does not emphasize action over feeling
and thinking, and unlike psychoanalysis, it is not concerned with unconscious wishes and drives.
At first he called his method nondirective therapy, later client-centered and person-centered
therapy.
 The method can be defined partly by what Rogerian therapists don't do, or rarely do: ask
questions; make diagnoses; conduct psychological tests; provide interpretations, evaluations, and
advice; offer reassurance, praise, or blame; agree or disagree with clients or express opinions of
their own; point out contradictions; uncover unconscious wishes; or explore the client's feelings
about the therapist.
 The method can be defined partly by what Rogerian therapists don't do, or rarely do: ask
questions; make diagnoses; conduct psychological tests; provide interpretations, evaluations, and
advice; offer reassurance, praise, or blame; agree or disagree with clients or express opinions of
 their own; point out contradictions; uncover unconscious wishes; or explore the client's feelings
about the therapist.
 What that leaves is letting clients tell their own stories at their own pace, using the therapeutic
relationship in their own way. The therapist provides a model of reflective listening without
trying to point out directions and provide solutions. Rogers popularized the use of the term
"client" rather than patient to set the relationship on more equal terms, emphasizing that the
person being treated is not passive and the therapist is not an authority but an agent.
What does it aim for?

 Client-centered therapists aim to understand how the world looks from the point of view of their
clients, checking their understanding with the client when in doubt. The principle is that clients
know more about themselves than the therapist can possibly know. They don't need the guidance
or wisdom of an expert. Instead, the therapist must create an atmosphere in which clients can
communicate their present thoughts and feelings with certainty that they are being understood
rather than judged.
 Client-centered therapists say that their clients have a natural tendency toward growth, healing,
and self-actualization. They act self-destructively or feel bad because of an environment that
distorts this tendency. But they can find their own answers to their problems if the right
therapeutic environment is provided. Psychotherapy does not involve doing something to clients
or getting them to do something about themselves, but rather freeing them for movement toward
normal maturity, independence, and productivity.
How does it helps the clients?

 A permissive and indirect approach, according to the theory, makes clients more aware of aspects
of themselves that they have been denying. By responding to the client's feelings rather than to
the objects of those feelings, the therapist brings the client's self into the foreground. By avoiding
judgments and not intruding their own personalities, therapists themselves avoid becoming an
object of the client's attitudes and feelings. The aim is not so much to solve particular problems or
relieve specific symptoms as to free clients of the sense that they are under the influence of
malevolent forces beyond their control.
Facilitating Conditions:
1. Accurate empathy, or empathic understanding, means sensitively tracking the moment-to-
moment feelings and thoughts of the client, with all their nuances and implications, and
conveying this to the client partly by summarizing or restating what the client says (observers
listening to tapes of Rogers's therapeutic sessions noticed that he even tended to match the tone of
voice of the client.)
2. Congruence or transparency means that therapists must not put up a façade of any kind or
deceive clients about their feelings. Congruent responses should be stated in the first person,
without false objectivity: "I feel," "This is how I experience," and so on. A therapist who cannot
or does not want to answer a question should give a personal reason: "I don't know enough," "I
feel uncomfortable talking about that." Accurate empathy conveys what the therapist thinks the
client is feeling; congruence conveys what the therapist is feeling or thinking, and the therapist
should make this distinction clear.
 3. Unconditional positive regard, or unpossessive warmth, is the way a therapist conveys to clients
that they are regarded as valuable and worthwhile, without accepting or condoning everything
they do or think. It means prizing clients as persons.
Criticisms:
1. Vagueness of its principles
2. Antipathy to diagnosis
3. Claim that therapists need little training
4. Emphasis on the client’s self-evaluation as the way to judge the outcome of therapy

 Rogers died in 1986, and today only a small proportion of mental health professionals regard
themselves chiefly as taking a client-centered or person-centered approach. But his ideas about
personality are still found in textbooks, and one survey found 50 journals and 200 organizations
all over the world now devoted to some variant of client-centered or person-centered therapy.
Beyond that, client-centered principles may have influenced the practice of many other therapists.
For example, self-disclosure (transparency, congruence) has become more acceptable to
psychodynamic and cognitive behavioral therapists.
 Client-centered principles are central to motivational interviewing, which has been found as
effective as cognitive behavioral therapy in a clinical trial of alcoholism treatment. In this
method, clients set the agenda, and the therapist acts as a partner in dialogue rather than an
authority. Motivational interviewers avoid warnings, diagnosis, and direct attempts to argue,
persuade, or educate. They try to supply accurate empathy and reflective listening. Instead of
directly confronting resistance to change, they promote self-efficacy, which is related to self-
actualization as conceived by Rogers.
 Central to Rogers' (1959) theory is the notion of self or self-concept. This is defined as "the
organized, consistent set of perceptions and beliefs about oneself". It consists of all the ideas and
values that characterize 'I' and 'me' and includes perception and valuing of 'what I am' and 'what I
can do'.
 Consequently, the self concept is a central component of our total experience and influences both
our perception of the world and perception of oneself. For instance, a woman who perceives
herself as strong may well behave with confidence and come to see her actions as actions
performed by someone who is confident.
 The self-concept does not necessarily always fit with reality, though, and the way we see
ourselves may differ greatly from how others see us.