Facing the Unavoidable: How Existential Dilemmas Show Up in Therapy

In therapy, we often find ourselves returning to the same deep questions, sometimes quietly, sometimes urgently. These aren’t just personal questions; they are existential ones. Gestalt therapy is deeply rooted in existential philosophy, emphasizing personal responsibility, present-moment awareness, and the courage to face life’s inherent uncertainties. As Gestalt Therapists, we invite clients to confront what is, rather than escape from it.

Psychiatrist Irvin D. Yalom identified four “ultimate concerns” that define the human condition: death, freedom, isolation, and meaninglessness. These existential dilemmas are inescapable, and while they often generate anxiety or avoidance, they also hold the potential for profound transformation.

Based on the work of philosophers like Heidegger, Kierkegaard, Sartre, Camus, Frankl, and others, these core concerns reflect what it means to be human in a world with no guaranteed answers.

Below, we explore how these dilemmas often appear in the therapy room and what it means to work with them.

1. Death: The Tension of Our Mortality

We are the only species known to live with the awareness that our lives are finite. Philosopher Martin Heidegger called this being “toward-death”, the idea that truly living means acknowledging, not denying, our mortality.

In therapy, death anxiety might not be obvious. It can manifest as:

• An urgency to “make the most” of life

• An avoidance of deep reflection

• A pervasive, unnameable dread

Clients may fear not just dying, but not having lived fully. Confronting this fear in therapy can awaken a more conscious, values-driven life.

2. Meaninglessness: Confronting the Void

If the universe doesn’t provide us with inherent meaning, we are left with the task and the freedom of creating our own. For Sartre, this was a call to action. For Camus, it was absurd but not without hope. For Viktor Frankl, it was an opportunity, especially when meaning is created in response to suffering.

In therapy, the theme of meaninglessness can show up as:

• Depression or emotional numbness

• Loss of direction

• Spiritual or existential crisis

• “What’s the point?” thinking

Exploring meaning doesn’t always lead to answers, but it often leads to movement. Even small, self-defined purposes can anchor us during difficult times.

3. Isolation: The Longing to Be Seen

Existential isolation is not just physical loneliness; it’s the deeper truth that no one can ever fully experience our inner world. Martin Buber distinguished between surface-level connection (I-It) and authentic, mutual contact (I–Thou). And yet, despite this gap, we long to be seen.

In therapy, isolation may emerge as:

• Chronic feelings of disconnection

• Difficulty trusting others

• A deep hunger to be known/or a fear of it

The therapeutic relationship itself becomes a site for exploring this dilemma: how to be fully ourselves in the presence of another without losing our individuality.

4. Freedom (and Responsibility): The Weight of Choice

Freedom sounds like a good thing—until we feel the full weight of it. As Sartre said, we are “condemned to be free.” There’s no roadmap, no script. We must choose—and own the consequences.

This can show up in therapy as:

• Avoidance of decisions

• Overwhelm or paralysis in the face of change

• A tendency to defer responsibility to others

Working through this involves helping clients recognize the power they do have, while also acknowledging the anxiety that comes with that freedom. The goal isn’t to eliminate fear, but to move forward despite it.

Why These Dilemmas Matter in Therapy

These existential themes may not be the reason someone walks into therapy, but they often live underneath the surface. When clients explore their fear of failure, struggle to connect, or feel paralyzed by indecision, they’re often brushing up against one of these deeper truths.

Existential work doesn’t offer easy answers. Instead, it invites presence, reflection, and the courage to face what is most human in us. As therapists, we don’t resolve these dilemmas; we make space for them, helping clients navigate with greater awareness and agency.

Interested in learning more about yourself in therapy?