Approaching mindful multicultural case formulation: Rogers, Yalom, and existential phenomenology

ABSTRACT

Narrow or restricted case formulation considerations can limit therapeutic effectiveness, limit the lived base of evidence guiding psychotherapy, and contribute to psychotherapist microaggressions. Notably, Person-Centered Therapy (PCT) and existential phenomenology have, in combination, actively maintained that the cultural landscapes or interconnected world horizons of historical, contextual, and sociocultural matters are inseparable from lived experience. In what can be understood as mindfulness perspectives in their own right, the non-judgmental and presence-centered emphases of PCT and existential phenomenology are suited for mindful and meditative attunement to socioculturally diverse clients. This article sets out to begin providing a basis for person-world centered case formulation themes that are mindfully and meditatively linked with a psychotherapist’s depthful ontological attunement and cultural or contextual pan-experiential attunement to clients. These interdependent forms of Humanistic Existential Psychotherapy (HEP) attunement can open onto multiculturally informed person-world centered themes that may contribute to experiential restructuring and sociocultural self-actualization. As a way to enhance HEP’s sociocultural sensitivity, existential givens, phenomenological themes, and multicultural worldview values are integratively re-visioned as Sociocultural Lifeworld Themes.

Des présentations de cas étroitement ou restrictivement réfléchies peuvent limiter l’efficacité thérapeutique, altérer la prise en compte de l’expérience vécue comme base de la thérapie et contribuer à des microagressions de la part du psychothérapeute. La Thérapie centrée sur la personne (TCP) et la phénoménologie existentielle ont soutenu activement ensemble l’idée que l’expérience vécue est inséparable des paysages culturels et des horizons mondiaux interconnectés dans leurs aspects historiques, contextuels et socioculturels. Dans ce que nous comprenons comme étant des perspectives pleinement conscientes à part entière, l’importance accordée par la TCP et la phénoménologie existentielle au non-jugement et à la présence sont les éléments appropriés d’un accordage méditatif et pleinement conscient avec des clients socioculturellement variés. Cet article se propose de commencer à fournir une base pour des thématiques de formulation de cas centrées sur le monde de la personne qui soient pleinement consciemment et méditativement reliées à l’accordage ontologique profond du thérapeute et à l’accordage culturel ou contextuel pan-expérientiel du client. Ces formes interdépendantes d’accordage en Psychothérapie Existentielle Humaniste (PEH) peuvent ouvrir le champ à des thématiques multiculturellement ancrées propres au monde du client et qui peuvent contribuer à une actualisation de soi socioculturellement et expérientiellement restructurante du client. Pour mettre en valeur la sensitivité socioculturelle de la PEH, les données existentielles, les thématiques phénoménologiques et les visions multiculturelles du monde sont intégrativement revisitées comme étant des thèmes socioculturels inhérents au monde vécu.

Las consideraciones de formulación de casos estrechas o restringidas, pueden limitar la efectividad terapéutica, limitar la base vivida de evidencia de la psicoterapia y contribuir a las micro agresiones del psicoterapeuta. En particular, la Terapia Centrada en la Persona (PCT) y la fenomenología existencial, en combinación, han mantenido activamente que los paisajes culturales o los horizontes mundiales interconectados de contextuales históricos, y socioculturales son inseparables de la experiencia vivida. En lo que puede entenderse como perspectivas de atención plena por derecho propio, los énfasis sin prejuicios y centrados en la presencia del PCT y la fenomenología existencial son adecuados para la sintonía consciente y meditativa con clientes socioculturalmente diversos. Este artículo se propone comenzar a proporcionar una base para los temas de formulación de casos centrados en el mundo de la persona que están vinculados de manera consciente y meditativamente ligados con la profunda sintonización ontológica de un psicoterapeuta y la sintonización cultural o contextual pan-experiencial para los clientes. Estas formas interdependientes de sintonización de psicoterapia existencial humanista (HEP) sintonizadas pueden abrirse a temas centrados en el mundo de personas multiculturalmente informdas que pueden contribuir a la reestructuración experiencial y la autorrealización sociocultural. Como una forma de mejorar la sensibilidad sociocultural de HEP, los conceptos existenciales, los temas fenomenológicos y los valores multiculturales de la cosmovisión se reven integrativamente como Temas Socioculturales del mundo de la Vida.

Las consideraciones de formulación de casos estrechas o restringidas, pueden limitar la efectividad terapéutica, limitar la base vivida de evidencia de la psicoterapia y contribuir a las micro agresiones del psicoterapeuta. En particular, la Terapia Centrada en la Persona (PCT) y la fenomenología existencial, en combinación, han mantenido activamente que los paisajes culturales o los horizontes mundiales interconectados de contextuales históricos, y socioculturales son inseparables de la experiencia vivida. En lo que puede entenderse como perspectivas de atención plena por derecho propio, los énfasis sin prejuicios y centrados en la presencia del PCT y la fenomenología existencial son adecuados para la sintonía consciente y meditativa con clientes socioculturalmente diversos. Este artículo se propone comenzar a proporcionar una base para los temas de formulación de casos centrados en el mundo de la persona que están vinculados de manera consciente y meditativamente ligados con la profunda sintonización ontológica de un psicoterapeuta y la sintonización cultural o contextual pan-experiencial para los clientes. Estas formas interdependientes de sintonización de psicoterapia existencial humanista (HEP) sintonizadas pueden abrirse a temas centrados en el mundo de personas multiculturalmente informdas que pueden contribuir a la reestructuración experiencial y la autorrealización sociocultural. Como una forma de mejorar la sensibilidad sociocultural de HEP, los conceptos existenciales, los temas fenomenológicos y los valores multiculturales de la cosmovisión se reven integrativamente como Temas Socioculturales del mundo de la Vida.

As considerações estritas ou restritivas na formulação de casos podem limitar a eficácia terapêutica e a vivência das evidências que orientam a psicoterapia e contribuir para microagressões do psicoterapeuta. É evidente como, quer a Terapia Centrada na Pessoa (TCP), quer a Fenomenologia Existencial defenderam ativamente que o panorama cultural ou os temas relacionados com os horizontes históricos, contextuais e socioculturais interligados dos indivíduos são inseparáveis da experiência vivida. Naquilo que pode ser entendido como perspetivas de mindfulness de pleno direito, os focos da TCP e da Fenomenologia Existencial – atitude de não fazer juízos de valor e conceito de presença – são adequados à sintonização mindful e meditativa de clientes de meios socioculturais muito distintos. Este artigo destina-se a fornecer uma base para a formulação de casos no mundo centrado na pessoa que se encontre ligada, de forma mindful e meditativa, a uma sintonização profunda e ontológica do psicoterapeuta e a uma sintonização cultural ou pluri-experiencial e contextual dos clientes. Estas formas interdependentes de sintonização pela Psicoterapia Existencial Humanista (PEH) podem dar abertura a temas de inspiração multicultural do mundo centrado na pessoa, os quais podem contribuir para uma reestruturação experiencial e para uma auto-atualização sociocultural. Os pressupostos existenciais, temas fenomenológicos e valores multiculturais de perspetiva do mundo são colocados em perspetiva novamente e de forma integrada, na sua qualidade de Temas Socioculturais de Perspetiva do Mundo, como forma de ativar a sensibilidade sociocultural da PEH.

KEYWORDS:

• Experiential restructuring
• mindfulness meditation
• sociocultural self-actualization
• ontological attunement
• pan-experiential attunement

[C]an we be of significant help in improving

relationships between minority groups – blacks

[sic], Chicanos, Indians, women – and the

so-called Establishment?

   Carl Rogers

   A Way of Being, (p. 243)

Empiricist constructions … hide from us in the

first place ‘the cultural world’ or ‘human world’

in which nevertheless almost our whole life is led.

   Maurice Merleau-Ponty

   The Phenomenology of Perception, (p. 23)

As the contemporary voices of protest opposing racial, gendered, and socially charged violence, inequality, and inequity in the U.S. grow, the Western and Humanistic Existential Psychotherapy’s (HEP) aspiration to begin developing and integrating a multicultural approach that addresses mindful and meditatively grounded case formulation remains vital (Felder & Robbins, 2016; Masuda, 2014). Attending to the impacts of discrimination and race-based stressors is an important part of multiculturally attuned psychotherapy (Comas-Díaz et al., 2019; Lago, 2011). In practice, narrow or restricted case formulation considerations can limit therapeutic effectiveness, limit the lived base of evidence guiding psychotherapy, and contribute to psychotherapist microaggressions (Sue, 2010, 2015). Moreover, socioculturally adapted psychotherapies are more effective than non-adapted approaches when aligned with a client’s cultural perspectives (Benish et al., 2011; Wamplold, 2015). Notably, Person-Centered Therapy (PCT) and existential phenomenology have, in combination, maintained that the cultural landscapes or interconnected world horizons of context and culture are inseparable from lived experience. From a non-Eastern perspective, the non-judgmental and presence-centered¹ emphases of PCT and existential phenomenology can be viewed as inherently suited for mindful meditative attunement to socioculturally diverse clients (Felder & Robbins, 2016).

Awakening from the forgetfulness of sociocultural being

This article sets out to sketch a preliminary basis for person-world centered case formulation themes that can reawaken lost perceptions of culture and context. These case formulation themes are collaboratively linked with a psychotherapist’s depthful ontological² attunement to client being, as well as to a breadthful pan-experiential³ attunement to a client’s being in the world. These person-world centered themes and forms of mindful meditative attunement are socioculturally informed by HEP’s experience-near and culture-near or context-near orientations. They are also contemplatively informed by the integrated and sensually intelligent human body.

As part of an embodied person-world dialogue, HEP’s contemplative⁴ hermeneutic approach to worlded understanding shares an affinity with the Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality 2017 (APA, 2017) (hereafter referred to as Multicultural Guidelines) focus on microlevel and macrolevel contexts that interact with sociocultural identities. Namely, various HEP approaches have included emphasis on a circular movement of understanding that fluidly moves from part to whole, depth to breadth, and lived experience to culturally situated experience.

To begin, this article will introduce preliminary HEP mindfulness and multicultural case formulation process considerations before integrating existential givens and phenomenological themes with multicultural themes.

Contemplative attunement

Mindfulness and Carl Rogers

Felder et al. (2014, 2016) and others (Jooste et al., 2015) have detailed how an HEP psychotherapist’s mindful presence to the flow of client experience is made possible by three of Rogers (1957) six therapeutic conditions: unconditional positive regard (acceptance, nonjudgmentalism), empathy (experiential attunement), and genuineness (congruence, presence). These relationally communicated conditions of therapy overlap with Kabat-Zinn’s (2005) characterization of mindfulness as ‘moment-to-moment, non-judgmental awareness’ (p. 24).

Although Rogers (1980) wrote about and acknowledged an interest in Eastern teachings, the mindfulness-based practitioner, Lumpkin (2014) notes that ‘[w]hen reading [Rogers] today, it is clear that he was writing from the perspectives and values of mindfulness before it was coined as a term’ (p. 148). To be sure, PCT includes the psychotherapist’s attentiveness to mindfully and congruently communicating nonjudgmental, empathic, and here-and-now attunement to clients. For example, Rogers (1959/1989a) suggested that a PCT psychotherapist attends to ‘being immediately present to his [sic] client relying on his moment-to-moment felt experience in the relationship’ (p. 10). Rogers furthermore underscored the importance of perceiving ‘as sensitively and accurately as possible all of the perceptual field as it is being experienced by the client’ (Rogers, 1951, p. 34). Moreover, Tudor (2011) reminds us that the PCT psychotherapist’s communication of empathic understanding to a client can be collaboratively renegotiated based on ‘how the client experiences and perceives the therapist’ (p. 170).

Mindfulness and phenomenology

‘Mindfulness can be viewed as inherently phenomenological, in part because of its emphasis on nonjudgmental presence to the phenomenon of experience’ (Felder & Robbins, 2016, p. 116). Specifically, phenomenological mindfulness is informed by Husserl’s (1913/1998) bracketing (epoché) of biases or judgments so that the present moment immediacy of the things themselves can be experienced in the stream of ‘pure’ awareness (Brown & Cordon, 2009: Felder et al., 2014; Felder & Robbins, 2016; Hanna et al., 2017; Husserl, 1913/1998). From the perspective of Martin Heidegger, a ‘mindfulness of being’ (Yalom, 1980, p. 31) occurs through a noninterfering phenomenological effort ‘to let that which shows itself be seen from itself in the very way in which it shows itself from itself’ (Adams, 1995; Heidegger, 1927/1962, p. 58). This mindfulness of being’s spontaneous unfolding can also be followed by a meditative hermeneutic disclosure of situated being and its meanings (Felder et al., 2014; Felder & Robbins, 2016; Heidegger, 1959/1966; Nanda, 2010). From a third phenomenological perspective, Merleau-Ponty (1945/1962, 1964/1968) placed emphasis on the direct and nonjudgmental perceptions that range across the body’s world-bound senses (Felder et al., 2014; Felder & Robbins, 2016). Moreover, Merleau-Ponty (1945/1962) held that ‘judging is not perceiving’ (p. 34), nor is it ‘analytic reflection’ (p. 33). Rather, for Merleau-Ponty, both of these cognitive mind-sets substitute logical explanations and conclusions for ‘authentic reflection’⁵ (p. 33) that is attuned to the immediacy of bodily senses and emotions.

In keeping with these core phenomenological thinkers, an HEP psychotherapist’s mindful attentiveness to bare lived experience and senses can be combined with meditative reflection on related lifeworld (Lebenswelt) contexts and meanings. By recognizing that natural attitude biases or natural enculturated attitudes can inform or impede the direct experience of ‘self’ and other, an HEP psychotherapist’s attunement to diverse clients can be safeguarded.

Mindfulness meditation in practice

HEP’s revelatory case formulation mosaic rests in ontological and pan-experiential attunement to depth and breadth – to the feeling-toned depths of lived being and to the experiences that index the breadth of lifeworld contexts.

Ontological attunement

A contemplative HEP approach provides space for clients to experience increased synchrony with lived experience and its depths. It also encompasses a psychotherapist’s immersion in ontological attunement to each client’s connection to the felt flow of being. Mindful ontological attunement attends to a client’s bodily or mooded way of being; whether or not the client is in dim or depthful moment-to-moment connection with the past, present, or future. This can include attunement to a client’s self-world style of reflection (e.g., high context or low context) and to that client’s capacity for sustaining watchful awareness of lifeworld experiences, emotions, and ‘internal’ dialogue. In an anonymized example, a non-Western engineer whose cultural values had been informed by Eastern traditions was able to reflectively realize that the troubling use of anger as an all-purpose emotion signified a tendency to view emotions through the lens of rationalized thinking. As an act of reclaiming cultural values and insight, this client exclaimed: ‘The brain is the secondary organ for meditation!’ As such, this example illustrates how ontological attunement allows a psychotherapist and client to identify a client’s style of somatic, emotional, or abstracted attunement to being.

Pan-experiential attunement

HEP case formulation is also characteristically infused with a psychotherapist’s pan-experiential attunement or generative ‘panoramic’ receptivity to a client’s cultural, historical, and lived of context experiences and meanings as they relate to her, him, or them⁶ as a ‘sociocultural-being-in-the-world’ (Felder & Robbins, 2016, p. 106). Rather than presume that clients are enclosed in minds, HEP’s breadth perspective acknowledges that clients are engaged with the world in the form of co-being or being-with people, places, and things – even a client’s psychotherapist. Pan-experiential attunement thus attends to how clients embody openness and constriction to being in the world – that is, to being whole or to being in felt meaningful relationship with living things, people, and various life contexts. By striving for wholeness, a personal or spiritual crisis of meaning may be avoided. ‘Put differently, meaning is understood and informed by the social and cultural contexts (e.g., racialized politics, local norms, religion, myth, language, art) in which, or upon which, one’s experiences are situated. Experientially speaking, human being is part of a larger meaning-ful whole’ (Felder & Robbins, 2016, p. 112).

By way of a disguised case example, an undocumented Mexican client struggled after having been banished from a tightly structured religious sect. As the psychotherapist and client depthfully (ontologically) attuned to her way of being in relation to vaguely felt fears and trauma concerning the broader (pan experiential) contexts of religious shunning and deportation possibilities, she began to recognize the combined influences of culturally sanctioned gender conformity, shunning by the religious community and feared abandonment by God and country. In doing so, she subsequently exhibited heightened resolve to seek a meaningful life by overcoming self-limiting anxieties.

Do all clients enact mindful self-world reflection?

HEP fosters a mindful psychotherapy relationship that respects a client’s unreadiness or enculturated preference not to connect with the raw and sometimes stormy waters of lived experience. An HEP psychotherapist therefore mindfully respects a client’s enactment of cultural coping styles with the understanding that these styles may sometimes be ‘culture-syntonic’ (Felder & Robbins, 2011, p. 366) or ‘culture-dystonic’ (p. 366). This can occur, for example, with multiracial clients or with clients navigating conflicting values associated with intersectional identities.

From a culture syntonic perspective, discursive thinking (e.g., judgmental, analytical, generalized, or third-person ways of talking about self) may alternatively exemplify a client’s congruent enactment of cultural values and reflective styles. This suggests that a client’s style of reflection and presence can be influenced by cultural value dimensions that may include doing/being, high context/low context, individualist/collectivist, emotional expression/suppression, power distance, or relations to the world (Hall, 1976; Hofstede, 2011; Kluckhohn & Strodtbeck, 1961; Triandis, 2000). Regardless of a client’s motivations for enacting discursive thinking, a socioculturally attuned psychotherapist would nevertheless seek to comprehend and reflect back a client’s personally and socioculturally informed styles of expression or self-world reflection in ways that the client can feel perceived, understood, and affirmed.

McMindfulness or being wide awake

Recent critiques of mindfulness suggest that a ‘’fast-food-style’’ (Stanley, 2019, p. 110) McMindfulness has emerged in the form of commercialized and politicized Buddhism that removes social, racial, and economic contexts of suffering from consideration (Purser, 2019). From our perspective, however, the contemplative HEP psychotherapy relationship openheartedly attends to in-depth and breadthful frames of reference (Felder & Robbins, 2011, 2016). In doing so, client distress and trauma can be discerningly linked to cultural-historical, economic, homophobic, misogynistic, racialized, or transphobic contexts in need of social transformation.

Culture: its relevance and meaning

Practitioners of Westernized psychotherapy values can sometimes overlook the distinctively different sociocultural realities and life experiences of clients. As such, psychotherapist’s taken-for-granted beliefs and values can be misattuned, insensitive, injurious, or cause therapeutic harm to socioculturally diverse clients (Helms, 1984; Sue, 2015; Wendt et al., 2015). Unfortunately, it is non-majority clients and women who may already endure ‘microaggressions’ (APA, 2017, p. 167), implicit biases, institutionalized discrimination, and traumas of living difference and gender outside of psychotherapy. Consequently, it is important to know that culture-bound experiences and worldviews are part of the meaning-making process (Wong, 2010).

Herein, culture is to be understood as ‘a shared pattern of beliefs, attitudes, norms, role perceptions, and values’ (Triandis, 2002, p. 3) that varies within groups and also evolves through transactions with diverse others. Race is viewed as a sociopolitical construction without biological basis that may sometimes be conjoined with racialized hierarchies of (de)valuation. From the U.S. Census Bureau (2018) perspective, its racial category assignments ‘reflect a social definition of race recognized in this country and not an attempt to define race biologically, anthropologically, or genetically.’

Carl Rogers and culture

Misunderstandings of PCT tend to narrowly emphasize PCT’s focus on a client’s individualistic frame of reference. These misunderstandings include ‘criticisms of Western psychology in general and [PCT] in particular as being individualistic’ (Singh & Tudor, 1997, p. 32). As a counterbalance, the following sections will instead illustrate how Rogers’ work quite explicitly acknowledged the broader person-world centered contexts of multicultural issues (Felder & Robbins, 2016).

Sociocultural allies

In one of the epigraphs that introduce this article, Rogers (1980) openly espoused social justice-themed beliefs that psychotherapists are equipped to address impactful multicultural matters. Rogers added, ‘We, as psychologists have available many of the skills for facilitating communication and problem-solving procedures between these often bitter and alienated groups and the culture which has mistreated them’ (p. 243). Additionally, Rogers ardently challenged practitioners to risk ‘being a significant social factor’ (p. 257) and build communities among divided cultural and racial groups, not just foster self-actualization.

By extension, we submit that Rogers’ later body of work concerning cultural and international conflict dialogue may prioritize ‘sociocultural community actualization’ (Felder & Robbins, 2016, p. 110), a ‘therapeutics of culture’ (Felder & Robbins, 2011, p. 372), ‘sociotherapy’ (Schmid, 2015, p. 221) and a Multicultural Guidelines (n.d.) emphasis on ‘justice [and] human rights’ (p. 45) in an effort to transform societies and cultures. Similarly, Proctor (2011), supports political advocacy for sociocultural groups with limited access to power. Proctor also promotes allyship for non-normative individuals. In her words, ‘[T]he person – centered approach can be a useful ally against grouping, with its phenomenological philosophy emphasizing the uniqueness of each individual’ (p. 232).

Rogers and May: actualizing what?

At the individual level, Rogers also discussed the relevance of culture (Felder & Robbins, 2016). For instance, Rogers’ (1961/1989b) perspective on the ‘fully functioning person’ (p. 409) and the ‘good life’ (p. 413) emphasized the importance of a person balancing self-actualization with the need to ‘live constructively with his [sic] culture as a balanced satisfaction of needs demand’ (p. 418). Here, Rogers expanded the understanding of self-actualization to include a sociocultural self-actualization of efforts to relationally bring cultural values, beliefs, and practices into being.

In another example of culture’s relevance, Rogers disagreed with May’s (1982) assertion concerning the preexistence of destructive ‘daimonic urge’ (p. 11) possibilities. In contrast to May, Rogers located enactments of destructiveness, and even evil, within the co-constructed context of ‘cultural influences’ (Rogers, 1982a, p. 8), ‘social conditioning and voluntary choice’ (Rogers, 1982b, p. 87). For example, Rogers held that a disenfranchised person’s ‘tendency [emphasis added] toward self-actualization’ (p. 86), such as criminal behavior, might occur because of limited socioeconomic opportunities or choices informed by developmental contexts. Twenty years earlier, however, Rogers acknowledged that non-environmental forces can also impede the growth tendency. In what can be viewed as partial convergence with May’s positing of the daimonic urge, Rogers (1951) strikingly acknowledged the existence of ‘internal’ tensions: ‘The forces which make for growth tend to overbalance the regressive and self-destructive forces [emphasis added], but not by some large margin’ (p. 122). Thus, for Rogers, the organism’s tendency toward optimal growth and actualization does not exist in vacuo. It may also coexist with growth-impeding or destructive ‘internal’ dynamisms.

In any case, Colin Lago (2011) maintains that a psychotherapist’s acceptance and ‘identity recognition’ (p. 244) of diverse clients can serve as an extension of Rogers’ unconditional positive regard. Furthermore, the American Psychological Association (APA) (2009) Task Force on Appropriate Therapeutic Responses to Sexual Orientation ‘suggest[s] client-centered, multiculturally competent approaches’ (p. 86) are effective.

Existential phenomenology and culture

As a precursor to HEP’s breadthful sociocultural and racial responsiveness, Boss’ (1971/1979) distinctive phenomenological psychotherapy approach, known as Daseinsanalysis, characterized human beings as a ‘world-spanning openness’ (p. 134). Boss viewed a person’s capacity for being-here as bound up with the world context of social reality or 'the “there“ of beings that reveal themselves' (p. 105). As such, Boss acknowledged ‘the great abundance of contexts and meaning and reference inherent in things that make up the comprehensible human world’ (p. 152). Similarly, contemporary existential and phenomenological writers and practitioners have affirmed the interconnection between world spanning-contexts and lived awareness.

To be sure, Schneider’s (2013) existential humanistic approach acknowledges how the awareness of awe concerning the wonder and mystery of existence can counter dichotomous cultural doctrines and forms of bigotry rooted in a polarized mind. Spinelli’s (2005) existential analysis recognizes how existential phenomenology stands in contrast to Western culture’s individualistic orientation or ‘self-focused way of being and relating’ (p. 184). Walsh’s (2008) phenomenological perspective addresses how the empathy of mindful reflection is hermeneutically linked to broader life contexts. Van Deurzen’s (2007) existential therapy maintains the importance of attending to the Mitwelt or one’s social position and relationship with the public world. More generally, Felder and Robbins (2016) have previously discussed how core phenomenological writers have highlighted that the world pole of existence through their references to Dasein (t/here being) (Heidegger, 1927/1962), being in the world (Heidegger, 1927/1962; Merleau-Ponty, 1945/1962), and the ‘life-world (Lebenswelt)’ (Husserl, 1954/1970); each of which serves as culture’s pervasive meaning giving backdrop to experience.

Following each of the perspectives described above, a presence-centered psychotherapist would seek to openly inhabit the full perceptual field of client suffering through nonjudgmental listening and sensing in experience-near, culture-near, or context-near ways. Furthermore, the nonjudgmentalism of contemplative HEP psychotherapy allows for kindhearted and attuned empathy (Heidegger, 1927/1962; Rogers, 1975), care (Heidegger, 1927/1962; Rogers, 1980), and love (Charura & Lago, 2018; Robbins, 2015; Rogers, 1951).

Introducing sociocultural themes

Psychotherapists aspire to cultural competence by contemplatively acknowledging their own cultural biases while also seeking to understand each client’s culturally informed experiences and worldviews (American Psychological Association [APA], 2017). In this way, HEP case formulation themes arise out of a co-evolving attunement process that can open onto experiential restructuring. An HEP psychotherapist’s collaborative mindful meditative attunement and listening contribute to a client’s expansive and experiential restructuring of identity and lived experience. These are important ‘mechanisms’ of client change or transformation. Without them, the internalization of debilitating perceptions of ‘self’ and other can malignantly persist and ultimately substitute for being present, being whole, and being mindfully and reflectively engaged with experience.

Existential and sociocultural lifeworld perspectives

Not unlike Buddhism’s concern with suffering (Amore & Ching, 1996), Yalom’s (1980) poignant existential givens⁷ of freedom, death, meaninglessness, and existential isolation also address issues of suffering. Although some may view these valuable existential givens as comprised of Western, non-theistic, or scientific worldviews (Karasu, 2002), Yalom and Leszcz (2005) inclusively maintain, ‘It is imperative that therapists learn as much as possible about their clients’ cultures as well as their attachment to or alienation from their culture’ (p. 8). The multicultural openness espoused by Yalom and Leszcz encourages consideration of diverse cultural worldviews and where clients locate themselves. From the existential-humanistic perspective of Hoffman (2013), it is valuable to ‘move toward a more inclusive existential psychology that accepts and embraces different ways of understanding and being existential.’

Comparatively, Boss’ (1971/1979) has described a number of pliable phenomenological characteristics of human existence: spatiality (lived space), temporality (lived time), human bodyhood (expressive bodily being), coexistence (lived relationality), attunement to existence (mooded attunement), memory based in historicity (historical existence), and death (mortality). Boss’ characteristics of human existence accommodate experience-near aspects of being that can exceed fixed medical and natural science categories of human experience. As we will see, a client’s lived existential characteristics or themes may sometimes be intertwined with context- or culture-near values and worldview orientations. As such, the integration of sociocultural diversity perspectives with Boss’ and Yalom’s existential themes can give rise to Sociocultural Lifeworld Themes (SLTs) or person-world perspectives inclusive of sociocultural worldview considerations. An HEP psychotherapist’s attentiveness to these inceptual SLTs can serve as a response to Merleau-Ponty (1960/1964) challenge: ‘If Western thought is what it claims to be, it must prove it by understanding all “life-worlds”’ (p. 138).

By way of clarification, SLTs can be described as a person’s constellation of lived meanings informed by an assemblage⁸ of personal, sociocultural, and context-dependent values and norms. A client’s unique in-the-moment awareness of diverse experiences may at times exceed the reach and grasp of SLTs. Consequently, a psychotherapist’s measure of awe and respectful attunement to unique client experiences allows for letting-go of less relevant existential and sociocultural themes or hermeneutically enriching such thematic perspectives.

Sketching existential and lifeworld themes

The following sketch of SLTs serves as a preliminary integration of sociocultural values with Boss’ characteristics of human existence and Yalom’s existential givens. Accordingly, a number of the cultural values and attitude dimensions described by the cross-cultural pioneer, Triandis (2000) and others will be considered. In practice, the clinical utility of considering themes described by Boss, Yalom, Triandis, and others is meant to derive from a contemplative and collaborative attunement and re-attunement process between psychotherapist and client, not an analysis of their theoretical underpinnings.

Cultural themes

Triandis recognized that a ‘cultural distance’ (p. 145) between people and cultures can occur, in part because of differences in cultural values, worldviews, cosmologies, identities, and practices. In order to understand worldview similarities and differences, Triandis identified nine value patterns that make up a macro-culture’s overarching system of meaning: complexity, tightness, individualism, and collectivism, vertical and horizontal cultures, active-passive cultures, universalism-particularism, diffuse-specific, instrumental-expressive, and emotional expression, or suppression.⁹

Apart from Triandis’ value theme patterns, many other cultural value dimensions can be considered. For example, the societal distribution of gender values and the unequal power distribution reflected in power distance (Hofstede, 2011) may sometimes be relevant. Human nature orientations (e.g., good, evil, mixed), time orientations, and activity orientations (e.g., doing, being, becoming) (Kluckhohn & Strodtbeck, 1961) can also be considered. Though it is beyond the scope of this preparatory article to provide an exhaustive account of cultural value patterns, an ongoing effort to understand and supplement emerging values and cultures will eventually be necessary.

Yalom’s existential themes

In this next section, Yalom’s previously described existential givens are placed in a dialogue with culturally diverse worldview values.

Meaninglessness

Yalom suggests that the individual’s creation of meaningful existence can be vitalizing when such meaning is realized against the backdrop of a universe that does not possess inherent meaningfulness. By contrast, the decision to endorse absolute conclusions may vary across cultures, even on ultimate questions concerning the meaningfulness or meaninglessness of life. For example, Hofstede (2011) asserts that different cultures may vary in the degree to which they engage in ‘uncertainty avoidance’ (p. 10). As a result, adoption of certain truths about the meaning of existence can be influenced by societal or religious choices and beliefs in areas where other societal and cultural values allow for ambiguity and uncertainty. Thus, one culture’s engagement with uncertainty may contrast with another culture’s orientation toward certain truths and definitive codes of conduct. In this light, individualistic or collectivistic cultures may encourage or discourage people from independently defining meaning.

Freedom

In a universe without inherent structure, the individual is ‘doomed to freedom’ (Yalom, 1980, p. 220) and ultimately responsible for life choices according to Yalom. In some cultures, however, the individualist emphasis on freedom and responsibility may not always apply. Since some cultures adopt a collectivistic value set rather than an individualistic value set, it can be the case that collectivist cultures instead privilege collective responsibility and being-for-others over emphasis on personal responsibility and being-for-self. Similarly, Hofstede’s description of power distance suggests that a societal distribution of power may influence the expectation of how much power and freedom is granted to people of different genders, age groupings, and status groups. Here a psychotherapist may consider the extent to which a client’s free choice is supported by institutionalized beliefs and practices.

Finally, Kluckholn and Strodtbeck remind us that one person’s cultural emphasis on embracing the flow of ‘being’ may contrast with another person’s cultural emphasis on ‘doing,’ or rather, pursuing accomplishments and preferred vocations.

Existential isolation

Although individuals live in an everyday world with numerous possibilities for establishing interpersonal connections, for Yalom (1980), there is a fundamental separation between self and others that exists as an ‘unbridgeable gulf between oneself and any other being’ (p. 355). Here, a culture’s embodiment of collectivist or individualist values, as well as instrumental or expressive values can contribute to fundamental beliefs concerning isolation and interconnectedness.

Death

Yalom reminds us that death (p. 30) is not only relevant during the final moment of one’s life. He also asserts that the awareness of death and mortality is unmatched in its capacity to generatively shake one out of tranquil everyday awareness into a mindfulness of being. It can also stir anxieties that motivate one’s defenses against acknowledging death and finitude.

It must of course be said that different religions have varied perspectives concerning the afterlife (Samovar et al., 2017). Indeed, dominant religions and their fundamental tenets may be woven into the fabric of a national culture’s worldview assumptions. These worldviews can influence how an individual engages with or avoids confrontations with afterlife perspective that include eternal life, transcendence of life and death, or the finality of death (Robbins, 2018). For example, Hofstede’s (2011) description of a culture’s “Long-term versus Short-Term Orientation” (p. 13) may contribute to whether or not one believes that significant life events take place in the present, the past, or will most likely occur in the future. It can also be said that people may hold different perspectives on the significance of life and death if they are from armed-conflict regions or have limited access to health care.

Boss’ lifeworld themes

In the following section, Boss’ characteristics of human existence are described and adapted to acknowledge sociocultural value dimensions:

Living space

On an individual level for Boss, spatiality does not strictly reference the mathematical and geometric measurements of space between people. It refers to the lived feeling of being close or distant with people in one’s social world. This kind of spatiality accounts for the degree to which one makes room for interpersonal connection. It thus reflects one’s connection to the world of things and others.

For Triandis (2000), ‘cultural distance’ (p. 145) between people may structurally exist or expand when, for instance, people differ in their religious beliefs, speak different languages, occupy different status levels on a vertical culture hierarchy, or differ in individualistic or collectivistic cultural values. In addition, someone who culturally adheres to personalized and expressive relationship values may experience felt distance and disconnection with another person whose cultural values are weighted toward instrumental or means-ends relationships. Miscommunication and conflict may follow. From our perspective, the existential backdrop of zeitgeist tensions for gendered, sociocultural, religious, and racial stressors can also contribute to experienced distance or closeness.

Living time

Mechanical clock time is characterized by the persistent succession of new now-points that arrive in the orderly march of present moments that disappear into the past. For Boss, however, lived time is characterized by the variety of unique ways people dwell in the temporal moments of past, present, and future. For example, one may connect with past, present, and future moments in unique non-linear combinations (e.g., anticipating the past repeating itself in the future). Alternatively, one may find oneself preoccupied with a specific dimension of time (e.g., past regrets, death in the future). Consequently, one’s varied presence to the broad spectrum of time can contribute to lived time feeling fluid/frozen, limited/plentiful, slow/fast, or empty/fulfilling.

From a cultural value perspective, Kluckhohn and Strodtbeck (1961) caution against the view that ‘folk peoples have no time sense and no need of one, whereas urbanized and industrialized people must have one’ (p. 13). Rather, a society’s preferential emphasis on the past, present or future can vary. For Kluckhohn and Strodtbeck, the North American focus on a better future may contrast with a Hispanic culture focus on present time, in part because the future is uncertain. In addition, Kluckhohn and Strodtbeck suggest that a Chinese cultural emphasis on the past, on traditions, and on ancestor worship may exist because ‘nothing new ever happened in the Present or ever would happen in the Future’ (p. 14). We might also suggest that the persistence of past and present injustices and inequalities can also influence one’s expectations of the future.

Living embodiment

The human body exists as something more than an anatomical object of the natural sciences. As a lived human body, Boss emphasizes its existence as a living body that openly perceives its relationship to people and things inhabiting its world. As a signifying body for Boss, it is also an expressive body that is able to verbally or non-verbally engage in ‘bodying forth’ (Boss, 1971/1979, p. 102) meanings, ways of being, and relational orientations to what is encountered.

From a sociocultural perspective, the way in which bodies are valued in terms of size, shape, gender, sexual orientation, age, and racialized categories vary across societies and cultures. Thus, how human bodies perceive self, other, and what different bodies may do or say is informed by sociocultural value contexts. From Triandis’ emotional expression-suppression value perspective, standards around emotional freedom influence what feelings may be experienced or expressed. From Hofstede's masculinity-femininity dimension perspective, allowances for assertiveness and modesty (e.g., verbal, sexual) may be societally prescribed. In vertical cultures that emphasize wide power distances between people, the opportunities for authenticity and presence may be limited. Since tight cultures prescribe numerous defined rules and norms, opportunities for behavioral freedom may also be limited. The tightness of normative rules may also constrain freedom of expression among different ages, races, sexual orientations, (trans)gender identities, and religions.

Living coexistence

Instead of viewing human existence as consisting of self-contained individuals or subjects, Boss characterizes human coexistence as a state of ‘primary togetherness’ (Boss, 1971/1979, p. 109) in a shared community or world. Human beings, for Boss, are relational beings that can bridge connection through language and expression, whether as existents serving means-ends purposes or as beings emotionally connecting with others. Consequently, sociocultural values can influence how togetherness is lived.

Similarly, in a collectivist culture, one may be expected to embody and conform to a cultural ideal of selflessness for the sake of social harmony. In contrast, individualistic cultures allow for the separate realization and actualization of unique personal needs, desires, and values. The felt quality of collectivist and individualist relationships can however be influenced by one’s value allegiances concerning instrumental–expressive relations. Instrumentally sanctioned relations, for instance, contribute to functional or means-ends relationships whereas expressive relations may prioritize felt connection and closeness. At the same time, tendencies to view human nature through the lens of good and evil categories described by Kluckhohn and Stodtbeck can influence whether sociocultural groups coexist in relational integration or isolated segregation. Finally, the doing and being continuum of cultural values may influence whether people are appreciated for their qualities of being and personhood or potentially viewed as superior or inferior based on cultural measures of what people ‘should’ accomplish or do.

Living emotional attunement

‘Because human existence is by nature an open and clear realm of understanding, it is inherently attuned in some way or other’ (Boss, 1971/1979, p. 109). For Boss, one’s moods and emotional states clarify and color the meanings of one’s perceptions. One’s ongoing melody of felt attunement to the experiential flow of everyday existence reflects ‘the particular breadth or narrowness, brightness or obscurity of that existence’ (Boss, 1971/1979, p. 110). A person’s emotions of love, hate, joy, and anger can thus open or limit perception depending on how serenely emotions and their lifeworld referents are experienced.

From a person-world dialogue perspective, sociocultural values influence how people attune to their body, their world, and to others. The majority of sociocultural values already described in this article may actively participate in co-constructing a person’s flow of attunement. For example, sociocultural values emphasizing instrumentality, verticality, tightness, doing, and specified responses emphasize pre-structured attunement and response styles. In contrast, passive, expressive, emotional, diffuse, and particular values allow for individualized responses to their world.

Discussion: contemplativeness and sociocultural being in the world

This article’s preliminary sketch of contemplative and multicultural case formulation processes and themes outlined how person-world centered depth (ontological) and breadth (pan experiential) attunements to clients can sensitively open the door for exploring human being and sociocultural-being-in-the-world. In this light, it was suggested that possibilities for sociocultural self-actualization and attuned experiential restructuring may be realized by clients. In the final stanza of this article, multiculturally adapted existential and SLTs were combined in a manner that considered how different ways of being and being with others may be informed by cultural values.

With respect to limitations and future consideration, it will be important for SLT narratives to receptively integrate new and emerging cultural values. One overlooked example can include attentiveness to how electronic communication and emerging technologies impact the formation of identities and cultures. From a broader contextual perspective, it is suggested that a psychotherapist’s inclusive recognition of macrolevel sociocultural worldviews can illuminate the dynamic interactions between microvalue dimensions described in this article and broader macrocultural worldviews.

Although Eastern nondualistic mindfulness meditation perspectives may place emphasis on overcoming identification with a fixed sense of ‘self,’ HEP psychotherapists nevertheless begin the process by meeting clients where they are. In doing so, an HEP psychotherapist’s shared attunement to erosive dehumanization in the form of ‘oppressive constructions of self’ (Vereen et al., 2017, p. 80) and ‘wounding through racialization’ (Lemberger-Truelove, 2016, p. 59) can prevent the pain of lived debasements from becoming added suffering – a suffering that can be mitigated by a psychotherapist’s unrestricted presence to sociocultural and race-based identity experiences.

Consent

Client case material has been anonymized.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Andrew J. Felder

Andrew J. Felder, Ph.D. is the former Clinical Director for the Los Angeles Sexual abuse Treatment Program and is currently a Clinical Psychologist at UCLA’s Counseling and Psychological Services. He previously facilitated dialogs in the U.S. and internationally with cultural groups historically in conflict. He has also facilitated mindfulness groups and taught courses that include existential-phenomenology, intercultural dialogue, and psychotherapeutic listening.

Brent D. Robbins

Brent D. Robbins, Ph.D. is the former President of APA Division 32, Society for Humanistic Psychology. He is also the Chair and Professor of Psychology at Point Park University. He is also the author of The Medicalized Body and Anesthetic Culture (2018, Palgrave Macmillan).

Notes

1. Presence-centered attunement includes an open-hearted journey from incongruence to lived presence. The therapist–client relationship attends to nonjudgmentally bringing congruent and resonant words to the lived experiences of past and present moments.

2. Ontology involves the study of being. Entering into the ever-changing flow of being – as a way of being – has been a central consideration for PCT, existential phenomenology, and Buddhism.

3. An HEP psychotherapist’s attunement to the panoramic view of client attends to understand client experiences as part of a larger whole or interconnected totality of contexts (e.g., being in the world).

4. In this article, the terms “contemplative” and “mindfulness meditation” are used interchangeably. We suggest that a contemplative HEP psychotherapist nonjudgmentally and empathically engage clients in co-meditation on in-the-moment aspects of experience and their contexts.

5. In existential phenomenology, authentic refection is grounded in moods, senses, and life contexts. Comparatively, Tudor (2011) views authenticity as a level of transparency that a PCT psychotherapist embodies with the client “in the relationship” (p. 169). Singh and Tudor (1997) suggest that a PCT client may begin psychotherapy from a state of incongruence (inauthenticity) that includes divergence from the client’s self-concept and/or a client’s disconnection from lived sociocultural contexts.

6. We are using gender-neutral pronouns to acknowledge non-binary and transgender identities.

7. Yalom’s (1980) description of four existential givens includes an understanding of meaning with respect to the broader meaning of life and the more personal meaning of one’s own life. According to Yalom, defining personal meaning is necessary in the face of a universe that appears to be meaningless or without preordained coherence. As a second existential given, Yalom’s description of “freedom” (p. 216) references the existential design of the universe as one without an inherent moral or ethical structure. Amid this groundless cosmological space of freedom, people hold ultimate responsibility for being the sole author of their lives and existence. It is this jarring realization that occasions an existential anxiety that one is “doomed to freedom” (p. 220). As a third existential given, Yalom contrasts a fundamental “existential isolation” (p. 355) from others over against worldly “interpersonal isolation” (p. 353) from others or “intrapersonal isolation” (p. 354) and disconnection from one’s own experiences. For Yalom, existential isolation becomes apparent when one returns from being lost or absorbed in the world and realizes that an “unbridgeable gulf between oneself and any other being” (p. 355). Finally, Yalom reminds us that death (p. 30) is not only part of life’s facticity during the final moment of one’s existence but rather awareness of death is also an impetus for living fully and authentically while alive. In accord with Heidegger, Yalom maintains that the experience of death awareness is unmatched in its capacity to shake one out of tranquil everydayness into a mindfulness of being.

8. Though we have not specifically referenced the assemblage theory of Deleueze & Guattari, 1987, their dynamic system perspective on how the elements of self-organization assemble in fluid rather than static hierarchies and forms is worth consideration. In their theory, such forms or gestalts are subject to ongoing deterritorialization and reterritorialization.

9. The following summarizes Triandis’ (2000) cultural syndromes: (a) “complexity” (p. 147) in which complex cultures consist of individuals and subgroups with differing attitudes and values, whereas simple cultures tend to exhibit value consensus; (b) “tightness” (p. 147) wherein relatively isolated cultures have numerous rules and prescriptions for behavioral conduct in contrast to loose cultures that are more tolerant of difference and have fewer rules; (c) “individualism and collectivism” (p. 147), in which individualism and autonomy are contrasted with a collectivist emphasis on conformity to socially valued identities and allegiance to family and community; (d) “vertical and horizontal cultures” (p. 148) in which vertically weighted cultures are characterized by hierarchies and horizontally weighted cultures emphasize equality; (e) “active-passive cultures” (p. 148) wherein active orientations focus on changing the environment in order to suit individual and cultural needs in contrast to passive orientations that encourage people to establish harmony by adapting to situations; (f) “universalism-particularism” (p. 148) in which a universalized approach to interacting with others is contrasted with an emphasis on unique forms of engagement with varieties of people and situations; (g) “diffuse-specific” (p. 148) values in which diffuse or generalized reactions to situations and people contrast with specific and differentiated engagement with situations and people; (h) “instrumental-expressive” (p. 148) values in which instrumental relationships place emphasis on functional usefulness of others that contrasts with expressive ways of connecting with others that privilege the importance of the relationship; and (i) “emotional expression or suppression” (p. 148) values that distinguish between cultural codes supporting free expression of emotion and those codes that emphasize controlled expression of emotion.