Freedom
Humans are condemned to freedom, and
existential therapists have followed suit by
articulating the many ways in which freedom is
an anxiety-loaded burden (Sartre, 1971).
Personal responsibility is the first and primary
burden of freedom. If you are free, you are
responsible. Every action becomes a choice.
• The more freedom you experience, the more
choices you have; and the more choices you
have, the more responsibility you have.
• Personal responsibility is a heavy burden to
carry. It’s so heavy that many individuals can’t
bear the weight. When the weight of personal
responsibility is too heavy, individuals defend
themselves with denial, displacement, and
blaming.
Isolation
Every individual is fundamentally alone.
We enter life as an independent being and we leave
from life alone.
Many individuals who come for therapy come
because of social problems that include feelings
of loneliness.
Isolation
The goal of existential therapy with respect to
isolation is to help clients connect as deeply
as possible with others. Yalom refers to this as
a “need-free” relationship. Need-free
relationships are unselfish relationships in
which one person knows another person
intimately, gives love without a personal
agenda. When a need-free relationship exists,
both parties usually feel more alive and
engaged in life.
Isolation
Martin Buber has written on the “I-Thou”
relationship. An I-Thou relationship has the
deepest of all possible connections between
two individuals. It is a completely mutual
relationship. I-Thou moments are rare and
relatively brief. This is the relation toward
which we should strive, but it is impossible to
live consistently in an I-Thou connection.
Isolation
Yalom claims that denial is the most common
way that humans deal with the conflict between
being an individual and experiencing the
frightening quality of existential isolation.
One of the most common forms of denying
isolation is through love with another individual.
Isolation
You’ve been around friends, relatives, or clients who
desperately seek social or intimate contact. These
individuals hate being alone, and if they’re in an
intimate relationship that ends, they move quickly
to replace their former partner. They have not
developed the inner strength, identity, and sense
of completeness to face the painful anxiety
associated with existential isolation.
Isolation
• The heightening a client’s awareness of
existential isolation should improve the ability
to form healthy interpersonal relationships.
• Getting in touch with existential isolation has
a positive effect. To face aloneness gives us
the strength to face the world.
Meaninglessness
The existential crisis or existential neurosis
occurs when an individual faces the
question “What is the meaning of my life?”
Seeking life’s meaning can be an painful
process. It’s common for many of us to just
stay busy with daily activities, instead of
grappling with life’s biggest question.
Meaninglessness
Most existentialists would likely respond to “It is
up to you to invent, create, or discover meaning
in your life. Your challenge is to find meaning in
meaningless world.”
Meaninglessness
Frankl has written the most about the
importance of living a meaningful life. He
believes the “will to meaning” is a primary
motive.
Many clients come to therapy because they are
suffering from the absence of meaning in their
lives.
Is Life Meaningful?
Frankl is claiming two things:
1. Humans have a will to meaning.
2. Meaning does exist in the world, it’s up to us to
find it.
Frankl emphasizes that the individual does not find
meaning through preoccupation with the self. We
must look outside ourselves to find meaning.
Is Life Meaningful?
Frankl’s approach to helping clients find
meaning in life is logotherapy (logos =
meaning; therapeia = healing).
The key to logotherapy is to confront clients
directly with the need for meaning. Clients
are responsible for their lives and choices
regarding the seeking of meaning.
Is Life Meaningful?
The question “Is life meaningful?” can be answered
in many different ways:
• Altruism: Clients can serve others by
unselfishness.
• Dedication to a cause: Clients can dedicate
themselves to political, religious, medical,
familial, scientific, or other causes.
Is Life Meaningful?
• Creativity: Clients can choose to create
something beautiful, powerful, and
meaningful.
• Self-transcendence: Guilt, depression,
personal salvation, and other self-oriented
goals can be put aside to follow selflessness.
Is Life Meaningful?
• Suffering: Clients can face suffering with
optimism, dignity, and integrity.
• God/religion: Clients can focus on serving God
or their religion instead of serving self or
seeking material goals.
Is Life Meaningful?
• Hedonism: Clients can choose to live life to the
fullest each moment, to drink up the
excitement, joys, and sorrows of daily life.
• Self-actualization: Clients can dedicate
themselves to self-improvement, to meeting
their potential.
Existentialism and Pessimism
Death,
Freedom>>>>Burdens of responsibility,
Love>>>>>>>isolation
Meaninglessness
Existentialism is often linked with
depressing thoughts about life’s ultimate
concerns.
But the goal is not pessimism or depr, but
to embrace life and foster hope.
Self-Awareness
Self-awareness is central to existential
therapy. The goal of existential therapy is to
facilitate self-awareness—including the
awareness of death, freedom, isolation,
and life’s meaning.
Humans are always looking at themselves and
engaging in self-discovery.
Theory of Psychopathology
Psychopathology results from failure to
adequately face and integrate basic inner
daimonic impulses, and from failure to
acknowledge life’s ultimate concerns. It
results from decreased self-awareness.
Theory of Psychopathology
Signs of decreased self-awareness:
• Emotional numbness or automation living
• Avoidance of one’s anxiety, guilt, or other
meaningful emotions
• Avoidance of inner daimonic impulses.
• Failure to acknowledge and reconcile life’s
ultimate concerns
Successful therapy is about living as fully in the
moment as possible.
Neurotic behavior is linked to avoidance. As
clients reject natural urges and avoid ultimate
concerns, they progressively or suddenly
develop psychological, emotional, or
behavioral symptoms.
Theory of Psychopathology
The treatment involves facing oneself, facing
life, and acceptance the reality of death,
freedom, isolation, and meaninglessness.
This does not mean that life becomes easy.
However, clients who face ultimate concerns
with an integrated sense of self will
experience normal anxiety and guilt, rather
than neurotic anxiety and guilt.
The practice of existential therapy
• Providing informed consent is essential in
existential therapy. Here-and-now interactions
should continue gently and educationally in
first session.
A Word (or Two) on Specific Therapy
Techniques
– Existential practitioners are generally reluctant to
discuss therapy techniques because technical
interventions are viewed as artificial or fake.
– The I-Thou interpersonal existential encounter
is viewed as the change agent and not
technique.
• Firstly, the interpersonal therapy encounter
develops. Then, therapists may use specific
techniques for awareness, creativity and selfdevelopment.
The Therapy Process
– I and Thou,
– Here and Now,
– What and How
The therapeutic factor employed by
existentialists is the therapeutic encounter.
This encounter is best articulated by Buber’s IThou relationship. The therapy encounter
facilitates creativity, the expansion of
awareness or consciousness, and selfdevelopment.
Forming an I-Thou Relationship and
Using It for Positive Change
I-Thou relationship is characterized by:
–Depth
–Mutuality
–Connection
–Immediacy
• Personal Responsibility: As the therapist,
you’re responsible your behavior within the
session. You aren’t responsible for your
client’s wellbeing, but you are responsible
for therapy process. Therapist’s job is to
create conditions to facilitate an
interpersonal therapeutic encounter and
avoid behavior inhibiting therapy.
• Presence: As the therapist, you’re alert,
interested and as fully in the room as
possible during every minute of every
session. If you feel bored or distracted, your
responsibility is to get reconnection.
• Here and now.
• Empathic Mirroring and Focusing:
• Some specific verbal techniques:
– Topical focus: «take a moment to see what’s present for
you». «what really matters right now?» «Can you give me
an example?»
– Topical expansion: «tell me more» «stay with that feeling
a few moments».
– Content-process discrepancies «you say you are fine, but
your face is downcast». «when you talk about that job,
your eyes seem to get wet».
• Feedback and Confrontation:
• When therapist are ready and mirroring back
to clients what they see, hear and
experience, feedback and confrontation are
used. Feedback and confrontation are
together with presence, empathic mirroring
and focusing.
– Without a strong therapeutic connection or
alliance, feedback and confrontation can be too
painful to integrate.
Mindfulness is a Buddhist approach, emphasizes
acceptance of one’s thoughts and of challenging
life situations.
Mindfulness meditation was a factor in the
development of Linehan’s dialectical behavior
therapy, Acceptance and Commitment Therapy &
Mindfulness Based Cognitive Therapy.
Mindfulness emphasizes acceptance of internal
cognitive thought processes.
Existential Therapy Techniques
Specific Existential Therapy Techniques
Most existential therapists reject the use of
techniques. Some existentialists, particularly
Frankl and Fritz Perls, wrote about
interventions:
Paradoxical Intention
Cognitive Reframing
Paradoxical Intention
Paradoxical intention was a technique originally
used by Alfred Adler.
Frankl attributes the success of this approach to
humor. He claims that humor is therapeutic in
that it allows individuals to place distance
between themselves and their situation.
• Frankl emphasizes that through this
technique, clients are taught to intentionally
exaggerate, rather than avoid, their personal
existential realities. Frankl claims that
paradoxical intention is effective for anxiety,
compulsions, and physical symptoms.
Cognitive Reframing
has its origins in the individual psychology of
Adler. However, Frankl employed this
technique, and later Ellis and Beck
emphasized its power as a therapeutic
technique.
Awareness and Existential
Integration
• Constriction, expansion and centering:
Constriction and expansion are natural
human rhythms. We experience intermittent
periods of expansion and constriction.
Expansive periods are characterized by
growth, risk, and moving forth, Constrictive
periods are characterized by inhibition,
isolation, and drawing back.
Shifting from expansion to constriction to
expansion is healthy. Different situations
produce a natural rhythm between expansion
and constriction.
• Therapists are intermittently nondirective and
directive. They develop an I-Thou relationship,
then push the clients to difficult issues. Doing
existential therapy requires significant training
and personal psychotherapy.
• Existential therapy focuses on moment to
moment experiences inside and outside the
therapy office. Therapists don’t depend on
treatment planning.
• Therapist is not comfortable offering direct
advice. Offering direct advice is inconsistent
with existential philosophical values to impose
her frame for living onto her client.
• When it comes to big life decisions, an
existential therapist doesn’t assume to know
what’s best for another person.
• Generally, the client’s problems are related to
weakened awareness, avoidance of death
anxiety, and avoidance of acknowledging the
limits of personal control.
Interventions
Therapy techniques include:
 establishing a therapeutic presence (I-Thou
relationship)
 empathic mirroring
 feedback and confrontation
 cognitive reframing
 monitoring client’s constrictions and expansions
with the goal of becoming a more centered, selfaware and intentional being.
Outcomes measurement
• Traditional existential therapists don’t believe
in using assessment instruments.
Psychometric assessment procedures are
useless, antitherapeutic and/or unethical
because they decrease the human encounter.
• But, to narrow the focus and to seek the
measure specific behaviors are possible. In
some existentialists’ model, the focus is on
meaninglessness.
• Life Regard Index (Battista & Almond, 1973)
• Purpose in Life Test (Crumbaugh, 1968; Crumbaugh
& Henrion, 1988)
• Seeking of Neotic Goals Test (Crumbaugh, 1977)
• Spiritual Meaning Scale (Mascaro, Rosen, & Morey,
2004)
• Toronto Mindfulness Scale (Lau et al., 2006)
Cultural and Gender Considerations
• Existential therapy continues its paradoxical
preoccupation with polarities.
• Some view it as culturally and gender
insensitive. Because it emphasizes on the
individual experience and discovery of the
unique self, it can be viewed as
ethnoculturally sensitive. Feminists complain
that existentialism is a theory of wealthy,
white, Western men.
Cultural and Gender Considerations
“Only in existentialism and the movies, people have
unlimited freedom, construct their own meanings and
execute boundless choices. Save it for the wealthy,
worried well.” (Prochaska & Norcross, 2003, p. 133)
• Others view it and enact it in a way that is
respectful of the individual.
Cultural and Gender Considerations
• To say «I know how you feel» is a violation of
existential therapy.
• The best we can do is to communicate to
clients, regardless of their cultural
background.
Evidence-Based Status
• There is a small amount of empirical research
supporting existential group therapy.
• There is some research on the effectiveness of
paradoxical intention.
Concluding Comments
• Existential therapy is about finding meaning.
It’s about facing the fact that we die and often
we feel very much alone.