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JHPXXX10.1177/0022167820931987Journal of Humanistic PsychologyIn additional to developing the necessary knowledge and skills, therapists wanting to expand their services to help clients affected by pandemics and disasters will need to learn how to market their services in times of crisis or network with individuals that work directly with disaster response
for referrals. This can come in various forms. With most disasters, it is ideal to begin with face-to-face crisis services as quickly after the disaster as possible (<xref ref-type="bibr" rid="bibr26-0022167820931987">Ruzek, 2006</xref>). For therapists who provide these services, they may not be able to offer continuity of care, especially if their practice location is not close to the disaster location. It is important to address these limitations
upfront with clients. Telepsychology is one option for providing continuity of care. In situations where there are insufficient mental health resources at the location, Telepsychology may be an option for supplementing face-to-face services, particularly for individuals not in active crisis. Triaging can help assure that individuals experiencing a mental health crisis are directed to face-to-face services, while guiding individuals in less distress to
other options, such as Telepsychology. In the situation of a pandemic or disaster in a remote area, Telepsychology may be the only option for many individuals, even if less than ideal.Hoffman
research-article2020
Article
Journal of Humanistic Psychology
Existential–Humanistic
1–22
© The Author(s) 2020
Louis Hoffman1
Abstract
The COVID-19 pandemic has dramatically affected the mental health field.
The unique distress caused by the pandemic along with the need for many to
transition their therapy practices to TeleHealth/Telepsychology modalities
caught many therapists, including existential–humanistic therapists,
unprepared to make the necessary adjustments to treat clients in a manner
that is safe and effective. Existential–humanistic therapy often is neglected
with trauma and disaster relief work, despite its relevancy and important
contributions. All therapies must adjust in crisis situations, particularly when
adjustments to how services are offered are disrupted; however, the impact
of these changes varies by therapeutic orientation. As an approach that
values genuineness, empathy, and presence, existential–humanistic therapy
faces unique challenges when employed with disaster response. However,
when these challenges are faced, existential–humanistic therapy has much to
offer disaster response, including consideration of existential guilt, existential
shattering, existential anxiety, and existential perspectives on self-care.
Keywords
disaster response, trauma, existential–humanistic therapy, existential–
integrative therapy, COVID-19
1
Rocky Mountain Humanistic Counseling and Psychological Association, Colorado Springs,
CO, USA
Corresponding Author:
Louis Hoffman, Rocky Mountain Humanistic Counseling and Psychological Association, 655
Southpointe Court, Suite 200, Colorado Springs, CO 80906, USA.
Email: lhoffman@rmhcpa.org
2 Journal of Humanistic Psychology 00(0)
has a bright light behind them, it may be difficult to clearly see the client’s
nonverbals. If the client or therapist do not have good quality cameras,
microphones, and speakers, this, too, can limit the ability to clearly com-
municate, particularly some of subtleties that are important for existential–
humanistic therapy.
After several years of practicing Telepsychology on a limited basis, my
professional opinion is that Telepsychology is not ideal for existential–
humanistic therapy. However, I also believe that it has its place. In addition to
use during pandemics and crisis situations, Telepsychology can be useful for
clients who may have physical issues preventing them from traveling, clients
who move but would benefit from continuity of care, and clients who live in
remote areas with limited access to therapy services. As there are many areas
where there are no existential–humanistic therapists, it also provides access
to this type of therapy for many individuals who otherwise may not be able to
seek out existential–humanistic therapy.
Short-Term Strategies
The immediate response to crisis situations necessitates short-term interven-
tions, which many existential–humanistic therapists are averse to relying on.
However, it is possible to implement these in a manner that is consistent with
the depth psychology framework of existential–humanistic therapy (see
Schneider, 2008a). The primary objection to many short-term interventions
and techniques is that they focus on the symptoms and quick fixes rather than
engaging the deeper being-level issues, such as learning to stay with one’s
emotions, becoming curious about one’s emotions, and listening to the mes-
sage of these emotions. However, clients who are overwhelmed by a crisis or
trauma often cannot go into the deeper clinical work without some resources
that provide confidence in one’s ability to manage emotions they perceive as
overpowering.
It is important to distinguish between short-term interventions as an end to
therapy versus short-term interventions as part of deeper work. While manag-
ing emotions and other symptoms is the goal of some approaches to therapy,
in an existential–humanistic or existential–integrative framework, this is a
starting point (Wolfe, 2008). Short-term interventions tend to focus on coping
and skill development. While coping is necessary with many forms of psy-
chological distress, to simply learn to cope falls short of the full potential of
existential–humanistic therapy. When short-term interventions are imple-
mented in the context of what Serlin et al. (2019) refer to as a whole-person
approach, they become consistent with an existential–humanistic approach.
There are a variety of strategies we can discuss to help you cope with the
intense emotions. In some approaches to therapy, learning these skills is the
primary focus of therapy. I tend to approach this differently. Learning to
manage and cope with strong emotions can help you gain a sense of control
over them. As you become more confident in your ability to control your
emotions, it becomes easier to be curious about what these emotions may be
telling you and seek out deeper levels of change that address underlying issues.
It is always up to you as to whether you want to focus on managing and coping
with your emotions, or whether you want to continue working with deeper
emotions and possible underlying challenges after you are more confident in
your ability to manage your emotions.
8 Journal of Humanistic Psychology 00(0)
emphasizing that each person is unique and may respond differently (see
Figley, 2019). The emphasis on the varied individual responses is important
to avoid pathologizing clients for “not grieving right” or “not recovering
right.” It also may serve to help clients begin recognizing choices and options
of which they may not have been aware.
Connecting disaster victims with relational support is critical. Stolorow
and Atwood (1992) note,
Although Stolorow and Atwood are focusing on children in this quote, this is
applicable to adults as well with some adaptations given the additional psy-
chological resources most adults have. Trauma is always best understood in a
relational context and how it develops within the person is necessarily influ-
enced by the interpersonal context during and after the traumatic event. The
relational context and resources influence whether a potentially traumatic
event manifests with long-term traumatic consequences (Shallcross et al.,
2016; Sharp et al., 2017). While the therapist may be an important aspect of
the relational context, their interaction with the individual is more focused
even in the context of ongoing therapy. It is important for the client to connect
with other relational support beyond the therapist.
Short-Term Strategies and COVID-19. Many therapists felt unprepared for the
necessary transitions to keep clients and therapists safe in the midst of the
COVID-19 pandemic. COVID-19 demonstrated that it is important for all
therapists to be prepared to adjust their practice in case of pandemics or
other disasters that may disrupt usual practice. In consideration of pandem-
ics such as COVID-19, it is important that therapists begin by assessing the
current challenges clients are facing in all their complexities. For example,
clients may be dealing with multiple issues, including direct impact of the
virus (i.e., contracting the virus or having friends or family who have con-
tracted the virus), fears of contracting the virus, school or employment dis-
ruptions, financial distress, feelings of isolation, and feelings of existential
guilt. There may be implications at the individual and communal levels as
well (Olweean, 2019). When interaction time is limited, therapists must be
aware of common issues to quickly assess the client’s sources of distress
and current needs.
Hoffman 11
Long-Term Strategies
For many disaster situations, the recovery process takes many months or
years. The word recovery can even be seen as suspect in this context. If
recovery is taken to mean being fully restored to the state of existence prior
to the disaster, then this is an inappropriate term. It even can be harmful as it
creates unrealistic expectations and neglects the valuable lessons that can be
learned from the tragedy. Instead, I am using recovery to mean transitioning
to a new state in which most aspects of well-being have been restored, even
if looking and feeling different than the predisaster state. Furthermore, recov-
ery can be understood as inclusive of integrating new knowledge and wisdom
resulting from honestly facing and working through the crisis situation,
which could be viewed as posttraumatic growth.
The aftermath of COVID-19 will leave a tremendous impact on the lives
of many people for years to come. Sadly, it is likely that the most vulnerable
will experience the most sustained negative impacts. There will be a long
period of recovery at the individual, social, and cultural levels. It is important
for therapists to be aware of the layers of impact that may influence clients.
Existential–humanistic therapy is well suited for the postcrisis work with
clients who have experienced disaster situations or pandemics. There are
trauma models, such as whole-person approaches to integrated care, that
have strong roots in existential and humanistic psychology (Serlin et al.,
2019). Existential therapists tend to be attuned to the tragic elements of
human existence and open to exploring these within the therapy context. The
influence of Frankl’s (1984) experience in the concentration camps on his
therapeutic approach is just one of many examples. In this section, I address
a few concepts from existential psychology that are particularly relevant to
disaster response.
12 Journal of Humanistic Psychology 00(0)
This form of existential guilt calls all people toward social responsibility to
others, even though the person may not have control over the outcome. This
guilt, too, may be connected with complacency or inaction in the face of harm
or evil, or the participation in a system in which harms are being perpetuated
without recognizing what one ought to recognize or voice concern about what
one recognizes but may not be able to change.
This form of existential guilt can be closely connected with survivor guilt. As
people reflect on what they did or did not do after the crisis has passed, guilt
may become more prominent. This guilt is rooted in human finitude—the
limitations that are part of being human.
The helplessness faced by many in the midst of a crisis or pandemic can
easily become existential guilt. One may feel they can never do enough.
Many who minimized COVID-19 or claimed it to be an overreaction or a
hoax may experience guilt as the impact of the virus becomes more evident.
Individuals who worry that they may have inadvertently passed the virus to
others or believe that they did not do enough to prevent spreading the virus
similarly may experience existential guilt. This guilt emerges from believing
that one did not do enough to help those who are suffering or through recog-
nition that their privilege protected them while others without that same priv-
ilege suffered greater than they did.
Existential guilt easily becomes neurotic if not faced, but when individu-
als directly face their existential guilt it can become productive (Hoffman,
2018). Existential–humanistic therapists help clients compassionately
explore their choices and actions during the time of crisis. When engaging
in this process, clients may recognize their moral or other failures. As this
Hoffman 13
on the person of the therapist. As the person of the therapist is a central aspect
of existential–humanistic therapy, this is even more vital within this approach.
Clarifying the impact of Telepsychology is important to recognize the unique
self-care needs not being met through other forms of self-care.
These can be healing for both the therapist and the client, particularly
when combined with a belief in the power of the therapy process. Belief in
the healing potential of therapy helps empower therapy through the hope
that on the other side of the suffering is something better. Suffering, then,
is no longer mere suffering, but suffering for a purpose and suffering with
potential.
Yet boundaries remain necessary for balance. Therapists need different
types of restoration, including more active and restful forms of self-care.
Setting appropriate boundaries can be a way of affirming another source of
meaning: the value of oneself. For me, the deepest meaning in life is rooted
in compassionately serving others. Yet, I also recognize that when I am over-
worked my compassion and empathy for others can become depleted, which
leads to compassion fatigue (Pardess, 2019). Compassion fatigue negatively
affects the restorative qualities of relationships, including relationships with
clients. If we do not take care of ourselves, the therapy services we offer will
be negatively affected.
more pleasurable or less stressful activities. While, at times, these may not
be as deep of relationships, they serve an important purpose in helping dis-
engage from the stressful work environment and possible rumination about
the related challenges.
Conclusion
While COVID-19 is undoubtedly a tragedy, it is a tragedy that can be
learned from as a field and society so that we are better prepared for
future pandemics, should they occur. While existential–humanistic ther-
apy is often neglected in disaster response, it has much to offer in these
contexts. It is important for existential–humanistic therapists to be pre-
pared to adapt their therapeutic approaches to meet the needs of the many
who are suffering in times of crisis, which may include being prepared for
the use of Telepsychology. As illustrated in this article, this can be done
in a manner that stays true to the foundations and values of existential–
humanistic therapy.
Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.
ORCID iD
Louis Hoffman https://orcid.org/0000-0002-4288-0072
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Author Biography
Louis Hoffman, PhD, is psychologist in private
practice in Colorado Springs, Colorado. He is
the executive director of the Rocky Mountain
Humanistic Counseling and Psychological
Association and assistant director of the IIEHP.
An avid writer, he has published 17 books,
including Humanistic Approaches to
Multiculturalism and Diversity and Existential
Psychology East-West (Volumes 1 & 2) as well
as over 100 journal articles and book chapters.
He teaches at the University of Denver, the
University of Colorado, Colorado Springs, and
Saybrook. In addition to his university teaching, he is an affiliate instructor with the
Existential-Humanistic Institute and regularly provides training and supervision in
China through the IIEHP.