Existential theory and solution-focused strategies: Integration and application.

A sound theoretical approach is essential to the professional integrity of mental health counselors. This article examines the basic concepts of existential theory, indicates how this theory provides a sound theoretical basis for mental health counseling, and supports the thesis that brief solution-focused therapy is a clinical application of existential theory. An illustration of brief solution-focused existential therapy is provided from the author's experience counseling tsunami victims in Sri Lanka.

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The existential approach disclaims the deterministic view of human nature and emphasizes the freedom that human beings have to choose what to make of their circumstances. One of the main goals existential-humanists share is for their clients to get in touch with their real selves and to make deliberate choices in accordance with the real self and its wants, rather than permitting other persons or events to determine their behavior. One's real self is the way one is, with authentic feelings and emotions. When individuals are able to see themselves with their own feelings and emotions, they are also able to see their potential to grow and improve. Moustakas (1994) observed that when people are dominated by public opinion and affected by the world outside, they are in a state of fallenness. In this state individuals take on the values, ideas, and beliefs of others and lose their individuality. They become distracted by superficial relationships and lose focus on their potential to express their unique existence. The existential approach calls for individuals to make choices for themselves, while taking into consideration their role in the family and community in doing so.

MacDonald (1991) has noted that the resistance of some mental health counselors to identify with a single theory may be the consequence of their belief that a single theory cannot be relevant to their diverse clienteles. Additionally, Harris (1991) has observed that some counselors may not find available theories applicable to all settings. Bauman and Waldo (1998) have argued that existentialism addresses both of these concerns. They proposed that existential theory is exclusively suited to the field of mental health counseling, presents undeniable explanations of the importance of these mental health counseling principles, and offers a theoretical foundation which directs mental health counseling interventions. Vontress, in his interview with Epp (1998), characterized mental health as being in balance and harmony with one's inner-self; with one's friends, family, and colleagues; with one's physical environment; and with one's spirituality. He contended that the existential standard of mental health is an advanced standard and the existential counselor considers every area of the client's life to make sure each part is satisfied.

In recent years mental health professionals have identified brief, short-term interventions that have gained considerable attention due primarily to their cost-effectiveness (Langenbucher, 1994). One such approach is solution-focused brief therapy. Solution-focused therapy (SFT) has evolved over the past 20 years and is now a widely used approach (Gingerich & Eisengart, 2000). SFT encourages the client to develop a vision of an alternative future. This approach "does not attempt to eliminate problems but rather attempts to develop new meanings or new ways of looking at problems so that the process of solution building can begin" (Bezanson, 2004, p. 184).

The purpose of this paper is to address the void in the literature on the integration of existential concerns into solution-focused brief therapy. The paper proceeds as follows. First, I provide an overview of existential theory, its key concepts, the role of the counselor, therapeutic goals, counselor-client relationship issues, and central techniques and methods. Second, I present a brief overview of solution-focused therapy concepts and interventions. Third, I provide a practical application of existential theory as it pertains to solution-focused brief therapy.

OVERVIEW OF EXISTENTIAL THEORY

The four givens, or premises, of the human condition that existential psychology addresses are discussed in this section. These "givens" are an inescapable part of human existence in the world and can be labeled as death, freedom, isolation, and meaninglessness. Existential therapy deals with a basic anxiety that comes out of each person's accomplishments and undertakings---conscious and unconscious--to deal with the complex facts of life that are rooted in the person's existence (Yalom, 1980).

Awareness of death and its certainty bring terror, because humans wish to continue to live and are terrified by the concept of "nonbeing" (Bauman & Waldo, 1998). Death is inevitable, both our own death and the death of our loved ones. This "given" is perhaps the most obvious, and is evident through the enormous efforts of human beings, using modern technology, to extend life and escape death's grasp. With regard to freedom, we cannot avoid the freedom that we possess to do as we wish in creating our world and ourselves. We have to make up our own life stories. The givens of death and freedom are brought to our attention when they are addressed and confronted by the character of Trudi in the novel Stones from the River (Hegi, 1994). Trudi is a zwerg, a dwarf, growing up in 20th century Germany. She uses an enormous amount of energy in futile efforts to grow, until she realizes that she would die someday and until then it is left to her to resolve what would happen to her. Trudi realized the humbling and unavoidable responsibility that accompanies the freedom to shape her life.

Existential isolation refers to the unavoidable fact that no matter how close we may find ourselves to another person, there is a fundamental separateness that we cannot remove. This ultimate aloneness of the human condition is that we enter and leave the world alone despite our ardent wish to fuse with others or be protected by them (Bauman & Waldo, 1998). Most people when dying are clearly aware of their isolation. We have sometimes seen our loved ones who have been terminally ill turn away from us as their lives come to an end.

The last "given" discussed by Yalom (1980) is meaninglessness, which implies absence of any apparent meaning or sense to our life. When people believe that there is no pre-designed direction or pre-approved plan for their life and recognize that there is no meaning innate in the universe, they face meaninglessness. Individuals create their reality and their own meaning in life, which in turn, gives them direction and structure (Krueger & Hanna, 1997). Meaning is discovered by the individual rather than given from sources outside the self (Frankl, 1984). Frankl's work is based on the idea that the will to meaning is the main human motivation. He wrote:

"A creative life and a life of enjoyment are banned to him. But not only creativeness and enjoyment are meaningful. If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death. Without suffering and death human life cannot be complete." (p. 76)

The above words by Frankl remind us that human suffering too can be meaningful. May (1989) believed that a human being will not change undesirable behavior patterns until forced to do so by suffering. Vast amounts of advice, persuasion, or even outside requests will result in a slight, temporary change. Many neurotic individuals prefer to stay in their current situation than to risk the uncertainty that would come with change. Suffering is known to be one of the most potentially inspiring forces in nature (May; Frankl, 1984). Suffering can help one to appreciate life and give it meaning. In support of this perspective, Lantz and Gregoire (2000) studied 27 couples facing breast cancer and noted that 23 reported their experience "facing and dealing with breast cancer" as helping them appreciate life and their marriage to a "much greater degree." Thirteen couples in the same study had stated that they were "glad that they had gotten cancer" because the illness "forcefully makes you value your life, your spouse and your family" (p. 321). However, suffering can also be painful, debilitating, depressing and overwhelming for those faced with terminal illness, trauma, devastation from natural disasters, war, genocide, or death of a child to name some.

EXISTENTIAL THEORY AND THE HUMAN CONDITION

That we have choices in every situation is a view confirmed by Frankl's experiences in the concentration camps (Frankl, 1984). Referring to prisoners, he noted: "they may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms--to choose one's attitude in any given set of circumstances, to choose one's own way" (Frankl, p. 75). Freedom in an existential framework claims that we assume responsibility for our choices and act upon those choices (Yalom, 1980). Our decision to act or not to act is also a choice. Sometimes we make a decision by not making a decision--deciding by not deciding.

Considering our own ability to choose can stir up existential anxiety (Yalom, 1980), because we are unaware of the consequences of that choice. Existential anxiety is a profound feeling of nervousness and worry that arises from our awareness of death, isolation, freedom, and meaninglessness. For example, the uncertainty of one's death and lack of knowledge of the aftermath of death evokes existential anxiety (Vandenberg, 1991). Existential anxiety is the response to our understanding that we have the responsibility to create a meaningful existence in the limited time we have available (Bauman & Waldo, 1998). It has a significant role in the clarification of our values. This existential anxiety can become neurotic (Yalom, 1998). We experience neurotic anxiety when we try to evade existential anxiety or when we experience excessive amounts of it to the point where it restricts our growth. Neurotic anxiety manifests itself as a loss of a subjective sense of free will and an inability to take responsibility for our own life. When we lose touch with ourselves, we no longer know who we are and what we ought to be. Our capacity for self-awareness is a part of our human condition. Neurotic anxiety blocks our self-awareness (DeCarvalho, 1992) and tends to immobilize us. Our awareness of death and nonbeing can alternatively enhance our quality of life. According to Vandenberg (1991), when we are confronted by existential uncertainty we seek attachment with others and establish meaningful relationships with them as a strategy for coping.

ROLE OF THE COUNSELOR

The counselor is the catalyst of self-reflection in the quest for a healthier life. The counselor does not confront the client with the issues of love, death, suffering, and meaning, but construes them in the heart of every issue that is presented in session and uses the session to pay attention to these deeper points of concern. The role of the counselor is to channel the client's suffering into productive paths rather than to alleviate the suffering. The counselor can point out each week the manner in which the sufferings of the client during the past week were related to faulty attitudes and behaviors. It is important that the counselor looks for the client's honesty rather than focus on pathology. According to Vontress, in his interview with Epp (1998), the existential counselor is a "companion in reviewing one's life in its totality, not merely one's pattern of thoughts, feelings, or unconscious conflicts" (p. 3). Similarly Yalom (1980) believed the existential counselor is a co-explorer who helps the client discover the reality of the meanings and meaning potentials that call to the client for their discovery, actualization, and recollection as a way to "shrink" the existential meaning vacuum. Moreover, Lantz (1995) contended that Frankl's ideas about time and reality propose that the functions of the therapist should be to: (a) notice meaning potentials in the future, (b) actualize such meaning potentials in the "here-and-now," and (c) re-collect and honor the meaning potentials that have been actualized and accumulated in the past. Helping clients notice meaning potentials that can be actualized in the "here-and-now" can be difficult. Meaning potentials are affected by the client's fear of the susceptibilities and responsibilities that accompany the awareness of the meaning (Lantz).

THERAPEUTIC GOALS

The goal of existential therapy is not to free clients from anxiety, but rather to help them accept, bear, and live constructively with anxiety. Clients need to first begin the process of identifying the ways in which they have submissively accepted situations and given up control. Thereafter they are able to consciously begin to mold and manipulate their own lives. May (1958) believed that the goal of counseling is for the client to "experience his experience as real" (p. 85) and that the purpose of the therapeutic process is to assist clients in becoming aware of their existence to the degree that they be mindful of their full potential, as well as act on the basis of that awareness.

COUNSELOR-CLIENT RELATIONSHIP

In existential therapy the counselor strives to be with the client in the here-and-now, and to understand and experience the ongoing emotional and mental state of the client. In order to do this, the counselor needs to express his or her own feelings. This coming together in the here-and-now may create an existential moment or existential encounter through which the isolated client comes to experience the existence of the counselor. Yalom (1980) stated: "it is the real relationship that heals" (p. 404). The relationship "analyzed properly will facilitate other relationships--the therapist helps to heal by developing a genuine relationship with the patient" (p. 405). The therapist relates to and communicates with the client in a genuine caring manner, on a human level, and makes every effort to reach moments of authentic encounter. All other requirements such as genuineness, warmth and positive regard relate not to what the therapist must do, but to what the therapist must be--his or her "real self." The client needs to be able to relate deeply to the therapist as a real person. Yalom (1980) observed that "the patient, in terror of existential isolation, relates deeply and meaningfully to the therapist and then, strengthened by this encounter, is led back again to a confrontation with existential isolation" (p. 406). The counseling process is at its best when the therapist uses his or her authentic and genuine self to meet the authentic and genuine self of the client, both involved in the I-Thou encounter and an authentic relationship.

CENTRAL TECHNIQUES AND METHODS

Existential theory does not limit the counselor to specific techniques and interventions. It is especially important for counselors to show compassion for another human being. In this sense, worrying about collecting clever techniques, therapeutic tricks, using psychological jargon, etc., does not help if compassion and empathy are missing from the therapeutic encounter. Vontress (as cited by Epp, 1998) expressed his views on existential counseling as a philosophical discussion about life customized to a client's issues. It is a discussion about living and dying--the living is explicit and the dying is implicit. The discussion uses the harsh reality of life to drive the search for its marvelous aspects of love and meaning (Bauman & Waldo, 1998; Epp, 1998; Yalom, 1980). Thus, by viewing symptoms as a sign of existential anxiety, and therefore as an encouraging signal that the client is internally motivated toward growth, the counselor can help the client in examining the existential givens. Because these are universal concerns experienced both by the counselor and the client, the counselor naturally experiences and communicates empathy, which contributes to the development of a genuine and authentic client-counselor relationship. This approach to counseling is an invitation to clients to recognize the ways in which they are not living authentically and to challenge them to make choices that will lead to their becoming what they are capable of being.

In the existential approach, the central issues in counseling are freedom and responsibility. Yalom (1980) stated that the first step to help a client assume responsibility is not a technique, but the counselor's attitude. The counselor must consistently maneuver within the context that a client has responsibility for his or her own misery. The counselor must figure out what role a particular client plays in his or her own predicament, and find ways to communicate this insight to the client. In some cases, external forces that are completely beyond a client's control, such as natural disasters, violence, poverty and illness, may be responsible while in other cases the client's own actions may be responsible for the problem. Regardless of the cause of the misery, however, there can be no motivation to change until the client realizes that he or she is responsible for responding to and overcoming his or her own misery.

May and Yalom (2000) observed that some individuals evade responsibility by entering "a temporary irrational state in which they are not responsible even to themselves for their behavior" (p. 285). The counselor needs to identify the many ways and methods in which clients avoid responsibility, and convey these to their clients. The readiness to accept responsibility differs from client to client. The next step is for the client to appreciate how he or she has contributed to a situation--then he or she will be free to change the structure of his or her own life. The most effective methods available to counselors involve analyzing the client's "here-and-now in-therapy behavior and demonstrating that the client recreates microcosmically, in the therapy situation, the same situation that he or she faces in life (Yalom, 1980, p. 233).

A Japanese proverb states: "To know and not to act is not to know at all." Awareness of responsibility alone does not make change take place neither does one's awareness of thoughts, feelings and behaviors; it is only the first step in the process of change. When a client is aware of his or her actions, takes responsibility for them and genuinely desires to change, the counselor observes the client's readiness to accept responsibility and to change. The client has then begun the journey of moving from awareness to action. Counseling can lead to personality change in the awareness-to-action journey, only in so far as it guides the client to embrace a new mode of behavior. A real change happening in the absence of action is a practical and theoretical impossibility (Yalom, 1980).

SOLUTION-FOCUSED THERAPY

Solution-focused therapy (SFT) is a cooperative and non-pathological approach to therapy developed by de Shazer and others in the 1980s and 1990s (de Shazer, 1991; Sharry, Darmody & Madden, 2002). Gingerich and Eisengart (2000) provided preliminary support for solution-focused brief therapy as an effective tool in helping individuals with psychological problems. The focus is on the client's health rather than problems, on strengths rather than weaknesses or deficits, and on skills, resources and coping abilities that would help in reaching future goals (Sharry et al.; Dermer, Wilhite, Hemesath, & Russell, 2000). The counselor is less concerned with how the problem arose, and more concerned with working together with the client to arrive at a solution to the problem (Dzelme & Jones, 2001). SFT counselors believe that it is more useful for clients to understand and elaborate these solutions rather than dwell on the problems of the past. Clients are encouraged to believe that positive changes are always possible. Counselors also view their clients' presenting problems in a positive light and compliment clients on their perseverance and resourcefulness, helping them to focus on what is going right in their lives rather than focus on what went wrong. Focusing on what is going right in their present lives also helps clients plan the next small step.

Encouraging clients to think of what needs to happen to make things better is also an essential concept in SFT. Often clients are in counseling because they have continued to do whatever that is not working for them. It is important to help clients understand that when something is not working it is beneficial to stop doing it and also, if something is working, to do more of it. Counselors may also clarify the logical bind clients have created for themselves. To help clients change, the emphasis in counseling is on how change happens rather than focusing on how problems develop (Price, 2004).

Solution-Focused Brief Therapy (SFBT) has become known as a practical approach in the treatment of many psychological problems (Berg & Hopwood, 1991). During recent years, this approach and other brief, minimal, and short-term interventions have gained significant attention due primarily to their cost-effectiveness (Langenbucher, 1994). These interventions with their solution-directed acts can be driven by existential theory that is dynamic and action-based. Existential focus on lived experience have recently appeared in solution-focused approaches that are critical of theoretical assumptions about intrapsychic life (Ellerman, 1999).

EXISTENTIAL THEORY'S APPLICATION TO SOLUTION-FOCUSED BRIEF THERAPY

Ellerman (1999) observed that in his work with patients in an outpatient clinic of an urban hospital, using solution-focused brief therapy was none other than a clinical application of existential psychology. In the clinics, individuals and families would be offered ten sessions, and within this time-limited, solution-focused context, Ellerman practiced existential therapy. He decided to call it Brief Solution Focused Existential Therapy (BSFET) and even referred to it as pragmatic existential therapy. While Yalom's (1980) insight based existential therapy focuses on the creation of mechanisms to defend against anxiety that is created by the awareness of existential concerns (Rogers, 2001), Ellerman's pragmatic existential therapy focuses on (a) lived experience, (b) self-creation, and (c) existential anxiety. Pragmatic existential therapy is not contemplative and insight focused, but dynamic and action based (Ellerman). This view is indeed congruent with the existentialist argument that in human issues there is hope only in action (Sartre, 1960).

Counselors who use BSFET remain on the same plane of common experience with their clients, focusing on life problems, and using clients as problem solvers (Ellerman, 1999). The counselor uses BSFET as an approach useful to some clients who have become stuck in problem solving, and moves them into a position of learning to take responsibility for their life--an essential part of growing up. "Life ultimately means taking the responsibility to find the right answer to tie problems and to fulfill the tasks which it constantly sets for each individual" (Frankl, 1984, p. 85). Ellerman has noted that in order to create a therapeutic encounter dedicated to solving problems of lived experience, "it is helpful to think of clinical interventions with reference to simple dynamic images arising from common experience" (1999, p. 52). This is effectively illustrated by

Ellerman's example of a driver's futile attempts at releasing a vehicle stuck in snow. The harder the driver tries the deeper the vehicle entrenches in the snow, its wheels spinning but not moving forward. The frustrated driver requires a push to get unstuck from the entrenched position. When dealing with anxious clients within the pragmatic existential framework, behavioral and cognitive techniques can help the clinician to lessen disabling symptoms. Giving clients a positive confrontation with death during BSFET is a method that is used to bring about a new appreciation of life and an eager awareness of the preciousness of present and future time. For example, a counselor may, at an appropriate time, ask a client "If you learned that you had only six months to live, what would you do within that remaining time?"

A CLINICAL APPLICATION OF BSFET

Selection of Clients and Client Characteristics

I took the opportunity to apply BSFET in Sri Lanka a few months after the tsunami hit the south and south-east Asian region in December 2004. The clients to whom I provided brief therapy were pre-selected, their suitability determined by a priest who was involved in the recovery effort and re-housing of victims. They were all females, living in oppressive conditions following displacement from their homes, and having lost all hope of getting back on their feet again. It was important that these clients had an increased likelihood to benefit from what I had to offer them in a brief period of time. However, I decided that formulating too many selection criteria was neither effective nor appropriate given that the need for counseling services was high and the number of counselors who could provide counseling in the native language was very low.

All these survivors experienced severe trauma either because of loss of their homes and all personal belongings and/or near-death situations that were connected with the tsunami. A problem-solving, solution-focused approach seemed appropriate under the circumstances. Based on my initial meeting with these clients it was evident that they were searching for meaning and purpose in their lives. Their values and goals in life were not clear to them when all they could feel, see and experience were loss, destruction and anxiety. I had 6 weeks to provide BSFET. My clients were all middle-aged women with families, non-English-speaking and with limited financial means. They had lost their homes and all their belongings except for the clothes they were wearing at the time the tsunami struck. They were temporarily housed in tents, with families of five or six members living in each tent. Hundreds of tents were pitched in what looked like a baseball field. During my 6 weeks with them they were still living in these temporary homes with very basic amenities that were provided by the community parish or temple. The roofs of the tents were aluminum that heated to high tropical temperatures, making it almost impossible to be inside during daytime hours.

I was able to build rapport with each of the women at the first meeting, which lasted an hour and a half. They were relieved that I could speak their native language, Sinhala, and also appreciative that I took the time to listen to their horrific stories. In the aftermath of the tsunami each suffered more or less silently while still being forced to carry out their day-to-day adult responsibilities as heads of families, mothers and workers.

In solution-focused therapy, clients are quickly moved from talking about the problem to thinking and choosing the solution. However, in this situation it was necessary for clients to talk, explain and describe their experiences and not feel rushed into moving to finding solutions. At the beginning they shared their fears of death, the anxiety they were feeling on a daily basis, their feelings of isolation, and the difficulty they faced in finding meaning in their lives in order to move forward or envision the future. In addition to exploring these existential concerns I also used SFBT in helping them solve problems and find solutions. I will describe a number of BSFET interventions that I used with these clients, particularly: (1) listening for strengths, (2) moving from problems to goals, (3) exploring how clients cope, and (4) using scaling questions.

Listening for Strengths

While using empathic listening skills to make my clients feel understood, respected and not judged, I also acknowledged their pain and suffering. In addition it was important to acknowledge their strength and resilience in response to the traumatic experience and ensuing problems. To hold up a positive, reflective mirror to these clients of their own abilities and strengths (Sharry, Darmody & Madden, 2002) seemed essential because they believed that only chance and the charity of others could lift them out of helplessness and despair. Thinking positively about these women and their actions to carry out the daily responsibilities of family and work and reflecting this back to them was a shift from the problem conversation to a strength-based conversation. I worked at communicating my belief in their strengths and capabilities and in the possibility that they can work toward making things better for themselves and their families. I will share some actual transcripts from my sessions with one of the survivors. As an example, the following is a transcript of a strength-based conversation I had with this survivor.

Counselor: How do you get yourself nicely dressed everyday and bring your grandchild to school?

Client: Well I thought of my three grandchildren and their predicament if f stayed in bed all day.

Counselor: Sounds like you do a lot for your daughter's family ... you really want to make things easier for them.

Client: Yes, they need me to take care of the kids because my daughter works full-time at a sewing factory, and I want a future for my grandkids.

Counselor: So what does that say about you? Client: (hesitatingly) That I'm strong and resilient. I can suffer any amount of pain (begins to cry).

Moving from Problems to Goals

The "victim" mindset served as a barrier for all these women to taking positive steps toward moving forward in their lives. It also enabled them to be critical as well as dependent on others' actions and kindness. At this stage it was necessary for me to help each client articulate clear, positive, and concrete goals in as much detail as possible. My goal was to help them envision a future with less hopelessness and despair, better coping and to describe this in detail. Consider this exchange with the same survivor:

Counselor: Your life after the tsunami must be very difficult for you to feel that things will never change and that you will continue to live in a temporary tent for a long time?

Client: Yes, I'm tired of the mosquitoes and heat from the aluminum roof. My heart is heavy because I lost everything that I saved for my daughter.

Counselor: Before the tsunami you said things were good and you felt good. What was it like to feel good?

Client: I would wake up in the morning and cook rice for everyone.... I had boundless energy and I was happy. My son-in-law would take his lunch out on the boat.... out to sea.... but there's no boat anymore.

Counselor: So you would like a little more happiness and more energy in your life?

Client: That might not happen for a long time ... but yes, if you put it that way.

Counselor: I'm curious to know what you would be doing differently if you had more energy and you felt happier.

Client: I would be busy sewing the fishing nets for our family and my sister's family. I would feel that we could eventually buy an additional boat.

Exploring How Clients Cope

Although it was important to explore the damaging effects of the tsunami on each of the clients it was crucial to explore how these women responded and coped with the aftermath of the tsunami and its destruction on their lives. Sharry, Darmody and Madden (2002) state that "Such a focus can be more empowering in helping clients identify strengths and resources to manage the problem effectively" (p. 393). The women's individual and collective strength both humbled and fascinated me. What keeps them going on a day-to-day basis, what their greatest support is when faced with feelings of hopelessness and helplessness, were some of the questions that I asked to explore their ways of coping. Each woman's spirituality, religious beliefs, and practice served as her main coping skill. Working within their roles as mothers, care-takers, and workers also helped them cope. They needed help focusing on control and choice, away from hopelessness and the "victim" mind set. Asking them specific coping questions also helped them recall their coping skills during the first few days after the tsunami, and the weeks and months thereafter. It was also a useful method to help them further validate and acknowledge their strengths and resources (Corcoran, 2002). The following exchange is an example of positive exploration of goals and coping mechanisms.

Counselor: How do you cope with feeling that there's nothing left for you and the family?

Client: Well I don't have anything left. Often I feel that things are not going to get better for us.

Counselor: I understand it has been really difficult for you ... yet you are happy to be here at the session ... in fact you were early ... somehow it seems that you have been handling things although it is very tough for you and the family ... what do you think has helped?

Client: We all help each other and I come to church, and talking to Father and praying helps me ... I know God will never fail me, but sometimes it is difficult to believe even that. Counselor: So when you talk to your neighbors and Father it helps you ... what helps you the most?

Client: Praying and sharing with others helps me

Using Scaling Questions

Solution-focused therapy also utilizes scaling questions as an intervention, which involves ranking client change and progress on a 10-point scale, while it also helps the client understand and build on his or her change. Scaling allows clients to assess their current functioning and what needs to be done to move up on the scale. What differences does the client experience in being at a 3 rather than 2, what was the highest point the client has reached on the scale, what would be different if the client moved to a higher number on the scale, and what needs to happen for that move to take place are some of the scaling questions that were helpful to the women. Consider the following exchange with the same survivor:

Counselor: On a scale of 1 to 10, where 10 is the happiest you felt, and 1 is the worst and saddest you felt where would you say you are now?

Client: I think I'm at a 3. I wouldn't be below that because unlike some others I did not lose family members (she mentioned a few names of friends who lost family members).

After four sessions of counseling the client indicated that she was at a five.

Counselor: What is different for you to be at a 5 rather than a 3?

Client: I feel a little happier.... that we might actually get a house. I know God hears the cry of the poor, and although I feel angry with Him at times I still pray a lot.

CONCLUSION

This paper examined the basic concepts of existential theory providing an overview of the "givens," i.e., death, freedom, isolation and meaninglessness. It indicated how the theory provides a foundation for mental health counselors and supported the notion that brief solution-focused therapy is a clinical application of existential theory. The author's experience counseling tsunami victims in Sri Lanka served as an illustration.

Death reminds us that existence cannot be postponed. We realize that as long as we have life, we have possibility, but only until the last moment. That is what Ebenezer Scrooge's near-death dream experience in Charles Dickens' 1843 classic, A Christmas Carol, was about, and what propelled his transformation. As Yalom (1980) stated, "Life and death are interdependent; they exist simultaneously, not consecutively; death whirs continuously beneath the membrane of life and exerts a vast influence upon experience and conduct" (p. 29). Usually in BSFET leading clients in the direction of accepting the journey of solving their main problems occurs in conjunction with a "gentle" confrontation with the prospect of death. "If you learned that you had exactly one year to live, what would you do with the time you have left?" is a question I have asked some of my clients. Each time it is asked it has produced a marked effect on the client. However, the near-death experience of the women victims of the tsunami was not a gentle confrontation by the counselor. It was a real experience that forced them to deal with life and death issues, such as the meaning of life and issues of suffering, anxiety, isolation and the death of loved ones. These existential givens found their way into the midst of every issue that was presented in each session. As a counselor working from an existential perspective using a brief solution focused approach, I found myself channeling the tsunami victims' suffering into productive paths rather than trying to alleviate their suffering. I was not attempting to alleviate my clients' suffering. Instead, I was helping them identify and act on ways to cope with their distress.

As a counselor, I believe that helping others find meaning and happiness in life is one of the most important and fulfilling roles in society. Helping clients to openly discuss life and death issues, freedom, anxiety, suffering, and isolation also challenges them to deeply reflect on the meaning of their existence. During these encounters counselors are able to 'live' the experience with their clients in the here-and-now and be present in a genuinely caring manner.

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Delini M. Fernando is an assistant professor of counselor in the the Department of Counseling, Development, and Higher Education at the University of North Texas. Correspondence concerning this article should be addressed to Delini M. Fernando, Department of Counseling, Higher Education, and Early Childhood Education, University of North Texas, 1400 W. Highland Street, Stovall Hall, P.O. Box 310829, Denton, TX 76203 or sent via e-mail to [e-mail].