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The fundamental contribution of existential psychiatry and psychoanalysis as explicated by Medard Boss is its understanding of man as being. It does not deny the validity of dynamisms and the study of specific behavior patterns in their rightful places. However, it holds that drives or dynamisms, by whatever name one calls them, can be understood only in the context of the structure of the existence of the person with whom we are dealing. The distinctive character of existential analysis is that it is concerned with ontology, the science of being, and with dasein, the existence of this particular being sitting opposite the psychotherapist. Being and becoming are fundamental concepts in the existential framework of Boss. In his viewpoint, the problem is not at all that patients happened to have endured emotionally traumatic or impoverished pasts; it is rather that they cannot or do not commit themselves to the present and future. Some hope and commitment to work toward changing something in the immediate future, be it overcoming anxiety or other painful symptoms or integrating one's self for further creativity, is necessary before any uncovering of the past will have reality and be truly meaningful.
Boss's understanding of the process of insight in the existential frame is conveyed by the engaging term augenblick, literally meaning the “blinking of an eye” and generally translated “the pregnant moment.” It is the moment when a person suddenly grasps the meaning of some important event, in the past or future, in the present. Its pregnancy consists of the fact that it is never an intellectual act alone; the grasping of the new meaning always presents the possibility and the necessity of some personal decision, some shift in gestalt, some new orientation of the person toward the world and future. This is experienced by most people as the moment of most heightened awareness; it is referred to in psychoanalytic literature as the “aha” experience.
Existential psychiatrists a