Existential Exchanges 3: The Sublime

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/07/22

Sapira Cahana is a New York-based mental health counsellor (MHC-LP) and is an interfaith chaplain-in-training specializing in existential and relational therapy. Sapira Cahana and Scott Douglas Jacobsen explore the concept of the sublime as both a Romantic heritage and a contemporary phenomenon. Originating in the late 18th century as a reaction to industrialization, the sublime was sought in vast natural landscapes by figures like Wordsworth and Coleridge. Today, artificial means—classical music, immersive technologies, algorithmic stimuli—can reliably evoke awe, yet risk hollowing out its authenticity by masking its existential depth. True sublimity, they argue, arises from organic encounters—nature’s unpredictability, human relationships, ritual, and contextual rootedness—that confront us with infinity, shadow, and wonder, fostering genuine meaning and connection.

Scott Douglas Jacobsen: Today, we’re here once again with the philosophically broad-minded therapist, Sapira Cahana. We’re going to talk about the sublime. We’ve already covered comedy and the humdrum. So, when you think of the sublime—beyond the musical band—what comes to mind?

Sapira Cahana: First of all, thank you again for doing this with me. I find these conversations stimulating and enriching. Exploring topics we all care about with you is deeply rewarding.

The sublime evokes the Romantic period. The term emerged in the late 18th century as a response to modernity and industrialization, capturing our experience of transcendence in the face of grandeur. It was during the Industrial Revolution—when people fled polluted cities for remote natural heights—that Romantic thinkers sought solace in experiences that moved beyond everyday life.

Classic figures like William Wordsworth, Samuel Taylor Coleridge, and William Blake in Britain, and Goethe in Germany are central to Romanticism. They emphasized the sublime as a counterbalance to industrial rationalism.

Jacobsen: How are you defining modernity in the contemporary period?

Cahana: I begin with the Industrial Age—the rise of mechanization, urban crowds, and smog—pushing people toward mountaintops and untouched wilderness. That unrest birthed our modern idea of sublimity: seeking transcendence, now entwined with today’s ideologies.

Jacobsen: It does bring Tolkien to mind—The Lord of the Rings presents a countercultural critique of industrialization: the march on Isengard, the idyllic elves, and the harmony of nature versus destructive machinery. Do we see nostalgia for a pre-industrial “natural” life cropping up repeatedly in literature and culture?

Cahana: Absolutely. This is central to Romantic imagery: nature as an antidote to industry. Artists like Caspar David Friedrich painted lone figures and mountainous vistas to evoke awe and introspection. You mentioned invisibility in modern industry—reminds me of a thought attributed to Neil deGrasse Tyson: if car emissions were visible, people wouldn’t drive them. The hidden nature of pollution makes it acceptable. It’s an industrial convenience built on invisibility.

The power of the sublime often depends not just on sight but on the phenomenological experience—intense feelings of awe, terror, or grandeur. The Romantics heavily emphasized natural spectacles—stormy seas, towering mountains—as conduits for sublime experience. But the sublime can also emerge in human relationships.

Jacobsen: Do you believe the sublime relates to the physiological response to that sense of awe or transcendence that nature can produce?

Cahana: Yes—while nature is a classic source of the sublime, so are profound human encounters. Intense emotions—whether in beauty, love, or existential revelation—can trigger a cognitive suspension and physiological rush akin to the sublime.

Jacobsen: What are the artificial ways we try to recreate these experiences? Much classical music over the centuries was oriented toward this. It was often composed in deeply religious contexts. Still, nonetheless, it was rooted in a profound devotion to something unseen, something that may or may not exist, but devotion to something invisible, regardless.

Cahana: Yes, I recently attended a workshop where I listened to opera in the forest, among the trees. It took the Romantics out of the opera house. It placed them directly into nature, which produced different emotional invocations—or perhaps evocations. The emphasis on the emotional state intensifies the sublime. It amplifies it. Yes.

Jacobsen: Is there a threshold for the sublime? Can you even experience the sublime in an industrial context?

Cahana: Right. That’s an important and fascinating question. You alluded to it earlier, and I was thinking of Robert Nozick’s “experience machine.” It’s a thought experiment about hedonism—whether people would choose simulated pleasure over authentic experience.

Nozick argued that even if the machine provided maximum pleasure, something would still be missing. It would feel simulated—inauthentic—and most people would not choose to plug in. He concludes that we want more than pleasure; we want meaning and genuine connection. This brings to mind works like Brave New World by Aldous Huxley—literature that explores artificial experiences of pleasure that appear intense but ultimately feel empty or dehumanizing.

I wonder—this is just speculation—but perhaps that’s why naturally induced ecstatic states, like those from ecstatic dance, breathwork, or even childbirth, are so revered. They represent organic, full-bodied experiences that contrast with synthetic ones. We seem to valorize those states and look suspiciously at simulations.

It’s because the shadow side of simulated experiences looms large. It casts a long shadow over the pleasurable aspect of artificially induced sublimity. In contrast, when the sublime is naturally produced—emerging through practice, ritual, or careful preparation—the shadow is worked through more organically. It’s anticipated. It’s processed. I wonder what you think about that. I’m curious.

Jacobsen: I think so. The Canadian pianist Glenn Gould, who was especially famous for his interpretations of Bach, comes to mind. He died in 1982. He visited the Soviet Union and played a little Bach and other pieces of music they hadn’t heard live in some time.

To some, it may have felt alien, mechanical, or even divine—yet it was a man, sitting at a piano, performing with deep devotion. He, along with Herbert von Karajan, was an early pioneer of recorded music. They foresaw an era where music became a private, immersive experience—listened to alone in a room, during a jog, or while biking—enriching our engagement with the world around us.

Much of the music people play in those settings is banal or repetitive. Still, some of it—at the right moment—can provoke awe, even in the heart of an industrial environment. Think of New York City: people with headphones on, listening to a favourite track on repeat for hours. That, too, can be a sublime experience—personal, transcendent—even amid the noise and chaos of urban life.

You always have Philharmonic orchestras in various cities, and those performances can provide the sublime on a larger scale. But the artificially induced sublime can be achieved—it can be done reliably and repeatably.

So, in some sense, newer technologies blur the line between the industrial period and the Romantic ideal of a more idyllic past. The Romantics chose to move away from the industrial context toward something more ideal. Still, you could not necessarily reverse that movement.

To live in that artificial context, you must first build the entire industrial infrastructure. It is not a vice versa situation. You cannot have the artificially sublime without the industrial scaffolding that enables it in the first place. So when it comes to inducing sublime experiences, whether privately or publicly, the context matters deeply.

Cahana: Yes. That’s about inducing. There’s something mechanical that strips away layers of mystery. It tends to amplify a sense of meaninglessness. The trajectory of the sublime aims toward transcendence—toward ultimate meaning, a sense of oneness, or even non-dualism, depending on your philosophical lens.

But when the experience is metabolized in a way that is deliberate, IV-dripped, algorithmically generated—when it is produced through engineered dopamine hits—it takes on a sinister undertone. It undermines the confrontation that authentic sublimity offers: the experience of infinitude, solitude, depth, the abyss. Ultimately, it’s this confrontation that leads to wonder.

There’s an almost alchemical quality to this movement into the infinite. It is not culturally exclusive, even though its intellectual framing comes out of the Enlightenment and the Western philosophical tradition. It feels more universal. It speaks to a human capacity for wonder. It’sn’t limited by culture.

Jacobsen: That brings something to mind—a minor footnote. There’s a not-so-well-known documentary about Glenn Gould by Bruno Monsaingeon, titled The Alchemist. It portrays him, I think, before the significant decline in his mental health. He eventually suffered a stroke and passed away.

But the other thought is that our current fears—especially around audio-based artificial intelligence—might be misplaced. These systems rely on statistical reproduction, not true generativity.

Noam Chomsky has a famous point in linguistics: language systems are built from a finite set of rules and symbols, but they permit infinite generativity. That is, from a finite base, we can produce endless meaning. We need those boundaries to allow for infinite variation—for different styles and flavours of infinity, so to speak. Human communication happens within this context.

These AI systems, on the other hand, are based on finite statistical models that tend to loop. Think of your favourite song played over and over again. Our evolved context assumed peak experiences happened rarely, sporadically. But we’ve created superstimuli—intense inputs designed to elicit robust responses—that we plan for and repeat obsessively. This may be out of sync with our evolved emotional and cognitive systems.

So, to your earlier point about dopamine and other neurochemical effects, yes—it can resemble a drug. And as with most drugs, overuse can leave us unbalanced. We may be leaving ourselves vulnerable to emotional and cognitive imbalance due to these engineered experiences. We are not fully accounting for that.

And yet, we tend to focus only on the more obvious cases. But even subtle artificial stimuli can impact us in profound ways. This brings me to two additional thoughts. First, the value of more natural environments, where there is an ebb and flow that matches human rhythms. And second, the richness of human relationships within those environments, where you’ve had these profound experiences. And they, in a sense, mean more because they happen less often.

Cahana: They occur less frequently, yes—but they’re also situated within a community that recognizes ebb and flow. So, while there may be death in one’s life, there’s also birth. In a kinship model, you’re in a relationship with everyone and everything. You’re cultivating depth, and simultaneously holding the presence of both birth and death—sometimes on an almost daily basis.

And not to overly romanticize kinship models—they bring their existential weight, if you will—but within relationships, there’s a kind of meaning-making that naturally arises. In contrast, to be atomized, artificially induced into pseudo-sublime experiences, and easily manipulated, that undermines the evolutionary architecture our corporeal states are designed to orient us toward.

We have evolutionary drives. They do not pull us in every direction. Still, they do make us vulnerable—vulnerable to manipulation through superstimuli and false transcendence.

Jacobsen: And everything we produce—vocally or otherwise—is one-off. I think you mentioned this earlier, how the vocal cords shape sound musically, and each production is unique. Over time, a person’s voice changes. We can hear youth, aging, and emotional states.

Similarly, every birth is different. Every death is different. There’s a reason for that design—an evolutionary rationale, perhaps. So when we create artifice built on repeatable sameness, it may prove maladaptive in the long term. There’s a psychological model known as variable reinforcement—that’s the one I was thinking of—where the reward is unpredictable. It’s not uniform repetition, but patterned unpredictability. That seems to strengthen behaviour and resilience.

Each expression may share similarity, but not sameness. That kind of variability is more aligned with how we evolved, and how we should structure societies, favouring diversity in experience over uniformity.

Cahana: What you’re saying makes me think of context as fundamental, and the dangers of losing it. For example, encountering a random mountain can feel transcendent. You’re on a meandering path, and suddenly you come upon an awe-inspiring scene. The novelty of that moment helps create the right conditions for the sublime.

But when we’re entirely out of context—and the things we interact with are out of context—when the world loses its historical and emotional grounding, everything becomes rootless. It’s as if we’re constantly presented with flowers in a vase, detached from the soil they grew in. And we cannot tell if they even grew together or separately.

In that decontextualized state, the sublime becomes hyper-individualized and one-off. It loses continuity. It lacks lineage. By contrast, think about birth—as you were mentioning the metaphor of the voice and the birth canal. There’s a gestational period, a timeline, a lineage of genetic material. It happens at a specific moment, in a particular place.

Whether or not we assign meaning to that place or time, there is an embeddedness—a situatedness—that gives the process weight. It creates a slow unfolding. And that slowness, that contextualization, matters.

And I have, perhaps, a bias—though it feels grounded. I will still name it as a bias: I believe we reach experiences of profound transcendence when we truly engage with the details of our embeddedness. 

That existential moment—floating on a rock in space—can evoke dread or the existential sublime. But it can also lead to diverging responses that make it difficult to pin down as a coherent experience of the sublime. It is just one option among many—nihilism, awe, existential vertigo. All become equally plausible.

But when we engage with the specific context—say, the mountain that is directly provoking the sublime experience—it grounds us. It anchors us to the Earth, to our lives. And from that rootedness, we are then lifted upward, diagonally, or however one visualizes transcendence.

It may be a bias, but it feels aligned with more profound wisdom. It invites us to confront our shadows. It reaches into the core of what it means to have a transcendent experience. What do you think?

Jacobsen: I mean, context is relational. The richness of any context lies in the richness of its relations. And for us, those relations only matter to the extent we are aware of them. For instance, someone who is blind might not see a mountain, and if no one describes it to them, they might only feel inclines and declines underfoot. That is still meaningful, but very different from visually encountering the full grandeur of a sunlit mountain in a forest in British Columbia.

It is a very different experience. That’s why the Zen koan comes to mind: If a tree falls in the forest and no one is there to hear it, does it make a sound? Or, if one hand claps, is that still clapping?

These koans push us toward the idea of the echo, toward internal resonance. The sublime, in our experience, is an internal echo. There is an amount of sensory input required, yes, but also a readiness to perceive.

I think of Ezra Pound’s line: “The water-bug’s mittens show on the bright rock below him.” That image requires a pond, a rock, light from a nuclear furnace—a sun—reflecting on water, and a mind able to register it. You need the scene to be framed—what Pound called the “four wide frame.” There’s a vast temporal and material context required for even a fleeting internal response in a bug.

For us, it is the same. Internal experiences are never isolated. They are embedded in extended, temporal, and material contexts. And honestly, who does not love a big old rock with some trees and dirt on it? It is great.

So when it comes to contextualization, it is primarily relational. It relies on having an internal model, even one you do not entirely control. Our experience of the sublime emerges from that lack of complete control. We are born into the world without mastery over our internal experiences. And that is a prerequisite for encountering the sublime.

If you are not registering those sensations, something has likely gone wrong neurologically or emotionally. For most people, most of the time, we have emotions, and we have them whether we want them or not. Emotional self-regulation can help us manage those states, but the feelings still come. The same is true for the sublime.

How we manifest that sense of the sublime, what it is connected to, the words we use to describe it—those will be culturally shaped. But the core capacity for awe remains. Just as we see many different languages but a very likely universal grammar underlying them, I think we see various manifestations of the sublime. Still, they are all rooted in a shared system of sentiment and response. Otherwise, we would probably be a different species altogether, with an entirely different framework for how we engage with the world.

Cahana: I was holding onto your comment about what we consider different abilities or disabilities. There are many wisdom stories about people who, after losing one sense, become mystic seers. The Pythia in ancient Greek mythology—the Oracle at Delphi—was, I believe, blind. She was the high priestess who evoked the transcendent for others who could see, but could not see clearly.

I’m also thinking of the parable of the elephant—the large elephant being touched by different blind people, each describing only the part they can feel. And there are Hasidic stories, too, involving blind beggars or deaf mystics. So yes, we are all limited—each of us. And our limitations can hinder us from fully experiencing the transcendent. Yet at the same time, we all have an infinite capacity for it.

That feels important—that the sublime is not culturally dependent or body-dependent. It is life-dependent. It is the very essence of being alive: to gravitate toward awe, to orbit around the transcendent, to oscillate between meaning and questioning, to wrestle with it, to confront it. It is our haunting.

Jacobsen: Are there any psychotherapeutic cases where someone is incapable of experiencing the sublime?

Cahana: Incapable?

Jacobsen: Yes. I mean structurally, where there’s a psychological or neurological block, and it becomes nearly impossible to access.

Cahana: I could not be a therapist if I believed anyone was incapable of experiencing the sublime. I do think there are times in our lives when our choices are narrowed—when we do not have 360 degrees of possibility. Sometimes we only have four degrees of movement.

But even within those four degrees, there is space. We feel more constrained, yes, but that does not mean the sublime is inaccessible. I believe that when the internal tension—the inner gnarl—emerges, it creates the conditions for the sublime to descend, to interact, to make contact. That is the inevitable potential in each human being.

Cahana: Now, sometimes life is tragically shortened. Babies die. Do they have a whole life through which to experience the sublime? Perhaps not directly. But the very fact of their existence—being born into context—can evoke the sublime in others. Their brief presence may generate the conditions for others to experience awe, grief, love, and the profound shadow cast when the sublime is absent, when we feel the finite rather than the infinite.

Jacobsen: Let’s say I walk into a bar… Let’s say I walk into a neuroscience lab… Let’s make it a joke:

Let’s say an Orthodox priest, a Hasidic rabbi, and a Muslim Sufi walk into a psychotherapist’s office. Each speaks their respective native language—let’s say Church Slavonic, Hebrew, and Arabic.

They share some intermediate grasp of a lingua franca, perhaps English, and manage to connect on shared ground. Now, imagine they all come to British Columbia. They look upon a majestic mountain, its grandeur wrapped in trees and mist. They each experience awe. They feel the sublimity of the moment.

Perhaps, at the same time, a band named Sublime is playing in the background, singing about a “Lou Dog” being the only way to stay sane. Their English is just good enough to catch the meaning. They translate this lyric into Hebrew, Cyrillic script, and Arabic in their heads.

Then they all fly to New York City and sit in your office. They ask you to help them bridge the gap between their internal and cultural experiences of the sublime. How do you help someone translate intercultural senses of the sublime?

Cahana: So, first, to demystify your example, these are individuals who are already primed for the experience of the sublime.

Jacobsen: It’s speculative, of course. But religious leaders, people who live theological lives with sincere commitment—even with the existence of bad actors—are generally attuned to the unseen. They are sensitized to awe.

Cahana: Yes. That sensitivity cannot be contrived. It cannot be manufactured. That’s what we were discussing earlier, when we talked about artificial experiences of the sublime. Two people can climb Mount Everest and have entirely different experiences—one drawn to the physical exertion, the climb itself; the other struck by the vastness of the view from the summit.

The sublime arises at different moments. It can emerge in the night or bright daylight. When someone walks through my office door and brings me an experience of the sublime through their cultural lens, my role is to hold that experience with them, for longer.

My goal is to draw it out. Let the moment linger. Help them explore it and begin to unpack the symbolic layers, because the sublime is always a symbolic experience—it points to something larger. It belongs to the territory of meaning. So what is the meaning? Does the experience make them feel ready to die, not out of despair, but from encountering something so immense and transcendent that life itself feels complete?

Or is the feeling rooted in fear, perhaps fear of the world’s direction? That’s what the sublime demands. That’s what I try to help them uncover: what is the more profound message? Even someone as spiritually seasoned as a Sufi mystic needs that help. No one is impervious. No one is immune to misinterpreting the message of the sublime. No one is immune to overstating it either. Regardless of training, ritual, or devotion, we are embodied beings.

And that matters. That’s part of the meaning. Our physicality is part of our access to the sublime. You do not become God simply because you have experienced God.

Jacobsen: Any favourite quotes on the sublime before we go?

Cahana: I love Samuel Taylor Coleridge’s Kubla Khan. He writes: “Beware! Beware! His flashing eyes, his floating hair!” It’s this incarnation of the sublime—intense, luminous, almost divine. Coleridge was under the influence of opium when he wrote that poem—an artificial production of the sublime.

And even in that state, he went straight to the danger—the shadow side of it. That warning, that caution he evokes, is one of the reasons not to over-romanticize the sublime. Instead, we should honour it with reverence, for both what it can produce and what it can provoke.

Jacobsen: Sapira, thank you, as always, for your expertise and your time. Lovely to see you again.

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Ghiblian Pixar: Healing, Theory, and Existential Freedom

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/06/26

Sapira Cahana is a New York-based mental health counsellor (MHC-LP) and interfaith chaplain-in-training specializing in existential and relational therapy. Cahana explores the intersection of psychotherapy and philosophy, discussing how theoretical frameworks shape clinical practice while maintaining client-centred flexibility. Cahana emphasizes the challenges of integrating diverse philosophical traditions, the role of neologisms, and the importance of honouring a client’s lived experience over rigid theoretical application. They examine Jewish philosophy, existentialism, and the impact of cultural context on therapy. Cahana reflects on working with clients in hospice care, the nature of authentic relationships, and the evolving self. She advocates for a reverent, phenomenological approach that embraces human complexity, creativity, and transformation.

Scott Douglas Jacobsen: Today, we are here with Sapira Cahana. She is a New York-based mental health counsellor (MHC-LP) specializing in existential and relational therapy. With a background in philosophy, human rights, ritual studies, and Jewish studies, she offers a compassionate, justice-oriented space for clients navigating identity, caregiving, chronic illness, and life transitions.

Sapira works with adults, seniors, LGBTQ+ individuals, artists, and neurodiverse clients, guiding them through self-exploration and meaning-making. Her therapeutic approach integrates existential, psychodynamic, and experiential modalities, emphasizing the therapeutic relationship as a source of wisdom. Fluent in English, Hebrew, and French, Sapira provides telehealth services across New York, fostering a reflective environment for personal growth and healing.

In addition to her clinical work, Sapira is training as an interfaith chaplain specializing in hospice care. As an interfaith chaplain, she serves individuals from diverse religious, spiritual, and secular backgrounds, offering inclusive support that honours each person’s unique worldview.

So, we will do some philosophizing around this — it has to be done. What are some important ground rules people should bear in mind when mixing psychotherapy and philosophy? How much is psychotherapy necessarily decoupled from philosophy outside of actual practice? 

Sapira Cahana: Outside of direct practice, theory and worldview shape how someone approaches psychotherapy. The underlying philosophical and theoretical frameworks influence how one conceptualizes healing, therapy goals, and what constitutes a successful outcome. A therapist’s style — their way of being with a client — naturally emerges from this. Many psychotherapists are encouraged to integrate multiple approaches, blending different modalities and theories to meet client needs. However, there are consequential differences between theoretical orientations, such as psychodynamic and behavioural approaches.

Those theoretical differences matter. If you reduce therapeutic methods to superficial techniques, integration seems easy. But if you take theories seriously — really engaging with the work of the theorists — integration can be complex. For example, a Lacanian psychoanalyst is very different from a Kleinian psychoanalyst. If you are part of these traditions, you understand the differences: they are not merely stylistic but rooted in fundamental theoretical and clinical assumptions. Thus, meaningful integration becomes challenging when one respects the depth and specificity of each tradition.

In practice — in the actual praxis of psychotherapy — the client comes first. While therapists maintain a loyalty to theory and recognize the value of their intellectual lineage, clinical practice requires flexibility. There is a reverence for the traditions that inform one’s practice — standing, in a sense, on the shoulders of giants — but direct clinical work prioritizes the client’s unique, lived experience.

In existential-phenomenological therapy, the client’s lifeworld is central. The therapist stays close to the client’s words and tries to understand what the client says and what the client means by each word. This involves exploring symbolic meanings and bringing deeper insights into view. The therapeutic task is to grasp the client’s experience as authentically as possible.

Theory matters a great deal in theory and academic writing. In clinical practice, theory still matters, but the client’s integrity—and maintaining clinical integrity—takes precedence.

Jacobsen: Now, in some fields, there is a tendency to create many new terms — neologisms. Is that common in your space?

Cahana: Yes, neologisms are part of psychotherapy,New terms help articulate subtle aspects of therapeutic interactions and processes — trying to capture the nuances of what happens between therapist and client. They can provide language for previously unnamed experiences and facilitate more precise communication.

For example, neologisms may describe mechanisms of therapeutic change, qualities of the therapeutic alliance, or specific dynamics between therapist and client. If someone adopts a mechanistic philosophy, they may specify each micro-process of therapy to make healing reproducible across different clients.

However, while I want healing to happen for my clients in my philosophical approach — and in the camp I belong to — I am not focused on rigidly reproducing healing outcomes. Healing is a complex, individualized process. It is not something that can or should be mechanistically reproduced from one client to the next. That does not mean I am indifferent to my clients’ healing — far from it — but I respect each person’s journey’s unique and emergent nature.

I want my clients to heal and graduate from therapy. I do. But I am not trying to evidence the healing. I am not trying to create a theory — which many theoretical orientations, unfortunately, tend to do — to reinforce the idea that I have produced healing through a therapeutic encounter. I tend to flow with the clients, staying close to where they are and using their language, material, and symbolic representations to fashion — or come close to — relational healing.

That is my philosophy. That is the camp where I stand. But there is much anxiety in the field, and there is a history in the field of psychotherapy — a history of wanting so desperately, honestly, to taxonomize everything and make it into a science. When psychology, like many other disciplines, was pressured to prove its legitimacy, it made a political decision to move closer to the sciences. This movement is often called scientism — the ideological extension of the scientific method beyond its appropriate domain.

While the scientific method is valuable for demonstrating evidence in a limited sense, this shift displaced psychotherapy’s mystical, curious, enlivening aspects — which is the camp where I want to be. I want to talk about meaning. I want to talk about vision. I want to talk about the inner prophecy of one’s life and dream alongside the person. There are relatively few therapists outside the evidence-based camps who work with a person’s soul — their deeper self and psyche.

Jacobsen: What do we mean by vision? I am assuming something like the vision someone has for their life and prophecy— getting at the idea of a self-fulfilling prophecy — what someone might envision for what they want to get out of life. In a non-religious sense, but rather a full-bodied experience, life is worthy.

Cahana: That there is a self-transcendence. Psychotherapy is not only for moments of deep suffering when there is no experience of joy. Rather, psychotherapy is for the full range of human experience. It is not only for when we feel “unwell” or “stuck,” but for the continual unfolding of life.

There is a kind of heartache about the outcome of one’s life, and psychotherapy can help a person use their beautiful insights about themselves to envision forward—to propel themselves into the life they seek. It is about seeking what we want from life, what we hope for in our death, and what we want from our relationships. Through this work, we can repair, rework, and come to new experiences. We are not stuck or fixed. There is always perpetual change and transformation.

Vision, prophecy — not self-fulfilling prophecy in the simplistic sense, but a self-fulfilled prophecy, maybe. A vision is fulfilled by becoming who one is meant to be.

Jacobsen: When people come to you and need healing in the sense you describe, what does that look like? What is its philosophy, and how does it appear in the process?

Cahana: It does appear through the process. When people come to therapy, it is often because things are sticky in their lives. Things are not working anymore. Their former selves no longer feel resonant with their lived experience but have not yet developed a new language for their current self. They still use old narratives to describe themselves — narratives that no longer fit.

Yes. They come to me, and they are in a sea of trouble. It feels tumultuous. There is a path forward, but how — or by what possible way — to get there is unclear. Yet there is a sense that there is another side to this: more experiences than the current one.

Together, through dialogue—with me as a quiet listener and an active listener—I can tolerate the silences and soliloquies that people need to experience. They hear themselves. They see and hear another person react. Through this ongoing time—time that is consecrated, repeating, dialoguing, and even “dialoguing” dialoguing—through the shared phenomenological experience and relationship, healing inevitably comes. It does.

Because I am an anonymous other who is not demanding anything of them — I am not raising their children or managing their lives — I am simply human. We are connecting through our shared humanity. There is an unspoken understanding: conceptually, they know I am human, that I suffer too, that I have my own family, my own life experiences. With all the sinews, blood, muscles, and all the elements that create the human that I am, I can be fully present, looking directly at them and sharing an authentic encounter.

Through that process, healing inevitably occurs.

Jacobsen: In a sense, are people in public life, outside of a therapeutic context, when they need these types of services, largely not being heard? Something traumatic happens, and they do not have a neutral space to explore that feeling or experience.

Cahana: It is not exactly that they are not being heard. It is that there is separation — and so rarely do we get a truly separate phenomenological experience where I get to be someone’s other without them asking who I am. It is extraordinary.

Not to overly invoke philosophy, but many beautiful philosophers explore phenomenology. The Hegelian version of phenomenology is more conflictual, even violent, but here it is different. In this subject-other experience, the client retains their full subjecthood, and I become the other for them. They can place their transference onto me.

I make an ethical vow: I will not impose countertransference on them. So it is not that people are not being heard — it is that people rarely have the deep opportunity for consecrated time — a separated human experience where they do not owe much. Right? They do not owe much.

Of course, the relationship still has integrity. However, the therapist, the other, ceases to exist in service of their own needs and instead holds space entirely for the subject. It is profound. It is a devout process for the therapist, and it is a devout process for the client.

It is hard not to see the therapist as a person, so there is curiosity: I am sharing so much of myself; can you tell me something, too? It is a delicate choreography. I will share some if necessary, but that is not the point.

If I reveal too much, the phenomenological experience—this sacred encounter—could be at risk. There is always space for repair, which is part of therapeutic doctrine and a beautiful part of the work. However, maintaining connection and separateness is part of the integrity of the relationship.

Jacobsen: How does Jewish philosophy enter into your method? 

Cahana: I connect to Kabbalistic concepts of being and nothingness from the Jewish perspective — where we are all embroiled in a kind of oneness, and there is both being and non-being, right? My vision of death comes from this idea of a return to nothingness and the being that exists outside of that.

Of course, I mentioned Hegel earlier, but one of my central guides is Martin Buber. His concept of encounter is a vision for the phenomenological experience that happens in therapy — for me, at least. I do not know if that is strictly Jewish philosophy, but Buber was a Jewish philosopher whose ideas deeply informed my work. There is divinity in humans. I believe that.

In Sartre’s vision, existence precedes essence — and I also feel that truth. But I also believe there is a sacred essence in each person. I carry that belief into my relationships: I believe in someone’s potentiality, as Sartre did, but maybe with an extra tincture — a drop of the divine spirit. If even a blade of grass cleaves to the divine, so are humans.

Jacobsen: Is there any philosophy you once adhered to, but during your development, experience, education, or practice, you changed your mind about — or put permanently on the shelf?

Cahana: Oh — did you mean Jewish philosophers or philosophers more broadly?

Jacobsen: Philosophers broadly.

Cahana: I love Louis Althusser. There are few therapeutic encounters where I am purely talking about ideology, but he is always in the background of my intellectual formation. I love Lacan — I love Lacanian thinking — but his writing is so dense. I have a heart space for his general theories in therapy, but I do not always apply Lacanian neologisms because they can alienate clients.

I love some of Kierkegaard’s writings. Among existential phenomenologists, I love Heidegger’s work, and I borrow from Heideggerian theory. Emmy van Deurzen is a classic existential psychotherapist who draws from Heidegger, and I borrow from her work. The concept of the lifeworld is a great stand-in, but I am always wary of invoking philosophy unnecessarily in therapy — I try to stay close to where the person is.

So, philosophy is part of my formation — it is all part of how I approach the work.

Jacobsen: How often do you enter a session with an unresolved philosophical flaw?

Cahana: My thesis was on Frantz Fanon — specifically Fanonian decolonial therapy and what that might look like. There is some very good work happening these days trying to retrieve Fanon’s psychotherapeutic practice because he was an analyst in Tunisia and Algeria, which is amazing. Yes — he engaged in what is called institutional psychotherapy.

Jacobsen: Anyway, in Algeria, there were French colleagues, right?

Cahana: Yes. Fanon was from Martinique, and he went to Algeria. He taught and practiced there. He has some extraordinary psychotherapeutic writing that is now being unearthed in psychotherapy. Fanon was largely relegated to political philosophy for a long time — which is one truth about him — but he was a full person and a psychotherapist. A psychiatrist, to be exact.

Many of those thinkers crossed disciplines quite fluidly. The terms people used for fields then did not necessarily mean what we mean today. They were more invested in being polymaths—Renaissance people—deeply studied in ancient and modern eras.

Today, we expect specialization. And because of that, we have, in many ways, lost the art of the polymath. We are astonished when we meet one now — we call them a genius. There is a kind of enigmatic, heterodox quality to a public intellectual who spans fields, knows astrophysics and loves poetry. It is so charming.

It probably protects against a narrow, mechanical way of thinking — what you might call a “bug mind.” A vaguely mystical persona is behind it, but it comes from spending time in the crossovers between disciplines. That is where the richness lies.

I do not disparage it — it is a rare and beautiful quality. It is outrageous in the best sense. And yes, you are right that it feels mystical. I aspire to be more well-rounded all the time. I want to borrow from everything. It is so beautiful that there are so many disciplines. I try to keep my curiosity supple.

Jacobsen: That ties back to what we discussed — the earlier question about philosophers you read before entering a session or how philosophy informs your practice. When dealing with someone one-on-one, you are, in a sense, mostly anonymized to them outside of your title, right? Yet you provide support that does not carry the same pressures or commitments others do.

Another part is a two-parter: How does Foucault build into your work a little more? Second, do you ever get into the thickets of philosophy if you are with a client who is a graduate student in psychotherapy, philosophy, or a related field?

Cahana: If a graduate student comes to me and talks about their intellectual magic — that rush of discovery — I am excited. But I am also attentive to what is happening beneath it. I think: Why are we attaching so much to the intellectual? What is happening in the heart space?

There is always something meaningful going on beneath the intellectual fervour. Honouring intelligence and excitement is as important as staying attuned to what is happening emotionally, relationally, and existentially.

I will certainly engage—I am engaged—but I try to stay centred on the person and their experience. Right? Because I do not want to reinforce the idea that people must articulate themselves perfectly. They do not need to attach to Nietzsche’s words—always Nietzsche—to find affirmation, belonging, meaning, purpose, or drive. They already have those things internally.

So it becomes another delicate choreography — lifting the symphony of knowledge that exists in the world while also pushing it aside enough to stay present with someone’s relationships, their seeking, and their vision for their life.

Yes, suffering can happen when someone over-intellectualizes and ties their ego to that place—especially at the ripe stage of life when someone is a graduate student or even an undergraduate student just entering the adult world. The first fruits they taste are these gorgeous ideas that they internalize so deeply that they might overspend or over-rely on them.

It would be true if we were talking about choreographers, not just philosophers. If someone is trying so hard to replicate a choreographer in their dancing, I would also start talking to them about their style. You cannot be Pina Bausch. You cannot be Alvin Ailey. You have to be yourself. It is not about replication but refining how you will present your gifts to the world.

Jacobsen: How often do people who come to therapy present a false self? Or maybe it is better to say: is it more like a dial than a switch — not a simple yes or no? To what degree does this happen?

Cahana: Yes. I do not know if people who come to therapy do it more or less than anyone else.

The statistics suggest that people often lie to their therapists, which is horrifying. I will not give a hard number here, but I accept that people may lie, especially in a short-term relationship. If you are only in therapy for ten weeks and then it ends, there is little perceived consequence to that lying.

But in an ongoing, curated, cultivated therapeutic relationship — which is my philosophy — the relationship itself becomes the vehicle for healing. Building that relationship takes time. I do not expect anyone to trust me in the first session. I do not.

In the same way that we might have fleeting trust with a stranger on a plane or a sweet interaction with a grocery clerk, initial trust in therapy can be superficial. True trust in the therapeutic relationship takes sustained time and care.

I would not assume that initial presentations are fully authentic—they can be genuine slices of someone’s life, but I would never assume that they represent the full relationship.

Once we hit the six-month, one-year, or two-year mark—and for sure at five years, though I have not yet had the blessing of that longevity as a psychotherapist—I imagine that if there is lying, I will be able to detect it. Then, I can find gentle and loving ways to act as someone’s mirror. The goal is to be a mirror so clients can see themselves in new lights and fashion new selves.

We want to stay supple and creative without denying that there is a truth out there. It is not relativism, so I situate myself within existentialism — ontology and phenomenology — as opposed to other philosophical camps. I identify most with ontology.

Jacobsen: What about those who come into session and are not consciously lying? They are deluded — and their self is deluded — so what they present is not necessarily clearly false, but eventually, it becomes apparent that something is not fully true. Yet they believe their own presented falsehood or not-self.

Cahana: I believe there is a delay in those cases — a delay in the full emergence of the authentic relationship. I know how to suspend disbelief, of course. I listen to the noble self trying to emerge and honour that with dignity. I would not immediately confront or dismantle it. Through that process — through honouring and holding space — a newer, more integrated version can eventually emerge.

But again, people are not fixed. There are stormy periods in people’s lives when they become different versions of themselves. When someone articulates that there is a past version of themselves, I believe them. I believe in people’s pasts and futures. I believe in the potential of whom they can become and invest in honouring their account of their past struggles.

Therapy is a world constructed with words but also grounded in real-time experience. So if something is incongruent — if someone says something I do not directly experience with them — my first instinct is to believe them. It is more important that I believe them than that I try to fix them at the moment.

I have worked with many clients, including people with disabilities, whose lived realities are often marginalized or encroached upon by the world. Often, people see themselves as infinitely more capable than society allows them to be, and there is real conflict there. I am a strong advocate. I am always on the side of the person.

Institutions — and we have discussed this — often encroach on individual freedom.

There are so many cases in which people are experiencing profound anxiety. I remember when I was in training, working with clients with disabilities who were aging and dually diagnosed. Every day, at the same time, they would experience profound anxiety about transportation.

Obviously, it was not their deficiency — they were anxious because they relied on the public transportation system. They depended on a van to take them from point A to point B. Sometimes the van was late, sometimes early, and often there was no clear communication.

If you looked at that one slice of experience and said, Oh my gosh, every day at 4:00 PM, you’re anxious — you must be paranoid; that would be ridiculous. It would be preposterous, honestly. It was crucial to understand that their interaction with the world was deeply threatening — that they were profoundly dependent on and vulnerable to a system. Sometimes, the van driver might even yell at them without warning. They lived in a precarious state of dependence.

I was present at that transitional, liminal point. My interventions were simple and human: I would play music by the window, sit together, and sing—Michael Jackson or whatever they wanted. I entered their world.

I did not dare to believe that I was an expert coming in to label them paranoid, delusional, or any other stigmatizing word. I was their advocate. That was my role.

Now, I also work with clients in hospice, at the precipice of death. Sometimes, people have visions at that threshold. They call their ancestors and descendants into the room — and they see them.

I am committed to seeing them, too. If you are talking to your mother and feel you are a child again, then you are talking to your mother. I want to know what she is saying. I want to be there with you.

In the Heideggerian sense, I am happy to enter someone’s lifeworld. That feels like my duty as a psychotherapist: to enter someone’s world, not to descend from above, prescribing what I believe reality to be.

At the same time, there is truth. I am not the sole holder of truth, but there is a capital Truth—an ontology—and we are all striving to figure out what that ontological cosmology might be within the order of everything. There is ontology, and there is phenomenology. I privilege both to create a form of existentialism.

Jacobsen: Where do existentialism and Jewish philosophy match, and where do they not?

Cahana: It is hard to say because Jewish philosophy is so ancient. Both share some deep roots. You can even trace the lineage of existentialism back to thinkers like Parmenides.

But more practically, the clearer points of intersection arose in the nineteenth and twentieth centuries, when Jewish philosophers began consciously borrowing from and shaping existentialist models.

Walter Benjamin—I do not know if I would call him an existential philosopher exactly, but he is a beautiful philosopher. He was a Jewish philosopher who wrote about history, aura, and technology. You can see existential themes throughout his work, partially because he was writing in the context of the Second World War.

He has been a big inspiration to me.

However, if we look for points of divergence between existentialism and Jewish philosophy, we will see that Jewish philosophy tends to believe in essence. There is an idea of an essence that is divinely imbued. I have found ways to harmonize existentialism with a notion of essence—maybe a kind of apologia—but it is not a simple match.

Both Jewish philosophy and existentialism care deeply about being and duty on earth. Even within the idea of the messianic promise in Jewish thought — the potentiality — you could see a point of confluence: the sense of an ever-shifting world, a current state, and a transformative future. There is reality and a kind of meta-reality always at play. Wisdom, perhaps, sits at the center.

So, yes, there are many confluence points, and there are divergences in the details.

Jacobsen: Who do you think is the most consequential psychotherapist who has taken on either existentialism, Jewish philosophy — or both?

Cahana: I am trying my best to name someone other than Viktor Frankl, but it is hard. Whoever scrawled that famous phrase on the prison walls — “He who has a why to live can bear almost any how” — we owe him acknowledgment. Frankl is famously at the intersection of existentialism and Jewish philosophical thought. He always centred the question of meaning — the why.

Of course, Irvin Yalom also comes to mind. He is deeply steeped in Jewish tradition and is one of the foremost existential psychotherapists today. He has written interesting novels that explore these themes—for example, his novel on Spinoza. Yalom is a prolific, beautiful writer, constantly producing work that blends philosophy and psychotherapy.

So yes, maybe Yalom and Viktor Frankl. No one is more classically existential and changed the field of existential psychotherapy as profoundly as Frankl did.

Jacobsen: Do you find that a psychotherapist’s geographic and cultural context changes the flavor of their existential or Jewish philosophy—or even the character of their psychotherapy?

Cahana: Yes. Even doing therapy in a different language changes it. Even in the same cultural context but switching languages, I notice different selves emerging. Different expectations and norms around language and interaction come to the surface, subtly but profoundly shifting the flavour of the therapeutic encounter.

Yes, definitely. Language constructs reality — and culture constructs reality, too—expectations, ideology — going back to earlier ideas. I do not always frame it this way in therapy, but I can say it here: our presentation is bound by institutions and ideological commitments. We may be returning to Lacan.

One of Lacan’s famous ideas is that one of the most challenging moments in a person’s life is when, as a baby, they see themselves in a mirror and realize, Oh my gosh, that person in the mirror is also me. The amorphous, gaseous being they feel themselves to be — with feelings, thoughts, and experiences — becomes attached to a physical form that other people perceive.

So yes, culture and the external world shape who we are. There is no question that in my work — in the effort to birth the self anew — we are also working within embeddedness, facticity, and the given conditions of the world.

But the world is still creative and supple. There are backdoors and labyrinths we can navigate differently. It is not fixed. Everything is in motion—transition, flux, fluidity.

Jacobsen: Do certain contexts tend to produce a self that is more rigid, less pliable than others — so that a therapeutic context, if you are trying to move from a dysfunctional self toward something more authentic and functional, takes more time?

Cahana: For sure. Now, we are getting into Simone de Beauvoir. Right? There is infinite human potential, but then facticity — the concrete conditions of life — constructs and limits who we are, making change more challenging.

Her philosophy emphasizes that being is difficult. You are not born a woman; you become one. You are transformed into an Other. Fanon shares a similar flavour in his thinking: we are otherized.

As an Other, you are both imprisoned and, paradoxically, free to maneuver within certain constraints. So yes, absolutely — context can harden the self and make therapeutic transformation slower and more complex.

But I have to say — and I want to be clear — I fully recognize that we are socio-temporal beings and that intersectional identities play an enormous part in who we are. Intersectionality is not an addendum; it is foundational. Evaluating how identities interact, conjoin, and localize within a single embodied experience is essential.

Yet, I do not believe that intersectional identity is purely deterministic, either. Movement, potential, and creativity exist — even within deeply embedded realities. Hospice has taught me that I can go into so many different people’s rooms, and frankly, I am very aware of social theory and how social identity gets constructed. I know that.

And yet, each individual is so, so, so unique — truly unique.

A certain category of being is not more willing to grow than another category of being. There is embeddedness, of course, but growth depends far more on personality, resilience, and individual outlook. And then, yes, culture influences how people articulate their experiences.

But when I move from room to room, it feels like a pilgrimage. I meet people who are HIV positive, people from all sorts of backgrounds and identities where you might think, oh, that must mean X — and I am constantly surprised. I am constantly surprised by how people articulate their lives, how their outcomes unfold, and what a good death looks like for them — or what a bad death looks like.

Jacobsen: Do you find any through-lines or common threads in what people consider a good life and a bad life, especially in their reflections in hindsight?

Cahana: Yes. People care about relationships. When relationships are unresolved, there is often despair — but not always. I cannot even say always. I have seen people who are fully accepting of estranged relationships, and I have been surprised and often deeply touched.

Still, people generally care about their social relationships. They want to be in good standing with their community. They mostly want to feel settled in terms of their finances and affairs. They do not want to be a burden.

Maintaining dignity in the final chapter of life is highly important. Many people who are undergoing the death and dying process want to do it gracefully. People have different relationships to what grace and dignity look like, but whatever dignity they hold onto, they want it respected by the community where they are dying.

Jacobsen: What about the cases where the individual is — or has been for a while — disintegrating in real time? Cases of dementia, brain cancer, Alzheimer’s, and so on? What does a good death look like in those situations?

A subquestion beneath that: in such cases, does the dignity of the death rely more on the meaning that dignity has for those around them since the person is disappearing?

Cahana: Yes. We live in a world where people know these outcomes are possible, and many people plan for how they want to be seen when they become vulnerable in these ways.

I often hear family members say, “This is what they told us they wanted,” I feel grateful when they guide me in honouring a person’s will—either as a retained memory or a formal directive.

I have had many beautiful encounters where family members tell me who the person was. They will say, “This is my partner,” “This is my mom,” or “This is my dad.” Even if that person now has dementia or is non-verbal, they want me to know the fullness of their life. They want me to see their loved ones as they are now and truly are—the loved, vibrant, complex person they were.

I try to make that the point — to attune to what the person wants and stay loyal to their expressed or implied wishes. Because ultimately, it is their death. It is not only about someone else’s grief or the family’s loss — it is about the individual’s journey.

Jacobsen: That touches on people’s relations to various collectivities. In Jewish history — not only Jewish philosophy — there are these various arcs: tragedy, overcoming, and triumph. Ebbs and flows across generations. Does that pattern — that historical rhythm — also get embedded into people’s sense of self, whether in hospice in their last days or in therapy, looking to reintegrate in a new way? Do those broader patterns get brought into session or interaction?

Cahana: Absolutely. People bring whatever material is meaningful for them.

We all project onto others — especially when occupying the position of the other for someone; it happens. When people know that I am Jewish, for instance, they might make certain assumptions about me. They might assume aspects of my life history or even recognize family names or connections.

The truth is, it can be both a hindrance and an enhancement. It depends on the therapeutic encounter.

Sometimes, someone wants to be seen by a fellow Jewish person at that moment—to feel that kinship and community. And sometimes, that shared identity can enhance the healing process.

But it can also be a hindrance. It can create a fog between self and other, between subject and other, obscuring the therapeutic work that needs to happen. So, it depends. I am very careful and tentative about when I invoke shared identity and when I do not.

Jacobsen: My buddy Rick Rosner—the one I mentioned earlier who wrote for Jimmy Kimmel for twelve years—and I often have a session or conversation every night or every other night, covering a wide range of topics.

He is Reform Jewish. I share a namesake with the founder of Reform Judaism, Israel Jacobson, who was born around 1810 in Germany. At least etymologically, there is just a slight letter change from “e” to “o.”

Anyway, when I asked Rick what he believes, his response — consistently — has been: We don’t know what we’re supposed to believe. Coming out of Conservative and Orthodox Judaism, there is a different theological framing and upbringing.

So, if we were to parse these three ways—Reform, Conservative, and particularly Orthodox Judaism—how well do they mesh with existentialism and psychotherapy?

Cahana: The philosophical differences between Reform, Conservative, and Orthodox Judaism are significant, but they are often treated as less divisive because there is a communal sense — a broader tent that we still share.

I believe a deep connection to the world of doing remains across all three streams—Reform, Conservative, and Orthodox. That is an important distinction.

In Christianity, there is this concept that one circumcises the heart — that belief is internal, centred in the mind or spirit.

In Judaism, particularly across all streams, the focus is more on orthopraxy — correct practice — rather than orthodoxy— correct belief. We emphasize that what you do matters and how you live matters.

That orientation naturally harmonizes more easily with existentialism and psychotherapy because existentialism is also deeply concerned with how one acts, chooses, and lives in an often ambiguous world.

It is about mastery over the earth and being fully in the world. There is a delay in knowing what happens in the divine realm, but we are not so concerned with that.

Of course, there are rabbis, thinkers, and mystics who are deeply concerned with what the divine world looks like, who engage in creative theological play and explore the love of the divine. But ultimately, our task is to fix the world (tikkun olam). It is on us.

All people must be part of the world’s healing—it is not the responsibility of one individual alone. It is a communal prerogative and imperative.

Jacobsen: Last question: How can an existentialist psychotherapist reconcile the absolute transcendent authority of Torah min ha-Shamayim (Torah from Heaven) with the therapeutic imperative to foster personal freedom, authentic choice, and self-derived meaning — particularly for those drawing upon Orthodox Jewish beliefs? How does the Orthodox existential psychotherapist reconcile these tensions?

Cahana: It is not as hard as it might seem within Jewish thought because so much of Orthodox Judaism is built around studying the cacophony of different voices across history.

There is an acknowledgment that the Torah is divine, but it is always studied alongside centuries of traditions, responsa, and commentary — a cacophony of voices. An eleventh-century rabbi is in conversation with a fifteenth-century rabbi, and sometimes one ruling is followed, sometimes another. Each community has its rabbi and its interpretive lineage.

Navigating how freedom and identity intersect with communal expectations can be complicated.

Much of my work with Orthodox Jewish clients revolves around navigating what one is expecting or hoping from the community and what expects or hopes from the individual.

I may draw on my knowledge because I come from within that inner language. It is not as black-and-white as it might seem — even if people wear black and white.

Jacobsen: Or in the artistic style of a Ghibli movie.

Cahana: [Laughing] Yes.

Jacobsen: Thank you. 

Cahana: Fantastic. Thank you so much, Scott. This was so much fun. Yes, if you have different topics in mind, we can explore them. Your interview style was really fun, and I appreciate it.

Jacobsen: Thank you.

Cahana: Ciao.

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#ExistentialTherapy #HospiceChaplaincy #JewishExistentialism #PhilosophicalIntegration #RelationalPhenomenology

Exploring Existential Therapy and Hospice Care

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/06/05

Sapira Cahana is a New York-based mental health counsellor (MHC-LP) and interfaith chaplain-in-training specializing in existential and relational therapy. Cahana integrates philosophy, human rights, ritual studies, Jewish studies, and diverse wisdom traditions into her therapeutic work. She emphasizes honouring client subjectivity, building trust, and engaging playfully with existential themes such as death, freedom, and meaning. From sources like the Hebrew Bible, existential psychotherapy, and Plato’s allegory of the cave, Cahana fosters transformative relationships that navigate complexity, uncertainty, and growth across psychotherapy, hospice care, and broader human experience.

Scott Douglas Jacobsen: Today, we are here with Sapira Cahana. She is a New York-based mental health counsellor (MHC-LP) specializing in existential and relational therapy. With a background in philosophy, human rights, ritual studies, and Jewish studies, she offers a compassionate, justice-oriented space for clients navigating identity, caregiving, chronic illness, and life transitions.

Sapira works with adults, seniors, LGBTQ+ individuals, artists, and neurodiverse clients, guiding them through self-exploration and meaning-making. Her therapeutic approach integrates existential, psychodynamic, and experiential modalities, emphasizing the therapeutic relationship as a source of wisdom. Fluent in English, Hebrew, and French, Sapira provides telehealth services across New York, fostering a reflective environment for personal growth and healing.

In addition to her clinical work, Sapira is training as an interfaith chaplain specializing in hospice care. As an interfaith chaplain, she serves individuals from diverse religious, spiritual, and secular backgrounds, offering inclusive support that honours each person’s unique worldview.

How do your secular and interfaith principles contribute to ethical decision-making, particularly globally, when providing telehealth services?

Sapira Cahana: Thank you for asking. When I refer to “secular,” I do not mean excluding religion; instead, I mean not privileging any single hermeneutic tradition. Instead, I engage with a broad tapestry of traditions and wisdom sources. I incorporate interreligious and intercommunal dialogue richness without centring any community over another. By integrating imagery, language, and wisdom from many traditions—including secular humanist perspectives—clients are supported in a way that enriches ethical decision-making. Ethical practice becomes informed by a multiplicity of voices rather than a singular authority, allowing for more expansive and authentic reflection.

Jacobsen: How would you characterize the principle of linking different sources together in a way that resonates with a particular client’s context?

Cahana: You are asking about creating experiences that resonate at a deep, personal level, correct? The goal is to meet the individual where they are, drawing upon traditions, images, and wisdom that are meaningful to their personal story and context. It is about situational responsiveness—tailoring the integration of sources to make the work ethically grounded and personally meaningful.

Well, we are all embedded in our contexts. We are all situated individuals. Each human is positioned within their vantage point and integrates many sources of material and wisdom.

Once I begin parsing through where a client’s language, imagery, and metaphors are coming from—whether from capitalist culture, Rembrandt, or elsewhere—I start weaving with them to create curated, connected experiences. I enter what Heidegger would call their “life worlds,” together, we expand and deepen their meaning through their language. In this work, I am constantly the “other” in the space. They are the subject. I am there to honour their subjecthood, using my otherness to relate, connect, disconnect, and reconnect—this is the essential material of the phenomenological approach.

This profound experience of being connected—subject and other, facing one another in an “I-Thou” relationship—translates into different relationships and experiences. It fosters individuation, the ability to separate one’s material from another’s. Yes, it is a transformative process that changes people’s lives, families, communities, and, ultimately, the world.

Jacobsen: What are the factors of rapport and trust? How do you ensure those are built into the therapeutic space?

Cahana: Yes. My first assumption is that there is no complete knowing of another. It is profoundly uncomfortable, especially as a therapist, because my deepest intention is to know and connect, while the client’s deepest intention is to be known and seen.

However, I clarify that as much as I desire that connection, true knowing is elusive. Yet the yearning—the deep wish to cleave into a relationship—is vital. That yearning brings integrity and builds trust. Naming the inevitable dissonance of relationships—acknowledging that there will be fractures—creates space for repair. I remain steady, stable, and ready to receive someone fully. We are never fully known, but we can make deep, persistent attempts to move closer and closer.

Jacobsen: The therapeutic population you work with is either self-selecting or sometimes mandated to attend therapy. It is not an entirely random sample of the general population. For your style of therapeutic process, what do you notice are some through-lines among the people who come to you?

Cahana: People who come to me are often in oblivion—an unknown, a fugue. They seek someone willing to be with them in that haze, someone who can sit in the fog without rushing to clarity. Together, we begin clearing the path, walking through the jungle of their experience.

I walk alongside people. I meet them closely where they are, believing I cannot fully know them. Clients are often drawn to my deep love of wisdom and ability to weave together world knowledge and cultures. My orientation is global, not confined to the microcosm of New York City—even though New York itself is so expansive. It is a world-based approach that resonates with people looking for something broader, something that connects across cultures and traditions.

There are so many people in New York, yet there is still a whole world beyond New York. Even if the world moved to New York, there would still be a world outside. I focus on transcendence and the magnitude of colour, grass, poetry, andhistory—that sense that there is a past and a future. It is so psychedelic and beautiful. There are microbiomes, astronauts, and the vastness of the universe.

Even though we may focus on one person in therapy, we are also a vessel, a signal for the magnitude and largeness of life. My goal is always to help people fall back in love with that grandeur.

Jacobsen: Are there particular cases where an individual is almost not fully a person in the sense of being fragmented internally—where the structure they present is quite chaotic and difficult to map and reorient toward a more coherent, stable self?

Cahana: My assumption is—and this may turn the idea on its head—that most people are chaotic. That description applies broadly. People are endlessly surprised. You might think you can put a thumbprint on someone and say, “This is my easy client,” and suddenly, something unexpected surfaces.

When I was training, I worked with clients with disabilities who were aging and had secondary diagnoses. A good example would be someone with schizophrenia muscular dystrophy who was 85 years old, nearing death. On paper, you could say that it is a complex case—a lot is happening—but they are still themselves.

I developed a sense of what therapeutic deep care looks like. It is not love—not in the romantic or familial sense—but rather a profound cherishing. It is the feeling of holding a human life in your hands with deep reverence. That is so profound and special.

I do not find anyone easily cast into a descriptor. People are too complex, too fluid. I am happy to flow with curiosity. To answer your earlier question, that is why people come to me: I am not writing a rigid script or saying, “This is our goal, and you will be fixed in three weeks.” I do not know—and I am comfortable with that uncertainty. The people who journey with me are also comfortable with it.

It would be lovely if healing were as simple as checking a box—finished and done. But that is not how I relate to grass, the moon cycles, or the world. If I am journeying with you, it is because there is an attraction to that kind of fluidity and comfort within the oblivion that I mentioned earlier.

Jacobsen: What existential themes arise for people who are in hospice?

Cahana: Well, in hospice, yes, the most excellent existential theme is, of course, death. But even more deeply, the real existential theme is freedom—people’s desire for freedom and their profound experience of alienation in an institutionalized setting.

I work in a beautiful hospice and am deeply grateful for where I am. But ultimately, even the best institutional setting cannot fully curate a person’s death. People are not in complete control. Much of my work happens after people have been poked, prodded, and spoken to clinically about dosages, pain acuity, or critical status. I get to come in and ask: But who are you?

Often, people say, “This shell that you’re seeing—that’s not who I am.” Surprisingly, hospice becomes an extraordinarily playful space. People experience alienation because institutions almost inevitably create distance. Very few people truly thrive in institutional environments.

At the end of life, people are trying to decide how they will relate to their death—specifically through their experiences of freedom. It is extraordinary. Much of my time with people at the end of life is spent playing. There is so much levity alongside so much depth. It has been an enormous gift to witness and be part of that.

Jacobsen: When people are isolated in institutional settings or confronted by the sterility and artificial regularity of those environments, how do they describe it?

Cahana: People are seeking a home, a feeling of home. They often say, “I want to go home.”

One charming patient, who was deeply righteous and fiercely independent—almost a literary character—once described the staff to me. She said, “Sapira, the staff here are butterflies.” I said, “Butterflies? That’s curious.” And she explained, “They flit.” Then she waved goodbye and said, “I’m going to bed now. Bye-bye.”

It was so charming and poignant—a beautiful image. Her description of the staff flitting reflected her desire to flit away, to have agency, even if it was limited. At that moment, her only absolute control was the power to dismiss me. And I consider it the most incredible honour to leave when asked.

In hospice, within the span of two encounters, one patient may call me “an angel,” praising me effusively, while another might say, “You liar—you didn’t come back at 4:35!” It is the same material—an endless oscillation between praise and vitriol—and it is all profoundly human.

It is the same energy. It is a desire to relate, be in control, and be connected—but on someone else’s terms. It is my most incredible honour to be the vessel for someone’s praise, and equally, it is my most incredible honour to be the vessel for someone’s rejection. Yes, it has been beautiful work—excellent work.

Jacobsen: Now, given the occasional vitriol—perhaps not actual vitriol, but a little berating—are mutual respect and empathy always necessary for efficacious therapy? Or are those sometimes secondary to therapeutic goals set earlier by the client when doing meaning-making work?

Cahana: Thank you for asking that critical question. My roles as a chaplain and a psychotherapist are quite distinct in this respect. That is a key point of separation.

In chaplaincy, especially end-of-life chaplaincy, I must receive whatever is given to me unquestioningly and with profound respect. It is a great honour to be one of the last people someone encounters, even if I have only known them briefly. I allow unconditional empathy to exist there, and I am deeply comfortable with that.

In psychotherapy, however, if there is ongoing deep anger, berating, or profuse vitriol—and it persists week after week—while the person continues to show up and remains engaged, I am much more likely to confront it directly. I might say, “I am here. I want to be here. I see that you deeply want to be here. But what is happening? How are we going to sustain a relationship like this?”

I would allow it to continue for weeks before naming it explicitly, but if the dynamic persists and a blockage in empathy and trust prevents movement, we need to delineate what is happening. Is the goal to move through the muck together? Or is the goal to express anger?

That becomes a question of choice. When clients opt into therapy with me, they are making a choice. But if something consistently blocks relational growth, we must face it together.

By contrast, people do not opt into therapy in hospice. I call my role “making pilgrimage”—moving from room to room, offering presence without expectation. It is very different: in hospice, I am the visitor; in psychotherapy, there is a mutual contract of engagement.

Jacobsen: What about a finer-grained analysis of your health and well-being as someone working in hospice or psychotherapy? For instance, if a client’s berating crosses the line into abusive behaviour toward you as a service provider, are you ethically permitted to terminate the therapeutic relationship under specific circumstances?

Cahana: Yes. There are ethical guidelines that permit termination under certain circumstances. I have, in fact, led group therapy where a participant berated me consistently for eight months. It was not easy, but as long as it served the therapeutic process and the group dynamics held, I remained.

However, if the dynamic becomes truly abusive—meaning it impedes the therapeutic process, harms the provider’s well-being, or risks creating a harmful environment for others—ethically, termination must and sometimes be considered. It would involve careful documentation, clear communication, and, ideally, a referral to another provider to keep the client’s care uninterrupted.

It is always a balancing act: honouring the client’s suffering and expression while protecting the integrity and health of the therapeutic space—for the client’s sake, my own, and anyone else involved.

And I stayed with it. I have pretty good patience—yes—and that is a skill. I knew intuitively that if someone had a deep hatred toward me—if my breathing made their skin itch, if they had overwhelming emotions directed at me—that was still something we could work on.

I had a client who berated me for about eight months. I was leading group therapy sessions, talking about active listening, morality, existentialism, or running psychodrama exercises. This particular person would sit on the outside of the group and heckle constantly: “You’re stupid,” “You don’t know what you’re talking about,” “Why are you treating us like babies?”

And there must be feedback hidden there. I would respond calmly: “Yes, I hear you. I am leading right now, so if you could give me five seconds to complete this point, I would be happy to hear your input afterward.” They would heckle again, and I would stay steady: “That’s noted.”

Then, unexpectedly, they received a serious medical diagnosis. And for whatever reason, they asked me to be the person to listen to them.

It is almost a silly story because there was an arc, but I was comfortable without needing that arc to conclude. It was fine either way.

I have also had other clients who have been highly dysregulated—one who came right into my face in a moment of extreme agitation and called me the wrong name. They said, “Slippers! You’re not listening!”

I kept my face completely still, but inside, I was cackling. It was wonderful. You do not have to know my name—I do not expect you to—but you wanted to name me—you wanted to relate to me—and even though you got it wrong, the impulse to connect was there.

I see so much of this as material. I am not innately afraid of clients or people. I could have reason to be, but I am not.

I understand fundamentally that people are born and people die. That is the facticity of life. Those two facts bind us all, no matter who we are or what we’ve lived. Whether you are religious or not, those facts themselves are extraordinary. There is divinity in the facts of life.

However someone interprets it—religiously, spiritually, or otherwise—it remains extraordinary to be a human being on this Earth.

Sometimes, I think of it like the yellow Google Maps figure you can drag and drop anywhere in the world. Maybe it is a reference from 2012, but that image captures it for me: this ability to be placed anywhere and the wonder that, wherever you are dropped, there is life happening—life, with all its magnitude and mystery.

It is like that—a yellow, amorphous being that you can dangle and then drop into a street view. So much of life is just coming into consciousness, and suddenly, you think, “I have great-great-grandparents? What are you talking about? My parents were once children. My guardians were once young?”

What is life? There is history, journalism, psychotherapy—it is all so bizarre. We are all just here. And if you can stay with the mastery and magnitude of whatever created existence—or whatever it is—then it is pretty amazing. It is extraordinary.

And then there are queer studies, disability studies, and all these different hermeneutic lenses you can bring to bear, seeing the world through various frameworks of how Islam views the world, how a small sect within Islam views the world. You have never even heard of how another sect might be at war with the first in a region.

There is the king of Jordan—endlessly famous within Jordan—yet, in North America, he could walk the street anonymously. It is astonishing how much richness there is in this world.

Jacobsen: How does the allegory of Plato’s cave help structure the philosophy of your meta-hermeneutic approach?

Cahana: Well, yes—sense perceptions are central.

The cave is a critical image. I love other powerful metaphors, like Pirandello’s Six Characters in Search of an Author, which also touches on these ideas, though it is less widely known.

The therapeutic space itself is a cave. It is an oasis, perhaps—but it is also a dark, enclosed space where you can throw off the cliff whatever you do not want to work with that day. You can parse through your experience and even reach first principles. That is what the cave represents: it is dug into the mountain’s edge, a space apart.

We are all cleaving toward truth. There is a truth in the universe, and none of us fully knows it. Some might be closer than others, but even that is uncertain. We are all in the mystery together.

At the same time, other people in our worlds have different visions and perspectives. They encroach on us, intentionally or not. Our relationships are often unsatisfying. Our material reality is messy and never perfectly “right.” If we hyper-fixate on that imperfection, it can lead to deep isolation or a belief that only the self is reliable—which is another false perception.

There is, perhaps, an ideal world—Plato’s world of Forms: the ideal horse, justice, and truth. We always strive toward that ideal, climbing a ladder we might never reach the top of.

But the goal, ultimately, is to harmonize with reality, to see others more softly, to recognize that others were born and that they, too, have lived experiences, dreams, and failures.

We sincerely wish to fix the world and put everything in perfect order. But the waves will crash, and the sandcastle will dissolve. The work is to rebuild—again and again.

It is about rebuilding the sandcastle. I have also been thinking a lot about Sisyphus lately. Yes, reflecting on Sisyphus as a figure of punishment.

I heard a beautiful podcast–”Everything is Alive- Chioke Grain of Sand“–that discussed how, over hundreds of thousands of years, the conditions in the story of Sisyphus—where he is condemned to push an enormous boulder up a mountain for eternity—would inevitably change.

It becomes a striking image: perhaps the boulder becomes like a marble over time, and the mountain face flattens. Eventually, it is no longer an endless toil but something meaningful. Sisyphus could even play games with that bit of marble. I find that image beautiful and spectacular.

We also recently read another piece. It is a poem by a literary critic, poet translator with his take on Sisyphus is named Stephen Mitchell. He writes that Sisyphus loves the boulder. He loves everything about the boulder. You can say what you want about his punishment, but Sisyphus fully cleaves to his reality. It goes as follows:

We tend to think of Sisyphus as a tragic hero,

condemned by the gods to shoulder his

rock sweatily up the mountain, and again up the mountain, forever.

The truth is that Sisyphus is in love with the rock. He cherishes every roughness and

every ounce of it. He talks to it, sings to it. It has become the Mysterious Other. He

evens dreams of it as he sleepwalks upward. Life is unimaginable without it, looming

always above him like a huge gray moon.

He doesn’t realize that at any moment he is permitted to step aside, let the rock hurtle to

the bottom, and go home.

That, too, is a beautiful lens into the story.

There are endless powerful images—whether from the Hebrew Bible, the Christian Bible, or other sources. But the cave allegory remains especially helpful: it says things are not quite what they seem, and we start working it out.

Let us go through a dialogue. Let us wrestle with the endless questions: What are the shadows? Who are those shadows? What is the outside? What happens when the shackles come off? What happens when you try to convince others?

There are so many good, rich questions there.

Jacobsen: Could you share some of your favourite existentialist or Hebrew quotes that you find relevant to therapy? 

Cahana: So, my favourite quotes are from the Hebrew Bible and Existentialist. I am always connected to the book of Ecclesiastes from the Hebrew Bible. I often repeat the opening line, which is so strong: “Futility of futilities, everything is futile.” It is a fantastic and strangely charming statement. It captures so much existential truth.

As for an existentialist quote, I love a line from Irvin Yalom, the existential psychotherapist. He says—and I am paraphrasing slightly—”It’s the relationship that heals. It’s the relationship that heals. It’s the relationship that heals.”

That mantra sits on my professional rosary. It is something I find beautiful and endlessly relevant.

Jacobsen: Perfect—both quotes feel like mantras. And both seem deeply relevant for hospice work, too.

In North America, the image of someone in hospice with a rosary is common, so the idea of a professional or therapeutic rosary fits beautifully.

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#endOfLifeCounseling #ExistentialTherapy #griefSupport #HospiceCare #palliativePsychology

A quick #introduction to all of my new friends on mastodon.green!

I'm an therapeutic #counsellor living in #Kent in the UK.

I'm interested in:

#counselling #psychotherapy #ecotherapy #walking #bushcraft #conservation #biophilia #existentialism & #existentialtherapy #camping #academia #phd #teaching #cooking #clinicalsupervision #integrativecounselling #neurodivergence #community #ncs #counsellorsconnect

I'm also part of #thewildspacekent project (thewildspacekent.co.uk)