While not easily defined, existential therapy builds on ideas taken from philosophy, helping clients to understand and clarify the life they would like to lead (Iacovou & Weixel-Dixon, 2015).
Although there is no single existential therapy, each approach shares the same basic principle that while life is fraught with dilemmas, we choose our values and whether and how we live by them (Adams, 2013).
This article introduces existential therapy before exploring how it is performed. We also provide helpful worksheets, questions, activities, and exercises to equip therapists for each session and support clients.
Before you continue, we thought you might like to download our three Meaning and Valued Living Exercises for free. These creative, science-based exercises will help you learn more about your values, motivations, and goals and give you the tools to inspire a sense of meaning in the lives of your clients, students, or employees.
This Article Contains:
- How Does Existential Therapy Work?
- Real-Life Example of a Treatment Plan
- 4 Best Counseling Interventions & Techniques
- 5 Activities & Exercises for Your Sessions
- Helpful Worksheets to Give in Therapy
- 4 Questions to Ask Your Clients
- 3 Fascinating Books on the Topic
- A Look at Our Meaning & Valued Living Masterclass
- Resources From PositivePsychology.com
- A Take-Home Message
How Does Existential Therapy Work?
“The existential therapist recognizes that we all face certain universal conditions and that the differences between us come down to how we choose to respond to these conditions” (Iacovou & Weixel-Dixon, 2015, p. 8).
Faced with the certainty of a life that will one day end, some of us try to deny the truth, while others tackle the reality head-on, living life to the fullest.
Existential therapy neither passes judgment nor applies pressure. It aims to uncover the client’s worldview and help them understand their values, beliefs, and attitudes. Once illuminated, the client is free to decide if their thoughts, feelings, and behaviors are helping them live a life of meaning (Iacovou & Weixel-Dixon, 2015).
Instead of pathologizing the patient, existential therapists see their role as helping the client reflect on their freedom and clarify “their values and beliefs, and the attitude they take to their world” (Iacovou & Weixel-Dixon, 2015, p. 9).
How to use existential therapy for grief
Whether expected or not, the death of a loved one is a shock that we typically hope to get over in order to return to ‘normal’ life. However, we may need to accept that life may never be the same again; and yet, it can still be meaningful and fulfilling (Adams, 2013).
Existential therapists offer clients a safe and supportive space to talk about what finiteness means, for the person they have lost and for their own existence.
How to use existential therapy for depression
Feelings associated with depression can often arise from a sense that we lack the power to make life different. We are left feeling helpless and passive.
Existential therapy suggests that “depression is not something a person has – it is what they are, it is their way of defining their way of being-in-the-world” (Adams, 2013, p. 111). Therapy encourages the person with depression to take risks and reconnect with their world and their autonomy.
Real-Life Example of a Treatment Plan
The companion website to Skills in Existential Counselling and Psychotherapy (van Deurzen & Adams, 2016) provides valuable videos exploring putting existential theory into practice and turning essential concepts into treatment plans.
Iacovou and Weixel-Dixon (2015) describe the example of bereaved clients attending therapy, where treatment may follow a plan discussing these points:
Recognize that losing someone brings about questions regarding our own mortality.
- Awareness of death
Fostering an understanding that this is not a dress rehearsal; there is only one chance to live this life.
- Choice of living
The client is immersed in deciding whether to retreat from life or accept the challenge of choosing how to live.
- Handling existential anxiety
An awareness of others’ (and our own) limited lifespan can lead to existential dread and requires support from the therapist.
Existential therapy does not provide a ‘one-size-fits-all’ treatment plan, but instead moves the client through their understanding, providing support along the way as they recognize their values and choices.
4 Best Counseling Interventions & Techniques
Existential therapists adopt an attitude of encouragement when working with clients, using a variety of techniques and counseling interventions to identify and reflect on what is important to them (van Deurzen, 2002; Iacovou & Weixel-Dixon, 2015).
Similar to other therapeutic styles, in existential therapy the opening session is crucial for stating the therapist’s intention to help the client uncover their difficulties in living. It also provides the opportunity for the client to take stock of strengths and limitations and recognize that the therapist’s role is not to provide empathy or sympathy but to use the existential approach to methodically explore their ability to live (van Deurzen, 2002).
Essential points to clarify in the first session with the client regarding the therapeutic approach include (modified from van Deurzen, 2002):
- Existential anxiety is a feeling of unease associated with becoming aware of our vulnerability.
- Therapy is not aimed at removing anxiety but to find the courage to live with uncertainty.
- Authentic living involves making the most out of life and finding clarity in our goals and intentions.
- Authentic living is a goal, and while never fully achieved, the journey increases enjoyment and vitality.
Exploring the four worlds
The four worlds of human existence help orient the client’s position in the world. They prompt reflection on potentially unsolvable dilemmas and paradoxes that evoke anxiety throughout our lives (Iacovou & Weixel-Dixon, 2015).
- Physical world
How we relate to our environment and our mortality, prompting us to ask (Adams, 2013, p. 27):
“How can I live my life fully knowing I may die at any moment?”
- Social world
How we relate to others and the culture to which we belong, prompting us to ask (Adams, 2013, p. 27):
“What are other people there for?”
- Personal world
How we relate to ourselves, including our imagination, and how we see our past and future, prompting us to ask (Adams, 2013, p. 28):
“How can I be me?”
- Spiritual world
How we relate to the unknown, our personal value system, and our vision for an ideal world, prompting us to ask (Adams, 2013, p. 28):
“How should I live?”
The therapist listens for which world, or worlds, has prominence or have been neglected by the client.
Mapping the client’s worldview
The client’s worldview consists of their “attitudes, expectations and assumptions with respect to self, other and the world” and is essential to make sense of and give meaning to our place within a constantly changing world (Iacovou & Weixel-Dixon, 2015, p. 106).
The therapist works with the client to identify and map their worldview. Once understood, the client can begin to see where specific strategies may restrict their chance of leading a fulfilling and meaningful life (Iacovou & Weixel-Dixon, 2015).
Choosing and changing
In existential therapy, the client is encouraged to take ownership of their choices. They learn to see their existing reality more clearly and recognize their contribution to the situation.
The client is encouraged to take responsibility for consequences and recognize that authentic living requires taking risks.
5 Activities & Exercises for Your Sessions
Existential therapy requires becoming aware of our values and beliefs and identifying whether we behave in line with them.
The following activities and exercises contribute to the client’s understanding of their existing and potential reality.
Denial of responsibility
We may talk about our lives in specific ways to assert our lack of responsibility over what happens in them (Adams, 2013), including:
- Substituting “I” with other pronouns (such as they)
- Talking about the past (and even the future) and avoiding discussing the present
- Being reactive rather than proactive
- Seeing ourselves as passive rather than active
Ask the client to consider a time when they used each of the above approaches (or others) to avoid owning their reality:
What was I trying to avoid by talking in this way?
Becoming aware of your emotional vocabulary
When exploring and explaining emotions, we are often limited by our education and personal and cultural history (Adams, 2013).
Ask the client to list 10 of their most familiar emotional states (such as anger, happiness, fear, envy, hopeful, sadness). These are ones they encounter daily.
Then they should ask someone close to them to do the same.
Compare the lists and consider what emotions may have been missed, ignored, or avoided.
It can be challenging to live an authentic and meaningful life without a clear understanding of our personal values and beliefs.
Ask the client to consider the following values questions and discuss their answers within the session (Adams, 2013):
How do you want to live your life?
How do you want to treat others and be treated?
How do you build/evolve a sense of overall meaning and purpose?
How do you feel about human existence as a whole?
2 Role-play exercises to try
Role-play can be a safe and fun way to explore emotions, values, and behavior.
Living with values
Having answered the previous question regarding values, take turns within a pair reflecting on how to live according to these values in different scenarios (at work, home, out with friends, etc.).
Each person asks questions of the other regarding what they would do in a real or imagined situation.
Person one – “How would you interact with the staff in your team at work?”
Person two – “I would be open and honest in my dealings, considering their requests and providing fair responses.”
The role-play aims to encourage each person to see how behavior and talking can reflect personal values.
Most meaningful life
In pairs, take turns interviewing the other person regarding how their most meaningful life might look.
The interviewer makes up the questions, but they may include:
What job would you have in your most meaningful life?
Would you have a partner?
If so, how would you treat and be treated by that partner?
What sort of friends would you have?
The aim is, without judgment, to help the person answering form an image of what a meaningful life might be for them.
Existential therapy (overview) – Cornerstone Psychological Services
Helpful Worksheets to Give in Therapy
The following worksheets offer insight into what a meaningful life might look like for the client and examine the potential for bias from the therapist.
Becoming aware of our assumptions as existential therapists
All of us, including therapists, bring biases into conversations with others.
The Becoming Aware of Assumptions worksheet helps therapists reflect on what biases they carry that could impact the content and effectiveness of a treatment session.
Remembering Our First Times
When reflecting on what is happening in our lives, over-familiarity with events can cloud our feelings.
The Remembering Our First Times worksheet encourages reflection on how something felt the first time it happened and its impact.
Things That Went Well or Badly
Life is always unpredictable. While it can be difficult feeling out of control, we have a say over how we react.
The Things That Went Well or Badly worksheet allows us to reflect on an event that was important and felt like either a success or a failure.
Learning New Skills
Learning new skills can be extremely rewarding, encouraging growth and fostering new opportunities. However, the process can bring anxiety, apprehension, and even fear (Adams, 2013).
The Learning New Skills worksheet helps the client reflect on times they learned new skills to help them normalize and accept the feelings accompanying the growth process.
Four Worlds of Human Existence
As we have already seen, the four worlds of human existence are an essential aspect of existential therapy and can stimulate ongoing reflection in clients (Adams, 2013).
The Four Worlds of Human Existence worksheet can be shared with clients and revisited throughout treatment to encourage the client to reflect on their lives.
Managing Existential Anxiety
Considering some of life’s bigger questions as part of existential therapy can lead clients to experience a sense of fear, known as existential anxiety, that may discourage further work or risk taking (van Deurzen, 2002).
Share the Managing Existential Anxiety worksheet to help them recognize that existential anxiety is normal and consider the positive experiences and emotions they experience in life to maintain a balanced outlook.
4 Questions to Ask Your Clients
The following four questions are incredibly helpful for promoting reflection in clients.
They are very big questions, and it is important to make clear to the client that there are no right or wrong answers, but the act of reflecting is powerful (van Deurzen & Adams, 2016).
What do I intend to do before I die?
How do I get along with my friends, family, and those closest to me?
What do I owe myself in life, and how do I get it?
What are my moral values, and how do I live up to them?
3 Fascinating Books on the Topic
We have included three books that introduce trainees or experienced practitioners to the central ideas behind existential therapy.
1. Existential Counselling & Psychotherapy in Practice – Emmy van Deurzen
This insightful and far-reaching book explores the theory and practical methods for the therapist to help clients understand what constitutes meaning and value in their lives.
Find the book on Amazon.
2. A Concise Introduction to Existential Counselling – Martin Adams
This is a valuable introduction to existential counseling for students and those new to the field wishing to understand the key concepts.
Martin Adams explores how to use the therapeutic process to work effectively with clients, teaching them to live according to their values.
Find the book on Amazon.
3. Existential Therapy: 100 Key Points and Techniques – Susan Iacovou and Karen Weixel-Dixon
This is an insightful and accessible book for understanding the human challenges of existence.
The authors provide a comprehensive introduction and overview of ideas and techniques central to the philosophical theories underpinning existential therapy, along with practical approaches for use with clients.
Find the book on Amazon.
For further reading, we also recommend these 7 Best Books to Help You Find the Meaning of Life.
A Look at Our Meaning & Valued Living Masterclass
The Meaning and Valued Living Masterclass is an online program for therapists, psychologists, counselors, coaches, and practitioners who want to help their clients find meaning and discover their values, connecting them to their ‘why’ so that they can bear any ‘how.’
The course consists of three modules. The introduction provides an in-depth look at positive psychology; the meaning module provides clarity on the complex topic of ‘meaning’ and tools to increase meaning in life; and the third module addresses valued living to help clients discover what is important to them.
The masterclass has received sterling reviews from entrepreneurs, business owners, and coaches, and can also help you earn continuing education credits.
Resources From PositivePsychology.com
Existential therapists work with clients to explore some of the most meaningful questions in their lives, including living fully and with meaning.
Why not download our free Meditations on Meaning exercises pack and try out the following powerful tools?
- The Top 5 Values
This helpful exercise is a valuable tool for increasing clients’ awareness of their values.
This is a valuable worksheet for helping clients discern how they live in line with their values.
Other free resources include:
- The PERMA Model
Understand and apply the PERMA model to your life by adopting a positive attitude and finding things that make you happy and engaged.
- Self-Esteem Journal for Adults
Journaling can promote positive self-reflection and encourage and enhance self-esteem.
More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:
- The Life Certificate
Enduring the death of a loved one can be one of the most painful experiences in our lives. It can help to remember the many good things about the deceased by creating a life certificate, including:
- Reflecting on favorite stories that characterize the person and what they meant to you
- Thinking of words that best describe them and how you appreciated them
- How they helped you be the person you are today
- The Values Timeline
Invite the client to reflect on their values and how they have changed over their lifetime while recognizing they remain in control of what they are:
- Clarify your top five core values.
- Identify core values from earlier stages of your life.
- Recognize how these values have changed over your life.
- Examine how these values are serving you now.
If you’re looking for more science-based ways to help others discover meaning, check out this collection of 17 validated meaning tools for practitioners. Use them to help others choose directions for their lives in alignment with what is truly important to them.
A Take-Home Message
Existential therapy is based on the idea that our problems arise from the essential paradoxes of human existence rather than personal pathology.
We choose our values and whether and how we live according to them.
Existential therapists recognize that many of us are practiced at deceiving ourselves regarding life’s realities; we fail to see how the way we behave, think, and feel may be contributing to our unhappiness and lack of fulfillment (Iacovou & Weixel-Dixon, 2015).
During therapy, the practitioner encourages the client to remain open to other ways of living and being that they are not currently choosing. As such, it can be demanding, asking clients to comprehend and accept their responsibility for the choices they make. Taking responsibility for our lives can be a great source of anxiety, directly or indirectly, and requires dedicated and professional support (Adams, 2013).
This article introduces the theory and practices behind existential therapy and provides tools, worksheets, and questions to help clients in sessions or as homework.
We hope you enjoyed reading this article. Don’t forget to download our three Meaning and Valued Living Exercises for free.
- Adams, M. (2013). A concise introduction to existential counselling. SAGE.
- Iacovou, S., & Weixel-Dixon, K. (2015). Existential therapy: 100 Key points and techniques. Routledge/Taylor & Francis Group.
- van Deurzen, E. (2002). Existential counselling & psychotherapy in practice (2nd ed.). SAGE.
- van Deurzen, E., & Adams, M. (2016). Skills in existential counselling & psychotherapy. SAGE.