James Bugental and Irvin Yalom
Two Masters of Existential Therapy Cultivate Presence in the Therapeutic Encounter
Orah T. Krug Existential-Humanistic Institute
James Bugental and Irvin Yalom, noted existential psychotherapists and educators, both emphasize a psychotherapeutic method that cultivates presence. This important yet difficult to define therapeutic method deserves greater clarification due to its role in effecting therapeutic change. The present study compared Bugental and Yalom on selected presuppositions that relate to the cultivation of presence in order to explore their influence on each man’s practice of existential psychotherapy. a psychobiographical framework illuminated how their personal experiences influenced the formation of these presuppositions. The present study revealed that the different presuppositions, which Bugental and Yalom hold about existential psychotherapy, influence each therapist’s theoretical understanding of the cultivation of presence, which in turn shape how each practices existential psychotherapy. although both therapists concentrate more on process than on content, Bugental usually attends to the intrapersonal processes of the client whereas Yalom often attends to the interpersonal processes. The findings of the present study help explain current research related to the significance of contextual factors in the therapeutic endeavor. The findings also highlight the importance of clarifying therapeutic presuppositions and assumptions. Finally, the findings illuminate the benefit of integrating intrapersonal and interpersonal approaches.
Keywords: James Bugental; Irvin Yalom; intrapersonal presence; interpersonal presence; existential psychotherapy; contextual factors
I have been practicing psychotherapy from an existential–humanistic perspective for almost 30 years. For nearly 20 of those years, I have learned my craft from two masters in the field of existential–humanistic psychotherapy: James Bugental, PhD and Irvin Yalom, MD. Both have significantly influenced my work and my life.
James F. T. Bugental, PhD, was one of the founders of humanistic psychology along with Rollo May, gordon allport, abraham Maslow, and Carl Rogers. His writings, in particular Search for Authenticity (1965, 1981), provided intellectual inspiration and legitimization to this third wave of psychology in the United States (DeCarvalho, 1991). a psychotherapist for nearly a half century, Bugental has authored numerous books and articles exploring the practice and teaching of existential–humanistic psychotherapy. My association with the late James Bugental began in 1987, when he closed his private practice and turned his attention to teaching and training.
The field of psychology recognizes Irvin Yalom, MD, as a master therapist whose contributions include two classic texts, The Theory and Practice of Group Therapy (1975) and Existential Psychotherapy (1980). Professor emeritus in psychiatry at Stanford Medical School, Dr. Yalom practices in Palo alto, where he lives, and in San Francisco. My association with Irvin Yalom began in 1994 as a member of his consultation group.
Each of my mentors has contributed to the field of existential psychotherapy in numerous ways (Cooper, 2003; Schneider & May, 1995; van Deurzen-Smith, 1997). One notable contribution is their articulation of a psychotherapeutic method, the purpose of which is to illuminate here-andnow processes emerging in the therapeutic encounter. The current study compares the ways in which Bugental and Yalom theoretically understand this method. The phrase here-and-now refers to what is emerging, in the here of the therapy room and the now of the immediate moment. Yalom specifically uses this phrase in his texts on psychotherapy (1975, 1980, 1998, 2002), Bugental does not, but refers to the work in a similar way; that is, he talks about illuminating what is “in this room in this now” (Bugental, 1999).
I have chosen to call this method the cultivation of presence. The name not only implies the here-and-now, but also describes a therapeutic attitude, that of cultivating as well as a therapeutic intention that of expanded presence. Thus, the name meets two important requirements: It comprehensively describes the method and by including presence in the name, it anchors the method in existential therapeutic theory.
Presence is a fundamental principle of existential therapy and is considered by many existential theorists to be central to effecting change (Bugental, 1987; Friedman, 1985; May, 1958; Schneider & May, 1995; Yalom, 2002). These theorists believe that presence plays a vital role in the development of a healing environment and a safe and intimate therapeutic relationship. Meta-analytic research confirms that such contextual factors as opposed to specific treatment techniques, are primarily responsible for helping people change (Wampold, 2001). Moreover, in a recent book review, Wampold (2008) concurred with noted existential theorist, Kirk Schneider, suggesting that the principles of existential therapy may be “needed by all therapists, as it adds a perspective that might . . . form the basis of all effective treatments."
Even though presence is fundamental to existential therapy and related to these contextual factors, it remains vaguely understood and loosely defined (Geller & Greenberg, 2002). The literature typically describes it in regards to the capacity of the therapist to be deeply connected to self and/ or to self and other (Cooper, 2005; Friedman, 1985; geller & Greenberg, 2002; Schneider, 2003). It is suggested here that Bugental and Yalom articulate an expanded conception of being present that includes, but goes beyond, experiences or moments of deep connection with self and other.
Their approach assumes not only that each person is related to self, to other, and to the physical world, but also that each person’s past is present in the here-and-now. Using these assumptions as a basis for their work, Bugental and Yalom typically focus more on the unfolding processes to cultivate presence than on the objective content, with the intention of illuminating the client’s underlying subjective constructs of self and world. The term self and world constructs refers to how the client implicitly understands and manifests through behaviors and attitudes his or her own nature and relationship to the world. Existential therapists understand people as a beings-in-the-world who construct their physical, personal, and relational worlds from their individual experiences and circumstances in the world. The in-the-moment illumination provided by the therapist is an opportunity for the client not only to experience a deep connection with self and other but also to experience how specific behaviors and/or attitudes block him or her from these deeper connections.
This intentionality to illuminate unconscious behavioral and attitudinal patterns by a focus on process distinguishes their work and expands the definition of therapeutic presence. each has written extensively on the merits of working in this way (Bugental, 1976, 1978, 1981, 1987, 1999; Yalom, 1975, 1980, 1989, 1999, 2002). The cultivation of presence requires the therapist to identify “what is implicitly present but unregarded” (Bugental, 1999, p. 23). For Bugental and Yalom, the cultivation of presence is not didactic or theoretically abstract; it is instead experiential and concrete. Because they both believe that a person’s way of being in therapy is a reflection of how that person is in his or her life (Bugental, 1999; Yalom, 2002), they attend to and illuminate what is implicitly and explicitly happening in the present moment. Bugental has noted the challenging nature of this method. “It does not just accept and encourage; it helps the client face the implicit and often unrecognized contradictions within his or her own outlook” (Schulenberg, 2003, p. 275).
For instance, if a client embodies childlike attitudes and behaviors and relates to the therapist as a parent, the existential therapist would not likely explain this to the client. Instead, the therapist would carefully and respectfully illuminate aspects of the client’s subjective and intersubjective experiences that are manifesting in the present moment such as, “your voice is so soft and little right now” (subjective) or “you seem to be asking for my advice (intersubjective).”
Yet what they are present to in the here-and-now is often quite different. Bugental’s focus on process is typically subjective or intrapersonal. This means he is keenly attending to what is “subjectively alive in the now” (Bugental, 1999, p. 37). “You hesitated just then” or “it’s sometimes hard for you to show your feelings” (p. 143). When working with Bugental in a roleplay, I experienced his presence as only inches away psychically. His lack of reference to our relationship did nothing to diminish my sense of his empathic and sensitive presence; he was like a mirror, reflecting me back to myself.
Yalom’s focus on process is typically interpersonal or intersubjective, which means that he is closely attending to what is happening relationally. In fact, Yalom defines process exclusively in interpersonal terms. “What do the words (and the nonverbal behavior as well) tell us about the nature of the relationship between the parties engaged in the interaction?” (Yalom, 2002, p. xviii). Thus, he might say, “as much as I enjoy hearing your stories, they seem to create distance between us, and I want to be closer to you.” In consultation with Yalom, I have frequently experienced his skill and care in addressing our relationship issues.
It is interesting to note that Bugental’s focus on the subjective realm and Yalom’s focus on the intersubjective realm articulates the divergent thinking of existentialists regarding what helps a person expand their authenticity and realize their potential. It has been a challenge to integrate their different perspectives into my clinical practice. In doing so, I have come to appreciate how an approach, integrating both perspectives, can create an even more effective context for change by providing clients with multifaceted experiences of their subjective and relational ways of being. Moreover, as a result of my work with them, an intriguing question developed which drove this research.
Purpose and Statement of the Problem
The purpose of this study is to explore the following question: Why are Bugental and Yalom frequently present to different processes even though they are similarly devoted to cultivating presence in the here-and-now? The thesis advanced here is that the basis for Bugental’s focus on intrapersonal processes (though not exclusively) and Yalom’s focus on interpersonal processes (though not exclusively) is their respective presuppositions. The study draws from their published work on this topic and on the researcher’s consultative work with them. The intention is not only to compare their presuppositions but also to begin to understand how their presuppositions influence their attention to different aspects of the therapeutic process and to explain the origins of their approaches.
To achieve this, their presuppositions are compared on five dimensions of existential therapy. The five dimensions are (a) the essence of human beings and their existential predicament, (b) the central aim of existential therapy, (c) the meaning and value of working in the here-and-now, (d) the role and focus of attention for the therapist, and (e) the value of the therapeutic relationship.
The choice of these five dimensions was influenced by Corsini and Weddings’s Current Psychotherapies (1995) in which they chose to compare current psychotherapies along similar dimensions, that is, therapeutic theory and therapeutic process. By loosely applying their selected dimensions to a comparison of Bugental’s and Yalom’s perspectives on existential therapy, the five aforementioned dimensions emerged. The inclusion of the last four dimensions was also influenced by the fact that both Bugental and Yalom (Bugental, 1978, 1987, 1999; Yalom, 2002) examined similar dimensions when considering aspects of the therapeutic encounter.
The first dimension—the essential nature of human beings and their existential predicament—deserves some elaboration because of its significance in the present study and some readers may not be familiar with it. It is a concept developed by Paul Tillich (1962), the noted theologian and philosopher, who argued that existential psychotherapy has erred by concentrating predominately on the existential predicament and not sufficiently on essentialist thought. In the essay, he proposes a philosophical foundation for psychotherapy in which essentialist and existentialist thought coexist in a complementary dialectic relationship. Tillich suggests that the nature of human beings aptly reflects the essential/existential dialectic saying, “One can describe man’s essential nature and one can describe man’s existential predicament” (p. 39).
According to Tillich, an aspect of human beings essential nature is their power to create themselves. This power is possible because all human beings have the freedom to choose and he suggests that there is an essential structure to this power. He calls this aspect of human nature, “an essentialist doctrine of freedom” (Tillich, 1962, p. 40). The existential predicament of human beings is related to their essential nature in the particular way that each individual chooses to relate to the givens of existence. For example, in psychotherapy we see individuals who are acutely anxious and deeply estranged from self and others, reflecting their particular way of choosing (unconscious though it may be) to constrict and/or block their awareness of the givens of existence, such as death or isolation.
Tillich (1962) argues that if the practice of psychotherapy recognized this contrasting union of essentialism and existentialism, it could more adequately describe the relationship between the essential nature of human beings and their existential predicament. Tillich insightfully illustrated this view, saying, “in order to understand estrangement . . . [we] must understand that from which we are estranged, namely our own essential nature” (p. 42). Tillich’s perspective has great merit—a focus on essentialist thought does indeed need to be a part of psychotherapeutic theory as much as existential thought. Consequently, this dimension is included to facilitate an examination of the extent to which the presuppositions by Bugental and Yalom recognize this union of essentialism and existentialism in existential psychotherapy.
Rationale and Significance
Several motives fuel this research. although presence as a construct is fundamental to existential therapy and is considered by many a key element in effecting therapeutic change, the research indicates (as already noted) that the concept is difficult to define and understand. Consequently, an exploration of how these two masters cultivate presence may enhance our understanding of this important construct and the ways in which it effects change. My personal experience as a student of both Bugental and Yalom provides an unusual vantage point for this exploration. Their perspectives on cultivating presence—as found in their published texts—can be filtered through a personal as well as scholarly lens.
In addition, it is hoped that an important factor in the education and training of existential psychotherapists will be addressed, that is, the need for therapists-in-training to be aware of their own presuppositions with respect to, for example, the dimensions explored in this essay. This awareness is important to discern which issues and which approach may be most relevant to a particular patient. Without this clarity, the therapist is like a navigator without a compass. Bugental and Yalom are well able to navigate the murky therapeutic waters because each has a finely honed internal compass that points him towards what cultivates change and a sense of how to facilitate that change. To explore these questions, the remainder of the article will compare the presuppositions of Bugental and Yalom on the aforementioned five dimensions.
Bugental’s Presuppositions Related to Existential Psychotherapy
The Essence of Human Beings and Their Existential Predicament
If Paul Tillich (1962) is correct in suggesting that a focus on essence is as important as a focus on existence, then James Bugental’s work has made a significant contribution in that direction. Bugental’s focus on intrapersonal process is grounded in his rather radical presupposition that we are essentially a process and not a substance.
The essence of my being is that I am subjective awareness continually in process . . . In short, I am no thing, nothing. I am solely the process of my being—as an example, I am the process of writing these words, but I am not the content of the words or the ideas they express. I am the being aware of writing, the choosing of ways of expressing thoughts, the hoping for communication, the enjoying of the emergence in thoughts and images of what I have experienced. (Bugental, 1976, p. 14)
Bugental’s perspective of “self-as-process” has obvious and significant implications regarding the fundamental structures of human existence. although he never elaborated on the structure of this essential process, a number of philosophers, including alfred N. Whitehead, have. I do not know if Bugental was aware of Whitehead’s process philosophy, but Whitehead’s focus on the structure of experience provides a solid philosophical foundation for Bugental’s perspective on self-as-process and not as substance (Whitehead, 1978). It is beyond the scope of this study to elaborate on Whitehead’s metaphysics and its potential contribution to existential psychotherapy but such a study by this author and Victor goulet is currently underway.
In 1963, as president of the newly formed association of Humanistic Psychology, Bugental (1963) suggested five basic postulates regarding human essence: (a) man, as man, supersedes the sum of his parts; (b) man has his being in a human context; (c) man is aware; (d) man has choice; and (e) man is intentional. His focus on people as aware, free, and capable of choice was a reaction to the reductionistic and positivistic theories of behaviorism and psychoanalysis.
As result of his more humanistic perspective, Bugental did not often focus on the existential predicament (i.e., awareness of the facts of existence) in his writings. Instead, his focus on the self-as-process leads him to understand the central problem for those in therapy to be self-alienation because of a psychological split.
Self-alienation, Bugental believes, leads a person to live a life similar to that of a prisoner who is driven by a suspicious and relentless keeper. The person is split into a tyrannical boss and an untrustworthy worker who continually strives to do more, to do it better, to prove self against an impossible standard. (Bugental, 1978, p. 127)
Bugental does acknowledge the existential predicament, in that, as this person experiences himself or herself as a process and not a fixed substance, he or she will be “on the verge of a terrible emptiness and a miraculous freedom” (Bugental, 1978, p. 133). But his focus is not primarily on accepting the limitations and tragic aspects of existence, but rather, on accepting the fact that our identities are solely as processes and that we arbitrarily construct our world. Once persons open to that awareness they recognize that they can choose to remake their lives (pp. 134-135).
Bugental has suggested that his belief in self-as-process came as a result of his observations that one could never completely grasp a person, that there was always something more occurring within that person in the next moment. He assumed that when he took his first college psychology course he would be better able to understand the something more. He was disappointed; in fact, it seemed the psychology course, instead of explaining the something more, made something less of people (Bugental, 1987). “The world of something more is the subjective world,” about which, according to Bugental, we know so little, and yet it is our homeland (p. 19).
The Central Aim of Existential Therapy
Bugental’s presupposition about self-as-process significantly influences his perspective on the central aim of existential therapy. He aims for internal wholeness (Bugental, 1978, p. 124), to repair the split and alienated self by recovering the “lost sense of being” (Bugental, 1976, p. 10). He believes that when the sense of being is recovered, when there is internal wholeness, people are freed from the bonds of “fear, guilt, shame and conflict” (Bugental, 1978, p. 106). He is absolutely certain that the way to recover one’s lost sense of being is to concentrate almost exclusively on inner awareness, to discover one’s “I-ness” (Bugental, 1976, p. 5). “Presence is the sine qua non of most depth or life-changing psychotherapy” (Bugental, 1983, p. 1). Over and over again in his writings we find this conviction. The following are but a few examples. “Centrally important . . . is heightening the client’s own immediate and subjective awareness” (Bugental, 1999, p. 23). “Increased awareness of ourselves in the living moment means increased effectiveness of self-direction and increased satisfaction in living” (Bugental, 1999, p. 24). a person who does this work is able to live in their “truer nature” (Bugental, 1978, p. 114).
It is very interesting to note that Bugental’s perspective on what needs to heal (self-alienation) and the way of healing (focusing on inner awareness) has its roots in his relationship with himself and others. In The Search for Existential Identity (1976), he shares his own experiences of growing up in a home where his mother was cold, aloof, and withholding of love. To win back her acceptance, he would promise to be good and be right. Father was loving but undependable because he drank. Bugental grew up feeling that he had to hide his secret self, which he believed was shameful because it was sexual, emotional, and unpractical, in other words, not right. “It want[ed] to play when I forced it to work” (p. 280).
Bugental’s (1976) sense of self was split between a tyrannical boss and an untrustworthy worker, resulting in significant self-alienation. “I was never taught to listen within myself. Instead, I was taught to listen to the outside—to parents, teachers, Boy Scout leaders” (p. 283). One can easily understand why, given Bugental’s personal experiences, he values inner awareness, over and above awareness of others. as we shall see, this belief in the primacy of the subjective, which apparently has roots in his childhood, became the guiding light for his therapy. Humans have their being in a human context, but for Bugental, this fact may pose a serious problem: Interpersonal experiences can result in alienation from self.
The Meaning and Value of Working in the Here-and-Now
Bugental’s belief in the healing power of inner awareness requires a therapeutic approach that heightens the client’s subjective awareness in the immediate moment (Bugental, 1999, p. 23). “The process of being aware is itself the creative, growth-evoking process” (Bugental, 1976, p. 289). Working in the here-and-now meets that requirement because it assumes that “what is actual is what is in this room, in this now” (Bugental, 1999, p. 20). For Bugental, cultivating presence means a focus on the clients subjective processes, listening less to what is said, and more to how and when the saying occurs; his aim is to have the person in therapy recognize their actual but unregarded ways of being that are avoidant or distortive and begin to take responsibility for their life choices.
To do this, Bugental focuses almost exclusively on his client’s intrapersonal processes and the inner stream of awareness.
The great bulk of my attention during the hour is directed to the processes of the client’s activity rather than to the content. I am concerned to assess the degree to which my partner is genuinely present—accessible to the inner stream of awareness and expressive of all that is found there. (Bugental, 1978, p. 106)
It is evident from these quotes that genuine presence for Bugental means accessibility to subjective awareness and an ability to express what is found there. He frequently stresses the importance of the therapist’s own presence as critical for a successful outcome (Bugental, 1978, p. 40). But what he does not acknowledge is the influence of the therapist’s presence on the client’s inward presence; is not the client’s stream of awareness to some extent influenced by the therapist? Similarly, he does not seem to value a focus on the interpersonal; yet does not a focus on the relational or interpersonal often deepen that which is intrapersonal?
The skill of subjective searching (i.e., the ability to access and express inner experiences) is for Bugental the primary means for dissolving blocks constricting inner awareness.
as the client is encouraged to search inwardly . . . he will demonstrate how he sees his own nature . . . [T]he difficulties the client experiences in trying to use the hour optimally are probably expressions of ways the client structures his life generally. (Bugental, 1999, p. 86)
Patterns and layers of resistance are revealed in the searching process (Bugental, 1978, p. 51). as the blocks are revealed and dissolved, the major work, according to Bugental, has been done, because now the client experiences herself as a subject and not an object. a client-as-subject can “claim her own power, which has been latent all along” (Bugental, 1999, p. 24). Moreover, the skill of searching provides the client with “lasting access to inner awareness and thus the potential to enrich life long after the therapy is terminated” (Bugental, 1978, p. 122). The fact that Bugental believes the key to significant life change is found in recovering one’s centering of life in subjective awareness helps explain why Bugental has a primarily intrapersonal focus with his clients.
Bugental says (Schulenberg, 2003), that his approach was influenced by Carl Rogers and Roger’s student, Victor Raimy, who was Bugental’s doctoral thesis advisor. In addition, Bugental was influenced by the work of george Kelly and more personally by george Frumkes, his analyst. Bugental said,
My experience in analysis definitely contributed particularly to my emphasis on present tense . . . When I worked with george, I decided to be on the couch and he encouraged me to pay attention to the stream of awareness that came to me as I lay there. (Schulenberg, 2003, p. 280)
The Role of and Focus of Attention for the Existential Therapist
Bugental describes his role as a coach: “We are not consultants on how to live . . . we can be coaches for clients doing their own life work, using their own innate capacity” (Bugental, 1999, p. 89). In conversations, Bugental likened his role to that of a track and field coach who, running along side the hurdler, helps him maintain his form. “My function is that of being my client’s ally, of supporting the client’s effort to be authentically present and effectively self-exploring” (Bugental, 1978, p. 106). as the client engages in the search process, he becomes aware of self-defeating patterns of behavior. These patterns are part of his self and world construct system (“that is—how the client implicitly defines himself and the nature of the world in which he lives” [1978, p. 87]). They serve to protect him but also limit his ability to experience himself as subject and not object.
Bugental (1999) believes “the central focus of the therapist’s stance is the client’s self-governance, the ways in which the client is self-defeating, and how the client uses his own powers for his own best interests” (p. 89). The therapist’s “core of attention is to the actual, for the therapist seeks to identify in the living moment the ways in which the client ill serves his own fulfillment” (p. 89). Here are some examples of how Bugental attends to what is actual but implicit in the client. “Your feelings are at war, the impatience attacking the sadness . . . You sound very distant as you say that” (pp. 20-21). These examples illustrate Bugental’s subjective versus relational focus. “For the kind of work I am concerned with, the primary locus must be within the client’s own experiencing for the bulk of our time” (Bugental, 1978, p. 107).
Bugental acknowledges that there is a time during which the relationship is the appropriate concern, but he stresses this is only after “the client has gained a strong hold on the skill of inward searching” (Bugental, 1978, p. 107). Furthermore, he seems to regard a focus on the relationship or on himself as a necessary but not very valuable diversion from the real work of inward searching. “[W]e must deal with these intrusions [italics added] before anything else” if a client has difficulty staying with the inward searching process (p. 107). That said, the reader may get the impression that Bugental is somewhat cold and distant as he works. Nothing could be further from the truth. Working in consultation with Bugental on my own issues, I have always felt his care and genuine engagement in my struggles. He believes this kind of engagement makes possible his ability to tune into the “implicit, the deeply subjective, and the nascent” (1978, p. 114). However, in these experiences with Bugental, it must be said that I was not encouraged to attend to what was happening between us.
The Value of the Therapeutic Relationship
The statements by Bugental mentioned above indicate that he does not see focusing attention on the therapeutic relationship as an especially effective means for accelerating the healing/growth process. In fact, he appears to regard attention on the interpersonal as more of a diversion from the real work rather than a valuable method for facilitating change and growth. “Too active a therapist participation . . . can disrupt the client’s immersion in self-exploration” (Bugental, 1978, p. 90). Here again, although this statement is true to a degree, Bugental does not acknowledge the implicit influence a therapist has on his client’s self-exploration, nor the benefits that can be derived from relational exploration.
If the therapeutic relationship is not central to the healing/growth process for Bugental, how then does he relate to it? He understands it as a partnership in which the therapist is facilitating his partner’s self-exploration so that the partner’s constricting blocks can be dissolved. “The ideal relationship for client and therapist is the one which will most facilitate client inner exploration . . . The work of client and therapist is that of freeing the former’s awareness of encumbering armor” (Bugental, 1978, p. 63). The qualities of an ideal existential therapeutic relationship include: mutuality, honesty, respect, dynamism, vitality, and trust (pp. 66-71).
Even though Bugental believes it is terribly important for the therapist to be aware of the state of the relationship, he does not advocate explicitly asking that question. “I seek and count on an understanding that is rarely expressed in words” (Bugental, 1978, p. 105). He acknowledges that “care is itself a healing influence” (p. 115) but does not give it the weight that he gives to cultivating subjective awareness. He seems to interpret the feedback he receives from clients about his steady caring not as a contributor toward healing per se, but rather as a way to model how to care for oneself (p. 114). Interestingly, at least one client differs with him on that point. “Let’s face it, Jim’s feelings about me were and still are, the most important part of our work together, maybe the only part. He liked me” (quoted in Bugental, 1978, p. 118).
Yalom’s Presuppositions Related to Existential Psychotherapy
The Essence of Human Beings and Their Existential Predicament
Yalom’s presupposition about essence acknowledges the five humanistic postulates that Bugental articulated in 1963 (Yalom, 1980, p. 18), but he does not conceptualize the self-as-process as does Bugental. Instead, he puts forth a dynamism called “existential psychodynamics” (Yalom, 1980).
“Existential psychodynamics” stands in contrast to Freudian psychodynamics. “The existential position emphasizes a different kind of basic conflict: neither a conflict with suppressed instinctual strivings nor one with internalized significant adults, but instead a conflict that flows from the individual’s confrontation with the givens of existence” (Yalom, 1980, p. 8). By givens Yalom refers to certain facts of human existence which he calls concerns: death, isolation, freedom, and meaninglessness. “The individual’s confrontation with these facts of life constitutes the content of the existential dynamic conflict” (p. 8).
Yalom believes that awareness of these concerns leads to existential anxiety and guilt. Yalom’s perspective on self-awareness is darker than Bugental’s. He focuses more on “human limitations and the tragic dimensions of existence” (Yalom, 1980, p. 19). In that regard, he aligns more with existentialist thinkers than humanistic thinkers in believing that every individual will, to some extent, mute his or her awareness of these ultimate concerns to cope with the unwanted existential anxiety and guilt. This muting of awareness results in “specific defenses . . . which arise to serve the specific function of coping with each of the primary existential fears” (p. 10). Yalom believes that people will often seek therapy if they experience a significant level of despair in regard to their human condition.
It is interesting to note that Yalom’s darker focus on the inherent tragedies of existence may have been influenced by the near loss of his father at an early age. as a child, Yalom was very close to his father and more distant from his mother. He describes how he enjoyed warm moments with his father, playing chess with him on Sunday mornings; he said he rarely shared a warm moment with his mother whose anger he disliked (Yalom, 1999). In private conversation and in his interview with Ilene Serlin (1999), Yalom describes how his focus on aspects of existence was definitely influenced by the writings of Rollo May. as a young psychiatric resident, at analytically oriented Johns Hopkins in 1958, he met Rollo May “in spirit through his writing.” Yalom said that Existence (May, 1958) revealed “another whole unexplored wing of the edifice of psychotherapy . . . I think it changed me in a very significant way” (p. 142). after that, Yalom began his philosophical education, taking undergraduate philosophy courses at Johns Hopkins.
His interest in developing an existential approach to therapy is evident in the choices he has made throughout his professional life. He has led research studies at Stanford with terminal cancer patients, the elderly, and the bereft; this has provided him with opportunities to work with or teach students how to work with people experiencing intense existential pain. When his work with cancer patients began to trigger his own death anxieties, he sought therapy with Rollo May. His relationship with May, first as a patient, later as a friend and colleague, lasted until May’s death. Yalom has described how May’s determination to face his deteriorating condition courageously, deeply inspired him.
The Central Aim of Existential Therapy
Yalom believes that people in therapy fall into despair “as a result of a confrontation with the brute facts of the human condition” (Yalom, 1998, p. 43). This despair results not from a split self (which is Bugental’s presupposition), but from the individuals inability to bear existential predicaments. Thus, for Yalom, the central aim of existential therapy is “to de- repress, to reacquaint the individual with something he or she has known all along” (Yalom, 1980, p. 16). This process has two parts. The first is to “encourage the individual to look within . . . to attend [and to accept] his or her existential situation” (p. 14). This confrontation “is painful but ultimately healing” (p. 14).
But acceptance of responsibility for one’s life is not enough for Yalom. at this point, the person has only entered the “antechamber of change” (Yalom, 1998, p. 73). For real change to occur the person has to act, to behave differently in the world. Thus, the real work of therapy begins when the therapist embarks on an effort “to transform a sense of personal dissatisfaction into a decision to change and then into the act of change” (p. 73).
For Yalom, the act of change involves will. “The intrapsychic agency that initiates an act, that transforms intention and decision into action, is will. Will is the primary responsible mover within the individual” (Yalom, 1998, p. 73). Like Rollo May and Otto Rank, Yalom believes the therapist’s role is not to create will but to “remove encumbrances from the bound or stifled will of the patient” (p. 74). When will is disencumbered, the person accepts his or her own agency and no longer tries to change the environment instead of himself or herself (Yalom, 2002, p. 147).
Yalom’s belief that the central aim of existential therapy is to re-acquaint the individual with something he or she has known all along is evident in his text of case studies, Love’s Executioner (1989). In fact, the title alludes to the way in which Yalom concentrates his efforts on helping clients dissolve the illusions they have constructed to avoid facing the realities of existence: Thelma’s obsession with her former therapist so as to avoid the reality of death and disintegration, Betty’s gay and entertaining way of being to avoid her feelings of emptiness and isolation, and Penny’s neurotic guilt over not being present when her daughter died to avoid facing her real guilt over the neglect of her two sons. Over and over in these case studies we appreciate Yalom’s refusal to ignore these self-destructive illusions and instead to root them out so as to free his clients from their constricting bonds.
Yalom has a third perspective on what needs to heal and grow that comes from his training and interest in group therapy. “I have generally stressed that my interests in group psychotherapy and existential psychotherapy are separate and discrete: Not only do the therapies have different formats . . . but they operate from different frames of reference” (Yalom, 1998, p. 43). Yalom was trained at John Hopkins by Jerome Frank, a master of group psychotherapy and was influenced by neo-Freudians such as Horney and Sullivan. as a result, he assumes from a group psychotherapy perspective that “patients fall into despair because of their inability to establish and maintain stabilizing and intimate relationships with others (p. 43). Thus, from this perspective, another task of the therapist is to illuminate for clients how their ways of relating are insufficient or destructive and help expand their capacity for intimate relationships.
Although it is true that these therapies operate from different frames of reference, I must take exception with my mentor if he assumes that existential philosophy and existential therapy do not include a focus on one’s relationships with others. One only needs to look to the relational perspectives of several existential thinkers, including Buber (1937/1970) and Marcel (1995). Yalom’s own mentor, Rollo May (1983), specifically references Heidegger’s existential perspective regarding “three simultaneous aspects of world—which characterize the existence of each one of us as being in the world” (pp. 126-127). There is the Umwelt, or the environment, the Mitwelt, or the world of interrelationships with human beings, and the Eigenwelt, or our own world, which not only presupposes self-awareness and self-relatedness, but is the basis on which we relate to the real world. “The human being lives in Umwelt, Mitwelt, and Eigenwelt simultaneously. They are by no means three different worlds but three simultaneous modes of being in the world” (p. 129). May points out that even though
Mitwelt and interpersonal theory should not be identified, Mitwelt and interpersonal theory have a great deal in common. The danger at this point, however, is that if Eigenwelt in turn is omitted, interpersonal relations tend to become hollow and sterile. (p. 130)
May’s statements certainly support the notion that when a therapist is focusing on the relationship in the here-and-now, he or she could be working from an existential or interpersonal orientation or both. Moreover, May’s reference to Heidegger’s modes of being-in-the-world provides further confirmation that an interpersonal focus is as much a part of existential therapeutic theory as is an intrapersonal focus. Not only are both intra- and interpersonal foci appropriate existentially, but May also argues that both are necessary so that neither mode of being is emphasized to the exclusion of the other.
Yalom’s interest in and focus on interpersonal difficulties—specifically on the isolation which many individuals in therapy experience—may be rooted in his personal experiences. In his texts he describes his childhood and teenage years as a period during which he experienced a good deal of isolation (Yalom, 1989). He grew up in racially segregated Washington, DC, as the only son in the only White Jewish family living in the midst of a Black neighborhood. He recalled how the Black kids would pick on him because he was White and the White kids would pick on him because he was a Jew. at a talk at the Jewish Community Center of San Francisco recently (2006), Yalom described how he sought refuge in the library and how books became his friends. These early experiences may have influenced his perspective on what needs to heal, and it seems to have influenced how he has chosen to live his life. It is apparent to me that even though Yalom takes pride in his significant professional achievements, he seems to take as much pride and put as much effort into his personal relationships as a husband, father, friend, and mentor.
The Meaning and Value of Working in the Here-and-Now
If for Yalom, what needs to heal and/or grow is (a) acceptance of the givens of existence and assumption of personal responsibility, (b) willful choice, and (c) increased capacity for intimate relationships, then a method of therapy that illuminates in the moment how the person is blocked in these ways is needed. Yalom (1998) firmly believes in the value of cultivating presence by working in the here-and-now. [The] “here-and-now approach . . . is the signature of my particular approach to therapy, both individual and group therapy” (p. 43). “The here-and-now is the major source of therapeutic power, the pay dirt of therapy, the therapist’s (and hence the patient’s) best friend,” (Yalom, 2002, p. 46). In Love’s Executioner (1989) he continually points to the ways in which a therapist gains leverage by working in the here-and-now. The here-and-now, according to Yalom, refers to
The immediate events of the therapeutic hour, to what is happening here (in this office, in this relationship, in the in-betweeness-the space between me and you) and now, in this immediate hour. It is basically an ahistorical approach and de-emphasizes (but does not negate the importance of) the patient’s historical past or events of his or her life. (Yalom, 2002, p. 46)
Interestingly, Yalom’s definition of what it means to work in the hereand-now is similar to Bugental’s, in that its focus is on the now, that is, on the immediate present moment rather than on the past. Yet he defines the here differently than does Bugental. Like Bugental, Yalom’s here is in the office but here is not a concentration on the client’s intrapersonal process; instead it is a concentration on the interpersonal process occurring between the therapist and client (Yalom, 2002, p. xvii.) Yalom defines process primarily in terms of the interaction. Consequently, working in the hereand-now for Yalom, unlike for Bugental, means illuminating expressions of the individual’s self and world construct system as it manifests in the relationship.
Yalom’s rationale for working in the here-and-now rests on several assumptions which come from interpersonal, not existential, theory, but which he combines with existential theory in his individual therapy. “I value the entire range of therapeutic factors, but I place particular importance on interpersonal learning (and its accompanying here-and-now focus)” (Yalom, 1998, p. 42). The first assumption is that many people who come to therapy are suffering from an inability to establish and maintain satisfying relationships. The second is that therapy is a social microcosm, which means that “eventually the interpersonal problems of the patient will manifest themselves in the here-and-now of the therapy relationship” (Yalom, 2002, p. 48). The third assumption is that working in the here-and-now cultivates the therapeutic relationship by enriching the in-betweenness of therapist and patient (Yalom, 1998, p. 428). The final assumption is that working in the here-and-now allows the existential therapist to illuminate how the existential issues such as personal freedom and assuming responsibility for oneself are influencing “the nature of the relationship of the therapist and patient” and are affecting “every single therapy session” (Yalom, 2002, p. xviii).
The Role of and Focus of Attention for the Existential Therapist
Yalom’s conceptualization of his role as a therapist is that, “[w]e are all in this together and there is no therapist and no person immune to the inherent tragedies of existence” (Yalom, 2002, p. 8). He states, “[t]his tragic but realistic view of life has long influenced my relationship to those who seek my help” (p. 7). Consequently, he believes that the most accurate view of the therapeutic role is as a fellow traveler alongside his patients. This view eliminates the “distinction between ‘them’ (the afflicted) and ‘us’ (the healers)” (p. 8). This view of the therapist as fellow traveler would likely cultivate the reciprocal, bidirectional aspects of presence described by Buber (1937/1970), Cooper (2005), Marcel (1995), and Schneider and Leitner (2002). In abolishing distinctions between the afflicted and the healers, Yalom presupposes the necessity for the therapist to enter into an honest, intimate, and self-disclosing relationship with the patient. “Be real,” he admonishes; “an authentic human encounter in psychotherapy should never be sacrificed” (Yalom, 2002, p. 76).
“Therapists must convey to the patient that their paramount task is to build a relationship together that will itself become the agent of change” (Yalom, 2002, p. 34.) Yalom believes change and growth will only occur within the context of a safe and intimate relationship. It is within this safe and intimate relationship that “a great many of our patients [who] have conflicts in the realm of intimacy . . . obtain help . . . sheerly through experiencing an intimate relationship with the therapist” (p. 11). It is within this safe and intimate relationship that patients are able to face and accept the givens of existence and willingly choose to live differently. “The basic encounter provides presence and a ‘being-with’ in the face of harsh existential facts of life . . . There is a deep comfort from relating intimately to other fellow travelers in the world” (Yalom, 1998, p. 24). One can almost hear echoes of Buber (1937/1970) and Marcel (1995) in Yalom’s valuing the relationship and cultivating the realm of the in-between. Contrast this with Bugental’s perspective, “[o]ur homeland is within and there we are sovereign—Until we discover that fact anew . . . we are condemned to wander seeking solace where it cannot be found, in the outer world” (Bugental, 1978, p. 125). We can see from Yalom’s and Bugental’s statements how differently each values the therapeutic relationship. Yalom believes that the relationship provides the intimacy of being with a fellow traveler that allows and encourages the fellow traveler to face and accept the harsh realities of existence. In contrast, even though Bugental acknowledges the need for an intimate therapeutic relationship, he contends that solace cannot be found in the other but rather in oneself; thus he seemingly does not value a focus on the interpersonal as a method for cultivating change.
Yalom’s writings reveal a great deal of flexibility and comfort in moving his therapeutic focusing, from the client’s intrapersonal processes to interpersonal processes and occasionally to his own intrapersonal processes, depending on what is best for the individual in that moment. (Note again that Yalom defines process only in interpersonal terms. He uses the term psychodynamics when referring to intrapersonal processes; Yalom, 1980.). The following quotes provide a sampling of his flexible focus.
On being present to intrapersonal (psychodynamic) processes Yalom (1980) says, “[t]he proper method of understanding the inner world of another individual is the ‘phenomenological’ one (p. 24). Look out the other’s window . . . try to see the world as your patient sees it” (Yalom, 2002, p. 18). Moreover, Yalom encourages intrapersonal reflection by encouraging his clients to bring their dreams to therapy so that together they can explore the latent and implicit experiential world of the person in therapy.
On being present to interpersonal processes Yalom (2002) says,
Therapy is invariably energized when it focuses on the relationship between therapist and patient . . . human problems are largely relational . . . People fall into despair because of their inability to form and maintain enduring and gratifying interpersonal relationships. (p. 48)
This is true, but what is also true is one may fall into despair because of an inability to form an enduring relationship with oneself.
On being present to intrapersonal processes of the therapist Yalom (2002) says, “[I]t is counterproductive for the therapist to remain opaque and hidden from the patient. There is every reason to reveal oneself to the patient and no good reason for concealment” (p. 83).
It is important to remember that even though Yalom frequently shifts the focus of attention, it is ultimately in the service of cultivating more intimacy and safety in the therapeutic relationship. One of Yalom’s central presuppositions is that an intimate and safe therapeutic relationship is the real agent of change. This is why he always brings his focus and his partner’s focus back to what is happening in the in-betweeness. “Nothing takes precedence over the care and maintenance of my relationship with the patient, and I attend carefully to every nuance of how we regard each other” (Yalom, 2002, p. 11). He says he never lets an hour go by without checking into the relationship, sometimes with a simple statement like: “How are you and I doing today?” or “How are you experiencing the space between us today?” (p. 12). Yalom’s focus on the interpersonal is, as noted earlier, the signature of his particular approach to therapy.
The Value of the Therapeutic Relationship
It is apparent from the previous quotes that, for Yalom, the therapeutic relationship is the “sine qua non for effective therapy . . . [a] proper therapeutic relationship is characterized by trust, warmth, empathic understanding, and acceptance” (Yalom, 1998, p. 25). a proper and effective therapeutic relationship is built by a focus on the relationship as it lives in the here-and now. explanations “keep patient and therapist tightly connected while the real agent of change—the therapeutic relationship—is germinating” (Yalom, 2002, p. 176). The here-and-now focus germinates the relationship by enriching the in-betweenness of therapist and patient (Yalom, 1998, p. 428). Thus, for Yalom, the therapeutic relationship is the agent of change and a focus on the here-and-now builds it:
The therapeutic act of establishing a deeply intimate and authentic relationship, in itself, is healing. Such a relationship can become an antidote to loneliness and offer an internal reference point for patients, who learn that such intimacy is rewarding and that they are capable of attaining it. Furthermore, the work of creating and sustaining an authentic relationship with the therapist is often excellent modeling for the formation of future relationships in a patient’s life. (p. 428)
Summary of the Presuppositions by Bugental and Yalom
The Essence of Human Beings and Their Existential Predicament
Bugental’s central focus is on the experiencing subject whose truest identity is a process, not a fixed substance. This self-as-process is always searching and making meaning, constructing its world from its awareness. Bugental does not, however, emphasize the existential predicament. Yalom’s primary focus is not on the experiencing subject per se, but rather on how the experiencing subject is relating to the existential givens—that is, the subject’s existential predicament.
The Central Aim of Existential Therapy
The presuppositions by Bugental and Yalom concerning the essential nature of human beings and their existential predicaments significantly shape how each answer the question: “What needs to heal or change?” Bugental, influenced by a presupposition of self-as-process, believes that what needs to heal or change is self-alienation, which occurs because the individual is pushed around by internalized outside influences. Yalom, influenced by a presupposition that the givens of existence are rooted in existence, believes that what needs to heal or change is the underlying despair resulting from the individual’s inability to accept the human existential predicament. Both agree that the individual is somehow blocked, but their presuppositions about essence and existence lead them to focus on different approaches to heal this problem. Bugental emphasizes subjective awareness and expanding potential, whereas Yalom encourages acceptance of the existential limitations and activation of the will. Yalom’s interest in group therapy leads to another aim, which is to heal interpersonal difficulties. This goal stems from an assumption that an inability to maintain intimate relationships causes people to despair. The way to heal this despair is to illuminate destructive interpersonal patterns and to cultivate a capacity for intimate relationships by forming an intimate therapeutic relationship.
The Meaning and Value of Working in the Here-And-Now
One of the most striking aspects of this research was discovering why Bugental and Yalom understand what it means to work in the here-and-now so differently. although they both define this approach as a method that focuses more on process than on content, and as a method that cultivates presence, they define what they are with or present to quite differently. This is because Bugental seems to assume that process refers to that which is actual but unregarded within the client, that is, the client’s intrapersonal processes. Whereas, Yalom assumes that process refers to the interpersonal relationship between client and therapist. Yalom’s interest in the theory and practice of group psychotherapy has influenced his embrace of the hereand-now method with which it is associated. For Bugental, working in the here-and-now cultivates change because it illuminates what is actual but unregarded within the individual. Subjective awareness is expanded and the lost sense of being is recovered. But for Yalom, working in the here-andnow cultivates change because it illuminates existential issues of personal freedom as they manifest in the therapeutic relationship and encourages the individual to assume responsibility for his or her life; it cultivates the therapeutic relationship by enriching the in-betweeness.
The Existential Therapist’s Role and Focus of Attention
The perspectives of Bugental and Yalom regarding the therapist’s role and appropriate focus of attention were influenced by their presuppositions concerning essence and existence, what needs to heal, and what approach does heal. “Coach” Bugental is on the sidelines, focusing almost exclusively on how his “athlete” (client) is intrapersonally blocked from performing at his or her peak (searching with genuine presence). “Coach” Bugental encourages his “athlete” to keep faith with himself or herself and not attempt to seek solace in the outer world, because it cannot be found there. “Fellow traveler” Yalom sits alongside his traveling companion, encouraging him or her to face and accept the unacceptable, implying, “I too experience the tragic dimensions of existence—you are not alone—we are in this together.”
The Value of the Therapeutic Relationship
Another striking difference between Bugental and Yalom is the value they place on the therapeutic relationship as a means to accelerate change and growth. Bugental values the relationship as a necessary ingredient for the real work of therapy (expanding subjective awareness) to proceed smoothly, but he does not give it the prominent position that Yalom does. Yalom believes that a safe and intimate relationship with his patient is not simply necessary but is in fact the real agent of change.
Discussion and Conclusion
The Significance of Therapeutic Presuppositions
The present investigation reveals that personal experiences did influence both Bugental and Yalom with regard to the formation of their presuppositions. This finding suggests how important it is for therapists to examine their personal experiences because these may influence the formation of their presuppositions, which in turn shape how they work with clients. Such an examination grounds a therapist in his or her work by clarifying the rationale for using a particular approach. This awareness can also broaden perspective and guide a therapist to adapt and individualize the approach to each client’s specific issues. Bugental spoke often of the need for a steadying perspective, referring to it as a pou sto, that is, “a place to stand,” or “a base of operations” (Bugental, 1999, p. 85). I believe that to be an effective and skillful therapist, one must be grounded in one’s therapeutic assumptions and that this is more helpful than mastering a variety of therapeutic techniques.
Even though Bugental and Yalom work from somewhat different presuppositions, both have been extremely effective therapists. Why is this so? My sense is that each can navigate the often murky therapeutic waters with purposeful clarity because each is deeply grounded in his approach and therefore believes in its powers. a solid belief in their approach provides them with steady support as they attempt to dissolve the blocks that constrict and imprison. But to believe in one’s approach, as my two mentors do, one must first know, very specifically, what the basis and rationale for that approach is. examining one’s therapeutic presuppositions is the beginning of this process of understanding.
The Presuppositions of Bugental and Yalom and the Cultivation of Presence
The results of this investigation reveal that the presuppositions by Bugental and Yalom do influence their understanding of what it means to cultivate presence in the here-and-now, which in turn shapes how they practice existential psychotherapy. They share a number of similar presuppositions. For example, they both believe that working in the here-and-now is the most effective therapeutic method because what is actual in the room is what is real. Bugental and Yalom both believe that if the therapist consistently provides here-and-now experiences of self and world, the client will likely progress in self-awareness, self-direction, and assumption of responsibility.
However, the investigation reveals that Yalom and Bugental have a number of different presuppositions related to what constitutes change and what helps a person change and grow. If we compare their presuppositions on the nature of existential therapy through Tillich’s lenses, we see that each man emphasizes one-half of the whole. Bugental’s presupposition regarding self-as-process focuses his attention on the individual’s everemerging becoming. Yalom’s presupposition regarding the repressed self focuses his attention on de-repressing awareness of the harsh facts of existence. Thus, if we combine Bugental’s focus on essence and Yalom’s focus on the existential predicament, we create the union of essentialism and existentialism for which Tillich argued.
If we compare their presuppositions on what it means to work in the here-and-now, we can understand the difference in each therapist’s focus— that is, Bugental focus on cultivating intrapersonal presence and Yalom’s on cultivating interpersonal presence. One of Bugental’s most significant contributions to the field is his attention to the preverbal, kinesthetic, and tacit dimensions of subjective experience. One of Yalom’s most significant contributions is his attention to the development of a safe and intimate therapeutic relationship. Meta-analytic research indicates that these and other contextual or human factors of therapy are primarily responsible for explaining therapeutic effectiveness, leading the researcher to recently suggest that all therapists might benefit from an exposure to the principles of
existential therapy (Wampold, 2001, 2008). It is hoped that the present study has successfully illustrated the relationship between the cultivation of intra and interpersonal presence and these contextual factors, thus further clarifying how and why change occurs.
The present study reveals that Bugental’s and Yalom’s points of view contribute an exceedingly important element to this therapeutic endeavor. Indeed, as stated earlier, each viewpoint is one half of a whole. as May (1983) suggests, because Mitwelt (the world of interrelationships) and eigenwelt (the world of self-relatedness) are simultaneous modes of being neither should be emphasized to the exclusion of the other. each therapist’s approach focuses on cultivating a different dimension of personal presence— presence with self and presence with self and others. a person’s awareness of both dimensions allows for an appreciation of how intimacy with self as well as intimacy with other is limited. each focus is appropriate at different times and with different people depending on their psychological issues. It is essential that a therapist tailors the therapy to the needs of the client and when brought together, and applied appropriately, the personal and interpersonal are of optimal value to the therapeutic work. Thus, by integrating the intrapersonal approach of Bugental with the interpersonal approach of Yalom, the theory and practice of existential psychotherapy is enriched.
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