This paper discusses the practice of existential therapy as a process of engaged understanding for lived meaning. Understanding is viewed as a validating, contextualizing and resolute process of unfolding of what matters in the life projects of those entrusted to our care. Such "matterings," or meanings, are neither lost, found nor created, but lived in each moment of our lives, and most fully disclose themselves in the engaged participation of the therapeutic relationship. Our engagement both provides respect and dignity of any way of be-ing in situations, and offers the possibility of "being otherwise," if one chooses to do so, without privileging how one should be over how one has been or how one is in one's current circumstance. This kind of practice is based on the human science tradition and inseparability of existential-hermeneutical-phenomenological thought and practice; We meaningfully experience through understanding our ownmost limitations and possibilities within a shared human condition. Important distinctions are made in these reflections between a more familiar "deficit-correction" model of care and the stance suggested in this paper: An understanding-collaboration model of care. The latter model places a primacy on "being-with" as both an ontological, or inherent and common given of the human condition, and as an ontic, or particular, expression of therapeutic care. The paper closes with suggested implications for evidence-based concerns in relation to this project.