HUMANISTIC AND EXISTENTIAL APPROACHES & HUMANISTIC-EXISTENTIAL THERAPIES
Unlike the behavioral and psychodynamic treatments, no coherent set of procedures marks the humanistic-existential therapies. Rather, these therapies seem to be a loose federation of therapeutic styles that are united by ... I think what I probably feel is a certain element of "I've been cheated." (Her voice is very tight and her throat chokes up.) And I've covered up very nicely, to the point of consciously not caring. But I'm, I'm sort of amazed to find that in this practice of, what shall I call it, a kind of sublimation that right under it-again words-there's a, a kind of passive force that's, it's pas-it's very passive, but at the same time it's just kind of murderous.
THERAPIST: SO there's the feeling, "I've really been cheated. I've covered that up and seem not to care and yet underneath that there's a kind of a, a latent but very much present bitterness that is very, very strong." CLIENT: It's very strong. I-that I know. It's terribly powerful. THERAPIST: Almost a dominating kind of force. CLIENT: Of which I am rarely conscious. Almost never. ... Well, the only way I can describe it, it's a kind of murderous thing, but without violence.... It's more like a feeling of wanting to get even.... And of course, I won't pay back, but I'd like to. I really would like to. In the above excerpt, the feelings of bitterness and the desire for revenge begin to surface as a result of the therapist's patient understanding and reflection. Client-centered techniques, however, are not the only ones available for reaching a patient's feelings. Gestalt therapists, to which we now turn, utilize a different approach to the same issue.
FREDERICK PERLS AND GESTALT THERAPY Trained in Europe as a physician and psychoanalyst, Frederick (Fritz) Perls (1893-1970) repudiated large portions of psychoanalytic theory, while using some other aspects of that theory as part of his Gestalt therapy (1970). In common with other humanistic-existential therapists, Gestalt therapists have little interest in the past except as it impacts on the immediate present. When it does, then Gestalt therapists seize upon it, open it up, and make it extraordinarily vivid. If, for example, a young woman is still rankling over the way her mother treated her when she was eight, then a Gestalt therapist will take the mother's role and ask the client to act out the conflict. In this way, the vivid experience of those times will be re-experienced and confronted, perhaps even resolved. Gestalt clients are urged to re-experience these emotions as vividly and as violently as is necessary. They are encouraged to swear, kick, and scream, all in the service of teaching people that they can know, control, and be responsible for their feelings, rather than allowing their feelings to control them.
One of the techniques that Perls carried over from psychoanalysis to Gestalt therapy was dream analysis. But rather than have the therapist and client merely interpret dreams, Peds encouraged them to act out the dreams, as the following excerpt indicates:
In a large group therapy session, Jane has just described a dream in which she has returned to her parents' home. She opens the door to the large house, but the house is dark. She calls out to her mother and father, but there is no answer, and so she goes from room to room looking for them. Finally, "I get into the bedroom and my mother and father are in bed but they're, they're just, they're not my m they're skeletons. They don't have any skin. They're not, they don't talk. .. they don't say anything. And I shake-This dream happens over and over and lately... I've gotten brave enough to shake them." At one point during the analysis of this dream, Peds asked Jane to "resurrect" the skeletons, and to talk to them. PERLS: Talk to them. JANE: Wakeup! (Peds: Again.) JANE (loudly): Wakeup!(Perls: Again.) JANE (loudly): Wake up! (Peds: Again.) JANE (loudly): Wake up! (loudly, almost crying) You can't hear me! Why can't you hear me?... (sighs) And they don't answer. They don't say anything. The analysis of the dream continues, and Peds tells Jane to talk to her parents again. PERLS: Tell them that you still need them. JANE: I still need you. PERLS: Tell them in more detail what you need. JANE: I still need my mother to hold me. PERLS: Tell this to her. JANE: I still need you to hold me. (crying) I want to be a little girl, sometimes forget the "sometimes." PERLS: You're not talking to her yet. JANE (sobbing): O.K. Mother, you think I'm very grown up.... And I think I'm Very grow up. But there's a part of me that isn't away from you and I can't, I can't let goof. Confronting feelings is the first step in accepting and taking responsibility for them. It is, moreover, a way of understanding how the emotional experiences of the past directly affect the present, the here and now.
VIKTOR FRANKL AND LOGOTHERAPY Learning about one's feelings and especially about personal values-the meaning that life has-is a central feature of existential therapies. Viktor Frankl, a leading existential analyst, was imprisoned in Nazi concentration camps during WorId War II. Even under those conditions of unbearable suffering, however, Frankl found that life can be made meaningful. For example, he found meaning by helping others rather than concentrating merely on self-preservation and his own personal suffering. Though physically imprisoned under harsh circumstances, he believed that people were still free to give meaning to their lives. Logotherapists (and their existential counterparts) use a variety of techniques to communicate that individuals are free to control their lives and to endow them with meaning. Two techniques especially should be noted here. The first is dereflectlon, which involves turning clients' attention from their symptoms and pointing out how much they could be doing, becoming, and enjoying if they were not so preoccupied with themselves. The second is termed paradoxical intention, which encourages clients to indulge and even exaggerate their symptoms. Clients who claim that they cannot control their desires for, say, ice cream, are encouraged to eat it by the gallon, while those who need to wash their hands twenty times a day are told to double or triple their ablutions. In that way, clients quickly learn that they have considerable control over their symptoms and not vice versa. Moreover, they can then consider whether the values that are represented by, say, self-indulgence or excessive cleanliness.
EYALUATING THE HUMANISTIC-EXISTENTIAL APPROACH The humanistic-existential approach to personality and its disorders is very difficult to evaluate, in large measure because the approach is really a group of philosophical positions rather than a scientific theory. This especially applies to the existential components of that viewpoint, for who can prove whether people are really good rather than evil, free rather than bound by the past and present, capable of will or fully responsible for their acts? Fundamentally, these are matters of belief. Among the very attractive features of these views is the degree to which they accord with everyday notions of personality. Most people believe that there is such a thing as the self, and they reflect that belief in their ordinary language when they say such things as "myself," "yourself," and "ourselves." Moreover, people behave as if they and others are responsible, as if they are free to do what they will, and as if their lives have meaning. Thus, the law, for example, holds people responsible for their behavior with fairly rare exceptions. It reflects the common belief that people act freely, for better or for worse, and that they should be held accountable for their actions. Rightly or wrongly, the humanistic-existential perspective reflects a good deal of common sense.
There are, however, two criticisms of the humanistic-existential approach that merit careful consideration.
The first is that the approach spans such a diverse collection of views that even if it were possible to evaluate them, it would be hard to know how to begin. The approach seems a conglomeration of views that have little coherence and often bear little relation to each other. Moreover, what has been called humanistic at one time may not be termed humanistic at another (Wertheimer, 1978). Thus, it is sometimes difficult to know which views to include under this flag, and which to omit. A second criticism is directed toward the treatments that have emerged from the humanistic-existential perspective. With only one notable exception, about which we will speak momentarily, those who have derived treatments from humanistic and existential issues have neglected to examine the effectiveness of those treatments. And when they have been examined, as we will see they have proved to be by and large ineffective. However, just why they are ineffective is not clear, for unlike behavioral, cognitive, and psychoanalytic therapists, humanistic-existential therapists have not been careful to stipulate their procedures such that they or others can determine precisely the causes of their ineffectiveness. The one exception to the general failure of humanistic therapists to be concerned with evaluation is that of Carl Rogers and his students. Early on, Rogers insisted on evaluating the effectiveness of client-centered therapy. He invented techniques for assessing therapeutic techniques, and particularly a technique called the Q-sort, which enables researchers to examine the subjective world of the client (Rogers and Dymond, 1954). Rogers also was one of the first therapists to tape-record his counseling sessions, and thereby to open his therapeutic endeavors to the scrutiny of other scientists. Finally, view that therapist empathy and warmth are significant ingredients in the therapeutic process (Mitchell, Bozarth, and Krauft, 1977). One effect of Rogers's scientific efforts has been to open the entire field of psychotherapy to research, both with regard to process and to outcome (see Garfield and Bergin, 1978; Parloff, Waskow, and Wolfe, 1978). The results of these efforts appear to indicate that client-centered therapy is a moderately effective treatment with clients who are not psychotic.
SUMMARY 1. Both humanistic and existential psychologies assert the philosophical premise that people are fundamentally free or that, at the very least, they need to perceive themselves as being free. That freedom makes choice meaningful, and it enables them to be responsible for their choices, actions, and their futures.
2. Human experience is characterized by reciprocal determinism. People affect the environment as much as it affects them.
3. When there are constraints on perceived freedom, there may be psychological reactance, the tendency to react against the constraints rather than making free choices. 4. Humanists place heavy emphasis on the role of the self as the organizer of perception and behavior. They believe that the self provides a sense of wholeness and unity to the personality. Humanists believe that the self is naturally good and seeks fulfillment through self-actualization, which in turn develops best when individuals experience unconditional love.
5. Most humanists subscribe to Maslow's view that needs are organized hierarchically. The needs that must first be satisfied are those that keep the individual and species alive: food, air, water, and sex. Once those are gratified, needs for safety, love, and esteem emerge and clamor for gratification. And once those are satisfied, higher needs, such as self-actualization, emerge.
6. Existentialists believe that the fundamental anxiety is fear of death. Psychologically, death means nonbeing. Because the fear of death is so threatening, people attempt to endow themselves with immortality by becoming special or by fusion with others, which may lead to inauthentic, or false, modes of behavior.
7. Existential theorists hold that we are the authors of our experience. We determine what we perceive and what we experience; we are responsible for how we behave. Freedom and responsibility, however, may create anxiety. Responsibility avoidance is occasionally achieved through denying ownership of behavior and thought. In extreme form, that denial appears as "craziness" or drunkenness, which are purposeful behaviors designed to make it seem that we are not responsible.
8. Existentialists often posit two kinds of will: exhortative will forces US to do what we know we should do, and goal-directed will is unleashed when we have freely chosen our goals and want to pursue and achieve them.
9. Carl Rogers's client-centered therapy stresses the role of unconditional positive regard and therapist empathy and warmth in enabling people to overcome their defensiveness and to begin to self-actualize. Rogers and his students have conducted considerable research on the characteristics ofgood therapists, and they have by and large substantiated their
10. Fritz Perls's Gestalt therapy stresses conscious experience and feelings, dealing with the past only insofar as it has implications for the present. Gestalt therapists are particularly concerned to re-evoke and resolve conflictual feelings. Patients are encouraged to act out feelings, roles, dreams, and events.
11. Logotherapists like Victor Frankl stress the meanings that symptoms have for an individual's life, as well as the individual's freedom to alter those meanings. They use two techniques to do this: dereflection and paradoxical intention.
12. Much about the humanistic-existential approach cannot be evaluated, such as matters of belief and values. Other aspects of the approach require careful evaluation, particularly those that relate to treatment. With the exception of Rogers's client-centered therapy, however, humanistic and existential treatments have generally not undergone careful evaluation.