Mental Health, Religion & Culture

June 2006; 9(3): 265275

Can existential psychotherapy be good news?

Reflections on existential psychotherapy from
a Christian perspective
ROGER BRETHERTON
Lincolnshire Partnership NHS Trust, Lincoln, UK

Abstract
One of the major difficulties in advocating a positive approach to therapeutic work is that
most candidates for psychotherapy are preoccupied with the negative or painful aspects of
their lives. However, it is argued that positive clinical practice can be derived from the
therapist recognizing a shared human predicament with the client, a recognition which
requires a degree of honesty on the part of the therapist. This frank self-reflection is much
in evidence in the writings of the existential atheists, largely due to their assertion that
there is no observing deity who may judge the faults and weaknesses of human beings.
Believers in a theistic God, however, may be more cautious in acknowledging sources
of shame or guilt in themselves out of fear of divine disapproval. From a Christian
perspective, the life, death, and resurrection of Jesus Christ justify human existence
and provide evidence of Gods love. Acceptance of this can allow the Christian
psychotherapist to be cognizant of potential shortcomings and thereby experience a strong
identification with the challenges of living presented by the client. This can enable a
positive and non-pathologizing relationship with clients of any religious or ideological
persuasion.

Introduction
The historical and conceptual connections between existential philosophy and
Christianity are well documented (e.g., Macquarrie, 1972). Establishing a link
between existential psychotherapy and the recent development of positive
psychology, however, is rather more difficult (see Bretherton & rner, 2003,
2004). But, if a positive existential psychotherapy is difficult to conceptualize,
a positive Christian existential psychotherapy is doubly so. The problem does not
so much lie in the coalescence of Christianity with existentialism mentioned
above, but rather lies in the combination of these with positive psychology,
Correspondence: Roger Bretherton, Department of Psychological Services, Adult Psychology
Speciality, Baverstock House, St Annes Road, Lincoln LN2 5RA, UK. E-mail: roger.
bretherton@lpt.nhs.uk
ISSN 1367-4676 print/ISSN 1469-9737 online 2006 Taylor & Francis
DOI: 10.1080/13694670600615490

266 Roger Bretherton

especially given the aversion of positive psychologists to such notions as sin or
guilt. Nevertheless, I consider my approach to therapy to be Christian, existential,
and positive, and in a sense, this paper represents an attempt to hold together
these seemingly antithetical perspectives. It could perhaps best be considered
a response to the challenge to philosophical consistency, posed by the existential
psychotherapist Emmy van Deurzen-Smith (1988):
Unless the counsellor is experienced and creative enough to meld different approaches and
assumptions into a new and consistent synthesis, the result may be extremely confusing. Clients
may pick up the message that life is confusing and the counsellor does not really have a clue
about which direction to follow. (van Deurzen-Smith, 1988, p. 3)

It represents a first attempt to put into words the underlying assumptions of the
approach that I have been using daily with clients, and thrashed out in reading
and conversation with colleagues, but have not yet stated explicitly. This is
a beginning, therefore, rather than a conclusion; a starting-point to be developed
and revised, rather than an absolute statement of policy.

Why people seek psychotherapy

The major and immediate problem that springs to mind in writing about a
positive approach to being a psychologist or psychotherapist is that my clients
are not positive. They come to me not because they wish to develop themselves
as people, but because they have encountered some significant challenge in their
lives. Sometimes, having been referred by a family doctor or psychiatrist, they do
not even know what they want, or what the process of psychological therapy will
require from them. But all my clients end up seeing me because they have
a problem, complaint, or dilemma that has driven then to seek assistance.
Sometimes what I do aids people with their difficulties, and at others it does not,
but (as far as my caseload is concerned) once the problem disappears, so does
the client.
It is pain and suffering that motivates people to break silence, overcome shame,
and negotiate the often formidable administrative obstacles involved in meeting
with a psychologist. They do so, because they feel they have to in order for
things to be better. As Anderson (2002) put it, dissatisfaction is the unifying
feature of people presenting for psychotherapy:
People seek psychotherapy because they are dissatisfied with some aspect of their lives . . . The
patient may be dissatisfied with the way he or she is thinking, feeling, acting etc. The patient
may be dissatisfied with the way someone else is behaving. The patient may be dissatisfied with
a course of study, with a career, with anything under the sun, but the patient comes for
psychotherapy dissatisfied. Patients are dissatisfied because it compares unfavourably with the
way they want to think feel or act; it compares unfavourably with the way they would like their
husband to be, or wife to be, or child to be, or boyfriend to be, or girlfriend to be, or job to be,
or mother-in-law to be, etc. (Anderson, 2002, pp. 456457)

Dissatisfaction means that they are not where they would like to be;
something feels wrong. This something wrong can manifest itself in specific
symptoms (obsessions and compulsions, depression, anger, binge eating,

Can existential psychotherapy be good news? 267

addictive behaviour), but sometimes it just comes from a sense of being out
of sorts, ill at ease, or out of synch with their environment. Dissatisfaction, for
me, sums up the situation of my clients well, because, while it implies that
something is wrong or lacking, that things are not quite as good as they could
be, it is also suitably global and vague to cover the whole range of concerns
with which they present. It incorporates the characteristic predicament of
most of my clients that, while they struggle to understand exactly what is
wrong with them, they also have little notion of what state it is that they have
fallen short of and what they would therefore like for themselves, other than
evanescent fantasies of being happy or my normal self. Dissatisfaction
therefore sums up their attitude to their presenting concerns and the nebulous
nature of their future direction.
But this vague notion of somehow falling short is not a unique complaint of
clients in psychotherapy. Ostensibly at least, all of us have at some point, whether
through illness, frustration or adversity, found ourselves groaning against the
seemingly unbridgeable deficit between where we are and where we would
like to be. In writing of his neurological patients, Sacks (1990) treats this
wistfulness as a common human experience:
For all of us have a basic, intuitive feeling that once we were whole and well; at ease, at peace,
at home in the world; totally united with the grounds of our being; and then we lost this primal,
happy, innocent state, and fell into our present sickness and suffering. We had something of
infinite beauty and preciousnessand we lost it; we spend our lives searching for what we have
lost; and one day, perhaps, we will suddenly find it. And this will be the miracle, the
millennium! (Sacks, 1990, p. 29)

However, in considering this common intuition, I find it difficult to avoid

relating it to the traditional notion of singiven that the term sin itself derives
from an Old English expression used in archery, meaning a missing of the mark
or to fall short (Vine, 1981). It is the experience of falling short that most of my
clients bring into sessions.
Except, usually the sin my clients have committed is not against an almighty
god of some description. Only occasionally do they arrive with a notion of having
transgressed some divine expectation; more often it is against the harrowing
expectations of their societal or cultural context, in which they feel too quickly
judged and dismissed, and too infrequently listened to, against which they feel
they have sinned.
The eating-disordered young woman feels she has fallen short of the slim
epitome of womanhood that graces our TV screens. The anxious young man
views himself as lacking in comparison with the unflappable desensitized
masculinity portrayed by so many cultural icons. The middle-aged business
man facing redundancy, endures the humiliation and sadness of having failed to
reach the heights of professional accomplishment that seemed so previously
accessible. The isolated housewife turns her daily grind of caring and cleaning
into an obsessive ritual of earth-shattering significance, under the nagging doubt
that she could have been so much more, and the suspicion that society at large has
passed her by as a nobody. Many of the psychological problems that present daily

268 Roger Bretherton

in our consulting rooms could easily be considered the fallout of a ruthlessly
competitive society, a winner-takes-all economy which for its survival requires far
more losers than winners (Smail, 1993).
It may be that the theological concept of sin has lost its credence in the
consciousness of popular culture. But, just as the existential writer Camus
(19131960) transformed theological concepts into secular metaphors (Wood,
2000), it seems that the general sense of falling short has not evaporated but
intensified, as people in the industrialized western world compare themselves
to the illusory ideals of functional humanity presented by the media.
Dissatisfaction, a sense of falling short, is therefore the ubiquitous precipitant
of people seeking therapy, just as a felt sense of fallenness may have once
precipitated consultation with a clergyman. According to Seligman (2003), the
modern psychological obsession with pathology owes its historical origin to the
doctrine of original sin:
The rotten-to-the-core view pervades Western thought, and if there is any doctrine positive
psychology seeks to overthrow it is this one. Its original manifestation is the doctrine of original
sin. In secular form, Freud dragged this doctrine into 20th-century psychology where it
remains fashionably entrenched in academia today. For Freud, all of civilisation is just an
elaborate defence against basic conflicts over infantile sexuality and aggression. (Seligman,
2003, p. 126)

The theological concept of sin therefore appears to have been replaced by

a cultural concept but, to my mind, the latter is infinitely more pernicious that
the former. When we strayed in sin before God, we could at least look to
heaven for salvation, but when we feel ourselves falling short of the expectations
of a globalized economy, there are no saviours, only other consumers like
ourselves.
It is therefore understandable that clinicians and practitioners of psychology
have tended to study the negatives: problems, disorders, complaints, and
concerns. In doing so, they have only been responding to the demand placed
upon them; addressing the most pressing and pertinent issues raised by their
clientele. To ignore or circumvent these immediate concerns, resorting instead to
a series of comforting aphorisms, would result in a gross trivialization of human
suffering, and the bewilderment of the client. Whatever a positive approach to
clinical psychology is, therefore, it certainly does not consist of ignoring the real
pain expressed by the people we work with.

How we identify with others

There is a difference, however, between identifying with people in their suffering
and making an objective study of the specifics of their pain. The distinction
between being a spectator of other peoples difficulties or being a participant in
their lives has been well put by the existential philosopher Marcel (1950):
The spectator is present on the scene, his dominating motive is curiosity which has no touch of
anxiety, still less of anguish, about it, for he knows very well that he is not himself caught up in
anything that is happening on the stage; however bloody the conclusion of the tragedy may be,

Can existential psychotherapy be good news? 269

he feels sure that he himself can leave the theatre peacefully, catch his bus or his tube,
and arrive home in time for a cup of tea, having on the way home, brushed away whatever
emotions the play may have aroused in him, rather as one brushes dust off a coat. (Marcel,
1950, pp. 121122)

Given that most of my clients arrive in my office having already formed a rather
depraved view of themselves, it is a great and convenient temptation to act as
a spectator by placing them in an entirely separable class of humanity to myself.
It is easier to relegate the man who collapses with panic in my office, or the woman
who screams in my face about my uncaring attitude, to an inert category of mental
illness, than endure the discomfort of attempting to understand and identify with
them. As Foucault (1961) so brilliantly demonstrated, we distance ourselves from
the madness of others so as not to be confronted by the madness that resides in our
own being. Leaping to the conclusion that the person is sick allows me to erect an
invisible partition between they and I. In focusing on pathology, I prevent the
person from getting to me but equally miss the opportunity to get to the person.
I see a problem to be solved, not a person to be met.
A positive perspective to my clinical work gradually emerged in direct
proportion to my capacity to view my clients as human beings like myself.
I began to recognize in myself many of the perceived inadequacies that so
troubled them. I saw the struggles and challenges in my own marriage, the
oppressive moments of apathy and listlessness into which I occasionally plunge,
the sexual fantasies and temptations that all too frequently course though my
consciousness. A statement by May (1989), which had previously made a great
impression on me, became a reality in my experience: I have never dealt with
a counsellee in whose difficulty I did not see myself, at least potentially. Every
counsellor, theoretically, will have this same experience. It is a matter of There,
but for the grace of God, go I. There is no room for arrogance or
self-righteousness, but all the room in the world for humility, in the counselling
occupation (May, 1989, p. 57).
However, the progressive willingness to see in myself the problems of my clients
was not just a professional development; it corresponded to a much more general
period of personal upheaval. The same journey I had embarked upon in the realm
of psychology reflected wider developments in connection with my church life.
One of the dangers of belonging to any formalized religious or social group,
particularly one which experiences itself at odds with the prevailing trends of
the culture in which it exists, is what Marcel (1964) described as the spirit
of excommunication; the tendency to fall into the trap of thinking that those
who belong to your particular sub-culture are good, noble, right, and pure,
whereas those who do not belong to it are sinful, lacking, and purposefully
belligerent in their refusal to see the light and join the group.
According to Benyei (1998), it is these kinds of church dynamics that
can result in spiritual abuse or scapegoating. She describes the tendency of those
belonging to religious communities to think of their particular sect, denomination, or stream as a model of edenic perfection, and therefore the enormous
difficulty they encounter in attempting to reconcile this with the inevitable faults

270 Roger Bretherton

and failings that emerge in any human community. This is not just a characteristic
of churches; it is a process that can be found operating in any charismatic group,
not just those of religious persuasion (Galanter, 1999).
For my part, I have had to learn to view those who do not share my beliefs or
participate in my community as human beings like myself, recognizing the
commonality I share with their human condition, stepping down from my selfacquired superiority, and recognizing in myself what I had previously only been
prepared to see in others. Again, it was Marcel (1964) who articulated most
clearly, the attitude I found myself adopting:
We shall understand nothing of the relation between the believer and the non-believer and
there is a danger of giving the most harmfully pharisaic interpretation of it if we fail to perceive
something else that is even more mysterious, namely the symbiosis of belief and unbelief in the
same soul. If the believer has any duty at all, it is to become aware of all that is within him of the
non-believer. (Marcel, 1964, p. 121)

This in no way represented a loss of faith, or a diluting of previous beliefs;

if anything, this period of my life forced me to confront the simple admission that
I had not been as Christian as I thought I had been. Perhaps in conforming to the
expectations of the religious community, I had excelled, but in openness and
availability to human beings beyond this, I had been sorely lacking. Recognizing
this did not make me less Christian, but rather enabled me to accept the highest
priorities of Christ himself, to love both God and my neighbour, as summarized
here by Buber (1947):
The neighbour is to be loved as one like myself (not as I love myself; in the last reality one
does not love oneself, but one should rather learn to love oneself through love of ones
neighbour), to whom, then, I should show love as I wish it may be shown to me. (Buber, 1947,
pp. 5960)

Why atheists can afford to be honest

A positive approach to distressed people requires identification with their
situation; and identification requires frank self-reflection from the clinician. But
the degree of honesty required to see oneself in the most disturbed and even
malicious individuals can at times be almost intolerable. Especially if one tends
to view oneself as ever so slightly superior to others, it can be quite traumatic to
suddenly identify their faults in ones own life. Being honest and accepting of
oneself in this way requires some courage.
When I first read Yaloms (1989, 1999) accounts of conducting existential
psychotherapy, I was absolutely astounded at how honest he allowed himself to
be, how perfectly prepared he was to see faults in himself, whether feeling
irritation or anger or sexual desire towards his clients. I marvelled at the level of
security he possessed in order to freely admit things in himself that could easily be
considered reprehensible in a professional therapist. It bothered me intensely that
he could allow himself such freedom, while I struggled to acknowledge even
my most rudimentary errors and omissions. Why did I find it so difficult to

Can existential psychotherapy be good news? 271

acknowledge aspects of myself I did not like? One of the reasons, I concluded, was
because I believed in God.
If God is dead, said Dostoyevsky in 1880 through the mouth of Ivan
Karamazov, then everything is permissible. The reason Yalom could be so
honest about himself, even his weaknesses and vulnerabilities, was that, as far as
he was concerned there was no-one watching. He freely asserts that there is no
God (e.g., Yalom, 2002), and as a result, he does not stand continually
accountable before an ever-present set of watching eyes. And Yalom is not
alone among the existential atheists in drawing the conclusion that Gods
apparent absence allows human beings to see themselves more clearly. In Thus
Spake Zarathustra, Nietzsche (1961) has one of his characters exclaim that
God had to die because of the pressure his insidious presence exerted on human
consciousness:
But he (God)had to die: he looked with eyes that saw everythinghe saw the depths and
abysses of man, all mans hidden disgrace and ugliness. His pity knew no shame: he crept into
all my dirtiest corners. This most curious, most over-importunate, over-compassionate god had
to die. He always saw me: I desired to take revenge on such a witnessor cease to live myself.
The god who saw everything, even man: this god had to die! Man could not endure that such a
witness should live. (Nietzsche, 1961, pp. 278279)

And Sartre (1952) also, in his play, Lucifer and the Lord, concludes that once
one does away with an ever-present personal (and therefore evaluating) God,
one is freed to see the world in a new luminosity that previously was not possible:
I tell you God is dead. We have no witness now, I alone can see your hair and
your brow. How real you have become since he no longer exists (Sartre, 1952,
p. 170).
As long as one holds to a monotheistic understanding of the existence of God,
one understands that we stand constantly under the gaze of the almighty. Only
when the pressure of being watched and weighed up has been lifted can we begin
to find the space to form an opinion about ourselves. If God does not exist, we
can accept ourselves, because there is no higher being who may label our
weaknesses sin in any absolute sensewe simply are the way we are.
If there is a God, the question is whether he is the kind of God who will accept
us as we are and thereby allow us to accept ourselves. Will he use his formidable
abilities to intimidate us, or, in the words of Macquarrie (1978), will he be
humble, down to earth, and meet us where we are at? If there is a God, the
question becomes, what kind of God is he? On this question hangs the possibility
of a positive religious psychotherapy.

The crux of Christian candour

As this paper is about positive Christian psychotherapy, the answer I give to this
question is unavoidably wrapped up in my personal discipleship to Jesus and
participation in the church. This is not to say that it is not possible to consider the
same question from other perspectives whether Jewish, Islamic, Buddhist, or
Agnostic, but on this occasion, I am outlining the way in which I myself have

272 Roger Bretherton

reconciled some of the tensions that have emerged between my faith and my
therapeutic practice.
The fear of seeing bad things in ourselves, to me, is linked with the fear of
punishment; that if we recognize some failing or weakness, we will have to
immediately make amends in some way. If we believe ourselves to be totally
depraved, evil, inescapably black-hearted, or intrinsically bad, then we recoil from
taking a good look at ourselves for fear of what we might discover. We always have
to do something to prove ourselves, to make sure that we conceal or act against
the evil inclinations that we assume to be ours by inheritancewe have to justify
our existence. As Rowe (2003) put it:
Knowing that you are bad you must constantly struggle to be good, to present an acceptable
face to the world . . . You can never be yourself, since if people knew what you were really like
they would reject you. You might have been wearing a mask or playing a role for so long that,
even if you wanted to, you could not be yourself because you do not know who you are or what
you are really like and you dare not take the risk of finding out. To know how to behave you
have to rely on other peoples opinions, and so you live under the tyranny of they. What will
they think? Is the thought that accompanies every action and determines every decision.
(Rowe, 2003, p. 19)

In order to reflect on ourselves, however, to see things in our lives that we may
dislike or wish to change, we need to be prepared for what we might discover.
We need to know in advance that we can accept whatever we find in ourselves
without having our sense of worth decimated. Again, Rowe (2000) describes how,
if we can accept that there is nothing wrong with us, we can rest and no longer feel
compelled to act in order to justify our existence:
We were born just being. We looked around and found the world an interesting place. Then,
adult voices began instructing us, Do this, Be that, Be good, Try harder, Arent you
ashamed? You should feel guilty. We took what these voices said inside us and lost the
ability to just be. But it can be found again. The key to this discovery is to understand that it is
not wicked to just be. (Rowe, 2000, pp. 481482)

Dorothy Rowe does not have any religious context in mind in these
descriptions; she is simply elaborating what it means to be able to live with
oneself. But what these passages have offered to me is a way of grasping the
psychological implications of accepting the Christian assertion that God has
unconditionally accepted us through Christs death. We no longer have to exert
ourselves to justify our existence because God in Christ has justified us; we can
just be. Through believing in him, we are declared good, we can return to
the childlike acceptance of ourselves described above. As a result, we need fear
no self-reflection, need not be chary about seeing our sometimes selfish or
unacceptable motivations, because we have been accepted, and therefore, in the
words of Tillich (1952), can accept acceptance.
Among certain writers, it seems customary to view the cross as Gods way
of getting us to do something against our will. Szasz (1974) refers to it as
a symbol of power designed to induce guilt and thereby produce compliance.
And Camus summed up the Christian aspiration for unity as, All together at
last, but on our knees and heads bowed. (Camus, 1957, p. 100). In other words,

Can existential psychotherapy be good news? 273

it aims to bring people into unity by plastering over their unique individuality and
secures their compliance by making them feel guilty, almost as if Jesus died to
induce pity in us, to make us feel sorry for him and thereby coerce us into belief.
But it can only really be good news if the costly death of Christ is a free gift
which can be declined as well as accepted. This is what the theologian,
Bonhoeffer (1948), called the weakness of the gospel, the complete renunciation of force or manipulation in attempting to persuade those who do
not believe.
Yalom (2002), could view himself with great honesty because, in his opinion,
God was not watching. But being honest with oneself while God is watching
requires not a quietly judging God with an inescapable gaze, but a God of
humility, a down-to-earth God who loves and understands, a participating
God rather than a spectator. This is the kind of God who, as a Christian, I claim
to worship.
How is this good news?
Ultimately, however, the question must be asked, in what way is this a foundation
for a positive psychotherapy? If, because of my trust in Christ, I claim to be
declared good, what does this mean for my relationships with other people who
may not share this belief ?
If God has actually died in order to make up the deficit between individual
human beings and himself, if he has satisfied the dissatisfaction with ourselves
that we often experience, if he has taken the step of accepting us whether we wish
to take advantage of it or not, then every person I meet, whether friend, client, or
colleague, has been dignified by Gods action. To put it another way, if I wish to
assert that the work of Jesus on the cross was intended to benefit all people, then
I equally have to accept that every person I meet is a potential beneficiary of
Gods action, irrespective of whether they know or recognize this. The natural
outworking of my having accepted this for myself is that I am free not only to
recognize my own value and worth, but also to see the immense significance
of others.
There is also a more subtle, less obvious way in which my Christian startingpoint allows me to recognize the dignity and significance of the people I work
with. The theologian Newbigin (1986) suggested that the crucifixion of
Christ was a public event, accessible for all to see, whereas the resurrection was
largely a private affair for the benefit of the disciples. If the resurrection had been
a public event like the crucifixion, then it would have presented the world with
a final, pretty much indisputable demonstration of Gods power, thereby leaving
us only one of two options: belief or condemnation. However, because the
resurrection was a private affair, it has allowed a period of time in which dissent is
possible, and we are given the freedom not to believe, a state of grace to draw our
own conclusions without being coerced into religious conformity.
In short, it means that my therapeutic approach is positive, not because
I hold my clients to be essentially good but because I hold them to be

274 Roger Bretherton

immensely significant, and thereby lend full weight to their actions. This betokens
a high view of human life that recognizes each individual as indispensably
significant, and their words, actions, thoughts, and beliefs as supremely
consequential. The misuse of this significance to harm others or ourselves is
a tragedy, but so too is the denial of our significance. For me as a psychologist,
this means that everything about my clients is important, really important. It also
lends my approach an unmistakably existential flavour in its emphasis on the
compulsory freedom and responsibility of the human being, and an interest in all
aspects of the clients experience. These are the philosophical ingredients that at
least allow me to outline the beginnings of a positive Christian existential
psychotherapy.

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