Reasons to not be an existential therapist

I didn’t become a therapist until I was almost 40 years old.

Some folks who become a therapist in their forties have the great excuse of having already had a “career,” as we call it. Or maybe they’ve had kids. I had no such excuses.

To be frank, I struggled with jobs. In my twenties, I was 100% committed to being a writer and artist, and I worked nothing jobs in retail and food service. I got fired from jobs for “not smiling at the customers.” I lived below the poverty line so that I could avoid spending the time and energy needed to build a “career.” My goal was to write poetry, to get that poetry published, and of course, to be recognized as the genius of a generation.

There was another complicating factor, though, and that was that I kept either meeting or hearing about absolutely terrible therapists.

Years ago, at a burrito shop with a friend, we ran into his therapist. His EXISTENTIAL THERAPIST, he clarified.

It should be noted that this friend was . . . intense. He was, like many of the men I’ve gravitated towards, loud, assertive, and intellectually brilliant. He talked about a million miles a minute, and his mind leaped from Kant to Mogwai to Russian anarchist philosophy. This was what he was like, so when he excitedly saw his therapist and introduced him to all of us, no alarm bells went off.

Until the therapist simply . . . joined him.

The therapist began vigorously debating my friend. They immediately got into a heated exchange about . . . oh, one of the things philosophers argue about . . . and they just sat there, yelling at each other. My friend was, as he was wont to do, clearly getting high off the whole thing. And I get that. I get high off intellectual debate, too. But the therapist was also clearly getting high off it. At one point my friend gleefully told me, “This is exactly what our therapy sessions are like!! I’m basically getting a free therapy session here!”

Later, after the very annoying therapist had left to (as he of course had to announce to everyone) “have sex with one of my partners,” my friend kept reiterating that he was an EXISTENTIAL THERAPIST. This had the predictable effect of making me file away “existential therapists” under “pretentious, self-gratifying assholes.”

In which I try to not be a pretentious, self-gratifying asshole

To this day, when people ask me what existential psychotherapy is, I hesitate.

My first priority is to ensure they don’t envision my old friend’s jerk of a therapist. But there’s a bigger question at play. While that poly-before-poly-was-cool dick was doing a bad job at it, his engagement with my friend was an answer to a question, the question being: what is the role of logic and intellect in therapy? The therapist’s answer was patently wrong — therapy is not an intellectual debate — but he was at least answering the question.

You might think that my grad program in existential-phenomenological psychology would have answered this question, but alas, such a program left me with more questions than I started with. Also, existential and phenomenological psychotherapists tend to see their approach as having more to do with the person of the therapist, or how they do therapy, rather than prescribing what they are doing in sessions.

One thing I can confidently say is that existential psychotherapy is not a so-called “manualized” approach like CBT, DBT, or EMDR. I like to call these approaches 1-2-3 therapies: first do this, then this, then that.

The thing is, I’ve found that I sometimes need a 1-2-3. Sometimes the patient needs a 1-2-3. With complex and/or developmental trauma, many patients flail in emotional overwhelm. It’s an absolute lifeline when I can tell someone, “First, I want you to put your phone away. Second, every day for the next week, do this breathing exercise. And third, when X thought comes, here’s how you can respond to it.”

In my grad program, I did feel like the teaching for how to respond to emotional overwhelm was basically, “Sit with the patient. Allow them their feelings.” I tried this until I had my first borderline patient who was — lucky me! — literally my first patient. In my internship. First day on the job. It was a shit show, and I feel confident saying I did her absolutely no good at all.

So after grad school, I sought out the 1-2-3 approaches for trauma, which quickly became my specialty area.

Coming home (question mark?)

Maybe if I’d lived during a different time, I wouldn’t have returned to existential therapy. But the times are . . . something.

Many of my patients work in the tech sector. They have built things that, apparently, will make it impossible for their children to have a job. Other patients work in medicine, where the insurance-companies-turned-cartels dictate care for their patients. Others are being driven insane by their screen addictions and rising panic. Those who are religious potentially have some kind of a meaning-making system, but those institutions also have to navigate current questions about gender, politics, and nationalism. And those who aren’t religious have no easy solutions; reasonably, they aren’t going to just submit without question to a faith they don’t endorse, but that also removes the possibility of a ready-made community.

So, I caved. I went back to my existential books. I restarted intentional journaling about questions like, “What do I think a person is?” and “How do I feel in my current dialogue with technology?”

The annoying EXISTENTIAL THERAPIST at the burrito shop was, yes, doing it wrong. But I also can’t pretend that a quiet, “And how did that make you feel?” is the right response to every moment in therapy. In fact — and I’m sort of shocked to hear myself say this — I think that therapists may have become a little too obsessed with pure emotions. Our logical and intellectual needs are real. They, too, are always connected to our emotional beings, because we are animal bodies that generate a felt sense. And I’m finding a deeper need to engage with the questions of existentialism in my therapy work, and not simply chalk everything intellectual up to emotional avoidance.

Again, sometimes at the end of a post, I offer you a quick pause. Maybe close your eyes, close your laptop, and consider whether you need to stay on your screen after this. Maybe you do. And maybe it’s time for a break, time to stop scrolling and clicking and reconnect with the real world.

Intellectualization

I frequently have patients and clients tell me that they struggle with intellectualizing their problems. What they mean by this is that they’ve read some books, analyzed their lives and thoughts to death, and all the while they believed that if they could just understand their struggles, they would evaporate.

I suspect this is why psychobabble is so popular on social media. It feels powerful when you hear someone say, “10 Signs Your Ex Is Borderline,” you listen to the 10, you think, “My god! ALL my exes were borderline! Now I just have to figure out why I’m attracted to these kinds of people, and that will lead to peace and happiness.” Cue years of reading and therapy, and at the end of it you’re thinking, “Shit. Now my actual WIFE has a borderline personality. How did that happen?”

And yeah, it may have partially been because you were intellectualizing. It’s certainly the case that reading Susskind and Aristotle won’t necessarily teach you how to love humans and enjoy being alive. And yes, there are those who try to escape the wildly complicated and confusing realities of human relationships by plunging themselves into books, computers, intellectualism, and even meditation.

But blaming the intellect itself feels off to me. For one thing, you’re sort of . . . doing a bad job at being an intellectual if you fail to ask yourself, “Why am I so lonely?” If you are unhappy, and it seems to be part of a larger life pattern, you’re not intellectualizing very well if you keep circling around your two or three favorite answers to problems, repeating them to yourself over and over, never asking the question: what if I’m wrong?

Which is all to say, when people say they intellectualize or over-intellectualize, I want to say that they’re actually using the intellect poorly.

What does philosophy have to do with psychology?

Honestly, it’s not hard to spot when the intellect is getting in the way in psychotherapy. When a patient offers a crystal clear, erudite, calm account of their failings and how “this all goes back to my mom/dad/dead cat/blah, blah, blah,” that’s the intellect trying to run the show. I look for ways to make them productively uncomfortable, and I don’t let up until they either fire me or see improvement. Simple.

Before I wanted to become a therapist, I wanted to be a midwife. The initial inspiration came when I learned that Socrates’s mother was a midwife. I was so fed up with Socrates and Plato’s misogyny, I could think of no better revenge than to follow in Phaenarete’s footsteps.

Then I discovered I hate medical monitoring machines (apparently those are a big deal in medicine these days?), and suddenly I was in love with psychology.

Over the years I’ve realized that my approach to psychotherapy is very similar to Socrates and Plato’s approach to philosophy, at least in the early dialogues. The gist of it was to ask a person what their interpretation was of a situation, poke holes in their interpretation, make them uncomfortable, and then . . . well, leave them that way.

The benefit for the therapist, then, of thinking about philosophy is not to offer grist for debate in therapy sessions. Thinking philosophically is good for the therapist. Donna Orange puts it this way:

“[R]eading philosophy teaches us to read and listen differently and to notice what we might miss if we read only the theoretical formulations of our own tradition. Above all, we may notice the anomalies in our own clinical experience. Why does saying and doing what I have been taught seem not to work in this situation?”

Why philosophy is central to my work

A philosophical approach to psychology is, for example, why I approach the discourse around neurodiversity the way I do. On the one hand, I’m not one for bandwagons, and everyone on the Left is enthusiastically jumping on the neurodiversity bandwagon. This gives me pause in how I listen to and metabolize the discourse. On the other hand, I am shocked by how narrow the band for “normal” keeps getting, even within my lifetime. This prompts me to examine the definition of “normal” itself. The benefit of thinking philosophically is, to some extent, that I am made uncomfortable. Philosophy denies me the easy comfort of fitting in with any one ideological group. Intellectual rigor demands that I take seriously many of the lived experiences of ADHDers and Autistic folks, as well as the research being done on neurodiversity. It also demands that I take seriously the role of social media, and trends in devaluing expertise.

Other examples include how I think about and use Internal Family Systems and EMDR. Philosophy also helps me work through how to do therapy with people who are in polarized positions: e.g., one session may be with a woo-woo, I-heal-myself-through-communion-with-angels type, while the next is with an MD. For me, it’s a huge challenge to move between these folks, and I find philosophy indispensable in helping my intellect and my emotions talk to each other.

To return to Donna Orange’s point, this is why I say on my website that “it’s important to me that I avoid hitting everyone over the head with ‘what worked for me,’ or even what worked for previous patients.” I see my task as a persistent, almost obsessive, digging into what is not like me. What is not intuitive. What doesn’t feel obvious to me.

To be clear, this is not easy. For one thing, I have my own moral, political, and spiritual values. And I notice that it’s tiring to always be open to looking at things a new way; I frequently feel exhausted by my job, and I often think it’s just from having spent eight solid hours telling myself over and over again, “Okay, that’s your knee-jerk response. What are some other possibilities?” But the fatigue of it doesn’t make it not the right way to go about psychotherapy. And I can’t imagine trying to do therapy any way that doesn’t include philosophical inquiry.