Rebecca Emberger, LAMFT

Sex & Relationship Therapist
Sex, Gender, & Relationship Diversity Specialist

Applying Existential Therapy to Lesbian Clients Dealing with Discrimination


Applying Existential Therapy to Lesbian Clients

Dealing with Discrimination

Rebecca Emberger

Capella University

Applying Existential Therapy to Lesbian Clients Dealing with Discrimination

The existential theory is concerned with aspects of the human condition that are believed to be universal (Bauman & Waldo, 1998), and which often cause all sorts of emotional and psychological distress. These universal core concerns include death, freedom, isolation, and meaninglessness. A minority client dealing with discrimination would be guided to reframe their issues from the perspective of these four concerns, to develop a capacity for self-awareness, and to become willing to accept personal responsibility for their lives.

Case Analysis

Overview of Clients and Presenting Issue

Jane and Elise are a couple, and have maintained their relationship for almost two years. Jane recently convinced Elise to come out to her parents, who have reacted poorly to the news and have threatened to disown Elise. Jane, meanwhile, is having difficulty with a co-worker, who is openly homophobic and has been making crude and insensitive comments to and about Jane. Both are not sure how to handle the various forms of discrimination they’re facing and the anxiety they’re experiencing as a result of the discrimination.

Lesbian, gay, and bisexual (LGB) people experience discrimination, prejudice, and oppression in a variety of ways, some overt and some more subtle (Palma & Stanley, 2002). The heteronormative society in the United States considers anyone who doesn’t fit that norm as “deviant, disturbed, or inferior” (Palma & Stanley, 2002, p. 76). Exposure to constant heterosexism takes its toll on LGB people, who are showing up in counselors’ offices in increasing numbers. It’s important for counselors to understand that the psychological distress experienced by LGB people  is “not a person’s sexual orientation, per se” (Smith & Ingram, 2004, p. 57), but rather the reality of belonging to a stigmatized group and withstanding heterosexism on a daily or almost-daily basis (Smith & Ingram, 2004; Palma & Stanley, 2002; Mays & Cochran, 2001). Mays and Cochran (2001) describe how “experiences with discrimination and stigmatization have been shown to lead to greater vulnerability to depressive distress and anxiety and perhaps to higher rates of some psychiatric disorders” (p. 1869).

Overview of Existential Theory

Existential counseling addresses several core universal issues associated with the human condition: death, freedom, isolation, and meaninglessness (Bryant Frank, 2003; Bauman & Waldo, 1998). “Change evolves from the a client’s willingness to participate in the interpersonal encounter by confronting loneliness, experiencing individuality, encountering true connection, and developing the inner strength to transcend the life situation” (Bryant Frank, 2003, p. 144). In this theoretical perspective, people are not seen as defective; rather, they are viewed as possessing much potential, and the existential counselor’s goals is to help people develop ways of dealing with and finding meaning in their lives, which leads them to actualizing their potential (Bryant Frank, 2003; Bauman & Waldo, 1998). Existential theory is appropriate for use with minority clients, such as the lesbian clients discussed in this analysis, because it “embodies the understanding of the individual in the cultural context and time as well as the nature, meaning, and feelings of that existence” (Bryant Frank, 2003, p. 132). In other words, the client is seen for who they are, within their own cultural context, and they are helped to understand themselves from the perspective of the universal core concerns.

Applying the Theory

In this case, all of the existential concerns are present. Before addressing the core existential concerns with the clients, however, it will be important to establish a relationship based on trust, compassion, understanding, and respect. The clients need to believe that the counselor is not biased against them on the basis of their sexual orientation and will not try to convert them (Heffner, 2003). The counselor can achieve this through empathetic listening, through (if appropriate) self-disclosure about her own sexual orientation, and by displaying gay-friendly literature on her bookshelves. Once a therapeutic relationship has been established, the counselor and clients can together explore their issues from the perspective of the existential core constructs.


Death anxiety stems from a realization that we are all destined to cease to exist (Ellerman, 1999). However, physical death is not the only source of this anxiety. We also fear life circumstance changes (Bryant Frank, 2003), which involve “little deaths”. In this case, the threat from Elise’s parents to disown her are akin to a death threat, and so some of her anxiety stems from this fear of being dead to her parents. She is also confronting the death of the illusion of herself as a “straight,” or heterosexual, person. When working with Elise, the counselor might encourage her desire to be more authentic, by challenging her to reflect on death. This process would be expected to prompt Elise to see that, to make the most of her remaining life, coming to terms with her parents’ reaction and living her life as she sees fit would lead her to becoming more authentic and ultimately enjoying a sense of well-being (Ellerman, 1999).


“Individuals are free to create themselves with reference to the biological, historical, and cultural context in which they are ‘thrown’” (Heidegger, as cited by Ellerman, 1999, p. 54). Existential freedom means realizing that a person has the ability to make choices about who and how they will be. “Although we can choose each thought we have, there are costs and benefits for each decision” (Bryant Frank, 2003, p. 140). This construct is related to that of personal responsibility, an important concept in existential theory. In this case study, freedom would be explored with both clients through challenging them to accept their personal responsibility for their thoughts, actions, and feelings about each of their experiences with discrimination. They have the power to choose how to react, and they also have the power to let go of responsibility that isn’t theirs. For instance, Elise can be guided to see that her parents’ reactions are not her responsibility, but that she has the choice to respond to them from a place of genuineness and compassion. Jane cannot control her coworker’s comments, but she has the power to stand up to him, to report him, and to learn not to take his comments so personally, recognizing that his prejudice is a problem within him, not her.


Isolation, also known as loneliness, is a recognition that we are all ultimately alone, and anxiety arises from fear of this reality (Bauman & Waldo, 1998). “At the root of loneliness is the fear that unless the self is recognized and affirmed by a valuable other, it will cease to exist” (Bauman & Waldo, 1998, p. 2). The anxiety due to isolation, then, is related to our fear of death. Again, looking at Elise, we can see where the threat of her parents’ disowning her contribute to a basic fear of isolation or loneliness, which can lead to depression, and other more aberrant or self-destructive behavior (Clamar, 1985). The therapeutic relationship itself acts as an intervention to help with this particular issue, through a shared experience of the moment, in which the counselor exhibits a sense of presence and acceptance toward the client (Bryant Frank, 2003).


The need to make our lives make sense is a driving human force, and anxiety comes from the awareness that life is inherently meaningless (Bauman & Waldo, 1998). It is each individual who creates meaning for his or her life, and it is his or her responsibility to find that meaning, and then to live by it. Through using interventions such as encouraging a centered awareness of being, and storytelling and mythmaking, clients can learn to increase their self-awareness and to see the larger patterns of their lives, both of which leads to finding meaning within those patterns (Bryant Frank, 2003).


“The central thrust of existential psychology: human beings become who they are through decisions, choices, self-commitments, and actions” (Ellerman, 1999, p. 55) It is imperative, for this learner, for people to become aware of the power of their choices and of their personal responsibility for creating their lives. Self-awareness and a willingness to accept personality responsibility are keys to alleviating anxiety and psychological distress, to changing behavior and personality constructs, and to creating a life that is more authentic and fulfilling. Existential theory, while difficult to understand and to apply, addresses a breadth of universal human concerns, leaving room for multicultural applications. This learner believes that this theoretical orientation has great potential, if developed more fully for clinical application.


Bauman, S., & Waldo, M. (1998, January). Existential theory and mental health counseling: If it were a snake, it would have bitten!. Journal of Mental Health Counseling, 20(1). 13-18.

Bryant Frank, M. L. (2003). Existential theory. In Capuzzi & Gross (Eds), Theories of Psychotherapy (pp. 132-157). Boston, MA: Pearson Custom Publishing.

Clamar, A. (1985). Loneliness, the human condition, and psychotherapy [Abstract]. Paper presented at the Annual Convention of the American Psychological Association, Los Angeles, CA.

Ellerman, C. P. (1999). Pragmatic existential therapy. Journal of Contemporary Psychotherapy, 29(1). 49-64.

Heffner, C. L. (2003). Counseling the gay and lesbian client: Treatment issues and conversion therapy. Retrieved November 24, 2007, from AllPsych Online,

Mays, V. M, Cochran, S. D. (2001, November). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91(11). 1869-1876.

Palma, T. V., & Stanley, J. L. (2002, Spring). Effective counseling with lesbian, gay, and bisexual clients. Journal of College Counseling, 5. 74-89.

Smith, N. G., & Ingram, K. M. (2004). Workplace heterosexism and adjustment among lesbian, gay, and bisexual individuals: The role of unsupportive social interactions. Journal of Counseling Psychology, 51(1). 57-67.

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