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EXISTENTIAL THERAPY
Slides created by
Barbara A. Cubic, Ph.D.
Professor
Eastern Virginia Medical School
To accompany
Current Psychotherapies 10
Learning Objectives

This presentation will focus on:
• Overview of existential
psychotherapy
• History of existential psychotherapy
• Applications of existential
psychotherapy
• Treatment techniques associated
with existential psychotherapy
Existential Psychotherapy


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Can be integrated with other therapy
approaches.
Represents a way of thinking about
human experience that can
constitute a part of all therapies.
Asks deep questions about human
experiences such as anxiety,
despair, grief, loneliness, isolation,
anomie, meaning, creativity and
love.
Existential Psychotherapy
In his seminal work,
Existential
Psychotherapy, Yalom
(1980) likened
the unique aspects of
interactions therapists
have with their patients
as the extras in a recipe
that make it work.
Basic Concepts
Existential
psychotherapy is “an
encounter with one’s
own existence in an
immediate and
quintessential form.”
— Rollo May (1967)
Basic Concepts

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People are meaning-making beings who
are both subjects of experience and
objects of self-reflection.
Focus on questions like:
• Who am I? Is life worth living? Does it have
a meaning? How can I realize my humanity?

Asserts that only in reflecting on our
mortality can we learn how to live.
Basic Concepts
 Existential
therapy believes
we all must come to terms
with the questions related to
our existence.
 Each of us is responsible for
who we are and what we
become.
Authenticity and Subjectivity

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Because theories may dehumanize
and objectify people, authentic
experience takes precedence over
artificial explanations.
When experiences are molded into
some preexisting theoretical model,
they lose their authenticity and
become disconnected from the
individuals who experience them.
Authenticity and Subjectivity

Existential psychotherapists focus
on the subjectivity of experience
rather than “objective” diagnostic
categories.
Existential Crises

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We are thrown alone into existence
without a predestined life structure
and destiny.
Each of us must decide how to live
as fully, happily, ethically, and
meaningfully as possible.
Existential Crises

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Diagnosable presenting
“symptoms” may mask existential
crises.
Existential dilemma ensues from
the existential reality that although
we crave to persist in our being, we
are finite creatures.
Ultimate Concerns

Freedom
• As authors of our own lives, we face
responsibilities we dread and try to escape.

Isolation
• Interpersonal, intrapersonal, or existential
isolation

Meaning
• Search for purpose can throw us into crisis.

Death
• Death awareness is painful, but enriches
life.
Ultimate Concern: Freedom
“Humans are
condemned to
freedom.”
Freedom
 Refers to fact that humans are the
authors of their own world.
 We are responsible for our own
choices.
 Conflict is between
groundlessness and desire for
ground/structure.
Freedom

Implications for therapy:
•
•
•
•
•
Responsibility
Willing
Impulsivity
Compulsivity
Decision
Isolation

Existential isolation differs
from:
• Interpersonal isolation: Divide
•
between oneself and others.
Intrapersonal isolation: Fact we
are isolated from parts of
ourselves.
Isolation
Each of us enters existence
alone and must depart from
it alone.
Meaninglessness
What is the
meaning of
life?
Ultimate Concern: Death
"Everything wishes
to persist in
its own being."
— Spinoza
Ultimate Concern: Death
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The most obvious ultimate concern
“A Terrible Truth”
Conflict between awareness of death
and desire to live.
To cope, we erect defenses against
death awareness.
Psychopathology, in part, is due to
failure to deal with the inevitability of
death.
The Fellow Traveler
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Awareness of ultimate concerns as
givens of existence produces a
relationship between therapist and
patient as one of fellow travelers.
Labels of patient/therapist,
client/counselor suggest distinctions
between “them” (the afflicted) and “us”
(the healers).
The Fellow Traveler
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We are all in this together; no person is
immune to the inherent tragedies of
existence.
Sharing the essence of the human
condition becomes the bedrock of
therapeutic work.
COMPARING
EXISTENTIAL
PSYCHOTHERAPY TO
OTHER APPROACHES
Key Differences with Other
Approaches
Psychodynamic  Existentialists reject
predetermined explanatory
systems concerning
humans.
 Conflict viewed as grounded
in the human predicament,
not suppressed instincts.
 Existentialists are not drawn
to concepts (e.g. Jung’s
archetype, collective
unconscious).
Key Differences with
Other Approaches
Gestalt


Cognitive
and
Behavioral
Less emphasis on technical
contrivance in an existential
model.
Gestalt approaches exemplify
more optimism.
 Existentialists view these
systems as oversimplifying
human experience.
 CBT has a more circumscribed
plan for change.
Comparison of Existential Theory to
Humanistic Approaches
 Humanistic therapies overlap
considerably with existential
approaches.
 Both emphasize growth and
fulfillment of the self.
 Goals are for self mastery, selfexamination and creativity.
Comparison of Existential Therapy to
Other Therapies
Most Different
Behavioral
Humanistic
Most Similar
Psychoanalytic
Other Key Contrasts of Existential
Theory Compared to Other Systems
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Existentialists reject concept of the
person as propelled by drives and
instincts.
Existentialists feel Jungians quickly
avoid the patient’s immediate crises by
being too focused on theory.
Client-centered therapists do not
confront the patient directly and firmly.
Precursors
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Philosophers, theologians, poets
throughout time have wrestled with
existential issues.
Epicurus emphasized death concerns
may not be conscious to the individual
but might be inferred by disguised
manifestations.
Nabokov viewed life as crack of light
between two eternities of darkness.
St. Augustine believed that only in the
face of death is a person’s self born.
Beginnings
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Term existentialism is associated with
Sartre and Marcel.
Influenced by philosophers including
Heidegger, Husserl, Levinas and
Buber.
Central foundational philosophers of
existential psychotherapy are
Kierkegaard and Nietzsche.
Rollo May

Existence: A New Dimension
in Psychiatry and
Psychology
• May, Angel, and Ellenberger
• Introduced existential
psychotherapy to the US in
1958.
• May wrote two main
chapters:
– The Origins of the Existential
Movement in Psychology
– Contributions of Existential
Psychology
Beginnings
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Other influences:
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Binswanger
Ellenberger
Minkowski
Straus
von Gebsattel
Kuhn
Fromm
Beginnings
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Works by Yalom
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Existential Psychotherapy (1980)
Love’s Executioner (1989)
Momma and the Meaning of Life (1999)
When Nietzsche Wept (1992)
Lying on the Couch (1996)
The Schopenhauer Cure (2005)
The Spinoza Problem (2012)
Staring at the Sun: Overcoming the Terror of
Death (2008)
Other Key Writings
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Victor Frankl
• Man’s Search For Meaning (1956)
– Influential text that sets out an
approach to logotherapy, a form of
psychotherapy focused on will,
freedom, meaning, and responsibility.

Allen Wheelis
• How People Change (1973)
– Wrote about the specter of death and
the search for meaning.
Current Status
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Existential psychotherapy has never
supported specific institutes because
it deals with issues underlying
therapy of any kind.
Existentially-oriented
psychotherapists tend to further their
knowledge through personal therapy,
supervision, and reading.
Current Status
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Therapists trained in different schools
can legitimately call themselves
existential if their assumptions are in
line with those of existentialists.
Concerned with rediscovering the living
person amid dehumanizing modern
culture.
Human-focused approaches to
psychotherapy suffer in a climate of
market forces.
Existential Therapy
"... is concerned with patients' ways of
dealing with the fundamental issues of
human existence, the meaning and
purpose of life, isolation, freedom and the
inevitability of death. In this method of
treatment, increased awareness of the self
is more important than exploration of the
unconscious, but many of the techniques
are borrowed from brief psychoanalytic
therapy."
Oxford Textbook of Psychotherapy
Theory of Personality
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Existential focus concerns whether
or not people are living as
authentically and meaningfully as
possible.
Utilizes a dynamic model of
personality as a system of forces in
conflict with one another.
Emotions and behavior may exist at
different levels of consciousness.
Existentialists
Suggest we do not possess a
personality rather we embody an
experience.
 Neurosis is tantamount to
avoidance.

• Example: Neurotic individuals are
living in the every day rather than
dealing with the challenges of ultimate
concerns.
Psychotherapy
and Freedom

Freedom is the capacity to choose
within natural and self-imposed limits of
living.
•
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Freedom implies responsibility.
Destiny refers to awareness of our
limitations.
The ultimate limitation is death.
Through struggle, freedom and destiny
are appreciated.
Psychotherapy and Isolation
Authenticity must be modeled by
the therapist.
 Therapist meets the patient in the
space between “I” and “Thou.”
 Therapeutic relationship heals
through therapist’s presence,
genuineness, and receptiveness.
 Done from a position of being a
fellow traveler.

Psychotherapy and
Meaninglessness
Therapist must be aware of the
importance of meaning as for
some it is profound and pervasive.
 Jung estimated that >30% of
patients sought therapy because
of meaninglessness.
 Victor Frankl:

• “Happiness cannot be pursued, it
can only ensue.”
Psychotherapy and Death
“An awakening experience.”
 A personal confrontation with
death may cause a radical shift in
life perspective and lead to
personal change.
 Death anxiety may be a primary
focus of therapy.

Every Day Concerns
and Existential Issues
 Fear
of flying
• Ultimate concern of death
 Difficulty
adjusting after a
divorce
• Ultimate concern of isolation
Existential Frame of Reference
Awareness of Ultimate Concern
Anxiety
Defenses
Denial Systems: Specialness
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Individuals hold beliefs of personal
inviolability, invulnerability, and
immortality.
Unconsciously, individuals believe laws
of biology do not apply to them.
People can camouflage their fears of
death behind a belief that one’s
specialness will somehow override it.
People may seek therapy when the
defense of specialness fails to ward off
anxiety.
Denial Systems: Belief
in an Ultimate Rescuer
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Belief that someone is watching over in
an indifferent world.
People may imagine their rescuer to be
human or divine.
May result in a character structure
displaying passivity, dependency, and
obsequiousness.
Individuals may dedicate their lives to
locating and appeasing an ultimate
rescuer.
Process and Content
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Strategies similar to other dynamic
therapies, but with different content.
Focus on patient’s current life situation
and enveloping unconscious fears.
Therapeutic relationship viewed as
fundamentally important in itself,
especially with regard to engagement
and connection.
Emphasis on a here-and-now, not from
a longitudinal perspective.
Therapeutic Goals
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Focus is on the self experience of the
patient, and capacity for selfactualization and self-transcendence
through engagement in life.
Goal is anxiety reduction and
constructive use of the anxiety.
Therapeutic Goals
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Identify methods and instances of
responsibility avoidance.
Help patients make decisions and
tolerate uncertainty.
Address existential isolation directly.
Address meaninglessness with
engagement.
Confront death and death anxiety.
Mechanisms
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Empathy
The here-and-now
Dreams
Fellow travelers
Genuineness
Mechanisms
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Therapists’ personal therapy
experiences
Therapist transparency
Seeks unfolding, meeting, and
presence
Applications
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Therapy can be adapted to different
situations and conditions.
A thorough existential approach with
ambitious goals is most appropriate in
long-term therapy.
Shorter durations can be effective.
Applications
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Appropriate with patients who confront
boundary situations.
• Confrontations with death, important
decisions, sudden isolation, or milestones
that mark passages

Individuals, groups, families, and
couples
Evidence
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May take the form of idiographic
examples and anecdotes that share
some common themes.
Gains continue to elude
randomized-controlled trials and
objective forms of research.
Evidence highlights the relationship
as the mechanism of healing.
Existential Therapy in a
MultiCultural World
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All humans share in the dilemmas of
existence and must come to terms
with the ultimate concerns.
Difficulties arise when individuals
adopt broad formulas for managing
ultimate concerns based on their
cultural and religious systems.
Cultures create belief systems that
defend against the terrors of stark
confrontation with existential
concerns.