He points out the influence of European psychoanalysts who emigrated to America as to highlighting particular aspects: the role of the will and of death anxiety (Otto Rank, later built upon by Ernest Becker), the future-oriented motivation of the individual (Horney), fear and freedom (Fromm), and responsibility and isolation (H. Kaiser[2]).

Yalom also points out that he frequently refers to works of writers in his book, including Fyodor Dostoyevsky, Leo Tolstoy, Franz Kafka, Jean-Paul Sartre, and Albert Camus.

He names some philosophers' views, works of literature and examples from clinical practice that assign to death awareness a role in fostering inner changes and personal growth.

He offers explanations on its widespread omission in the theory and practice of psychotherapy – in particular also by Sigmund Freud who saw it as a mere disguise for a deeper source of concern.

[...] the patient has to cope with the problem of choice—what he or she wants to do" and that "at both individual and social level, we engage in a frenetic search to shield ourselves from freedom."

[9] Yalom recites examples in literature, case studies and therapeutical implications concerning situations in which persons avoid responsibility.

Concerning the therapeutic approach to increase patients' responsibility, he notes that Kaiser's contributions, published 1965 in a book entitled Effective Psychotherapy, stand out for thoughtfulness and consistency.

[9] He subsequently reviews empirical findings that certain forms of psychopathology, in particular depression, are found to be more likely associated with an external locus of control or, in Martin Seligman's model, with learned helplessness.

He cites one example among his patients who experienced existential guilt as regret, which in the course of therapy gave place to a sense of possibility, another example of a patient who experienced existential guilt as self-contempt which later gave place to a sense of choicefulness, to self-confidence and to self-love.

He points out that fusion is a common escape from existential isolation and that this has a high overlap to the "ultimate rescuer" belief.

He discusses various answers related to questions around the "meaning of life", distinguishing between "cosmic" and "terrestrial" meaning, and noting that "most Western theological and atheistic existential systems agree [that] it is good and right to immerse oneself in the stream of life", describing hedonism and self-actualization, which have a main focus on the self, and altruism, dedication to a cause, and creativity, which focus more on transcending oneself.

Therefore, Yalom's proposed therapeutic answer to "pure" meaninglessness is to remove obstacles that prevent the patient from wholehearted engagement.

[14] In his own words, Yalom intended with this book to "demonstrate [..] that the existential approach is a valuable, effective psychotherapeutic paradigm, as rational, as coherent, and as systematic as any other".