Aetiological component (where do problems start?)

Being-in-the world & flow of experiencing
• Whether we like it or not, our lives are always embedded in a 'world'. Our world offers various threats/limitations and resources/opportunities. This includes our 'human condition', 'existential boundaries' and 'life givens', such as our mortality, freedom, and paradoxes (‘life’s givens’; others: ‘ultimate concerns’)
• We cannot know with absolute certainty whether there is a 'Reality' or 'World' (this is a theoretical and metaphysical question), but we do have our subjective, authentic flow of experiencing ourselves inside the world. 
• Existential therapists help clients to check whether the explanations/appraisals and meanings they developed about themselves and the world, actually align with their subjective, authentic flow of experiencing. They help clients to focus on, accept and describe their flow of experiencing in most open way possible (‘phenomenological bracketing’) to understand how we are in the world. 

Being inside or outside of the flow of authentically experiencing life
In overly simple terns, humans have two options (although reality is more gradual):

• Be inside the hot flow of experiencing: We may accept and stay close to our authentic flow of experiencing. For example, people describe this as flow, mindfulness, peak experience, life satisfaction, and describe this with the present particle (-ing) and adjective, e.g. ‘I feel that I’m living a meaningful life

•Be outside the hot flow of experiencing life: We often avoid, deny or transform our experiences, partially or entirely, for example, due to the influences from our social context (society, social networks, personal life situation), our appraisals, and the meanings we envision and try to realise in our world. For example, people describe this with symbols and imagination, ‘heady’, theoretical, disconnected, and with nouns, such as ‘The Meaning Of Life’. The psychiatrist Viktor Frankl called this 'hyper-reflection' and 'hyper-intention'.

Three appraisals
Existential therapists rarely use the term 'appraisal', but their therapeutic models often align with the appraisal model from Crystal Park. Clients usually present their appraisals, NOT their primary raw experiences.

• Primary appraisal: This involves an individual's assessment of the threats and limitations of their situation. Individuals may accept the threat/limitations, or change their perception of these, for example, due to existential defence mechanisms against feelings of terror. Terror Management Theory for example demonstrates that individuals may use 'proximal defences' such as in the short-term ignoring reminders of the threats/limitations, avoiding, or distracting; individuals may use 'distal defences' such as in the long-term creating complex meaning systems, identities, and culture. 

• Secondary appraisal: This involves an individual's assessment of the resources and opportunities, or lack thereof, in their situation. This may involve external resources, such as money, social support, and socioeconomic status. This may also involve internal resources, such as skills, resilience, coping styles, life experiences, and attitudes towards the situation.

• Tertiary appraisal: This involves an individual's assessment of their responses and decisions to the threats/limitations and resources/opportunities. In other words, this is about how individuals try "to live a meaningful life in spite of everything". This is about how individuals negotiate the meaning of a specific situation with their global sense of meaning in life. Research has shows that people have an evolutionary, neurobiological drive, motivation or will to try to live a meaningful life. 

Therapeutic mechanisms of change (how could therapists help?) 

• Primary appraisal: Existential therapists may help clients identify defence mechanisms, tolerate existential anxieties, and accept their experiences as they appear in flow of experiencing, for example with the help of methods such as phenomenological explorations., focusing and mindfulness.

• Secondary appraisal: Existential therapists may help clients in doing a realistic assessment of their resources/opportunities to cope with their realistic threats/limitations, such as the existential priest Martin Niebuhr's Serenity Prayer said: " God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference". Existential therapists often underline the freedoms and responsibilities that individuals may have, even in challenging life situations, which Joel Vos called a 'dual attitude' that he found in the work of many existential therapists, like Viktor Frankl stimulated clients to have a combined attitude of optimism and a realistic understanding of the tragic limitations of their situation ('tragic optimism'), Karl Jaspers spoke of 'transcendence', and Soren Kierkegaard spoke of a 'leap of faith'.  

• Tertiary appraisal: Existential therapists may explicitly and systematically explore a client’s freedom and responsibilities, and help them to live a meaningful life despite life’s givens, prevent black-or-white rigid responses and decisions, and stimulate a focus on dual attitude.