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Existential therapy

Reviewed by Susan Radzilowski, MSW, LMSW, ACSW

Illustration of several characters floating in separate bubbles, each examining the world around them through heart, mind, or other means

Existential therapy is a philosophical approach to mental health care that helps people explore the meaning of their lives and choices. It asks clients to think deeply about their beliefs and values, learn to accept responsibility for the choices they make, and increase their self-awareness and authenticity.

This type of therapy can be used in the short or long term, and in an individual or group therapy setting. Existential therapy can also be integrated with other types of psychotherapy, including:

The existential approach

Existential therapy sees human behavior as influenced by a combination of biology, culture, and luck. Treatment centers on the challenge of figuring out how to exist and find purpose in the face of conflict, uncertainty, suffering, or death. Providers emphasize six core elements:1

  • Self-awareness: Most people have the capacity to reflect on their own thoughts, feelings, and actions.
  • Personal responsibility: Everyone is responsible for the consequences of their own free choices.
  • Identity through connection: Each person’s identity is unique to them and can be understood only through their relationships with others.
  • Constant search for meaning: The meaning of each person’s life isn’t set or static—it changes as part of their unique lifelong journey.
  • Anxiety as part of the human condition: It’s normal to feel a little anxious about the uncertainty of life and the choices we make (as long as this anxiety doesn’t interfere too much with daily functioning).
  • Mortality: Every person eventually dies, and this truth can help each person prioritize what matters most to them.

Core ideas

This therapeutic approach also addresses four basic ideas that people tend to struggle with:2

  • Death: Our time in life is limited.
  • Freedom: By reflecting on our experiences and acknowledging external challenges, we’re able to make choices and take responsibility for our own actions.
  • Isolation: No matter how connected we become to others, each of us is still fundamentally a separate person, entering and leaving the world alone.
  • Meaninglessness: Life doesn’t have one predetermined or universal meaning. We must create our own.

Religious or spiritual ties

While existential therapy doesn’t have an inherent connection to spirituality or religion, it can be valuable for people who want to explore existential questions in the context of their spiritual or religious beliefs. Some people may find that existential therapy enhances their spiritual or religious practice by providing a space for deeper reflection.

Mindfulness, another practice that may or may not be a part of a person’s spirituality or religion, has some common ground with existential therapy. Both practices promote presence in the moment, self-awareness, and a deep exploration of your experiences.

Existential vs. humanistic therapy

Existential therapy has some similarities with humanistic therapy, another approach focused on understanding the human experience. These therapies share a belief in the importance of self-awareness, personal responsibility, growth, authenticity, and choice, but humanistic therapy tends to focus on acceptance and self-actualization, while existential therapy emphasizes meaning, freedom, and making responsible decisions.3 Existential therapy also views people’s fundamental struggles as rooted in anxiety over isolation, loneliness, despair, and mortality.4

How existential therapy works

An existential therapist will try to help you with three main goals:5

  1. Be honest with yourself.
  2. See yourself and the world from a wider perspective.
  3. Figure out how to move forward while learning lessons from the past and creating something meaningful to live for right now.

The first session is about building a connection—making sure you and your therapist trust and respect each other. In addition to the broad goals mentioned above, it’s likely that your therapist will help you set more individual goals as well.

While talking about your life and concerns, you’ll explore different dimensions of human experience (physical, social, personal, and spiritual) to figure out where you feel comfortable, where you struggle, and where you have strength. Your therapist will also help you clarify your values and beliefs, understand your relationships, and figure out where you’re not taking responsibility.

This process helps you connect with your emotions and find a sense of purpose. It’s not about getting rid of or avoiding anxiety, but facing it and learning to cope with uncertainty.

How effective is existential therapy?

Further study is needed, but some forms of existential therapy have proven helpful for certain groups of people. In particular, researchers have seen positive results for physically ill clients whose mental health was treated with structured therapies involving psychoeducation, prescribed activities, and positive discussions about meaning in life.6 These interventions, which use an organized framework, are designed to address specific issues and achieve therapeutic goals. For instance, a client with chronic pain may benefit from exploring the meaning of their experience and finding ways to cope with its impact on their life.

Existential therapy may be especially helpful for people with physical illnesses because concerns about death, meaninglessness, isolation, and freedom are more pressing. In the case of palliative care or life-threatening illness, existential interventions can offer crucial support for patients and their families, helping them navigate the emotional and psychological complexities associated with the end of life.7 The goal is to improve quality of life, foster a sense of peace, and enable patients to live as fully as possible in the time they have left.

Is existential therapy right for you?

Existential therapy shows some promising results, but it isn’t necessarily the right approach for everyone. In addition to the shortage of scientific data supporting its effectiveness in a wide range of groups, existential therapy is also:

  • Philosophical and abstract: It may not be suitable for people seeking concrete solutions or those who aren’t comfortable with deep philosophical discussions.
  • Important to practice in culturally competent ways: Existential therapy explores broad themes of existence, but it’s also rooted in Euro-American cultural assumptions and may need to be adapted to align with the client’s cultural background and worldview.8
  • Lacking a focus on systemic inequities: Existential therapists can help people navigate their choices in light of their individual experience, including core aspects of identity like race and gender. However, this type of therapy and some practitioners have been criticized for largely remaining silent on issues of social justice outside of session.9
  • Incompatible with some conditions: If you’re seeking help for a specific concern, such as anxiety or depression, other therapeutic approaches may be more appropriate. Existential therapy is also not recommended for people in immediate crisis or those with severe mental health conditions.
  • Not standardized: Unlike therapies that offer specific techniques or interventions, existential therapy is less prescriptive. Therapists may draw from a range of methods, and the lack of a standard approach can make it hard to know what to expect.
  • Less common: Existential therapy requires therapists to be well versed in philosophy and existential principles, which can limit the number of practitioners.

Despite the limitations of existential therapy, it can still be a valuable approach to healing. It may be a good fit if you’re:

  • Seeking personal growth and meaning, rather than looking to treat symptoms of a mental health condition or address an immediate crisis
  • Interested in using it as a framework with another evidence-based therapy
  • Curious about exploring deeper existential questions and concerns
  • Open to engaging in self-reflection and introspection
  • Aware of the challenges and potential discomfort that intense existential questioning can bring

If you’d like to learn more about existential therapy, a mental health professional can help. Browse our directory to find a licensed provider near you.

About the author

The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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