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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 ones 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 persons 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


  • Workshop Work Sheet

    Associations to:



    Being alone




  • 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; Custers 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 Wordens (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 ones 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 clients 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


    Social Recognitionrespect and admiration


    Equalitybrotherhood and equal

    opportunity for all (T)

    True Friendshipclose companionship


    An Exciting Lifea stimulating, active life


    Wisdoma mature understanding of

    life (T)

    Family Securitytaking care of loved ones


    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


    Inner Harmonyfreedom from inner conflict


    Salvationsaved; eternal life (T)

    Mature Lovesexual and spiritual

    intimacy (T)



    National Securityprotection from attack


    A Sense of Accomplishment

    a lasting contribution (T)

    Page 2

  • Rokeach Value Survey Instrumental Values

    Ambitioushardworking and aspiring


    Independentself-reliant; self-sufficient




    Intellectualintelligent and reflective


    Capablecompetent, effective


    Logicalconsistent; rational


    Cleanneat and tidy


    Lovingaffectionate and tender


    Courageousstanding up for your beliefs


    Loyalfaithful to friends or the

    group (I)

    Forgivingwilling to pardon others


    Obedientdutiful; respectful


    Helpfulworking for the welfare of

    others (I)

    Politecourteous and well-

    mannered (I)

    Honestsincere and truthful


    Responsibledependable and reliable


    Imaginativedaring and creative


    Self-controlledrestrained; self-disciplined


    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: