Traditional Intervention Strategies
Although supported by a fully developed theory and philosophy, techniques, when used, are complementary to the relationship and process.
From an existential perspective it is essential that even when specific "techniques" are incorporated, they are never used in the same way twice. The reason... is not lack of utility, but because techniques that are applied are not as effective as techniques that emerge. This is the art of psychotherapy . . . primarily engaging or encountering [the client]. (Hoffman, 2009, p. 24)
Existential theory is steeped in phenomenological awareness. Therefore, the following intervention strategies flow from a respectful understanding of the individual coming into counseling.
Telling the Story: Finding the Meaning of Myth In his last work, May (1992) viewed myths as central to gaining existential meaning. "Myths represent the universality of the existential givens and the particularity of cultural responses to those givens" (Hoffman, 2009, p. 26). In the counseling or psychotherapy session, stories may be facilitative in helping clients understand events in their lives. Clients also create their own stories as they detail their past and future.
Telling the painful events to a counselor is healing (Lantz & Walsh, 2007) because it brings the event into the counseling encounter and gives it a name and voice. As the story unfolds, the client can see the patterns from a larger perspective. As Ruzicka (2007, p. 339) noted, "When myths speak of the things past, their sense, however does not dwell in the past. The mythical reality is here and we are in it again to find a resource for the new selfhood." Only through sharing of the story can the healing begin, meaning gleaned, the pain honored, and then released.
The existential relationship is the primary therapeutic intervention, and the client is an existential partner. Viewed with compassion, clients are not met with pity or sympathy but with deep respect, honoring their existence and pain (Lantz & Walsh, 2007). Yalom's relational approach focuses on "being real," and it is critical to develop a genuine, authentic relationship that focuses on the "in-betweenness," because only that can heal (Krug, 2009, p. 347). As Bugental (1978) asserted,
Presence is the quality of being in a situation in which one intends to be as aware and as participative as one is able to be at that time and in those circumstances. Presence is carried into effect through mobilization of one's inner (toward subjective experience) and outer (toward the situation and any other person in it) sensitivities.. . . Presence is being there in the body in emotions, in relating, in thoughts in every way. (pp. 36-37)
Spillers (2007) stated that presence is also listening:
Listening to understand allows the time and space for emotional and spiritual issues to arise.
It focuses on the feeling tone beneath the words and invites response to the feeling tone rather than to surface content of the message. . . . The more clients feel understood and supported, the more fully they can participate in their own treatment, (p. 195)
Emerging from the intervention is a deep sense of relatedness, which Lockett (2009) and Parlow (2008) called love. Included in the relatedness, and therapeutically significant, the counselor or therapist must be able to use himself or herself as an indicator of what is occurring within the client. As May (1979) noted, "It is not possible to have a feeling without the other having it to some degree also.. . . The use of one's self as an instrument requires a tremendous self-discipline on the part of the therapist" (p. 122). "Being with" the individual in counseling can, and most often will, have an impact on and potentially change the therapist (Frommer, 2009).
Taking responsibility for growth is important, but taking responsibility for self-destructive actions is not easy. Yang (2009) wrote, "To be aware of responsibility is to be aware of creating one's own self, destiny, life predicament, feelings, and if such be the case, one's own suffering" (p. 184). This intervention involves helping clients take ownership of their lives. First, they must be accountable for their choices. Equally important is letting go of the responsibility that others own in the process of relating (Spinelli, 2007). Being responsible acknowledges that obligation can be assumed, shared, and owned by others.
Counselors and therapists working in a variety of approaches have regarded dreams as the window to the unconscious. In existential counseling and therapy, dreams have an additional usefulness. Through dream work, the counselor or therapist is better able to help the client see the pattern of being in the world as well as a window to the therapeutic relationship (Yalom, 2009). After traumatic life experiences (Barnett, 2009), dreams give voice to the fear and uncertainty of survival, and at the end of life (Bulkeley & Bulkley, 2005), dreaming may help resolve existential issues and bring peace. Though unsettling, the existential experience of dreams moves the individual closer to authenticity. Dreams are like insight. They provide a reflection of people's inner feelings, hopes, and fears, and dreamers are compelled to discover their meaning.
Disclosing and Working Through Resistances
Addressing resistances to awareness requires a sensitive intervention, and the counselor or therapist is most effective when addressing issues supportively. Bugental (1978) suggested that counselors and therapists use comments such as "You can feel how much that way of being has cost you all of your life" and "You have wanted so much to be loved that you have often forgotten to take care of your own needs" (p. 90). Recognizing resistance to talking with the counselor while at the same time struggling with a lack of relationships outside the counseling setting can provoke insight and change (Hoffman, 2009). The client owns the responsibility and the power to address the issues blocking awareness and authenticity. The counselor or therapist serves as the midwife in the birth of a more authentic being.
Confronting Existential Anxiety
Probably the most important intervention is being aware of the client's existential issues. Addressing issues of death and loss is difficult, and for most individuals, these issues are met with denial. It takes courage to discuss the forbidden subject of death. "By acknowledging and facing our anxiety and fear of death, we can create our own response to the world in which we live: we can create meaning" (Home, 2009, p. 67). As Yalom (1980) wrote, "If we are to alter therapeutic practice, to harness the clinical leverage that the concept of death provides, it will be necessary to demonstrate the role of death in the genesis of anxiety" (p. 59). It may come through dreams, through the counseling relationship, through issues the client is facing, or through reviewing life patterns, but confronting anxiety can help individuals to find freedom and meaning. By confronting the ultimate losses (e.g., relationships, life, and self) and by being present through the resultant anxiety, counselors and therapists have a powerful tool to help clients work through fear.
Facing the end of the helping relationship is the final confrontation with reality. It is expected that additional issues will arise to delay the inevitable ending. The intervention of termination requires continued authenticity and willingness to be present. The counselor or therapist and the client may never meet again. Paralleling every other loss in the lives of both the client and the counselor or therapist, termination represents a very real death to both people. It is critical that the practitioner help the client by processing the ending of counseling or therapy, by creating a good parting. The difficulty with this intervention is that it exposes the reality of ending that is present in all relationships.