- Orah Krug
Existential Humanistic Therapy: Principles Method and Practice
Part III, Chapter Fifteen: The World Handbook of Existential Therapy
Orah T. Krug, PhD
Existential-Humanistic (E-H) therapy is a relational and experiential therapy, which focuses on clients’ and therapists’ actual, lived experiences. The goals are to expand experiential awareness and to use the therapeutic relationship to cultivate genuine encounters and real therapeutic change. It assumes that if life-limiting protections are diminished or dissolved, more joy, satisfaction, meaning and purpose can emerge.
While E-H therapists attune to the explicit or content dimension (i.e., the client’s story) they more frequently attune to the implicit or process dimension (i.e., the client’s attitudes or feelings underlying his or her story). Their aim is to enter their clients’ self-constructed worlds, using their own personal contexts to develop responsiveness to clients’ feelings, experiences and protective patterns. Within a safe and collaborative therapeutic relationship, clients work with their protective patterns and core wounds through experiential reflection and relational enactment. They see “close-up” how they miss a fuller life by constricting or blocking their capacity to live.
Consciousness, responsibility and choice take root in this reflective process—thus supporting the reclamation of previously abandoned ways of being. A reclaiming of one’s life is the ultimate goal, but this cannot be achieved until one knows what has been disowned. Unlike other therapies, symptom removal is not the primary focus (although symptom removal often occurs). Rather, this type of change is in the core of one’s being; it is “whole-bodied” and transformative.
Consequently, E-H therapy emphasizes: (a) an experiential and relational way of knowing oneself and others (b) freedom to become within ones given limitations (c) experiential reflection on one’s personal meanings about becoming and (d) responsibility to respond to what one becomes.
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 term, actually refers to 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 Existence (1958), edited by Rollo May and colleagues. 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. It introduced into the “sunny” humanistic landscape, flush with possibilities and potentialities, more “cloudy” existential concerns, such as death, limited freedom, and uncertainty.
Perhaps, even more significant was the authors’ challenge to an accepted “way of knowing.” They introduced a radical epistemology for understanding human beings, drawn from existential philosophers such as Kierkegaard, Husserl and Heidegger. 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.
E-H 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 E-H 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 E-H 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.
Increasingly, even the science backs E-H therapists opposition to the standardization of therapy. In a comprehensive overview of the effectiveness of humanistic principles of practice, Angus, Watson, Elliott, Schneider, and Timulak (2015) found that for the majority of problems typically addressed in therapy, humanistic principles of practice, such as an emphasis on the relational and experiential aspects of the work, are on par with—and in some cases superior to—more programmatic principles of practice, such as those of cognitive–behavioral therapy. Leading researchers such as Bruce Wampold and John Norcross have been espousing similar positions for the past several years (Wampold, 2007, 2008; Norcross & Lambert, 2011).
To summarize, 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 mix was a radical method of understanding human beings, not through a lens of abstract theories but through a direct encounter with the individual’s experiential world. (For further elaboration on the historical context of E-H therapy, see Krug, 2016, in A. Consoli, et al).
The current leaders of the existential-humanistic perspective owe a great debt to their mentors. Rollo May, James Bugental and Maurice Friedman mentored Kirk Schneider. James Bugental and Irvin Yalom mentored this author, Orah Krug.
One of Kirk Schneider’s major contributions is an elaboration on a constrictive/expansive continuum of conscious and subconscious personality functioning (Schneider, 1999). His work echoes that of Nietzsche, Kierkegaard, Tillich, and May as it emphasizes the paradoxical nature of human functioning. For Schneider, it is the interplay among constrictive and expansive capacities that constitute personal and interpersonal richness and health. Kirk also has introduced the concept of “awe” into the existential landscape most persuasively (Schneider & Krug, 2010).
As a result of Orah Krug’s long associations with both James Bugental and Irvin Yalom, she initiated an integration of the primarily intrapsychic focus of James Bugental with the interpersonal focus of Irvin Yalom. By doing so, Krug highlighted the value of integrating existential-humanistic presence: a focus not only on subjective process but also on interpersonal process (Krug, 2009). In addition, this author’s interest in existential meaning making has brought new attention to the influence of personal context on perception and contact (Krug, 2010).
In 1997, Kirk Schneider and Orah Krug, along with their colleagues Nader Shabahangi and Sonja Saltman founded the Existential-Humanistic Institute in San Francisco, CA. Inspired by their mentor, James Bugental, and with his support, they envisioned EHI primarily as a teaching institute with a mission to educate the next generation of therapists interested in practicing from an existential-humanistic perspective (for further elaboration on EHI’s models of supervision and training see Krug & Schneider, 2016).
The current leaders of E-H therapy have also encouraged its evolution as an integrative methodology. 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 (Schneider & May, 1999; Schneider 2008). In their textbook, Existential-Humanistic Therapy, 2010, Schneider & Krug expanded on this new perspective. The authors suggested that E-H therapy could serve as an effective foundation for many therapeutic perspectives, by offering a phenomenological method of entering the experiential world of the person. As a result, today’s E-H therapy has become, for many, an increasingly integrative therapy by being a bridge to both mainstream and existentially oriented therapies.
Principles of Practice Related to Identity Formation and Personal Context
1. Human beings make meaning from experiences in the external world to create their personal (inner) worlds.
Existential meaning making is an intrinsically human process related to identity formation. It is the act of “making sense” of an experience. Existential theory challenges the Cartesian notion of a world made up of objects—and subjects who perceive those objects. Instead, existential theory understands that individuals participate in constructing their reality by making meaning (sense) of their perceptions and experiences as they relate to the external world. Thus they are not simply aware, they are conscious—aware of being the ones who construct meanings from experiences.
If individuals construct their personal worlds, then within the definition of existence lies: a) agency (i.e., we are centered in our being and create meanings about our world and ourselves), b) freedom (i.e., we choose how we define our perceptions and experiences), c) responsibility (i.e., we are responsible for the choices we make), and d) change (i.e., we have agency to create new meanings about our world and ourselves).
Understanding the process of existence through this meaning-making lens underscores the need for therapists to sensitively attune to and explore the personal meanings and associated feelings of clients over and above dispensing a particular treatment or technique.
2. The constructed meanings result in a set of beliefs about oneself and others (self and world constructs).
The meanings an individual makes from lived experiences create a set of self and world constructs, essentially a set of beliefs regarding self, others and the world. These constructs are understood as an individual’s personal world or context that varies, continually influenced by the cultural, historical and cosmological experiences of each individual.
Quite often these constructs are created outside of one’s awareness. Moreover, these constructs are not constituted as dry abstractions but as embodied meanings, richly laden with personal feelings, thoughts and opinions. All incoming and outgoing information flows through the lens of one’s personal context. One’s personal context is always “in process,” being shaped and re-shaped.
Rollo May (1975) described this process of shaping and re-shaping reality and consciousness as “passion for form,” which results in, as he called it, an “I am” experience, or the formation of one’s identity. The following example will illustrate. One individual, let’s call her Amy, has shaped and re-shaped her context so that currently she perceives herself as essentially lovable but acknowledges her occasional “unlovable behavior with others.” Amy currently perceives her world as generally kind and accepting yet recognizes, that on occasion, her world may be harsh and unaccepting. Amy’s “I am” experience is: “I am essentially loveable, my world is generally kind and accepting, and I can be open and accepting towards others.” We can describe Amy’s self and world construct system (or her personal context) as fluid and flexible.
Contrast Amy’s context with Robert’s, who perceives himself as essentially unworthy and his world as consistently judgmental and harsh. Robert’s “I am” experience is: “I am unworthy, my world is unsafe, and I must to be wary of others.” We can describe Robert’s self and world construct system (likely out of his awareness), as “calcified” and rigid.
Clearly, Amy and Robert experience the external world through very different context lenses. Amy’s lens is fluid and flexible. She’s can take in “raw data” from the external world. Amy is able to have a “primary experiencing” of the external world. As a consequence, she usually able to be present in her life, engaging projects and people with curiosity, acceptance and openness. Whereas Robert, whose context lens is calcified, and rigid has more difficulty taking in “raw data” because it gets distorted as it flows through his context lens. We can describe Robert as “caught in his context,” unable to perceive what’s really “out there,” because he can only experience the world through his rigid set of beliefs about himself and others. Robert is typically limited to having a “secondary experiencing” of the external world. Consequently, Robert usually constricts his life and relationships, perhaps avoiding real intimacy. Using Amy and Robert as examples we can appreciate that fluid and flexible construct systems often result in joyful living and close relationships whereas “calcified” and rigid construct systems often result in emotional distress along with deadened living and superficial relationships.
We can assess healthy functioning by evaluating the extent to which a person is able to be truly present with self and others versus a person who is consistently caught in his or her context.
3. Protective patterns (“spacesuits”) develop alongside rigid self and world constructs.
Most of us have difficulty fully facing and accepting some life experiences—especially those that are particularly painful and devastating. If we use Robert again as an example, we can imagine that Robert’s past may have included rejecting and abandoning experiences, which wounded and overwhelmed him. These experiences led him to conclude that he is unworthy of love and that the world is cruel and rejecting. In order to cope and live, Robert may have buried or disowned, at an early age, his sense of unworthiness and developed a “workaholic protective pattern” to block him from experiencing this painful core belief and wound. Consequently, as an adult Robert is consistently stuck wearing his spacesuit, always anticipating rejection from others, behaving in ways that validate his assumption again and again. Today Robert is a successful and powerful company executive, who never stops “doing” and whose relationships are superficial, not intimate. Robert may say things like: “I can’t slow down,” “I have too much to do,” and “I’m fine, I don’t need close relationships.”
James Bugental (1999) likened protective patterns to wearing spacesuits in outer space: they allow us to survive and function, but they don’t give us the freedom to scratch our noses! Robert may come to therapy when some life event makes his “spacesuit” too constricting, thereby causing him sufficient distress to seek help. Robert likely has an internal battle raging between a part of himself that wants to emerge (perhaps his desire for intimacy) and his “spacesuit” that holds the emerging part back to protect him (perhaps from his fear of intimacy or rejection).
Awareness of self and world constructs helps therapists hone in on their clients’ unique perspectives about their natures and relational worlds, as well as on their clients’ protective patterns that both constrict and support survival. Awareness of self and world constructs also focuses the therapist on his or her own personal context that may be impeding therapeutic effectiveness with a particular client.
4. The client’s past is alive in the present moment
In each moment, the client’s past—all of the meanings constructed about self and others—flows into the present moment, actual and real. In the therapeutic encounter, clients’ self-constructed worlds and protective patterns (spacesuits) manifest concretely in vocal tones, affect, body postures, language, dreams, and relational behavior patterns. These “ways of being and relating” are understood as the client’s process, an amalgam of feelings, thoughts, and behaviors, which are present in the living moment but are often out of awareness.
Robert, for example, who relates to himself and to the therapist as a machine, also comes consistently late to sessions. As therapy progressed, his objectifications and tardiness were revealed to be concrete manifestations of a core decision: “If I treat myself and others as objects, and if I never allow myself to risk real connections with others, then I’ll never get rejected or hurt by others.” Another “composite” client, let’s call her Renee won’t reach over to take a new tissue, even though hers is shredded from crying. Her behavior, as the work revealed was a concrete manifestation of her core decision: “If I always makes do, I’ll never have to rely on anyone, and thus, never get let down.”
Each of these examples serve to illustrate that not only are the clients before us but so are their lives, and their protective patterns, constructed to insulate them from overwhelming hurt and pain. If we recognize this, then we need not go on an “archeological dig” to find the “actuality” of a client’s life—it is, in fact, concretely manifesting in the here and now, visible and kinesthetically felt. Our task is to appropriately respond and reflect back our clients’ intra and interpersonal processes. If we do that, the consequences will likely be clients expanded experiential awareness of themselves and others. More on how this unfolds is described in the next section.
5. 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, the givens of existence, and our personal, cultural and historical context. An awareness of the impact of natural and self-imposed limitations on one’s personal freedom helps the therapist appreciate the challenges inherent in effecting healing and change: the “constancy” of personhood is a powerful counterweight to freedom and change. The tension between constancy (of old, familiar patterns) and change (to new, unfamiliar patterns) often results in internal battles that clients like Robert struggle to resolve in therapy.
6. Personal context influences perception and contact with others
E-H therapists appreciate that one’s context is continually influencing one’s perceptions and experiences of the external world. As Bonnie Raitt, the philosophical singer-songwriter suggests, “no matter if our glasses are on or off, we see the world we make.” In other words, as much as we strive to brush away our biases and to be deeply present, our personal context inevitably limits, to some extent, our interpersonal contact. However, what is also true is that interpersonal contact is always influencing one’s intrapersonal context.
Consequently, our task, as E-H therapists is first and foremost to “know thyself,” in other words: how is our personal context i.e., our biases and worldviews influencing the work with clients? Our second task is to help Robert, Renee (and all of our clients) become curious about how their personal contexts impact their experiences of the external world. Our task is to help them develop “reflective secondary experiencing,” in other words, a capacity to non-judgmentally reflect on how their personal context might be clouding their primary experiencing of themselves and of others—us for example. We can cultivate their curiosity because we are a crucial part of our clients’ present, external world. This means that how we relate to them can significantly influence how they see themselves and us, helping them to re-evaluate their unconstructive relational patterns.
Conception of Human Change Processes
E-H 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 beings-in-the-world—relating to their 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. Hence human beings have agency: they are 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 both free and determined.
The path to greater freedom is paradoxically found through an encounter with the ways in which one is bound. This means E-H therapists help clients experience and attune to their polarized, limiting protection patterns and their underlying traumas, fears and anxieties. In so doing, clients 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 they may have been avoiding, denying, or repressing. 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 and then choose more life-affirming patterns for themselves and with others.
Method and Practice: The Process of Therapeutic Change
1. Employ the Cultivation of Presence
E-H therapists aim to know the person who comes for therapy at a structural level of being so as to illuminate the blocks and limiting polarized patterns. To accomplish this, E-H therapists employ the cultivation of intra and interpersonal presence to 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 (1970), it means that the person who is before me 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. Understanding the therapeutic meeting or encounter in this way promotes attitudes of “being with” and “being for” clients, it germinates safe and close therapeutic relationships, which form the foundation upon which other, more challenging work relies.
The cultivation of presence promotes a real encounter between two individuals; it is not a hierarchical meeting in which one is a shadowy figure holding all the knowledge and power. On the contrary as May (1983) suggests, “encounter [is] a way of participating in the feelings and world of the patient (p. 66). Yalom (2002) describes it as a meeting of two “fellow travelers” on life’s journey together. Hence presence is both the ground for a genuine encounter and a method for effecting transformational change.
The intention of the cultivation of presence is to treat every client as an individual and not as a diagnosis, classification or symptom. Presence and curiosity cannot be cultivated when abstract models of human behavior or clinical diagnoses are projected onto clients or supervisees. E-H therapists understand clients’ symptoms not as problems to eliminate, but rather as methods to maintain selfhood by shutting out disavowed feelings or experiences. They wonder, “What is the meaning of this symptom at this point in my client’s life? What does the symptom want “to tell” my client?”
2. Cultivate a Presence to Process More Than Content
Although E-H therapists value the content (or explicit features) of clients’ experiences, they are acutely and simultaneously attuned to the process or implicit aspects of those experiences. Thus, E-H therapists carefully cultivate presence to what is most alive in the moment and respond accordingly: it may be to the personal process (of the therapist or of the client) or to the interpersonal process (of the therapist or of the client). They wonder, “How is my client telling me his story?” “Is his voice flat and unemotional or filled with trembling emotion?” “Does he look at me or does he turn away as he tells me his story?” Another way to consider the relationship between process and content is to think of content as the “words” of a song and process as the “music” of a song. The “music” conveys the tone and the mood often at a deeper level than the “words” themselves. Similarly, a focus on process will often reveal meanings of a deeper nature than does a focus on content.
To the extent that clients are desirous and capable of deeper work, E-H therapists focus on the “here and now,” as opposed to the “then and there.” The “here” refers to the therapeutic encounter and the “now” refers to the present monument. Working in the “here and now” is a powerful tool for therapists because if one assumes the client’s past is alive in the present moment, then the therapeutic relationship becomes a microcosm of the client’s personal and relational worlds. This makes the therapeutic encounter a “living laboratory,” whereby therapeutic process refers not only to immediate interactions between client and therapist, but it also refers to the underlying personal and relational processes of both client and therapist. Consequently, E-H therapists appropriately reflect back clients’ implicit personal and relational ways of being that are evident but unnoticed: for example, my focus on the Renee’s shredded tissue.
They may also attend to how the client occupies personal space---with confidence and ease or with hesitation and constraint? They may comment on clients’ relational ways of being, i.e., “You seem to not like what I just said.” Or they may simply attend to how clients relate to them—in engaged, open ways or in a detached, aloof ways? If therapists bring a full and genuine presence to the encounter they can bracket their own world perspective sufficiently to see a person as he or she really lives and relates, and understand his or her unique meanings made from past experiences.
3. Illuminate the Actual but Unnoticed Protective Patterns
Healing and change happens as protective patterns are mirrored back to clients allowing them to experience how their patterns are embodied and enacted within the therapeutic relationship. With Renee for example, when I felt she might be caught in her protective pattern with me, I would check in, asking: “Are you “making do” right now by not asking me for something you need or want?” This “up close” experiencing of self-limiting patterns also highlights the internal battle between the parts that want to emerge and those which need to stop the emerging part. Implicit in mirroring Renee’s protective pattern is the question: “Is this how you want to continue living?”
By mirroring self-protective patterns, clients begin to develop a capacity to reflect on their protective life stance (their spacesuits) instead of being unaware them: Renee becomes aware of: “There I go, just making do” again, or Robert opens to: “There I go again, showing up late to our session.” Reflection requires pausing, i.e., slowing down the client and the interpersonal process. By pausing, we help clients develop “reflective secondary experiencing.” First, we help them develop a non-judgmental witness to their protective stance, “Can you notice, without judging how you’re making do with me?” Then we may invite them to attend to what’s happening in their bodies or to what’s happening in the relational field. We invite images, associations about meanings and past experiences to become more conscious. “Just go slow and see what’s there,” is something we might suggest shifting clients from a “doing” mode to a “being mode.” Cultivating personal and relational presence in this way often allows clients to feel the pain of a wound, no longer numbed by the protective pattern. The belief about self finds expression: Renee, “I’ve never felt worthy of being cared for—I’m damaged, that’s why I don’t reach out to you.” Or, Robert, “I feel unlovable—I’m afraid if I engage with you and let you matter to me, you’ll reject me.” To the extent appropriate, meanings made about self, others, and world, and the associated hurt and pain are felt and worked through at an embodied, not cognitive level in the safety of the therapeutic relationship. By supporting clients to experientially embody their self-restrictive patterns, clients can face and accept the givens of existence and their core decisions and wounds that may have been avoided, denied, or repressed. Together past relational patterns can be dissolved and new ones developed.
Awareness, responsibility, and choice now become a part of the exploratory, reiterative process: Renee, “Oh, there I go again, just making do! Is that what I want to keep doing? Maybe not.” Or, Robert, “There I go again, not thinking I matter to you, showing up late to our session. Maybe I can risk showing up and engaging with you. Maybe you won’t reject me?” Jim Bugental (1999) likened a person’s protective pattern to a mask on one’s face, and as therapy progresses, and awareness about the protective pattern increases, the client slowly pulls the mask away bringing it into ever-greater focus.
Responsibility is assumed for constructing the protective pattern, along with a newfound sense of agency and choice. The process of healing and change is by no means linear, nor is it primarily cognitive. Whereas discussions can help a client incorporate, for example, a memory of abuse—deep attunement or presence can help a client experience the self-limiting stance created to protect him or herself 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.
4. Emergence of New Meanings and New Behaviors
Responsibility assumption is not sufficient—it is simply preparatory for substantive change evidenced when clients first make new meanings about themselves, e.g. Renee, “I don’t have to just make do, I can lean on others because I am worthy and good enough.” Or, Robert, “I don’t have to avoid engaging with people, I’m loveable, and not a pariah.” These new meanings about self typically result in the construction of more functional, satisfying and meaningful patterns of living and relating to others both personally and professionally.
E-H therapists use the cultivation of presence to effect healing and change. Presence involves aspects of awareness, acceptance, availability, and expressiveness in both therapist and client. If one can be truly present with another, then a genuine encounter has occurred in which previously disowned protective patterns and wounds can be faced, dissolved or managed and new, more functional patterns can emerge. This “whole-bodied” transformation can even, at times, lead clients to notably new attitudes toward life in general; an attitude of humility and wonder, or sense of adventure that can fruitfully be termed “awe-inspiring” (Schneider & Krug, 2010).
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