Existential Psychotherapy: A Brief Overview

In this column, I would like to give my readers a brief introduction to the existentialist school of thought in the field of psychology. It is a school the study of which I believe to be quite fruitful and enrichening, albeit in our age regarded by most academic circles as “unscientific”, and unfortunately featured merely as a passing reference in most curriculums, if at all.

Two Leading Figures of Existential Psychotherapy: Irvin Yalom and Emmy van Deurzen

Before delving into my brief introduction, I shall first give a succinct biography of the two leading figures I will be mentioning throughout my column.

Irvin Yalom

According to his own autobiographical notes (Yalom, n.d., para. 1-2), Irvin Yalom was born in Washington, D.C., on June 13, 1931, into an uneducated family living in a ghetto, and was a boy who was mesmerised by the world of books, especially that of fiction. The choices for a career for a boy, according to him (n.d., para. 3), were thought to be limited to either medicine or business in the family and ghetto he was born to, and so he took up medicine, knowing full well he’d specialize in psychiatry because of his interest in the human psyche.

His initial writings were for scientific journals (Yalom, n.d., para. 4-6), his first book being The Theory and Practice of Group Psychotherapy, followed by the famous Existential Psychotherapy, which were then followed by various novels such as When Nietzsche Wept, and The Schopenhauer Cure, which he believes belong to a new genre, the “teaching novel”.

According to Serline, as cited in Krug, (2009, p. 342), Irvin Yalom’s existential leanings come from his interactions with Rollo May, first having read his book Existence, and then undergone therapy with May (because of the death anxiety that he developed working with patients with fatal illnesses), later become colleagues, and finally friends.

Emmy van Deurzen

According to Deurzen (n.d.a para. 1) Emmy van Deurzen was born on the 13th of December, 1951, in The Hague, Netherlands. According to Deurzen (n.d. para 2-4) she worked in several psychotherapeutic centres in France whilst completing her Ph.D in clinical psychology, and also went to the UK, becoming a member of the British Psychological Society, and then to the USA for both studying and teaching purposes. Her most well known work is Existential Counselling and Psychotherapy (Deurzen, n.d.a, para. 3).

According to Van Deurzen (n.b.b, p. 2), the existential approach is the only one in the field of psychotherapy that has its roots mainly in philosophy. As is mentioned in Yalom’s book, Existential Psychotherapy (1980, pp. 6-7), it is a dynamic approach to psychotherapy, dynamic as in psychodynamic, which is to say that, much like Freud’s views of the individual, existential psychotherapists act with the assumption that there are conflicting forces inside the individual, some conscious and some unconscious, and it is these which cause anxiety and other pathological behaviours. According to Yalom (1980, p. 6), in this regard existential psychotherapy can be grouped together with the likes of Freudian and Neo-Freudian therapy. Yet, Yalom contınunes, what sets existential psychotherapy apart is its unique view of what those “dynamics”, the elements causing inner conflict are.

In Yalom’s view (1980 p. 8), instead of inner conflicts arising from suppressed instincts or the impressions made on us during our childhood, it arises from the “givens of existence”. He, in the same page, further clarifies what these givens of existence are; the four most significant ones, the “ultimate concerns” as he puts them are “death”, “freedom”, “isolation”, and “meaninglessness”. According to Yalom (1980, p. 9-10), the first given, “death”, causes conflict because of its inevitability and the human being’s wish to live forever; the second because of the lack of any inherent external order or structure found in nature, and in contrast the human being’s constant striving for order; the third because of the fact that, however close we may get to another person, there is always a gap, as we all must face certain things on our own (most importantly death), and finally the fourth because humans have evolved to seek meaning in all that they do, and yet, as a result of the three ultimate concerns mentioned above, there does not seem to be an inherent meaning or order in life, which may lead to despair.

The existentialist psychotherapist, then, according to Van Deurzen (n.b.b. p. 13), has to recognize the specific nature of the inner conflict that is taking place in the client, to see which of the ultimate concerns bother them the most (there are of course other non-ultimate ones, which are not as ubiquitous), and help them put to rest this conflict. The therapist, according to her (n.b.b, p. 2), has to reinvent their therapeutic approach for each individual client, for each client is akin to a universe of its own, and this is precisely why existential therapy cannot ever be formalized or conducted in a positivistic way. The goal of the therapist goes further, according to Van Deurzen (n.b.b p. 13), who says after having aided and acted as guides in bringing to a resolution the inner conflicts of the client, they also must aid them in finding their own values and goals in life, and setting out a course for the future.

Existential Psychotherapy’s Philosophical Roots

As is apparent from the section above, the existential approach is far from positivistic outlook of schools such as behaviourism. It does not concern itself with measurable factors, but with the deeper and the immeasurable facets of life. It is only natural that such an approach to psychotherapy is greatly involved with philosophy, and even literature. According to Yalom (1980, p. 16) the most important of those philosophical works, serving as a foundation of existentialism to some extent, is Heidegger’s Being and Time, which is cited numerous times by him, as well as in the articles of Van Deurzen (n.d.b). As I’d mentioned above, death is one of the ultimate concerns, and as cited in Yalom (1980, p. 30), Heidegger claimed that instead of being a cause of inner conflict, death is a transformative force of life. As cited in the following page in Yalom (1980, p. 31), there are two states of being, the first in a forgetful manner, lost in the trivialities of everyday life, and the second in a mindful manner, fully aware of the possibilities of being.

According to Heidegger, as cited in Yalom (1980, p. 31), to move from the first state to the next one needs a push, and the realization of death is one such push. It is only in the face of death that life gains value. It is quite easy to see how this philosophical outlook on life applies to existential psychotherapy, which is interested in the self-growth of the client, allowing them to live in a more fulfilled, connected, and mindful way, having become used to living with their fear of death, if not outright overcome it.

Other than Heidegger, the leading figures of existentialist school of philosophy, Camus and Sartre are to be mentioned. As cited in Yalom (1980, p. 427), Camus’ view that the human being is absurd as he seeks meaning in a world in which there is no external meaning to be found, is identical to the description that was given by Yalom in explaining one of the four ultimate concerns, that is. meaninglessness, and, much like Heidegger, Camus thought that one could attain a higher level of being by facing this absurdity. As for Sartre, as cited in Yalom (1980, p. 431), his fictional works showcase the importance of finding solidarity in the world, being free to choose as one wishes, standing up for the rights of oneself and others, altruism, taking meaningful action, coming to realise one’s full potential, and, just as is the case with Camus, finding one’s own meaning in life. One of the famous sayings of Nietzsche, who can be considered the progenitor of existentialism, is also in line with those views, “He who has a why to live can bear almost any how.”

Philosophy is not limited to merely works of non-fiction, and Yalom references novels and plays quite a bit in his book. He argues (1980, p. 21) that Dostoevsky, Tolstoy, Kafka, along with Camus and Sartre, touch upon the fundamental, ultimate concerns of humanity in a masterful way. As an example, Yalom (1980, p. 33) gives Tolstoy’s two famous works, War and Peace and The Death of Ivan Ilyich. In the former, as cited in Yalom (1980, p. 33), the protagonist, Pierre, feels despair in the face of the meaningless of the Russian aristocratic life, searching for a purpose, and comes to find his purpose and appreciate living quite late in the novel, after being pardoned from his execution at the very last second, having watched five men before him get executed one by one. Reminding us of Heidegger’s views on being, Pierre leaves behind his forgetful manner of living behind and transcends to the mindful state only in the face of death. A similar manner of transcendence takes place in The Death of Ivan Ilyich as well, the bitter titular protagonist, who faced with a mortal illness finds meaning in life only during his final days. All of this is much in line with the tenets of existential psychotherapy.

As to the Criticism of Existentialist Psychotherapy

According to Yalom (1980, p. 21), the main criticism the academia has for existential psychotherapy are as a result of the positivistic and empirical tradition dominating it. As Yalom mentions (1980, p. 22), the concept of the “ultimate concerns”, “the meaning of life”, “living life more fully”, and “developing more meaningful relationships with others”, all of which are central to existential psychotherapy, are quite hard to define and measure in a positivistic manner. There is also the fact, according to Yalom (1980, p. 22), that existential psychotherapy takes the human being as a whole, and does not reduce him to components or definitions. In short, to them the whole is greater than the sum of its parts, whilst positivistic traditions, by their nature, must reduce the human being to measurable components. Because of the limitations imposed by such a reduction, existential psychotherapy shuns any tools of diagnosis or measurement, and it is only natural for it to be criticised by the status quo, who live by measurement and standardization.