Existential Treatment of Anxiety

Question 1

What types of clients would you use Existential Therapy with?

Answer 1

1. Adults experiencing anxiety or depression not attributed to either biochemical influences or single incident traumas.
2. Adults or adolescents without significant outside sources of distress in their lives (spousal abuse, poverty, job loss, illness, divorce)
3. Adults or adolescents with significant verbal skills ( abstract conceptual thinking ability, large vocabulary, good verbal fluency and intellectual curiosity)

Question 2

After establishing report and doing an assessment, which anxieties are necessary to be distinguished?

Answer 2

1. Realistic (accidents, assaults, disasters)
2. Pathological (repeatedly paralyzed
   A. Neurotic (phobias) - Avoidable
   B. Personality Disorder (general) - Unavoidable
   C. Psychotic (no escape) Unavoidable
3. Existential (death/meaning)

Question 3

Once the distinction is made the therapist circumlocates the papameters of the anxiety. What are they probing for?

Answer 3

Times, settings and activities in which anxiety occurs and symptoms

Question 4

Why does existential anxiety occur?

Answer 4

Because the client bases their worth and meaning on something other than solid ground (ultimate purpose). If the individual’s sense of significance depends on wealth, power, fame, material possessions or beauty, he/she will likely be plagued with existential anxiety. The disturbance would be expected to continue until the individual adopts a more permanent basis for their sense of worth. This might include such sources as the love and acceptance of God, family members or friends.

Question 5

What is the primary agent of change in Existentialism?

Answer 5

The relationship between the client and the therapist

Question 6

How does the change occur?

Answer 6

Empathic support and focusing, and EMDR, Gestalt and Dual Chair Work

Question 7

What other technique does an Existential Therapist use?

Answer 7

Confrontation with reality (do you believe it could happen that way?)
Cognitive Challenges (would you feel that way?)
Paradoxical Intention (what if you encountered the worst possible situation, what would you do?)

Question 8

Existential Therapy goes beyond symptom relief? What does it involve?

Answer 8

At the core it involves self healing. The symptom is not to be eradicated, but rather seen as a marker to notify the individual in the therapeutic relationship

Question 9

Clients manifest existential anxiety in 4 major ways:

Answer 9

1. Flight (avoidance, Drugs)
2. Combat (struggle, anger)
3. Destructive Aggression (hate)
4. Paralyzing/Numbing (dissoc)

Question 10

What does the therapist seek to do

?

Answer 10

To induce authentic decisions and bring about responsible ways of dealing with life and the world

Question 11

What are clients encouraged to do?

Answer 11

Accept insecurity while embracing ultimate security

Question 12

Existential Therapy sometimes includes role-plays to develop?

Answer 12

Social Skills and art therapy to provide opportunities for creative expression

Question 13

Existential Psychotherapy
Format:
Length:
Setting:
Therapeutic Relationship:
Therapist:
Focus:

Answer 13

Format: individual or group
Length: long term - not just symptom removal but personal growth
Setting: seated, face to face
Therapeutic Relationship: encounter btw 2 human beings
Therapist: fully present, authentic, must be ready to confront his own ontological fears
Focus: on the individual, not the experience (human rather than the problem)

Question 14

Existential Psychotherapy Goals

Answer 14

1. To make use of a boundary situation or crisis (existential given or concern such as death, isolation, meaningfulness, freedom) ie) car accident, divorce, death of loved one
2. To bring the client to a point where he can make free choices
3. to understand the clients experiences of being in the world and their unconscious conflict (death-life, isolation-belonging)
4. To identify maladaptive defences (symptoms) against the primary anxiety
5. To diminish secondary anxiety by replacing it with more constructive methods of dealing with the primary anxiety. The goal is to decrease the primary anxiety to tolerable levels and to help the client to use it constructively.

Question 15

What is a primary anxiety?

Answer 15

anxiety originates in a situation of confrontation with such ontological givens as death, isolation, meaninglessness, and/or freedom. Such anxiety is too overwhelming to handle. People defend themselves against it. Such defenses help to reduce the primary anxiety but prevent people from growth and produce the secondary anxiety (fear of darkness)

Question 16

What is a secondary anxiety?

Answer 16

Anxiety about some object/situation, onto which the primary anxiety is displaced. It is more tolerable than the primary anxiety as a results of being less frightening, more concrete and simpler to deal with.

Question 17

What is the process of Existential Psychotherapy?

Answer 17

Attention is dedicated primarily to the here and now. the therapeutic relationship is used to identify defence mechanisms used by the client

Question 18

What is the application of Existential Psychotherapy?

Answer 18

used with various populations to deal with multiple issues, especially beneficial if short terms beh modification techniques fail.

Question 19

What are the exceptions to not use Existential Psychotherapy?

Answer 19

Exceptions: clients suffer from trauma, clients who are not highly educated, clients with a sensing personality vs intuitivity (Myers Briggs Personality Inventory

Question 20

Limitations of Existential Psychotherapy?

Answer 20

not validated empirically (subjective cannot be measured)

Question 21

What are the Concepts of Existential Psychotherapy?

Answer 21

1. Psychodynamic Conflict
   A. Life (possibility) vs Death (absence of possibility)
   B. Structure (in control) vs Nothingness
   C. Belonging vs Isolation
   D. Meaningfullness (need to construct meanings to fit the situation into a recognizable patterns Vs. Meaninglessness (no meaning and we live and die alone)

Question 22

What are the Concepts of Existential Psychotherapy?

Symptoms reduce anxiety but prevent the client from growth

Answer 22

Psychopathology
1. Confrontation with an ultimate given (death) as a result of some critical incident (car accident)
A. Desire to continue living
B. Realization of living into death
- Primary Anxiety
- Universal Defense Mechanisms
- Failure of these mechanisms - need for additional defense mechanisms
- Additional defense mechanism against the primary anxiety (clients symptoms)
- Secondary anxiety

Question 23

Stages of therapy

Answer 23

1. Beg the development of an alliance
2. Arousing and focusing the client’s capacity for self awareness
3. Disclosing and working through resistances
4. Confronting existential anxiety (lets go of defences, experiences anxiety and faces underlying conditions of being human (death destroys us and rescues us simulataneously)
5. Supporting new learning and new ways of being
6. Seperating

Question 24

Interventions:

Answer 24

It is not a collecting of techniques but an orientation. Techniques are used from various approaches to promote the clients awareness and acceptance of ontological givens, to empower the client and to make free and responsible choices and to redirect energy spent on defences against anxiety towards activities that are more constructive and meaningful for the client.

Question 25

What are some techniques?

Answer 25

1. Analysis of transference/countertransference
2. confrontation of the clients methods/instances of avoidance of responsibility
3. Dream analysis
4. Interpretation of the clients experiences
   owning technique (to own their feelings)
   Various exercises to promote the clients awareness of ontological givens