Existential Models

Learning Opportunity 8.1

Americans live in one of the most affluent countries in the world, yet we suffer from extremely high rates of substance use disorders, suicides and depression when compared to other industrialized countries. What is your opinion as to what accounts for these high rates of substance use disorders (SUDs) and mental health problems? Is America experiencing an existential crisis?

Introduction

This chapter focuses on existential therapy and its application to addiction counseling. Existential therapy is more of a philosophical approach than specific style, technique or strategy (Corey, 2017). “Rather than being a technical approach that offers a new set of rules for psychotherapy, it represents a way of thinking about human experience that can be — or perhaps should be — a part of all therapies” (Yalom & Josselson, 2014, p. 265). Existential therapy, therefore, evolved from existential philosophy in the years following World War II. It is important to take into account what was going on in the world (specifically in Europe and Scandinavian countries) at the time existentialism was being developed. Having been through two world wars, political revolutions in Russia, industrialization, there was a great deal of personal turmoil in which individuals began to question personal meaning in a meaningless world. Therapists who have contributed to existential theory includeVictor Frankl, Rollo May, Abraham Maslow, IrvinYalom and Friedrich Nietzsche.

Key Terms

existential vacuum: Frankl’s term to describe a sense that life has lost all meaning.

personal responsibility: existentialists believe that people are responsible for their own conditions. They are also responsible for making meaning out of their lives.

ultimate concerns/crises: there are four ultimate concerns or existential crises that people must face: freedom, isolation, death and meaninglessness.

Existential Approach

Existential counseling is based on the belief that human beings have the need for meaning and purpose in life. They also have the capacity for freedom and choice. Further, existential counselors believe that human beings function more effectively when they take responsibility for their lives. Additionally, human beings will inevitability face limitations and challenges in their lives, and function most effectively when they face — rather than avoid or deny — these challenges (Vos, Craig, & Cooper, 2015, p. 115).

Existentialists believe that everyone experiences challenges, life crises (Johnson, Griffen-Shelley, & Sandler, 1987) or ultimate concerns (Yalom & Josselson, 2014). These challenges, ultimate concerns or crises include freedom, isolation, death,and meaninglessness. “The individual’s confrontation with each of these [ultimate concerns] ... constitutes the content of the existential dynamic conflict” (Yalom, 1980, p. 8).

The life crises that all of us share are: the recognition that we are finite, that we must die; the recognition that we are free and that we cannot escape that freedom and the responsibility that it entails; the recognition that as individuals we are all inexorably alone; and the recognition that if our lives are to have meaning, it will be of our own creation.

(Johnson, Griffin-Shelley, & Sandler, 1987, p. 17)

Further, these concerns or crises are associated with anxiety and despair which can be linked to substance use problems (Lewis, 2014).That is, some people turn to alcohol and/or drugs in order to reduce feelings of anxiety, depression and despair. However, the paradox of substance abuse is that it usually adds to feelings of isolation and despair over time. It is common as people progress deeper into SUDs that they become more isolated, lonely and disconnected from others.

The next section addresses these four crises/ultimate concerns of freedom, isolation, death and meaninglessness. The section following this discussion presents the application of this existential approach to addiction counseling. The chapter ends with a case study.

The Four Crises/Ultimate Concerns/Challenges Freedom

... freedom refers to the absence of external structure — that there is a lack of structure to the universe with no inherent design. Therefore, individuals are entirely responsible for — that is, is the author of — his or her own world, life design, choices, and actions. “Freedom” in this sense, has a terrifying implication: it means that beneath us there is no ground — nothing, a void, an abyss. A key existential dynamic, then, is the clash between our confrontation with groundlessness and our wish for ground and structure.

(Yalom, 1980, p. 9)

Yalom and other existentialists believe that freedom ultimately means that we are the authors of our own lives. Therefore, we must take responsibility for our own choices and perspectives “and we bear the burden for knowing that we are responsible for all of our experience” (Yalom & Josselson, 2014, pp. 266—267). Once a person realizes that s/he is “groundless” and alone in these choices, the person experiences existential anxiety (Lewis, 2014, p. 350). Failure in dealing with existential freedom may lead to compulsive behavior (Johnson et al., 1987).

Isolation. Isolation refers to the experience that we are alone in the universe (Yalom, 1980, p. 9) “Existential isolation refers to an unbridgeable gulf between oneself and any other being. It refers, too, to an isolation even more fundamental — a separation between the individual and the world” (Yalom, 1980, p. 355). Existential isolation must be separated from interpersonal isolation as it is not related to geographic or poor social skills, but to the “fundamental separation between people that underlies human existence” (Lewis, 2014, p. 351).This awareness of our fundamental isolation may lead to anxiety and powerlessness (Lewis, 2014, p. 351). Further, the “fear of existential isolation (and the defenses against it) underlies a great deal of interpersonal psychopathology” (Yalom & Josselson, 2014, p. 275).

Death. Death is the ultimate concern as we recognize our own mortality. For existentialists, a “core inner conflict is between awareness of inevitable death and the simultaneous wish to continue to live” (Yalom & Josselson, 2014, p. 276). “Death is a primordial source of anxiety and, as such, is the primary fount of psychopathology” (Yalom, 1980, p. 29). However, the acceptance of death and one’s mortality can give life meaning and purpose.“Death is the condition that makes it possible for us to live life in an authentic fashion” (Yalom, 1980, p. 31). We cannot live life fully until we have grappled with death honestly (Feifel, 1969).

Meaninglessness. Frankl (1992) believed that the search for meaning is a person’s primary motivation.

The human being seems to require meaning. To live without meaning, goals, values, or ideals seems to provoke, as we have seen, considerable distress. In severe form it may lead to the decision to end one’s life. Frankl noted that in the concentration camp the individual with no sense of meaning was unlikely to survive.

(Yalom, 1980, p. 422)

Feelings of meaninglessness and emptiness are what Frankl (1992) referred to as an existential vacuum. When experiencing an existential vacuum a person feels “indifference, apathy or boredom and a sense of meaninglessness with life” (Nicholson, Higgins,Turner, James, Stickle, & Pruitt, 1994, p. 24). Consequently, this lack of meaning can lead to anxiety and psychopathology'. More specifically, in relation to alcohol and other drug-related problems, Frankl (1978) stated that “addiction ... is at least partially to be traced back to the feeling of meaninglessness” (p. 26). Indeed Nicholson and colleagues (1994) found that those with substance abuse problems had lower levels of meaning of life when compared to a control group of non-abusing people.

Learning Opportunity 8.2

In small groups of four, divide the ultimate concerns/crises among group members. Discuss the ultimate concerns/crises of freedom, isolation, death and meaninglessness. Then discuss how they might relate to substance use, abuse and addiction as well as how these concepts might be applied in treatment.