Existential Therapy
Vos, Cooper et al. article
 Compared to other psychotherapies, little research is conducted on existential therapies
and most of the available studies use a qualitative or phenomenological method and/or
describe only one case
o This may be explained by the underlying existential philosophy that “existence
precedes essence”
o That is: we should not speak in reductionist terms and scientific labels but
focus on the client’s subjective lived experience and on what reveals itself
as truth in the therapeutic relationship
 However, our practices are embedded in a world where health
insurances and governments expect to see quantitative research
as justification for financing mental health care
o ET follows a ‘coherence theory of truth’
o This epistemology implies that all scientific methods are insufficient to
describe the totality and subjectivity of a clients lived experience, as the
client’s reality is not directly accessible by instruments, calculations and
observations
o Existential concepts are difficult to study and operationalize
 ET concepts emphasize that the validation, justification and
improvement of therapies can and should only be developed in
client-centered ways, for instance by focusing on the client’s selfreflection, the therapeutic relationship and the therapist’s own
development
 Clinical Model
o ET does not have one unified clinical model
o Some therapists see the identification of clinical concepts as “labelling”
and burdening clients with psychopathological diagnosis from which they
need to be cured
 Opposes the existential assumption that the client’s subjectively
lived experience is irreducible to any label or diagnosis and that
the problems of the client often have to do with universal
problems in living that need to be accepted and faced
o Authors asked leading ET psychotherapist to discuss their implicit understands
and definitions of ET. Although consensus was not achieved, several assumptions
were frequently reported and developed into an existential model of clinical
distress
o Assumes that there are ‘givens of existence’ which define the
phenomenological reality of clients, such as our human capacity for
freedom and choice, being embedded in relationships with others and
our world and inevitably facing limitations and challenges
o Assumes that clients immediately understand these ‘givens of existence’
as they have a primary subjective phenomenological flow of experiencing
their daily life world
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 Only secondarily, they may give meaning/interpretation to these
experiences and thus cover the primary experiences of these
givens
 The primary experience of life’s givens has often been described
in terms of existential moods, such as death anxiety, existential
guilt, isolation, urgency, absurdity, boredom and vacuum
o Existential moods differ from emotions and
psychopathology, as they do not have a specific object or
meaning but regard a primary unstructured experience of
existence-as-such
 For instance, is there any sensible way to measure
these constructs
Assumes that individuals have the freedom to either authentically accept
these existential moods and face these givens (“uncover reality”) or to
inauthentically deny or avoid these (cover reality)
 Many individuals respond w/ existential defense mechanisms in
confrontation with the bare givens of their existence such as
mortality – through denial, avoidance, re-interpretations – shifting
their attention to what is meaningful in their life
Assumes that individuals are oriented to, driven or motivated by
existential ‘ needs’ ; and they seem to function more effectively when
these are fulfilled, for instance by actualizing their human potential and
taking responsibility for their choices
 Meaning in life has often been described as crucial for optimal
human functioning
Assumes that individuals may differ in how they cope with the givens of
existence, due to differences in existential skills and life experiences
 Such individual differences can be seen regarding the important
skill of accepting our primary experiencing, life’s givens and life’s
irresolvable tensions and paradoxes
o The latter implies that clients have the capacity to develop
a ‘dual attitude;: simultaneously accepting life’s
possibilities/freedom/responsibility and its limitations
 Research from pilot studies suggests that only 70%
of people have this skill
 At later age, it may be possible to develop a dual
attitude, for instance in psychotherapy
 Intervention studies demonstrate the
possibility of learning to tolerate existential
moods, be flexible, and simultaneously
commit to daily life and accept life’s givens
Assumes that ineffectively coping with life’s givens may result in
psychological distress and requesting psychotherapeutic intervention
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 For instance, individual may ask questions about life leading to a
crisis or demoralization, regarding meaning of life,
spirituality/religion, identity and existence
 Existential concerns and not merely psychopathology may explain
the request for psychotherapeutic help in individuals, especially in
boundary situations in life – e.g. being diagnosed with a fatal
health condition, after a divorce, entering retirement, etc.
Therapeutic Model
o Organized into three overarching domains, crossing the difference b/w particular
existential schools: phenological practices, relational practices and practices
informed by existential assumptions
 Phenomenological practices focus on the client’s subjective flow of
experiencing, to do just to the totality of the client’s inner experiences
and help them gain deeper self-awareness and insight
 This includes adopting of an “understanding stance towards the
client”
o Possibly associated with Roger’s person-centered practice
of empathy
 Relational practices focus on establishing an in-depth, authentic
therapeutic relationship with clients; along with reflection, on and
analysis of the relational encounter
 Four main relation categories in ET
1. Adopting a relational stance (e.g. being present, caring,
authentic)
2. Addressing what is happening in the therapeutic
relationship (being aware of one’s reactions to the client,
self-disclosure)
3. Relational skills (therapeutic listening)
4. Person-centered skills (equal power relationship,
unconditional positive regard)
 Aside from ET, empirical research strongly supports the emphasis
on the quality of the therapeutic relationship, with APA Task force
concluding that “the therapy relationship makes substantial and
consistent contributions to psychotherapy outcomes independent
of the specific type of treatment
 Practices informed by existential assumptions involves explicitly
addressing life’s givens, such as freedom, choice, responsibility, being-inthe-world, mortality, existential anxiety and uncertainty of being
 Explicitly exploring the client’s worldviews, their ways of relating
to life and their authenticity
ET can be effective for clients with a particular strong wish to speak explicitly about
existential topics such as cancer patients and those in palliative care contexts
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This may be explained by the fact that negative life events, such as
physical suffering often elicit explicit existential concerns
 Such events seem to shatter the fundamental positive illusions
that many people have in daily life for instance that they are
invulnerable, immortal and in control and that life is just and
understandable
Despite serious limitation such as small number of studies, some clients
may significant benefit from certain types of ET
 Particularly clients in boundary situations in life may benefit from
meaning-oriented group therapies
 ETs have similar or slightly larger effects than other nonexistential psychotherapeutic interventions for cancer
patients such as cognitive-therapy and mindfulness
 Few studies about clients without physical diseases; the existing
studies in physically health samples suggest small, non-significant
effects
Existential Therapy: 100 Concepts
 What is existentialism?
o Ultimately existentialism concerns itself simply with what it is to exist as a human
being. It is a philosophical approach to understanding our experiences, our world, our
relationships and this thing we call our ‘self’. It doesn’t deny the validity of natural
science, but makes the point that human beings cannot be fully understood in terms
of it. Human existence can be understood only through a thorough examination of
our experience of what it means to be (Heidegger, 1978) and through an
understanding of the universal issues we face in being human, including freedom,
responsibility, meaning, isolation, death and anxiety.
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Historical backgrounds, philosophical foundations
o The roots of existential therapy lie in 3,000 years of philosophy and, in particular, in
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the human quest to understand life and overcome adversity (Deurzen, 2007). These
roots encompass the wisdom of the Ancient Greeks, incorporating tenets of Eastern
philosophies such as Buddhism and Taoism and taking inspiration from the work of
an eclectic mix of philosophers, writers, artists and theologians.
Existential philosophy -it was a philosophy that emphasised human individuality,
freedom and responsibility, and encouraged resistance to systems of thought that
sought to control, or to reduce the complexity of human existence to a set of laws,
rules or statistics
Often described as a study of things as they appear, phenomenology was originally
developed by the German mathematician Edmund Husserl (1859– 1958). Husserl
rejected the idea that truth was to be found solely in objective, natural science and
instead proposed a method of studying human experience that acknowledged both
the objective and the subjective.
 What phenomenology aims to do is reveal things as they actually are by
studying them in a way that removes the assumptions and preconceptions
that limit our understanding of the
o Existential psychotherapies, including Daseinsanalysis, Logotherapy, and the therapies
that make up the American and British schools of existential therapy, each bring their
own particular blend of ideas from existential philosophy and phenomenology and
present credible alternatives to therapies based on the dominant medical model of
mental health.
o The basis of an existential approach to therapy
o Unlike other forms of psychotherapy, which take their inspiration primarily from
psychology or medicine, existential therapy is philosophy-based.
o The existential therapist recognises that we all face certain universal conditions and
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that the differences between us come down to how we choose to respond to these
conditions.
Existential therapy focuses on this uniqueness – resisting the tendency to place
people in boxes or typologies according, for example, to their personality, age,
gender, educational background, behaviour, sexual preferences, political views or
choice of lifestyle. It is therefore a ‘non-pathologising’ therapy, in which a very wide
range of human thought, behaviour and emotion is considered normal, and where
terms like ‘diagnosis’, ‘illness’ and ‘symptoms’ and the medical model of mental
health are seen as largely unnecessary and potentially harmful, restricting both our
understanding of their world and the sense of responsibility and freedom with which
we approach our challenges.
clarifying their worldview, their values and beliefs, and the attitude they take to their
world, and to the people and events they encounter. Illuminating these stances
leaves the client free to consider whether or not these ways of being, thinking, feeling
and behaving will best help them live a life in line with their values, a life that is
meaningful, a life in which they engage actively with the choices they make and
strive to make them in light of their own needs and the needs of others.
The existential therapist recognises that we are good at deceiving ourselves and that
this ability to rationalise, ignore or underestimate the significance of evidence that
contradicts what we want to believe can often make us strangers to ourselves,
standing in the way of our ability to truly know our reality. As a result, we may refuse
to see how we, or other people, are contributing to our unhappiness, distress or lack
of fulfilment, perhaps because we are frightened of what we might lose, or how we
might have to change if we were to open our eyes.
Clients are invited to describe and examine their behaviours, relationships, thoughts
and ideas and encouraged to be open to those alternative ways of thinking, behaving
and being that they are not currently choosing. Existential therapy is not necessarily
about major change (though for many clients it leads to new and profound ways of
being). A client may decide to make some, or even many, changes in their life, or
they may decide not to make any outward changes at all. Often the inward changes
in emotions, attitudes and ideas are enough to allow them to move forward and deal
with any challenges they are facing.
Although existential ideas are relevant to everybody, existential therapy is not a
flavour of therapy that everyone finds palatable (Tantam, 2002). It demands much of
clients, who must be prepared to wrestle with, and ultimately come to accept, the
dilemmas and paradoxes of human existence, to take responsibility for the choices
they make (and the consequences that result from them) and to confront absurdity,
meaninglessness and the finitude of their own existence with courage and tenacity.
Existential Therapy Here and Now
o Over the last ten years, the number of schools of existential therapy around the world
together with the number of practicing existential therapists has grown rapidly
o Reflects the continuing dominance of the British School of Existential Therapy in the
development and promotion of existential theory and practice
o Types of existential therapies and representation per region:
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The Universals of Human Existence
o The universals of human existence are the conditions that pertain to every human
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life, across all cultures, and across all époques. These conditions are often referred
to as ‘givens’, or the ‘existentials’
Philosophers and practitioners focus their enquiries on different existential
universals, making it difficult to establish a definitive list. However, almost all those
that hold an existential perspective agree on these fundamental givens: freedom,
temporality, facticity, which is also known as ‘throwness’ (Heidegger, 1972) (the
specifics of our situation that are beyond our choice, e.g. the place of our birth, the
fact of suffering and death), choice, death, uncertainty, isolation and relatedness,
meaning and meaninglessness, guilt and anxiety.
 Each and any of these givens have implications for the others; it is difficult to
even speak of one aspect without referring to the others.
These dimensions of human existence are inescapable: they affect everyone, all the
time. Although at particular times in our clients’ lives one concern may seem to be in
the ‘foreground’, or the dominant aspect of their focus, in reality, all the other givens
are in attendance.
What is valuable about the existential therapist’s perspective on universals or givens
is that they recognise that although these givens are inevitable, how any of us
respond to these is a matter of choice.
Existential therapists do not impose a value judgement on such responses. Instead
they provide a space where their clients can explore their reaction to the different
universals and consider a full range of alternative stances.
Existence Precedes Essence
o When Sartre coined the phrase ‘existence precedes essence’ he was reminding us
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Daseinanalyis – represents ET from Canada, Greece, Switzerland, Austria
and Brazil
 In Europe, Daseinalysis and Logotherapy (meaning focused) dominate
 In the US, existential-humanistic therapy is preeminent, largely because of
the popularity of the leading proponent Victor Yalom
There are many challenges facing existential therapists today – including how to
explain and teach an approach that has been inspired by such a diverse range of
thought, and that takes an epistemological stance that resists systematisation,
indeed considers it to be the antithesis of good practice.
that just as there are an infinite number of ways of being a table, there is no
predetermined pattern, set of ideal characteristics or ‘essence of human being’, that
we need to fit into.
For the existentialist, a human being is not a clearly defined object, or an essence
that can be totalised, finalised or perfected. There is no ‘human nature’ that defines
us. Therefore we cannot seek to understand another by slotting them into convenient
typological boxes in the form of personality types, levels of intellect, groups of
medical symptoms or astrological signs. In the therapeutic setting, these
classifications serve only to hide the uniqueness of the individual by encouraging
both parties to make assumptions about the client, thereby restricting that individual’s
awareness of her freedom to change.
When clients seek to categorise themselves – ‘I am a depressive’, ‘I have my father’s
personality’ – the existential therapist will be curious as to how and why they have
chosen to identify these things as part of the ‘essence’ of who they are and what the
implications of these choices are for that individual.
Four Worlds: Physical, Personal, Social and Spiritual
o Many existential therapists use this model as a basis for thinking about and exploring
their clients’ worldviews. Deurzen-Smith (1995, p9) suggests that when clients
describe their experience of each of the worlds in detail they gain insights into how
they see the world and their place within it and ‘become truthful with themselves
again’.
 The Umwelt or physical dimension refers to embodiment and the physical
environment. This is the most fundamental of the dimensions, as we cannot
be human without having a physical presence, and without being affected by
the elements in our environment,
 Key polarities within this dimension include birth versus death and
expansion versus contraction of the physical world.
 The Mitwelt or social/public dimension comprises everyday social
interactions; this would include our attitudes towards public constructs such
as race, gender, class or family, for example. It would also include ways in
which we relate to others, and contains polarities such as trust versus
distrust, competition versus cooperation and conformity versus
individualisation.
 The Eigenwelt or personal/private dimension is that which reflects our
attitudes and assumptions about the intimate others in our lives, as well as
the view that we hold of ourselves. This is the dimension we most commonly
associate with counselling, as it involves the person’s relationship to his or
her self and to family, close friends, etc. (Deurzen & Kenwood, 2005). In this
context we may discern how the client values, or devalues, themselves, as
well as the meaning and attitudes they hold with reference to their closest
friends and family. Polarities in this dimension include self-acceptance versus
selfdevelopment and authenticity versus inauthenticity.
 The fourth dimension is the Überwelt or spiritual dimension , which includes
our assumptions and perspectives on the world, the universe and the
cosmos. Here we find our philosophical and spiritual values and assumptions
about life, and the sphere beyond. Polarities within this world include
meaning versus meaninglessness, good versus evil and transcendence
versus mundanity. These dimensions are inter-connected and crossreferential, in much the same way as the givens of existence: it is difficult to
consider one without implicating the others. This model is a structure by
which we can begin to understand our own and others’ worldview. It helps
the therapist to stand back from the client’s day-to-day concerns and ensure
that all the different aspects of their reality are explored (Cooper, 2003).
Where there is an emphasis on one dimension in a person’s concerns, or
when there is a paucity of reference to any particular category, these
imbalances are suitable focal points for reflection and exploration
o The Foundational Elements of an Existential Therapeutic Relationship
o The initial meeting between client and therapist continues the process of ‘co-creating’
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the therapeutic relationship that started as soon as initial contact was made.
 As Cohn (1997, p33) points out: The client you meet as the therapist is the
client who meets you. There is no client as such. If two therapists meet the
same client, it is not the same client.
It is advisable to notice the quality of relationship that has already begun, even
before the first meeting: what impressions linger, what assumptions are in play. The
phenomenological method can provoke reflection and assist in clarifying and
bracketing pre-judgements and suppositions.
The client’s worldview begins to unfold at the first utterance: the narrative reveals the
significant relationships and issues that are currently demanding their attention.
Role of the therapist
o The existential phenomenological stance regards each client as individual and each
therapeutic encounter as unique. Unsurprisingly, therefore, existential therapists are
concerned that articulating ‘a way of being a therapist’ will result in the application of
an approach to working with clients that is rigid and manualised.
o Some forms of existential therapy are more explicit about the role of the therapist,
than others. Deurzen, for example, describes the therapist as a ‘mentor’ or ‘wise
person’ who brings a special wisdom and experience to the client’s reflections
(Cooper, 2003). In Logotherapy, therapists are expected to take charge of the
therapeutic process, while therapists influenced by R.D. Laing (1960) will allow the
client to structure the session. In Daseinsanalysis, the therapist may focus on the
client’s maladaptations and dysfunctional ways of being, while therapists who share
the philosophy of the anti-psychiatry movement might look for the intelligibility and
purposefulness of the client’s symptoms (Cooper, 2012).
o What is true in all forms of existential therapy is that the role of the therapist will
reflect the aims of therapy and the therapist will start by facilitating an exploration of
the client’s lived experience, that is, her ‘worlding’ as represented by her worldview.
o In a joint enterprise, the therapist and client work to clarify the values and
assumptions integral to the client’s worldview.
o The emphasis is on ‘being with’ the client: this is in the service of establishing a
relationship in which the client can more readily and freely describe their lived
experiences. Existential practitioners do not aspire to cures, or even changes in
behaviour: rather, they provide a relationship that offers the opportunity for the client
to reflect on the nature of their own difficulties, and possible alternative ways of
responding to their possibilities of being-in-the-world.
o the practitioner must resist attempts to be drawn into suggesting particular changes
or remedies to the client’s difficulties.
Role of the client
o Each client must come to find their own, personal way of being in the world and must
choose for himself or herself how to face both the universal and the unique
challenges their journey presents.
o On those occasions when a significant understanding or shift in perception occurs, it
is useful to reflect what has happened, and how it has been a consequence of the
client’s willingness to reflect and explore, providing further demonstration as to how
the participation of both therapist and client serves the aims of therapy. Additionally,
when there are meetings in which the client does not feel inclined to participate, this
too should be viewed by the therapist as an opportunity to discover with the client
what is impeding their engagement; this, again, can illustrate to the client that the
quality of the engagement, as well as that of the therapy, is, in part, a consequence
of their own contribution. Finally, it is the role of the client to determine if the therapy
is useful; in fact, it is their obligation. If there is an educative element to the therapy, it
is in the appreciation of how reflection can clarify, to some extent, the basis on which
the client chooses to live their life.