- Orah Krug
Existential, Humanistic, and Experiential Therapies in Historical Perspective
Updated: Aug 11, 2019
Orah T. Krug, PhD
Existential therapy is not a singular therapy but rather a rich aggregate of many therapeutic practices that organize around a shared concern: the lived experiences of human beings. Cooper (2003) describes four main existential approaches to therapy as they chronologically originated: (a) the Daseinanalytic approach from Europe which encourages clients to experience their ‘Being-in-the-world,’ (b) Victor Frankl’s Logotherapy which helps clients discover meaning in their lives, (c) the existential-humanistic approach from the United States, which encourages clients to explore their personal and interpersonal lived experiences and to also focus on the existential givens impacting their lives, and (d) R.D. Laing’s approach developed by the British school of existential analysis which is a non-pathologizing, descriptive model of therapy. This chapter focuses primarily on contemporary existential-humanistic therapy (or E-H therapy), the prevailing American model of existential therapy, as well as other experiential approaches such as gestalt and emotion-focused therapy.
The first section of the chapter provides a historical context for E-H therapy, highlighting those existential philosophers whose perspectives have contributed to the creation of E-H therapeutic theory. The second section highlights those psychological pioneers of E-H therapy who have contributed to its theoretical development. Gestalt therapy and emotion-focused therapy are discussed as variations on the existential-humanistic approach and then illustrated with a few different examples. An explication of how change occurs based on the common core principles of all experiential therapies follows, with a primary focus on E-H therapeutic theory of human functioning and human experience. The last two sections review research on the efficacy of E-H and other experiential therapies and their sensitivity to the particular issues of diverse populations.
Keywords: Existential-Humanistic Therapy, Experiential Therapies, Phenomenological Method, Experiential Reflection, Meaning.
Historical Background of Existential, Humanistic, and Experiential Therapies
“It takes outward courage to die; but inward courage to live.” Lao Tzu
How shall we live? How are we living in this moment? What really matters to us? How can we pursue what really matters? Existential-humanistic therapy is an experiential therapy, which assumes that if life-limiting blocks are dissolved, more joy, satisfaction, meaning, and purpose will emerge. As Lao Tzu suggests, awareness of our existence requires an inward courage to face life—not avoid it. Existential therapy aims to help clients, through experiential reflection, understand how they miss a fuller life by constricting their living. Consciousness, personal freedom, and responsibility take root in this reflective process, supporting the incorporation of previously abandoned ways of being. A re-claiming of one’s life is the ultimate goal, but this cannot be achieved until one knows what has been disowned. This type of change is not primarily concerned with symptom removal, although symptom removal often occurs. Rather, this type of change is in the core of one’s being; it is “whole-bodied” and transformative.
What is meant by existential-humanistic therapy? Existentialism is concerned with the living experience of becoming and originates from the Latin root “ex-sistere,” which literally means “to stand forth” or “to become.” Humanism comes from the Greek tradition of “knowing thyself” (Schneider & Krug, 2010). Thus, “existential-humanism,” although a seemingly static name, actually references the dynamic process of becoming and knowing oneself.
Existential-humanistic therapy came into being in the early 1960’s in the United States with the publication of Rollo May’s edited book Existence (1958). Existence (1958) arrived at a time when humanistic psychology, founded by Abraham Maslow and Carl Rogers was gaining popularity by challenging the more prevalent therapeutic approaches of behaviorism and psychoanalysis. The book’s themes expanded the focus of American humanistic psychology by introducing “gloomier” existential concerns, such as death, limited freedom, and uncertainty into the “sunnier” humanistic landscape, flush with possibilities and potentialities. Perhaps, even more significant was the authors’ challenge to an accepted “way of knowing” when they introduced a radical epistemology for understanding human beings, drawn from the European existential philosophers. This phenomenological epistemology valued knowing the person directly as opposed to projecting onto the person abstract models of human behavior, be they behavioral or psychoanalytic.
Thus, existential-humanistic therapy developed as an amalgam of American and European perspectives, uniting existential accents on limited freedom with humanistic accents on potentiality. Added to this distinctly American mix is a radical method of understanding human beings, not through a lens of abstract theories but through a direct encounter with the person’s experiential world. Consequently E-H therapy emphasizes: (a) an experiential way of knowing oneself and others (b) freedom to become within one’s given limitations (c) experiential reflection on one’s personal meanings about becoming and (d) responsibility to respond to what one becomes.
Existential-humanistic therapy has its origins in the existential and humanistic philosophies that trace back to Greek, Renaissance, Romantic, and even Asiatic sources. However, the formalization of existential philosophy came about in the mid-19th century with Soren Kierkegaard (1813-1855). One day while sipping coffee and musing on his lackluster life, he had a flash of insight. Unlike his successful friends, who made life progressively easier by developing the railways and steamboats, he decided, given his “limited capacities, to undertake to make something harder” (as cited in Yalom, 1980, p.15). Kierkegaard reasoned that ease could be dangerous in its excessiveness—better to look for difficulties. He didn’t have far to look. As he considered his own existence he encountered “his own dread, his choices, his possibilities and limitations.” Kierkegaard devoted his life to exploring his existential situation and in 1844 published Concept of Dread. Kierkegaard worried that science was becoming a new god. He maintained that objective and rational perspectives were insufficient to explain how and why we do what we do. He advocated passion and inwardness. He was not a subjectivist, however. He believed that both objectivism, with its emphasis on the measurable, and subjectivism, with its emphasis on internal experiencing, were needed to fully inform our understanding of ourselves.
Kierkegaard believed that human beings exist on many levels, some contradictory and many unknowable; nevertheless, all levels must be included so we may fully grasp what it means to be human—human in the abstract, but more importantly, human in the particular, whether it be ourselves or another. He also suggested that human beings have a capacity to limit and to extend themselves, and that problems ensue when one capacity is emphasized to the exclusion of the other. Thus the emotionless objectivist can be understood as too limited or contracted, while the passionate subjectivist may be understood as too extended or expanded. A healthy individual moves between both polarities (see Schneider & May, 1995, for an expanded explanation). Kierkegaard’s perspectives on human functioning with regard to inclusiveness and complementary polarities form the foundation of E-H therapeutic theory and have influenced subsequent experiential therapies such as gestalt and emotion-focused therapies.
Drawing from the perspectives of the pre-Socratic philosopher, Heraclitus, the iconoclastic Friedrich Nietzsche (1844-1900) challenged the dominant European view that valued rationality and order over spontaneity and abandon. In Twilight of the Idols (1889) Nietzsche predicted the demise of European culture if what he called “Apollonian consciousness” (reason and logical thinking) eventually excluded “Dionysian awareness” (emotions and instincts). Similar to Kierkegaard, Nietzsche understood how cultural problems would ensue if people embraced only one way of being, to the subordination or exclusion of its complementary opposite. Nietzsche believed our lives would be more balanced, natural, and dynamic if we acknowledged not only our need for order and discipline but also for spontaneity and abandon.
With science and technology ascending to greater heights in the early part of the 20th century, coupled with the shock of World War I, the writings of Kierkegaard and Nietzsche found new supporters in Edmund Husserl (1859-1938), Martin Heidegger (1884-1976), and Jean Paul Sartre (1905-1980). Each objected to the increasing objectivism of the day to the exclusion of subjectivism and responded by formulating in different ways the structure of subjective experiencing.
Husserl introduced a radically new method to study human functioning that he called phenomenology, outlined in his book, Ideas: General Introduction to Pure Phenomenology (1913). Husserl contended that the imposition of scientific attitudes on the study of humans reduced the human experience. It only provided a surface understanding of deeply complicated human behaviors such as smiling. An understanding of smiling could not be arrived at by using a simple stimulus-response paradigm, as in the “smile muscles” contract in response to a certain stimulus. Husserl posited the person on whose face the smile has manifested must be studied—the smile originates from the person’s subjective feelings and/or thoughts—and not from the “smile muscles” contracting. Husserl’s method valued experiential immediacy of the subject, arrived at because the researcher has bracketed (epoché) his or her presuppositions about the phenomenon. This phenomenological mode of knowing blends aspects of art and science and has had a profound influence on existential-humanistic therapeutic theory and other experiential therapies.
Heidegger was primarily concerned with exploring what it means “to be” or to exist. What if we could transcend our role-dominated lives and exist in our fullness, he wondered? These musings became Heidegger’s project, combining a phenomenological inquiry of himself with Western philosophy that culminated in the publication of Being and Time in 1962. In this landmark work, Heidegger developed a philosophy of being. Heidegger contrasted “being-in-the-world” with “being-in-the-midst of the world.” The former refers to an authentic self who is separate, centered (i.e., a self in contact with one’s subjective experience), and related to the world. The latter refers to an inauthentic self, an un-centered self—a self that lives and does for others. The authentic self is present and responsive to self and the world; the inauthentic self is unresponsive to self and responds from habit and custom. Moreover, Heidegger’s unusual phrasing “being-in-the-world” was his attempt to illustrate that no person or “dasein” could be separated from the world he or she lived in, because from the perspective of experience “dasein” is always contextualized, i.e., a person is continually being influenced by the external world, and continually understanding this world from the context of his or her personal world. Finally, “dasein” refers to the fact that a person is a constituted object, and at the same time people (i.e., persons) constitute or create their world.
Sartre (1905-1980) was deeply affected by his experiences as a soldier during World War I and by Heidegger’s views on human beings. In Being and Nothingness (1956) Sartre pointed out an increasingly worrisome practice: even though peoples’ experiences of being were radically different than those of things, people persistently confused being with their roles—be it a truck driver, a nurse, or a factory worker. Consequently people treat themselves and others as things or objects. To live authentically, said Sartre, one must constantly free oneself from this frozen “thing” identity and declare oneself a “no-thing.” Sartre’s extreme view of “no-thingness” meant a constant negating of one’s past identities and the creation of new ones, to ward off the potential objectifying of oneself.
Maurice Merleau-Ponty (1908-1961) brought a more balanced perspective to existential philosophy and phenomenology. In The Phenomenology of Perception (1962), Merleau-Ponty updated Husserl’s quest to find all knowledge in subjectivity, with a more balanced goal of “revealing the indeterminate intersubjectivity of viewpoints—always open to revision” (Schneider & May, 1995, p. 63). While he argues against essences, he challenged Sartre’s view of nonessentialism, suggesting that Sartre diminished the potent contextual influences such as culture, history, and the subconscious on human functioning. Merleau-Ponty re-claimed the balanced perspectives of Kierkegaard and Nietzsche, challenging the notion that human experience was one-sided.
Martin Buber (1878-1965) is best known for his work I and Thou (1958) in which he describes two basic levels of interaction: the “I-it” and the “I-thou.” If one is treating a person as a thing, or an object to be manipulated, then one is interacting on the “I-it” level. Most interactions take place, as Kierkegaard pointed out, on this level. But if one assumes that the human being is complex and unique, then one will cultivate an attitude of surprise and interact on the “I-thou” level. Buber’s emphasis on the “I-thou” level of connecting known as “the between” space became a foundational principle of E-H therapeutic theory.
While earning his graduate degree at Columbia University, Rollo May met professor Paul Tillich (1886-1965), a brilliant philosopher and theologian, exiled from Nazi Germany in the early1930’s. Tillich’s philosophy of human beings exerted significant influence on May’s thinking. Tillich mentored May and eventually they became good friends and colleagues. Tillich’s best known work entitled The Courage to Be (1952) explores the challenges of being human, a reflection on the courage we need to face life full on, without contracting to avoid our finite freedom, just one of the realities of existence. Tillich maintained that the goal of therapy was to help people accept the unacceptable.
Major Theoretical Developments and Variations
E-H therapeutic theory developed when cries of protest arose from various corners of the European therapeutic community—objecting to the reigning behavioral and psychoanalytic models of human beings. Rollo May, influenced by Alfred Adler in Europe and Paul Tillich in the United States, was the initial shaper of E-H therapeutic theory. Others followed with their own variations on his theme. This section reviews these theorists and their theories.
The phenomenological method—a way to enter the person’s experiential world.
Existential psychology developed in Europe as a rebellious response to behaviorism and psychoanalysis, the two major psychological movements of the 20th century. Ludwig Binswanger and Medard Boss, among others in the existential-analytic movement in Europe, contended that neither behaviorism, spearheaded by Watson and Skinner, nor psychoanalysis, developed by Freud, had a theory of human beings that truly explained a person as he or she really was. They worried that the theories postulated by behaviorism and psychoanalysis obfuscated the real, living persons whose worlds are unique and concrete. To help clients, the therapist must truly know them, which means the therapist must find ways to enter into and exist in their clients’ experiential worlds—not merely project onto them some theoretical notions of human functioning. This radical, experientially oriented method of understanding the lived experience of human beings challenges the assumption that humans can be adequately understood in terms of some theory, whether it be mechanistic, biological, or psychological. Existential-humanistic therapy as well as its variations (e.g,. gestalt and emotion-focused therapies) was founded on this new phenomenological method of understanding human beings and the world they live in.
By the late 1960’s, existential-humanistic therapy became a recognized therapeutic orientation. Rollo May’s edited book Existence (1958) and James Bugental’s The Search for Authenticity (1965) allowed E-H therapy a place at the table alongside the two major psychotherapeutic orientations: behaviorism and psychoanalysis. But E-H therapy differed from these orientations in that it was not offering the field of psychology a new therapeutic system. Rather, it offered a new understanding of the structure of human existence, and a new method to enter into the personal worlds of human beings that could serve as a foundation “on which all specific therapeutic systems could be based” (Schneider & May, 1995, p. 85).
Existential-humanistic therapy met with a good deal of resistance when May introduced the approach to the United States, even though it was widely accepted in Europe. To some extent, the existential-humanistic approach still suffers from a lack of support from the academic community in part because the academic community overvalues quantitative empirical research as a way to validate knowledge. The basic principles of existential-humanistic therapy do not lend themselves easily to quantitative empirical study. And yet, the phenomenological method is intuitively understandable to all therapists. To understand the inner world of their clients, therapists must encounter their clients without standardized instruments or preconceived notions. As Yalom (1980) suggests, “so far as possible one must ‘bracket’ one’s own world perspective and enter the experiential world of the other” (p. 25). There is nothing esoteric or highbrow about this method. All good therapists engage in this way of being with the client—it simply means being present, accepting, empathic, and attuned to the meanings clients have made about themselves and their experiences.
Human beings make meaning from experiences in the objective world to create their personal worlds.
In Existence, (1958, p. 11), Rollo May defined existentialism as the “endeavor to understand man by cutting below the cleavage between subject and object which has bedeviled Western thought and science since shortly after the Renaissance.” What did May mean by “cutting below the cleavage between subject and object”? Existential theory challenges the Cartesian notion of a world made up of objects, and subjects who perceive those objects. Individuals, according to existential theory, do more than simply perceive and experience reality; they in fact participate in constituting their realities by making meanings of their perceptions and experiences as they relate to the objective world. Thus they are not simply aware, they are conscious—aware of being the ones who makes meanings from experiences. This is a core concept across all existential, humanistic and experiential therapies. Within this definition of existence lies: a) agency: we are centered in our being and create meanings about our world and our selves, b) freedom: we choose how we define our perceptions and experiences, and c) responsibility: we are responsible for the choices we make, and d) change: we have agency to create new meanings about our world and our selves.
The process of shaping consciousness results in a sense of self.
E-H therapy assumes that the process of constituting or shaping one’s reality results in the creation of self and world constructs (i.e., how we understand our nature and our experiential world). Rollo May (1975) called this shaping of reality or consciousness passion for form that results in, as he called it, an “I am” experience. May’s concept, while clearly informed by the existential philosophers was also informed by process philosophy’s great thinker Alfred N. Whitehead. Whitehead’s understanding of human beings as part of nature and therefore a matter of process was helpful to May’s formulations about human beings. Whitehead’s philosophy is part of a philosophical tradition going back to Heraclitus that focuses on process. Reality is not an assortment of material things, which is the Aristotelian notion, but one of process. Nature is a process not a thing. A river is not a thing but a continuing flow that only exists if it has two complementary parts: water and a riverbed. Therefore, a human being, being a part of nature, is also not a thing but a continuing flow or process that exists with two complementary parts: constancy and change. In every moment (or “actual occasion”), the past (constancy) flows into the present (change) and orients the organism (us) to the future. In other words, our past is alive in the present moment (we have embodied memory) influencing how we are aware of the present moment and how we will project ourselves into the future (we have embodied anticipation). We are never simply aware of bare existence or thought. Awareness is our subjective reaction to our present moment derived from our past experiences and the external world. As May posits: “I can shape feelings, sensibilities, enjoyments, and hopes into a pattern that makes me aware of myself as a man or woman. But I cannot shape them into a pattern as a purely subjective act. I can do it only as I am related to the immediate objective world in which I live” (May, 1975, p. 135). Whitehead’s perspective provides May (and existential psychotherapy) with a sound philosophical position from which to explain how a sense of identity is created—identity is created not as a purely subjective act but only as a dialectical process with the objective world.
Human beings are both free and determined.
A corollary to the dialectical process of identity formation is the assumption that human beings are both free and determined: a paradoxical premise with roots tracing back to the Greek philosopher Heraclitus. Humans are free because they make meanings from their experiences, and they are determined because these meanings are limited by natural and self-imposed limitations. In other words, our subjective freedom—that is, our freedom to form attitudes, meanings and emotions about an experience—is limited by the objective facts of the experience and our personal, cultural and historical context. We have the capacity to be aware of ourselves objectively, for example: “I have a cold with the symptom of a stuffy nose;” conversely we can experience ourselves subjectively: “My head feels like its full of cotton and I feel rotten.” Objective awareness pertains to measurable facts; subjective awareness pertains to feelings and experiences. They are not in opposition; rather they form a paradoxical unity of human experience. Human beings, unlike most organisms, have the remarkable capacity to make meaning and create an experiential world that is unique and personal, a world that includes both subjective and objective awareness.
May (1980) considers this paradox of human experience as the human dilemma; one that should not be resolved because choosing to emphasize one pole to the exclusion of the other can result in behavior that is either too expanded or too limited. Many people come to therapy suffering from an over emphasis of one pole, such as the emotionally repressed, objectively focused intellectual (too limited), or the pleasure seeking, subjectively focused risk-taker (too expanded). E-H therapists are sensitive to this human dilemma, so they encourage a way of being that supports the development of both—objective and subjective awareness. The ability to move between the subjective and the objective pole is the source of human creativity and energy, but it is also deeply challenging.
In The Courage to Be (1952) Tillich brilliantly articulates this fundamental challenge of living courageously—to face the reality of our “finite freedom,” without avoidance, denial, or repression. It takes courage to be fully present in life, to face the “givens” of life and of one’s personal experiences and limitations. The choices we make determine who we become. Often an internal battle develops between those parts of self seeking consciousness and the protective life stance, created to block those parts from consciousness. This psychological split often results in self-alienation or estrangement. Illuminating and holding the client’s internal battle is a major focus for E-H therapists. In Escape From Freedom (1941), Eric Fromm describes how people have tended to resolve this internal battle by relinquishing personal freedom for the safety and security of authoritarian governments or, in the more modern version, by conforming unconsciously to cultural, societal, or mass media norms, thus avoiding the burden of personal responsibility.
Variations on E-H therapeutic theories.
An existential-humanistic understanding of healthy functioning rests on three interdependent dimensions: engagement in experiential reflection, exercise of personal freedom, and the assumption of personal responsibility. While E-H theorists almost invariably highlight all three of these dimensions, they do so in unique and varied ways. For example, Rollo May (1981) gives primary attention to freedom and that which he terms “destiny.” By freedom, May means the capacity to choose within the natural and self-imposed (e.g., cultural) limits of living. Freedom also implies responsibility, for, as he challenges: if we are conferred the power to choose, is it not incumbent upon us to exercise that power?
James Bugental (1915-2008) gave primary attention to the client’s subjective lived experience. Bugental’s life project was to de-construct the process of existential-humanistic therapy. Bugental made it knowable by inviting his readers into the therapy room to illuminate the therapeutic encounter with pristine clarity. His theory emphasized the self as a matter of process yet embodied, separate but related to the world. The person who comes to therapy is usually self-alienated because of a psychological split. This person experiences an internal battle between a tyrannical boss who drives an untrustworthy worker to do more and to prove him or herself worthy against unreasonable expectations. This characterization is akin to the overly constricted person who objectifies him or herself and is bound by excessive rules. Bugental aims for internal wholeness and authenticity by recovering the person’s lost sense of being. This re-claiming of self occurs by heightening the client’s immediate subjective awareness—an awareness that implies, freedom, choice, and responsibility.
Bugental’s therapeutic perspective illustrates the close ties between existential therapy and humanistic therapy. His emphasis on individual subjective experiences and the need for human beings to be true to their own needs rather than conform to the needs of others shows the influence of humanistic psychologists such as Abraham Maslow (1968) and Carl Rogers (1961). On the other hand his emphasis on the individual as a freely choosing, self-aware, and meaning making being draws more from the existential approach.
Irvin Yalom is probably the most famous existential psychiatrist practicing today. In his widely read “teaching novels,” academic textbooks, and intriguing case studies, existential theory and practice becomes not only understandable but also intuitive. A gifted storyteller, Yalom has brought an awareness of existential concepts to people in every corner of the globe.
Early in Yalom’s career at Stanford University he wrote Existential Psychotherapy (1980), in which he outlines, using vivid case histories to illustrate, the existential therapeutic perspective. In it he describes four “givens” of human existence: death, freedom, isolation, and meaninglessness. Yalom asserts that the extent to which we are able to confront these givens will determine the extent of the dynamic conflict. If we need, for example, to deny the reality of death, we may cope by developing over-expanded, extreme risk-taking behavior, or we may cope with over-constricted, excessive rule-bound behavior. But if we are able to face these givens sufficiently, our lives will be more balanced, free, honest, and congruent.
Thus, the central aim of therapy is to “de-repress” and re-acquaint the individual with something she or he has known all along. This consists of two parts. The first part involves encouraging the individual to engage in experiential self-reflection and attend to his or her existential situation. Although painful but healing, this confrontation allows the individual to accept responsibility for shaping one’s life. But responsibility assumption is only the first step. For real change to occur, the person has to behave differently. This happens when the therapist asks the client implicitly and sometimes explicitly if he or she is satisfied with how his or her life is unfolding. When the likely negative response arrives, the therapist embarks with the client on a difficult journey to transform personal dissatisfaction into constructive action.
Kirk Schneider (1999, 2008) has elaborated on a constrictive/expansive continuum of conscious and subconscious personality functioning. According to Schneider, this constrictive/expansive continuum of personality functioning has a capacity that is both freeing and yet limiting. We have a capacity to “draw back” and constrict thoughts, feelings, and sensations, as well as an equivalent capacity to “burst forth” and expand them. For Schneider, it is the interplay among constrictive and expansive capacities that constitute personal and interpersonal richness and health.
E-H therapy evolved further in the form of an integrative methodology. In their 1995 book, The Psychology of Existence (updated by Schneider in 2008), Schneider and May set about to reinvigorate E-H practice by drawing inspiration from May’s original perspective: E-H therapy offered the field of therapy an understanding of the structure of human existence that could serve as a foundation for all specific therapeutic systems. With the advent of “existential-integrative” (EI) therapy Schneider and May developed one way to utilize a variety of therapeutic modalities within an overarching existential or experiential context.
Thus E-H therapy has become a new bridge to both mainstream and existentially oriented therapies. Schneider and Krug expanded on this new perspective of E-H therapy in their textbook, Existential-humanistic therapy (2010). They proposed that E-H therapy could possibly serve as a foundation for all effective treatments by offering mainstream and existentially oriented therapies a phenomenological method of understanding the experiential world of the person. As a result, today’s E-H therapy has become for many an increasingly integrative therapy.
Currently three variations on the existential-humanistic approach exist. They are: gestalt therapy, emotion-focused therapy, and client or person-centered therapy. Because client or person-centered therapy is essentially a rebranding of humanistic therapy, the principles of which have been explained in the preceding sections, only gestalt and emotion-focused therapies will be discussed as they chronologically originated.
Gestalt therapy was founded by Frederick “Fritz” Perls (1893-1970) and flourished during the 1960’s. It continues as a therapeutic system because of its focus on the lived experience of the whole person. Existentialism informs many aspects of gestalt therapy. The existential viewpoint that Western societies have exalted intellectual reasoning over subjective experience was turned into the challenge by Perls to “lose your mind and come to your senses” (Truscott, in Vandenbos, et al, 2014, p. 189). Other existential influences are seen in its emphasis on choice and responsibility and its focus on how a person lives not on why the person behaves in a certain manner. Illuminating the present subjective experience is most important—the “what is.” The causes are assumed to be irrelevant. Contact with one’s immediate experience in the present moment results in healthy functioning by allowing an awareness of how one is thinking, feeling and doing.
Leslie Greenberg (Elliott & Greenberg, this volume) whose training included gestalt and humanistic therapies developed emotion-focused therapy (or EFT) as a guide to working systematically with emotions. Emotions according to EFT are “fundamentally adaptive…providing our basic mode of information processing…automatically appraising situations for their relevance to our well-being and producing action tendencies to meet our needs” (Greenberg, in Vandenbos, et al, 2014, p. 117). Greenberg posits that “emotion schemes,” which are internal memory structures, form the foundation of a person’s emotional response system. “They are internal emotion memory structures that synthesize affective, motivational, cognitive, and behavioral elements into internal organizations that are activated rapidly, out of awareness, by relevant cues” (Greenberg, in Vandenbos, et al, 2014, p. 119). The similarities of existential concepts to that of emotion-focused concepts are notable.
Specifically similar is the concept of self and world construction to the concept of emotional schemes construction. In both theories people (i.e., persons) do more than simply perceive and experience reality; they in fact participate in constituting (or in EFT language “synthesizing”) their reality by making meaning of their perceptions, and experiences as they relate to the objective world. In E-H therapy this “constituting” results in the creation of self and world constructs and in EFT this “synthesizing” results in emotional schemes. The two theories interrelate further by understanding experiencing as an amalgam of feelings, thoughts, and behaviors which are present in the living moment but often “unregarded” in existential terminology and “out of awareness” in EFT terminology.
Theory of Change in Existential, Humanistic, and Experiential Therapies
E-H and other experiential practitioners base their conception of human change processes on their suppositions about human nature, human experience, and human functioning. Human beings are understood to be always in the process of becoming, situated as a being-in-the-world—related to the physical, personal, and social worlds. Human beings are not simply a collection of drives and behavior patterns within encapsulated selves— human beings are more than the sum of their parts. Human beings continually shape their experiences because they are capable of self-reflection and subjective meaning making; thereby they participate in continually constructing personal worlds from their unique perceptions of the objective world (in EFT terms “synthesizing” experiences into emotional schemes). This is the meaning of consciousness: “I can be aware that I am a being who has a world.” Personal identity making is thus an ongoing, dialectical process of self and world, two poles united and always relating. Hence human beings have agency: free to change, to make new meanings—yet are bound by the givens of existence, and their unique personal, cultural, and historical contexts. We are free and we are determined.
The meanings made from lived experiences create a set of self and world constructs that allow individuals to understand their nature and their experiential world. These constructs about self and world constitute an individual’s context that varies, influenced by the personal, cultural, historical and cosmological experiences of each individual. An individual’s context acts as a “lens” from which one sees and makes sense of one’s world and oneself. One person, for example, may see himself as loveable and perceive his world as kind and accepting, whereas another may see herself as unworthy and perceive her world as judgmental and critical. The present, objective world is continually influencing the individual’s context—simultaneously one’s context is continually influencing one’s perceptions and experiences of the objective world, that is, perception and experience are always contextualized. As Bonnie Raitt, the philosophical singer-songwriter suggests, “no matter if our glasses are on or off, we see the world we make.”
One’s context inevitably limits one’s capacity to be fully free, fully open, or fully responsible. Most people have developed some type of limiting or constricting pattern of protection. These protection patterns or life stances can be understood as over emphasized or polarized ways of being, e.g. excessive rationality, excessive emotionality, excessive giving, or excessive withholding. E-H practitioners (as well as other experientially focused practitioners) believe that if polarized, protection patterns are experientially embodied in therapy, then clients will be more willing and able to re-claim disowned or undeveloped aspects of self in the future. Put another way: the path to greater freedom is paradoxically found through an encounter with the ways in which one is bound. Moreover, clients’ symptoms are understood not as problems to eliminate but rather as methods to maintain selfhood by shutting out disavowed feelings or experiences.
The road to a fuller, more vital sense of being is to help clients experience and attune to their polarized, limiting protection patterns and their underlying fears and anxieties. In so doing, E-H therapists help clients to reflect upon, as opposed to react against, evocative material. This work typically results in clients appreciating the “functionality” of their symptoms and experiencing their polarized protection patterns as restrictive or self-limiting. Thus by encouraging clients to experientially embody their restrictive patterns, clients can face and accept the givens of existence that may have been avoided, denied, or repressed. However for the E-H practitioner, responsibility assumption is not sufficient—it is simply preparatory for substantive change evidenced when clients first make new meanings about themselves, then choose more life-affirming patterns for themselves and with others.
E-H therapists aim to know the person who comes for therapy at a deep structural level of being so as to illuminate the blocks and limiting polarized patterns. They wonder: “How is this person, in this present moment coping with his/her awareness of being alive?” They attune deeply (as do other experiential therapists) to the client’s implicit experiences and process (a way of relating to self and others) underlying his or her “story.” Being present, in this way, will illuminate the client’s subjective self and world constructs (or in EFT terminology, emotional schemes) because the client’s past is alive (embodied) in the present moment. People (i.e., persons) make meaning of their experiences not as dry abstractions but as embodied memories richly laden with emotions and opinions about self and others, which then manifest concretely in vocal tones, affect, body postures, language, dreams, and relational behavior patterns. Experientially oriented therapists know they don’t have to go on a treasure hunt to understand the client’s past—it’s right in front of them! If therapists bring a full and genuine presence to the encounter they can empathically enter their clients’ experiential worlds and know them as they are and the meanings they have made about themselves and their lives.
The Latin root for presence is prae (before) + esse (to be)—presence means, “to be before.” Consequently, presence can be understood as the capacity “to be before” or to be with one’s self and/or “to be before” or to be with another human being. Presence involves aspects of awareness, acceptance, availability, and expressiveness in both therapist and client. Presence implies that the encounter is real. For Martin Buber (1958), it means that the person who is before one has ceased being an “it” and has become a “thou”; it means that we are all humans who include each other in each other’s recognition. If one can be truly present with another, then a genuine encounter has occurred. Hence presence is both the ground for a genuine encounter and a method for effecting transformational change.
Given this background, it may be clearer why E-H therapists and other experiential therapists cultivate a presence to the client’s immediate and implicit experience and process. They attune to what is most alive in the moment and responds accordingly: whether it is a focus on the interpersonal space or on the client’s subjective experiencing. Whereas discussions can help clients incorporate a specific event, for example, a memory of abuse, deep attunement or presence can help clients experience the self-limiting stance created to protect their selves from overwhelming feelings. The process of illuminating the life stance that both echoes and transcends the event and then helping one to re-claim the disowned feelings hidden behind the stance is the life-changing work of E-H therapy. The deepest roots of trauma cannot be talked about or explained away; they must be discovered, felt, and lived through. Change is evidenced when new meanings about self are made, e.g. “ I no longer feel damaged—I feel loveable.” These new meanings about self typically result in a construction of more functional patterns of living and relating to others.
E-H therapists attend to three dimensions of experience and process: a) the personal or subjective dimensions of both client and therapist, (i.e., a focus on “self”), b) the interpersonal or relational dimension, (i.e., a focus on the “in-between” field of client and therapist), and c) the ontological or cosmological dimension, (i.e., an existential focus on “the world”). Being present to all three dimensions of experience and process is crucial—all three dimensions are “actual” in the present moment, and provide entry into the feelings and world of the client (for a case illustration see Schneider & Krug, 2010, p. 69). Moreover, E-H therapists and other experiential therapists work to facilitate change in clients by cultivating therapeutic presence, activating deep experiential reflection, identifying and illuminating polarized protective patterns, and supporting the reclamation of disowned experiences, thus allowing for the creation of new meanings and more constructive ways of being. Said briefly, the net result for clients is an expanded sense of self.
To sum, E-H theorists and other experiential therapists share four core aims: 1) to help clients to become more present to themselves and others; 2) to help them experience the ways in which they both mobilize and block themselves from fuller presence; 3) to help them take responsibility for the construction of their current lives; and 4) to help them choose or actualize ways of being in their outside lives based on facing, not avoiding, the existential givens such as finiteness, ambiguity, and anxiety.
Research on the Efficacy and Effectiveness of Existential, Humanistic, and Experiential Therapies
Recently therapeutic outcome research, using meta-analytic methods, found that the most significant factors responsible for therapeutic effectiveness were a healing environment, the therapeutic relationship, and the therapist and client’s personal styles—and not specific techniques or treatment modalities (Elkins, 2007; Norcross, 2002; Wampold, 2001). These common or contextual factors, as they have come to be called, are the foundational principles of E-H therapy and other experiential therapies. According to Elkins (2007), these meta-analytic findings support what existential and humanistic practitioners have assumed: techniques and particular modalities have their usefulness, but change and healing occurs in the human dimension, characterized by qualities of safety, honesty, and acceptance as therapist and client work together.
Leading therapy researcher Bruce Wampold (see Schneider & Krug, 2010, p. 89) in a review of Kirk Schneider’s edited book Existential-Integrative Psychotherapy (2008) asserts that the existential-integrative approach meets the criteria as a scientific psychological treatment. Even more importantly, he agrees with Schneider’s supposition that an understanding of the principles of existential therapy may be needed by all therapists and could help form the basis of all effective treatments.
Unfortunately, contextual factors research has only had a limited impact on the field in the areas of orientation and training (Cooper, 2004; Elkins, 2007). Most mainstream practitioners still believe that empirically supported treatments (ESTs) are the treatments to employ and the training to learn (Elliott 2002; Westen, Novotny, & Thompson-Brenner, 2004). The EST movement has relied on readily quantifiable forms of practice (e.g., cognitive-behavioral)—while neglecting or overlooking the contextual factors (and meta-analytic findings) mentioned above (see Cain & Seeman, 2002, and Wertz, 2001, for comprehensive reviews).
Nonetheless there has been a shift that has given existential-humanistic therapy a good deal of momentum. The randomized controlled trial, once considered the “gold standard” of measurable psychotherapy has been criticized from many quarters (see Bohart, O’Hara, & Leitner, 1998; Schneider, 2001). Conversely, qualitative research, once shunned by academic psychology, has recently received greater acceptance, while mainstream conceptions of outcome research have undergone significant changes (APA Taskforce on Evidence-Based Practice, 2006; Wertz, 2001). Existential and experiential therapies have been gaining a small but substantial foundation of empirical support (Elliott & Greenberg, 2002; Walsh & McElwain, 2002). As previously mentioned there is growing support for the existential principles of practice in the area of systematic quantitative research, which is worthy of elaboration. The so-called “context” or common factors research consistently points to the relationship as opposed to technique as the factor responsible for change (Wampold, 2001). This research is reinforced in the growing research on expressed emotion (Gendlin, 1996; Greenberg, Rice & Elliot, 1993). Another interesting area of quantitative inquiry for E-H practice is the neuroscience of emotional regulation. Greenberg (2007) posited that in order for emotional regulation to endure it must be worked through with non-verbal (embodied) approaches and not with those that stress cognition. Existential therapy has produced rich and expressive qualitative case studies (e.g. Binswanger, 1958; Bugental, 1976; May, 1983; Schneider & Krug, 2010; Yalom, 1989). These expressive cases convey the lived experiences of therapist and client, vividly illustrating the healing powers of the therapeutic relationship. Finally, there is more research in the area of clinical training (Fauth et al., 2007), which supports the principles of E-H practice by calling for an emphasis on the personal dimensions of training including presence and responsiveness.
Related to these shifts is the recent publication by the American Psychological Association of a textbook on existential-humanistic therapy (Schneider & Krug, 2010), a companion video series called “Psychotherapy Over Time” (Schneider, 2009), and plans to develop a textbook that focuses on the training and supervision of students from an existential-humanistic perspective. Increasingly, there has been an integration of existential and humanistic principles into modalities like cognitive-behavioral approaches (Schneider & Langle, 2015).
Empirical investigation of E-H and other experiential psychotherapies is at an early but promising stage. Studies, from therapy outcome to neurology to psychiatric care, show convincingly that all experiential therapies have something important and helpful to offer our profession. Certain conceptual dimensions related to experiential practice such as the value of the therapeutic relationship over technique, the significance of the personality of the person who delivers the therapy, client’s capacity for self-healing, and the value of emotional regulation have been confirmed by both quantitative and qualitative research while other areas need further clarification (Bohart & Tallman, 1999; Greenberg, 2007; Greenberg, Rice & Elliot, 1993; Wampold, 2001). Empirical investigation of experiential practice is at an early but propitious stage. It may soon become a model evidence-based modality that stresses four crucial variables: experiential reflection, the therapeutic relationship, the therapist’s presence or personality, and the active self-healing of clients.
Diversity in Existential-Humanistic Therapy
The following section examines the value and limitations of employing E-H therapy with a diverse population of clients. Although the other experiential therapies such as gestalt and emotion-focused therapies are not specifically referred to in this section, one can appropriately generalize from the discussion about E-H therapy and diverse populations given that all value understanding the lived experiencing of the individual over treatments delivered to the individual. Consequently E-H therapy, and other experiential therapies lend themselves to use with a variety of populations. There are case studies reporting successful use of E-H therapy with children, adults and couples from a wide variety of cultural, religious and ethnic communities (for an expanded explanation see Schneider 2008; Schneider & Krug 2010).
Strengths from a diversity perspective.
E-H therapy can be useful for a diverse population of clients because it does not demand a particular way of viewing reality. On the contrary, E-H therapists want to enter their clients’ worlds and learn how they view reality. With its emphasis on presence and the I-thou relationship, clients from differing backgrounds, age brackets, and sexual orientations are provided with an accepting space to express their particular perspectives, values, and cultural norms. For example E-H therapists would attune to the lived experience of a religious person in the same way they would attune to the lived experience of an atheist because attunement to lived experience is foundational to E-H practice. Consequently, E-H therapy can be effectively applied with diverse client populations, with a range of specific problems and in a wide array of settings.
The research on the effectiveness of common factors or contextual dimensions of therapy detailed above also supports the efficacy of E-H therapy with diverse populations. The issue for the E-H therapist is not so much the cultural background of the client but rather the meaning of that background for the client. How is that meaning manifesting in client’s present unfolding experience? A person’s unfolding experience may not conform to their demographic profile; and to understand a person simply on his or her demographics is a diminution of his or her vital, lived experience. The E-H therapist’s task is to assess the client’s desire and capacity for change and how to best mobilize, support, and release that desire and capacity. That being said, much more research is needed to understand the value of E-H therapy with clients from diverse backgrounds. Specifically, we need to know how the principles of E-H practice, like presence or the cultivation of meaning, impact clients from different backgrounds with different needs.
Vontress and Epp (2001) suggest that existential counseling is the most useful approach for clients of all cultures because of its focus on common concerns which all humankind faces: concerns related to love, death, anxiety, and meaning. These concerns transcend separate cultures. They further believe that therapists-in-training would benefit from an education that initially focuses on the commonalities between people from different cultures and secondarily on the areas of differences. It is more important to infuse the therapist-in-training with a tolerant and sensitive perspective than teach specific interventions for each culture.
Shortcomings from a diversity perspective.
E-H therapy does have specific shortcomings. One of them is its tendency to invite depth and intensity when that invitation may not be appropriate. For example, if a client’s desire or capacity for change is limited due to psychological, cultural, or intellectual factors, he or she may not benefit from or be capable of engaging in deeper experiential reflections. By contrast, a client who wants symptom-reducing therapy will probably not find intensive explorations into his or her life concerns particularly useful, at least not initially. That being said, most E-H therapists are unlikely to display such insensitivity to clients’ needs. The sine qua non of E-H therapy is to meet clients where they are, and not where therapists want clients to be. E-H therapists have developed a high degree of sensitivity to the world of the other. Because of their skilled presence, most are quite effective at responding appropriately and effectively to the needs of their clients. E-H therapists understand that every client demands a new therapy that is unique to his or her needs and ways of relating. For example E-H therapists working with children will listen and communicate empathically, using each child’s special language to convey an understanding of and empathy for that child’s unique and personal experiences.
In sum, there is no cardinal rule about for whom or in what circumstances E-H therapy will prove most effective. In keeping with the E-H practice philosophy, each connection, each setting, and indeed, each moment must be thoughtfully and attentively evaluated. Again, we cannot say enough about the value of “presence” for assessing the appropriateness of E-H (or any other kind of) therapy for struggling, panicking lives. To the extent that therapists can draw on their whole-bodied experience in therapy, they will be in an enhanced position to relate to, assess, and serve the clients they engage.
Conclusions and Key Points
The challenge of living courageously means one must face the reality of our “finite freedom,” without avoidance, denial, or repression. It takes courage to be fully present to life, to face the “givens” of existence and of one’s personal experiences and limitations. If one is able to be fully present to life then according to existential thought one will not be psychologically split, but whole, living authentically, being the author of one’s life. The choices we make determine who we become. Often an internal battle develops between the parts of self that want to become conscious with the protective life stance erected to keep those parts from consciousness. This “split in self” can cause a sense of estrangement and alienation from self. Illuminating and holding the client’s internal battle is the primary focus for E-H therapists, a focus that often leads to an incorporation of these denied parts, which results in “whole-bodied” transformative change in the client.
a) The foundation of existential-humanistic therapy unites existential accents on limited freedom with humanistic accents on potentiality. In addition, it introduces a radical phenomenological epistemology concerning how one understands human beings—not by projecting onto the person abstract models of human behavior but by entering their experiential worlds.
b) E-H therapy differed from the psychoanalytic and behavioral orientations, in that it was not offering the field of psychology a new therapeutic system; rather, it was offering a new understanding of the structure of human existence, to serve as a foundation on which specific therapeutic systems could be based.
c) Human beings make subjective meanings from experiences in the objective world to create their personal world. A person is not simply aware; he or she is conscious, aware of being the one who makes meaning from experiences.
d) Humans are free because they make meanings from their experiences, and they are determined because these meanings are limited by natural and self-imposed limitations
e) E-H therapy assumes that the process of constituting one’s reality, or to put it another way, shaping consciousness, results in identity formation, e.g. a sense of self. Often an internal battle develops between the parts of self that want to become conscious with the protective life stance that keeps those parts from consciousness. Illuminating and holding the client’s internal battle is a major focus for E-H therapists.
f) The road to a fuller, more vital identity is to help clients appreciate their polarized, limiting protection patterns; assist them to “embody” those patterns and their underlying fears and anxieties, and help them attune, at the deepest levels, to the implications of what has been discovered.
g) E-H therapists (and other experiential therapists) cultivate a “presence to implicit experience or process” (process refers to an implicit way of relating or being, a life stance that manifests in body posture, vocal tone, etc.) over content, that is, discussions about the past.
h) Existential-Humanistic therapy and other experiential practices may soon become models of evidence-based modalities that stresses four crucial factors: 1) experiential reflection, 2) the therapeutic relationship, 3) the therapist’s presence or personality, and 4) the active self-healing of the client.
i) E-H therapy and other experiential therapies can be useful for a diverse population because they do not demand a particular way of viewing reality, instead they value understanding the lived experiencing of human beings.
Who were the key people responsible for the historical development of E-H theory and what were their contributions?
What are the distinguishing aspects of existential-humanistic theory?
What are the distinguishing aspects of subsequent experiential therapies?
How does an E-H therapist facilitate the change process?
How does current research support or challenge the efficacy of the E-H approach and other experiential therapies?
Further Readings and Online Resources
Becker, E. (1973). Denial of death. New York: Free Press.
Laing, R. D. (1969). The divided self: An existential study in sanity and madness. Middlesex, UK: Penguin.
Mendelowitz, E., & Schneider, K. (2008). Existential Psychotherapy. In R. Corsini & D. Wedding (Eds.) Current psychotherapies (8th ed.) (pp. 295-326). Belmont, CA: Thompson/Brooks Cole.
Schneider, K. J., Bugental, J. F. T. & Pierson, J. F. (Eds.). (2001). The handbook of humanistic psychology: Leading edges in theory, research, and practice. Thousand Oaks, CA: Sage.
Schneider, K. J., Pierson, J. F., & Bugental, J. F. T. (Eds.). (2015) The handbook of humanistic psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage.
Yalom, I. (2002). The gift of therapy. New York: HarperCollins Publishers
Bugental, J. F. T. (Speaker). Existential-humanistic psychotherapy in action [DVD]. San Francisco, CA: Psychotherapy.Net (available at http://www.psychotherapy.net).
Existential-Humanistic Institute (EHI) website: http://www.ehinstitute.org
May, R. (2007). (Speaker). Rollo May on existential psychotherapy [DVD]. San Francisco, CA: Psychotherapy.Net (available at http://www.psychotherapy.net).
Schneider, K. J. (2006). (Speaker). Existential therapy [DVD and online article.] American Psychological Association Systems of Psychotherapy Series 1 (available at htpp://www.apa.org/videos).
Schneider, K. J. (2009). (Speaker). Existential-humanistic therapy over time [DVD]. Washington, D.C.: American Psychological Association (available at http://www.apa.org/videos).
Yalom, I. (Speaker). Irvin Yalom: Live case consultation [DVD]. San Francisco, CA: Psychotherapy.Net (available at http://www.psychotherapy.net).
APA Task force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.
Binswanger, L. (1958). The case of Ellen West. In May, R., Angel, E., & Ellenberger, H. (Eds.). (1958). Existence: A new dimension in psychiatry and psychology (pp. 237-364). New York: Basic Books.
Bohart, A. C., O’Hara, M., & Leitner, L. M. (1998). Empirically violated treatments: Disenfranchisement of humanistic and other psychotherapies. Psychotherapy Research, 8, 141-157.
Bohart, A. C., & Tallman, K. (1999). How clients make psychotherapy work: The process of active self-healing. Washington, DC: American Psychological Association.
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