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An Existential Framework for Understanding the Counseling Needs of Clients

Contact author: Cindy S. Spillers, Dept. of Communication Science and Disorders, 221 Bohannon Hall, 1207 Ordean Court, University of Minnesota Duluth, Duluth, MN 55812. E-mail: cspiller{at}d.umn.edu.

Purpose: To offer an existential framework for understanding some of the emotional and grieving issues that can accompany communication disorders.

Method: A narrative review of selected existential psychology literature is provided. I. Yalom's (1980, 1986) model is used as a foundation to explore the 4 existential issues of death, freedom/responsibility, loneliness, and meaninglessness. This model is then applied to communication disorders based on the work of D. Luterman (1984, 2001). These 4 existential issues are juxtaposed with K. Moses' (1989) model of the grief response, which includes denial, anxiety, fear, depression, anger, and guilt. Suggestions for responding within one's scope of practice are provided.

Conclusion: Combined, existential and grieving models can offer clinicians new insight into clients' loss resolution work. This inner work constitutes a spiritual journey that may parallel the journey through therapy and rehabilitation. The case is made that attending to these issues can enhance long-term outcomes of treatment.

Key Words: counseling, grieving, existentialism, clinical issues