Book Review: Case Studies in Existential Therapy: Translating theory into practice

As with most things in life, a 'review' of a book, the chance to offer an opinion on it, is a multifaceted thing. What follows is less my judgement as to whether it is a good book or not (it is), but rather in what ways it is clearly useful and where it might be less so.

It was a delight to pick up a book with a combination of names (and topics) that are familiar alongside some that are less so. It showcases the diverse contributions of existential therapy and because it is an edited collection, its structure, like an anthology of short stories, means that it is perfectly possible to pick it up, start where you want and move around at will. There is no need to start on page one and finish on page 333 – unless you so desire. I found this ability to move around was an important part of reading the book, I could dip into a familiar author at one moment and then meet someone new next.

The balance of the familiar and the novel is something worth thinking about. The less familiar material made me curious, had me wonder about it and because these authors write well, drew me in. However, I found the experience with some of the familiar material a bit tricky. With some of the names being so familiar, their contribution already risks being less new, less novel. This was particularly true with, for example, du Plock's own chapter on addiction. This chapter is very close to his text in my own edited collection, Sexuality: Existential Perspectives and in van Deurzen and Iacovou's Existential Perspectives on Relationship Therapy. While it is nice to have this case study to hand, its familiarity meant it captured me less. This was a little disappointing. Of course, this may be very specific to those who are familiar with his existing work; for someone who has not read his earlier printings, it will not be an issue.

Like the previous edition of du Plock's case studies, each chapter in this volume culminates in the author and the editor engaging in reflection on some of the issues that arise. These are useful in their own right. For example consider Helen Acton's engagement with sexuality and whether existential theorists should understand sexual orientation as a matter of choice or as a given. This is a tension that has long existed and I have struggled over the years to understand why some existential colleagues seem rooted to the idea of choice to the degree that they do. My own view is that phenomenologically a sense of an immutable given is a possibility, about all kinds of things. The theoretical consideration of whether this is 'correct' or not, is often not a meaningful matter for the client and maybe it should not be for that therapist engaged in that therapy – we can of course be interested in whatever we want to be elsewhere. I think as a community we have a similar complexity in relation to race and racism, the impact on how we understand ourselves racially and the tension between focusing on race or on a 'colour blind' approach to therapy. While neither this chapter nor the dialogue with the editor 'settle' the matter, I was pleased that it has been put 'back on the table' as an area worthy of consideration and engagement, and I hope that it will invite trainees and qualified practitioners alike to wonder in a more sophisticated fashion. What place culture and what place personal choice? What is chosen and in what manner? What is given? And of course, the interaction between these different aspects.

Acton is right, this tension needs further reflection, and without it, we run the risk of alienating, silencing or gaslighting our LGBTQ+ clients. The question, even if only implied, "How did your choice come about?" is a way in which we treat LGBTQ+ clients differently. Why do we consider gayness as something fundamentally chosen – and then ask about it - while our heterosexual clients seldom get asked about how they came to be straight? That approach parallels much cultural homophobia and our LGBTQ+ clients will know this. They have been subjected to it as they navigate heterosexist society. So well done Helen and Simon for reminding us of this important discussion.

In light of discussions like this, there is an interesting – and very pleasing – tone in the book, existential therapy proudly engaging in areas it has not always spoken to. In Eleftheriadou's case study with a young refugee, we see racism unapologetically named. We need to do this more. In Richards' case study with a non-binary young person urgent moral issues are foregrounded, as is the scarcity of economic and service resources – these are hugely important considerations in the practice of therapy, so it was wonderful to see them being considered here. In Scheiner's illustration of existential equine-facilitated therapy, we have a real chance to see Scheiner and her client engaging with the more than verbal and more than human world. These are all wonderfully thought-provoking case studies.

More prosaically, it is also pleasing to see non-defensive engagement with other ways of seeing the world, in particular with psychoanalysis and CBT, something I feel our community sometimes fails to do. Far too often, it seems to me, existential therapy practitioners have tried to describe our work by referencing what we are not, what we do not do and what we do not think. There is rhetorical logic to this of course, take what others know, show the difference and then we will be seen as distinct. However, there are times when I think we have ended up rejecting and demonising other schools through habit. In this book some of the contributors are unapologetic in acknowledging their engagement with concepts and processes, no matter where they come from. In doing so, it allows the reader to simply enjoy and learn about the person-to-person encounters being described, rather than getting too hung up on intellectual identity marking and professional/academic territoriality.

The book has an ambitious subtitle – 'Translating theory into practice', one which invites the question as to whether the balance between theory and case study is right. I find myself on the fence in this regard. On some occasions I felt the balance was not quite right, not when the reader is already familiar with the theory and practice of a particular area. In those chapters, there were times that the theory sections seemed a distraction, relegating the case study to second place. Did I need the phenomenological method explained again? Did I need some of the key philosophers' concepts outlined one more time? I am not sure I did. The reason for that was not just arrogance but rather that as case studies – and good case studies such as those in this collection – are relatively rare in our field, I was left wanting more. It was like being invited to dinner, having to sit through a lot of description of the menu and then only receiving a taster of the menu.

If I said I sat on the fence that is because, there were also occasions when I felt, to the contrary, that the balance was right. I suspect the balance is definitely right where the reader feels a newcomer to the topic. Personally, I found it helpful when reading, for example, Scheiner's chapter on equine assisted therapy and Gavin's chapter on child work. These are both areas that I am interested in but do not have a great deal of experience with. On those occasions the theory did prove helpful, adding to my grasp of the case study. So maybe the balance suits or does not suit people, depending on their existing knowledge and expertise.

So, overall, I like this book and am already planning to refer a couple of chapters to trainees on a course I teach. The book is suggestive of a field that has matured. It softly takes the reader well beyond what can sometimes be presented as an isolated, heady, intellectual theory into practice with our clients' and our own, rich lived experience, in a variety of complex and intersecting experiences. Well done Simon and contributors.

Martin Milton

The Wiley World Handbook of Existential Therapy

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

The Handbook of Existential Therapy makes an important contribution to the field of existential psychotherapy. As soon as I finished reading it, I had the feeling that I had in my hands a book that changes the map of the existential approach to psychotherapy. Like the book Existence: A New Dimension in Psychiatry and Psychology by May, Angel & Ellenberger, which introduced the existential approach in the US, this book, edited under the general guidance of Emmy van Deurzen, raises the existential approach to a global scale. It essentially seizes a large part of the extensive and diverse landscape of existential psychotherapy, as given by a multitude of therapists, researchers and academics who study and embrace the existential approach. Psychotherapists from all over the world bring their personal touch, present new ideas, make important distinctions in existing theoretical ideas and show ways of applying existential psychotherapy.

The existential approach to psychotherapy has specific peculiarities which make any attempt to present it particularly difficult. In fact, the existential approach includes four main pillars. The first pillar is the philosophy behind the approach. Here we find the influence of not one but many different philosophers who are part of the existential tradition. The second pillar consists of existential psychotherapists. There are many important names in the field that utilise existential psychotherapy in their practice. Each of them has something different to contribute. While they are all characterised as existential psychotherapists or therapists who value existential thinking in therapy, their theories and practices vary considerably. That is, there is no single way to be an existential psychotherapist. The third pillar consists of the existential issues. Precisely because the landscape of existential psychotherapy is so rich and often contradictory, a common ground has been sought between all of them. This common place is the existential issues. That is, the issues that are common to almost all existential philosophers and also of particular concern to almost all existential psychotherapists. These issues include, but are not limited to, freedom, responsibility, meaning and mortality. Finally, the fourth pillar is that of art. The use of art has an especially important role precisely because the nature of this approach leads it to treat the psychotherapeutic process as something that goes beyond the medical model and has elements reminiscent of the process of creating art. All of these pillars are presented in this book so that the reader will come to understand the richness, depth and extent of what it means to be an existential psychotherapist.

In this review I chose not to name any of the authors as the number of those who contributed to its writing is extremely large and any particular reference would do injustice to the rest. Suffice to say that almost all the known existential psychotherapists who are currently working either therapeutically, as researchers or educators are included, either directly with their own contribution or indirectly in the extensive referencing by their colleagues.

This book also presents the new challenges of existential-phenomenological therapy. It is rightly pointed out that the times we live in differ radically from the time of Plato and Socrates, Nietzsche and Kierkegaard, or even from the time of Heidegger and Sartre. The explosion of technological advances brings unprecedented challenges to existential psychotherapy. The references in the book raise awareness of the problems and difficulties that modern existential psychotherapists face, including the growing practice of working online. The book does not offer definitive answers, but the budding reflections and growing awareness in the writing are useful. Finally, in the chapter on the modern challenges to existential psychotherapy, existential coaching, with its own characteristics and peculiarities, is presented. This is an important development as this branch may experience significant growth in the near future.

One aspect of the book that I found particularly valuable was the presentation of existential thinking in psychotherapy by psychotherapists and thinkers from different countries beyond the UK and the US. I was pleased to touch base with existential thinking in psychotherapy as it has developed in Latin America, the Nordic countries, Russia, Southern Europe and China. This is what gives the book a truly global dimension, showcasing a diverse range of thought and distinctive psychotherapeutic practices. The book delivers the opportunity for other countries that already have some existential psychotherapists to appear in the future, as well as advertising and spreading its approach in places that until now had little contact with the existential approach.

The book makes a significant contribution to group existential psychotherapy. So far, there has been no model of group therapy that can be described as existential. Even Yalom's work on group therapy, as he explicitly states, is not a model of group existential psychotherapy. However, here a first theoretical framework for working with a group based on existential thinking is clearly presented, bringing to the fore a new way of working. It invites psychotherapists and researchers in the future to reflect on how the existential way fits into the context of group psychotherapy. This is a real and important contribution to the existential space.

I believe this book proves a valuable addition to the field of existential psychotherapy, so much so that it is not particularly easy for me to critique it constructively. That said, it is important that I highlight those aspects that may be improved or worked on in a different way. First, while the authors mention the importance of art in relation to existential psychotherapy, there is not enough relevant material that actually proves this importance. Perhaps herein lies an opportunity for the future, as the subject of art is one of the most fertile fields to be used, in so many different ways, by existential psychotherapists.

Next, all the selected texts meet the conditions to be included in such an important project. However, among them there are some that stand out for their quality – texts that either show a deeper understanding of the existential approach or that provide noteworthy original ideas. This cannot be said for all chapters. Thus, there is a risk that a reader who does not work through the book from cover to cover may miss some of its most valuable ideas. I guess this is my way of saying that anyone who wants to be called an existential psychotherapist, or is interested in this approach, should read the entire book. The effort is not wasted and, really, having completed the book myself, I feel I have a richer and more complete picture of the field of existential psychotherapy.

I conclude that this book offers something for every type of reader. It is an essential tool for every psychotherapist, supervisor, educator, teacher and researcher in the existential approach. It is also a worthwhile read for students or professionals from other theoretical backgrounds. For instance, for those coming from approaches that are closely related to existential psychotherapy (for example person-centred or Gestalt therapy), this book represents a chance to gain a better understanding of the distinctions and similarities between these approaches, while also contributing to the realisation of our common philosophical worldview. For those who come from more distinctive schools of psychotherapy such as psychoanalysis or cognitive behaviour therapy, the book provides an opportunity for a fruitful dialogue on different philosophical and psychotherapeutic approaches.

Alex Harisiadis