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Review of "Existential Psychotherapy"

By Daniel Sousa
Palgrave Macmillan, 2017
Review by Kate Mehuron on May 15th 2018
Existential Psychotherapy

Daniel Sousa's Existential Psychotherapy: A Genetic-Phenomenological Approach seeks to legitimize two lesser-known psychotherapeutic approaches. First, Sousa intends to establish the therapeutic legitimacy of existential psychotherapy within the big tent of psychotherapies in general. Second, he defends the value of static and genetic phenomenology, drawn from Husserl's phenomenology of time consciousness, to the existential psychotherapeutic enterprise.

          Chapter one provides a review and synthesis of the major meta-analyses of empirical research to date, regarding the most effective, and least effective psychotherapeutic interventions and correlative psychotherapist skills and qualities. The chapter offers a valuable list of the therapeutic principles that receive strong empirical support and that are basic to any effective psychotherapeutic practice. These informative insights from Sousa's synthesis of all the meta-analyses studied are articulated: 1) there is consensus between medical models and contextual models regarding specific effective psychotherapeutic factors, and 2) variability of effectiveness among psychotherapists is not related to therapist age, gender, academic qualifications nor years of experience, nor by their patients' age, gender and diagnosis, but rather to therapists' specific personal and professional qualities. Years of experience do not translate into increased clinical expertise. Rather, the factors that lend to improvement in clinical expertise and those lending to improvement in expertise in other professions are found to be nearly identical: the best clinicians deliberately practice more, acquire deeper knowledge of their area, systematically gather feedback on their performance, learn in a structured way to surpass habits and performance, work harder, focus on specific aims, and consciously monitor their performance and results over long periods of time.  Sousa successfully summarizes these general criteria for effective psychotherapeutic practices, supporting his defense of the legitimacy of existential psychotherapy within the big tent of psychotherapies in general.

          Sousa's second objective, in Chapter two, is to articulate the value of the philosophical resources of genetic phenomenology for existential psychotherapeutic applications. The chapter is a competent overview of Husserl's phenomenological contribution to philosophies of subjectivity. But Sousa's second objective is a harder sell. To this end, he asks his desired audience, presumably psychotherapists, to assimilate Husserl's conceptual framework: internal time consciousness, phenomenological vocabulary and epistemological formulations, and the techniques of epochéand eidetic analysis, as relationally reconfigured. Thus readers have a model of static and genetic phenomenology to consider, which Sousa argues to be the desirable theoretical underpinning of existential psychotherapy. Sousa concisely summarizes the theoretical framework of the genetic-phenomenological approach into seven theoretical claims that are key concepts presupposed by all existential philosophies: intentionality, inner-time consciousness, self-reflective narrative identity, passive geneses of experience, angst, interrelatedness, and the givens of existence. (133-134)

          Many psychotherapeutic practitioners will question whether existential psychotherapies, already a minority within the psychotherapy tent, ought to assimilate this Husserlian epistemological framework. They may wonder: for what reasons and in service to what clinical objectives? Unfortunately, Sousa undermines his own aim when he describes, in Chapter Three, some of the "misconceptions" in the world of existential psychotherapy. One of these, supposedly contributing to its outsider status, is the error of presenting existential psychotherapy as a philosophical approach. Sousa writes, "The approach is based on an existential-phenomenological epistemology, but is not distinguished from other therapeutic models for being philosophical – all models have philosophical roots – since its theoretical principles are rooted in psychology and psychotherapy." (131) The phenomenological scaffolding that is so carefully developed in Chapter Two and Three is contradicted by Sousa's claim, unless we erroneously assume that phenomenology is not "philosophical" but rather "psychological."

          Chapter three expansively develops all of these theoretical presuppositions introduced in chapter two, organizing their implications and synthesizing them with the transversal findings of evidence-based effective therapeutic techniques defined in the first chapter. It presents and defines relational stances, organized within "static" phenomenology that encompasses the use of the phenomenological epochéand eidetic analysis within the relational context of the therapeutic situation. (144-147) Further, Sousa presents a schema of existential psychotherapy techniques aligned with evidence-based practices in general and with  "genetic" phenomenology in particular. This schema provides the subjective (and phenomenological) fundamentals of techniques facilitating the client's process of change during the existential psychotherapeutic treatment. These include: hermeneutics of dream interpretation, focus on embodiment, existential challenges to the client's assumptions, experiential validation, and reflexive activation of the passive geneses of experience in the present situation of interpretation. (148-151)

          The accomplishments of the first three chapters - meta-analysis findings, epistemological and technical schema - are weakened by the editorial error of allowing chapter four, "Practical Applications and Clinical Case" to stand as the final chapter. This chapter is poorly edited: riddled with incomplete sentences, lack of paragraph structure, and typographical errors, such as referencing an "attachment" in the body of the text, instead of the intended Table A.1 that is included in the Appendix. The chapter provides four interviews with four different patients, "vignettes," that are used to illustrate existential clinical methods, and one interview-based case that explores the emotional impact on someone who is indirectly, but deeply affected by the 9/11 terrorist attack on the New York World Trade Towers and occupants. This case is presented in largely descriptive terms, using the psychotherapeutic discourse of trauma and concepts of genetic phenomenology elaborated in chapter four. Some of the existential descriptive passages about this person's suffering seem gratuitously philosophical and esoteric, for example in the application of Heideggerian notions of Dasein and its experience of fallen-ness and the uncanny.  The Husserlian notion of "passive geneses sedimented in the retentional chain of temporal consciousness" appears to be a substitute for the more commonly used notion of the unconscious and pre-conscious strata of mind. (208) But there is no theoretical rationale anywhere in the book, for the substitutions of phenomenology for such psychological concepts. It is all offered as an alternative, densely complex discourse. For what reasons and in service to what clinical objectives? This is a question that is never addressed.


© 2018 Kate Mehuron


Kate Mehuron, Professor of Philosophy, Eastern Michigan University, Academic Candidate, Michigan Psychoanalytic Institute. Correspondence: kmehuron@emich.edu