“Who am I? And why am I here?”
Lofty questions like these are the premise upon which existential therapy operates. The approach, which is rooted in the works of philosophers such as Nietzsche and Kierkegaard, believes that all human problems boil down to four essential issues: Meaning, freedom, connections with others, and death.
Mulling over these challenging topics is common after a major milestone, event, trauma, or even without apparent incentive.
When contemplating them leads to symptoms of mental health conditions, such as depression and anxiety, existential therapy can be a helpful guidance, since this form of therapy focuses on the person, rather than the symptoms – with the goal of learning to live with these big questions.
What happens in a typical existential therapy session
Different existential therapists take different approaches. Common activities you might encounter in sessions include:
Listening to your own self-talk
As you work toward greater self-awareness, your therapist may help you listen more carefully to your own thoughts and assumptions.
Reflection on the past and preparation for the future
Existential therapy is essentially focused on the future and your power to shape it. However, your sessions will likely include a look back at your past and how it can help you make rational choices going forward.
Making connections to existential questions
As you discuss your present concerns and life choices, your therapist will prompt you to relate these experiences to the bigger questions of who you are and what you believe.
Activities to help you define your goals and assets
Learning to accept both the freedom and the responsibility of being human is a key goal of existential therapy. Accordingly, you may work with your therapist to identify how you can embrace that freedom and what you hope to do with it.
Exercises around accepting anxiety
Existential therapy assumes that some level of anxiety will always be part of life, so your sessions will likely include techniques for facing that anxiety and learning to live with it.
Practice noticing the positive aspects of life
Some people assume that existentialism is negative or pessimistic, but it is actually focused on how to create positive meaning amid life’s uncertainty. Your therapist may encourage you to be more mindful about noticing and appreciating the world’s inherent wonders.
Taking action and analyzing results
Part of the goal of existential therapy is learning to use your freedom to take positive action, so you may decide on courses of action with your therapist’s help and then devote time in sessions to discussing how it went.
Existential therapy session structure
Unlike some kinds of therapy, there is no set structure for existential therapy sessions. However, many existential therapists will guide you through some version of the following structure:
Talking through the issues that brought you to therapy
Your first session or two may focus mostly on building rapport with your therapist and developing a shared understanding of your past and present experiences with mental health. You’ll also get into your thinking around core existential questions, as well as any current experiences (such as life transitions) that relate to them.
Defining your values and identity
Once you’ve built a foundation with your therapist, you may move on to a deeper discussion of your own personal values and identity. These conversations are geared toward helping you clarify how you see yourself and your purpose in life.
Focusing on your relationships
Existential therapy sees connections with others as as a key source of meaning and identity, so you may work with your therapist to better understand your relationship and learn ways to strengthen them.
Making authentic choices
Learn to take action you believe in is a common focus of existential therapy. Your therapist will likely work with you to build your sense of personal responsibility and agency.
Gaining self-awareness and flexibility
Over time, the goal is to have a clearer sense of yourself and how you interact with the world. You will also work toward being more accepting of the inherent uncertainty of life. Your therapist can help you learn ways to be flexible in the face of these ever-changing challenges.
Issues existential therapy can help with
Existential therapy can be helpful for a broad range of mental health concerns, including:
That said, you don’t need to have a specific mental health condition, or symptoms, to seek existential therapy. It can be helpful for anyone who’s contemplating big life questions and how to handle them.
Effectiveness of existential therapy
Compared to some other kinds of therapy, there is relatively little scientific research on existential therapy.
However, one review found that existential therapy can be helpful for:
- Individuals dealing with physical illnesses
- Individuals dealing with a wide range of mental health conditions 
Frequency of existential therapy sessions
Weekly, as core treatment
Existential therapy sessions can be held on a weekly basis, if that is the approach and treatment that your therapist recommends.
Occasionally, on an as-needed basis
Some therapists may recommend more or less frequent sessions, based on your symptoms and treatment goals.
As complement to other types of treatment
Existential therapy can be used sporadically, as a complement to other kinds of therapy sessions.
Length of treatment in existential therapy
There is no set endpoint for existential therapy. Treatment might take place over the course of a few weeks, a few months, or a longer period of time.
As with any therapy, you and your therapist will agree on treatment goals early on in the therapeutic process. This discussion should also include ways to measure progress based on your individual goals, as well as how you’ll know when it’s time to end treatment.
What to look for in an existential therapist
Existential therapists may be social workers, psychologists, psychiatrists, or another kind of mental health professional. No matter what kind of therapist you choose to work with, make sure that they meet the following criteria:
- An advanced degree in a mental health field
- Licensure to practice in the state where you live
- Additional experience and/or training using existential therapy
- If applicable, experience working with people who share your specific concerns (if you’re dealing with a certain mental health condition) or identity (if you feel that any aspect of your identity may be relevant to treatment)
- Most importantly, you’ll want to find a therapist you trust – and with whom you feel you can develop a strong therapeutic alliance
Existential therapy works by helping you come to terms with life’s major questions. The goal is to help you see yourself as a responsible, effective leader of your own life, even though you don’t have the power to change the basic realities of being human.
Existential therapy focuses on building your individual power to gain self-awareness, make rational choices, and take positive action. You won’t solve necessarily solve life’s big dilemmas, but you can nonetheless learn to live with the mysteries they present and live up to your own full potential.