**2. Humanistic-existential approach: introduction and foundations**

#### **2.1. History and premises**

Known as the "*third force*" in psychology, the humanistic-existential approach was founded in the 1940s in the United States. This movement was created as a distinct complement to the dominating behavioral and psychoanalytic traditions. Inspired by the existential and phenomenological philosophies, the founders of humanistic-existential psychology believed that the subjective experience is the starting point from which all comprehension may emerge [2–4]. A few authors are commonly associated to the humanistic-existential movement, notably Maslow, Rogers, Bugental, Frankl, May, and Yalom.

With such a focus on subjectivity, humanistic-existential psychologists rely on phenomenology to explore and understand the meaning of different human experiences. Phenomenology may be described as the investigation of the "*lived experience*," as opposed to the study of an objective reality. Phenomenology, both as a clinical stance and as a research method, involves bracketing all assumptions about the world (and about the other) to illuminate the essence and the meaning of an experience. Phenomenologists aspire to get as close as possible to "*what it is like*" to be the other person, and to "*what it is like*" to experience the world as he or she does. Thus, humanistic-existential psychology is essentially concerned with the way a patient experiences his symptoms or illness, as opposed to the actual presence (or absence) of symptoms or diagnosis.

The term "*Trauma*," from the Ancient Greek "*trauma*," refers to the notion of "*wound*" or "*damage*." In that sense, PTSD may refer to the wound left by an experience that disrupted the person's previous relationship to self, to others, and to the world. Trauma survivors are often said to live with an "*invisible wound*" in a state of relative chaos that may be left unnoticed. The only concrete manifestations of such internal suffering may narrowly be reduced to a visible

As a matter of fact, mainstream approaches to "*assessing*" and "*treating*" PTSD are repeatedly criticized for their propensity to solely focus on the visible aspects of trauma: symptoms [1, 11, 12]. Therefore, the humanistic-existential perspective may be understood as a complement to the pathology-focused model, which may mainly aim at improving symptom management. The humanistic-existential approach to PTSD may not focus primarily on symptom, or even on the traumatic event itself. It may rather emphasize the exploration of the lived experience

In this chapter, we aim to discuss how PTSD may be conceptualized, recognized, and healed from a humanistic-existential perspective. To do so, we will review the basic foundations of the humanistic-existential approach. We will explore its unique understanding of human being and his potential for growth and healing. We will also suggest how the humanistic-existential approach can offer a different outlook on trauma comprehension and healing through the introduction of two different case studies. Finally, we will discuss the limits and contributions

of the humanistic-existential approach and its implications for the therapist's stance.

**2. Humanistic-existential approach: introduction and foundations**

Known as the "*third force*" in psychology, the humanistic-existential approach was founded in the 1940s in the United States. This movement was created as a distinct complement to the dominating behavioral and psychoanalytic traditions. Inspired by the existential and phenomenological philosophies, the founders of humanistic-existential psychology believed that the subjective experience is the starting point from which all comprehension may emerge [2–4]. A few authors are commonly associated to the humanistic-existential move-

With such a focus on subjectivity, humanistic-existential psychologists rely on phenomenology to explore and understand the meaning of different human experiences. Phenomenology may be described as the investigation of the "*lived experience*," as opposed to the study of an objective reality. Phenomenology, both as a clinical stance and as a research method, involves bracketing all assumptions about the world (and about the other) to illuminate the essence and the meaning of an experience. Phenomenologists aspire to get as close as possible to "*what it is like*" to be the other person, and to "*what it is like*" to experience the world as he or she does. Thus, humanistic-existential psychology is essentially concerned with the way a patient

of the individual and, most importantly, of its existential meaning.

180 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

ment, notably Maslow, Rogers, Bugental, Frankl, May, and Yalom.

configuration of symptoms.

**2.1. History and premises**

In the 1960s, the founders of the humanistic-existential movement defined their approach by five premises, articulated by Bugental [5]. First, *human beings, as humans, supersede the sum of their parts. They cannot be reduced to components, symptoms, or behaviors*. This premise calls for a holistic comprehension of the human experience. It also calls for the necessity to explore an individual's experience beyond symptoms and behaviors. It aspires to honor and comprehend the uniqueness of each individual, and the unique meaning of one's lived experience.

The second premise states that *human beings have their existence in a uniquely human context*. As a result, the individual experience must be approached and comprehended in the light of its unique contextual reality. Humanistic-existential psychology is concerned with *being*, seen as an expression and influence of societal, cultural, and individual reflections that capture the most personal of experiences [6]. This assumption may remind us that the psychotherapist also develops his subjective comprehension of the reality from his own context.

Third, from a humanistic-existential perspective, it is presumed that *human beings are aware and aware of being aware*. Awareness and consciousness of awareness are major distinctive traits of human beings. Most importantly, it is believed that human potential for growth and healing is possible through the process of increasing awareness of one's experience of self, of others, and of the world. Greater awareness may allow the possibility to make choices and to exert one's existential freedom. As Frankl [7] puts it, humans carry the freedom and the ability to find meaning as long as they are conscious.

Fourth, *human beings also have the ability to make choices and therefore have responsibility*. Awareness and freedom inevitably come with the responsibility to act according to our will and values. It also accounts for recognizing one's responsibility—as opposed to biological or environmental determinism. Existential responsibility is believed to be one of the fundamental challenges of human existence, along with finiteness, isolation, and absurdity [8]. Human being cannot avoid confrontation to the absurdity of the modern world and—to some extent—to the absurdity of the human condition itself. Existential responsibility calls for the recognition of the inherent limitations and possibilities of our human condition. Most importantly, humans have the responsibility to search and create meaning out of life's journey. For Frankl, man's ultimate freedom and responsibility refers to his capacity to choose the attitude toward different life situations. Since death, loss, and suffering are intrinsically a part of what it means to fully experience life, the ultimate freedom and responsibility is to create meaning out of suffering [9].

Consequently, from a humanistic-existential perspective, *human beings are believed to be intentional, to aim at goals, to be aware that they cause future events, and to seek meaning, value, and creativity*. For instance, Frankl believed that (1) human beings carry the ability to find meaning as long as they are conscious; (2) they have a basic will to find such meaning; and (3) they carry within themselves the knowledge that life has meaning.

In summary, humanistic-existential psychology reintroduces the subjective experience as the first instance of the human existence. It relies on phenomenology and emphasizes the importance of the "*here and now*" knowing that the only moment we directly experience is "*right now*"—as we become aware of ourselves in the world. The humanistic-existential psychologist is concerned with the human experience as a whole, and recognizes the meaning and value of nonhedonist emotions and experiences, such as suffering, conflict, grief, guilt, and death. Inevitable loss, mortality, and absurdity are part of the human condition and are recognized as existential universal realities that all beings have to face and adjust to with their unique, creative, yet complex manner [8]. Those existential challenges and the suffering that comes with it are normal, but are also worthy and may be transforming. As such, suffering may open an opportunity for change and for potential healing and growing. Humanistic-existential psychotherapists have genuine interest and curiosity for every individual potential for growing and healing.

#### **2.2. Human potential for growing and healing**

The etymology of the term "*healing*" refers to "*wholeness*" or being "*whole*." From the humanistic-existential point of view, psychotherapy may signify "*to make more whole*." Wholeness may therefore be understood as a sense of completeness, integrity, and coherence. It may as well mean to exist more fully as a human being, including with the condition of being mortal. For May [10], health and healing means "*to experience more fully, deeply, consciously, and authentically one's existence*." The psychotherapy process consequently involves the exploration of barriers people may have, preventing them from experiencing and expressing their freedom in choices and will [11, 12]. Healing may as well be understood as a process that leads to a deeper and fuller engagement with the self, with others, and with the world. As Jager [13] puts it, "*being human means standing in a relationship to others, to things, and to the world*." Healing may therefore occur in a relationship that allows the narration and reflection of one's subjective experience. The other's presence can be understood as a key allowing us to become more aware of ourselves, of the other, and of the world [14].

#### **2.3. Healing together: the humanistic-existential encounter**

It is within the clinical encounter that the process of healing can occur. The psychotherapeutic relationship involves the validation and value of the individual's unique way of being. It also implies the recognition of the singular contribution of the therapist's subjectivity. Hence, the psychotherapeutic encounter can be understood as a process of shared discovery in which the meaning of the patient's lived experience is explored, understood, and eventually transformed. Repeated events of "*meaning*" and of mutual comprehension of the patient's lived experience may allow a deeper awareness and more freedom of choice and will. New freedom, allowed and supported by the therapeutic relationship, opens up the possibility to seek and cocreate new meanings. The psychotherapist is therefore involved in articulating, comprehending, validating, and contributing to the patient's search of meaning [15].

The humanistic-existential therapeutic encounter, as a unique and intersubjective space of cocreation, aims at supporting, promoting, or restoring the individual's fundamental sense of self-cohesion [16]. As Quintin [15] puts it, psychological suffering is not something that can be fixed with expertise, opinions, or advices. The humanistic-existential stance rather refers to a process of discovery of new meanings to replace one's old assumptions about the world that are no longer true. Previous meanings, as relic of the past, may obstruct the patient's sense of inhabiting the world in a free and meaningful way in his current life's situation. Old meanings cease to be coherent with the patient's actual experience of the world. Disruption of meaning or "*shattered assumptions*" [17] is at the core of the humanistic-existential comprehension of trauma.
