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In a classic text in the H-E movement, Irvin Yalom outlined the Four Givens of human existence being death, loss of freedom, isolation, and meaninglessness. The Four Givens are the inescapable realities of human existence, and the focus of Existential Psychotherapy that provides clients a way to not only cope but grow psychologically from the existential conflicts of the Four Givens.

The first conflict, the core existential conflict, is the conflict between the reality of death and the wish to continue to exist. The second existential conflict is the challenge of freedom, which is the freedom of a random and groundless world with the wish for organization and structure. The third existential conflict is between the innate awareness of absolute isolation with the desire for connection to others, the need to become part of something greater, and the existential awareness that humans enter the world alone and will leave the world alone. Meaningless is the fourth existential conflict: awareness that human beings are meaning-seeking creatures with the reality that existence has no clear, apparent meaning or purpose.