What is existential psychotherapy

Existential Therapy 
World Confederation for Existential Therapy 
 In 2014-2016, an international group representing a cross-section of contemporary existential therapists joined together in a cooperative effort to create this broad definition. It was written in the spirit of inclusiveness and diversity that characterizes this unique orientation, toward the goal of arriving at an accessible, succinct, “good enough” working definition of existential therapy. This definition recognises and honours the shared and unifying stance which underpins and informs the various differing ways of understanding and practicing existential therapy today, without doing violence to its inherent spontaneity, flexibility, creativity and mystery. What follows is the current version of an ongoing, continually evolving, collective quest. 
1. What is existential therapy? 
Existential therapy is a philosophically informed approach to counseling or psychotherapy. It comprises a richly diverse spectrum of theories and practices. Due partly to its evolving diversity, existential therapy is not easily defined. For instance, some existential therapists do not consider this approach to be a distinct and separate “school” of counseling or psychotherapy, but rather an attitude, orientation or stance towards therapy in general. However, in recent years, existential therapy is increasingly considered by others to be a particular and specific approach unto itself. In either case, it can be said that though difficult to formalize and define, at its heart, existential therapy is a profoundly philosophical approach characterized in practice by an emphasis on relatedness, spontaneity, flexibility, and freedom from rigid doctrine or dogma. Indeed, due to these core qualities, to many existential therapists, the attempt to define it seems contradictory to its very nature.  
As with other therapeutic approaches, existential therapy primarily (but not exclusively) concerns itself with people who are suffering and in crisis. Some existential therapists intervene in ways intended to alleviate or mitigate such distress when possible and assist individuals to contend with life’s inevitable challenges in a more meaningful, fulfilling, authentic, and constructive manner. Other existential therapists are less symptom-centered or problem-oriented, and engage their clients in a wide-ranging exploration of existence without presupposing any particular therapeutic goals or outcomes geared toward correcting cognitions and behaviors, mitigating symptoms or remedying deficiencies. Nevertheless, despite their significant theoretical, ideological and practical differences, existential therapists share a particular philosophically-derived worldview which distinguishes them from most other contemporary practitioners.  
Existential therapy generally consists of a supportive and collaborative exploration of  patients’ or clients’ lives and experiences.  It places primary importance on the nature and quality of the here-and-now therapeutic relationship, as well as on an exploration of the relationships between clients and their contextual lived worlds beyond the consulting room.  In keeping with its strong philosophical foundation, existential therapy takes the human condition itself — in all its myriad facets, from tragic to wondrous, horrific to beautiful, material to spiritual — as its central focus. Furthermore, it considers all human experience as intrinsically inseparable from the ground of existence, or “being-in-the-world”, in which we each constantly and inescapably participate.  

Existential therapy aims to illuminate the way in which each unique person — within certain inevitable limits and constraining factors — comes to choose, create and perpetuate his or her own way of being in the world.  In both its theoretical orientation and practical approach, existential therapy emphasizes and honors the perpetually emerging, unfolding, and paradoxical nature of human experience, and brings an unquenchable curiosity to what it truly means to be human.Ultimately, it can be said that existential therapy confronts some of the most fundamental and perennial questions regarding human existence: “Who am I?” “What is my purpose in life?”  “Am I free or determined?” “How do I deal with my own mortality?” “Does my existence have any meaning or significance?” “How shall I live my life?” 
2. Why is it called “existential” therapy? 
Existential therapy is based on a broad range of insights, values, and principles derived from phenomenological and existential philosophies. These philosophies of existence stress certain “ultimate concerns” — often in dialectical tension with each other — such as freedom of choice, the quest for meaning or purpose, and the problems of evil, isolation, suffering, guilt, anxiety, despair, and death. For existential therapists, “phenomenology” refers to the disciplined philosophical method by which these ultimate concerns or “givens” are addressed, and through which the person’s basic experience of being-in-the-world can best be illuminated or revealed, and thus, more accurately understood. This phenomenological method begins by deliberately trying to set aside one’s presuppositions so as to be more fully open and receptive to the exploration of another person’s subjective reality.  

Though there can be many different motivations for individuals choosing to engage in this explorative process, as with most forms of counseling, psychotherapy, or psychological and psychiatric treatment, existential therapy is commonly sought by people in the throes of an existential crisis: some specific circumstance in which we experience our basic sense of survival, security, identity or significance as being threatened. Such existential threats may be of a physical, social, emotional or spiritual nature, and may be directed toward one’s self, others, the world in general or the ideas and perceptions we live by. They shock and shake us out of our sense of safety and complacency, forcing us to question and doubt our most deeply held beliefs or values. Because, according to existential therapists, human existence is, by its very nature, continually changing or becoming, we are naturally prone to experiencing such existential challenges or crises across the lifespan. In existential therapy, these disorienting and anxiety provoking periods of crisis are perceived as both a perilous passage and an opportunity for transformation and growth.  
3. How does existential therapy work? 
Existential therapists see their practice as a mutual, collaborative, encouraging and explorative dialogue between two struggling human beings — one of whom is seeking assistance from the other who is professionally trained to provide it. Existential therapy places special emphasis on cultivating a caring, honest, supportive, empathic yet challenging relationship between therapist and client, recognizing the vital role of this relationship in the therapeutic process.  
In practice, existential therapy explores how clients’ here-and-now feelings, thoughts and dynamic interactions within this relationship and with others might illuminate their wider world of past experiences, current events, and future expectations.  This respectful, compassionate, supportive yet nonetheless very real encounter — coupled with a phenomenological stance — permits existential therapists to more accurately comprehend and descriptively address the person’s way of being in the world. Taking great pains to avoid imposing their own worldview and value system upon clients or patients, existential therapists may seek to disclose and point out certain inconsistencies, contradictions or incongruence in someone’s chosen but habitual ways of being. By so doing, some existential therapists will, when necessary, constructively confront a person’s sometimes self-defeating or destructive ways of being in the world. Others will deliberately choose to avoid viewing or addressing any experience or expression of the person’s being in the world from a perspective that construes it as being positive/negative, constructive/destructive, healthy/unhealthy, etc. In either case, the therapeutic aim is to illuminate, clarify, and place these problems into a broader perspective so as to promote clients’ capacity to recognize, accept, and actively exercise their responsibility and freedom: to choose how to be or act differently, if such change is so desired; or, if not, to tolerate, affirm and embrace their chosen ways of being in the world.   
To facilitate this potentially liberating process, existential therapy focuses primarily on enhancing the person’s awareness of his or her “inner” experiencing, “subjectivity” or being: the temporal, transitory, vital flux of moment-to-moment thoughts, sensations and feelings. At the same time, existential therapy recognizes the inevitable interplay between past, present and future. In this regard, existential therapists respect the impressive power of the past and the future, and directly address it as it impacts upon the present. 
4. What makes existential therapy different from other therapies? 
In addition to its unique combination of philosophical worldview, phenomenological stance, and core emphasis on both the therapeutic relationship and actual experience, existential therapy is generally less focused on diagnosing psychopathology and providing rapid symptom relief per se than other forms of therapy. Instead, distressing “symptoms” such as anxiety, depression or rage are recognized as potentially meaningful and comprehensible reactions to current circumstances and personal contextual history. As such, existential therapy is primarily concerned with experiencing and exploring these disturbing phenomena in depth: directly grappling with rather than trying to immediately suppress or eradicate them. Consistent with this, existential therapy tends to be more exploratory than specifically or behaviorally goal-oriented. Its principal aim is to clarify, comprehend, describe and explore rather than analyze, explain, treat or “cure” someone’s subjective experience of suffering.  
5. What techniques or methods do existential therapists employ? 
 Existential therapy does not define itself predominantly on the basis of any particular predetermined technique(s). Indeed, some existential therapists eschew the use of any technical interventions altogether, concerned that such contrived methods may diminish the essential human quality, integrity, and honesty of the therapeutic relationship. However, the one therapeutic practice common to virtually all existential work is the phenomenological method. Here, the therapist endeavors to be as fully present, engaged, and free of expectations as possible during each and every therapeutic encounter by attempting to temporarily put aside all preconceptions regarding the process. The purpose is to gain a clearer contextual in-depth understanding and acceptance of what a certain experience might signify to this specific person at this particular time in his or her life.  
Many existential therapists also make use of basic skills like empathic reflection, Socratic questioning, and active listening. Some may also draw on a wide range of techniques derived from other therapies such as psychoanalysis, cognitive-behavioral therapy, person-centered, somatic, and Gestalt therapy. This technical flexibility allows some existential practitioners the freedom to tailor the particular response or intervention to the specific needs of the individual client and the continually evolving therapeutic process. However, whatever methods might or might not be employed in existential therapy, they are typically intentionally chosen to help illuminate the person’s being at this particular moment in his or her history.
6. What are the goals of existential therapy?  
The overall purpose of existential therapy is to allow clients to explore their lived experience honestly, openly and comprehensively. Through this spontaneous, collaborative process of discovery, clients are helped to gain a clearer sense of their experiences and the subjective meanings they may hold. This self-exploration provides individuals with the opportunity to confront and wrestle with profound philosophical, spiritual and existential questions of every kind, as well as with the more mundane challenges of daily living.  Fully engaging in this supportive, explorative, challenging process can help clients come to terms with their own existence, and take responsibility for the ways they have chosen to live it. Consequently, it can also encourage them to choose ways of being in the present and future that they, themselves, identify as more deeply satisfying, meaningful and authentic.  
7. Who can potentially benefit from existential therapy?  
An existential approach may be helpful to people contending with a broad range of problems, symptoms or challenges.It can be utilized with a wide variety of clients, ranging from children to senior citizens, couples, families or groups, and in virtually any setting, including clinics, hospitals, private practices, the workplace, organizations, and in the wider social community. Because existential therapy recognizes that we always exist in an interrelational context with the world, it can be especially useful for working with clients from diverse demographic and cultural backgrounds.   
While existential therapy is particularly well-suited to people who are seeking to explore their own philosophical stance toward life, it may, in some cases, be a less appropriate choice for patients in need of rapid remediation of painful, life-threatening or debilitating psychiatric symptoms. However, precisely due to its fundamental focus on a person’s entire existence rather than solely on psychopathology and symptoms, existential therapy can nonetheless potentially be an effective approach in addressing even the most severe reactions to devastating psychological, spiritual or existential disruptions or upheavals in their lives, whether in combination with psychiatric medication when needed or on its own.    
8.What scientific evidence is there regarding the efficacy of existential therapy? 
A range of well-controlled studies indicate that certain forms of existential therapy, for certain client groups, can lead to increased well-being and sense of meaning (Vos, Craig & Cooper, 2014). This body of evidence is growing, with new studies showing that existential therapies can produce as much improvement as other therapeutic approaches (e.g., Rayner & Vitali, in press). This finding is consistent with decades of scientific research which shows that, overall, all forms of psychotherapy are effective, and that, on average, most therapies are more or less equally helpful (Seligman, 1995; Wampold & Imel, 2015), with specific client characteristics and preferences determining the best therapeutic approach for any given individual. There is also a good deal of evidence indicating that one of the core qualities associated with existential therapy – a warm, valuing and empathic client or patient-therapist relationship — is predictive of positive therapeutic outcomes (Norcross & Lambert, 2011). Additionally, existential therapy’s central emphasis on finding or making meaning has been shown in general to be a significant factor in effective treatment (Wampold & Imel, 2015).  
9. Where can I find out more about existential therapy and/or professional training to become an existential therapist?  
Until recently, there were few if any formal training programs for existential therapists. In recent years, this situation has changed, with the creation of various training programs in the United States, the United Kingdom, Belgium, Austria, Germany, Switzerland, Italy, Portugal, Russia, Canada, Scandinavia, Israel, Argentina, Mexico, Chile, Peru, Colombia, Brazil, Lithuania, Greece, Australia and many other countries.  
A full list of training courses has been compiled by Edgar A. Correia and is available on this website.   
Additional references  
Norcross, J. C., & Lambert, M. J. (2011). Evidence-based therapy relationships. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed., pp. 3-21). New York: Oxford University.  
Rayner, M., & Vitali, D. (in press). Short-term existential psychotherapy in primary care: A quantitative report. Journal of Humanistic Psychology. [Spanish translation published as Rayner, M. y Vitali, D. (2015). Psicoterapia existencial de corto plazo en atención primaria: Un reporte cuantitativo. Revista electrónica Latinoamericana de Psicologia Existencial “Un enfoque comprensivo del ser”. N° 11. Octubre.] 
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. doi: 10.1037/a0037167  
Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (2nd ed.). New York: Routledge.