Existential suffering in the face of death. Helping and hindering factors in the existential counseling and psychotherapy of people facing death

For centuries, people have pondered fundamental questions of life. Yalom describes four ultimate existential givens (death and life, connectedness and loneliness, freedom and responsibility, meaning and meaninglessness) which we all inevitably are challenged with in confrontation with death or other limit situations. The confrontation with those situations represents the pronounced possibility of becoming aware of one’s existence. However, when people miss personal resources to cope with existential threats and when pain threatens their integrity as a person, they can suffer severely. Existential suffering is thus perceived as a response to the major existential challenges in life. 

Severe physical illness as well as psychiatric disorders are pre-eminently limit situations with existential suffering. The sudden confrontation with a life-threatening disease like cancer shakes our relationship to life and its finitude. This can provoke an existential crisis. People suffering severe and life-lasting psychiatric illnesses are confronted with death in a more lasting way. They experience feelings of hopelessness and injustice. Although the profound struggle with existential concerns is prominent, yet this struggle receives little attention in clinical medicine and research. In addition, very few caregivers feel adequately versed in existential themes to discuss them with patients.

Existential psychotherapy and counseling seeks to alleviate this existential suffering of patients by reflecting on these questions of life. Experiential-existential psychotherapy more specifically accesses one’s living experience, one’s felt meaning, by staying close to the embodied feeling of what is meaningful for the client in approaching their existential concerns, rather than a mere intellectual exploration of these concerns. 

The general goal of this research project is to investigate how people deal with existential suffering when they are confronted with death experiences in severe somatic or psychiatric illness, and what they experience as helpful or hindering in existential therapy and counseling. In a mixed-method comparative case study we explore how the existential givens are experienced by the patient. We examine if experiential depth can influence existential suffering in patients with cancer facing death. In a qualitative study (N=18), we explore how caregivers encounter existential themes in their patients with a death wish related to unbearable psychiatric suffering (DWUPS) and how they experience these themes during counseling. In a next study with DWUPS patients (N=10), we explore which important experiences in their dealing with life and death they encounter. Finally, in another study with DWUPS patients (N=10), we examine which changes people with DWUPS perceive in their existential counseling.