Existential Theory vs. Reality Theory - Term Paper Example

?Running head: Existential theory versus reality theory Existential Theory vs. Reality Theory Existential Theory vs. Reality Theory Case Nancy is a 25 year old patient admitted for attempted suicide and depression. Throughout her 25 years, she has experienced significant childhood trauma as she has been raised in the orphanage and was not adopted until she was in her teens. She was left at the orphanage by her unidentified mother when she was 5 years old. She has no recollection of her life prior to the orphanage. She had a history of physical and sexual abuse with some of the temporary placement homes where she stayed. She also had a history of drug and alcohol abuse. She has been rehabilitated for substance abuse when she was 16 years old. She stayed clean for two years, until she was recruited by a gang of teenage and young adults. She then returned to her drug and alcohol abuse. She was arrested by the police since she was 15 years old for different crimes – possession, driving while under the influence, theft, malicious mischief, and similar minor offences. She was in and out of prison for the better part of 5 years since she turned 18. Two years prior to admission, she got pregnant by her boyfriend who subsequently abandoned her. She decided to keep the baby, staying clean and turning her life around. When her baby was born she sought gainful employment. Her baby got sick with pneumonia and died at the age of 1 year and 2 months. On her child’s death, she returned to her self-destructive life – doing drugs and alcohol and being involved in gang activities. She was plunged into depression and attempted suicide a week prior to admission. She is now undergoing therapy and rehabilitation. 1. Presenting Problems Based on the existential theory, the problems which need to be resolved in Nancy’s case is based on the lack of will or reason to live. Another problem presenting is also the diminished conscience in Nancy’s personal make-up. Also, Nancy is in a noogenic neurosis or a state of spiritual or existential neurosis. In other words, she is experiencing an empty, meaningless, aimless, and purposeless life and is responding to these experiences by manifesting unusual behaviors which hurt herself, hurt others, hurt society, or all three (Boeree, 2006). Based on the reality theory by William Glasser, Nancy problem which needs to be resolved is her lack of relationships. According to the reality theory, lack of relationships or having unsatisfying relationships can lead to psychological problems. 2. Problem Causes Since Nancy was raised in an orphanage, she has limited personal and family ties; and what reason she had to live and to live a fruitful life died with her child. For most people, their will and reason to live is most often tied to their family – their parents, their siblings, other relatives, and for the most part, to their children. She has lost these ties when she was abandoned in the orphanage by her mother. Since she also had a history of sexual and physical abuse in the orphanage, she also could not have established familial and close ties with her foster parents and other caretakers. At a time when she finally found someone with whom she could share family ties with – she lost that person to an illness. As a result, she is manifesting behavior which, according to the existential theory is hurtful to her and to society. Her sense of right and wrong which is basically a major part of one’s conscience has been distorted. Her upbringing in the orphanage did not instill in her the essential values in order to choose right over wrong. She has lost her sense of responsibility throughout the years because she has not gained enough responsibility for her actions while in the orphanage. In effect, she chose to live her life not feeling responsible for anyone or accountable to anyone. After all, she was raised in an environment which did not take responsibility for her and which did not feel accountable to her. To her mind, she is asking herself, “Why should I care if I am hurting anyone or harming anyone with my actions? They never cared for their actions when they were raping me or hitting me.” Her sense of right and wrong is very much influenced by her upbringing and by her lack of accountability to anyone. This is one of the issues which have to be considered in coming up with a therapeutic plan for Nancy. Based on the reality theory by William Glasser, Nancy problem which need to be resolved is her lack of relationships (Ridgway, 2007). According to the reality theory, lack of relationships or having unsatisfying relationships can lead to psychological problems. This point of view has similarities with the existentialist theory as it bases its assessment of a person’s issues on that person’s possibly purposeless life. Purpose in life is mostly found in one’s relationships with other people (family or social life). Nancy’s life is practically lacking in relationship and more importantly, lacking in satisfying relationships. She has no family to speak of and the one person she was able to share a relationship with, died. There are however differences between these two theories in terms of presenting issues. The existentialist theory looks further back to the basic values of a person – including his conscience and his upbringing in order to evaluate a person’s presenting issues (Ridgway, 2007). The realist theory focuses more on a person’s relationships – the presence (or lack) of relationships and the sense of satisfaction which is present (or absent) in the relationship. The realist theory assesses and determines presenting problems on the personal relationships and dynamics which exists in a person’s life – and then deems the existence of psychological issues (Ridgway, 2007). The existentialist theory goes beyond a person’s personal relationships; he looks into the person’s upbringing, his sense of purpose and meaning in life (whether or not it is based on relationships), and evaluates these as means to retaliate or to hurt himself and other people. These two perspectives provide a viable evaluation of the presenting problems in Nancy’s case. These two theories, as a whole, present a balanced assessment of Nancy’s personal issues and help provide a direction for her therapeutic intervention. 3. Treatment Recommendations a. Existentialist therapy In accordance with the existentialist theory, the basic technique which can be applied to Nancy is that of phenomenology. Phenomenology is the “conscious setting aside of preconceptions and dogma in an effort to discover the client or patient’s actual subjective experience or being” (Diamond, 2011). The intervention and therapy based on the existentialist theory is therefore about not taking things at face value and about looking beyond the attitudes and behavior which a person is exhibiting. It is about dismissing whatever stereotypical thoughts and judgments which may arise from a person’s behavior or demeanor; and trying to consider the reasons and experiences which gave rise to such behavior. By digging deeper into the person’s psyche, the intentions of the patient may be evaluated and understood – and eventually be appropriately responded to by the mental health professional (Diamond, 2011). The treatment focus for Nancy under the existentialist therapy is the present or the current circumstance, not on her formative years. It only considers the past in order to understand the aspects of a person which would influence the person’s current psyche. In this case, only aspects of the Nancy’s past which are relevant to her current psyche would be considered in her treatment. The therapy would also focus on helping the patient make personal choices and gain personal and social responsibility. This would be a difficult matter to implement for Nancy because she has had limited personal choices all her life. She also gained limited personal and social responsibility in her life. Nevertheless, the process needs to be started in order for her to gain social responsibility and courage (Diamond, 2011). The existentialist therapist would not limit his role to that of a passive psychoanalyst. He must have the courage and commitment to encounter each patient as a unique individual. The therapist must not disregard his anxiety and conceal himself behind a rigid persona (Diamond, 2011). In existentialist therapy, the focus is on the human interaction between the patient and the therapist which earns priority over technical methods and means. The goal of the therapist is to have a more compassionate, but professional, human relationship with the client – one which has structure and a potential for therapeutic transformation (Diamond, 2011). The goal of treatment, according to the existentialist theory, is to establish an effective therapeutic relationship with the client. Another goal is also to help the patient transition into a more responsible and socially involved member of society. Frankl sets forth two techniques in existentialist therapy, that of paradoxical intention and de-reflection. In paradoxical intention, if a person tries to achieve happiness, he will not likely achieve it because happiness has to happen, and not be forced by focusing on what a person demands or wants from life (Ridgway, 2007). In the case of Nancy, she is very much depressed because she is lingering too much on what she does not have in her life. She has had a difficult life from the very start. She has no family to speak of, nor does she have a stable life. It is logical to deduce that she wanted to have another chance at happiness through her child. When she lost that chance, she also lost her purpose in life. Existentialist therapy is now based on slowly allowing threads of happiness to enter Nancy’s life. A shift of priority or purpose – away from the desire to belong can be the starting point for her. Straining to make herself happy by dwelling on her wants and desires in life would only create an unrealistic situation for her – one which is largely based on unreachable goals which she would be hard put to achieve. The therapist as an existentialist therefore needs to focus on her current situation and build on her current status to establish a more achievable goal in life. Hyperintention is also an element of paradoxical intention. In its simplest terms, it can be applied in another context for Nancy. In trying to assist her in getting over her anger and depression, it may be prudent to try to ask her to get as mad and as sad as she can. In this way, some humor may be injected into her situation and eventually draw her out of her depressed state. In applying de-reflection, since Nancy has lost her zest for life ever since her daughter died, it may be prudent to ask her to focus more on her daughter and what her daughter would have wanted for her. De-reflection helps a patient focus on other people, rather than focusing on the self (Ridgway, 2007). Frankl stresses that people must “find a meaning in our suffering and all successful sufferers, he contends, find that meaning to some extent” (Ridgway, 2007). In short-term logotherapy, which is also part of existential psychotherapy, the therapist highlights the attention given by the patient on herself, and draws it out—redirecting it instead to other concerns and possibly, to other people. This type of therapy is a crucial part of self-actualisation -- of thinking beyond one’s individual goals and needs, and of forgetting oneself. For Nancy, it would be effective to bring her face to face with the other possibilities in her life and to allow her to consider these beyond her current state of depression. From the very start, Nancy’s life has been ruled by what she has experienced in her childhood and her teenage and early adult life. She allowed these experiences to shape and dictate her behavior. The existentialist therapy would not attempt to first draw out Nancy from her depression and then gradually redirect and focus her needs and demands away from her previous goals. b. Reality Therapy There are similarities of reality therapy and existentialist therapy. Both types of therapies seek to veer away from the person’s past. The existentialists use the past to guide their current interventions and plans for the patient; while the realists steer away from the past altogether because they believe that a patient’s current relationships are the ones which are impacting on his life (William Glasser Institute, 2010). In reality therapy, discussing of symptoms and complaints are avoided because the realists believe that the patient would be using these symptoms to deal with his unsatisfactory relationships. In Nancy’s case, the realist would not focus too much on the patient’s symptoms, but would focus more on her current relationships and how these relationships affect her. Her current symptoms like depression and suicidal tendencies would also not be focused on during the therapy. A major part of the realist therapeutic process is also in understanding the patient’s total behavior and to focus on what they can do directly and what they act and think (Sharf, 2011). There is less time spent on what the patient cannot do, and a better focus instead on what the patient can change in terms of his actions and thoughts (William Glasser Institute, 2010). In the case of Nancy, the approach to her therapy would be on directing her thoughts and actions to what she can actually do, not on what she cannot realistically achieve. Avoidance in criticism and blame is also another part of the reality therapy (William Glasser Institute, 2010). Avoiding criticism and blame would help Nancy avoid the damaging external control behaviors which often destroy their relationships with other people (William Glasser Institute, 2010). In effect, the therapist in the realist set-up should also be non-judgmental and non-coercive. He must encourage Nancy to evaluate what other people are doing through the choice theory. In other words, Nancy would be instructed to ask herself if what she is doing is getting her closer to the people she needs to get close to. If she discovers that her choice of behavior is not effective, the therapist would now guide Nancy in establishing other behavior which would actually facilitate better connections with other people. In reality therapy, therapists also focus on teaching patients to not make excuses because these excuses interfere with how these patients can make the essential connections with other people (Reynolds and Fletcher-Janzen, 2007). Nancy would therefore not be allowed to make excuses about why she is not trying to make connections with other people. A greater focus on specifics is also seen in reality therapy. In this instance, the therapist would help the patient establish who he is disconnected from and help him establish reconnecting behaviors (William Glasser Institute, 2010). In instances when they are completely disconnected from each other, the therapists would assist in directing the patients towards establishing new connections. In the case of Nancy, she has not firmly established any ties with other people – atleast the ties which would have been beneficial for her. However, she can be assisted in establishing ties with new people. These new people could be other friends and support groups she can make friends and connect with in the institute. New people can also include new friends she can meet in the healthier social scene. Reality therapy is also concerned with helping the patients make specific and workable plans in reconnecting with the other people they need to reconnect with and to evaluate their progress. The counselor can also point out to the patient that there may be different ways and different plans which can be used in order to reconnect with other people. Nancy can be guided in this process by helping her plan how she would choose to make connections with other people and to revise and adjust plans accordingly. Finally, reality therapy also emphasizes on patience and support for the client in terms of her disconnectedness. There is bound to be atleast one person in her past that Nancy may want to reconnect with—someone she admires and looks up to. By guiding and supporting her, it is possible to help her build enough courage to reconnect with such a person. Works Cited Boeree, G. (2006). Viktor Frankl: 1905 – 1997. Shippensburg University. Retrieved 04 April 2011 from http://webspace.ship.edu/cgboer/frankl.html Diamond, S. (2011). What Is Existential Psychotherapy? Psychology Today. Retrieved 04 April 2011 from http://www.psychologytoday.com/blog/evil-deeds/201101/what-is-existential-psychotherapy Reynolds, C. & Fletcher-Janzen, E. (2007). Encyclopedia of Special Education: A Reference for the Education of Children, Adolescents, And Adults With Disabilities And Other Exceptional Individuals, Volume 2. New Jersey: John Wiley & Sons. Ridgway, I. (2007). Viktor Frankl (1905-1997). Theory and Practice. Retrieved 04 April 2011 from http://www.myauz.com/ianr/articles/lect11frankl07.pdf Ridgway, I. (2007). Reality Therapy: William Glasser (born 1925). Theory and Practice. Retrieved 04 April 2011 from http://www.myauz.com/ianr/articles/lect5realitytherapyglasser.pdf Sharf, R. (2011). Theories of Psychotherapy & Counseling: Concepts and Cases. California: Cengage Learning. William Glasser Institute (2010). Reality Therapy. 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