Existential Psychotherapy

Essentially, existentialism seeks to build an understanding of human beings out of the recognition that we are united by the parameters of our existence: We are born into a world that we must make sense of and in which we must take our place; our time here is finite and is lived by the choices we make through what are often little more than acts of faith: We can only live in the present; the future is uncertain; it is only by looking back that we understand. This philosophy was developed into approaches to psychotherapy by gifted clinicians such as Ludwig Binswanger, Medard Boss, Irvin Yalom and R. D. Laing, each of whom wrote beautifully and prolifically.

The approach is concerned with the question of identity – who am I? What are the values by which I wish to live? How can I discover what really matters to me in life? Such questions often come to the fore when we are faced with an emotional crisis such as a psychotic episode, periods of clinical depression or acute anxiety.

The existential perspective conceives of emotional distress as lying on a continuum of severity from day to day frustrations at one end of the spectrum through to acute psychosis at the extreme. Such a perspective makes for a psychological understanding of how people move up and down this continuum. Our research illustrates the advantages of such a transdiagnostic approach to an understanding of emotional distress.

For example, Dr. Marlowe and his colleagues have demonstrated that R. D. Laing’s concept of ontological insecurity (a universal feature of the human condition that may manifest in deep seated fears about the coherence and integrity of our identity or sense of self, thought to underpin the development of psychological problems) is related to both mild and severe psychological conditions. Persons with high levels of ontological insecurity may be prone to experiencing themselves in disturbing ways, particularly under interpersonal stress such as ambiguity, invalidation, criticism or over-involvement by others.

Such findings suggest that ontological insecurity may be an important focus in effective psychotherapy or open dialogue therapy. Ultimately, of course, the focus emerges out of the collaborative relationship between the therapist and the client. In the words of Irvin Yalom: The therapist must invent a new psychotherapy for every new patient.