Existential Psychotherapy in a Community Context: The Inspiring Case of "Keo"

Shapiro’s (2023) case of Keo is an important contribution to the body of case study literature about the practice of culturally informed existential psychotherapy. We hope it receives wide readership, especially among clinical and counseling psychologists who are in the early stage of their careers and working with diverse populations. The author is dedicated to addressing the client’s anxiety and dread of his future from an existential perspective, but must adapt this therapeutic approach to the client’s cultural worldview. The blend of existential psychotherapy with community and family interventions make this case an exemplar of creative adaptation to the needs and culture of the client. We do wonder whether some of the author’s perspective on and maintenance of professional boundaries in a small-town environment might, on occasion, present substantial difficulties in managing or understanding dynamics in the psychotherapy relationship. We also note how little is said (except that peer consultation was utilized) about how the author managed his own anxiety in relation to the client’s need for periodic breaks from weekly sessions, and in relation to the client’s invitation to social events. Finally the delay of 50 years between the successful termination of psychotherapy and publication of the case study is also a point of curiosity, and to our minds not adequately addressed in the paper. We speculate on what this might mean in hopes of learning more in the author’s reply.