Existential Interventions During the Age of COVID
How focusing on meaning in life can create hope in patients and therapists.
The Psychological Impact of COVID-19
Unexpected events, including life-threatening illness or dealing with COVID-19, are often catalysts for thinking about meaning in life, values, and priorities (Hill, 2018).
The constant level of anxiety about falling victim to COVID-19, or being the agent spreading it has made the pandemic upsetting and potentially traumatic for individuals.
At other times of global trauma, we have been able to physically come together to provide emotional support, comfort, and protection. However, in this current crisis, we are told to do the opposite, robbing humans of the universal healing and coping response brought on by proximity and touch.
A leader in the field of trauma and posttraumatic stress, Bessel van der Kolk (2014) describes the feelings of safety with others as “probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.” The COVID-19 pandemic drives a physical wedge between these natural connections.
The unique challenges presented by COVID-19 may exacerbate underlying feelings of isolation, vulnerability, perceived lack of control, and trigger memories of previous medical trauma.
At the same time, individuals with preexisting conditions may be better equipped to cope with aspects of the pandemic, having previously confronted fundamental truths such as life’s uncertainty, the random nature of events, and the inevitability of death.
Gordon et al. (2020) recently summarized existential-humanistic (E-H) and relational approaches to psychotherapy during the pandemic [Insert Link #1 here]. The article addressed potential risk and vulnerability factors for patients with preexisting medical conditions during the pandemic, but the clinical tools are broadly applicable.
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Existential-Humanistic Perspectives on Meaning
The E-H perspective on therapeutic interventions emphasizes creating meaning, being more present in the moment, taking responsibility, living in a manner consistent with one’s values, and expanding the capacity for agency, commitment, and action (Schneider et al., 2017).
The eminent psychiatrist and Holocaust survivor Victor Frankl (2019), believed that while humans generally do not choose their difficulties, they do have the freedom to select their attitudes. He shifts the emphasis away from “What can one expect from life?” to “What does life expect from us?”
Similarly, Kirk Schneider (2020) has stressed the importance of the ability to define — rather than being defined by — one’s circumstances through utilizing’s one’s imagination, intuition, and creativity.
Another central E-H theme popularized by Irvin Yalom (1980) is the idea that humans have an intrinsic need to construct meaning through tolerating uncertainty and passionate engagement in life (Hill, 2018).
Yalom (2008) regularly incorporates the concept of "rippling" into his many writings on existential therapy. Like ripples in a pond, rippling is the notion that we inevitably leave something behind after death — whether a trait, an act of kindness, the fruits of labor, or our wisdom or personality — which tempers the pain of transiency.
Therapeutic Interventions During COVID-19
Reevaluation of Values and Priorities
Experiencing a potentially-life threatening event may provide an opportunity for growth and reevaluation of one’s priorities and values. During times of personal crisis, our values and priorities may shuffle like a deck of cards. As a result, a “card” toward the bottom of the pile for most of a life may become a priority at the top of the deck, a personal value that may now resonant more deeply (Remen, 2000).
Asking Open-Ended Questions About the Meaning in Life
Questions that may be catalysts for helping patients think about meaning in life (Hill, 2018) include “What would you like your legacy to be?” “When do you feel most engaged in life?” and “What provides you with passion, pleasure, and meaning?"
Asking Open-Ended Questions About Growth
The process of positive life changes following a traumatic event has been referred to as posttraumatic growth (PTG; (Tedeschi et al, 2018).
Questions posted by Gordon et al. (2020) that may facilitate the therapeutic process include “Have you experienced any positive changes amidst these challenges?” “What have you discovered about yourself through the journey?" and “If you had not experienced these previous hardships, would you be dealing with the pandemic differently?”
Learning From Emotions
E-H therapeutic approaches take advantage of what each emotion can teach us. For example, depression and sadness can help individuals understand and discover what is most important in life (Buechler, 2004).
Dream Interpretation
Dreams can be interpreted as attempts at problem-solving, ways of mastering trauma, and explorations of paths not chosen in life (Lippman, 2000). Having the patient retell the dream in the present tense (Schneider et al., 2017) and asking “How would you have wanted your dream to end?” can facilitate a sense of presence and agency.
Concluding Thoughts
The therapeutic relationship provides a much-needed space for patients and therapists to reflect upon how COVID-19, while anxiety-provoking and frightening, is changing them in unanticipated ways.
Therapists are placed in the challenging position of navigating how to simultaneously process and make sense of their own heightened feelings of vulnerability and anxiety, while also staying attuned to their patients’ needs and creating a “holding space” for their patients’ anxieties.
Although decidedly challenging, a potential positive result for therapists has been the opportunity to experience true vulnerability first-hand, and to confront their own fears of mortality and life’s uncertainty. This has provided an opportunity for many clinicians to reflect on their values, priorities, and what is most meaningful in life (Gordon et al., 2020).
“Finding meaning does not require us to live differently, it requires us to see our lives differently.” (Remen, 2000, p. 29). That is, learning to perceive the familiar aspects of our lives in new ways (Remen, 2000).
Stories of PTG are beginning to emerge, as a result of enduring the COVID-19 pandemic, including improved relationships, a higher level of self-reflection on one’s values, priorities, and personal strengths, and living life with greater intention and purpose.
Resources:
Schneider, K. What Existentialists Can Teach Us About COVID-19
Read article on Psychology Today: https://www.psychologytoday.com/us/blog/psychological-trauma-coping-and-resilience/202101/existential-interventions-during-the-age
References
Buechler, S. (2004). Clinical values: Emotions that guide psychoanalytic treatment. The Analytic Press.
Frankl, V. E. (2019). Yes to life: In spite of everything. Beacon Press.
Gordon, R. M., Dahan, J. F., Wolfson, J. B., Fults, E., Lee, Y. S. C., Smith-Wexler, L., Liberta, T. A., & McGiffin, J. N. (2020). Existential-humanistic and relational psychotherapy during COVID-19 with patients with preexisting conditions. Journal of Humanistic Psychology. Published online: November 2020, https://doi.org/10.1177/0022167820973890
Hill, C. E. (2018). Meaning in life: A therapist’s guide. American Psychological Association. https://doi.org/10.1037/0000042-000
Lippmann, P. (2000). On Listening to Dreams. The Analytic Press.
Remen, R. N. (2000). My grandfather’s blessings: Stories of strength, refuge, and belonging. Riverhead Books.
Schneider, K. J. & Krug, O. T. (2017). Existential-humanistic therapy (2nd Edition). American Psychological Association. http://dx.doi.org/10.1037/0000042-000
Schneider, K. J. (2020). What Existentialists Can Tell Us About COVID-19. Psychology Today. https://www.psychologytoday.com/us/blog/awakening- awe/202005/what-existentialists-can-teach-us-about-covid-19
Tedeschi, R. G., Shakespeare-Finch, Taku, K., & Calhoun, L. G. (2018). Posttraumatic Growth: Theory, Research, and Applications. Routledge. https://doi.org/10.4324/9781315527451
van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking. http://dx.doi.org/10.7812/TPP/14-211
Yalom, I. D. (1980). Existential Psychotherapy. Basic Books.
Yalom, I. D. (2008). Staring at the Sun: Overcoming the Terror of Death. Jossey-Bass. https://doi.org/10.1080/08873260802350006
