Existential Psychotherapy

Document Sample
Existential Psychotherapy Powered By Docstoc
					           Existential Psychotherapy

 Primary concerns are deeply buried by means of
 repression, denial, displacement, and symbolism

 Access primary conflicts through deep reflection,
 dreams, nightmares, flashes of profound experience
 and insight, psychotic utterances, and through the
 study of children
                    Existential Position

 Conflict flows from the individual‘s confrontation
 with the givens of existence
    Certain intrinsic properties that are part of human existence

    Discovery often catalyzed by deep personal reflection following
     a ―border‖ or ―boundary‖ experience in which one is faced with
         one‘s own death
         major irreversible decision
         collapse of meaning-providing schema
                        Major Concerns

 Death
     Tension between the awareness of the inevitability of death and
      the wish to continue to be
 Freedom
    Clash confrontation with groundlessness and our wish for
      ground and structure
 Existential Isolation
    tension between awareness of our absolute isolation and our
      wish for contact, protection, and wish to be part of a larger
 Meaninglessness
    Conflict that stems from the dilemma of a meaning-seeking
      creature who is thrown into a universe that has no meaning
              Life, Death, and Anxiety

 Life and death are interdependent
    they exist simultaneously, not consecutively

    death whirs continuously beneath the membrane of life
     and exerts a vast influence upon experience and conduct
 Death is a primordial source of anxiety and, as such,
  is the primary source of psychopathology
                    Two States of Being

 State of Forgetfulness of Being
    one lives in the world of things and immerses oneself in
     the everyday diversions of life

 State of Mindfulness of Being
    one remains mindful of being, not only mindful of the
     fragility of being but mindful of one‘s responsibility for
     one‘s own being
        Cancer- Confrontation with Death

 Evidence of startling shifts, inner changes, and
 personal growth
    Rearrangement of life‘s priorities: trivializing of the trivial
    A sense of liberation- being able to choose not to do something
     that they do not wish to do
    Enhanced sense of living in immediate present rather than
     postponing life until retirement or some other point in the
    Vivid appreciation of the elemental facts of life- the changing
     seasons, the roses, and so forth
    Fewer interpersonal fears- less concern about rejection,
     greater willingness to take risks
                    Death and Anxiety

 Death transcendence is a major motif in human existence
 Robert Lifton describes several modes by which man
 attempts to achieve symbolic mortality
 1.Biological mode- Living on through one‘s progeny, through an endless
    chain of biological attachments
 2. Theological mode- Living on in a different, higher plane of existence
 3. Creative mode- Living on through one‘s works, creation or impact on
 4. Theme of Eternal Nature- One survives through rejoining the life
    forces of nature
 5. Experiential Transcendent Mode- through ―losing oneself‖ in a state
    so intense that time and death disappear an one lives in the
    ―continuous present‖
                Death and Anxiety

Three Types of Death Fear – Jacques Choron
 1. What comes after death
 2. The event of dying
 3. Ceasing to be

How can we combat anxiety?
By displacing it from nothing to something.
                Death and Psychopathology

 Either due to extraordinary stress or inadequate defensive
  strategies, one who enters the realm called ―patienthood‖ has
  found insufficient the universal modes of dealing with death
  fear and has been driven to extreme modes of defense

 Psychopathology- An ineffective defensive mode
     Even defensive maneuvers that successfully ward off severe
      anxiety can be considered psychopathology if they prevent growth
      and result in a constricted and unsatisfying life

     Ex: Individual maintains symbiotic relationship with mother. Avoids
      death anxiety, but this defensive mode leads to secondary anxiety (ei:
      reluctance to separate from mother may interfere with attendance at
      school, or the development of social skills)
 Two Fundamental Defenses Against Death

 One who either fuses or separates, embeds or
    He affirms his autonomy by standing out in nature or seeks
     safety by merging with another force
  Psychopathology in Response to Death Denial

 Compulsive Heroism- heroic individuation represents the best
  that man can do in light of his existential situation
 Narcissism- if a belief in personal inviolability is coupled with
  a corresponding diminished recognition of the rights and the
  specialness of the other, than one has fully developed
  narcissistic personality
 Aggression and control
 Success Neurosis- individuals on the verge of success develop
  crippling dysphoria which often ensures they will not succeed

 When goal is to fashion life around a belief in personal
  specialness and inviolability
     Depression often ensues when the belief collapses.

 To live for the dominant other is to attempt to merge
  with another whom one perceives as the ―dispenser of
  protection and meaning in life‖
     dominant other may be one‘s spouse, mother, father, lover, therapist,
      or an anthropomorphization of a business or social institution

     Ideologies may collapse: the dominant other may die, leave,
      withdraw love and attention, or prove too fallible for the task
                  Sex and Death Anxiety

 Sexual activity as a mode of assuaging death anxiety is often clinically

     Successful being who devotes self utterly to power, to getting ahead,
      standing out, and making a name for himself must at some point come
      face to face with the lonely unprotectedness inherent in individuation

            Example
               Death and Psychotherapy

 The reality of death is important to the field of
 psychotherapy in two distinct ways:
    Death awareness may act as a ―boundary situation‖ and
     instigate a radical shift in life perspective
    Death is a primary source of anxiety

    Boundary Situation: an event, an urgent experience, that
     propels one into a confrontation with one‘s existential
     situation in the world
      confrontation with death is the boundary situation that has the
       power to provide a massive shift in the way one lives in the world
      Death reminds us that life cannot be postponed

 Disidentification is an important part of Roberto Assagioli‘s system of
  psychosynthesis in which he tries to help one his/her ―center of pure
  self-consciousness‖ by asking him to imagine shedding, in a systematic
  way, his body, emotions, desires, and finally, intellect

 Example of structured Disidentification Exercise—
     In peaceful setting, ask one to list on cards 8 answers to the question ―Who am I?‖

     One reviews the 8 answers and arranges the cards in order of importance and centricity
             The answers closest to their core at bottom, the more peripheral responses at the top.

     Participants are then asked to study their top card and meditate on what it would be like
      to give up that attribute
             This process continues until one has divested themselves of all 8 attributes.

     Following that, help the patient to integrate by going through this process in reverse.
     Death as a Primary Source of Anxiety

 The concept of death provides the psychotherapist
 with two major forms of leverage:

 1. Death is of such momentous importance that it can, if properly
    confronted, alter one‘s life perspective and promote a truly
    authentic immersion in life.

 2. Based on the premise that the fear of death constitutes a
    primary source of anxiety, that it is present in early life, is
    instrumental in shaping character structure, and continues
    throughout life to generate anxiety that results in manifest
    distress and in the erection of psychological defenses.

 Denial of Responsibility

    Innocent victim: common type of responsibility avoidance in
     which one experiences themselves of innocent victims of
     events that they themselves have unwittingly set into motion

    Losing control: to be temporarily ―out of one‘s mind.‖ Patients
     enter a temporary irrational state in which they act
     irresponsibly for which they believe they are not accountable.
Assumption of Responsibility and Psychotherapy

 To assist a patient in assuming responsibility, the therapist
  must continually operate within the frame of reference that
  a patient has created his own distress.

     The Self-Fulfilling Prophecy: The individual expects a certain event to
      occur, then behaves in such a way as to bring the prophecy to pass,
      and finally relegates awareness of his r her behavior to the

     Ex. Mary has certain beliefs/expectations about men that distort her
      perception, and perceptual distortion resulted in her behaving in ways
      that elicited the very behavior she dreaded

  -- Awareness of one‘s own feelings constitute a therapist‘s most
     important instrument for identifying a patient‘s contribution to his or
     her life predicament.
        Affect Block and Psychotherapy

 The purpose of affect arousal is not sheer catharsis
 but to help patients rediscover their wishes
            Compulsivity and Impulsivity


 One who acts immediately on each whim avoids wishing just
  as one who stifles wishes
      Thus, one avoids having to choose among various wishes which,
       if experienced simultaneously, may be contradictory

 One who cannot discriminate among his wishes, attempts to
  fulfill all of them, and in doing so loses his true self- the self
  that wants one thing more deeply than another thing.

 To wish is to lunge into the future, and one must consider the
  future implications & the consequences of acting upon a wish
         Impulsivity and Compulsivity

--Compulsivity, a defense against responsibility
  awareness, also constitutes a disorder of wishing,
  one that appears more organized and less capricious
  than impulsivity.

--One is propelled to act, often against one‘s wishes,
  and if he does not act, feels acutely uncomfortable.
         Why are Decisions So Difficult?

 For every yes there must be a no. To decide one thing
 always means to relinquish something else.

 A fundamental decision also confronts each of us with
 existential isolation. A decision is a lonely act, and it is
 our own act; no one can decide for us.

 Many people are highly distressed by decision and,
 attempt to avoid it by coercing or persuading others to
 make the decision for them.
 Decision: Clinical Strategy and Techniques

 It is a decision that slips the machinery of change into
  gear. No change is possible without effort, and decision is
  the trigger of effort.

 The therapist‘s task is not to create will but to
  disencumber it. Here are two methods:
  1. Help patient become aware of the inevitability and the omnipresence
     of decision.

  2. Assist in laying bare the deeper implications (the meaning) of that
                     Insight and Decision

 Insight effects change

  1. How to help liberate that patient‘s stifled will:
        -enable patients to realize that only they can change the world they
     have created;
        -that there is no danger in change, that to get what they really want
     they must change; and that each individual has the power to change.

  2. Search for understanding is the glue that binds patient and therapist
        -it keeps them occupied in a mutually satisfying task
                 -patient is gratified by having his inner world scrutinized
                 with such thoroughness

 Leverage Producing Insights:
  1. Only I can change the world I have created. (The patient has
     fully grasped the full implications of his or her responsibility)
  2. The therapist must help patient understand that responsibility
     is continuous: one is continuously creating oneself.
  3. The therapist must help the patient take a step toward
     realizing that, just as one is soley responsible for being what
     one is, one is soley responsible for changing what one is.
                         Existential Isolation

 Three Types of Isolation

     1. Interpersonal: Loneliness, refers to isolation from other individuals.

     2. Intrapersonal: Process by which one partitions off parts of oneself. Results
      whenever one stifles one‘s own wishes, distrusts one‘s own judgment, or buries
      one‘s own potential.

     3. Existential: an unbridgeable gulf between oneself and any other being. It
      refers, too, to an isolation even more fundamental- a separation between the
      individual and the world.

  ‗The Loneliness of Being One‘s Own Parent‘.
     To the extent that one is responsible for one‘s own life, one is alone.
     Responsibility implies authorship: to be aware of one‘s authorship means to
     forsake the belief that there is another who creates and guards one. Deep
     loneliness is inherent in the act of self creation.
         Growth and Existential Isolation

--The word ―Exist‖ implies differentiation
  ( ―ex-ist‖= to stand out)

--The process of growth, is a process of separation, of becoming
  a separate being.

--The words of growth imply separateness: autonomy, self-
  reliance, individuation, independence.

--Not to separate means not to grow up, but the toll of
  separating and growing up is isolation.
     Existential Growth and Relationship

 The problem of relationship is a problem of fusion-
 isolation. One the one hand, one must learn to relate to
 another without giving way to the desire to slip out of
 isolation becoming part of that other.

 But one must also learn to relate to another without
 reducing the other to a tool, a defense against isolation.
    ―I believe that if we are able to acknowledge our isolated situations
   in existence and to confront them with resoluteness, we will be able
   to turn lovingly toward others. If on the other hand, we are overcome
   with dread before the abyss of loneliness, we will not reach out
   toward others but instead will flail at them in order not to drown in
   the sea of existence.‖
                                               -- Irvin Yalom
Characteristics of a Mature Relationship

   1. To care for another means to relate in a selfless way: one lets go of self-consciousness and
    self-awareness; one relates without the overarching thought ―What does he think of me?‖or
    ―What‘s in it for me?‖
   2. To care for another means to know and to experience the other as fully as possible. If one
    relates selflessly, one is free to experience all parts of the other rather than the part that
    serves some utilitarian purpose.
   3. To care for another means to care about the being and the growth of the other. With one‘s
    full knowledge, the product of genuine listening, one endeavors to help the other become
    fully alive in the moment of encounter.
   4. Caring is active. Mature love is loving, not being loved. One gives lovingly to the other;
    one does not ―fall for‖ the other.
   5. Caring is one‘s way of being in the world; it is not an exclusive, elusive magical connection
    with one particular person.
   6. Mature caring flows out of one‘s richness, not out of one‘s poverty- out of growth, not out
    of need. One does not love because one needs the other to exist, to be whole, to escape
    overwhelming loneliness.
   7. Caring is reciprocal. To the extent one truly ―turns toward the other,‖ one is altered. To the
    extent one brings the other to life, one also becomes more fully alive.
   8. Mature caring is not without it‘s rewards. One is altered, one is enriched, one is fulfilled.
    Through caring one is cared for.
                         Need – Free Love

 ―Man does not exist as a separate entity. Man is a creature of the
  between.‖ –Buber

 Buber asserts that there are two types of relationships:

     1. The ―I-It‖

     2. The ―I-Thou‖

  The ―I-It‖ relationship refers to a relationship between a person and equipment, a
    functional relationship, a relationship between subject and object which lacks

  The ―I-Thou‖ relationship refers to a wholly mutual relationship in which involves a
    full ―experiencing‖ of the other.
 Fusion- the human being‘s ―universal conflict‖
 -- One strives to be an individual, and yet being an
  individual requires that one endure a frightening

 Kierkegaard said : ―With every increase in
 consciousness, and in proportion with that increase,
 the intensity of despair increases: the more
 consciousness, the more intense the despair.‖
  Isolation and the Therapist-Patient Encounter

 First maxim of psychotherapy: ―The goal of psychotherapy is to
  bring the patient to the point where he can make a free choice.‖

 Second maxim of psychotherapy: ―It is the relationship that heals.‖

 How does the Therapeutic Relationship Heal?

     Two ways:

         1. In-Therapy relationships are mediating in a way that improves the equality of
          other, or future relationships by instructing the patient about their maladaptive
          interpersonal behavior

         2. These relationships have value in and for themselves-as ―real‖ relationships, they
          effect intrapersonal shifts.

 How does a being who needs meaning find meaning in a
  universe that has no meaning?

 Meaning refers to sense, or coherence. A search for meaning
  implies a search for coherence.

 Purpose refers to intention, aim, function.

 Secular personal meaning

     Dedication to a cause

     Creativity

 The Hedonistic Solution
   The purpose of life is, in this view, simply to live fully, to
    retain one‘s sense of astonishment at the miracle of life, to
    plunge oneself into the natural rhythm of life, to search for
    pleasure in the deepest possible sense.

 Self-Actualization
   Belief that human beings should strive to actualize
    themselves, that they should dedicate themselves to realizing
    their in-built potential.
 Viktor Frankyl‘s three categories of life meaning:

     1. What one accomplishes or gives to the world in terms of one‘s

     2. What one takes from the world in terms of encounters and

     3. One‘s stand toward suffering, toward a fate that one cannot

  *Three meaning systems: creative, experiential, and attitudinal.
              Clinical Manifestations

 Existential Vacuum- Common phenomenon
 characterized by the subjective state of boredom,
 apathy, and emptiness. One feels cynical, lacks
 direction, and questions the point of life‘s activities.

 If patient develops, in addition to feelings of
 meaninglessness, overt clinical neurotic symptoms,
 then Frankyl refers to the condition as an
 Existential Neurosis.

 Salvador Maddi‘s three clinical forms of ―existential sickness‖

1. Crusadism- powerful inclination to seek out and to dedicate oneself to dramatic and
    important causes

2. Nihilism- an active, pervasive need to discredit activities that others find

3. The Vegetative form of Existential Sickness- most extreme degree of purposelessness
   in which one sinks into a severe state of aimlessness and apathy- a state that has
   widespread cognitive, affective, and behavioral expressions.

Cognitive- inability to believe in the usefulness or value of life‘s endeavors
Affective- pervasive blandness
Behavioral- lack of selectivity of behavior- it becomes immaterial which activities the
  person pursues.
             Summary of Research Results

 1. Lack of sense of meaning in life is associated with psychopathology in a
  linear sense: the less the sense of meaning, the greater the severity of

 2. A positive sense of meaning in life is associated with deeply held
  religious beliefs.

 3. A positive sense of life meaning is associated with self-transcendent

 4. A positive sense of meaning in life is associated with membership in
  groups, dedication to some cause, and adoption of clear life goals.

 5. Life meaning must be viewed in a developmental perspective; the types
  of life meaning change over an individual‘s life; other developmental tasks
  must precede development of meaning.
          Why Do We Need Meaning?

--When one is unable to find a coherent pattern, one
  feels not only annoyed and dissatisfied but also
  helpless. The belief that one has deciphered meaning
  always brings with it a sense of mastery.

-- It is evident that we crave meaning and are
  uncomfortable in its absence. One finds a purpose
  and clings to it for dear life. Yet the purpose one
  creates does not relieve discomfort effectively if one
  continues to remember that one forged it.
             Meaning in Life and Values

 Once a sense of meaning is developed, it gives birth
  to values- which, in turn, act synergistically to
  augment one‘s sense of meaning.
 Values:
    Constitute a code according to which a system of action may be
    Provide the individual with a blueprint for personal action
    Make it possible for individuals to exist in groups.
    Emanate from a meaning schema that has the consensus of the
    Provide predictability necessary for social trust and cohesion.
          Meaning in Life and Values

 Ernest Becker argues that our ―universal ambition‖ is
 ―prosperity‖, and that death is the chief enemy with
 which we must contend.
                Therapeutic Strategies

 Dereflection- (Frankyl) Involves diverting the attention of the
  patient away from themselves, from the source of their
  dysphoria, from the source of their neuroses and toward the
  intact parts of their personalities and the meanings that are
  available for them in the world.

 The therapist‘s goal is engagement. The task is not to create
  engagement nor to inspirit the patient with engagement–
  these the therapist cannot do. But it is not necessary: the
  desire to engage life is always there within the patient, and the
  therapist‘s clinical activities should be directed toward
  removal of obstacles in the patient‘s way.
                      Work Cited

Yalom, I. D. (1931). Existential psychotherapy. United States of
  America : Harper Collins Publishing.