While considering Existential Therapy it is helpful not to identity it as a specific framework for therapy but rather as a Philosophical orientation of the mental health therapist. Existentialism is inherently anti-theoretical in it’s contention that scientific theory clashes with the subjective experiences of one’s existence. Existential health could be defined as an appreciation for being in the moment of existence that empowers us to make use of our freedom. Individuals are responsible for making use of this freedom to form the conditions of their existence.
Let's begin with a brief discussion of the Existential movement;
Existentialism- Philosophical movement that contends that subjective experience must be the genesis of thought. Places emphasis on the moment and the freedom to choose within that moment to understand why people exist in the ways that they do. It examines the implications of freedom when weighed against the encumbrance of responsibility and seeks to understand how and why people think and act in certain ways under this anxiety.
This school of thought found it's genesis with the Phenomenology of the early 20th Century as described Merleau-Ponty, Husserl, and Heidegger who were preceded by the Existentialists of the Mid 19th Century such as Kierkegaard and Nietzsche.
This movement found it's way into mental health therapy by way of Swiss Psychiatrists such as Ludwig Banswanger and Medard Boss who Introduced these concepts into Psychotherapy. Later Otto Rank (1884-1939) part of Freud’s Vienna Psychoanalytic Society brought these new ideas to therapeutic circles in the U.S. via national lecture tours.
Perhaps the most well known case is that of Psychiatrist Victor Frankl (1909-1997) who is considered instrumental in the “Third School of Viennese Psychotherapy," He and his family were Imprisoned in Auschwitz & Dachau and he later wrote of this experience in "Man’s Search for Meaning," a seminal work in the development of his Logotherapy or therapy through meaning.
Lastly, Paul Tillich (1886-1965) and his contemporary Rollo May were responsible for finding a theoretical common ground between Psychoanalysis and Existential Philosophy.
Central Tenets of Existentialism
Existentialism contends that;
- Existence, the process of continual growth and change supersedes Essence, the state of merely being.
- Humans are both objective and subjective, therefore they cannot merely be but must question their own existence.
- We ultimately are solely responsible for the state of our own existence.
- Phenomena can only be fully authentic through experience.
This ideas gave rise to central therapeutic themes such as;
- Rational explanations must not extinguish all mystery from life.
- Inspiration and creativity arise from strife, angst, and pain.
- Unique individual is above the “organizational man,” (someone overly culturally indoctrinated).
- Joy and meaning are found in the aesthetic and the ecstatic.
Existential crises can accompany developmental changes such as children leaving home, retirement, death of a loved one, or diagnosis of a chronic or terminal illness. These events leave people asking questions such as, "What is the meaning of life?", "Is there a god?," Does anything I do even matter?," "Is this the only existence we’ll ever know?," "Why is there suffering in the world?," and "What are the keys to happiness and fulfillment?"
Individuals with good existential health are said to possess a healthy state of Dasein, that is a healthy sense of self in relation to the world of nature and of natural Laws called Umwelt, a healthy sense of self in relation to others, called Mitwelt, and a healthy sense of self acceptance or sens of self in relation to self (Eigenwelt). Being in a disconnected state in any of these three areas can result in purposelessness, alienation, and angst.
The Existential paradox is that full and free realization of one's unfettered existence within the world carries with it the dread of death or non-being. In the face of this Existential, "Angst," we retreat from being fully being free (Dasein) into anxiety and self-destructive coping mechanisms. Such as addiction,over-conformity, hostility, despair, and compulsion.
Existential Psychopathology distinguished between two types of anxiety. Normal Anxiety comes with the acceptance of responsibility and freedom. It is a by-product of progress within one’s existence and a necessary part of being. Neurotic Anxiety is incommensurate to the threat of being and results from a refusal to acknowledge the freedom and responsibility inherent in existence. Further pathology can develop from an in balance in any of the three ways of relating to the world that were already discussed. These imbalances are referred to ontological guilt.
Umwelt Guilt- With increased civilization and industrial progress we become estranged from nature and develop an innate sense of guilt.
Mitwelt Guilt- According to Phenomenology we can only know the world through our own experience and accordingly we can only relate to each other in a limited capacity.
Eigenwelt Guilt- Results from our own limited self-realization. We can always increasingly approach our potential and thus always have a sense of guilt propelling us toward full actualization.
Intentionality and Existential Therapy
We begin to reconcile Existential angst and bring the subjective (self) and objective (environment) into healthy balance through intentionality. The “meaning” of our actions is brought forth in intentionality. Our acts in the world become purposeful and directed toward a teleology or ends. The same subject can act on the same object with a multiplicity of intentions and this gives a meaning and a responsibility to our choices. Having taken responsibility for the freedom with which we are imbued we begin to analyze how we act on the world through the acts of wishing and willing.
To will is to organize one’s capacities towards a goal. A wish enables and gives content to the will, but the wish is immature. The lack of will can serve to protect the wish from failure by depriving it of conscious action and so will cannot exist without wish but can become trapped by it.
Frankl wrote of two types of freedom, the theoretical under-pining of which were a result of his time as a prisoner in WWII. Existential Freedom is the freedom to make choices and act upon those choices. Essential Freedom is the freedom to realize one’s self and one’s potential. His observations regarding those who survived the concentration camps was that survivors exercised a full existential freedom even while being denied essential freedom. The driving difference between these types of people was a sense of destiny or an ability to exercise one's will, within current limitations (like imprisonment), towards the goals set before one's self.
May outlined stages of development as they relate to embracing one's freedom;
- Innocence- Precede the ego and self-conscious, have infantile drives to fulfill needs.
- Rebellion- Desire independence but have little understanding of it’s inherent responsibilities.
- Decision- Transition toward independence, decisions are made on how to fulfill rebellious wishes.
- Ordinary- Normal adult ego, retreats from individual responsibility into conformity and cultural norms.
- Creative- Authentic self, transcendent and self-actualized, beyond ego-centrism.
From this model Existential angst and Psychopathology may be the result of complications in navigating these stages, for example;
if a first instances of childhood rebellion are met with harsh criticism. Then rebellion which should be the first affirmation of freedom instead becomes a source of anxiety with freedom takes on a negative and fearful connotation. A disconnection from nature, others, and self. (umwelt, mitwelt, eigenwelt) Leads to a dimming of the consciousness, an inability to be known to others and a directionless apathy. A refusal to pursue one’s destiny may be due to a disproportionate fear of death, nothingness, or the responsibility that accompanies freedom.
And so from the Existential view-point Psychological symptomology is a by-product of the patients attempt to escape their own freedom. Therapy therefore is intended to engage people in the use of their own freedom. The therapist, through developing a friendship of guidance, must invite the patient to subjectively live through their emotional experiences. The therapist must help them choose to venture forth freely into their potential destiny by reevaluating the situations from their past which caused freedom to become associated with negativity.