The Two Stages of an Existential‐hermeneutic Approach to Psychic

Suffering
In the first stage we ask what the suffering person is suffering from. This is a
hermeneutic question and is identical to the question of to what he is especially
sensitive. The general answer to this question is always the same: the person
seemingly suffering from a mental disorder is suffering from his own being. This is true
for neurotic, psychosomatic, and even psychotic suffering. But when we deal with an
individual person with specific symptoms, we have to ask to which ontological truth he
or she is especially sensitive. In a second stage, we ask how the suffering person
responds to what he or she is especially sensitive to. The general answer to this
question is also always the same: because the ontological experience is threatening or
even traumatizing, he responds by either trying to battle against it with the
illusionary aim of overcoming its message, or by capitulating and retreating into a
state of depression. For an illustration of both stages we can turn again to our
examples: Illustration 1 When someone suffers from anorexia or bulimia we can ask if
he or she is especially sensitive to what it means ontologically to be subjected to the
biological need to feed oneself day by day as long as one lives. We can guess that
feeling hungry has become an ontological experience for this person, which reminds
him of being inevitably dependent on bodily needs, which is not only experienced as
threatening, but also as insulting because it goes against the ideal of self‐sufficiency.
Illustration 2 When someone suffers from a severe disturbance of his time
management, we can guess that he or she is especially sensitive to what it means
ontologically to be subjected to the law of time. And we can guess that the seemingly
harmless look at the watch is enormously threatening to this person because it reminds
him of his finitude.66 Alice Holzey-Kunz Illustration 3 If someone feels paralyzed
whenever he has to take a decision, we can guess that he or she is especially sensitive
either to the ontological truth that to decide always means having to renounce other
opportunities, or for the ontological truth that you can never know for certain if you do
not take a wrong decision you will deeply regret later on. Both truths can have a
paralyzing effect. Illustration 4 If someone suffers from hypochondria, we can ask if he
or she is especially sensitive to the ontological message in even minor bodily
symptoms such as a mild headache, because even a mild headache ontologically
indicates our bodily frailty and our being inevitably, as Heidegger put it, “towards
death.” Our second question is concerned with the hidden desire in all psychic
symptoms. There is something very special and even shocking about this desire
because it is not compatible with the “normal” wish to be freed from the limiting
pathological symptoms and regain mental health. If we assume that psychic
suffering is a suffering from our own being, then the character of its inherent desire
cannot be other than ontological. Someone who is oversensitive for the ontological
conditions wants to evade them or to battle against them. But whereas we can at least
in principle overcome ontical reasons for suffering, there is no way of getting rid of
the human condition. Therefore the desire inherent in all psychic suffering is an illusory
one. More precisely, our second question is concerned with the concrete “acting out” of
the ontological desire, which is realized in the manifest symptoms. Instead of taking
these symptoms as mere deficiencies, we understand them now as ontical actions with
an illusory ontological purpose. Illustration 5 We can guess that a person suffering
from anorexia seems to believe that she can free herself from being subjected to
bodily laws if she avoids eating enough food. Illustration 6 We can guess that a
person suffering from severe time‐problems seems to believe that he can free himself
from being temporal by revolting against all specific timetables and ignoring all
temporal arrangements. Illustration 7 We can guess that a person suffering from an
inability to take decisions seems to believe that he can save all his possibilities for the
future or, more often, that he can avoid becoming guilty by refraining from taking any
decisions. Illustration 8 We can guess that a person who suffers from hypochondria
seems to believe that he can gain total control over his body by constantly studying it
and that he can overcome its fundamental vulnerability by his own ontical means. Of
course, all these examples constitute mere guesswork. More than this can only be
achieved through an engaged dialogue with the patient and by listening carefully to
what he tells us about his suffering. There are two remaining questions that are
connected to each other. Both are important but must stay unanswered here. The
first concerns the origin of an ontological oversensitivity (see Holzhey‐Kunz 2016, 16
– 27); the second concerns the role of childhood experiences in psychic suffering (see
Holzhey‐Kunz 2014).

The overall task of the existential‐phenomenological therapist

is to facilitate the discovery and understanding of the assumptions that influence a
client’s decisions and actions, so that new choices can be made and owned more
deliberately. As we are permanently in the world with others, there is a reflexive
demand on ourselves to identify and understand how our own assumptions constrain
and restrict our perception. In this way we ensure ethical practice by simultaneously
acknowledging both our autonomy and that of the client. p 170 Martin Adams

With respect to our assumptions; our clients need us to have them, but only if we know
what to do with them. Our attempt at self‐awareness, our reflexivity, is the protection
our clients have from our assumptions taking over and turning existential
phenomenological therapy into a sophisticated form of suggestion. Life is continuous,
so reflecting on our evolving assumptions is continuous. It begins before, is present
during, and continues after the session. The client’s own distress and the questions
they have about their life indicate that their assumptions are flawed, inconsistent, or
unexamined. What is important is not so much whether their assumptions are correct,
but what they mean to the client and how they inform the client’s decisions about their
life, and whether these choices are satisfactory to them. Following Husserl, there are
two parts to phenomenological practice called epoché (or bracketing) and verification.
Although the overall aim of existential‐phenomenological therapy is to promote
understanding, in order to do this we first need to attend, and the entire
therapeutic process begins with and is sustained by attention. This kind of attention
facilitates openness both to ourselves and also to the client’s unfolding meanings.
Spinelli (2015) refers to it as un‐knowing, but in phenomenology it is better known as
an attitude of wonder or not knowing. Our ability to attend is correlated with our ability
to live with ambiguity and uncertainty. If our attention wanders or we find we are
searching for an explanation or a theory it probably means that we are not attending
well enough. But as long as we attend we will become increasingly aware of our
assumptions and the reductions will follow.