Existential Psychotherapy

Existential therapy is concerned with our existence as humans, however we want to understand that existence. This approach was developed by philosophers, therapists and psychiatrists and can be used to work therapeutically with any presentations.

In therapeutic terms we can also refer to this approach as Daseinanalysis. Dasein is from the German Da-Sein, the ‘there-being’, as is the person that is there. This term was introduced by Martin Heidegger (1903-1976). His philosophic work was not initially thought to be used for therapy. Heidegger was mainly concerned with philosophy and what it means to be, to exist.

Ludwig Binswanger (1881-1966) and Medard Boss (1903-1990) created a therapeutic approach based on existential philosophy. Binswanger and Boss produced more than simply adapting the work of Hidegger to support psychotherapeutic and psychiatric practice. These two Swiss psychiatrists worked on their own understanding of Hidegger and created two separate, yet somehow complementary, philosophical approaches. In the current landscape of Daseinanalysis it is still possible to distinguish different approaches. However they all refer to the original philosophies of Hidegger, Boss and Binswanger.

The end of the Renaissance produced a sceptic look on science and progress, which created brilliant thinkers and writers such as William Shakespeare (1564-1616) and Rene Descartes (196-1650). This scepticism was celebrated highlighting feelings and emotions by Shakespeare’s poetry and plays. On the flip side, Descartes created a more philosophical thought on the dualism between material thing (res extensa) and thinking thing (res cogitans). This is aligned with the difference between subject and object of knowing.

This split between subject and object was then explored further and expanded in philosophical terms during the following century. We now refer to that time as the Enlightenment. It prioritised objective knowledge, science and the power of the intellect. In the nineteenth century, the trend of putting science over passions was finally counterbalanced by Romanticism. This movement includes the work of brilliant writers such as Goethe, Kierkegaard, Dostoevsky, Nietzsche and many others. The Romantics embraced nature, passion and everything that is ephemeral and enigmatic. This means looking into the depth of the human soul including its mysteries and contradictions.

In the beginning of the twentieth century, the interest for human existence became so prominent that it created a whole new science: psychoanalysis. Sigmund Freud has the merit of being the first of codifying a therapeutic approach; however he separated it from the original philosophical roots. So psychoanalysis became a scientific approach because it reconnected to the subject-object split (I’m the expert doctor and I analyse you!).

Medard Boss and Ludwig Binswanger took the interest for human existence back to the philosophical roots. Psychoanalysis is a hermeneutic approach because it’s a research methodology, rather than a philosophy. In an existential sense, Freud was right to say “we know nothing”, and yet misleading in saying that “we are obliged to assume” (Freud, 1933/1964, p.70). Another thing that needed to be left behind was the idea that there is something in the psychic that is hidden (namely the unconscious). Boss and Binswanger reluctantly accepted the idea of the unconscious, but understood in a different way. They thought it was an unnecessary construct (Boss, 1963).

A very accessible guide to existential therapy in Yalom’s Existential Therapy (1980). The author describes the human concerns in a simple, yet deep manner. He introduces the ‘givens of existence’: 1) Death, 2) Isolation, 3) Freedom, and 4) Meaninglessness. We all need to come to terms with these facts about our lives.
In existential therapy we think about issues on a continuum. For example:

- freedom, responsibility, and agency;

- human limitation, and finiteness;

- isolation and connectedness;

- meaning and meaninglessness;

- emotions, experience, and embodiment

As a therapist I want to ask myself where is my client in this continuum?

At this point it is important to introduce some philosophical terminology. First of all, we call hermeneutic the interpretation of something. So, for instance, Heidegger’s approach is hermeneutic, because it’s interpretative.

Another way to understand reality is via phenomenology. This is an approach to knowledge, based on description. The phenomenon is the event, ‘what is happening’, so phenomenology is the study of what happens. There are different ways to understand phenomenology in psychotherapy. For existential therapy we refer to the work of Edmund Husserl (1859-1938).

Another important point is the difference between ontic and ontological. In Heidegger we call ontic the everyday reality of existence. For example, my ontic experience is that I’m sitting in front of my laptop typing. The other side of the coin is ontology. Ontology deals with existence as such. This aspect is fundamental for existential therapy.
“The distinctive character of existential analysis is [...] that it is concerned with ontology, the science of being” (May, 1958 p.37).
We always move between the two dimensions: the everyday one and the ontological one. This ontic-ontological analysis is a central part of the existential analysis as such. We want to think about our existence from an ontic perspective, as well as from an ontological one.

Hidegger’s most important and successful publication on human beings (Dasein) is ‘Being and Time’ (1987/2001). Erik Craig (2019) individuates three important points to Being and Time:
1) My own being can relate to other beings, including itself.

2) The being is necessarily a ‘being-in-the-world’.

3) The ontic-ontological analysis is essential to understand what it means to be human.

Hidegger is mainly concerned with ontological questions, such as: what does it mean to be? The therapist would not necessarily need to find an answer to such questions, but the activity of questioning existence can be a valid topic of reflection.

Another important thing when we think about the ontological dimension of life is to come consider the facts of our existence. Hidegger introduces first the concept of existential angst. Various authors translated him in different ways, so sometimes we can also talk about existential anxiety. This is seen as a given in our existence. When I was doing my training as a psychotherapist, I used to say ‘I’m anxious because I’m alive’, and there is nothing else to add. We sometimes ‘hook’ this ontological anxiety to ontic situations, so that we can have anxieties about all sorts of things (health, relationships, open spaces, circumstances, performance and so on). All these ontic anxieties stem from the ontological angs/anxiety described by Hidegger as a given of existence.
For example illness reminds us of our mortality or a relationships break up reminds us of our existential isolation.
In Heidegger, there is this difference between living authentically or inauthentically. We live inauthentically when we see ourselves as passively caused by the past, and we wait for the circumstances to be more favourable. This usually condemns us to repeat previous mistakes, it reinforces the illusion of causation and denies the possibility for change.
We live authentically when we are in touch with ontological truth about our existence. This means freedom, self-determination, change, self-affirmation. In this case we are also inevitably embracing the anxiety that comes with it. It can be very hard for a client, because this implies being more in touch with uncomfortable feelings. Embracing this anxiety allows us to turn it perhaps into a motivation. I believe it’s important to use that anxiety and turn it into something I can use to my benefit. This could be a successful treatment course for anxiety.

I hope this article gave an accessible overview of existential psychotherapy. A good book to take things forward is The Wiley World Handbook of Existential Psychotherapy (2019) edited by Emmy Van Deurzen, which provides a more in depth explanation of theories and practice.

Boss, M. (1963). Psychoanalysis and Daseinanalysis. New York: Basic Books.

Cooper, M. (2007). Existential Therapies, 2e. London: Sage.
Craig, E. (2019). The history of Daseinanalysis. In: The Wiley World Handbook of Existential Psychotherapy (ed. E. Van Deurzen), 33-54. Hoboken, NJ: John Wiley & Sons.
Deurzen, E. van, Ed. (2019). The Wiley World Handbook of Existential Psychotherapy. Hoboken, NJ: John Wiley & Sons.
Freud, S. (1964). New introductory lectures on psycho-analysis. In: The Standard Edition of the Complete Psychological Work of Sigmund Freud, vol. 22 (ed. and trans. J Strachey), 1-182. London: Hogarth Press (Original work published 1933).

May, R. (1958). Contributions on existential psychotherapy. In: Existence: A New Dimension in Psychiatry and Psychology (ed. R. May, E. Angel, H.F. Hellenberger), 37-91. New York: Basic Books.

Yalom, I. (1980). Existential Psychotherapy. New York: Basic Books.