Introduction

A primary challenge in considering the evidence-based foundations to existential therapy is that one first must determine which existential psychotherapy is being discussed. Although common themes across the existential psychology approaches exist, there remain important distinctive features (Cooper 2003; Hoffman 2009a). Hoffman (2009a) suggested that, when talking about existential therapy as a whole, it is best to think of it as a mosaic, or a collection of themes, approaches, and values, that most existential therapists tend to agree upon. Within this mosaic, there are few aspects that all existential therapists agree upon; however, individuals identifying as existential therapists tend to incorporate most of the mosaic into their own approach.

The fluidity of the existential approach establishes it an ideal foundation for an integrative approach to therapy (see Schneider 2008; Wampold 2008). It can be readily adapted to individual and cultural differences as well as integrating other approaches to therapy, such as cognitive behavioral therapy (Bunting and Hayes 2008; Wolfe 2008) and psychoanalytic psychotherapy (Dorman 2008). The ability for it to be adapted does not mean this is easy or something that all practitioners can do. As with any therapy orientation, a foundation of knowledge, experience, and skill is necessary to appropriately adapt therapy approaches.

Despite limited research directly on existential therapy (Hoffman 2009a; Walsh and McElwain 2001), Hoffman et al. (2009a, 2012, 2013) maintain that existential therapy can be rightly claimed as an evidence-based practice. The common factors literature in psychology (Duncan et al. 2009; Elkins 2009; Wampold 2001, 2009a) support the assertion that the primary change agents in psychotherapy are connected to various common factors embedded in most therapy approaches. This suggests that while researching particular psychotherapies has an important utility, it is not necessary to rely upon narrowly defined specific outcome research on specific approaches to determine if it fits evidence-based practice.

When the mosaic of existential psychology is examined in the light of psychotherapy research, the strong empirical support for its efficacy is evident. In this article, we examine the evidence basis for three central components of existential therapy practice closely associated with existential-humanistic psychotherapy: relationship, emotion, and meaning. This school of existential therapy follows in the tradition of Rollo May and James Bugental (1987, 1999) and is exemplified in the contemporary writing of Kirk Schneider (Schneider 2008; Schneider and Krug 2010).

Evaluating the Evidence

Therapists and researchers have engaged in extensive debate about what constitutes an “evidence-based” approach to therapy (see Norcross et al. 2006). As noted by Wampold et al. (2007), evidence is an ambiguous word that can include different sources of data including quantitative research, qualitative research, scholarship, and clinical expertise. Evidence-based approaches are more inclusive, adaptable, and rigorous than other more narrowly defined ways of considering therapy efficacy, including the empirically supported treatments that were myopically tied to specific methods of outcome evaluation. Although existential therapists have been leery of evidence-based practice in psychology (EBPP), as long as EPPP is understood broadly and inclusively it is not a threat to existential practice (Cleare-Hoffman et al. 2013; Hoffman et al. 2012). Instead, existential therapists should engage in the dialogue about EBPP to assure it continues to be defined in a broad, inclusive manner.

The American Psychological Association (APA) Presidential Task Force on Evidence-Based Practice (2006) identified three aspects of EBPP: (1) research, (2) clinical expertise or competency, and (3) patient characteristics, culture, and preferences. EBPP is not strictly tied to a therapy modality, but rather focuses on an appropriately skilled therapist implementing a valid approach of therapy. Hoffman et al. (2012) advocated that existential therapists should engage EBPP through demonstrating that existential therapy is already an evidence-based practice. It would behoove existential therapy to continually examine weaknesses in its evidence-based foundation while seeking to address these limitations. There are three important aspects of this. First, existential therapists should examine where the evidence is weak and seek to gather further evidence to support existential therapy. Second, weaknesses in the existential approach should be identified and addressed. Third, existential therapists should engage the EBPP literature to see where it can inform the future development of existential practice.

In unpacking these three pillars of existential practice, the first task is to address the research. EBPP practice encourages the utilization of various types of research. Although this can include outcome studies and randomized clinical trials, this is not the only method for establishing an evidence-basis. The type of research should be geared to the research question, not an arbitrary choice of preferred methodology imposed upon all contexts and therapy modalities.

Second, clinical expertise or competency refers to assessment and diagnosis, treatment planning, interpersonal expertise, utilizing appropriate research to inform therapy, offering a cogent rationale for treatment approach, assessing progress, and other foundational competencies (APA Presidential Task Force on EBPP 2006). Many of these factors should be interpreted broadly. For example, diagnosis does not need to be restricted to a DSM-5 diagnosis. Rather, this refers to working with the client to agree upon a statement of the problem from which a cogent plan to address the problem can be developed. Existential therapy relies upon a competency approach that is, in reality, quite similar to the conception advocated by the APA Presidential Task Force on EBPP. Norcross notes, “Perhaps more than any other clinical approach, existential psychotherapy depends upon a set of individual skills and characteristics—the therapist him or herself” (p. 53).

These competencies are consistent with the expectations for basic skills all psychologists should have entering independent practice. One must have certain foundational therapeutic competencies to be competent in any particular approach to therapy. These competencies vary in accordance with the different therapy modalities. Hoffman et al. (2012) advocated that

existential-humanistic psychology could claim to have an evidence-based foundation relevant to the clinical [expertise] dimension if (a) there is sufficient demonstration that various clinical competencies are utilized within the framework of [existential therapy] and (b) approaches to existential-humanistic psychology have been appropriately vetted in the peer-reviewed literature by experts in the field (p. 6).

The competencies refer more to the therapist than the therapy modality. For existential therapy to meet this standard of EBPP it is necessary that the foundational competencies fit with, can be adapted to, and can be integrated into an existential therapy approach.

Third, patient characteristics, culture, and preferences require that existential therapy can be adapted to individual as well as group contexts and needs. Although the nature of existential therapy is readily adaptable to individual and cultural differences, it has struggled in actualizing this value. Recent advancements helped address this including the identification of indigenous Chinese (Bao 2009; Wang 2011) and Greek (Dallas et al. 2013) approaches to existential therapy, international applications (Hoffman et al. 2009b), and new conceptions of the self (Hoffman et al. 2009a).

Relationship

Research evidence supports that one of the primary determining factors for successful psychotherapy is the client-therapist relationship (Elkins 2009; Norcross 2009; Wampold 2001, 2009a; see also Norcross 2002), which can be conceived in various ways. Rogers (1961) described the ideal relationship between client and therapist as having three conditions: genuineness, unconditional positive regard, and empathy. Bugental (1987) described presence, which is a quality of being engaged and participating on a deep level, as a foundation of relationship. Bugental (1978) also emphasizes the therapy alliance, which he described as comprising “mutuality, honesty, respect [and is] dynamic, vital and trusting” (p. 70). As Schneider (2008) notes, European existentialists call the quality of presence “Dasein” (p. 60) or “being there.”

Yalom (1980) focused on the “interpersonal” nature of relationship with the therapist and client. Often, the therapeutic relationship comprises a microcosm of what’s happening in the client’s world outside of therapy. Bugental focused more on the intrapersonal relationship, where what is happening within each individual in relationship with the other is primary (Krug 2009). Despite differences such as these, most existential therapists agree that it is the interpersonal nature, or the relationship, between therapist and the clients that promote healing conditions.

Research

Much of the existing research on existential therapy has been clinical experience where experienced therapists documented their findings in a systematic manner; however, more attention recently has been directed to empirical research. Wampold (2001, 2009a, 2009b), whose findings supported the supposition that the relationship is foundational to healing, is one of the leading empirical researchers of therapy outcomes. Wampold (2009b) writes, “there are hundreds of studies that show that a purposeful collaborative relationship between a therapist and the patient—what we call the therapeutic alliance—is related to therapeutic progress” (Sect. 3, para. 2).

A review of the literature shows that psychotherapy is effective and that one therapy is not superior to others (Elkins 2009; Wampold 2001; Wampold 2009a, b). Studies conducted by van Hees et al. (2013) demonstrate that differences based upon therapy approach “are small and they are often not significant” (p. 7) and therefore should be adjusted to client preferences. Norcross and Lambert (2010) indicate psychotherapy is beneficial to clients in 75–80 % cases across therapeutic models and, based upon a meta-analysis sponsored by two APA divisions, the primary tool for effective psychotherapy is the client-therapist relationship (Norcross and Lambert 2010).

Research by Norcross (1987) indicated most existential therapists rated the relationship values of warmth, empathy, and authenticity extremely high on the therapeutic interventions commonly used, indicating the intricate link between existential psychotherapy principles and the research on therapy effectiveness. Wampold (2008) states that “it could be argued that an understanding of the principles of existential therapy is needed by all therapists, as it adds a perspective that might… form the basis of all effective treatments” (para. 15). Moreover, recent research in neuropsychology demonstrates “a positive and attuned interpersonal relationship enhances neural plasticity [the brain’s ability to change and learn new patterns] and learning” (Cozolino 2002, p. 292), which adds neuropsychological support for the therapy relationship.

Clinical Expertise/Competency

A significant portion of the competencies identified by the APA Presidential Task Force on EBPP (2006) focus on the therapeutic relationship. Given that existential therapy emphasizes the relationship, there is a strong convergence between existential therapy and the relational competencies of EBPP. Bugental (1978) describesimportant therapist qualities as including: “The therapist’s own well-being, commitment to being a ‘pro’, dedication to the healing/growth process, presence, cultivated sensitivity and lastly, skills” (p. 43). Bugental’s emphasis on the therapist well-being emerges from the existential viewpoint that the person of the therapist is the primary therapeutic tool that the therapist brings (see also Hoffman 2009a). The therapist’s well-being fits well with the EBPP competencies of interpersonal skills, self-reflection, acquisition of skills, working with cultural and individual differences, and seeking out appropriate consultation and/or supervision as needed (APA Presidential Task Force on EBPP 2006).

Schneider and Krug (2010) indentify existential stances, which are not techniques, but rather a set of skills that, when cultivated, provide the necessary environment for change. Those stances include, “the cultivation of therapeutic presence, the cultivation and activation of therapeutic presence through struggle, the encounter with the resistance to therapeutic struggle, and the coalescence of the meaning, intentionality, and life awakening that can result from the struggle” (p. 35). Schneider and Krug (2010) describe presence as something that can concurrently hold and illuminate what is relevant within the client and in the therapeutic relationship. Although this is a complex relational skill, it includes relational factors identified by Norcross (2009) as important aspects of effective therapy relationships, including empathy, positive regard, cohesion, openness, genuineness, and being collaborative.

A second existential stance is the ability to facilitate the client’s experiential awareness by using such techniques as invoking the actual (Schneider and Krug 2010). Invoking the actual is calling “attention to the part of the client that is attempting to emerge” (p. 114). This can be done in a myriad of ways including the therapist pointing out what is happening in the present moment or calling attention to the physical responses the client is demonstrating such as moistening eyes or tightening of facial features. This is complex relational skill converges with the relational factors identified by Norcross (2009) of listening to the client and privileging their experience.

Third, Schneider and Krug (2010) discuss vivifying and confronting resistance as a skill that helps therapists reflect what clients reveal pertaining to resisting or deflecting difficult emotional material. This confrontation is not harsh and must be approached cautiously to avoid re-traumatizing clients. It draws upon various relational skills identified as part of effective therapy (see Norcross 2009) includingestablishing a basis of unconditional positive regard and collaboration, which allow the therapist to encourage the client to safely engage more difficult emotional material.

Unlike other therapies, existential therapy does not offer a manual on how to conduct therapy. Yalom (1980) suggests therapists create and adapt a new therapy for each client. The skills required to be an effective existential therapist area highly tuned, oft-practiced, and carefully cultivated way of being. Similarly, Norcross (2009) notes that excessive rigidity is not effective in psychotherapy, stating, “Using an identical therapy relationship (and treatment method) for all clients is now recognized as inappropriate and, in selected cases, even unethical” (p. 131).

Individual and Cultural Differences

Because of the relational foundation of existential psychotherapy and the valuing of the client’s self-and-world constructs, it is well-suited to meet the needs of a variety of clients. It is unique in its approach to individual and cultural differences in that it is not so much the clients’ experience that matters as it is the meaning the client attributes to the experience (Schneider and Krug 2010). The therapist and client must attend to the individual and cultural levels of meaning and experience (Hoffman 2009b). Vontress (1979) notes that self-understanding serves as a basis for understanding others, particularly clients with different cultural backgrounds. Engaging in a deep self-exploration assists therapists avoid what Vasquez (2007) calls psychotherapy bias, wherein the therapist has difficulty “staying present and empathic with a person who is struggling with a painful discriminatory event” (p. 881).

As previously noted, existential psychology needs to continue to advance in integrating the cultural and social aspects of the client in a more explicit and direct manner. Existential scholarship historically has neglected this issue. However, numerous recent publications have established a strong foundation for adaptations of existential therapy in working with diverse clientele (Alsup 2008; Brown 2008; Cleare-Hoffman et al. 2013; Comas-Diaz 2008; Hoffman and Cleare-Hoffman 2011; Hoffman et al. 2014; Hoffman et al. 2009a, b; Monheit 2008; Rice 2008; Serlin 2008; Wang 2011).

Emotion

Emotion is central to all approaches to psychotherapy. A primary reason most individuals enter therapy is to deal with emotional struggles. Diverse therapy approaches conceive of and approach emotions differently. Some therapy modalities focus on controlling and coping with emotions while otherapproaches facilitate emotional experiencing and expression. Much of the contemporary field of psychology tends to pathologize certain emotions, such as anger, anxiety, and sadness, while others emphasize that all emotions have value and, at their base, are normal. Every therapy modality has an implicit or explicit theory of emotions influencing how therapy is applied. From an existential perspective, all emotions are normal with the potential to be healthy, but sometimes become problematic for individuals because of the way the person isrelating to or experiencing the emotions (Hoffman 2009a). Therefore, existential therapy seeks less to change emotions than some other approaches while focusing more on changing the way people experience their emotions.

Existential therapy encourages clients to welcome their emotions, experience them more deeply, and make meaning from them (Hoffman 2009a; Hoffman and Cleare-Hoffman 2011). To accomplish this, therapists develop a strong therapeutic alliance, create a safe environment for the clients to enter their emotions, and encourage clients to move into their emotions at a safe pace. At times, this means developing coping skills or other strategies to help clients feel confident managing their emotions as they move more deeply into them. As the clients engage their emotions, therapists facilitateunderstanding their meaningand using emotions to create meaning.

Research

Greenberg et al. (2001) note that a wealth of research supports the importance of emotional expression as well as the physical and psychological risks of ignoring, denying, or suppressing emotions. Whelton (2004), reviewing research on emotions in therapy across modalities, states, “There is accumulating evidence that both the in-session activation of specific, relevant emotions and the cognitive exploration and elaboration of the significance and meaning of these emotions are important for therapeutic change” (p. 58). Regardless of the approach to therapy, experiencing and exploring emotions is an important change factor.

Client-centered and experiential therapies, like existential therapy, are classified under the umbrella of “humanistic.” These approaches tend to approach emotions in similar ways, including encouraging experiencing, processing, and finding meaning in emotion. In their review of research on person-centered and experiential therapies, Watson et al. (2010) state that the research indicates that experiencing emotions has a clear relationship with successful therapy outcomes, even if that relationship is “never ‘very high’” (p. 139).

One aspect of experiencing is emotional arousal. Emotional arousal and the ability to tolerate moderate to high levels of emotion is associated with better therapy outcomes (Watson et al. 2010). Some clients enter therapy with this ability; however, for others, increasing their ability to be comfortable with or tolerate the emotional arousal is an important part of the healing process in therapy. Therapists play an important role in facilitating and processing emotions. Bugental (1987, 1999) was highly focused on the emotional aspects of therapy. Similar to Rogers, Bugental recognized that therapist responses to their clients influence their going deeper into their experience or shifting away from their emotions. He was critical of therapists that targeted getting to the emotions as if this was some type of therapeutic gold or magic bullet. Instead, he advocated for a nuanced way of moving in and out of the emotions balancing emotional experiencing, cognitive reflections on the emotion, and creating meaning from the emotional experience. This moving in and out of emotions (i.e., emotional processing) is key to Bugental’s existential approach.

Bugental drew his conclusions about processing emotions from clinical experience; however, research has supported his approach. Watson et al. (2010), drawing directly from the research, summarize that activating and expressing intense emotions during therapy is a good predictor of successful outcomes, but not if the client remains in this level of emotional expression for too long. Adams and Greenberg (as cited in Watson et al. 2010), in research tracking emotion in therapy sessions, noted that therapists’ experiential focus, or focus on the depth of emotional processing, influenced the client’s experiencing of emotion and successful therapy outcomes.

Clinical Expertise/Competency

Various clinical competencies help establish a basis for clinical practice when working with emotions. In this section, we focus on (a) self-reflection, (b) interpersonal expertise, (c) assessment, and (d) providing a cogent rationale for treatment.

Self-awareness is afoundation for existential therapy practice (Bugental 1987, 1999; Hoffman 2009a). Therapists need to be comfortable with their own intense emotions as well of those of their clients. When therapists are not comfortable with these emotions, they struggle to facilitate client emotional processing and expressions, and may even intentionally or unintentionally discourage these emotions. Self-awareness, then, provides a basis for interpersonal practice. In order to facilitate emotional expression and processing, therapists create a safe space to enter these emotions. Bugental (1987) and Hoffman (2009a) discuss specific skills that can further help clients gently move deeper into their emotions or come out of more intense emotional arousal.

Although existential therapists are not prone to using DSM-5 diagnosis, they do work with clients to develop an understanding of the problem from the client’s perspective. Typically, this focuses on the client’s lived experience of the problem. For instance, clients struggling with anxiety may focus on how the anxiety is impacting them in their relationships or work. While many therapy modalities are quick to identify symptoms and then chart a plan to cope with, reduce, or eliminate them, existential approaches do not assume clients are seeking symptom reduction. When it is a goal of the client, it is often not the sole or primary goal. Prior to developing a treatment plan, the therapist helps the client’s explore possible desired outcomes, which, at times, means helping the client understand a variety of options. From an existential perspective, treatment plans are fluid and there is concern that a rigidly adhered to treatment plan may prevent the therapist and client from recognizing or considering emergent problems (Elkins 2009; Hoffman 2009a). From an existential approach, it is important to regularly discuss the treatment process and direction in order to maintain a cogent, agreed upon treatment approach.

Individual and Cultural Differences

Hoffman and Cleare-Hoffman (2011) note, “mainstream Western psychology has often approached most, if not all, emotions as a problem to be solved or a spurious aspect of human nature that needs to be controlled” (p. 261). Embedded in much of Western psychology is an implicit theory of emotions that tends to impose upon clients without consideration being given pertaining to the client’s view of emotions. There are wide cultural and individual differences pertaining to experiencing and expressing emotion. Without consideration and sensitivity given to these differences, it is easy for therapists to impose a value system related to emotions upon clients.

Kang et al. (2003) note that cultural variation in emotional expression does not necessitate cultural variation in the intensity or experiencing of emotions. Regardless of culture, people have emotions and may have similar levels of intensity of emotion. However, Kang and colleagues found that the way the person relates to emotions has varied implications for aspects of well-being, such as relational well-being. Their study found emotional expressiveness to be more important in predicting relational health in individualist cultures whereas emotional differentiation (i.e., making subtle distinction between emotions) was a better predictor of relational health in collectivist cultures.

While research has suggested that experiencing emotional arousal and processing emotion is consistently associated with better therapy outcomes, this does not necessitate a particular way of experiencing or expressing emotions. Hoffman and Cleare-Hoffman (2011) note that different types of emotional experiencing and expression are healthy for different cultures. To impose a particular way of experiencing and expressing emotions upon a client may be detrimental. Therapists ought be able to work with emotional experiencing and expression in various ways.

Meaning

Although meaning is a central concept throughout existential thought, it is more explicitly central in certain approaches (Frankl 1959/1984; Hirsch 2009; Hoffman 2009a, b; Wong 2012a, 2012b; Yalom 1980). Frankl (1959/1984) discusses the role meaning plays in coping with and transforming suffering. Regarding coping, Frankl was fond of quoting Nietzsche: “He who has a why to live for can bear almost any how” (as cited in Frankl 1959/1984, p. 109). Frankl more frequently spoke to the transformative role meaning can play in people’s lives: “suffering ceases to be suffering at the moment it finds a meaning” (p. 117). Wong (2012a) extended Frankl’s work on meaning incorporating a dual-systems model. While much of existential psychology focused on making meaning through suffering, Wong advocates for the importance of balancing this with the more positively rooted ways of seeking meaning.

Yalom (1980) identified meaning as one of the existential givens. For Yalom, there is no meaning that innately exists in the world for one to discover, but rather meaning comes from being engaged and committed in the world. For some existentialists, Yalom’s focus on the meaningless aspect is considered too pessimistic (Greening 1992). May (1991) identified meaning as embedded in myths (see also Hoffman 2009b), which are understood as pertaining to how individuals organize their meaning systems. Myths are not untrue, but rather highly symbolic beliefs or beliefs systems that cannot be proven to be true. Myth and meaning often rely upon a type of faith, trust, or belief, though not necessarily spiritual. While abstract, May also recognized that myths are lived out in the world. While meaning is approached from various perspectives in existential thought, the idea of meaning being connected to one’s lived experience is a consistent theme. As Wong (2012a) states, “Every philosophy of life leads to the development of a certain mindset—a frame of reference or prism—through which we make value judgments” (p. 5).

Existential therapists engage in various approaches to work with meaning in therapy, including integrative approaches (Schneider 2008; Wong 2012a, b). Relationships are key to helping clients engage meaning in their lives; including using the therapy relationship as the primary vehicle of change as well as identifying relationships as one of the deepest and most sustaining forms of meaning (Frank 1959/1984; Hoffman 2009a, b; Schneider and Krug 2010; Yalom 1980). Existential therapists encourage clients to explore and analyze the meaning in their lives, including reflecting upon what guides their decisions, behaviors, and priorities (Frankl 1959/1984; Hirsch 2009; Hoffman 2009a; May 1991; Wong 2012a, 2012b; Yalom 1980). Because of their inherent similarities in reference to meaning, narrative (Richert 2010) and constructivist (Raskin 2008) approaches are frequently integrated with existential therapy.

Research

Research evidence supports the relationship between meaning or purpose in life and psychological well-being (Addad and Himi 2009; Dezutter et al. 2013; Halama 2009; Jafary et al. 2011; King and Hicks 2012; Maddi et al. 2011; Neimeyer et al. 2006; Pan et al. 2008;  Solomon, 2012; Steger 2012; Tavernier and Willoughby 2012). Increasing research demonstrates a link between meaning and physical health (Thompson et al. 2003; Krause 2012; Roepke et al. 2013). Meaning, or purpose in life, has been found to be a protective factor in situations of psychological and physical distress or trauma (Mascaro and Rosen 2006; Stark et al. 2009; Thompson et al. 2003). Given the preponderance of theory and research supporting the importance of meaning for psychological and physical health, this aspect of existential theory is clearly established. The association between meaning and well-being does not answer the question of how therapy helps clients discover, create, or enhance meaning in their lives or whether existential therapy is effective in accomplishing this goal.

Salvatore et al. (2010) conducted a particularly relevant study utilizing a case study model to examine meaning over the course of therapy. Although the identified therapy was constructivist, it was consistent with existential therapy including a relational/intersubjective focus, intentional examination of one’s meaning systems, and seeking to change the client’s experience as opposed to focusing on symptoms or solely on cognitions. The results demonstrated that the client initially showed a decrease in meaning; however, by the end there was an overall increase. Although this was a single-subject case study and needs further replication, it does show the potential for therapies to increase meaning. The U-shaped process in which meaning may initially decrease could prove important in understanding how meaning changes through therapy. Hoffman (2009c), for example, discusses how existential therapy often involves a process of deconstructing and re-constructing meaning.

Fillion et al. (2009) examined the impact of meaning-centered interventions on job satisfaction and quality of life with palliative care nurses. While there were increases in the perceived meaning of working on a palliative care unit, there were not significant changes in job satisfaction and quality of life. The intervention was brief (4-weeks) and largely psycho educational. It is not clear that the intervention was able to impact the experiential or lived level that Frankl, Schneider, and others emphasize. Furthermore, the focus was on a very narrow aspect of meaning. Breitbart et al. (2010) examined meaning-centered interventions in a group setting with patients with advanced cancer. The results found an increase in spiritual well-being and meaning as well as a decrease in psychological distress. Compared with the Fillion study, Breitbart and colleagues used an 8-week group intervention and focused on less discrete outcome measures.

Holland et al. (2007) reviewed the efficacy of personal construct therapy (PCT), which bears many similarities to existential therapy pertaining to meaning. Although noting they found weaker results than previous reviews, overall their results supported the efficacy of PCT when compared to other forms of therapy or a control group pertaining to increases in meaning as well as more traditional outcome measures, such as depression.

Clinical Expertise/Competency

Meaning, as a factor consistently associated with better psychological well-being, can be integrated into psychological assessment, treatment planning, and developing a cogent rationale for treatment strategies. Examining meaning or purpose in life and working to facilitate its development for clients has a long and established history in the peer-reviewed literature (Bugental 1990; Hoffman 2008; May 1991; Schneider, 2012; Spinelli 1997; Yalom 1989, 1999). One competency identified by the APA Presidential Task Force on EBPP (2006) was the evaluation and use of appropriate research. The strong research support for the importance of meaning in psychological well-being demonstrates it is an important factor to consider in psychotherapy. Related to assessment, meaning is an important factor for therapists to assess (Leitner et al. 2000). If clients are struggling in identifying or living in accordance with meaning in life, this may contribute to psychological difficulties. It also can be part of treatment planning and developing a rationale for treatment. Clients generally can readily understand that a lack of meaning contributes to their psychological difficulties.

Individual and Cultural Differences

May’s (1991) work on myth, though largely contained to Western myths, provides a foundation for analyzing meaning systems in the context of culture. Expanding upon May, Hoffman (2009b) states: “myths represent the universality of the existential givens and the particularity of cultural responses to those givens” (p. 264). Meaning systems require consideration of cultural and individual aspects of meaning. As an illustration, Hoffman et al. (2009a) discuss myths of self. The self is conceived of differently in different cultural contexts, yet consistently is connected to the way meaning is understood and experienced. Although no universal agreement on what the self is exists, much of Western psychology is built upon an individualistic conception of the self that does not fit well with all cultures. Hoffman et al. argue that different conceptions of the self may be associated with psychological well-being in different cultures. Psychological models must be adaptable to different views of the self.

Conclusion

Existential therapy has a strong evidence based foundation when considering the principles of EBPP. Yet, EBPP in psychology is about more than the therapy approach, as it also considers the competency of the therapists. It could be maintained that existential therapists competent in the general practice of psychotherapy and existential psychotherapy in particular are practicing consistent with the standards of EBPP. Existential practitioners ought not feel apologetic or defensive about their approach. While there are places where existential therapy ought strengthen its evidence-based foundation, there is already in place a solid foundation to existential therapy. Existential therapists need not fear the EBPP movement in psychology as it poses no threat to existential therapy and, in fact, provides a solid support for its practice.