Many years ago, while taking a summer class at a local university, I happened upon a copy of Existential Psychotherapy by Irvin Yalom, a title which appealed to me given that I was a newly graduated philosophy major. Reading that book was the tipping point in my decision to go to graduate school. Throughout my graduate studies, I kept searching for a faculty member or practicum site supervisor to engage me in mutual exploration of the existential concerns that were elaborated in that work. Unfortunately, those discussions never really materialized in the way that I envisioned or hoped, as at that time Cognitive Behavioral Therapy was emerging as the predominant school of thought informing most psychology graduate programs.
Since then, my clinical work with children, adolescents, and adults who have experienced complex trauma has brought me face-to-face with these fundamental human concerns, in particular with the need for meaning and purpose and for a sense of belonging in a sustaining community where we work out our identity and contribute to the welfare of others. Many of the leaders in the trauma field have emphasized the critical importance of these most basic human needs, which have also been identified and expanded upon by the work of clinicians, teachers, and researchers in the fields of constructive developmental psychology, mindfulness, and social neuroscience.
Recently I have started re-reading Existential Therapy, motivated by the ever-increasing number of clients with whom I have worked who struggle with existential concerns arising out of the unfolding environmental crisis. While my own understanding and confrontation with the “givens of existence,” as Yalom refers to them, has evolved significantly over the decades, his work and that of others such as Frankl and Buber assume heightened significance for me today. Clients struggling with often debilitating anxiety in the face of climate change span a wide range of ages, occupations, socioeconomic statuses, and cultures. Perhaps they are somewhat over-represented by younger adults and adolescents, but questions of meaning, purpose, and belonging are common, pressing concerns for many persons who have sought psychotherapy with me.
The COVID pandemic, the ongoing traumas associated with colonialism, systemic oppression, discrimination, and marginalization of people of color and others, political and social unrest, economic injustice, and now the invasion of Ukraine, impact our individual and collective health and well-being in significant and interacting ways. As such, I realize that I cannot isolate the environmental crisis apart from other highly stressful conditions of our time that my clients share with me. I believe, however, that the environmental crisis is unique in that it serves as the broader context or background against which other challenges play out, and that its impact on these other factors is both pervasive and at times subtle, factors which invite us to avert our gaze from the potentially catastrophic and irreversible effects of climate change. This latter dynamic heightens the distress felt by many.
While I approach diagnosis with healthy doses of skepticism and caution, I believe that a good argument can be made for a new DSM diagnostic category, “existential anxiety disorder,” one that recognizes the serious, traumatic impact of climate change on mental health—an impact that I believe will only increase in the coming years. I think it important that psychotherapists recognize and address the very real, oftentimes terrifying, fears and anxieties associated with climate change that clients bring into therapy.
***
Co-authored by 270 prominent researchers from 67 countries, the most recent report (2022) from the United Nations’ Intergovernmental Panel on Climate Change is a 3000+ page document with which a surprising number of my clients are familiar. They are aware of the disproportionate impact of climate change due to social factors such as economic inequities, marginalization, and colonialism, especially for indigenous peoples and those whose basic daily needs are directly dependent on the local ecosystem. The report addresses the unsustainability of natural resources related to both consumption and production, and how this contributes to a situation where half of the world’s population experiences water shortages, where increased incidence of flood and drought lead to acute food insecurity and malnutrition, as well as where forced displacement and immigration have disproportionately impacted those parts of the world with the least ability to supply basic infrastructure needs and provide a safety net for residents. Issues of justice and morality are evident here, and I often witness aspects of moral injury as my clients recount their struggles living as witnesses to and participants in actions that they find ethically and morally unacceptable.
This situation is only going to grow more urgent as the reality of an ever-degrading environment finally breaks through our collective denial and we can no longer avoid the reality of what we have wrought upon ourselves. Several of my clients have expressed a fear that as a species, we are collectively committing suicide, and they struggle with hopelessness, despair, depression, and a genuine lack of purpose and motivation. For many of them, existing meaning-making narratives are inadequate to the task of grounding oneself in a time of great uncertainty. At the core, these clients are experiencing a crisis of meaning, one that calls to mind the words of William Butler Yeats from The Second Coming:
“Things fall apart; the centre cannot hold;
The best lack all conviction, while the worst
Are full of passionate intensity.”
It has been personally challenging for me to serve these clients, especially as the collective “we” are all facing the same increasingly dire situation. My ability to maintain consistent self-care and sustaining connections with others, and my own spirituality and meaning-making narratives, are frequently challenged.
***
I do not believe that manualized treatment protocols targeting cognitive distortions and maladaptive schema are up to the task of adequately addressing our clients and their fears over the possible extinction of humanity. I suspect that this might be a very opportune time as a profession to refamiliarize ourselves with some of the grounding ideas of existential psychotherapy that have been elaborated in the fields of psychology, philosophy, and spirituality.
As an illustration of what I am seeing in my practice, let me introduce Maria, a young professional who initially came to therapy describing herself as “quite anxious” and concerned by increasing difficulties in maintaining focus and motivation at work. At the time, she was employed as an organizational consultant in a field that she finds intrinsically rewarding, and until recently had found her work highly satisfying. In the initial session she described a tendency to “overthink everything,” a gnawing self-doubt that was both new and troubling, anxiety related to health concerns, and a vague sense of purposelessness.
Maria also shared that she had started asking herself the question “Is this all there is?” when reflecting on her chosen career and lifestyle. Maria had begun to seriously question notions of hard work, productivity, and success in life and career, questions that cast doubt on the inherent value of the ideals of progress, advancement, and acquisition underlying our capitalist society. Indeed, as her awareness of the factors contributing to the environmental crisis broadened, she had given voice to a growing conviction that this worldview was itself toxic, unsustainable, and as it has played out, immoral. Her developing recognition of the interdependence of people, and indeed of all life and the planet itself, had further served to catalyze her current crisis of meaning.
Aware of the disproportionate burden that residents of the world’s least resourced countries are bearing, she became increasingly uncomfortable with her privileged position. She was actively involved in advocacy efforts at raising awareness of the need for more urgent, far-reaching and impactful action to protect our environment through comprehensive, long-term adaptation planning and implementation. Nonetheless, Maria often felt an almost paralyzing guilt that, coupled with the realization that she could do very little to directly affect significant change, had seriously impacted her ability to appreciate life. Maria’s anger over the lack of resolve on the part of world leaders and governments alternated between increased irritability and open expressions of frustration, and times where she felt stuck, powerless, and hopeless. She and her partner also struggled with the question of whether to become parents, painfully aware of the moral implications of bringing children into a world where the future appears so uncertain.
Throughout the course of our work, Maria has explored questions of purpose and meaning, of personal values and considerations of social justice, and how these might guide her daily life. Against the finitude of human existence, the question of whether and how our individual lives matter has been a prominent theme. While not religious, she is a deeply spiritual person, and this has been an important aspect of our work together.
Questioning the dominant Western view of the autonomous, independent self and developing a more nuanced appreciation for human altruism and the self within the context of neuroscience have challenged traditional notions of the “selfish” self by providing Maria evidence that one’s sense of self can contribute to a broader social cohesiveness. Finally, recognizing the impact of small, personal acts of kindness flowing outward like ripples on a pond, interacting with other ripples, changing one another as they interact and spread out across the water, have all been important aspects of a therapy seeking to address existential concerns arising out of the environmental crisis.
***
Like Maria, many of my clients are struggling to fashion a coherent framework for meaning-making, one that accounts for our interrelatedness with the Earth and her creatures, one that recognizes and honors that we are part of an interdependent whole, a living organism where the fate of one is tied inextricably to the fate of all. They recognize, some explicitly, others on an intuitive level, that many of the religious traditions that they are familiar with do not adequately address these relational, contextual realities. Neither do the guiding myths of hard work, resource exploitation, unsustainable consumption, and success that are embedded within capitalism. Not in a world where these notions have run amok and have brought us collectively to the precipice of an unimaginable environmental crisis, which is simultaneously a crisis of meaning and purpose.
It is my hope that professional training opportunities will develop to help prepare therapists for what I suspect is going to be a growing number of clients who are struggling with issues of meaning, hopelessness, and despair as they attempt to find the motivation to get out of bed in the morning and put one foot in front of the other. I am constantly running into these issues in my private practice, and I suspect that I am not alone.
File under: The Art of Psychotherapy, Musings and Reflections
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Since then, my clinical work with children, adolescents, and adults who have experienced complex trauma has brought me face-to-face with these fundamental human concerns, in particular with the need for meaning and purpose and for a sense of belonging in a sustaining community where we work out our identity and contribute to the welfare of others. Many of the leaders in the trauma field have emphasized the critical importance of these most basic human needs, which have also been identified and expanded upon by the work of clinicians, teachers, and researchers in the fields of constructive developmental psychology, mindfulness, and social neuroscience.
Recently I have started re-reading Existential Therapy, motivated by the ever-increasing number of clients with whom I have worked who struggle with existential concerns arising out of the unfolding environmental crisis. While my own understanding and confrontation with the “givens of existence,” as Yalom refers to them, has evolved significantly over the decades, his work and that of others such as Frankl and Buber assume heightened significance for me today. Clients struggling with often debilitating anxiety in the face of climate change span a wide range of ages, occupations, socioeconomic statuses, and cultures. Perhaps they are somewhat over-represented by younger adults and adolescents, but questions of meaning, purpose, and belonging are common, pressing concerns for many persons who have sought psychotherapy with me.
The COVID pandemic, the ongoing traumas associated with colonialism, systemic oppression, discrimination, and marginalization of people of color and others, political and social unrest, economic injustice, and now the invasion of Ukraine, impact our individual and collective health and well-being in significant and interacting ways. As such, I realize that I cannot isolate the environmental crisis apart from other highly stressful conditions of our time that my clients share with me. I believe, however, that the environmental crisis is unique in that it serves as the broader context or background against which other challenges play out, and that its impact on these other factors is both pervasive and at times subtle, factors which invite us to avert our gaze from the potentially catastrophic and irreversible effects of climate change. This latter dynamic heightens the distress felt by many.
While I approach diagnosis with healthy doses of skepticism and caution, I believe that a good argument can be made for a new DSM diagnostic category, “existential anxiety disorder,” one that recognizes the serious, traumatic impact of climate change on mental health—an impact that I believe will only increase in the coming years. I think it important that psychotherapists recognize and address the very real, oftentimes terrifying, fears and anxieties associated with climate change that clients bring into therapy.
***
Co-authored by 270 prominent researchers from 67 countries, the most recent report (2022) from the United Nations’ Intergovernmental Panel on Climate Change is a 3000+ page document with which a surprising number of my clients are familiar. They are aware of the disproportionate impact of climate change due to social factors such as economic inequities, marginalization, and colonialism, especially for indigenous peoples and those whose basic daily needs are directly dependent on the local ecosystem. The report addresses the unsustainability of natural resources related to both consumption and production, and how this contributes to a situation where half of the world’s population experiences water shortages, where increased incidence of flood and drought lead to acute food insecurity and malnutrition, as well as where forced displacement and immigration have disproportionately impacted those parts of the world with the least ability to supply basic infrastructure needs and provide a safety net for residents. Issues of justice and morality are evident here, and I often witness aspects of moral injury as my clients recount their struggles living as witnesses to and participants in actions that they find ethically and morally unacceptable.
This situation is only going to grow more urgent as the reality of an ever-degrading environment finally breaks through our collective denial and we can no longer avoid the reality of what we have wrought upon ourselves. Several of my clients have expressed a fear that as a species, we are collectively committing suicide, and they struggle with hopelessness, despair, depression, and a genuine lack of purpose and motivation. For many of them, existing meaning-making narratives are inadequate to the task of grounding oneself in a time of great uncertainty. At the core, these clients are experiencing a crisis of meaning, one that calls to mind the words of William Butler Yeats from The Second Coming:
“Things fall apart; the centre cannot hold;
The best lack all conviction, while the worst
Are full of passionate intensity.”
It has been personally challenging for me to serve these clients, especially as the collective “we” are all facing the same increasingly dire situation. My ability to maintain consistent self-care and sustaining connections with others, and my own spirituality and meaning-making narratives, are frequently challenged.
***
I do not believe that manualized treatment protocols targeting cognitive distortions and maladaptive schema are up to the task of adequately addressing our clients and their fears over the possible extinction of humanity. I suspect that this might be a very opportune time as a profession to refamiliarize ourselves with some of the grounding ideas of existential psychotherapy that have been elaborated in the fields of psychology, philosophy, and spirituality.
As an illustration of what I am seeing in my practice, let me introduce Maria, a young professional who initially came to therapy describing herself as “quite anxious” and concerned by increasing difficulties in maintaining focus and motivation at work. At the time, she was employed as an organizational consultant in a field that she finds intrinsically rewarding, and until recently had found her work highly satisfying. In the initial session she described a tendency to “overthink everything,” a gnawing self-doubt that was both new and troubling, anxiety related to health concerns, and a vague sense of purposelessness.
Maria also shared that she had started asking herself the question “Is this all there is?” when reflecting on her chosen career and lifestyle. Maria had begun to seriously question notions of hard work, productivity, and success in life and career, questions that cast doubt on the inherent value of the ideals of progress, advancement, and acquisition underlying our capitalist society. Indeed, as her awareness of the factors contributing to the environmental crisis broadened, she had given voice to a growing conviction that this worldview was itself toxic, unsustainable, and as it has played out, immoral. Her developing recognition of the interdependence of people, and indeed of all life and the planet itself, had further served to catalyze her current crisis of meaning.
Aware of the disproportionate burden that residents of the world’s least resourced countries are bearing, she became increasingly uncomfortable with her privileged position. She was actively involved in advocacy efforts at raising awareness of the need for more urgent, far-reaching and impactful action to protect our environment through comprehensive, long-term adaptation planning and implementation. Nonetheless, Maria often felt an almost paralyzing guilt that, coupled with the realization that she could do very little to directly affect significant change, had seriously impacted her ability to appreciate life. Maria’s anger over the lack of resolve on the part of world leaders and governments alternated between increased irritability and open expressions of frustration, and times where she felt stuck, powerless, and hopeless. She and her partner also struggled with the question of whether to become parents, painfully aware of the moral implications of bringing children into a world where the future appears so uncertain.
Throughout the course of our work, Maria has explored questions of purpose and meaning, of personal values and considerations of social justice, and how these might guide her daily life. Against the finitude of human existence, the question of whether and how our individual lives matter has been a prominent theme. While not religious, she is a deeply spiritual person, and this has been an important aspect of our work together.
Questioning the dominant Western view of the autonomous, independent self and developing a more nuanced appreciation for human altruism and the self within the context of neuroscience have challenged traditional notions of the “selfish” self by providing Maria evidence that one’s sense of self can contribute to a broader social cohesiveness. Finally, recognizing the impact of small, personal acts of kindness flowing outward like ripples on a pond, interacting with other ripples, changing one another as they interact and spread out across the water, have all been important aspects of a therapy seeking to address existential concerns arising out of the environmental crisis.
***
Like Maria, many of my clients are struggling to fashion a coherent framework for meaning-making, one that accounts for our interrelatedness with the Earth and her creatures, one that recognizes and honors that we are part of an interdependent whole, a living organism where the fate of one is tied inextricably to the fate of all. They recognize, some explicitly, others on an intuitive level, that many of the religious traditions that they are familiar with do not adequately address these relational, contextual realities. Neither do the guiding myths of hard work, resource exploitation, unsustainable consumption, and success that are embedded within capitalism. Not in a world where these notions have run amok and have brought us collectively to the precipice of an unimaginable environmental crisis, which is simultaneously a crisis of meaning and purpose.
It is my hope that professional training opportunities will develop to help prepare therapists for what I suspect is going to be a growing number of clients who are struggling with issues of meaning, hopelessness, and despair as they attempt to find the motivation to get out of bed in the morning and put one foot in front of the other. I am constantly running into these issues in my private practice, and I suspect that I am not alone.
File under: The Art of Psychotherapy, Musings and Reflections