What is distinctive about the Existential approach to working with addiction? Discuss.

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What is distinctive about the Existential approach to working with addiction? Discuss.

 First of all, what is Addiction? There is a struggle around the concept of addiction and what constitutes addiction.  One important perspective views addictive behaviours as a dysfunctional solution to a developmental wound while other theorists see it to be an entity of itself with its own meaning (Baker, 1996). Addiction has been defined as the continuing, habitual and merciless nature that motivates a particular behaviour despite physical and psychological harm to the abuser or society (Baker, 1996). Over 50 years ago, Horney (1950, cited in Baker, 1996) astutely described addiction as a ‘Comprehensive neurotic solution…a solution not only for a particular conflict but one that implicitly promises to satisfy all the inner needs that have arisen in an individual…it promises not only a riddance from his painful and unbearable feelings of being lost, anxious, inferior and divided, but in addition an ultimately mysterious fulfilment of himself and his life…no wonder that…it becomes compulsive.” A phenomenological definition by Black (1991) is that addiction ‘involves sensation, that to begin with, are immediate, brief pleasant and repetitive, without producing satiation. Repetition leads to habituation with an accompanying loss, or reduction, of pleasurable sensations, and stopping is an aversive experience; but any discomfort may be relieved by further repetition of the addictive behaviour’. There are many kinds of addictive behaviours often presented and worked on in therapy. Some themes have involved: substance abuse, sex and pornography, the internet, eating disorders and gambling but even ordinary functional behaviours, such as shopping, have also been presented to be a problem for some clients (Baker, 1996).  

Addiction has been controversially categorised as an inherited disease, a choice, as well as a maladaptive behaviour due to environment. Specifically, this disease concept suggests that biological vulnerability and psychosocial behaviours contribute to addiction. This has proved effective convincing clients, who doubted their abilities to change, of the seriousness of their addictions but unfortunately, also gives the message that they are victims of their disease and powerless to change their behaviour (Ford, 1996).  This concept challenges the entire core dimensions of Existentialism and in this essay, the main argument addressed is that of the distinction in Existential therapy when dealing with addictions. Existential therapy confronts the misinterpreted disease concept, which suggests an addict is ‘powerless victim’ of the disease of addiction (Ford, 1996). While Existentialists accept the importance of inherited and environmental influences on a person, a clear distinction is made that addiction is a matter of choice rather than part of the disease concept (Black, 1991).

Existentialism is an eclectic approach of applied philosophy used in psychotherapy that prides itself on a positive view of human nature, where the self is in a constant state of ‘transition…and becoming’ (Pesciallo, 2000). Existential therapy (and it’s counterpart, Logotherapy, which will not be discussed in this essay but has been used effectively in the treatment of drug addiction since 1966), is a phenomenological and person-orientated approach aiming to promote clients to make emotionally free experiences, authentic decisions and to bring about responsible ways of dealing with life-on life’s terms (Langle, 1994; Durzen-Smith, 1996). Existentialists focus on a higher level of well being for the client, rather than diminishing pathology and see not the content of what is said between counsellor and client but the process of the therapeutic encounter the most critical component in therapy (Waldo, 1998).

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Insight and self-awareness are of value to an individual, in and out of therapy, with an emphasis put on responsibility and the freedom to choose one’s own fate (Pesciallo, 2000). Existentialists see this choice as a never-ending freedom for action and responsibility in an individual’s life; that a person is defined through their choices regardless of past or present experience. Furthermore, the autonomous self is defined upon the continuing requirement of having to make choices, and of accepting the consequences that those choices have on themselves and others (Black, 1991). This is best summed up from the words of Sartre, ...

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