Existential Therapy

Key takeaways

• Existential therapy is based on the principles of existential philosophy, which explores themes of individuality, freedom, and choice.

• Existential therapists use techniques such as Socratic questioning and mindfulness to help clients find meaning in their lives through self-awareness and acceptance.

• Existential therapy is especially helpful for people who want to explore their inner world, live more authentically, and develop resilience.

Understanding existential therapy

Existential therapy is a humanistic approach to mental health and well-being derived from existential philosophy. Like all humanistic approaches, it is based on the belief that people have an innate drive towards personal growth and well-being.^[1] The role of a therapist is to help the client fulfill that drive.

In line with this belief, existential therapy is fundamentally explorative. Rather than guiding clients towards a ‘healthy’, ‘helpful’, or ‘accurate’ perspective, existential therapists help clients discover their own beliefs and values.^[2] Clients can use this self-knowledge to build authenticity, develop resilience, and live a fulfilling life.

Another key aspect of existential therapy is the understanding of time. Existential philosophy argues that we can only experience the present moment.^[3] Even when we remember the past or consider the future, we are doing so from the present. Existential therapy follows this principle, focusing almost exclusively on the present moment. Clients are encouraged to consider both the past and the future in the context of the present.

Types of existential therapy

Existential therapy is an approach in its own right, but there are also existential approaches and interventions aimed at specific groups or problems. These include^[4]

• Meaning-centered group psychotherapy: This is a program designed to help terminal cancer patients find meaning through exploring ideas around death, legacy, isolation, and freedom. It has also been adapted to work with individuals.^[5][6]

• Meaning-making intervention: This approach was developed to help patients with PTSD cope with symptoms such as flashbacks and nightmares. It encourages clients to stay centered in the present while exploring both the past and the future.^[7]

• Meaning of life: The meaning of life intervention is a brief form of therapy, designed to help clients review their lives and understand how their attitudes and values have shaped their understanding.^[8]

• Hope process framework: This 6-week group therapy approach is designed to help clients look beyond their current experiences and increase hope.^[9]

• Cognitive-existential therapy: This approach combines finding meaning by exploring existential topics with aspects of cognitive behavioral therapy (CBT) designed to reframe unhelpful thoughts and beliefs.^[10]

• Dignity therapy: This therapeutic intervention was designed to help those with terminal illness create a legacy. Clients talk about themselves and their lives, and this conversation is transcribed and given to the client to bequeath to a loved one.^[11]

• Logotherapy: Logotherapy is a comprehensive existential approach to therapy. As well as traditional existential philosophers, it draws inspiration from Stoic philosophers and prioritizes helping clients find their own personal meaning or “logos”.^[12]

How it works

Existential therapy aims to help clients improve their well-being by developing their understanding of the fundamental questions of human existence. Rather than providing answers to these questions, existential therapy encourages clients to explore the issues involved and find their own answers.^[13]

Within existential therapy, mental health conditions are thought to stem from clients’ unresolved existential concerns. For example, clients may develop phobias, eating disorders, or obsessive-compulsive disorder (OCD) as a reaction to the knowledge that they will eventually die.^[13] By exploring these questions, clients find a degree of inner peace, and their symptoms recede.

Existential therapists don’t try to fix problems. Symptoms or problems are recognized as understandable responses to current circumstances. The principles of existential therapy are often combined with other humanistic therapies or approaches such as CBT.^[4][14]

What is existential therapy used for?

Existential therapy can help clients cope with many difficult situations. Direct, open conversations about death and mortality may be especially helpful for clients with terminal illnesses or those who have experienced bereavement. The focus on finding meaning may be attractive to clients who are struggling with low satisfaction or lack a sense of purpose.

This approach can be useful for clients with disorders, including^[15][16]

• Depression

• Anxiety

• PTSD

• Substance use disorder (SUD)

What to expect from existential therapy

Existential therapists are careful not to impose their own worldview on their patients. They are there to help clients find their own meaning, not impose meaning upon them. As clients explore their personal value systems, an existential therapist will ask questions designed to prompt deeper thinking and point out inconsistencies. They may also help clients recognize aspects of their behavior that aren’t aligned with their personal values, and explore their responsibilities and freedoms.

Some of the prominent themes typically explored in existential therapy are^[13]

• Death awareness

• Identity

• Isolation

• Freedom

• Meaning

Techniques

Techniques commonly used in existential therapy are designed to help clients explore their own beliefs and values. They include^[17]

• Socratic questioning: The therapist will ask philosophical questions that encourage the client to think deeply about important themes. These questions don’t have right or wrong answers, and the client is encouraged to elaborate on their answers to gain a greater understanding.

• Mindfulness: Existential therapy emphasizes being in the present. Clients are encouraged to pay attention to their thoughts, emotions, and experiences as they happen.

• Journaling: Existential therapy often raises questions that can’t be answered immediately. Journaling regularly can help clients develop their thinking and keep track of their insights.

The goal of existential therapy

The ultimate aim of existential therapy is to transform human suffering into thriving.^[4] The path to this is believed to be through awareness and acceptance. Importantly, existential therapy doesn’t aim to remove or prevent pain, sadness, or negative emotions, which are seen as an inevitable part of life.^[18] Instead, existential therapists work with clients to help them accept the reality of their circumstances and find their own meaning.

Effectiveness and limitations

Like many other humanistic therapeutic approaches, the effectiveness of existential therapy hasn’t received as much research attention as other approaches.^[19] Evidence suggests that it can help reduce symptoms of anxiety and depression, improving physical health and quality of life.^[20][21]

Existential therapy is commonly recommended for people who are facing some form of existential challenge, such as those with terminal illnesses.^[4] It can also be helpful for people who experience mental health symptoms associated with a loss of meaning or excessive fear and anxiety. Brief existential therapy has been used to treat substance use disorder, helping clients to confront the underlying causes of their substance use.^[22]

In addition to dealing with mental health issues, existential therapy may be valuable for people who are discontent with their lives or failing to flourish. By focusing on the whole person and helping individuals to find meaning, purpose, and acceptance in their lives, existential therapy can be used to maintain and improve good mental health, not just overcome problems.^[23]

Things to consider

Existential therapy is not specifically intended to treat mental disorders. Instead of addressing symptoms or problems directly, this approach focuses on helping clients find deeper meaning.^[13] This means that it may not be appropriate for those who are experiencing acute problems or serious mental health issues.

Existential therapy is highly individualistic, encouraging clients to find their own answers to questions of identity and meaning. In some cases, clients with a highly collectivist cultural background may find this invalidating or counterintuitive.^[24]

Existential therapy can be highly theoretical and complex. This may be challenging if you’re not used to thinking about questions in this way. It may also be counterproductive for clients who over-intellectualize their problems, as it can reinforce this tendency.^[25] This way of working may not be compatible with some strong religious or philosophical beliefs. For example, existential therapy may include exploring what it means for life to be finite, which may not resonate for some religious clients.

Finding an existential therapist

Existential therapy requires exploring topics that can be intellectually and emotionally difficult. Having a comfortable and trusting relationship with your therapist allows you to feel safe while seeking answers to these difficult questions. When looking for an existential therapist, take your time to find someone you believe you can build a trusting relationship with. Look at their profile, ask questions about their approach and experience, and consider having a trial session or two to see whether they’re right for you.

What to look for

When looking for a therapist, you need to know that the person you’ll be working with is qualified, capable, and trustworthy. Here are some things to look for that can help you tell whether a therapist meets those criteria.

• Qualifications: Do they publicize their qualifications? What additional training have they done since qualifying? Have they received training in the type of therapy you are looking for?

• Licenses and permissions: Do they hold the relevant licenses or certifications for practicing in your state? Do they hold the right insurance? Are they members of any professional organizations?

• Experience: How long have they been practicing? Do they have experience working with clients with similar issues to yours?

Final thought

Existential therapy can be a powerful approach for personal development and dealing with some of the inevitable challenges in life. Starting existential therapy begins a process of exploration and self-reflection, which can be profound for many clients.