What is existential therapy and who can it help? Read how questions of death, freedom, isolation and meaning are explored in therapy and in everyday life.
Some kinds of distress have no clear name. They are not exactly depression, nor an anxiety disorder, nor a relationship problem. They are more like a question that appears as you look at yourself in the mirror in the morning: "Did I really choose this life?" Or a strange emptiness that settles in after the sudden loss of someone close: "If everything ends one day anyway, what is the point of all this rushing around?" Existential therapy is a psychotherapy approach that aims to work with exactly these kinds of questions. In this article we explain which ideas the existential approach rests on, the four core themes it addresses in therapy, how a session unfolds, and when the search for meaning can turn into distress that calls for professional support.
What Is Existential Therapy?
Existential therapy is a psychotherapy approach that sees human distress not only as the symptoms of a disorder but also as the result of encountering the inescapable realities of being human. Its roots reach back to the philosophy of thinkers such as Kierkegaard, Nietzsche, Heidegger and Sartre. Figures such as Ludwig Binswanger, Rollo May, Viktor Frankl and Irvin Yalom were decisive in bringing it into psychotherapy.
One of the most widely known examples of this approach is logotherapy, developed by Frankl. Drawing on his experiences in the concentration camps, Frankl argued that even in the harshest conditions a person retains the freedom to choose the attitude they take towards those conditions, and that finding meaning increases the strength to endure. Yalom, meanwhile, introduced the approach to a wide audience through books that translated existential thought into everyday clinical practice.
The existential approach is less a package of techniques than a way of seeing. The therapist sees the client not as "a problem to be fixed" but as a human being trying to build the meaning of their own life. For this reason, many therapists also make room for existential themes while working with cognitive behavioural, psychodynamic or humanistic approaches.
The Four Core Questions Addressed in Existential Therapy
Yalom speaks of four fundamental existential realities that every person faces sooner or later. These are the main themes existential therapy focuses on.
Death
Everyone knows they will die one day; yet most of us push this knowledge aside in everyday life. A serious illness, the loss of someone close or a disaster suddenly puts it in front of us. The fact that, after the 6 February 2023 earthquakes, many people felt that "belongings, savings and plans can lose their meaning overnight" is a recent example. The existential outlook argues that awareness of death can be not only a source of fear but also a prompt to live more consciously. For more on this, you can read our article on death anxiety.
Freedom and responsibility
According to existential thought, a person is the author of their own life; the responsibility for their choices is theirs. This idea is both liberating and frightening, because saying "I had no other choice" is sometimes far more comforting than saying "I chose this." Existential therapy gently brings into view the points where a person avoids responsibility; at the same time, it does not ignore real constraints, that is, economic circumstances, family obligations and social pressures.
In Turkey this theme often takes a particular form. A large share of major decisions, such as a profession, a marriage or the city to live in, are made together with the family's expectations, the worry about "what people will say" or the sense that "this was simply meant to be". Existential therapy does not belittle these cultural ties; loyalty to family can itself be a value. But it helps the person notice how much say they have in decisions about their own life, where they are truly choosing and where they are avoiding choice. Sometimes what changes is not the decision itself but the person owning that decision.
Existential isolation
However close our relationships, no one can see the world exactly through our eyes; in a sense we are alone at birth and at death. This is a more fundamental kind of aloneness, different from everyday feelings of loneliness. People sometimes lose themselves in relationships, cling to someone or constantly seek out crowds in order to escape it. Existential therapy explores ways of forming more genuine bonds with others while accepting this aloneness.
Meaninglessness
If there is no ready-made meaning in the universe, who will build meaning, and how? The existential approach argues that meaning is created rather than found; it emerges through commitment to work, to a relationship or to a value. A sense of meaninglessness is often a sign of the intuition that "I am living the wrong life".
In existential therapy the question is not "How do I get rid of this feeling?" but "What is this feeling telling me about how I live?"
What Happens in a Session? An Attitude More Than a Technique
Existential therapy has no standard protocol. Even so, some features stand out in sessions.
The here-and-now relationship: The therapist values building a real, sincere relationship with the client. Feelings that arise in the session, such as the client keeping the therapist at a distance or constantly waiting for approval, can be discussed as a reflection of their relationships outside.
Phenomenological listening: Rather than immediately interpreting the client's experience according to their own theory, the therapist tries to understand how the client lives the world, just as it is. Questions such as "What does failure mean for you?" bring out the personal meanings of words.
Making choices visible: Situations described as "I have to" are examined. Imagine a young person who has been preparing for the KPSS (Turkey's public sector recruitment exam) for three years and experiences a deep reluctance before every exam. As the conversations progress, it emerges that a civil service job was really their parents' dream of "secure employment", and that they themselves never truly chose this path. The therapist does not impose a decision; but they help the young person see together the reality that "Whether you stay on this path or change it, you will be the one choosing."
Talking about boundary situations: Turning points such as illness, loss, retirement, divorce or children leaving home are when existential questions are felt most intensely. In therapy these periods are approached not only as crises but also as opportunities to rethink one's life.
Who Might This Approach Help?
The existential outlook is not specific to a particular diagnosis; it may be meaningful above all for people who come at particular stages of life and with particular kinds of questions:
- People who feel they are living a life that looks successful but feels empty inside
- People who have received a serious diagnosis or are facing a loved one's illness
- Those going through a major transition such as a loss, divorce, retirement or migration
- People on the threshold of an important decision who freeze under the weight of choosing
- Those who have had symptom-focused therapy before, whose symptoms have eased, but who are left with the open question, "What am I living for now?"
On the other hand, in situations such as intense panic attacks, marked obsessions or severe depression, structured methods aimed at these symptoms may need to come first. Existential questions can also be addressed within or after this work.
The Difference Between Existential Distress and Depression
Not everyone searching for meaning is depressed; but the two can sometimes become intertwined. Telling them apart matters for reaching the right support.
In existential distress a person can often keep up with daily tasks, sleep and appetite are largely preserved, and the questions come with a heavy but intellectual curiosity. While asking, "What is the meaning of this life?", the person also keeps looking for an answer.
In depression, symptoms such as low mood, loss of interest and pleasure, low energy, changes in sleep and appetite, and feelings of worthlessness and guilt last for weeks. The questions are asked not with curiosity but with hopelessness: "Nothing means anything, nothing will ever change."
It is also possible for both to be present together. This distinction is not a diagnostic tool on its own; but it can help you think about which way your distress is leaning. If a sense of meaninglessness is drawing you in more and more, our article on coping with the thought that life has no meaning may also be helpful.
Working With Existential Questions in Everyday Life
Existential thinking can be a compass not only in the therapy room but in everyday life too. You can try the following exercises at your own pace:
- A letter from yourself in old age: Imagine yourself near the end of your life and write a letter to who you are today. What would that older self want you to do more of, and what to let go of? This exercise is usually clarifying rather than frightening. Waiting a few days after writing the letter and then reading it again helps you notice sentences you missed at first.
- The "I have to" list: For a week, note down the things you say you "have to" do. Then write next to each one: "I choose this because..." Some items genuinely reflect a value; others are unexamined habits.
- Mapping sources of meaning: According to Frankl, meaning comes in three ways: creating something or putting effort into a task, loving someone or being immersed in an experience, and taking a stance towards suffering we cannot change. What is there in your life in each of these three areas?
- Being able to be alone: Take short silent walks without your phone or music. Listen to the thoughts that rise within you without immediately pushing them down. Noticing what a constant escape into crowds is covering up is an important step.
- Taking on a small responsibility: Take a small but real step on something you value and have long been putting off. Meaning often becomes clearer through doing rather than thinking.
When Should You Seek Professional Support?
Reflecting on meaning and existence is a healthy human experience. However, it is important to speak with a professional in the following situations:
- A sense of meaninglessness has lasted for weeks and is noticeably affecting your work, relationships or self-care
- You are struggling to reconnect with life after a loss, an illness or a disaster
- Thoughts of death frequently occupy your mind during the day and are causing anxiety
- There are marked changes in your sleep, appetite and energy
- Thoughts such as "It wouldn't matter if I didn't live" or thoughts of harming yourself are crossing your mind
If the last point applies to you, do not keep these thoughts to yourself; talk to someone you trust and to a mental health professional as soon as possible. In an emergency, call 112 (emergency services).
How Are Questions of Meaning and Values Addressed in Therapy?
Existential therapy as a distinct school is practised by therapists trained in this field. Clinical Psychologist Eda Erkan Alapala is a clinical psychologist who completed four years of Cognitive Behavioural Therapy training to EABCT standards with the Association for Cognitive and Behavioural Therapies (KDTD), and she works within this framework. Even so, questions of meaning, values and responsibility also hold an important place within the cognitive behavioural tradition. Acceptance and commitment therapy in particular, one of the third-wave approaches, centres on clarifying what a person values and on taking steps in line with those values even when difficult feelings are present; in this respect it is a close relative of existential thought.
If a sense of meaninglessness comes together with depressive symptoms, work in the area of depression and mood can address both the symptoms and the values that give direction to the person's life. Sessions can take place face to face in Çorum or online.
In practice this might look like this: with someone who has been experiencing a lack of motivation for a long time, steps are first planned to ease symptoms related to sleep, movement and daily routine. Then, or alongside this, the conversation turns to which areas of life the person has become estranged from, what they used to value, and which step, however small, could bring them closer to that value again today. In this way the question of meaning does not remain an abstract discussion but settles into the life of the week.
Frequently Asked Questions
Is existential therapy opposed to religion or faith?
No. Among existential thinkers there are both religious and non-religious figures. The aim in therapy is not to impose a worldview on the person but to explore together how they build meaning within their own beliefs and values. A person's faith is treated with respect as one of their sources of meaning.
Does existential therapy require knowing philosophy?
No. Philosophical concepts are not debated in sessions; the conversation is about the person's own life, choices and feelings. The philosophical roots inform the therapist's outlook; no such knowledge is expected of the client.
Which age groups is this approach suitable for?
It is mostly used with adults; existential questions become especially pronounced in transitional periods such as the search for direction in one's thirties, midlife, retirement and older age. The outlook can also be helpful in adolescents' search for identity and meaning.
Can existential therapy be short-term?
Work focused on a particular life event, such as a loss or an important decision, can fit into a few months. A broader questioning of one's life usually takes longer. The length is decided together according to the person's needs.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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