Existential-Integrative Therapy

Developments over the past 15-25 years in psychology have led to the development of many eclectic and integrative approaches to psychotherapy. This idea is not new to existential therapy. Yalom (1980) suggested that existential therapy is more of a frame than a specific therapy approach. As such, it is necessary to integrate some aspects of other theories in the application of existential therapy. Schneider and May (1995) proposed an existential integrative approach to therapy which considered new directions in existential therapy, including how other realms of thought and therapy could be integrated with existential therapy.

For some time, I’ve been a fan of the existential integrative approach proposed by Schneider and May. The existential frame provides a great foundation for integrative work in psychology and psychotherapy. However, this does not come without potential dangers, too. In this brief essay, I will discuss some of the strengths and dangers of integrative work from an existential perspective.

Pitfalls of Integrative Psychology
My concerns with integrative and eclectic approaches in psychology fall in three major realms: 1) utilitarian applications, 2) consistency, and 3) depth. Each of these concerns is related, but also offers a unique limitation.

The concern regarding utilitarian applications are maybe best reflected in the eclectic psychotherapy movements, though also applicable to integrative approaches. The underlying philosophy is ‘if it works, use it.’ This begs the questions ‘what is mean by works?’ and ‘to what ends does it work?’ Frequently, a hedonistic values system underlies this thinking. It is assumed that all clients are seeking to maximize their happiness while decreasing their pain and discomfort. This assumption is simply not accurate. Furthermore, it encompasses a dangerous value system which is implicitly being imposed upon clients. An existential perspective emphasizes the potential value and gains of experiencing a broader array of emotions. To simply blindly seek happiness without taking into consideration of the client’s values or the consequences of this striving is dangerous.

A second concern is the internal inconsistencies that potentially arise in integrative work. A great example of this is many of the approaches attempting to integrate existential and cognitive therapies. One potential danger comes to the surface quickly. Existential therapy believes that anxiety is not necessarily unhealthy and potentially a great ally to the therapy process. Many existential therapists will align with the anxiety and use this to facilitate the therapeutic process. To cut off the anxiety without consider how it may be beneficial and healthy is irresponsible. Many (thought not all) cognitive therapist quickly seek to allay anxiety quickly without considering the deeper existential issues involved. Existential perspectives value the journey through the suffering and purport there is meaning and growth associated with this journey. Any quick approach to alleviating suffering runs the risk of being counterproductive.

This is not intended to say it is not possible to integrate existential and cognitive approaches, though I am skeptical of what I’ve seen. Often it seems that it is a very shallow or selective understanding of existentialism that is being integrated. At times, I can’t help wonder if “existential” isn’t being attached more for the aesthetics of how it sounds or appears more than out of a true interest in existentialism. A true integration of these theories requires careful consideration to these issues to avoid being internally inconsistent.

Despite the limitations, aspects of these limitations can be integrated in a coherent system. For example, existential therapists will borrow some of the cognitive restructuring ideas developed by cognitive therapists. However, it will generally be done thoughtfully with attention paid to how this fits with the overall therapeutic approach. Similarly, cognitive therapist can easily borrow some of existentialism ideas on what may be eliciting the anxiety or aspects of an existential theory of emotions, which would emphasize our inability to fully control our emotions.

The final concern, depth, is closely related to the previous concern of internal inconsistencies. Anyone who takes a deep look at the philosophy and values underlying cognitive and existential theories should quickly become aware of the challenges of integrating them. When seeking to integrate different theories, the values, intended outcomes, and epistemology need to be considered along with how these impact the therapy process.

Potential Strengths of an Existential Integrative Approach
Existential theory emphasizes the idea that a new therapy is created with each client (Yalom, 1980, 2002). In other words, existential therapy is designed to be adaptive to the client’s needs, desires, and values. This lends itself to being a very adaptable therapeutic approach. Furthermore, being a rather unstructured approach that opposes rigidity, this approach is easier to adapt than most.

Of course, there are adaptations which will not fit well into this system because it would lead to the problems espoused above. A therapist can bend their approach only so much to meet the client. At times, there is still the need to refer the client to a therapist of a different orientation who will be a better fit. For example, a client entering therapy desiring a very quick reduction in anxiety is someone I would likely refer to another therapist. However, if the client is interested in trying to better understand their anxiety and take a more gradual approach to getting to the roots of the anxiety, I feel I’m a good fit. There is a good deal of space for adaptation between these two positions. To build on this example, I often work with clients to help them contain their anxiety along the way to their desired outcome. This is something that typically I work with clients to find the appropriate balance of managing anxiety while still allowing the anxiety to do its work.

A final consideration of the strengths pertains to the breadth of existential theory. This breadth allows for it to be an ideal ground for assisting other theories in becoming more complete. A great example of this is some of the contemporary psychoanalytic approaches to therapy. By integrating in existential ideas, it allows for psychoanalysis to become more inclusive and holistic. Several theorists, such as Stephen Mitchell, have done this quite well. Working more from an existential base, Kirk Schneider is also working toward an approach which integrates some contemporary psychoanalytic ideas, such as Stolorow’s intersubjectivity.

Existential theory provides a great frame for psychotherapy integration. At the same time, it emphasizes the importance of carefully considering the implications of such integration. Haphazard integration is not beneficial for the therapist or client. However, thoughtful integration assists therapist in becoming more skilled in helping a wide variety of individuals seeking healing.

Original version added January, 2006.