Modalities (2)

road sign illustrating psychotherapy as a way to deal with problems


Existential psychotherapy originally arose out of Existential Philosophy, in particular, the work of Soren Kierkegaard in the 1800s. It is best described as an approach that influences a counsellor’s style of therapy, as it does not have clearly defined techniques or statements of principles. Some of the earliest influences in this field were Viktor Frankl, Rollo May, Ernesto Spinelli and more recently, Irvin Yalom.

This approach is dynamic, intuitive and concerned with exploring the dilemma of one’s existence. It moves away from seeing the therapist as the expert, or therapy as a system of techniques, but examines the ultimate concerns in everyone’s life, e.g. death, existential isolation, meaninglessness and desire for freedom without responsibility. Confrontation with these concerns produces anxiety and the installation of defense mechanisms.

Its basic aims are to enable clients to see that they are free to choose how they live, to become aware of what they are capable of becoming and to recognise any blocks in the way to achieving that freedom. The relationship with the therapist is the agent of change, with an emphasis upon understanding the client’s world, where they are challenged to find deeper meanings to their presented problems.

Cognitive behaviour / rational emotive:

Both Cognitive Behaviour and Rational Emotive Therapies (REBT) are part of the family of Cognitive Behaviour Therapies (CBT).

Albert Ellis has been known as the grandfather of CBT and the founder of REBT. He comes from a psychoanalytical background but combined humanistic, philosophical and behavioural therapies to form REBT. This is an extremely didactic and directive model of therapy, believing that pathology arises through irrational beliefs arising in childhood that have been retained by auto suggestion and self talk. The therapist is quite confrontational and functions mainly as a teacher.

Aaron Beck also came from a psychoanalytical background. During the 1960s, he developed an approach known as Cognitive Therapy (CT) which, like REBT, is directive, time-limited and structured, but has a greater focus on encouraging clients to arrive at their own conclusions. It is a collaborative approach that uses techniques such as Socratic dialogues along with identification of beliefs, unhelpful self talk and underlying schemata. CT believes that the internal dialogue of clients plays a major role in their behaviour and the goal is to change the way that they think, by cognitive restructuring and home work, to practise new beliefs in real life situations.


Gestalt Therapy, an existential-phenomenological theory, was founded in the 1940s by Frederick (Fritz) and Laura Perls. It stresses the importance of here-and-now awareness for clients, who ‘dialogue’ with their therapist to achieve greater self knowledge.

Underlying the concept of Gestalt Therapy is Field Theory, which is a method of exploring the whole field, of which the event is currently a part. In Gestalt Therapy, the whole is greater than the sum of its individual parts.

The goal in Gestalt is to gain greater awareness, not necessarily to change, although changes may happen as a result of this knowledge. The therapist works as a guide and is an active presence, as growth occurs through contact with the therapist’ presence and authentic dialogue. The past may be brought into the present as unfinished business if it is interfering with the clients’ present awareness, through various techniques available. These include ’empty chair’, ‘stay with it’ and guided fantasies, all of which require the client to role play.

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