Pragmatic Existential Psychotherapy with Personality Disorders

Abstract

HERBERT M. POTASH: Pragmatic Existential Psychotherapy with Personality Disorders. Gordon Handwerk Publisher, Madison, NJ. Pragmatic Existential Psychotherapy with Personality Disorders attempts to present a new blend of therapy appropriate to personality disorders. In the first part, Dr. Potash goes length to demonstrate the roots of psychology in existentialism. He is taking us a historical excursion through the development of the thought. His anchor point in existentialism is in the philosophy of human existence as viewed by Heidegger. The main theme is that man is experiencing process. This theme becomes the basic tenet for his therapeutic approach. According to Potash, seeing the individual as an experiencing process will enable the psychologist to understand the meaning of that person's world. He takes issue with psychoanalytic therapy by questioning the processes of transference and countertransference as implicitly recognizing an inability of patient and therapist to understand each other. The second tenet of the pragmatic therapy, closely linked to the first one, is that of viewing human beings as changing in emerging processes. This requires the therapist to understand the patient's thinking as the basis for his actions. The author extends this view to the concept of dealing with the patient's reality by arguing that from the emotional point of view there is no difference between the real world and fantasy for the individual. For example, fantasizing of being at the beach could be as real to the patient as being on the beach. The author rejects the problem of patients who blur the distinction between reality and fantasy as the main source of their emotional conflicts. The third tenet of the author's therapeutic approach borrowed from Kierkegaard is that human beings experience dread. Dread and fear of death are basic human negative feelings that constitute the basic pain of being human. These two existential givens, according to the author, are guiding and directing human behavior affecting the meaning of the individual's actions. In this context, people suffering from personality disorders are unable to cope with these basic facts and as such do not develop their own individuality. They are in bad faith and disconnected from others. The goal of psychotherapy is to help these individuals to free themselves from their fears in order to self-actualize and to become authentic to themselves. The author believes that these people practice self-deception because of the impoverished self rooted in their physical and psychological brutalization in childhood. In his opinion, the psychodynamics of neurotics does not include the same degree of childhood abuse. The application of these principles to psychotherapy leads to inconsistencies and contradictions in treatment. The author, arguing that DSM III divided artificially personality disorders into various types, comes to the conclusion that all personality disorders can be linked together since they have in common the experience of psychological pain due to the patient's destructive behavior. …