The following is a term paper for a course on Theories of Psychotherapy. I elected to report on Existential Psychotherapy using Irvin Yalom's Existential Psychotherapy (1980) as my primary guide yet also was able to refer to other sources I had the experience of reading during my years as a philosophy student.
Introduction
There are plenty of moments where I wish I could be different than I am. I sometimes wish I could fit in more with the crowd but in doing so I feel I’m wishing away something about myself. Perhaps it is my inner truth or it is my awareness of the ever existing realities of the human condition. When I was younger I had a lot of difficulty living with those contrasting desires between being fully myself and fitting in with society. Now that I’m older I’m a lot more comfortable living with the dilemma as I’m more aware of the ebb and flow of my desires. Sometimes I even let them lead me into having a novel experience and other times I will myself to remain on course. The important thing is that I’m ever aware of the process as it is occurring as well as my continual ability to choose how to respond. The feeling of me choosing responses sits in opposition to feeling powerless or even victimized by my life experiences..
Though I feel in a better place than I was before I still question over how to live joyfully while at the same time remaining aware of the feeling that “the other shoe is about to drop”, that each tidal flow is followed by an ebb, that each life is bookended by a death. It’s a question I’ve been pondering since my first experience with death and one that I know adds weight to everyone’s shoulders, whether they are conscious of it or not. It was thus surprising to me to learn that professional counseling included methods that addressed such universal yet highly personal concerns.
The following paper will cover the topic of existential psychotherapy and its utility in the counseling profession. One of the primary resources used is Irvin Yalom’s book titled Existential Psychotherapy where he provides a thorough review of the method and its application using the topics of death, freedom, isolation, and meaninglessness. In reviewing existentialism, its application to clinical counseling, and Yalom’s work I hope to simultaneously explain why I am personally drawn to this theory. I aim to offer my own perspectives and critiques of its application for the counseling profession. As a former student of philosophy who spent a good amount of time with existentialism I feel as though I can offer a unique perspective based on my familiarity with existentialist theories and thinkers. This experience may further inform the integration of existential philosophy into a mental health setting.
Life, Death, and Meaning
Life is meant to be “lived forwards” and “the necessary resting place from which to understand it-backwards” (Kierkegaard, 1959, pg. 89). Oftentimes however we find ourselves trying to do just the opposite. We dig deeper for a meaning for things when they seem inconsistent with the way we believe things should happen. One of the greatest inconsistencies is death, especially when it is sudden and/or unnatural. I attempted to extract meaning out of such an event with my father’s passing when I was six. Not only was it unexpected it was also by his own choosing to leave this life. My own life catapulted into a quest for meaning given knowledge of the harsh reality that not only people die but that they can choose it. It was an additional hard-learned fact that these truths also applied to people with whom I was emotionally attached.
After the loss of one parent I was incredibly fearful about the potential loss of another. Chronic fears led to nightmares, unescapable thoughts of being left alone, and a high amount of social phobia. With the help of family and a school guidance counselor I eventually regained some sense of stability. That stability came in the form of making new friends at school and establishing new connections within the surrounding communities. As these relationships faded, and I entered my adolescence, intense feelings of anxiety resurfaced. However, this time my fears were of a different kind. It wasn’t that I was once again afraid of death but what I was afraid of was forming new relationships. It was challenging for me to see the positives of forming new relationships when I had an overlying awareness of their fragility. Why form a relationship if it was ultimately going to end? This prevented me from making many new connections with people and further drove me into social isolation. I still managed to cultivate and preserve a few close friendships in addition to my relationship with my mother and brother.
It was at this point in spending a lot of time with myself that I couldn’t ignore how much I didn’t like being with myself. I imagined it wouldn’t get any better and so I made a conscious effort to create a self that I wanted myself to be and I felt I needed more guidance in order to do that well. I scanned one of the family bookshelves for some reading material and I saw the spine of one old tiny weathered book which read “Man’s Search for Meaning”. I remember thinking to myself how appropriate of a title that was for someone in my current state. Without knowing anything about the book, or about Viktor Frankl, I took it and read. It left me feeling the desire to know more about finding meaning in suffering, how to be a more responsible human being, and most importantly it sparked an interest in learning how to love.
I’m purposefully using my own life story because that is the style of existentialism. Meaning is derived from our individual experiences. It isn’t handed down to us nor can it be learned prior to living out our lives. Just as with clients in the counseling setting, it is often the case that meaning and positive change comes from within. Sometimes this requires a dramatic turn of events that shine light on our emotional vulnerability and physical mortality.
Origins of Existential Psychotherapy
The origins of existentialist philosophy are not cut and dry. Some sources begin the story of existentialism with a 19th century Danish scholar named Soren Kierkegaard. Based on the general ideas of existentialism we can say that many people before have highlighted the significance of our individual relationships to death, freedom, and responsibility. For some, such as Kierkegaard, one of the main questions was how to have faith in God based on one’s own personal experience. A “leap of faith” in the face of the absurd facts of life is stirred up by the awareness of the conditions that we have to make a choice on what to believe. A symptom of that awareness is anxiety. The relationship between his social self and his spiritual self was one of the more anxiety-producing experiences for Kierkegaard.
That story is not unique to Kierkegard. St. Augustine was writing in a similar style of existentialism more than a thousand years before Kierkegaard. Take the following passage from Augstine’s seminal work, Confessions, as an example: “Thou hast made us for thyself, O Lord, and our heart is restless until it finds its rest in thee” (1960, Book I, Chapter I). Prince Siddhartha Gautama a thousand of years before Augutsine considered the psycho-spiritual implications of suffering and potential for the fear of death to propel one into a way of living more fully in the present moment. In order to come to this awareness he had to experience the anxiety that came from a feeling that how he was living wasn’t in alignment with the way things really are in the world and that death applies to all. The shock of this awareness caused Siddahartha to wake up and see things differently as the Buddha. The benefits of integrating Buddhist concepts into patient care is becoming more recognized in clinical settings, particularly in instances where the fear of death is not ungrounded. It is through practicing more mindfulness around death that we could potentially achieve more mindfulness in life (Masel, Schur, and Watzke, 2012). Saint Augustine and Buddha are just two examples of many others who helped to define what we know as existential thought.
What is unique to Kiekeggard is that he chose to directly address the feeling of existential angst most of everyone experiences at different points in their lives. He went so far as to dedicate one of his works, The Concept of Anxiety, entirely to better understanding that feeling and deciphering what it means to the person feeling it. He was one of the first modern western thinkers to highlight its liberating potential as well as its connection to a deeper relationship with one’s true love and connection with God. For Kierkegard anxiety was the “dizziness of freedom” to choose however to live your life given its conditions (Kierkegaard, 1980, pg. 188). It wouldn’t be until later philosophers such as Fredrich Nietzche, Martin Heidegger, and Jean-Paul Sartre developed a concentration on a more pressing concern. That being the concern of death as being “one’s ownmost possibility” and perhaps the reason people are often so dreadfully anxious beneath the surface (Wheeler).
What was a common theme among these various sources was that they seem to have the same feeling that in order to wake up to the truth of life, we often have to be standing at the edge of an abyss, staring down the barrel of a gun, or at our own mortality. When that happens an awakening happens and there is a realization that the time we have as living beings is limited. So, it behooves one to live as authentically as possible. In order to do this there is not a method or guide from which to follow. The doing is through simply remaining aware by paying attention to your life as it is happening. With full presence comes an inability to escape the realities of your experience. An experience that includes existential themes Yalom chose to highlight such as death, isolation, and meaninglessness.
Those aforementioned themes are at first glance dark but nonetheless offer positive counter themes that are will, responsibility, freedom. It is tempting to go into more detail with each of these themes yet that would require a whole different study. What’s important in regards to the focus of this paper is their application in psychotherapy. However, it is important to note that through having more experience with any one of them we may find ourselves with a greater understanding of their utility for anyone seeking counseling.
Therapeutic Goals for Existential Psychotherapy
We may first understand how existentialism can be applied in clinical counseling by first outlining goals of existential psychotherapy which are arguably the same goals for any existentialist existing within any context. Goals include clients to rise to such a level of self-awareness as to be able to accept responsibility for everything that has happened in their lives. Even to the point of reframing negative events that have happened to them as a happening for rather than a happening to in a way that one’s taking personal responsibility for any situation is always possible because “like it or not [we] are faced with choice and cannot escape this freedom” (Yalom, pg. 243). With responsibility comes an awareness of the freedom to choose how one can exist and consequently has implications for mental well being.
Despite how isolating it is, it is impossible to escape the common ground in the fact that everyone in the world is dying and that all are potentially free to choose how life is to be lived. It may be argued that if those shared aspects of being are used as foundations for the formation of communities, then members of those communities would have more inclusive relationships with one another compared to communities formed around qualities such as wealth, race, ethnicity, political values, and religious beliefs. Breaking down our superficial differences in order to reveal our commonalities can be considered another goal for existential psychotherapy.
In philosophy and physics there are exercises called Gerdankens, or thought experiments, which allow people the opportunity to play out theories in hypothetical scenarios so that they may test their validity through mental experimentation in absence of performing a real experiment. In this instance a scenario is needed in which to test how we would connect if our socio-politico-religio-cultural markers fell apart. One then can consider the common plots of post-apocalyptic movies as a Gerdanken in this case where the world as we know it is turned upside down by a flood of disasters, an invasion of aliens, or swarms of zombies. Audiences are gradually introduced to a cast of survivors who are so culturally different from one another and who normally wouldn’t associate with one another based on their external differences. In an ironic turn of events, the existing social structures crumble forcing the survivors to form new ones based on qualities that they all share as human beings, including the awareness of death.
Central Techniques and Methods of Existential Psychotherapy
i) Accepting Responsibility
Responding to such deep and perennial issues underlying our surface anxieties and resulting behaviors requires a client-centered approach since it is the client who’s personal experiences will be the primary source for meaning. Therapists utilizing an existential approach most likely would adopt reflective stances which encourage clients to view themselves without comparison to any cultural or statistical norm. With no measure for success or failure, with no determinant for good or bad, this leaves clients in a very powerful position to make changes to their lives. They can exist in a place where judgment based on things outside of the clients are less likely to cloud choices made for the benefit of them. It can also be somewhat of a rattling position and may be viewed as unsupportive on the part of therapists yet that is precisely the point.
Another way around the therapist-client power differential that could influence a client’s autonomy is the incorporation of existential themes in group counseling settings. A group is a “microcosm” of the world and thus a client could play out their life within the world through their role within the group (Yalom, pg. 240). In the group they are confronted with loneliness by being the sole proponents of their own distinctive values in contrast with the variety of value systems possessed by other members of the group. A client thus has the potential to discover how their autonomy can be a pathway towards accepting more responsibility for how they affect other people in the world through how they affect the functioning of the group.
As a graduate student in philosophy I experienced a few shifts in my life all at once. For one, I started school right after one of my first deep romantic relationships ended in an abrupt breakup. Secondly, I had to live half of the week in a city two hours away from where I worked in order to attend classes. The last big change was opting to quit my job as a personal trainer in order to devote more time to school. All of these changes drove me into further isolation and resulted in me experiencing depression while at school. I was clinically diagnosed with both depression and insomnia during that time. I chose to utilize the school health services that came with my tuition and found a weekly group counseling circle for graduate students. What surprised me about the group counseling sessions was how different the students were from myself and the feeling that we weren’t a group who held things in common. As a result I felt more aware of the uniqueness of my values and priorities. This made me more aware that these were things that I was choosing for myself and that awareness of choice made me feel more ownership over my situation which often felt like I was constantly responding to what was happening to me.
After a year in the graduate program I realized that despite spending so much time, money, and energy into getting into it, it was not something that made me feel fulfilled. The thought that I had to finish weighed down on me because I felt many resources would’ve just been wasted were I to change my life’s direction. It didn’t feel like I had a choice and that I made my decision long ago not fully understanding the consequences of my decision. Through group counseling and other forms of self-care I was reintroduced to the awareness that I always had a choice and the meaning that things have in my life is the meaning I give to it. I felt more fulfilled at work, training clients, and interacting with my coworkers and I had another opportunity to choose that during the summer break after my first year in grad school. It was painful to choose not to continue into a second year and pursue a Masters degree. It was a choice I knew I had to make and it is one that today I for which I joyfully accept responsibility.
ii) Sitting With Death
When clients come to terms with their ownmost realities and uncover the true sources of anxiety they can have a healthier relationship with them in a way that allows them to live with the wisdom of knowing rather than the ignorance and imprisoning passivity resulting from avoiding the unknown certainties, particularly death. Certain in the sense that we will die and unknown in the sense that we never know when and what happens to our Self afterwards. The “anticipation of death provides a rich perspective for life concerns” so much so that many people’s fears fade and they begin to live more fully in the present, being more genuine and compassionate, especially to others (Yalom, pg. 160).
For myself personally I had a few memorable events in relation to death that transformed my life perspective and consequently my behavior in the face of typically anxiety producing experiences. One of those events took place during a time where many of my relationships were shifting dramatically including the relationship I had with my career. During a time of respite I listened to a guided hypnosis on my mobile phone. As I was laying on the beach alone and zoning out to this meditation I gradually began to envision a cave within a mountain on an deserted island in the middle of the ocean. Within the cave I encountered myself multiple times at stages of life. First I met myself as a child, then I met myself as a teenager, then as a young adult, and so on. I then walked to a dark end of the cave not quite lit by the sun where I saw someone’s bones sitting in a lotus position. For some reason I knew they were my bones and I was looking at my remains. Within the lap of those remains I saw a newborn baby wiggling and cooing. Again I felt the baby was myself. When I came out of the hypnosis I felt something within me had shifted dramatically to such an extent that I felt reborn.
I felt I was given another chance at defining who I am and will be. It was an awareness that I am always dying and I always have the potential to let go of who I think I am in order to move into a more authentic version of myself. This couldn’t have come at a better time when I felt as though my previous actions and behaviors defined who I was and thus limited what I could do and how I should feel about myself. It wasn't destiny or fate that kept me going, it was a choice at every moment. My habits however made me feel like it wasn’t a choice and that includes habits of the mind. I was able to see my beliefs about myself as habits as well and was stunned some years later when I overheard a peer in an anatomy workshop group say… “The greatest addictions are the beliefs we have about ourselves.” It surprised me because I felt this in my life yet didn’t quite have the words to describe what it was that I felt and so the wisdom from my previous experiences with it felt lost in time.
VI. Three Takeaways From Yalom
Irvin Yalom offered new insights into the clinical applications of existentialism and overall has sparked my curiosity about existentialism even more as a tool for clinical counseling. It is odd that before I never would've equated the two even though the main drive for my time studying academic philosophy was for promoting my mental stability. It wasn’t about a job or acquiring job-related skills. It was both about living well leaving this world gracefully.
i) The Awareness of Death in Children
I once thought the impact of my father’s death at a young age was something unique to me and led me to think about death more than other children whose first experiences with death were less immediate. In the chapter, The Concept of Death of Children, Yalom shared anecdotes and research that suggested children think about death quite regularly. Yalom cites the research of Gregory Rochlin to highlight that at ages as early as three years old “the fear of death is communicable in unequivocal terms” (Yalom, pg. 85). Reading the chapter made me feel as though I forgot so much about my own innate wisdom about life that most children seem to have even without having to experience personal loss. It isn’t unusual for a child to state things as they see them without a filter. It is something that we find intriguing about children, something that adult’s admire yet can’t fully practice themselves due to the potential social implications of sharing their observations.
What I also learned was that there are stages of death awareness in early childhood and development which helped me to understand my own transition in death-awareness. Three age groups were given as an example: childhood, pre-adolescence, and adolescence. In each group there are concerns that characterize each age group. For example those within the childhood age group of five to eight years old a child may develop a greater sense of “his or her survival [being] endangered” through the awareness of death and so responds primarily through actions of self-protection (Yalom, pg. 90). As children get older they become more involved with the activities of daily life and death slowly begins to have less importance and/or elicit less “emotional response” (Yalom, pg. 91). At later stages a child may also “believe in his or her personal specialness, omnipotence, and invulnerability…” (Yalom, pg. 109). I know from personal experience as a teenager that I often felt invincible and that I had all of the time in the world and these were feelings I shared with my peers.
ii) Examples of Applying Existential Psychotherapy
One of my frustrations with academic philosophy was spending weeks reading and trying to understand a single text, concept, or argument only to run back into the real world which didn’t seem to change one bit from my activities. Existentialism, as an academic study, seemed to be the closest I would get to applied philosophy though there really weren’t any clear demonstrations of how to apply it. The closest to a field guide I could get came in the forms of self-help or spiritual books written by Eastern philosophers.
It was encouraging to read about how Yalom incorporated Existential Psychotherapy in clinical settings. By sharing some of the actual actions he took in sessions it was very helpful for me to imagine how I would be able to apply existential themes in similar settings. Yalom, in the second half of his book, stresses the importance of taking actions and incorporating actionable exercises. Doing this in sessions seems to be highly effective in promoting the impact of the time spent in therapy. Yalom shares the example of an exercise where he asked participants in a group session to write out eight responses to the question of “Who am I?” on a deck of cards. The next step was to order them in relevance to the core of who they are. Following that step they were asked to meditate on each card until “they divested themselves of all eight attributes” (pg. 164).
Yalom also outlined a systematic way of making the transitions from accepting responsibility to taking action within the therapeutic relationship. This outline helped me to understand how it may look to integrate different existential topics into one therapeutic relationship for the sake of promoting overall positive changes and improving mental health. “In order to change, one must first assume responsibility” but guiding a client towards awareness of responsibility is not enough (Yalom, pg. 286.). “The therapist must court action” through a process of willing, which stems from our wishes that are tied in with our ability to feel (Yalom, pg. 287). “Once an individual fully experiences wish, he or she is faced with a decision or choice. Decision is the bridge between wishing and action.” (Yalom, pg. 314). Making decisions is also an area of limitation and is a difficult bridge to cross. Overcoming this challenge requires the therapist to adopt an attitude of “unconditional [positive] regard” in combination with their authentic presence as a therapist in the relationship to help the client begin to respond (Yalom, pg. 339).
iii) Balancing Meaning with Meaninglessness
It seems hypocritical to talk about the positive ramifications of recognizing the overall meaningless of the things we do. With no clear absolute external authority it feels somewhat odd to assign oneself as an authority but it's a process that could potentially help many clients who have difficulty finding meaning in their lives. It is the challenge for the therapist to listen and learn what potential meaning makers there are existing within the lives of clients. Sometimes meaning can extend beyond oneself and that is often beneficial for the mental well being and fulfillment of clients.
I learned from Yalom that there are two sides to this issue. On one hand we may encounter a “patient who is excessively self-absorbed” and to call upon them to derive meaning from their own lives could “compound the problem” (Yalom, pg. 473). A strategy may be to redirect the client’s “curiosity and concern” towards others (Yalom, pg. 474). Group therapy settings are, by design, conducive to promoting that effect. On the other hand if clients are not too focused on themselves and already lean towards an objective view of things, then there is a risk of drawing away “the vitality from [one’s own] life” (Yalom, pg. 479.) Clients may risk losing appreciation and a sense of themselves or the concern and appreciation for others. A general solution seems to avoid over analyzing meaning because meaning comes from activity or “engagement” (Yalom, pg. 482). It can be summed up in the following passage: “The question of meaning in life is, as the Buddha taught, not edifying. One must immerse oneself in the river of life and let the question drift away.” (Yalom, pg. 483).
Existential Psychotherapy and Multicultural Concerns
Though Yalom’s review of Existential Psychotherapy seems thorough by including such topics as death and freedom it nonetheless falls short of covering the diversity of issues people need help with in counseling. It feels limiting to read from one perspective about universal life concerns but that’s an understanding I think readers have when taking up the text. Similarly, it's a position clients should have when selecting a counselor. It may be an additional duty of the counselor to inform the client of the limitations of the perspective and approach.
i) Omitting Social Concerns
One of the first potential issues that stands out is that existentialism deals with “excessively individualistic” concerns that “ignores the social factors that cause human problems” (Corey, pg.154). Social factors in this sense include socially oppressive forces that limit potentials based on such traits as race, ethnicity, gender, sexuality, and economic wealth. It may be argued that underneath everyone’s concerns, whether individual or social, death is ever the common denominator and that societies are composed of individuals, each with their own relationship to existential concerns. The formation of societies may also be largely tied in with the desire to satisfy individual existential needs such as finding meaning in the absurd conditions of life, the ability to exercise personal freedom, and taking responsibility for one’s place in the world. There are many ways to integrate existentialism with social concerns given that the intentions of the sessions are directed towards a mutual outcome such as the prospect of promoting an overall “social change” (Corey, pg. 154).
ii) Finding Room for Cultural Values
The place of religious and cultural values also seems to be a big red line in the world of existentialism which may repel people and or make their practices and beliefs feel incompatible, unappreciated, and/or undervalued. At first glance it would seem existentialism is a gateway to a destruction of our current values and beliefs. Jean-Paul Sarte was a staunch atheist, Friedrich Nietizche is famously quoted for “God is dead”, and even Soren Kierkegaard didn’t have much praise for the churchgoing masses. The problem however is that these are bits of information thrown out without the context. Given the context and the supporting material one will find that there may be legitimate reasons for their words and attitudes. Existentialist themes, just as with any other distinctive themes of a type of philosophy, can mean something to anyone without threatening one’s currently held belief systems. A thorough intake of a client’s belief systems may be advisable prior to introducing certain ideas, concepts, and books into a session. Adopting a general attitude of curiosity about the client and focusing on meeting the client at the current place of belief and receptivity feels to be the more appropriate approach. From there, if existentialist themes did seem helpful, then they would be shared in respect to what they had in common with the client’s current belief systems.
VII. Conclusion
My interest in existential psychotherapy didn’t start with Irvin Yalom’s book but I never before thought of “existentialism” and “psychotherapy” together until reading it. From my personal life I developed a love and appreciation for existentialism and its potential impact on my mental well being. The processes that resulted in this didn’t feel as though they were things that one could teach or facilitate for another. Irvin Yalom demonstrated how similar life processes could be seen through the lens of existentialism and consequently may have beneficial effects for addressing mental health concerns. With such topics as death, freedom, will, and meaning it is no wonder why existential literature gets right to the soul of matters and encourages people to think more deeply about how they are living life. Is it out of fear? Is it out of self-direction? Those are the kinds of questions which we appropriately consider perennial.
Perennial questions have no cut and dry answers. Once we have an answer, who's to say it won’t change when our lives change. That is existentialism in a nutshell and it is a highly adaptable mental tool we can use for our entire lives to instill qualities such as resilience, adaptability, authenticity, and creativity for the entirety of our lives.
References
Augustine, Saint. (1961). Confessions. Penguin Classics.
Corey, G. (2021). Theory and practice of counseling and psychotherapy (10th ed.). Cengage Learning
Kierkegaard, Soren. (1959). The journals of Kierkegaard, Ed. by Dru, A. Torch Harper Books.
Kierkegaard, Soren. (1980). The concept of anxiety: A simple psychologically orienting deliberation on the dogmatic issue of hereditary sin. Princeton University Press. (Original work published 1844).
Masel E.K., Schur S., Watzke H.H. (201), Life is Uncertain. Death is Certain. Buddhism and Palliative Care, Journal of Pain and Symptom Management, 44(2), 307-312. https://linkinghub.elsevier.com/retrieve/pii/S088539241200262X
Wheeler, M. (2020) Martin Heidegger, The Stanford Encyclopedia of Philosophy (Fall 2020 Edition), Edward N. Zalta (ed.) Stanford University. https://plato.stanford.edu/archives/fall2020/entries/heidegger.
Yalom, Irvin D. (1980) Existential psychotherapy. Yalom Family Trust.
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