Philosophical counselling is an extension of philosophical consultancy which focuses on outcomes of an emotional or psychological nature. Philosophical counsellors help people in distress or confusion to evaluate their worldviews and reorient their emotional dispositions, without applying diagnostic labels or imposing clinical treatment programs. Philosophical counselling can have profound psychological benefits. Counsellors engage in dialogue about personal problems, predicaments and values, addressing the issues of concern in a professional and respectful manner and reflecting on the best ways to act or adjust. Often philosophical progress can alleviate the sources of stress and anxiety more directly than courses of medication or programs of psychotherapy. For many people, this is a personal breakthrough. Existential Counselling Existential Counselling focuses on the individual’s lived experience and examines the nature of their worldviews and the meaning of their emotions, promoting philosophical reflection and a coherent purpose in daily life. It is a humanistic and phenomenological approach to counselling, which encompasses insights and methods from many philosophical paradigms. It takes its name from the nature of the problems it addresses rather than from the Continental doctrines of Existentialism; it is independent of particular philosophical paradigms. For an accessible summary, see Emmy van Deurzen’s “What is the Existential Approach?”. Logic-Based Therapy LBT is an extension of rational emotive behavior therapy and cognitive behavior therapy. It assumes that emotions embody the conclusions of practical syllogisms, and attempts to identify and correct flawed premises. Read more in Elliot D. Cohen’s “Philosophical Principles of Logic-Based
Jungian therapy
Jungian therapy – or Jungian analysis as it is also known – is a psychoanalytic approach that was developed by leading psychotherapist, Carl Gustav Jung. Along with Freud, Jung is considered one of the pioneers of modern depth psychology, particularly of the unconscious mind. Although Jung worked with Freud for some time, they eventually parted ways due to differing theories. Whilst Freud asserted that dreams and the unconscious are personal things contained within an individual, Jung believed that the personal unconscious is only the top layer of a much deeper, larger collective unconscious – the uncontrollable, inherited part of the human psyche which is made up of patterns (archetypes) common to all humanity. In Jungian therapy, these patterns can explain why we have habits we cannot break, such as addictions, depression and anxiety. Therefore the approach aims to analyse these archetypes in order to better understand the human self. Through the process of self-awareness, transformation and actualisation, Jungian therapy can help individuals see what is out of balance in their psyche. This is to empower them to consciously make changes that will help them to become more balanced and whole.
Existential psychotherapy
Existential psychotherapy is based upon the principles of psychodynamic therapy, humanistic and existential psychology, the latter being a movement with roots in the existential philosophy and writings of Heidegger, Husserl, Dostoevsky, Kafka, Camus, Kierkegaard, Nietzsche, Sartre, and others. During the mid-twentieth century, pioneering European clinicians like Otto Rank, Karl Jaspers, Medard Boss, and Ludwig Binswanger were among the first to apply existential principles to the practice of psychotherapy, followed prominently by Viktor Frankl (Vienna), R.D. Laing (London), Rollo May (pictured here) and Irvin Yalom (United States). Existential psychotherapy is often misperceived as some morbid, arcane, pessimistic, impractical, cerebral, esoteric orientation to treatment. In fact, it is an exceedingly practical, concrete, positive and flexible approach. At its best, existential psychotherapy squarely and soberly confronts the “ultimate concerns” (Tillich) and sometimes tragic “existential facts of life”: death, finitude, fate, freedom, responsibility, loneliness, loss, suffering, meaninglessness, evil and the demonic (May and Diamond). Existential psychotherapy is concerned with more deeply comprehending and alleviating as much as possible (without naively denying reality and la condition humane) pervasive postmodern symptoms such as excessive anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair, depression, guilt, anger, rage, resentment, embitterment, purposelessness, madness (psychosis) and violence as well as promoting the meaningful, life-enhancing experiences of relationship, love, caring, commitment, courage, creativity, power, will, presence, spirituality, individuation, self-actualization, authenticity, acceptance, transcendence and awe. As consumers are increasingly confronted with the very real limitations of what managed mental health care, ever-briefer therapy and ubiquitous psychopharmacology can provide (see my prior post), existential psychotherapy is enjoying some resurgence. Existential psychologist Rollo May (1986) warned, whenever you perceive a person merely as a particular diagnostic disorder, neurological deficit, biochemical imbalance, cognitive schema, set of behavioural patterns, genetic predisposition, collection of complexes, or “as a composite of drives and deterministic forces, you have defined for study everything except the one to whom these experiences happen, everything except the existing person him [or her] self” (p. 25). Existential psychotherapy strives to empower and place the person–and his or her existential choices–back at the centre of the therapeutic process. To cite Sartre on this subject: “We are our choices.” While the techniques of existential psychotherapy can include Freudian, Jungian, Gestalt, cognitive, behavioural or other methods, the fundamental technique shared by all existential therapists is phenomenology. Phenomenology refers to the conscious setting aside of preconceptions and dogma in an effort to discover the client or patient’s actual subjective experience or “being” (Dasein). It is through this that the true experience, will and intentionality of the patient at any given moment may be discerned, understood, and appropriately responded to by the therapist. The focus of treatment is on the present, here-and-now, current circumstance, rather than exclusively on early formative influences. While the power of the past and of unconsciousness– those aspects of ourselves of which we are unable or unwilling to become aware– to influence the present detrimentally is recognized and addressed as it arises in treatment, the patient’s subjective experience of self (“I am”) and of the therapeutic encounter is of primary importance. Choice, personal and social responsibility, integrity of the personality, courage, and authentically facing rather than escaping existential anxiety, anger and guilt are central features of existential psychotherapy. The existential therapist is not confined to the passive, neutral, anonymous and interpretive role of the psychoanalyst. The courage and commitment to truly and genuinely encounter each unique patient is required by the existential therapist, who must not avoid his or her own anxiety by hiding behind a rigid professional persona or rote therapeutic technique. In existential therapy, the human relationship between patient and therapist takes precedence over technical tricks, and, as now corroborated by research, is the basic healing factor in any psychotherapy. Coming to terms with reality– and one’s own inner “demons”– without denying, avoiding, distorting or sugar-coating it is key to existential therapy. As Rollo May, the acknowledged American “father” of existential psychotherapy pithily put it: “I do not believe in toning down the demonic. This gives a sense of false comfort. The real comfort can come only in the relationship of the therapist and the client or patient” (Diamond, 1996, p. xxii). This compassionate, shared, professional yet profoundly personal human relationship provides both the structured, supportive container and potent existential catalyst for therapeutic transformation.
What is DBT?
Dialectical behaviour therapy (DBT) treatment is a type of psychotherapy — or talk therapy — that utilizes a cognitive-behavioural approach. DBT emphasizes the psychosocial aspects of treatment.
The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.
People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.
Components of DBT
Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
Generally, dialectical behaviour therapy (DBT) may be seen as having two main components:
1. Individual weekly psychotherapy sessions that emphasize problem-solving behaviour for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviours take first priority, followed by behaviours that may interfere with the therapy process. Quality of life issues and working toward improving life in general may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.
Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviours, especially as they occur within the therapeutic relationship[…]. The emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises […]. Telephone contact with the individual therapist between sessions is part of DBT procedures. (Linehan, 2014)
During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.
2. Weekly group therapy sessions, generally 2 1/2 hours a session which is led by a trained DBT therapist. In these weekly group therapy sessions, people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught.
The 4 Modules of Dialectical Behaviour Therapy
1. Mindfulness
The essential part of all skills taught in skills group are the core mindfulness skills.
Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”
Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
2. Interpersonal Effectiveness
The interpersonal response patterns –how you interact with the people around you and in your personal relationships — that are taught in DBT skills training share similarities to those taught in some assertiveness and interpersonal problem-solving classes. These skills include effective strategies for asking for what one needs, how to assertively say ‘no,’ and learning to cope with inevitable interpersonal conflict.
People with borderline personality disorder frequently possess good interpersonal skills. They experience problems, however, in the application of these skills in specific contexts — especially emotionally vulnerable or volatile situations. An individual may be able to describe effective behavioural sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar set of behaviours when analysing their own personal situation.
This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
3. Distress Tolerance
Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behaviour therapy emphasizes learning to bear pain skilfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation. Although the stance advocated here is a non-judgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
Distress tolerance behaviours are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus wilfulness.
4. Emotion Regulation
People with borderline personality disorder or who may be suicidal are typically emotionally intense and labile — frequently angry, intensely frustrated, depressed, and anxious. This suggests that people grappling with these concerns might benefit from help in learning to regulate their emotions.
Dialectical behaviour therapy skills for emotion regulation include:
Learning to properly identify and label emotions
Identifying obstacles to changing emotions
Reducing vulnerability to “emotion mind”
Increasing positive emotional events
Increasing mindfulness to current emotions
Taking opposite action
Applying distress tolerance techniques
Martyn is accredited with the APT(Association of Professional Therapists) for DBT therapy to level 2.
