SOURCE_DOCUMENTS/journal_011_1.txt

Volume 11, Number 1 Spring/Summer 1988 
CONTENTS 
A Meaning Model in Family Treatment . . . . . . . . . . . . . . 2 James Lantz and Mary Pegram 
Dilemmas of Today -Logotherapy Proposals. 5 Joseph Fabry 
Logomedicine: A Doctor-Patient Partnership. . . . . . . . . . 13 Edward Lazar 
Ethological Existentialism for Substance Abuse. . . . . . . . 17 Harold D. Rosenheim 
The Secular Character of Logotherapy. . . . . . . . . . . . . . . 23 Stephen S. Kalmar 
Logotherapy and African-Oriented Therapy. 27 Charles Okechukwu Iwundu 
Egocentricity and Two Conceptual Approaches to Meaning in Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Joseph T. McCann and Mary Kay Biaggio 
Listen to Life: A Tribute to Joe Through Logotherapy. 38 Carol Crosby 
A Critique of Logotherapy as Personality Theory. . . . . . 42 Robert F. Massey 
Childlike Adults and Meaning in Life. . . . . . . . . . . . . . . . . 55 Paul Welter 
Book Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
60 
INSTITUTE OF LOGOTHERAPY 
P.O.BOX 156 * Berkeley, CA 94704 * (415) 845-2522 
Clinical Application of the Logochart 
Manoochehr Khatami 
TLc logochan is a therapeutic technique -a homework assignment for patients to help them become aware of the selective ways in which they distort reality or refuse to face responsibility. It helps them find new responses to a certain problem situation, helps their thinking about the situation so they can see the meaning in it. The chart helps them sec the problem in a way that shifts their response from their automatic self, which is part of their biology and psyche, to their authentic self, which is part of their noos, their spirit. 
With the assistance of the therapist, patients apply tlw logochart to daily events in their lives, especially those events that provoke anxiety or create depression. The chart helps patients solve problem:, in areas such as job, family, and relationships. The chart 1s done as a continued homework assignment during and after therapy. It 
becomes them in  pan of the their day-to-day  patients' functi notebooks, oning.  assisting  
Hypotheses The logochart  concept  is  that  the  Self  

(individual) is the sum of the Automatic Self and the Authentic Self. The automatic self represents a person's automatic reaction to a situation, the result of physiology, heritage, genetics, past, environment, and the "gut feelings" of emotional response In Frank!'s terms, the automatic self is not "what I am," but "what l have." 
Thi: authentic self is what I really am, my essence and uniqueness, my responsible, decisionmaking, meaning-oriented self. 
It was my hypothesis that most people respond to situations through the automatic self, and that mature persons use a greater part of the authentic self which 1s more creative, meaningoricnted, and responsible. I also hypothesized that the more we use the automatic self the greater will be our inner turmoil. This turmoil is the result of holding on to past responses that arc no longer in accord with the meanings of the moment in a changing environment. Greater use of the automatic self .:.:reates greater discord and turmoil and, as a res,1lt, more severe symptoms or neurotic patterns. The person who uses the authentic part of the self is more adaptable and flexible, demonstrates a greater understanding :)f the phenomena of the world, and a greater 1:nderstanding and enjoyment of things that are meaningful. The therapeutic goal is to develop and strengthen the authentic self. and to reduce, or at least understand, the automatic part. 
The chart lists three parameters: cognition, meanrng, and response (rcspon-se-ability). Cognition is the way we filter the incoming information through our subjective value and belief systems. 1,2 Meaning refers to our conscious and unconscious search, which differentiates the human from all other animals.3 , 4 And response refers to what we actually do in response to what we think and what meaning we see in a situation. 
Patients are asked to separate their automatic and authentic reactions and sort them into three categories: cognition, meaning, response/behavior. The automatic reaction lists patients' automatic cognition, meaning, and response/behavior in a particular situation, based on biological and 
psychological influences. All phenomena in the authentic-self portion cognition, meaning, and' response/behavior come from the noetic dimension. The authentic-self column contains much of what Frankl labels attitudes, the result of a person's defiant power to take a stand against physical, psychological, and environmental 
influences. 
One Problem per Chart 
On top of the chart patients write the problem situation they wish to deai with. Each chart deals with only one problem situation.Preferably, patients should fill in the automatic-self before the automatic-self column. 
Cognition. In the automatic-self square of the Cognition column they · write their automatic thoughts about the situation, their preconceived 
beliefs. Most of these beliefs were acquired in childhood and, although no longer useful, have been carried into adult life as if still needed for survival. Some of the cognitive distortions which happen automatically in our thinking are: perfection as the only standard, the "all or nothing" law, approval-seeking, and seeing everything as catastrophe. Certain cultural norms such as conformity, dependence, authority, group domination, power struggles, identification with aggressors, or prejudices may also contribute to cognitive blocks or premature judgments. 
Pa1icnts are made aware that many of their underlying hc:licfs are obsolete. Cognitive distortions an~ identified. Patients are helped to examine these distortions under the authentic-self heading. They sec they are not just by-products of their thinking,assumptions,beliefs and judgments, 
but  can  actively  evaluate  and  choose  thoughts  that  
arc  more  rational,  realistic,  and  adaptable.  
Meaning.  In  the  Meaning  column,  the  
automatic-sci f  entry  is  likely  to  reflect  the  

automatic focus on pleasure, power, money, position, or fame. Here. what Frankl secs as meaningnegating attitudes may have an influence: nihilism (there is no meaning so I'll get out of life what I can); reductionism (I am nothing but an animal or a machine, not concerned with meaning); fatalism O have no controi over my life and its meanings). Patients arc encouraged to use the resources of their spirit -1hcir will to meaning, goals, purposes, creativity, love, conscience, intu1t10n, selftranscendencc, and consciousness of a higher 
meaning in life. 
In filling out the authentic-self square of Meaning, patients are to ask themselves: "What is the meaning of this event? What is the task for me in this area? How would I like to fill that square if I were close to death? Beyond pleasure, power, and self-interests, how would I want to respond in that 
69 
column?" This is the most crucial component of the logochart. It is the part that motivates patients to 
develop  the  part  of  themselves  that  shows  their  
uniqueness  and  creativity  and  distinguishes  them  
from  all  others.  

Response/Behavior. In the third part of the chart patients put down their response to the problem situation: how they routinely behave or are likely to behave. In marital conflicts, shouting and blaming, abusing partner and children. With phobics, avoidance of the feared situation. With depressives, withdrawal. Behaviorists correct these automatic responses by conditioning. Logotherapists, in the authentic-self portion of the Response/Behavior column, challenge patients with questions like these: How would you respond to the problem s1tuat1on if you had new cogn1t1ve insights based on a more rational cognition, as well' as on a more meaningful answer to the actual event? With marital problems, could you sit down and talk with the partner, try to resolve the conflict, and maybe gain a new sense of meaning through the discussion? With the phobic, can you paradoxically face the feared situation, using a sense of humor? With the depressive, after correcting the distortions, can you find out the significance of the depression at this particular time, and possibly go out and engage in some meaningful action such as helping other depressives or work with groups like Alcoholics Anonymous? Change doesn't come about by just correcting cogn1t1on or exploring meaning: change comes by doing something about it. 
At the bottom of the chart patients are asked to write down the percentage of their automatic as against their authentic reaction to that particular event, as they see it. They may decide that they responded 70% with their automatic self. and 30% with their authentic self. They can now piace their reactions "under a microscope," :rnalyze them, and become aware that they have choices and can select more rational. meaning-oriented reactions. The therapy sessions, through the Socratic dialogue, help them shift their reactions toward the authentic-self coiurnrL This p1ucess not only allows them to have more authentic reactions to the particular problem, but in doing their homework ever::, day with all sorts of problems, they become more authentic persons, aware that they need not reacL aut1.nnatically. The therapy goal is selfdistancing from an automatic toward an authentic reaction, by shifting their answers to problems more and more toward the authentic-self column. 
How Therapists Use the Chart 
During the first three to five sessions, the therapist educates the patients about the concepts of cogmt1ve therapy and logotherapy, then assigns books by FrankJ3.4 Lukas,5,6 Beck, 1 and Burns.2 After the patients arc familiar with these concepts and have learned how distorted thinking and lack of meaning affect their daily lives, they are given blank copies of the chart, one for every day. (Or more copies if they wish to work on more problems in one day.) They are instructed to take one problem situation at a time and to list their automatic thoughts about the event, its traditional meaning or lack of meaning, and their own customary responses to it. Then the therapist helps the patients analyze their reaction to the problem situation along the three parameters of thinking, meaning, and response (response-ability). Patients arc made aware that their answers need to be shifted to the authentic-self portion, making use of their noetic dimension. The Logochart becomes the springboard for a Socratic dialogue: what rational, realistic, and adaptable thoughts can he elicited in contrast to the automatic thoughts about that event? What are the meaningful responses to that event, what is the responsible behavior in this situation? How would the patient have responded to the thoughts, meanings, and behavior if he or she had tapped into the noetic dimension? The therapist assists patients to see alternate ways of responding to life's problems and questions. In essence, therapy helps patients to exercise the noetic dimension and seek 
,.,, 
out more rational thinking, more meaningtul 
goals, more appropriate responsible behavior. They 
continue the logochart assignment at home on a 
daily basis with different problem situations, to be discussed during the following therapy sessions. 
The Socratic dialogue helps patients move from the automatic-self to the authentic-self portion of the logochart, from the psychobiological to the noetic dimension. The chart provides short-time therapy of 15 to 20 sessions, but booster sessions are recommended at one-month, three-months, sixmonths, and one-year intervals. Booster sessions may consist of two or three meetings, depending on diagnosis and therapeutic needs. 
Patients are instructed to use the logochart on a daily bnsis in their lives as a continuous process. They call the therapist periodically to report progress and ask questions. The logochart is useful for such conditions as depressions, anxiety neuroses, phobias, marital conflicts, or existential crises. It is not recommended for severe psychiatric conditions such as schizophrenia, manic depressions and borderline syndromes, or any psychiatric illnesses that show thought disorder or a strong biological predisposition or cause. Other problems such as drug addiction and adolescent reactions that can be treated by logother.ipy may also be helped by the logochart. 
A Pragmatic Technique 
The logochart is a simple technique that patients can apply to their daily lives, with their spouses, children, friends, and family. The longer they do this homework, the more confident they become. They gain a better perspective into their lives and into the questions they have never asked and are now ready to answer. They arc not lost; they have an anchor, a technique in the form of their homework, and they have their notebook. 
The logochart is compatible wi1h all forms of therapy, psychoanalysis, behavior therapy, logotherapy. It encompasses them all and does not minimize any of them. It simplifies them in a pragmatic way that applies to the patients' day-byday living. The chart reduces the automatic-self portion which comes from obsolete cultural responses, the past, or psychic development, and increases the authentic-self portion which comes from the noctic dimension, reason and rationality. This shift from the automatic to the authentic facilitates the patients' maturation and their development into meaning-oriented, self-actualized individuals who function in society based on knowledge, information, reason, and on their spiritual resources. 
MANOOCHEHR KHATAMI, M.D., is professor of clinical psychiatry, University of Texas Health Science Center, Dallas, and medical director, Center for BioBehavioral Medicine, St. Paul Medical Center, Dallas. 
REFERENCES: 
l. Beck, A.T.Cognitive Therapy and Emotional Disorders. New York, International University Press, 1976. 
2. 
Burns, D.D. Feeling Good. New York, Morrow and Co, 1980. 

3. 
Frankl, V. E. Man's Search for Meaning. New York, Washington Square Press, 1985. 

4. 
__________. The Will to Meaning, New York, World Publishing Comp., 1969. 

5. 
Lukas, E. Meaningful Living, New York, Grove Press, 1986. 

6. 
_______, Meaning in Suffering. Berkeley, Inst. of Logotherapy Press, 1986. 


LOGOCHART 
Event (Problem): 
Self = Automatic + 
Self  
COGNITION:  Distorted  
What do  I think  Irrational  
about  the  situa Unrealistic  
tion? How do I  Rigid  
perceive  it?  Learned  
Un true  

MEANING:  Power  
What  arc  the  Pleasure  
values,  purposes,  Fame  
goals  rn  this  Material  
situation?  things  
Unethical  
Selfishness  

thoughts 
motivation 
Authentic Self 
Realistic Rational Adaptable Reasonable Valid True Chosen 
Love Creativity Purpose Ethical values Spiritual values Opcnmindedncss Self-
transcendence 
RESPONSE/ BEHAVIOR: 
What do I do about this situation? (Actions, Physical responses or consequences) 
Passive 
Habitual 
Dependent 
Lazy 
Rigid 
Aimless 
Impulsive 
responses 
Active Unique-new Independent Positive Flexible Goal-directed Delayed 
gratification Responsible 
What percentages do you assign to your reactions to the event evaluated in this chart? Automatic: ___% Authentic: ___% 
SAMPLE LOGOCHART 
((C Ii 1JL I}.;' ii--:.;, ; µ. ./;,:,2_ ,t 4-S ( J Event: ,(...,;,, ·f .v,.111 I-i,:.; io:i.,v-cJ:-fr; ici<-J.,.-., Name: ,,( Y /-C -u..:_ ~--1.v\-,1 ie,tult/-(.1(1/i f-,' ,-,.~ ,<,{-'}-r',:,,..,,(' I, -Date: /CI I / I(~ J ' 1,/·( 
Se1f = Automatic Self + Authentic Self 
============= 
==================== ~================== 
COGNITION 
") ,. c r Lu l ti c:1-cn 
..; (~_ .·>U--t... r._., .
MEANING: 
f,x ff,._,,,_ .4 ,J..-, 'f f'1 Y /)J7 le_ , ) {· ,:>t,t-.._ ,i,_~ .U<-tA..
h;-~_,(,,-f'-e_ fc-"t 5~,><-;: C•L( L' fft.€ ,-fiL .,._,_, wi '( .< f°I f ( _<:: t /-A--,-,A,., s-c e w, I 6--,~. _) 

============= 
--================== =================== 
A 'I, i ,{ .,1.,:/'l/u,,__, \ lt.L<-L ( ,a,_ t ( ./-r,r0-<._,_~ (i,<,L,,( 
·,\ --. / ,/ 
//.-1,-u,1..fL_ t/A,) _r,.,,,__..L ,_(
,A,t-<..,-( ')t ,._,.,,_,) ,,:-Lp /,l 
1)_)/.,• l {1.--t.~-1-F...i_ n-•i:-t.-{ri.,/ 

RESPONSE/ BEHAVIOR 
============= ==================== ==================
What percentages do you assign to your reactions to the event evaluated in this chart? Automatic: -2...£__% Authentic: __,_7-'0'--1 _%
1 
The PIL Test: Administration, 
Interpretation, Uses 
Theory and Critique 
James C. Crumbaugh and Rosemary Henrion 
The Purpose-in-Life (PIL) Test4 ,6,7 is an attitude scale constructed with the orientation of logotherapy. This scale measures a person's "will to meaning" and "existential vacuum." 
According to Frankl,12 the person who fails to find meaning and purpose in life experiences "existential vacuum," a state of emptiness, manifested chiefly by boredom. If not relieved, this state results in "existential frustration" and may lead to noogenic neurosis. Existential vacuum is not in itself a neurosis or abnormality, but rather a human condition, characteristic of the machine age and loss of individual initiative. Noogenic neurosis develops in neurotically predisposed persons. Logotherapeutic research estimates that about 20% of the typical present-day clinical case load consists of patients with noogenic neuroses, and that existential vacuum affects in some degree more than half of the general population. 
Treatment consists of guiding individuals in their search for meaningful values and goals. For existential vacuum, this guidance is adequate therapy and may be conducted by any counselor familiar with logotherapy. The presence of noogenic neurosis requires additional therapy by someone of the psychiatric profession. 
The aim of the Purpose-in-Life Test is to detect existential vacuum. Whether noogenic neurosis is also present must be determined by evaluation of the usual symptoms of neurosis, using either psychometric methods (e.g., the MMPI) or 
clinical  procedures,  usually  both.  Final  diagnosis  is  
always  a  psychiatric  function.  
The  Purpose-in-Life  scale  has  proved  useful  
in  the  following  situations:  

1. 
Individual counseling of students, vocational guidance and rehabilitation, and Lreatment of in-or out-patient neurotics. The test is particularly pertinent to alcoholics and to retired and handicapped populations. In all these, neither this scale nor any other ''self-test" (in which subjects record opinions about themselves) should ever be used without correlating evidence from other sources as a basis for psychodiagnosis or counseling. Such instruments are accurate group measures, but arc subject to individual distortion because of uncontrollable variables. Therefore these instruments should always be employed with caution in any compet1t1ve situation where motivation to present a favorable self-image exists. 

2. 
Group administration for research and screening purposes. Here the scale has successfully distinguished a variety of populations (such as older people, alcoholics, psychotics) according to predictions based on their expected degree of 


462 1. 23
meaning and purpose in life. 1, , , By the method of contrasting groups, the scale has succeeded in distinguishing experimental from control groups according to various hypotheses, and aiso in distinguishing before-and-after treatmnent based on a variety of hypotheses on meaning and purpose in life. 
Structure of the Scale The PIL is divided into three parts: 
(a) A 20-item psychometric scale that evokes responses about the degree to which an individual experiences "purpose in life." PIL was designed on the unorthodox principle that, while theoretically persons cannot accurately describe their real attitudes and these must be 
arrived al indirectly, in practice--and particularly concerning attitudes--they can and will give a pretty reliable approximation of their true feelings from conscious consideration. If this assumption 
were wrong, it would show up both in low reliability and in low validity as measured against an operational criterion of either mental health or "life purpose." After extensive analysis of the test written by test participants on life goals, ambitions, hopes, future plans, what has provided them meaning in the past, and what could motivate them in the future. 
items,  20  were  sel.ected  which  adequately  met  the  
criteria.  
(b)  A  13-item  "incomplete  sentences"  test  
designed  to  indicate  the  degree  to  which  an  
individual  expe r iences  purpose  in  life.  
(c)  A  biographical  data  paragraph  to  be  

Parts B and C are subject only to clinical interpretation in individual usage. Part A is objectively scored, and is the only part ordinarily used in research, though it can also be used individually. The test and manual are published by Psychometric Affiliates [P.O. Box 807, Murfreesboro, TN 37133] and can be ordered from them or from the Institute of Logotherapy in Berkeley. 
Administration and Scoring 
The test instructions are easily understood by nearly all adults and most adolescents above fifth-grade level. No time limit is stipulated and most subjects complete the scale in 10 or 15 minutes. 
Part A is scored by adding the numerical values circled for the 20 items. Parts B and C must be evaluated by a clinical psychologist, psychiatrist, or clinically trained counsellor. For most research purposes these sections may be ignored. They are helpful in individual clinical use where therapists and counsellors examined the content in connection with a client interview. So far, attempts to quantify Parts B and C have added little objective infom1ation to that furnished by Part A. 
Percentile equivalents of the raw scores for Part A are given in the test manual. These norms are based on 1,151 cases.4 In that study the larger number of "normal" participants unduly raises its mean of 112.42 in relation to the smaller number of patients (346). for which the mean was 92.60. It is therefore estimated that the best "cutting score" between these populations is 102 (halfway between the two means), with an overall estimated standard deviation of 19 (instead of the obtained overall mean of 106.47 and S.D. of 18.94 for the 1,151 cases). Raw scores of 113 or above suggest the presence of definite purpose and meaning m life, while raw scores of 91 or below suggest lack of clear meaning and purpose. Complete normative data are provided 
in the PIL manual. 
Validity 
Construct validity and concurrent criterion validity of the PIL were assessed, and the data given in the Manual of Instructions. 
In construct validity, Crumbaugh4 correctly predicted the scoring order of four "normal" populations. Predictions of this order amo~g psychiatric populations were less accurate but did show the expected drop from neurotics to alcoholics to nonschizophrenic psychotics, as well as the 
predicted overall difference between normal and patient populations. Concurrent criterion validity of the test was evaluated by: 
•The 
correlation between PIL scores and therapists' ratings (therapists completed a PIL as they thought the patient should have completed it) and 

•The 
correlation between PIL scores and ratings by ministers of the degree of purpose and meaning exhibited by participating parishioners. 


The relationship between the scale and therapists' ratings was .3 8 (Pearson Product-Moment, N = 50). The relationship between the scale and ministers' ratings was .47 (Pearson ProductMoment, N = 120). These results arc in line with the level of criterion validity usually obtained from a single measure of complex traits.4 
The split-half (odd-even) reliability of the PIL was determined by Crumbaugh and Maholick6 as .81 (Pearson Product-Moment, N = 225, 105 "nomrnls" and 120 patients), Spearman-Brown corrected to .90. The same relationship was determined by Crumbaugh4 as .85 (Pearson Product-Moment, N = 
120 Protestant parishioners, nonpaticnts), Spearman-Brown corrected to .92. 
When developing the scale, the authors established the relationship between its scores and those of other instruments. Since then a large number of experimenters have determined its relationship to many other tests reported in the PIL manual and attendant bibliography (latest revision 1981). Small or moderate relationships have been found to a number of variables of neuroticism. The most consistently substantial correlation has been with measures of depression, which have ranged from .30 to .65 in various populations. 
While the PIL authors found no consistent relationships between the scores and age, sex, education or intelligence, some studies have claimed these relationships. There has been no overall agreement on these variables, probably because of contamination by population differences. 
Critique 
The Purpose-in-Life Test has been used for more than 20 years in about 150 research studies, cons1strng mostly of masters theses and doctoral dissertations. While the majority reported successful discriminations according to hypotheses, there have been criticisms from both theoretical and research standpoints. A fair appraisal of the pros and cons can be found in Buros's Seventh Mental Measurements Yearbook.3 A more thorough and up-to-date evaluation appears in the review by 
R. R. Hutzell in this issue of the Forum, Several critical questions should be addressed: 
1. Is the PIL so heavily contaminated with the tendency to give socially desirable responses that its usefulness is impaired? 
Yalom25 argues that it is quoting the review by Braun and Dolmino3 which reports a study in which a correlation of .57 was found between the Crowne-Marlowe Social Desirability Scale and PIL. Neither source seems to be familiar with three studies indicating the opposite: 
(a) Snavely23 found. a correlation of .57 (N = 40 college undergraduates) between the PIL and the Crowne-Marlowe Social Desirability Scale. Then an independent variable was introduced: Half of the subjects were selected at random and given false norms as to their standing -they were told they were at an unacceptable level of purpose and 
meaning. The other half were told that they were at an acceptable level. All were retested on both the• PIL and the Crowne-Marlowe one week later. The prediction was that the false-normed acceptable group would not change significantly on either scale, while the unacceptable group would show a sharp rise in PIL scores, indicating that subjects were not responding to the PIL with a consistent personality trait but rather with a desire for social acceptability. We further predicted that correlation between the two measures would increase, showing that in a competitive situation the PIL becomes primarily a measure of social conformity. 
Actually the retest results yielded a correlation between the scales of only .36 and only a slight nsc in the PIL mean of the socially unacceptable group. The PIL was evidently responding to the variable of social desirability in a quite different way than the scale designed to measure it, and therefore cannot be considered highly influenced by this trait. 
(b) Durlak10 found a correlation of .01 (N = 
94) between the PIL and the Crowne-Marlowe. 
( c)  Durl ak  again 1 1  found  a  very  low  
correlation 'between  these  two  scales,  this  time  of  
less than .04 (N  =  39).  
A  new  study20 (48  staff  members  and  spouses,  
total  96,  who  volunteered  in  a  rnidwestern  

university; P-<.001) finds a correlation of .39 between PIL and Crowne-Marlowe. But the authors note that social desirability is open to interpretation and that the claim of loss of scale accuracy with transparent items needs further research. They partialled out the effects of social desirability in dealing with other relationships, which is what other researchers concerned with this factor in PIL application should have done. 
81 
We have repeatedly emphasized that any selftest is subject to some motivated manipulation, and that such scales should not be used -especially alone -in any compet1t1ve situation. In the McCannBiaggio study there is probably some competition (overt or covert) within married couples to make a good impression, and thus a correlation in the moderate range would be predicted. 
McCann-Biaggio also note the possible biases in the relatively small percentage (13.75%) of staff members and spouses who participated in the study. Their main objective was to differentiate Maslow's self-actualization from Frankl's will to meaning. In this they have succeeded. Their handling of the PILsocial desirability issues are in . justifiable perspective. 
A high correlation between the scales would be a priori predicted from the "transparency" (obviousness of the trait to be measured) of the PIL items; and this is what seems to have impressed both Yalom and Snavely. 
2. ls the PIL cross-culturally valid? 
The test has been translated into at least six languages and used virtually globally in research. Would American norms hold true in other cultures? No verbal scale can be assuredly valid in any translation because connotation of words varies in different cultures, even in subcultures within a language territory. Norms must be established for every special culture group, and for each translation. The PIL manual norms can furnish a comparative guide but should never be assumed valid for either non-English-speaking cultures or for all American subcultures. Hutzell and Peterson17 have shown that the PIL is inapplicable to some geriatric populations and regressed schizophrenics, as well as to very young 
populations, because these populations find some of the descriptive adjectives ambiguous or confusing: In these cases, a better instrument 1s the Life Purpose Questionnaire, which correlates highly with the PIL while offering simplified items.1 5 But the PIL has proved useful with a large number of mainstream Americans as well as with many special groups where group norms have been established. 
3. Does the PIL really measure "meaning and purpose in lzfe "? 
Critics25 have usually agreed that the PIL does seem to measure some independent personality variable. But what is it? Preble22 and Lukasl 8, 19 suggest that it may reflect "success-experience" and that the Lukas Logotcst (validated for North America by Preble, and available from the Institute of Logotherapy) measures true meaning. Preble obtained a correlation of -.42 (the negative value merely reflects opposite scoring directions) between the PIL and Logotest. This indicates a definite overlap but does not identify the functions measured. The question is, which--if either-measures meaning? Or perhaps do they both measure unidentified variables, while true meaning remains elusive? 
Meaning and Success 
Preble bases her claim that the PIL measures "success" upon these facts: In her sample of 524 subjects, of which 141 completed both the PIL and the Logotest, correlation of the Logotcst was not significant, but correlation of the PIL was significant with two other measures: educational level and employment. She assumes that these two factors represent "success." She does not offer a multiple R for the correlation of either the Logotest or the PlL with these combined variables, and she 
does not give details about "employment." Subjects were counted as employed or not, according to their statements. Neither the nature of employment nor the reasons for unemployment were specified. 
From these incomplete data it is impossible to determine just what might be the true relationship between PlL scores and the composite of education and employment. It is still more difficult to determine whether such a composite represents "success," since Preble does not define success. 
Obviously there are two basic kinds of success: material success, primarily attainment of money, and noetic or "spiritual" success, primarily achievement of altruistic goals. Preble seems to think of success primarily in materialistic terms, but it is doubtful whether either education or employment per se correlate highly with either kind of success. 
Based on logotherapeutic as well as most other personality theories, there would be a priori a substantial relationship between true meaning and noetic success, and probably also between true meaning and at least m the initial phases of material success. (In many instances material success gradually fades m meaning, because true meaning is based upon the feeling of being Somebody and Useful, whereas material success often leads to disillusionment in this respect.) The PIL does reflect relationship to both kinds of success, as indicated by high scores among serviceclub personnel (representing a generally high level of material success)4 and among trainees in a religious order (individuals to whom noetic goals are most meaningful).5 
Any instrument which does not represent some relationship to both types of success probably docs not measure true meaning because this 
relationship seems inevitable. The key to the relationship lies in how one feels about one's degree· of success, of whatever kind. Most people who show either kind of success will feel it is meaningful, though noetic success is more likely to be lasting and to sustain the individual in times of trouble. 
Can Meaning be Measured? 
To measure meaning we need (a) an operational definition of what it is to have meaning and purpose in life, and (b) an external criterion of this definition. Neither have been determined. These are difficult problems; they parallel those of intelligence testing from which all other psychological testing developed. These problems have never been solved for intelligence. We still have no adequate definition of intelligence and no criteria of it external to tests except such 
operational measures as scholastic achievement. That is why modern intelligence tests can be considered primarily as tests of scholastic aptitude, and why their validation has been approached primarily by construct rather than criterion validity. This is also true of both the PIL and the Logotest 
We face a similar impasse in developing any adequate measure of meaning as conceived in logo-therapy. That docs not, however, prevent successful use of the PIL and the Logotest to determine, according to predictions from logotheory, the effectiveness of therapeutic treatments, or the status of various populations and their probable need for such treatments. We are now using the PIL in these \vays, and the Logotest has also been so employed. Our own use of the PIL has been primarily with alcoholic and cancer patients.8,16 
Such potential uses make it important to encourage developmental studies of the PIL and the Logotest, and of other measures based on logotheory. 
These would include: 
1. 
The Life Purpose Questionnaire.1 5 

2. 
The Life Regard Index.2 

3. 
The Starck Meaning in Suffering Test 


(MIST).24 
4. 
The Existential Anxiety Scale.1 4 

5. 
The Dansart Attitudinal Value Survey.9 

6. 
The Belfast Test.13 

7. 
The MMPI Existential Vacuum Scale (EVS) for logotherapy research. 1 7 


We agree with Preble that the Logotest holds promise as a clinical and research instrument. So do the other scales. Perhaps future studies factoranalyzing all these measures may yield clues to the best approach in evaluating the logotherapeutic construct of meaning in life. As Yalom25 has noted, for over twenty years the PIL has been "the only game in town." It is time to evaluate other approaches. One measure may emerge as most 
productive; all measures may prove superior in some specific uses; some elements of all may be incorporated to produce a new and superior test for general purposes. In the meantime most tests should have a sphere of usefulness. The prospective user should evaluate each in relation to the problem to be studied. We hope that sometimes the best choice will continue to be the PIL. Undoubtedly, at times it will be one of the other scales. 
Definition of "meaning rn life" and an adequate external criterion of any definition accepted are likely to remain problems. But the function of research is to attack problems. We look 
to new and young researchers, because they have always looked to the future. And the future belongs_ to those who look to it. 
JAMES C. CRUMBAUGH, Ph.D., C.L,, is clinical psychologist (retired) for the V.A. Medical Center at Biloxi, MS and regional director of the Institute of Lo go therapy. ROSEMARY HENRION, R.N., M.S.N., M.Ed., C.L., C.M.P., is a psychiatric clinical nurse specialist in the V.A. Medical Center, Biloxi, MS. 
REFERENCES: 
1. 
Acuff, F.G. "Retirement, Meaning and Adjustment." Unpubl. Ph.D. dissertation, Univ. of Missouri, 1967. 

2. 
Battista, J. and R. Almond. "The Development of Meaning in Life." Psychiatry, 1973, li, 409-427. 

3. 
Braun, J. and G. Dolmino. "The Purpose in Life Test," in Buras (Ed.), The Seventh Mental Measurements Yearbook. Highland Park, N.J., 

Gryphon Press, p. 656, 1978. 

4. 
Crumbaugh, J. C. "Cross-Validation of Purposein-Life Test Based on Frankl's Concepts." J. Indiv. Psychol., 24, 74-81, 1968. 

5. 
___ , Lozes, Sr. M. Raphael, and R. Shrader. "Frankl's Will to Meaning in a Religious Order." J. Clinical Psychology, XXVI (2), 206-207, 1970. 

6. 
_____________ and M. T. Maholick. "An Experimental Study in Existentialism." J. Clin. Psychol., XX (2), 200-207, 1964. 

7. 
and M. T. Maholick. "The Purpose in Life Test." Murfreesboro, TN, Psychometric Affiliates, 1969. 

8. 
____, W. M. Wood, and W. C. Wood. Logotherapy: New Help for Problem Drinkers, Chicago, Nelson-Hall, 1980. 

9. 
Dansart, Bernard. "Development of a Scale to Measure Attitudinal Values as Devised by Viktor Frankl." Ph.D. dissertation, Northern Illinois Univ. 1974. 

10. 
Durlak, J. A. "Relationship between Individual Attitudes toward Life and Death." J. Consulting and Clinical Psychology, 38 (3), 463, 1972. 

11. 
_________ "Relationship between Attitudes toward Life and Death among Elderly Women." Developmental Psychology, .8. (1) 146, 1973. 

12. 
Frankl, V. E. The Doctor and the Soul. New York, Alfred A .Knopf, 1955. 

13. 
Giorgi, B. "The Belfast Test: A New Psychometric Approach to Logotherapy." Intern. Forum for Logotherapy, i (1), 31-33, 1982. 

14. 
Good, L. R. and K. C. Good. "A Preliminary Measure of Existential Anxiety." Psychol. Reports, :M,, 72-74, 1974. 

15. 
Hablas, R. R. Hutzell, and E. Bolin. "Life Purpose and Subjective Well-Being in Schizophrenic Patients." Intern. Forum for Logothcrapy, .3_(2), 

44-45, 1980. 

16. 
Henrion, R. "The PIL Test on Cancer Patients." Intern. Forum for Logothcrapy, fi. (1) 55-59, 1983. 


17.' Hutzell, R. R. and T. J. Peterson. "An MMPI Existential Vacuum Scale for Logotherapy Research." Intern. Forum for Logotherapy, .8._ (2), 97-100, 1985. 
18. 
Lukas, E. Personal Correspondence with Jana Preble, quoted in Reference 22, 1985. 

19. 
___ "Manual for the Logotest." Berkeley, The Institute of Logotherapy Press, 1988. 

20. 
McCann, J.T. and M.K. Biaggio. "Egocentricity and two Conceptual Approaches to Meaning in· Life." Intern. Forum for Logotherapy JL(l), 3 1 37, 1988. 

21. 
Nyholm, S. E. "A Replication of a Psychometric 

Approach to Existentialism." Unpubl. Master's Thesis, Univ. of Portland, 1966. 

22. 
Preble, Jana. "The Logotest: First North American Norms." in F. and J. Jones, eds. Viktor Frankl's Logotherapx, Berkeley, Institute of Logotherapy Press, 1986. 

23. 
Snavely, H. R. An unpublished special course project, Carleton College, 1962; pers. correspondence, 1963. 

24. 
Starck, P. "Patients' Perceptions of the Meaning of Suffering.'' Intern. Forum for Logotherapy, fi. (2), 110-116, 1983. 

25. 
Yalom, I. E. Existential Psychotherapy. New York, Basic Books, 1980. 


A Review of the Purpose In 
Life Test 
R. R. Hutzell 
The Purpose in Life Test (PIL)8 is used to measure the degree to which individuals experience life as meaningful, how much they feel like "somebody that matters," or how strongly they have developed a sense of purposeful direction in life. 
Crumbaugh 3 developed the PIL Test as part of his work to objectify the Frankl concept that the strongest human motive is to find meaning and purpose in life. This is accomplished through the actualization of personally meaningful, self-
transcendent  values.  Thus,  Frankl's  philosophy  is  
action- and  goal-directed  consonant  with  Western  
ideological  thought.  According  to  logotheory,  
existential  vacuum  ensues  when  one  fails  to  
establish  a  sense  of  personal  meaning.  This  
vacuum,  in  turn,  motivates  the  individual  to  strive  

harder to discover meaning or, al tcrnatively, opens the door to noogenic (existential) neuroses. Crumbaugh originally developed the PIL to be an objective measure of existential vacuum. 
As Forum readers know, the test consists of three parts. Part A lists 20 items and asks for their scoring on a scale from 1 to 7. Part B is a 13-item incomplete sentences test. Part C allows respondents to write a paragraph detailing aims, ambitions, goals in life, and progress being made in achieving these. Objective scoring of Parts B and C has not been established, and research with the PIL pertains only to Part A. 
Many researchers have developed altered versions of the PIL . These focus upon Part A only. and include one or more of the following: a smaller sample of the 20 items; simplified wording for the two extreme points of each item; 7-point ratings of agreement with only one end point of each item; and dichotomous choice items. The PIL is written for adults. Although the manual says that the instructions are easily understood by most adults and adolescents with fourth-grade reading level, some words arc hard for young persons to interpret. 
Practical Applications 
One major area of application for the PIL derives from its original intent to objectify Frankl's concept of existential vacuum. As noted in the manual, existential vacuum affects more than half the general population, and noogenic neuroses constitute roughly one-fifth of a typical clinical case load. The authors of the PIL suggest that it can be used to detect the presence of existential vacuum so that logotherapy may be instituted where needed, especially invocational guidance, rehabilitation, 
and  counseling  of  students,  neurotic  patients,  
alcoholics,  handicapped  persons,  and  retirees.  
However,  there  is  little  in  the  scientific  literature  

except for anecdotal data to support the hypothesis that using the PIL to select patients for logotherapy improves overall outcome. Additional research rs needed in this area. 
A second practical application of the PIL is as a research tool to measure the degree to which an individual has developed a sense of life-meaning. As one might expect, this application of the PIL has seen more use in professional literature than has the use of the PIL to detect existential vacuum for case selection. 
As a research tool, the PIL has been employed in a wide variety of settings, particularly in studies emphasizing existential, humanistic, and theological ideas. Most research with the PIL has been for master's theses and doctoral dissertations, often unpublished and difficult to locate. However, the current manual includes a two-page bibliography insert that provides information about thesis and dissertation research before 1980. Journal publications on the PIL appear rn journals of clinical psychology, social psychology, psychological measurement, existentialism, and humanism . Publications in theological journals are 
90 
less prevalent, although much of the unpublished 
thesis and dissertation research would fit well in 
such journals. 
The PIL has found application in research 
with a wide variety of individuals, such as persons 
with strong religious orientations, retired 
individuals, neurotics, psychotics, college students, 
alcohol and drug abusers, criminals, the critically 
ill, adolescents, and delinquents. · 
Numerous potentially relevant variables may 
be related to one's sense of meaning. The PIL has 
been used in many studies to assess the relationship 
between the PIL and the following variables: 
alcohol abuse, anomie, death issues, demographic 
variables (including socio-economic status), 
depression, job satisfaction, mental health 
adjustment, subjective well-being, and time 
orientation. 
Holistic medicine or wellness offers potential for new applications. Most holistic medicine programs include a spiritual component that is considered a vital, but often slighted, aspect of a complete wellness program. 
Administration of the Test 
The PIL can be presented in individual or group settings. The instructions are printed on the answer sheet. For Part A, the examiner's participation in the testing process, scoring, and interpretation of the scores can be minimal. Most individuals can complete Part A in 10 to 15 minutes. Parts B and C require more time to complete, and need professional interpretation by a clinical psychologist or other person similarly trained. 
No particular expertise is required of the test administrator for Part A. The manual notes, however, that the PIL should be employed with caution in any compet1t1ve situation where motivation to present a favorable self-image exists; thus the test administrator should have some skill at defusing natural tendencies toward competition or social responding. 
Scoring of Part A consists of summing the numerical values circled for the 20 items. Scores 
can range from 20 to 1--10. Interpretation of the scores is objective. The manual suggests using the mean of ''normals" (112) and of patients (92) 3 s cutoff scores; thus. scores above 112 suggest definite feelings of lifc-meanitH!., scores below 92 suggest lack of meaning, and s~ores of 92 through 112 arc of uncertain definition. For research purposes. raw scores typically arc employed for 
corrclational  and  outcome  studies.  In  both  cases.  
higher  raw  scores  suggest  a  stronger  sense  of  life- 
meaning.  

Technical  Aspects  
The  four-page  manu:.11  provides  little  
information  about  the  technical  and  st:itistical  
aspects  of  the  PIL.  It  provides  technical  data  from  
only  six  studies,  three  of  which  arc  unpublished.  

Although a large number of studies have been conducted with the PIL, many of them arc published in obscure journals or remain unpublished. The following review of technical material includes data from studies additional to those reviewed in the manual. Given the varied sources of PIL articles. some relevant articles may have been missed. The data discussed arc statistically significant unless otherwise indicated. 
PIL split-half reliability estimates and testretest reliability estimates appear adequate for a short, paper-and-pencil. self-report scale and suggest that the PIL offers sufficient consistency for its intended use. 
Two studies reviewed in the manual, plus several others, present split-half reliability correlations that range from . 77 (Spearman-Brown corrected to .87) to .85 (Spearman-Brown corrected to .92). The data were collected largely from students, psychiatric outpatients of mixed diagnoses, hospitalized alcoholics, penitentiary inmates, "high purpose" nonpatients, and active Protestant parishioners2,3,7,11 , 12
Test-retest reliability is not discussed in the manual, but several studies have been conducted, 
yielding the following data: a 1-week coefficient of .83 (N = 57 church members)10; a 6-week coefficient of .79 (N = 31 college students)12 ; and a 12-week coefficient of .68 (N = 17 penitentiary inmates)11 . 
Validity PIL assessment has been cumbersome because there is no direct criterion for quantitative experiences of life-meaning against which to validate. 
Face validity seems adequate because the items look like they measure what is intended. Two of the items (#7, retirement, and #15, preparation 
for death), may cause negative reactions by many people. 
Frankl Questionnaire 
to estimate the presence of existential vacuum 
1 . Does your life have meaning? 
2. 
If so, what is its meaning? 

3. 
Are you suffering from a feeling that your life is meaningless? Never? Rarely? Often? 

4. 
What makes your life meaningful, or what would give meaning to what you consider a meaningless life? 

5. 
Do you find meaning in specific deeds, achievements in your profession or elsewhere? Or experiences with nature? Art? Encouter with people? Love? 

6. 
If the last, what do you mean by love? 

7. 
Can unavoidable suffering have meaning? 

8. 
Have you ever thought of suicide? 

9. 
If so, for what reason? 

10. 
Did you ever intend suicide? 

11. 
Did you ever attempt suicide? 

12. 
If so, d0 you regret your attempt? Or are you sorry to have been saved? 

13. 
When you decided not to carry out your intended suicide, what prevented you? 


93 
There is evidence that the PIL correlates with "existential vacuum." The sum of 6 quantifiable items from a series of 13 questions (see Frankl Questionnaire, questions 1, 3, 8, 10, 11 and 12) used by Frankl to estimate the presence of existential vacuum was found to correlate .68 with the PIL as reported in the manual (N = 136 mixed patients and 
nonpatients)7 and .56 in a separate study (N = 200 church members)10 . Meier and Edwards report similar correlations of .68 and .59 from two unpublished dissertations. Although these correlations are statistically significant and in the predicted direction, they are smaller than one might wish if the PIL and the Frankl Questionnaire are to 
measure  the  same  phenomenon.  ·  
Regarding  concurrect  validity,  the  manual  
provides  additional  data. 3  After  two  therapy  
sessions,  psychotherapists  completed  PILs  for  50  
psychiatric  outpatient  neurotics  with  mixed  

diagnoses. The therapists were instructed to complete the PILs in the way they thought the patient should have filled them out in order to be truthful. The correlation between the therapists' ratings and the patients' actual PIL scores was .38. A similar study with 39 subjects7 yielded a correlation of .27, which was not statistically significant. In addition, Crumbaugh constructed a rating scale by which ministers scored 120 parishioners for evidence of life-meaning; a carrelation of .47 was found between these ratings and the parishioners' PIL scores. These correlations are in the predicted direction but are disappointingly small and add only minor support to the validity of the PIL. 
The manual reviews a construct validity study 3 in which it was reasoned that if the PIL measures life-meaning, and if certain groups experience greater levels of meaning than others, then those groups should receive higher PIL scores. The order of the mean PIL scores of four 'normal" populations was predicted correctly: 
94 
Successful business or professional personnel (M -118.90, SD = 11.31, N = 230) 
Active and leading Protestant parishioners (M -114.27, SD =15.28, N =142) College undergraduates (M = 108.45, SD = 13.98, N = 417) Indigent, nonpsychiatric hospital patients (M = 106.40, SD= 14.49, N = 16). 
The prediction of the order of means of psychiatric populations was less accurate but did show a predicted drop from neurotics to alcoholics to nonschizophrenic psychotics. 
The manual also argued that, within Frankl's logotheory, some but not all psychiatric syndromes 
evolve  from  lack  of  life-meaning.  Thus,  one  would  
expect  some  psychiatric  patients  to  have  a  lower  
than  normal  sense  of  meaning.  Statistically,  this  

would be reflected m PIL scores of psychiatric patients showing a lower mean and greater variance than that of a normal population. In Crumbaugh's data, both the means and the variances of the patient and the nonpatient populations were indeed different at statistically significant levels (combined "nom1al" groups: M = 112.42, SD = 14.07, N = 805; combined psychiatric groups: M = 92.60, SD = 21.34, N = 346). 
Other studies replicate the relationship between mean PIL scores and various group memberships. Crumb augh and Maholick,7 for example, had shown a significant discrimination between nonpatients (M -119, N = 105) and patients (M = 99, N = 120). Once again there was a progressive decline in mean PIL scores as predicted: 
•ttliigh purposc0 nonpatients (M = 124.78, SD = 11.80, N = 30) 
•Undergraduate 
college students (M = 116.84, SD = 14.00, N = 75) 

•Psychiatric 
outpatients, mixed diagnoses (M = 101.80, SD = 22.38, N= 49) 

•Patients 
from a nonprofit psychiatric outpatient clinic, mixed diagnoses (M = 101.30, SD = 18.14, N = 50) 

•Inpatient 
alcoholics (M = 89.57, SD = 16.60, N = 21). 


Garfield9 also found statistically significant differences rn mean PIL scores between several groups: 
•Religion 
graduate students (M = 119.29, SD = 10.01, N = 48) 

•Commune 
inhabitants (M = 113.43,SD = 1 l.03,N =42) 

•Psychology 
graduate students (M = 102.93, SD = 17.18, N = 50) 

•Professional 
engineers (M = 94.26,SD = 19.89,N =42) 

•Ghetto 
residents (M = 85.71, SD =24.27, N = 40). 


Black and Gregson 1 found statistically significant differences between: 
•New 
Zealand normals (M = 115.07,SD = 13.87, N = 30) 

•First-sentence 
penitentiary inmates (M = 99.07, SD = 18.72, N = 30) 

•Recidivist 
penitentiary inmates (M = 86. 80, SD = 15.35, N = 30). 


Correlation of the PIL with existing psychometric instruments can help clarify the construct of life-meaning as measured by the PIL. Viewing studies that correlate the PIL with a particular psychometric instrument and studies that correlate the PIL with separate instruments designed to assess similar personality variables, the PIL has shown a potential, small, positive 
correlation with the following: absence of depression, extroversion and group achievement, 
positive  attitude  toward  life  at  present  and  in  the  
future,  self-acceptance,  psychological  mindedness,  
self-control,  emotional  stability,  absence  of  anxiety,  
responsibility,  and  absence  of  anomie.  

These studies of correlations between the PIL and personality variables help clarify the construct of life-meaning as measured by the PIL. The results do not validate the PIL directly, but most fit predictions generated from logotheory and most are what would be expected from a valid measure of the strength of subjective life-meaning. 
Another interesting area of study is not 
. reviewed in the manual but supports the validity of the PIL. If the PIL is a valid measure of meaning, its scores should increase if an individual participates in an experience that increases a sense of meaning. Crumbaugh's logoanalysis 5 is designed to help individuals increase such a sense. He administered the PIL to 81 inpatients at the beginning and end of alcoholism treatment. 4 Thirty of the patients were selected to participate in logoanalysis in addition to the regular alcoholism treatment. The 51 remaining patients served as a comparison group. PIL scores increased more for the alcoholics who participated in logoanalysis than for those who did not. Similarly, Crurnbaugh and Carr6 found that the PIL scores of subjects who started therapy with existential vacuum increased more after participating in closed-ended logoanalysis sess10ns than did control patients who did not receive logoanalysis (N = 25 alcoholic inpatients per group). In broad overview, then, the data supports the validity of the PIL as a measure of the degree to which an individual experiences life as meaningful. Data supporting the validity of the PIL are 
consonant with predictions made from logotheory, yet many of the relationships are small and support is indirect. It would be useful to conduct a largescale investigation using the multitrait-multimethod matrix, which can provide information to answer questions that remain regarding convergent and discriminant validity of the PIL. 
The manual does not present data about psychological norms from individuals representative of any particular population. Rather, data arc based on 1,151 cases3 largely influenced by convenience and availability. 
Approximately 70% of these cases are labeled as "normal," and the remaining 30% are "patients." 
The manual states that no consistent relationships have been reported between PIL scores and age, education, intelligence, or gender. There have been several attempts (many not reviewed in the manual) to detect relationships between PIL scores and these variables. Studies of gender effects have produced mixed results. Age, education, and intelligence, on the other hand, often have shown very slight (not statistically significant) but positive relationships with PIL scores. A small, positive relationship between PIL scores and these latter variables might be found if a large sample were obtained to reflect the normal distribution of these variables in the general population. 
Relative to the discussion of norms, Garfield9 argues that the PIL is based upon assumptions grounded in a white, middle-class, capitalist establishment that advocates the work ethic, stresses future orientation, tends toward the unidimensional, reveres purposive behavior and advises high levels of stimulation. He also argues that the PIL is biased by the following Western perspectives: acceptance 
of mind-body dualism, primacy of physical over spiritual existence, and advocacy of process over stasis. Garfield presents clinical evidence that the PIL items are less appropriate for assessing lifemeaning or meaninglessness in populations that deviate from middle-class, Western philosophical thought. 
Critique 
As a test of the degree to which an individual experiences life as meaningful, Part A of the PIL has much potential for use in noncompetitive situations. It has been used with adults and adolescents in a wide variety of settings. The protocols are hand-scored. With little guidance, Part A can be self-administered, self-scored, and selfinterpreted easily. 
The manual needs to be updated and expanded. 
Potential PJL users would gain if the results of all the studies employing the PIL were collected and synthesized into a single document. Although the development, technical aspects, and statistical elements of the PIL are not adequately documented, the PIL does remain the most systematically developed and most frequently used test to come out of Frankl's logotheory. 
Available reliability scores appear adequate, but reliability estimates m divergent populations need to be established. Criteria regarding the validity of the PIL are hard to identify. The PIL demonstrates face validity in that it "looks like" it measures that which it is purported to measure. Other validity assessments, though indirect, generally support the validity of the instrument. 
The PIL was designed to measure a concept that other psychological instruments do not measure, and thus the PIL would not be expected to 
show a high correlation with existing psychometric 
instruments.  Although  PIL  shows  consistent  
relationships  with  other  instruments  and  
personality  variables,  those  relationships  are  
expectedly  low.  

Normative data are notably absent. Although the position that higher PIL scores suggest higher life-meaning might be expected across many groups, establishment of local norms for cutoff scores rather than those suggested in the manual is highly recommended until more representative data are published. 
It must be remembered that the PIL was developed out of Frankl's logo philosophy, which suggests that life-meaning is experienced by actualizing personally meaningful, selftransccndant values. As this philosophy 1s consonant with Western philosophy and middleclass thought, divergent cultural and subcultural groups may find life-meaning in contexts not addressed by the PIL or may interpret the PIL items differently from the bulk of the samples studied to date. Middle-class America and populations with similar values include a large number of individuals for whom the PIL is a potentially relevant predictor of the degree to which meaning is experienced, but for groups that depart from middle-class American values, the generalization of the PIL must be questioned and specific validity studies are warranted. 
R. R. HUTZELL, Ph.D. is clinical psychologist at the Veterans Administration Medical Center, Knoxville, Iowa. This review is adapted from Dr. Hutzell's critique of the PIL in DJ.Keyser and R.C. Sweetland (eds.) Test Critiques: VI. Kansas City: Test Corporation of America, 1987. 
REFERENCES: 
1. 
Black, W.A.M., and R.A.M. Gregson, "Time Perspective, Purpose in Life, Extraversion and Neuroticism in New Zealand Prisoners." British Journal of Social and Clinical Psychology, 12... 50-60, 1975. 

2. 
Butler, A.C., and L. Carr. "Purpose in Life Through Social Action." Journal of Social Psychology, 1.Q., 243250, 1968. 

3. 
Crumbaugh, J.C. "Cross-Validation of Purpose-in-Life Test Based on Frankl's Concepts." Journal of Individual Psychology, 24, 74-81,1968. 

4. 
"Changes m Frankl's Existential Vacuum as a Measure of Therapeutic Outcome." Newsletter for Research in Psychology, pp. 35-37, May 1972. 

5. 
Everything to Gain: A Guide to Self-

Fulfillment through Logoanalysis. Chicago, Nelson-Hall, 1973. 

6. 
___________, and G.L. Carr. "Treatment of Alcoholics with Logotherapy." International Journal of the Addictions, li, 847-853, 1979. 

7. 
, and L.T. Maholick." Experimental Study in Existentialism: The Psychometric Approach to Frankl's Concept of Noogenic Neurosis." Journal of Clinical Psychology, 2-(l 200-207, 1964. 

8. 
______________________ "Manual of Instructions 

for the Purpose in Life Test." Murfreesboro, TN: Psychometric Affiliates. 1969. 

9. 
Garfield, C. A. "A Psychometric and Clinical Investigation of Frankl's Concept of Existential Vacuum and of Anomia." Psychiatry, }ii, 396-408. 


100 
1973. l 0. Meier, A., and H. Edwards. "Purpose-in-Life Test: Age and Sex Differences." Journal of Clinical Psychology, JJL 384-386. 1974. 
11. 
Reker, G. T. "The Purpose-in-Life Test in an Inmate 

Population: An Empirical Investigation." Journal of Clinical Psychology, 11, 688-693. 1977. 

12. 
________, and T. E. Cousins. "Factor Structure, Construct Validity and Reliability of the Seeking of Noetic Goals (SONG) and Purpose-in-Life (PIL) Tests.·• Journal of Clinical Psychology, 15_, 85-91. 1979. 


101 
.
Group Logotherapy Ill Latin America 
Jose V. Martinez Romero 
In Buenos Aires, psychotherapists have been working with a model that adds group logotherapy to our present treatment techniques. Our task is 
mainly  clinical.  We  have  obtained  a  critical  basis  - 
analytically  responsible,  open  to  dialogue,  and  
nonsectarian  -for  the  theories  and  applications  of  
lo gotherapy.  

The epistemological, anthropological and psychopathological aspects of this critical basis have been analyzed by the Argentine School of Logotherapy. I direct a team of physicians, psychologists and educational psychologists. Our institute is called "SENTIDO" (Meaning), Center of Psychological Encounter and Communication in honor of Viktor Frankl who considers lack of meaning to be the cause of our present crisis. Our own experiences do not contradict the general concepts of psychology, group dynamics, or logotherapy. On the contrary, we have revised the theories and techniques of various schools with an epistemological point of view and incorporated whatever is pertinent to achieve our principal aim: helping people find meaning in their lives. 
As psychologists, we help "cure" the sick in their physical and psychic dimensions. We also attend to the spiritual dimension, which, according to Frankl, is the essent.ial dimension of human existence. He adds that "neuroses can take root also in [the spiritual] dimension, because persons suffering from moral conflicts, conflicts of conscience, spiritual problems, or an existential 
crisis, may fall ill with a [noogenic] neurosis."1 
The primary importance of group procedures lies not in stimulating certain actions by group participants, but in enabling them to find meaning at any particular moment in their lives. Our main 
"technique" is human understanding an "encounter" where participants talk about their life histories, their present situations, personal experiences and goals. 
People in crisis receive help from the vocational expertise of the logotherapist who provides theoretical grounding, and from group members, who sympathize and help each other find meaning in their existence. 
Group participants do not see others as "objects," but as "subjects" who pay attention to each other's inner feelings and significant gestures. We help group members to fight against feelings of meaninglessness and to confront the existential vacuum which affects people today on an almost epidemic scale, leading to what Frankl calls "collective noogenic neuroses." 
The tragic trilogy--depression, aggression, and addiction~-results from a lack of meaning. Logotherapy applies self-detachment and selftranscendence to overcome the vacuum and find a firm base on which to stand even in the most unfortunate circumstances. 
Logotherapy groups effectively stop people from constantly thinking about themselves. It puts them in a situation where they think about others, feel others' suffering, sympathize, and help those who suffer. 
Community and Family 
In Latin America, community and family ties still exist because immigrants brought and established creative and attitudinal values based on ~ol~d~rity. 1:he relationship between community and md1v1duals 1s reciprocal. Sentido Center does not accept the collectivist view which stresses the overriding value of community -this view may lead ~o . ~pprc_ssion.. Neither does Sentido accept an md1v1duahst pomt of view which ignores the value of solidarity and love toward others. The solution lies in a balance, with the person in the center, but 
not  isolated  from  the  community.  And  the  
community entities.  is  made  up of  human  beings,  not  of  

We may deduce the existence of pathological 
communities of different sorts and ideologies which 
are sometimes aggressive, mistaken in their 
solidarity, purposeless, massified, and driven by 
autocratic leaders. 
Group logotherapy educates people to see that everyone, isolated or lacking a sense of meaning, needs personal fulfillment achievable through community. 
The community may be more important than 
the person if the person is seen as a monistic 
individual. But if the person is seen as transcending 
the community, accepting freedom, responsibility 
and love; capable of finding meaning even in the 
worst circumstances; and potentially self
transcendent, no authoritarian state, no alienating 
ideology , no autocratic leader can lead us to a 
supposedly beneficial but actually enslaving 
collectivism. 
Faced with the problem of the relationship between community and individual -politically, economically, socially, and culturally --we need to find a genuine human solution, a "communal personalism" which allows both self-transcendence and inclusion of the person in a modern community. 
This solution requires a humanistic anthropology and makes it imperative for logotherapy to transcend psychology and psychiatry, to work humanistic ally, to become involved with those who suffer or bear frustrations that make their lives meaningless. Such involvement is based not on theoretical consideration but on a way of life, and this is the key to any therapy, especially logotherapy. 
We cannot say that logotherapcutic groups are good or bad for the individual. Some groups will help participants find meaning in life. Help is sought through different techniques, based on the assumption that we are "beings-for-others," that everything going on in the group is important for ourselves and the others. 
The staff of Sentido does not believe in 
prolonged psychotherapy . If we can help "in two 
or three sessions, the patient does not have to come 
50 times."2 This is directly related to the therapist's attitude. As to tec'hnique, the key question is: What 
will reveal to clients their true selves at this moment? It is of utmost importance that the therapist is not merely a interpreter of simple 
language and unconscious codes. The logotherapist aims at understanding the "being" of clients, helping them see their existence realistically, perceive their potentials, and act accordingly. The most important consequence of this process is commitment. 
Commitment must be experienced by the therapist too. Lukas states that "logotherapy is more than a method. It is a healthy way of living 
that can be used in therapy if it is actually lived first by the therapist, then --with the help of the therapist--by the patient. Which means: If you 
don't  live  logotherapy  you  cannot  use  it  m  
healing."2  
In  the  broadest  sense,  to  become  "cured"  is  to  
beccome  able  to  direct  one's  efforts  to  expanding  
and  improving  one's  own  life.  

Procedure 
To decide in the first interview whether group logotherapy will be effective, we undertake a series of procedures including more interviews, psychodiagnosis, consideration of the empathetic relationship established, type of disturbance, possibility of client stop treatment prematurely, degree of commitment, and the possibility of spontaneous remission. We never impose a therapy plan upon clients without interviews in which we ask them to consider two possibilities: finding meaning in life, and making use of their freedom and responsibilities. 
These considerations apply also to their future treatment -clients must know what they will have to face and what they will be responsible for. Frankl calls this the "challenge to responsibility." This is our motto we apply to clients as well as to therapists. We walk the road together, with true commitment, each in our own role, to find each other after realizing our own meaning in life. 
105 
Having analyzed all this, and by mutual agreement, weekly sessions of group logotherapy are held, combined with weekly individual sessions. There are many ways to undertake group therapy. Each school follows its own view of human nature and reinforces aspects it considers important. It is up to the therapist to handle the different 
techniques of group dynamics, psychodrama, gestalt psychology, psychoanalysis, and behaviorism, especially in psychoprophylactic groups. 
Videotaping the sessions is useful for analysis by the therapeutic team, and later by the clients. It is valuable for diagnosis and prognosis, and for enabling clients to change unwanted aspects of their personalities by observing the way they relate to others. Because of the modifying exercises and new experiences in the group, there will be changes in the way participants confront existence. These changes will not always go in the direction the group and therapist intend. The changes result from the greater freedom group members experience in relation to others and to the world, as they realize their lack of spontaneity, lack of harmony, stagnation, and existential vacuum. Participants can thus assume the commitment of freely choosing their future, and are left celebrating, with the rest of the group, the conclusion of their treatment. 
JOSE V. MARTINEZ ROMERO, prof., lie., is director of 
Sentido,  Centro  de  Actualizacion  Psicologica  del  
Encuentro  y  la  Comunicacion,  Buenos Aires,  
Argentina.  

REFERENCES: 
1. 
Frankl, V.E., Theoric und Therapic dcr Neurosen, Munich, Reinhardt, 1983. 

2. 
Lukas, E., Meaning in Suffering. Berkeley, Institute of Logotherapy Press, 1986. 


LOGOTHERAPY AND THE HYPERSOMATIC 
FAMILY 
Jim Lantz and Karen V. Harper 
The hypersomatic family is one whose members consistently hyperreflect about physical health because of their need to fill their existential vacuum. Hyperreflection in families, whether or not actual physical illness exists,2 can be useful because it protects the members from despair that is associated with the existential vacuum. But it also is destructive because it inhibits the family from facing and overcoming the vacuum. 
Existential Reflection 
Existential reflection helps the family identify meaning and meaning potentials that can fill the existential vacuum and reduce the opportunity for symptoms to develop.2,3,4,5,6,7 The Socratic dialogue, dereflection, and paradoxical intention are special logotherapeutic treatments to facilitate cxistenti al 
56
reflection. 2,3,4 , , ,7 This article presents the treatment results of family therapy with 16 hypersomatic families seen by the first author in private practice since 1982. 
All 16 families were referred for treatment by their family physician. In each instance she had, in our opinion, accurately made the assessment that the family was signaling the presence of an existential vacuum by hyperreflecting about physical concerns. All family members were considered to be in excellent health by the physician, and extensive medical assessment, including tests, confirmed her medical judgment. In spite of such good physical health, each of the 16 families had spent an unusually high number of visits at the doctor's office. Table 1, column 4, shows the number of visits to the doctor's office before family logotherapy was instituted. 
Each family member, 16 years or older, was given the Purpose-in-Life test. 1 The family test score was determined by dividing the families' total score by the 
number of family  members  tested.  Table 2, col.  2,  shows  
the  family  PIL  test  score  at  the  start  of  the  treatment.  
All  16 families  scored  92  or  lower,  

which is considered a good indication of the presence of an existential vacuum. 
Table 1. Number of Doctor's Visits Before, During, and After Logotherapeutic Family Treatment 
Family  Nr. in  Year of  Annual Visits with M.D.  
Family  Treatmen  before  during  after  
treatment  
A  5  1982  46  48  47  
B  6  1982  52  24  19  
C  4  1982  33  18  16  
D  5  1982  44  28  23  
E  3  1983  41  22  17  
F  3  1983  39  36  42  
G  7  1983  52  19  22  
H  4  1983  34  15  16  
I  3  1984  46  24  18  
J  5  1984  49  47  53  
K  6  1984  51  36  21  
L  3  1985  43  25  19  
M  5  1985  46  29  21  
N  6  1985  54  26  19  
0  5  1985  37  18  23  
p  4  1985  3 1  21  19  
------------------ -------------------- 
Mean  43.6  27.2  24.7  

All family members were provided with logotherapy to help them discover, create, and experience meaning. 3,4,5,6,7 Treatment included the standard logotherapeutic approaches of paradoxical intention, dereflection, and Socratic dialogue. 
Results 
Family logotherapy was helpful to 13 of the 16 families. The exceptions were families A,F, and J. The mean number of yearly visits to the doctor decreased from 43.6 in the year before treatment to 27.2 in the year of 
treatment, and to 24.7 in the year after treatment was concluded. This indicates that the benefits gained during the year of the treatment were continued during the year following. The family doctor made no attempts to limit family visits at any time, and all medical appointments were provided upon demand. 
Table 2. Family PIL Score Before and After Treatment 
Family 
Family PIL Score 
Hours m 
Treatment
at start at end one year 
of treatment follow-up 
29
A 
84 
82
90 
B 
18
91 
118 
112 
112 
114 
24
C 
87 
28
D 
92 
114 
118 
E 
42
84 
124
119 
F 
43
78 
81
84 
124 
118 
20
G 
88 
H 
91 
113 
25
108 
I 
114 
24
73 
123 
J 
85 
87 
38
89 
K 
118 
29
76 
124 
L 
112 
114 
32
86 
M 
92 
117 
26
123 
21
N 
91 
118 
114 
34
74 
114 
123
0 
p 
22
83 
118 
116 
Mean 84 112 110 
The family PIL test scores are another indication that logotherapy was useful. Thirteen of the 16 families showed significant improvements in their family PIL scores -from a mean of 84 at the start to 112 at the end of the treatment. In the year following family logotherapy the mean family PIL test score for all 16 families was 110. A test score of 112 or more indicates definite meaning orientation. 
Although our research was done on a small sample, it raises hope that family logotherapy, in conjunction with adequate medical evaluation and treatment is useful with families hyperreflecting on their physical health to fill an existential vacuum, especially when no actual physical illness is present. 
James Lantz, P.D. is assistcnt professor at The Ohio State University, College of Social Work, and clinical director of Village Counseling Associates, Columbus, Ohio. 
Karen J. Harper, Ph.D. is assistant professor at The Ohio State University, College of Social Work, and a consultant and education specialist at Village Counseling Associates. Columbus, Ohio. 
REFERENCES: 
1. 
Crumbaugh, J. and L. Maholick. "Purpose-in-Life Test," Murfreesboro, Psychometric Affiliates, 1976. 

2. 
Lantz, J. Family and Marital Therapy, New York, Appleton Century Crofts, 1978. 

3. 
______ "Meaning in Family Therapy," Int. Forum f. Logotherapy i(l), 1982. 

4. 
______ "Family Logothcrapy," J. Contemporary Family Therapy li.,_ 1986 

5. 
______. "Franklian Family Therapy,"Int. Forum f. Logotherapy lQ, 1987 

6. 
______ . "The Use of Frankl's Concepts in Family Therapy," J. of Independent Social Work 2... 1988. 

7. 
______ and E. Mann, "Family Therapy and the Existential Vacuum," J. of Religion and Psychiatry §., 1988. 


Logotheory in Hospice Social Work 
Ellen Gibson, Janet Forrest, Elisa McIntyre, Marilyn Shannon, Jean Stepl'lan, and Pam Walker 
Hospice of Columbus is a City Health Department Agency to help terminally ill people live their remaining time in their own home with dignity and respect. The agency privides services in nursing, health aid, medical consultation, and social work to individuals and families faced with a potentially terminal disease. The role of the social worker is to provide family and individual counseling, offer advocacy and environmental modification services, and help clients sort through bills, insurance reimbursement problems, and financial difficulties. A crucial role is to assist clients and their families to discover meaning in response to the tragedy they are facing. Logotheory is of great benefit in our practice of social work in 
the  hospice  situation.  The  following  clinical  stories  
illustrate  the  use  of  logotheory  concepts  in  our  
work.  

The Case of A 
A is a 40-year-old nurse who was diagnosed with ALS (Lou Gehrig's disease) in April of 1985. Her first symptom was weakness in her left thumb. She was stable for seven months until her right hand became weak. When she could no longer catherize her patients and could not do sutures, she decided to quit her job. Before leaving the hospital where she was employed, A gave an in-service talk on ALS and was awarded with a standing ovation. That was in September of 1986 and to this day A is committed to making people aware of the disease. 
A is alert, mentally vital. She struggles with grief as her body deteriorates and her mobility and dexterity vanish. She experiences anxiety both from not knowing what to expect from day to day and also from knowing very well what she can expect in the future. 
I often ask A what keeps her going. Her response is always the same--a genuine desire to teach people not only about ALS, but also about the real options and freedom which dying people still have. A is very committed to a "death with dignity" philosophy. 
As part of our work , A has enthusiastically agreed to make an educational video we will use with our hospice treatment team and other people who are interested in learning what this terminally ill, willfully alive woman has to say about her experience and her future death. 
A also has a very strong belief in afterlife and reincarnation. Recently, she has been collecting messages from close friends and family members to take to "loved ones on the other side." I have supported her in these efforts as it is obvious the meaning this venture has to her and the purpose it has given to her remammg time. 
A believes that things happen for a reason; that there is always something to be learned. She states that her lesson in this experience is to cultivate patience. Once an extremely independent woman, A is now dependent on those around her for everything--fceding, bathing, every aspect of personal care and every lighting of every cigarette. As A's physical condition continues to decline, her struggle to find meaning becomes more pronounced. We talk about her grief and we cry about her losses. I affirm for her how much I have learned from her regarding the preciousness of life 
and  time.  She  always  responds  to  a  hug  and  the  
recognition  that  her  life  is  as  meaningful  now,  as  
ever.  

The Case of B 
Ruth B has fought a battle with cancer for almost five years. She has had surgery several times, has been in remission, but has now been given a prognosis of terminal. Ruth has been married to Bob for over 30 years. They live in a comfortable house in an upper middle-class neighborhood, and have two grown children who are no longer Iiving at home. Ruth, by her choice, has not worked outside the home during her marriage. She felt her place in life was to be a "good" wife and mother, and even after the children left, her home and family continued to be the focus of her life. She has stated that "Bob had the office and I ·had the home," and that "that was the way it was supposed to be." 
When I first met Ruth, she had been given a prognosis of about two months. She was weak, almost bedfast, but not in pain. Bob, who owns his own business, had virtually moved his office into the house so that he could be with her and care for her. 
At that time, Ruth was focusing on her own imminent death. She appeared to have accepted that whe was dyi,ng. Ruth is a religious woman. She believes she will continue to exist after death, but has many concerns about what form this life after death would take. Many of her concerns were about her family--would she be able to "see" them? Would she be able to follow their lives? This was of great importance to her. 
The family's first grandchild was to arrive about the time Ruth expected to die. Her son and daughter-in-law were living in another state. While Ruth expressed sadness that she might not see the child, her main concern was that if she should die about the time of the baby's birth, her son would be torn between staying with his wife and attending his mother's funeral. We discussed this and joked about her dying "at the convenience of her family." 
As it turned out, Ruth did not die within the time she had been given. Her condition has remained fairly stable, although her prognosis continues to be terminal. Her grandchild was born and she was able to sec the baby. In fact, her son and his family have since returned to live in Columbus so she has been able to spend time with them. As it became apparent that her death was not imminent, treatment has become more oriented to 
the  present.  As  she  looks  at  the  meaning  of  "still  
being  here,"  she  examines  what  she  can  still  
produce,  create  and  contribute.  

Bob was the dominant partner in the marriage. Ruth has described him as overly critical, controlling and unable to show warm emotion. Bob's way of coping with her illness has been to keep control by obtaining as much information as possible about diagnoses, procedures and medications. He is in charge of administering all her medications. So far, he has avoided attempts on my part to explore his feelings about his wife's illness, and what may now be a long-term, rather than a short-term, situation. 
Ruth, however, has begun to look at her own part in the relationship, and to make a conscious effort to be more assertive, more responsible for and aware of her own feelings. She has been able to admit that she has feelings of anger and resentment toward Bob, and we have discussed the possibility that this extra time she has been given may 
meaningfully enable her to work through these feelings, and develop a more open relationship with Bob before her death. 
Another way rn which Ruth is finding meaning in her terminal situation is to develop a more emphatic understanding of how the emotional needs of other cancer patients can be met. She has some regrets about what she calls her "thoughtlessness" for the pain of sick people while she herself \Vas healthy. She has spent time recently talking with a friend who had just been diagnosed with cancer. She has expressed satisfaction with being able to help her friend and woud like to be able to help others. 
Ruth continues to search for meaning both in 
her life and in her dying. During the past months, 
she has been able to expand her would from its 
narrow focus upon her own death, and how it can 
least inconvenience her family, to a striving for a 
better understanding of herself, her own and her 
family's needs, and also the needs and feelings of 
people outside her own personal little world. Ruth 
has expanded her self-transcendent skills from her 
family to the outside world. 
The Case of C 
Mr. C was a 43-year-old executive with a rare form of cancer that has not responded to aggressive therapy. He lived in an upper middle-class neighborhood with his wife and twin teenage sons. At the time of the referral to the Hospice, Mr. C had only recently become incapacitated by the disease. At the time, he had essentially isolated himself from the outside world, refusing many visitors and outside stimulation. 
There were many changes in the family lifestyle since Mr. C's confinement at home. One change was Mrs. C's extended leave of absence from her job. A second change was the frequent 
absences  of  the  twins  from  the  home.  Upon  
questioning  the  twins,  both  acknowledged  
discomfort  in  bringing  home  friends.  The  boys  did  

not feel comfortable "living" in their own home. Mr. C felt discouraged that he could no longer participate in family activities as he had done in the past, and feared that this would adversely affect the boys. He expresses the hope that his family, and particularly the boys, would not suffer emotional problems because of his illness. 
After much thought, Mr. C concluded that one thing that he could still do was teach his children how to die with dignity and self-respect. He made a list of things to talk to his family about before his death. We encouraged Mrs. C to add to these discussions her future needs and the decisions that she would· be forced to make upon her husband's death. Included rn these discussions were arrangements for the eventual funeral and decisions about medical care needs. Also discussed were the parents' hopes and dreams for their boys and what Mr. C anticipated for the boys' future. A presentation of signet rings (duplicates of Mr. Cs) was to be made on the anticipated date of the boys' graduation from high school in one year. 
As Mr. and Mrs. C became more verbal about their memories and future plans, the boys were spending more time at home with Mr. C. The boys are able to provide meaningful respite for their mother and spend nights talking to Mr. C who experienced sleeplessness. At the time of Mr. C's death, the family closely gathered around his bed. Both Mrs. C and the boys express wonderment that they had been able to give Mr. C his dying wish to remain in his home to die. This was a feat they had 
considered impossible at the time of the initial Hospice referral. This accomplishment has been extremely meaningful to both the wife and the boys. 
Conclusion 
In all three of these clinical illustrations, logotheory was helpful to the social worker in her attempt to facilitate the client's search for meaning. At times, logotheory helps us determine "what to do" and at times it helps us remember to "stay out of the way" in an effort to keep from disrupting the client's personal search for meaning especially when it might be different from our own. 
ELLEN GIBSON, JANET FORREST, ELISA MCINTYRE, MAR/LY SHANNON, JEAN STEPHAN, and PAM WALKER are all social workers at Hospice of 
Columbus.  The  authors  would  like  to  thank  Jim  
Lantz  for  his  encouragement  and  support  in  our  
writing  of this  paper.  

Family Logotherapy for Weight Reduction 
Jim Lantz and Karen T. Harper 
Between 1983 and February 1985 the first author had his private practice in a building where a nationally known weight-loss center was located. When the center moved to a new location, 19 clients felt they needed a more "intense" form of treatment because they had failed to lose weight at the center. Four were referred to a psychiatrist because they were diagnosed psychotic needing psychiatric intervention. Three unmarried clients received individual logotherapy; for the 12 married clients family logotherapy was recommended. Three of them decided not to accept this recommendation. Nine clients remained in treatment until they and the family logotherapist felt that service was no longer needed. All nine clients and their families made good progress during and after treatment as measured by weight loss and improvement on the 
Purpose In Life1, 2 test scores for themselves and their families. This article describes the family logotherapy approach with the nine weight-loss center dropouts and documents the changes they made during and after treatment. 
Family logotherapy has been described in previous publications.5,6,7,8,9,lO. The family is understood to be a group with four major functions: physical (providing physical wellbeing for family members); developmental (facilitating development 
of family members); social (facilitating support for each other); and existential (helping the members discover and experience meaning). All four tasks are important and interrelated hut the meaning task is considered primary and too frequently ignored in other approaches to family treatment.7, 10 
Family logotherapy9,10 recognizes that from 20% to 40% of all families experience existential vacuum. 3,4 Their search for meaning has been 
blocked, repressed, or disrupted, and the resulting sense of emptiness is filled by anxiety, depression, confusion, substance abuse and, at times, overeating. Logotherapists help family members discover and experience meaning,8, 10 filling the vacuum and diminishing opportunity for symptoms 
to develop.7 It is assumed that the family search for 
meaning  has  been  disrupted  by  repression,  
unhealthy  interactional  patterns,  or  family  
structural  problems.7,8,9,10  

Logotherapists facilitate the family search for meaning, using interest, empathy, direction, guidance, and reflection experiences to help the family discover meaning more effectively. Treatment methods include dereflection, paradoxical 
intention, and existential rcflcction.5, 8, 9, 1 0 Paradoxical intention helps family members shortcircuit anticipatory anxiety which disrupts the family search for meaning.5, 8 Dereflection helps avoid hyperreflection and hypcrintention which hinders the search for meaning, and existential reflection helps family members rediscover meanings which have been repressed or pushed into the noctic unconscious.7,8,9,10 
All nine clients accepted for family logotherapy manifested serious weight problems. They had failed to lose weight at a responsible and competent weight-loss center which used diet, behavior modification, and social encouragemenL 
All nine clients scored below 92 on the Purpose In Life test (PIL) 1 which is considered a reliable measure of the existential vacuum. The mean family PIL test score for all these clients was also less than 
92. A PIL score of less than 92 indicates the presence of an existential vacuum.2 The mean family PIL score is figured by giving all family members 15 years or older the PIL test, and dividing the_ total score by the number of tests given. Client 
weight, PIL test scores, and mean family PIL test scores at intake arc shown in tables 1 and 2. 
Table 1. Changes in Client Weight 
Weight  in  Lbs  
Sex and  Hours of  One Year  
Client  Height  Treatment  Start  End  Follow-Up  

A  F  5'3"  36  169  106  108  
B  F  5'7"  25  183  128  129  
C  F  5'2"  43  192  109  111  
D  F  5'8"  54  196  134  138  
E  M 6'2"  22  290  194  192  
F  F  5'9"  18  198  13 8  132  
G  M 5'6"  59  230  170  174  
H  F  5'7"  34  194  143  141  
I  M 5'3"  47  214  160  158  

The PIL test results indicate that in every family the individual suffering with weight problems and 
the family as existential vacuum. for meaning had (eating) appeared 
a group were experiencing an In all nine families the search been disrupted, and excess weight to be a symptom filling the 
existential vacuum. Logotherapy helped all nine overweight members lose weight. It also helped them and their families improve their PIL scores at the end of treatment. At the termination of treatment, mean weight loss for the individual client was 65 lbs. and all of them improved their score considerably on the PIL test (mean increase 32.5 points). The average mean family PIL test score increased from 85 at intake to 118 at termination--an average mcrease of 3 3 points. Because of the small size of participants, and because treatment was not standardized and is inappropriate in an existential orientation, no useful statistical correlation can be established betwen time in treatment, client weight loss, and improvement on the PIL test scores. But it is clear from the descriptive empirical data that such changes did occur at roughly the same time during the therapy. 
Table 2. PIL Scores for Client and Families 
Client PIL Score Family PIL Score One Year 
Familx_ Start End Follow-Up Stall E_n d Follow-Up 
One Year 
A 86 114 112 91 113 118 B 88 122 116 86 118 117 C 91 118 121 84 123 123 D 76 118 126 90 116 119 E 82 117 115 88 112 118 F 90 113 114 91 127 121 G 91 115 119 89 119 114 H 89 119 128 79 113 115 I 78 118 124 90 121 126 
All nine weight-loss center dropout clients and their families were contacted approximately one year after treatment was terminated. At the followup evaluation the clients' weight was measured and the PJL test was again given to them and their family members, who had taken the PIL earlier. Tables 1 and 2 clearly indicate that the changes which had occurred at termination had been maintained for one year. 
To sum up: family logotherapy can be extremely useful with families that experience an existential vacuum and 111 which at least one member develops an overeating symptom in response to the existential vacuum. The data presented in this clinical study highlights our opm1on that family logotherapy has considerable potential for this type of clinical situation. 
JIM LANTZ, Ph.D., is assistant professor at The Ohio State University, College of Social Work and clinical director of Village Counseling Associates in Columbus, Ohio. KAREN J. HARPER, Ph.D., is assistant professor at The Ohio State University specialist at Village Counseling Associates in Columbus, Ohio. 
REFERENCES 
1. 
Crumbaugh, J. and Maholick, L. Purpose in Life Test, Murfreesboro, Psychometric Affiliates, 1976. 

2. 
Crumbaugh, J. "Cross-validation of Purpose in Life Test Based on Frankl's Concepts," Journal of Indiv Psychology, 24, 74-81, 1968. 

3. 
Frankl, V. From Death Camp to Existentialism, Boston, Beacon Press, 1959. 

4. 
________ . The Will to Meaning, New York, New American 

Library, 1969. 

5. 
Lantz, J. "Meaning in Family Therapy," International 


Forum for Logotherapy, i, 44-46, 1982. 6. 
-----· "Never Trust a Family Therapist Who is Younger than Forty," Voices, 2.1, 18-19, 1985. 
7. 
"Family Logotherapy," Journal of Contemporary Family Therapy, .8.., 124-135, 1986. 

8. 
______ "Franklian Family Therapy," International Forum for Logotherapy, l.Q., 22-28, 1987. 

9. 
______ and R. First, "Family Treatment and the Noetic Curative Factor," International Forum for Logo


therapy, l.Q., 110-111, 1987. 
10. _ _____ and E. Mann, "Family Therapy and the 
Existential Vacuum," Joural of Religion and Psychiatry, Q_, 4-7, 1 9 8 8 . 
121 
A COMPARISON OF SOCRATES' AND FRANKL'S PHILOSOPHICAL FUNDAMENTALS AND METHODS 
William Blair Gould 
Socrates (469-399 B.C.) represents the early philosophical speculations of the Greeks, developed and revised by Plato (427347 B.C.) and Aristotlc(384-322 B.C.). 
Viktor E. Frankl (A.D. 1905-) while aware of the Greek contribution, represents a philosophical viewpoint that is ;:: mixture of secularized Judaism, Renaissance thinking, Germar Enlightenment, existentialism, phenomenology, and humanistic psychology. 
SOCRATES FRANKL 
Knowledge is virtue. Knowledge is a means of achieving a life of meaning. 
\'; :"Luc 1s happiness. Virtue is found in a meaningful task well done and in caring for others. 
The self is the scat of moral The self is the scat of noos (spirit), soma (body), and
ideas. 
psyche (mind). Noos is the key to the self. 
Error is due to ignorance. Error is due to human frailty and the failure to recognize and use the noctic in the will to meaning. 
In morals, we should advance In morals. we must make our the individual and then own existential decisions anc proceed to the self in its then apply them to society, corporate relationships. aware on their effect on others. 
The dialectic (questioning) The dialectic method is used, method is a preferred way to but may be revised to use learn. paradoxical intention and attitude modification. 
Happmess is the greatest good. A life of meaning is the greatest good. 
While aware of our culture 
(including its pressures and corruption as well as rewards), 
the self must make its own 
choices in life. 
The soul must be "purged" and released from the prison of the body to progress toward "1 r,ms-migration" of the soul after death. 
The moral dimension is a vital 
element of the self. 
Mind is the true reality. 
The universe is essc.1tially 
rational. 
We learn from the past and 
look forward to the future. 
An unexamined life is not 
worth living. 
Suicide may be an option for 
the self. 
Position identical with Socrates. 
The soul is an essential part of the self in interaction with mind and body. No "doctrine" of afterlife but a sense of Providence and shared humanity. 
The moral dimension is basic to the self in which respon sibility is an essential expression of meaning. 
Meaning through the no et i c 
is the true reality. 
The universe, despite its ambiguities and conflicts, docs have meaning. 
Position identical with 
Socrates. 
An unexamined life leads 
to a noogenic neurosis. 
Suicide is never an option. 
We can find meaning in every 
situation if we use the 
resources of the noetic. 
WILLIAM BLAIR GOULD, Ph.D. is professor of philosophy and Religious Studies at the University of Dubuque, Iowa. 
The International Forum for 
LOGOTHERAPY 
JOURNAL OF SEARCH FOR MEANING