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COPYRIGHT 2001 American Counseling Association
Existential therapy in groups for older adults can help to provide life meaning; to facilitate social support; and to improve coping with grief loss, chronic illness, and ultimately death. A scenario is presented that provides a clinical illustration of the use of existentialism in groups with older adults.
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Fear of death can be defined as the anxiety experienced in daily life caused by the anticipation of death. Death anxiety may be a result of one imagining a future of facing death. This may be through aging or experiencing circumstances that confront one with the idea of death. The existentialist considers death as essential to the discovery of meaning and purpose in life. The existential perspective suggests that death and life are interdependent: The physicality of death destroys one, and the idea of death saves one. The recognition of death can bring some perspective to life and help one live in a more authentic mode. The prospect of death motivates individuals to assume responsibility and respond to the opportunities life has to offer (Heidegger, 1962; Tomer, 1992; Yalom, 1980).
Fully recognizing and being aware of death may decrease anxiety to some degree. For some people, however, life could have a different meaning. Some individuals may have a strong attachment to the world and their existence and not much understanding of death and their nonexistence. Others could have many questions, doubts, and fears about death and of the unknown. One might expect individuals with stronger religious beliefs to have less fear of death, especially when the beliefs involve the concept of an afterlife. However, research has demonstrated that if an individual's faith stresses notions of punishment in the afterlife, then religiosity is positively related to fear of death (Cicirelli, 1999).
Death is a certainty that human beings need to face. Because many are afraid of facing the reality of their own death and the anxiety that goes with it, individuals might attempt to escape the awareness of this reality (Corey, 2000). According to May (1961), "The price for denying death is undefined anxiety, self-alienation. To completely understand himself, man must confront death, and become aware of personal death" (p. 65).
The main therapeutic function of Rollo May's (1961) existential approach is to help the client confront normal anxiety, which is an unavoidable part of the human condition. The existential view of personality structure emphasizes the depth of experiences at any given moment, and the existential therapist does not spend a great deal of time in therapy helping the client to recover a personal past (M. R. Thomas, 1990). Frankl (1963) supported this view and added that it is not how long one lives but how one lives that determines the quality and meaningfulness of life. Therefore, the way one perceives life and death affects one's level of anxiety. Tomer (1992), in a review of the research, noted that a number of studies have found a positive correlation between purpose in life and death anxiety.
Four ultimate concerns in existential theory are death, freedom, isolation, and meaninglessness (Yalom, 1980). According to Yalom (1998), clients, given the slightest encouragement, will bring in an extraordinary amount of material related to a concern about death. They discuss the deaths of parents or friends, they worry about growing old, and their dreams are haunted by death. When doing group therapy with older adults, it is suggested that positive outcomes are more probable when group facilitators understand the unique needs of older persons, carefully match participant capacities and needs with the treatment modality, and modify the group organization to accommodate the unique characteristics of older individuals (C. M. Thomas & Martin, 1992).
Awareness of death and the anxiety it generates has significant implications for the practice of group work. The concern with living life fully, rather than merely existing, is a recurrent theme in many groups. Corey (2000) suggested that a counselor should tackle this theme by encouraging group members to ask themselves honestly how they feel about the quality of their lives. He then recommended asking them to answer this same question as if they knew that they were about to die. The key is how the two answers differ. By discovering some decisions that were not carried through, this process can uncover the opportunities for change that the client had been ignoring. By reflecting on their unfinished business, participants may come to realize that they are not living the kind of life they would like to live, and they may be able to identify the reasons for this unsatisfactory existence.
Counseling groups can...
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