Book Review: Existential Therapy: Legacy, Vibrancy and Dialogue

Laura Barnett and Greg Madison have edited a book that is more than just another book on existential therapy. It aspires to be a landmark. It delineates an international state of the art of existential therapy a decade within the 21st century.

The book aspires to making a new mark in our therapeutic landscape well over 50 years after the seminal classic Existence by Rollo May, Ernst Angel and Henri Ellenberger. And although the present book does not reach the outstanding heights of its fore-runner, it does however make a significant contribution, that deserves to be read widely and also to be enrolled in various reading lists at our training institutes.

We now have two books giving us an up to date picture of what existential therapy is like today: The book of Mick Cooper giving an overview seen from the outside and this book giving 15 engaged expositions seen from the inside perspective of practicing psychotherapists.

The book consists of 15 chapters written by Erik Craig, Roger Frie, Alice Holzhey-Kunz, Tamas Fazekas, Laura Barnett, Les Todres, Greg Madison and Eugene Gendlin, Betty Cannon, Michael Guy Thompson, John M. Heaton, Keith Hoeller, Mick Cooper and Ernesto Spinelli, Alfred Längle, Emmy van Deurzen, Linda Finlay, Kirk J. Schneider and Simon du Plock, Maurice Friedman, Havi Carel, Judith Hassan and Donna Orange.

There are many fine texts in the book. Either whole chapters or often just sections of chapters. It is not possible here to comment on every chapter, so I have singled out three themes of existential therapy that run through some of the chapters.

One of the themes that shine through some of the chapters is a theme that is seldomly treated explicitly in books on existential therapy: The crucial role of therapeutic love in existential therapy (or if you wish: caring, caritas or compassion). In our foundational writings on existential therapy this important quality of the therapist and the therapeutic process is very discernible in the writings of as different authors as Rollo May, Irvin Yalom and Medard Boss (very clearly in his main work Existential Foundations but unfortunately much more in the German original, it has been partially lost in the English translation).

In the present book this quality of therapeutic love is present in the extraordinary well-written and beautiful opening chapter by Erik Craig. Therapeutic love is here explained as a function of the differentiation between the ontological and the ontical level and the therapist's ability to maintain his 'ontological eye' upon the client. Craig gives a very clear exposition of the importance of this ontological eye for existential therapy.

Other chapters enter in a Buber-inspired and respectful dialogue between two authors, especially the chapter by Ernesto Spinelli and Mick Cooper and the one by Kirk Scheider and Simon du Plock. Although the term 'therapeutic love' is not mentioned in these chapters the dialogue that is demonstrated constitutes a very nice example of the kind of relationship we want to see between the therapist and the client in our existential therapies.

A second pervading theme in several chapters is the historical and contemporary relation between existential therapy and psychoanalysis. Are the two closely related like siblings or cousins? Or are they actually in opposition to each other? This theme is especially interesting when seen in a special light as it is done in the very interesting chapters of Roger Frie and Alice Holzhey-Kunz/Tamas Fazekas: Is our existential therapy mainly to be understood as derived from Medard Boss (and thereby indirectly from Martin Heidegger) or do we in fact owe more to Ludwig Binswanger? The consequences of understanding our enterprise in one or the other way is clearly exposed here.

A third theme dealt with in a number of chapters is the role of the body and our bodily processes in existential therapy. This is without doubt a very important theme although very little treated in our literature on existential therapy. With some clients at least we have a problem of involving the bodily processes in the therapy. And if the therapeutic process does not access the body besides thoughts, feelings, world views and relations, there is a risk of relapse or non-success.

There are three chapters dealing explicitly with bodily processes, by Les Todres, Greg Madison/Eugene Gendlin and Betty Cannon. Two of these are dealing with the work of Eugene Gendlin. It is interesting to see that Eugene Gendlin with full right is placed within the existential tradition. Gendlin with his method of focusing is often conceived of as a body therapist. But he is in fact very Heideggerian and it is nice to see him represented in this collection.

I am a little amazed however that the exposition of existentially accessing the body is restricted to Gendlin. In the last decades Peter Levines method of 'somatic experiencing' is spreading all over the world. I guess that many of us by now integrate the fruitful ways of questioning the body that has been developed by Peter Levine in our existential therapies. It seems very fair to see Eugene Gendlin as a fore-runner of somatic experiencing since there are obvious similarities and his concept of 'felt sense' is apparently being used in the same way by Peter Levine.

On the whole the present book (except for the discussion of psychoanalysis) is silent about the question on the many present exciting developments in psychotherapy and the possibilities of integrating elements of these in our existential therapies. But our colleagues are experimenting with integrating not only SE, but also mindfulness, elements of ACT and other newer developments into a basic, truthful and consistent version of existential therapy. This is also an interesting aspect of present day existential therapy.

I have read the manuscript of this book some time ago and was at that time very impressed. Now after a second reading I find some serious limitations:

The book represents an Anglocentric narrowness which this reviewer does not find appropriate for the 21st Century and the idea of Existential Therapy as a truly international endeavour with a forthcoming world conference. The editors write 'after much deliberation we took the editorial decision to confine ourselves to UK and US therapists, with the exception of Daseinsanalysts and Logotherapists. This has meant excluding contributors from important centres across the world…' Here the reader wonders what this thorough editorial deliberation was based upon. Practical considerations? Book market considerations? That the Anglo-American authors are simply the best? All three could be fine arguments if they are the case but why do the editors hide their arguments? Why not be open and transparent about the truth which I believe we adhere to as existential therapists? An openness and transparency that I hope and believe the editors practice when being therapists. Were Canadians and Australians excluded too? Or were they not good enough and could not reach the high level of the selected UK and US authors?

Another issue: even if the authors are often outstanding colleagues, what is printed here from their hand are not always the best pieces we have seen from these authors. A reprint of some of their best texts would have been preferable to mark a milestone. In addition some of the authors are building on many many years of original work. That is in itself excellent. But with it follows a certain inclination to look back on past achievements rather than to look out into the future with the open and curious eyes that these authors also possess and which we take to be a crucial virtue in existential therapy. So in many ways the book represents a retrospective look on the past fifty years rather than a curious appetite for the next fifty years.

The book is a landmark. But with limitations. Next time somebody writes a book to symbolise a landmark in the development of existential therapy, what more would we want? First of all we would want to find a more true internationalism with authors from all over the globe representing different national and cultural tappings of our common therapeutical and theoretical heritage. Secondly we could need a more cogent and well-defined theoretical background for our therapies. And thirdly Existential Therapy's proper, unique and – at the present moment not yet found – solution to the the riddle of how to convincingly justify and 'evidence-base' our work. Until then take pleasure in this significant volume.

Bo Jacobsen

Existential Therapy: Legacy, Vibrancy and Dialogue

Laura Barnett & Greg Madison (eds.) (2012). London: Routledge.

The book Existential Therapy: Legacy, Vibrancy and Dialogue, edited by Laura Barnett and Greg Madison, is an ambitious project that celebrates over 50 years after the appearance of the book Existence published by Rollo May, which first introduced existential psychotherapy to English speaking countries and which, in a way, helped make this approach known throughout the American continent. In this case, the book Existential Therapy is not only an introduction to the existential approach; it also depicts the state of affairs after 50 years of development and evolution. The book introduces a great amount of authors from different perspectives on existential psychotherapy, facilitating access to different views from different parts of the world. Many of the authors are very important figures in our field; renowned authors such as Laura Barnett, Betty Cannon, Havi Carel, Mick Cooper, Erik Craig, Emmy van Deurzen, Tamas Fazekas, Linda Finlay, Roger Frie, Maurice Friedman, Eugene Gendlin, Judith Hassan, John Heaton, Keith Hoeller, Alice Holzhey-Kunz, Alfred Längle, Greg Madison, Donna Orange, Simon du Plock, Kirk Schneider, Ernesto Spinelli, M. Guy Thompson, and Les Todres.

Thus, the book is truly an overview, necessary for any person interested in the existential perspective on psychotherapy, not only in its theory, but in its practice as well.

In the introduction, Laura Barnett and Greg Madison describe their intention of offering a kind of 'manifesto' on existential therapy for the XXI Century, an era when we've become open to different perspectives and even debates about the definition of existential therapy and its main lines of focus and practice. This reinforce's the relevance of the dialogues included in the book, coherently with the ideals of the existential psychotherapy approach, which places dialogue as one of its most elevated objectives, and also emulating the therapeutic situation in itself, which is built through dialogue between the participants.

In spite of the differences between the forms of approaching existential therapy introduced in the text, we can also note some common points, such as the phenomenological emphasis, the opening to a non-dualistic view of human beings, the calling into question of psychopathology systems, a rejection of the role of the therapist as an expert, and, on to a greater or lesser degree depending on the different proposals, we may discover a certain accentuation of the therapeutic relationship and the analysis of human existence as being-in-the-world. Even though in the book we don't get to know the perspective of existential therapists who develop their work in places other than the UK and the US, it is an important effort so that more of us can join in this desire to allow the different voices within the perspective to be heard.

Chapter 1. Existential psychotherapy, by Erik Craig, attempts to present an overview of phenomenological and hermeneutic existential thought and its applications to psychotherapy. It is an excellent essay that acts as an introduction to the rest of the book, including small vignettes that help us understand the points it wishes to make and underscore the lines that were the historical pioneers in the development of existential thought in psychotherapy, as is the case with Binswanger's perspective. The chapter establishes five lines that, in Erik Craig's view, characterize Existential Therapy from other approaches. The first line invites us to approach human reality from a perspective that transcends the natural sciences; the second is an invitation to acknowledge relatedness; the third emphasizes consciousness; the fourth is about our capability to navigate in the word, which allows for choice and reflection; and the fifth includes the temporal aspect of human nature, its historical aspects directed towards the future.

Chapter 2. Existential psychotherapy and post-Cartesian psychoanalysis, by Roger Frie, introduces the tendencies of contemporary psychoanalysis, which have much in common with the phenomenological existential approaches. It demonstrates the proximity of these new forms of psychoanalysis to the thought of philosophers such as Husserl, Heidegger, Sartre and Merleau-Ponty; it also explains their proximity to the thought of Binswanger (who was a friend of Freud). He narrates the historical development of these new forms of psychoanalysis reviewing some of the different influences of figures such as Fromm, Sullivan, Lacan, Winnicott and others, as well as their relationship with therapists of a more existential orientation such as Laing and Friedman.

Chapter 3. Daseinsanalysis we witness a dialogue between Alice Holzhey-Kunz and Tamas Fazekas, which explains that there are in fact three distinct approaches to the existential psychotherapy approach: a) The approach of Binswanger, b) that of Boss and c) a third proposal that arises from the dialogue between these two and the chapter's authors.

Chapter 4. Tedium, ennui, and atonement, by Laura Barnett, explores one of the most confrontational, defying and classic aspects of existential studies: the emotional experience of being in the world, especially in its manifestations of tedium, ennui and atonement, reviewing not only the classical perspective of Heidegger on this issue, but also enhancing it with the perspectives of Kierkegaard and Sartre.

Chapter 5. Experiential-existential therapy, by Les Todres, explores a specific proposal for the application of the existential approach to psychotherapy, which implies a profound revision of the experience as sensed in the body. Based on the work of Gendlin, he puts forth the importance of direct experience or experimentation when working with issues such as vulnerability and freedom.

Chapter 6. Palpable existentialism presents an interview with Eugene Gendlin by Greg Madison (editor of the book), which is the perfect follow-up to the previous chapter, since it delves into the contributions made by Gendlin's ideas to the field of psychotherapy in general and existential therapy in particular. Gendlin's proposals suggest great possibilities for their application, in congruence with Merleau-Ponty's perspectives about the lived experience expressed in the body.

Chapter 7. Applied existential psychotherapy, written by Betty Cannon, introduces this author's perspective on existential psychotherapy, which has a strong influence from the ideas of Jean-Paul Sartre as well as the work with bodily experience, contemporary psychoanalysis and techniques commonly associated with Gestalt Therapy and corporal therapies. Philosophically speaking, it is a widely Sartrean approach, and methodologically it promotes experiential interventions typical of Gestalt Therapy. It offers an example of dream work following lines that are very similar to the work done by Fritz Perls.

Chapter 8. R. D. Laing revisited puts forth a dialog-debate between M. Guy Thompson and John M. Heaton about the concept of authenticity in the existential perspective and in general, and particularly this term as conceived by Ronald Laing and Martin Heidegger, though acknowledging the affinity of Laing with the ideas of Jean-Paul Sartre. This chapter reminds us about the importance of sustaining the phenomenological attitude of questions, though it may be frustrating when they don't necessarily lead us to definitive answers.

Chapter 9. The existential 'therapy' of Thomas Szasz, by Keith Hoeller, follows logically from the previous chapter, since it introduces some of the criticism, from the perspective of Szasz, of the traditional way of understanding psychotherapy or, especially, psychoanalysis and traditional psychopathological concepts. Szasz has been considered as an existentialist thinker (in his writings there are frequent references to other existentialist authors, he was a member of the editorial committee of the Review of Existential Psychology and Psychiatry and of the Journal of Humanistic Existential Analysis), although there have been moments when he's been very critical of existential psychotherapy, especially of the figure of Ronald Laing. Towards the end of the chapter he questions to what point could Szasz be considered, or not, a member of the existential psychotherapy movement.

Chapter 10. A dialogue on dialogue is an entertaining dialogue between Mick Cooper and Ernesto Spinelli about the nature of dialogue and its relevance to existential psychotherapy. It clears up some confusions about this term, demonstrating its relational importance, as well as the difficulties of approaching it through questions, that the other we are in dialog with is an alien to ourselves, and proposing that in every dialogue we're building ourselves in a co-participatory way.

Chapter 11. The Viennese School of Existential Analysis, by Alfred Längle, first introduces a brief historical review of Logotherapy or the existential analysis originally generated by Viktor Frankl. Afterwards he focuses on the theory of existential motivations mainly developed by Frankl and the existential analysis he proposes: 1. The question about existence, about being. 2. The question about life. 3. The question about being oneself. 4. The questions about the continuous process to achieve being or permanent change. Towards the end he makes some reference to the specific practice of this approximation through a case example.

Chapter 12. Reasons for living, by Emmy van Deurzen. Following a consistent line, this chapter by Van Deurzen poses the question about meaning in life trying to make the readers reflect about these issues from a philosophical and existentialist perspective with brief references to Kierkegaard, Nietzsche, Husserl, Heidegger, Jaspers, Marcel, Buber, Lévinas, Sartre, Beauvoir, Camus and Merleau-Ponty, and adding contributions to psychotherapy from leading figures such as Binswanger and Frankl. She offers several examples about how to apply these perspectives in psychotherapy remembering one of the main aims of existential therapy: to help people search for their own truth, supporting them in reconnecting with life.

Chapter 13. Research, by Linda Finlay. This author focuses her reflection on one of the aspects that presents more challenges to current existential approaches. Research tends to be seen as a frightening factor, alien or hard to understand for many of the people who approach the therapeutic world from an existential point of view, since it seems to suggest proximity with the positivist view, the natural sciences or the search for effectiveness traditionally associated with CBT. However, Finlay poses that if we wish to dialogue with the current and future scientific, psychological and psychotherapeutic traditions, we must develop our own paths of research without betraying our original philosophical basis. She reminds us that hermeneutic phenomenology is a way to approach research that not only doesn't betray but actually supports our basis, and she challenges us to redefine our professional identity.

Chapter 14. Depth and the marketplace, a dialogue between Kirk J. Schneider and Simon du Plock. In this essay, Schneider introduces the concept of existential intelligence proposed by Gardner in his last work and describes his proposal of awe-based education and psychology, a perspective that would include large features of our being, from the most terrifying or undesirable, to our greatest possibilities. Simon du Plock responds clarifying some of the similarities and differences between the American and British perspectives on existential psychotherapy, with the similarities being on the issues that must be considered important and the differences in the responses to them.

Chapter 15. On Reading Irvin Yalom's Staring At The Sun: Overcoming The Dread Of Death, by Maurice Friedman, Havi Carel, Judith Jassan, and Donna Orange. The book's closing chapter is precisely the review of another text by American psychotherapist Irving D. Yalom (famous worldwide as an existential psychotherapist for his novels about psychotherapy stories). In this case, four different authors comment on his book Staring At The Sun. Maurice Friedman is the first. He glances over some of the book's ideas and his relationship with Rollo May and Irvin D. Yalom, stressing his own dialogical perspective on psychotherapy; while Havi Carel takes the reflection from how to help patients face the issue of death, to how to live well with your own disease and a prognosis that is not very hopeful. Judith Jassan takes the reflection to the survival of