Existential Psychotherapy is a way of doing psychotherapy grounded in the existential philosophical tradition. In contrast with other contemporary approaches that theoretically depend from a theory on the human psyche, Existential Psychotherapies pursue a philosophical understanding of man while focusing on central and universal issues of human existence. The existential way of doing psychotherapy seeks the understanding of one’s position in the world and the clarification of what it means to exist, aiming to help people authentically cope with life’s core dilemmas. It is committed to exploring these questions with a reflective openness and a non-dogmatic attitude, making use of Phenomenology and Hermeneutics as methods of investigation. The therapeutic process is conducted with broad-mindedness and an attitude of wonder, as free as possible from preconceptions, presuppositions, and pre-established interpretations.
The roots of Existential Psychotherapy are found in the works of existential philosophy and phenomenological school. Although arising from different roots, these two traditions have had a history of close alliance to each other and are often studied reciprocally when applied to psychology.
Existentialism represents most fundamentally a philosophy that attempts to turn its focus on profound problems of human life. Prominent existential philosophers include Kierkegaard, Nietzsche, Heidegger, Jean-Paul Sartre and Karl Jaspers. Sartre summed up his philosophy in 1943, when he wrote that humans are “condemned to be free”. For existentialist philosophers, human existence has a fundamentally distinct nature from anything else – unlike other beings, humans are conscious and aware of their own mortality, which means they have the freedom, and responsibility, of deciding in each moment what to do and how to be.
The school of phenomenology was founded by Edmund Husserl, who was inspired by the concept of “intentionality”, which refers to the essential quality of human consciousness to direct itself towards specific objects and apprehend them as they appear to this consciousness. This led Husserl to propose a philosophy that sought to study phenomena “as they appear” naming it “phenomenology”. The phenomenological method aims to understand the phenomena as they present themselves to consciousness without unnecessary bias.
Existential Psychotherapy took shape as a psychotherapeutic practice during the third decade of the 20th century, as many psychiatrists and psychologists in Europe began to take an interest in the existential or phenomenological ideas by applying them to their work. Paramount figures that synthesize existentialism with the fields of psychiatry and psychology include Ludwig Binswanger, Medard Boss, Viktor Frankl, R.D. Laing, Ernesto Spinelli and Emmy van Deurzen in Europe and Rollo May and Irvin Yalom in the U.S.
Existential therapy focuses on attempting to understand the human condition. It rejects a fixed view of human nature but instead contends that each person must ultimately define his/her personal existence. The theoretical concepts that shape this approach encompass:
· Image of the person: Human beings are asserted as open-minded, flexible and capable of an enormous range of experiences. The person is in a constant process of becoming. I create myself as I exist and I am reinventing myself daily. There is no essential self as I define my personality and abilities in action and relation to my situation. This impermanence and uncertainty give rise to a deep sense of anxiety in response to the realization of one’s insignificance and simultaneous responsibility to have to create something in place of the emptiness we often experience.
· Four Ultimate Existential Concerns: Irvin Yalom articulated explicitly the four ultimate givens of the human condition:
1. Death - while life is the “possibility of possibility” (Kierkegaard), death is the “impossibility of further possibility” (Heidegger). Death is the ultimate boundary that limits and structures our existence. Confronting our finitude is necessary to understand our existence and allows us to lead a more authentic life.
2. Existential isolation - we are unable to ever overcome the separation of ourselves from the world. No matter how close one becomes to another, there is an ultimate unbridgeable gap. As Yalom states “To the extent that one is responsible for one's life, one is alone. Responsibility implies authorship; to be aware of one’s authorship means to forsake the belief that there is another who created and guards one. Deep loneliness is inherent in the act of self-creation.”
3. Meaning – humans are meaning-seeking and meaning-creating beings. It is meaning that can make existence bearable. Conversely, the lack of meaning is one of the greatest existential terrors.
4. Freedom - refers to the responsibility and freedom to make our lives as we will, to be the sole authors of our lives, which leaves us groundless with no one to determine our destiny but ourselves. Existential freedom allows us to find, choose and embrace meaning.
The individual's confrontation with each of these facts of life constitutes the content of the existential dynamic conflict that has become the basis for the field.
Existential Angst: Anxiety is inherent to human existence, and it happens in response to Existential Concerns. If, on one hand, human beings develop meaning in one’s life, they face constant uncertainty about their own meanings because they are embedded in the dynamic relationship with others. For existential therapists, existential angst is perceived as a sense of threat to our existence or to the values we identify with, as well as a source of transformation and growth, recognizing it as potentially meaningful and comprehensible reactions to current circumstances and personal contextual history.
· Conceptualization of Psychological Disorder and Health: Disorder and health are two sides of the same coin. It is only by facing the positive and negative poles of existence that we move ahead. Psychological disturbance is seen as a consequence of either avoidance of truth or inability to cope with it. Discontent is generated by many people through self-deception. To be authentic is to be true to oneself and one’s innermost possibilities and limitations, the most important of all being finitude - the impossibility of further possibilities.
Existential therapy is primarily concerned with understanding the individual’s experienced world to help him reach new insights and formulate new alternatives. The process is oriented at grappling with alternative worldviews rather than trying to immediately suppress or eradicate them. Consistent with this, existential therapy tends to be a non-directive and exploratory approach, and not specifically or behaviorally goal oriented.
The principal aim of existential therapy is to clarify, explore, accept and co-exist constructively with the suffering that is inherent to living, rather than to “cure” or free the clients from their symptoms. In this sense, therapy is primarily concerned with helping clients experience their existence from a more original point of view; any symptomatic cure is a byproduct or a secondary goal.
The general therapeutic goals are:
- To develop a more authentic attitude towards the clients’ own existence;
- To widen their perspectives on themselves and the world around them;
- To take stock of their situation, values and beliefs;
- To find clarity on what the purpose in life is and how they can learn from the past and create something valuable and meaningful to live for;
- To understand themselves and others better and find ways of effectively communicating and being with others.
- To make sense of paradoxes, conflicts and dilemmas of their everyday experience.
The Therapeutic Relationship
At the core of this process is a relationship of trust, meant to create a safe space to explore what is one’s position in the world and what he wishes it to become.
Flexibility is necessary. The therapist is ready to consider any past, present or future matter that is relevant to the client. There should also be a constant appreciation of the client’s unique situation and historicity. The therapist takes the dilemmas of the client and solutions with openness and wonder as essential attributes and does not preclude humor when appropriate. They are fundamentally concerned with what matters most to the client avoiding making normative judgments. The existential therapist resists the temptation of trying to change the client. The therapist does not teach or preach how life should be lived.
Main uses and indications
Existential Psychotherapies reject diagnostic categories as the core element of the evaluative process, even if they recognize their importance as cluster descriptions. Indeed, they consider psychopathological disorders as forms of non-authentic existence. Primarily, their approach aims to help people face the anxieties of life and embrace the freedom of choice, taking full responsibility for these choices as they do so. Moreover, the human being is essentially bound by finitude. Existentialists consider the confrontation with death, captured in the concept of Heideggerian concept of “being-towards-death”, as necessary to open the space for singularity and responsibility. The goal is to help individuals live more authentic lives, expanding their autonomy and existential potentialities. Each person is valued in its singularity, and the therapist encourages them to take ownership of their lives, to find meaning and to live fully in the present.
Individuals who are interested in self-knowledge and self-development and those who view their concerns as issues of living rather than symptoms of a psychiatric illness are more likely to benefit from this approach because it values the person in its singular way of being, takes its full worldview and expands the perception about oneself and one’s existential potentialities. Existential therapy is particularly well suited to those facing limit situations, for example, those with a terminal illness or contemplating suicide, or those going through a transition in their life, particularly in the work of grief, or in the face an important decision, as well as coping with physical limitations and chronic medical illness, as it allows existential struggles to be explored with depth and in a holistic manner, offering insights into one’s capabilities and limitations in any given situation.
The existing evidence [A1] regards [A2] Existential Psychotherapies as viable psychotherapeutic models (Elliot et al., 2013). There is evidence that it should be offered as a treatment in three important client populations: depression, relational/interpersonal problems, and those coping with chronic medical conditions (Elliot et at., 2013). Evidential support is specially found in literature [A3] [A4] for structured interventions incorporating psychoeducation, exercises, and discussing meaning in life directly and positively with physically ill patients (Vos J. et al., 2015).
Being and Time, first published in 1927 and written by Martin Heidegger (1889-1976), a German philosopher, was seen as the time of its publication as the most influential [A1] version of existential [A2] philosophy.
Man's Search for Meaning, first published in 1946 and written by Viktor Frankl (1905-1997), an Austrian psychiatrist, neurologist and philosopher, and focuses on his experiences as a prisoner [A3] during the Holocaust and advocates his theory on Logotherapy[A4] , the so-called “Third Viennese School of Psychotherapy”.
Existence, Love and Will and Man’s search for himself, all written by Rollo May (1909-1994), an American existential psychologist and leading figure of the existential [A5] movement.
Existential Psychotherapy, the foundational book of this psychotherapeutic practice, was first published in 1980 and written by Irvin D. Yalom (1931-), American existential psychiatrist and currently, emeritus professor of psychiatry at Stanford University.
Comment from an expert
“Phenomenology is a method but so is the clinic. “Clinic” derives from the greek word Kliné, that means bed. It’s at the bedside of the patient that the clinic is born. Not the patient in general but that concrete patient, unique, singular that is laying down, in pain. The logic of the clinic is the logic of specificity, the singular, the unique. Clinical Phenomenology is then the study of the mode of being of this concrete being that, in the bed or armchair of the clinical office, puts the very question of his being.” — Prof. Vitor Amorim Rodrigues
Comment from a trainee
“Human beings are committed with the ever-unfinished task of giving meaning to their own existence and, in order to do it authentically, they have to confront the givens of existence. The therapeutic encounter in existential therapy is one that promotes such confrontation, a relationship involving being-with and being-for that values the totality of individual experience without fragmenting it. Coming from a background in psychiatry, this is one of the key aspects that impacted my clinical practice.” —Dr. Pedro Sousa Martins
Training and Research
Training and research opportunities are offered in many societies and training institutes linked down below.
Existential Psychotherapy Societies and/or Training Institutes List
· Sociedade Portuguesa de Psicoterapia Existencial (SPPE)
Located in Lisbon, Portugal. Contact: https://www.sppe.pt
· Scuola Italiana di Psicoterapia Esistenziale
Located in Torino, Italy. Contact: www.psicoterapiaesistenziale.org
· Society for Existential Analysis (SEA)
Located in London, UK. Contact: http://www.existentialanalysis.org.uk/
· Associação Brasileira de Daseinsanalyse (ABD)
Located in São Paulo, Brasil. Contact: http://www.daseinsanalyse.org.br/
· Centre et École Belge de Daseinsanalyse (CEBDA)
Located in Bruxelles, Belgium. Contact: http://daseinsanalyse.be/
· École Française de Daseinsanalyse (EFDA)
Located in Paris, France. Contact: http://www.daseinsanalyse.fr/
· Existential Analysis Society of Canada (EAC)
Located in Langley City, Canada. Contact: https://www.existentialanalysis.ca/
· Gesellschaft für Logotherapie und Existenzanalyse (GLE-Ö)
Located in Wien, Austria. Contact: https://www.existenzanalyse.at
· Akademie für Logotherapie und Existenzanalyse
Located in Berlin, Hamburg and Hannover. Contact: https://www.existenzanalyse.com/
· Associazione di Logoterapia e Analisi Esistenziale Frankliana
Located in Piacenza, Italia. Contact: http://alaef.com/
· Nederlands Instituut voor Logotherapie en Existentiële Analyse (NILEA)
· Swiss Society for Logotherapy and Existential Analysis
· Suomen Logoterapiainstituutti Oy
Located in Turku, Finland. Contact: https://logoterapia.fi/
· Sällskapet för Existenstiell Psychokoterapi
Located in Sweden. Contact: https://sept.nu/
· Viktor Frankl Institut
Batthyány, A., & Viktor-Frankl-Institut. (2016). Logotherapy and existential analysis: Proceedings of the Viktor Frankl Institute Vienna. Volume 1.
Elliott, R., Greenberg, L. S., Watson, J., Timulak, L., & Freire, E. (2013). Research on Humanistic-Experiential Psychotherapies. In M. J. Lambert (Ed.), Bergin & Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 495-538).
Heidenreich, T, Noyon, A, Worrell, M, & Menzies, R. (2021). Existential approaches and cognitive behavior therapy: Challenges and potential. Int J Cogn Ther,14, 1.
Nigesh, K., Saranya, T. S. (2017). Existential Therapies: Theoretical basis, Process, Application and Empirical Evidences. International Journal of Education and Psychological Research, 6, 2.
Sun, F.K., Chiu, N. M., Yao, Y. C., Wu, M. K., Hung, C. F., Chen, C. C., Lee, Y. H., Chiang, C.Y. (2021). The effects of logotherapy on meaning in life, depression, hopelessness, and suicidal ideation, in patients with depression: An intervention study. Perspectives in Psychiatric Care.
Vos, J., Craig, M., & Cooper, M. (2015). Existential therapies: a meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83, 1, 115-28.
Zieske, C. (2020). A Brief History and Overview of Existential-Phenomenological Psychology. American Journal of Undergraduate Research, 17, 2, 45-58.