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In employing the use of existential therapy with Ruth, I would initially seek to assist her in identifying and explaining her assumptions about the world. I want to know what her current values are and how she perceives the world. Then, with Ruth, I want to examine these perceptions and values and discover if these reflect the way that she really feels, or are they merely a reflection of the feelings of those around her. She has internalized much of the moral standard of her father. What part of this standard does she really feel is true? A large part of Ruth's identity has been defined by her roles of homemaker, wife and mother, a role that she had seen her mother fill. Is she happy with this identity? After studying these values and perceptions, I would assist Ruth in discarding those that she felt no longer fit her life. This is vital in beginning Ruth's search for meaning.
It would also be one of my priorities to assess and assist Ruth in expanding her capacity for self awareness. I feel that when Ruth returned to school, she became a little more self aware. She now realizes that she has the potential to make her own decisions. Through therapy, she will realize that inaction has been her decision in response to many of the situations that she has faced in life. A large part of uncovering this will be in the use of my asking responsibility focused questions. When she mentions that she often eats to comfort herself, and is unhappy with her weight and her resulting low self esteem, I will respond with, "What did you do to contribute to your weight?" When she describes how dissatisfied she presently is with her life, I will pointedly ask, "Ruth, how did you contribute to your current situation?" Though uncomfortable, this will help Ruth realize that she possesses the ultimate freedom and responsibility in regards to her life. Ruth mentions several times that she makes decisions based on how others will react. She mentions that she hesitates in counseling and "getting herself together" for fear that her husband will leave her. Through therapy, Ruth will need to develop a commitment to choose herself. In addition to this, I will assist Ruth in recognizing that she often chooses to remain inactive and allow others to make her decisions. The thought that she is the author of her life, and must make decisions for herself while taking responsibility for those decisions for those decisions will inevitably cause some anxiety.
One concept that Ruth will need assistance in grasping is that anxiety is a condition of living. I believe that when Ruth returned to school, that it began to dawn on her that she had severely limited herself for many years. She may have comforted herself with thoughts such as 'I could never have gone back to school earlier than I did' or 'I had to make those sacrifices for my family'. Through therapy, she will realize that it was really she that had made the decision to allow others - her father, her husband, her children - to limit her and make her decisions for her. She has been living a largely inauthentic life. As therapy progresses, Ruth will have to come to grips with the fact that anxiety is an unavoidable fact of life. When she reaches this realization she can no longer pin the responsibility of her decisions of her family or background with a clear conscious. Ruth, who previously shed her old values and is now overwhelmed with the meaninglessness in life, will now feel the full weight of her freedom and choice and this will no doubt cause her to experience existential anxiety. For the therapist, this anxiety is a positive thing as it heralds that Ruth is nearing the point where she ready to make a personal change in her life by taking steps to establish her autonomy. It is time for Ruth to take an active role in creating her own meaning in life. Ruth may respond by taking a more confident and assertive role in her marriage and family. She is concerned about the state of her marriage; now she may ask John to attend counseling with her. She may also respond by taking care of herself with exercise and a healthier diet and accept that job as a substitute teacher with the private school. The anxiety serves to make Ruth more aware of her freedom and the consequences of giving her freedom away and subsequently becomes a catalyst for change.
If at any time Ruth seems lost in frustration that she is feeling toward herself, or if she is discouraged that she seems to have taken 'two steps forward and three steps back' in her progress, I would utilize the technique of dereflection. When she voices her frustrations, I would draw her attention to the determination that she has shown thus far in the therapeutic process by saying, "I know you're discouraged, but don't forget how far you have come. I think that you have shown tremendous resolve in dealing with your situation thus far, and are following through wonderfully." This will take Ruth's focus off of her perceived shortcomings and place them on positive aspects of herself.
Ruth has expressed that her self esteem suffers due to the fact that she is overweight. She admits that she overeats habitually, and recognizes that this is a bad habit. However, up until this point she has taken a helpless stance when it comes to her weight, and subsequently, her health. "I just can't seem to get rid of the pounds." she insists. Then, during a subsequent session she mentions that she is about to begin yet another diet and exercise regimen, though it is obvious that she is skeptical that she will be successful this time. I would respond to Ruth by utilizing an existential technique called restraining. To an outsider, it may sound strangely that I am discouraging Ruth from her new endeavor. "Ruth," I would say, "instead of exercising 3 to 4 times this week as you have planned, I want you to exercise only once this week." She comes into the session the next week in a cheerful mood. I eventually ask her how her new exercise program is going. "Oh, I meant to tell you!" she says. "I felt so good after exercising that first time, that I ended up exercising four times last week!" In this case, Ruth going against my request of limiting exercise is a good thing. She has realized that she is not limited by others and is successfully implementing her own freedom to choose.
It is important to note that the changes that occur as a result of existential therapy are not intended to end when therapy ends, but to continue on for the duration of the client's life. Ruth would be encouraged to continue to embrace her freedom and take responsibility for the decisions that she makes, living an authentic life. By continuing to integrate this philosophy into her life, she has truly made the therapeutic process a success.