Working Through Existential Anxiety Toward Authenticity: A Spiritual Journey of Meaning Making

Abstract

All human beings experience life’s givens or the ultimate concerns of death, isolation, freedom, and meaninglessness. Whether there is awareness or not, these givens influence how individuals interact and relate to self, others, and the world. Failure to understand these existential concerns can lead an individual to behave inauthentically in relation to her core values. This article will illuminate the role of existential psychotherapy in revealing the effect of life’s givens on an individual’s lived experience. First, this article will ground existential therapy within its philosophical roots. Second, it will highlight the use of the phenomenological method in existential psychotherapy as a means of building a strong therapeutic alliance between therapist and client. Attention to the client’s lived experience in a value-free way will provide space for the client to work through his or her existential anxiety toward authenticity. The client, in feeling deeply understood will be able to respond more authentically to the therapeutic relationship and by extension to others in his or her world. A framework for understanding how life’s givens can manifest across the physical, personal, social, and spiritual life dimensions are presented. This framework is used to conceptualize a case study of a client struggling with existential issues.

Keywords

existential anxiety life’s givens meaning making

As the experience of life carries with it the experience of existential anxiety, so arises the prevalence of existential thought in all aspects of society (Pyszczynski, Greenberg, & Koole, 2004). This anxiety, from which everyday worries and anxieties can be traced (van Deurzen & Adams, 2011), is ontological in nature and is a universal aspect of existence (Langdridge, 2013). While all individuals share in this, each does so in his or her own subjective way. Yalom (1980) argues that individuals, whether they are conscious of the fact or not, still experience the impact of existential anxieties. The experience of life involves certain givens that have a profound impact on the individual’s ability to understand self and relationship with the world. Existential anxiety originates with the individual’s struggles to work through these life givens or ultimate concerns. While there are various givens in life, this article will focus on those highlighted by Yalom (1980): death, isolation, freedom, and meaninglessness.

This article will explore the impact of these ultimate concerns on the individual’s subjective experience of his or her world. The individual is surrounded by circumstances that lie outside his or her control, a fact that is captured in Heidegger’s (1962) concept of “thrownness.” In an attempt to understand his or her own experience while being pressured by external structures, an individual enters into a struggle to make meaning; a struggle that can trigger anxiety, isolation, despair, depression, and substance abuse (Moore & Goldner-Vukov, 2009). Being unaware of these existential anxieties, the individual tries to adhere to external rules and guidelines in living life. If left unresolved, anxiety grows and the individual may begin to act in ways that do not resonate with inner core values (van Deurzen, 2002), thus entering a state of inauthentic living. It should be stated that authenticity is not a final goal but that as a necessary aspect of life, it is something that should be worked toward (Heidegger, 1962). The existential approach to psychotherapy is valuable because it is concerned with the subjective experience of life, as well as to how the individual relates to the external environment.

This article will first reveal the roots of existential therapy as arising out of philosophical thought (Schneider & Krug, 2010) and as such does not adhere to a rigidly defined set of techniques. Rather, existential therapy focuses on the way in which the individual experiences the world and the meaning he or she derives from this experience (Langdridge, 2013; van Deurzen, 2011). This has implications not only on how the individual relates to other people but also the unique way in which the therapist and client must forge a therapeutic alliance. Second, this article will demonstrate the necessity of the phenomenological method in the existential approach. The phenomenological method provides a structure for the therapist to approach clients in a way that ensures the client feels heard, understood, and respected. Third, a framework, revealing how the four life givens (death, isolation, freedom, meaninglessness) manifest in the lived experience (physical, personal, social, spiritual) of persons, will be proposed. Lastly, this framework will be applied to the conceptualization of a case study based on Christopher Daniels’ autobiographical book Money’s on the Dresser: Escorting, Porn, and Promiscuity in Las Vegas (2013).

From Philosophy to Psychology

A formal existential “school” within philosophy emerged in the 19th century with the work of Kierkegaard (Yalom, 1980). Indeed, Kierkegaard is largely considered to be the father of existential philosophy (Lander & Nahon, 2005; Langdridge, 2013; Sartre, 1965). Kierkegaard (1980) put forth that humans can and should learn from anxiety and despair and that subjective truth was of more importance than given truth. Nietzsche, another early and influential existential thinker, similarly placed emphasis on the importance of the subjective experience of life over objectivity. His approach was antitheistic and critical of external structures that made claims of objective facts, primarily those of the natural sciences and moral authorities (Langdridge, 2013). For Nietzsche, values and morality come from within. While Nietzsche and Kierkegaard differed in their theistic beliefs, both believed that to live fully and in the face of external demands and constraints, one must develop a sense of personal enlightenment. That is, the individual must look inward to his or her own subjective experience of the external world (Langdridge, 2013). Another important figure in the development of existential philosophy, Heidegger (1962), focused on the concept of being. He proposed that humans are the only creatures to question the nature of their existence, thus their human being is unique. This is important to understand for the therapist working with clients, as all humans are involved on some level in dealing with questions surrounding human being (Langdridge, 2013).

Existential psychology emerged at a time when psychology and psychotherapy focused primarily on human behavior from the perspective of particular scientific and theoretical approaches (May, 1962). The human experience is broken down into parts, such as biological, behavioral, social, and spiritual and studies are conducted to demonstrate how and why humans interact with their world as they do (van Deurzen & Adams, 2011). While psychology looked to the parts to explain the whole (Yalom, 1980), existential thinkers such as Sartre (1970) and Heidegger (1962) put forth that existence comes before essence. This is to say, that we are is fundamental and precedes what we are (van Deurzen & Adams, 2011).

While in the past the existential approach to psychology and psychotherapy has been rebuffed for its lack of empirical evidence, Yalom (1980) notes that the scientific tradition has focused too intently on breaking down a complex organism into its parts. These parts, even when combined do not explain the whole. Such research is often found to be inapplicable and inappropriate in explaining the meaning of what the individual is dealing with as it does not focus on the entire subjective experience, rather, on singular aspects of psychic structure (Yalom, 1980). Viktor Frankl (2000) goes further to say that this meaning-making component is spiritual and is what distinguishes humans from other animals. The individual must create meaning for his own life, rather than look to the world around him to provide it (Moore & Goldner-Vukov, 2009).

Existential Psychotherapy

Today, existential therapy can be thought of in four different approaches or schools (Cooper, 2003a, Cooper, 2003b Vos, Craig, & Cooper, 2015) from which various training programs have emerged. The first school is referred to as Daseinsanalysis, or the analysis of human existence, and is largely influenced by Heidegger’s writings (Cooper, 2003b ). This approach focuses on an open therapeutic relationship in which the client is able to freely express himself or herself and is moved toward developing openness toward her or his world (Vos et al., 2015). The second school, logotherapy, was developed by Frankl (1992) and aims to help clients discover the meaning and purpose in their lives (Cooper, 2003b, Vos et al., 2015 ). Logotherapy has had significant mainstream success and influenced other professions, such as social work, nursing, and dentistry (Cooper, 2003b ). The third approach can be identified as the British school of existential psychotherapy and is based largely on the writings of R. D. Laing (Cooper, 2003a; Spinelli, 2007; Vos et al., 2015) and pioneered primarily by Emmy van Deurzen (Cooper, 2003a, Cooper, 2003b ). This approach is phenomenological in nature and focuses on exploring the client’s experience of existence and relationship with others (Cooper, 2003b ; Spinelli, 2007). The final school of thought is often referred to as an American approach and includes the existential–humanistic approach. It focuses primarily on the client’s inward, subjective experience and was established by Rollo May, who acted as mentor to James Bugental, Irving Yalom, and Kirk Schneider (Cooper, 2003a, Cooper, 2003b ). From within the American school, two schools have emerged: supportive–expressive group therapy which is directed toward cancer patients; and experiential–existential which focuses on bridging existential therapy with experiential interventions (Vos et al., 2015).

Each of these approaches has influenced a plethora of training programs across the world. Daseinsanalyis has been influential primarily across mainland Europe and opened its first training facility in 1971: the Daseinsanalytic Institute for Psychotherapy and Psychosomatic Medicine (Cooper, 2003b). Logotherapy continues to grow and training institutes can also be found internationally through the Viktor Frankl Institute (http://www.viktorfrankl.org/e/) and the International Sociey for Logotherapy and Existential Analysis (GLE International; http://www.existential-analysis.org), among others. The British school has spurred various training programs and facilities such as the Existential Psychotherapy Program in the School of Psychotherapy and Counselling at Regent’s College, London (Spinelli, 2007) and van Deurzen’s own New School of Psychotherapy and Counselling in London (https://www.nspc.org.uk). Last, the American approach has spawned other training facilities such as the Existential–Humanistic Institute (http://www.ehinstitute.org/index.html) in San Francisco and the nearby International Institute for Humanistic Studies (http://www.human-studies.com/index.php).

The field of existential therapy is widespread and encompasses various approaches from different schools of thought. While this may seem problematic for some (Correia, Cooper, & Berdondini, 2015), for others it is consistent and inherent in the existential approach that focuses on the subjective, phenomenological experience of the individual (Spinelli, 2007; Yalom, 1980). Indeed, in his description of his own approach to existential therapy in which he recognizes and describes what he sees as a three-phase approach, Spinelli (2007) notes that neither he nor any other therapist would or should ever follow the three phases precisely as described. Instead, it is his attempt to provide an understanding as to what is otherwise a fluid approach to therapy. The therapist must, therefore, focus more on which phase she or he and the client are in and flow though the process which they create in order to gravitate toward the needs of the client.

The Phenomenological Method

Phenomenology was established by Husserl as a philosophical school and was further developed by other philosophers in the early 20th century (Jacobsen, 2007; Langdridge, 2013; Spinelli, 2007). Jacobsen (2007) explains that this approach is based on the premise that the individual exists in relation to the world. Furthermore, it grew out of a concern that the field of psychology focused excessively on what can be measured rather than on the significance of the item being studied (Hersch, 2005 ). Rather than focus on the behavior of an individual observed by another, the focus should be on the individual’s experience and according to his or her own understanding. The literature that arises from the application of the phenomenological method to the study of human existence is existential in nature, meanwhile, the application of existential psychotherapy is based on the phenomenological method (Adams, 2014).

The phenomenological method relies on three primary rules: those of parenthesis, description, and horizontilization (Jacobsen, 2007; Langdridge, 2013). The rule of parenthesis, states that it is necessary to bracket expectations and presumptions (Hersch, 2005). While it has been noted that this is not always possible, it is imperative to understand one’s own assumptions (Langdridge, 2013) before attempting to understand another’s experience. Laing (1965) further demonstrates the importance of this when dealing with clients suffering from psychosis. The individual’s experience must be treated seriously, even when the experience is that of delusions to avoid dismissing the client’s understanding of the world. The rule of description makes explicit the need to rely on description, not explanation or causation. What is most important with this rule is to convey how things appear or are felt by the individual, rather than focusing on what we know them to be (Hersch, 2005). In the rule of horizontilization, Jacobsen (2007) emphasizes the need to give equal weight to all elements of the description. It is imperative to avoid making any one aspect more important than another for as long as possible. In order to explore the descriptions, there must follow a process of critical reflection in order to gain understanding of what is most essential and requires further exploration (Hersch, 2005).

Thus, phenomenology seeks to encounter the phenomenon as it is, stripped of assumptions and stereotypes. In this way, the counsellor meets the client as she or he is and strives to understand the individual in his or her own experience of an event (Jacobsen, 2007). Listening carefully and learning about the experience of the client leads to the experience of the client feeling deeply understood (Langdridge, 2013). The therapist explores and emphasizes the client’s present experience of relating to another, in the form of the therapist, as this experience unfolds in their therapeutic interaction (Spinelli, 2001). The concept of intentionality is key to the phenomenological approach (van Deurzen & Adams, 2011). It is not taken for granted that every act of consciousness is intended for something (Hersch, 2005). The therapist, then, must take the client’s experience at face value to understand him or her more deeply. The therapist avoids providing explanations and refrains from reducing the client’s experience to previous causes in order to better understand how this experience reveals itself in his or her consciousness (Langdridge, 2013).

Existential Anxiety

The experience of life involves the interaction with certain existential givens. These givens can be considered ultimate concerns and are inherent, inexorable, aspects of the individual’s existence in the world (Yalom, 1980). While there is not an agreed upon set of ultimate concerns in the field of existential philosophy and psychotherapy, there are certain concepts that arise frequently in the literature. This article will focus on the four givens emphasized by Yalom: death, isolation, meaninglessness, and freedom. These givens are chosen as they commonly arise across existential writings despite differences in emphasis. Individuals experience existential anxiety when they are confronted with accepting or not accepting life’s givens (Lucas, 2004).

An important aspect of the concept of existential anxiety is its distinction from fear. Fear is a sensation the individual experiences resulting from an external object, that is, a definitive source. Anxiety, on the other hand, has no object, the threat of anxiety is nowhere (Heidegger, 1962; Stolorow, 2007; Tillich, 2000; Weems, Costa, Dehon, & Berman, 2014; Yalom, 1980). For Heidegger (1962), the lack of object in existential anxiety renders external factors meaningless and irrelevant. Existence itself becomes equal to nothingness because embedded in existence is the understanding of the certainty of death, that is, the end of existence. Everyday significance thus collapses and the individual is left with a feeling of strangeness and the sensation of “not-being-at-home” (Heidegger, 1962, p. 188).

Iacovou (2011) points out that there are other forms of anxiety. People experience normal anxiety when they react fittingly and within proportion to everyday threatening events. Normal anxiety can be used to deal with typical dilemmas or conflicts in a healthy manner, or it can lead to neurotic anxiety. Neurotic anxiety is the failure to accept and manage the uneasiness and insecurity present in our very existence, that is, existential anxiety. Furthermore, behaviors associated with neurotic anxiety allow the individual to suppress the dread of the unknown with a more relatable and finite object, such as a specific fear. Neurotic anxiety is the result of behaviors that the individual uses to defend the self (Cooper, 2003b ) from the fundamental concerns that are embedded in the human experience. Existential anxiety is different from neurotic and normal anxiety as it emerges as a feeling of powerlessness when confronted with the challenges of existence, and this may result in apathy and a lack of feeling as a defense (May, 1983).

The Givens of Life

Death

Humans are internally motivated toward self-preservation while at the same time aware of their impermanence (Florian, Mikulincer, & Hirschberger, 2002; Greenberg, 2012; Heine, Proulx, & Vohs, 2006; Weems et al., 2014). This impermanence results in nonbeing. Nonbeing exists within being: Both are fundamental to human existence (Tillich, 2000). It is not merely the realization that one will die or the experience of the death of others, but rather the influence of these situations on the individual’s underlying understanding of his or her own impending finitude. Thus, awareness of the constant possibility of nonbeing causes the individual to be in a constant state of anxiety (May, 1983; Tillich, 2000). What is more, humans actively seek to remove the realization of their impending death from conscious thought (Florian et al., 2002; Hirschberger, Florian, & Mikulincer, 2002).

Yalom (1980) suggests that people are typically more aware of their specific fears of dying or of losing loved ones, but are often not as aware of their generalized dread of nonbeing. They protect themselves from this terror with two main defense mechanisms. According to Yalom, the first is the belief that the individual is special, that he or she is not susceptible to death. This mechanism allows the individual to face the challenges of life without being burdened by his or her impending nonbeing. The other defense mechanism is for the individual to put faith in a higher power to save him or her through an instrument or another human. Yalom suggests that these defense mechanisms are used interchangeably as needed to protect the individual from the terror of eventual nonexistence. Although he is a self-proclaimed atheist, Yalom notes that these defense mechanisms do not negate the existence of God or other religious and spiritual beliefs. Rather, he points out that these commonly held beliefs serve a purpose to protect the individual against death anxiety.

Conflicts may arise when the individual is not able to negotiate the relationship between self-preservation and the temporariness of life. Indeed, studies have demonstrated that there is a relationship between death anxiety and depression, anxiety, and traumatic stress (Weems et al., 2014). Florian et al. (2002) found that increased awareness of mortality, or mortality salience, is related to increased reliance on partners in a relationship. Furthermore, problems in romantic relationships were related to an increased accessibility to death-related thoughts. Studies have also shown that increased awareness of death motivates individuals to not only seek out a mate but also to lower their standards in mate selection. In this situation, individuals will select mates based more on availability than on desirability to buffer death anxiety (Hirschberger et al., 2002).

Isolation

The feeling of isolation is the awareness of the individual’s separateness from others and the external world (Moore et al., 2009). The individual experiences conflict when she or he feels this separateness yet yearns for protection and to belong (Yalom, 1980). The individual suffering from existential anxiety has no object on which to concentrate his or her efforts. She or he is in this state without help and is thus isolated (Tillich, 2000). Indeed, humans are a social species and successful relationships have been shown to improve the health of the individual while a lack of relational success is associated with a decline in longevity, an increase in mental illness, and difficulties in handling stressful events (Heine et al., 2006).

According to Pinel, Long, Landau, Alexander, and Pyzczynski (2006), shared experiences with others bolsters validations in shared beliefs and fulfills a need to feel connected to others. This serves to quiet feelings of isolation. However, these feelings of isolation reveal that one can never know someone else’s internal experience, thus one can never be completely known. This awareness, then, threatens the individual’s feelings of connectedness. Furthermore, individuals experience others as people or as objects (Laing, 1965). One encounters others, acquires information about them, and then decides how one feels about them (Pinel et al., 2006). Individuals construct what Pinel et al. describe as Me and I constructs. Me is the self-concept, it builds on itself over time and includes factual information. The “I” aspect is the part that is experiencing events and interactions and changing with them. Individuals draw inferences about one another’s experience to connect with the other, what is known as “I-sharing” (Pinel et al., 2006, p. 244). This is done in order to buffer existential isolation.

Freedom

Freedom is often thought of as a positive concept, something that is sought after. Indeed, people willingly die for freedom (May, 1981). In the existential sense, freedom means to be distinct from external structures however, this leads to being engrossed by dread (Yalom, 1980) or angst (Langdridge, 2013). Human beings desire structure and experience a sense of being ungrounded when confronted with freedom. May (1981) suggests that the concept of freedom is not preestablished. It is always changing. It is a process of development, which can enhance one’s life, or it can cause one to regress and retreat. He also posits that all values such as love, honesty, and courage spring forth from the value of being free. Values are diminished if the individual is not free to choose to exhibit and live by them. Freedom, therefore, is fundamental to the capability to value and the possibility of valuing (May, 1981). When the individual moves inward to understand internal core beliefs she or he is no longer confined to the external, objective factors that limit the human experience (Langdridge, 2013) and so experiences true freedom in life.

Meaninglessness

Meaninglessness is the result of the anxiety produced from the other ultimate concerns (Yalom, 1980). If we are to die, if there exists no structure outside ourselves, if we are all alone, then what is the meaning of life? This raises questions of the manner in which to live. Yalom points out that there is conflict in being meaning-seeking beings existing in a world that is meaningless. Feelings of emptiness increase as meaning in life, the future, and the external world decrease (Weems et al., 2014). Thus, humans look for meaning to make sense of things. They look to establish a relationship between self and external world (Greenberg, 2012). Meaning connects parts of the self, such as behavior, thought, memory, needs, roles, and characteristics to the external world (Heine et al., 2006). Meaning acts as a mechanism that guards the individual from existential anxieties relating to life’s givens such as mortality. It also serves to define oneself as distinct and unique from one’s culture (Pyszczynski, Greenberg, Solomon, Arndt, & Schimel, 2004).

In contrast, a sense of meaninglessness can lead to an array of symptoms. Although it can result in feelings of anxiety, isolation, and despair, it has been shown to develop into depression, crisis of identity, substance abuse, and lack of life direction or purpose (Moore et al., 2009). As an individual experiences ongoing meaninglessness, she or he may convince his or her self that she or he is no longer able to direct his or her own life, affect other’s opinions of self, or to have an impact on the external world. To protect the self an individual may give up wanting and feeling through apathy (May, 1969). In addition, when events or the behaviors of others appear random, this threatens an individual’s sense of meaning, which in turn affects his or her sense of personal value (Landau, Sullivan, Rothschild, & Keefer, 2012).

Interplay of Life Givens

The four givens described above have a profound impact on the individual’s experience of existential anxiety. There is often interplay between these givens as illustrated in humankind’s interaction with money. Zaleskiewicz, Gasiorowska, Kesebir, Luszczynska, and Pyszczynski (2013) state that studies have shown that money has more value than mere purchasing power. Money has been found to carry with it symbolic and emotional value that is used to manage existential anxiety, particularly death anxiety. Money serves the function of securing meaning and transcending death (Fromm, 1976; Yalom, 1980). It provides one with a sense of control and indeed can be used to purchase things that can help enhance health and safety (Zaleskiewicz et al., 2013), relating it to the concept of freedom. Alternatively, individuals reminded of death have been found to enhance the value of money, giving it special meaning (Zaleskiewicz et al., 2013). Money also has been linked to the given of isolation as it relates to a sense of lesser social rejection (Zhou, Vohs, & Baumeister, 2009) and an increased sense of self-reliance and independence (Zaleskiewicz et al., 2013).

Schneider and Krug (2010 ) describe Greening’s (1992) conceptualization of life’s givens as dialectics in which each existential given offers a challenge to which one must respond. For death, there is life. To overcome death anxiety, the individual must act in the present with full knowledge that he or she will die. In this way, she or he accepts what is unavoidable to engage in reality rather than in the anxiety. For meaning, the individual must face the chaos and randomness of life and make meaning in a personal way, meanwhile, remaining open to reforming personal meaning as necessary (Schneider & Krug, 2010). With freedom there is personal responsibility. Although the individual does not control external factors, she or he does control his or her role in events as do all persons (May, 1981). A healthy approach to freedom is to explore possibilities while remaining aware of the impact of one’s decisions and actions on others and the surrounding environment. Last, when it comes to isolation there is community (Schneider & Krug, 2010). We are always in relation to others (Buber, 1970). When an individual chooses to isolate herself or himself, she or he is still making a statement regarding his or her relationship with others (van Deurzen & Iacovou, 2013). A healthy approach to isolation is to be open to genuine relationship with others while risking objectification and rejection (Schneider & Krug, 2010).

Authenticity

Impact of Existential Anxiety on Authentic Living

While existential anxiety can cause strange and unpleasant feelings, or a sensation of “not-being-at-home” (Heidegger, 1962) it can also lead to a process of creative growth (Schneider & Krug, 2010), openness, new possibilities, and ultimately authenticity (van Deurzen, 2002). While merely conforming to societal norms may lead to inauthenticity (Becker, 1973), May (1975) suggests that the individual is able to shape her or his subjective experiences, that is, feelings, responsiveness, satisfactions, and hopes, which create awareness of self. However, this cannot be an exclusively subjective experience. Awareness comes only in relation to the external, objective world (May, 1975). May (1975) suggests that by being open to existential anxiety, the individual enters into a continuous interactional process between the subjective and objective experiences of reality. This process is the application of creating genuine meaning within and applying it to the experience of existence, thereby creating a sense of self.

Becker (1973) describes a paradox within human existence that while we are at once animals, we are at the same time divine. From this paradox emerges Kierkegaard’s (1980) concept of dread. If humans were either animal or divine, dread would not exist. Anxiety comes from the struggle to navigate through the experience of life while living in both dimensions. Becker (1973) describes the human experience of sexuality within this context. Sexuality is a social concept shaped by society and parents, but carried out by the individual. Individuals often feel guilt during sex because the act may suppress the self for the body. It becomes a physical act and the self is lost in this to absolve the painfulness of the existential paradox between self and body. According to Becker, the concept of love helps solve this as the self may safely enter or collapse into the animal sphere without feelings of guilt or fear. Rather, through intimate love with another, the individual feels safe and secure that the animal within will not subsume her or his unique freedom.

Exerting energy in avoiding the negative feelings associated with existential anxiety is common and leads to unhealthy and often destructive behavior (May, 1983). Existential psychotherapy thus encourages the client to meet the tension found within each existential given (Yalom, 1980). While existential anxiety can lead to myriad negative behaviors, awareness and motivation to accept the challenge of existence moves the individual toward an authentic and fulfilling life. For Frankl (2000), this involved accepting responsibility for one’s very existence.

According to van Deurzen (2002), confronting existential anxiety helps the individual to realize new possibilities. However, this confrontation creates a state of not knowing and as such is uncertain, open to failure, and discomforting, which can increase anxiety. Ignoring a vision to new possibilities becomes a way of creating security and defending against existential anxiety, however, this can lead to focusing on the possibilities of others, rather than one’s own possibilities. When this focus on others is challenged through existential anxiety, the individual’s concept of life begins to deteriorate and the security that was created leaves him or her vulnerable to the experience of inauthenticity (Daitz, 2011). Yet by bringing the past into the present, the individual can approach the current situation with new possibilities, even if in a limited fashion.

Situating Existential Anxiety in Lived Experience

It is important to emphasize that the existential approach to psychotherapy is not in itself a modality, but rather a way of thinking or philosophical approach meant to inform all counsellors, psychotherapists, and psychologists within the context of their varied theoretical approaches (Berry-Smith, 2012). Existential therapy does not provide specific rules or a set of techniques, but rather, it focuses on concepts about the human experience. To make sense of their lives and of themselves, individuals must first make sense of life (van Deurzen, 2002). As clients begin to see the reality of their existence, they experience anxiety. This anxiety need not be pathologized, but rather used in the therapeutic process for the purpose of client growth (Daitz, 2011).

While the existential approach resists the reduction of the subjective experience to various factors in life (e.g., biological), life is nonetheless revealed in these factors (Langdridge, 2013). Van Deurzen (2002) identified four key dimensions: physical, personal, social, and spiritual that serve to structure life. First, it is important to address issues in the physical dimension of life as it most directly influences a client’s sense of being-in-the-natural-world (Langdridge, 2013). Accordingly, living in harmony with one’s physical dimension will prepare the client to deal with issues in the other life dimensions. Second, the personal dimension is akin to the individual’s inner or psychological world. Langdridge (2013) states that individuals are in relation to others as soon as they are born but have not yet developed a sense of self. As people grow and develop they are better able to self-reflect and thus begin to understand and construct a coherent sense of self. In turn, this unfolding sense of self determines how the individual engages the world. Therein is the possibility for a significant amount of therapeutic work such as shoring up the client’s resources (van Deurzen, 2002). Third, in the social dimension, van Deurzen (2002) states that the individual interacts with learned social constructs created by social class, country, language, family, and work environments. These constructs inform the individuals’ learned behaviors, customs, and cultures. In the social dimension, the focus is on learning how to navigate problems as they arise in relationships (Langdridge, 2013). Specifically, the individual must learn to balance egoism and altruism in order to find harmony with others (van Deurzen, 2002).

Van Deurzen (2002) includes the spiritual as the fourth and often overlooked dimension after the physical, social, and personal dimensions of life. The spiritual realm is where the individual can explore ideological beliefs and values. This exploration may translate into religious interaction or not, depending on the client’s beliefs. However, it is spiritual in nature as it helps the client determine the ideals to live by in the physical, social, and personal realms. For van Deurzen, in seeking self-understanding through spirituality an individual can then relate authentically in relation to the other life dimensions. Griffith (2010) suggests that personal spirituality is religion for the individual and that existential questions are essential for determining how an individual’s spirituality manifests in life. These questions are safe and universal and help the individual to explore how they handle adversity and normalize experience. Existential questions can be used for the client to discover which spiritual and religious beliefs resonate with their inner core beliefs (Griffith, 2010). In fact, making meaning can be considered a spiritual endeavor. Frankl (1992) emphasized the importance of taking responsibility for one’s life and creating meaning. For Frankl (2000), that the human existence is synonymous with spiritual existence is a key marker of an authentically lived life.

Establishing the Therapeutic Alliance

If all humans suffer from the dread of existence, then the therapist and client share in this feeling, albeit in their own subjective way (Yalom, 1980). The therapist, then, is not removed from the experience of existential anxiety. Existential therapists, or any therapists for that matter, should at the least be aware of inner conflicts so that such awareness may inform how to best intervene with clients. The therapist cannot know the client’s subjective experience of existence, but she or he can respect and honor it. Clients who are at a low point in their understanding of existence can be quick to detect inauthenticity within a therapist. Thus, it is imperative that the therapist has accepted his or her own existential anxiety to approach the client in a genuine and nonpatronizing way (van Deurzen, 2002). Yalom (1980) reflects that many therapists actively avoid life givens because it is too difficult for the client, the therapist, or both to face. Yet existential givens arise regularly in therapy. It is a question of whether the therapist will acknowledge and explore the givens or simply categorize them as a typical product of the experience of life more closely related to neurotic anxiety (Yalom, 1980).

In a true phenomenological approach the therapist must bracket his or her assumptions, describe rather than explain the client’s experience, and consider all aspects of the client’s experience to be of equal importance until it is made clear which area needs further exploration (Jacobsen, 2007; Langdridge, 2013). It is also imperative that the existential therapist pay particular attention to the client’s way of relating to others including the therapist as the subjective experience of the client is defined in part by the context of the intersubjective structure of the therapeutic alliance (Langdridge, 2013). The therapist needs to increase access to the lived experience of the client in order to understand and accept how the client’s affective world in relation to life and the therapeutic alliance is experienced (Spinelli, 2001). The client is then able to experience what it is like to be with another human being who truly accepts his or her real self. In the presence of the therapist’s attitude of acceptance and openness, the client can accept how his or her own way of being has come to pass and then choose to continue to live this way or to adopt a new manner of living (Spinelli, 2001).

Thus, creating a strong therapeutic alliance is essential to existential psychotherapy. This alliance is a collaborative bond between the therapist and the client (Krupnick et al., 1996). While studies are created to demonstrate the efficacy of the varying approaches to therapy, it is not these varying approaches alone that have proven to be most effective (Graybar & Leonard, 2005). Rather, the strongest predictor of positive outcomes in therapy is the quality of the therapeutic relationship (Krupnick et al., 1996). Specifically, clients report that the opportunity to talk in a structured setting, the experience of being heard by another, and the understanding of the therapist’s humanity are linked to the achievement of therapeutic effectiveness (Spinelli, 2001).

While it is essential for the therapist to listen to and enter into the subjective experience of the client, it is equally important to recognize that the therapist represents “the other,” all those who are in relationship with the client (Spinelli, 2001). The therapist is uniquely situated to understand and accept the client’s self and his or her experience of life. While this acceptance establishes trust, it provides an example for the client of how to interact with others. According to Spinelli, the therapist must guide the relationship further by challenging the client’s perception of others and their impact on self. In turn, through the discovery of meaning and taking responsibility, the client must be prepared to deal with any consequences his or her decisions and actions have on others. Here too the therapist must not impose some kind of value system or morality, but rather, help the client explore how his or her new way of being will affect already lived experience and those she or he is in relationship with.

Implications for Counseling Practice

As it has been described above, individuals experience life in a subjective way (Langdridge, 2013; Yalom, 1980). The manner in which one navigates experience can lead to a rich and fulfilling life, however, it can also lead to struggle and conflict. Existential anxiety is a part of the human experience and when confronted with this, individuals are presented with a choice in how to respond (Yalom, 1980). In order to live authentically, one must confront existential anxiety and look inward to determine inner values and ideals in order to determine how to address these issues in life (van Deurzen & Adams, 2011). The following case demonstrates how the existential process might look with a client. This case study is based solely on the first author’s understanding of Daniels’ (2013) autobiographical book Money’s on the dresser: Escorting, porn, and promiscuity in Las Vegas.

Case Study: Christopher Daniels

Christopher Daniels is a gay sex worker in Las Vegas working primarily in pornographic films and the escort industry. Although he reports having spent most of his life desiring to have someone to share his life with in an intimate relationship, he believes his line of work makes this difficult, if not impossible. Throughout his youth and adulthood he has experienced significant feelings of isolation, anxiety, self-hatred, fear, guilt, shame, and extended states of deep depression, although these have not been experienced as intensely in more recent years.

Christopher grew up in a religious family wherein it was impressed upon him that homosexuality was a sin. Soon after he realized that he was attracted to the same sex at age 5, he internalized the belief that these feelings were wrong and immoral, that he could not go to his family with his secret, and that it was highly likely that if he pursued these feelings he would contract HIV/AIDS and die a painful and lonely death. Although he reports that his family showed him love, they were unknowingly rejecting a fundamental and core aspect of who he was. This rejection, coupled with daily abuse from his peers from early childhood until his late teens, left him feeling rejected for who he was, isolated with no one to care for him, and condemned by a higher power.

Christopher reported that he kept his sexual orientation private until he was 22. He was able to reveal this to his family only because he had decided to attempt to suppress his homosexuality by joining a Christian ministry that helped men put aside these feelings, as well as various sexual addictions, in order to live according to their interpretation of Christianity. His experience with this organization caused significant distress for Christopher and he eventually left the ministry.

In the following years Christopher began to explore his feelings and pursued his first significant relationship with a man. After many years in what he described as a co-dependent relationship, Christopher found himself alone and in need of money. He was immediately drawn to the quick earning potential of escorting and also to the opportunity to explore his sexuality further. He reports that his primary motivation was money, however, he also wants to push his sexual boundaries. Furthermore, Christopher reports that he was drawn to the escorting business because it supports his self-described narcissistic needs for desirability, attention, and approval from others. However, escorting has fallen short in fulfilling his needs for love and intimacy.

Case Conceptualization

With the phenomenological method in mind and a strong therapeutic alliance established, the therapist can begin to consider the effects of existential anxiety that are emerging in Christopher’s life. Christopher has shared in detail clear examples of each of the four givens of life as described above. Many of these emerged in his youth yet they have had an impact on aspects of his present life. That he chose to report these events as significant in shaping his present experience demonstrates the central nature of these issues.

As Christopher described his childhood, he reported two key issues related to death anxiety. First, he described that in his religious upbringing he developed a fear that if he were to act on his natural feelings regarding his sexuality, he would likely contract HIV/AIDS. He worried that he might die a slow, painful, and solitary death in a hospital surrounded by strangers who did not care for him. Second, he developed a fear based on his understanding of his family’s religious beliefs that he would consequently enter an eternity in hell if he were to ever act on these same natural sexual feelings. Christopher’s fears led to anxiety about his everyday feelings and actions. While he was aware that he would someday die, Christopher defends himself by rejecting his faith and putting aside thoughts of his eventual demise. Despite rejecting his religious beliefs, to this day when he is having sex with another man or partying, he reports that he still hears a voice reminding him that he is going to hell for his behavior.

As discussed above, individuals seek to remove the realization of their impending death from conscious thought. In this way, it appears that Christopher is defying death, and thus his anxiety by confronting it head on. By engaging in acts that create his death anxiety and surviving he conquers death in his mind and thus reduces his anxiety. As he pushes his sexual boundaries, one of his primary goals in his chosen profession, it is as though he becomes insusceptible to death, at least the death he expected to experience, and feels free to live. Putting faith in a higher power or another person as Yalom (1980) suggests humans do to quell their death anxiety did not work. He feels betrayed by both and left to defend himself.

From early childhood, Christopher reports having struggled with feelings of isolation. Since the age of 5 years, he has felt his separateness from his family and community, both religious and mainstream, yet at the same time he has yearned for protection, to be cared for, and to belong. As he was adopting his parent’s religious beliefs, Christopher attempted to suppress his sexuality in order to connect with his family, religious community, and mainstream society and in doing so, behaved inauthentically. When Christopher later accepted his sexual orientation as a young adult, he then suppressed the part of him incongruent with his sexuality: his religious beliefs and to a degree, the family and other aspects of society that he felt had mistreated or misunderstood him.

Christopher rejected his religious identity to diminish his isolation anxiety; however, it did not resolve his feelings of loneliness. This demonstrates the anxiety of navigating within the paradox between self and body. He chose a profession that he hoped in part would fill his need for connection and desirability from others. However, while he uses sex to quiet his existential anxiety, it increases it instead by preventing him from forming intimacy. Although he enjoys the money and many aspects of the work, he reports that the escort service and porn industry do not provide him with an avenue for authentic intimacy or sustained connection. While he craves closeness, his profession, which acted in part as a defense against isolation, prevents him from entering into a meaningful intimate relationship.

Throughout his life, Christopher has attempted to make meaning. It has been a strength for him and helps make sense of his world. Due to internal conflicts, however, life meaning has been challenged and reduced to feelings of emptiness, which have had a significant impact on his daily existence. Christopher originally derived meaning from his parent’s religious beliefs as they were taught to him, while internally rejecting his sexuality. This occurred before he understood the feelings associated with his sexuality. While he wanted to believe and conform, he was still ostracized by his internal desires that went against his faith, and by the religious and familial community he was a part of. This led to feelings of emptiness and a myriad other negative symptoms such as anxiety, both neurotic and existential, depression, loneliness, and risky behavior. After rejecting his religion, Christopher now makes meaning based on that which promotes his self-worth and acceptance. He reports that an important aspect of his current work is to make his clients feel connected and close. For example, he reported feeling honored by helping a widower overcome his grief and by providing clients who were suffering from terminal illness the opportunity to be touched sexually by another human being. He believes that he is helping all clients fulfill their sexual desires, a belief which is important to Christopher, as he spent a significant part of his life suppressing his own desires and living inauthentically.

After feeling trapped by his familial, religious, and community expectations, Christopher has attempted to master his own freedom by embracing his sexuality. He exerts control by using his sexuality as a protest against the social constructs that brought him shame and guilt. By controlling his sexuality, he attempts to relieve it of its determinism. While this has not eliminated the symptoms reported above, their intensity and frequency have reduced over the years. Although there are negative aspects associated with his chosen profession, Christopher is now able to make choices for himself while recognizing that there are consequences for those choices. In a sense, his decisions are informed.

Throughout his upbringing, Christopher felt that he could not be connected to a man because it was sinful. At times he dreamed of marrying a woman in order to fulfill his desire to share his life with another. These desires led to guilt, shame, and inauthenticity. By the time he entered into his first significant relationship he was not prepared to deal with the intimacy he had longed for because he had not yet fully accepted himself. Although he now exerts control over his life, he chooses a profession that fulfills his desire for money and sex, yet prevents him from intimacy and sustained acceptance and connection with another. While Christopher is authentic in refusing to conform to the societal expectations that have caused him significant emotional pain, his choice of life work continues to block his lifelong ambition: to be intimately connected to another.

Although Christopher has made some gains in seeking freedom from external structures (e.g., religion) and embracing his sexual orientation, he continues to struggle in this regard. Rather than accepting his sexuality as having inherent worth he has objectified and commodified his physical being in an attempt to garner self-worth. Christopher is striving to live authentically in relation to his life values of love, caring, altruism, and intimacy. His value of altruism (e.g., providing affection and touch to individuals with terminal illness) is authentic, yet his means of living out of this value (e.g., selling his body) undermines his true sense of self and prevents the opportunity for transcendence and intimate connection to others and the divine. Furthermore, his choice to engage in escorting, while appearing to be freely taken, continues to expose him to risk in the physical (e.g., HIV), personal (e.g., lack of security), social (e.g., interpersonal abuse), and the spiritual dimensions (e.g., compromised, empty self). See Table 1 for examples of how the four life givens (i.e., death, isolation, freedom, meaninglessness) manifest across the four life dimensions (i.e., physical, personal, social, spiritual) for the case of Christopher.

Table 1.

Case Analysis of the Manifestation of Existential Concerns or Life Givens Across Life Dimensions.

Life givens	Life dimensions
Life givens	Physical	Personal	Social	Spiritual
Death	• Fear of contracting AIDS/HIV	• Engages in risky behavior	• Dying alone and misunderstood	• Belief that his life will result in going to Hell
	• Uses body to provide solace to those in need	• Self-preservation is compromised	• Rejected by others in his past
			• Relationships are business
			• Relational complications due to the nature of his work
			• At risk for physical, sexual, emotional abuse
Isolation	• Viewing his body as a commodity isolates self from body	• Sexual orientation separates him from family and religion	• Rejection of religious community	• Disconnected from others
	• Selling his body separates him from mainstream society	• Current work interferes with self-understanding and acceptance	• Outside of larger community	• No support
		• His self-concept (Me construct) is in conflict with his experiences and interactions (I construct)	• Outside the larger gay community	• Intimacy is not achievable
		• Undeserving of love and protection (I am gay and Christian, but I am rejected and therefore bad)	• No external validation for his sense of self	• Unacceptable in the eyes of God
			• Unable to make intimate connections	• Relationship with divine is not achievable
			• Rejects others to preserve selfAwareness that no one can fully understand another
Freedom	• Body is a commodity to be used to fulfill relational and self needs	• Self is objectified	• Rejects old external structures (e.g., family, church) to seek freedom in gay lifestyle	• Ungrounded, lack of life-giving meaning
		• Personal values (e.g., altruism and caring for others) are diminished by his work	• Accepts new external structure (i.e., escort business) that places him outside the realm of true intimacy with others	• Libidinal urges dominate and thus transcendence is not achievable
			• Freedom from old structures creates new conflicts
Meaning	• Concept of death as he is relates to ultimate rejection (i.e., Hell)	• Meaning resides in the value of self as an object for other’s pleasure	• Failure to meet the terms of various social constructs despite great effort	• He is alone in his experience
		• Self-worth is conditional on this objectification	• Who he is prevents him from being accepted by his family, faith, and greater community	• Unloved
		• Lack of an authentic self	• Lack of connection fosters meaninglessness	• Unaccepted
				• Meaninglessness
				• State of emptiness—lacks integration of inner life–giving values and outer expression of self (i.e., escort)
				• Cut off from the divine

To attend to Christopher’s needs while following the phenomenological method, it is imperative that the therapist first brackets his or her own assumptions. For example, Christopher is involved in the sex industry therefore the therapist will need to reflect on her own opinions and values regarding sexuality in order to put aside any beliefs that may cause her to impose her own agenda on the client. For her to influence his process would result in his adoption of the values of another, which would lead to inauthentic behavior. Next, the therapist will need to listen to Christopher tell his story. Regardless of the symptoms he presents with, it is important to allow him to describe his own subjective experience. As Christopher describes his experience in the four dimensions and the impact of existential anxiety, themes will emerge and become apparent to both Christopher and the therapist. These themes may be unexpected by both but will need to be met with an attitude of openness and explored in depth. As Christopher’s story unfolds, it is imperative that the therapist does not focus on the themes that resonate most with her, but rather, watch for where Christopher leads her to further exploration. The issues that resonate most with him will emerge as he describes his experience and relationship with each of the life dimensions. As the therapist brackets her assumptions, listens attentively and with empathy, and does not encourage Christopher to resolve the issues she feels are most pressing, it is likely that Christopher will feel truly listened to and understood. This will establish trust and furthermore, it will model a healthy and supportive relationship that accepts all aspects of the client.

Limitations and Gaps in the Literature

As noted above, the existential approach to therapy tends to focus on the concept of the human experience rather than on specific techniques and rules and guidelines (van Deurzen, 2002) and as such there remains a lack of specific training in this approach. Furthermore, there exists uncertainty that comes with the existential and phenomenological approach. The existential approach refrains from providing new therapists with techniques, rules, and guidelines to direct the therapist in her or his interventions with a client. This can create anxiety for the therapist, especially early on. Entering into the therapeutic alliance can be highly intimidating and it is difficult to ride the waves of anxiety that emerge without clear direction of where to take the client. Some therapists may find this approach difficult and uncomfortable. As well, Jacobsen (2007) points out that the existential approach to psychotherapy is significantly different from mainstream approaches as it focuses inward on subjective experience rather than outward on what can be observed. As such, existential therapy has received minimal academic and research attention.

Conclusion

Existential anxiety is a universal experience. Each individual is affected by life’s givens, such as death, isolation, freedom, and meaninglessness. This impacts how the individual interacts and relates to self and the world. Failure to understand one’s core values can lead an individual to behave inauthentically. The phenomenological method is important to existential psychotherapy as it provides the potential to build a strong therapeutic alliance between the therapist and client. In using an existential approach with the phenomenological method, the therapist is able to build a strong therapeutic alliance in order to facilitate the client in working through his or her existential anxiety toward authenticity.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Matthew Temple began his studies in Middle Eastern and African Studies at the University of Alberta. He obtained a Master of Arts degree in Counselling and Spirituality at Saint Paul University, Ottawa in 2015 with concentration in Couples and Families. In 2015, he and a partner started a private practice, Foundations Counselling & Psychotherapy. He continues to develop as a new professional and enjoys working with both couples and individuals.

Terry Lynn Gall, PhD, is a full professor in the Faculty of Human Sciences at Saint Paul University in Ottawa, Canada. She teaches in the School of Counselling, Psychotherapy, and Spirituality. Specifically, she trains in the practicum for individual counselling, teaches ethics and counselling and supervises research seminars. Dr. Gall has conducted extensive research in the area of spirituality and coping with life stress. She has presented her research internationally including at conferences in China, Australia, Iran, Turkey, and various European countries.

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