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Conceptualization and Treatment
Plan
Theories Of Counseling (Liberty University)
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CONCEPTUALIZATION AND TREAMTENT PLAN 1
CONCEPTUALIZATION AND TREATMENT PLAN
Maame P. Afrifa
Counselor Education and Family Studies, Liberty University
Author Note
Maame P. Afrifa
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Maame P. Afrifa
Email: [email protected]
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CONCEPTUALIZATION AND TREAMENT 2
Abstract
The Existential theory originated in the 19th century and was shaped by various key influencers.
These influencers were either philosophers or writers that provided major contributions that has
shaped existentialism. During the World War II era, many individuals began to display signs of
increased stress, anxiety, and depression. This attitude was created to ease these symptoms and
to place emphasis on human nature. Existential therapy allows for the client to focus on their
inner conflicts to help reshape their lives in a positive manner. Research shows that this
particular therapy can be implemented in the psychoanalytic process in different aspects. In
addition, integration of this therapy can help to alleviate high stress levels. However, this
approach is not a one size fits all method. Individuals carry different backgrounds, culture,
beliefs, and values. Not every individual may find this therapy to be effective. Furthermore,
application of this therapy for the current client may help to manage presenting symptoms,
however, there will need to be further research implications for the effect of existential therapy
in crisis patients.
Keywords: Existential, influence, humanistic, approach
Overview of The Existential Theory
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The Existential theory provides a humanistic approach to the psychotherapy process
between the counselor and the client. The existential psychotherapy method is conveyed is not
subjected to a singular method. However, it is depicted as a form of perspective towards the
psychotherapy process (Corey 2021). This perspective serves multiples purposes and can be
utilized in different according to the counselor’s preferred techniques. This therapy centers on
human nature and explores inner components such as stress, anxiety, separation, and a sense of
freedom (Corey 2021). The Existential theory allows client to the dissect these components,
reflect, and to search for the core meaning as it applies to their own life.
Origin of the Existential Theory
Existential therapy began to develop in certain areas of Europe during the 1940s to the
1950s (Corey 2021). It emerged in different psychiatry and psychology institutions and was
derived from the teachings of philosophers within the 19th century. At this time, the negative
effects of World War II caused havoc and led to symptoms of depression and hopelessness in
individuals. This collaborative form of therapy was created to help individuals who were
experiencing a crisis-like moment or higher levels of stress (Cooper et. al, 1111). These 19th
century influencers included Soren Kierkegaard and Friedrick Nietzsche. These major
developers are also writers. Key developers such as Rollo May, Martin Heidegger, Martin Buber,
Ludwig Binswanger, Irvin Yalom, Victor Frankl, Jean-Paul Sartre, and Medard Boss, played
major roles in shaping the existential therapy process (Corey 2021).
Beliefs about Human Nature and the Counseling Process
The existential therapy movement highly regards humans’ nature and encompasses
respect for the many aspects within humans. These can include cognitive, emotional, or even
physical aspects. The key developers believed that aspects such as self awareness, freedom,
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anxiety, and finding purpose are attributed to human nature. James Bugental created the term
“existential-humanistic” psychotherapy, which provided a different perspective to the existential
movement (Corey 2021). Bugental valued the therapeutic process between the counselor and
the client.
Therefore, helped psychotherapists to breakdown and value each step within the
therapeutic process essentially crafting a collaborative approach (Corey 2021). It is the
counselor’s responsibility to attain self-awareness regarding their clientele. This allowed
counselors to take on their role as the helper and to build or concentrate on their skills. On the
other hand, clients are allowed to take on their role and further deepen their understanding of
themselves. Clients also carry the duty to be responsible for the choices and actions in this life.
James Bugental strived for clients to focus on the present and how this applies to their personal
lives.
Research
Soren Kierkegaard is known to be the patriarch or the primary founders of existentialism
(Cooper et. al, 2019). According to Cooper et. al (2019) “it was Kierkegaard who described
despair in such a profound manner and who understood that we condemn ourselves to despair
when we fail to become ourselves and when we betray our deepest inner values (p.10).
Kierkegaard’s contribution to existential therapy paved the way for more influencers to flourish
in this field. Life is what individuals make of it. On the other hand, Emmy van Deurzen
provided another key contribution to the existential therapy. Emmy Van Deurzen recognized the
potential in clients to build a sense of resilience or strength to tackle their past conflicts (Corey,
2021). As a result, this helped clients to identify core the problem within their lives.
A research study was conducted to identify the effects of existential therapy interventions
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on patients who exhibited stress-related symptoms (Stephenson & Hale, 2020). As a result,
Linda Stephenson, and Beverley Hale, found that existential psychoanalytic therapy helped to
decrease levels of stress as clients were able to gain a sense of self-control. However, limitations
to the utilization of existential therapy, holds that this approach may not work for all clients.
Each client carries different needs; therefore, it is highly important for practitioners to
encapsulate that understanding.
Compatibility with Diverse Cultures
Existential therapy is not meant be considered as a singular approach. However, it is
meant to be provided as a broad perceptive to the psychoanalytic process. This can be beneficial
to various cultures due to the flexibility of the approach. Regardless of any culture, individuals
can still experience symptoms of grief, anxiety, compassion, and stress. Existential therapy can
serve as strength towards the therapeutic process because it is not singular.
On the other hand, existential therapy can serve as a major limitation due to its disregard
for social conflicts that can attribute to inner human conflicts. This approach also serves as a
disadvantage in some cultures. For example, in Thai culture, mental disorders derive from evil
spirits or entities (Conrad & Johnson, 2020). This also stems from Buddhist beliefs. As a result,
individuals from this culture have no desire to receive professional help from psychoanalysts or
counselors (Conrad & Johnson, 2020). As a counselor in training, it is highly crucial to gain self-
awareness especially in regard to my client’s cultural beliefs. I want to ensure that the client has
the space and comfortability to express themselves. According to my client’s culture, there may
have to be adjustments to their treatment plan. One size does not fit all. The existential provides
multicultural benefits, however, it may not work for every client that I may encounter in the
counseling field.
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Appropriateness for Crisis Intervention
The Existential-humanistic approach provides a broad spectrum of opportunities for
practitioners create a therapeutic plan that best suits their clientele, while taking the client’s
needs into consideration. This approach can help clients who are undergoing a crisis or stress-
like symptoms. This can include natural disasters, suicidal tendencies, violence, crippling
anxiety, etc. Many individuals went through some form of a crisis during the COVID-19
pandemic. Some individuals lost their sense of meaning or purpose in this life. According to
Hoffman (2021), “Meaning, therefore, should be a natural source of self-care for existential-
humanistic therapists” (p.48). Existential-humanistic therapy can be deemed as a helpful
treatment in a crisis-like situation, however, if the lack of meaning from the counselor or the
client, then this approach may not serve as a beneficial source.
Christian Worldview Compatibility
The first compatibility with Christianity is freedom. The existential therapy approach
promotes clients to seek the freedom to change their own lives. Galatians 5:1 state “It is for
freedom that Christ has set us free. Stand firm, and do not let yourselves be burdened again by a
yoke a slavery” (biblegateway). Christ desires freedom for all individuals, but it is up these
individuals to lean on Christ’s understanding.
Existentialism encourages the client to make their own decisions to shape their life
however they see fit. The second compatibility is meaning. Jeremiah 29:11 conveys that “For I
know the plans I have for you, declares the Lord, plans to prosper you and not to harm you,
plans to give you hope and future” (biblegateway). The goal of Existential therapy is for clients
to essentially find their sense of meaning in life. The Lord also proclaims this in the book of
Jeremiah and does not wish for hopelessness for human beings.
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The final compatibility with Christianity is self awareness. Lamentations 3:40 conveys
“Let us examine our ways and test them and let us return to the Lord” (biblegateway). The Lord
tells us to be self-aware of all aspects of ourselves and to lean on Christ. In addition, the
existential approach motivates clients to become fully aware of their inner conflicts and to
embrace them. The first incompatibility with Christianity is aloneness.
The existential theory wants the client to acknowledge their aloneness and how essential
it is to their therapeutic process (Corey, 2021). However, from a biblical perspective, an
individual is not alone in their journey if they stand by Christ. The second incompatibility with
Christianity is relationship with others. The existential approach acknowledges understands the
client’s need for a relationship with other individuals, however, this may not be the case for
everyone. Individuals from a Christian perspective may only desire a closeness with God to
strengthen their spiritual health. The final incompatibility with Christianity is death. Awareness
of death is essential in existential therapy so that the client does not take their own life for
granted. However, from a Christian perspective, there is eternal life after death, if an individual
has accepted Jesus Christ in their spiritual life.
Case Conceptualization Using the Existential Theory
Step One
The client, Mr. Tony Stark, exhibits a great difficulty in properly managing his anxiety
which has led to a few instances of panic attacks. Mr. Stark feels an immense responsibility to
save the world which resulted in severe anxiety and lack of personal functioning. Mr. Stark also
suffers from depression and prefers to be alone. As a result, this depression has a negative
result on Mr. Stark’s relationship with Ms. Pepper Potts. Tony Stark also depicts great
difficulty with occupation functioning, specifically, with members of his team, such as Captain
Steve Rodgers.
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Step Two
In Tony Stark’s case, I have identified the thematic group, clinical thematic group.
Through assessments with Mr. Stark, cognitively, Stark struggles with racing and troubling
thoughts, that leads into severe anxiety. According to Stark, these thoughts can become
irrational. These troubling thoughts result in a negative effect on Stark’s mental state and leads to
higher levels of stress or anxiety. Mr. Stark’s behavioral pattern to mentally shutdown, as a
result, can lead to disturbances in his personal relationship with Ms. Potts. This can also
negatively affect his work performance at his profession. Essentially, Mr. Stark suffers from
severe anxiety, depression, and suffers from heart complications from time to time due to the
high levels of stress.
Step Three
Application of the existential therapy approach has a allowed for a deeper understanding
of Tony Stark’s symptoms. Mr. Stark described his anxiety as “a rollercoaster ride”. There are
high and low moments. Existential therapy allows Mr. Stark to acknowledge what is normal
anxiety versus severe anxiety. Mr. Stark understands that his normal anxiety allows him to make
simple daily decisions and to arrive to work on time. However, extreme life decisions that
involves the fate of the world, attributes to extreme anxiety and leads into panic attacks. On the
other hand, the client expresses his immense love for high significant other, Ms. Potts. Mr. Stark
understands that he feels a responsibility to take care of Ms. Potts, however, he neglects to care
for himself properly. This leads to distance in their current relationship and has lead to moments
of depression. Existential therapy will allow Mr. Stark to recognize all aspects of his internal
self and find the freedom to gain control of his life once again.
Step Four
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After taking Mr. Stark’s identifiable issues into account, the clients core understanding is
“I am not enough for the ones I love, and I am consistently in a restless state”. The client exhibits
a fear of not being good enough, in regard to loved ones and to himself. Stress, anxiety, and
depression has become the center of the client’s life. The weight of the world is literally on the
client’s shoulders. Mr. Stark desires to be good enough, physically and mentally.
Evidence Based Considerations
This theory best suits the client’s presenting problems because it can the client attain
proper control of his life. Existential therapy is not a singular method, however, there are endless
possibilities to this approach. This approach can be adjusted to help manage the client’s present
symptoms. Flexibility of this approach allows for a collaborative effort between the counselor
and the client to a create a suitable treatment plan to fit the client’s best needs (Hoffman, 2021).
Ethical Considerations
According to the ACA Code of Ethics (2014), “Counselors monitor themselves for signs
of impairment from their own physical, mental, or emotional problems and refrain from offering
or providing professional services when impaired” (§C.2g). The existential therapy approach also
strives for both the counselor and the client to attain self-awareness, because it is highly crucial
towards the psychoanalytic process. As a counselor, it is possible to put high amounts of energy
into work. As a result, this can lead to burnout and stress. I feel that it may be difficult to be
mindful of this, however, counselors cannot work while suffering from burnout.
Cultural Considerations
The client is a Caucasian male, that was born and raised in Manhattan, NY. The client’s
culture mainly stems for his everlasting love for technology and inventions because he was
primarily alone for most of his life. Technology is his life and culture. To ensure that this therapy
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is helpful and accustomed to my client’s needs. I would utilize my own sources of technology
and create presentations to give the client a visual representation of what his symptoms are like
and possible existential interventions to help manage them.
Theoretical Interventions
Exercise Intervention
Aside from the client’s love for Ms. Potts, technology, and inventions, fitness also serves
as an important aspect of the client’s lifestyle. Mr. Stark finds exercise as an escape from his
core symptoms. In addition, exercise is proven to not only help the human body, but also it can
serve as a holistic treatment. The client currently lives in a big city where many civilians are
outside and active during the day. I encourage the client to take a morning stroll in his
neighborhood or a public park, alone or with Ms. Potts. While embarking on this stroll, I
encourage the client to speak words of affirmation, and think about what he is grateful for. This
will allow the client to alleviate some stress and to recognize gratitude within this life.
Mindfulness Intervention
The next intervention is to integrate a mindfulness session. Racing thoughts can become
overwhelming and irrational. As a result, this can lead to an increase in anxiety levels and
depression. I encourage Mr. Stark to take at leave five minutes, each day in the week to perform
a mindfulness session. In the mindfulness session, the client would sit comfortably, in an upright
position, in any kind of setting is reasonable. The client would then proceed to close his eyes
and focus on breathing. Slow and deep breathing can help the client to focus on himself. Proper
breathing techniques can help the client to slow down the heart rate and to reduce stress.
Journal Intervention
The client tends to have a rapid-paced speech and finds it beneficial to write out personal
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thoughts to establish a sense of self-awareness. I encourage the client to obtain a journal, and to
implement daily journal entries. This can help the client to properly organize thoughts, write out
the current stressors, and to establish words of affirmation. Writing helps to manage racing and
irrational thoughts. Journal writing can help the client to reduce stress, anxiety, and depression.
Spiritual Application
The primary spiritual challenge is Mr. Stark’s disbelief and lack of faith in a God or a
divine power. From Christian counseling perspective, I would like to pray for the client if that
was allowed, to bring a sense of hope and faith into his heart. I want the client to know they are
good enough by the Lord’s grace. With the Lord’s understanding, there is no hopelessness,
fear, or anxiety, because of the Lord’s greater love for others. Lastly, if the client allowed, I
would educate the client promptly about Christianity and what it means to take care of your
spiritual health. Proper care of spiritual can help to alleviate stress, anxiety, and depression.
Prognosis/Outcome
After utilizing these interventions, my hope for the client is reduction in stress, proper
management of anxiety, improvement in personal relationships, and a reduction in depressive-
like states. I would like to see more improvement within the client’s self-awareness and self-
worth. The challenging aspects within this treatment plan is withdrawal of presenting symptoms.
It is expected for the client to improve in a health growth, however, there days that the client may
revert to the same presenting symptoms. For a referral, I recommended Mr. Stark see a
practitioner who specializes in anxiety mental health disorders. This practitioner would have the
proper skill set to assist the client on a long-term basis. The interventions provided may help,
however, it is not guaranteed to assist the client on a long-term level. Clients that are in a crisis
will need the proper resources to manage their emotions to prevent long-term consequences
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(Hoffman, 2021).
Theoretical Orientation
The existential theory is like my personal beliefs with a slight difference implicated. The
existential perspective holds the humans have the option to shape their lives in their own vision. I
agree that as humans, we have the ability to convey a sense of self-awareness and freedom.
However, as a Christian, I firmly believe that everything happens for a reason, because of the
Lord. I also agree that counselors have the responsibility to work on their professional skills and
that clients have a duty to gain a sense of stability within their personal lives. As a counselor, I
respect that the existential approach allows for flexibility and is not necessarily confined to a
singular method. Furthermore, implementation of aspects such as self-awareness, responsibility,
relationships, purpose in life, and death, can help the client to view their conflicts from a
different perspective. However, I understand that this method may not work for all clients.
Some clients may not respond well to this approach; therefore, it is crucial attain self-awareness
before integrating this approach into the counseling practice.
References
American Counseling Association. (2014). 2014 ACA code of ethics.
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https://www.counseling.org/knowledge-center
Correia, E., Berdondini, L., Cooper, M., & Correia K. (2017). Characteristic Practices of
Existential Psychotherapy: A Worldwide Survey of Practitioners’ Perspectives. The
Humanistic Psychologists, 45(3), 217-237. http://dx.doi.org/10.1037/hum0000061
Conrad, C., & Johnson, D. (2020) Existential Therapy Intercultural Western-Thai Therapeutic
Relationships. Human Sciences, 12(1), 160-180. Doi:
Cooper, M., Craig, E., & Deurzen, E. (2019). Introduction: What is Existential Therapy? The
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Schneider, D. and Tantam, S. Plock), 1-27
Corey, Gerald. (2021). Theory and Practice of Counseling and Psychotherapy (10th ed.).
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%205%3A1&version=NIV
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Hoffman et. al (2019). Challenges and New Developments in Existential Humanistic and Existential-
Integrative Therapy. The Wiley World Handbook of Existential Therapy, 1e (ed. E.V. Deurzen, E.
Craig, A. Langle, K.J. Schneider, D. and Tantam, S. Plock), 290-303
Jeremiah 29:11. (n.d.) Bible Gateway. https://www.biblegateway.com/passage/?
search=jeremiah+29%3A11&version=NIV
Lamentations 3:40. (n.d.) Bible Gateway. https://www.biblegateway.com/passage/?
search=lamentations+3%3A40&version=NIV
Stephenson, L., & Hale, B. (2020). An Exploration into Effectiveness of Existential Phenomenological
Therapy as a U.K. NHS Psychological Treatment Intervention. Journal of Humanistic
Psychology, 60(3), 436-453.
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Tan, S., & Wong, T. (2012). Existential Therapy: Empirical Evidence and Clinical Applications from a
Christian Perspective. Journal of Psychology and Christianity. 31(3), 272-277.doi: