Why Existential Psychology Goes Deeper Than Symptom-Focused Therapy

Psychology was born from philosophy, and existential psychology is the tradition that has most consciously preserved its philosophical roots.

An existential psychologist might be imagined as the kind of practitioner Aristotle, Epictetus, Seneca, Spinoza, Kierkegaard or Nietzsche might have become had they practised psychology in the modern world: someone who does not ask only how stress can be relieved, but what it reveals about the way a person lives, chooses, relates to others and understands their own existence.

Long before human experience was measured through diagnostic criteria, behavioural patterns and personality scales, philosophers were already asking the questions that remain at the centre of psychological life: What makes a life meaningful? How should we live? What do we owe to others? How do we face freedom, uncertainty, loneliness, suffering and death? And what does it mean to become oneself?

Modern psychology developed systematic ways of observing, classifying and treating psychological distress. This made the field more scientifically accountable, but it also introduced the risk of reducing a person to symptoms, traits, diagnoses or learned patterns.

Existential psychology remains informed by scientific knowledge while insisting that no psychological explanation is complete if it excludes the person living through the experience—with the singularity of their character, history and inner world.

Different approaches isolate different dimensions

The difference between psychological approaches lies not only in the techniques they use, but also in which part of the person they place at the centre of attention.

A diagnostic model may ask:

Which diagnosis corresponds to this cluster of symptoms?

Cognitive Behavioural Therapy may ask:

Which cycle of thoughts, behaviours and avoidance is maintaining the symptom, and how can it be interrupted?

Psychoanalysis may ask:

Which unconscious conflict or early relational pattern is being repeated here?

Positive psychology may ask:

Which strengths, habits and resources could increase this person’s sense of wellbeing?

Systemic therapy may ask:

Which pattern within the family or relationship system is sustaining the difficulty?

Each question can reveal something important, but each begins by selecting one dimension of the person: a diagnosis, a cognitive-behavioural cycle, an unconscious pattern, a personal resource or a relational system.

Beyond symptoms and diagnoses

Many psychological models organise distress through diagnosis, classification and symptom categories. This can be valuable: a diagnosis may help professionals communicate, guide treatment and allow a person to recognise that their suffering is neither unique nor incomprehensible.

The difficulty begins when the diagnosis ceases to be a tool and becomes an identity.

Existential psychology does not assume that every form of distress is best understood as an illness located entirely within the individual.

It considers psychological struggles within the life in which they have emerged: their underlying causes, the person’s environment and relationships, their values and responsibilities, and the particular circumstances of their present stage of life.

Instead of asking only, “What is wrong with this person?”, existential psychology also asks:

What has this person lived through? What are they confronting now? What might their distress be expressing?

Anxiety may arise not only from distorted thinking, but from prolonged uncertainty, unresolved conflict or the avoidance of a necessary decision. Emptiness may not simply be a symptom to eliminate; it may indicate that former values, roles or ambitions no longer provide direction. Depression may have biological and psychological dimensions while also expressing grief, disillusionment, isolation, the experience of being unseen or undervalued, or a life that has become disconnected from meaning.

Existential work therefore refuses to confuse one observable aspect of a person with the person as a whole.

The whole human condition enters the room

Existential therapy is concerned not merely with psychological functioning, but with the conditions under which every human life is lived. It permits therapy to engage with questions that cannot always be reduced to symptoms or solved through technique.

These include mortality and limitation, freedom and responsibility, isolation and belonging, meaning and absurdity, morality, spirituality, authenticity, guilt, choice and uncertainty about one’s direction in life.

A fear of death, for example, is not automatically regarded as irrational. Death is real, and awareness of mortality may intensify after bereavement, illness, ageing, parenthood or a major transition. The therapeutic task is not necessarily to suppress this awareness, but to understand what it changes and how a person might live more fully in its presence.

Loneliness is not always resolved by increasing social contact. A person may be surrounded by others yet remain unable to reveal themselves, experience genuine intimacy or participate in relationships based on mutual recognition.

Freedom is also more complex than being able to do whatever one wants. Freedom brings responsibility: if I am able to choose, I must also live with what my choices create. Avoiding a decision is itself a decision, although it may preserve the comforting illusion that no choice has yet been made.

A non-pathologising stance

One of the defining qualities of existential psychology is its reluctance to treat every psychological struggle as evidence of something defective within the person.

This does not mean denying mental illness, dismissing diagnosis or assuming that every condition can be resolved through philosophical reflection. It means refusing to mistake a clinical description for the totality of a human being.

Distress may be an intelligible response to bereavement, betrayal, prolonged responsibility, moral conflict, displacement, relationship breakdown, failure, social isolation or the collapse of a former identity. Even when a diagnosis is clinically appropriate, it cannot fully explain what the experience means within that particular life.

Existential therapy takes the client’s experience seriously without assuming that every interpretation of it must be accepted as true. A person can be deeply understood while their assumptions are still examined and challenged. Validation is therefore not passive agreement; it is the recognition that an experience has arisen within an intelligible personal, relational and existential context.

Symptom reduction is not the only aim

Clients naturally seek relief from anxiety, intrusive fears, low mood, emotional dependency and recurring patterns of distress. Symptom reduction matters, but existential therapy does not regard the disappearance of symptoms as the only measure of psychological health.

A symptom may be performing a function that has not yet been recognised. Persistent anxiety may postpone a difficult decision. Emotional dependence may preserve a painful relationship while protecting the person from loneliness. Perfectionism may sustain achievement while defending against a fragile sense of worth. Exhaustion may reveal a life constructed almost entirely around duty, performance and external expectations.

If a symptom is removed without understanding the psychological or existential structure supporting it, the unresolved conflict may later return in another form.

Existential work therefore considers not only how a symptom can be reduced, but why it became necessary, what it protects and what would have to change for it to lose its purpose. Through greater self-understanding, emotional maturation and a more authentic engagement with life, symptoms may gradually become less intense or less necessary.

Change then occurs not because the person has learned to perform psychological wellbeing, but because the inner conditions that sustained the symptom have begun to transform.

Ethics as part of psychology

Existential psychology cannot be separated from ethics because psychological decisions affect other people. The relevant question is not merely, “What do I want?” but also, “What kind of person am I becoming through this choice, and what consequences will it create?”.

A decision may relieve anxiety while violating a person’s deeper values. A boundary may be presented as self-protection while functioning as punishment or avoidance. The language of authenticity may be used to justify impulsivity, cruelty or indifference to others.

Ethical reflection helps distinguish a genuine value from an immediate desire, and responsible freedom from freedom exercised without consideration of its consequences.

This does not mean that the therapist imposes a moral system upon the client. The purpose is to help the person examine their values, contradictions and responsibilities with greater clarity, so that important decisions are not governed entirely by fear, dependency, social pressure or momentary emotion.

The therapist is not an interpreter standing above the client

Existential therapy does not position the therapist as someone who possesses a ready-made explanation for another person’s life. The therapeutic relationship is a meeting between two human beings, although their roles and responsibilities within that relationship remain different.

The therapist listens for what is spoken, what is avoided and what remains internally contradictory. Questions are not designed merely to retrieve memories or guide the client towards a predetermined conclusion. They are intended to create insight and a new vision.

The aim is not to make the client dependent upon the therapist’s interpretations. It is to strengthen the person’s ability to perceive themselves, examine reality, tolerate uncertainty and make choices without surrendering responsibility.

Who may be drawn to existential psychology?

Existential psychology may be especially meaningful for people experiencing a loss of meaning, inner emptiness, major transitions, bereavement, relationship breakdown, identity conflict, persistent anxiety, uncertainty about the future or difficulties in making a choice.

It can also be valuable for people who function highly in external life while feeling internally disconnected: professionals carrying significant responsibility, military personnel, elite athletes and those whose sense of worth has become inseparable from performance.

Such clients may not need to be taught how to function. They may need a space in which they are no longer reduced to what they produce, endure or achieve.

Not a formula, but a way of seeing

Existential psychology is not defined by a single technique. It is a way of seeing the person: not as a collection of symptoms, traits or conditioned responses, but as a whole and complex individual living within relationships, circumstances, values, choices and limitations.

This does not make existential psychology superior to every other approach. Different difficulties require different methods, and responsible practice must remain informed by psychological evidence. Its distinctive contribution is to prevent the method from becoming more important than the human being for whom it is intended.

References and Further Reading

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

Buber, M. (1970). I and thou (W. Kaufmann, Trans.). Charles Scribner’s Sons. (Original work published 1923)

Cooper, M. (2016). Existential therapies (2nd ed.). SAGE Publications.

Frankl, V. E. (2006). Man’s search for meaning. Beacon Press. (Original work published 1946)

May, R. (1983). The discovery of being: Writings in existential psychology. W. W. Norton & Company.

May, R., Angel, E., & Ellenberger, H. F. (Eds.). (1958). Existence: A new dimension in psychiatry and psychology. Basic Books.

Schneider, K. J., & Krug, O. T. (2017). Existential–humanistic therapy (2nd ed.). American Psychological Association.

Spinelli, E. (2014). Practising existential therapy: The relational world (2nd ed.). SAGE Publications.

van Deurzen, E. (2012). Existential counselling and psychotherapy in practice (3rd ed.). SAGE Publications.

Vos, J., Craig, M., & Cooper, M. (2015). Existential therapies: A meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83(1), 115–128. https://doi.org/10.1037/a0037167

Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388. https://doi.org/10.1037/0003-066X.47.3.373

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

Anastasia Domanska

Existential Psychologist