Running head: EXISTENTIAL THERAPY WITH OLDER ADULTS 1

Existential Therapy with Older Adults: Finding Meaning in Change

Rachel C. Sykes

Bridgewater State University

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Abstract

Older adulthood is often a period of great change; children mature to adulthood, aging parents

require care and ultimately pass away, and working adults retire from traditional working life.

For many, this period is marked not only by change but also by loss of family and friends, and

some individuals may turn to counseling to make sense of these changes and seek new meaning.

This paper discusses these common experiences in older adulthood in detail and proposes that

Existential Therapy may be an appropriate therapeutic approach with this population. It also

reviews some of the core beliefs of Existential Therapy and demonstrates that they are in

alignment with many of the needs of the older adult population.

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Existential Therapy with Older Adults: Finding Meaning in Change

Older adults face unique pressures; it is often a time when adults spend time caring for

aging parents, perhaps in addition to raising their own children. Some adults must deal with

changing identity roles, as adult children begin to live independently and require less care. This

can be a time when adults must repurpose their efforts away from childcare to other meaningful

pursuits. Many adults also begin to transition away from the working world into retirement.

Furthermore, sometimes these changes occur in conjunction with existing mental health

challenges. Counseling professionals can provide support to clients with such transitions and

responsibilities. Given the likelihood of experiencing significant life changes in older adulthood,

Existential Therapy may be appropriate to help clients deal with loss and find purpose.

Elder Care Responsibilities

Learning to deal with pressures of caring for aging parents can grow to be a daily or even

full-time responsibility, and carers are often faced with limited assistance from friends and

family. It can become an increasing burden for years—even decades—and often takes an

emotional toll on the caregiver. Watching a parent, a formerly powerful figure, diminish

physically, emotionally, and/or mentally can be a complicated experience. Many adult carers

experience frustration with their aging parent and with the situation itself, which can arouse

feelings of guilt and remorse. Given the often lengthy nature of this responsibility, it is not

surprising to find that many of these caregivers experience higher incidences of depression and

anxiety, particularly when the parent has some form of cognitive impairment (Sohlberg,

Sohlberg, & Peterson, 2014). Further, Townsend et al. (1989) found that caregivers’ perception

of their own caregiving abilities and perceived stress were indicators of depressive symptoms,

suggesting that mental health counseling may be a useful intervention. Even those adult children
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who are less central to their parent’s daily care often experience feelings of guilt (Townsend,

Noelker, Deimling, & Bass, 1989).

In addition to the practical task-oriented struggles of providing for an elder parent, carers

must also prepare for the inevitable—this parent will ultimately pass away. Preparing for the

experience of parental loss can itself be stressful and grief-inducing. A Danish study found that

family caregivers struggling with high levels of grief prior to the passing of a family member

reported, post-death, high levels of psychological distress and unpreparedness for this passing

(Nielsen et al., 2017).

Counseling may provide adult carers the skills and support needed to cope with stress and

address depressive feelings. One study of adult daughters found that caregivers who struggled to

cope emotionally were more likely to be depressed than others who employed more effective

emotional mastery (Li, Seltzer, & Greenberg, 1999). These authors also noted that adults with

greater access to social and psychological resources, such as supportive siblings and counseling

services, were better able to cope with caregiving stress.

Transition to Retirement

Another important change in adult life is the transition into retirement. Individuals effect

their retirement in different ways and for various reasons. Traditionally, when an individual

retired from a work, they shifted from a full-time obligation to full-retirement; retirees are now

often choosing different paths into their later years. Some pre-retirees may choose to reduce the

days or hours worked to offer them more time for personal pursuits, or simply transition to a

more meaningful job, such as volunteer work or teaching. There are some individuals who are

fortunate enough to plan for their retirement upon their own terms, seeking to engage in a time of

leisure and personal pursuits. Many others retire involuntarily, due to job loss, difficulty
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obtaining a job in their older years, or for health reasons. Further, parents with primary child

care responsibilities may have worked inside the home in an unpaid capacity, and, finding their

parental duties are largely complete, seek to retire.

Many individuals naively look forward to retirement as a time to leave their obligation to

work but often have not defined how to create new meaning in their lives. A 2016 study shows

that some retiring individuals experience a loss of social and financial resources and of their self-

identity (Henning, Lindwall, & Johansson, 2016). Individuals approaching retirement often feel

anxiety due to lack of planning or confidence in their own ability to deal with the retirement

transition (Fretz, Kluge, Ossana, Jones, & Merikangas, 1989). Some of these individuals may

benefit from therapeutic support to define how best to transition to retirement to ease feelings of

anxiety and depression.

Attitudes about retiring can vary among individuals but most will experience a loss of

friends, spouses and abilities that may be difficult to accept. Retirees will need to find new ways

of structuring their time to create meaning through personal activities and socializing. In the

past, many older adults have increased time spent in religious pursuits. However, a 2015 Pew

Research Center publication found that, between 2007 and 2014, the number of religiously

unaffiliated Americans has grown by 6 percentage points while those who identify as Christian

Americans dropped by 8 percentage points. Given the shift in middle class American values

away from religious faith as well as in church attendance and related activities, it is possible that

more older Americans will struggle to find meaning in an increasingly secular society.

Common Needs Among Older Adults

While it may be expedient to characterize older adults homogeneously, they have a wide

range of capabilities and needs. Nonetheless, there are some thematic issues that are likely to be
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present in this large group of individuals, including the ability to deal with loss and a desire to

find meaning in life. Older adults are likely to lose friends and family, including spouses, to

death at an increasing rate. Such losses can be expected to result in normal levels distress,

however, these symptoms sometimes become more serious, resulting in clinical levels of

depression. In one study, researchers noted that 10-15% of bereaved individuals experienced

persistent grief and chronic depression (Coifman & Bonanno, 2010). Even the less tragic losses

experienced during this time—those of direct childcare responsibilities and career changes—

often create an emotional and responsibility vacuum.

Existential Therapy: Dealing with Loss and Creating Meaning

Existential Therapy is based on three primary tenets: free will, the search for meaning,

and self-determination (Neukrug, 2018). Practitioners seek to develop an authentic basis with

clients to encourage them to identify problematic beliefs and take responsibility for addressing

them. Ultimately, this therapeutic approach seeks to help clients understand themselves and their

own choices and help them in their search to take responsibility to live more authentically. Some

of the key concepts of existential therapy are closely aligned with the needs of older adults and

offer clients a forward-looking framework by which to view their circumstances and create a

path forward. These related existential concepts include death and non-being, freedom,

responsibility, isolation, meaninglessness, anxiety, guilt, and authenticity.

Death and non-being

When faced with the impending or actual death of a parent, especially in a caregiving

situation, individuals often manifest anxiety as a symptom to avoid acceptance of death. One of

Existential Therapy’s primary concepts is that one’s fear of death is central and anxiety-

provoking, and drives individuals to develop inauthentic ways of living to avoid recognition of
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our ultimate death. This fear can be comprised of multiple aspects, including fear of pain

associated with death, fear of abandonment, and loss of dignity (Garrow & Walker, 2001).

While the loss of friends and family are not exclusive to older individuals, it is more likely that,

as one ages, one’s elders and contemporaries begin to pass on with increasing frequency. The

work of Garrow and Walker (2001) supports the idea that when an individual must deal with a

loss of life, it may trigger fear; they share that “death anxiety” (pp. 77) can manifest when one is

faced with the experience of a death. One of the goals of Existential Therapy is for a client to

face their fate directly so that person can recognize past behaviors intended to avoid the reality of

death and non-being, and ultimately make an informed decision about how to live life in a

meaningful way (Neukrug, 2018).

Freedom

There are many types of freedom: there is freedom from enslavement and oppression, as

well as economic freedom and psychological freedom (Neukrug, 2018). An Existential therapist

may seek to help clients create a life that includes the freedom to change (Garrow & Walker,

2001). Many individuals feel bound by a self-imposed sense of obligation that prevents them

from making choices to live authentically. Such a person may fail to recognize that this

obligation may be self-imposed and based on some faulty assumptions. For example, a parent of

adult children may choose to work in a hated job due to a self-imposed obligation to earn enough

money to assist his adult children. This therapist would likely challenge such an assumption to

help the client see that it is actually a choice rather than an obligation, and encourage the client to

see that he possesses the freedom to make many choices.

Responsibility
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A concept closely related to freedom is responsibility (Neukrug, 2018). When an

individual recognizes that they indeed have the freedom to make choices, they must also accept

that they are responsible for their own happiness. Many mid- to late-life adults must also deal

with physical and cognitive impairments, which may seem limiting. However, from an

existential perspective, these adults may develop the capacity to see that they still have the

freedom and responsibility to determine how they respond to such circumstances. A counselor

could assist the client to feel empowered by such choices and create a new way forward. One

research paper described a case study in which a depressive elderly man reported he could no

longer enjoy ballroom dancing due to worsening health (Laidlaw & Pachana, 2009). Therapy

was able to help him see that, while his circumstances had changed, he could take responsibility

for his own happiness. As such, he chose to participate in specific dances that were less

physically problematic and to participate in a fewer number of dances per outing. This change in

perspective and behavior enabled him to take responsibility for his own well-being, continue his

valued activity, stay connected socially, and ultimately enjoy life.

Isolation

From an existential perspective, one must recognize that there are various types of

isolation, including isolation from one’s social community, isolation from oneself, and existential

isolation (Neukrug, 2018). Existential isolation refers to the recognition that individuals are all

alone in this world and must therefore make peace with being alone (Neukrug, 2018). When a

person retires, they often miss the structure if not the content of their former life, and may

struggle with spending far more time alone. Existential therapy may help clients to recognize

this fear as a mechanism to avoid this sense of isolation, and to learn to accept “aloneness” (pp.

171). Yalom (1980) suggests that existential counseling in a group format can be a vehicle that
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provides clients insight into their own behavior, the impact it has on others, and that they must

take responsibility for dealing with their own isolation.

Meaninglessness

One of this approach’s primary tenets is that we are all born into a world devoid of

meaning or purpose and that many of our behaviors are intended to help us avoid recognition of

life’s absurdity. Neukrug (2018) suggests that while many individuals fear to acknowledge the

meaningless of life, one may instead choose to see it as empowering, move away from old

preconceptions, and take responsibility to create one’s own definition of meaning. Faced with

the death of one’s contemporaries, changing role as parent, or a change to a more retiring

lifestyle, individuals may find that their conceptions about what is important no longer apply.

Finding the courage to identify new ways to create meaning can be a goal of existential therapy.

One study suggests that existential counseling in a group setting can help older adults challenge

their acceptance of societal views on aging and encourage them to find meaning in a way that

reinforces their self-respect (Garrow & Walker, 2001).

Anxiety

From an existential perspective, there are two categories of anxiety—existential anxiety

or angst, which is experienced when an individual realizes that they are in fact alone in this

world and that life has no inherent purpose, and neurotic anxiety, which is a manifestation of a

person’s resistance to accepting the truth of existential anxiety. While this may appear to be an

over-simplification, existential therapy contends that these conflicts underlie unhealthy

avoidance behaviors and are even the underlying cause of illness (Neukrug, 2018). These

avoidance behaviors can be likened to Freud’s defense mechanisms and Adler’s negative

compensatory behaviors. Anxiety is a common presenting problem for adults in therapy,

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although, contrary to common expectations, one study found that older adults suffer from anxiety

at a lower rate than working adults (Laidlaw & Pachana, 2009).

Guilt

Like the existential view on anxiety, the existential therapist would contend that there are

two types of guilt: neurotic or moral guilt, and existential guilt. Neurotic guilt is encountered

when a person fails to act in accordance with their own moral beliefs, and existential guilt relates

to one’s recognition that he or she has failed to live up to one’s own potential. When caring for

one’s aging parents, an adult might feel guilty about their resentment and frustration with this

responsibility. An existentialist might suggest that, in fact, the individual has chosen to care for

their aging parents, and that they have the freedom to choose how to respond to the situation.

This might be a helpful coping skill for a client to address guilty feelings and enable him to

choose a different emotional response.

Authenticity

Upon retirement, individuals often find themselves with more time to reflect on life,

which provides them with the opportunity to determine if they have been living in accordance

with their true goals and beliefs. One fosters existential authenticity by living in a meaningful

way. For example, a client may have adopted values and goals that are materialistic, and, upon

retirement, may find herself able to recognize the contradiction between actual and ideal beliefs,

and choose to strip away non-authentic ways of being. An existential therapist would contend

that one is only living authentically when she accepts the meaninglessness of existence and the

inevitability of death, and still chooses to take responsibility to create a meaningful life.

Limitations of Existential Approach

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While this approach offers many opportunities to create meaning for older adults, it may

not be appropriate for all. Individuals who lack the capacity or interest to comprehend abstract

concepts such as meaninglessness and death and non-being are likely not good candidates for an

existential approach. Further, individuals who are more comfortable with an external locus of

control may be uncomfortable taking responsibility for their own happiness. While

existentialism may be compatible with some religions such as Buddhism, it may be less effective

with highly religious individuals who believe in more proscriptive views and external sources of

power.

In conclusion, older adults are likely to experience a series of meaningful transitions, as

they move from child-rearing and traditional working life to caretaking for parents and

experiencing retirement. During this time, older adults also increasingly experience the personal

loss of family and friends. Existential Therapy emphasizes concepts that align well with these

life changes, such as death and non-being, freedom, responsibility, isolation, meaninglessness,

anxiety, guilt, and authenticity. As such, it may offer a good fit theoretical fit for this large and

growing population.
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