Humanistic & Existential Therapy
Where do growth, meaning, freedom and responsibility meet?
A quick note on this page. Humanistic and existential therapy are close neighbours and often overlap, but they emphasise different things. This page distinguishes them without separating them too rigidly, and asks what existential questions – death, isolation, freedom, meaning – look like in disabled lives. Each of those four needs a different kind of conversation, and most of them turn up in ordinary moments rather than dramatic ones.
Two emphases
Humanistic therapy often foregrounds
- growth
- self-acceptance
- authenticity
- relationship
- potential
Existential therapy foregrounds
- meaning
- freedom and responsibility
- death and finitude
- isolation
- uncertainty and choice
Key figures and ideas
- Viktor Frankl – Man’s Search for Meaning (first published in German in 1946) and logotherapy: the search for meaning as a central human motivation, including the meaning a person can find in their attitude toward unavoidable suffering.
- Rollo May – The Meaning of Anxiety (1950) and Love and Will (1969): anxiety as part of being free, and the courage to choose.
- James Bugental – The Search for Authenticity (1965): presence and authenticity in the therapeutic encounter.
- Irvin Yalom – Existential Psychotherapy (1980): four “ultimate concerns” – death, freedom, isolation and meaninglessness.
- Emmy van Deurzen – existential therapy in Britain, including her model of four dimensions of existence: physical, social, personal and spiritual.
The central correction: freedom is always situated
Existential therapy emphasises freedom and responsibility. Disabled people have real freedom – and real constraints that they did not choose and cannot simply decide their way out of. Existential work can still explore:
Where is choice available within what I did not choose?
But it must never turn structural constraint into “you simply need to choose differently”. Responsibility can be explored without pretending everybody has the same options.
Four concerns, four different conversations
Yalom’s four concerns are often discussed together, but with a disabled client each tends to need a different kind of attention. The table is this site’s suggestion, not Yalom’s.
| Concern | How it might show up | What the conversation may need |
|---|---|---|
| Death | A progressive diagnosis; a friend from a support group dying; filling in an advance care plan; simply noticing the body ageing faster. | Willingness to talk plainly, at the client’s pace – and not assuming that disability means death is the main concern. Many disabled people are not dying, and being treated as a reminder of mortality is a burden. |
| Isolation | “Nobody really knows what my body is like.” Being the only disabled person at work. Losing friends after becoming ill. | Two strands kept apart: the existential sense that no one can fully share our experience, and the produced isolation of stairs, cancelled transport and absent invitations. The first may need company; the second may need change. |
| Freedom | Deciding whether to use a wheelchair full-time; whether to disclose at work; whether to stop a treatment. | Mapping what is genuinely open, what is constrained and by whom. Respecting the weight of the choice without implying the client is responsible for the constraints around it. |
| Meaning | “What’s the point of me now I can’t work?” Or the opposite: being told the disability must mean something. | Openness to meaning without requiring it. The client decides whether their disability carries meaning – and “no, it’s just hard” is an acceptable answer. Meaning may be found elsewhere entirely. |
Existential questions in everyday life
Existential concerns are often pictured as late-night reflections on mortality. In disabled lives they more often arrive in ordinary forms:
- a benefits form asking you to describe your worst day – a question about identity and how you are seen;
- choosing a wheelchair colour – a small, real act of authorship;
- deciding whether to go to a wedding when it will cost three days of recovery – freedom, limits and what matters;
- a new symptom and a wait for test results – uncertainty, and how to live inside it;
- a care worker who doesn’t turn up – dependence, and who you can rely on.
A therapist attuned to existential themes can hear these as more than logistics, without turning every practical problem into philosophy. Often the practical problem needs solving and the existential question deserves room.
You might recognise this
- “Everyone else gets to pretend they’ll live forever. My body doesn’t let me.”
- “I didn’t choose any of this. I do choose how I talk to myself about it.”
- “If one more person tells me my illness is a gift, I’ll scream.”
- “Filling in that form, I didn’t recognise the person I was describing.”
Illustrative composite voices written for this site – not quotations from individuals, and not findings from a study.
Where it can misread disability
- Radical freedom + structural constraint → barriers reframed as choices. “You are choosing not to go out” when the venue is inaccessible is not existential insight; it is blame.
- Meaning in suffering + disability → suffering required to be meaningful. Frankl’s idea can slide into the expectation that disabled people should find their disability valuable or redemptive.
- Facing death + a disabled client → disability equated with mortality.
- Isolation as a given + inaccessibility → produced isolation treated as existential.
- Existential depth + practical problems → urgent needs left unsolved while the therapy explores their meaning.
In the therapy room
- Explore choice inside constraint, while naming the constraint honestly.
- Notice which of the four concerns is in play, and adjust the kind of conversation to it.
- Listen for existential questions inside everyday events.
- Be willing to talk about death, decline and uncertainty when the client brings them, without assuming they are the main concern.
People keep telling me I have a choice in how I respond. Some days that just makes me feel guilty.
There’s a lot you didn’t choose and can’t change. Is it the progression that’s been on your mind?
Not really. It’s my son’s parents’ evening. The school hall has steps and I’ve already said I’ll go.
I went somewhere much bigger than you were. So the “choice” is going and struggling, or not going and feeling you’ve let him down – when the real problem is the steps. Could the school meet you somewhere else?
Evidence and status
- Documented: the works and ideas of Frankl, May, Bugental, Yalom and van Deurzen named above.
- Documented research: a meta-analysis by Vos, Craig and Cooper (2015, Journal of Consulting and Clinical Psychology) pooled 15 trials. Meaning-centred therapies showed the clearest effects, particularly on meaning in life; other forms showed small or no significant effects. The authors stressed the small number and low quality of the studies. Meaning-centred psychotherapy has also been tested in trials with people with advanced cancer (Breitbart and colleagues).
- We have not located research on existential therapy with disabled clients as a group.
- This site’s synthesis: the four-conversations table, the everyday examples, the misreadings, the composite voices and the exchange.
If none of this fits – if meaning feels like the wrong question entirely right now – that is allowed. Existential work is an invitation, not an obligation to find your life profound.
One question to carry: within everything you didn’t choose, where is there still room that is yours?
Where this connects
Freedom is always situated.
Within the hub
- Safety, Agency & Choice – the conditions that make choice real.
- Authenticity, Masking & Adaptation – existential authenticity, adapted.
- Laing, Lived Experience & the False Self – the existential-phenomenological edge.
Across the site
- Chronic Illness and Uncertainty – living with not knowing.
- Grieving the Life You Expected – meaning without cure.
- Acceptance and Commitment Therapy – values and meaning in another tradition.
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