Ethical Principles of Existential Psychotherapy: An Exploration
As the National Institute of Mental Health jettisons the DSM-5, I find myself pondering the “science” of psychology and its relationship to existentially oriented clinical practice. One must concede psychology’s woefully dubious track record: from phrenology and Mesmerism to prejudiced intelligence testing and pathologization of sexual orientation. Cause for suspicion abounds. Although we might like to think the “science” of psychology has evolved considerably, response to the DSM-5 suggests otherwise.
Thompson (2000) contends that academic psychology provides a rather poor foundation for existential therapy, offering philosophy as an alternative. Of course, philosophy is constitutional to existential therapy. Yet, through pursuit of credibility, research backing, insurance coverage, and licensure requirements, we remain bound to psychological precepts. Ethical principles are correspondingly deemphasized.
In professional psychology, ethics have come to mean defensive, risk-management strategies, geared more to lawyers than patients. The ethics implicated in existential philosophy, by contrast, entails critical, dynamic engagement of the weighty questions of what it means to be human and to live life well. Such an ethics, I propose, should form the atlas of the existentially oriented therapeutic journey. In this call, I am indebted to Cushman (1996), who argues that failure to be cognizant of the inevitable ethical implications of psychotherapy leads us to reify the status quo (in modern times, a construct of self that is isolated, mechanistic, and consumer-oriented) rather than encouraging clients to examine latent biases and explore alternatives. In the following paragraphs, I will delineate six ethical underpinnings of existential psychotherapy and conclude with brief remarks on the construct of therapy to which such principles point.
Let us begin with the ethic of subjectivity. In the existential view, diagnosis and treatment stem primarily from patients’ subjective, embedded experience, rendering irrelevant manuals such as the DSM-5. Theory and scientific research may aid in the treatment process, but nothing trumps the primacy of subjective experience.
Secondly, let us turn to the ethic of honesty, which Thompson (2004) has devoted considerable attention to in his explication of the ethics of psychoanalysis. Existential philosophy likewise argues the imperative of facing issues head-on: no hiding, no disguising, no magic pills. Symptom reduction is not the ultimate aim, although symptoms are likely to ameliorate as patients become more fully present to their own experience. Indeed, resisting experience is thought to have much to do with psychopathology (Adame, & Leitner, 2011). A third ethic, then, is that of fidelity to the present moment.
Focus on the present naturally includes the client-therapist relationship. Existential therapy considers disconnection from others central to psychopathology and posits that change occurs only through genuine human connections. The therapist-patient relationship facilitates a reconfiguration of the patient’s atrophied or heavily armored relational core (Brinkmann, 2006; Adame & Leitner, 2011). Provision of an embodied, caring, authentic human relationship, then, comprises our fourth ethical principle.
Existential therapy distinguishes itself through its explicit attention to existential issues, and this commitment comprises our fifth ethic. We ask patients to wrestle with mortality, isolation, loss, meaninglessness, and freedom with the same frankness we request regarding the particularities of their presenting complaints (Stolorow, 2011). Examining these matters naturally elicits considerable and abiding anxiety. Thus, existential therapy offers no perfect bliss. As Cushman (1996) states bluntly, “Nothing has cured the human race, and nothing is about to” (p. 7). We seek to assist patients in discovering meaning, purpose and agency in their lives, despite inescapable limiting conditions (Adame & Leitner, 2011).
Indeed, cultivating agency or freedom, despite our lack of choice in the “thrown” existence and the mounting societal pressure to cast psychological distress as “disease” is pivotal to existential therapy. Regardless of life circumstances, the existentialist assertion is that each person retains a measure of agency, and that we must accept responsibility for their choices (Davenport, 2007). This belief in human agency is our sixth ethical principle.
Collectively, these values point to a process that is both challenging and decidedly counter-cultural (Schneider & du Plock, 2012). For example, subjectivity directly opposes the objectivity touted by scientific positivism, while emphasis on agency and the healing power of relationship contradict the disease model and manualized treatment packages. Honesty and embracing life’s existential themes oppose our cultural emphasis on quick fixes, positive thinking, and the attainability of absolute and enduring “happiness.” Further, the construct of therapy defined by this ethical vision places a demand on the patient that (particularly against our current cultural backdrop) raises the question: why would anyone sign up?
In response, existential therapy proffers more expansive rewards than its more mainstream counterparts. Not only are symptoms addressed, but patients, in a successful treatment, become more open, conscious, vibrant, creative, agentic and connected to others (Adame & Leitner, 2011; Stolorow, 2011; Schneider & du Plock, 2012). Enhanced sense of agency and interpersonal connectivity, moreover, create through their combination a sense of responsibility not only for one’s own life, but also for the world around us. When individuals both assume responsibility for their own existence, and acknowledge that existence is a collaborative venture, “it becomes our responsibility to fully address the world from the core of our being” (Adame & Leitner, 2011, p. 54). Thus, responsibility can be thought of as respond-ability in a transpersonal sense.
The hopefulness of this vision, founded upon firm belief in the human spirit, is profound. I suggest that it constitutes a value unto itself: regardless of all evidence to the contrary, existential therapists hold fast to the dignity and vast potential of humans (Schneider & du Plock, 2012).This vision, it seems to me, is well worth fighting for.
Adame, A. L., & Leitner, L. M. (2011). Dialogical constructivism: Martin Buber’s enduring relevance to psychotherapy. Journal of Humanistic Psychology, 51(1), 41.
Brinkmann, S. (2006). Questioning constructionism: Toward an ethics of finitude. Journal of Humanistic Psychology, 46(1), 92-111.
Cushman, P. (1996). Constructing the self, constructing America: A cultural history of psychotherapy. Reading, MA: Addison-Wesley/Addison Wesley Longman.
Schneider, K. J., & du Plock, S. (2012). Depth and the marketplace: Psychology's Faustian plight: A dialogue. (pp. 193-208). New York, NY: Routledge/Taylor & Francis Group.
Stolorow, R. D. (2011). The phenomenology, contextuality, and existentiality of emotional trauma: Ethical implications. Journal of Humanistic Psychology, 51(2), 142.
Davenport, J. (2007). Will as commitment and resolve: An existential account of creativity, love, virtue and happiness. New York, NY: Fordham University Press.
Thompson, M.G. (2000). The sceptic dimension to psychoanalysis: Toward an ethic of experience. Contemporary Psychoanalysis, 36(3), 457-481.
Thompson, M. G. (2004). The ethic of honesty: The fundamental rule of psychoanalysis. Amsterdam and London: Rodopi.
-- Amber M. Trotter
Today's guest contributor, Amber M. Trotter, has a background in sociology and environmental activism and is currently pursuing her doctorate in clinical psychology at the California School of Integral Studies.