Existential psychotherapy of Irvin Yalom as an integral approach to teaching existentialism to psychology students / Экзистенциальная психотерапия И. Ялома как интегральная модель для преподавания экзистенциализма студентам-психологам

Крючков Кирилл Сергеевич Преподаватель, кафедра психотерапии и психологического консультирования, Московский институт психоанализа 107031, Россия, г. Москва, ул. Петровка, 17, с4, оф. 69 Kryuchkov Kirill Sergeevich Educator, the department of Psychotherapy and Counseling Psychology, Moscow Institute of Psychoanalysis 107031, Russia, Moskva oblast', g. Moscow, ul. Petrovka, 17s4, of. 69 kkryuchkov@gmail.com Другие публикации этого автора

Teaching Existential Psychology and Psychotherapy in a classical academic institution sometimes is a tricky task. Existentialism is under-represented even among the counseling psychology concentrations (majors). Quite often, there is only one course dedicated to that approach that designed to introduce students with existential theories and values. When designing such course an instructor usually faces several challenges. The model we present in the current report could to some extent help to overcome those challenges. Our setting was Russian middle-size state University that offered wide range of educational programs including psychology undergraduate and graduate programs. Counseling psychology was a concentration for ‘specialist’ students^[1] majoring in psychology, as well as a concentration for bachelors enrolled into the psychology major. This institution also offered Masters Program in Counseling Psychology, but existential psychology was not included into its curriculum. Existential Psychology and Psychotherapy was a part of a Counseling Psychology concentration requirement for ‘specialists’ offered on their 5’th year and took one term (3-credits course). For bachelors, Existential Psychology and Psychotherapy was offered as an elective on their 3’d year and also took 1 term (3-credits course). Both courses were evaluated on a pass-fail basis (in Russia courses in the most cases are ‘matched’ with the year of studying, one must take the course during the certain year). We were teaching that course both for the full-time students and for the part-time.

It is important to note, that the model is based on the author’s experience of teaching existentialism in Russia and may be not well applicable in another settings. We also did not perform any formal quantitative evaluation of the efficacy of our model. It is also important to note that we do not discuss what approaches to include or not include whithin the field of ‘existentialism.’ Nor do we discuss the rationale for those choices. Even though we discussed these issues with our students, those questions are beyond the scope of the present article.

Traditional Ways of Teaching Existentialism: Limitations and Needs for Changes

When we were assigned to teach the course in Existential Psychology and Psychotherapy the first time we decided to follow the traditional design of the introductory psychotherapy class. The course was taught in a chronological order – from the earliest concepts to the more recent. However, we were not very successful teaching this course that way. Students perceived this course as ‘too difficult’, ‘weakly logically connected’ and generally ‘giving them a hard time’. In addition, we found that ‘chronological’ order of teaching was not helpful for students to acquire existential attitudes. Learning a number of theories did not help them to ‘apply’ that material to their own life and work. So, we started thinking about how to redesign the course. One possible option among ‘traditional’ approaches to teach existentialism (in addition to chronological order) for us was to concentrate on one specific school and just mention other schools briefly. We rejected this way of teaching due to program format and limitations of our own formal training (we explain this further).

Goals and Challenges for Teaching Existentialism

When redesigning the course we had to think about the goals we wanted to achieve and to recognize the challenges that we faced (reasons why ‘traditional’ approach does not fit this course) and would face during teaching.

According to the academic program structure, students were first introduced to different schools of counseling and were given an opportunity to develop their own ‘style’ during practicums. On one had this format required us to expose students to as many approaches as possible; and on the other hand, as a result of such format sometimes students perceived theories and practical skills as separated entities. Taking that into account, we set the goal to expose students to the wide variety of existential schools and try to form a systemic understanding of them (not as ‘just a pile of texts’, but both theory and practice). We divided all the various challenges we met when designing that course into the two categories: ‘technical’ and ‘methodological’. ‘Technical obstacles’ were mainly related not to the nature of existentialism itself, but to the structure and limitations of the academic system. Among them there were:

1) Variations in student’s entrance level, their previous knowledge and experience: some students were nearly completely unfamiliar with any existential writers prior to that course (existential texts usually are limitedly incorporated into course syllabi even in counseling psychology programs);

2) Limitedness of literature on existential psychology available in Russian: while some approaches were very well presented in Russian and a lot of books and papers were translated, some other were not presented at all or to a very limited extent;

3) Time-limitations (one course, 40 hours);

4) Academic program format that required us to expose students to a wide range of approaches not to concentrate on one specific school

5) Instructor’s own experience and certification level. We had some training in one existential approach but not a level of trainer: that was certainly not enough for deep exploration of single specific approach.

In addition to formal, ‘technical’ challenges there were much more complex issues related to the nature of existential psychology itself. As Emmy van Deurzen noticed, Existential Therapy doesn’t have one single founder ^[18]. Thus, the chronological order was not convenient for this course. Another obstacle which is met often is the lack of direct ‘techniques’ or ‘skills’. Van Deurzen emphasizes that Existential therapists often avoid mentioning ‘skills’ in favor of freedom and responsibility – so each therapists creates own way of working. Existential Psychology and Psychotherapy is more about attitude than technique ^[18].

Yalomian Existential Therapy as a Teaching Tool

Justification of the Choice of Certain Theory

The specific integrating unit was needed in order to logically ‘bind’ different theories and schools together. It could have been, for example, ‘external’ unit offered by methodology of psychotherapy (for example, continuum ‘directive-indirective’ or ‘reflection-interpretation’). Nevertheless the usage of such units would not be very natural, as long as that methodological terms do not belong to the field of existentialism. Looking for such units in the field of existentialism itself once more we can again refer to E. van Deurzen – existentialism deals with the familiar questions: life and death, meaning, relationships and so on ^[18]. Common sense prompted, that it would be legitimate to organize course around such questions. But why are they so important to become ‘binding units’ for our course? To address that question we had to go deeper into the philosophy of science.

Philosophical grounds for the choice of ‘binding units’. To us it seemed obvious that the ‘units’ that would logically bind different theories for the didactical purposes of our course must have been natural to existential psychology. In addition they must be logically adjustable to the very process of learning, not to be very superficial so the students would acquire them easily with an understanding why those ‘units’ were necessary and why that units have been chosen in the exact way, not the other way.

Philosophy and methodology informs us that the most seminal root of any social practice including existential psychology and psychotherapy is ontology – the question of being. It informs both epistemology and ethics (the way we know things and the values we are guided by). Although, some authors, offer to abandon the very idea of ontology in relation to ethics and not only ethics ^[16] the mainstream idea is quite clear: ontology is the basis for epistemology and ethics and thus the basis for nearly any social practice including psychotherapy (see, for example: ^{[1, 3, 4, 5, 6,7, 8, 9, 10, 12, 13, 14 15, 17, 19]}). So to us it seemed logical to organize our course around ontological questions, make them the ‘binding units’ of our course syllabus. It must be noted that we presented both philosophical existential approaches and psychotherapeutic approaches. It is obvious that existential psychotherapy is deeply rooted into the philosophy and in some cases it is even very hard to distinguish one from another.

An Overview of the Model Offered

Decided to base the course on the ontological questions we then had to find such questions per se. As we quoted above, existentialism is known for dealing with the ‘ultimate questions of being’ such as ‘what is being itself?”, death, meaninglessness e.t.c.. Reading different existential texts we noted one interesting feature of the most of them: authors intentionally or unintentionally usually emphasized one or more (a limited number) of such ‘ultimate issues’ and organized their models around them. It doesn’t mean that these authors did not pay attention to the other factors, but they just highlighted some of them more than the other ones. So, we decided to base our model on such factors and to present existential approaches through the prism of such factors. Of course it did not mean, that we would present approaches as ‘matched’ to the certain factors, but instead we would show the relationships between different approaches through the prism of the factors and between factors themselves.

The question then was: what exact theory? What collection of ‘existential ultimate issues (questions, factors)’ would be non-extensive and on the other hand non-bobtailed? Scrutinizing tons of literature we finally found out an existential theory that included a limited amount of ‘factors’ that allowed us to represent through them virtually the most of the most prominent existential approaches. That theory was Irvine Yalom’s Existential Psychotherapy. Even though, other scholars have identified the existential givens, too, Yalom’s theory is one of the best represented in Russia: a lot of books have been translated and published including books with the clinical examples of that theory application. The style of Yalom’s papers is very accessible and even entertaining, on the other hand, Yalom referred not only to philosophy and his own clinical practice but also to clinical researches (that would made it more reliable for our students, and, what was also important, for our fellow instructors).

Presenting Existential Psychotherapy Through the Prism of Ultimate Concerns

Yalom ^{[20, 21, 22]} identifies the four “ultimate concerns of life”—death, freedom, existential isolation, and meaninglessness and describe existential conflicts that springs from people’s confrontation with each of them.

Approaches presented through the prism of different concerns. According to Yalom, death is the primary and the most powerful existential concern people face ^[2,11,20,22]. The existential approaches that we presented to our students through the ‘prism’ of death were philosophy of Martin Heidegger and therapy approaches of Ludwig Binswanger and Medard Boss. There is a significant number of the philosophical and psychotherapeutic schools concerned with freedom (and a notion of responsibility). As long as we do not discuss in the present paper what approaches to consider existential and what not, we just list approaches that seemed to us as the most relevant to be presented through the prism of ‘freedom-responsibility’ concern. There were J-P Sartre’s philosophy, and Erich Fromm’s freudian-marxism (ironically the concept of alienation originally belonged to Marxism was the cornerstone of Russian education in Soviet times.). Speaking about loneliness, we continued presenting E. Fromm’s philosophy. We also presented the philosophy of Martin Buber which is often referred to by different existential psychotherapists. Finally, we presented several approaches through the prism of ‘meaninglessness’ as an ultimate concern. We introduced students with the notion of that the meaning is not ‘given by default’, but one must find it or create it for oneself. Coming to an extreme we could suggest that it is impossible to achieve any notion of meaning at al – meaninglessness is eternal. We exposed students to writings of A. Camus and to the schools of psychotherapy developed by V. Frankl, A. Laengle and Russian author F. Vasilyuk (all of them are mainly dealing with meaning).

Of course, it was impossible to cover all existing existential schools and approaches. In the present paper, we did not mention, for example, some Russian approaches we also exposed students to (e.g. M. Bakhtin). However, it is important, that not all approaches ‘fit’ the ‘ultimate concern’ pattern. Those particular approaches we were dealing with were R. May’s, J. Budgental’s. Both of these authors payed a lot of attention to the professional qualities (and even skills) of existential psychotherapists, so we presented these approaches under the title of ‘art and ethics’ in existential psychotherapy. Sometimes we also exposed students to S. Kierkegaard philosophy but most of the time we just mentioned it without going deeper as it was way too difficult and time-consuming to go deeper into it.

Short conclusion of the ‘ultimate concerns’ didactic model. Summarizing our description of the didactic model based on Yalom’s existential therapy we may present it as a table (table 1)

Table 1.

Didactic Tools to Facilitate Learning

Readings and discussions

The course was designed mainly around I. Yalom’s book Existential Psychotherapy that was a required reading. In additions students were given extractions from different texts of different existential writers. Readings were not discussed in class directly, understanding was evaluated through short essays (3-4 questions) offered at the beginning of every seminar. Rather than discussing texts, in class we were mainly talking about existential ultimate concerns in relation to life and psychology so that students could ‘feel’ them.

Class discussion usually were facilitated in a Socratic or ‘problematizing’ way. Students were asked direct questions such as ‘if we are ultimately lonely why bother with relationships?’ or ‘if the meaning is an illusion – so, why live?’ Such questions were addressed to each and any student first individually and then the group discussion have been stimulated. Student’s individual responses were not evaluated (and that was explicitly said by an instructor), so the students could freely raise their opinions, however, the level of participation in the group discussion have been evaluated. We usually adjusted questions to the student’s level of knowledge and also to their level of vulnerability and safety (for example, the question like ‘why live’ was rarely asked and if asked, only in the group that had good rapport with an instructor). Confidentiality rule has been explicitly established at the beginning of the very first session – so students should not share any personal information they heard during sessions.

Interviews and demonstrations

The best person who can tell about psychotherapeutic approach is an author of that approach. So, when that was possible instead from lecturing students from the book we were showing them interviews or lectures given by the leading existential thinkers (either already translated into Russian or with subtitles or, when possible, simultaneously translating it to them in class). We also made students to read clinical cases In addition to the mentioned above cases of Lola Voss and Ellen West we asked students to read at least three cases from I. Yalom’s Love Executioner or J. Bugental’s Intimate Journeys, we also have shown students video-recorded existential therapy sessions. In addition to interviews and therapy sessions videos we have shown student’s movies that we picked up for each ‘ultimate concern’. Than student’s were asked to discuss movie and then to write a short essay. For example, for the topic of ‘death’ we have shown students the movie ‘Now is good’ that was telling the story of a girl dying of cancer. This story in our opinion very well illustrated Heideggerian concept of authentic/inauthentic being and being-toward-death as well as ‘Das Man’ (fallen-ness).

Therapy story film

Probably the most creative tool we used was the creation of ‘therapy movie’ by students. (15-25 minutes long) based on the therapy case they picked up from Yalom’s or Budgental’s book with cases. We learnt this tool during our own university years in the Moscow State University of Psychology During the two years, we were teaching this course, two group of students made their movies. The main idea of this tool is that during the film creation students ‘live through’ the story and thus acquire to some extent existential attitudes implicitly (or explicitly) described in the story. Film creation gave students an opportunity to interpret those attitudes in their own unique way.

Summary

In the present report we described the model we designed and used for teaching existential psychology and psychotherapy for Russian counseling psychology students. The model is based on the Yalomian Existential Psychotherapy and considers other existential schools through the prism of Yalomian ‘ultimate concerns’: death, freedom, loneliness, and meaninglessness. It is important to note, that we offer not a methodological but didactic model. This model, of course, is neither ideal nor ‘complete’. It does not include each and every existential approach. Nor does it leave a lot of space for practical training of exact skills. However, we think it was more important to provide students with the notion of existential ‘attitude’, the way of thinking, rather than train them a bunch of ‘techniques’ or than go deep into one approach reducing the field of existentialism to the limited number of approaches. We did not performed any quantitative or formal evaluation of this model and consider it efficient only according our own subjective experience and students’ feedback. We should again make a remark, that we do not guarantee an applicability of this model to each and any institution, course format or group of students. However, we welcome instructors to use it and modify for their own classes.

^[1] Specialist was a Russian Degree existed before 2015 (last enrollment – 2010) that is equal to BS+MS degrees. Five to six years in a row, three years of basic education and two to three years of concentration (general major must have been chosen prior enrollment to the University, high school graduates applied not to the University in general, but to the specific program). Since 2010 Russian Higher Education system has transitioned into the BS+MS 4+2 years system, specialist degree was remodeled and now exists only for limited number of areas (military education, medical education, clinical psychology, forensic psychology, police, intelligence, and state security education, engineering education (in several concentrations: e.g. nuclear power)). For more information on Russian Higher Education System see, for example: http://eacea.ec.europa.eu/tempus/participating_countries/overview/russia_country_fiche_final.pdf; http://www.euroeducation.net/prof/russco.htm; http://en.russia.edu.ru/edu/description/sysobr/923/