Existential Psychotherapy Rollo May and Irvin Yalom overview

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Existential Psychotherapy

Rollo May and Irvin Yalom

Existential psychotherapy arose spontaneously in the minds and works of a number of psychologists and psychiatrists in Europe in the 1940s and 1950s who were concerned with finding a way of understanding human beings that was more reliable and more basic than the then-current psychotherapies. The “existential orientation in psychiatry,” wrote Ludwig Binswanger, “arose from dissatisfaction with the prevailing efforts to gain scientific understanding in psychiatry” (1956, p. 144). These existential therapists believed drives in Freudian psychology, conditioning in behaviorism, and archetypes in Jungianism all had their own significance. But where was the actual, immediate person to whom these things were happening? Are we seeing patients as they really are, or are we simply seeing a projection of our theories about them?
These therapists were keenly aware that we are living in an age of transition, when almost every human being feels alienated from fellow humans, threatened by nuclear war and economic upsets, perplexed by the radical changes in marriage and almost all other mores in our culture—in short, almost everyone is beset by anxiety.
Existential psychotherapy is not a specific technical approach that presents a new set of rules for therapy. It asks deep questions about the nature of the human being and the nature of anxiety, despair, grief, loneliness, isolation, and anomie. It also deals centrally with the questions of creativity and love. Out of the understanding of the meaning of these human experiences, existential psychotherapists have devised methods of therapy that do not fall into the common error of distorting human beings in the very effort of trying to help them.
Basic Concepts
The “I-Am” Experience
The realization of one’s being—“I am now living and I could take my life”—can have a salutary effect on a patient. “The idea of suicide has saved many lives,” said Nietzsche. The human being will be victimized by circumstances and other people until he or she is able to realize, “I am the one living, experiencing. I choose my own being.”
It is not easy to define being because in our society we often subordinate the sense of being to our economic status or the external type of life that we lead. A person is known (and knows self) not as a being or a self, but as a ticket seller in the subway, a grocer, a professor, a vice president of AT&T, or as whatever his or her economic function may be. This loss of the sense of being is related to mass collectivist trends and widespread conformist tendencies in our culture. The French existentialist Gabriel Marcel (May, Angel, & Ellenberger, 1958, p. 40), makes this trenchant challenge: “Indeed I wonder if a psychoanalytic method, deeper and more discerning than any that has been evolved until now, would not reveal the morbid effects of the repression of this sense [of being] and of the ignoring of this need.”
Existential therapy endeavors to be this “deeper and more discerning” type of therapy. A patient, the daughter of a prostitute, had been an illegitimate child and had been brought up by relatives. She said:
I remember walking that day under the elevated tracks in a slum area, feeling the thought, I am an illegitimate child. I recall the sweat pouring forth in my anguish in trying to accept that fact. Then I understood what it must feel like to accept “I am a Negro in the midst of privileged whites,” or “I am blind in the midst of people who see.” Later on that night I woke up and it came to me this way, “I accept the fact that I am an illegitimate child.” But “I am not a child anymore.” So it is “I am illegitimate.” That is not so either. “I was born illegitimate.” Then what is left? What is left is this, “I Am.” This act of contact and acceptance with “I am,” once gotten hold of, gave me the experience “Since I Am, I have the right to be.” (May et al., 1958)
This “I-Am” experience is not in itself a solution to an individual’s problems. It is, rather, the precondition for the solution. The patient in the preceding example spent some two years thereafter working through specific psychological problems, which she was able to do on the basis of her experience of being.
This experience of being points also to the experience of not being, or nothingness. Nonbeing is illustrated in the threat of death, or destructive hostility, severe incapacitating anxiety, or critical sickness. The threat of nonbeing is present in greater or lesser intensity at all times. When we cross the street while looking both ways to guard against being struck by an automobile, when someone makes a remark that disparages us, or when we go into an examination ill-prepared—all of these represent the threat of nonbeing.
The “I-Am” experience, or the experience of being, is known in existential therapy as an ontological experience. This word comes from two Greek words, ontis meaning “to be” and logical meaning “the science of.” Thus it is the “science of being.” The term ontological is valuable in existential psychotherapy.
Normal and Neurotic Anxiety
Existential therapists define anxiety more broadly than other psychotherapeutic groups. Anxiety arises from our personal need to survive, to preserve our being, and to assert our being. Anxiety shows itself physically in faster beating of the heart, rising blood pressure, preparation of the skeletal muscles for fighting or fleeing, and a sense of apprehension. Rollo May defines anxiety as “the threat to our existence or to values we identify with our existence” (1977, p. 205).
Anxiety is more basic than fear. In psychotherapy, one of our aims is to help the patient confront anxiety as fully as possible, thus reducing anxiety to fears, which are then objective and can be dealt with. But the main therapeutic function is to help the patient confront the normal anxiety that is an unavoidable part of the human condition.
Normal anxiety has three characteristics. First, it is proportionate to the situation confronted. Second, normal anxiety does not require repression: We can come to terms with it, as we come to terms with the fact that we all face eventual death. Third, such anxiety can be used creatively, as a stimulus to help identify and confront the dilemma out of which the anxiety arose.
Neurotic anxiety, on the other hand, is not appropriate to the situation. For example, parents may be so anxious that their child will be hit by a car that they never let the child leave the house. Second, it is repressed, in the way most of us repress the fear of nuclear war. Third, neurotic anxiety is destructive, not constructive. Neurotic anxiety tends to paralyze the individual rather than stimulate creativity.
The function of therapy is not to do away with all anxiety. No person could survive completely without anxiety. Mental health is living as much as possible without neurotic anxiety, but with the ability to tolerate the unavoidable existential anxiety of living.
Guilt and Guilt Feelings
The experience of guilt has special meaning for the existential therapist. Guilt can, like anxiety, take both normal and neurotic forms. Neurotic guilt feelings (generally called guilt) often arise out of fantasized transgressions. Other forms of guilt, which we call normal guilt, sensitize us to the ethical aspects of our behavior.
Still another form is guilt toward ourselves for failure to live up to our potentialities, for “forgetting being” as Medard Boss puts it. The attitude toward such guilt in existential therapy is well illustrated in a case Medard Boss (1957b) cites of a severe obsessive compulsive whom he treated. This patient, a physician suffering from hand-washing compulsions, had gone through both Freudian and Jungian analyses. He had had for some time a recurrent dream involving church steeples, interpreted in the Freudian analysis in terms of phallic symbols and in the Jungian in terms of religious archetypal symbols. The patient could discuss these interpretations intelligently and at length, but his neurotic compulsive behavior, after temporary abeyance, continued, as crippling as ever. During the first months of his analysis with Boss, the patient reported a recurrent dream in which he would approach a lavatory door that would always be locked. Boss confined himself only to asking each time why the door needed to be locked. Finally the patient had a dream in which he opened the door and found himself inside a church. He was waist deep in feces and was tugged by a rope wrapped around his waist and leading up to the bell tower. The patient was suspended in such tension that he thought he would be pulled to pieces. He then went through a psychotic episode of four days, after which the analysis continued with an eventual successful outcome.
Boss (1957b) points out that the patient was guilty because he had locked up some essential potentialities in himself. Therefore he had guilt feelings. “If you lock up potentialities, you are guilty . . . (or indebted to) . . . what is given you in your origin, in your ‘core.’ In this . . . condition of being indebted and being guilty are founded all guilt feelings.” This patient had locked up both the bodily and the spiritual possibilities of his experience. The patient had previously accepted the libido and archetype explanations and knew them all too well; but that is a good way, says Boss, to escape the whole thing. Because the patient did not accept and take into his existence these two aspects, he was guilty, indebted to himself. This was the origin of his neurosis and psychosis.
The Three Forms of World
Another basic concept in existential psychotherapy is called being-in-the-world. We must understand the phenomenological world in which the patient exists and participates. A person’s world cannot be comprehended by describing the environment, no matter how complex the description. The environment is only one mode of world. The biologist Jakob von Uexküll argues that one is justified in assuming as many environments as there are animals. “There is not one space and time only,” he goes on to say, “but as many spaces and times as there are subjects” (von Uexküll, cited in May et al., 1958). How much more is it true that the human being also has his or her own world? This confronts us with no easy problem: for we cannot describe world in purely objective terms, nor is world to be limited to our subjective, imaginative participation in the structure around us.
The human world is the structure of meaningful relationships in which a person exists and in the design of which he or she participates. That is, the same past or present circumstances can mean very different things to different people. Thus, one’s world includes the past events that condition one’s existence and all the vast variety of deterministic influences that operate upon one. But it is these as one relates to them, as one is aware of them, molds, and constantly reforms them. For to be aware of one’s world means at the same time to be designing it, constituting one’s world.
From the point of view of existential psychotherapy, there are three modes of world. The first is Umwelt, meaning “world around,” the biological world, the environment. The second is Mitwelt, literally the “with-world,” the world of one’s fellow human beings. The third is Eigenwelt, the “own-world,” the relationship to one’s self. Umwelt is the world of objects about us, the natural world. All organisms have an Umwelt. For animals and human beings the Umwelt includes biological needs, drives, and instincts. It is the world of natural law and natural cycles, of sleep and awakeness, of being born and dying, of desire and relief, the world of finiteness and biological determinism to which each of us must in some way adjust. Existential analysts accept the reality of the natural world. “The natural law is as valid as ever,” as Kierkegaard put it.
The Eigenwelt, or “own-world,” has been least adequately dealt with or understood in modern psychology and depth-psychology. Own-world presupposes self-awareness and self-relatedness and is uniquely present in human beings. It is a grasping of what something in the world personally means to the individual observer. D. T. Suzuki has remarked that in Eastern languages, such as Japanese, adjectives always include the implication of “for-me-ness.” That is to say, “This flower is beautiful” means “For me, this flower is beautiful.”
One implication of this analysis of the modes of being-in-the-world is that it gives us a basis for understanding love. The human experience of love obviously cannot be adequately described within the confines of Umwelt. We can never accurately speak of human beings as “sexual objects,” because once a person is a sexual object, we are not talking about a person anymore. The interpersonal schools of personality theory have dealt with love as an interpersonal relationship. Without an adequate concept of Umwelt, love becomes empty of vitality, and without Eigenwelt, it lacks power and the capacity to fructify itself. The importance of Eigenwelt was stressed by Friedrich Nietzsche and Søren Kierkegaard, who continually insisted that to love presupposes that one must already have become the “true individual,” the “Solitary One,” the one who “has comprehended the deep secret that also in loving another person one must be sufficient unto oneself.”
The Significance of Time
Existential psychotherapists are struck by the fact that the most profound human experiences, such an anxiety, depression, and joy, occur more in the dimension of time than in space.
Existential therapists agree with Henri Bergson that “time is the heart of existence” and that our error in the modern day has been to think of ourselves primarily in terms of space, as though we were objects that could be located like substances at this spot or that. By this distortion we lost our genuine existential relation with ourselves, and indeed also with other persons around us. As a consequence of this overemphasis on spatial thinking, says Bergson, “the moments when we grasp ourselves are rare, and consequently we are seldom free” (Bergson, cited in May et al., 1958, p. 56).
But in the with-world, the mode of personal relations and love, we can see particularly that quantitative time has much less to do with the significance of an occurrence. The nature or degree of one’s love, for example, can never be measured by the number of years one has known the loved one. It is true, of course, that clock time has much to do with Mitwelt. We are referring rather to the inner meaning of the events. “No clock strikes for the happy one,” says a German proverb. Indeed, the most significant events in a person’s psychological existence are likely to be precisely the ones which are “immediate,” breaking through the usual steady progression of time, like a sudden insight or a view of beauty that one sees in an instant, but which may remain in one’s memory for days and months.
Finally, the Eigenwelt, the world of self-relatedness, self-awareness, and insight into the meaning of an event for one’s self, has practically nothing whatever to do with clock time. The essence of self-awareness and insight is that they are there—instantaneous and immediate—and the moment of awareness has its significance for all time. One can see this easily by noting what happens in oneself at the instant of an insight. The instant occurs with suddenness; it is born whole, so to speak. One will discover that, though meditating on an insight for an hour or so may reveal many of its further implications, the insight is not dearer—and disconcertingly enough, often not as dear—at the end of the hour as it was at the beginning.
Whether or not a patient can even recall the significant events of the past depends upon his or her decision with regard to the future. Every therapist knows that patients may bring up past memories ad nauseam without any memory ever moving them, the whole recital being flat, inconsequential, and tedious. From an existential point of view, the problem is not that these patients endured impoverished pasts; it is rather that they cannot or do not commit themselves to the present and future. Their past does not become alive because nothing matters enough to them in the future. Some hope and commitment to work toward changing something in the immediate future, be it overcoming anxiety or other painful symptoms or integrating the self for further creativity, are necessary before a patient’s uncovering of the past will have reality.
Our Human Capacity to Transcend the Immediate Situation
If we are to understand a given person as existing, dynamic, at every moment becoming, we cannot avoid the dimension of transcendence. Existing involves a continual emerging, in the sense of emergent evolution, a transcending of one’s past and present in order to reach the future. Thus transcendere—literally “to climb over and beyond”—describes what every human being is engaged in doing every moment when not seriously ill or temporarily blocked by despair or anxiety. One can, of course, see emergent evolution in all life processes. Nietzsche has his old Zarathustra proclaim, “And this secret spake Life herself to me. ‘Behold’ said she, ‘I am that which must ever surpass itself’” (cited in May et al., 1958, p. 72).
The neurobiological base for this capacity is classically described by Kurt Goldstein (cited in May et al., 1958, p. 72). He found that brain-injured patients—chiefly soldiers with portions of the frontal cortex shot away—had specifically lost the ability to abstract, to think in terms of the possible. They were tied to any immediate concrete situation in which they happened to be. When their closets happened to be in disarray, they were thrown into profound anxiety and disordered behavior. They exhibited compulsive orderliness—which is a way of holding oneself at every moment rigidly to the concrete situation. When asked to write their names on a sheet of paper, they would typically write in the very corner, any venture out from the specific boundaries of the edges of the paper representing too great a threat. Goldstein held that the distinctive capacity of the normal human being is precisely this capacity to abstract, to use symbols, to orient oneself beyond the immediate limits of the given time and space, to think in terms of “the possible.” The injured, or “ill,” patients were characterized by loss of range of possibility. Their world space was shrunk, their time curtailed, and they suffered a consequent radical loss of freedom.
We human beings possess the ability to transcend time and space. We can transport ourselves back 2,000 years to ancient Greece and watch the drama of Oedipus being performed in ancient Athens. We can instantaneously transport ourselves to the future, conceiving what life will be like in, say, the year 2500. These forms of transcendence are part and parcel of human consciousness. This capacity is exemplified in the human being’s unique capacity to think and talk in symbols. Thus, to make promises presupposes conscious self-relatedness and is a very different thing from simple conditioned social behavior, acting in terms of the requirements of the group or herd or hive. Jean-Paul Sartre writes that dishonesty is a uniquely human form of behavior. “The lie is a behavior of transcendence,” because to lie we must at the same moment know we are departing from the truth (Sartre, 1956, p. 1203).
This capacity to transcend the immediate situation is not a “faculty.” It is, rather, given in the ontological nature of being human. To abstract, to objectivate, are evidences of it, but as Martin Heidegger puts it, “transcendence does not consist of objectivation, but objectivation presupposes transcendence” (cited in May et al., 1958, p. 75). The fact that human beings can be self-related gives them the capacity to objectify their world, to think and talk in symbols. This is Kierkegaard’s point when he reminds us that to understand the self we must see clearly that “imagination is not one faculty on a par with others, but, if one would so speak, it is the faculty for all faculties. What feeling, knowledge, or will a man has depends upon what imagination he has, that is to say, upon how these things are reflected. Imagination is the possibility of all reflection, and the intensity of this medium is the possibility of the intensity of the self” (Kierkegaard, 1954, p. 163).
Other Systems
First we shall consider the differences between existential theory and the theory of behaviorism. This radical distinction can be seen when we note the chasm between abstract truth and existential reality.
Kenneth W. Spence (1956), a leader of one wing of behavior theory, wrote: “The question of whether any particular realm of behavior phenomena is more real or closer to real life and hence should be given priority in investigation does not, or at least should not, arise for the psychologist as scientist.” That is to say, it does not primarily matter whether what is being studied is real or not.
What realms, then, should be selected for study? Spence gives priority to phenomena that lend themselves “to the degrees of control and analysis necessary for the formulation of abstract laws.” Nowhere has this point been put more clearly than by Spence—what can be reduced to abstract laws is selected, and whether what is studied has reality or not is irrelevant to this goal. Many an impressive system in psychology has been erected, with abstraction piled high upon abstraction until an admirable and imposing structure is built. The only trouble is that the edifice has often been separated from reality in its very foundations.
Psychiatrists and psychologists in the existential psychotherapy movement insist that it is necessary and possible to have a science that studies human beings in their reality.
Orthodox Freudianism
Ludwig Binswanger and some other existential therapists differed from Freud in several important respects, including rejection of the concept of the patient propelled by instincts and drives. As Sartre put it, Freudians have lost the human being to whom these things happen.
The existentialists also question the view of the unconscious as a reservoir of tendencies, desires, and drives from which the motivation for behavior arises. This “cellar” view of the unconscious leads patients in therapy to avoid responsibility for their actions by such phrases as, “My unconscious did it, not I.” Existentialists always insist that the patient in therapy accept responsibility by asking such questions as, “Whose unconscious is it?”
The differences between existentialism and Freudianism are also seen in the modes of the world. The genius and the value of Freud’s work lie in uncovering the mode of instincts, drives, contingency, and biological determinism. But traditional Freudianism has only a shadowy concept of the interrelation of persons as subjects.
The Interpersonal School of Psychotherapy
A consideration of the three modes of world discloses the differences between existential therapy and the interpersonal school. Interpersonal schools do have a theoretical basis for dealing directly with Mitwelt. Though they should not be considered identical, Mitwelt and interpersonal theory have a great deal in common. The danger of this point, however, is that if Eigenwelt, one’s own-world, is omitted, interpersonal relations tend to become hollow and sterile. H. S. Sullivan argued against the concept of individual personality and went to great efforts to define the self in terms of “reflected appraisal” and social categories—that is, the roles the person plays in the interpersonal world. Theoretically, this approach suffers from considerable logical inconsistency and indeed goes directly against other contributions of Sullivan. Practically, it tends to make the self a mirror of the group around one, to empty the self of vitality and originality, and to reduce the interpersonal world to mere “social relations.” It opens the way to a tendency directly opposed to the goals of Sullivan and other interpersonal thinkers, namely, social conformity.
Jungian Psychology
There are similarities between Jungian and existential therapy. But the main criticism existentialists make is that Jungians too quickly avoid the immediate existential crises of patients by leaping into theory. This is illustrated in Medard Boss’s case related in the previous section titled “Guilt and Guilt Feelings.” A patient who was afraid to go out of the house alone was analyzed by a Jungian therapist for six years, in the course of which the therapist interpreted several dreams as indicating that “God is speaking to you.” The patient was flattered, but still couldn’t go out of the house alone. She later was enabled to get over her crippling neurosis by an existential therapist who insisted that she could overcome her problem only if she actively wanted to, which was a way of insisting that she, not God, needed to take responsibility for her problem.
Client-Centered Approach
The difference between existentialism and Rogerian therapy is seen in statements made by Rollo May when he was acting as a judge of client-centered therapy in the client centered experiment at the University of Wisconsin. Twelve outside experts were sent tapes of the therapy to judge. Rollo May (1982), as one of the outside experts, reported that he often felt that there were not two distinct people in the room. When the therapist only reflects the patient’s words, there transpires “only an amorphous kind of identity rather than two subjects interacting in a world in which both participate, and in which love and hate, trust and doubt, conflicts and dependence, come out and can be understood and assimilated” (p. 16). May was concerned that the therapist’s overidentification with the patient could “take away the patient’s opportunity to experience himself as a subject in his own right or to take a stand against the therapist, to experience being in an interpersonal world” (p. 16).
In spite of the fact that client-centered therapists, both individually and collectively, have advocated openness and freedom in the therapeutic relationship, the outside judges concluded that “the therapist’s rigid and controlling nature closed him off to many of his own as well as to the patient’s experiences” (p. 16).
One of the Rogerian therapists, after experience as an independent therapist, wrote this criticism:
I used the early concept of the client-centered therapist to bolster the inhibition of my anger, my aggression, etc. I got some feedback at that time that it was difficult for people, because I was so nice, to tell me things that were not nice, and that it was hard for people to get angry at me. (Raskin, 1978, p. 367)
In other words, client-centered therapy is not fully existential in that it does not confront the patient directly and firmly.
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