The Existential Approach 16
Running head: THE EXISTENTIAL APPROACH TO GROUP THERAPY
The Existential Approach to Group Therapy
Jesse Rabinovitch
University of Calgary
Existential psychotherapy is considered principally as a form of thinking rather than as a particular style of group therapy. As opposed to other therapeutic techniques, existential therapy is not restricted to following any one particular form of delivery and can be used in conjunction with other counselling paradigms. Existentialists focus on four universal human concerns, referred to as the givens of human existence, including: death, isolation, meaninglessness, and freedom. This paper identifies the strengths and weaknesses of using existential therapy in a group format and provides examples of conditions that it has proved to be beneficial for, as well as conditions which it has not been beneficial for.
The literature review was conducted using a systemic search strategy. Electronic databases were used to search for relevant sources. These databases include: PsycInfo, Psychology and Behavioural Sciences Collection, Health and Psychosocial Instruments, and Google Scholar. Search terms used include: existential therapy, group therapy, logotherapy, meaning of life groups, and the givens of existence. This was followed by a search for specific sources based on the references of the articles received through the electronic sources.
The Existential Approach to Group Therapy
Aside from the four main focal points of existential therapy, a goal is to encourage clients to pursue a meaningful direction in life. Existential therapy can be used to emphasize group members’ freedom to choose what to make of their lives, and promotes a sense of personal empowerment among group members, allowing them to assume responsibility for their choices. Searching for meaning is another major premise of existential therapy. Therapists using existential therapy in groups convey the notion to its members that instead of regarding themselves as victims of their circumstances, they need to make meaningful choices that allow them achieve their goals in life. Discovering alternatives and choosing among them has been demonstrated as a successful means for accomplishing this goal (Somov, 2007). Differentiating between the dreadful dimensions of human existence and the opportunities for enhancing peoples’ lives is how group members will discover their true attitudes towards life and uncover their internal passions.
Strengths
Existential therapy is a unique form of psychotherapy that concentrates on the questions of existence. Its primary function is to enhance the self-knowledge of clients, and infuse them with the enthusiasm needed to take control of their own lives (Szasz, 2005). Issues involving the givens of existence (i.e. death, freedom, isolation, and meaninglessness) are central concerns of existential forms of psychotherapy, as these four topics are the major anxiety-provoking life events amongst humans. Anxiety is seen a positive attribute among existential therapists, and clients must seize it. Therapists applying an existential perspective to therapy believe that anxiety arises as the result of being confronted with the givens of existence, and this is how people are provided with instructions on how to live more authentic lives (Overholser, 2005). By discussing death, freedom, isolation, and meaninglessness, existential therapy provides clients with clarification as to what gives meaning to their lives. A lack of meaning is seen as a major source of existential stress and anxiety in the world. Corey (2008) suggests that “through the experience of existential therapy people enlarge their vision of themselves as being free to engage in action that aims at change” (p. 218). Existential therapy aims to broaden individuals’ perspectives of themselves, as well as their attitude towards those in the world around them. In the eyes of existential therapists, what we become is largely the result of the choices that we make, and thus we are held responsible for directing our own lives.
Death is conceived as an essential topic in existential work. This subject is seen as the key to discovering meaning and purpose within our lives. Research indicates that when we “accept the reality of our death, we realize more clearly that our actions do count, that we do have choices, and that we must accept the ultimate responsibility of for how well we are living” (Kinnier, Tribbensee, Rose, &Vaughan, 2001). By identifying with the fact that our time in this world is finite, we are able to look at our priorities, and to understand what it is that we value most. Existential therapists view counselling as an encounter in which therapists assist their clients with the demands of living while they are on separate paths with the same end point, death (Vontress, 1996). In existential therapy, death is acknowledged as a mechanism for helping individuals discover meaning in their lives. Challenging clients to become their authentic selves by engaging in life, and making a commitment to assuming responsibility, existential therapy seeks to help clients know and accept their limits. In relation to group therapy, existential therapy allows clients decipher the identities that they have assumed because of the conscious choices they have made. At the same time, existential group therapy provides clients with hope, as it teaches them that their identity is not cast in stone, and they alone have the power to give new direction and meaning to their lives (Corey, 2008).
Through intimate conversations that have significant emotional meaning attached to them, existential therapists strive to reshape clients’ self awareness and to activate an internal locus of control within them. This allows clients to live life to the fullest. Bugental and Bracke (1992) maintain that through the therapist’s concern, sensitivity, and presence, individuals are invited to disclose the core life issues that they are struggling with in their lives. By becoming truthful with oneself and the members in group therapy, individuals can more readily answer the question of what gives meaning to life for them, and apply the answer to their own life in an effort of taking control and assuming responsibility. By allowing clients to disclose the issues they choose to, existential therapy offers a sense of personal empowerment to group therapy, which members will likely apply to their personal lives and the choices that they make outside of therapy. Another significant attribute of existential therapy that makes it a beneficial approach to group therapy, is the fact that it focuses on creating collaborative relationships with clients (Overholser, 2005). Existential therapists view therapy as a partnership with clients and a shared venture that promotes a reciprocation of learning from one another. Not only can existential therapy be beneficial for clients in group therapy, but it can also be advantageous for therapists as this approach allows them the opportunity to bring their own subjectivity into their work as a means for broadening their own worldview. The function of therapists in existential therapy is primarily to display the ways in which clients are constricting their awareness, and the inherent costs of doing so. Existential therapy is a beneficial approach to group therapy that has proven to yield many positive results with various groups of people who seek counselling for a number of different reasons.
Weaknesses
While existential therapy is noted as a beneficial approach to group therapy due to its indefinite nature, the literature has noted several drawbacks to using existential therapy with clients in group settings. Overholser (2005) has noted that existential therapy is not very appropriate in short term counselling situations. More often than not, existential therapy will carry on for numerous months, maybe even years, and turns into a costly venture for clients due to its long-term nature. Clients looking for more convenient modes of group therapy that do not turn into such a long-term commitment will likely benefit from more solution-focused types of groups. Another downfall of existential therapy in relation to its application in group settings is that it is completely dependent on the skills of the therapist. Corey (2008) states that existential therapists must have a great deal of maturity, life experience, and intensive training in order to provide beneficial existential counselling to clients in a group therapy situation. Groups not looking to focus on matters that require intense discussion concerning the givens of existence would likely fare better with a more appropriate and shorter-term form of therapy. Another criticism is that because of its philosophical roots, practitioners who are not of a philosophic mind set may find it quite difficult to apply existential topics as they are lofty, abstract, and elusive (Buxton, 2005). In order to successfully deliver existential therapy sessions to clients, the therapist must trust in its ideals and have a deep understanding of the theory behind existential therapy’s focus on human existence. Aside from the therapist, clients must also be of a certain type for existential therapy to be effective. Group members must be enthusiastic and able to have a close relationship with others, as well as allow themselves to become engaged in a very intimate conversation in which they can be aware of and able to recognize their feelings on existential matters. Existential therapy is not effective for all groups, and similar to any other theory, it has its share of flaws. Existential therapy is a widely applicable treatment modality that has proven to be effective with many different counselling groups; however, it is not a therapeutic approach that everyone will benefit form. Both therapists and clients need to have certain existential qualities in order to take advantage of the philosophic nature of existential therapy.
Using Existential Therapy with Particular Conditions
From psychoeducational groups to therapeutic groups aimed at assisting rape victims, existential therapy is a broadly applied therapeutic format of group therapy. Existential therapy is a therapeutic approach that can be used in conjunction with many other forms of therapy, such as cognitive therapy (Kissane et al., 1997). Van Deurzen (1990) points out that existential therapy allows practitioners to take a distinctive approach, because therapists can shift their own stance on the issues being discussed. Aside from dealing with the givens of existence, the loose arrangement of the concepts to cover as therapy progresses allows therapists to employ a flexible format to groups. Existential therapy does not impose particular values and meanings on people, but rather investigates the values and meanings that group members attribute to their own circumstances. This enhances group members’ ability to engage on a journey of self discovery. By focussing on the universal commonalities between clients, existential therapy has proven to be effective for groups focussing on substance abuse, bipolar disorder, HIV infection, and numerous other groups of people with commonalities that may be difficult to deal with alone.
Bipolar Disorder
A recent treatment for bipolar disorder is that of existential psychoeducational groups. Existential psychoeducation is a type of phenomenological group therapy that assists group members in giving inner consent to their own actions (Goldner-Vukov, Moore, & Cupina, 2007). Researchers have stated that psychoeducation dealing with the givens of existence is a beneficial mode of treatment for individuals living with bipolar disorder because it has yielded results that demonstrate subjective improvement in self confidence, behaviours, and social functioning (Goldner-Vukov et al). Goldner-Vukov et al. suggest that the reason why the givens of existence provide such a useful platform for treating bipolar disorder is because individuals who have this cognitive impairment face these very challenges through their difficulties in: (1) dealing with others in the world; (2) dealing with their own life problems; (3) facing the challenges of being oneself and understanding those challenges; as well as, (4) rectifying concerns regarding the future and their identity. Death, freedom, isolation, and meaninglessness are issues which correlate to the literal challenges that individuals living with bipolar disorder face on a daily basis. Researchers revealed that their psychoeducational group with people who have bipolar disorder was so successful that it resulted in 90% of members attaining full-time employment and a 100% adherence with pharmacotherapy and follow-up (Goldner-Vukov et al.). The psychoeducational approach to treating bipolar disorder among university graduates yielded successful findings, demonstrating the beneficial nature of existential therapy to members in a group environment. As a result of group members’ better understanding of their illness, the psychological stressors they face, and the universality of existential conflicts, they were better able to develop adaptive responses to the adversity and cruelness that they fight day to day in their lives.
Breast Cancer
Previous research has demonstrated that women living with breast cancer exhibit higher levels of distress, concern with physical symptoms, anxiety, interpersonal difficulties, negative self perceptions as well as negative thoughts regarding the future when compared to women not living with breast cancer (Kissane et al., 1997). The morale of women who are fighting breast cancer is a clear side effect of the stressors of this condition. Psychosocial morbidity is a clear concern among women who are fighting breast cancer and beneficial interventions that focus on improving their quality of life are required. In response to this finding, Kissane et al. experimented with cognitive-existential group therapy for women with primary breast cancer. The group dynamic served a beneficial function for the members in terms of promoting self disclosure between members, and acknowledging the grievances to one another. Furthermore, the existentially focussed topics of anxiety about death and meaninglessness were demonstrated to exhibit the largest cognitive shifts among women with breast cancer toward an improvement in their quality of life. As the topic of death was confronted, members “began to accept cancer as a threat to life, and grappled with the reality of finitude” (Kissane et al., p. 28). The sharing of thoughts and feelings among members allowed them to feel less threatened by death and as a result, less isolated. As the group members shared more with one another, they were able to come to the realization as a whole that death is a natural part of life, but until that day comes, they can choose to live well. With an emphasis on honest confrontation and an attempt to provide group members with a sense of personal empowerment, researchers noted that an existential group approach was particularly useful because it demonstrated that only by recognizing that the members have control over their lives, can they begin pursue them meaningfully.
Substance Abuse
Existential therapy is a commonly applied form of group therapy for substance abusers. In existential therapy, an emphasis is placed on clients’ present state and how they must make the choice between using and not using. Research has demonstrated that narrowly defined self concepts are less stable than those which comprise of distinguished roles (Linville, 1985). A cardinal trait of substance abusers is that they have narrowly defined self concepts (Somov, 2007). As such, existential therapy seeks to bring the constructs of the mind to awareness. Research indicates that it is a successful therapeutic mode for assisting substance abusers toward the realization of accountability for one’s actions. Through the creation of a broader self concept, logotherapy in particular has received credit for helping clients achieve this goal as its aim is to help clients attain meaningful lives (Somov). Logotherapy is an existential technique which promotes client recognition in regards to how they alone are responsible for creating the quality of their existence (Frankl, 1963). The major theme of logotherapy is that life does not simply happen to us, but rather is the product of our choices; only by assuming responsibility for our decisions can we enhance the quality of our life. Through reshaping substance abusers’ self perception as addicts, logotherapy strives to help them establish a multidimensional self concept. Fuhrmann and Washington (1984) noted that upon completion of substance abuse interventions, addicts are likely to ask themselves “if there was any sense of their being cured and what they will do with the life that was restored to them” (p. 263). Somov notes that this is a reason why logotherapy will be a beneficial type of therapy for substance abusers; its focus on meaning. As opposed to incentive-based interventions that aim at helping clients initiate change, meaning-based interventions, such as logotherapy, assure the maintenance of change by assisting clients to establish and focus on their goals following the completion of therapy (Somov). The use of group therapy with an existential framework has been cited as useful because the group therapy environment “provides a safe setting for substance use clients to break through their social isolation and let go of their defences” (Fuhrmann & Washington, p. 62). With the assistance of other members as well as the group therapist, substance abusers can find the meaning in their lives that they had lost, and assume responsibility for their choices. Logotherapy is particularly applicable to this population of individuals because its theoretical foundation promotes the idea of recovery being a means to an end, rather than an end in itself (Somov). The usefulness of a logotherapy group for substance abusers lies in the safe environment that the group provides to members and the normalization of substance abuse that existential therapists offer to group members. Logotherapy allows clients to discuss substance abuse not only as a product of existential anxiety, but also as an existential coping choice.