EXISTENTIAL THERAPY – CHAPTER 12 – Flashcards

Seeks to confront the ULTIMATE CONCERNS & frequently tragic EXISTENTIAL FACTS OF LIFE, such as ISOLATION, SUFFERING, MEANINGLESS, EVIL, LOSS & DEATH - BUT instead of being said or overly intellectualized, CEP is a PRAGMATIC, CONCRETE & POSITIVE TREATMENT APPROACH! -It DOES NOT DENY or MINIMIZE the bad natures/circumstances of the human condition but instead is a realistically hopeful, holistic, and fundamentally Humanistic method of treatment *THE ULTIMATE PURPOSE OF CEP; is not to ameliorate painful psychiatric symptoms or to modify problematic cognitions & behavior BUT ALSO TO HELP PTN ACCEPT ASSERT & CREATIVELY EXPRESS THEMSELVES IN LIFE, TO FIND & FULFILL THEIR DESTINY* *-Places special emphasis on ANXIETY* as the "central problem" in Psychopathology & Psychotherapy -the proper attitude of both CO & CL toward anxiety & other negative affects is absolutely critical. PTN MUST BE TAUGHT to carefully listen to & confront their anxiety rather than reflexively running from it *Courage;* & consideration of its source, is another ultimate concern in CEP- they reconize the efficacious treatment requires more than removing the obstacles of growth.

Recognizes the human potential for both good & evil, the freedom to choose who & how to be within the limits of fate, & our responsibility for those choices, as well as the INNATE NEED FOR MEANING & PURPOSE *-VIEWS ANXIETY AS* A SIGNIFICANT & POTENTIALLY positive indicator or inner conflict & a critical call for growth or change- the anguish of anxiety is an unavoidable concomitant to human freedom, choice & responsibility. altho painful & at time debilitating, ANXIETY SIGNIFIES THE EXISTENTIAL STRUGGLE FOR MEANING, INTEGRITY & AUTHENTICITY -A core principle of ET is that chronically avoiding/repressing normal anxiety leads to pathological anxiety - ET encourages ACCEPTANCE & TOLERATION OF ANXIETY to a degree possible, so that the PTN might learn to see its Psychological significance, be productively motivated by it, creativity channel it & creativity live W/ it *-Kierkegarrd & anxiety being a teacher - PG 326* -*Courage & Creativity ;* is a central term in ET

FREEDOM, MORALITY, MEANINGLESS & ISOLATION

Refers to those naturally occurring, universal & inescapable elemental realities characterizing the human condition. -what all humans share in common, irrespective of background/demographic characteristics, their existence in a beautiful but crazy, dangerous & at times meaningless world.

We do our best to make sense of the world & to feel secure in it, BUT sooner/later reality shatters any illusions of "SPECIALNESS", a magical & often unconscious belief in our own immunity to life's tragic struggles rendering us susceptible to experiencing a EC -central to ET is the concept of an EC as both PERILOUS PASSAGE & PRECIOUS opportunity for transformation & growth

A crucial distinction B/W *"Normal"* (ontological or Existential) & *"Pathological"* (neurotic or psychotic) anxiety. *(PG. 325)*

Arises partially from the fact that human existence is transient & tenuous. We desperately seek the ILLUSION OF SECURITY thru material possessions, spiritual or scientific certainty, relationships, power or prestige, BUT this can be stripped away at any moment (ie natural disaster, economy collapse, terrorism attack, evil, violence). -The ever present possibility of death constantly threatening our very being. *-According to MAY; EA is essential & necessary part of fundamental & normal human processes such as growth & creativity* -EA can be conceptualized as a form of Death anxiety.

Entails a haunting feeling of EXISTENTIAL GUILT regarding unfulfilled possibilities that can manifest into NEUROSIS or at times even PSYCHOSIS. -CEP-therapists, influenced PARTLY by Maslow's humanistic psych- THEY STRESS SELF- ACTUALIZATION & ENCOURAGE PTN TO ACTIVELY PURSUE THEIR POTENTIAL & DESTINY AS A ANTIDOTE/PREVENTION OF DA -Noted by - Yalom (2009);a greater sense of life unlived leads to a greater dread of death -Inversely related to the degree to which one has authentically engaged in the process of SELF-ACTUALIZATION (Maslow).

*PTN are encouraged to become themselves, a process that DEMANDS terrific courage; THE COURAGE TO BE* -Adler Observed most ppl seeking counseling are deeply DISCOURAGED & in need of ENCOURAGEMENT

INDIVIDUATION or SELF-ACTUALIZATION requires courageous choices to constantly affirm our innermost values, meaning & existence in the face of forces that would destroy, diminish or negate our being. -We are responsible for actively choosing & defining ourselves *COURAGE IS ESSENTIAL FOR COPING EFFECTIVELY WITH LIFE'S EXISTENTIAL CRISES. ITS INDISPENSABLE TO CREATIVE SELF EXPRESSION, WHICH DEMANDS EXPOSING OUR INNERMOST BEING TO OTHERS & TO CREATIVELY SHAPING OUR EXISTENCES, AT THE RISK OF DISAPPOINTMENT & FAILURE*

-can be potent antidote to the EXISTENTIAL CRISES that typically leads PTN to treatment -*Creative endeavors;* can help constructively channel disturbing daimonic affects that might otherwise manifest as pathology, violence, and evil -ET acknowledges & deeply respects the PTN need for creative self expression. -it explicitly encourages the creative process in all its forms & ultimately the creation of ones self & ones contextual world -thru these projects PTN can transcend death & attain a type of immortality, -*Creativity* is BOTH DRIVEN BY & OFFERS an effective countermeasure to Death Anxiety *(creative blocks, and how this process is extended to the outer world & how it shapes our will, & how the consequences for the ppl who are unable to do this creative process) PG. 327*

*May reffered this as; any natural function which has the power to take over the whole person such as sex, anger or the will to power.-by definition its BOTH CREATIVE & DESTRUCTIVE depending on how the individual CHOOSES to relate to it* -This experience of being driven/possessed by some powerful emotion, impulse or idea is common place especially in Psychopathology & thus has far reaching Phenomenological validity relevance to therapy; -tho not every ETherapist embraces this idea and makes EXPLICIT use of this concept -Creativity thus provides a viable alternative to the negative expression of the DAIMONIC & to the PROBLEMS OF EVIL yet another of CEP's distinctive ultimate concerns *PG. 327- (Jungs notion of the shadow, the implicit existential paradigm of the daimonic, controversial topic of daimonic, mays approach to treatment W/ daimonic & critical attitudes that differentiates ET from most other current treatment approaches*

-Viktor Frankl- the dude W/ the statue of liberty on the east coast & statue of responsibility on the west coast -*A FUNDAMENT OF CETherapy IS THAT NEITHER FATE NOR FREEDOM IS ABSOLUTE, THERE'S NO FREEDOM W/O RESPONSIBILITY (VICE VERSA)* -One of the most confounding issues that PTN bring to Psychotherapy;RATHER EXPLICITLY OR NOT IS THAT OF PERSONAL RESPONSIBILITY; Commonly PTN make the mistake of either too little or too much responsibility for life events.

Refers to the Existential givens of life, those aspects of existence over which we can exert little to no control -We are NOT responsible for our fate

-To be free is to be FULLY responsible for our actions, to accept the EXISTENTIAL GUILT & ANXIETY that ALWAYS accompanies freedom -"Freedom is like a muscle that must be developed & exercised regularly a blessing but also a burden" -When we habitually repudiate responsibility for problematic thoughts, feelings , and behaviors and their adverse effects on others, we perceive ourselves as passive victims of fate & the power to creatively transform ones self, and relationships is diminished

Is related to the word DESTINATION - Refers to what we may become -We are responsible for our destiny *Destiny is NOT determined by fate, BUT how we RESPOND to fate*

-CEP's say there's time to resolutely accept or creatively use fate & time to courageously fight it -such Existential choices determine our destiny-the secret is to discover the balance among fate, destiny & responsibility W/O relinquishing our relative freedom to become who we wish, to creatively transform our circumstances & ourselves -when we find ourselves no longer able to respond adequately & in a constructive fashion to fate, we fall into despair

Is a universal human experience & a core concern to CETherapists - we all experience it- but typically it dissipates fairly quickly & life goes on

Occurs when despair deepens & becomes chronic, causing diminished quality of life & impaired daily functioning -deep discouragement, and loss of faith in ones ability to find meaning & fulfillment & to create a satisfactory future

Meaningless suffering of despair can be addressed by helping PTN courageously confront & discover some personal or transpersonal significance in their suffering. -Chronically avoiding or denying Existential despair, & the daimonic in general-sets the stage for clinical despair

Results when deep-seated clinical despair is marked by a sense of life's absurdity, loss of faith & courage & a bitter rejection of meaning, moral values, or any sense of Existential purpose -Commonly underlies the chronic depressive symptoms, malaise & ennui of individuals seeking psychotherapy

Entails a willingness to accept life wholly, the evil W/ the good the ugliness W/ the beauty & to love life & fate none the less - An apprehension of some ultimate concern along W/ absolute & unconditional faith in life having some "ultimate meaning" however is difficult to discern -CEP's view spirituality as a fundamental faith in life & in our responsibility & freedom to find & fulfill our destiny-to live courageously & creatively despite the constant threat of nonbeing & death

A way of making sense in a senseless world. -narrative patterns that give significance to our existence -B/C myths encapsulate eternal truths about the human condition emerging from our shared collective history, they can make life more rich & meaningful & help lessen our sense of existential aloneness -they reveal that our experience especially our suffering is not personal but also transpersonal or archetypal -this universal need for creating meaning thru myth makes it essential for the CETherapist to have at least some familiarity W/ the major myths of various religion & cultures

-Many of those who seek treatment today suffer from a disdain of ordinariness & a despairing or even nihilistic rejection of lifes seemingly absurd uphill labors -their existence seems meaningless W/O purpose -In support of this; one study found that 68% of PTN entering outpatient therapy reported seeking "increased meaning in life" was an important motivation for treatment -in another study about 30% of PTN manifested "major problem involving meaning" -Unequivocal Engagement or encouraging the heroic commitment to the total investment in life IS KEY CONCERN in CETherapy *(Yalom & Engagement, PG 331*

unlike other contemporary treatment approaches, ET does not define itself primarily on the basis of any particular technique -CETherapy DIFFERS radically from more technically based approaches in that the individual CO of what (if any) intervention to use must be a continual & conscious choice in response to whatever is phenomenologically emerging in the moment -sometime simple PRESENCE being as intently & fully focused on the here & now Encounter as possible, precludes the need for applying any specific technique leading to ET enigmatic yet effective technique of no technique -in addition to this extensive ecocentrism, CETherapy entails innovations life role playing, commenting on body language, nonverbal behavior, journal/letter writing, exercise, emphasizing PROCESS over CONTENT and other here and now interventions *Table 12.1 --PG. 331*

-What will best reveal the existence of this particular PTN at this moment in history? -What will best illuminate this PTN being in the world?

A fundamental premise of ET's is that the CO can accurately discern & empathically respond to the PNT true subjective experience of will intentionality, & being in the world only thru the disciplined practice of Phenomenology -The goal of Phenomenology; is to perceive the PTN true inner reality or being as directly as possible W/O excessive interpretation, valuation, distortion or dogma - this is the ultimate foundational clinical concern of all CETherapist's -The challenge is to become as mindful as possible of any preconceived frames of reference about PTN's & the practive of psychotherapy to reconize them as much & to consciously choose to "bracket off" or set them aside momentarily in order to become as present as humanly possible to the presents true being

The most precious quality for both CO & CL to cultivate in CEP is PRESENCE - *-In the (PHENOMENOLOGICAL METHOD);* facilitates presence which is essential to creating & maintaining the therapeutic relationship or "working alliance" & promoting awareness & development in the PTN -Existential presence is central to creating an authentic human encounter -B/C Presence is a part of ET its NOT a substitute for basic clinical skills, technique devoid of presence lacks the therapeutic qualities that make existential & most other psychological treatment effective

Refers to the critical moment of readiness & receptivity for recognizing some new understanding or resolution of ones presenting problem, as in common in the EC itself -its about actively seizing & making good use of that fertile moment, as it may never recur for the PTN -KAIROS LIKE PRESENCE RELATES TO BEING FULLY MINDFUL IN EACH MOMENT -At certain times in treatment a particular interpretation, recommendation, gesture, comment or other CO response can be profoundly transformative for the PTN -Such *Existential Interventions* are always random rather than planned out *-Existential Practitioners;* recognize that the effectiveness of therapy is not necessarily determined by the duration of treatment or the frequency of sessions, but by how well each present moment of each precious session is used therapeutically *EFFECTIVE E.T IS MORE ABOUT QUALITY THAN QUANTITY OF THE ENCOUNTERS B/W CLINICIAN & CL*

*Yalom* distinguishes B/W 2 primary components of psychotherapy; *CONTENT* v.s *PROCESS* -*Process;*meaning what happens verbally & behaviorally B/W PTN & Therapist Within the interpersonal relationship -*Content;* may be salient for only some (but not all) PTN's at some (but not all)stages of therapy - *TO BE AN EFFECTIVE THERAPIST U SHOULD NEVER TRY TO FORCE DISCUSSION OF ANY CONTENT AREA; Therapy should NOT be theory-driven, but Relationship-driven* -THE IMPORTANCE THAT CETherapy places on the QUALITY of a PTN-Therapist relationship characterized by Phenomenology, presence, empathy, authenticity, caring & kairos is robustly supported by research citing the Therapeutic Alliance as one of the common factors in every effective psychotherapy -CETherapy *REJECTS* the Classic Psychoanalytic notion of providing a passive "BLANK SCREEN" onto which the PTN's project/transfer their unconscious conflicts, although a Transferential element is sometimes present in the therapeutic dyad. *last paragraph on PG. 335*

From an Existential standpoint, the true dialectical challenge is to maintain sufficient scientific objectivity & distance while being able to simultaneously & authentically encounter & personally relate to the PTN -The act of SD by the ET, be it of personal history, circumstance, or countertransference, should be chosen ONLY WHEN CLEARLY IN THE PTN BEST INTEREST -This is the part that distinguishes Psychotherapy from friendships and other relationships *SIMPLY DISCLOSING PERSONAL DATA TO PTN'S IS NOT NECESSARILY THE SAME AS BEING FULLY PRESENT & COMMITTED TO THEM & THE THERAPEUTIC PROCESS* -The aim is always an appropriate degree of therapist SD , especially in the form of a willingness to genuinely share reactions, impressions, concerns, associations & feelings strategically implemented at the proper time *(KAIROS)* & for the right reason.

-Throw ins can make/break the outcome of therapy but they can be extremely difficult/impossible to quantify or replicate B/C even the same type of intervention varies significantly depending on who's applying it Is a unique notion as a therapeutic technique follows logically from the core clinical concepts of ETherapy -Yalom refers to this type of intervention techniques as *"THROW INS"* -*Yalom says* how a CO should have an exercise accompanying the CO's Improvisation technique *PG. 336*

To carefully monitor & be constantly aware of ones own Subjectivity & Countransference while remaining receptive to the PTN in the here & now & sensitive to the subtle Intersubjective relationship or unconscious phenomenological field existing B/W PTN & Therapist

*A form of Mindfulness;* that has long been practinced in ETherapy as central to the process of experientially discovering ones sense of self or being -1 of the CETherapists primary roles is to facilitate "the PTN conscious, mindful awareness of the infinitely subtle flux feelings, impulses, sensations and cognitions that make up his/her being in that moment to moment

The subjective experience on ones own existence & intentionality is intricately linked to exploring the implicit/explicit existential question; WHO AM I? -The non judgemental cultivation of presence & discernment in CETherapy is similar to the traditional practice of meditation & mindfulness intrinsic to Taoism & buddhism. *PG 337*

*PG. 337 - 338*

-What if anything, does the PTN make of it? -How did he/she feel during the dream & upon waking? -What Associations are made to each dream image?

Is viewed as more critical & potentially a transformative phase in the therapeutic process than merely as a specific endpoint. -How this is handled (or mishandled) can influence the treatment outcome. -Otto Rank & "End Setting"

-The anxious anticipation that happens leading up to Termination phase can stimulate some of the most intensive therapeutic work - for this reason it can in many cases be considered the culminating & most crucial stage of CETherapy -ONE OF THE MOST DEEP SEATED & DIFFICULT PROJECTIONS FOR PTN'S OR CL TO RELINQUISH; during termination phase is the unconscious belief in the ultimate rescuer, an omnipotent force or being that loves & protects us -Termination represents loss of a valued, supportive and intimate human relationship, there is a tendency for PTN's to avoid this or prolong their treatment -May says the true purpose of ETherapy is to set ppl free -appropriate & timely termination must be counted as central among the CETherapists ultimate concerns

-Have i attained my goals for therapy? -Can i continue to feel better & remain condifient W/O therapy? -Can i let go of the Therapist as "Ultimate Rescuer" & accept my Existential aloneness? -Am i strong & resilient enough now to handle the Existential challenges of life?

-Diagnosis is but a preliminary , tentative, & admittedly superficial step toward understanding the person's problems -It would be a critical error for CE Clinicians to completely dismiss the diagnostic process & appropriate use of psyh. meds as some still do this -When done expertly & compassionately diagnosis is an indispensable part of CE practice that doesn't need to be a reductionistic act of objectifying & categorizing a PTN. RATHER it can be a way of acknowledging & naming a persons EXISTENTIAL SUFFERING-in this way diagnosing can become a potent therapeutic intervention. -When a Mental Health Professional properly diagnosis a PTN symptoms he/she will rather willingly or not, has already begun to proffer some meaning & significance for that PTN suffering & to advance some hope for therapy salvation from tormenting psychological DEMONS like depression, psychosis addiction etc and other debilitating mental disorders

-Psychopharmacology is NOT ONLY compatible W/ CETherapy , but also can be complimentary to it -Mainstream theories of major psych. disorders tend to dogmatically presume a neurobio cause & thus routinely & automatically give meds. -CEpractitioners must consciously consider how to provide ethical & effective treatment to individuals suffering from SMI and symptoms that may require or benefit from meds W/O undermining the PTN freedom, personal responsibility & creativity or derailing the delicate therapy process -This Resulting to a ultimate concern for CETherapy is recognizing & dealing with the complex & subtle psych underlying today's psychopharmacology movement -Ultimately the task of the ETherapist is to conjure up the devils rather than put them to sleep -Altho taking meds or more responsibly manage distressing & potentially dangerous psychiatric symptoms may at some point be a critical & even life saving part of treatment, ETherapists believe this must always be in service of real psychotherapy & NEVER SUBSTITUTE FOR IT -The task of Existential Therapists is to conjure up the devils rather than put them to sleep PG 340

-First: Rather some emotional suffering is an inevitable existential fact of life that must to some extent be acknowledged & accepted, or merely a pathological problem to be medicated & eradicated -The 2nd question involves our general attitude toward the daimonic, since whatever their benefits, psch. meds tend to suppress the failure of therapy, rather than its success, when it drugs the daimonic, tranquilizes it or in other ways fails to confront it head on.

ET's believe that all individuals must confront & come to terms W/ the Existential facts of freedom, isolation, meaningless, evil & death - At the same time, individual differences in experience & expression of these concerns are important. -As a RESULT = CETherapy considers the situation of the whole person in the context of his/her culture & social relationships to be essential aspects of the PTN phenomenological world & therefore Important to their treatment -CETherapy recognizes what we always exist in a contextual world rather than as totally independent, encapsulated entities.-these contextual worlds contribute to individual differences yet we also are responsible for how we choose to relate to that world, & for transforming our innerselves & outer interpersonal world as creatively as possible -The objective of ET is to enable ppl to stand courageously in the tensions of life in a ways that ennobles & revitalises them , while taking account of the context of the horizons of the world in which they live. - this is especially appropriate for diverse demographic and clinical populations -ET has been explored in relation to Asian culture, religion & philosophy & thru a # of cases exemplify the course of CETreatment W/ Latino, AA & Native American CL-also may incorporate elements of Feminist therapy or employed in with LGBT community -A Contemporary existential treatment approach also can be applied to a wide spectrum of clinical situations using different modalities including brief and time limited as well as more traditionally open ended therapy -Issues for which kind of existential therapy may be applied to more than one person includes; domestic abuse, growth oriented support, chronic pain, PTSD, SMI, And severe physical illnesses -For the CE Clinician it isn't the PTN;s intelligence quotient, educational level, economic status social & psychiatric history nor even the so called psychological mindedness that matters so much as the therapists willingness to honor that PTN humanity -Always to empathize W/ the PTN Existential suffering & to enter respectfully and deeply into his/her phenomenon world is both the art and science of ETherapy, it's precisely this empathic, pragmatic, phenomenological stance that makes ET so amendable to addressing the Existential crises of diverse individuals in various settings

-FRANKS LOGOTHERAPY; is by far the most scientifically researched & validated variation of ETherapy -most of these studies have focused almost all on FRANKLS circumscribed technique of *"PARADOXICAL INTENTION"* (symptom prescription) as applied the treatment of diverse symptoms such as Insomnia, Urinary Retention, Agoraphobia, Anorexia, Blushing, OCD & Phobic Disorders. -Studies have been conducted across a variety of cultures on the logotherapy process itself, supporting its efficacy in treating anxiety, aggression, depression & low self esteem. -Recent study of logotherapy & Existential analysis reported statistically significant improvements in mental, physical & Interpersonal functioning in general therapeutic population

-Comparatively few well controlled scientific studies have been conducted to date explicitly measuring the clinical efficacy of CEP as a specific treatment modality -Some Contemporary Research is comparative in nature, exploring the relative utility of ETherapy vis a vis other approaches -Additional research has explored the value of existential interventions in a group setting *(Mosher L, significant philosophical differences B/W Existential & Psychodynamic Approaches) PG 343* *(Shelder, Bateman et al, Linehans, Wampolds 2001 study) PG 344*

-The field of PT now little more than a centry old is seen by some as being the midst of a kind of existential identity crisis, its future uncertain -The very idea of traditional "talk therapy" particularrly Existential & PPT threatens to be overshadowed by psychopharmacology, managed mental health care & attenuated methods of treatment such as CBT *PG 344 - 345*

-Despite signifigant differences in theory & method both Existential Therapy & Depth Psychology make the phenomenon of uncounscious expirience and ultimate concern -In many ways ETherapy & Depth Psychology complement rather than contradict eachother = *CET provides* a disciplines phenomenological method, technical improvisation & empathic humanis, *Depth Psychology provides* a dynamic richness, archetypal myths & accrued clinical wisdom in dealing W/ uncounscious -BOTH OF THESE PROSPECTIVES; are esential to the current& future practice & survival of PT, not only as they complement eachother but also as they compensate for the LIMITED SCOPE & depth of pharmalogic & CBsymtom focused interventions

-Independently less powerful these 2 classic theraputic approaches (ET & Depth Psychology) constitute a formidable force When allied synergistically together into an Existential Depth Psychology

*ETherapy;* is deliberate in its consideration of good as well as evil & in its attention to such life-affirming human experiences as love, beauty, awe joy & creativity. -Much like Positive psychologist, CET seek to make life more fulfilling & meaningful & to promote individual growth & happiness rather than concentrating sole on diagnosing & readmitting deficiencies & disorders -Positive Psychology's consideration of the whole person rather than reducing ppl to pathological symptoms seems consistent W/ May's phenomenological view that focusing exclusively on drives & deterministic forces fails to consider "the one to whom experiences happen, the existing person himself" -Central to positive psychology are the concepts of self-efficacy , resilience & learned optimist which correlate closely W/ the ultimate concerns of freedom, will, courage & personal responsibility in ETherapy -CET parts company W/ Positive Psychology at the point where so called positive aspects of existence are emphasized to the devaluation or denial of such tragic realities as suffering, meaninglessness, evil, death and the daemonic. -IN CONTRAST TO BOTH HUMANISTIC & POSTIIVE PSYCHOLOGY- where EXISTENTIAL THERAPY can be more accurately described as taking an attitude of "tragic optimism" or redemptive despair toward life.