What Is Existential Therapy? Meaning and Choice

What Is Existential Therapy?

Existential therapy is a philosophical approach to therapy that explores how you relate to the fundamental challenges of being human: meaning, freedom, isolation, mortality, and identity. Rather than treating specific symptoms, it helps you examine how you are living and whether the choices you are making align with what genuinely matters to you.

This is not therapy that gives you tools or techniques to manage your feelings. It is therapy that helps you sit with the big, uncomfortable questions that most of us avoid, and find your own answers. If you are going through a period where life feels empty, directionless, or fundamentally uncertain, existential therapy meets you in that space rather than rushing to fix it.

How Existential Therapy Works

Philosophical roots

Existential therapy draws on a tradition of European philosophy stretching back to the 19th century. The key thinkers include Soren Kierkegaard, who explored anxiety, choice, and the individual's relationship with meaning; Martin Heidegger, who examined what it means to exist authentically in the face of death; Jean-Paul Sartre, who argued that we are "condemned to be free" and must create our own meaning; and Maurice Merleau-Ponty, who focused on how we experience the world through our bodies and perceptions.

You do not need to have read any of these philosophers to benefit from existential therapy. Your therapist draws on these ideas to inform how they work with you, but sessions are conversations about your life, not philosophy seminars.

Key figures in UK existential therapy

Existential therapy has a particularly strong tradition in the UK, largely shaped by two figures.

Emmy van Deurzen is a leading existential therapist and author who founded the New School of Psychotherapy and Counselling in London. Her work has been central to establishing existential therapy as a distinct approach in British clinical practice, and she has written extensively on how existential ideas apply to everyday therapeutic work.

Ernesto Spinelli has contributed significantly to the development of existential phenomenological therapy in the UK. His approach emphasises the importance of staying with the client's lived experience rather than imposing theoretical frameworks onto it.

Their influence means that existential therapy in the UK tends to be grounded and practical rather than abstract, focused on how philosophical ideas illuminate real-life struggles.

The core concerns

Existential therapy organises human experience around several fundamental concerns, sometimes called "givens" of existence. These are not problems to be solved. They are realities to be engaged with.

Meaning and meaninglessness. Life does not come with a built-in purpose. You have to create or discover your own. When meaning breaks down, through loss, failure, disappointment, or simply the passage of time, existential therapy helps you explore what matters to you now and how to live in accordance with it.

Freedom and responsibility. You are freer than you might think, which is both liberating and frightening. With freedom comes responsibility for your choices, including the choice not to choose. Existential therapy explores where you are avoiding choice, hiding behind "I have to" when the reality is "I am choosing to," and what it would mean to own your decisions more fully.

Isolation and connection. No matter how close your relationships, there is an irreducible aloneness in being human. No one else can fully know your experience. Existential therapy explores how you navigate this, how you seek connection while accepting the limits of what others can provide.

Death and finitude. Your time is limited. This is not something to be morbid about. It is a fact that, when faced honestly, can clarify what matters and motivate you to live more deliberately. Existential therapy does not dwell on death for its own sake, but it does not shy away from it either.

Identity and authenticity. Who are you when you strip away the roles, expectations, and narratives others have placed on you? Are you living your life or someone else's version of it? Existential therapy helps you examine the assumptions you have absorbed and decide which ones you want to keep.

What happens in sessions

Existential therapy is dialogue-based. There are no standardised techniques, no worksheets, no homework in the traditional sense. Sessions are structured conversations in which your therapist helps you explore your experience at a deeper level.

Your therapist will listen carefully, ask questions that open up your thinking, and gently challenge assumptions you may not have examined. They are not trying to make you feel better in the short term. They are trying to help you understand yourself more honestly, which often does lead to feeling better, but through a different route.

A session might explore:

Why a particular situation feels so significant to you
What you are avoiding and what that avoidance is protecting you from
How you make choices and what patterns you notice
What meaning you are drawing from your experiences
How your relationship with time, mortality, or freedom shapes your daily life

The therapist's stance is one of genuine curiosity and engagement. They are a thinking partner, not an expert dispensing advice. They will not tell you what to do. They will help you see more clearly so you can decide for yourself.

Existential therapy tends to be medium to longer-term, typically 20 sessions or more, though some people find shorter engagements helpful for specific life transitions.

What the Evidence Says

It is important to be straightforward about the evidence base for existential therapy: it is limited compared to approaches like CBT, and the nature of the therapy makes it harder to study using the standard methods that produce the strongest evidence.

The most relevant research is the Vos et al. (2015) meta-analysis, which reviewed studies on meaning-centred interventions (therapies that focus on helping people find or create meaning in their lives). The review found that these interventions had significant positive effects on psychological wellbeing, particularly for people dealing with cancer, terminal illness, and loss of meaning. While not all the interventions reviewed were strictly existential therapy, the findings support the core premise that engaging with questions of meaning has measurable therapeutic value.

Qualitative research (studies that explore people's experiences in depth rather than measuring outcomes with numbers) provides a richer picture. Multiple qualitative studies have found that clients value the depth, honesty, and philosophical engagement of existential therapy. Clients consistently report feeling met as whole people rather than as collections of symptoms, and describe shifts in how they relate to their difficulties rather than simply a reduction in symptoms.

Logotherapy, developed by Viktor Frankl (a related meaning-centred approach), has a somewhat stronger evidence base, with studies showing effectiveness for depression, anxiety, and existential distress in palliative care settings.

The honest assessment is this: existential therapy is supported by theoretical depth, clinical experience, and a growing body of qualitative and mixed-methods research. But it does not have the volume of large-scale randomised controlled trials (RCTs, the gold standard for testing whether a treatment works) that would place it alongside CBT or EMDR in terms of quantitative evidence. This partly reflects the nature of the therapy itself. Existential therapy resists the kind of manualisation (standardising a therapy into a step-by-step protocol) that makes RCTs easier to conduct.

Existential therapy is not currently recommended by NICE for any specific condition. This does not mean it is ineffective. It means the type of evidence NICE requires has not yet been produced in sufficient volume.

What Existential Therapy Is Good For

Existential therapy tends to be most helpful for people grappling with questions about how they are living, rather than people seeking relief from specific, defined symptoms.

Existential crises: periods where the foundations of your life feel shaken, where the question "what is the point?" is genuine and persistent
Major life transitions: retirement, career change, divorce, becoming a parent, children leaving home, emigration, or any shift that forces you to re-examine who you are and what you want
Loss of meaning or direction: feeling stuck, flat, or disconnected from life without a clear reason why
Grief and bereavement: particularly where loss has triggered wider questions about mortality, meaning, and how to live with absence
Identity questions: uncertainty about who you are, what you value, or how you want to live, whether related to sexuality, career, relationships, culture, or ageing
Anxiety about death or the future: not panic attacks or phobias (which respond well to CBT), but the deeper, more diffuse anxiety that comes from confronting the uncertainty and finitude of life
Feeling inauthentic: the sense that you are living according to expectations rather than your own values, or that you have lost touch with what genuinely matters to you
Chronic illness or disability: where questions of meaning, identity, and how to live well within constraints become central

Limitations and Alternatives

Existential therapy is a specific kind of approach, and it is not suited to every person or every difficulty.

It is not symptom-focused. If you are looking for rapid relief from specific symptoms like panic attacks, OCD rituals, or phobias, existential therapy is unlikely to be the most efficient route. Approaches like CBT have strong evidence for targeted symptom reduction and will usually produce faster results for these presentations.

It requires comfort with uncertainty and philosophical exploration. Existential therapy does not offer clear answers or structured frameworks. If you prefer practical tools, homework, and measurable progress, you may find it frustrating. It asks you to sit with ambiguity, which can be uncomfortable.

The evidence base is limited. As discussed above, existential therapy has less quantitative research support than more established approaches. If having strong trial evidence behind your therapy is important to you, this is worth considering.

There are fewer trained therapists. Existential therapy requires specific postgraduate training, and there are fewer existential therapists in the UK compared to CBT, person-centred, or integrative therapists. This can make finding the right match more difficult, particularly outside London.

It may not be suitable for acute mental health crises. If you are in significant distress and need stabilisation, a more structured approach is usually more appropriate as a first step.

If existential therapy does not feel right, there are related approaches that share some of its qualities:

Person-centred therapy also offers a non-directive, relationship-focused approach, though it is less philosophically oriented
Psychodynamic therapy explores how past experiences shape present patterns and also works at depth, but through a different theoretical lens
ACT (Acceptance and Commitment Therapy) shares existential therapy's interest in values and meaning, but within a more structured, skills-based framework

What to Expect

If you are considering existential therapy, here is what the process typically looks like.

First sessions. Your therapist will want to understand what has brought you to therapy, but the conversation may go broader than you expect. Rather than focusing narrowly on a presenting problem, an existential therapist is interested in how you are living your life as a whole: your relationships, your values, your choices, and what feels meaningful or meaningless. This can feel refreshing or disorienting, depending on what you are used to.

The therapeutic relationship. The relationship between you and your therapist is central to the work. Your therapist is not a blank screen or a detached expert. They are genuinely engaged, willing to be challenged, and transparent about their own thinking process (within appropriate boundaries). The quality of this relationship is a large part of what makes the therapy work.

The middle phase. As therapy progresses, you will explore recurring themes in your life with increasing depth and honesty. Your therapist will help you notice patterns in how you relate to freedom, meaning, isolation, and mortality. This is not intellectual analysis for its own sake. It is about understanding how these fundamental human concerns show up in your daily decisions, relationships, and emotional life.

No quick fixes. Existential therapy does not promise rapid symptom reduction. What it offers is a deeper understanding of yourself and your life that can shift how you relate to difficulties, choices, and uncertainty. Many people describe the change as a gradual shift in perspective rather than a sudden improvement.

Cost. Private existential therapy in the UK typically costs £60 to £80 per session. Availability varies by area, with more therapists practising in London and larger cities. Aligned can help you find an existential therapist online or in person.

Finding a therapist. The Society for Existential Analysis is the main UK professional body for existential therapists. Look for therapists who are members or who have completed training at institutions associated with the existential tradition.

Session format. Sessions are usually 50 to 60 minutes, held weekly. Existential therapy tends to be medium to longer-term. Some people work with an existential therapist for six months to a year, while others continue for longer. The pace is determined by the work, not by a predetermined protocol.

How Aligned Can Help

If existential therapy sounds like it might be a good fit for you, Ally, our matching agent can help you find a therapist trained in this approach. The matching conversation takes around 10 minutes, and our team will find someone who fits your needs, budget, and location. The service is completely free.

Frequently Asked Questions

Do I need to know anything about philosophy to do existential therapy?

Not at all. Existential therapy draws on philosophical ideas, but your therapist translates them into ordinary conversation about your life. You will not be expected to read Heidegger or discuss Sartre. The philosophy informs how your therapist thinks and works, but sessions focus on your lived experience, your choices, and your struggles. If anything, the best existential therapy feels like a deeply honest conversation, not an academic exercise.

Is existential therapy the same as existential crisis counselling?

Not exactly, though it is well suited to people going through an existential crisis. An existential crisis is a period where your sense of meaning, purpose, or identity breaks down. Existential therapy can help during these periods, but it is not limited to them. Some people seek existential therapy when things are broadly fine but they want to live more deliberately and authentically. Others come during a specific crisis. Both are valid reasons to explore this approach.

How is existential therapy different from person-centred therapy?

Both approaches are non-directive and relationship-focused. Person-centred therapy is grounded in the belief that you have an innate tendency towards growth and healing, and the therapist's role is to create conditions (warmth, empathy, genuineness) that allow this to unfold. Existential therapy is more philosophically oriented and actively engages with the fundamental challenges of human existence. An existential therapist is more likely to challenge your assumptions and explore uncomfortable truths about freedom, mortality, and meaning. Person-centred therapy tends to follow your lead more closely, while existential therapy brings a specific philosophical lens to the conversation.

Can existential therapy help with depression or anxiety?

It can, though it approaches them differently from symptom-focused therapies. Existential therapy does not target depression or anxiety as disorders to be eliminated. Instead, it explores what they might be telling you about how you are living. Depression might reflect a loss of meaning. Anxiety might signal that you are avoiding important choices. By engaging with the underlying existential concerns, people often find that their depression or anxiety shifts, though this is usually a slower process than symptom-focused approaches like CBT.

Is existential therapy suitable for trauma?

Existential therapy can be helpful for people processing the aftermath of trauma, particularly where the trauma has raised questions about meaning, fairness, identity, or mortality. However, it is not a trauma-processing therapy in the way that EMDR or trauma-focused CBT are. If you are experiencing active PTSD symptoms (flashbacks, nightmares, hypervigilance), a specific trauma-focused approach is usually more appropriate as a first step. Existential therapy may complement this work by addressing the broader questions that trauma often raises.

How do I know if existential therapy is right for me?

Existential therapy tends to suit people who are drawn to reflection and honest self-examination. If you are grappling with questions about meaning, identity, or how to live rather than seeking relief from a specific symptom, it may be a good fit. If you value depth over speed, and are comfortable with a therapy that does not offer quick answers or structured techniques, it is worth exploring. You can discuss whether it might suit you during your matching conversation with Ally, and our team will help you find the right approach.