**5. Discussion**

By presenting Mark's and Eleanor's cases in detail, we wanted to show how PTSD can take various forms of expression. Its experience and healing process are complex and unique to every individual, despite common symptoms. PTSD may be understood as a complex experience that has biological and psychological components, but also cultural and existential. A humanistic-existential approach to PTSD emphasizes the exploration of the patient's lived experience, as well as the idiographic meaning that trauma takes for the individual. By relying on phenomenology and on the safety of the therapeutic encounter, a humanistic-existential psychotherapy for PTSD aims at exploring new meanings for the traumatic event and new meanings to surviving, healing, and growing.

was complex and profound, and that it required time. We worked on reintegrating her story in a different way, so she could try to relate to herself, to others, and to the world more freely. While Eleanor seemed to slowly get better (having more energy and no more nightmares), she wanted to know more about "*growing*" from trauma. At this point, I decided to lend her my book "*Man's search for meaning*" [27], in which Frankl tells about his own history of concentration camps and in which he extrapolates his theory on life's meaning. Eleanor was particularly moved by the understanding that suffering may have meaning. Following this reading, she initiated rich and deep discussions about the different sources of meaning in her own life. Notably, she mentioned increasing her awareness and gratitude of the value of the relationship she had with her adoptive parents. She would still feel guilty at times for what the world has given her, but would also be able to relate to her experience differently, which motivated her for a fuller engagement toward life. In fact, Frankl's strong thoughts about self-engagement toward life empowered Eleanor to continue to search for and to create her own unique and

198 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

In the meantime, Eleanor continued to take nursing classes on a part-time basis. She temporarily postponed her practical training and started volunteering at the hospital to see if she could develop a new way to relate to others' illness and suffering. By volunteering, Eleanor experienced rich human contact and compassionate care with patients and got progressively used to witnessing suffering. She created significant bonds with patients and other caregivers, and received good feedback on her listening abilities, kindness, and compassionate way of being. Such bounds may have facilitated her sense of worth and value. Eleanor started giving meaning to her suffering, thinking that her past history contributed to cultivate her sense of humanity and compassion. We worked on cultivating this self-compassion, especially when

After a moment, Eleanor felt that she was ready "*to fly a bit on her own*." The overall psychotherapy process lasted 18 months, on a regular weekly basis. Before saying goodbye, Eleanor and I identified what her next challenge may be: for the first time, she was thinking in building an intimate relationship with someone. Although the idea pleased her, she was still terrorized by physical and psychological intimacy and quite aware of the challenges it would be to develop attachment toward someone. She fluctuated between states of hope (being with someone), desire for self-protection, and preservation (it is easier to be alone) or self-depreciation (no man would be interested in me). To date, Eleanor still struggles with self-worth at

By presenting Mark's and Eleanor's cases in detail, we wanted to show how PTSD can take various forms of expression. Its experience and healing process are complex and unique to every individual, despite common symptoms. PTSD may be understood as a complex experience that has biological and psychological components, but also cultural and existential. A humanistic-existential approach to PTSD emphasizes the exploration of the patient's lived

valuable way of living a purposeful existence.

her feelings of guilt and worthlessness would surface.

times, but has come a long way from the first time I met her.

**5. Discussion**

In both cases, we wanted to show how the therapeutic process aimed at exploring the history and the lived experience of Mark and Eleanor. In both cases, the exploration process allowed to shed light on the meaning of the traumatic experience itself, as well as the disrupted meanings of life as it was experienced here and now. The co-comprehension enabled by the therapeutic encounter made possible the exploration of other meanings of the event, and of a search for new meanings in life. In both cases, the psychotherapeutic process involved exploration, comprehension, and reconstruction. This sequence should not be seen as linear, but as a repeated and iterative process.

We have chosen cases that honor the diversity and the complexity of PTSD manifestations, origins, recovery, and, most importantly, meaning. In both cases, we offered a humble, yet incomplete view of the meaning of humanistic-existential psychotherapy with trauma patients. With both cases, we also wanted to show how humanistic-existential psychotherapy can be complemented by other approaches.

For instance, in Mark's case, symptom management was first ensured by medication for allowing conditions of deeper exploration. As a matter of fact, exploration may not be possible if the person is constantly in a state of arousal. In Eleanor's case, she had already completed 3 years of psychotherapy before addressing the existential aspects of her traumatic history. Moreover, in the future, Eleanor may again be confronted with life's situation that will reopen her wound. Major grief or loss could trigger PTSD symptoms and another psychotherapeutic process may be helpful at that time. Such experience may not be understood as static conditions that can be treated, but as major existential challenges that may as well be an opportunity for existential growth.

The humanistic-existential psychotherapy has often been criticized for being too intellectual or too abstract. By presenting concrete, yet incomplete case studies, we aimed at illustrating different ways to approach PTSD from a humanistic-existential perspective. That being said, such an approach may not be relevant or helpful with all PTSD patients. In the cases presented above, both Eleanor and Mark were able to verbalize their lived experience and reflect upon their existence. In that sense, they already had significant existential awareness.

However, the therapeutic process being coconstructed between the therapist and the patient, we can imagine how different therapists may have approached Mark's and Eleanor's stories differently. Different path would have been as valuable. The humanistic-existential movement represents a great diversity of approaches that may differ in their philosophical roots, premises, definitions, and views of psychotherapy. Although of crucial importance, more detailed descriptions of those nuances appeared to be beyond the scope of this chapter.

Humanistic-existential psychotherapy may also share theoretical thoughts or even therapeutic techniques with other approaches. In fact, some third wave cognitive psychotherapy may include relaxation techniques such as mindfulness meditation that are congruent with the approach we presented. It is also close to Frankl's description of experiential values. Moreover, Frankl's belief in man's ability to take a different attitude toward situations that cannot be changed may be part of the acceptance and commitment therapy. However, the humanisticexistential approach distinguishes itself from others by its focus on increasing existential awareness and, therefore, freedom of being. Such a freedom accounts for new existential responsibilities: to live a life that is coherent and meaningful.
