In: Psychiatry: Interpersonal and Biological Processes, 81: 207-211, 2018.
The Existential Sensibility: Self and Psychotherapy in an Uncertain World
Michael Stadter, PhD is a clinical psychologist in private practice and a faculty member of the Washington School of Psychiatry, the Center for Existential Studies and Psychotherapy, and a founding faculty member of the International Psychotherapy Institute.
Address correspondence to Michael Stadter, PhD, 4400 East-West Hwy. # 1028, Bethesda, MD, 20814. E-mail: firstname.lastname@example.org.
The material in this article is based on a conference held at the Washington School of Psychiatry, co-sponsored with the Center for Existential Studies and Psychotherapy, April 7-8, 2017. Megan Flood, Jane Prelinger, and Michael Stiers also contributed to this article.
In the early years of the Washington School of Psychiatry, Edith Weigert, one of the School’s major contributors, was interested in existential theory and how it could complement the work of psychoanalytic therapy. In 1949 in this journal, she wrote “the psychotherapist looks at trees, the existentialist at the forest as a whole” (Weigert, 1970, p. 376). She meant that psychotherapists focus on individual patients, their unique histories, present experiences, and hopes for the future. By contrast, existentialists focus on the common conditions and themes of being human. Also, in contrast with many therapists, many existential therapists (e.g., van Deurzen, 2010) prefer the term client rather than patient to suggest a different therapeutic process than implied by the medical model.
In this article, I summarize some of the major themes of this two-day conference. It was designed to engage participants both cognitively and affectively, and the conference sessions included lectures, a case presentation and consultation, an experiential session on death anxiety, small group work, and a plenary session.
ON BEING PRESENT AND HUMAN: EXISTENTIAL THEMES IN PSYCHOTHERAPY AND LIFE
I opened the conference with this lecture and discussion. Existentialism is a diverse philosophy. Starting with the work of Soren Kierkegaard in the 19th century, it came to prominence in the mid 20th century with the writings of Jean-Paul Sartre, Albert Camus, Simone de Beauvoir and others. The theory sprang from the trauma and despair in Western Europe following World War I, the great depression, and World War II. Other prominent existentialists include Martin Heidegger, Paul Tillich, Martin Buber, and Victor Frankl. The existentialists are a dissimilar, even unruly group of philosophers who disagree with much among themselves. Yet, it is a philosophy that has continued to develop and includes Black, Feminist, Latin American, and Chinese perspectives, among others.
The following are five basic tenets of existential philosophy:
- Existence precedes essence. There is no essence that defines the being of a particular person. Existentialism does acknowledge that there are givens: for instance, culture, race, physical limitations, and mortality. However beyond those givens, an individual exists and experiences life and being in the world. It is this experience of being that comes to define a person’s essence.
- A phenomenological perspective is the method of study. Attention to present experience and ongoing experience of the individual and of the individual in relation to others is the way to true, deep understanding of a person.
- Individuality and authenticity are valued. Each person is unique and the search for and creation of self is a lifelong project. We all carry the diagnosis: Fundamentally Human NOS (not otherwise specified).
- Every person is free. This does not deny that many people are constricted, oppressed, threatened, imprisoned or enslaved. Still, every person has the potential to make choices. However, the person is responsible for the choices they make. This is the meaning of Sartre’s (1956, 2007) frequently cited concept that each human being is condemned to be free: free to choose but responsible for one’s own life, for one’s actions and for one’s lack of action.
- To be fully human is to accept that life includes both suffering and joy. A person is most real and fully human if they face these realities of existence. Indeed, a Chinese perspective on existential therapy is Zhe Mian Therapy (Wang, 2011) which translates as “face directly.”
How can an existential sensibility inform psychotherapy? Different therapists answer that question individually which is why the conference used the term existential sensibility rather than existential therapy. It has been said that there are probably as many different existential therapies as there are existential therapists. Two illustrative definitions of existential therapy are van Deurzen’s (2010) and Yalom’s (1980):
[Existential therapy] forcefully confronts clients with their set mode of living and their current ways of being in the world…It also holds out the promise that it is possible to live a worthwhile and meaningful life…if one is willing to face up to one’s share of human misery and eager to relish one’s share of joy. (Van Deurzen, 2010, p. 255)
“A dynamic approach to psychotherapy which focuses on concerns that are rooted in the individual’s existence.” (Yalom, 1980, p. 5)
Also, working with the contributions of Tillich (1952), Yalom (1980) emphasizes the following four themes of human existence:
- The wish to live and the inevitability of death
- Freedom and responsibility
- Connection and isolation
- Meaning and meaninglessness
The existential sensibility can influence the therapist in numerous ways and here are just a few of them. First, the therapist invites the client to be fully human and alive – even in the face of pain and suffering. Second, while the past may still be carefully examined, there is an emphasis on present moments of experience at various levels – somatic, psychological, interpersonal, and spiritual. Yalom (1980) notes that the predominant time tense in existential therapy is the present becoming future. Third, the client’s experience is viewed through a lens of individuality and of being. The existential sensibility is not a pathology lens or model. Fourth, therapist and client explore ways to bear the suffering of being, some profound and some simple. In a profound sense, finding meaning in life (personal, communal, spiritual, etc.) helps one live through suffering, even trauma. In a less profound sense, humor can transform the suffering, losses, unfairness, and absurdity of human existence. Fifth, the therapist is aware that there are aspects of human existence that are difficult and inevitable and that the therapist, too, may be inclined to avoid them. The vignette below exemplifies this.
At the time of this vignette, Celine, fifty-two, a white, married mother of four was in hospice care. She had been in therapy with me for seven years and over this time her physical condition had deteriorated due to multiple medical problems. In this session, she was talking about her recent birthday party and how wonderful it was. It was a special celebration because neither she nor anyone else believed that she would live to see it. As she talked about the party and about turning fifty-two, she asked me how old I was. I said, “sixty-eight.” Celine paused for a few moments and then said, sadly, “I guess I might have to lose you.” My internal reaction was swift and passionate. I wanted to say, “No you don’t, I will be here for you. That’s one thing you won’t have to deal with. I often feel that I haven’t given you much in the midst of your suffering but I can give you this.”
Of course, that was my own existential denial. Fortunately, I paused, and said, “I plan to be with you through all of this, but you’re right we don’t know, you might lose me.” Then, we sat together, joining and joined in our common mortality.
THE SEARCH FOR MEANING IN THE 21st CENTURY: THE FEAR OF INSIGNIFICANCE
The conference’s keynote speaker was the Swiss/Israeli existential psychoanalyst and philosopher, Carlo Strenger. A professor of psychology and philosophy at Tel Aviv University, he presented his research and thinking on globalization and its impact on meaning and social identity (Strenger, 2011). He especially highlighted its role in developing a global creative class whose members find their community and identity more within their technologically-assisted cohort than they do within national or local groups. It is important to note that globalization affects many more people than simply this global creative class, as indicated below. He states that the members of the global creative class share the following characteristics. They have very high expectations from life and, therefore, frequent dissatisfactions. Self-realization and making a difference in the world are essential. Also, the search for meaning is important and frequently includes the following question “Am I leading a significant life?” While globalization has many positive aspects, such as identification with humanity in general, it also can make the search for significance more daunting – to be significant in the global village is much more difficult to achieve than it is within the local village.
Strenger highlighted two challenging and damaging effects of globalization. On the global stage, self-esteem management is more fraught; who can compete with, as he put it, “the icons of success pulsating through the Global Infotainment System?” It can then produce a feeling of insignificance or loss of significance of self and of the local village. He argues that this evokes death anxiety, which initiates the following cycle. Death anxiety is repressed and a defensive intolerance of otherness replaces it. In turn, this promotes a rise in populism from the political right, a trend currently in evidence in many countries. At the individual level, there is an increased pull toward types of celebrity and ratings through the Global Infotainment System. This can range from the TIME 100, Top Ten Actors, Top Rated Tennis Players to high numbers of Facebook friends, Instagram likes, You Tube clicks, etc. He suggests that these are attempts at symbolic immortality – to defend against “vanishing without a trace from the global playing field.”
Strenger concluded with recommendations to explore ways to make the globe more of a holding environment, to develop new systems of meaning, and to promote a concept of global citizenship. This is currently evolving but it will require concerted efforts, including early education and access to social, scientific and artistic networks.
BONNIE AND CLYDE: FINDING MEANING THROUGH EXCITEMENT, FEAR, FANTASY, AND PLAY IN THE THERAPEUTIC RELATIONSHIP
Megan Flood, a member of the WSP and CESP faculties presented a case with Strenger as the discussant. The client, pseudonym Charlie, a middle-aged man with a serious psychiatric history, was struggling to find meaning in a life depleted by repetitive negative feedback from teachers, parents, employers, and women. As the client said at the beginning of treatment, “nothing matters in my life.” In the presentation, themes of love, fear, and excitement in the therapeutic relationship were highlighted. Strenger characterized their relationship as, in part, a sort of “ love affair” and that Charlie became alive through it. He also noted the significance of the experience of therapy being enlivening and meaningful for both Charlie and the therapist. This was the first step toward resuscitating a long-ago lost version of Charlie — one more available to form other intimate relationships in his current life. It also released a previously blocked process for the development of meaning and identity for Charlie’s future. Strenger emphasized the importance of engagement, authenticity, and an individualized approach which does carry certain risks but also substantial benefits.
The case was presented in a manner that combined client history, clinical considerations and therapy process including Flood’s internal experience with Charlie. This generated a spontaneous and informal dialogue between her and Strenger, which was then opened up to include contributions from the audience. This format facilitated an intimate, here and now experience for the presenters and conference participants, modeling an existential approach of working in the moment with experience near material.
INTIMATIONS OF THE END: DEATH ANXIETY IN THE CONSULTING ROOM AND IN OUR LIVES
Jane Prelinger and Michael Stiers, members of the WSP faculty and co-founders of CESP, presented this workshop. It seemed fitting that this segment of the conference focused on death and death anxiety would occur near the end of the conference. The goal was to establish an ongoing conversation that would become increasingly more inclusive. The prior events at the conference consisted of lectures, small group work, and a case presentation. At this point in the conference, members were invited to participate as volunteer presenters by sharing experiences related to the topic of death and death anxiety. The hope was for the conference membership to engage in conversation about these important issues that arise both in life and in clinical work, that is, the anxiety that arises when thinking about death.
The 90 minute workshop had three parts. In the first 30 minutes, the leaders began the conversation by talking with each other about the importance of awareness of death, and death anxiety, noting that these are issues that clients and therapists frequently avoid. The topics of death and death anxiety are clinically relevant beyond working with clients who are terminally ill or are acutely grieving. Intimations of death infuse many situations, for instance, the inability to make choices, separation anxiety, aging, thrill-seeking, other dangerous behavior, and the struggle for meaning. Personal and clinical experiences of death anxiety were discussed, with the hope that other therapists would offer their own views and experiences.
In the second 30 minutes, six participants were invited to continue and to broaden the conversation by talking about these issues from multiple vantage points. The volunteers came to the front of the room and formed a panel with eight chairs arranged in a semi-circle, six for the volunteers and two for the facilitators.
In the final thirty minutes, the leaders expanded the discussion to include all participants. It was thoughtful, emotional, and personal. One of the many observations was that actual death and dying are such powerful and terrifying topics that workshop participants focused much more on death and dying per se than on the less obvious intimations of death in other clinical and personal situations.
Stiers chaired the closing plenary meeting. As the conference neared its close, space was created to face the end of the conference learning community. The Final Moments plenary review session consisted of all members and faculty. The purpose was to integrate aspects of the total conference experience, to offer feedback on what participants appreciated, what they wished had been different, and to collectively say goodbye. The hour long plenary was unstructured to allow for individual expression of cognitive and affective responses. Certainly, the conference themes of mortality, uncertainty, limits, aloneness, authenticity, despair, freedom, and acceptance were discussed, as was the key question of how is an existential sensibility manifested in therapy (partial answer: in many different and very individual ways). A number of participants noted their own professional work on existential themes with children, college students, active duty military, individuals near the end of life, and others. Members also described meaningful professional and/or personal insights that had come from the conference. The concept of finality was articulated, explicitly and implicitly, in this final event.
- Sartre, J-P. (1956). Being and nothingness. (H. C. Barnes, Trans.), New York: Washington Square. (Original work published 1943)
- Sartre, J-P. (2007). Existentialism is a humanism. (C. Macomber, Trans.), New Haven: Yale University Press, (Original work published 1946)
- Strenger, C. (2011). The fear of insignificance: Searching for meaning in the 21st century. New York: Macmillan.
- Tillich, P. (1952). The courage to be. New Haven, CT: Yale University Press.
- van Deurzen, E. (2010). Everyday mysteries: A handbook of existential psychotherapy 2nd edition. London: Routledge.
- Yalom, I. (1980). Existential psychotherapy. New York: Basic Books.
- Wang, X. (2011), Zhi Mian and existential psychology. Humanistic Psychology, 39, 240-246.
- Weigert, E. (1970). Existentialism and its relation to psychotherapy. The courage to love (pp. 358-382). New Haven: Yale.
Special thanks go to the conference small group leaders: Elaine Klionsky, Nancy Lithgow, Venus Masselam, Bill Pinney, Emily Randall, Lenore Shapiro, Michael Stiers, and Michael Stadter.