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Existential Issues in Trauma: Implications for Assessment and Treatment

Conference Paper · August 2013

DOI: 10.13140/RG.2.1.5166.2881

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Louis Hoffman Heatherlyn Patrona Hoffman

Rocky Mountain Humanistic Counseling and Psychological Association University of Colorado Colorado Springs
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Saybrook University
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Existential  Issues  in  Trauma:  
Implications  for  Assessment  and  Treatment  
 
Louis  Hoffman,  PhD   Heatherlyn  P.  Cleare-­‐
Saybrook  University   Hoffman,  PsyD  
San  Francisco,  CA   Argosy  University,    
  San  Francisco  Bay  Area    
 
Lisa  Vallejos,  MA  
Saybrook  University  
San  Francisco,  CA  
 
 
Trauma,   by   its   nature,   is   existential   through   its   impact   on   the   manner   in  
which   the   individual   experiences   the   world,   their   self-­‐understanding,   and  
their  sense  of  place  in  the  world.  Despite  the  recent  proliferation  of  trauma  
literature,   it   remains   common   for   trauma   to   be   oversimplified   in   its  
conception   and   treatment.   In   particular,   much   of   the   treatment   focuses   on  
categorizing   trauma   into   the   diagnoses   of   posttraumatic   stress   disorder  
(PTSD)   or   adjustment   disorder,   and   then   treating   the   symptoms   through  
medication   and/or   a   behavioral   conception   of   the   symptoms.   It   is   vital   that  
we   move   to   a   more   nuanced   understanding   of   trauma.   Trauma   comes   in  
many  genres  and  various  degrees  of  severity.  This  is  further  complicated  in  
that   it   will   have   different   impacts   depending   upon   one’s   development,  
resiliency,  and  interpersonal  support,  among  other  factors.  In  this  paper,  we  
focus   on   the   role   of   various   existential   issues   in   the   conceptualization   and  
treatment   of   trauma,   particularly   relevant   to   Greening’s   conception   of  
“existential   shattering.”   Whether   an   individual   exposed   to   traumatic   events  
experiences   an   existential   shattering   or   not   is   important   for  
conceptualization  and  treatment.  Traumatic  reactions  that  include  existential  
shattering   are   likely   to   be   resistant   to   or   insufficiently   treated   by   symptom  
focused   treatments   that   do   not   address   the   implications   of   the  
deconstruction   or   shattering   of   one’s   world   view,   which   is   an   important  
source   of   sustaining   meaning   and   resilience.   Although   most   trauma   clients  
may   benefit   from   the   consideration   of   existential   issues,   for   some   clients,  
whose   worldview   and   meaning   systems   have   been   shattered,   it   is   an  
essential  part  of  the  healing  process.1    
 
 

                                                                                                               
1  This  paper  was  presented  as  part  of  the  symposium  titled,  “Developing  Resiliency:  Compassion  Fatigue  and  
Regeneration”  (I.  Serlin,  Chair),  at  the  121  Annual  Convention  of  the  American  Psychological  Association,  
July/August,  2013,  Honolulu,  HI.  
Existential  Issues  in  Trauma       2  

 
  Although  trauma,  by  its  nature,  is  inherently  existential,  the  existential  dimensions  
are  often  ignored  in  its  treatment.  Furthermore,  trauma  has  not  been  sufficiently  addressed  
in  the  existential  literature.  In  this  paper,  we  attempt  to  advance  an  existential  approach  to  
trauma  with  implications  for  assessment  and  treatment.    
 
Terminology  
 
Existential  Shattering:    A  devastating,  unexpected,  irreversible  event,  a  trauma,  in  which  
one's  fundamental  meaning  and  relating  systems  are  irreparably  shattered  (Greening,  2012,  
personal  communication).  
 
Trauma  
  Trauma  is  common  topic  in  professional  psychology  and  is  also  a  psychological  term  
that  is  frequently  used  in  a  more  generalist  lexicon.  According  to  DuBose  (2010),    
 
Trauma  is  the  description  given  to  overwhelming,  uncanny,  or  absurd  experience,  
usually  involving  some  kind  of  violence,  abuse,  or  loss,  that  threatens  death  [or]  
injury  to  oneself  or  another,  and  that  resists  one’s  capacitates  to  process,  make  
meaning  of,  or  schematize  the  occurrence  in  typical  or  familiar  ways.  (p.  925)  
 
Traditional  definitions  have  often  focused  on  the  uncanny,  absurd,  or  uncommon  aspects  of  
the  event,  which  seems  to  suggest  trauma  cannot  result  from  more  normal  experiences.  
However,  DuBose’s  definition  is  particularly  useful  in  that  it  includes  “overwhelming”  as  an  
additional  option  for  the  trauma  event.  Similarly,  Levine  and  Frederick  (1997)  maintain  
that  focusing  on  the  nature  of  the  event  alone  is  problematic  and  they  suggest,  instead,  that  
it  is  equally  or  more  important  to  also  consider  the  response  to  the  event.    
DuBose  further  clarifies  that,    
 
It  is  important  to  note,  though,  that  a  trauma  is  not  only  the  event  itself  that  occurs,  
but  is  shaped  as  well  by  how  the  event  is  understood  by  those  undergoing  it,  and  
how  one  is  cared  for  before,  during,  and  after  such  events.  (p.  926)  
 
Similarly,  Stolorow  and  Atwood  (1992)  maintain  that  trauma  always  occurs  within  
an  intersubjective  context,  and  that  it  is  the  breakdown  in  affect  attunement  that  is  a  
primary  cause  of  the  traumatic  reaction.  They  further  clarify  stating,  “pain  is  not  pathology”  
(p.  54),  and  that  trauma  should  not  be  reduced  to  just  being  about  the  emotional  reaction,  
particularly  immediately  following  the  event.  Whether  an  event  brings  about  a  disruptive  
traumatic  reaction  is  dependent  upon  many  factors  in  the  individual  and  their  response  to  
the  event.    
Existential  Issues  in  Trauma       3  

From  this  discussion,  we  can  distinguish  between,  1)  the  traumatic  event,  which  
carries  the  potential  for  an  intense,  overwhelming,  or  disruptive  response,  2)  the  
immediate  response  to  a  traumatic  event,  including  thoughts,  emotions,  and  behaviors,  and  
3)  a  more  enduring  reaction,  which  may  or  may  not  include  much  disruption  to  one’s  life  
and  likely  will  change  over  time.    
 
Existential  Shattering  
  Although  most  often  triggered  by  trauma,  existential  shattering  is  not  the  same  at  
posttraumatic  stress  disorder  (PTSD).    PTSD  emphasizes  "trauma  and  stress"  while  
existential  shattering  is  concerned  with  the  "enduring  irrevocable  destruction  of  one's  
former  ground  of  being"  (Greening,  2012,  personal  communication).  Greening,  the  
originator  of  the  concept,  describes  existential  shattering  as  an  event  that  causes  one  to  
experience  "a  fundamental  assault  on  our  right  to  live,  on  one’s  sense  that  the  world  
(including  people)  basically  supports  human  life."    One’s  relationship  with  existence  itself  
is  shattered,  including  the  beliefs  and  world  constructs  that  were  held  as  a  result.      
Stolorow  (2007)  describes  a  similar  experience  as  follows:  
 
Such  absolutisms  are  the  basis  or  a  kind  of  naïve  realism  and  optimisms  that  allow  
one  to  function  in  the  world,  experienced  as  stable  and  predictable.    It  is  in  the  
essence  of  emotional  trauma  that  shatters  these  absolutisms,  a  catastrophic  loss  of  
innocence  that  permanently  alters  one’s  sense  of  being-­‐in-­‐the-­‐world.    Massive  
deconstruction  of  the  absolutisms  of  everyday  life  exposes  the  inescapable  
contingency  of  existence  on  a  universe  that  is  random  and  unpredictable  and  in  
which  no  safety  or  continuity  of  being  can  be  assured.  (p.  16)    
 
Mainstream  PTSD  treatment  focuses  on  integrating  the  traumatic  experience  into  one's  life  
and  adjusting  to  life  accordingly  but  does  not  address  the  deeper  implications  of  the  
traumatic  experience  such  as  questions  of  meaning,  safety,  and  ones  way  of  being  in  the  
world.  As  Krippner,  Pitchford,  and  Davies  (2012)  point  out,  “the  self-­‐talk  of  psychodynamic  
approaches  and  the  desensitization  of  cognitive-­‐behavioral  approaches  may  bypass  these  
core  issues”  (p.  115).    For  a  person  who  has  experienced  existential  shattering,  their  entire  
worldview  has  been  destroyed  and  there  is  no  going  back  to  "normal"  or  integrating  the  
experience  into  former  ways  of  being.    The  person's  self  and  world  construct  has  been  
effectively  annihilated  and  they  are  left  at  an  existential  ground  zero.      
  The  defining  feature  of  an  existential  shattering,  similar  to  trauma,  is  not  the  event  
or  what  happened;  it  is  the  underlying  effect  of  the  event  or  how  the  person  experiences  
the  event.    It  is  possible  for  one  person  to  experience  an  event  and  develop  PTSD  without  
any  signs  of  existential  shattering  while  another  person  might  experience  the  same  event  
and  experience  existential  shattering  without  PTSD.  Additionally,  some  individuals  may  
experience  both  PTSD  and  existential  shattering.  The  PTSD  is  characterized  by  a  number  of  
Existential  Issues  in  Trauma       4  

disruptive  symptoms  in  one’s  life,  while  existential  shattering  involves  a  questioning  of  
one’s  worldview  and  oneself.    
For  example,  a  woman  is  raped  violently  in  her  home.    Although  she  was  severely  
traumatized,  the  incident  did  not  provoke  her  to  engage  with  the  deeper  questions  of  
existence  and,  after  therapy,  she  was  able  to  resume  her  life  as  she  had  lived  before  the  
rape.    The  rape  was  not  a  shattering  experience  for  this  woman,  as  the  trauma  did  not  force  
her  to  confront  the  givens  of  existence.  However,  another  woman  who  experiences  the  
same  scenario  will  be  radically  changed  by  the  rape  as  she  confronts  her  life,  the  choices  
she  had  made  and  not  made  as  well  as  her  way  of  being  in  the  world.  As  a  result,  she  may  
struggle  with  issues  of  despair  and  meaninglessness;  however,  if  she  is  able  to  successful  
confront  these  challenges  she  may  over  time  make  career  changes,  have  more  fulfilling  
relationships,  and  feel  more  engaged  with  life.    
The  important  questions  to  explore  with  existential  shattering  are  not  about  what  
happened  but  how  the  person  experienced  the  event  and  the  effect  of  the  event  on  how  
they  see  themselves,  the  world,  and  any  meaning  structures  they  had  in  place  prior  to  the  
event.    Existential  shattering  is  highly  subjective  but  nonetheless  has  many  defining  
features.    
First,  a  defining  factor  of  existential  shattering  is  that  the  event  was  sudden,  
irreversible,  and  unexpected.  This  can  include  traumatic  events  such  as  car  accidents,  
sudden  illness,  losing  a  job,  deaths  of  loved  ones,  assaults,  divorces,  and  may  also  include  
other  experiences  not  always  seen  as  horribly  traumatic  such  as  betrayal  by  a  trusted  loved  
one.    Again,  it  is  not  what  happened  to  the  person  as  much  as  it  is  the  effects  of  the  event  or  
how  the  person  experienced  the  event.    
The  second  factor  of  existential  shattering  is  that  the  event  caused  a  severe  
disruption  to  the  person’s  meaning  and  relating  (self  and  world  construct).    A  person  who  
has  experienced  an  existential  shattering  will  not  be  the  same  person  they  were  before  the  
experience,  which  will  cause  them  to  see  themselves  differently  and  will  alter  how  they  
interact  with  others.    For  instance,  a  person  who  might  have  been  passive  previously  might  
find  a  new  vigorous  way  of  being  after  facing  a  shattering  experience.    Also,  a  person’s  way  
of  relating  to  others  will  be  changed  as  he  or  she  engages  the  world  in  a  new  manner.      
The  third  defining  factor  of  existential  shattering  is  the  event  forced  confrontation  
with  one  or  more  of  the  givens  of  existence.  This  can  leave  the  person  feeling  groundless  
and  cause  a  sense  of  disillusionment  with  a  formerly  cherished  belief  or  beliefs.    Yalom  
(1980)  defines  the  givens  of  existence  as  consisting  of  death,  freedom,  isolation,  and  
meaninglessness.  Although  Yalom’s  classification  of  the  givens  is  the  best  known,  he  has  
been  criticized  for  focusing  primarily  on  the  more  starkly  negative  aspects  of  the  givens  
(Greening,  1992;  Hoffman,  2009).  Greening  (1992),  in  particular,  notes  that  each  of  the  
givens,  if  faced,  also  has  a  potential  for  a  benefit  or  opportunity.  However,  it  is  agreed  that  
the  givens  always  consist  of  a  challenge.  A  forced  confrontation  with  one  of  the  givens  of  
existence  can  cause  a  person  who  had  previously  given  little,  if  any,  thought  to  those  
Existential  Issues  in  Trauma       5  

realities  to  suddenly  come  face  to  face  with  the  often-­‐harsh  life  one  is  thrust  into.  This  sort  
of  forced  confrontation  can  be  an  unwelcome  experience  as  a  person  who  was  previously  
comfortable  with  their  life  is  now  questioning  the  very  foundation  upon  which  their  life  
was  built.        
Fourth,  the  event  leaves  the  person  feeling  groundless.    Groundlessness  is  the  sense  
of  being  thrown  into  the  world  without  having  choice  or  the  things  generally  used  to  create  
a  sense  of  solidarity.      For  instance,  a  person  might  be  left  questioning  or  leaving  a  religious  
group  they  have  associated  with  for  most  of  their  life  and  without  that  familiar  ground,  feel  
lost,  without  anchor  or  lacking  solid  ground.    
Finally,  the  event  causes  a  person  to  feel  a  sense  of  disillusionment  with  a  formerly  
held  or  cherished  belief.    Often,  those  beliefs  are  not  even  conscious  or  recognized  as  beliefs  
until  they  are  shattered,  but  once  it  happens,  the  person  is  aware  of  it.    A  person  might,  for  
example,  carry  the  unrecognized  belief  that  bad  things  do  not  happen  to  good  people  but  
when  something  “bad”  happens  to  them,  they  are  forced  to  examine  that  belief.    If  bad  
things  only  happen  to  bad  people,  then  either  they  must  be  a  bad  person  or  that  belief  is  
not  true.    If  that  belief  is  not  true  then  perhaps  they  have  wrongly  judged  the  people  in  the  
past  that  have  had  “bad”  things  happen  to  them.    Those  formerly  held  beliefs  that  were  a  
cherished  and  valued  part  of  the  individual’s  belief  structure  are  no  longer  tenable.    The  
person  is  then  left  to  either  attempt  to  reconstruct  the  beliefs  or  to  toss  them  out  altogether.    
For  practitioners  who  treat  clients  and  would  like  to  differentiate  between  PTSD  
and  existential  shattering,  the  above  criteria  will  be  a  useful  guide.    Assisting  someone  who  
has  experienced  existential  shattering  will  come  in  the  form  of  helping  them  to  understand  
what  they  have  experienced  while  assisting  them  in  transcending  the  "paradoxical  givens"  
to  create  new  meanings,  beliefs,  and  way  of  relating  with  the  world.    Greening  (2003)  has  
described  four  existential  challenges  and  three  responses  to  each,  which  can  be  a  valuable  
tool  for  practitioners  in  assisting  those  who  have  experienced  an  existential  shattering.      
Greening  (2003)  points  out  that  each  of  these  givens  are  a  "blessing  and  a  curse."  
We  hold  both  the  capacity  for  expansion  and  constriction,  the  promise  of  life  with  the  
finality  of  death,  the  headiness  of  freedom  with  the  weight  of  responsibility,  and  the  sense  
that  we  are  "endowed  with  some  but  not  enough"  (p.  1).    Greening  (2003)  describes  the  
three  ways  in  which  a  person  can  respond  to  the  existential  givens:    
 
1. Simplistic  over-­‐emphasis  on  the  positive  aspect  of  the  paradox.    False  triumph  over  
the  difficulties  presented  by  the  challenge  
2. Simplistic  over-­‐emphasis  on  the  negative  aspect  of  the  paradox.  Fatalistic  surrender  
to  the  difficulties  presented  by  the  challenge.  
3. Confrontation,  creative  response,  and  transcendence  of  the  challenge  (p.  6).    
 
There  is,  of  course,  no  right  or  wrong  outcome  for  a  person  who  experiences  
existential  shattering,  as  each  person’s  journey  is  as  unique  as  the  individual.    It  is,  however,  
Existential  Issues  in  Trauma       6  

most  beneficial  for  the  individual  to  confront,  overcome,  and  transcend  the  challenges  
presented  with  the  shattering  experience.      
 
Assessment  
 
  Several  years  ago,  one  of  the  authors  (Louis)  was  contacted  to  ask  if  he  accepted  
Tricare  Insurance  in  order  to  accept  soldiers  returning  with  PTSD  as  clients.  The  referral  
source,  who  worked  for  the  military,  was  looking  for  someone  who  would  treat  PTSD  from  
an  existential  perspective.  Although  I  was  not  on  Tricare,  one  of  the  therapists  in  our  center,  
who  worked  from  an  existential  perspective  and  continued  in  an  existential  therapy  
consultation  group  led  by  two  of  the  authors  (Louis  and  Heatherlyn),  became  a  Tricare  
provider  and  began  seeing  these  referral  clients.    
  The  referral  source,  who  was  a  physicians  assistant,  noted  that  he  believed  some  
soldiers  returning  from  deployment  needed  more  than  the  typical  treatment  modalities  
that  focused  on  the  symptoms.  He  believed  the  more  traditional  treatments,  such  as  
cognitive-­‐behavioral  therapy,  dialectical  behavioral  therapy,  and  EMDR,  were  effective  for  
many  of  the  returning  soldiers.  Some  of  these  returning  soldiers,  who  experienced  a  more  
profound  disruption  in  how  they  experienced  themselves  and  the  world,  he  believed  
needed  something  more.  Although  not  a  therapist  himself,  from  his  researching  therapy  
approaches,  he  believed  existential  therapy  was  the  ideal  fit  for  these  soldiers.  After  about  a  
year  of  the  therapist  in  our  center  receiving  these  referrals,  I  had  a  conversation  with  the  
referral  source.  He  noted  that  he  was  very  satisfied  and  was  seeing  good  results  with  the  
referrals  to  our  center.  Furthermore,  he  noted  that  many  of  these  referrals  had  not  had  
success  with  other  therapists  and  were  clients  that  would  often  be  considered  difficult  to  
treat.    
For  many  soldiers  returning  from  war,  many  of  the  symptoms  they  experience  can  
be  understood  as  having  their  roots  in  adaptive  behavior.  For  example,  while  in  active  
combat  zones,  being  hypervigilant  is  often  necessary  in  order  to  remain  safe  in  an  
environment  where  threats  to  one’s  safety  could  emerge  literally  at  any  second.  When  this  
carries  over  into  situations  where  it  is  no  longer  necessary  to  be  hypervigilant,  then  it  is  
disruptive.  Many  of  the  symptoms  of  PTSD  could  be  similarly  understood.  To  a  large  degree,  
these  symptoms  can  be  understood  at  the  behavioral  level,  even  though  they  are  likely  to  
frequently  have  at  least  some  implications  going  beyond  this  behavioral  level.    
With  other  clients,  the  traumatic  event  or  exposure  has  deeper  or  more  profound  
disruptions.  For  example,  a  soldier  who  goes  to  war  deeply  believing  that  people  are  in  
essence  good  will  likely  have  this  belief  severely  challenged  through  what  they  experience  
in  a  combat  zone  witnessing  the  atrocities  of  wars.  Similarly,  individuals  who  believe  that  
God  would  not  allow  for  certain  things  to  occur  can  have  their  belief  system  severely  
challenged  when  exposed  to  various  types  of  traumatic  events.  As  a  different  type  of  
example,  some  individuals  will  have  their  view  of  themselves  challenged  or  destroyed  
Existential  Issues  in  Trauma       7  

when  reflecting  upon  their  actions  or  lack  of  actions  on  the  battlefield.  All  of  these  are  
suggestive  of  more  fundamental  disruptions,  or  shattering  experiences.  Many  of  these  fit  
with  Greening’s  conception  of  existential  shattering.    
At  the  assessment  level,  it  is  important  for  clinicians  to  be  aware  of  the  possibility  of  
existential  shattering  or  other  existentially-­‐based  problems.  Existential  shattering  is  not  a  
diagnostic  category  and  we  are  not  advocating  that  it  should  be  considered  a  diagnostic  
category.  Reifying  the  concept  in  such  ways  would  likely  create  more  problems  and  
misunderstandings.  However,  recognizing  the  presence  of  existential  issues  or  existential  
shattering  can  be  important  in  helping  identifying  what  is  needed  in  the  treatment  
approach.    
This  is  not  to  suggest  that  clients  who  have  existential  issues  or  who  have  
experienced  an  existential  shattering  will  only  benefit  from  an  existential  treatment  
modality.  In  many  cases,  particularly  when  the  existential  shattering  is  combined  with  
PTSD,  various  treatment  modalities  will  positively  impact  many  of  the  symptoms  described  
previously  as  being  largely  at  the  behavioral  level.  Additionally,  it  is  important  to  note  that  
the  research  suggests  that  the  various  bona  fide  treatments  tend  to  be  fairly  equivalently  
effective  in  treating  PTSD  (Benish,  Imel,  &  Wampold,  2008).  However,  the  recognition  of  
existential  shattering  can  help  inform  clinicians  of  the  need  to  attend  to  the  destroyed  
aspects  of  one’s  meaning  system  or  worldview,  and  not  just  focus  on  the  more  discrete  
symptomology.    
Schneider’s  (2008)  existential-­‐integrative  model  to  therapy  may  be  a  particularly  
useful  example  here.  Schneider  has  advocated  existential  therapy  can  provide  a  foundation  
for  many  different  approaches  to  treatment,  and  included  in  this  volume  are  illustrations  of  
combing  cognitive-­‐behavioral  therapy  (Bunting  &  Hayes,  2008;  Wolfe,  2008),  
psychoanalytic  therapy  (Dorman,  2008),  and  other  modalities  with  the  existential  approach.  
What  the  existential  approach  adds  is  the  focus  on  issues  related  to  existential  shattering.    
In  conclusion,  assessing  for  existential  shattering  in  the  early  phases  of  assessment  
and  treatment  may  help  therapist  be  more  informed  in  their  treatment  approach  and  
modality.    Therapists  may  accomplish  this  by  attending  to  the  client’s  story  about  
themselves  and  the  meaning  in  their  lives,  not  just  the  symptoms  they  present  with.    
 
Treatment  
 
  The  identification  of  existential  shattering  has  many  important  implications  for  the  
therapy  process.  In  many  ways,  existential  therapy  naturally  works  with  issues  such  as  
existential  shattering  through  its  attentiveness  to  the  existential  givens,  particularly  the  
meaning  in  the  individual’s  life.  However,  it  is  still  important  to  maintain  an  awareness  of  
existential  shattering.  In  this  section,  we  provide  an  overview  of  some  important  aspects  of  
existential  therapy  that  may  be  particularly  relevant  when  working  with  clients  who  have  
experienced  an  existential  shattering.  This  is  not  intended  as  a  comprehensive  guide  to  
Existential  Issues  in  Trauma       8  

using  existential  therapy  with  trauma  clients,  or  even  client’s  who  have  experienced  an  
existential  shattering.    
 
Working  with  Vulnerable  Clients  
  At  the  outset,  it  is  important  to  note  that  many  clients  may  not  recognize  or  
understand  their  existential  shattering.  Even  if  they  do,  they  may  not  share  this  with  their  
therapist,  especially  at  first,  for  a  variety  of  reasons.  It  may  feel  to  painful,  they  may  not  
trust  the  therapist,  or  they  may  feel  ashamed  that  are  questioning  such  basic  things  about  
their  existence.  Thus,  the  therapist  may  come  to  recognize  the  experience  of  existential  
shattering  over  time.    
Suicide  becomes  a  primary  consideration  for  clients  who  have  experienced  an  
existential  shattering.  Meaning  and  various  aspects  of  one’s  worldview  are  important  
protective  factors  for  clients  experiencing  severe  emotional  challenges  and  often  serve  to  
help  organize  and  make  sense  out  of  their  difficult  experiences  in  the  world.  As  these  often  
are  destroyed  through  the  shattering  experience,  clients  may  become  more  vulnerable  to  
suicide.  Thus,  therapists  must  be  more  cautious  when  encouraging  clients  to  face  and  work  
through  their  painful  experiences.  Additionally,  it  becomes  more  important  to  help  
facilitate  the  develop  of  resources  and  protective  factors  that  can  help  sustain  the  client,  
such  as  developing  a  strong  therapeutic  alliance,  supportive  relationships  outside  of  
therapy,  and  coping  resources.    
 
Presence  
Presence  is  regularly  identified  as  a  central  concept  in  existential  therapy  (Hoffman,  
2009;  Schneider,  2008;  Schneider  &  Krug,  2009).  Schneider  (2008)  defines  presence  as,  “an  
attitude  of  palpable  –  immediate,  kinesthetic,  affective,  and  profound  –  attention,  and  it  is  
the  ground  and  eventual  goal  of  experiential  work”  (p.  60).  As  such,  presence  forms  the  
basis  for  relational  work,  as  well  as  experiential  work  in  therapy.  Through  providing  a  
relational  context  of  attentiveness  and  acceptance,  the  therapist  works  to  create  an  
environment  where  clients  are  able  to  discuss  difficult,  even  shameful  topics.    
 
Resistance  
  Presence  is  not  always  sufficient  for  bringing  about  the  types  of  disclosure  and  
openness  necessary  for  therapy  to  be  effective.  Bugental  (1999)  recognizes  the  paradoxical  
nature  of  resistance.  Resistance  protects  against  harm,  but  can  also  prevent  growth.  Clients  
resist  change  and  yet  seek  change  at  the  same  time.  From  a  clinical  perspective,  it  is  vital  to  
have  respect  for  resistance.  Too  often,  resistance  is  seen  merely  as  something  to  be  worked  
through,  confronted,  or  broken  down.  In  Bugental’s  perspective,  it  is  important  to  honor,  
and  even  align  with,  the  resistance  while  gently  helping  the  client  to  move  into  a  space  in  
which  the  resistance  can  gradually  be  lessened.    
Existential  Issues  in  Trauma       9  

  For  clients  who  have  experienced  trauma  and/or  shattering,  resistance  can  be  
something  that  is  saving  and  protecting  them  in  vital  ways.  Instead  of  trying  to  quickly  
work  through  the  resistance,  it  is  important  for  therapists  to  get  an  understanding  of  what  
role  the  resistance  is  serving.  As  the  therapist  gains  empathy  for  the  purpose  of  the  
resistance,  they  are  able  to  gently  assist  clients  in  working  on  the  issues  that  the  resistance  
is  protecting  while  honoring  the  client’s  need  to  remain  somewhat  resistant.  This  approach  
to  working  with  resistance  can  be  quite  powerful  with  clients  who  have  experienced  
trauma  or  shattering.    
   
The  Daimonic  and  Creativity  
  May  (1969)  defined  the  daimonic  as,  “any  natural  function  which  has  the  power  to  
take  over  the  whole  person”  (p.  65).  May  did  not  perceive  the  daimonic  in  itself  as  good  or  
bad;  rather,  it  is  more  important  to  be  concerned  with  how  one  uses  the  daimonic.  In  
particular,  the  denial  or  repression  of  the  daimonic  can  empower  it  and  increase  its  
harmful  or  destructive  potential  (Hoffman,  2009).    Trauma  and,  in  particular,  existential  
shattering  can  often  be  connected  with  the  daimonic.  The  deeply  painful  experiences,  
particularly  when  repressed  or  denied,  can  begin  to  exert  an  increasingly  powerful  force  
over  the  individual  until  the  person  is  eventually  consumed  with  their  trauma  or  shattering  
experience.    
  From  an  existential  perspective,  creativity  is  an  important  part  of  the  response  to  
the  daimonic.  It  becomes  important  to  find  ways  to  integrate  the  daimonic  into  one’s  self-­‐
understanding  and  worldview.  When  clients  are  successful  in  doing  this,  they  often  can  
transform  their  traumatic  experience  into  something  meaningful.    
 
Moving  In  and  Out  of  the  Depths    
  Bugental  (1987),  in  discussing  the  process  of  psychotherapy,  advocates  that  it  is  
important  for  therapists  to  be  able  to  guide  clients  through  moving  in  and  out  of  the  depths  
of  their  emotional  experience.  It  is  common  for  therapists  to  focus  excessively  on  the  
emotional  depths  or  stay  just  at  the  cognitive  level.  However,  Bugental  recognized  the  
importance  of  the  experiential  and  cognitive  levels.  Indeed,  it  is  this  shift  from  cognition  to  
emotion  that  can  be  understood  as  what  is  meant  by  “processing  emotions.”    
  Clients,  as  well,  may  have  a  tendency  to  stay  in  the  emotional  or  cognitive  realms,  
which  often  results  in  feeling  “stuck.”  The  therapist’s  role,  then,  is  to  help  guide  the  client  
gently  back  and  forth  between  the  cognitive  and  emotional  realms,  often  gradually  helping  
them  go  more  and  more  into  their  emotions.  This  back  and  forth  process  helps  client  
deepen  their  understanding  of  their  experience  and  create  meaning  from  it.  In  this  process,  
clients  are  often  able  to  gradually  rebuild  their  worldview  and  sense  of  self.    
 
 
 
Existential  Issues  in  Trauma       10  

Summary  
  This  is  far  from  a  comprehensive  overview  of  an  existential  approach  to  trauma  
therapy  or  working  with  existential  shattering.  However,  we  have  provided  a  brief  
overview  and  summary  of  several  key  concepts  that  illustrate  some  of  what  existential  
therapy  has  to  offer  the  trauma  literature.    
 
Conclusion  
 
  Existential  shattering  is  an  important  concept  in  the  treatment  of  trauma  that  has  
implications  during  the  assessment  and  treatment  phases  of  psychotherapy.  Attentiveness  
to  this  concept  can  help  distinguish  between  different  types  of  trauma  reactions  that  have  
important  implications  for  treatment.  Existential  therapy  and  other  therapies  informed  by  
existential  perspectives  are  ideally  suited  to  work  with  clients  who  have  struggled  with  
trauma  and,  in  particularly,  existential  shattering.  
 
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