existential treatment plan

Running head: EXISTENTIAL TREATMENT PLAN

Existential Treatment Plan Michelle Deen, France Goulard, and Jaylene Betcher University of Calgary

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Existential Treatment Plan Client Name: Stuart Little Date of Birth: July 9, 1966 Date of Report: November 2, 2011 Presenting Problem: Stuart is dealing with a number of concerns. Foremost, he feels like he does not have the support that he needs from his friends and family members, specifically, from his mother and his children. He is experiencing difficulty accepting unpleasant emotions following his divorce and is frequently angry when he thinks about his children and their relationship with his ex-wife and her recent fiancé. He also feels a sense of loss pertaining to his life-style, his business, and propriety, which lead to an inability to let go of his past relationships. Treatment Goal: Although a number of concerns were presented, the two issues that Stuart would like to focus on during therapy are his inability to let go of past relationships, allowing himself to experience unpleasant emotions (e.g., loneliness and anger), and accepting that he cannot avoid these unpleasant emotions. On the other hand, the therapist would like Stuart to be more self-aware of  his role in his current situation, and accept responsibility for the choices that he has made, as well as help him to confront the anxieties that he is trying so hard to avoid. Working together over a number of sessions, the therapist and Stuart will collaborate to guide Stuart’s treatment. Treatment Plan:  Important Note: Note: Existential therapy is not a comprehensive psychotherapeutic process but a a model by which the therapist analyzes and comprehends a client’s frame of reference –  reference – a suffering in a particular manner (Yalom & Josselson, 2010). The Therapeutic Task: Support Stuart in Becoming Aware of and Confronting the Anxieties that he has Tried so Hard to Avoid Using an existential framework, Stuart’s therapist will help Stuart see that everyone experiences the four ultimate concerns of the human condition (freedom, isolation, meaninglessness, and death), which creates feelings of anxiety in everyone (Yalom & Josselson, 2010). She will encourage him to observe that existential (normal) anxiety is an inevitable part of the human condition and indicates that individuals recognize the need to accept responsibility for their lives and are engaged in efforts to create a worthwhile and meaningful existence. Comparatively, existential guilt and neurotic anxiety, which Stuart is currently experiencing, are a result of his failure to take responsibility for making his life meaningful and worthwhile (Corey, 2009). His current guilt and anxiety reflect his awareness that he has allowed his life to  be controlled by chance and circumstance. Therefore, Stuart’s therapist will act as his companion and co-explorer to help Stuart find value, meaning, and purpose in his life. The purpose of therapy will be to help Stuart become more aware of what he is doing to cause existential guilt and neurotic anxiety and to get him out of the victim role. Step One: Developing a Therapeutic Alliance

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The above case study lists a number of concerns for Stuart. For the purpose of this case study, the first step to be taken by the existential therapist is to develop a close and caring therapeutic relationship so that the therapist is a companion and co-explorer with Stuart (Corey, 2009). This type of relationship between Stuart and the therapist will be developed during the initial sessions with the therapist coming to an understanding of Stuart’s current reality and unconscious fears before helping him come to new understandings and options. There will be little opportunity for Stuart to look into his past since the therapist will want to focus on his current state and the anxieties he is dealing with now. The past is what has brought the client to the present and an existential therapist is working towards the future (Yalom & Josselson, 2010). Session Details: Prior to Stuart’s arrival, the therapist prepared the counseling room b y having two comfortable chairs placed face-to-face with a coffee table between them. Curtains were checked to minimize any glare and tissues were were placed on the table within easy reach of the client’s chair. chair. The therapist also spent a couple of quiet moments to clear her mind of external, prevailing thoughts from other clients in order to ensure Stuart had her full attention.

When Stuart arrived at his session, the therapist introduced herself and spent some time developing rapport in an attempt to make Stuart feel at ease and comfortable. Making general conversation about the weather and about how Stuart’s day da y had been so far started off the first session. To formally begin the session, the therapist asked Stuart whether he had received the counseling agency’s letter sent to confirm his appointment details and a brochure containing containing information about the counseling service including fees, hours of opening, qualifications of staff and map location. Stuart confirmed he had received the leaflet and said that it had been very useful and informative. Afterwards, the therapist asked if Stuart had any questions not covered in the information brochure or of the the therapist’s qualifications or therapy procedures. Stuart replied in the negative and the therapist proceeded to ask Stuart what had brought him to counseling. While the therapist waited for Stuart to start speaking, she maintained good eye contact and an open posture. After about twenty seconds of silence and looking down at the floor, Stuart finally spoke. “My life is a mess! I left my wife for anoth er woman and since it didn’t didn ’t work out with the other woman, who by the way was my dental assistant, I had to leave my job because I could not deal working with the other woman. My kids are getting older and soon will be out of the house, not like they enjoy being there as it is. My ex-wife ex- wife is now getting remarried and I’m trying to start up a new business business in my home but I’m I’m really just moping around the house. I just don’t seem to be able to move on with my life!” Before the therapist responded, she observed Stua rt’s emotional r eaction and reflecting concern and said, “You seem rather uncertain uncertain about all the changes that are going going on right now. What do you think?” Sitting back in his chair, Stuart replied, “Well, I know I’m pretty angry about what is going goin g on. If Sheera had been a better wife, less emotionally abusive, less neglectful towards my needs, I  probably wouldn’t have left the relationship. I blame her for a lot of this! And the kids would

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rather be with their mom and her fiancé because they are buying their affectio n.” Stuart continued telling the events of his life during the past year, pausing to take a deep breath or wipe his eyes occasionally with a tissue from the box nearby. Stuart described the emotional abuse from Sheera, how he began an affair with his dental assistant who appeared supportive of him and his career goals. goals. He also voiced his disappointment with his friends and family members, feeling that they blame him for the collapse of his marriage. marriage. He felt a lack of support from them. Throughout the conversation, Stuart voiced uncertainty about his future. The therapist continued to stay focused on Stuart emotionally and to use encouragers and reflections of feelings to confirm and validate his feelings. After one of many silences, during which the therapist had remained silent but attentive, Stuart looked up without speaking. The therapist concluded that this was an opportune time to summarize some of the issues Stuart had raised so far and said, “Stuart, you’ve described a huge upheaval in your life over the past year or so. With all of these changes, there comes a lot of uncertainty and anxiety. Where do you you think  this anxiety stems from?” Stuart replied, “Well, when the kids are gone to school or over to their mother’s house, I’m alone in that great, big house. I know I should be working working on this new business venture, but I’m just walking around from room to room. room. I guess I’m I’m worried that I’m always always going to be alone, that no one will love and care for me in my old age. This may sound silly, but I think that I’ll end up dying alone.” The therapist let Stuart vent all his worries and anxieties, expressing emotion that had been bottled up for a very long time. With the session nearly over, the therapist reviewed their results, discussed how Stuart should deal with the next few days before the next session and gave him a number to call in case of  emergencies. The therapist also provided him with an email address in case he wanted to touch base before the next session. Step Two: Understanding the Ultimate Concerns of the Human Condition In the upcoming therapy sessions, Stuart’s therapist must support him in confronting his deepest fears and anxieties about the expected challenges of life, such as freedom, isolation, meaninglessness, and death. Reviewing and reflecting on Stuart’s histor y will facilitate this process, and help him identify barriers that impede his movement toward an authentic and personally meaningful life (Yalom & Josselson, 2010). Freedom Although many human beings desire it, freedom can be terrifying as it conflicts with the innate need for structure and implies responsibility for one’s actions, choices, and life (Yalom & Josselson, 2010). Stuart often refused to take responsibility responsibili ty for his actions as he routinely blamed others and external events for his misfortu nes. For example, Stuart’s Stuart’s discontent with his marriage propelled him to employ defense mechanisms (blaming Sheera for emotionally abusing and neglecting him) to help ease the anxiety associated with accepting the responsibility for their marital issues. To help Stuart attain freedom, Stuart’s therapist not only nee ds to assist him with assuming responsibility for his present distress, but also needs to assist him with finding

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motivation to repair his relationship with Sheera, his children, and his mother (Yalom & Josselson, 2010). Stuart’s therapist must continually continually remind him that he is responsible for his choices, actions, and ultimately his past and present distress (Yalom & Josselson, 2010). Isolation Once Stuart begins to take responsibility for his life, it is likely that he will also encounter a sense of existential isolation. Existential isolation is the most basic form of isolation, whereby the knowledge of aloneness creates anxiety and sometimes terror (Yalom & Josselson, 2010). Stuart’s fear fear of isolation can be observed through his need for validation from others. For example, when Stuart felt emotionally abused and neglected by Sheera he sought an intimate relationship with his dental assistant, in which he displayed “suffocating” beh aviour aviour to alleviate the pain accompanying his feeling of isolation. isolation. To ease Stuart’s isolation isolation anxiety, Stuart’s therapist must support him in learning the limits of intimacy and what he can and cannot obtain from others (Yalom & Josselson, 2010). Furthermore, Stuart needs support in creating meaningful and mutual relationships with others, which may be addressed by modeling genuine and receptive interactions to Stuart during therapy sessions (Yalom & Josselson, 2010). Meaninglessness In an unpredictable world human beings often become unsettled and search for an explanation or meaning for their existence, if this search proves to be unsuccessful it may result in crisis (Yalom & Josselson, 2010). Stuart viewed his relationship with Sheera as the means for his existence. In high school Stuart felt validated when Sheera expressed interest in him, and throughout their marriage Stuart found meaning in his assumed role of the provider, which eventually drove Sheera away and resulted in Stuart feeling anxious and unwanted. To help Stuart re-discover re-discover meaning in his life, Stuart’s therapist needs to query and challenge Stuart to identify his belief systems, long-term goals and ambitions, and creative interests (Yalom & Josselson, 2010). Furthermore, Stuart needs to recognize and remove numerous obstacles (e.g. letting go of his past relationship with both Sheera and his assistant) that are obscuring his view of genuine meaning. Stuart is the author of his own life, and he must confront his beliefs and goals to find meaning for why and how he exists (Yalom & Josselson, 2010). Death

Of all anxieties that human beings experience, anxiety towards an inevitable demise is the most distressing, resulting in mechanisms to distract and decrease death’s terror (Yalom & Josselson, 2010). Stuart suppressed his anxiety towards death by always being involved in an intimate relationship, enjoying the company of his children (prior to the divorce), and assuming the responsibility of sole provider for his family. However, S tuart’s defenses against his anxiety towards death began to fade as major life events began to simultaneously occur (e.g. marital issues, affair, children getting ready to leave home, and diminished career). To help Stuart deal with his anxiety towards de ath, Stuart’s therapist must emphasize the significance of living meaningfully, as well as being aware of strengths and weaknesses in a context of free will and choice (Yalom & Josselson, 2010). Instead of constantly worrying about dying dying alone, Stuart must realize what he needs to change to live life with no regrets; ultimately using death to enrich life. Step Three: Understanding the Potentials of the Human Condition

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The unavoidable concerns of the human condition seem to present Stuart with a bleak  image of life; however, through existential therapy, Stuart and his therapist must now explore how he can use his various strengths (awareness, authenticity, freedom and responsibility, actualization, and making meaning) to transcend those inevitabilities (Corey, 2009). Awareness Stuart must come to realize that he has the capacity for awareness of himself and the world. The greater his awareness becomes the more possibilities that are open to him and the more successful he will be at addressing his fears and anxieties (Yalom & Josselson, 2010). For example, he must become aware of his role in Sheera’s emotional and ph ysical distancing from him as well as the role he played in their divorce. Once he is aware of these aspects he can truly address the underlying anxieties of freedom and isolation, which may have led to him cheating on his wife. Although awareness may not bring Stuart pleasure or peace, it will allow him to recognize the limitations and challenges in his life and enable him to make wise choices that can make his life worthwhile. Authenticity If Stuart takes responsibility for the choices he has made based on his new found awareness, he will demonstrate authenticity, which will allow him to live more fully in the present and he can can be himself in other relationships. For instance, when Stuart cheated on his wife with his dental assistant, he began to smother his new partner in an attempt to compensate for the anxieties of isolation that he was experiencing with his wife. Therefore, he was not experiencing authenticity authenticit y in his life. His decisions were based on denial and past losses (e.g., the failure of his marriage) and he became too dependent on his new partner. In other words, he was wearing a “mask of authenticity” (Yalom & Josselson, 201 0) that prevented others from truly knowing who he is. Freedom and Responsibility Once Stuart accepts that he has freedom to be aware, to make choices, to act, and to change (no matter what the circumstance), he will learn that he has the responsibility to: 1) be aware of his past history, his current options, and his future potential; 2) to make choices that give meaning to his life; and 3) to exercise courage and thought in taking action toward improving his life (Yalom & Josselson, 2010). Once he sees that he has freedom, he can no longer view his decisions and behaviors as purposeless and accidental, make excuses for himself  (e.g., sleeping with his dental assistant was ok because his wife was emotionally and physically unavailable), and shift the blame for his unhappiness to others (e.g., blaming Sheera for their divorce and blaming Sheera’s fiancé for for taking his wife and children). Overall, throughout this step, Stuart and his therapist will collaborate to help him assume responsibility for himself and recognize that he is the only one in charge of his life (not his ex-wife, his mother, his children, or his dental assistant). Actualization During the process of actualization, Stuart will come to realize his potential (as determined by his essential nature) and with the support of his therapist he will be lead towards growth and fulfillment (Yalom & Josselson, 2010). Specifically, Stuart must realize that his actualization has been blocked by his overwhelming fear of ending up alone, which may have

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lead to a forced marriage when he was younger and guilt caused by forcing his wife to stay at home to look after the children and then later cheating on his wife. Making Meaning Stuart’s Stuart’s awareness, recognition that he has freedom, his authenticity, and his will toward actualization will eventually allow him to know and face unsettling aspects of himself and the world, such as the inevitability of death and his ultimate aloneness, and to surpass these anxieties by creating meaning in his life (e.g., having a positive relationship with his children, his ex-wife, and his mother as well as continuing to build on his successful career as a dentist). Summary During existential therapy, Stuart was encouraged to become aware and examine his own subjective experience in the world, and to take responsibility for how he chose to be in the world. His therapist taught him how to reflect on his own anxieties and to accept his role in creating the problems in his marriage and in his relationship with others. In the final phase of existential counseling, Stuart’s therapist must now help him take what he has learned about himself and put it into action (Corey, 2009). He will soon be able to use his strengths and find ways to utilize them in order to live a purposeful existence.

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References

Corey, G. (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Brooks/Cole. Yalom, I.D., & Josselson, R. (2010). Existential psychotherapy. In R. J. Corsini & D. Wedding th (Eds.), Current Psychotherapies (9 ed., pp. 310-341). Belmont, CA: Thomson Brooks/Cole.