Introduction
According to the American Psychiatric Association (2000), a trauma is a shocking and emotionally overpowering situation that makes an individual experience a threat to psychological or physical integrity of self or others, leading to a reaction of intense fear, horror, and helplessness (Stolorow, 2007). Ver Der Kolk (1996) opines that "traumatized people lead traumatic and traumatizing lives", because they tend to re-victimize themselves, inflict self-injury, and externalize their trauma by victimizing others. The childhood trauma may trigger severe psychological reactions like Post-traumatic Stress Disorder (PTSD) that may affect the individual by subjecting him or her to severe depression and alcohol or drug dependence (Shevlin, Dorahy and Adamson, 2007). Taking into consideration the prevalence of traumatic experience of childhood sexual abuse, rape, and interpersonal violence in the American society, a therapist must take special care for the trauma survivors. In the case study in hand, the client is a trauma survivor. She is a 63 year old woman who was a victim of childhood physical abuse in the hand of her elementary teacher. She is a typical patient of PTSD suffering frequent bouts of depression and anxiety. She lacks a sense of security and suffers from low confidence. She also has problem connecting with her husband and siblings. Existential psychotherapy, which refers to a unique style of therapy that emphasizes upon the human condition as a whole, is considered to be an effective treatment for PTSD. This paper would take a look at the contemporary literature on existential therapy and then on the basis of it, I would make a treatment plan for my client.
Literature Review
The fundamental principles of existential psychotherapy are uniquely suitable for addressing the personal existential struggles experienced by a trauma survivor. Trauma therapy is a complex psychological, biological, and social project that requires the therapists to understand the mental state and idiosyncrasies of their clients and take into account the range of factors contributing to the mental state (Shevlin, Dorahy and Adamson, 2007). Existential psychotherapy employs a positive approach by making use of the technique of applauding the human capacities and simultaneously acknowledging the limitations of human beings, human mind, and human spirit. Though there are a number of variants of existential therapy available like humanistic-existential, psychoanalytic-existential, and existential-humanistic Therapy, each of these is influenced by mainly three forms of existential thought. Firstly, a holistic approach is taken in which what it means to be human is understood. Secondly, the concept of phenomenology is emphasized upon by placing considerable value on the subjective human experience, and finally, existential therapists take an honest approach about the human condition (Fisher, 2005).
Existential therapy regards each person as a unique individual whose life is shaped by the choices they have made. The existential therapist empowers the patient to assume responsibility for their decisions. They guide their patients to accept their fears and adopt skills required to overcome these fears through action. Existential therapists help their patients in gaining a control on their life and then design its course in a way they desire (Feeny, Keller and Zoellner, 2010). This begets a sense of hope and liberation in the clients, making them let go of their despair.
According to Pitchford (2009), the role of an existential therapist is to understand the experiences of the client and help him through existential struggles. Existential therapists do not concentrate on the patient's past. Rather, they work with the patients to seek and explore the choices lying ahead. Through the technique of retrospection, the existential therapist makes the patient try to perceive the implications of his past choices and how his beliefs influenced those choices. This way the therapist helps the patient gain an internal wisdom through introspection. The therapist all through the process does not lay emphasis on the past and uses the patient's past experience as tool to find freedom and confidence (Pitchford, 2009). By making the patients realize how their past choices have influenced their lives with their present condition having nothing to do with destiny, the therapists teach the patients to take responsibility for their choices and move ahead. This makes the patients free from the bondage of despair and feel free.
Therapeutic relationship is an essential component of existential psychotherapy, and it has been associated with positive outcome, better engagement of patients and better adherence. According to Feeny, Keller, and Zoellner (2010), therapeutic relationship is particularly important for treating PTSD of childhood sexual trauma survivors. It helps the trauma survivor gain back the lost sense of safety by creating an environment appropriate for healing.
Existential therapists further use the technique of emotional processing to treat the psychological trauma. They realize that the avoidance to confront one's own fear and attempts to control the emotional states result in psychological stress, and therefore, they believe that the pent up emotions hidden within the psyche of childhood sexual abuse survivors must be confronted and expressed in one way or the other to let the patient feel free of the emotional baggage (Pitchford, 2009). By building a therapeutic alliance with the patient, an existential therapist takes the patient back to her past experience and tries to efface the psychological impact of the trauma by using the past experience as a tool to look at life in a positive way.
The Treatment Plan for the Client of the Case Study
In this treatment plan, the therapist would first try to understand the mental state of the client and factors contributing to it. According to Totton (2005), traumatic experiences of childhood can leave lifelong impact on a person, influencing his or her life in adulthood. Traumatic experiences related to childhood sexual abuses make a child feel insecure and influences his connection with the external world, as it changes a child's entire perception about the world (Fisher, 2005). Since the therapist’s client has suffered sexual abuse early in childhood, it has left an indelible imprint on her mind, which typically affects the mental well-being of her adult years. The traumatic incident has changed her perception about the world around her, making her lose confidence in people and in herself, and this explains why she is unable to connect with her husband and siblings.
Since sexual trauma in childhoods disrupts the victim's sense of security, in order to pull her out of depression and the intense fear of insecurity, the therapist would build a therapeutic relationship with her in an interpersonal manner so that she feels secure to confide in the therapist. Other than that, the therapist would also imbibe emotional processing to help her confront her inner fear and come to terms with the world.
Many existential practitioners consider the use of existential therapy in a clinical practice more effective when it is combined with other treatment settings. Pitchford (2009), for instance, believes that the application of existential therapy in a group setting is more effective as it makes the client connect with the survivors of similar kind of experiences. The therapist also believes the same that by making the client go through a group therapy along with existential therapy would help her come out of inner shell as she will be to see and connect with other people who have gone through similar experience as her.
Limitations
Since existential therapy is predicated on themes and values rather than manual protocols and techniques, the endeavors made to examine its effectiveness in treating psychological disorder of trauma patients have been limited, and therefore, though the current psychotherapy literature supports the use of existential therapy in the treatment of trauma, it is, however, not recognized as an evidence-based practice in psychotherapy (Shevlin, Dorahy and Adamson, 2007).
Conclusion
The therapist’s client is a victim of childhood physical abuse. She is a typical case of PTSD suffering from intense depression and lack of confidence, which prevents her from communicating with her husband and siblings. Since trauma leaves a permanent imprint on the victims of childhood physical and sexual abuse, it is important for the therapist to take a holistic approach by imbibing the fundamental principles and techniques of existential theory in the treatment. Along with building an interpersonal relationship with the client to help her feel secure with the therapist and emotional processing to help her express her feelings, the therapist would also make her go through a group therapy to enable her to connect with the outside world.
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC.
Feeny, N. C., Keller, S. M., and Zoellner (2010). Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support. Journal of Consulting and Clinical Psychology. 78(6). pp. 974-979. doi:10.1037/a0020758
Fisher, G. (2005).Existential psychotherapy with adult survivors of sexual abuse. Journal of Humanistic Psychology. 45. pp. 10-40. doi:10.1177/0022167804269042.
Pitchford, D. B. (2009). The existentialism of Rollo May. Journal of Humanistic Psychology. 49(4). pp. 441-461. Doi:10.1177/0022167808327679.
Van der Kolk, B. A. (1996) Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York, NY: The Guilford Press.
Totton, N. (2005). Can psychotherapy help make a better future?. Psychotherapy and Politics International. 3(2). pp. 83–95.
Shevlin, M., Dorahy, M., and Adamson, G. (2007). Childhood traumas and hallucinations: An analysis of the National Comorbidity Survey. Journal of Psychiatric Research. 41. pp. 222-228.
Stolorow, R.D. (2007). Trauma and Human Existence: Autobiographical, Psychoanalytic and Philosophical Reflections. New York and London: The Analytic Press.
