Feature

Many areas of psychology are great at answering such questions as how stress influences mood or why depression can lead to substance abuse. But what if you want answers broader than a diagnosis or a neurochemical explanation for why your brain does what it does? What if you want to know how to lead a fuller, richer life, not just change a problematic behavior?

You might consider existential-humanistic psychology, which seeks to give clients a greater awareness of how their constellation of pleasures, worries, thrills and anxieties all come together to form their experience of living.

What can existential-humanistic psychology offer?

"It asks about the meaning of life," says Louise Sundararajan, PhD, president of Div. 32 (Humanistic). "That term sounds kind of trite, but it's not."

Existential-humanistic psychology doesn't promise the answer to that question, she says, but it can help clients and other psychologists frame their questions about the larger issues at work behind depression, anxiety and other causes of mental angst and dissatisfaction with life. Many people want a more holistic experience that does more than address their symptoms, she says. They want a therapy that helps them know more about their lives and feelings.

To that end, humanistic psychologies draw from a range of philosophical approaches such as existentialism, feminism, postmodernism and constructivism, all designed to orient the study of the mind and behavior toward understanding what it means to a be a human being. Existential-humanistic psychology emphasizes the importance of human choices and decisions and feelings of awe toward life.

Put in a therapeutic context, existential-humanistic approaches to therapy emphasize the same factors that research suggests make any therapy successful, such as therapeutic alliance, empathy, the provision of meaning, the provision of hope and affective attunement, says Kirk Schneider, PhD, a psychologist and faculty member at Saybrook University and the Existential-Humanistic Institute in San Francisco, who advocates for the field. Schneider and his colleague Orah Krug, PhD, also at Saybrook, last year co-edited APA's first book about the field, "Existential-Humanistic Therapy." This fall, Schneider says, a partnership between Saybrook and EHI will launch the first nationally recognized certificate program in existential-humanistic practice.

What sets apart existential-humanistic psychology, Schneider says, is that all aspects of therapy are seen through the lens of a concept called presence. He describes presence as entering into a heightened awareness of yourself, opening yourself up to learning what truly matters to you and experiencing in the here-and-now the barriers to and opportunities for change that therapy offers.

"We try to work with everyone in as present a manner as possible — presence is essential to an existential approach," he says, for both clients and their therapists. "Presence helps us to understand and attune to the fuller ranges of a person's experience. … You learn to co-exist with your anxieties."

Meeting needs

Existential-humanistic psychology's roots go back several decades, to Rollo May, PhD, who helped found Saybrook University in San Francisco in 1971, and to the work of Abraham Maslow, PhD, who developed a hierarchy of human needs. Maslow, May and like-minded colleagues emphasized understanding the existential causes of mental distress rather than just focusing on symptoms.

Other modes of psychology aren't always as equipped to deal with such heady issues, believes Steven Hayes, PhD, a clinical psychologist at the University of Nevada, Reno, who focuses on mindfulness. Hayes hasn't traditionally been linked to existential-humanistic psychology — in fact, he's more often been identified as having behaviorist leanings. But in 2008, he contributed a chapter to a book edited by Schneider, "Existential-Integrative Psychotherapy," encouraging researchers and practitioners to home in on the more existential, client-focused elements of therapy, such as presence and therapeutic alliance. Many fields of psychology, he says, have specialized so much that while they're great at helping clients work through specific issues, an existential framework might work better to help clients see the big picture in their lives, if that's what they're looking for.

The fact that cognitive-behavioral treatments are beginning to incorporate aspects of meditation and mindfulness hints that psychology as a field is starting to buy into the existential-humanistic framework, says Bruce Wampold, PhD, a counseling psychologist at the University of Wisconsin–Madison and an expert on various modes of psychotherapy.

"It could be," he elaborates in a 2008 PsycCritiques article, "that an understanding of the principles of existential therapy is needed by all therapists, as it adds a perspective that might ... form the basis for all effective treatments." In fact, many of existential-humanistic psychology's insights might already be at work among mental health workers, according to a paper published in January in the Journal of Humanistic Psychology (Vol. 51, No. 1). In it, Elliot Benjamin, PhD, a mathematician and doctoral student studying humanistic psychology at Saybrook University, notes that the core ingredients of a humanistic approach — empathy, authenticity and dedication to creating a bond with a client — are frequently practiced by mental health professionals, whether they identify those as existential-humanistic practices or not.

The strength of a specifically existential approach, says Hayes, is that therapists can go beyond helping clients address their stated concerns and get at the roots of a client's cognitive distress. "It's one thing to label something as existential angst and it's another to know how to identify it in someone's life and … to understand where they came from in the first place, to learn why the modern world would give rise to anxiety," he says.

Barry Wolfe, PhD, a clinical psychologist in Rockville, Md., integrates existential and humanistic practices with other forms of therapy such as cognitive-behavioral therapy and psychodynamic therapy. In a typical session, he says, he'll first work to build a therapeutic alliance with his client, because that's the foundational step for any effective therapy. Next, he'll use cognitive-behavioral therapy to give people the tools to get past their fears and anxieties. But then he gives his clients a choice: whether to delve deeper into their anxieties and figure out what's ultimately behind them, or to stop there and leave them with their cognitive-behavioral tools.

Many people are just fine stopping at that point, he says. The existential-humanistic framework isn't universally applicable. Action-oriented people who want to know what to do to get over their insecurities and then move on with their lives don't care much about the root causes of those insecurities.

"But some people, not many but some, really do live inside their feelings," he says. "If they want to explore the roots of their anxieties, I'll shift focus. You have to work with the framework that the client brings."

Wolfe gives an example of a young, recently married woman who came to him seeking help for her driving phobia. As therapy progressed, he says, they discovered what was behind that phobia.

It turned out that her marriage was built on convenience and she regretted the fact that she'd never evolved into an independent person before she settled down.

"Her fear was that if she drove too far, she'd never come back home, she'd never come back to her marriage," Wolfe says.

So she felt trapped between her desire for independence and the time and energy she'd invested in her relationship. In other words, an existential crisis. They could have stopped therapy after providing her with the tools to get past her phobia, but she ultimately learned much more about herself, her emotions and needs by going deeper, he says.

Criticism and proof

Existential-humanistic psychologists consider their looseness and openness a strength, but their approach has also isolated the field somewhat from other forms of psychology that rely more on empirical evidence and quantifiable results.

Schneider says that, in the case of existential-humanistic psychology, a qualitative approach instead is often the most useful. "Existential psychology teases out deep, subjective shifts," he says, which are difficult to capture using quantitative methods.

But that doesn't mean that these issues can't be investigated and discussed from a more empirical point of view, Sundararajan says. Because it hasn't yet been done doesn't mean that it shouldn't be. "It's entirely possible to do both quantitative and qualitative [research]," she says. "And I think that you should do both."

Some researchers are, in fact, trying to quantify whether existential-humanistic approaches to therapy work, Hayes says. For example, an article published in December in Archives of General Psychiatry (Vol. 67, No. 12) found that mindfulness-based cognitive-behavioral therapy was as successful as antidepressants in preventing relapse in symptoms of major depressive disorder. But large-scale empirical testing of existential methods and the existential framework remains to be done.

That shouldn't stop clients and other psychologists from turning to the existential-humanistic framework to expand the range of their therapies and emphasize the importance of the big picture, though, Schneider says. That's a worthwhile and doable goal for anyone looking for more meaning in his or her life.

"If it's ignored, the whole question of what is meaningful in a person's life — and not just what is meaningful from an intellectual standpoint or from a culturally conditioned standpoint, but from that person's deep subjective point of view — could be overlooked," he says.