Conference Agenda

Existential psychotherapy is grounded in existential philosophy, which describes the basic conditions of human existence. We are thrown into the world without choosing when, where or as whom we are born. We are mortal and our life unfolds towards death form the moment of birth. There is no pre-given life meaning. Religious, philosophical or value systems can be chosen, but none of them finally exempt us from deciding how and for what to live. As Sartre puts it, we are “condemned to freedom”: we did not create ourselves, yet we remain responsible for what we do.

In a suicidal crisis these existential givens are experienced with particular sharpness. Life may feel meaningless, death not only inevitable but also relieving, and the person can feel entrapped in an unbearable situation. On one level, clinicians help patients address specific psychological problems that lead to suicidal ideation or behaviour. On another level, these problems also have an existential dimension.

A clearer awareness of existential givens can help clinicians perceive suicidal patients’ difficulties more broadly, recognising in them not only individual deficits or failures, but also universal human struggles. This may support patients in accepting that part of their suffering is linked to what cannot be changed in life and must be borne rather than solved. Such a stance is crucial, because not all problems in a suicidal crisis are technically fixable.

In facing such issues, the therapist’s presence becomes central. Existential psychotherapy emphasises being with the client rather than primarily doing for the client. Instead of relying only on interventions directed at change, the existential therapist seeks to accompany the person in their darkest moments so that their pain is no longer endured in total isolation. This shared presence can make previously unbearable suffering more bearable.

Background: There is a need for age-adapted treatments for older adults with psychological distress and existential therapy could be of particular relevance for mental health issues related to aging. The aim of this study was to understand the process of existential therapy for older adults by exploring how pathways to change are expressed in experiences from existential group treatment.

Methods: Seventeen participants aged 75 and above with psychological distress took part in individual interviews after completion of a 7-week existential group treatment in primary care. The participants were recruited from five primary care centers in the Västra Götaland Region of Sweden. Data were analyzed using thematic analysis in relation to pathways to change in Wampold's Contextual Model of Psychotherapy.

Results: The analysis resulted in six themes. Central themes in understanding pathways to change in existential group treatment for older adults were Dare to talk about life and death, Letting myself be old, and Making the most of life despite difficulties. When recognizing things as they are and being able to face the reality of being old without avoidance, a wish to make the most of life despite difficulties emerged. Perspectives on the therapeutic process also included Commitment matters, Engaging with others and Developing new and different relationships. These themes captured the participants' experiences of choosing to commit to treatment and the relational process of engaging in existential group treatment.

Conclusions: Older adults' experiences of existential group treatment suggest that engaging in existential dimensions of aging can be helpful when done in a structured setting together with others. Reduced experiential avoidance, increased determination to do what feels meaningful, relational aspects as well as one's own commitment to therapy can help explain how existential group treatment may contribute to change among older adults with psychological distress.

Theoretical background: Brief Cognitive Behavioral Therapy (BCBT) is a mechanism-focused psychotherapy that has repeatedly demonstrated significant reductions in suicide attempts across multiple randomized clinical trials. Recent methodological advances, particularly within optimization science, offer opportunities to sharpen the precision and efficiency of BCBT.

Research question: Which therapeutic components and change processes within BCBT most strongly contribute to reductions in suicide risk, and how can optimization methods improve the treatment’s precision and real-world utility?

Method: Using the Multiphase Optimization Strategy (MOST), individual BCBT elements—such as narrative assessment, crisis response planning, and emotion regulation skills—are systematically isolated, evaluated, and compared. Iterative experimental cycles assess the mechanisms by which each component influences suicidal thoughts and behaviors, and determine which elements are active, redundant, or in need of refinement.

Results: Emerging evidence indicates that specific BCBT components disproportionately drive therapeutic change. Optimization cycles have supported the removal of inactive procedures, streamlined intervention delivery, and enhanced those components most directly associated with rapid symptom improvement and stabilization.

Conclusion: Optimization science provides a rigorous framework for refining BCBT and increasing its impact. By identifying what works, for whom, and under what conditions, next-generation psychotherapies can more precisely target mechanisms of change and yield stronger, more durable outcomes in suicide prevention.

Theoretical Background: ASSIP flex is an optimized adaptation of the original ASSIP brief intervention. Its flexible delivery across inpatient, outpatient, and home-based settings helps bridge care gaps at critical transition points. The format enables the activation of core therapeutic processes: building a strong therapeutic alliance through the narrative interview; fostering cognitive restructuring and emotional integration via video playback; and developing an individualized treatment and safety plan within the patient’s personal case formulation of suicidal behavior, supported by a sustained therapeutic bond maintained through long-term follow-up letters.

Research question: Under which clinical, organizational, and population-related conditions can ASSIP’s mechanisms of action be reliably activated, and for which patient groups and care contexts is ASSIP flex particularly suitable?

Method: The analysis draws on two complementary observational studies. A longitudinal subanalysis (N = 64) examined changes in therapeutic alliance, self-efficacy, and suicidal ideation across the three sessions. A feasibility and implementation study (N = 105) assessed clinical changes, acceptability, and practical delivery of ASSIP flex in inpatient, outpatient, and home-based settings.

Results: ASSIP flex reliably activated key mechanisms of change. Therapeutic alliance strengthened across all sessions, and self-efficacy increased significantly, with these increases negatively associated with suicidal ideation. However, the effectiveness of these processes was content dependent. Full delivery of intervention elements, methodological fidelity, and sufficient therapist support proved essential. Patients with lower clinical complexity, fewer comorbidities, and more stable baseline conditions responded more favorably, whereas individuals with higher burden showed reduced responsiveness.

Conclusion: ASSIP flex demonstrates that core therapeutic processes can be effectively activated across diverse clinical contexts when delivery is structured and well supported. Its flexible format enhances continuity of care and responsiveness to individual needs, offering a practical approach toward more adaptive and person-centred suicide prevention.