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Existential Therapy Conceptualization and Treatment Plan
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The existential therapy approach allows the client to take accountability for their choices and create the present and future they want. Existential therapy draws from the belief that internal conflict surrounding basic fears such as death, freedom, isolation, and meaninglessness are contributing factors to the client’s problems. Existential therapy has been shown to be effective for individuals struggling with depression, substance abuse, anxiety and addresses certain questions relating to the meaning of life and formulation of identity. Existential treatment is based on a client’s personal experiences, which makes potential ethical issues a possibility. Existential therapy is an effective approach when working with multicultural issues because the subjective nature of the treatment shaped by the client’s own historical, social, and cultural background. Existential therapy can be effective in confronting personal and developmental crisis by formulating an understanding of the client’s anxieties as related to their experience. Dereflection is a technique used to project the client’s area of focus outward, to distract from the internal struggles that are going on. Self-disclosure is a technique that the counselor can use in order to gain trust and to provide personal insight obtained through the counselor’s own experience without imposing values or personal beliefs onto the client. Paradoxical intention is a technique that involves trying to get the client to experience the behavior they fear in a controlled environment, in order to try and infuse some humor into the situation. Existential therapy shares both compatibilities and incompatibilities with the Christian faith.
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Case Conceptualization using Existential Therapy
The development of ET is largely based on the works of existential philosophers and psychotherapists (Murdock, 2013). Within the realm of existential philosophy, Soren Kierkegard and Frederich Nietzsche are two of the more well-known and influential contributors (Murdock, 2013). As for the contributors associated with psychotherapy, Victor Frankl and his book Man’s Search for Meaning, has provided the theory of logotherapy (Murdock, 2013). Other contributors from the psychotherapy angle include James Bugental, Emmy van Deurzen-Smith, and Eric Fromm, to name a few (Murdock, 2013). For counseling purposes, Irvin Yalom and his book Existential Philosophy contributed a vast amount of working knowledge to the formulation of existential theory (Murdock, 2013).
Existential Therapy is defined by Yalom as ” a dynamic approach to therapy which focuses on concerns that are rooted in the individual’s existence” (Jones ; Butman, 2011, p. 293). The goal of ET is for the client to achieve self-actualization through a deliberate search for meaning amidst trial by exercises in free will.
Because ET is a theory of counseling that is heavily reliant upon philosophy, testing the efficacy of the theory can be difficult to accomplish within certain established scientific paradigms (Murdock, 2013). The efficacy of ET is supported by case studies and qualitative research as well as drawing from wider studies in psychotherapy and psychology (Murdock, 2013). A study was recently conducted by Vos, Craig, and Cooper (2015), which completed a methodical review of a multitude of existential therapy types and their outcomes. The study showed that clients seem to benefit from
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existential group therapy interventions. The clients involved in the study appeared to find greater purpose in life; their level of psychopathology decreased, and their self-efficacy was strengthened (Vos, Craig ; Cooper, 2015).
Existential therapy has been shown to be effective with the treatment of anxiety and depression. The theory assumes that anxiety is universal and the there are certain “ultimate concerns”, which are death, freedom, isolation, and meaning that need to be confronted (Murdock, 2013, pp. 184-185).
Jackie Peyton seems to be a good candidate for existential therapy for multiple reasons. She exhibits the courageous nature needed to question the meaning of life and confront unhealthy patterns that have become comfortable for her. She is struggling with what she wants for herself. She has a long-standing definition of herself as a nurse and a mother; she is feeling guilty about not being present as a mother and abusing her duties as a nurse. Jackie is facing a number of developmental crises, such as wondering what life is about now that her children have seemed to grow up without her and her job as an emergency room nurse has been jeopardized by her drug abuse. As Jackie begins to explore the choices open to her, her anxiety is increasing.
Jackie will more than likely respond well to existential therapy, being that she is a woman and ET reinforces throughout the viewing of the person as a subject rather than an object (Murdock, 2013). Existential therapy can be used to treat clients who have experienced trauma in their lives, though ET is an extended process and cannot offer immediate relief in crisis situations.
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Existential therapy can be extremely effective when treating addictions. Existential therapy can be used to address aspects influencing substance abuse disorders, such as lack of meaning in one’s life, fear of death or failure, isolation from others, and spiritual voids. Existential therapy accesses the underlying vacancies related to substance abuse disorders, often aiding clients to seek replacements for substances to satisfy the emptiness the client is experiencing.
Jackie has become reliant upon opiates in order to manage her feelings and emotions. Jackie begins using drugs as a way to cope with her anxiety, both in the hospital and transitioning into her family life. Her drug abuse has affected nearly all of her close relationships in a negative manner. Her family relationships have become completely unmanageable. Her presence becomes an anomaly in her daughters’ and husband’s lives, while her time is spent feeding her addiction. Jackie’s occupation is a major part of her identity and contributes substantially to her anxiety. She obtains the majority of her drugs from the hospital, turning her occupation into an enabler on multiple levels. Her closest friends are also co-workers. Her best friends, fellow nurse Zoey, Dr. O’Hara, and the pharmacist Eddie have all been manipulated by Jackie during the course of her addiction and they all have grown weary of her intentions. She longs for the help of her higher power to overcome her addiction. A spiritual void and search for meaning in life are well-articulated contributors to her addiction and problems.
Three treatment goals have been identified for Jackie, which are to reduce anxiety through coping strategies and an established routine, be present as a parent, and to
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strengthen her connection to her higher power. Teaching Jackie healthy coping strategies will hopefully help her to deal with life stressors and reduce her urges to use. Jackie needs to concentrate on being present as a mother. Her daughters are an integral part of her life and wellbeing. Their successes and their failures directly translate into Jackie’s life. Jackie has the foundation for a strong spiritual connection in her life; she needs to foster it. Deciphering where her higher power lies and how to strengthen that connection will be crucial in her recovery.
Dereflection is a technique used in existential therapy, which focuses the client’s attention externally and away from the client’s internal struggles (Murdock, 2013). An emphasis on directing the client’s attention outward on something positive and meaningful, bringing the concentration away from internal processes. This technique will be beneficial for the reduction of Jackie’s anxiety and getting her more involved in her children’s lives. I would encourage Jackie become actively involved with each of her daughters, making a dedicated time each week to participate in something constructive (creative, physical, spiritual;, etc.). I would suggest approaching it as a fun but meaningful time to spend together and learn from each other through communication. I would suggest structuring this time as a shared planning responsibility, i.e. Jackie plans one week’s activity and one of her daughters plans the next week’s. The activity could be an arts and crafts night at the house for just Jackie and one of her daughters one week and a hike through a local park the next week.
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I believe this form of dereflection would guide Jackie’s thoughts onto projecting positively on her daughters. Making time for constructive connection with her children would redirect her focus from her internal anxieties and how to manage them, onto the strengthening of a meaningful relationship. Projecting her focus onto meaningful activities, which are meant to foster growth, will help her quell the anxieties she feels related to being an absent piece in her children’s upbringing.
In order to strengthen the client/counselor relationship, the counselor needs to make him or herself known to the client (Murdock, 2013). This can be a crucial element in establishing trust. Jackie needs to strengthen her connection to her higher power and having a relatable story of how it can positively impact recovery is crucial. In this instance, I would open up to Jackie about my own struggles with addiction and how establishing a stronger connection to a higher power helped me in recovery. I would also share with her about how identifying the values that are important to me and then using them as driving force in my life contributed to meaningfulness. This would have to be done using extreme caution, as to not impose any personal values or religious views upon Jackie or to take the focus away from Jackie’s journey.
I believe this would help Jackie to start the process of exploring her spirituality. I also believe that this technique would encourage Jackie to identify the values that are important to her and shift her focus away from a success oriented life and one oriented around values. Hearing a first hand account of struggle and hardship which was overcome through diligence, the use of the proper tools, and strength in a higher power
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will hopefully help Jackie to find her spiritual connection and strengthen the client-counselor relationship.
Paradoxical intention was introduced by Frankl and is one of the better-known ET techniques (Murdock, 2013). This technique encourages the client to isolate one symptom or problem that they are experiencing and experience it deliberately, and while experiencing the problem, the client needs to try and add humor to the situation (Murdock, 2013). I believe that this technique would work well in Jackie’s treatment considering that she incorporates a lot of humor into her life. I would ask her to focus on her anxiety related to the stressors involved with her job. Isolate a specific situation where she was overwhelmed at work and unable to cope. I would ask her to imagine that a patient is yelling at her and a doctor is behind her asking for a medical device that she does not have, or some sort of similar situation. I would then ask her to envision this scenario played out with someone close to her that has no training as a nurse in her shoes instead. What would they do? How would they react? How would the patient and the doctor react? Hopefully this technique will help Jackie realize that she is extremely capable and good at her job. It may also introduce some humor into the situation and help her cope with some of the anxieties presented at work.
Existential therapy shares certain compatibilities with the Christian faith. The first compatibility with Christianity is that existential therapy encourages treating the “whole” person. Existential therapy views the client as a cognitive being who has the ability to
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assign meaning to things, have a certain level of introspection, and ability to imagine. Christianity asserts that human beings were created in the image of God, possessing purpose and dignity (Jones & Butman, 2011). The second compatibility with Christianity is that existentialism enforces the individual to be authentic and veer away from conformity to the agendas of others. Christianity reinforces maintaining individuality and not conforming to norms held by society or other individuals just because it is the easiest way. The third compatibility with Christianity is the role of self-examination in the counseling process (Jones & Butman, 2011). During the counseling process, counselors are encouraged to explore their own flaws and through that process help the client become open to a deeper exploration of themselves. The Christian faith encourages individuals becoming aware of their own personal sin and in so doing knowing that they are still accepted in God’s eyes.
Several incompatibilities exist between existential therapy and the Christian faith, the first of them being the elevation of humans. Within existentialism the ultimate level of transcendence that one can achieve is self-actualization whereas the Christian faith believes that the ultimate level of transcendence exists in the afterlife. This transitions into the second incompatibility, being that existential thought believes that life ends with death, where the Christian faith believes in the afterlife. The third incompatibility lies in the accountability of human actions. Existential though believes that the individual is only accountable to themselves, whereas Christian belief declares that individuals are accountable to God (Jones ; Butman, 2011).
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Ultimately, Jackie is seeking meaning and fulfillment out of life. Existential therapy will help her in this endeavor. She is trying to fill a spiritual and emotional void in her life with opiate use. Reducing Jackie’s anxiety within her workplace and at home with her family though dereflection and paradoxical intention techniques will help her achieve this goal. I strongly believe Jackie needs a therapeutic approach that will be positive in it’s nature due to her tendency to focus on negative aspects of life and existential therapy offers just that. Wong (2015) developed a type of existential therapy called Meaning Therapy, which focuses on a positive integration of a rewarding lifestyle based on values through the use of such techniques as dereflection (Wong, 2010).
Self-disclosure will strengthen the bond between counselor and client and offer some experiential insight into dealing finding meaning. Reflection on the “ultimate concerns” may unearth some additional underlying anxieties and offer opportunities for Jackie to embrace these aspects as part of life. One of the most important and difficult aspects for Jackie during the course of treatment will be to strengthen her spiritual connection. Her ability to grow spiritually has been repressed by her debilitating substance abuse and it is necessary in order for her to find solace in recovery. According to Claessens, “We live in a system that fosters such inauthenticity by encouraging a reliance on inadequate and, in its objectification of our environment for our self-serving use, ultimately self-destructive means of negotiating the limitations of our existence” (Claessens, 2009, p.109 +). I strongly believe that Jackie will lower her anxiety, develop a spiritual connection, and become more connected with her family throughout the course of existential therapy.
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Claessens, Marina. “Mindfulness and existential therapy.” Existential Analysis, vol. 20, no. 1, 2009, p. 109+. Academic OneFile, http://link.galegroup.com/apps/doc/A196305881/AONE?u=vic_liberty;sid=AONE;xid=76c30538. Accessed 29 July 2018.
Jones, S., ; Butman, R. (2011). Modern Psychotherapies: A Comprehensive Christian Appraisal
(2nd ed.). Downers Grove, Illinois: InterVarsity Press.
Murdock, N. (2013). Theories of Counseling and Psychotherapy: A Case Approach (3rd ed.).
Upper Saddle River, New Jersey: Pearson Education.
Vos, J., Craig, M., ; Cooper, M. (2015). Existential therapies: A meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83(1), 115-128.
Wong, P. T. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85-93.