Existential Psychotherapy – What is it?

I’ve recently been exploring an aspect of psychology that intertwines two recent interests of mine: existential philosophy and psychoanalysis. This is, in essence, what existential psychotherapy is. This branch of psychological therapy orients treatment around the patient’s engagement with the profound, or existential, aspects of the human condition, like the search for meaning, freedom, and mortality.  If you’ve ever pondered the meaning of your life, grappled with your choices and regrets, or faced the harsh reality of mortality, then you’ve already touched upon the themes that existential psychotherapy delves into.

Where Does It Come From?

‘Existentialism’, the intellectual movement upon which existential psychotherapy draws, emerged from the backdrop of the horrors of the Second World War; the Nazi death camps, mass loss of life, atomic bombings, etc. These atrocities encouraged a new generation to confront the hard questions and inherent anxieties of the human condition. Notable existentialists include philosophers like Fredrik Nietzsche and Jean-Paul Sartre, but also novelists like Albert Camus and Dostoevsky, directors, artists, civil rights leaders, and psychologists (championed by newer writers like Irvin Yalom, Emmy Van Deurzen, Eckhart Tolle, who have all written some amazing stuff).

Another note, ‘L’étranger’ or ‘The Stranger’ by Camus is mentioned in Wikipedia as ‘the exemplary existential novel’. I haven’t read enough existential literature to know if that’s true, but I have read the story twice, once before knowing about existentialism, and once after, and both times it’s been very thought-provoking and very good. It’s short as well. I would definitely recommend.

Because of its pervasion into many aspects of life, not just intellectual thought, existentialism is actually quite an abstract term that doesn’t refer to a coherent system or philosophical doctrine like say, stoicism. That being said, there are a few things that bind the movement together (Aho, 2023).

            Influenced by Nihilism

Nietzsche’s famous ‘God is Dead’ phrase encapsulates the rise of nihilism amidst the increasingly secular and scientific world emerging in the late 19^th century. The loss of religion’s divinely ascribed framework for existence and the resultant void that comes from the realisation of ‘if not God, then what?’ gave rise to modernity’s signature existential explorations of the human condition: anxiety, alienation, meaninglessness, boredom. These were only elevated in importance in the post-WW2 era.

Importantly, existentialism is not nihilism – it is the opposite. It seeks to confront and overcome meaninglessness so as to not succumb to nihilism. It’s just been influenced by nihilistic lines of inquiry, seeking to practically address them.

            ‘Existence Precedes Essence’

Sartre argued against the well-entrenched and divinely validated assertion that essence precedes existence, or that humans are born with a predetermined purpose. Instead, he believed that we have no such predetermined essence and that it is up to us to create and determine meaning in our lives.

What is ‘essence’? Essence is, in this context, the core qualities of something that make it what it is. Take the example of a chair. The traditional view holds that the essence of a chair is to provide a place to sit. Its essence (to be somewhere to sit) preceded its existence. Sartre’s existentialist view would argue that if a person uses a chair as a piece of art instead of for sitting, its essence (art) has been determined after its existence.

The chair analogy isn’t perfect, but it helps explain this concept when applied to humans. Traditional views tend to argue that the essence of a human is predetermined. For example, to love and serve God (theism), to achieve happiness through reason and logic (Aristotle), to attain the highest forms of knowledge (Plato), to cultivate virtues like benevolence, righteousness, and societal well-being (Confucius). Instead of these, Sartre and other existentialists argue that our essence is not predefined at all and it’s not really the business of anyone or anything else. Instead, our essence is ours to create and define. In Kierkegaard’s (paraphrased) words, meaning is the very experience of finding one’s values, beliefs, and purpose, or meaning, in an essentially meaningless world. 

             Freedom

Recognising that we have no predetermined essence, it is then up to the individual to develop their own essential meaning through their choices, actions, and self-reflections. Existentialists generally agree that what distinguishes our existence from that of other beings is our capacity to be self-conscious, or, aware and engaged with our thoughts and actions. This allows us to be free and responsible for who we are and what we do, as opposed to the determinist stance that we are the sum of our histories, or the passive converters of inputs into outputs. Our capacity to interpret and give meaning to experiences and then proactively engage with that given meaning allows us to transcend determinism and gain freedom.

             Authenticity

Existentialists criticise our ingrained tendency to conform to social norms, which they feel prevents us from being authentic, or true to our essential being, or self-defined meaning. Being authentic means being willing to break with social norms and pressures and live courageously in line with whatever meaning that we ourselves have ascribed. These social forces tend to play a large role in our determined selves, and so while living authentically isn’t inherently in contradiction, a reckoning with how they may be determining our thoughts and actions is important a necessary step towards authentic living.

I try to apply this to my own life by actively trying to see how social norms and expectations may be determining my actions. The times where I have been aware and am then able to act in a more authentic way are often very liberating, though it is anxiety-inducing and not particularly natural. I do think that where you can, it’s good to practice being anxious.

Back to Therapy

Existential therapy doesn’t get too involved in these messy philosophical debates, although it does utilise them. In particular, the notion that wellbeing and happiness can be achieved through guiding a patient to live authentically, with freedom, and towards the meaning they have ascribed to their own life. Done successfully, it seems obvious that this path would be effective in alleviating all sorts of psychological strain.

Individuals struggling with the ideas discussed above would definitely benefit from this approach to therapy, but these ideas are often very intertwined with more broader afflictions like stress, depression, trauma, addiction, etc. Like with all therapy, it’s very individual and not determined by diagnosis what therapeutic approach may work best.

What does an existential therapist actually do?

From speaking to a few, and reading a lot about it, existential therapists act as both guides and companions as a client goes on their own journey of self-discovery. This may involve encouraging clients to explore the deeper meaning of their past choices, experiences, and beliefs, and how these manifest in the present. This doesn’t mean dwelling on the past, as is the pop-culture stigma surrounding psychoanalysis, but rather, using the past as a tool to promote present-orientated authenticity, freedom, and meaningful living. Through this, you may notice how external structures and past experiences may prevent you from living authentically and in accordance with a self-created meaning. Because of the focus on past experiences, usually the most profound ones, it can be quite an emotionally and psychologically challenging process. If I ever try it, which I hope to, I’ll let you know.

How do you become an existential psychotherapist?

For those looking to practice in the UK, an academic background in psychology, psychiatry, or something similar, is preferred but not mandatory. For some training institutions, it’s a requirement. You’d then need to do postgraduate training, with two main paths available.

1. Specific Training in Psychotherapy

Course length varies but it’s 2-3 years (longer if part-time). During this, you’ll study, clinically practice under supervision, and undergo personal analysis, usually through your own psychotherapy. This would then give you accreditation through one of the recognised organisations like the BPC, the Institute of Psychoanalysis, or the UKCP, and you’d be free to practice either privately or with an institution.

2. Clinical Doctorate with a later focus in psychotherapy

The 3-year clinical doctorate is another route. The main three differences are a) DClins are usually funded by the NHS b) have a wide-spread engagement with varying psychological interventions, of which psychotherapy will just be one and c) require at least 1-2 years of work experience or training before you apply, and as they are usually very competitive, it may take years before being accepted.

Both paths have benefits, route 1 will give you a more specific focus on psychotherapy and you will start working sooner; route 2 will be funded, give you a broader focus, a highly recognised and valued qualification, and the capacity to engage in research. Conversely, route 1 is self-funded and limits the breadth of training, route 2 is very competitive, known to be very academically rigorous, and it would take much longer if you wanted to specialise in psychotherapy, let alone existential psychotherapy.

Thanks for reading.