Chapter Five: Existential Theory and Therapy

1. Chapter Five:Existential Theory and Therapy

2. Historical Context and Key Figures • The Third Force • Strong Link to Philosophy • Soren Kierkegaard and Fredrick Nietzsche • Rollo May • Jean Paul Sartre • Fritz and Laura Perls

3. Theoretical Principles of Existential Theory and Therapy • Based on “I-AM” • Daimonic • The Nature of Anxiety • Normal and Neurotic Guilt

4. Existential Psychodynamics • ·        Death • ·        Freedom • ·        Isolation • ·        Meaninglessness

5. Other Issues • Self-Awareness • Existentialism and Pessimism

6. Gestalt Theory in Action • The Whole, Self-Regulating Person • Field Theory • The Figure-Ground-Formation Process • Peeling the Onion • The Therapy Process • I and Thou, • Here and Now, • What and How.

7. Theoretical Models of Applied Learning Theory • Applied Behavioral Analysis • Neobehavioristic, Mediational Stimulus-Response Model • Social Learning Theory • Cognitive Behavioral

8. Theory of Psychopathology • Failure face and integrate daimonic impulses • Failure to acknowledge and reconcile life’s ultimate concerns

9. The Practice of Existential Therapy • Preparing yourself • Preparing your client • Assessment Issues and Procedures

10. Existential Therapy Techniques • Techniques are artificial • Techniques are inauthentic • The therapeutic encounter • Buber’s I-Thou relationship • Assessment is inadequate and does not serve the relationship

11. Specific Use of Techniques • Frankl • Paradoxical Intention

12. Gestalt “Experiments” • Staying with the feeling • I take responsibility for. . • Playing the projection • The reversal technique • The exaggeration experiment. • The empty-chair technique or dialogue experiment

13. Gestalt Dream Work: Four steps • Tell the story of the dream. • Revive the dream • Organize the dream as a play • Act out the dream

14. Extended Case Example • …and this is my existence

15. Therapy Outcomes Research • Existentialists question the suppositions of the scientific method • Effects of this type of therapy cannot be assessed through the use of traditional outcome measures

16. Multicultural Perspectives • Existentialists often accused of only serving the “worried, wealthy, well.” • Individually, many are multiculturally sensitive. • Focus is on the individual at a deep, singular level.

17. Concluding Comments • Existential theory and therapies tackle life’s biggest issues.

18. Student Review Assignments • Critical corner • Reviewing key terms • Review questions

19. Critical Corner • Existential approaches have primarily been developed, promoted, and oriented toward White men. In fact, aside from Laura Perls, whose contributions have been relatively ignored, it’s difficult to find women or minorities who were deeply involved in the development of existential thinking and therapy. Even within the domain of Yalom’s four primary ultimate concerns, the absence of any reference to the birth experience—a deeply powerful ultimate experience that must be dealt with exclusively by women—is striking. As you contemplate existential theory and therapy, consider whether it is a therapy for the masses, or perhaps just an approach oriented toward wealthy men who have had far too much time on their hands for deep thought and reflection. On a related note, how can existential theory and therapy become more relevant for individuals who don’t have time in their daily lives for deep thought and reflection?

20. Critical Corner (continued) • Despite the emphasis in this chapter on the flexible, clinically astute behavior therapist, most behavior therapists are just technicians. For the most part, they aren’t attuned to or very interested in client’s feelings, the dynamics of the therapy relationship or life’s meaning and so they ignore these bigger issues, focusing instead on trivial and less important matters.

21. Critical Corner (continued) • Although existential therapists encourage individuals to embrace their deepest fears, they have not, themselves, embraced the concept of scientific or empirical evaluation of existential therapy. Could it be that existentialists are too afraid to expose their therapy approaches to scrutinizing scientific evaluation? If existentialists are interested in the complete human experience, why do they avoid and demean scientific procedures? It seems that scientific evaluation of therapy effectiveness, despite its limitations, reflects an important part of human experience—and the effort to understand and quantify therapeutic process and outcome should be recognized as having at least some validity. Comment on the existentialists’ clear lack of openness to the scientific side of human experience.

22. Critical Corner (continued) • The length to which behavior therapists will go to dehumanize individuals is scary. Examples include aversive conditioning using electric shock, token economies that curtail the freedom and dignity of patients, and the excessive punishment of children in our schools. The biggest problem with behavior therapy is that humans are treated more like rats or pigeons than humans.

23. Critical Corner (continued) • As noted in the chapter, existentialists are also generally opposed to standardized psychological assessment and evaluation. Can you imagine a situation where the administration of a psychological assessment procedure might be helpful to an individual? Can you imagine this even if you look at the process from an existential perspective? Are there parts of human experience that can be accurately measured? Consider anxiety and guilt. Is it possible to measure a client’s anxiety and guilt experiences and conclude whether she is experiencing neurotic or normal anxiety or guilt?

24. Critical Corner (continued) • One of the strong contemporary movements in psychotherapy and counseling practice is manualized therapy. The manualized approach is appealing because it provides therapists with clear guidelines and structure for conducting therapy. Although therapy manuals are not to be used like “cook-books” they provide therapists, both new and old, with standard procedures. How can existential or Gestalt therapy approaches survive when they are based on spontaneity and authenticity—a foundation that is completely counter to contemporary emphases on standardization of therapy?

25. Critical Corner (continued) • Gestalt therapy focuses on clients’ body awareness and trusts the individual to make contact with the environment and move in a positive and growthful direction. As practiced by F. Perls and others, Gestalt therapy is confrontive and provocative. Consider the application of Gestalt therapy with low functioning or psychotic clients. What might be the dangers of using an empty chair technique with a dissociative client? What might be the dangers of having a paranoid, borderline psychotic client “play his projection?” Do you think the Gestalt Prayer, “You do your thing and I do mine” would be a useful philosophy to teach men and women who are in prison because of their criminal behavior? In general, list and discuss with your class the potential contraindications of Gestalt therapy.

26. Review Key Terms • Ontological experience • Neurotic anxiety • Neurotic guilt • Ultimate concerns • Logotherapy • I-Thou relationship • Nihilism • Gestalt • Field theory • Figure-Ground-Formation

27. Key Terms (continued) • Will to meaning • Self-regulating • Confluence • Retroflection • Deflection • Projection • Contact • Gestalt experiments • Paradoxical intention • Cognitive reframing

28. Key Terms (continued) • Staying with the feeling • And this is my existence • The empty-chair dialogue experiment • Top-dog • Underdog • I take responsibility for • Playing the projection • The reversal technique • The exaggeration experiment • Gestalt dream work

29. Review Questions • Discuss how Kierkegaard’s Christian faith and Nietzsche’s atheism can be viewed as philosophical polarities that lead to a deeper understanding of the individual self. • Frankl openly admitted to facing nihilism and eventually discovering meaning. Did Frankl initially face nihilism before, during, or after his concentration camp experiences? Reflect on whether you believe (a) meaning naturally exists in the world or (b) individuals must create meaning in their lives. • What does Sartre mean by existence preceding essence? What are the implications of the opposite philosophical position, that essence precedes existence?

30. Review Questions • Is Frankl’s will to meaning a drive or a striving? What difference does it make? • Gestalt perceptual principles suggest that the whole is greater than the sum of its parts. If this is the case, then why do so many Gestalt therapy techniques involve breaking the individual down into fragments or parts (as in dream work or the empty chair dialogue)? • Describe the figure-ground-formation process and discuss how it is related to unfinished business.

31. Review Questions • Is it possible for a therapist to maintain an “I-Thou” relationship throughout the duration of a therapeutic encounter? Discuss ways in which you might, as a therapist, try to establish and maintain an I-Thou relationship with your clients. • According to Yalom, facing death can motivate individuals to live life more fully. Describe how the four ultimate concerns of existential theory can be used as a positive motivation with clients in therapy.

32. Review Questions • What is cognitive reframing and how did Frankl apply it to confront clients with a deeper sense of personal meaning? • Describe the two different ways a therapist can initiate a Gestalt empty chair dialogue. • List and discuss the sorts of questions an existential and/or Gestalt therapist might use with clients to help keep them focused on their immediate experience in therapy. • How does the Gestalt therapist view her client’s dreams? What are the four steps to dream work the Gestalt therapist employs?