A collective concept to denote psychotherapeutic approaches that emphasize “free will”, free development of the individual, awareness of a person’s responsibility for the formation of his own inner world and choice life path.

The term comes from the Late Latin existentia existence. To a certain extent, all psychotherapeutic approaches of existential psychotherapy have a genetic relationship with the existential direction in philosophy - the philosophy of existence, which arose in the twentieth century as a consequence of the shocks and disappointments caused by the two world wars.

The ideological source of existentialism was Kierkegaard's teachings of phenomenology and philosophy of life. The central concept of the teaching is existence (human existence) as the undivided integrity of object and subject; the main manifestations of human existence are care, fear, determination, conscience, love. All manifestations are determined through death; a person gains insight into his existence in borderline and extreme states (struggle, suffering, death). By comprehending his existence, a person gains freedom, which is the choice of his essence. In the narrow sense, the term existential psychotherapy is usually mentioned when talking about Frankl's existential analysis. In a broader sense, existential psychotherapy refers to the humanistic direction in psychotherapy in general.

In 1963, the president of the Association of Existential Psychotherapy, James Bugental, put forward five fundamental postulates:

1. Man as a whole being is greater than the sum of his parts (in other words, man cannot be explained by the scientific study of his partial functions).
2. Human existence unfolds in context human relations(in other words, a person cannot be explained by his partial functions, in which interpersonal experience is not taken into account).
3. A person is aware of himself (and cannot be understood by psychology that does not take into account his continuous, multi-level self-awareness).
4. A person has a choice (a person is not a passive observer of the process of his existence: he creates his own experience).
5. A person is intentional (a person is oriented towards the future; his life has a purpose, values ​​and meaning).

The main feature of existential psychotherapy is its focus on man as being-in-the-world, i.e. on his life, and not on the personality as an isolated mental integrity (by the way, many existential therapists avoid using the concept of “personality”). The very concept of “existence” literally means “emergence”, “appearance”, “becoming”. This accurately reflects the essence of all existentialism, not only in psychology and psychotherapy, but also in philosophy, art, literature, etc. The main thing in it is not a person as a static set of characterological and personal qualities, forms of behavior, psychodynamic mechanisms, but as a being that is constantly emerging, becoming, i.e. existing.

The main goal of existential therapy is to help a person better understand his life, better understand the opportunities it provides and the boundaries of these opportunities. At the same time, existential therapy does not pretend to change the client, to rebuild his personality; All attention is focused on understanding the process of concrete life, the contradictions and paradoxes that appear in its everyday life. If a person sees reality undistorted, he gets rid of illusions and self-deception, sees his calling and his goals in life more clearly, sees meaning in everyday worries, finds the courage to be free and responsible for this freedom. In other words, existential therapy does not so much cure as it teaches the discipline of life. This can also be called harmonization of human life. Although this is only the most general definition of the goals of existential psychotherapy, it is clear that it is more like psychological analysis personality, but on the philosophical study of human life.

It is for this reason that existential psychotherapy is initially interconnected with philosophy. It seems to be the only school of psychotherapy whose methods have a fairly clear philosophical basis. Among Western philosophers who are of exceptional importance for existential psychotherapeutic practice, one can single out the founder of existential philosophy, the Danish thinker S. Kierkegaard, a classic of modern existential philosophy, the German philosopher M. Heidegger, the German philosophers M. Buber, K. Jaspers, P. Tillich, the French philosopher J.-P. Sartre, although this is not an exhaustive list of names. Among the Russian philosophers whose works are important for existential therapy, one can name primarily V. Rozanov, S. Trubetskoy, S. Frank, N. Berdyaev, L. Shestov. Existential therapy borrowed many of its concepts from the existential-philosophical dictionary: existence, being-in-the-world (Dasein), feeling of being, authenticity and inauthenticity of being, etc.

The first attempt to combine philosophy and psychiatry was made by the Swiss psychiatrist and psychoanalyst Ludwig Binswanger in the 30s of our century, proposing the concept of existential analysis (Daseinanalyse). He can be considered the founder of existential therapy. Although he himself did not engage in practical psychotherapy, he determined the principles of a phenomenological description of the patient’s inner world, which is where existential therapy begins.

The first truly psychotherapeutic existential concept was proposed by another Swiss psychiatrist Medard Boss in the 40-50s of our century. His version of existential analysis was in form psychoanalytic therapy, but reformed on the basis of Heideggerian philosophy. While maintaining the analytical conceptual apparatus and methods, they were nevertheless interpreted in an existential or, as M. Boss said, in an ontological context. Daseinanalysis as one of the areas of existential psychotherapy continues to develop today.

A very fruitful and original existential psychotherapeutic school is the logotherapy of the Austrian psychotherapist Viktor Frankl. It views the human pursuit of meaning as the cornerstone of human life. Logotherapy itself is a system of ways to help a person overcome existential emptiness and loss of the meaning of existence.

For the development of existential therapy, its American branch is very important, although existential therapy is not very popular in the USA. First of all, we should mention the famous American psychologist, one of the fathers of the humanistic psychology movement, Rollo Meia. He was the first, relying on the European existential and phenomenological tradition, to formulate the prerequisites and main characteristics of the therapist’s existential attitude in psychotherapy (he denied the existence of existential therapy as an independent direction in psychotherapy). Closely related to his concept is James Bugental's humanistic-existential psychotherapy, in which he attempts to combine the principles of humanistic and existential psychology (although they are often contradictory).

Modern ideas about existential therapy are developed by the so-called English school, the most prominent representatives of which are Emmy van Deurzen and Ernesto Spinellia.

What sets existential therapy apart from other schools of psychotherapy? First of all, this is an understanding of man as being-in-the-world or as a continuous process of life, in which the self of a person and his world as the context of life are inextricably linked. Thus, if we want to truly understand a person, we must first examine his life, as manifested in his relationships with the world. There are 4 main dimensions of human existence (being-in-the-world): physical, social, psychological (personal) and spiritual (transpersonal). In each of these dimensions, a person “meets” the world and, experiencing it, forms his basic prerequisites (settings) for life. To understand a person means to understand how he exists simultaneously in these basic dimensions of life as a complex bio-socio-psycho-spiritual organism.

Another fundamental feature of existential therapy is the desire to understand a person through the prism of his internal ontological characteristics or universal existential factors. These are factors that affect the life of every person. We identify 7 such universal human characteristics:

1. sense of being;
2. freedom, its limitations and responsibility for it;
3. human limb or death;
4. existential anxiety;
5. existential guilt;
6. life in time;
7. meaning and meaninglessness.

In the process of psychotherapy, the client’s attitudes are examined in relation to these universal circumstances of life, in which the roots of our psychological difficulties and problems are hidden.

Psychological health Existential therapy connects the possibility of psychological disorders, respectively, with a genuine and inauthentic way of existence. Live true life, according to J. Bugental, means to be fully aware of the present moment of life; choose how to live this moment; and take responsibility for your choices. In reality, this is quite difficult, so most of their lives people live an inauthentic life, that is, they tend to conform, refuse the risk associated with choice, and try to shift responsibility for their lives onto others. Therefore, almost all people throughout their lives constantly face various difficulties and problems, sometimes reaching the level of pronounced disorders.

In existential therapy, therapeutic changes are associated, first of all, with the expansion of the client’s consciousness, with the emergence of a new understanding of his life and the problems that arise in it. What to do with this newfound understanding is the responsibility of the client himself. On the other hand, the real results of therapy should manifest themselves not only in internal changes, but also necessarily in real decisions and actions. However, these actions must be deliberate, taking into account their potential negative consequences, more conscious than spontaneous.

Sometimes existential therapy is reproached for excessive pessimism, which manifests itself in emphasizing not so much the unlimited possibilities of a person, but rather the boundaries of these possibilities, including in therapeutic changes. But this is more a manifestation of realism rather than pessimism. Existential therapy advocates a realistic outlook on life and the acceptance of many circumstances as given and inevitable.

All people without exception can be clients of existential therapy. There is only one requirement: the active involvement of the person himself in the process of studying his life, the desire to look at his not always successful life as openly and honestly as possible. On the other hand, it is existential therapy that can be the most effective in psychotherapeutic assistance to people who find themselves in life crises and faced with exceptional life circumstances. This is the experience of meaninglessness, emptiness of life, apathy and depression, suicidal intentions, sudden changes in quality and lifestyle (loss of job, retirement, loneliness, deterioration in quality of life, personal and professional failures, divorce, etc.), loss of loved ones and bereavement, encounters with death (accidents, incurable diseases), etc. Existential therapy as an adjuvant can be useful in chronic or acute somatic illnesses, in working with mental patients for better understanding and greater acceptance changed realities of life.

The task of traditional psychotherapy is to reveal in consciousness the deep phenomena of mental life. In contrast, logotherapy seeks to turn consciousness toward truly spiritual entities. Logotherapy as a practice of existential analysis is intended, first of all, to lead a person to an awareness of his own responsibility, since awareness of responsibility is the basis of the foundations of human existence. Since being human means being aware and responsible, existential analysis is psychotherapy based on the principle of awareness of responsibility.

In an explicit or implicit form, this question is inherent in the very nature of man. Doubts about the meaning of life, therefore, should never be considered as manifestations of mental pathology; these doubts are significantly to a greater extent reflect truly human experiences, they are a sign of the most humane in a person. Thus, it is quite possible to imagine highly organized animals, even among insects, say, bees or ants, which in many ways have surpassed humans in organizing their communities. But it is impossible to imagine that such creatures would think about the meaning of their own existence, thus doubting it. Only man is given the ability to discover the problematic nature of his existence and feel all the ambiguity of existence. This ability to doubt the significance of one’s own existence sets man apart from animals much more than such achievements as walking upright, speaking or conceptual thinking.

The problem of the meaning of life in its extreme version can literally take over a person. It becomes especially urgent, for example, in adolescence, when growing young people in their spiritual quests suddenly discover all the ambiguity of human existence. A high school science teacher once explained to high school students that the life of any organism, including humans, is ultimately nothing more than a process of oxidation and combustion. Suddenly, one of his students jumped up and asked the teacher a question full of excitement: “If this is so, then what is the meaning of life?” This young man had already clearly realized the truth that a person exists on a different plane of existence than, say, a candle that stands on the table and burns until it goes out completely. The existence of a candle can be explained as a combustion process. Man has a fundamentally different form of existence. Human existence takes the form of historical existence, which, unlike the life of animals, is always included in historical space (“structured” space, according to L. Binswanger) and is inseparable from the system of laws and relations that underlie this space. And this system of relationships is always governed by meaning, although it may not be explicitly expressed, and perhaps not at all amenable to expression.

Data of existence - These are the final factors that are an integral, inevitable component of human existence in the world.
There are four ultimate givens - death, freedom, isolation, meaninglessness. Existential dynamic conflict is generated by the individual's confrontation with any of these life factors.

Death. The most obvious, most easily realized final reality. We exist now, but the day will come when we will cease to exist. Death will come, and there is no escape from it. This is a terrifying truth that fills us with “mortal” fear.

In the words of Spinoza, “everything that exists strives to continue its existence,” the confrontation between the consciousness of the inevitability of death and the desire to continue to live is the central existential conflict.

Freedom. This fact is less obvious. Usually freedom seems to be an unambiguously positive phenomenon. Doesn’t man long for freedom and strive for it throughout the entire recorded history of mankind? However, freedom as a primary principle gives rise to horror.

In an existential sense, “freedom” is the absence of external structure. Everyday life harbors the comforting illusion that we are entering (and leaving) a well-ordered universe, arranged according to a definite plan.

In fact, the individual bears full responsibility for his world - in other words, he himself is its creator. From this point of view, “freedom” implies a terrifying thing: we do not rest on any ground, beneath us there is nothingness, emptiness, an abyss. The discovery of this emptiness conflicts with our need for soil and structure. This is also a key existential dynamic.

Existential isolation. It is not isolation from people with the loneliness it engenders, nor is it the inner isolation - both from other creatures and from the world - that hides behind every sense of isolation. No matter how close we are to someone, there always remains a final and insurmountable gap between us; each of us comes into the world alone and must leave it alone.

The existential conflict generated is a conflict between the perceived absolute isolation and the need for contact, for protection, for belonging to a larger whole.

Pointlessness. We must die; we ourselves structure our universe; each of us is fundamentally alone in an indifferent world - what then is the meaning of our existence? Why do we live? How should we live? If nothing is initially destined, it means that each of us must create our own life plan.

But can this own creation be strong enough to withstand our lives? This existential dynamic conflict is generated by the dilemma facing a creature seeking meaning, thrown into a meaningless world.

Let us recall that I. Yalom defined existential psychotherapy as a psychodynamic approach. It should be noted right away that there are two important differences between existential and analytical psychodynamics. First, existential conflicts and existential anxiety arise as a result of the inevitable confrontation of people with the ultimate givens of existence: death, freedom, isolation and meaninglessness.

Second, existential dynamics does not imply the adoption of an evolutionary or “archaeological” model in which “first” is synonymous with “deep.” When existential psychotherapists and their clients engage in in-depth exploration, they do not focus on everyday concerns but reflect on core existential issues. In addition, existential approaches can also be used to solve problems related to freedom, responsibility, love and creative potential. [AND. Yalom writes that psychotherapeutic approaches “reflect the pathology that they can treat, and are shaped by that pathology.”]

In connection with the above, existential psychotherapy is mainly focused on long-term work. However, elements of an existential approach (for example, an emphasis on responsibility and authenticity) can also be included in relatively short-term psychotherapy (for example, associated with working with post-traumatic conditions).

Existential psychotherapy can be carried out both individually and in group form. Usually the group consists of 9-12 people. The advantages of the group form are that patients and psychotherapists have a wider opportunity to observe distortions that arise during interpersonal communication, inappropriate behavior and correct them. Group dynamics Existential therapy aims to identify and demonstrate how the behavior of each group member:

1) is considered by others;

2) makes others feel;

3) creates an opinion about him in others;

4) influences their opinion about themselves.

The greatest attention in both individual and group forms of existential psychotherapy is paid to quality psychotherapist-patient relationship. These relationships are considered not from the point of view of transference, but from the standpoint of the situation that has developed among patients to date, and the fears that torment patients at the moment.

Existential therapists describe their relationships with patients using words such as presence, authenticity And devotion. Individual existential counseling involves two real person. An existential psychotherapist is not a ghostly “reflector”, but a living person who strives to understand and feel the patient’s being. R. May believes that any psychotherapist is existential, who, despite his knowledge and skills, can relate to the patient in the same way as, in the words of L. Binswanger, “one existence relates to another.”

Existential psychotherapists do not impose their own thoughts and feelings on patients and do not use countertransference. This is due to the fact that patients may resort to various methods of provoking connection from psychotherapists, which allows them not to address their own problems. Yalom talks about the importance of implicit “infusions.” We are talking about those moments of psychotherapy when the therapist shows not only professional, but also sincere, human involvement in the problems of patients, thereby sometimes turning a standard session into a friendly meeting. In his case study (“Every Day Brings You A Little Closer”), Yalom examines such situations from both the perspective of a psychotherapist and the patient. So, he was amazed to find out what great value One patient of his gave such small personal details as warm glances and compliments on the way she looked. He writes that in order to establish and maintain a good relationship with a patient, a psychotherapist needs not only complete involvement in the situation, but also such qualities as concern, wisdom and the ability to be involved as much as possible in the psychotherapeutic process. The therapist helps the patient “by being trustworthy and interested; being affectionately present next to this person; trusting that their combined efforts will ultimately lead to correction and healing.”

The main goal of the psychotherapist is to establish an authentic relationship in the interests of the patient, so the question psychotherapist self-disclosure is one of the main ones in existential psychotherapy. Existential psychotherapists can reveal themselves in two ways.

First, they can talk to their patients about their own attempts to come to terms with extreme existential anxieties and preserve the best qualities of humanity. Yalom believes he made a mistake by engaging in self-disclosure too rarely. As he notes in The Theory and Practice of Group Psychotherapy (Yalom, 2000), whenever he shared a significant portion of his self with his patients, they invariably benefited from it.

Secondly, they can use the process of psychotherapy itself, rather than focusing on the content of the session. It is the use of thoughts and feelings about the here and now to improve the therapist-patient relationship.

Over the course of a number of psychotherapeutic sessions, patient A. demonstrated behavior that she herself regarded as natural and spontaneous, while other group members assessed it as infantile. She showed in every possible way her activity and willingness to work on herself and help others, described her feelings and emotions in detail and colorfully, and willingly supported any topic of group discussion. At the same time, all this was of a half-playful, half-serious nature, which made it possible to simultaneously provide some material for analysis and avoid a deeper immersion into it. The psychotherapist, suggesting that such “games” could be associated with the fear of approaching death, asked why she was trying to be either an experienced adult woman or a little girl. Her answer shocked the whole group: “When I was little, it seemed to me that my grandmother stood between me and something bad in life. Then my grandmother died and my mother took her place. Then, when my mother died, she found herself between me and the bad guy. older sister. And now, when my sister lives far away, I suddenly realized that there is no longer a barrier between me and the bad, I am standing face to face with him, and for my children I myself am such a barrier.”

In addition, the key processes of therapeutic change, according to Yalom, are will, acceptance of responsibility, attitude towards the therapist and involvement in life. Let's look at them using the example of working with each of the basic alarms.

Working with Death Awareness

Study of people who have been to extreme situations who have experienced clinical death, as well as chronically ill patients, irrefutably testifies that increased awareness of death can lead to a greater appreciation of life. The situation of being close to death causes a wide variety of reactions in people. Many try to deny this fact. Others fall into panic, apathy or fruitless thinking (“Why me?”, “What have I done wrong in my life and how can I fix it?”). Still others begin to take revenge on everyone healthy people or simply those who can survive them themselves. Other people activate funds psychological protection, distorting reality, but thanks to this they more or less calmly perceive information regarding death.

Therefore, it is important to prepare any person for this in advance and teach him to use his illnesses as an opportunity for personal growth. Awareness of uniqueness and finitude human life leads to “the unbearable lightness of being” - a revaluation of values, acceptance of the present moment, a deeper and more complete experience of art, the establishment of close and sincere contacts with all people, and not just with relatives and acquaintances, an understanding of the relativity of human fears and desires, the establishment of closer contact with nature. Therefore, increasing awareness of death can also cause a radical shift in patients who are not terminally ill.

Participant E. began one of the personal growth groups by voicing the problem of a relationship with participant S. that had deteriorated outside the group, with whom E. had had a fairly strong friendship for some time. According to E., this was due to the alienation and antipathy that arose in S. due to pressure from some of their mutual acquaintances, with whom E. is in a tense relationship. The group, consisting mainly of psychology students, willingly began to study the problem posed, quickly discovering that in almost all relationships E. with women, the same scenario is observed - the impossibility long time maintain warm friendly relations. This topic, both in a broader context (female rivalry) and in relation to E., caused quite strong emotional reactions in the group. Throughout the entire discussion, E.’s tears flowed silently several times, but she responded to the attention of those around her with a request to “not pay attention,” since they flow “just like that,” behind them “there is nothing” and with her “in lately this happens often.” The facilitator suggested that the next time they flow and there are emotions associated with them that E can talk about in the group, have her give a sign - for example, stamp her foot. And after a few minutes he asked the question: “E., what is happening in your life now?” The ensuing explosion of emotions of fear, resentment, and sadness shocked the entire group: it turned out that for about a month E. had been waiting every hour for news of the death of the only remaining loved one, a mother suffering from severe cancer. The group, which had previously been quite active in trying to help E.

solve the problem she stated, experienced shock, a feeling of guilt and tried, to the best of her ability, to support her. The awareness of the minute proximity of death led to the fact that almost at the very end of the group, already when summing up its results, one of the participants, Zh., said that she might have cancer and that due to fear and reluctance to live further she does nothing for his further diagnosis and therapy. The subsequent series of stories about close or similar experiences did not convince her to turn to specialists that time. However, in the next group, she talked about her “secret” trip to the hospital and her subsequent feelings of both relief and disappointment. This allowed the group to focus not only on discussing the issues of death, but also the meaning of life and the responsibility for bringing that meaning to life.

Yalom recommends starting from the following point: anxiety associated with death is inversely proportional to life satisfaction. Increasing awareness of the inevitability of death may increase anxiety, but the therapist should aim not to anaesthetize patients' anxiety, but to help them come to terms with it and use it constructively.

Technique of “permission to endure” is to make patients understand that discussion of issues related to death is highly valued in counseling. This can be done by taking an interest in patients' self-disclosure in this area, as well as by encouraging their self-disclosure. In addition, psychotherapists should not encourage death denial in patients. On the contrary, it is necessary to actively encourage these issues to remain “in the public eye.” To do this, the psychotherapist himself must be resistant to his own anxiety associated with death.

While listening to a patient talk about the importance and responsibility of the work he was doing, the therapist suddenly asked him to stop and listen, and then say what he heard. “The ticking of the clock that hangs on your wall,” the patient answered in bewilderment. “That’s right,” the psychotherapist confirmed. - Only this is not just a clock: it measures time. The time allotted to us for today's meeting. And also the time that is generally allotted to us for life. It is different for everyone and depends on genetics, lifestyle, will to live and a host of other factors. But in one thing it is similar - it cannot be calculated and reversed. Now think about whether the importance and prestige of the work you are doing are really those significant things for which you are willing to spend so much of your personal time?”

Techniques for working with defense mechanisms consists of identifying inadequate defense mechanisms and their negative consequences. Psychotherapists try to help patients accept that they will not live forever rather than deny death. Existential psychotherapists require tact, persistence, and timing to help patients identify and change their childishly naive views of death.

Techniques for working with dreams is that existential psychotherapists encourage patients to talk about their dreams. Since dreams (especially nightmares) can manifest subconscious themes in an unrepressed and unedited form, they often contain themes of death. Therefore, discussion and analysis of dreams are carried out taking into account the existential conflicts occurring in patients at the moment. However, patients are not always ready to deal with the material presented in their dreams.

Yalom (1997, pp. 240-280) cites the case of Marvin, an elderly man of 64 years old. One of his nightmares was as follows: “Two men, very tall, pale and thin. In complete silence they glide across the dark field. They are dressed all in black. With tall black chimney sweep hats, long black coats, black spats and boots, they resemble Victorian undertakers or footmen. Suddenly they approach a stroller where a little girl lies, wrapped in black diapers. Without saying a word, one of the men begins to push the stroller. Having traveled a short distance, he stops, walks around the stroller and with his black cane, which now has a white-hot tip, unrolls the diapers and slowly inserts the white tip into the baby’s vagina.”

Yalom gave the following interpretation of this dream: “I am old. I'm at the end of my life's journey. I have no children and I face death full of fear. I'm suffocating in the dark. I am suffocating from this silence of death. I think I know the way. I'm trying to pierce this blackness with my sexy talisman. But this is not enough."

Subsequently, when Yalom asked Marvin to tell what associations he had in connection with his dream, he said nothing. When Marvin was then asked how he processed all the images of death that arose in his mind, Marvin preferred to consider his nightmare in terms of sex rather than death.

Reminder technique fragility (frailty) of existence . Psychotherapists can help patients identify and cope with death anxiety by tuning patients into the signs of mortality that are part of normal life(Thus, the death of loved ones can be a powerful reminder of personal mortality; the death of parents means that it is now the next generation's turn; the death of children can cause a feeling of powerlessness due to the awareness of cosmic indifference). In addition, a serious illness can bring patients face to face with their own vulnerability.

Also, the awareness of mortality reminds itself in transition periods life. Of greatest importance are the transition from adolescence to adulthood, the establishment of permanent relationships and the associated assumption of corresponding obligations, children leaving home, marital separation and divorce. In middle age, many patients become more aware of death, realizing that now they are not growing up, but aging. In addition, the loss of a job or the unexpected threat of career derailment can make the awareness of death much more profound.

In everyday life, a person is constantly faced with reminders of the passage of time. Physical signs of aging, such as the appearance gray hair, wrinkles, spots on the skin, decreased flexibility of joints and endurance, deterioration of vision - all this destroys the illusion of constant youth. Meetings with friends from childhood and youth show that everyone is getting old. Often birthdays and various anniversaries generate existential pain along with or instead of joy, as these dates are milestones in the aging process.

Technique of use aids to deepen awareness of death consists of asking the patient to write his own obituary or fill out a questionnaire with questions that relate to anxiety associated with death. In addition, psychotherapists can invite patients to fantasize about their death, imagining “where,” “when,” and “how” they will meet it and how their funeral will go. Yalom describes two ways to get patients to interact with death: observing terminally ill people and including a terminal cancer patient in a patient group.

The technique is close to this technique reducing sensitivity to death. Psychotherapists can help patients cope with the horror of death by repeatedly forcing them to experience this fear in reduced doses. Yalom notes that when working with groups of cancer patients, he often saw that the fear of death in these patients gradually decreased simply by receiving new detailed information.

Interesting example semantic revaluation of death cited by V. Frankl. He was approached by an elderly doctor who had been depressed for two years over the death of his wife. “How could I help him? What should I tell him? So, I didn't say anything, but instead posed the question: "What would happen, Doctor, if you died first and your wife had to survive you?" “Oh,” he said, “it would be terrible for her, how she would suffer!” Then I responded: “You see, doctor, she escaped this suffering, and it was you who saved her from it, but you must pay for it by surviving and mourning her.” He didn’t answer a word, but shook my hand and calmly left my office.”

Working with responsibility and freedom

When patients have extreme anxiety about freedom, therapists focus on increasing patients' awareness of their responsibility for their lives and helping patients take on this responsibility.

Techniques for determining types of defense and ways to evade liability is that psychotherapists can help patients understand the function of certain behaviors (eg, compulsivity) as avoidance of responsibility for choices. In addition, psychotherapists can work with patients to examine their responsibility for their own unhappiness and, if necessary, confront patients with this responsibility.

Vera Gulch and Maurice Temerlin, based on an analysis of audio recordings of psychotherapeutic sessions, compiled a collection of confrontational interviews aimed at increasing awareness of responsibility. They give an example where one man complained bitterly and passively that his wife refused to have sexual contact with him. The therapist clarified the hidden choice with the remark: “But you must like it, because you have been married so long!” In another case, a housewife lamented: “I can’t cope with my child, all he does is sit and watch TV all day.” The therapist made the hidden choice explicit with the following remark: “And you are too small and helpless to turn off the TV.” The impulsive, obsessive man shouted: “Stop me, I'm afraid I'll commit suicide.” The therapist said, “Should I stop you? If you really want to commit suicide—to really die—no one can stop you but yourself.” One therapist, in a conversation with a passive, oral-dependent man who believed that the reason for his discord with life was his unrequited love for an older woman, began to sing: “Poor little lamb, he's lost.”

The essence of this technique is that when a patient complains about an unfavorable situation in his life, the therapist is interested in how the patient created this situation. In addition, the therapist may focus on the patient's use of "avoidance language" (eg, people often say "I can't" instead of "I don't want to").

Technique for identifying evasion of responsibility focuses on the therapist-patient relationship. Psychotherapists confront patients with their attempts to transfer responsibility for what happens within or outside of psychotherapy to the therapists. For this, it is very important for the psychotherapist to be aware of his own feelings regarding patients, which helps to identify emotional reactions in patients.

Many clients seeking psychotherapeutic help expect the therapist to do all the necessary therapeutic work for them. The motivations for such expectations can be very diverse, ranging from “You are better off, you are stronger, you have a more advantageous situation” and ending with “You studied this, this is your profession, I pay you money for this.” By influencing in this way the psychotherapist’s various feelings (guilt, conscience, conscientiousness, etc.), the patient shifts the burden of responsibility for the changes occurring to him onto the shoulders of the psychotherapist.

In student study group Participant A. responded to all attempts at help and support both from the facilitator and from other group members with approximately the same words: “I don’t know... Perhaps this is so... At least, You this is how you see...” Feeling that such a position of passive opposition had become familiar to her, and avoiding a provocative slip into teaching, the therapist told her an anecdote: “Late at night, a woman walks along a dark, deserted street. Suddenly he hears heavy male steps behind him. Without turning around, she quickens her pace. The steps are also becoming more frequent. She runs - the pursuer runs after her. In the end, she runs into some yard and realizes that there is no way out. Then she boldly turns to her pursuer and shouts loudly: “Well, what do you want from me?”, to which the pursuer calmly replies: “I don’t know, this is your dream.” Despite the fact that the patient reacted aggressively to this anecdote, in the future his last phrase served as a good “marker” for identifying deviations. As soon as A. began to demand something from the psychotherapist and the group or to accuse them of anything, she was immediately reminded: “But this is your dream.”

A technique for confronting the limitations of reality. Since objectively unfavorable situations periodically arise in the life of any person, this technique is aimed at changing the patient’s point of view. This change comes in several varieties.

First, the psychotherapist can help identify those areas of life that the patient can continue to influence despite the limitations that have arisen. So, for example, no one can change the fact of a serious illness, but it depends only on the person whether to take the position of a passive victim in relation to this fact or try to find aristos - “the best in a given situation” (classic examples - “real person” A . Maresyev, circus performer V. Dikul, etc.).

Secondly, psychotherapists can change the existing attitude towards those restrictions that cannot be changed. We are talking about both accepting the injustice that exists in life and reframing along the lines of “if you can’t change the situation, change your attitude towards it.”

W. Frankl illustrated this type of change with the following anecdote: “During the First World War, a Jewish military doctor was sitting in a trench with his non-Jewish friend, an aristocratic colonel, when a massive bombardment began. Teasing him, the colonel said: “You are afraid, aren’t you? This is further proof of the superiority of the Aryan race over the Semitic.” “Of course, I am afraid,” answered the doctor, “but who has the superiority? If you, dear colonel, were afraid like me, you would have run away long ago."

Techniques for confronting existential guilt . As already noted, in existential psychotherapy one of the functions of anxiety is considered to be a call to conscience. And one of the sources of anxiety is guilt caused by unsuccessful realization of potential.

In order to launch psychological work with existential guilt in a group format, a modification of the parable from “The Trial” by F. Kafka is well suited.

One person learned that somewhere there is a Castle in which the Law reigns, wisely distributing happiness and misfortune “in fairness.” As expected, he goes on a journey and, having worn out the required amount of clothes and worn out the prescribed number of shoes, finally finds him. The guard, in front of one of the countless gates, greets the traveler, but immediately announces that he cannot let him through at the moment. When a man tries to look into the bowels of the Castle for himself, the guard warns: “If you are impatient, try to enter, do not listen to my prohibition. But know that my power is great. But I am only the most insignificant of the guards. There, from peace to peace, guards stand, one more powerful than the other. And you will have to fight with each of them."

Then the man decided to wait until he was either allowed to enter, or someone else came, ready to fight the terrible and powerful guards. Sometimes he would talk for a long time with the first guard on different topics. From time to time he tried to bribe the guard with various bribes. He took them, but still didn’t let them pass, explaining his actions like this: “I’m doing this so that you don’t lose hope.”

In the end, the man grew old and, feeling that he was dying, asked the guard to fulfill his last request - to answer the question: “After all, all people strive for the Law, how did it happen that in all these long years no one except me demanded that Did they miss him? Then the guard shouted back (since the man was already hard of hearing): “No one can enter here, these gates were intended for you alone!” Now I’ll go and lock them up.”

There is a difference between guilt for bad choices made in the past and guilt associated with failing to make new choices. As long as patients continue to behave in the present as they did in the past, they cannot forgive themselves for the choices they made in the past.

This is well illustrated by one Buddhist parable. One day, two monks were walking along a narrow mountain road and at one of the turns they met a girl standing in front of a huge puddle. The first monk calmly walked past, and the second silently approached her, took her on his shoulder, carried her across the puddle and moved on. Already in the evening, approaching the walls of the monastery, the first monk broke the traditional silence: “Our charter prohibits touching women.” To which the second monk replied: “I’ve only been dogging her for three minutes, and you’ve been carrying her for an hour.”

A technique for releasing the ability to want. It is impossible to experience desires without contact with your feelings. Therefore, to understand a person’s true desires, existential psychotherapists work with suppressed and repressed affects that block desires. At the same time, unlike other methods of psychotherapy, they try to avoid dramatic global breakthroughs, since their (breakthroughs) impact is usually short-lived. Instead, within the context of an authentic relationship, existential therapists continually attempt to answer the question, “What are you feeling?” and “What do you want?”, thereby exploring the source and nature of patients' blocks and the underlying feelings that patients are trying to express.

Decision-making facilitation technique is that existential psychotherapists encourage patients to realize that every action is preceded by a decision. Since alternatives are excluded when making a decision, decisions are a kind of boundary situations in which people create themselves. Many patients paralyze their ability to make decisions with questions that begin with “Yes, but...” or “What if...” (eg, “What if I lose my job and can’t find another one?”). Therapists can help patients explore the ramifications of each "what if..." question and analyze the feelings that are induced by those questions. Psychotherapists can encourage patients to actively make decisions in such a way that making a decision will promote activation in them. own strength and resources.

In a situation where the patient is faced with the need to make a decision, but tries in every way to shift this decision to the psychotherapist, the therapist can tell another Eastern parable. One day, a woman who lived in a remote village and was reputed to be the wisest there, learned that Khoja Nasreddin would pass through this village. Fearing for her authority, she decided to test his wisdom. When he entered the village, she approached him with a small bird clutched in her hand and asked loudly: “Tell me, is the bird in my hand alive or dead?” This was a very tricky question, because if he had answered that she was alive, she would have clenched her fist tighter and the bird would have suffocated. If Khoja had answered that the bird was dead, the woman would have unclenched her hand and the bird would have flown away. “Everything is in your hands, woman,” Nasreddin answered her.

If necessary, existential psychotherapists help patients exercise their will. The therapist's approval allows patients to learn to trust their will and gain confidence that they have the right to act.

Yalom recommends conveying the following messages to patients with suppressed will as often as possible: “Only I can change the world I created,” “There is no danger in change,” “To get what I really want, I must change,” “I has the power to change."

Working with insulation

Techniques for confronting patients with isolation. The therapist can help the patient understand that ultimately every person is born, lives, and dies alone. This is quite painful, since it destroys all the romantic models of human relationships extolled by culture. Nevertheless, like death, the awareness of total loneliness significantly affects the change in the quality of life and relationships. [It is not without reason that in his work “The Art of Love” E. Fromm defines the ability to be alone as a condition for the ability to love.] By exploring their loneliness, patients learn to determine what they can and cannot get from relationships.

Thus, when assessing the groups, many participants note the important fact for them that, thanks to the groups, they escaped from their everyday surroundings for some time.

In addition, the psychotherapist can offer the patient the following experiment - to isolate himself from the outside world for a while and be in isolation. After this experiment, patients become more deeply aware of both the horror of loneliness and the extent of their hidden resources and the degree of their courage.

Technique for identifying protection mechanisms consists of identifying the defenses that patients use to cope with the contradiction between the need for belonging and the fact of existential isolation.

One of the groups, which was devoted to the problem of building family relationships, was attended by several people with compulsive behavior, manifested in increased falling in love, chronic unrequited love, frequent changes of love objects, and the formation of dependent relationships with them. All attempts to study the deep processes behind this were defeated by intellectual defenses. To demonstrate that behind this behavior there are defense mechanisms against loneliness, the psychotherapist told the following parable.

“There lived a lonely and unhappy man. And one day his loneliness and despair reached such a degree that he shouted to God: “Lord, send me a beautiful woman!” His cry was so strong that God heard and paid attention to him. God asked: “Why not the cross?” The man got angry: “I’m not tired of life, I want to find a beautiful woman and a friend.” The man got everything, but soon became even more unhappy. This woman became a pain in his heart and a stone on his neck. And then he again prayed: “Lord, give me a sword.” God asked again: “Or maybe it’s a cross?” But the man shouted: “This woman is already worse than any cross. Just send me a sword!”

God sent a sword, a man killed a woman, was captured and sentenced to crucifixion. And on the cross, praying to God, he laughed loudly: “Forgive me, Lord! I didn’t listen to You, but You asked whether to send me a cross from the very beginning. If I had listened, I would have gotten rid of all this unnecessary fuss "".

Technique for identifying interpersonal pathology. Taking ideal freedom from needs or “I-Thou” relationships as a criterion, it is possible to identify ways in which patients avoid real relationships with others. To what extent do patients view other people as objects to satisfy their wants and needs? How capable are they of love? How well do they listen and open up to others? How do they keep people at a distance? Psychotherapists can teach patients the “ABC of the language of intimacy,” which provides skills for accepting and expressing feelings.

Using the therapist-patient relationship to identify pathology. Existential psychotherapists believe that focusing solely on transference interferes with therapy because it eliminates the authentic therapist-patient relationship. This is due to the fact that, firstly, the analytical paradigm eliminates the reality of the relationship itself, considering it as a kind of key to understanding past experience, and secondly, it provides the psychotherapist with a rational basis for self-defense. In turn, the inability to self-disclose blocks the ability to sincerely and empathically understand the inner world of another. Self-disclosure of a psychotherapist (as described by R. Mayagape - love devoted to the good of another) allows the patient to take step by step towards his own disclosure.

Healing relationships. Existential psychotherapists strive to develop real relationships with patients. Although the therapist-patient relationship is temporary, the experience of intimacy can be permanent. The therapist-patient relationship can promote self-empowerment in patients because it is extremely important to them that someone they respect and who really knows all their strengths and weaknesses, accepts them. Psychotherapists who are able to establish deep relationships with their patients can help them confront existential isolation. In addition, it helps patients realize their responsibility for life and the relationships that develop in it.

Dealing with meaninglessness

Problem redefinition technique. When patients complain that “life has no meaning,” they seem to assume that life has a meaning that they cannot find. This point of view is close to the logotherapeutic position. However, according to other existential approaches, people give meaning rather than receive it. Therefore, existential psychotherapists raise patients' awareness that there is no objectively inherent meaning in life, but that people are responsible for creating their own meaning. Often what falls into the category of meaninglessness is best studied in relation to other ultimate concerns related to death, freedom and isolation. We can also find an example of the use of such a technique for redefining the problem of meaninglessness in an Eastern parable. So, one legend tells that one day Khoja Nasreddin died and went to heaven in a wonderful garden, where an obedient genie fulfilled all his desires. Very soon Khoja got bored with this and decided to do some work. However, the genie forbade him to do this. Then, after a while, Nasreddin began to ask to go somewhere else, or at least to hell. “Where do you think you are?” - the genie laughed.

A technique for identifying types of defense against anxiety of meaninglessness. Existential psychotherapists help patients become more aware of the defenses they use against the anxiety of meaninglessness. First of all, this is related to the clarification of such questions as to what extent the desire for money, pleasure, power, recognition, status is rooted in their inability to confront the existential problem associated with meaninglessness. How seriously does a person take life in general? The defense against meaninglessness may be one of the reasons why patients take life lightly, thereby creating problems that they consciously or subconsciously try to avoid solving.

Techniques to assist patients in their more active participation in life is that the therapist assumes that the patient has an innate desire to always participate in life. This technique may involve psychotherapists inviting patients to establish and maintain authentic relationships during psychotherapy, which is already their significant contribution to the therapeutic process. Psychotherapists can explore a wide range of patients' hopes and goals, their belief systems, their capacity to love, and their attempts to express themselves creatively.

Note that working with meaninglessness differs from working with other ultimate grounds. In cases of death, freedom and isolation, the therapist organizes the process in such a way that the patient comes face to face with them. However, when it comes to meaninglessness, the therapist helps to turn away from the issue by making a decision about involvement in life.

Existential psychotherapy is a direction of psychotherapy that involves helping people understand the concepts of death, responsibility, and isolation using certain techniques. Highlight large number techniques that the psychotherapist selects individually, depending on the problem and characteristics of the person. Psychologists who have a basic background are allowed to work within the framework of existential therapy higher education and have undergone professional retraining in this area.

Existential psychotherapy: description of the direction

Existential psychotherapy (“existentia” - emergence, appearance, existence) - psychotherapeutic approaches that emphasize the free development of personality, awareness of a person’s responsibility for the formation of the inner world and the choice of life path. The founder of this method is the Danish philosopher Soren Kierkegaard. He believed that the solution to any problem is a difficulty created artificially, which should outweigh the real troubles in importance. Existential psychotherapy arose in Europe in the second half of the 20th century due to the dissatisfaction of psychologists with deterministic views of man and the development of existential philosophy.

The foundation of existential psychotherapy consists of 4 basic concepts that underlie human thinking aimed at realizing a negative attitude towards the environment:

• death;
• freedom;
• insulation;
• meaninglessness.

Existential psychotherapy is based on the belief that a person’s internal conflict is formed on the basis of his own attitude to the problem that has arisen, i.e., what can be a huge misfortune for one person is perceived by another as a minor difficulty and passes by unnoticed. Main feature This psychotherapeutic method is focused on the life of the individual, and not on the personality, therefore many psychotherapists of this direction avoid using this term. The main goal of existential psychotherapy is to help you understand your life, to better understand your capabilities and their limits. There is no provision for restructuring the patient's personality. That is why this direction is associated with philosophy.

The following philosophers influenced its development:

• M. Heidegger;
• M. Buber;
• K. Jaspers;
• P. Tillich;
• J.-P. Sartre;
• V. Rozanov;
• S. Frank;
• N. Berdyaev

Features of this direction

With the development of existential psychotherapy D. Bugental put forward the main postulates of this direction (1963):

1. 1. Man as an integral being is greater than the sum of his parts, that is, man cannot be explained as a result of the scientific study of his partial functions.
2. 2. Human existence unfolds in the context of human relationships, that is, it cannot be explained by its partial functions, which do not take into account interpersonal experience.
3. 3. Man is self-aware.
4. 4. Man has a choice.
5. 5. A person is intentional, that is, he is oriented towards the future.

Another feature of existential therapy is the desire to understand a person through his internal universal characteristics. There are 7 such factors:

• freedom, its limitations and responsibility for it;
• human limb or death;
• existential anxiety;
• existential guilt;
• life in time;
• meaning and meaninglessness.

Representatives

One of the representatives of this psychotherapeutic trend is Viktor Frankl (1905-1997). His teaching is called “logotherapy” - a version of existential analysis, which means a person’s desire for meaning. There is a specific and non-specific scope of application of this method. The first includes neuroses, and the second includes various other diseases.

According to V. Frankl, a person strives for meaning in any situation. There are three basic concepts in this approach:

• free will (people retain basic freedom to make decisions);
• the will to meaning (a person not only has freedom, but he is free in order to achieve certain goals);
• the meaning of life (meaning is objective reality).

Frankl’s teaching highlights such a concept as values, which are the result of a generalization of typical situations in the history of society. He identifies three groups of values: creativity, experiences and relationships. The values ​​of creativity are realized through work. The values ​​of experience include love.

The main problem of logotherapy is the problem of responsibility. Having found meaning, a person is responsible for its implementation. The individual is required to make a decision: whether to implement this meaning in a given situation or not.

American psychologist R. May formulated the reasons for the development and characteristics of this direction. This scientist denied that existential psychotherapy is an independent branch of psychotherapy. J. Bugental sought to combine the principles of humanistic and existential psychotherapy and identified the main provisions of this direction:

1. 1. Behind any human problems lie deeper unconscious existential problems of freedom of choice and responsibility.
2. 2. This approach is to recognize the humanity in each individual and respect his uniqueness.
3. 3. The leading role is given to working with what is relevant at the present time.

Work in the existential direction

Anyone can seek existential therapy. It is important that the patient is actively involved in the process of exploring his life and is open and honest. This direction helps those who find themselves in crisis circumstances, when they do not see the meaning of existence and complain of apathy and depression. This type of psychotherapy is indicated for people who have experienced changes in their lifestyle or loss of loved ones. It helps those who suffer from acute or chronic somatic illnesses and mental pathologies, improving understanding and acceptance of changes due to illness.

A psychotherapist, working in this direction, studies behavior, speech, dreams and biography. Existential psychotherapy is carried out individually and in a group of 9-12 participants.

In most cases, work is carried out in a group, as it has a number of advantages over the individual form. Patients and therapists can obtain more information about a person through interpersonal communication, see inappropriate actions and correct them. In existential psychotherapy, group dynamics are important, which aims to identify how the behavior of each group member is viewed by other people, makes them feel, creates an opinion about the person and influences their self-image. Training in this area is carried out on the basis of basic psychological education.

Specialists do not impose their own thoughts on patients. The work of psychotherapist such as Irvin Yalom mentions the importance of implicit “infusions.” We are talking about those moments in the session when the consultant shows not only professional, but also human involvement in the patient’s problems. This turns the psychotherapeutic session into a friendly meeting.

To establish and maintain a good relationship with a client, a specialist needs to be fully involved in problematic situation, wisdom and concern, the ability to be involved as much as possible in the psychotherapeutic process. There is a question about the self-disclosure of the psychotherapist. A specialist can do this in two ways.

First, tell your interlocutors about your own attempts to come to terms with problems and preserve the best human qualities. Irvin Yalom says he made a mistake by rarely engaging in self-disclosure. As the author notes in his work “The Theory and Practice of Group Psychotherapy” (2000), every time he shared his experience with patients, the latter benefited for themselves.

Secondly, it is not necessary to focus on the content of the session. Therapists can simply use this time to apply thoughts and feelings that relate to what is currently happening to improve the therapist-patient relationship. Key points are will, acceptance of responsibility, attitude towards the therapist and involvement in life.

Methods and techniques

There are a large number of techniques for applying the concepts of this area. Their selection is made by a specialist based on their effectiveness, the client’s problem and individual characteristics. If some problems are not resolved by the psychotherapist himself, then he is incompetent in solving them and it is necessary to refer the patient to another.

There are techniques for working with existential anxieties: death, responsibility and freedom, isolation and meaninglessness. Sometimes other techniques are recommended. Their use can increase the effectiveness of psychotherapy.

Death

The technique of “giving permission to endure” is to make patients understand that discussing issues related to death is highly valued in counseling. This can be done by showing interest in self-disclosure in this area and by encouraging it.

The therapist does not need to encourage clients to deny death. It is necessary that these issues remain “in sight”.

The technique of working with defense mechanisms is that the psychotherapist tries to help patients recognize that they will not live forever. Such psychologists need to have persistence and the ability to choose the right time to help clients deal with and transform their childish and naive views on death.

Dream work is carried out by patients telling stories about their dreams. In dreams (especially in nightmares), various themes can unconsciously appear in an unsuppressed form, and the motif of death is often present in them. In this way, dreams are analyzed and discussed.

The technique of using auxiliary aids is that the patient is asked to write his own obituary or fill out a questionnaire with questions on the topic of death. The consultant may suggest that they fantasize about their death, imagining where, how and when they will meet it and how their funeral will go. Close to the previous one is the technique of reducing sensitivity (sensitivity) to death, according to which the psychotherapist helps to cope with the horror of death, repeatedly forcing one to experience this fear.

Responsibility and freedom

The technique for identifying types of defense and ways to evade responsibility is that the psychotherapist helps the client understand the functions of his behavior in the form of evading responsibility for choice. Sometimes the consultant, together with the patient, analyzes the responsibility for his own misfortunes and brings him face to face with it. This method involves when a person complains about a negative situation that has happened in his life, the therapist asks how he created it, and also focuses on the ways in which the interlocutor uses the language of avoiding responsibility (i.e., often says “I can’t” instead of “I don’t want to”).

The next technique focuses on the relationship between therapist and patient (identifying avoidance of responsibility). It consists in the fact that specialists bring clients face to face with their attempts to transfer responsibility for what happens within and outside of psychotherapy to the consultant. That is, many patients who seek help from a psychologist expect the therapist to do everything necessary work for them, sometimes treat him as a friend. By influencing the consultant's feelings in this way, the client shifts responsibility to the consultant.

The technique of facing the limitations of reality is that the therapist helps to identify areas of life that the patient can influence, despite difficulties. The specialist changes the setting to those restrictions that cannot be changed. It enables the interlocutor to accept the existing injustice.

Isolation and meaninglessness

Using the technique of working with isolation, a psychologist helps to understand that every person is born, develops and dies alone. Awareness of this concept affects changes in the quality of life and relationships in society. The psychotherapist invites the interlocutor to isolate himself from the outside world for a while and stay in isolation. As a result, clients become aware of loneliness and their hidden capabilities.

The problem redefinition technique is used when patients complain that life has no meaning. What they really mean is that life has meaning, but they can't find it. The therapist’s task in this case is to explain: there is no objective meaning in life, but man is responsible for creating it. The technique for identifying types of defense against anxiety and meaninglessness is that a specialist helps you become more aware of them. It is precisely these concepts that are often associated with the fact that patients do not take their lives seriously and create problems that have to be avoided.

Existential psychotherapy ( English existential therapy) - direction in psychotherapy, which aims to lead the patient to comprehend his life, realize his life values ​​and change his life path based on these values, taking full responsibility for his choice. Existential therapy originated in the 20th century as an application of ideas existential philosophy To psychology and psychotherapy/

Existential therapy, following philosophical existentialism, argues that a person’s life problems stem from human nature itself: from awareness the meaninglessness of existence and the need to search meaning of life; due to availability free will, the need to make a choice and the fear of being responsible for this choice; from an awareness of the indifference of the world, but the need to interact with it; due to inevitability death and natural fear in front of her. Famous modern existential therapist Irvin Yalom identifies just four key issues that existential therapy deals with: death,insulation,freedom And inner emptiness. All other psychological and behavioral problems of a person, according to supporters of existential therapy, stem from these key problems, and only the solution, or, more precisely, the acceptance and understanding of these key problems can bring a person true relief and fill his life with meaning.

A person’s life is viewed in existential therapy as a series of internal conflicts, the resolution of which leads to a rethinking of life values, the search for new paths in life, development human personality. In this light, internal conflicts and the resulting anxiety,depression,apathy, alienation and other conditions are considered not as problems and mental disorders, but as necessary natural stages for personality development. Depression, for example, is seen as a stage of loss of life values, opening the way for finding new values; anxiety and worry are seen as natural signs of the need to do something important life choice who will leave a person as soon as the choice is made. In this regard, the task of the existential therapist is to bring a person to an awareness of his deepest existential problems, to awaken philosophical reflection on these problems and to inspire the person to make the life choice necessary at this stage if the person hesitates and puts it off, “getting stuck” in anxiety and depression.

Existential therapy has no generally accepted therapeutic techniques. Existential therapy sessions typically take place in the form of a mutually respectful dialogue between therapist and patient. At the same time, the therapist in no case imposes any points of view on the patient, but only helps the patient to understand himself more deeply, draw his own conclusions, realize his individual characteristics, your needs and values ​​at this stage of life.

Methods and techniques of existential psychotherapy

Let us recall that I. Yalom defined existential psychotherapy as a psychodynamic approach. It should be noted right away that there are two important differences between existential and analytical psychodynamics. First, existential conflicts and existential anxiety arise as a result of the inevitable confrontation of people with the ultimate givens of existence: death, freedom, isolation and meaninglessness.

Second, existential dynamics does not imply the adoption of an evolutionary or “archaeological” model in which “first” is synonymous with “deep.” When existential psychotherapists and their clients engage in in-depth exploration, they do not focus on everyday concerns but reflect on core existential issues. Additionally, existential approaches can also be used to address issues related to freedom, responsibility, love, and creativity. [AND. Yalom writes that psychotherapeutic approaches “reflect the pathology that they can treat, and are shaped by that pathology.”]

In connection with the above, existential psychotherapy is mainly focused on long-term work. However, elements of an existential approach (for example, an emphasis on responsibility and authenticity) can also be included in relatively short-term psychotherapy (for example, associated with working with post-traumatic conditions).

Existential psychotherapy can be carried out both individually and in group form. Usually the group consists of 9-12 people. The advantages of the group form are that patients and psychotherapists have a wider opportunity to observe distortions that arise during interpersonal communication, inappropriate behavior and correct them. Group dynamics Existential therapy aims to identify and demonstrate how the behavior of each group member:

1) is considered by others;

2) makes others feel;

3) creates an opinion about him in others;

4) influences their opinion about themselves.

The greatest attention in both individual and group forms of existential psychotherapy is paid to quality psychotherapist-patient relationship. These relationships are considered not from the point of view of transference, but from the standpoint of the situation that has developed among patients to date, and the fears that torment patients at the moment.

Existential therapists describe their relationships with patients using words such as presence, authenticity And devotion. Individual existential counseling involves two real people. An existential psychotherapist is not a ghostly “reflector”, but a living person who strives to understand and feel the patient’s being. R. May believes that any psychotherapist is existential, who, despite his knowledge and skills, can relate to the patient in the same way as, in the words of L. Binswanger, “one existence relates to another.”

Existential psychotherapists do not impose their own thoughts and feelings on patients and do not use countertransference. This is due to the fact that patients may resort to various methods of provoking connection from psychotherapists, which allows them not to address their own problems. Yalom talks about the importance of implicit “infusions.” We are talking about those moments of psychotherapy when the therapist shows not only professional, but also sincere, human involvement in the problems of patients, thereby sometimes turning a standard session into a friendly meeting. In his case study (“Every Day Brings You A Little Closer”), Yalom examines such situations from both the perspective of a psychotherapist and the patient. Thus, he was amazed to learn how much importance one of his patients attached to such small personal details as warm glances and compliments about the way she looked. He writes that in order to establish and maintain a good relationship with a patient, a psychotherapist needs not only complete involvement in the situation, but also such qualities as concern, wisdom and the ability to be involved as much as possible in the psychotherapeutic process. The therapist helps the patient “by being trustworthy and interested; being affectionately present next to this person; trusting that their combined efforts will ultimately lead to correction and healing.”

The main goal of the psychotherapist is to establish an authentic relationship in the interests of the patient, so the question psychotherapist self-disclosure is one of the main ones in existential psychotherapy. Existential psychotherapists can reveal themselves in two ways.

First, they can talk to their patients about their own attempts to come to terms with extreme existential anxieties and preserve the best qualities of humanity. Yalom believes he made a mistake by engaging in self-disclosure too rarely. As he notes in The Theory and Practice of Group Psychotherapy (Yalom, 2000), whenever he shared a significant portion of his self with his patients, they invariably benefited from it.

Secondly, they can use the process of psychotherapy itself, rather than focusing on the content of the session. It is the use of thoughts and feelings about the here and now to improve the therapist-patient relationship.

Over the course of a number of psychotherapeutic sessions, patient A. demonstrated behavior that she herself regarded as natural and spontaneous, while other group members assessed it as infantile. She showed in every possible way her activity and willingness to work on herself and help others, described her feelings and emotions in detail and colorfully, and willingly supported any topic of group discussion. At the same time, all this was of a half-playful, half-serious nature, which made it possible to simultaneously provide some material for analysis and avoid a deeper immersion into it. The psychotherapist, suggesting that such “games” could be associated with the fear of approaching death, asked why she was trying to be either an experienced adult woman or a little girl. Her answer shocked the whole group: “When I was little, it seemed to me that my grandmother stood between me and something bad in life. Then my grandmother died and my mother took her place. Then, when my mother died, my older sister found herself between me and the bad one. And now, when my sister lives far away, I suddenly realized that there is no longer a barrier between me and the bad, I am standing face to face with him, and for my children I myself am such a barrier.”

In addition, the key processes of therapeutic change, according to Yalom, are will, acceptance of responsibility, attitude towards the therapist and involvement in life. Let's look at them using the example of working with each of the basic alarms.

The effectiveness of psychological counseling is understood as its final results for the client, namely, what in his psychology and behavior actually changed under the influence of counseling.

It is assumed that the results of psychological counseling in most cases are positive, at least as expected by the client and the consulting psychologist. However, expectations and hopes are one thing, reality is another matter. Sometimes an obvious positive, immediate result of psychological counseling may be absent and even at first glance seem negative. As a result of psychological counseling, something in the client’s psychology and behavior may actually change, but not immediately.

In addition, sometimes there are unforeseen, unexpected, negative results of psychological counseling. This often happens when something significant in counseling is not sufficiently thought out in advance from the point of view of possible negative consequences, or when psychological counseling is carried out by a professionally unprepared and insufficiently experienced psychologist. However, due to the rarity of negative results in psychological counseling, we will not specifically discuss such cases and will focus our attention only on cases with a positive or neutral outcome of counseling.

The positive result of psychological counseling can be judged by a number of signs.

A positive, optimal solution that satisfies both the consulting psychologist and the client to the problem with which the client turned to psychological counseling.

The effectiveness of the result is confirmed by the totality of positive results.

At the end of the consultation, both parties - the consultant and the client - recognize that the problem for which the consultation was carried out has been successfully resolved, and there is convincing objective evidence for this. Neither the counseling psychologist nor the client requires any additional arguments in favor of the fact that the counseling was truly successful.

A consulting psychologist may believe that the counseling was successful and the client’s problem has been solved, while the client himself may doubt this, deny it, or not fully experience the real results of psychological counseling.

Sometimes, on the contrary, the client thinks that as a result of counseling he has completely managed to cope with his problem, while the psychological consultant doubts this and insists on continuing the consultation, wanting to receive additional convincing evidence that the client’s problem has indeed been successfully solved.

Positive changes in those aspects of the client’s psychology and behavior, the regulation of which psychological counseling was directly aimed at regulating. This refers to the main, predictable and possible additional, positive effects obtained from psychological counseling.

The fact is that, while influencing some psychological processes and forms of behavior of the client, counseling can significantly affect others. As a rule, in the case when positive results of the impact of psychological counseling on the client’s personality are discovered, his behavior, relationships with people and much more in his psychology also change. Improving a client's memory usually has a positive effect on his intelligence, although it is also possible that intelligence has a reverse effect on memory.

Often in the practice of psychological counseling, along with its indisputable positive results, there are problematic and controversial aspects of assessing its results.

Let us note that, according to its results, psychological counseling can manifest itself in other ways: objectively, subjectively, internally and externally.

Objective signs of the effectiveness of psychological counseling are manifested in the fact that it is accompanied by reliable facts indicating the success of counseling.

Subjective signs of the effectiveness of psychological counseling are manifested in the feelings, sensations, opinions and ideas of the consultant.

Internal signs of the effectiveness of psychological counseling are manifested in changes in the client’s psychology. They may be felt (realized) or not felt (not realized) by the client, they may or may not appear in his real behavior, in the actions and actions of the client that are accessible to external observation.

External signs of the effectiveness of psychological counseling, on the contrary, always and quite clearly manifest themselves in visible forms of behavior that are accessible to direct observation and assessment.