What is Existential Therapy?

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Important Concepts

Existential therapy integrates several disciplines that all have perspectives on existentialism. It remains a topic of discussion in philosophy and is driven by an interconnectedness between humans, human experience, and the relationship between humans and their world (Barnett & Madison, 2012). Existential therapy utilizes the therapeutic alliance in a person-centered way to facilitate the client’s search for their authenticity. It does not shy away from the discussion of death, freedom, responsibility, and the meaning of life (Spinelli, 2015). Marini and Stebnicki (2016) discuss what existential therapists consider natural stages and responses to life’s uncertainties which result in patients presenting with anxiety, alienation, and depression. Krug (2009) identifies these same key elements as “the essence of human beings and their existential predicament.” Lastly, existential therapists and philosophers stress that with ultimate freedom comes a heavy responsibility, but it is through grappling with balancing of the two that facilitates meaning and well-being (Van Deurzen & Adams, 2016).

Characteristics of Healthy Personality

According to existential theorists, a healthy personality can be defined by several characteristics. A person with a healthy personality would not be bothered with the past, but remain present- and future-focused (Barnett & Madison, 2012). Also, a person who is healthy by the standards of an existential theorist would have the ability to: face the anxieties of life directly, accept one’s own mortality and a fear of death, and would revel in their freedom and the balance of the responsibility that requires (Van Deurzen & Adams, 2016). According to Spinelli (2015), one can achieve these by achieving authenticity, genuineness, self-awareness, and self-transcendence, which is fostered by building, loving and creating.

Factors That Contribute to Problems

              In existential theory, mental illness and psychological dysfunction are not considered the root of problems or why humans get “stuck.” The factors that impact a person’s anxiety are the refusal or inability to deal with (1) mortality, (2) isolation, (3) meaninglessness, and/or (4) freedom (and it’s parallel factor of responsibility) (Spinelli, 2015). An unawareness of alternate choices to existence has also been cited as a factor that leads to alienation, anxiety, and depression such as being influenced by society to the point of a person’s lack of self-awareness surrounding their ability to be authentic and genuine (Van Deurzen & Adams, 2016).

Stages of Life

Existential theory emphasizes life stages, also known as the four stages of development of existential awareness, in terms of both age and the 4 Worlds. However, Van Deurzen and Adams note that stages of awareness are not exclusively connected to age depending on the individuals’ life experiences and influences (2016).  The first life stage is infancy up to age two or three. At this stage, infants are innocent and curious, open to learning. The second begins at age two or three and is characterized by children’s reactions to the world around them, particularly their parents, through “accepting, demanding, defying, or using” (Sharf, 2016). The third stage is less governed by age and rather by the realization and consciousness of being an individual. The last stage is also not guided by age but is achieved through transcendent consciousness — the awareness of how one fits into the world around them (Cooper, 2017).

The 4 Worlds or the 4 Ways of Being are considered to envelope aspects of development and are the intersections of the 4 dimensions of life (Van Deurzen & Adams, 2016). Umwelt is the physical realm or “around-world.” This is regarded as a person’s surroundings, environment, or otherwise how they view the world around them. Mitwelt is the social realm or “with-world.” This is deemed as an individual’s social or cultural environment, particularly focusing on the integration or isolation of the individual. Eigenwelt is the psychological realm or “own-world.” This can be considered self-awareness or one’s personal world that is experienced through their own mind and body (Barnett & Madison, 2012).  Überwelt is the spiritual realm or “over-world.” This refers to the way an individual wants the world to be or that individual’s ideal world (Van Deurzen & Adams, 2016).

Influences on Development

Barnett and Madison (2012) reference parents as influences on values-development, ease of reaching authenticity, and possibly a presentiment of ones future. If parents enable children to be independent and they foster their achievement, children more easily develop values and self-reliance. If a child is dependent upon parents or, on the other hand, struggles with rejection or emotional abuse/neglect from parents, they are less likely to reach self-transcendence (Cooper, 2017). As children with existential under-development reach adulthood, they may harbor added stress after seeing their parents’ sufferings throughout their life which adds to their anxiety (Barnett & Madison, 2012).

Order of Important Elements in Existential Therapy

              Interpersonal relationships are of utmost importance in development as well as the therapeutic alliance in existential therapy. It serves as the foundation on which all learning, growth, and transcendence can occur (Hoffman, Vallejos, Cleare-Hoffman, & Rubin, 2015). Cognition, emotion, and behavior are intertwined within existential therapy and often act as synchronous experiences that influence and are also influenced by self-awareness and worldview (Spinelli, 2015). Physiological symptoms are hardly important when referenced as psychological distress or mental illness, as existential theory endorses the idea that alienation, anxiety, and depression develop from the refusal or inability to face one’s mortality, freedom and responsibility, life’s meaning, and interaction versus isolation as mentioned in the contributing factors section of this paper (Spinelli, 2015). Even discussing these factors, they are only the conduit for realization of the dissonance that is present in one’s world (Van Deurzen & Adams, 2016).


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Anastasia Canfield, MM, MT-BC, RP, hails from Texas, but has found a new home in Colorado, where she has lived since 2013. She is a master’s level board-certified music therapist and registered psychotherapist having earned her first master’s degree in neurologic music therapy from Colorado State University in 2016. Her studies encompassed a broad overview of music therapy with all populations, but Anastasia pursued extra clinical hours working in schools and mental health clinics to emphasize her interest in psychiatric music therapy. Her master’s research focused on music therapy with a child with an emotional disability in a specialized classroom. Anastasia has worked as a music therapist for nearly three and a half years, offering individual and group services addressing a variety of individualized goals at facilities and private practices such as Highlands Behavioral Health System, Rocky Mountain Music Therapy, and the Colorado Mental Health Institute at Fort Logan. She specializes in music therapy with mental health populations across the lifespan, as well as children and young adults with developmental disabilities, intellectual disabilities, and autism spectrum disorders. Anastasia is joining Brightside Counseling as a practicum student while she pursues her second master’s degree, Master of Arts in Mental Health Counseling from Northwestern University, to earn dual-licensure as a board-certified music therapist and a licensed professional counselor.



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Spinelli, E. (2015). Practising existential therapy: The relational world. Thousand Oaks, CA: Sage Publications Inc.

Van Deurzen, E. & Adams, M. (2016). Skills in existential counselling & psychotherapy. Thousand Oaks, CA: Sage Publications Inc.

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