Existential Therapy: Distinctive Features

The book, Existential Therapy: Distinctive Features by Emmy van Deurzen is a good reminder to view each person as a free individual, responsible for their life. But, on another level, it is a book about how to push a particular set of belief on another person.

Van Deurzen describes the existential therapy approach as:

The life we lead, the person we become, the choices we make, are our responsibility and ours alone. Existential therapists believe that by becoming more aware of our freedom, and the responsibility it holds over us, we can make better choices for ourselves. Rather than blaming our situation on past events or on other people (say our parents) we can take responsibility for our part in what has happened and choose how to live and respond differently in the future…Existential therapy is about finding a gentle way to face those aspects of life that are difficult. It’s about facing up to life’s challenges and allowing both the good and the bad, the joy and the suffering, into our lives.

Van Deurzen attempts to understand her clients from an existential perspective, but she only goes so far. While she tries to understand her clients, she also pushes her own set of values as the ideal values. Because she works within the medical model, she seeks to medicalize problems in living so as to existentially boost herself in her chosen profession.

For example, van Deurzen values flexibility, scientific thinking, and inspiring “people with the sense that life is precious and that they have many yet unexploited abilities and talents to discover and hone.” This is all good, but not everyone values these fine aspirations.

For example, Karl Jaspers, a psychiatrist, philosopher, and existential therapist had one client commit suicide, and he considered this a case of successful therapy! His client’s decision to die voluntarily was in alignment with the client’s values.

The existentialist, unlike the psychiatrist, acknowledges that life is no picnic, and not everyone can or wants to go on living. The existential perspective should embrace all of life, including voluntary death, not just the good things in life, which van Deurzen embraces.

You can see van Deurzen’s values coming through in her video below on suicide prevention. Again, this is a fine approach, but I don’t see it as an existential approach. It does not embrace the totality of life, including death by choice. Suicide brings important values to light, and the existential perspective allows for all values to be considered, including the value expressed by suicide – that life may not be worth living.

Existential therapy should about meeting each person on their level and seeking to understand a person’s choices in the broader context of their lives, not seeking to change another person’s set of values. It is not clear whether such an existential approach is possible within the medical context.

To be clear, Van Deurzen’s approach is laudable. But, I do not see it as existential because it does not embrace the idea that each person has a unique set of values. In the final chapter of the book, Van Deurzen pushes her own set of values, which is fine, but I don’t see this as a departure from other forms of therapy. I believe that the existential approach must look to uncover each individual’s set of values and examine whether they are the values that one truly wants to hold.

4 thoughts on “Existential Therapy: Distinctive Features

  1. It’s difficult to comment on an approach that I’ve trained in and be diplomatic about it. For me Existential Psychotherapy training is like everything else in this life – there’s an idea of what existential psychotherapy is, and then there’s the reality of how it is taught. They weren’t the same, as I discovered during training.

    I’d also add a further distinction between existential training and the application of it into a form of therapy that can actually be practical and helpful in the real world. That translation takes a huge amount of personal work to make it more than just chit-chat (because most people who seek therapeutic help really don’t have the time to chat if they have real struggles, torments and life or death anxieties). As frustrating as that process was, it also suited me as a person because the creative formulation of an approach to working with people makes it your own. The idea that existential analysis is a fixed, definable thing is false I think. Emmy van Deurzen has her version and there may well be loads of folks mimicking her version. But it isn’t my version and I’m sure there are many people out there who do their own very different versions too. i think that’s what makes the existential approach unique really. Contrast this with something like CBT, which really is largely learning by rote, but it at least has clarity.

    The psychotherapy/ psychology/ psychiatry field, once again, is very political. Full of politicians and people who want to make a name for themselves. That’s the part of it I find tedious, so I no longer participate in the party. I’d sooner get on with helping people where I possibly can.

    One thing I’d add on the suicide question (I haven’t watched the video by the way) We have to consider that most people in therapy who are suicidal aren’t viewing suicide as a philosophical question or possibility. Most, in my experience, are suffering from depression – a significantly altered state of mind that has a discreet course of decline. Not saying it’s an illness, but it is a place where the possibility of suicide is often one arising out of utter desperation for the pain and suffering to end. People do recover and they do express gladness that they didn’t go through with it. As a psychotherapist is our job to help them through this and to recognise their possibilities for living according to their values. In depression one’s understanding of one’s usual values can be all over the place.

    I’m enjoying reading your blog by the way.

    Liked by 1 person

    1. Stephen, thanks for your thoughtful comments. I think we view suffering and depression from totally different angles. When you say someone is suffering from depression it makes it sound like there is something, some entity or thing called depression that one suffers from. But feeling sad and depressed is part of life. Those feeling are something one should listen to and understand. When someone is suffering, wanting to end life is understandable. The desire is not due to some thing outside of one’s control – from my point of view. Philosophers throughout the ages have told us that the thought of being able to end one’s life has got them through many a dark night. Suicide from the psychiatrists/psychologist point of view is a symptom of an illness – likened to death from cancer. But suicide is much different, it is a solution to one’s problems, not a symptom of a terminal illness. Suicide is the ultimate solution although mental health experts will never admit it. I agree with Szasz who said:

      He who does not accept and respect the choice to reject life does not truly accept and respect life itself.

      During the past century, most people in developed countries concluded that when it comes to having children, less is more. If we want to improve our lot on earth, we shall have to apply this principle to the length of our own life. Having ten children is not necessarily better than having one or two. Why should living, say, ten more years at age seventy or eighty be better than living only five, two, one, or no more years? We have learned that, to prosper as middle-aged persons, we must practice birth control when we are young. We shall have to learn that, to prosper as old persons, we must practice death control while we can.

      Vases made of glass are more fragile than vases made of steel. The lives of lonely and depressed persons are more fragile than the lives of persons engaged in life and who are not depressed. The “condition” psychiatrists call “being suicidal” is and ought to be regarded as a disposition: some people are more likely to kill themselves than others, just as some vases are more likely to break than others. From a relatively early age, every person can imagine killing himself and is, in a manner of speaking, “suicidal.” A person disposed to kill himself knows that he is so disposed. If he wants to protect himself from his inclination, he can do so by avoiding objects or situations that would facilitate his self-destruction or by asking others to protect him. The person who undertakes the complex task of killing himself is responsible for his premeditated act, just as the person who undertakes to carry out any other complex task is responsible for executing it. One of psychiatry’s most fundamental mandates and most far-reaching confusions stems from the belief that it is the psychiatrist’s job to prevent “suicidal” persons from killing themselves.

      Liked by 1 person

  2. Hi, thank you for your reply and the quotes. I wouldn’t necessarily argue with Szasz. I don’t see it as my job to prevent suicide. But what I do see is this, and I’ll list them as points to make it easier for me to clarify in myself, speaking only from my own experience and without suggesting I am right and everyone else is wrong!:

    People who come to me for therapy when they are suicidal come because they DON’T want to kill themselves. They are struggling with it and recognise in themselves that they have the urge to do it but they want help not to do it. Otherwise why bother paying a therapist?
    You can’t actually stop anyone from killing themselves, unless you treat them as an object and tie them down. All you can do is help them examine what’s going on and help them find answers. Part of this, for me, is acknowledging that they are free at any time to take their lives and that it isn’t my job to stop them. Taking away the ‘I must stop you from killing yourself’ implication is about taking away the pressure that I think can prompt people to suicide through their resistance to you. It’s also not my responsibility to stop someone killing themselves. It’s my responsibility to help them find meaning in life, find a way through their troubled times, so that they come out the other end stronger and wiser.
    I speak as someone who has faced suicide as an option several times. There isn’t one of those times where I wouldn’t have wanted a caring, genuine human being to be with me in that state, listening to me, caring enough about my life to want the best for me, and respectfully listening to my options without trying to force me one way or the other. Most of the time it has been the absence of genuine, caring individuals in my life that has been the precursor to suicidal ideas because authentic relationships are what give my life meaning. And yes, having suicide as a real possibility has definitely helped me through those times.

    I haven’t come across anyone contemplating suicide from a purely philosophical perspective. Perhaps if I did then I would have some additional experience to add to the above. As it is, I remain of the view that most of the people (and any other life forms for that matter) that I have encountered have an overwhelming need and drive to live, not to kill themselves. There are of course terminally ill people in unimaginable suffering who just want a dignified end to the inevitable. I’ve never worked with a person like that, and that could raise some new questions for me.

    In the end, from an existential and psychotherapy standpoint, I think the important thing is to clarify where we stand on various questions, including suicide in various scenarios. This is about being clear on who we are, what our values are, and in acknowledgement that other people will have their own position on all of this. This way we can avoid the notion that something is ‘more existential’ than something else or that ‘to be existential’ we need to adhere to an existential philosopher’s thesis or viewpoint. The definition of existential enquiry for me is that we earnestly concern ourselves with what it is to exist in this world, courageously examining everything as possibility and clarifying what we are about at any one moment. We also recognise that all this can change as we evolve, but that the authentic concern remain.

    Liked by 1 person

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