The Four Ultimate Concerns in Existential Therapy
Existential therapy is not a set of techniques, but a way of understanding what it means to be human. Rooted in philosophy rather than pathology, it invites us to face life’s deepest realities, such as death, freedom, isolation, and meaninglessness. These are not problems to be solved, but truths to be courageously confronted.
In therapy, I often see how these concerns lie beneath the surface of what clients describe as anxiety, depression, or relationship distress. Beneath our everyday struggles, we are all grappling with being finite, responsible, separate, and searching for purpose.
Existential Therapists Irvin Yalom, Rollo May, and Viktor Frankl each illuminated these challenges in unique ways. Yalom described them as the “ultimate concerns” that underlie much of human conflict and avoidance. May focused on the courage required to live authentically, and to face anxiety rather than flee from it. Frankl stated that even in profound suffering we can find meaning, and that our search for purpose is the deepest expression of our humanity.
Existential therapy can helps us explore these truths with honesty, compassion, and courage. By turning toward what we fear, we often discover what we most value. Awareness of death can awaken us to life’s immediacy; accepting freedom reminds us that we are the authors of our own choices; recognising isolation invites deeper connection; and exploring meaninglessness can guide us toward a life rich in purpose and authenticity.
Death: The Boundary of Life
The Concern:
Death is inevitable, and its awareness can provoke anxiety, denial, or despair. Yet this awareness can also awaken us to life’s urgency and remind us of what truly matters.
Yalom’s View:
Yalom saw the fear of death as a central source of psychological distress, often disguised as perfectionism, procrastination, or fear of change. Therapy, he suggested, helps clients bring this fear into awareness and transform it into a motivator for living more fully and authentically.
Frankl’s Contribution:
Frankl believed that even in the face of mortality, we can find meaning. During his imprisonment in Auschwitz, he observed that those who found purpose, through love, work, or moral conviction, were more resilient in the face of suffering.
Therapy Example:
A client grieving a parent may begin to fear their own mortality. The therapist might invite reflection on legacy: What kind of life feels meaningful to you? How do you want to live while you are here? Death becomes not only an ending to fear, but a mirror reflecting what we most wish to embody.
Freedom: The Weight of Choice
The Concern:
We are free to choose, yet with freedom comes responsibility. Many people feel burdened by the need to decide, or paralysed by the fear of making the “wrong” choice.
Yalom’s View:
Yalom described how avoiding freedom often leads to passivity, dependency, or blaming others for our unhappiness. Therapy helps clients reclaim agency by recognising that, even within constraints, we always have some degree of choice.
May’s Insight:
Rollo May wrote of the “courage to be”, which is the courage to face anxiety and make choices aligned with one’s true self, even when those choices are uncomfortable or unpopular. Freedom requires not just will, but authenticity.
Therapy Example:
A client stuck in a career they hate may say, “I have no choice.” The therapist gently challenges this belief, exploring the fears that keep them immobilised and helping them envision alternative paths. The goal is not to push for action, but to awaken ownership and responsibility for their own direction.
Isolation: The Solitude of the Self
The Concern:
Existential isolation is the recognition that no one can ever fully know our inner world. Even in love or deep connection, we remain ultimately separate.
Yalom’s View:
Yalom described this as the most fundamental isolation, not merely social or emotional, but existential. Therapy becomes a space where genuine connection can be experienced, even while accepting the limits of that connection.
May’s Perspective:
May viewed isolation as both anxiety-provoking and liberating. By accepting our separateness, we stop demanding that others complete us and instead begin to relate from a place of authenticity and choice.
Therapy Example:
A client surrounded by people but feeling deeply alone may explore fears of vulnerability and rejection. The therapist models empathy and presence, helping the client tolerate the loneliness of being a separate self while learning how to connect more openly and meaningfully with others.
Meaninglessness: The Search for Purpose
The Concern:
In a universe without inherent meaning, we are tasked with creating our own. For many, this realisation brings despair or a sense of emptiness, yet it also offers freedom.
Frankl’s View:
Frankl’s logotherapy was founded on the belief that the search for meaning is our primary human motivation. He taught that meaning can be discovered through work, love, suffering, and even death, by the stance we take toward our circumstances.
Yalom’s View:
Yalom observed that a sense of meaninglessness often lies beneath depression and anxiety. Therapy helps clients uncover meaning through exploring their values, passions, and the personal stories they tell about their lives.
Therapy Example:
A client experiencing burnout might say, “What’s the point?” The therapist will invite reflection: What matters most to you? What gives you a sense of vitality? What kind of life feels worth living? Through this exploration, despair begins to transform into direction.
Final Reflection
Existential therapy encourages us to live consciously, to meet life’s realities not with avoidance, but with awareness and courage. As Yalom reminds us, “Though the physicality of death destroys us, the idea of death saves us.” May would add that it takes courage to live authentically, and Frankl would remind us that meaning can be found even in suffering.
To face death, freedom, isolation, and meaninglessness is to face life itself, and in doing so, we often discover that our deepest anxieties point us back toward what makes life most precious: love, purpose, connection, and choice.
Freedom and the Weight of Being: Sebastian Junger’s Freedom
Sebastian Junger’s book Freedom is a meditation on autonomy, belonging, and survival. In its pages it recounts a 400-mile walk along railroad lines with a small group of ex-servicemen companions. But beneath this journey, it’s a philosophical inquiry into what it means to be free. From an existential perspective, I see in Junger’s reflections a confrontation with some of the core elements of human existence that have preoccupied thinkers over time.
The Paradox of Autonomy and Belonging
Junger’s and his friend’s journey is based on physical independence: walking off-grid, sleeping rough, evading authorities. Yet, this freedom is only possible because of deep interdependence in the group. He and his companions rely on each other for safety, food, and emotional support. The tension between the need for autonomy and the need for connection is a central concern in existential therapy.
Jean-Paul Sartre was quoted as saying “man is condemned to be free,”. Simone de Beauvoir added that freedom is not just about individual will, but about how our choices affect others. In Freedom, Junger writes about this tension, and how his autonomy is never absolute.
Responsibility and the Anxiety of Choice
You can argue the existential freedom is not license; it is responsibility. Junger’s and his companions are faced with many choices—where to sleep, how to stay safe, when to move on. Each decision carries weight, and with each decision comes the emotional weight of being the author of one’s life.
This echoes the philosophical concept of “existential dread”, what one feels when they realise the vastness of our freedom. In therapy, clients often come face-to-face with this same dread. They long for freedom, yet fear the space and responsibility it entails.
Security vs. Meaning
Junger points out how Western society is obsessed with comfort and safety, and suggests that it can come at the cost of meaning. He observes that despite our material abundance, we are often more anxious, isolated, and unfulfilled. This aligns with Viktor Frankl’s statement that “life is never made unbearable by circumstances, but only by lack of meaning and purpose.”
In existential therapy, we explore how the pursuit of security can easily lead to inauthentic living, when we conform to expectations rather than live in alignment with our values.
Mortality and the Fragility of Freedom
Death is also discussed in Freedom. Junger, a former war reporter who has faced death many times, writes our awareness of life’s fragility. Philosopher Martin Heidegger argued that authentic existence begins when we confront our own death. To be free is to live with the awareness that our time is limited, and to act accordingly. Junger’s reflections in Freedom embody existential philosophy: freedom is not about escaping death, but about living meaningfully in its shadow.
Freedom as an Existential Practice
Sebastian Junger’s Freedom is not a philosophical text, but it is full of existential insight. It reminds us that freedom is not ease or escape, it is effort, responsibility, and connection. It is the courage to walk our path, knowing that no one else can walk it for us.
Junger’s writes about embracing the paradoxes of freedom. To choose, to care, to belong, and to do so with eyes wide open.
If you’re wrestling with questions of autonomy, meaning, or connection, Freedom may help you with this process.
Finding Tranquility in the Face of the Death: Epicurus and the Art of Living Well
As a clinical psychologist, I often sit in therapy with clients grappling with the anxieties that arise when confronting the inherent uncertainties and limitations of life. The concept of mortality, the search for meaning in a seemingly indifferent universe, and the burden of freedom can be overwhelming to many clients. In these moments in therapy, I often find myself looking to the writings of Epicurus, whose philosophy offers a framework for navigating existential conflict and addressing the fear of death.
Epicurus introduced the concepts of ataraxia, a state of tranquility and freedom from disturbance, and aponia, the absence of physical pain.
The Concepts of Ataraxia and Aponia
Epicurus centred his writings on the belief that the ultimate goal of life is happiness or pleasure (in the sense of a tranquil state, not sensual excess). This goal is achieved through the twin concepts of ataraxia and aponia.
Ataraxia (Freedom from Mental Disturbance)
Ataraxia literally translates to "untroubledness" or "impassivity."
It is described as a state of tranquility, serenity, and freedom from fear, anxiety, and distress. Epicurus believed that the greatest threats to happiness were mental anguish, particularly the fear of death, the fear of the gods, and the anxiety arising from unfulfilled desires. Ataraxia is achieved by understanding the natural limits of one's desires (and satisfying only the natural and necessary ones) and by applying rational thought to dispel irrational fears. Philosophical study, cultivating meaningful friendships, and reflecting on the limits of desire and the nature of the universe can help you achieve this state.
Aponia (Reduction of Physical Pain)
Aponia translates to "freedom from pain." While ataraxia deals with the mind, aponia is the corresponding state for the body. It is the state where the body is in good health and comfort, with minimal physical suffering. Epicurus taught that once the body is free from pain, the level of physical pleasure cannot increase further; the absence of pain is the limit of bodily pleasure. Maintaining good health, eating and drinking moderately, and avoiding circumstances that lead to physical discomfort or injury would help you reach Aponia.
In summary, the Epicurean life of pleasure is not about seeking intense, fleeting gratification, but about establishing a stable and lasting condition of mental peace and bodily comfort. Epicurus wrote, "Do not spoil what you have by desiring what you have not; remember that what you now have was once among the things you only hoped for." This is can be achieved through appreciating you present blessings and to recognise the futility of chasing endless desires.
The Theraputic Perspective
From an existential therapeutic perspective, particularly drawing on the insights of Existential Therapists Rollo May and Irvin Yalom, the Epicurus perspective resonates deeply. May, a pioneer of existential psychology, emphasized the importance of confronting our freedom and responsibility, which can often lead to anxiety. Yalom, known for his focus on the "givens of existence" (death, freedom, isolation, and meaninglessness) recognized that an authentic encounter with these truths is essential for a rich and meaningful life.
How can Epicurus's understanding inform your perspective on life, particularly concerning death anxiety?
Re-evaluating Our Desires: The Epicurean Hedonic Calculus
Epicurus taught that "We should look for someone to eat and drink with before looking for something to eat and drink." This highlights the importance of quality relationships and simple pleasures over material accumulation. In therapy, when a client expresses anxieties about not having achieved enough or not experiencing enough before death, we can explore their underlying desires. Are they genuinely their own, or have they been influenced by societal pressures?
Technique: You can write a "Desire Inventory" where you list your core desires and then evaluate which ones genuinely contribute to your well-being and which ones might be sources of unnecessary striving. You can then apply an Epicurean lens, asking: "Does this desire truly lead to ataraxia and aponia, or does it create more disturbance and suffering in my life?"
Confronting the Fear of Death: "Where I am, death is not; where death is, I am not."
Perhaps Epicurus's most direct assault on death anxiety lies in his argument that death is nothing to us. Since all ‘good’ and ‘bad and evil’ lie in sensation, and death is the loss of sensation, then death is not an evil. This logical reasoning, while not always instantly comforting, can be a helpful cognitive reframing.
Therapeutic Technique: Cognitive Restructuring for Death Anxiety. You can actively challenge your catastrophic thoughts about death using Epicurus's logic. For example, if you fear the pain of dying, you can explore the idea that the experience of pain is a living experience, and death itself is the cessation of all experience. If the fear is of "non-existence," you can consider Epicurus's point that where we are, death is not. It’s about being present and recognizing that the future state of "not being" is not something we experience.
The Power of Friendship and Community: A Buffer Against Existential Isolation
Epicurus believed that friendship was one of the greatest sources of pleasure and a fundamental component of a good life. "Of all the means which wisdom acquires to ensure happiness throughout the whole of life, by far the most important is the acquisition of friendship." This quote speaks directly to Yalom's "given" of existential isolation. While we are ultimately alone in our subjective experience of life, meaningful connection can provide immense comfort and a sense of belonging.
Therapeutic Technique: "Circles of Connection." You can map out your social support network, identifying who brings you joy, solace, and a sense of belonging. You can then explore how to nurture and expand your connections, recognising their vital role in mitigating feelings of isolation and providing a sense of shared humanity in the face of life's challenges.
Living a Virtuous Life: The Path to Inner Peace
Epicurus believed that living a life of prudence, honor, and justice was the most effective way to achieve pleasure and avoid pain. He understood that actions leading to guilt or social discord ultimately undermine ataraxia.
Therapeutic Technique: Values Clarification and Alignment. You can identifying your core values and then examine how your current actions align with these values. If there's a significant disconnect between your values and actions, this will lead to inner conflict and anxiety. By consciously striving to live in accordance with your values, you can cultivate a greater sense of integrity and inner peace, reducing regret and fostering a sense of a life well-lived. This, in turn, can lessen your death anxiety by creating a feeling of completion and authenticity.
The writings of Epicurus, when integrated with the principles of existential therapy, offers a useful lens through which to examine and alleviate the profound anxieties of human existence. By re-evaluating our desires, confronting the reality of death, making meaningful connections, and living virtuously, we can move towards a life characterised not by a avoidance of suffering, but by a profound appreciation for the present moment and a tranquil acceptance of our ultimate end. As Epicurus stated, "A free life cannot acquire many possessions, because this is no easy feat without servility to mobs or monarchs." It's a reminder that true freedom, and true peace, often lie in simplicity, introspection, and authentic connection.