What is Existential Psychotherapy?

Existential psychotherapy is based in the core tenets of being a human being born into the life that we are a part of and our ability to deal with life’s givens: mortality, isolation, meaninglessness and freedom. It is an exploration of meaning from the perspective that we are fundamentally alone yet at the same time require connection to others to find context. It seeks to guide individuals into the most authentic state of experiencing possible.

History of Existential Psychotherapy

Existential Psychotherapy is rooted in the principles of Existential Philosophy, which emphasizes individual existence, freedom, and choice. These ideas were developed by philosophers such as Søren Kierkegaard and Friedrich Nietzsche, and further shaped by the phenomenologist Edmund Husserl. Otto Rank, a colleague of Freud, is widely regarded as one of the first existential psychotherapists. He introduced the concept of Life and Death Fears, suggesting that humans experience a tension between a “life instinct,” which drives individuation, independence, and autonomy, and a “death instinct,” which draws us toward merger, union, and community.

Viktor Frankl expanded existential thought through his work on the Existential Vacuum, a state of boredom or apathy that can lead to neurosis. He argued that this arises when individuals have the capacity to reflect on, rather than simply act out, their instincts, and when traditional frameworks such as religion or ritual no longer provide guidance. Frankl’s approach, Logotherapy, focuses on helping individuals discover meaning even in the face of suffering.

In the 1960s, Ronald Laing applied existential concepts to the treatment of schizophrenia and psychosis. He argued that humans face essential psychic challenges of existence and require ontological security—a stable sense of being supported by continuous, reliable environments—to maintain positive emotional states and a coherent sense of self. When these conditions are absent, the resulting chaos and anxiety can contribute to neurosis.

Modern existential psychotherapy has been shaped by thinkers such as Irvin Yalom, who emphasizes the role of death awareness. Yalom suggests that avoiding the reality of death is a common source of anxiety, but that confronting mortality—though difficult—is essential for living fully, cultivating authenticity, and experiencing life with greater richness, compassion, and presence.

Key Terms in Existential Psychotherapy

Ontological insecurity

In Existential Psychotherapy, ontological insecurity refers to a fundamental uncertainty about one’s own existence or being. It arises when individuals lack stable, reliable foundations—internal or external—that validate their sense of self, leading to vulnerability, anxiety, and existential distress. This concept, emphasized by Ronald Laing, suggests that emotional and psychological stability depends on consistent environments, meaningful relationships, and the development of self-certainty. Ontological insecurity can manifest as chronic anxiety, identity confusion, or difficulty establishing intimate or trusting relationships, and existential therapy seeks to support clients in developing a more secure, grounded sense of being.

Existential crises

An existential crisis occurs when an individual confronts fundamental questions about life, identity, purpose, or mortality. These crises often emerge during significant life transitions, trauma, or moments of profound self-reflection, forcing individuals to confront issues such as freedom, isolation, or meaninglessness. In therapy, existential crises are not seen as pathological but as opportunities for growth and self-understanding. Existential Psychotherapy supports clients in facing these crises directly, exploring their values, choices, and the implications of living authentically.

Four worlds

The concept of the Four Worlds, as used in existential approaches, refers to the multiple dimensions in which human existence unfolds: the physical/worldly, the social/interpersonal, the personal/psychological, and the spiritual/existential. Each “world” encompasses distinct but interconnected experiences, and psychological distress can arise when balance is lost or when one dimension is neglected. Existential Psychotherapy encourages exploration across these worlds, helping individuals understand how their choices, relationships, and personal meaning-making interact across different dimensions of life.

Death anxiety

Death anxiety is the fear or apprehension associated with the awareness of mortality. In existential thought, particularly in the work of Irvin Yalom, it is considered a central source of human anxiety and a motivating force in shaping behavior, values, and life choices. Confronting death anxiety directly in therapy allows clients to engage more fully with life, prioritize authentic experiences, and cultivate deeper connections with others. Rather than eliminating fear, existential approaches encourage acknowledgment and integration of mortality as a guiding presence.

Life and death instinct

Originating with Otto Rank, the life and death instincts describe two fundamental human drives. The life instinct propels individuation, autonomy, creativity, and personal growth, while the death instinct draws individuals toward union, merger, and dependency, reflecting a desire for security or dissolution of separateness. Existential Psychotherapy explores the tension between these forces, helping clients recognize how their choices, relationships, and coping patterns are shaped by the interplay of autonomy and connectedness, independence and attachment.

Existential vacuum

Viktor Frankl’s Existential Vacuum refers to a state of emptiness, boredom, or apathy that arises when life lacks meaning or purpose. It is most apparent in individuals who have lost external frameworks for direction—such as social norms, traditions, or religious rituals—and who have the capacity to reflect on life without a guiding structure. Existential Psychotherapy, and specifically Frankl’s Logotherapy, addresses the Existential Vacuum by supporting individuals in discovering personal meaning, fostering responsibility, and taking active steps toward purposeful living.

Logotherapy

Logotherapy is Viktor Frankl’s existentially-oriented therapeutic approach, emphasizing the search for meaning as the primary human drive. It holds that even in suffering, humans can find purpose through choice, values, or engagement with others. In practice, Logotherapy encourages clients to identify meaningful goals, clarify personal values, and transform their experience of existential frustration or the “Existential Vacuum” into an opportunity for growth. It is often integrated into broader existential work to provide a structured framework for meaning-centered intervention.

Life’s “givens”: mortality, isolation, meaninglessness, and freedom

Existential Psychotherapy addresses the four “givens” of human existence: mortality (awareness of death), isolation (fundamental separateness), meaninglessness (the need to create personal significance), and freedom (responsibility for one’s choices). These realities are unavoidable aspects of human life, and existential therapy does not aim to eliminate them but to help individuals confront, understand, and integrate them. By working with life’s givens, clients can cultivate authenticity, embrace responsibility, and develop a resilient and meaningful engagement with existence.

Terror management theory

Terror Management Theory (TMT) is a psychological framework that examines how awareness of mortality drives human behavior, often through the creation of cultural worldviews and self-esteem. In existential psychotherapy, TMT provides empirical support for the notion that death anxiety influences decision-making, social behavior, and interpersonal conflict. Therapists may use this understanding to explore how unconscious fear of death shapes values, defenses, and life priorities, facilitating reflection on authenticity and existential freedom.

Socratic dialogue

Socratic dialogue in existential therapy refers to the use of questioning to guide clients toward self-reflection, awareness, and authentic understanding. Rather than providing answers, the therapist helps the individual examine assumptions, values, and choices, clarifying meaning and purpose in their life. This method supports exploration of existential concerns such as freedom, responsibility, and mortality, fostering insight and personal growth through active, reflective engagement.

‘Here-and-now’

The “here-and-now” principle emphasizes focusing on present experience, bodily sensations, thoughts, and emotions rather than solely on past events or abstract theorizing. In existential therapy, it helps clients confront immediate feelings of anxiety, freedom, or isolation as they occur, enhancing awareness of choice and responsibility in real time. Engaging with the here-and-now allows for authentic experience, facilitates emotional integration, and supports the practical application of existential insights to daily life.

Applications of Existential Psychotherapy

What sets Existential Psychotherapy apart is its focus on the universal fears and anxieties inherent in the human condition, rather than on specific behaviors, family history, or ingrained relational patterns. It is less concerned with pathology or diagnosis and more with an individual’s frame of meaning and their capacity to confront life’s existential realities.

It is particularly useful in circumstances such as:

  • Mid-life crises – helping individuals navigate transitions, reassess life purpose, and make authentic choices.

  • Apathy and feelings of meaninglessness – supporting those struggling with boredom, disengagement, or the sense that life lacks significance.

  • Fear of death – addressing mortality anxiety to foster fuller, more conscious engagement with life.

  • Existential isolation – exploring the tension between the need for connection and the recognition of fundamental aloneness.

  • Freedom and responsibility – assisting individuals in accepting the burden and opportunity of choice, and in taking responsibility for their actions and values.

Through exploration of these themes, Existential Psychotherapy enables individuals to develop clarity, authenticity, and a deeper sense of personal meaning.

Limitations of Existential Psychotherapy

Existential Psychotherapy focuses primarily on helping individuals explore meaning, personal responsibility, and their position in the world, rather than analyzing behavioral patterns, subconscious processes, or relational histories that contribute to current difficulties. Its emphasis on the here-and-now and existential concerns can be refreshing, but it may offer limited insight into how familial, developmental, or societal contexts have shaped emotional regulation, attachment, and habitual ways of relating.

As a result, existential therapy alone may not be the most effective approach in certain situations, including:

  • Severe trauma or unresolved childhood abuse – deep emotional dysregulation may require containment and trauma-informed interventions before existential exploration.

  • Attachment and relational difficulties – individuals with insecure attachment may need therapy addressing relational and emotional regulation skills.

  • Severe anxiety, depression, or psychosis – acute symptoms can limit the capacity to engage with abstract existential themes; stabilization may be necessary first.

  • Habitual maladaptive behaviors – ingrained behaviors or compulsions are not the focus of existential therapy and may require cognitive-behavioral or psychodynamic approaches.

  • Lack of context for personal development – when understanding familial, societal, or developmental influences is necessary, existential therapy alone may leave gaps.

  • Need for structured coping strategies – individuals requiring practical tools for emotion regulation, impulse control, or behavioral change may benefit from complementary therapies.

In these cases, existential approaches are most effective when integrated with other therapeutic methods that address relational, behavioral, or trauma-related needs, ensuring a more comprehensive framework for personal growth and emotional resilience.

Further resources

Key Books & Texts

Organisations & Training

Further Reading Lists & Overviews

Additional Resources & Research Links