Process & Goals

The process of therapy, as I understand and practise it, involves reflection on oneself, one's thoughts and feelings and choices, on how one relates to others and to one's environment and on how one operates in the world.

The aims of therapy are broadly to increase our self-understanding, to reduce our futile suffering, to understand our possibilities and to clarify our path through life.

Therapy involves an exploration of three inter-related areas:

a) on a person's actual lived experience;

b) on how a person interprets and understands their experience;

c) on how a person finds, or has difficulty finding, direction and value in life.

More pragmatically and where appropriate - for example, where a person is suffering from overwhelming moods and emotions; intrusive thoughts and feelings; or impulsive, compulsive and/or addictive behaviours - there may be a specific focus

d) on symptom reduction.

Activities

The conversations that we have in therapy are different from the kind of conversations that we normally have in everyday life. They aim to facilitate three important therapeutic activities:

a) reflection

- the process of being attentive to whatever we are actually experiencing in aspects of our lives, physically and emotionally; particularly those areas of experience which normally fall under the radar of our awareness.

b) thinking

- becoming aware of how we normally make sense of our experience; being able to put this into words; perhaps starting to question things and, if appropriate, challenge ourselves on some of this.

c) decision

- determining what we believe to be truly important in life, understanding the things we truly value; thinking through how we can use this understanding to decide upon the directions we would like to take and how we would like to confront our problems.

Core conditions of human life - a note on existential thinking

Existential therapy places emphasis on the core conditions (or givens) of life and the challenges that these conditions pose to human beings. Psychological suffering arises from our encounter with these challenges. It is also assumed that through working with these challenges a person can arrive at satisfaction and fulfilment.

a) Embodiment and environment

We are physical beings with a basic dependence on the physical world and on the intervention of others for the fulfilment of our needs. Furthermore, everything we have and everything we are is subject to decay and loss. Denial of our basic vulnerability and mortality can lead us to waste the limited and uncertain time we have available to us in life; acceptance challenges us to live in ways which are meaningful and valued.

b) Relations with others

Our sense of who we are and what it is possible for us to achieve is initimately bound up with the fact that we live in a world of other people. To navigate our way through life is to enter into all sorts of different relations to other people, some of whom will inspire the deepest emotions in us. We often look to others for validation of who we are and can suffer greatly when we feel that others do not value us. We can respond to this vulnerability in many ways, from the extreme of total isolation to that of total submersion in conformity with a group culture

c) The separateness of the self

Within the first two to four years of our lives, we start to understand that there is separation between ourselves and others, that our thoughts and feelings are our own and that they cannot always be read by other people. From now on, all our experiences have a certain taste of "me-ness" permeating through them, as if there is an invisible boundary separating an inner, private world from the external world of people and events.

d) The creation of meaning

Life is meaningful because human beings create and choose meaning. To be conscious is to be capable of having experiences; but human beings go further than this in that we take up attitudes towards our experiences. To have an attitude towards some object or person or event is to experience this as personally meaningful, even if this attitude is only one of boredom or indifference. Thus all our experiences, however insignificant they may seem, are personally meaningful; and, wherever we encounter something as meaningful, we have also, on some level, assigned value to it.

A note on narrative therapy

Where CBT aims to identify habitual thinking patterns, narrative therapy listens to the ways in which people tell their story or, in other words, construct narratives about themselves and the lives they live. Even the simplest narratives have underlying principles of construction: in telling a friend about what I did at the weekend, I make decisions, often without being fully aware of it, about what I should include and what I should leave out, which aspects I emphasise, the effect that I want the story to have on the listener.

Like certain habits of thinking, narrative constructions become habitual and automatic. To take a simple example: suppose during my life I have done a number of things that I consider to be failures, then I might start to see my life as a story about failure. I begin to give more emphasis to moments of failure and less to those times when I succeeded or when success and failure were not important. I start to see myself as a failure and I come to expect that what I do in the future will also fail. The narrative that I have constructed as a way of understanding my experience becomes a self-fulfilling prophecy.

Working from this perspective in therapy also allows the therapist and the client to think about external narratives - the narratives of family and peer groups, social and cultural narratives - and the ways in which these can impact on the client's personal narrative. I find this particularly relevant as an approach when working with issues of identity and direction in life.