Book Review: Nietzsche and Psychotherapy

Nietzsche and Psychotherapy

Manu Bazzano. 2019. London: Routledge.

Some years ago I gave a talk on Nietzsche's usage of psychology which began by showing some fifty or so photographs and pictures of him to the accompaniment of one of his piano pieces – yes he was also a composer and, yes, you can get recordings of his work. The purpose of this exercise was to remind the audience that there are many views of his philosophy, and that what they were about to hear was 'my' Nietzsche. This thought came back to me on reading Bazzano's introduction to his book, in which he noted that innumerable volumes had been written entitled 'Nietzsche and…'. And indeed, they are, and though he offers a slight apology as to his choice of title, it is far from needed. His 'Nietzsche and' is an impressive and much-needed addition to the literature which places the philosopher's work firmly and squarely into the therapeutic frame, where it raises many challenging questions about fundamental practices and assumptions.

Certainly aspects of Nietzsche's ideas have been covered before, particularly with regard to Freud's acquisition of the idea of 'drives', but here we have a perspective that offers an understanding of, and an approach to, practice that constantly questions what are often self-referential and indeed somewhat precious theories of much contemporary practice that omit any consideration of how both participants in the encounter are caught up in an essentially Christian world-view that is firmly embedded in the West's culture to the extent that it may not even be noticed. Most practitioners might claim a secular stance, advocating personal choice, self-actualization etc., coupled with a wish to make their clients' lives more pleasurable by attempting to ameliorate despair, anxiety and the various ills that human flesh is heir to. In reality, they are buying into precisely the same issues that Nietzsche questions, that have their roots in a shared culture, and in effect are offering more of the same under the guise of offering a solution.

These therapists, whom Bazzano terms homo neoliberalis, often begin their training in institutions whose glossy prospectuses are larded with claims emphasising the importance of embracing diversity and difference, but ultimately impose the uniformity of pre-determined learning outcomes in the name of equality, later to be regimented by various registering bodies. Who can argue with such noble ideals framed in weasel words? Well Bazzano for a start. But before getting into the substance of his objections, and how he proposes they are to be addressed, let us step back and look at how Nietzsche described the fundamental problems of the language we use (or are used by), a key concern for both the philologist and the therapist.

Starting with Nietzsche's (in)famous statement that 'there are no facts, only interpretations', a claim going beyond the idea that all interpretations are subjective, for even the nature of the experiencing 'subject' is itself an interpretation emerging from unconsidered horizons always lurking in the background, Nietzsche de-stabilises our reliance on the certainties of language even further by making the claim that all language is metaphoric. He suggests it thus: that in the beginning, the observer saw an object, and turned it into a meaningful image (first metaphor). However, the image reflected the immediate, temporal concerns of the observer, who made sense of it in terms of what was important at the moment of perception. Nietzsche conjectures that other life forms might see the object in radically different ways, thus implicitly questioning the status of Euro, or any other, centric perspectives, granting even the mosquito the validity of its perceptions. Being gifted with language, humans then moved to the second stage of sense-making by giving a word-sound to the image (the second metaphor) and thus here we are always two metaphors away from the Husserlian ideal of seeing 'things as they are'. Interestingly, given his dislike for Socratic/Platonic metaphysics, this analogy echoes Plato's claim that the carpenter's bed is a poor copy of the Ideal, and the painter who then depicts it further distances his work from its originating source. However, the bottom line for Nietzsche is not situated outside of our world but within it. It is a world created by the language we use to describe it and ourselves, which is never clear and objective but is ultimately aimed at making the world comprehensible, secure and understandable for our own needs and purposes. In the midst of all this, a sense of self or ego once emerged to identify the speaker, which subsequently became reified as some sort of internal object. It has since led to all sorts of psychological and philosophical confusions that much of this book seeks to clarify when we, as psychotherapists, are asked to unravel the consequences of our clients' search for their 'true self', the finding of which might, apparently, make everything clear.

Bazzano begins to unravel some of these confusions by returning, like Nietzsche, to the roots of early Greek thinking. Here he introduces key themes in Greek drama which emphasise the tragic, that is the sense of fate, destiny and a readiness to endure the extremes of experience, ideas that are central to Nietzsche's understanding of the human condition, and Bazzano's later expansion of their importance (and general omission) in the work of current psychotherapy. In a world where the Gods were alive, and whose hands (and at times other of their members) were understood as being a direct influence in daily life, there was a culture that is hard to grasp today. Indeed, Bazzano suggests that we live in a world without any real culture at all – everything being driven, with the aid of much of the therapeutic world, towards creating an amorphous and undifferentiated form of humanity where wellness, happiness and the goal of living a problem-free life is the agenda of choice.

In the past the Gods had different ideas: we were to be exposed to contradictions and confusions, living them out in acceptance or rebellion – the latter choice not always the wisest; denial inevitably trawling problems in its wake. True, Mount Olympus could be seen today as housing the world's first dysfunctional family (James Hillman once commented that the Gods had not died but had become today's diseases). Of course, there were Gods for everything – the deity of the doorframe, another for the hinges and, most relevant for therapy, for the door itself, the most tangible of the therapist's boundaries, around which many myths still hover. For Nietzsche, it was Apollo and Dionysus who held centre stage in his writings, an apparently simple contradiction of logos and sensory abandonment that Bazzano questions, his scholarship unravelling the hidden components of the one in the other, and what this might mean for understanding ourselves. Bazzano demonstrates that there is much more in all of this than an academic diversion into the Wests' collective past.

The Gods, with their different agendas and power issues, were for Nietzsche the first metaphors for how we are all caught in the contradictory circumstances of our life, and thus faced with the problem of what to do with competing desires. Ah, well, we might think, nothing much new here. We're all beset by conflicting wishes; the second slice of cake, or do what the doctor suggested. Nietzsche's view of this conundrum is radically different and lies at the heart of the therapeutic style that is central to Bazzano's approach, questioning the assumptions of virtually all modalities by placing Nietzsche's view of the human being at its centre. Phrasing questions in terms of either/or (sorry, Søren) of having competing desires that need to be resolved for our well-being, already traps us in a picture that forms the basis of the vast majority of therapeutic theories. It is the picture of a self or ego, whether inchoate at birth and awaited 'actualization', or developed through life experiences, a centre that is ultimately 'who we are'. It provides the assumed vantage point from which all competing wishes, urges, lusts or drives are to be regulated, integrated or assimilated into an individuated self, or play a part of an ongoing process of becoming, or what have you.

All lead towards what, for Nietzsche, is a fundamental error – the image of a unified self. For Nietzsche, as with Wittgenstein, the self is no more than an artefact of grammar, a socially useful device that acknowledges someone expressing a wish or thought (I would like a cup of tea; I think Boris Johnson is a joker) but does not name the speaker as a discrete self. It is only the expressed wish or the thought that is being stated. Alas, as Nietzsche suggests, at some point in our history, the wish or thought became conflated with the speaker, who had now become a 'self', the self-contained originator of everything expressed or done under its guise and, to some extent, we are stuck with this. But if I am not a quasi-Cartesian ego, the originator of my thoughts, to whom all my feelings ultimately devolve, then what is happening, and what are the implications for the psychotherapist? For Nietzsche it all comes down to the Will to Power¹.

This phrase, from now on abbreviated as WTP, is much misunderstood within psychology, such as Maslow's 'self-actualization' with its implication of some ego-driven urge towards a peak, unifying experience that consolidates an individual's identity by amplifying or integrating contradictory feelings into a coherent whole. For Nietzsche, the reverse is the case. The illusion of a coherent self is created by the interplay of diverse thoughts and feelings, of bodily sensations and creative actions. Interestingly, the mystical philosopher G.I. Gurdjieff offered a similar picture of the human being as a fine mansion at which a caller arrives demanding to speak with the master of the house. However, anyone who answered the door – butler, chambermaid, boot boy, etc. – declared themselves to be the master, believing in the moment that they really were. Thus, with our various drives and desires, each one giving rise in the moment to a fictitious, initiating ego, each one with its own WTP, and with it a raft of interpretations aimed at sustaining its perspective at the cost of all others.

It is in the very act of our immersion in multiplicity that gives rise to the sense of a self because, as Safranski (2002: 300) puts it 'we cannot endure the dynamics of anonymous actions, we append an invented agent to these acts'. The human being is not an individuum, not a dynamic unity as Safranski continues: 'but rather a swarm of diverse ambitions, an arena of energies battling for power'. This is strong stuff to which Bazzano brings many philosophers and examples from literature into unravelling and exploring the implications of being, not an individuum, but a dividuum, in which an endless multiplicity of interpretations, the expressions of diverse WTPs, all vie for a hearing. While this is challenging enough for any ego-orientated psychotherapist, there is worse to come. Far from psychotherapy in its many conventional forms being a process leading towards clarification, a possible working through and an acceptance of the consequences of earlier experiences, its painstaking endeavours are really covert acts of revenge.

The claim is that at our core rests an unacknowledged resentment against the vicissitudes of life, where an apparently objective search for causes, of which science is the prime example, masks a need to apportion blame and (Christian) guilt. Weren't me, Lord, its my genes, my bad upbringing, t'was wicked uncle Ernie's 'fiddling about', and if it wasn't for all of this, it would be fine and dandy. At first reading this seems like crass victim-blaming (blaming the victim being just another form of blaming) and as all of us have worked with people who have suffered terrible experiences at the hands of others, what are we to make of this assertion, that the need to blame is but another example of one drive's WTP? There is little doubt that in today's world many seek to describe themselves as victims, and thus gain some power (and possibly substantial cash) as a consequence of this perspective gaining dominance. Similarly, there is the phenomenon of some 'personality' receiving a shitload of sanctimony for voicing some mildly controversial opinion, another shared WTP trying to maintain its illusory status in the face of complexity. That said, there still remains something very hard-edged in the claim that blaming lies at the heart of any search for truth, and its to Bazzano's credit that he explores this quandary at some considerable depth, bringing into his discussion a range of philosophical and psychotherapeutic views, along with some examples of his client work.

Central to this discussion is how we make sense of the situation that Nietzsche suggests is our lot. In short, to be the person in whom these forces play out their respective WTP so that we can become aware of how we have been caught by them. Zurich Jungians have termed such experiences a 'still point', where we are given a glimpse of who we are at that moment, and though such instants tend to be transitory they can be liberating and, occasionally, life-changing. Biography suggests that Nietzsche would be familiar with such moments though, paradoxically, towards the end of his creative life he was seized by an idea that throws into complexity the whole issue of our 'making changes'. These lie at the heart of much psychotherapy, by suggesting that we might have to endure things as they always have been without knowing, or even actively willing them to be as they were: the concept of the Eternal Return.

The idea that time and our part in it might repeat cyclically is as old as all the hills in Greece and Asia. In his student days, Nietzsche was certainly aware of its Greek origins, but one day in August 1881 in Switzerland's Engadin he was hit by the full force of it, and it became a central theme in his thinking, despite its obviously metaphysical nature. Although he suggested everything repeats absolutely ('even this spider in the moonlight') the various ways in which this theme was itself repeated opens up other interpretations. Bazzano focuses on these possibilities, exploring at some depth their implications for psychotherapy and making explicit the important consequences of what, at first glance, seems a bizarre idea that was for Kaufmann (1974: 323) evidence that perhaps it was the overwhelming experience rather than the idea itself that made such an impact on Nietzsche. What might follow from confronting aspects of our life with the thought, do I want to do this again and again, forever? How could I reformulate what is for it to become genuinely transformative and not holding some fantasy of being 'whole' or 'authentic', all of which would be in the thrall of some WTP? This section is particularly illuminating on the different ways of thinking about time and repetition, though Bazzano does bring in an idea from computing: the mathematics of recursion.

In the past, I have spent many hours avoiding work by writing variant codes for the Mandelbrot Set, which generate intriguing patterns via recursion. These patterns repeat precisely despite random shifts of size and direction, and I was not too sure where he was going with this. The idea comes right at the end, almost as an afterthought, and is not explored with the same lucidity as what has gone before. Overall the book is written with great clarity, occasional bursts of wicked humour, and consistently draws on an impressive range of thinkers, all illuminating the breadth of his considerable understanding of Nietzsche. As a whole the book conveys not only his learning but also his passion for Nietzsche's ideas, and his wish for them to be understood by psychotherapists in the hope that they will challenge the stultifying nature of much training and practice. Indeed, it is this evident passion for Nietzsche's work to be accessible to all that at times raised questions for me about how its language may best be conveyed that allow both openness to change while also acknowledging the veracity of the original text.

At several points, I could not quite agree with Bazzano's attempts at a more gender-neutral translation -mensch as 'human' and on occasions turning 'him' or 'man' into the feminine. While I can see in this a genuine wish to avoid stereotypes, it risks going against the whole spirit of language by implying that words have fixed and certain meanings. They do not; they have usage that at times is complex. Nietzsche would describe the moral, upstanding Christian as a Nihilist and a degenerate. Nihilist because, like a believer in any form of metaphysics, an imaginary world 'outside' of the real one is given precedence and explanatory power over earthly realities; decadent because the body with its sensations and urges is denigrated and reviled as the source of all sin. If the idea of the 'superman' is problematic, and the idea of a 'superwoman' risks different forms of stereotypes, then it may be useful to note that Nietzsche did not always use that term. Kaufmann (ibid: 308) points out that Nietzsche initially used the phrase über dir – over (or above) you – as in 'your true self …, does not lie deeply concealed within but immeasurably high over you'. While the term übermensch is used elsewhere, the 'super' arises in translation and to me seems less personal. Perhaps Nietzsche's alleged misogyny has created a wish for greater linguistic generosity, but I am not sure it always works here, and in its own way might suggest an inability on the reader's part to engage with polysemy. I write 'alleged' because this easily reached-for putdown has also been questioned by feminist philosophers who have offered radically different interpretations of Nietzsche's use of feminine imagery.

Frances Nesbitt Oppel's Nietzsche on Gender (2005) similarly explores early Greek mythology, expanding our understanding of Apollo and Dionysus and exploring at some depth how Nietzsche actually used gender roles, sometimes reversing them. However, in terms of Bazzano's work, and his reiterating Nietzsche's emphasis on the body as the indisputable and fundamental reality of our existence, the writing of Irigaray (1991), while clearly sympathetic to Nietzsche nevertheless offers important challenges. Much of her work is concerned with exploring the sexed/gendered body and thus the nature of physical realties, and their varied interpretations. Given that all bodily sensations are also interpretations, Irigaray's work draws attention to a body that is open to the world in a certain way, that has cyclic rhythms, a body that she claims has 'an irreducible relationship to the universe' (1994: 25), can become pregnant, can give new life to the world, all emphasise the very differences that Nietzsche's demands we have to face. Each urge, each wish embodying a WTP that seeks expression and dominance within us. At various points in his book Bazzano suggests that we try thought experiments when confronted by one of Nietzsche's challenging claims, and Irigaray's stance would also provide fuel for this. While thought experiments are an excellent way of beginning to explore and question new ideas, wondering how they may pan out in practice and what feelings their possibilities bring up for us, they have one powerful limitation: we can't imagine what we can't imagine. Hence, the necessity of the Other, here in the form of the therapist.

So what should the Nietzschean therapist 'do'? A highly problematic question, given that many clients seek to resolve their issues as painlessly as possible, often wishing for themselves less conflicts, greater happiness, the finding of their 'true self' or, in the case of a breakdown, wishing to return to who they used to be when things, apparently, were fine. While many approaches would want to question some or all of these understandable aspirations, the Nietzschean therapist would hold a picture of the human condition that radically challenges just about every assumption that can be stated, and many that have yet to arise. Inevitably, as the very style of Nietzsche's philosophising invites alternatives and contradictions as Jaspers noted, Nietzsche's own contradictions could be seen, not as errors of consistency, but as illustrating the very substance of his philosophical approach. Nevertheless, Bazzano offers valuable pointers, in the main echoing Nietzsche's emphasis on the importance of personal creativity that is life affirming, engaging with concepts of fate, destiny and transformative possibilities. Though his overall stance is critical of many waffle-bound aims to 'be-with', have 'I-Thou' moments, experiencing 'relational depth', 'congruence', 'authenticity' and whatever is the latest buzz phrase, the criticisms are perceptive comments on much of today's 'non-culture' and its impact of psychotherapy. Overall, this is a lucid and thought-provoking book, extremely well written and referenced, which encapsulates many perspectives on Nietzsche's work, and I would find it hard to take seriously anyone seeking to question Nietzsche's relevance for psychotherapy who has not read it. The discussions are profound and important, and I am aware that after reading them 'my' Nietzsche is not quite the same person as before. And nor am I.

Mike Harding

Notes

¹ Bazzano reminds us that this phrase has nothing to do with National Socialism, it may be useful to offer the following from a genuine Nazi, quoted on p 340 in the Safranski biography: Ernest Kriek, an influential National Socialist philosopher, remarked ironically: 'All in all Nietzsche was an opponent of socialism, an opponent of nationalism, and an opponent of racial thinking. Apart from these three bents of mind, he might have made an outstanding Nazi.' 'Nuff said.

References

Safranski, R.(2002). Nietzsche: A philosophical biography. London: Granta Books.

Kaufmann, W. (1974). Nietzsche, Philosopher, Psychologist, Antichrist. Princeton: Princeton University Press.

Oppel, F.N.(2005). Nietzsche on Gender. University of Virginia Press.

Irigaray, L.(1991). Marine Lover of Friedrich Nietzsche. New York: Columbia University Press.

Irigaray, L.(1994). Thinking the Difference. London: The Athlone Press.

The Wiley World Handbook of Existential Therapy

Emmy van Deurzen (editor-in-chief); Erik Craig, Alfried Längle, Kirk J. Schneider, Digby Tantum, Simon du Plock (eds). 2019. Chichester: Wiley Blackwell.

The Wiley World Handbook of Existential Therapy represents more than one hundred organisations in over forty countries that offer programmes and training to prepare individuals to provide a variety of existential therapies. It is a document that was inspired by a meeting, in 2015, in London of a committee of forty delegates to the First World Congress for Existential Therapy and was readied in time for publication and launching at the Second World Congress for Existential Therapy, which was held in May 2019, in Buenos Aires. Each congress welcomed about five hundred people.

In this encyclopedia of existential therapies, six editors (three from the UK, two from the US, and one from Austria) have assembled in thirty-eight chapters more or less freestanding parts on (I) Daseinsanalysis; (II) Existential-Phenomenological Therapy (EPT); (III) Existential-Humanistic and Existential-Integrative Therapy; (IV) Logotherapy and Existential Analysis; (V) Existential Group Therapy; and (VI) International Developments: Theory, Practice, and Research. The headings of the first five parts name a total of seven varieties of existential therapy. In some cases, variations of a given modality are identified; for example, four versions of Daseinsanalysis are described in Part I.

Following a general introduction by two of the editors and a third contributor, the topic of each of part (section I-V) is provided with its own introduction. Sections on (1) the history of the modality (or modalities) are subsumed under the part heading; (2) its 'philosophy and theory'; (3) its 'method and practice'; (4) case illustrations of practice; (5) key texts for further reading on the modality; and (6) new developments in the modality and challenges facing it, respectively. Part VI is arranged differently. Following an introduction, it is organised by geographic area: (i) Scandinavia; (ii) Eastern Europe and Russia; (iii) Southern Europe; (iv) Latin America; and (v) Asia. This part's last two chapters are a 'Review of Research on Existential-Phenomenological Therapies' and 'Conclusions by the Editors'. In Part VI's penultimate chapter on research, the discussion is limited to 'Existential-Phenomenological Therapies' (cf. Part II). In Chapter 34, I was surprised to learn that Greece, Israel, Portugal, Spain and Turkey are considered part of Southern Europe. Only Mexico and Argentina are discussed in Chapter 35 on Latin America, even though there is a thriving Daseinsanalytic community in Brazil. Chapter 36, on Asia, is titled 'An East-West Dialogue' and discusses work going on in China, India, Japan, South Korea, Malaysia and Singapore.

Given the handbook's claim to being global in purview, the prospective reader should note that seventy-one of the one hundred contributions are by individuals from only three of the nineteen countries discussed, and of these, about one-half of these individuals are stationed in the UK. The five general editors are also heavily represented with twenty-four contributions in all (about one-fourth of the named authors). A number of the chapters were translated, but no acknowledgements are given of the translators.

Oddly, though he is mentioned fairly often in passing, perhaps the clearest exponent of existential psychotherapy, Ernesto Spinelli, is not represented among the contributors. In this connection, the title may be puzzling to some, since it suggests that this is not a book about psychotherapy per se. It would be fair for someone new to this area of psychotherapy to ask how therapy differs from psychotherapy and how, in turn, these are to be distinguished from counselling and other sorts of helping professions. Consider that one of the most widely used introductory textbooks on the topic, Current Psychotherapies (11th ed., 2019), continues to include a chapter on 'Existential Psychotherapy', which is co-authored by one of the contributors to this handbook.¹ This is not an incidental matter, given that the roughly fourteen named modalities described in the handbook may sound very similar to each other to a novice in the field of mental illness care who consults the handbook. The list of forms of existential therapy includes Daseinsanalysis; Daseinsanalytic Psychotherapy; Hermeneutic Daseinsanalysis; Humanistic-Relational Daseinsanalysis; Short-term Daseinsanalytic Therapy; Existential Phenomenological Therapy, Existential Psychotherapy; Existential Coaching; Existential-Humanistic Therapy; Existential-Integrative Therapy; Logotherapy; Existential Analysis; Personal Existential Analysis; and Existential Group Therapy. The beginning reader may wonder, for example, how Daseinsanalytic Psychotherapy and Existential Psychotherapy are unique among the other forms of existential therapy to which the handbook is devoted.

Among the many forms of existential therapy presented, the introduction is plain in giving priority to Daseinsanalysis, stating that out of the nineteenth century tradition of what were then first termed the human sciences 'would eventually emerge the practice of Daseinsanalysis as a specific approach to psychiatric and psychotherapeutic practice and, from this in turn, the development of existential psychotherapy in general' (p 6). This ur-modality therefore deserves the pride of place it has been given as Part I in introducing the reader to the range of approaches subsumed by the umbrella term existential therapy.

The presiding figure in the history Daseinsanalyse was the German thinker Martin Heidegger (1889-1976). His work is referenced at some point in each of the six parts of the handbook, although he is least evident by name in the part on Existential-Humanistic and Existential-Integrative therapy. A major figure looms large in the references and recommended texts for each of the first four parts. They are Heidegger himself, R.D. Laing, Rollo May and Viktor Frankl. Like all of us, the authors of chapters are inclined to refer to themselves as often as possible in their contributions.

A great part of the difficulty of understanding the tradition of existential therapy is still linguistic. The attentive reader will see that there is no consensus on the translation of several German words that play an important role in the literature on existential therapy: Dasein, Existenz and Sein. The early major players in the history of the approach were German-speaking. Yet at least two of them, Medard Boss and Viktor Frankl, were very much at home in English, as are all of the handbook's editors. It is odd, then, that no agreement was reached among the editors about how to render the vocabulary of existence for purposes of the handbook. A system of cross-referencing might remedy this in a future edition. Until clear practices of usage have been established, full appreciation of the gist of what is printed in the pages of this handbook will be handicapped, especially for the reader who is from outside the field (cognitive-behaviour psychotherapy, Gestalt therapy, psychoanalysis, analytical psychology and the rest). See my note on Corsini (2019).

Assuming that the volume is meant for the general reader in clinical psychology and allied professions, greater attention might have been given throughout to clarifying the connections between existential therapy and (a) French existentialism, (b) therapies based on the three 'forces' in academic psychology (psychoanalysis, behaviourism and the humanistic school), and (c) relational psychotherapy, currently considered to be the cutting edge psychotherapy, at least in the US.

If, as we read in the general introduction, Daseinsanalysis is the granddaddy of all the named modalities, it is important to recall that for the founders and current practitioners of Daseinsanalysis, the modality is a modification of psychoanalysis. This makes it theoretically difficult, then, to find a place for Existential-Humanistic and Existential-Integrative therapy among the modalities, which derive from humanistic psychology. It is well known that the three principal founders of the 'Third Force' (Gordon Allport, Abraham Maslow and Carl Rogers) were far from supportive of the existential inspiration in psychology. Rogers, for example, dismissed it as 'vague', 'philosophical' and 'untestable'. Yet existential therapy overall is characterised for its uniqueness precisely as a 'philosophically informed approach to counselling and psychotherapy' (p 2). This reviewer is concerned about the loose use of the words philosophy and phenomenology by many of authors, which leaves the reader with a sense of some confusion among the practitioners themselves (and a few clients who have contributed material to the handbook) about what they have in common.

The general introduction, part introductions and sections on history and philosophy and theory in each of the first five approaches make for fascinating reading, especially in their diverse accounts of the provenance, scope and prospects for existential therapy as a genus of current psychotherapies. One concludes reading this handbook heartily in agreement with a passage in the general introduction, that 'the philosophy of existential work… invites each practitioner to reinvent the approach with each client and with each session of existential therapy' (p 24). This is a heroic undertaking, but it seems to be in conflict with the idea that there is an approach called existential therapy that can be learned, defended theoretically and practiced within a coherent framework of philosophical orientation, self-understanding, and science. This is especially important when comparing existential therapy with other current modalities.

One other question suggests itself. That all of the approaches remain founded on the medical model of intervention (what Heidegger termed 'interventional looking after') seems undeniable, but this is in stark contrast with what Heidegger termed 'way-making looking after', which made the daseinsanalytic approach, beginning with Medard Boss, on which all of the existential therapies are based, unique. It seems to have been forgotten that individuals seek out an existential therapist rather than someone from any other approach, not because they wish to change rather because something has changed in their lives that they want to come to terms with. The single goal of existential therapy, which makes it unique among the rest, is to provide a situation in which the patient or client can recover his or her present in his or her own way and therewith his or her freedom. Reading these accounts, we also wonder whether preparation as a medical doctor is in any way an advantage for providing existential therapy.

Dear prospective reader: caveat lector, and proceed with critical caution. A book for psychiatrists and clinical psychologists on schizophrenia should not contain material that reflects delusional thinking or has a hallucinatory quality. Nor should a book on the treatment by psychotherapists of fellow human beings who are suffering from an attack of awareness of the fundamental ambiguities of existence and the challenge to make meaning where none is inherent be ambiguous and disorienting. Life is indeed a crazy quilt of contradictions and partial misunderstandings, but a book on that fact should be vague as infrequently as possible and as free as possible of imprecisions, especially in the presentation of its underlying philosophical principles, terminology, and basic ideas. There is no virtue in kaleidoscopic presentation in science or philosophy. A text on the therapy of the word should not read like a treatise on pataphysics or a poem by René Char, evocative and inspiring as they are. In life there is mystery and the sacred, but prose on the themes should be plain and secular especially when a fee is charged for practices based on the theory that grounds them.

Miles Groth