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The last decade the evidence that existential concerns are intertwined with the struggles clients bring to the therapy room has been growing. Existential concerns have for example been associated with several forms of psychopathology, including eating disorders, depression, anxiety disorders, addiction, and psychosomatic illnesses (Fuchs, 2013; Glaw et al., 2017; Iverach et al., 2014; van Bruggen et al., 2014). Accordingly, different psychotherapy models have underlined the need for mental health professionals to address the existential experiences of their clients (Cooper, 2017). This recommendation raises the question how we can train mental health professionals to work with their clients existential concerns adequately. In the literature a start has been made to explore questions that, directly and indirectly, address this issue. Examples include: How therapist experience working with clients’ existential concerns (Frediani et al., 2022); Which challenges therapists experience when confronted with clients’ existential suffering (Hill, 2017; Lundvall et al., 2018; Sundström et al., 2018; Ulland & DeMarinis, 2014; Vanhooren, 2019); How the concept of existential empathy may be of importance in addressing clients’ existential concerns (Vanhooren, 2022). These studies all focus on the client as an individual human being and on therapists who have been trained to engage with a single client at a time. The literature however informs us that when facing existential struggles, people do not only attune to their own experiencing, but also to the experiencing of other family members. In the first conversation with the family about a family member’s death, the family for example tends to only disclose the information the most vulnerable family member is ready to hear (Rober & Rosenblatt, 2013). Also some couples who have suffered the loss of a child choose to not talk about their own existential pain with their partner as a way to search for a bearable distance from their own grief and their partner’s grief and as a way of attuning to their relational context (Hooghe et al., 2018). Hooghe and colleagues (2018) argue that the couples’ intrapersonal process of emotional regulation rests on an interpersonal process of attunement. These studies thus teach us that relating to one’s existential struggles, which is often considered as a very personal and lonely experience, is nevertheless often interwoven and influenced by complex interpersonal processes. This leads to the question how family therapists deal with these complex dynamics when a family member raises existential concerns in the session. Family therapists are at that moment required to not only attune the individual family member’s existential suffering, but to each family member’s suffering and also to the family’s suffering as a whole. Do family therapists therefore encounter different challenges than individual therapists when relating to the existential layer of the family members’ concerns? What do family therapists experience when they are confronted with a family’s existential suffering? Do family therapists maybe even identity different themes as existential than individual therapists do? To our knowledge, these research questions have not been addressed yet. They are however valuable questions to explore as they could inform us on how the help train family therapists to deal with existential concerns that arise in the context of family therapy. Our research aims to explore this topic. References: Cooper, M. (2017). Existential Therapies. Sage. Frediani, G., Krieckemans, L., Seijnaeve, A., & Vanhooren, S. (2022). Engaging with the client’s existential concerns: The impact on therapists and counselors [Manuscript submitted for publication]. Department of Psychology, KU Leuven. Fuchs, T. (2013). Existential Vulnerability: Toward a Psychopathology of Limit Situations. Psychopathology, 46(5), 301–308. https://doi.org/10.1159/000351838 Glaw, X., Kable, A., Hazelton, M., & Inder, K. (2017). Meaning in Life and Meaning of Life in Mental Health Care: An Integrative Literature Review. Issues in Mental Health Nursing, 38(3), 243–252. https://doi.org/10.1080/01612840.2016.1253804 Hill, C. E. (2017). Therapists’ perspectives about working with meaning in life in psychotherapy: A survey. Counseling Psychology Quarterly, 30(4), 373-391. https://doi.org/10.1080/09515070.2016.1173014 Hooghe, Rosenblatt, P. C., & Rober, P. (2018). “We Hardly Ever Talk about It”: Emotional Responsive Attunement in Couples after a Child's Death. Family Process, 57(1), 226–240. https://doi.org/10.1111/famp.12274 Iverach, L., Menzies, R. G., & Menzies, R. E. (2014). Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review, 34(7), 580–593. https://doi.org/10.1016/j.cpr.2014.09.002 Lundvall, M., Lindberg, E., Hörberg, U., Palmér, L., & Carlsson, G. (2018). Healthcare professionals’ lived experiences of conversations with young adults expressing existential concerns. Scandinavian Journal of Caring Sciences, 33(1), 136–143. https://doi.org/10.1111/scs.12612 Rober, P., & Rosenblatt, P. C. (2013). Selective disclosure in a first conversation about a family death in James Agee’s novel A Death in the Family. Death Studies, 37(2), 172–194. Sundström, M., Edberg, A.-K., Rämgård, M., & Blomqvist, K. (2018). Encountering existential loneliness among older people: perspectives of health care professionals. International Journal of Qualitative Studies on Health and Well-being, 13(1). https://doi.org/10.1080/17482631.2018.1474673 Ulland, D., & DeMarinis, V. (2014). Understanding and working with existential information in a Norwegian adolescent psychiatry context: a need and a challenge. Mental Health, Religion & Culture, 17(6), 582–593. https://doi.org/10.1080/13674676.2013.871241 van Bruggen, V., Vos, J., & Glas, G. (2014). Existentiële angst. In B. van Heycop ten Ham, M. Hulsbergen, & E. Bohlmeijer (Eds.), Transdiagnostische factoren. Theorie en Praktijk (pp. 313–334). BOOM. Vanhooren, S. (2022). Existential empathy: A necessary condition for posttraumatic growth and wisdom in clients and therapists. In M. Munroe & R. Ferrari (Eds.) Posttraumatic growth to psychological well-being: Coping wisely with adversity. Springer. Vanhooren, S. (2019). Existentiële empathie: Over experiëntiële en existentiële aanwezigheid. Tijdschrift Persoonsgerichte Experiëntiële Psychotherapie, 57(1), 3–10

This research is part of a PhD project that aims to explore existential empathy. Existential empathy refers to therapists’ capacity to resonate and be present with their clients’ ultimate existential concerns (such as life’s finitude, the meaning of life, one’s fundamental loneliness in life,…), and to express their empathy towards these existential experiences (Vanhooren, 2019, in press). Existential empathy is a new concept within the scientific literature. While studies have started to emphasize the importance of existential empathy in working with clients’ existential concerns (Vanhooren, 2019, in press), up till date only one empirical study (regarding an Existential empathy Questionnaire; Vanhooren et al., in press) has been done to examine this concept. Our research project aims to start to fill this gap by exploring therapists’ in-session experiences when a client raises existential concerns. In the psychotherapy literature therapist’s general empathy is decomposed into different elements. According to Rogers (1961, 1980) empathy starts with the ability to see the world through others’ eyes and to experience other’s feelings as they do. This is in line with what Barret-Lennard (1993) calls empathic resonance in his three-phase model of empathy. According to Barret-Lennard (1993) empathic resonance is the first step towards perceived empathy. In accordance with these theories, we hypothesize that received existential empathy starts with the therapist’s empathic resonance of client’s existential concerns and thus we argue that examining therapists’ lived experiences of clients’ existential concerns is a highly needed first step in order to explore the concept of existential empathy. Up to date no studies examine the in-session experiences of therapists when they are confronted with clients’ existential concerns. The limited studies that document how therapists experience their clients’ existential struggles all focus on their general experiences as they reflect upon their existential encounters with clients (through focus groups, interviews and surveys) (e.g. Hill, 2017; Lundvall et al, 2018; Sundström et al., 2018; Ulland & Demarinis, 2014). What is missing in these studies is an exploration of therapists’ moment-to-moment experiences in the actual heat of the session. Gaining knowledge on these in-session experiences of therapists is very valuable: on the one hand it could shed light on the difficulties therapists experience to empathically join their clients in their existential struggles, providing information about which obstacles therapists need to tackle to improve their existential empathy. On the other hand it could also shed light on which inner and interpersonal processes contribute to existential empathy. Furthermore, exploring how therapists’ moment-to-moment experiencing influences their interventions in the session can provide vital information about empathic communication, which according to Barrett-Lennard’s model of empathy (1993), is the next phase towards received empathy. Empathic communication refers to the ability of therapists to communicate their empathic resonance to clients. This phase in the model thus concerns specific therapist-level behaviours and refers to what therapists do to convey their empathy towards clients based on their inner experiences. To acquire a deeper and broader insight in therapists’ lived experiences of existential empathy, we will need to study these therapist experiences in a broad experiential range of therapists, including novice as well as experienced therapists. References: Barret-Lennard, G. T. (1993). The phases and focus of empathy. British Journal of Medical Psychology, 66, 3-14. https://dx.doi.org/10.1111/j.2044-8341.1993.tb01722.x Hill, C. E. (2017) Therapists’ perspectives about working with meaning in life in psychotherapy: A survey. Counseling Psychology Quarterly, 30, 373-391. https://doi.org/10.1080/09515070.2016.1173014 Lundvall, M., Lindberg, E., Hörberg, U., Palmér, L., & Carlsson, G. (2018). Healthcare professionals’ lived experiences of conversations with young adults expressing existential concerns. Scandinavian Journal of Caring Sciences, 33(1), 136–143. https://doi.org/10.1111/scs.12612 Sundström, M., Edberg, A.-K., Rämgård, M., & Blomqvist, K. (2018). Encountering existential loneliness among older people: perspectives of health care professionals. International Journal of Qualitative Studies on Health and Well-being, 13(1). https://doi.org/10.1080/17482631.2018.1474673 Ulland, D., & DeMarinis, V. (2014). Understanding and working with existential information in a Norwegian adolescent psychiatry context: a need and a challenge. Mental Health, Religion & Culture, 17(6), 582–593. https://doi.org/10.1080/13674676.2013.871241 Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin Company Rogers, C. (1980). A way of being. Mariner Books. Vanhooren, S. (2019). Existentiële empathie: Over experiëntiële en existentiële aanwezigheid. Tijdschrift Persoonsgerichte Experiëntiële Psychotherapie, 57 (1), 3-10. Vanhooren, S. (In press). Existential empathy: A necessary condition for posttraumatic growth and wisdom in clients and therapists. In M. Munroe & R. Ferrari (Eds.) Posttraumatic growth to psychological well-being: Coping wisely with adversity. Springer.