Both forms of therapy have been shown to be effective especially with people in institutionalized settings. While existential therapy tries to help people find meaning in their lives and through this help them overcome a crisis, SFBT tries to provide brief therapy that will enable the client to deal with future problems (Corey, 2013). Considering the nature of the two therapies it becomes apparent why they would work well with populations such as people in institutionalised settings. SFBT has shown to be effective when working with people in prison.
A study conducted by Lindforss and Magnusson (1997) evaluated the success of SFBT when applied to Swedish prisoners in Hageby Prison. The study divided its participants into two groups. One being the control group and one being the experimental group. Both groups had 30 participants. Participants in the experimental group received on average five meetings that lasted between one to two hours. After their release participants were evaluated 12 months and 16 months later to assess their level of recidivism.
Members of the experimental group were less likely to commit further crimes than members of the control group both when assessed at 12 months and 16 months. At 12 months 47% of the experimental group had not committed any further crimes, while only 24% of the control group had not relapsed into crime. At 16 months 40% had continued to not commit any more crimes in the experimental group, compared to 14% of the control group. Considering these findings it could be suggested that SFBT has a positive effect on the level of recidivism in prisoner that were released from prison.
This could potentially be due to the goal-oriented and future focused nature of this therapeutic approach and the fact that it is brief, therefore being able to show improvement in the short amount of time therapy can be provided to prisoners or people in other institutionalised settings. Existential therapy can also be effective when working with institutionalised populations. This therapy tries to help people take responsibility for their lives and actions and through this enable them to make positive changes and design their future.
This can be valuable when working with the mentioned population since often times people belonging to this group have to make major life decisions or face developmental challenges such as figuring out what to do after they are released from the institution. Further existential therapy focuses on a person’s ability to be self-aware and have the freedom to choose one’s future (Corey, 2013). This can be helpful when working with people in institutions, since most of the clients did not choose to engage in therapy and often times do not want to change.
When using existential therapy the clients tend to feel less pressured to change, because the focus is directed away from their need to change to increasing their self-awareness and their freedom to decide to change or not. Hence this approach can be very useful in establishing a better and less resistant relationship with the client. Another important factor of existential therapy that can help with this population is its focus on death and anxiety as part of the human condition. Many in institutional settings have experience with death.
Often times they become numb to death, especially their own, which can lead to unhealthy and risk taking behaviour. Existential therapy can aim at making people become aware of their attitudes in order to evaluate them and the decision to change or keep them (Himelstein, 2011). In these ways existential therapy can be useful and effective and these specific elements of it have to be considered and incorporated when combining it with SFBT. Integration of Theories When integrating these two therapeutic approaches one can serve as a theoretical foundation, while the other provides specific techniques for this integrated approach.
Both theories stress the client’s ability to change and the fact that the client is the expert on their own life and worldview. Further both theories focus mostly on the client’s future and do not concentrate on the problems of their clients past. They both believe that their should be an authentic and collaborative relationship between clients and counselors and that the client is in charge of their own change. Both therapies also do not stress diagnosis. Existential therapy in contrast to SFBT does not have a lot of techniques that are used in therapy.
Therefore it serves well as a foundation of this integrative approach. When working with this foundation the counselor sees their client as capable of self-awareness, responsible and able to choose their own future, in search of meaning in their life and faced with anxieties that are part of the human condition. This can work well with SFBT techniques that are goal-oriented, positive, and focus on the future.
Techniques from SFBT that can be integrated with the existential therapy foundation are pretherapy change, he exeption questions, the miracle question and scaling questions. Pretherapy change looks at what the client has already done to change before the first therapy session. This can help demonstrate to the client the importance they have in the design of their own future. It also makes the client rely less on the therapist and more on their own capabilities to change as is emphasised in both existential therapy and SFBT. The exception question asks the client when their problem was absent or less prominent in their lives.
This is supposed to show the client that the problems they face are not all powerful and can provide the client with solutions they applied previously and can apply again to help with their current situation. The miracle question can also be used as a valuable technique. For this the client is asked to imagine that they wake up tomorrow and their problem has disappeared. How could they tell? This shift the attention towards the future and focuses on future possibilities, this focus of the future again complying with both the elements of existential therapy and SFBT.
Further scaling questions that ask clients to rate their improvement on a scale from 1 to 10, allow the counselor to track the change in the client and emphasis this change as encouragement, focusing on the positive. Using existential therapy as a foundation provides the counselor with an understanding of the human capabilities and emphasises the client’s importance in their own therapy. When combined with SFBT it can lead to people being more focused, active and involved in the individual therapy sessions due to the short term nature and time restrictions of the therapy.
Further SFBT provides a more technique focused approach to existential therapy and supplies the therapeutic approach with more structure, emphasising goal orientation. This especially could be a benefit when working with populations in institutionalised settings, since it allows them to clearly observe their progress, for example through scaling questions, and allows them to determine their own specific goals they want to work toward during their time in therapy, providing extra motivation (Corey, 2013). The Case of Stan
To demonstrate how these two theories can be integrated they will be applied to a case study presented in the form of The Case of Stan. Stan is a 35 year old man, who struggles with his alcohol dependency and his sense of worthlessness. The start of his therapy was court appointed due to his convictions of driving under the influence. However he does want to change his life, even though he does not know how to. He started to go to college and is studying psychology because he wants to be able to work with troubled children as a counselor or social worker.
Furthermore he was able to leave some of his troubled past behind him which he is proud of. He has problems with socialising and easily gets intimidated by women. Further he had a difficult childhood and feels like he disappointed his family. He has thought of suicide in the past and often feels anxiety and guilt. He is determined to change his life and wants to feel better about himself and stop being dependent on alcohol (Corey, 2013). When working with Stan using this integrative perspective it is important to first assess his thoughts about suicide and conduct a risk assessment (Corey, 2013).
Stans willingness to be the driving force in changing his life is very important, since he will be the one directing his change. A counselor has to encourage Stan in seeing that he is responsible for his actions and how his future will develop. During therapy the counselor can ask Stan about his goals and what he wants to achieve. Since Stan wants to both graduate college to work with troubled children and make himself feel better about himself, as well as stop drinking alcohol, these could be some of the goals he could name.
The counselor could inquire if their have ever been exceptions to Stan’s problems or moments where his problems were not as prominent. These exceptions could then be used as guidelines for developing other possible ways of helping Stan cope with certain situations or problems. The fact that Stan managed to get into college to work towards his dream of helping children and his ability to leave some of his troubled past behind him are both exceptions to his problems.
Scaling questions over the course of therapy can help stan visualise his improvement and might provide him with more motivation to take charge of his life and direct his future, since he has the freedom to change. The miracle question could help Stan focus on a future that has improved and shows him the possibilities in his life. Overall Stan should gain more self-awareness during therapy and realise that he is the expert of his own life and has the ability to choose his actions.
Further he should learn coping mechanisms that work for him, that can be helpful to him in the future after the end of therapy, when other problems or situations may arise and he has to handle them himself. When the therapy comes to an end the Stan and the counselor should review the improvements made by Stan and the purpose he sees in his life at the moment or the future goals he has set for himself. Conclusion In conclusion, existential therapy and SFBT have many elements in common. Both do not emphasise diagnosis, but emphasis the client’s ability to change. Both therapies are very subjective, viewing the reality as personal to the client.
They also focus on the future and de-emphasise the past either to focus on solutions rather than problems (SFBT) or to convince the client that they are not a victim of their past but that they have the freedom to choose their future (existential therapy). When integrated, existential therapy serves as a foundation that helps the counselor understand the human condition and emphasises the client’s capability of choice and change. SFBT provides the techniques that allow the therapy to be more focused and goal orientated, allowing the client to see their change and improvement.
This form of therapy is especially useful when working with clients in institutionalised settings, such as prisons. It allows the clients to feel less pressure to change their behaviour, due to its emphasis on self-awareness rather than change, which in turn can lead to a better relationship between the counselor and client, that allows for better therapeutic progress. The fact that this form of therapy is brief, usually less than 10 sessions, is perfect for institutionalised setting in which time is often limited and improvement has to become noticeable rather quickly.
