Today’s generation of young clinicians appear unfamiliar with how to incorporate existential concepts when treating adolescents experiencing internalizing symptoms. Empirically validated treatments for this population, including cognitive–behavioral, interpersonal, and psychopharmacological approaches undoubtedly are clearly beneficial. Several core existential concepts, however, can be effectively integrated with these empirically supported treatments to enhance outcomes. The article begins with a discussion of Rank, Tillich, and May’s conceptualization of existential anxiety for those unfamiliar with existential theory. This is followed by an examination of evidence supporting the adolescent’s capacity to contemplate existential concerns as well as evidence indicating existential focus in adolescent mental life. Building on the therapeutic aims and implications of existential–integrative therapy outlined by Schneider, the article concludes with specific recommendations regarding how existential thinking can be incorporated into the treatment of many anxious and depressed adolescents.