Do people care more about themselves than others?

Understanding why people do or do not help one another has been a question that involved social scientists, psychologists, anthropologists as well as neuroscientists. As noted by authors Manning and Levine (2017), “helping”, “prosocial” and “altruism” are terms that are often used interchangeably in the scientific literature, often without consistency from the same authors. This is because, although all three behaviours are objectively the same, in that they all describe a form of interpersonal support from one individual to another, they differ in underlying driving motivation for each. Research has shown how social and cultural influences, emotions as well as identity and genetics, all play a role in the manifestation of altruistic behaviour. Thus, in this essay, the extent to which human altruism exist will be critically evaluated, starting from an evolutionary and anthropological overview of its origin, followed by a brief discussion on the biology and neuroscience involved and how it develops from childhood to its morality and social importance.

Evolutionary theory has consistently and accurately predicted how the environmental challenges a species face, shape its gene pool promoting the survival of the fittest. Thus, in an environment of scarce resources, fierce competition and a consequent pursuit of self-interest lead to selfish behaviour so to ensure the passing on of genetic information to the next generation; humans are not exempt from this natural order, as described by Dawkins (1976). However, humans are distinct from other animals in that they will frequently help unrelated strangers as well as people they have never met, without any expectation of a reward or reciprocity (Richerson & Boyd, 2005), a behaviour at odds with most other lifeforms. Among the first ideas that sought to explain altruism from a genetic perspective, was that of inclusive fitness theory where this behaviour is explained as outcome-oriented instead of emerging from inherent motivation (Hamilton, 1964). These theories would suggest, however, that helping behaviour is dependent on the individual’s cost-benefit analysis of any given situation, such as the notion of reciprocal altruism which describes how people may help others with an expectation of being helped back in the future (Trivers, 1971).

As truly altruistic behaviour is understood as the action an individual takes towards another or a group outside that individual’s self-interest, it has been argued that it is impossible to demonstrate pure altruism (Piliavin, et al., 1981). Egoistic or selfish behaviour is indeed distinguished by the fact that it only benefits its actor. However, when one’s personal benefit includes the wellbeing and happiness of one’s tribe or group of belonging, the scope of self-interest extends beyond the self. Thus, altruistic behaviour emerges as an extension of self-interest, as described by Batson’s model (1987), where an overlap occurs between the self and the other. Moreover, the theory of reciprocal altruisms also supports the viewpoint that the motivation driving such behaviour is the expectation that it will be reciprocated in the future. As Hamilton (1964) suggested, natural selection would favour an altruistic gene if the benefit of altruism outweigh its cost, thus ensuring that altruistic behaviour is passed on to the next generation.

More recent research in evolutionary psychology, however, suggest that, has early humans learned to cook, and thus gained a more efficient and less time-consuming method for obtaining calories, the brain had the opportunity to develop its prefrontal cortex by increasing the number of cortical neurons (Gabi, et al., 2016). This development of the brain is significant as the relationship between the feeling of empathy and activity in the prefrontal cortex has been demonstrated both the research conducted with fMRIs (Seitz, et al., 2006), as well as in studies involving patients with brain damage to that region of the brain (Shamay-Tsoory, et al., 2003). As the human ability and capacity to experience empathy increased, the species was better equipped to deal with the evolutionary challenges it encountered on its path, as helping others would have increased the chances of survival through cooperation instead of pursuing rigid competition. Indeed, one crucial and distinctive feature of human empathy is that it is not restricted to interaction with kin, nor does it have to be prompted by the actual perception of distress signal or emotion contagion (Decety, 2011, p. 35).

The claim that truly altruistic behaviour would be impossible to demonstrate, however, was soon disproved by the research conducted by Dovidio et al. in 1990, in which an experiment with the goal to demonstrate purely egoistically motivated helping, as posited by the empathy-altruism hypothesis, showed the opposite, as also noted by Piliavian in 2009. This hypothesis posted that it would be in the individual’s self-interest to minimize emotional distress and thus when in the experimental condition participants were exposed to a person in emotional distress and then given the chance to help, it was thought that altruistic behaviour would decrease. Instead, the opposite was found to be true: participants would consistently help more in relation to the distress perceived. Such finding seems to indicate that the motivation driving altruistic behaviour is the same as the helping behaviour, as in an empathic response from individuals towards one another. The arousal: cost-reward model put forward in the research by Piliavin et al. (1981), does suggest that observing a situation of emergency, raises a state of arousal in bystanders that becomes increasingly unpleasant the longer it continues, thus perhaps explaining what would motivate the helping behaviour in such circumstances. This, however, does not apply when other people are present as, in such a scenario, another effect comes into play: the bystander effect, where the diffusion of responsibility can be observed and the reaction is heavily influenced by social influence (Darley & Latané, 1968).

Is altruistic behaviour, therefore innate or a social construct product of the required cooperation for ensuring survival? Studies have shown that small children display a preference for actors that demonstrate altruistic behaviour, as the research conducted by Hamlin et al. (2011) has shown. Further research has also shown that babies from the age of 14 to 18months, will help others without the expectation of any reward; interestingly, rewarding the behaviour appears to reduce its occurrence (Warneken & Tomasello, 2009). This would suggest, therefore, that altruistic behaviour is not only understood but also sought intuitively from an early age, thus validating, to some extent, Hamilton’s theory on the role of genes in the propagation of altruistic behaviour through the generations of the human species and thus that it is innate in humans.

Yet, the early theory of mind, pioneered by Jean Piaget in the 1920s, acknowledges that one of the states of early childhood development is egocentrism, in that the child is not yet aware that other people have different thoughts and feelings about the world. Although, there is evidence that helping behaviour remains stable throughout childhood, as the research by Zahn et al. (2001) suggests, developmental psychology identifies the achieving of the child recognizing its own mental state, thoughts and belief and, consequently the ability to infer the mental state of others, by the age of five (Hughes & Donaldson, 1979). Moreover, one of the stages of moral development identified by Kolhberg (1969) also shares the quality of altruistic behaviour: stage 3 – The morality of interpersonal concordance “Be considerate, nice and kind: you’ll make friends”. Such stage explicitly indicates the social value of prosocial behaviour as it helps create a new connection with other people using kindness as a currency, indicating, therefore, that altruistic behaviour is an acquired social tool in the developmental stages of childhood. Indeed, in a social world, reputation is as valid as a currency and consequently, altruistic behaviour acquires value to one’s group (Mifune, et al., 2009).

From a social perspective, moral foundation theory (Haidt & Joseph, 2004) suggests that there are fundamental rules to ethical behaviour that are true throughout all cultures as they are the foundation upon which moral behaviour is built upon. Of these foundations, two appear to reflect features of altruistic behaviour: the care/harm foundation, which underlies the virtues of kindness gentleness and nurturance, and the foundation of fairness/cheating from which the principle of reciprocal altruism and justice can be extrapolated. This would indicate, therefore, that altruistic behaviour is both a social construct, as much as it is one of the underpinnings of human cooperation that is innate of the human species on which rules for cooperation have been built upon.

Therefore, considering this body of research, altruistic behaviour could be understood to be both a product of human evolution, as well as the outcome of social reinforcement, as well as people’s empathic reaction towards the world around them. As experiments have shown (Coke, et al., 1978), helping behaviour is driven by one’s empathy, yet social influence also plays a role in the reaction time of the actual helping, if any does indeed occur (Piliavin, et al., 1981). The definition of Prosocial behaviour, however, indicates that it is the kind of behaviour that is generally beneficial to other people and to the ongoing social system (Piliavin, et al., 1981, p. 4). It has indeed been argued that the same emotional and cognitive processes which lead people to display altruistic behaviour towards strangers, constitute an inherent part of the human psychological equipment (Tamas, 2008).

In conclusion, it is undeniable that human altruism does indeed exist. Evolutionary theory and anthropological psychology both describe how it was a natural development of early humans have adapted to a changing environment, particularly stemming from the most important discovery of humankind: cooking, which then led to the ability to experience empathy with far more complexity than any other animal in nature. Consequently, this led to the development of the social structures at the foundations of civilization, from its moral and ethical rules to its cultures. Although innate, it is reinforced through childhood that helping one another is far more beneficial and advantageous than competing against each other.


Batson, D. C., 1987. Prosocial Motivation: Is it ever Truly Altruistic?. Advances in Experimental Social Psychology, Volume 20, pp. 65-122.

Coke, J. S., Batson, D. C. & McDavis, K., 1978. Empathic mediation of helping: A two-stage model.. Journal of Personality and Social Psychology, 36(7), pp. 752-766.

Darley, J. M. & Latané, B., 1968. Bystander intervention in emergencies. Journal of Personality and Social Psychology, Volume 8, pp. 377-383.

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Dovidio, J. F., Allen, J. L. & Shroeder, D. A., 1990. Specificity of empathy-induced helping: Evidence for altruistic motivation. Journal of Personality and Social Psychology, 79(2), pp. 249-260.

Gabi, M. et al., 2016. No relative expansion of the number of prefrontal neurons in primate and human evolution. National Academy of Sciences, 8 August.

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Hamlin, K. J., Wynn, K., Bloom, P. & Mahajan, N., 2011. How infants and toddlers react to antisocial others. Proceedings of the National Academy of Sciences, 108(50), pp. 19931-19936.

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Piliavin, J. A., 2009. Altruism and Helping: The evolution of a field: The 2008 Cooley-Mead presentation. Social Psychology Quarterly, 72(3), pp. 209-225.

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Richerson, P. J. & Boyd, R., 2005. Not by Genes Alone: How Culture Transformed Human Evolution. Chicago IL: University of Chicago.

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Shamay-Tsoory, S. G., Tomer, R., Berger, B. D. & Aharon-Peretz, J., 2003. Characterization of empathy deficits following prefrontal brain damage: the role of the right ventromedial prefrontal cortex. Journal of Cognitive Neuroscience, 15(3), pp. 324-337.

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Are Decisions Being Made With Patients’ Best Interests In Mind? Understanding Groupthink

OUTLINE: When making decisions concerning the care of patients, the team must ensure patients’ best interests are kept in mind. To ensure that the best decisions are being made, we will be looking at two psychological theories that consist of the main phenomena observed in the decision-making process and how they can be applied practically.


‣ In 1969, psychologists Moscovici and Zavalloni observed the tendency of members of a group engaged in the decision-making process to shift their initially held views to a more extreme position after a group discussion.

THIS LEADS TO riskier decisions being taken by the group and potentially going against the best interests of patients.

WHY DOES THIS HAPPEN? It has been suggested that this could be the result of a combination of two factors, here described by corresponding theories: social comparison theory, where we compare ourselves against others in order to pursue conformity, and persuasive arguments theory, where arguments brought forward are more likely to reinforce existing views of other members of the group. (Isenberg, 1986).

PLEASE REMEMBER, of course, that taking a more polarised view does not imply that the decision is necessarily wrong.


‣ In 1972, Irving Janis identified a phenomenon that was observed in group decision making where members’ desire to reach a unanimous agreement overrides the motivation to pursue a proper and rational decision-making process.

THIS LEADS TO the members having the illusion that the group is “invulnerable, moral and unanimous”, thus encouraging policing of the group to ensure conformity among themselves and others.

WHY DOES THIS HAPPEN? Because not all available options are being properly and fully evaluated by the group whilst also being unaware that discussions and evidence brought forward are more likely to further the dominant view.

ALTHOUGH empirical research on the concept has produced overwhelmingly equivocal support for the groupthink model, it is something to consider when reaching a decision as a team.


Methods for overcoming groupthink and group polarisation:

• Be impartial – don’t endorse any specific position.

• Assign a devil’s advocate.

• When possible, subdivide the group occasionally and reunite to air differences.

• Consult outside experts or colleagues.

• Call a ‘second chance’ meeting before implementing decisions.


The decision-making process must include provisions for ensuring that focus remains on patients’ best interests. As the two theories mentioned above have shown, it is with ease that members of groups may inadvertently fall into the trappings of seeking social conformity, thus leading astray from the desired outcome. A systematic and structured approach to this process is, therefore, recommended when undertaking the tasks of making decisions as a group, ensuring that all options are adequately considered and evaluated so that the patients’ best interests are kept paramountly.


Isenberg, D.J. (1986) ‘Group polarization: a critical review and meta-analysis’, Journal of Personality and Social Psychology, vol. 50, no. 6, pp. 1141–51.

Janis, I.L. (1972) Victims of Groupthink: A Psychological Study of Foreign Policy Decisions and Fiascoes, Boston, MA, Houghton Mifflin.

Janis, I.L. (1982) Groupthink, 2nd edn, Boston, MA, Houghton Mifflin.

Moscovici, S., and Zavalloni, M. (1969) ‘The group as a polarizer of attitudes’, Journal of Personality and Social Psychology, vol. 12, no. 2, pp. 125–35.

Considerations of systemic (family and relationship) issues in a counselling case study


The systemic approach to psychotherapy involves drawing from different approaches of therapy and, it is often useful when counselling family groups and/or individual cases within such groups. The key factor of this approach is to acknowledge the individual as a relational being that can only be understood as part of a social system (Vossler, 2016). In this approach, the focus is shifted away from the individual and towards its relationships and social interactions within the family group. As such, there is no ‘right’ way to interpret a situation but, instead, different perspectives to understanding it; conflicts that emerge can often lead family members to be ‘stuck’ in their interactions, thus requiring counsellors to draw from multiple approaches towards the development of multiple hypotheses. In this essay, the fictional case study of Davide and the relationship with his sister Rosa will be discussed to illustrate how a systemic approach to therapy might be more advantageous than any individual approach in resolving their relational conflict. Starting with a description of the case study, a discussion of possible interpretations and a few hypotheses will follow, with a further discussion on how a systemic approach would benefit the resolution of this hypothetical scenario.

Case study

Davide is a 66 years old man originally from Palermo, Italy, and has lived in the suburbs of West London for the past 30 years. He has recently moved in with his sister Rosa following a particularly difficult divorce that separated him from his only son. Davide used to be a restaurant owner for the past 25 years but has been forced to retire as the business did not survive the competition from the high street. Davide and Rosa migrated together to the UK in the 1980s, and they are from a strict catholic upbringing. She is younger by 5 years and has had a history of alcohol and heroin abuse that started after their relocation. Rosa has been relying on Davide for financial support for most of her life as she was never able to hold a job long enough to be independent. They were raised by their single mother and never met their father as he abandoned the family soon after Rosa’s birth. Their mother then passed away when Davide was in his early twenties, and he has looked after his sister ever since. He had been divorced before when he married young, with a local girl from Palermo, and it ended abruptly when he discovered she became pregnant out of an affair entertained with a childhood friend of theirs. This was the single motivator behind their migration. He then remarried a woman of Caribbean origin he met in the UK, and together they had a child. Years later she filed for divorce for unreasonable behaviour due to Davide spending most of his time absorbed by his business and never taking any real-time off; he was working 7 days a week with shifts of 15 hours a day at the time. After moving to the UK, Davide has never developed any real friendships other than with his ex-wife. The closure of his business followed soon after the divorce; he briefly attempted to return to the workforce as a cabbie driver for an online company, but lacked motivation and stopped soon after. Around the same time, he started having heated arguments with Rosa almost daily. According to his GP, Davide has lost significant weight in the past 6 months and has developed irregular sleep patterns often being unable to sleep at all for days in a row. He has also been experiencing episodes of panic attacks whenever outside of the house. Davide also reported being in a depressed mood most of the time and now feels unable to leave his room as moving anywhere requires considerable effort. Moreover, for the past six weeks, Davide has been experiencing suicidal thoughts.

Case study discussion

To understand Davide’s situation, a sociocultural perspective is required as he is originally from a small town in the south of Italy, where certain values about what it means to be a man are instilled from an early age. Qualities such as being hardworking, upholding one’s honour and patriarchy are at the core of Italian masculinity both in Italy and outside of the country’s boundaries (Perrotte, 2000). Thus, his inability to fulfil such standards inherited from his culture would potentially influenced his self-esteem and overall mental well-being. With his manhood in question, Davide may be unable to adequately react and adapt to the adverse circumstances he finds himself in. His age is also a factor to consider as, in combination with his perception of himself as a hard-working man, he is unable to return to the workforce in a way that he sees dignified. Moreover, as both he and Rosa experienced being migrants, being outsiders without speaking the language at first, they would have encountered a degree of difficulty in integrating into communities that could have impacted their ability to develop meaningful social connections. As Rosa was dealing with her own struggle to integrate, her path towards alcohol and heroin abuse could be explained by having made the wrong type of connections within the framing of this forced change of environment. Davide’s relationship with his sister is also affected by the lack of a father figure in their lives. Studies indicate that such absence can impact the economic and social as well as emotional well-being of children throughout their lives (McLanahan, Tach & Schneider, 2013). Moreover, since the death of their mother, Davide would have filled the role of a parent in Rosa’s life, altering their sibling relationship. It must be noted that southern Italy, particularly Sicily, is known to promote a strict hierarchical family structure where women are to ‘know their place’ from an early age (Cucchiari, 1990). Due to having moved to the UK at the cusp of cultural change, Rosa may not have benefited from the shift in perception of her womanhood and change of expectations of her gender. By swapping the familiar role of the caring brother to that of the surrogate father, Davide may have imposed his direction in life to Rosa, limiting her choices. By behaving in an overly protective manner, he removed that level of relationship that exists between accomplice siblings that would have been crucial for the development of her independence. Without that crucial emotional support, replaced by Davide’s role as a guardian in Rosa’s life, she was perhaps unable to fully experience freedom in adulthood (Namyslowska & Siewierska, 2010). Rosa’s path towards alcohol and heroin abuse can be, therefore, seen as the logical adaptation to a circumstance that was not of her choosing. Similarly, Davide might have felt that he had no choice but to help his sister, fuelling further his sense of responsibility towards her. Often, acts of love can be misunderstood as an imposition of control when that love is not communicated adequately, as in the case of Ryan from the documentary analysed in the module material (The Open University, 2016). Ryan’s perception of his mother trying to fulfil her role was perceived as an impediment to his freedom, leading to him aggressively resenting her and thus resulting in their damaged relationship during his teenage years.

Another aspect to consider is Davide’s trust issues that emerged following his first divorce as it would have impacted his ability to build new social relationships and friendships necessary to integrate into any community he would be part of. By developing a self-defence mechanism that did not allow him to trust anyone to get too close to him and his family, he also missed the opportunity to have the support that comes from such relationships. As his reaction to that event was to put literal distance between him and his past, it would have undoubtedly affected his identity in such a way that it influenced his behaviour for the remaining of his life. As a further defence mechanism, Davide would have found comfort in pouring all his energy into his work and becoming a workaholic. As the existential psychotherapist Yalom (1980 ) suggests, placing himself as the ‘ultimate rescuer’ would be a way to overcompensate and take control over his life (Yalom, 1980), albeit in the most dysfunctional manner that jeopardised his second marriage. Davide, therefore, feels he has no choice but to continually `sacrifice` himself for Rosa by providing financial support in the role of parent and elder brother.

Working with this client systematically

The first issue to address is that Davide would fit the diagnosis for ‘major depressive episode’ according to the criteria set in the DSV-IV. It is important to note, however, that these symptoms did not occur in a vacuum. They are the result of the deterioration and alteration of Davide’s social and personal relationships which have significantly impacted his perception of the world and of himself. Losing his business would have impacted his self-esteem, particularly due to how much of his time he spent working in it, as well as the breaking up of his second marriage and the separation from his only child. His recurring heated arguments with his sister, for whom he provides, are also to be considered in understanding the origin of his depressive mood. Therefore, systematically, this case would have to be approached from multiple perspectives.

Approaching this case systematically involves the participation of his sister Rosa, as their relationship is now identified by their arguments rather than by their biological bond and history. Davide and his sister are now `stuck` in a pattern of behaviour that is leading to an increasing conflict and are unable to resolve it on their own. Indeed, families can get `stuck` when unable to adapt to the changing demands of the `family life cycle` (Carter & McGoldrick, 1999). Since moving in with Rosa, Davide, partly due to his patriarchal upbringing and partly out of feeling a lack of control in his life, may have behaved in an increasingly overprotective and controlling manner towards his sister leading to their relationship spiralling outside of their normal roles.

During the course of systemic treatment, they would benefit from the practice of `reframing` both their relationship and their interaction. At present, Davide feels that his sister is being ungrateful towards him whilst she blames him for using her state of helplessness as an excuse for controlling and limiting her freedom. Another tool available to the systemic counsellor is that of engaging in circular questioning during the assessment phase. As Vossler (2016) notes, the answers can have illuminating effects and offer the potential to change their interaction (Vossler, 2016). Moreover, role-playing with the help of a team of counsellors would be beneficial for them as observers, as it would offer them a perspective of how the other feels in regards to their circumstances. As they are both resentful of the circumstance they find themselves in, they perhaps lack the ability to understand or see one another without the filter of their own narrative due to their excessive emotional investment in them. A team of counsellors would help by suggesting alternative narratives to their own. Indeed, as Vossler (2016) notes further, there are no `correct` assumptions about a situation, but there are multiple hypotheses that would be useful to trigger the change necessary for relationships to improve.

Davide and Rosa’s case can also be approached from a humanistic perspective as his depressive mood, loss of motivation and her feeling entrapped in a situation, not of her choosing, would be understood as a state of incongruence. Their idea of themselves is at odds with the reality of the situation they find themselves in, thus leading them to a loop in which the concept of the self is being threatened. This, in turn, leads them to feel increasingly anxious and vulnerable, potentially blocking them from getting ‘unstuck’ as they are incapable of understanding the cause of their pain.  


In conclusion, this fictional case study has illustrated the importance of approaching therapy by acknowledging the relationship of individuals and the social interactions that occur first in the family as well as the social environment surrounding them. Davide and Rosa have both found themselves in circumstances not entirely of their own choosing and were unable to adapt to changing demands of the family life cycle; their interaction deteriorated due to their inability to adequately communicate their intentions leading them to be both ‘stuck’ in their own narratives and, therefore, unable to make the necessary changes towards a resolution on their own. Approaching cases like this systematically allows the counsellor to adequately attend the full sphere of factors that lead individuals like Davide and Rosa towards the deterioration of their mental well-being, as all perspectives are considered as well as offering the benefit from different therapeutic approaches towards a path of improvement and, hopefully, resolution.

2137 words


Carter, B., & McGoldrick, M. (1999). “The expanded family lifecycle. Individuals, family and social perspective”. Boston, MA: Allyn and Bacon.

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Langdridge, D. (2016). “Existential psychotherapy”. In The Open University, Understanding counselling and psychotherapy (pp. 125 – 143). London: The Open University.

McLanahan, S., Tach, L., & Schneider, D. (2013, July). “The Causal Effects of Father Absence”. Annual Review of Sociology, 39, 399-427. doi:DOI: 10.1146/annurev-soc-071312-145704. Online, accessed on March 8, 2017.

Namyslowska, I., & Siewierska, A. (2010). “The significance and role of siblings in family therapy”. Archives of Psychiatry and Psychotherapy, 1, 5-13. Retrieved from Online, accessed March 8, 2017.

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Salkovskis, P. M. (2016). “Cognitive-behavioural Therapy”. In The Open University, Understanding Counselling and Psychotherapy (pp. 145-166). London: The Open University.

The Open University. (2016). “The process of systemic family therapy – families getting stuck” [Video]. D240 Understanding counselling and psychotherapy. (accessed March 8, 2017) 

Vossler, A. (2016). “Systemic approaches”. In The Open University, & A. V. Meg Barker (Ed.), Understanding Counselling and Psychotherapy (pp. 191-210). London: The Open University.

Yalom, I. D. (1980). “Existential psychotherapy”. New York: Basic Books.

Working with Fear and Sadness: Existential methodology VS Cognitive-Behavioural approach.


Following Freud’s popularisation of psychoanalysis, his successors found that the approach they had been taught did not, fully satisfy the needs they were confronted with. Although psychoanalysis is preoccupied with past events, the subconscious, the intangible which lies below the surface of consciousness, it did not deal with the immediacy of the present, such as those experiences that preoccupy the day-to-day life reality of people seeking therapy. New theories and new approaches to counselling emerged in response, some with philosophical roots such as existential therapy, and others backed by scientific research such as cognitive-behavioural therapy. With an emphasis on the present and the future rather than the past, Existential therapy was developed at the dawn of the 20th century and refined in the last 30 years, stemming from ideas of existential philosophy from the 19th century onwards. Similarly preoccupied with resolving immediate psychological problems, Cognitive-Behavioural Therapy (CBT) focuses on dealing with the management of symptoms. Emerging from theories on cognitive and behavioural approaches, it evolved as a therapy method thanks to the work of Beck (1976) on the cognitive theory of emotion (Beck, 1976). This essay will discuss these two approaches by comparing and contrasting them in relation to understanding fear and sadness, starting with a summary of each and a discussion of their similarities and differences, merits and flaws, concluding with an explanation of why an evidence-based approach, such as CBT, is more adequate in understanding anxiety and depression.

The Existential Approach

Existentialist philosophy focuses on the individual’s responsibility to existence, freedom and choice. When, in the 19th century, Kierkegaard proposed that the responsibility of finding meaning in life lies with the individual, he did so to counter the prevailing thought of the time, dominated by the hierarchical doctrine of Christianity (Stanford University, 2016). This idea on the individual’s responsibility is what led Nietzsche and other philosophers to build upon it and develop it to its current form, highlighting the importance of acknowledging the inevitability of the “human condition” and one’s own fate. These ideas then influenced the development of the existential approach to therapy by Ludwig Binswanger and Medard Boss in the early 20th century as an alternative to the psychoanalytic model, which they both had been trained in, and by the work of Emma Van Deurzen and Ernesto Spinelli in recent years, with their further contribution in refining the method of practice(as cited in Langdridge, 2016). This therapeutic approach focuses on the phenomenological method, which aims to understand the world as it appears to the client, without prejudices. This method engages in a process known as epoché and is divided into four parts, beginning with bracketing where the therapist attempts to better understand the world of the client by setting aside prejudices and preconceptions during an initial assessment. This leads to the building and developing of an understanding of the client’s state of mind from their point of view allowing for an authentic relationship to form during therapy. Following this, the next step is to describe the world as it is, rather than seek reasons and explanations as to why things are the way they are, empathising the experience of the world, rather than its meaning. Once the experience is described, the step that follows is to horizontalize it, so as to avoid placing hierarchical importance when compared to other events. In the mind of the counsellor, during this step, all events and experiences described by the clients are of equal importance. Finally, the counsellor will seek to verify their understanding of the client’s experience to ensure its description accurately reflects their reality by engaging in a conversational approach focusing on the what and how. During the process, the counsellor is highly engaged and entertains a dialogue with the client, where ideas from existential philosophy are occasionally used as tools to bring self-awareness to one’s self, as well as awareness of the world as it is. This awareness, both of the self and the world, can then be directed towards the realisation of the client’s potential and freedom to choose their own path, as existential therapy aims to eradicate what obstacles that lead to it.

The Cognitive-Behavioural Approach

In the 1960s, following the research on behaviourism led by Skinner which built upon the work on conditioning by Pavlov, theories of cognitive and behavioural approaches emerged in response to the dissatisfaction and inadequacy offered by traditional psychoanalysis in the 1960s. However, these ideas on their own did not offer a useful approach method (Salkovskis, 2016). When Arron Beck, a trained psychoanalyst, was conducting research on dreams, he noticed how the thematic content did not reflect the existing notion in psychoanalysis of wish fulfilment (as cited in Salkovskis, 2016). As Salkovskis (2016) notes, those dream accounts involved more of the everyday experience, daily concerns and fears of people, rather than their subconscious desires (Salkovskis, 2016). This led Beck (1976) to develop his theory of cognitive emotion (Beck, 1976). This theory proposes that it is not so much the events causing an emotional response but the meaning attached to it. Beck’s theory suggests that the meaning an individual assigns to any given event is the result of a complex interaction between that person’s mood state, context and personal history. As Salkovskis (2016) notes further, “Often the meanings are conscious, sometimes there are not, but with careful questioning they can be identified” (Salkovskis, 2016). This therapeutic method involves identifying the client’s issues and obstacles so as to find ways to overcome them by offering alternative narratives, often challenging a pre-existing belief. The approach begins with an initial assessment where clients are asked about how their psychological problem or problems are affecting their lives and identifying what coping mechanisms they have devised to overcome them. Outlining the goal sought by the client in terms of short, medium and long term, helps design the trajectory of the therapy sessions as well as provide realistic objectives. The relationship that builds between the counsellor and the client is akin to an alliance, where an emphatic response to the client’s experience helps build the trust necessary throughout the process. Following this, a more specific assessment takes place where the counsellor works with the client to understand how the problem works, identify a recent occurrence, and work through understanding the process by deconstructing it. This leads to a formulation in which the vicious cycle is broken into easily identifiable parts, with an emphasis on the cognitive mechanism which feeds the intrusive or negative thoughts and the safety-seeking behaviour. This formulation is then put forward to the client as a theory to the problem, followed by a discussion leading to an alternative interpretation of the stressful event. Understanding the client’s own coping strategy is key to the process and leads to the development of an alternative theory in an attempt to break the cycle. Throughout the course of the therapy, the client will be encouraged to engage in behavioural experiments so to determine what works and what does not. This offers the client an opportunity to evaluate their own belief and to consider alternative cognitive behaviours to take outside of the therapy.

Existential vs Cognitive-Behavioural Approach

Fear and sadness, respectively an extension of anxiety and depression, are interpreted differently by each approach. Kierkegaard saw anxiety as the price to pay for freedom and Martin Heidegger described it as a fundamental feature of human existence (as cited in Langdridge, 2016). Furthermore, Langdridge (2016) goes on to explain that existential psychotherapy sees fear as a form of anxiety, better understood as a universal aspect of existence rather than a diagnosis (Langdridge, 2016). Similarly, sadness and depression are interpreted in the existential approach, as a consequence of a person’s restricted understanding of the world and thus unable to be truly free. Eugene Minkowski proposed that depression is the manifestation of an unfulfilled or unrealised potential leading to existential guilt. This notion leads to entrenched beliefs which, in turn, work towards reinforcing it. Thus, the phenomenological method helps identify which aspects of the world are being ignored and which are instead being embraced. Whereas in CBT, fear and anxiety are viewed within a cognitive framework, where meaning is attached to what is happening and thus, can be changed by proposing alternative ways of thinking. Similarly, sadness and depression are also viewed as problems to be tackled by behavioural experimentation: a process aimed at breaking the pattern of behaviour that leads to the reinforcement of the psychological problem. Both approaches acknowledge the vicious cycle of negative thought and offer different ways to counter it. As described above, breaking from traditional psychoanalysis, both approaches are not preoccupied with the past in their treatment methods, but instead focus on how to empower the individual to move forward. Albeit in different ways, they both aim at an awareness of the client of how things are so that to help understand how the world works. Existential therapy seeks to help the client by raising self-awareness as a means to cope with the inevitability of existence. CBT, on the other hand, is more concerned with the attributed meaning of events, finding ways to challenge preconceived beliefs in order to alter the self-reinforcing pattern of negative behaviour. In the methodology of existential therapy, all events are dealt with as equally important whereas in CBT the focus is on the most recent occurrence of the problem that is to be resolved. Both approaches aim at empowering the client to choose their own path, thus both approaches can be said to be neither directive nor non-directive but rather directional. Critically, however, CBT is an evidence-based approach where behavioural experiments play a key role during the therapeutic process; on the other hand, existential therapy, although based on a significant body of work, lacks empirical evidence and does not offer reliable methods of quantifying progress during the process. Moreover, the existential approach to therapy relies heavily on the ability of counsellors and their knowledge with a considerable intellectual toll, as philosophical ideas must continuously be engaged with, outside of the therapeutic sessions and developed to fit the client’s needs during the process (Langdridge, 2016). Both approaches do require a level of high engagement with the client, as in both cases the process is based strongly on a relationship built upon trust and understanding. A criticism that both approaches face is the risk that such therapy may resolve in worsening the condition of the client, as the process can potentially feed the pre-conceived notion and negative thought into the intrusive pattern which leads to the psychological problem.


In conclusion, an evidence-based approach is, in my opinion, more equipped, than one lacking empirical evidence on its benefits, to understand how to better deal with fear, sadness, anxiety and depression. Although, there are undeniable merits to the existential approach to therapy, such as when assisting terminally ill patients (Spiegel, 2015), it may lack day-to-day practicality when dealing with issues that a client suffering from anxiety or depression encounters, as it appears too abstract in its interpretation. Furthermore, there is evidence that CBT does alter brain connectivity over time (Liam Mason, et. al 2017). Also, CBT has been proven to be an effective method of treating phobias via the method of graded exposure (Salkovskis, 2016). It is indeed due to the growing amount of empirical evidence that CBT is rapidly evolving, making it an increasingly effective treatment alternative to a pharmacological approach (Kathryn McHugh, et. al 2013). Moreover, it is worth noting that neither approaches are set in stone nor are their methods definitive. Both existential therapy and cognitive-behavioural therapy are still evolving, often one borrowing ideas from another. As discussed, Freud’s psychoanalyst approach was unsatisfactory for the 21st century, leading to the emergence of alternative therapies and approaches, such as the humanist and the more recent mindfulness approach. The tools and technology available to contemporary research are helping, now more than ever to determine which is more effective, but not necessarily excluding one over the other. In my opinion, cognitive-behavioural therapy is a more effective approach because of its roots in the scientific method as well as the growing evidence of its effect on the wiring of the brain, thus leading me to conclude that it is a more efficacious approach in understanding fear and sadness.


Beck, A. T. (1976). “Cognitive Therapy and the Emotional Disorders”. New Yotk: International Universities press.

Langdridge, D. (2016). Existential Psychotherapy. In T. O. University, Understanding Counselling and Psychotherapy (pp. 125-143). London: The Open University.

Mason, L. Peters, E.Williams, S.C. and Kumari, V. (2017). “Brain connectivity changes occurring following cognitive”. Translational Psychiatry, 7. doi:doi:10.1038/tp.2016.263. Online, accessed on January 28, 2017. Available at

Kathryn McHugh, R. Sarah W. Whitton, Ph.D., Andrew D. Peckham, B.A., Jeffrey A. Welge, Ph.D., and Michael W. Otto, Ph.D (2013). “Patient Preference for Psychological vs. Pharmacological Treatment of Psychiatric Disorders: A Meta-Analytic Review”. The Journal of Clinical Psychiatry, 74(6), 595-602. doi:10.4088/JCP.12r07757. Online, accessed on January 28, 2017. Available at

Salkovskis, P. M. (2016). Cognitive-Behavioural Therapy. In The Open University, “Understanding Counselling and Psychotherapy” (pp. 145-166). London: The Open University.

Spiegel, D. (2015). “Existential Psychotherapy for Patients”. JOURNAL OF CLINICAL ONCOLOGY, 33(24). Online, Accessed on January 28, 2017, from

Stanford University. (2016, July). “Søren Kierkegaard”. Online, accessed on January 28, 2017, from Stanford Encyclopedia of Philosophy:

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