SOURCE_DOCUMENTS/journal_021_2.txt

Volume 21, Number 2 Autumn 1998 
The International Forum for Logotherapy, 1998, 21, 65-71. 
THE APPLICATION OF LOGOTHERAPY IN PUBLIC EDUCATION 
Bianca Z. Hirsch 
The techniques of logotherapy can be applied in public education for children of all ages. Children as well as teachers and other adults come to school with "baggage," a variety of positive and negative' experiences, feelings, fears, and concerns that intensify under challenging conditions such as physical, emotional, or attitudinal difficulties. 
When school opens in September, kindergarten teachers have lists of twenty or more names but little knowledge of the children personally. How many children have had preschool experience? How many have difficulties separating from parents? How many have never participated in large groups? Which child has recently experienced the loss of a parent or grandparent? A new addition to the family? Is there a child among them who can read? Is there a child who has been physically or sexually abused? Emotionally traumatized? 
Teachers and other school staff also have "baggage." Has the teacher ever taught a kindergarten class? Has the teacher taught in a culturally diverse community? Are the secretary and janitor new to the school? Has the teacher or principal recently undergone personal trauma? 
As logotherapists we must recognize the opportunities for growth as well as the situations that limit growth in the school. We must recognize that past experiences may be baggage but much of it can be left behind as opportunities and experiences are explored and attitudes are modified. Adults and children can be helped to reach their full potential in the context of what is meaningful to them, but each person 
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has to make choices, seek opportunities, take a stand, and perhaps transcend personal aspirations. 
Logotherapy teaches that we do not dwell on the past but take what we have and move forward. We cannot change past experiences, but we can use them as building blocks in the present and the future. If nothing else, we can change attitudes toward past experiences. 
Where is the best opportunity to practice these logotherapeutic insights but in the schools--elementary, high school, university, or the school of life? Most likely, it will be the most significant lesson that any of us can learn. 
Self-Transcendence 
Frankl states: " ...Man's primary concern does not lie in the actualization of the self, but in the realization of the values and in the meaning potentials which are to be found in the world. "2•P·68 And again: "The meaning which a being has to fulfill is something beyond himself, it is never just himself. Only if this otherness is retained by meaning, can meaning exert upon a being that demand quality which yields itself to a phenomenological analysis of our experience of existence. Only a meaning which is not just an expression of the being itself, represents a true challenge. "2• P-11 
Even in the early grades, we do not simply exist in this world, but we search for meaning--an encounter with others, an experience, a purposeful accumulation of knowledge. We transcend personal desires and interests to please others, i.e., the parent, the teacher, etc. In my work as a school psychologist, I have had the opportunity to apply these logotherapy principles in many situations. For example ... 
Jeremy was referred to me by his parents because his behavior was intolerable. He constantly fought with his older brother. He was unkind to his little sister, locked her out of his room, bullied her, and was rude. When I talked to him, he told me that he was a middle child, that his parents had very little time for him, and he felt "left out." Academically, he did well and never presented problems in school. He loved to read. (This was my "logohook. ") I asked if he would be kind enough to give up some of his playtime at school to read to kindergarten children who did not have a big brother. He thought that this would be great fun since he loved to read out loud and tell stories. I arranged for him to go to one of the kindergarten classes a half hour, twice a 
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week. The kindergarten children eagerly looked to the 
time when he came to read to them. Within a short time, 
his parents told me that at home he began to read to his 
little sister, putting her on his lap and spending playtime 
with her. Much to his surprise, as he transcended his 
own personal feelings of "being left out," and learned to 
reach out to others, he developed a close bond to his 
sister who responded with affection and adoration, and 
he established a good relationship with his older brother. 
In this situation, emphasis was placed, not on Jeremy's negative behavior, but on his positive school performance. He was helped to focus on his academic skills in a positive way. By giving up playtime to read to others, his self-concept improved. This was a by-product as he transcended his personal need for attention. 
Socratic Dialogue 
Fabry points out: "Socratic dialogue takes its name from the Socratic concept of the teacher whose job is not to pour information into students but to make students aware of what they already know deep within. "1 This enables students to get in touch with their noetic unconscious and become aware of their true evaluation of themselves and their potentials, their preferred directions, and their deepest meaning orientation. Such discovery is comprehensive--since it is not merely rote learning but looking within, searching for new ways of using what has been learned in the past. 
In many classes, teachers will spend endless hours using didactic questions to enable youngsters to arrive at answers that could have been given much more quickly and easily in a lecture. What students learn through Socratic dialogue, most likely, will be generalized to numerous new situations. 
Dereflection 
Frankl uses the therapeutic device of dereflection primarily to counteract compulsive inclinations to self-observation. There are many children who misbehave on a day-by-day basis and enjoy the attention they receive for constantly disrupting the classroom. These children focus on their non-conformity, often as a way to draw attention away from their poor academic skills. This does not imply that there is an underlying neurosis. Dereflection can be used to focus on achieving positive interactions with others. That is, the teacher can clarify the job 
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of learning, the pride of mastery that will make parents and teachers happy, rather than point to Johnny's inability to perform adequately. 
When a child's poor academic skills are emphasized, classmates often pick this up and taunt the child. The child retaliates by boasting, acting out, becoming verbally or physically abusive. However, if children are encouraged to work occasionally as a team, the focus on team success can supersede the success or failure of the individual child. Each child can make a contribution within the scope of his or her abilities. Consequently, there is no need to hyperreflect on failure. Children thus do not focus on personal adequacy or inadequacy but rather view the process and product as a joy brought about by the group as a whole. The less successful child can receive support to enhance skills, but need not be made to feel inadequate. 
Peter, a child who was aware of his inability to write down his ideas because of a learning disability, came into a new classroom situation fully prepared not to be able to do the work. His teacher did not ask him to write answers to a set of questions related to a reading assignment. Instead, she encouraged him to see how many questions he could formulate that would relate to 
the passage and then ask other children to answer them. He was so excited about the assignment that he actually scribbled a few notes. Eventually, this type of notetaking was expanded until he was able to write an entire paragraph. Thus, the teacher did not focus on his handicap but explored possibilities of what Peter could do. 
My role as School Psychologist was to provide support for Peter as well as to his teacher. I helped him see the value of his contributions. I pointed out to the teacher that in recognizing what Peter could do, she had provided alternative learning situations as well as novel ways to evaluate his performance. I acknowledged her skill in the way she had assessed Peter's strengths rather than having focused on his area of weakness. 
The Defiant Power of the Human Spirit 
Teachers are challenged often to evoke a difficult child's defiant power of the human spirit, to motivate the child to become engaged in .....J the learning process despite a negative attitude or a form of maladaptive • behavior. It often becomes a challenge for a principal or teacher to find ways that children "will buy into the learning process." That, too, is a form of evoking the defiant power of the human spirit. 
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Youngsters give up easily when they do not perform well, unless the 
defiant power of the human spirit is activated to overcome adversity. 
They must be encouraged to continue to work "not to give up," to perform "in spite of" difficulties, to master material or a situation. Jared's teacher had explained to the class that failure at the end of the term was a possibility for students who did not complete their assignments. Jared's father, a teacher, was greatly concerned that his son was not doing well in school. Each evening, he sat down with Jared after dinner, but invariably they had a battle about his school performance and his homework. The father came to me in desperation because Jared was beginning to lie about his work. I suggested that Jared be the one who was held responsible for his work. It might be better if the father and Jared would find activities to do on the weekend, and let Jared do his work as best as he can. When I talked to Jared, he told me that he was disappointed because his father had so little faith in him, and so he just wasn't interested in school work anymore. He enjoyed playing tennis, where he excelled. He and his dad started to spend their weekends playing tennis, but they were very competitive. I asked Jared what would surprise his father the most about his school performance; he readily admitted that doing homework without procrastinating and getting good grades in academic areas, "would blow his dad out of the water." Jared thought about this a minute and said: "Wouldn't that be something if I would beat him on the tennis court and do well in school. He wouldn't have anything to get upset about." By the end of the term, Jared's attitude toward school had changed greatly, and so had his father's game of tennis. 
Change of Attitude 
All of us have opportunities to chose attitudes, behaviors, and the 
stands we take toward situations. We all have freedom to change. The 
school is a fertile ground to try out changes and make adjustments-
many avenues are open for adults and children to exercise choices and 
make changes. Bill was referred because of such violent behavior that suspension from school was imminent. In a 
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counseling session, I discovered that Bill had many good learning skills but did not have many social skills that would endear him to classmates. He always had to win, be better than someone else, outdo others, etc. If he could not boast of his skills, he would lie about them. When his classmates would challenge him, he would yell, scream, or hit them, but rarely would he join them in a game because "they didn't know how to play," "they didn't know the rules," or "they were too stupid." We talked about a variety of table games. He hardly knew any of the rules precisely, and those he did know he changed as he felt the need. Time was spent teaching him rules of various board games, practicing appropriate comments, teaching him about facets of his life over which he did and did not have control. We also taped some of his expressions and the way he talked to me when he won and lost. Such feedback was very revealing. Whenever the opportunity presented itself, we talked about how people respond to negative comments and "put downs." We practiced saying things differently, even if the comments were not positive, he could at least express them in a non-hurtful manner. (i.e., not "you're so stupid, that's why you lost... " but instead "I was just lucky, I had all the good cards.") One day, during the sixth or seventh session, he stood up and said: "I don't have to get angry anymore when someone says something I don't like... , I'll just tell him that I don't like what he said." After that, Bill no longer had violent outbursts. 
Paradoxical Intention 
One of the interesting techniques Frankl has developed is 
paradoxical intention. This technique, as explained by Fabry, uses the 
unique human quality of self-distancing which allows an individual to 
step back from oneself, look at oneself from the outside, oppose and 
even laugh at oneself.2 · P-137 In a school situation, this technique can be used to teach children to 
cope in a more appropriate manner. Jimmy could not draw well, yet each day the teacher asked the children to illustrate their work with a small pencil drawing. Jimmy became so upset that he no 
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longer would do any written work. The more the teacher reprimanded him the more upset he became, and his mother had a hard time to get him to go to school. The more he thought about having to draw, the more upset he became (anticipatory anxiety). When he came to me, I explained to him how paradoxical intention works. We talked about making big drawings, so big he had to use the sidewalk because there simply was no paper big enough to make any of his illustrations. We got some chalk and went into the school yard and I asked him: "Show me how big a drawing you can make." At first he drew a few lines a couple of feet long. I asked him if he could not make them bigger. He then really got involved and said: "I can make them bigger than the hopscotch court, no, as big as the whole four-square court, no, as big as the kindergarten yard." By then he laughed, enjoying his boasting. After a few more drawing sessions in the yard, Jimmy returned to the classroom, and completed his assignments, drawings and all. 
As we can see, the very "baggage" (anger, eagerness, need for approval, loneliness, etc.) with which children and adults come to school can be used to foster the learning process. It does not have to be part of an in-depth, therapeutic encounter, but it can be the road one takes to achieve one's potential. 
Schools are thus not only settings where academic learning takes place, but they also provide the milieu and opportunities for social, emotional, and personal growth for all who participate in the educational process. 
BIANCA Z. HIRSCH, PH.D. [115 San Anselmo Ave., San Francisco, California 94127 USA] is Past-President of the Viktor Frankl Institute of Logotherapy, a School Psychologist in the San Francisco Unified School District, and Associate Clinical Professor of the University of California Medical School, Division of Behavioral and Developmental Pediatrics. 
References 
1. 
Fabry, J. (1968). The pursuit ofmeaning. San Francisco: Harper & Row. 

2. 
Frankl, V. E. (1967). Psychotherapy and existentialism. NY: Simon & Schuster. 


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The International Forum for Logotherapy, 1998, 21, 72-77. 
PURPOSEFUL GOALS AND ALCOHOLIC RECOVERY: A CORRELATIONAL STUDY 
Julia Ungar, David C. Hodgins, & Maria Ungar 
(ABSTRACT) Theory and research informed by Viktor Frankl's Logotheory suggest that finding meaning and purpose in life is indispensable for recovery from addictions. The present study focused on alcoholics' reasons for abstinence, hypothesizing that those citing a meaningful goal as the reason for abstinence would be less likely to relapse, and would experience less severe relapse episodes than those not motivated by such goals. Eighty-four alcohol-dependent individuals were interviewed regarding their drinking behavior and reasons for stopping or remaining abstinent. They were then followed up over a 12month period. Support was found for both hypotheses, providing support for the use of Logotherapy in addictions counseling. 
According to Frankl' s logotherapy, alcohol abuse cannot be adequately understood without reference to 
4 169
existential vacuum. P Existential vacuum ensues when one's will to meaning is frustrated, and is expressed as a sense of boredom and futility, a perceived pointlessness in life. Thus, substance dependence is akin to what Frankl calls "provisional existence"4 · r-114 since it also involves inability to aim to a meaningful goal and make sacrifices for that goal. 

Conversely, "One who has a why to live for can bear with every how"--as Frankl affirms.4 · r-109 Extrapolating to alcoholics, this means that those individuals who have a clear sense of purpose should be better able to abstain from drinking than those who do not. llllll 
The therapeutic significance of having a goal to aim at in addiction counseling is further elaborated by Lukas. 10 In her reflections on "selfhealers" she observes that what propels ex-drinkers toward abstinence 
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is existential motivation to live for something or somebody. It is finding meaning in living for a worthwhile cause that enables one's spiritual self to rescue the biological self, the latter being a "prisoner of the substance." From Lukas' perspective, abstinence should not be one's goal per se. Rather, its a precondition for, and a side-effect of, pursuing a meaningful life goal. This observation is corroborated by a recent report by Haines, which points out that permanent recovery from addiction is attainable only if meaning is realized as an integral part of sober life.6 
Although there is ample theoretical support for the link between meaningful goals and abstinence, thorough empirical validation of this relationship is still lacking. On the one hand, Guttmann and Cohen5 report a positive correlation between "excessive behaviors"--including alcohol use--and purpose in life (as measured by a shortened version of the Meaning-in-Life Scale) in a sample of Israeli elderly. Crumbaugh and his associates1•2 on the other hand, have found that hospitalized alcoholic patients could be distinguished from two groups of nonpatients on the basis of their low scores on the Purpose in Life (PIL) test, and that logotherapy produced a significant rise in alcoholic clients' PIL scores. A subsequent study confirmed that individuals who have completed Logoanalysis scored higher on feelings of life-meaning and purpose than those who had not completed such training. Moreover, participants of a Logoanalysis group were more likely to show positive behavioral changes associated with alcohol abuse. 9 Anecdotal evidence 
735 739
also supports this finding. 3• 
Our study examines the hypothesis that having meaningful goals predicts abstinence in alcoholic clients. Specifically, we predict that individuals who cite a meaningful goal as the reason for abstinence (i.e., for ending their relapses or not giving in to temptations to drink) ( 1) are less likely to relapse and (2) experience less severe relapse episodes than those who are not motivated by such goals. 
Methods and Procedure 
This study was part of a larger project.7 Subjects (N = 55 males + 29 females = 84) were recruited from two outpatient counseling centers in Calgary. Subjects were 23 to 65 years old M = 37.3 years, SD =9.3); Alcohol Dependent by DSM-111-R criteria; had been using alcohol for an average of 14 years (SD = 7. 8); and had never received psychiatric treatment for disorders other than substance abuse or depression. At the onset of data collection, they were required to be abstinent for at least two weeks in order to ensure commitment to 
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abstinence. At the time of the initial interview, the majority of the 
subjects (62 %) indicated extreme commitment to abstinence and had been abstinent for a mean of 32 days (SD = 29). 
Participants were interviewed at 3, 6, and 12 months following the initial assessment, using a modified version of the Relapse Experience Interview (REI), 11 which gathered information about the precipitants, the course and termination of relapse, and crises episodes. Any alcohol use following the required two-week abstinence period was termed a relapse, with each subsequent relapse being distinguished from the preceding one by a clear period of abstinence, as defined by the subjects. Crises were defined as periods of strong temptation to drink that did not result in substance use. A maximum of 5 episodes were discussed during each interview. Responses were then analyzed according to: "What was the main reason for stopping/getting control?" (item "M" of the REI). 
Reasons for terminating crises and relapses were sorted into two categories using a slightly modified version of an existing scheme. 8 One category was Immediate Drinking-Focused Reasons. These did not refer to meaningful goals as a reason for abstinence. Instead, abstinence was attributed to lack of availability of alcohol, no opportunity to drink, physical sickness, or disgust of intoxication and lack of enjoyment from drinking. The other category was Goal-Oriented Reasons. These were responses that clearly indicated a meaningful/personal goal as the reason for abstinence. Inter-rater reliability for this distinction was 87% (kappa = .84). Four percent of the reasons (e.g., feelings of shame and guilt) were ignored due to lack of relevance to our hypothesis. Next, a ratio of meaning orientation was obtained for each subject by dividing that subject's number of Goal-Oriented Reasons by the total number of responses the subject gave. The use of ratios was necessary because the actual number of reasons reported for quitting or staying abstinent varied across subjects. 
Relapses were classified as major (substance use for more than one day, or more than five standard drinks, or drug use to intoxication) or minor episodes (all remaining relapses). 11 To quantify the severity of relapse episodes, major and minor relapses and crisis episodes were assigned scores of 2, 1, and 0, respectively. Adding all the scores accumulated over the twelve-month follow-up period resulted in an Ill estimate of relapse severity for each subject. Finally, meaning orientation ratios were correlated with (1) the number of relapses and 
(2) relapse severity scores. 
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Results 
Of the 84 participants, 57 (68%) relapsed at least once, and 20 (24%) remained abstinent over the entire follow-up period. Attrition rate was 8 % . All of the abstinent subjects and 2 7 of the relapsers experienced at least one crisis episode. Overall, 268 relapses (193 major and 75 minor) and 83 crises were reported. The majority of the relapse and crisis episodes (74%) were ended for more than one reason (M = 1.8, SD = .86); subjects reported a total of 546 reasons for stopping/getting control. Of these, 199 (36%) were Immediate Drinking Focused Reasons and 347 (64%) were oriented toward some personally meaningful goal. Considering all participants, the mean ratio of meaning orientation was .63 (SD = .29). 
The correlation between meaning orientation and the number of relapses was statistically significant and in the predicted direction (r = . 5 7, p < .0005)--the more meaning-oriented considerations (as opposed to immediate/drinking focused considerations) motivated one's decision to stop drinking or remain abstinent, the fewer relapse episodes one had over the 12-month period. Similarly, meaning orientation was inversely related to the severity of relapses (r = -.48, p < .0005). 
Discussion 
Our data support both hypotheses. Clients who chose to abstain or terminate alcohol use for predominantly meaning/goal-oriented reasons met more success than clients whose motivation for stopping or getting control was centered on immediate/drinking-focused factors. Specifically, 32 % of the variability in number of relapses and 23 % of variability in the severity of alcoholic relapses were accounted for by variation in meaning-orientation. 
These findings support the perspective of logotheory on substance abuse. Although it would be naively simplistic to claim that existential vacuum is the cause of alcoholism, our study indicates that lack of a clear sense of purpose is associated with serious setbacks in clients' journey toward recovery. We found that roughly one-third of the variation in the number of relapses could be explained by meaning orientation; this corroborates previous figures indicating that 25 to 35 percent of alcoholics manifest a primary problem in lacking meaning and purpose in life. 1 Pertaining to Lukas' assertion that aiming at abstinence as a goal in itself is not sufficient for full recovery, it is interesting to note that many of our subjects reported sobriety as a value per se. In fact, it motivated quitting or resisting temptations to drink in 1 2 % of the participants. Unfortunately, it was not possible to investigate how 
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abstinence as a goal contributed to outcome due to small sample size 
and multifactorial reasons for abstinence. 
Our results have implications for clinical work with alcohol dependent clients. Given that the lack of purposeful goals predicts relapse, one can identify clients who face a higher risk of returning to substance use, and therefore need special prevention-focused attention. Our study also provides support for the use of logotherapy in addictions counseling: logotherapy is known to help increase clients' sense of purpose in life,1 which is associated with fewer and less severe relapses. It is therefore recommended that clients--especially those suffering from lack of meaningful goals--receive logotherapy in conjunction with other forms of treatment. 
Because our study was correlational, causality can be inferred only on theoretical grounds. Moreover, our hypotheses need to be replicated with different measures. The validity of our instruments has not been evaluated. Also, due to the crudeness of our measures, we could not break down personally meaningful goals into more specific components. In particular, it would be of great interest to logotherapists to explore the relative involvement of attitudinal, experiential, and creative values in recovering alcoholics' goals, and the extent to which finding meaning in these values is predictive of abstinence. 
JULIA UNGAR, B.A.(Hon.) is a graduate student at Hardin-Simmons University, Abilene, Texas 79698 USA. 
DAVID HODGINS, PH.D. [6th Floor North Tower, 1403 29 St. NW, Calgary, Alberta, Canada, T2N 2T9] is an Adjunct Associate Professor in the Departments of Psychology and Psychiatry at the University of Calgary. He is a Clinical Psychologist working at the Addiction Center, Foothills Hospital. 
MARIA UNGAR, M.ED. [6-145 Education North, The University of Alberta, Edmonton, Alberta, Canada, T6G 2G5] is a Doctoral Student of Counseling and School Psychology at the University of Alberta, Edmonton, and former student of Ors. Robert and Dorothy Barnes in Abilene, Texas. 
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References 
1. 
Crumbaugh, J. C., & Carr, G. L. (1979). Treatment of alcoholics with logotherapy. The International Journal of the Addictions, 14, 847-853. 

2. 
Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl's concept of noogenic neurosis. Journal of Clinical Psychology, 20, 200-207. 

3. 
Crumbaugh, J. C., Wood, W. M., & Wood, W. C. (1980). Logotherapy: New help for problem drinkers. Chicago: Nelson-Hall. 


4. Frankl, V. E. (1963). Man's search for meaning: An introduction to logotherapy. NY: Pocket Books. 
5. 
Guttmann, D., & Cohen, B. Z. (1993). Excessive behaviors and meaning in life among the active elderly in Israel. Journal des Viktor-Frankl-lnstituts, 1(2), 38-55. 

6. 
Haines, P. (1997). Addiction recovery: Transcending the existential roots of relapse. The International Forum for Logotherapy, 20, 1-9. 

7. 
Hodgins, D. C., el-Guebaly, N., & Armstrong, S. (1996). Prospective and retrospective reports of mood states prior to relapse to substance abuse. Journal of Consulting and Clinical Psychology, 63, 400-407. 

8. 
Hodgins, D. C., Ungar, J., el-Guebaly, N., & Armstrong, S. (in press). Getting back on the wagon: Reasons and strategies for terminating alcoholic relapses. The Psychology of Addictive Behaviors. 

9. 
Hutzel!, R. (1984). Logoanalysis for alcoholics. The International Forum for Logotherapy, 7, 40-45. 

10. 
Lukas, E. (1994). Die Bedeutung de Sinnfindung als Therapieziel im Genesungsprozess von Suchtkranken (The importance of finding meaning as a goal in therapy in the process of recovery from substance abuse). In E. Lukas, Psychotherapie in Wurde (pp.3041). Munchen: Ouintessenz. 

11. 
Marlatt, G. A., & Gordon, J. R. (1985). Determinants of relapse: Implications for the maintenance of behavioral change. In P. Davidson & S. Davidson (Eds.), Behavioral medicine: Changing health lifestyles. NY: Brunner/Maze!. 


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The International Forum for Logotherapy, 1998, 21, 78-84. 
LOGOTHERAPY WITH CHRONIC PHYSICAL ILLNESS CLIENTS 
Jim Lantz 
Logotherapy has been found to be an effective treatment approach in a wide variety of psychiatric, trauma, crisis, and psychosomatic clinical 
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situations.2· •· · The article below presents the results of a clinical study of a logotherapy approach to the treatment of clients with chronic physical illness. In addition, the article reviews qualitative themes given to the logotherapist by the clients (research subjects) in the study that point out the factors these clients believed to be important in psychotherapy and treatment of persons with chronic physical illness. 
The Chronic Physical Illness Client 
The chronic physical illness client is very different from the hypersomatic client.4 While the hypersomatic client experiences physical symptoms and problems reactive to social functioning problems, the chronic physical illness client often (but not always) experiences social functioning problems reactive to his or her chronic physical illness problems.4 Using existential terms, the chronic physical illness client experiences a disruption in meaning and being reactive to the physical illness and chronic difficulties that cannot be cured.4 The potential impact of chronic physical illness upon a person's life is illustrated in the following figure. 


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Chronic illness and 
I 
' 
chronic pain 
Feedback Loop 
" 
Disruptions in the 
client ·s meaning and 
beinB in the world 
Logotherapy with chronically physically ill clients should be directed toward helping them find a sense of meaning and purpose in life in spite of the tragic and ongoing suffering, helping them to make use of the meaning opportunities still available, and helping them to remember the meaning potentials previously actualized and deposited into the past, in spite of their suffering, illness, and pain.3.4,5,5 The following descriptive clinical study provides data on the use of logotherapy with chronically physically ill clients. 
A Clinical Study 
Between 1986 and 1993, this author treated 33 chronically physically ill clients referred for logotherapy by either their primary-care physician, their medical specialist physician, or a social worker at a health-care setting. All 33 clients were treated using the author's approach to logotherapy.3.4,5,5 Each client received a reduced fee at the author's private practice in exchange for participating in evaluation activities at intake, termination, and at a three-year follow-up evaluation. Each client was give the Purpose-In-Life Test (PIU1 at these three points. Data about the 33 clients are presented in Table 1. 
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Table 1 
Chronic  PIL at  PIL at  
Client  Medical  Hours of  PIL at  Termi 3-Year  
No.  Problem  Treatment  Intake  nation  Follow  

1.  M.S.  18  78  118  116  
2.  Arthritis  16  86  117  118  
3.  C.P.  22  94  123  122  
4.  Stroke  16  97  126  129  
5.  Heart Disease  17  92  119  116  
6.  Heart Disease  15  91  124  119  
7.  Lupus  24  89  126  117  
8.  Arthritis  20  76  116  118  
9.  Stroke  13  103  118  118  
10.  Emphysema  15  105  117  115  
11 .  Emphysema  23  107  128  126  
12.  Arthritis  13  89  134  128  
13.  Stroke  14  109  118  118  
14.  C.P.  21  79  126  127  
15.  M.S.  27  87  129  132  
16.  M.S.  25  94  132  119  
17.  C.P.  13  98  118  119  
18.  Emphysema  16  71  117  114  
19.  Arthritis  23  84  124  122  
20.  Lupus  22  105  129  118  
21.  Heart Disease  14  109  123  124  
22.  Stroke  19  97  118  119  
23.  Lupus  18  83  114  116  
24.  Arthritis  13  107  121  115  
25.  M.S.  28  68  123  121  
26.  M.S.  25  79  119  118  
27.  Stroke  18  84  123  124  
28.  C.P.  22  96  118  121  
29.  Arthritis  23  104  120  119  
30.  Arthritis  18  101  124  123  
31.  Stroke  19  95  121  124  
32. 33.  Emphysema Stroke  21 27  99 102  118 117  119 121  l at  

Mean 19.33 89.32 118.72 114.39 
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Table 1 presents data that show the basic chronic illness problem faced by each client, the hours of treatment received by each client, and the client scores on the Purpose-In-Life Test at intake, termination, and at the three-year follow-up evaluation. The mean PIL score for the 33 clients changed from 89.32 to 118.72 between intake and termination. This increase suggests that considerable improvement occurred during treatment. The mean score on the PIL demonstrated very little "slippage" between termination and the three-year follow-up evaluation. 
Study Limitations 
Although it is interesting to "group" the data in this clinical study, it is always a problem to study the impact of logotherapy on any clinical population. In logotherapy, intervention is always "tailored" to meet the unique treatment needs of every client. As a result, all 33 clients treated were, in fact, provided with 33 different forms of logotherapy. As a result, the study data that are grouped must be understood within the context of this data problem and with an understanding of the limitations of such a grouping strategy. 
A second problem with the study is that it did not contain a "control" group. It is generally considered unethical to withhold treatment from a client in a primary practice setting in order to develop a control group for research purposes. 4 The data presented in this article were obtained through evaluation efforts in a private practice setting where the primary goal was service provision and a secondary goal was evaluative research. As a result, this author can say only that the 33 clients made significant changes during treatment. The author cannot be certain that the changes occurred "because" of treatment or that these changes would not have occurred without treatment. 
An additional problem with this evaluation-research report is that none of the clients was measured and evaluated prior to the start of treatment. Therefore, no baseline data were obtained. Only basepoint data were obtained. Baseline data were not obtained because, in order to obtain such data, treatment would have to have been delayed in order to obtain data on two or more "points" of the baseline. This author did not believe it is ethical to delay treatment in order to obtain baseline data in a private practice, service-provision setting. 
In spite of these limitations, the clinical study does support the position that logotherapy with chronic illness clients can be helpful, useful, and effective. If the changes in PIL scores had not occurred, one might conclude that the described treatment approach was not useful with this population group, and alternative treatment approaches should be considered. 
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Qualitative Clinical Themes 
Although all 33 chronic illness clients made important improvements during treatment, it is also rewarding to hear what the clients said about their treatment experience at termination and at the follow-up interview to learn which aspects of treatment they considered most helpful. The following themes emerged and re-emerged during both the termination and follow-up interviews. 
Respect for the Client's Pain 
Almost all of the clients treated with logotherapy during this study reported that their family doctor or specialist medical practitioner appeared "not to respect me" and did not understand the client's suffering and pain. Most clients felt that their physician "blamed" them for their chronic illness and viewed them as "weak" if they could not "control" their symptoms and/or pain. Almost all of the clients believed that their medical practitioners used technology and problem-solving both to "help me" and to "avoid" any emotional contact and/or empathy "with me." Most clients reported that the logotherapist's willingness to "care about me--not just about controlling my symptoms" was especially helpful. 
Mastery and Control 
Although almost all of the clients in this study described the importance of the therapist's respect, empathy, and emotional availability, they also considered it important that the therapist had been able to use specific treatment activities to help them to control pain, to minimize the effects of their chronic illness, and to "work together" to control the effects of chronic illness. Clients in this study found relaxation and pain-management strategies offered by the logotherapist to be a useful part of treatment. 
Cleansing 
Most of the clients in this study reported that during previous nonlogotherapeutic treatment they did not feel permission to cry and "grieve my loss." Many provided humorous stories about how uncomfortable their physicians would become when they would "start to cry." A large proportion reported that the logotherapist's willingness to "let me cry" and to "listen to my tears" was helpful and "cleansing." Many clients reported that the logotherapist's willingness to accept crying and tears felt like he was "witnessing my pain." 
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Hope 
Most of the clients treated in this clinical study reported that the logotherapist had provided them with a "realistic" sense of hope. Hope for these clients did not lie in acceptance of unrealistic expectation about finding a cure, but rather in developing a realistic set of expectations about how they might "manage" their illness so that it did not disrupt the meanings and meaning potentials in their lives. Paradoxically, the logotherapist's willingness to "tell the truth" about the "limitations" of treatment helped the clients to believe that the therapist's hope for the achievement of realistic expectations was sincere. 
Existential Realization 
Existential realization occurs when the logotherapist is able to help the clients discover, create, and experience a sense of meaning and purpose in life in spite of their suffering, tragedy, and pain. 2 •4 Most of the clients in this study reported that the therapist's ability to help them to "notice" meaning potentials was particularly helpful. They also reported that the logotherapist's ability to help them remember and "honor" actualized meaning potentials deposited into the past was significant and helpful. Many reported that Socratic reflection treatment activities had helped them to find a reason, meaning, and purpose for working hard to overcome the impact of their illness on their life. Most of the clients viewed their increased sense of meaning and purpose in life to be the most important and helpful result of the treatment process. 
Conclusions 
Logotherapy with chronically physically ill clients can be a useful approach to meeting their treatment needs. In such a treatment approach, Socratic reflection treatment activities are used to help the client to "notice," "actualize," and "honor" the meanings and meaning potentials to be found in life in spite of chronic illness and chronic pain. The descriptive clinical study presented in this article supports the position that such a logotherapy treatment approach can be effective with chronic illness clients. The article also reported a number of qualitative themes that the participants in this study believed would be important for the therapist who works with this population to hear and to understand. 
83 
JIM LANTZ, PH.D. [1947 College Road, Columbus, Ohio 43210 USA] is a Dip/ornate in /ogotherapy, Co-Director of Lantz and Lantz Counseling Associates, and a faculty member at The Ohio State University, College of Social Work. 
References 
1. 
Crumbaugh, J., & Maholick, L. (1966). The purpose in life test. Murfreesboro: Psychometric Affiliates. 

2. 
Frankl, V. (1969). The will to meaning. NY: New American Library. 

3. 
Lantz, J. (1974). Existential treatment and the Vietnam veteran family. In Ohio Department of Mental Health Yearly Report (pp. 3336). Columbus: Ohio Department of Mental Health. 

4. 
Lantz, J. (1993). Existential family therapy: Using the concepts of Viktor Frankl. Northvale: Jason Aronson. 

5. 
Lantz, J. (1996). What works in logotherapy? Voices, 32, 32-40. 

6. 
Lantz, J. (1996). Logotherapy as trauma therapy. Crisis lnteNention and Time Limited Treatment, 2, 243-253. 


84 
The International Forum for Logotherapy, 1998, 21, 85-90. 
THE USE OF VISIBLE METAPHOR IN LOGO THERAPY 
Cora Moore 
The present paper illustrates the use of visible metaphor in logotherapy. The term "visible metaphor" refers to metaphor using things that can be seen. The use of visible metaphor offers one process through which the person can move to a spiritual level, discover meaning, and experience life as worthwhile and meaningful. 
The specific objectives of the present paper are to show how visible metaphor can: 
• 
be used to explore alternative meaning possibilities, toward the discovery of meaning 

• 
facilitate the sharing of meanings and of productive therapeutic change 

• 
be used as a vehicle for communicating the discovery of a spiritual level of functioning 

• 
stir the imaginations of therapists and stimulate their professional creativity and effectiveness 


Metaphor in Psychotherapy 
Most (95%) of the members of the American Association of Marital and Family Therapy (AAMFT) have reported using therapeutic metaphor, two-thirds frequently or very frequently.5 The metaphors include: client language or the idioms and metaphors the clients bring; self-disclosure; movies and theater; literature and music. The manners of delivery include: reframes; storytelling; religious symbols; poetry/pictures; and art. The visible metaphor we are dealing with in the present paper comes closest to the categories of pictures and art, but in some respects is unique--the client is required to create with visible material 
85 
in order to symbolize inner processes. In the particular case illustration cited below in this paper, a variety of plant materials gathered from a garden was used to communicate about the self in the process of transcending the self and entering the spiritual dimension of meaning fulfillment. 
Metaphor can open up alternative meanings or understanding, which increases the possibility of finding new solutions and therefore facilitating therapeutic change.3·6·9 The view that metaphors can be regarded as "transitional phenomena mediating and providing links in both directions between inner and outer worlds"2 · P· 202 is particularly relevant when considering visible metaphor. The visible outer metaphor becomes the pathway to the inner world of experience. Through metaphor the client is encouraged to observe similarities in dissimilarities rather than to formulate an antecedently existing similarity. 4 In this way new realities are detected, new links are observed between realities, and thus perhaps the person can come up with new or different solutions. 
Use of Metaphor in Logotherapy 
Metaphors symbolize inner experience in three ways: they provide an associative link to experience; they represent aspects of self-identity; and they symbolize role relationship patterns (the style of interaction with others).1 • P· 374 In terms of logotherapy, metaphors can serve as the language through which the possibility of the higher level of functioning is communicated to a person who is stuck on lower levels, and the person may be made aware of the possibility of meaningful outerconnectedness. Metaphors can serve also as the language through 
which the person can talk about the discovery of this higher level of functioning and consolidate such awareness. 
What makes metaphor such an attractive possibility for therapy is the fact that it can be adapted to varying therapist styles and client situations. The logotherapist works from the basic premise that: People have Freedom of Will which enables them to weigh up alternative ways of thinking about themselves and their world and to choose one attitude or course of action above another. In this context metaphors can become a vehicle through which alternative views can be conveyed, thus opening up alternative ways of looking at the self and the world. Since the person has freedom to choose between these alternatives, .....J changes can be facilitated in the attitudes he or she chooses to adopt. -
Frankl stresses the uniqueness of human experience--therefore, meanings cannot be forced on the client by a therapist.7 The freedom of will allows tor a highly individualized human being; and it is a freedom 
86 
the therapist should value and respect. The therapist can use vehicles to try and introduce alternative meaning possibilities, but can never fathom the depths of other persons' being or predict which events will touch and change the others' impressions and interpretations of the world. 
Humans have will to meaning which motivates them to find meaning in life. This allows the therapist to believe in the positive nature of human beings and in their desire to discover and fulfill meaning in whatever life has to offer, and therefore to be purposefully connected to life. Metaphors can be used to facilitate the process of discovering and fulfilling the world of potential meanings. 
Humans search for meaning of life and therefore are open to the world. Men and women become fully human only if they transcend themselves and function on a spiritual level where life consists of meaningful encounters with others and the world. By using the visible metaphor to describe the self, the person is forced to focus on the self. In a sense this might sound like an escalation of hyperreflection, but in another way it is linked to paradoxical intention.8 While wanting to get rid of the obsession with the self, the person is forced to be busy with the self, but through a new medium and in a different way, making it possible to entertain new ways of seeing the self in relation to the world and others. 
The use of visible metaphor is particularly helpful in cases where a person has difficulty getting in touch with the self or parts of the self. Not knowing who you are or who you would like to be, and not knowing how others perceive you, makes it very difficult to enter into meaningful relationships. A thwarted perception of the self at a given point in time can cause a great deal of confusion in interpersonal relationships, whereas an incomplete perception can emphasize a void felt in the person's life. 
Visible metaphor is of value where clients are in touch with certain aspects of themselves (e.g., their rational side) but find it almost impossible to get in touch with other parts (e.g., their emotions). Metaphor can therefore be useful in establishing a cohesive sense of self, and decreasing feelings of fragmentation. 10 However, this is only possible where an empathic bond has developed between the therapist and the client and "empathy becomes the glue that repairs the fragmented self."3, P-352 
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Extracts from the Case of K 
The use of visible metaphor in psychotherapy is demonstrated with K, a 22-year-old who had been in therapy for about four months. When she entered therapy, she had been depressed, extremely self-centered, emotionally immature, and she had displayed undisciplined thought patterns. Her extreme self-absorption and hyperreflection had led to an attempted suicide and her world had become so small that she found it difficult to get out of bed in the morning. Near the completion of therapy, K was presented with a variety of plant material from a garden and was asked to make an "arrangement" which would represent herself both at the time she entered therapy and at the present time. 
Extracts from the session show the following: 
• 
How freedom of will operates. How K was able to weigh options and choose one course of action rather than another. Visible metaphor became a vehicle through which K could reflect about the choices and the resultant changes. 

• 
How will to meaning was demonstrated in the talking through the visible metaphor. 


K:  This dry stem represents the old that has died.  
T:  Does the old refer to something specific?  
K:  The depression has died and the things that go  
hand in hand with it.  

T:  What are those things?  
K:  Well, uninvolvement, insecurity, worry, pain, and  
emotionality. Basically everything about the self  
of  a  negative  nature.  The  way I interact with  
people now is different to  what it was before,  
and also the inclination to withdraw has changed.  

K: 
If you look at this plant it looks dead but actually it is very much alive. 

K: 
If you look at the bud and you look at the flower, you can see what you can actually become. 


• 
How visible metaphor became the vehicle to facilitate the _j process of self-transcendence where she was able to think, to reflect, to have value judgements about herself and the world; to experience will to meaning--a movement away from self

• 
How visible metaphor allowed K to grasp and describe the remarkable difference between the world of the depressed (where the person is dehumanized by meaninglessness and worthlessness) as opposed to functioning on the noological dimension where life is filled with hope and meaning. 


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centeredness to other-and outer-centeredness and to become aware of creative values. 
K:  These colours represent my own ability. I feel I  
have a lot to give to the environment, my friends,  
my family. It reminds me of my creative abilities,  
my singing. It represents the change. I was like  
this flower before. It is white--a neutral colour. I  
was too scared to venture out, too scared to do  
things for myself.  
T:  The arrangement is becoming very colourful.  
K:  I think so, too.  
T:  It makes me feel excited, how does it make you feel?  
K:  It makes me feel quite comfortable. I don't feel  
afraid.  

K: I like this green and yellow plant. When a plant is scorched by the sun it becomes yellow... The green represents the hope, the move away from the pain, the sorrow, and the doubt. It describes my goals for the future, my dreams and aspirations, the things I want to become. 
T: And are you feeling that hope inside you at the moment? 
K: Yes, very much so, and every day it develops a little bit more. 
T: We should really have put water in the vase for those dreams and aspirations to grow. 
Visible metaphor helped validate, for K and the therapist, her perceived growth from stuckness on lower levels of functioning to her inclusion of the spiritual dimension into her life. 
89 
CORA MOORE, PH.D. [Department of Psychology, University of South Africa, P. 0. Box 392, Pretoria, Republic of South Africa 0003] is an Associate Professor in the Department of Psychology at the University of South Africa. A version of the present paper was presented at the Eleventh World Congress of Logotherapy, Dallas, Texas, 25-29 June, 1997. Financial assistance for participation was granted by the Centre for Science Development of the Human Sciences Research Council. 
References 
1. 
Angus, L. E., & Rennie, D. L. (1989). Envisioning the representational world: The client's experience of metaphoric expression in psychotherapy. Psychotherapy, 26, 372-279. 

2. 
Atwood, J. D., & Levine, L. 8. (1991 ). Ax murderers, dragons, spiders and webs: Therapeutic metaphors in couple therapy. Contemporary Family Therapy, 13, 201-217. 

3. 
Berlin, R. M., Olson, M. E., Carlos, E. C., & Engel, S. (1991 ). Metaphor and psychotherapy. American Journal of Psychotherapy, 45, 359-367. 

4. 
Black, M. (1955). Metaphor. Proceedings of the Aristotelian Society, 55, 273-294. 

5. 
Bryant, L., Katz, 8., Becvar, R. J., & Becvar, D. S. (1988). The use of therapeutic metaphor among members of the AAMFT. The American Journal of Family Therapy, 16, 112-120. 

6. 
Engel, S. (1988). Metaphors: How are they different for the poet, the child and the everday adult? New Ideas in Psychology, 6, 333341. 

7. 
Frankl, V. E. (1970). The will to meaning: Foundations and applications of logotherapy. NY: New American Library. 

8. 
Lukas, E. (1986). Meaning in suffering: Comfort in crisis through logotherapy. Berkeley, CA: Institute of Logotherapy Press. 

9. 
Muran, J. C., & DiGuiseppe, R. A. (1990). Towards a cognitive formulation of metaphor use in psychotherapy. Clinical Psychology Review, 10, 69-85. 

10. 
Wheelwright, P. (1962). Metaphor and reality. Bloomington, IN: Indiana University Press. 


90 
The International Forum for Logotherapy, 1998, 21, 91-99. 
MEANING IN EDUCATION The Constructivist Teacher 
George E. Rice & Mitchell B. Young 
The American classroom is dominated by teacher talk. Seventy percent of instructional time involves verbal interaction, with teachers outtalking students by a ratio of three to one. 1 Teachers disseminate 
knowledge and expect students to \'·., repeat the knowledge. The . information presented to students is most often aligned with textbook information which usually provides only one view of many complex issues. Students are rarely asked to think through issues but rather to seek the "right" answer as if there exists a fixed world of knowledge to be mastered. Many students struggle to understand concepts in isolation, to learn parts without seeing wholes; they become disillusioned with a system that emphasizes retaining the concepts or parts long enough to be measured on a standardized test. For these students, success in school has very little to do with true understanding, and much to do with coverage of the curriculum to prepare them for a good job. Other students have difficulty understanding important concepts, or see no meaning in the endless bits and pieces of information, and are labeled as slow or disabled by a system that refuses to adapt the curriculum to the needs of the student. The present system of education not only ignores basic needs of students (freedom, power, community), but also denies opportunities to develop and experience the most important of basic needs--the will to meaning and purpose, the 'why' of living and learning. 
91 
Researchers believe that a lack of meaning is responsible for the recent, frequent phenomenon of emptiness or existential frustration. For example, Cushman writes of the "empty self," a self responding to the current cultural milieu, a self devoid of community, tradition, and shared meaning.5 Such a self experiences a lack of personal conviction, lacks a sense of worth, which results in a chronic emotional hunger. This hunger is often satisfied with alcohol, drugs, gangs, sex, or violence, and further alienates students. Cushman attributes the development of the empty self to a culture that values consumption over character, form over substance, and fun (escapism) over emotional realities, which by nature incudes sadness, pain, and suffering. The inner emptiness prompts students to seek emotional experiences through chemicals and relationships without heartbreak. The empty self is unwilling to worry through difficult problems or push to understand new and difficult concepts when encountered. We are paying the price for this empty self by the vast number of educational dropouts. These individuals do not value education, they openly scorn the current educational system, and, if involved in the system at all, they attempt to erase standards. Frankl suggests that when the educational system fails to provide appropriate levels of tensions (expectations) people are likely to create them either in healthy or unhealthy ways (i.e., sports, drugs, etc.). 
An education that is still based on the homeostasis theory is 
guided by the principle that as few demands as possible should 
be imposed upon young people. It is true that young people 
should not be subjected to excessive demands. However, we 
also have to consider the fact that, at least today, in the age of 
an affluent society, people suffer too few demands rather than 
too many. The affluent society is an under-demanding society 
by which people are spared tension.... and people who are 
spared tension are likely to create it in a healthy or unhealthy 
way.9· p.45 
These are the symptoms of an educational vacuum. Cushman argues that in a culture lacking community and tradition, structural societal change is needed to fill the vacuum. This may be a new role for education. Educators may need to develop aspects of students' character by helping them find a sense of meaning in education and life; teaching them about the realities of psychological and emotional courage, empathy, respect for self and others. Currently, students cannot relate what they are asked to do in school with any sense of 
92 
meaning, or with ways to incorporate their education into their lives. Hamby notes that students do not give up or drop out of school because they do not want to learn. He believes that students want to learn if the outcomes of education serve a purpose. 10 
Meaningful instruction and meaningful learning are keys to working with students relative to their attitudes and value systems. Students, especially those having the most difficulty in school, need personal reasons (meaning) to meet the psychological demands for learning. Frankl sees the deliberate act of building meaning as one of the main aims of education. Frankl elaborates on the ultimate goal of education: 
It therefore stands to reason that in an age such as ours, that 
is to say, in an age of the existential vacuum, the foremost task 
of education, instead of being with transmitting tradition and 
knowledge, is to refine that capacity which allows man to find 
unique meanings. Today education cannot afford to proceed 
along the lines of tradition, but must elicit the ability to make 
independent and authentic decisions.9• P·64 
Yet formal education and educational reforms continue to thrive on external controls, evaluation, competition, higher standards, and longer hours to motivate those for whom school holds little meaning. The repression of students' will to meaning causes them to feel that school has no purpose, no challenge, and that it makes no difference what they do because they are trapped in circumstances beyond their control. When this feeling continues without relief, it results in "educational frustration," the belief that the absence of meaningful education is going to be chronic. To counter the problems created by "educational frustration" experienced by a large number of youth, it is proposed that those responsible for education of our young closely examine the tenets of Frankl's logotherapy. Frankl asserts that our basic motivation for living is not to find pleasure, happiness, or power, but meaning.8 ·P· 25 He also states that "pursuit of happiness or identity when made a target of our intention, becomes self-defeating ...that man's search for meaning is a worldwide phenomenon." This idea is supported by Capuzzi and Gross,3 authors of a text used in graduate level training of mental health professionals. These educators write that happiness is not a goal necessary for mental health; rather, humans call for new goals and purposes when current ones are achieved. 
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The Principles of Logotherapy 
Logotherapy sees humans as primarily meaning-seeking beings, concerned not merely with needs but also with purpose shaped by the past and the future. Logotherapy does not dwell on one's limitations but directs people toward their potential. If people repress or ignore the will to meaning, they feel empty, experiencing the "existential vacuum" which manifests itself in a state of boredom.7 Education may even add to the existential vacuum: 
The students' sense of emptiness and meaninglessness is 
reinforced by the way in which scientific findings are presented 
to them, by the reductionist way, that is. Students are exposed 
to an indoctrination along the lines of mechanistic theory of 
man plus a relativistic philosophy of life.9· P-85 
If this state continues over a period of time, it becomes "existential 
disintegration" resulting in apathy, helplessness, depression, or addictive adaptations.1 For those students to maintain long-term recovery, they must overcome the beginning addictive behaviors, lack of purpose, and boredom. Many in treatment for addictive behaviors state that the pain of boredom and lack of meaning motivate drug use and relapse. 
Logotherapy's view of people as meaning seekers provides structure for ideas that make logotherapy a useful tool for professionals in education as well as those who are responding to an "educational vacuum." Logotherapy stresses personal choices, our power to overcome limitations, or at least to control our attitudes when limitations cannot be overcome. Frankl emphasizes "that meaning is available to each and every person regardless of sex, age, 10, educational background, environment, or character structure... "7· P· 28 Logoeducation, then, is a model of teaching and learning based on the establishment of meaning as part of the curricula experience. 
The Meaning of Meanings 
Meaning is experienced on two levels: the ultimate meaning of life, and the meanings of the moment. According to Fabry ultimate meaning can never be found in totality, but can only be pursued to the best of our abilities; and what we decide to do or not to do does make a difference in our search.6 The second type of meaning--the meanings lllli of the moment--are more accessible. Meanings of the moment are unique for the moment and the individual. Our students must become aware that they are not only free to find meaning as they pursue their 
94 
goals, but have a responsibility to do so if they wish to build stability and sound mental health. Frankl emphasizes self-responsibility of the individual: 
I have not offered [people] a cheap escape from guilt feelings 
by conceiving of them as victims of biological, psychological, 
or sociological conditioning processes. Nor have I taken them 
as helpless pawns on the battleground of id, ego, and 
superego. I have not provided them with an alibi.9· P-7 
Students must realize their responsibility for finding meaning although they can have help (teacher, parent, peers). Teachers are in a unique position to serve as models in finding meaning in the three areas Frankl outlines--activities, experiences, and attitudes. To be accepted as a guide, teachers must demonstrate meaning in their lives as well. Wirth states that "the lifestyles of teachers and schools are contagious. If the teachers are cynical, bored, and defeated, the young will get the message, no matter how many literary classics they are required to read. "13· P-232 Meaning-oriented teachers should share their values and convictions, their happiness and disappointments, and emphasize students' strengths and uniqueness. 
Teachers must not only model enthusiasm for teaching and for the student, but they must also know their discipline and they must give thought to content relevance. Since many students do not automatically sense the relevance of such things as meaning, relevance can emerge through the mediation of the teachers. They must model life-long learning and possess the confidence and professional judgment that will allow the shifting of responsibility for learning to students with a balanced, relevant program that encompasses active teaching and learning for meaning. Frankl said, "What teachers can give to their students is not meaning, but an example, the personal example of their own dedication and devotion to the cause of research, truth, and science. • P-87 In addition, simply
"9 having tasks for students to do is not enough; the teacher must allow students freedom and encourage responsibleness. Then, the individual student has a responsibility to choose and to find meaning for himself or herself. It is the task of the teacher to persuade students that meaning is available, but not impose the meaning upon them-"meaning is something to be found rather than given, discovered rather than invented. "9• P-52 
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Educators may also need to emphasize that success will not only depend upon ability, but also on effort expended to accomplish the task. This encourages persistence and a can-do attitude. Such students will stay with a task longer, have the perception that they can accomplish the task, and be willing to venture into novel areas in exploration. 
The Move to Constructivist Teaching 
The fragmentation of the curriculum has made intellectual inquiry so rare that by 7th grade most curricula are departmentalized and filled with information to be memorized for recall. During their 6-hour school day students often see seven or eight differentteachers, each teaching a different curriculum. Within this structure, students perceive knowledge as separate strands of unrelated information. They study, complete assignments, pass tests, receive good grades, and appear to be successful. Yet, these are not meaningful experiences. Instead, they illustrate form over substance, coverage over depth, external assurance over internal meaning. Every day that students enter school hoping to find meaning in what they experience is an opportunity for educators to nurture students' natural curiosity, provide time for their inquiry, and seek their points of view. We must change the traditional paradigm of the educator as a "prescriber" of meaning to a paradigm that encourages students to discover meanings within their frames of reference. Students can become aware, through our modeling, that they have choices and have responsibility for finding meaning. 
Educators should begin to make a difference in how students learn by encouraging student-to-student interaction, initiating lessons that foster cooperative learning, and providing opportunitiesfor students to be exposed to an integrated curriculum. Most importantly, students should be persuaded to understand that they are ultimately responsible for their learning. Csikszentmihalyi suggested that educators need to be sensitive to students' goals and desires, empower students to take control of their learning, and provide clear feedback to students without threatening or making them feel self-conscious.4 
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Curriculum reports of the 90's, though dealing with specific disciplines, reveal several common areas that support the move to a meaning-oriented teaching model. These include: 
• 
Less whole-class, teacher directed instruction 

• 
Less student passivity: sitting, listening, and absorbing 

• 
Less teacher coverage of large amounts of materials 

• 
Less rote memorization of facts and details 

• 
More inductive, hands-on learning 

• 
More emphasis on higher-order learning 

• 
More responsibility of students for their work 

• 
More cooperative, collaborative activity.14· P-5 


The teaching approach that incorporates these features is referred to as constructivist teaching. Students are encouraged to discover their own meanings and develop new understandings through inquiring, reflecting, problem-solving, and applying. Constructivist educators organize information into concepts and present it "whole" to "part." When students can disassemble concepts into parts they understand, they can make sense of the concepts. This contrasts with traditional teaching approaches where the focus is on broad coverage of subject areas that have been broken into pieces that students are expected to learn without understanding the structure of the whole. 
Each of us makes sense of our world by synthesizing new experiences into what we have previously come to understand. Idiosyncratic constructions of prior experiences form the basis of the paradigms (frameworks of thinking) we each use to perceive and consider the phenomena around us.11 Paradigms are the lens that orders, but also limits, our perception and thinking. A "paradigm shift" occurs within individuals who are able and willing to change their views when current paradigms no longer account for information being perceived. 2 Constructivist teaching helps learners internalize and reshape new information. This transformation occurs through the creation of new understandings that result from the emergence of thinking and re-thinking of prior ideas and their relationships to new experiences. Constructing understanding of one's world, then, is an active, mind-engaging process. 
While it is true that we all take in some information passively, it must be mentally acted upon in order to have meaning for the learner. As early as 1969 Postman and Weingartner wrote of wanting to elicit from students the meanings that they have stored so that they may subject those meanings to a verifying, reclassifying, modifying, and 
97 
12
extending process. In this process, students are not passive recipients; they become active producers of knowledge. 
Closure 
It is the constructivist's task to structure an environment and set an intellectual and social tone that encourages the creation of the meanings of the moment for students without trying to impose meaning. The constructivist is a catalyst or a facilitator in the educational process that recognizes individual students for their uniqueness. Our present curriculum and reductionisticmethods are not applicable to the needs of individuals in today's society and actually contribute to society's problems (i.e., drugs, teen pregnancy, etc.). 
Meaningful school reform has to address the central unit, the classroom, and must seek to alter the ways teaching and learning have traditionally been practiced. Education that merely disseminates information and distributes supplies as students move through a fixed curriculum must be replaced. Classrooms must become settings in which students are encouraged to develop meaning, make connections, work cooperatively, and search for understanding. Such a classroom will combine the teacher as a facilitator within a constructivist paradigm, thus producing students with increased selfefficacy. They will have a greater sense of wholeness, purpose, and meaning. Such students will have the ability and awareness to construct their own reality and, in that sense, greater self-efficacy. They will possess a greater sense that they can meet the demands of the twenty-first century. 
GEORGE E. RICE, Ph.D. [Educational Leadership & Counseling, Northeast Louisiana University, Monroe, Louisiana 71209 USA] is currently Professor, Department of Educational Leadership & Counseling, Northeast Louisiana University, and Professor, Louisiana Consortium (Grambling State University, Louisiana Tech University, and Northeast Louisiana University). 
MITCHELL YOUNG, Ph.D. is currentlyAssistantProfessor, Department of Educational Leadership and Counseling, Northeast Louisiana University. He has numerous presentations and publications in the areas ofshame, attachment, and addiction. 
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References 
1. 
Alexander, D. (1987). The disease and adaptive models of addiction: A framework evaluation. The JournalofDrug Issues, 17, 47-66. 

2. 
Barker, J. A. (1992). Paradigms: The business of discovering the future. NY: Harper Collins. 

3. 
Capuzzi, D., & Gross, D. (1997). Introduction to the counseling profession (2nd Ed.). Boston: Allyn & Bacon. 

4. 
Csikszentmihalyi, M. (Spring, 1990). Literacy and intrinsic motivation.Daedalus, 199, 115-140. 

5. 
Cushman, P. (1990). Why the self is empty. American Psychologist, 45, 599-611. 

6. 
Fabry, J. B. (1987). The pursuit of meaning: Viktor Frankl logotherapy and life. Berkeley: Institute of Logotherapy Press. 

7. 
Frankl, V. E. (1978). The unheard cry for meaning. NY: Simon & Schuster. 

8. 
Frankl, V. E. (1984). Man's search for meaning. NY: Washington Square Press. 

9. 
Frankl, V. E. (1988). The will to meaning. NY: New American Library. 

10. 
Hamby, J. V. (1989). How to get an "A" on your dropout prevention report card. EducationalLeadership, 46, 21-28. 

11. 
Kuhn, T. (1962). The structure of scientific revelations. Chicago: The University of Chicago Press. 

12. 
Postman, N., & Weingartner, C. (1969). Teaching as a subversive activity. NY: Delacorte Press. 

13. 
Wirth, A.G. (1979). New directions in schools. In J. 8. Fabry, 


R. P. Bulka, & W. S. Sahakian (Eds.) Logotherapyin action. NY: Jason Aronson. 
14. Zennelman, S., Daniel, H., & Hyde, A. (1993). Best practices: New standards for teaching and learning in America's schools. 
Portsmouth, NH: Heineman. 
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The International Forum for Logotherapy, 1998, 21, 100-110. 
THE ROLE OF MEANING IN STRESS MANAGEMENT 
Arlen R. Salthouse 
A special contribution of logotherapy to understanding stress at all levels is the introduction of the component of meaning. Meaningful activities and relationships create healthy tension; while lack of meaning, and whatever is done to compensate for that lack, create unhealthy stress. Any activity, be it work or play, without purpose or meaning is likely to produce harmful stress. Logotherapy refers to such a deficit of meaning as existential vacuum, and refers to the failure to find meaning as existential frustration. 
We experience stress at three levels. The first is the general stress that exists within our society. Examples are the implicit threat of layoffs due to downsizing; or the threat of random acts of violence. This is manifested as a sense of "too much to do in too little time," resulting from the general pressures of living and working in modern times, or increasing isolation from family, neighbors, career, church, etc. Such general stress is experienced, more or less and in differing ways, by all members of the society. 
The second level of stress is particular to subculture members, such as ethnic, religious, occupational, or professional groups. There are unique stresses common to groups such as caregivers, the elderly, adolescents, coal miners, airline pilots, therapists, police, fire-fighters, military personnel, schoolteachers, single parents, students, homosexuals--to name but a few. These can be enumerated in terms of the expectations, hazards, attitudes, and values--including the sense of worth, purpose, or meaning--generally perceived within the group. 
The third level of stress is unique to us as individuals. It depends on what is going on in our lives, against the background of a lifetime of uniquely personal experiences, and the meaning we have found in them. 


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It also includes those resources, techniques, and attitudes developed for coping with stressful situations. 
What Is Stress? 
A common denominator in all forms of stress is change. Some changes are relatively minor and expected; others are major, unexpected, and sudden. The latter tend to be most stressful. 
While stress is a reaction to change that affects us physically and psychologically, logotherapy adds the spiritual dimension. The human spirit remains intact at its essential core, thus becoming a primary agent for healing and coping with stress. It is in this spiritual dimension that we find the meaning in life that reduces and helps us manage what otherwise would be destructive stress. 
Stressful changes may be explicit, such as a marriage, pregnancy, the birth of a child, a new job, or loss of a spouse. They may also be implicit, such as a surprise visit from a friend, revision of the commuter train schedule, alteration of one's job description or work expectations. Implicit change can also include the way one perceives a situation, such as a task that has become so routine as to seem meaningless; an old friendship that has become tiresome; or an old belief that has lost its significance. 
In addition, logotherapy recognizes the stress created by a conflict of values. P, a woman in her late 20's, was experiencing stress-related sleep and digestive disorders. After several counseling sessions, she admitted being "in love with two men"--her husband of five years, as well as an older, recently widowed, co-worker. Until this conflict was resolved by making an intentional, meaningful choice, her symptoms remained. Once that choice was made, the symptoms disappeared. 
How Does Stress Affect Us? 
Stress affects persons physically, psychologically, and spiritually. At the most basic level this occurs as an instinctive "fight or flight" reaction. Typically, in this primitive stress response, adrenalin starts flowing, the heart beats faster, blood pressure rises, and the rate of breathing increases. It keeps us ·alert to danger, and enables us to survive in the face of imminent danger.4·P· 108 However, the fight or flight reaction, which serves well where the threat is physical and identifiable, falls short where the threat is intangible or hard to identify; as are many of the dangers we face nowadays. New situations, new rules, new roles, new expectations, and new pressures trigger the stress response as they call for adjustment in human behavior and attitudes. Those 
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bodily adjustments, such as rising blood pressure, that worked well in primitive conditions, are detrimental in the modern context, and work against instead of for us. In contrast to our ancestors, whose stress response stimulated them to enhanced performance, we often find it reducing our ability to perform well. At the extreme, it causes us not to perform at all. We simply become numb. 
In addition to the symptoms of the fight or flight reaction, there are numerous other effects of overstress in our lives today. This writer has identified nearly 50 such symptoms which may be considered warning signs of overstress and its unhealthy consequences. Their function is to awaken us to danger and motivate us to alter our lifestyle. These symptoms range from mild tension headaches and tightened muscles to suicide. 
Consistent with the logotherapeutic premise that the human being is an entity consisting of body, mind or psyche, and spirit, these consequences of overstress are understood not only as psychological but also as psychosomatic or noosomatic disorders. Psychosomatic stress disorders are those in which the stressed-out mind or emotions cause dysfunction of the body, such as stomach or bowel distress. Noosomatic stress disorders are those in which stress in the noetic or spiritual area, such as existential frustration, guilt, or conflict of values, is at the root of physical disorders. 
How Much Stress Can We Take? 
Not only is stress normal, but a certain level of stress keeps us alert, energizes and makes us productive. As Frankl states, "What man needs is not a tensionless state but the striving and struggling for something worth longing and groping for. What man needs is not so much the discharge of tensions as it is the challenge of the concrete meaning of his personal existence that must be fulfilled by him and cannot be fulfilled but by him alone. The tension between subject and object does not weaken health and wholeness, but strengthens them. "2· P-75 
However, there is an optimal point between stress and productive energy. When stress increases beyond that point, energy levels off, then begins to lag; efficiency plateaus, then suffers; productivity stabilizes for awhile, then diminishes. Beyond that optimal point, overstress becomes counter-productive. The point of optimal stress/energy correlation varies with individuals, depending on how meaningful the stressor is perceived to be; and on the person's ability to cope with stress. Much depends on our attitude toward stress; whether we view it as destructive or constructive; how much it is valued; or how much we are prepared to 
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bear in order to achieve some desired meaningful end. An athlete, for instance, willingly endures considerable stress on his or her body to win a race or game. Endurance for stress is unique to each person; and it is helpful to know one's own capacity. In some instances, this selfknowledge is an objective of therapy. 
This capacity for stress endurance does not remain static throughout life. The logotherapist seeks to enable the patient to expand that capacity by calling the patient's attention to past successes in dealing with stressful conditions, or assisting the patient to discover previously unrealized, potential meaning in the circumstance causing the stress. It is amazing how much stress we can endure when we perceive some meaning in the stressful situation. 
C, a middle-aged woman, married for 28 years to a verbally belligerent, controlling husband, had three children between ages 20 and 25. The middle child had been treated for cancer seven years prior and was currently in remission. Chad a long history of heart disease for which she had had several surgeries. She also was partially paralyzed from a stroke and crippled with severe arthritis. At the time she began counseling, she was faced with the added stress of having discovered her husband's long-standing affair with another woman. She felt this was "the last straw" and described herself as "at the end of my rope." When, however, she was helped to see how she had courageously survived so much past stress, C began to view her ability to cope with her present stress in a new and positive light. She came to see herself as a courageous, strong woman. She found new meaning in her situation, and especially in being able to share her experience as an inspiration to others faced with similar stress. 
Coping With Stress 
Techniques for coping with stress can be physical, psychological, or spiritual. As stress affects the entire person, the most effective way to cope with it is an holistic approach embracing all three dimensions. Spiritual resources, especially the will to meaning, need to be viewed together with psychological and physical means of coping. 
The underlying premise for attempting to cope with stress is that human beings possess the ability to change. Just as change is at the root of much of the stress we face, so change is also our foundation for coping with it. The change that engenders stress is largely undesired. Coping requires desired changes--in behavior, attitudes, ways of thinking, and acting. It is also meaningful change--in a more meaningful direction. Logotherapy contends that such meaningful change is always 
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a possibility, even in the most stress-filled adversities. It is possible, but in highly stressful circumstances not always readily apparent. The function of the logotherapist in this situation is to help clients to see that they have alternatives; then challenge them to accept, and more importantly, to act upon that premise. Frankl explains, " ... our assertion of human existence as a self-creating act corresponds to the basic assumption that a man does not simply 'be,' but always decides what he will be in the next moment. At each moment the human person is steadily molding and forging his own character. Thus, every human being has the chance of changing at any instant. There is a freedom to change, and no one should be denied the right to make use of it. "2· P-59 
This freedom to change may be blocked in persons experiencing extreme stress. Ways need to be found to unblock it. Here is where some physical and psychological means can work in concert with spiritual resources. 
Distancing is a key to stress reduction. This takes place in three ways: distancing from symptoms, distancing from external stressors, and distancing from internal stressors. Symptoms, such as gastrointestinal distress or headaches, may have become a preoccupation for the clients, blocking the road to meaning. Such persons need to be shown that they are more than the symptom. Attention should be paid to such matters as nutrition and exercise. Good diet and daily exercise can reduce stressful symptoms. As persons experiencing high levels of stress frequently turn to substance or food abuse, junk foods, caffeine, alcohol, and street drugs which exacerbate stress must be strictly controlled. The challenge to do this can be a source of meaning. Other ways of distancing from symptoms are through relaxation response, medication, vitamin therapy, music, humor, prayer, and meditation. These, too, can be presented as meaningful vehicles for better living. 
Relaxation response is intentional, measured breathing and muscle de-tensioning. It decreases the heart rate and breathing rate, lowers metabolism, and brings the body into healthier balance. Starting at five minutes a day, it can be increased to 20 minutes, possibly divided into four segments during the day. Patients can be encouraged to practice relaxation response at such times as in the car while waiting in traffic, or while "on hold" on the telephone. 
Modern medications and vitamins for reducing stress can be prescribed by a physician as an adjunct to logotherapy. Their purpose should be neither to entirely relieve, nor fully mask symptoms, but to 
-
reduce the overstress that stands in the way of dealing with the causes of stress. A danger of using medication is that the patient may be 
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tempted to discontinue counseling before having dealt with the issue of meaning. It should be made clear that drug therapy and counseling go hand in hand. 
Music, depending on its qualities, can either i_ncrease or decrease stress. This writer cites his own experience that in times of heightened stress, listening to a work of Mozart has often had a calming effect. Appropriate music may be recommended as a means of distancing from symptoms of stress. 
Humor is another means of distancing from stress and stressors. Paradoxical intention is an effective logotherapeutic technique used to this end. Frankl states, " ...humor is a paramount way of putting distance between something and oneself. One might say as well, that humor helps man rise above his own predicament by allowing him to look at himself in a more detached way. So humor would also have to be located in the noetic dimension. After all, no animal is able to laugh, least of all at himself. "2• P·20 
The benefits of meditation and prayer in distancing from stress and its symptoms have been well tested in clinical practice. These include slowing of breath and heart rate, decrease in oxygen consumption and 
4 191
skin conductivity, lowering or stabilization of blood pressure. • P· Prayer has similar characteristics, and, by its self-transcending nature, prayer is secondarily an effective means of reducing stress and its effects. 
Distancing from external stressors begins as clients start to identify sources of stress in their lives. They need to ask, "What changes or conflicts have recently occurred in my life?" Logotherapy focuses primarily on changes in the recognition of meaning. It is not the event per se, but how it affects the person, that determines the extent to which it becomes a stressor. Often, simply identifying the stressor begins the process which both distances from it and reduces it. The process continues as one examines the stressor more fully, talking through the concerns and worries it produces. This helps clients to see their situation in a different light, and enables them to distinguish between those stress-producing circumstances that can and cannot be altered. Here clients may need to be reminded of their ability to make a choice. The therapist may need to challenge them to exercise their defiant power of the human spirit to change those circumstances that can be changed. Frequently simple changes in lifestyle free us from bondage to stressful conditions. 
Stressors that cannot be changed include irreversible losses, such as loved ones, health, limbs, work, treasured possessions, past failures, 
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mistakes, hurts, and wrongdoing. In such cases, stress may be manifested as blame or guilt, resentment, or anger. In all instances of stress resulting from irreversible circumstances, logotherapy insists that what always can be changed is one's attitude, stance, or perspective toward the stressor. Modification of attitudes is always a possibility arising from the freedom of the human spirit or the will to seek meaning in all circumstances. 
Internal stressors are stress-producing thoughts or emotions, such as anxiety about change, low self-esteem, negative valuation of one's competence or ability to learn or perform, self-blame, hyperreflection on one's problems, deficiency of self-image, and preoccupation with criticism. Fear of failure, along with perfectionism, also cause stress. Much present-day stress is generated and nurtured within ourselves. 
This is where logotherapy steps in with its admonition, "You don't have to take every nonsense from yourself!" The human spirit is able to stand up to stress-producing negative thoughts or emotions. It is here we see the practical value and application of Frankl' s assertion that the human spirit is distinct from the psyche.3• p. ,s The defiant power of the human spirit enables us to say "No" to stress-producing emotions. But merely saying "No" is insufficient. Those old negative scripts should be replaced with new positive scripts in which meaning is the theme. Internal stressors are replaced with a meaningful outlook and attitudes. 
A was a person who, for most of his life, tended to "catastrophize" situations. He could find the dark cloud in even the sunniest sky; and he caused himself both anxiety and stress by always "waiting for the other shoe to fall." Years of high stress produced a history of gastro-intestinal problems. As he was helped to see his own role in creating stress, along with his ability to do something about it by making meaningful changes, and as he was challenged to experiment with more positive attitudes, he discovered the freedom and joy of living with less stress and coping with what remained. The outcome was life-changing indeed. 
Safeguards Against Future Stress 
Coping positively with today's stress will go a long way toward helping us deal with tomorrow's stress. But there are other ways to safeguard against future overloads of stress. One good way is to learn to relax. The problem for many of us, however, is that the harder we try, the less we succeed. Trying excessively to relax can prove to be lllll highly stressful. Instead of relieving stress, it can actually add to it! While relaxation techniques, such as those mentioned above, are useful when used in moderation, they become counter-productive when we try 
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too hard. When learning to relax becomes a burdensome chore, or when we become uptight about relaxing, that's when we may be better off quitting the struggle to relax and, instead, give in to the stress. Logotherapy goes even further, offering the option of paradoxical intention. Reuven Bulka proposes a de-reflective exercise: "Resign yourself to the fact that you are going to be tense, and then just concentrate on doing things that you enjoy. Take your mind off relaxing. Remove the pressure of having to relax, and just go about finding things that you like doing and focusing on those things. Then, whether or not you are relaxed will become irrelevant. "1• P-133 As logotherapy contends, it is impossible to wish for something and fear it at the same time.2· P 190 
Of course, one cannot totally protect oneself against all future overstress. There are, however, some measures for minimizing the chances of becoming overwhelmed by it. One way is to review and reaffirm old sources of meaning in your life. What brought you joy and satisfaction in the past? What gave you a purpose for living? Answers to questions like these provide clues for finding meaning in the present and future. Sometimes the memories themselves are meaningful. Often they can be reaffirmed by telephoning or sending a note to a long-lost friend or taking up an enjoyable hobby again. 
A second safeguard against future stress is to discover and affirm new sources of meaning. Meaning cannot be created, invented, or added to circumstances. It must be discovered in relationships, tasks or creative work, and values. The latter includes one's faith, convictions, and attitudes. Once discovered, those meanings need to be affirmed by action. 
Thirdly, much future overstress can be avoided by practicing "the meaning of the moment." By living meaningfully in the present we avoid that stress which arises from two things. One is regret, blame, or guilt over past mistakes and failures. Yesterday can never be undone or changed; but one can certainly learn from the past and make the most of its legacy today. The other stress that is avoided by practicing the meaning of the moment is worry or anticipatory anxiety about what might happen in the future. This is not to suggest that we should not plan for the future. Indeed, the meaning of the moment may be to make decisions that positively affect the future. Living with meaning in the present, and finding meaning in the circumstances at hand, is splendid preparation, as well as safeguard against future overstress. 
We can also protect ourselves from much future overstress by having a strong support network of caring, supportive family, friends, and co-workers. A lot of unnecessary stress is lessened by sharing it 
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with others. Knowing that others have gone through similar stresses, that they care and stand with us, that they are there to listen and are willing to share our burden--all this lessens stress and enables us to cope with it. But such support rarely comes unbidden. It needs to be developed and nurtured. By befriending others, reaching out to them, listening and sharing, and actively seeking their friendship and support, we create and build our own support networks. Nurturing meaningful relationships now can be invaluable in helping us to deal with future 
stress.s. P 22s-229 Finally, it is important to continue to build and reinforce stressreducing, meaningful attitudes. As circumstances change, as crises and conflicts occur and new stressors arise, fresh responses are called for. We cannot merely react with the old fight/flight syndrome. Neither can we react with old scripts or attitudes wrought out of yesterday's conditions. Each circumstance offers unique opportunities to discover new meaning in our lives. Among these are those meaningful positive attitudes that need to be built and reinforced to safeguard us from future overstress. 
ARLEN R. SALTHOUSE, PH.D. [2761 Arrowhead Drive, Langhorne, Pennsylvania 19053 USA] is an Associate and Life Member of the Viktor Frankl Institute of Logotherapy, and serves on its Board of Directors. He is a Pastor Emeritus, in private practice in Counseling for Meaningful Living, Flemington, New Jersey, and frequent leader and speaker at conferences and retreats. 
References 
1. 
Bulka, R. (1990). Uncommon sense for common problems. Toronto: Lugus. 

2. 
Frankl, V. E. (1967). Psychotherapy & existentialism. NY: Dell Publishing. 

3. 
Frankl, V. E. (1986). The doctor and the soul. NY: Washington Square Press. 

4. 
Pelletier, K. R. (1977). Mind as healer, mind as slayer. NY: Dell Publishing. 


5. Welter, P. (1987). Counseling and the search for meaning. Waco, TX: Word. 
7 1 
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Common Warning Signs and Symptoms of Overstress 
SHORT-TERM 
Tension headaches 
Tightened head, shoulder, and back muscles 
Stomach and/or bowel upsets 
Feeling impatient, irritable, anxious, unappreciated 
Broken, restless sleep 
Lowered resistance to colds, flu, PMS 
God seems more distant 
Harder to concentrate, do creative work 
Shut out good advice 
Devotional life languishes 
Hyperactivity alternating with exhaustion 
Feelings of self-blame, bearing a heavy burden 
MEDIUM-TERM: "BROWN OUT" 
Reduced work efficiency and satisfaction 
Hypertension 
Strained personal relations, especially marriage & family 
Feeling unacceptable to God 
Cynicism 
Heart disease 
Going through the motions (work, etc.) 
Accident prone 
Waves of hopelessness and emptiness 
Anger at God 
Depression 
Insomnia 
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LONG-TERM: "BURN OUT" 
Lethargy 
Inability to pray 
Impotence (sexual and general) Sexual misconduct 
Suicidal thoughts 
Sense of detachment 
Loss of faith Alcoholism 
Disorientation 
Eating disorders, especially overeating 
Domestic violence 
Feelings of guilt 
Ulcers, colitis 
Heart attacks 
Paranoia 
Marriage break-up 
Addiction (i.e., drugs, smoking, gambling) 
Cancer 
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The International Forum for Logotherapy, 1998, 21, 111-120. 
A PHENOMENOLOGICAL ANALYSIS OF SUFFERING 

T eria Shantall 
The sufferings discussed in this article refer only to unavoidable suffering where meaning can be found by the attitudes we take. The meaning in avoidable suffering lies in avoiding it.3· P· 135 
Frankl' s views on the meaning of unavoidable suffering were authenticated in the concentration camps of Nazi Europe.3 As an inmate, he found himself part of what he often describes as a monstrous experiment. What will a man be when he is stripped of everything he has-money, power, fame, luck--and when he is left with nothing but himself and his own naked existence? In the white heat of suffering and pain, the human being is melted down to the essentials. What remains is not what we "have", but what we are called to "be. • P-110
"2 A contemplation and in-depth analysis of Frankl' s observations on suffering can help us to arrive at an essential description of this important phenomenon common to the human experience. Thus, the following exploration was conducted of the phenomenon of unavoidable suffering as it was experienced and subsequently reflected upon by Viktor Frankl in his writings. 
Phenomonological Methodology 
The method used in the present study in contemplating and analyzing Frankl' s writings on suffering can be described as phenomenological with a heuristic, that is self-exploratory, complement. Frankl describes his understanding of the phenomenological research approach as follows: "Phenomenology speaks the language of man's 
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The process of the explication of the data made explicit what is implicit. The themes that emerged from the explication of the data are presented not only from Frankl' s viewpoint but also from the essential understanding of the experiencing person. Studying Frankl's observations on suffering in this way, facets and faces of suffering present themselves. 
Suffering Challenges Us 
Suffering corners and questions us. This is the very function of human suffering: "Suffering is intended to guard man from apathy, from psychic rigor mortis. As long as we suffer, we remain psychically alive. In fact, we mature in suffering, grow because of it--it makes us richer and stronger. • p.ss Suffering forces us to look at ourselves and the
"4 quality of our own lives. "Suffering establishes a fruitful, one might say a revolutionary, tension in that it makes for emotional awareness of what ought not to be. • P-86 The "ought" quality of suffering destroys
"4 every sense of false security. It makes us aware of our vulnerability and helplessness, of how fragile life is, how easily it can be damaged or lost. We are faced with our own mortality. If life proves to be something we can lose, something we have to give up at one time or another, what have we achieved with it? We have not given birth to ourselves, nor are we able to stop ourselves from dying. Life has been given to us and will be required of us. How are we going to hand it over or give it back? Will our lives testify for or against us? Suffering painfully calls us to account, but it also challenges us to change and grow to a stature that will be able to stand the test or the verdict of our own conscience. 
In Grief, Suffering Commissions Us 
A powerful function of suffering is to break and soften us through grief. "For the inner biography of a man, grief and repentance do have meaning. · P-97 Frankl asks us to consider the case of having lost a loved 
"4 one, for example. Grief is felt not only at having lost a loved one, but of losing the opportunity to make up for the wrong, the hurt we have caused, the many times we have missed to show the deceased our love and appreciation. Nothing can bring back the loved one, however. None of our acts of commission or omission can be wiped off the slate as if they had never been. Nevertheless, "in repenting, man may inwardly break with an act, and in living out this repentance--which is an inner event--he can undo the outer event on a spiritual, moral plane. · P-97
"4 Frankl quotes Scheler, who said: "Repentance has the power to wipe out a wrong; though the wrong cannot be undone, the culprit 
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himself undergoes a moral rebirth. "4• P· 87 Repentance cannot change the past, but it can change the present and herald a new future. Our changed, more sensitive and caring lives can become a monument in loving memory of those we have lost. The past, by having served the purpose of changing us for the better, has meaning! 
Grief is a commission to the living. Rather than falling victim to survivor guilt, Frankl5 urges us to rise to a level of survivor responsibility. We can emulate the example of those who could rise from the ashes of the gas chambers to a new life. Those among them who could pick up the pieces and build a new life are those who turned their grief into a mission. They felt imbued with a strong sense of responsibility toward the dead. Living full, rich, and sensitive lives, the survivors could erect spiritual monuments in memory of those who perished. Their deaths served to instill a sense of heightened responsibility in those who survived. 
Suffering Inspires Us 
A most unique value of suffering is that it can make us aware that we are living, not in some enclosed space, but before something or someone. It is this thought with which Frankl encouraged his fellow inmates. They were to think of themselves as being watched. He urged them to think of themselves as being surrounded by witnesses. It was possible to think that, in the immediate moment, there was someone who looked down on them in their difficult hours--a friend, a spouse, somebody alive or dead, or God--and they would be expected not to disappoint such highly concerned and interested parties. They would be expected to suffer proudly, and not miserably. They were, in fact, to observe themselves and how they were bearing their sufferings. They were to take note of themselves almost as if, at some future date, they would have to relate to someone how they bore their sufferings. Frankl lifted himself above his immediate sufferings as he imagined himself giving a lecture about the concentration camp to some future audience. How he would relate his story to his beloved wife had the most inspiring effect upon Frankl. How proud she would feel if she heard how courageously he suffered! Frankl communicated with her in his own mind. He could hear her answering him, he saw her smile, her frank and encouraging look. "Real or not, her look was then more luminous than -...ii the sun which was beginning to rise. 113• P-36 -. 
It was in contemplating his beloved, and communing with her in his thoughts, that a truth dawned on him. Love is the highest goal to which man can aspire. "The salvation of man is through love and in love. 113• P-35 
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He came to the conclusion that by enduring his sufferings in the right way--an honorable way--in such a position humans can achieve a sense of deep and abiding fulfillment. They can be raised to levels beyond the transitory. Enraptured with the thoughts of his beloved, Frankl realized: "Love goes very far beyond the physical person of the beloved. It finds its deepest meaning in his spiritual being, his inner self. Whether or not he is actually present, whether or not he is still alive at all, ceases somehow to be of importance.3• P·37 
Suffering Leads Us to Spiritual Victory 
Suffering is like the final stretch toward the finishing line of life, its last challenge or hurdle to overcome. The last thrust in any race is often the hardest. But it is exactly this last stretch, or final opportunity, which is the chance to realize the highest value in life and to fulfill its deepest meaning. There is no real difficulty in experiencing life as meaningful and exciting when we are young and carefree, when there is so much to be done and experienced, so many good things to be enjoyed. But we are meant to mature, to become shepherds of the young. If we embrace only part of life, can we in any way live it fully? Pushing through to the end, taking life to its final conclusions, is to discover that life never ceases to hold and retain meaning even up to its very last moment. It is one's attitudes toward suffering that gives unavoidable suffering meaning. 2 
To discover meaning in suffering is to overcome the hurdle of fear. A basic affliction inherent to the human condition, fear eats at the heart of every person who has not yet come to terms with suffering and death and has not yet discovered its meaning. Plagued with a fear of the unknown, all of life must then be built in defense against the tragic facts of life. We are pushed into the consolations of pleasure or intoxicate ourselves with the dazzle of success. Youthfulness and pleasure become cults. Personal fame, material riches, and comfort become allconsuming ambitions. Since, however, such ways of living are built on illusions--that we can escape pain, sorrow, and death; that there is no God and we will not have to account for ourselves in any final sense-we are devastated when suffering hits us. We are ill-prepared and not able to stand up to troubles which suddenly confront us. Suffering, therefore, can be a blessing in disguise! It exposes the true foundations ot life and invites us to stand on the sure rock of meaning. 
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The Nature of Suffering 
Interlinking the above themes, it is possible to describe the essential nature of suffering, and its negative and positive aspects. 
A Struggle to Overcome Fear 
To find the meaning of our sufferings involves a struggle. We have to find the meaning in the face of fear and threat, of deep anxiety and shock which our sufferings evoke. We have to exercise courage. This courage grows to the extent we are brave enough to do battle with the negative aspects of our sufferings. Indeed, the triumph we experience when we have broken through to a dimension of meaning includes the sense of achievement at having persevered, however strong the temptation at times to give up the struggle. We have struggled through to a sense of meaning despite our fears. We have made it! 
A Process 
We experience our suffering as a process. There are several aspects to our suffering that are interrelated. We never experience anything in neat steps: one aspect has dimensions of another. However, the nature of suffering in experiencing its pain and distress (its negative side), and discovering its meaning (its positive side), is clarified by singling out what may seem like steps or discernible aspects in the experience of suffering. 
Negative Side of Suffering 
•Our 
ordinary ways of being are disrupted by distressful events. Suffering seems to confront us with questions we ordinarily do not consider and may even be reluctant to ask. 

•Suffering 
brings us into the immediate moment, starkly faces us to the here and now. Our past ways of living are disrupted. Our plans are shaken, we are no longer sure what the future will hold for us. Our patterned lives are brought into disarray by the distress that has befallen us. The only thing left is to take things one step at a time. 

•Suffering 
causes the collapse of our secure defenses and strips us of all former securities. We feel as if we are standing vulnerable before an event beyond our control, something bigger than we are, something we cannot grasp. We may become aware of a dimension beyond us, a dimension we now find ourselves confronted with or unnervingly (or awesomely) aware of. 

•Suffering 
presents us with the reality of choice: we have to act one way or another, come to some conclusion, stand, or attitude. 



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The experience of suffering can act as a watershed. We can, in our panic, defend ourselves against such a state of extreme vulnerability to a dimension beyond us and self-defensively close our minds to it. Several negative reactions are possible--despair, apathy, indifference, cynicism, nihilism, bitterness, spitefulness, anger, and vengefulness. But we can progress beyond the initial, painful, aspects of suffering. This very point of extreme vulnerability or exposure, the uncanny awareness of being in the presence of something bigger than ourselves, can also, in our pursuit of meaning, cause us to move beyond our sufferings. Suffering isolates us; we suffer alone. Yet it is this very isolation that removes from us the clammerings of unessential things, and it allows us, perhaps for this first time, to seriously consider the meaning in our own lives. It allows us to take stock of ourselves. This willingness to take account of our lives, signifies a real breakthrough which moves us from the negative into the positive side of suffering. 
What decision we make at this watershed point, therefore, determines the outcome of our sufferings: either as something that hardens and embitters us (in which case our suffering has been meaningless), or as something that causes us to grow in an ethical or moral sense (in which case our suffering has been meaningful). 
Positive Side of Suffering 
•Suffering 
makes us painfully aware of time. In most cases of suffering, time seems to have been snatched away from us. It no longer stretches endlessly before us. We are aware of the fact that we have limited time left. What previously we have taken for granted, suffering now etches into our minds as infinitely precious. The awareness of limited time commissions us. It is as if we are called upon to embrace these valuable things as tasks in the time we have left. 

•As 
we, with a heightened sense of responsibility, seize the day and live the moment, making the choices immediately presented to us in the light of an awakened or sharpened conscience, we are brought into greater contact with reality; we feel more grounded and sure; in fact, right choices seem to sustain us. Whereas we seemed to have hit the rock-bottom of meaning in our lives, now instead of sinking further, we gain ground, and make inner progress. 

•The 
spiritual side of our nature emerges during our sufferings; we grow in appreciation and understanding; we feel deeper, more real; we think more profoundly. In fact, our old way of life now seems superficial, thoughtless, and immature in comparison. We have a much 


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stronger or more authentic sense of self. We realize that our way of looking at life has changed, that we are now living a changed life. 
•We begin to realize meaning in our sufferings; we experience moments of deep intensity, even joy. We have a sense of achievement, even victory. We feel raised to a higher level of being; we feel more mature; we have a greater openness and sensitivity toward life; we have gained in spiritual wisdom. 
Extracting from these broadly defined issues a more essential and, at the same time, an explicated description of the meaning of suffering, we can say suffering has a confrontational and questioning character. By cornering us, it challenges us with choice. It brings us into the stark reality of the immediate moment. Our ordinary defenses and securities stripped from us, we can become aware of being addressed by our own consciences. If we do not give in to panic--and do not look for a way out of having what we sense is a deeply personal confrontation, a call to take stock of ourselves--we can begin to discern what course we are called upon to take. Suffering, therefore, commissions us, that is, calls us to personal account (responsibility). What we have previously taken for granted in our lives is presented to us as valuable, as a task (something to appreciate, preserve, and realize). As we heed the call, we find ourselves sustained by these values. We become aware that these values exist independently outside of ourselves. Beyond human manipulation and destruction, those things in life which really matter to us, exist as values in an external sense, on a dimension beyond the transitory. In exercising these values in our daily lives, we become more real, more authentically ourselves. Our lives gain in meaning and content, become unique, irreplaceably valuable. We experience a sense of fulfillment, triumph, and joy which we have not known in quite such depth before. Our lives rise above blind fate. We live in the dimension of meaning! 
A final question to determine the core aspects of meaning in unavoidable suffering is the following: "What is essential, however implicit, to the psychological organization of any experience of suffering?" 1 
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Extracting from the above synopses, the essential elements, include the following: 
• 
suffering has a confrontational character; 

• 
it exposes us to choice; 

• 
it brings us into the reality of the immediate moment; 

• 
we feel called to responsibility or commissioned; 

• 
things that are precious to us are presented to us as tasks; • our realization of values in our lives sustains us; • our lives take on more spiritual content and meaning; 

• 
living in the dimension of meaning, we experience moments of triumph and joy. 


Conclusion 
The vital and exhilarating truth that can be gained from our analyses of Frankl' s views on meaning in unavoidable suffering is that in suffering--more than in any other less stressful and, therefore, less challenging situation of life--we can realize life's highest values. In suffering, the choices between right and wrong, what is required or expected of us, are clearest. In difficult circumstances, where the right choices are costly, our conscience is sharpened and acute. Since humans have a conscience, in suffering, more than in any other situation in life, we can, through our choices, become optimally human. Suffering can call us out of the moral apathy and mindlessness of mere existence; it can cause us to grow and mature and live our lives, no longer mindlessly, but responsibly. 
TERIA SHANTALL, PH.D. [Department of Psychology, University of South Africa, P. 0. Box 392, Pretoria 0003, Republic of South Africa] 
is a Clinical Psychologist and lecturer at the Department of Psychology of the University of South Africa. She obtained her Ph.D. at this University for her research on the meaning of suffering among Holocaust survivors living in South Africa. She was also a student of Viktor Frankl on the occasion of the establishment of his first logotherapy center at the University of the United States in San Diego in 1970. She was a founding member of the Viktor Frankl Foundation of South Africa and represented the Foundation and delivered a paper at the Eleventh World Congress on Logotherapy in Dallas during June, 
1997. She has launched a student self-empowerment and enrichment program for disadvantaged Black students which is offered at the University of South Africa centers throughout the country. 
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References 
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D. D. Smith (Eds.), Duquesne studies in phenomenological psychology (vol. Ill, pp. 135-157). Pittsburg: Duquesne University Press. 
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Frankl, V. E. (1967). Psychotherapy and existentialism. Selected papers on logotherapy. NY: Simon & Schuster. 

3. 
Frankl, V. E. (1968). Man's search for meaning. An introduction to logotherapy. London: Hodder & Stoughton. 

4. 
Frankl, V. E. (1969). The doctor and the soul. From psychotherapy to logotherapy. NY: Bantam Books. 

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Frankl, V. E. (1970). The will to meaning. Foundations and applications of logotherapy. NY: New American Library. 

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Giorgi, A. (1994). A phenomenological perspective on certain qualitative research methods. Journal of Phenomenological Psychology, 25, 190-220. 

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Moustakas, C. (1990). Heuristic research. Design and Methodology. Person-Centered Review, 5, 170-190. 


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ISSN 0190-3379 IFODL 22(1)1-64(1999) 
The International Forum for 
LOGOTHERAPY 
Journal of Search for Meaning