Something feels off. You’re successful by most measures, but it doesn’t feel like enough. You find yourself asking questions that don’t have easy answers: What am I doing with my life? Does any of this matter? Why do I feel so disconnected even when I’m surrounded by people?

These aren’t signs that something is wrong with you. They’re signs that you’re human—grappling with the same existential questions human beings have faced throughout history. Existential therapy focuses on these fundamental concerns, helping you explore questions about the meaning of life, freedom, isolation, and mortality not as problems to solve but as realities to engage with thoughtfully.

In Washington DC, where achievement and status often substitute for deeper purpose, existential questions can feel particularly urgent. The gap between external success and internal fulfillment is real, and closing it requires more than symptom management.

At Therapy Group of DC, our existential therapists help you explore what matters most, take personal responsibility for your choices, and build a life aligned with your values. We believe that confronting life’s uncertainties—rather than avoiding them—is the path to living more fully.

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Is Existential Therapy Right for You?

You might benefit from existential therapy if you:

• Feel lost or disconnected from a sense of purpose or meaning
• Are going through a major life transition—career change, relationship ending, midlife questioning
• Struggle with anxiety that seems connected to bigger questions about life and death
• Feel like you’re just going through the motions rather than truly living
• Experience a gap between your external success and internal satisfaction
• Are grappling with grief, loss, or confronting your own mortality
• Feel isolated even in relationships or crowds
• Want to understand yourself more deeply rather than just reduce symptoms
• Are questioning the values and path you’ve followed
• Feel overwhelmed by the freedom and responsibility of making your own choices

What to Know

• Existential therapy aims to increase self-awareness and self-understanding rather than simply eliminating symptoms
• This approach views psychological pain as a normal part of the human condition, not merely something to fix
• Existential therapy can be integrated with other therapeutic approaches for a comprehensive treatment
• The therapeutic relationship between you and your existential therapist is central to the work
• Both individual and group therapy formats can incorporate existential approaches

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Understanding Existential Therapy

Existential therapy is a philosophical approach to mental health that focuses on the human experience of existence itself. Rather than viewing you through the lens of diagnosis or symptom reduction, existential psychotherapy engages with the deeper questions that shape how you live in everyday life.

Existential therapy is not a single, unified practice but rather a family of approaches grounded in existential philosophy. What unites them is a focus on the individual’s subjective experience and the search for meaning in a world that doesn’t provide ready-made answers.

The Roots of Existential Therapy

Existential therapy is rooted in existential philosophy and existential personality theory, which emphasize individual freedom, choice, and the idea that who we become emerges through our choices rather than being predetermined. Key figures in existential philosophy include Søren Kierkegaard, who emphasized subjective truth and the individual’s struggle to find meaning; Friedrich Nietzsche, who introduced concepts of radical freedom and personal responsibility; and Martin Heidegger, whose work focused on the meaning of being and our relationship to time and mortality.

In the therapeutic realm, Viktor Frankl developed logotherapy, emphasizing the “will to meaning” as a primary human drive—suggesting that psychological suffering often stems from a lack of meaning. Rollo May brought existential ideas to American clinical psychology, making these philosophical concepts accessible for therapeutic practice. Contemporary existential psychotherapist Irvin D. Yalom identified four ultimate concerns that underlie human experience: death, freedom, isolation, and meaninglessness. Humanistic psychologists like Carl Rogers also influenced the field, contributing the emphasis on the therapeutic relationship and unconditional positive regard.

How Existential Therapy Differs from Other Approaches

While many therapeutic approaches focus on reducing symptoms or changing specific behaviors, existential therapy emphasizes understanding human experience and focuses on the client rather than the symptom. The existential approach assumes that psychological problems often stem from not exercising choice and judgment enough to forge meaning in their own lives.

Humanistic therapy shares some common ground—both believe in the innate capacity for growth and self-awareness. Humanistic psychology focuses on acceptance and self-actualization, while existential therapy emphasizes personal responsibility and confronting life’s inherent challenges. Existential humanistic therapy combines elements of both traditions.

Unlike brief therapies focused on symptom relief, existential psychotherapy explores the fundamental conditions of human existence. It can work alongside other therapeutic approaches—including cognitive-behavioral therapy, gestalt therapy, or narrative therapy—to enhance treatment outcomes. The phenomenological method, which involves setting aside assumptions to understand your lived experience, guides much of this work.

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The Four Pillars of Existential Therapy

Irvin Yalom’s framework identifies four ultimate concerns—the major themes that existential therapy addresses. These aren’t problems to solve but realities of the human condition that we’re all inevitably confronted with.

Death and Mortality

We all face inevitable death, yet most of us live as if we have unlimited time. Existential therapy involves an acceptance of mortality—not as morbid preoccupation but as motivation to live fully in the present moment. Confronting death can clarify what truly matters and liberate you from trivial concerns.

Freedom and Responsibility

Freedom in existential therapy refers to your ability to make choices for yourself—and the responsibility that comes with these choices. You are the author of your own life, which is both liberating and anxiety-provoking. Existential therapy helps you embrace this freedom rather than flee from it into conformity or helplessness.

Existential Isolation

Existential therapy recognizes the fundamental isolation between individuals. No matter how close our relationships, we each enter and exit existence alone. This existential isolation isn’t loneliness that can be solved by company—it’s a basic condition of being human. Acknowledging it can paradoxically deepen your connections with others.

Meaninglessness

The concept of meaninglessness in existential therapy addresses a core question: What is the meaning of life? The existential answer is that life has no inherent, pre-given meaning. This isn’t nihilism—it’s an invitation. If meaning isn’t handed to you, you have the freedom and responsibility to create your own meaning. Existential therapy encourages you to create your own purpose and values rather than accepting those imposed by society.

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What Existential Therapy Helps With

Existential therapy can be useful for a wide range of concerns, particularly those connected to meaning, identity, and life’s larger questions.

Life Transitions and Identity Crises

Major transitions—career changes, retirement, divorce, becoming a parent, children leaving home—can trigger existential questions. When the structures that defined you shift, you’re forced to ask who you really are. Existential therapy is effective for addressing crises related to identity and life transitions, supporting the healing process as you navigate uncertainty.

Anxiety and Depression

Existential therapy addresses symptoms such as excessive anxiety, apathy, alienation, and depression. Rather than simply medicating or managing these experiences, the existential approach explores what they might be telling you about how you’re living. Sometimes anxiety signals that you’re not living in alignment with your values; depression may reflect a lack of meaning or authentic engagement with life.

Grief and Loss

Confronting loss brings us face to face with mortality and meaninglessness. Existential therapy provides a framework for processing grief that honors its depth rather than rushing to “get over it.” Loss can become an occasion for profound personal growth and clarification of what matters. The healing process itself can reveal what you truly value.

Feelings of Emptiness and Disconnection

If you feel lost, disconnected, or like something is missing despite having “everything,” existential therapy can help you grapple with the uncertainty of life to find freedom and meaning. The approach is particularly beneficial in times of disconnection, helping people make meaning of their suffering.

Substance Abuse and Addiction

Existential therapy views psychological problems, including substance abuse, as resulting from an inhibited ability to make authentic, meaningful, and self-directed choices. The approach is often used in conjunction with more traditional substance abuse treatment, addressing the underlying search for meaning that addiction often masks. Existential perspectives can enhance clinical psychology’s standard treatment protocols by focusing on purpose and authenticity.

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How Existential Therapy Works

Existential therapy work looks different from more structured approaches. There are no standardized techniques or protocols—the emphasis is on the therapeutic encounter itself.

The Therapeutic Relationship

The therapeutic relationship in existential therapy is a safe, non-judgmental space that focuses on the client’s experience. Many existential therapists see this relationship as the primary vehicle for change. The therapist’s role isn’t to fix you or give you answers but to accompany you in exploring your own existence, engaging with you as one human being to another within a relational context of mutual respect.

Therapeutic Dialogue

Therapeutic dialogue in existential therapy includes Socratic questioning and reflective dialogue to explore your beliefs and values. Through active listening and genuine curiosity, the existential therapist helps elicit insight into your patterns and possibilities. Rather than interpreting your experience or directing you toward predetermined insights, the therapist engages authentically with the client’s world.

Exploring the Four Dimensions

Many existential therapists work with clients across four dimensions of existence: the physical world (your body and environment), the social world (relationships and culture), the personal world (your relationship with yourself), and the spiritual or meaning-making dimension. This comprehensive view addresses human existence in its full complexity.

Present-Focused but Not Present-Limited

While existential therapy emphasizes the present moment and current choices, it also explores how past experiences shape your current relationship with freedom, meaning, and mortality. The focus isn’t on analyzing the past but on understanding how it influences your being in the world now.

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What to Expect in Existential Therapy

The Therapeutic Process

Existential therapy typically begins with exploring what brought you to therapy and what you’re seeking. Your existential therapist will be interested not just in your symptoms but in your experience of your life as a whole—your sense of meaning, your relationship to choice and responsibility, your awareness of mortality and isolation.

Sessions involve open dialogue rather than structured exercises. You might explore existential questions directly: What gives your life meaning? What would you do if you truly accepted your freedom? What are you avoiding by staying busy? The goal is to increase self-awareness and help you live more authentically.

Duration and Approach

Existential therapy can be both long-term exploratory work and adapted for brief interventions depending on your needs. Some people engage in existential psychotherapy for years as an ongoing practice of self-understanding. Others seek shorter-term work focused on a specific life transition or crisis.

The approach can stand alone or integrate with other forms of therapy. If you’re also working on specific symptoms or skills, existential therapy provides the deeper framework of meaning and purpose. Engaging clients in this philosophical exploration creates space for lasting transformation.

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Our Existential Therapists

Our therapists bring training in existential and humanistic approaches. They understand the existential challenges of living in a high-pressure, achievement-oriented city like Washington DC.

Dr. Paul Rizzo, Psy.D.

Dr. Rizzo uses client-centered, existential, and humanistic approaches to help clients navigate questions of meaning, purpose, and authentic living. His focus on self-determination and personal growth supports clients in exploring the deeper questions and creating meaningful lives aligned with their values. View Dr. Rizzo’s full profile →

Dr. Rob Drinkwater, Ph.D.

Dr. Drinkwater integrates family systems and existential approaches in his work. He focuses on helping clients create concrete, tangible goals while also engaging with the larger questions of how to live intentionally. His existential orientation makes him well-suited for clients grappling with meaning and purpose. View Dr. Drinkwater’s full profile →

Kevin Malley, MS, LPC, NCC

Kevin uses existential, relational, and person-centered approaches to help clients explore questions of meaning, identity, and authentic living. He creates a therapeutic relationship grounded in genuine engagement and helps clients take personal responsibility for creating their own lives. View Kevin’s full profile →

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Begin Existential Therapy in Washington DC

Existential therapy offers a space to engage with the questions that matter most—and to discover that confronting them, rather than avoiding them, is the path to a more authentic, meaningful life.

Schedule an Appointment →

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Frequently Asked Questions

What are the 4 pillars of existential therapy?

The four pillars (or ultimate concerns) identified by Irvin Yalom are: death (confronting mortality), freedom (and its accompanying responsibility), existential isolation (the fundamental separateness between individuals), and meaninglessness (the absence of inherent life meaning, requiring us to create our own). Existential therapy helps clients engage with these realities rather than avoid them.

What is an example of existential therapy?

In existential therapy, a client experiencing a midlife crisis might explore questions like: “What have I been living for? Whose expectations have I been meeting? What would I do if I truly accepted that my time is limited?” Rather than offering solutions, the existential therapist helps the client sit with these questions, increasing self-awareness and supporting them in making more authentic, self-directed choices about their life direction.

What triggers an existential crisis?

Existential crises are often triggered by major life events that disrupt your usual sense of meaning or identity: death of a loved one, serious illness, job loss, divorce, milestone birthdays, or achieving a long-sought goal only to feel empty. Any experience that forces you to confront the ultimate concerns—mortality, freedom, isolation, meaninglessness—can trigger existential questioning.

Who is the founder of existential therapy?

Existential therapy doesn’t have a single founder but emerged from the work of several existential thinkers and therapists. Key figures include Viktor Frankl (logotherapy), Rollo May (who brought existential ideas to American psychology), Irvin Yalom (who systematized the four ultimate concerns), and Emmy van Deurzen (a contemporary existential psychotherapist who has developed existential approaches further). The philosophical foundations come from Kierkegaard, Nietzsche, Heidegger, and Sartre.

Is existential therapy right for everyone?

Existential therapy may not be the best fit for everyone. It requires willingness to engage with philosophical ideas and sit with uncertainty rather than seek quick fixes. People who are uncomfortable with existential questions or who need immediate symptom relief for conditions like acute psychosis may benefit more from other approaches first. However, for those drawn to deeper exploration, existential therapy can play a vital role in creating meaningful lives.

How is existential therapy different from humanistic therapy?

Both approaches share roots and believe in your capacity for growth and self-awareness. Humanistic therapy emphasizes acceptance, self-actualization, and positive regard, while existential therapy places more emphasis on confronting life’s difficult realities—death, freedom, isolation, and meaninglessness. Many therapists practice existential humanistic therapy, blending both traditions to support personal growth and authentic living.