Book Review: Practising Existential Psychotherapy: The Relational World

I have long been interested in existential psychotherapy. The writings of Ronnie Laing were a strong influence on me as a young psychologist. I saw Laing and Rogers as describing similar radical perspectives. Indeed, in terms of their writings on the nature of the person and the concept of disorder, I saw nothing but similarities, though their approaches to therapy were different. In 1972, or perhaps it was 1973, when Laing gave a public lecture in San Diego State University, I nervously tried to bring my two heroes together by extending to Laing an invitation from Rogers to meet. Laing declined, not too politely, and my hoped for opportunity was lost.

In more recent years I have continued to have a 'view from the boundary' of existential psychotherapy. I noted what seemed to be comparative coherence within the approach in terms of an underlying theory of the person, but I struggled to get a grip of the theory of therapy. There seemed to be such a range, from what looked like an abridged psychoanalytic method to something much closer to my own emphasis on a particularly relational way of working. I suspected that Ernesto Spinelli was closer to the latter and that was confirmed when I attended one of his classes – the language was different, but the observations were similar. There was the same special emphasis on taking a phenomenological perspective; a discomfort with techniques; a view of symptoms as clues to dis-ease rather than treatment targets; a valuing of the therapeutic relationship as an en-counter; and a familiar valuing of empathy, acceptance and immediacy.

So, that is the background from which I approach this review of Spinelli's book. I am external to existential psychotherapy and the review will undoubtedly reflect that naivety. Yet, an external perspective can sometimes also be refreshing in the observations that naivety permits.

The first thing to note about this work is that it is a textbook. Spinelli eschews that categorisation, simply professing that he is describing the system of working he has developed over time. Perhaps there would also be political issues and other sensibilities involved if this were to be seen as a textbook for existential psychotherapy as a whole, though I imagine that the publisher would not be averse to such a classification. In its structure and production it fulfils all the criteria for a textbook. It is a 'first-level' text. It is written intelligibly for new students with each term diligently explained at the three levels: conceptually, in more but smaller words; and by means of exemplars. It begins by explaining the underpinnings of the approach as well as its basic tenets and moves on to breakdown the therapeutic process into three phases, conventionally corresponding to 'beginnings', 'middles' and 'endings'. In its detailed description of the therapeutic process it offers a 'how to…' structure for the new student, but it does that skilfully while not debasing the thoroughly phenomenological essence of the therapeutic relationship. It further fulfils the criteria for a textbook by consistently adding 'for example…', and by including self-reflective exercises at the end of each section.

Briefly, the content of the book is as follows. It is written in two parts, with part one including three chapters on the philosophical foundations of the approach, the concept of the 'worldview', and the underpinning theoretical assumptions. Part two describes Spinelli's Structural Model of existential psychotherapy in four chapters, the first being an introduction to the whole and the others describing the three phases corresponding to 'co-creating, exploring and closing down' the therapy world. Also included in this section is an addendum chapter on existential psychotherapy with couples and groups.

The heart of the book is the structural model with its three phases. In phase one the client and the therapist co-create a therapy world. Spinelli acknowledges that this is an unequal endeavour with the therapist contributing most to the structuring. He sets the scene for phase one as follows:

Thus, two people agree to investigate the worldview adopted by one of them. They agree that the primary way of attempting this enterprise is through their experience of relatedness under a set of agreed-upon conditions that are shared by both participants, even if these shared conditions are likely to be unequal in that their content and focus have been principally determined by one participant…

(p. 99)

I am delighted by Spinelli's critical attitude towards many of the conventional aspects of the early structuring of the therapy world. He acknowledges that there is no empirical evidence supporting most of the ways the therapist seeks to structure the setting, yet many have become so enshrined in the profession that to fail to go along with them could be regarded as unprofessional. I can't help wondering if most of this early structuring is more about the therapist creating a safe environment for themselves rather than a creative one for the client. Spinelli uses the delightful metaphor of 'magic feather's (aka Dumbo) to describe these elements of structuring whose power is more illusory than real.

The essential relational aim of the first phase is that the client establishes sufficient trust in the therapist to embark upon the greater challenges of phase two. While in phase one the therapist sought to attune themselves to the client's world, in phase two the therapist offers their self as an 'other' to the client – a self with a different worldview that the client can use in juxtaposition to their own. Hence, the therapist not only listens to but also challenges the client's narrative as part of exploring their worldview. In this phase Spinelli describes elements such as the inter-relational realms of the encounter and working with intimacy. One of the case illustrations Spinelli uses throughout the book is of his work with a young man who is particularly concerned with the phoniness of the world around him (and later within him). A lovely example is on pages 152 and 153 where Spinelli and the client explore the question of Spinelli's phoniness. Until this point in the book I was struggling to see how the relatedness that is very much Spinelli's emphasis could come through the relentless Socratic dialogue. But this extract well illustrates Spinelli's willingness to be used in relationship as an other to the client and also his good humour in doing that.

In phase three the work is concerned with 'the exploration of the potential 'bridging' between the therapy world and the wider world worldviews' (p. 178). In phase two the attention had been drawn tightly around the two therapy participants, with concentration upon the client's 'I-Focus, You-Focus and We-Focus' in the context of that relationship, but now the attention begins to include the 'They-Focus' in terms of the client's awareness of other worldviews. In this phase the relationship continues to be the important medium for the work as the therapist provides the 'other' in terms of alternative worldviews. I like the balance Spinelli offers in this phase. His task is not to represent the world of others outside of the client, but more to help the client to access the world of others that is within him or her. The person is not only part of their community – their community is part of them. Too often therapists are prepared to end the therapy with the client glowing in excitement at having found their own growth, but only finding out afterwards that other people in their life are also a part of them.

In recent times there have been many moves within the therapy world to attach greater emphasis to the relationship as the key dimension. In modern psychoanalysis we see, for example, a greater willingness to work with the real relationship as well as the transference relationship (Mitchell, 2000) and in person-centred therapy there is a radical emphasis on 'relational depth' in therapy as a working method particularly with hard-to-reach clients (Mearns & Cooper, 2005). Spinelli's emphasis on the relationship is certainly within this same 'family' of developments, but probably closer to the former than the latter. The key distinguishing issue is how far the therapist is pro-actively seeking to develop the relationship and to what depths of experiencing of both parties. In Spinelli's work, as with that of the modern analysts, whatever relationship that happens to develop is used. But the emphasis is still on the dialogue rather than the relationship building.

Dave Mearns