Existential Approach to Counselling



Existential Approach to CounsellingLacey HastingsStenberg CollegeExistential Approach to CounsellingThere are many counselling theories out there, with different structures, different values, and different goals. Thus these differing theories allow for counsellors to vary in their approaches, to find theories that appeal to them, and that reside with their own values and beliefs about counselling. Existential therapy is a unique philosophical approach to counselling, focusing on the understanding of existence, and what it means to be a human being. Recognizing we are all faced with limitations however we have choices and responsibility in how we live our life’s. This approach is powerful in how it allows clients to recognize these limitations, come to terms with them and live with them constructively. The writer resonates with this approach, looking at all as equals, facing the same limitations, and strongly agrees with the ideas that individuals can benefit from being more self-aware and recognizing they have choices and possibilities, and thus taking more responsibility in their life’s. This paper will discuss existential therapy, and its unique and powerful approach to counselling, including a case study and a treatment plan utilizing this approach.HistoryThe historical background to this approach is that of 3,000 years of philosophy, with many philosophers contributing, and influencing the approach (Van Deurzen, 2010). The philosophers who are especially pertinent are those whose work is directly aimed at making sense of human existence. But the philosophical movements that are of most importance and that have been directly responsible for the generation of existential therapy are phenomenology and existential philosophy (Van Deurzen, 2010). The starting point of existential philosophy can be traced back to the last century and the work of Kierkegaard and Nietzsche (Vallejos & Shah, 2013; Young, 2000). Kierkegaard theorized human discontent and internal wisdom, while Nietzche furthered the theory with his ideas of free will and personal responsibility (Vallejos & Shah, 2013). In the early 1900’s, many more philosophers began exploring and contributing to existential philosophy, and Heidegger being one of them, ended up being one of the greatest influences on existential psychotherapy and counselling (Young, 2000), with his focus on the philosophical understanding of what is meant by ‘being’(SEP, 2011) . Philosophers, therapists, and psychiatrists such as Otto Frank, Ludwig Binswanger, Paul Tillich, Rollo May, Medard Boss, Hans W. Chron, Irvin Yalom, Emmy van Deurzen and more, have all made contributions in the development of existential psychotherapy and counselling over the years(Vallejos & Shah, 2013; Young 2000; Buxtom, 2005). There is no one school of existential therapy any more than there is one school of existential philosophy (Young, 2000).Theory and basic concepts and goalsExistential psychotherapy is not a specific technique or set of techniques. As discussed it is more philosophical in nature, focusing on issues central to human existence. These issues are called ‘givens of existence’, they are labelled as death, freedom, isolation and meaninglessness and are considered to be “an inescapable part of human existence” (Fernando, 2007, p.227). Young (2001). Human existence inevitably involves living with and towards these givens of existence, and having the responsibility of finding meaning in one’s life (p.74). Within these givens of existence is choice, and responsibility; and recognizing our own ability to choose can stir up existential anxiety (Fernando, 2007). Existential anxiety is a profound feeling of nervousness and worry that arises from our awareness of death, isolation, freedom, and meaninglessness (Fernando, 2007). This anxiety is the “response to our understanding that we have the responsibility to create a meaningful existence in the limited time we have available” (Bauman & Waldo, 1998; as cited in Fernando, 2007, p.230). Existential counselling focuses on working through the anxieties that come from these ‘givens of existence’, these problems in living that we are all subjected to (Fernando, 2007). Identifying them, living constructively with them, and gaining awareness of false assumptions and preconceptions about one’s life (Spinelli, 2006)-revolving around these anxieties. It is then about choices and responsibility, opening of opportunities, confronting difficulties, facing up to anxiety and taking control of one’s life. Clients often seek this therapy when they are feeling stuck, unable to change, feeling their life’s are restricted or lacking purpose (Young, 2001). With existential therapy the goal is to have clients come to realize they have more freedom then they may have thought (Young, 2001), they can adapt to these challenges or givens of existence, and that there is a possibility of a change in outlook, that their assumptions about themselves and their possibilities are just that, assumptions, that can be challenged.Therapeutic relationshipIn the relationship between counsellor and client, the counselor becomes “the catalyst of self-reflection in the quest for a healthier life” (Fernando, 2007, p.230). This approach becomes humanistic, whereas the therapist is not superior to the client, having respect for them as another human being, equal with one another facing the same ‘givens’ (Mulhauser, 2011). The counsellor is a co-explorer, exploring the client’s meanings, experiences and anxieties. The counsellor is not focused on freeing the client of anxiety or difficulties, but rather to help them accept, bear, and live constructively with anxiety (Fernando, 2007). The counsellor is in the here and the now with the client (Fernando, 2007), setting aside prejudices and theories, judgments and ideas of what is best for the client (Young, 2001). It is about being naive and open minded, and simply listening to the client, being with them, and hearing their concerns from their perspective (Young, 2000). The therapist creates a genuine, caring relationship, communicating on a human level and making every effort to “reach moments of authentic encounter” (Fernando, 2007, p.231)RelevanceThe writer has similar values and beliefs to existential theory, the writer believes we all have the choice to be who we want to be, to take responsibility, decide how we want to live our life’s, this is our freedom. We may have limitations that we are subjected to, but we have a choice in how we respond to these limitations. This writer also beliefs we are all equals, we all have weaknesses, limitations, anxieties and difficulties that we face. However we also all experience these differently and no one person can decide what is best for another. Being the therapist in the relationship does not make one superior, does not give us the answers for another human beings struggles. The writer agrees that a counsellor should be a ‘co-explorer’, taking a journey with their client, providing the atmosphere and the relationship to foster change. Like the existential approach, the writer doesn’t agree with focusing on diagnostic categories (Young, 2001), with labelling people, just to have a definable illness. Rather the writer believes the focus should be on the issues this client is facing, their feelings and experiences not their label or their diagnosis.Thus the existential approach to counselling fits with the writers values, attitudes and intentions for a counselling relationship. The writer would use this approach with any client facing limitations, anxieties and doubts in themselves, providing a trusting, caring, safe relationship between two equals, a relationship where an individual can explore, face and work through these concerns, these ‘givens’ of existence, and find meaning in their life and experiences.Case studyM.L. is a middle age aboriginal woman, with a developmental disability as well as suffering on and off with depression and anxiety. She has a long history of physical, sexual and mental abuse from her family, and has lost many people in her life. She was continuously told she was ‘stupid’, ‘retarded’, ‘useless’ etc., and this has had a lasting effect on her, where she has begun to believe these ‘assumptions’ about herself, that her life is essentially ‘meaningless’. M.L. is living a life she is not in control of or happy with. She is living in an apartment where she has spent years hoarding and collecting things, to the point where it is no longer livable. She has had numerous inspections and a threat of eviction. M.L. feels hopeless and ‘stuck’, and the eviction threat has further increased her anxiety and depression. M.L. blames this on past experiences, states she can’t fix it, and expresses anxiety about change, choices and responsibility.The writer has built a caring, trusting relationship with M.L over the time of workingWith her, demonstrating equality between them, allowing M.L. to feel comfortable discussing her concerns, beliefs and assumptions of life and herself. This allowed the writer to gain an understanding of M.L’s life or ‘existence’ as she sees it, while leaving out her own knowledge, prejudices, and interpretations. As noted in the literature, this allows for openness, allowing the counsellor to be available to the client, discovering what life is like for her (Young 2001; Spinelli, 2006; Van Deurzen, 2006). Through this openness the writer gained an insight into M.L.’s experiences, anxieties, and assumptions. Based on this, the NANDA nursing diagnosis chosen were ‘anxiety’ as evidenced by feelings of worry, fear, inadequacy and apprehension, and expressions of helplessness and ‘disturbed personal identity’ as evidenced by feelings of powerlessness and emptiness, and expressions of her life being meaningless. The goal while working with M.L. is to increase her self-awareness and explore her meaning and assumptions about life, for her to live constructively with her anxieties, live in the here and the now and take responsibility. For her to realize she has more freedom and possibilities than she thinks, and to start to make choices for herself. Existential counselling is not focused on specific techniques or interventions (Fernando,2007), it is focused on the counsellor’s attitude and the relationship with the client (Oliveira, 2012). It is about showing compassion for another human being, showing empathy, and developing a genuine and authentic client-counselor relationship (Fernando, 2007), as the client needs to relate deeply to the counsellor as a real person(Yalom 1980; as cited in Fernando, 2007), to allow for that exploration, self -awareness and action potential (Iacovou, 2009; as cited in Corbett & Milton, 2011). A research study of clients undergoing existential therapy suggest that a successful therapeutic relationship where progress can emerge (according to the clients themselves), is based on the counsellors ability to establish a humanized/substantial/authentic therapeutic relationship, as well as the therapist’s non-judgmental attitude which demonstrates openness and respect in the sense that he/she approaches the individual as a human being, not an object/pathology (Oliveira, 2012). Therefor this is the main ‘technique’ in M.L.’s treatment plan, to facilitate the relationship and space for her to further explore and reveal herself, and become more self-aware. As Yalom (2002) suggests, a “strong client/therapist bond can potentially be curative in and of itself “(as cited in Crosby, 2008).With M.L. the writer wants to focus on a here and now approach, leaving the problems ofThe past in the past, as M.L. appears to be stuck there, blaming all her current challenges on her past wrong-doings. It is suggested that when individuals stay focused on the past this perpetuates their flight from responsibility, and keeps them squarely in the victim role (Crosby, 2008) which is what was happening with M.L. In focusing on the here and now sessions are “energized and ahistoric” (Yalom, 1980; as cited in Crosby, 2008), allowing M.L. to focus on what she can do now, and become responsible for what she has control over, the present moment.While keeping in the here and now, the writer wants to gear conversation to the ‘assumptions’ and anxieties, M.L has about herself and her life, and challenge these assumptions. The writer wants to make a point to explore and acknowledge with M.L. that these anxieties are normal, they are part of life and part of being a human being, i.e. the writer will support her and let her know she is not alone, help her identify that she can live constructively with these anxieties. In challenging or questioning M.L.’s ‘assumptions’ , such as her being helpless, useless and not able to change how she is presently living, she will be asked to further explain and clarify, and thus potentially tease out these assumptions and focus on reality, allowing her world view to emerge (Young, 2001).In questioning her own firmly held assumptions about life and what is possible for her, it is hoped that M.L. will recognize she has more choice and possibilities than she has previously thought, and thus potentially become aware of her own responsibility for herself and her life (Young, 2001).Thus while working with M.L. the writer would keep a safe/trusting/authentic relationship, allow for exploration on behalf of M.L, keep focused on the here and now, and assists with the challenging and exploring of assumptions. In doing so this the hope is that this will allow M.L. to feel she is able to explore herself and her assumptions, focus on what she can do in the present time, and become more aware of all her possibilities, and thus responsibilities in life. In evaluating the progress, the writer would look for a slow progress in M.L.’s decision making, and action potential, is she beginning to take responsibility for her apartment and the state it was in, is she making progress? Is M.L. recognizing that she can make change, that she isn’t ‘stuck’. In evaluating if M.L. is dealing with her anxieties, the writer would identify if M.L. is constructively working with these anxieties towards change and responsibility, and taking steps in that direction. For the nursing diagnosis ‘disturbed personal identity’ the writer would evaluate if the explorations and discussions about her assumptions, her life and her experiences, are helping with M.L. to identify who she really is, what she wants from life, and what her responsibility is. This writer acknowledges this will take time; this is a life-changing process for the client, not a quick fix.ConclusionExistential counselling can be a powerful approach to counselling, focusing on deep philosophical understandings of what it is to be human and what it means to exist (Young, 2001).It is powerful in that it allows the client to explore their world, becoming more self-aware and opening up possibilities, accepting their limitations and anxieties, and taking responsibility for their lives. However,“Existential psychotherapy is not primarily a process to quickly and superficially fix, cure or eliminate people's problems, symptoms and anxieties. Nor to save or rescue them from their painful existential, psychological or spiritual suffering. Not to suppress or exorcise their demons, but to confront and consciously come to terms with them” (Kohn, 1984; as cited in Diamond, 2013). Thus existential therapy goes deeper than just eliminating symptoms and anxieties, it allows for one to recognize and confront them, learn to adapt and live constructively with them, and thus much more powerful than any quick fix. ReferencesCorbett, L., & Milton, M. (2011). Existential Therapy: A Useful Approach to Trauma?. Counselling Psychology Review, 26(1), 62-74. Retrieved from: , C. (2008). Existential treatment of personal and career concerns: A case study. International Journal of Existential Psychology and Psychotherapy, 2(2). Retrieved from , S. A. (2013). Secrets of Existential Psychotherapy (Part One). Dasein, 10, 68. Retrieved from , D. M. (2007). Existential Theory and Solution-Focused Strategies: Integration and Application. Journal Of Mental Health Counseling, 29(3), 226-241.Retrieved from: , G. (2011). An Introduction to Existential Counselling. Counselling Resource, Mental Health Library. Retrieved from:, A. (2012). Significant Events in Existential Psychotherapy: The Client's Perspective. Existential Analysis: Journal Of The Society For Existential Analysis, 23(2), 288-304. Retrieved from , E. (2006). Existential psychotherapy: An introductory overview. 3 (XXIV): 311-321. School of Psychotherapy and Counselling. London, UK. Retrieved from:, S. (2000).Personal construct counselling and psychotherapy. In Palmer, S. Introduction to counselling and psychotherapy: The essential guide (p. 186-198). London, UK: Sage Publications Ltd.Vallejos, M.N., Shah, P. (2013). Existential Psychotherapy. Good Therapy. Retrieved from: Deurzen, E. (2010). The Framework of Existential Therapy. Sage Publications.4030Ch-01.indd7. Retrieved from: ................
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