What Does Existential Therapy Look Like? A Guide to This Misunderstood Approach
If you've been researching therapy options, you've probably come across existential therapy and thought: That sounds either deeply profound or completely impractical, and I'm not sure which (and that’s if you’ve heard of it at all).
You're not wrong to be confused. Existential therapy gets a bad rap —dismissed as philosophical navel-gazing for people who want to talk about death and meaning instead of actually solving their problems. Or it gets romanticized as some ethereal, abstract conversation about the nature of existence that has nothing to do with your actual life.
Both of those pictures are so wrong.
As an existential therapist, I'm going to let you in on what this approach actually looks like, where it came from, and why it matters now more than ever.
Where Existential Therapy Comes From
Existential therapy emerged in post-World War II Europe, born from the rubble of a world that had witnessed unprecedented violence, genocide, and the complete shattering of what people thought they knew about civilization and human nature (sound familiar?). Philosophers and psychiatrists like Viktor Frankl, Jean-Paul Sartre, Simone de Beauvoir, Erich Fromm, and Rollo May were grappling with a specific crisis:
How do people find meaning and continue living authentically, and find true and deep connection, when the structures that previously told them everything would be okay if they just followed the plan… you know the one that has you acting more compliant with what the powers that be think you should… collapses completely/ fails to live up to that promise?
Viktor Frankl lost everything to Nazi concentration camps—his parents, pregnant wife, brother, and his lifelong manuscript he’d sewn into the lining of his coat—and somehow, came out the other side with a manifesto that has us shook nearly a hundred years later. A psychiatrist by trade, he tried to help his fellow inmates find ways to increase their likelihood of survival, and he found that those who were somehow able to tap into their sense of agency and create a narrative that brought meaning into what could easily be the most dire and hopeless of scenarios, were much more likely to endure than those who couldn’t.
“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.
When we are no longer able to change a situation, we are challenged to change ourselves.”
Around the same time, over in France, a dynamic and definitely progressive (ahem, taboo at times, and thus immediately one of my binge reads when I discovered them in high school) couple found themselves resisting conformity in their own myriad of ways, not the least of which was through their writings on the subject. Jean Paul Sartre and Simone de Beauvoir rejected marriage, monogamy, and pretty much every social script handed to them, insisting that we're "condemned to be free"—that there's no cosmic playbook, no essential nature telling you who you're supposed to be.
Sartre said existence precedes essence, which is a fancy way of saying you're not born with a predetermined self—you create it through your choices, whether you admit it or not. De Beauvoir took that idea and ran with it in The Second Sex, arguing that women aren't born, they're made—constructed through endless performances of femininity that serve everyone except the woman doing the performing. Her question cut to the bone: What would you be if you stopped playing the role everyone else needed you to play?
Rollo May then brought these ideas across the Atlantic to 1950s America—white picket fences, nuclear families (biological parents still together raising their babies), and the suffocating pressure to smile through it all. He was working during the McCarthy era when conformity wasn't just encouraged, it was patriotic, and asking "who am I really?" could get you labeled dangerous.
May looked at his anxious, depressed patients living picture-perfect lives and said something radical for times (and I would argue, even today): your anxiety may not be a malfunction at all. In fact, it might be your psyche screaming that you're living someone else's life. He refused to pathologize the existential dread of people who'd done everything "right" and still felt hollow, insisting instead that anxiety is often the price of freedom—the signal that you're aware you have choices and terrified of making the wrong ones.
Erich Fromm, a German psychologist who also fled the Nazi’s, was asking different questions—not just about individual authenticity but about love itself. He watched post-war society turn everything into a transaction, including relationships, and wrote The Art of Loving to push back against the idea that love is something that just happens to you if you're lucky enough to find the right person. Fromm said mature love isn't about finding someone who completes you or makes you feel whole—that's just another form of dependence, another way of avoiding your own freedom.
Real love requires you to be a whole person first, capable of standing alone, choosing connection from a place of strength rather than need. He distinguished between immature love ("I love you because I need you") and mature love ("I need you because I love you")—and argued that most people never make that leap because it requires confronting your own separateness, your own responsibility for your life, instead of using another person as an escape hatch from existential loneliness.
There are many others, too many to highlight in depth, but I’d be remiss if I didn’t mention the more recent figure who became my clinical archetype for my own practice: Irvin Yalom. This man took all that philosophy and made it literally breathe in the therapy room, and all while keeping a first hand account of his experiences so everyone could learn from them. The chutzpah on this one! Most clinicians could never, I promise you that!
Yalom's approach is unapologetically direct and, in my opinion, sadly uncommon in our industry—he'll tell you what he's noticing about you in real time, use what's happening between the two of you as a window into how you show up everywhere else, and refuses to hide behind the neutral therapist mask. If he thinks you might be holding back in session, he'll name it. If he feels bored or disconnected, that's data worth examining together.
He made existential therapy less about abstract rumination (what he calls “content”) and more about immediate, lived experience (what he calls “process”):
What's happening right now between us?
What are you avoiding?
What does your fear of my judgment tell us about how you move through the world?
His work gave us therapists permission to be real humans in the room, not blank screens, and to trust that the relationship itself could be the vehicle for transformation.
To me, all of this rings just as true now as it did then.
We're living through our own collapse of stable meaning-making systems. Religious institutions are declining with most except for baby boomers and ironically, a growing number of youngest gen z’ers/ older gen alphas. Political polarization has fractured families and friend groups. Traditional life scripts (graduate, marry, buy a house, retire) no longer hold. Social media has created a hall of mirrors where everyone is utterly obsessed with what others are doing or not, even though we know goddamn well it’s not good for our mental health!
The same questions that drove existential therapy's originators are showing up in therapy offices right now:
Who am I when I stop worrying what others think or doing what someone else says I should?
What do I actually want?
What makes my life meaningful?
How can I get the most out of life?
How do I know if I’m in the best relationship for me?
What if I die without living up to my potential?
The Core Tenets of Existentialism (Translated into Real Life)
Existential therapy is built on the recognition that certain internal conflicts are part of being human. Here's what those actually look like in your life:
Freedom and Responsibility
Translation: "I feel paralyzed by all my options" / "I'm afraid of making the wrong choice"
You have far more freedom than you think you do which often freaks people out because it means you can't hide behind "I had no choice." The decision paralysis, the endless pros and cons lists, the waiting for certainty before you act? It really comes down to dealing with the weight of being responsible for the life you're creating. Not making a choice is actually making a choice, just by default, and one I’d never recommend.
Meaning and Meaninglessness
Translation: "Something's missing but I don't know what" / "My life might look good on paper but it feels empty" / "What's the point of any of this?"
Listen, as nice as it would’ve been, life simply doesn't come with a preset instruction manual. There's no cosmic authority telling you what your purpose is (I don’t care what some dude in a pointy hat told you). YOU have to create meaning, which is both liberating (you get to decide!) and destabilizing (wait, I have to decide?). That vague sense of emptiness even when things are "fine"? Often that's the recognition that you're living according to someone else's definition of a meaningful life. It might work for them, but what if it’s not for you?
“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma - which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.”
Connection and Isolation
Translation: "I feel lonely even around people" / "No one really knows me" / "I'm craving deeper friendships or romantic relationships but don't know how"
You are fundamentally separate from every other person. No one can fully know what it's like to be you, and you can never fully access another person's inner world. And yet connection is essential to being human. This tension—between the impossibility of being 100% known at all times and the desperate need to be seen—shows up as chronic loneliness, fear of vulnerability, or the exhausting performance of being whoever you think others need you to be (or maybe the’ve even flat out told you what they “need” you to be).
Life and Death
Translation: "I'm running out of time" / "What if I'm wasting my life?" / "Midlife crisis even though nothing's wrong"
You're going to die. Everyone you love is going to die. It’s really not morbid at all, but rather just the fundamental reality that gives life its urgency and preciousness. When clients come in at forty or fifty saying "I feel like I'm running out of time" or "What if this is all there is?"— I don’t see it as a crisis. It’s simply death anxiety doing what it's supposed to do: waking you up to the finite nature of your existence and forcing you to ask whether you're actually living the life you want. LFG!!
Why I Love Existential Therapy (And How I Actually Use It)
Here's what drew me to this approach: Existential therapy treats you like an intelligent adult capable of grappling with hard truths about your life. It doesn't pathologize your experience or try to "fix" you. It doesn’t come at you with patronizing platitudes or acts like you could somehow just medicate or journal your way out of the hard questions we all have to answer for ourselves (… not saying those might not be part of a comprehensive overall treatment plan though so don’t come for me). It says: You're having a completely human response to being alive in a world that doesn't come with instructions.
In my practice, this looks like:
I trust your intelligence. If you're lying awake at 3am questioning everything about your life, I'm not going to hand you a worksheet about cognitive distortions. We're going to examine what you're actually asking and why it matters. Your “existential crisis” holds valuable information about where you're living out of alignment with yourself.
I challenge you to be honest. Not in a harsh way, but in a "let's look at what you're actually doing here" way. If you're complaining about feeling stuck but refusing to make any different choices, we're going to talk about that. If you're sacrificing what you want to keep other people comfortable, I'm going to name that pattern. Existential therapy requires you to take responsibility for how you're showing up in your life.
I don't pretend there are easy answers. Sometimes the work is sitting with the discomfort of not knowing. Sometimes it's grieving the life you thought you'd have. Sometimes it's accepting that you can't make everyone happy and you have to choose. I'm not going to sell you a simple five-step process, because real transformation doesn't work that way (but it can work fast depending on the situation and the person).
I meet you in the mess. Existential therapy is about being with someone in their uncertainty, their fear, their confrontation with freedom and mortality and meaninglessness. It's about helping you find a way to live that's YOURS; not borrowed, not performed because that’s how they taught us, and certainly not someone else's script with your name on it.
This approach is particularly powerful if you:
Left a restrictive religious or family system and are rebuilding your sense of meaning
Are in midlife realizing you've been living someone else's version of success
Feel disconnected from the people around you, even if you're never alone
Are dealing with major identity shifts and don't recognize yourself anymore
Are burnt out with political overwhelm, climate change crisis, and social media bullshit
Want depth work, not just symptom management
Are tired of therapies that treat you like you need to be fixed instead of helping you figure out how to actually live
If you're grappling with questions about who you are, what you want, and what makes your life meaningful, this is the perfect time to figure out how to live authentically in a world that just doesn’t fucking get it.
Ready to explore what existential therapy could look like for you? Learn more about my approach and schedule a consultation.
TLDR: Common Questions About Existential Therapy
What is existential therapy?
A depth-oriented approach that helps people navigate the bigger questions in life like “Who am I? Why am I here? Where am I going? And who’s coming with me?” It’s about feel confident in your own skin and finding deep connection with others as well as purpose in life. It’s never about reducing people to just their symptoms.
Who is existential therapy best for?
People going through a pivot in life or an identity shift where what used to work is no longer working, whether that’s in a relationship or career or religion, etc. It’s also amazing for people who feel like they’re “running out of time” or those who can’t stand the thought of being boxed in or unfulfilled in life. And of course, if you’re burnt out by the world or afraid of dying, it’s amazing for that too.
Can existential therapy help with anxiety or depression?
Absolutely. Especially when it’s about more than just a chemical imbalance or short lived scenario. Existential therapy highlights any gaps between who you really are and want and any misalignments with that. It makes any next actions steps feel doable.
What is existential anxiety?
It’s a term we use to refer to the discomfort, sometimes intense even, that comes with this life is finite, and it’s on you to make the most of it in whatever ways seem best to you, even if others have made things harder at times (e.g., toxic family, religion, or political systems etc.). Existential therapy is AMAZING at working with this type of anxiety (sometimes also referred to as “existential dread”) and helping you find peace and even passion in your journey!
How is existential therapy different from CBT?
Put simply: CBT helps you cope with distress. Existential therapy helps you confront what the distress is asking you to change.
CBT is primarily concerned with symptom relief through thought and behavior change. Existential therapy is concerned with meaning, choice, identity, and how a person relates to all that it means to be human and to carve out an existence that feels authentic. One manages distress; the other helps people decide how they want to live.
Most counselors, including myself, use more than one modality, and nearly all include CBT techniques in their work, regardless of primary focus.
Can existential therapy help with trauma, even complex trauma/ C-PTSD?
YES. In fact, as an existential therapist, I believe most people have what I now call “authenticity trauma” or wounding that comes from being yourself in a world, starting with well-meaning loved ones, that couldn't handle who we actually were. Existential therapy addresses self-concept as the core foundation of everything else, allowing for deep healing and often quickly.
When someone gets back to who they were before the world told them to be someone else, everything else clears up.No more guilt. No more impostor syndrome. No more holding back or stressing about what others think.Just clarity and sovereignty (what I call radical autonomy).
