Working Therapeutically with Existential Distress

Recognising existential distress is only the beginning; therapists also ask what to do upon seeing it. This article explores how effective therapy helps clients develop a more compassionate, meaningful relationship with life’s deepest uncertainties.

Related articles: The Fear Beneath the Fear: How Mortality Awareness Shapes Everyday Life, Why Uncertainty Feels So Difficult: The Hidden Psychology of Existential Anxiety.

Introduction

The conversation has reached an unexpected place.

A client who initially sought therapy for anxiety now finds themselves asking whether their life still has meaning after a relationship has ended. Another, recovering from burnout, quietly wonders who they are now that work no longer defines them. A third sits in silence before asking, “What’s the point?”

For many therapists, these moments feel different from other clinical conversations. The questions are no longer simply about reducing symptoms, changing behaviours, or solving practical problems. Instead, they touch concerns that lie at the heart of the human condition: meaning, identity, mortality, freedom, uncertainty, and belonging. Clients are not merely seeking answers; they are trying to find a way of living alongside realities that cannot be changed.

Recognising existential distress, however, is only part of the therapeutic task. Once these deeper concerns have emerged, therapists often face an equally important question of their own: How do I help when there are no simple solutions?

Existentially informed therapy offers a subtle but important shift in perspective. Rather than attempting to remove uncertainty, grief, vulnerability, or awareness of life’s limitations, it seeks to help clients develop a more compassionate, flexible, and meaningful relationship with these realities (May, 1983; van Deurzen, 2012; Yalom, 1980). In doing so, therapy becomes less about eliminating existential suffering and more about accompanying clients as they learn to navigate it.

This article explores what that therapeutic stance looks like in practice and how clinicians can support clients in engaging more fully with life, even when its deepest questions remain unanswered.

Existential distress is not a problem to be solved

One of the greatest challenges for therapists is tolerating the understandable impulse to make suffering disappear.

Mental health professionals are trained to assess, conceptualise, intervene, and alleviate distress. In many situations, this is entirely appropriate. Evidence-based interventions can reduce symptoms, strengthen coping skills, improve emotional regulation, and support meaningful psychological change. Yet existential distress often asks something different of both client and therapist.

Questions such as Who am I now?, What gives my life meaning?, How do I live with uncertainty?, or How do I move forward after profound loss? cannot be answered through reassurance alone. They are not problems to be solved once and for all, but realities to be encountered repeatedly throughout life (Yalom, 1980).

Therapist pressure to provide certainty

This distinction is important because therapists can sometimes feel pressure to provide certainty where none exists. Clients may ask whether they are making the “right” decision, whether life will ever feel normal again, or whether things will work out in the end. The temptation to reassure is understandable, born from empathy and a genuine desire to ease suffering. Yet premature certainty can unintentionally close conversations that are inviting deeper exploration.

Consider this brief exchange:

• Client: “Just tell me what I’m supposed to do.”
• Therapist: “I wonder whether part of what makes this so difficult is that there isn’t one perfect answer.”
• Client: “I was hoping you’d know.”
• Therapist: “I wish I could remove that uncertainty for you. Perhaps instead we can explore how you might live with it without letting it decide everything for you.”

Notice that the therapist does not withdraw support or become philosophically detached. Instead, they acknowledge the client’s longing for certainty while gently shifting the conversation toward the client’s capacity to engage with uncertainty itself.

Not supplying answers but creating space for encountering the questions

Existential approaches suggest that the therapist’s role is not to supply meaning, prescribe purpose, or resolve life’s deepest questions. Rather, it is to create a therapeutic space in which clients can encounter those questions with honesty, curiosity, and compassion. As clients gradually develop a different relationship with uncertainty, grief, freedom, responsibility, or mortality, they often discover that the goal is not to eliminate existential distress but to live more fully alongside it (May, 1983; van Deurzen, 2012).

Paradoxically, this shift often reduces the sense of isolation that accompanies existential suffering. Clients discover that they are not failing at life because they cannot answer life’s biggest questions. They are experiencing something profoundly – and universally – human.

The therapeutic stance: Presence before answers

If existential distress cannot simply be solved, the therapist’s way of being becomes just as important as the interventions they employ.

Existential therapists have long suggested that healing does not occur solely through insight or technique, but also through the quality of the therapeutic relationship itself. Clients who feel disoriented, disconnected, or overwhelmed by life’s deepest questions often benefit first from experiencing another human being who is willing to remain present with them without rushing to certainty, explanation, or premature optimism (van Deurzen & Baker, 2018; May, 1983; van Deurzen, 2012; Yalom, 1980).

Not “fixing” uncertainty but tolerating not knowing

This can be more challenging than it sounds. Most therapists are compassionate people who naturally want to reduce suffering. When clients describe despair, emptiness, or uncertainty, the impulse to reassure, encourage, or quickly identify solutions is understandable. Yet existential work often asks clinicians to tolerate not knowing alongside the client for a time. Rather than immediately asking, “How do we fix this?”, the therapist may first wonder, “What is this experience asking us to understand?”

This stance is not passive. Nor is it a withdrawal from clinical responsibility. Instead, it reflects confidence that some forms of growth emerge not through escaping difficult questions but through engaging with them thoughtfully and compassionately.

Consider the following exchange:

• Client: “Everything I worked for has fallen apart. I honestly don’t know who I am anymore.”
• Therapist: “That sounds profoundly unsettling.”
• Client: “I keep hoping someone will tell me how to get back to the person I was.”
• Therapist: “Perhaps part of our work is not finding your way back, but discovering who you are becoming now.”

Notice that the therapist does not dismiss the client’s grief or immediately search for a positive interpretation. The response honours the loss while gently opening the possibility that identity is not fixed, but continues to develop throughout life (van Deurzen Baker, 2018).

Existentially informed therapy often involves balancing two seemingly opposite tasks. On the one hand, therapists validate suffering without minimising it. On the other, they remain attentive to the client’s capacity for agency, meaning, and choice. This “both-and” stance allows room for grief and hope, vulnerability and courage, uncertainty and commitment to coexist rather than compete.

Clinical pearl: Clients rarely need therapists to have all the answers. More often, they need someone who is willing to remain thoughtfully present while life’s deepest questions unfold.

Presence, in this sense, is not simply physical attendance or empathic listening. It is the willingness to meet another person’s uncertainty without retreating into false certainty ourselves. Ironically, therapists who become more comfortable acknowledging that they do not have every answer often create the conditions in which clients begin discovering answers that genuinely belong to them.

For many clinicians, this requires an important shift. Rather than measuring therapeutic success by the speed with which distress disappears, existential work invites us to ask a different question: Is the client developing a richer, more compassionate, and more authentic way of relating to themselves and their life? When the answer is yes, meaningful therapeutic change may already be underway (May, 1983; Yalom, 1980).

Common therapeutic pitfalls

Working with existential distress requires a slightly different therapeutic compass from approaches that focus primarily on symptom reduction. While evidence-based interventions remain essential, existential concerns can easily become obscured if therapists respond too quickly to the understandable urge to fix, reassure, or explain.

One common pitfall is premature reassurance. Clients who ask, “Will things ever feel normal again?” or “How do I know I’m making the right decision?” are often seeking certainty in situations where certainty simply cannot be offered. Although reassurance may provide temporary comfort, it can inadvertently communicate that uncertainty itself is the problem rather than an inevitable aspect of being human.

A second pitfall is over-pathologising existential experiences. Feelings of emptiness, questioning identity after major life transitions, wrestling with mortality, or searching for meaning are not necessarily signs of psychological disorder. While they may coexist with anxiety, depression, or trauma, they may also represent healthy attempts to adapt to profound changes in life circumstances. Recognising this distinction can prevent therapists from unintentionally framing normal human struggles as symptoms requiring elimination.

Therapists may also find themselves moving too quickly into problem-solving. Clients facing existential questions are often looking less for advice than for space to think, feel, and make sense of experiences that have disrupted long-held assumptions about themselves and the world. Before exploring solutions, it is often helpful to understand what has been lost, challenged, or transformed.

Another subtle pitfall involves imposing meaning. It can be tempting to encourage clients to “find the silver lining” or identify lessons before they are ready. While growth and meaning reconstruction are genuine possibilities, they cannot be rushed or prescribed. Meaning emerges through the client’s own reflection and lived experience, not through the therapist’s optimism.

Therapists not immune, so be humble

Finally, therapists themselves are not immune to existential anxiety. Clients’ questions about death, freedom, identity, or purpose may resonate with the clinician’s own experiences and uncertainties. Developing awareness of these responses – through supervision, reflective practice, or personal therapy – helps therapists remain present without becoming overwhelmed or unintentionally steering conversations away from difficult but important territory.

Existential therapy therefore invites humility. Rather than striving to remove every uncertainty, therapists can cultivate the confidence to accompany clients thoughtfully through experiences that neither person can completely resolve. In doing so, they communicate a powerful message: that uncertainty can be faced, suffering can be shared, and meaningful conversations need not depend upon having all the answers (May, 1983; van Deurzen, 2012; Yalom, 1980).

Helping clients re-engage with life

If existential therapy is not primarily about solving life’s deepest questions, what does therapeutic progress look like?

Often, it begins with movement.

Not necessarily dramatic transformation, but small shifts in how clients relate to themselves, other people, and the realities they cannot control. Rather than waiting until uncertainty disappears before fully engaging with life, clients gradually begin participating in life while uncertainty remains.

This process often involves helping clients reconnect with what they value most. For one person, this may mean repairing an important relationship. For another, it may involve returning to creative pursuits, spending more time in nature, engaging with community, or rediscovering a sense of purpose through caregiving, learning, spirituality, or service. The specific direction matters less than the fact that it reflects the client’s own values rather than attempts to avoid discomfort.

Intersection with psychological flexibility and values-based living

Existential approaches frequently intersect here with contemporary therapies that emphasise psychological flexibility and values-based living. Clients need not wait until they feel completely certain, confident, or free from distress before taking meaningful action. Instead, they can begin asking a different question: Given the reality I am living with, how do I want to respond? (Pakenham et al., 2020; Hayes et al., 2012).

Consider a client whose retirement has left them feeling unmoored. Early sessions focus largely on what has ended: professional identity, routine, status, and daily purpose. As therapy progresses, the conversation gradually shifts. Rather than asking, “How do I get my old life back?”, the client begins wondering, “What kind of life do I want to create now?” Nothing about the loss is minimised, yet the client’s relationship with the future becomes more open, curious, and intentional.

Paradox: Meaningful life with unanswered questions

Importantly, re-engaging with life does not require abandoning grief, uncertainty, or vulnerability. These experiences often continue alongside hope, purpose, and connection. The goal is not to replace one with the other, but to help clients discover that both can coexist. They can mourn what has been lost while investing in what remains. They can acknowledge uncertainty while making meaningful choices. They can recognise life’s fragility while continuing to love, create, contribute, and belong.

Perhaps this is one of the quiet paradoxes of existential therapy: clients often become most fully engaged with life not after resolving every existential question, but after recognising that a meaningful life can still be lived while many of those questions remain beautifully – and sometimes painfully – unanswered (Pakenham et al., 2020; Frankl, 1946/2006; Hayes et al., 2012; Wong, 2010).

Therapeutic accompaniment: Walking together through the human condition

Perhaps the most distinctive contribution of existential therapy is not a particular technique, intervention, or framework. It is a way of being with another human being.

Existential distress often leaves clients feeling profoundly alone. They may believe that no one else could understand the questions they are asking or the uncertainty they are experiencing. They may feel isolated by grief, identity loss, mortality awareness, or the painful recognition that some aspects of life cannot be controlled or resolved. In these moments, therapy offers something deeply significant: the experience of not facing the human condition alone.

This is why existential therapists often speak of accompaniment rather than rescue. The therapist does not stand outside the client’s experience, directing them towards certainty or prescribing ready-made meaning. Instead, they walk alongside the client as a fellow human being who also lives within the realities of uncertainty, vulnerability, freedom, responsibility, love, loss, and finitude.

Importantly, this does not diminish professional boundaries or clinical expertise. Rather, it acknowledges that therapist and client share a common humanity. The therapist brings knowledge, experience, and therapeutic skill, while recognising that they are not exempt from the existential questions that shape every human life. In many ways, this shared humanity becomes one of the most powerful resources available within the therapeutic relationship (van Deurzen & Baker, 2018; May, 1983; Yalom, 1980).

Parallel process of participation

There is a quiet parallel process at work here. As clients gradually move from withdrawing from life toward participating in it more fully, therapists participate alongside them – not by taking over the journey, but by remaining present, curious, compassionate, and willing to accompany them through uncertainty. The therapist’s presence communicates something words alone cannot: You do not have to face this by yourself.

Perhaps this is one of the deepest expressions of hope within existential therapy. Hope is not offered because suffering can always be removed or because certainty can eventually be guaranteed. Hope emerges because human beings are capable of meeting one another within suffering, discovering meaning through relationship, and continuing to engage with life despite its inevitable uncertainties.

When viewed in this way, therapy itself becomes an act of participation. The client participates more fully in their own life. The therapist participates more fully in the client’s unfolding story. Together, they make space for grief and joy, uncertainty and commitment, vulnerability and courage. The existential questions may remain, but they no longer need to be carried in isolation.

In the end, existential therapy is less about finding definitive answers than about cultivating the capacity to keep walking. Not alone, not with false certainty, but with greater honesty, compassion, and willingness to participate in the remarkable, unfinished experience of being human (van Deurzen & Baker, 2018; Frankl, 1946/2006; May, 1983; van Deurzen, 2012; Yalom, 1980).

Conclusion

Existential distress reminds us that some of life’s most important questions cannot be answered through certainty alone. As therapists, our task is not to remove the realities of uncertainty, loss, freedom, or mortality, but to help clients develop the capacity to engage with them more openly and compassionately. In doing so, we discover that therapy is less about providing answers than about creating a relationship in which people can rediscover the courage to participate fully in their own lives.

Key takeaways

• Existential distress often emerges through questions of meaning, identity, freedom, mortality, uncertainty, and belonging rather than through symptoms alone.
• Recognising existential themes is only the beginning; therapeutic work focuses on helping clients develop a different relationship with these realities.
• Existential therapy shifts attention from eliminating suffering to accompanying clients as they navigate life’s unavoidable challenges.
• The therapist’s presence is often as important as any specific intervention. Remaining curious, compassionate, and willing to tolerate uncertainty creates space for meaningful exploration.
• Premature reassurance, over-pathologising, rushing to problem-solving, and imposing meaning can inadvertently close important therapeutic conversations.
• Re-engagement with life often begins through values-based action, relationships, creativity, contribution, and other personally meaningful forms of participation.
• Existential therapy does not encourage clients to wait until uncertainty disappears before living; it helps them participate in life while uncertainty remains.
• Therapists are not observers standing outside the human condition. They accompany clients as fellow human beings while bringing professional knowledge, ethical responsibility, and therapeutic skill to the relationship.
• Hope within existential therapy arises not from eliminating life’s uncertainties but from discovering that they can be faced with greater honesty, courage, compassion, and connection.

Questions therapists often ask

Q. How can I recognise when a client’s difficulties are existential rather than simply symptomatic?

A. Existential concerns often emerge through recurring questions about identity, meaning, purpose, mortality, freedom, responsibility, or belonging. These themes may accompany anxiety, depression, grief, burnout, or life transitions, but they point beyond symptom reduction toward deeper questions about how the client understands and wishes to live their life.

Q. Should I introduce existential concepts directly in therapy?

A. Usually, it is more helpful to follow the client’s language than to introduce philosophical terminology. Exploring experiences of loss, uncertainty, identity change, or meaning naturally creates opportunities for existential reflection without requiring abstract discussion.

Q. What if I don’t know how to answer a client’s existential questions?

A. You are not expected to have definitive answers. Existential therapy values thoughtful presence over certainty. Often, clients benefit more from having their questions explored respectfully than from receiving advice or reassurance.

Q. How do I balance acceptance of existential realities with helping clients move forward?

A. Acceptance is not resignation. Therapists help clients acknowledge realities that cannot be changed while identifying meaningful choices that remain available. Even when uncertainty or grief persists, clients can continue making values-based decisions and participating more fully in life.

Q. What makes existential therapy different from simply having supportive conversations?

A. Existential therapy combines compassionate presence with purposeful exploration of universal human concerns. Rather than offering comfort alone, it helps clients examine how they relate to uncertainty, freedom, responsibility, mortality, meaning, and connection, supporting the development of greater psychological flexibility, authenticity, and engagement with life.

References

• Frankl, V. E. (2006). Man’s search for meaning. Beacon Press. (Original work published 1946)
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford Press.
• May, R. (1983). The discovery of being: Writings in existential psychology. W. W. Norton.
• Pakenham, K.I., Landi, G., Boccolin, G., et al. (2020). The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy. Journal of Contextual Behavioral Science, 17, 109-118. https://doi.org/10.1016/j.jcbs.2020.07.003
• van Deurzen, E. (2012). Existential counselling and psychotherapy in practice (3rd ed.). Sage.
• van Deurzen, E., & Arnold-Baker, C. (2018). Existential perspectives on human issues: A handbook for therapeutic practice (2nd ed.). Red Globe Press.
• Wong, P. T. P. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85–93.
  https://doi.org/10.1007/s10879-009-9132-6
• Yalom, I. D. (1980). Existential psychotherapy. Basic Books.