Existential psychotherapy is a philosophical approach to psychotherapy. It addresses the large, universal themes of life. These themes, considered to be the givens of existence, create a focus for existential psychotherapy. In existential psychotherapy, mental health exists when the existential themes are worked through and resolved. Many older adults seek psychotherapy, not just for psychiatric or medical disorders, but for psychological issues that are developmentally common to this age group. The goal of existential psychotherapy is to help clients face the anxieties of life, freely choose their life direction, take responsibility for their choices, and create a meaningful and purposeful existence. This chapter initially presents the author's experience in treating older adult clients. It then describes the key concepts of existential psychotherapy. The chapter finally presents a case study of a client who was at crossroads regarding their decision to retire and ends with a few questions for reflection.