Positive Health Online

Regular readers of this column will recall the two articles on existential philosophy and psychology which appeared this summer.

Recently, I heard from a colleague who has always been critical of existentialism. What has that to do with the everyday work of psychotherapy in the "salt mines" (one of his favourite expressions to describe the sometimes difficult task of the psychotherapist)?

In response to him, let me discuss a typical example of how the existentialist's approach to the human dilemma can be a useful tool in the consulting room. It is not unusual that confused patients, often young men, suffer from problems of diffuse identity. Who am I? they ask themselves, without having a satisfactory answer.

Many feel a strong conflict between their family background and their own needs. They would like to have better relations with their fathers, for example, but somehow meetings between father and son end in ferocious quarrels. Others have constant conflicts with brothers or sisters. Some have avoided their family for years but feel a great deal of guilt over losing their "roots". Some who seek to find their roots, dig into the family tree, but continue to live what they call a "rootless" life if they fail to connect with their ancestors.

Here is a point where the existential teachings of choice and responsibility for self can play a part. Basically, we are all thrown into the world alone, and although family can help and be a great support at times, if one doesn't have a loving relationship with relatives, one can still forge one's own identity.

Sometimes a rather simple, though elegant exercise is useful for people struggling with this problem. Instead of seeking your "identity" through your forefathers, family or whatever, try to focus on your physical identity in the here and now. In other words, seize the existentialist moment – focus on your existence at the instantaneous slice of time. Sometimes I request the patient to stand up at this time, and gently request that he or she focus on support from the ground – feel your legs under you. Feel how they hold you up. Are they sturdy? Shaky? Can you feel support from them and the ground under you? A very specific concentration on what is happening just at this minute, will do more to forge an awareness of self than all the digging into one's family tree.

Another fruitful experiment is to focus on one's breathing. Just simply feel how the air comes in and flows out; don't try to change anything, simply focus on how it is, just now. If you are sitting, put your awareness on the chair under you, and feel how it holds you up.

These types of gestalt therapy exercises are very helpful in reaching a concrete, physical feel of the actuality of one's body interacting with the environment. The emphasis is on the immediacy of one's experience at this moment in space and time.

After concentrating on these and other exercises, one has a stronger sense of who one is, and a new clarity replaces the lamenting for lost roots or whatever it is that one felt was lacking. For those types of self-doubting experiences are only abstract theorising; direct concrete contact in the existential moment strengthens one's boundary in the real world.

When a patient goes on and on, constantly complaining about the lack of good relations with his family, and never lets go of the abstract idea that strong family ties are a prerequisite for a good life, I sometimes remind him of the other side, by citing the well-known adage: "Friends are the family you choose". When one is an adult, it is possible to find a new family through friends instead of lamenting what has never been, and perhaps can never be with one's original family.

Here it is useful to emphasise the existentialist credo of choice and responsibility: "You are the sum of your choices."

There are those who have a difficult time in "letting go" of their fixed ideas of how life should be. They often speak in terms of "blood ties", or "blood is thicker than water". I like to give them the fine line from author Richard Bach: "The bond that links your true family is not one of blood, but of respect and joy in each other's life." Fritz Perls used to put it this way, asking patients: "How much do you owe a parent who doesn't give you respect?" I often also heard him say to someone: "Look, you're 28 years old, what do you need your father for? Sure, when you were eight you maybe needed a Dad, but now…?"

There are other types of patient for whom a dose of existential thinking can be a healing elixir. I have seen several young people, serious and heavy-minded, who complain that they want to put life on "hold" until they can find some "meaning to it all". For this sort of confused person, I sometimes recommend that they read the short essay by Albert Camus on "The Myth of Sisyphus". This is an excellent, short good read by the Nobel Prize winner who died too young. The message it teaches is that the meaning of life consists of the living through it. The point is not to wait until you have a solution before taking on the everyday tasks, but to jump in.

Many patients have gone to psychoanalysis with a similar, dangerous wait-and-see attitude. The message they get is that one should put off important life decisions until after the therapy. However, the problem is that the time on the couch drags on and on and on… and in the meantime, the patient goes down the drain, doing nothing at all in the crucial here and now. It is better to try some tentative moves; "bracket off" your worrying, I sometimes tell them, and get on with life. The healing can often be found through working things out in reality, with the support of a skilled therapist. To sit back and wait until a thunderbolt of understanding hits you… well, in my experience, that's more pie-in-the-sky fantasy.