Developing a Treatment Plan for Existential Distress

Demoralization can be countered by improving any physical or emotional stressors and by strengthening a client’s resilience to stress (Griffith & Gabym, 2005).

These approaches are at the heart of existential therapy which is a modality that health professionals can use when working with clients who have a chronic or serious illness.

Existential Therapy

Existential therapy differs from other therapeutic modalities because it is focused on self-determination and the search for meaning rather than focusing on alleviating symptoms or finding a root problem. Clients with a chronic or serious illness already know the root problem of their existential distress and demoralization (typically caused by their chronic or serious illness). Existential therapy seeks to help clients come to terms with the uncertainty of the future and to overcome existential distress and demoralization. In contrast, treatment approaches for depression would focus on pharmacotherapy interventions or identifying the root cause of depression in order to work through and alleviate it.

Video: What is Existential Therapy?

3:18

In this video, we will learn about some foundational aspects to existential therapy to provide us with a sufficient foundation on which to later discuss intersections between this modality and psychedelic-assisted therapy.

Components of Existential Therapy

Existential therapy has four main components which navigate the four existential givens or ultimate concerns that people with chronic or serious illness may have (Yalom, 1980).

Mortality

Clients with chronic and serious illness contemplate the end of their mortality as death approaches. Death in the context of mortality also comes with the fear of not being remembered or our identities being lost forever.

Isolation

The idea that we all are born alone and die alone further contributes to existential distress. Humans have a deep need for connection (which is why it is part of the Numinus care model), and an approaching death is a fundamental isolation from others and the world. Furthermore, the diagnosis of a chronic or serious illness can be isolating in that few others can relate to that client’s experience.

Freedom

Freedom refers to the felt sense that clients are responsible for their own choices and actions which restrict freedom while also providing a sense of structure.

Meaninglessness

Having a sense of meaning is a motivating factor on a daily basis for many. Those with existential distress may feel a strong sense of meaninglessness tied to the uncertainty of the future that lay before them and a contemplation of the meaning of life.

Existential Postures

The goal of existential therapy is helping clients to shift their vulnerability (for example: helplessness) into a resilience (for example: agency). In the chart below, we look at the target resilience approach to combat the corresponding vulnerability and a brief explanation.

Vulnerability Resilience Guiding Question

Despair

Hope

What are some sources of hope that can be drawn from? What motivates a client from giving up on challenging days?

Confusion

Coherence

How does a client make sense of what they’re going through?

Isolation

Communion

How does a client work to experience communion, in other words, the felt presence of a trustworthy person?

Helplessness

Agency

How can clients go from feeling helpless to feeling like they can making meaningful choices and that their actions matter?

Meaninglessness

Purpose

How can a client find a purpose in their lives? Can they identify someone or something worth choosing to continue living for?

Cowardice

Courage

How can a client refuse to be manipulated by fear even when the fear is really intensely felt?

Resentment

Gratitude

How can a client transform their resentment into gratitude? Can they work to experience gratitude even for the simple, daily things alongside feelings of resentment and sorrow?

Required Reading

Please read the following paper which outlines the nine different types of existential therapy to give you a high-level overview of the types of interventions involved with existential therapy.

Learn More

To learn more about treatment options for existential distress and evidence supporting these interventions, please read this optional reading.

Health Professional Tip

What are some strategies that can be used to strengthen a client’s resilience?

Some strategies that you could use to strengthen a client’s resilience is

  • Acknowledging their suffering

  • Look for opportunities to restore their dignity

  • Compassionate witnessing (non-judgmental, non-fixing, being present)

  • Validating their distress

  • Normalizing their distress as that of a normal person responding to difficult circumstances

  • Empathic dialogue

References

Griffith, J. L. & Gaby, L. (2005). Brief Psychotherapy Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness

Yalom, I. D. (1980). Existential psychotherapy. Basic Books.