What Are Ultimate Concerns?

Existential theologian and philosopher Paul Tillich first introduced the concept of ‘ultimate concerns’ in his 1952 work. These are the things that matter most to us, providing our lives with a sense of commitment, meaning, and purpose. Our ultimate concerns influence our values, choices, and actions, even if we don’t always acknowledge or admit to them.

Exploring and clarifying our ultimate concerns is an essential task in psychotherapy. However, most modern psychotherapy is symptom-focused, goal-oriented, and technique-driven, often neglecting the patient’s ultimate concerns.

For instance, a patient might start discussing beauty, God, death, or the problem of evil in therapy sessions. Some might view this as irrelevant or off-topic, but these archetypal ultimate concerns are at the heart of what therapy is really about: helping people discover what truly matters to them and provides their lives with meaning, purpose, and significance.

Why Do We Need to Address Ultimate Concerns in Therapy?

Therapy should be receptive to a patient’s ultimate concerns, as these concerns often drive their symptoms and problems. Ignoring or dismissing these concerns can lead to a lack of meaningful progress in therapy.

For example, a patient might express their concern about beauty, which is closely connected to their existential reality of evil, loss, suffering, tragedy, disease, and death. Addressing these ultimate concerns can help patients become more fully present, aware, and accepting of themselves, others, and the world.

Therapist Rollo May shares his own experience of rediscovering beauty in his semi-autobiographical book ‘My Quest for Beauty’ (1985). He recounts how, during a nervous breakdown, he stumbled upon a sea of wild poppies in Greece and experienced a life-altering epiphany, realizing that he had not listened to his inner voice about beauty. This reawakening helped him lift out of his despair and propel him toward a new, more authentic, creative, and vital life.

The Therapeutic Value of Addressing Ultimate Concerns

Addressing ultimate concerns in therapy can have a profound impact on a patient’s symptoms and suffering. By acknowledging and addressing these concerns, therapists can help patients grapple with existential questions and find meaning, purpose, and significance in their lives.

Therapist Rollo May shares a memorable therapy session with a patient who, despite being focused on her mundane marital problems, started discussing beauty, God, death, and evil. May assured her that no topics could be more important than these, highlighting the significance of addressing ultimate concerns in therapy.

By including spiritual and existential questions in therapy, practitioners and patients can recognize the pragmatic therapeutic power, relevance, value, significance, and profound importance of acknowledging and addressing our ultimate concerns. This can lead to a more meaningful and fulfilling therapeutic experience.