Section 6 Brief Humanistic and Existential Therapies Summary
Brief Humanistic and Existential Therapies
Humanistic and existential psychotherapies:
Employ diverse approaches to case conceptualization, therapeutic goals, intervention strategies, and research methodologies.
Share an emphasis on understanding human experience and focusing on the client over the symptom.
View psychological problems, including substance abuse disorders, as stemming from an inhibited ability to make authentic, meaningful, and self-directed choices about life.
Aim interventions at increasing client self-awareness and self-understanding.
Key words:
Humanistic therapy: Acceptance and growth.
Existential therapy: Client responsibility and freedom.
Shared Belief:
Humanistic and existential approaches both recognize people's capacity for self-awareness and choice, though based on different theories.
Humanistic Perspective:
Views human nature as inherently good, with the potential for healthy, meaningful relationships and choices beneficial for oneself and others.
Focuses on freeing people from disabling assumptions and attitudes to enable fuller lives.
Emphasizes growth and self-actualization over curing diseases or alleviating disorders.
Targets present conscious processes rather than unconscious processes and past causes.
Holds that problems arise from not being one's true self.
Uses the therapeutic relationship to foster psychological growth, aiming for a warm, accepting environment that trusts the client's inner drive for healthy actualization.
Existentialist Perspective:
Aims to help clients find philosophical meaning in the face of anxiety by choosing to think and act authentically and responsibly.
Considers central problems to be rooted in anxiety over loneliness, isolation, despair, and death.
Recognizes creativity, love, authenticity, and free will as potential paths toward transformation, enabling meaningful lives amidst uncertainty and suffering.
Acknowledges that suffering and losses cause anxiety, reminding individuals of human limitations and inevitable death.
Understands human influence as being shaped by biology, culture, and luck.
Assumes that problems arise from insufficient exercise of choice and judgment in forging meaning in life.
Considers life more as a confrontation with negative internal forces compared to the humanistic perspective.
Brief Therapy Application
Brief therapy requires rapid therapeutic alliance formation.
These therapies address factors shaping substance abuse disorders, such as lack of meaning, fear of death or failure, alienation, and spiritual emptiness.
They penetrate deeply into issues related to substance abuse disorders, often catalyzing the search for alternatives to substances.
The counsellor's empathy and client insight foster recovery by providing opportunities for new existential choices.
These therapies add self-respect, self-motivation, and self-growth, facilitating treatment.
Humanistic and existential approaches are well-suited for short-term substance abuse treatment because they facilitate therapeutic rapport, increase self-awareness, focus on inner resources, and establish client responsibility for recovery.
Clients may be more likely to envision recovery as a lifelong process of reaching their full potential.
Effective Use
These approaches may not always directly address substance abuse itself, requiring conjunction with traditional treatments.
Underlying principles can enhance any therapy by facilitating the client-therapist relationship.
Using Humanistic and Existential Therapies
Many aspects of humanistic and existential approaches (empathy, encouragement of affect, reflective listening, and acceptance of the client's subjective experience) are useful in any type of brief therapy session, whether it involves psychodynamic, strategic, or cognitive-behavioural therapy.
They help establish rapport and provide grounds for meaningful engagement with all aspects of the treatment process.
Emphasize lived experience, authentic therapeutic relationships, and recognition of the subjective nature of human experience.
Focus on understanding how reality is influenced by past experience, present perceptions, and expectations for the future.
Becoming aware of this process yields insight and facilitates the ability to choose new ways of being and acting.
Focus on Decision-Making
Help clients focus on the fact that they make decisions about substance abuse and are responsible for their own recovery.
Essential Skills
Therapist's personal philosophy must align with the theoretical underpinnings of these approaches.
The therapist must engage the client authentically to facilitate meaningful change.
Sensitivity to "teachable" or "therapeutic" moments is crucial.
When to Use
Useful at all recovery stages for creating respect and mutual acceptance of experiences.
Client-centred therapy can be used immediately to establish rapport and clarify issues.
Existential therapy is effective when clients can access emotional experiences or overcome obstacles to recovery.
Narrative therapy can help clients conceptualize treatment as assuming authorship of their lives.
Gestalt approaches can facilitate genuine encounters with the therapist and the client's experience.
Transpersonal therapy can enhance spiritual development by focusing on intangible aspects of human experience.
These approaches increase self-awareness, promote self-esteem, and empower clients to make choices.
Duration and Frequency
Empathy, meaning, and choice are central to these therapies, valuable for brief substance abuse treatment.
They increase therapeutic rapport and enhance conscious experience and acceptance of responsibility.
Episodic treatment can focus on the client's tasks and experience between sessions.
These therapies assume growth occurs outside meetings, focusing on broader problems as lifelong journeys.
Focusing on specific substance abuse issues provides a framework for change and discrete goals.
Techniques work well with other therapy types.
Initial Session
The opening session is extremely important in brief therapy for building an alliance, developing therapeutic rapport, and creating a climate of mutual respect.
The opening session should:
Develop the alliance
Emphasize the client's freedom of choice and potential for meaningful change
Articulate expectations and goals of therapy (how goals are to be reached)
Developing the alliance can be undertaken through reflective listening, demonstrating respect, honesty, and openness; eliciting trust and confidence; and applying other principles that emerge from these therapies.
Emphasizing freedom of choice and potential for meaningful change may be deepened by a focus on the current decision (however it has been reached) to participate in the opening session.
Expectations and goals can be articulated through strategic questions or comments like, "What might be accomplished in treatment that would help you live better" or "You now face the choice of how to participate in your own substance abuse recovery."
Early Phase
Engaging the client early is crucial due to time constraints.
"Engaging" includes boosting motivation for aspects like group therapy.
Early interaction patterns persist.
The initial experience's significance determines motivation; negative experiences deter, while positive ones encourage poorly motivated clients.
Compatibility with 12-Step Programs
Humanistic and existential approaches align with many tenets of 12-Step programs.
However, some may disagree with AA's identification of "disease" as a core trait or interpretations of "powerlessness."
Existentialism's free choice and free will might seem incompatible with 12-Step acceptance and surrender.
Yet, surrender must stem from conscious decisions.
AA's rigorous self-assessment—embracing limitations and acting by principles—harmonizes with existential and humanistic values.
Research Orientation
Traditional social science research stems from natural science, seeking causal relationships by isolating variables.
Behaviour or outcomes are quantified and statistically analyzed for objectivity.
This is useful for observable phenomena but insufficient for understanding lived human experience.
Von Eckartsberg: "Science aims for an ideal world of dependent and independent variables in their causal interconnectedness quite abstracted and removed from personal experience of the everyday life-world" (Von Eckartsberg, 1983, p. 199).
Blewett: "The importance of human experience relative to behaviour is beyond question for experience extends beyond behaviour just as feeling extends beyond the concepts of language" (Blewett, 1969).
Qualitative Approach
It's claimed to be more appropriate for understanding human experience (Giorgi, 1985).
The personal and unique construction of meaning, the importance of such subtleties as "the relationship" and the "fit" in therapy, and shifts in internal states of consciousness can be quantified and measured only in the broadest of terms.
Emphasizes understanding and description over prediction, control, and replication.
Narrative descriptions of experience are valued over statistical analysis.
Qualitative understanding values uniqueness and diversity as much as generalizability.
Objectivity is seen as illusory; goals include openness, participation, and awareness of subjectivity.
Intersubjective dialog aids in comparing experiences and avoiding bias.
Importance of Humanistic and Existential Therapies
Alternative research strategies may be required in order to understand the necessary and sufficient conditions for therapeutic change.
Carl Rogers: "Presented a challenge to psychology to design new models of scientific investigation capable of dealing with the inner, subjective experience of the person" (Corey, 1991, p. 218).
He pioneered the use of verbatim transcripts of counselling sessions and employed audio and video taping of sessions long before such procedures became standard practice in research and supervision.
The Humanistic Approach to Therapy
Humanistic psychology:
A "third force" next to behaviourism and psychoanalysis.
Deals with human potential and unique personal experience.
Values awareness of behaviour antecedents and childhood/unconscious processes.
Views humans beyond behaviours or unconscious forces; it is holistic.
Establishes collaborative, accepting, authentic therapeutic relationships.
Assumes psychological, biological, social, and spiritual dimensions are interrelated.
Assumes people have innate self-understanding and psychological health capacity.
Key proponents:
Abraham Maslow:
Popularized "self-actualization."
Carl Rogers:
Formulated person-centred therapy.
Fritz Perls:
His Gestalt therapy focused on the wholeness of an individual's experience at any given moment.
Essential characteristics:
Empathic understanding of the client's frame of reference and subjective experience.
Respect for the client's cultural values and freedom to exercise choice.
Exploration of problems through an authentic and collaborative approach to helping the client develop insight, courage, and responsibility.
Exploration of goals and expectations, including articulation of what the client wants to accomplish and hopes to gain from treatment.
Clarification of the helping role by defining the therapist's role but respecting the self determination of the client.
Assessment and enhancement of client motivation both collaboratively and authentically.
Negotiation of a contract by formally or informally asking, "Where do we go from here?"
Demonstration of authenticity by setting a tone of genuine, authentic encounter.
Usefulness in substance abuse treatment:
Emphasizing the choice of seeking help promotes courage; responsibility and wisdom are emphasized.
Respect, empathy, and authenticity are maintained.
Client judgment may be impaired early in treatment.
Figure 6-1: A Case Study
Application of humanistic or existential therapy to a case study. Sandra:
38-year-old African-American woman with a history of substance abuse (cocaine, heroin, alcohol, and marijuana) for 15 years.
Left high school, worked as a prostitute for 5 years, then as a sales clerk.
Has two children (daughter, 15; son, 18) living with relatives due to her substance abuse.
In treatment repeatedly, with periods of sobriety and minor relapses; married for 2 years to Steve, a substance-free carpenter who supports her sobriety.
Recently diagnosed with AIDS after being HIV-positive for 5 years; relapsed after learning about AIDS symptoms.
Seeks counselling due to fear about her marriage, concerns about children and job, and fear of death.
Client-Centered Therapy
Assumptions:
Client holds the keys to recovery.
Therapist facilitates discovery in an accepting relationship.
Therapist's role:
Offer a relationship where the client can openly discover and test his own reality, with genuine understanding and acceptance.
Necessary conditions for change:
Unconditional positive regard: Warm, positive, and accepting attitude without evaluation.
Accurate empathy: Conveying accurate understanding through active listening.
Beliefs of client-centred therapists (Carson, 1992):
Each individual exists in a private world of experience in which the individual is the centre.
The most basic striving of an individual is toward the maintenance, enhancement, and actualization of the self.
An individual reacts to situations in terms of the way he perceives them, in ways consistent with his self-concept and view of the world.
An individual's inner tendencies are toward health and wholeness; under normal conditions, a person behaves in rational and constructive ways and chooses pathways toward personal growth and self-actualization.
Focus:
Client's self-actualizing core, positive forces, and past coping skills.
Therapist acceptance and client's self-understanding.
Aims:
Reflect client feelings, overcome resistance with acceptance, and replace negative attitudes with positive ones.
Techniques
Helpful for:
Addressing denial and motivating clients.
Motivational interviewing.
Response to the case study
The Therapist:
Would offer reflective listening, accepting Sandra and her past, and would clarify her current situation and feelings.
Once Sandra developed a trust with the therapist, he would emphasize her positive characteristics and her potential to make meaningful choices to become the person she wants to (and can) become.
Goal of therapy:
Help her develop sufficient insight to make choices aligned with her values and principles.
Past guilt mitigation:
Express appreciation for her struggle to accept her past, highlight her choice to leave prostitution, and underscore her current commitment to choosing a better life.
Supported and accepted, not criticized, and would be encouraged to express her fear of death and the effects of the fear.
This may be the first time in her life that someone has been unconditionally accepting of her.
It is reflected by her return to therapy and her insight about needing help.
Outcome:
Self-esteem and hope would increase, shame would decrease.
She would feel supported in making critical choices in her life and more confident to resume her recovery.
Narrative Therapy
Origins:
Emerged from social constructivism and assumes events in life are inherently ambiguous and meaning is influenced by family, culture, and society.
Assumptions:
People's lives are shaped by language and the knowledge/meaning in their life stories.
Emphasizes storytelling for enhancing self-awareness.
All cognition is inherently metaphorical.
Significance:
Narratives reveal a deeper truth about the meanings of our experience than a factual account of the events themselves.
Personal mythologies give meaning to the past, understanding to the present, and direction to the future (Feinstein and Krippner, 1997, p. 138).
Process:
Life stories evolve into meaningful and healing constructions.
Therapists assist by identifying alternative ways of understanding events, helping clients rewrite their stories.
Narrative therapy helps clients resolve their problems by:
Helping them become aware of how events in their lives have assumed significance
Allowing them to distance themselves from impoverishing stories by giving new meaning to their past
Helping them to see the problem of substance abuse as a separate, influential entity rather than an inseparable part of who they are (note the discrepancy between this and the AA member's statement, "My name is Jane, and I am an alcoholic")
Collaboratively identifying exceptions to self-defeating patterns
Encouraging them to challenge destructive cultural influences they have internalized
Challenging clients to rewrite their own lives according to alternative and preferred scripts
Engaging Clients
Storytelling is a way of articulating a subjective, experiential truth, and it is important for the therapist and client to become aware of the significance of the story being told and its potential therapeutic value.
Contemporary Approaches
Therapy is a collaborative attempt to increase clients' awareness of the ways in which events in their lives become significant. In effect, the therapist says, "Let's be curious about your story together."
Therapist Questions
Helps situation the stories of the client as an external influence.
Such questions can help identify positive aspects and potential resources occurring in people's narratives that can be enhanced, as well as deficits that must be overcome.
Response to the case study
Therapist Actions
The therapist may initially ask Sandra to describe some of the important transitional moments in her life.
These may include examples of loss of innocence occurring early in her life, her experience of school, circumstances and influences surrounding prostitution and drug use, the experience of being supported by her husband, and internal resources that enabled her to enter treatment and maintain sobriety.
The therapist would ask questions about expectations she felt from family, society, and herself.
Question to shift the Narrative
The therapist then could ask, "How did addiction interfere with your attempts to be a good mother" or "How has fear contributed to your recent relapse and feelings of hopelessness?"
Question to find positive reinforcements
Positive aspects of her story and exceptions to destructive aspects of her narrative could be identified by asking questions like, "Were there times that you didn't allow addiction to make choices for you?" and "How has your ability to accept love and support from your husband helped you?"
New narratives
The focus of therapeutic dialog could then shift toward developing alternatives to hopeless aspects of personal and cultural expectations.
It would be helpful to remind her that recent advances in medical treatments mean that AIDS may not be the death sentence it was once thought to be.
Alternative Questions to create alternative narratives:
"As you begin to understand the positive and negative influences in your life, what qualities must you possess in order to remain sober and develop better relationships with your husband and children?"
She may need help replacing these stories with more positive narratives about herself.
Benefits of asking
As Sandra talks about the people and events in her life, such as her childhood and her children, she can discover some of her feelings, as well as the personal meaning in her story.
She can experience a great deal of healing through the therapist's feedback and questions that uncover the desires and emotions beneath her story.
A continued focus on identifying, practicing, or even imagining changes in her story can begin the process of developing new ways of living.
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Transpersonal Therapy
Background:
Emerged as the "fourth force" in psychology in the late 1960s, rooted in humanistic/existential psychologies, Jungian analysis, East-West dialogue, and ancient wisdom traditions.
It is a bridge between psychology and spiritual practice.
Emphasis:
Development of the individual beyond the ego.
Acknowledges spiritual quests, striving for unity, truth, and freedom.
Cultivates intuition alongside rational modes.
Recognizes growth potential in shifts in consciousness.
Incorporates perspectives from ancient wisdom traditions.
Defined by orientation and scope, not techniques.
Wittine's five postulates (Wittine, 1989):
Transpersonal psychotherapy is an approach to healing and growth that recognizes the centrality of the self in the therapeutic process.
Transpersonal psychotherapy values wholeness of being and self-realization on all levels of the spectrum of identity (i.e., egoic, existential, transpersonal).
Transpersonal psychotherapy is a process of awakening from a limited personal identity to expanded universal knowledge of self.
Transpersonal psychotherapy makes use of 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.
Integration Goal
Integrating insights and practices in everyday life is the goal of every therapy.
Bringing the transpersonal dimension to the forefront may involve the following:
Exploration of "inner voices" including those of a higher self that provides guidance for growth of the individual (Rowan, 1993)
Refinement of intuition or non-rational knowing
Practice of creativity in "formal" (art) or informal (personal relationships) encounters
Meditation
Loving service
Cultivation of mindfulness
Use of dreams and imagery
Shift in consciousness
A therapist may directly cultivate shifts in consciousness (e.g., through meditation [Weil, 1972], or imaginal work [Johnson, 1987]), providing immediate insight and inspiration that may not be available through more conventional means (Hart, 1998).
This may provide clients with a skill they can practice on their own; initiating such activity represents a potential for brief intervention.
Integrating insights
Integrating psychological development with spiritual growth (Nelson, 1994).
Without such integration there is danger of "spiritual bypassing,' where issues of basic psychological functioning are avoided in the name of spiritual development; the basic psychological work should be undertaken first.
Additional observations
Substance abuse disorders as an attempt to fill a spiritual void or to defend against a natural drive for growth.
Addiction, like spirituality, raises questions of surrender (May, 1991): for example, to what and to whom do we surrender?
Substance abuse may be understood as a means for shifting out of a normal waking state of consciousness; may be an attempt to fulfil an innate drive (Weil, 1972) for non-rational consciousness.
Response to the case study
Facing Death
Sandra is now confronted with death due to AIDS; is an opportunity to reconsider and reprioritize her life.
Catalyst To Brief Therapy
It could be argued that the best catalyst to brief therapy may be a death sentence because it has the potential to wake up an individual.
Helping the client move toward an appreciation that the individual is not bound to or defined by a limited ego, is the goal of transpersonal therapy. This can be seen as a transformation of identity.
Emergent Spirituality
Emergent spirituality can change the quality and direction of existence very quickly.
Community Support
Sharing experiences with a group of others in a similar predicament often quickly moves the client beyond isolation and a sense of self-separateness to connect intimately with others who understand her situation.
This community may not only bring comfort and support but also a deep sense of communion with humanity.
In this instance, breaking through the shell of isolation may enable Sandra to begin to make new connections with her family and with herself.
The core foundations for growth:
A sense of interconnection.
Many instances of people can begin to let go of such feelings as guilt, shame, disappointment, and anger that have kept her life less satisfying than it could be.
Methods for shifting her consciousness through forgiveness release.
Accessing the imaginal through art or dreams, for example, can provide a clear and symbolic expression of unresolved issues.
The use of rituals or rites-of-passage inspired by the wisdom traditions can provide some catalyst.
The therapist may engage in a wide variety of methods (e.g., imagery, art, or dream work, meditation, rituals).
The heart of the work is in the simple and humane spirituality that is embodied by the therapist's loving presence along with the therapist's openness to explore the full range of human experience directly.
Gestalt Therapy
Gestalt theory
Analysis of parts does not equal the whole.
Opposes rational, mechanistic views of human beings.
Client's experiential world is understood through direct experience.
Gestalt Therapy Goal
Seeks to help their clients gain awareness of themselves and the world.
Origins of discomfort:
Discomfort arises from leaving elements and experiences of the psyche incomplete, primarily past relationships and intrapsychic conflicts that are unresolved which Perls calls "unfinished business."
Core concepts:
See the organism as a whole (physical, mental, and emotional aspects).
Being in the "here and now" is paramount.
"How" is more important than "why."
The individual's inner experience is central.
For Gestalt therapists "power is in the present" (Polster and Polster, 1973).
Helping the client make contact with the present moment.
Perls's Invocations
Perls's invocation to "lose your mind and come to your senses" implies that a feeling-level, "here and now" experience is the optimal condition for therapeutic work.
Methods to have the Individuals look into themselves
Explicitly asking clients to pay attention (e.g., "What are you aware of now? How does your fear feel to you?").
The therapist may point out how the client could be avoiding the present moment through inauthentic "games" or ways of relating such as "talking about" feelings rather than experiencing them directly.
Clients may be asked to exaggerate certain expressions (e.g., pounding a fist) or role-play certain internal dialogs (e.g., through an empty chair technique).
They may all serve the goal of helping clients move into the immediacy of their experience rather than remaining distant from it through intellectualization or substance abuse.
The term contact in Gestalt refers to meeting oneself and what is other than oneself; without appropriate contact and contact boundaries there is no real meeting of the world, so one remains either engulfed by the world on one hand or, on the other hand, distant from the world and people.
The individual may distort or thwart the natural cycle at any of the following points:
Experiencing the need
Mobilization of energy
Contact
Satisfaction
Withdrawal
Rest
Treatment involves bringing awareness to each of these dimensions and the client's strategies of avoidance.
Introjection
Substance abuse may also be understood as "introjection" in which the client attempts to "swallow whole" or "drink in" his environment without contact and discrimination. This type of client bypasses and blocks other experiences that might enable contact and the development of discrimination.
Perls maintains that such a client seeks immediate confluence without preparatory contact; this pattern of interaction extends to other relationships (besides the substance) as well.
Therapist
Maintain a fine-tuned, present-moment immediacy, even serving as a "resonance chamber" (Polster and Polster, 1973) for the client's experience.
They, too, must be able to make and sustain contact with the client and with their own reactions.
Response to the case study
Starting point:
The Gestalt therapist begins with Sandra's current experience of the world, starting with awareness and attention.
Therapist actions:
The therapist may simply help her become aware of basic sights, sounds, somatic reactions, feelings, and thoughts as well as what her attention drifts to.
The immediate contact between therapist and client is a component of the "now" where these sensations are explored directly.
Therapist questions:
The therapist might notice and ask about her style of eye contact, or her fidgeting body, or stream of thoughts (e.g., "What is it like to make eye contact now? What is the sensation in your body at this moment?").
Sandra may also identify certain issues such as substance abuse, relationship difficulties, and the threat of death from AIDS that seem to dominate her life.
The therapist might invite her to name and explore the sensation that the thought of death, for example, brings; perhaps this involves a sense of a void, or feeling cold and dark, or a feeling of engulfment.
Acting techniques:
She then may be asked to become these sensations—for example, the therapist may ask her to be "the void" and encourage her to speak as if she were that void.
This may then open possibilities for a dialog with the void through acting out the opposite polarity: separateness and choice using an empty chair technique in which the client would literally move into the chair of the "void," speak as if she were that, and then move into an opposite chair and respond in a dialog.
Exploration of inner perspective:
A therapist could also explore her introjection through questions such as, "How is this void different or the same as from the feeling of alcohol or in relationships with your children or husband?"
She might also use this same technique to dialog with family members, or certain aspects of herself.
A great deal of "unfinished business"
Experimentation with these sensations may begin to free her to express and meet these feelings more directly.
All of this work encourages Sandra's experimentation with new ways of relating both during and outside of the session in order to move into the "here and now" and work toward the resolution of "unfinished business."
The Existential Approach to Therapy
Six propositions:
All persons have the capacity for self-awareness.
As free beings, everyone must accept the responsibility that comes with freedom.
Each person has a unique identity that can only be known through relationships with others.
Each person must continually recreate himself. The meaning of life and of existence is never fixed; rather, it constantly changes.
Anxiety is part of the human condition.
Death is a basic human condition that gives significance to life.
Focus question
How do I exist?"
Achieve Authenticity
An individual achieves authenticity through courage and is thus able to define and discover his own meaning in the present and the future.
There are important choices to be made (e.g., to have true freedom and to take responsibility for one's life, one must face uncertainty and give up a false sense of security).
Being in the world:
An authentic individual values symbolization, imagination, and judgment and is able to use these tools to continually create personal meaning.
Focus on Concerns
Existential therapy focuses on specific concerns rooted in the individual's existence such as death, isolation, freedom, and emptiness; the role of the therapist is to help the client focus on personal responsibility for making decisions.
Low Meaning in Life
Preliminary observations and research indicate individuals with low levels of perceived meaning in life may be prone to substance abuse as a coping mechanism.
In the context of treating substance abuse disorders
The existential therapist often serves as a coach helping the client confront the anxiety that tempts him to abuse substances. The client is then focused on taking responsibility and making his own choices to remain substance free.
The challenge for the existential therapist
To help the client make personal decisions about how to live, drawing upon creativity and love, instead of letting outside events determine behaviour.
Time and Existential Therapy
Although Existential therapy has the principles of the client's struggle for meaning in the face of death can be applied to a time-limited setting.
Brief therapy (no matter what the modality) must be concerned with the "here and now."
Both existential and brief therapies are also concerned with the limitations of time.
Time focus
Hoyt suggests that in brief therapy time should always be an issue for discussion, and the therapist should make a point of reminding the client of his use of time and the time scheduled for terminating therapy.
Mann's Focus
In Mann's approach, the time limitation of brief therapy is emphasized to help the client confront issues of separateness and isolation; this facilitates the client's becoming engaged in and responsible for the process of recovery.
Response to the case study
Assumptions to apply
An existential therapist may help Sandra understand that her diagnosis of AIDS forces her to confront the possibility of death and, consequently, face the responsibilities thrust upon her by life.
The actions of the therapist:
The therapist could accomplish this by helping her understand that her life (like everyone else's) is finite; therefore, she is challenged to forge meaning from her life and make difficult decisions about her relationships and ways of dealing (or not dealing) with choices about substance abuse.
The focus for the therapist
The focus in her therapy would be on choosing the life she wants to live.
The therapist would assist her in dealing constructively with anxiety so that she can find meaning in the rest of her life.
She may be encouraged to "play out" scenarios of choices she faces and acknowledge the accompanying fears and anxieties.
Helpful questions for the therapist:
, "What keeps you from sharing your fears with your husband, and accepting the possibility of his support?" or "Imagine yourself expressing your love for your children and regret for the mistakes you have made."
The therapist would help her understand that making difficult choices in the face of death is actually a way to find integrity, wholeness, and meaning.
Teaching of Yalom:
The teachings of the existential therapist, Yalom, can be a useful resource in dealing with issues related to death, since he has worked with terminally ill cancer patients for many years, helping them to use their crisis and their danger as an opportunity for change.
Yalom explains that although death is a primary source of anxiety for a client, incorporating death into life can enrich life and allow one to live more purposefully.