Research Paper: Existential Therapy: History and Application

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Existential Therapy: History And Application

Existential Therapy

Existential theory has deep roots dating back to 19th and early 20th century European philosophers. When psychiatrists began to read the works of these philosophers their approach to treating patients began to take on a more holistic approach that emphasized 'being' within a physical world and attending to the quality of interrelationships. As this theory was passed from generation to generation it was molded and transformed by fresh insights, a process entirely appropriate for a theory that promotes the same process in individuals. Although the rise of existentialism in Europe was fueled by the aftermath of two world wars, wars blamed by some on reductionist thinking and science, recent scientific studies testing the efficacy of existential psychology has shown it to be very effective in reducing the morbidity and mortality of patients with heart disease. This essay examines the emergence of existential theory, first in Europe and then America. The theory's strengths and weakness are discussed, in addition to recommended applications.

Existential Therapy: History and Application

Introduction

Rollo May, a renowned proponent of existential psychology in America (Bakris, 1977; De Castro, 2009), first entered the world of existentialist thought and theory while convalescing during his fight against tuberculosis (May, 1969, p. 1-4). His scholarly interest at the time was anxiety and was engaged in writing a book on the topic, but only found one author who was able to describe the anxiety he was personally experiencing as he waited for a once-a-month chest x-ray and updated prognosis. This was before effective medications were available that could cure tuberculosis. The author he identified with on a personal level was Soren Kierkegaard (1813-1855), who "… described anxiety as the struggle of the living being against nonbeing & #8230;" (p. 2). From May's perspective, his year and a half stay in a sanitarium was essentially this, with periodic episodes of escalating dread in anticipation of the monthly chest x-ray.

May (1969) also considered Freud's writings on anxiety, but found little comfort in his theories about repressed libido and ego fearing the loss of a loved object. The contrast between Kierkegaard and Freud, from May's perspective, captured the essence of existentialism because the former fearlessly entered the chaotic world of human experience and the latter reduced human experience to theory. Existentialism therefore rejects deconstructed human experience into quanta and instead embraces the holistic experience of existing.

May (1969) used the depression and physical illness experienced by the renowned American psychologist, William James, to make his point (p. 5-11). James eventually decides that he is fully capable of creating meaning in his own life through an act of will. The other principles that May, Kierkegaard, and James emphasized was 'knowing through doing' and the requisite antecedents 'decision and commitment.' Existentialists are therefore primarily concerned with human experience as it is being lived and the 'pre-rational' lens through which we all interpret our experiences. May and James do not reject the importance of a behaviorist approach to psychology, but as psychotherapists concerned with the welfare of patients felt reductionists approaches were not sufficiently therapeutic. In essence, existentialist psychology is concerned with the experience of 'existing' and the clinically-significant problems this creates.

To better understand existential theory and its contributions to clinical psychology This essay will first review the historical roots of contemporary existentialism. This will be followed by a discussion of applied existential psychology and its strengths and weaknesses.

History of Existential Theory

George Bakris (1977) describes contemporary existential psychology as a 20th century European reaction to two world wars and man's apparent ability to reduce or eliminate individual value through 'science.' If science could be described as an extroverted act interested only in quantifying and dominating the world, then existentialism represents its counterpart by emphasizing the inner experiential world of mankind. Bakris cites the philosophical works of Kierkegaard and Freidrich Nietzsche (1844-1900), both 19th century philosophers, as the philosophical foundation upon which contemporary existentialism has been built. Although psychoanalysis also provides an introverted perspective on human experience, existentialists reject the technical approach employed by this school of thought as dehumanizing.

The language used by existential psychologists was developed by the German philosopher Martin Heidegger (1889-1976), who was a student of the phenomenologist Edmund Husserl (1859-1938) (Bakris, 1977). Heidegger was also inspired by Kierkegaard and Neitzsche, among others (Halling & Nill, 1995). Heidegger felt that literary expressions, such as poetry, were more appropriate for communicating human experience than was science (Bakris, 1977). However, there are a number of contradictions associated with Heidegger, including a negative view of psychology, a rejection of himself as an existentialist, and his membership in the Nazi Party throughout the Second World War (Halling & Nill, 1995).

Husserl, Heidegger's mentor, relished the wonderment of consciousness, but Heidegger was instead captured by the wonderment of 'being' (Halling & Nill, 1995). From Heidegger's perspective the act of 'being' was simultaneously revealed and hidden to a person, which is essentially equivalent to conscious and unconscious experiences. The act of 'being was also an active experience, not static. Another essential component of Heidegger's philosophy was that 'being' was inseparable from the physical world in which an individual lives. In other words, 'being' is both a product and reaction to the physical world and the challenges it poses. In a surprising philosophical twist, considering his Nazi Party membership, Heidegger believed that the more we become immersed in the ideology of anonymous authority we become increasingly inauthentic and alienated from our own 'being.' When faced with death, however, the formally embraced delusions are rapidly discarded as we become more authentic. Halling and Nill (1995) concluded that Heidegger left a long trail of moral and ethical inconsistencies and therefore recommend reading his writings critically.

Heidegger used the German term 'Dasein' to capture a person who is aware of 'being' in an interconnected world and beginning to question the nature of his or her existence (Halling & Nill, 1995). Existential psychologists therefore engage in 'daseinanalyse' (Bakris, 1977). The conversion of Heidegger's philosophy into a psychological theory has been attributed to the work of the Swiss psychiatrist Medard Boss (1903-1991) (Halling & Nill, 1995). The two began to collaborate closely shortly before the start of the Second World War. Boss also helped bring existentialism to America during a successful speaking tour. Another major contributor to the clinical application of existentialism was Swiss psychiatrist Ludwig Binswanger (1881-1966); however, in contrast to Boss's daseinanalytic approach Binswanger emphasized interrelationships as more important that Heidegger's 'being in the world.' With his medical background Binswanger naturally emphasized the importance of the doctor-patient relationship.

The English translations of Binswanger's writings in the book Existence, published in 1958 and edited by Rollo May, Ernest Angel, and Henri F. Ellenberger, has been cited as the origin of American existential psychology (Hoffman, 2009, p. 4-5); however, a number of other events predated this event (Halling & Nill, 1995). The lead editor of this book, Rollo May, has also been called the father of American existential psychology (Hoffman, 2009). Existential psychology has been further promoted in the U.S. By the works of James T. Brugental, Irvin Yalom, and Kirk Schneider.

Applied Existential Psychology

Rollo May, in 1981, defined the goals of existential-integrative therapy as setting people free emotionally, cognitively, and physically, but within the limitations imposed by the physical world (Schneider & May, 1995, p. 135-173). The four basic intervention phases are "(1) presence, (2) invoking the actual, (3) vivifying and confronting resistance, and (4) meaning-creation" (p. 152). Presence is the ability to tune into an interaction with another person, which is equivalent to Heidegger's dasein. Invoking the actual is a process of refocusing on the needs and concerns of the client, especially those hidden from view. If clients are resistant to the second phase then the resistance becomes the focus of a therapeutic interaction. The meaning-creation phase is designed to help clients consolidate their insights in ways that give their life meaning. The primary application of existential therapy is therefore personal growth and actualization.

Strengths of Existential Theory

Psychosocial problems are increasingly recognized as a contributing factor to physical morbidity and mortality, which should fall within the domain of existential therapy. Roncella and colleagues (2013) tested the efficacy of existential therapy by examining the health of patients following major cardiac surgery, who were then treated with either standard care or short-term existential therapy. Although this was a preliminary study of 94 cardiac patients, those randomized to existential therapy experienced a 94% decline in the incidence of cardiac problems. Patients in the treatment group were less likely to be hospitalized, reported a higher quality of life, were less depressed, and disease severity declined.

As discussed in the introduction to this essay, existentialism helps patients to confront the issues that may be having an adverse impact on their psychological and physical health. Importantly, one of the outcome measures in the study by Roncella and colleagues (2013) was the prevalence of angina, which was reduced dramatically in the treatment group. In addition, three of the patients… [END OF PREVIEW]

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