This manuscript was published as a chapter in: Vanhooren, S. (2018). Experiential-existential psychotherapy: Deepening existence, engaging with life. In M. Bazzanu (Ed.), Re-visioning person-centred therapy: The theory and practice of a radical paradigm (pp. 151-163). London, UK: Routledge. Experiential-existential psychotherapy: Deepening existence, engaging with life Siebrecht Vanhooren Introduction Therapy is of the essence of life, and is to be so understood (Rogers, 1951, p. x). With this introductory sentence in his book Client-centred therapy, Carl Rogers expresses his fascination for the unique life process of the client. He shares this view with other existential and humanistic pioneers such as Rollo May (1983). From May’s point of view, at the heart of therapy lies his concern and care for the client’s being. Clients do not only bring their problem but their whole existence into the consultation room. Therapy is about helping clients to experience their existence in a more profound way and to become oriented toward the fulfillment of their existence (May, 1983). From his early work on, Rogers (1942) emphasizes how therapy can help clients regain their freedom to make authentic choices, find new ways to relate to others, and discover new directions in life. Therapy is originally characterized by the absence of techniques that would reduce the self-directive power of the client and by a well-defined therapeutic presence which expresses a sacred and empowering respect for the client’s process (Rogers, 1942, 1951, 1980). Rogers’ introductory sentence also expresses his concern about the downside of theorizing the client’s and therapist’s experiences. Instead of supporting the uniqueness of every 1 therapeutic encounter, theory could become a narrowing framework. Paradoxically, even a person-centred theory could serve as a constricting mindset which could prevent the therapist from meeting the client at the fullest. Gendlin (1990) expresses the same concern when he notices that focusing – the experiential method he developed in order to deeply connect with the client’s existence – is sometimes used as a technique. In those cases, focusing does not support the life process of the client; it is used as a way to do something when meeting the client seems too challenging for the therapist. “The essence of working with another person is to be present as a living being” Gendlin states (1990, p. 205). “Do not let focusing, or reflecting, or anything else get in between… You can have at least as much courage as the client has (Gendlin, 1990, p.206).” The courage to be with the client’s existence – and with one’s own existence at the same time – might be an even bigger challenge for contemporary therapists compared to therapists in the past. First, due to the zeitgeist therapists are encouraged to work in a more solution-oriented way. As they become specialists in micro-tasking and in the treatment of very specific client problems, the majority of therapists express that they don’t feel equipped to meet the existential layer of the client’s problems such as meaning in life (Hill, 2016). Although micro-level process-outcome research might have been successful when it comes to achieving contemporary evidence-based requirements for therapy (Angus, Watson, Elliott, Schneider & Timulak, 2014), this might have been at the expense of the loss of the art of not-knowing and the capacity to fully resonate with the process of the client (Bazzano, 2016; Ikemi, 2017; Vanhooren, 2014). Although knowledge about micro-processes, markers, and tasks doesn’t necessarily mean that therapists would not be able to resonate with the client’s being, a framework that connects this contemporary micro-knowledge with a theory of being does not exist at the moment. As a result, therapists often feel lost when they discover that their clients actually bring their whole existence in the therapy room. 2 Second, contemporary western society is facing unseen challenges such as mass migration, an increasing older population, climate change, etc. Existential themes such as death, sickness, limitations, isolation, responsibility, and meaninglessness are all around. It is not a coincidence that the World Health Organization expects depression to be the most common threat of wellbeing and health in 2030 (Lépine & Briley, 2011). Not only will existential themes be increasingly present in private practices, a growing group of therapists is already working in specific settings such as refugee camps, oncology hospitals, palliative care and so forth, where existential themes are paramount. However, patients are largely dissatisfied with the attention given to their existential struggles (Dezutter et al, 2017). At the same time, satisfaction with the attention given by practitioners to the existential domain – compared to attention given to the physical, psychological, and social domain – is the strongest predictor of life satisfaction, less depressive symptoms, and lower pain in chronic pain patients (Dezutter et al., 2017). As therapists are facing problems which can’t be solved, medical and solution-focused therapy models might lose their efficacy. For these reasons, there is a high need for a theory and practice that can deal with these challenges. Although returning to the source – and learning from Otto Rank, Carl Rogers, Rollo May, Eugene Gendlin, and many others – is absolutely meaningful and inspiring, we also want to remember the lessons learned in the years since. Therefore, the real challenge is to integrate the micro-process research – which has largely been conducted by focusing-oriented and emotion-focused scholars – into a theory that would support our actual being-with-ourselvesand-our-clients. From my point of view, the experiential-existential approach could serve as such a framework. In its core, this approach is strongly based on Gendlin’s philosophical tenets, is influenced by other existential writers and models (such as Buber, Tillich, May, Yalom, Frankl, van Deurzen), and is person-centred and experiential in its therapeutic format (Madison, 2010, 2014a, 2014b). Instead of having intellectual talks with client about their existence, 3 experiential-existential therapy helps to be with the bodily-felt existence of the client (and therapist) in the here-and-now. Being both existential and experiential, this approach might pave the way for a deeper integration of the best of both therapeutic approaches. In this chapter, I will introduce experiential-existential psychotherapy as an emerging framework, delineate how micro-processes could be understood from an existential point of view, and finally make suggestions for future research and practice. Experiential-existential psychotherapy Experiential-existential psychotherapy has emerged from the experience that the integration of an existential understanding of the client’s concerns within a focusing-oriented framework (and vice versa) can help facilitating, deepening, and broadening therapeutic change (Madison, 2010, 2014a; Leijssen, 2014, 2016; Vanhooren, Leijssen & Dezutter, 2015). In our experience as therapy trainers the aforementioned authors found that discovering the existential roots of experiential therapies helps us to be more present with our clients. Experiential psychotherapists who took an in-depth course on existential therapy i repeatedly shared how this training helped them to be more present. Moreover, the existential approach – infusing a certain amount of darkness into their humanistic optimism – helped them to be more grounded and to feel more confident to engage with the existential challenges of the client. They experienced a heightened awareness for existential themes and felt freer to explore, re-experience, and communicate their empathy. This is remarkable considering that most of these students had been practicing personcentred, focusing-oriented, Gestalt, or emotion-focused therapy for a number of years. Existential understanding seems to facilitate a different type of therapeutic presence and it even fosters the experiential work itself. When the existential reality comes into the experiential picture, focusing becomes accessing existence again. One might ask how an existential 4 understanding could broaden and deepen the work of experienced experiential and processexperiential psychotherapists. There are different answers to these questions. Facing one’s own existential challenges A first answer might be found in the fact that facing one’s own existential challenges helps the therapist to connect with the client in a deeper way. Existential training courses in Flanders (Belgium)ii have been based on experiential learning right from the start. Students are not only asked to learn about existential psychology but also to scrutinize their own existential realms. In a way, working through one’s own existential issues broadens one’s capacity to be with the ultimate concerns of the client (Leijssen, 2013). By not having to avoid themes such as finitude, isolation, freedom, guilt, responsibility, and meaninglessness, therapists experience themselves more open to pick up the existential layers of the client’s presence. They have a broader vocabulary that helps them meet the client at this level. They are more able to be with darkness on the one hand and to see the light through the cracks on the other hand. As Madison (2014b) argues, infusing darkness into the optimistic bias of humanistic and experiential therapies helps the therapist being with whatever comes. This “being with what is really there” and the capacity to resonate with the inescapability of certain existential givens, is the main road to what Otto Rank calls change (Kramer, 1995). Change within the proto experiential-existential framework of Otto Rank is not about altering these existential tensions, but rather about changing how one lives with and within these givens (Kramer, 1995). Tillich (1952/2000) would say that change means finding the courage to be while facing not-being, and by creating new meaning which embraces meaninglessness. Likewise, the majority of these students discovered a new courage to be with their existential challenges. Not only did this courage enlarge their capacity to contain their clients’ existential concerns; the therapeutic relationship was also transformed in an important way. Therapists experienced themselves 5 more as fellow companions and were more at ease with the fact that they didn’t have all the answers. This increased capacity to be with the client’s existential concerns and to search together for meaning is beneficial in different clinical settings. Not only for therapists who work in private practice, but also for therapists who work on oncology, chronic pain, and palliative services in hospitals who feel inspired by this experiential-existential approach. At the moment, new experiential-existential group programs are being launched and studied in hospital settings. The existential roots of experiential therapies A second set of answers might lay in the fact that experiential therapies such as focusingoriented therapy have strong existential roots. Reconnecting to these roots might help therapists to understand their own practice in a more profound way. At the same time, as we noticed in our postgraduate person-centred therapy training (KU Leuven), it helps new students understand that therapeutic interventions are there to support the life process of the client as well as their own being. For example, Gendlin’s focusing-oriented therapy has profound existential-phenomenological grounds (Ikemi, 2014). Gendlin (1966, 1973), being both a philosopher and a psychotherapist, reconnected abstract existential philosophical concepts to the here-and-now experience, or to what Bugental (1999) calls the living moment. Inspired by the existential and phenomenological philosophies of Heidegger, Merleau-Ponty, and Sartre, Gendlin (1966, 1973, 1990) understands human existence as Dasein (being-in-the-world). For Gendlin, to be human means that we are primarily and constantly in interaction. Moreover, we are our interaction and situation. What we sense when we are practicing psychotherapy is our being-ourselves-with-our-client, and the client’s existence at that very moment is being-withher-with-the-therapist. In this way, this being-together already means a first element of change (both for the client and the therapist). 6 Gendlin (1973, 1978) proposes a direct way to access this being-in-the-world or existence which he calls focusing. Existence is primarily bodily felt and our felt sense is the result of our bodily-environment interaction (or being-in-the-world here and now, or existence). Attending to our bodily senses in the here-and-now-moment reveals the implicit meaning of our actual life situation (Gendlin, 1962/1997). Our implicit and often unattended existential needs become explicit by symbolizing (or giving meaning to) our felt sense. At the same time, we are in touch with our situational or larger direction in life. Remarkably, attending to our existence in this direct way carries our existence further: our life process moves in a more authentic way (Gendlin, 1973). We are becoming our own truth (Madison, 2014b). It is not a coincidence that Gendlin’s focusing has been adopted within the existentialhumanistic approach (Hoffman, 2009; Schneider & Krug, 2010). For existential therapists without experiential background, using focusing brings the existential concepts to life (Madison, 2014a). Existential concerns are not merely talked about but can be directly experienced. Klagsbrun (2014) gives examples of how focusing helps sick and dying clients meet their existential challenges. Moreover, as Missiaen (2016) suggests, approaching the existential challenges in an experiential way can help clients contain their challenges. By helping clients to connect to their bodily felt senses and to search for a bodily-located safe place, an experiential haven can be created from where clients can explore anxiety-provoking themes. Whatever comes, the client can always return to his or her bodily existence. The level of access a person has to his or her bodily-felt existence has also been called one’s openness to experience. Rogers and Gendlin developed an experiencing scale which was later further elaborated by Mathieu-Coughlan and Klein (1988). Research based on these experiencing scales and other instruments has been very clear about the significance of deepening the client’s experience in terms of therapy outcome (Cain, 2016, Angus at al., 2014). 7 The therapist’s own level of experiencing would be essential for deepening the client’s experiential awareness (Sachse & Elliott, 2002). However, deepening the level of experience of the client is not just about deepening the experience as such. It is about opening to one’s bodily felt being-in-the-world. Interestingly, understanding anew the existential cornerstones of Gendlin’s theory sheds a totally different light on the research findings concerning the level of experiencing. If it is not merely about the level of experiencing but about one’s being-in-the-world, then how can we understand microprocesses? Micro, Meso, and Macro Searching Micro-processes can be understood as tiny steps or moments in the larger process of psychotherapy. Where Rogers (1961) was primarily studying the therapeutic process as a whole, Gendlin (1978) and later Greenberg, Rice and Elliott (1993) took a more microscopic look at processes which influenced the larger process in a significant way. This endeavor gave birth to what today is called focusing-oriented therapy (Gendlin, 1996) and emotion-focused therapy (EFT) (Elliott et al, 2004). The theoretical framework of emotion-focused therapy is completely different from Gendlin’s existential-phenomenological philosophical approach. EFT combines dialectical constructivism with contemporary cognitive science and emotion theories (Greenberg et al., 1993). The micro-unit is not Dasein as in Gendlin’s theory but the cognitive-affective scheme. It is through this lens that processes are understood and interpreted in EFT. Thanks to this research, the person-centred approach is recognized as an evidence-based treatment in certain countries for categories such as depression and others(Angus et al., 2015; Greenberg & Watson, 2006). However, from an experiential-existential point of view, using the EFT framework and language to explain these processes results in leaving the existential 8 layer unexplored or implicit. A good example of this unattended existential layer is the way meaning is discussed in EFT. Meaning In EFT, meaning is understood as a dialectical constructivist process (Angus & Greenberg, 2011; Elliott et al., 2004; Greenberg et al., 1993; Greenberg & Pascual-Leone, 2001). Inspired by focusing – but without adopting the underlying existential-phenomenological theory – EFT considers the creation of meaning to be a bottom-up process induced by attending the felt sense combined with the process of symbolization (Greenberg & Pascual-Leone, 2001) or narrating/contextualizing unclear emotions (Angus & Greenberg, 2011). This creation of meaning would influence higher-order affective-cognitive schemes such as the self-image, identity, worldview, life narrative, etc. Angus & Greenberg (2011) extracted from case study research an interesting list of meaning problem markers and meaning-making markers. Surprisingly, in their study on meaning, existential meaning (Vos, 2016) and spiritual meaning (Leijssen, 2014) are not included. Likewise, the possibilities of meaninglessness (not as a problem but as a possible reality) or groundlessness (Yalom, 1980) are not considered. In a way, one could say that meaning as understood in EFT includes meaning as a result of a micro search for meaning (e.g. “What does this felt sense mean”; meaning of specific feeling, behavior, situation) and a meso (identity) search for meaning (e.g. “Who am I”; self-image, self-narrative, worldview). However, EFT does not attend to macro searching in an explicit way (e.g. “why am I”; existential meaning and mattering, spiritual meaning). Contrary, existential frameworks often do not attend to micro searching. For example, meaning-centred therapies (e.g. Breibart & Popitto, 2014) put a lot of effort in meso (identity) and macro searching (sources of existential meaning), but don’t include micro searching as part of their therapy program. 9 From an experiential-existential point of view, all three levels of searching contribute to a fuller and deeper experience of meaning. Depending on the needs of the client, more time might have to be spent on a micro, meso, or macro searching level. For example, micro searching will be an important step for clients who are overwhelmed by their emotions or who have a hard time contacting their feelings or felt sense (Leijssen, 2007). Without having the ability to find meaning on this micro-level, a search for meaning on a macro-level (what’s the meaning of my life) might be a fruitless endeavor. However, all levels of searching come together in one moment, for example during a focusing session. Leijssen (2007) explains how focusing on a bodily felt sense can open the door for the transcendent. In the same way, all levels of searching seem to crystallize in moments of what Mearns and Cooper (2005) call relational depth. Since meaning is basically about connecting, a search for meaning at each level might evoke a change in one’s Dasein or being-in-the-world. From I-Me and I-it to an I-I and I-Thou relationship An important part of EFT’s micro-work is about evoking an experiential access to specific “cognitive-affective schemes” such as the inner critic (Elliott et al., 2004). Based on Gendlin’s philosophy, we know that experiencing is about having deeper access to one’s existence. EFTtasks such as empty chair work and chair dialogues can be understood as ways of helping clients reconfigure their inner relationships, or their being-with-one’s-self, or their Eigenwelt. Inspired by Buber (1923/2003), Cooper (2015) describes how clients often feel alienated from their inner existence. Instead of truly meeting their inner existence, people often treat their inner life in an object-like way. Cooper calls this distancing relationship to one’s self an I-Me relationship, whereas having an authentic and open relationship to one’s self is called an I-I relationship. These kinds of inner I-Me relationships have serious implications on the way people connect 10 with others (Gunst & Vanhooren, in press; Vanhooren, Leijssen, & Dezutter, 2017). At the core lies an existential alienation from their inner experience (I-Me) and from the others (in Buber’s terms I-it) at the same time. They have lost touch with their own existence. May (1982) states that clients sometimes give up their existence in order to survive. Or in other terms, they accept “nonbeing in order that some little being may be preserved” (May, 1982, p.27). Just like in focusing, EFT micro-tasks such as chair dialogues could be understood as an active way to help clients to move from an I-Me to more of an I-I relationship. When it works, the shift in their being-with-one-self is accompanied by a search for meaning on a micro-level (“How can I understand what just happened during this experience?”) often followed by meso searching (“How does this fit into my life story?”), and – in our experience – also followed by macro searching (“What does this mean on a spiritual level?”). Gendlin’s (1973) interaction first principle helps us understand that a more I-I relationship is often transferred into a more authentic relationship with the therapist and with others (an I-Thou relationship in Buber’s terms) and the other way around: our experience of the other and of ourselves is part of the same interactional reality. Gendlin’s idea about experiencing as having access to one’s existence also helps us understand that having deeper I-I and I-Thou relationships are accompanied by experiencing deeper levels of meaning in life. For Gendlin (1973), accessing one’s existence, becoming more deeply related to one’s self through the help of a deeply related other, discovering meaning, and finding direction in life all come together. One could question whether a change of framework from a scheme-based thinking toward a being-in-the-world thinking would really make any difference. From an experiential-existential point of view, the answer is yes. By using a different theory in order to understand the microprocesses, therapists and researchers might notice different aspects of the same microprocesses. On a therapeutic level, knowing about macro searching might help the therapist be aware of and actively attend to the existential consequences of micro shifts. For researchers, 11 being aware of the existential layer might help identify and name these aspects while studying process-outcome research. For example, an often used qualitative measure called Helpful Aspects of Therapy (HAT) (Llewelyn, 1988) doesn’t contain any category that refers to existential searching or meaning: some categories are about gaining insight but don’t distinguish between our described levels of meaning. As a result, the existential aspects cannot be scored and remain unnoticed. Being unnoticed, these existential aspects are not included into newer theories. Considering the fact that therapists may face an increasing amount of existential issues, and that these same therapists feel rather unequipped to meet these existential concerns (Hill, 2016), a huge challenge is waiting for the whole psychotherapy and counseling community. The Therapist is Fully Implied One way to respond to this challenge is to revisit the therapeutic process with fresh eyes and ears. Reclaiming the existential and experiential sources of humanistic psychotherapies – which can be traced back to Otto Rank (Kramer, 1995) – can help us understand anew what therapy is all about. This is not only helpful for the individual practitioner but also for the researcher. Re-evaluating measures on their compatibility with the existential foundations might help bring the existential layer of the therapeutic process back into the picture. In order for therapists to be more equipped to face the existential challenges of their clients, micro, meso, and macro levels of searching and existential functioning have to be studied. Research on micro searching and the shift from an I-Me to an I-I relationship could possibly reveal new aspects. Likewise, meso and macro searching need to be implied in both research and practice. From a process-researcher’s point of view, a lot is unknown about these latter 12 levels. For example, we might know how focusing works, but we know less about what exactly happens after we have completed a focusing cycle. However, knowing more about these different levels of existential searching will not be sufficient. As the therapist is a fundamental part of the client’s being-in-the-world – at least when she or he is in the therapy office – the therapist’s avoidance in meeting his or her own existential challenges might prevent change in the client (Gendlin, 1973; May, 1983). Therefore, therapists should not only be trained in how to deal with micro-processes but should also develop an enduring encounter with their own existential layers. It is not the therapist’s knowledge but his/her level of experiencing – the ability to access one’s own existence in the here and now – which helps the client contact the existential layer (Ikemi, 2014). According to Gendlin’s (1973) interaction first principle, it is not only the therapist who is part of the client’s being-in-the-world, but the client too is part of the therapist’s existence during therapy. This explains why experiences of relational depth touch the therapist in his or her deepest core (Mearns & Cooper, 2005). Likewise, the problems of the client often feel particularly palpable in the therapeutic relationship and can leave a deep trace in the therapist’s existence. Alliance ruptures (Safran & Muran, 2000) between client and therapist are experientially noticeable in the therapist and dealing with these ruptures is not only for the sake of the client. As the therapist is also the subject of change in a therapeutic encounter (Gendlin, 1973; May, 1983), existential support and spiritual nourishment might not be a luxury. Existential scholars such as Leijssen (2013), Schneider (2013, 2017), Hoffman (Hoffman et al, 2009), and Yang (2017) have picked up on this need and provide inspiring frameworks for therapists. Concluding thoughts 13 After developing his theory and noticing the similarities with existential writings, Rogers (1980, p. 39) realized that his approach was a sort of a “home-grown brand of existential philosophy.” Although many have discussed whether or not person-centred therapy could be identified as an existential approach (e.g. Stumm, 2005; Cooper, 2012), Rogers deepens his “therapy is of the essence of life” in his last book. While contemporary therapists experience the scattering of the person-centred approach in different tribes and stiles (Sanders, 2012) the existential background of person-centred theories could serve as a compass to navigate different person-centred and existential methods. In the spirit of Rogers, May and Gendlin, therapy is about being with existence. Using this benchmark, the therapist does not have to solve the existential challenges of the client. Instead, therapy becomes – for the client as well for the therapist – a vehicle to engage with life and its challenges in a fuller and more authentic way. A therapeutic framework that adopts this point of view sheds a different light on how we can understand change in therapy. Even on a micro-level, change is not so much about solving but about fully meeting every fiber of the client and giving every aspect its right to exist and speak. It is through the meeting of the therapist and the client, and the meeting of the client and his or herself, that one’s inner and outer relationships will shift (Leijssen, 2007). Every meeting has the capacity to bring forth new meaning. On an intrapersonal level, meeting one’s bodily felt existence helps to make implicit felt meanings explicit (Gendlin, 1962/1997). On an inter- and meta-personal level, meeting the other person or life itself at the fullest can change one’s own being and meaning in life (Buber, 1923/2003). Therapists can only meet their clients if they are willing to meet themselves and are willing to be touched by what happens during therapy. Being with the client is essentially also being with one’s self. As a result, therapy is not only an adventure for the client but for the therapist as well. 14 References Angus, L. E., & Greenberg, L. S. (2011). Working with narrative in emotion-focused therapy: Changing stories, healing lives. Washington, DC: American Psychological Association. Angus, L. E., Watson, J. C., Elliott, R., Schneider, K., & Timulak, L. (2014). Humanistic psychotherapy research 1990-2015: From methodological innovation to evidence-supported treatment outcomes and beyond. Psychotherapy Research, Advance online publication. doi: 10.1080/10503307.2014.989290 Bazzano, M. (2016). 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In G. Madison (Ed.), Theory and practice of focusing-oriented psychotherapy: Beyond the talking cure (pp. 113-127). London, UK: Jessica Kingsley Publishers. Mathieu-Coughlan, P., & Klein, M. H. (1988). Experiëntiële psychotherapie: Beslissende gebeurtenissen in de interactie tussen cliënt en therapeut. Psychotherapeutisch paspoort, 2, 505-549. May, R. (1983). The discovery of being. New York, NY: Norton & Company. Mearns, D., & Cooper, M. (2005). Working at relational depth in counselling and psychotherapy. Londen, UK: Sage Publications. Missiaen, C. (2016). Existentiële demonen in de ogen kijken [Facing your existential demons]. Tijdschrift Persoonsgerichte Experiëntiële Psychotherapie, 54, 37-44. 17 Rogers, C. R. (1942). Counseling and psychotherapy. Boston: Houghton Mifflin Company. Rogers, C. R. (1951). Client-centered therapy. London, GB: Constable. Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin Company. Rogers, C. R. (1980). A way of being. Boston: Houghton Mifflin Company. Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York, NY: The Guilford Press. Sanders, P. (Ed.) (2012). The tribes of the person-centred nation: An introduction to the schools of therapy related to the person-centred approach, second edition. Ross-on-Wye, UK: PCCS Books. Sachse, R., & Elliott, R. (2002). Process-outcome research on humanistic therapy variables. In D. J. Cain & J. Seeman (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 83116). Washington, DC: American Psychological Association. Schneider, K. J. (2013). The polarized mind: Why it’s killing us and what we can do about it. Colorado Springs, CO: University Professors Press. Schneider, K. J. (2017). The spirituality of awe: Challenges to the Robotic revolution. Waterfront Press. Schneider, K. J., & Krug, O. T. (2010). Existential-humanistic therapy. Washington, DC: American Psychological Association. Stumm, G. (2005). The person-centered approach from an existential perspective. Personcentered & Experiential Psychotherapies, 4, 106-123. doi: 10.1080/14779757.2005.9688375 Tillich, P. (1952/2000). The courage to be. New Haven: Yale University Press. Vanhooren, S. (2014). De moed om niet te weten, het lef om niet te kunnen. Tijdschrift Cliëntgerichte Psychotherapie, 52, 100-115. Vanhooren, S., Leijssen, M., & Dezutter, J. (2015). Posttraumatic growth during incarceration: A case study from an experiential-existential perspective. Journal of Humanistic Psychology, Advance online publication, 1-24. doi: 10.1177/0022167815621647 Vanhooren, S., Leijssen, M., & Dezutter, J. (2017). Ten prisoners on a search for meaning: A qualitative study of loss and growth during incarceration. The Humanistic Psychologist, 45, 162-178. doi:10.1037/hum0000055 Vos, J. (2015). Meaning an existential givens in the lives of cancer patients : A philosophical perspective on psycho-oncology. Palliative and Supportive Care, 13, 885-900. doi: 10.1017/S1478951514000790 Yalom, I. (1980). Existential psychotherapy. New York: Basic Books. Yang, M. C. (2017). Existential psychology and the way of the Tao: Meditations on the writings of Zhuangzi. New York, NY: Routledge. 18 These stude ts took the course “pecialisatiejaar E iste tiële Ps chotherap at Focus o E otio Belgiu . There are three e iste tial trai i g courses i Fla ders Belgiu : “pecialisatie E iste tiële ps chotherapie (Focus on Emotion and KU Leuven), Existentieel Welzijn (KU Leuven), and the Edx Massive Open Online Course Existential Well-Being: A person-centred and experiential approach (KU Leuven) i ii 19