What Is Existential Psychotherapy?

Existential psychotherapy is based upon the principles of psychodynamic therapy, humanistic and existential psychology, the latter being a movement with roots in the existential philosophy and writings of Heidegger, Husserl, Dostoevsky, Kafka, Camus, Kierkegaard, Nietzsche, Sartre, and others. During the mid-twentieth century, pioneering European clinicians like Otto Rank, Karl Jaspers, Medard Boss, and Ludwig Binswanger were among the first to apply existential principles to the practice of psychotherapy, followed prominently by Viktor Frankl (Vienna), R.D. Laing (London), Rollo May (pictured here) and Irvin Yalom (United States).

Existential psychotherapy is often misperceived as some morbid, arcane, pessimistic, impractical, cerebral, esoteric orientation to treatment. In fact, it is an exceedingly practical, concrete, positive and flexible approach. At its best, existential psychotherapy squarely and soberly confronts the "ultimate concerns" (Tillich) and sometimes tragic "existential facts of life": death, finitude, fate, freedom, responsibility, loneliness, loss, suffering, meaninglessness, evil and the daimonic (May and Diamond). Existential psychotherapy is concerned with more deeply comprehending and alleviating as much as possible (without naively denying reality and la condition humaine) pervasive postmodern symptoms such as excessive anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair,depression, guilt, anger, rage, resentment, embitterment, purposelessness, madness (psychosis) and violence as well as promoting the meaningful, life-enhancing experiences of relationship, love, caring, commitment, courage, creativity, power, will, presence, spirituality, individuation, self-actualization, authenticity, acceptance, transcendence and awe.

As consumers are increasingly confronted with the very real limitations of what managed mental health care, ever-briefer therapy and ubiquitous psychopharmacology can provide (see my prior post), existential psychotherapy is enjoying some resurgence. Existential psychologist Rollo May (1986) warned, whenever you perceive a person merely as a particular diagnostic disorder, neurological deficit, biochemical imbalance, cognitive schema, set of behavioral patterns, genetic predisposition, collection of complexes, or "as a composite of drives and deterministic forces, you have defined for study everything except the one to whom these experiences happen, everything except the existing person him [or her] self" (p. 25). Existential psychotherapy strives to empower and place the person--and his or her existential choices--back at the center of the therapeutic process. To cite Sartre on this subject: "We are our choices."

While the techniques of existential psychotherapy can include Freudian, Jungian, Gestalt, cognitive, behavioral or other methods, the fundamental technique shared by all existential therapists is phenomenology. Phenomenology refers to the conscious setting aside of preconceptions and dogma in an effort to discover the client or patient's actual subjective experience or "being" (Dasein). It is through this that the true experience, will and intentionality of the patient at any given moment may be discerned, understood, and appropriately responded to by the therapist. The focus of treatment is on the present, here-and-now, current circumstance, rather than exclusively on early formative influences. While the power of the past and of unconsciousness-- those aspects of ourselves of which we are unable or unwilling to become aware-- to influence the present detrimentally is recognized and addressed as it arises in treatment, the patient's subjective experience of self ("I am") and of the therapeutic encounter is of primary importance.

Choice, personal and social responsibility, integrity of the personality, courage, and authentically facing rather than escaping existential anxiety, anger and guilt are central features of existential psychotherapy. The existential therapist is not confined to the passive, neutral, anonymous and interpretive role of the psychoanalyst. The courage and commitment to truly and genuinely encounter each unique patient is required by the existential therapist, who must not avoid his or her own anxiety by hiding behind a rigid professional persona or rote therapeutic technique. In existential therapy, the human relationship between patient and therapist takes precedence over technical tricks, and, as now corroborated by research, is the basic healing factor in any psychotherapy. Coming to terms with reality-- and one's own inner "demons"-- without denying, avoiding, distorting or sugar-coating it is key to existential therapy. As Rollo May, the acknowledged American "father" of existential psychotherapy pithily put it: "I do not believe in toning down the daimonic. This gives a sense of false comfort. The real comfort can come only in the relationship of the therapist and the client or patient" (Diamond, 1996, p. xxii). This compassionate, shared, professional yet profoundly personal human relationship provides both the structured, supportive container and potent existential catalyst for therapeutic transformation.