Ernesto Spinelli, Practising Existential Psychotherapy The

Relational World

Sage Publications Ltd., London, U.K., 2007, 216 pp, 31 tables (of

“exercises”), $34.95 US, ISBN 978-1-4129-0774-3 or ISBN 978-1-4129-

0775-0 (pbk)

Reviewed by: Edwin L. Hersch M.D., Psychiatrist in Independent

Practice, Toronto, Canada. (authour of From Philosophy to

Psychotherapy: A Phenomenological Model for Psychology, Psychiatry,

and Psychoanalysis).

In Practising Existential Psychotherapy Ernesto Spinelli presents us with his attempt to

provide a readable, accessible, and practical outline of the theory and practice of his

existential approach to psychotherapy. The book consists of two main parts, the first

describing what the authour feels to be the basic theoretical underpinnings of existential

psychotherapy followed by a second, longer section describing what he calls “a structural

model” to “practising existential psychotherapy.” As emphasized by the title of the book,

his main focus is on the latter section.

Spinelli argues in his introduction that there are a number of books around dealing

with “various forms and expressions of existential theory” while he feels there is
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presently a “paucity” of books “focusing directly and methodically upon the application

of existential-phenomenological theory to psychotherapeutic practice.” This book is an

attempt to at least partially remedy that situation by providing a more practical or

“structural” model for existential psychotherapy as outlined in the present volume. It’s a

bit of a “how to” book in an age in which popular manuals to various types of

psychotherapy abound. In the case of existential psychotherapy in particular though, this

presents some very interesting and almost paradoxical problems. This is so, largely

because the existential approach itself is likely as far from (and as philosophically

opposed to) a manualized, one-size-fits-all approach as one can get in the psychological

field. But the authour is quite clear that he is only presenting “an approach” or “a model”

(his own) of existential psychotherapy, not “the way” of proceeding. Indeed he quotes

Nietzsche’s famous pluralistic motto from Zarathustra on “my” way (for “the way – it

doth not exist”) as the first of several excellent chapter-introducing quotations. Similarly

the content of his approach, which emphasizes an uncommon degree of openness, an

extremely non-judgmental stance toward patients, and even a concept he calls “un-

knowing” (as opposed to a know-it-all’s approach) make it clear that his way is anything

but one which treats patients as if they were all quite similar.

On the other hand, someone has to be able to address such questions as those of

“what do existential psychotherapists actually do in practice?” and “how does this

approach proceed differently than other approaches?” These are important questions to

answer particularly for trainees in the field and it is no coincidence that it is Dr. Spinelli

who takes up this difficult task, likely responding to a need he has had much first-hand

experience with in his capacity as the director of a training program in existential

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psychotherapy (in London, U.K.). Many of the “exercises” he outlines in the second half

of the book seem particularly directed toward either trainees in this approach or to

practitioners from other backgrounds who are trying to newly acquaint themselves with

existential psychotherapy.

One important item of note to potential readers regards Spinelli’s use of the term

“Structural” or “Structural Model.” These terms could be quite misleading to many in

the psychotherapy field if it is not made clear that the authour here is using the term

structural only in referring to the basic procedural patterns or organizational forms of

how one proceeds in this type of therapy. His usage of the term structural is not at all

related to Freud’s familiar “structural model” (e.g., of ego, id, and superego “structures”)

and should not be confused with those or any other model of “structures” as describing

particular mental “contents.” Indeed, one of Spinelli’s criticisms of some other attempts

at developing psychotherapies based on existential-phenomenological understandings is

that many of those attempts (including those of “daseinanalysis”) still rely too heavily

upon concepts and procedures derived from traditional psychoanalysis. As this reviewer

understands it, Spinelli’s use of the term is about the “structure” or form in which therapy

proceeds, not about “mental structures” in the mind.

Thematically, Spinelli’s model of existential psychotherapy organizes the therapy

around three central principles: 1) Relatedness, 2) Existential Uncertainty, and

3) Existential Anxiety. He also emphasizes the uniqueness of each person’s experience

of “relating with, and construing meaning from, the world.” In terms of how the therapy

sessions actually proceed his approach is much more descriptive in focus than

specifically curative in aim (as distinct from most traditional psychotherapies).

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Historically this descriptive emphasis may be seen to follow more from Husserl’s

descriptive phenomenological method than from the works of the other more existential

writers who followed him. In Part II of the book the authour further describes three

phases of an existential psychotherapy involving: 1) the co-creation of a ‘therapy-world,’

2) the descriptive investigation of the client’s experience of co-habitating that therapy-

world with the therapist, and 3) putting into practice some reconfigurations of the client’s

“wider world” worldview, via incorporating new alternatives provoked by 1) and 2)

above.

In sum this book provides a brief introduction to existential psychotherapy theory

followed by an interesting illustration of how an existential psychotherapy might proceed

in practice. The material is well organized and the authour presents a body of complex

material in a clear manner. What new terms he introduces are well defined in the text.

In terms of its weaknesses, the book does not really provide an exhaustive literature

review of this area, nor does it contain extensive comparisons and contrasts with other

(particularly other recent relational) approaches to psychotherapy or psychoanalysis. In

fairness, however, those items (though they would be desirable) are beyond the stated

scope of the book.

Overall, I would say that this is a very good book and one I would not hesitate to

recommend. It will be particularly useful, I believe, to students and practitioners with

some sense of, or interest in, what existential thought is about but who are curious to see

an example of how an existential psychotherapy might actually proceed in practice.