A True North Psychology publication
Written by Dr Sara Tookey
In my early 20s, I found myself at a crossroads in my career. I was craving a deeper, more meaningful approach to therapy. That's when I discovered existential psychotherapy - a captivating blend of philosophy and psychology. Existentialism opened my eyes to a new way of making sense of life’s deepest questions and set me on a professional and personal journey of discovery.
Existential psychotherapy explores the unique experiences of humans, emphasising personal responsibility and the freedom to make choices in pursuit of living a more authentic and meaningful life.
In this post, I’ll share my personal connection to existential therapy and provide an accessible overview of how it works.
Finding Meaning in the Mystery: My Journey with Existential Therapy
Life's mysteries have intrigued me since childhood. Growing up in a household with contrasting belief systems, my father was an adamant atheist; my mother, a devout Catholic. I learned to sit with life's biggest questions, particularly the ones that don’t have answers. My parents taught me to critically examine my beliefs and to explore what felt right to me, while appreciating differing perspectives.
When I was 16, my mother died of cancer. Her guidance during her courageous journey toward death enabled me to explore the depths of my grief and gain insight into the precious impermanence of life. I realised then that connection gives life meaning.
Working as a counsellor in my early career, I was learning to apply Cognitive Behavioural Therapy and Dialectical Behavioural Therapy in group in-patient settings. I felt we were merely scratching the surface of clients' struggles and felt somewhat disheartened by psychological approaches that aimed to alleviate symptoms without addressing the core causes of people’s suffering. This led me to look for the answers in spiritual and philosophical texts. Here I found my connection with existential philosophy. Existentialism offered me hope, a sense of calm amid the uncertainties of life, and permission to embrace life in all its messiness. Existential psychotherapy resonated deeply, blending philosophy and psychology to explore life's core questions.
I trained as an existential psychotherapist in Seattle University's Existential Phenomenological Psychotherapy program, beginning a professional and personal journey of discovery. During my training I underwent my own therapy as a client of this approach, and the educational program provided more than theoretical knowledge and practical skills. The teachings were deeply personal and meaningful, which enabled me to incorporate existential concepts into my daily life and way of being personally and professionally.
I later went on to train as a Clinical Psychologist, specialising in various therapeutic approaches and in areas of psycho-oncology, palliative care, identity and relationship issues and psychedelic therapies. Existential psychotherapy remains integral to my practice, helping others navigate the complexities of existence, confront their fears, embrace life's uncertainties and find meaning.
What is Existential Psychotherapy?
Existential psychotherapy is a unique form of therapy that looks to explore difficulties clients encounter from a philosophical perspective. The therapist takes a unique role in therapy by abandoning the role of the expert, relating to the client in a genuine way, as a fellow human with shared struggles. Existential psychotherapy empowers people to examine the impact of their personal choices on their life, to take responsibility for them, and to come to terms with their own fears and limitations. It is applicable to all facets of the human condition, from broad struggles like lack of meaning, relationship conflicts, identity crises, depression and anxiety, to specific challenges including social anxiety, obsessive patterns, and addictions.
Existentialism emphasises the importance of understanding individual subjective experiences, and argues that human existence is in its very nature, subjective. Existential therapy focuses on addressing fundamental existential concerns that are intrinsic to being human, including death, meaninglessness, isolation, and freedom (Yalom, 1980). Psychological difficulties are therefore seen as arising from core existential issues.
Rather than techniques, existential psychotherapy offers guiding principles for practice. The therapeutic relationship, and way of being with the client, takes precedence over techniques aiming to change behaviour. The focus is not learning skills or habits but confronting one’s fears, taking responsibility for our choices and actions, to find meaning and lead an authentic and fulfilling life.
The aim of the therapist is to guide clients to accept realities like uncertainty and take responsibility for choices. They help the client to question their assumptions, allowing clients to uncover new possibilities (Dattilio et al., 1998).
If you’re interested in learning more about the history and theory of Existential therapy, I recommend book, which offers a comprehensive overview of the various existential psychotherapy schools and approaches.
Existential therapy draws on existential philosophy to explore life’s core questions:
Who am I? | How do I face mortality? |
What is my purpose? | How do I live authentically? |
Who can it help?
Existential therapy is applicable for various challenges of living. It has been successfully applied to address difficulties such as anxiety, depression, existential crises, identity confusion, relationship challenges and trauma (Rayner & Vitali, 2015; Vos, 2016).
While the evidence base for existential therapy continues to evolve, research and clinical practice have demonstrated its effectiveness across various contexts. Studies reveal positive outcomes including lowered anxiety, improved self-esteem and relationships, enhanced wellbeing, meaning, hope and optimism (Rayner & Vitali, 2015; Vos, 2016). Existential therapy shows promise for specific populations too, like individuals receiving end-of-life care where it has been linked to reduced existential distress and improved quality of life (Moadel et al., 1999; Fawzy et al., 1995).
This therapeutic approach can be beneficial for people facing existential crises, feelings of emptiness, lack of direction, or searching for a deeper sense of purpose and fulfilment in in their lives.
Limitations:
Like any therapy, existential psychotherapy has limitations. Key critiques include lack of empirical evidence compared to other therapies, reliance on client motivation or readiness for change, and applicability across diverse cultural frameworks.
Some argue it fits Western individualistic cultures more than collectivist ones that define self through social ties. It may not fully address social factors causing problems that clients feel powerless to change.
Additionally, as a perspective rather than structured approach, it lacks a systematic framework, posing challenges for standardised research. Clinically, those seeking a problem-focused approach may be disappointed by philosophical discussion. Applications are also limited for clients who have severe mental lines, those in extreme crisis and people unable to express themselves in dialogue.
How does it help?
Core existential questions are addressed in dialogue to help clients:
Confront their existential anxieties: The anxiety that arises from the awareness of one's mortality and the uncertainty of life's outcomes is explored in an open and honest dialogue with the therapist. By facing these fundamental concerns, individuals can develop resilience, find acceptance, and discover new perspectives that enable them to live more fully in the present.
Connect with their authenticity: Learning to live authentically is seen as a goal in life and in therapy. Clients are encouraged to connect with their true values, beliefs, and desires for living, rather than conforming to societal expectations or norms.
Enhance self-awareness: A client learns to gain insight into their thoughts, emotions and behaviours. Through introspection and reflection, one can make conscious choices aligned with their authentic selves, leading to personal growth and self-empowerment.
Take personal responsibility: Clients are empowered to recognise their freedom of choice and to take ownership of their choices, actions, and responses to life circumstances, empowering them to create meaningful change and embrace their personal agency.
Engage in a meaning-making process: Clients are guided to explore and create their own personal meaning and purpose in life, even in, and especially in the face of adversity or existential challenges.
Acknowledge existential isolation: Clients are encouraged to acknowledge the inherent sense of aloneness in the human condition. They are guided to find ways to connect with themselves, others and the world around them.
Focus on the ‘Here-and-Now’: Clients are encouraged to focus on the ‘here-and-now’ and the person’s immediate experience rather than dwelling on the past or worrying about the future. In therapy sessions the therapist also works in a relational way, focusing on the therapeutic relationship between the therapist and client (Yalom, 2002).
The Experience as a Client in Therapy:
In my own experience as a client in existential psychotherapy, the therapeutic bond with my existential therapist was the single most impactful factor in my therapy. This is because existentially oriented therapists strive for mutually authentic and honest relationships with their clients. Therapist and client interact as equals, with the therapist demystifying the process by answering questions transparently rather than remaining opaque (May & Yalom, 1989). This genuine relating with my therapist allowed me to be open and vulnerable in a way that I never had been before, which enabled me to feel safe to confront my fears and practice acceptance.
As a psychologist and psychotherapist who works in an existentially oriented way, many of my clients have expressed how grateful they have been for my transparency, my honesty and shared humanity. As a result of engaging in existentially oriented psychotherapy, my clients have described an increased self-awareness, being able to connect with their inner-direction or compass, feeling empowered and having a greater sense of ease and acceptance of the difficulties of life.
Below is a testimonial from one of my clients, depicting their experience of existential therapy:
"Before starting existential therapy, I was paralysed by my fear of death. My fear kept me from really engaging with life and connecting with the people I loved the most. Together we explored what was really important to me and she helped me to find ways to reconnect with my inner joy and my sense of self that had been hidden from me for so many years. Though still anxious at times, I now understand the role of my anxiety and feel empowered to live in a way that is true to who I am and I can do the things I used to love without fear holding me back. Existential therapy helped me to open up my perspective, reconnect with my resilience and be more accepting of the things I can’t control. I'm forever grateful for this opportunity to rediscover meaning and joy.”
Conclusion & Summary
Existential psychotherapy allows us to navigate the complexities of existence, grapple with our fears, and find meaning amidst life's uncertainties. It is a pathway that invites us to embrace the fullness of our humanity, to explore the depths of our emotions and to live lives that resonate with our true selves.
While research continues to expand our understanding of its efficacy, existential therapy stands as a valuable perspective for individuals seeking to explore their existence and find meaning and authenticity. Drawing upon existential philosophy and psychology, existential therapy provides a unique perspective on the complexities of human experience. By addressing existential concerns, a person can discover purpose, enhance self-awareness, foster acceptance, and cultivate resilience.
If you’re seeking meaning, purpose, direction or a deeper understanding of yourself, existential therapy may be the right fit for you.
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Relevant References and Resources
Books:
Bakewell, S. (2016). At the Existentialist Café: Freedom, Being, and Apricot Cocktails. Other Press.
Barnett, L., & Madison, G. (Eds.). (2012). Existential Therapy: Legacy, Vibrancy and Dialogue. Routledge.
Camus, A. (1991). The Myth of Sisyphus and Other Essays. Vintage Books. (Original work published 1942)
Cooper, M. (2003). Existential Therapies. SAGE Publications.
Dattilio, F. M., Freeman, A. (Eds.), & Blue, J. L. (1998). Comprehensive clinical psychology: Vol. 6. Interpersonal, family, and group therapy. Elsevier Science/Pergamon. (link to PDF text)
Frankl, V. E. (2006). Man's Search for Meaning. Beacon Press. (Original work published 1946)
May, R. (1969). The Discovery of Being: Writings in Existential Psychology. W. W. Norton & Company.
May, R., & Yalom, I. D. (1984). Existential therapy. In R. J. Corsini (Ed.), Current psychotherapies (3rd ed., pp. 354-391). Peacock Publishers.
May, R., & Yalom, I. D. (1989). Existential psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (4th ed., pp. 363–402). F.E. Peacock. (link to PDF text)
Seguin, C.A. (1965). The existential therapist. In R. May (Ed.), Existential psychology.
Tillich, P. (2014). The Courage to Be. Yale University Press. (Original work published 1952)
Yalom, I. D. (1980). Existential Psychotherapy. Basic Books.
Yalom, I. D. (2002). The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients. HarperCollins.
Articles Published in Scientific and Academic Journals:
Fawzy, F. I., Fawzy, N. W., Arndt, L. A., & Pasnau, R. O. (1995). Critical review of psychosocial interventions in cancer care. Archives of General Psychiatry, 52(2), 100–113. https://doi.org/10.1001/archpsyc.1995.03950140018003
Moadel, A., Morgan, C., Fatone, A., Grennan, J., Carter, J., Laruffa, G., Skummy, A., & Dutcher, J. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psycho-Oncology, 8(5), 378-385. https://doi.org/10.1002/(SICI)1099-1611(199909/10)8:5<378::AID-PON406>3.0.CO;2-A
Rayner, M., & Vitali, D. (2021). Short-term existential psychotherapy in primary care: A quantitative report. Journal of Humanistic Psychology. Advance online publication. https://doi.org/10.1177/00221678211018281
Spinelli, E. (2015). Existential psychotherapy: An introductory overview. The Journal of Contemporary Psychotherapy, 45(1), 7-15. https://doi.org/10.1007/s10879-014-9285-0
van Deurzen, E., Craig, E., Laengle, A., & Taylor, S. (2017). The effectiveness of Existential Psychotherapy: A systematic review of empirical studies. Existential Analysis, 28(2), 349-368.
Vos, J., Craig, M., & Cooper, M. (2014). Existential therapies: A meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83(1), 115-128. https://doi.org/10.1037/a0037167
Vos, J. (2016). Working with meaning in life in mental health care: A systematic literature review of the practices and effectiveness of meaning-centred therapies. In P. Russo-Netzer, S. Schulenberg, & A. Batthyany (Eds.), Clinical perspectives on meaning: Positive and existential psychotherapy (pp. 61–87). Springer International Publishing. https://doi.org/10.1007/978-3-319-41397-6_4
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge. https://doi.org/10.4324/9780203582015