Existential Psychotherapy Ghaemi., S. (2007).

Existential Psychotherapy

Ghaemi., S. (2007). Feeling and Time: The Phenomenology of Mood Disorders, Depressive Realism, and Existential Psychotherapy. Schizophrenia Bulletin, 33(1), 122-30.

Gahemi is a member of the Bipolar Disorder Research Program in the Department of Psychiatry / Rollins School of Public Health at Emory University in Atlanta, Georgia. Hi focus here is to discover whether or not the depressive realism model is a more applicable line of therapy that the more typically used cognitive distortion model when it comes to the treatment of patients with mild to moderate depressive states. He further suggests that the process of existential psychotherapy is a necessary tool in application of the depressive realism model in these instances. He further relates this to cases of chronic subsyndromal depression that is frequently associated with bipolar disorder under treatment that may under his view represents existential despair instead of a depressive disorder. This suggests that a proper intervention would be the use of existential psychotherapeutic methods.

The author points out that it is important understand that in relation to severe mood disorders, the prevailing research should assess how manic and depressive states differ from a phenomenological perspective and then draw a more relevant diagnosis with both biological as well as therapeutic implications. He goes on to provide a current overview of the research regarding many of the phenomenological aspects of mood states and then proposes the clinical implications of such knowledge. He goes on to present quite a bit of information regarding mixed mood disorders as well as perspectives on time perception, insight and despair.

He finds that the depressive realism model is a viable model of depression and that current modes in psychiatry have neglected the positive effect that a more phenomenological approach may yield regarding depressive disorder. He further notes that Existential psychotherapy may best be used as a treatment for persons with mild depression as understood under the depressive realism model. Here there are no cognitive distortions of reality to remove, and if anything the patients are overly realistic about their lives in general. Furthermore, in the case of the patient with mild depressed who has no hallucinatory illusions there are no illusions left for psychoanalysis to strip away. Therefore the standard treatments under the Cognitive-Behavioral Model are inappropriate. Existential psychotherapy on the other hand accepts the patient as he or she is. It also acknowledges the valid portrayal of the perceived depressing realities of existence that the patient experience and goes on from that point. As the author states it is a, "pure encounter of two souls in the travails of life, rather than a treatment of a sick person by a healthy one." (Ghaemi, 2007, p. 127)

While the article certainly supplies a great deal of information regarding the current treatment of mild depressive disorder, it does so from secondary sources. Dr. Ghaemi certainly proposes new and interesting ideas in the understanding and possible treatment of mild depression suing phenomenological approaches such as existential psychotherapy. However, while it is certain that sometime people experience existential angst and they are treated with medication for it instead of therapy, the possibility of misdiagnosis may be an issue. Someone who needs medication may be given therapy and the consequences could be less then nominal. But one must admit that the author certainly has a point consideration the prevalence of prescribed anti- depressive drugs has soared in the past 20 years alone. Medical doctors and not psychiatrist prescribing most of it creates another issue regarding misdiagnosis when neither an existential therapist nor a psychiatric professional is examining the patient for a mood disorder along the DMV axis.

Keshen, a. (2006). A New Look at Existential Psychotherapy. American Journal of Psychotherapy, 60(3), 285-98.

In his article the author contends that existential psychotherapy has remained largely absent in the mainstream practice of psychotherapy. Dr. Keshen feels that the reason for this is that most of the literature that is available on the subject is extremely convoluted. Even the foremost authors on the subject disagree on it verities making most existential psychotherapists' ideas heterogeneous. However, the author feel that if a more precise and well-defined model of existential psychotherapy could be developed that would be amenable to some kind of empirical validation it may be more accepted by the psychotherapeutic community. The author's purpose for this article is to crate a more clinically oriented version of existential psychology and crate a template for a "manualized" approach into the field of existential psychotherapy.

The author goes on to explore the main principles of existential psychotherapy and create an excellent diagram to exampling the overall components of the process (this is reproduced in the appendix). The main tenant of existential psychology is that all human beings have a will to purpose, a sense of engagement that give their live meaning. However, if this will to purpose remains unfulfilled for too long, an existential vacuum or void in their lives develops which may in turn become an existential neurosis (see the diagram in the appendix). This dilemma makes the patient engage in actions such as defense mechanisms to fill this void. Many are often demeaning and self-destructive such as addictive disorder, social anxiety some type of narcissism and replacement factors such as a workaholic syndrome. These are purpose substitutes because they are substitutes for activities that give authentic purpose.

The author attempt to quantify Authentic Purpose with the following definitions:

Authentic Purpose (AP) is derived from anything that one has a genuine love or interest in (as long as it does not compromise others or self). Authentic Purpose has some core similarities to the concept of "authenticity" (Bugental, 1987; Heidegger, 1962; Sartre, 1958) but is less philosophically loaded and abstract; thus, it is more applicable to clinical use. (Keshen, 2006, p. 292-293)

Dr Keshen then goes on to review six case studies in support of the clinical effort to research and develop a substantiated analysis for the application existential psychotherapy in the mainstream field of psychology.