Humanistic and existential psychotherapies use a wide range of approaches to case conceptualization, therapeutic goals, intervention strategies, and research methods. It combines an emphasis on understanding human experience and a focus on the client rather than the symptom. Mental health problems (including substance use disorders) are viewed as resulting from an inhibited ability to make authentic, meaningful, and self-directed decisions about life. Consequently, interventions aim to increase the client's self-awareness and self-understanding.
While the keywords for humanistic therapy areadoptionandgrowth, the main subjects of existential therapy are the clientresponsibilityandfreedom. This chapter defines some of the most important concepts of these two therapeutic approaches and describes how they can be applied in brief therapy in the treatment of substance use disorders. A brief case illustrates how each theory would address the client's problems. Many of the properties of these therapies have been incorporated into other therapeutic approaches, such as B. the narrative therapy, integrated.
Humanistic and existential approaches share the belief that human beings have the capacity for self-knowledge and choice. However, the two schools arrive at this belief through different theories. The humanistic perspective views human nature as fundamentally good, with an inherent potential to maintain healthy, meaningful relationships and make choices that are in our own best interests and those of others. The humanistic therapist focuses on helping people break free from limiting assumptions and attitudes so they can live more fulfilling lives. The therapist emphasizes growth and self-actualization rather than curing disease or alleviating disorders. This perspective targets present conscious processes rather than unconscious processes and past causes, but like the existential approach, it assumes that humans have an inherent capacity for responsible self-direction. For the humanistic therapist, the source of problems is not being your true self. The therapeutic relationship serves as a vehicle or context in which to facilitate the process of psychological growth. The humanistic therapist seeks to create a therapeutic relationship that is warm, accepting, and trusts that the client's inner drive is to actualize in a healthy direction.
The existentialist, on the other hand, is more interested in helping the client find philosophical meaning in the face of anxiety by choosing to think and act authentically and responsibly. According to existential therapy, people's central problems are embedded in the fear of loneliness, isolation, despair and ultimately death. Creativity, love, authenticity, and free will are recognized as potential avenues for transformation, allowing people to live meaningful lives in the face of uncertainty and suffering. Everyone experiences losses (e.g., the death of friends, the end of relationships), and these losses cause fear because they remind us of human limitations and the inevitable death. The existential therapist recognizes that human influence is shaped by biology, culture, and luck. Existential therapy is based on the belief that people's problems stem from not exercising choice and judgment enough—or well enough—to give their lives meaning, and that each individual is responsible for making their own lives to give meaning. However, outside forces can contribute to the individual's limited ability to make decisions and live a meaningful life. For the existential therapist, life is much more a confrontation with negative inner forces than it is for the humanistic therapist.
In general, short-term therapy requires the rapid formation of a therapeutic alliance compared to long-term treatment modalities. These therapies address factors that shape substance use disorders, such as B. Meaninglessness in one's own life, fear of death or fear of failure, alienation from others and spiritual emptiness. Humanistic and existential therapies delve deeper into issues related to substance use disorders and often serve as a catalyst for finding alternatives to substances to fill the void the client is experiencing. The counselor's empathy and acceptance, as well as the insights gained from the client, contribute to the client's recovery by providing opportunities for her to make new existential choices, beginning with an informed decision to use or abstain from substances. These therapies can add a dimension of self-esteem, self-motivation, and self-development for the client that will better facilitate their treatment. Humanistic and existential therapeutic approaches may be particularly appropriate for the short-term treatment of substance abuse, as they tend to facilitate therapeutic rapport, increase self-awareness, focus on potential inner resources, and establish the client as the person responsible for recovery is responsible. As a result, patients are more likely to look beyond the limitations of short-term treatment and envision recovery as a lifelong process of working to reach their full potential.
Because these approaches attempt to address the underlying factors of substance abuse disorders, they may not always confront the substance abuse itself directly. Because substance abuse is the main problem and should remain a priority, these therapies are most effectively used in conjunction with more traditional treatments for substance use disorders. However, many of the underlying principles developed to support these therapies can be applied to almost any other type of therapy to facilitate the client-therapist relationship.
With humanistic and existential therapies
Many aspects of humanistic and existential approaches (including empathy, fostering affect, reflective listening, and acceptance of the client's subjective experience) are useful in any type of brief therapy session, whether psychodynamic, strategic, or cognitive-behavioural therapy. They help establish a relationship and provide the basis for meaningful engagement with all aspects of the treatment process.
While the approaches discussed in this chapter encompass a wide variety of therapeutic interventions, they are unified by an emphasis onlivedExperience, authentic (therapeutic) relationships and the recognition of the subjective nature of human experience. The focus is on helping the client understand how reality is affected by past experiences, present perceptions, and expectations for the future. Schordescribes the process by which our experiences take on meaningApperzeption(Schor, 1998). Becoming aware of this process brings insight and facilitates the ability to choose new ways of being and acting.
For many clients, current circumstances and issues related to substance abuse may seem more pressing, and notions of integration, spirituality, and existential growth may be too distant from their immediate experience to be effective. In such cases, humanistic and existential approaches can help clients focus on the fact that they actually make choices about substance abuse and are responsible for their own recovery.
By their very nature, these models do not rely on a comprehensive set of techniques or procedures. Rather, the therapist's personal philosophy must be consistent with the theoretical underpinnings of these approaches. The therapist must be willing and able to genuinely and authentically involve the client to help bring about meaningful change. Sensitivity to “teachable” or “therapeutic” moments is essential.
When should brief humanistic and existential therapies be used?
These approaches can be useful at all stages of recovery to provide a basis for respect for clients and mutual acceptance of the meaning of their experiences. However, there are some therapeutic moments that lend themselves more to one or more specific approaches. The details of the specific approaches are presented later in this chapter.customer orientedFor example, therapy can be used immediately to build relationship and resolve issues throughout the session.existentialTherapy can be used most effectively when a client has access to emotional experiences or when there are obstacles to be overcome to help a client enter or continue recovery (e.g., to help someone who insists on remaining helpless , to make them take responsibility).NarrativeTherapy can be used to help the client conceptualize treatment as an opportunity to take ownership and start a 'new chapter' in life.GestaltApproaches can also be used throughout therapy to allow for a genuine encounter with the therapist and the client's own experience.TranspersonalTherapy can enhance spiritual development by focusing on the intangible aspects of human experience and awareness of unrealized spiritual abilities. These approaches increase self-awareness, which promotes self-esteem and allows for more client responsibility, giving the client a sense of control and the ability to make choices. All of these approaches can be used to support the goals of addiction therapy.
Duration of therapy and frequency of sessions
Although many aspects of these approaches are found in other therapeutic strands, concepts such as empathy, meaning, and choice are central to humanistic and existential therapies. They are particularly valuable for the short-term treatment of addictions because they increase therapeutic rapport and promote conscious experience and the assumption of responsibility. Within this framework, episodic treatment could be designed, with the treatment plan focusing on the client's tasks and experiences between sessions. Humanistic and existential therapies assume that much growth and change occurs outside of meetings. When focused on broader issues, these therapies can be lifelong journeys of growth and transformation. At the same time, focusing on specific substance abuse problems can provide a framework for change and more discrete targets. These techniques also work well in conjunction with other types of therapy.
The opening session is extremely important in brief therapy to build an alliance, build a therapeutic relationship, and create a climate of mutual respect. Although the approaches discussed in this chapter have different ways of addressing the client's problems, the opening session should attempt to:
Start developing the alliance
Emphasize the client's agency and the potential for meaningful change
Articulate expectations and goals of therapy (how goals are to be achieved)
Alliance development can be done through reflective listening, respect, honesty and openness; evoke trust and confidence; and the application of other principles that emerge from these therapies. The emphasis on agency and the potential for meaningful change can be deepened by focusing on the current decision (however made) to attend the opening session. Expectations and goals can be articulated through strategic questions or comments, such as “What could be achieved through a treatment that would help you live better” or “You now have a choice about how to participate in your own substance abuse recovery “.
Because of the time constraints inherent in brief substance abuse treatment approaches, the early phase of therapy is critical. If the therapist fails to engage the client at this early stage, treatment is likely to be less effective. "Engagement" includes helping the client increase motivation for other aspects of substance abuse treatment, such as group therapy. Furthermore, the interaction patterns established in the early phase tend to persist throughout therapy. The level of motivation felt by the client after the first session is largely determined by the level of meaning experienced during the first therapeutic encounter. A negative experience can discourage a highly motivated client from coming back, while a positive experience can lead a poorly motivated client to see the potential of a treatment as helpful.
Compatibility of humanistic and existential therapies and 12-step programs
Humanistic and existential approaches align with many principles of the 12-step programs. For example, existential and humanistic therapists would accept the meaning emphasized by the "serenity prayer".acceptthe things that can't be changed, theMutto change what can be changed and whowisdomto know the difference. However, some would argue against the extent to which Alcoholics Anonymous (AA) identifies a person's "sickness" as a central character trait, or the way one might interpret the notion of "powerlessness." The principles of existentialism, free choice, and free will may seem incompatible with the 12-step philosophy of acceptance and surrender. However, such devotion must result from conscious choices made by an individual. The AA concept of rigorous self-evaluation—accepting one's personal limitations and continually choosing and redeciding to act upon certain principles as a way of life—is consistent with both existential and humanistic principles.
The dominant research strategy or methodology in the social sciences is rooted in the scientific or rational-empirical perspective. Such approaches generally attempt to identify and demonstrate causal relationships by isolating specific variables while controlling for other variables such as personal differences between therapist and client. For example, variations in behavior or outcomes are often quantified, measured, and subjected to statistical procedures to isolate the researcher from the data and ensure objectivity. Such strategies are particularly useful for studying observable phenomena such as behavior. However, traditional approaches to understanding human experience and meaning have been criticized as inadequate means of understanding human experiencelivedreality of human experience. Von Eckartsberg remarked: "Science strives for an ideal world of dependent and independent variables in their causal interdependence, completely abstracted and detached from personal experience of everyday life" (Von Eckartsberg, 1983, p.199). Similarly, Blewett argued: "The importance of human experience in relation to behavior is unquestionable, for experience extends beyond behavior just as feeling extends beyond the concepts of language" (Bleiwett, 1969, p. 22). Therefore, traditional methodological approaches seem inadequate to understand the meaning of human experience and the process through which self-understanding is manifested in the context of a therapeutic relationship.
A humanistic science or qualitative approach rooted in phenomenology is considered more appropriate to the complexities and nuances of understanding human experience (Georgi, 1985). The personal and unique construction of meaning, the importance of such subtleties as "the relationship" and the "fit" in therapy, and changes in inner states of consciousness can only be quantified and measured in the broadest sense. A more subtle science is required to describe the human being and the therapeutic process.
Instead of predicting, controlling and replicating results, a humanistic-scientific approach emphasizes understanding and description. Instead of the statistical analysis of quantifiable data, she relies on narrative descriptions of experiences. Qualitative understanding appreciates uniqueness and diversity - the "little stories" (Lyotard, 1984) – as well as generalizability or more comprehensive explanations. In general, this approach assumes that objectivity, as assumed in rational empirical methods, is illusory. For the qualitative researcher and the therapist, the goals are the same: openness to the other, active participation, and awareness of one's subjectivity rather than illusory objectivity. Intersubjective dialogue provides a means of comparing subjective experiences in order to find similarities and differences, and to avoid researchers' bias.
Because humanistic and existential therapies emphasize the psychological process and therapeutic relationship, alternative research strategies may be needed to understand the necessary and sufficient conditions for therapeutic change. For example, Carl Rogers "challenged psychology to design new models of scientific inquiry capable of dealing with the person's inner, subjective experience" (Cory, 1991, p. 218). Some 50 years ago he pioneered the use of verbatim transcripts of counseling sessions and employed audio and video recordings of sessions long before such procedures became standard practice in research and supervision.
The humanistic approach to therapy
Often referred to as the “third force” alongside behaviorism and psychoanalysis, humanistic psychology is concerned with human potential and the individual's unique personal experience. Humanistic psychologists do not generally deny the importance of many of the principles of behaviorism and psychoanalysis. They value awareness of behavioral history and the importance of childhood experiences and unconscious psychological processes. However, humanistic psychologists would argue that human beings are more than the collection of behaviors or objects of unconscious forces. Therefore, humanistic psychology is often described as holistic in the sense that it tends to incorporate and accept different theoretical traditions and therapeutic practices. The focus of many humanistic therapists is to create a therapeutic relationship that is cooperative, accepting, and authentic, and that honors the unique world in which the client lives. The humanistic approach is also holistic in that it assumes an interrelationship between the psychological, biological, social and spiritual dimensions of the client. Humanistic psychology assumes that people have an innate capacity for self-knowledge and mental health.
Some of the key proponents of this approach include Abraham Maslow, who popularized the concept of "self-actualization," Carl Rogers, who formulated person-centered therapy, and Fritz Perls, whose Gestalt therapy focused on the totality of an individual's experience in any given moment. Some of the essential characteristics of humanistic therapy are
empathic understandingthe frame of reference and the subjective experience of the client
Respectfor the client's cultural values and freedom of choice
exploration of problemsthrough an authentic and collaborative approach to help the client develop insight, courage and responsibility
exploring goals and expectations,including articulating what the client wants and hopes to achieve from the treatment
Clarification of the helping roleby defining the therapist's role but respecting the client's autonomy
Assess and increase customer engagement both collaboratively and authentically
negotiation of a contractby asking, formally or informally, "Where do we go from here?"
Demonstration of authenticityby setting the tone for a genuine, authentic encounter
These features can prove useful at all stages of substance abuse treatment. For example, immediately emphasizing the choice to seek help as a sign of courage; Assigning responsibility and wisdom to the client can follow. Respect, empathy, and authenticity must be maintained throughout the therapeutic relationship. Presenting wisdom to the patient may be helpful at later stages of treatment, but a patient who is currently using or has recently stopped (within the last 30 days) may not be able to make reasonable judgments about his or her well-being to fell future.
Each type of therapy discussed below differs from the others in how it would respond to the case study presented inFigure 6-1.
Figure 6-1: A case study.This case study is referred to throughout this chapter. There will be an example to which any kind of humanistic or existentialist therapy will be applied.Sandra is a 38-year-old African American woman who was abused(more...)
Client Centered Therapy
Carl Rogers' client-centered therapy assumes that the client holds the key to recovery, but suggests that the therapist must offer a relationship in which the client can openly discover and test their own reality, with real ones Understanding and acceptance on the part of the therapist. Therapists need to create three conditions that will help clients change:
Unconditional positive regard
A warm, positive, and accepting attitude that does not involve judgment or moral judgment
Accurate empathy, whereby the therapist conveys an accurate understanding of the client's world through skillful, active listening
According to Carson, the client-centered therapist believes that
Every individual exists in a private world of experience in which the individual is the focus.
The most basic aspiration of an individual is the preservation, improvement and realization of the self.
An individual responds to situations in terms of how they perceive them in a way that is consistent with their self-concept and worldview.
A person's inner tendencies are toward health and wholeness; under normal conditions, a person behaves rationally and constructively, choosing paths to personal growth and self-realization (Karson, 1992).
A client-centered therapist focuses on the client's self-actualizing core and the client's positive powers (i.e., the skills that the client has used in the past to deal with specific problems). The client should also understand the unconditional nature of the therapist's acceptance. This type of therapy does not aim to interpret the client's unconscious motivations or conflicts, but rather to reflect on what the client is feeling, to overcome resistance through consistent acceptance, and to help replace negative attitudes with positive ones.
Rogers' techniques are particularly useful for therapists trying to address a substance abuser's denial and motivate her to continue treatment. For example, motivational interviewing techniques draw heavily on Rogerian principles (see TIP 35,Increasing motivation to change substance abuse treatment[CSAT, 1999c], for more information on motivational interviewing).
Answer to the case study
A client-centered therapist would practice reflective listening, accepting the client and her past, and clarifying her current situation and feelings. As Sandra developed trust in the therapist, he began to emphasize her positive qualities and her potential to make meaningful choices in order to become the person she wants (and can) become. Choices that better reflect the values and principles it aspires to. She may want to tell her husband about her symptoms and try to strengthen their marriage.
When Sandra began to feel guilty about her past as a prostitute, the therapist showed appreciation for her struggle to accept that aspect of herself and emphasized the fact that she eventually decided to leave him. He may note that she did her best then and underscore her current commitment to choosing a better life. Sandra should be supported and accepted, not criticized. She would be encouraged to express her fear of death and the effect that fear is having on her. This could be the first time in their life that someone accepts them unconditionally or focuses on their strengths instead of their weaknesses. She obviously has a problem-solving ability, which is reflected in her return to therapy and her realization that she needs help. By being understood and accepted, her self-esteem and sense of hope would increase and her shame would decrease. She would feel supported in making important decisions in her life and she would feel more confident in continuing her recovery.
Storytelling therapy emerges from social constructivism, which posits that events in life are inherently ambiguous and the way people construct meaning is largely influenced by family, culture, and the knowledge and meaning contained in the stories that they hear and tell about their lives. Recent approaches to understanding psychological growth have emphasized the use of storytelling and mythology to enhance self-awareness (seeCampbell, 1968;Feinstein and Krippner, 1997;Middelkoop, 1989).
Parker and Horton argue that "studies in a variety of disciplines suggest that all cognition is inherently metaphorical" and note "the crucial role that symbolism plays in cognition" (Parker and Horton, 1996, p. 83). Offering the “perspective that the universe is made of stories, not atoms,” the authors suggest, “Myth and ritual are vehicles through which the value-impregnated beliefs and ideas by and for which we live are preserved and transmitted ” (p. 82). From this perspective, narratives reveal a deeper truth about the meaning of our experience than a factual account of the events themselves. As Feinstein and Krippner note, "Personal mythologies give meaning to the past, understanding to the present, and direction to the future" (Feinstein and Krippner, 1997, S.138).
As people tell and retell (with the help of a therapist) their life stories, the stories evolve into increasingly meaningful and healing constructs. When narrative therapists listen to clients' stories, they help them by finding alternative ways to make sense of events in their lives. In doing so, they help clients take authorship of their lives to rewrite their stories by breaking patterns and creating new solutions. Narrative therapy helps clients solve their problems by
To help them become aware of the meaning events in their life have taken on
Allowing them to distance themselves from impoverished stories by giving new meaning to their past
Help them see the problem of substance abuse as a separate, influential entity, rather than as an inseparable part of who they are (note the discrepancy between this statement and the AA member's statement, "My name is Jane, and I'm an alcoholic ")
Identifying exceptions to self-defeating patterns together
They encourage them to challenge destructive cultural influences that they have internalized
Challenge clients to rewrite their own lives from alternative and preferred scripts
Narrative therapy can be a powerful approach to getting clients to describe their lives and offering them opportunities to gain insight into their life stories and change those "scripts" that they lack for the therapistandThe client should become aware of the meaning of the story being told and its potential therapeutic value.
Narrative approaches to psychological healing have been used across cultures for thousands of years (Cat, 1993), but they have often been overlooked by mainstream mental health professionals. Contemporary approaches to narrative therapy recognize the importance of understanding how human experience makes sense. A person's life is influenced by the narratives they construct, which in turn are influenced by the narratives of those around them. Therefore, therapy is viewed as a collaborative attempt to increase clients' awareness of the ways in which events in their lives become meaningful. In effect, the therapist says, "Let's be curious about your story together."
The narrative approach often involves framing questions in a way that positions the problem as an external influence. "When the problem is externalized, it's as if the person behind it can see out" (Nichols and Schwartz, 1998, p. 412). For example, in treating substance abuse, a client might be asked, "How has substance abuse affected your life?" or "Have there been times when you have not allowed the addiction to take over?" Such questions can help to identify positive aspects and potential resources in people's narratives that can be improved, as well as gaps that need to be overcome.
In order to be understood, clients sometimes tell a story to enlighten the therapist about their culture or lifestyle. Therefore, it is imperative for the therapist to appreciate the unique influences (both positive and negative) of the client's specific cultural experiences and identity. Often these stories do not represent sharing in its usual sense. Listening to them, one can sense that these stories have been told over and over again over the years. Through this sense of storytelling - as oral history - we reveal our values, expectations, hopes and fears. For the therapist, a story provides insight into clients' responses, their need to act on the responses, and their desire to be heard or understood. A story can become an opportunity for a client to become both a participant and an observer to find new solutions or break down barriers.
Answer to the case study
The therapist may begin by asking Sandra to describe some of the important transitional moments in her life. These may include examples of loss of her innocence that occurred early in her life, her school experience, circumstances and influences related to prostitution and drug use, the experience of being supported by her husband, and internal resources that enabled her to become herself seek treatment and stay sober. The therapist asked questions about the expectations she had of family, society and herself. She might be asked questions like, "How has addiction affected your efforts to be a good mother" or "How has anxiety contributed to your recent relapse and feelings of hopelessness?" Positive aspects of her story and exceptions to destructive aspects of hers Narratives could be identified by asking questions such as, "Have there been times when you have not allowed addiction to make decisions for you?" and "How has your ability to accept love and support from your husband helped you?"
The focus of therapeutic dialogue could then shift to developing alternatives to hopeless aspects of personal and cultural expectations. It would be helpful to remind them that recent advances in medical treatment mean that AIDS may not be the death sentence it was once intended to be. Other important questions can help her develop an alternative story: "As you begin to understand the positive and negative influences in your life, what qualities do you need to possess to stay sober and develop better relationships with your husband and children ?" She may need help replacing these stories with more positive narratives about herself. When Sandra talks about the people and events in her life, like her childhood and her children, she can discover some of her feelings as well as the personal meaning of her story. She can experience much healing through the therapist's feedback and questions, which uncover the desires and emotions behind her story. A continued focus on recognizing, practicing, or even imagining changes in their history can initiate the process of developing new ways of life.
Transpersonal psychology emerged in the late 1960s as the "fourth force" in psychology and has strong roots in humanistic and existential psychology, Jungian analysis, East-West dialogue, and ancient wisdom traditions. Transpersonal therapy can be viewed as a bridge between psychology and spiritual practice.
A transpersonal approach emphasizes the development of the individual beyond, but inclusive of, the ego. It recognizes the human spiritual quest and recognizes the human quest for unity, ultimate truth and deep freedom. It cultivates intuitive modes of knowing that complement rational and sensory modes. This approach also recognizes the potential for growth inherent in "peak" experiences and other shifts in consciousness. Although grounded in psychological theory, transpersonal practitioners also tend to incorporate perspectives from ancient wisdom traditions.
The practice of transpersonal therapy is defined by its focus and scope, rather than by any particular set of techniques or methods (Borstein, 1980). Wittine proposes five postulates for transpersonal psychotherapy (Wittine, 1989):
Transpersonal psychotherapy is a healing and growth approach that recognizes the centrality of the self in the therapeutic process.
Transpersonal psychotherapy values wholeness of being and self-actualization at all levels of the identity spectrum (i.e., egoic, existential, transpersonal).
Transpersonal psychotherapy is a process of awakening from a limited personal identity to an expanded universal knowledge of oneself.
Transpersonal psychotherapy harnesses the healing, restorative nature of subjective awareness and intuition in the process of awakening.
In transpersonal psychotherapy, the therapeutic relationship is a vehicle for the process of awakening in both client and therapist.
Integrating knowledge and practices into everyday life is the goal of every therapy. Bringing the transpersonal dimension to the fore may require:
Exploring the "inner voices", including those of a higher self, that provide guidance for the individual's growth (Rowan, 1993)
Refinement of intuition or non-rational knowledge
Practice creativity in "formal" (art) or informal (personal relationships) encounters
cultivation of mindfulness
Use of dreams and images
These techniques can be explicitly taught and supported in the therapy session. Sometimes a therapist can directly cultivate changes in consciousness (e.g., through meditation [Weil, 1972], or imaginary labor [Johnson, 1987]) that provides immediate insight and inspiration that may not be available in more traditional ways (Hart, 1998). This can give clients a skill to practice on their own; Initiating such an activity represents a potential for brief intervention.
Transpersonal Therapy recognizes the need for fundamental psychological development to be integrated with spiritual growth (Nelson, 1994). Without such integration, there is a danger of "spiritual bypassing," in which issues of basic psychological functioning are sidestepped in the name of spiritual development. In other words, the basic psychological work should be done first.
Substance abuse disorders can generally be viewed as an attempt to fill a spiritual void. They can also be understood as the ego's defense against a natural drive for growth. As growth took place, the ego power would find that its dominance had been relinquished. Addiction, like spirituality, also raises questions of surrender (May 1991): for example, to whom and to whom do we surrender? What role does constructive devotion (regularly described spiritual traditions) play in a culture and psychology dominated by questions of rational ego control? How does constructive devotion become destructive and distorted into substance addiction? In addition, substance abuse can be understood as a means of getting out of a normal waking state of consciousness. This may be an attempt to fulfill an innate drive (Weil, 1972) for non-rational consciousness.
Answer to the case study
As the existentialists remind us, there is nothing better than death to capture our attention. A glimpse of death—for example, the aftermath of a serious car accident—reminds the witness of the value of life and brings up other issues as well. Sandra is now confronted with death from AIDS. This opportunity to face death and life head-on provides an opportunity to reconsider and reprioritize their lives. In fact, one might assume that the best catalyst for a short therapy might be a death sentence, precisely because it has the potential to wake a person up. In many ways, the goal of transpersonal therapy is to help the client wake up from habitual, mechanical routines that often rely on ego protection and move toward an appreciation that the individual is not bound by or limited by a limited ego this is defined. This can be seen as a transformation of identity.
Many inspirational cases of people confronting death, including death from AIDS, have shown that emerging spirituality can change the quality and direction of existence very quickly. For treatment, fundamentally sharing these experiences with a group of others in a similar predicament often quickly leads the client to overcome isolation and a sense of self-separation and to connect closely with others who understand her situation. This community can bring not only comfort and support, but also a deep sense of connection with humanity. In this case, breaking the shell of isolation can allow Sandra to make new connections with her family and with herself. A sense of connectedness, a central tenet and experience in the wisdom traditions, can replace their perceived isolation.
Sandra can use this opportunity to face possible death to begin the encounter and release feelings of guilt, shame, disappointment, and anger that have made her life less satisfying than it could be. can express unresolved problems clearly and symbolically. The application of rituals or rites of passage inspired by the wisdom traditions can provide a catalyst for shifting their consciousness through forgiveness and liberation.
The therapist may engage in a variety of methods (e.g. imagery, art or dream work, meditation, rituals) but the heart of the work lies in the simple and human spirituality that is conveyed through the therapist's loving presence along with the openness of the therapist to directly explore the full range of human experience. For Sandra, this experience can be seen as an opportunity to practice love and forgiveness, to move out of rigid self-separation, to face fears and to change her self-definition.
Gestalt theory states that the analysis of parts can never provide an understanding of the whole. In a therapeutic setting, this approach contradicts the notion that human beings can be fully understood through a rational, mechanistic, scientific process. Proponents of Gestalt therapy insist that a client's world of experience can only be understood through that individual's direct experience and description. Gestalt therapists try to help their clients become aware of themselves and the world. Discomfort with elements and experiences of the psyche remaining incomplete—principally past relationships and intrapsychic conflicts that remain unresolved in what Perls calls “unfinished business” (Pearls, 1969). According to the gestalt theory
The organism should be considered as a whole (physical behavior is an important component, as is a client's mental and emotional life).
Being in the "here and now" (i.e., being aware of the present experience) is paramount.
How is more important than why (i.e. causes are not as important as results).
The focus is on the inner experience of the individual.
For Gestalt therapists, the “power is in the present” (Upholstery and Upholstery,1973). This means that the "now" is the only place where awareness, responsibility and change can take place. Therefore, the therapy process is designed to help the client get in touch with the present moment.
Rather than seeking detailed intellectual analysis, the Gestalt therapist attempts to create a "safe emergency" in the therapeutic encounter. Perls' call to "lose your mind and come to your senses" implies that an emotional level experience, the "here and now," is the optimal condition for therapeutic work. This can be accomplished in a relatively short amount of time by explicitly asking clients to pay attention (e.g., "What are you aware of now? How does your anxiety make you feel?"). Therapist can suggest how the client could avoid the present moment through inauthentic "play" or relating such as "talking about" feelings rather than directly experiencing them. Patients may be asked to exaggerate certain expressions (e.g., punching their fists) or to role-play certain internal dialogues (e.g., through an empty chair technique). All of this can serve the purpose of helping clients move into the immediacy of their experience, rather than staying away from it through intellectualization or substance abuse.
The termContactin gestalt refers to the encounter with oneself and that which is different from oneself. There is no real encounter with the world without appropriate contacts and contact boundaries. Instead, one remains either swallowed up by the world on the one hand or remote from the world and people on the other.
Substance abuse disrupts the flow of what Perls called "organic self-regulation." The result is that individuals cannot achieve satisfaction of their needs and be unaware of their needs. The drug addict can distort or thwart the natural cycle at any of the following points:
mobilization of energy
Treatment involves creating awareness of each of these dimensions and the client's avoidance strategies.
Substance abuse can also be understood as “introjection,” in which the client attempts to “swallow” or “drink in” their environment whole without contact and discrimination. This type of client bypasses and blocks other experiences that might allow contact and the development of discrimination. Perls claims that such a client seeks an immediate match without preliminary contact. This interaction pattern extends to other relationships (besides substance).
For this work to proceed, the therapist must maintain a finely tuned present moment immediacy and even serve as a “resonance space” (Upholstery and Upholstery, 1973) for the customer's experience. They too must be able to establish and maintain contact with the customer and their own reactions.
Answer to the case study
The Gestalt therapist begins with Sandra's current experience of the world, beginning with awareness and awareness. The therapist can simply help her become aware of basic sights, sounds, somatic responses, feelings and thoughts, and what her attention is focused on. The face-to-face contact between therapist and client is part of the "now" where these sensations are directly explored. Therapist may notice her way of making eye contact or her wriggling body or stream of thoughts (e.g., "What's it like making eye contact now? What's the feeling in your body right now?") and ask about it.
Sandra can also identify specific issues such as substance abuse, relationship problems and the threat of death from AIDS that seem to dominate her life. The therapist might invite them to name and explore the sensation associated with, for example, the thought of death; perhaps this involves a feeling of emptiness, or a feeling of cold and darkness, or a feeling of being engulfed. She can then be asked to become those sensations - for example, the therapist can ask her to be "the void" and encourage her to speak as if she is that void. This can then open possibilities for a dialogue with the void by acting out the opposite polarity: separateness and choice. This could involve using an empty chair technique, where the client literally sits in the chair of the "emptiness," speaks as if she is, and then moves to another chair and responds in dialogue. A therapist could also explore her introjection through questions such as, "How is this emptiness different or the same as feeling from alcohol or in relationships with your children or husband?" She could also use the same technique to communicate with family members or certain aspects of herself to speak himself.
Sandra seems to have a lot of "unfinished business" that involves unspoken feelings (e.g., anger, longing, pain). Experimenting with these sensations can help her express and face these feelings more directly. All of this work encourages Sandra to experiment with new ways of relating, both in and out of session, to get into the "here and now" and work toward resolving "unfinished business."
The existential approach to therapy
The existential therapy approach emphasizes the following six theses:
All human beings have the capacity for self-knowledge.
As free beings, all must accept the responsibilities that come with freedom.
Each person has a unique identity that can only be recognized through relationships with others.
Everyone has to constantly recreate themselves. The meaning of life and existence is never fixed; rather, it is constantly changing.
Fear is part of being human.
Death is a basic human condition that gives meaning to life.
The core question in existential therapy is, "How do I exist?" in the face of uncertainty, conflict, or death. An individual attains authenticity through courage and is thereby able to define and discover their own meaning in the present and future. There are important choices to be made (e.g., to have true freedom and take responsibility for your life, you have to face insecurities and give up a false sense of security).
A core feature of the existential view is that an individual is a "being in the world" who has biological, social, and psychological needs. Being in the world includes the physical world, the world of relationships with others, and one's relationship with oneself (May and Yalom, 1995, p. 265). The "authentic" individual values symbolization, imagination, and judgment, and is able to use these tools to continuously create personal meaning.
Existential therapy focuses on specific concerns rooted in the individual's existence. Contemporary existential psychotherapist Irvin Yalom identifies these concerns asdeath, isolation, freedom,andEmpty.Existential therapy focuses on the anxiety that arises when a client is confronted with the conflict inherent in life. The therapist's role is to help the client focus on personal responsibility for decision-making, and the therapist may incorporate some humanistic approaches and techniques. Yalom, for example, sees the therapist as a "traveller" through life, using empathy and support to evoke insight and decision-making. He strongly believes that the relational context of group therapy is an effective approach because people exist in the presence of others (Jalom, 1980).
Preliminary observations and research suggest that individuals with low levels of perceived life purpose may be vulnerable to substance abuse as a coping mechanism. Frankl first observed this possibility in inpatient drug addicts in Germany in the 1930s (Frankl, 1959). Nicholson and colleagues found inpatient drug abusers had significantly less purpose in life compared to a group of matched, nonabusive controls (Nicholsonet al., 1994). Shedler and Block conducted a longitudinal study and found that low perceived meaning in life in young children preceded drug abuse patterns in adolescence (Shedler and Block, 1990).
In the context of treating substance abuse disorders, the existential therapist often serves as a coach, helping the client face the fear that drives them into substance abuse. The client then focuses on taking responsibility and making their own decisions to stay substance free. If he chooses to avoid the fear of substances, he cannot go forward to find truth and authenticity. The challenge for the existential therapist is to help the client make personal choices about how to live, drawing on creativity and love, rather than letting external events dictate behavior.
Time and existence therapy
While existential therapy may not have been designed for temporary practice, its underlying principles can be applied to a temporary setting in relation to the client's struggle for meaning in the face of death. Brief therapy (regardless of the modality) must deal with the “here and now”. Existential and short-term therapies also deal with the limitations of time. Hoyt suggests that the length of brief therapy should always be a topic of discussion and the therapist should take care to remind the client of their use of time and the scheduled time for the end of therapy (Hoyt, 1995).
Mann's model of temporary psychotherapy (Mann, 1973;Mann and Goldman, 1994), although partly based on psychodynamic theory, also uses an existential approach to the primacy of time. Mann's approach emphasizes the time limitation of brief therapy to help the client deal with issues of separateness and isolation. This makes it easier for the client to become involved and accountable for the recovery process.
Answer to the case study
An existential therapist can help Sandra understand that her diagnosis of AIDS is forcing her to confront the possibility of death and, consequently, to face the responsibilities that life throws at her. The therapist might do this by helping her understand that her life (like everyone else's) is finite. As a result, she is challenged to make sense of her life and to make difficult choices about her relationships and manners (or how she behaves).Notdealing) with drug abuse decisions. The focus of her therapy would be to choose the life she wants to live. The therapist would help her deal with anxiety constructively so she can find meaning for the rest of her life. This could be accomplished by engaging them in combat to take ownership of their decisions. She may be encouraged to 'play out' scenarios of decisions she faces and to acknowledge the fears and anxieties that accompany them. You may be asked, "What is stopping you from sharing your fears with your husband and accepting the possibility of his support?" or "Imagine expressing your love for your children and regretting your mistakes. In this way, the therapist would help her understand that making difficult decisions in the face of death is actually a path to finding integrity, wholeness, and meaning.
The teachings of existential therapist Yalom can be a useful resource in dealing with death-related issues, as he has worked for many years with terminally ill cancer patients, helping them use their crisis and danger as an opportunity for change (Yalom, 1998). . Yalom explains that although death is a major source of anxiety for a client, incorporating death into life can enrich life and allow one to live more purposefully.