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Clinical psychology must adapt to help humanity deal with existential threats

In a review of the literature recently published in clinical psychologista team of psychologists and philosophers led by Travis J Pashak of Saginaw Valley State University argues for an existence-based clinical psychology.

Given the lengthening of lifespans and the growing awareness of “existential” challenges important to humanity (e.g., technology and climate change), they see the relevance of clinical psychology as linked to the broader adoption of a humanistic approach that accepts the limits of our knowledge of ourselves and the world around us, our mortality and the meaning we give to our limited lives, and our lasting impact on the planet .

The authors write:

Given this interesting set of historical circumstances and the identity of clinical psychology as a field directed towards understanding the human condition and improving it, we argue that an existence-based clinical psychology would be well placed. to address some of these complex and controversial issues by confronting them with honesty and transparency…[W]We argue against the hope of a life without death, without isolation, without foundation and without structure, but rather in favor of the acceptance of our circumstances – an existence-based clinical psychology values ​​our humanity, limitations included.

The authors discuss the importance of existentialism as a philosophical framework to inform clinical psychology that rejects the modern obsession with rationality and objectivity (“God’s view” of the world) that can be found in psychology and psychiatry’s pursuit of be seen as “hard” sciences. In its place, existence-based clinical psychology would promote a phenomenological perspective that prioritizes human subjectivity and emotion, which is more authentic to human experience. Such a perspective promotes the “raw freedom” of the human condition by helping individuals and societies to make sense of our existence as a holistic project of life in the face of the “finitude” of death.

Existentialism recognizes the anguish of inevitable death as a basic fear of all humans. It examines how moments in life (eg, the death of loved ones, the loss of a job) can create a sense of insignificance that threatens our existence. To address this issue, clinical psychologists can help people by encouraging them to reflect on death, their responsibility to be authentic to themselves, and by avoiding automatic deference to cultural norms by encouraging them to reflect on what that matters most to them and to work towards the most meaningful existence. .possible.

Considering the postmodern contribution of existentialism to a more conscious understanding of science, the authors note:

The sciences themselves, like individual persons, have a life in the sense that they constitute permanent projects of meaning. They are human traditions in real time, born of culture and not floating from it. They really adapt to the coming and going of new system languages ​​- to adapt the world and the human being to it. As such, they shape reality; they don’t just point it out. Modern attitudes to science had often held the promise of being able to get answers to life’s greatest questions once and for all – by designing the system to end all systems. Existentialism, as a postmodern movement, expects that all explanatory systems will be doomed from the outset and that the scientist will even want to be eclipsed.

Considering existentially oriented psychotherapies, the authors point to a long history of conceptualizing mental health in existential terms, including figures such as Viktor Frankl, Charlotte Bühler, Rollo May, James Bugental and Irving Yalom. Many of these approaches focus on working with defenses against existential themes of freedom, meaninglessness, isolation, and death through acceptance in a relational context between therapist and patient characterized by reciprocity and spontaneity.

The authors cite studies that have examined the diverse practices of contemporary existential therapists and argue that existential therapies are evidence-based citing treatment outcome studies and meta-analyses.

The authors also reviewed the study of death anxiety as a psychological construct central to existential approaches. They cover the efforts of early psychologists in the late 19e century to study death anxiety psychometrically (e.g., G. Stanley Hall’s “thanatophobia”), consider the most empirically supported instruments created for this purpose, and call on researchers to continue this work.

While interesting, the authors also point out the harsh criticisms of this quantity-based project, including the superficial sense of death anxiety that can be obtained from such measures, as well as a lack of focus on other existentially relevant concepts like existential isolation or freedom. loaded burdens.

The authors also review research on Terror Management Theory (TMT) as an existential psychological theory relevant to explaining how societies across time and space have dealt with death. These include individuals’ use of different defenses against this major existential threat, such as “proximal” defenses such as reassurance about one’s health or connecting more to cultural systems of meaning to achieve some sense of symbolic immortality. (e.g., the “distal” defense of high-success at work). However, they point out that while these defenses can sometimes be healthy, they have also led people to act in destructive ways for themselves and others.

The authors discuss how death anxiety is considered a transdiagnostic factor in different forms of psychopathology not explained by other factors such as neuroticism or attachment style. They recommend that clinical psychologists incorporate existential themes by adopting a more phenomenological approach working with patients centralizes the unique subjectivity of patients and therapists “join” them in this.

An existence-based psychotherapy is, by its nature, transcendent to any pre-existing prescriptive protocol in that it is an inner-seeking journey of two (or more) people in a close and trusting relationship. No roadmap can exist because the path is unique and the territory uncharted. Although probably well-intentioned, efforts to streamline or speed up the psychotherapy process by systematically imposing certain topics/activities usually come at the expense of space for organic and meaningful discoveries.

Integration of an existential approach to treatment with other orientations, such as CBT and psychodynamics, is also encouraged. Above all, from an existential point of view, our categorical labels for psychopathology that inform diagnosis and treatment are seen only as imperfect representations. Clinicians should be prepared to consider evolving their understandings as new ones emerge that make more sense.

From a research perspective, existential theory grounds clinical psychology as a human science that understands its focus of human subjects analyzing themselves. Thus, the authors “encourage a return to the person” that avoids a detached and unaffected professional position by emphasizing the narratives of participants and researchers in published research, such as conducting qualitative studies.

The authors echo the encouragement of others for mixed-methods approaches to clinical psychological science:

“By keeping the whole person visible, research projects will naturally begin to incorporate mixed methodologies, case studies, and qualitative/narrative considerations. The questions we ask in clinical psychology and the data we collect from study participants should treat them like humans, not numbers. This is not, of course, a call to abandon objective statistical methods – but again a recommendation to more firmly integrate multiple voices, methods and perspectives.

Other recommendations for clinical psychology researchers are to ask research questions that are existentially informed (e.g., “What do clients think of the discussion of existential themes in session, and how do they perceive them to be related to their experiences outside of the session?”). This also includes encouraging peer-reviewed journals to allow authors to express more of their humanity when writing about the mental health of real people.

Finally, the authors examine how teaching and training in life-based clinical psychology can be improved. Recognizing the limits of domain knowledge allows teachers to be humble about what we can know and to consider the dynamic nature of science.

In addition, freedom of choice for instructors and supervisors in what they teach could encourage them to think more deeply about what they want to convey to their students/trainees and create more meaningful learning goals. . The authors also recommend that instructors/supervisors engage students/supervisees as co-creators in the learning process that values ​​trainees’ perspectives and gives them personal agency to pursue topics that are meaningful to them.

An existentially informed clinical psychology teacher is also authentic. Clinical interns need supervisors who can sit with them in the depths of agonizing questions about the nature of life, stimulated by the difficulties of their clients. Students need instructors who can face uncomfortable classroom topics with the courage of honesty and the audacity of not knowing. Hiding behind ostensibly robust frameworks echoing the Age of Enlightenment (e.g., DSM/CIM descriptions of disorders; essentialist genetic attributions on etiology; rigidly formalized treatment designs) can help our field emerge more like “hard science” on a superficial examination, but ultimately failing to serve our learners in the best possible way. Teaching clinical psychology is about teaching people to exist authentically while inviting others to do the same, so it is imperative that the instructor models this behavior by embracing a postmodern sense of uncertainty and a humanistic sense of transparency.


Pashak, TJ, Nelson, OM, Tunstull, MD, Vandersstelt, BH, Nichols, DP and Hitt, JM (2022). Embrace Subjectivity: The Science, Practice, and Teaching of Existence-Based Clinical Psychology. clinical psychologist1–18. https://doi.org/10.1080/13284207.2022.2108695

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