Module 4:

EXISTENTIAL PSYCHOTHERAPY

Overview of the Existential Viewpoint,

 The word ‘existence’ is derived from the Latin word existere, literally meaning
‘to stand out, to emerge’.
 Existence is not a static process, but entails the process of coming into being or becoming.
 Existential approaches to therapy are concerned with the science and processes of being.
 Existential therapists assist clients to stand out or to affirm their existences, despite and
within the constraints involved in existence.
 The existential approaches to therapy are rooted in existential philosophy.

Prominent existential philosophers

 Kierkegaards’s existentialism was within a Christian framework and he described the
dread, anxiety and despair – ‘the sickness unto death’ – of humans estranged from their
essential nature (Kierkegaard, 1954).
 Nietzsche was an atheist existentialist who presented a nihilistic picture of the world in
which ‘God is dead’ as the background for human self-affirmation ( Tillich, 1952).
 Heidegger’s (1962) Being and Time focused on the quest for being and analyzed the
concept of Dasein, being there or existence.
 Sartre, a Marxist, echoed Nietzsche’s thoughts about a Godless world.
He emphasized humans’ inescapable need, in their struggle against despair and non-being,
to make the choices that make the essence of their existences (Sartre, 1956).
Existential approaches to therapy have also been influenced by religious philosophers,
such as Buber, the Jewish theologian, and Tillich, the Protestant Christian theologian.
 Buber (1965, 1970) thought that humans were not separate entities, but existed as the
creatures of the in-between.
The two special types of in-between relationships were ‘I-It’ relationships, involving
functional relationships in which others were objects, and ‘I-Thou’ relationships, involving
mutual influence and a full experiencing of another.
 Tillich’s (1952) book ‘ The Courage to Be’ examines human existence within a religious
framework. For Tillich the courage to be is the ethical act in which man affirms his own
being in spite of those elements which conflict with his essential self-affirmation

 Existential psychotherapeutic approaches go beyond dealing with surface problems to

assist clients to confront the basic issues of their existence :
 Anxiety
 Despair
 Death
 Loneliness
 Alienation and
 Meaninglessness
 All the preceding issues have the potential to generate ‘existential pain’ (Yalom,
1989).
 Existential approaches to therapy are also concerned with questions of freedom,
responsibility, love and creativity.
 There are many existential approaches to therapy. Yalom and May’s existential
therapy and Frankl’s logotherapy are two such approaches that widely influence
contemporary counseling and psychotherapy.

 BASIC CONCEPTS

 Being and non-being

 May (May et al., 1958) observed that ‘being’ is a participle of a verb and implies that
someone is in the process of becoming something.
 He stated that, when used as a noun, ‘being’ means potentia, the source of potential.
 Humans can choose their own being.
 The choices that they make about being are not just concerned with whether or not to
commit suicide, but are relevant to every instant of their lives.
 Because of widespread collectivist and conformist trends in society, modern humans
have repressed their sense of being.
 People’s sense of being refers to their whole experience of existence, both conscious
and unconscious.
 They need to experience themselves as beings in the world and have a basic ‘I-Am’
experience, expressed by one of May’s clients as ‘Since, I am, I have the right to be’
(May et al., 1958).
 The ‘I-Am’ experience is not the solution, but rather the precondition for the solution
to client’s problems.
 The opposite of being is non-being or nothingness.
 Existence implies the possibility of not existing.
 Death is the most obvious form of non-being.
 However, there are numerous other threats to being in the form of loss of potentiality
through anxiety and conformity, and through lack of clear self-awareness.
 In addition, destructive hostility and physical sickness can pose threats to being.
 However, people who are able to confront non-being can emerge with a heightened
sense of being, including a greater awareness not only of themselves, but of others and
the world around them.
 The three forms of being-in-the-world –
 Existential therapy distinguishes three modes of world that characterize people’s
existence as being-in-the-world.
 First, there is the Umwelt, the ‘world around’.
 The Umwelt represents the natural world, the laws of nature and the
environment.
 For animals and human beings alike, the Umwelt includes biological needs,
drives, instincts.
 Also, it includes each daily and life cycles.
 The natural world is accepted as real.
 Second, there is the Mitwelt, the ‘with-world’.
 This is the social world of relating to fellow humans singly and in groups.
 Both in personal and group relationships people influence each other and the
structure of meaning that develops.
 May writes: ‘the essence of relationship is that in the encounter both persons
are changed’ (May et al., 1958).
 How people relate to intimate relationships, for instance their degree of
commitment, influences the meaning of the relationships for them.
 Third, there is the Eigenwelt, or ‘own world’.
 The Eigenwelt is uniquely present in humans and entails self-consciousness
and self-awareness.
 Also, the Eigenwelt entails grasping the personal meaning of a thing or person.
 Individuals need to own their relationships to things and people: for instance,
‘This flower is beautiful’ means ‘For me, this flower is beautiful’.
 The three modes of being are interrelated –

 Normal and neurotic anxiety

 To be human is to be anxious.
 Anxiety is an unavoidable part of human life.
 May (1950) distinguished between normal and neurotic anxiety.
 He defines anxiety as ‘the threat to our existence or to values we identify with our
existence’ (May, 1977).
 In the course of normal development everyone experiences various threats to their
existence.
 One source of normal anxiety is humans’ existential vulnerability to nature, sickness
and death.
 Another source is the need to progressively become independent from parents with the
tensions and the crises that this process can create.
 However, people can use such threats constructively as learning experiences and
continue to develop.

 The reaction of normal anxiety has three characteristics –

 Existential therapists view their main function as helping clients come to terms with
the normal anxieties that are part of human existence.
 Neurotic anxiety possesses the opposite characteristics to normal anxiety.
 Neurotic anxiety is a disproportionate reaction to an objective threat, involves
repression, and is destructive rather than constructive.
 Another way of viewing neurotic anxiety is that people subjectively react to objective
threats in terms of their inner psychological patterns and conflicts.
 The repression and blocking of awareness involved in neurotic anxiety leave people
more vulnerable to threats since they lose access to important information with which
to distinguish and deal with the threats.
 Normal, neurotic and existential GUILT

 Like anxiety, guilt is part of human existence.

 A distinction may be drawn between normal and neurotic guilt.
 Neurotic guilt derives from imagined transgressions against others, parental
injunctions, and societal conventions.
 Normal guilt is a call to conscience and sensitizes people to the ethical aspects of their
behavior.
 Existential or ontological guilt represents another form of guilt.

 May distinguished between three forms of existential guilt –

 Existential guilt is universal.
 It is rooted in self-awareness.
 Existential guilt does not arise from violation of parental injunctions, ‘but arises from
the fact that I can see myself as the one who can choose or fail to choose’ (May et al.,).
 Thus existential guilt is inevitably linked with the notion of personal responsibility.
 Existential guilt is not in itself a form of neurotic guilt, though it possesses the
potential to turn into neurotic guilt.
 However, if correctly addressed, existential guilt can have constructive outcomes both
in terms of greater humbleness and sensitivity to others and in increased creativity.

 Transcendence

 The unique capacity of humans to think and talk in symbols allows them the possibility
of transcending time and space.
 Humans can project themselves into the past and into the future.
 In addition humans can transcend themselves in their social relations and see
themselves as others see them and give appropriate weight to others’ perceptions.
 The capacity to transcend immediate concrete situations provides humans with the
basis of both their freedom and their responsibility.
 ‘Transcendence’ is derived from the Latin word transcendere, meaning ‘to climb over
and beyond’.
 Existing involves humans in a continuous process of emerging in which they transcend
their pasts and presents to create their futures.
 Unless seriously ill or blocked by anxiety or despair, all humans engage in this
process.

 Existential ultimate concerns

 Yalom (1980) has identified four existential ultimate concerns –

 DEATH
 FREEDOM
 ISOLATION
 MEANINGLESSNESS
  DEATH
 Life and death, being and non-being, are interdependent rather than concurrent.
 Death is the fundamental source of anxiety, whether it be neurotic, normal or
existential.
 Perhaps the term ‘death terror’ denotes the force of death concern better than ‘death
anxiety’.
 Death anxiety, the fear of ceasing to be, can be both conscious and unconscious.
 From early in their lives children are extremely preoccupied with death.
 Strong death anxiety is likely to be repressed.
 To cope with the terror of potential non-being, people erect denial-based defenses
against death anxiety.
 To a large extent psychopathology has its origins in failed attempts to transcend death.
 The first existential conflict is that between awareness of the inevitability of death and
the wish to continue to live: the conflict between fear of non-being and wishing to be.

 FREEDOM
 Humans are ‘condemned to freedom’ (Sartre, 1956).
 Humans do not live in a well-ordered and structured universe.
 There is no secure ground undergirding existence.
 Rather there is lack of structure and groundlessness which generates both anxiety and
dread.
 Because of their freedom, humans are also condemned to responsibility.
 They are not only responsible for imbuing the world with significance, but entirely
responsible for their lives, for their actions and their failures to act.
 The second existential conflict is that between people’s confrontation with
groundlessness and freedom, and their wish for ground and structure.

 ISOLATION
 There are three important forms of isolation:
1. Interpersonal isolation - often experienced as loneliness, means that people are in
varying degrees cut off from others. This may be through deficient social skills,
psychopathology or by choice and of necessity.
2. Intrapersonal isolation means that people are blocked from awareness of or
dissociated from parts of themselves.
3. Existential isolation is rooted in the human condition in that each person enters, lives
in, and leaves the world alone.
 Ultimately there is an unbridgeable gap between self and others.
 Yalom (1980) observes that existential isolation refers to an even more fundamental
form of isolation, namely ‘Separation from the world’.
 The third existential conflict is that between people’s awareness of their fundamental
isolation and their wish for contact, protection and to be a part of a larger whole.
  MEANINGLESSNESS
 What is the meaning of life?
 Humans require coherence, purpose and significance.
 They organize random stimuli into figure and ground.
 They are neuropsychologically organized to seek patterns and meaning.
 However, the human paradox is that of existence in an indifferent universe with no
predetermined meaning.
 A distinction may be made between cosmic meaning, whether human life fits into
some overall cosmic pattern, and terrestrial meaning, the meaning of my life.
 With the decline in religious beliefs, modern humans are faced with the need to
discover secular personal meaning in the absence of cosmic meaning.
 The fourth existential conflict is that of humans confronting their need for meaning in
an indifferent world that has no meaning.

 ACQUISITION
Despite existential anxieties and conflicts being inescapable part of life, the question still
remains of how people develop different modes of dealing with the ultimate concerns of
existence.
 DEATH:
o Young children, even though not intellectually equipped to understand what death
means, grasp its essence.
o Yalom (1980) believes that children then deny their first knowledge of death.
o Mechanisms of denial include such beliefs as death is temporary, children do not die, I
will not die because I am special, and there is an ultimate rescuer.
o Coming to terms with the concept of death is a major developmental task which some
children handle better than others.
o Exposure to death can be for good or ill.
o Factors likely to be helpful include the presence of already existing ego resources,
good genes and supportive adults able to deal with their own death anxieties.
o However, exposure to death can be traumatic when these factors are insufficiently
present.
o Death of sibling and of parents can be especially frightening and exceed children’s
coping resources.
o Research indicates that both neurotic and psychotic psychiatric patients have lost a
parent more frequently than the general population.
o The degree of cultural acceptance of death also influences how much anxiety death
will generate in both adults and children.
o The quality of death education that parents offer to their children affects their
awareness and acceptance of death.
o Children are often protected from death by misinformation, denial, fairy tales,
euphemisms, and assurances that children do not die.
o As with sex, children do not ignore the issue, but turn to other sources of information
of varying degrees of reliability.
o Western cultures offer no real guidelines about how parents should educate their
children about death and this is not helped by many adults seeking comfort in childlike
beliefs.
 FREEDOM:
o The modern-day emphasis on freedom and responsibility as existential concerns
derives from the breaking down of traditional belief system, religions, rituals and rules.
o In the twentieth century, there was a rapid disintegration of structures and values.
o Permissive parenting has now left many young people with the need to choose but
without clear guidelines as to how or what to choose.
o Numerous people are unprepared for the freedom they now have.
o Frequently, when confronted with the existential fact of their responsibility for their
lives, they experience difficulty in handling this realization.
o Now people are less faced with what they must do, instead the emphasis is on what
they want to do.
o In what may be a transitional period between old and new ways of being-in-the-world,
many people have failed to learn adequately how to wish, how to will and how to
decide and stay committed to their decisions.
 ISOLATION:
o Interpersonal isolation - Cultural and technological change plays a large part in the
creation of this form of isolation.
o In the United States and other Western cultures there has been a decline in community
links – churches, local shops, neighbors who know each other and have local roots,
family doctors and so on.
 Intrapersonal isolation stems from obstructions and frustrations that occur early in
life and threaten some vital aspect of the individual’s emerging sense of self.
 Existential isolation is closely interwoven with interpersonal isolation.
 Many people failed to develop the inner strength, confidence and sense of identity that
enables them to face existential isolation.
 Never having received genuine growth-inducing love, they do not know how to offer it
to others.
 If committed and authentic therapist – client relationships can help clients confront and
come to terms with their existential isolation, it can safely be inferred that clients have
insufficiently experienced such relationships in their pasts.
 MEANINGLESSNESS:
 Many factors in contemporary culture contribute to people having a diminished sense
of life’s meaning compared to their forebears in the pre-industrial agricultural world.
 First, instead of meaning supplied by religion, now most people neither believe in
religion nor go to church.
 Second, the spread of urbanization and industrialization has contributed to people
losing a sense of meaning through their contact with nature.
 No longer are most people closely connected with the cycles of the land and of farm
animals.
 Third, most contemporary humans no longer belong to and have roles in rural
 communities, but instead often live in relatively impersonal urban communities.
 Fourth, many contemporary humans are alienated from their work and think they
engage in mechanical and routine tasks of little intrinsic interest.
 Fifth, contemporary humans are less beset with basic survival needs, such as food,
shelter and water.
 Their greater security and leisure confronts them much more with abyss of
meaninglessness.
 Time on their hands means time to be haunted by issues of meaning.
 In addition, in economic recessions, many people are confronted by unemployment
with the loss of and need for meaning.
 Sixth, contemporary humans face the possibility of nuclear annihilation and global
environmental destruction.
 If the world is not going to last, why bother?

 THERAPY

Most people’s problems are now loneliness, isolation, and alienation.-Rollo May and
Irvin Yalom

 THERAPEUTIC GOALS

 Existential therapy is more a mode of viewing human beings than a rigorous system.
 In the final analysis, existential therapists view clienthood as ever-present.
 However, generally clients are more troubled than their therapists.
 The underlying assumption is that the fundamental neurotic process is the repression of
the ontological sense, thus involving the loss of a sense of being and the truncation of
awareness and potential.
 Since therapy is primarily concerned with helping clients experience their existence,
any symptomatic ‘cure’ is a by-product or secondary goal.
 Existential therapists attempt to avoid a technical, mechanical approach to clients that
can lead to clients obtaining a symptomatic ‘cure’ at the expense of constricting their
existence.
 Great stress is placed in viewing clients in human rather than behavioral terms and on
authentic therapist – client relationships.
 More specifically, existential therapy entails assisting clients to embark on a journey of
self-investigation, whose goals are:
• To understand the unconscious conflict;
• To identify the maladaptive defense mechanisms;
• To discover their destructive influence;
• To diminish secondary anxiety by correcting restrictive modes of dealing with self and
others; and
• To develop other ways of coping with primary anxiety (May and Yalom, 2000).
 LOGOTHERAPY
Logos is a Greek word that connotes both ‘meaning’ and ‘spirit’, the latter word
without primary religious connotation.
 Humans are meaning-seeking beings and the search for meaning in itself is not
pathological.
 Existence confronts people with the need to find meaning in their lives.
 The main purpose of logotherapy is to assist clients in their search for meaning.
 The origins of logotherapy go back to Victor E. Frankl’s early struggles to find
meaning in his own existence.
 Frankl coined the term ‘logotherapy’ in the 1920s and in the 1930s used the word
existential analysis, as an alternative word for logotherapy.
THEORY

Basic concepts
 Freedom of will:
 Humans possess freedom of will.
 Humans are capable of reflecting upon and judging their choices.
 What matters is not the features of people’s character or their drives and instincts, but
the stand they take towards them.
 People are free to shape their own characters and are responsible for what they make
out of themselves.
 Will to meaning:
 The will to meaning is the fundamental motivational force in humans.
 People are confronted with the need to detect meaning literally to their last breaths.
 Frankl writes ‘Man’s search for meaning is a primary force in his life … This meaning
is unique and specific and can be fulfilled by him alone; only then does it achieve a
significance that will satisfy his own will to meaning’ (Frankl, 1963).
 What people need is the tension of striving for some meaning that is worthy of them.
 Frankl viewed self-actualization as only a side-effect of the will to meaning.

Consciousness and the unconsciousness

What is the source or referent point against which people can detect meaning in their lives?
The search for meaning can involve both conscious activity and getting in touch with
unconscious layers of the self.
 Consciousness:
 Consciousness implies awareness.
 Logotherapy aims to increase clients’ consciousness of their spiritual selves.
 Humans need to be conscious of their responsibility for detecting and acting in terms
of the unique meaning of their lives in specific situations in which they are involved.
 Conscience can intuitively reveal the unique possibilities for meaning to be to be
actualized in specific situations.
 Conscience, or ‘Ethical instinct’, is highly individual in contrast to the other instincts,
 which work for the greatest number of species.
 In addition to moral conscience, Frankl considers love and art are rooted in the
emotional, intuitive, non-rational depths of the spiritual unconscious.
 Conscience can intuitively reveal the unique possibilities for meaning to be to be
actualized in specific situations.
 Conscience, or ‘Ethical instinct’, is highly individual in contrast to the other instincts,
which work for the greatest number of species.
 In addition to moral conscience, Frankl considers love and art are rooted in the
emotional, intuitive, non-rational depths of the spiritual unconscious.
 The religious unconscious:
 It exists within the spiritual unconscious.
 Humans have always stood in an intentional relation to transcendence, even if only on
an unconscious level.
 This ‘unconscious God’ is hidden in two ways -
 First, the human relationship to God is hidden.
 Second, God is hidden.
 Even in highly irreligious people, religiousness is latent.
 Repression of religiousness, as with repression of other aspects of the unconscious,
leads to neurosis: ‘… once the angel in us is repressed, he turns into a demon’ (Frankl).
Meaning of life & death
 Meaning of life:
 Frankl writes that ‘being human means being responsible for fulfilling the meaning
potential inherent in a given life situation’ (Frankl , 1975).
 Being human means being at the same time different, conscious and responsible.
 The concept of responsibility is the foundation of human existence.
 Human freedom as not a ‘freedom from’, but rather a ‘freedom to’, namely the
freedom to accept the responsibility.
 Freedom is what people ‘are’: it is not something that they ‘have’ and can therefore
lose.
 People have many potentialities within them.
 They are not fully conditioned or determined.
 Rather, moment by moment, they are free to decide what they will become in the next
moment.
 Meaning of death:
 Death does not rob life of its meaning.
 If people were immortal they might put off doing things indefinitely.
 Death belongs to life and gives it meaning.
 People’s responsibility springs from their finiteness.
 Consequently, they need to realize the full gravity of the responsibility that they bear
throughout every moment of their lives.
 Destiny, like death, is essential to the meaning of life.
 They are not fully conditioned or determined.
 Rather, moment by moment, they are free to decide what they will become in the next
moment.
Self – transcendence
 Self – transcendence is an essential characteristic of human existence.
 Humans are essentially beings who reach out beyond themselves.
 They become most human when they transcends the boundaries of their selves by
either fulfilling a meaning or encountering another person lovingly.
 Frankl sees the basic human need as a search for meaning rather than a search for the
self.
Sources of meaning
 Frankl (1967, 1988) talks of three principle ways in which people can find meaning in
life:
 The existential vacuum
 The existential vacuum describes a state in which people complain of an inner void.
 They suffer from a sense of meaninglessness, emptiness and futility.
 The existential vacuum is an ‘abyss experience’ in contrast to the peak experience
described by Maslow.
 The causes of existential vacuum suggested by Frankl are –
1. Unlike other animals, humans are no longer programmed by drives and instincts in
what to do.
2. Humans are no longer told by traditions, conventions and values what they should do.
Sometimes they do not know what they wish to do and doing what others do or doing
what others wish them to do.
 Existential frustration:
 Apathy and boredom are the main characteristics of existential frustration.
 Existential frustration is not in itself pathological or pathogenic.
 Frankl regards the existential vacuum with its attendant frustration, as ‘something
sociogenic and not at all a neurosis (Frankl, 1975).
 Noogenic neurosis:
 The existential vacuum can lead to neuroticism.
 The term ‘noogenic neurosis’ refers to those cases where the existential vacuum leads
to clinical symptomatology.
 Such neurosis arise from spiritual conflicts to do with people’s aspirations for a
meaningful existence and the frustration of their will to meaning.
 The mass neurotic triad:
 Frankl uses the term ‘mass neurotic triad’ (Frankl, 1975) for the three main effects:
 Regarding depression, there is ample evidence that suicide rates are increasing,
especially among the young. Frankl sees the cause as the spreading existential
frustration.
 Regarding addiction – A frequently cited reason for taking drugs is the desire to find
meaning in life.
 Regarding aggression, Frankl considers that statististical evidence favors his
hypothesis that people are most likely to become aggressive when they are caught in
feelings of emptiness and meaninglessness.
 Therapeutic interventions
 Following are some methods by which Frankl focused on issues of meaning –
  Teaching the importance of assuming responsibility for meaning:
 Frankl viewed his task as helping clients achieve the highest possible activation of
their lives.
 He shared his view that human life never, under any circumstances, ceases to have a
meaning.
 Clients need to learn that they are always responsible for detecting the meaning of
specific situations in their unique lives.
 Logotherapy teaches clients to view their lives as an assignment.
 Assisting clients to listen to their conscience:
 Frankl often said that meaning must be found and cannot be given.
 Clients are guided in their search for meaning by their consciences.
 Clients require alert consciences if they are ‘to listen to and obey the ten thousand
demands and commandments hidden in the ten thousand situations with which life is
confronting him (Frankl, 1975).
 Asking clients about meanings:
 Therapists can ask clients about creative accomplishments they might bring about, and
support them as they search for answers.
 Clients can also be asked to explore and identify meanings in their relationships and in
their suffering.
 Broadening horizons about sources of meaning:
 Logotherapists can assist clients to obtain broader views for sources of meaning.
 Frankl (1955) cites a client who declared her life was meaningless and that she would
only get better if she found a job that fulfilled her.
 Frankl assisted her to see that it was not only the job that she did but the attitude
towards how she performed her job that might allow her a unique opportunity for
fulfillment.
 Furthermore, in her private life she could find meaning as a wife and mother.

Logotherapeutic techniques for psychogenic neurosis

 Paradoxical intension:
 It’s use is recommended for the short-term treatment of obsessive-compulsive and
phobic clients.
 In paradoxical intension, clients are invited to intend precisely that which they fear.
 Obsessive-compulsive neurotics fear the potential effects of their strange thoughts.
 If therapists succeed in assisting clients through paradoxical intension to stop fighting
their obsessions and compulsions, their symptoms soon diminish and may finally
disappear.

 [Link]:
 Paradoxical intension tries to assist clients to ridicule their symptoms, while
dereflection assists clients to ignore them.
 Sexual neurosis, such as frigidity and impotence, are one area for dereflection
 APPLICATION & EXCLUSIONS
 The clinical indications and contraindications for existential approaches have not been
systematically established.
 Historically, existential therapy was developed in work with psychotic patients.
 Yet, there is also evidence that existentialist approaches may have much broader
application.
 Yalom (1980), for example, has described in detail his work with a wide variety of
patients who were not psychotic, but who suffered from severe feelings of isolation,
loss of meaning, impairment of the will or confrontation with death.
 The contraindications to these methods have also been based largely on clinical
impression, not rigorous study.
 Patients who may be unable to tolerate strong feelings toward the therapist – for
example, individuals who tend to escalate their hopes and expectations for help and
care from the therapist, or who become excessively angry when such expectations are
disappointed – may find existential approaches countertherapeutic.

 EMPIRICAL STUDIES & FURTHER DEVELOPMENTS

 Though primarily an individual approach, sometimes existential therapy is conducted
in groups of eight to ten members (Yalom, 1995).
 A study conducted by Wilgosh et al., (1981) revealed that existential theory of Frankl
(1969, 1975) appears particularly promising as a model for therapy with women.
 Lantz et al., (1996) conducted Existential psychotherapy with chronic illness couples
and it indicated that existential psychotherapy can be a useful approach to meeting
their treatment needs.
 A study conducted by Randall et al., (2001) revealed that in a case of panic disorder of
three years duration complete remission of symptoms occurred within the third week
of existential psychotherapy.
 Existential family trauma therapy conducted by Lantz et al., (2002) indicated that such
a treatment process can help turn a disruption of family existence into a pattern of
family growth.
 Applying Existential Theory and Intervention to Career Decision-Making by Cohen et
al., (2003) revealed that this model has an especially useful framework when working
with middle-aged, college education clients who are undergoing a career transition.
 Existential Trauma Therapy with Men After a Heart Attack conducted by Lantz et al.,
(2003) suggests that the approach can be useful with men who are recovering after
myocardial infarction when utilized in a combination of individual, marital and family
treatment modalities.