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Clients With Serious Mental Health Issues

Existential counseling has been used with a wide variety of presenting problems. Whatever the reason, mental disorders represent the loss of an individual's potential. In the confrontation with life and death, many people develop a desperate sense of isolation (Hoffman, 2009). Still, existentialists offer promise and hope.

Several populations of individuals with serious mental disorders have been a recent focus for existential interventions. Patterson and Staton (2009) used an existential approach to work with adults who have acquired a traumatic brain injury. Offering recommendations to counselors working with this population, the authors suggested that self- awareness, developing a solid therapeutic relationship, and bringing in family members to help work through issues are essential. For family survivors of homicide, an existential- empowerment family therapy (Miller, 2009) focused on helping families find meaning through symbolic activities that may include telling stories, standing up for what is right, and helping others to regain a reason to live. Likewise, Simonelli et al. (2008) worked with individuals with gynecologic cancer who continue to have problems in physical functioning to help them find meaning in their experience. The authors found that the existential intervention helped people cope and lessen depressive symptoms.

Depression is a natural reaction to existential despair, and several studies reflect that existential counseling not only addresses the life concerns but also provides a basis for the symptoms. Teal (2009) discovered that treating depressed individuals with an SSRI (selective serotonin reuptake inhibitor or serotonin-specific reuptake inhibitor) draws a curtain between the client and everything else, where the world "can no longer touch them" (p. 19). This is a curtain that needs to be opened for the client to heal. Mascara and Rosen (2008) focused on existential meaning and depressive symptoms and found that individuals with a sense of life purpose and meaning are less likely to show depressive symptoms. In their study, Maselko, Gilman, and Buka (2009) found that those with regular church attendance and higher existential well-being were less likely to be diagnosed with major depression. Existential meaning and hope were addressed in relation to depression (Mascara & Rosen, 2008; Mela et al., 2008). Likewise, bipolar disorder (Goldner-Vukov, Moore, & Cupina, 2007) benefits from an existential approach. Existential counseling, an approach focused on relationships in an honest encounter of beingness, seems to be particularly effective with the affective disorders.

Schizophrenia, anxiety, dissociation, and alcoholism have been treated effectively using an existential approach (Schneider, 2008). Psychological issues arising from rape (Lantz & Walsh, 2007) and suicidality (Taliaferro, Rienzo, Pigg, Miller, & Dodd, 2009) have also benefited from an existential approach. Hoffman (2009) wrote, "What many therapies label as pathology existential therapy conceptualizes as 'existence pain'" (p. 51). The existential counselor does not focus on the diagnosis, regardless of its severity, but rather on the person and the relationship in the here and now.

The full spectrum of anxiety disorders are a direct result of existential struggles and can be addressed through existential counseling (Schneider, 2008). Anxiety is a universal experience of being "thrown" into existence (Heidegger, 1962), of being alive in a threatening time and being aware of the predicament. In the treatment of individuals with anxiety disorders, it has been found that most of the time the core issues are existential dilemmas (Wolfe, 2008). Viewing the center of the panic as something to be explored and understood rather than escaped serves to disempower the anxiety.

Individuals with serious disorders respond to an existential approach. Hansen (1999) specifically noted the usefulness of existential counseling in working with individuals with borderline personality disorder, schizophrenia, depression, and mania. Bola and Mosher (2003) showed that existential, relationship-based interventions were helpful with individuals diagnosed with schizophrenia and schizophreniform disorders. Individuals with symptoms of anorexia nervosa seem to experience lower existential well-being than their peers with no eating disorders (Fox & Leung, 2009). Existentialists believe that relationships can be transformed through counseling to allow a person to live more authentically (Nye, 2008). In spite of everything, relationships and the resulting anguish and stress are always present in struggling to understand one's purpose in life.

The existential crisis and confrontation of it also produce depression and dysthymia. Anomic depression (Lantz & Walsh, 2007) is the term used to describe the affective reaction to meaninglessness. To find meaning, the path is often filled with despair, hopelessness, and longing. Lichtenthal et al. (2009), pointing to the importance of addressing these core questions of being at every stage, noted that although dying individuals were found to have heightened existential concerns, they showed no increase in depression or anxiety. Through the struggles on the journey, the client gains insight, understanding, and responsibility, which allows him or her to be more resilient in the face of new life pressures.

Of all the mental disorders discussed thus far, possibly the most unsettling is a loss of self in the world, or existential isolation (e.g., avoidant, dependent, obsessive-compulsive personality disorders as well as major depression). Knowing that every person is never fully known and always alone can lead some counselors to work on changing the behaviors associated with anxiety and not address the existential issues themselves (Cowan, 2009). It requires a commitment for a counselor to go on a journey with an individual through the ultimate aloneness of not being.

When individuals fail to develop inner strength, worth, and identity, they move beyond being isolated to feeling a profound sense of loneliness. Existential isolation occurs when an person fails to develop an authentic sense of self and lack of participation in the world (Dahlberg, 2007). The person instead internalizes anxiety and searches for any available sanctuary. Because existentialism embodies hope, even the most serious disorder holds the promise of breakthrough. The sanctuary may provide an authentic connection with another person and then with the lost aspects of self.

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