Book Review: Existential Thought and Therapeutic Practice: An Introduction to Existential Psychotherapy

Writing a review of a book written by an author who is both known to me and who has already helped to influence my own practice of psychotherapy, has proved to be a new and different experience. When writing reviews I have always tried, as far as is possible, to maintain a position of critical appraisal. In this instance that endeavour has been somewhat tested! But so...

Psychoanalysis seems to be in particular disarray with fragmentation appearing to be the order of the day. Gill (1994) has suggested that positing a division between 'internal' and 'external' is misleading unless it is recognised that each contributes to shaping the other. Elsewhere, the notion of 'intersubjectivity' has been invoked in psychoanalytic writing (Stolorow R.,Brandschaft B.,& Atwood G. 1987). What can be seen in psychoanalytic theory, then, is a gradual shifting away from the classical emphasis on the internal to a more equable balance between internal and external factors. These theorists move toward intersubjectivity but then hover and refuse to abandon Descartes' subject/object split and thence the intrapsychic system. Crossing over this borderline and fully embracing intersubjectivity would of course have serious ramifications for psychoanalytic theory. Hans Cohn views the existential-phenomenological approach to psychotherapy as a response to psychoanalysis and comments also on the many psychoanalytic theorists and practitioners who are phenomenologically informed but reluctant to completely break away from the psychoanalytic project.

The current dramatic rise in both popularity and demand for psychotherapy (and counselling), with multivariate trainings, schools, and approaches, has brought with it, Cohn believes, an almost colloquial use of the word 'existential', detached from its meaning in the context of existential philosophy. The model that he has introduced is based on the attempts of two Swiss therapists, Ludwig Binswanger and Medard Boss, to find a "new foundation" for the practice of psychotherapy in the philosophical concepts of Martin Heidegger. Their work and writings are, in the author's view," the most comprehensive and radical attempts made so far to provide a philosophical answer and alternative to Freud's scientific project." The author, however, sees their work as "a point of departure" and points to the need "to go beyond it" by also including reference to the work and influence of philosophers Jean-Paul Sartre and Maurice Merleau-Ponty. They are, with Heidegger, "the most distinct voices" in existentialism. It is the ideas of these three philosophers, then, who predominantly inform the existential-phenomenological framework presented in this book.

Cohn has opted for a short and concise book, purposely not depicting the full conceptual spectrum of existential-phenomenological thinking. He therefore sets aside the many variations and deviations and runs the risk of making existential psychotherapy appear a much more consistent approach than it actually is. He cites his aim in writing this book as twofold: "... to present an overall framework for an existential-phenomenological approach to psychotherapy and at the same time show how such an approach affects the day-to-day practice of the therapist." Throughout the book an existential-phenomenological framework is compared with the assumptions of the psychoanalytic framework as originally proposed by Freud. So, how far does Cohn succeed in these two respects?

The book is structured into twelve chapters but is, in essence, divided into two parts, with a concluding chapter on the 'Aims of Psychotherapy'. The first part, consisting of the first three chapters, is introductory in nature: 'What is Existential Psychotherapy?' and 'Philosophical Background' are, in a sense, a philosophical preamble and the introductory portrayal of a framework for an existential-phenomenological approach. The context of classical Freudian theory is described with its natural scientific framework together with Binswanger's and Boss's response in providing a philosophical answer and alternative. 'Philosophical Background' provides a brief introduction to the basic concepts of existentialism, but also engages in an enlightening exploration of Heidegger's differential between 'ontic' and 'ontological'. This in turn leads to a comparison of Binswanger's and Boss's work, clarifying also the differences (and links) between existentialism and phenomenology. In 'Existential Psychotherapy and Psychoanalysis: a Comparison', the third of these introductory chapters, the author starts his comparison with Sartre's comment that "existence precedes essence" and suggests that in contradistinction to psychoanalysis, with its interest in what is valid for all human beings (essences), Sartre gave priority not to what all human beings have in common but rather to their individual uniqueness (existence). The differing ramifications for the theory and practice of both approaches are explored in terms of concept of 'mind', the place of 'disturbance', and issues to do with 'relatedness'.

The less stigmatizing perspective of the existential-phenomenological approach becomes quite evident.

In the second part of the book, being the latter chapters, the author sets about his aim of showing in a more detailed fashion how an existential-phenomenological framework affects the day-to-day practice of the therapist. Coming from a background in psychoanalytic psychotherapy I was particularly interested in this part of the book, with its more detailed characterization of an existential-phenomenological approach In "The Therapeutic Relationship' the author contrasts the notions of 'transference' and 'countertransference', which define the psychoanalytic understanding of the therapeutic process, with the existential-phenomenological approach where there is no distinction between a 'real' and a 'transference' relationship. " The therapeutic relationship is always real but - as all reality - in need of elucidation." The rules of epoche, description, and equalization are outlined and exempled with a case illustration. Specific detail exploring the givens of Psychotherapeutic practice ie. 'space for therapy', 'the couch', and the place of 'interpretation' are then described. On the latter the author suggests that in psychoanalysis interpretation reduces the experience recounted to something else. An existential-phenomenological approach however "will try to discover the fuller meaning of the phenomenon. The fuller meaning may at first sight be hidden from both client and therapist, but can be unfolded." He perspects the difference with psychoanalysis beautifully:" Analytically a snake disappears behind the phallus; hermeneutically it stays at the centre of the interpretation displaying the full range of its manifold meanings."

Apart from two chapters, 'Existential-phenomenological Dimensions of Groups' and 'The Question of the Unconscious', the remainder of the book focuses on an exploration of experiences and distress commonly encountered by therapists: 'Mind and Body' where body and mind are seen, phenomenologically, as different aspects of the same experience. They are not therefore seen as split, as in psychosomatic medicine, and the relation is not seen as causal. The author suggests: " It seems to me that it might be helpful to drop the assumption of a causal connection and see consciousness as a total situation in which both physical and non-physical processes are involved." In the context of psychoanalysis, and indeed western medicine, this is radical, if not revolutionary, thinking. This radical thinking pervades in the further themes explored: 'Aspects of Anxiety and Guilt' where an existential-phenomenological view sees anxiety not as the result of a psychological mechanism but as an inevitable aspect of existence itself. The author, however, adds that it is important to consider "the particular way in which we individually experience it." 'Dreams and Symptoms' where " the phenomenologist instead of distinguishing between surface and depth, tries to establish ever-widening contexts... Dreams are an uncovering, an unveiling, and never a covering up or a veiling of psychic content." Phenomenological dream interpretation is then exempled in several 'Illustrations' of case material. Sexuality which "has been strangely neglected by writers on existential psychotherapy" is addressed in 'Being-in-the-World Sexually'. The author here suggests that" we are all sexual beings and our sexuality, like all existence, has 'given' aspects. It is our responses to these 'given' aspects which vary. An existential-phenomenological approach needs to explore what these 'givens' are and the ways in which we respond". Throughput, Freud's views are also contrasted and discussed. Working with 'psychotic' clients is described in 'Withdrawal and Delusion' where the author questions whether a clear distinction between 'neurosis' and 'psychosis' can be made or what the criteria for such a distinction could be? And further, in complete contrast to psychoanalytic therapy, the philosophical framework within which existential therapists try to understand their clients' disturbances applies to 'psychotic' clients as much as it does to other clients.

This is a thought provoking, concise and erudite text. Though some readers might criticize in terms of repetitiveness, much is packed into this short book. The author clearly has a finely tuned knowledge and feel for both the frames compared. As it is, we live in a society with language and common parlance littered with a Freudian psychoanalytic perspective: from the BT advert 'It's good to talk', to 'in denial', 'identification', 'beneath the surface' and the notion of 'the unconscious' itself. Any challenge to this newly conceived 'conventional wisdom' will be construed as quite radical and possibly dismissed. As an 'Introduction to Existential Psychotherapy' I therefore welcomed Cohn's decision to introduce the less familiar existential-phenomenological approach as a response and contrast to psychoanalysis. I tried, on occasion, to read this book as if a beginner and found that by not taking a magical mystery tour through the 'unconscious' and coating it with a veneer of science, I was left thinking how 'sensible' and in a way 'obvious' the existential-phenomenological approach is! This was well exempled in the 'Mind and Body' chapter where the separation of mind from body (psychosomatic) is in fact an intellectual speculation, not a reflection on our actual experience. How mental symptoms become physicalised is unknown and remains a mystery.

On a more critical note I wondered about the overall structure and resulting flow of the book. I would have preferred the first three chapters, which are essentially introductory to both psychoanalytic theory and existential-phenomenological thinking, to be pulled together as a springboard for the following chapters. As a mainly theoretical chapter, 'The Question of the Unconscious' might also have been included therein. The chapter on groups, 'Existential-phenomenological Dimensions of Groups', though of interest and not written about by existentially oriented writers, I felt to be an insertion which interrupted the flow of my more clinical gaze on commonly met client experiences and distress. I, however, know this area to be of particular interest to the author and wonder if he agrees that this theme could well stand as a book to itself?

All psychoanalytic writing has itself to take a stand either in agreement or in disagreement with Freud and I started this review perspecting psychoanalytic theory as being 'in transition'. But in transition to what? Existential phenomenology? Perhaps Hans Cohn has introduced that thought and provided a startpoint. I learned when reading this book and was challenged to place myself in my own practice which still contains residues of psychoanalytic thinking. As there are many ways of doing phenomenology and many ways of being an existentialist, this book also recognises this and sets out to be a startpoint, an introduction, to which others can respond forthwith. I recently read that a sophisticated primer should be an introduction to a field and encompass it in a way that is enlightening to the experienced as well as the beginner. This book, I think, meets that request.

Nick Zinovieff

References

Gill, M.M. (1994) Psychoanalysis in Transition London: The Analytic Press.

Stolorow, R., Brandschaft, B. & Atwood, G. (1987) Psychoanalytic Treatment: An Intersubjective Approach Hillsdale, NJ The Analytic Press.