Existential Issues in Psychotherapy and Couples Counseling

Existential issues are internal conflicts arising from the ongoing, inescapable confrontation with the givens of human existence–isolation, powerlessness, responsibility, death, and the desire for meaning.

Most people defend themselves from fully acknowledging such realities. Therapy needs to illuminate how these defenses shape the behavior and thinking that brings people into therapy. We can help patients understand that truths like the following–rather than their presenting problems–are the issues with which they are really grappling:

  • Loving involves pain and, ultimately, abandonment or separation
  • Suddenly or gradually, we will lose our physical abilities
  • Regardless of how we are treated, we are responsible for how we express our feelings
  • As we get older, more and more people become sexually ineligible or uninterested in us
  • We have made life choices with consequences we don’t like
  • We can’t prevent the people we love from making mistakes or suffering
  • Some people who have mistreated us are going to get away with it

Clinicians struggle with the same existential truths as all people. In addition, our work can restimulate our personal losses and vulnerabilities; make us feel fraudulent because of our own imperfect lives; and painfully remind us that our power to heal others is limited.

Understandably, clinicians and patients can unwittingly collude to avoid facing existential struggles, leading to therapeutic errors and treatment failures. This presentation examines a practical framework within which clinicians can identify, explore and resolve these common, intense, but often unaddressed, challenges.

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