The Theory Reference Guide:

A Quick Resource for Expert and Novice Mental Health Professionals

Existential Psychotherapy: Philosophy and Practice

Claire Arnold-Baker, MA; Emmy van Deurzen, PhD

A. Theory Description (Key people, history, basic concepts – an introduction to the

theory)

The existential approach to psychotherapy and counseling has its grounding in existential
philosophy and is concerned with human existence and the way in which humans live and
exist in the world. Although Kierkegaard is usually considered to be the founding father
of the existential tradition the roots of existential thinking can be found in the work of
Socrates, Plato and Aristotle. Existential philosophy blossomed on the European
continent from 1844 to the 1970’s. The main existential philosophers were Sören
Kierkegaard (1813-1855), Friedrich Nietzsche (1844-1900), Martin Heidegger (1889-
1976), Jean-Paul Sartre (1905-1980), and Maurice Merleau-Ponty (1908-1961). Other
prominent philosophers include Edmund Husserl (1859-1938), Martin Buber (1878-
1965), Karl Jaspers (1883-1969), Paul Tillich (1886-1965), Simone de Beauvoir (1908-
1986) and Albert Camus (1913-1960). Although these philosophers’ views diverge a
great deal from each other they are all concerned with the concrete existence of human
beings.

Existential philosophy addresses questions we all ask ourselves. What does it mean to be
alive? Why is there something rather than nothing? What is the purpose of my
existence? This differs from traditional psychology which focuses on defining
personality or explaining behavior. Existential philosophy has identified common themes
or issues that human beings experience in their everyday living, which are highlighted
below.

Death
Death is a central theme of existential philosophy, as it is our death and our temporality
that put our lives into perspective making them meaningful and purposeful. The one
certainty we have is that we are going to die, that we have a finite period of time, which
is unknown. Existential philosophers believe that death and our temporality permeate our
lives, either directly or indirectly. Heidegger (1927) believed that for the most part we
try to avoid thinking about our own death and live in an inauthentic way. Yet despite this
we are always moving towards death and death will finally complete us. Heidegger talks
of an awareness of death as shifting us from one mode of existence to another. He states
that there are two different ways of looking at death. The first is the forgetfulness of
being, where Dasein1 flees from itself, falls in with others, and is tranquillized by trying
to find all kinds of securities in life. In this way Dasein tries to escape death by

1
Dasein literally means ‘Being there’ and is used as a shorthand for “human being”, Heidegger never
speaks of the “self” but only of “Dasein”.

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immersing itself in the everyday diversions of life and by thinking that death is something
that happens to other people.

“The ‘they’ has already stowed away an interpretation for this event. It talks of it in a
fugitive manner, either expressly or in a way that is mostly inhibited, as if to say ‘one
of these days one will die too, in the end, but right now it has nothing to do with us’”
(Heidegger, 1927: 297).

However, Heidegger believed that rather than trying to avoid death we should face our
mortality, which is a reality of our existence right now, since we are dying a little bit
everyday and are fundamentally mortal, temporal and temporary beings. We should
embrace the possibility of death as well as the limitations that it entails. Having an
awareness of your own death brings an awareness of life and shifts trivial preoccupations
towards things that really matter. Inevitably awareness of death evokes a certain amount
of anxiety.

Anxiety
Kierkegaard (1844) is probably best known for his writing on Angst or anxiety. He
turned his back on the objective scientific view of his day to concentrate on examining
the kind of life people lived. He queried whether there is an adequate life, i.e. whether
the person is living with subjectivity and individuality or whether they are somehow
wasting their life and following the crowd. Kierkegaard saw human life as an effort that
is not easy, one full of anxiety. Kierkegaard claims that there are no rules to life and that
our life is determined by ourselves rather than by some external force or law. For
Kierkegaard a person does not exist in the mode of being but of becoming, and what we
become is our own responsibility even though frequently we conceal this from ourselves.
When we do not live up to our own possibility we experience existential anxiety, which
reminds us of our fundamental freedom and the vastness of our responsibility in the face
of infinity.

Freedom and Choice

Sartre developed this theme of freedom. He stated that “Man is condemned to be free”
(Sartre, 1943: 632). With this statement he captured the paradoxical problem with
freedom, that we are both enslaved and liberated by it at the same time. We have the
freedom to choose what to do, who to be but this freedom comes with the price of
responsibility. Sartre believed that everything about our life has to be chosen. We have
no choice but to choose, even if we are living our lives passively and by default, this is a
choice we have made. Therefore the way we live our life is down to us, it is our
responsibility. However this freedom to choose causes us to feel anguish because the
future is open to all possibilities, it is undetermined by our past or the external world. It
is this freedom to choose our future, which is our obligation to create meaning and create
our own world. The anxiety we experience in relation to our life is a sign we are alive,
and that we need to make a choice about our lives. By recognizing the responsibility we
have towards ourselves and our lives we enable ourselves to make deliberate choices.
We can determine the path we want our life to take and re-examine the way we have

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lived before, reassessing our values and beliefs and having the courage to follow our
original project.

Guilt
Freedom to choose not only carries with it anxiety but also guilt. Heidegger elucidates
this as existential guilt, which is where we are indebted to ourselves, where we have
failed to live up to our own potential. “Dasein is guilty because of a lack in its own
being” (Heidegger, 1927). Existential guilt is about our being and what we haven’t done
rather than about something we have done wrong. Heidegger states that this guilt is
inescapable; it is an inherent part of our existence. When we choose there is always an
alternative that we reject and therefore another possibility that we are not able to follow.
We can not pursue all our potentials and so our experience of guilt is over those that we
have failed to realize. Something always remains to be done.

Meaning
If we are to create a life for ourselves, we have to create a meaningful one. Many people
reach a point when their lives have become meaningless and they question what they are
doing and where they are going. This happens mainly when a person has not been
reflecting on their life or when they have reached a low point in their lives. The stark
reality of life sinks in and we wonder what the point of continuing is. Viktor Frankl
(1905-97) discovered the importance of meaning when he was a prisoner in the Nazi
concentration camps at Auschwitz and Dachau. He discovered through his experiences at
the camps that those who were able to create a meaning for all the suffering they were
experiencing were better able to survive. Nietzsche expressed a similar sentiment when
he wrote “He who has a why to live for can bear with almost any how” (in Frankl, 1984:
97). After the war Frankl’s work focused on the meaning of human existence and man’s
search for it. He saw this as the primary focus of life, as we are creatures who try to find
meaning. Frankl developed a therapeutic approach called Logotherapy 2 to help clients
find a purpose in life.

Time and Limit Situations

For Heidegger (1927), time is not a linear progression, where past, present and future
appear as separate points on a time-line. Instead the past is always part of the present and
projects into the future, so that both our past and our future are part of our present
experience. Our past is also not something that is fixed and determines our present.
Rather our relationship with our past changes by our present experiences in the same way
that our present can be influenced by our past experiences. For both Heidegger (1927)
and Sartre (1943) we are always in a process of becoming and therefore in terms of time
we are always projecting ahead into the future. We are never the finished article and our
death sets a time limit on our existence. As we are limited in time we are also limited by
other boundary situations. Jaspers (1951) spoke of limit situations, the limits of human
existence which are imposed upon us by the world and which we can not change. Jaspers
believed that we must accept these limits and live our life within them as they are part of
human existence. These ultimate situations include our historicity, i.e. our
parents/family, culture, gender and past, and the fact that we must die, suffer and
2
‘Logos’ is the Greek term for meaning

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experience conflict in our lives as well as the fact that we have to accept imperfection and
failure as part of life. Jaspers believed that we must engage in the tasks of life without
illusion, accepting the limits to our life, both the general limitations and our own personal
limitations and that we must at the same time go forward in spite of them.

Existential Psychotherapy
Existential philosophy, with its focus on human nature, lends itself well to therapeutic
work. The early existential practitioners, Karl Jaspers (1883-1969), Ludwig Binswanger
(1881-1966) and Medard Boss (1904-1990), were all psychiatrists who had become
disillusioned with the medical model. They found in the writings of existential
philosophers a new way of approaching their patients, looking at their patients’ problems
as life issues rather than as pathology. Binswanger and Boss were particularly influenced
by the work of Heidegger; in fact Heidegger gave a series of lectures to Boss’ psychiatric
students3. Jaspers took his inspiration from the work of Kierkegaard and Nietzsche.
Further practitioners followed in their footsteps and these included Viktor Frankl (1905-
1997), Rollo May (1909-1994), Thomas Szasz (1920- ), Ronald Laing (1927-1989) and
Irvin Yalom (1931- ). Today there is a burgeoning movement of existential practitioners
in the UK, which include Hans W. Cohn (1916-2004), Emmy van Deurzen (1951-) and
Ernesto Spinelli (1949-). Existential therapists are concerned with helping clients to
understand their issues as problems in living, clarifying where the difficulties lie and
enabling clients to find new and meaningful ways of living.

1. Key Concepts

a. Nature of Persons

The existential approach considers human nature to be open-ended, flexible

and capable of an enormous range of experience. Although existential
practitioners would not talk about human nature per se instead they would
focus on human existence and the ontological concerns that we all share. The
existential approach contends that there is no fixed self and that we are
continually in a process of becoming. This means that existential therapists
do not have a theory of personality, nor do they pathologize or label the
individual. Rather existential therapists aim to describe the various levels of
existence that we operate with in the world. Heidegger believed that
individuals were not just isolated subjects who inhabit a world, rather that
they are interconnected with the world; Heidegger (1927) called this Being-in-
the-World. Binswanger (1946) was particularly interested in Heidegger’s idea
of Being-in-the-World and set out three basic dimensions of human existence,
May (1983) further elucidated these dimensions and van Deurzen (1988)
added a fourth dimension which had been inferred in earlier work.

3
These lectures have been published in Zollikon Seminars: Protocols – Conversations – Letters, M. Boss
(ed.) (2001) Evanston, IL: Northwestern University Press.

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Umwelt – physical dimension
The Umwelt is the physical dimension and it relates to the natural world
around us and our environment. It is the dimension of our bodily needs, our
senses and our embodiment. It is also the dimension that we are born into,
which includes our gender and heredity. This dimension also relates to our
health, wealth and fitness, as well as our relationship to the climate and our
physical environment, including our relationship to animals. This dimension
is about life and death, feelings of safety or lack of it and about learning to
adapt to the limits of the physical world.

Mitwelt – social dimension

The Mitwelt is the social dimension and represents our relationships with
other human beings. These include relationships with our family, extended
family, friends, work colleagues, acquaintances and interactions with others
that we do not know. This dimension is not just about relationships, it is
about our public domain so includes our relationships with our language,
culture and society. It covers our attitudes to our country of origin, race and
social class. This dimension is about intimacy and isolation, feelings of love
and acknowledgement or rejection.

Eigenwelt – personal dimension

The Eigenwelt is the personal dimension, the world of the self. It is about our
identity and our relationship to our self. It includes our feelings, thoughts and
personal characteristics. Our sense of who we are develops out of our
interactions with other people and the world around us. Our self is not fixed
but continues to be refined and adapted as we live our lives. This dimension
concerns finding out about our strengths and weaknesses and finding an
authentic way of living.

Überwelt – spiritual dimension

The Überwelt is the spiritual dimension and represents the world of our beliefs
and aspirations. It is our ideal world, our original project and it is where we
make sense of our lives. The spiritual dimension does include our relationship
to religion but it is also about how we create meaning and purpose in our
lives. This dimension is about truth and wisdom.

Human needs can be looked at from a number of perspectives, since we have

physical, social, personal and spiritual needs. The satisfaction of some
physical needs is essential to our survival; other needs are secondary and their
satisfaction enables us to live a fulfilled life. The first kind of needs center on
basic biological needs such as hunger, thirst, warmth and a level of security.
These days, in the west, these needs are easily met for most people and do not
concern our daily existence even though we all have to work hard for our
living. However, in third world countries, particularly those struggling with
natural disasters or famine, meeting these basic biological needs can become
deeply problematic. With our basic needs met, our attention turns to

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 secondary needs such as those of social stability and personal fulfillment or
even meaning and truth. From an existential perspective all these needs can
be seen in terms of poles of existence. We constantly go between the poles
that exist on each dimension of existence, for instance between strength and
weakness, truth and lies, highs and lows. We are rarely at one pole or the
other but oscillate between the two. Typical poles include health vs sickness,
closeness vs distance, active vs passive and happiness vs sadness.

b. What other theories and/or philosophical underpinnings inform this

theory?
The existential approach to psychotherapy is most closely related and
informed by positive psychology. Positive psychology (Seligman, 2002)
emphasizes people’s strengths and what is going well in their life rather than
focusing on an individual’s weaknesses or problems. Positive psychology
aims for optimal human functioning, by helping people to realize their
strengths. Clients are encouraged to re-look at their life in view of these
strengths, which allows them to start living in a different way. The aim is for
human happiness, well-being and living a good life.

Other disciplines that inform the approach include anthropology, politics and
sociology. These are important as they take the social context of living into
account and provide insights into the relational aspects of human beings.

2. Healthy vs. Unhealthy/Dysfunctional

a. Healthy Functioning

From an existential perspective healthy functioning and dysfunction are seen

as opposite poles on the same continuum. Healthy functioning would be seen
as a person living an authentic life. What this means is that they are being
true to themselves and accepting life’s limitations as well as their own
personal limitations. Well-being is about being open to what life can bring
both good and bad. Authentic living involves daring to stand in the
unknowing and anxiety of human being and to become as Heidegger (1927)
states, a “being towards death”; as it is only by accepting our own mortality as
a real possibility that we can live authentically. Authentic living also involves
recognizing our freedom and responsibility for ourselves, which invariably
means making choices that realize our true potential. Ultimately authentic
living is about wisdom and truth. It is about seeing our lives and ourselves in
a truthful and honest way and tuning into our feelings of existential anxiety
and guilt and what it tells us about what is lacking. Authentic living is also
about seeking wisdom about the world and human being, being open to all
that that implies.

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 b. Dysfunction

If healthy functioning were seen as authentic living then dysfunction would be

seen as inauthentic living. Inauthentic living is where we are closed off to the
reality of life or living in a self-deceived way about ourselves or about the
world. Heidegger (1927) saw inauthentic living as being ‘the They’, this is
like Nietzsche’s (1969) ‘herd mentality’, where we fall into averageness and
live our lives like ‘They’ do. This involves not questioning what we are doing
but accepting other people’s values and ways of living. It is about living your
life by default, going along with the crowd, not daring to be different or think
for yourself. This means living by other people’s standards and rules and not
thinking about the rules and standards that you want to determine your life.
Heidegger believed that most of us live our lives in this way for the majority
of the time. It is only when we are confronted by our conscience, or as
Heidegger (1927) said ‘where we hear the call of conscience’ that we are able
to overcome this inauthentic way of being. This is where we become more
open to the possibilities that are available to us. In addition we often
experience feelings of anxiety and guilt about the way we are living our lives,
which can prompt us to make changes in the way we are living.

The existential approach does not pathologize or seek to categorize

individuals. All of us live in both authentic or inauthentic ways; there is no
value judgment involved in recognizing this. Life is seen as a struggle and
clients’ issues are seen as problems in living, however the more open and
reflective we are then the more likely we will be to experience a sense of well-
being and ownership over our lives.

3. The Change Process

a. Change

Change happens all the time. Human Beings are always in transformation.
Change for the better is not a direct goal of existential psychotherapy but it is
a by-product, which comes about when a person truly examines their life in an
open and honest manner. Existential psychotherapy focuses on helping clients
to explore their life and way of living. It is a descriptive process, which
involves an examination of their relationships to the world and others and of
themselves. Clients are encouraged to reflect on their attitudes, values and
beliefs and reassess them in light of their present context. It is through this
process of reflection and re-examination of their life that clients begin to
choose a more purposeful way of living. This may involve a change in the
way that they live their life but more importantly it will involve a change in
how they think and reflect on their way of living and how they experience
themselves and others.

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 Change is difficult because the way we think about ourselves and our lives is
often ingrained and solidified. Rather than face the anxiety of knowing that
we are free to choose ourselves we try to create a fixed view of who we are,
and repeat patterns of behaviors and interactions to make us feel we are
something substantial rather than nothing. To embrace this existential anxiety
and all that it means is difficult. It is impossible to do it all the time. To go
about the daily process of living involves, as Heidegger put it, a forgetfulness
of being. However much of the time we are making small changes in our
lives without really knowing it. This is quite simply inevitable, since change
and transformation are the root of human living. Every choice that we make
will have its impact. Often clients are not aware that change is taking place
and it is through psychotherapy that they are able to recognize and
acknowledge this change and enhance it. However there are times in people’s
lives when big changes occur and these often coincide with some kind of
crisis, such as bereavement, redundancy or some natural disaster or event.
These moments of crisis shake the individual out of their sedimented way of
being and make them reassess everything that they stand for. In these
moments individuals are able to make changes to their lives that either did not
seem possible before, or did not seem warranted.

b. Therapeutic Environment

The existential approach to psychotherapy aids the process of change by

challenging the client to examine their worldview, attitudes and values. This
is a collaborative process. The existential therapist will embark on a real
relationship with the client encouraging self-reflection and a questioning
stance to their experience and world. Both therapist and client will enter into
a dialogue, seeking to find the truth and reality of the client’s life. Existential
therapists help clients to come to terms with the contradictions of life as well
as accepting its limitations. Existential therapists will highlight self-deception
about responsibilities to others and to oneself. In particular they will focus on
times when clients are not accepting their role in what is happening in their
lives. Existential therapy can help clients to understand life and its ensuing
struggles and to find creative and courageous ways of dealing with the things
that life throws up. In this way clients are able to face their difficulties rather
than shy away from them and in doing so will be able to make choices for
how they are to proceed. Through these choices and by living in a purposeful
rather than reactive way, change can occur.

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B. The Therapeutic Process

1. Assessment and Diagnosis

a. Theory-Based Assessment Strategies

Existential psychotherapists do not clinically assess or diagnose their clients

as practitioners from other approaches might do, as it suggests that there is a
problem that can be assessed, diagnosed and treated, which goes against the
philosophy of the existential approach. Instead existential therapists prefer to
use description and understanding in place of assessment and interpretation,
allowing the individual’s situation and worldview to unravel in the therapeutic
process. This is often referred to as the phenomenological process of taking
stock. This includes bringing to awareness the assessments, assumptions and
judgments people make about themselves and the world around them.

This awareness will also allow therapists to question how their judgments
might impact on the therapy and their ability to understand the client from
their perspective.

The only other type of assessment that may be undertaken is whether

existential therapy is suitable for a particular client. Clients will need to
accept that their problems are about living rather than a form of pathology and
they need to have a desire to question and reflect on their life, coming up with
their own answers. Clients who want to be diagnosed or to be told what to do
might be better suited to other forms of therapy. Existential therapy suits
those clients who feel a sense of alienation or who feel their life lacks
meaning. In particular those who have recently suffered some kind of crisis or
who are embarking on a new phase of their life or who are facing death would
be particularly suited to existential therapy and its focus on existence. Clients
for existential therapy should be able to articulate their feelings, emotions and
views about themselves and their world, which on the whole makes the
approach more suited to adults rather than children, though some children may
be quite capable of philosophical thinking.

Existential therapists will look for a client’s ability to question and reflect on
their life; for an openness and commitment to search for meaning and
purpose. No specific assessment tools would be used other than the dialogue
that takes place during the therapeutic relationship. A systematic structured
analysis on the four-world model is sometimes done.

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2. Treatment

a. Goals

“The goals of existential therapy are

 To enable people to become truthful with themselves again
 To widen their perspective on themselves and the world around them
 To find clarity on how to proceed into the future whilst taking lessons
from the past and creating something valuable to live for in the
present” (van Deurzen, 1990: 157).

These can be seen as the overall aims of existential therapy, however

individual goals may be set along the way. An individual goal may involve
clients returning to their original project or discovering their motivation to
pursue a new course in life. It could also entail helping clients to clarify for
themselves what they really want out of life. Any individual goals will be set
through dialogue between the therapist and the client and will always come
from the client. The setting of goals often comes about as a natural result of
the exploration that clients undertake in therapy. As clients gain greater
clarity on their life and what is important to them they find new directions to
go in or other avenues to explore.

With regard to the overall aims of existential therapy the purpose would be to
enable clients to live a more authentic life, where they are living up to their
full potential and gaining a deeper understanding of the life they have created
for themselves. Although authenticity can never be fully achieved, clients can
strive for a more reflective and open attitude where they are able to weather
most things that are thrown at them, by drawing on their inner resources and
strengths. The purpose of setting individual goals will be down to the
individual client. Most clients come to therapy with a particular problem to
sort out or an issue to explore. Many will want their progress to be charted in
some way and may set goals for themselves as a way of doing this. Any goals
that are set will be discussed at length in the therapy session to determine the
motivation behind them and the purpose they fulfill. This dialogue will also
ensure that the client’s goals are realistic ones. Clients may come to therapy
saying ‘I want to change my life’ or ‘I don’t like the life I am living’, through
the therapy clients can explore exactly what they do want to change or how
they want to live, therefore refining their goals or aspirations to realistic and
achievable ones, rather than blanket statements which are hard to live up to.
So goal setting is more seen as a continuous search for direction, enabling
clients to get more in tune with their original project whilst tackling concrete
and real issues in their lives in a specific way.

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b. Detailed Phases of Treatment

Joining Phase

As with all therapeutic approaches a clear contract needs to be established at

the beginning of existential therapy. This includes the duration of the therapy,
whether it is short-term or long-term, where and when the therapy will take
place and the fee involved. It is important that the physical setting of the
therapy is welcoming and conducive to therapy. Equally important is how
well the therapist fits with the client. Often initial sessions are an opportunity
for both therapist and client to establish whether they can work together. The
therapist will usually describe his/her way of working to enable the client to
get an understanding of what is involved and whether they want to continue.
Usually the therapist will not take a formal case history, instead they will
encourage clients to give a detailed description of what is concerning them, as
well as information about themselves and their world. The way in which the
client opts to present their life story is as significant as what they leave out.
The therapist may explore obvious gaps or merely point out that they exist.
Initial sessions are concerned with establishing trust and developing a working
alliance. Clients need to feel that their views are taken seriously and are valid
ones. Often clients seeking therapy for the first time are apprehensive about
what will happen and need to be reassured and encouraged. This can come
about by therapists explaining that it is the client rather than the therapist that
holds the answers and that these can be found through exploring the client’s
world together. By emphasizing the joint nature of the exploration, the
therapist is demonstrating the equality in the relationship and empowering
clients to find their own answers. At the same time the therapist is unafraid of
showing the need for direction or in pointing out contradictions in the client’s
discourse or consequences of actions.

Working Phase

The main body of the work in existential psychotherapy involves enabling

clients to describe in great detail their life, issues and resulting concerns.
Therapists will systematically map the client’s experience onto the four
dimensions of human experience. Discovering which dimension the client
feels at home with, which cause unease or difficulty and which dimension
they have mastery over. Through this process the client discovers their
strengths and the therapist helps the client to draw on these when dealing with
their weaknesses. The therapist will encourage the client to clarify their
values, beliefs and attitudes and to work out how these impinge on the way
they live. This may lead to the client reassessing or reformulating previously
held beliefs and values. Existential therapists will enable clients to examine
their relationships, to see which relationships they are happy in, which are
difficult and what part the client plays in these relationships and their
interactions with others. Clients will also be challenged to look at areas of

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 their life where they are not making active choices or not taking responsibility
for themselves. This will also include where they are self-deceived and the
therapist will help them to reflect openly and honestly on this. Allowing
clients to get in touch with their emotions can assist them in understanding
these emotions and what they say about the person at that time.

Through this process of clarification and exploration clients can get in touch
with their original project. They can find the motivation and purpose to create
a more fulfilling and meaningful life. Throughout this process the therapist
will be listening out for the existential themes that were discussed at the
beginning of the chapter. These themes will guide the therapist in
understanding where the client’s difficulties lie and how the client responds to
the givens of life. Inevitably the client will experience the anxiety of
existence at some point in the therapy. The aim of the therapist is not to try
and lessen the anxiety or find ways to get rid of it, rather the client will be
encouraged to face the anxiety and all that it means. Existential
psychotherapy is about helping clients to confront those aspects of their lives
that they wish to avoid or run from so that they learn to cope with the
unpredictability of life and face the difficulties that lie ahead.

Termination Phase

As with most therapies the ending of the therapy will enable clients to get in
touch with other endings they have had in their life and inevitably their own
ending. Therapy, with its finite time limit and definite ending, mimics the life
span, although it differs in that the ending is often known in advance.
Enabling clients to think about their own mortality and death helps them to
make decisions about what is important in their life. Clients can start living
more urgently and with purpose. Heidegger (1927) believed that it was only
as ‘being towards death’ that we can start to live authentically. The anxiety
that is experienced in relation to our own death can be used creatively to
ensure that clients are living up to their full potential in the time they have left.

In practical terms the decision to end the therapy is usually a joint one but
guided by the client. Existential therapy is about getting clients back on track
so they can live their lives in a better more meaningful way. This means that
therapists do not try to prolong the therapy but encourage them towards
independence. As clients become more proficient at the art of living,
therapists may suggest that sessions become more spaced out, or that an
ending is set with follow up sessions if needed.

c. The Nature of the Therapeutic Relationship

“Existential counseling can be seen as a process of exploration of what can

make life meaningful” (Deurzen, 1988: 3). This statement encapsulates the
existential approach to counseling and psychotherapy. It implies that the

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 therapy is both a process and an exploration that is undertaken by both client
and therapist. As well as it being a life-centered approach it is a client
centered approach, in that the focus is on the client to bring up and explore
particular issues, rather than directing the client to speak about certain things.
It is also a relationship centered approach in that the therapeutic relationship is
an important aspect of the approach not just because it aims at a more equal
relationship but also in that it proposes a two way process. It is as essential
for the therapist to monitor his/her feelings, assumptions and motivations in
relation to a client as it is for the client to examine his/her feelings,
assumptions and motivations. The bias of each will be under constant
scrutiny. The phenomenological attitude will enable a collaborative looking at
reality from both perspectives so that the client gains more understanding of
the various aspects of reality and of the multiple connections of their life. The
importance of the therapeutic relationship also highlights the relational aspect
of existential philosophy. What happens between the therapist and client, i.e.
the dialogue, is paramount. Martin Buber (1923) in this respect represents the
existential approach very accurately, with his contention that there is never an
‘I’ in isolation, because there is always a ‘you’ or an ‘it’ the ‘I’ relates to. His
I-Thou relationship signified a meeting where both individuals are
fundamentally changed by the experience, “My Thou affects me, as I affect it”
(Buber, 1923: 30), thus both client and therapist can be changed by the
therapeutic relationship. In final analysis therapy happens in the in-between
created by therapist and client together. Fundamentally the therapeutic
relationship is about the relationship the client has with himself or herself.
The therapy allows a space for clients to discover themselves, their lives, their
hopes and fears, their possibilities and their limitations. The therapeutic
relationship is an uncovering of the layers that we build around ourselves so
that the client is brought face to face with themselves, warts and all.

3. Techniques
a. Techniques Used

The existential approach does not have a specific set of techniques that can be
used; instead it uses a philosophical method. The existential approach is often
called an existential-phenomenological approach to psychotherapy. This
highlights the importance of Husserl’s phenomenological method, which was
later advocated by Heidegger as a method of answering the question of Being.
The phenomenological method was developed to clarify the essence of
experience, to go back to “the things themselves”. Spinelli (1989, 2005)
adapted Husserl’s phenomenological method for use in psychotherapy. He
proposed three steps to follow in working phenomenologically, step 1 is “The
Rule of Epoché”, the second step is “The Rule of Description” and the third
step is “The Rule of Horizontalisation”.

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The Rule of Epoché is a way of approaching something as if it were new to
you, all initial biases and prejudices are put aside and the phenomena is then
revisited. Epoché is about bracketing our expectations and assumptions
temporarily, as far as it is possible, so that the focus is purely on the
experience. This can only be a partial bracketing as it is impossible to totally
bracket our assumptions and biases. The therapist needs to be quite clear what
their assumptions are and how they are influencing how the therapist is
understanding and seeing the client. Therapists do this through reflection and
self-questioning while listening to the client. Often when we think we
understand the client we are closing something down or not looking at the
whole picture. It is about imposing an openness on our immediate experience,
looking at the situation naively as though it was the first time you had come
across it. We normally make judgments about what we perceive in our
everyday lives and accept that what we perceive is actually there. Epoché is a
way of looking at things anew, to learn to see what is before our eyes rather
than thinking that we know the answer.

The Rule of Description can be summed up as “Describe, don’t explain”

(Spinelli, 1989: 17). What is important is the description of an experience
rather than trying to make sense of it in terms of different theories, as this will
limit the experience. As with the first step the limitation of this step is that a
totally explanation free description is impossible to achieve. The aim of this
step is to open up the clients experience, enrich it with lots of detail so that the
client is fully present in the experience. Enabling the client to enter into this
description will ensure that possibilities are not closed down prematurely and
that each avenue is explored fully. The therapist should remain with the
description and engage in a dialogue with the client through clarifying
assumptions and helping them to articulate what they mean by the narrative
they use.

The Rule of Horizontalization or the Equalization Rule requires that initially

the therapist does not try and impose hierarchies or significances to what is
heard. All information is treated as equally important, of equal value and
significance. Again this is an ideal rather than an aim of this step. Instead the
therapist should avoid making hierarchically based judgments that could be
misleading and take the client away from other potentially important aspects
of their narrative. It is only through a thorough exploration of the clients’
situation that the importance of each experience will come to the forefront.

The three steps highlighted above make up the phenomenological method, but
they should not be used in a step approach as suggested by their titles, rather
therapists will consider them simultaneously as points of focus when listening
to their clients. This phenomenological method requires a certain attitude of
the existential therapist and his/her approach to working with clients. The
therapist needs to be open to what the client brings, to free themselves of their
assumptions and prejudices, as far as it is possible, and to develop an

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 enquiring attitude. This stance towards the client will allow the client’s world
to unfold and they can explore in detail their situation and way of living. By
not closing down parts of the clients narrative the therapist enables them to
see the full picture of their life and all its richness, complexity and
implications. By treating everything that the client says as equally important,
allows the client to come up with their own formulation of what matters to
them. Again this process keeps the dialogue open and does not lead to
interpretations, which can close aspects of the narrative down. In the process
meaning will emerge for the client as they get a better understanding of
themselves and their life.

C. Strengths and Limitations

1. Strengths of this Theory

The strengths of the existential approach lie in the fact that the therapeutic
relationship is a real relationship and not based on a transferential one. The
dialogue between therapist and client involves frank and open discussions. This
means that clients are not burdened by psychological theory, which they may not
fully understand, or focused on past events that may seem distant and not relevant
to their present day context and concerns. The existential approach encourages
clients to become independent thinkers and to find their own solutions to their
difficulties, thus reducing the reliance on the therapist for their well-being and
ability to cope.

Undoubtedly the biggest strength of the existential approach is its focus on life
issues and the things that really matter to clients, allowing them to grapple with
the things that are troubling them at that moment in time. The main philosophical
themes discussed at the beginning of this chapter, really are issues that concern us
all and that we are confronted with on a daily basis. Clients coming to therapy
often see life for what it is, they see the struggle that is involved, the randomness
and often unfairness of life and they often feel that their life has lost meaning.
For them to see that what they are experiencing is part of what it is to be human is
hugely empowering, as they learn about the paradoxes and intricacies of life. To
be able to find a way through all the difficulties that life brings without going
under gives clients a sense of agency and control in their life.

2. Limitations of this Theory

In terms of limitations the approach has often been thought of as somewhat

intellectual and indeed some clients like to philosophize about the world and their
life without reference to their emotional life. Clients sometimes avoid paying
attention to their emotions, which closes down an avenue of potential exploration.
In fact emotions can provide clients with a much needed direction in life and can
give a lot of information about what is really concerning the client at that

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moment. Heidegger and Sartre both considered emotions to be an important
mode of being and sought to understand how emotions can be made more active
and articulate rather than remaining passive and reactive. Van Deurzen (1988)
has set out a cycle of emotions that shows the direction in which emotions lead us.
Once clients are able to read and understand their emotions they will feel more in
control and see them as signposts to their emotional life rather than as being at
their mercy and out of control.

A further limitation of the approach centers on the client’s ability to think about
their issues in existential or philosophical terms. As mentioned earlier in the
section on assessment, some clients are not suitable for existential psychotherapy,
either because they want a more directive approach or are not able or willing to
examine their life and question the way that they live.

The existential approach has been criticized for not having a theory of human
development or human sexuality and that it is not a psychologically approach.
However because the existential approach has a philosophical rather than a
psychological focus this does not mean that these aspects of human functioning
are not considered by the approach. In fact Kirby (2005) and Smith-Pickard and
Swynnerton (2005) elucidate an existential approach to human development and
human sexuality in the recently published book Existential Perspectives on
Human Issues (van Deurzen & Arnold-Baker (eds.), 2005), which seeks to answer
critics of the approach. The existential approach has much to say on how we
develop, not just in terms of aging but also how we develop ethically and in terms
of morality. An existential theory of human sexuality will focus on our
relationships to others and how we relate to others sexually, Merleau-Ponty
(1962) has written much on this subject.

The final limitation is in relation to the training of practitioners. Many new

trainees find the apparent lack of technique and tools difficult to cope with when
trying to work in an existential way. Part of the training is to help trainees
develop a new attitude and way of looking at the world and others. Through
immersing themselves in the existential literature and focusing on the existential
issues that emerge trainees can find their own way of working. There are as many
ways of working existentially as there are practitioners and each person has to
find their own particular way. Many practitioners will use the existential approach
as an integrative framework, which allows them to apply other techniques and
methods within an existential perspective. To do so effectively it is important to
use both the method, phenomenology, and the philosophical literature as a
background. Each encounter will be unique to that therapist and that client at that
particular time, therefore each session will be as though they are meeting for the
first time.

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 3. What issues/aspects of human functioning might this theory not adequately
address?

The existential approach does not really have a theory on health and illness and so
does not explain or provide a theory for mental health problems. The existential
approach however helps clients live in the best way that they can within their
personal limitations (i.e. mental health problems) and the general limitations of
the world. This limitation is therefore seen as a strength by existential
practitioners themselves. The approach also does not classify or diagnose clients
and so does not seek to explain disorders in the same way that other approaches
would, for this reason there is a dearth of research in this area and this is
something that needs to be addressed urgently.

D. Summary Paragraph

The existential approach provides not an alternative technique or yet another

method of therapy but a philosophical dimension of enquiry which can
complement other approaches. It has an important role to play in an increasingly
technological and alienated society and provides clients with a direct and
intensive way of re-examining their lives and finding new meaning.

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Bibliography

Binswanger, L. (1946) ‘The Existential Analysis School of Thought’. In R. May et al

(Eds.) Existence, New York: Basic Books.
Buber, M. (1923) I and Thou, Trans. W. Kaufmann, Edinburgh: T&T Clark.
Frankl, V. (1984) Man’s Search for Meaning, New York: Washington Square Press.
Heidegger, M. (1927) Being and Time, Trans. J. Macquarrie & E. S. Robinson, New
York: Harper & Row.
Jaspers, K. (1951) The Way to Wisdom, Trans. R. Manheim, New Haven and London:
Yale University Press.
Kierkegaard, S. (1844) The Concept of Anxiety, Trans. R. Thomte, Princeton, N.J.:
Princeton University Press.
Kirby, S. (2005) Existential Perspectives on Human Issues: A Handbook for Therapeutic
Practice, E. van Deurzen & C. Arnold-Baker (Eds.), Basingstoke: Palgrave.
May, R. (1983) The Discovery of Being: Writings in Existential Psychology, New York:
Norton.
Merleau-Ponty, M. (1962) The Phenomenology of Perception, Trans. C. Smith, London:
Routledge.
Nietzsche, F. (1969) On the Genealogy of Morals, Trans. W. Kaufmann & Hollingdale,
New York: Vintage Books.
Sartre, J-P. (1943) Being and Nothingness: An Essay on Phenomenological Ontology,
Trans. H. Barnes, London: Routledge.
Seligman, M. (2002) Authentic Happiness: Using the New Positive Psychology to
Realize your Potential for Lasting Fulfillment, New York: Free Press.
Smith-Pickard, P. & Swynnerton, R. (2005) Existential Perspectives on Human Issues:
A
Handbook for Therapeutic Practice, E. van Deurzen & C. Arnold-Baker (Eds.),
Basingstoke: Palgrave.
Spinelli, E. (1989, 2005) The Interpreted World: An Introduction to Phenomenological
Psychology, London: Sage.
Van Deurzen, E. (1988) Existential Counselling in Practice, London: Sage.
Van Deurzen, E. (1990) In W. Dryden (ed.) Individual Therapy: A Handbook, Milton
Keynes: Open University Press.

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Please create a final, separate page to include your name, address, e-mail address, and
affiliation.

Claire Arnold-Baker
New School of Psychotherapy and Counselling
Royal Waterloo House
51-55 Waterloo Road
London SE1 8TX
UK

carnoldbaker@aol.com

Prof. Emmy van Deurzen

New School of Psychotherapy and Counselling
Royal Waterloo House
51-55 Waterloo Road
London SE1 8TX
UK

emmy@dilemmas.org

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