Client therapist relationship existential therapy and death

client therapist relationship existential therapy and death

Existential therapy (or existential psychotherapy) is based on some of the main for Existential Therapy; The Existential Therapy Relationship; A Take . It's all well and good to help a client overcome their fear of death, but if. The client's way of being in psychotherapy Existential way of being in therapy Within the therapeutic relationship, the existential .. crisis such as confronting death or experiencing meaninglessness and isolation, who have. Within the context of Existential Therapy the therapeutic relationship is one . social supports to sustain advanced cancer patients through illness and death.

And, further, that in terms of our current understanding, it remains uncertain as to how subtle or radical, beneficial or detrimental, the impact of any given directed manipulation may be upon a particular client's current way of being. Rather, the encounter between therapist and client, while undeniably focused upon the client, is, nonetheless, mutually revelatory.

In their attitude of being-for their clients, existential psychotherapists express their willingness to attempt a non-judgemental, descriptively-focused entry into that way of being in order to disclose, together with their client, the underlying, often implicit and inadequately acknowledged, values, beliefs, assumptions, attitudinal stances and their accompanying affective and behavioural components which infuse and maintain it. While neither the attempt to be-with or be-for the client can ever be fully achieved, and remains an aim or attempt rather than an fulfilment, nonetheless the undertaking may well provoke one of the biggest challenges that the client is likely to experience: A related, and more explicitly inter-relational, approach toward such investigations has been suggested and developed by present author in various papers and texts Spinelli, This approach focuses upon four distinct inter-relational realms.

I-focused inquiry attempts to describe and clarify "my experience of being 'myself' in any given relationship". It asks, in effect, "What do I tell myself about my current experience of being me in this encounter? You-focused inquiry attempts to describe and clarify "my experience of 'the other' being in relation with me". It asks, in effect, "What do I tell myself about the other's experience of being with me in any given encounter? In short, it asks each to consider "what do I tell myself about the experience of being us being in relation with each other in this encounter?

As such, it expresses explicitly that inter-relational grounding that exists and is more implicitly expressed in the statements which emerge from I-focused and You-focused inquiry. In brief, it challenges the client to consider the various facets of inter-relations between the client and these others as the client imagines they experience and interpret them.

client therapist relationship existential therapy and death

Further, it challenges the client to consider the impact of his or her stance upon the inter-relations between one other or group of others and a different other or group of others.

The They-focused realm of encounter serves to extend the "world-dimensions" of the therapeutic relationship.

client therapist relationship existential therapy and death

It is an explicit stance that can be adopted by existential psychotherapists to highlight the inter-relational dimensions of existence and to counter the more common psychotherapeutic tendency to consider the client in isolation, or out of inter-relational context. The exploration of all four realms of encounter via the therapeutic relationship itself bestows upon that relationship a lived experience of its being real and valid rather than merely substitutive, symbolic, or "transferential".

It is the basic view of existential psychotherapists that 'it is not the understanding that follows technique, but the technique that follows understanding' Misiak and Sexton, The unorthodox and iconoclastic relational psychotherapist, Leslie Farber, stands as a major representative of this stance.

Instead, Farber's focus centred on a way of talking that led both therapist and client toward a "truthful dialogue" with themselves and one another Farber, This notion of a "truthful dialogue" has been further explicated by the philosopher, George Gadamer. Gadamer contrasted the truthfulness that emerges via a dialogue that is not pre-set in its focus and intent by one or any of the participants to one that has been pre-set in its intention or direction by at least one of the participants.

All dialogues, Gadamer acknowledged, have - or more accurately, find a direction, but there exists a truthful quality to a dialogue that shapes its own form and focus that cannot be ascertained - or experienced - in a dialogue that is being actively directed toward a certain pre-set goal.

One consequence of this, as Gadamer wrote, is that 'the way one word follows another, with the conversation taking its own twists and reaching its own conclusion, may well be conducted in some way, but the partners conversing are far less the leaders than the led. Hopefully, it can now be understood that this proposed stance is not some perverse belittlement or rejection of more typical psychotherapeutic enterprises but is, rather, a necessary constituent for the possibility of truthful dialogue.

Indeed, according to the psychotherapist, Zack Eleftheriadou, 'existential With regard to the on-going debates concerning sexuality and sexual orientation, existential-phenomenological authors such as Maurice Merleau-PontyHans W. Cohnas well as the present author Spinelli, have provided highly innovative contributions emphasising the inter-relational dimensions of embodied sexual being, as opposed to medically-derived concerns of "normal" and "abnormal" sexual practices and typologies.

client therapist relationship existential therapy and death

Further, the adoption of this model removes from psychotherapists much of their professional mystique, and a good deal of the power that comes with this Spinelli, For example, existential psychotherapists have proposed that the problems of mental disturbances are principally rooted in socio-ethical bases expressive of intolerable inter-relationally derived anxieties rather than in organic disorders and diseases requiring medical forms of intervention.

As various authors have argued, a medical language focused on illness, disease and disorder creates significant power imbalances in the relationship between therapist and client Laing, ; Szasz, ; Pilgrim Similarly, those who inhabit a foreign culture or who are members of a minority group within a dominant culture and society might find existential psychotherapy to be of particular value van Deurzen-Smith, In general, existential psychotherapy may be of greatest benefit to those clients who find themselves in various forms of transition and who are open to the challenge of grappling with complex and paradoxical issues.

Clients who are open to an approach which is reflective, exploratory and deeply challenging will warm to this system. On the other hand, those seeking certainty, and who wish to use psychotherapy to drive towards a fixed outcome, may struggle with the ambiguity it embraces. Existential psychotherapy has sometimes been accused of over-emphasising a pernicious form of individualism that is thoughtless or empty of direction and which elevates an extreme form of solipsism. Hopefully, this brief discussion has demonstrated that such views express a distortion of the most basic existential assumption: As such, rather than foster an individualistic ethos that separates self from others, or the client from his or her life and work context, the existential approach is foremost among approaches in asserting the necessity to acknowledge and place oneself in an inter-relational context.

Overall, existential psychotherapy's emphasis on "being qualities" and meaning exploration as opposed to the development and refinement of the psychotherapist's "doing" skills and repertoire runs counter to current dominant assumptions and emphases within psychotherapy as a whole. Whether this divergence will eventually prove to be the its greatest strength or weakness remains to be seen.

Even so, because of the overwhelming significance to existential psychotherapy of the therapeutic relationship itself, its potential strengths and weaknesses rest predominantly upon the therapist's ability to "stay with" the client in the relationship as it presents itself.

What this implies is that the existential psychotherapist must demonstrate the capacity to acknowledge and even embrace the insecurity and uncertainty that comes with the willingness to engage with the client as he or she is being in the current encounter rather than focus upon who the client may have been in the past or who he or she may be in the future.

This focus may challenge many of the therapist's professional assumptions regarding the therapeutic enterprise itself and, as well, may challenge the therapist's own personal assumptions regarding "the right" or appropriate ways to be. As such, if the primary emphasis given to the relationship itself may be seen as existential psychotherapy's greatest strength, this same emphasis may well highlight the therapist's lack of preparedness for, or willingness to adapt to the uncertain conditions and implications of inter-relation and, hence, expose the weaknesses not so much of the approach itself but of those who attempt to practice it.

Reported outcomes from this approach include individuals being more congruent with their lived experience and thereby, becoming clearer about who they are and who they are not; the accessing of skills for managing complexity, ambiguity and anxiety; and the enhancement of attitudes of self-responsibility and ownership of choice within an inter-relational context.

Some preliminary verification of this assertion has emerged from the successful outcome studies of the Soteria project focused upon the existentially-derived treatment of severe mental disturbances Mosher, In spite of the paucity of research data, it would be incorrect to conclude that existential psychotherapy is antagonistic to, or disinterested in, research concerned with either psychotherapeutic outcomes or process analyses.

Video Role Play Sophie. Illustration Experiential Existential Counseling

At the same time, existential investigators' views of relevant and appropriate research stand in direct contrast to the currently dominant natural scientific viewpoint and its underlying assumptions principally because the questions they pose and the methods they employ are grounded in a carefully articulated, but undeniably different, set of philosophical assumptions Spinelli, However, what might be the distinguishing characteristics of such a relationship that serve as key factors to any process of change remain uncertain.

While psychotherapists tend to focus on particular skills or forms of interventions, research analyses of client statements centre upon various experiential factors of which the client's experience of the "way of being" of the therapist emerge as pivotal Spinelli, ; Sherwood, Such studies strongly support existential psychotherapy's foundational emphasis upon inter-relation. Further, they highlight the importance of those analyses that centre upon the means by which the "way of being" of both the client and the psychotherapist can be further explicated and expressed as critical psychotherapeutic factors.

This area of investigation is one to which contemporary existential psychotherapy has much to offer. The present author's current interests are focused upon the impact of such a re-focus upon the therapeutic relationship Spinelli, This is the view that the person is a self-contained unit, understandable within his or her own set of subjectively-derived meanings and behaviours. The debate provoked by these two competing views is crucial: The most basic striving of an individual is toward the maintenance, enhancement, and actualization of the self.

An individual reacts to situations in terms of the way he perceives them, in ways consistent with his self-concept and view of the world. An individual's inner tendencies are toward health and wholeness; under normal conditions, a person behaves in rational and constructive ways and chooses pathways toward personal growth and self-actualization Carson, A client-centered therapist focuses on the client's self-actualizing core and the positive forces of the client i.

The client should also understand the unconditional nature of the therapist's acceptance. This type of therapy aims not to interpret the client's unconscious motivation or conflicts but to reflect what the client feels, to overcome resistance through consistent acceptance, and to help replace negative attitudes with positive ones. Rogers' techniques are particularly useful for the therapist who is trying to address a substance-abusing client's denial and motivate her for further treatment.

Response to the case study A client-centered therapist would engage in reflective listening, accepting the client and her past, and clarifying her current situation and feelings. As Sandra developed trust in the therapist, he would begin to emphasize her positive characteristics and her potential to make meaningful choices to become the person she wants to and can become.

Another goal of therapy would be to help her develop sufficient insight so that she can make choices that reflect more closely the values and principles to which she aspires.

For example, she may want to tell her husband about her symptoms and try to strengthen her marriage. If Sandra began to feel guilt about her past as a prostitute, the therapist would demonstrate appreciation of her struggle to accept that aspect of herself, highlighting the fact that she did eventually choose to leave it.

He may note that she did the best she could at that time and underscore her current commitment to choose a better life. Sandra would be supported and accepted, not criticized. She would be encouraged to express her fear of death and the effect this fear has on her. This might be the first time in her life that someone has been unconditionally accepting of her or focused on her strengths rather than her failings.

She apparently has the ability to solve problems, which is reflected by her return to therapy and her insight about needing help. By being understood and accepted, her self-esteem and sense of hope would increase and her shame would decrease. She would feel supported in making critical choices in her life and more confident to resume her recovery. Narrative Therapy Narrative therapy emerges from social constructivism, which assumes that events in life are inherently ambiguous, and the ways in which people construct meaning are largely influenced by family, culture, and society.

Narrative therapy assumes that people's lives, including their relationships, are shaped by language and the knowledge and meaning contained in the stories they hear and tell about their lives.

Recent approaches to understanding psychological growth have emphasized using storytelling and mythology to enhance self-awareness see Campbell, ; Feinstein and Krippner, ; Middelkoop, Parker and Horton argue that "Studies in a variety of disciplines have suggested that all cognition is inherently metaphorical" and note "the vital role that symbolism plays in perception" Parker and Horton,p. The authors offer the "perspective that the universe is made up of stories rather than atoms" and suggest, "Myth and ritual are vehicles through which the value-impregnated beliefs and ideas that we live by, and for, are preserved and transmitted" p.

From this perspective, narratives reveal a deeper truth about the meanings of our experience than a factual account of the events themselves. As Feinstein and Krippner note, "Personal mythologies give meaning to the past, understanding to the present, and direction to the future" Feinstein and Krippner,p. When people tell and retell their life stories with the help of a therapistthe stories evolve into increasingly meaningful and healing constructions.

As narrative therapists listen to the stories clients tell, they assist them by identifying alternative ways of understanding events in their lives. Thus, they help clients to assume authorship of their lives in order to rewrite their stories by breaking patterns and developing new solutions. Narrative therapy helps clients resolve their problems by Helping them become aware of how events in their lives have assumed significance Allowing them to distance themselves from impoverishing stories by giving new meaning to their past Helping them to see the problem of substance abuse as a separate, influential entity rather than an inseparable part of who they are note the discrepancy between this and the AA member's statement, "My name is Jane, and I am an alcoholic" Collaboratively identifying exceptions to self-defeating patterns Encouraging them to challenge destructive cultural influences they have internalized Challenging clients to rewrite their own lives according to alternative and preferred scripts Narrative therapy can be a powerful approach for engaging clients in describing their lives and providing them with opportunities to gain insight into their life stories and to change those "scripts" they find lacking.

Storytelling is a way of articulating a subjective, experiential truth, and it is important for the therapist and client to become aware of the significance of the story being told and its potential therapeutic value.

Narrative approaches to psychological healing have been used across various cultures for thousands of years Katz,but they have often been overlooked by mainstream mental health professionals. Contemporary approaches to narrative therapy recognize the importance of understanding how human experience becomes meaningful. A person's life is influenced by the narratives he constructs, which are in turn influenced by the narratives of those around him.

Thus, therapy is viewed as a collaborative attempt to increase clients' awareness of the ways in which events in their lives become significant. In effect, the therapist says, "Let's be curious about your story together. In substance abuse treatment, for example, a client might be asked, "How has substance abuse influenced your life? In an effort to be understood, clients sometimes tell a story as a way of educating the therapist to their culture or lifestyle.

Therefore, it is essential for the therapist to appreciate the unique influences positive and negative of the client's specific cultural experiences and identity.

Often these stories do not constitute sharing in its usual meaning. When listening to them, one may sense that these stories have been told repeatedly over the years. It is through this sense of storytelling--as oral history--that we reveal our values, expectations, hopes, and fears. For the therapist, a story provides insight into the clients' responses, their need to act on the responses, and their desire to be heard or understood.

A story can become a way for a client to become both participant and observer in order to find new solutions or break down barriers. Response to the case study The therapist may initially ask Sandra to describe some of the important transitional moments in her life.

These may include examples of loss of innocence occurring early in her life, her experience of school, circumstances and influences surrounding prostitution and drug use, the experience of being supported by her husband, and internal resources that enabled her to enter treatment and maintain sobriety.

client therapist relationship existential therapy and death

The therapist would ask questions about expectations she felt from family, society, and herself. She may be asked questions like, "How did addiction interfere with your attempts to be a good mother" or "How has fear contributed to your recent relapse and feelings of hopelessness?

It would be helpful to remind her that recent advances in medical treatments mean that AIDS may not be the death sentence it was once thought to be. Other important questions can help her to begin to create an alternative story: As Sandra talks about the people and events in her life, such as her childhood and her children, she can discover some of her feelings, as well as the personal meaning in her story.

She can experience a great deal of healing through the therapist's feedback and questions that uncover the desires and emotions beneath her story. A continued focus on identifying, practicing, or even imagining changes in her story can begin the process of developing new ways of living.

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Transpersonal Therapy Transpersonal psychology emerged as a "fourth force" in psychology in the late s and has strong roots in humanistic and existential psychologies, Jungian analysis, the East-West dialog, and ancient wisdom traditions.

Transpersonal therapy may be thought of as a bridge between psychological and spiritual practice.

client therapist relationship existential therapy and death

A transpersonal approach emphasizes development of the individual beyond, but including, the ego. It acknowledges the human spiritual quest and recognizes the human striving for unity, ultimate truth, and profound freedom. It cultivates intuitive ways of knowing that complement rational and sensory modes.

This approach also recognizes the potential for growth inherent in "peak" experiences and other shifts in consciousness. Although grounded in psychological theory, transpersonal practitioners also tend to incorporate perspectives from ancient wisdom traditions. The practice of transpersonal therapy is defined more by its orientation and scope rather than by a particular set of techniques or methods Boorstein, Wittine suggests five postulates for a transpersonal psychotherapy Wittine, Transpersonal psychotherapy is an approach to healing and growth that recognizes the centrality of the self in the therapeutic process.

Transpersonal psychotherapy values wholeness of being and self-realization on all levels of the spectrum of identity i. Transpersonal psychotherapy is a process of awakening from a limited personal identity to expanded universal knowledge of self. Transpersonal psychotherapy makes use of the healing restorative nature of subjective awareness and intuition in the process of awakening. In transpersonal psychotherapy, the therapeutic relationship is a vehicle for the process of awakening in both client and therapist.

Integrating insights and practices in everyday life is the goal of every therapy. Bringing the transpersonal dimension to the forefront may involve the following: Exploration of "inner voices" including those of a higher self that provides guidance for growth of the individual Rowan, Refinement of intuition or nonrational knowing Practice of creativity in "formal" art or informal personal relationships encounters Meditation Cultivation of mindfulness Use of dreams and imagery These techniques may be taught and supported explicitly in the therapy session.

At times, a therapist may directly cultivate shifts in consciousness e. This may provide clients with a skill they can practice on their own; initiating such activity represents a potential for brief intervention. Transpersonal therapy recognizes the need for basic psychological development to be integrated with spiritual growth Nelson, Without such integration there is danger of "spiritual bypassing," where issues of basic psychological functioning are avoided in the name of spiritual development.

In other words, the basic psychological work should be undertaken first. Substance abuse disorders may be seen broadly as an attempt to fill a spiritual void. They may also be understood as a means for the ego to defend itself against a natural drive for growth. If growth were to occur, the ego might find its dominance relinquished.

Addiction, like spirituality, also raises questions of surrender May, In a culture and a psychology that are dominated by issues of rational ego control, what is the role of constructive surrender regularly described in spiritual traditions? How does constructive surrender become destructive and distorted in substance dependency? In addition, substance abuse may be understood as a means for shifting out of a normal waking state of consciousness.

This may be an attempt to fulfill an innate drive Weil, for nonrational consciousness. Response to the case study As the existentialists remind us, there is nothing like death to rivet our attention. A glimpse of death--for example, seeing the aftermath of a serious car crash--reminds the witness of how valuable life is, bringing up other issues as well. Sandra is now confronted with death due to AIDS. This opportunity to face death and life squarely provides a chance to reconsider and reprioritize her life.

In fact, it could be argued that the best catalyst to brief therapy may be a death sentence precisely because it has the potential to wake up an individual. In many respects, helping the client wake from habitual, mechanical routines that are often based on ego protection and move toward an appreciation that the individual is not bound to or defined by a limited ego, is the goal of transpersonal therapy.


This can be seen as a transformation of identity. Many inspiring instances of people facing death, including death through AIDS, have shown that emergent spirituality can change the quality and direction of existence very quickly. For treatment, the basic sharing of these experiences with a group of others in a similar predicament often quickly moves the client beyond isolation and a sense of self-separateness to connect intimately with others who understand her situation. This community may not only bring comfort and support but also a deep sense of communion with humanity.

In this instance, breaking through the shell of isolation may enable Sandra to begin to make new connections with her family and with herself.

A sense of interconnection, a central postulate and experience in the wisdom traditions, may replace her perceived isolation. Sandra may use this opportunity of facing possible death to begin to encounter and let go of such feelings as guilt, shame, disappointment, and anger that have kept her life less satisfying than it could be.

Accessing the imaginal through art or dreams, for example, can provide a clear and symbolic expression of unresolved issues. The use of rituals or rites-of-passage inspired by the wisdom traditions can provide some catalyst for shifting her consciousness through forgiveness and release.

The therapist may engage in a wide variety of methods e. For Sandra, this experience may be seen as an opportunity for practicing love and forgiveness, moving out from behind rigid self-separateness, facing fears, and transforming her self-definition. Gestalt Therapy Gestalt theory holds that the analysis of parts can never provide an understanding of the whole.

In a therapeutic setting, this approach opposes the notion that human beings can be understood entirely through a rational, mechanistic, scientific process. The proponents of Gestalt therapy insist that the experiential world of a client can be understood only through that individual's direct experience and description. Gestalt therapists seek to help their clients gain awareness of themselves and the world. Discomfort arises from leaving elements and experiences of the psyche incomplete-- primarily past relationships and intrapsychic conflicts that are unresolved, which Perls calls "unfinished business" Perls, According to Gestalt theory The organism should be seen as a whole physical behavior is an important component, as is a client's mental and emotional life.

Being in the "here and now" i. How is more important than why i. The individual's inner experience is central. For Gestalt therapists the "power is in the present" Polster and Polster, This means that the "now" is the only place where awareness, responsibility, and change can occur.

Therefore, the process of therapy is to help the client make contact with the present moment. Rather than seeking detailed intellectual analysis, the Gestalt therapist looks to create a "safe emergency" in the therapeutic encounter.

Perls' invocation to "lose your mind and come to your senses" implies that a feeling-level, "here and now" experience is the optimal condition for therapeutic work. This may be accomplished in a fairly short amount of time by explicitly asking clients to pay attention e. How does your fear feel to you? The therapist may point out how the client could be avoiding the present moment through inauthentic "games" or ways of relating such as "talking about" feelings rather than experiencing them directly.

Clients may be asked to exaggerate certain expressions e. These may all serve the goal of helping clients move into the immediacy of their experience rather than remaining distant from it through intellectualization or substance abuse. The term contact in Gestalt refers to meeting oneself and what is other than oneself. Without appropriate contact and contact boundaries there is no real meeting of the world.