Integrating Existential Therapy and Cognitive-Behavioral Strategies in the Treatment of Self-Harm: A Case-Based Application

Abstract

Self-harming behaviors commonly emerge from complex emotional, cognitive, and existential struggles. This case-based article presents an integrated therapeutic approach that combines elements of Existential Therapy and Cognitive-Behavioral Modification (CBM) to treat a young female client exhibiting depressive symptoms, unresolved emotional conflict, loneliness, and recurrent self-harm arising from maladaptive self-talk. Across eight structured sessions and follow-up visits, the intervention aimed to help the client explore the meaninglessness she experienced, reconstruct a sense of purpose, and replace irrational internal dialogue with healthier cognitive patterns. The treatment process involved: (1) identifying repressed emotions and the existential vacuum underlying the client’s despair; (2) guiding the client to discard old, harmful assumptions about self-worth; (3) fostering new personal meaning based on Viktor Frankl’s logotherapy framework; and (4) applying CBM techniques to restructure negative self-statements, develop adaptive internal dialogue, and acquire practical coping skills. Post-intervention evaluation indicated substantial reduction in self-harm behavior, improved emotional regulation, re-engagement with family, and the establishment of meaningful short- and long-term life goals. This integrated approach demonstrates how combining existential meaning-making with cognitive restructuring can provide an effective pathway for clients whose self-harming behaviors stem from distorted self-perception, isolation, and unresolved emotional experiences.