Existential Therapy

What is existential therapy?

Existential therapy is a talking therapy about the big questions of life. Its four main themes are death, meaning, isolation and freedom.

Existential therapists do not assume your distress is a sign of illness. They see it as part of the difficulty of living, which everyone meets.

You might come to it at a turning point. A loss, an illness, a big birthday or a hard choice can all raise these questions.

Sources: BACP: existential therapy, SEA: existential analysis

Where it comes from

It draws on the ideas of philosophers such as Kierkegaard, Heidegger and Sartre.

Viktor Frankl, a psychiatrist in Vienna, survived the Nazi concentration camps. His approach, logotherapy, sees the search for meaning as the main force in a human life.

In 1980, Irvin Yalom named four "ultimate concerns": death, freedom, isolation and meaninglessness. In the UK, the Society for Existential Analysis has brought existential therapists together since 1988.

Sources: Vos et al. 2015, VFI: biography, VFI: logotherapy, Yalom 1980, SEA: overview

How it works

It is less about techniques and more about how you live. It works with your present rather than digging into your past.

Your therapist helps you describe your experience as it is, before anyone tries to explain it. The existential therapist Emmy van Deurzen looks at four areas of life: physical, social, psychological and spiritual.

The aim is to understand your anxiety rather than only to reduce it. You look at what it says about your life and your choices.

Sources: UKCP: approaches, BACP: existential therapy, Vos et al. 2015, van Deurzen 2006, SEA: existential analysis

What sessions look like

Like most therapy, sessions usually last about 50 minutes. Each one takes the form of a conversation.

Some people come for a short time and some for longer. Van Deurzen describes a course of three months to two years, and sometimes more.

Many therapists blend it with other approaches. You can see a therapist on your own, as a couple or in a group.

Sources: BACP: counselling, van Deurzen 2006, SEA: existential analysis, BACP: existential therapy, UKCP: approaches

Who it might suit

It can be a good fit if you:

• Keep asking what the point of it all is
• Face a big choice, or regret one you made
• Have been shaken by a death, an illness or a close call
• Feel alone even when you are with other people
• Are at a turning point, such as a new decade, a divorce or retirement
• Would rather explore your life than be given a label

It may suit you less well if you want relief from symptoms more than a search for meaning. Therapies such as CBT are more structured, with goals and tasks between sessions.

Source: van Deurzen 2006

How it differs from other humanistic therapies

Existential therapy is one of the humanistic approaches, like person-centred and gestalt therapy. All of them see you as a whole person, not a list of symptoms.

The difference is where they look. Humanistic therapy in general looks towards growth and your potential. Existential therapy looks at the limits nobody escapes, such as death.

Source: BACP: types of therapy

The evidence

The research is thin. A 2015 review found 15 trials to pool, and its authors called them few and of low quality.

Most of the trials involved people living with a physical illness, such as cancer. The clearest gain came from structured courses about meaning, which improved people's sense of meaning in life.

NICE does not name existential therapy in its guidance on depression or anxiety. The NHS Talking Therapies manual does not list it either.

If you are weighing up a few options, our guide to the different approaches sets them side by side.

Sources: Vos et al. 2015, NICE NG222, NICE CG113, NHS England: talking therapies manual