Existentialism and psychotherapy

Although I studied a variety of therapies in my preparation for a career as a psychotherapist, I never identified exclusively with one approach – gestalt, client-centered, behavioral, psychodynamic – as a descriptor of my style of therapy. I was an eclectic practitioner, but have always considered my therapeutic orientation to be existential.

I respect that there are therapists whose work has a religious foundation, but mine was a secular practice. I validated faith in God and prayer as best I could, with clients who found meaning in their religious beliefs; but if clients asked me to pray with them, I declined. Although I was raised as a Christian, and most of my values are rooted in the Judeo-Christian ethic, I’m an agnostic of the kind that’s very comfortable with saying “I don’t know” when asked about specific religious beliefs. I think that it’s just as arrogant for an atheist to assert sure knowledge that there is no God as it is for a religious person to assert that I’m in error for not believing what they believe. Define God, then we can talk.

I don’t believe that I have the authority to definitively answer questions about religion and am tolerant of  those who claim to “know” that their beliefs are true, as long as they do no harm as a result of religious beliefs. Of course, there’s considerable room for debate about what constitutes harm. (I personally consider any form of indoctrination to be harmful.)  I consider myself an existentialist because existentialism directly addresses morality and personal responsibility, without the excess baggage of sin and redemption and pleasing God. I’ll briefly summarize some of the basic principles of existentialism, as I understand them.

First, existentialism asserts that there’s no universal Meaning “out there” that all right-thinking people can apprehend – as opposed to religions, which assert that there is, i.e. “God’s plan.” To existentialists, concepts like Sin and Redemption and Divine Intercession are constructs based on religious doctrine. They don’t exist in any objective sense. Meaning only exists in the eye of the beholder. Life is absurd, as illustrated by Albert Camus in “The Myth of Sisyphus.”  Sisyphus continues to push the boulder up the hill, despite knowing that it will just roll back down. He persists, despite the absurdity of his efforts, because the act has meaning for him.

Because there are no absolute rules, or Divine rewards or punishments in an afterlife, we are each free to do whatever we want. But the other side of the coin of freedom is responsibility. We’re absolutely responsible for whatever we choose to do, and can choose to behave morally even if we don’t believe in Heaven and Hell. We can choose to live in good faith with others, because of our moral responsibility for all of our actions. Although we can find joy and meaning in authentic relationships, we’re all essentially alone in our lives. (A song sung by Country singer Bill Monroe expresses this as well as anything I’ve read on the subject; “You’ve got to walk that lonesome valley,/ You’ve got to walk it by yourself,/ ‘Cause nobody else can walk it for you./ You’ve got to walk it by yourself.”) We each have to deal with Angst (anxiety) and dread that comes from the knowledge that we will someday cease to exist. Existentialists don’t rely on the comfort of religious promises of eternal life for the faithful, to come to terms with our mortality.

To say that there’s no objective Meaning to existence “out there” isn’t to say that meaning is unimportant. As an existentialist I’m free (like Sisyphus) to find, or create, my own meaning. One of the best-known existential therapists, Viktor Frankl, named his school of psychotherapy logotherapy – from the Greek “logos”: meaning, or reason. (I’ve written about Frankl in previous posts. I’ve recommended his book, Man’s Search for Meaning, to more clients over the years than any other book.) Although I didn’t practice logotherapy, per se, I’ve worked with many therapy clients to help them find or create meaning in their lives. It can be a life-or-death matter with people who are suicidal.

I initially saw existentialism as grim and forbidding: if there’s no extrinsic Meaning to existence, then all we can do is to sweat along with Sisyphus, acting as if there was meaning to our lives. But now I see the richness of choice, where I once saw austerity. Existentialism gave me a philosophical context for the I-Thou encounters of psychotherapy. We all have a need for our lives to mean something; but we needn’t rely on “God’s plan,” as taught by this or that religion, or on promises of eternal life, to find meaning in our lives.

If you want to learn more about existentialism and the colorful characters (Jean-Paul Sartre, Simone de Beauvoir, as well as Camus, Heidegger and Merleau-Ponty) who formulated its principles, I recommend Sarah Bakewell’s highly-readable At the Existentialist Café: Freedom, Being and Apricot Cocktails. I’d never have guessed that phenomenologist Maurice Merleau-Ponty was good at dancing the Jitterbug.

Suicide prevention

While the act of suicide is sometimes a long-considered, planned option which nobody can prevent, most suicide attempts are impulsive. According to one study, approximately one quarter of the people who try to kill themselves do so within five minutes of their decision to attempt suicide. Only a small fraction of people who survive a suicide attempt go on to die by their own hand. Throughout my career as a psychologist, I assessed many people shortly after a suicide attempt. A question I always asked of them was, “Are you glad that you’re still alive?” Almost all of them were glad that their suicide attempts had failed. I concluded that most suicide attempts are mood-specific behaviors, often involving intoxication on alcohol or other drugs. Once their mood changes, or they sober up, they no longer want to end their lives.

While in grad school, I volunteered as a telephone crisis hotline worker. I was trained to talk to people who were in crisis, to keep them from engaging in attempts to harm themselves or others. From early in my clinical practice I was called on to evaluate the suicide potential of clients. I learned that many people who attempt suicide are ambivalent about living. “To be, or not to be; that is the question.” At the core of this ambivalence is the issue of existential meaning.

One of the major existential therapists of the twentieth century was Viktor Frankl, an Austrian psychiatrist that I’ve written about in previous posts. His book Man’s Search for Meaning was based on his experiences as a survivor of a Nazi death camp. He observed that in such a hellish environment, those who fought to live were people who had a sense of meaning in their lives. He called his method of psychotherapy logotherapy (logos means “reason” or “plan” in Greek), and his therapeutic approach was to help patients find, or create, meaning in their lives.

Lives bereft of meaning are empty lives, but sometimes the vacuum can be filled. Although I was able to help some suicidal clients to find something to live for, one of my severely depressed therapy clients died by his own hand. It was the worst thing that happened in my career. I really liked “Allen,” saw strengths and personal qualities that he couldn’t see, and worked in therapy to help him find reasons to go on living. I saw him on Wednesday afternoons, and he always kept his appointments. When he didn’t come in one Wednesday, I immediately called his apartment. When he didn’t answer after several tries, I looked up his address and drove to his apartment. When he didn’t come to the door when I knocked and rang the bell, I intuited that he was dead, inside. Sadly, this proved to be the case. It turned out that he’d bought a gun that morning, gone home, and used it. On a Wednesday, instead of keeping his therapy appointment.

I went through predictable self-recriminations and judgments. Could I have done anything differently that would have prevented his suicide? But I recognized this as a question that could never be answered. My colleagues knew that I was grieving as if I’d lost a family member, and supported me in my grief process. A peer review of my clinical records found that I’d done and documented everything properly, in terms of recognizing and dealing with Allen’s suicide risk.

A few years ago a close friend committed suicide. She suffered from bipolar disorder, and had confided in Maria and me that she would take a drug overdose in certain future hypothetical situations. She said it matter-of-factly, and wasn’t depressed when she said it. We knew that there was nothing we could say that would change her mind. We hoped that she’d never find herself in one of those imagined situations.

Philosophically, I’m torn on the issue of the “right to die,” because if suicide were to be legalized, it’s inevitable that some depressed people would convince themselves – or be convinced by others – that it was their duty to die, perhaps because they felt useless, or they wanted to leave an inheritance, rather than spend their money on their own medical care in old age. I’m no longer a therapist, but if I knew that someone was acutely suicidal, I’d do whatever I could to try to prevent an impulsive suicide attempt. (Many times, as a Designated Examiner in the Probate Court, I recommended involuntary hospitalization for suicidal people.) But once a person has suicided, I don’t make judgments about their decision to end their life. I don’t have the authority to judge.

Most people who end their own lives do it to escape intolerable pain – whether physical or emotional. Allen killed himself because he could no longer endure living with severe depression. His life had no meaning worth living for. I tried unsuccessfully to help him find reasons to live. Albert Camus considered suicide to be “the fundamental question of philosophy.” He wrote, “I see many people die because they judge that life is not worth living. . . . I therefore consider that the meaning of life is the most urgent of questions.”

Which takes us back to Viktor Frankl, who found meaning in the Hell of a Nazi death camp, survived, and went on to be a founder of the humanistic psychology movement.

My psychology grad school reunion

I’ve already written about humanistic psychology as the “third force” in twentieth century psychology, after Freudian psychodynamic theory and behaviorism. I recently attended a reunion of my psychology graduate program at the University of West Georgia (West Georgia College when I attended), and I’d like to share with you some of the reasons I’m so thankful for my preparation as a psychotherapist in this particular program.

Dr. Chris Aanstoos, a faculty member for over two decades, wrote that the graduates of the program have gone on to be “not only psychologists and professors, but also city commissioners, college presidents, U.S. congressmen, computer wizards and millionaires, as well as poets, magicians, mystics, theologians and farmers. Essentially they have gone on to become themselves.” To which list I’ll add corporate consultants, business entrepreneurs, and all sorts of holistic healers.

Part of the lyric of the Crosby, Stills, and Nash song Teach Your Children is “. . . and so become yourself/ because the past is just a goodbye.” Their are forces in our society that conspire to make us conform, to be “normal.” Becoming your authentic self and living up to your unique potentials was what the West Georgia psychology department was all about. The program wasn’t organized so much to train you for a specific profession as to help you discover and realize your potentials, and to find your vocation – your calling. Since the inception of the humanistic program in 1967, it’s always been a program freed from the conventional stereotypes of the day, and in it I learned that no scientific or therapeutic model has all the answers for everybody. I learned about holistic health long before it caught on.

The WG psychology program is characterized by cultural diversity (i.e. both Eastern and Western psychologies) and innovation, and was ahead of its time in many respects. Carl Rogers’ client-centered therapy is being re-discovered in the corporate world as person-centered management. Yoga and meditation were validated as ancient transformative psychotechnologies – ways of re-wiring the brain – long before they went mainstream. There was an emphasis on wellness, and the holistic unity of body and mind.

While I received an excellent preparation for a career as a psychotherapist dealing with (for the most part) chronically mentally ill persons, psychopathology wasn’t the primary focus. We also studied creativity, and barriers to achieving one’s highest potentials. We questioned the notion of “adjustment therapy,” asking, “adjustment to what?” (See my prior post, “Who is normal?”) Behavioral psychology was the dominant force in psychology at that time, and the medical model was the unquestioned basis for determining diagnosis and treatment.

No faculty member ever told me what model I should follow or recommended which therapeutic techniques I should use. Although behavioral psychology wasn’t popular in the program, over the years I became a practitioner of cognitive and cognitive behavioral therapies, along with Rogerian,  gestalt, and other therapeutic modalities. My faculty advisor never advised me; he dialogued with me about goals, choices, opportunities. My love of learning caught fire as never before, because I was encouraged to think for myself and choose my own path.

The man who made the WGC psychology department into a humanistic program was Dr. Mike Aarons, and at the reunion I finally heard the full story that I’d heard pieces of over the years. As a child in public school, he was labeled “unteachable/retarded,” and wasn’t expected to be able to complete high school. But he earned a high school diploma and went on to college. Working as a cab driver, he found a book someone had left on the back seat of his taxi. It was Viktor Frankl’s Man’s Search for Meaning, and it changed his life. (See my post, “Freedom of attitude.”) It introduced him to existentialist  psychology, and he found a French mentor in existentialism who encouraged him to apply to the psychology PhD program at the Sorbonne University, in Paris. Mike had no bankroll and spoke no French, but that didn’t stop him. Long story short, he returned from Paris a few years later with a French wife and a PhD from the Sorbonne. His dissertation was on the topic of creativity. He went on to post-graduate studies with Abraham Maslow, at Brandeis University.

Dr. Jim Thomas, a behaviorist in the WG psychology department, had read Carl Rogers and Abraham Maslow, and had a vision of  establishing a humanistic program in the department. He won over some of the other faculty members, then wrote Maslow, asking if he could recommend someone to start a humanistic psychology program. To everyone’s surprise, Maslow answered, recommending Mike Aarons without  reservation.  Mike was hired and set about recruiting a faculty on the cutting edge of the humanistic psychology revolution. The rest is history.

Not only has the UWG psychology department continued to offer an exceptional education in psychology, it has continued to grow. While a Master of Arts (MA) degree remains the only masters degree available for now, the department now offers a Bachelor of Science (BS) degree program. What used to be a Doctor of Psychology (PsyD) degree program is now a PhD program.

The department has drawn students from all over the country – as well as many international students – to the Georgia town of Carrollton. The question I heard most often at the reunion was “What brought you to the program?” I heard story after story about so-called coincidences, “accidental” meetings, and things (usually books) found – like Mike Aarons finding the copy of Man’s Search for Meaning – that pointed people in the direction of the program. What I also heard a lot over the weekend was expressions of gratitude by alumni for having had the good fortune to study in this unique psychology department.

Freedom of attitude

Viktor Frankl’s book Man’s Search for Meaning is one of the most important books I’ve ever read. I’ve recommended it, as “bibliotherapy,” to clients in my clinical practice more than any other book, by far. I recommend it too you as a book of useful philosophy. Its conclusions resonate with cognitive therapy, Buddhism and the Serenity Prayer.

Dr. Viktor Frankl was an Austrian psychotherapist and a survivor of a Nazi death camp. The first part of the book isn’t an easy read, as it recounts the hellish circumstances of daily life in a death camp and the heartbreaking choices people were sometimes forced to make. Frankl had studied to be a doctor before he and his wife were arrested for the crime of being Jewish, and sent by train to separate death camps. He never saw her again.

In his book he separates his fellow prisoners into two categories: those who continued to fight for survival, and those who lost the will to live. There were many ways to die in a death camp. Just refusing an order from a brutal guard could get you beaten to death. Giving away your bread to others would hasten death by starvation. Some chose death over life in Hell.

A philosopher by nature, Frankl sought to determine what made the difference for those who fought to live, rather than surrendering to circumstance. His conclusion was that those who lost the will to live were those who could no longer find meaning in their suffering. Frankl found meaning in hope for survival and of possible reunion with his wife. His love for her was alive, as well as his hope. He knew he had something to live for, even if he couldn’t specify what it was, even if there were no guarantees.

Viktor Frankl asserted that we have a choice that nobody can take away from us, regardless of our circumstances. We are always free to choose our attitude toward whatever situation we find ourselves in. If I’d heard this from someone else I might not have given it much weight, but I learned it from Viktor Frankl. I’m unlikely to ever find myself in a situation nearly as dire as what Frankl lived through. If he could apply this wisdom in a Nazi death camp, surely I can apply it to any circumstance I find myself in.

Any fortunate circumstance can be sullied by a negative attitude, and any unfortunate circumstance will inevitably be made worse by negative thinking and expectations. A positive attitude, on the other hand, can make good situations even better, and a positive attitude opens the possibility that an otherwise intolerable situation can be made bearable. We find – or create – the meaning of our life circumstances by our choice of attitude. A negative attitude cannot improve anything.

Frankl called his approach to psychotherapy “logotherapy,” from the Greek word for meaning. In his professional practice, he tried to help his patients discover or create meanings that helped them in their struggles. Exercising your freedom of attitude allows you to re-frame your experience. What does it mean? Are you suffering because that’s what you deserve? Or is your suffering a test, an ordeal from which you can emerge, a better person? Nobody can decide the meaning of your life experiences but you.