Siebrecht Vanhooren

Existential empathy is an emerging construct within humanistic and person-centered psychology. It refers to the therapist’s capacity to remain present with a client’s existential concerns, to resonate with these concerns, and to communicate this resonance empathically. Recently, an experiential–existential psychotherapy (EEP) training program was developed to cultivate existential empathy by enhancing therapists’ openness to existential concerns and their ability to engage with them. This qualitative study explores how therapists experience the development of their existential empathy following participation in EEP training. It also explores which elements of the training they perceive as most helpful. Ten therapists were interviewed before and after the 1-year training program using two methods: a Change Interview and an Existential Cue Interview, the latter involving a video stimulus of a client expressing her existential concerns. Findings suggest that training can enhance therapists’ existential awareness, their capacity to remain present with existential issues, and their ability to engage with these issues from a human-to-human stance. Effective training appears to require a combination of cognitive components, such as theoretical frameworks, and experiential components, including personal engagement with one’s own existential issues.

Objective: This study explored the therapeutic skills and attitudes mental health care (MHC) workers draw on when engaging with existential concerns in working with individuals with a persistent death wish related to unbearable psychiatric suffering (DWUPS) and examined whether sustained exposure to specialised existential care settings shapes existential responsiveness and relational presence. Method: A qualitative design was employed, following Elliott and Timulak's descriptive‐interpretative methodology. Eighteen in‐depth interviews were conducted with two samples: non‐specialised (Sample A) and specialised MHC‐workers affiliated with Reakiro, a care centre for persons with DWUPS which operates from an existentially grounded, presence‐based palliative and recovery‐oriented framework (Sample B). Interview transcripts were organised into thematic categories through inductive analysis. Comparative frequency analysis identified specific patterns. Findings: Four core domains characterised MCH‐workers' engagement with persons with DWUPS: existential, relational and palliative skills and attitudes, alongside the importance of self‐care. Across both samples, participants described personal existential processing, presence, and existentially oriented interventions, relational engagement within the therapeutic space, facilitating connection with significant others and openness to the death wish as central to their work. Differences between samples were secondary and context‐related. Specialised MHC‐workers showed less hesitation in addressing the death wish, whereas non‐specialised MHC‐workers more strongly emphasised life‐affirming interventions and reported greater ethical and emotional burden. Conclusion: Working with individuals with DWUPS requires an existentially grounded therapeutic stance that integrates openness to both life and death. The findings highlight the need for clinical training, peer support, and reflective supervision focused on existential presence, relational engagement and dual‐track care.

This paper examines factors that may facilitate existential counseling or psychotherapy for persons with an enduring death wish related to unbearable psychiatric suffering (DWUPS) and explores how personalized care can be provided and conditions for change can be created. The study employed a generic descriptive–interpretative qualitative research method, analyzing 10 in-depth interviews of individuals with DWUPS. Findings indicate that counseling or psychotherapy centered on acknowledgment of the death wish and the gravity of suffering—combined with genuine involvement—can foster conditions for tentative contact with oneself, others, and death-and-life concerns. Despite ongoing, multilayered suffering, participants described moments of tentative hope, emerging meaning, and a fragile sense of the right to exist. Existential counseling or psychotherapy may support individuals with DWUPS in accepting their suffering, developing the ability to engage with their death wish, and fostering meaningful connection with others and with life itself. Through acknowledgment and presence, participants not only became more attuned to their inner and relational world but also demonstrated a cautious yet tangible ability to connect—despite the weight of their suffering. The findings highlight the value of existential presence, dignity, and attunement—moving beyond symptom management toward human encounter.

Research shows how therapists struggle to stay present with their clients' existential concerns. Our goal was to explore what hinders and enables therapists to stay present and engaged when existential concerns surface in the session. We invited 22 therapists (12 novice and 10 experienced) to engage in a role-play with a client expressing her existential concerns using a standardized script. Subsequently, the therapists were interviewed using a videotape-assisted recall procedure. Data were analyzed according to the descriptive-interpretive qualitative research approach. When confronted with existential themes in the session, novice therapists experienced overwhelming feelings of powerlessness and uncertainty, blocking their ability to remain open to the client's existential experiences. Lack of knowledge and encountering their own existential vulnerability were mentioned as triggers. For experienced therapists, the main challenge was to stay present while feeling impacted by the existential topic, which they managed by grounding and reanchoring themselves. Our findings support the idea that embracing one's own existential issues and being at ease with existential themes may be essential conditions for staying present and fostering an authentic therapeutic encounter. Furthermore, our findings suggest that gaining knowledge about the existential process and learning to ground and reanchor oneself are essential for therapists. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Empirical findings describe substantial variations in the prevalence of depression across countries, but lack clear explanations. This study aimed to replicate findings on the mediation of the relation between meaning experience and depression severity by existential anxiety. Second, the mediating role of connectedness with embodied experience was investigated, as well as the direct effect of connectedness with embodied experience on existential anxiety. Finally, the study examined whether culture plays a role in explaining the variations in depression prevalence across countries. Path analysis was applied to the responses of 1,217 participants ( M _age = 42,56; SD = 14.250) from 97 countries to a survey about meaning, depression symptoms, existential anxiety, and connectedness with embodied experience (or the ability to “focus”). Existential anxiety and connectedness with embodied experience mediated the relation between meaning experience and depression severity. A significant direct positive effect of connectedness with embodied experience on existential anxiety was found. Connectedness with others tempered the negative association between meaning experience and depression severity. No other significant cultural differences in the relation between meaning experience and depression severity were found. These results confirm the importance of existential anxiety, connectedness with embodied experience, and connectedness with others in the understanding and treatment of depression.

This study describes the lived experiences of persons with a long-lasting death wish related to unbearable psychiatric suffering (DWUPS) regarding their relationship to life and death. The findings are evaluated considering existing literature on suicidality and euthanasia, with a particular focus on the humanistic-existential perspective. An open-ended data-gathering strategy was employed to elicit comprehensive descriptive information about the phenomenon from ten in-depth interviews, applying the method of generic descriptive-interpretative qualitative research. Persons with DWUPS experience difficulties in connection with others, with themselves, with the world and with life itself. Concurrently, they indicate new possibilities for nascent connection in relation to others by receiving support and being able to share their death wish. This can result in growth in relation to themselves, in allowing hope, meaning and new engagement in life. The desire to die manifests itself in a variety of ways, including a strong and persistent death wish, an ambivalent attitude, or a temporary suspension of their death wish. The process of exploring the death wish can assist persons with DWUPS in accessing potential ambivalence between life and death, in regulating emotional distress and in bearing existential concerns related to the life-and-death-questions.

Empirical findings describe substantial variations in the prevalence of depression across countries. Yet clear explanations for these results are lacking. Objectives: The present study aims to replicate earlier findings on de mediation of the relation between the ability to experience meaning and severity of depression by existential anxiety. Second, the mediating role of the ability to connect to the embodied experience in the relation between the ability to experience meaning and severity of depression is investigated, as well as the direct effect of the ability to connect to the embodied experience on existential anxiety. Last, this study examines whether culture may play a role in the explanation of the variations in the severity of depression across countries. Specifically, the extent to which a culture reinforces people to connect to others, and the extent to which a culture encourages people to be open to new experiences are considered. Method: Path analysis with maximum likelihood estimation was applied on the responses of 1217 participants on a demographical questionnaire and four questionnaires about meaning, symptoms of depression, existential anxiety, and the ability to connect to the embodied experience (or the ability to ‘focus’), with an average age of 42,56 years old ( SD =14.250), living in 97 different countries. Results: Existential anxiety and the ability to connect to the embodied experience were both found as mediators of the relation between the ability to experience meaning experience and severity of depression. Also a significant direct positive effect of the ability to connect to the embodied experience on existential anxiety was found. No significant cultural differences for the indirect paths between the ability to experience meaning and severity of depression, trough existential anxiety and the ability to connect to the embodied experience, were found. Only for the direct path between the ability to experience meaning and severity of depression a significant difference was found between societies with a predominant collectivistic and societies with a predominant individualistic culture. Conclusion : These results confirm the importance of existential anxiety and the ability to connect to the embodied layer of life events in the understanding and therapeutic treatment of depression. In addition, this study suggests that existential anxiety and the ability to connect to the embodied experience might be universal underlying mechanisms in the relation between meaning experience and severity of depression. Cultural differences are situated in the possibility people have to find meaning in their lives, making them less or more prone to symptoms of depression. Yet culture appears to not affect the underlying mechanisms, i.e. existential anxiety, and the embodiment of life events.

Therapist empathy toward existential concerns might be a critical component of clinical practice. This study aims to explore the psychometric properties of the Existential Empathy Questionnaire (EEQ), a self-report instrument developed to measure levels of existential empathy among mental health professionals. The EEQ was completed by a sample of 393 therapists recruited in Belgium, along with measures of general empathy, experiential avoidance, and existential avoidance. To assess the test–retest reliability, 353 participants of the same sample completed the EEQ a second time 2 weeks later. Clinical experience and therapeutic theoretical background were assessed to inform professional characteristics. The results support the use of the EEQ as a unidimensional measure of existential empathy. It demonstrates good internal reliability and temporal stability. A principal components analysis indicates three components with small to moderate intercorrelations, labeled as “Communication,” “Avoidance and Overwhelming Feelings,” and “Resonance and Presence.” EEQ total scores show a moderate positive association with general empathy and a moderate negative association with experiential and existential avoidance. Furthermore, the EEQ significantly uniquely predicts experiential and existential avoidance after controlling for general empathy. Years of clinical practice and a humanistic-oriented therapeutic approach correlated moderately with high EEQ scores.

Difficulty in the experience of meaning has been both theoretically and empirically linked with depression. This cross-sectional study first aimed to replicate the association between difficulty in meaning experience and depression in a sample of 77 psychotherapists and counselors (77.1% females; M _age : 49; SD _age = 12.25). Second, this study wanted to extend the body of research findings by investigating whether existential anxiety, and focusing manner, that is, the ability to attend to one’s bodily felt experiences, mediated the relation between meaning experience and the severity of depression. Surprisingly, meaning experience did not show a significant association with severity of depression. Furthermore, existential anxiety mediated the association between meaning experience and severity of depression. Focusing manner showed no significant mediating role in the relationship between meaning experience and severity of depression. These findings suggest that existential anxiety might be an important underlying mechanism in depressive disorder. Addressing the anxiety evoked by existential questions in the patient’s life might be important in the psychotherapeutic treatment of depression. Future prospective research is needed to further disentangle the relationship between meaning experience, depression, focusing, and existential anxiety.