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Existential–Humanistic Therapy
Second Edition
 Theories of Psychotherapy Series
Acceptance and Commitment Therapy
Steven C. Hayes and Jason Lillis
Adlerian Psychotherapy
Jon Carlson and Matt Englar-Carlson
The Basics of Psychotherapy: An Introduction to Theory and Practice
Bruce E. Wampold
Behavior Therapy
Martin M. Antony and Lizabeth Roemer
Brief Dynamic Therapy, Second Edition
Hanna Levenson
Career Counseling
Mark L. Savickas
Cognitive–Behavioral Therapy, Second Edition
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Cognitive Therapy
Keith S. Dobson
Emotion-Focused Therapy, Revised Edition
Leslie S. Greenberg
Existential–Humanistic Therapy, Second Edition
Kirk J. Schneider and Orah T. Krug
Family Therapy
William J. Doherty and Susan H. McDaniel
Feminist Therapy
Laura S. Brown
Gestalt Therapy
Gordon Wheeler and Lena Axelsson
Interpersonal Psychotherapy
Ellen Frank and Jessica C. Levenson
Narrative Therapy
Stephen Madigan
Person-Centered Psychotherapies
David J. Cain
Psychoanalysis and Psychoanalytic Therapies
Jeremy D. Safran
Psychotherapy Case Formulation
Tracy D. Eells
Psychotherapy Integration
George Stricker
Rational Emotive Behavior Therapy
Albert Ellis and Debbie Joffe Ellis
Reality Therapy
Robert E. Wubbolding
Relational–Cultural Therapy
Judith V. Jordan
APA Theories_Schneider_Existential-Humanistic_2ndEd Title 4/12/17 12:46 PM Page 2

Theories of Psychotherapy Series

Jon Carlson and Matt Englar-Carlson, Series Editors

Existential–Humanistic
Therapy
Second Edition

Kirk J. Schneider and Orah T. Krug

American Psychological Association

Washington, DC
Copyright © 2017 by the American Psychological Association. All rights reserved. Except
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Library of Congress Cataloging-in-Publication Data
Names: Schneider, Kirk J., author. | Krug, Orah T., author.
Title: Existential-humanistic therapy / Kirk J. Schneider and Orah T. Krug.
Description: Second edition. | Washington, DC : American Psychological
Association, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2016058351| ISBN 9781433827372 | ISBN 1433827379
Subjects: LCSH: Existential psychology. | Humanistic psychology. |
Existential psychotherapy.
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Second Edition
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 Contents

Series Preface ix
How to Use This Book With APA Psychotherapy Videos xiii
1. Introduction 3
2. History 7
3. Theory 15
4. Therapy Process 37
5. Evaluation 97
6. Future Developments 109
7. Summary 115
Appendix A. Short-Term Case 2: Hamilton 121
Appendix B. Phases of Change in a Typical Long-Term
Existential Therapy 127
Appendix C. Long-Term Case 2: Claudia 131
Appendix D. Summary of Experiential Stances
of the Existential–Integrative Model 145
Glossary of Key Terms 149
Suggested Readings and Resources 155

vii
 Contents

References 157
Index 173
About the Authors 185
About the Series Editors 187

viii
 Series Preface

S ome might argue that in the contemporary clinical practice of psy-

chotherapy, evidence-based intervention and effective outcome have
overshadowed theory in importance. Maybe. But, as the editors of this
series, we don’t propose to take up that controversy here. We do know that
psychotherapists adopt and practice according to one theory or another
because their experience, and decades of good evidence, suggests that hav-
ing a sound theory of psychotherapy leads to greater therapeutic success.
Still, the role of theory in the helping process can be hard to explain. This
narrative about solving problems helps convey theory’s importance:

Aesop tells the fable of the sun and wind having a contest to decide
who was the most powerful. From above the earth, they spotted a
man walking down the street, and the wind said that he bet he could
get the man’s coat off. The sun agreed to the contest. The wind blew,
and the man held on tightly to his coat. The more the wind blew, the
tighter he held. The sun said it was his turn. He put all of his energy
into creating warm sunshine, and soon the man took off his coat.

What does a competition between the sun and the wind to remove a
man’s coat have to do with theories of psychotherapy? We think this decep-
tively simple story highlights the importance of theory as the precursor
to any effective intervention—and hence to a favorable outcome. With-
out a guiding theory, we might treat the symptom without understanding

ix
 Series Preface

the role of the individual. Or we might create power conflicts with our
clients and not understand that, at times, indirect means of helping (sun-
shine) are often as effective—if not more so—than direct ones (wind). In
the absence of theory, we might lose track of the treatment rationale and
instead get caught up in, for example, social correctness and not wanting
to do something that looks too simple.
What, exactly, is theory? The APA Dictionary of Psychology (Second
Ed.) defines theory as “a principle or body of interrelated principles that
purports to explain or predict a number of interrelated phenomena”
(VandenBos, 2015, p. 1081). In psychotherapy, a theory is a set of princi-
ples used to explain human thought and behavior, including what causes
people to change. In practice, a theory creates the goals of therapy and
specifies how to pursue them. Haley (1997) noted that a theory of psycho-
therapy ought to be simple enough for the average therapist to understand
but comprehensive enough to account for a wide range of eventualities.
Furthermore, a theory guides action toward successful outcomes while
generating hope in both the therapist and client that recovery is possible.
Theory is the compass that allows psychotherapists to navigate the
vast territory of clinical practice. In the same ways that navigational tools
have been modified to adapt to advances in thinking and ever-expanding
territories to explore, theories of psychotherapy have changed over time.
The different schools of theory are commonly referred to as waves, the first
wave being psychodynamic theories (i.e., Adlerian, psychoanalytic), the sec-
ond wave learning theories (i.e., behavioral, cognitive–behavioral), the third
wave humanistic theories (person-centered, gestalt, existential), the fourth
wave feminist and multicultural theories, and the fifth wave postmodern
and constructivist theories (i.e., narrative, solution-focused). In many ways,
these waves represent how psychotherapy has adapted and responded to
changes in psychology, society, and epistemology as well as to changes in the
nature of psychotherapy itself. Psychotherapy and the theories that guide it
are dynamic and responsive. The wide variety of theories is also testament to
the different ways in which the same human behavior can be conceptualized
(Frew & Spiegler, 2012).
It is with these two concepts in mind—the central importance
of theory and the natural evolution of theoretical thinking—that we

x
 Series Preface

developed the American Psychological Association (APA) Theories of

Psychotherapy Series. Both of us are thoroughly fascinated by theory and
the range of complex ideas that drive each model. As university faculty
members who teach courses on the theories of psychotherapy, we wanted
to create learning materials that not only highlight the essence of the major
theories for professionals and professionals in training but also clearly
bring the reader up to date on the current status of the models. Often in
books on theory, the biography of the original theorist overshadows the
evolution of the model. In contrast, our intent is to highlight the contem-
porary uses of the theories as well as their history and context. Further, we
wanted each theory to be reflected through the process of working with
clients who reflect the full range of human diversity.
As this project began, we faced two immediate decisions: which theo-
ries to address and who best to present them. We looked at graduate-
level courses on theories of psychotherapy to see which theories are
being taught, and we explored popular scholarly books, articles, and
conferences to determine which theories draw the most interest. We then
developed a dream list of authors from among the best minds in contem-
porary theoretical practice. Each author is one of the leading proponents
of that approach as well as a knowledgeable practitioner. We asked each
author to review the core constructs of the theory, bring the theory into
the modern sphere of clinical practice by looking at it through a context
of evidence-based practice, and clearly illustrate how the theory looks
in action.
Each title in the series can stand alone or be grouped together with
other titles to create materials for a course in psychotherapy theories. This
option allows instructors to create a course featuring the approaches they
believe are the most salient today. To support this end, APA Books has
also developed a DVD for most of the approaches that demonstrates the
theory in practice with a real client. Many of the DVDs show therapy over
six sessions. Contact APA Books for a complete list of available DVD pro-
grams (http://www.apa.org/pubs/videos).
In this monograph, Kirk Schneider and Orah Krug show how existential–
humanistic psychotherapy provides effective treatment in contemporary
psychological practice. This is an approach that integrates not only existential

xi
 Series Preface

and humanistic theories but also strategies and techniques from other
contemporary approaches. Schneider and Krug discuss numerous cases
that assist readers in understanding how this approach, rooted in phi-
losophy, is also very practical for a wide range of clients. They highlight
how the struggles of existence are often at the root of so much of our
psychological suffering. As their case studies unfold, Schneider and Krug
help readers gain familiarity with this theory, see how it looks in practice,
and understand how integration occurs. Both authors use their extensive
experience to provide a clear and concise delineation of the theory and
practice of existential–humanistic therapy.
—Jon Carlson and Matt Englar-Carlson

xii
 How to Use This Book With
APA Psychotherapy Videos

E ach book in the American Psychological Association (APA) Theories

of Psychotherapy Series is paired with a DVD that demonstrates the
theory applied in actual therapy with a real client. Many DVDs feature
the author of the book as the guest therapist, allowing students to see an
eminent scholar and practitioner putting the theory he or she writes about
into action.
The DVDs have a number of features that make them excellent tools
for learning more about theoretical concepts:

77 Many DVDs contain six full sessions of psychotherapy over time, giving
viewers a chance to see how clients respond to the application of the
theory over the course of several sessions.
77 Each DVD has a brief introductory discussion recapping the basic fea-
tures of the theory behind the approach demonstrated. This feature
allows viewers to review the key aspects of the approach about which
they have just read.
77 DVDs feature actual clients in unedited psychotherapy sessions. This
provides a unique opportunity to get a sense of the look and feel of real
psychotherapy, something that written case examples and transcripts
sometimes cannot convey.
77 There is a therapist commentary track that viewers may choose to play
during the psychotherapy sessions. This track gives unique insight into
why therapists do what they do in a session. Further, it provides an

xiii
 How to Use This Book With APA Psychotherapy Videos

in vivo opportunity to see how the therapist uses the model to concep-
tualize the client.

The books and DVDs together make a powerful teaching tool for
showing how theoretical principles affect practice. In the case of this book,
the DVD Existential–Humanistic Therapy Over Time, which features lead
author Kirk Schneider as the guest expert, provides a vivid example of
how this approach looks in practice.

xiv
APA Theories_Schneider_Existential-Humanistic_2ndEd Title 4/12/17 12:46 PM Page 1

Existential–Humanistic Therapy
Second Edition
 1

Introduction

Those with outward courage dare to die; those

with inward courage dare to live.
—Lao Tzu

H ow shall we live? What really matters to us? How can we pursue what
really matters? As the quote that opens this chapter implies, this
book is about the inward courage to live. Existential–humanistic (E–H)
therapy is about helping people reclaim and reown their lives.
The basic principles of E–H therapy are an expansion on the basic
principles of all therapies that point beyond the conventional emphasis
on external, mechanical change. In this way, E–H therapy is increasingly
becoming an existential–integrative (E–I) therapy. By existential–integrative
therapy, we mean the coordination of a range of modalities within an overall

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Existential–Humanistic Therapy, Second Edition, by K. J. Schneider and O. T. Krug
Copyright © 2017 by the American Psychological Association. All rights reserved.

3
 EXISTENTIAL–HUMANISTIC THERAPY

existential–humanistic context (Schneider, 2016; Shahar & Schiller, 2016a;

Wolfe, 2016). Another way to put this is that beyond the traditional E–H
emphasis on therapeutic exploration, E–I therapy opens to a variety of bona
fide modalities. The question for these modalities, however, is Do they per-
tain to this given individual in this given relational setting? Correspond-
ingly, E–I therapy augments more conventional therapeutic strategies by
contextualizing them with fuller or deeper possibilities for exploration.1
For example, E–H therapy expands on medical intervention by invit-
ing reflection on the meaning of the intervention. Hence, if a withdrawn
person uses fluoxetine to transform herself into a sociable person, the
existential therapist might invite a dialogue with that person about the
subjective meaning of that change. Is this the change that the person genu-
inely desires, or is this a change that is dictated by her peer group, culture,
or employer, without essential reference to herself? And if this is not the
change that the person deeply desires, what is that change? How can it be
engaged? What is one’s willingness to deal with its consequences?
Or correspondingly, what if a depressed person uses a cognitive–
behavioral strategy, such as rational reframing, to exhibit positive thoughts
and behaviors? The existential therapist in such a case might question
what “positive” means for that person. Does it mean a change that is endur-
ing, enriching, or emotionally and physically fulfilling? Or does it mean
a change that is expedient, convenient, or easy to assimilate? What are
the consequences of such a change—a simpler but less reflective life, or a
manageable but jaded life? Existential therapists do not provide answers
but help people address questions.
The way in which E–H therapists help people address these questions
is also a unique part of our approach. It may seem from the preceding
paragraph that we engage our clients primarily in an intellectual dialogue,
but that is not the case. Instead, we focus on the unfolding process in the
living moment. We carefully attune to how our clients relate to themselves
and to us, appropriately reflecting back aspects of themselves that are evi-
dent but unnoticed. We take note if our client is self-critical or indecisive.

1 Unless otherwise indicated, the abbreviation E–H will from now on imply the contemporary
existential–humanistic/integrative perspective described in this paragraph.

4
 Introduction

Does he relate to us in a dependent manner or in a detached or aloof

manner? How does he occupy his personal space—with hesitation and
constraint, or with confidence and pluck?
Why do we focus our attention in this way? Because we assume that
not only is our client before us, but so is her life: her wish to live and her
awareness of death, her yearning for connection and her fear of rejec-
tion, her desire to change and her fear of the unknown. We believe that
the meanings our client has made of her past experiences and life condi-
tions are alive in the living moment, some more conscious than others,
expressed in her body, her voice, her behavior, her values and attitudes.
Everything she says or does reflects her relationship to herself, to others,
and to her world in general. If we can deeply attune to her and help her be
more present, she will more likely connect with what really matters to her
and, as a result, revitalize her life.
These, then, are the mooring points, the enlarged frames, within
which E–H therapy operates. The question as to who or what is making
a change—for example, the medication, the logical argument, the peer
group, or the person himself or herself—is pivotal from the E–H stand-
point, but so is the question of how change is pursued—that is, the “soup”
or medium within which it is explored.
As we shall see, E–H therapy as an integrative therapy is beginning
to exert a broad influence on clinical psychology as a whole, and not just
within its traditional domain of E–H practitioners (Shahar & Schiller,
2016a; Wampold, 2008). Accompany us now as we enter full throttle into
the heart of E–H practice, a practice that embraces the questions we have
posed here: How shall you live? What really matters to you? How do you go
about cultivating what really matters? These are issues that press upon each
of us, but especially therapy clients who yearn for a full and meaningful life.
This is a life beyond the expedient and mechanical, one that embraces the
maximal spectrum of human possibilities from love to death and fear to joy.
The focus of this book accordingly is on E–H therapy, which is one
particular expression of the global existential therapy that has evolved
since the days of Freud. Although myriad forms of existential therapy
are discussed and applied throughout the world (e.g., see Cooper, 2017),
E–H therapy has a distinctly American character (e.g., see J. F. T. Bugental,

5
 EXISTENTIAL–HUMANISTIC THERAPY

1987; Burston, 2003; Cooper, 2017), and that is what we will largely con-
fine ourselves to in this volume.
What are the distinguishing factors of E–H therapy? Although we will
expand on this concept throughout this text, here we provide a thumbnail
sketch: E–H therapy is an amalgam of European humanistic and exis-
tential philosophy and American humanistic psychology. Consolidated in
the early 1960s, E–H therapy welds the European heritage of self-inquiry,
struggle, and responsibility with the American tradition of spontane-
ity, optimism, and practicality. Brought together, E–H therapy forms a
dynamic and timely stew.
In the chapters that follow, we examine the history, theoretical frame-
work, and practical application of E–H therapy as it is currently under-
stood by a diverse and growing constituency. This constituency, comprising
both practitioners and clients, extends to a surprisingly broad cultural and
diagnostic arena, and it is increasingly challenging stereotypes. One stereo-
type is that E–H practice is a “highbrow” form of philosophy, relevant only
to cultural elites. Another stereotype is that E–H practice is hyperindivid-
ualistic and does not validate connections between people. Still another
presumption is that E–H psychotherapy is capricious and undisciplined.
Although these stereotypes might seem to have some legitimacy, particu-
larly in the context of certain delimited influences from the human poten-
tial movement of the 1960s (Moss, 2015), they ring increasingly hollow
(Burston, 2003; O’Hara, 2015; Schneider, 2008).
As we shall see, today’s E–H therapy is applicable to a wide array of
settings, diagnostic populations, and ethnicities (see especially Chapter 4,
this volume), and because the personal and interpersonal context is at the
core of E–H training, it is becoming an increasing influence on the thera-
peutic profession as a whole (Krug & Schneider, 2016; Schneider, 2008;
Schneider & Längle, 2012; Wampold, 2008).
“Expanded horizons notwithstanding,” as Mendelowitz and Schneider
(2008) put it, “contemporary existential [humanistic] psychology shares
with its predecessors this bedrock value; the uncanny core to be found at
the heart of existence and the spirit of inquiry that resides at the deepest
levels of consciousness” (p. 303). We shall now turn to this “uncanny core”
and its legacy of literary, philosophical, and psychological depth.

6
 2

History

E xistential–humanistic (E–H) theory is rooted in the deepest recesses

of recorded time. All who have addressed the question of what it
means to be fully and subjectively alive have partaken in the E–H quest.
Existentialism derives from the Latin root ex-sistere, which means to “stand
forth” or “become” (May, 1958b, p. 12), whereas humanism originates in
the ancient Greek tradition of “knowing thyself ” (Grondin, 1995, p. 112).
Therefore, existential humanism can be understood as a process of becom-
ing and knowing oneself.
In the early 1960s, American humanistic psychology drew on both
humanism and existentialism to bring a new dimension to psychology. This
dimension opposed what it viewed as reductionist trends in psycho­analysis
and behaviorism and emphasized such qualities as choice, spontaneity of

Portions of this chapter were excerpted or adapted from “Existential–Humanistic Psychotherapies,” by

K. Schneider, 2003, in A. Gurman & S. Messer (Eds.), Essential Psychotherapies (2nd ed., pp. 149–181),
New York, NY: Guilford Press. Copyright © 2003 by Guilford Press. Adapted with permission.
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Existential–Humanistic Therapy, Second Edition, by K. J. Schneider and O. T. Krug
Copyright © 2017 by the American Psychological Association. All rights reserved.

7
 EXISTENTIAL–HUMANISTIC THERAPY

expression, and transcendence. But it also emphasized, thanks mainly to

its philosophical wing, the existential accents on death, poignancy, and
human limitation (Burston, 2003; May, 1958b). To some extent, these
latter emphases set the existential dimension apart from other humanistic-
oriented purviews, such as those formulated by Rogers (1951) and Perls
(1971), on one hand and elements of the transpersonal movement on
the other (May, 1981; Mendelowitz & Schneider, 2008). Those departures
will be more evident in subsequent chapters, but for now, it is enough to
say that today, existential humanism is a distinctly American amalgam
that combines existential accents on human limitation with humanistic
accents on human possibility. This combination creates a paradoxical
unity of complementary opposites. E–H therapy consequently embraces
three values: (a) freedom (to become within the givens of human limita-
tion), (b) experiential reflection (to grapple with the challenges to what
one becomes), and (c) responsibility (to act on or respond to what one
becomes). To put it another way, contemporary E–H therapy stresses
(a) the “whole-bodied” (i.e., cognitive–affective–kinesthetic) capacity to
choose, within limits, who one will become; (b) the whole-bodied capac-
ity to discern the meaning of those choices; and (c) the whole-bodied
capacity to act on or express the choices made.
On the basis of these values, E–H therapy has developed a method-
ology grounded in the assumption that fundamental change occurs not
merely through intellectual or behavioral reprogramming, but through
experiential or “whole-bodied” reawakening. To illustrate this point, take
the case of Hamilton, who, as described in Appendix A of this volume,
suffered from a fear of heights. Although Hamilton learned to suppress
this fear through conditioning techniques, it wasn’t until he was able to
be fully and experientially present with his fear that he learned to work
through and transform it.
Consequently, the key to the E–H approach is an emphasis on whole-
bodied encounter. This type of approach is critical in our view, particularly
as clients develop what we call intentionality, or the capacity to (re)claim
their lives.

8
 History

Origins
Although existential humanism has its roots in Socratic, Renaissance,
Romantic, and even Asiatic sources, as depicted in the epigraph in Chap-
ter 1 of this volume (Moss, 2015; Schneider, 1998b; E. Taylor, 1999), it was
not until the mid-19th century that existential philosophy, as such, was
formalized. With the publication of Søren Kierkegaard’s (1813–1855)
The Concept of Dread (Kierkegaard, 1844/1944), a new era had dawned
in which freedom, experiential reflection, and responsibility played an
increasingly pivotal philosophical and therapeutic role. In Kierkegaard’s
thesis, freedom emerges from crisis, and crisis from intellectual, emo-
tional, or physical imprisonment. In Kierkegaard’s time, this imprison-
ment often took the form of robotic adherence to the Catholic Church or
to objectifying trends in science. But it could be any limiting experience.
Kierkegaard called these limiting experiences the points at which “angst”
or anxiety “educate”:

Whoever is educated by anxiety is educated by possibility, and only

he who is educated by possibility is educated according to his infini-
tude. Therefore possibility is the weightiest of all categories. . . . This
possibility is commonly regarded as the possibility of happiness,
fortune, etc.
But this is not possibility. . . . No, in possibility all things are
equally possible, and whoever has truly been brought up by possibil-
ity has grasped the terrible as well as the joyful. So . . . such a person
graduates from the school of possibility, and he knows better than a
child knows his ABC’s that he can demand absolutely nothing of life
and that the terrible, perdition, and annihilation live next door to
every man. (Kierkegaard, 1844/1944, p. 156)

Kierkegaard was nothing if not complex and paradoxical. In one of

the most damning oppositions to social objectification and doctrinaire
living ever waged, Kierkegaard called for a complete transformation of
values. We must move, Kierkegaard exclaimed, from a mechanized or
externalized life to one that is centered in the subject and that struggles

9
 EXISTENTIAL–HUMANISTIC THERAPY

for the truth of the subject. It is only through facing and grappling with
our selves, he elaborated, that consciousness can expand, deepen, and seek
its vibrant potential.
Writing at about the same time, but with an even feistier style, Friedrich
Nietzsche (1844–1900) traced the devitalization of conventional culture to
the dominance of Apollonian (or rationalist–linear) living over Dionysian
(or nonrationalist–spontaneous) living. Although these strains were in
tension—in Nietzsche’s time, as in the time of the ancient Greeks who
formulated them—Nietzsche foresaw the era when Apollonian techno­
cracy would overshadow and level all in its path. To remedy this situ-
ation, and to restore the Dionysian spirit, Nietzsche (1889/1982) called
for a Dionysian–Apollonian rapprochement. This rapprochement would
“afford” people “the whole range and wealth of being natural” but also, and
in concert with the latter, the capacity for being “strong, highly educated,”
and “self-controlled” (p. 554).
The next major revolution in E–H psychology and philosophy
occurred in the early 20th century with the advent of behaviorism and
psychoanalysis. Although behaviorism, championed by such advocates as
American psychologist John Watson, stressed the mechanistic and overt
aspects of human functioning, psychoanalysis, spearheaded by Freud and
his followers, promoted covert intrapsychic determinism. In neither case,
existential humanists contended, was the human psyche illuminated in its
radiant and enigmatic fullness, its liberating and yet vulnerable starkness,
and so they rebelled. Among these rebellions were the far-ranging medita-
tions of William James (1902/1936) on spirituality, Otto Rank (1936) on
the fear of life and fear of death, Carl G. Jung (1966) on mythology, and
Henry Murray (Murray et al., 1938) on creativity.
But although this group drew tangentially from existential–
humanistic philosophy, another group of mainly former Freudians drew
directly on the existential–humanistic lineage. Ludwig Binswanger (1958)
and Medard Boss (1963), for example, based their psychiatric practices on
the existential and phenomenological philosophy of Martin Heidegger
(1962) and Edmund Husserl (1913/1962). Expanding on Kierkegaard’s
emphasis on the subjective, Heidegger developed a philosophy of being.

10
 History

By being, Heidegger meant neither self-enclosed individualism nor deter-

ministic realism, but a “lived” amalgam of the two he termed “being-in-
the-world.” Being-in-the-world is Heidegger’s attempt to illustrate that
our Western tradition of separating inner from outer, or subjective from
objective, is misleading and that, from the standpoint of experience, there
is no clear way to separate them. In a phrase, we are both separate sub-
jective selves and related to the external world, according to Heidegger.
To develop his thesis, Heidegger drew on the method and practices of
phenomenology, originated by his mentor, Edmund Husserl. According
to Husserl (1913/1962), the chief task of phenomenology is to apprehend
human experience in its living reality—that is, in its full subjective and
intersubjective context (see also Churchill & Wertz, 2015; Giorgi, 1970).
By the 1960s E–H psychotherapy—under the banner of its umbrella
movement, humanistic psychology—evolved into a mature and recognized
perspective, but it was also a varied perspective. Although most E–H prac-
titioners stressed freedom, experiential reflection, and responsibility, they
did so with varying degrees of intensity. There were times, for example,
such as in the aftermath of World War II and during the flowering of the
human potential movement of the 1960s, when existential freedom may
have been stressed to the neglect of responsibility (e.g., see May, 1969, 1981;
Merleau-Ponty, 1962; Yalom, 1980) and other times when responsibility
was accented to the detriment of freedom (Rowan, 2015) or experiential
reflection to the neglect of responsibility (Spinelli, 2015).
To further complicate matters, with the appearance of May’s edited
book Existence (May, Angel, & Ellenberger, 1958), which imported existen-
tial psychology to America, the broad outlines of E–H practice philosophy
collapsed into two distinct camps, one emphasizing the cultural traditions
of continental Europe and the other the historical influences of the United
States. Although the former “existential–analytic” camp evolved a com-
paratively restrained, verbal style, the latter “existential–humanistic” camp
developed a comparatively expansive, experiential style. For example,
whereas an existential–analytic practitioner might comment on a client’s
upbeat story (thus staying “right with” the client’s manifest intentions), an
E–H practitioner might take a calculated risk to invite the client to notice

11
 EXISTENTIAL–HUMANISTIC THERAPY

how he’s hunched over as he tells his story (thus expanding on the client’s
manifest intentions). These respective styles and the controversies they
generate persist today (see Burston, 2003; Cooper, 2017; and Schneider,
Pierson, & Bugental, 2015, for elaboration).

Contemporary Approach:
Evolution to Present
Despite and perhaps in light of these controversies, today’s E–H practi-
tioners have an advantage over their predecessors—hindsight. With such
hindsight, many contemporary E–H therapists are wary of one-sided
formulations, be they of the existential–humanistic variety or those with
which E–H practitioners traditionally differ. Contemporary E–H practitio-
ners, moreover, tend to value a pluralistic understanding of human nature,
psychotherapeutic integration, and complementariness among therapeu-
tic approaches. They tend to see the intrapsychic aspects of therapy on
a par with those of intersubjectivity, the social and cultural implications
of their work on a level with individual transformation, and the intellec-
tual and philosophical bases of practice on a plane with those of emotion
and spirit. The contemporary E–H practitioner, moreover, does not shy
away from programmatic or even biological interventions, as those may be
appropriate (Cooper & McLeod, 2010; Schneider, 1995, 2008).
Although the field of E–H therapy has not traditionally included many
female practitioners, this situation is changing. E–H therapy now embraces
a range of female practitioners who influence its focus and tone (Brown,
2008; Comas-Díaz, 2008; Fosha, 2008; Krug, 2009; Monheit, 2008; Pierson,
2015; Serlin, 2008; Sterling, 2001). Until recently, with the exception of one
of the field’s founders, Charlotte Buhler, very few female voices had been
heard expressing their interpretations of E–H therapy. The advent of this
substantial group of female voices in itself has been a corrective by provid-
ing an intrinsically feminine perspective of E–H therapy as a counterpoint
to the heretofore almost exclusively male one.
This breadth of outlook, coupled with a more diverse group of prac-
titioners, has widened the E–H client base. Less and less is E–H practice

12
 History

confined to the rarified environs of its psychoanalytic forebears or to

upper-class elites; it is opening out to the world within which most of
us dwell (Hoffman, Cleare-Hoffman, & Jackson, 2015; O’Hara, 2015;
Pierson, Krug, Sharp, & Piwowarski, 2015; Schneider, 2013, 2017). Put
another way, the E–H attitude can be seen in a variety of practice settings,
including drug counseling (Ballinger, Matano, & Amantea, 2008), therapy
with war veterans (Decker, 2007), therapy with minorities (Alsup, 2008;
Rice, 2008; Vontress & Epp, 2015), gay and lesbian counseling (Brown,
2008; Monheit, 2008), therapy with psychotic clientele (Dorman, 2008;
Mosher, 2015; Thompson, 1995), emancipatory practices with groups
(E. Bugental, 2008; Lerner, 2000; Lyons, 2001; Montuori & Purser, 2015;
O’Hara, 2015; Rice, 2015), cognitive–behavioral interventions with anx-
ious and phobic clients (Bunting & Hayes, 2008; Wolfe, 2008), psycho­
dynamic mediations with spiritually and religiously distressed clients
(Hoffman, 2008), and neurobiological and experiential interventions with
sufferers of attachment disorder (Fosha, 2008).
Yet in spite of their expanded vision, contemporary E–H practitioners
still share a core value with their predecessors—the personal or intimate
search process that is at the crux of depth practice. By depth practice, we
mean practice that is intensive, exploratory, and embodied. We also mean
the provision of four basic stances or conditions that will be elaborated in
the Chapter 3: (a) the cultivation of therapeutic presence, (b) the activa-
tion of presence through struggle, (c) the working through of resistance
(or protections), and (d) the coalescence of meaning and awe.
In the 7 years since the first edition of this book, the recent trends
have only multiplied. For example, there are more studies of integrative
E–H practices, as highlighted by the special section on the subject in the
March 2016 issue of the Journal of Psychotherapy Integration (Shahar &
Schiller, 2016b). This is a major development as it is the first time of
which we are aware that E–H therapy has been featured in the flagship
journal of the psychotherapy integration movement. There are also con-
tinued trends toward multicultural and spiritual dimensions of practice
(e.g., see Hoffman et al., 2015; Hoffman, Yang, Kaklauskas, & Chan, 2009)
as well as at least three new clinical training programs drawing on E–H

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 EXISTENTIAL–HUMANISTIC THERAPY

and existential–integrative therapeutic principles (i.e., the Existential–

Humanistic Institute [http://www.ehinstitute.org] in the San Francisco
Bay Area; the Existential–Humanistic Northwest in Portland, Oregon
[http://www.ehnorthwest.org]; and The Living Institute [http://www.
livinginstitute.org] in Toronto, Ontario, Canada).
Finally, there have been a surfeit of new psychotherapy outcome studies
that have supported E–H principles of practice, such as the emphasis on
therapeutic relationships, the alliance, empathy, collaboration, and authen-
ticity (see Angus, Watson, Elliott, Schneider, & Timulak, 2015, and Elkins,
2016, for reviews). (For additional references to the E–H philosophical
heritage, see also Barrett, 1958; Becker, 1973; Buber, 1937/1970; Camus,
1955; de Beauvoir, 1948; Friedman, 1991b; Marcel, 1956; Sartre, 1956; and
Tillich, 1952. For additional references to the psychological heritage of
existential humanism, see J. F. T. Bugental, 1965; Frankl, 1963; Hoffman,
Yang, et al., 2009, May, 1983; Moustakas, 1972; Rogers, 1951; Schneider &
May, 1995; Schneider et al., 2015; Wheelis, 1958; and Yalom, 1980.)

14
 3

Theory

Goals of the Approach

Freedom Within Limits

The aim of existential–humanistic (E–H) therapy is to “set clients free”
(May, 1981, p. 19). Freedom is understood as the capacity for choice within
the natural and self-imposed limits of living (Schneider, 2008). Freedom
is also understood as a spectrum of liberation levels, from the physiological
to the behavioral, the cognitive to the psychosexual, and the interpersonal to
the experiential. The natural limits of living refer to the inherent limitations
of birth, heredity, age, and so forth and the realities of living—often referred
to as “the givens of existence”—such as death, separateness, and uncertainty.

Portions of this chapters were excerpted or adapted from “Existential–Humanistic Psychotherapies,” by

K. Schneider, 2003, in A. Gurman & S. Messer (Eds.), Essential Psychotherapies (2nd ed., pp. 149–181),
New York: Guilford Press. Copyright © 2003 by Guilford Press. Adapted with permission.
http://dx.doi.org/10.1037/0000042-003
Existential–Humanistic Therapy, Second Edition, by K. J. Schneider and O. T. Krug
Copyright © 2017 by the American Psychological Association. All rights reserved.

15
 EXISTENTIAL–HUMANISTIC THERAPY

Self-imposed limits are the boundaries established by humans, such as

culture, language, and lifestyle.
The freedom to do or to act is probably the clearest freedom we
possess. The freedom to be or to adopt attitudes toward situations is a
less clear but even more fundamental freedom (May, 1981). Freedom to
do is generally associated with external, physical decisions, whereas free-
dom to be is associated with internal, cognitive, and emotional stances.
Within these freedoms, we have a great capacity to create meaning in our
lives—to conceptualize, imagine, invent, communicate, and physically
and psychologically enlarge our worlds (Yalom, 1980). We also have the
capacity to separate from others, to transcend our past, and to become
distinct, unique, and heroic (Becker, 1973). Conversely, we can choose to
restrain ourselves, to become passive, and to give ourselves over to others
(May, 1981; Rank, 1936). We can choose to be a part of others or apart
from others, a part of our possibilities or apart from our possibilities
(J. F. T. Bugental & Kleiner, 1993).

Acknowledge Freedom’s Limitations

Notwithstanding the vast possibilities, there are great limitations on all
these freedoms. We can only do and be so much. Whatever we choose
implies a relinquishment of something else (J. F. T. Bugental, 1987, p. 230).
If we devote ourselves to scholarship, we relinquish a degree of athleticism.
If we engage in wealth accumulation, we lessen our opportunities for spiri-
tual pursuits. Moreover, every freedom has its price. If one stands out in a
crowd, one becomes a larger target for criticism; if one acquires responsi-
bility, one courts guilt; if one isolates oneself, one loses community; if one
merges and fuses with others, one loses individuality, and so on (Becker,
1973; May, 1981).
Finally, every freedom has its counterpart in destiny. May (1981)
defined four kinds of destiny, or “givens” beyond our control: cosmic,
genetic, cultural, and circumstantial. Cosmic destiny embraces the limita-
tions of nature (e.g., earthquakes, climatic shifts), genetic destiny entails
physiological dispositions (e.g., lifespan, temperament), cultural destiny

16
 Theory

addresses preconceived social patterns (e.g., language, birthrights), and

circumstantial destiny pertains to sudden situational developments (e.g., oil
spills, job layoffs). In short, our vast potentialities are matched by crush-
ing vulnerabilities. We are semiaware, semicapable, in a world of dazzling
incomprehensibility.
How, then, shall we deal with these clashing realities according to
existential theorists, and what happens when we do not? Let us consider
the latter first. The failure to acknowledge our freedom, according to
existential theorists, results in the dysfunctional identification with limits,
or repressed living (May, 1981). This dysfunctional identification forfeits
the capacity to enliven, embolden, and enlarge one’s perspective. The
reticent wallflower, the pedantic bureaucrat, the paranoid reactionary,
and the robotic conformist are illustrations of this polarity. The failure
to acknowledge our limits, at the other polarity, results in the sacrifice of
our ability to discipline, discern, and prioritize life’s chances (May, 1981).
The aimless dabbler, the impulsive con artist, the unbowed hedonist, and
the power-hungry elitist exemplify this polarity.

Integrate Freedom and Limitation

The great question, of course, is how to help clients become emancipated
from their polarized conditions and “experience their possibilities” as they
engage their destinies (May, 1981, p. 20). Put another way, how do we help
clients integrate freedom and limits? This question strikes at the heart of
another existential problem—that of identity. Whereas reprogramming
clients’ behaviors or helping them understand the genesis of their polarized
conditions leads to partially rejuvenated identities, for existential theorists,
experiential encounters with these conditions are the great underappreciated
complements to these change processes (see, e.g., the case vignettes in this
volume, as well as Schneider, 2007, 2008, 2013). The E–H practitioner
believes that if life-limiting patterns are experienced in the present, then
clients will be more willing and able to choose life-affirming patterns in the
future. Put another way, the path to greater freedom is paradoxically found
through an encounter with the ways in which we are bound (Krug, 2009).

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 EXISTENTIAL–HUMANISTIC THERAPY

The experiential modality for existential theorists embraces four basic

dimensions: the immediate, the kinesthetic, the affective, and the profound
or cosmic (Schneider, 2008). The road to a fuller, more vital identity, in
other words, is to help clients experience their polarized conditions, to
assist them to embody those conditions and their underlying fears and
beliefs, and to help them attune, at the deepest levels, to the implica-
tions of what has been discovered. In so doing, E–H therapists help clients
respond to, as opposed to react against, panic-filled material. This work
typically results in clients experiencing their polarized conditions as
restrictive or self-limiting. Consequently, it not only allows clients to
understand their part in the construction of their restrictive patterns; it
also helps them accept the givens of existence that may have been avoided,
denied, or repressed.
However, for the E–H practitioner, responsibility assumption is often
not sufficient. It is simply preparatory for substantive change evidenced
when clients choose more life-affirming patterns for themselves and with
others. (This process of affirming one’s being by acknowledging one’s
limitations is illustrated by the short case in Chapter 4 of this volume
of Mimi, who must first relinquish her “sense of specialness” so she can
embrace more life-affirming patterns.) The net result, according to exis-
tential theorists, is an expanded sense of self, specifically an enhanced
capacity for intimacy, meaning, and spiritual connection in one’s life
(J. F. T. Bugental, 1978; May, 1981).

An Illustration of This Process

The classic case of Mercedes, by May (1972), illustrates this standpoint.
Mercedes lived much of her life in subordination to others. Her stepfather
was a pimp and her mother a prostitute. Mercedes herself was coerced
into prostitution to enable the family to subsist. Yet Mercedes bristled at
her subservient position. She harbored tremendous resentment toward
her “clientele” and even more toward her “caretakers.” She was frequently
depressed, impaired in her love life, and unable to carry her pregnancies
with her husband to full term. May used many approaches to help

18
 Theory

Mercedes confront and integrate her rage, which in his view portended
her freedom. These efforts, however, invariably failed to spark her, until
one day when he encountered her experientially. Instead of encouraging
her to acknowledge her resentment, he acknowledged it for her. He vented
his fury at her stepfather, he unleashed his indignation toward her mother,
and he embodied the bitterness she had harbored. In turn, Mercedes was
finally able to affirm and express these qualities—directly and bodily—
in herself. The upshot, according to May, was that Mercedes integrated
her freedom: She quit prostitution, revived her marriage, and carried a
pregnancy to term.

Varied Interpretations of Experiential Encounter

The experiential mode is diversely interpreted by existential theorists.
For example, Yalom (1980) appeared to stress the immediate and affective
elements of his interpersonal therapeutic contacts, but he referred little
to kinesthetic components. J. F. T. Bugental (1987) stressed kinesthetic
elements of his encounters—illuminating what is “implicitly present but
unregarded” (J. F. T. Bugental, 1999, p. 25)—but placed lesser emphasis on
interpersonal implications of those elements (Krug, 2009). Tillich (1952)
and Friedman (1995) accented the interpersonal dimension of therapeutic
experiencing but conveyed little about the kinesthetic aspect.
There are also differences among existential theorists regarding
verbal and nonverbal channels of communication. May (1983), Yalom
(1980), and Friedman (1995), for example, relied relatively heavily on
verbal interventions, whereas J. F. T. Bugental (1987), Gendlin (1996), and
Laing (1967) drew on comparatively nonverbal forms of mediation. Krug
(Krug & Schneider, 2016) held the intra- and interpersonal dimensions
of therapeutic experiencing with about equal weight, depending on both
context and alliance between client and therapist.
Finally, there are differences among existential theorists with regard
to philosophical implications of therapeutic experiencing. Although most
existential theorists agree that clients need to confront the underlying
givens (or ultimate concerns) of human existence during the course of a

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 EXISTENTIAL–HUMANISTIC THERAPY

typical therapy, the nature and specificity of these givens vary. Whereas
Yalom (1980), for example, focused on the need for clients to experien-
tially confront death, freedom, isolation, or meaninglessness, Bugental
(J. F. T. Bugental & Kleiner, 1993) provided a more elaborate schema: the
need for clients to confront embodiment–change, finitude–contingency,
action–responsibility, choice–relinquishment, separation–apartness, or
relation–being a part of. And whereas May (1981) united these positions
with his notion of freedom and destiny (or limitation), as previously
suggested, there is only a vague explication of this synthesis in his work.

A Central Concern: The Present Moment

Despite these differences, each theorist shared a central concern—namely,
How is this client in this moment coping with his or her awareness of
being alive? The E–H theorists addressed this concern by focusing more
on the implicit—moment-to-moment—processes in therapy than on
explicit content. E–H theorists took an ahistorical approach; that is, the
past is integral only insofar as it is alive, within the person, in the present
moment. Moreover, E–H therapists seek to understand a person as a human
being in the world, related to his or her physical, personal, and social
worlds. It is assumed that a person is not simply a collection of drives and
behavior patterns within an encapsulated self. It is further assumed that
each person is more than the sum of his or her parts and that each per-
son constructs a particular world from unique perceptions of the world
through a process of meaning making. Finally, as May (1983) suggested,
“the person and his world are a unitary, structural whole. . . . Two poles,
self and world, are always dialectically related” (p. 122).
Consequently, the E–H theorist takes a step back from examining
a person’s drives and specific behavior patterns; with a wider scope, she
or he understands these in the context of a person’s relation to existence
(May, 1958a, 1958b; Merleau-Ponty, 1962). These relations, which manifest
as structures, are not abstract but actual, described by J. F. T. Bugental
(1987) as self and world constructs. Although a person’s self and world con-
structs may be obscured from conscious awareness, they are nevertheless

20
 Theory

evident (though perhaps implied) in the present moment, expressed

through bodily gestures, vocal tones, dreams, and behavior patterns and
not so much through words spoken.

The Cultivation of Presence

The existential therapist aims to know the person who comes for therapy
at this structural level. As May (1958a) stated, “The grasping of the being
of the other person occurs on a quite different level from our knowledge
of specific things about him” (p. 38). In order to “grasp the being” of the
client, and consequently help the client grasp his or her being, the therapist
must bring a full and genuine presence to the therapeutic encounter. The
Latin root for presence is prae (“before”) + esse (“to be”); thus, presence
means “to be before.” Consequently, presence in a therapeutic setting can
be understood as the capacity “to be before” or to be with one’s being and
“to be before” or to be with another human being.
Presence involves aspects of awareness, acceptance, availability, and
expressiveness in both therapist and client. Presence implies that the
encounter is real. For Buber (1970), it meant that the person who is before
one has ceased being an “it” and has become a “thou”; it means that we are
all humans who include each other in each other’s recognition. Indeed,
as Marcel (1960) suggested, intersubjective presence begins with “we are” as
opposed to “I think.” If one can be truly present with another, then a genuine
encounter has occurred.
Even with this emphasis on presence, E–H theorists recognize the influ-
ence of the past in their present-centered encounters. They acknowledge,
for example, the power of developmental deficits to influence therapeutic
processes (Schneider, 2008; Yalom, 1980). However, the bases of those
deficits and the contexts within which they are addressed differ significantly
from those advanced by more conventional standpoints. For example,
whereas psychoanalytically oriented theorists tend to view ruptures in
early interpersonal relationships as the bases for developmental deficits,
E–H-oriented theorists take a wider view. This view acknowledges those
early ruptures but goes beyond them to embrace the fuller experience of

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 EXISTENTIAL–HUMANISTIC THERAPY

rupture or estrangement before being itself (May, 1981; Schneider, 2008;

Yalom, 1980). Put another way, whereas psychoanalytic theorists tend to
focus on isolable family or physiological factors in the etiology of suffer-
ing, E–H theorists tend to home in on dimensions that are purported to
underlie such factors, such as the experience of life’s vastness; the terror
of dissolving before or, alternatively, exploding into life’s vastness; and the
struggle with the enigma of death (Becker, 1973; Schneider, 1993, 1999,
2008; Yalom, 1980).
E–H theorists also endeavor to understand the phenomenology
of a given client’s struggle and to avoid diagnostic and psychodynamic
presuppositions. Although such presuppositions can certainly inform
the E–H practitioner’s understanding, the E–H practitioner attempts to
stay as open as possible to the living, evolving person who may or may
not conform to preset categorization. For example, to understand the
phenomenology of a client who is depressed, the E–H practitioner may
explore how the client is relating to his depression, his lived experiences of
the depression, and his particular meanings and feelings associated with
his depression.
Given this background, it may now be clearer why E–H theorists focus
on here-and-now experiences of the past (as manifested in body posture,
vocal tone, and so forth) over discussions about the past. Whereas dis-
cussions can help clients assimilate a specifiable event, such as an abuse
memory, experiential awareness can help clients assimilate the life stance,
such as the sense of dissolution that both echoes and transcends the event.
For E–H theorists, accordingly, the deepest roots of trauma cannot simply
be talked about or explained away; they must be rediscovered, felt, and
lived through (J. F. T. Bugental, 1987; Krug, 2009; Schneider, 2008).

Four Core Aims

To sum, E–H theorists share four core aims: (a) to help clients become
more present to themselves and others, (b) to help them experience the
ways in which they both mobilize and block themselves from fuller pres-
ence, (c) to help them take responsibility for the construction of their

22
 Theory

current lives, and (d) to help them choose or actualize ways of being in
their outside lives based on facing, not avoiding, the existential givens such
as finiteness, ambiguity, and anxiety.

Key Concepts
E–H therapy includes several key concepts, one of which is the construc-
tion of personal identity or sense of self, formed as meanings made from
lived experience. Following the discussion of identity formation, we describe
several patterns of psychological health based on various constructs of
lived experience.

Sense of Self
E–H psychology assumes that one does not experience a personality;
one lives an experience. Moreover, E–H psychology assumes that lived
experience is the basis on which one forms or creates a sense of self (May,
1975). E–H theorists’ understanding of identity formation, or the “I am”
experience, has been significantly influenced by May’s perspective on
human experience. His perspective focuses on awareness as an essence of
being that has two dimensions. The first dimension is the fact of aware-
ness: Every person is aware that she or he exists and consequently copes
in various ways with this awareness. This is understood as the “existential
predicament” and has been a major focus of existential philosophy and
psychology (see Camus, 1955; Marcel, 1956; May, 1975, 1981; Sartre, 1956).
The second dimension focuses on how a person is aware and refers to
the foundational structure of human experience—namely, how anxiety,
which stems from awareness of existence, drives a person to create mean-
ing through an ongoing dialectical process between the subjective and
objective poles of reality. Existential meaning making is an intrinsically
human process related to identity formation. It is the act of making sense
of an experience. Existential theory asserts that individuals aren’t simply
subjects who perceive objects (i.e., the Cartesian notion); on the contrary,
individuals participate in constructing their realities by making meaning

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 EXISTENTIAL–HUMANISTIC THERAPY

(sense) of their perceptions and experiences as they relate to the external

world. Thus, they are not simply aware; they are conscious—aware of
being the ones who construct meanings from experiences. May (1975)
asserted that this dialectical process of meaning making, which he called
“passion for form,” is the essence of genuine creativity.
If individuals construct their personal worlds, then within the definition
of existence lie agency (i.e., we are centered in our being and create meanings
about our world and our selves), freedom (i.e., we choose how we define
our perceptions and experiences), responsibility (i.e., we are responsible
for the choices we make), and change (i.e., we have agency to create new
meanings about our world and our selves). Understanding the process
of existence through this meaning making lens underscores the need for
therapists to sensitively attune to and explore the personal meanings and
associated feelings of clients over and above dispensing a particular
treatment or technique.
As alluded to earlier, the meanings an individual makes from lived
experiences create a set of self and world constructs, essentially a set of
beliefs regarding self, others, and the world. These constructs are under-
stood as an individual’s personal world or context that varies, continually
influenced by the cultural, historical, and cosmological experiences of
each individual.
May acknowledged that his principle of human experience is simi-
lar to the ideas of several great philosophers, one of whom is Alfred N.
Whitehead (1960). Whitehead’s philosophy is part of a philosophical
tradition going back to Heraclitus that focuses on process. Reality is
not an assortment of material things, which is the Aristotelian notion,
but one of process. Nature is a process, not a thing. A river is not a thing but
a continuing flow. Therefore, human beings, being a part of nature, are
understood as a matter of process, of activity, of change (Rescher, 2000).
In Whitehead’s ontology, every organism or “occasion of experience”
is “a dipolar unity . . . that enfolds . . . the past . . . into the present . . . and
orients the organism toward the future in a ‘creative advance’” (de Quincey,
2002, p. 174). A significant aspect of the structure of experience is that the
past is always flowing into the present moment. Another significant aspect

24
 Theory

is the ongoing shaping of experience into a pattern from the “welter of

material” from the past and from the external world. Whitehead argued
that a person is never simply aware of bare existence or thought. Awareness
is a person’s subjective reaction to his or her environment derived from
a shaping of a welter of emotions, thoughts, hopes, fears, and valuations
into a consistent pattern of feelings. According to Whitehead, this shaping
results in a sense of unity or “I am.” May (1975) specifically correlated his
conceptualization of “passion for form” and its relationship to the formation
of a sense of self or identity to Whitehead’s “process of shaping” and the
resulting “sense of unity”:

What I am calling passion for form is, if I understand Whitehead

aright, a central aspect of what he is describing as the experience of
identity. I am able to shape feelings, sensibilities, enjoyments, and
hopes into a pattern that makes me aware of myself as a man or
woman. But I cannot shape them into a pattern as a purely subjective
act. I can do it only as I am related to the immediate objective world
in which I live. (p. 135)

Whitehead’s process perspective provided May, and existential psy-

chotherapy, with a sound philosophical position from which to explain
how a sense of identity is created. Identity is created not as a purely sub-
jective act but only as a dialectical process with the objective world. By
understanding the “I am” experience as an ongoing dialectical process
between subjective and objective poles, E–H theorists and practitioners
have a more complex understanding of how a sense of self or identity
is created and maintained. This understanding can be like a road map
for therapists, helping them see more clearly in the living moment the
ways in which their clients are forming their worlds. The road map also
elucidates the significant role the therapist plays in helping a client recon-
stitute his or her world. Finally, the road map confirms in a concrete way
a basic assumption of existential therapy, which is that human beings
have the potential to grow and re-create themselves through ongoing
creative practices.

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 EXISTENTIAL–HUMANISTIC THERAPY

Patterns of Psychological Health

As previously noted, the notion of psychological health can have a static,
culturally normative quality that may not reflect the lived experience of
distinctive individuals (see Becker, 1973; Fromm, 1941; Wheelis, 1958).
Nevertheless, there are patterns within these lived experiences (charac-
terological structures) that existential humanists have carefully described
phenomenologically. Let us consider a sampling.

May: Freedom and Destiny

The E–H understanding of functionality, as intimated earlier, rests on
three interdependent dimensions: freedom, experiential reflection, and the
assumption of responsibility. Although E–H theorists almost invariably
highlight all three of these dimensions, they do so in unique and varie-
gated ways. For example, May (1981) gave primary attention to freedom
and that which he termed destiny. By freedom, May meant the capacity
to choose within the natural and self-imposed (e.g., cultural) limits of
living. Freedom also implies responsibility, for, as he suggested, if we are
conferred the power to choose, is it not incumbent upon us to exercise
that power?
It is the dynamic encounter with the clashing polarities of freedom
and destiny, then, that gives life meaning (May, 1981). Only through
struggle, May emphasized, can freedom and destiny, capabilities and limits,
be illuminated in their fullness, substantively explored, and meaningfully
transformed.

J. F. T. Bugental: The Embodied Yet Changing Self

The polarities of freedom and destiny or limitation, and the challenge to
respond to these polarities, are central to leading E–H theorists’ concep-
tions of psychological health. James Bugental (J. F. T. Bugental & Sterling,
1995), for example, drew on a similar dialectic with his emphasis on the
self as embodied, yet changing; choiceful, yet finite; isolated, yet related.
We are ever in the process of change, according to Bugental (consider, also,
the ancient Greek philosopher Heraclitus), no matter how we choose to
conceive it. Our challenge, Bugental elaborated, is to face that change, sort

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through its manifold features, and etch out of it a meaningful and action-
oriented response.

Yalom: Four Givens of Existence

Irvin Yalom (1980) conceived of four givens of human existence—death,
freedom, isolation, and meaninglessness. Depending on how we confront
these givens, Yalom elaborated, we confront the design and quality of our
lives. To the extent that we confront death, for example, we also encounter
the urgency, intensity, and seriousness that death arouses. To the extent
that we confront isolation, we also contact and become aware of our needs
for relation or their opposite, solitude. For Yalom, the composition of a life
is directly proportional to the composition and array of one’s relationship
to givens and the priorities one sets to integrate, explore, or coexist with
those givens.

Greening: The Givens as Dimensions or Dialectics

In an elaboration of Yalom’s work, Tom Greening (1992) understood the
givens as existential dimensions or dialectics (e.g., life and death, freedom
and determinism, meaning and absurdity, relatedness and separateness).
Greening suggested that as paradoxical dialectics, each given challenges us to
respond, and we do so by embracing each in one of three ways: (a) through
a simplistic overemphasis on the positive aspects, (b) through a simplistic
overemphasis on the negative aspects, and (c) through a confrontation,
creative response, and transcendence of the dialectic. According to Greening,
psychological health or maturity, from an existential perspective, is the
capacity to accept and creatively respond to all four existential dialectics.
Let us now explore how each of the givens is a challenge to respond:

1. Life (and death) challenges us to respond because of our awareness that

we are alive and that we will die. One response is an overemphasis on
aliveness, optimism, and death denial, as in death-defying activities.
Another response is to be pessimistic, obsessed with dying, accident
prone, and neglectful of health. Finally, a third response is to confront
the dialectic and engage fully in the present moment knowing, as Camus
observed, that we have no future—we choose life knowing we will die.

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 EXISTENTIAL–HUMANISTIC THERAPY

2. Meaning (and absurdity) challenges us because we are limited in our

capacity to be conscious and make meaning. One response is an
overemphasis on rational or intuitive thought or on blind faith, as in
true believers addicted to cults, ideologies, or gurus. Another response
is an anti-intellectual or a militantly atheistic or nihilistic stance—the
result is a flight to action through drugs or death to escape conscious-
ness. A third and more creative response is to face the absurdity and,
in spite of it, to make satisfying personal meanings—to choose and act
while remaining open to revision.
3. Freedom (and determinism) challenges us because we are finitely
free. One response is an assertion of boundless freedom, regardless of
the impact on others. Another response is an abdication of freedom
resulting in self-enslavement, codependency, and substance abuse,
for example. A third and more creative response is an exploration of
possibilities with awareness of the interpersonal and physical context.
4. Community (and aloneness) challenges us because we are social beings,
conceived, born, and raised in relationships. At the same time, we are
separate physical and psychological entities. One response is a denial
of isolation, overinvolvement in organizations, selfless service, and
enmeshed relationships. Another response is resignation to loneliness
or a rejection of people, snobbishness, or self-effacement to avoid the
risk of rejection. A third and more creative response is a willingness to
engage authentically with another in a world where one may likely get
treated as an object—to reach out to another in spite of the possibility
of rejection.

Schneider: The Constrictive–Expansive Continuum

and the Existential–Integrative Approach
Kirk Schneider (1999, 2008) elaborated a constrictive–expansive con-
tinuum of conscious and subconscious personality functioning. This
continuum is identified as a capacity that is freeing, yet limited. We have
a vast capacity to “draw back” and constrict thoughts, feelings, and sen-
sations, as well as an equivalent capacity to “burst forth” and expand
thoughts, feelings, and sensations. At the same time, each of these capacities

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 Theory

is delimited. We can constrict (e.g., focus, accommodate) and expand

(e.g., enlarge, assimilate) only so far before the givens of existence—such
as death, genes, and culture—deter and curtail us. For Schneider, it is
the interplay among constrictive and expansive capacities, the ability to
respond to those capacities, and the ability to integrate those responses
into a dynamic whole that constitute personal and interpersonal richness
and health.
In more recent years, Schneider (1995, 2008) has developed an
“existential–integrative” (E–I) approach to therapy. This approach holds
that levels of “liberation,” such as the physiological, the environmental,
and the interpersonal, are interwoven into the constrictive–expansive
continuum. E–I therapy is now at the vanguard of a broadened and
steadily growing E–H practice philosophy (Bradford, 2007; Hoffman,
2008; Karavalaki & Shumaker, 2016; Lac, 2016; Shahar & Schiller, 2016a;
Shumaker, 2011; Wampold, 2008; Watson & Bohart, 2015). This practice
philosophy draws from conventional E–H principles but differs in one
major respect—scope of practice. Whereas the conventional E–H model
emphasizes only the experiential level of client contact and thus restricts
its practice base, the E–I model explicitly embraces diverse levels of client
contact and thus expands its capacity to serve. Put another way, the E–I
approach arose out of the need to address today’s ethnically and diagnos-
tically diverse clinical populations, whereas the older E–H modality arose
out of a narrower set of priorities (May, 1958b; Schneider, 2008).
Within that context, E–I interventions are viewed as “liberation
conditions” and client dysfunctions as “levels of freedom” or choice
(Schneider, 2008, p. 35). Liberation conditions can represent a wide range
of interventions, ranging from the relatively “nonexperiential” medical
and behavioral strategies, to the “semiexperiential” psychoanalytic and
intersubjective modalities, to the relatively “experiential” existential and
transpersonal approaches. Depending on the client’s desire and capacity
for therapeutic change, E–I therapy proceeds holistically toward an expe-
riential level of contact. By holistically, we mean that even when E–I therapy
is engaged non- or semiexperientially, it is still engaged within an ever-
varying, ever-available experiential context. As we explore the theory and

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practice of E–H therapy, we will also elaborate the E–I approach, trace its
relevance to E–H therapy, and apply it to diverse cases.

Buber, Friedman, and Yalom: The Dialogical

or Interpersonal Dimension
Yet another expression of existential practice emphasizes the immediate,
here-and-now encounter. Echoing the philosophy of Martin Buber,
Maurice Friedman (1995, 2001) developed a dialogical approach to psycho-
logical functioning. The dialogical approach, based on Buber’s philosophy
of I–Thou relationships, accents the interpersonal and interdependent
dimension of personality. For Friedman, psychological growth and devel-
opment proceed not merely or mainly through the encounter with self,
but through the encounter with another. This “healing through meeting,”
as Friedman put it, is characterized by the ability to be present to and con-
firming of oneself, while at the same time being open to and confirming
of another. The freedom and limits of such a relationship then become
transferred to the freedom and limits experienced within one’s self and
the trust developed to risk affirmation of the self.
Yalom (2002), another existential therapist who valued the I–Thou
relationship, believed that change and growth occur only within the con-
text of a safe and intimate therapeutic relationship. Clients, who typically
have difficulty forming intimate relationships in their lives, learn how to
create one with the therapist. It is within the safety of this intimate relation-
ship that clients can face and accept the givens of existence and choose
to live differently. Consequently for Yalom (2002), building an intimate
therapeutic relationship with his client was the central task because it “will
itself become the agent of change” (p. 34).
Finally, although there is a great deal of overlap with regard to other
humanistic and existentially oriented therapies throughout the world
(e.g., see Cooper, 2017), there are several points on which contemporary
E–H therapy can be seen to be comparatively distinct, among them are:

77 E–H theory’s stress on the relational as well as the personal;

77 its emphasis on an E–I approach rather than an exclusively exploratory
focus;

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 Theory

77 its use of techniques (e.g., cognitive–behavioral, gestalt) as they are organ-

ically called for, as distinct from a preset formula or set of suppositions;
77 its openness to mindful risk taking, such as the invitation to clients
to explore tacit yet potentially illuminating processes as distinct from
contents in the flow of their interactions; and
77 related to this openness to exploration, E–H therapy’s reliance on the
therapist’s whole body experience as well as clinical and philosophical
elucidations to help guide the therapeutic process.

E–H therapy, as with several other humanistic and transpersonal therapies,

is also increasingly opening to a spiritual or “awe-based” dimension of the
work that appears to be a natural extension of earlier existential–spiritual
lineages (such as those of Becker, 1973; Buber, 1970; James, 1902/1936;
Marcel, 1960; Rank, 1936; Tillich, 1952; Whitehead, 1960; and others) that
have only recently come to a new prominence.

Clinical Assessment:
The Capacity for Presence
The question of assessment is essentially the question of understanding:
On what basis do E–H therapists understand an individual’s pattern of
interaction, symptomatology, and adaptive resources? E–H therapists
employ a variety of means to understand their clients’ lives. Among these
means can be paper-and-pencil tests, ratings of symptomatology, and his-
tory taking. However, these modalities tend to be implemented sparingly
rather than as a staple of practice. The reason for this caveat is that, as a
rule, assessment—like therapy—is an ongoing process for E–H practitio-
ners, and not a linear or mechanistic procedure. Appraisal is holistic, in
other words, and should not be mistaken for a global or rigid declaration
(J. F. T. Bugental & Sterling, 1995). A client may be labeled as a “depressive”
in other approaches, but for an E–H practitioner he is a living, dynamic
human being who happens to be depressed.
E–H practitioners are concerned with depth and breadth of context
as much as or more than they are with specific overt behaviors. Ideally,

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 EXISTENTIAL–HUMANISTIC THERAPY

nothing is spared in E–H therapeutic assessment: The unfolding moment,

the client’s explicit and implicit intentions in the moment, the horizons of
the past, and the full person-to-person field that is evoked each moment
are of equal and abiding import (Fischer, 1994; Schneider, 2008).
As previously indicated, contemporary E–H practice tends to be an
integrative practice (Schneider, 2008; Watson & Bohart, 2015). E–H prac-
titioners value the whole human being—conscious and nonconscious,
past, present, and evolving—in the therapeutic encounter. As such,
E–H practitioners are concerned with how best to understand clients in
their moment-to-moment unfolding and their given level of relation and
experience.
The client’s capacity for intra- and interpersonal presence is the chief
tool of E–H assessment. Through presence, the holding and illuminating of
clients’ moment-to-moment experience, E–H therapists become attuned
to the subtlest nuances of clients’ concerns, from the cognitive and behav-
ioral to the affective and spiritual.
Although E–H therapists value the content (or explicit features) of
clients’ experiences, they are acutely and simultaneously attuned to the
process or implicit aspects of those experiences. The following example
from Orah Krug serves to illustrate:1

Recently I was sitting with a crying client. As I listened to her story,

I noticed that she refused to take another tissue even though the
one she was using was torn and tattered. I gently commented at
an appropriate time on her refusal to take another tissue. Her eyes
welled up with more tears as she realized that this behavior was a
familiar way of being, and she said, “I always just make do with
what I have.”
This attunement to process presupposes that each person is
related to self, to other, and to the physical world and also that each
person’s past is present in the here and now. That is, each person

All case material in this volume is disguised. In most instances, case material entails a composite
1

drawn from the authors’ respective practices.

32
 Theory

shapes her or his past experiences into a unique sense of self that is
in some way evident in the here and now. Using these assumptions
as a basis for my work, I focused on the unfolding intra- and inter-
personal processes with the intention of understanding this client’s
underlying subjective constructs of self and world. Self and world
constructs refer to the client’s construal of existence, both conscious
and subconscious, as derived from the client’s unique shaping of
her or his subjective experiences with the objective world (May’s
“passion for form”). Thus, one part of my client’s shaped sense of self
was that she “always just makes do with what she has.” Consequently,
she related to herself and to me in that way, and this construct of
herself and her world was concretely reflected in her behavior regard-
ing the tissue.

The E–H therapist understands that the underlying nature of a

problem may be different from the surface content. For example, whereas
the content of a client’s report (e.g., binge eating) may be physiological
in nature, the process or implicit aspects may be intensely spiritual,
ontological, or interpersonal in nature. E–H assessment, therefore, is
predicated on not only a client’s presenting problem (or complaint), but
also the entire atmosphere of a client’s predicament. Everything and any-
thing is open to investigation within the E–H framework, from the ini-
tial manner in which the client greets the therapist to the position of the
client’s hands while elaborating her concern. Put another way, every E–H
assessment is holographic. Every moment is believed to be a microcosm
and in some sense dovetails with every other moment. No moment stands
in isolation.
To illustrate further, one of the first areas of focus within E–H
therapy—even before any words are exchanged—are questions such
as, What is my client expressing in his body, and in what ways are those
expressions indicative of my client’s self and world construct? How does
he relate to himself, and how does he relate to me? The E–H therapist is
particularly attuned to the manner in which these expressions resonate
within herself or himself—their shape, texture, and future intimations.
In effect, the E–H therapist uses her or his body as a barometer or register

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 EXISTENTIAL–HUMANISTIC THERAPY

of clients’ tacit and overt struggles. Here is a sample of our own thoughts
upon greeting a given client:

What is this man’s sense of self and world? What kind of life design
do his muscles, gestures, and breathing betray? Is he stiff and waxy, or
limber and fluid? Is he caved in and hunched over, or stout and thrust
forward? Does he curl up in a remote corner of the room, or does
he “plant himself in my face”? What does he bring up in my body?
Does he make me feel light and buoyant, or heavy and stuck? Do my
stomach muscles tighten, or do my legs become jumpy? Do my eyes
relax, or do they become hard or guarded? What can I sense from
what he wears? Is he frumpy and inconspicuous, or loud and out­
rageous? What can be gleaned from his face? Is it tense and weather
beaten, or soft and innocent? Does he meet my gaze or turn away?
(See Schneider, 2008, p. 61, for an elaboration.)

Each of these observations begins to coalesce with others, cumulatively, to

disclose a unique world. Each oscillates with others to form a shape, sense,
and overarching gestalt of this particular man’s strife and life patterns.
Intra- and interpersonal presence, then, is the sine qua non of E–H
assessment. Through the illumination of presence, E–H therapists open to
and begin to discover clients’ constructs of self and world, overt and covert
scripts, ostensible and tacit agendas, and unfolding rivalries within the
battleground of self. Further, they begin to sense the shape of their own
responses to these revelations and how best to meet or facilitate them. For
example, an E–H therapist might ask (silently to herself), What are the
resources, difficulties, and potential tools necessary to address an acutely
fragile client? What about a combative client or a client who resists explo-
ration? These are issues that challenge any serious-minded therapist but
are especially trying to E–H practitioners, who prize depth of connection
over symptom relief.
The question for the E–H therapist is, How can I best meet this client
where he or she “lives,” within the abilities and constraints of where he or
she lives, and yet hold out the possibility for a fuller and deeper connection?
This holding out of the possibility for an enlarged and deepened contact

34
 Theory

is one of the primary distinctions between mainstream and E–H visions

of healing. Whereas mainstream practitioners may tend to calibrate their
actions to given parts of the therapeutic concern (e.g., those that pertain
to behavior or cognition or childhood), E–H practitioners endeavor to be
available to clients in their multilayered and emergent wholeness, from
the measurable and overt to the felt and unformed. It is in this sense that
diagnosis is a part of the ongoing contact in E–H therapy and that for-
mulations must fit people, and not the other way around (Fischer, 1994;
May, 1983).
Given its evolving and holistic approach, then, E–H assessment must
be artfully and mindfully engaged. Although psychiatric diagnoses may be
useful to E–H practitioners at given stages of therapy, the assessment over-
all is based on therapist attunement, experience, and clinical judgment.
As a rule, the client’s desire and capacity for change and the therapist’s
mindful and sensitive alertness to these criteria guide the ensuing work.

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 4

Therapy Process

A s we established in Chapter 3, the aim of existential–humanistic

(E–H) therapy is to “set clients free.” However, when we speak of
this, we do not at all mean helping clients become capricious or licentious
louts. What we do mean is helping clients cultivate the capacity for choice,
and choice, as is well established in the existential literature, implies limits,
ambiguities, and risks (May, 1981; Tillich, 1952), about which E–H thera-
pists and clients alike become acutely aware. At the same time, choice is
cherished as the point of being alive in E–H therapy, in spite of and per-
haps even in light of its inherent difficulties.
Given that contemporary E–H therapy is both integrative and incre-
mental in its approach to freedom, the practitioner faces an array of choice
points on his or her facilitative journey. The client’s desire and capacity for

Portions of this chapters were excerpted or adapted from “Existential–Humanistic Psychotherapies,” by

K. Schneider, 2003, in A. Gurman & S. Messer (Eds.), Essential Psychotherapies (2nd ed., pp. 149–181),
New York: Guilford Press. Copyright © 2003 by Guilford Press. Adapted with permission.
http://dx.doi.org/10.1037/0000042-004
Existential–Humanistic Therapy, Second Edition, by K. J. Schneider and O. T. Krug
Copyright © 2017 by the American Psychological Association. All rights reserved.

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 EXISTENTIAL–HUMANISTIC THERAPY

change (Schneider, 2008), the alliance and context of the therapy (J. F. T.
Bugental, 1987), and practical elements (Yalom, 1989) all figure in. Hence,
for some E–H clients, at some stages of therapy, choice can mean drug-
induced stability, or nutrition-based evenness of mood, or reason-based
empowerment, for example.
However, that which distinguishes E–H facilitation is its ability to
address not merely programmatic (i.e., externally based) adjustments but
internally sparked commitments. Commitment, for E–H therapists, refers
to a sense of “I-ness,” agency, or profound caring about a given direction
(May & Yalom, 1995). It implies assumption of personal responsibility
and a sense that the life one chooses really matters to oneself and is worth
one’s whole (embodied) investment (J. F. T. Bugental, 1987). This onto-
logical or experiential level of commitment manifests clinically as a sense
of immediacy (aliveness), affectivity (passion), and kinesthesia (embodi-
ment) and is typified in the deepest and most pivotal stages of therapy. In
short, E–H therapists endeavor to meet clients “where they are at,” but also
to be available to the fullest potential of those clients to “own” or claim the
life that is presented to them.
In light of this background, E–H therapy can vary in both length and
intensity. It can proceed, on rare occasions, within one or two sessions
(e.g., Galvin, 2008; Laing, 1985), or it can occur in a limited way within a
short-term focused format (e.g., J. F. T. Bugental, 2008). Typically, how-
ever, E–H engagements are intimate (e.g., trust-building), long-term (e.g.,
3–5 years), and intensive (e.g., weekly to twice weekly). Furthermore, E–H
therapy can be of benefit to a more diverse range of clientele than is gener-
ally presumed (e.g., see May, 1972; Vontress & Epp, 2015), although those
who tend to be introspective, emotionally tolerant, and exploratory are
likely to derive maximal benefits.
Finally, the shift toward a more integrative E–H therapy has opened
the E–H perspective to a wider range of treatment modalities than it had
in the past (Shahar & Schiller, 2016a). It is now not unusual for an E–H
therapist to begin with a focus on immediate symptoms, such as I (Kirk
Schneider) did in my work with my E–H therapy client Anita (available
in the Existential–Humanistic Therapy Over Time video series; American
Psychological Association, 2009) and later to uncover deeper and more

38
 Therapy Process

profound therapeutic concerns. I addressed Anita’s presenting problem of

lack of assertiveness at the start of therapy but soon worked with her fuller,
more intensive issue—her general lack of freedom in her life. I drew on
cognitive–behavioral elements to help her with assertiveness (which indeed
helped for a time), but followed up with more experiential dimensions as it
became clear that she felt “held back” in her life more globally. These expe-
riential dimensions included periodic check-ins with how she felt in her
body as we discussed traditionally cognitive–behavioral challenges, such as
overgeneralizations and dichotomous thinking, or what her facial expres-
sions seemed to suggest as she reported evocative dreams or reveries.
It is important to note that therapeutic presence was a critical aspect
of this deepening encounter and that it was the “container” that supported
Anita to more fully disclose. We will discuss more about how presence
facilitates such fuller engagements momentarily, but suffice it to say that
in the case of Anita and with many clients, skillful engagement of presence
provides a very fruitful complement to virtually any application of thera-
peutic technique; without it, just as without an openness to techniques as
appropriate, the therapy is likely to suffer (J. F. T. Bugental, 1987; Geller &
Greenberg, 2012; Wolfe, 2008).
To summarize, then, the chief question for the E–H therapist is,
How does one help this person (client) find choice—meaning, clarity,
poignancy—in her or his life, in spite of (and sometimes in light of) all
the threats to these possibilities? Clearly, there are no easy answers to this
question, yet it is precisely freedom’s difficulty, its intensity, that for E–H
therapists is key to its unfolding. In other words, E–H therapists challenge
clients to grapple with their concerns, not just intellectually, behaviorally,
or programmatically, but experientially, to maximize their capacities to
transform themselves (Wolfe, 2016).

Role of the Therapist, Client,

and Their Relationship
In this section, we elucidate the major dimensions of E–H therapy as they
unfold in action. We draw on case vignettes to bring theoretical material
alive. In keeping with the E–H practice philosophy, therapist, client, and

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 EXISTENTIAL–HUMANISTIC THERAPY

relational roles are presented here not as isolable units but as interweaving
strands comprising an integral whole. Each role will thus become evident
in its interlinking and inextricable context.

Existential Stances or Conditions

To achieve the aims of E–H therapy, practitioners draw on a variety of
means. These means, however, are not techniques in the classical sense;
they are stances, or conditions, through which experiential liberation and
profound transformation can take root. Among the core intertwining and
overlapping E–H stances are

77 the cultivation of therapeutic presence (presence as ground);

77 the cultivation and activation of therapeutic presence through struggle
(presence as method and goal);
77 the encounter with the resistance to (or self-protection from) thera-
peutic struggle; and
77 the coalescence of the meaning, intentionality, and life awakening (awe)
that can result from the struggle.

Let’s consider each of these stances in turn.

Cultivation of Therapeutic Presence: Presence as Ground

Previously, we referred to presence as the sine qua non of E–H practice.
There is a very moving story about the travails of the distinguished exis-
tential philosopher, Martin Buber, that vividly illustrates the life-and-
death significance of therapeutic presence. As conveyed by Friedman
(1991a), Buber was in the throes of a mystical rapture when a curious
caller appeared at his door. The caller was a dour and anxious young man
who had come to seek Buber’s advice: Should he (the caller) volunteer
to go to the front of a major battle (during World War I), or should he
resist and find refuge as a noncombatant? Although Buber greeted this
young man with his customary graciousness, his usual attunement was
wanting. In short, in the midst of his meditative raptures, Buber failed to
“meet” this young man, and tragedy followed. Sometime later, we are told,

40
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the young man enlisted in the army and died precipitously on the front.
Although multiple in its potential meanings, Buber took this situation as
a dire warning to himself and others to never underestimate the gravity of
presence. Subsequently, according to Friedman, he never did. The gravity
of presence is further illustrated by May’s incisive declaration that in
in-depth E–H therapy, the client’s “life is at stake,” and that is how the
therapist should view it (as cited in Schneider, Galvin, & Serlin, 2009).
There is a vivid distinction, in our view, between a therapist who
approaches a client as a problem-solving “doctor” and a healer who is
available for inter- and intrapersonal connection. Whereas the former
stands apart from a client to offer a specific set of remedies for an isolated
and definable malady, the latter stands with a client to offer a relation-
ship, an invitation, and an accompaniment on a journey. And whereas
the former is likely to appeal to a client’s immediate needs for relief, the
latter is likely to appeal to a client’s underlying urges for connection, self-
discovery, and vitality. To be sure, both modalities are often relevant over
the course of a given therapy, and both are useful. But in today’s market-
driven, standardizing atmosphere, rarely are both made available.
Through the dimension of presence, however (including a willingness
to negotiate fees!), both the problem-solving and journey-accompanying
modalities can be made available to clients. And clients, in turn, can
substantively benefit from these resources. Without the latter (journey-
accompanying) mode, however, clients are likely to feel shortchanged—
and, arguably, like Buber’s caller, short-circuited.
Thus, presence is the “soup,” the seedbed of substantive E–H work.
Yalom (1980) drew an intriguing parallel between the masterful prepa-
ration of a meal and E–H therapy. Whereas the average cook prepares a
meal in accordance with a standardized menu, the masterful cook, while
not ignoring those guidelines, attunes to the evolving, emerging, and sub-
jectively engaging in preparation. The masterful cook, in other words, has
a good sense of how to prepare a basic meal but can also throw in spices,
seasonings, and flavorful mixtures that can radically enhance and trans-
form it. For Yalom (1980, p. 3), it is precisely these nonprescriptions, these
“throw-ins,” as he put it, that matter most.

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 EXISTENTIAL–HUMANISTIC THERAPY

Analogously, it is precisely the present and attuned therapist who is

prepared to help clients most, according to E–H practice philosophy. Such
a therapist is optimally prepared to provide the atmosphere, personal-
ity, and moment-to-moment adjustments that can mobilize client change
(J. F. T. Bugental, 1987). Interestingly, even standardized psychotherapy
research upholds this postulate: Wampold (2001), for example, found that
“common factors,” such as therapist–client alliance and personality vari-
ables, account for about nine times the variance in outcomes over specific
therapeutic techniques. Yalom (1989) put it this way:

The capacity to tolerate uncertainty is a prerequisite for the profes-

sion. Though the public may believe that therapists guide patients
systematically and sure-handedly through predictable stages of ther-
apy to a foreknown goal, such is rarely the case. . . . The powerful
temptation to achieve certainty through embracing an ideological
school . . . is treacherous: such belief may block the uncertain and
spontaneous encounter necessary for effective therapy. (p. 13)

“This encounter,” Yalom (1989) concluded, is “the heart of psycho­

therapy, . . . a caring, deeply human meeting between two people, one
(generally, but not always, the patient) more troubled than the other” (p. 13).
Finally, the value of being present as a vulnerable and yet distinc-
tive person was illustrated by Friedman (1995) in the following client-
authored vignette. After a 4-year therapy with Friedman, his client, Dawn,
reported the following:

When I think about our therapeutic relationship, it is the process that

stands out in my memory, not the content.
Up until the time I met Maurice [Friedman], I had always “picked
out” a male authority figure (usually a teacher or psychologist), put
him on a pedestal, and obsessed about him a lot—not usually in a
romantic or sexual way, although there was an erotic element. I just
wanted him to like me and approve of me and to think I was smart
and interesting. A real relationship, though, was terrifying to me—
I kept my distance and rarely ever talked to them. The greater the
attraction, the greater the fear.

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 Therapy Process

When I first met Maurice, I could feel myself wanting to fall into
this same pattern with him. However, I could never quite feel intimi-
dated by him—although I think I really wanted to. He was too human
for that. I never felt that I had to be interesting or smart, good, bad,
happy, or sad—it just wasn’t something I had to be concerned with.
If the therapist can be human and fallible, that gives me permis-
sion to be human and fallible, too. (p. 313)

For Friedman, as with most E–H therapists, then, the cultivation of

presence is the foundation that both holds and illuminates. It holds by
supporting, embracing, and opening to clients’ travails, and it illuminates
by witnessing, disclosing, and engaging with those travails. In short, pres-
ence holds and illuminates that which is palpably—immediately, affec-
tively, kinesthetically, and profoundly—relevant within the client and
between the client and therapist, and its cultivation is the ground, method,
and goal of substantive E–H transformation.

Cultivation and Activation of Presence:

Presence as a Method and a Goal
As we have noted, presence not only forms the ground for E–H encounter,
it also forms the method of clinical practice and culminates in its goal. To
the extent that clients can attune, at the most embodied levels, to their
life-limiting patterns of being and to their severest conflicts, healing in the
E–H framework is likely to ensue. This healing is a kind of reoccupation
of oneself, an immersion in the parts of oneself that one has designed a
lifetime to avoid. And it is an integration thereby of the potential or open-
ings that become manifest through that reoccupation.
To help clients recognize their life-limiting patterns and conflicts, the
E–H therapist focuses more on process than on content. This axiom is
illustrated by the example in Chapter 3 of Orah Krug’s focus on her client’s
behavior regarding the well-used tissue. This intervention illustrates how
people in therapy experience their patterns and conflicts as real, in the
immediate moment. It also exemplifies how clients come to appreciate the
restrictive nature of their patterns and, more importantly, their responsi-
bility in having constructed them. Therapeutic attention to process may

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vary from an intra- to interpersonal focus depending on the extent to which

a particular therapist values an intra- or interpersonal focus (Krug, 2009).
Regardless of therapeutic focus, most E–H practitioners assume that the
way a person engages in the therapeutic encounter is a reflection of how that
person engages in his or her life (J. F. T. Bugental, 1999; Yalom, 2002). Thus,
E–H therapists illuminate that which is implicitly and explicitly present at
each critical juncture. This experiential method of knowing is an inquiry
into the client’s and the therapist’s lived and immediate experiences based
on the phenomenological method (Craig, 1986; Schneider, 2008).
E–H therapists cultivate intra- and interpersonal presence to shine a
light on the client’s processes or constructs of self and world as they emerge
in the therapeutic encounter. For instance, if a client embodies childlike
attitudes and behaviors and relates to the therapist as a parent, the thera-
pist would not likely explain this to the client. Instead, the therapist would
carefully and respectfully identify aspects of the client’s subjective and
relational behaviors that are manifesting in the present moment—such
as, “Your voice is so soft and young right now” or “You seem to be asking
for my advice”—in effect, holding up a mirror to the client.
The aim is not to explain or interpret but to cultivate the client’s abili-
ties to experience kinesthetically and express the ways in which he or she
relates to self and to the therapist, who is “a substitute for the world” (Trub,
as cited in Friedman, 1991b, p. 498). This phenomenological approach is
an experiential, as distinct from an intellectual, illumination of what it
means to be present with self and others. The question for this particular
phase of the therapeutic process is, What are the most effective ways and
means to activate presence in the client? Or, how can therapists help mobi-
lize clients’ presence (J. F. T. Bugental, 1987)?
Consider the following vignette by Schneider (2007) as an illustration:1

My client James is sitting across from me hurriedly reporting on the

difficulties he had over the past week. I take a full breath and center

1 The case of James is from “The Experiential Liberation Strategy of the Existential–Integrative Model
of Therapy” by K. Schneider, 2007, Journal of Contemporary Psychotherapy, 37, p. 36. Copyright ©
2007 by Springer. Reprinted with permission.

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myself: “James,” I interject, “I wonder if you can take a moment

and check in with what you’re feeling right now, as you talk about
that ‘put-down’ last week.” A little taken aback, James suddenly
pauses a moment. He looks inward, and he inhales. “I’m pissed!”
he exclaims.
“I’ve had a week—no, a lifetime—of being treated like shit, I turn
to a person I thought was a close friend, and even she, apparently,
can’t stand the sight of me, and I just don’t get it—don’t know where
to turn.” (Now James is connecting with himself; he’s slowed down
enough to be authentically present to his anger, here and now. His life
is not just a string of complaints; it has some passion, aliveness, and
I decide to highlight that passion and aliveness.)

KS: Boy, you have a lot of energy all of a sudden, James.

James: Yeah, I do—but what the hell good is it? I can get mad from
now until doomsday, and it won’t change the fact that women think
I’m a pervert, men think I’m a weakling, and my boss thinks I’m
incompetent!
KS: And what do you think of you? What do you feel towards
yourself?
James: I feel like a jerk—what do you think!?
KS: I don’t know, James, I can’t speak for you, but I hear you.
(James slouches in his chair as if to fold up in total resignation.)
KS: Where are you now, James?
James: [eyes moistening] I’m stuck, I’m screwed . . .
KS: Looks like some emotion is welling up.
James: Yeah, sometimes I feel like my life is a big wall—and I’m the
bug that constantly gets squashed.
KS: Is that where you are now?
James: Not exactly.
KS: Take a moment and be with where you are, James.
James: I’m hurting.
KS: Can you describe where in your body you feel that hurt, James?

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James: Yeah, it’s in my chest—it’s all clogged up.

KS: See if you can stay with that feeling in your chest; what other
feelings, sensations, or images come up for you as you stay with that
feeling?
Summary: This vignette illustrates how invoking the actual has
helped James move from a distant “reporter” to an embodied partici-
pant. Gradually, as James experiences more and more of himself—
e.g., his affect and body sensations—more and more of himself can
be accessed and expressed. (p. 36)

As we shall elaborate momentarily, the cultivation and activation of

client presence within E–H therapy is characterized by two basic modes
or access points—the intrapersonal and the interpersonal. Although it has
long been recognized that these modalities overlap and indeed intertwine
(Merleau-Ponty, 1962), they nevertheless reflect two traditional E–H
practice styles that are gradually—and for many, refreshingly—beginning
to merge (Krug, 2009; Portnoy, 2008).
Cultivation and Activation of Intrapersonal Presence. J. F. T. Bugental
(1987) is representative of the intrapersonal tradition in E–H therapy,
although this characterization is far from discrete and much about his
approach can be considered interpersonal as well. Within the former tra-
dition, however, Bugental (1987) outlined four basic practice strategies, or
that which he termed “octaves,” for activating clients’ presence: listening,
guiding, instructing, and requiring.
The first octave, listening, draws clients out and encourages them to
keep talking so as to obtain their story without “contamination” by the
therapist. Examples of listening include “getting the details” of clients’
experiences, “listening to emotional catharsis, learning [clients’ views of
their] own life or . . . projected objectives” (J. F. T. Bugental, 1987, p. 71).
The second octave, guiding, gives direction and support to clients’ speech,
keeps it on track, and brings out other aspects. Examples of guiding include
exploration of clients’ “understanding of a situation, relation, or problem;
developing readiness to learn new aspects or get feedback” (p. 71).
The third octave is instructing. Instructing transmits “information or
directions having rational and/or objective support.” Examples include

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“assignments, advising, coaching, describing a scenario of changed living,”

or reframing (p. 71). Finally, the fourth octave is requiring, which brings a
“therapist’s personal and emotional resources to bear” to cause clients to
change in some way. Examples of requiring include “subjective feedback,
praising, punishing [e.g., admonishing], rewarding,” and “strong selling of
[a] therapist’s views” (p. 71).
Listening and guiding comprise the lion’s share of E–H activation of
presence. Whereas instructing and requiring can certainly be useful from
the E–H point of view, they are implemented in highly selective circum-
stances. For example, instructing may be very helpful to clients at early
stages of therapy; those who have fragile emotional constitutions, such as
victims of chronic abuse; or clients from authority-dependent cultures.
Requiring, similarly, may be useful in these situations but also in the case
of therapeutic impasses or entrenched client patterns, as we shall see. For
the majority of E–H practice situations, however, listening and guiding
are pivotal to the deepening, expanding, and consolidating of substantive
client transformation.
May (1981) illustrated the value of listening with his notion of the
pause. “It is in the pause,” he wrote,

that people learn to listen to silence. We can hear the infinite number
of sounds that we normally never hear at all—the unending hum and
buzz of insects in a quiet summer field, a breeze blowing lightly through
the golden hay. . . . And suddenly we realize that this is something—the
world of “silence” is populated by a myriad of creatures and a myriad
of sounds. (p. 165)

The client, similarly, is almost invariably enlivened in the pause. As J. F. T.

Bugental (1987, p. 70) suggested, it is in the therapist’s silence at given
junctures that abiding change can take root.
The provision of a working “space,” a therapeutic pause, not only
helps the therapist understand, but most importantly, assists the client to
vivify (or intensively elucidate) himself or herself. This point is illustrated
at several junctures in the previous vignette of James, but most certainly
when Schneider invited James to “check in with what you’re feeling right
now.” This invitation to pause allowed James to slow down and elucidate

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himself. As intimated earlier, vivification of a client’s world is one of the

cardinal tasks of E–H therapy. To the extent that clients can “see” close up
the worlds in which they’ve lived, the obstacles they’ve created, and the
strengths or resources they possess to overcome those obstacles, they can
proceed to a foundational healing. Listening elucidates one of the most
crucial realizations of that vivification—the contours of a client’s battle.
The client’s battle—and virtually every client has one—becomes evi-
dent at the earliest stages of therapy. For some this battle takes the form
of an interpersonal conflict, for others an intrapsychic split. To cite just
a few examples, it may encompass the compulsion for and rejection of
binge eating, a conflict with one’s boss, or a struggle between squelched
vocational potential and evolving aspirations. Regardless of the content of
clients’ battles, however, their form can be understood in terms of two basic
valences—the part of themselves that endeavors to emerge and the part
of themselves that endeavors to resist, oppose, or block themselves from
emerging (Schneider, 1998a). One can understand from this description
of resistance and defenses that existential therapy is, as Yalom (1980) sug-
gested, a kind of dynamic therapy that models its understanding of “forces
in conflict” on Freud’s dynamic model of mental functioning. Again, by
referring to the James vignette, we can illustrate this point. James’s battle
appears to be an interpersonal conflict. Although James’s underlying rela-
tional issues are not revealed in this short vignette, we can see their out-
lines as James expresses his anger at the way he is thought of and treated
by people in his life.
Whereas therapeutic listening acquaints and sometimes immerses
clients in their battle, therapeutic guiding intensifies that contact. Thera-
peutic guiding can be further illustrated by encouragements to clients to
personalize their dialogue—for instance, to give concrete examples of their
difficulties, to speak in the first person, and to own or take responsibility
for their remarks about others. Guiding is also illustrated by invitations
to expand or embellish on given topics, such as in the suggestion “Can
you say more?” or “How does it feel to make that statement?” or “What
really matters about what you’re saying?” Finally, guiding is exemplified
by the notation of content–process discrepancies, such as “You smile as

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you vent your anger at him” or “Notice how shallow your breathing is
right now” (J. F. T. Bugental, 1987; Schneider, 2008). Again referring to
the James vignette, we can see guiding in action as Schneider pointedly
directs James to put himself in the equation with these people by asking,
“What do you think of you?” James’s answer that he feels “like a jerk” and
his previous lament that “I just don’t get it” are indications that James is
beginning to face his part in his relational difficulties. Schneider guides
James further to get beyond his fury at constantly getting squashed by
others to an acknowledgment of the hurt that underlies it. In this way,
James is assisted to experience the complexity of his reactions beyond his
rigidified patterns.
Schneider (1998a, 2008) formulated a mode of (minimally directive)
guiding called embodied meditation. This approach has proven pivotal
for many clients, particularly those who battle overintellectualization.2
Embodied meditation begins with a simple grounding exercise, such as
breathing awareness or progressive relaxation (usually assisted by the
closing of the eyes). From there, it proceeds to an invitation to the client to
become aware of his or her body. The therapist may then ask what, if any,
tension areas are evident in the client’s body. If the client identifies such
an area, which often occurs, the therapist asks the client to describe, as
richly and fully as possible, where the tension area is and what it feels like.
Following this and assuming the client is able to proceed with the
immersion, he or she is invited to place his or her hand on the affected
area. (This somatic element can often be, although not necessarily, expe-
rientially critical.) Next, the client is encouraged to experientially associ-
ate to this contact. Prompts such as “What, if any, feelings, sensations, or
images emerge as you make contact with this area?” can be of notable
therapeutic value. Schneider has seen clients open emotional floodgates
through this work, but he has also seen clients who feel overpowered by
it. It is of utmost importance for the therapist to be acutely attuned while
practicing this and other awareness-intensive modes. Schneider illustrates

2
Although several variations of embodied mediation have been shown to be highly effective with
certain populations (e.g., see Gendlin, 1996; Leijssen, 2006), in the wrong hands they also can be
debilitating. As with all approaches discussed in this volume, care must be taken to ensure that facili-
tation is preceded by appropriate training, skill development, and sensitivity to clients’ needs.

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this technique in the James vignette when he asks his client to locate the
hurt in his body and then focus on the hurt in the chest and see what feel-
ings and associations emerge.
Guidance is also illustrated by a variety of experimental formats that
can be offered in E–H therapy. These experiments, including role-play,
rehearsal, visualization, and experiential enactment (e.g., pillow hit-
ting, kinesthetic exercises), serve to liven emergent material and vivify
or deepen the understanding of that material (Mahrer, 1996; Schneider,
2008; Serlin, 1996). The phrase “Truth exists only as it is produced in
action” (Kierkegaard, as cited in May, 1958b, p. 12) has much cachet in this
context. When clients can enact (as appropriate) their anxieties, engage
their aspirations, and simulate their encounters, they bring their battles
into the room—in “living color”—for close and personal inspection.
Although experimentation within the therapeutic setting is invalu-
able, experimentation outside the setting can be of equivalent or even
superior benefit. After all, it is the life outside of therapy that counts
most for clients, and it is in the service of this life that therapy proceeds.
Experimentation outside of therapy, then, has two basic aims: (a) It
reinforces intratherapy work, and (b) it implements that work in the most
relevant setting possible—the lived experience. Accordingly, E–H thera-
pists encourage clients to practice being aware and present in their out-
side lives. They may gently challenge clients to reflect on or write about
problematic events, or they may propose an activity or therapeutic com-
mitment (e.g., Alcoholics Anonymous, assigned readings). They may also
challenge clients to do without a given activity or pattern. For example,
Yalom (1980) challenged his promiscuous client Bruce to try living with-
out a sexual partner for an extended period. This was a highly demanding
exercise for Bruce, whose sexual compulsions were formidable and afforded
no pause. Yet after the exercise, Bruce reported rich therapeutic realizations,
like the degree to which he felt empty in his life and the blind and compul-
sive measures he took to fill that emptiness. Emptiness, Yalom reported,
subsequently became the next productive focus.
Prompts to clients to “slow down” or “stay with” charged or disturbing
experience can also facilitate intensified self-awareness. We have known

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many a supervisee (and even seasoned colleague) who has had difficulties
with this facilitation. They are superb at helping clients to reconnect with
the parts of themselves they have shunted away, and they inspire deep
somatic immersion in expressiveness, but they are left with one gaping
question: “What do I do after the client is immersed?” The exasperation
in this puzzlement is understandable. E–H work can seem tormenting. It
can instigate profound moments of unalloyed pain. The last thing a thera-
pist wishes to do in such a situation is to enable increased suffering or to
hover in continued despair. And yet, given the client’s desire and capacity
for change, these are precisely the allowances that E–H therapists must
provide, precisely the groundworks they must pursue. They must develop
trust and a sense that the work will unfold (Welwood, 2001). Hence, what
do we advise our supervisees and colleagues? We suggest that it is in their
interest to trust—in particular, to trust that gentle prompts to “stay with”
or “allow” intensive material will almost invariably lead to changes in that
material. Although these changes may not feel immediately welcome or
gratifying—indeed, they may even feel regressive for a time—they do rep-
resent evolution, the “more” that every person is capable of experiencing.
Working with dreams is another venue in which self-awareness and the
“more” is cultivated. Dreams represent a restatement of the client’s central
concern in a language of visual imagery (Yalom, 2002). They are concrete
representations of a person’s attitudes, experiences, and feelings—a falling
down house, crossing a bridge, descending into a basement. Yalom (2002)
took a pragmatic approach to dreamwork, using it to accelerate therapy.
Orah Krug finds it helpful to bring dreams into the here and now by hav-
ing clients retell their dreams in the present tense. It is also helpful to listen
for statements that clients make about themselves and others in the dream
as well as the context of the dream. Asking “What is the most prominent
feeling in the dream?” and “What is most striking to you about the dream?”
can further the process of self-exploration and the “more.”
Much of the therapist’s task within E–H therapy is to facilitate this
“more.” In time, and as clients become aware of their wounds, they also
tend to feel less daunted by those wounds, less imprisoned; they begin to
realize, in other words, that they are more than their wounds and, through

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this process, that they are more than their “disorder.” For example, David
felt sure that he was despicable, plaguelike, and demonic. His parents had
convinced him so over a period of 18 years—not through the usual route
of abuse and punishment but exactly the opposite, through indulgence.
David was led to believe he was a king, a seer, and a god. He was given
“everything” and praised for virtually every routine move. The result: As
soon as David hit adulthood, with the trials and pressures of college, dating,
and vocation, his bubble burst. No longer could he live under his former
illusions but now had to face his incompetencies, inabilities to compete, and
his far-from-developed will. The convergence of these factors sent David
into a tailspin. His view of himself completely reversed: Now in his 30s, he
repudiated himself whereas he had earlier glorified himself; where he once
saw a titan for whom every whim was fulfilled, he now saw an outcast for
whom every desire was unreachable.
The work with David is highly illustrative of the trust dimension in
the cultivation and activation of presence. Although his self-hatred was
formidable, it was not irrevocable. The therapist spent many sessions
tangling with David’s anguish, self-pity, and searing guilt. There were many
times when he could go only so far with these feelings and had to warp
back into the semblance of self and self-image that he had constructed
as a defense. But there were times, increasingly productive times, when
he could glimpse a counterpart. For example, in the midst of his self-
devaluing, he might suddenly become frustrated and realize moments of
self-affirmation—that is, times when he actually liked himself, and liked
being alive, regardless of the strokes he would receive from doting associ-
ates. At first this realization was fleeting, but eventually, as he stayed with
it, it became the major counterpoint to his despairing self-reproach. Back
and forth he would swing, between burning self-debasement and gleam-
ing self-validation, including compassion, appreciation, and even exulta-
tion at being alive. This latter quality was also connected to his growing
sense of outrage not only at his outdated sense of self, but at his upbring-
ing and his well-intentioned but clueless parents. He began to realize that
his lowliness was far from an inherent defect but a product of environment,
circumstance, and, in part, choice.

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To summarize, despite David’s repeated resistance and readiness to give

up, the therapist’s empathic invitations to “give his hurt a few moments”
or to “see what unfolds” were crucial to his reengagement with his larger
self. And through this reengagement, he began to discover that he was so
much vaster than his stuck sense of unworthiness; he began to see that he
was sensitive, alive, and resiliently mortal—and that these were enough.
Cultivation and Activation of Interpersonal Presence. The cultivation
and activation of presence can also occur through the interpersonal route,
or that which E–H therapists term the encounter (Phillips, 1980–81). The
encounter is illustrated by E–H therapists in myriad and diverse forms.
For example, the calling of attention to disturbances or undercurrents in
the immediate relationship exemplifies the E–H concern with encounter,
as does the recognition of transference and countertransference projec-
tions, as does the encouragement to explore the status of the therapeutic
bond at given junctures. The E–H encounter assumes that each person
brings his or her way of being and relating to self and other into the ther-
apy room. As a whole, the E–H encounter is characterized by the following
three criteria: (a) the real or present relationship between therapist and
client (which can include projections from the past but chiefly as they are
experienced now rather than in the remoteness of reminiscences, as in the
difference between reporting about and “living” transferential material),
(b) the future and what is potential in the relationship (vs. strictly the past
and what has already been scripted), and (c) the enactment or experienc-
ing, to the degree possible, of relational material.
Attention to the encounter or the interpersonal is a vital part of
E–H facilitation (Krug, 2009; Portnoy, 2008). Buber (1970), Friedman
(1995, 2001), Sullivan (1953), and Yalom (1980) all emphasized the
interpersonal—or as some psychoanalysts (e.g., Stolorow, Brandchaft,
& Atwood, 1987) have called it, the “intersubjective.” The reason for this
emphasis on the inter­personal is that such contact has a uniquely inten-
sive quality that both accentuates and mobilizes clients’ presence. More-
over, a focus on the interpersonal develops the therapeutic relationship
by enriching the “in-betweenness” of the therapist and client (Yalom,
1998). An interpersonal focus accentuates presence by awakening it to

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what is real, immediate, and directly relational, and it mobilizes pres-

ence by demanding of it a response, engagement, and address. There is
something profoundly naked about the turn to an immediate interaction.
It takes the parties out of their inward routine (assuming that is there) and
focuses the spotlight on a new and utterly alternative reality—themselves.
In short, there is something undeniably “living” about face-to-face inter-
actions. They peel away the layers of pretense and expose the inflamed
truth of embattled humanity. There are no easy exits from such inter­
actions, and there are fewer “patch-up jobs” as a result.
Take the case of Elva. A thorny and self-aggrandizing widow, Elva
spared few with her humor-laced vitriol. Yet Elva’s battle was the pro-
found sense of helplessness that underlay her bravado. Since the death of
her husband, and despite her bouts with loneliness, Elva had been making
a comeback through therapy. She was just beginning to reclaim her self-
worth, and her jokes were becoming less caustic, when the bubble burst
and she was mugged. The period following this attack, a purse snatching,
was a trying one for Elva. She was retraumatized, and even her attempts
at false bravado fell short.
Yet Elva’s battle was clear—she was face-to-face with her worst fears of
helplessness, and her wounds were exposed raw. It was at this critical junc-
ture that Elva’s therapist and author of this case, Yalom (1989), took a risk.
Instead of encouraging her to report about her terrors, which might have
alleviated some of her internal pressure but not genuinely confronted her
wound, he invited her to experience her terrors directly with him. But
instead of making it a one-sided exercise, he encouraged her disclosure
with some disclosures of his own: “When you say you thought [the purse
snatching] would never happen to you,” Yalom (1989, p. 150) confided
to Elva, “I know just what you mean.” He elaborated: “It’s so hard for me,
too, to accept that all these afflictions—aging, loss, death—are going to
happen to me, too” (p. 150).
He went on: “You must feel that if Albert [her deceased husband]
were alive, this would never have happened to you. . . . So the robbery
brings home the fact that he’s really gone” (p. 150). “Elva was really crying
now,” Yalom (1989) continued, “and her stubby frame heaved with sobs

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for several minutes. She had never done that before with me. I sat there
and wondered, ‘Now what do I do?’” (p. 150). But he sensed “instinctually”
just what to do. He took one look at her purse—“that same ripped-off,
much abused purse,” and challenged: “Bad luck is one thing, but aren’t you
asking for it carrying around something that large?” (p. 150).
This sardonic quip, which was also an offering to dialogue, set off a
whole new direction for Elva and Yalom. “I need everything in that purse,”
Elva protested. “You’ve got to be joking,” retorted Yalom, “Let’s see” (p. 150).
With that cue, not only did Elva proceed to open up her purse to
Yalom; they shared intimately in the discussion of its contents. Finally,
“when the great bag had . . . yielded all,” Yalom elaborated, “Elva and I
stared in wonderment at the contents. We were sorry the bag was empty
and that the emptying was over” (p. 150). But what struck Yalom most
of all was how “transforming” that engagement had been, for Elva, in his
view, had “moved from a position of forsakenness to one of trust” (p. 150).
That was “the best hour of therapy I ever gave” (p. 150), Yalom concluded.
Through sharing that bag, Elva accessed more vulnerability, more
anxieties about trust, and more possibilities for risking, healing, and
bridging than she would likely ever have, had she simply reflected on its
contents. By inviting Elva to share the bag’s contents, Yalom provided her
with an opportunity to experience an exceedingly intimate moment with
him. Yalom (2002) asserted that “therapists must convey to the patient
that their paramount task is to build a relationship together that will itself
become the agent of change” (p. 34). Yalom’s work with Elva vividly illus-
trates how he built a safe and intimate therapeutic relationship with her.
The interpersonal encounter for E–H therapists is rife with responsi-
bility, the ability to respond to the injured other (i.e., client) such that he
or she can respond to and reconnect with the parts of himself or herself
that have been damaged. According to Buber, and following him Friedman
(2001), such responsibility entails

hearing the unreduced claim of each hour in all its crudeness and
disharmony and answering it out of the depths of one’s being. . . .
[It entails] the great character who can awaken responsibility in
others . . . [and] who acts from the whole of his or her substance

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and reacts in accordance with the uniqueness of every situation.

(Friedman, 2001, p. 343)

Mutual confirmation, or what Buber called an “I–Thou” relationship,

meaning “a relationship of openness, presence, directness, and immedi-
acy,” is essential to the therapist’s responsibility, according to Friedman
(2001, p. 344). Although there is a place for modulating this confirma-
tion, and no professional relationship can be mutual in the sense of a
friendship, such a notion is nevertheless a bellwether, a palpable and reli-
able indicator, of intensive therapeutic transformation. Why is this so?
Because the further that one can be present to and work out differences
with another, the more one can generally engage in the same relational
dynamics toward oneself.
In her discussion of Sylvia, Sterling (2001) articulated both sides of
the responsibility question, and she did so poignantly and incisively. “My
client leaned forward,” Sterling (2001) began her case illustration, “eyes
intently on me, voice passionately intense, and said to me, ‘I just want to
be in your kitchen while you cook’” (p. 349). Sterling went on,

Inwardly, I froze. Not one therapist sinew, not one trained muscle
of years of practice, flexed into action. Nowhere in me was there a
standard response, and I parody our standard psychotherapeutic rep-
ertoire a bit here: “Tell me how that would be” or “You would like to
be closer to me” or “Our meetings aren’t enough for you” or just a
genuinely open and quiet waiting for my client to continue.
Instead I reacted viscerally.
In my frozen moment, I saw the dishes left as I hurried out early
that morning. I felt my pleasure in my own rhythm of my potter-
ing about. I wondered how my family would take to this new person
slipped into their lives. These images supplanted my unawareness
that I could not sustain my client’s intense pressure. I felt, in short,
inadequate to her proposition. (p. 349)

Sterling took Sylvia’s request as a “concrete proposition to which

[Sterling] was called to give a concrete answer. . . . And so, the gist
of [Sterling’s] reply carried all of these feelings and many more to which

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[she] was then blind: ‘Oh, you might not like me so much if you were
around me more.’” And “in one blind stroke,” Sterling conceded, “I
had cleaved open a chasm of distance, betrayal, shame, fury, and mis­
construal” (p. 349).
Caught up in her own discomfiting anxieties about being wanted,
needed, and accompanied, Sterling reacted—as would many therapists in
similar situations—with modified, low-grade panic. But, and this is where
the existential, I–Thou notion of encounter becomes so relevant, Sterling
did not desist at the point of her anxiety. She did not “fold up” and revert
to some stilted or rehearsed professionalism, nor did she abandon Sylvia,
either physically or emotionally. To the contrary, she stayed profoundly
with her evolving distress, remained immersed in it, took time to study it,
explored it with Sylvia, and gradually, charily, fashioned a response to it.
The response that Sterling fashioned recognized both her own and
Sylvia’s shortcomings, but also their humanity. Sterling was overwhelmed
by Sylvia’s neediness in her request, and she had a right to experience
this sensibility; at the same time, Sylvia had a right to expect something
more from Sterling, something that acknowledged her plea. Sterling
took inspiration from the existential–phenomenological philosopher
Emmanuel Levinas:

The ability to respond is the primary meaning of responsibility.

Levinas took this further to show that responsibility also carries the
experience of being beholden to the other person. . . . Responsibil-
ity, for Levinas, meant that simply by the fact of the face of the other
person, one is “taken hostage”—before thought, choice, or action. . . .
It is this level of our human condition, brought into presence by our
naked encounter, that Sylvia and I . . . had to reckon with. (Sterling,
2001, p. 351)

Although Sterling “failed” to meet the “obligation” of human encoun-

ter, in her very failure, she realized, were the seeds of her success. For, as
Sterling put it about her discouraging remark to Sylvia,

Sylvia was [nevertheless] in my kitchen with me—conflicts, mess,

hurry, and all. At that moment, [Sylvia] had what she would get in my

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kitchen in actuality, if not what she wanted in feeling. I was as naked

as she was, if only she (and I) could see it. (Sterling, 2001, p. 352)

But Sterling did see it. In time, she acknowledged how overwhelmed she
was by Sylvia’s fantasy. She opened up some about her own weaknesses, fears,
and misgivings, and this, as Sterling put it, “altered” their relationship. From
that point on, Sylvia was freed to respond as a person to Sterling, because
Sterling, in turn, had responded as a person with Sylvia. But by acknowledg-
ing her limits with Sylvia, both as person and professional, Sterling helped
free Sylvia to respond to something else—her nurture of herself—and the
challenge thereby to actualize that relationship.
To summarize, the E–H cultivation of interpersonal presence is a com-
plex, organic, and dynamic process whereby the entire therapeutic context
is taken into consideration. Among the salient factors within this context
are the client’s desire and capacity for engagement, the therapeutic alliance,
and practical considerations. The guiding therapeutic question is, To what
extent does encounter build the therapeutic relationship and further the
cause of engagement with the client’s life-limiting patterns? Or, alterna-
tively, to what extent does encounter do the opposite, and defeat or stifle
facilitative processes?

Encounter With Resistance (Protections)

When the invitation to explore, immerse, and interrelate is abruptly or
repeatedly declined by clients, then the perplexing problem of resistance,
or as we are increasingly framing it, “protections,” must be considered.
Resistance is the blockage to that which is palpably (immediately, affec-
tively, kinesthetically) relevant within the client and between client and
therapist. E–H practitioners assume that resistance, or protections, are
concrete manifestations of clients’ inabilities to fully face and accept some
life experiences—especially those that are particularly painful and devas-
tating. E–H practitioners consequently appreciate resistance behaviors
because they illuminate the ways in which a client views her or his sense
of self and the world. The following vignette from Orah Krug’s work with
Diana provides an illustration. Our session began with Diana describing,

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with evident pride and satisfaction, how she had accepted a challenging
task from her supervisor and had successfully completed it.

OK: You seem very pleased with your accomplishment.

Diana: [exclaiming strongly] Following through on a commitment is very
important to me.
OK: There’s a lot of energy there. Your statement seems to have a great
deal of meaning for you. Can you go inside and explore its meaning a little
more? Just let your mind relax and say whatever is there. (I intentionally
slowed the process down here because Diana’s energy identified aliveness.
I try to encourage more of that with a person who typically tamps it down,
as was Diana’s tendency. I sensed that a part of Diana was attempting to
emerge, and so I invited her to make “space” for it.)
Diana: It’s about being responsible, showing up in life, growing as a per-
son. (Suddenly she stopped and laughed.) I don’t know where I’m going.
OK: You’re doing just fine. (I immediately realized my mistake. My com-
ment was an attempt to rescue her from her discomfort instead of allow-
ing her to explore and understand what had just happened. I backtracked
and tried to have her get curious about her process.)
OK: Did you notice that your comment about not knowing where you’re
going seemed to stop you dead in your tracks? Go inside and see if you can
discover what’s happening in there.
Diana: [smiling] I thought I was saying something stupid, blah, blah, blah,
and I thought you thought so, too.
OK: You know in that moment of stopping yourself, you stopped show-
ing up for yourself. The irony is that before you stopped yourself, you
were showing up for yourself. Perhaps showing up for yourself triggers
some fear?
Diana: [quiet for a moment, and then with tears in her eyes] Yes, a fear of
being out there and not knowing what’s coming—I squish myself.

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OK: So when some feeling is emerging inside, you get afraid? Can you go
slow and explore what scares you in the emerging?
Diana: I feel exposed, I feel vulnerable.
OK: Can you imagine another feeling you could have instead of fear?
Diana: I could be curious—that’s how I was last week, when I went out
with a group of friends from work. I realized I was attracted to one of the
men in the group and felt that curiosity. I thought, there are a lot of men
out there that I could feel this way with, instead of going to that fear place
of there’s only one man and I have to attach to him.
OK: How is it to share this with me?
Diana: I feel a little shy, but OK. I didn’t realize how and why I stop myself,
and it feels good to have us both knowing what goes on with me.

This crucial therapeutic moment could have been lost if Krug hadn’t
recognized that reassuring Diana in her moment of discomfort was not
facilitative. Diana needed support to explore her repetitive pattern of
stopping herself when feeling “out there and stupid.” A more therapeutic
response prepared the soil for her to embody her silent, constricted way of
being constructed long ago to avoid feelings of vulnerability and exposure.
Diana’s painful shame-based feelings were so palpable that Krug reactively
tried to protect her from them. This experience emphasizes how quickly
subconscious reactivity can take the place of conscious presence.
This session marked a turning point in our work. Since Diana and
Krug were now both aware of her shame-based constrictive pattern, the
work focused on having the “light of day” shine on her sense of shame
and “not OK-ness.” Eventually, she was able to acknowledge, accept, and
ultimately dissolve those shameful feelings. As that happened, Diana grew
into her womanhood.
This session illuminates what it means to cultivate presence and to
work with the client’s resistance to expansion. It helps us understand resis-
tance as a protective mechanism and as an expression of the client’s under-
lying sense of self and world constructs. Diana’s resistance or protective

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pattern helped her avoid feeling “stupid,” a belief she held about herself
created from past experiences from which she concluded she was stupid
and therefore needed to hide herself away.
As is often the case, clients bring these protective, patterned ways of
being into the relationship and transfer onto the therapist particular atti-
tudes and beliefs that express their underlying sense of self in relation to
the other. E–H therapists’ understanding of transference was articulated
well by J. F. T. Bugental (1965) as “a patterned way of being in the world
that involves a significant other and that is reactivated in the patient’s rela-
tion to the therapist” (p. 138). In Diana’s case, she experienced herself as
“stupid” and Krug as the “judgmental other.” It is important to work with
these negative transferences when they arise and give clients corrective
emotional experiences, as illustrated in this vignette. Krug worked both
intrapersonally and interpersonally to help Diana dissolve her underlying
wound of “I’m stupid” and her associated shameful feelings.
There are several caveats that must be borne in mind when consider-
ing client resistance. First, therapists can be mistaken about resistance.
What the therapist labels resistance may in fact be a refusal on the part
of the client to accept the therapist’s agenda for him. Resistance is mostly
a safety issue for clients—as in Diana’s case—or an issue of cultural or
psychological misunderstanding. From an E–H perspective, it is of utmost
importance that therapists suspend their attributions of resistance and
discern their relevant contexts (see Cooper, 2009).
Second, it is crucial to respect resistance, from an E–H point of view.
Resistance is a lifeline to many clients, and as miserable as their patterns
may be, this lifeline represents the ground or scaffolding of an assured or
familiar path. Although this path may seem crude or even suicidal, to clients
who experience it, it is starkly preferable to the alternatives (May, 1983).
Accordingly, it is important for E–H therapists to tread mindfully when it
comes to resistance, acknowledging to clients both its life-giving and life-
taking qualities. J. F. T. Bugental’s (1987) conceptualization of resistance
as a person’s “spacesuit” is useful because it metaphorically describes its
essence and purpose—that is, as a pattern of being that is life affirming
and life limiting.

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Finally, it is also important to be cognizant of challenging clients’

resistance prematurely, lest such challenges exacerbate rather than allevi-
ate defensive needs. A safe and intimate therapeutic relationship must be
in place before challenging clients’ protective patterns of being.
From an E–H point of view, resistance work is mirroring work. By
mirroring work, we mean the feeding back and elucidation of clients’
monumental experiential battle. As suggested earlier, this battle consists
of two basic factions: the side of the client that struggles to emerge (e.g.,
to liberate from, transcend, or enlarge her or his impoverished world) and
the side that vies to suppress that emergence and revert. Whereas the acti-
vation of presence (e.g., the calling of attention to what is alive) mirrors
clients’ struggles to emerge, resistance work elucidates clients’ barriers to
that emergence and the ways and means they immobilize.
James Bugental (1999) likened protective patterns to wearing space-
suits in outer space: They allow us to survive and function, but they don’t
give us the freedom to scratch our nose! Robert, for example, may come
to therapy when some life event makes his “spacesuit” too constricting,
thereby causing him sufficient distress to seek help. Robert likely has an
internal battle raging between a part of himself that wants to emerge
(perhaps his desire for intimacy) and his “spacesuit” that holds the
emerging part back to protect him (perhaps from his fear of intimacy or
rejection). Awareness of self and world constructs helps therapists hone
in on their clients’ unique perspectives about their natures and relational
worlds, as well as on their clients’ protective patterns that both constrict
and support survival.
Clients’ barriers are often outside of their awareness, and as seen in
the session with Diana, sometimes clients’ barriers are outside therapists’
awareness. Consequently, the E–H therapist must be deeply attuned to
himself or herself, the relationship, and the client in order to effectively
illuminate what is actual but unregarded, both interpersonally and intra-
psychically, in both the client and therapist. The resistance or protection
patterns that unfold in the encounter enable the therapist and client to
give direct and immediate attention to them, thereby having an immedi-
ate impact on the client’s (and on the therapist’s) life. Awareness of self

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and world constructs and protective patterns also focuses the therapist
on his or her own personal context that may be impeding therapeutic
effectiveness with a particular client. For example, Krug’s desire to quickly
reassure Diana could have impeded the therapy if it had gone unnoticed.
By holding up a relational mirror, E–H therapists help clients
experience the ways in which they create their life situations and their
problems. This awareness helps clients assume responsibility for their
lives—responsibility assumption is required before any lasting change
can occur. The E–H practitioner understands resistance or protection
patterns as multidimensional.
Another case example will help illustrate these resistance or protec-
tion patterns and show how an E–H therapist (in this case, Orah Krug)
understands them as multidimensional.

Hank came to therapy wanting to improve his relationships with

women. Hank was often late for therapy, checking it off his to-do list,
and wanted me just to tell him what to do so he could find a “good
woman.” Hank held himself up as an object to be analyzed. I recog-
nized that Hank’s analytic and passive stance made it difficult for him
to take responsibility for the way his life was turning out.
The first evidence of resistance (interview resistance) usually
occurs in the first few sessions. When I pointed out Hank’s persistent
tardiness, for example, Hank deflected my comments with no real
interest in exploring his tardy behavior, saying, “I often get busy with
work and lose track of time. It has nothing to do with therapy; I’m
always late.” I understood that Hank’s lateness was not an isolated
event, but a segment of a larger life pattern (life-pattern response).
Hank was not ready to accept that his tardiness was a resistance to
therapy because it was a familiar way of being.
Helping Hank see that his tardiness was part of a constellation
of patterns that were limiting his functioning and truncating his
ability to have the satisfaction and fulfillment that he wanted (life-
limiting processes) was a crucial step. Soon Hank began to realize
that just 60% of him showed up for therapy, just as in the rest of
his life. “If I never fully show up, I don’t expose myself to the risk of

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getting hurt.” In his interior life, Hank was dysfunctionally expan-

sive. To distract himself from what he was feeling, he was either
fantasizing about being blissfully happy with a woman or plotting
revenge on her for scorning him. In the meantime, on the outside,
he ran from activity to activity, never engaging deeply in his work
or in relationships and at the same time wondering, “How did I end
up being 40 and alone?”
Another resistance dimension was that of the self and world con-
struct system. This dimension is commensurate with J. F. T. Bugental’s
(1987) “spacesuit” concept. Each of us needs to construct a concep-
tion of who we are and what the world is. We all shrink the world to a
proportion that feels safe. Hank treated himself like an object and saw
people as objects as well. Fearing rejection everywhere, he never risked
it and consequently never really committed to anything or anyone.
His rationalization was, “I really didn’t want it anyway” or “They were
really jerks for not appreciating me.” He created an internal fantasy
world and externally focused on one detail after another, rarely stop-
ping to experience his feelings of emptiness and loneliness. If he did,
he ran a little faster.
Resistance work with Hank involved helping him experience
his life-limiting patterns of behavior, which he created to protect
himself from pain but which ultimately limited his ability to com-
mit to anything or anyone. The impersonal, almost mechanical,
way that Hank related to me suggested than an interpersonal focus
would be helpful to teach Hank about empathy. After he had repeat-
edly been late to therapy, I began our next session by asking, “How
do you imagine I feel when you come late to our meetings?” He
seemed stunned by my question. He said he never considered that
his behavior would affect me. My question marked a turning point
in our relationship. From then on, we used our relationship as the
medium in which to cultivate Hank’s empathy for others as well as
for himself.
As Hank’s layers of resistance or protections peeled away, he was
able to face his unfaceable fear, that he was unlovable. Eventually,
Hank was able to acknowledge his painful belief of unlovability
because he felt accepted and safe in our relationship. Our “healing

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through meeting” allowed Hank to develop more empathy for me

and for himself and, ever so slowly, to begin to like who he was and to
reach out to others. Hank’s self and world construct system enlarged,
ironically, to include his soft and vulnerable side, which led him to
see himself as an acceptable man in a world populated with accept-
ing people.

There are two basic forms of resistance work: vivification and con-
frontation. Vivification of resistance is the intensification of clients’ aware-
ness of how they block or limit themselves. Specifically, vivification serves
three basic functions: (a) It alerts clients to their defensive worlds (i.e.,
their self and world constructs), (b) it apprises them of the consequences
of those worlds, and (c) it reflects back the counterforces (or “counterwill,”
as Rank, 1936, put it) aimed at overcoming those worlds. There are two
basic approaches linked to vivifying resistance—noting and tagging.
Noting apprises clients of initial experiences of resistance—for exam-
ple, “You suddenly get quiet when the subject of your brother arises.” “You
laugh when speaking of your pain.” “We were just speaking about your
anxieties working with me, and you suddenly switched topics.” “I sense
that you’re holding down your anger right now.” In a distinctly dramatic
illustration of noting resistance, J. F. T. Bugental (1976) reported a highly
stilted initial interview with a client in which decorum rather than genuine
feeling permeated. Laurence, Bugental’s client, took extensive pains to show
how competent he was, how many accolades he had won, and how impor-
tant his life was. But after some period of this self-puffery, Bugental “took
a calculated risk” (p. 16). Instead of placating his new client or emulating
the standard intake role of detached observer, Bugental turned to Laurence,
faced him directly, and averred, “You’re scared shitless.” At that, Laurence
shed his mask of bravado and began a genuine interchange with Bugental.
Sometimes noting resistance takes the form of nonverbal feedback. For
example, just sitting with clients in their uncertainty at a given moment
can feed back to them the realization that a change or mobilization of
some sort is necessary in their life. Or, through the therapist’s mirroring of
clients’ crossed arms or furrowed brow, clients may begin to become clearer
about how closed they have been or how tensely they hold themselves.

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Tagging alerts clients to the repetition of their resistance. Consider

these examples of tagging: “So here we are again; at that same bitter place.”
“Every time you note a victory, you go on and beat yourself up.” “You
repeatedly insist on the culpability of others.” “What is it like to feel helpless
again?” Like noting, tagging implies a subtle challenge, a subtle invitation
to reassess one’s stance. Implicitly, it enjoins clients to take responsibility
for their self-constructions and to revisit their capacities to transform.
Revisitation is a key therapeutic dimension. Every time clients become
aware of how they stop (or deter) themselves from fuller personal and inter-
personal access, they learn more about their willingness to approach such
situations in the future. Frequently, there are many revisitations required
before “stuck” experiences can be accessed; clients must revisit many frus-
trations and wounds before they are ready to substantively reapproach those
conditions. Yet, as entrenched as their miseries may be, each time clients face
them, they face remarkable opportunities for change, and each incremental
change can become monumental—a momentum shift of life-changing
proportions. Let’s take the case of James again.

In the following vignette, I (Kirk Schneider) press James in an area

that we have revisited many times—being chronically identified
with his “lowly” position in society. Although I mainly vivify or alert
James about his chronic identification, at points I begin to confront
or attempt to alarm him. (We will elaborate on confrontation with
resistance momentarily.) Here is the sequence of our interaction:

James: Rachel called me the other day. She was the one friend I had
some decent contact with—until I went and stuck my foot in my
mouth. She asked me to see a movie with her and I made a stupid
remark about seeing a porno flick to jazz up our evening together.
She then told me abruptly that she was offended by my sugges-
tion, and that further, she was no longer “in the mood” to go out
that night. How could I have done that?! How could I have taken
a perfectly decent relationship, a relationship I knew wouldn’t go
anywhere romantically, and push it off the cliff? There’s just no way
around it, I’m doomed to be a shit.

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KS: Is that all you are, James? Is that what your whole life and all
you’ve been through comes down to?
James: Seems so.
KS: Yeah, you seem insistent on that—you’ve seemed insistent on
that for weeks. Is that acceptable to you?
James: No, but there’s nothing I can do about it.
KS: What are you willing to do about it?
James: We’ve been around that bend before.
KS: Yes, we have, James. Are you willing to go around it in the same
way you have before?
(James pauses and looks down. It’s the first time in this sequence that
he’s slowed down enough to reassess himself.)
James: Well, I am sick and tired of it.
KS: I hear you. What else is here, James?
James: That maybe I wasn’t as much the shit as I made myself out to
be—that I always make myself out to be. That I slipped up—I made
a stupid comment, am I gonna condemn myself for life?
KS: Stay with it, James, what else is present for you?
James: A hint of pride, fight . . .
KS: Say more.
Comment from Kirk Schneider: In the sequence above, James is
able to move from a tiring and familiar self-loathing to a realization
of the narrowness of that loathing and the possibility for something
more, some kind of pride or “fight” in his life. Those are attributes
that we (as E–H therapists) can build on. (Schneider, 2007, p. 38)

This vignette notwithstanding, a note of caution is called for in regard

to vivifying and mirroring clients’ resistance. There are clients who grow
to resent such frequent revisitations to their resistance and feel that they
are being “put upon.” For example, Schneider had a client—let’s call her
“Sue”—who was seemingly impervious to the noting and tagging of
her resistance. I would convey back to her the diversions or closed body
stances that I experienced with her at given points, and she would either

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greet me with blank stares or ignore me altogether. After some exhaus-

tion over Sue’s inertia and apparent obstinacy, I finally confronted her
about her experience with me. Her response was informative to me, as it
was vehement: “I don’t want to change,” she snapped. “I feel like it is you
who wants me to change, and I’m tired of that. I’m tired of people—all
my life—telling me that I should change, or be something different than
who I am. I just want to be accepted for me for a while, no matter how I
come across!”
This tongue-lashing was an important lesson about the phenomenol-
ogy of certain clients. Further, it was a valuable lesson in self- and other
acceptance and in how, despite all our efforts to increase these, our inter-
ventions sometimes backfire. For this particular client, self-acceptance
meant just letting her “be”—which, in this case, was obstinate; any ques-
tioning (noting or tagging) of this obstinacy felt coercive to her (just like
the people throughout her life who insisted that she be other than who
she is). It was not until I understood this position from her that I could
more artfully work with her—and gradually, organically, enable change to
issue from her, not some proxy.
Another form of vivifying resistance is tracing out. Tracing out entails
encouraging clients to explore the fantasized consequences of their resis-
tance. For example, Schneider has encouraged obese clients who fear
weight loss to review and grapple with the expectations of that weight
loss—not just intellectually, but experientially, through dramatizing an
anticipated scene; identifying the feelings, body sensations, and images
associated with the scene; and encountering the fears, fantasies, and antic-
ipated consequences of following the scene to its ultimate conclusion.
Although clients often find such tracing out disconcerting, they also often
find it illuminating, as it animates their overinflated fears, unexpected
resources, and resolve in addition to harrowing frailties. The tracing out
of capitulating to a behavior or experience is also highly illuminating.
Such tracing out, for example, might take the form of forgoing weight
loss and the anticipated fears, fantasies, and implications of maintaining
the status quo. The question “Where does this [reluctance to lose weight]

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leave you?” or “How are you willing to respond [to such intransigence]?”
can help elaborate these exercises.
When clients’ stuckness becomes intractable, but with a potential for
substantive change, a confrontation may be in order. Confrontation with
resistance is a direct and amplified form of vivification. However, instead
of alerting clients to their self-destructive refuges, confrontation alarms
them. In lieu of nurturing transformation, confrontation presses for and
demands (or “requires,” to use wording from J. F. T. Bugental, 1987) such
transformation (Schneider, 2008).
Several caveats, however, about confrontation bear consideration. First,
confrontation may risk an argument or power struggle between client and
therapist, as opposed to a deepening or facilitative grappling. Second,
confrontation risks the surrender of clients’ decision-making power to
therapists with the resultant withdrawal of that decision-making power
from clients’ own lives. Third, confrontation risks alienating clients—not
merely from an individual therapist, but from therapy as a whole.
As unfortunate as these potentially calamitous outcomes may be,
they are not by any means foreordained. Engaged optimally, confronta-
tion requires careful and artful encouragements to clients to change but
also, and equally important, a full appreciation for the consequences of
such encouragements. Prior to decisions to confront, therefore, therapists
must carefully weigh the stakes, such as their intervention’s timeliness,
their degree of alliance with clients, and their own personal and profes-
sional preparedness.
J. F. T. Bugental (1976) provided a keen illustration of confrontation
with his case of Frank. Frank was an obstinate and reproachful young
man. He repeatedly scorned life and yet refused to entertain its possi-
bilities for betterment. At one peculiarly frustrating juncture, Frank chas-
tised Bugental: “Whenever you guys want to make a point but can’t do it
directly, you tell the sucker he’s got some unconscious motivation. That
way . . .” Bugental responded, “Oh shee-it, Frank. You’re doing it right now.
I answer one question for you and get sandbagged from another direction.
You just want to fight about everything that comes along.”

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Frank: It’s always something I’m doing. Well, if you had to eat as much
crap everyday as I do, you’d . . .
Bugental: Frank, you’d rather bellyache about life than do something
about it.
[Frank’s “pouting tone” changes.]
Bugental continues: Frank, I don’t want all this to get dismissed as just
my tiredness or your sad, repetitive life. I am tired, and maybe that makes
me bitch at you more. I’ll take responsibility for that. But it is also true
that somehow you have become so invested in telling your story of how
badly life treats you that you do it routinely and with a griping manner
that turns people off or makes them angry. You don’t like to look at that,
but it’s so, and I think some part of you knows it. (p. 109)

This vignette illustrates several important points. First, by intensify-

ing his description of Frank’s behavior, Bugental stuns or gently shocks
Frank into a potentially new view of himself—that of a responsible agent
rather than passive victim. By accenting Frank’s investment in complain-
ing, he tacitly asks Frank to reassess that investment, and his entire stance
in fact, of treating himself as a victim. Second, the vignette illustrates how
a therapeutic interaction can reflect a more general reality in a client’s day-
to-day world. As Bugental’s comment makes plain, Frank’s “griping” must
turn off a lot of people, and, as is the case with Bugental, this reaction can
only complicate, if not exacerbate, Frank’s intransigent bitterness. Third,
and by way of summary, Bugental’s remarks challenge Frank to reassess
his whole stance, the issues leading up to that stance, and the necessity of
maintaining that stance. In effect, Bugental beseeches, What is the payoff
of staying bitter, and is it worth the price?
In contrast, there are notable times, as illustrated by Schneider’s client
Sue, when such imploring (or even gentle inquiring) with clients is futile,
if not outright hazardous. At such times, clients may feel sapped, spent, or
defiantly entrenched. Instead of confronting or challenging those states,
which may have the unintended effect of threatening and thereby harden-
ing intractable defenses, the best strategy, from the E–H view, may simply
be to enable or allow those devitalizing realities (e.g., see Schneider, 1999).

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Frequently, for example, we have found that clients’ investments in their

resistance directly parallel our own investment in their over­coming that
resistance. Further, as illustrated earlier, we have found that when E–H
therapists pull back some from our own intransigence, clients, too, tend
to loosen up and pull back. This dynamic makes sense, for what is being
asked of clients, in effect, is to leap headlong into the doom that they
have designed a lifetime to avoid. However, to the extent that such clients
feel that they have room, can take their own pace, and can shift in their
own time-tested fashion, they are often more pliable, flexible, and inclined
toward change.
To summarize, resistance work is mirror work and must be artfully
engaged. Vivification (noting and tagging) of resistance alerts, whereas
confrontation alarms clients about their self-constructed plights. Presump-
tuousness, however, must be minimized in this work. Whereas some clients
are amenable to the accentuation and vivification of their life patterns,
others are more reticent, and such reticence should not be undervalued. It,
too, can be informative and eventually facilitate a fuller and deeper stance.
In short, the press to change is mercurial. The more therapists invest
in changing clients, the less they enable clients to struggle with change. By
contrast, the more therapists enable clients to clarify how they are living,
the more they fuel the impetus (and often frustration) required for lasting
change (Schneider, 1998a).

Coalescence of Meaning, Intentionality, and Awe

As clients face and overcome the blocks to their aliveness, as they begin to
choose rather than succumb to the paths that beckon them, they develop a
sense of life meaning. This meaning is wrought out of struggle, deep pres-
ence to the rivaling sides of oneself, and embodied choice about the aspect
of oneself that one intends to live out. The overcoming of resistance, in
other words, is preparatory to the unfolding of meaning, and the unfold-
ing of meaning is preparatory to revitalization.
Such revitalization, or what May (1969) termed intentionality, is the
full-bodied orientation to a given goal or direction. It is different from
intellectual or behavioral change because its impetus derives from one’s
entire being, one’s entire sense of import, and one’s entire sense of priority

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(see also the “I am” experience in May, 1983). But intentionality goes
beyond singular priorities; it embraces a whole new way to be. Such being
draws on the humility and wonder, thrill and anxiety, or, in short, awe of
the liberation process itself.
By the cultivation of awe, we mean clients’ renewed abilities to expe-
rience the fullness of their lives—their deepest dreads as well as their
most dazzling desires—and their rejuvenated capacity for choice. Among
some clients, there is also a renewed capacity to experience the mystery,
or “unknowing,” that envelops all our lives (Spinelli, 1997). This capacity
is often experienced as buoyant, poignant, or releasing (Bradford, 2007;
Cortright, 1997; Schneider, 2004, 2008).
Returning to Schneider’s work with James, a few excerpts from their
final session serve to illustrate:

James: The grocer gave me a snippy look again today.

KS: So, where did that leave you? Correction: Where does that leave you?
James: Well, it leaves me in a very different place than it would have a few
years ago. Back then, I would’ve buried myself in shame and self-loathing.
Today I moved on. It made me realize how far I’ve come since those dark
days—after that grocer gave me that look, I got pissed, momentarily, but
then I took a breath, carried my bags outside, and noticed the air around
me. It was crisp and cool. I felt a big refreshing buoyancy inside that
reflected the buoyancy and freshness of the day. And then I remembered
how much I had going in my life—the budding friendship with Al, the
new focus on my computer studies, my relationship with Sonny (James’s
dog), and the fact that I was alive, OK with the life I’ve built. So that’s how I
feel now; it’s not all sweetness and light, for sure, but I don’t feel so trapped
anymore, so driven. And that has afforded me the chance to get on with
what really counts in my life—to live it.

Better words for existential and experiential liberation could hardly

be chosen, for in the terms of May, it’s not just this or that problem, but
one’s “life that is at stake”—and this is what therapists, and indeed healers
of all stripes, must realize (as quoted in Schneider, 2007, pp. 38–39).

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As the vignette with James illustrates, the coalescence of meaning,

intentionality, and awe takes many forms. Sometimes clients find it on the
job site, in the home, with friends, or with community. At other times it
takes the form of a sport, a class, or a trip. At still other times, it is without
delineated form. The pivotal issue here is attitude. To what extent does a
client’s life meaning align with his or her inmost aspirations, sensibilities,
and values, and how much is the client willing to risk, or take responsibil-
ity for, the consequences of those alignments?
The task of the therapist at this stage is to assist clients in their quest
to actualize their life meanings. This assistance may take the form of a
Socratic dialogue about possible ways to change one’s lifestyle, or to relate
to a partner, or to begin a new project. It may be manifest as an invitation to
visualize or role-play new scenarios, inner resources, or concerted actions.
It may develop as a reflection on one’s dream life and the symbols, patterns,
and affects associated with the dream’s message. It may take the shape of
a challenge to try out newfound capacities in real-life circumstances—
a desired encounter, a wished-for avocation, a contemplated journey. Fol-
lowing each of these explorations, meaning is further mobilized by encour-
aging clients to sort through their experiential discoveries. For example, by
attuning to the feelings, sensations, and general life impact of risking a new
relationship, clients are in an enhanced position to evaluate the significance
of that relationship.

Summary of the Primary Change Mechanisms

As previously indicated, the core of E–H change processes is the cultiva-
tion of intra- and interpersonal presence. Without presence, there may
well be intellectual, behavioral, or physiological change but not necessarily
the sense of agency or personal involvement that core change requires. To
put it another way, E–H therapy stresses presence to what really matters,
both within the self and between the self and the therapist. The cultivation
of presence has four basic functions:

1. It reconnects people to their pain (e.g., blocks, fears, anxieties).

2. It promotes an experience of agency and assumption of responsibility.

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3. It attunes people to the opportunities to transform or transcend

that pain.
4. It builds an intimate and safe therapeutic relationship, which in itself
promotes growth and change.

Presence is, at once, the ground (condition or atmosphere), method,

and goal for E–H facilitation. As ground, presence holds and illuminates
that which is palpably—immediately, affectively, and kinesthetically—
relevant within the client and between the client and therapist. Presence
in this sense provides the holding environment whereby deeper and more
intensified presence can take root. As a method, presence illuminates
the client’s actual but unrecognized patterns of behavior and attitudes
that are manifesting in the here and now. The in-the-moment illumi-
nation allows clients to experience not only deep connections with self
and others but also how they are blocked from self and others (Krug,
2009). As goal, presence mobilizes clients. It accompanies them during
their deepest struggles, their search to redress those struggles, and their
day-to-day integration of those struggles (J. F. T. Bugental, 1987; Frankl,
1963; May, 1969).
In addition to facilitating experiential forms of change, presence
guides and provides a container, where appropriate, for more behavioral
or programmatic levels of change. The question that presence illuminates
is, “What is really going on with this client, and how can I optimize my
assistance to her?” Or, to put it another way, “What is this client’s desire
and capacity for change?” (Schneider, 2008).
Insight in E–H therapy is more like “inner vision,” as J. F. T. Bugental
(1978) framed the term. Inner vision facilitates an experience of past, pres-
ent, or future issues rather than an explanation or formulation about them.
The end goal of inner vision is not so much to figure issues out as to stay
with them, attend to their affective and kinesthetic features, and sort out
how or whether one is willing to respond to them. To the degree that one
can follow this process through, one can become more intentional (that is,
concerted, purposeful) in one’s life, but also, and paradoxically, more flex-
ible, tolerant, and capable of change.

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Interpretations are provided in E–H therapy to facilitate a deepening

of experience more than a strengthening of analytical skills. Although a
strengthening of analytical skills can certainly be of benefit over the course
of an E–H regimen, the thrust of the work is toward empowering clients
to find their logical or adaptive paths. In this sense, interpretations tend
to take the form of mirroring responses in E–H therapy, reflecting and
amplifying clients’ rivaling impulses.
E–H change processes comprise both an intra- and an interpersonal
dimension. The intrapersonal aspect is facilitated through concerted efforts
to survey the self, whereas the interpersonal dimension is facilitated through
the naturally evolving I–Thou dynamic of relationship. Although E–H
practitioners tend to emphasize different aspects of intra- and interpersonal
exploration, there is essential unanimity when it comes to the core of these
emphases—immediacy and presence.
To summarize, E–H therapy has four essential aims: (a) to help cli-
ents become more present to themselves and others, (b) to help them
experience the ways in which they both mobilize and block themselves
from fuller presence, (c) to help them take responsibility for the construc-
tion of their current lives, and (d) to help them choose or actualize more
expanded ways of being in their outside lives. These aims are fulfilled by
therapists through their capacity to attune, tolerate struggle, and vivify
emergent patterns and by clients through their commitment to, desire
for, and capacity for change. Although E–H therapy parallels, and indeed
grounds, many other intensive therapies, its emphasis on presence, strug-
gle, and whole-bodied responsiveness renders it unique.

Short-Term and Long-Term Strategies

and Techniques
E–H therapy applies to a diverse session length and client base. Despite its
highbrow image, E–H practice has been applied, both long term and short
term, to substance abusers, ethnic and racial minorities, gay and lesbian
clientele, psychiatric inpatients, and business personnel (O’Hara, 2001;

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Schneider, 2008; Schneider & May, 1995). Further, a plethora of prac-

tice orientations have arrived independently at and adopted E–H prin-
ciples of presence, I–Thou relationship, and courage (e.g., see Bunting
& Hayes, 2008; Stolorow et al., 1987). That said, however, the expansion
and diversification of E–H therapy is a relatively recent phenomenon;
most E–H practice still tends to be long term and to take place in White
middle- to upper-class neighborhoods with white middle- to upper-class
clientele. Yet there is no necessary link between such contexts and suc-
cessful E–H therapy. As E–H practitioners are discovering, the benefits of
presence, I–Thou encounter, and responsibility are cross-cultural as well
as cross-disciplinary (Vontress & Epp, 2015).
Although E–H therapists realize that they cannot be “all things to all
people” and that certain problems (e.g., simple phobias, brain pathology)
are best handled by specialists, a definite ecumenism applies to contempo-
rary E–H practice. This ecumenism is correlating with cross-disciplinary
openness, adaptations for diverse populations, and sliding fee scales.
Let’s consider some examples of brief and long-term strategies (or
conditions) in which substantive E–H transformation was facilitated. We
will use this opportunity not only to elaborate our strategies but also to
animate them in the context of a case.

Short-Term Case: Mimi

The following case is an example of how Orah Krug integrated an E–H
approach with cognitive and behavioral techniques to help Mimi, a young
mother, rapidly resolve a recent traumatic experience. Although not cen-
tral to the therapy, Mimi’s Persian heritage, culture, and worldview were
also factors in how Krug worked with her.
Mimi was an attractive, 29-year-old woman of Persian descent, mar-
ried, with two small children, and 7 months into her third pregnancy.
Mimi had come with her parents and sister to the United States when she
was 12. After graduating from nursing school, she worked in a pediatric
hospital for several years before her children were born.
Mimi was referred to me by her primary care physician because she
was exhibiting posttraumatic stress symptoms resulting from an incident

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that involved her and her children. Two months previously, she and her
children had been sitting in their living room when a small plane making
an emergency landing sheared off a corner of their house. In our first ses-
sion, Mimi described her confusion; at first thinking it was an earthquake,
she grabbed her children and ran to the nearest doorway. Only then did
she look around to see the nearby plane and the devastation it caused.
As she related the event, I could see how much she was “caught” in the
experience; it was as if in the retelling she was reliving the experience.
This is a common and unfortunate aspect of posttraumatic stress disorder
(PTSD). By emotionally reliving the trauma, she was in effect retraumatizing
herself each time she retold the story.
Mimi seemed to be coping with her fear, horror, and sense of helpless-
ness with an overlay of anger toward the person piloting the plane:

I was just innocently sitting in my home, and now because of this

person’s negligence, my house has been violated, my children were
scared, and perhaps my unborn child has been affected. I know I’m
not relaxed and happy like I was with my other pregnancies. I’m very
irritable, I’m not being the mother I want to be, and we have to live
in a cramped apartment until our house is repaired. Mice have gotten
into my house and eaten my clothes and shoes. I feel like my things
have been defiled.

The injustice of the event was gnawing at her like the mice that ate her
clothes. Mimi was unable to stop replaying the event in her mind and the
consequent retraumatization. She also was experiencing a general numb-
ing of emotions, as evidenced in her complaint that she didn’t feel the joy
or pleasure in life she had known before. Moreover, she expressed a desire
to move out of her house now that it held such bad memories. She was
very jumpy. Loud noises scared her, and she worried that she would never
feel calm again. If all that wasn’t enough, Mimi had taken on the respon-
sibility of caring for her terminally ill sister who lived with her parents.
Mimi’s days were spent at her parents’ house caring for her own children
as well as her sister and her frail parents.
Mimi allowed that she was carrying a heavy load but said she was
OK with the situation because it meant that she was fulfilling her role

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as a dutiful daughter and a caring sister. Mimi explained that in her cul-
ture, adult children were expected to care for their elderly parents and
siblings when needed. I reflected that on the positive side her tasks seemed
to give her life greater purpose and meaning, but on the negative side, they
seemed to be not only a physical strain but an added emotional strain to
her already emotionally stressed system. By framing the situation in this
way, I hoped to acknowledge the value she placed on her caregiving in
light of the norms of her culture but at the same time acknowledge its
deleterious impact on her. My approach allowed Mimi to feel supported
and not judged. Eventually it enabled her to delegate some of the caregiv-
ing tasks to a visiting nurse.
Overall, Mimi appeared to have been a high-functioning woman who,
prior to the incident, had felt generally happy and content with her mar-
riage and life but whose sense of security was now badly ruptured. Mimi
was drained both physically and emotionally, but she was extremely moti-
vated to feel better and get “her old life back.” Given that Mimi was set
to give birth in a few months, we had a limited time period in which to
work. Consequently, I met with Mimi just eight times over 2 months. Her
high functionality, cooperative attitude, and motivation contributed to
her rapid progress.
My work with Mimi was an integration of behavioral strategies within
an existential context. The aims were to alleviate her PTSD symptoms, to
help her be more present to herself, and to constructively incorporate the
traumatic experience into her life. I shared my aims with her and explained
how I worked in the here and now to help her become more aware of her
thoughts and behavior patterns that might be blocking her healing process.
I asked her if she felt OK about working with me in this way. She readily
agreed, saying that she wanted to do whatever was needed to feel better.
I wanted her to understand that our work would be a collaborative
effort, and so I began with Mimi, as I do with all my clients, to build the
therapeutic relationship with my self-disclosures. I don’t believe in keep-
ing the process of therapy mysterious. I want my clients to understand
the way I work and, more importantly, to have an experience of it in the
first session. Throughout the work, I made sure to check in about our
interpersonal connection by asking questions like “How was it to share

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that with me?” or “How has the space felt between us today?” or “What
was the most difficult part of our session today?” These types of questions
brought Mimi’s focus to our relationship. By inviting her to express her
feelings about me and our relationship, I intentionally cultivated inter­
personal presence and a sense of safety and intimacy between us. I also tried
to help her feel safe and understood by cultivating intrapersonal presence.
I listened to her “music” as much as her words, mirroring back to her my
felt sense of her terror and anger.
After laying this groundwork, I began to focus her on her anger
because it was clear that she was stuck in it. She expressed it as a sense of
injustice (“it isn’t fair; I wasn’t prepared”). By tagging these expressions,
I helped her become more conscious of how much and in what ways she
was expressing this injustice. I held up a mirror to her experience, noting,
“Once again, you say how unfair it is” or “Can you hear yourself getting
angry again as you tell me what happened?” Fairly quickly, she began to
agree with my comment that her repetitive statements were gnawing away
at her like the mice gnawing on her clothes. I tried to help her move out
of her stuckness by suggesting that she use a “Stop” technique (Penzel,
2000). Whenever she heard herself begin the repetitive litany, she was to
say, “Stop; I don’t need to go down this road” and imagine a place where
she felt safe and cozy. I asked her to practice the Stop technique as many
times as she needed to between sessions.
At the next session, she reported that at first she struggled to stop her
repetitive thinking, but after using the technique for a while, she was able
to stop reminding herself of her plight and started to feel better. Given
that Mimi was beginning to let go of her anger, it seemed the right time to
help her open to whatever other feelings were associated with her trauma.
Consequently, I suggested we explore her feelings of unfairness. I shared
with her my sense that the energy with which she said “It isn’t fair” implied
the existence of some important feelings beyond anger. “First, take some
nice deep breaths,” I said, “and when you’re ready, turn your attention
inward and make some space for your feelings of ‘It isn’t fair.’” As soon as
she began to slow down and breathe deeply, tears began to run down her
face. “Are there any words?” I asked softly. “There was no place to go, and
I thought we were going to die. I didn’t know what was happening, and I

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couldn’t protect my children.” Mimi was with her experience, not caught
in her experience this time. By connecting with her inner self, she was
able to be both in the experience and outside of it. This is exactly what she
reported at the end of our session. “I felt different,” she said. “I felt separate
from them [her feelings] for the first time.” Now Mimi could begin to heal.
By encouraging Mimi to be more present with herself, she moved from
repetitively expressing her anger to experiencing her fear of dying and
sense of helplessness in a constructive and healing way.
Over the next few sessions, as Mimi allowed herself to be with her death
terror and sense of helplessness, her repetitive angry statements gradually
disappeared. Now we could help her dissolve her traumatic memories. I
used a modified version of eye movement desensitization and reprocess-
ing (EMDR), as developed by Shapiro (1998), by asking her to call up the
memory and view it as if she were on a train and the landscape was moving
past her. As she recalled the memory, I told her to tell herself, “This is just
a memory. It’s in the past. I can let it go by and focus on my safe and cozy
place.” We practiced this exercise after first doing abdominal breathing for
5 minutes. I suggested that she try to do this exercise four times before our
next session. I told her that if at any time she felt “caught” in the experience,
she should stop, focus on her breathing, and return to her safe place.
Two weeks went by between sessions. Mimi walked in looking more
relaxed and alive. She had found the exercise to be extremely helpful, say-
ing that it allowed her to take a step back from the incident and not feel
caught up by it. She reported that she was no longer plagued by the mem-
ories and was beginning to feel more alive in her life. She reported that
she was sleeping more soundly, was less irritable, and no longer jumped
at loud noises. Many therapists would be satisfied with these results and
would likely have no further aims other than to consolidate the learn-
ing. But as an existential therapist, I sensed that one of the difficulties
underlying Mimi’s symptoms was her inability to accept a crucial aspect
of existence, namely that personal safety and security are an illusion—at
any moment they can be shattered.
Short-term therapy requires a therapist to balance time restrictions
with the ability to help a person open to her or his self and world con-
structs that are both protective and life limiting. I sensed that Mimi’s

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difficulties in accepting the accident stemmed in part from an aspect of

Mimi’s self and world construct system. Mimi held, as most of us do, a
belief in her specialness that often results in the unconscious belief that
life’s contingencies happen to everyone else but us.
Yalom (1980) described this process quite well:

Once the defense is truly undermined [as it was in Mimi’s case],

once the individual really grasps, “My God, I’m really going to die,”
and realizes that life will deal with him or her in the same harsh way
as it deals with others, he or she feels lost and, in some odd way,
betrayed. (p. 118)

This was Mimi’s unspoken attitude, and it seemed important to help her
explore and hopefully resolve it to some extent within our limited time
together.
Consequently, in the next couple of sessions, in addition to practicing
the desensitization technique, we devoted a substantial amount of time to
working with Mimi’s inability to accept the contingencies of existence. As
we explored Mimi’s feelings about life’s uncertainties, she began to realize
how she typically coped with uncertainty—by being self-sufficient and
by trying to be in control, by being “on top of everything” and “keeping
a lid on her feelings.” Her phrase “it isn’t fair” reemerged, but now Mimi
understood it as her unwillingness to face and accept the harsh contin-
gencies of life. “Go slow,” I suggested, “and let yourself explore what it
means now.” She responded, “It isn’t fair that there is no plan, no struc-
ture, no protection—anything can happen.” After a few sessions of being
with her recognition that anything can happen to her and to those she
loves, Mimi acknowledged, “I don’t like it, but I guess that’s just how life
is.” By acknowledging the condition of being unprotected, she paradoxi-
cally could now begin to accept the unacceptable. Although she never
verbalized her sense of specialness, she implicitly began to accept her vul-
nerability and finiteness. Because of our limited time together, I decided
not to invite a more personal exploration of Mimi’s sense of specialness.
I felt that given our time constraints, my responsibility was to help her
build more effective coping strategies to deal more effectively with an
awareness of life’s contingencies. Over the next few sessions, Mimi was

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more able to accept her lost sense of security and to build a more realistic
view of what it meant to be safe and secure based on her newly formed
awareness.
I met with Mimi 3 weeks later, and she reported that she was doing
much better and that she and her family were returning to their repaired
home the following week. She said she liked it even better than before, and
she felt better about herself and her life than she ever had. She declared
her intention to continue practicing the meditative deep breathing every
day, saying it helped her stay calm and energized. I asked her what her
experience of our work was together. She said she learned a great deal
about who she was and why she did what she did. She reported that she
felt more willing and able to face life’s challenges even though paradoxi-
cally she recognized that bad things can and will happen to her and those
she loves.
I followed up with Mimi 4 months later. She and her husband were
enjoying their new baby in their rebuilt home. Mimi reported that she felt
“like my old self, but better.” She told me she wasn’t taking on as many
tasks and was finding more enjoyment in her children, family, and life in
general. She said she rarely experienced bad memories from the accident,
and when they did surface, she did her EMDR exercise. She continued to
meditate, felt relaxed during the day, and slept as well as could be expected
with a new baby.
Appendix A offers a short-term existential–integrative (E–I) case of
Hamilton conducted by Kirk Schneider. Let’s turn now to techniques used
in long-term therapy.

Long-Term Strategies and Techniques

In this section, we present Kirk Schneider’s case of Emma, which illus-
trates his E–I approach to therapy. In addition, in Appendix B we pre­
sent Orah Krug’s conceptualization of the phases of change in a typical
long-term therapy, and in Appendix C we present Krug’s long-term case
of Claudia. Both of these approaches illustrate diverse but related applica-
tions of long-term E–H therapy.

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Long-Term Case: Emma

In this case, Kirk Schneider elaborated a long-term E–I therapy with a
particular emphasis on the experiential level of contact. I use this case
to illustrate both the framework within which I understand psychologi-
cal suffering (polarization) and the means by which core aspects of suf-
fering can be transformed. Although much of this illustration can be
understood on the basis of that which has already been described in this
volume—particularly regarding constrictive–expansive dynamics, limi-
tation and freedom, and the cultivation and activation of presence—for
a more detailed elaboration, see Schneider (2008). See also Appendix D,
“Summary of Experiential Stances of the Existential–Integrative Model.”
Typically, there is a tenuous link between a client’s initial presenting
behavior and core (constrictive or expansive) dread. Generally, it takes
months, even years, to unpack the layers of fears and defenses overlaying
a client’s core terror and basic defensive stance. This core condition, how-
ever, may suggest itself the moment therapy begins. Such was the case with
Emma, a dynamic and multifaceted woman.3
Emma entered my office on a bright and cloudless day. She was of
medium build, approximately 40 years old, and White.
Emma was also charming. She was vibrant and articulate, and it was
clear that she had “been around.” She dressed with style, spoke in clear, firm
tones, and got right to the point (as she understood it at the time). “There
is something terribly wrong with my life,” she exclaimed. “I am at the end
of my rope.”
As I sat with this last statement and with Emma herself, I saw a person
of solid conventional resources. She knew the societal game and how to
play it. There was a hardness to her look, and her makeup was formed by
sharp and careful lines. It was clear that Emma—if she so desired it—had
weight in the world.

3 Parts of this vignette were excerpted from “Existential Processes,” by K. Schneider, 1998, in L. Greenberg,
J. Watson, and G. Lietaer (Eds.), Handbook of Experiential Psychotherapy (pp. 103–120). New York, NY:
Guilford Press. Copyright © 1988 by Guilford Press. Adapted with permission.

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However, there were signs of strain beneath Emma’s tough veneer.

There was a fearfulness in her eyes and a melancholy about her face. Her
otherwise resonant voice was interrupted by moments of urgency and
breathlessness. It became increasingly evident to me that somewhere, deep
in the recesses of her world, Emma was in turmoil.
When I invited Emma to elaborate on what was wrong in her life,
I learned that she hailed from a family of four: her mother, father, and
slightly younger brother. When Emma was 3, her father deserted the fam-
ily and never returned. It was at this point that her paternal uncle, roughly
the same age as her father, gradually began to replace his brother as “head
of the household.” Although Emma’s mother was devastated by the deser-
tion of her husband, in her weakened state she accepted and even encour-
aged the uncle’s evolving new role. The mother and uncle exchanged some
romantic feelings, according to Emma, but this was short lived. Basically
theirs was an arrangement of convenience, which everyone in the family
grew to recognize.
Although Emma’s memories of those early years were vague, by age 4
she knew something was askew. She felt that she experienced something
with her uncle that no one else in the family had experienced and that to
the degree they did experience it, they suppressed it. According to Emma,
the uncle possessed a terrifying demeanor. He was very tall, well over 6 feet,
of stocky build, and bullish. Her main memory of him at this early age was
that of his booming voice and rancid breath.
Emma’s memory clarified significantly as she recalled her late child-
hood (e.g., age 9) and early adolescence. Emma conveyed that she had
been brutalized by her uncle at these ages. She recalled him literally throw-
ing his weight around with her—bellowing at her, pushing her, shoving
her on her bed. She had a clear memory of him forcing a kiss on her and of
being enraged when she rebuffed him. Although she did not recall being
overtly sexually molested by her uncle, her dreams teemed with this motif
and with many other sinister associations.
As I and others have found typical, Emma’s reaction to these hei-
nous scenarios was complex. The terms helpless or hopeless are too facile
to describe this reaction. Indeed, virtually all words—much to the con-
sternation of modern psychology—fail to address her layers of response.

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The closest she could come to describing her earliest feelings was as a
sense of paralysis. Beyond being an oppressor, her uncle acquired a kind
of metaphysical status before Emma, and she, in turn, felt virtually infan-
tile before him.
Yet Emma was no shrinking violet. By adolescence, she became “wild,”
as she put it, displaying a completely new character. She became heavily
involved in drugs, smoking, and seducing young men. She would leave
home for days, periodically skip school, and associate with a variety of
“bad boys.” Speed and cocaine became her drugs of choice because they
made her feel “wicked”—noticed, special, above the crowd. She didn’t
“take any shit,” as she put it, and she occasionally exploded at people, usu-
ally males, if they got in her way. She even began raging at her uncle for
brief periods, despite his continued dominance of her.
Emma’s hyperexpansions, however, were short-lived. They were blind,
semiconscious, and reactive. Beneath them all, her world was collapsing—
narrowing, spiraling back on itself. The clearest evidence for this was the
essential vacuity of Emma’s life. She concealed herself behind makeup and
laughter. She felt ashamed around peers and classmates. Although she was
popular for a period, her substantive relationships were a shambles. The
men she involved herself with would beat her. She, in turn, would lash
back at them but with woefully limited results.
Emma was condemned by her past. As desperately as she endeavored
to escape that past, she chronically reentered it. She repeatedly sought out
boys and men like her uncle, repeatedly hoped that something—perhaps
she or some magic—could transform them from being like her uncle, and
repeatedly felt let down by such men and fantasies.
In sum, Emma was traumatized by hyperexpansion. The godlike
power of her uncle made Emma feel wormlike. He came to symbolize her
world—perpetually alarmed, perpetually confined, perpetually depreci-
ated. Emma found ways—albeit transient and semiconscious—to coun-
ter this wormlike position, but her basic and unresolved stance remained
wormlike, permeated by dread.
Emma’s chief polarization, therefore, clustered around hyperconstric-
tion. Her secondary polarization clustered around hyperexpansion and
many gradations in between. In keeping with my E–I theoretical stance, I

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invited Emma to confront her polarized states as they emerged, gradually

proceeding to their core.
Following is an illustration of my interaction with Emma at a highly
delicate stage of work, after about 8 months of therapy. At this point,
Emma had just broken up with a boyfriend with whom she had had a
fleeting affair, received a disturbing phone call from her uncle, and felt
increasingly agitated at work. She had also began superficial cutting
behavior on her forearm, which she hadn’t engaged in since the begin-
ning of our work. She denied suicidal intent.

KS: Where are you, Emma?

Emma: Pissed.
KS: [pausing and taking a full breath] Yeah, I see that—let it out if you
want, Emma.
Emma: [glaring, intense] What do you want me to say? You know the
scene. (She shows me the light red marks on her arm.)
KS: Yes, I know the scene, but you’re living it—that’s a lot tougher.
Emma: Yeah, well, I’m not living it very well. My uncle called the other
night; all he said was call your brother—he went into detox again. Just
hearing his grating voice, his bullying manner, it all came back to me. I
broke up with Tim, you know, the rat, he wouldn’t do shit for me.
KS: Man, you do have a lot going on right now—see if you can slow down
a moment and stay with what’s right here.
[Emma pauses, reflects.]
KS: Where are you now, Emma?
Emma: I’d like to kill him! [She screams about her uncle, tearing, writh-
ing.] Who the fuck does he think he is breaking into my life again, sticking
his dirty business in my face again—I don’t care if it’s about my broken
brother. He broke my brother! [The floodgates open, and Emma is sob-
bing furiously.]
KS: [delicately, softly] I’m here, Emma, just allow it—let it out.

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[Emma slinks down into her chair. Her weeping subsides, and she begins
to free associate.]
Emma: I just get into this hole, like the bottom’s dropped out and there’s
no way to stop. Everything gets dark—everything gets big, except me; I
become this little toy doll and I spiral down, down—other figures come
in the hole and they brush me aside, they throw me into corners. I’m
cornered, stepped on, squashed. My blood is on the floor, but the floor
drops out and I keep dropping, endlessly, helplessly. . . . This is how I feel
before I cut. Cutting takes me out of the deadness—it makes me feel alive,
in control—even for a moment. It’s something I can do and nobody can
fuck with me.
(As I listen to Emma, I become heartsick, but I also realize the significance
of this moment. Emma is now directly aligned with her wound. I pause.)
KS: And where are you now, Emma? Do you still feel alive?
Emma: No, that’s the tragedy. The aliveness lasts only a few seconds—it
always does, whether I cut, snort [coke], or screw somebody. I’m sick of
it! Sick of being pitiable!
KS: You suddenly perk up . . .
Emma: Yeah, well it’s true. My dark world has been with me too long. It’s
not all horrific, mind you; it provides a refuge sometimes. I can get away
there and form relationships with characters and places that would make
most people’s heads spin. It’s my fantasy land—magical but deadly.
KS: So what do you feel will help you work your way out of that land—is
there anything you’d like to try this week that’s different?
Emma: Well, I have thought about taking a drive out to my favorite hiking
spot. It’s been many years since I’ve been there, and I feel a mystical con-
nection with the place. The trees and the animals “speak” to me there—it
feels healing.
KS: That sounds good, Emma. Why don’t we highlight that as a task for
the week? The other piece I must say I have concern about is your cutting.
I’m hearing that as much as it gives you a temporary high, it also destroys

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you in some way; it keeps you stuck and broken—literally—and it does

nothing to break your cycle. I’m also afraid that it may kill you. How about
collaborating on a way to stop the cutting this week, too?
Emma: [mindfully] Yes, that’s something I’d like to do.

Following this pivotal session, Emma’s experiential liberation pro-

ceeded to unfold over 4 arduous years. We revisited the “dark place” many
times and sometimes dropped into it together, but gradually, through
ever-fuller immersions, we witnessed Emma’s evolving resiliency to these
moments, both accommodating to and assimilating their foundational
threats. Overall, we experienced the gamut of emotions during our inten-
sive contacts, from searing vulnerability, to panic, to rage, to bottomless
grieving, and to disappointment with, fury at, and terror of me.
I worked with her to personally and intensively stay present to these
feelings and to use role-play, rehearsal, journal writing, exploration of our
relationship, embodied meditation, dream analysis, and even a 6-month
stint of emergency medication to facilitate this engagement. I also strug-
gled with Emma over her tenacious resistance to (protection from)
change. First, I assisted her to explore these familiar yet corrosive stances,
then to mobilize her frustration with them, and finally to overthrow and
transcend them.
The core of Emma’s dysfunction was the dread of standing out. The
closer we came to this core, the more Emma fought to deny it. This was
understandable; not only did Emma fear standing out before her uncle,
she feared the fuller implication of that fear—standing out before life.4
Although the former fear could be explained and discussed, the
latter fear exceeded explanations and words; it had to be experienced. By
tussling with and remaining steadfastly present to this fuller fear, Emma
was able to enter a new part of herself. She was able to “hold” that which

4 This realization of the larger fear of the vastness of being, alongside of as well as beyond the fear of the
interpersonal, is one of the distinctive features of the E–H position on suffering; the locus of suffering
(as well as health) is not confined to the individual or even interpersonal but extends by association
to the “intersituational,” or one’s ultimate relations to being (see Heidegger, 1962, and Schneider,
1999, 2008, for an elaboration).

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was formerly unmanageable. As a result, she became more resourceful,

trusting, and bold. She was also able to declare herself, not merely before
me and her abusers but before life itself. Today, Emma is in a nourishing
and committed relationship, is active in her community, and asserts firm
boundaries with her uncle. She also has found new resources to realize her
avocations: travel, collage making, and hiking. But most importantly, she
has found new resources to realize life itself. She still suffers, but she does
not equate herself with that suffering. Now when she communes with the
woods, it isn’t to simply find refuge; it is to linger over and revel in their
beauty, immensity, and capacity to renew.

Long-Term Case: Malcolm

In another example of long-term therapy with Kirk Schneider, Malcolm,
a 25-year-old African American man, was the middle child in a family of
five boys. Malcolm grew up in a tough lower-middle-class neighborhood.
Although he had a history of depression, Malcolm had no history of self-
destructive or suicidal behavior. Malcolm grew up in a home that centered
on his mother and grandmother. Malcolm’s father was a traveling sales-
man and spent many days away from home. He was also separated from
Malcolm’s mother when Malcolm was 10 years old. Malcolm’s mother
was intensely religious and belonged to a charismatic church. On many
afternoons, Malcolm would find his mother reading the bible or organiz-
ing fundraisers for her church.
As a youth, Malcolm was bright and outgoing and centered his time
on completing most of his assignments for school and hanging out with
friends in his neighborhood. Sometimes he got into trouble with those
friends and received harsh punishments from his mother, such as being
grounded in his bedroom for 10 nights in a row and even head slapped
on occasion.
In general, Malcolm described his childhood as one of a “normal kid”
who got into “typical” mischief, especially for the neighborhood in which
he lived, but who constantly felt put down. These put-downs stemmed not
only from Malcolm’s mother, for whom he had mixed feelings, but also
from the religious philosophy espoused by his mother’s church, which he

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frequented as a child. Being a sinner was drilled into Malcolm, and his
only recourse, according to his mother and minister, was to repent—to
become an obedient “robot,” as Malcolm put it. Malcolm grew to despise
religion and everything associated with it.
I was aware of an acute struggle being waged within Malcolm. As we
sat together, I could not help but feel that there were two Malcolms before
me—one who was downcast and exasperated and one who yearned to
break out from being downcast and exasperated. I was also aware of our
racial differences during this initial meeting but did not feel a need to
comment on those differences, at least for the time being. However, I did
feel a need to acknowledge his sadness and anger, which I encouraged him
to express.
Malcolm was essentially lost. He felt like a pawn in the hands of those
more powerful, and he had no sense of how to work out of the situation.
This self-appraisal was accompanied by a grave sense of having squan-
dered his potential (he had long desired to be a teacher, and occasionally
he attempted to write poetry). He also longed for a sustained and gratify-
ing relationship. Although Malcolm and I were constrained to an extent
by his 12-session insurance plan, we also decided it was important to stay
open to what evolved in our encounters and to renegotiate fees if neces-
sary when the insurance ran out.
The bulk of our sessions focused on helping Malcolm stay present
to the rivaling sides of himself—the side that shriveled and felt like an
“untouchable” and the side that seethed and yearned to transform. But we
also looked closely at what transpired between us and how this influenced
his struggle. Here’s a sampling of our encounter at about our fifth session:

KS: How are you, Malcolm?

Malcolm: I’m OK, I just feel beaten down [he lowers his head]. It’s as if
the fortunes of life have passed me up. I got no job, no girl, and don’t have
much of a life.
KS: [homing in on what I experienced as most salient] What would a “life”
be for you, Malcolm? What would it look like?

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Malcolm: That’s a good question; I haven’t really taken that much time to
look at that. I think it would have to do with not feeling like a chump so
much of the time; like my life would really mean something.
KS: What does it “mean” now?
Malcolm: I’ve already told you, it doesn’t mean shit—I get a job (I don’t
really even like); I start out decently in the job, and then I’m accused of
being too slow [at record keeping], and then I say something a little agi-
tated because my supervisor is a goon, and I get fired. I go out to clubs to
meet a good woman, and I end up with backstabbers.
KS: [we both take a breath] What’s happening now, Malcolm?
Malcolm: I just don’t know, I just don’t know how my life ended up like
this . . .
KS: What are you feeling in your body right now? Can you describe it?
Malcolm: Yeah, it’s like a big weight, right here on my chest.
KS: See if you can stay with that a moment . . .
Malcolm: It’s no use; life just sucks.
KS: So is that all that you and life come down to, Malcolm? That you’re a
useless, incompetent loser?
Malcolm: Maybe so.
KS: Do you really buy into that?
Malcolm: What else should I buy into?
KS: I can’t tell you that, Malcolm, but what else are you willing to buy into?
[This question gets in; he takes a moment to reflect.]
Malcolm: Yeah, you got a good point there, Doc; I have been doing a lot
of buying in that I don’t really want to do. And yeah, there are a few more
things in my life than just being a fool.
KS: Like?

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Malcolm: Like wanting to go on and get a degree in education, wanting

to make a difference in a kid’s life—continuing with my poetry, which I
haven’t worked on in over a year now.
KS: [taking a chance, pressing a little] Would you be willing to start on one
of those things right here, now, at this moment?
Malcolm: How could I do that?
KS: Well, what if we collaborated on helping you take steps toward looking
into a degree program? For example, would you be willing—this week—
to obtain and look through one university catalog describing an educa-
tional degree?
Malcolm: [after some deliberation] Well, yes, OK, that’s something I
could do.
KS: Something you “could” do, or something you are willing and wanting
to do?
Malcolm: Yes, it’s definitely something I’m wanting to do—it’s been
too long.

In the next session, Malcolm reported with some encouragement that

he obtained a brochure from a local school and was intrigued with the
program. He was also hopeful about the prospects for a loan to enroll in the
program. Sometimes simple challenges, such as looking through a college
catalog, are enough to kick-start a seemingly intransigent life. Sometimes
they are not, but they are certainly worth considering and potentially
reverberating to in the reassessment of one’s life.
In our subsequent sessions, Malcolm gradually became more aligned
with the “more” of who he was and less patient with a narrow self-identity.
The search for, and subsequent enrollment in, an educational program led
Malcolm to explore other possibilities in his life. With my encouragement,
for example, he started a poetry journal, which also focused on life obser-
vations and reflections on his here-and-now struggles. This activity then
led to one of the pivotal events of Malcolm’s life—his reconsideration of
spirituality. As Malcolm revisited the hurts and torments of his religious

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upbringing, he began to realize that there were moments—for example, in

prayer or during spirited hymns—that he felt a kind of love in the air. It
was a love unlike anything he had ever felt from his mother (which struck
him as highly conditional), and it radiated throughout his whole being, his
whole sense of self. For the first time since rejecting religion altogether, he
felt as if there might be a force or spirit that accepted him for who he was,
regardless of what he did. He viewed this God or spirit not as the punish-
ing overseer he was brought up with, but as the “beyond” that granted and
thereby affirmed his existence. (This understanding, interestingly, dove-
tails with Paul Tillich’s notion of accepting the acceptance of God, which
I shared with Malcolm. I also shared with Malcolm the following Tillich
[1952] quote: Accepting acceptance “is the paradoxical act by which one is
accepted by that which infinitely transcends one’s individual self ” [p. 165].)
We spent many hours exploring this newfound hope, even trust, in
the beyond of the universe, as it genuinely altered Malcolm’s life. Now,
when Malcolm contacted himself experientially, he would often enter into
a sense of “at homeness” or a place where he was “at rest.” As our relation-
ship strengthened, he was able to find this place even when he felt some
discomfort with me, which was decreasingly frequent. We attributed this
decrease to the ample attention we paid to what it was like for him to be
in relation with me and to observing shifts in that experience, as well as to
the flow of his internal experience.
Although our racial difference could potentially have been a barrier,
it did not seem to be, perhaps because we checked in so often about our
general relationship as well as immediate experience. I don’t believe race
invariably needs to be broached between individuals of different racial
backgrounds; the main issue is whether the participants can stay open to
each other, regardless of the particular conflict. The reason for this is that
it is not two races who encounter each other, but two people, and if race
happens to be what is most salient at a given moment (or beckons to be
addressed), then that’s what should be addressed. If not, then it is a bit of
a sham, and it may even be more racially insensitive in itself to press the
matter (see Vontress & Epp, 2015). At the same time, I try to stay mind-
ful of the way that race, or any culturally or politically charged issue, may

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potentially impact the therapeutic context and to stand ready to address

it (see also Rice, 2008).
E–H therapy is not simply a two-person predicament; we must also
account for the world in which we dwell. The question is, How can we
account for that world in a way that engenders therapeutic deepening—
not to mention relevance and sensitivity—for the client? In Malcolm’s
case, the issue of race was addressed implicitly through the authenticity
of our relationship and our openness to as many issues as possible that
impinged on this relationship. Sometimes this readiness to explore is all
that is needed in fostering the therapeutic bond; at other times, with a
more distrusting client, for example, race or any charged issue must be
explicitly addressed.
As the harshness within Malcolm began to recede, he developed a
more open and appreciative demeanor. This demeanor impacted his entire
world, from his engagement with studies to his relations with friends and
potential romantic partners.
In essence, and through many searches of himself, his relationship with
me, and his relationship to his past, Malcolm re-formed his relationship to
life. Through cultivation of presence, in other words, Malcolm expanded
his ability to “see” himself, and this “inner sight,” as J. F. T. Bugental (1978,
p. 12) termed it, led to key shifts. Moreover, as Malcolm shifted, he edged
ever closer to that ultimate shift—his core sense of acceptance.
Acceptance gave Malcolm the sense that no matter what he achieved
(or did not achieve), he was alright, that achieving was not the absolute
goal, and that the “being” or presence he brought to the achieving made
all the difference. After 8 intensive months, Malcolm and I agreed to end
our relationship, strong in feeling that he had begun a new life.

Obstacles and Problems in Using

the E–H Approach
The main obstacle to engaging an E–H approach to therapy is economic.
This barrier is evident, from the dearth of funding for E–H therapy training
programs (Pierson, Krug, Sharp, & Piwowarski, 2015), to the paucity

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of third-party reimbursement for longer term, exploratory therapies

(Miller, 1996a), to the scarcity of support for E–H therapy outcome
research (Walsh & McElwain, 2002). It is also evident from the struggle of
clinical graduate students, who tend to be squeezed by debt and harried by
short-term, cost-driven training (Elkins, 2007; Miller, 1996b).
Culturally, E–H therapy is also challenged. A core dimension of our
industrialized, achievement-oriented society is efficiency (F. W. Taylor,
1911). Efficiency emphasizes speed, instant results, and appearance and
packaging—dimensions that sometimes contrast with comprehensive
E–H care (Schneider, 2005). At the same time, the field of psychotherapy
is increasingly recognizing the value of in-depth, personal dimensions
of effective practice (see Chapter 5, this volume), and E–H therapy, par-
ticularly with its integrative emphasis, is on the forward edge of that
recognition. Consider, for example, leading therapy outcome researcher
Bruce Wampold’s (2008) suggestion that “an understanding of the prin-
ciples of existential therapy is needed by all therapists, as it adds a per-
spective that might . . . form the basis of all effective treatments” (p. 6).
Further, E–H therapy is being engaged by an increasingly diverse base
of practitioners, as evinced by the variety of case studies in the textbook
Existential–Integrative Psychotherapy (Schneider, 2008; see also Shahar
& Schiller, 2016b), along with the growth of E–H therapy training cen-
ters, such as the Existential–Humanistic Institute, The Living Institute,
Saybrook University, the Michigan School of Professional Psychology,
the Existential–Humanistic Northwest, and the International Institute
for Humanistic Studies.
We hope that this book, with its call to a more integrative E–H per-
spective, will be another important step toward both the diversification
and expansion of E–H practice principles. Correspondingly, those who
value E–H principles need to find more ways to bolster their impact on
the profession as a whole. More training programs are needed, even on a
pilot basis, along with more dedication to research and more outreach by
E–H practitioners to underserved communities. The therapy and theory
need to be expanded to concretely clarify their relevance to a diversity of
clientele, but also their limitations. There need to be more conferences,

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debates, dialogues, and collaborations with mainstream therapeutic

communities.
Bridge building in humanistic books and journals (e.g., the Journal
of Humanistic Psychology)—as well as at professional conferences—is a
start in this direction, but much more such activity is needed at the levels
of academia, research, and public and private institutions (see Krug &
Schneider, 2016; Pierson, Krug, Sharp, & Piwowarski, 2015, for an elabo-
ration). E–H therapy cannot be all things to all people, but it does have
a striking potential to revitalize lives. This revitalization can take place
across many individual and collective sectors of our society, and this is
the next step, as far we are concerned, in the evolution of our discipline.

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 5

Evaluation

I t is one of the supreme ironies of our field that the most salient fac-
tors in therapeutic outcome research—a healing environment, the
therapeutic relationship, and the therapist’s and client’s personal styles—
echo incisively the precepts emphasized by existential–humanistic (E–H)
therapy, one of the field’s least-studied modalities (Elkins, 2007; Lambert,
1992; Norcross, 1987; Walsh & McElwain, 2002; Wampold, 2001, 2008).
As Elkins (2007) pointed out, the meta-analytic findings upholding these
context factors “are a powerful confirmation of what humanistic psychol­
ogists have maintained for years” and yet have eluded much systematic
inquiry (p. 496). He went on to note that it’s not so much “theories and
techniques that heal . . . but the human dimensions of therapy and the
‘meetings’ that occur between client and therapist as they work together”
(p. 496).

http://dx.doi.org/10.1037/0000042-005
Existential–Humanistic Therapy, Second Edition, by K. J. Schneider and O. T. Krug
Copyright © 2017 by the American Psychological Association. All rights reserved.

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 EXISTENTIAL–HUMANISTIC THERAPY

Leading therapy researcher Bruce Wampold (2008) was just as ada-

mant. In a review of Schneider’s edited book Existential–Integrative Psycho-
therapy, he wrote, “I have no doubt that EI approaches would satisfy any
criteria used to label other psychological treatments as scientific” (p. 5).
And it bears repeating: “It could be . . . that an understanding of the prin-
ciples of existential therapy is needed by all therapists, as it adds a per-
spective that might, as Schneider contends, form the basis of all effective
treatments” (p. 6).
Finally, in a landmark special section of the Journal of Psychotherapy
Integration, Shahar and Schiller (2016a) contended outright that “in the
last few decades, the existential–humanistic tradition in psychology—also
known as the third force—has taken over the field of clinical psychology”
(p. 1). They went on to report that this development has occurred qui-
etly but has nevertheless permeated all the major orientations in psycho-
therapy and has been driven in large part by the meta-analytic studies
upholding contextual and relational factors as foundational to effective
psychotherapy.
Yet as robust as these cited meta-analyses of therapeutic outcome have
been, they seem to have had a limited impact on both the training and
orientations of mainstream practitioners (Cooper, 2004; Elkins, 2007;
Westen, Novotny, & Thompson-Brenner, 2004). The so-called empiri-
cally supported treatment (EST) movement, on the other hand, which
established highly stringent—some would say “truncated”—parameters
of methodological validation, still dominates the thinking in professional
practice and training (American Psychological Association [APA] Presi-
dential Task Force on Evidence-Based Practice, 2006; Elliot, 2002; Westen
et al., 2004). The EST movement accentuates the investigation of overt
and quantifiable (e.g., cognitive–behavioral) forms of practice while
neglecting or overlooking the contextual factors (and meta-analytic find-
ings) elucidated previously (see Cain, Keenan, & Rubin, 2016, and Wertz,
2015, for comprehensive reviews).
This state of affairs is shifting (APA Presidential Task Force on Evidence-
Based Practice, 2006; Norcross, 2002), and existential–humanistic therapy
is in a prime position to be a beneficiary of this shift (Schneider, 2008).

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 Evaluation

In the past decade, mainstream conceptions of outcome research have

undergone notable reevaluations. Models formerly considered invulner-
able are now being revised. The randomized controlled trial, for example,
once considered the gold standard of (overt and measurable) psycho-
therapy evaluation research, has been roundly criticized and re-assessed
(see Bohart, O’Hara, & Leitner, 1998; Goldfried & Wolfe, 1996; Schneider,
2001; Westen et al., 2004). Conversely, qualitative research, once con-
sidered practically and scientifically untenable, has attained greater
professional acceptability (APA Presidential Task Force on Evidence-
Based Practice, 2006; Wertz, 2015). There is now even a notable qualitative
component to the newly titled Society for Quantitative and Qualitative
Research (Division 5 of APA).
In light of these changes, existential psychotherapy has been accu-
mulating a considerable base of empirical support. Although still com-
paratively modest, this literature is both rigorous and compelling (Angus,
Watson, Elliott, Schneider, & Timulak, 2015; Bunting & Hayes, 2008; Vos,
Craig, & Cooper, 2015). As previously mentioned, in the domain of system-
atic quantitative inquiry, there is growing support for key existential prin-
ciples of practice. This support is worth elaborating. The so-called context
or common factors research consistently upholds relationship, as opposed
to technique, as the core facilitative agent (Norcross & Lambert, 2011;
Wampold & Imel, 2015). This research is reinforced in findings on the ther-
apeutic alliance (Horvath, 1995), empathy (Bohart & Greenberg, 1997),
genuineness and positive regard (Orlinsky, Grawe, & Parks, 1994), and cli-
ents’ capacity for self-healing (Bohart & Tallman, 1999). It is also mirrored
in the burgeoning research on expressed emotion (e.g., Gendlin, 1996;
Greenberg, Rice, & Elliott, 1993) and presence (e.g., Geller & Greenberg,
2012). Further, in a little known but provocative study of existential
therapy with patients diagnosed as schizophrenic and treated at Soteria
House, an alternative, minimally medicating psychiatric facility, Mosher
(2001) reported the following: At 2-year follow-up, the experimental
(existentially treated) population “had significantly better outcome” along
such dimensions as rehospitalization, psychopathology, independent
living, and social and occupational functioning than their conventionally

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treated counterparts (p. 392). In a follow-up review of the efficacy of all

controlled trials (comprising 223 participants) using the Soteria model,
Calton, Ferriter, Huband, and Spandler (2007) concluded,

The Soteria paradigm yields equal, and in certain specific areas, bet-
ter results in the treatment of people diagnosed with first- or second-
episode schizophrenia spectrum disorders (achieving this with
considerably lower use of medication) when compared with conven-
tional, medication-based approaches. Further research is urgently
required to evaluate this approach more rigorously because it may
offer an alternative treatment for people diagnosed with schizophrenia
spectrum disorders. (p. 181)

Another promising area of quantitative support for E–H practice is

the neuroscience of emotional regulation. Greenberg (2007), in an over-
view of this area, concluded that for affect regulation to endure, it gener-
ally must be mediated through nonverbal (e.g., embodied) therapeutic
modalities rather than those that stress cognition. “Cognitive control,”
he stated,

can be useful for people who feel out of control [but] over time, it is
the building up of implicit or automatic emotion regulation capaci-
ties that is important for enduring change, especially for personality-
disordered clients. The provision of a safe, validating, supportive,
and empathic environment is the first level of intervention that helps
soothe and regulate automatically generated underregulated distress.
(p. 416)

He summed up as follows:

Looking at emotion regulation in a broader, dynamic systems view, we

thus see that much affect regulation occurs implicitly through the right
hemispheric processes, and is not verbally mediated. This processing
is highly relational, and is most directly affected by processes such
as the autonomic generation of self-soothing and self-compassion,
and relational communications through facial expression, vocal
quality, and eye contact. (p. 415)

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Finally, there is a growing body of research in the area of clinical train-

ing that also provides quantitative support for existential processes. In
a review of the literature, Fauth, Gates, Vinca, Boles, and Hayes (2007)
called for a new emphasis on personal dimensions of training, including
responsiveness and presence:

Research indicates that traditional psychotherapy training practices

do not durably improve the effectiveness of trainees because they
overemphasize theory, technical adherence, and didactic learning.
Thus we propose that future psychotherapy training focus on
a few “big ideas,” such as therapeutic responsiveness [and] . . . the
development of psychotherapist metacognitive skills (i.e., pattern
recognition and mindfulness) via experiential practice. (p. 389)

Interestingly, these concepts have received a comprehensive update in a

new volume by Krug and Schneider (2016) called Supervision Essentials
for Existential–Humanistic Therapy, which is part of APA’s Clinical Super-
vision Essentials Series. This volume is one of the first to formally organize
the framework of E–H principles for the supervision and training of clini-
cal and counseling graduate students.
On the qualitative side of the equation, existential psychotherapy has
produced some of the most eloquent case studies in the professional lit-
erature (e.g., Binswanger, 1958; Boss, 1963; Bugental, 1976; May, 1983;
Schneider & May, 1995; Spinelli, 1997; van Deurzen, 2015; Yalom, 1989).
These studies help us understand lived experience, not just reports about
experiences. For example, Boss (1963) showed how phenomenological
dream analysis can illuminate a client’s subjective grasp of his suffering;
Bugental (1976) vividly elucidated his personal struggles—thoughts, feel-
ings, and even kinesthetic reactions—in his depictions of his work with
clients; Schneider and May (1995) and Schneider (2008) showed the value
of existential principles for some of the least “typical” client populations;
and Yalom (1989) explicated the liveliness and even humor of profound
therapeutic rapport.
In the area of more formal qualitative studies, Bohart and Tallman
(1999); Pierson, Krug, Sharp, and Piwowarski (2015); Rennie (1994); and

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Watson and Rennie (1994) demonstrated the value of such existential

concepts as presence and the expansion of the capacity for choice in effec-
tive facilitation. Successful psychotherapy, they have shown, necessitates a
“process of self-reflection” and a consideration of “alternative courses of
action and making choices” (Walsh & McElwain, 2002, p. 261). In a related
study, Hanna, Giordano, Dupuy, and Puhakka (1995) investigated what
they termed “second order” or deep, sweeping change processes in therapy.
They found that “transcendence” (moving beyond limitations), which is
compatible with existential emphases on liberation, was the essential
structure of change. They found, further, that transcendence consisted of
“penetrating, pervasive, global and enduringly stable” insights accompa-
nied by “a new perspective on the self, world, or problem” (p. 148).
Finally, in a study of clients’ perceptions of their existentially ori-
ented therapists, Schneider (1985) reported that although techniques
were important to long-term success, the “personal involvement” of the
therapist (her or his genuineness, support, and understanding) was by far
the most critical factor identified. Such involvement, moreover, inspired
clients to become more self-involved and to experience themselves as
increasingly capable, responsible, and self-accepting. (See Angus et al.,
2015; Elliot, 2002; Rennie, 2002; Walsh & McElwain, 2002; and Watson &
Bohart, 2015, for a comprehensive review of these and other E–H thera-
peutic investigations.)
For all its productivity, however, it must be admitted that, taken as
a whole, the systematic, corroborative evidence for existential therapy is
relatively limited (Vos et al., 2014; Walsh & McElwain, 2002). There are
two essential reasons for this. First, the existential theoretical outlook has
tended to attract philosophically and artistically oriented clinicians more
interested in clinical practice and narratives than in laboratory procedures
or experimental design (DeCarvalho, 1991). Second, when existential
therapists and theorists attempt to conduct research, they find themselves
facing an array of theoretical, practical, and political barriers. Among
these are the difficulties of translating long-term, exploratory therapeutic
processes and outcomes into controlled experimental designs (Schneider,
1998b; Seligman, 1996). It is not easy to quantify complex life issues

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(Miller, 1996a), and the obstacles to obtaining research funds for “alter-
native” approaches are legion (Miller, 1996b). These obstacles are even
more daunting for clinicians who favor qualitative or phenomenological
assessments of their work. Although such methodologies tend to be more
appropriate than quantitative studies to investigate existential psycho-
therapy’s main domain of interest—clients’ subjective and intersubjective
worlds—there are substantial costs associated with their implementation
(Wertz, 2015). Not least among these challenges is estrangement from
a quantifying or medicalizing research community that tends to deal
in-efficiently with that which lies outside its purview (Shedler, Mayman,
& Manis, 1993).
But this situation, too, may ease as practitioners are now realizing
the advantages, both professional and even personal, of practicing from a
more intimate, depth-oriented perspective. A recent article in the Journal
of Social and Clinical Psychology reported that humanistic and transper-
sonal psychologists are less likely to experience burnout and more likely to
show positive personal growth as a result of their work with human suffer-
ing compared with other types of therapists (e.g., those using cognitive–
behavioral therapy; Linley & Joseph, 2007).
Empirical investigation of existential psychotherapy, then, is at an
early but promising stage. Certain conceptual dimensions related to exis-
tential practice have been confirmed by both quantitative and qualitative
research, whereas others await further exploration.1 If current trends in
therapy research continue, existential practice may well become a model
evidence-based modality that stresses four critical variables: the therapeu-
tic relationship, the therapist’s presence, the therapist’s personality, and
the active self-healing of clients. From this standpoint, it is conceivable
that statistically driven programs and manuals will give up center stage
and come to play a supporting role (Bohart & Tallman, 1999; Messer &
Wampold, 2002; Schneider & Längle, 2012; Westen & Morrison, 2001).

1
One of the challenges of this exploration is to tease out the respective degrees of effectiveness among
E–H and other, similar approaches, such as client-centered and gestalt therapies, which also empha-
size common factors.

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 EXISTENTIAL–HUMANISTIC THERAPY

Specific Problems and Client Populations

As previously intimated, E–H therapy can be effectively applied with a
diverse population of clients. Furthermore, E–H principles of presence,
I–Thou relationship, and courage have been adopted by a wide variety
of practice orientations (e.g., see Schneider, 2008; Stolorow, Brandchaft,
& Atwood, 1987). Still, the expansion and diversification of existential
therapy are a relatively recent phenomenon, because it has historically
been practiced in White, middle- to upper-class neighborhoods with
White, middle- to upper-class clients. There is, however, no necessary
link between such clientele and effective psychotherapy. The benefits of
presence, the I–Thou encounter, and responsibility are cross-cultural and
cross-disciplinary (May, 1972; Rice, 2008; Vontress & Epp, 2015).
In short, there is considerable ecumenism in contemporary E–H
practice. This ecumenism is characterized by cross-disciplinary openness,
adaptations for diverse populations, and sliding fee scales. In the end, no
formulaic guideline determines the course of E–H therapy. Each client
and therapist pair—each humanity—must have its say.
Still, E–H therapy, even of the integrative variety, has specific problems
as well as advantages. One of the problems of E–H therapy is its tendency
to invite depth and intensity when circumstances may or may not call
for such (Cooper, 2004). For example, within the existential–integrative
model of practice, clients whose desire and capacity for change are highly
delimited (e.g., because of psychological fragility, cultural outlook, or
intellectual acuity) may not benefit from the fuller, experiential phases
of that approach (Schneider, 2008). By the same token, clients who seek
short-term, symptom-reducing therapy probably will not appreciate
lengthy or intensive opportunities to anatomize their life concerns. Never-
theless, a signal advantage of E–H therapy, particularly of the integra-
tive variety, is that should ostensibly short-term clients change or respond
unexpectedly to the E–H experiential field, intensive, longer term explora-
tion may be just what they ultimately require.
In sum, there is no cardinal rule about for whom or in what circum-
stances E–H therapy will prove most effective. In keeping with the E–H
practice philosophy, each connection, each setting, and, indeed, each

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moment must be carefully and mindfully appraised. Again, we cannot say

enough about the value of presence for assessing the appropriateness of
E–H (or any other kind of) therapy for struggling, panicking lives. To
the extent that therapists can draw on their whole-bodied experience
in therapy, they will be in an enhanced position to relate to, assess, and
serve the clients they engage.

How Does E–H Therapy Work With a Diverse

Range of Clients?
E–H therapy is evolving successfully with a wide variety of client popu-
lations. The research on the effectiveness of common factors or contex-
tual dimensions of therapy also upholds the value of a comprehensive
E–H approach (Elkins, 2007; Wampold, 2001, 2008). The issue for E–H
therapy is not so much the background of a given client but the mean-
ing of that background for clients’ living, unfolding experience. People’s
living, unfolding experience, in other words, may or may not conform to
their demographic profile, and although it is important to account for
that profile, it is abasement, in our view, to overestimate its role. The chief
question is, What is the client’s desire and capacity for change, and how
can the therapeutic experience best mobilize, support, and help unleash
that desire and capacity? This is the E–H therapist’s charge.
Consider, for example, the existentially oriented case study of an
African American client, Darrin, by Rice (2008). After a “breakdown of
rapport” between Darrin and his former White therapist, who attributed
Darrin’s depression to overwork, Darrin sought counseling from Rice, an
African American existential therapist. By attuning to Darrin’s immediate
socioeconomic plight, helping him manage his debts, and supporting him
to develop choice, Rice was able to assist Darrin to reflect more substan-
tively on his life, not merely his pocketbook.
In a parallel vein, the existential case of Mariana, by Comas-Díaz
(2008), incorporated what Comas-Díaz called “Latin-American human-
ism” and “Latino psychospirituality” (p. 100). By these terms, Comas-Díaz
meant a “wisdom”—sabiduría—that connects spiritual development

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with healing (p. 101). By attending to Mariana with these sensibilities,

Comas-Díaz was able to support her to rediscover both the tragedy and
opportunity in an ancestral trauma and to rediscover her roots—as well
as herself—through art. “Therapy helped me to become an artist of life,”
Mariana proclaimed at the conclusion of the study (p. 107).
These examples notwithstanding, much more research is needed to
deepen our understanding of the salience of E–H offerings. We need to
know more specifically how presence, invoking the actual, working with
resistance or protections, and cultivating meaning and awe affect clients
from diverse backgrounds with diverse needs. Vontress and Epp (2015)
emphasized the point:

Existential cross-cultural counseling is a rich philosophical approach

to psychotherapy that shares many of the same tenets with the world’s
major cultures and religions. . . . It is this fact that makes it a univer-
sally applicable theory of counseling. However, existentialism also
challenges the other counseling perspectives in its expansive view
of life . . . and its belief that a narrow focus on cognitions, feelings,
or psychodynamics in the therapeutic relationship addresses only a
narrow slice of existence. Ultimately, the existential cross-cultural
counselor wishes to concertedly explore with the client all of life; not
simply the random issues that emerge in the session. (p. 386)

A Note About the Social and Spiritual

Dimensions of E–H Transformation
The quote from Vontress and Epp (2015) brings into focus a major cri-
tique of psychotherapy in recent years. This criticism comprises three
main points: (a) that psychotherapy is overly individualized; (b) that it
feeds a materialist, consumerist mind-set; and (c) that it is politically naive
or regressive (Cushman, 1995; Hillman & Ventura, 1992). “We have had
100 years of psychotherapy,” Hillman and Ventura (1992) inveighed, “and
the world’s getting worse.”
The question, however, is which form of psychotherapy the detrac-
tors are targeting and whose particular world is “getting worse.” Although

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Hillman and Ventura (1992) appeared to include E–H therapy in their

generalized indictment, is this inclusion warranted? From an E–H point
of view, for example, there is certainly merit to the problem of a worsen-
ing world. In many quarters of the globe, class divisiveness and materialist
ambition appear to be on the rise, whereas, at the same time, conviviality,
interethnic understanding, and magnanimity appear to be waning. But
is E–H practice among the instigators of these developments? We would
reply both yes and no: yes in the sense that it is sometimes overly individu-
alistic, but no in the sense that it has consistently opposed the simplistic,
cosmetic, and mechanical in therapeutic conduct, which are the primary
corrosive influences in our view (e.g., see Laing, 1967; May, 1983).
In any case, one point has become increasingly clear: One cannot sim-
ply heal individuals to the neglect of the social context within which they
are thrust. To be a responsible practitioner, one must develop a vision of
responsible social change, alongside of and in coordination with one’s
vision of individual transformation—and increasingly, E–H practitioners
are becoming conscious of this interdependence (Mendelowitz, 2008;
O’Hara, 2001; Pierson, Krug, Sharp, & Piwowarski, 2015).
The question is one of social advocacy: On whose behalf does a
therapist function—the culture, the institutional norm, the conventions
of the health care industry, or the client? Although none of these can be
neglected from an E–H point of view, it is emphatically the client, and the
profound subjective and intersubjective realizations of depth experiential
inquiry, that reflect the chief priority of E–H therapy. This person-centered
priority, moreover, is not just for the revitalization of individuals, it is for
the revitalization of their (our) community, culture, and indeed, world
(e.g., see Buber, 1970; Bugental & Bracke, 1992; Friedman, 2001; Hanna
et al., 1995; May, 1981). To put it another way, E–H therapy promotes
depth inquiry, and depth inquiry promotes a sense of what deeply matters.
Although such a sense does not always lead to social and spiritual con-
sciousness, in our experience—and that of many E–H practitioners—this
is predominantly what results.

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Future Developments

T he problems with market-driven health care—or the“quick-fix”model

for living—continue to mount (Cushman, 1995; Schneider &
Längle, 2012; Watson & Bohart, 2015). Yet approaches such as existential–
humanistic (E–H) therapy, which prize the person of the client, provide a
hedge against this intensifying trend. This is not to say that E–H therapists
deny the periodic need for expedience in the facilitation of therapeutic
healing. As we have taken pains to point out in this volume, E–H thera-
pists increasingly appreciate such practicality, but—and this is key—only
within the context of a more holistic availability. For example, E–H thera-
pists are circumspect about “treating” a client as a medical doctor “treats”
a patient or a pharmacist gives a patient a remedy. At the same time, E–H
therapists recognize that there are moments, such as in emergencies, when
clients both seek and need such guidance from therapy, and it should be
implemented accordingly. The key point here, however, is that therapy

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does not generally end with such moments and that opportunities for
clients to develop agency (meaning, depth, alignment with what matters)
are critical.
Although remedies in the medical sense may be seductive, and even
helpful, initially, they can also prove notoriously short-lived. Consider the
conclusion of Wampold (2001), after an exhaustive analysis of the literature:

Therapy practice is both a science and an art. . . . The master thera-

pist, informed by psychological knowledge and theory and guided by
experience, produces an artistry that assists clients to move ahead in
their lives with meaning and health. Treating clients as if they were
medical patients receiving mandated treatments conducted with
manuals . . . stifle[s] the artistry. (p. 225)

Forward Edge of Practice

E–H therapy, in our view, is at the forward edge of the movement to which
Wampold alluded: the melding of art and science, evidence and expe-
rience. The question is, Can E–H therapy lead this movement into the
coming era? This question is crucial because the frame we use to integrate
practice will have profound effects on the public we serve. For example, if
cognitive–behavioral therapy is the context within which we incorporate
other therapeutic modes, then the context of clients’ healing will be bound
by cognitive–behavioral techniques, principles, and goals.
We contend that E–H therapy should be a leading context within which
integrative practices are used (see also Shahar & Schiller, 2016a; Wolfe,
2016). Consider, for a moment, what an E–H integration of practice is likely
to instill: the enhancement of presence, both to oneself as therapist and to
one’s client; the value of this enhancement for the understanding and sup-
port of the therapeutic process; the clarification of clients’ core struggles;
the elucidation of the blocks to that clarification; and finally, the enabling
of access to clients’ range of possibilities for a poignant and meaningful life.
What clients would not benefit from such opportunities? What therapists
would not appreciate the benefits that such opportunities can bring?
Indeed, there is a growing consensus among major theorists (e.g.,
Geller & Greenberg, 2012) that the cultivation of presence should be a

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core competency of psychotherapeutic training. Moreover, it is the con-

viction of the authors of this book that presence is in fact the hub around
which evidence-based therapeutic practices revolve, and it is high time our
profession recognizes it as such (see also Schneider, 2015). Given the cen-
trality of presence to effective psychotherapy, we will even go so far as to
call for the cultivation of presence as a professional competency, just as the
alliance, empathy, and collaborative attunement are viewed as competen-
cies at the level of bona fide clinical graduate training.
Some of the newer branches of E–H practice that we would like to
see pursued include the existential–integrative model we have discussed
in this volume as well as specific integrations of practice in the areas of
multiculturalism (Comas-Díaz, 2008; Rice, 2008; Vontress & Epp, 2015),
gender identity (Brown, 2008; Monheit, 2008; Serlin, 2008), sexual abuse
(Fisher, 2005), psychoses (Dorman, 2008; Thompson, 1995), religion and
spirituality (Bowman, 1995; Bradford, 2007; Elkins, 2015; Hoffman, 2008),
cognitive–behavioral therapy (Bunting & Hayes, 2008; Wolfe, 2008),
and psychodynamic and relational modalities (Fosha, 2008; Krug, 2009;
Portnoy, 2008; Stolorow, 2008).
We also encourage the continued development of E–H therapy in the
areas of group encounter for older adults (E. Bugental, 2008), supportive
therapy for returning war veterans (Decker, 2007; Paulson & Krippner,
2007), and arts-based therapy for people with emotional and physical dis-
abilities (Serlin, 2007; Serlin & Speiser, 2007). Finally, we encourage the fur-
ther elaboration of E–H theory with respect to aspects of the self, identity
formation, and therapeutic change (Krug, 2010, 2016).

Outlook and Challenges

The outlook for E–H therapy is increasingly favorable, although some-
what guarded at the same time. It is guarded to the extent that all depth
therapies are guarded and under threat today—by an encroaching ethos
of standardization. Moreover, as students, instructors, and professional
organizations acquiesce to, and in some cases encourage, that ethos, there
is a decreasing incentive to teach and apply E–H alternatives (Bohart et al.,
1997; Schneider, 1998a, 1999; Schneider & Längle, 2012).

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Nevertheless, the outlook for the future is increasingly hopeful for

an E–H/integrative renaissance. As suggested previously, there are trends,
such as the embrace of experientially informed practice, that run directly
counter to the scenario outlined in the preceding paragraph. These trends
suggest that a backlash is building and that E–H therapy is on its cutting
edge, as is holistic and integrative medicine, comprehensive health care, and
social and spiritual activism (e.g., see Criswell, 2001; Elkins, 2016; Lyons,
2001; Montuori & Purser, 2015; Schneider, 1998b, 2004; Serlin, 2007; Shahar
& Schiller, 2016a).
As E–H therapy evolves, moreover, it is converging with other liberation-
based therapies. These therapies are influencing the culture beyond the
traditional two-person context. Drawing on E–H practice principles,
for example, O’Hara (2001, 2015) has elaborated an ever-widening E–H
application. She documented the use of E–H approaches in the schools,
business community, and human services fields and pleaded for a society-
wide E–H reformation. Finally, what Schneider (2004, 2009) termed the
“awe-based” in psychology is an attempt to apply existential depth prin-
ciples to a variety of social arenas—from child-rearing to education and
from the work setting to religion and government (e.g., see Schneider,
2016, on applying E–H principles to community and legislative settings).
Others, such as gang mediator and former gang leader James Hernandez,
are furthering this awe-based approach directly. Hernandez spearheaded a
project for the Ernest Becker Foundation of Seattle, Washington, to bring
awe-based principles of practice to his work with violent and troubled
youth (“Assisting Youth,” 2007). Such communalization of practice is
critical, in our view, if society is to both mature and flourish.
To the extent that these trends continue—and, as noted, there is
mounting optimism that they will (e.g., Ray, 1996; Shahar & Schiller,
2016a)—then correlative trends should also grow, such as funding for
E–H practices, support for E–H training, and investment in E–H theory
building. For example, the American Psychological Association’s Com-
mission on Accreditation (2017) recently included “effective [therapeutic]
relationships” as well as a call for more “diversity” of training to their
proposed criteria for “approved” clinical graduate training.

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 Future Developments

Nevertheless, we do not want to sound glib about the difficulties E–H

and related practice modalities face in the coming years. Managed care,
programmatic mental health practices, and medicalization are here to
stay, and there are sound bases for their existence. But what we do wish to
emphasize is that with discernment, focus, and passion, a major transfor-
mation can be staged in psychotherapy. This change will not be exclusivist,
and it will not reject conventional modalities, but it will widen, deepen, and
integrate these modalities, and it will weave them into a liberating whole.

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Summary

T his book has examined the history, theoretical framework, and prac-
tical application of contemporary existential–humanistic (E–H)
therapy—now rapidly expanding toward an existential–integrative (E–I)
therapy. Deeply rooted in the question of what it means to be fully and sub-
jectively alive, E–H therapy is an amalgam of approaches that emphasize
experiential liberation and transformation.

Background
Beginning in the late 1950s, E–H therapy became an established therapeutic
orientation. With the publication of Rollo May’s Existence (May, Angel,
& Ellenberger, 1958) and culminating in James Bugental’s The Search
for Authenticity (1965), E–H therapy took its place alongside the three
major practice orientations of the era—psychoanalysis, behaviorism, and

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client-centered therapy. Yet E–H therapy also departed from all three ori-
entations on the basis of a radically new outlook—at least for the United
States. This outlook emphasized freedom, experiential reflection, and
responsibility. Although psychoanalysis advocated freedom (albeit in a
restricted form), it lacked the stress on whole-bodied, experiential reflec-
tion, and although it supported ego development, it lacked an accent on
personal responsibility. Behaviorism, meanwhile, lacked almost any empha-
sis on freedom, experiential reflection, and responsibility and wedded its
philosophy to conditioning. Client-centered therapy came closest to E–H
therapy in its aims—and shared its humanistic philosophy—but lacked its
intensity, particularly in the area of personal and interpersonal struggle.
May and Bugental thus augmented these trends within American ther-
apy with vigorous new practice modalities that added concreteness, inten-
sity, philosophical depth (imported mainly from Europe), and spiritual
breadth. Among the modalities elaborated were presence, authenticity,
and will.
By the 1980s, Irvin Yalom (1980) had consolidated his predecessors’
therapeutic outlook with an accessible, highly scholarly guide called Exis-
tential Psychotherapy. This text helped make E–H therapy more com-
prehensible to a diversity of practitioners. With its focus on the “givens”
of existence—death, freedom, isolation, and meaninglessness—and its
emphasis on relationship to negotiate them, Yalom’s perspective gave E–H
therapy a map. Maurice Friedman (1991a, 1991b, 1995, 2001), too, embel-
lished on this map with his evocation of Martin Buber’s (1970) I–Thou
philosophy. Like Yalom, Friedman emphasized “healing through meeting”
as the chief therapeutic wedge.

The Present Situation

By the 1990s, E–H therapy began yet another evolution in the form of
integrative methodology. In their 1995 book, The Psychology of Existence,
Kirk Schneider and Rollo May assessed the shortcomings of rarified forms
of E–H practice, along with proliferating managed care policies, and set
about to reinvigorate both. With the advent of E–I therapy (updated by

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 Summary

Schneider in 2008), Schneider and May drew inspiration from May’s orig-
inal, prophetic stance:

[E–H therapy] does not purport to found a new school . . . over

against other schools or to give a new technique of therapy . . . [but]
seeks rather to analyze the structure of human existence . . . which if
successful, should yield an understanding of the reality underlying all
situations of human beings in crisis. (May, 1958b, p. 7)

Hence, by setting forth one way to coordinate a variety of therapeutic

modalities within an overarching existential or experiential context, E–I
therapy became a new bridge to both mainstream and existentially ori-
ented therapies. This new bridge offered fresh cross-fertilizations of
knowledge and expanded repertoires of practice; it has also received very
favorable assessments by mainstream researchers (Wampold, 2008; Wolfe,
2016). As a result, today’s E–H therapy has for many become an integra-
tive therapy, affecting diverse clinical and socioeconomic needs (Shahar
& Schiller, 2016a).

Increasing Research Support

for E–H and E–I Therapy
As can be seen in Chapter 5 of this volume, there is a striking upsurge in
empirical support for E–H therapy. Studies from therapy outcome to neu-
rology, from clinical training to psychiatric care, show convincingly that
E–H therapy is on to something critical for the viability of our profession.
This critical factor appears to be associated with the personal and inter-
personal dimensions of therapy—presence, experiential encounter, and
mobilization of will. Without these dimensions—incidental or intended—
healing is compromised. With them, instead, healing is facilitated.
Recent research, moreover, shows that personal and interpersonal
factors, not therapeutic techniques, are primarily responsible for positive
therapeutic outcome. To the extent that these factors are at the core of
E–H practice, we propose that students who have specific training in E–H
therapy will likely be more capable of effecting therapeutic change.

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 EXISTENTIAL–HUMANISTIC THERAPY

The outlook for E–H and E–I therapy is encouraging but guarded. In
addition to developing integrative modalities, E–H therapy is also fostering
new relationships to the world. For example, the Existential–Humanistic
Institute (EHI) and the International Institute for Humanistic Studies, both
in the San Francisco Bay Area, are disseminating E–H practices to a grow-
ing regional and worldwide audience. Among the countries benefiting
from trainings by these institutes (or their instructors) are Russia, Lithu-
ania, Poland, Greece, Turkey, Japan, and China (the first major U.S.–China
existential therapy conference took place in April 2010). Younger E–H
theorists, such as Louis Hoffman and Mark Yang at Saybrook University;
Shawn Rubin, 2016–17 president of the Society of Humanistic Psychol-
ogy (Division 32 of the American Psychological Association); Nathaniel
Granger at Saybrook University; Sarah Kass at Mercy College; and Alicia
Trotman at St. Francis College have been actively introducing students to
fresh and diverse E–H practice philosophies, and women such as Orah Krug,
Elizabeth Bugental, Eleanor Criswell, Molly Sterling, Fraser Pierson, Caroline
Mardon, Ilene Serlin, Theopia Jackson, and Myrtle Heery have long been
advancing a new feminist sensibility in E–H theory and practice.
Finally, there is no end to the E–H practice philosophies being applied
today, and the surge of energy around this approach is palpable. One
example of this trend was the 2012 launch of the first (to our knowledge)
formalized certificate program in E–H therapy in the United States. This
program, Foundations of Existential–Humanistic Practice, was developed
by the EHI and cosponsored by Saybrook University, a leading graduate
school in E–H theory and practice. A second example, founded by former
EHI board member Bob Edelstein, is the Existential–Humanistic North-
west in the Portland area, which offers training and conferences to a grow-
ing community of therapists in the Pacific Northwest. A third illustration
is the advent of The Living Institute, a 3-year training program in Toronto,
Ontario, Canada, leading to a diploma in existential–integrative psycho-
therapy. A further example of the surge of energy around E–H therapy
globally is the new World Confederation for Existential Therapy, which
emerged from the first World Congress for Existential Therapy in London,
England, in May 2015, at which the authors of this book played a key role.

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 Summary

We and many E–H therapy contributors will also likely participate at the
second World Congress of Existential Therapy slated for Buenos Aires,
Argentina, in May 2019. There is also a new volume in preparation, The
Wiley World Handbook of Existential Therapy (van Deurzen, Craig, Längle,
Schneider, & Tantam, in press), authored by many of the E–H and other
existentially oriented theorists previously mentioned, which promises
to bring E–H and related perspectives to an increasingly broad reader-
ship. (See also Hoffman, Stewart, Warren, & Meek, 2009; Hoffman, Yang,
Kaklauskas, & Chan, 2009; and Krug & Schneider, 2016, for comprehensive
overviews of existential psychology’s diverse and growing influence.) That
said, it remains to be seen whether and how E–H advocates will be received
in the coming years given societal trends. Although these trends show signs
of increasing openness to E–H and E–I sensibilities, they also, as noted in
Chapter 6, show signs of quashing those sensibilities or converting them
for expediency.

Conclusion
To achieve the aims of E–H and E–I therapy, practitioners draw on a variety
of means. These means, however, are not techniques in the classical sense;
they are stances (or conditions) through which experiential liberation and
profound transformation can take root. Among the core intertwining and
overlapping E–H stances are the following: the cultivation of therapeutic
presence (presence as ground); the cultivation and activation of therapeu-
tic presence through struggle (presence as method and goal); the encoun-
ter with the resistance to therapeutic struggle; and the coalescence of the
meaning, intentionality, and life awakening (awe) that can result from the
struggle. Although E–H therapy converges on these themes, their expres-
sion and the manner in which they are facilitated are contextual. Each ther-
apist, and therapist–client pair, must rediscover what is optimal, and each
moment can signal what can be optimized. This is the art—and emerging
science—of contemporary E–H practice.

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 Appendix A
Short-Term Case 2: Hamilton

T he following case draws on Kirk Schneider’s (2008) existential–

integrative (E–I) approach to therapy. E–I therapy coordinates a variety
of therapeutic approaches (e.g., physiological, environmental, cognitive,
psychoanalytic, experiential) within an overarching existential or experien-
tial context.
E–I therapy is exemplified in Schneider’s work with Hamilton,
a 28-year-old, White, married salesperson with acrophobia, a fear of
heights. Although Hamilton had a circumscribed concern, acrophobia,
and was mainly interested in “curing” that concern within the parameters
of his 16-session HMO plan, he was also open to finding out more about
his life and the potential connections that could be made for his overall
health.
In deference to Hamilton’s main focus, but also acknowledging his
openness to exploration, I worked with him along an interweaving path.
On the one hand, I worked with him to alleviate his phobia, and on the
other, I assisted him to be present to spontaneously emerging material.
This stance is not atypical for existential–humanistic (E–H) practitioners.
With clients who exhibit well-delineated problems, E–H practitioners find
ways to address those problems while remaining open to the deeper con-
texts within which those problems arise (e.g., Wolfe, 2008).
In Hamilton’s case, I explained to him my interweaving approach and
contracted with him to begin the process with a modified application of

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 appendix a

systematic desensitization and in vivo exposure. This kind of prepara-

tory communication (or psychoeducation) is often helpful, particularly
within brief formats, to mobilize clients’ capacities for change (J. F. T.
Bugental, 2008). It is also helpful within such settings to set relatively
clear objectives and to confine expectations to realistic parameters (J. F. T.
Bugental, 2008). In accord with this latter axiom, I proceeded cautiously
with Hamilton, neither overestimating nor underestimating his ability to
deepen therapeutic awareness.
Put another way, I attempted to remain as attuned as possible to
Hamilton’s desire and capacity for experiential change, or change that
is felt and lived, not just adopted. The desire and capacity for change,
in my view, are a key bellwether of integrative existential practice. It
has two basic functions: (a) It signals to therapists when and with what
degree of intensity clients can be therapeutically engaged, and (b) it
guides therapists in the selection of appropriate liberation conditions
for those engagements. Among the liberation conditions available are
nonexperiential modalities, such as those of cognitive behaviorism;
semiexperiential modalities, such as those of psychoanalysis; and expe-
riential modalities, such as those associated with existential humanism
(Schneider, 2008).
Within our desensitization–experiential focus, I interwove all three
liberation conditions with Hamilton. Given his desire and capacity for
delimited change, I emphasized the cognitive–behavioral offering but
weaved in and out, as warranted, with both semiexperiential and expe-
riential offerings, challenging him to deepen his newly conditioned
responses.
We began our work, accordingly, with a discussion of and prepara-
tion for systematic desensitization. Gradually and at his pace, I assisted
Hamilton to develop an anxiety hierarchy and to pair deep relaxation with
ever-intensifying visualizations of his phobia (Wolpe, 1969). Hamilton
began the exercise with a visualization of waking up on the day he
was about to climb the steps of a tall building (a feat he had recently,
but unsuccessfully, attempted). Next, I assisted him to pair relaxation

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 appendix a

(diaphragmatic breathing) with that very first image. After he was able
to fully relax into that image, I then helped him pair relaxation with a
visualization of himself approaching the target building. We then worked
with his entrance into the building, and so on.
After about 3 weeks, we were ready for the next critical encounter
with his anxiety hierarchy—the visualization of his ascent to the top of
my building, about five stories high. We delicately approached this stage,
which we both knew he would attempt to enact, by combining systematic
desensitization skills with periodic explorations of his anxiety. Hence, as
the moment warranted, I would gently invite Hamilton not just to report
about his feelings as he was visualizing, say, climbing the stairs to the
fifth floor landing, but to stay present to those feelings and to associate to
related feelings, sensations, and images as they arose. At times this exer-
cise yielded minimal responsiveness from Hamilton, but at other times,
he expressed vivid and bountiful impressions, from a childhood stumble
on a playground to a shaky moment on a bridge. But the percepts became
even more subtle.
On one occasion, for example, he envisioned a churning in his stom-
ach area, which then led to a memory of sitting with his grandmother
when he was very small. The details were sketchy, but what he remem-
bered most was that his grandmother was sobbing and his mother was
deathly ill. He also remembered feeling utterly alone in that moment and
terrified that he would be abandoned. I invited Hamilton to stay present
to that moment and see what other feelings, sensations, or images might
emerge. His face reddened and he began to tear up. Fear was his main feel-
ing, and the sense that he could not fill the hole of his parental longing,
his sense of being left.
After encouraging Hamilton to stay with his painful affects for a
period, he was able to enter a renewed, if temporary, sense of solidity.
At this point we agreed to continue working with his anxiety hierarchy
and gradually progressed toward his target goal. We spent a number
of other sessions on similar shifts between desensitization conditioning
and periodic explorations of affect. We talked about emergent material

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 appendix a

and worked with him to stay present to the here-and-now experience of

that material. In time, and at the point when we both felt he was ready, I
accompanied Hamilton up the five flights of stairs to the top of the well-
secured and accessible landing. I frequently checked in with Hamilton as
we ascended and provided him with ample moments to stop and practice
his breathing exercises. To our mutual gratification, Hamilton felt surpris-
ingly positive at virtually each point along the ascent. When we arrived at
the top, I checked in with Hamilton one more time and suggested that he
practice his relaxation response. He did so and then raised his head to the
level of the vista spread out before us. Slowly and somewhat anxiously,
he began to survey the scene. As he did so, I checked in with him about
his experience, which was generally quite stable. Over time, we made
five ascents to this landing, and each one became progressively easier for
Hamilton. In between ascents, we would continue to integrate desensiti-
zation with here-and-now exploration and would embellish on this regi-
men, though in modified form, at the top of the landing.
After each trip up the stairs, we would return to the consulting room
and debrief. Hamilton and I agreed that after 16 weeks, he underwent a
significant transformation. Not only was he freer to ascend heights, both
in my building and in his life in general; he was freer with his feelings and
his ability to communicate. By the time we ended therapy, it seemed to
me—as well as to Hamilton—that he had assimilated parts of himself
that he had long shut away and that cultivating presence seeded a new
intrapersonal relationship. He seemed to feel more centered in himself
and less edgy, more aware, and less threatened. It also seemed that the
groundlessness that Hamilton experienced as a child and that still clearly
reverberated in his life bore a significant relationship to his anxiety on
steep physical structures. Although systematic reconditioning removed
some of this anguish, working with him to “reoccupy” himself, to live
through his most dreaded recollections, appeared to add a fresh dimen-
sion. This dimension was evident as a general sense of robustness in his
life. He gained more energy, became more decisive, and felt more assured.
It was as if he “grew up” a very young part of himself during the course of
our brief work. Both literally and figuratively, he became a larger presence,
and that presence had salutary effects.

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 appendix a

In closing, although Hamilton made critical gains over the course

of our EI work, it is not at all clear how long those gains would endure.
The most E–H therapists can say about shorter-term mediation is that it
can provide a highly beneficial tool or staging ground for continued life
growth (J. F. T. Bugental, 2008; Galvin, 2008). The question as to whether
this growth can be sustained by the client or will require adjunctive facili-
tation is a function of both the depth of the client’s suffering and his or
her means or capacity to maximally redress that suffering.

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 Appendix B
Phases of Change in a Typical
Long-Term Existential Therapy

W hat follows is a model developed to help explain how and why

E–H therapists focus on the unfolding process to cultivate intra-
and interpersonal presence.1 This model arbitrarily divides the therapeu-
tic journey into three phases, although in reality the journey is never as
linear or concrete. Therapy is, in fact, a circular and reiterative process.
Accordingly, in approaching this model, remember that the model is not
the experience, but simply a crude attempt to abstract the complex and
vital experience of the therapist and client. Each phase of change describes
(a) the ways in which the client is typically present, (b) the therapeutic
goal, (c) the problem and challenge, (d) the process to resolve the problem,
and (e) the typical outcome.

Phase One
Typically present: Anxiety
Goal: To develop an intimate therapeutic relationship and to help the client
have “I am” experiences; that is, “I am aware that I exist and that to some
extent I am willing to take responsibility for the life that I have.”

1 The structure of this model is based on several chapters in May’s (1983) classic text and on J. F. T.
Bugental’s (1978, pp. 92–100) phases of therapy, but mostly it is based on 30 years of therapeutic col-
laboration with my (Orah Krug’s) clients, whose courage to grow and change never ceases to inspire.
The phases of change are illustrated in Appendix C, which presents a case study of a client, Claudia.

127
 Appendix B

Problem: The problem is twofold: (a) Without a sense of safety and security,
the client will not be able to do his or her work, and (b) the client’s sense
of self is typically repressed, which results in a constricted and/or frag-
mented sense of self. Anxiety signals that adjustment is breaking down.
There exists in the client a potential for reconstituting her or his sense of
self and world if the therapist can create a safe and intimate therapeutic
relationship.
Process: The therapist encounters the client with deep presence and empa-
thy, focusing on both intra- and interpersonal dynamics and attending to
the client’s concrete ways of being and relating, such as her or his posture,
voice, behaviors, and assumptions. The intention is twofold: (a) to create
a safe and intimate therapeutic relationship and (b) to illuminate what
is immediate but unnoticed in the living moment. The cultivation of
intra- and interpersonal presence is essential to help the client identify
her or his blocks or life-limiting patterns of behavior that function to
keep the client safe but that are ultimately restrictive. The therapist
may use dreams as well as spoken metaphors to further facilitate this
process.
Outcome: The client, feeling safe, takes a more active stance in therapy,
becomes more engaged in the therapeutic process, and assumes appro-
priate responsibility for creating her or his life-limiting patterns of
behavior. The client experiences a limited amount of personal freedom:
“I can choose how to be.”

Phase Two
Typically present: Willingness: The client feels sufficiently safe and secure
in the therapeutic relationship; client and therapist are an effective
collaborative team.
Goal: To discover deeper levels of “I am” (intentionality) to effect real and
lasting change.
Problem: “I am” experiences are only the prerequisite for change. The client
needs to move from awareness and responsibility to action. A client’s
awareness of her or his intentionality is usually needed for this to
happen—that is, “I understand that I continually create meanings

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 Appendix B

about my self and my world, I make choices based on these meanings,

and I act accordingly; therefore, ‘I am.’”
Process: The encounter is focused primarily on illuminating deeper levels
of subjective experience, often using dreams and the searching process
for this purpose. The focus is on removing the blocks interfering with
the ability to wish, want, and act.
Outcome: The client is more conscious of her or his intentionality. There
is increased willingness to face existential givens and an increased desire
for meaning and purpose. The client experiences an expanded sense of
self through action. She or he is in the process of reforming a sense of
identity, of self and world.

Phase Three
Typically present: Creativity: The client experiences expanded self and
relational presence.
Goal: To fulfill the evolutionary task of creative engagement; to dissolve
the client’s blocks or life-limiting patterns so that the client can realize
greater possibilities and have a deeper sense of meaning and purpose
in her or his life.
Problem: Expanded consciousness and expanded sense of self are only the
first of a two-part process. The second part involves creatively engaging
in the world. The client needs to actualize her or his potentialities within
the givens of her or his life.
Process: The therapist supports, cultivates, and nurtures newly emerging
self-actualizing attitudes, behaviors, and actions, working with the client
intra- and interpersonally to focus on blocks or barriers to enacting
potentialities.
Outcome: The client has expanded consciousness, expanded sense of self,
and self-actualizing experiences. The client experiences a greater capac-
ity to love and work. The client can creatively engage in her or his life
with meaning and purpose.

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 Appendix C
Long-Term Case 2: Claudia

W hen a new client walks into my therapy room, I (Orah Krug) am

often aware of the fact that neither of us has any idea of what
paths we will travel or how long our journey will be. That, for me, is one
of the fascinating aspects of this work.
When “Claudia” walked into my office, I could not have foreseen the
intense and challenging path on which we were about embark, a path that
would significantly affect our lives and change us both. Fifteen minutes
into our first session, however, Claudia gave me a clue about what the focus
of our work would be. She looked right at me for the first time and seemed
to search my face for an answer to her question, “Are you the one I can trust
to help me?” It has been suggested that a client reveals all of her or his issues
in the first hour. As an existential therapist, I essentially accept that premise,
assuming as I do that the past is alive in some way in the present moment.
As she searched my face, Claudia seemed to be saying, “I want help, but I’m
afraid to trust.” At the time, I did not know the full extent of her desire to
be known and her fear of that happening. We came to understood that her
conflict was both intra- and interpersonal in nature, one that we would
revisit many times throughout our work together.
Claudia came to therapy ostensibly to decide if she should move for-
ward in a relationship with a man with whom she had been living for several
years. At the time, Claudia was 29 years old, single, recently unemployed,
and uncertain about her career path. She was financially independent as

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 Appendix C

a result of a substantial trust fund set up by her mother and father, who
owned a successful commercial real estate company in the South. Unlike
her two younger brothers, who worked in the family business, Claudia
showed no interest in following in her parents’ footsteps. In fact, Claudia
seemed as lost with respect to what she wanted to do in her life as she was
about her relationship.
In the first few sessions, I noted that Claudia’s “lostness” was related
to her lack of connection to her inner experience. This manifested in sev-
eral ways. She typically observed herself from the outside, treating herself
like an object to be analyzed. She talked very fast and low as if she really
didn’t want me to hear what she was saying. At the start of each session,
she would curl her petite frame into a ball on my couch, remaining that
way throughout, looking rarely at me but out the window. This is why in
our first session, when she unexpectedly searched my face for an answer
to her question, she caught my attention. She had difficulty making “I”
statements and typically talked about herself in the third person, carefully
editing everything she communicated and often laughing afterward to
diminish the impact of her statement.
Her trust issues emerged more concretely in our second session as she
related how her first great love had abruptly left her without any expla-
nation. She was hurt and confused by his actions and had had difficulty
trusting other men’s expressions of love and affection since then. I asked
her if she was generally mistrustful of people’s intentions. She hesitated
and then looked at me and nodded yes.

OK: Perhaps you’re aware of having difficulty trusting me right now?

[Claudia nods.]
OK: How is it to tell me this?
Claudia: I’m afraid I’ve hurt your feelings.
OK: Do you want to ask me something about that?
Claudia: [gathering her courage] Have I?
OK: Not at all. Most people have difficulty trusting their therapist when
they begin. I know I did. After all, you don’t know me yet. I must dem-

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 Appendix C

onstrate my trustworthiness to you. Our goal is to build a relationship in

which you feel safe and accepted. This takes time because it takes time to
build trust.

Claudia seemed to relax after hearing this. A little later I had an

opportunity to share with her my understanding of our collaborative
effort. I told her it means that I will often focus on our relationship, as
I did earlier, to find out what is happening between us. I asked her if
this way of working was OK with her, and she said yes. Phase 1 of our
therapy had begun, as I focused Claudia on our relationship and created
opportunities for her to be present to herself and present to me in our
relationship.
We met once a week for about 1 year. During that time, I attempted to
have Claudia experience the ways in which her “lost” feelings were perpet-
uated by her constant self-analysis. When I tried to teach her how to slow
down, make space, and search within, she became agitated or reported
that there was nothing there. She was clearly uncomfortable connecting
subjectively. She was in her comfort zone when reporting about herself as
a neutral, outside observer. She could talk about feeling stupid and unlov-
able but never allowed herself to experience those feelings in the moment.
It seemed imperative that she keep herself disconnected from her feelings
so that she wouldn’t know in an experiential way that something mattered
or that she hurt.
When she was not being neutral, she was being critical. Her harsh
internal critic constantly berated her for not doing something right.
For example, she was mad at herself for always yielding to her boy-
friend’s wishes, but she felt unable to change, believing as she did that
he would leave and there would be no one else because she was such
a loser. It struck me that Claudia’s voice was like a harsh prison guard
speaking to an unruly prisoner. My mirroring that back to her didn’t
seem to help her silence the voice, no matter how many times I pointed
it out.
Something was obviously blocking Claudia from being compassion-
ate with herself and from believing in her worth and value. As Claudia

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 Appendix C

revealed her family history, I began to understand why. Claudia’s fam-

ily looked great on paper—an intact, churchgoing family whose parents,
Charles and Renee, were fabulously successful business partners as well as
marriage partners. But behind the scenes, things were less rosy. Charles
was a distant and domineering husband and father. He ruled the house-
hold as he ran his business—demanding perfection and instilling fear in
those around him. He was quick to anger and would verbally and some-
times physically abuse his children. Renee once confided to Claudia that
she knew he’d had a number of affairs, but as she told her daughter, she
kept quiet because she was afraid he would leave if she confronted him.
Renee presented a picture of a powerful and successful businesswoman.
But Claudia sensed her mother’s unhappiness and insecurity. Claudia
tried to be a “good girl,” hoping this would make her mother happy and
keep her under her mother’s radar. But Renee was not maternal and had
little patience for her children.
To say that as a child Claudia’s feelings, wants, and wishes went un-
acknowledged would be a huge understatement. Outwardly, her child-
hood was a dream come true—a beautiful home, lots of clothes, and the
best schools—but inwardly there was little to nurture her. Claudia grew up
feeling unloved and uncared for, lonely and scared. Moreover, she consis-
tently questioned her talents and abilities because they went unnoticed by
her parents. But I still wondered after a year of therapy why Claudia was
so disconnected from her feelings.
She had made some progress that year; she decided to break up with
her boyfriend, even though it scared her, and she began to explore what
she really wanted to do in her life. Shyly she told me about her passion for
art and photography. As a child, she walked around with a drawing pad
and pencil in hand, sketching everything in sight. At age 14, she bought
a camera and began taking photo portraits of friends and people on the
street. Although she loved her creative side, she constantly shoved it to one
side, telling herself she wasn’t good enough to make a career of it. Neither
of her parents valued her talent, although many teachers recognized it and
vigorously encouraged her to pursue it. Instead, she did as her parents
wanted. She majored in business, with a minor in art, and then got her

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 Appendix C

MBA. After graduate school, she worked at a large company for 2 years
but disliked the corporate environment and the work.
Even though she knew she didn’t want to work in the corporate world,
she nevertheless had great difficulty imagining that she could have a career
in a more artistically oriented world. Her dream was to be a portrait photo­
grapher, but she had difficulty sharing her artistic desires, hopes, and
dreams with me. Each time she tried, her critical voice would pounce,
mocking her dreams as a waste of time and reminding her of her lack of
talent. Her critical voice kept her from even opening to, much less believ-
ing in, the possibility that she could be a successful photographer. I knew
that I needed to ally myself with the part that was struggling to emerge.
One day she asked if I wanted to see some of her work. Seeing it, I immedi-
ately understood why she had received so much encouragement. Unfortu-
nately, her magnificent talent was buried under a barrage of self-criticism
and self-doubt.
A dream early in our work highlighted her fears of revealing herself
to me and to herself. In the dream, Claudia was in a crowded restaurant
eating breakfast alone. Suddenly, a piece of bagel got lodged in her throat.
She couldn’t use her voice to cry for help, and she knew that if she didn’t
“get it out,” she would die. As we worked with the dream, Claudia confided
to me that she was afraid I would see her as weak and needy. I told her that
I sensed that she was hurting and afraid of hurting even more and that
it was very scary to have me know this, even though a part of her really
wanted me to know.
My expression of her ambivalent attitude at first relieved her but
then, not surprisingly, scared her. Although she wanted me to know her,
she was certain that if I really did, I would find her damaged and unlov-
able core and leave. I sensed that her projection about me reflected an
internal conflict within herself. Indeed, that proved to be true. Claudia
was afraid that whatever she found out about herself would be too much
to bear—so bad, in fact, that she feared it would kill her. But to abandon
the search meant a continuation of her misery. Of course, I didn’t know
this at the time, but as the therapy progressed, it became clearer that the
stakes were that high and that Claudia’s conflict tied her in knots. Time

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 Appendix C

and again, when Claudia felt seen by me, she would clam up. Her silence
was her attempt to wall off her inner self—not only from me, but more
importantly from herself. I knew I had to go very slow and respect her
protective patterns.
Claudia revealed another dream one day. In it she asked me if she
could come twice a week, and I said no. She told me that I said no
because I believed that nothing was really wrong with her. The dream
revealed Claudia’s inner confusion as to whether she was really OK and
only creating problems or whether there really was something wrong.
Again she externalized it onto me. In the dream, I confirmed one side
of her fear—that she was making mountains out of molehills. The
other side of her fear was that she was so damaged, there was no hope.
I recognized this as she shared the dream and consequently responded
carefully:

OK: In your dream, I think that there’s nothing really wrong with you. Do
you want to ask me what I really think?
Claudia: [looking fearful but determined] Yes, I do. Do you think there’s
something wrong with me?
OK: Let me put it this way. I see your fear and sense your hurt and pain,
even though it seems you don’t know much about it yet. I don’t think
you’re making anything up. I think you’re wanting to come more often
because you’re feeling scared about something—perhaps you know what
you’re scared about and can’t tell me yet, or perhaps you just feel fear and
don’t know much more than that. Whatever it is, I think coming more
often is a good idea. Hopefully getting together twice a week will help you
feel safer and less scared.
Claudia: [after smiling and letting out her breath] Thank you. I’m glad
you’re OK with meeting more often, but now that I’ve asked, I’m scared
of what I’ve gotten myself into.

We began meeting twice a week and about 6 months later increased

our meetings to three times a week. This began after Claudia started

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 Appendix C

having disturbing nightmares and memories of her father sexually abus-

ing her when she was little. Claudia’s memories were triggered after she
was given anesthesia for a tooth extraction.
Her nightmares and memories terrified and disturbed her, so much
so that Claudia couldn’t share them with me. Even so, I could see that she
was upset and trapped in her silence. She tried to tell me by canceling
appointments, saying “I just can’t do this today.” Being of the mind that
a client has that choice, I at first didn’t call her back. This, I soon learned,
was a mistake. When she didn’t receive a call, she assumed either that I
didn’t care about her or that she was fine.
After several reoccurrences of this pattern and some discussion with
her, I finally understood that Claudia needed me to reach out to her at
these times, even if she insisted she was fine, because she was too trapped
behind her wall of fear and shame to reach out to me. I wish I had been
able to understand what Claudia needed sooner. I’m afraid that early in
our work I failed Claudia all too often. It was a combination of her deter-
mination to keep me at arm’s length and my difficulty in appreciating
her inability to cope with the material emerging in her nightmares and
memories. I guess I was sufficiently empathic with Claudia during this
time; she gave me many chances to learn what she needed. As I did, her
trust in me grew.
Our work continued for several years in this way, some disclosure
and trust building, then silence. We seemed to be in a holding pattern. I
continued to ally myself with the side of Claudia that wanted to emerge,
patiently holding steady when the other side slapped her down or terri-
fied her. Because she couldn’t speak about her memories and dreams, she
coped with her terror and pain by cutting her legs. One day she admitted
to cutting; she said it had scared her so much that she wouldn’t do it again.
But she did do it again and then again. She seemed to feel at this point that
she had crossed a line, which meant she no longer could tell me about it.
When finally I guessed, she was visibly relieved that I saw through her wall
of silence. After some wrangling, she agreed to call me if she felt the urge
to do it again. I suggested that she continue to come more frequently and
told her not to hesitate to call if she felt in trouble. I began reaching out to

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her in between sessions just to let her know I was there for her. Sometimes
she would call, asking to come in for another session, but once there, she
would be unable to speak. She would try but then would stop, locked in
silence, staring out the window.
Working with Claudia was extremely difficult for me during this phase.
I am grateful that my consultation group was able to give me support and
helpful feedback because Claudia’s silence made it difficult for me to gauge
the level of her despair. I feared she might hurt herself or worse. Several
times when things got critical, I shared my fears and sense of helpless-
ness with her. Twice I insisted that if she didn’t tell me what was going on,
I would have no choice but to hospitalize her. Setting those limits both
relieved and contained her. She always responded by letting me know what
her pain was about. It wasn’t just Claudia’s silence that often created dif-
ficulty for me. Her negative transferences (projecting onto me her angry
and intrusive father or her oblivious mother) sometimes challenged me to
remain steady. Often suspicious and vigilant, she scrutinized every gesture
and inflection of mine for signs of rejection, judgment, or betrayal. At
those times I felt under a microscope, sometimes frustrated by her inabil-
ity to encounter me and not her ghosts. I knew that what she needed most
was my steadiness because that would help her see me, trust in me, and feel
secure in knowing that I would not desert her under any circumstances.
My stance, sometimes verbalized, sometimes implied, was “I’m here, I care
about you, and we will get through this together. Your silence and vigilance
exist to protect you. It isn’t going to push me away or make me mad. It’s
safe to open the door and let me in.”
At times she was able to tell me about her memories and nightmares.
Most would involve her father coming up to her room when she was a
little girl and hurting her either sexually, physically, or emotionally. She
struggled to express the nightmares and memories, asking me occasion-
ally to sit next to her, which I did. I tried to help her separate from the
memories using the modified eye movement desensitization and repro-
cessing technique (Shapiro, 1998; see also Chapter 4 of this volume). I sug-
gested that she view her memories as if she were on a train and they were
the scenery passing by. I said things like, “Watch them go by as if watching

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the scenery on a train, Claudia. You’re safe here with me.” Sometimes
this helped her stay present, but so often she couldn’t and disconnected
from her memories and me. All I could do then was remind her of where
she was, hoping that she could hear me. These sessions would often be
followed again by silence. She feared disclosing the nightmares, which
confirmed a damaged self to me and to herself. She knew she was caught
in a dilemma. She was afraid to trust and tried to keep me out, but when
she did, she got scared because the “it doesn’t matter” voice, which was in
place to protect her from the pain, was reckless: When it was in charge,
she cut herself.
Claudia’s battle, personality characteristics, and protective mecha-
nisms were similar to those of many adults who suffered sexual and emo-
tional abuse as a child. I believe that existential therapy, with its emphasis
on personal and relational presence, provides survivors of sexual abuse
with an extremely effective healing milieu. Fisher (2005) effectively elabo-
rated on this perspective. Like Claudia, adult survivors of sexual abuse
feel damaged, disconnected from themselves, and mistrustful of others. As
Claudia opened up to herself and to me for the first time, the early trauma
was reactivated.
Claudia faced several challenges at the same time. First, she was chal-
lenged to incorporate a heretofore subconscious aspect of herself as an
incest survivor into her sense of self. It directly countered her “I am tough
and strong; you can’t hurt me” persona. Second, she had to acknowledge
not only her father’s anger toward her but now his outright abuse of her.
Third, she was challenged to trust me. Although she wanted my help, she
struggled with letting me get close. She feared that if she revealed herself
to me, I would leave like everyone else. Finally, she felt so damaged that
she couldn’t believe that a better life was possible for her. Death was a
back door that ironically allowed her to live another day. She knew how
dangerous this thinking was but held on to it for a long time. When she
finally let it go some 3 years later, she had, to some extent, incorporated
her four challenges to accept her identity as an incest survivor, to accept
her father’s abuse, to trust me more, and to believe in the possibility of a
better life. Even more important was the fact that in choosing life, she had

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closed the door on death as a way out of her misery. This marked the end
of Phase 1 of our therapy. What follows is a condensed version of the events
in this pivotal period.
Claudia told me about her decision to live after the fact, when we
resumed our work following a 2-week Christmas break. She told me she
had fully intended to kill herself over the break. A job as photojournal-
ist with a travel magazine fell through, and her attempts to develop her
photography business were proving difficult. She felt unable to get any
traction in her life despite all her efforts, and on top of it all, she was still
alone. She was devastated. She believed that nothing would change. But
something did change for her when she actually faced death. She realized
she could do it, that she could choose to die, and with that realization, she
chose instead to live. In that moment, she began to accept her identity as
a survivor and all of life’s challenges.
One particular question that challenged Claudia soon after the afore-
mentioned incident was, “Who am I going to be now?” Claudia’s question
highlights the functionality and tenacity of our self and world constructs.
Although they limit us, they also serve to shape our sense of identity. We
typically feel notably shaky when we choose to shed some of the old con-
structs and create new ones. This was my challenge in Phase 2—to help
Claudia forge a new sense of self that acknowledged the past but held hope
for the future. Our therapy was radically different in this phase. With our
therapeutic relationship stronger, Claudia felt safer in it and more trusting
of me. In Phase 2, a client’s anxiety is often replaced by willingness. This
was true for Claudia, although she still experienced significant anxiety.
But because she trusted me more, she was able to express her feelings
more easily. When she got scared and put up a wall, she could speak from
her fears and mistrust instead of acting them out. For the most part, she
experienced me as her ally and not her enemy, and when she did see me
as the enemy, we worked through it. She was challenged in this phase to
incorporate her sense of herself as an incest survivor, to face her hurt and
anger toward her parents, to begin to love herself, and to experience her-
self as lovable, talented, and competent. Our work focused on the ways
in which she blocked herself from these aspects of herself—her belief in

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her damaged self, her fear of failure, her mistrust of others, and her cruel,
harsh, and demanding voice that often ran the show.
This phase lasted several years in which she worked very hard to accept
her past, to be present in the moment, and to develop a future. We worked
with many dreams and memories. She struggled to experience her feelings
and to express them in the moment. When she disengaged from her feel-
ings, talking in the third person, I encouraged her to make “I” statements.
She still edited her thoughts before speaking and often struggled not to
feel something if she didn’t know what it meant. I tried to help her accept
her feelings and to express her wants and wishes.
She decided at some point to tell her mother and her siblings about
the sexual abuse. None of them believed her, with the exception of one
brother. She had hoped her mother and brothers would embrace her, but
instead they either denied it or, in the case of one brother, told her to just
put it in the past. It was a very painful time, full of anger, self-doubt, and
despair. But she weathered it bravely. She continued to paint and take
photographs, which gave her a constructive outlet for her pain. At the
same time, she decided to enroll in an art therapy program to learn how
to use such therapy with sexually abused children. By the end of this phase,
Claudia was experiencing herself as much more than a damaged loser. Her
photography business was taking off, and she was working as an art thera-
pist with children at a local hospital. She met and began to date Garth, a
very good man whom she liked and trusted. The end of this phase was
marked by a pivotal session, abbreviated here:

Claudia: [looking drawn] I just want to take a break. [Tears stream down
her face, and she struggles to hold them back. I mirror back her struggle not
to feel.] I just don’t know what it means. There’s no reason for me to feel this
way. [She then begins to list all the good things that are happening to her.]
OK: When you shut the door on your feelings like you just did, you lose
the chance to find out what’s going on. Are you willing to leave the door
open for a bit? [She agrees, and I suggest that she let herself freely associate
to the phrase, “I just want to take a break,” trying not to edit, just letting
whatever is there to be spoken.]

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Claudia: OK. [Then slowly, being present to herself, she begins.] I just
want to take a break from my work. I just want to take a break from my
painting. I just want to take a break from my family. [With those words,
her tears start freshly flowing. Through her tears she says,] I’m tired of
thinking about them. I’m tired of wishing they would change. [She pauses
and then in a stronger voice says,] I’m tired of thinking about myself only
in that way [being abused by her father]. [She stops, and then looks at me.]
I don’t mean that I want to dismiss it.
OK: I didn’t hear that. I think you’re saying that you know that it’s a part
of who you are, but not all of you.
Claudia: [nodding] That’s it. I never thought I’d be saying that or feeling
that. It’s been such a long time—I am more than what happened to me.

The final phase of therapy, or Phase 3, is typically marked by a great

deal of creativity. This was certainly true in Claudia’s case. Within a num-
ber of years, Claudia was able to create a life of purpose, meaning, and
intimate relationships. She is still with Garth and has developed many
other intimate relationships. She has a successful photography business
and has continued to work with abused children, deriving great satisfac-
tion from this volunteer work.
But life has by no means been rosy for Claudia. She lost a close friend
during this time and faced and worked through significant fears triggered
by her increasingly intimate relationship with Garth. Not surprisingly,
even though she loved Garth, she occasionally projected her father onto
him. At those times she experienced him as angry, scary, and uncaring.
Then she reacted as a terrified little girl or as a rebellious teenager, imper-
vious to pain. Both stances protected her from her core fear and feeling
that Garth and everyone else would eventually go away because she was
damaged and unlovable.
It is so important to appreciate the tenacity of negative core beliefs.
They do not resolve easily. Resolution occurs through a reiterative pro-
cess that provides the client with multiple opportunities: first to be open
to their locked-away feelings and then to have a corrective experience of
them. Claudia and I became quite familiar with this reiterative process. But

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working with her core issues in Phase 3 was quite different. Unlike earlier
in therapy, now Claudia recognized what was happening. She wasn’t as
caught in it as before. She could step back and experience coming from her
little girl place or from her rebellious teenager place. She recognized them
now as two patterns of being, each trying to protect her from the pain of
being unlovable.
A brief exchange between me and Claudia illustrates this point. Late
in a session, Claudia assumed her rebellious teenager stance, unwilling to
talk further about a recent exchange with Garth—sure in that moment
that Garth wouldn’t take her needs into consideration and would eventu-
ally leave like everyone else.

OK: The 13-year-old seems to be running the show right now.

Claudia: It’s easier to feel hate than feel pain. My 2-year-old trusted my
father, and then he turned on me.
OK: Can you try and let yourself open to what you’re experiencing right
now, instead of having the 13-year-old shut you down?
Claudia: [She takes several deep breaths, and slowly her expression
changes from anger to sadness. She turns and looks at me with tears in
her eyes.] I’m afraid to open to Garth. I’m afraid I’m too much to love.
[Her eyes fill with tears, and she turns away from me. She seems to be dis-
connecting from me and her painful feelings of being “too much to love.”
I mirror that back to her and suggest that she make eye contact with me.
She tries and then looks away again.]
Claudia: When I look at you, I feel like something bad will happen. [She
tries to maintain eye contact with me as she tells me this but can’t and looks
away again.]
OK: [softly and gently] And now you go away again. [I am silent and wait,
silently calling her back to be with me in our room.] Where are you now?
Claudia: [looking at me] I move away and I watch. [I smile at her, but she
quickly looks away. She falls silent again, but soon I notice something has
changed on Claudia’s face. Her sadness has been replaced by a smile.]

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OK: [noting her smile] What’s happening now?

Claudia: I’m sitting on a curb—I’m little, and you’re sitting right next to
me. I don’t have to do anything. [looking at me] You’re OK with me.
OK: Yes, I am, Claudia, very OK with you. [Our eyes, full of tears, meet,
and we grin at each other—no need for words now.]

In this significant session, Claudia and I revisited her fear of being too
much to love. First she went to the fearful, then sad place. But by allowing
herself to be present with me and not transfer “dad” experiences onto me,
she could experience me as I was: safe, trustworthy, and caring. With a
shift in her experience of me, she was able to experience herself in a more
accepting and loving way.
Slowly, over many years, Claudia shed her sense of self as damaged,
incompetent, and unlovable. Those feelings were replaced with feelings of
acceptability, lovability, and capability. At the end of our therapy, she told
me that what helped her most was knowing that I always believed in her.
She was right—I always did.

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 Appendix D
Summary of Experiential
Stances of the Existential–
Integrative Model

T he following is an outline of the experiential level of contact of the

existential–integrative (E–I) model as demonstrated in this volume
(see also American Psychological Association, 2009, and Schneider, 2008).

Overview
The ongoing and implicit questions of E–I therapy, at every point of the
work, are How is the client presently living? and How is the client willing
to live, in this remarkable moment, with this highly attuned witness? Put
another way, the general idea of E–I therapy is to assist clients to optimize
choice (freedom) within the natural and self-imposed (e.g., cultural) limi-
tations of living. These limits may emphasize one’s physiology, environ-
mental conditioning, cognitive capacity, range of affect, and so on. Choice
is characterized by the capacity to constrict and expand as the person and
situation demand. Although choice always entails will, it does not have to
be willful; it can, if a person is so inclined, reflect deliberate decisions to
give up one’s will or to stay present to that which impels one.
The client’s desire and capacity for change are the key determinants of
choice. Desire and capacity for change are derivative of clients’ and thera-
pists’ dispositions. To the degree that therapists are open and available to
clients for deeper contact, clients, too, may, within their unique parameters,
become maximally open and available. Generally, the greater clients’ desires

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and capacities for change, the more they can become present to themselves,
and the more they can “occupy,” that is, be present to, the denied sides of
their (self–world) existence. Through being present to the denied parts of
their existence, clients can discover themselves and roam within, as it were, to
live as richly, poignantly, and fully as the designs of their lives will permit.
The following are stances or conditions of the experiential (i.e., imme-
diate, affective, kinesthetic, and profound) level of contact within the
E–I model. (The experiential level of contact generally, but not necessarily,
follows the more programmatic non- and semiexperiential levels of con-
tact within the E–I model [see Schneider, 2008, for an elaboration]). These
experiential stances are discussed in rough order of priority.

Presence
Presence holds and illuminates that which is palpably (immediately, affec-
tively, and kinesthetically) significant within the client and between client
and therapist. Presence implies the question, What is really going on here
within the person and between the person and me? And how is the per-
son willing to live? Presence is the “soup,” the atmosphere within which a
struggle or battle becomes clarified.

Invoking the Actual

Invoking the actual is helping the client into that which is palpably signifi-
cant or charged. Put another way, it calls attention to the part of the client
that is attempting to emerge. Invoking the actual is characterized (though
not exhausted) by the following elements:

77 topical focus, as in questions such as “What’s of concern?”, “What really

matters right now?”, or “Where are you at?”
77 personal focus, as in encouraging “I” statements or statements in the
first person, staying present to what really matters at a given moment,
or giving a concrete example.
77 topical expansion, as in questions and invitations such as “Can you tell
me more?”, “Stay with that feeling for a moment.”, or “Try slowing down.”

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 Appendix D

77 attention to process as much as or more than content, as in attending to

the preverbal or kinesthetic way clients talk and hold themselves and to
their vocal fluctuations and breathing, and attention to process–content
discrepancies, such as “I hear your serious words, and yet you laugh.”
77 embodied meditation, or concerted attention to body sensations, often
accompanied by invitations to clients to place their hand on areas
noted, such as tension areas or areas that feel blocked, and by follow-
up invitations to associate any other feelings, sensations, or images to
these areas.
77 interpersonal encounter, or attention to charged themes in the living
therapeutic relationship, attention to process dimensions of themes,
pursuit and exploration of the associations to those dimensions, and
mutuality as facilitative of client self-exploration.

Put succinctly, invoking the actual holds a mirror up to how clients are
attempting to break through or liberate themselves from familiar but
dysfunctional patterns.

Vivifying and Confronting Resistance

(Protections)
Vivifying resistance is intended to alert clients about how they block pal-
pably significant material. Vivifying resistance is exemplified by noting
and tagging points at which clients diverge from or suppress emotionally
charged material. Confronting resistance, on the other hand, is intended to
alarm clients about how they block palpably relevant material. Confront-
ing resistance must be cautiously engaged. If confrontation is too harsh, it
can retraumatize clients; if it is ill timed, it can prompt destructive back-
lashes or, conversely, passive dependency. Both vivifying and confronting
help clients see close up how they construct their worlds and implicitly
challenge clients to make a decision about those worlds. Put another way,
resistance work holds a mirror to the side of the client that is attempting to
keep herself or himself in the familiar yet debilitating pattern of the past.
By implication, it builds the counterwill (or frustration) necessary for the
client to overcome her or his blocks.

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 Appendix D

Rediscovery of Meaning and Awe

As clients overcome the blocks to that which deeply matters in their lives,
they begin to develop new, more aligned life paths. These paths may take
the form of a new job, a project, or a relationship. But they may also grow
beyond specific goals to encompass the freedom to embrace life itself—in
all its stark possibility. This new relationship to life is often characterized by
awe—the humility and wonder or sense of adventure toward all that exists.
This adventure is the same that clients experience—albeit in embryonic
form—from the beginning of therapy. From the start, in other words,
clients learn to shift from abject terror to blossoming wonder—from
humiliation to audacity—and this template, as it were, forms the basis
for clients to experience awe: the maximal capacity to live. (See Schneider,
2004, 2008, 2009, for an elaboration on the rediscovery of awe.)

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 Glossary of Key Terms

AWE Humility and wonder before the bigger picture of living, often
attained by clients following the removal of blocks to their inner-
most sensibilities about life and their maximal ranges of experience.
The sense of awe is an increasingly recognized spiritual dimension of
intensive existential–humanistic practice and a vital context for the
optimal appreciation of life.
CLIENT’S BATTLE Client’s internal struggle between the part that
endeavors to emerge and the part that endeavors to resist or block
the emerging.
COMMITMENT Sense of “I-ness” or agency, or profound caring about
a given direction. It implies assumption of personal responsibility
and a sense that the life one chooses really matters to oneself and is
worth a full investment.
CONFRONTATION Amplified form of vivification of resistance;
instead of alerting clients to their self-destructive patterns, it alarms
them and presses for transformation.
CONSTRICTIVE–EXPANSIVE CONTINUUM Kirk Schneider’s under-
standing of personality functioning as a range within which humans

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 Glossary of Key Terms

have a vast capacity to “draw back” and constrict thoughts, feelings,

and sensations, as well as an equivalent capacity to “burst forth” and
expand thoughts, feelings, and sensations.
CULTIVATING AWE Therapeutic goal characterized by clients’ renewed
abilities to experience the fullness of their lives—their deepest dreads
as well as most dazzling desires—and their rejuvenated capacity for
choice.
CULTIVATING PRESENCE Therapeutic method and goal character-
ized by openness, engagement, and deep attunement to the unfolding
processes of both client and therapist with the intention of illuminat-
ing the client’s self and world constructs in the therapeutic encounter.
EMBODIED MEDITATION Concerted attention to body sensations,
often accompanied by invitations to the client to place his or her hand
on areas noted, such as tension areas or areas that feel blocked. Initial
invitations are often followed by further invitations to associate feel-
ings, sensations, or images to these areas of the body.
EXISTENCE Central focus of existential therapy, whose Latin root
ex (“out from”) and sistere (“to stand”) means “to stand out from”
or “become.”
EXISTENTIAL–HUMANISTIC (E–H) THERAPY Form of therapy
that emphasizes freedom, experiential (or whole-bodied) reflection,
and responsibility (or the ability to respond to one’s freedom and
reflection). E–H therapy, as described in this volume, refers broadly
to the U.S. version of existential therapy, which overlaps with other
humanistically oriented therapies but with an accent on struggle,
circumspection, and depth.
EXISTENTIAL–INTEGRATIVE (E–I) THERAPY Mode of therapy
inspired by Rollo May and James Bugental and developed by Kirk
Schneider that coordinates a variety of therapeutic modalities within
an overarching existential or experiential context.
EXISTENTIAL PREDICAMENT Major focus of existential psychother-
apy; refers to the fact that every person is aware of his or her existence
and consequently must cope in various ways with this awareness.
EXISTENTIAL STANCES Conditions through which experiential lib-
eration and transformation can take place. Existential–humanistic

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 Glossary of Key Terms

stances (intertwining and overlapping) include the cultivation of

presence (presence as ground), the cultivation and activation of ther-
apeutic presence through struggle (presence as method and goal), the
encounter with resistance to (or protections from) the therapeutic
struggle, and the coalescence of the meaning, intentionality, and life
awakening (awe) that can result from the struggle.
EXPERIENTIAL MODALITY Process embracing four basic dimensions—
the immediate, the kinesthetic, the affective, and the profound or
cosmic. The road to an expanded identity is to help clients experience
their polarized conditions, assist them to embody those conditions,
and attune to the nature of those conditions.
FREEDOM AND DESTINY Capacity for choice (freedom) within the
natural and self-imposed limits (destiny) of living. The challenge to
respond to these polarities is central to leading existential–humanistic
theorists’ conception of psychological health.
GIVENS Basic conditions of human existence. Yalom conceived of four
givens: death, freedom, isolation, and meaninglessness. The design
and quality of our lives depend on how we confront these givens. Tom
Greening understood these four givens as paradoxical dialectics that
present us with life challenges.
HUMAN-BEING-IN-THE-WORLD Existential–humanistic under-
standing of a person as related to his or her physical, personal, and
social worlds; sense of self or identity is formed as a result of this
interrelation of person and world.
“I AM” EXPERIENCE Rollo May’s phrase describing the experience of
identity formation, which includes the fact of awareness and the drive
to make meaning of it through an ongoing dialectical process between
the subjective and objective poles of reality.
INTERPERSONAL PRESENCE Capacity to be present to experiences,
feelings, and attitudes occurring between therapist and client that
are implicitly or explicitly unfolding in the present moment in the
therapy room; the terms interpersonal processes and intersubjective
processes are also frequently used in this regard.
INTRAPERSONAL PRESENCE Capacity to be present to inner experi-
ences, memories, feelings, and attitudes that are implicitly and explicitly

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 Glossary of Key Terms

unfolding in the present moment in the therapy room; the terms intra-
psychic and subjective also connote the intrapersonal realm.
INVOKING THE ACTUAL Helping the client into that which is palpa-
bly relevant or charged to call attention to the part of the client that is
attempting to emerge from a resistance or protection that is blocking
emergence.
LIFE MEANING Sense of significance that occurs as clients face and
overcome blocks to their aliveness and begin to choose their paths
and assert themselves; the working through of resistance or protective
patterns is preparatory to the unfolding of meaning.
MIRRORING WORK Therapists’ active and passive responses to clients
that help clients see close up how they are presently living and how
they are willing to live. Put another way, mirroring work helps clients
vivify their self and world constructs so that they are in a better posi-
tion to decide how they are going to respond to those constructs and
thereby their overall life. Active mirroring entails comparatively inten-
sive communications by therapists, such as personal disclosures as to
how therapists experience their clients in the moment, whereas passive
mirroring refers to comparatively softer forms of communication, such
as therapists’ expressions of empathy or support or direct paraphrasing.
NOTING Aspect of vivifying resistance that apprises the client of initial
experiences of resistance.
OCTAVES FOR ACTIVATING PRESENCE James Bugental’s strategies
for activating clients’ presence, which include listening, guiding,
instructing, and requiring.
PASSION FOR FORM Rollo May’s phrase for each person’s dialectical
process of meaning making, which May believed to be the essence of
genuine creativity.
PHENOMENOLOGICAL PHILOSOPHY Basic philosophy of the phe-
nomenological method, which is the chief empirical base for existen-
tial theory and therapy. The phenomenological method emphasizes
intimate and detailed description of lived experience.
PRESENCE Foundational element of existential therapy, whose Latin
root is prae (“before”) and esse (to be), meaning “to be before.”

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 Glossary of Key Terms

Presence is the capacity to be before or to be with one’s being and

to be before or to be with another human being. Presence assumes
both availability and expressiveness. It holds and illuminates that
which is palpably (immediately, affectively, kinesthetically, and
profoundly) relevant within the client and between client and
therapist.
PROCESS VS. CONTENT Reference to the therapist’s attention to the
preverbal or kinesthetic way the client talks more than what the client
says and to the way clients hold themselves, their vocal fluctuations
and breathing, and the way they relate to the therapist.
RESISTANCE OR PROTECTION Blockage to that which is palpably
(immediately, affectively, kinesthetically) relevant within the client
and between client and therapist. Existential–humanistic practitioners
assume that resistances or protections are concrete manifestations of
some aspect of a client’s self and world construct system.
RESPONSIBILITY ASSUMPTION Acceptance by the client of respon-
sibility for creating his or her life situation, thus enabling him or
her to choose differently in the future; a critical goal for existential–
humanistic therapists.
REVISITATION Key therapeutic dimension in which clients cycle
through the ways in which they stop or block themselves from fuller
personal and interpersonal presence; also called reiteration. Many
revisitations are typically required before stuck ways of being can be
accessed. Each time a revisitation occurs, clients learn more about
their willingness to approach such situations in the future.
REVITALIZATION or INTENTIONALITY Full-bodied orientation to a
given goal or direction; differs from intellectual or behavioral change in
that its impetus derives from the client’s entire sense of being, import,
and priority.
SELF AND WORLD CONSTRUCTS Client’s construal of existence,
both conscious and subconscious, as derived from the client’s unique
shaping of his or her subjective experiences with the objective world.
A person’s self and world constructs are present in the living moment
but may be hidden from consciousness.

153
 Glossary of Key Terms

TAGGING Method of alerting clients to the repetition of their resis-

tance; implies a subtle challenge to reassess their ways of being and
take responsibility for their self-constructions.
THERAPEUTIC ENCOUNTER Caring meeting between two human
beings in which the therapist consciously cultivates a collaborative
relationship. The existential–humanistic encounter assumes that how
the client relates to the therapist is how he or she relates to others. The
encounter can involve attention to undercurrents in the immediate
and evolving relationship, recognition of transference and counter-
transference projections, or exploration of the therapeutic bond.
TRACING OUT Form of vivifying resistance that encourages clients to
explore the fantasized consequences of their resistance—for exam-
ple, the fantasized consequences of weight loss.
TRANSFERENCE Aspect of the therapeutic encounter that involves a
client’s protective, patterned ways of being with self and other that
is reactivated in the therapeutic relationship. Working through the
negative transference in the here and now allows the client to shed
constricted ways of being.
VIVIFICATION OF RESISTANCE Intensification (or mirroring) of
clients’ awareness of how they block or limit themselves; vivification
alerts clients to these blocks or limits, whereas confrontation alarms
clients.
WORKING IN THE HERE AND NOW Existential–humanistic empha-
sis on the intra- and interpersonal processes that are implicitly and
explicitly unfolding in the present moment in the therapy room.
WORKING SPACE Pause that helps the therapist understand and, more
importantly, assist the client to vivify (or intensely elucidate) himself
or herself.

154
 Suggested Readings
and Resources

Suggested Readings
Becker, E. (1973). Denial of death. New York, NY: Free Press.
Bugental, J. F. T. (1976). The search for existential identity: Patient–therapist dialogues
in humanistic psychotherapy. San Francisco, CA: Jossey-Bass.
Bugental, J. F. T. (1999). Psychotherapy isn’t what you think. Phoenix, AZ: Zeig,
Tucker.
Cain, D. J., Keenan, K., & Rubin, S. (Eds.). (2016). Humanistic psychotherapies:
Handbook of research and practice (2nd ed.). Washington, DC: American
Psychological Association.
Cooper, M. (2003). Existential therapies. London, England: Sage.
Krug, O. T., & Schneider, K. J. (2016). Supervision essentials for existential–
humanistic therapy. Washington, DC: American Psychological Association.
Laing, R. D. (1969). The divided self: An existential study in sanity and madness.
Middlesex, England: Penguin.
May, R., Angel, E., & Ellenberger, H. (Eds.). (1958). Existence: A new dimension in
psychiatry and psychology. New York, NY: Basic Books.
Mendelowitz, E., & Schneider, K. (2008). Existential psychotherapy. In R. Corsini
& D. Wedding (Eds.), Current psychotherapies (8th ed., pp. 295–326). Belmont,
CA: Thomson Brooks/Cole.
Schneider, K. J. (Ed.). (2008). Existential–integrative psychotherapy: Guideposts to
the core of practice. New York, NY: Routledge.
Schneider, K. J., & May, R. (1995). The psychology of existence: An integrative, clinical
perspective. New York, NY: McGraw-Hill.
Schneider, K. J., Pierson, J. F., & Bugental, J. F. T. (Eds.). (2015). The handbook
of humanistic psychology: Theory, research, and practice (2nd ed.). Thousand
Oaks, CA: Sage.

155
 Suggested Readings and Resources

Yalom, I. (1980). Existential psychotherapy. New York, NY: Basic Books.

Yalom, I. (2002). The gift of therapy. New York, NY: HarperCollins.

Web Resources
Existential–Humanistic Institute. (n.d.). [Home page]. Retrieved from http://
www.ehinstitute.org
Hoffman, L. (n.d.). Why become an existential therapist? Retrieved from http://
existential-therapy.com/why-become-an-existential-therapist-2/

DVD Resources
American Psychological Association (Producer). (2006). Existential therapy
[DVD]. Available from http://www.apa.org/pubs/videos/4310756.aspx
American Psychological Association (Producer). (2009). Existential–humanistic
therapy over time [DVD]. Available from http://www.apa.org/pubs/videos/
4310867.aspx
American Psychological Association (Producer). (2016). Existential–humanistic
therapy supervision [DVD]. Available from http://www.apa.org/pubs/videos/
4310953.aspx
Psychotherapy.net (Producer). (2005). Existential–humanistic psychotherapy
in action [DVD]. Available from https://www.psychotherapy.net/video/
existential-humanistic-bugental
Psychotherapy.net (Producer). (2005). Irvin Yalom: Live case consultation [DVD].
Available from https://www.psychotherapy.net/video/yalom-consultation
Psychotherapy.net (Producer). (2005). James Bugental: Live case consultation with
Orah Krug [DVD]. Available from https://www.psychotherapy.net/video/
bugental-case-consultation
Psychotherapy.net (Producer). (2006). Existential–humanistic psychotherapy:
A demonstration with James F. T. Bugental, PhD [DVD]. Available from
https://www.psychotherapy.net/videos
Psychotherapy.net (Producer). (2007). Rollo May on existential psychotherapy [DVD].
Available from https://www.psychotherapy.net/video/rollo-may-existential-
psychotherapy
Psychotherapy.net (Producer). (2015). Irvin Yalom on psychotherapy & writing
[DVD]. Available from https://www.psychotherapy.net/video/yalom-
psychotherapy-writing

156
 References

Alsup, R. (2008). Existentialism of personalism: A Native American perspective.

In K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the
core of practice (pp. 121–127). New York, NY: Routledge.
Angus, L., Watson, J. C., Elliott, R., Schneider, K., & Timulak, L. (2015). Human-
istic psychotherapy research 1990–2015: From methodological innovation to
evidence-supported treatment outcomes and beyond. Psychotherapy Research,
25, 330–347. http://dx.doi.org/10.1080/10503307.2014.989290
American Psychological Association (Producer). (2009). Existential–humanistic
therapy over time [DVD]. Available from http://www.apa.org/videos/4310867.aspx
American Psychological Association Commission on Accreditation. (2017).
Implementing regulations: Section C. IRs related to the Standards of Accreditation
(Section C-8 I: Profession-wide competencies). Washington, DC: American Psy-
chological Association. Retrieved from http://www.apa.org/ed/accreditation/
section-c-soa.pdf
American Psychological Association Presidential Task Force on Evidence-Based
Practice. (2006). Evidence-based practice in psychology. American Psychologist,
61, 271–285. http://dx.doi.org/10.1037/0003-066X.61.4.271
Assisting youth with understanding the impact of civility and violence within
their communities. (2007, June). Ernest Becker Foundation Newsletter, 14, 3.
Ballinger, B., Matano, R., & Amantea, A. (2008). A perspective on alcoholism: The
case of Charles. In K. J. Schneider (Ed.), Existential–integrative psychotherapy:
Guideposts to the core of practice (pp. 177–185). New York, NY: Routledge.
Barrett, W. H. (1958). Irrational man: A study in existential philosophy. New York,
NY: Doubleday.
Becker, E. (1973). Denial of death. New York, NY: Free Press.

157
 References

Binswanger, L. (1958). The case of Ellen West. In R. May, E. Angel, & H. Ellenberger
(Eds.), Existence (pp. 237–364). New York, NY: Basic Books.
Bohart, A. C., & Greenberg, L. S. (Eds.). (1997). Empathy reconsidered. Washington,
DC: American Psychological Association.
Bohart, A. C., O’Hara, M., & Leitner, L. M. (1998). Empirically violated treat-
ments: Disenfranchisement of humanistic and other psychotherapies. Psycho-
therapy Research, 8, 141–157.
Bohart, A. C., O’Hara, M., Leitner, L. M., Wertz, F. J., Stern, E. M., & Schneider,
K. J. (1997). Guidelines for the provision of humanistic psychosocial services.
The Humanistic Psychologist, 24, 64–107.
Bohart, A. C., & Tallman, K. (1999). How clients make therapy work: The process
of active self-healing. Washington, DC: American Psychological Association.
Boss, M. (1963). Psychoanalysis and daseinsanalysis. New York, NY: Basic Books.
Bowman, P. (1995). An existential–spiritual perspective: The case of Sarah. In
K. J. Schneider & R. May (Eds.), The psychology of existence: An integrative,
clinical perspective (pp. 293–301). New York, NY: McGraw-Hill.
Bradford, G. K. (2007). The play of unconditioned presence in existential–
integrative psychotherapy. Journal of Transpersonal Psychology, 39, 23–47.
Brown, L. S. (2008). Feminist therapy as meaning-making practice: Where there is
no power, where is the meaning? In K. J. Schneider (Ed.), Existential–integrative
psychotherapy: Guideposts to the core of practice (pp. 130–140). New York, NY:
Routledge.
Buber, M. (1970). I and thou (W. Kaufmann, Trans.). New York, NY: Scribner’s.
(Original work published 1937)
Bugental, E. (2008). Swimming together in a sea of loss: A group process for
elders. In K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guide-
posts to the core of practice (pp. 333–342). New York, NY: Routledge.
Bugental, J. F. T. (1965). The search for authenticity: An existential–analytic
approach to psychotherapy. New York, NY: Holt, Rinehart, & Winston.
Bugental, J. F. T. (1976). The search for existential identity: Patient–therapist dia-
logues in humanistic psychotherapy. San Francisco, CA: Jossey-Bass.
Bugental, J. F. T. (1978). Psychotherapy and process: The fundamentals of an
existential–humanistic approach. New York, NY: McGraw-Hill.
Bugental, J. F. T. (1987). The art of the psychotherapist. New York, NY: Norton.
Bugental, J. F. T. (1999). Psychotherapy isn’t what you think. Phoenix, AZ: Zeig,
Tucker.
Bugental, J. F. T. (2008). Preliminary sketches for a short-term existential therapy.
In K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the
core of practice (pp. 165–168). New York, NY: Routledge.

158
 References

Bugental, J. F. T., & Bracke, P. E. (1992). The future of existential–humanistic

psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 29, 28–33.
http://dx.doi.org/10.1037/0033-3204.29.1.28
Bugental, J. F. T., & Kleiner, R. (1993). Existential psychotherapies. In G. Stricker
& G. Gold (Eds.), Comprehensive handbook of psychotherapy integration
(pp. 101–112). New York, NY: Plenum.
Bugental, J. F. T., & Sterling, M. (1995). Existential psychotherapy. In A. S. Gurman
& S. B. Messer (Eds.), Essential psychotherapies (pp. 226–260). New York, NY:
Guilford Press.
Bunting, K., & Hayes, S. (2008). Language and meaning: Acceptance and commit-
ment therapy and the EI model. In K. J. Schneider (Ed.), Existential–integrative
psychotherapy: Guideposts to the core of practice (pp. 217–234). New York, NY:
Routledge.
Burston, D. (2003). Existentialism, humanism, and psychotherapy. Existential
Analysis, 14, 309–319.
Cain, D. J., Keenan, K., & Rubin, S. (Eds.). (2016). Humanistic psychotherapies:
Handbook of research and practice (2nd ed.). Washington, DC: American Psy-
chological Association. http://dx.doi.org/10.1037/14775-000
Calton, T., Ferriter, M., Huband, N., & Spandler, H. (2007). A systematic review of
the Soteria paradigm for the treatment of people diagnosed with schizophrenia.
Schizophrenia Bulletin, 34, 181–192. http://dx.doi.org/10.1093/schbul/sbm047
Camus, A. (1955). The myth of Sisyphus and other essays (J. O’Brien, Trans.).
New York, NY: Knopf.
Churchill, S., & Wertz, F. J. (2015). An introduction to phenomenological research
in psychology: Historical, conceptual, and methodological foundations. In K. J.
Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic
psychology: Theory, research, and practice (2nd ed., pp. 275–295). Thousand
Oaks, CA: Sage. http://dx.doi.org/10.4135/9781483387864.n20
Comas-Díaz, L. (2008). Latino psychospirituality. In K. J. Schneider (Ed.),
Existential–integrative psychotherapy: Guideposts to the core of practice
(pp. 100–109). New York, NY: Routledge.
Cooper, M. (2003). Existential therapies. London, England: Sage.
Cooper, M. (2004). Viagra for the brain: Psychotherapy research and the chal-
lenge to existential therapeutic practice. Existential Analysis, 15, 2–14.
Cooper, M. (2009). Interpersonal perceptions and metaperceptions: Psycho­
therapeutic practice in the interexperiential realm. Journal of Humanistic
Psychology, 49, 85–99. http://dx.doi.org/10.1177/0022167808323152
Cooper, M. (2017). Existential Therapies (2nd ed.). London, England: Sage.
Cooper, M., & McLeod, J. (2010). Pluralistic counselling and psychotherapy.
Thousand Oaks, CA: Sage.

159
 References

Cortright, B. (1997). Psychotherapy and spirit: Theory and practice in transpersonal

psychotherapy. Albany, NY: State University of New York Press.
Craig, P. E. (1986). Sanctuary and presence: An existential view of the therapist’s
contribution. The Humanistic Psychologist, 14, 22–28. http://dx.doi.org/10.1080/
08873267.1986.9976749
Criswell, E. (2001). Humanistic psychology and mind/body medicine. In K. J.
Schneider, J. F. T. Bugental, & J. F. Pierson (Eds.), The handbook of humanistic
psychology: Leading edges in theory, research, and practice (pp. 581–591). Thou-
sand Oaks, CA: Sage. http://dx.doi.org/10.4135/9781412976268.n43
Cushman, P. (1995). Constructing the self, constructing America: A cultural history
of psychotherapy. Reading, MA: Addison-Wesley.
de Beauvoir, S. (1948). The ethics of ambiguity. New York, NY: Citadel.
DeCarvalho, R. (1991). The founders of humanistic psychology. New York, NY:
Praeger.
Decker, L. (2007). Combat trauma: Treatment from a mystical/spiritual perspec-
tive. Journal of Humanistic Psychology, 47, 30–53. http://dx.doi.org/10.1177/
0022167806293000
de Quincey, C. (2002). Radical nature: Rediscovering the soul of matter. Montpelier,
VT: Invisible Cities Press.
Dorman, D. (2008). Dante’s cure: Schizophrenia and the two-person journey. In
K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the
core of practice (pp. 236–245). New York, NY: Routledge.
Elkins, D. N. (2007). Empirically supported treatments: The deconstruction of a
myth. Journal of Humanistic Psychology, 47, 474–500.
Elkins, D. N. (2015). Beyond religion: Toward a humanistic spirituality. In K. J.
Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic
psychology: Theory, research, and practice (2nd ed., pp. 681–692). Thousand
Oaks, CA: Sage.
Elkins, D. N. (2016). The human elements of psychotherapy: A nonmedical model
of emotional healing. Washington, DC: American Psychological Association.
http://dx.doi.org/10.1037/14751-000
Elliott, R. (2002). The effectiveness of humanistic therapies: A meta-analysis. In
D. J. Cain & J. Seeman (Eds.), Humanistic psychotherapies: Handbook of research
and practice (pp. 57–81). Washington, DC: American Psychological Association.
http://dx.doi.org/10.1037/10439-002
Fauth, J., Gates, S., Vinca, M. A., Boles, S., & Hayes, J. A. (2007). Big ideas for
psychotherapy training. Psychotherapy: Theory, Research, Practice, Training,
44, 384–391. http://dx.doi.org/10.1037/0033-3204.44.4.384
Fischer, C. T. (1994). Individualizing psychological assessment. Hillsdale, NJ:
Erlbaum.

160
 References

Fisher, G. (2005). Existential psychotherapy with adult survivors of sexual

abuse. Journal of Humanistic Psychology, 45, 10–40. http://dx.doi.org/10.1177/
0022167804269042
Fosha, D. (2008). Transformance, recognition of self by self, and effective action.
In K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to
the core of practice (pp. 290–320). New York, NY: Routledge.
Frankl, V. E. (1963). Man’s search for meaning: An introduction to logotherapy.
New York, NY: Pocket Books.
Frew, J., & Spiegler, M. (2012). Contemporary psychotherapies for a diverse world
(Rev. ed.). New York, NY: Routledge.
Friedman, M. (1991a). Encounter on the narrow ridge: A life of Martin Buber.
New York, NY: Paragon House.
Friedman, M. (1991b). The worlds of existentialism: A critical reader. Atlantic
Highlands, NJ: Humanities Press.
Friedman, M. (1995). The case of Dawn. In K. J. Schneider & R. May (Eds.),
The psychology of existence: An integrative, clinical perspective (pp. 308–315).
New York, NY: McGraw-Hill.
Friedman, M. (2001). Expanding the boundaries of theory. In K. J. Schneider,
J. F. T. Bugental, & J. F. Pierson (Eds.), The handbook of humanistic psychology:
Leading edges in theory, research, and practice (pp. 343–348). Thousand Oaks,
CA: Sage. http://dx.doi.org/10.4135/9781412976268.n26
Fromm, E. (1941). Escape from freedom. New York, NY: Holt, Rinehart, & Winston.
Galvin, J. (2008). Brief encounters with Chinese clients: The case of Peter. In
K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the
core of practice (pp. 168–175). New York, NY: Routledge.
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach
to effective psychotherapy. Washington, DC: American Psychological Asso-
ciation. http://dx.doi.org/10.1037/13485-000
Gendlin, E. T. (1996). Focusing-oriented psychotherapy. New York, NY: Guilford Press.
Giorgi, A. (1970). Psychology as a human science: A phenomenologically based
approach. New York, NY: Harper & Row.
Goldfried, M. R., & Wolfe, B. E. (1996). Psychotherapy practice and research:
Repairing a strained relationship. American Psychologist, 51, 1007–1016.
http://dx.doi.org/10.1037/0003-066X.51.10.1007
Greenberg, L. S. (2007). Emotion coming of age. Clinical Psychology: Science and
Practice, 14, 414–421. http://dx.doi.org/10.1111/j.1468-2850.2007.00101.x
Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change:
The moment-by-moment process. New York, NY: Guilford Press.
Greening, T. (1992). Existential challenges and responses. The Humanistic Psy-
chologist, 20, 111–115. http://dx.doi.org/10.1080/08873267.1992.9986784

161
 References

Grondin, J. (1995). Sources of hermeneutics. Albany, NY: State University of

New York Press.
Gurman, A. S., & Messer, S. B. (Eds.). (2003). Essential psychotherapies (2nd ed.).
New York, NY: Guilford Press.
Haley, J. (1997). Leaving home: The therapy of disturbed young people. New York,
NY: Routledge.
Hanna, F. J., Giordano, F., Dupuy, P., & Puhakka, K. (1995). Agency and transcen-
dence: The experience of therapeutic change. The Humanistic Psychologist, 23,
139–160. http://dx.doi.org/10.1080/08873267.1995.9986822
Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.).
New York, NY: Basic Books.
Hillman, J., & Ventura, M. (1992). We’ve had a hundred years of psychotherapy
and the world’s getting worse. San Francisco, CA: Harper San Francisco.
Hoffman, L. (2008). An EI approach to working with religious and spiritual clients.
In K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the
core of practice (pp. 187–201). New York, NY: Routledge.
Hoffman, L., Cleare-Hoffman, H., & Jackson, T. (2015). Humanistic psychol-
ogy and multiculturalism: History, current status, and advancements. In K. J.
Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic
psychology: Theory, research, and practice (2nd ed., pp. 41–55). Thousand Oaks,
CA: Sage. http://dx.doi.org/10.4135/9781483387864.n4
Hoffman, L., Stewart, S., Warren, W., & Meek, L. (2009). Toward a sustain-
able myth of self: An existential response to the postmodern condition.
Journal of Humanistic Psychology, 49, 135–173. http://dx.doi.org/10.1177/
0022167808324880
Hoffman, L., Yang, M., Kaklauskas, F., & Chan, A. (2009). Existential psychology
East–West. Colorado Springs, CO: University of the Rockies Press.
Horvath, A. O. (1995). The therapeutic relationship: From transference to alli-
ance. In Session, 1, 7–17.
Husserl, E. (1962). Ideas: General introduction to pure phenomenology (W. R. Boyce
Gibson, Trans.). New York, NY: Collier. (Original work published 1913)
James, W. (1936). The varieties of religious experience. New York, NY: Modern
Library. (Original work published 1902)
Jung, C. G. (1966). Two essays on analytical psychology (R. F. C. Hull, Trans.).
Princeton, NJ: Princeton University Press.
Karavalaki, M., & Shumaker, D. (2016). An existential–integrative (EI) treatment
of adolescent substance abuse. The Humanistic Psychologist, 44, 381–399.
http://dx.doi.org/10.1037/hum0000036
Kierkegaard, S. (1944). The concept of dread (W. Lowrie, Trans.). Princeton, NJ:
Princeton University Press. (Original work published 1844)

162
 References

Krug, O. T. (2009, Summer). James Bugental and Irvin Yalom: Two masters of exis-
tential therapy cultivate presence in the therapeutic encounter. Journal of Human-
istic Psychology, 49, 329–354. http://dx.doi.org/10.1177/0022167809334001
Krug, O. T. (2010, August). Is existential meaning making at the heart of thera-
peutic change? In K. J. Schneider (Chair), Is there an existential–humanistic
foundation to effective psychotherapy? Symposium conducted at the meeting
of the American Psychological Association, San Diego, CA.
Krug, O. T. (2016). Existential, humanistic, experiential therapies in histori-
cal perspective. In A. Consoli & L. Liebert (Eds.), Comprehensive textbook of
psychotherapy: Theory and practice (2nd ed., pp. 91–105). Oxford, England:
Oxford University Press.
Krug, O. T., & Schneider, K. J. (2016). Supervision essentials for existential–
humanistic therapy. Washington, DC: American Psychological Association.
http://dx.doi.org/10.1037/14951-000
Lac, V. (2016). Amy’s story: An existential–integrative equine-facilitated psycho-
therapy approach to anorexia nervosa. Journal of Humanistic Psychology, 57,
1–12. http://dx.doi.org/10.1177/0022167815627900
Laing, R. D. (1967). The politics of experience. New York, NY: Ballantine.
Laing, R. D. (1969). The divided self: An existential study in sanity and madness.
Middlesex, England: Penguin.
Laing, R. D. (1985). Theoretical and practical aspects of existential therapy (Cassette
No. L330-W1A). Phoenix, AZ: Erickson Institute.
Lambert, M. J. (1992). Implications of outcome research for psychotherapy inte-
gration. In J. C. Norcross & M. R. Goldstein (Eds.), Handbook of psychotherapy
integration (pp. 94–129). New York, NY: Basic Books.
Lao Tzu. (1988). Tao te ching (S. Mitchell, Trans.). New York, NY: Harper Collins.
Leijssen, M. (2006). Validation of the body in psychotherapy. Journal of Human-
istic Psychology, 46, 126–146. http://dx.doi.org/10.1177/0022167805283782
Lerner, M. (2000). Spirit matters. Charlottesville, VA: Hampton Roads.
Linley, P., & Joseph, S. (2007). Therapy work and therapists’ positive and nega-
tive well-being. Journal of Social and Clinical Psychology, 26, 385–403. http://
dx.doi.org/10.1521/jscp.2007.26.3.385
Lyons, A. (2001). Humanistic psychology and social action. In K. J. Schneider,
J. F. T. Bugental, & J. F. Pierson (Eds.), The handbook of humanistic psychology:
Leading edges in theory, research, and practice (pp. 625–634). Thousand Oaks,
CA: Sage. http://dx.doi.org/10.4135/9781412976268.n46
Mahrer, A. R. (1996). The complete guide to experiential psychotherapy. New York,
NY: Wiley.
Marcel, G. (1956). The philosophy of existentialism. New York, NY: Philosophical
Library.

163
 References

Marcel, G. (1960). Mystery of being: Vol. 2. Faith and reality (Gateway ed.). Chicago,
IL: Henry Regnery.
May, R. (1958a). Contributions of existential psychotherapy. In R. May, E. Angel, &
H. Ellenberger (Eds.), Existence: A new dimension in psychiatry and psychology
(pp. 37–91). New York, NY: Basic Books. http://dx.doi.org/10.1037/11321-002
May, R. (1958b). The origins and significance of the existential movement in psy-
chology. In R. May, E. Angel, & H. Ellenberger (Eds.), Existence: A new dimen-
sion in psychiatry and psychology (pp. 3–36). New York, NY: Basic Books.
May, R. (1969). Love and will. New York, NY: Norton.
May, R. (1972). Power and innocence. New York, NY: Norton.
May, R. (1975). The courage to create. New York, NY: Norton.
May, R. (1981). Freedom and destiny. New York, NY: Norton.
May, R. (1983). The discovery of being. New York, NY: Norton.
May, R., Angel, E., & Ellenberger, H. (Eds.). (1958). Existence: A new dimension in
psychiatry and psychology. New York, NY: Basic Books.
May, R., & Yalom, I. (1995). Existential psychotherapy. In R. Corsini & D. Wedding
(Eds.), Current psychotherapies (5th ed., pp. 262–292). Itasca, IL: Peacock.
Mendelowitz, E. (2008). Lao Tzu and ethics: Intimations on character. Colorado
Springs, CO: University of the Rockies Press.
Mendelowitz, E., & Schneider, K. (2008). Existential psychotherapy. In R. Corsini
& D. Wedding (Eds.), Current psychotherapies (8th ed., pp. 295–327). Belmont,
CA: Thomson Brooks/Cole.
Merleau-Ponty, M. (1962). The phenomenology of perception (C. Smith, Trans.).
London, England: Routledge & Kegan Paul.
Messer, S. B., & Wampold, B. E. (2002). Let’s face facts, common factors are
more potent than specific therapy ingredients. Clinical Psychology: Science
and Practice, 9(1), 21–25. http://dx.doi.org/10.1093/clipsy.9.1.21
Miller, I. J. (1996a). Managed care is harmful to outpatient mental health ser-
vices: A call for accountability. Professional Psychology: Research and Practice,
27, 349–363. http://dx.doi.org/10.1037/0735-7028.27.4.349
Miller, I. J. (1996b). Time-limited brief therapy has gone too far: The result is
invisible rationing. Professional Psychology: Research and Practice, 27, 567–576.
http://dx.doi.org/10.1037/0735-7028.27.6.567
Monheit, J. (2008). A lesbian and gay perspective: The case of Marcia. In K. J.
Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the core
of practice (pp. 140–146). New York, NY: Routledge.
Montuori, M., & Purser, R. (2015). Humanistic psychology in the workplace.
In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of
humanistic psychology: Theory, research, and practice (2nd ed., pp. 723–734).
Thousand Oaks, CA: Sage.

164
 References

Mosher, L. (2001). Treating madness without hospitals: Soteria and its successors.
In K. J. Schneider, J. F. T. Bugental, & J. F. Pierson (Eds.), The handbook of human-
istic psychology: Leading edges in theory, research, and practice (pp. 389–402).
Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/9781412976268.n30
Mosher, L. F. (2015). Treating madness without hospitals: Soteria and its succes-
sors. In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook
of humanistic psychology: Theory, research, and practice (2nd ed., pp. 491–504).
Thousand Oaks, CA: Sage.
Moss, D. (2015). The roots and genealogy of humanistic psychology. In K. J.
Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic
psychology: Theory, research, and practice (2nd ed., pp. 3–18). Thousand Oaks,
CA: Sage. http://dx.doi.org/10.4135/9781483387864.n1
Moustakas, C. (1972). Loneliness and love. Englewood Cliffs, NJ: Prentice Hall.
Murray, H. A., Barrett, W. G., Langer, W. C., Morgan, C. D., White, R. W., Diven,
K., . . . Wolf, R. E. (1938). Explorations in personality: A clinical and experimen-
tal study of fifty men of college age. New York, NY: Oxford University Press.
Nietzsche, F. (1982). Twilight of the idols. In W. Kaufmann (Ed.), The portable
Nietzche (pp. 465–563). New York, NY: Penguin. (Original work published
1889)
Norcross, J. (1987). A rational and empirical analysis of existential psycho-
therapy. Journal of Humanistic Psychology, 27, 41–68. http://dx.doi.org/
10.1177/0022167887271005
Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work. Oxford,
England: Oxford University Press.
Norcross, J. C., & Lambert, M. J. (2011). Evidence-based therapy relationships.
In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based
responsiveness (2nd ed., pp. 3–21). New York, NY: Oxford University Press.
http://dx.doi.org/10.1093/acprof:oso/9780199737208.003.0001
O’Hara, M. (2001). Emancipatory therapeutic practice for a new era: A work
of retrieval. In K. J. Schneider, J. F. T. Bugental, & J. F. Pierson (Eds.), The
handbook of humanistic psychology: Leading edges in theory, research, and
practice (pp. 473–489). Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/
9781412976268.n36
O’Hara, M. (2015). Humanistic psychology’s transformative role in a threatened
world. In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook
of humanistic psychology: Theory, research, and practice (2nd ed., pp. 569–584).
Thousand Oaks, CA: Sage.
Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in
psychotherapy—noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Hand-
book of psychotherapy and behavior change (pp. 270–378). New York, NY: Wiley.

165
 References

Paulson, D., & Krippner, S. (2007). Haunted by combat: Understanding PTSD in

war veterans, including women, reservists, and those coming back from Iraq. West-
port, CT: Greenwood Press.
Penzel, F. (2000). Obsessive–compulsive disorders: A complete guide to getting well
and staying well. Oxford, England: Oxford University Press.
Perls, F. (1971). Gestalt therapy verbatim. New York, NY: Bantam Books.
Phillips, J. (1980–81). Transference and encounter: The therapeutic relationship
in psychoanalytic and existential therapy. Review of Existential Psychology &
Psychiatry, 27(2/3), 135–152.
Pierson, J. F. (2015). Closing statement. In K. J. Schneider, J. F. Pierson, & J. F. T.
Bugental (Eds.), The handbook of humanistic psychology: Theory, research, and
practice (2nd ed., pp. 742–744). Thousand Oaks, CA: Sage.
Pierson, J. F., Krug, O. T., Sharp, J. G., & Piwowarski, T. (2015). Cultivating ther-
apeutic artistry: Model existential–humanistic training programs. In K. J.
Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic
psychology: Theory, research, and practice (2nd ed., pp. 631–651). Thousand
Oaks, CA: Sage.
Pierson, J. F., & Sharp, J. (2001). Cultivating psychotherapist artistry: A model
existential–humanistic training program. In K. J. Schneider, J. F. T. Bugental,
& J. F. Pierson (Eds.), The handbook of humanistic psychology: Leading edges
in theory, research, and practice (pp. 539–554). Thousand Oaks, CA: Sage.
http://dx.doi.org/10.4135/9781412976268.n40
Portnoy, D. (2008). Relatedness: Where existential and psychoanalytic psycho-
therapy converge. In K. J. Schneider (Ed.), Existential–integrative psychotherapy:
Guideposts to the core of practice (pp. 268–281). New York, NY: Routledge.
Rank, O. (1936). Will therapy (J. Taft, Trans.). New York, NY: Knopf.
Ray, P. (1996, Spring). The rise of integral culture. Noetic Sciences Review,
pp. 4–15.
Rennie, D. L. (1994). Storytelling in psychotherapy: The client’s subjective
experience. Psychotherapy: Theory, Research, Practice, Training, 31, 234–243.
http://dx.doi.org/10.1037/h0090224
Rennie, D. L. (2002). Experiencing psychotherapy: Grounded theory studies.
In D. J. Cain & J. Seeman (Eds.), Humanistic psychotherapies: Handbook of
research and practice (pp. 117–144). Washington, DC: American Psychological
Association.
Rescher, N. (2000). Process philosophy: A survey of basic ideas. Pittsburgh, PA:
University of Pittsburgh Press.
Rice, D. (2008). An African American perspective: The case of Darrin. In K. J.
Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the core
of practice (pp. 110–121). New York, NY: Routledge.

166
 References

Rice, D. (2015). Humanistic psychology and social action. In K. J. Schneider, J. F.

Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic psychology:
Theory, research, and practice (2nd ed., pp. 707–721). Thousand Oaks, CA: Sage.
Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications,
and theory. Boston, MA: Houghton Mifflin.
Rowan, J. (2015). Existential analysis and humanistic psychotherapy. In K. J.
Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook of humanistic
psychology: Theory, research, and practice (2nd ed., pp. 549–561). Thousand
Oaks, CA: Sage.
Sartre, J. P. (1956). Being and nothingness (H. Barnes, Trans.). New York, NY:
Philosophical Library.
Schneider, K. J. (1985). Clients’ perceptions of the positive and negative characteris­
tics of their counselors. Dissertation Abstracts International: Section B. Sciences
and Engineering, 45(10), 3345b. (UMI No. NN84217)
Schneider, K. J. (1993). Horror and the holy: Wisdom-teachings of the monster tale.
Chicago, IL: Open Court.
Schneider, K. J. (1995). Guidelines for an existential–integrative (EI) approach.
In K. J. Schneider & R. May (Eds.), The psychology of existence: An integrative,
clinical perspective (pp. 135–184). New York, NY: McGraw-Hill.
Schneider, K. J. (1998a). Existential processes. In L. S. Greenberg, J. C. Watson,
& G. Lietaer (Eds.), Handbook of experiential psychotherapy (pp. 103–120).
New York, NY: Guilford Press.
Schneider, K. J. (1998b). Toward a science of the heart: Romanticism and the
revival of psychology. American Psychologist, 53, 277–289. http://dx.doi.org/
10.1037/0003-066X.53.3.277
Schneider, K. J. (1999). The paradoxical self: Toward an understanding of our con-
tradictory nature (2nd ed.). Amherst, NY: Humanity Books.
Schneider, K. J. (2001). Closing statement. In K. J. Schneider, J. F. T. Bugental, &
J. F. Pierson (Eds.), The handbook of humanistic psychology: Leading edges in
theory, research, and practice (pp. 672–675). Thousand Oaks, CA: Sage.
Schneider, K. J. (2003). Existential–humanistic psychotherapies. In A. Gurman &
S. Messer (Eds.), Essential psychotherapies (2nd ed., pp. 149–181). New York,
NY: Guilford Press.
Schneider, K. J. (2004). Rediscovery of awe: Splendor, mystery, and the fluid center
of life. St. Paul, MN: Paragon House.
Schneider, K. J. (2005). Biology and awe: Psychology’s critical juncture. The Human-
istic Psychologist, 33, 167–173. http://dx.doi.org/10.1207/s15473333thp3302_6
Schneider, K. J. (2007). The experiential liberation strategy of the existential–
integrative model of therapy. Journal of Contemporary Psychotherapy, 37, 33–39.
http://dx.doi.org/10.1007/s10879-006-9032-y

167
 References

Schneider, K. J. (2008). Existential–integrative psychotherapy: Guideposts to the

core of practice. New York, NY: Routledge.
Schneider, K. J. (2009). Awakening to awe: Personal stories of profound trans-
formation. Lanham, MD: Jason Aronson.
Schneider, K. J. (2013). The polarized mind: Why it’s killing us and what we can do
about it. Colorado Springs, CO: University Professors Press.
Schneider, K. J. (2015). Presence: The core contextual factor of effective psycho-
therapy. Existential Analysis, 26, 304–312.
Schneider, K. J. (2016, April). Experiential Democracy Project: An “I–Thou”
dialogue on racism and policing. Mad in America. Retrieved from http://
www.madinamerica.com/2016/04/experiential-democracy-project-an-i-
thou-dialogue-on-racism-and-policing/
Schneider, K. J. (2017). The spirituality of awe: Challenges to the robotic revolution.
Cardiff, CA: Waterfront Digital Press.
Schneider, K., Galvin, J., & Serlin, I. (2009). Rollo May on existential therapy.
Journal of Humanistic Psychology, 49, 419–434.
Schneider, K. J., & Längle, A. (2012). The renewal of humanism in psycho­
therapy: Summary and conclusion. Psychotherapy, 49, 480–481. http://
dx.doi.org/10.1037/a0028026
Schneider, K. J., & May, R. (1995). The psychology of existence: An integrative, clini-
cal perspective. New York, NY: McGraw-Hill.
Schneider, K. J., Pierson, J. F., & Bugental, J. F. T. (Eds.). (2015). The handbook
of humanistic psychology: Theory, research, and practice (2nd ed.). Thousand
Oaks, CA: Sage.
Seligman, M. E. P. (1996). Science as an ally of practice. American Psychologist,
51, 1072–1079. http://dx.doi.org/10.1037/0003-066X.51.10.1072
Serlin, I. A. (1996). Kinesthetic imagining. Journal of Humanistic Psychology, 36,
25–34. http://dx.doi.org/10.1177/00221678960362005
Serlin, I. A. (Ed.). (2007). Whole person healthcare (Vols. 1–3). Westport, CT: Praeger.
Serlin, I. A. (2008). Women and the midlife crisis: The Anne Sexton complex. In
K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to the
core of practice (pp. 146–163). New York, NY: Routledge.
Serlin, I. A., & Speiser, V. M. (2007). Introduction to the special issue “Imagine:
Expression in the service of humanity.” Journal of Humanistic Psychology,
47, 280–287. http://dx.doi.org/10.1177/0022167807302184
Shahar, G., & Schiller, M. (2016a). A conqueror by stealth: Introduction to the spe-
cial issue on humanism, existentialism, and psychotherapy integration. Journal
of Psychotherapy Integration, 26, 1–4. http://dx.doi.org/10.1037/int0000024
Shahar, G., & Schiller, M. (2016b). Existentialism and humanism in psychotherapy
integration [Special section]. Journal of Psychotherapy Integration, 26(1).

168
 References

Shapiro, F. (1998). EMDR: The breakthrough therapy for overcoming anxiety,

stress and trauma. New York, NY: Basic Books.
Shedler, J., Mayman, M., & Manis, M. (1993). The illusion of mental
health. American Psychologist, 48, 1117–1131. http://dx.doi.org/10.1037/
0003-066X.48.11.1117
Shumaker, D. (2011). An existential–integrative treatment of anxious and
depressed adolescents. Journal of Humanistic Psychology, 52, 375–400.
http://dx.doi.org/10.1177/0022167811422947
Spinelli, E. (1997). Tales of unknowing: Therapeutic encounters from an existential
perspective. London, England: Duckworth.
Spinelli, E. (2015). Existential analysis and humanistic psychotherapy: A reply
to John Rowan. In K. J. Schneider, J. F. T. Bugental, & J. F. Pierson (Eds.),
The handbook of humanistic psychology: Leading edges in theory, research, and
practice (pp. 465–471). Thousand Oaks, CA: Sage.
Sterling, M. (2001). Expanding the boundaries of practice. In K. J. Schneider,
J. F. T. Bugental, & J. F. Pierson (Eds.), The handbook of humanistic psychology:
Leading edges in theory, research, and practice (pp. 349–353). Thousand Oaks,
CA: Sage. http://dx.doi.org/10.4135/9781412976268.n27
Stolorow, R. D. (2008). Autobiographical and theoretical reflections on the “ontolog-
ical unconscious.” In K. J. Schneider (Ed.), Existential–integrative psychotherapy:
Guideposts to the core of practice (pp. 281–290). New York, NY: Routledge.
Stolorow, R. D., Brandchaft, B., & Atwood, G. E. (1987). Psychoanalytic treatment:
An intersubjective approach. Hillsdale, NJ: Analytic Press.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York, NY:
Norton.
Taylor, E. (1999). An intellectual renaissance in humanistic psychology? Journal of
Humanistic Psychology, 39, 7–25. http://dx.doi.org/10.1177/0022167899392002
Taylor, F. W. (1911). Shop management, the principles of scientific management and
testimony before the Special House Committee. New York, NY: Harper & Row.
Thompson, M. G. (1995). Psychotic clients, Laing’s treatment philosophy, and
the fidelity to experience in existential psychoanalysis. In K. J. Schneider &
R. May (Eds.), The psychology of existence: An integrative, clinical perspective
(pp. 233–247). New York, NY: McGraw-Hill.
Tillich, R. (1952). The courage to be. New Haven, CT: Yale University Press.
van Deurzen, E. (2015). Paradox and passion in psychotherapy: An existential
approach. Chichester, England: Wiley/Blackwell.
van Deurzen, E., Craig, E., Längle, A., Schneider, K., & Tantam, D. (Eds.). (in press).
The Wiley world handbook of existential therapy. Hoboken, NJ: Wiley Blackwell.
VandenBos, G. R. (Ed.). (2015). APA dictionary of psychology (2nd ed.). Washing-
ton, DC: American Psychological Association.

169
 References

Vontress, C. E., & Epp, L. R. (2015). Existential cross-cultural counseling: The

courage to be an existential counselor. In K. J. Schneider, J. F. Pierson, &
J. F. T. Bugental (Eds.), The handbook of humanistic psychology: Theory,
research, and practice (2nd ed., pp. 473–489). Thousand Oaks, CA: Sage.
http://dx.doi.org/10.4135/9781483387864.n38
Vos, J., Craig, M., & Cooper, M. (2015). Existential therapies: A meta-analysis
of their effects on psychological outcomes. Journal of Consulting and Clinical
Psychology, 83, 115–128. http://dx.doi.org/10.1037/a0037167
Walsh, R. A., & McElwain, B. (2002). Existential psychotherapies. In D. J. Cain
& J. Seeman (Eds.), Humanistic psychotherapies: Handbook of research and
practice (pp. 253–278). Washington, DC: American Psychological Associa-
tion. http://dx.doi.org/10.1037/10439-008
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and
findings. Mahwah, NJ: Erlbaum.
Wampold, B. E. (2008, February 6). Existential–integrative psychotherapy
comes of age [Review of Existential–integrative psychotherapy: Guideposts
to the core of practice]. PsycCritiques, 53, Release 6, Article 1.
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evi-
dence for what makes psychotherapy work. New York, NY: Routledge.
Watson, J., & Bohart, A. (2015). Humanistic–experiential therapies in the era
of managed care. In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.),
The handbook of humanistic psychology: Theory, research, and practice
(2nd ed., pp. 585–600). Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/
9781483387864.n47
Watson, J. C., & Rennie, D. L. (1994). Qualitative analysis of clients’ subjective
experience of significant moments during the exploration of problematic
reactions. Journal of Counseling Psychology, 41, 500–509. http://dx.doi.org/
10.1037/0022-0167.41.4.500
Welwood, J. (2001). The unfolding of experience: Psychotherapy and beyond. In
K. J. Schneider, J. F. T. Bugental, & J. F. Pierson (Eds.), The handbook of human-
istic psychology: Leading edges in theory, research, and practice (pp. 333–341).
Thousand Oaks, CA: Sage.
Wertz, F. J. (2015). Humanistic psychology and the qualitative research tradi-
tion. In K. J. Schneider, J. F. Pierson, & J. F. T. Bugental (Eds.), The handbook
of humanistic psychology: Theory, research, and practice (2nd ed., pp. 259–274).
Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/9781483387864.n19
Westen, D., & Morrison, K. (2001). A multidimensional meta–analysis of treatments
for depression, panic, and generalized anxiety disorder: An empirical examination
of the status of empirically supported therapies. Journal of Consulting and
Clinical Psychology, 69, 875–899. http://dx.doi.org/10.1037/0022-006X.69.6.875

170
 References

Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The empirical

status of empirically supported psychotherapies: Assumptions, findings, and
reporting in controlled clinical trials. Psychological Bulletin, 130, 631–663.
http://dx.doi.org/10.1037/0033-2909.130.4.631
Wheelis, A. (1958). The quest for existential identity. New York, NY: Norton.
Whitehead, A. N. (1960). Process and reality: An essay in cosmology. New York, NY:
Harper Torchbooks.
Wolfe, B. E. (2008). Existential issues in anxiety disorders and their treatment.
In K. J. Schneider (Ed.), Existential–integrative psychotherapy: Guideposts to
the core of practice (pp. 204–216). New York, NY: Routledge.
Wolfe, B. E. (2016). Existential–humanistic therapy and psychotherapy inte-
gration: A commentary. Journal of Psychotherapy Integration, 26, 56–60.
http://dx.doi.org/10.1037/int0000023
Wolpe, J. (1969). The practice of behavior therapy. New York, NY: Pergamon.
Yalom, I. (1980). Existential psychotherapy. New York, NY: Basic Books.
Yalom, I. (1989). Love’s executioner. New York, NY: Basic Books.
Yalom, I. (1998). The Yalom reader. New York, NY: Basic Books.
Yalom, I. (2002). The gift of therapy. New York, NY: HarperCollins.

171
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Absurdity, challenge of, 28 Attitude(s)

Act, freedom to, 16 of E–H therapy, 13
Addressing questions, 4–5 freedom to adopt, 16
Affective dimension, 18, 39 Awareness
Affirming one’s being, by dimensions of, 23
acknowledging one’s facilitating, 50–51
limitations, 18 as subjective reaction, 25
Agency Awe
in definition of existence, 24 coalescence of meaning,
sense of, 38 intentionality, and, 71–73
Aliveness, 39 cultivation of, 72
Aloneness, challenge of, 28 in E–I therapy, 148
American humanistic psychology, 7–8 Awe-based approach, 112
American Psychological Association,
112 Be, freedom to, 16
Angel, E., 11, 115 Become distinct/unique/heroic,
Anxiety capacity to, 16
cognitive–behavioral interventions Behaviorism, 10, 116
for, 13 Being
and meaning making, 23–24 choosing/actualizing ways of, 23
Apollonian (rationalist–linear) philosophy of, 10–11
living, 10 “Being-in-the-world,” 10–11
Applications of E–H therapy, 13, Binswanger, Ludwig, 10
75–76 Bodily expression, of self and world
Arts-based therapy, 111 constructs, 33–34
Assessment, 31–35. See also Bohart, A. C., 101–102
Evaluation Boles, S., 101
Attachment disorder, clients with, 13 Boss, M., 10, 101

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Buber, Martin, 21, 30, 40–41, 53, Clinical training programs, 13–14
55–56, 116 dearth of funding for, 94
Bugental, Elizabeth, 118 need for, 95
Bugental, J. F. T., 19, 20, 26–27, research on, 101
46–47, 61, 62, 69–70, 74, Cognitive–behavioral interventions,
101, 115 13, 76–82, 111
Buhler, Charlotte, 12 Comas-Díaz, L., 105–106
Commission on Accreditation (APA),
Calton, T., 100 112
Camus, Albert, 27 Commitment, 38
Capacity(-ies) Common factors, outcomes due to
to become distinct, unique, techniques of therapy vs., 42,
heroic, 16 99–100
for choice, 37–38 Communication
and constrictive–expansive of self and world constructs, 21
continuum, 28–29 verbal and nonverbal channels
to create meaning, 16, 28 of, 19
for presence, 21, 31–35 Community, challenge of, 28
for psychological health/ The Concept of Dread (Kierkegaard), 9
maturity, 27 Confrontation with resistance, 69–71
to separate from others, 16 Constrictive–expansive continuum,
to transcend past, 16 28–29
Caring, about direction, 38 Content, process vs., 32–33, 43–46
Change Cosmic destiny, 16
in definition of existence, 24 Cosmic dimension, 18
in E–I therapy, 145–146 Covert intrapsychic determinism, 10
experiential, 122 Craig, E., 119
inter- and intrapersonal Creation of meaning, 16
dimensions of, 75 Creativity
and I–Thou relationships, 30 growth and re-creation through,
in long-term therapy, 127–129 25
presence as container for, 74 meaning making in, 24
primary mechanisms of, 73–75 Murray on, 10
second order/deep, 102 Criswell, Eleanor, 118
in self, 26–27 Cultivation
who, what, and how of, 5 of awe, 72
Choice, cultivating capacity for, of capacity for choice, 37–38
37–38 of presence, 21–22, 40–58, 73–74,
Circumstantial destiny, 17 110–111
Client base for E–H therapy, 12–13 Cultural destiny, 16–17
Client-centered therapy, 116 Culture
Clients’ battles, 48 as obstacle to E–H therapy, 5
Clinical assessment, 31–35 as self-imposed limit, 16

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 Index

Death Embodied self, lived experience of,

challenge of, 27 26–27
as given of existence, 15, 27 Embodiment of client presence, 44–46
Depression, phenomenology Emotional disabilities, people with,
of, 22 111
Depth practice, 13, 112 Emotional regulation, neuroscience
De Quincey, C., 24 of, 100
Destiny, 16–17, 26. See also Empirically supported treatment
Limitations (EST) movement, 98
Determinism, challenge of, 28 Encounter(s), 53
Diagnosis deepening, 39
in E–H therapy, 34–35 influence of past on, 21
presuppositions in, 22 with resistance, 58–71
Dialectical process, identity creation self and world constructs in, 44
as, 25 therapeutic presence as ground for,
Dialectics, givens as, 27–28 40–43
Dialogical approach, 30–31 Epp, L. R., 106
Dimensions, givens as, 27–28 Ernest Becker Foundation, 112
Dionysian (nonrationalist– EST (empirically supported
spontaneous) living, 10 treatment) movement, 98
Distinct, capacity to become, 16 Evaluation, 97–107
Do, freedom to, 16 of E–H therapy with diverse range
Dreams, working with, 51 of clients, 105–106
Drug counseling, 13 research on E–H therapy, 97–103
Dupuy, P., 102 of social and spiritual dimensions
Dysfunctional identification, of transformation, 106–107
with limits, 17 for specific problems and client
populations, 104–105
Economic obstacles to E–H therapy, Existence
94–95 awareness of, 23
Edelstein, Bob, 118 givens of. See Givens of existence
EHI (Existential–Humanistic and meaning making, 24
Institute), 15, 118 relation of a person to, 20–21
E–H theory. See Existential– Existence (May, Angel, and
Humanistic theory Ellenberger), 11, 115
E–H therapy. See Existential– Existential–analytic approach, 11–12
Humanistic therapy Existential humanism, 7, 8
E–I therapy. See Existential– Heidegger’s philosophy of being,
integrative therapy 10–11
Elkins, D. N., 97 and humanistic psychology, 11
Ellenberger, H., 11, 115 in psychology and psychiatry,
Emancipatory practices, 13, 17–19 10–11
Embodied meditation, 49–50 roots of, 9

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 Index

Existential–humanistic approach, background of, 115–116

11–12, 98–99 basic principles of, 4–5
Existential–Humanistic Institute client base for, 12–13
(EHI), 15, 118 contemporary approach in, 12–14
Existential–Humanistic Northwest, distinctions between other
15, 118 therapies and, 30–31
Existential–Humanistic (E–H) theory, distinguishing factors of, 6
15–35 with diverse range of clients, 105–106
acknowledgment of freedom’s ecumenism in, 104
limitations in, 16–17 evaluation of, 97–107
capacity for presence in, 31–35 female practitioners in, 12
clinical assessment in, 31–35 as forward edge of practice,
constrictive–expansive continuum 110–111
in, 28–29 goal of, 15–16
core aims in, 22–23 integrative practices in, 13–14,
cultivation of presence in, 21–22 29–30
dialogical approach in, 30–31 origins of, 9–12
embodied yet changing self in, outcome studies supporting, 14
26–27 outlook and challenges for, 111–113
existential–integrative approach practice philosophies in, 118–119
in, 28–30 present situation for, 116–117
four givens of existence in, 27 process of. See Therapy process
freedom and destiny in, 26 research on, 97–103
freedom within limits in, 15–16 research support for, 117
givens as dimensions or dialectics social and spiritual dimensions of
in, 27–28 transformation, 106–107
goals of, 15–23 for specific problems and client
integration of freedom and populations, 104–105
limitation in, 17–19 stereotypes of, 6
interpersonal dimension in, 30–31 and trends in health care, 109–110
interpretations of experiential values of, 8, 13
mode in, 19–20 varied perspectives in, 11
key concepts in, 23–31 Existential–Integrative Psychotherapy
patterns of psychological health in, (Schneider), 98
26–31 Existential–integrative (E–I) therapy,
present moment as central concern 3–4, 13–14, 28–30
in, 20–21 experiential stances of, 145–148
sense of self in, 23–25 practice philosophies in, 118–119
Existential–Humanistic (E–H) present situation for, 116–117
therapy, 3–6 problems and client populations
application areas for, 13, 75–76 in, 104
assessment of, 31–35 research support for, 117
attitude of, 13 Wampold on, 98

176
 Index

Existentialism, 7 Experience(s). See also Lived

Existential philosophy. See also experience
Existential humanism content vs. process of, 32–33
in American existential “I am,” 23, 26
psychology, 11 limiting, 9
and behaviorism and of presence, 22
psychoanalysis, 10 shaping of, 25
existential predicament in, 23 structure of, 24–25
formalization of, 9 Experiential change, 122
Kierkegaard, 9–10 Experiential mode, interpretations of,
Nietzsche, 10 19–20
Existential predicament, 23 Experiential reflection, 8
Existential psychology/therapy, 25 as dimension of functionality, 26
in America, 11–12 variation in stress on, 11
basic assumption of, 25 Experimentation
empirical support for, 99–103 outside of therapy, 50–51
evaluation of, 97–107 within therapy, 50
and existential humanism,
10–11 Fauth, J., 101
existential predicament in, 23 Fear, of life and of death, 10
forms of, 5 Female E–H practitioners, 12
identity creation position in, 25 Ferriter, M., 100
limited evidence for, 102–103 Foundations of Existential–
obstacles to obtaining research Humanistic Practice, 118
funds in, 103 Freedom, 8
qualitative studies of, 101–102 acknowledging limitations of,
quantitative studies of, 99–101 16–17
Existential stances or conditions, as aim of E–H therapy, 37
40–73 to be or to adopt attitudes, 16
coalescence of meaning, challenge of, 28
intentionality, and awe, in definition of existence, 24
71–73 and destiny, 16–17, 26
cultivation and activation of as dimension of functionality, 26
presence, 43–58 to do or to act, 16
cultivation of therapeutic presence, in E–H theory, 15
40–43 emerging from crisis, 9
encounter with resistance failure to acknowledge, 17
(protections), 58–71 as given of existence, 27
interpersonal presence, 53–58 and “healing through meeting,” 30
intrapersonal presence, 46–53 integration of limitation and, 17–19
presence as ground, 40–43 within limits, 15–16
presence as method and goal, price of, 16
43–58 variation in stress on, 11

177
 Index

Freud, Sigmund, 10 History of Existential–Humanistic

Friedman, M., 19, 30, 40–43, 53, therapy, 7–14
55–56, 116 contemporary approach, 12–14
origins, 9–12
Gates, S., 101 Hoffman, Louis, 118
Gay and lesbian counseling, 13 Holistic appraisal, 31
Gender identity, 111 Holistic therapy, 29, 109–110
Gendlin, E. T., 19 Huband, N., 100
Genetic destiny, 16 Human-being-in-the-world, 10–11
Giordano, F., 102 Humanism, 7
Givens of existence Humanistic psychology, 7–8, 11
acceptance of, 18 Human potential movement, 11
destinies as, 16–17 Husserl, Edmund, 10, 11
as existential dimensions/
dialectics, 27–28 “I am” experience, 23, 26
helping clients face, 23 Identity, 17, 18
natural limits of living, 15 Identity formation, 23–25
nature and specificity of, 20 Immediate dimension, 18, 39
need to confront, 19–20 Imprisonment, 9
Giving self over to others, 16 “I-ness,” sense of, 38
Goal(s) of E–H therapy, 15–23 Inner vision, 74
Granger, Nathaniel, 118 Instructing, to activate client presence,
Greenberg, L. S., 100 46–47
Greening, T., 27–28 Integrative practices
Ground for encounters, presence as, E–H as leading context for, 110
40–43, 74 in E–H therapy, 13–14
Groups Intentionality, 8, 71–73
emancipatory practices with, 13 Interdependent dimension, 30
for older adults, 111 International Institute for Humanistic
Growth, I–Thou relationships Studies, 118
and, 30 Interpersonal dimension, 19, 30–31,
Guiding, to activate client presence, 75
46–50 Interpersonal presence, in therapy, 44,
53–58
Hanna, F. J., 102 Interpersonal relationships, early
Hayes, J. A., 101 ruptures in, 21–22
“Healing through meeting,” 30 Interpretations, 75
Health care, market-driven, 109, 113 Intersubjective presence, 21. See also
Heery, Myrtle, 118 Interpersonal presence
Heidegger, Martin, 10–11 Intimacy
Hernandez, James, 112 enhanced capacity for, 18
Heroic, capacity to become, 16 and I–Thou relationships, 30
Hillman, J., 107 Intrapersonal dimension, 19, 75

178
 Index

Intrapersonal presence, in therapy, 44, Lived experience

46–53 constrictive–expansive continuum
Intrapsychic determinism, 10 in, 28–29
Invoking the actual, in E–I therapy, of embodied yet changing self,
146–147 26–27
Isolation, as given of existence, 27 experimentation in, 50–51
I–Thou relationships, 30, 56, 57 of freedom and destiny, 26
and givens of existence, 27–28
Jackson, Theopia, 118 sense of self created from, 23
James, William, 10 The Living Institute, 15, 118
Journal of Psychotherapy Integration, 13 Long-term therapy, 38, 104
Journal of Social and Clinical Claudia (case), 131–144
Psychology, 103 Emma (case), 83–89
Jung, Carl G., 10 Malcolm (case), 89–94
phases of change in, 127–129
Kass, Sarah, 118 strategies and techniques for,
Kierkegaard, Søren, 9–10 82–94
Kinesthetic dimension, 18, 19, 39
Krug, O. T., 19, 32–33, 43, 51, 58–61, Marcel, G., 21
63–65, 76–82, 101–102, 118, Mardon, Caroline, 118
131–144 Market-driven health care, 109
May, R., 11, 18–21, 23–26, 41, 47, 71,
Laing, R. D., 19 101, 115–117
Längle, A., 119 Meaning
Language, as self-imposed limit, 16 anxiety and creation of, 23–24
Lao Tzu, 3 capacity to create, 16
Levinas, Emmanuel, 57 challenge of, 28
Liberation, 29, 88 coalescence of intentionality, awe,
Liberation-based therapies, 112 and, 71–73
Liberation conditions, 29 developing sense of, 71
Lifestyle in E–I therapy, 148
challenge of, 27 enhanced capacity for, 18
as self-imposed limit, 16 form polarities of freedom and
Limitations destiny, 26
attunement to, 43 and self and world constructs, 24
of freedom, 15–17 Meaninglessness, as given of
and “healing through meeting,” 30 existence, 27
integration of freedom and, 17–19 Meditation, embodied, 49–50
natural limits of living, 15 Mendelowitz, E., 6
self-imposed, 16 Method, presence as, 43–58, 74
Limiting experiences, 9 Minorities, therapy with, 13
Listening, to activate client presence, Mirroring work, 62–63, 67–68, 71
46–48 Mosher, L., 99–100

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 Index

Multicultural dimensions of practice, in E–I therapy, 146

13, 111 experiencing ways of mobilizing/
Murray, Henry, 10 blocking, 22
Mythology, 10 as ground, 40–43, 74
helping clients to experience, 22
Natural limits of living, 15. See also interpersonal, 44, 53–58
Givens of existence intrapersonal, 44, 46–53
Nature, as process vs. thing, 24 as method and goal, 43–58, 74
Nietzsche, Friedrich, 10 Present moment
Noting resistance, 65–66, 71 as central concern, 20–21
experiences of the past in, 22
O’Hara, M., 112 formation of client’s world in, 25
Older adults, 111 influence of past on encounters
Outcomes. See also Evaluation in, 21
due to common factors vs. to Presuppositions, 22
techniques of therapy, 42 Process, 24, 25
research on E–H therapy context of client experiences, 32–33
factors, 97–103 content vs., 32–33, 43–46
studies supporting E–H therapy, 14 in E–H therapy. See Therapy
process
Passion, 39 Profound dimension, 18
Passivity, capacity for, 16 Protections. See Resistance
Patterns of psychological health, Psychoanalysis, 10
26–31 and early interpersonal
Perls, F., 8 relationship ruptures, 21–22
Phenomenology, 11, 22 and principles of E–H therapy, 116
Phobic clients, cognitive–behavioral Psychodynamic modalities, 111
interventions with, 13 Psychodynamic presuppositions, 22
Physical disabilities, people with, 111 Psychological health, patterns of, 26–31
Pierson, Fraser, 118 The Psychology of Existence (Schneider
Pierson, J. F., 101–102 and May), 116
Piwowarski, T., 101–102 Psychoses, 111
Posttraumatic stress disorder (PTSD) Psychotic clientele, therapy with, 13
case, 76–82 PTSD (posttraumatic stress disorder)
Presence, 21. See also Therapeutic case, 76–82
presence Puhakka, K., 102
activation of, 43–58
assessing client’s capacity for, Rank, Otto, 10
32–34 Rationalist–linear (Apollonian) living,
capacity for, 21, 31–35 10
as core competency, 110–111 Reality
cultivation of, 21–22, 40–58, construction of, 23–24
73–74, 110–111 as process vs. things, 24

180
 Index

Relational modalities, 111 Saybrook University, 118

Relationships in therapy. See Roles Schneider, K. J., 6, 19, 28–30, 34,
and relationships in therapy 44–46, 48–50, 66–67, 70–72,
Religion, 111 82–94, 101, 102, 112, 116–117,
Religiously distressed clients, 119, 121–125
psychodynamic mediations The Search for Authenticity (Bugental),
with, 13 115
Rennie, D. L., 101–102 Self
Requiring, to activate client presence, embodied yet changing, 26–27
47 sense of, 18, 23–25
Research Self and world constructs,
on clinical training programs, 20–21, 24
101 bodily expression of,
on E–H therapy, 97–103, 117 33–34, 44
on E–I therapy, 117 in therapeutic encounter, 44
increasing support for, 117–119 Self-awareness, facilitating, 50–51
obtaining funds for, 103 Self-imposed limits, 16
Resistance, 58–71 Self-protection, 58–71
caveats when considering, 62–63 Sense of self, 18, 23–25
examples of, 58–61, 63–66, 69–70 Separateness
forms of work with, 65–71 capacity for, 16
mirroring work with, 62–63 as given of existence, 15
revisitations with, 66–67 Serlin, Ilene, 118
transference of, 61 Sexual abuse, 111
Responsibility assumption, 8 Sharp, J. G., 101–102
as commitment, 38 Short-term therapy, 38, 104
for construction of current lives, Hamilton (case), 121–125
22–23 strategies and techniques in,
in definition of existence, 24 75–82
as dimension of functionality, 26 Social dimensions, 106–107
as preparation for substantive Society of Humanistic Psychology,
change, 18 118
variation in stress on, 11 Soteria House, 99–100
Restraint, capacity for, 16 Spandler, H., 100
Revisitation, 66–67 Spiritual connection, enhanced
Rice, D., 105 capacity for, 18
Rogers, C. R., 8 Spiritual dimensions, 13, 31,
Roles and relationships in therapy, 106–107
39–75 Spirituality, 10, 111
existential stances or conditions, Spiritually distressed clients,
40–73 psychodynamic mediations
primary change mechanisms, 73–75 with, 13
Rubin, Shawn, 118 Standardization, ethos of, 111

181
 Index

Stereotypes of E–H, 6 Therapy process, 37–96

Sterling, M., 56–58, 118 existential stances or conditions in,
Strategies and techniques 40–73
for activating client presence, obstacles and problems
46–47 encountered in, 94–96
long-term, 82–94 primary change mechanisms in,
short-term, 75–82 73–75
Structure of experience, 24–25 roles and relationship in, 39–75
Struggle, 26. See also Resistance short- and long-term strategies
Sullivan, H. S., 53 and techniques in,
Supervision Essentials for Existential– 75–94
Humanistic Therapy (Krug and Tillich, R., 19
Schneider), 101 Tracing out, 68–69
Transcendence, 102
Tagging resistance, 66–67, 71 Transcend past, capacity to, 16
Tallman, K., 101–102 Transpersonal movement, 8
Tantam, D., 119 Trauma, roots of, 22
Techniques of therapy. See also Trotman, Alicia, 118
Strategies and techniques Trust dimension, 51–53
long-term, 82–94
outcomes due to common factors Uncertainty, as given of existence,
vs., 42, 99–100 15
short-term, 75–82 Unique, capacity to become, 16
Theory. See Existential–Humanistic
(E–H) theory Values
Therapeutic encounters. See of Existential–Humanistic therapy,
Encounter(s) 8, 13
Therapeutic experiencing, Kierkegaard on, 9–10
philosophical implications of, Van Deurzen, E., 119
19–20 Ventura, M., 107
Therapeutic pause, 47–48 Vinca, M. A., 101
Therapeutic presence Vivification of resistance, 65–69, 71,
activation of, 43–58 147
as aspect of deepening encounters, Vontress, C. E., 106
39
cultivation of, 40–58 Wampold, B., 95, 98
gravity of, 40–41 Wampold, B. E., 42, 110
as ground, 40–43 War veterans, 13, 111
as method and goal, 43–58 Watson, J. C., 102
modalities of, 41 Watson, John, 10
value of, 42–43 Whitehead, Alfred N., 24, 25
Therapeutic relationship, 53 Whole-bodied capacities, 8

182
 Index

The Wiley World Handbook of World Congress for Existential

Existential Therapy (van Therapy, 118, 119
Deurzen, Craig, Längle,
Schneider, & Tantam), 119 Yalom, I., 19, 20, 27, 30, 41,
Working “space,” 47–48 42, 48, 50–51, 53–55, 81,
World Confederation for Existential 101, 116
Therapy, 118 Yang, Mark, 118

183
 About the Authors

Kirk J. Schneider, PhD, is a licensed psychologist and leading spokes­

person for contemporary existential–humanistic psychology. Dr. Schneider
is past president (2015–2016) of Division 32 of the American Psychologi­
cal Association (APA), the Society for Humanistic Psychology; past editor
of the Journal of Humanistic Psychology (2005–2012); president-elect of the
Existential–Humanistic Institute; and adjunct faculty at Saybrook University
and Teachers College, Columbia University.
A Fellow of APA, Dr. Schneider has published more than 100 arti­
cles and chapters and has authored or edited 11 books (several of which
have been translated into Chinese, German, Greek, Russian, Turkish, and
Portuguese). These books include The Paradoxical Self, Horror and the Holy,
The Psychology of Existence (with Rollo May), The Handbook of Humanistic
Psychology (2nd ed., with Fraser Pierson and James Bugental), Rediscovery
of Awe, Existential–Integrative Psychotherapy, Existential–Humanistic Ther-
apy (with Orah Krug; an accompanying APA video is available), Human-
ity’s Dark Side: Evil, Destructive Experience, and Psychotherapy (with Art
Bohart, Barbara Held, and Ed Mendelowitz), Awakening to Awe, The
Polarized Mind, and Supervision Essentials of Existential–Humanistic Therapy
(with Orah Krug). The Wiley World Handbook of Existential Therapy (with
Emmy van Deurzen et al.) and The Spirituality of Awe: Challenges to the
Robotic Revolution are in preparation.
Dr. Schneider is the recipient of the Rollo May Award from Division 32
of APA for “outstanding and independent pursuit of new frontiers in

185
 About the Authors

humanistic psychology”; the Cultural Innovator award from The Living

Institute, Toronto, Ontario, Canada, a psychotherapy training center that
bases its diploma on Schneider’s existential–integrative model of therapy;
and an honorary diploma/membership from the Society for Existential
Analysis of the United Kingdom and the East European Association of
Existential Therapy. He is also a founding member of the Existential–
Humanistic Institute in San Francisco, which in August 2012 launched
one of the first certificate programs in existential–humanistic practice to
be offered in the United States.
In April 2010, Dr. Schneider delivered the opening keynote address at
the First International (East–West) Existential Psychology Conference in
Nanjing, China, and has repeatedly been invited to speak at similar venues
in China and Japan over the past several years. He delivered a keynote
address at the first World Congress for Existential Therapy in London in
May 2015. For further information about Dr. Schneider, visit his website
(http://www.kirkjschneider.com).

Orah T. Krug, PhD, is a licensed psychotherapist with a private practice in

Oakland, California. She is the clinical training director of the Existential–
Humanistic Institute of San Francisco and teaches at Saybrook Graduate
School. Dr. Krug received her doctorate from Saybrook Graduate School,
where she was awarded the Rollo May Scholarship for an essay comparing
the theoretical approaches of her two mentors, James Bugental and Irvin
Yalom. She has produced two videos, Conversations With Jim and “Joe”:
A Demonstration of the Consultation Process, with James Bugental.
Her current research focuses on the relationship between the cultiva­
tion of intra- and interpersonal presence and the contextual factors of
therapy associated with therapeutic change. Her article in the Journal of
Humanistic Psychotherapy, “James Bugental and Irvin Yalom: Two Masters
of Existential Therapy Cultivate Presence in the Therapeutic Encounter,”
began an exploration of this research.

186
 About the Series Editors

Jon Carlson, PsyD, EdD, ABPP, is distinguished professor, psychology and

counseling at Governors State University and a psychologist at the Wellness
Clinic in Lake Geneva, Wisconsin. Dr. Carlson has served as editor of several
periodicals including the Journal of Individual Psychology and The Family
Journal. He holds Diplomates in both family psychology and Adlerian
psychology. He has authored 175 journal articles and 60 books including
Time for a Better Marriage, Adlerian Therapy, Inclusive Cultural Empa-
thy, The Mummy at the Dining Room Table, Bad Therapy, The Client Who
Changed Me, Their Finest Hour, Creative Breakthroughs in Therapy, Moved
by the Spirit, Duped: Lies and Deception in Psychotherapy, Never Be Lonely
Again, Helping Beyond the Fifty Minute Hour, Psychopathology and Psy-
chotherapy, How a Master Therapist Works and Being a Master Therapist.
He has created over 300 professional trade video and DVDs with leading
professional therapists and educators. In 2004 the American Counseling
Association named him a “Living Legend.” In 2009 the Division of Psy-
chotherapy of the American Psychological Association (APA) named him
“Distinguished Psychologist” for his life contribution to psychotherapy
and in 2011 he received the APA Distinguished Career Contribution to
Education and Training Award. He has received similar awards from four
other professional organizations.

187
 About the Series Editors

Matt Englar-Carlson, PhD, is a professor of counseling at California

State University–Fullerton. He is a fellow of Division 51 of the Ameri-
can Psychological Association (APA). As a scholar, teacher, and clinician,
Dr. Englar-Carlson has been an innovator and professionally passionate
about training and teaching clinicians to work more effectively with their
male clients. He has more than 30 publications and 50 national and inter-
national presentations, most of which are focused on men and masculinity
and diversity issues in psychological training and practice. Dr. Englar-
Carlson coedited the books In the Room With Men: A Casebook of Thera-
peutic Change and Counseling Troubled Boys: A Guidebook for Professionals
and was featured in the 2010 APA-produced DVD Engaging Men in Psy-
chotherapy. In 2007, he was named Researcher of the Year by the Society for
the Psychological Study of Men and Masculinity. He is also a member of
the APA Working Group to Develop Guidelines for Psychological Practice
With Boys and Men. As a clinician, he has worked with children, adults, and
families in school, community, and university mental health settings.

188