Leave it to a medical doctor to add something as substantial to the human experience as existential factors as “almost an afterthought” in his list of primary therapeutic factors for successful group psychotherapy (Yalom, 2005, p. 98). One can hardly fault Yalom for doing this. “Ultimate questions,” i.e. questions that are subsumed in the label “existential factors”— like about the meaning of life, death, our own aloneness and utter responsibility for our lives— are hard to quantify. Medical doctors are, after all, part healer and part scientist. But in the pursuit of healing, Yalom noticed that something was missing that he recognized as “important sentiments expressed by both clients and therapists” (Yalom, 2005). To account for these sentiments Yalom added a factor that included “these five items:
- Recognizing that life is at times unfair and unjust
- Recognizing that ultimately there is no escape from some of life’s pain or from death
- Recognizing that no matter how close I get to other people, I still face life alone
- Facing the basic issues of my life and death, and thus living my life more honestly and being less caught up in trivialities
- Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others” (Yalom, 2005).
These five elements account for the major themes of existentialist philosophy and give a good framework for using them in the healing process of group therapy.
Yalom further illuminated these principles of existentialism and how they work themselves out in group therapy in an interview that was published in the Journal of Psychotherapy in the summer of 2005, just before the 5th edition of The Theory and Method of Group Psychotherapy was released. Yalom pointed out in this interview that much of the work that is done in group therapy within the realm of existential concerns cannot be put in a treatment manual since so much of it requires immediacy, genuineness and spontaneity (Overholser, 2005). Furthermore, he noted that while he views existentialism factors as an important aspect of group psychotherapy, he has never understood existential psychotherapy as a free-standing therapy “akin to schools like cognitive-behavioral.” He also asserted that “existential sensibilities” have to be “grafted onto or added onto a well-trained, well-rounded, dynamic psychotherapist” in order for them to be maximally useful in the group experience (Overholser, 2005).
The idea that existential factors may be “useful” in group therapy was explored in a short article entitled Existential Group Therapy as a Treatment Modality for Exiting Christian Fundamentalists (Brent, J. S. 1991). This article deals with a group therapy scenario wherein the members were tackling the problem of separating themselves from a system of belief that unequivocally answers all of the existential questions/problems raised by Yalom’s existential factors 5 items; thus, freeing adherents from their responsibility (Yalom’s item 5) and their freedom. It illustrates how the “fundamentalist” worldview is “acutely unable to tolerate ambiguity and uncertainty in life” and how existential thought can be used to help group members become more “authentic” and “courageous” despite how this may bring on “deep anxiety” that was previously masked by the “certainty” of their religious faith (Brent, J.S. 1991, p. 2). In other words, religion can be a way to escape existential responsibility for our lives.
Conversely, healthy religious faith can be useful in providing a framework for dealing with existential factors. Gerdenio M. Manuel dealt with how religion can be useful along these lines in his article entitled Group Process and the Catholic Rites of Reconciliation (1991). He argues that group curative factors as described by Yalom are present in the rites of the Catholic religion in general and specifically in their Rites of Reconciliation (Manuel, 1991, p. 125). Quoting Yalom, Manuel agrees with him and notes that what most people in group report to be “the most difficult to share” is a “deep conviction of basic inadequacy” and a “deep sense of interpersonal alienation” (aloneness) (Manuel, 1991; Yalom, 2005, p.8). Therefore, it is argued by Manuel that what both the Rites of Reconciliation and the group therapeutic process are attempting to ameliorate are the same. Generally speaking, religious faith can be useful in dealing with existential factors in group therapy.
At this intersection of existential factors and religion[1] one will likely find their value system. Bernard Frankel, in his article entitled Existential Issues in Group Psychotherapy, points out how existential thought is both a philosophy and a values system (Frankel, 2002). He argues that in an age of increasing alienation of “man from himself” the features of existentialism can be applied as a unifying values system, something that Christianity used to provide for the Western world (Frankel, 2002). A component of this new existential value system is the search for meaning. Frankel suggests that a cooperative search for meaning helps group members to establish and clarify their values system and move forward in the therapeutic experience (Frankel, 2002, p. 218).
This search for meaning out of life is fundamental task that readily comes to mind when speaking of existential philosophy. As Frankel (2002) says “our common fate is mortality” and this, in part, is what binds group members together in the common search for meaning. Victor Frankl’s Logotherapy is thus defined as a system of therapy where this need to have a meaningful existence is leveraged for therapeutic work, what he called “will to meaning” (Frankl, 2006). For Yalom, on the other hand, this knowledge of our own mortality is not fundamental, nor is meaning making the primary therapeutic task (Overholster, 2005).
Nevertheless, Yalom has been deeply committed to the pursuit of existential concerns in his work. In fact, the integration of these multiple, perhaps disparate, aspects of the application of Yalom’s existential factors can be found in Yalom’s famous book Love’s Executioner (1989). In Love’s Executioner, Yalom describes his therapeutic relationship with ten clients. Each of these clients has a particularly poignant clinical issue that touches upon the fundamental existential experience. This book moves the reader from the textbook description of what existential factors are right into the immediate experience of them in therapy. And more than anything else, the existential factors concern immediate states of existence and how group and therapist deal with and make meaning of the five items subsumed by existential factors.
Personal Reflection
The existentialist/humanist psychotherapist owes a debt of gratitude to existentialist philosophers such as Jean Paul Sartre, Frederick Nietzsche, and Martin Heidegger. Each of these groundbreakers in modern philosophy gave shape to the way that postmodern persons think about their own existence. Nietzsche (1844-1900) gave us the Übermensch (the Humanist Superman) , and the “death of God” with its perspectivism[2]; Heidegger (1889-1976) gave us the word and, perhaps, the concept of Dasein (existence), which can easily be distilled into the concept of a “here-and-now” focus without doing all that much damage to the root concept. Certainly Heidegger seems to have understood Dasein as active, like what happens in the here-and-now focus of a psychodynamic group therapy session—it is part and parcel of the group existential. Sartre (1905-1980) dealt with freedom and responsibility. In his seminal lecture l’Existentialisme est un humanisme (Existentialism is a Humanism) Sartre explained his belief that freedom entails total responsibility (http://www.marxists.org/reference/archive/sartre/works/exist/sartre.htm). For Sartre this meant, in part, that no divine power could be thanked or blamed for our personal existential state. In fact, he theorized that our existence precedes our essence; or rather the brute fact that we are physically present in the world comes before any meaning at all is assigned to that presence (existence). This is the Atheist, and sometimes humanistic position with regard to the assignment of responsibility for one’s life. All of the therapeutic movement that we expect to see happen in clients is predicated on this belief, at least under Yalom’s framework. To summarize, I mean to say that each of these notable philosophers emphasized a part of the intellectual underpinning of what we now take for granted as necessary in a psychodynamic/interpersonal type group: each group member’s perspective, a here-and-now focus, and personal responsibility.
Perhaps more closely associated with asking the kinds of questions that Yalom means to address with his therapeutic dimension of Existential Factors was an earlier philosopher by the name of Soren Kierkegaard. In Kierkegaard’s (1813-1855) famous book Fear and Trembling, he dealt with the very poignant existential problem encountered by the great Patriarch of the Judeo-Christian faith, Abraham. The book is about “working out” one’s salvation, hence, the title Fear and Trembling is taken from a biblical passage in the New Testament that reads “…continue to work out your salvation with fear and trembling” (Philippians 2:12). In the first part of the book Kierkegaard lays out Abraham’s problem: Yahweh (or so Abraham believed) has told Abraham to sacrifice (i.e. kill) his beloved son Isaac on a sacrificial mound.
This frightful story, of course, brings forth a moral problem of the first order. It is what philosophers might call a Teleological problem; Teleology being the study of design and purpose. Therefore the first order problem in this case is “Whose morality is higher? Humanity’s, which says do not kill your son? Or Yahweh’s whose morality, at least in this case, requires a blood sacrifice?” This striking teleological questioning is at the extreme end of what I think happens on a much smaller scale in any mundane psychotherapy group.
Indeed, I think it is a rare case when a person comes to a psychotherapy group already convinced of the alternative to some kind of personal Teleology. The alternative is the metaphysical naturalist position that says all of nature has no design or purpose—this is not common, even among Atheists. For the truth is that we all seem to crave some meaning, some design and/or purpose and when in a psychotherapy group this craving becomes all the more relevant and universal. We bring Nietzsche’s disparate perspectives, we employ Heidegger’s Dasein (working in the here-and-now), and Sartre’s utterly irreligious sense of personal responsibility… and yet we still long for a deeper, more universal purpose and meaning in our conversations about, for instance, the end of life.
The enormous existential problem wherein stems all of our root anxiety, or what the existentialist philosophers often called dread is the knowledge of our own death. Kierkegaard’s antidote to this dread was each human being’s own rationality, which he argued would serve in dealing with it as far as it was adequate. But he also said that at the end of the day our rationality is inadequate to deal with existential problems such as death— and I agree (Kierkegaard, S., 1978). When the group’s therapeutic task is to come to a place of acceptance and comfort around the grim reality of death, it seems axiomatic that the comfort will come, at least in part, in the realm of the irrational, i.e. the realm of faith, superstition, tradition, legend, etc. I do not believe that this principle is mitigated or changed in any way by race, gender, age, sexual orientation, culture or ethnicity—it simply strikes at the core of us all. That being said, I think it is especially important for group therapists of all religious (or nonreligious) backgrounds to thoroughly examine their own biases when dealing with existential factors. As I have pointed out, “existential problems” are enormous and “existential answers” are deeply personal—what Yalom might refer to as the “subjective experience of the client,” but a more sacred subjective experience since it deals with subjective ultimate reality. (Yalom, 1980).
As mentioned previously in this paper, religion can work for or against the existential therapeutic work. On the one hand religion can provide existential answers, but on the other hand, as was in the case in the fundamentalist article, religion can deny us our authenticity and ability to deal with existential issues. Either way, if the group members are to feel completely at liberty to explore Yalom’s existential factors safely, religious belief cannot be taboo, it is simply too closely related to existentialist questions and answers.
[1] a set of beliefs concerning the cause, nature, and purpose of the universe, esp. when considered as the creation of a superhuman agency or agencies, usually involving devotional and ritual observances, and often containing a moral code governing the conduct of human affairs. http://dictionary.reference.com/browse/religion
[2] Nietzsche believed that the loss of belief, i.e. the “death of God” would cause human beings to lose all “perspective” and that society as a whole would then degenerate into many, disparate perspectives with no unifying base to any of it. The famous pop song Locomotive Breath by Jethro Tull is a nod to Nietzsche’s perspectivism.
Brock, G. (1990). Ritual and Vulnerability. Journal of Religion and Health, 29(4), 285-295.
Frankl, V. E. (2006). Man’s Search for Meaning (1st ed.). Beacon Press.
Kierkegaard, S. (1978). Soren Kierkegaard’s Journals and Papers, Vol. 5: Autobiographical, Part 1: 1829-1848. Indiana University Press.
Manuel, G. M. (1991). Group Process and the Catholic Rites of Reconciliation. Journal of Religion and Health, 30(2), 119-129.
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Yalom, I. D., & Leszcz, M. (2005). Theory and Practice of Group Psychotherapy, Fifth Edition (Fifth Edition.). Basic Books.
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