Being a Person Is Tough: Client-Centered and Existential Therapies - Building a Better You

Psychology For Dummies - Adam Cash 2013

Being a Person Is Tough: Client-Centered and Existential Therapies
Building a Better You

In This Chapter

Image Accepting the person

Image Facing death, guilt, anxiety, time, transcendence, and freedom

A 35-year-old woman, I’ll call her Mrs. Garcia, had recently attended her mother’s funeral and was having a difficult time going back to work and interacting with her family. She went to her family physician for fear that she may be depressed. Instead of putting her on medication, her family physician referred her to a psychologist.

Consider the following opening exchange between Mrs. Garcia and the psychologist:

Therapist: Hello, Mrs. Garcia, nice to meet you. Dr. Huang had mentioned that you’ve been having some trouble going to work and that you recently attended your mother’s funeral. Please, sit down.

Patient: Thanks. First of all, I want to say that I’m a little uncomfortable with this. I’ve been through psychoanalysis before, and I didn’t like it. My doctor was too impersonal and cold.

T: I’m sorry that you had a bad experience. Just so you know, I’m not a psychoanalyst. Would you like to talk about that experience?

P: Not really, not now anyway. I’ve been feeling pretty bad lately, really ever since my mother became ill. I’d go and help my sister take care of her and leave feeling this sense of doom and gloom. But I didn’t really feel sad about the fact that she was dying; she had suffered for a long time, and I accepted that her death would probably be a relief. It was her life, not her death, that seemed to be bothering me.

T: Her life was bothering you. You had accepted her death. Tell me more. You did not approve of her lifestyle?

P: Kind of. It was like she was living for everyone else, the boss, my father, us children, the grandchildren. I felt really bad about judging her, especially when I began to realize that I was living the exact same life.

T: You’ve been living the same way as your mother?

Mrs. Garcia’s feelings and experience are illustrative of the kinds of issues that practitioners of humanistic therapies (client-centered and existential) are concerned with. She’s questioning her life, her very identity, her sense of self. Who is she really living for? Is she being true to herself? Humanistic therapies approach human difficulties with the core tenets that humans are dignified, have choices, and struggle with life’s inevitabilities (death, illness, conflict, and so on), but have the freedom to make changes and address these difficulties with appropriate support.

Although each of them made unique contributions to the theory and practice of psychotherapy, the big names in humanistic therapy such as Carl Rogers, Rollo May, and Irvin Yalom all had one thing in common. Each of them saw great potential in all of us. They believed that all people strive for maximum development of themselves and their potential and take responsibility for their lives.

Many of the forms of psychotherapy I introduce in this book (psychoanalysis in Chapter 15 and behavior and cognitive therapies in Chapter 16) have been criticized for being too technical, sterile, or out of touch with the real experience of the patient or client. They’ve been accused of making too little room for the real person. The therapies discussed in this chapter all have the personhood of the patient seeking help as a central theme.

This section introduces humanistic and existential therapies that focus on the core issues of being a person and how a person struggles with, through, and around these issues.

Client-Centered Therapy: Shining in the Therapist’s Spotlight

Image Take a minute to do a little exercise. Get a piece of paper and a pen and make a list of all the people you admire and hold in a positive light. Who’s on the list — teachers, spouses, celebrities, parents? What about yourself? Are you on your list of people you positively regard? Would you be a member of your own fan club?

In this big, chaotic world of billions of people, sometimes it seems like I don’t matter, like my individual identity is so small, so insignificant. Yet I walk around with the sense of being an individual. Sometimes I feel so independent that I actually feel lonely and isolated, like no one cares about me. “What about me? Don’t I matter?”

Carl Rogers cared. Rogers (1902—1987) is perhaps one of the most famous psychologists of all time, nominated for the Nobel Peace Prize and considered on par with Sigmund Freud. His influence on psychotherapy has been profound. He put the person back into the process, attempting to understand and value each of his patients as unique individuals with real problems and not just as abstract theories and models. You can say one thing for sure about Carl Rogers’s client-centered therapy — it placed great value on the humanness of each and every patient. Rogers believed that all humans inherently strive toward the fullest development of their capacity to maintain an optimal level of survival. It’s kind of like the US Army slogan, “Be all you can be.”

Growth is a big buzzword for client-centered therapists. A patient’s personal growth is foremost in the therapist’s mind and central to the therapy process. Every time I read something from a client-centered perspective or something that Carl Rogers wrote, I start reflecting and asking myself, “Am I growing?” If you count my waistline, the answer is definitely yes. As far as that personal growth and expanding abilities stuff . . .

What does Carl Rogers’s belief in the inherent worth of each of his patients have to do with helping them get better? Are client-centered therapy patients paying for someone to like them, to value them? Maybe, but that would be a gross oversimplification. It’s more than an “I’ll love you until you can love yourself” therapy or “I’ll accept you until you can accept yourself.”

Image The healing or helping mechanism in client-centered therapy is found in the process of the therapist working to understand the patient’s unique experiences, thoughts, behaviors, and feelings. As the therapist strives to understand where the patient is coming from, the patient learns to experience herself in a new, and more productive, life-enhancing way.

Understanding theory of the person

Why would Carl Rogers think that making a genuine connection with his patient and really trying to understand what it’s like to be that particular individual has a helping or healing effect? The answer to that question may seem obvious: All of us like to feel understood. (See Chapter 10 for more on the importance of relationships.) Having people get what you’re about seems to give you a sense of well-being, a feeling of being more alive and present against the backdrop of a dark and uncaring world.

Wanting to be understood

Although he’s not considered a client-centered therapist, Eric Fromm introduced a concept that attempts to explain why being understood is so important to everyone. Fromm believed that people all make constant attempts to check their perceptions and experiences against the perceptions and experiences of others, particularly people whose opinion is of value. You may have heard of the concept of a reality check — like asking someone if she just saw the UFO land in the field next to the highway. “Did you just see what I just saw?” If the other person saw it too, you experience something Fromm called validation. Validation is the experience of having someone concur or support your experience of reality. Validation brings a sense of presence; it makes you feel like you exist. According to Fromm, without validation, people would feel as if they didn’t exist.

Have you ever talked to someone when she wasn’t getting what you were trying to say, like she didn’t understand you? This type of experience can feel pretty bad. In situations like this and many others, you can feel disconnected and, in extreme cases, isolated.

Why is being understood or understanding others so difficult at times? Rogers believed that each and every person has a unique frame of reference from which he experiences the world. Think about it. Someone else in this world may look just like you, have the same name, and be exactly like you in almost every other way. Biologically, identical twins even share the same genetic code. But even identical twins are not exactly alike. They are, in fact, two separate people. I like to look at it this way. No other person can occupy the same physical space that I occupy at the same time I occupy it. And they can’t occupy the same mental space either! In the abstract, people can “walk a mile in my shoes,” but in the literal sense, only when I’m not wearing them.

Developing a sense of self

You’re unique! Our individual experience is specifically separate from others’, and as you differentiate your experience from the experiences of others, you begin to develop a sense of self, a sense of who you are. A sense of self depends first, however, on how other people see you and relate to you. As children, experience is intertwined and merged with the experiences of parents, families, and caregivers. They serve as an experiential guide of sorts, providing the first models of understanding and experience in the world. Later, you begin to differentiate your experience from the experiences of others.

Image This experience-differentiation process is only possible, however, within an environment of positive regard and support from those around you. If I see a UFO, and the other person doesn’t, he may still support me in my experience by saying that he doesn’t see the UFO, but that doesn’t mean I didn’t see it. If he wasn’t supportive, he may say, “You’re crazy! You don’t see a UFO!” More realistically, I’ve often witnessed a young child who gets hurt or upset and goes to a parent for comfort only to have the parent say, “You’re not hurt. You’re okay.” This situation is the opposite of validation; it’s an invalidating experience. The child may get confused, thinking, “I feel hurt, but Daddy says I’m not. Am I really hurt or not?” Pretty confusing stuff for a kid.

Dealing with differences in self-perception

Rogers called the experience of oneself, as it depends on the views of others, the conditions of worth. As long as people continue to meet the conditions of worth set up by others, they’ll do fine. But when they don’t receive unconditional acceptance, they can get into trouble and experience distress. They may then start seeking the conditional acceptance of others because they’ve yet to experience their own unconditional acceptance.

When seeking conditional acceptance, a person lives a lie of sorts, adopting a confusing and undifferentiated experiential approach to living. If her experiences are different than the experiences of those around her, she may distort her own thinking, feelings, or behavior in order to be in line with those of others. She may walk around with a belief that, if she thinks, feels, and behaves in accordance with the people around her, she’ll get the positive regard she is longing for.

Even if people don’t receive unconditional acceptance, they still have this underlying sense of individuality and uniqueness. When there’s a disconnection or inconsistency between your experience of yourself and your experience of yourself as you distort it to be in line with other’s views, you’re incongruent. This involves having two views of yourself: how you actually are, and how you think others think you are. Rogers believed that what lies at the core of psychological maladjustment is the incongruity between your total experience and your distorted self-concept. This incongruity leads to feeling estranged, disconnected, and not whole. You’re then only living out part of your full being and therefore not fulfilling your basic need to experience, enhance, and expand your being.

As a person travels along this compromised path, he may use different defense mechanisms to keep up the act. He may selectively process information about himself, others, and the world so as not to overturn the apple cart of reality. For example, a lot of families have a “black-sheep” member who stands out. At times, this person may deliberately do something that goes against the grain in order to stay in line with his family-derived self and the image that everyone has of him. Sometimes, he can stick to this plan in such a rigid manner that he may actually lose touch with reality.

Reconnecting in therapy

One of the main goals of client-centered therapy is to help the patient reintegrate different versions of the self: how the patient sees himself and how he thinks others see him. At the center of this process is perhaps Rogers’s most important contribution to psychotherapy — unconditional positive regard. This involves accepting the patient as a person without judging his experiences, feelings, thoughts, or behaviors in a moral sense. The therapist does not want to repeat the invalidating experience that the patient probably went through growing up or continues to go through.

Client-centered therapists engage in what Rogers called reflection — communicating to the patient that they hear what the patient is saying and that they’re trying to understand where the patient’s coming from. Rogers emphasized accurate empathy. Therapists who adopt this concept stay away from imposing their own understandings and structures on the patient’s experience. This helps patients begin to see how they’ve distorted their own experiences without introducing any new distortions in relation to the therapist’s expectations.

The therapist reflects you back to yourself by being attentive and describing to you the self that you’re presenting to him. During this process, your self-awareness increases, and you start to see yourself in a way that you’ve never been able to before. The client-centered therapist is kind of like a mirror or a self-amplifier.

Image Another huge contribution Rogers made to psychotherapy was the introduction of his six necessary and sufficient conditions that must be in place for therapy to be helpful:

Image A professional, respectful, and accepting relationship formed between the client and therapist.

Image A patient’s willingness to be vulnerable and to experience strong feelings, such as anxiety, and the therapist’s ability to motivate the patient to seek and stay involved in the therapy relationship.

Image Genuineness — the client is expected to be “freely and deeply” himself, not distorting how he feels or what he thinks.

Image Unconditional positive regard.

Image Accurate empathy.

Image Perception of genuineness — the therapist has to be a real person (with feelings, thoughts, and behaviors of his own), not just a person playing a role, acting, or pretending for the sake of the client.

Rogerian, or client-centered, therapy has been around in one form or another for about 60 years now. The ultimate question for any form of psychotherapy, psychological intervention, or medication is whether it works or not. Research into the effectiveness of client-centered therapy has typically investigated the specific “necessary and sufficient” conditions.

Most studies, including one conducted by Beutler, Crago, and Arezmendi, have shown that three of the six conditions, empathy, genuineness, and prizing (unconditional positive regard), are valuable but not necessary or sufficient (on their own) to bring about therapeutic change. That is, a therapist doesn’t have to possess or do these things in order to be helpful. Orlinsky and Howard, however, found that warmth, empathy, and genuineness facilitate the therapy process. That is, therapy may go a little better if the therapist creates these conditions. It doesn’t seem to hurt, so why not?

Being at Peace with Your Being: Existential Therapy

In the 1960s, the Tibetan Book of the Dead became really popular among members of the counterculture (you know, hippies). The book is a Buddhist instruction manual for what to do when you die — go toward the light, don’t go toward the light, that sort of thing. The book and its subject matter captured a lot of people’s imaginations, as death always seems to do. Death seems to have a profound effect on the quality of our lives. Whether a person is facing death himself or dealing with the loss of someone important to him, the looming presence of death almost invariably stirs up strong emotions.

A group of psychologists from the school of existential psychology places death center stage among the most important issues to discuss in psychotherapy. In addition to death, they view some issues (anxiety, freedom, and choice) as very basic to human existence and at the core of much of what is called psychopathology (psychological problems). In a way, the existentialists cut straight to the chase concerning therapy by placing ultimate importance on deep philosophical issues such as:

Image Anxiety

Image Guilt

Image Death

Image Time

Image Transcendence

Why all this morose fascination? Existential therapists, such as Rollo May (author of the famous book Love and Will, published in 1969) and Irvin Yalom, professor emeritus at Stanford University, shared a philosophical perspective that was deeply dissatisfied with the focus of much of psychoanalysis and other forms of therapy. They believed that our most important issues were ignored, or at the very least indirectly addressed, by forms of therapy such as psychoanalysis and cognitive-behavioral therapy. Specifically, they saw behavior therapy (see Chapter 16) as an overly narrow and technical exercise that didn’t respect the struggles that humanity faces. They wanted to do therapy with a real person sitting across from them, examining his or her real concerns and deepest issues. It seems like they didn’t want to be distracted by theories and models that dehumanized therapy, which at its heart is a basic human process.

Image Existential therapy is more of a philosophical position than a specific technique. It does, however, make some unique contributions to technique, as I discuss later in this chapter. At the center of the philosophy is the assumption that all human beings have a core experience of “I am.” This experience is our basic sense of being alive and striving toward being.

Image If you ever want to take a road trip into hardcore philosophical obscurity concerning the issue of being or not-being, read Jean Paul Sartre’s On Being and Nothingness. It’s like a computer instruction manual for existential philosophy.

Hanging out with your hang-ups: Death, guilt, and anxiety

People are all striving to realize their truest sense of being, the truest sense of ontological existence. Ontology is a branch of philosophy that concerns itself with determining what is real in our universe. I feel real. Hopefully, you feel real, too. If you and I are both real, there’s common ground to speak about the sense of ontological existence and sense of being.

There’s always a catch, though. If there’s going to be being, there has to be not-being. The ultimate not-being experience is death. When a person faces death, his own or someone else’s death, he experiences anxiety over the thought of not-being, of not being around anymore.

Normal and neurotic anxiety

Existential therapists tend to focus on the differences between a patient’s normal or healthy anxiety and what they call neurotic anxiety. Normal anxiety comes from striving to be and facing threats to our being. Wait a minute, normal anxiety? Before I started learning about the existential approach, I always thought that anxiety was pretty much a bad thing. It feels pretty bad, and it can get in the way of doing a lot of things.

Healthy anxiety is anxiety that is proportionate to the situation and not out of control. Therefore, healthy anxiety doesn’t need to be repressed because it’s manageable and realistic. It’s also constructive and helpful. If I’m appropriately anxious about my test, I may just sit down and study in order to pass it. My anxiety can motivate me. Many people can relate to anxiety being at the core of a lot of what they do. “No problem,” say the existentialists, as long as your anxiety is working for you and it’s not overblown.

Neurotic anxiety has two qualities that work against our realization of being and cut us off from fully engaging the world around us:

Image It’s disproportionate to the situation at hand. Fearing that they may fail, a lot of college students get worked up and anxious about taking big exams. For many people, failing an exam is a big deal, but being anxious about the exam is fine, as long as they don’t get carried away. Anxiety becomes a problem when it becomes disproportionate to the situation. If you’re so anxious that you think you’re going to die if you fail, the anxiety has definitely become a problem, and existentially speaking, it’s out of whack.

Image It’s destructive. Staying with the exam example, all that anxiety may make students physically ill. If they’re sick, they can’t study. If they don’t study, they fail. Their anxiety was counterproductive. Neurotic anxiety should be tolerated as it comes up, but it should be eliminated to the greatest extent possible. People also tend to repress, or “stuff,” neurotic anxiety into their unconscious in an attempt to cope with it. The anxiety is painful, and when something is painful, they try to forget it exists.

Normal and neurotic guilt

Like anxiety, guilt is a key existential phenomenon. Guilt is an important concept in our society and, probably, in most others as well. The existentialists aren’t priests who seek to absolve their patients of guilt; instead, they help their patients focus on issues of guilt as they relate to the full experience of being.

Guilt may be normal or neurotic. Normal guilt arises from two situations:

Image Failing to properly engage in ethical This type of guilt comes up when you actually do something wrong according to your own and your social group’s ethical and moral standards. Guilt is a normal and healthy emotion.

Image Failing to live up to our own expectations: This one is often downplayed in psychotherapy. Individuals often talk about letting other people down. A lot of people actually come to therapy because they’ve let someone down through infidelity, physical abuse, and so on. But what about your own standards for yourself? How are you supposed to feel when you let yourself down? Guilty!

Neurotic guilt is guilt that comes from our fearful fantasies of having done someone harm that actually didn’t happen. Are you afraid to tell someone what you really think for fear of hurting her feelings? That’s nice. Are you afraid that you’ve hurt someone’s feelings even when you’re sure that you didn’t? That’s a fantasized transgression — a created or imagined trespass that never occurred.

Being in the here and now: Time and transcendence

When I think of the concept of being, I always think of smoke-filled coffee shops with beatnik poets sporting goatees, berets, and sunglasses and spouting poetry about the nobility of a cockroach.

They’re alive, man!

Their legs are so short that they can’t help but be down to earth.

They scurry around with zest and zeal, never worrying about money or pride.

They’re just looking for their next meal.

Sorry, I couldn’t help it, but my little existential poem does illustrate the idea that there’s a genuineness in the simplicity of the cockroach. They seem focused on what really matters; to them, it’s food. They’re not distracted by neurotic guilt or anxiety. They are what the existential therapists call being-in-the-world.

Existential therapists try hard to understand the experience of their patients and how they accomplish “being-in-the-world.” There are three important levels of this being:

Image Umwelt: Being among or within one’s environment and the external world of objects and things

Image Mitwelt: Being within one’s social world

Image Eigenwelt: Relating to oneself

Being is maximized when people are in touch with each of these levels to a sufficient degree, engaging with each level without neurotic anxiety or guilt (see the preceding section for details on anxiety and guilt). Remember the cockroach — he ain’t guilty, man!

Being-in-the-world includes the experience of time. Time is an absolute fact of life. It’s an existential given. Time goes on whether or not you try to resist it. The key for the existentialists was for people to learn to live in the present and the immediate future. They shouldn’t waste their time worrying about the past. They should commit to the present, realizing that time only moves one closer to his or her inevitable death and that life is what one makes of it. Make life, or it will make you, I guess.

Another important existential issue that serves as background for the actual practice of existential psychotherapy is the concept of transcendence. If you weren’t depressed before you started reading this chapter, you may be now. All this talk about death, time, anxiety, and guilt isn’t much fun. It’s not all hopeless, though. The existentialists see a way out. Transcendence involves trying to realize our being. It’s the act of living one’s life without being overly anxious or ill, and striving to transcend the past and grow toward the future.

Being flexible with your time

A quick story: My wife and I went to Paris, France, to see some paintings. We went to the Salvador Dalí museum to check out The Persistence of Memory and a couple of his other works. When we arrived, it wasn’t there! It was in a gallery in St. Petersburg, Florida. We couldn’t believe it. St. Petersburg? Come on!

Anyway, my fascination with this painting comes from Dalí’s representation of time using flimsy clocks draped over different objects like the way you drape dirty clothes over the back of a chair. I’m no art critic, but I took that to symbolize the flexibility of time — it’s not brittle; it doesn’t break; it only bends. Time drapes over everything, and nothing escapes it. Well Mr. Dalí, the existentialists would have probably agreed.

Image The human imagination and the ability to think abstractly are powerful tools in this cosmic struggle. To abstract something is to remove it or extract it. A person can take herself beyond the limits of her immediate situation with the ability to think of or imagine herself as outside of these limits. An individual’s ability to separate herself by thinking creatively creates a psychological space of sorts. She can envision possibilities. As long as a person is able to imagine alternatives and other possibilities, she can continue to strive toward being. This power is crucial to the existential concept of freedom. It also sounds like hope to me.

Facing freedom, isolation, and meaninglessness

As if addressing anxiety and guilt isn’t enough, existential therapy also takes on a patient’s struggle with four more existential issues: death, freedom, isolation, and meaninglessness. Just when you thought you’ve gotten away from a discussion of death, it comes right back. I’ve often wondered if the existentialists were obsessed with death. In therapy, they emphasize that psychopathology and problems in living are the result of a patient’s inability to transcend the idea of death. There’s no escaping it. You’re conflicted — you want to live, but you know you’re going to die. Knowing that you are going to die may lead to despair. You may think, “If I’m going to die, why should I even try?” Existential therapy helps patients face the fact of death without despair.

Image After working in jails and prisons, I’ve come to really cherish one thing — my freedom. Existential psychologists emphasize the importance of the concept of freedom in a patient’s life. They don’t believe that some absolute structure to the universe is waiting to be discovered. Humanity makes up the structure as it goes along. For some people, freedom feels burdensome. Freedom requires that people take responsibility for all their actions, and it means that they’ve got nobody but themselves to blame when things go wrong. The good part: They can take full credit when things go right!

Just in case you thought you may catch a break from the existentialists and not have to face every single crappy fact of life, they throw in isolation for good measure. A lot of people find shelter from the harshness of the world in companionship. At the core, people realize that they are essentially alone and they’ll die alone. Individuals try to overcome this fact by attempting to merge with others. When a person seeks a merger in the extreme, he engages in disingenuous relating, using other people as a means to an end (ending isolation). When someone’s identity is so dependent on others, he may find himself feeling as if he doesn’t exist without the other person. He longs for recognition. “Get over it!” say the existentialists. “You’re alone, and there’s nothing you can do about it!”

What’s the meaning of life? Don’t go to an existential psychologist for the answer to this question. Each person is expected to create his own meanings, to construct something out of this meaningless mass of confusion. When someone adaptively and creatively uses his will to build meaning for himself, he’s on the right track.

Patient: I’ve wanted to get a new job for a while, but I can’t seem to find anything.

Therapist: Have you been looking?

Patient: Not really.

Therapist: Then how can you say that you can’t find anything when you’re not looking? Do you really want another job badly enough to actually look for one?

Patient: I don’t know. I think I just want to be treated with more respect at work.

Therapist: Then what you really want is respect, not another job.

Patient: Respect is important.

Therapist: To whom?

Patient: Respect is important to me. I want it.

After the patient becomes aware of what he wants, the therapist helps him remove any obstacles or blocks to action. The therapist also points out that the patient makes decisions every day, even when he doesn’t realize it. If you’re standing in your own way, move over. Here comes the existential express: I’m a lean, mean, existential fact-facing, decision-making machine.

Letting go of defense mechanisms

When you use defense mechanisms to protect yourself from what can sometimes feel like an abyss of existential truth, you can get into trouble. Sometimes, you can do the following:

Image Develop an unconscious sense of being special or omnipotent to ward off the unknown: Irvin Yalom points out that this development may lead to being selfish or even paranoid. I once knew a man who thought he was Jesus Christ. I told him that I had just met Jesus Christ in a previous therapy session with another patient, and I was pretty sure there could be only one. He insisted he was the one. There must have been a lot of emptiness or meaninglessness in this patient’s life.

Image Believe in an ultimate “rescuer”: Too much indulgence in this kind of thinking can lead to dependency. This is a no-no in existential therapy. It’s a cop-out and serves as a poor excuse for facing the existential facts. Man, the existentialists won’t even let me carry around my almighty teddy bear, Snuggles. Sorry, Snuggles, I guess I’ll just have to go it alone. The existentialists take all the fun out of everything.

Claiming responsibility

With all their talk about being, you may begin to wonder if the existential therapists ever do anything but philosophize. Existential therapy incorporates core issues into therapy and uses them to guide the focus of the therapist in treatment. Existential therapists

Image Help their patients to act willfully and responsibly in the face of the existential facts.

Image Listen for existential themes and point them out to patients when they suspect one is lurking underneath a trivial dilemma or psychological symptom.

Image Explore these existential themes and point out the patients’ compromised and maladaptive ways of coping with them.

Image Set out to help patients develop more adaptive coping behaviors.

Image Expect patients to create their own lives and worlds through action and choice.

Image Expect patients to exercise their will in making decisions without being too impulsive or compulsive.

Acting impulsively and compulsively are not active approaches to living in an existential sense. Active approaches are thoughtful, deliberate, and responsible actions, and active approaches are what existentialists look for. Existentialists emphasize responsible action without the need to defer to someone around us to make our decisions. Because of this, existential therapists can sometimes be frustrating to a patient because the therapist refuses to get into a caregiver—care receiver interaction.

Image If you have trouble “owning up” to the circumstances of your life and accepting responsibility for them, existential therapy may help. It includes an expectation of owning one’s experiences, including feelings, thoughts, and behaviors. One way to demonstrate this ownership is for patients to learn how to say I, instead of you, when talking about their experiences. Check out this example:

Patient: There are people in your life who you love, and when they hurt you, it sticks with you.

Therapist: I want you to practice saying I instead of you. For example, instead of saying, “There are people in your life,” try saying, “There are people in my life who I love, and when they hurt me, it sticks with me.”

Patient: There are people in my life . . .

Therapist: Good. How does that feel?

Patient: It kind of makes you feel sad.

Therapist: It makes me feel sad?

Patient: No, it makes me feel sad.

Therapist: You feel sad.

Patient: Yes.

I hope I haven’t painted too bleak of a picture of existential therapy. The truth is that existential therapy is one of the most hopeful therapies out there. It doesn’t sound like it at first because it kind of works in reverse. Instead of using hope in external things, such as other people and supernatural forces, it points patients inward, helping them generate hope from small actions. With each step a person takes, she is exercising the hope that the ground will not fall out from under her. It’s a leap of faith facilitated through willful action. By taking patients down to the bare bones of existence, the existentialists show them how every thought, feeling, and behavior is an act of will that demonstrates the presence of their being — their striving to exist and survive.