Primary concerns are deeply buried by means of
repression, denial, displacement, and symbolism
Access primary conflicts through deep reflection,
dreams, nightmares, flashes of profound experience
and insight, psychotic utterances, and through the
study of children
Conflict flows from the individual‘s confrontation
with the givens of existence
Certain intrinsic properties that are part of human existence
Discovery often catalyzed by deep personal reflection following
a ―border‖ or ―boundary‖ experience in which one is faced with
one‘s own death
major irreversible decision
collapse of meaning-providing schema
Tension between the awareness of the inevitability of death and
the wish to continue to be
Clash confrontation with groundlessness and our wish for
ground and structure
tension between awareness of our absolute isolation and our
wish for contact, protection, and wish to be part of a larger
Conflict that stems from the dilemma of a meaning-seeking
creature who is thrown into a universe that has no meaning
Life, Death, and Anxiety
Life and death are interdependent
they exist simultaneously, not consecutively
death whirs continuously beneath the membrane of life
and exerts a vast influence upon experience and conduct
Death is a primordial source of anxiety and, as such,
is the primary source of psychopathology
Two States of Being
State of Forgetfulness of Being
one lives in the world of things and immerses oneself in
the everyday diversions of life
State of Mindfulness of Being
one remains mindful of being, not only mindful of the
fragility of being but mindful of one‘s responsibility for
one‘s own being
Cancer- Confrontation with Death
Evidence of startling shifts, inner changes, and
Rearrangement of life‘s priorities: trivializing of the trivial
A sense of liberation- being able to choose not to do something
that they do not wish to do
Enhanced sense of living in immediate present rather than
postponing life until retirement or some other point in the
Vivid appreciation of the elemental facts of life- the changing
seasons, the roses, and so forth
Fewer interpersonal fears- less concern about rejection,
greater willingness to take risks
Death and Anxiety
Death transcendence is a major motif in human existence
Robert Lifton describes several modes by which man
attempts to achieve symbolic mortality
1.Biological mode- Living on through one‘s progeny, through an endless
chain of biological attachments
2. Theological mode- Living on in a different, higher plane of existence
3. Creative mode- Living on through one‘s works, creation or impact on
4. Theme of Eternal Nature- One survives through rejoining the life
forces of nature
5. Experiential Transcendent Mode- through ―losing oneself‖ in a state
so intense that time and death disappear an one lives in the
Death and Anxiety
Three Types of Death Fear – Jacques Choron
1. What comes after death
2. The event of dying
3. Ceasing to be
How can we combat anxiety?
By displacing it from nothing to something.
Death and Psychopathology
Either due to extraordinary stress or inadequate defensive
strategies, one who enters the realm called ―patienthood‖ has
found insufficient the universal modes of dealing with death
fear and has been driven to extreme modes of defense
Psychopathology- An ineffective defensive mode
Even defensive maneuvers that successfully ward off severe
anxiety can be considered psychopathology if they prevent growth
and result in a constricted and unsatisfying life
Ex: Individual maintains symbiotic relationship with mother. Avoids
death anxiety, but this defensive mode leads to secondary anxiety (ei:
reluctance to separate from mother may interfere with attendance at
school, or the development of social skills)
Two Fundamental Defenses Against Death
One who either fuses or separates, embeds or
He affirms his autonomy by standing out in nature or seeks
safety by merging with another force
Psychopathology in Response to Death Denial
Compulsive Heroism- heroic individuation represents the best
that man can do in light of his existential situation
Narcissism- if a belief in personal inviolability is coupled with
a corresponding diminished recognition of the rights and the
specialness of the other, than one has fully developed
Aggression and control
Success Neurosis- individuals on the verge of success develop
crippling dysphoria which often ensures they will not succeed
When goal is to fashion life around a belief in personal
specialness and inviolability
Depression often ensues when the belief collapses.
To live for the dominant other is to attempt to merge
with another whom one perceives as the ―dispenser of
protection and meaning in life‖
dominant other may be one‘s spouse, mother, father, lover, therapist,
or an anthropomorphization of a business or social institution
Ideologies may collapse: the dominant other may die, leave,
withdraw love and attention, or prove too fallible for the task
Sex and Death Anxiety
Sexual activity as a mode of assuaging death anxiety is often clinically
Successful being who devotes self utterly to power, to getting ahead,
standing out, and making a name for himself must at some point come
face to face with the lonely unprotectedness inherent in individuation
Death and Psychotherapy
The reality of death is important to the field of
psychotherapy in two distinct ways:
Death awareness may act as a ―boundary situation‖ and
instigate a radical shift in life perspective
Death is a primary source of anxiety
Boundary Situation: an event, an urgent experience, that
propels one into a confrontation with one‘s existential
situation in the world
confrontation with death is the boundary situation that has the
power to provide a massive shift in the way one lives in the world
Death reminds us that life cannot be postponed
Disidentification is an important part of Roberto Assagioli‘s system of
psychosynthesis in which he tries to help one his/her ―center of pure
self-consciousness‖ by asking him to imagine shedding, in a systematic
way, his body, emotions, desires, and finally, intellect
Example of structured Disidentification Exercise—
In peaceful setting, ask one to list on cards 8 answers to the question ―Who am I?‖
One reviews the 8 answers and arranges the cards in order of importance and centricity
The answers closest to their core at bottom, the more peripheral responses at the top.
Participants are then asked to study their top card and meditate on what it would be like
to give up that attribute
This process continues until one has divested themselves of all 8 attributes.
Following that, help the patient to integrate by going through this process in reverse.
Death as a Primary Source of Anxiety
The concept of death provides the psychotherapist
with two major forms of leverage:
1. Death is of such momentous importance that it can, if properly
confronted, alter one‘s life perspective and promote a truly
authentic immersion in life.
2. Based on the premise that the fear of death constitutes a
primary source of anxiety, that it is present in early life, is
instrumental in shaping character structure, and continues
throughout life to generate anxiety that results in manifest
distress and in the erection of psychological defenses.
Denial of Responsibility
Innocent victim: common type of responsibility avoidance in
which one experiences themselves of innocent victims of
events that they themselves have unwittingly set into motion
Losing control: to be temporarily ―out of one‘s mind.‖ Patients
enter a temporary irrational state in which they act
irresponsibly for which they believe they are not accountable.
Assumption of Responsibility and Psychotherapy
To assist a patient in assuming responsibility, the therapist
must continually operate within the frame of reference that
a patient has created his own distress.
The Self-Fulfilling Prophecy: The individual expects a certain event to
occur, then behaves in such a way as to bring the prophecy to pass,
and finally relegates awareness of his r her behavior to the
Ex. Mary has certain beliefs/expectations about men that distort her
perception, and perceptual distortion resulted in her behaving in ways
that elicited the very behavior she dreaded
-- Awareness of one‘s own feelings constitute a therapist‘s most
important instrument for identifying a patient‘s contribution to his or
her life predicament.
Affect Block and Psychotherapy
The purpose of affect arousal is not sheer catharsis
but to help patients rediscover their wishes
Compulsivity and Impulsivity
One who acts immediately on each whim avoids wishing just
as one who stifles wishes
Thus, one avoids having to choose among various wishes which,
if experienced simultaneously, may be contradictory
One who cannot discriminate among his wishes, attempts to
fulfill all of them, and in doing so loses his true self- the self
that wants one thing more deeply than another thing.
To wish is to lunge into the future, and one must consider the
future implications & the consequences of acting upon a wish
Impulsivity and Compulsivity
--Compulsivity, a defense against responsibility
awareness, also constitutes a disorder of wishing,
one that appears more organized and less capricious
--One is propelled to act, often against one‘s wishes,
and if he does not act, feels acutely uncomfortable.
Why are Decisions So Difficult?
For every yes there must be a no. To decide one thing
always means to relinquish something else.
A fundamental decision also confronts each of us with
existential isolation. A decision is a lonely act, and it is
our own act; no one can decide for us.
Many people are highly distressed by decision and,
attempt to avoid it by coercing or persuading others to
make the decision for them.
Decision: Clinical Strategy and Techniques
It is a decision that slips the machinery of change into
gear. No change is possible without effort, and decision is
the trigger of effort.
The therapist‘s task is not to create will but to
disencumber it. Here are two methods:
1. Help patient become aware of the inevitability and the omnipresence
2. Assist in laying bare the deeper implications (the meaning) of that
Insight and Decision
Insight effects change
1. How to help liberate that patient‘s stifled will:
-enable patients to realize that only they can change the world they
-that there is no danger in change, that to get what they really want
they must change; and that each individual has the power to change.
2. Search for understanding is the glue that binds patient and therapist
-it keeps them occupied in a mutually satisfying task
-patient is gratified by having his inner world scrutinized
with such thoroughness
Leverage Producing Insights:
1. Only I can change the world I have created. (The patient has
fully grasped the full implications of his or her responsibility)
2. The therapist must help patient understand that responsibility
is continuous: one is continuously creating oneself.
3. The therapist must help the patient take a step toward
realizing that, just as one is soley responsible for being what
one is, one is soley responsible for changing what one is.
Three Types of Isolation
1. Interpersonal: Loneliness, refers to isolation from other individuals.
2. Intrapersonal: Process by which one partitions off parts of oneself. Results
whenever one stifles one‘s own wishes, distrusts one‘s own judgment, or buries
one‘s own potential.
3. Existential: an unbridgeable gulf between oneself and any other being. It
refers, too, to an isolation even more fundamental- a separation between the
individual and the world.
‗The Loneliness of Being One‘s Own Parent‘.
To the extent that one is responsible for one‘s own life, one is alone.
Responsibility implies authorship: to be aware of one‘s authorship means to
forsake the belief that there is another who creates and guards one. Deep
loneliness is inherent in the act of self creation.
Growth and Existential Isolation
--The word ―Exist‖ implies differentiation
( ―ex-ist‖= to stand out)
--The process of growth, is a process of separation, of becoming
a separate being.
--The words of growth imply separateness: autonomy, self-
reliance, individuation, independence.
--Not to separate means not to grow up, but the toll of
separating and growing up is isolation.
Existential Growth and Relationship
The problem of relationship is a problem of fusion-
isolation. One the one hand, one must learn to relate to
another without giving way to the desire to slip out of
isolation becoming part of that other.
But one must also learn to relate to another without
reducing the other to a tool, a defense against isolation.
―I believe that if we are able to acknowledge our isolated situations
in existence and to confront them with resoluteness, we will be able
to turn lovingly toward others. If on the other hand, we are overcome
with dread before the abyss of loneliness, we will not reach out
toward others but instead will flail at them in order not to drown in
the sea of existence.‖
-- Irvin Yalom
Characteristics of a Mature Relationship
1. To care for another means to relate in a selfless way: one lets go of self-consciousness and
self-awareness; one relates without the overarching thought ―What does he think of me?‖or
―What‘s in it for me?‖
2. To care for another means to know and to experience the other as fully as possible. If one
relates selflessly, one is free to experience all parts of the other rather than the part that
serves some utilitarian purpose.
3. To care for another means to care about the being and the growth of the other. With one‘s
full knowledge, the product of genuine listening, one endeavors to help the other become
fully alive in the moment of encounter.
4. Caring is active. Mature love is loving, not being loved. One gives lovingly to the other;
one does not ―fall for‖ the other.
5. Caring is one‘s way of being in the world; it is not an exclusive, elusive magical connection
with one particular person.
6. Mature caring flows out of one‘s richness, not out of one‘s poverty- out of growth, not out
of need. One does not love because one needs the other to exist, to be whole, to escape
7. Caring is reciprocal. To the extent one truly ―turns toward the other,‖ one is altered. To the
extent one brings the other to life, one also becomes more fully alive.
8. Mature caring is not without it‘s rewards. One is altered, one is enriched, one is fulfilled.
Through caring one is cared for.
Need – Free Love
―Man does not exist as a separate entity. Man is a creature of the
Buber asserts that there are two types of relationships:
1. The ―I-It‖
2. The ―I-Thou‖
The ―I-It‖ relationship refers to a relationship between a person and equipment, a
functional relationship, a relationship between subject and object which lacks
The ―I-Thou‖ relationship refers to a wholly mutual relationship in which involves a
full ―experiencing‖ of the other.
Fusion- the human being‘s ―universal conflict‖
-- One strives to be an individual, and yet being an
individual requires that one endure a frightening
Kierkegaard said : ―With every increase in
consciousness, and in proportion with that increase,
the intensity of despair increases: the more
consciousness, the more intense the despair.‖
Isolation and the Therapist-Patient Encounter
First maxim of psychotherapy: ―The goal of psychotherapy is to
bring the patient to the point where he can make a free choice.‖
Second maxim of psychotherapy: ―It is the relationship that heals.‖
How does the Therapeutic Relationship Heal?
1. In-Therapy relationships are mediating in a way that improves the equality of
other, or future relationships by instructing the patient about their maladaptive
2. These relationships have value in and for themselves-as ―real‖ relationships, they
effect intrapersonal shifts.
How does a being who needs meaning find meaning in a
universe that has no meaning?
Meaning refers to sense, or coherence. A search for meaning
implies a search for coherence.
Purpose refers to intention, aim, function.
Secular personal meaning
Dedication to a cause
The Hedonistic Solution
The purpose of life is, in this view, simply to live fully, to
retain one‘s sense of astonishment at the miracle of life, to
plunge oneself into the natural rhythm of life, to search for
pleasure in the deepest possible sense.
Belief that human beings should strive to actualize
themselves, that they should dedicate themselves to realizing
their in-built potential.
Viktor Frankyl‘s three categories of life meaning:
1. What one accomplishes or gives to the world in terms of one‘s
2. What one takes from the world in terms of encounters and
3. One‘s stand toward suffering, toward a fate that one cannot
*Three meaning systems: creative, experiential, and attitudinal.
Existential Vacuum- Common phenomenon
characterized by the subjective state of boredom,
apathy, and emptiness. One feels cynical, lacks
direction, and questions the point of life‘s activities.
If patient develops, in addition to feelings of
meaninglessness, overt clinical neurotic symptoms,
then Frankyl refers to the condition as an
Salvador Maddi‘s three clinical forms of ―existential sickness‖
1. Crusadism- powerful inclination to seek out and to dedicate oneself to dramatic and
2. Nihilism- an active, pervasive need to discredit activities that others find
3. The Vegetative form of Existential Sickness- most extreme degree of purposelessness
in which one sinks into a severe state of aimlessness and apathy- a state that has
widespread cognitive, affective, and behavioral expressions.
Cognitive- inability to believe in the usefulness or value of life‘s endeavors
Affective- pervasive blandness
Behavioral- lack of selectivity of behavior- it becomes immaterial which activities the
Summary of Research Results
1. Lack of sense of meaning in life is associated with psychopathology in a
linear sense: the less the sense of meaning, the greater the severity of
2. A positive sense of meaning in life is associated with deeply held
3. A positive sense of life meaning is associated with self-transcendent
4. A positive sense of meaning in life is associated with membership in
groups, dedication to some cause, and adoption of clear life goals.
5. Life meaning must be viewed in a developmental perspective; the types
of life meaning change over an individual‘s life; other developmental tasks
must precede development of meaning.
Why Do We Need Meaning?
--When one is unable to find a coherent pattern, one
feels not only annoyed and dissatisfied but also
helpless. The belief that one has deciphered meaning
always brings with it a sense of mastery.
-- It is evident that we crave meaning and are
uncomfortable in its absence. One finds a purpose
and clings to it for dear life. Yet the purpose one
creates does not relieve discomfort effectively if one
continues to remember that one forged it.
Meaning in Life and Values
Once a sense of meaning is developed, it gives birth
to values- which, in turn, act synergistically to
augment one‘s sense of meaning.
Constitute a code according to which a system of action may be
Provide the individual with a blueprint for personal action
Make it possible for individuals to exist in groups.
Emanate from a meaning schema that has the consensus of the
Provide predictability necessary for social trust and cohesion.
Meaning in Life and Values
Ernest Becker argues that our ―universal ambition‖ is
―prosperity‖, and that death is the chief enemy with
which we must contend.
Dereflection- (Frankyl) Involves diverting the attention of the
patient away from themselves, from the source of their
dysphoria, from the source of their neuroses and toward the
intact parts of their personalities and the meanings that are
available for them in the world.
The therapist‘s goal is engagement. The task is not to create
engagement nor to inspirit the patient with engagement–
these the therapist cannot do. But it is not necessary: the
desire to engage life is always there within the patient, and the
therapist‘s clinical activities should be directed toward
removal of obstacles in the patient‘s way.
Yalom, I. D. (1931). Existential psychotherapy. United States of
America : Harper Collins Publishing.