How Existential Therapy Works

There are two things all humans have in common: We are born onto this Earth and we will die on this Earth. This knowledge of the human condition is the source of endless existential questions, concerns and searches for some sort of meaning to make sense of the time we’re here. It’s the driving force for countless decisions and the topic of many late-night deep conversations—you know the ones.

But, it's not just reserved for those heart-to-hearts with loved ones, it’s also a topic commonly tackled with a mental health professional. Existential therapy, in particular, centers around these questions and concerns, providing a safe space to dive into the big philosophical points of life.

What Existential Therapy Helps With

Existential therapy can help with things such as anxiety (including around death), hopelessness, low self-esteem, and more. “Human existence is full of uncertainty—and uncertainty breeds anxiety. Existential therapy is about how we grapple with the uncertainty of life to find freedom and meaning,” says Kelli Collins, a licensed marriage and family therapist and the regional clinical director for Two Chairs. “In existential therapy, you can expect to face big scary things like death, isolation, and meaninglessness, and to seek to find purpose and meaning in your life in spite of it all.”

Yalom described four core concerns addressed in existential therapy:

• Freedom
• Isolation
• Meaninglessness 
• Death

Studies have shown that existential therapy techniques can have benefits such as improved existential well-being in cancer patients. However, further research is needed to fully understand the evidence behind existential therapy.

The 19th century Danish philosopher, Søren Kierkegaard, is considered the father of existentialism and stressed the importance of giving meaning to your own life instead of searching for it in external factors like religion.

How Does Existential Therapy Work?

An existential approach to therapy emphasizes:

1. Any person can have self-awareness
2. Free will brings responsibilities for actions
3. Each person is unique and needs interpersonal relationships to be fully understood
4. The meaning of an individual’s life is fluid and constantly changing, thus they must be regularly recreating themselves
5. Anxiety is a universal part of being human
6. Death is the constant that brings life meaning

Existential therapy focuses on current and future experiences, rather than diving into past events or attempting to diagnose symptoms, adds Nilou Esmaeilpour, a registered clinical counselor at Lotus Therapy and Counselling Centre. It also grapples with the individual responsibilities and free will each person contends with as you move throughout your life.

Part of this process is delving into the pain these choices can bring. “We all have the freedom to choose our attitudes and what we want to be about in life, and we have the responsibility to actualize our values and live according to our principles,” says Dr. Avigal Lev, a licensed clinical psychologist at Bay Area CBT Center. “This sense of freedom and the responsibility to choose a meaningful life often bring humans a lot of pain.”

A great deal of existential therapy also centers around the ways you relate to other people. “This approach aids in finding ways to cope with existential isolation, the reality that we are all born alone and die alone yet are still interconnected and interdependent,” says Lev.

The Role of Existential Therapy in Modern Psychology

Existential therapy is a tool some mental health professionals do use in conjunction with other therapeutic techniques. “An existential therapist might also incorporate some basic tools to help relieve symptoms quickly by drawing from other therapy models, like cognitive behavioral therapy,” says Collins. “Existential therapy works well with therapy models that focus on exploring values and purpose, like acceptance and commitment therapy.”

Some limitations of existential therapy involve its abstractness and lack of a clearly focused structure, explains Esmaeilpour. It also typically isn’t focused on identifying or coping with specific mental health disorders (or even symptoms) which can be challenging if a person needs help in those areas.