People often ask me about how I “do” therapy. I believe this to be a rather irrelevant question as a therapist does not “do” therapy but rather he or she “participates” in therapy or “views human nature in a certain way” or one “relates to another in a kind, compassionate, human to human fashion” as therapy. However, usually when I am asked this question, it is asked by a client who is paying me directly to “DO” therapy and they surely deserve a direct answer rather than some flowery, intellectualized avoiding of the question (quite possibly like the one above). And while this frou frou view of therapy is, in my mind, accurate, it also doesn’t quite encompass what I believe I “do” and what therapy is. So what is it that I do as a therapist? One possible reason for my overdramatized, yet accurate view of therapy sadly, I must admit, is that I often find myself struggling for an answer. What a therapist actually does has a distinct vagueness about it that only comes in gray hues. Again, however, the average paying therapy customer isn’t usually satisfied with their therapist answering “what do you do” with “Idunno”.
Allow me then, to attempt an “answer” with a slight change of the question. Rather than “what do you do”, I’ll ask the question “what is your theoretical orientation towards therapy”. For those of you who are not grad school counseling majors, this question asks what is the theory of human nature that guides your attempt to help those who come to you with psychological and emotional distress? There are multitudinous theories that guide the work of a therapist but most of us in the helping fields cling to at least one or two tried and true ideas very closely. The list of these schools of thought would be quite long and boring and quite frankly you’d stop reading my blog, so I’ll spare you the details and just move on to, at least part, of an answer.
Among other therapeutic titles, I refer to myself as an Existential Therapist. (note the capital letters to make it a proper noun and therefore more important!) This means many things and has been influenced by many theorists and also has some of my own special blend of herbs and spices. The main theorist by whom I’ve been influenced in this regard is a psychiatrist and a contemporary existential philosopher named Irvin Yalom. In the field of psychology, Yalom is possibly the closest thing to a rock star we have. He is considered the foremost expert and theorist on the idea of existentialism as a therapeutic modality and has written at length on the subject. A couple of years ago, I attended a conference at which Yalom was the keynote speaker and with giddy, childlike excitement, I told a therapist friend that I had “walked just a few feet behind him as he was on his way up to the podium”. Yeah, I know, lame but I gotta be me. If you are interested in Yalom’s theories, I’d suggest you start with any of his books as I’ll just provide here only the briefest of brief description of some of his ideas and how I have attempted to apply them in my own psychotherapy practice. Before I start, however, allow me some disclaimers: As I’m aware, Existentialism as a therapeutic approach is not one that’s real frequent in grad school course loads. It’s not like the core abnormal psychology, developmental psychology, cognitive psychology and all the other stuff that most of us as therapist were required to study for our eventual license. To my knowledge, there’s no hard, formal school of thought on the idea of existentialism as a therapeutic approach except for Yalom and a few others and as I can tell, even they don’t consider it a hard science. I say that to say, what is presented here is MY version of what I’ve studied from Yalom and others, not a version that was taught to me directly by a professor or internship or one that may be accepted as THE description of an existential therapeutic approach. Furthermore, I’m not suggesting that this idea is perfect and will work for every client. It is not “the thing”. What is presented is a theory. A lens through which to view the world. It is NOT a silver bullet with which to kill to kill the werewolf named psychological and emotional distress. If that’s what you’re looking for, you’ll be better off seeking what will ultimately be false promises and disappointment in the self help section of your local book store.
So let’s start with what Yalom refers to as the “givens of existence”. These are qualities that we all share as humans and that if employed in the proper manner, can enhance our mental and emotional health. We’ll start with death. Now there’s a fun way to begin a session with our clients right? Let’s talk about death. You came here because you were feelin bad, let me make it a little worse right? However, there’s an ironically positive twist. According to Yalom, looking at death more closely, grappling with it, coming to terms with it, and accepting our fate can help one live more fully. It can serve as a motivation. I’m running out of time and that means I’ve got to get done stuff done and I don’t have the option of waiting. And speaking of getting stuff done, the next given of existence to discuss is the idea of free will. We have it. Period. This could be argued for another million years but for now, just go with it because you’ll be wasting your time reading if you don’t. Very often, A client of mine will state something to the effect of “I can’t” (work, lose weight, stop smoking, be a better husband, stop being depressed, control my anxiety, etc) and I’ll respond with a direct and blunt challenge. “Bullshit. You’re a grown man/woman with free will and resources. You’re saying can and can’t but I believe this falls more into the category of will or wont. You have the power to change this if you can mobilize your free will to do so”. If we doubt have a sense of free will there’s no real possibility of change unless it comes externally. If it comes externally it’s weaker, shorter lived and gives us less power for true, long lasting change. Therapy without behavior change is pointless. We can gain all the insight we want to but if we don’t do anything with it we’ve wasted our time. If we as therapist are working with something that lacks the power for genuine, long lasting change from the inside out, then we’ve got nothing.
The next given of existence, responsibility piggy backs on the idea of free will nicely. If we don’t have free will then responsibility means nothing. If we don’t have responsibility then why have free will? Yalom suggests that we’re the authors of our own lives. We write the book. If our lives aren’t going the way we want them too, then we have a role in it being that way and we have the largest role in changing it. Obviously there are uncontrollable outside forces but how we respond to them, what we do with them, is the expression of free will.
Yalom suggests further that there is no inherent meaning in life. We’re not here for any real purpose we just kind of are. Now this is not a uniquely Yalomian idea and has been suggested by a million different philosphers and will possibly be debated until the end of time. But here again is the positive spin: if you can help a client understand that their life has no meaning that sounds pretty depressing. But if you can help someone understand that there is no PREDETERMINED MEANING, that also suggests that they have the power to CREATE any meaning they want. Furthermore, not only do they have the free will to do so, they also have the responsibility to do so and necissarily have to get on the ball with it because some day they are going to lose their chance to do so through death… well then, that suddenly sounds a bit more optimistic. Now a person has options, they have power, they have purpose.
So the last part to discuss is isolation. When I discuss this with my clients I say “you and I can sit here for a million years and talk and get to know each other but I’ll never know you as well as you know you. As hard as I’m going to try I’ll never be able to see things through your eyes exactly as you do. I can show empathy and understanding but I can’t truly know what it’s like to feel how you feel. Furthermore I can’t really do anything for you”. Now here’s how this ties in with the other ideas. If someday I’m going to die, that means I have a limited amount of time to find fulfillment. I have not only the free will to do that in the best way I see fit but also the responsibility to make sure it happens before I die and since no one can do it for me or truly experience it the way that I do that means I must necessarily do it alone.
Okay, so there’s your crash course. Maybe some stuff got left out or misrepresented but my dear friend whom I’ve never met, Dr Yalom, please forgive me.
Before I wrap up this summary, that due to its brevity, surely doesn’t do justice to a theoretical orientation so dense and multilayered, allow me to give a brief example from my own life of how the “outcome” or “application” of Existential therapy might look in practice. I self disclose a great deal in my work with clients and I’m sure that most of them are tired of hearing about me so if you are one of them and you have grown weary of my personal examples, you might want to stop reading now (if for no other reason than you’ve probably already heard this one).
For several years now, I’ve had this thing on my side. It’s a dull ache near my ribs that has been unexplainable by doctors. As a individual who leans greatly towards the general state of “anxiety ridden worry wart”, I always assumed it was cancer or some other medical doom. It made me lose sleep, it made me irritable and the worry took up large amounts of emotional energy and mental space. After much soul searching and eventually asking myself “what would you encourage your client to do”, I decided it was time to practice what I preach. I CHOSE to stop worrying about it and to accept it. I chose to accept that this thing was going to kill me. I literally said to this “thing” “Come get me…If you’re gonna kill me, bring if fucker! BUT UNTIL YOU DO, I’M GOING TO LIVE LIKE IVE NEVER LIVED BEFORE”. With a heightened awareness of what I still felt was my impending doom, I began to take more healthy risks. It suddenly felt as if what I did mattered less because I was going to die anyway so I did more of what I wanted and less of what I didn’t want to do. I CHOSE to accept that I was dying, I chose to accept that it was my responsibility to make the remaining days I had the most fulfilling, I CHOSE to believe that I had the free will to make all these things happen and that no one could do it for me or experience it as I could. I do not say this to suggest that this was a simple or easy process, nor do I suggest that this happened overnight or that this process is complete now or ever will be. Certainly, by no means, am I assuming that the path towards mental and emotional health is to simply “do what I did” nor am I suggesting that I have achieved perfect mental and emotional health. However, the mental and emotional stability I have achieved has been, in part, due to grappling with some of the givens of existence which Yalom mentions. When one choses to accept the inevitability of death, accepts responsibility to create meaning in a life devoid predetermined meaning, mobilizes one’s free will and accepts the “unbridgeable gap” that exists between us that does not allow for others to see things through our eyes, the potential for the inherent anxiety that can cripple us, loses some of its sting and we have to potential to live more fully.
Unrelated Book Suggestion: Harry Potter. All of them. Read the series and then watch the movie. A good time will be had.
Unrelated Song: I’m totally cheating on this one cause this is my band and I stole the title from one of my blogs: