1. CHAPTER 13: Existential Therapy in the Treatment of Substance Abuse and Addiction Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

2. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-2 Introduction Concerned with existence itself, how to create meaning and what it means to be human A therapeutic attitude and philosophy rather than a structured treatment model Focuses on freedom, human choice, and living authentically The chapters aims to explore the major tenets of existential therapy, discuss the “ultimate concerns” and how they relate to substance abuse clients, examine the application of existential therapy with substance abuse clients, and identify existential techniques

3. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-3 Major Tenets of Existential Therapy Daesin (Being-in-the-World) Awareness of existence that entails striving for higher levels of awareness and consciousness by investigation the self, others and the world Self-transcendence The ability to transcend the immediate situation and strive for something above or beyond the self Authenticity Holding a realistic perspective on oneself, others and the world View of Human Nature Taking responsibility for who you are and who you become

4. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-4 The Four Givens of Existence Key existential issues that all humans confront on a daily basis: Death This existential conflict results in tension between the unavoidability of death and the wish to continue to be in existence Anxiety about death may underlie everyday anxieties that are experienced Understanding death allows humans to live authentic lives Boundary experience: an event that throws individuals into crisis, such that they are transformed by the process Substance abuse may be a means to cope with death anxiety

5. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-5 The Four Givens of Existence Continued Freedom A person is responsible for his own world, life design and choices Realization that one is alone in these choices can cause existential anxiety Substance abuse clients deny responsibility for life to avoid this anxiety Isolation No matter how close we get to others, there is still a gulf between people Conflict between awareness of isolation and desire for contact and protection from others Individuals must learn to integrate this awareness into their lives

6. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-6 The Four Givens of Existence Continued Meaninglessness Individuals strive to find and understand their meaning in life A lack of sense of meaning can lead to deviant behavior and psychopathology Substance abuse can be a way to cope with existential anxieties, including feelings of meaninglessness Suffering can motivate clients to live more authentic and meaningful lives Meaning can be found in the recovery process

7. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-7 Existential Psychodynamics Anxiety is not caused by instinctive impulses, it is caused by a greater awareness of the ultimate concerns, leading to the use of defense mechanisms Existential anxiety is the tension and worry that emerge when we become aware of the ultimate concerns Psychological and behavioral problems result when we try to ignore or evade existential anxiety Existential defense mechanisms The idea that one is special and unique The idea of the ultimate rescuer

8. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-8 Process of Existential Therapy Function of the existential clinician I-thou relationship-involves mutual respect Infuse ultimate concerns in whatever topic is discussed Help turn suffering into productive pursuits Three phases Initial phase-explore client assumptions about the world Middle phase-challenge to examine value systems Final phase-help develop client’s will to act Types of existential counseling Yalom’s approach Frankl’s approach (logotherapy)

9. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-9 Application of Existential Therapy with Substance Abuse Problems Focuses on how subjective experiences play a large role in maintaining one’s substance use behavior Integration of subjective experiences re-interprets compulsive substance use as a psychological process rather than a behavioral problem with physiological components Substance abuse may be a way of manifesting internal experiences and denying existential issues Existential perspective may enhance substance prevention

10. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-10 Application of Existential Therapy with Substance Abuse Problems Continued Development of maladaptive behavior Results from ineffective coping with anxiety that come from confronting the four ultimate existential concerns Goals of existential therapy with substance abuse Help clients constructively live with anxiety Become aware of avoidance strategies Explore the ultimate concerns Reaching one’s full potential

11. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-11 Existential Techniques Existential therapy does not place high value on techniques Logotherapy techniques Dereflection Paradoxical intention Socratic dialogue Death awareness techniques Connection to others Self-disclosure Rippling Discovering wisdom and leading a fulfilling life

12. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-12 Existential Techniques Continued General techniques Development of an alliance Focusing the client’s motivation to have a centered awareness of being Pointing out and working through resistance Confronting existential anxiety Supporting new learning and new ways of being

13. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-13 Existential Therapy in the Treatment of Diverse Populations The focus on the human condition and concerns of all people is pertinent regardless of cultural background; A majority of cultures connect with the idea of meaning Encourages examination of values in social and cultural contexts Logotherapy was developed based on the experience of cultural oppression, which makes it applicable to individuals who have experience racism Critics argue that social factors and causes of behavior are overlooked and it may not fit with Eastern cultures

14. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-14 Running Case Study: Michael The clinician demonstrates existential therapy by building a positive I-thou relationship, encouraging Michael to take responsibility, exploring the ultimate concerns by examining Michael’s values, and developing meaning into action Michael was able to identify deep issues that may play a role in his substance use of which he was not previously aware

15. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-15 Strengths, Limitations, and Ethical Issues related to Existential Therapy Strengths Can be used effectively in individual or group settings Focuses on the “givens” of existence, which is relevant to clients who abuse substances Gets to the core of the issue Focuses on here and now existence, avoiding non- productive discussions about the past or worry about the future Clinicians use whatever works for the clients

16. Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 13-16 Strengths, Limitations, and Ethical Issues related to Existential Therapy Continued Limitations May not be suitable for all clients Clinicians may struggle with the limited techniques used Solely focuses on individualism Ignores the need to address addictive thought processes Small empirical research base Ethical Issues The topic of death and death awareness may not be appropriate for all clients Rejects traditional addiction concepts and applications that have empirical support