Freedom Humans are condemned to freedom, and existential therapists have followed suit by articulating the many ways in which freedom is an anxiety-loaded burden (Sartre, 1971). Personal responsibility is the first and primary burden of freedom. If you are free, you are responsible. Every action becomes a choice. • The more freedom you experience, the more choices you have; and the more choices you have, the more responsibility you have. • Personal responsibility is a heavy burden to carry. It’s so heavy that many individuals can’t bear the weight. When the weight of personal responsibility is too heavy, individuals defend themselves with denial, displacement, and blaming. Isolation Every individual is fundamentally alone. We enter life as an independent being and we leave from life alone. Many individuals who come for therapy come because of social problems that include feelings of loneliness. Isolation The goal of existential therapy with respect to isolation is to help clients connect as deeply as possible with others. Yalom refers to this as a “need-free” relationship. Need-free relationships are unselfish relationships in which one person knows another person intimately, gives love without a personal agenda. When a need-free relationship exists, both parties usually feel more alive and engaged in life. Isolation Martin Buber has written on the “I-Thou” relationship. An I-Thou relationship has the deepest of all possible connections between two individuals. It is a completely mutual relationship. I-Thou moments are rare and relatively brief. This is the relation toward which we should strive, but it is impossible to live consistently in an I-Thou connection. Isolation Yalom claims that denial is the most common way that humans deal with the conflict between being an individual and experiencing the frightening quality of existential isolation. One of the most common forms of denying isolation is through love with another individual. Isolation You’ve been around friends, relatives, or clients who desperately seek social or intimate contact. These individuals hate being alone, and if they’re in an intimate relationship that ends, they move quickly to replace their former partner. They have not developed the inner strength, identity, and sense of completeness to face the painful anxiety associated with existential isolation. Isolation • The heightening a client’s awareness of existential isolation should improve the ability to form healthy interpersonal relationships. • Getting in touch with existential isolation has a positive effect. To face aloneness gives us the strength to face the world. Meaninglessness The existential crisis or existential neurosis occurs when an individual faces the question “What is the meaning of my life?” Seeking life’s meaning can be an painful process. It’s common for many of us to just stay busy with daily activities, instead of grappling with life’s biggest question. Meaninglessness Most existentialists would likely respond to “It is up to you to invent, create, or discover meaning in your life. Your challenge is to find meaning in meaningless world.” Meaninglessness Frankl has written the most about the importance of living a meaningful life. He believes the “will to meaning” is a primary motive. Many clients come to therapy because they are suffering from the absence of meaning in their lives. Is Life Meaningful? Frankl is claiming two things: 1. Humans have a will to meaning. 2. Meaning does exist in the world, it’s up to us to find it. Frankl emphasizes that the individual does not find meaning through preoccupation with the self. We must look outside ourselves to find meaning. Is Life Meaningful? Frankl’s approach to helping clients find meaning in life is logotherapy (logos = meaning; therapeia = healing). The key to logotherapy is to confront clients directly with the need for meaning. Clients are responsible for their lives and choices regarding the seeking of meaning. Is Life Meaningful? The question “Is life meaningful?” can be answered in many different ways: • Altruism: Clients can serve others by unselfishness. • Dedication to a cause: Clients can dedicate themselves to political, religious, medical, familial, scientific, or other causes. Is Life Meaningful? • Creativity: Clients can choose to create something beautiful, powerful, and meaningful. • Self-transcendence: Guilt, depression, personal salvation, and other self-oriented goals can be put aside to follow selflessness. Is Life Meaningful? • Suffering: Clients can face suffering with optimism, dignity, and integrity. • God/religion: Clients can focus on serving God or their religion instead of serving self or seeking material goals. Is Life Meaningful? • Hedonism: Clients can choose to live life to the fullest each moment, to drink up the excitement, joys, and sorrows of daily life. • Self-actualization: Clients can dedicate themselves to self-improvement, to meeting their potential. Existentialism and Pessimism Death, Freedom>>>>Burdens of responsibility, Love>>>>>>>isolation Meaninglessness Existentialism is often linked with depressing thoughts about life’s ultimate concerns. But the goal is not pessimism or depr, but to embrace life and foster hope. Self-Awareness Self-awareness is central to existential therapy. The goal of existential therapy is to facilitate self-awareness—including the awareness of death, freedom, isolation, and life’s meaning. Humans are always looking at themselves and engaging in self-discovery. Theory of Psychopathology Psychopathology results from failure to adequately face and integrate basic inner daimonic impulses, and from failure to acknowledge life’s ultimate concerns. It results from decreased self-awareness. Theory of Psychopathology Signs of decreased self-awareness: • Emotional numbness or automation living • Avoidance of one’s anxiety, guilt, or other meaningful emotions • Avoidance of inner daimonic impulses. • Failure to acknowledge and reconcile life’s ultimate concerns Successful therapy is about living as fully in the moment as possible. Neurotic behavior is linked to avoidance. As clients reject natural urges and avoid ultimate concerns, they progressively or suddenly develop psychological, emotional, or behavioral symptoms. Theory of Psychopathology The treatment involves facing oneself, facing life, and acceptance the reality of death, freedom, isolation, and meaninglessness. This does not mean that life becomes easy. However, clients who face ultimate concerns with an integrated sense of self will experience normal anxiety and guilt, rather than neurotic anxiety and guilt. The practice of existential therapy • Providing informed consent is essential in existential therapy. Here-and-now interactions should continue gently and educationally in first session. A Word (or Two) on Specific Therapy Techniques – Existential practitioners are generally reluctant to discuss therapy techniques because technical interventions are viewed as artificial or fake. – The I-Thou interpersonal existential encounter is viewed as the change agent and not technique. • Firstly, the interpersonal therapy encounter develops. Then, therapists may use specific techniques for awareness, creativity and selfdevelopment. The Therapy Process – I and Thou, – Here and Now, – What and How The therapeutic factor employed by existentialists is the therapeutic encounter. This encounter is best articulated by Buber’s IThou relationship. The therapy encounter facilitates creativity, the expansion of awareness or consciousness, and selfdevelopment. Forming an I-Thou Relationship and Using It for Positive Change I-Thou relationship is characterized by: –Depth –Mutuality –Connection –Immediacy • Personal Responsibility: As the therapist, you’re responsible your behavior within the session. You aren’t responsible for your client’s wellbeing, but you are responsible for therapy process. Therapist’s job is to create conditions to facilitate an interpersonal therapeutic encounter and avoid behavior inhibiting therapy. • Presence: As the therapist, you’re alert, interested and as fully in the room as possible during every minute of every session. If you feel bored or distracted, your responsibility is to get reconnection. • Here and now. • Empathic Mirroring and Focusing: • Some specific verbal techniques: – Topical focus: «take a moment to see what’s present for you». «what really matters right now?» «Can you give me an example?» – Topical expansion: «tell me more» «stay with that feeling a few moments». – Content-process discrepancies «you say you are fine, but your face is downcast». «when you talk about that job, your eyes seem to get wet». • Feedback and Confrontation: • When therapist are ready and mirroring back to clients what they see, hear and experience, feedback and confrontation are used. Feedback and confrontation are together with presence, empathic mirroring and focusing. – Without a strong therapeutic connection or alliance, feedback and confrontation can be too painful to integrate. Mindfulness is a Buddhist approach, emphasizes acceptance of one’s thoughts and of challenging life situations. Mindfulness meditation was a factor in the development of Linehan’s dialectical behavior therapy, Acceptance and Commitment Therapy & Mindfulness Based Cognitive Therapy. Mindfulness emphasizes acceptance of internal cognitive thought processes. Existential Therapy Techniques Specific Existential Therapy Techniques Most existential therapists reject the use of techniques. Some existentialists, particularly Frankl and Fritz Perls, wrote about interventions: Paradoxical Intention Cognitive Reframing Paradoxical Intention Paradoxical intention was a technique originally used by Alfred Adler. Frankl attributes the success of this approach to humor. He claims that humor is therapeutic in that it allows individuals to place distance between themselves and their situation. • Frankl emphasizes that through this technique, clients are taught to intentionally exaggerate, rather than avoid, their personal existential realities. Frankl claims that paradoxical intention is effective for anxiety, compulsions, and physical symptoms. Cognitive Reframing has its origins in the individual psychology of Adler. However, Frankl employed this technique, and later Ellis and Beck emphasized its power as a therapeutic technique. Awareness and Existential Integration • Constriction, expansion and centering: Constriction and expansion are natural human rhythms. We experience intermittent periods of expansion and constriction. Expansive periods are characterized by growth, risk, and moving forth, Constrictive periods are characterized by inhibition, isolation, and drawing back. Shifting from expansion to constriction to expansion is healthy. Different situations produce a natural rhythm between expansion and constriction. • Therapists are intermittently nondirective and directive. They develop an I-Thou relationship, then push the clients to difficult issues. Doing existential therapy requires significant training and personal psychotherapy. • Existential therapy focuses on moment to moment experiences inside and outside the therapy office. Therapists don’t depend on treatment planning. • Therapist is not comfortable offering direct advice. Offering direct advice is inconsistent with existential philosophical values to impose her frame for living onto her client. • When it comes to big life decisions, an existential therapist doesn’t assume to know what’s best for another person. • Generally, the client’s problems are related to weakened awareness, avoidance of death anxiety, and avoidance of acknowledging the limits of personal control. Interventions Therapy techniques include: establishing a therapeutic presence (I-Thou relationship) empathic mirroring feedback and confrontation cognitive reframing monitoring client’s constrictions and expansions with the goal of becoming a more centered, selfaware and intentional being. Outcomes measurement • Traditional existential therapists don’t believe in using assessment instruments. Psychometric assessment procedures are useless, antitherapeutic and/or unethical because they decrease the human encounter. • But, to narrow the focus and to seek the measure specific behaviors are possible. In some existentialists’ model, the focus is on meaninglessness. • Life Regard Index (Battista & Almond, 1973) • Purpose in Life Test (Crumbaugh, 1968; Crumbaugh & Henrion, 1988) • Seeking of Neotic Goals Test (Crumbaugh, 1977) • Spiritual Meaning Scale (Mascaro, Rosen, & Morey, 2004) • Toronto Mindfulness Scale (Lau et al., 2006) Cultural and Gender Considerations • Existential therapy continues its paradoxical preoccupation with polarities. • Some view it as culturally and gender insensitive. Because it emphasizes on the individual experience and discovery of the unique self, it can be viewed as ethnoculturally sensitive. Feminists complain that existentialism is a theory of wealthy, white, Western men. Cultural and Gender Considerations “Only in existentialism and the movies, people have unlimited freedom, construct their own meanings and execute boundless choices. Save it for the wealthy, worried well.” (Prochaska & Norcross, 2003, p. 133) • Others view it and enact it in a way that is respectful of the individual. Cultural and Gender Considerations • To say «I know how you feel» is a violation of existential therapy. • The best we can do is to communicate to clients, regardless of their cultural background. Evidence-Based Status • There is a small amount of empirical research supporting existential group therapy. • There is some research on the effectiveness of paradoxical intention. Concluding Comments • Existential therapy is about finding meaning. It’s about facing the fact that we die and often we feel very much alone.