Let’s not kill Phenomenology

Phenomenology is defined as first person subjective descriptions of what it means to live in a subjective world. That is, it is more concerned with lived experience rather than objective truths. In Psychotherapy this has traditionally been a powerful tool for helping people understand and come to terms with how they perceive the world and what it means to live in their subjective world.

With the surge in neuroscience and the heavy weight of authority given to DSM V (Diagnostic and Statistical Manual of the American Psychiatric Association), the phenomenology of psychiatric and psychological clients seems to have become less important. Both Neuroscience and the DSM have revolutionised the way we think about mental health, but we run the risk of converting clients into “objects of research”.

Objective classifications as laid out by the DSM and developments in Neuroscience research enable to emphasise the external, observable, measurable and recordable features and characteristics of a mental disorder. Undoubtedly this gives clinicians a huge advantage in helping sufferers and advances in Neuroscience help understand the how and the why.

However, it is also of upmost importance, in my opinion, not to lose sight of the clients lived experience of such phenomena.

Below I’d like to present two different perspectives for the same phenomena, the first is a description of Agoraphobia reproduced from A different existence by Van de Berg. J 1972

“The houses…gave the impression of being closed up, as if all the windows were shuttered, although he could see this was not so. He had an impression of “closed citadel”. And looking up, he saw the houses leaning over towards the street, so that the strip of sky between the roofs was narrower than the street on which he walked. On the square, he was struck by the expanse that far exceeded the width of the square. He knew he would not be able to cross it. An attempt to do so would, he felt, end in so extensive realisation of emptiness, width, rareness and abandonment that his legs would fail him. He would collapse…It was the expanse, above all that frightened him.”

Secondly, I have my copy of DSM V open at page 217 and it states:

“Agoraphobia

      A.      Marked fear or anxiety about two (or more) of the following five situations

·         Using Public Transport

·         Being in open spaces

·         Being in enclosed spaces

·         Standing in line or being in a crowd

·         Being outside of the home alone

      B.      The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms.”

The second enables me to coordinate well with my support psychiatrist and helps me to plan strategies and interventions, but the first powerful description helps me to understand what it means to clients to live in “their world”. Both perspectives are of equal importance.  

Why I’m Eclectic

I’m often accused of sitting on the fence by colleagues and indeed that is a luxury that age and experience has permitted me. Apart from my Psychology degree I have post graduate training in CBT and Gestalt therapy, which for me, far from being in conflict with each other are complimentary and enable me to incorporate different focus at different moments of the therapeutic process.

 Eclectic is defined as selecting or employing individual elements from a variety of sources, systems or styles.

My experience has shown me that different levels of processing are important at all phases of any therapeutic process and different models of therapy can be useful depending on where the client is at any given moment. Of course I’m not suggesting that any process is linear, but am just using a construct to emphasize my argument.

I agree with Rollo May in that an important therapeutic aim is to “set people free”, which can be interpreted as the perceived capacity for choice within the natural and self-imposed limitations of living in “our” world.

We can understand human experience or consciousness in terms of 5 interwoven levels of freedom. The physiological, the environmental, the cognitive, the interpersonal and the experiential. Each incorporates growing levels of freedom at deeper levels of consciousness.

The physiological level relates to organic freedom and is activated and limited by, amongst other things, genes, physical disposition, diet, exercise and drug consumption. This relates directly to environmental freedom where choice and freedom to manipulate external stimuli can be explored using classical and operant conditioning of behaviourism. Here one may obtain observable and measurable results in losing weight, stopping smoking and getting healthy.

At a cognitive level long held beliefs about oneself or the world, that may no longer be adaptive, can be challenged through questioning these belief structures and through cognitive restructuring.

These levels of freedom and restriction relating to physiology, environmental manipulation and cognitive processes could be considered as conscious measurable levels of psychophysiological liberation, but the remaining two, interpersonal and experiential levels of experience often undermine and sabotage environmental and cognitive processes.

At an interpersonal level, we are in the realms of attachment and separation fears, where often our personal uniqueness and striving comes into conflict with our need for connectedness and dependence. Here we need to experience more and think less. Psychodrama and gestalt therapy have no equal as phenomenological experiential approaches.

The last and in my opinion most profound level of freedom is at an experiential level, this in itself transcends words and cannot be talked “about” but is experienced and lived. This kind of experiential freedom can be a hugely humbling experience which can leave people in awe, not of anything in particular, but of being in contact with the wonder that is existence itself, “being” in the world and participating fully in it.