Transformed everyday: How my training in an acute inpatient unit has
made me a better existential therapist
Abstract
This presentation demonstrates how training in acute psychiatric
units has promoted my development as existential therapist.
Different aspects of time-limited inpatient work can enhance
existential orientation. I will address the meaning of my growth,
relevance of existential approach to an acute inpatient
population, appreciation for my clients, and limitations in applying
my training experience to other settings.
Introduction
I spent 90% of my predoctoral training and 20% of my
postdoctoral training on acute psychiatric units.
Initially, I was concerned how I could be helpful to inpatient
clients in 1-2 sessions working from existential orientation.
I overlooked the fact that my clients would affect me as well.
Soon I realized I was growing due to my interactions with
them while providing therapeutic interventions (Rnnestad,
Rnnestad, & Skovholt, 2003; Rbu, Moltu, Binder, &
McLeod, 2016) .
Background
Major components pertinent to my pre- and postdoctoral
training in acute psychiatric units
a. Involuntary clients being in crisis, often suffering suicidality or
psychosis
Most individuals were hospitalized for 96 hours due to being a
danger to themselves and/or others.
Clients reportedly opened up about their emotional pain for the
first time.
b. Evaluation and stabilization as goals of multidisciplinary care
Differential diagnosis, conceptualization, and referrals for
outpatient services following stabilization were among the
objectives for acute inpatient treatment.
There was no anticipation that psychotherapy would remove
disorders during the brief stay.
TEMPLATE DESIGN 2008
www.PosterPresentations.com
Sooin Lee, Psy.D.
slee@freemanhealth.com
Ozark Center/Freeman Health System, Joplin, MO
Background
Major components pertinent to my pre- and postdoctoral
training in acute psychiatric units
c. One or two individual sessions during a 96-hour hold
Only some clients, not all, were seen for individual
psychotherapy upon their requests or doctors orders.
The length of each session varied.
d. Daily group therapy for support and psychoeducation
Individuals were encouraged to attend daily group sessions.
Group treatment was transdiagnostic and run for an hour.
e. In general, less expectation to fix clients
I felt less pressured to bring immediate outcomes.
The overall focus was to understand each individuals current
crisis.
My Growth
I have grown as existential therapist by becoming more:
a. Attentive to clients immediate experience in session
As most individuals stayed on the units for a brief period of time,
I became more interested in each persons immediate experience
during a session.
Being time-limited, our interactions were oriented toward what
was the most relevant here and now (Lamont, 2012).
b. Focused on understanding rather than treating from an
unknowing stance
With the purpose of inpatient care providing proper diagnoses, I
was allowed to spend more time exploring clients chief
complaint in their life context than intervening.
Many clients appreciated being heard and feeling validated
when I relied on more a relational way of knowing (Josselson &
Mattila, 2012).
My Grouth
I have grown as existential therapist by becoming more:
c. Appreciative of symptoms as part of ones lived experience
While many individuals presented their crisis as perplexing or
tiring, I reflected ones internal conflict could be something worth
exploring (Spinelli, 2007; Yalom 1980).
I knew it was not my job or within my abilities to alleviate
someones emotional pain in 1-2 sessions.
Several clients reported becoming more receptive to their own
experience after the session.
d. Attuned to existential concerns underlying the individuals
presentation
As people made more sense of their symptoms in the context
of their life, our dialogues often revealed ultimate concerns.
It seemed that individuals in acute crisis were relatively more
candid or even brave about their existential predicaments, likely
with their defense lowered (Yalom 1980).
Death, meaninglessness, uncertainty, dread, and choice were
among the most discussed subjects in both individual and group
sessions.
encountered existential approach during their stay on the units.
e. Connected with clients as a fellow human being, not as an
expert
By relating to the clients existential realities, I was better able to
connect as another human being.
Often during a group session, my attempts to humanize each
participants subjective experience subsequently increased group
cohesiveness and a sense of relief.
The continuum of human experiences joined all of us as
suffering together (Heriot-Maitland, Vidal, Ball & Irons, 2014;
Josselson & Mattila, 2012).
Conclusion
a. Appreciation for acute inpatient clients and my experience
with them
I acknowledge I have matured as existential therapist thanks
to my clients who were willing to work with me in the midst of
their suffering (Rbu et al., 2016).
b. Openness to the unexpected opportunities to grow personally
and professionally
It was a gift that I had never thought of. As a result, I learned
to remain more open to various life experiences.
c. Courage to unfold with clients
It takes courage to transform, and I am more than willing to
with my clients.
Limitations
a. Particular state of acute inpatient clients not generalized to
those in other settings
Individuals were placed in a structured, therapeutic environment
for their acute crisis. People seemed to feel safe enough to
share while feeling vulnerable.
b. Lack of formal data on how clients experienced existential
therapy on the units
This presentation is mostly based on my personal experience.
Further research will need to investigate how clients
References
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Rbu, M., Moltu, C., Binder, P.-E., & McLeod, J. (2016). How does practicing psychotherapy affect
the personal life of the therapist? A qualitative inquiry of senior therapists experiences.
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