Book Review: Daseinsanalysis

Alice Holzhey-Kunz's definitive and comprehensive guide to Daseinsanalysis is a fascinating and productively uncomfortable read. For the existentially trained therapist, it will provide challenges and a requirement for openness to a method which goes beyond the clearly defined parameters of the approach favoured by the British School of Existentialism.

Taking the reader into a deep and applied understanding of Heidegger's Being and Time, Holzhey-Kunz goes beyond the philosophical and describes a practice which amounts to a psychoanalysis from a hermeneutic-existential perspective – two approaches that are rarely seen together in contemporary therapeutic modalities.

The combination of philosophical understanding, historical knowledge and first-hand clinical experience makes for a text book which can only have been penned by the leading voice in the specific form of analysis explicated in this book. From its opening pages, this compelling work succeeds in giving an historical account of the pioneering work in the field carried out by Binswanger and then Boss, a contemporary of Heidegger's and co-facilitator of the Zollikon seminars – the one place where Heidegger met with those who wished to apply his philosophy to therapeutic practice. Initially a gifted student of Boss herself, Holzhey-Kunz was to find her own way forward at the point at which her own thinking and discoveries diverged from his.

Bringing these ideas together with the psychoanalytic discoveries of Freud, she demonstrates persuasively in this book how neither the existential schools of therapy, with their focus on being-with, nor the psychoanalytic method as a scientific approach to knowing and understanding the patient, is complete without the influence and complementary application of the other – a combination which comes together as a clinical method under the aptly named title Daseinsanalysis.

The question 'What is daseinsanalysis?' – with its foreign-sounding name – is answered early on in the book, alongside a persuasive argument explaining why it should be retained thus and not translated. She argues in her introduction that in the Anglophone world, the term 'existential analysis' refers to existential ideas that serve the quest for a practical therapeutic approach, rather than a theoretical analysis of phenomena.

My reading of the book did not have the impact of pushing me into a defensive corner with a wish to remain within the territory with which I am familiar; rather, it reminded me that as we cannot know reality itself, we can come to know something of it through our perceptions of phenomena through our own personal and sensory experiences. Reading this book became something of an experience of this in itself – I did not always immediately understand the ideas and concepts, in spite of Holzhey-Kunz's excellent descriptions and examples provided. I did, however, feel that I had taken in enough of something which could be observed and experienced in my own clinical practice that I had not been aware of before, which might give greater understanding of the client or patient, and occasionally provide some symptom relief, and this turned out to be true.

The experience of reading the book immediately places the reader in the role of the reluctant philosopher (a concept named by Holzhey-Kunz and central to her approach) and has the effect of disarming you while powerfully subjecting you to the painful experience of being in touch with what she, following Heidegger, calls the ontological. The reluctant philosopher (p 146) is a specially-sensitive individual, unable to use the defence that Heidegger calls 'The Everyday' to shield himself from the ontological truth of his existence. Holzhey-Kunz writes beautifully of the experience of suffering from one's own being, as opposed to suffering from neurotic symptoms, as a way of interpreting states which have been pathologized and understood as deviations from a very particular and prevalent idea of mental healthiness. For these especially sensitive individuals, the truth of our actual ontological state of isolation, emptiness and an awareness of their own existential nothingness, is present most of the time, and for them the feeling of staring into the abyss with an awareness of the fundamental meaninglessness of our actual existence cannot be assuaged by common sense, rational arguments, everyday distractions or acting out, as ways of avoiding the ontological.

The powerful examples given in the book had a profound impact on me, in which I became exposed to the state of the reluctant philosopher, and unable to remain secure through the usual defences. Holzhey-Kunz makes the point that attempts to translate ontological anxieties into ontic fears which can be somehow 'treated' and 'relieved' through traditional methods of interpretation, is impossible, because the ontological is irreducible to transformation through understanding. Instead, the daseinsanalyst learns to bear the patient's suffering because she is increasingly able to open herself to her own ontological anxiety and become a fellow sufferer. interestingly there are remnants of this in Freud's early references to anxiety where he refers to the mother as the nebenmensch (fellow human being), required to suffer the infant's unbearable death anxiety with him in order to relieve him. For the daseinsanalysand, the being-with of the analyst provides some solace for his feelings through knowing that he is not alone in his suffering of the human condition.

The role of the unconscious is more important in the therapeutic practice of daseinsanalysis than in its more humanistic contemporaries. Holzhey-Kunz explains Sartre's existential interpretation of the unconscious, and shows how for her the psychoanalytic method is at the heart of daseinsanalysis, with both an acceptance of a dynamic unconscious and a setting which allows it to manifest. In her experience, this underlying awareness of our own ontological dread at being-towards-death is repressed, and manifests itself in the particular expression of being which reveals itself to us through many forms, symptoms and mental suffering. In her fascinating section on dreams, she describes ways in which the ontological anxiety can often be exposed to us in a particular state of being experienced when dreaming. We are, she says, in bad faith most of the time when it comes to the actual state of the human condition, and at times while reading her book I found myself jolted out of my everyday complacency. It is one of those rare and deeply affecting books, to which the open-hearted reader can have an experience which may bring some understanding and increased ability to tolerate the 'neurotic' client who brings into the consulting room her ontological dread through a range of ontic presentations.

Early sections of the book take the reader through philosophical and anthropological concepts of the human being, and lead us through sections on philosophical and psychological conceptions into the area of human suffering (as opposed to mental illness). The book is comprehensive and is divided into many sections with sub-headings, which enable the reader insight into areas such as phenomenological eidetic dream analysis, the body as an entity into which we are born and to which we are forced into owning as 'mine', and daseinsanalytic ways of interpreting shame, guilt and desire, amongst other existential moods.

Holzhey-Kunz makes use of an extensive vocabulary, which is not impaired in any way by Sophie Leighton's excellent translation from the German into English, and we are introduced to new ways of seeing through careful explanations of concepts applied to repeated clinical examples that are brought back throughout the book and reconsidered in light of an evolving discourse (Binswanger's patient with a heel-phobia is a particularly good example of this). If and when the book is given a reprint, the inclusion of an index of terms would be a welcome addition.

We are taken on what feels like a seamless journey from our own already established thinking, wherein the movement between the ontical and the ontological, and from cognitive understanding to attunement, appears effortless. Holzhey-Kunz makes light work of guiding the reader through Heidegger's departure from Kant's emphasis on perception and thought – the fundamental cognitive faculties – to a type of understanding that can be gained by the revelation of internal states through attunement to what Heidegger calls moods. The reader is required to both work hard and at the same time enjoy the journey, as each time we begin to feel we might be lost, the author provides another useful example.

In the latter parts of the text, Holzhey-Kunz draws upon concepts from other existential philosophers, including Sartre and Kierkegaard, and considers these alongside Heidegger's, the psychoanalytic discoveries of Freud and more recent contributions from Gadamer, arguing for the importance of what she calls an existential hermeneutic approach. I found her sections on Sartre, and in particular her explanation of Sartre's Being-for-others and its effect on the individual's experience of Being in the world, a particularly compelling addition to this already scholarly volume. It is, in my view, a must-read for anyone working with patients with whom they feel 'stuck' after common sense, traditional wisdom and empathic understanding have elicited no growth. It challenges most provocatively the well-contested area that existential therapy holds no place for a model of the unconscious and the role of interpretation, and will therefore be challenging on both a professional and – for the reasons mentioned earlier – on a personal level. For those existential analysts who are open to this writing and to having a reflexive approach to their own work and their own being it will, I believe, prove revolutionary in its impact on their ideas and subsequent practices as therapists.

Donna Christina Savery