Teetering on the boundaries between philosophy and psychotherapy, existential therapy involves helping clients find meaning in their lives and emphasizes that the driving force in life is an innate spiritual desire to find this meaning. Because this therapy's roots are planted firmly in the concepts of existential philosophy—a philosophy that deals squarely with questions of human existence—it might be easier to think of existential therapy as more of a counselor's philosophical approach to therapy than a well-defined school of therapy with specific techniques at its disposal.1

Considering this perspective, it is easy to see why many addiction counselors who serve adolescents might initially shy away from any thought of using existential therapy. The reasons for their hesitation are obvious, because the concepts of existential therapy just seem too nebulous and abstract for their adolescent clients to comprehend—and too boring to hold their attention for long. This hesitation is unfortunate, because nothing could be further from the truth.

The experiences of the staff at an adolescent residential substance abuse treatment center in rural Mississippi, Sunflower Landing, demonstrate just how easy, effective, and rewarding a use of creative vehicles to convey existential concepts can be. Staff members have been using such approaches for more than a decade, and the adolescent counselors will readily attest to their success.

Since 12-Step treatment forms the cornerstone of the treatment approach at this facility, counselors have always welcomed any way to clarify, expand, and add substance to the existential thrust of that program. However, like anything worthwhile, the process is not without effort. It dares the counselor to be brave enough to try something different and to unleash his/her full imaginative potential. On top of this, it requires a sound understanding of the adolescent developmental period and the unique nature of adolescents' substance use.

Understanding adolescents

Drug use is inevitable with high-risk adolescents for many reasons. These include the quick, surefire reprieve drugs offer from depressive emptiness; the false sense of self-confidence induced by drugs; and the semblance of acceptance, which adolescents so desperately crave, from drug-using peers.

It is only logical to presume that adolescents who fail to find healthy, real identities will also fail to find any real internal meaning in life. When they fall short of finding it on the inside, they will look in many places on the outside, but usually in places such as the beer can and the blunt. Underneath their substance abuse lies an existential dread. If an adolescent counselor really wants to get to the root of a client's substance abuse, this is where it will be found. It could be considered a therapeutic travesty not to address this important fundamental factor with those adolescents who are willing and cognitively capable of going there.

Counselors can easily get an idea of which adolescents will probably profit most from an existential approach if they have a basic comprehension of the cognitive processes underlying an adolescent's budding ability to think abstractly. At Sunflower Landing the solution to this dilemma is rather simple and comes soon after admission, when counselors introduce their clients to Step One of the 12 Steps.2 This step revolves around two relatively abstract concepts, one of which is powerlessness. A client's ability to explain, at even the most fundamental level, what powerlessness means to him and how he might apply the concept in his own life is a sound indication that he can handle simple abstract ideas and that existential approaches might be fruitful. Another way is to give a client a camera with instructions to take several photographs of an abstract concept such as serenity or gratitude. Give no further instructions—in spite of almost certain pleadings from the client to do so—and see what the client brings back. This technique is not only effective and fun, it often generates some surprising results.

Getting creative

It is normal and correct for counselors to assume that adolescents, especially high-risk, substance-using adolescents, will have short attention spans and need a barrage of almost constant stimulation. This is why many adolescent counselors hesitate to try an existential approach. Yet the answer to counselors' hesitation can be found by creatively searching for tangible ways to convey intangible concepts. Activities that counselors at Sunflower Landing have successfully used with their substance-using clients include creative outlets such as photography, horseback riding, pet therapy, and astronomy.

Photography is frequently used as an experiential individual or group activity with photographic assignments, called photo shoots. A typical photo shoot involves taking 10 photographs representing a particular existential concept, such as spirituality, higher power, or serenity. Once the clients have taken and printed their photographs, they hang them on the group room wall during a group session. Each group member then selects one of their photos and shares their thoughts on the work with the rest of the group. This is quite effective, since adolescents are much more likely to open up about a sensitive issue when using something outside them, such as the photograph of a mesmerizing sunrise. Their discussions are never unproductive and often proceed like chain reactions, with the first reflection on a photograph serving as a springboard for sharing.

Photography generates a lot of extra benefits as well. Sunflower Landing has acquired a remarkable photography collection that bears evidence of previously untapped artistic talent. The collection is on permanent display in the center's photo gallery, and the overflow of photos sometimes adorns the dining room and hallways. The collection has gained a local reputation of being one of the area's more notable art collections, and is a popular attraction at local civic clubs and the blues festivals held in the Mississippi Delta.

Creative vehicles for our existential projects are not always cheap, and Sunflower Landing's photography project is no exception. Fortunately, some of the same imaginative staff members who come up with existential activities also have devised creative ways to fund the projects. The photography project got its start with generous financial assistance from the Dreyfus Health Foundation, a New York City-based organization with an affinity for helping small organizations put feet on innovative dreams. Sales of the adolescent photographers' work also help support the project.

Horseback riding is another effective vehicle used at Sunflower Landing to convey existential concepts. The possibilities for hitching existential concepts to horses are almost endless. Some of these concepts include trust, healthy risk taking, overcoming fears, negotiating hurdles, responsibility, and teamwork. Using a team of adolescent clients to steer a horse through an obstacle course offers a prime example of the power of cooperation in action. A ride into the cotton fields and woods surrounding the facility at sunset on an Indian summer day, far from the sounds of civilization, offers many possibilities. In these settings it is easy to stimulate a discussion on the meaning of life or serenity. These discussions are never superficial and always memorable. Drugs and loud music are left galaxies away while the present experience becomes the focus.

Pets provide a wonderful opportunity to connect existential concepts to something tangible and meaningful. Lots of “pet therapists” live at Sunflower Landing, including 10 dogs, many cats, a few pigs and sheep, some ducks, a bright yellow and red parrot, and a thriving community of rabbits. The dogs and cats attend group counseling sessions and classes throughout the day with the clients, and at night they are usually found in bed sleeping with them. Many teens who come to Sunflower Landing do not know how to show concern for others or might be afraid to because they have been rejected in the past when they tried; pets give them a renewed opportunity. Pets also encourage adolescents to focus outside of themselves and their own problems. They provide adolescents with many other existential opportunities, including the chance to give and receive unconditional love, to learn the rewards of responsibility, and to gain a sense of connectedness to all creation.

Astronomy is especially existentially stimulating. The astronomical concepts of infinity, nothingness, and light years beg for serious consideration from even the “coolest” adolescent who is trying not to look too nerdy.

The use of Socratic dialogue is a good way to kick off meaningful discussion with these creative vehicles. Socrates realized that the best way for his students to learn was not through telling, but asking. He realized his students already knew the answer to life's questions, but they just didn't know they knew. Our therapy settings might not be as grand as Socrates' marble porticos of the Acropolis, but the techniques work just as well in whatever treatment settings we find ourselves in with our adolescent clients. Here are some typical Socratic dialogue questions that counselors at Sunflower Landing might ask after a photo shoot, a night of looking at the cosmos through telescopes, or from horseback in the middle of an isolated cotton field immersed in the warmth of the setting sungr:

Looking for results

Creative approaches to existential therapy not only give adolescent clients the opportunity to explore meaningful concepts in a fun way, they also are intended to bring about deep-seated internal change. Counselors can detect the internal changes that flow from their adolescent clients' newfound sense of meaning in life through their external behaviors.

The spiritual principles of the 12-Step program provide counselors at Sunflower Landing with some of the tools they need to gauge these changes. These principles describe noticeable changes in behavior that are expected to accompany spiritual growth and can easily be used as a guide to assess the effectiveness of existential interventions. Some of the changes the staff at Sunflower Landing look for include behaviors that reflect an increased acceptance of responsibility for one's own actions, a decreased incidence of arguing, an increase in overt signs of gratitude, an improved sense of humor, and a growing desire to reach out and help fellow residents. In addition, clients periodically complete depression and anxiety scales to document improvement in these states over time. This latter method of assessment is important, since both of these states can be assumed to be ameliorated as clients begin to find meaning and experience a sense of belonging in life.

Employing existential therapy through creative vehicles with substance-using adolescents might not be for every counselor, or for every adolescent. But the experiences of the staff at Sunflower Landing show that the efforts are more than worthwhile, and only the boundaries of the imagination limit what can be done. A sign on the door of one of the Sunflower Landing counselors speaks with profound impact to the adolescents who pause daily to read it, reminding them where to find real happiness: “Boredom does not mean we having nothing to do; it means we cannot find meaning in what we are doing.”3