Wtf is existential therapy?

“I mean, aren’t these things just part of life?” My client asks me this with a note of challenge. Like, what are you going to do about it, therapist lady? And I get it. She feels trapped in her life and unconvinced that anything could improve. I’d be kind of a smartass too.

Her story is familiar and maybe it’s one you’ve lived. Routines of work, school, and home squeeze us all into an autopilot setting, and only quietly do we hear the internal question: “what am I doing all this for?”

I often see clients who have followed these scripts for so long that a layer of numbness and disconnection has built up, and that inconvenient nagging question will not be ignored any more.  Existential therapy offers support, perspective, and tools with the encouragement that asking such an annoyingly overwhelming question is not only worthwhile—it is the only way we can take inventory enough to make life really meaningful.

So mazel tov, you’re having an existential crisis. Now what, scream into the void for a while? As scary as acknowledging this head space can be, standing back and reevaluating your life is not a bad thing. It gives you the opportunity to make different choices. Not to mention that if left unaddressed, existential issues can well up in more disruptive ways like chronic anxiety, panic attacks, depression, and substance abuse.  However, to use the opportunity you need to be in a solidly grounded mental state, and not just flat-out panic.

One of my all-time favorite visual depictions of therapy. Even more true of existential therapy, as most people have little practice or venues to explore themes of meaning and uncertainty.

If you’re more of the flat-out panic persuasion, you can think of existential therapy as offering a hand to hold in the dark. Seeing an existential therapist helps to organize your own experiences and personal themes. They know good questions to ask, and have enough experience with the territory to detect blind spots. They can keep up the narrative from week to week that lets you make progress in understanding your needs, which can otherwise get buried beneath that daily routine and its thousand demands on your attention.

While the decisions about what is meaningful never stop being your own, an ongoing dialog within a framework enables you to make those decisions with thought and care. For example, one framework that I enjoy starting with is Irvin Yalom’s Four Existential Givens, or major existential themes. According to this model, the core themes that frame existential work are death, freedom, isolation, and meaning. Some themes jump out more for different people, and talking about that helps to lead to more specific conversations about fears and needs that might be unaddressed, and what has so far gotten in the way. Which of these Four Givens jumps out the most at you? 

Just like being around a new person, existential questions become more comfortable the more time you spend with them.  I see many clients like the one at the beginning progress along a growth arc in this domain. At first they feel chronically tormented by existential problems and might be acting out against them. However, with support, dialog, and other tools; it is in fact possible to find peace coexisting with the “givens” of life. Just like a new person too, you might even kind of like hanging out with them after awhile.