Exploring the Depths of Existential Psychotherapy: Three Profound Case Studies

“And to have finally dealt with suffering, you have to consume it into yourself. Which means you have to—with eyes open—be able to keep your heart open in hell. You have to look at what is, and say, ‘Yeah, Right.’” – Ram Dass

We live in a time of unprecedented change. The technological revolution has brought with it AI and the rise of “deep fakes”: pretty soon, it’ll be impossible to discern fact from fiction (and who then might the arbiters of truth be?). Additionally, many economists are forewarning of a potential world war three, given the geopolitical tensions in Europe and the Pacific; Putin, for the first time, has moved nuclear weapons to Belarus. And if the threat of a world war and the destabilisation of reality itself weren’t enough, why not throw in a rapidly changing climate, the likes of which will displace millions . . . you know, just for fun. The unequal distribution of wealth is widening the gap between the rich and the poor; the political aisle, too, widens, seemingly by the hour; the cost of living is ridiculous (there’s no other word for it); corporate agendas driven by the dirty, dark incentives of capitalistic greed are unequivocally unethical—to put it diplomatically—and consumerism leaves us all paralysed with choice in a world of infinite, and therefore, overwhelming possibility. Yep, it’s no wonder people are a little on edge right now!

I was raised a Catholic. Not much of my religious upbringing, if I’m being honest, remains with me apart from the American theologian Reinhold Niebuhr’s Serenity prayer. Here it is for those unaware:

God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference, living one day at a time; enjoying one moment at a time; taking this world as it is and not as I would have it; trusting that You will make all things right if I surrender to Your will; so that I may be reasonably happy in this life and supremely happy with You forever in the next. Amen.

As a deep admirer of Buddhism, I am quick to recognise the ideas of detachment woven into the deeper fabric of the prayer. Surrender and acceptance of reality as it is, not as I wish it to be, is a challenge, but a guiding north star, nonetheless. How then might we come to embody the wisdom of differentiating between what we can and cannot control? How might we navigate the contemporary world with these ideas in mind?

For one, there is a very significant difference between existential and socioeconomic suffering; understanding these differences will help us stay focused on our own personal visions whilst accepting, paradoxically, just how little control we have.

The Four Existential Givens

Sometimes, when I’m in need of a bit of comic relief, I’ll find myself re-watching Ricky Gervais’ blooper-reels on YouTube. I can’t get enough of them. His humour matches mine perfectly. I love him. One particular blooper springs to mind. Gervais’ character from The Office, David Brent,is explaining the reasons why he manages people the way he does. Brent states (before he bursts into laughter), “If you want the rainbow, you’ve got to put up with the rain.” Although what soon follows is a hilarious blooper involving Dolly Parton, his words are pertinent for this article. And I would add that, if you want the rainbow, you do not merely have to “put up with” the rain, but rather, accept (and learn to love) that you will get rained on whether you like it or not. C’est la vie!

It is not an easy thing to accept existential suffering (and I might add that the reason why I draw upon it in my writing so frequently is because I, too, struggle to make sense of, and accept it). After having spent years working as a counsellor, I am inclined to believe that accepting the existential givens is a lifelong task.

Existential suffering is the suffering we all experience, the pain augmented by the cultivation of self-awareness. As we learn more about what it means to live as human beings, we come to reckon with what Psychiatrist Dr. Irvin Yalom calls the “givens” of life: death, freedom, isolation and meaninglessness. As the Danish theologian and philosopher Soren Kierkegaard stated, “With every increase in the degree of consciousness, and in proportion to that increase, the intensity of despair increases: the more consciousness the more intense the despair.” What does it mean to live as a “lonely ‘I’” bobbing on a vast, volatile sea without bearing or direction? That the universe is indifferent to our wellbeing seems unjust and cruel. But then, what of the fact that these harsh “givens” are inevitable? That, somehow, the suffering we experience is a part of the human condition, whether we like it or not? Might acceptance of what we cannot control shine a much needed light upon this abyss we find ourselves floating in?

What I like about existential thinking is how raw it is. There’s no beating around the bush, there’s no sugar-coating. How do we find a way to live, given that we’re vulnerable and mortal? What do we do, given that everyone is always judging us and that the constant feeling of insufficiency is inescapable? What of the fact that these “givens” that cripple us with anxiety and dread are actually a part of being human, and not the cause of some hidden mental illness? In other words, we’re not broken for suffering; suffering is built into the fabric of existence, even if sometimes that suffering gets pushed into the background whilst we enjoy a morning coffee or laugh with a friend. As Dr. Jordan Peterson states:

“The meaning to life is the pattern of thought and action that you take that enables you to tolerate—to at least tolerate—the conditions of life. And then maybe you could move one step beyond that if you’re feeling optimistic and say: the meaning of life is the pattern of conception and action that enables you to welcome the conditions of life. And then you might ask yourself: well, is there such a mode of being, given the nature of the problem you have to contend with? . . . The vulnerability, the judgment, the insufficiency—it’s worth it under these conditions.”

If we bring these ideas to our modern world, we may ask of ourselves: Given the prospect of a global war, climate change and the rise of AI—is there a way we could each live that would enable us to welcome these conditions?

Aside from private practice, I also used to work as a telehealth counsellor for 24/7 service lines in Australia. This is a very different form of counselling. In private practice, one enjoys the slower, more in-depth approach, otherwise known as psychotherapy. Counselling, on the other hand—especially on a 24/7 phone lines—is much more acute and lends itself to helping individuals create and achieve short-term goals as well as managing high-risk situations. This is counselling on the frontlines. It is a service offered to all Australians, for free. This service is available whenever people need to speak with someone. I loved it. It was real, raw and money was no barrier for those in need.

Much of the time, telehealth counsellors are responsible for helping people manage and reduce their risk of suicide, self-harm and/or potential harm to others. People will call up in a highly volatile state, describing their means and plans for suicide precipitated by acute events that have pushed them over the edge. For these individuals, self-soothing tools and external support is required. And then there are others who aren’t suicidal, who aren’t in imminent danger, but who struggle to see the point in life (and there is a very important difference between being suicidal and wanted to discuss suicide). To me, these are the existentialists. I have found great benefit in helping these individuals find the words and come to terms with existential concepts. A few clients come to mind.

The Irishman, the Millionaire and the Bohemian

The Irishman called up in tears, overwhelmed by his impossible list of responsibilities as a father and employee working in a toxic environment. The Irishman suffered from the painful knowledge of existential freedom and isolation. Free in this modern world to make his own choices, he found himself lost in a foreign country, void of friends and a social support network, behind in his work commitments, depressed from a perpetuating lack of joy and vitality in his life, and hopeless, given nothing but dreaded groundhog days lay beyond the horizon. Within minutes, he and I discussed suicide. Though he was safe and had no means, access or imminent plans, his ideation was significant. (It is always much better to “go there”, so to speak, with the client; to be with them and entertain difficult conversations with them. They will feel much less isolated and shameful, and much more accepting of their otherwise perceived “unnatural” or “forbidden” thoughts.)

A common theme with people who are feeling suicidal is that they are looking for a way to end their pain, not necessarily their lives. This is a monumental insight because it can lead to help-seeking behaviour. It isn’t themselves, as a whole, they are looking to dispense with; rather, the parts of themselves that cause untold misery. In other words, if there was a way to end their pain, thoughts of ending their life would cease to exist also. It can help to validate this for them, to help them see that they’re not broken for thinking about suicide; rather, their minds are trying to find ways to alleviate their suffering. What working mind wouldn’t?

The Irishman and I spoke for about twenty-five minutes. It became clearer to me that the solution to his problems was to be found in acceptance of Dr. Yalom’s “givens” as opposed to emotional management strategies, assertiveness training (for his superiors at work) or some other more superficial plan of attack. The Irishman wasn’t dumb; he was quite intelligent. He knew what he had to do to pull himself up by his bootstraps—and it is my personal and professional opinion that most people in crises do too. He wasn’t looking for solutions, he was looking for support. He was looking for someone to say, “Hey, I get it. I’ve been there. You’re not alone. You’re a human like the rest of us. We want you to be a part of our club. Come. Pull up a chair.” I wasn’t there to solve his problems. He knew he’d eventually have to pack up his tent and sleeping bag and climb, once more, up the ever-ascending mountain. For now, he was in pain: his feet were blistered, he was sunburnt, he was hungry, tired and had forgotten his ‘why’, his raison d’etre.

It’s Just Like Seneca Said . . .

The Millionaire called up, also in tears. “I’m in a car, and I could drive this thing straight into a truck.” Though he was suicidal, had a plan to end his life, and had the means to do so, the Millionaire wasn’t in imminent danger. Beyond the trembling words and tears, the Millionaire was lost in a world that, according to him, wouldn’t care whether he lived or died.

One thing to look out for when counselling someone in distress are the contradicting core beliefs one holds. Contradicting beliefs present themselves frequently and offer insight into the conflicting emotions one is struggling to come to terms with. Though one might have a family who they know loves them very much, for example, one, also, simultaneously feels worthless and believes wholeheartedly that no one would care if they ended their life. The goal is to get the client to see that that sense of worthless comes from within—an inner conflict or issue of self-perception or worth—and isn’t uniquely associated with someone else’s view of them.

The Millionaire was particularly humble. I asked him about a time when he felt happy. He said that, prior to his consulting company booming, he enjoyed working with like-minded people, united by a common goal, brainstorming, chatting, drinking coffee and accomplishing tasks before returning home to be with his beautiful family. His voice trembled as he finished his sentence. I was interested in his crying, so I asked him where his tears were coming from. He said he hadn’t felt like that in a long time. I asked him what he meant. “Do you mean you haven’t felt excited to see your family in a long time or that you haven’t had a sense of purpose?” His trembling stopped momentarily. He said that because his company had been so successful, he’d sold it years ago and hadn’t had much to do. This was particularly intriguing for me. Not long after we began speaking, he’d disclosed an ADHD diagnosis and stated that he’d been on medication for some time. The medication, apparently, made him feel “tired” despite helping him be more present.

“What must it be like for you to not have a mission and a purpose given everything you said to me before about how wonderful it feels to have a million things to do and not enough time to do them.”

“It feels awful. I don’t know who I am.”

“Of course you don’t”, I said. “No one does when they don’t have anything to do. Our identity comes from what we’re doing; our identity is our behaviour across time (think of it like a maths equation). And what we are doing comes from where we’re trying to get to, it comes from our goals. Without goals—explicit and implicit—we have no identity. A very successful, ambitious individual like yourself, with ADHD too, would feel a Lamborghini stuck in traffic! You were born to change the world. Now having summited the entrepreneurial mountain—an unbelievable accomplishment, mind you—you feel lost. That’s because you’ve spent too long up there, enjoying the view. And now the view is boring. Where’s your next mountain?”

Fulfilment lies in the tension between achieving a goal and the actions required to do so. Fulfilment is Sisyphus pushing his boulder and Jesus carrying his cross. The achievement of a goal only brings with it temporary satiation before, once again, existential ambiguity about one’s aims and endeavours. As psychiatrist Viktor Frankl states, “Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual.” What I would add here—only because it comes up so often in therapy—is that there is no single task or mission one must find or discover in life. Rather, we each have many purposes throughout the lifespan, and we should cultivate enough flexibility to be open to climbing new mountains if and when they present themselves.

Herein lies another of humanity’s inevitable conditions: We are wired not to be happy but to strive to be happy. We are the ultimate survivalists. We are born to do, first, so that we can feel happy to be. If we weren’t wired this way, there’d be no drive to work hard to find food, build protective enclosures, make friends (power in numbers) and the rest! Again, we have evolved not to be happy but to strive for safety. Without safety, the world is horrifyingly dangerous. Without striving, the world is painfully meaningless. “If a man knows not to which port he sails, no wind is favourable.”

Living Unconventionally Means Being Authentic, Not Weird

The Bohemian, if I’m being honest, saddened me. In the beginning he presented as a typical Aussie bloke, a car salesman who loved the footy, a man who enjoyed a beer with his mates. He called the service line because he “felt a bit rattled”, like a “possum caught in the headlights”. He’d been a car salesman for much of his adult life but was “getting on” and having a tough time thinking about the next stage of his life. I asked the Bohemian about what he was looking forward to in this next stage. When he responded with apprehension over the thought of looking forward to the future, I began to think that his anxiety and distress were emanating from deeper waters. Respectfully as I could, I probed his sentiments about the future.

I’ve come to believe that our ideas about what the future holds are heavily impacted by what has occurred in our pasts. Given that the mind is, among other things, a prediction machine, it stands to reason that, without conscious awareness, we will continue to repeat behavioural patterns not because we necessarily want to or believe that the patterns serve our highest intentions, but because, in one way or another, our evolutionary wiring has declared those patterns to be the safest ways of getting around in the world. We’re wired to live, not to thrive. This seemed to be conducive to the Bohemian’s experience. He’d played it safe in life. He’d lived comfortably. And now that comfort was eating him alive because, as he said it, “I’ve always thought of myself as a Bohemian.”

He told me he’d always wanted to dance but was afraid he wouldn’t be good enough and that he’d fail at it.

“Surely it’s just about skill development?” I was shocked he believed it possible to fail at creativity, the one thing without boundaries, rules and standards.

“I’m telling you mate; I won’t be any good. And now it’s too late.”

He was fifty-one.

The Bohemian was worried about not being able to make enough money to support his passion for dancing. Upon closer inspection, it wasn’t the lack of money he feared, moreover what he thought a lack of financial security meant for his ability to enjoy his upcoming “golden years”. Having lived his entire life doing “the right thing”, he was now closer to death—in his view—without the financial means to live out his days authentically as the Bohemian dancer he always was. It was at this point when the tears began. I’ve never heard a man cry like he did. If I’m being honest, I began to cry too. It just so happened that, since it was a telehealth counselling session, I could conceal my tears to ensure he still felt I was holding the space, enabling him to let go even more.

As a self-proclaimed delusional optimist, I was quick to get to work, attempting to help the Bohemian realise the opportunity in crisis, the gift that his introspection afforded him. It was the wrong time. Our rapport was strong, so he could sense I was coming from the right place; but I could tell I’d missed the mark, judging by his reaction to me telling him that Colonel Sanders was sixty-five when he founded KFC. Being a good counsellor means knowing when to empathise and validate, and when, conversely, to offer solutions—to help someone realise their potential.

I try to ask clients how best I can support them so that I don’t have to guess what their needs are, and so that they can maintain agency over their lives, but I failed to do so with the Bohemian because his vulnerability pulled me in too close. I lost myself in his story and a countertransference occurred. My sentiments about Colonel Sanders were a friendly wake up call to be there for ‘the’ Bohemian, not the Bohemian ‘within me’, the part of me that fears—and therefore seeks to find solutions for—the possibility of parting this world not having lived authentically and to my fullest potential. This is not your counselling session Tom, I reminded myself, as the Bohemian blew his nose.

A few minutes passed before I once again got lost in his story. I told the Bohemian that now was the time to explore the world like a child does; to run around as if the floor were lava; to dance—horribly—but with delight, without a care in the world, and with courageous eclecticism. I told him about a personal story whereby a therapist of mine told me to “Do what you must, just don’t lose your soul.” I told him what a gift it was to still have years left to live in accordance with his soul. This went down terribly. Again, it was empathy he needed, and validation, not someone else’s solutions. Once again I got it wrong, having projected my own insecurities surrounding existential meaninglessness onto him. This might have been what I’d have wanted to hear, but from the Bohemian’s perspective, it was all easy for me to say given I had the privilege of time on my side.

As the counselling session neared its end, it became clearer to me, given my two failed attempts, that the Bohemian simply wanted a shoulder to cry on and a hand to hold. Solutions were pointless and, to be frank, condescending. My idol Dr. Yalom writes frequently in his books that it is often the therapeutic relationship itself that heals the most, moreover the solutions, tools and techniques discussed. Now, I cannot help but agree. When the call ended, I wiped away my tears, took a ten minute break and went downstairs to unpack the dishwasher.

The Antidotes to Existential Suffering

All of us suffer existentially in our own way. American cultural anthropologist and author of the 1974 Pulitzer Prize-winning book, The Denial of Death Ernest Becker went so far as to posit that everything we do is an attempt to squash our fear of death. No matter what you believe, solace can be found in acceptance of what we cannot control—namely, that we are mortal; that we are free to make our own choices—and therefore responsible for the worth of our lives; that, no matter how close we get to others, no one will ever truly know what it’s like to experience this world as we do; and that, finally, we are meaning-seeking creatures floating in a universe void of any inherent meaning. There isn’t anything we can do to change these “givens”. Changing our attitude toward them, then, is how we come to “tolerate” first, as Dr. Peterson stated, and then accept them completely (and maybe even welcome them), thereby assuaging the suffering that arises from resistance to the reality of the conditions of life. As the late Vietnamese monk Thich Nhat Hanh said, “Hello, solitude. How are you today? Come, sit with me, and I will care for you.”

Based upon Dr. Yalom’s work, we see that the antidotes to existential suffering are fulfilment, willing, connection and engagement.

For death: Given that we will die, how might we live such that we can look back on our lives when our time is up and say with integrity that it was all worth it? What tasks must we accomplish, which mountains must we climb? Who should we befriend? How much should we laugh?

For freedom: Given that, existentially, the success of our lives comes down to the choices we make, how can we accept that level of responsibility and fail willingly, determined to learn from each mistake; to get up, dust ourselves off and, as Brené Brown states, “Get back in the ring” to fight another day?

For isolation: Given that being alive means being destined to sail as “lonely I’s” on a vast sea—how then might we seek not to eliminate our existential loneliness but empathise with others’ experiences, thereby validating our own? Whilst it might be true that no one can die our deaths for us, the same is also true for everyone else. Paradoxically, unity and connection to others emerges from the isolation we all feel.

And finally, meaninglessness: How do meaning-seeking creatures such as us come to accept the fact that we live in a world that doesn’t care whether we live or die? I will leave Dr. Yalom to answer this question: “Engagement is the therapist’s most effective approach to meaninglessness . . . One must immerse oneself in the river of life and let the question [What is the meaning of life?] drift away.” When we are so lost in what we’re doing, the fact that our universe is void of any meaning doesn’t appear to be the least bit significant. Engage completely with what the world has to offer; come back down into the forest and get lost in the trees and participate fully in the game of life . . . even if it is just a game.