Thumbnail - download.e-bookshelf.de · Emmy van Deurzen is a philosopher, chartered counselling psychologist and a registered existential psychotherapist. She is the Principal of

Paradox and Passion in Psychotherapy

lsquoParadox and Passion in Psychotherapy is a personal passionate and eloquent statement about the power of paradox to unshackle lives It is not by any means an easy statement nor should it be but it is conveyed with both clarity and depth These features along with its personal anecdotes case studies and crisp description of the very latest in existential analytic inquiry will inspire both students and professionals alike Paradox and Passion in Psychotherapy is a roadmap to poignant livingrsquo

Kirk Schneider PhD author of Existential-Integrative Therapy and The Polarized Mind

lsquoEmmy van Deurzenrsquos Paradox and Passion in Psychotherapy is that very rare thing ndash a book which inspires the reader and holds their attention from the first page to the last Both learned and deeply accessible it addresses unflinchingly the absurdity and wonder of the human condition and encour-ages us to follow this example and look upon the human condition with a clear and steady gaze Van Deurzen draws on her long experience ndash both personal and professional ndash to show how we can use the wisdom and insights of philosophy to become more vital and resourceful in both our everyday lives and our therapeutic practice This is without doubt a classic text and a repository of wisdom which not only deserves a place on every therapistrsquos shelf but which will repay frequent re-readingrsquo

Professor Simon du Plock Middlesex University UK

lsquoThis second edition is more than an update of a valuable text but a refine-ment and development By taking a personal and heartfelt approach Professor van Deurzen clarifies how stormy life can be offers insight into the ways that passion can steady the tiller as we engage with lifersquos difficult yet inherent paradoxes A stimulating and challenging text that encourages the reader in their search for ethical and passionate engagement with both therapeutic practice and with life more generallyrsquo

Professor Martin Milton Regentrsquos University London UK

lsquoIn this book Emmy van Deurzen does what she does best taking on a wide variety of subjects and subjecting them to an original and incisive but always philosophically rigorous examination It is in turns provocative insightful and challenging and sometimes all three at the same time What cannot ever be doubted is the authorrsquos passion and commitment to exploring and com-municating the truths of human existencersquo

Martin Adams Regentrsquos University London UK

Paradox and Passion in Psychotherapy

An Existential Approach

Second Edition

Emmy van Deurzen

This edition first published 2015copy 2015 John Wiley amp Sons Ltd

Registered OfficeJohn Wiley amp Sons Ltd The Atrium Southern Gate Chichester West Sussex PO19 8SQ UK

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For details of our global editorial offices for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at wwwwileycomwiley‐blackwell

The right of Emmy van Deurzen to be identified as the author of this work has been asserted in accordance with the UK Copyright Designs and Patents Act 1988

All rights reserved No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise except as permitted by the UK Copyright Designs and Patents Act 1988 without the prior permission of the publisher

Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books

Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names service marks trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book

Limit of LiabilityDisclaimer of Warranty While the publisher and author have used their best efforts in preparing this book they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom If professional advice or other expert assistance is required the services of a competent professional should be sought

Library of Congress Cataloging‐in‐Publication Data

Van Deurzen EmmyParadox and passion in psychotherapy an existential approach Emmy van Deurzen ndash Second edition pages cm Includes bibliographical references and index ISBN 978-1-118-71385-3 (hardback) ndash ISBN 978-1-118-71384-6 (paperback) 1 Existential psychotherapy I Title RC489E93V364 2015 61689prime14ndashdc23 2015007893

A catalogue record for this book is available from the British Library

Cover image Rembrandt Rest on the Flight to Egypt 1647 National Gallery of Ireland Dublin Photo Scala FlorenceBPK Bildagentur fuer Kunst Kultur und Geschichte Berlin (photo Hermann Buresch)

Set in 1012pt Sabon by SPi Global Pondicherry India

1 2015

To Digbyfor keeping paradox and passion alive

Infinite passion and the pain of finite hearts that yearn hellipRobert Browning

About the Author ixPreface to the Second Edition xPreface to the First Edition xiiAcknowledgements xv

Introduction 1

Section 1 Paradox 15

Introduction The Central Role of Paradox in Human Existence 15

1 Ontological Insecurity Revisited Self‐confidence Versus Anxiety 23

2 Courting Death Life in the Balance 37

3 The Survival of the Self Identity Freedom and Disintegration 58

4 Intimacy and Love Closeness and Distance Between Self and Other 69

5 Alienation and Adaptation Being a Stranger in a Foreign Land 77

Section 2 Passion 87

Introduction The Central Role of Passion in Human Existence 87

6 A Passion for Life Rediscovering the Intensity of Living 95

7 Truth as a Touchstone Reality and Meaning as the Bedrock of Living 106

Contents

viii Contents

8 Hard‐earned Lessons A Therapistrsquos own Journey to Self‐understanding 121

9 Letting the Clientrsquos Life Touch Yours The Art of Resonance and Presence 143

10 The Moral Compass How Can Counselling and Therapy Help 158

Section 3 Existential Psychotherapy 173

Introduction A New Way of Working 173

11 Widening Horizons Universal Dimensions of the Human Dilemma 177

12 What is Existential Analysis Sketch for an Existential Approach 189

13 Philosophy as Therapy The Ultimate Goal of our Work 200

14 A New Challenge Towards Transcendence 208

Section 4 Illustrations of Existential Work 223

Introduction What We Can Learn From Practice 223

15 Marie‐Louise Letting Go of the Past in Order to Reclaim it 227

16 Vicky Learning to Be More by Being Less 233

17 Peter Finding Oneself in Spite of Psychotherapy 241

18 Jerry Transcending Trauma 251

Conclusions 263

References 266Index 273

Emmy van Deurzen is a philosopher chartered counselling psychologist and a registered existential psychotherapist She is the Principal of the New School of Psychotherapy and Counselling London and visiting professor with Middlesex University She is a Director of the Existential Academy and Dilemma Consultancy where she runs her private practice as well as a low‐cost clinic

Emmy was a major force in establishing existential therapy in the United Kingdom and Europe by founding the Society for Existential Analysis in 1988 writing and publishing prolifically and by training thousands of stu-dents all over the world She was the first chair of the United Kingdom Council for Psychotherapy and served as External Relations Officer to the European Association for Psychotherapy She is much in demand as an international speaker on existential social moral psychological and philo-sophical issues Her many books have been translated into numerous languages especially her best‐selling texts Existential Counselling and Psychotherapy in Practice (third edition Sage 2012) and Everyday Mysteries (second edition Routledge 2010)

Emmy is of Dutch origin and grew up in the Netherlands She lived studied and worked in France during the early 1970s but she has been a resident of the UK since 1977 She divides her time between the Peak District National Park in South Yorkshire where she writes paints and walks and London where she works She is married to Professor Digby Tantam and has two adult children and two adult stepchildren as well as two step‐grandchildren

About the Author

In its first edition this book was part of a series that I edited for Wiley which included Freddie and Alison Strasserrsquos book Time Limited Existential Therapy and Simon du Plockrsquos book Case Studies in Existential Therapy The three books came out just before the turn of the millennium as the profession of psychotherapy was going through many changes It was clear that people increasingly needed help to deal with crucial existential issues and that it was no longer sufficient to tackle with emotional problems as if these were purely functions of intra‐psychic mechanisms It was time to address the human alienation that is generated by living with the growing pressures of technology bureaucracy and a rapidly increasing population

Existential therapy is based in philosophy and helps people to re‐evaluate personal problems in a social cultural political and philosophical context It pays attention to the values and beliefs a person lives with not in order to change these and adjust the person to the status quo but in order to illumi-nate their position in the world and liberate them from feeling compelled to carry on doing the same thing day after day It encourages people to exam-ine their lives and rediscover or recreate purpose and meaning in their exist-ence It makes room for paradox and the acceptance of the inevitable facts of life that we so often try to evade or avoid It allows for questioning and re‐evaluation It encourages a person to find their own direction and face up to their personal possibilities and limitations

Existential psychotherapy has been practised for well over a century and its underpinning theories go back to the nineteenth century philosophies of freedom of Kierkegaard and Nietzsche and the twentieth century philoso-phies of Heidegger and Sartre amongst others Indirectly it draws on a much longer lineage in that all of Western and Eastern philosophy are relevant to such a reappraisal of everyday life Indeed the beginning of philosophy in ancient Athens was an existential project When Socrates con-tended that the unexamined life was not worth living he inspired those

Preface to the Second Edition

Preface to the Second Edition xi

around him to consider their silent and unconscious assumptions about life and to throw light on aspects of human existence that had previously remained hidden or denied Socrates taught people to reflect on what they had taken for granted and to question what they had not even realized was problematic

Existential therapists follow in these footsteps and enable people to take charge of their life affirming their personal authority instead of following the crowd and putting up with unacceptable living conditions The book will demonstrate the principles on which this work is based and illustrate this with a range of case illustrations The existential approach to therapy has been much better documented over the past decades than it had been for its earlier years as many existential practitioners have accepted that while they abhor formalization and manualization of therapeutic methods and techniques it is of value to document how we work philosophically so that others can learn from these earlier developments and experiences

This does not mean that the method discussed here is the only way to practice existentially There are many different sorts of existential practice as these are always based in local knowledge and wisdom and change from culture to culture and from person to person

In this book I shall discuss a wide range of issues ranging from death to freedom and from the idea of the self to the concept of human communica-tion It discusses matters of relevance to every therapistrsquos practice and it aims to raise more questions than it provides answers In the final analysis that is the main objective of the book to provoke and stimulate thought about the way in which we conduct our lives what goes wrong with our experi-ence of human existence and how we may seek to set it right It is in reflect-ing on the human dilemma and the many ways in which it perplexes us that we get better at living I have learnt as much by being in dialogue with my clients over a therapeutic career which started in 1973 as I have learnt from reflecting on my own mistakes and successes in living I have certainly learnt more from this dual reflective existential practice than I have been able to gather from the theories and philosophies in the books I have read much as I have always valued philosophy and psychology I hope that this book will inspire you to start experimenting a little bit more with your own way of living and your own way of being in therapy May it provoke new thoughts about the paradoxes of human existence and may it trigger new passions that will rekindle your love of life

Hollow Meadows South Yorkshire September 2014

Preface to the First Edition

Because of the dramatic ways in which my own life has been transformed over recent years I have become more aware of the manner in which my psychotherapeutic work is responsive to the level of awareness that I can muster in my personal life The quality of my work increases or decreases in accordance with the quality of my life Throughout this book it will be clear that I want to encourage a more intense link between the way in which we live in the world and work with others towards greater understanding

This does not mean that I advocate suffering or emotional upheavals Interventions made during times of quietude can contribute calm accept-ance or even serenity Interventions made in times of personal turmoil might contribute a higher level of personal resonance and direct insight Neither is intrinsically better or worse but I do believe that therapists can offer more to their clients if their work reflects an openness to the para-doxes of human living and if they are willing to live their own lives with full engagement and vitality There are no short cuts to becoming a good psychotherapist or counsellor skill alone might safeguard us from mal-practice but if we are to offer excellence we have to draw on the strengths that we can only acquire by living life intensely and bravely with integrity and flexibility with a complete readiness for what destiny holds in store for us

We need to find the kind of equilibrium that is usually called wisdom and that is never quite mastered but always within reach I have come to believe that there is an optimum tension somewhere between complacency and catastrophe which enables me to be secure enough to be steady and anxious enough to be alert which serves both me and my clients best in managing life in all its contradictions Somewhere between boredom and terror we can learn to be ourselves in harmony with the flow of life rather than obstruct it or feel obstructed by it This book represents my search for this optimum tension and describes my own journey along the tortuous path where

Preface to the First Edition xiii

moments of obstruction and stagnation co‐exist with moments of new dis-coveries and flashes of insight that make it all worthwhile

Some of the chapters in this book appeared as articles in a variety of pub-lications at an earlier stage They are the product of a decade of thinking and writing about psychotherapy and counselling and they speak for themselves To publish these papers in this form is very satisfying to me as it allows me to harvest the fruits of the past and store them safely for future use That paradox and passion were present throughout the period when these words were written is abundantly obvious by the intense and perhaps sometimes controversial nature of what I say

Some chapters highlight my concern with the establishment and safe-guarding of the existential approach something that I took very much to heart for many years It resulted in me bringing together psychotherapists from a number of very different organizations and orientations in order to found the Society for Existential Analysis as a forum for philosophical debate and in order to secure a place for the approach in this country The Society has now become a strong organization and the approach has been spread widely partly because of the 18 years of hard work spent in build-ing up a School of Psychotherapy and Counselling first with Antioch University then at Regentrsquos College where people could be trained in the existential approach It is rather ironic that I have become dissociated from both the Society and the School when these have reached the matu-rity and mainstream credibility that I aimed for and yet can now see the mortal dangers of It is sad to have to let go of what one has created and it is hard to see others take these things into directions one did not want to go in oneself

While I feel gratitude for having had the opportunity to bring these organ-izations into the world with the people who have cared for them with me perhaps the greater existential lesson was to have to relinquish them There is a tremendous excitement and exhilaration in having to start from scratch and no longer being able to take anything for granted having to prove one-self worthy and able to survive Founding the New School of Psychotherapy and Counselling and rediscovering the anxious pleasure of pioneering cer-tainly put my own ability to live what I teach to the test

Some other chapters refer directly to my experience as chair of the United Kingdom Council for Psychotherapy which made me sensitive to the politi-cal and social dimensions of psychotherapy which are so often neglected by professionals in this field This political awareness has continued to increase through being external relations officer to the European Association for Psychotherapy which has also inspired some of the writing in this book It has become increasingly obvious to me that we need to take an international and trans‐cultural view of human nature working together to overcome the unnecessary conflicts and fears that stop us in our tracks

xiv Preface to the First Edition

The very personal nature of some of the chapters illustrates what I think is most precious in the existential approach that it can be about life itself as it is actually lived by individuals in the moment rather than about theory or skill I continue to be deeply committed to valuing life in all its complex contradictory paradoxical reality and I believe that hazarding these per-sonal observations even if they are going to be scrutinized by others is the only way to do justice to an approach that demands directness and courage If we ask our clients to be open and self‐aware we must be capable of such openness ourselves If we truly believe that life is there to be lived to the full passionately and in all its intensity then we should be pleased to take some risks and let others know of the dangers we have encountered on the way To overcome the obstacles is always the objective until we realize that it is the process of passionate overcoming not the safety that results at the end that is lifersquos paradoxical joy

I am deeply grateful to my parents Anna and Arie van Deurzen to my children Ben and Sasha Smith and to my companion Digby Tantam for hav-ing been true and good when everything else failed Their love is the light on my way

Sheffield September 1997

Some of the case studies in this book first appeared as illustrations of existential therapy in the many different versions of my chapter on this approach in the various editions of Drydenrsquos Handbook for Individual Therapy (Sage) I am grateful to Windy Dryden for having inspired the writing up of these thera-peutic vignettes and for requiring regular updates of these in the new ver-sions of his handbooks so that the old ones became redundant and thus available for publication elsewhere It is always challenging to write about my clients in a fair and balanced manner and to be accurate enough about what happened without betraying client confidentiality I am grateful to the many clients I have worked with since I first became a therapist in 1973 Without their trust and sincerity in their work with me over the decades I would never have had the opportunity to learn so much about human real-ity and the many ways in which it can be experienced I feel very privileged to have known these struggling hardworking deeply‐feeling human beings

Acknowledgements

Paradox and Passion in Psychotherapy An Existential Approach Second Edition Emmy van Deurzen copy 2015 John Wiley amp Sons Ltd Published 2015 by John Wiley amp Sons Ltd

Background

Psychotherapy and counselling are professions that concern themselves with human dilemmas human difficulties human distress human aspirations human fears and dreams and many more such human preoccupations In other words psychotherapy and counselling are about understanding the human condition

The human condition is riddled with contradictions We live within a force field of constant tensions between opposites moving between wake-fulness and sleep confidence and doubt belonging and isolation sickness and health life and death As soon as we are born our eventual death is immediately posited and becomes inevitable Though we know this we find it hard to grasp We tend to postpone thinking about it as it is likely to hap-pen much later in a distant future Nevertheless at the back of our minds we feel uneasy about the prospect of our inexorable progress towards darkness We can never be completely sure of our survival After all death can strike suddenly and unexpectedly Our safety is often in question We are all con-fronted with catastrophes that come out of the blue and that revolutionize our lives During our lifetime we are all visited with shocking losses that we were not prepared for It is not surprising then that many of us live with a constant sense of the fragility of things and with the intuited knowledge of our own vulnerability Whenever things go well in our lives we become at once apprehensive of the next problem or potential catastrophe which we know from experience might be waiting for us just around the corner Even at the best of times life is a constant cycle of ups and downs achievements

Introduction

2 Introduction

and failures encounters and separations joys and sorrows hopes and dis-appointments Exposure to these contradictions generates emotions that can easily swing us out of our precarious balance bouncing us out of our com-fort zone pushing us towards the abyss There are times when we just seem to hit one obstacle after another until we reach a new zenith of experience where we feel quite lost despondent and at the mercy of fate We soon learn that life is an obstacle course for which there are no dry runs no training no qualifying trials and no diplomas of competency or expertise Nobody is ever a complete expert at living As soon as we think we have licked it des-tiny throws a new punch at us There are no magic short cuts or backdoors that lead to ongoing success or lifelong security The only way to keep on the right side of life is to remain prepared for new experiences and new learning We only ever improve by immersing ourselves and reflecting on our per-sonal mistakes If we fail to learn the lessons that life is teaching us they will be represented to us in many different guises until we learn them and can move forward

Often when people come to see a therapist they complain of feeling stuck confused or overwhelmed by the constant cycle of adversity they are experi-encing They want to understand how they can get out of these vicious cir-cles and make things work out for them They have read many books about it and have discovered that theories cannot save our souls Other peoplersquos clever ideas and interventions can never stand in for our own efforts We have to figure it out for ourselves Even so there is much to be learnt from the wisdom accumulated through the ages The vast vacuum of existential meaning that exists in contemporary culture has got to be filled by some-thing that helps a person to start looking in the right place that is inside ourselves and the way in which we relate to the world

But we have to be careful about where to turn for advice or new learning We can see all around us how fools rush in where angels fear to tread Celebrities and stars of stage and screen fall over themselves to become life gurus telling us what to do how to live and what to think They preach a rather simplistic positive philosophy that is based in wishful thinking They appeal to peoplersquos desire for quick solutions and easy gimmicks The secular credo conveyed by these glitterati appears be something along the lines of lsquowork hard look good act young and be cool stand up for yourself and be successful look at us for we know what it is like to achieve fame and for-tune and get the media attention we deserve therein alone lies the proof of our superior authorityrsquo They often throw in a message of altruism and humility to make it all sound moral cheerful and caring But these messages can be utterly confusing or annoying to people who are in the middle of a real‐life existential crisis They are not really fooled by these so‐called lsquorole modelsrsquo for they know that their messages are cheap and cheerful and that their superficial benefits were never intended or appropriate for those who

Introduction 3

are struggling with their emotional or physical survival When you are fight-ing for your life or are overwhelmed by moral or ontological challenges easy recipes for the good life are not very helpful Often enough the celebri-ties in question find this out for themselves when their stars are waning or destiny deals them a hard blow that floors them

Unfortunately a lot of people who have not yet been awakened to the realities of life get drawn on to the paths that are recommended and fre-quented by the glamorous icons of post‐modern fiction fashion and fantasy Their way of life seems so beguiling that it may take quite a while before a person is disenchanted and becomes aware of the serious limitations of their role modelrsquos advisory capacity Yet none who try to follow in their illustrious footsteps are in any doubt of what these human beings are actually after It is the external signs of success fame and fortune that they crave and favour and the apparent advantages that these can convey to a person Anyone with ears to listen and eyes to see can hear and perceive the unspoken and taboo message very clearly that the key to the good life is to achieve much (even if it is just notoriety) and make a lot of money so that you can be independ-ent of others and impose your views on them as you have freed yourself once and for all from the boring life you are condemned to if you are merely eking out your existence in an ordinary manner It is a thinly disguised striv-ing for ease comfort and happiness that is a materialistic and hedonistic pursuit of the illusion of omnipotence and immortality

This is a very poor philosophy of life and while it may briefly work for some who are careful not to be fooled by the advantages of celebrity the idea that becoming a champion is the key to living well is a toxic deception that does not begin to do justice to the way life works at all Too many young people receive such distorted images of reality and give up in despair when their personal experiences do not match their fantasy and their capacity fal-ters and fails before they reach the dizzy heights of happiness Even those who are lured into lucrative professions in order to stalk success and wealth often come to a sobering point where they realize the lifestyle is more upset-ting and unrewarding than they realized to begin with Many are tempted and attempt to obtain the best possible position on the social ladder Many have to fall down to the ground before they come to themselves The falling down often happens when people reach the ceiling of their willingness to compromise their own feelings of integrity and propriety To their great credit they baulk at the compromise of ethics that is required for them to do well Yet as they opt out of morally unsound practices they may be left baf-fled and upset wondering if they are too sensitive This is when they have an existential crisis and begin to think more carefully about life Often people have lost their objectivity about what it is that really matters to them They are out of touch with their values as they have been on a wild goose chase or have been digging in the mines for nothing but foolrsquos gold They wake up

4 Introduction

to find that what they hold in their hands is worthless and that they have weighed themselves down with the trappings of a fake and false existence Their existential reality has become distorted and their values are twisted But as human beings they still know somewhere deep inside them that they have played a game and have lost track of what they were after in the first place All people eventually want to wake up and live life for real More than anything we want to live our lives rather than just survive or exist There are no substitutes for truth and human existence is the same for all of us In the face of death we wish we had been more truthful more loving more real and more daring but most of all more ourselves and more alive

So in spite of todayrsquos nihilistic tendencies the task of learning how to live our lives well has never been more important more pressing If we have a choice between buying into a consumerist myth of the positive life as por-trayed by the idols of hedonism or the harsh but real explorations of life as it actually is and works few people opt for the former Most of us simply do not realize what we are choosing until it is too late and something goes badly wrong We do not notice that we have given away our freedom and have become alienated from ourselves What gets lost is the idea that it is actually possible to work out how to live well without great achievements or loads of money Too many good people give up on the very idea before they have even started thinking They may opt for scepticism which usually turns to cynicism soon after This is likely to lead them into a downward spiral of despondency destitution and dejection They become disgusted with the world and self‐loathing with their own impotence in improving it They may on the other hand fall for the quick fixes and wishful thinking using dope alcohol stimulants or increasingly over‐the‐counter or prescrip-tion happy pills or painkillers This path also leads to the desperate search for good advice from the merchants of hope and healing who dole out mira-cle cures It commits people to seeking their salvation in the reassuring min-istrations and soothing predictions of astrologers tarot readers mediums and other sellers of snake oil We all want to be healed of our sorrows and it is hard to just step aside from this whole sorry business of false promises and misleading prophecies

How hard it is to opt for the path of truthful investigation and cautious careful observation How long it takes to find and tread this path and stay on it rather than getting distracted by its many side roads It is all too easy to lose the will to follow it to the end Many get waylaid and search for some message of redemption or deliverance of all their pain and labour seeking support in the old fundamental religions that promise the prize of eternal life escape from evil or union with a source of infinite power It is either that or a return to the mistrustful sarcastic end of the spectrum

Of course there is still another way which is that of mental illness where we fall into the trap of castigating ourselves for our many failings and bad

Introduction 5

feelings pathologizing our disaffection and suffering Society will immedi-ately support the low view you have of yourself and label you insane before you have had a chance to defend yourself of that particularly damning nom-ination We can easily fall into this kind of victimization if we have not found our own foothold in reality before fate deals us a blow that makes us lose our balance When we feel lost and turn to psychiatrists psychologists or therapists to learn what is wrong with us we may soon find out what disorder has maimed us We may not realize at that stage that psychiatry and psychology themselves are confused and riddled with contradictions and imperfections We are inclined to believe the experts The practice of diagnosing and labelling can quickly take over from a conversation about the hardships we are suffering Before we know it we consent to a label that seems to explain our troubles as it is now our brains or nervous system that are being blamed for what is happening This takes the onus off us to take charge or take responsibility for what is wrong We are placed in a distinct category of pathology so that we can be treated for it and this may seem mildly reassuring for a while We donrsquot realize that this will also block our personal reflection on what is going on and how to correct it We are now ill and it is not our problem to find the cure What we donrsquot realize yet is that there is no medical cure for mental and emotional problems and that the human condition is terminal and has to be handled cautiously While the professionals will make repeated sincere attempts at helping they cannot solve the problem without your commitment to working it out for yourself What has gone wrong in your life is not your fault nor is it the fault of your parents or society Recovery is only possible for those who are willing to uncover the source of lifersquos problems We can only move forward from men-tal illness or emotional problems if we find our inner courage and confi-dence to tackle life in a new way We have to be prepared to live and learn

Diagnosis and prognosis are treacherous as they draw us into the pretence that something is physically the matter which we can tackle with medica-tion When we categorize medicate and persuade the person back into con-formity we fail to take the time to understand and unravel the existential drama that led to the moment of crisis in the first place People who are at rock bottom mostly do better when they use that opportunity to shoot deeper life roots into the ground of being than when they start slipping off the edge by giving up and letting other people take over for them But we should not apportion blame even then Mental health professionals work hard and are confronted with dire situations all the time Like most of us they are overworked and overwhelmed by the suffering they encounter They rarely have the time energy or patience to sit with their patients or clients to work it all out with them If they did they would almost certainly be considered to be wasting time or to be over‐identifying So most psycho-logical interventions do not seek deep understanding They are merely trying

6 Introduction

to stave off the worst outcome and aim to push the person back into role and conformity Professional theories of mental health are mostly prescrip-tive rather than exploratory They aim to provide some relief and help a person cope They do not intend to explore life philosophically or go to the heart of the matter of what it is that really happened

Psychotherapists who should know better are similarly at risk of failing to connect to their clients making interpretations and interventions in line with theories and ideas they have absorbed in their training rather than being really present with the person in their battle with reality Psychotherapists are not usually prepared for philosophical debate Socratic dialogue herme-neutic explorations truth finding and dialectical understanding They are well intentioned but may not have gone themselves into the no‐manrsquos land where values have to be reconsidered and re‐evaluated They are much more likely if well trained to have some knowledge about what works They will know that some of us are better at meeting the challenges of life than others sometimes by temperament and genetic constitution sometimes because of early childhood experience and social privilege or deprivation They will be good at finding out the traumas in the background and will be sensitive to the pain and the despair of the client and bear with it but they will rarely be incisive enough to actively challenge and debate the political and social issues underlying the problem They have been taught to draw clear bounda-ries and stay on the well‐trodden paths They have learnt to be careful and cagey Even cognitive therapists who do engage with beliefs and values have learnt to do so by rote in a manualized manner according to a particular method Few therapists would take the plunge and actively discuss the phi-losophy of life from a more passionately engaged perspective That is prob-ably a good thing because they have not been trained to be in philosophical dialogue and search for truth in a disciplined way It is hard to establish the best ways of living for a person Nobody knows or should impose their views on the other We have to find our own way through trial and error No two human lives are the same But many people are totally lost and need help to start the process of working it out

Much as we would like to think that people might consult a psychothera-pist or counsellor in order to get better at managing their problems in living the reality is that people come to therapy principally when they feel over-whelmed and beyond help They feel incapacitated and powerless They wait to wave until they are sinking and drowning They wait to learn to swim until they feel they are out of their depth and quite at sea But it is not easy to learn to float calmly on the water when your life is in danger and you already feel out of control under the assault of the waves It would be so much easier to teach people the art of living before things go wrong It might even stop them getting into quite such deep water when they are not ready prepared for the surf and spray Almost invariably people come to see a

Introduction 7

therapist because they feel they can no longer cope and are in desperate need of help not just to make sense of their predicament but in order to continue living at all This feeling of need may either be chronic or acute but it is always urgent by the time the person turns to therapy The client who enters the consulting room often appears to be in the dark their problems are stark and startling They come with the expectation that the therapist will show them how to shed new light on their plight instantly and in a definitively healing manner They are lost and need to find themselves They have to understand where they are before they can begin to move in a new more sure‐footed way and into a more desirable direction They feel as if they are in a hole terrified and alone and in need of the courage and other mental and emotional resources enabling them to climb out of their desolation and despair They are confused and afraid and often feel they are ill or unwell They say they want to be lsquocuredrsquo or lsquohealedrsquo They need to start by describing the situation they are in and trace its origins if they are to make sense of things again They often donrsquot feel they can take the time to do this and are surprised when they are shown the importance of finding a safe and calm space in which to stop and think and listen to their own story before they even start to tackle the most urgent problems Coming to therapy is in itself therapeutic because it opens up the very possibility of finding peace being heard and taking stock But of course that is only the first step and the pro-cess of making sense of what has actually gone wrong is a bit more compli-cated Learning how to live without going under can take a bit longer No wonder that many therapies available to the general public never go as far as that They limit themselves to providing a kind of mental first aid putting plasters and bandages in place and telling people how to think and behave It is no great wonder then that people clamour for medication to make it all stop and go away

Breaking Away From Pathology

But there is another way A lot depends on how the therapist collects the story of a personrsquos difficulties distress and trauma There is a tendency in the field of psychotherapy and counselling to consider such moments of trouble and need for assistance as evidence of personal psychopathology As we have seen it is easy to fall into this way of thinking and talking and to adopt a medical vocabulary Even those therapists who have rejected the medical model for a more psychological model may still fall into the trap of considering their clientsrsquo issues as evidence of disorders The psychological categories of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) and of the International Classification of Disease of the World Health Organization (ICD) treat human emotional

8 Introduction

difficulties exactly as if they were diseases rather than problems in living They overlook to a very large extent how frequently such problems are situ-ational set against a social cultural historical and political background They do not take sufficient account of the interpersonal and systemic aspects of these problems They certainly do not consider how such problems arise from ontological human issues from existential and moral value‐based problems or from momentary situational confusions or contradictions It is difficult to stop assuming that when a person is distressed anxious or depressed this must be the consequence of some intrinsic personal psycho-logical or character problem Norms are set for instance for the amount of depression a person should or is likely to experience after a significant bereavement and if people go beyond this normal response and linger too long in their grief they are considered to be in need of treatment It may be clear that they are in need of something but we cannot just assume that we know what this something should be as it will vary from person to person For some people it may mean that they need more time or more space by themselves to adjust to new circumstances or come to terms with a shock In some cases it may mean they need help but they should be at liberty to determine what kind of help this should be rather than have it imposed upon them

None of this has been made easier by recent neuro‐scientific progress We have become too used to assuming that emotional problems are ailments caused by a defective brain or mind and that society is entitled or required to intervene accordingly Now that we can see on fMRI scans which parts of the brain light up (because of increased blood‐flow in the area) when a per-son thinks or experiences something and we are much clearer about the hormonal and chemical pathways of neuronal and network response we have come to give the physical substratum of human experience rather more than its fair share of attention The temptation is to control or suppress mental processes rather than understand them or allow them to evolve and expand This is very much in contradiction with the human capacity for exploration natural reparation and search for insight We forget that our brains and minds adapt and change to the way we live and experience things We are putting the cart before the horse as if we have come to believe that doctoring the motor of the car will make drivers automatically better at finding their destination on the road Of course we should not disdain the importance of well‐functioning mechanisms A well‐running vehicle (or good legs) are a necessity when you want to get somewhere A well function-ing brain is similarly necessary to function as a human being but most of our brains are in good working order before we start meddling with them Of course there are exceptions We need neuro‐psychiatrists and neuro‐psychologists to deal with the hardware problems that occur when people are born with brain abnormalities or when their minds become obscured by

Introduction 9

physical problems caused by such illnesses as dementia or strokes It is also helpful to intervene in the brain box if someone has symptoms like epilepsy or aphasia caused by a brain tumour affecting their efficient functioning or threatening survival But there is no reason to elide such physical problems where neurological intervention is indispensable with the emotional per-sonal relational and moral problems that most of us are entangled in when we become depressed or feel anxious These are of an entirely different order These problems do not arise because of a malfunctioning brain They are existential problems related to the way we live feel and think To get better at understanding and solving these problems we need experts in phi-losophy psychology and therapy Most importantly we need to be willing to learn about living

Psychotherapy has been shown to be a very effective method in healing problems that medication only temporarily mends (Wampold 2014) Therapy works best when there is an engaged therapeutic relationship that creates a safe space for people to unburden themselves of tensions confu-sions and pressures It works best when there is sufficient time and attention to rethink the situation with calm and care It works best when the human interaction is active uses feedback and mutuality and is honest and direct Quite often the medications that people were prescribed before they found a psychotherapist to help them have not just not solved the problem but have created new problems as well When chemicals are used to temporarily interrupt the brainrsquos normal functioning people may feel less perturbed but they also become unable to think clearly for themselves While this paralysis of our thinking may come as a relief when the thinking was excessive and unproductive eventually we have to get back to working it all out We can-not procrastinate in that process endlessly We have at some point to take charge and start thinking through the issues When the temporary dysfunc-tion of our mind is not caused by a defective brain but by a moment of stress distress or trauma messing with the brain functions may very well make things worse rather than better Addressing the problem as a personal-ity or character problem does not help either It merely confuses the issue Yet this is what we are inclined to do in contemporary culture We deal with the person affected as if there is an intrinsic rather than extrinsic fault in their personal make up We try to set this straight either physically by pre-scribing medication or psychologically by trying to correct wrong thinking through cognitive‐behavioural input in an attempt to redress the balance We direct the person to behave and think in specific set ways and this may sometimes be helpful to get them back on the straight and narrow But if there is a bigger issue at stake that needs creative thinking and learning these ways of dealing with the problem are not sufficient and possibly coun-terproductive Not all emotional problems are caused by erroneous think-ing Most of our difficulties in living stem from experiences that outstrip our

10 Introduction

current understanding because they are too complex and have not previ-ously been encountered If we live normal lives such experiences will almost certainly happen at some point This is why most people are likely to hit rock bottom sooner or later Far from this being abnormal it is almost inevi-table Far from it being a catastrophe or a medical emergency it is a fact of life that most of us can and will have to work with We take some time out we take the trouble to think and talk about it until we understand the prob-lem address it learn from it and move forward strengthened by our new intelligence

But in order for us to find the right space and time to reflect we may need to see a therapist Life is too full of action pressure and duty to easily fit in such thinking by ourselves Other people are too preoccupied to make room for this kind of searching and pondering It helps to do it with someone who understands the troubles of life and who can enhance our reflection about the life issues that have upset us Nobody is immune from the kind of diffi-culties and losses that our lives expose us to None of us is exempt from overload or confusion We cannot be prepared for all eventualities Life is challenging and new situations arise that may affect us beyond what we are temporarily able to cope with Why conclude that if people do not cope there is something wrong with them rather than with the complexity or contradictions in the situation Why assume that what is wrong can be set right by some kind of curative intervention We would not think that some-one who had nearly drowned had some illness called rsquodrowningrsquo We would suspect that they had instead never learnt to swim or had fallen into extremely deep and troubled waters Yet when someone tells us that they are drowning in sadness we call that an illness which we call depression Or if they start drowning their fears or worries in alcohol or drugs we assume that they have an illness called addiction It should be self‐evident that they have instead fallen into the deep seas of life where the currents are so strong that they suffer a profound sense of confusion and loss while they are flail-ing about desolate in their own incapacity to come back to the surface It should be obvious that quite a lot of people who are distressed in this man-ner are so upset that they long for oblivion and because of this reach out to extreme measures They may self‐harm or behave in a risky manner in order to administer some relief for themselves and find some reminder of life being worth living The search for peace in the eternal and transcendence is almost always present in such symptoms of the unease of living

In spite of all their training therapists soon discover that they cannot cure anyone of such symptoms forever We know that we cannot cure anyone of the risks that life brings and the troubles that we will all experience We can-not cure anyone of life other than by death Life as someone once put it is a terminal illness which can only be remedied by dying Life is rarely easy even for those who have all the luck and comforts There is nothing surprising

Introduction 11

in finding that people get very much lost occasionally and need some assis-tance in retrieving their sense of direction There are certain life events such as immigration bereavement of a loved one loss of a job and many other sorts of losses which can throw even the most balanced person out of their balance and kilter There are certain accumulations of stress that can carry distresses beyond what one previously thought endurable We cannot avoid the realities of human existence neither can we always bear them when they visit Life is hard and people are not always equal to its challenges Thatrsquos how it has always been and always will be But life is also rewarding for those who are willing to put their shoulder to the plough and carry on regardless Those who do so discover that they can develop new strengths and find new enjoyments but it is quite important that they know how It is also important that they rediscover the release of letting go

Facing Human Dilemmas

One of the paradoxes of living is that we can only get better at it by immers-ing ourselves and are thus likely to go under occasionally We do not learn to live in theory and then apply it to the practice of living Learning to live well is really very much like learning to swim well It is risky and sooner or later we have to jump in at the deep end and discover that we are buoyant if we donrsquot thrash about in panic The more we practice the better we get at it though a bit of instruction at the right times can stop us giving up and pro-vide us with useful tips But we cannot learn to be champion swimmers on dry land If we never plunge into the water and remain safely standing by the side with our feet on the ground wrongly assuming that swimming is too dangerous we grow stiff and afraid and darenrsquot jump in Avoidance creates fear and practice makes perfect Yet at times practice can be tricky especially if we get into waves that grow bigger than expected and we find ourselves smashed back onto the shore smacked unconscious by the force of the ocean Some people who have watched others suffering that fate are not prepared to immerse themselves in life and they hold back apprehensively avoiding the unavoidable They attempt to evade the human condition hiding away from challenges finding themselves increasingly incapable of coping because they have opted for pseudo safety and become cut off and incompetent When we are out of practice we are easily overwhelmed when things go wrong Life demands that we continue learning all the time If we let our-selves become idle we become rusty and soon grind to a halt altogether

Cutting off from life is not a solution in dealing with its misfortunes Yet immersing ourselves in the full flow of life inevitably brings the possibility of suffering as well as that of enjoyment Counsellors and psychotherapists need to be prepared to work with this paradox Therapy from an existential

12 Introduction

perspective is about helping people to find back the courage to face their predicaments and struggles in the best way possible It is about helping peo-ple to find their inner resources and light that small spark in their heart that will eventually bring back some passion into their lives

Paradox and passion are the bedrock and fuel of the work of therapy and it is by opening ourselves to their full impact that new purpose can be gener-ated and sustained If the objective is to help a person get better at living we have to be prepared to help them look at the way they live now in a radically fresh and revolutionary way We cannot content ourselves with old‐fashioned or dogmatic interpretations We have to set aside our personal and pro-fessional prejudice We have to be prepared as it were to look life in the eye We do this by talking with people about their deepest fears their most painful sorrows their gravest worries and most awful horrors When we do so we do not blame or shame them We do not attach labels We do not interpret their trials and tribulations in a language that is alien to them We do not prescribe a new course of thought or action and we do not impose solutions We invite people to rediscover their own mind their personal world their own capacity for making sense and interpreting reality We help them talk through the issues and enable them to face the unwanted realities underneath the experience Then by going to the root of the problem we find a way to tackle it understand it and get the better of it Of course we bring much existential expertise to this tricky process But we never impose our knowledge We keep it at our clientsrsquo disposal if they want it We hold back We have faith that each person is capable of doing their own research of drawing their own conclusions and finding their own ways of coming to terms with the ebb and flow of existence

This isnrsquot an easy thing to do but then the predicaments that our clients bring to us are not easy to live with or to overcome either Psychotherapy is never about taking the easy way out The paradox that should guide our work is that the more we engage with our difficulties and the more intensely we live the stronger we get and the more satisfying life is If we shirk and avoid facing reality we become weak and soft and we live a life that is dull and full of denial

Nietzsche gave us an interesting challenge when he said

My suffering and my pity ndash what of themFor do I aspire after happinessI aspire after my work

(Nietzsche 1883)

The work that this book speaks of is that of letting human paradox and human passion matter again and activate our living It is the work of unveiling the truth of reality and keeping at it regardless of our pain and