My orientation to psychotherapy is to approach every session as a creative undertaking, whether it is with an individual or a group, a couple or a family, a child, an adolescent, or an adult. This is true for every stage of the treatment process, beginning with engagement and problem clarification, with developing a working relationship based on trust, and moving constructively forward in relation to established objectives. The process of each session involves engaging purposefully to facilitate problem resolution, newness, and growth. A particular area of specialty for me has been assisting clients with the challenges inherent in social role transitions across the life span.
Last May I received a call from the mother of a high school senior I had treated for panic attacks when he was in middle school. He was again experiencing episodes of intense anxiety and she inquired about my availability. We had a brief conversation and she said she’d speak with him and call me back. When she did she sounded discouraged. He was willing to re-engage in therapy, she said, but he wanted to pursue a recommendation from a friend and see someone who uses existential therapy.
She said this somewhat disdainfully and expressed feeling it would involve mainly unproductive philosophical discussions. She preferred he see me, she said, as she knows I practice Cognitive Behavioral Therapy (CBT), but she felt she needed to go with his choice. I agreed with her decision and I didn’t want to seem to argue it by explaining that, along with my primary methodology of CBT, I have long used an existential therapy orientation in my work. I actually find the two to be quite compatible, and I welcomed her comment as an opportunity to refresh my understanding of why this is true.
It happened that my summer reading list included the recent book: At the Existentialist Café - Freedom, Being, and Apricot Cocktails, by Sarah Bakewell. This book tells the story of the development of existentialism, from a fresh, contemporary perspective, by focusing on the lives of the philosophers themselves, as they were impacted by the tumultuous events of mid-20th century Europe. Ms. Bakewell writes beautifully, and clearly summarizes the important philosophical contributions of the major existentialists, highlighting their differences and their common ground.
Re-inspired by the arguments of Existentialism, its valuable relevance in our struggle with contemporary personal and social dilemmas, I was moved to review the material that originally excited me about this as a therapeutic methodology. That project included re-reading the chapter on "Existential Social Work," in an old textbook I studied when I was in Social Work School many years ago. I also skimmed through a couple of books I never parted with from an undergraduate course on Existentialism. In the end I ordered the new edition of Existential-Humanist Therapy, by Kirk J. Schneider and Orah T. Krug, 2017, to be sure I’m up to date on the methodology.
I do, of course, fully understand the concern of the parent who thought existential psychotherapy would involve only an abstract philosophical exercise that might be interesting to her son, but would at best serve as a distraction from the anxiety he was experiencing in his final months in high school. However, as Sarah Bakewell describes so well in her book, existentialism, following the lead of phenomenology, took the tradition of philosophy on a radical turn from elaborate exercises in abstract reasoning to a primary concern with individual, concrete human existence. As Ms. Bakewell puts it: existentialists developed "a way of doing philosophy that reconnected it with normal lived experience."
Although the heyday of the pioneering existentialists was the middle of the last century, and the world today is a different place in significant ways, there are many parallels of individual, social, and political instability, and anxiety provoking uncertainty. As we experience exciting and challenging technological change, and witness amazing scientific developments, the timeless questions about consciousness, about freedom and values, about how to fully engage with our world and live meaningful, responsible, rewarding lives, call out for our attention in profound ways.
Existentialism breaks this down to a heightened focus on the reality of here and now. As Sarah Bakewell writes: "An existentialist concentrates on describing lived experience as it presents itself…and by describing experience well, he or she hopes to understand this existence and awaken us to ways of living more authentic lives."
While recognizing individual innate limitations, as well as the complex spectrum of environmental constraints, existentialists believe that we are free to choose, at every moment, what we will become. Importantly, this leaves us responsible for what we do. Jean-Paul Sartre reduced this fundamental principle of existentialism to three words: "existence precedes essence." In other words, we are born with certain intrinsic qualities but our essence as human beings is something that is being continually constructed as a result of our life decisions and experiences.
This continuous process of building and modifying who we are brings an adventurous approach to living; though it throws open the door to the experience of existential anxiety. A compelling aspect of this self-creation is that in practice it encourages engaging with the world through meaningful social, political, and creative projects; which is both personally rewarding, and contributes to a more humanistic larger culture.
While an existentialist orientation expands and deepens the mindset I bring to the practice of psychotherapy, it is not often that I actually use the word "existentialism" in sessions. However the helping process of psychotherapy involves being deeply present with clients, and listening carefully to their detailed description of how they view their world and the challenges they encounter. This does not generally involve reaching for lofty goals of personal transformation; but is does easily blend with the techniques of Cognitive Behavioral Therapy (CBT).
CBT provides a practical method for evaluating the underlying thought processes and beliefs that shape our perceptions, our emotional responses to events, and our resulting behaviors. This process is grounded in an examination of the constraints, both internal and environmental, that impact on our potential for free choice. The therapeutic work concentrates on expanding the field of what we embrace as within our power to change, and developing the skills to make that happen.
This brings us back to the question of free will, and the arguments that it’s largely an illusion. Scans showing the brain’s response to certain stimuli, for example, appear to show that people respond behaviorally to a stimuli before the decision making functions of the brain have finished choosing from the available options. Also, the disease model of addictive behaviors, which is (for sound reasons) gaining increasing acceptance, has been stretched by some to a point that it, in effect, absolves an addict of personal and legal responsibly for behaviors resulting from their addiction.
Such arguments rattle the ground on which Existentialism and CBT, as well as our larger moral, ethical, and legal framework rests. They are provocative and worthy questions; but for me this presents more of a motivational challenge to hold in the forefront the central existentialist principle that, in ways that matter most, existence does precede essence.
Therefore, I see my work as helping clients appreciate and "come to terms with" their various immutable constraints; guiding them to question false and unhelpful beliefs, and then proceeding from the basis that we are, and continually become, the product of what we do. A primary focus of this work is on the decisions, large and small, that we make everyday, with the objective of making choices, mindfully, to allow us a healthier, more satisfying and less troubled existence. This involves embracing available freedom, while thoughtfully managing the responsibility that comes with that freedom, and actively engaging our world in ways that bring meaning and, to use the existentialist term, "authenticity" to our lives.