Running head: EXISTENTIAL THERAPY AND COGNITIVE BEHAVIORAL THERAPY

Existential Therapy and Cognitive Behavioral Therapy Theory Paper

Jade L. Pearson

California State University, Northridge

College Counseling and Student Services

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Existential Theory

Vignette

Loren is a young woman, age 27, who has generalized anxiety and acute panic episodes.

She struggles to sleep at night and oftentimes fears the concept of death. Loren recently started a

master’s program, went through a significant breakup, and is having trouble adjusting to the

changes, stating that she is afraid that “life will continually get more difficult” and she is “not

sure how to cope with that thought.” Throughout the day Loren frequently thinks about her faith

and the implications this has on her life. Loren believes she has a “calling” but struggles to find

her place in the world. Loren currently struggles with the fear of loss, due to the recent shootings

that have been going on, as well as the loss of a significant relationship. She currently

experiences bouts of anxiety with features of depersonalization and derealization when she tries

to fall asleep. When she tries to fall asleep, she fears that she will die and states that she “thinks

she is going crazy sometimes.”

Case Conceptualization

The client is a 27-year-old single female who has close relationships with their parents

and lives at home. The client is very resourceful in that she seeks therapy, counseling, and

mentorship. The client is a middle-class and educated with a psychologically minded tendency.

The client identifies as a Black woman and is in good health. She goes to the gym 2-4 days out

of the week which “gives her a sense of control”.

Although Loren has a close family who is supportive, she often feels uncomfortable

sharing her fears with family members who “may not understand.” Loren is very self-aware and

has a high motivation to assume responsibility for her life choices. She generally avoids the
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here-and-now with verbiage that is most indicative of the past and the future. Loren has trouble

staying in the present, which is “hard for her because she is mostly future-oriented.”

Loren experiences existential anxiety and feels uncomfortable with the concept of death.

She frequently wonders what will happen beyond death and what the implications are for her

faith and the fate of others. Loren struggles with freedom, in that the universe feels random and

lacks external structure. Loren is someone who likes order and tends to have black-and-white

thinking. Because of this, though, she assumes responsibility for her choices and actions.

Loren struggles with the feeling of isolation in that when she is not in a relationship, she

feels that her worth is not seen or understood. She also struggles to conceptualize grief relating to

the end of her significant relationships. Loren feels the need to be a part of a larger whole, which

manifests in her choice of profession in counseling. She has a general feeling of angst in which

she experiences dread at the uncertainty of life.

Loren sometimes feels that she is in an existential vacuum in which she experiences

emptiness at the thought that life is meaningless. This causes her most distress when he tries to

fall asleep and is alone with her thoughts. However, Loren believes that she has a “calling” to be

what she was meant to be and is comfortable not knowing exactly what that is. Loren searches

for meaning in her life through her faith which helps her combat feelings of meaninglessness.

It is important to focus on the I/thou relationship rather than the I/it relationship between

the client and the therapist which is essential to focus on the spirit and achieving true dialogue. It

is important to have direct, mutual, and present interaction (Corey, 2017). The therapist must

have faith in the client’s potential to cope authentically with their troubles and to discover
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alternative ways of being. The therapist-client relationship is a key mechanism for positive

change (Shumaker, 2011).

The client views her problems as a hindrance to everyday life, in which the sleeping

issues oftentimes affect her functioning throughout the next day. Additionally, her dwelling on

the loss of her significant relationship makes her feel “hopeless that she will be in a healthy

relationship and get married”. In an existential framework, “No relationship can eliminate

existential isolation, but aloneness can be shared in such a way that love compensates for its

pain” (Yalom & Josselson, 2001, p. 326).

Treatment Plan

1. Initial Phase Therapeutic Tasks

a. Develop working counseling relationships.

b. Identify and clarify the client’s assumptions about the world

c. Invite the client to define and question the ways that they make sense of their

existence.

2. Initial Phase Client Goals

a. Increase clarity about assumptions about the client’s world

i. Objective: The client will identify 10 assumptions about the world and

take responsibility to either accept or change their assumptions.

b. Increase client responsibility on life’s choices.

i. client will reflect on the choices she made today to determine their

meaningfulness.

c. Interventions
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i. The therapist will teach Loren how to reflect on her existence to examine

her role in creating her problems.

i. Therapist will assist the client in ways to which they constrict their

awareness and the cost of such constrictions.

3. Working Phase Therapeutic Tasks

a. More fully examine the source of the client’s present value system, beliefs, and

assumptions to explore their validity.

b. Encourage self-exploration that will lead to new insights and restructuring of

values and attitudes.

c. Explore the concept of death and non-being.

d. Distinguish between neurotically dependent attachments and life affirming

relationships.

4. Working Phase Client Goals

a. Increase self-exploration and understanding of personal values, beliefs and

assumptions about the world.

i. Objective: The client will keep a journal and list 10 personal values, 10

personal beliefs, and 5 assumptions about the world. They will then work

to identify where these beliefs originated and how these items contribute

to their self-concept.

b. Increase exploration of pain, fears, guilty feelings, and anxiety to decrease angst.

i. Objective: The client will engage in journal writing each night to identify

at least 5 “problem” events and thoughts each day, writing one response to
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each, reconstructing the meaning of these events that contribute to the

desired direction of their life.

c. Increase awareness of aloneness and relatedness to decrease anxiety about loss of

relationships.

i. Objective: The client will spend time alone 1 full day per week and write 1

thing that they learned about themselves during this time. They will then

be actively aware of this 1 item when interacting with others.

ii. Objective: client will examine meaning that exists in current relationships

and start evaluating whether she should keep them based on her values.

d. Increase awareness of death as a positive force.

i. Objective: The client will write each thought they have about death at

night in their nightly journal before sleeping. They will begin to actively

conceptualize death as a source of zest for life and creativity (Corey, 2017)

by writing this down every night.

e. Interventions

i. Therapist will challenge the client to assume responsibility for designing

their present life (Schneider & Krug, 2010).

ii. The therapist will encourage experimentation of alternative ways of being

outside of sessions that contribute to the client’s self-concept.

iii. Therapist will promote the rediscovery of meaning by remaining an

authentic presence, by invoking the actual and attending to the clients

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immediately felt experience, and by vivifying and confronting resistance

(Schneider, 2011).

iv. Therapist will talk directly to the client about the reality of death,

encouraging the client to explore the concept of morality.

5. Closing Phase Therapeutic Tasks

a. Implementing examined and internalized values in a concrete way outside of

sessions.

b. Discover strengths and use them in a way that contributes to a purposeful

existence.

6. Closing Phase Client Goals

a. Increase implementation of learned skills and values to increase responsibility

i. Objective: The client will write at least one way they were able to work

towards personal clarity each day, and will write at least two ways they

implemented their newly-found values each week.

b. Interventions

i. Therapist will encourage client to choose more expanded ways of being in

their daily life and becoming the “hero” of her own life (Corey, 2017;

Schneider & Krug, 2010).

Cognitive Behavioral Theory

Vignette

Loren is a young woman, age 26, who has episodes of bingeing and then withholding

from food entirely. During this time, Loren says that she feels guilty so she engages in working
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out excessively to cope, stating that she has to “burn off all the calories.” Loren says that she was

“hefty” as a child, and oftentimes got made fun of. This hurt her feelings, and then after moving

to a new town with kids who didn’t look like her, she decided to go on an extreme diet at the age

of 12. Throughout high school and college, Loren gained weight and often starved herself to lose

weight, fluctuating between very thin and “healthy” looking. Loren also took diet pills and

excessively worked out, sometimes without eating, to achieve the physique that was “better” in

her eyes. Today, Loren says that she still struggles with her body image, never “feeling good

enough” and is afraid to eat at times. She currently engages in intermittent bingeing behavior

after her episodes of withholding from food for a period of time. She also uses exercise as a way

to cope and gain control over her body and mind.

Case Conceptualization

Loren is a 26 year old female who has struggled with body image issues for 14 years. She

has been able to positively cope with this by exercise and self-help books and displays

willingness to change. Loren identifies as a Black woman and is in good physical health and has

been a vegetarian for two and a half years now. Loren’s family was critical of her body image as

a young girl, but is now accepting of Loren, with no knowledge of the restrictive eating

behaviors. They are supportive of Loren and her endeavors in work and school.

Loren grew up in Los Angeles in a middle class SES and moved to Santa Clarita at the

age of 10 to an affluent white neighborhood. Loren experienced occasional bullying and felt like

an outsider during her years in elementary school because of her weight and ethnicity. In middle

school, Loren decided to go on a diet at the age of 12 and lose a significant amount of weight to

which she received praise from her peers and family members.
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Loren has an automatic thought that she must be “thin” to be accepted in response to

being around others. Because Loren was bullied and reprimanded as a child for being overweight

by both peers and family members, she overgeneralizes by believing that everyone will hold a

negative view toward her if she gains weight. Loren portrays her identity on the basis of her

imperfections and engages in labeling by telling herself that if she does not live up to her

expectations of what she should look like, she is mediocre. Loren scrutinizes parts of her body,

comparing herself to thin and attractive people on social media, leading her to draw the

conclusion that she is unattractive if she doesn’t look that way (Murphy, Straebler, Cooper,

Fairburn, 2010).

There are basic “musts” or irrational beliefs that we internalize that inevitably lead to

self-defeat (Ellis & Dryden, 2007). Loren is reinforcing an early-indoctrinated irrational belief

and internal dialogue that she must “look good” to be accepted and is behaving in ways that are

consistent with this belief. She also “must” do well to win the approval of others, or else she is

no good. When Loren doesn’t feel thin or “good enough” she engages in a self-repetitive

behavior of bingeing, restricted eating, and excessive exercise. The activating event of a bingeing

episode results in the belief, “I will be too fat.” Consequently, Loren feels guilty and engages in

restrictive eating behavior and excessive exercise.

The therapist functions as a teacher and active participant, collaborating with a client on

homework assignments and in teaching strategies for straight thinking; the client is a learner who

practices these new skills in everyday life. The practitioner is also open and direct in disclosing

their own beliefs and values. It is important to establish an egalitarian relationship as opposed to

presenting as a non disclosing authority figure (Wolfe, 2007). Additionally, Therapists are
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encouraged to be creative and flexible in their methods, tailoring techniques to the needs of each

client (Dryden, 2007).

Treatment Plan

1. Initial Phase Therapeutic Tasks

a. Assess individual, systematic, and cultural dynamics.

b. Develop collaborative working alliance with the client in order to target the

problem.

c. Educate client on the importance of examining automatic thoughts and self-talk.

d. Help the client restructure thought schemas that enable her to view problems in a

new light.

2. Initial Phase Client Goals

a. Loren will self-monitor her thoughts and learn to reframe and understand her

thoughts of inadequacy as cognitive distortions.

i. Objective: Loren will keep a journal and each day record each negative

thought and consequential feeling that arises. She will then label and

identify the cognitive distortion associated.

b. Loren will change her internal dialogue to be one one of self-acceptance.

i. Objective: When Loren starts to feel unaccepted, she will tell herself,

“Opinions of others don’t matter. I am still a wonderful person, and I

accept myself as I am.”

c. Interventions
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i. Therapist will administer cognitive, behavioral, and interpersonal

assessments.

ii. Therapist will assist client in identifying and evaluating automatic

thoughts, intermediate beliefs, and core beliefs.

3. Working Phase Therapeutic Tasks

a. Clarify specific problems and critically evaluate faulty thinking.

b. Identify maladaptive behaviors and introduce adaptive behavioral alternatives.

4. Working Phase Client Goals

a. Decrease occurrence of binging behavior by having the client plan meals

i. OBJECTIVE: The client will go 80% of the time without bingeing

behavior per week by planning 3 meals and 2 snacks throughout each day.

b. Decrease perfectionism to decrease dietary restraint, exercise, and shape checking

i. Objective: Client will be aware of perfectionist judgements, writing down

other areas of non-performance related strengths and a list of 10 positive

qualities of herself.

c. Interventions

i. Therapist will educate the client on perfectionism and how this intensifies

maladaptive thoughts and behaviors.

ii. Therapist will dispute the three basic “musts,” negative cognitive triad,

and related core schemas.

iii. Therapist will help the client identify triggers or activating events to

certain beliefs and actions.

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5. Closing Phase Therapeutic Tasks A

a. Introduce cognitive and behavioral techniques to help client make the changes she

desires.

b. Interrupt downward maladaptive thinking, feeling and behaving, while teaching

more adaptive ways of coping.

c. Implementing new adaptive thoughts learned in therapy and assessing outcomes.

6. Closing Phase Client Goals

a. Increase overall positive self-talk about self-worth and expectations from self to

reduce anxiety and feelings of inadequacy.

i. Objective: Loren will identify, evaluate, and respond to dysfunctional

beliefs and replace them with self-identified positive self-talk.

b. Increase awareness of ongoing beliefs and automatic thinking outside of therapy.

i. Objective: Loren will view her basic beliefs and automatic thoughts as

hypotheses to be tested and become her own personal scientist by writing

them down and detecting, debating, and discriminating against them.

c. Interventions

i. Socratic dialogue to help the client develop positive view of self and life.

ii. The therapist will use cognitive restructuring and behavioral experiments

to help patients to reach a more balanced view of their self-worth.

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References

Corey, G. (2017). Theory and practice of counseling and psychotherapy. Boston, MA: Cengage

Learning.

Dryden, W. (2007). Rational emotive behaviour therapy. In Dryden's handbook of individual

therapy (5th ed., pp. 352-378). London: Sage

Ellis, A., & Dryden, W. (2007). The practice of rational-emotive therapy (2nd ed.). New York:

Springer.

Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for

eating disorders. The Psychiatric clinics of North America, 33(3), 611–627.

doi:10.1016/j.psc.2010.04.004

Schneider, K.J. (2011). Existential-humanistic psychotherapies. In S. B. Messer & A. S. Gurman,

(Eds.), Essential psychotherapies: Theory and practice (3rd ed. Pp. 261-294). New York:

Guilford Press.

Shumaker, D. (2011). An Existential–Integrative Treatment of Anxious and Depressed

Adolescents. Journal of Humanistic Psychology, 52(4), 375–400. doi:

10.1177/0022167811422947

Schneider, K. J., & Krug, O. T. (2010). Existential-humanistic therapy. Washington, DC:

American Psychological Association.

Wolfe, J.L. (2007). Rational emotive behavior therapy (RBET). In A. B. Rochlen (Ed.), applying

counseling theories: An online case-based approach (177-191). Upper Saddle River, NJ:

Pearson Prentice-Hall.
EXISTENTIAL THERAPY AND COGNITIVE BEHAVIORAL THERAPY
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Yalom, I. D., & Josselson, R. (2011). Existential psychotherapy. In R. Corsini & D. Wedding

(Eds.), Current psychotherapies (9th ed., pp. 310-341). Belmont, CA: Brooks/Cole,

Cengage Learning.