What is Existential Therapy

by Prof. Digby Tantam

New School of Psychotherapy and Counselling (NSPC) and the Existential Academy

The first world conference of existential therapists took place in May 2015 in London and was organized by the Existential Academy in conjunction with the New School of Psychotherapy and Counselling.

Over 600 delegates attended the three-day event indicating that there was a substantial recognition of what existential therapy was but at the end of the conference one of the attendees challenged some of the presenters at the conference to define what existential therapy was.  It turned out to be a difficult, sometimes challenging task to do so, especially when carried out through email discussions.   Here is the definition that resulted:

Existential Therapy is a philosophically informed approach to counselling and psychotherapy. Existential Therapy focuses on the clarification of human existence to enable a person to engage with problems in living in a creative, active and reflective manner in order to find new meaning and purpose.

Like most definitions resulting from a group consensus, this one lacks specificity.  So here is my own perspective on what the definition is alluding to, in practice.

Philosophical basics

I am not going to define counselling or psychotherapy since I assume that most readers will know that it involves regular conversations with a professional in order to ameliorate distress or depression, to enhance well-being, and sometimes to ameliorate the symptoms of mental illness.  There is more information about this, also taken from the outcome of the discussions after the world conference, in another document on this site, ‘More about the existential approach’

The philosophical foundations of existential therapy are derived from those philosophers who have been particularly preoccupied by what it means for each of us to live life as an individual, rather than a devotee of God or the gods, as the servant of a lord or lady, or as a person carrying out a role required of us by society.  The growth of this kind of awareness, of ‘individuality’, began in Europe following the Reformation and the rejection by many Europeans of the authority of the Roman Catholic priesthood.  Being an individual brings autonomy,  personal choice, and accountability but these are not without their downside, not least in determining for ourselves how we live with others, and whether our natural spirituality can be separated from obedience to spiritual authority.  John Bunyan, in his Pilgrim’s Progress, thought that one of the principal obstacles on life’s journey was the slough of despond, but nowadays the pilgrim is more likely to get lost in the thicket of ‘anything goes’ where the seeming freedom to go in any direction simply results in going in no direction.

Philosophers like Kierkegaard, Nietzsche, Jaspers, Heidegger, Sartre and de Beauvoir—often cited as the key existential philosophers—addressed these issues of freedom, authority, choice, and accountability directly (their approach might also be called an ontological one).  Kierkegaard rejected the Hegelian notion that the future of individuals, like the future of states, was determined by some inherent characteristic—which Hegel called spirit, but which we might nowadays call personality—arguing instead that rather than being pushed by our pasts we are all trying to live, and often failing, to strive for a future state.  Only when we have reached that future can we look back and see what sort of a person we have been because it is our existence that discloses what sort of person we are.  There are no essences that determine that one is this or that sort of person. This future orientation does not mean that the past is irrelevant, only that it is not determinative.

The existential approach has been greatly assisted by another philosophical development of the early 20th. century, ‘phenomenology’.  Husserl is the main philosopher who turned this into a philosophical system inspiring Heideggerian ontology, and also a group of philosophers, most prominently Edith Stein and Edward Scheler, who managed to blend Husserl’s individual perspective with the phenomenology of human beings in relation to each other, in families or social groups.

An analogy from the science of neurology that was developing at the same time as phenomenology might help to illustrate their approach.  Neurologists discovered that there were two distinct areas in the cerebral hemispheres, which they termed sensory and motor cortices.  They thought that we know about the environment purely through our sensory cortex that received data from our eyes, ears and other senses and creates a kind of mirror image in our minds of that environment.  We act to change our relation to that environment, for example, by moving to avoid an obstacle only once we have a picture of it.  So the process was imagined to be like this: we passively obtain information about the world, we process it to form a model of it, we consider the model, and if necessary we act using the model to guide us.  It is obvious that this observer orientated approach is consistent with the science of the time that assumed that the scientist can look at an independent natural world and draw conclusions from it.  It is also consistent with the ‘essentialism’ of Hegel and others (and of modern-day personality theorists and geneticists).  Less obviously, it can be linked to the colonialist approach of its day, in which ‘native’ societies could be observed by the European visitor as if the visitor was having no effect on the ‘native’ society and the so-called superior European was able to grasp the ‘essence’ of the ‘native’ culture by observing it.

This observing, thinking, and acting model does not apply to someone who is in a totally dark and silent place.  Then it is replaced by groping, touching and moving.  It is our motor cortex that allows the person to develop a map of where they are, and even if they do not the kind of model of the environment that eyes and ears would give, they have a map that would allow them to find the door or to navigate the place without hitting their shins too often.

Phenomenology pays attention to this ‘motor’ kind of knowledge: to what we grasp about the world.  It is much more relevant to learning about the world than we might expect.  For example, we learn the name of an object as often by using the word and being corrected as we do by observing all of the words that people utter in the presence of a particular object, and then concluding which one is the name of the object.  For the existentialist motor knowledge, grasp provides a good model of how we live forwards forever seeking to grasp our objectives.  This is not to say that the past has no influence, any more than when someone tries to grasp something they ignore all sensory knowledge.  They might reach up their hand to catch a ball, only to feel a twinge in their back from an older injury and quickly change their posture and adjust their reach to avoid the twinge.  The movement has changed, to avoid the pain, but the objective remains, to catch the ball.

Schools of existential therapy

Psychotherapy as we would now recognize it, emerged in the early part of the twentieth century and quickly became dominated by the approach of Sigmund Freud—psychoanalysis.  Some psychiatrists in the German-speaking world adopted psychoanalysis although it made less headway at first in other parts of Europe or in the English speaking world generally.  A few of these psychiatrists also became interested in existentialism.  These included Ludwig Binswanger, the nephew of the neurologist who cared for Nietzsche during his long catatonic disorder, and Medard Boss.  Binswanger develops a method of therapy combining existential and Freudian approaches that he called ‘existential analysis’.  Boss who taught with Heidegger developed an approach more strongly influenced by Heidegger’s later, post-war work, which he called ‘Daseinsanalysis’.  Another German-speaking psychiatrist, Viktor Frankl,  developed a form of therapy called ‘logotherapy’.  Although he did not attribute this to any particular philosophical approach, it has proved so compatible with existential analysis and Daseinsanalysis that one of Frankl’s successors, Alfried Langle, has renamed the approach existential analysis.  Existential analysis independently developed in the UK as a development of the work of another psychiatrist, Ronald Laing.  Existential analysis would not have developed as it has without the life-long dedication to it of Emmy van Deurzen, who is one of its leading proponents.

What do existential therapists do, and why is it different?

All therapists are aware that life can be difficult, and that very few people escape feeling depressed, despondent or despairing at times, and even fewer escape feeling anxiety.  Most of the time, most people also feel happy, contented, annoyed, aggravated, and so on, too.  It is only when the negative emotions predominate that people go to a therapist.  Sometimes their well-being may only be mildly affected, but they may think that therapy would enhance it sufficiently to make life worthwhile.  Other times, the mood gets locked in or other negative states.

Existential therapy has a unique approach to mood and getting stuck in a negative mood.   But it also takes account of one of the great challenges of individuality which I will call self-reflection but which might also be called spirituality or meaning or living life philosophically.   Franklin Man’s Search for Meaning summarizes this as follows: “Man does not simply exist but always decides what his existence will be, what he will become the next moment. By the same token, every human being has the freedom to change at any instant.” Emmy van Deurzen writes in Psychotherapy and the Quest for Happiness, “ Therapy when practised well is a fine but delicately balanced intervention in another person’s life. It requires a devotion to truth and merciless pursuit of right living”. This emphasis does not preclude how important shelter, food, protection, family life, and other fundamental human rights are but reflects that these are not enough.  It also reflects the reality that aiming to be happy or successful is not the best way to be happy or satisfied with life.  Living life backwards, not forwards, is what matters.  Is my objective one that, if I reach it, will give me the sense that I have lived a good life?  Only by looking backwards can I be sure to know the answer.    The surprising thing is that people rarely make the choices in their life that will most directly achieve this objective.

One reason for not looking forward is that anxiety becomes overwhelming because we cannot be sure of the future, or even how our present will to us when we look back on it.  The existential approach to anxiety was first formulated by Kierkegaard, who thought of it as a kind of fear although not one that can be attributed to any concrete threat.  The particular kind of anxiety that Kierkegaard daily experienced himself and that he thought was so important was the fear of breaking free from social conventions and the need to be approved by other people.  This did not mean being unprincipled—Kierkegaard was self-flagellating honest about his own shortcomings and tried to live always according to high standards. He meant to live by these standards even if other people find them too onerous or even weird.

Anxiety in the existential tradition is seen as something inevitable, and something that as often as not tries to stop us from taking the right path.  It may well be helpful for therapists to assist people to reduce their anxiety but not as a rule because it is pathological or something to be avoided, but because it is something to be gone through.  I was once asked by a woman whose husband was a keen mountaineer but who herself got very anxious about heights what attitude she should take to her anxiety.   Should she tell herself that she should not try to avoid it and should go with her husband up dangerous climbs, or should she take note of it and avoid situations where she got anxious because she thought that she might fall.

Her fear of falling was well-founded.  She was not very well coordinated.  So the issue was for her to consider what her objective was.  Did she want to accompany her husband?  If so, then her anxiety implied that she should do quite a bit more climbing training in safe conditions before doing so.  Was she torn between wanting to accompany her husband, and being aware that she could not realistically do so, safely.  Then her objective would be to resolve this predicament, presumably in conversation with her husband and perhaps getting specialist advice from a physiotherapist about whether or not she would be likely to acquire a safe level of proficiency with training.  Finally, was she anxious to stop her husband going climbing at all, in which case she might have to question herself at to whether this was a legitimate objective for her to have, given that it would involve restricting her husband’s freedom.

The last paragraph demonstrates a kind of existential analysis that involves the self-reflection or enquiry after meaning in ourselves that is arguably the core of the existential approach.  It does not involve pathologizing moods, however extreme, or assuming that abnormal ideas or experiences necessarily prevent a person making choices.  Nor does it deny contingency.  Sometimes people are impaired and so have difficulty in self-reflecting.  And sometimes they grip so tightly to some kind of self-deception that they are not willing to participate in self-reflection.  For example, once one starts believing that the world is at fault, it becomes hard to consider that there is any need to change oneself. Existential therapy does not deny that such states exist, or that there are mental and brain illnesses, like dementia, that affect decision making.  But the existential approach does assume that choice and choosing are fundamental human characteristics and that no-one is ever free of the responsibility to be free.

Freedom is of particular importance to the English school of existential analysis that was inspired initially by the work of Laing, who was himself inspired by Sartre.  Emmy van Deurzen, Principal of the New School of Psychotherapy and Counselling (NSPC)  was herself educated as a philosopher and a psychologist in France living through the outpouring of anti-authority feeling during the riots of May 1968.  One of the student slogans at the time was “ Enjoy without hindrance” but that is not the slogan of existential therapy.  Freedom does not result from being unhindered.  In fact, hindrances, like anxiety, are often pointers to issues to which we might have given enough thought.