Phenomenological Therapy: Centering Subjectivity

Phenomenological therapy aims to put us, clinicians and clients alike, in touch with what it means to be this human, not any other, in this context, with all its attendant nuances. Clinicians center our clients’ subjectivity and challenge our own sense of expertise. We approach the client with beginner’s mind and together explore the client’s way of being-in-the-world with an aim toward empowerment, resilience, integration, and well-being.

We start in the lifeworld, a term Edmund Husserl (the founder of phenomenology) coined to describe the everyday world of consciousness that encompasses thoughts, emotions, and embodied experiences. This is where immediate, subjective experience happens, and is the focus of phenomenological inquiry. The principle of intentionality holds that consciousness is not abstract, but always directed toward something: there is always context for a thought or an emotion. Framed this way, distress is not simply contained within the individual (which is how traditional psychiatry and psychology based on a premise of objectivity would have us understand it) but is a meaningful response to one’s lifeworld.

The phenomenological concepts of bracketing, reduction, intersubjectivity, and embodiment guide us on this journey.

Bracketing: Fewer assumptions, more curiosity

Bracketing (called the epoché) is the starting point to unpacking phenomena (experiences) in a client-centered way. We all start out walking through the world with a perspective that we take for granted, even though it is informed by sociocultural and interpersonal lenses. Husserl called this “the natural attitude.” Through bracketing, we use metacognition to see the way we are seeing and learn to see differently.

“Nonjudgmental” is a buzzword in the field. Rather than imagining we will suddenly be free of judgments because we can name our biases, we can use bracketing to navigate this complex terrain. This framework accounts for the fact that we are all subjective beings with conditioned beliefs. Stepping outside our subjectivity is not possible.

But we can learn to become aware of them as they arise in us. In order to not let those judgments fuel understanding, we see and name our preconceptions and hold them lightly—that is, maintaining awareness while using our own reflective capacities to hold multiple perspectives at once. This requires the ability to be nonshaming toward our own judgments as well as a willingness to be wrong.

For me, this means not starting with diagnosis, for two reasons. First, I don’t know a new client well enough to interpret their experiences in the framework of diagnosis. Second, what are diagnoses if not codified biases and preconceptions?

As many in the field do, I have strong concerns about the entire diagnostic framework. In my own work, I do not want to start with a label that purports to tell me about the experiences of my clients based on normalized data and in textbook terms. (Not to mention the problem of vast financial connections between the pharmaceutical industry and DSM-5 -TR authors.)

When a client describes their anxiety, for instance, the phenomenological therapist doesn’t reach for diagnostic criteria or treatment protocols. Instead, they ask: What do I believe about anxiety? What did school teach me about anxiety? What does the DSM say about anxiety? Does this match what my client is saying, or do they have a different experience?

When therapists lead with curiosity, not terminology, clients feel that they are being seen, not as statistics or cases, but for themselves. They are invited to share further about their distress without being labeled and thus subject to assumptions, which shuts down rather than invites further exploration.

Reduction: Getting to the essence of the thing

Bracketing is the first stage of phenomenological reduction. The “reduction proper” is the second. The goal is to understand the essence of our client’s experience. We do this partly through holding our judgments and preconceptions lightly, and then through probing into the client’s subjective experience without interpreting. The reduction is not an end goal of therapy, but a start.

Part of phenomenological work with clients is to peel away, layer by layer, cultural beliefs, social conditioning, cognitive interpretations, family narratives, and self-judgments to move toward deeper understanding of the thing itself: the emotion, physical sensation, thought, memory, or whatever else they’re showing up with. Rather than interpreting the statements they are making, clinicians invite more description. What we know is not important in this process; it is what the client knows that matters.

Let’s continue with the example of anxiety. How does this person know that they are anxious? How does it show up in their body, their thoughts, their relationships? What social conditions may be shaping the experience of this anxiety? How do other people respond to their anxiety?

The commonly recommended mainstream approach to anxiety, and many other so-called disorders, is cognitive-behavioral therapy (CBT). While phenomenological investigation involves moving toward the experience to uncover more truth, the CBT approach is more of a pushing away from the experience to force a different truth upon the client.

For instance, the American Psychological Association explains that CBT treatment includes “learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.” (emphasis added)

Who defines what a distortion in thinking is? The clinician. Whose reality is lit up, so to speak? The clinician’s. Whereas the phenomenological therapist says, please help me understand your thinking. Please explain your reality to me, so that I may join you there. This approach makes deep attunement, which is healing in and of itself, possible. Joining with the client in this way can provide a felt experience of nonjudgment, as the therapist is able to affirm the sense in the client’s experience. It also offers the client the opportunity for more self-awareness, which in turn supports self-esteem.

In approaching client experience not as symptoms needing elimination, but as meaningful in and of themselves, we can start to see how these expressions have helped the client or are natural responses to something that happened. Depathologizing and reframing can remove the burden of stigma clients may be carrying.

Description of this nature can also produce insight for clients. Maybe it is not anxiety at all, but a kind of excitement for the unknown. Or maybe it is anxiety not caused by a romantic relationship, but something at work that shares a quality with a personal dynamic. Most likely, this anxiety has a root in the past, when it was an adaptive response to something threatening. If we were to treat it with CBT (which focuses on the present), we might never learn about this.

Intersubjectivity: Sharing meaning

Intersubjectivity speaks to the way our experiences of the world are formed in relation with others. This principle of phenomenology emphasizes that we construct meaning and interpretation of the world through interacting and developing understanding with others, as opposed to accepting a single, objective truth that stands outside subjective experience. Intersubjectivity has at least two layers in therapeutic work.

First, in meaning-making and experiential therapies, such as existential or narrative practices, client and therapist work together to arrive at a shared understanding of client experience. The client contributes their first-person perceptions, bodily and emotional experiences, narratives, and interpretations. The therapist contributes learned knowledge about common human patterns, social dynamics, and internal states; their own first-person perceptions and experiences; and observations of the client. Each participant comes into the relationship with different information, and together they build a deeper and more nuanced picture of the client’s world. This process gives the client valuable insight into their internal landscape and social relationships. The “shared third perspective” constructed with the client provides witnessing and normalization, rather than denial and pathologization.

Second, intersubjectivity emphasizes the importance of relationality. Before procedural modalities and “evidence-based” protocols took center stage, it was understood that the therapist-client relationship was the healing. This is still true, as the Frontiers in Psychology study “The Strength of Alliance in Individual Psychotherapy and Patient’s Wellbeing” and a number of meta-analyses published in APA’s Division 29 Psychotherapy journal remind us. In the therapeutic relationship, clients are able to explore thematic relational patterns that have been causing distress. They practice new ways of relating. And perhaps most of all, they have the opportunity to heal relational wounds with a caring other who can witness and participate in that healing without their own agenda or burdens to heal.

For this process to happen, though, the clinician must place the client’s truth at the center of the journey. In A Different Existence: Principles of Phenomenological Psychopathology, J. H. van den Berg details the way a clinician might apply standard psychotherapeutic concepts—projection, conversion, transference, and memory distortion—to a patient.

He then notes: “It is remarkable how much these terms imply a negation. Projection denies the patient’s observations. Conversion denies the existence of the patient’s bodily sensations. Transference denies what the patient can find in others. Memory distortion denies what the patient remembers. The theory is really a four-fold denial of the patient’s reality.”

He concludes: “The mentally ill person is alone with his mental mechanisms … Loneliness is the central core of his illness, no matter what his illness may be.” This is precisely the opposite of what client-centered phenomenological therapy aims to do, which is to offer connection and a sense of being known.

Embodiment: The lived body

Maurice Merleau-Ponty, an influential phenomenologist of the twentieth century, distinguished the “lived body” that is an inherent part of the human experience from the traditional Cartesian understanding of the body as a complex biological machine reducible to its components. We encounter the world through our bodies: cognitive knowledge is often built on sensory input, and emotions are experienced in the body.

Because Western dualism treats the body as a biological object, traditional therapies have disregarded or downplayed the felt sense as a source of insight and site of healing. Fortunately, we now have multiple traditions of somatic therapy that center bodily knowing. However, attention to the lived body should not be relegated to that corner of the field.

Much of communication happens through the body, not the voice. Clients communicate with therapists nonverbally through changes in posture, hand and foot movement, eye position, breathing, and more—and therapists also communicate with clients this way. How much we would miss, then, if we didn’t track the body as closely as we track the thoughts. Using this attunement, we can sense what clients may be feeling that they are suppressing or afraid to say. And with the right rapport, naming such observations helps clients orient and relax into their feelings and beliefs.

What’s more, our bodies take in and respond to information happening around us faster than our cognition. Neuroception, the nervous system’s sensing of safety or danger in a specific environment, is one example of this. The body receives and holds a lot of information that is central to subjective experience. Interacting directly with the embodied felt sense can provide a more accurate reflection of the client’s truth than a cognitive interpretation. A cognitive statement may be based on what a client believes to be a right, acceptable, or likely answer to a question or problem. Direct description of bodily sensations, on the other hand, can lead to more authentic reflection of experience and emotion, which can then be made sense of through cognition.

Situating embodiment as a core tenet of therapy also invites an understanding of oppression. When we experience the world (and the world experiences us) through our bodies, the details of those bodies—race, size, ability, assigned sex, and so on—are highly relevant to how we experience mental distress or well-being. These particulars become central to the therapeutic experience instead of side notes, something the clinician ignores or waits for the client to bring up.

Standard cognitive-behavioral therapies don’t have a built-in way to center bodies, and by design guide clients toward normality. This is a problem in part because what is normal was defined by (almost all) white, cis, heterosexual, Judeo-Christian men. Most bodies are by definition excluded from “normal,” and thus are told to change or conform in order to improve well-being. The opposite is actually true: relieving distress comes when we name the subjugation that produces distress in the first place and embrace liberation, rather than conformity, as the goal.

How clients benefit from phenomenological therapy

Phenomenological therapy (which is closely connected to the existential tradition of psychotherapy) creates space for authentic expression, sometimes for the first time in a client’s life. When therapists skillfully bracket and seek to understand a specific phenomenon without agenda, clients feel witnessed and affirmed. Leading with curiosity rather than interpretation opens up space for clients to tell their own truth without feeling broken or like something is wrong with them.

This frees clients from the pathologizing narratives found both in the field and the sociocultural narrative around mental well-being. True depathologizing involves understanding that symptoms are always contextual, always directed toward something. From this lens, clients come to understand their expressions of distress as reasonable responses to stressful conditions. This reduces shame, guilt, and self-judgment.

More embodied attunement to one’s internal world leads to more-self awareness and insight, which can be invaluable for managing something like depression, panic, or traumatic triggering. Sensing early-stage bodily cues provides the opportunity to intervene in such cycles and develop greater resilience. Using the felt sense can also help clients uncover emotional truths that cognitive narratives mask. Working directly with the body offers a way to release emotional energy, including that which is built up over time in response to trauma or ongoing distress.

Phenomenological inquiry welcomes clients who don’t have mainstream white, Western narratives to bring the fullness of their stories into therapy. Rather than imposing a mainstream solution to fixing distress, this approach honors a full range of how clients make sense of mental happenings, healing approaches, and well-being. For instance, hearing voices carries different meanings in different cultures, and a depathologized approach to this phenomenon can mean the difference between integrated understanding of unusual experience and harm or abuse at the hands of the psychiatric system.

Phenomenological therapy takes longer than CBT and medication. It also offers sustainable change based on a foundation of new self-insight, embodied feeling, present-moment awareness, and resilience. Perhaps the most profound benefit is liberating clients from a system that labels normal and abnormal, inviting them to restore self-trust and learn what authentic being and action is for them.