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Death is an inseparable part of life — arguably the most certain event in anyone’s life after birth. Besides their own life experiences, every counsellor inevitably meets, in professional practice, people seeking help who are either worried about how those close to them will face the death of a loved one, or who feel unable to cope well with the aftermath of a loved one’s sudden or gradual death. Usually, much of what worries the first group is how the young children around them will react psychologically to a death. In the same way, schoolteachers and school pastoral staff, given how many children they work with, meet some pupils every year who have lost an important person in their lives through death. Meanwhile, it is probably the parents or carers of these children who feel the greatest strain at such times, and who most need to understand how children of different ages react psychologically to the death of someone close, and the right ways to respond to those reactions.

The truth is that children react to the death of someone close very differently from adults, and within childhood their understanding of death also varies with age. Preschool children see death as temporary and reversible; up to about age 3, for example, the concept of death is beyond a child’s grasp. Between 3 and 5, children see death as a long journey and cannot understand that it is irreversible. At this age death is equated with sleep, and if children have not had enough chance to talk about death, or have been made very anxious by the way the adults around them handled it, they may develop problems with sleep and falling asleep. They may put the absence of an important person down to their own bad behaviour and hold themselves responsible, and so feel great guilt. Sometimes this guilt can leave serious problems with staying calm, sleeping, eating, and forming and keeping relationships with peers and adults.

Between 5 and 8, a child’s understanding of death becomes more like an adult’s, but most children of this age still imagine it will never happen to them or to anyone they know. After 8 or 9, almost all children know that death is final and could happen to them at any moment. At this age, besides the anxiety of their loved one being gone, the child also develops anxiety about their own non-existence. They can also, to some degree, foresee the grief and anxiety of those close to them after their own possible death, and be affected by that too. After 12, alongside all this, anxiety about leaving things unfinished, about loved ones being left alone, and finally about the mystery of death’s journey can be seen clearly in the adolescent.

How these anxieties show themselves, though, may differ fundamentally from adults. The death of someone close can bring great sorrow, despair and much anger. When a loved one passes away from a family, besides the emotional blow and confusion the child may feel directly, the distress of the other grieving adults and the emotional effects they experience can reduce how much they care for and support the child, which in turn adds to the child’s confusion and anxiety. Apparent indifference, or a mild emotional reaction, in some children — especially young ones — for a few weeks after a loved one’s death is not necessarily abnormal. It may be because they do not fully grasp that the person will not return, or cannot foresee the negative consequences. But where this indifference or denial of the death goes on, or grief reactions are delayed too long, it can cause much more serious problems later.

At the burial, if a child is afraid to attend, they should not be forced. Clearly, involving them in the memorial service, the seventh-day and fortieth-day gatherings, setting the memorial table and so on helps restore their balance sooner. At such times the child should be given the chance to mourn and cry freely, to talk about their memories of the person who has died, and to express the love — or even resentment — they may feel towards them.

A very important point: children under 12 are not advised to see the body of the deceased, and those around them should prevent it (especially if, for whatever reason, the body is no longer in its natural state).

A child’s aggression (and even an adult’s) often comes from frustration in meeting basic needs. Since the person who has died met many of the child’s basic needs and their material and emotional security, the loss, as a major frustration, can produce a lot of aggression in the child. Clearly, if this aggression lasts too long or is very intense, the help of a child psychologist is essential. After a parent’s death, some children begin to behave more childishly than their actual age: more babyish behaviour, dependence at mealtimes, attempts to get the attention of those around them, a strong need to be held, and even baby talk can be seen clearly.

When a child is very young, because of the egocentrism with which they understand the world, they attribute the cause of everything around them to themselves (until about age 7). At this stage they are quite likely to imagine that they themselves were the main cause of the person’s death. Clearly, the guilt from this thought can be very anxiety-provoking, and the anxiety shows itself in many behavioural signs. If it persists, it is a very major risk to mental health.

Key points

In the light of all this, when we are with a child who has lost an important person in their life, we should keep the following general points in mind:

1. Children aged 3 to 5 imagine that the person who died has gone on a journey.

2. Children aged 5 to 8 understand to some extent the idea of a journey with no return, but may show no signs of mourning at all.

3. After age 8, the idea that death is final becomes settled in the child.

4. After 12, children have a fairly complete idea of death, but their emotional reactions can differ from adults’: for example, they may say less, eat more easily, and even seem more active than before.

5. What is common to almost all these stages is the anxiety of no longer seeing the loved one.

6. Up to age 8, take care not to give the child messages suggesting the person who died has gone on a temporary trip, because it will leave them waiting for something that will never happen and delay their adjustment to the death. After 12, the child knows for themselves that there is no coming back.

7. When the person who died is one of the child’s parents, anxiety about being unprotected and unsupported is clearly visible. So at any age it is essential to have someone who, despite their own grief, can answer the child’s needs for attachment and support. Because of the intensity of their own emotions, the surviving parent may not be the best person for this; be sensitive to it.

8. Give the child the chance to express their positive and negative emotions freely, without shame, fear or denial. At such times it is essential to have an adult who, while showing their own sorrow, can listen calmly to the child, look at them, and support them directly or indirectly.

9. It is strongly recommended that children are kept from seeing the body being washed or buried (especially under 12). It has repeatedly been observed that nightmares, mistaken beliefs about life and death, and fears of soil, sleep, darkness and basements develop in children afterwards.

10. During memorial ceremonies, always give the child practical responsibilities suited to their abilities.

11. If signs of sorrow, grief and mourning are delayed in the child for more than two weeks, be sure to see a child psychologist or child psychiatrist.

12. What matters for the child to pass healthily through this time is that the people around them respond in the right way — which, sadly, despite the best of intentions, is often full of mistakes. So meeting the specialists mentioned above can help you help the child understand what has happened and adjust well.

13. If the child is at school, contact the school directly. Discuss the situation with the head teacher, the pastoral lead, the counsellor and, above all, their class teacher.

14. School staff can help most by giving the pupil enough time to readjust. At such times remember that a temporary dip in grades and poor schoolwork is nothing strange. Giving the pupil a chance to talk about their memories of the person who died, and the sympathy of friends and teachers, are very encouraging.

15. While showing the child their own sorrow, giving them room to talk, and supporting them in expressing their worries, sadness and negative emotions, teachers should take care not to make too much of it. Sometimes a pupil who has not felt at the centre of others’ attention before may be inclined to express exaggerated feelings, and keep them up, to draw attention.

16. And finally, let us remember that we cannot live through the experience for the child; we can only stand beside them and make their passage through the tragedy easier. This, of course, takes trust in God and time — so let us not lose patience.

Dr Bahman Bahmani, PhD in counselling, associate professor and faculty member, University of Social Welfare and Rehabilitation Sciences

Institute for Humanities and Cultural Studies

Comprehensive Portal of Humanities

“People with special needs” refers to a wide range of human conditions in which people, for various reasons, have difficulties that create special needs for them. Exceptional children are one of these groups. Sadly, exceptional children are often poorly understood, and are sometimes even looked down upon. This article is about exceptional children or, more accurately, children with intellectual developmental delay.

Some people think a diagnosis of intellectual developmental delay is right only when a person’s intelligence is below normal, and that most of these children cannot learn or look after themselves. In fact, diagnosing intellectual developmental delay requires two features together: first, a below-average IQ; and second, difficulties in coping with everyday life, to the point that the person cannot learn the basic, essential tasks of a fairly self-sufficient life. Even so, most children with a lower IQ can learn a great deal. As adults they can build fairly independent lives, and, more importantly, they too can enjoy life like anyone else.

They too can enjoy life like anyone else.

In the past, parents of an exceptional child were advised to place their child in an institution for exceptional children. That practice is now outdated. Today it is recommended that these children stay with their families, so that they can take part in social life too. The law also guarantees that the costs of their education and the services they need are met by the state from public funds.

A child may also suffer from other physical and emotional difficulties at the same time. These children sometimes have problems with sight, hearing and speech that keep them from making good use even of the mental abilities they do have.

A comprehensive, thorough assessment of these children’s physical and psychological abilities and disabilities is one of the most essential steps, and should always be done. Since no single specialist can assess and treat every dimension of a human being alone, it is essential to involve different specialists and draw on their cooperation. Medical and neurological tests and hearing, vision and physical tests are also very useful, and necessary, in helping these children.

A low IQ does not mean all is lost. These people usually have positive qualities that specialists should identify and make the best of.

Sadly, one common consequence of intellectual developmental delay — especially milder forms, in which the child is bright enough to compare themselves with those around them and their peers and to pick up on others’ remarks and hints — is emotional disturbance. These children often try to keep up with their peers, but because they learn slowly, or cannot learn everything others learn, they feel they have failed, and become anxious, withdrawn and discouraged from social contact. Since they are less able to put their sadness and worry into words, their depression soon turns into other behavioural reactions, and they show new behavioural problems, for example with eating and sleeping. Naturally, the earlier intellectual developmental delay is diagnosed, the more can be done to help.

Ways of treatment:

Contrary to popular belief, medication is not the most effective treatment for the effects of intellectual disability; rehabilitation, behaviour therapy, educational support and family counselling should always be used as well.

So, in general:

1. Intellectual developmental delay has degrees, ranging from mild to very severe.

2. Intellectual developmental delay does not mean all is lost. These people usually have positive qualities that specialists should identify and make the best of.

3. Genetic causes, illness, injury, cultural causes and a deprived learning environment are among the factors that cause intellectual developmental delay.

4. Most people with intellectual developmental delay can learn the skills needed for a fairly independent life.

5. Some people with intellectual developmental delay can complete their schooling under specialist supervision.

6. Identifying other conditions that accompany intellectual developmental delay, such as problems with sight, hearing and speech, and treating or rehabilitating them, is essential to their mental health, and must be acted on.

7. Most children with near-normal IQ (mild intellectual developmental delay) suffer from emotional difficulties that need treatment.

8. Diagnosing and treating intellectual developmental delay and its effects requires many specialisms: psychology, education, rehabilitation and medicine.

9. The mother should be the mainstay of help for these children. So in every case of a child with special needs it is essential to support the mother, train her well, give her an accessible counselling service for when she needs new information or to rethink behaviours, and encourage her to keep going.

Dr Bahman Bahmani, PhD in counselling, associate professor and faculty member, University of Social Welfare and Rehabilitation Sciences. Adapted from the monthly Exceptional Education, issue 1

Related reading:

An introduction to rehabilitation counselling

An introduction to child and adolescent counselling

“Cognitive–existential psychotherapy” is an approach that integrates cognitive and existential theories.

Helping people facing a serious threat of death, sensory–motor paralysis, human catastrophes, tragedies and natural disasters — or any situation in which a person’s core meanings are threatened or lost — calls for psychotherapy approaches that can effectively help them rebuild the meaning of their lives and adjust, effectively and realistically, to the consequences of such enormous losses.

Being unable to rebuild meaning effectively can lead to severe, lasting depression and to a sharp decline, or complete collapse, in quality of life. The onset or worsening of psychosomatic illness, low morale and listlessness, generalised anxiety, phobias of many kinds, and a severe loss of motivation are among the consequences of being unable to rebuild threatened meanings.

Cognitive–existential psychotherapy can be seen as a unique, integrated approach that draws on the benefits of “combining cognitive theory and existential theory” in understanding the pathology of anxiety and depressive disorders.

The approach assumes that cognitive therapy techniques can not only correct dysfunctional schemas, negative automatic thoughts and cognitive errors, and so ease the psychological distress and injury of people struck by tragedy, but can also address existential concerns — such as dread of death, uncertainty, meaninglessness and loneliness — which other psychotherapy approaches have generally not answered well, and which lie behind much harmful anxiety.

Dr Bahman Bahmani, PhD in counselling, associate professor and faculty member, University of Social Welfare and Rehabilitation Sciences

Moeen Counselling Centre has run many workshops on cognitive–existential psychotherapy. To hear about upcoming workshops, please contact the centre.

Persian translation by Dr Ali Mohammad Nazari, Abbas Mouziri and others

About the book

This book was written to set out the foundations of the solution-focused approach and explain how its skills are applied in many fields, including mental health, childcare and organisational consulting.

Therapists often, and naturally, pay little attention to research. Yet in developed countries there is a growing need for evidence in therapy: the effectiveness of treatments must be established by the models of scientific research accepted for evaluating medical treatments. This book gives a broad review of contemporary research, including the author’s own research data.

One of the book’s aims is to show how the solution-focused approach applies in organisational settings; I hope it will be a useful resource for managers and management consultants looking for effective interventions.

What others have said about this book

A book full of ideas and exercises for trainees and therapists. A comprehensive account of solution-focused ideas and how to use them in the workplace. An essential book for professionals who want to improve their solution-focused skills. Alasdair brings to this book the knowledge of years of expertise, research and passion for the solution-focused approach.

Bill O’Connell.

Fred Roddick.

***

Alasdair Macdonald has created a landmark in the development of solution-focused approaches. He brings together the history, research and evidence for solution-focused therapy, and offers many practical exercises, from severe mental illness to conflicts at work. The book is a collection of brief, concise insights, [human] relationships and thought-provoking questions, very authoritative and clear.

Mark McKergow, author of “The Solutions Focus: The SIMPLE Way to Positive Change”.

Alasdair has an important and special place in the solution-focused world because of his long-standing interest in research. That interest, and his background in adult mental health work, shine through in this book, which presents them apart from the introduction to the approach. At a time of limited resources and professionals under pressure, this book highlights the flexibility and suitability of the solution-focused approach, which can be effective and practical for clinicians and managers in the field.

Evan George, BRIEF, London.

Contents

Chapter 1: The solution-focused therapy model: the first session, part one

Chapter 2: The solution-focused therapy model: part two

Chapter 3: A case study

Chapter 4: Ethics in solution-focused therapy

Chapter 5: The historical roots of solution-focused brief therapy

Chapter 6: Solution-focused brief therapy in mental health

Chapter 7: The solution-focused approach to severe mental illness

Chapter 8: The solution-focused approach at work

Chapter 9: Future directions for solution-focused therapy

Appendix 1: Websites of academic and training centres for the solution-focused approach

Appendix 2: Rapid, repeated breathing: a remedy for anxiety syndrome

Persian translation by Dr Esmaeil Asadpour, Abbas Mouziri and Fatemeh Naderi

About the book

Dr Elaine Clanton Harpine is a motivational psychologist specialising in the design of group-centred motivational programmes, with 35 years’ experience designing and running motivational programmes for children and adolescents.

Written to help school psychologists and counsellors and others working in school health, this book sets out the theoretical framework of group interventions in schools and gives examples of how to apply them. Although group interventions for schools take many forms, the book focuses on group-centred interventions: preventive programmes that aim to equip pupils to learn and so to perform more successfully.

Group-centred interventions help pupils develop and improve cognitive, emotional and behavioural skills through a series of structured sessions. An element of “play” for children, and a programme of “taking part in social activities” for adolescents, are added to these interventions. As the term “group-centred” suggests, all the interventions discussed draw on the therapeutic power of the “group”; and if the group is led well, “group cohesion” can become an important source of change in its members.

This book can serve as a supplementary resource and training guide for school counsellors with less training in designing and running group interventions with children. It can also be useful and practical for group specialists who want to make their skills more effective, and for newcomers to group work. We hope that by the end of the book readers will be familiar with using group-centred interventions in school settings.

Contents

Foreword

Introduction

Chapter one: School-based prevention programmes to make up for failure

Chapter two: Retraining the skills that build a sense of efficacy

Chapter three: Intrinsic versus extrinsic motivation

Chapter four: Process and change in groups

Chapter five: Choosing effective interventions

Chapter six: A one-week group-centred motivational intervention programme

Chapter seven: Designing group-centred motivational interventions

Chapter eight: Building cohesive group interventions

Chapter nine: Running and evaluating the programme: the long-term goal

How meeting basic needs shapes marital adjustment

That meeting our basic needs affects marital adjustment is taken for granted today, but recognising our needs and learning how to meet them requires knowing ourselves and our spouse. This article looks briefly at the subject.

Introduction

Humanity’s basic, fundamental needs have been discussed in theories across many scientific fields, especially psychology; many theories of personality devote a special section to the subject (Schultz and Schultz, Persian translation by Seyed Mohammadi). One of the most recent approaches to take it up seriously is reality therapy, or choice theory, put forward by William Glasser, which has been very well received in research and clinical practice, especially over the last two decades (Corey, Persian translation by Seyed Mohammadi).

Glasser believed that just as survival needs are genetically programmed in all animals, in human beings — the most complete of animals — four higher and more complex needs are genetically programmed as well (Glasser, Persian translation by Rahmanian). These four needs, usually known as love and belonging, power (achievement/competence), freedom (independence) and fun (enjoyment), are regarded as the basic psychological needs, while survival is the one basic physiological need in human beings. These five needs are shared by all humanity, regardless of age, ethnicity, race or gender. Even so, how much each matters, and in what order, differs from one person to another. In other words, everyone has these five basic needs, but in each person one or more of them stands out as more important than the rest. According to choice theory, it is very important for people to become aware of their own unique pattern of basic needs, because this awareness can play an important part in making healthy, constructive choices in personal and social life (Glasser).

Whether or not the five needs are met has a direct, tangible effect on our feelings and physical states. When they are met well, we experience pleasant feelings and physical states; but if, for any reason, we fail to meet them, we experience unpleasant ones. Our feelings and physical states are in fact clues to whether our basic needs are being met well at the moment. For example, if we feel physically unwell, our survival need may be threatened by an internal infection; or if we feel pleasure and happiness, our need for love and belonging may be well met. In general, this can hold for each of the needs (Glasser, Persian translation by Rahmanian). Each of the five basic needs is described below (Glasser, Persian translation by Rahmanian; Wubbolding et al.).

1) The need for survival

The need for survival is shared by all living beings, and broadly refers to a creature’s drive to stay alive and have a safe place in the world. Much of the behaviour linked to survival, especially in animals, is instinctive. But one essential difference in humans is that, besides instinctive and involuntary behaviour, we can meet our survival needs in highly intelligent and complex ways. And unlike animals, humans usually meet their survival needs with interpersonal and social demands in mind.

2) Power

The need for power refers to the wish to control people or things. It also includes the wish for mastery, achievement and a sense of competence. In general, the need for power can be a good source and driver of progress in different areas of personal and social life. On the other hand, when it appears as an intense wish to exert influence and dominate others, the unhealthy, destructive side of this need has come to the surface. This dysfunctional side of the need for power, which runs against many aspects of healthy, constructive social life and relationships, may show itself in all kinds of hostility and interpersonal conflict.

3) The need for freedom

The need for freedom refers to the human inclination to decide, choose, be independent and act without interference from others or outside constraints. In other words, it is the need for a person’s private life, will and independence not to be attacked by the power and external control of others.

4) The need for fun

The need for fun refers to the sense of liveliness and enjoyment that pleasurable, well-loved experiences and activities bring. Learning about what interests us may be the most important way of meeting this need. The idea of learning matters so much here that Glasser saw fun as the genetic reward for learning.

5) Love and belonging

For today’s social human being, the need for love and belonging is often the most important need. Indeed, meeting the other four needs well is in a sense possible only in the shadow of this one, because all basic needs can be met only in a social context and in relationships with others (Gardner). In other words, a person’s psychological nourishment comes through this need. That is why Glasser believed that someone who has long been unable to experience loving relationships full of affection and belonging will without doubt develop psychological symptoms. In Glasser’s view, chronic psychological problems, whatever form they take — depression, anxiety, obsession or any other — are in fact signs of relationship problems. When the need for relationship, love and belonging is damaged over a long time, psychological illness is unavoidable. Failure to meet this psychological need can come from two main sources: a) the person is caught up in very destructive relationships that have damaged it, or b) the person has no positive, supportive relationships at all. For Glasser, a satisfying, happy marriage requires the need for love and belonging to be well met for both partners.

Using questionnaires and observation, Fitzpatrick[1] and Gottman identified three types of stable[2] marriage. The marital relationships these three types produce are: 1) “traditional”[3] couples, 2) independent[4] couples and 3) “avoidant”[5] couples.

Traditional couples:

They accept conventional gender roles and lifestyles, and resolve conflict in an indirect, so-called low-key[6] way. In short, traditional couples:

• Accept traditional gender roles.
• Put family goals before individual goals.
• Keep a regular, predictable daily routine.
• Do not each keep private space or belongings at home.
• Are moderate in expressing positive and negative feelings.
• Avoid getting caught up in minor conflicts.
• Take up important conflicts between them with the aim of resolving them.
• When starting to resolve a conflict, each first tries to listen to the other’s point of view, and then states and defends their own position.
• Try to persuade the other only after listening properly to their view.

Independent couples:

Striving for equal roles, they resolve conflict in an active, direct, so-called fiery[7] way.

• They accept androgynous, egalitarian roles.
• Family goals come after individual goals.
• They have no particular regular, predictable daily routine.
• Even at home, each keeps private space or belongings that the other may not use without permission.
• They are not especially moderate in expressing positive and negative feelings.
• They prefer to keep wrangling over the issues between them.
• From the very start of a disagreement, without trying to listen to each other, they set out to prove their own view and persuade the other.
• They have many positive and negative feelings towards each other.

Avoidant couples:

They accept conventional roles but lead parallel lives, and, unlike traditional couples, try on principle to avoid attending to points of conflict in their relationship.

• They accept traditional gender roles.
• They try to avoid any kind of conflict.
• Their conflict-resolution skills are very weak. In the few cases where they acknowledge a conflict, they simply state their own views, without any attempt to persuade each other or reach a compromise.
• They play down their disagreements compared with the values and common ground they share.

Gottman’s study also identified two types of unstable couple, described as “hostile”[8] couples and couples who are “completely disengaged”[9] from each other.

Hostile couples:

The first group notice conflict in their relationship and do fight, but they do not seek to solve the problem; mostly they tear each other down.

• They take up their conflicts but make no attempt to resolve them.
• Constant blame, mind-reading and defensiveness are the main features of their interactions.
• They express a great deal of negative emotion and very little positive emotion.
• Their usual pattern of interaction is attack and withdraw.
• They express very high levels of negative emotion towards each other, and very little positive emotion.

Completely disengaged couples:

To prevent confrontation, the second group avoid everyday contact with each other on principle, and put up with each other in a kind of complete silence and indifference.

• They avoid conflict, and their conflict-resolution skills are also very weak.
• Brief episodes of blame, mind-reading and defensiveness appear in their interactions.
• They express very little negative emotion, and positive emotion is almost absent.
• Their conflict pattern is avoid/avoid.

Gottman found that in the three types of stable couple, the ratio of positive to negative verbal exchanges when resolving conflict was 5 to 1, whereas for unstable marriages it was reported to be roughly 1 to 1. Gottman’s and Fitzpatrick’s work especially stresses the fact that stable, lasting patterns of marriage are very varied. Their findings underline the importance of couples taking up their conflicts (with the aim of resolving them) rather than staying silent and ignoring them. Attending to each other’s negative points does damage only when it exceeds one for every five positive responses. In fact, moderate negativity of the kind described above may even help build and deepen mutual social understanding, and so play a useful part in balancing the need for intimacy with the need to exercise power, helping to keep the relationship attractive in the long run.

[1] Fitzpatrick

[2] stable

[3] traditional

[4] androgynous

[5] avoidant

[6] low key

[7] fiery approach

[8] conflictual

[9] Disengaged

Sources: Gottman, J. M. (1993). The roles of conflict engagement, escalation, and avoidance in marital interaction: a longitudinal view of five types of couples. Journal of Consulting and Clinical Psychology, 61, 6–15; and Fitzpatrick, M. A. (1988). Between Husbands and Wives: Communication in Marriage. Newbury Park, CA: Sage.

As one of the centres licensed for specialist premarital counselling and family strengthening, Moeen Counselling Centre plans to run specialist premarital counselling courses and family therapist training courses for students and professionals in counselling and psychology, taught by Dr Bahman Bahmani and other leading teachers in Iran. To hear about course dates and requirements, join our network.

Existential theory

If we allow ourselves to set aside the everyday concerns of life and let ourselves be deeply affected by our situation in the world, we inevitably arrive at the deep structure of existence.

Four ultimate concerns stand out in existential psychotherapy: life and death; freedom, responsibility and choice; isolation and love; meaning and meaninglessness.

Life and death

There is one certainty in life: that it comes to an end. Although we do not know how or when we will die, we know that we certainly will. Awareness of death, frightening as it is, can pave the way for a creative life. In his work with cancer patients, Yalom shows how they came to terms with their approaching death. He does not limit his discussion to adults: he points to many studies showing how children deal with death through denial. Some children believe that children do not die; some personify death (“death takes bad children”); and some see death as a temporary state or a kind of sleep. Frankl did not see death as a threat; he believed that death moves people to live life to the full and to use every opportunity to do meaningful things. So attending to death can open the way to creativity and a full life.

Freedom, responsibility and choice

The right to life also brings responsibility. In the existentialist view, human beings do not enter or leave a structured world with a coherent design. Rather, in seeking freedom, people are responsible for their world, their life plans and their choices. We are free to choose paths that fit the responsibility we have for our own lives, and to adopt the values that matter to us. Sartre held that human beings are condemned to be free: they are responsible for creating their own world, which is built on nothingness. The choices we make, Sartre says, are what make our true selves.

Responsibility means owning our choices and dealing honestly with freedom. Sartre uses the term “bad faith” in speaking of human limitation and finitude. A person who says, “Because I was mistreated as a child, I can’t treat my children well”, or who says, “Because I didn’t go to a good secondary school, I can’t get into a good university”, is acting in bad faith, because they blame someone else and do not consider their own inherent limitation. Responsibility also includes being considerate of others and not blaming them for one’s personal problems.

In discussing freedom, May uses the concept of willing — turning responsibility into action. Willing has two aspects: wishing and deciding. May sees mental illness as not wishing, which means emptiness and despair. Part of an existential therapist’s task is to mobilise clients’ feelings towards wishing and carrying out decisions. After wishing or desiring, people must choose. This is somewhat frightening, and it leads people to expect someone else to choose for them. After every choice, people must also bear the other side of what they chose. Accepting responsibility for choice, depending on a person’s situation and their ability to act in good faith, can cause intense anxiety.

Isolation and love

Yalom describes three kinds of isolation: interpersonal, intrapersonal and existential. By interpersonal isolation he means a distance — geographical, psychological or social — that has opened between us and others. Someone with schizophrenia, for example, is cut off from others by being unable to form relationships with them. When a person separates parts of themselves from other parts, through defence mechanisms or other ways of ignoring their own wishes, they are in intrapersonal isolation: someone who does not focus on what they need to do, does not trust their own judgement, and is unaware of their inner abilities and capacities.

Existential isolation is more fundamental than the other two. It means distance and separation from the world. In such isolation we are captive to deep loneliness and solitude. Existential isolation intensifies in the face of death: a car crash brings existential isolation and intense fear. The feeling of complete loneliness and helplessness brings with it a deep terror of nothingness.

Meaning and meaninglessness

Throughout their lives people ask themselves questions about the meaning of life, such as: Why am I here? What if I found the meaning of life? What in my life gives it purpose? Why do I exist? As May and Yalom say, human beings need life to be meaningful. Meaning lets people interpret events and form values about how to live and what they want from life.

Frankl stressed the important role of finding meaning in life. He was concerned that people would neglect spiritual meanings and stay within the bounds of material values. It may seem paradoxical, but Yalom found that people with a fatal illness discover the meaning of their lives — a meaning they had paid no attention to before they fell ill.

Moeen Counselling Centre plans to run specialist existential therapist training courses for students and professionals in counselling, psychology and psychiatry, taught by Dr Bahman Bahmani. To hear about dates and course requirements, join our network.

Gestalt therapy is an existential, phenomenological and process-based approach, founded on the principle that:

People must be understood in the context of their ongoing relationship with their environment

Fritz Perls believed that clients must grow up, stand on their own two feet and deal with the problems of their lives themselves.

Perls’s style of therapy

Perls had two aims in therapy: moving the client from environmental support towards self-support, and reintegrating the disowned parts of their personality.

In Gestalt, maladjustment rests on two principles:

1. Body and mind are inseparable.

2. The person and the environment form an organismic unity.

In Perls’s view, neurosis comes down to three main issues:

1. The growth and development of aggression

2. Self-preservation and the search for balance

3. The interaction of person and environment

The Gestalt theory of change holds that the harder we try to become who we are not, the more we stay the same. It matters that clients be as fully as possible what they are now, rather than trying to become who they “should be”. Rather than relying on change directed by the therapist, Gestalt therapists focus on creating conditions that help the client grow (Yontef, 2005).

Key concepts in Gestalt therapy:

The here and now

Organismic self-regulation

Responsibility

Polarities and polarisation

Holism

Therapeutic goals:

Although Gestalt therapists do not stress predetermined goals for their clients, they do attend to one particular goal: helping the client gain greater awareness, and with it greater choice. Awareness includes knowing the environment, knowing oneself, accepting oneself, and being able to make contact.

Six elements of method are vital in Gestalt therapy: 1) the continuum of experience, 2) the present moment, 3) the paradoxical theory of change, 4) experiment, 5) authentic encounter, 6) process-oriented diagnosis.

For those interested in this approach, Moeen Counselling Centre plans to run workshops and specialist Gestalt therapist training courses taught by Dr Amir Askari. To hear when workshops are held, join our network.

History:

The existential therapy movement was not founded by any one person or group; several currents of thought gave rise to it. Existential therapy grew out of philosophy and emerged spontaneously in different parts of Europe, among different schools of psychology and psychiatry, in the 1940s and 1950s. After the Second World War many Europeans felt the war had devastated their lives, and they were wrestling with existential issues such as isolation, alienation and meaninglessness. Early writers focused on the individual’s experience of being alone in the world and facing the anxiety of that condition (Sharp and Bugental, 2001).

The thinking of existential psychologists and psychiatrists was influenced by several nineteenth-century philosophers and writers. To understand the philosophical foundations of existential psychotherapy, we need to know figures such as Søren Kierkegaard, Friedrich Nietzsche, Martin Heidegger, Jean-Paul Sartre and Martin Buber. These major figures of existentialism and existential phenomenology, and their cultural, philosophical and religious writings, laid the foundation for existential therapy.

Key figures in existential psychotherapy:

Irvin Yalom, Viktor Frankl, Rollo May and James Bugental developed their existential approaches to psychotherapy from strong roots in existential and humanistic psychology.

Irvin Yalom:

Yalom may be called one of the most influential people in existential psychotherapy. Building on the idea that existentialism deals with the “ultimate concerns of existence”, he developed his own approach to individual and group psychotherapy. Isolation and relationship with others, death and living fully, and meaninglessness and meaning are its most important elements.

The existential school seeks a balance between recognising the limits and tragic dimensions of human existence on the one hand, and the possibilities and opportunities of human life on the other. It grew from a wish to help people deal with the hard situations of modern life.

“No relationship can eliminate existential isolation, but aloneness can be shared in such a way that love compensates for the pain of it” (Yalom and Josselson, 2011)

Moeen Counselling Centre plans to run specialist existential therapist training courses for students and professionals in counselling, psychology and psychiatry, taught by Dr Bahman Bahmani. To hear about dates and course requirements, join our network.