Book Review: After Psychotherapy: Essays and thoughts on existential therapy

Miles Groth brings together a number of essays and collection of thoughts on what he terms existential therapy, explicitly not psychotherapy here, because existential therapy is not directed to what has been called the 'psyche' (p 80). I must confess to not having heard of Groth before this point, and to a certain degree I am still none the wiser, as the book lacks the archetypal author biography. This stuck with me; my normal approach to a book is to read the back page, on which there is only a photo, and then the biography of the author. The lack of anything of the sort set the tone; for me this was already attempting to shift existential therapy away from the mainstream, and embody the idea that 'we will have to declare our independence from academic psychology and medical psychology' (p 23) and more.

Groth presents eight chapters after a brief introductory note, which tries to place each chapter in its original publication and time; all but one chapter was published in a peer-reviewed journal between 1995 and 2008. Interestingly, he does not offer a reason or rationale for why he has chosen now to bring these papers together, nor why these papers were selected as his publication list, which is way wider than these eight papers. For me the fifth, sixth and seventh chapters were the most interesting and relevant to therapy, not least as the only three case studies are contained within these sections. 'Therapeutic Validation in Existential Analysis' (chapter five) and the subsequent 'Authenticity in Existential Analysis', were both originally published in this journal in 2002 and 2008 respectively. In chapter five, the exploration of validation, and the ensuing case study of J, brought a clarity to the idea that one must strive to give the client an experience of 'being taken seriously as a human being' (p 119) through doing, ideally, nothing at all.

I found the case study of Charlie in chapter seven, 'Eros in Existential Analysis', insightful and intriguing. This was the only chapter that has not previously been published, and had its genesis in two conference presentations, resulting in a different style. The chapter deals with eros and the difference between that and sex, defined by Groth as heterosexual intercourse due to it being 'a brief transaction, the telos of which is the biological continuation of the species' (p 158). The case of Charlie, who had arrived wanting 'nothing really' (p 169) illuminates the relationship to the psychoanalytic concept of transference, a notion where I have struggled to link the theory and the practice. The relative simplicity, yet difficulty in remaining open to, eros, is well entwined in the practical and lived experience from Groth's years of practice. I felt this was really useful for an idea I have struggled to find the words for and it resonates well.

One paragraph in the chapter felt clumsy and awkward. In a discussion around homosexuality, Groth describes it as akin to the use by the ancient Greeks of slaves as something intermediate between sex and eros. He uses the term 'so-called' twice inside a paragraph, explicitly about homosexuality, saying he has argued this elsewhere already. Without a specific reference in the text, or a wider context at the end of the chapter, I wonder whether I have misinterpreted Groth's view, one which has left me feeling uncomfortable. I am also unable to explore it in his other writings, as it is not dealt with within the book. My understanding is that he is arguing that since reproduction cannot be an outcome of sexual activity between men, it is not sex but a substitute. It is interesting that this is only talked about in relation to the male-only practice, not addressing female-only activity, nor activity where reproduction cannot be achieved. As such, it feels like a throwaway line – and an uncomfortable one at that.

There was, somewhat inevitably, a degree of repetition from chapter to chapter, which at times felt inelegant. Further editing could have smoothed this repetition down somewhat, yet that would have made the later chapters feel potentially disjointed if they had simply referred to the above; if one were to treat each chapter as a separate paper, it works perfectly well. The first two chapters fell prey to this repetition, leaving me with a feeling that I was re-reading something I had already read.

'The Background of Contemporary Existential Psychotherapy' constitutes the first chapter and offers a pithy overview of the development of existential therapy up until 1999, initially through what reads like an overview author list. Originally written as introductory remarks for a conference in 1997, the chapter ends with a rationale for the conference, but also in part for the book as Groth feels it is 'important to bring together as many representatives of existential practice (in all its diversity) as possible in order to hear from each other about what existential psychotherapy now means' (p 6).

The second chapter, 'Existential Psychotherapy Today', works methodically through the contradictions as seen in the US therapeutic and medical models. The concepts of what existential therapy is, and is not, are brought to the fore, along with a more detailed history that builds and repeats from the previous chapter. The final section, the viewpoint of an existential psychotherapist, gives a reassuring view that 'we must finally admit that we do not know what the characteristics of a good psychotherapist are' (p 36). This appeals, potentially assuaging my own doubts about what we are aiming for. Inevitably, it is not developed to a conclusion and the section left me wanting a deeper, wider exploration. Groth clearly states that one needs 'in addition to a lifetime of wide reading, especially of history and literature, familiarity with languages and the great variety of cultures, characters and civilisations, including their literatures and religious traditions, that have grown up is also essential background for someone who seeks to understand another human being' (p 37). This seems like sage advice, however it would have been interesting and insightful had Groth pointed to some of the areas where he sees value, given that training, at least in the UK, relies heavily on thoughts emanating from white Western men. I would have liked greater clarification through examples.

He makes some illuminating comments such as 'we must welcome candidates from far-ranging fields, as psychoanalysis did in its early days' (pp 37-38). While I wholeheartedly agree, this seems at variance with the reality of the current situation and the truth of the early days of psychoanalysis. Then, as now, candidates are welcomed from a variety of backgrounds only if there is a privilege involved, given the investment of time and money required, investments which do not offer a payback, at least in modern times, in monetary terms. So the illumination is of a superficial and undeveloped nature, one where the limited potential candidates is recast in a positive light for the sake of the profession, ignoring the lack of diversity away from the white middle classes.

The final chapter, by far the longest, is entitled 'Notes on therapeutic phenomenology', and is disjointed in terms of flow compared with the rest of the book; it draws on the independent tradition including Winnicott, Bion, Rycroft, Khan, Laing and Szasz, through a series of thoughts and quotes. Groth deliberately does not reference the quotes in an attempt to encourage the 'reader… to read through these authors' works in their entirety' (p 181). This lack of structure is thought-provoking but infuriating, as I found when I came to review that I struggled to find and order things. That may have been the intention, and if so it succeeded, but without an introduction, it felt awkward and unwielding. As an addendum, it feels like an afterthought and could easily have been missed out without denigrating the overall affect of the publication.

Overall, I felt challenged by the uncompromising stance adopted by Groth, and the certainty with which he advocates for certain beliefs. He is not alone in these, especially that 'existential therapy is not possible when a fee is paid by anyone other than the other, since existential therapy precludes the involvement of third parties, including employers, representatives of insurance companies, courts or schools and other family members' (p 81). This feels a rather dated view to me and potentially indicative of the span of the papers, rather than a more modern view whereby therapy should not be limited to the middle classes, but for everybody within our respective communities. Simply, Groth seems to place psychotherapy in the current societal structures, rather than recognizing its potential as a political undertaking. Of course, it may be that time has not changed the viewpoint, but there is a lack of acknowledgement that autonomy and financial independence are not the same thing, and people experiencing existential change and challenge are not limited to middle class potential clients. Perhaps this is too far to expect an examination of this nature. After all, the text sets out to look at the foundations of existential psychotherapy. Nonetheless, the premise of it being limited in accessibility, not just from the quote, but also the idea that everybody could afford the time and expense to explore not feeling quite right in time, is not addressed in the slightest.

I really enjoyed the book for what it is; each of the first seven chapters, as individual entities, felt carefully thought through, cogent and written in an accessible style that belies some of the complexity of ideas being grappled with. I feel it has given a deep and meaningful insight into his understanding and experience of existential thought, and something of what he feels it is to practice. Limiting the case studies to three in a 283-page book feels light and like a missed opportunity, which leaves a sense of uncertainty as to how therapy can actually unfold. I am unsure as to whether I would recommend this book, as I am not sure to who and why I would. For both my peers who are studying and those colleagues already qualified, I think there are more focused offerings out there. While there are small parts which I feel presented a huge amount, on balance, it was not enough to justify persuading anybody in its direction.

Ben Scanlan