differences and similarities between existential therapy and-libre

Anders Draeby Soerensen, www.andersdraeby.com

Differences and Similarities between Existential Therapy and CBT

Differences and Similarities between Existential Therapy and CBT By Anders Draeby Soerensen, www.andersdraeby.com

Introduction

In this paper, I will compare and contrast the cognitive-behavioral with the existential approach to psychotherapy by addressing theories of Aaron Beck, David Clarks and Adrian Wells, Jeffrey Young and Emmy van Deurzen.

The cognitive-behavioral approach

Cognitive therapy (CT) was developed by Aaron Beck on a clinical basis for the treatment of depressive patients and led gradually to the development of cognitive behavior therapy (CBT) by integrating methods and concepts from behaviorism and behavior therapy. As a reaction against the psychoanalytic understanding of depression as aggression turned inward, Beck describes depression as an expression of the activation of a cognitive triad, where the patient interprets his experience of his world, himself and his future in a negative way (Beck 1970: 255-6). While classical psychoanalysis is based on an ontological principle that drives are fundamental to human psyche, this cognitive approach is based on an ontological principle of cognition as constitutive of human psychology, which means that cognitive structures are the major determinants of human behavior and feelings. Beck is inspired by Jean Piagets cognitive-constructivist theory of development and assumes that different experiences lead individuals to construct cognitive schemas that contain basic assumptions about themselves, the future and the world (Piaget 1972). These schemas are used to organize perception and to govern and evaluate behavior and the depressive person has formed a depressogenic schemata containing dysfunctional assumptions (Fennell 2009: 172; Williams 2009: 263)

His interpretation of his experiences, his explanations for their occurrence, and his outlook for the future, show respectively, themes of personal deficiency, of self-blame and negative expectations. These idiosyncratic themes pervade not only his interpretations of immediate situations but also his free associations, his ruminations, and his reflections (Beck 1970: 285) The dysfunctional assumptions are activated by critical incidents that produce negative automatic thoughts leading in turn to other behavioral, motivational, emotional and physical symptoms of depression producing more negative automatic thoughts and thereby forming a vicious circle.



According to Beck, the depressive schemas are maintained by systematic logical errors, and with the integration of behavioral components in the establishment of CBT different theorists have started to focus on the way in which dysfunctional schemas and assumptions are also maintained by dysfunctional life strategies.

The CBT-approach is largely based on the conventional diagnostic approach to psychopathology and has also been extended to other psychopathological phenomena than depression. For example, David Clark and Adrian Wells developed a cognitive model of social phobia following the general cognitive idea, that it is expectations and interpretations that produce negative emotions and that states of anxiety are due to a systematic overestimation of the danger in a given situation (Clark 2009b: 54). Based on early experiences, according to the model, patients have developed dysfunctional assumptions about themselves in social situations that lead to them to interpret normal social interactions in a negative way viewing them as signs of danger. These interpretations are triggered in social situations in turn triggering an anxiety programme consisting of three interlinked components: (1) the somatic and cognitive symptoms of anxiety; (2) the safety behavior in which the patients engage to reduce threat and prevent feared outcomes; (3) and a shift in the patients attention to monitoring and observation of themselves (Clark 2009b; 127-8).

In other words, according to the CBT approach, phenomena such as depression and social phobia might be described as specific psychopathological phenomena that are due to deficient learning of cognitive structures and behavioral skills. Therapy is primarily oriented towards faulty cognition and behavior and the strategy of therapy is to target this deficiency through a corrective learning process including behavioral experiments, verification of expectations and confrontation of beliefs. More accurately therapists use of a variety of emotional, cognitive and behavioral techniques tailored to suit individual patients such as debating irrational beliefs, gathering data on assumptions one has made, learning new coping skills, keeping a record of activities, engaging in Socratic dialogue, carrying out homework assignments, forming alternative interpretations, changing ones language and thinking patterns and confronting faulty beliefs etc. (ibid: 140-3; Beck 1970: 319-30). In recent years, CBT has been expanded to include a broad range of treatment strategies that Nicole Rosenberg lists as follows:

(1) An psychoeducational strategy aiming at educating the patient in his mental illness;

(2) An insight contracting strategy, with the aim that the patient obtains a better understanding of his mental processes;

(3) A problemsolving or coping strategy aimed at learning the patient new skills and new ways of thinking and acquiring more effective ways of coping with problems (Rosenberg 2007: 244).



In the 1990s the second wave of the cognitive-behavioral tradition was established including Jeffrey Youngs schema therapy, which integrates elements from attachment theory. This schema therapy is primarily developed for the treatment of patients with personality disorders that have proved difficult to treat with traditional short-term CBT. It is described as a clinical educational method focusing on early maladaptive schemasdefined as:

self-defeating emotional and cognitive patterns that begin early in our development and repeat throughout life (Young 2003: 7)

The inspiration from attachment theory shows in the assumption that the learning of early maladaptive schemas is the result of unmet core emotional needs in childhood (ibid: 9). If patients develop these schemas they will either surrender to them by using cognitive filters and self-destructive behavior patterns, block the release of the schemas by cognitive, emotional or behavioral avoidance or overcompensate by the help of cognitive or behavioral patterns (ibid: 34-5). Therapy can be described as a learning process that can be divided into: an assessment and education phase where the goal of treatment is to teach patients to strengthen the healthy schemas, so that they can learn to navigate, negotiate with or neutralize their dysfunctional schemas; and a change phase where the goal is to learn cognitive, emotional and behavioral changes aiming to help the patient to fight the maladaptive schemas and destructive ways of coping (ibid: 44-5).

The reason why straight CBT doesnt work with personality disorder is because there is a need for a more radical reparative element to people who havent learned early adaptive schemas. However, in general it can be viewed as a common assumption in both CBT and schema therapy, that the patients have never learned to do cognitive and behavioral self-care which they then have to learn through therapy. Since the motivation for change and the personal responsibility for the way of responding to events is crucial to both these theories the educational notions of choice and responsibility might be seen as the core of the cognitive-behavioral approach. The therapist must take a very intervening and active role as a teacher or consultant to facilitate the learning process of the patient. Therapy is present-centered and very strategically oriented to specific mental conditions and structured around clear goals and techniques of treatment.

Comparing with the existential approach

While the cognitive-behavioral tradition is based on the ontological idea that cognition constitutes the essence of human being the existential tradition rejects any essentialist conceptualisation of man. Instead, the existential approach is based on the ontological idea that existence is the core of human being and that existence precedes essence. This also entails a rejection of the conventional diagnostic approach to psychopathology, since this is based on the idea that it is possible to make a fundamental distinction between essentially normal and pathological ways of functioning. While the cognitive-



behavioral approach focused on the incorporation of dysfunctional and madadaptive thinking leading to emotional and behavioral disturbances, Emmy van Deurzen thus describes the object of existential psychotherapy as the dilemmas of living, that must be addressed in moral and human terms rather than in terms of sickness and health (Deurzen 2007: xiii). These dilemmas are not manifestations of specific dysfunctions but expression of diverse difficulties in relation to coming to terms with lifes challenges. People inevitably experience anxiety in the confrontation with the challenges of life and have a tendency to turn away from them and lose themselves in shared cultural ideas of the perfect and problem free life, which paradoxically might lead them into misery and distress (ibid: 17). These peoples problems are thus caused by a misguided philosophy of life and their biggest challenge is not overcoming the dilemmas of life and create a normal existence but to affirm and make creative use of the very paradox involved in living (ibid: 18). Unlike the cognitive-behavioral approach the aim of existential psychotherapy is not to cure people or change their dysfunctional way of adapting to the world but help them learn the art of livingas a personal way of tackling lifes problems. Similar to the cognitive-behavioral approach therapy can thus be described as a learning process but the aim of learning is described in terms of discovering a meaning with life and to live authentically in accordance with ones own truth in life rather than in terms of achieving more adaptive ways of functioning. While especially the CBT approach put much emphasis on the unlearning of dysfunctional cognitive schemas and assumptions and therefore was primarily focused on the transformation of the inner consciousness, van Deurzen furthermore puts more emphasis on encouraging the clients to explore the ways in which they relate to the world as dimensions of worldly being. Furthermore, while the cognitive-behavioral approach tends to put emphasis on the learning of specific functional cognitive, behavioral and emotional skills, van Deurzen attaches more importance to the client to learn their own personal answers to lifes challenges:

Attempting to coach people who feel alienated in particular skills or in ways of expressing themselves may be counterproductive and result in more rather than less alienation (ibid: 20)

However, similar to the cognitive-behavioral approach van Deurzen provides much emphasis on the notions of choice and responsibility by assuming:

the importance of the clients capacity for making well-informed choices about her own life and her attitude towards it (ibid: 2)

Additionally, just as the cognitive approach assumes that man has learned a certain schematic and assumptional disposition in relation to how it organizes perception and governs and evaluates behavior, van Deurzen describes how a persons way of relating to the world is connected to the meanings he has created for himself and his relations to his world through his life. In turn the learning process in the existential therapy focuses not on the unlearning of old schemas, assumptions and strategies and the strengthening of healthy skills and acquirement of new skills but on uncovering, exploring and developing those assumptions, talents and values, which are already there, even though



they may be deeply hidden (ibid: 21). While the cognitive-behavioral therapist tended to function as a teacher who had expertise in specific techniques and strategies, the existential therapist functions as a mentor in the art of living and stresses understanding and reflections first and techniques second (Ibid: 25). According to van Deurzen, the practice of existential psychotherapy must be based on wisdom and integrity rather than on technical expertise and the therapist must therefore have achieved autonomy, openness, existential maturity and sense of perspective on the human condition (Deurzen 1998: 112).

Conclusion

In CBT and schema therapy, the focus of the learning process is on a collaborative relationship where the therapist assists the patient in identifying dysfunctional beliefs schemas and discovering alternative strategies for living and promotes corrective experiences that lead to new skills. As the patients gain insight into their problems they must actively practice changing thinking and acting, and like the existential approach the cognitive-behavioral approach therefore emphasizes the individuals responsibility for his own life and the opportunity to make choices and change his living conditions. Both approaches also stress the importance of the here-and-now encounter and places emphasis on human beings ability as a reflective and acting creature. While CBT does not put much emphasis on relationships, schema therapy has more in common with the existential therapy in emphasizing human relationality. One of the major differences is the focus in existential therapy on the authentic dimension. While there are immediate differences between the two approaches there are also similarities, and many insights and practices from the cognitive-behavioral approach might be integrated into existential therapy. Especially schema therapy focuses on learning new skills and strengthening existing skills for cognitive, emotional and behavioral self-care, and this insight may be integrated into the existential focus on the learning of the ability to live life in an authentic way.

References

Beck, Aaron 1970 Depression, Philadelphia: Philadelphia University Press

Clark, David & Christopher Fairburn 2009a Panic and generalized anxiety, I: Hawton (ed)Cognitive behavior therapy for psychiatric problems, Oxford: Oxford University Press

Clark, David & Christopher Fairburn 2009b Panic disorder and social phobia, I: David Clark & Christopher Fairburn (ed.) Science and Practice of Cognitive Behaviour Therapy, Oxford: Oxford University Press

Deurzen, Emmy van 1998 Paradox and passion in psychotherapy, Chichester: Wiley



Deurzen, Emmy van 2007 Existential counselling and psychotherapy in practice, London: Sage

Fenell, Melanie 2009 Depression, In Keith Hawton et al (ed) Cognitive Behaviour Therapy for Psychiatric Problems, Oxford: Oxford University Press

Piaget, Jean 1972 The psychology of the child, New York: Basic Books

Rosenberg, Nicole 2007 Kognitiv terapi, I: Benny Karpatschof (ed) Klassisk og modern psykologisk teori, Copenhagen: Hans Reitzels Forlag

Williams, J. Mark 2009 Depression I: David Clark & Christopher Fairburn (ed) Science and Practice of Cognitive Behaviour Therapy, Oxford: Oxford University Press

Young, Jeffrey (2003) Schema therapy, London: Guilford

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