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Existential Factors and the Understanding and Treatment of

Disordered Gamblers

“If a way to the Better there be, it exacts a full look at the Worst”

Thomas Hardy

Charles D. Maurer, PhD

National Conference on Problem Gambling Seattle, WA

July 19 , 2013

Talking Points

• Core theme

• Existential Context

• Application to gambling and the gambler

• Integration within the psychotherapy of the problem gambler

• Specific existential strategies and case examples

Roots of Existential Psychotherapy

• Martin Heidegger, Edmund Husserl, Jean-Paul Sartre (discovery of one’s emerging self in totality)

• Victor Frankl (striving for meaning)

• Ludwig Binswanger (existential analysis)

• Fritz Perls (emphasis on here and now responsiveness w/in Gestalt context)

• Rollo May (Rx is assistance in self exploration in positive contexts)

Phenomenology

• Descriptive Method: (Lebenswelt) an effort to apprehend our surrounding world of immediate experience by observation and description

• Emphasis on Subjectivity: we live in a world of choice, value, action and responsibility

Core theme – The Essential Spices

Discussion of existential themes and how they may apply to a person’s progression into problematic gambling and how these themes, if addressed, can enhance treatment, recovery and life adaptation.

These themes are universal and treatment professionals, as well as our clients, often avoid taking them into consideration.

Existential Context

• Irvin Yalom, MD Existential Psychotherapy, Basic Books, 1980 and the “ultimate concerns of life”

– Death and mortality

– Freedom and responsibility

– Isolation and aloneness

– Meaning

Workshop Work Sheet

• Associations to:

– Exist

– Existential

– Being alone

– Death

– Freedom

– Meaning

Death and Mortality

• Basic Postulates:

– Life and Death are interdependent and sources of anxiety and distress that is both neurotic and normal

– An understanding of our mortality can enhance our life experience

– Therapeutic foothold: desensitization with repeated exposure and life inspection

Freedom and Responsibility

• Freedom, groundlessness and anxiety

• Avoidance strategies

– Play, distraction, diversion, displacement and denial

– The Devil made me do it

• Responsibility and existential guilt: “to know and not act is not to know at all” (Japanese proverb)

• Responsibility awareness, authorship and authenticity. From wanting/wishing to doing

Isolation and Aloneness

• Interpersonal – loneliness • Intrapersonal – self fragmentation and

dissociation • Existential- separation from self and any other

being in the world • Fear of existential isolation can lead to

dysfunctional relationships with self and others • Therapeutic task – “no matter how close I get to

others and they to me, I must still face life alone” • If you are never solitary you are never spiritual

Meaning and Value

• What is the meaning – Of life?

– Of my life?

• Why do we live, why are we here, what do we live for, what shall we live by?

• Humans strive for meaning and closure – the Zeigarnick Effect

• Meaning refers to sense and coherence

• Purpose to intention, aim and function

Existential Issues and Problem Gambling

• Life involves reality, pain, anxiety, aloneness, loss, responsibility

• We all need distractions but not dependencies

• Gambling is a powerful way of avoiding life pain and for the problem gambler that paradoxically leads to more pain and suffering

• We tend to resist approaching these issues

• Treatment facilitates approach, awareness, acceptance and understanding

Integration within treatment

• We must accept where the person is; Custer’s admonishment

• The timing of introducing existential themes is critical and must be gentle

• We facilitate the shift from avoidance to approach

• Early treatment dropout may reflect a too rapid approach

Specific Existential Strategies

• Loss, grief and bereavement – Worden’s (1996) model

– Acceptance of the reality of the loss

– Experiencing the pain/emotional aspects of the loss

– Adjusting to an environment in which the loss is missing

– Relocating the loss within one’s life and finding ways to memorialize the loss

Specific Existential Strategies

• Development of an approach to responsibility and work – the financial work, the relationship work

• Approaching aloneness – forced freedom from distraction (e.g., Kalaloch) with a focus on journaling “where am I with my self right now?”

• The Medicine Wheel - Life in balance; harmony and connection

Medicine Wheel

Values in the Therapeutic Process

• Is it important for the therapist to know and understand their own and their client’s values?

• What can happen if there are significant differences in values?

• Are there ethical and standards of practice at play?

Values a la Rokeach

• Google “Rokeach Human Values Survey” and go to the hit “Summit Counseling”

• Terminal Values

• Instrumental Values

Rokeach Values Survey - Terminal

A Comfortable Lifea prosperous life

(T)

Social Recognitionrespect and admiration

(T)

Equalitybrotherhood and equal

opportunity for all (T)

True Friendshipclose companionship

(T)

An Exciting Lifea stimulating, active life

(T)

Wisdoma mature understanding of

life (T)

Family Securitytaking care of loved ones

(T)

A World at Peacea world free of war and

conflict (T)

Freedomindependence and free

choice (T)

A World of Beautybeauty of nature and the

arts (T)

Healthphysical and mental well-

being (T)

Pleasurean enjoyable, leisurely life

(T)

Inner Harmonyfreedom from inner conflict

(T)

Salvationsaved; eternal life (T)

Mature Lovesexual and spiritual

intimacy (T)

Self-Respectself-esteem

(T)

National Securityprotection from attack

(T)

A Sense of Accomplishment

a lasting contribution (T)

Page 2

Rokeach Value Survey – Instrumental Values

Ambitioushardworking and aspiring

(I)

Independentself-reliant; self-sufficient

(I)

Broad-mindedopen-minded

(I)

Intellectualintelligent and reflective

(I)

Capablecompetent, effective

(I)

Logicalconsistent; rational

(I)

Cleanneat and tidy

(I)

Lovingaffectionate and tender

(I)

Courageousstanding up for your beliefs

(I)

Loyalfaithful to friends or the

group (I)

Forgivingwilling to pardon others

(I)

Obedientdutiful; respectful

(I)

Helpfulworking for the welfare of

others (I)

Politecourteous and well-

mannered (I)

Honestsincere and truthful

(I)

Responsibledependable and reliable

(I)

Imaginativedaring and creative

(I)

Self-controlledrestrained; self-disciplined

(I)

Page 3

2012 Workshop Results: Top Five Rankings by 18 Therapists

• Terminal Instrumental

- Wisdom - Helpful

- Health - Honest

- Family Security - Loving

- Friendship - Responsible

- Capable - Self Respect

2012 Workshop Results – Bottom Five Rankings by 18 Therapists

Terminal Instrumental

– World of Beauty - Obedient

– World of Peace - Clean

– National Security - Polite

– Social Recognition - Self-Controlled

– Equality - Imaginative

Thank you for your attention and curiosity.

Comments or questions:

[email protected]