Existential Psychotherapy With Older Adults

With the growing numbers of older adults, psychiatric and mental health clinicians will be providing increasing counseling and psychotherapy to this population. The characteristics of existential psychotherapy make it an appropriate modality for many of the boundary situations facing older adults, such as retirement transitions, chronic illness, and irreversible decisions. Many elderly persons will never seek out mental health professionals; however, those who do may be facing an existential crisis. Existential models of psychotherapy typically espouse personal growth and health promotion as broad treatment goals that are synonymous with a holistic fo-cus. The therapeutic goal in the existentialframe of reference is to assist the client to embark on a course of self-investigation by exploring the four ultimate concerns of freedom, isolation, meaninglessness, and death. This framework is particularly suited for older adults who are interested in personal growth or relief of pain and suffering resultingfrom undifferentiated causes or situations. (J AM PSYCHIATR NURSES ASSOC [1955] 1, 16-21) existentialism is the endeavor to understandhuman beings by cutting below the cleav-age between subject and object that has bedeviled western thought and science since the Renaissance. The philosophy of existentialism has been sug-gested as a theoretical basis for counseling and therapy in psychiatry and psychiatric nursing (Burnard, 1989). However, not all scholars agree with this approach (Hanly, 1985). The existential approach emphasizes the present instead of the past, quality rather than quantity, content rather than cause, subjective rather than objective awareness, freedom of choice instead of forced choice, and being instead of nothingness (Yalom, 1980). Exis-tential psychotherapy is appropriate for individu-als approaching a boundary situation, that is, an urgent event or an irreversible decision. Boundary situations include confronting death, being thrust into isolation, and experiencing developmental milestones such as retirement. Thus an existential orientation may be a useful frame of reference for older adults (McDougall, 1992)