Existential Psychotherapy

Question 1

Existential psychotherapy

Answer 1

Existential 
psychotherapy is “an 
encounter with one’s 
own existence in an 
immediate and 
quintessential form.”
— Rollo May (1967)

Question 2

What is existential therapy?

Answer 2

.. 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.”

Question 3

Can existential be integrated with other approaches?

Answer 3

• Existential psychotherapy can be integrated with
other approaches
• Rather than offering a new set of rules for
psychotherapy, it represents a way of thinking about
human experience that can constitute a part of all
therapies
• Asks deep questions about the nature of anxiety,
despair, grief, loneliness, isolation, meaning, creativity
and love

Question 4

Which are the basic concepts?

Answer 4

• Regards people as meaning-making beings who are
both subjects of experience and objects of selfreflection
• Asks: 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
• Each of us must come to terms with these questions
• Each of us is responsible for who we are and what we
become

Question 5

Where does it focus?

Answer 5

Authenticity and Subjectivity
• Because theories may dehumanize and
objectify people, authentic experience takes
precedence over artificial explanations
• Existential psychotherapists focus on the
subjectivity of experience rather than
“objective” diagnostic categories

Question 6

What is existential dilemma?

Answer 6

• Although we crave to persist in our being, we are finite creatures.
• 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.
• Diagnosable presenting “symptoms” may mask existential crises

Question 7

Which are the “Ultimate Concerns”?

Answer 7

• Freedom
We are the authors of our own lives, a terrifying responsibility that we
dread and attempt to escape
• Isolation
Interpersonal, intrapersonal, or existential isolation
• Meaning
Our ongoing search for substantial purpose-providing life
structures often throws us into a crisis
• Death
Awareness of death is painful, but enriches life

Question 8

What is freedom?

Answer 8

• Refers to the 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.
• “Humans are condemned to freedom.”

Question 9

What is Isolation?

Answer 9

• Existential isolation differs from:
• Interpersonal isolation: Divide between oneself and others
• Intrapersonal isolation: The fact that we are isolated from parts of
ourselves.
Each of us enters existence alone and must depart from it
alone.

Question 10

What is Meaninglessness?

Answer 10

What is the meaning of life?

Question 11

What is Death?

Answer 11

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.

Question 12

Therapeutic relationship?

Answer 12

The Fellow Traveler
• Awareness of ultimate concerns as givens of existence
produces a relationship between therapist and patient of
fellow travelers
• Labels of patient/therapist, client/counselor, suggest
distinctions between “them” (the afflicted) and “us” (the
healers)
• 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

Question 13

Existential and theory od personality

Answer 13

• 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

Question 14

Existential Psychosynamics

Answer 14

• The existential model postulates that basic
conflict is between the individual and the
“givens,” the ultimate concerns of existence
• Freud’s DRIVE → ANXIETY → DEFENSE
is replaced with
AWARENESS OF ULTIMATE CONCERN → ANXIETY
→ DEFENSE MECHANISM

Question 15

Which are the sources of Anxiety and Conflict?

Answer 15

• A certain amount of anxiety is a normal, inevitable,
aspect of every personality
• Relationships create dangers of merger and
isolation, using and relating; people may react with
fusion or compulsive sexuality
• Living necessitates meaning and values
• To cope with the terror of death, we erect defenses
against death awareness

Question 16

What is Specialness (Denial Systems)?

Answer 16

• Individuals have deep, powerful beliefs in personal
inviolability, invulnerability, and immortality
• At a deeply unconscious level, we believe that the
ordinary laws of biology do not apply to us
• 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

Question 17

What is an Ultimate Rescuer (Denial Systems)?

Answer 17

• Belief that someone is watching over one 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

Question 18

Existential Sensibilities

Answer 18

• Existential therapists notice patients’ concerns
emanating from existential conflicts
• Existential therapists are people with a sensibility to
existential issues
• No therapist focuses on existential issues all the time
• Therapists notice that defenses may produce
secondary anxiety

Question 19

Process and Content

Answer 19

• Strategies similar to other dynamic therapies, but
with different content
• Focus in 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 perspectives of a here-and-now crosssection, not from the perspective of a historical
longitudinal section

Question 20

Therapeutic Goals

Answer 20

• Focus is on the self-experience of the patient, and capacity for
self-actualization and self-transcendence through engagement in
life.
• Aims to reduce anxiety to tolerable levels and then to use the
anxiety constructively. The existential therapist hopes to alleviate
crippling levels οf anxiety but not to eliminate it. Life cannot
be lived (nor can death be faced) without anxiety.
• Responsibility: to be responsible means to be the author of one’s
own life design → this realization leads to motivation for change.
• Therapists identify methods and instances of responsibility
avoidance, encourage patients to own their feelings, statements
and actions, help them make decisions (what do they want?) and
tolerate uncertainty, address existential isolation directly, address
meaninglessness with engagement, and confront death and death

Question 21

The role of the therapist

Answer 21

• The existential therapist strives for an understanding οf the
patient’s current life situation and current enveloping
unconscious fears. The existential therapist works in the
present tense. The individual is to be understood and helped
to understand himself or herself from the perspective οf a
here-and-now cross-section, not from the perspective οf a
historical longitudinal section.
• The existential therapist believes, as do other dynamic
therapists, that the nature οf the therapist-client relationship
is fundamental in good psychotherapeutic work; thus the relationship is fundamentally important in itself, especially in
regard to engagement and connection.
• Existentialists look deep into the person. For Freud deep meant “early,” and so
the deepest conflict meant the earliest conflict in the individual’s life. Thus, the
fundamental sources οf anxiety, for example, are considered to be the earliest
calamities: separation and castration. From the existential perspective, deep
means the most fundamental concerns facing the individual at that moment.
The past (i.e., one’s memory οf the past) is important only insofar as it is part οf
one’s current existence and has contributed to one’s current mode οf facing ultimate concerns. Existential therapy does not attempt to excavate and understand the past; instead, it is directed toward the future’s becoming the
present and explores the past only as it throws light on the present.

Question 22

Who Can Benefit?

Answer 22

• 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
• Appropriate with patients who confront boundary
situations (confrontations with death, important decisions,
sudden isolation, or milestones that mark passages)
• Individuals, groups, families, and couples

Question 23

Cultural Considerations

Answer 23

• Humans from all backgrounds share in the dilemmas of existence and must come to terms with the ultimate concerns of freedom, isolation,
meaninglessness and death
• Difficulties arise when treating people who have
adopted broad formulas for managing these
concerns that were provided by their cultural and religious systems
• Cultures create belief systems that defend against
the terrors of stark confrontation with existential concerns