Humanistic and existential psychotherapies use a wide range of approaches to case design, therapeutic goals, intervention strategies, and research methods. They are united by an emphasis on understanding the human experience and focusing on the client rather than the symptom. Mental health problems (including substance use disorders) are viewed as resulting from an inhibited ability to make authentic, meaningful, and self-directed decisions about life. Consequently, interventions aim to increase the client’s self-awareness and self-understanding.
While the keywords of humanistic therapy are acceptance and growth, the main themes of existential therapy are the client’s responsibility and freedom. This chapter broadly defines some of the main concepts of these two therapeutic approaches and describes how they can be applied to brief therapy in the treatment of substance use disorders. A brief case illustrates how each theory would solve customer problems. Many of the characteristics of these therapies have been incorporated into other therapeutic approaches such as narrative therapy.
Humanistic and existential approaches share the belief that human beings have the capacity for self-knowledge and choice. However, the two schools come to this belief through different theories. The humanistic perspective views human nature as fundamentally good, with an inherent potential to maintain healthy and meaningful relationships and make decisions that are in the best interests of self and others. The humanistic therapist focuses on helping people break free from limiting assumptions and attitudes so they can live more fulfilling lives. The therapist emphasizes growth and self-actualization rather than curing disease or alleviating disorders. This perspective points to present conscious processes rather than unconscious processes and past causes, but like the existential approach, it assumes that humans have an innate capacity for responsible self-direction. For the humanistic therapist, the source of problems is not being himself. The therapeutic relationship serves as a vehicle or context in which to facilitate the process of psychological growth. The humanistic therapist seeks to establish a warm and accepting therapeutic relationship, trusting that the client’s inner drive will be translated in a healthy direction.
The existentialist, on the other hand, is more interested in helping the client find philosophical meaning in the face of anxiety by choosing to think and act authentically and responsibly. According to existential therapy, people’s core problems are embedded in fears of loneliness, isolation, despair, and ultimately death. Creativity, love, authenticity, and free will are recognized as potential avenues for transformation, allowing people to live meaningful lives in the face of uncertainty and suffering. Everyone experiences losses (e.g., the death of friends, the end of relationships), and these losses cause fear because they are reminders of human limitations and inevitable death. The existential therapist recognizes that human influence is determined by biology, culture, and luck. existential therapy is based on the belief that people’s problems stem from not exercising enough choice and judgment, or not doing well enough, to create meaning in their lives, and that each individual is responsible for making life give meaning. However, external forces can contribute to the individual’s limited ability to choose and lead a meaningful life. For the existential therapist, life is much more a confrontation with negative inner forces than it is for the humanistic therapist.