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Existential Therapy

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					Existential Therapy
          EDCE 655
   Theories & Techniques II
     Existential Approach
                   I Am Aware that I
Who Am I?         am Unique & Have
                       Meaning
Existential Psychotherapy is more
of a therapeutic attitude & train of
  thought than a Process Theory!
Victor E. Frankl (1905-1997)

 That which
does not kill
me makes me
 stronger!!!
        Victor Frankl (1905-1997)
 Born in Vienna on March 26, 1905, he earned a
  doctorate in medicine in 1930 and was put in charge of a
  ward treating female suicide candidates.
 When the Nazis took power in 1938, Dr. Frankl became
  chief of the neurological department of the Rothschild
  Hospital, the only Jewish hospital in Vienna at the time.
 But in 1942, he and his parents were deported to the
  Theresienstadt concentration camp near Prague.
 1945, Dr. Frankl returned to Vienna, where he became
  head physician of the neurological department of the
  Vienna Polyclinic Hospital, a position held for 25 yrs.
 Starting in 1961, Dr. Frankl took five professorships in
  the USA -- at Harvard and Stanford universities, as well
  as at universities in Dallas, Pittsburgh, and San Diego.
        Victor Frankl (1905-1997)
 Obituary (4 pages) began: “VIENNA, Austria --
  Psychiatrist Viktor E. Frankl, who transformed years of
  suffering in Nazi concentration camps into insights for
  his lifelong study of man's quest for meaning, has died
  at 92. Dr. Frankl had been suffering from heart
  problems, the Austria Press Agency reported, citing the
  Vienna Viktor Frankl Institute. He died in Vienna on
  Tuesday and his funeral was held immediately.”
 Dr. Frankl survived Auschwitz and three other Nazi
  concentration camps from 1942 to 1945, but his parents
  and other members of his family died in the death
  camps.
 Dr. Frankl's teachings have been described as the Third
  Vienna School of Psychotherapy, after those of
  Sigmund Freud and Alfred Adler.
        Victor Frankl (1905-1997)
 Dr. Frankl's native Austria virtually ignored him, even
  while his teachings were acclaimed in the United States
  and elsewhere.
 Dr. Frankl's 32 books have been translated into 26
  languages. He also held 29 honorary doctorates from
  universities around the globe.
 "There is nothing in the world, I venture to say, that
  would so effectively help one to survive even the worst
  conditions as the knowledge that there is a meaning in
  one's life," he wrote.
 Dr. Frankl wrote that one can discover the meaning in
  life in three different ways: "by creating a work or doing
  a deed; by experiencing something or encountering
  someone; and by the attitude we take toward
  unavoidable suffering."
                      Rollo May
 American spokesperson for Existentialism
 Unhappy childhood – 2 failed marriages, tuberculosis – but
  not a negative outlook on life
 Studied with Adler in Vienna
 Greatest influence: Paul Tillich (German Philosopher)
 Writings deal with the nature of the human experience,
  recognizing and dealing with power, accepting freedom &
  responsibility, & discovering one’s identity
 Feels that counseling should be aimed at helping people
  discover the meaning of their lives
 Feels the greatest challenge for a person is to live in a
  world alone where they will eventually face death
       Definition, Focus, & Purpose of
                Existentialism
 Definitions:
      The doctrine that existence takes precedence over essence and holding that man is totally free and
       responsible for his acts. This responsibility is the source of dread and anguish that encompass mankind.
      A philosophy that emphasizes the uniqueness and isolation of the individual experience in a hostile or
       indifferent universe, regards human existence as unexplainable, and stresses freedom of choice and
       responsibility for the consequences of one's acts.

 Focus:
      Mankind has free will & Life is a series of choices that creates stress
      Few decisions are without any negative consequences - If one makes a decision, he/she must follow through
      Some things are irrational or absurd, without explanation
      Emphasizes the limitations and the individual power of human existence
      Focus is on the individual’s experience while dealing with existential key concepts
      Understanding of the person’s subjective view or the world
 Purpose:
      To challenge clients to discover alternatives and choose among them
      To allow members to learn that they can chance and some things cannot be changed
      Group represents a microcosm of the world where self discovery arises through sharing existential concerns
      Enabling members to become truthful with themselves
      Widening their perspectives on themselves and the world around them
      Clarifying what gives meaning to the present and future
            Existential Key Concepts
 Self Awareness                                              Self-Determination &
      Basic goal - expand self-awareness and increase potential Personal Responsibility
       for choice
                                                                     Freedom to choose between
      Help members discover their unique being in the world          alternatives
      Expression of own unique feelings                             Responsible for directing our lives
      Learn to deal with anxiety                                    How we are and what we have
      View anxiety in a positive manner                              become is the result of our own
      As we become more aware - it is harder to revert back to       choices
       our old ways                                                  Freedom can never be taken form us
      Higher degree of self-awareness allows us to recognize:        because we have choices
         • to chose to expand our awareness vs. limit our            Help members face and deal with
             perception of self                                       anxieties and situations that they
         • determine the direction of our lives vs. allows            cannot escape
             others to determine our lives                           Self-determination is to confront
         • use our potential for action vs. choose not to act         members with the realities of freedom
                                                                      and not letting them deny it
         • choose to establish meaningful ties with other vs.
             choose to isolate self                                  When people come to believe that
                                                                      they can direct their own destiny,
         • search for uniqueness vs. allow for conformity
                                                                      they assume control over their lives
         • create & find meaning in life vs. lead empty lives
                                                                     Assistance with observing how one
         • engage in risks and anxieties vs. choose security of       creates a victim like existence
             dependence
                                                                     Leader encourages members to
         • make the most out of the present vs. hide from             assume genuine responsibility for
             reality                                                  their role in group
           Existential Key Concepts
 Existential Anxiety                                       Death & Nonbeing
      A basic characteristic of human beings                      Life has meaning because it must
      Basic to living with awareness and being fully alive         end
      Can be a strong motivation toward growth                    The present is important because it
      Results form having to make choices w/o knowing              is all we have (May, 1983)
       the outcomes                                                Living life fully vs. merely existing -
      Members adjust too comfortable and resist anxiety            asking how they feel about the
       -this change to accepting anxiety involves viewing           quality of their life
       life as an adventure                                        How would you change your life if
      Encourage members to accept anxiety as a growth-             you knew you were going to die?
       producing experience                                        Expand death to include other
      Assisting members to come to terms with                      forms of death
       paradoxes of existence                                      We have areas of our lives that die
          • life - death / success - failure                        to make room for new growth
      Must be faced and worked through in counseling
       that involves:
                                                               Aloneness & Relatedness
          • Recognition of need for self and others
                                                                   Ultimately we are alone
          • Guilt over not living authentically
                                                                   We must accept our aloneness and
          • emptiness and lack of meaning
                                                                    then we can genuinely and
          • burden of responsibility & choice                       meaningfully relate to others
          • fear of death & non being                              We must stand alone before we can
                                                                    truly stand besides another
         Existential Key Concepts
   Search for Meaning                                     Search for Authenticity
        Who Am I?                                              Paul Tillich “The Courage to
        Where Am I Going?                                       Be”
        Why am I here?                                         Authentic living is a process
        What gives my life purpose and meaning?                Being true to ourselves
        Life does not have a positive meaning itself           Engaging in activities what is
        It is up to us to create meaning                        meaningful to us
        A lack of meaning is the major source of               Becoming a person that we are
         existential stress and anxiety                          capable of becoming
        Existential Vacuum: feeling of inner void              Challenging members to become
         due to lack of meaning                                  authentic by engaging in life and
                                                                 making commitments
        Counselors assist members in finding
         meaning for themselves
        Challenging and discarding values to
         become meaningful is central for the
         counselor
        Do you like the direction of your life? If
         not, what are you doing about it?
        What are the aspects of your life that
         satisfy you most?
        What is preventing you from doing what
         you really want to do?
 Strengths & Limitations of the
     Existential Approach
 Strengths                                 Limitations
      People do not have to remain              Quite abstract
       victims of their past                     Difficult to apply
      People have the power to decide           Must have the mindset or may
       for themselves and take action             feel that concepts are elusive and
      Wide range of applicable group             lofty
       settings                                  Not good for those not interested
      Help individuals reclaim a sense           in self-exploration
       of power                                  Not good for problem-solving or
      Techniques follow                          the relief of specific symptoms
       understanding - less ability of           Counselors do not serve as a
       abusing techniques                         director or substitute parent
      Very suitable for those living in         Counselors must have a good
       foreign countries                          grasp of the approach
      Highly Multicultural in
       orientation
      Respect of uniqueness
               Group Leader Roles
 Counselor is fully present
 Counselor’s first concern is with genuinely grasping the core struggles of
  the members
 Experiencing the clients present moment
 Counselor tries to understand the members subjective world
 Tasks are accomplished through encounter not techniques
 Focus on the human side of members
 Counselors bring their own subjectivity into the group
 Change comes from the relationship between counselor and member
 Counselors are free to draw from other techniques from other orientations
 Counselor must foster meaningful relationships among members
 Focus on key existential concepts and explore them fully
 Counselors must be and become somebody rather than doing or
  implementing techniques
       Appropriate Populations for
           Existential Groups
 People who:                          Rape Groups
      feel alienated                  Battering Groups
      search for meaning
                                       Crime Groups
      are at a cross roads
      are at the edge of existence
                                       Abuse Groups
 Those interested in                  Bereavement / Loss
  dealing with their                    Groups
  problems rather than                 Empty Self Groups
  curing pathology                     Multicultural Groups
                                       ?????
 Phases of the Existential Method
INTAKE PHASE: Determining the appropriateness of the method and
introducing terminology and concepts
•Is the method suited to the client’s expectations, treatment, and capacities?
•What level of reading material is appropriate for the client?
•What will be the frequency of the sessions and duration of treatment?



PHASE 1: Recognizing anxiety as a provocation that begins the transition to
authenticity
•What personal message is contained in my quietness?
•What facets of my life have become a matter of dissatisfying routine?
•Am I living according to beliefs and values that are not my own?



PHASE 2: Conceptualizing that our existence is temporary
•How do I perceive the temporal limits of my existence?
•Have I postponed my authentic projects due to assuming an abundance of time?
•Am I willing to consider that an awareness of my heritage and sense of destiny may open possibilities in my
present dilemma?
  Phases of the Existential Method

PHASE 3: Reviewing familial-cultural heritage and demonstrated possibilities
•What resources from my heritage and personal history are essential for a sense of wholeness and purpose?
•What possibilities have I closed off due to their anxiety-producing quality?



PHASE 4: Selecting possibilities for future repetition
•What few uncustomary and meaningful activities am I prepared to initiate that will draw on my newfound
sense of heritage and destiny?
•How will I continue to hold myself open, so as to recognize those few projects that are truly my own?



PHASE 5: Resolving to continue in authenticity despite the presence of nonbeing
•How will I draw on my accomplishments in therapy to persevere in authenticity?


Brent, J. (1998). A time-sensitive existential method for assisting adults in transition. Journal of Humanistic Psychology, 38 (4), 7-24.
                Existential Case Study
Pauline
The existentialist views death as a reality that gives meaning to life. As humans we do not have
forever to actualize ourselves. Thus, the realization of the fact that we will die jolts us into
taking the present seriously and evaluating the direction in which we are traveling. We are
confronted with the fact that we have only so much time to do the things we most wanted to do.
Thus, we are motivated to take stock of how meaningful our life is. With this existential
perspective in mind, assume that a young woman of 20 comes to the center where you are a
counselor.

Some Background Data
Pauline has recently found out that she has leukemia. Though she is in a period of remission,
her doctors tell her that the disease is terminal. Pauline is seeking counseling to help herself
deal with the crisis and at least get the maximum our of the remainder of her life. She is filled
with rage over her fate; she keeps asking why this had to happen to her. She tells you that at
first she could not believe the diagnosis was correct. When she finally got several more
professional opinions that confirmed her leukemia, she began to feel more and more anger –
toward God, toward her healthy friends, whom she envied, and generally toward the
unfairness of her situation. She tells you that she was just starting to live, that she had a
direction she was going in professionally. Now everything will have to change. After she tells
you this, she is sitting across from you waiting for your response.
     Case Study Review Questions
Attempting to stay within the frame of reference of an existential counselor, what
direction would you take with her? Think about these questions:
What do you imagine your immediate reactions would be if you were faced with
counseling this client? What would be some of the things that you would initially say
in response to what you know about Pauline?
What are your own thoughts and feelings about death? To what degree have you
reflected on this reality as it applies to you? Do you avoid thinking about it? In what
ways have you accepted the reality of your eventual death? How do you think that
the answers to the above questions will affect your ability to be present for Pauline?
What goals would you have in counseling her?
In what ways would you deal with the rage that Pauline says she feels?
Pauline tells you that one of the reasons that she is coming to see you is because of
her desire to accept her fate. How would you work with her to gain this acceptance?
What specific things might you do to help her find ways of living the rest of her life
to the fullest?
Do you see any possibilities for helping Pauline find meaning in her life in the face of
death?
          Existential Therapy Outline
 Introduction

 3 Phases of Therapy
      ID & clarify client’s
       assumptions about the
       world
      Encourage client to
       examine the source and
       authority of their value
       system
      Help client to put what
       they learn about
       themselves into action
           Existential Therapy Outline
 6 Major Existential Propositions
      The capacity for Self-Awareness:
         • The greater our awareness, the greater our possibilities for freedom
         • We can choose to either expand or restrict our consciousness
         • A price is paid for increased awareness (you can’t go home again)
      Freedom & Responsibility:
         • Focus is on client’s responsibility for their situation
         • Challenge client to explore other ways of being that are more fulfilling
      Striving for Identity & Relationship to Others:
         • Challenge client to examine ways in which they have lost touch with their identity
         • Confront clients with the reality that they alone must find their own answers
         • Lack of relationship to others cause anxiety
      The Search for Meaning:
         • Clients are faced with the task of creating meaning for their own lives
         • Existential guilt is explored to help clients learn about the way they are living their
            lives
      Anxiety as a Condition of Living:
         • Anxiety is used as a tool to motivate change in the client
         • The counselor helps the client move from dependence to autonomy
      Awareness of Death and Non-being:
         • Client learns to relinquish the neurotic aspects of their past
         • Client is encouraged to create a fuller life
                          The Purpose of Life Test
This questionnaire consists of twenty items to be rated on a seven point scale. On each item position 4 is designated as “neutral” and
different descriptive terms are given for positions 1 and 7. A person’s response can fall anywhere in between 1 and 7.

1.     I am usually                       Completely bored                 1234567                  Exuberant, excited

2.     Life seems to me:                  Completely routine               1234567                  Always exciting

3.     In life I have:                    No goals or aims at all          1234567                  Very clear goals & aims

4.     My personal existence is:          Utterly meaningless,                                      Very purposeful,
                                          without purpose                  1234567                  meaningful

5.     Every day is:                      Exactly the Same                 1234567                  Constantly new & different

6.     If I could choose, I would:        Prefer to have never                                      Like nine more lives like
                                          been born                        1234567                  this one

7.     After retiring, I would:           Loaf completely the                                       Do some exciting things I’ve
                                          rest of my life                  1234567                  always wanted to do

8.     In achieving life goals            Made no progress                                          Progressed to complete
       I have:                            whatever                         1234567                  fulfillment

9.     My life is:                   Empty, filled only                                             Running over with
                                     with despair                          1234567                  good things
10.    If I should die today I would Completely                                                     Very
       feel that my life has been:   worthless                             1234567                  Worthwhile

11.    In thinking of my life I:          Wonder why I exist               1234567                  Always see a reason for being
                      The Purpose of Life Test
12.   As I view the world in
      relation to my life,          Completely                                       Fist meaningfully
      the world:                    confuses me                1234567               with my life

13.   I am a:                       Very irresponsible         1234567               Very responsible

14.   Concerning man’s freedom      Completely bound by                              Absolutely free
      to make his own choices,      limitations of heredity                          to make all
      I believe man is:             & environment:             1234567               life choices

15.   With regard to death, I am:   Unprepared/Frightened      1234567               Prepared & Unafraid

16.   With regard to suicide,       Thought of it seriously                          Never given it a
      I have:                       as a way out               1234567               second thought

17.   I regard my ability to find a
      meaning, a purpose or
      mission in life as:           Practically none           1234567               Very Great

18.   My life is:                   Out of my hands and                              In my hands and
                                    controlled by external                           I am in control
                                    factors                    1234567               of it

19.   Facing my daily tasks is:     Painful & Boring           1234567               Pleasuring & satisfying

20.   I have discovered:            No mission or purpose                            Clear-cut goals and a
                                    in life                    1234567               satisfying life purpose

                      Taken from Existential Psychotherapy, by Irvin D. Yalm, 1980, pgs. 455-456.
        2 Key Figures in Existential Therapy
 Victor Frankl                                  Rollo May
      Born & Educated in Vienna                     American spokesperson for
      Prisoner in German Concentration               Existentialism
       Camp – where his parents, brother,            Unhappy childhood – 2 failed
       first wife and children died                   marriages, tuberculosis – but not a
      Views love as the highest goal to              negative outlook on life
       which humans can aspire – our                 Studied with Adler in Vienna
       salvation is through love                     Greatest influence: Paul Tillich
      Feels that everything can be taken             (German Philosopher)
       from a person except the right to             Writings deal with the nature of the
       choose one’s attitude in any given set         human experience, recognizing and
       of circumstances                               dealing with power, accepting
      Feels that we can discover the                 freedom & responsibility, &
       meaning of being human through our             discovering one’s identity
       actions and deeds, by experiencing a          Feels that counseling should be aimed
       value and by suffering                         at helping people discover the
      “That which does not kill you makes            meaning of their lives
       you stronger”                                 Feels the greatest challenge for a
                                                      person is to live in a world alone
                                                      where they will eventually face death
         Historical Background in Existential Philosophy
   Counseling was not founded by any particular person or group

   It grew out of an effort to help people engage the dilemmas of contemporary life (i.e.,
    isolation, alienation, meaninglessness

   The thinking of existential counselors was influenced by the themes of many 19th and
    20th century philosophers and writers such as:

        Dostoyevski: creativity, meaninglessness, and death

        Kierkegaard: creative anxiety (angst), despair, fear and dread, guilt nothingness

        Nietche: death, suicide, and will

        Heidegger: authentic being, caring, death, guilt, individual responsibility, & isolation

        Sartre:meaninglessness, responsibility, & choice

        Buber: interpersonal relationships, I / thou perspective in counseling, & self-
         transcendence
   3 Phases in the Process of Existential Counseling



                    Middle Phase:
Initial Phase:                           Final Phase:
                    The client is
Counselor assists   encouraged to        Counselor focuses
client in           more fully           on helping the
identifying &       examine the          client put what
clarifying their    source and           they are learning
assumptions         authority of their   about themselves
about the world     value system         into action
Examples of Topic Within the 6 Dimensions of Human Condition

 Initial Phase: Counselor (1) helps clients become aware of their choices (2) takes
 responsibility for those choices (3) assists clients in finding internal direction and (4)
 reconnecting with who they are and what they want from life. (5) Acquaints clients with
 the concept fo anxiety and (6) the notion that life and death are intertwined, in order to
 grow parts of ourselves must die.

 Middle Phase: (1) Clients come to realize that they are failing to live in the present
 because of preoccupations with the past, and learn that although they cannot change
 certain events of their lives they can change the way they view and react to those events.
 (2) The counselor assists clients in discovering how they are avoiding freedom of choice
 and encourages them to learn to risk using it. (3) The counselor helps clients to examine
 ways they have been living to please others and (4) aids them in confronting “existential
 vacuum” and (5) “existential anxiety”. (6) The counselor challenges clients to examine
 their own unfinished business.
 Final Phase: (1) The clients accept their limitations yet still feel worthwhile, for
 they understand that they do not need to be perfect to be worthy. The counselor
 challenges the clients to (2) consider using their freedom to create new patterns and (3) to
 confront the reality that they alone must find their own answers. (4) The clients uses
 existential guilt and (5) anxiety as a motivation to challenge the meaning and direction of
 life. (6) Finally, clients become more comfortable with inevitable death and seek to live
 authentically.
                           Existential Therapy Case Study
Susan, a 30 year old client has come to see a counselor at a local mental health agency. Although Susan tells the
counselor that she doesn’t think she has any serious problem, she has come to counseling after a long period of
fights with her husband which climaxed recently in her husband threatening divorce unless she “gets some help”
for what he describes as her “clingy-ness”.
Following is a summary of the information Susan shared during her initial interview with the counselor:
I’m 30 years old and married for almost 9 years now. I have a 8 year old daughter, Olivia. I met my husband Tim
in college. He is 1 year older. At the end of my sophomore year, I got pregnant and we decided to get married.
Since Tim was almost ready to graduate, he finished school but dropped out after the 1 st semester of my junior
year.
For a while the relationship was pretty good, I think. Tim worked a lot and I was busy taking care of Olivia. Ever
since Olivia started going to school all day, things between Tim and I seem to have gotten worse and worse. I don’t
have as much to do, so I look forward to spending time with Tim at night and on the weekends, but he says I’m
suffocating him. And he gets mad and can’t understand why I don’t what him to go off all the time for a whole day
to play golf on Saturday when that’s the only time he has to spend with me and Olivia. Well, like I said, it’s just
gotten worse. Last week, he actually said if I didn’t “get a life of my own” he wasn’t sure “how much longer he
could take it”.
I sometimes think it would be nice to do something else with the free time I’ve got now, but I can’t exactly get a
job. Olivia still needs someone to be home after school and I don’t even know if that’s what Tim means. If he
wants me to go to work, I wish he’d just say so, but…I don’t know what he wants.
Watch the role play of the next session between Susan and the counselor. Does the therapist accomplish (or
attempt to accomplish) theses 3 key tasks?
1. Assist the client in recognizing that they are not fully present in the counseling process itself.
2. Support the client in confronting anxieties they have been avoiding.
3. Help the client redefine themselves in a way that encourages greater genuine of contact with life.