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Existential therapy Dr veera balaji kumar

  1. Existential Psychotherapy Dr.V.Veera Balaji Kumar, PhD Health Psychologist
  2. Learning ObjectivesLearning Objectives This presentation will focus on  An overview of existential psychotherapy  The history of existential psychotherapy  Applications of existential psychotherapy  Treatment techniques associated with existential psychotherapy
  3. No single founder - Many sources  existential therapy ‘cannot be traced to a single authoritative source’ - no Freud or Rogers, to give the approach a common theoretical and practical basis.  existential approaches to therapy have emerged spontaneously – and, at times, independently – in diverse parts of western Europe and subsequently the United States.  the philosophical field on which it is based is, itself, enormously diverse.
  4. Nietzche  He who has a why to live can bear with any how  That which does not kill me, makes me stronger
  5. Key existential philosophers  Kierkegaard, Søren (1813–55): Danish philosopher & father of modern existentialism.  Criticised the lack of passion and the conformity of nineteenth century Christendom,  Argued that human beings needed to turn towards their own subjective truths, and make a personal leap of faith towards God.  Buber, Martin (1878–1965): Jewish philosopher and theologian. Emphasised the relational nature of human existence, and the distinction between ‘I–Thou’ and ‘I–It’ modes of relating.
  6. Key existential philosophers  Nietzsche, Friedrich (1844–1900): German philosopher. Attacked the slavish, herd mentality of conventional Christianity, and preached an atheistic gospel of aspiration towards the Übermensch: the autonomous superman who creates his or her own values and morality, and lives an earthly life of passion and power.  Jaspers, Karl (1883–1969): German psychiatrist- turned-philosopher, whose important idea of unavoidable ‘boundary situations’ that human beings face.
  7. Key existential philosophers  Heidegger, Martin (1889–1976): German philosopher, influential -existential thinker.  Earlier work emphasised resolution in the face of anxiety, guilt and death, whilst later work placed greater emphasis on language and an openness towards Being.  Sartre, Jean-Paul (1905–80): French novelist philosopher, playwright and social critic.  Emphasised the freedom at the heart of human existence and the angst, meaninglessness and nausea that it evokes.
  8. Key existential philosophers  Marcel, Gabriel (1889–1973): French philosopher, playwright and Christian.  Emphasised mysteriousness and immeasurability of existence,  and the importance of fidelity and openness to others, as well as the primacy of hope.  Camus, Albert (1913–60): French novelist and philosopher. Emphasised the absurdity of human existence, but the possibility of creating meaning in a meaningless world.
  9. History of ExistentialismHistory of Existentialism
  10. What existentialism is …  A philosophical view that emphasizes the importance of existence, including one's responsibility for one's own psychological existence.
  11. Existentialism continued …  Is NOT a technical approach to counseling that offers new rules for therapy.  Psychoanalysis – use of transference, free- association  Behaviorism – stimulus/response, +reinforcement/- reinforcement/punishment - It is a frame-of-reference or way of viewing and understanding a client’s suffering
  12. History of ExistentialismHistory of Existentialism ““Existence precedes essence”Existence precedes essence” SartreSartre ““Truth dwells in the inner man”Truth dwells in the inner man” AugustineAugustine Existential thinking has occurred throughout history Exemplified by Augustine, Scotus, Pascal, Kierkegaard, Nietzsche
  13. Existential View of Human Nature  Assumption One: As humans, our basic conflict is between ourselves and the “givens” of our existence.  It’s not from instinctual drives (ego & superego)  It’s not from significant adults in one’s early life (need for acceptance and approval)  It’s this anxiety we experience when we are confronted with the givens of our existence
  14. Existential View of Human Nature  Assumption Two: Existing in the world brings about both normal and neurotic anxiety. “Anxiety arises from our personal need to survive, to preserve our being, and to assert our being (Corsini & Wedding, 2005, p. 271)  Anxiety occurs as we try to deal with important life themes:  living and dying  freedom, responsibility, & choice  isolation & loving  meaning & meaninglessness.
  15. Existential View of Human Nature  Assumption Three: As humans we have the capacity for self-awareness.  The greater our self-awareness, the greater our possibilities for freedom.  We can increase our capacity to live life fully.
  16. Existential View of Human Nature  Assumption Four: If a person is to be understood and helped to understand him/herself. That person must be understood from the perspective of the here-and-now.  The past is important only insofar as it is part of one’s current existence.  There are no attempts to uncover what happened in the past, instead there is a focus on experiences in the present.
  17. Existential View of Human Nature  Assumption Five: The significance of our existence (who we are) is never fixed. We are always re-creating ourselves, evolving, and becoming (Corey, 2005).  The essence of who we are is never fixed until we die.  Resistance to using theorotypes or labels
  18. Existence as Verb-like  Existentialists conceive human existence as not a noun-like thing, but a verb-like happening.  human existence is fundamentally dynamic in nature, that it is a flux, an unfolding event, a path (Jaspers, 1986) or a process.  Indeed, the very word ‘exist’ comes from the Latin verb ‘existere’, which means to stand out or emerge.  Existence, then, can be conceived of as an upsurge (Sartre, 1943/1958): a becoming, a bursting forth into the world
  19. A phenomenological exercise  Reflect, for a minute, on what you are experiencing as you listen my words.  Initially, you may perceive yourself as a thing-like self encountering another thing: my lecture.  If you try to bracket this natural attitude, however, and simply focus on what you are experiencing, you may come to see that your experiencing is a listening-to-my-words-now, or a wondering-what-  this-is-all-about, rather than a fixed thing encountering another fixed thing
  20. A phenomenological exercise  From an existential perspective, then, we are first and foremost a verb-like being, and it is only subsequently that we may define ourselves as a noun-like thing: such as ‘an extrovert’ or ‘a therapist’.  This is the meaning of the well-known Sartrean phrase: ‘Existence precedes essence’ (see Figure 2.2).  In other words, human beings are not fixed selves, but a relationship towards their own being
  21. From Mick Cooper
  22. Basic ConceptsBasic Concepts Existential psychotherapy is “an encounter with one’s own existence in an immediate and quintessential form” May (1967)
  23. Existential PsychotherapyExistential Psychotherapy  Not a specific technique, more philosophical in nature  Focuses on issues central to human existence  Task of therapy is to facilitate genuineness  Emphasis is on the phenomenological moment between therapist and client
  24. Existential Psychotherapy -Existential Psychotherapy - OverviewOverview  “Endeavour to understand the man as he really is”.  Existential approach is all about exploring meaning and values, and living authentically – in accordance with one's own ideals, priorities and values.  It views human beings as creature of continual change and transformation, living finite lives in a context of personal strengths and weaknesses as well as opportunities and limitations created by the environment.
  25. Heidegger’s Two Basic Patterns of Being  Inauthentic mode  Giving oneself over to externally derived definitions, “everydayness”  Authentic (ontological) mode  Recognizing one’s uniqueness, remaining true to self
  26. Existential Psychotherapy:Existential Psychotherapy: The Basic “I-Am” Experience”The Basic “I-Am” Experience” “I am now living and I could take my life” “The idea of suicide has saved many lives” Nietzsche Existential psychotherapy seeks a deeper and more discerning type of therapy
  27. Existential Psychotherapy: The Basic “I-Am” Experience” (continued) The “I am” experience is not a solution in itself It is a precondition for a solution An ontological experience  Ontis = to be  Logical = the science of
  28. Existential Psychotherapy: The Basic “I-Am” Experience” (continued)  Nonbeing is illustrated in the experience of  fear of death, destructive hostility,  severe anxiety and  critical sickness
  29. EXISTENTIAL MODEL OF ANXIETY Anxiety is moreAnxiety is more basic than fearbasic than fear Anxiety arises from our personal need to survive, to preserve our being, and to assert our being
  30. EXISTENTIAL MODEL OF ANXIETY Normal AnxietyNormal Anxiety Proportionate to the situation Does not require repression Can be used for creativity Neurotic AnxietyNeurotic Anxiety Exceeds or minimizes the situation It is repressed Destructive
  31. EXISTENTIAL MODEL OF ANXIETY Awareness of Ultimate Concern (Death, Freedom, isolation, meaninglessness) Anxiety Defenses
  32. EXISTENTIAL MODEL OF GUILT Normal GuiltNormal Guilt Proportionate to the situation Sensitizes us to the ethical aspects of behavior Can be used for creativity Neurotic GuiltNeurotic Guilt About fantasized transgressions “Forgetting being” Destructive
  33. The Three Forms of World:The Three Forms of World: Being-In-the-WorldBeing-In-the-World UmweltUmwelt MitweltMitweltEigenweltEigenwelt
  34. The Three Forms of World:The Three Forms of World: Being-In-the-WorldBeing-In-the-World  Umwelt = world around; biological world  Mitwelt = with world; world of one’s fellow human beings  Eigenwelt = own world; relationship to one’s self
  35. Basic concepts  Sensing being as real  Understanding of a person as a being in the world  Differentiating ego from being  Considering the fact of non-being death and termination  Viewing anxiety and guilt as ontological.
  36. Focus  On the relationships a person has both with himself and with the world around him.  When the relationships are not navigated effectively psychological disturbance occurs.  Well-being can be negotiated gradually by coming to terms with life, the world and oneself.  A person may be enjoying relatively healthy functioning, yet still experience ‘Existential angst’ - existential vacuum – a realization that his life is meaningless.
  37. Objectives  Four-part framework of client’s existence :  Physical dimension  Social dimension  Psychological or personal dimension  Spiritual dimension
  38. Significance of Time HumanHuman experiencesexperiences like joy,like joy, depressiondepression and anxiety occurand anxiety occur in the dimensionin the dimension of time rather thanof time rather than spacespace
  39. Significance of Time Love can not be measured by the number of years one has known the loved one “No clock strikes for the happy one”
  40. Human Capacity to Transcend the Immediate Situation Transcendere means “to climb over and beyond” Existing involves a continual emerging A transcending of one’s past and present must occur in order to reach the future This capacity might be neurobiologically based
  41. The phenomenological method  A key contribution - as developed by the German philosopher Edmund Husserl (1859–1938).  adopted a standpoint of radical doubt, arguing that all we can know is what we experience: the ‘inner evidence’ that is given to us intuitively in our conscious experiencing of things.  In other words, to truly know ourselves and our world, we need to turn our attention to our conscious, lived-experiences.
  42. The phenomenological method  Three interrelated steps. The first of these steps is the rule of ‘epoché’, whereby we are urged to ‘set aside our initial biases and prejudices of things, to suspend our expectations and assumptions,  in short, to bracket all such temporarily and as far as it is possible so that we can focus on the primary data of our experience’.  Husserl urges us to set aside our ‘natural attitude’ – that objects in the external world are objectively present in space &time – and instead focus solely on our immediate and present experiencing of them
  43. The phenomenological method  The second step in the phenomenological method, is the ‘rule of description’, the essence of which is ‘Describe, don’t explain’ (Ihde, 1986: 34).  Here, we are urged to refrain from producing explanations, hypotheses or theories as to what we are experiencing, and  instead to stay with the lived-experiences as they actually are.
  44. The phenomenological method  Finally, there is the ‘rule of horizontalisation’, which ‘further urges us to avoid placing any initial hierarchies of significance or importance upon the items of our descriptions, and  instead to treat each initially as having equal value or significance’
  45. The ExistentialThe Existential TheoryTheory of Personalityof Personality
  46. Existentialists Suggest we do not possess a personality rather we embody an experience Ontology = science of being Normalcy is seen as a failure in becoming Neurosis is tantamount to avoidance, i.e. neurotic individuals are living in the every day rather than dealing with the challenges of ultimate concerns
  47. Ultimate Concern: DeathUltimate Concern: Death
  48. Ultimate Concern: DeathUltimate Concern: Death The most obvious ultimate concern “A Terrible Truth” Conflict between awareness of death and desire to live To cope we erect defenses against death awareness Psychopathology in part is due to failure to deal with the inevitability of death
  49. Ultimate Concern: FreedomUltimate Concern: Freedom Humans areHumans are “condemned to freedom”“condemned to freedom” SARTRE
  50. Ultimate Concern: FreedomUltimate Concern: Freedom Refers to fact that humans are the authors of their own world We are responsible for our own choices Conflict is between groundlessness and desire for ground/structure
  51. Ultimate Concern: FreedomUltimate Concern: Freedom Implications for therapy  Responsibility  Willing  Impulsivity  Compulsivity  Decision
  52. Ultimate Concern: IsolationUltimate Concern: Isolation Existential isolation differs from Interpersonal isolation = Divide between oneself and others Intrapersonal isolation = Fact we are isolated from parts of ourselves
  53. Ultimate Concern: IsolationUltimate Concern: Isolation
  54. Ultimate Concern:Ultimate Concern: MeaninglessnessMeaninglessness
  55. Ultimate Concern:Ultimate Concern: MeaninglessnessMeaninglessness Meaning creates hierarchal order of our values Tells us how to live not why we live Conflict stems from “How does a being who requires meaning find meaning in a universe that has no meaning”
  56. Existential Frame of Reference Awareness of Ultimate Concern Anxiety Defenses
  57. Existential Frame of Reference Specialness Despite rationality we often believe the laws of biology are not applicable to us Ultimate Rescuer Belief in a personal omnipotent servant to guard and protect us
  58. History ofHistory of Existential PsychotherapyExistential Psychotherapy Fundamental questions leading to the development of existential psychotherapy included  Where was the actual immediate person to whom these things were happening?  Are we seeing patients as they really are, or are we simply seeing a projection of our theories about them?
  59. History ofHistory of Existential PsychotherapyExistential Psychotherapy In 1958 existential psychotherapy introduced to the US with publication of Existence: A New Dimension in Psychiatry and Psychology by Rollo May, Ernest Angel, and Henri Ellenberger Yalom published the first comprehensive textbook in existential psychiatry entitled Existential Psychotherapy in 1981
  60. Existential Psychotherapy WritingsExistential Psychotherapy Writings Rollo May  The Meaning of Anxiety (1977)  Man’s Search for Himself (1953)  Existential Psychology (1961) James Bugental  The Search for Existential Identity (1976) Medard Boss  The Analysis of Dreams (1957)  Psychoanalysis and Daseinanalysis (1982)
  61. Existential Psychotherapy WritingsExistential Psychotherapy Writings (continued)(continued) Viktor Frankl  Man’s Search for Meaning (1963) Helmut Kaiser  Effective Psychotherapy (1965) Writings by Leslie Farber, Avery Weisman, and Lester Havens
  62. Existential TherapyExistential Therapy existential psychotherapy " concerned with patients' ways of dealing with the fundamental issues of human existence, the meaning and purpose of life, isolation, freedom and the inevitability of death. In this method of treatment, increased awareness of the self is more important than exploration of the unconscious, but many of the techniques are borrowed from brief psychoanalytic therapy." Oxford Textbook of Psychotherapy
  63. Existential PsychotherapyExistential Psychotherapy Ultimate concerns have implications for therapy process  Death  Freedom  Isolation  Meaninglessness Psychodynamic treatment model is followed
  64. Examples of how “every day” concerns have “ontological underpinnings” Fear of flying  might represent ultimate concerns regarding death Difficulty adjusting after a divorce  might relate to loneliness concerns
  65. Existential Approach is an Attitude Therapist is a guide Therapist is a symbol that an existential ordeal can be faced and survived The relationship heals when the therapist is a companion as the client confronts existence and all it entails
  66. Existential PsychotherapyExistential Psychotherapy Ultimate concerns create boundary situations Boundary situations are experiences which force individuals to confront an existential situation  Examples might be the diagnosis of a terminal illness or death of a family member or friend Psychotherapy can address existential isolation Jung suggested 30% of patients seek treatment because of personal meaninglessness
  67. Existential GroupExistential Group PsychotherapyPsychotherapy Patients learn how their behavior  Is viewed by others  Makes others feel  Creates opinions others have of them  Influences their opinions of self
  68. Comparing Existential Psychotherapy to Other Theories
  69. Psychodynamic  Existentialists reject predetermined explanatory systems concerning human ordeal  Conflict viewed as grounded in the human predicament, not suppressed instincts  Existentialists are not drawn to concepts (e.g. Jung’s archetype, collective unconscious) Key Differences with Other Approaches
  70. Gestalt  Less emphasis on technical contrivance in an existential model  Gestalt approaches exemplify more optimism Cognitive and Behavioral  Existentialists view these systems as oversimplifying human experience  CBT has a more circumscribed plan for change Key Differences with Other Approaches
  71. Comparison of Existential TheoryComparison of Existential Theory to Humanistic Approachesto Humanistic Approaches  Humanistic therapies overlap considerably with existential approaches  Both emphasize growth and fulfillment of the self  Goals are for self mastery, self-examination and creativity
  72. Comparison of ExistentialComparison of Existential Therapy to Other TherapiesTherapy to Other Therapies Most DifferentMost Different Most SimilarMost Similar BehavioralBehavioral PsychoanalyticPsychoanalytic HumanisticHumanistic
  73. Other Key Contrasts of ExistentialOther Key Contrasts of Existential Theory Compared to Other SystemsTheory Compared to Other Systems Existentialists reject concept of the person as propelled by drives and instincts Existentialists feel Jungians quickly avoid the patient’s immediate crises by being to focused on theory Client-centered therapists do not confront the patient directly and firmly
  74. Applications of Existential Therapy The clinical setting determines the applicability of the existential approach Most applicable when patients are dealing with a phase of life issue or a boundary situation A comprehensive existential approach is most feasible in long term therapy
  75. Evidence for ET  Systematic, corroborative evidence for ET is relatively limited  Difficult to create controlled experimental designs to test the approach  Much of the research supporting ET uses qualitative/phenomenological methods  ET is supported by the research behind “common factors”
  76. Evidence for ET  ET was used to treat patients with schizophrenia and compared to conventional approaches  less re-hospitalization and psychopathology  Improved independence and functioning  Qualitative research has validated the importance of presence, self-reflection, and consideration of alternatives in therapy  Studies have shown transcendence essential to change