How I work

Understanding before changing

You have probably come here because something in your life needs to change, and that is fair. In my experience, though, change that lasts tends to follow understanding rather than replace it. So we begin there: with your situation, how you live it, and what it means to you.

On this page I describe the ideas I work from and what our work together is likely to feel like. Please read it as a description rather than a promise. Every piece of therapy is shaped by the two people, or three, who are in it.

Dr Ramesh Pattni walking in a garden, deep in thought

Therapy as practical philosophy

Existential therapy grew out of philosophy before it became a therapy, and I still think of it as practical philosophy: a way of helping you understand your life and live it with greater awareness.

That doesn't make it abstract. The questions I will ask you are concrete and personal. What matters to you? What are you avoiding? What would it mean to live by your own values rather than someone else's? I explore them with you in a spirit of curiosity, without fitting you into a ready-made theory.

“Life is a mystery to be lived, not a problem to be solved.”
van Deurzen & Adams (2016, p. 1)

The facts of being alive

I don't start from a theory of what has gone wrong with you. I start from what every one of us has to face. Existential therapists often speak of four “givens” of human life.

Death

Our time is limited, and we know it. That knowledge can frighten us into a smaller life, or wake us up to what matters.

Freedom

We are always choosing, even when we would rather not. With that freedom comes responsibility for the shape of our lives.

Isolation

However close we come to others, no one can live our experience for us.

Meaninglessness

Life does not hand us a ready-made purpose. Meaning has to be found, made and kept.

None of these is a symptom, and none can be treated away. But much of what brings people to me (anxiety, a stuck decision, a marriage gone quiet, grief that won't settle) turns out to be connected to one or more of them. When you can face them more openly, there is often a relief that coping alone doesn't bring.

Four dimensions of a life

I find it helpful to think of a life as lived in four worlds at once. Each brings its own challenge, and each challenge, when you face it rather than avoid it, can bring its own strength.

Umwelt

The physical world

Your body, health, surroundings and the material facts of your life.

Mitwelt

The social world

How you meet other people, and the culture you belong to.

Eigenwelt

The personal world

Your relationship with yourself: identity, feelings, memories.

Überwelt

The spiritual world

Your values and beliefs, and what you hold sacred, religious or not.

We won't work through these one by one. They simply help us notice where a difficulty lives in your life, and where you may have strengths you've overlooked.

Dr Ramesh Pattni listening attentively

Describing before explaining

My way of listening comes from phenomenology, the philosophy of lived experience. In practice, it means three things.

  1. I set my assumptions aside. I try to hold back my own beliefs and theories, so that I hear what you are actually saying rather than what I expect to hear.
  2. I stay with what is happening now. Your immediate experience, including how it feels to be here with me, is where we begin.
  3. I describe before I interpret. We stay with what happened and how it felt, in detail, before reaching for explanations, because explanations offered too early tend to close things down.

This is slower than giving advice, and it is meant to be. What usually emerges is something you already half knew but hadn't yet been able to say.

“It is not the understanding that follows technique, but the technique that follows understanding.”
Misiak & Sexton (1973, p. 87), quoted in Spinelli (2006, p. 312)
Dr Ramesh Pattni listening attentively

The heart of the work

What happens between us

For me, the relationship between us is not a way of delivering techniques. It is the work itself. This is what you can expect from me.

A safe and confidential space

What you bring stays between us, within the limits I explain at our first meeting. Our sessions are protected time: unhurried, private and yours.

Presence

My doctoral research explored how a therapist's long-term meditation practice shapes the way they are with clients. Presence, attentive, open and grounded, is something I value deeply and continue to cultivate, so that when you are with me, you have my full attention.

Meeting you as a person

The philosopher Martin Buber wrote of the difference between managing another person and truly meeting them. I aim to meet you: not as a case or a diagnosis, but as someone with a life of your own.

Holding what is difficult

You may bring things you have never said aloud: shame, grief, fear or anger. I will hold them with care and without judgement, and we will go at a pace that feels bearable to you.

Honesty, given with respect

I will be honest with you, even when that is uncomfortable, and always with respect. I won't tell you how to live; my part is to help you see your own life more clearly.

Our relationship as part of the work

The way you relate to me often echoes the way you relate to others. If something between us feels wrong, I would much rather you told me. Working it through together, here and now, is often where change begins.

“You don't need to arrive with the right words. You only need to come as you are.”

Dr Ramesh Pattni speaking, gesturing as he explains

Both, and

Many of the dilemmas you might bring are framed as either/or: stay or leave, duty or freedom, closeness or independence. I am wary of forcing such choices too early. Life's deepest tensions are rarely solved once and for all; they are lived with, worked through and revisited.

Learning to tolerate some uncertainty, and the anxiety that comes with it, is often what frees a person to choose well.

We will walk this path together, with all its complexities, paradoxes and tensions. My part is to help you explore and understand your experience, so that you can find your way through life with that deeper understanding.

Beginning, middle and end

Therapy has a shape, even when we don't plan it session by session. I think of it in three broad phases.

  1. Beginning

    We get to know each other and agree how we will work: how often we meet, face-to-face or online, what you hope for, and how confidentiality and practical matters are handled. You get a sense of whether this is right for you, and so do I.

  2. Middle

    This is usually the longest part. Together we explore your experience and the way you live your relationships, choices and losses. Things you have taken for granted may come into question, and that can feel unsettling before it feels freeing.

  3. Ending

    Endings matter, because every life is lived towards an ending of its own. We decide together when to finish, look back on what has happened, and think about what you will take with you.

Along the way, we will pause now and then to talk about how the work is going for you: what is helping, what isn't, and whether we are still working on the right things. There are no questionnaires or scores. It is simply a conversation, and you can start it as easily as I can.

Couples & relationships

When you come as a couple

When you come as a couple, the relationship itself is the third presence in the room. I attend to each of you as a person in your own right, and to the world you have built between you.

Couples therapy room with two armchairs at Dr Pattni's practice

“The relationship itself is the third presence in the room: unhurried, held, and heard.”

The core tension

Love and will: intimacy without losing yourself

Rollo May wrote about the tension between love and will: the wish to be joined with another, and the need to remain a self who chooses. In my experience, many couples struggle not because they love too little, but because one or both of them has lost the freedom to be fully themselves inside the relationship.

Therapeutic stance

Clear sight, not taking sides

I won't take sides, and I won't decide whether you should stay together. My task is to help each of you see yourself, and the other, more clearly, so that whatever you choose is genuinely chosen.

Boundaries & commitments

What you won't find here

Therapy is not a medical procedure or a set of coaching exercises. Understanding what is not part of this work is just as important as knowing what is.

No labels

No diagnosis or clinical reduction

I don't begin with a diagnosis, and I won't reduce you to one. You are met as a person facing the challenges of life, not a set of symptoms.

No formulas

No homework, worksheets or scores

I don't set homework, worksheets or scores. Our work together is an authentic, unscripted human dialogue shaped by what is real for you.

No shortcuts

No quick-fix techniques

I don't offer quick techniques for making difficult feelings go away. Lasting change follows understanding rather than replacing it.

No dogmas

No ready-made philosophy

I won't give you a philosophy to adopt. The point is to find your own authentic way of answering the questions your life is asking.

Looking for a short, structured programme? If you are looking for a short, manualised programme focused on a specific symptom, another approach may suit you better, and I am happy to say so when we speak.

Curated bibliography

If you would like to read more

These books describe the existential approach in more depth. None of them is required reading.

Foundational 1958

I and Thou

Martin Buber (R. G. Smith, Trans.; 2nd ed.)

Scribner

The seminal philosophy of genuine dialogue and meeting the other as a "Thou".

Comprehensive 1980

Existential Psychotherapy

Irvin D. Yalom

Basic Books

The classic textbook exploring the four givens: death, freedom, isolation, and meaninglessness.

Relationships 1969

Love and Will

Rollo May

W. W. Norton

A profound exploration of love, intimacy, choice, and authentic human connection.

Phenomenology 2005

The Interpreted World

Ernesto Spinelli (2nd ed.)

Sage

An accessible and rigorous introduction to phenomenological psychology.

Clinical Practice 2015

Practising Existential Therapy

Ernesto Spinelli (2nd ed.)

Sage

Focuses on the relational world and how existential principles unfold in session.

Skills & Method 2016

Skills in Existential Counselling & Psychotherapy

Emmy van Deurzen & Martin Adams (2nd ed.)

Sage

Clear, structured guide covering the four dimensions and phenomenological listening.

Overview 2017

Existential Therapies

Mick Cooper (2nd ed.)

Sage

A lucid contemporary survey examining Daseinsanalysis, meaning-centered, and relational branches.

Also quoted in the text: Misiak, H., & Sexton, V. S. (1973). Phenomenological, existential, and humanistic psychologies: A historical survey. Grune & Stratton. Spinelli, E. (2006). Existential psychotherapy: An introductory overview. Análise Psicológica, 24(3), 311–321.

If this way of working speaks to you

Write to me with a few lines about what brings you here, and I will reply to suggest how we might begin. Replies may take a few days at present.