Tuesday, February 28, 2012

Why Existential Therapy? (Reflections on Praxis)

I have an eclectic style, but one school of therapy that informs much of how I practice is existential therapy. I wanted to write a bit about how and why I came to this kind of practice.

First, I think it's important to say exactly what I mean when I say "existential therapy." Basically, the brief distinction is this: Existential psychotherapy addresses concerns that arise out of existence itself. Some of the most common existential concerns are death, meaning in life, responsibility, freedom and choice.

That may sound a bit opaque and irrelevant to the actual lives of people, but ironically it was because of the immediate relevance of these issues that I began to practice existential therapy.

Since the beginning of my career as a therapist I have worked with individuals who are HIV positive. In particular, I had developed a niche within that field of those who are recently diagnosed with HIV.

For years, I sat with hundreds of clients who had just found out that they were infected with HIV. And while each individual is unique, I did notice some common themes. People would be frightened that they were going to die. They had guilt and shame around contracting the virus. Many of them wondered, "How could this happen?" Some of them questioned their faith in a higher power--"Why did God let this happen to me?" And almost every single client wrestled with concerns about how HIV would effect relationships with family, friends and romantic partners. I noticed all of these themes, and found ways to address them in session.

One spring day I was attending a conference on dialectical behavioral therapy (which is a wonderful practice that I employ as well), and I made the 'healthy' decision to scarf down some McDonald's in my car. While eating my lunch and I picked up a book I had just purchased--Irvin Yalom's Love's Executioner--and began to read. Yalom wrote that there are four main topics of concern in existential therapy: Death, responsibility, meaning in life, and isolation. I think I choked on my french fries at that point--he had just identified the four major reasons that my clients were seeking therapy!

As I read more about existential therapy, I began to suspect that there was an immediate applicability to my practice. This was not abstract--it was something that my clients related to as daily struggles.

I remember one critique that I heard early on was basically this: "Your clients are mostly poorly educated individuals. They are not going to understand or relate to these 'existential' ideas." I might have even believed this at one point, but it is not true.

For example, one of my clients--a woman who had dropped out of school at age 13 and had spent years as a sex worker to support her heroin addiction--quoted Nietzsche at me: "What doesn't kill me makes me stronger," she said. I took the ball and ran with it: "You know, that's from the work of a philosopher named Frederich Nietzsche. He believed that our struggles are the things that define us; that in the moment of difficulties, we have a chance to grow and improve." We then had a brief dialogue about how that applied to her life. Later, when she was struggling with a particular issue that she believed she had previously resolved, she said: "It's so frustrating that I have to deal with this again!" I took that and went back to dear old Frederich. "Remember how we talked about Nietzsche once? About how 'that which doesn't kill us makes us stronger?' Well, he also said, 'When we are tired, we are attacked by ideas we conquered long ago.' Does that make sense for you now?" And in fact, this client did relate to what Nietzsche had written, and her therapy was richer and more successful overall due to some of the existential material that we worked with.

I began to realize that the applications went beyond my work with HIV+ people, and I began to practice existential therapy with a broad range of clients. I have come to see how the existential concerns are frequently present in human distress, and are frequently just under the surface of the concerns that clients come to therapy to resolve. And ultimately, that's why I practice existential psychotherapy: Because it is relevant.

1 comment:

  1. I love this. How anyone could think that poor or uneducated people can't understand these concepts is beyond me. These people live with these concepts every day! It is the privileged class that can convince themselves that these issues are irrelevant or don't apply to them directly. It's an interesting psychosis.