CHAPTER 26 Positive Psychology and Psychotherapy: An Existential Approach ROGER DRETHERTON and RODERICK J. ORNER ‘axstmriat armonct to poychotherapy malnians hat human potential AS be developed even in confronting the Inteveribe dificalts of tae itis this sense that an existential perspective ome cores tive approach in therapeutic paytology--nat bermanefcanenooe ele aes Boe things in if, but eather by suggesting tet vig and pene ek, emerge from courageously confronting unavatlatle chaleges eek eda lation os of contol and meaningless. Any postpeche oe ioe ans thevich posites cfeistence thot eines to kali ete re sess fantsy, The abity of eaten pops end pcarsey lean profound insights ftom aversy suggests ee a ea does not deliver us from ous troubles bt speaks tous in iin PNB AN OUTLINE OF EXISTENTIAL THOUGHT This chapter provides abroad idea of what existetiaisn is by identifying some ofthe historical contributors to existential thinking, Westek te dean oot opin, tins by which thee philsophical considerations can seve the roeee ta shothetapy and highigh some of th dct anaes which ecko tek became applied to therapeutic practice nthe ventet erry Ween Pree bre case ty in which the speci methodslgy an theoretic ogee itentia psychotherapy are examined in their capac tocterspaiee epee tothe aetty of helping people tesapenteci A Bauer Deetnrrions Mary Warnock (1970) sums up the central concern of existential philosophy: 420 Positice Psychology and Psychotherapy: An Existential Approach 421 Broadly speaking, we ean say thatthe common interest which unites Existential philosophers isthe interest in human freedoms. for Existentialist the pecblem of fceedonn isin a sense a practical problem. They aim above all, to show people Hat ‘hey ae Fes, to-open ther eyes to something which has always been true but which for one reason or another may not always have been recognized, namely that men are free to choose, not only what o do on a specific occasion, but what to value and how to live. (pp. 1-2, original italics) She tells us first that the great theme that unites existential philosophers, and. particularly those thinking and writing in Continental Europe during the 1940s and 1950s, is human freedom. To put it more directly, atthe heart ofthe existential inguiry lies the human ability to decide, Second, the philosophers ofthe existential tradition devote themselves to a specific methodology in examining human free- «dom, in that they seek to examine human freedom from the inside out. They aim to describe what itis like to be a human being whois able to make choices and the im- plications ofthis capacity for choice on our interaction with the world. Third, and pethaps most importantly as far asthe therapeutic endeavor is concerned, Warnock (1970) draws our attention to the missionary zeal ofthe existentialist, They are not content with mere rational proof of their assertions, but rather aim to bring their readers into a living experience, a new way of seeing the world [xistenial, BEGINNINGS: PASCAL, KIERKEGAARD, AND NIETZSCHE tis difficult to pinpoint precisely the historical beginnings of modern existential Philosophy. Many of the themes of later existential thought can be detected in the ‘writings ofthe French philosopher Blaise Pascal (1623-1662), He described his dra- matie conversion to Christianity as a breaking away from the “god ofthe philoso- pphers" into a relational apprehension of the divine in which he could know God in experience, but not by dispassionate thought (Rogers, 1998). Pascal's insight into the failure of the academic philosophy of his time ta give an account of human ex- istence has been a recurrent motif in existential thinking to the present day. Soren Kierkegaard (1813-1855), the Danish intellectual whom many would consider to be one of the first existentialist thinkers (Gardiner, 1988), forged ‘many of his ideas in direct opposition to the philosophical views of his contem- poraries. Ina similar tone, but from a different perspective, Friedrich Nietesche (1844-1900), the German atheistic existentialist, lamented the philosophers of his day who dedicated their prodigious output to thinking about the world Without reference to the pains and passions of being htiman (Tanner, 1994). In his writing, Kierkegaard pillories the tendency to construct elegant systems of thought that do not correspond to everyday human experience He comparer it to a man who builds a magnificent mansion, yet lives in a shack next door (Kierkegaard, 1849/1989) or, in another passage, to a king who turns everything to gold and then dies of starvation (Kierkegaard, 1843/1985) Existential thinking, therefore, from the beginning, has always been inter- ‘ested in the lived experience of human beings, and it is this that enables it to in- form psychotherapy. It could be argued that the writings of Pascal, Kierkegaard, and Nietzsche, with their persuasive and varied attempts to convince theit read ers and with their astute insights into the human condition, offer a therapeutic prototype, a means of helping others to make sense of the world,422. Posinive PsycHovogy IN THE ConsutTiNG Room, ‘Teixee TwenmieTH-Cavrury Bxistenriatists ‘The three major twentieth-century existential philosophers we wish to focus on are Paul Tillich (1886-1965), Martin Heidegger (1889-1976), and Jean-Paul Sartre (1905-1980). Our reason for this emphasis isnot that they were the only existential thinkets of that period, but rather that they best illustrate the application of exis- tential thought to therapeutic practice and, during their lifetimes, made direct contributions to psychiatry and psychotherapy. Pai Tillich In 1933, the philosopher and theologian Pau! Tillich was dismissed rom teaching theology in German universities because of his opposition to the ‘Nazi regime, The same year, he accepted an invitation to jein the staff of Union ‘Theological Seminary in New York, where he had a profound effect on those who ‘came under his influence. ‘Most notably as far as existential psychotherapy is concerned, he supervised a PRD thesis by Rollo May, which was later published as The Meaning of Anxiety (May, 1950} in which the concept of nonpathological anxiety was espoused as the ac- companiment to human freedom, Arguing from previous existential thinkers, such as Kierkegaard, May asserted that existential arity resulted from the awareness ofthe full seape of human freedom and the enormous responsibility this places on us as human beings. This led to a responding volume by Tillich (1952), called The Courage to Be in which he elaborated the value of selfaffirmation for fulfilled human existence. Rollo May was instrumental in introducing the Anglophone world to any of the continental existential psychotherapists by arranging the translation, and editing of an anthology of papers entitled Existence (May, Angel, & Ellenberger, 1958). His concern not just with the individual, but with society as a whole, was the direct result of his interaction with Tillich and has become a hallmark of existential paychotherapy. Martin Heidegger Heidegger's seminal work, published in 1927, was Being and Time, ‘which was, according tothe existential psychotherapist Hans Cohn: to. great extent, the analysis of the Being of human beixgs which [Heidegger] Sees as radically different from the Being of other beings tis just Because human beings can be aware of their Belg and have always already some understanding of it, however vague, that they are also able to forget it. (Cohn, 2000, p. 2) For a firsttime reader, this quotation may be confusing, but the basic gist of CCohn’s précis is that we as human beings differ from rocks, trees, and flowers in ‘ur ability to be conscious of ourselves and to choose how we relate to ourselves. A rock cannot know that itis a tock, but a human being can not only be aware that it is a human being but also consider what it means to be so. Throughout Being and Time, therefore, Heidegger refers to human beings using the German word Dasein, literally meaning “being-there,” indicating that we as human beings understand ourselves, to some degree explicitly (Heidegger, 1927/1982). This understanding fof what it means to be human is of vital importance to psychotherapists because it is often the awareness that something is wrong or undesirable that initially moti- vvates a person to seek out psychotherapy or counseling; and from Heidegger's per- spective, this ability to be aware of ourselves is a uniquely human characteristic. Positive Psychology and Psychotherapy: An Existential Approach 423 Heidegger made an explicit impression on the development of existential psy chotherapy when, from 1959 to 1969, he conducted a series of seminars atthe home of Medard Boss, a Swiss prychoanalyst, in which he outlined his thinking for psychotherapists (Cohn, 2000, 2002). Boss went on to develop Deseinsanalysis (Boss, 1963), which can be detected as an influence in many of the more recent writings of existential psychotherapists (Cohn, 1997; van Deurzen-Smith, 1988; Yalom, 1980). Viktor Frankl, the Viennese psychiatrist and founder of logotherapy, also describes conversing with Heidegger (Frankl, 1969), and his therapeutic approach ‘ould be considered a synthesis of existential thought with religious belief Jean-Paul Sartre Jean-Paul Sartre's philosophical treatise, published in 1943, was en- titled Being and Nothingness asa direct acknowledgment of Heidegger's earlier man- script it contains possibly the most well-known passage in existential philosophy: What do we mean by saying that existence precedes essence? We mean that frst of all man exists, encounters himself, surges up inthe world—and defines himself af terwards. Iman asthe existentialist ses him is not definable itis because to begin ith he is nothing. He will not be anything nti later, and then he will be what he makes of himself (1943/1956, p. 28) Sartre identified radical freedom with being human, and his assertion that ex- istence precedes essence means that man is not determined, he has no essential sell ands, therefore free to make of himself what he will, With reference to ps) chotherapy,ithas been argued thatthe principle aim of any effective therapeutic approach isto enable individsals who come feeling confined of limited to regain Sm appreciation of thet freedom as human beings (May, 1981) In addition, many ofthe ideas developed in Being dd Natingness can be dis cerned in embryonic form in Sartre's earlier Sketch for Theory ofthe Emations (Gartre, 1939/1962). In this, he demonstrates his radical view of human freedom, by suggesting that emotions do not just happen tous but that we ehoose them as a way of altering our way of perceiving the work. He draws a distinction be- {ween reflected and untelected emotions: those of which we are aware and those that we express unknowingly. Sketch foro Theory of the Emations i, therefore, a prime source for Sarre’s views on the nature of psychology (Warnock, 1994) and has been influential among contemporary existential psychotherapists (es, Strasser, 199) ‘THE CASE OF MEREDITH Having set the scene by reviewing some of the main historical figures in existen- tial philosophy and the channels by which much of their thinking has tickled into the practice of existential psychotherapy, we now turn to a bref case study, ‘The case of Meredith identifies many of these existential themes in the context of therapy and demonstrates how an existential approach can be the catalyst for a positive outcome. ‘Meredith (names have been changed) was referred to the department of clinical psychology by her family doctor with a letter stating that she suffered from high blood pressure and panic attacks, Over the course of the frst three sessions, she save an account of how her anxiety began with the birth of her first and only child,424 Postrive PsvcHoLocy i THE CoNsuLTING ROOM Toby, six years before seeking therapy. The birth had been an intensely dificult ex perience, with numerous complications both for her and the infant requiring @ pro- Tonged stay in the hospital, ducing which she was not always informed precisely ‘what was going on. She was, therefore, let feeling helpless and bewildered as vari- ‘ous intravenous medications for high blood pressure were administered, and on more than one occasion, the child was whisked away from her for tests. After sev- eral weeks in the hospital, she and Toby were discharged, but following discharge, she developed frequent spells of dizziness and was returned to the hospital for ob- servation lasting a further week, However, the way she reported her story seemed unusual, Throughout her account of the traumatic events surrounding the birth of Toby, she showed very little emotion, she did not cry or become angry, and almost every time she reached a natural pause in her narration of the episode, she broke out into an incongruous smile: a smile that was, however, marred by a spasin in her lips, ‘which seemed to signal that immense energy was being exerted in an attempt to conceal powerful emotions. “Meredith was seen for long-term individual psychotherapy, which focused not con direct techniques for alleviating her anxious symptomatology, but on elaborat- ing and clarifying the way in which she related to the world generally. Many sig- nificant dilemmas were confronted using this approach, These included her need to conceal her emotions to feel safe in the presence of ocher people, the anxiety elicited by situations in which she was required to make decisions, her frequent inability to know what she wanted, and the fear of being left alone following the death of her mother. As Meredith explored and clarified her attitudes to these areas of het life, she began to gain the freedom to choose her response to them. As her sense of freedom increased, her courage in confronting the problems pre- sented by life increased also. What began as a referral for panic became a com- plete reexamination of the values by which she lived. Discussing her difficulty in relating to some ofthe irreversible givens of human existence allowed her to take the opportunity to make changes in her relationships with people, her occupa- tional direction, and her understanding of the world. POSITIVE ASPECTS OF THE EXISTENTIAL APPROACH As shown with Meredith, there are numerous ways in which an existential per- spective can be used to shed positive light on the human condition ApvexsaRiat. Grown: ‘The existential approach is positive in the way it responds to traumatic events. It is in this respect that work on posttraumatic growth (P1G; Tedeschi, Park, & Cal hhoun, 1998) has often used existential theory as a starting point for its empirical study (Bretherton é Orner, 2001; Linley, 2003). By facing the questions posed by suffering, existential psychotherapy lends itself to the understanding of people, like Meredith in the case study, who are confronting the extreme challenges of life, Other examples may include HIV (Milton, 1997) or terminal cancer (Jacob- sen, Joergensen, & oergensen, 2000). (See Linley & Joseph, 2004; and Tedeschi é Calhoun, Chapter 25, this volume, for reviews of adversarial growth.) The exis tential approach can, therefore, be considered a positive approach in therapeutic mn + Se mamane Positive Psychology and Psychotherapy: An Existential Approach 425 Peyehology in its recognition of human potenti even gven the prospect of ie versible difficulty Tur PriENoMENOLOGICAL METHOD In terms of methodology, the existential approach parallels pasiive psychology in tot being principally concerned with global models of delict and disorder but Tather with what is presented by the patient In meeting the patient, pacitioners existential psychotherapy use wha is known asthe Phenomenological method 4 way of attending to the world originally proposed bythe philosopher Edmund Hisser (1889-1938). Husserl suggested that all knowledge consists of that (hich he called the nema) and a how hich he called the nos). In other words, Keown something isnot ast about the content (aoema) of what fs known, ut alno the process (noes) trough and by which if known, Adams (2001) ks tates this with reference to the consciousness of pnt of mill in which te ik iets the noema tha, the content of the experience, andthe bottle is the noe Si that ite form or process in which the experience appears Spinel (1989) ap- plies this distinction toa phenomenon more epplcable to the therapeutic situation of Meredith, namely Iisening to someone peak, in which what said tthe con- ten, bt the varios coitive and affective bases ofthe istener form the iter petation ofthe experience ‘Given this bipolar understanding of knowledge, Husserl devised three rules to se tas far a8 possible, “things in themselves.” These three rules area common feature of paychotherapy conducted from an existential perspective (eg, Sasser {Stassr, 197) and form the phenomenological method. Rule 1; Bracketing This rule suggests that, as much as possible, the therapist should put to one side prejudices, assumptions, and stereotypes. The therapist, therefore, notes but does not settle on certain conclusions concerning the patient, including strong emotional responses or desires and the interpretation of these that the therapist might otherwise be partial to take as decisive. The desire for therapeutic progress itself may even be bracketed at times. Meredith, for example, ‘was referred with specific complaints concerning panic and high blood pressure, bbut bracketing these presenting symptoms allowed the recognition and examina” tion of other significant aspects of her way of being. Rule 2: Description The second rule proposes that that which is presented (the phe- nomena) is described, rather than inferring an underlying essence or cause. Stick- ing as closely as possible to that which presents itself is, according to existential thinking, the means by which truth is found. Ernesto Spinelli explains". "teuth’ for Heidegger, does not mean what we have grown to suppose. It is not, ‘the cor: ‘ectness ofan assertion.’ Rather, Heidegger points out that the original meaning of truth was derived from the Greek term letheie—meaning the unconceatedness, the transparent presence, of beings” (Spinelli, 2000, p. 14). And in the therapeutic en= counter, as with Meredith, the existential psychotherapist adheres tightly to what is presented by the patient to better engage with his or her way of being, Rule 4: Equalization The rule of equalization suggests that every phenomenon is possibly as any other, No particular fact or perception should necessarily be given426 Posmrve PsyCHOLOGY IN THE CONSULTING ROOM precedence over another. Equalizing in this way leaves the therapist open to dis- Cover alternative clusters of meaning inthe patient's presentation, rather than set- ting with the usta suspect. The phenomenological method is positive in that, by stepping back from his or her own prejudices and stereotypes, the existential therapist can identify patients’ possibilities as well as their limitations and their strengths as well as theit weak: hhesses (van Deurzen-Smith, 1988), rather than being attuned principally to the signs and symptoms of psychological disorder. The existentialists suggest that by identifying the constellations of meaning by which we relzte to the world, we al- ford ourselves the opportunity of decision—to decide to alter our way of being 'A further positive correlate of using the phenomenological method in psy chotherapy is that the existential approach has been instrumental in facilitating the integration of many of the modern psychotherapy traditions, Largely because ofits use of the phenomenological method rather than a theory-driven approach to the therapy situation, it has been able to transcend the lines of demarcation that have habitually divided the different therapeutic orlantations (Corey, 1996; see also Hubble & Miller, Chapter 21, this volume). Possiitrry AND Nacesstry [Necessity refers to the givens of life, the things that are unavotdable, such as death and the existence of other human beings. With reference to the necessities of life, Heidegger (1962) described existence as having the quality of “thrownness.” That is, we do not choose many of the givens of life, for example, our parents and the ‘way the world is; nor do we choose to be born, but rather we are thrown into life and, therefore, have to do with itas best we can. In our case study, Meredith was being confronted with many of the unavoidable givens of lie, such as her mother’s death, her difficulty in relating to others (especially her baby), and the need in life to make decisions. Itis the unashamed manner with which these nonnegotiable givens are con- fronted that has, at times, led to the attribution of a rather morbid reputation to existential thinking. In his paper Logotherapy and the Challoge of Sufering, Viktor Frankl (1967) responds to the accusation of morbidity as follows: It has become fashionable to blame existential philosophy fer overemphasising the ‘ragie aspects of human existence. Logotheraps, whieh is zonsidered one of the ‘schools of existential psychiatry, has become the target of the same reproaches. Lo- igothesopy its te, centers on issues suchas dying and su‘fering, This, however, must not be interpreted as evidence ofa pessimistic slant and bias. What we rather have (o deal with isan optimistic position; namely, the conviction that even dying and suffering are potentially meaningful. (p. 87) It is the freedom to choose a response to the givens o' life that, according to Frankl, makes an existential perspective positive. Even from a less optimistic perspective, Emmy van Deurzen-Smith (1988) notes the aropensity for existen- tial philosophers to draw strength from confrontation wilh necessity ‘The European existential philosophers .. never intended to create the llusion of being able to solve the human dilemma. There is nothing in their writing that Positive Psychology and Psychotherapy: An Existential Approack 427 suggests the prospect of a paradise on earth, inhabited by self-actualised individa- als Thei aim has been to gain insight into the unavoidable paradoxes that life pres font and to gain strength from that knowledge. (p In contrast to necessity (what is given) stands possibility (what we can make of it) Possibility refers to the openness of existence—that humans are free to choose the way they relate to life, how they define themselves, and the way they ander stand the world. The existential dual concern with both possibility and limitation, therefore, provides a framework within which the practice of positive psychology «an recognize human potential without succumbing to an unrealistic optimist, Optimism represents the expectation of a favorable outcome whereas hope, being more flexible, recognizes situations in which a favorable outcome is less likely and, therefore, maintains an openness to the difficulty of the experience and a flexibility of response to its challenges (Calhoun & Tedeschi, 1998). The ex- ‘stential approach is, therefore, to adjust Frankl’ terminology, neither pessimistic nor optimistic, but it can be profoundly hopeful by finding meaning even in the face ofthe unchangeable givens of life such as pain, guilt, and death, VALUES AND MEANING Seligman (2003) referred to positive psychology as being concerned with the pleas: ant life the good life, and the meaningful life. He described the meaningful life as, “the use of your strengths and virtues inthe service of something muck larger than you are” (p. 127). The existential approach is also concerned with living meaning- fully by engaging with life (Yalom, 1980) and acting, consistently with our values (Frankl, 1986), In our case study, Meredith ised her period of isis to reexamine her life and thereby increase her sense of meaning by acting more in keeping with the things she Valued, Our values are those things for which we ate prepared to give up other things (van Deurzen-Smith, 1988). One way of understanding the di ference between rales and values is that whereas a rule is to be obeyed, values are realized or fulfilled. That is, we bring them into reality when we act on them. Therefore, the way we relate fo ourselves, the world, and others both discloses and is dictated by the values we hold. Viktor Frank! (1986) places values at the center of logotherapy. He categorizes ‘human values into three distinct clusters: creative, aesthetic, and attitudinal. Cre ative values are realized by shat we produce or the ways we transform our environ- ‘ments. Aesthetic values involve the appreciation of things that are already given, Atttudinal values become most relevant in situations that cannot be changed or ap- preciated, but to which we can still adapt ourselves through a change in attitude or in the position we adopt towvard them, Frankl suggests that meaning in life is al- tained by the realization of values and refers to hi ability to find meaning even in the Nazi concentration camp by quoting Nietzsche's maxim, “He who has a why to live for can endure almost any how” (Frankl, 1955). However, whereas Frankl and others suggest that the meaning of life is out there to be found, more atheistic thinkers suggest that life in itself is meaningless anc that the best we can do, therefore, is create meaning for ourselves, particularly through engagement with life (eg. Yalom, 1980). But whichever isthe case, it may be that the activity of discovering or of making meaning may involve the same cre ative process. For example, when reading a novel, it could be argued that finding,428. Positive PsycHotocy iN THE ConsutTING Room the author's meaning ean be achieved only by creatively constructing it from the text, but, having cone this, it may be that the reader has not created the meaning but only identified what the author had intended to communicate. Bither way, the positive aspect is that fulfillment in life can be gained from realizing values; no matter what situation we are placed in, we can still realiz or adopt attitudinal val- tues and, from this rationale, as Frankl (1958) says, life remains meaningful to the last gasp. Concern ror Society A final positive aspect of existential psychotherapy is its concern not just with the individual but with the person in society. Rollo May (-973), having been influ- enced by the profound cultural analysis of Paul Tillich, came to the view that Western society is at a point of transition and change. He argued that while this produces an atmosphere of anxiety and uncertainty it ako prompts vast creativity fn the part of those who feel the tension of such a transtion, One ofthe implica- tions is that therapy should not aim to conform its beneficiaries to society if soci- oly itself is unstable, but rather see its task as enabling individuals to transcend the confusing cultural challenges in which they find themselves. It was from this perspective that May could write cogently about the place of sexual behavior in so- ciety and the difficulties this poses to the individual (May, 1969). More recently, Emmy van Deurzen (1998) has made a case in the strongest terms that existential therapy could be atthe forefront of a changing society: Itis an outrageous state of affairs that there are so many casualties of post-modern society, incading the nearly a quarter of a million peope who try to ill thems selves every year in this country alone. We need to take extemely seriously the role of counseling and psychotherapy in remedying the situation, The therapeutic pro- fession needs to claim its proper place in the world of professions and will come Into its own only if tis willing to take up its role of secular and postscientific reli lon. (van Deurzen, 1988, p. 126) She traces the etymology of the word religion tothe Latia verb religne, meaning to bind together. The assertion that psychotherapy should occupy previously religious territory may be debatable, but the ultimately positive aspiration of the existential psychotherapy movement is well stated. In a society suffering fragmentation and lacking in direction, the existential approach aims to act asa force for clarity and co- hhesion, to enable individuals and communities to thrive CONCLUSION It is therefore our assertion that a therapeutic approach derived from existential thinking can be profoundly positive and hopeful, in spite of the morbid and pes- simistic reputation occasionally associated with the existential approach, The positive aspects outlined are not intended to be an exhaustive list. It is rather, an indication of the benefits found in an approach that does not shy away from ac- knowledging the difficulties of lif, yet recognises the coarage of the human spirit that directly confronts these givens of existence. 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