What is existential psychotherapy?

Author: Ole Magnus Vik

Existential psychotherapy (EPT) is a form of therapy based on issues and insights from existential philosophy. In EPT, the idea is that mental health problems are primarily due to how we relate to the basic conditions of life in unhelpful ways and to our own unnuanced narratives about ourselves. In other words, it’s not about having “thought errors” or traumatic experiences. At least not necessarily.

Conversations in EPT will often revolve around your assumptions about yourself, others and the world. The goal will be to try to gain more clarity about the narratives you create and how they affect the life you live. While everyone has the right to construct their own narratives, those that do not deal with the basic existential conditions will often cause problems. EPT is therefore a therapy that is more focused on discovering and nuancing the narratives people create about their lives than it is a form of therapy that teaches techniques or exercises.

Who is existential therapy suitable for?

Basically, EPT is suitable for anyone who experiences life as difficult. There is always an existential dimension worth exploring when life comes to a standstill or has been demanding for a long time. Existential perspectives are used when facing a variety of disorders. Both more severe conditions such as schizophrenia and substance abuse disorders and “lighter” mental health problems such as anxiety and depression. Many people also find that EPT is useful even though they may not be struggling with anything in particular at the moment. Through an existential therapy process, most people will gain a deeper understanding of what it means for you to live as a human being. The idea is that you will be better equipped when crises arise, because you are already “psychologically vaccinated”.

Turn off the autopilot!

We take many of our own narratives for granted without questioning them. This leads us to live our lives on a kind of “autopilot” where we are simply acting according to the accepted norms, rules, values and assumptions of our culture at the moment, confusing the self we are most comfortable with for our “real self.” Instead of trying to figure out why we react or act in certain ways, we assume that it’s “just the way we are.” This passive approach to life is both impractical and unsatisfying. Questioning the things we take for granted can be uncomfortable and tiring, but it gives us the opportunity to live better and richer lives. This is because by discovering how we understand, think, feel and act, we are in a better position to take responsibility and choose freely. This makes us more flexible and effective in our lives. To put it another way: Being human is far too complicated a project to risk doing it on autopilot.

Live your life.

In EPT, exploring your stories is not done to find out how you are “living wrong” or to necessarily change them. Everyone has the right (and perhaps even the duty) to create their own unique narratives. This right also includes the right to live inconveniently and unfulfillingly. In many ways, EPT is a liberation project that can help us to take a step back and consider our narratives about ourselves and the world more clearly. This helps us to live more freely, take more responsibility and live more honestly.       

In other words, EPT recognizes that everyone has a fundamental right to live life in their own way. Even though others may criticize it. Even if others would describe it as immoral, it’s still your privilege. Everyone has a fundamental right to choose to live “immoral” lives, even if it is not necessarily always practical (but everyone also has the right to live impractical lives). In existential psychotherapy, you will therefore never be met with moralism or condemnation. The only moral requirement is that you must live on your own terms, regardless of cultural norms and the expectations of friends, family, partners and colleagues. This does not mean that existential psychotherapy is a form of therapy where everything is okay or where one is encouraged to live immorally. Nor is it a form of therapy that encourages people to live in defiance of all societal norms. It’s more about helping people to find out what they really think and how they really want to live their lives. If someone wants to live completely in line with the norms and rules that exist in society, that’s of course perfectly fine, as long as you have a thoughtful relationship with it. Many of the cultural norms we have today are very good and practical and definitely worth following – but don’t follow them just because they’re there, follow them because you think they’re right.

Although everyone has the right to choose to live the way they want and create their own moral beliefs and narratives, they are also always responsible for them. And the reasons for your choices are just as important as the consequences. In EPT, the starting point is therefore that as long as we are willing to take responsibility and not lie to ourselves, we can live the way we want. For example, some people live their lives with almost no regard for others. That’s fine, if you’re willing to accept a good dose of loneliness and very little closeness. If, on the other hand, you live without a willingness to show consideration, and at the same time expect to have many close relationships, you are living a lie (that you can have your cake and eat it too: both freedom and closeness), and that is more problematic. As long as we live with our eyes open, knowing that we have chosen to live this way and knowing that we always have the option to live differently, we are living honestly. 

Why some have it harder than others – an existential understanding of the pain of life

Being human is hard. It has never been easy, and it never will be. Some people are so afraid of chaos and freedom that they have deluded themselves into believing that life is clear, simple and unproblematic. I’m sure that’s nice. For the rest of us, life will sooner or later offer a good dose of confusion, frustration and pain. However, some people find it particularly difficult. In EPT, it is thought that when someone develops symptoms such as anxiety and depression, they are struggling with unsolvable life conflicts that they have not yet learned to deal with in a good way. Often, it is also thought that they have a self-narrative that destroys more than it helps in life. Therapy will therefore be about finding good and nuanced descriptions of these conflicts and narratives. This is done, not necessarily to change them, but to give people a better opportunity to choose how to relate to them.

Life-pain is also very often about being caught between different legitimate considerations, wishes or needs. When someone finds it particularly difficult, it is often because they are desperately trying to square a circle. As human beings, we are not whole, but divided. We are always made up of multiple narratives, and many of them are contradictory. Just like a three-year-old with a knocking board, frantically trying to knock a square into the circle hole, we often try to tie together aspects of living that are simply not compatible. And just like the three-year-old, we become despondent, furious and resigned.    

The art of living with tensions.

Because of the tensions between the unresolvable conflicts we all live with, and because of our fragmented and unbalanced self-narratives, ‘harmony’ and ‘inner peace’ are never lasting inner states. EPT is skeptical of anyone who promises this. Peace and harmony are, of course, feelings that are entirely possible to experience, but just like “happiness”, they are momentary experiences that come and go. Unfortunately, they are not meant to be there all the time. Therefore, the goal in existential therapy will never be to make life conflict-free, but rather to relate to the natural tensions of existence.

Bjarne: An example of an existential therapy process

“Bjarne” started therapy because he felt tired and stressed. Over the past few weeks, he had also experienced several episodes of severe anxiety. After visiting the emergency room several times, fearing he was having a heart attack, he was recommended to see a psychologist by his GP. In the first meeting, Bjarne told him that his life goal was to become “the best version of himself” and during the first few hours, he and the psychologist explored what this meant in practice. Among other things, they discovered that in his job as a teacher, he would never make students wait more than a week to get corrected tests back and that he would always be positive and enthusiastic when teaching. Furthermore, Bjarne said that he always showed up at his children’s football training sessions and helped with driving and other practical things when there was a match. For Bjarne, there were few things more important than being there for others and making sure those around him had a good time – especially his students and his children. However, these ideals meant that he often worked late into the evening, leaving little time for personal interests, rest or relaxation. In further therapy, Bjarne explored how he seemed to be in an unresolvable conflict between legitimate ideals of ‘being there for others’ and ‘doing a good job’ on the one hand, and legitimate needs for rest and personal time on the other.

He was also able to realize how his symptoms of anxiety and fatigue were not necessarily the result of “living wrong.” In part because he saw that he didn’t have to accept the narrative that he needed to “take more care of himself” or stop “burning the candle at both ends” as everyone around him suggested. Quite simply, he could understand his exhaustion as an expression of choosing to prioritize some important considerations over others. During therapy, Bjarne gave himself the opportunity to recognize the symptoms as the price he paid for living in line with his own principles and goals. Although he knew even before he started therapy that he wasn’t taking good care of himself, he couldn’t bear the thought of abandoning his ideals. After a few months in therapy, the symptoms of exhaustion were still present, but the anxiety was greatly reduced and it was agreed that the therapy should be terminated.

Bjarne was finally able to see his lack of energy as a natural consequence of living his life the way he wanted to. Crucial to the change was also that he had recognized his own life project instead of listening to all those who in practice said that he was living wrong.

The example of “Bjarne” above is fictional. But it is based on real issues and real therapy processes. It is easy to question Bjarne’s life choices and criticize them for not being sustainable. But this is Bjarne’s, and everyone else’s, privilege: everyone has the right to live less sustainable lives. For Bjarne, living in line with his values was so important that he really had no problem accepting the risk of becoming exhausted and even ending up on sick leave.

Your symptoms are not the problem.

The above example also shows how EPT rarely has the removal of symptoms as its main goal. Unlike many other therapy traditions, recovery is not always understood as “symptom relief”. The important thing for a good life is not which symptoms we experience at any given time, but how we understand and act on them. For Bjarne, exhaustion was not a “symptom,” but a natural consequence of an authentic life practice.

Paradoxically, the attempts we make to feel good can often lead us to living less well. When we try to remove our symptoms, we often end up living less free and honest lives because the fear of feeling uncomfortable becomes the driving force behind the choices we make. It’s not hard to imagine how the ability to live meaningfully is limited if escaping painful emotions is the prevailing principle in life. Consider, for example, how difficult it would be to get close to someone. EPT is about trying to live more freely and authentically, i.e., in line with the self-narratives one can reasonably hold to be true, rather than trying to reduce discomfort to an absolute minimum. If, on the other hand, you consciously and deliberately -knowing the unavoidable price you will have to pay – set out to reduce emotional discomfort to a minimum, then no one can really be criticized for that, either. If this is the ideal you want to strive for in your life, that’s fine.

Pain is inevitable, but suffering is not.

Existential psychotherapy does not promise redemption. Its only promise is that it can help us to make life less difficult than it needs to be. Even if it sometimes means letting go of hope for example by mourning how life turned out the way it did instead of trying to change it. The pain of life is inevitable, but it is possible to prevent the pain from turning into mental suffering.

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