The Freedom To Change: Existential Approaches & Experiential Methods

According to Yalom (1989), the primary task of a therapist is to make him or herself obsolete. I strongly agree with this statement, and also believe that therapy should assist the client to build the skills necessary to no longer need therapy or the therapist. As an alcohol and drug counselor, I have been working within a cognitive-behavioral framework for many years.

While I continue to believe that cognitive-behavioral therapy is a useful component in the therapeutic process, I have come to believe that lasting change requires opportunities for deeper exploration into fundamental issues that adolescents face. It seems to me that existential psychotherapy is an excellent, although uncommon, approach for working with adolescents, as it addresses those fundamental issues central to adolescence. In fact, this seems such a natural approach for working with teens that I am surprised that literature searches on the topic resulted in extremely little on the use of existential psychotherapy with adolescents.

Yalom (1989) wrote,
To explore deeply from an existential perspective does not mean that one explores the past; rather, it means that one brushes away everyday concerns and thinks deeply about one’s existential situation. It means to think outside of time, to think about the relationship between one’s feet and the ground beneath one, between one’s consciousness and the space around one; it means to think not about the way one came to be the way one is, but that one is (p. 11).

These would be challenging therapeutic objectives with any client. To strive for these goals with teens seems especially difficult. However, as I am primarily interested in working with adolescents, this is the challenge I give myself.

All adolescents face the psychosocial tasks of developing identity, autonomy, intimacy, sexuality, and achievement (Steinberg, 2005). According to Fitzgerald (2005), there is “a stark similarity” between what adolescents experience in their daily lives and the concepts of existentialism. He wrote, “It is commonly agreed that adolescence is a time filled with conflicts. A number of these conflicts closely resemble existential issues” (p. 795).

Defining Existential Psychotherapy
Existential psychotherapy “examines individuals’ awareness of themselves and their ability to look beyond their immediate problems and daily events to problems of human existence” (Sharf, 2008, p. 146). Yalom (1980) wrote that existential psychotherapy “is a dynamic approach to therapy which focuses on concerns that are rooted in the individual’s existence” (p. 5).

Yalom (1989) wrote, “I have found that four givens are particularly relevant to psychotherapy: the inevitability of death for each of us and for those we love; the freedom to make our lives as we will; our ultimate aloneness; and, finally, the absence of any obvious meaning or sense to life. However grim these givens may seem, they contain the seed of wisdom and redemption” (p. 5). Below I look more closely at these four givens—death, meaning, freedom, and isolation—with special consideration to their potential relevance for adolescent clients.

Death
Yalom (1980) wrote “a core existential conflict is the tension between the awareness of the inevitability of death and the wish to continue to be” (p. 8). Death may seem like a strange topic to be at the core of a theoretical approach for working with adolescents. However, based on my personal experience with this population, I have I believe it to be extremely relevant. Adolescents confront death regularly. For example, my current caseload includes a client whose father died from liver failure within the last year; another client in foster care due to drug overdoses by both parents; a third client’s best friend recently died from leukemia. In addition, I have five clients who attend a school that has seen two student suicides this academic year. Clearly death is not a stranger to teens.

Yalom (1980) wrote that in general adolescents show higher death anxiety than other age groups. He also said that individuals who exhibit pathology express higher death anxiety than does the general population. This seems to suggest that adolescents in therapy would exhibit an especially heighten likelihood for death anxiety. Not only are they are at a vulnerable age, but if in a clinical setting also exhibit some form of pathology. One reason of this heightened likelihood for death anxiety may be that teens experience both biological and symbolic death with some regularity.

According to Fitzgerald (2005), “[A]dolescents not only must face biological death, but also the death of a once-accepted world view” (p. 797). Neither child nor adult, the adolescent lives in a transitional state, required to suffer the death of his or her childhood years before being fully allowed into adulthood. The transitions of adolescents are examples of what Yalom (1980) termed boundary situations, “an event, an urgent experience, that propels one into confrontation with one’s existential ‘situation’ in the world” (p. 159).

As teens confront the many boundary situations inherent in their transitional status, they are forced to face both actual and symbolic deaths. In my experience, for teens in clinical settings this boundary situation is often made more confounding by unresolved developmental tasks due to substance abuse, mental health issues, trauma, abuse, neglect, and various environmental challenges. Clearly therapists working with adolescents should be prepared to address death, both biological and symbolic, as well as the anxiety it may create.

Meaning
For Yalom, death is the most important of the four givens. For Frankl, though, meaning was clearly of primary importance. Indeed, Frankl (2006) wrote, “[S]triving to find a meaning in one’s life is the primary motivational force in man” (p. 99). Logotherapy, an existential approach developed by Frankl, focuses on the concept of will to meaning, a belief that it is the striving to find meaning in one's life that is the primary motivation for individuals.

Frankl (2006) wrote that logotherapy focuses on the future, specifically on “the meanings to be fulfilled by the patient in his future” (p. 98). I believe that the future focus of logotherapy, and existential psychotherapy in general, is particularly valuable with adolescents. Again, I come back to my core belief about psychotherapy, that therapy should be a tool to assist the client in moving forward into the future. Helping clients discover the meaning in their lives is an important part of this forward movement.

According to Yalom (1980), “Each of us must construct our own meanings in life” (p. 9). When this does not occur, when an individual is living a life devoid of meaning, that individual is likely to face existential frustration. Frankl (2006) wrote, “[E]xistential frustration is in itself neither pathological nor pathogenic. A man’s concern, even his despair, over the worthwhileness of life is an existential distress but by no means a mental disease” (p. 102).

Existential frustration due to feeling that life is meaningless does not indicate mental illness. If anything, I would suggest it indicates mental health, for one should feel frustrated by meaninglessness. This psychic pain, like physical pain, indicates that something is wrong. For adolescents who have not yet developed a clear sense of identity, such psychic pain is likely to be especially common (Blair, 2004).

According to Yalom (1989), “[M]eaningfulness is a byproduct of engagement and commitment, and that is where therapists must direct their efforts” (p. 13). In other words, by assisting adolescent clients to more fully engage in their own lives and more authentically connect with others, meaningfulness will naturally result.

More specifically, according to Frankl (2006),
[T]here are three main avenues on which one arrives at meaning in life. The first is by creating a work or doing a deed. The second is by experiencing something or encountering someone… More important, however, it the third avenue to meaning in life: even the helpless victim of a hopeless situation, facing a fate he cannot change, may rise above himself, may grow beyond himself, and by so doing change himself. He may change a personal tragedy into a triumph (p. 145).

For many adolescents in therapeutic settings, personal tragedy is a given. It seems to me that a vital goal of therapy should be helping these clients find the meaning in their life experiences.

Freedom
Yalom (1980) wrote, “Ordinarily we think of freedom as an unequivocally positive concept… [However,] in its existential sense freedom refers to the absence of external structure” (p. 8). He continues, “Freedom in this sense, has a terrifying implication: it means that beneath us there is no ground—nothing, a void, an abyss” (p. 9). In my experience, most teens in therapeutic settings have already slipped into this abyss.

In a limitless universe, we are forced to make choices daily. With each choice, we must take responsibility for having eliminated other options. Yalom (1980) wrote that existential anxiety can be “lurking when any major event, especially an irreversible one, occurs in a patient’s life” (p. 171). Irreversible decisions create “the impossibility of further possibility (Yalom, 1980, p. 171). As teens confront new and unique boundary situations, and are regularly faced with reducing possibilities, the likelihood of existential anxiety is predictably high.

Jon, a client of mine, recently stated, “Lots of times I feel like I’m living in some kind of void, a black hole. I’m alone, but not really, because everything is there. It’s black, because that’s what black holes are, right? But black is really all the colors at once, every single one of them. And that’s too many colors if you ask me.”

Being faced with all the colors at once is a boundary situation common to adolescence. The limitless possibilities Jon described immobilize him in a dark, lonely void. His freedom to choose among all the colors was a clear source of existential anxiety. Frankl (2006) wrote, “[I]ndividuals search for ways to fill the void and quickly become vulnerable to symptoms such as depression or other problems” (p. 335). For Jon these problems include generalized anxiety disorder, social anxiety, and substance abuse.

Isolation
Adolescents are often experiencing their first true autonomy. Indeed, developing autonomy is a primary developmental task of the teen years. However, according to Yalom (1980), “We yearn for autonomy but recoil from autonomy’s inevitable consequences—isolation” (p. 251). This isolation is fundamental, “an isolation both from creatures and from the world” (Yalom, 1980, p. 9), and can lead to existential anxiety, alienation, and various developmental challenges.

Bronfenbrenner (as cited in Cross, 2007) identified four dimensions of influence upon adolescents: family, school, peers, and work or play. Subsequent research suggested that alienation is the result of disruptions in these dimensions. Calabrese (cited in Cross, 2007) stated, “Trouble comes when an adolescent experiences alienation in more than one world at a time, or finds no solace in their other worlds” (p. 5). When an adolescent experiences a disruption in any of these dimensions, a ripple effect is likely to occur with negative impacts in the other worlds. This ripple effect is likely to increase the teen’s sense of alienation and decrease his or her sense of autonomy.

Since establishing autonomy is a primary developmental task of adolescents, when this happens Yalom’s paradox can become magnified and distorted in profound ways that likely lead to a sense of alienation. Dean (as cited in Cross, 2007) stated that alienation is the result of three factors: powerlessness, or feeling unable to influence one’s own choices; normlessness, or feeling one’s value system is inconsistent with that of society; and isolation. Neither normlessness nor powerlessness is one of Yalom’s givens. However, both have strong existential reverberations through all the four givens of death, meaning, freedom, and isolation.

The impact of existential anxiety on the core developmental task of establishing autonomy is clear. Teens striving to establish autonomy, but recoiling from isolation have approached a truly significant boundary situation, one that forces them to confront responsibility for their own lives and their own ultimate isolation. The safety of childhood is in the past, the future is inherently unknown, and the adolescent is alone in an undefined existential vacuum filled with all the colors at once.

The Adolescent Existential Vacuum
Frankl (2006) defined this existential vacuum as “a feeling of emptiness and meaninglessness” (p. 141). Jon, the client who told of his void of many colors, is clearly trapped in such an existential vacuum. Like many adolescents, this client’s primary complaint is not his substance abuse, his family problems, his school failure, or his anxiety. It is boredom. According to Frankl (2006), “The existential vacuum manifests itself mainly in a state of boredom” (p. 106). Such a vacuum is likely to lead to depression, aggression, and addiction in adolescents (Frankl, 2006). This is evident among my clients, who generally report boredom as the most commonly given reason for substance use, closely followed by anger.

Ironically, not only does addiction result from boredom, it leads to it. In his autobiography of addiction, Sheff (2007) wrote, “Using is such a fucking ridiculous little circle of monotony. The more I use, the more I need to kill the pain, so the more I need to keep using. Pretty soon it seems like going back, facing all my shit, well, it’s just too goddamn overwhelming. I’d rather die than go through it” (p. 146). It seems clear that Sheff’s addiction is about escaping—at least temporarily—his own existential vacuum. He wrote, “I don’t care. Isn’t that the greatest gift in the world—just not to care? I feel so grateful for it. That’s nothing I ever knew sober” (p. 60). Not only is Sheff attempting to escape his own existential vacuum, it would appear he is attempting to avoid responsibility. Perhaps he is even trying to avoid awareness of responsibility.

According to Yalom (1980), “One of the more common dynamic defenses against responsibility awareness is the creation of a psychic world in which one does not experience freedom but exists under the sway of some irresistible ego-alien force” (p. 225). Yalom continues by stating that this ego-alien force is compulsivity. In this framework, addictions can be seen as an attempt to avoid responsibility. This conceptualizing of addiction certainly seems true, at least with some adolescents.
Yalom (1989), “The first step in all therapeutic change is responsibility assumption” (p. 100).

In my experience, even teens committed to sobriety often avoid true, full responsibility. Tina, a current client, illustrates this well. She states with absolute conviction that she is “an insane druggie,” yet avoids true responsibility by continuing to use. Since she identifies her alcoholism as something outside her own control, calling it “a genetic joke played on me by my alcoholic parents,” she has no reason to change. For Tina, creating change requires increasing her “readiness to accept responsibility” (Yalom, 1980, p. 231).

Creating Change
Yalom (1989) wrote that responsibility assumption is “extraordinarily hard, even terrifying” (p. 38). It is precisely because of this difficulty that I believe skills building is an appropriate component of any to working with teens. I believe that therapy should be about creating change and that my role as a therapist is to facilitate the change process. This change process takes effort from the client, a willingness to be challenged. However, adolescents frequently require assistance in identifying the action necessary to move forward (Blair, 2004).

Part of helping clients create change, then, must be helping them to define and take the necessary steps. Rugalal and Waldo (as cited in Blair, 2004) wrote, “When employing an existential theory, mental health counselors are free to borrow techniques from other approaches, provided they are consistent with the therapeutic encounter” (p. 334). One approach that I believe to be especially effective for working with adolescents in therapeutic settings is experiential learning.

Experiential learning is “a philosophy and methodology in which educators [or clinicians] purposefully engage with learners in direct experience and focused reflection in order to increase knowledge, develop skills, and clarify values” (AEE, n.d.). Having utilized experiential learning in clinical settings for about ten years, and having facilitated experiential learning in other contexts for another decade before that, I am a strong believer in the efficacy of this methodology. I have seen experiential learning engage even the most resistant clients and lead to life-changing therapeutic breakthroughs.

Experiential learning has two critical steps, doing and processing. The doing step is the activity. Common activities include hikes, kayaking, initiative games, and ropes courses. In clinical settings, the doing step is often focused on skills building. Other common clinical uses of experiential learning are building group cohesion, illustrating concepts, and increasing self-efficacy. In the processing step, participants reflect on the experience of doing, with the facilitator or therapist helping them to review the activity and generalize the learning to other areas of their lives (Luckner & Nadler, 1997).

Processing within an existential framework could focus on discovering the meaning within the activity, exploring choices and decision making during the activity, and examining interpersonal connections made or required to successfully complete the activity.

Experiential learning theory includes a core belief that learning and change occurs most readily when the participant is “confronted with a balance between stress and comfort” (Webb, 2007, p. 3). In other words, when the participant is confronted with tension. This idea fits well with ideas of Frankl. According to Frankl (2006), “[M]ental health is based on a certain degree of tension, the tension between what one has already achieved and what one still ought to accomplish, or the gap between what one is and what one should become” (p. 104).

This tension can be manufactured through experiential activities in three ways. First, experiential activities generally strive to present an uncertain outcome. Second, experiential activities most often contain a high level of perceived physical, emotional, or social risk. Finally, experiential activities often occur outdoors or in an environment unfamiliar to the client (Coons, 2004).

Whatever the experience, it is the unknown aspects of the activity that force the client to leave his or her comfort zone and enter into a state of tension. Central to experiential learning is the idea that “we encourage people to try things that they would not generally do on their own. In other words, they leave their safe, familiar, comfortable and predictable world for uncomfortable new territory” (Luckner & Nadler, 1992, p. 28). When clients enter this new territory, they are likely to experience the tension Frankl (2006) stated is necessary for change.

Rose (1998) wrote that most youth with life problems “have dedicated and rigid strategies for dealing with problems and are disinclined to look at other possibilities" (p. 177). Steve, a former client, provided a good example of this when he said, “What I like the most about drugs is that I know what to expect. I smoke. I get high. No surprises.” For youth like Steve, there is an inherent reinforcement in a life of “no surprises.” And, that predictability is appealing. That predictability allows him to avoid the tension necessary to create change. An individual’s comfort zone contains only what is already known, feels safe, and presents no tension.

It is only when a client leaves his or her comfort zone and confronts tension that learning and change can occur. Frankl (2006) wrote, “[I]f therapists wish to foster their patients’ mental health, they should not be afraid to create a sound amount of tension through a reorientation toward the meaning of one’s life” (p. 105). Through this reorientation, the adolescent client is able to find meaning and then exit his or her existential vacuum. According to Blair (2004), this ultimately leads clients to “an increasing awareness of the freedoms and choices they possess” (p. 341), including the freedom to change. And, that freedom to change is ultimately what therapy is all about.

References
Blair, R. (2004). Helping older adolescents search for meaning in depression. Journal of Mental Health Counseling, 333-347. Retrieved February 15, 2010, from EBSCO.

Coons, V. (2004). Advantages of adventure therapy for adolescents. Counselor, 42-44. Retrieved February 12, 2010, from EBSCO.

Cross, R. (2002). The effects of an adventure education program on perceptions of alienation andpersonal control among at-risk adolescents. Journal of Experiential Education, 247-254.Retrieved February 8, 2010, from EBSCO.

Fitzgerald, B. (2005). An existential view of adolescent development Adolescence, 793-799. Retrieved February 15, 200, from EBSCO.

Frankl, V. (2006). Man’s search for meaning. Boston: Beacon Press.

Luckner, J. & Nadler, R. (1992). Processing the Experience. Dubuque, IA: Kendall/Hunt Publishing.

Rose, S. (1998). Group Therapy with Troubled Youth. Thousand Oaks, CA: Sage Publications.

Sharf, R. S. (2008). Theories of psychotherapy and counseling. Belmont, CA: Thomson Brooks/Cole.

Sheff, N. (2007). Tweak. New York: Antheneum.

Steinberg, L. (2005). Adolescence. Boston: McGraw Hill.

Webb, L. (2006). Learning by doing. Training Journal, 36-41. Retrieved February 8, 2010, from EBSCO.

Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.

Yalom, I. D. (1989). Love’s executioner. New York: HarperCollins Books.

Handout: Fostering Resiliency with LGBTQ Teens

This handout was for a workshop presented at Saying It Out Loud, May 14, 2010

Defining Resiliency
• Resiliency is the ability to “spring back” from adversity.
• Most people have some level of natural resiliency.
• Children from troubled families or environments often develop skills that help them cope with the adversity in their environment and grow emotionally stronger in the process.
• The idea of natural resiliency goes against much traditional thinking about outcomes for youth who grow up in challenging situations.
• Resiliency can be learned.

The Relevance of Resiliency with LGBTQ Teens
• A disproportionate number of “at-risk” youth are LGBTQ.
• Various studies have shown this population to be particularly high risk for:
-- Suicidal ideation and attempts.
-- Self-harming behavior.
-- Verbal and physical harassment.
-- Substance abuse.
-- Sexually transmitted diseases.
-- Engagement in prostitution.
-- Truancy and poor school performance.

According to the National Network of Runaway and Youth Services, up to 40% of all youth who experience homelessness identify as LGBTQ.

The psychosocial problems of gay and lesbian adolescents are primarily the result of societal stigma, hostility, hatred and isolation… These youth are severely hindered by societal stigmatization and prejudice, limited knowledge of human sexuality, a need for secrecy, a lack of opportunities for open socialization, and limited communication with healthy role models… [This] may lead to isolation, runaway behavior, homelessness, domestic violence, depression, suicide, substance abuse, and school or job failure.
~ American Academy of Pediatrics

The Risk of At-Risk Labels
• When we define a group as at-risk, the way we work with that group changes.
• As professional helpers, we start looking for deficits and pathologies.
• Interventions and clinical work becomes about fixing problems.
• We forget to ask, “What do you have already that makes you strong?”
• Avoiding the At-Risk Label does not mean ignoring the real challenges or dangers faced by LGBTQ teens.

Five Resiliency Skills
• Insight – Honestly assessing one’s situation.
• Initiative – Remaining determined to prevail despite adversity.
• Integrity – Doing the right thing even when it is hard.
• Creativity – Using imagination to relieve troubling emotions and environmental chaos.
• Connectedness – Building positive relationships with others.

What is connectedness? It is a sense of being a part of something larger than oneself. It is a sense of belonging, or a sense of accompaniment. It is that feeling in your bones that you are not alone. It is a sense that, no matter how scary things may become, there is a hand for you in the dark. While ambition drives us to achieve, connectedness is my word for the force that urges us to ally, to affiliate, to enter into mutual relationships, to take strength and to grow through cooperative behavior.
~ Edward M. Hallowell, Finding the Heart of the Child

Fostering Resiliency
• Intentionally integrate the five resiliency skills into your work as a helping professional.
• Provide opportunities for youth to use their natural resiliencies and develop new ones.
• Without ignoring real challenges that may exist, focus on strengths.
• Create opportunities for meaningful contributions.
• Help youth improve self-efficacy.

Further Reading
• Lesbian and Gay Youth: Care and Counseling, by Caitlin Ryan and Donna Futterman
• The New Gay Teenager, by Ritch C. Savin
• Queer Kids, by Robert E. Owens, Jr.
• Resiliency In Action, Nan Henderson, editor
• The Resilient Self, by Steven J. Wolin and Sybil Wolin
• We Don’t Exactly Get the Welcome Wagon, by Gerald P. Mallon