Danish existential psychology

1. Introduction

Version followed: Bo Jacobsen, Invitation to Existential Psychology: A Psychology for the Unique Human Being and its Applications in Therapy (Wiley, 2007; Wiley lists the print edition as 2008). This is the English development of his Danish Eksistensens psykologi (1998), which was also published in Norwegian translation (reviewed in 2000). Only the publisher's sample (preface and most of chapter 1), the table of contents and two reviews are drawn on; the book's chapters 2–7 and Appendix B ("Existential therapy and counselling") are not. Wherever this guide goes beyond those pages it is marked [synthesis] or [uncertain].

What it is. This is not a manualised therapy. It is an existential psychology: a body of concepts about how individual people relate to the basic dilemmas of life, built up by Bo Jacobsen (professor at the Centre for Research in Existence and Society, Department of Sociology, University of Copenhagen; practising psychologist, existential psychotherapist and supervisor). His therapy training came from John Smidt Thomsen, Emmy van Deurzen and Ernesto Spinelli, so the clinical stance is close to the British existential-phenomenological school. He led "an intensive qualitative study" of the psychological problems and existential reflections of cancer patients. Most of the clinical examples in the Danish and Norwegian book come from interviews with cancer patients. [source: Wiley author page; e-bookshelf sample, preface and p. vii; Kamps 2000 review] The design, sample and findings of the cancer study were not found in any source opened [uncertain]. A Norwegian reviewer reads Jacobsen as offering an approach that can be combined with established ways of working, rather than a separate school. [source: Kamps 2000]

How change happens. Existential therapy "explicitly invites the client or patient to find their feet" in relation to the big life dilemmas (p. 1). Those dilemmas are happiness and suffering, love and aloneness, crisis, death, choice and meaning. Change does not come from fixing a diagnosed deficit. It comes from a phenomenological conversation in which the person feels deeply understood. In that conversation the client comes back into contact with their life feeling, life courage and life energy, and can face the dilemma on their own terms. [source: e-bookshelf sample, pp. 1–7] The book's titles, such as "the role of crisis in human development", suggest that adversity is treated as possible ground for development, but the text arguing this is not drawn on here [uncertain].

Do not confuse this with: Bjarne Jacobsen, a different Danish author, who wrote a Kierkegaard-based analysis of somatic illness and crisis (Psyke & Logos, 1999). That article is not Bo Jacobsen's work and is not used for the procedures below.

2. Framework

No phase model is documented in the sources used. The sample and the reviews describe a theme-based book, not a protocol with stages, session numbers or criteria for moving on. A Danish reviewer notes that the 1998 book takes no stand on what is necessary or characteristic for a therapy to count as existential. [source: Hjort 1999, p. 278] The structure below is a working frame built from the book's layout and the stance in chapter 1. It is entirely [synthesis].

Working phase [synthesis]	Goal	Typical format	Move on when
A. Phenomenological opening	Meet the client's lived world without diagnostic "spectacles"; find out what the client wants rather than assuming it	1–3 sessions, 50 min, weekly. For a cancer patient: flexible length, at the bedside or clinic, fitted around treatment	The client recognises their own experience in your descriptions, and a central life dilemma has emerged on its own
B. Dilemma work	Explore the one or two dilemmas that matter to this client (happiness/suffering, love/aloneness, crisis, death, choice, meaning), and their life feeling, courage and energy	Open-ended. No session count is given by Jacobsen [uncertain]	The client speaks from their own position ("I" statements, choices owned) rather than from "should" or from the illness role
C. Commitment and integration	Translate understanding into how the client wants to live now, whether with remaining time or after crisis, in line with their own life values	A few sessions, then spacing out or open-door follow-up	The client names what they are choosing or accepting, and reports more life feeling in daily life

In medical and palliative settings, phases may collapse into a single conversation. Follow the patient's pace and energy, not the frame. [synthesis]

3. Guiding principles

[source for 1–8: e-bookshelf sample, preface and ch. 1, pp. ix–7; 9–11: Kamps 2000 review; 12: Wiley/e-bookshelf blurb and preface]

Psychology about life itself. Practical meaning: your subject is how this person lives and meets life's dilemmas, not a symptom profile. Diagnoses (DSM/ICD) and trait models act as "spectacles", so use them only where needed for safety or coordination.
Phenomenology first. Practical meaning: meet what appears as it appears. "We have to ask and listen carefully" (p. 2), because you never simply know what another person wants.
Epoché, or the rule of parenthesis (adopted from Spinelli). Practical meaning: notice your expectations about this client and set them aside while listening.
Description, not explanation (Spinelli). Practical meaning: ask what and how, not why. Avoid causal stories.
Horizontalisation, or equivalisation (Spinelli). Practical meaning: treat every element the client brings as equally important for as long as possible, and let what matters emerge.
Being-in-the-world and relatedness. Practical meaning: the person is not an isolated psyche. In Jacobsen's words we may be little more than the sum of our relationships, so always explore the person-in-their-world.
Life feeling, life courage, life energy as basic concepts. Practical meaning: track when the client feels alive or "dead inside" (life feeling), their affirmation of their own life (life courage, after Tillich, with a natural and a moral component), and their vitality. The life-energy section is not drawn on here [uncertain].
Existential psychology is empirical. Practical meaning: hold your formulations as claims that the client's experience can confirm or refute.
Uniqueness of the individual. Practical meaning: do not assume general recipes. Grieving in groups or putting feelings into words is not automatically helpful for everyone.
Do not make projects of the dying. Practical meaning: "hjelperne må unngå å lage prosjekter for den døende", meaning helpers must avoid making projects for the dying person or their relatives. Accompany rather than steer. [source: Kamps 2000]
The present shapes the past. Practical meaning: how people colour and recall childhood depends partly on how they live now, so work with the past as it lives in the present rather than as a fixed cause.
Acknowledge good and bad. Practical meaning: help people develop a fuller way of being, meet adversity, and acknowledge both what is good and what is bad in their lives. Do not aim only at symptom removal. Attend to cultural variation in how dilemmas are lived.
Combinable with other methods. Practical meaning: you can hold this stance inside CBT, nursing, pastoral or palliative work. [source: Kamps 2000, reviewer's reading; synthesis on application]

4. Intervention inventory

Jacobsen's book gives concepts, case examples and clinical implications, not a list of named techniques. The sources used describe items 4.1–4.4 directly, and items 4.5–4.8 rest on concepts from those pages. Items 4.9–4.14 follow the book's chapter themes, whose content is not drawn on here, so their steps are [synthesis] and grounded in general existential-phenomenological practice. Item 4.15 rests on the Norwegian review. Example language throughout is the author's own illustrative wording, not Jacobsen's.

4.1 Epoché (rule of parenthesis)

Purpose / when: In every session, and especially early on or when you notice you are "sure" what the client needs. For example, you might assume a cancer patient must be afraid of death. [source: sample pp. 3–4, Spinelli's rules as presented by Jacobsen]
Steps: (1) Before or during the session, note privately your hypotheses, diagnosis-based expectations and personal reactions. (2) Put them "in parentheses". Do not act on them and do not voice them as facts. (3) Ask open questions that let the client define the issue. (4) Afterwards, compare what emerged with what you expected, and note which assumptions would have misled you. [steps 1 and 4: synthesis]
Example language (illustrative): "I don't want to guess what this has been like for you. Can you tell me how it actually is, day to day?"
Watch for: You may be filling silences with your own theory. It is working when the client corrects or surprises you, and when they say they feel understood.

4.2 Description rather than explanation

Purpose / when: When a client (or you) jumps to causes, such as "because of my childhood" or "it's the chemo". The aim is to slow down into how the experience is actually lived. [source: sample pp. 3–4]
Steps: (1) Pick one concrete moment the client mentions. (2) Ask what happened, what they noticed, felt, thought and did, in sequence. (3) Reflect the description back in their words. (4) Hold off on why questions and interpretations until the description is full. [synthesis on steps]
Example language (illustrative): "Let's stay with yesterday evening when you got the scan result. Where were you? What was the first thing you noticed in yourself?"
Watch for: Intellectualising, and "why" spirals. It is working when the account becomes vivid, in the present tense and with bodily detail, and when new aspects appear.

4.3 Horizontalisation (rule of equivalisation)

Purpose / when: When material is complex, or when you are tempted to pick out the "real" problem early. [source: sample pp. 3–4]
Steps: (1) Map everything the client brings, without ranking it. (2) Give each item comparable attention and curiosity. (3) Notice what the client keeps coming back to or what carries energy. (4) Only then ask which matters most to them now. [synthesis on steps]
Example language (illustrative): "You've mentioned your garden, your daughter, the hospital food and not sleeping. I'd like to hear a bit about each before we decide what's most important."
Watch for: Your own bias towards dramatic or diagnosable content. It is working when the client's own priority emerges, and it may differ from the referral reason.

4.4 Asking instead of assuming the person's wish

Purpose / when: In care settings (nursing homes, oncology, hospice) where staff decide on the patient's behalf. Jacobsen's example: a nurse assumed a resident wanted to spend Christmas in the nursing home, without asking. In fact he had seven nearby siblings who had invited him. [source: sample pp. 2–3]
Steps: (1) Identify decisions being made about the client (care, visits, information, rituals). (2) Ask the client directly what they want, and do not ask relatives first. (3) Check the meaning behind the wish. (4) With consent, convey the wish to the care team. [steps 3–4: synthesis]
Example language (illustrative): "People often assume they know what patients want at this point. I'd rather ask you: how would you like to spend the next weekend?"
Watch for: The client may defer to staff or family. It is working when the client voices a preference and the plan changes to fit it.

4.5 Exploring life feeling (when do you feel alive?)

Purpose / when: With flatness, depression-like deadness, or loss of identity in illness. In Jacobsen's interview study, people said they felt most alive in practical tasks, sport, family and social bonds, inward focus (for example Tai Chi, or a walk after illness) and nature. Others described feeling "dead inside". The concepts behind this are Rollo May's "I-am" experience and Laing's ontological security. [source: sample pp. 5–7] Using the study question as a therapy intervention is [synthesis].
Steps: (1) Ask when, recently or ever, the client felt really alive. (2) Explore one instance descriptively (4.2): where, with whom, what in the body. (3) Ask about the opposite: when they feel dead, absent or unreal. (4) Look for what links the alive moments, and whether any can be reached now, within the illness or crisis. (5) Revisit over sessions.
Example language (illustrative): "When in the last weeks did you feel most yourself, most alive, even for a moment?" / "And when do you feel furthest from that?"
Watch for: Ontological insecurity, such as a fragile sense of being real and continuous, which Jacobsen, following Laing, links to psychotic states. Assess, and refer or adapt if present. [source: sample p. 7; synthesis on action] It is working when the client spontaneously reports moments of aliveness between sessions.
Optional adjunct: Jacobsen cites Kabat-Zinn's meditation work, in which patients learn to "taste their own wholeness as they are". Brief mindfulness practice can support life feeling. [source: sample p. 7; use as adjunct: synthesis]

4.6 Strengthening life courage

Purpose / when: When a client is retreating from life, for example after a diagnosis, or is living by avoidance. Following Tillich, life courage has a natural component (part of living itself) and a moral component (something one strives for and affirms). [source: sample p. 7; the rest of that section is uncertain]
Steps (synthesis): (1) Identify where the client is already showing courage, including small acts. (2) Name the natural courage, the will to go on, and honour it. (3) Explore what the client would affirm about their life if they dared. (4) Agree one concrete step that expresses that affirmation.
Example language (illustrative): "Coming in today, after the week you've had, took something. What kept you going?"
Watch for: Pushing courage as a duty, which could become another "project". It is working when the client's steps come from their own values, not to please you.

4.7 Mapping being-in-the-world (relationship map)

Purpose / when: To understand the person as the sum of their relationships: to others, work, body, place, nature and time. Use early, and whenever illness or crisis has disrupted these. [concept source: sample p. 5; the mapping procedure is synthesis]
Steps: (1) Ask the client to name the people, places, activities and things that make up their world. (2) For each, explore what it gives them and how illness or crisis has changed it. (3) Note which relationships carry life feeling and which drain it. (4) Use the map to choose where to work.
Example language (illustrative): "If we drew your life as a web of connections, what would be on it? Which threads feel strongest right now, and which have frayed?"
Watch for: Isolation, which links to the love and aloneness theme (4.10). It is working when the client sees themselves in context rather than as "the illness".

4.8 Re-reading the past from the present

Purpose / when: When the client explains the present by a fixed past. Jacobsen questions whether the past determines the future, and notes that people shape and colour childhood memories from their present way of living. [source: Kamps 2000]
Steps (synthesis): (1) Hear the past story descriptively. (2) Ask how the client is relating to that past now. (3) Explore how recalling it differently might fit who they are becoming. (4) Return to present choices (4.13).
Example language (illustrative): "That's how you remember it. How does that memory sit with the person you are now? Has it changed over the years?"
Watch for: Invalidating real trauma. Do not suggest the past "didn't matter". It is working when the client moves from "I am this way because…" to "I can relate to that differently…".

4.9 Working with happiness and suffering

Purpose / when: When the client asks "why me?", feels their life is ruined, or measures life only by happiness. Chapter 2 covers what suffering is, "four ways of dealing with suffering", happiness as an existential concept, and "the role of happiness in therapy". [source: table of contents] The four ways and the chapter text are not drawn on here [uncertain]. Do not present any list as Jacobsen's.
Steps (synthesis): (1) Describe the suffering concretely (4.2) without hurrying to relieve it. (2) Explore how the client is currently relating to it, for example fighting it, avoiding it, bearing it or finding something in it. (3) Explore what happiness means to them, as opposed to cultural images of happiness. (4) Look for moments where suffering and some form of happiness or meaning coexist.
Example language (illustrative): "What would a good day look like for you now, not before the illness, but now?"
Watch for: Premature "silver lining" talk from you. It is working when the client can hold both pain and value without either cancelling the other.

4.10 Love and aloneness

Purpose / when: Loneliness, dependence, fear of burdening others, relationship strain under illness. Chapter 3 asks whether people can learn to stand alone, and how personal development and social bonds can go together, and it has a section on helping clients with problems of love and aloneness. [source: table of contents; content uncertain]
Steps (synthesis): (1) Separate chosen solitude from painful isolation in the client's own descriptions. (2) Explore the kinds of love present or missing. (3) Explore the existential aloneness no one can take away, such as facing illness or decisions oneself, and what helps the client bear it. (4) Identify one bond to strengthen and one area where standing alone can be accepted.
Example language (illustrative): "There are parts of this no one else can go through for you. What is it like to know that? And who can walk alongside you, even so?"
Watch for: Withdrawal that is depressive rather than chosen. Screen for this. It is working when the client describes both closeness and a steadier sense of self.

4.11 Crisis work

Purpose / when: After diagnosis, relapse, bereavement, divorce, job loss. Chapter 4 distinguishes crisis from trauma, contrasts "three other schools" with "the existential theory of crisis", names "three dimensions of a crisis", and asks whether crises are desirable or undesirable. [source: table of contents] Those dimensions and the theory itself are not drawn on here [uncertain]. Do not attribute a model to Jacobsen beyond these titles.
Steps (synthesis): (1) Stabilise first: practical needs, sleep, support, safety. (2) Describe what has been shaken, such as plans, identity, beliefs and relationships. (3) Explore what the client's life rested on before, and what still holds. (4) Only when the client is ready, explore what the crisis may be asking of them or opening. Never prescribe growth.
Example language (illustrative): "Before the diagnosis, what did you lean on in life? What's still standing, and what's been knocked over?"
Watch for: Trauma reactions such as intrusions, dissociation and hyperarousal. Treat these with trauma-informed methods rather than meaning-making alone [synthesis]. It is working when the client begins to speak of the crisis as part of their life story, not only as an end.

4.12 Death anxiety and life commitment (including the dying patient)

Purpose / when: Cancer and palliative patients, bereaved clients, and clients with diffuse death anxiety. Chapter 5 covers approaching one's own death, "three theories of death anxiety", the effect of being exposed to death, "how can I help a dying person?" and "what is a serene relationship to death?". [source: table of contents; content uncertain] In the Norwegian edition, the chapter "Å stå overfor døden" (Facing death) draws mainly on interviews with cancer patients. [source: Kamps 2000]
Steps (synthesis): (1) Ask, do not assume, how the person relates to death right now. Some are anxious, some sad about leaving life, some prefer not to think about it. A Danish hospice study, not by Jacobsen, found patients sorrowful about leaving life rather than anxious. [source: Moestrup & Hansen 2015 abstract] (2) Follow the patient's lead on whether and how much to talk about death. (3) Explore what the patient wants to commit to with the time left: people, unfinished business, everyday pleasures. (4) Support practical decisions the patient raises. (5) Include relatives only as the patient wishes.
Example language (illustrative): "Some people want to talk about dying and some don't. What would be right for you today?"
Watch for: Suicidal thoughts and wishes to hasten death. Assess using standard practice: ask directly, then explore intent, plans, protective factors and access to means. Coordinate with the palliative team on symptom control and on safe storage of medicines. [synthesis] It is working when the patient can talk about death at the depth they choose and invests in chosen parts of remaining life.

4.13 Free choice and the obligations of life reality

Purpose / when: Indecision, feeling trapped, or illness taking choices away. Chapter 6 covers how important life decisions are made, how decisions shape one's way of being, "what do we do when we cannot choose freely?" and "can you take over your present life?". In the Norwegian edition this chapter is called "choice and commitment". [source: table of contents; Kamps 2000; content uncertain]
Steps (synthesis): (1) Map the given limits (illness, obligations, finances) and the remaining zones of freedom. (2) Describe how past important decisions were actually made. (3) Explore the attitude the client can take where outer choice is impossible. (4) Name one area where the client can "take over" their present life.
Example language (illustrative): "The illness decided a lot for you. Where do you still get to decide, even something small?"
Watch for: Over-responsibility, as in "I chose to get cancer". Correct this firmly [synthesis]. It is working when the client owns choices without self-blame.

4.14 Life meaning and life values (redirecting one's life)

Purpose / when: Meaninglessness, burnout, or life review late in life or illness. Chapter 7 covers life goals, life meanings and life values, how they change across life, cross-cultural perspectives, and "redirecting your life in accordance with your life values". [source: table of contents; content uncertain]
Steps (synthesis): (1) Elicit the client's actual life goals and values, as distinct from inherited ones. Recall May's idea that basic values can grow from the I-am experience (sample p. 6). (2) Trace how these have shifted over time. (3) Compare current daily life with these values. (4) Choose small redirections. (5) Respect culturally different value frames.
Example language (illustrative): "Looking at your life now, what matters most to you, not what you were taught should matter?"
Watch for: The therapist supplying meaning. It is working when the client articulates values in their own words and acts on them.

4.15 Accompanying without projects (cancer patients, the dying, relatives)

Purpose / when: In all work with seriously ill and dying people and their families. Jacobsen warns helpers against making projects for the dying person or their relatives. He questions whether grief is best worked through in groups and whether verbalising feelings is always helpful. [source: Kamps 2000]
Steps (synthesis): (1) Check your own agenda, for example "a good death", reconciliation, or expressing feelings, and bracket it (4.1). (2) Offer, do not push: talking, silence, practical help, presence. (3) Ask what kind of support the person wants (4.4), and accept that some cope by not talking. (4) Offer group or verbal grief work as an option, not a norm. (5) Review regularly whether your involvement is still wanted.
Example language (illustrative): "I don't have a plan for what we should get to. I'm here, and we can talk, or not, about whatever you like."
Watch for: Relatives or staff pressing their own projects on the patient. It is working when the patient sets the agenda and reports feeling accompanied rather than managed.

5. Handling problems

The Jacobsen sources used do not include a troubleshooting section, and Appendix B is not drawn on here. Guidance below is [synthesis] unless a source is tagged.

Stuck client, going round in circles. Return to description (4.2) of one concrete recent moment. Horizontalise (4.3) again: the "stuck" topic may not be what matters most. Ask the client directly whether this is the conversation they want. [synthesis; stance from sample pp. 2–4]
Client wants answers, advice or a technique. Acknowledge the wish, and offer practical help where it is legitimate, such as coordination or information. Then explore what having "the answer" would mean. You may combine with established methods, such as CBT for insomnia or mindfulness, while keeping the existential frame. [source: Kamps 2000 on combinability; synthesis on how]
Resistance to talking about death or illness. Treat not talking as a valid way of coping, not denial to be broken down. Ask permission before each step towards the topic, and follow the patient's lead. [source: Kamps 2000 on verbalisation; synthesis]
Overwhelm, for example at the moment of diagnosis or relapse. Shift from exploration to stabilisation: grounding, practical needs, short sessions, more structure. Defer meaning-oriented work (4.11, 4.14) until the client has some footing. Watch for acute stress reactions and treat trauma symptoms with trauma-focused methods. [synthesis]
Non-adherence (missed sessions, cancelled visits). With medically ill clients, assume fatigue or treatment burden before reluctance. Offer phone, bedside or shorter contact. Ask, without assuming, what the absence means (4.4). [synthesis]
Rupture: client feels judged, pushed or misunderstood. Name it, and take your share: "I think I got ahead of you." Check whether you had slipped into a project for the client (4.15) or into explaining rather than describing. Return to the client's own description. [stance: sample; Kamps 2000; repair wording: synthesis]
Therapist's own death anxiety or over-identification (modality-specific). Work with dying patients stirs the therapist's own mortality. Signs include rushing to reassure, avoiding the topic, or needing the patient to reach acceptance. Use supervision. Jacobsen himself works as an existential supervisor. [source: author bio; synthesis on use]
Relatives or staff pushing their own agendas. With consent, give the team the patient's actual wishes (4.4). Offer relatives separate space rather than mediating their projects through the patient. [synthesis based on Kamps 2000 and sample pp. 2–3]
Turning suffering into "growth" too early (modality-specific risk). The crisis-and-development theme (ch. 4 titles) can be heard as "this happened for a reason". Never prescribe benefit-finding. Let any sense of development come from the client. [synthesis]
Fragile sense of self or psychotic features. Jacobsen, after Laing, links ontological insecurity to psychotic states (sample p. 7). Open-ended existential exploration may destabilise. Prioritise psychiatric assessment, structure and grounding, and adapt or refer. [synthesis on management]
Suicidal thoughts, or a wish to hasten death, in serious illness. Ask directly, then assess intent, planning, history, hopelessness, uncontrolled symptoms and supports. Distinguish passive wishes to die from active intent. Involve the medical or palliative team: symptom control, depression treatment, and safe storage or removal of stockpiled medication. Follow local risk protocols and document. [synthesis; standard practice]
Cultural or religious frames. Jacobsen treats life values and dilemmas as culturally varying (preface; ch. 7 titles). Explore the client's own frame and do not impose a secular-existential one. Collaborate with chaplaincy where the client wishes. [synthesis]

Sources

Sources:

Invitation to Existential Psychology – publisher sample (front matter, preface, ch. 1) – primary; main source for sections 1–4.8.
Wiley – Invitation to Existential Psychology, author information
Wiley-VCH e-bookshelf – Invitation to Existential Psychology (description, contents)
Kamps H. (2000). Kroppens eksistens (book review). Tidsskrift for Den norske legeforening and PDF version – review of the Norwegian translation (transl. Tone Anderssen). The page gives the book as Kroppens eksistens; whether that is the translated title or the review headline is [uncertain].
Hjort S. D. (1999). De eksistentielle dimensioner. Psyke & Logos 20, 278–289 – review including Eksistensens psykologi.
Jacobsen, Bjarne (1999). Sygdom og krise. Psyke & Logos 20, 75–94 – listed only to separate this different author from Bo Jacobsen; not used for procedures.
World Database of Happiness – entry for Jacobsen (2007) What is happiness? Existential Analysis 18, 39–49 – citation only; the database lists the author as "Jacobson, E.", so attribution to Bo Jacobsen is [uncertain]. No text was available.
Moestrup L. & Hansen H. P. (2015). Existential concerns about death: a qualitative study of dying patients in a Danish hospice. Am J Hosp Palliat Med 32 – secondary Danish context; not Jacobsen.