Existential Psychotherapy An Important and Multicultural Approach Who

Existential Psychotherapy An Important and Multicultural Approach

Who are You? Really? CIRCLES OF MY MULTICULTURAL SELF

Word Association What word or phrase first comes to your mind when I say “Existential Psychotherapy”?

The Existential Experiences of Cats

Quick Background (Livingston, 1971) Philosophical Quest for Meaning Existentialism is Becoming 1. Soren Kierkegaard – Father of Major 20 th Century Theologians Existential Philosophy 1. Paul Tillich (Christian) 2. Frederick Nietzche 2. Martin Buber (Jewish) – I 3. Both Reacting to the Thou Relationship Dehumanizing of Individuals

Psychotherapy Control Freedom Awareness 1. Viktor Frankl – Man’s Search for Meaning (1959); Nazi’s took everything except his ability to forgive. 2. Rollo May – Love and Will (1969). 3. Irvin Yalom – Existential Psychotherapy (1980).

Basic Tenets / Assumptions From its roots until now – Existentialism Seeks the Whole not the Parts of a Person • Freedom – “responsible for and author of own world” (Yalom & Josselson 2014, p. 274) – Entails responsibility

Basic Tenets / Assumptions • Isolation – “aloneness in the universe” (Yalom & Josselson 2014, p. 267) • Meaning – search for meaning / purpose – search for significance • Death – Can bring anxiety. “Dread of nonbeing” (Yalom & Josselson 2014, p. 269)

Crucial Elements of the Existential Therapist with Multicultural Attributes 1. Traveling on their own journey of “beingin-becoming, ” especially in terms of MSJCC (Ratts, Singh, Nassar, Butler, & Mc. Cullough, 2016). 2. Genuine / Authentic. 3. Willing to be a “Fellow-Traveler” and entering into client’s worldview for stronger therapeutic alliance and better services (Crumb, Haskins, & Brown, 2019, 32).

The Existential Therapist Must Be … • Aware of Self and Culture – Aware of self as noted by Ertl, Mann-Saumier, M. , Martin, R. , Graves, D. , & Altarriba, J. (2019) as an “awareness of one’s beliefs, biases, and attitudes” (p. 316) and also culturally aware from which they and the client come from (Feize & Gonzalez, 2018). • Aware of Intersectionality – Research done by Moleiro, Freire, Pinto, & Roberto (2018) has shown that clinicians fail to see the importance of intersectionality within the lived experience of a client in their cultural context leaving them ineffective as a helping professional. • Becoming – Reflecting on Martin Buber’s I-Thou Relation where “I become my relation to the Thou; as I become, I say Thou” (p. 11), which leaves Amari (2019) to contend that “counseling psychologist can continue to rediscover their identity everytime they succeed in meeting their clients as Thou” (p. 11)

A Word on Intersectionality “Intersectionality requires being cognizant of withingroup differences as well as between-group differences” (Ratts, 2017, p. 88) – counselor awareness + client worldview + counseling relationship + counseling and advocacy interventions (p. 92).

Therapeutic Goals 1. Two Schools of Thought (Krug, 2009) a. Bugental – Awareness b. Yalom - Change 2. Authenticity in the New Reality 3. Process of Therapeutic Change a. Therapeutic Alliance (subjectivity) b. Here-and-Now not the Past c. Responsibility in the Here-and-Now

Therapeutic Goals • • Expand self-awareness. Accept responsibility. Choose differently. Experience authentic meaning / existence.

The Therapist • Focus on self (attunement) and therapeutic relationship. • Focus on client’s worldview (subjective). • Expand on inner self-awareness.

Multicultural Perspective • Universal – unique for each client. – Some see as it being too limiting and focusing on individual (but it positions us to see the client in their “context. ” • Thoughts, Emotions, and Behavior come out a cultural and social environment.

Congruent with Multicultural Sensitivities THE EXISTENTIAL APPROACH

Multiculturalism and philosophy into therapeutic equation and “appreciates diversity, such as An Existential Approach Brings … race, culture, religion, gender, and sexual orientation” among other dimensions (Amari, 2019, p. 3).

Effective with Arab Americans • During the immigration influx from war-torn Middle Eastern countries, Arabs show a loss of freedom to choice and a life of meaning due to isolation and a loss of identity (Basma & Gibbons 2016, 151). • Basma & Gibbons (2016) contends that “the existential approach recognizes the relational aspect of life and counseling; therefore, it helps clients become aware of their experiences, potentialities, and means of interaction with the counselor” (p. 152).

Research Suggests … (Gundel, Bartholomew, & Scheel, 2020)

A Research Project and A Case Study USING EXISTENTIALISM TO UNDERSTAND BUILD BRIDGES

Research Suggests Gundel, Bartholomew, & Scheel (2020), concluded that the necessary themes for change were: (a) open exploration of culture; (b) integration of salient cultural factors; and (c) expectation of addressing culture (p. 25). This comes from being a “Fellow-Traveler”

Existential Psychotherapy contends that each person is different, unique even in a common culture. Therapy is subjective. As Hoffman & Cleare-Hoffman (2011) found, cultural knowledge is not enough and may simply lead to adopting various stereotypes, but when combined with the personal lived experience of the client, greater awareness for the counselor is possible (p. 266).

A Case Study in Addiction (Center for Substance Abuse Treatment, n. d. )

Case Study in Addiction (Center for Substance Abuse Treatment, n. d. , 111) Sandra is a 38 -year-old African-American woman who has abused a number of substances, including cocaine, heroine, alcohol, and marijuana over the past 15 years. She left high school and was a prostitute for 5 years. Later she found a job as a sales clerk at a home furnishings store. Sandra had two children in her early twenties, a daughter who is now 15, and a son, aged 18. Because of her substance abuse problems, they live with other relatives who agreed to raise them. Sandra has been in treatment repeatedly and has remained substance free for the last 5 years, with several minor relapses.

Case Study in Addiction (Center for Substance Abuse Treatment, n. d. , 111) She has been married for 2 years, to Steve, a carpenter; he is substance free and supports her attempts to stay away from substances. Last month she became symptomatic with AIDS. She has been HIV-positive for 5 years but had not developed any illnesses related to the disease. Sandra has practiced safe sex with her husband who knew of her HIV status.

Case Study in Addiction (Center for Substance Abuse Treatment, n. d. , 111) Recently, after learning from the physician at her clinic about her HIV symptoms, she began to “shoot up, ” which led her back into treatment. Out of fear, she came to the treatment center and asked to see a counselor at the clinic one day after work. She is worried about her marriage and that her husband will be devastated by this news. She is afraid she is no longer strong enough to stay away from drugs since discovering the onset of AIDS. She is also concerned about her children and her job. Uncertain of how she will keep on living, she is also terrified of dying.

What would the therapeutic goals be from an Existential perspective? According to the Center of Substance Abuse Treatment (n. d. ) it would be “to get them to move from resistance to take responsibility. These approaches increase self-awareness, which promotes self-esteem and allows for more client responsibility, thus giving the client a sense of control and the opportunity to make choices” (p. 107).

An Existential Response (Center for Substance Abuse Treatment, n. d. , 119) An existential therapist may help Sandra understand that her diagnosis of AIDS forces her to confront the possibility of death and, consequently, face the responsibilities thrust upon her by life. The therapist could accomplish this by helping her understand that her life (like everyone else’s) is finite. Therefore, she is challenged to forge meaning from her life and make difficult decisions about her relationships and ways of dealing (or not dealing) with choices about substance abuse.

An Existential Response (Center for Substance Abuse Treatment, n. d. , 119) The focus in her therapy would be on choosing the life she wants to live. The therapist would assist her in dealing constructively with anxiety so that she can find meaning in the rest of her life. This could be accomplished by engaging her in the struggle to assume authorship of her choices. She may be encouraged to “play out” scenarios of choices she faces and acknowledge the accompanying fears and anxieties. She might be asked, “What keeps you from sharing your fears with your husband, and accepting the possibility of his support? ” or “Imagine yourself expressing your love for your children and regret for the mistakes you have made. ” Thus, therapist would help her understand that making difficult choices in the face of death is actually a way to find integrity, wholeness, and meaning.

An Existential Response (Center for Substance Abuse Treatment, n. d. , 119) The teachings of the existential therapist, Yalom, can be a useful resource in dealing with issues related to death, since he has worked with terminally ill cancer patients for many years, helping them to use their crisis and their danger as an opportunity for change (Yalom, 1998). Yalom explains that although death is a primary source of anxiety for a client, incorporating death into life can enrich life and allow one to live more purposefully

OK. Now What? LET’S THINK APPALACHIA

Word Association When I say “West Virginia” or “Appalachia” what first and immediately comes to your mind?

Maybe Something Like …

Since the late 1800’s, Cooper, Knotts, & Elders (2011) have recorded how outsiders have characterized Appalachians as poor, ignorant, lazy, and violent mountaineers (p. 458) in various print material. Long Running Stereotypes

A People Exploited • Russ (2010) warns clinicians that they must develop a sense of trust in therapeutic relationship due to the heavy exploitation that Appalachians have experienced, especially by outsiders (p. 2). • Absentee land coal mine owners, government promises in the “Great Society” era just to name a few (Russ 2010, 2). • *Bonus Video – See Slide #41 (exploited by both political parties)

So To Be Effective … Due to stark differences between Appalachia and the rest of the United States, traditional approaches are not as effective leaving the clinician with the need to know the culture and the individual client within the culture (Russ 2010, 1).

Intersectionality – People are not Monolithic • Protivnak, Pusateri, Paylo, & Kyoung (2017) note that just as any other group, Appalachians want to have their voice heard (p. 81) and in order to hear those voices, clinicians must be see the intersectionality as it may pit the core of individuals against their cultural norms (p. 83). • Due to the changing fabric of America, monocultural theories will continue the marginalization of individuals (Lee & Kelley -Petersen, 2018, P. 155).

How Many Aspects in this One Culture – For Just One Person? (up to 03: 40)

Why Can it Not Be This Attitude That Pops Into Your Mind? (Again think of the individuals) Here-and-Now Responsibility Choice Freedom

Self-Care: Even Apart – We are Together

*Bonus Video A People Exploited by the Left and the Right Existentialism seeks the Lived Experience

References

Amari, N. (2019). Counseling psychology practice as the pursuit of the I-Thou relationship. The Humanistic Psychologist. Advance online publication. doi. org/10. 1037/hum 0000155 Basma, D. & Gibbons, M. (2016). The anguish of freedom: Using an existential approach with Arab immigrants. Journal of Humanistic Counseling, 55(2), 151 -162. doi. org/10. 1002/johc. 12031.

Center for Substance Abuse Treatment (n. d. ). Brief interventions and brief therapies for substance abuse. Treatment Improvement Protocol (TIP) Series, 34. Available from: https: //www. ncbi. nlm. nih. gov/books/NBK 64939/ Crumb, L. , Haskins, N. , & Brown, S. (2019). Integrating social justice advocacy into mental health counseling in rural, impoverished American communities. Professional Counselor, 9(1), 20 -34. Ertl, Mann-Saumier, M. , Martin, R. , Graves, D. , & Altarriba, J. (2019). The impossibility of client-therapist “match: ” Implications and future directions for multicultural competency. Journal of Mental Health Counseling, 41(4), 312 -326. doi. org/10. 17744/mehc. 41. 4. 03

Feize, L. & Gonzalez, J. (2018). A model of cultural competency in social work as seen through the lens of self-awareness. Social Work Education, 37(4), 472 -489. doi. org/10. 1080/02615479. 2017. 1423049 Frankl, V. (1959; 2006). Man’s search for meaning. Cutchogue, NY: Beacon Press. Gundel, B. , Bartholomew, T. , & Scheel, M. (2020). Culture and care: An illustration of multicultural processes in a counseling dyad. Practice Innovations, 5(1), 19 -31. doi. org. 1037/pri 0000104 Hoffman, L, & Cleare-Hoffman, H. (2011). Existential therapy and emotions: Lessons from cross-cultural exchange. The Humanistic Psychologist, 39(3), 261 -267. doi. org/10. 1080/088773267. 2001. 594342

Krug, O. (2009). James Bugental and Irvin Yalom: Two masters of existential therapy cultivate presence in therapeutic encounter. Journal of Humanistic Encounter 49 (3), 329 -354. Lee, K. , &Kelley-Petersen, D. (2018). Service learning in human development: Promoting social justice perspectives in counseling. Professional Counselor, 8(2), 146 -168. Livingston, James C. (1971). Modern christian thought: From the enlightenment to vatican 2. New York: Macmillan Publishing Company. Mitcham, M. , Greenidge, W. , & Smith, S. (2013). Teaching the multicultural course: Facilitating courageous conversations and transformational multicultural pedagogy. Retrieved March 15, 2020, from https: //www. counseling. org/docs/default-source/vistas/teaching-the-multicultural-counselingcourse-fascilitating-courageous-conservations-and-transformational-multicultural pedagogy. pdf? sfvrsn=9. Reprinted with permission for ACA for educational purposes only.

Moleiro, C. , Freire, J. , Pinto, N. , & Roberto, S. (2018). Integrating diversity into therapy processes: The role of individual and cultural diversity competencies in promoting equality of care. Counseling and Psychotherapy Research, 18(2), 190 -198. doi. org/10. 1002/capr. 12157 Protivnak, J. , Pusateri, C. , Paylo, M. , Choi, K. (2017). Invisible outsiders: Developing a working alliance with Appalachian clients. The Practitioner Scholar: Journal of Counseling and Professional Psychology, 79 -91. Ratts, M. (2017). Charting the center and the margins: Addressing identity, marginalization, and privilege in counseling. Journal of Mental Health Counseling, 39(2), 87 -103. doi. org/10. 17744/mehc. 39. 2. 01

Ratts, M. , Singh, A. , Nassar, M. , Butler, S. , & Mc. Cullough, J. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44(1), 28 -48. doi. org/10. 1002/jmcd. 12035. Russ, K. A. (2010). Working with clients of Appalachian culture. Retrieved from http: //counselingoutfitters. com/vistas 10/Article_69. pdf Yalom, I. & Josselson, R. (2014). Existential psychotherapy. In Danny Wedding & Raymond J. Corsini (Eds. ), Current psychotherapies 10 th ed. (265 -298). Belmont: Brooks / Cole.

Image References

Addiction – Taken from https: //classifieds. usatoday. com/blog/education/morethan-just-physical-understanding-all-types-of-addiction/ Barney Google and Snuffy Smith – Taken from https: //www. amazon. com/Barney. Google-Snuffy-Smith-American/dp/0878162836 Lil Abner – Taken from https: //tvtropes. org/pmwiki. php/Comic. Strip/Lil. Abner

Looney Tunes – Taken from https: //www. davidpibworth. com/the-arches-theatrethats-all-folks MSJCC Model – Taken from https: //ct. counseling. org/2016/01/multicultural-andsocial-justice-counseling-competencies-practical-applications-in-counseling/ Research – Taken from https: //enil. eu/news/introducing-enils-independent-living -research-network/