Keywords

1 Introduction

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I –

I took the one less travelled by,

And that has made all the difference.

(Robert Frost: The Road not Taken)

The history of philosophy as well as that of literature, music and other forms of art is full of themes that relate to the topics of freedom, responsibility and guilt: from seemingly trivial decisions such as “Should I stay or should I go now” (The Clash) to Hamlet’s famous monologue “To Be or not to Be...” – decisions between different forms of behaviour (based on the freedom to choose between them) play a major role in human lives. The aim of this chapter is not to attempt an exploration of the extent of freedom people have in the face of a deterministic world – rather, we will try to elucidate how (a) people are able to choose between different, and often incompatible, life options and what the consequences are (freedom), (b) how the choices people make during their life are related to responsibility and (c) how freedom and responsibility are related to guilt and regret.

2 Freedom

Freedom is just another word

for nothing left to lose.

(Kris Kristofferson: Me and Bobby McGee)

Writing a chapter on freedom for a book on “Existential concerns and cognitive-behavioural procedures” has several potential starting points: first, the exploration of freedom as an existential concern, and second, the history of freedom in the history of CBT. We will start with a broader overview of freedom in a philosophical and political sense and then turn to freedom in existential psychotherapy and will finally address the history of freedom in behaviourism, cognitive therapy and new “third wave” CBT approaches. As will be demonstrated, early behaviourism and existential philosophy did not see eye to eye on the topic of freedom. Yet, freedom and its relevance for therapy have gained influence within the CBT tradition in the works of A.T. Beck and Albert Ellis.

2.1 Freedom as a Concept in Philosophy and Politics

Man is condemned to be free.

(Jean-Paul Sartre, 1943/1956)

The question “Are human beings free to choose whatever option they want or is life pre-determined by religious fate or natural determinism” – sometimes called the problem of free will or free-will problem – has haunted philosophy and psychology for centuries if not millennia, and it is highly unlikely that a definitive answer will be found in the near future. Historically, there are a large number of philosophical (e.g. O’Connor & Franklin, 2020), political (e.g. Arendt, 1961) and psychological (e.g. Skinner, 1971; May, 1981) publications on freedom and its relation to other topics. Dating back at least to the Stoics of ancient Greece and Rome (Bobzien, 1998), the question of how much freedom humans have in a potentially predetermined or deterministic world has been discussed intensely – a discussion that continues to this day (O’Connor & Franklin, 2020). With his Philosophical Inquiries into the Essence of Human Freedom, the German idealist philosopher Schelling (1809/2006) has paved the way for the understanding of freedom in existential philosophy (Heidegger, 1971) and later existential psychotherapy (Yalom, 1980).

Freedom in Existential Philosophy

In existential philosophy, freedom is one of the major themes for a number of authors (e.g. May, 1981, Yalom, 1980; see Noyon & Heidenreich, 2012, for an overview). As mentioned above, Heidegger, in his Being and Time, interprets freedom as the “[f]reedom to choose and grasp oneself” (in the German original: “Freiheit des Sich-selbst-wählens und -ergreifens”) (Heidegger, 1927/1962, 1967, p. 188).Footnote 1 As is well known, Heidegger’s language is highly idiosyncratic und thus hard to read, but the basic concept is easily grasped: humans have the potential to imagine what they could be (“Seinkönnen”), and they have a choice to either follow the call of what Heidegger terms “conscience” to this “could-be” or stick to what everybody (the “Man”, which has nothing to do with the current use of the English term “man”) does and expects. The state of not living up to one’s potential is termed “Uneigentlichkeit” by Heidegger – again, a word that is often translated as “authenticity” (Varga & Guignon, 2020). Varga and Guignon’s sophisticated analysis of the term “Eigentlichkeit” and its translations are as follows (online document without page numbers):

The most familiar conception of “authenticity” comes to us mainly from Heidegger’s Being and Time of 1927. The word we translate as ‘authenticity’ is actually a neologism invented by Heidegger, the word Eigentlichkeit, which comes from an ordinary term, eigentlich, meaning ‘really’ or ‘truly’, but is built on the stem eigen, meaning ‘own’ or ‘proper’. So the word might be more literally translated as ‘ownedness’, or ‘being owned’, or even ‘being one’s own’, implying the idea of owning up to and owning what one is and does (…). Nevertheless, the word ‘authenticity’ has become closely associated with Heidegger as a result of early translations of Being and Time into English, and was adopted by Sartre and Beauvoir as well as by Existentialist therapists and cultural theorists who followed them.

Freedom is also a central concept in the philosophy of Jean-Paul Sartre (most famously in Being and Nothingness, 1943/1956; see also Baggini (2002) for an analysis of Sartre’s Essay “Existentialism is a Humanism”) and Karl Jaspers, who introduced the concept to psychiatry and psychotherapy (Bormuth, 2013).

Freedom in a Political Sense

In the context of this book, including an analysis of the concept of freedom in a political sense is not possible. We will thus only mention a number of political authors who have become influential for existential concepts: Hannah Arendt, a former student of Martin Heidegger’s, wrote a famous chapter on “Freedom and Politics” (Arendt, 1961, p. 191), where she proposed an understanding of freedom based on social interactions:

... by freedom I do not mean that heritage of humanity which philosophers define in a variety of ways and isolate, to their own satisfaction, as one of the inherent attributes of man. (…) Basically, whether I enjoy freedom or suffer the reverse depends upon my intercourse with my fellow men and not on my intercourse with myself.

It should be noted that this intersubjective stance towards freedom is in line with Sartre’s thinking (existentialism is a humanism). The political consequences of psychological freedom were described by Erich Fromm in his book Escape from Freedom (1941). Based on his empirical work in Germany in the late 1920s and early 1930s (before fleeing the Nazi system), he argued that freedom is a frightening process and that a potential escape from freedom is to fall back into autocratic thinking.

Freedom and Decision Making

As the material discussed so far shows, freedom (or its opposite) manifests itself in the choices people make. We will not be able to discuss this in detail here, but both the literatures on decision theory (Peterson, 2017; Resnik, 1987) and on judgement under uncertainty (Kahneman et al., 1982; Pisano & Sozzo, 2020) would be interesting to explore against an existential background.

2.2 Freedom as an Existential Concern

Freedom and Its Connection to the Other Existential Concerns

Death, freedom, isolation and meaninglessness are the four existential concerns that Irvin Yalom describes in his seminal book Existential Psychotherapy (1980). We will not explain these concepts in our contribution because they are dealt with in other chapters of this book (see Dar-Nimrod in Chapter “Existentialism and Its Place in Contemporary Cognitive Behaviour Therapy” of this book on the role of death and death awareness, Helm and Greenberg in Chapter “Existential Isolation: Theory, Empirical Findings, and Clinical Considerations” of this book for isolation and Kuperis in Chapter “On the Need for Meaning” on meaning), but it is crucial to note that there are important links of freedom to the other three existential concerns of death, meaninglessness and isolation: death is a natural boundary to life – this means that humans can’t postpone decisions infinitely but rather that sooner or later it will be too late for some actions. Simone de Beauvoir developed a highly interesting thought experiment in her novel All Men Are Mortal (de Beauvoir, 1946/1992) where an Italian count is made immortal. While enjoying some aspects of this early on, his life becomes more and more meaningless since he can take all decisions without real consequences (because he could choose the other way round during his next cycle of life) – for a more Hollywood-style treatment of the same issue, see “Groundhog Day” with Bill Murray. Similarly, there is a close connection between freedom and meaning: making healthy choices in life will lead to experienced meaning, whereas failing to choose or choosing wrongly will lead to meaninglessness. May (1981, p. 6) has argued that “[f]reedom is thus more than a value itself: it underlies the possibility of valuing; it is basic to our capacity to value. Without freedom there is no value worthy of the name”. The link between freedom and isolation is multifold: decisions taken with personal freedom will very often involve other people and therefore have the potential of interpersonal isolation. Similarly, intrapersonal isolation (dissociating from personal experiences and potentials) and existential isolation (Yalom’s assumption that there is an unbridgeable distance between individuals) can be linked to the concept of freedom.

Freedom as a Topic in Therapy

The complete second part of Yalom’s Existential Psychotherapy is devoted to the concept of freedom, and, rather than starting with a theoretical or philosophical essay on freedom, Yalom relates clinical case examples that show the practical meaning of freedom for therapy in a variety of situations. One example is that of a patient who tells her therapist that her behaviour is controlled by her unconscious, and another is that of a therapist who has a “can’t bell” that he always rings when a patient uses the word “can’t”. An example that might be encountered nowadays is a patient who tells his therapist that his “addiction centre” had been triggered and that his “dopamine kick” had caused a relapse (notably, a similar example from Yalom features “the unconscious”). The therapist’s answer “And did your dopamine also buy the bottle of whisky?” puts it in a nutshell. Yalom argues that even these seemingly trivial instances can point to deep existential issues. Identifying the existential roots of these different therapeutic situations is of uttermost importance, and Yalom uses the works of both Martin Heidegger (1927/1962) and Jean-Paul Sartre (1943/1956) as a foundation for his reasoning.

Among the existential psychotherapists, Rollo May, who was a close friend of Yalom’s (Yalom, 2017), has dealt with the topic of freedom extensively. In his book Freedom and Destiny that appeared one year after Yalom’s Existential Psychotherapy, he – like Martin Heidegger – relates to the work of Schelling (see above) and describes freedom and its interrelation to destiny in the following way:

This personal freedom to think and feel and speak authentically and to be conscious of so doing is the quality that distinguishes us as human. Always in paradox with one’s destiny, this freedom is the foundation of human values such as love, courage, honesty. Freedom is how we relate to our destiny, and destiny is significant only because we have freedom. In the struggle of our freedom against and with destiny, our creativity and our civilizations themselves are born. (May, 1981, Foreword)

A few pages later (May, 1981, p. 5), he specifies:

What, then, is the nature of freedom? It is the essence of freedom precisely that its nature is not given. Its function is to change its nature, to become something different from what it is at any given moment. Freedom is the possibility of development, of enhancement of one’s life; or the possibility of withdrawing, shutting oneself up, denying and stultifying one’s growth.

May distinguishes two kinds of freedom: freedom of doing vs. freedom of being. Freedom of doing is defined in the following way: “Freedom is the capacity to pause in the face of stimuli from many directions at once and, in this pause, to throw one’s weight toward this response rather than that one” (May, 1981, p. 54). In contrast, freedom of being is described as “Whereas the ‘freedom of doing’ refers to the act, the ‘freedom of being’ refers to the context out of which the urge to act emerges. It refers to the deeper level of one’s attitudes and is the fount out of which ‘freedom of doing’ is born” (May, 1981, p. 55).

Also, Viktor FranklFootnote 2 (1946/1995) has explored freedom and its relevance for psychotherapy. He uses the term “pandeterminism” to characterise the (in his opinion incorrect) assumption that all freedom is an illusion because everything can be explained causally. On a psychological level, this means that humans are puppets on a string rather than active agents and don’t have any influence on their life courses. Thus, in a predetermined world, there can be no responsibility for one’s actions. Equally misleading, according to Frankl (1946/1995), is the so-called psychologism – the assumption that there is no fate at all and that everything that happens is a direct consequence of one’s thoughts or behaviour. Thereby, psychologism negates the existence of fate or coincidence since everything can be explained causally. Consequently thought through to the end, pandeterminism means that people have no freedom of choice but only an illusion of it (“Everything is fate – you are not responsible for anything”), while in the psychologistic world view, everything depends exclusively on the inner world of the person (“Anything goes – you are responsible for everything”).

Overall, existential approaches to psychotherapy tend to take a middle ground: while conceding that there are facts that can’t be influenced by individuals/that fall outside the realm of individual freedom (termed “destiny” by Rollo May, 1981), there is still plenty of room for free decisions. Following Sartre on a philosophical level and Yalom in existential psychotherapy, we assume that the reality of human life includes parts on which human beings can decide themselves (“freedom”) as well as events that enter life randomly and uncontrollably (“destiny”). Independent of the exact amount of freedom that is attributed to humans, there is one major consequence: responsibility (at least to some degree) for one’s actions. We will explore this in the next section.

Also, some clinical disorders such as depression are closely linked to the theme of freedom: regret over not having lived the potentialities of life may play an important role in depression (see Chapter “Failed Potentialities, Regret and Their Link to Depression and Related Disorders” of this book).

2.3 Freedom in Behaviourism, Cognitive Therapy and New Developments in CBT

Current CBT has come a long way since the first behavioural publications, and the discussion of freedom, free will and the like has changed tremendously over the decades. We will address each of these phases in turn.

Freedom in Behaviourism

Historically, the first works of behaviourism came after the first philosophers that are considered to be “existential” (e.g. Kierkegaard, who published The Concept of Anxiety in 1844), but some of them (e.g. Watson, 1913) appeared earlier than important existential philosophical works (such as Being and Time in 1927 and Being and Nothingness in 1943), and many of the influential works of existential psychotherapy appeared during a time when behaviourism was the dominant psychological philosophy of science.

From Watson’s early work (Watson, 1913, p. 163), the aim of behaviourism was to eliminate all references to consciousness: “The time seems to have come when psychology must discard all reference to consciousness; when it need no longer delude itself into thinking that it is making mental states the object of observation”. Since “freedom” as defined in a psychological sense is not empirically observable (“mentalist”), it is part of what Watson calls “absurd terminology” (p. 166f) and should therefore be eliminated from psychology.

About 40 years after Watson’s manifesto of behaviourism, B. F. Skinner wrote a highly influential book that carries the word “freedom” in its title – as can be expected, this word is not used in affirmative sense but rather as something to be overcome: Beyond Freedom and Dignity (Skinner, 1971). Skinner puts all emphasis on the environment and rejects the idea that a mentalistic concept of freedom is useful. Rather, he places freedom in the realm of operant conditioning:

Freedom is an issue raised by the aversive consequences of behaviour, but dignity concerns positive reinforcement. When someone behaves in a way we find reinforcing, we make him more likely to do so again by praising or commending him. (Skinner, 1971, p. 45)

And, on the next page:

Man’s struggle for freedom is not due to a will to be free, but to certain behavioural processes characteristic of the human organism, the chief effect of which is the avoidance of or escape from so-called ‘aversive’ features of the environment. (Skinner, 1971, p. 46)

Consequently, the emphasis of the analysis shifts from what Skinner terms the “autonomous man” to the control of the environment:

By questioning the control exercised by autonomous man and demonstrating the control exercised by the environment, a science of behaviour also seems to question dignity or worth. […] A scientific analysis shifts the credit as well as the blame to the environment, and traditional practices can then no longer be justified. These are sweeping changes, and those who are committed to traditional theories and practices naturally resist them. (Skinner, 1971, p. 26)

The struggle for freedom and dignity has been formulated as a defence of autonomous man rather than as a revision of the contingencies of reinforcement under which people live. A technology of behaviour is available which would more successfully reduce the aversive consequences of behaviour, proximate or deferred, and maximize the achievements of which the human organism is capable, but the defenders of freedom oppose its use. (Skinner, 1971, p. 124)

In spite of Skinner’s refutation of “autonomous man”, only one year after the publication of Skinner’s book, Ryback (1972) argued that existentialists and behaviourists failed to see their “common ground” which he sees in the underlying humanistic assumption. One reason could be the language used in behaviourism: “However, Behaviourists still lack the semantically ‘warmer’ language with which to communicate their increasingly broadening scope of activities” (Ryback, 1972, p. 53). As we will see, this “warmer language” entered the historical scene not from the Skinner box but from a new development called “cognitive therapy”. It should be noted that despite the contemporary preponderance of “cognitive-behavioural therapy”, these used to be two different approaches to therapy back in the early days: behaviour therapy with its emphasis on Skinner boxes and the like and cognitive therapy as the work of two psychoanalysts who were dissatisfied with the practice of their traditions.

Freedom in Cognitive Therapy

When A. T. Beck and his colleagues published Cognitive Therapy of Depression (Beck et al., 1979), it stood in sharp contrast to the rejection of mentalist concepts by Skinner and other behavioural writers. While “freedom” as a topic is not mentioned explicitly in this book, it is one general assumption that cognitive content such as thoughts can be changed more or less freely. In 1970 already, Beck defined cognitive therapy as a set of operations focused on a patient’s cognitions (verbal or pictorial) and on the premises, assumptions and attitudes underlying these cognitions.

The second founding father of cognitive therapy, Albert Ellis, wrote a text that deals with the very topic of freedom: in a response to a paper by Lucien Auger (“Are Human Beings Free?”, 1987), he describes his position in the following way: “I tend to be, however, a little more in favor of free choice or free will than he is” (Ellis, 1987, p. 54). He continues (p. 55) by stating that “human freedom seems to have some degree of reality –especially when it is backed by reflective thinking. For men and women are future-oriented as well as stuck in the conformist past and they can therefore choose to go through present pain for future gain (as when they give up smoking or fight to the death against political tyrannies so that their children may live in freedom)”.

(…) [H]umans – as rational-emotive therapy particularly emphasizes – can change their cognitions and interpretations. This very ability, I (along with George Kelly) would say, gives them at least some measure of freedom or “free will”. Limited yes but still existent. (Ellis, 1987, p. 56)

Freedom in ACT: Freely Chosen Values

As for acceptance and commitment therapy (ACT) and other new developments in CBT (sometimes termed “third wave”), freedom in the sense of this chapter is most prominent in the work with values. The term “values” has a very specific meaning in acceptance and commitment therapy. Wilson and Dufrene (2009, p. 64) define values as

freely chosen, verbally constructed consequences of ongoing, dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioural pattern itself.

In our context, the words “freely chosen” are of course paramount. Since the definition above is quite technical, we will briefly examine Fletcher and Hayes’ (2005, p. 321) elucidation of the term “values”:

Values differ from goals in that they are not objects to be attained, but rather are directions that integrate ongoing patterns of purposive action. In the case of values, language is useful in that it serves to link actions in the present into a coherent pattern of effective action. ACT exercises use the processes of acceptance, defusion, present moment awareness, and so on to clear the way for clients to identify valued domains of life (e.g., family, relationships, work). In choosing life directions that are meaningful, clients are able to disengage from the verbal processes that drive behaviours based on social compliance, avoidance, or fusion, and shift toward more appetitive forms of behavioural regulation.

It should be noted that in this paragraph, the expression of “choosing life directions that are meaningful” has a definitive “existential ring” to it – both choice (rooted in the possibility of freedom) and meaning are two of the most central concepts of existential psychotherapy.

It would be beyond the scope of this chapter to examine the role of freedom in other new developments in CBT such as mindfulness-based cognitive therapy (MBCT; Segal et al., 2013), dialectical behaviour therapy (Linehan, 1993) or behavioural activation (Jacobson et al., 2001). Nevertheless, it should be noted that freedom (of choice) tends to play a major role in these newer developments. In MBCT, for instance, it is one of the major aims to inhibit dysfunctional ruminative processing associated with low mood – the freedom to refrain from action is very important. Behavioural activation, like ACT, emphasises the role of choosing values (and engaging in them through actions).

Taken together, freedom in the sense provided by existential psychotherapists was refuted by early behaviourists as being mentalistic – however, it is highly compatible with the cognitive therapy approach, and it plays a major role in modern “third wave” CBT approaches.

3 Responsibility

Can you take responsibility for this?

(Fritz Perls)

Similar to the concept of freedom, responsibility is a concept that is relevant in a variety of contexts – from moral responsibility in philosophical ethics (Talbert, 2019) to political responsibility (e.g. Tholen, 2018). Having discussed the concept of freedom in great detail, we will deal with the concept of responsibility in a much more concise way as most of the issues related to the existential concern “freedom” are closely related to responsibility. Leaving aside the philosophical debate on compatibilist vs. incompatibilist accounts of the relationship between determinism and free will (and resulting responsibility of an individual; see Talbert, 2019), we may assume that freedom (in whatever amount) is a prerequisite for responsibility: if all actions are predetermined, it is impossible to make an individual responsible for their deeds.

Responsibility in Existential Philosophy

In existential philosophy, Sören Kierkegaard (1844/2015) has placed great emphasis on the responsibility for one’s actions and the resulting anxiety because making choices means deciding against all other options. Similarly, other existential philosophers have stressed the responsibility resulting from free will (see Noyon & Heidenreich, 2012).

Responsibility in Existential Psychotherapy

Much of what has been discussed in the context of freedom also applies to responsibility: Yalom (1980) places an emphasis on patients’ avoidance of responsibility (and, thus, the denial to accept the idea of freedom). Drawing on the work of Kaiser (1955), he discusses clinical case examples and literature that deal with avoidance of responsibility. In his view, it is important for patients to take responsibility for those facts in life they can control but also to be aware of “destiny” that is uncontrollable.

What are the clinical implications for failure to take on responsibility? Yalom (1980) describes a prolonged delay of decisions rooted in a deep form of existential anxiety towards taking responsibility for one’s actions. This anxiety is much deeper than a single pending decision. A phenomenon closely related to responsibility is certainty: some clients don’t move forward in the decision process because they want to achieve some kind of “absolute safety” to take the right decision. This very often goes hand in hand with the idea that the “right decision” will make everything possible and thus will have no negative consequences. This illusion is a misinterpretation of the existential fact of responsibility: there is no choice that does not come with the fact that it is a decision against all other options. The things that are not chosen are associated with non-existence, nothing, not-being (Le néant; Sartre, 1943/1956). Rejecting responsibility can be understood as a dysfunctional reaction to the anxiety that is inherent in freedom. Trying to avoid this kind of anxiety is highly dysfunctional because even the decision not to choose is a choice and is regularly associated with the avoidance of action. On the other hand, taking on responsibility for things that are not controllable (e.g. a diagnosis of cancer) can be quite harmful.

In summary, responsibility rests on the assumption that humans are free to choose their actions at least to some degree – in psychotherapy, a major task is to find out which actions are under the control of patients and which are not.

4 Guilt

The years rolled slowly pastAnd I found myself aloneSurrounded by strangers I thought were my friendsI found myself further and further from my home, and IGuess I lost my wayThere were oh-so-many roads(…)

(Bob Seger: Against the Wind)

Just as responsibility is a direct consequence of freedom, the possibility to be guilty is a direct consequence of responsibility: being guilty is only possible when at least two conditions are met – (a) there is responsibility for one’s actions (meaning that somebody is able to freely choose between alternatives), and (b) the harm caused (to others) was done intentionally. This is echoed in legal systems all over the world where there is a distinction between killing somebody intentionally vs. accidentally.

4.1 Three Forms of Guilt According to Yalom

Yalom (1980) proposes a distinction between three forms of guilt: neurotic, actual and ontological guilt. Since ontological guilt is of paramount importance in the context of this chapter, we will deal with the other two forms of guilt only briefly.

Neurotic Guilt

In Yalom’s psychodynamic approach to existential psychotherapy, neurotic guilt is conceptualised in a psychoanalytic way. Phenomenologically, neurotic guilt in this sense characterises a number of mental disorders: in major depressive disorder, for example, one criterion is “Feelings of worthlessness or excessive or inappropriate guilt nearly every day” according to DSM-5 (American Psychiatric Association, 2013). Similarly, guilt may play a role in obsessive-compulsive disorders (Shapiro & Stewart, 2011).

Actual Guilt

As stated above, actual guilt implies intention of one’s action (or inaction) and an ability to choose this action among other options. Guilt is something that is unavoidable in life (even though humans can try to minimise their negative impact on other people and nature). For Frankl (1946/1995), guilt is one part of the “tragic triad” (together with suffering and death). For him, not experiencing guilt is a sign of psychopathology rather than health (i.e. in antisocial personality disorder).

4.2 Ontological Guilt

The form of guilt most relevant in the current context is what is called ontological guilt (or sometimes existential guilt). In contrast to guilt resulting from harming others (actual guilt), ontological guilt refers to falling short of one’s possibilities. We will briefly consider the existential philosophical background of ontological guilt and then turn to therapeutic implications as discussed by Yalom (1980).

Ontological Guilt in Existential Philosophy

Although a large number of existential philosophers have written on this topic, it is Heidegger’s classical account (in paragraph 58 of Being and Time) (Heidegger, 1967, p. 280; 1927/1962) that has remained influential to this day (Elgat, 2020). The respective section in Being and Time is titled “Anrufverstehen und Schuld” (Summons and Guilt), and it describes the summons (by conscience) to a more authentic way of life and the ontological guilt that inevitably grows from the impossibility of ultimately bridging the gap between realising all of our “ownmost” possibilities for relating to our existence. In Heidegger’s own words (original version):

Das Anrufen des Man-selbst bedeutet Aufrufen des eigensten Selbst zu seinem Seinkönnen und zwar als Dasein, das heißt besorgendes In-der-Welt-sein und Mitsein mit Anderen. (Heidegger, 1967, p. 280)

We will not try to provide a translation but rather to highlight some central points: “Anrufen des Man-selbst” means that an everyday person is called (by conscience) to actualise her/his innermost self (in the German original, “eigensten” is the superlative of “own”). This actualisation is not in some speculative cosmos but rather within the world and in the being with others.

Karl Jaspers (1932/1969) is more concerned with the ontic aspects of guilt (those related to life in the world) than with the ontological. He conceives guilt as one of the “boundary situations” that are characteristic for human life. Just by grasping life and its possibilities, humans restrict others. Even trying to do nothing doesn’t solve this problem because this too has consequences.

Ontological Guilt in Existential Psychotherapy

Yalom (1980) draws from the above passage by Heidegger and specifies what he calls “existential guilt” as the failure to live life as fully as possible. This feeling of guilt is of course uncomfortable, but it may be very constructive in helping people overcome this impasse and move in a direction that is more in line with the authentic self. Breitbart (2017, p. 510), in a more recent paper, summarises this basic idea in a clear way:

This responsibility to create a life involves creating a unique life (one only we could have lived – authentic to us), and to live this life to its fullest potential, thus creating a life of meaning, purpose, direction, growth, and transformation, and becoming valued members of a culture and the world with meaning. Most, if not all of us, fail at this impossible task. Falling short of this responsibility leads to what existentialists describe as existential guilt, the notion that I could have done more, and that I missed opportunities or failed in some ways.

Clinically, working with ontological guilt can be rewarding as well as challenging. As a rule, the more options patients have in their lives, the easier it is to mine therapeutic gold from the mine of ontological guilt – consider the lyrics by Bob Seger at the beginning of this paragraph: assuming that he is still at an age where he can change things, we might ask questions such as “what did you neglect during these last years” and will try to activate some of these things. Other life circumstances make working with ontological guilt more challenging: this is especially true in end-of-life care and terminal illness, where there are only limited options to change. Again, in Breitbart’s words (Breitbart, 2017, p. 511):

Ultimately, it comes down to the singular choice of forgiving yourself for being an imperfect, vulnerable human being. Forgiving yourself for merely being human—all too human.

One can see an interesting parallel here to Erikson’s eighth and last stage of psychosocial development – a successful completion of this stage is associated with “a sense of coherence and wholeness” (Erikson, 1982, p. 65), while the opposite is described as despair.

5 Regret

I’d rather be sorry for something I’ve done

Than for something that I did not do.

(Kris Kristofferson and Rita Coolidge)

After taking a close look at freedom, responsibility and (ontological) guilt, we have arrived at a potential everyday consequence of these: regret. As we have seen, to authentically realise all potential aspects of one’s personality is impossible, so life will very likely always contain regret over unlived potentials to a smaller or larger degree. Nevertheless, the amount of regret over this will vary greatly between people (and in individual people at different times of their lives). We will not explore regret in more detail at this point (see the next two chapters of this book) but rather want to stress the fact that expectations of people (and what they are supposed to do in a “successful” life) are shaped by the cultures they live in as well as their “authentic” self – one example is a study published by Orna Donath, an Israeli sociologist, on regret of women associated with raising children (Donath, 2015): while many western societies proclaim that raising children has to be highly rewarding (especially for women), some seem to feel different. Similarly, many people devote most of their time to pursuing money and job success – very often at a very high cost for other areas of life.

It should also be noted that societies (and in part commercial interests) shape expectations of what people think they should do during their lives (and, in this way, avoid regret): so-called bucket lists consisting of things people want to do or experience before “kicking the bucket”; some of these bucket list items tend to be commercially available (go skydiving), while very often, interpersonal aspects (like re-engaging in the relationship to an alienated family member) are much more important. Morgan Freeman and Jack Nicholson (in the movie with the same title) beautifully exemplify this shift from commercially available items to relevant personal ones.

6 Conclusions

This chapter has delved into the basic concepts of existential philosophy and existential psychotherapy. In a book titled Existential Concerns and Cognitive-Behavioural Procedures: An Integrative Approach to Mental Health, this might seem a bit out of place and far removed from CBT procedures. But we believe that the opposite is the case: dealing with these philosophical roots enables therapists to see the deeper aspects of seemingly irrational behaviour. For example, a student who enters therapy with a diagnosis of mild depression and who shows difficulty deciding on potential job offers can be understood in a “narrow” sense where we as therapists do the usual decisional balance and motivational stuff. Having the background of existential thinking may enable us to see some of the real depth of a seemingly simple decision. This becomes especially prominent when we meet clients who have taken (in retrospect) unwise decisions or who have tried to refrain from deciding. These more clinical aspects will be explored in the two following chapters by Ross Menzies: His first chapter deals with “Failed Potentialities, Regret and Their Link to Depression and Related Disorders” and shows direct links of these ways of reasoning to CBT constructs such as a ruminative response style and post-event rumination, while his second chapter deals with “Reframing the Past and the Treatment of Existential Guilt and Regret”.