Humanistic-Existential and Solution -Focused Approaches to Psychotherapy
Chapter 6:
Nursing and the Humanistic-Existential Approach:
Humanistic-Existential Approach: Focuses on holism, self-actualization, facilitative
communication, and the therapeutic relationship.
Humanistic-Existential Theorists: Joyce Travelbee, Josephine Paterson, Loretta
Zderad, and Jean Watson.
Human-Human Relationship Model: Travelbee, Frankl, and Soren Kierkegaard
emphasize free will and the search for meaning in experiences of pain, illness, and
distress.
Humanistic Nursing Approach: Paterson and Zderad’s humanistic nursing approach
views nursing as a live dialogue between patient and nurse and places the
phenomenal method of inquiry at the center of importance.
Theory of Human Caring: Watson’s theory of human caring emphasizes a caring
relationship with patients that includes Carl Rogers unconditional acceptance and
positive regard as well as creating caring moments of healing.
Humanistic Concepts of Psychotherapy: Empathic attunement and the therapeutic
relationship are emphasized.
Three major theoretical orientations: Person-centered psychotherapy, Gestalt
psychotherapy, Extensional psychotherapy is commonly taught as the three foundational
psychotherapies of humanistic-existential psychotherapy.
Historical Roots:
Historical roots of humanistic existential psychotherapy: Extend back to the birth
of philosophes of humanism, existentialism, and phenomenology.
Humanism: A reform movement of the 14th century European renaissance developed in
response to medieval religious ideologies and focused on human values rather than the
divine. Humanism's dominant themes were happiness, spontaneity, creativity,
actualization, holism, and the goodness of the human spirit.
Existentialism: Existentialism emerged as a reaction to philosophy, rationalism, and the
objectivity of science during the mid-19th century and focused on personal choice and
commitment then later recognized the importance of human freedom, emotions, and
imagination.
Phenomenological Philosophy: Began with the dominant science of positivism with a
focus on a person's lived experience as a source of knowledge and truth. It is dedicated
to descriptive study of consciousness and subjective experience completely free of
preconceptions, interpretation, explanation, and evaluation.
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United States: The humanistic existential movement began in the United States soon
after World War Two. Scholars consider the birth of this method to be in 1964 when a
group of psychologists including Carl Rogers, Rollo May, Clark Moustakas, Gordon Allport,
and others defined and described humanistic extensional psychology.
Characteristics of Humanistic-Existential Psychotherapy:
1) Commitment to the phenomenological perspective: Strives to understand
the subjective experience of the patient in the context of his or her unique
experience and the patient's lived experience is paramount.
2) Centrality of the therapeutic relationship: The therapist patient relationship is
the primary source for constructive change in the humanistic essential approach.
Carl Rogers was the first to discover that the therapists’ characteristics of
empathy, genuineness, and unconditional positive regard along with the patient's
ability to perceive these characteristics are the necessary elements for therapeutic
change.
3) Belief in Holism: Holism means total or entire. Holism recognizes that people are
unique whole individuals who cannot be reduced or separated parts. The
expression the whole is greater than the sum of its parts. Each person is the
unified whole of mind, body, and spirit and that these aspects work together.
4) Focus on the Here and Now: Authentic contact and change can happen only in
the present, thus the here and now is the focus of therapy.
5) Emphasis on Humanistic-Existential Themes: These themes are concerned
with the universal human experiences of life. Prominent themes include
awareness, authenticity, freedom, choice, responsibility, meaning and self-
actualization. Awareness allows one the freedom to choose an organized life and a
meaningful way of living. Authenticity rather than self-deception allows a person to
be fully responsible and live a life with aliveness rather than feelings of dread,
guilt, and anxiety.
6) Prominence of Process: Humanistic existential therapies focus more on the
process rather than the content of therapy. The process of therapy describes the
flow of action in reaction. Within the session it includes pacing the rate of
movement in the session, timing, and tracking. Empathy and connection are the
emphasis however process is what provides the essential information as to how
the patient is experiencing and provides an avenue for real change to occur.
7) Use of Experiential Techniques: Humanistic existential therapists do not
interpret or give advice but use experiential techniques that are reflective and
experimental in style. Therapists work actively with patients using interventions to
heighten awareness, promote the expression of emotional support, contact, guide,
attentional focus to stimulate novel experiences which are carefully tailored to the
patient's specific wants and needs at any given moment.
Beliefs about Patients in the Humanistic Existential Approach:
Patients are:
• Endowed with an intent inherent tendency to develop their potential
• Resourceful and have the capacity to draw an inner and outer
resources
• Free to choose how to live in are responsible for the choices made
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• Resilient in manifesting their natural inclination to survive and grow
• Holistic and not reduced to the sum of their parts
• Contextual and best understood in relationship to others in their
environment
• Find meaning by creating a constructing reality from experience
• Social beings and have powerful need to feel valued and belong
• Diverse and worldviews inviable lifestyles that result in satisfying
lives
PERSON CENTERED THERAPY
Person centered psychotherapy: was founded by Carl Rogers in the 20th century. He
developed this nondirective patient centered approach to psychotherapy that recognized
the importance of facilitative counselling techniques such as reflection, exploring, and
clarification.
The central belief of person-centered therapy: is that people are basically good
and have a vast potential for self-growth. If their potential is tapped within a special type
of therapeutic relationship that provides the necessary facilitative conditions of empathic
understanding, unconditional positive regard, and congruence.
Key Concepts:
• Belief of human nature is a central belief in the person-centered approach,
there is a positive center at the core of all individuals. People are thought to be
trustworthy, creative, and resourceful. They are capable of self-understanding and
self-direction.
• Self-concept: An organized consistent set of perceptions about the self
continually influenced by experience and in its interpretation self-concepts that
includes self-worth, self-image, and the ideal self.
• Actualizing Tendency: The basic motivational force, and directional process in
humans to grow, develop, and strive towards self-realization in fulfillment.
• Fully Functioning Person: An individual who is fully engaged in the process of
self-actualization and is a fully functioning person as they demonstrate knowledge
of subjective experience, existential living, emphasizing choice, freedom, and
responsibility, awareness of emotions, ability to take risks, seek new experiences,
and engagement in a continual process of change.
GOALS of Therapy: The goal of person-centered therapy is for the patient to
become fully functioning and engaged in the process of self-actualization. The patient
can live life more authentically and cope well with current and future problems. The
therapist provides a climate conducive to helping the person achieve these goals.
Psychotherapeutic Interventions:
Assessment:
The therapist begins the assessment by asking the patient where to begin and what
issues to work on the patient's phenomenological experience rather than the
presenting problem is the focus the therapist is genuine comma empathetic comma
, 4
and caring and sets aside preconceptions and attempt to understand the inner world
of the patient period.
Psychotherapy Techniques: In the person-centered approach each session is
considered fresh and unpredictable. Structured techniques and process interventions
beyond facilitative listening are avoided. The therapist honors the wisdom of the
patient and the ability of the patient to determine the
direction of therapy.
• Nondirective-Facilitative Counseling: This approach is used with the aim of
helping patients become aware of their inner experiences. The therapist
attempts to understand the inner world of the patient and the patient's lived
experiences through a discovery-oriented approach.
• Psychological conditions necessary for personality growth: In the person-
centered approach the therapist embodies and implements the three core
conditions which are both necessary and sufficient for successful therapy
which are congruence, unconditional positive regard, and accurate empathic
understanding.
• Congruence: The therapist is genuine and authentic during the therapy
session and openly expresses their feelings, thoughts, and reactions with the
patient which may include the expression of a range of feelings including
annoyance but in a well-timed constructed fashion.
• Unconditional Positive Regard: The therapist has a deep caring for the
patient which is best achieved through empathic identification. The therapist is
nonjudgmental and warmly accepts the patient while being caring and through
this there is a greater chance that therapy will be successful. The greater the
degree of caring, prizing, accepting, and valuing of the patient the greater
chance the patient will begin to see the worth and value in himself or herself.
• Accurate Empathic Understanding: Empathetic understanding is the
cornerstone of person-centered approach therapy. Empathy requires
attunement to the patients experience as is revealed moment to moment
during the session as the therapist attempts to understand the meanings
expressed by the patients that often lie at the edge of awareness. Showing
empathy requires an understanding of the patients’ feelings and reflecting them
back to the patient to help him or her understand these feelings.
GESTALT PSYCHOTHERAPY
Gestalt Therapy: founded by Fritz Perl’s and Laura Perl’s is a clinically complex
approach to psychotherapy. Gestalt is a German word meaning organized and whole.
This therapy recognizes the unity of humans as integrated wholes not divided into parts.
Gestalt therapy can be described as humanistic-existential psychotherapy with
theoretical roots firmly grounded in holism, existential humanism, gestalt psychology,
organismic theory, interpersonal psychology, and eastern philosophy as it integrates
aspects of these theories to create a unified unique approach to psychotherapy.
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