Existential Therapies: A Review Of Their Scientific Foundations and Efficacy
54 Therefore, in 2010, we asked a network of leading existential psychotherapists, primarily based in the UK, to discuss their implicit understandings and definitions of existential therapy. Although consensus was not achieved, several assumptions were frequently reported which can be developed into an existential model of clinical distress. This is presented alongside non- systematic scientific evidence (Cooper, Vos, & Craig, 2011). First, an existential approach assumes that there are ‘givens of existence’ which define the phenomenological reality of clients, such as our human capacity for freedom and choice, being embedded in relationships with others and our world, and inevitably facing limitations and challenges in life. These assumptions are mainly based on philosophical and personal reflections, underpinned by clinical experience, qualitative research and narrative description of case studies (e.g.Frankl, 1998; Spinelli, 2005a; Yalom, 1980). Second, an existential approach assumes that clients immediately understand these ‘givens of existence’, as they have a primary subjective phenomenological flow of experiencing their daily life world. Only secondarily, they may give meaning/interpretation to these experiences and thus ‘cover’ the primary experiences of these givens (e.g.Spinelli, 2005a; Wrathall, 2011). Many qualitative/phenomenological methods have been developed to describe this stream of consciousness, and to distinguish it from the secondary interpretations (e.g.Smith, 2008/2011; Smith et al., 2009/2013). Some neuropsychological studies also suggest that consciousness starts with a primary ‘feeling of what happens’, even before we are aware of it and interpret it (Damasio, 1999). The primary experience of life’s givens has often been described in terms of existential moods, such as death anxiety, existential guilt, isolation, urgency, nausea, absurdity, boredom, and vacuum. As the following empirical studies seem to confirm, existential moods differ from emotions and psychopathology, as they do not have a specific object or meaning, but regard a primary unstructured experience of existence-as-such. For instance, Ryff summarised key existential clinical concepts which she operationalised with a quantitative questionnaire (Ryff, 1989, 1999). Other questionnaires measure for instance meaning, goals, purpose and benefit-finding (Brandstätter, Baumann, Borasio, & Fegg, 2012), existential anxiety (Van Bruggen, Vos, Westerhof, Bohlmeijer, & Glas, Submitted), post-traumatic growth (Tedeschi, Park, & Calhoun, 1998) and authenticity (e.g.Wood, Linley, Maltby, Baliousis, & Joseph, 2008). Although these instruments show good validity and reliability in many studies, these seem of limited use for screening and outcome measurement in clinical settings as norm groups are unavailable and it is questionable whether any relevant cut-off score can be made sensibly (e.g. when does someone not have sufficient meaning in life?).
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