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Existential Therapy Case Review

Read the Theories in Action: Existential Therapy below, and imagine this client came into your counselling practice.
1. Discuss the various assessment tools you would use to tap into the issues she presented. Explain why you selected these assessment tools.

2. Identify what other questions you might ask her in order to explore the biological, developmental, and psychological components of assessment.

3. Write a brief assessment of the individual client, based on what you have learned in the role-play. Include a description of the presenting issues and treatment goals for future work

Theories in Action
Existential Therapy
Mr. Tim Seibles

Existential therapy is loosely based on existentialism such as the writings of Jean Paul Sartre and Martin Buber. However, its application as a therapy is actually much more optimistic than the writings of many existentialist authors. Existential therapists believe in the importance of discussing the philosophy of existential therapy and view therapy as a shared journey that examines meaningfulness in life. Thus, it is not unusual for existential therapists to share their knowledge about living and dying. And even to periodically self-disclose as they attempt to develop an authentic relationship with their clients. Because existential therapy is based on the sharing of a philosophy, it does not offer specific techniques for doing therapy. However, some argue that sharing of philosophy is a technique in itself.

Some of the underlying assumptions of this philosophy include the following: The ability to self-reflect and be self-aware. Although individuals often choose a life of denial, they are capable of self-reflection and self-awareness. Feelings as a message of our being in the world—anxiety, guilt, depression, and other feelings are statements about the choices we make and should be examined in this context, not as an indication of pathology.

Choice. We are capable of making positive choices for ourselves and for all of humanity. Not choosing is a choice and can lead to what some have called an existential death or existential vacuum.

Responsibility. We have a responsibility to make choices that will positively affect ourselves and others. Otherwise, we all will live in chaos, meaning through our relationships with others. We are constantly redefining ourselves through our relationships. Therapy is a journey through which the therapist and the client are equal partners in their search for meaning.

The importance of authenticity. It is critical that we are real with others. Otherwise, we live a life of lies and deceit. A life filled with denial of ones true feelings and inner thoughts, a never-ending search for completeness and wholeness. As we become more authentic and more aware, healthy choices become more obvious and easier to make. However, due to the complexities of life, we will be faced with choices, sometimes difficult ones until we die. Let us see how Dr. Ed Neukrug applies this philosophy with his client, Betty, in their shared existential journey:

Dr. Ed Neukrug
Well Betty, I want to thank you for coming in today and agreeing to share some of your thoughts and concerns with me. I am just going to open it up and you can start wherever you like.

Betty
Well, I just recently retired from the police department and I am moving into a profession now with counseling where I understand that I will need to have some type of closeness or relationship with my clients. But I really do not have any that much experience in that regard because of my work and like the only substantial relationship I have had was with my mother.

Dr. Ed Neukrug
(Highlighting Intimacy Issues) This is fascinating. I find the contrast between being a police officer and a counselor interesting, especially when you talk about the fact that you—it sounds that you want some intimacy in your life but you have not really had that except for with your mother. And so there is a stark contrast there between—again, between being a police officer and being a counsellor. It sounds that you want to move into that direction of having more intimacy in your life in general.

Betty
Yes. It is just—I just find it hard to talk about.

Dr. Ed Neukrug
(Focusing on Difficult Feelings) Which part is hard to talk about?

Betty
("Feelings as Message About Self") The intimacy part and I do not understand how to work it. How to work it out because there are certain aspects of myself that I just did not acknowledge—I ignored. I would say the emotional part of myself was not honored and now that I am stepping out of a role which I had a script.

Dr. Ed Neukrug
Right.

Betty
I had the uniform. I knew what I had to do. There was no question about what I had to do each day.

Dr. Ed Neukrug
Right.

Betty
It was like a mantra. It was like something I did everyday.

Dr. Ed Neukrug
Right.

Betty
And now, I have to be—I have to come out of myself.

Dr. Ed Neukrug
(Highlighting Life of Inauthenticity) Right. It almost sounds robot-like that you kind of lived a role, and in fact, you even said it, you wore a uniform and you put a certain image out to the world. The image which was maybe not the real you as you saw yourself inside. And now you are really searching for who that inner being is.

Betty
Right. Moreso, also working in an environment that has been historically racist and sexist.

Dr. Ed Neukrug
Yes.

Betty
You tend to want to be invisible. I mean I tend to want to be invisible and not be upfront, so open about who I was. It was like I was just following the role being the good girl.

Dr. Ed Neukrug
Right.

Betty
And the womanhood was not honored. It was a minor thing and it was not just—it is just not talking about the people. I am talking about with myself and now it is coming out. That is who I am.

Dr. Ed Neukrug
(Empathy) OK, so you have found that in that environment of being a police officer—am I correct in hearing that you personally experienced racism and sexism and that was very difficult for you and you kind of hid. Is that accurate?

Betty
Yes.

Dr. Ed Neukrug
OK.

Betty
The way I dealt with that was to feel like I had to achieve in order to be accepted. It was conditional. I do not know what else to say about that. It was hard lessons. I learned a lot. I also had to look at how my role in all of it.

Dr. Ed Neukrug
(Choice to Hide Real Self) Right. You made some difficult choices I think as a police officer in terms of how you are going to live your life because of the sexism and the racism, and just the nature of being a police officer. And the choices were—and maybe they were not even that conscious. It sounds like the choices were kind to kind of hide your real self.

Betty
Well, it was not that like it was true. I was not conscious. I had to come to this point that reading books and looking at other people to realize how much of myself was unconscious of what I was really doing. It was detrimental to me as a person, and emotionally. So now that I have to work with people in that area, I need to know myself and how to be in the world authentically.

Dr. Ed Neukrug
(Inquiring About Newfound Search for Self) Well, I am certainly impressed that this is—that you switched roles like that and then this is your new goal for yourself. I am really interested with how you were able to raise your consciousness around your lack of awareness of self and your lack of intimacy and how you are playing roles. How did you do that?

Betty
Well, I would say it happened in two different ways. One way was books. There was a book I found called Black Feminist Thought. That really opened my eyes a lot. And also, when my mother was sick, I realized I was working and I realized that the role of caring in the heart is so much more important to me in this life than the—I do not know how the other way to put it—than the masculine way of being.

Dr. Ed Neukrug
OK.

Betty
Being out there, and then the role of caretaking when my mother was sick was very important. I had to like really open up to that, and that takes a lot of courage.

Dr. Ed Neukrug
(Affirming Client) Yes, it does and I hear how courageous you were. (Advanced Empathy) And I think I am also hearing kind of these two parts of yourself that are being opened up at the same time and that was that feeling part of yourself through your mother's illness. And also kind of the intellectual part of yourself through this book that you read and all the other books that you read. Both of those kind of raised your consciousness (Search for Authenticity and Meaning) about the importance for you that you found more authenticity in your life.

Betty
Because when you watch someone suffer, which is hard, I mean with the police work, it was more of a detached, pseudo kind of presence I guess and you knew that you had to bind yourself emotionally to get through it.

Dr. Ed Neukrug
I see.

Betty
It is not a bad thing because sometimes you need to do that.

Dr. Ed Neukrug
Right.

Betty
But I just do not know what to do with it. And when my mother was sick, I had to really look at those feelings and trying to integrate that. That was really hard, a lot of anger and all that.

Dr. Ed Neukrug
(Empathy) So again, your mother's illness really made you look at yourself in some deeper ways.

Betty
Right. I had to make decisions. I had to balance work and I was at the hospital with her a lot. So I had to balance work and be there or make the decision to leave work and be there. Leave so I had to—it was like—I do not know if this makes any sense but it was like dealing with my mother and father. Like the police department to me was like my surrogate father.

Dr. Ed Neukrug
OK.

Betty
Where you were like—not exactly I would say a balanced view of a father, but you had to be there. You had to stay strong. You had to do your job. But with my mom, it was different. I had to be open and receptive and feeling like you say—get in touch with the feelings.

Dr. Ed Neukrug
(Self-Disclosure/Shared Journey) Yes, I think I can really understand what you are saying. I had kind of a similar experience with my mom who is ill a few years ago and passed away. It was like I was living two lives in some ways. Is that kind of the experience that you had?

Betty
Yes. Yes exactly, living two lives.

Dr. Ed Neukrug
Yes.

Betty
Yes.

Dr. Ed Neukrug
(Gift of Search for Self) And I guess in a way—and I hope you understand how I mean this—the gift that your mom gave you in her illness was to help you see a deeper part of yourself.

Betty
All right. Yes absolutely, because I did have to walk through that and see—I mean I really had to just be there and connect with the deeper part of myself, which was not very easy or pretty. Life was very messy.

Dr. Ed Neukrug
(Chose to Focus on Authenticity) And so, now you have chosen a field which is—and maybe this is more of a conscious choice—you have chosen a field which deals mostly with authenticity and realness. And now, you want to move on with your life in a new way. In a way that where you have more realness in relationships, more intimacy, realness in counseling relationships, perhaps more realness in your friendship and love relationships. (Importance of Conscious Choices) And now, you can consciously begin to make choices about bringing yourself to this new place. Is that making sense to you?

Betty
Yes. I have to. I need to, I would say, honor my emotional life, which I have not done.

Dr. Ed Neukrug
OK.

Betty
It is usually a sign of weakness in my way of being in a world before.

Dr. Ed Neukrug
(Empathy) That was the you before.

Betty
Right.

Dr. Ed Neukrug
(Affirming Search for Authenticity) And now you have a new you. And I have got to say, I really respect this new you as you are honoring yourself, honoring your emotional self and beginning to listen to it more effectively and more frequently.

Betty
Yes, more frequently, thank you.

Dr. Ed Neukrug
(Highlighting Life's Difficulties) Well, it sounds like it has been kind of a hard road for you in recent years. (Validating Current Choices) But I am also hearing that you are making some really good choices for yourself as you are moving forward in your life. And again, I really respect that.

Betty
Thank you. It seems like I have to work really, really hard to be anything more than ordinary. So, I will just keep working as long as I do not lose myself in my work, that is a fear too.

Dr. Ed Neukrug
You want to remain real.

Betty
Right, yes.

Dr. Ed Neukrug
(Normalizing Difficulties in Life) I guess I am thinking that a lot of times, we think that life is going to be easy but as you are showing us, usually there are so many things in life that give us difficult, hard times (Life's Difficulties = Message to Self) and messages to ourselves about who we are and where we are going. I think you are really hearing some of the messages that you are sending up at yourself.

Betty
Can you give me something to take with me?

Dr. Ed Neukrug
(Continue Listening to Self) I guess what I am hearing—that is a great question. Because what I am hearing is that you have been giving yourself something and if I can give you anything, that is what I want to give you, and that is to continue to give yourself that sense of inner awareness that you have begun to give to yourself. Thank you for sharing today. (Life as Never-Ending Search for Completeness)

Betty
Thanks.

Dr. Garrett McAuliffe
Well, I enjoyed watching your session on existential counselling just now. I would like to know as I assume audience would want to know and students, what is unique about existential counselling?

Dr. Ed Neukrug
When I think of existential counselling therapy, I think of it as being in the school of existential and humanistic therapies much like person-centered and Gestalt therapy. But as opposed to those approaches which I think have kind of a preset way of doing things, with existential therapy, you are embodying more of a philosophy. And the philosophy has to do with things like having a shared journey with the clients thinking about the fact that the client, their feelings and anxiety in particular are messages to the client about his or her being in the world. Looking at the types of choices that people are making and how that helps to define who they are and where they are going in life. And so, I have those in the back of my mind when I am doing existential therapy as a way of living in the world and not necessarily having any preset techniques.

Dr. Garrett McAuliffe
So would you say there is some metaphors that tend to be or some terms that maybe characterize it. One is a journey and sharing the journey on some level with the client.

Dr. Ed Neukrug
Right.

Dr. Garrett McAuliffe
In a supportive and maybe challenging way.

Dr. Ed Neukrug
Right.

Dr. Garrett McAuliffe
Choices—and you did not say this—I am wondering taking responsibility for your life in those choices.

Dr. Ed Neukrug
Absolutely, taking responsibilities is important. We do not only take responsibility for ourselves but as we listen to ourselves and make choices, we are making choices for the whole world. And every choice I make affects in the world in some way, and that is what I am thinking about. I am also thinking when you mentioned the word journey that it is a short-shared journey and I feel somewhat comfortable sharing parts of myself and some of my own journey in my attempt to help the client understand his or her journey.

Dr. Garrett McAuliffe
Well, you mentioned that disclosing some of your own life or your own ideas—maybe values—and you can tell me if I am wrong, would be part of that process. What other counsellor responses might be used in existential counselling?

Dr. Ed Neukrug
OK. Well certainly, like in person who is in the counselling, certainly you would use a good share of empathy as you attempt to understand the client and help the client hear deeper parts of him or her self. We will also going to use questions so we can help understand the client and help them broaden their perspective of the world. Self-disclosure again, and also I think you help the client—help to point out the types of choices the client has made. So you might ask them about the types of choices and where they have gone and where they think they are going in the future.

Dr. Garrett McAuliffe
And I noticed you did some instruction. In a certain way, you might share some perspectives that you introduced to the client in the process of counseling. Would that be a possibility in existential counseling to tell them some perspectives to think about?

Dr. Ed Neukrug
Yes, I many existential therapists will actually kind of share their philosophy of existential therapy with the client and some people even actually or might even read some of the philosophy to them, so they have kind of a way of understanding how one might live in the world.

Dr. Garrett McAuliffe
OK. So in a lot of ways, it has some parallels to what I think of about is person-centered counseling. Can you help me with some of the—either the similarities and/or the distinctions between the two so we can get a handle on that?

Dr. Ed Neukrug
Well, I think the person-centered counseling—I think that the main role of the counsellor is to be empathic. That is the primary responsibility, to show empathy to the client. Empathy is showing the client that you understand what is happening with him or her and that the client hears you in some way. That is about—and empathy is very powerful, so I do not want to minimize it but that is about the only—I would say this loosely—but the only technique to use in person-centered counseling. You just are showing empathy. Empathy can take people to deep levels of self, but you do not tend to use questions. You do not use instruction. You do not talk about choices. You just listen and show your client that you have heard them in deep ways.

Dr. Garrett McAuliffe
Yes. So the humanistic person-centered approach, there is a profound belief that the person is almost like a self-discoverer and they are just waiting to be tapped into.

Dr. Ed Neukrug
Yes.

Dr. Garrett McAuliffe
Whereas the existential counsellors would add some instigations of questions, self-disclosure and instruction that would help both of the counsellor and client ponder some of the meanings that people are making and the responsibilities they are taking for those meanings.

Dr. Ed Neukrug
Excellent. That is an excellent description.

Dr. Garrett McAuliffe
I guess one other piece that seems important to me—my last question is what is the place of the idea of choice in existential counselling? It seems that that is a central issue in existential counseling.

Dr. Ed Neukrug
Well, we are constantly making choices for ourselves and as I think there was this client showed that sometimes we are aware of the choices we are making. Sometimes we are not so aware and she has lived a life where mostly she was not aware of her choices and there were kind of slightly out of—just slightly out of consciousness. And as the person becomes more thoughtful and is self-reflective, they begin to make better choices. I actually like what Carl Rogers said about choice at one point and he said that, "As people become clearer about themselves in who they are, their choices become clearer as if they do not have a choice." I love that remark because you know exactly how you are supposed to act in life.

Dr. Garrett McAuliffe
Yes.

Dr. Ed Neukrug
Yes.

Dr. Garrett McAuliffe
And they are joined in some ways. The thing I would also add is, taking responsibility for the choices. It sounds like existential philosophy, which is about being in the world without expecting somehow to be rescued or to be given the answer. And that seems to be what existential counseling asks the client to do, but that the counselor is a fellow traveler on that journey.

Dr. Ed Neukrug
Right, and that is why I responded with this client the way I did when she asked me to give her something. And what could I give her is maybe some reinforcement that she needs to give herself continued awareness of her being in life.

Dr. Garrett McAuliffe
So, she will have the choice that almost feels like it is not a choice in the future as she becomes more conscious of her place in the world or the place she wants to make in the world.

Dr. Ed Neukrug
Right.

Dr. Garrett McAuliffe
Well, good. Well, thank you for that. I appreciate your insights in existential counseling.

Dr. Ed Neukrug
Thank you for your fine comments.

Solution Preview

Dear Student,
Hi, and thank you for using BrainMass. The solution below should get you started. In this particular task, you are asking for help in answering 3 questions in relation to a case (which you included) from which I expect you are also being asked to make a clinical narrative. 250 words isn't much so you have to be precise with your words in 3explaining your ideas. I suggest sing this simple outline:

1. Assessments tools - 75 words
2. Questions - 75 words
3. Brief assessment - 100 words

You can use the listed resources to further explore the topic. Just let me know via the feedback section if you need further clarification. You can also use the listed resources to further explore the topic. All the best with your studies.

Case Review: Betty

In this particular case, the assessment perspective utilized was existential therapy. According to Philips (2014), "In the world of existential therapy, some assessment tools include bio-psycho-social, object relations, the Big Five factors and the Enneagram." careful review of the transcript showed that the subject, Betty has a number of issues including intimacy, issues of self ...

Solution Summary

The solution provides information, assistance and advise in tacking the task (see above) on the topic of putting together a case review using perspectives in existential therapy. Resources are listed for further exploration of the topic.

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