Book Review: Existential Counselling in Practice

Reading van Deurzen-Smith's Existential Counselling in Practice has been both an educative and refreshing experience. Educative in the sense that, having for some time fancied myself as something of a wild (à la Groddeck) existential therapist (unless hanging out with R.D. Laing and David Cooper for several years qualifies as a formal training in the art), the book opened my eyes to the numerous gaps in my own approach, as well as exposed my latent – dare I say it? – supportive and humanistic tendencies (ugh). Refreshing, in the sense that, at the same time, the philosophical approach outlined does not patronise or look at the world with what Foucault refers to as "the medical gaze". At this level, I felt immediate affinity and how nice it was to see a fellow existentialist still knocking about in this post-structural, post-modern world.

At the outset, van Deurzen-Smith makes it clear that her book is primarily addressed to practitioners (or would-be practitioners) in the art of existential counselling – though the book is clearly accessible to the lay reader, being written in a comprehensible, jargon-free style and punctuated with poignant examples taken from her own work with clients. Drawing primarily from the insights of the European tradition of existentialism and dasein-analysis (Kierkegaard, Nietzsche, Heidegger, Sartre, Binswanger, Boss and Laing), van Deurzen-Smith aims to articulate a comprehensive method or framework for working with people in distress from an existential perspective. For those of us interested in developing such an approach, she has certainly done us a great service, providing us with a touchstone from which we can spring forward in our own particular and idiosyncratic way.

The first two chapters of the book concentrate on the overall assumptions and aims of existential counselling. The latter is presented as hard work, both for the client and the practitioner. It is conceived of as an ongoing tutorial in the art of living well, or, to be more precise, authentically. This implies being in tune with one's intentions and values, and being able to make resolute (Heidegger) choices in accordance with them. The counsellor functions as a sort of socratic gadfly, assisting the individual in exploring his weltanschauung, so as to discover his own subjective truth (Kierkegaard) and direction in the face of the paradoxical limits of the human condition.

In contra-distinction to the more humanistic approaches which tend to focus on change, growth and the 'here and now', making use of various techniques along the way, existential counselling involves a more reflective process which allows the individual to think through his fundamental assumptions about life in the process of clarifying what has meaning and purpose for him. Interpretations and values are not imposed – rather, the individual conducts his own investigation into himself and the world. The counsellor assumes the client's inherent capacity to do this, and to also sense out of a seemingly absurd (Camus) universe. Where the client acts in bad faith (Sartre), refusing to acknowledge his radical freedom, the counsellor will point this out and underscores his belief in the individual's capacity to make informed choices regarding the direction he wishes his life to take. Although beset by certain human givens and existential paradoxes, the counsellor believes it is possible for the individual to create a meaningful life for himself, one rich with passion. This usually will involve a transvaluation of all values (Nietzsche) in which each pole of the various existential polarities (life/death, active/passive, etc.) is seen to have both 'good' and 'bad' aspects. Anxiety then is seen not as a 'symptom' which must be suppressed or relieved, but a message to the individual reminding him that life is insecure and unpredictable, and that, in some sense, each person must stand on his own two feet alone, with his own centre of gravity. The attitude of the counsellor throughout this process is one of confidence, vitality, humility and non-collusion.

In the next three chapters van Deurzen-Smith explores the general issues outlined above in more depth. She first of all articulates four dimensions along which this existential exploration ideally should proceed. These consist of the natural world (Umwelt), the public world (Mitwelt) – the world of social relations, the private world (Eigenwelt) – intimacy with self and others, and the ideal world (Überwelt) – of ideas, beliefs, values. This last is a dimension newly articulated by van Deurzen-Smith and not specified as such in the classical existential literature. Although, as she points out, the individual usually comes to counselling when there are problems in one dimension particularly, it is important to encourage the individual to explore all dimensions of their world-view as they will be intertwined. The initial task of existential work involves getting the client to take stock of all his underlying assumptions about the world, urging him towards determining what his ultimate values are, and encouraging him to live his life more in accord with those values and the dictates of his conscience. In order to do this, an examination of his talents is required, in order to see how they can best be put to work to implement his intentions. The overall work in this process of clarification requires an exploration of emotions, moods, dreams and the imagination – as all of these can offer clues to a person's motivations at a given moment.

Throughout, as mentioned, van Deurzen-Smith provides us with a wonderful host of practical examples which help to illustrate a particular point she is trying to make. From Julia, the mother of Nick, diagnosed as 'schizophrenic', to Sean, the philosophy student not wanting 'therapy' but 'an existential training', each individual's situation is explored – not in medical or psychodynamic terms, but in ethical and philosophical ones. The usual array of 'presenting symptoms' is covered – anxieties, post-partum depression, insomnia, etc. – but illuminated from a perspective which is distinctly different from that more commonly associated with psychiatric outpatient clinics.

In summary, then, van Deurzen-Smith's book provides a comprehensive framework for counselling in the existential mode. As such, it is an extremely useful, and rare, source for those of us embarking upon – or already pursuing – this kind of work. It is certainly not without its own limitations and is open to criticism in a number of respects. For one thing, it is questionable – given the plethora of existential thinkers – whether there is such a thing as the existential approach. Further, van Deurzen-Smith's approach is so systematically and comprehensively articulated that it comes dangerously close to smacking of the very rationalism which existentialism (a misnomer at the best of times) was, in some sense, a reaction against.

On other fronts, many voices are clamouring for attention. I can hear those of a humanistic orientation complaining that van Deurzen-Smith wants us to "lose our senses and come to our minds" and those of a post-structural/post-modern orientation calling for a deconstruction of the humanistic position inherent in her approach. To the latter one might reply that it's not 'post' until it's post[ed]). But there are two more cogent voices in my ear: the voices of two outstanding and, ironically enough, 'existential' psychiatrists. There is the voice of David Cooper asking "who does the existential counsellor anyway?" and wondering if existential counselling is just one more psychotechnology to be manipulated by the political status quo. And, of course, there is the inimitable voice of Ronnie Laing saying, with his eyes fluttering, "Don't take it seriously – it's only an experience."

Stephen J. Tickin