David Wakely, M.A. UKCP reg.
|15th August 2018|
I trained as an existential psychotherapist and counsellor and this continues to form the basis of my approach to therapy. I also draw upon other models of therapy, particularly narrative therapy and aspects of cognitive-behavioural therapies (CBT). These include some of the more recent "third wave" CBT models such as ACT (acceptance and commitment therapy) and mindfulness-based therapy.
Working existentially means that I regard the kind of problems that people bring to therapy less in terms of illness, dysfunction or maladjustment, and more in terms of how we grapple - as we all in our own way must - with the essential conditions of human existence (see below) and the basic conflicts and tensions that these give rise to.
My approach: process and goalsThe process of therapy, as I understand and practise it, involves reflection on oneself, on how one relates to others and to one's environment and on how one operates in the world.
The goals of therapy are to increase our self-understanding, to reduce suffering and to help clarify our sense of direction.
Therapy focuses on three main areas:
a) on a person's actual lived experience;
b) on how a person interprets and understands their experience;
c) on how a person finds, or has difficulty finding, direction and value in life.
Where appropriate - for example, where a person is suffering from overwhelming moods and emotions; intrusive thoughts and feelings; or impulsive, compulsive and/or addictive behaviours - there is also a fourth focus
d) on symptom reduction.
- the process of being attentive to whatever we are actually experiencing in aspects of our lives, physically and emotionally; particularly those areas of experience which normally fall under the radar of our awareness.
- becoming aware of how we normally make sense of our experience; being able to put this into words; perhaps starting to question things and, if appropriate, challenge ourselves on some of this.
- determining what we believe to be truly important in life, understanding the things we truly value; thinking through how we can use this understanding to decide upon the directions we would like to take.
These three activities more or less correspond to the three areas of focus mentioned above. A fourth set of activities (some of which may be done outside the session as "homework" exercises - never obligatory!) are:
d) symptom reduction exercises and reflective exercises
- for example: activity scheduling; recording or tracking moods, emotions, thoughts and behaviours; timetabling; goal-setting; journal writing; writing non-send letters; relaxation, meditation and mindfulness exercises.
Core conditions of human lifeExistential therapy places emphasis on the core conditions (or givens) of life and the challenges that these conditions pose to human beings. Psychological suffering arises from our encounter with these challenges. It is also assumed that through working with these challenges a person can arrive at satisfaction and fulfilment.
a) Embodiment and environment
We are physical beings with a basic dependence on the physical world and on the intervention of others for the fulfilment of our needs. Furthermore, everything we have and everything we are is subject to decay and loss. Denial of our basic vulnerability and mortality can lead us to waste the limited and uncertain time we have available to us in life; acceptance challenges us to live in ways which are meaningful and valued.
b) Relations with others
Our sense of who we are and what it is possible for us to achieve is initimately bound up with the fact that we live in a world of other people. To navigate our way through life is to enter into all sorts of different relations to other people, some of whom will inspire the deepest emotions in us. We often look to others for validation of who we are and can suffer greatly when we feel that others do not value us. We can respond to this vulnerability in many ways, from the extreme of total isolation to that of total submersion in conformity with a group culture
c) The separateness of the self
Within the first two to four years of our lives, we start to understand that there is separation between ourselves and others, that our thoughts and feelings are our own and that they cannot always be read by other people. From now on, all our experiences have a certain taste of "me-ness" permeating through them, as if there is an invisible boundary separating an inner, private world from the external world of people and events.
d) The creation of meaning
Life is meaningful because human beings create and choose meaning. To be conscious is to be capable of having experiences; but human beings go further than this in that we take up attitudes towards our experiences. To have an attitude towards some object or person or event is to experience this as personally meaningful, even if this attitude is only one of boredom or indifference. Thus all our experiences, however insignificant they may seem, are personally meaningful; and, wherever we encounter something as meaningful, we have also, on some level, assigned value to it.
A note on CBT (cognitive behavioural therapy)Cognitive behavioural therapy (CBT) is an approach which, in its original form, assumes that emotional disorders such as clinical depression and anxiety are rooted in deep-seated negative thoughts and patterns of thinking. It offers a variety of tools, which can be used in a session or set as "homework", which aim to identify and modify these thinking patterns. CBT often also works with clients to modify problem behaviours.
Since its beginnings in the 1960s, a wide range of CBT therapies have been developed. These now include what are sometimes referred to as "third wave" CBTs. These include mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT) and compassion focused therapy (CFT). Often the focus here is less on changing negative thoughts than on helping people to gain distance and perspective on their problems (there is evidence to suggest that this in fact is what traditional CBTs actually do) and on clarifying and encouraging the adoption of more positive and valued behaviours. The practice of meditation and awareness exercises is often a central part of these CBTs.
I have sometimes found CBT techniques useful in working with emotional problems (such as depression, various forms of anxiety, anger issues and stress) and with compulsive and/or addictive behaviours. These techniques are often helpful in attempting to gain some distance from the problem and to feeling more in control of one's life.
A note on narrative therapyWhere CBT aims to identify habitual thinking patterns, narrative therapy listens to the ways in which people tell their story or, in other words, construct narratives about themselves and the lives they live. Even the simplest narratives have underlying principles of construction: in telling a friend about what I did at the weekend, I make decisions, often without being fully aware of it, about what I should include and what I should leave out, which aspects I emphasise, the effect that I want the story to have on the listener.
Like certain habits of thinking, narrative constructions become habitual and automatic. To take a simple example: suppose during my life I have done a number of things that I consider to be failures, then I might start to see my life as a story about failure. I begin to give more emphasis to moments of failure and less to those times when I succeeded or when success and failure were not important. I start to see myself as a failure and I come to expect that what I do in the future will also fail. The narrative that I have constructed as a way of understanding my experience becomes a self-fulfilling prophecy.
Working from this perspective in therapy also allows the therapist and the client to think about external narratives - the narratives of family and peer groups, social and cultural narratives - and the ways in which these can impact on the client's personal narrative. I find this particularly relevant as an approach when working with issues of identity and direction in life.
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