Unit 4.

Humanistic-Existential Approaches II

Frankl

1) Key figures and historical context

- Very difficult.
- Just remember the contributions of Frankl, Yalom and Perls.

2) Theoretical Principles

i) The I-Am Experience

- The I-am experience is the experience of being, of existing. For existentialists, the
experience of being is often referred to as ontological experience (ontos means “to
be” and logical means “the science of”). Literally, then, a major focus of
existential therapy consists of exploring the immediate individual human
experience. You might think of it as suddenly waking up and being completely
tuned into what it’s like to be alive, to exist, to be here right now in this particular
moment in time.
- It follows that existential therapy is almost always in the service of self-awareness
or self-discovery. However, unlike psychoanalysts, existentialists seek to expand
client self-awareness rather than interpreting client unconscious processes. This is
because existentialists believe the entirety of an individual’s human experience is
accessible to consciousness. It’s not a matter of uncovering an elusive
unconscious, but a matter of elucidating the conscious.

ii) The Daimonic

- According to Rollo May, “The daimonic is any natural function which has the
power to take over the whole person”.
- The daimonic includes both positive and negative potential. Similar to Jung’s
more general conception of libido, it is a form of psychic energy or an urge that is
the source of both constructive and destructive impulses.
- The daimonic is the urge in every being to affirm itself, assert itself, perpetuate
 and increase itself. Again, just as Jung emphasized the integration of the shadow
archetype, May considers the harnessing and integration of the daimonic to be a
central task in psychotherapy. He views psychotherapy as an activity that plumbs
the depths of an individual’s most basic impulses in an effort to acknowledge,
embrace, and integrate every bit of being and energy into the whole person.
Integrating the biological and natural daimonic urge maximizes constructive and
creative behavior.

iii) The nature of Anxiety

- R. May was perhaps the first modern mental health professional to conceptualize
anxiety as a good thing (May, 1977). He emphasized that it was a normal and
essential byproduct of human existence. His formulation of anxiety encourages us
all to view anxiety differently. We should embrace it as a part of our experience.
We should explore it, experience it, engage it, and redirect it into constructive
activities—we should not avoid it.
- The existential perspective identifies two types of anxiety: normal anxiety and
neurotic anxiety. Normal anxiety is directly proportional to the situation. It is
within our awareness (not requiring repression or other defensive processes) and
can be used creatively. In contrast, neurotic anxiety is disproportionate to the
situation; it is usually repressed, denied, or otherwise avoided, and is not used for
creative or constructive purposes. Instead, it is destructive.
- The key differences are (1) you deny the importance of your life demands, (2) you
respond to the situation out of desperation, rather than responding with creativity,
and (3) you end up increasing your chances of having difficulties down the road
(literally) because you haven’t responsibly maintained your self (or your vehicle).

iv) Normal and Neurotic Guilt

- Guilt, like anxiety, has both positive and negative qualities. It may seem a bit odd,
but guilt is good—normal guilt, that is. Guilt inspires people to act in thoughtful
and conscientious ways. Normal guilt is sort of like a sensor: When functioning
well, it alerts us to what’s ethically correct and guides us toward morally
acceptable behavior.
- Psychopathology arises, not from the human experience of normal guilt, but from
neurotic guilt. Neurotic guilt usually consists of a twisted, exaggerated, or
minimized version of normal guilt. For example, when a victim of domestic abuse
feels guilty for provoking her abuser, it is a twisted guilt and does not serve a
productive purpose. Similarly, the abuser who feels only transient or minimal guilt
after physically battering his romantic partner is neurotically denying or
 minimizing his responsibility for the situation. He may experience complete relief
from guilt after delivering a quick apology and a dozen roses. Worse, he may
relieve his guilt by blaming his partner and demanding an apology from her. In
contrast, some individuals feel massive guilt and responsibility for even the most
minor, normal, human ethical transgressions. Excess guilt may make such people
think they should be punished, or make restitution, or both for their unacceptable
behavior. For example, after making a mistake that cost her employer several
hundred dollars, a guilt-ridden employee may commit unending hours of service
to her employer, church, and community in an effort to relieve herself of her guilty
feelings.
- The Gestalt perspective on neurotic guilt is somewhat unusual. Specifically, when
clients spoke of guilt, F. Perls often asked them to turn it into resentment. For
example, with the aforementioned neurotically guilty employee, Perls might ask
her to talk about resentments she has toward her employer, church, and
community. The Gestalt approach emphasizes that clients own the complete range
of their emotions, including the resentments lurking beneath neurotic guilt.

v) Existential Psychodynamics

- Similar to psychoanalytic theorists, existentialists believe that humans are in

intrapsychic conflict with powerful forces. However, instead of helping clients
cope with instinctual drives or rework internalized object relations, the existential
therapist helps clients face and embrace “ultimate concerns” of existence. These
ultimate concerns of existence produce anxiety that must be dealt with either
directly or indirectly via defense mechanisms.

- In his text Existential Psychotherapy, Irving Yalom (1980) describes four ultimate
concerns relevant to psychotherapy. These concerns are

• Death • Freedom • Isolation • Meaninglessness

- Death - Yalom (1980) outlines two therapy-relevant propositions about death.

First, he emphasizes that death and life exist simultaneously. As a consequence,
the possibility of death cannot be ignored. Any of us might suddenly face death in
the next moment, next day, or next week—or we may live for decades more.
Death is knowable and unknowable. We will die; it is only a question of when,
where, and how. Death is simply part of the reality of life. Second, Yalom claims
that death is a “primordial source of anxiety” and therefore is the main source of
 psychopathology. The purpose of facing death for existentialists is to experience
life more deeply and fully. To face death is to motivate oneself to drink with great
enthusiasm from the cup of life. Obviously, this is not a call for morbid
preoccupation about life’s end, but instead a call to shed external trappings and
roles and to live in the now as an individual self with freedom of choice.

- Freedom - Generally, freedom is considered a positive condition of life, eagerly

sought by many individuals. But this is not the view of the existentialist. Sartre
believed humans are condemned to freedom, and existential therapists have
followed suit by articulating the many ways in which freedom is an anxiety-laden
burden. Complete and total responsibility is inescapable. In the end, the more
freedom you experience, the more choices you have; and the more choices you
have, the more responsibility you have; and having a large load of responsibility
translates into a large load of anxiety. Personal responsibility is a heavy burden to
carry. It is so heavy that many individuals cannot bear the weight. When the
weight of personal responsibility is too heavy, individuals defend themselves with
denial, displacement, and blaming. For example, when an employee
underperforms, rather than claiming responsibility, he blames the situation (“I
didn’t have time to do a good job on the project”) or a coworker (“Bob is
impossible to work with. How can I be expected to produce a quality product?”)
or his employer. ibility, including fully experiencing the angst that comes along
with it. Overall, the essential point of freedom and responsibility for the
existentialist is this: You, and you alone, are the author of your experiences. Don’t
bother pointing the finger of blame at anyone but yourself.

- Isolation - The existential assumption is that every individual is fundamentally

alone. In Yalom’s words, there is “an unbridgeable gulf between oneself and any
other being”. There are also other, less deep and less permeating, forms of
isolation. For example, many individuals who come for therapy come because of
social problems that include feelings of disconnection and loneliness. In addition,
some clients experience intrapersonal isolation, in that they feel cut off from or
out of touch with their sense of self. Although both of these forms of isolation are
important in therapy, they are examples of surface symptoms rather than directly
representative of existential psychodynamics. The ideal or goal of existential
therapy with respect to isolation is to help clients connect as deeply as possible
with others while at the same time acknowledging their incontrovertible
separateness. Yalom refers to this as a “need-free” relationship. Needfree
relationships are unselfish relationships in which one person knows another
 person intimately, gives love without a personal agenda, and acknowledges the
other’s separateness and independence of thought. When a need-free relationship
exists, both parties usually feel more alive and engaged in life. When done
correctly, heightening a client’s awareness of existential isolation should improve
his or her ability to form healthy interpersonal relationships. Similar to death
anxiety and angst over the burden of personal freedom, getting in touch with and
embracing existential isolation has a positive consequence. To admit and face
aloneness gives us the strength to face the world and the motivation to connect in
deep and meaningful ways with other individuals.

- Meaninglessness The classic existential crisis or existential neurosis occurs when

an individual faces the question “What is the meaning of my life?” Seeking life’s
meaning can be an agonizing process. Consequently, it’s common for many of us
to just stay busy with daily activities, instead of grappling with life’s biggest
question. Of all existential theorists, Frankl has written the most about the
importance of living a meaningful life. He believes the “will to meaning” is a
primary motive, far surpassing the importance of Freud’s pleasure principle and
Adlerian superiority striving. He also emphasizes that, similar to Adler’s
formulations of human motivation, meaning is not a drive or push; instead it is
characterized by striving or willing.

vi) Self-Awareness

- Self-awareness is central to existential therapy. Earlier, we said the goal of therapy

was to help clients get in touch with their authentic self. We revised that goal to
emphasize the individual’s separateness. Now, consistent with the spirit of
existentialist thought, we are revising the goal of existential therapy again (recall
that because existence precedes essence, we are continually reinventing, revising,
and updating ourselves). For now, the goal of existential therapy is to facilitate
self-awareness—including the awareness of death, freedom, isolation, and life’s
meaning.

vi) Existentialism and Pessimism

- When we lecture on existential psychodynamics, many students justifiably

complain about the inherent pessimism associated with existentialist thought, and
they have a legitimate foundation for their complaints. After all, when
existentialists look at life, they see the rumblings of impending death. When they
 contemplate freedom, they become preoccupied with the burdens of responsibility.
When they consider love, they cannot stop themselves from lamenting that
individual isolation is a permanent condition of life. And when they talk about the
meaning of life, they are thrown into the nihilistic pit of meaninglessness and can
only dig themselves out by creating their own meaning. There’s no doubt that
existential philosophy has its share of depressing thoughts. On the other hand, we
believe that the whole point of existential thought is not to depress, but to provide
hope. Life is a struggle. Life is filled with suffering. But most of all, life is to be
lived. And that makes all the difference as we face the realities of death, freedom,
isolation, and meaninglessness.

vii) Theory of Psychopathology

- For existentialists, psychopathology results from failure to adequately face and

integrate basic inner daimonic impulses, and from failure to acknowledge and
reconcile life’s ultimate concerns. Typically, neurotic or maladaptive behavior is
linked to avoidance. As clients disavow natural urges and avoid ultimate concerns,
they progressively or suddenly develop psychological, emotional, or behavioral
symptoms. The cure generally involves facing oneself, facing life, and embracing
the reality of death, freedom, isolation, and meaninglessness. This does not mean
that life becomes easy. However, clients who face ultimate concerns with an
integrated sense of self will experience normal anxiety and guilt, rather than
neurotic anxiety and guilt. Gestalt theory defines psychopathology in a similar
manner. Specifically, when clients resist contact with the environment they are
likely to experience what Gestalt therapists call stuckness or an inability to grow,
adapt, and cope. Essentially, symptoms arise because of dysregulation in the
boundary between self and environment. Psychological health is characterized by
a healthy boundary between self and environment. A healthy boundary is one with
both permeability and firmness. Using the mental metabolism metaphor, the
healthy individual grows through biting off reasonably sized pieces of the
environment, chewing on them, and then determining whether the environmental
input is toxic or nourishing. If the bitten-off piece of the environment is toxic, the
individual rejects it, spitting it out. If the piece of environment is nourishing, one
swallows, digests, and assimilates the environmental information. To make
determinations about whether one’s environment is toxic or nourishing requires
confidence and trust in one’s taste and judgment.
 3) The practice of existential therapy
- From a more concrete perspective, developing self-awareness and interpersonal
skills will also help you practice existential therapy. The foundation of existential
therapy is the human contact between you and your client. Ideally, you should
seek to establish an I-Thou relationship with your client—a relationship
characterized by depth, mutuality, connection, and immediacy.
- The existential theme of personal responsibility has direct implications for the
therapist. As the therapist, you are completely responsible for your behavior
within the therapy session. Also, although you are not responsible for your client’s
welfare, you are responsible for the therapy process to which your client is
exposed.
- Beyond the therapy relationship, your focus is primarily on feedback. As a
therapist, your role is to provide your clients with feedback, while at the same
time honoring their personal experience.

i) Preparing Your Client

- The ethical principle of informed consent mandates that therapists tell clients what
to expect in therapy. There is perhaps no other form of therapy in which providing
complete informed consent is more essential than the existential approach. This is
because existential approaches, more than any other, include an immediate
confrontational component.
- In addition to providing presession informed consent, initial here-and-now
interactions with clients should proceed gently and educationally. This is true
whether the interaction is simply feedback about personal responsibility or
involvement in a Gestalt experiment.

ii) Assessment Issues and Procedures

- Existential therapists do not believe in assessment procedures. : All assessment

measures fall short of measuring anything close to a real, complete person. The
goal of existential therapy is not to narrow an individual’s conception of self, but
to expand it. As a consequence, for true existentialists, psychometric assessment
procedures not only are useless, but also might be considered anti therapeutic and
even unethical because they detract from the human encounter.
- Despite their anti-assessment/measurement perspective, existential therapists
undoubtedly use some implicit, less objective, assessment procedures with clients.
Overall, the existential therapist looks for neurotic anxiety, neurotic guilt,
 avoidance, denial, and other signs of pathology to guide the therapeutic encounter.
Additionally, the therapist might use specific questions oriented toward existential
ultimate concerns to enhance client self-awareness and promote personal
discovery. Examples include • What do you want? • What are you
experiencing/feeling right now? • Who are you? • What do you want to say right
now? • Where do you feel that in your body
- Gestalt therapy approaches primarily utilize confrontation to facilitate client self
assessment and discovery. As will be discussed, Gestalt therapy consists of
therapeutic experiments conducted in the here and now with the purpose of
expanding client self awareness. In some ways, the entire Gestalt therapy
approach involves facilitation of self-assessment. It is through self-awareness that
humans change. Without self awareness, there can be no self-regulation.

iii) Specific Existential Therapy Techniques

- Most existential therapists reject the use of techniques. However, some

existentialists, particularly Frankl and Fritz Perls, wrote extensively about
interventions that can be used with clients. Interestingly, Perls referred to his
techniques as “experiments,” a term that captures the immediate experiential
nature necessary in an existential encounter. The following techniques are derived
from Frankl, Perls, and contemporary experiential therapy approaches. -
- Paradoxical Intention- or anti suggestion was a technique originally employed by
Alfred Adler. Frankl also wrote about and used this approach. In a case example,
Frankl discusses a bookkeeper who was suffering from a chronic case of writer’s
cramp. The man had seen many physicians without improvement and was in
danger of losing his job. Frankl’s approach, implemented by one of his associates,
was to instruct the man to do just the opposite from what he usually had done;
namely, instead of trying to write as neatly and legibly as possible, to write with
the worst possible scrawl. He was advised to say to himself, “now I will show
people what a good scribbler I am!” And at that moment in which he deliberately
tried to scribble, he was unable to do so. “I tried to scrawl but simply could not do
it,” he said the next day. Within forty-eight hours the patient was in this way freed
from his writer’s cramp, and remained free for the observation period after he had
been treated. He is a happy man again and fully able to work. Frankl claims that
paradoxical intention is especially effective for anxiety, compulsions, and physical
symptoms. He reports on numerous cases, similar to that of the man with the
writer’s cramp, in which a nearly instantaneous cure results from the intervention.
In addition to ascribing the cure to humor and distancing from the symptom,
Frankl emphasizes that through this technique, clients are taught to intentionally
exaggerate, rather than avoid, their personal experience.
 - Cognitive Reframing As a modern therapy technique, cognitive reframing
probably has its origins in the individual psychology of Adler. However, Frankl
also employed this technique, and later cognitive therapists such as Albert Ellis
and Aaron Beck more forcefully emphasized its power as a primary therapeutic
technique.

iv) Specific Gestalt Therapy Techniques

- Staying with the Feeling Gestalt therapy places a strong emphasis on immediate
feelings. Overall, feelings are to be faced and confronted, not avoided. In some
ways, from the Gestalt therapy perspective, staying with the feeling is less a
specific technique than a general therapy strategy or philosophy. Gestalt therapists
use a variety of techniques to encourage clients to stay with or confront feelings
they’re trying to avoid. First, they use persistent, repeated questions such as
“What are you aware of now?” or “What are you noticing inside yourself right
now?” Second, clients can be instructed to give “voice” to their feelings and
sensations (e.g., “Let your anxiety have a voice and let it speak for a while”).
Third, clients can be encouraged to act on or act out their feelings in the here and
now. For example, Perls often had clients pull on and “stretch” him when they felt
inner tension and conflict. He believed that by acting out their feelings outside of
themselves, his clients would be able to identify and reintegrate their
uncomfortable or disowned feelings.
- Playing the Projection Much of Gestalt therapy as practiced by Perls was
conducted within group settings. He would routinely put group participants on the
hot seat and exhort them to become involved in Gestalt experiments and give
them feedback. An old supervisor of ours who was in a group facilitated by Perls
noted—with some enthusiasm—that being in the hot seat was one of the most
frightening and growthful experiences in his life. Playing the projection is
especially applicable to group therapy. Similar to psychoanalytic object relations
theorists, Perls believed much of what happens interpersonally to be a function of
projection. Therefore, when, in the therapy group, Perls noticed a group member
making a statement about someone else that seemed to have much more to do with
herself, Perls would ask the participant to play the projection. For example, if the
participant commented that she thought Robert (another group member) was too
critical of other group members, Perls might say to the woman, “Okay, I want you
to take on that quality. You are critical of everyone here. Go around the room and
criticize everyone.” Another way to apply this technique is to direct your client,
“Tell me something especially annoying you’ve noticed about someone else.”
When the client responds with something like “I hate it when Juan is so selfish
and insensitive,” ask the client to act selfish and insensitive. You can also have the
client amplify these selfish and insensitive feelings by having him engage in an
empty-chair dialogue, with one part being selfish and insensitive and the other
part being unselfish and sensitive. As the dialogue ensues, be sure to encourage
 the client to focus on what thoughts and feelings come up as he plays the two parts
or roles. We will discuss the empty-chair technique in more detail in an upcoming
section.
- The Reversal Technique This technique is designed to get clients in touch with
parts of themselves that they ordinarily minimize, deny, or ignore. Consequently,
passive individuals are asked to behave aggressively, exhibitionists are asked to
inhibit themselves, and a person who talks least is asked to talk the most. As with
the playing-the-projection experiment, the reversal technique is often employed in
a group therapy context. However, it can also be modified for individual clients.
As usual, the main emphasis is for clients to notice physical sensations, feelings,
and thoughts that emerge as they engage in these less prominent behaviors.
- The Exaggeration Experiment In this experiment clients are instructed to
exaggerate their subtle nonverbal behaviors. These nonverbals may or may not be
consistent with the client’s overall behavior pattern or verbal statements.
Exaggerating subtle nonverbal behaviors amplifies the meaning of the
behaviors—behaviors that may have been outside of awareness. This experiment
is used in conjunction with focusing and awareness instructions. For example, a
client who brushes her hand past her neck might be asked to exaggerate the
motion and then to focus on what she feels. In essence, the therapist says, “Make
that motion again, only make it bigger. That’s it, do it again, even bigger. What are
you aware of now?”
- The Empty-Chair Technique or Dialogue Experiment This technique is the best
known and best researched of all the Gestalt experiments. There are two different
ways to use the empty-chair dialogue in therapy. In the first version of
empty-chair, the client is instructed to play two different parts of herself,
depending upon the chair in which she is seated. Typically, this approach to the
empty chair results in the client taking on the “top dog” and “underdog” polarities
of her personality. The purpose of the empty-chair technique is to help clients
break out of being stuck in this self-torture game.
- The Gestalt Approach to Dream Work For the Gestalt therapist, dreams are to be
experienced, not interpreted. Additionally, in keeping with existential philosophy,
Gestalt therapists view the dreamer as 100% responsible for all dream images.
Specifically, if your client dreams of a terrible monster murdering an innocent
victim, both the monster and the victim are considered manifestations of the
dreamer. There are four main steps to Gestalt dream work. First, the dreamer tells
the story of the dream. Second, the dreamer “revives” the dream by changing the
language: Instead of telling the dream in the past tense, he or she reports it in the
present tense. Third, the dreamer becomes a director and organizes the dream as a
play, moving around, setting the stage, and describing where everyone is and
where every object is. Fourth, the dreamer then acts out the dream, always using
the personal pronoun “I” to enhance identification with each object and character
in the dream.