Existential therapy; different approaches in counselling

The first meeting with a counsellor can be challenging, even for the most confident client, but it is an important meeting particularly as this initial encounter provides an opportunity for the client to learn more about the various types of counselling provided.

Counselling is an investment in terms of time and emotional energy, as well as fees. Given that, it seems sensible for new clients to take time to consider whether the type of counselling being offered by the therapist contacted is likely to meet her or his needs. That can sometimes be a challenging discussion to have with a counsellor at an initial meeting, particularly if the client’s emotional world is in turmoil.

At that first appointment, there may not always be enough thinking space available to the client to allow for even a basic understanding of counselling options. That difficulty can be exacerbated if the therapist starts to talk about sophisticated methodologies. That challenge can be particularly evident if the counsellor refers to working as an existential therapist.

The word existential is capable of many different interpretations. Existential counselling takes directly from existential philosophy. The broad tenets of existentialism can include uncertainty, an awareness of the absence of defined structure in life but with an acknowledgement of personal accountability and responsibility.

Our existence presents us with perpetual choices, including those unsought. As we grow and develop from a childish state we become progressively more responsible for our personal decisions. We are increasingly accountable to ourselves. We may continually look to stand alongside others, but our reality is that we still stand alone.

If that is a brief glance at aspects of existential philosophy, an explanation of existential therapy and how it can be applied in the counselling room requires far more than a brief article. Nevertheless, the way in which a counsellor defines her or his practice and the reasons why an existential label is used may be a good starting point for a client who wants to learn more about existential therapy work.

There are two broad approaches with regard to the practice of existential therapy. The first sees therapists looking closely at the detailed content of what the client brings before suggesting a specific way of working. The type of counselling offered to the client will be strongly influenced by the issues and concerns presented by the client. These counsellors are likely to be trained in different strategies, not just existential therapy, and may follow what is now often referred to as a pluralist path in their work with clients.

For example, if the material presented by the client relates to a very specific emotional disturbance where immediate relief is sought from obsessive behaviours or intrusive thoughts, an appropriate approach may be some form of Cognitive Behaviour Therapy (CBT). A subsequent situation may, however, see the same counsellor working with another client where obsessive thoughts again appear. Yet, on this occasion, those thoughts may appear to be masking much broader themes including concerns of fundamental uncertainty. For that second client, the counsellor may suggest an existential approach to the work.

The counsellor’s way of working is very clearly driven by the material presented by the client. The therapist may decide to provide what could be regarded as existential support but only because that seems to fit with the client need at a particular time. The approach can be said to be situation-specific.

An alternative may be where the counsellor sees her or his primary way of working with clients as consistently involving an existential approach. The therapist regards her or his self as an existential therapist, per se. This therapist will always look to see the client material within an existential frame of reference. The work with the client will, for this counsellor, continually return to existential themes, albeit with a focus on those aspects of existential work which are likely to be most helpful for the client who is presenting in the therapy room.

There is no intention in this note to suggest to potential clients that either approach is right or wrong. These are quite simply two very different counsellor perspectives which clients may find it helpful to be aware of.

Perhaps a key question for the client is whether the approach adopted by their potential therapist is really that important. Is the technical position held by the therapist something for the client to be concerned about? Does a certain counselling approach really matter, or is the main influence on the effectiveness of the work likely to be the strength of the relationship in the room?

This question returns to the opening comments in this note. Does the potential new client want to have a detailed awareness of what is being offered by the therapist? There are certainly some basic requirements for effective counselling work which clients should always expect to find. This includes the provision of a safe and secure place, the establishment of a good working alliance and confidence on issues around confidentiality and the ethical dimension. But beyond this? Perhaps this depends on the approach of the client rather than the counsellor.

Some clients, in looking for a counsellor, will first and foremost want to find safety and a sense of being held. Methodologies and techniques for these clients may be unimportant perhaps because of the pressures of the moment.

Other clients, perhaps driven by intellectual curiosity, will require more than a good relationship with their therapist. These clients will want to know much about the intended process and content in order to decide whether to continue with the particular therapist.

The counsellor response from the outset should look to match client needs. If information on the therapy process is sought, then clients ought to expect that to be given. Some didactic therapies such as cognitive behaviour therapy (CBT) or solution-focused therapy can be described to new clients relatively easily.

Other approaches such as existential work may require a different form of explanation. Clients should however still expect that information to be provided in a straightforward way, even if that does require greater effort and imagination from the counsellor.