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Existential treatment of personal and career concerns: A case study C. Daniel Crosby Doctoral Candidate Brigham Young University The following is a case study that largely revolves around one session with a client, ABC (name and initials changed). I have examined this session in some depth, but also refer to other sessions in order to show progress and give context to the study. It is my hope that writing this case study will help illustrate how some of the more ethereal concepts of existential thought can have a great deal of utility in the therapy hour. ABC presented with both personal and career problems, both of which I conceptualized and attempted to treat from an existential framework. I do not feel as though my work with this client was extraordinary. Rather, I have chosen this case study because it is illustrative of a common course of treatment and common existential concerns.

Having largely conceptualized my work with ABC in an existential framework; I feel as though her distress results largely from her attempted avoidance of certain givens of existence (Yalom, 1980). I agree with Irvin Yalom when he states, “ the confrontation with the givens of existence is painful but ultimately healing (1980, p.8).” Conversely then, flight from such pillars of existence is both futile and pathological. In light of this philosophy, therapy becomes an enterprise in which the therapist becomes a co-traveler on life’s path who encourages the client to face the difficult www.ExistentialPsychology.org

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truths they have been avoiding. While unable to affect change directly, competent therapists can encourage and support clients in their own efforts to face the often anxiety-provoking realities of life. Though there are myriad existential realities that people deal with in a lifetime, two were most salient in my work with ABC, namely the disavowal of existential isolation and the flight from responsibility.

Developing a strong therapeutic alliance with ABC was a necessary first step for a number of reasons. First, I firmly believe that a strong client/therapist bond can potentially be curative in and of itself (Yalom, 2002). The second step, helping ABC to confront her avoidance of responsibility and existential isolation, also hinged on the existence of a bond between the two of us that will allow her the safety to explore these frightening issues. Finally, ABC’s personal problems and career concerns operated in a downward cycle that was mutually influential. Her personal problems complicated her career path, and her disrupted career path served to further exacerbate her personal distress, and so on. Having thus conceptualized this case, it became incumbent upon me to treat her personal and career problems in the context of a warm therapeutic relationship.

I believe that people are free to act for themselves within the various constraints of their environment. While freedom is often thought of in unequivocally glowing terms, the existence of freedom also necessitates the presence of responsibility. So, while we are free to act, we are also responsible for both the positive and negative consequences of our actions.

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The irony of freedom is that its attendant responsibility can often paralyze people into inaction. My client was just such a person who had been paralyzed by her anxiety surrounding responsibility. Rather than making choices and failing, or being authentic and being rejected; my client existed in a maddening limbo that affected both her career and relationships lives.

A second closely related existential reality is that of existential isolation. Different from both interpersonal and intrapersonal isolation, existential isolation is the fundamental divide that exists between individuals (Yalom, 1980). Existential isolation can be summed up with the maxim, that one’s living and dying are ultimately one’s own to work out. This reality does not negate the great need I see for interpersonal closeness or intrapersonal connectedness. Indeed, much of my work with ABC revolved around improving her interpersonal skills en route to having a more satisfying relational life. It merely means that ultimate reliance on externalities for living life is unrealistic and pathology forming. Historically, ABC fled from existential isolation by involving herself in unhealthy, unmeshed relationships with controlling men. In these relationships, control and jealousy masqueraded for genuine care and love. By seeking intense, highly directive relationships, ABC had fruitlessly attempted to shirk personal responsibility and cross an uncrossable divide. Having been burned in the past by these enmeshed relationships, ABC had now begun to distance herself from people entirely. In the following paragraphs, I will outline how my conceptualization of this case guided my interventions. www.ExistentialPsychology.org

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Throughout the session, I used here and now methods of relating to ABC. Two major advantages of here and now focused therapy is that it is energized and ahistoric (Yalom, 2002). In our initial two sessions, ABC predominantly spoke helplessly of things that had happened to her in the distant past. She seemed imbued of the popular notion that therapy is much like emotional archeology; with past traumas being exhumed, dusted off, and scrutinized. The effect of this approach was sessions that were boring and felt helpless. Focusing on the past perpetuated ABC’s flight from responsibility, and kept her squarely in the victim role. Focusing on the here and now kept our sessions energized, helped ABC work on interpersonal skills that would lead to a heightened support system, and made her responsible for the only thing she has any control over, the present moment.

Avoidance of responsibility is a ubiquitous human dilemma. At one point during the therapy session I changed a comment I made from, “What are we going to do about it?” to “What are YOU going to do about it?” This new comment was illustrative both of my belief in personal responsibility and ultimate isolation, as well as my countertransferential wish to help her in ways that were impossible.

My initial comment was reflective of my desire to be a driving force for change in ABC’s life. Feeling deeply for my clients, I have often desired to pick them up and be an active part of the process of change. However, I have another fundamental belief that makes such action impossible despite my fondest wishes.

Part and parcel with the concepts of freedom and responsibility comes the anxietyprovoking reality of existential isolation. As Yalom states, no matter how close each of us

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becomes to one another, there remains a final, unbridgeable gap, each of us enters existence alone and must depart from it alone. Thus, my original comment, while well-intentioned was not entirely accurate. Although outside forces can prod and encourage, any change that is to occur must start and end with ABC herself. Besides being illustrative of my views on existential isolation and responsibility, my revised comment also bespeaks my faith in ABC’s ability to change and my respect for her autonomy.

Another in-session example of responsibility avoidance, were ABC’s claims that she could not talk to a man because it was against societal rules she had internalized. In session, I questioned this internalized meta-rule and asked her (in not so many words) to take responsibility for her actions rather than be made to feel “powerless” about her dating life.

ABC seemed empowered by the notion that she could take her life into her own hands, and not be swept aside by the winds of perceived societal correctness. I feel that this acceptance of responsibility begets personal empowerment; an asset of immeasurable efficacy as she attempts to work through her personal and career difficulties.

Though I was didactic or directive at times in session, there are many more times that I feel that it is in a client’s best interest to come to an understanding of their actions on their own. This philosophy is in keeping with my previously stated belief that taking responsibility for one’s life is a positive process that leads to improved functioning. At one point in the session, ABC spoke of her false self; the self that she employs to keep people at a www.ExistentialPsychology.org

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distance. As she put it, it would be too painful to be rejected for who she really is. Instead, she presented a false front, that if rejected, could easily be written off as a rejection of her false self, and not a real rejection of her fundamental self. Incidentally, this type of behavior is consistent with my existential conceptualization of her flight from responsibility and existential isolation. Though she vacillated between enmeshment and aloofness, I see both of these behaviors as failed attempts at avoiding the real issue: existential isolation. Having mentioned her false self, I ventured that at least keeping a permanent façade is “safe.”

My hope in doing so, was that by holding out her own mistaken belief in front of her, ABC would attack that belief. Indeed, she did react, saying that “safe sucks” and coming to her own conclusions about why keeping her true self hidden from others was maladaptive.

Again, this could have been brought to her attention in a more directive way. However, I feel that the most powerful lessons in therapy come when a client can come to their own decisions about their behavior, albeit with a little help from a paradoxical intervention such as this.

Approximately 18 minutes into the session, I asked ABC a question, to which she replied, “I don’t know, will YOU tell me what to do?”

Seeing an opportunity to highlight the futility of avoiding responsibility, I created an answer about the path her life should take. Although this may have appeared somewhat comical at the time, it was actually an intervention with sound philosophical backing. My directive answer about what she should do and whom she should marry highlights the absurdity of giving other people responsibility for your 3

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decisions, something she was prone to do. By illuminating this truth in a non-threatening manner, I hoped that ABC would come to a realization that giving up responsibility for major life decisions is not as viable an alternative as she may have previously supposed. I believe humor and hyperbole to be valuable therapeutic interventions, and use these tools in many of my sessions.

Roughly 7 minutes into this session, I commented on ABC’s body language (eye rolling to be specific). There are numerous reasons for using such a technique. While most quotidian interactions focus strictly on the content of a conversation, I believe that a proficient therapist should attend to content, process, and nonverbal cues; all of which provide valuable information. One benefit of attending to nonverbal cues such as this, is that it showed my presence and attentiveness in the session.

As discussed elsewhere in this paper, a proper therapeutic bond has strong curative qualities and feeling listened to on a verbal and nonverbal level is a step toward forming such a bond. Second, this intervention also addressed ABC’s isolation, in that it broke down her “robotic” façade without destroying the relationship. By acknowledging this subtle act of displeasure, I sent ABC the message that I was engaged and cognizant of her discontent, and that her display of negative emotion was not scaring me away, as she feared it would scare the important people in her life.

At various times throughout the session, I made personal disclosures about my feelings of connectedness in the moment. The desired effect of this interaction was twofold: to model honesty in interpersonal dealings and to provide an emotionally corrective experi-

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ence. ABC grew up in an environment that she construed to be stifling of her emotional expression. Throughout the session she refers to “Robot ABC”, a phrase that vividly depicts the façade she had taken on due to the perceived unacceptability of her real self. As discussed in session, maintaining this façade was exhausting. Additionally, if someone did become close to her, she became dismissive of their devotion, claiming that they are in love with the image of her. As she slowly opened up, I tried to remain transparent regarding my reactions to her disclosures. In this way, I attempted to model honesty in my own dealings. By making here and now disclosures as to how her “realness” facilitated our closeness, I hoped to show ABC that not everyone she meets would reject her genuineness. Ideally, this sort of “emotionally corrective experience” will generalize, helping her to become more willing to take risks in other relationships. This intervention addressed issues of both responsibility and isolation. By encouraging ABC to be more emotionally honest, I admonished her to be responsible for her actions rather than relying on a false self that frees her from others’ appraisals. Similarly, this honesty will facilitate healthy interpersonal and intrapersonal connectedness. While the existential divide persists, anxiety regarding ultimate isolation can certainly be mitigated by the existence of accurate self-knowledge and genuine connectedness with others.

Evidence of a close therapeutic bond was present throughout the session. This was evident in ABC’s willingness to make self-disclosures, her honesty, her use of uninhibited language (e.g., swearing), and her own admission that she feels safe in session. Besides being curative in its own right (some think that

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therapeutic alliance is the greatest predictor of improvement), there are other reasons why a good therapeutic bond was absolutely necessary in this case. First, by her own admission, ABC’s personal relationships were impoverished and the cause of a great deal of stress in her life. By keeping people at a distance, she ostensibly reduced the risk of being hurt by maintaining a personal façade at great cost to her health. By achieving a close therapeutic bond with me, she reversed the trend of false, shallow relationships and could move toward a more satisfying relational life.

Second, as discussed earlier, ABC used these enmeshed relationships as a buffer against accepting responsibility and to assuage her feelings of existential isolation. By forming a close relationship with someone who still required her to think and act for herself, ABC was awakened to a new type of relationship that is caring without being overbearing. In all of this alliance building, the ultimate goal was generalization to her life outside of therapy. In an attempt to foster generalization, I made explicit in session the fact that there are people who can care for her without using her sexually or otherwise taking advantage of her.

Finally, ABC’s personal problems were heightened by her personal distress about schoolwork and career direction. As mentioned in session, she formerly based much of her self-worth on being intelligent and competent. Throughout her childhood and young adulthood, ABC looked at scholastic achievement as an external validation of her worth. Consequently, her recent indecision about her career, major, as well as her falling grades had been a great source of personal distress. At the time, ABC was channeling a great deal of energy into creating a false self, www.ExistentialPsychology.org

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maintaining hurtful relationships, and doing other people’s work (e.g., doing all of her roommate’s chores). Obviously, her schoolwork had suffered as a result, a consequence that had served to shake her resolve in her chosen major as well as her self-worth. It was my belief that a natural consequence of leaving behind these energy consuming behaviors would be an improvement in her schoolwork.

At the time of the session, ABC had chosen a major that she did not enjoy; a decision made by following a path of least resistance that would make her mother happy. It was my hypothesis, that as she began to take more responsibility for her life, she would be able to more accurately assess whether or not her major was one that she would like to pursue for her own purposes.

The interventions undertaken in this session were aimed at improving both the career and personal life of this client. Indeed, given the great deal of symptomatic overlap, it seemed reasonable to say that any improvement would lead to an improvement in both areas.

In the sessions that followed, the improvement that ABC made toward accepting responsibility led to improvement in her career path. Previously, ABC had much to say about her teachers, and had attributed many of her school failings to “bad luck” or bad teachers.

This external locus of control led her to feel helpless and powerless, causing her once good grades to fall. However, since focusing on the freedom and responsibility she has, ABC has become more empowered and her schoolwork has begun to improve accordingly.

In a more recent session, ABC became very angry at having lost a school assignment due to her own failure to save and properly

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document her work. Initially, she began to rant about how “this crap always happens to me” and how unlucky she was. About halfway through this angry diatribe, she stopped blaming luck, her teacher, and had what I believe to be an epiphany. She said, “If I just would have taken a minute more and saved and organized my work none of this would have happened.” Although this did not necessarily ease her immediate discomfort at having done poorly in her class, it did lead to a discussion about how much energy she was expending on blaming others for her life mistakes. She grasped at that moment how a little responsibility on her part, could have saved her a bad grade, an angry morning, and myriad other problems. This self-realization was profound and I anticipate that it will be of great use to her both personally and professionally. Finally, I identify strongly with Nietzsche’s existential maxim: “He who has

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a why to live can bear with almost any how (quoted in Frankl, pg.9).” As she has mentioned how important professional life is to her, I see career as relevant to the “why to live” of ABC’s life. It is my belief that as she works toward greater acceptance of responsibility, that she will be guided to a career or life purpose that will do much to make her other problems less salient. I have seen this principle at work in many other instances, and helping ABC find a fulfilling career, life purpose, or major, was also an integral part of my treatment plan. In this instance, an existential approach to addressing ABC’s presenting problems of personal and career dissatisfaction worked very effectively. Far from being impractical, as it is too often characterized, existential treatment modalities may often offer a great deal of utility for addressing a wide range of presenting problems.

REFERENCES Frankl, Viktor E. Man’s Search for Meaning (1992). Beacon Press:Boston.

Yalom, Irvin D. The Gift of Therapy (2002).

Harper Collins: New Yor. Yalom, Irvin D. Existential Psychotherapy (1980). Basic Books.

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