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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