British Journal of Psychiatry (1994), 165, 699—701

Reading About

What is Existential Psychotherapy?

Most forms of psychotherapy are rooted in psycho The models available to someone who wished to
analytical concepts. Although the majority of psy present a new science were those of the natural and
chotherapists and counsellors do not comply with physical sciences. So the psyche is presented to us as
the classical Freudian model —¿
they do not see their a “¿psychic
apparatus―which is “¿extended
in space―
clients four or five times a week nor do they sit and “¿made up of several portions― (Freud, An
behind them while they are lying on a couch —¿ they Outline of Psychoanalysis, 1940). This apparatus is
accept the basic psychoanalytical project. This can fuelled by “¿psychic
energy―and functions through
perhaps be expressed in the following way: un the interactions of its parts. Terms like ‘¿projection',
acceptable ‘¿instinctual'
wishes are warded off and ‘¿introjection'and ‘¿transference'are essentially
‘¿repressed'
into the ‘¿unconscious'.
When they try to mechanistic, describing psychic interchange as if it
return to consciousness, they have to do so in was the movement of matter in space.
disguise —¿
and a common disguise is that of a symp Freud himself was not altogether happy with his
tom. This symptom has to be demasked, so to spatial metaphors. In his Introductory Lectures,
speak —¿
what has been unconscious has to be made after describing consciousness and the unconscious
conscious for the symptom to disappear. This is, of as two rooms with a threshold between them on
course, an over-simplified account, but it is, I think, which “¿a watchman performs his function―and
the essence of the psychoanalytical process and has “¿acts
as a censor―,he admits that these ideas are
remained central to psychotherapeutic endeavour. “¿crude―
and “¿incorrect―
and that he has “¿some
This has been seen by some writers as an essen thing else to take their place―.But whatever that
tially biological theory, describing “¿instincts and was, it never emerged.
their vicissitudes―as the title of one of Freud's Freud regretted that his theories lacked predict
major papers puts it. “¿Instincts―
or “¿drives―
—¿
the ability and thus fell short of the classical scientific
German word is not “¿Instinkt― but “¿Trieb―
—¿
are model. His interest in meaning clearly went beyond
described by Freud as “¿lying on the frontier be the aims of the usual scientific project, which is
tween the mental and the physical―(Three Essays more concerned with origins and explanation.
on the Theoryof Sexuality, 1905)and graphically In the course of time, various psychoanalysts
defined by Laplanche & Portalis, in their Language and psychoanalytical theorists found the Freudian
of Psychoanalysis (1973) as “¿representatives sent model too narrow to account for the relational
into the psyche by the soma―.On the fate of these phenomena they met. D. W. Winnicott, for in
essentially biological forces, their sources, aims and stance, was not content to explore the mother
“¿objects―
and their protean disguises and trans child relationship only in the light of ‘¿object
formations, has the many-mansioned edifice of relations theory'. S. H. Foulkes thought the indi
psychoanalytical theory been built. vidual an “¿abstraction―,
believed in the priority of
It was important to Freud to present psycho the group and described communication as the
analysis as a science. To a great extent this was, of therapeutic process per se; this radical revision of
course, due to his scientific background; before he psychoanalytical theory became the foundation of
established himself as a neurologist he studied group-analytical therapy. But no matter how
zoology and worked under E. W. von Brficke at much these new ideas extended the psychoana
the Viennese Physiological Institute. But above all lytical base, nobody entirely broke away from it.
he was convinced that only a scientific (by which A man who did break away from his psycho
he meant a ‘¿rational') approach could counter analytical base was the Swiss psychoanalyst Medard
balance the dangers of irrationality, particularly as Boss, who had a great admiration for Freud's
embodied by systems of religious belief. therapeutic methods but had difficulties with the
699
700 READING ABOUT

naturalistic theory underlying them. He first turned In spite of these differences of approach, it is
to Jung but remained dissatisfied. A Swiss psychia possible to outline certain assumptions which
trist, Ludwig Binswanger, drew his attention to the most existential therapists are likely to see as the
work of the German philospher, Martin Heidegger. foundation of their therapeutic practice:
Boss found answers to his questions in Heidegger's
books, contacted the philosopher, who became a (a) We find ourselves in a world we do not
friend, and was prepared to conduct seminars in control and which contains a number of ‘¿givens'
Switzerland over ten years for students and prac we have not chosen (e.g. our genetic dispositions,
titioners of psychiatry. Thus the extensive exchange family, circumstances). We can, however, choose
of ideas between a psychoanalyst and the creator of our response to these ‘¿givens',
and in this is our
an existential philosophy led to the development freedom and responsibility.
of a school of existential psychotherapy. Boss's Q@)We are always part of a world context, in
book Psychoanalysis and Daseinsanalysis, which relation to others, defining them as they define us.
appeared in 1963 in the US, was a comprehensive We never meet an individual patient, we also meet
attempt to provide psychoanalytical practice with a his/her content, i.e. his/her family, partner, social
philosophical (rather than scientific) foundation. nexus, etc. For the existential therapist there is in
The philosophical foundation of existential psy fact no ‘¿individual'
therapy.
chotherapy has two roots: phenomenology and (c) We become part of the patient's context, and
existentialism. Phenomenology is an approach to s/he becomes part of ours. The patient cannot
knowledge open to the ‘¿phenomena',to what therefore be an ‘¿object' observed by a detached
‘¿shows'
itself, independent of our presuppositions, therapist. Patient and therapist always mutually
explanations and theories. When Freud, in his affect each other.
Introductory Lectures, stated that “¿thephenomena (d) Immediate experience has priority over theo
perceived must yield in importance to the trends retical assumptions, and what ‘¿appears' —¿
the
which are only hypothetical―,his aim was exactly phenomenon —¿ always has to be taken seriously.
the opposite of that of phenomenology. Thus in existential therapy it is important for the
Existentialism focuses on human existence —¿ a therapist to remain open to whatever the patient
word derived from the Latin ex-sistere meaning ‘¿tobrings, verbally and non-verbally, and not to
stand out'. It is characteristic of human existence impose theoretical assumptions on the phenomena.
that we can ‘¿stand
out' ofourselves sufficiently to be (e) Existential phenomenology distinguishes be
able to reflect on that we are, what we are and what tween chronological and ‘¿lived' time. We do not
we do. (The ‘¿mere'existence of animals, plants and experience time as one moment after the other with
stones does not allow this.) a clear distinction between past, present and future,
Most existential philosophers approach experi but the present always contains the past and points
ence phenomenologically; the openness to whatever towards the future. This is the core of the thera
shows itself is an aspect of man's inevitable and peutic endeavour; the patient presents an unsatis
primary involvement with the world and others. factory or damaged past in hope of a changed
Historically, existential philosophy can be seen as future. The existential therapist does not focus on
the creation of Heidegger, although Kierkegaard the past as a ‘¿cause'
of present disturbance, but as
and Nietzsche are often considered to be precursors. still alive in the present situation.
Many existential philosophers, among them Sartre (f) The fear and denial of death as an undisputed
and Merleau-Ponty, were crucially influenced by certainty in our life is of crucial importance in
Heidegger, although there is a great deal of modifi existential therapy.
cation and variation in different bodies of thought. (g) All experience is both physical and mental,
Equally, there are different ways of bringing and the body—minddichotomy is an abstraction of
existential notions to bear on psychotherapy. our own making, imposing on us the impossible
Binswanger, for instance, was more concerned with task of finding a link between aspects of existence
the strictly phenomenological aspects of mental which were never apart. This realisation changes
disturbance and had little to say about therapy. our framework for an understanding of so-called
Medard Boss, as we have seen, rewrote psycho ‘¿psychosomatic' symptoms.
analytical theory and practice in existential terms. (h) if we accept that we are capable of choosing
Sartre, who of course was not a therapist, offered an our response to what is ‘¿given', we need to
“¿existential
psychoanalysis―(which was very criti introduce new dimensions of anxiety and guilt into
cal of Freud) as part of his opus magnum in our work as psychotherapists. Being confronted
philosophy, Being and Nothingness (1943). with choice engenders a kind of anxiety which is
 READING ABOUT 701
different from neurotic anxiety, and avoiding choice Martin Buber. For anyone who is interested in this subject
engenders a kind of guilt which is different from and lacks the time to read widelyabout it, this collection
neurotic guilt feelings. These new dimensions we is indispensable.
call ‘¿existential'
anxiety and guilt. LANG, R. D. (1960) The Divided Self. 218 pp. London:
Tavistock.
Annotated reading list
This is a classic text on existential psychotherapy, and
BmiswANGsa, L. (1963) Being-in-the-world. Selected invaluable for its phenomenological descriptions of
papers of Ludwig Binswanger. Translated and with a schizophrenic states, giving meaning to what had until
Critical Introduction to his ExistentialPsychoanalysisby then been seen as meaningless by professionals. The
J. Needleman. 364 pp. London: Souvenir Press. theoretical framework is perhaps more controversial;
Unfortunately Binswanger'smain works have not been existential writers might think the concept of a ‘¿selfand
translated into English, but this collection of some of his its division misplaced in an existential context.
papers gives a good idea of the range of his interests and
the quality of his writing. Binswangerwas influencedby MACQUARRIE, J. (1972) Existentialism. An Introduction,
both Husserl,the creator of phenomenology(whowasnot Guide and Assessment. 314 pp. Harmondsworth: Penguin.
an existentialist), and Heidegger, who modified HumerI's
Twentyyears after its first appearance this is still the best
ideas to create a philosophy of existence.Binswanger's introduction to existential philosophy. Written by an
approach, for better or worse, lacks Boss's single expert—¿ he is one of the two translators of Heidegger's
mindedness —¿
it is less systematic but richer in ideas Being and Time —¿
it is a comprehensive survey, lucidly
and applications. The introduction by an American written and very accessible.
philosopher is over-long and overelaborate.
SPINELLI, E. (1989) The Interpreted World: An Introduction
Boss, M. (1963) Psychoanalysis and Daseinsanalysis. to Phenomenological Psychology. 210 pp. London: Sage.
Translated by L. B. Lefebre. 295 pp. New York: Basic
Books. More recentlypublished,this book does for phenomenol
This is one of the standard works of existentialpsycho ogy what Macquarrie does for existentialism. As the
therapy (herecalled “¿Dascinsanalysis―
whichmeans liter author is both a psychologist and psychotherapist, his
ally the analysis of “¿being
there―,Heidegger's way of expositiontakes account of various developmentsin exis
describinghuman existence).It is the author's attempt to tential psychotherapy. Spinelli is particularly clear in
provide Freudian practice (of which he approves) with outlining those aspects of phenomenologywhich are rel
a new philosophical (Heideggerian) foundation. This evant to the therapist. He also gives a much-needed
book comes as near to being a textbook of existential definition of humanistic psychology, which often presents
psychotherapyas can be obtained in English. itself as existentialphenomenology.

C@oN, B. (1991) Sarire and Psychoanalysis.An Existen VAN Dmntzmt-Swm, E. (1988) Existential Counselling in
tialChallenge
to Clinical Metatheory. 397pp. Kansas: Practice. 246 pp. London: Sage.
UniversityPress of Kansas. There are very few books which show the existential
This recent publication is the outstanding attempt of a approach to psychotherapy in action. This is such a book.
professor of the humanities and social sciences,who is Its strength is its wealth of illustrativeexamples;we are
also a psychotherapist, to create a psychotherapeutic introduced to a number of people with psychological
framework based on Sartre's ideas. It shows Freudian difficulties,the existentialimplicationsof these difficulties
theory in the light of Sartre's critique (which is essentially are outhned, and the existential therapist's approach is
contained in his chapter “¿Existential Psychoanalysis― .in indicated. The author is a philosopher and psychothera
his book Being and Nothingness(1943))and sketches in pist, and the Dean of the School of Psychotherapy and
great detail the various aspects of a Sartrian psycho Counselling at Regents' College, London, where a special
therapy. I know no other book with a similar aim, and diploma in existentialpsychotherapyis offered.
considering the complexity of the task, the writing is
surprisingly lucid. Y@u@oM,
I. D. (1980) Existential Psychotherapy. 524 pp.
New York: BasicBooks.
Famns@r@i,
M. (1964) The Worlds of Existentialism. A This book describeswhat the author calls “¿four
ultimate
Critical Reader. 362 pp. Chicago, Illinois: University of concerns―
—¿
death, freedom, isolation, meaninglessness—¿
Chicago. and the existential conflicts resulting from them. It has
This is an anthology of frequently sizeable extracts from been widely praised; it is easy to read, and what some
works by existentially orientated philosophers, theolo people might call journalistic smoothness, others would
glans and psychotherapists, as well as extended comments see as a lightness of touch. It is certainly a good if
by the editor, who has translated numerous works of somewhatlengthyintroduction to the subject.

Hans W. Cohn, PhD, Lecturer and Clinical Supervisor at the School of Psychotherapy and Counselling,
Regent's College, London
What is existential psychotherapy?
H W Cohn
BJP 1994, 165:699-701.
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