marlier.proThe Four Ultimate Concerns identified by Yalom
September 23, 2003
Existentialism is a philosophic school which holds that truth depends upon the existing person, who exists here (in the world) and now. Existential psychotherapy deals with the main existential realities, identified by Yalom as the “deep structures” of existence, the ultimate concerns of death, freedom, isolation, meaninglessness.
Death is the most obvious concern. It is the most terrible truth as it is inevitable and conflicts with man's wish to continue to exist. Death is a primary source of anxiety. But death anxiety is rarely seen in its simple form: this anxiety is dealt with by defense mechanisms. The presence of death anxiety has been described by clinicians in the full range of psychopathologies. And the proximity of death, for instance in seriously ill people, may instigate a radical shift in the way one lives. A confrontation with the person's possible or announced death represents a “boundary situation”.
Thus, severe illness can serve as a catalyst to help the patient face and conquer the fear of death. The therapist may also use many techniques to simulate an encounter with death: He will use such levers as birthdays and anniversaries; dreams and fantasies will be monitored and provide material to increase death awareness. Visiting graveyard, interaction with the Dying, living like old people for periods of time, writing one's own obituary, even LSD and shock therapy have been used in therapy.
The aim is not to suppress death anxiety by to alleviate it enough for it to become a source for personal growth.
Freedom is also a source of anxiety because it means that the individual is entirely responsible for his existence, without any possible “backup”. Because it is terrifying, many people try to avoid freedom. Freedom consists of two aspects, Responsibility and Willing.
Responsibility avoidance can take the form of compulsivity, displacement of responsibility to another person, denial of responsibility (the individual presents himself as an innocent victim, as losing control), avoidance of autonomous behavior and disorders of wishing and deciding. The therapist does not use a special technique but rather an obvious attitude: whenever the patient deplores his or her situation, the therapist asks how the patient has created this situation. He challenges the patient to recognize that he is responsible for the events in his life. To a patient who says that his behavior is controlled by his unconscious, the therapist will ask: “Whose unconscious is it?” (Yalom)
But this is not enough. “Awareness of responsibility in itself is not synonymous with change; it is only the first step in the process of change.” (Yalom, p.286). There must be some action. And willing is essential for action to take place. Will is not synonymous with will-power, it a combination of wish and choice (decision): “One initiates through wishing and the enacts through choice.” (Yalom, p. 302). The problem is that people are unable to feel what they wish (affect-block). The therapist's task is not to create the will, but to help reveal it so that the patient gain insight of what he wishes. They the mechanism will be the following: To get what I want, I must change. I have the power to change. Only I can change the world I have created. There is no danger in change. Then the choice / decision will lead to action.
Isolation can take several aspects: There is interpersonal isolation which is isolation from other individuals, or loneliness. Then there is intrapersonal isolation, a process where the individual separates from portions of himself. And last, there is existential isolation which refers to the fundamental isolation of the individual from other creatures and from the world. Even in the absence of interpersonal isolation, we are alone along our whole existence. The existential conflict then arises from our wish for closeness with other people and being part of a whole (being in the world), which is in contradiction with our absolute existential isolation. To allay their anxiety, some people need and search to be at all times surrounded by people, they find extremely difficult to spend time alone. One technique used to try and alleviate this anxiety treats the patient with periods of self-enforced isolation during which the patient records all his thoughts and feelings.
Isolation can take several aspects: There is interpersonal isolation which is isolation from other individuals, or loneliness. Then there is intrapersonal isolation, a process where the individual separates from portions of himself. And last, there is existential isolation which refers to the fundamental isolation of the individual from other creatures and from the world. Even in the absence of interpersonal isolation, we are alone along our whole existence. The existential conflict then arises from our wish for closeness with other people and being part of a whole (being in the world), which is in contradiction with our absolute existential isolation. To allay their anxiety, some people need and search to be at all times surrounded by people, they find extremely difficult to spend time alone. One technique used to try and alleviate this anxiety treats the patient with periods of self-enforced isolation during which the patient records all his thoughts and feelings.
Existential psychotherapy was said to be too philosophic, too abstract to be easily put into practice. It was also said to be aimed at well-off educated people who have the time to have existential interrogations. Yet it now seems to influence many trends of psychotherapy dealing with patients who are increasingly confronted with loneliness, isolation, and alienation.
Reference
Yalom, I. D. (1980). Existential Psychotherapy. New York: Basic Books.
September 23, 2003
Existentialism is a philosophic school which holds that truth depends upon the existing person, who exists here (in the world) and now. Existential psychotherapy deals with the main existential realities, identified by Yalom as the “deep structures” of existence, the ultimate concerns of death, freedom, isolation, meaninglessness.
Death is the most obvious concern. It is the most terrible truth as it is inevitable and conflicts with man's wish to continue to exist. Death is a primary source of anxiety. But death anxiety is rarely seen in its simple form: this anxiety is dealt with by defense mechanisms. The presence of death anxiety has been described by clinicians in the full range of psychopathologies. And the proximity of death, for instance in seriously ill people, may instigate a radical shift in the way one lives. A confrontation with the person's possible or announced death represents a “boundary situation”.
Thus, severe illness can serve as a catalyst to help the patient face and conquer the fear of death. The therapist may also use many techniques to simulate an encounter with death: He will use such levers as birthdays and anniversaries; dreams and fantasies will be monitored and provide material to increase death awareness. Visiting graveyard, interaction with the Dying, living like old people for periods of time, writing one's own obituary, even LSD and shock therapy have been used in therapy.
The aim is not to suppress death anxiety by to alleviate it enough for it to become a source for personal growth.
Freedom is also a source of anxiety because it means that the individual is entirely responsible for his existence, without any possible “backup”. Because it is terrifying, many people try to avoid freedom. Freedom consists of two aspects, Responsibility and Willing.
Responsibility avoidance can take the form of compulsivity, displacement of responsibility to another person, denial of responsibility (the individual presents himself as an innocent victim, as losing control), avoidance of autonomous behavior and disorders of wishing and deciding. The therapist does not use a special technique but rather an obvious attitude: whenever the patient deplores his or her situation, the therapist asks how the patient has created this situation. He challenges the patient to recognize that he is responsible for the events in his life. To a patient who says that his behavior is controlled by his unconscious, the therapist will ask: “Whose unconscious is it?” (Yalom)
But this is not enough. “Awareness of responsibility in itself is not synonymous with change; it is only the first step in the process of change.” (Yalom, p.286). There must be some action. And willing is essential for action to take place. Will is not synonymous with will-power, it a combination of wish and choice (decision): “One initiates through wishing and the enacts through choice.” (Yalom, p. 302). The problem is that people are unable to feel what they wish (affect-block). The therapist's task is not to create the will, but to help reveal it so that the patient gain insight of what he wishes. They the mechanism will be the following: To get what I want, I must change. I have the power to change. Only I can change the world I have created. There is no danger in change. Then the choice / decision will lead to action.
Isolation can take several aspects: There is interpersonal isolation which is isolation from other individuals, or loneliness. Then there is intrapersonal isolation, a process where the individual separates from portions of himself. And last, there is existential isolation which refers to the fundamental isolation of the individual from other creatures and from the world. Even in the absence of interpersonal isolation, we are alone along our whole existence. The existential conflict then arises from our wish for closeness with other people and being part of a whole (being in the world), which is in contradiction with our absolute existential isolation. To allay their anxiety, some people need and search to be at all times surrounded by people, they find extremely difficult to spend time alone. One technique used to try and alleviate this anxiety treats the patient with periods of self-enforced isolation during which the patient records all his thoughts and feelings.
Isolation can take several aspects: There is interpersonal isolation which is isolation from other individuals, or loneliness. Then there is intrapersonal isolation, a process where the individual separates from portions of himself. And last, there is existential isolation which refers to the fundamental isolation of the individual from other creatures and from the world. Even in the absence of interpersonal isolation, we are alone along our whole existence. The existential conflict then arises from our wish for closeness with other people and being part of a whole (being in the world), which is in contradiction with our absolute existential isolation. To allay their anxiety, some people need and search to be at all times surrounded by people, they find extremely difficult to spend time alone. One technique used to try and alleviate this anxiety treats the patient with periods of self-enforced isolation during which the patient records all his thoughts and feelings.
Existential psychotherapy was said to be too philosophic, too abstract to be easily put into practice. It was also said to be aimed at well-off educated people who have the time to have existential interrogations. Yet it now seems to influence many trends of psychotherapy dealing with patients who are increasingly confronted with loneliness, isolation, and alienation.
Reference
Yalom, I. D. (1980). Existential Psychotherapy. New York: Basic Books.
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