Book Review: Practicing Existential Therapy: The Relational World (2nd Edition)

This review concerns the second edition of Spinelli's most explicit statement of his own position on existential therapy. I was invited to review this book as someone who might be able to offer an appropriate critical reading that did not fall into either hagiography or obloquy. I felt happy to take up this challenge. I have admired Spinelli's work for some time and was looking forward to reading this book. Much of the content remains similar to the first edition with a beautifully clear exposition of his 'structural model', the major element that should prove useful to trainees and experienced therapists alike. The second edition contains new material mostly through expanded consideration of topics that were present in the first edition. Given that the first edition proved exceptionally popular, I have no doubt that this new edition will occupy a similarly prominent place on the shelves of people working in this field. I shall begin this review – somewhat counter intuitively – by (briefly) discussing the second part of the book that introduces Spinelli's 'structural model'. After that I shall spend more time on the first part of the book and, in particular, the rather unfortunate way that Spinelli sets up his own approach to existential therapeutic theory and practice in opposition to that of most of the other people writing on this topic. It was when I read the opening section of the book that I found myself really quite dismayed at both the way that the work of others was inaccurately portrayed (and then unfairly dismissed) and how I now – with regret – feel the need to challenge this misrepresentation in a review of an otherwise excellent book by an established figure in the field.

The great strength of this text is the very clear way that Spinelli outlines and explains his approach to therapeutic practice, with numerous practical exercises included to help develop skills and understanding. Part 2 introduces Spinelli's 'structural model' in which he outlines the three phases of therapy: Phase 1 – co-creating the therapy-world, Phase 2 – exploring the therapy-world, and Phase 3 – closing down the therapy-world. The emphasis throughout is on being 'descriptively attuned' to the client, a position that I would expect to see shared by most, if not all, existential therapists. This descriptive stance is understandably strongest in the first phase, described by Spinelli (p 119) as a stance in which we have 'the therapist as idiot'. This is a rather unfortunate phrase but we can see the focus here is on assuming a phenomenological attitude first and foremost as the relationship is developed, with the client able to 'hear their own voice more accurately and truthfully'. Phase 2 involves more engagement with matters such as existence tensions, sedimentations, the relational and intimacy. The final phase is rather briefly described but obviously concerns the ending and need to facilitate a bridging of 'therapy-world' and 'wider-world'. The section on the phenomenological method feels a little brief (and somewhat hidden) considering this forms the basis for practice amongst most existential therapists, but otherwise there is considerable depth to the material in this section and a great deal of knowledge generously shared that should be helpful in thinking through one's own practice. The book ends with a slightly expanded "addenda" in which there is consideration of therapy with couples and groups, supervision and working in a time-limited context. There is some interesting material here but it does feel like an underdeveloped 'add on', as implied in the section title itself. But this must surely be forgiven given that it is merely reflective of the fact that these areas remain underdeveloped within existential therapeutic theory and practice in general.

Turning to the first section of the book things become more problematic. Whilst there is much to like in the first section in terms of the clear explication of often complex ideas, the book begins with an introductory statement to the second edition expressing Spinelli's opposition to an amorphous Other (de Beauvoir 1949/1953; Said, 1978). The Other that has been constructed is rather underspecified but still problematic with the critical arguments appearing unnecessarily combative in intent. He positions his own approach to 'existential therapy' in opposition to those of many others, namely: Barnett & Madison, Boss, Cohn, Cooper, Jacobsen, Langdridge, May, van Deurzen, Adams, and Yalom. This opposition is made on two grounds. The first is that these others apparently define existential psychotherapy through 'themes' rather than 'principles' (p 3), which he goes on to explicate further in the first substantive chapter. The second is that they (we) apparently claim existential therapy is 'uniquely philosophically grounded' (p 3). Spinelli rightly points out the rejection of dualisms as a central feature of existential phenomenology so it is a terrible shame that he introduces his own (completely unnecessary) dualism here between self (right) and Other(s) (wrong).

The first argument rests on a spurious distinction between 'themes' and 'principles' that sets up a false opposition. In order to make this distinction Spinelli draws on a rather arcane article by Colaizzi (2002) that is itself deeply problematic. Colaizzi (2002) effectively seeks to explicate a number of principles for 'existential therapy'. He does this by setting up a false distinction between 'life' and 'existence' that leads to another false distinction between 'existential psychotherapy' and 'existential therapy':

This is why psychotherapists are not interested in anything which is not a problem for the general population, for the public at large, have no concern or use for the issues that stand at issue for Self-existence, and have never examined or even been struck by the distinction between life and existence – not even the so-called 'existential psychotherapist', which term, as should be evidence by now, is an internal contradiction and an existential impossibility.

(p 82)

This distinction is used by Spinelli to frame his work and distinguish it from those of the Others. I remain completely baffled by the supposed distinction between 'thematic existence concerns' and 'existential principles'. Why are 'existential relatedness', 'uncertainty' and 'existential anxiety' the 'foundational principles' (p. 11) for existential psychotherapy and how these are distinguished from the self-same entitled 'themes' described by other authors? In order to prosecute this argument, Spinelli once again creates a false Other who apparently fails to understand that, for instance, death is important to other forms of psychotherapy. I cannot locate a single existential psychotherapeutic writer who has said anything like this. Like Spinelli, who spends considerable time discussing such 'themes' in his own book, they would all argue that it is the way that existential philosophers address the issue of death that marks the difference with many (though not all) other therapeutic orientations. And more importantly, these other authors would also question the ability to distinguish 'anxiety' as a 'principle' from 'death' as a 'theme', given that the former is in large part the product – in existential terms – of the latter. I could go on but suffice it to say that throughout this opening position statement Spinelli misrepresents the views of those Others that are implicitly implicated through inclusion in the nameclist above.

The second argument is also easily dismissed for it is a gross misinterpretation of what other writers actually say about existential psychotherapy. I know of no one who has made the argument that Spinelli claims. His lack of a direct reference to a person's work to substantiate his claim is particularly problematic. It leaves the accusation hanging, over all of us who have sought to write about the theory and practice of existential counselling and psychotherapy. His position that 'all therapeutic theories are underpinned by philosophical assumptions and postulates' (p 3) is obviously true but I know of no one who has ever claimed otherwise. Existential therapy involves more direct engagement with philosophy qua philosophy than most other forms of therapy and that does distinguish it somewhat (in training and practice) but this is hardly a particularly profound or significant claim, and certainly not one that warrants the attack presented in the beginning of this book.

It is a shame that Spinelli feels the need to position his own approach in opposition to others. As Freud might appositely comment, internecine disputes are rarely more than the narcissism of small differences. Spinelli does seek to acknowledge that there are many forms of existential therapy but unfortunately still feels the need to frame his argument from the very beginning in oppositional terms. I wish he had simply made the positive case for his approach. I have never considered my own work in opposition to that of Spinelli and nor – I suspect – do many of those others named in this book. I have the greatest of respect for his work and have always drawn on his ideas for my own practice. It is unfortunate, therefore, that in this attempt to outline his own very valuable approach to existential psychotherapy he has done this in such negative terms.

Prof Darren Langdridge

References

Colaizzi, P. F. (2002). Psychotherapy and existential therapy. Journal of Phenomenological Psychology, 33(1): 73-112.

De Beauvoir, S. (1949/1997). The Second Sex. Trans. Parshley, H.M. (ed.). London: Vintage.

Said, E. (1978). Orientalism. New York: Pantheon Books.