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Center for Substance Abuse Treatment. Brief Interventions and Brief Therapies for Substance Abuse. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 34.)
Humanistic and existential psychotherapies use a wide range of approaches to caseconceptualization, therapeutic goals, intervention strategies, and researchmethodologies. They are united by an emphasis on understanding human experience anda focus on the client rather than the symptom. Psychological problems (includingsubstance abuse disorders) are viewed as the result of inhibited ability to makeauthentic, meaningful, and self-directed choices about how to live. Consequently,interventions are aimed at increasing client self-awareness and self-understanding.
Whereas the key words for humanistic therapy are acceptance andgrowth, the major themes of existential therapy are clientresponsibility and freedom. This chapterbroadly defines some of the major concepts of these two therapeutic approaches anddescribes how they can be applied to brief therapy in the treatment of substanceabuse disorders. A short case illustrates how each theory would approach theclient”s issues. Many of the characteristics of these therapies have beenincorporated into other therapeutic approaches such as narrative therapy.
Humanistic and existential approaches share a belief that people have the capacityfor self-awareness and choice. However, the two schools come to this belief throughdifferent theories. The humanistic perspective views human nature as basically good,with an inherent potential to maintain healthy, meaningful relationships and to makechoices that are in the interest of oneself and others. The humanistic therapistfocuses on helping people free themselves from disabling assumptions and attitudesso they can live fuller lives. The therapist emphasizes growth andself-actualization rather than curing diseases or alleviating disorders. Thisperspective targets present conscious processes rather than unconscious processesand past causes, but like the existential approach, it holds that people have aninherent capacity for responsible self-direction. For the humanistic therapist, notbeing one”s true self is the source of problems. The therapeutic relationship servesas a vehicle or context in which the process of psychological growth is fostered.The humanistic therapist tries to create a therapeutic relationship that is warm andaccepting and that trusts that the client”s inner drive is to actualize in a healthydirection.
The existentialist, on the other hand, is more interested in helping the client findphilosophical meaning in the face of anxiety by choosing to think and actauthentically and responsibly. According to existential therapy, the centralproblems people face are embedded in anxiety over loneliness, isolation, despair,and, ultimately, death. Creativity, love, authenticity, and free will are recognizedas potential avenues toward transformation, enabling people to live meaningful livesin the face of uncertainty and suffering. Everyone suffers losses (e.g., friendsdie, relationships end), and these losses cause anxiety because they are remindersof human limitations and inevitable death. The existential therapist recognizes thathuman influence is shaped by biology, culture, and luck. Existential therapy assumesthe belief that people”s problems come from not exercising choice and judgmentenough–or well enough–to forge meaning in their lives, and that each individual isresponsible for making meaning out of life. Outside forces, however, may contributeto the individual”s limited ability to exercise choice and live a meaningful life.For the existential therapist, life is much more of a confrontation with negativeinternal forces than it is for the humanistic therapist.
In general, brief therapy demands the rapid formation of a therapeutic alliancecompared with long-term treatment modalities. These therapies address factorsshaping substance abuse disorders, such as lack of meaning in one”s life, fear ofdeath or failure, alienation from others, and spiritual emptiness. Humanistic andexistential therapies penetrate at a deeper level to issues related to substanceabuse disorders, often serving as a catalyst for seeking alternatives to substancesto fill the void the client is experiencing. The counselor”s empathy and acceptance,as well as the insight gained by the client, contribute to the client”s recovery byproviding opportunities for her to make new existential choices, beginning with aninformed decision to use or abstain from substances. These therapies can add for theclient a dimension of self-respect, self-motivation, and self-growth that willbetter facilitate his treatment. Humanistic and existential therapeutic approachesmay be particularly appropriate for short-term substance abuse treatment becausethey tend to facilitate therapeutic rapport, increase self-awareness, focus onpotential inner resources, and establish the client as the person responsible forrecovery. Thus, clients may be more likely to see beyond the limitations ofshort-term treatment and envision recovery as a lifelong process of working to reachtheir full potential.
Because these approaches attempt to address the underlying factors of substance abusedisorders, they may not always directly confront substance abuse itself. Given thatthe substance abuse is the primary presenting problem and should remain in theforeground, these therapies are most effectively used in conjunction with moretraditional treatments for substance abuse disorders. However, many of theunderlying principles that have been developed to support these therapies can beapplied to almost any other kind of therapy to facilitate the client-therapistrelationship.