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Unfortunately, existentialists tend to be congruent. The theory that focuses on existence over essence is more centered on theory, counseling or psychotherapy, and people than on generating testable hypotheses, research design, and advancing the theory through scientific analysis (Lantz, 2004). Unintended or intended, one's biases can easily affect what is being studied and how one studies it.

Supporting Research

In a lengthy analysis, Hoffman (2009) reviewed outcome research using an existential approach. Noting the validity of an existential perspective based on multiple examples of case studies, qualitative research, and quantitative research, the point is made that existential counseling is of value not only because of its relationship-focused intervention but also because it falls in the realm of "evidence-based therapy." Lantz and Walsh (2007) acknowledged the diversity of research methods used to validate existential counseling. Meta-analytic studies also support existential psychotherapy as well as supporting an existential integrative approach that "is as scientific as any other psychological treatment" (Hoffman, 2009, p. 56).

Counseling or psychotherapy outcome research (Elkins, 2007) continues to include existential approaches. Regardless, it has continued to be shown that one theoretical approach to counseling or psychotherapy is not measurably more effective than any other. Spinelli (2007) observed how existential counseling, by its nature, is a form of research and noted, "Existential psychotherapy might best be understood as a direct expression of Human Science research in general and phenomenological research in particular" (p. 57). The process-relational variables common to existentialist studies tend to be an area of interest and growth.

At another level, existential counseling is a foundation for spiritual approaches and uniquely addresses the issues of faith (Hoffman, 2009). By addressing the personal encounter, validating the process as much as the content, existential counseling or psychotherapy offers the framework that counselors or psychotherapists and clients are most seeking. Moreover, existentialism is seen as an ethical approach, because the responsibility as well as inherent right of the client to choose is central (Tekosis, 2008). Ranheim (2009) reflected on the impact of an existential approach in the medical field:

the understanding that existence affects caring and caring affects existence, and contributes to the more general claim that it now is high time for ethical caring science theory to be visible and make a change in care. Highlighting the experience of existential caring intentionality, and relating the experience to theoretical caring substance, this study may contribute to the development of a more consciously ethical and individualized caring culture, (p. 78)

The analysis provided by Koslander, da Silva, and Roxberg (2009) also supports the claim that existential needs are critical to individuals' healing as an ethical approach. It is a counselor's responsibility to acknowledge the subjective experience of the individual, the human encounter, struggle, and responsibility. Mela et al. (2008) found in a comparative study of individuals both in treatment and not in treatment that existential concerns were tied to higher psychological functioning. For example, depressed clients had less existential well-being and less connection with religiosity and spirituality. Individuals attending religious services were less likely to be depressed. Burkhardt (2009) validated the importance of addressing existential and spiritual needs. Beyond traditional convention, it is important that the integrity of the individual and the counseling relationship supersedes political and scientific argument. Existentialism uniquely focuses on elements of the human experience that have been ignored but may provide the most important elements to facilitate growth and change.

The need for increased research has led to the development of existential scales that can spawn more existential research. Morgan and Farsides (2009), recognizing the need for existentialist issues, began by looking at measuring meaning in life through "a purposeful life, principled life, valued life, exciting life, and accomplished life" (p. 197). Next, using these results, they developed a self-report measure and finally developed validity and reliability for a new Meaningful Life Measure. Melton and Schulenberg (2008) reviewed five assessment instruments measuring meaning: Purpose of Life Test, Life Purpose Questionnaire, Seeking of Noetic Goals Test, Meaning in Suffering Test, and the Life Attitude Profile Revisited. Validity and reliability as well as studies to support these instruments are included. The McGill Quality of Life Questionnaire (Henry, Huang, Ferland, Mitchell, & Cohen, 2008) has continued to be studied and applied to patients at the end of life.

Addressing each research challenge, assessment must remain focused on the subjectively human person by using case study, as well as qualitative and quantitative methodology. As a whole, the psychotherapeutic community is beginning to arrive at this level of awareness. Assessing existential counseling or psychotherapy can first seem like trying to measure the counseling progress with a yardstick, knowing that the progress is neither linear nor unidimensional.

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