CBT(Cognitive behavioural therapy) And Existential Psychology.

Summary

Existential philosophers have proposed a range of fundamental aspects of human existence, or existential givens, including:

 

- existence means always being-in-the-world and with-others,

- meaning and meaninglessness s a fundamental existential tension,

- freedom and limitation,

- anxiety and guilt are existential and inevitable.

- existence is embodied,

- existence as attunement or mood is fundamental and

- existence as temporal and being-towards-death.

 

Existential philosophers have attempted to address such concerns from a specifically phenomenological viewpoint, i.e. via a structured method of investigation that prioritises the descriptive clarification of directly encountered phenomena rather than prioritising efforts at gaining a causal analysis.

 

Existential Reflections

In a small group (three to four people) of peers, consider the following questions:

 

- Existential philosophy has proposed a range of givens of existence that are proposed as universal. These givens are said to characterise human existence across culture, class and gender. To what extent do you agree with the givens that have been identified? Are there aspects of existence you believe to be more fundamental or to be missing from this list ?

 

- Many CBT interventions, although not all, focus on a specific clinical problem and seek improvement in that problem. What diference does it make to the field of therapy, and CBT in particular, to suggest that we need to contextualise such problems in relation to the nature of human existence as a whole ?

 

- To what extent and in what ways could the activity of conducting therapy be said to be itself philosophical ?

Aspects of existence - 'thrownness' choice/responsibility, embodiment, being-with-others, being-towards-death

 

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Existential anxiety

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Anxiety 'buffering'-defensive strategies:

World view maintenance

relational bonds-belonging

self-esteem enhancement

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Return of avoided 'existentials'

mortality salience, boundary situations

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Vulnerability and resilience factors-

genetic, environmental, relational

 

 

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Distraction, denial, avoidance -

problems in living-

psychopathology' 

as attempted solutions

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Strengthening of world view, maintenance of relational bonds

and self-esteem enhancement- effective coping/creativity

 

 

Figure 3.1 A model of existential anxiety

Summary

 

- While existential phenomenological philosophy has been described as 'the science of Being' (Craig, 2015), the question of the extent to which there can be an existential psychology is an open one.

 

- Experimentally minded researchers have conducted productive and revealing research into a range of existential themes.

 

- CBT researchers have increasingly drawn upon methods of research aligned more usually to a human science and existential phenomenological framework.

 

- In so doing, they have produced a range of findings that may challenge views of CBT that emphasise its supposed quasi-medical nature as a treatment for specific symptoms.

 

Existential Reflections

 

In a small group of peers, consider the following experiments into mortality salience:

 

- Each take a blank sheet of paper and write the words 'birth’ and ‘death’ at opposite ends. Start drawing a line from birth to death, Stop the line where you feel you currently are in your life. Be aware of any emotions and thoughts that arise as you do this.

 

- Imagine that each of you have been given an envelope inside of which is the exact date and time of your death as well as the manner of your death. Would you choose to open this envelope? Consider the thoughts and emotions that arise as you consider the question.

 

- Consider the extent to which the statement 'I am a CBT therapist or 'I am an existential therapist is central to your identity and worldview. Imagine a situation in which undisputable scientific evidence is revealed that all forms of CBT or existential therapy, are ineffective and that their theoretical concepts are incorrect.

What would 'the death of CBT or 'death of existential therapy' mean to you?

 

- If you are not a CBT or existential therapist, repeat the above exercise with your own preferred modality.

 

Summary

 

- Like CBT, there is no one existential therapy that finds universal agreement and acceptance among its practitioners. While there is a family resemblance that lies principally in the attempt by different therapists to draw inspiration from a range of existential phenomenological philosophers, each existential therapist is required to take up a position with or against these various perspectives to clarify for themselves and others where they stand.

 

- Important differences exist between continental European forms of existential therapy and US existential-humanistic therapy.

 

- Most forms of existential therapy emphasise a descriptive exploration of the client's experience of living.

 

Existential Reflections

In a small group of peers, consider the following questions:

 

- How often, in your practice, do larger questions around the meaning of life arise?

 

- Are there particular client presentations (such as depression) en where this is more common?

 

- To what extent do you believe that CBT, of any particular orientation, is able to address these concerns?

 

- In what manner, if any, are discussions with clients regarding the meaning of life experientially different compared with discussions about other forms of belief?

Existential Reflections on Uncertainty

 

In a small group of peers, recall a time when you worked with a client, preferably one where you felt that therapy was going well and that the client was progressing, whatever you considered that to be. Consider the following:

 

- What in your work with the client was experienced by you as potentially novel and unexpected?

 

- Were there any 'changes of course' that occurred after assessment and formulation that caused you to rethink and reconsider?

 

- If the overall outcome was as expected, what novel information did you encounter about your client and about yourself as therapist during the intervention phase? If the answer to this is not much, what might this suggest?

 

Existential Reflection on Anxiety

 

In a small group of peers, consider the following situation that arose in my practice, I was seeing Sally, a mother of three young children and a beauty therapist, in a General Practice Surgery.

 

She had been referred to me after experiencing panic attacks which, at their worst. had occurred three times a day, leading her to avoid work and social interaction. We worked together using CBT strategies for panic attacks.

 

This was highly successful and within six weeks her panic attacks had ceased. However, over the next six months Sally made regular follow-up sessions in order to review her progress.

 

In each of these sessions, she reported being panic free, yet she also spoke about a vague sense of unease.

 

Every now and then she reported having a sense of diffuse anxiety, commenting:

"Why do I have to Existential Practice experience this?

I just don't think it's right that I should have to live a life where I have any anxiety at all !“

 

How might you respond to a statement such as this?

In what way, if any, does the existential principle of anxiety relate to this statement in an informative way?

 

In summary, the principles of relatedness, uncertainty and anxiety have been proposed by Spinelli (2015) as constituting the fundamental principles of existential phenomenology.

 

They provide the fundamental starting point from which a wide range of other existential themes and dilemmas, such as embodiment, meaning, time, change and the nature of psychological problems, can be considered.

 

Summary

 

- Existential phenomenological thinking is founded on the principles of relatedness, uncertainty and anxiety.

 

- The principle of relatedness has profound implications for a range of issues, such as the relationship between emotion and cognition the nature of psychological problems, the process and dilemmas of change, the nature of the therapeutic relationship, and the possibilities and limitations of therapeutic dialogues.

 

- The clarification of these existential principles is useful when considering the potential relationship between existential phenomenology and various forms of CBT.

   

Existential Reflections

 

Spinelli (2015,pp. 111-112) has argued that: Acceptance requires of existential therapists the abdication of the assumption that the trained and expert professional who is the therapist can know and direct the means by which the client is to be helped.

 

In a small group of peers, consider the extent to which the above claim is possible within a therapeutic engagement understood to be CBT.

 

If you were to consider conducting a behavioural experiment in which you attempt to embody this proposal in your interactions with clients, what new possibilities might emerge?

 

What might be lost or no longer possible while holding this view?

What positive or negative consequences might follow from this stance if you were to attempt to generalise it?

  

Summary

 

- Standard 'Beckian' CBT was developed in a way that acknowledged influence from earlier existential phenomenological perspectives.

- The central focus on meaning is a clear point at which the two perspectives meet, as is the focus on the present and an emphasis on therapeutic explorations that stay with consciously assessable forms of meaning and experience.

- Beckian CBT appears to have both elements of a more rationalist objectivist stance as well as more constructivist elements. Over time, there has been a greater emphasis on the constructivist elements as well as greater complexity.

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