3.5 The Humanistic-Existential Model

Philip Berman is more than the sum of his psychological conflicts, learned behaviors, or cognitions. Being human, he also has the ability to pursue philosophical goals such as self-awareness, strong values, a sense of meaning in life, and freedom of choice. According to humanistic and existential theorists, Philip’s problems can be understood only in the light of such complex goals. Humanistic and existential theorists are often grouped together—in an approach known as the humanistic-existential model—because of their common focus on these broader dimensions of human existence. At the same time, there are important differences between them.

Actualizing the self Humanists suggest that self-actualized people show concern for the welfare of humanity. This 89-year-old social services volunteer (right), one of 65 million Americans who perform volunteer work each year (CNCS, 2013), has participated for the past 20 years as a companion to elderly persons with intellectual disability and developmental disabilities. The self-actualized are also thought to be highly creative, spontaneous, independent, and humorous.

Humanists, the more optimistic of the two groups, believe that human beings are born with a natural tendency to be friendly, cooperative, and constructive. People, these theorists propose, are driven to self-actualize—that is, to fulfill this potential for goodness and growth. They can do so, however, only if they honestly recognize and accept their weaknesses as well as their strengths and establish satisfying personal values to live by. Humanists further suggest that self-actualization leads naturally to a concern for the welfare of others and to behavior that is loving, courageous, spontaneous, and independent (Maslow, 1970).

self-actualization The humanistic process by which people fulfill their potential for goodness and growth.

Existentialists agree that human beings must have an accurate awareness of themselves and live meaningful—they say “authentic”—lives in order to be psychologically well adjusted. These theorists do not believe, however, that people are naturally inclined to live positively. They believe that from birth we have total freedom, either to face up to our existence and give meaning to our lives or to shrink from that responsibility. Those who choose to “hide” from responsibility and choice will view themselves as helpless and may live empty, inauthentic, and dysfunctional lives as a result.

The humanistic and existential views of abnormality both date back to the 1940s. At that time Carl Rogers (1902-1987), often considered the pioneer of the humanistic perspective, developed client-centered therapy, a warm and supportive approach that contrasted sharply with the psychodynamic techniques of the day. He also proposed a theory of personality that paid little attention to irrational instincts and conflicts.

client-centered therapy The humanistic therapy developed by Carl Rogers in which clinicians try to help clients by conveying acceptance, accurate empathy, and genuineness.

The existential view of personality and abnormality appeared during this same period. Many of its principles came from the ideas of nineteenth-century European existential philosophers who held that human beings are constantly defining and so giving meaning to their existence through their actions (Yalom, 2014).

The humanistic and existential theories, and their uplifting implications, were extremely popular during the 1960s and 1970s, years of considerable soul-searching and social upheaval in Western society. They have since lost some of their popularity, but they continue to influence the ideas and work of many clinicians. In particular, humanistic principles are apparent throughout positive psychology (the study and enhancement of positive feelings, traits, abilities, and selfless virtues), an area of psychology that, as you read in Chapter 1, has gained much momentum in recent years (see page 20).

Rogers’ Humanistic Theory and Therapy

According to Carl Rogers, the road to dysfunction begins in infancy (Raskin, Rogers, & Witty, 2014; Rogers, 1987, 1951). We all have a basic need to receive positive regard from the important people in our lives (primarily our parents). Those who receive unconditional (nonjudgmental) positive regard early in life are likely to develop unconditional self-regard. That is, they come to recognize their worth as persons, even while recognizing that they are not perfect. Such people are in a good position to actualize their positive potential.

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Unconditional positive regard Carl Rogers argued that clients must receive unconditional positive regard in order to feel better about themselves and to overcome their problems. In this spirit, a number of organizations now arrange for individuals to have close relationships with gentle and nonjudgmental animals. Here a Bosnian child hugs her horse during rehabilitation therapy at the Therapeutic and Leisure Center in Kakrinje, near Sarajevo.

Unfortunately, some children repeatedly are made to feel that they are not worthy of positive regard. As a result, they acquire conditions of worth, standards that tell them they are lovable and acceptable only when they conform to certain guidelines. To maintain positive self-regard, these people have to look at themselves very selectively, denying or distorting thoughts and actions that do not measure up to their conditions of worth. They thus acquire a distorted view of themselves and their experiences. They do not know what they are truly feeling, what they genuinely need, or what values and goals would be meaningful for them. Problems in functioning are then inevitable.

Rogers might view Philip Berman as a man who has gone astray. Rather than striving to fulfill his positive human potential, he drifts from job to job and relationship to relationship. In every interaction he is defending himself, trying to interpret events in ways he can live with, usually blaming his problems on other people. Nevertheless, his basic negative self-image continually reveals itself. Rogers would probably link this problem to the critical ways Philip was treated by his mother throughout his childhood.

Clinicians who practice Rogers’ client-centered therapy try to create a supportive climate in which clients feel able to look at themselves honestly and acceptingly (Raskin et al., 2014). The therapist must display three important qualities throughout the therapy—unconditional positive regard (full and warm acceptance for the client), accurate empathy (skillful listening and restating), and genuineness (sincere communication). In the following classic case, the therapist uses all these qualities to move the client toward greater self-awareness:

Client:

Yes, I know I shouldn’t worry about it, but I do. Lots of things—money, people, clothes. In classes I feel that everyone’s just waiting for a chance to jump on me…. When I meet somebody I wonder what he’s actually thinking of me. Then later on I wonder how I match up to what he’s come to think of me.

Therapist:

You feel that you’re pretty responsive to the opinions of other people.

Client:

Yes, but it’s things that shouldn’t worry me.

Therapist:

You feel that it’s the sort of thing that shouldn’t be upsetting, but they do get you pretty much worried anyway.

Client:

Just some of them. Most of those things do worry me because they’re true. The ones I told you, that is. But there are lots of little things that aren’t true…. Things just seem to be piling up, piling up inside of me…. It’s a feeling that things were crowding up and they were going to burst.

Therapist:

You feel that it’s a sort of oppression with some frustration and that things are just unmanageable.

Client:

In a way, but some things just seem illogical. I’m afraid I’m not very clear here but that’s the way it comes.

Therapist:

That’s all right. You say just what you think.

(Snyder, 1947, pp. 2–24)

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In such an atmosphere, clients are expected to feel accepted by their therapists. They then may be able to look at themselves with honesty and acceptance. They begin to value their own emotions, thoughts, and behaviors, and so they are freed from the insecurities and doubts that prevent self-actualization.

Client-centered therapy has not fared very well in research (Prochaska & Norcross, 2013). Although some studies show that participants who receive this therapy improve more than control participants, many other studies have failed to find any such advantage. All the same, Rogers’ therapy has had a positive influence on clinical practice (Raskin et al., 2014). It was one of the first major alternatives to psychodynamic therapy, and it helped open up the clinical field to new approaches. Rogers also helped pave the way for psychologists to practice psychotherapy, which had previously been considered the exclusive territory of psychiatrists. And his commitment to clinical research helped promote the systematic study of treatment. Approximately 2 percent of today’s clinical psychologists, 1 percent of social workers, and 3 percent of counseling psychologists report that they employ the client-centered approach (Prochaska & Norcross, 2013).

Gestalt Theory and Therapy

Beating the blues Gestalt therapists often guide clients to express their needs and feelings in their full intensity by banging on pillows, crying out, kicking, or pounding things. Building on these techniques, a new approach, drum therapy, teaches clients, such as this woman, how to beat drums in order to help release traumatic memories, change beliefs, and feel more liberated.

Gestalt therapy, another humanistic approach, was developed in the 1950s by a charismatic clinician named Frederick (Fritz) Perls (1893–1970). Gestalt therapists, like client-centered therapists, guide their clients toward self-recognition and self-acceptance (Yontef & Jacobs, 2014). But unlike client-centered therapists, they often try to achieve this goal by challenging and even frustrating their clients. Some of Perls’ favorite techniques were skillful frustration, role playing, and employing numerous rules and exercises.

gestalt therapy The humanistic therapy developed by Fritz Perls in which clinicians actively move clients toward self-recognition and self-acceptance by using techniques such as role playing and self-discovery exercises.

In the technique of skillful frustration, gestalt therapists refuse to meet their clients’ expectations or demands. This use of frustration is meant to help people see how often they try to manipulate others into meeting their needs. In the technique of role playing, the therapists instruct clients to act out various roles. A person may be told to be another person, an object, an alternative self, or even a part of the body. Role playing can become intense, as individuals are encouraged to express emotions fully. Many cry out, scream, kick, or pound. Through this experience they may come to “own” (accept) feelings that previously made them uncomfortable.

Perls also developed a list of rules to ensure that clients will look at themselves more closely. In some versions of gestalt therapy, for example, clients may be required to use “I” language rather than “it” language. They must say, “I am frightened” rather than “The situation is frightening.” Yet another common rule requires clients to stay in the here and now. They have needs now, are hiding their needs now, and must observe them now.

Approximately 1 percent of clinical psychologists and other kinds of clinicians describe themselves as gestalt therapists (Prochaska & Norcross, 2013). Because they believe that subjective experiences and self-awareness cannot be measured objectively, proponents of gestalt therapy have not often performed controlled research on this approach (Yontef & Jacobs, 2014; Leung, Leung, & Ng, 2013).

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Spiritual Views and Interventions

BETWEEN THE LINES

Charitable Acts

$308 billion

Amount contributed to charities each year in the United States

83%

Percentage of Americans who have made charitable contributions in the last year

33%

Percentage of charitable donations contributed to religious organizations

67%

Percentage of donations directed to education, human services, health, and the arts

(Information from: Gallup, 2013; American Association of Fundraising Counsel, 2010)

For most of the twentieth century, clinical scientists viewed religion as a negative—or at best neutral—factor in mental health (Bonelli & Koenig, 2013; Van Praag, 2011). In the early 1900s, for example, Freud argued that religious beliefs were defense mechanisms, “born from man’s need to make his helplessness tolerable” (1961, p. 23). This negative view of religion now seems to be ending, however. During the past decade, many articles and books linking spiritual issues to clinical treatment have been published, and the ethical codes of psychologists, psychiatrists, and counselors have each concluded that religion is a type of diversity that mental health professionals must respect (Peteet, Lu, & Narrow, 2011).

Researchers have learned that spirituality does, in fact, often correlate with psychological health. In particular, studies have examined the mental health of people who are devout and who view God as warm, caring, helpful, and dependable. Repeatedly, these individuals are found to be less lonely, pessimistic, depressed, or anxious than people without any religious beliefs or those who view God as cold and unresponsive (Bonelli & Koenig, 2013; Day, 2010; Loewenthal, 2007). Such people also seem to cope better with major life stressors—from illness to war—and to attempt suicide less often. In addition, they are less likely to abuse drugs.

What various explanations might account for the correlation between spirituality and mental health?

Do such correlations indicate that spirituality helps produce greater mental health? Not necessarily. As you’ll recall from Chapter 2, correlations do not indicate causation. It may be, for example, that a sense of optimism leads to more spirituality, and that, independently, optimism contributes to greater mental health. Regardless of how the correlation between spirituality and mental health should be interpreted, many therapists now make a point of including spiritual issues when they treat religious clients (Brown, Elkonin, & Naiker, 2013; Worthington, 2011), and some further encourage clients to use their spiritual resources to help them cope with current stressors (Galanter, 2010). Similarly, a number of religious institutions offer counseling services to their members (see MediaSpeak below).

Existential Theories and Therapy

Like humanists, existentialists believe that psychological dysfunctioning is caused by self-deception; existentialists, however, are talking about a kind of self-deception in which people hide from life’s responsibilities and fail to recognize that it is up to them to give meaning to their lives. According to existentialists, many people become overwhelmed by the pressures of present-day society and so look to others for explanations, guidance, and authority. They overlook their personal freedom of choice and avoid responsibility for their lives and decisions (Yalom, 2014). Such people are left with empty, inauthentic lives. Their dominant emotions are anxiety, frustration, boredom, alienation, and depression.

Existentialists might view Philip Berman as a man who feels overwhelmed by the forces of society. He sees his parents as “rich, powerful, and selfish,” and he perceives teachers, acquaintances, and employers as oppressing. He fails to appreciate his choices in life and his capacity for finding meaning and direction. Quitting becomes a habit with him—he leaves job after job, ends every romantic relationship, and flees difficult situations.

In existential therapy, people are encouraged to accept responsibility for their lives and for their problems. Therapists try to help clients recognize their freedom so that they may choose a different course and live with greater meaning (Yalom, 2014; van Deurzen, 2012; Schneider & Krug, 2010). The precise techniques used in existential therapy vary from clinician to clinician. At the same time, most existential therapists place great emphasis on the relationship between therapist and client and try to create an atmosphere of honesty, hard work, and shared learning and growth.

existential therapy A therapy that encourages clients to accept responsibility for their lives and to live with greater meaning and value.

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MediaSpeak

Saving Minds Along With Souls

By T. M. Luhrmann, The New York Times, April 18, 2014

A few weeks ago, one year after his son took his life while struggling with depression, [Rick] Warren, the founding pastor of Saddleback Church, one of the nation’s largest evangelical churches, teamed up with his local Roman Catholic Diocese and the National Alliance on Mental Illness for an event that announced a new initiative to involve the church in the care of serious mental illness.

Their goal is not only to reduce stigma for people with schizophrenia, bipolar disorder, depression and the like, though that is an important part of it. “We are all broken,” Mr. Warren said in his remarks. … “We’re all a little bit mentally ill.”

The larger goal is to get the church directly involved with the care of people with serious psychiatric illness by training administrators and pastors to handle psychiatric crises, to set up groups within the church for people with serious mental illness and to establish services within the church for people who need them. These churches are not trying to supplant traditional mental health care. “When someone asks, Should I take medication or pray?” one speaker remarked, “I say, ‘yes.’” But they think that there aren’t enough services available for people who are really sick, and they think that many people don’t turn to them anyway because of the stigma. And so they think that there are a lot of people who aren’t getting the help they need.

They are right. The public mental health system is a woefully underfunded crazy-quilt of uncoordinated agencies. … It can be hideously difficult to navigate even for someone who is not hearing hallucinated voices. … [And] many psychiatric clients hate the idea of being forcibly medicated.

Spirituality and science A few years ago, Tibetan spiritual leader the Dalai Lama (right) met with professor of psychiatry Zindel Segal (left) and other mental health researchers at a conference examining possible ties between science, mental health, and spirituality.

But they do often go to church. More than 40 percent of Americans say that they attend church nearly every week. Even people who have nowhere to live often go to church.

In an urban Chicago neighborhood where I did many months of research with homeless psychotic women, I found that these women often refused psychiatric care. … But fully half of them said that they had a church and that they went to that church at least twice each month, and over 80 percent of them said that God was their best friend—some, that he was their only friend.

Mr. Warren’s initiative is remarkable for several reasons. Evangelical churches don’t go in much for hospital-type care. … In a [religious] world that takes demons seriously, it is easy to interpret psychotic symptoms as demonic. One man … recalled ruefully that when he told his pastor that his son was hearing voices, the pastor told them only to pray more forcefully.

Even more remarkable is the initiative’s interest in training the ordinary people who work in church offices and hold prayer circles to be actively involved in mental health care. This can sound a little alarming. But in fact … a study just published in The Lancet demonstrated that this [kind of] community care [sometimes] produced modestly better outcomes for patients with schizophrenia than care in the psychiatric facility.

Might there be serious drawbacks to placing mental health care in the hands of strongly religious persons, even if they receive lay training?

… Psychiatrists are the least religious of all physicians, and the new initiative may leave them cold. But Mr. Warren has made an impact before: His initiative on H.I.V.-AIDS was partially responsible for generating George W. Bush’s President’s Emergency Plan for AIDS Relief. If this works, it could have a real impact on the mental health system.

We’re desperately in need of something that does.

(T. M. Luhrmann is a professor of anthropology at Stanford University and the author of When God Talks Back: Understanding the American Evangelical Relationship With God.)

April 19, 2014, “Contributing Op-Ed Writer: Saving Minds Along With Souls” by T. M. Luhrmann. From The New York Times, 4/19/2014, © 2014 The New York Times. All rights reserved. Used by permission and protected by the copyright laws of the United States. The printing, copying, redistribution, or retransmission of this content without express written permission is prohibited.

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Patient:

I don’t know why I keep coming here. All I do is tell you the same thing over and over. I’m not getting anywhere.

Doctor:

I’m getting tired of hearing the same thing over and over, too.

Patient:

Maybe I’ll stop coming.

Doctor:

It’s certainly your choice.

Patient:

What do you think I should do?

Doctor:

What do you want to do?

Patient:

I want to get better.

Doctor:

I don’t blame you.

Patient:

If you think I should stay, ok, I will.

Doctor:

You want me to tell you to stay?

Patient:

You know what’s best; you’re the doctor.

Doctor:

Do I act like a doctor?

(Keen, 1970, p. 200)

Existential therapists do not believe that experimental methods can adequately test the effectiveness of their treatments. To them, research dehumanizes individuals by reducing them to test measures. Not surprisingly, then, very little controlled research has been devoted to the effectiveness of this approach (Yalom, 2014; Schneider & Krug, 2010). Nevertheless, around 1 percent of today’s clinical psychologists use an approach that is primarily existential (Prochaska & Norcross, 2013).

Assessing the Humanistic-Existential Model

The humanistic-existential model appeals to many people in and out of the clinical field. In recognizing the special challenges of human existence, humanistic and existential theorists tap into an aspect of psychological life that typically is missing from the other models (Watson et al., 2011; Cain, 2007). Moreover, the factors that they say are essential to effective functioning—self-acceptance, personal values, personal meaning, and personal choice—are certainly lacking in many people with psychological disturbances.

The optimistic tone of the humanistic-existential model is also an attraction. Such optimism meshes quite well with the goals and principles of positive psychology (Rashid & Seligman, 2014). Theorists who follow the principles of the humanistic-existential model offer great hope when they assert that, despite past and present events, we can make our own choices, determine our own destiny, and accomplish much. Still another attractive feature of the model is its emphasis on health. Unlike clinicians from some of the other models who see individuals as patients with psychological illnesses, humanists and existentialists view them simply as people who have yet to fulfill their potential.

At the same time, the humanistic-existential focus on abstract issues of human fulfillment gives rise to a major problem from a scientific point of view: These issues are difficult to research. In fact, with the notable exception of Rogers, who tried to investigate his clinical methods carefully, humanists and existentialists have traditionally rejected the use of empirical research. This antiresearch position is just now beginning to change. Humanistic and existential researchers have conducted several studies in recent years that use appropriate control groups and statistical analyses, and they have found that their therapies can be beneficial in some cases (Schneider & Krug, 2010; Strumpfel, 2006). This newfound interest in research should lead to important insights about the merits of this model in the coming years.

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