What It’s Like to Visit an Existential Therapist

If you ever find yourself sinking into the plush blue couch of Dr. Jane Prelinger, you should know that she doesn’t want you to call her Dr. Prelinger. In her office, even when you’re on the couch and she’s facing you from her chair, looking at you through heavy eyeliner and the frame of her white-blond bangs, she insists: You’re just two humans. “It’s Faith and Jane,” she told me when I was in that position. “Here, it’s human to human.”

Jane is an existential therapist. She sees a lot of different clients with a lot of different problems, but she thinks all of those problems can be reduced to the same four essential issues: death, meaninglessness, isolation, and freedom.

Existential therapy isn’t new. Its roots go back to the existential philosophers of the 20th century, and specifically to Jean-Paul Sartre, who summed up his philosophy in 1943 when he wrote that humans are “condemned to be free.” Unlike other animals, humans are conscious and aware of their own mortality—but that means they have the possibility, and responsibility, of deciding in each moment what to do and how to be.

Read: What your therapist doesn’t know

Existential philosophy evolved into a methodology in the postwar years, as therapists in different corners of the globe began using its principles to inform their practice: After being freed from a concentration camp, Viktor Frankl wrote Man’s Search for Meaning in 1946, and coined logotherapy as a method of creating meaning. Rollo May brought this European perspective to America in the 1950s, giving it a more optimistic flair focused on the vastness of human potential, and called it the “existential-humanistic” approach. And in 1980, Irvin Yalom defined the four “givens” of the human condition—death, meaning, isolation, and freedom—that have become the basis for the field. Today there remain several different branches of existential therapy, but they all help clients face existential givens head-on so that they can move toward a more “authentic” and free existence.

Orah Krug, an existential therapist and the director of clinical training at the Existential Humanistic Institute in San Francisco, gave me an example of how existential therapy can help. She had a client who was eating lunch with her daughter when a car crashed right into the room. No one was badly hurt, but for years the client couldn’t let go of her anger at the driver—until Krug helped her realize that she wasn’t just angry at the driver. She was angry that she had no control to stop bad things from happening. “And here’s the place where she got to that deep acknowledgment … We cannot protect ourselves from life’s vicissitudes,” Krug told me. “They just happen. And to pretend that we can is dangerous.”

I tend to ruminate heavily—too heavily—on the existential. I worry constantly that my life isn’t meaningful, that I’m not putting my limited years to good use, that I could be doing more, that I could be more. It’s in between the busy moments—after I finish a task, or say goodbye to a friend, or wake up before my alarm in the dark hours of the morning—that I feel it most: time slipping through my fingers.

I was immediately intrigued when I first heard about existential therapy. But when my editor suggested I actually go to an existential-therapy session myself, I found I was secretly eager to see if it could really help me, as a person and not just as a journalist.

When I stepped into Jane’s small office, I felt like I was entering someone’s home; the floor was carpeted, the lighting warm. After I sat down stiffly in Jane’s rather Freudian chaise, she asked me what I’d like to talk about.

Read: The virtues of isolation

I told her that lately my anxiety about time passing has been getting worse; that I’m in my 20s, and finding myself in the midst of a quarter-life crisis—trying to figure out what makes a meaningful life, debating what I should prioritize, aware that any small decision could change my entire course; that I obsessively scan Wikipedia pages to see how old my favorite writers were when they first published.

I told her how isolated those fears make me feel, even though I know my friends are grappling with similar concerns. And because I was seeing an existential therapist, after all, I let myself really dive into that. “I can’t get around the fact that we’re all trapped in our own heads,” I said. “That I can never really access any one else’s internal experience.”

Jane guided the session gently. She asked clarifying but fairly typical follow-up questions: How long have you felt that way? And are you close to your mother? What about your relationships with friends? But then she’d reel me back to the big-picture questions—some of which caught me off guard, precisely because they were things I think about all the time. “How would you describe your own identity?” she asked at one point. “Not in terms of how other people see you, but in terms of who you feel you are, internally.”

She laughed along with me at some of my more absurd anxieties; she even told me at times that she worried about the same things. At several points, she said, “You might not feel better after I say this,” or “Well, this isn’t comforting, but …” and proceeded to confirm my deepest fears. No, we can’t ever know anyone else’s internal experience. No, there is no objective meaning, and yes, we will all fail at times to create it. Yes, you will die.Occasionally, Jane would stop and ask what I was feeling in that moment. It was a way of sticking to the idea of “presence” that is so essential to existentialists: that you have a responsibility to show up to your life. You can’t avoid it, in all its pain and beauty, by living in the past—personal histories and buried traumas matter, and they might inform the present, but it won’t do to dwell on them.

And that was it. For an hour, I talked about what it was like for me to be human, and why it often feels so hard. There were no answers—Jane didn’t give me any tips for processing mortality, or ways to make my life feel more meaningful. She didn’t tell me I had a purpose, or that I should strengthen connections with friends, or to tell my parents I loved them. After the session ended, I talked with Jane for a bit about her approach. “Part of the existential is just acknowledging That ship has sailed,” she said. “A lot of it is mourning. You mourn these realities so that you can move toward relinquishing them.”

Existential therapy has slowly been gaining recognition; in 2016, there were 136 existential-therapy institutions in 43 countries across six continents, and existential practitioners in at least 48 countries worldwide. Recent studies have supported the use of existential therapy for patients with advanced cancer, incarcerated individuals, and elderly people residing in nursing homes, among others; a number of meta-analyses have gathered data on its effectiveness. And when I spoke directly to existential therapists, they reported a significant rise in clients in recent years—and a notable increase in existential distress among them.

In Man’s Search for Meaning, Frankl described a similar kind of culture-wide existential hunger. He called it the “existential vacuum”: “a widespread phenomenon of the twentieth century,” he wrote, resulting from the technological developments of modern society. He believed that the conveniences of the Industrial Revolution had actually given people a harmful surplus of leisure time, leaving them purposeless, sad, and bored. “Such widespread phenomena as depression, aggression, and addiction,” he wrote, “are not understandable unless we recognize the existential vacuum underlying them.”

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Now, 72 years later, rates of suicide are higher than they’ve ever been before; in the United States, suicide rates rose in all but one state (Nevada) from 1999 to 2016. Social isolation, too, is on the rise; a recent survey of 20,000 American adults found that “most Americans are considered lonely,” and that two-fifths feel they are “isolated from others.” A new poll from the American Psychiatric Association found that nearly four in 10 U.S. adults are more anxious now than they were at the same time last year.

Clay Routledge, a researcher at North Dakota State University who studies existential psychology, believes Americans are experiencing a “crisis of meaninglessness.” Historically, he told me, Americans have turned to organized religion “not just because it provides this belief structure that you exist for a purpose, but also for community, social connections, and support.” Now Americans are increasingly dropping religion, often for more individualized spiritual pursuits. Routledge told me this can leave people feeling empty. “In religion, people find it comforting to be part of a group that’s been around for a long time,” he said. “There’s continuity—it’ll be there after you’re gone.” Routledge noted that in his own research, subjects primed to think about death get most anxious when they don’t see themselves as part of a bigger collective identity.

Existential despair has crept into the political realm, too. Many Americans are losing faith in political institutions, polarization is growing, and people therefore feel less hope and trust in others. And it’s not just the United States that is feeling the existential vacuum; global threats such as climate change, increasing automation, and globalization are all changes, happening rapidly, that make life feel profoundly uncertain. “I’ve never had more people come in bringing the world into the room than I do now,” Krug, of the Existential Humanistic Institute, told me. “And specifically talking about their anger, their powerlessness, their sense of—their world feels turned upside down.”

Read: Trust is collapsing in America

Even today, though, the existential approach remains somewhat on the fringe of psychotherapy. There have been relatively few controlled studies comparing it with other methods—in part because existential therapists themselves are often reluctant to test it. Mick Cooper, a psychologist and researcher at the University of Roehampton, told me that in existential therapy, “there’s a focus on the unique qualities of the individual … it’s very critical of a more mechanistic perspective, and existential therapists are fairly wary of things like control trials.” In the United Kingdom, where Cooper practices, existential therapists have a hard time getting funded by or employed within the National Health Service; the government is naturally reluctant to pay for something if they don’t know that it works.

But Louis Hoffman, a co-founder of the International Institute of Existential-Humanistic Psychology, sees it differently. “When you look at all the different primary components of existential therapy, there’s actually very broad, robust research supporting its efficacy,” he told me. Many studies have shown, for instance, that a sense of meaning contributes to psychological well-being, and that meaning-centered psychological interventions can help.

Hoffman feels confident that the field is going to keep growing. This May, the second World Congress of Existential Therapy will be held in Buenos Aires, gathering practitioners from all over the globe; the theme will be “Anxiety and Guilt in Times of Change.” Cooper, for his part, still doubts that existential therapy will ever be a mainstream approach. “It talks about subjects that not everyone wants to talk about, like death, meaning, limitations … It’s not exactly upbeat,” he told me.

Even when I was talking to Jane about those darker subjects, though, it didn’t really feel heavy; it just felt good to get them out in the open. “Existentialism can be so much fun, especially when you let yourself laugh,” Jane told me, chuckling. “We go through all this agony, just to die at the end!” When our time was up, Jane ended it directly and firmly. This was part of the approach, she told me—you have to be honest about things. “I don’t want to deny that things end brutally,” she said. “I can’t collude with the idea that there’s all the time in the world.”

I left the office then, out of the double doors and into the misty afternoon. It was cold for September, but I wanted to walk the hour home. I still had all the same existential concerns—the fear of time, the loneliness, all the myriad uncertainties. But I felt a little lighter, having had these anxieties listened to, and validated. It was a bit like coming across a line in a poem or a quote in a book that you relate to on an eerily intimate level—something of your most personal experience mirrored back to you, and you realize all at once that someone else has had the very same thought. Suddenly and certainly, if only for that moment, you are a little less alone.

FAITH HILL is an assistant editor at The Atlantic.