La Salle, Illinois: Open Court. The Ways Of The Will. New York: Basic Books. Gordon, E.
Mockingbird Years: a life in and out of therapy. Laing, R. The Divided Self. London: Tavistock Publications. Sanity, Madness and the Family. Harmondsworth: Penguin. Masson, J. Against Therapy. Sands, A. Falling for Therapy: psychotherapy from a client's point of view. London: MacMillan Press. Schilpp, P. The Philosophy of Martin Buber. Smail, D. How To Survive Without Psychotherapy. London: Constable. Spinelli, E. The Interpreted World: an introduction to phenomenological psychology. Demystifying Therapy. London: Duckworth. London: Continuum.
Strasser, F. London: Wiley. Becoming aware of this process yields insight and facilitates the ability to choose new ways of being and acting. For many clients, momentary circumstances and problems surrounding substance abuse may seem more pressing, and notions of integration, spirituality, and existential growth may be too remote from their immediate experience to be effective. In such instances, humanistic and existential approaches can help clients focus on the fact that they do, indeed, make decisions about substance abuse and are responsible for their own recovery.
By their very nature, these models do not rely on a comprehensive set of techniques or procedures. Rather, the personal philosophy of the therapist must be congruent with the theoretical underpinnings associated with these approaches.
The therapist must be willing and able to engage the client in a genuine and authentic fashion in order to help the client make meaningful change. Sensitivity to "teachable" or "therapeutic" moments is essential. These approaches can be useful at all stages of recovery in creating a foundation of respect for clients and mutual acceptance of the significance of their experiences. There are, however, some therapeutic moments that lend themselves more readily to one or more specific approaches.
The details of the specific approaches are laid out later in this chapter. Client-centered therapy, for example, can be used immediately to establish rapport and to clarify issues throughout the session.
Introduction to Existential Therapy
Existential therapy may be used most effectively when a client is able to access emotional experiences or when obstacles must be overcome to facilitate a client's entry into or continuation of recovery e. Narrative therapy may be used to help the client conceptualize treatment as an opportunity to assume authorship and begin a "new chapter" in life. Gestalt approaches can also be used throughout therapy to facilitate a genuine encounter with the therapist and the client's own experience.
Transpersonal therapy can enhance spiritual development by focusing on the intangible aspects of human experience and awareness of unrealized spiritual capacity. These approaches increase self-awareness, which promotes self-esteem and allows for more client responsibility, thus giving the client a sense of control and the opportunity to make choices. All of these approaches can be used to support the goals of therapy for substance abuse disorders.
Although many aspects of these approaches are found in other therapeutic orientations, concepts like empathy, meaning, and choice lie at the very heart of humanistic and existential therapies. They are particularly valuable for brief treatment of substance abuse disorders because they increase therapeutic rapport and enhance conscious experience and acceptance of responsibility.
Episodic treatment could be designed within this framework, with the treatment plan focusing on the client's tasks and experience between sessions.
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Humanistic and existential therapies assume that much growth and change occur outside the meetings. When focused on broader problems, these therapies can be lifelong journeys of growth and transformation.
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At the same time, focusing on specific substance abuse issues can provide a framework for change and more discrete goals. These techniques will also work well in conjunction with other types of therapy. The opening session is extremely important in brief therapy for building an alliance, developing therapeutic rapport, and creating a climate of mutual respect. Although the approaches discussed in this chapter have different ways of addressing the client's problems, the opening session should attempt the following: Start to develop the alliance Emphasize the client's freedom of choice and potential for meaningful change Articulate expectations and goals of therapy how goals are to be reached.
Developing the alliance can be undertaken through reflective listening, demonstrating respect, honesty, and openness; eliciting trust and confidence; and applying other principles that emerge from these therapies. The therapist's authentic manner of encountering the client can set the tone for an honest, collaborative therapeutic relationship. Emphasizing freedom of choice and potential for meaningful change may be deepened by a focus on the current decision however it has been reached to participate in the opening session.
Expectations and goals can be articulated through strategic questions or comments like, "What might be accomplished in treatment that would help you live better" or "You now face the choice of how to participate in your own substance abuse recovery. Because of time constraints inherent in approaches to brief substance abuse treatment, the early phase of therapy is crucial.
Unless the therapist succeeds in engaging the client during this early phase, the treatment is likely to be less effective. Moreover, the patterns of interaction established during the early phase tend to persist throughout therapy. The degree of motivation that the client feels after the first session is determined largely by the degree of significance experienced during the initial therapeutic encounter.
A negative experience may keep a highly motivated client from coming back, whereas a positive experience may induce a poorly motivated client to recognize the potential for treatment to be helpful. Humanistic and existential approaches are consistent with many tenets of Step programs. For example, existential and humanistic therapists would embrace the significance stressed by the "serenity prayer" to accept the things that cannot be changed, the courage to change what can be changed, and the wisdom to know the difference. However, some would argue against the degree to which Alcoholics Anonymous AA identifies the person's "disease" as a central character trait, or the way in which some might interpret the notion of "powerlessness.
Yet, such surrender must result from conscious decisions on an individual's part.
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The AA concept of rigorous self-assessment--of accepting one's own personal limitations and continually choosing and rechoosing to act according to certain principles as a way of living life--are compatible with both existential and humanistic principles. The predominant research strategy or methodology in social science is rooted in the natural science or rational-empirical perspective. Such approaches generally attempt to identify and demonstrate causal relationships by isolating specific variables while controlling for other variables such as personal differences among therapists as well as clients.
For example, variations in behavior or outcomes are often quantified, measured, and subjected to statistical procedures in order to isolate the researcher from the data and ensure objectivity. Such strategies are particularly useful for investigating observable phenomena like behavior. Traditional approaches to understanding human experience and meaning, however, have been criticized as an insufficient means to understanding the lived reality of human experience.
Von Eckartsberg noted, "Science aims for an ideal world of dependent and independent variables in their causal interconnectedness quite abstracted and removed from personal experience of the everyday life-world" Von Eckartsberg, , p. Similarly, Blewett argued, "The importance of human experience relative to behavior is beyond question for experience extends beyond behavior just as feeling extends beyond the concepts of language" Blewett, , p. Thus, traditional methodological approaches seem ill-suited for understanding the meaning of human experience and the process by which self-understanding manifests itself in the context of a therapeutic relationship.
A humanistic science or qualitative approach, which has its roots in phenomenology, is claimed to be more appropriate for the complexities and nuances of understanding human experience Giorgi, The personal and unique construction of meaning, the importance of such subtleties as "the relationship" and the "fit" in therapy, and shifts in internal states of consciousness can be quantified and measured only in the broadest of terms. A more subtle science is required to describe humans and the therapeutic process.
Rather than prediction, control, and replication of results, a humanistic science approach emphasizes understanding and description. Instead of statistical analysis of quantifiable data, it emphasizes narrative descriptions of experience. Qualitative understanding values uniqueness and diversity--the "little stories" Lyotard, --as much as generalizability or grander explanations. Generally, this approach assumes that objectivity, such as is presumed in rational empirical methods, is illusory.
For the qualitative researcher and the therapist, the goals are the same: openness to the other, active participation, and awareness of one's own subjectivity, rather than illusory objectivity. Intersubjective dialog provides a means of comparing subjective experiences in order to find commonality and divergence as well as to avoid researcher bias.