Humanistic-existential therapy

A Humanistic-Existential Approach…

Introduction

Human beings feel secure and purposeful when they seize life with awareness, responsibility, and courage.  However, when they are overwhelmed or avoid normal levels of anxiety and suffering, feelings of meaninglessness and guilt often result.  This understanding is at the core of the humanistic-existential approach, which generally favors a study of life rather than a philosophy of abstract ideas or theoretical formulations.  It focuses on how people are engaged and embedded in daily life.

As a mode of therapy, the intent of the humanistic-existential approach is to help people face some of the basic facts of life and to live more authentically.  A central tenet of this approach is that emotional problems do not create difficulties, but rather one’s attitude toward life is what tends to create emotional difficulties.  This suggests that, while people generally are innately growth-oriented and forward-looking, they can be stifled by inauthentic assumptions of self and world.

View of Human Nature

Inherent in life are certain “givens” so fundamental that to avoid them is practically to avoid life itself:  for example, we are born and will one day experience biological death; in between, we will likely make life-changing decisions, find meaning, encounter opposition, and experience love.

Despite these facts – or perhaps because of them – we must still choose our attitude toward life.  We can choose to live in the moment (not for the moment) and acknowledge and appreciate that ideas, events, and other people have subjective relevance for us.  On the other hand, remembering that individual choice is involved, we can choose to avoid these givens or pretend we have no role in choosing what happens to us.  We feel anxiety and guilt when we avoid existential givens (Tillich, 1952).

The Christian existentialist philosopher and theologian Paul Tillich (1952) describes the existential perspective as “an attitude of infinite concern” as distinguished from an attitude that is detached or theoretical.  It’s generally accepted that this type of deep and genuine involvement is required for therapy to be effective.  This is supported by research that shows that, although one particular type of therapy is not consistently more effective than another (Efran, Germer, & Lukens, 1986), the therapeutic relationship itself has consistently been demonstrated to be related to treatment outcome (Bonger & Beutler, 1995).

Human beings have free will, which is the ability to choose one’s reaction to circumstances, to other people, and to oneself – regardless of limitations or external circumstances.  Victor Frankl (1962) came to this conclusion based on his experience in a Nazi concentration camp, where he found a way to maintain his internal integrity and freedom.  He could have responded to his situation by putting his energy into hating his captors, but rather he concentrated his thoughts on his family and developing what became known as logo-therapy to give him the strength and purpose to endure immense hardships.

Abraham Maslow (1968), considered one of the founders of humanistic psychology, believed people are inherently growth-oriented, spiritual, and good.  We strive to perfect ourselves and are motivated by positive, transcendent aims.  Maslow writes, “…the human being is so constructed that he presses toward what most people would call good values, toward serenity, kindness, courage, honesty, love, unselfishness, and goodness.” (p. 155). Carl Rogers (1961), another founder of humanistic psychology, believed people naturally strive for trust, congruency, love, responsibility, and openness.

The obvious question that arises, then, is this: If people are essentially good and spiritual, how does one account for cruelty, cold rigidity, or psychological pain?  Free will is one answer. We can choose to avoid whether or not to live in accordance with our positive nature.

The doctrines of the fall, sin, and salvation can help explain this idea.  From this perspective, people are also described as good, perfect, and created by and in the image of God.  However, the existential predicament is having lost this state of being.  Therefore, even though people may have “fallen from grace” – resulting in inner imperfection or corruption – one’s essential goodness is still preserved by the creativity of God.  We can therefore chose to recognize our existential separation from God, a recognition that is necessary for restitution and reunion.

People are contextual and holistic, which means one can never be understood in isolation.  We have three modes of being-in-the-world:  Umwelt, the surrounding physical and biological worlds; Mitwelt, the social environment of people; and Eigenwelt, the internal relationship to oneself (Maddi, 1989).  These three modes are interdependent, in that a change in one will effect changes in the others.

Personality Development

As mentioned, Maslow (1970) believed the human personality is driven by an innate growth urge, which propels individuals toward higher dimensions of self-fulfillment and realization.  We begin life by devoting attention and energy toward gratifying the “lower” biological needs, and as these are satisfied, automatically seek to fulfill “higher” self-transcendent ones.  He writes, “the organism is dominated and its behavior organized only by its unsatisfied needs.” (p. 38).

This is Maslow’s “hierarchy of needs” model.  People first seek to meet physiological and safety needs (Umwelt) – shelter, hunger, thirst, sex.  Safety needs are those that allow the person to feel safe, secure and out of danger.  Next come psychological needs, which are related to a sense of belonging and love (Mitwelt).  This motivates a person’s desire for friends, family and colleagues.  People naturally seek to fulfill esteem needs, which include professional roles and recognition for competence.

Beyond esteem needs are self-actualization needs (Eigenwelt).  These are at the “peak” of Maslow’s pyramid, which he considered the place of optimal fulfillment.  Self–actualization is where people develop into their uniqueness and can transcend various biological and external forces, and can create meaning, values, and exercise freedom of choice.  Maslow (1968) writes, “…such people become far more self-determined and self-contained.  The determinants which govern them are now primarily inner ones, rather than social or environmental.  They are the laws of their own inner nature….” (p. 35).

According to Maddi (1989), people gravitate toward one of two personality types along a continuum.  A conformist’s personality and self-definition is little more than an actor of social roles and a personification of biological needs.  A conformist feels that social rules and biological urges are tantamount to objective, unchallengeable laws.  Toward the liberated side is individualism, which Maddi says “…leads to biological and social experiencing showing considerable taste, subtlety, intimacy, and love due to the humanizing, organizing effects of symbolization, imagination, and judgment.” (p. 348).

The idea is to have a sense of autonomy, agency, and freedom of choice, and to relate to others on a deeper level than prescribed behaviors would permit.  The difference between the individualist and the conformist is most poetically stated by Franz Kafka (1954):  “With the strongest light one can dissolve the world.  Before weak eyes it becomes solid, before still weaker eyes it grows fists, before still weaker eyes it becomes shamefaced and smashes anyone who dares to look at it.” (p. 198).

In terms of human development, Maddi (1989) distinguished between early and later stages.  In early development, children are dependent upon their parents’ impressions of the world, whereas in later phases, development is self-initiated.  The ideal outcome for the early stage of development is courage.  This disposition can be fostered by parents who expose their children to diversity, impose limits personally to their values, and who love and nurture growth and individuality, instructing them on the values of symbolization, imagination, and judgment.

Following courage is the aesthetic orientation, which largely takes place outside of the family (Maddi, 1989).  It is often described as hedonistic.  Having emerged from a childhood where they have had to stretch themselves to take responsibility, those who develop courage often feel the desire to experience anything and everything – without much of a plan.  Sooner or later, though, the lack of a larger plan for the future feels empty and anomic.

This ushers in the idealistic orientation.  At this point people tend to behave as if they have total control over life – to love is to love forever; committing to a political cause is automatically being willing to die for it.  Of course, organizing ourselves in this way is largely unrealistic because life is too complex and dynamic to conform to our expectations much of the time.

This realization or failure propels the individual into authentic being, the final stage of this developmental model, where the task is to integrate past, present, and future, and to recognize that people and events are not controllable.  In 1854 (a half-century before the advent of modern psychology), Henry David Thoreau described the transition from idealistic to the authentic orientation quite well.  He wrote, “If you have built castles in the air, your work need not be lost; that is where they should be.  Now put the foundations under them.” (p. 215).

Barriers to Growth

Many people feel isolated, trapped, or shameful, which may be related to inauthentic assumptions of self and world, denial of one’s finite nature, and avoidance of suffering,  According to Spira (in Chochinov & Breitbart, 2000), people are interpretive beings.  Not only do we impose our interpretations on the world through language, i.e., through symbolization, imagination, and judgment, our interpretations are imposed upon us as well.  While our self-image or “ego” may only be a mental construct that was created through a lifetime of cultural conditioning, it is still very difficult for people to recognize that the way the world appears to them may not be how it actually is – that it is an interpretation!

On one hand, our interpretations protect us from meaninglessness and chaos.  On the other, as Frankl (1955) noted, the primal experience of being human is consciousness, responsibility, freedom, and courage.  When people assume that their subjective experiences are objective facts, they are usually passively conforming to a way of life that precludes personal responsibility and consciousness.

The most obvious evidence for the shallowness of our interpretations comes during a life-threatening physical illness, when unconscious beliefs and habituations can (sometimes quite suddenly) become illuminated and even appear absurd and artificial.  (Fritz Perls, the Gestalt therapist, might say they are brought to the foreground of experience).  The sudden experience of distance from oneself feels like a “disassociated depersonalization,” and can produce anxiety – although eventually it can lead to a deeper sense of self.  This is known as an “existential crisis.”

According to Tillich (1995), rigidly adhering to interpretations produces anxiety of which there are three types:  the anxiety of fate and death, the anxiety of emptiness and meaninglessness, and the anxiety of guilt and condemnation.  On a fundamental level, it is the threat of nonbeing that causes people to feel anxiety.  In particular, the anxiety of fate and death results from the awareness that one day they will cease to exist, and every meaning ever attributed to life will dissolve.  This calls to mind the first of Rainer Maria Rilke’s (1923) Duino Elegies:

“Of course, it is strange to inhabit the earth no longer, to give up customs one barely had time to learn, not to see roses and other promising Things in terms of a human future; no longer to be what one was in infinitely anxious hands [italics added]; to leave even one’s own first name behind, forgetting it as easily as a child abandons a broken toy.  Strange to no longer desire one’s desires.  Strange to see meanings that clung together once, floating away in every direction” (p. 155).

While Rilke writes about death with tranquility, he must have been able to tolerate a great deal of nonbeing to experience it this way.  The anxiety that comes with the threat of nonbeing is usually too much to handle, and it becomes a barrier to growth rather than an opportunity for it.  In the next line of the passage quoted above, Rilke writes, “And being dead is hard work and full of retrieval before one can gradually feel a trace of eternity.” (p.155)

According to Tillich (1955), the anxiety of meaninglessness is the anxiety of a loss of ultimate concern.  Put differently, it is a threat of nonbeing to one’s spiritual existence.  When Frederick Nietzsche (in Jones, 1969) wrote “God is dead,” he meant that people no longer believe in a cosmic order behind their interpretations like they did in the past.  Science and reason have taken the place of the “objective” spiritual world.  However, people still use stories to make sense of the world.  Moreover, people will do almost anything to avoid the feeling of emptiness – even if that means fleeing into the safety of a herd-like conformity or developing a host of physical or mental ills.  Emptiness, though, when endured, will paradoxically transform into a wellspring of creativity.  Nietzsche (1968) writes,  “…one must still have chaos in oneself to be able to give birth to a dancing star….still have chaos in yourselves.”  (p. 129).

The anxiety of guilt and condemnation is the moral version of nonbeing (Tillich, 1955).  We have a responsibility to accept our freedoms, even though this very freedom implies that we can choose whether or not to avoid it!  In this way, it is similar to the Judeo-Christian notion of God having created human beings with free will and given them the choice whether or not to be spiritually obedient.  Every action has within it the possibility of not doing it; therefore, guilt is inherent in being.

Herein lies the difference between the normal and the pathological or neurotic types of anxiety.  In normal anxiety, people may deny nonbeing by transferring the emotion of anxiety into fear, which tends to have specific, concrete objects.  One is afraid of automobile accidents, one is afraid of clowns, etc.  Neurotic anxiety avoids nonbeing, to be sure, but to a much greater extent.  For the neurotic, avoidance of nonbeing is a negation of being itself, because once again being includes nonbeing.  Tillich says, “Neurosis is the way of avoiding nonbeing by avoiding being.” (p. 66).

Growth & Health

If one takes anxiety and nonbeing into oneself, if one affirms it and faces it with courage, then growth and mental wellness will occur ipso facto.  To be mentally well is to be in a state of perpetual growth and to grow is to be moving toward mental wellness.

According to Rollo May (1983), existence implies self-transcendence.  People are dynamic, ever in the process of becoming and moving toward the future.  May writes, “…transcendere – literally ‘to climb over or beyond’ – describes what every human being is engaged in doing every moment when he is not seriously ill or temporarily blocked by despair or anxiety.” (p.143).  Examples include rising above the present moment in time “to bring the distant past and long-term future into one’s immediate existence,” thinking abstractly and using symbols to identify the personal meaning of a situation, standing on the perimeter of something to talk about it through language, or seeing ourselves as others see us.  Part of what Eigenwelt means is being able to view us simultaneously as subject and object, and to organize our experience to make choices based upon a range of infinite possibilities.  Again, we can always transcend the immediate, concrete event, and by doing so rise above the part of our being that is stuck or confined by it.  We can always take responsibility.

Tillich (1955) points out three existentialist elements in Hegel’s philosophy:  his conception of negation and the mystery and anxiety of nonbeing; his doctrine that “to create” requires passion and interest; and his consideration of the individual’s contextual nature, particularly as one is embedded in a socio-historical context (but also in Spirit).  One cannot understand Hegel’s (in Jones, 1968) conception of individual growth apart from his conception of historical growth, because they are organically linked in a dialectical relationship.

Hegel describes history as a process of “Evolving Truth.”  People attempt to come to agreements regarding the truth through reason, negotiation, and dialogue.  Because each claim to truth is only partially true it necessitates a counter claim, which eventually forms a synthesis with the original claim.  However, because the synthesis itself is only a partial claim to Truth, it requires a “negation” by another claim to truth.  On and on and on it goes throughout history until all contradictions or partial claims to truth will be resolved and unified in the “Absolute.”

People begin life in fusion with the “social substance,” or spiritual objectification of human activity, i.e., the process of evolving truth at its current level of unfolding.  Some people individualize or differentiate by becoming self-conscious or aware of their false dependence on the social substance and make contact with their Being (which is the individual’s experience of the universal spirit in its current level of unfolding), which then provides an opportunity to have the option to reconnect to “the whole” in a more integrated fashion than when one was originally fused with it.  And by reconnecting to the whole, individuals further create the social substance.

For our purposes, we become consciously aware through exposure to diverse experiences, as the mind broadens and realigns itself.  We are able to become more authentic by connecting with a process higher or deeper than the self, which actually is the source of freedom, and not the outer, material world.  Jones writes, “Self-awareness is simply awareness of the object as more sharply distinguished than it once was, as more emphatically not me but other than me….” (p. 112) This awareness is an example of Maddi’s (1989) conception of developing courage, which parents can foster in their children by exposing them to a diverse array of experiences.

From a Buddhist perspective, the goal of life is “negation” of the self.  It is to be free of constructed images of the self that are illusory.  Ultimately, it is to feel one’s existence as holistic and peaceful and to view it against “the light of a ground of nondiscriminative unity with all existence” (Spira, p.204).  Rilke (in Mitchell, 1991) brilliantly described this unity.  He writes, “Extensive as the ‘external’ world is, with all its sidereal distances it hardly bears comparison with the dimensions, the depth-dimensions, of our inner being, which does not even need the spaciousness of the universe to be, itself, almost unlimited.” (p. 182)

Rogers believed that when people conform their lives to external standards, they become fixed or static.  But as people learn to live in according to their innate tendency toward growth, they feel in harmony with themselves and the world around them.  In the process of becoming one’s organism one experiences like more like a process.  He writes, “Life, at its best, is a flowing, changing process in which nothing is fixed….” (p.27)

Relationship

Therapists view themselves as partners on the journey of growth and wholeness.  Rogers (1961) believed that therapy must be based upon respect, acceptance, empathy, genuineness, congruence, and immediacy.  Genuineness in counseling essentially means having an authentic relationship, which should be approached with honesty and trust.  Above all, it should be open, trusting, and “free of deception and hidden agendas.” (p. 218)

Congruence requires a therapist’s inner and outer selves be organized, straightforward, and consistent.  Otherwise a lot of mixed messages will be communicated and cause mistrust.  Ralph Waldo Emerson (1891), though not a therapist, still makes the best argument for a therapist’s congruency.  He writes:

“If a teacher has any opinion which he wishes to conceal, his pupils will become as fully indoctrinated into that as into any which he publishes.  If you pour water into a vessel twisted into coils and angles, it is vain to say, I will pour it only into this or that; — it will find its level in all.  Men feel and act the consequences of your doctrine, without being able to show how they follow. Show us an arc of the curve, and a good mathematician will find out the whole figure. We are always reasoning from the seen to the unseen. Hence the perfect intelligence that subsists between wise men of remote ages. A man cannot bury his meanings so deep in his book, but time and like-minded men will find them….Therefore, Aristotle said of his works, ‘They are published and not published.'” (p. 108)

Immediacy involves focusing a session on the “here and now,” because, as previously noted, humanistic-existential therapy is focused more on process than on content.  This leads to increased awareness of fluid, internal experience , which is a fundamental element to growth and mental wellness.

Rogers’ idea of acceptance or “unconditional positive regard” (in Seligman, 2001) has had a tremendous impact on psychotherapy (and, I believe, on the culture at large). Genuine acceptance promotes the client’s ontological security and trust and encourages a sense of self-worth.  He believes in deep empathic understanding, which facilitates open exploration and self-disclosure.

Techniques

It is the therapy relationship itself that is the foundation for growth, change, and healing.  Therefore, techniques in this model tend to have a secondary role because the focus tends to be on the entire person, or Gestalt, rather than on particular symptoms to modify.  It is advised not to be reductionistic or overly focused on prescribed or proscribed actions because this runs the risk of reducing spontaneity and freedom.  Our natural way of being-in-the-world comes first.

De-reflection is an example of a particular technique.  Anxiety is often associated with “hyper-reflection,” which give issues an unnecessary amount of negative attention.  Frankl (1965) developed this to counteract hyper-reflection or as he put it, “the compulsive inclination to self-observation.”  By ignoring the symptoms of a problem we can transcend the problem itself.

This is accomplished by directing our attention to positive aspects inside ourselves, or perhaps even better, positive things outside of ourselves to transcend an isolated way of being in the world.  Goals then are more selfless or altruistic.  The focus is on possibilities rather than limitations.  A great example of this process is Jesus’ well-known imperative for people to give up their lives for the sake of a higher reality.  After giving up the old self, a new self returns – a self that is grounded in reality rather than in a set of false mental constructs.

Spira (in Chochinov & Breitbart, 2000) has developed a holistic approach that involves role modeling, exploring, and an appreciation of entering into fuller relationship with others and with life. (p. 205).  Seligman (2001) believes bibliotherapy is a cognitive therapy technique that encourages people to read about others who have successfully worked through similar dilemmas, thus reframing their own situation and bringing to light new options.

Mohr (1995) argues for the place of proscription in psychotherapy.  Sometimes what not to do is as important as what to do. This demonstrates flexibility because it mirrors the reality that events and feelings are dynamic, and, to some extent, unpredictable and uncontrollable.  A proscriptive approach fits in better with a holistic view than it does with a medical view.  The former takes into account the systematic nature of emotions, problems and events, whereas the latter is focuses merely on the symptomatic nature of them.  A proscriptive approach follows the principle “do no harm.”

A contextualist approach means that distressing psychological symptoms, such as depression, are not isolated affects that arise out of nowhere.  Rather, they are complex responses to life pressures and meanings and embedded in a context.  By using language we automatically participate in some type of community.  This challenges the idea that events or people have objective meanings outside of the way individuals think or talk about them through language.  Inherent in language are prescribed roles and identities that can be problematical for groups or individuals.  Symptoms are viewed within a social context. (Efran, Germer, Lukens, 1986).

Wong (1999) developed Meaning-Centered Counseling and Therapy, which includes a list of techniques such as confrontation, magic questions, story-making, journaling, dream analysis, modeling, the Socratic dialogue, and focusing on feelings in the here and now.

Other Considerations

The physical disability population is well suited to this approach.  Severe physical illness usually facilitated an existential crisis that precipitates the collapse of unconscious assumptions and beliefs.  The inevitably of biological death can no longer be pushed out of awareness.  Of course the reality of this death is paradoxically what gives meaning to life because being includes nonbeing.  Therefore, illness and crises are almost always opportunities for growth.  We can respond to our fates with either courage or despair.

The feminist perspective was influenced by the humanistic-existential tradition.  One must accept that oppressive socio-cultural influences toward women exist.  This provides an opportunity to explore the meanings and roles that are often prescribed for them by the society.  (Seligman, 2001).  Similarly, a Rogerian perspective fits particularly well with individuals from various ethnic and religious backgrounds because it encourages the self to unfold without undue interpretations and abstractions.  Developing one’s own meanings and belief systems independent of the “dominant culture” is an essential part of human dignity.

Summary

Human existence is often uncontrollable and unpredictable, but people still have responsibility for their decisions, attitudes, and beliefs.  Honesty, responsibility, and a willingness to accept life’s givens are more important than technical guidelines.  Having compassion and respect for another person’s suffering is foundational.  Living from a false set of mental constructs imprisons, but suffering that is faced rather than avoided plays a part in becoming more authentic with ourselves and with others.

References

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Frankl, V. E. (1965). The doctor and the soul: From Psychotherapy to logotherapy. New York: Alfred A. Knopf.

Jones, W. T. (1969). A history of western philosophy: Kant and the nineteenth century.  San Diego: Harcourt Brace Jovanovich.

Kaufman, W. (Ed) (1968). The portable Nietzsche.  Middlesex: Penguin.

Maddi, S. R. (1989). Personality theories: A comparative analysis. Pacific Grove: Brooks/Cole.

Maslow, H. (1968). Toward a psychology of being. (p. 155). New York: Van Nostrand Reinhold.

Maslow, H. (1970). Motivation & personality. New York: Harper & Row.

Mitchell, S. (Ed.) (1982). The selected poetry of Rainer Maria Rilke. New York: Vintage International.

Mitchell, S. (Ed.). (1991) The enlightened mind: An anthology of sacred prose. (p. 189). New York: HarperPerennial.

Mohr, D. C. (1995). The role of proscription in psychotherapy. Psychotherapy, 32, (2), 187-193.

Rogers, C. R. (1961) On becoming a person. Boston: Houghton Mifflin.

Seligman, L. (2001). Systems, strategies, and skills of counseling and psychotherapy. Upper Saddle River: Merrill Prentice Hall.

Spira, J. L. (2000).  Existential psychotherapy in palliative care. In H. M. Chochinov & W. Breitbart (Eds.), Handbook of psychiatry in palliative medicine (pp. 197-214)). Oxford: Oxford.

Thoreau, H. D. (1960). Walden or life in the woods & on the duty of civil disobedience. New York: Signet

Tillich, P. (1952). The courage to be. New Haven: Yale University.

Wong, P. T. P. (1999). Towards an integrative model of meaning-centered counseling and therapy (mcct). The International Forum for Logotherapy, 22(1), 48-55.

By Bradley Sears